CONFIDENTIAL

JORDAN

DEPARTMENT OF STATISTICS

IDENTIFICATION

GOVERNORATE

DISTRICT

LOCALITY

STRATUM NUMBER

ULTIMATE AREA BLOCK

CLUSTER NUMBER

HOUSEHOLD NUMBER

INTERVIEWER VISITS

FIRST VISIT
INTERVIEWER'S NAME
DATE
RESULT***
SUPERVISOR

SECOND VISIT
INTERVIEWER'S NAME
DATE
RESULT***
SUPERVISOR

THIRD VISIT
INTERVIEWER'S NAME
DATE
RESULT***

FINAL VISIT
DAY___
MONTH___
YEAR___
INTERNATIONAL CODE___
RESULT__

TOTAL NUMBER OF VISITS____

***RESULT CODES:

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

LINE NUMBER OF ELIGIBLE WOMAN

SERIAL NUMBER OF ELIGIBLE WOMAN

FIELD EDITED BY:

NAME
DATE

OFFICE EDITED BY:

NAME
DATE

KEYED BY:

NAME
DATE

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE TIME

102) First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, where did you live?

103) In what month and year were you born?

104) How old were you at your last birthday?

COMPARE AND CORRECT 103 AND/OR 104 IF INCOSTISTENT

105) Have you ever attended school?

106) What is the highest level of schooling you attended?

107) What is the highest grade you completed?

108) CHECK 106:

109) Can you read and understand any written material easily, with difficulty, or not at all?

110) Do you read a newspaper or magazine?

111) Do you usually listen to the radio?

112) Do you usually watch television?

113) What is the main source of water your household uses?

114) What kind of toilet facility does your household have?

115) What type of sewage system do you have in your house?

116) How many rooms in your house are used for sleeping?

117) BUILDING TYPE (RECORD OBSERVATIONS)

118) Does your house have:

Electricity?
A radio?
A television?
A refrigerator?
A video?
A telephone?
An air conditioner?

119) Does any member of your household own: CIRCLE ALL APPLICABLE RESPONSES

120) What is your religion?

SECTION 2. MARRIAGE

201) Are you married, divorced, separated, or widowed?

202) Have you been married only once or more than once?

203) In what month and year did you and your (first) husband begin living together (consummate your marriage)?

204) At what age did you and your first husband begin to live together (consummate your marriage)?

205) What is (was) the type of relationship between you and your (first) husband?

206) DETERMINE MONTHS MARRIED SINCE JANUARY 1985. ENTER "X" IN COLUMN 6 OF CALENDAR FOR EACH MONTH MARRIED AND ENTER "0" FOR EACH MONTH NOT MARRIED SINCE 1985.

FOR DIVORCED/ WIDOWED/ SEPARATED WOMEN OR WOMEN MARRIED MORE THAN ONCE:
PROBE FOR DATE COUPLE STOPPED LIVING TOGETHER OR DATE WIDOWED, AND FOR STARTING DATE OF ANY SUBSEQUENT UNION.

207) CHECK 201:

208) Does your husband usually live with you in this household?

209) In the last month were you and your husband living together all of the time, or were you apart some of the time, or apart all of the time?

210) How many days was he away in the last month?

211) Did he ever come to visit you in the last month?

SECTION 3. REPRODUCTION

301) Now, I would like to ask about all the births you have had during your life. Have you ever given birth?

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

How many sons live with you?

How many daughters live with you?

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

How many sons are alive but do not live with you?
And how many daughters are alive but do not live with you?

304) Have you ever given birth to a boy or a girl, who was born alive but later died?

IF "NO", PROBE: Any (other) baby who cried or showed any sign of life but only survived a few hours or days?

In all, how many boys have died?

And how many girls have died?

305) SUM ANSWERS TO 302, 303, AND 304, AND ENTER TOTAL
IF NONE ENTER '00'

306) CHECK 305:

307) CHECK 305:

308) Now I would like to talk to you about all of your births from all marriages, whether still alive or not, starting with the first on you had.

309) What name was given to your (first, next) baby?

310) RECORD A SINGLE OR MULTIPLE BIRTH STATUS

311) Is (NAME) a boy or a girl?

312) In what month and year was (NAME) born?

PROBE: What is his/her birthday?
OR: In what season was he/she born?

313) Is (NAME) still alive?

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

315) IF ALIVE: Is (NAME) living with you?

316) IF LESS THAN 15 YEARS OF AGE:

With whom does he/she live?

IF 15+: GO TO NEXT BIRTH

(GO TO NEXT BIRTH FOR ALL ANSWERS)

317) IF DEAD: How old was he/she when he/she died?

IF "1 YEAR", PROBE: How many months old was (NAME)?

RECORD DAYS IF LESS THAN 1 MONTH, MONTHS IF LESS THAN TWO YEARS, OR YEARS

318) COMPARE 305 WITH NUMBER OF BIRTHS IN HISTROY ABOVE AND MARK:

NUMBERS ARE DIFFERENT ( PROBE AND RECONCILE)

NUMBERS ARE SAME:

319) CHECK 312 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1985. IF NONE, ENTER 0 AND GO TO 321.

320) FOR EACH BIRTH SINCE JANUARY 1985 ENTER "B" IN MONTH OF BIRTH IN COLUMN 1 OF CALENDAR AND "P" IN EACH OF THE 8 PRECEDING MONTHS.

321) AT THE BOTTOM OF THE CALENDAR, ENTER THE NAME AND BIRTH DATE OF THE LAST CHILD BORN PRIOR TO JANUARY 1985, IF APPLICABLE.

322) Are you pregnant now?

323) How many months pregnant are you?

ENTER "P" IN COLUMN 1 OF CLANEDAR IN MONTH OF INTERVIEW AND IN EACH PRECEDING MONTH PREGNANT

324) At the time you became pregnant, did you want to become pregnant then, did you want to wait until later, or did you not want to become pregnant at all?

325) Have you ever had a pregnancy that did not end as a live birth; either miscarried, was aborted, or ended in a stillbirth?

326) When did the last such pregnancy occurred?

327) CHECK 326:

328) How many months pregnant were you when the pregnancy ended?

ENTER "T" IN COLUMN 1 OF CALENDAR IN MONTH PREGNANCY TERMINATED, AND "P" IN EACH PRECEDING MONTH PREGNANT

329) Did you ever have any other such pregnancies?

330) ASK FOR DATES AND DURATIONS OF ANY OTHER PREGNANCIES.
ENTER "T" IN COLUMN 1 OF CALENDAR IN MONTH PREGNANCY TERMINATED, AND "P" IN EACH PRECEDING MONTH PREGNANT.

331) When did your last menstrual period start?

332) Between the first day of a woman's period and the first day of her next period, when do you think she has the greatest chance of becoming pregnant?

SECTION 4: CONTRACEPTION

401) Now I would like talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy. Which of these ways or methods have you heard about?

402) Have you ever heard of (METHOD)?

METHOD 01 PILL Women can take a pill every day.

METHOD 02 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.

METHOD 03 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.

METHOD 04 FOAM/ JELLY/ SPONGE/ DIAPHRAGH Women can place a sponge, suppository, diaphragm, jelly or cream inside them before intercourse.

METHOD 05 CONDOM Men can use a rubber sheath during sexual intercourse.

METHOD 06 FEMALE STERILIZATION/ TUBAL LIGATION Women can have an operation to avoid having any more children.

METHOD 07 MALE STERILIZATION Men can have an operation to avoid having any more children.

METHOD 08 PERIODIC ABSTINENCE/ RHYTHM Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant.

METHOD 09 WITHDRAWAL Men can be careful and pull out before climax.

METHOD 10 PROLONGED BREASTFEEDING AS A METHOD OF CONTRACEPTION Women can breastfeed for longer period to avoid getting pregnant.

METHOD 11 ANY OTHER METHODS

403) Have you ever used (METHOD)?

METHOD 01 PILL Women can take a pill every day.

METHOD 02 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.

METHOD 03 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.

METHOD 04 FOAM/ JELLY/ SPONGE/ DIAPHRAGH Women can place a sponge, suppository, diaphragm, jelly or cream inside them before intercourse.

METHOD 05 CONDOM Men can use a rubber sheath during sexual intercourse.

METHOD 06 FEMALE STERILIZATION/ TUBAL LIGATION Women can have an operation to avoid having any more children.

METHOD 07 MALE STERILIZATION Men can have an operation to avoid having any more children: Has your husband ever had an operation to avoid having any more children?

METHOD 08 PERIODIC ABSTINENCE/ RHYTHM Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant.

METHOD 09 WITHDRAWAL Men can be careful and pull out before climax.

METHOD 10 PROLONGED BREASTFEEDING AS A METHOD OF CONTRACEPTION Women can breastfeed for longer period to avoid getting pregnant.

METHOD 11 ANY OTHER METHODS

404) Do you know where a person could go to get (METHOD)?

METHOD 01 PILL Women can take a pill every day.

METHOD 02 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.

METHOD 03 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.

METHOD 04 FOAM/ JELLY/ SPONGE/ DIAPHRAGH Women can place a sponge, suppository, diaphragm, jelly or cream inside them before intercourse.

METHOD 05 CONDOM Men can use a rubber sheath during sexual intercourse.

METHOD 06 FEMALE STERILIZATION/ TUBAL LIGATION Women can have an operation to avoid having any more children.

METHOD 07 MALE STERILIZATION Men can have an operation to avoid having any more children: Has your husband ever had an operation to avoid having any more children?

METHOD 08 PERIODIC ABSTINENCE/ RHYTHM Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant: Do you know where a person can obtain advice on how to use periodic abstinence?

405) CHECK 403:

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

407) ENTER "0" IN COLUMN 1 OF CALENDAR IN EACH BLANK MONTH (GO TO 411)

408) What have you used or done?

408P) What is the first thing you ever did or method you ever used to delay or avoid getting pregnant?

409) Where did you go to get this method the first time?

410) How many living children did you have at that time, if any?

411) CHECK 322:

412) CHECK 403:

413) FOR MARRIED/ SEPARATED WOMAN CHECK 201:

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

414) Which method are you using?

414P) CIRCLE '06' FOR FEMALE STERILIZATION OR '07' FOR MALE STERILIZATION

415) At the time you first started using the pill, did you consult a doctor or a nurse?

416) At the time you last got pills, did you consult a doctor or a nurse?

417) May I see the package of pills you are using now?

418) Do you know the brand name of the pills you are now using?

419) How much does one packet (cycle) of pills cost you?

420) If you miss taking a pill one day, how many pills do you take the next day?

421) Did you get the IUD at the place where you had it inserted or did you get it somewhere else?

422) How did it cost to have the IUD inserted?

423) In what month and year was the sterilization operation performed to you or your husband?

424) ENTER STERILIZATION METHOD CODE IN MONTH OF INTERVIEW IN COLUMN 1 OF CALENDAR AND IN EACH MONTH BACK TO DATE OF OPERATION OR TO JANUARY 1985 IF OPERATION OCCURRED BEFORE 1985 (GO TO 425P)

425) Where did you obtain (METHOD) the last time?

425P) Where did the sterilization take place?

426) How long does it take to travel from your home to this place?

427) Is it easy or difficult to get there?

428) What is the main reason you decided to use (CURRENT METHOD FROM 414) rather than some other method of family planning?

429) Are you having any problems in using (CURRENT METHOD)?

430) What is the main problem?

431) CHECK 414 AND 423:

432) ENTER METHOD CODE FROM 414 IN CURRENT MONTH IN COLUMN 1 OF CALENDAR. THEN DTERMINE WHEN SHE STARTED USING THIS MEHTOD THIS TIME. ENTER METHOD CODE IN EACH MONTH OF USE.

ILLUSTRATIVE QUESTIONS:
- When did you start using this method continuously?
- How long have you been using this method continuously?

433) I would like to ask some questions about all of the (other) periods in the last few years during which you or your husband used a method to avoid getting pregnant.

USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 1985.

USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

IN EACH MONTH, ENTER CODE FOR METHOD OR '0' FOR NONUSE IN COLUMN 1. IN COLUMN 2, ENTER CODES FOR DISCONTINUATION NEXT TO LAST MONTH OF USE.

NUMBER OF CODES ENTERD IN COLUMN 2 MUST BE THE SAME AS THE NUMBER OF INTERRUPTIONS OF CONTRACEPTIVE 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 OR BECAUSE OF OTHER REASONS. IF SHE GETS PREGNANT AFTER STOPPING, ASK HOW MANY MONTHS AFTER STOPPING DID SHE BECOME PREGNANT.

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

COLUMN 2:
- Why did you stop using the (METHOD)?
- Did you become pregnant while using (METHOD), or did you stop to get pregnant?

434) CHECK CALENDAR:

435) I see that you were using (METHOD) in January 1985
When did you start using (METHOD) that time?

(THIS DATE SHOULD NOT PRECEDE SIX MONTHS BEFORE THE DATE OF BIRTH OF ANY CHILD BORN BEFORE JANUARY 1985)
(GO TO 440)

436) I see that you were not using any method of contraception in January 1985. Did you ever use a method before that?

437) CHECK 312:

438) Did you use a method between the birth of (NAME OF LAST CHILD BORN BEFORE JANUARY 1985) and January 1985?

439) When did you stop using a method the last time prior to January 1985?

440) CHECK 413 AND 414:

441) CHECK 201 FOR CURRENTLY MARRIED AND SEPARATED WOMAN:

Do you intend to use a method to delay or avoid pregnancy at any time in the future?

442) What is the main reason you do not intend to use a method?

443) When you use a method, which method would you prefer to use?

444) Where can you get (METHOD MENTIONED IN 443)?

445) Do you know of a place where you can obtain a method of family planning?

IF YES:

446) How long does it take to travel from your home to this place?

447) Is it easy or difficult to get there?

448) Was there anything you may dislike about the services you (your husband) would receive from that place?

449) Is it acceptable to you for family planning information to be provided on the radio or television?

SECTION 5: BREAST FEEDING AND HEALTH

501) CHECK 319:

502) ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1985 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL FORMS).

Now I would like to ask you some more questions about the health of children you had in the past five years. (We will talk about one child at a time.)

LINE NUMBER FROM Q. 309

NAME FROM Q. 309

SURVIVAL STATUS FROM Q.313

503) At the time you became pregnant with (NAME), did you want to become pregnant then, did you want to wait until later or did you want no more children at all?

504) How long would you like to have waited?

505) When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy?

506) Where did you see this person the first time?

507) Why did you chose to go there?

508) Was the visit a regular checkup, because of illness related to the pregnancy, or because of illness unrelated to the pregnancy?

509) How many months pregnant were you when you first saw someone for an antenatal check on this pregnancy?

510) How many antenatal visits did you have during that pregnancy?

511) When you were pregnant with (NAME) were you given an injection in the arm to prevent the baby from getting tetanus?

512) How many times did you get this injection?

513) Where did you give birth to (NAME)?

514) Who assisted with the delivery of (NAME)?

PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING

515) What was the duration of the pregnancy?

516) Was (NAME) delivered normally or by caesarian section?

517) How much did (NAME) weigh?

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

519) During the six-week period (i.e., Nifaz period) following the birth of (NAME) did you see anyone for a check on your health?

520) Where did you see this person the first time?

521) Has your period returned since the birth of (NAME)? [Most recent birth within the last five years]

522) ENTER "X" IN COLUMN 3 OF CALENDAR IN MONTH AFTER BIRTH AND IN EACH MONTH TO CURRNET MONTH (OR TO CURRENT PREGNANCY)
(SKIP TO 524) [Most recent birth within the last five years]

523) How many months after the birth of (NAME) did your period return?

524) IF NOT PREGNANT: Have you resumed sexual relations since the birth of (NAME)? [Most recent birth within the last five years]
(IF PREGNANT, CIRCLE '1')

525) ENTER "X" IN COLUMN 4 OF CALENDAR IN MONTH AFTER BIRTH AND IN EACH MONTH TO CURRENT MONTH. [Most recent birth within the last five years] (GO TO 527)

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

527) Did you ever breastfeed (NAME)?

528) Why did you not breastfeed (NAME)?

(GO TO 539 FOR ALL ANSWERS)

529) How long after birth did you first put (NAME) to the breast? [Most recent birth within the last five years]

530) Do you know that colostrum is important for the baby? [Most recent birth within the last five years]

531) IF STILL ALIVE:
Are you still breastfeeding (NAME)?
(IF DEAD, CIRCLE '2')
[Most recent birth within the last five years]

532) ENTER "X" IN COLUMN 5 OF CALENDAR IN MONTH AFTER BIRTH AND IN EACH MONTH TO CURRENT MONTH [Most recent birth within the last five years]

533) How many times did you breastfeed last night between sunset and sunrise, and yesterday during the daylight hours? [Most recent birth within the last five years]

534) Do you breastfeed (NAME) whenever he/she wants of according to a fixed schedule? [Most recent birth within the last five years]

535) At any time yesterday or last night was (NAME) given any of the following?:
[Most recent birth within the last five years]

Plain water?
Sugar water?
Juice?
Herbal Tea?
Yansoon (Dill)?
Baby formula?
Fresh milk?
Tinned or powdered milk?
Other liquids?
Any solid or mushy food?

536) CHECK 535:
FOOD OR LIQUID GIVEN YESTERDAY? [Most recent birth within the last five years]

537) For how many months did you breastfeed (NAME)?

538) Why did you stop breastfeeding (NAME)?

539) CHECK 313:
CHILD ALIVE?

540) Was (NAME) ever given any water, or something else to drink or eat (other than breastmilk)?

541) How many months old was (NAME) when you started giving the following on a regular basis as part of the daily diet:
IF LESS THAN ONE MONTH, RECORD '00'.

Formula or milk other than breastmilk?

Water or other liquids?

Any solid or mushy food?

542) CHECK 313:
CHILD ALIVE? [Most recent birth within the last five years]

543) Did (NAME) drink anything from a bottle with a nipple yesterday? [Most recent birth within the last five years]

544) GO BACK TO 503 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 545

545) CHECK 312: ANY BIRTH IN 1982, 1983, OR 1984?

546) Did you ever feed (NAME) at the breast?

547) How many months did you breastfeed (NAME)?

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

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

550) CHECK 501:

SECTION 6: IMMUNIZATION, MORBIDITY, AND CHILD MORTALITY

601) Do you have a card where (NAME'S) vaccinations are written down?

602)

BCG?

POLIO 1?

POLIO 2?

POLIO 3?

POLIO BOOSETER?

DPT 1?

DPT 2?

DPT 3?

DPT BOOSTER?

MEASLES?

(GO TO 605)

603) Has (NAME) received any vaccinations?

604) Please tell me if (NAME) (has) received any of the following vaccinations:

A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that left a scar?

Polio vaccine, that is, drops in the mouth?

IF YES: How many times?

OPT vaccination against diphtery, pertusis and tetanus, that is an injection in the arm?

IF YES: How many times?

An injection against measles?

605) CHECK 313:
CHILD ALIVE?

606) GO BACK TO 601 FOR NEXT BIRTH; OR IF NO MORE BITHS, SKIP TO 624.

607) Has (NAME) been ill with any illness at any time in the last 2 weeks?

608) What is (are) the illness(es)?

IF NO OTHER ILLNESSES ENTER "00"

609) During the past two weeks, did (NAME) have one or more of the following symptoms?

610) CHECK 608 AND 609:
ANY ILLNESS/SYMPTOM?

611) Did you seek advice or treatment for the illnesses?

612) From whom did you seek advice or treatment?

(CIRCLE EACH MENTIONED)

613) Has (NAME) had diarrhea in the last two weeks?

614) GO BACK TO 601 FOR NEXT CHILD; OR, IF NO MORE CHILDREN, SKIP TO 624.

615) CHECK 531:
LAST CHILD STILL BREASTFED? [Most recent birth within the last five years]

616) During (NAME)'s diarrhea, did you change the frequency of breastfeeding? [Most recent birth within the last five years]

617) Did you increase the number of feeds or reduce them, or did you stop completely? [Most recent birth within the last five years]

618) Was (NAME) given any of the following:
CIRCLE ALL APPLICABLE CODES.

619) Did you seek advice or treatment for the diarrhea?

620) After how long did you start seeking advice?

621) From whom did you seek advice or treatment?

CIRCLE EACH MENTIONED.

622) GO BACK TO 601 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 623.

623) CHECK 618:

624) Have you ever heard of a special product called (AQUA CELL OR PARALAIT) you can get for diarrhea?

625) Have you ever seen a pack like this before?
(SHOW PACKET)

626) Have you ever prepared a solution with one of these packets to treat diarrhea in yourself or someone else?

627) Where did you get information to prepare the home made fluid made from sugar, salt and water given to (NAME)?
CIRCLE ALL PERSONS MENTIONED.

628) CHECK 618:

629) Who taught you to prepare this fluid?
CIRCLE ALL PERSONS MENTIONED.

630) RECORD THE TIME.

631) CHECK 309, 313, AND 319:

632) Now I would like to ask you some questions concerning your deceased child(ren) among those born to you in the last five years.

633) Was the death of (NAME) caused by an accident or by a disease?

IF ACCIDENT: Was it an accident such as falling or burning, or a birth injury/ problem?

634) What kind of accident?

(GO TO 632 FOR NEXT BIRTH OR, IF NO FURTHER BIRTHS, GO TO 637)

635) What was the disease(s) that caused the death of (NAME)?
RECORD THE NAME(S) OF THE DISEASES GIVEN BY THE RESPONDENT.

636) During the illness leading to the death of (NAME), did he/she have one or more of the following symptoms?

a. Unable to suck milk or did not suck normally after birth?

b. Unable to open mouth to cry?

c. Fever?

d. Rash?

e. Cough?

f. Red, teary eyes?

g. Prolonged cough followed by vomiting?

h. Whooping cough?

i. Red hair?

j. Swollen face and feet?

k. Emaciated/ very thin?

l. Three or more stools per day?

m. Difficult and rapid breathing?

n. Convulsions?

637) RECORD THE TIME

SECTION 7: FERTILITY PREFERENCES

701) CHECK 414P:

702) CHECK 201:

703) Now I have some questions about the future.

CHECK 322 AND MARK BOX:

704) CHECK 322 AND MARK BOX:

705) CHECK 313:
IF NO LIVING CHILDREN, CIRCLE '96'

How old would you like your youngest child to be before having another child?

706) Do you regret that you (your husband) had the operation not to have any (more) children?

707) Why do you regret it?

(GO TO 711 FOR ALL ANSWERS)

708) Given your present circumstances, if you had to do it over again, do you think you make the same decision to have a sterilization?

(GO TO 711 FOR ALL ANSWERS)

709) Have you and your husband ever discussed the number of children you would like to have?

710) Do you think your husband wants the same number of children that you want, or does he want more or fewer than you want?

711) CHECK 313 AND MARK BOX:

SECTION 8: HUSBAND'S BACKGROUND, RESIDENCE, AND WOMAN'S WORK

801) Did your (last) husband ever attend school?

IF NO: Can he read and write?

802) What was the highest level of schooling your husband attended?

803) What was the highest grade your husband completed?

804) What kind of work does (did) your (last) husband mainly do?

805) CHECK 804:

806) Does (did) your husband/ partner work mainly on his own land or family land, or on someone else's land?

807) Have you lived in only one or in more than one community since January 1985?

808) ENTER (IN COLUMN 7 OF CALENDAR) THE APPROPRIATE CODE FOR CURRENT COMMUNITY

BEGIN IN THE MONTH OF INTERVIEW AND CONTINUE WITH ALL PRECEDING MONTHS BACK TO JANUARY 1985
(GO TO 810)

809) In what month and year did you move to (NAME OF COMMUNITY OF INTERVIEW)?

ENTER (IN COLUMN 7 OF CALENDAR) "X" IN THE MONTH AND YEAR OF THE MOVE, AND IN THE SUBSEQUENT MONTHS ENTER THE APPORPRIATE CODE FOR TYPE OF COMMUNITY ("1" CITY, "2" TOWN, AND "3" VILLAGE). CONTINUE PROBING FOR PREVIOUS COMMUNITIES SINCE JANUARY 1985 AND RECORD MOVES AND TYPES OF COMMUNITIES ACCORDINGLY.

ILLUSTRATIVE QUESTIONS
- Where did you live before?.?
- In what month and year did you arrive there?
- Is that place in a city, a town, or a village?

810) REFER TO PLACE OF RESIDNCE IN JANUARY 1985:
When did you move to this/ that place?

811) Was the place you moved from a city, a town, or a village?

812) I would like to ask you some questions about working.

Are you now doing any work other than housekeeping, inside and outside the house, for cash or kind?

813) Have you ever worked since January 1985?

814) ENTER "0" IN COLUMN 8 OF CALENDAR IN EACH MONTH FROM JANUARY 1985 TO CURRENT MONTH. (GO TO 819)

815) What is (was) your (most recent) occupation? That is, what kind of work do (did) you do?

816) USE CALENDAR TO PROBE FOR ALL PERIODS OF WORK, STARTING WITH CURRENT OR MOST RECENT WORK, BACK TO JANUARY 1985.

ILLUSTRATIVE QUESTIONS
-When did this job begin (and when did it end)?
-What did you do before that?
-How long did you work at that time?
-Were you paid for this work?
-Did you work at home or away from home?

817) CHECK COLUMN 8 OF CALENDAR:

818) I see that you were working in January 1985. When did you start that job?

(GO TO 821 FOR ALL ANSWERS)

819) I see that you were not working in January 1985. Did you ever work prior to January 1985?

820) When did your last job prior to 1985 end?

821) CHECK 312/313/315: HAS CHILD BORN SINCE JANUARY 1985 AND LIVING AT HOME?

822) CHECK 812: CURRENTLY WORKING?

823) While you are working, do you usually have (NAME OF YOUNGEST CHILD AT HOME) with you, sometimes have him/her with you, or never have him/her with you?

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

825) RECORD THET TIME

SECTION 9: WEIGHT AND LENGTH

901) CHECK 319:

ONE OR MORE LIVING CHILDREN BORN SINCE JANUARY 1985 (PROCEED)
NO LIVING CHILDREN BORN SINCE JANUARY 1985 (GO TO END)

INTERVIEWER: IN 902-904, RECORD THE LINE NUMBERS, NAMES, AND BIRTH DATES OF ALL LIVING CHILDREN BORN SINCE JANUARY 1, 1985 STARTING WITH THE YOUNGEST CHILD. RECORD WIEGHT AND LENTH IN 905 AND 906.

902) LINE NUMBER FROM Q. 309

903) NAME FROM Q. 309

904) DATE OF BIRTH FROM Q.312 AND ASK FOR DAY

905) WEIGHT (in kilograms)

906) LENGTH (in centimeters)

907) METHOD OF MEASUREMENT

908) A. Arm fat (in millimeters)

B. Arm circumference (in centimeters)

C. Head circumference (in centimeters)

909) DATE CHILD WEIGHED AND MEASURED

910) RESULT

911) NAME OF MEASURER: _________

NAME OF ASSISTANT:__________