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DEMOGRAPHIC AND HEALTH SURVEYS INDIVIDUAL QUESTIONAIRE

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

HOUR___
MINUTES___

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?

CITY 1
TOWN 2
VILLAGE 3

103) In what month and year were you born?

MONTH___
DON'T KNOW MONTH 98
YEAR____
DON''T KNOW YEAR 98

104) How old were you at your last birthday?

COMPARE AND CORRECT 103 AND/OR 104 IF INCOSTISTENT

AGE IN COMPLETED YEARS___

105) Have you ever attended school?

YES 1
NO 2 (GO TO 109)

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

PRIMARY 1
PREPERATORY 2
SECONDARY 3
INSTITUTE 4
UNIVERSITY 5
HIGHER STUDIES 6

107) What is the highest grade you completed?

GRADE____

108) CHECK 106:

PRIMARY OR LESS (GO TO 109)
PREPERATORY OR HIGHER (GO TO 110)

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

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 111)

110) Do you read a newspaper or magazine?

RARELY 1
SOMETIMES 2
FREQUENTLY 3

111) Do you usually listen to the radio?

RARELY 1
SOMETIMES 2
FREQUENTLY 3

112) Do you usually watch television?

RARELY 1
SOMETIMES 2
FREQUENTLY 3

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

PIPED INTO RESIDENCE 1
PIPED INTO YARD OR PLOT 2
PUBLIC TAP 3
RIVER, SPRING, DAM 4
TANKER TRUCK 5
WELL 6
OTHER (SPECIFY)________ 7

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

PRIVATE SEPTIC LATRINE 1
SHARED SEPTIC LATRINE 2
OTHER (SPECIFY)__________3
NO FACILITIES 4

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

PUBLIC NETWORK 1
DUG HOLE 2
OTHER (SPECIFY)_______ 3
NO SEWAGE 4

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

ROOMS___

117) BUILDING TYPE (RECORD OBSERVATIONS)

CUTSTONE 1
CUSTONE + CONCRETE 2
CONCRETE 3
BRICK 4
MUDBRICK 5
ZINC/ METAL 6
OTHER (SPECIFY)________ 7

118) Does your house have:

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

ELECTRICITY:
YES 1
NO 2
RADIO:
YES 1
NO 2
TELEVISION:
YES 1
NO 2
REFRIGERATOR:
YES 1
NO 2
VIDEO:
YES 1
NO 2
TELEPHONE:
YES 1
NO 2
AIR CONDITIONER:
YES 1
NO 2

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

BICYCLE:
YES 1
NO 2
MOTORCYCLE:
YES 1
NO 2
PRIVATE CAR:
YES 1
NO 2
COMMERCIAL CAR:
YES 1
NO 2
PICKUP:
YES 1
NO 2
OTHER MODE OF TRANSPORTATION:
YES 1
NO 2

120) What is your religion?

ISLAM 1
CHRISTIAN 2
OTHER (SPECIFY)_______ 3

SECTION 2. MARRIAGE

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

MARRIED 1
DIVORCED 2
WIDOWED 3
SEPARATED 4

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

ONCE 1
MORE THAN ONCE 2

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

MONTH___
DON'T KNOW MONTH 98
YEAR ___
DON'T KNOW YEAR 98

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

AGE___

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

FIRST COUSIN FROM FATHER'S SIDE 1
FIRST COUSIN FROM MOTHER'S SIDE 2
SECOND COUSIN 3
OTHER RELATION 4
NO RELATION 5

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:

CURRENTLY MARRIED/ SEPARATED (GO TO 208)
DIVORCED/ WIDOWED (GO TO 301)

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

YES 1
NO 2 (GO TO 211)

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?

TOGETHER ALL THE TIME 1 (GO TO 301)
APART SOME OF THE TIME 2
APART ALL OF THE TIME 3 (GO TO 211)

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

DAYS (GO TO 301)

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

YES 1
NO 2

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?

YES 1
NO 2 (GO TO 304)

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

YES 1
NO 2 (GO TO 303)

How many sons live with you?

SONS AT HOME___

How many daughters live with you?

DAUGTHERS AT HOME___
IF NONE ENTER '00'

303) 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 304)

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

SONS ELSEWHERE___
DAUGHTERS ELSEWHERE___
IF NONE ENTER '00'

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

YES 1
NO 2

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?

BOYS DEAD__

And how many girls have died?

GIRLS DEAD__
IF NONE ENTER '00'

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

TOTAL___
If NONE ENTER '00'

306) CHECK 305:

Just to make sure that I have this right: you have had in TOTAL ___ live births during your life. Is that correct?
YES (GO TO 307)
NO (PROBE AND CORRECT 301-306)

307) CHECK 305:

ONE OR MORE BIRTHS (GO TO 308)
NO BIRTHS (GO TO 322)

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.

(RECORD NAMES OF ALL THE BIRTHS IN 309. RECORD TWINS ON SEPARATE LINES, ANSWER 309-317 FOR EACH BIRTH)

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

NAME____

310) RECORD A SINGLE OR MULTIPLE BIRTH STATUS

SINGLE 1
MULTIPLE 2

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

BOY 1
GIRL 2

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

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

MONTH___
YEAR____

313) Is (NAME) still alive?

YES 1
NO 2 (GO TO 317)

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

AGE IN YEARS____

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

YES 1 (GO TO NEXT BIRTH)
NO 2

316) IF LESS THAN 15 YEARS OF AGE:

With whom does he/she live?

IF 15+: GO TO NEXT BIRTH

FATHER 1
OTHER RELATIVE 2
SOMEONE ELSE 3

(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

DAYS 1__
MONTHS 2__
YEARS 3__

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

NUMBERS ARE DIFFERENT ( PROBE AND RECONCILE)

NUMBERS ARE SAME:

CHECK: FOR EACH LIVE BIRTH: YEAR OF BIRTH IS RECORDED __
: FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED __
: FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED __
: FOR AGE AT DEATH LESS THAN 2 YEARS: PROBE TO DETERMINE EXACT NUMBER OF MONTHS ___

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

NUMBER OF BIRTHS____

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?

YES 1
NO 2
UNSURE 8 (GO TO 325)

323) How many months pregnant are you?

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

MONTHS___

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?

THEN 1
NOT AT ALL 2
LATER 3

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

YES 1
NO 2 (GO TO 331)

326) When did the last such pregnancy occurred?

MONTH___
YEAR___

327) CHECK 326:

DATE LAST PREGNANCY ENDED SINCE JANUARY 1985 (GO TO 328)
BEFORE JANUARY 1985 (GO TO 331)

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

MONTHS___

329) Did you ever have any other such pregnancies?

YES 1
NO 2 (GO TO 331)

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?

DAYS AGO 1__
WEEKS AGO 2__
MONTHS AGO 3__
YEARS AGO 4__
BEFORE LAST BIRTH 994
NEVER MENSTRUATED 995
IN MENOPAUSE 996

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?

DURING HER PERIOD 1
REIGHT AFTER HER PERIOD HAS ENDED 2
IN THE MIDDLE OF THE CYCLE 3
JUST BEFORE HER PERIOD BEGINS 4
AT ANY TIME 5
OTHER (SPECIFY) ______ 6
DON'T KNOW 8

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?

CIRCLE CODE 1 IN 402 FOR EACH METHOD MENTIONED SPONTANEOUSLY.
THEN PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.
CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED.
THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 402, ASK 403-404 BEFORE PROCEEDING TO THE NEXT METHOD.

402) Have you ever heard of (METHOD)?

READ DESCRIPTION OF EACH METHOD.

METHOD 01 PILL Women can take a pill every day.

YES/ SPONT 1
YES / PROBED 2
NO 3

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

YES/ SPONT 1
YES / PROBED 2
NO 3

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

YES/ SPONT 1
YES / PROBED 2
NO 3

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

YES/ SPONT 1
YES / PROBED 2
NO 3

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

YES/ SPONT 1
YES / PROBED 2
NO 3

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

YES/ SPONT 1
YES / PROBED 2
NO 3

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

YES/ SPONT 1
YES / PROBED 2
NO 3

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.

YES/ SPONT 1
YES / PROBED 2
NO 3

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

YES/ SPONT 1
YES / PROBED 2
NO 3

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

YES/ SPONT 1
YES / PROBED 2
NO 3

METHOD 11 ANY OTHER METHODS

1 (SPECIFY)_____
2 (SPECIFY)_____
3 (SPECIFY)_____
YES/ SPONT 1
NO 3

403) Have you ever used (METHOD)?

METHOD 01 PILL Women can take a pill every day.

YES 1
NO 2

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

YES 1
NO 2

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

YES 1
NO 2

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

YES 1
NO 2

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

YES 1
NO 2

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

YES 1
NO 2

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?

YES 1
NO 2

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.

YES 1
NO 2

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

YES 1
NO 2

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

YES 1
NO 2

METHOD 11 ANY OTHER METHODS

1 (SPECIFY)_____
YES 1
NO 2
2 (SPECIFY)_____
YES 1
NO 2
3 (SPECIFY)_____
YES 1
NO 2

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

METHOD 01 PILL Women can take a pill every day.

YES 1
NO 2

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

YES 1
NO 2

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

YES 1
NO 2

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

YES 1
NO 2

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

YES 1
NO 2

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

YES 1
NO 2

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?

YES 1
NO 2

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?

YES 1
NO 2

405) CHECK 403:

NOT A SINGLE "YES" (NEVER USED) (GO TO 406)
AT LEAST ONE "YES" (EVER USED) (GO TO 408P)

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

YES (GO TO 408)
NO

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

408) What have you used or done?

CORRECT 403-405

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

PILL 01
IUD 02
INJECTIONS 03
DIAPHRAGHM/ FLOAT/ JELLY 04
CONDOM 05
FEMALE STERILIZATION 06 (GO TO 410)
MALE STERILIZATION 07 (GO TO 410)
PERIODIC ABSTINENCE 08 (GO TO 410)
WITHDRAWAL 09 (GO TO 410)
PROLONGED BREASTFEEDING 10 (GO TO 410)
OTHER (SPECIFY)_____ 11 (GO TO 410)

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

GOVERNMENT HOSPITAL 01
MCH/ HEALTH CENTER 02
FP ASSOCIATION CLINIC 03
PRIVATE DOCTOR 04
PRIVATE HOSPITAL 05
PHARMACY 06
FRIENDS/ RELATIVES 07
OTHER (SPECIFY)______ 08
DON'T KNOW 98

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

IF NONE ENTER '00'
NUMBER OF CHILDREN____

411) CHECK 322:

NOT PREGNANT OR UNSURE (GO TO 412)
PREGNANT (GO TO 433)

412) CHECK 403:

WOMAN/ HUSBAND NOT STERILIZED (GO TO 413)
WOMAN/ HUSBAND STERILIZED (GO TO 414P)

413) FOR MARRIED/ SEPARATED WOMAN CHECK 201:

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

YES 1
NO 2 (GO TO 433)
NOT CURRENTLY MARRIED 3 (GO TO 433)

414) Which method are you using?

PILL 01
IUD 02 (GO TO 421)
INJECTIONS 03 (GO TO 425)
DIAPHRAGHM/ FLOAT/ JELLY 04 (GO TO 425)
CONDOM 05 (GO TO 425)
FEMALE STERILIZATION 06 (GO TO 423)
MALE STERILIZATION 07 (GO TO 423)
PERIODIC ABSTINENCE 08 (GO TO 428)
WITHDRAWAL 09 (GO TO 428)
PROLONGED BREASTFEEDING 10 (GO TO 428)
OTHER (SPECIFY)_____ 11 (GO TO 428)

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

PILL 01
IUD 02 (GO TO 421)
INJECTIONS 03 (GO TO 425)
DIAPHRAGHM/ FLOAT/ JELLY 04 (GO TO 425)
CONDOM 05 (GO TO 425)
FEMALE STERILIZATION 06 (GO TO 423)
MALE STERILIZATION 07 (GO TO 423)
PERIODIC ABSTINENCE 08 (GO TO 428)
WITHDRAWAL 09 (GO TO 428)
PROLONGED BREASTFEEDING 10 (GO TO 428)
OTHER (SPECIFY)_____ 11 (GO TO 428)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2

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

RECORD NAME OF BRAND
PACKAGE SEEN 1: BRAND NAME____ (GO TO 419)
PACKAGE NOT SEEN 2

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

RECORD NAME OF BRAND
BRAND NAME_____
DON'T KNOW 98

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

COST???JD____
FREE 996
DON'T KNOW 998

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

ONE 1 (GO TO 425)
TWO 2 (GO TO 425)
OTHER (SPECIFY)________ 3 (GO TO 425)

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

YES, SAME PLACE 1
NO, SOMEWHERE ELSE 2

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

IUD??? JD______
INSERTION??? JD____
TOTAL??? JD____ (GO TO 425)
FREE 9996 (GO TO 425)
DON'T KNOW 9998 (GO TO 425)

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

DATE___
MONTH__
YEAR___

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?

(NAME OF PLACE)_______
GOVERNMENT HOSPITAL 01
MCH/ HEALTH CENTER 02
FP ASSOCIATION CLINIC 03
PRIVATE DOCTOR 04
PRIVATE HOSPITAL 05
PHARMACY 06
FRIENDS/ RELATIVES 07
OTHER (SPECIFY)______ 08 (GO TO 428)
DON'T KNOW 98 (GO TO 428)

425P) Where did the sterilization take place?

(NAME OF PLACE)_______
GOVERNMENT HOSPITAL 01
MCH/ HEALTH CENTER 02
FP ASSOCIATION CLINIC 03
PRIVATE DOCTOR 04
PRIVATE HOSPITAL 05
PHARMACY 06
FRIENDS/ RELATIVES 07
OTHER (SPECIFY)______ 08 (GO TO 428)
DON'T KNOW 98 (GO TO 428)

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

MINUTES 1___
HOURS 2___
DON'T KNOW 998

427) Is it easy or difficult to get there?

EASY 1
DIFFICULT 2

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

RECOMMENDATION OF FAMILY PLANNING WORKER 01
RECOMMENDATION OF DOCTOR/ NURSE 02
RECOMMENDATION OF FRIEND/ RELATIVE 03
SIDE EFFECTS OF OTHER METHODS 04
CONVENIENT TO USE 05
ACCESS/ AVAILABILITY 06
COST 07
WANTED PERMANENT METHOD 08
HUSBAND PREFERRED 09
WANTED MORE EFFECTIVE METHOD 10
OTHER (SPECIFY)_______ 11
DON'T KNOW 98

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

YES 1
NO 2 (GO TO 431)

430) What is the main problem?

HUSBAND DISAPPROVES 01
SIDE EFFECTS 02
HEALTH CONCERNS 03
ACCESS/ AVAILABILITY 04
COST 05
INCONVENIENT TO USE 06
STERILIZED, WANTS CHILDREN 07
OTHER (SPECIFY)______ 08
DON'T KNOW 98

431) CHECK 414 AND 423:

NEITHER STERLIZED (GO TO 432)
STERILIZED BEFORE JANUARY 1985 (GO TO 449)
STERLIZED SINCE JANUARY 1985 (GO TO 433)

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:

METHOD USED IN MONTH OF JANUARY 1985 (GO TO 435)
NO METHOD USED IN MONTH OF JANUARY 1985 (GO TO 436)

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

MONTH___
YEAR___

(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?

YES 1
NO 2 (GO TO 440)

437) CHECK 312:

HAD BIRTH BEFORE JANUARY 1985 (GO TO 438)
NO BIRTH BEFORE JANUARY 1985 (GO TO 439)

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

YES 1
NO 2 (GO TO 440)

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

MONTH___
YEAR___

440) CHECK 413 AND 414:

NOT CURRENTLY USING A METHOD (GO TO 441)
CURRENTLY USING A METHOD (GO TO 449)

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?

YES, NEXT YEAR 1 (GO TO 443)
YES, AFTER NEXT YEAR 2 (GO TO 443)
NO 3
WIDOWED/ DIVORCED 4 (GO TO 445)
DON'T KNOW 8 (GO TO 445)

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

RECORD VERBATIM ______________________
WANTS CHILDREN 01
LACK OF KNOWLEDGE 02
HUSBAND OPPOSED 03
COST TOO MUCH 04
SIDE EFFECTS 05
HEALTH CONCERNS 06
ACCESS/ AVAILABILITY 07
RELIGION 08
OPPOSED TO FAMILY PLANNING 09
FATALISTIC 10
OTHER PEOPLE OPPOSED 11
INFREQUENT SEX 12
DIFFICULT TO GET PREGNANT 13
MENOPAUSAL/ HAD HYSTERECTOMY 14
INCONVENIENT TO USE 15
OTHER (SPECIFY)______ 16
DON'T KNOW 98
(FOR ALL ANSWERS GO TO 445)

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

PILL 01
IUD 02
INJECTIONS 03
DIAPHRAGHM/ FLOAT/ JELLY 04
CONDOM 05
FEMALE STERILIZATION 06
MALE STERILIZATION 07
PERIODIC ABSTINENCE 08 (GO TO 445)
WITHDRAWAL 09 (GO TO 445)
PROLONGED BREASTFEEDING 10 (GO TO 445)
OTHER (SPECIFY)_____ 11 (GO TO 445)
DON'T KNOW 98 (GO TO 445)

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

(NAME OF PLACE)________
GOVERNMENT HOSPITAL 01 (GO TO 446)
MCH/ HEALTH CENTER 02 (GO TO 446)
FP ASSOCIATION CLINIC 03 (GO TO 446)
PRIVATE DOCTOR 04 (GO TO 446)
PRIVATE HOSPITAL 05 (GO TO 446)
PHARMACY 06 (GO TO 446)
FRIENDS/ RELATIVES 07 (GO TO 449)
OTHER (SPECIFY)______ 08 (GO TO 449)
DON'T KNOW 98 (GO TO 449)

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

YES 1
NO 2 (GO TO 449)

IF YES:

(NAME OF PLACE)________
GOVERNMENT HOSPITAL 01
MCH/ HEALTH CENTER 02
FP ASSOCIATION CLINIC 03
PRIVATE DOCTOR 04
PRIVATE HOSPITAL 05
PHARMACY 06
FRIENDS/ RELATIVES 07 (GO TO 449)
OTHER (SPECIFY)______ 08 (GO TO 449)

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

MINUTES 1____
HOURS 2____
DON'T KNOW 98

447) Is it easy or difficult to get there?

EASY 1
DIFFICULT 2

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

IF "YES": What is it? RECORD MAIN PROBLEM. __________
TOO EXPENSIVE 1
WAIT TOO LONG 2
STAFF DISCOURTEOUS 3
MALE STAFF 4
DESIRED METHOD UNAVAILABLE 5
OTHER (SPECIFY)______ 6
NO COMPLAINTS 7

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

ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8

SECTION 5: BREAST FEEDING AND HEALTH

501) CHECK 319:

ONE OR MORE LIVE BIRTHS SINCE JANUARY 1985 (GO TO 502)
NO LIVE BIRTHS SINCE JANUARY 1985 (GO TO 545)

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

LINE NUMBER___

NAME FROM Q. 309

NAME______

SURVIVAL STATUS FROM Q.313

ALIVE
DEAD

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?

THEN 1 (GO TO 505)
LATER 2
NO MORE 3 (GO TO 505)

504) How long would you like to have waited?

MONTHS 1___
YEARS 2___
DON'T KNOW 998

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

IF YES, Whom did you see?
Anyone else?
DOCTOR A
NURSE/ MIDWIFE B
TRADITIONAL BIRTH ATTENDANT C (GO TO 511)
OTHER (SPECIFY)_______ D (GO TO 511)
NO ONE E (GO TO 511)

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

PUBLIC HEALTH CENTER 1
MCH CENTER 2
GOVERNMENT HOSPITAL 3
PRIVATE HOSPITAL 4
GP CLINIC 5
SPECIALIST CLINIC 6
OTHER (SPECIFY)_______ 7

507) Why did you chose to go there?

LESS COSTLY 1
CONVENIENT 2
BETTER RELATIONSHIP WITH SERVICE PROVIDER 3
TECHNICAL COMPETENCE 4
OTHER (SPECIFY)________ 5

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

REGULAR CHECKUP 1
ILLNESS RELATED TO THE PREGNANCY 2
ILLNESS UNREALTED TO THE PREGNANCY 3

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

MONTHS___
DON'T KNOW 98

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

TIMES___
DON'T KNOW 98

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

YES 1
NO 2 (GO TO 512)
DON'T KNOW 8 (GO TO 512)

512) How many times did you get this injection?

TIMES___
DON'T KNOW 8

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

HOME 1
GOVERNMENT HOSPITAL 2
PRIVATE HOSPITAL 3
OTHER______ 4

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

PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING

A. DOCTOR 1
B. NURSE/MIDWIFE 1
C. TRADITIONAL BIRTH ATTENDANT 1
D. RELATIVE 1
E. OTHER (SPECIFY)_______ 1
F. NO ONE 1

515) What was the duration of the pregnancy?

LESS THAN 7 MONTHS 1
7 MONTHS TO LESS THAN 9 MONTHS 2
9 MONTHS+ 3
DON'T KNOW 8

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

NORMALLY 1
CAESARIAN SECTION 2

517) How much did (NAME) weigh?

GRAMS___
DON'T KNOW 9998

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

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

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?

IF YES, Whom did you see?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.
DOCTOR 1
NURSE/ MIDWIFE 1
TRADITIONAL BIRTH ATTENDANT 1(GO TO 521)
OTHER (SPECIFY)_______ 1 (GO TO 521)
NO ONE 1 (GO TO 521)

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

PUBLIC HEALTH CENTER 1
MCH 2
GOVERNMENT HOSPITAL 3
PRIVATE HOSPITAL 4
GENERAL PRACTITIONER CLINIC 5
SPECIALIST CLINIC 6
OTHER (SPECIFY)_______ 7

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

YES 1 (SKIP TO 523)
NO 2

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?

ENTER "X" IN COLUMN 3 OF CALENDAR FOR THE NUMBER OF SPECIFIED MONTHS WITHOUT A PERIOD, STARTING IN THE MONTH AFTER BIRTH.
IF LESS THAN ONE MONTH WITHOUT A PERIOD, ENTER "0" IN COLUMN 3 IN MONTHS AFTER BIRTH.

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')

YES (OR PREGNANT) 1 (GO TO 526)
NO 2

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?

ENTER "X" IN COLUMN 4 OF CALENDAR FOR THE NUMBER OF SPECIFIED MONTHS WITHOUT SEXUAL RELATIONS, STARTING IN THE MONTH AFTER BIRTH.
IF LESS THAN ONE MONTH WITHOUT SEXUAL RELATIONS, ENTER "0" IN COLUMN 4 OF CALENDAR IN THE MONTH AFTER BIRTH.

527) Did you ever breastfeed (NAME)?

YES 1 (GO TO 529)
NO 2

528) Why did you not breastfeed (NAME)?

ENTER "N" IN COLUMN 5 OF CALENDAR IN THE MONTH AFTER BIRTH
MOTHER ILL/WEAK 1
CHILD ILL/ WEAK 2
CHILD DIED 3
NIPPLE/BREAST PROBLEM 4
NO MILK 5
WORKING 6
MOTHER DOES NOT KNOW HOW TO BREASTFEED 7
OTHER (SPECIFY)________ 8
RECORD VERBATIM ____________

(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]

IMMEDIATELY 000
HOURS 1___
DAYS 2____

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 537)

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]

NUMBER OF DAYLIGHT FEEDINGS___
NUMBER OF NIGHTIME FEEDINGS___
TOTAL IN 24 HOURS____

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

DEMAND 1
SCHEDULE 2
BOTH 3

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?

PLAIN WATER:
YES 1
NO 2
SUGAR WATER:
YES 1
NO 2
JUICE:
YES 1
NO 2
HERBAL TEA:
YES 1
NO 2
YANSOON (DILL):
YES 1
NO 2
BABY FORMULA:
YES 1
NO 2
FRESH MILK:
YES 1
NO 2
TINNED/ POWDERED MILK:
YES 1
NO 2
OTHER LIQUIDS:
YES 1
NO 2
SOLID/ MUSHY FOOD:
YES 1
NO 2

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

YES TO ONE OR MORE (GO TO 541)
NO TO ALL (GO TO 540)

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

FOR EACH BIRTH RECORD THE NUMBER OF MONTHS BREASTFED IN THE BOXES___
ENTER "X" IN COLUMN 5 OF CALENDAR FOR THE NUMBER OF SPECIFIED MONTHS OF BREASTFEEDING, STARTING IN THE MONTH AFTER BIRTH.
IF BREASTFED LESS THAN ONE MONTH, ENTER "0" IN COLUMN 5 IN MONTH AFTER BIRTH.

538) Why did you stop breastfeeding (NAME)?

MOTHER ILL/WEAK 01
CHILD ILL/WEAK 02
CHILD DIED 03
NIPPLE PROBLEM 04
NO MILK/ NOT SUFFICIENT 05
WORKING OUTSIDE HOME 06
CHILD REFUSED 07
WEANING AGE 08
BECAME PREGNANT 09
OTHER (SPECIFY)_______ 10

539) CHECK 313:
CHILD ALIVE?

ALIVE(GO TO 541)
DEAD (GO TO 540)

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

YES 1
NO 2 (GO TO 544)

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?

FORMULA OR MILK:
AGE IN MONTHS____
NOT GIVEN 96

Water or other liquids?

WATER/LIQUIDS:
AGE IN MONTHS___
NOT GIVEN 96

Any solid or mushy food?

SOLID/ MUSHY FOOD:
AGE IN MONTHS___
NOT GIVEN 96

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

ALIVE (GO TO 543)
DEAD (GO TO 544)

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

YES 1
NO 2
DON'T KNOW 8

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?

YES (GO TO 546)
NAME OF LAST BIRTH PRIOR TO 1985: (NAME)__________
NO (GO TO 550)

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

YES 1
NO 2 (GO TO 548)

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

MONTHS___
DON'T KNOW 98

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

MONTHS___
NOT RETURNED 96

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

MONTHS____
NOT RESUMED 96

550) CHECK 501:

ONE OR MORE LIVE BIRTHS SINCE JANUARY 1985 (GO TO 601)
NO LIVE BIRTHS SINCE JANUARY 1985 (GO TO 701)

SECTION 6: IMMUNIZATION, MORBIDITY, AND CHILD MORTALITY

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

IF YES: May I see it, please?
YES, SEEN 1
YES, NOT SEEN 2 (GO TO 603)
NO CARD 3 (GO TO 603)

602)

(1) COPY VACCINATION DATEES FOR EACH VACCINE FROM THE CARD.
(2) WRITE '44' IN ALL COLUMNS IF CARD SHOWS THAT A VACCINATION WAS GIVEN BUT NO DATE RECORDED.

BCG?

BCG:
YEAR_
MONTH__
DAY__

POLIO 1?

P1:
YEAR__
MONTH__
DAY___

POLIO 2?

P2:
YEAR__
MONTH__
DAY___

POLIO 3?

P3:
YEAR__
MONTH__
DAY___

POLIO BOOSETER?

PB:
YEAR__
MONTH__
DAY___

DPT 1?

D1:
YEAR__
MONTH__
DAY___

DPT 2?

D2:
YEAR__
MONTH__
DAY___

DPT 3?

D3:
YEAR__
MONTH__
DAY___

DPT BOOSTER?

DB:
YEAR__
MONTH__
DAY___

MEASLES?

MEA:
YEAR__
MONTH__
DAY___

(GO TO 605)

603) Has (NAME) received any vaccinations?

YES 1
NO 2 (GO TO 605)
DON'T KNOW 8 (GO TO 605)

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?

YES 1
NO 2
DON'T KNOW 8

Polio vaccine, that is, drops in the mouth?

YES 1
NO 2
DON'T KNOW 8

IF YES: How many times?

NUMBER OF TIMES____

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

YES 1
NO 2
DON'T KNOW 8

IF YES: How many times?

NUMBER OF TIMES___

An injection against measles?

YES 1
NO 2
DON'T KNOW 8

605) CHECK 313:
CHILD ALIVE?

ALIVE (GO TO 607)
DEAD (GO TO 606)

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?

YES 1
NO 2 (GO TO 609)

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

1___
2___
3___
DON'T KNOW 98

IF NO OTHER ILLNESSES ENTER "00"

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

FEVER 1
RASH 1
COUGH 1
RED/ TEARY EYES 1
WHOOPING COUGH 1
RED HAIR 1
SWOLLEN FACE AND FEET 1
VOMITTING 1
EMACIATED/ VERY THIN 1
DIFFICULT AND RAPID BREATHING 1
CONVULSIONS 1
RED URINE 1
YELLOW EYES 1
DIFFICULTY IN SWALLOWING 1
BLOOD IN STOOLS 1

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

YES (GO TO 611)
NO (GO TO 613)

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

YES 1
NO 2 (GO TO 613)

612) From whom did you seek advice or treatment?

(CIRCLE EACH MENTIONED)

GOVERNMENT HOSPITAL:

YES 1
NO 2
PRIVATE HOSPITAL:

YES 1
NO 2
MOTHER AND CHILD HEALTH CENTER:
YES 1
NO 2
PRIMARY HEALTH CENTER:

YES 1
NO 2
GENERAL PRACTITIONER CLINIC:

YES 1
NO 2
SPECIALIST CLINIC:
YES 1
NO 2
PHARMACY:
YES 1
NO 2
HOME:

YES 1
NO 2
OTHER (SPECIFY)______ :

YES 1
NO 2

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

YES 1 (GO TO 615)
NO 2
DON'T KNOW 8

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]

YES (GO TO 616)
NO (GO TO 618)

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

YES 1
NO 2 (GO TO 618)

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

INCREASED 1
REDUCED 2
STOPPED COMPLETELY 3

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

A. ANTIBIOTICS 1
B. ORS 1
C. READY MADE HERBAL TEA 1
D. YANSOON 1
E. TEA 1
F. SUGAR WATER 1
G. MERANYA 1
H. BABUNIJ 1
I. RICE WATER 1
J. OTHER (SPECIFY) _______ 1

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

YES 1
NO 2 (GO TO 622)

620) After how long did you start seeking advice?

HOURS 1___
DAYS 2___

621) From whom did you seek advice or treatment?

CIRCLE EACH MENTIONED.

GOVERNMENT HOSPITAL 1
PRIVATE HOSPITAL 1
MOTHER AND CHILD HEALTH CENTER 1
PRIMARY HEALTH CENTER 1
GENERAL PRACTITIONER CLINIC 1
SPECIALIST CLINIC 1
PHARMACY 1
FRIENDS/ RELATIVES 1
OTHER (SPECIFY)______ 1

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

623) CHECK 618:

ORS SOLUTION MENTIONED FOR ANY CHILD IN 618 (ITEM #2 ON THE LIST) (GO TO 626)

ORS SOLUTION NOT MENTIONED OR 618 NOT ASKED (GO TO 624)

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

YES 1 (GO TO 626)
NO 2

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

YES 1
NO 2 (GO TO 628)

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

YES 1
NO 2 (GO TO 628)

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.

GOVERNMENT HOSPITAL 1
PRIVATE HOSPITAL 1
MOTHER AND CHILD HEALTH CENTER 1
PRIMARY HEALTH CENTER 1
GENERAL PRACTITIONER CLINIC 1
SPECIALIST CLINIC 1
PHARMACY 1
FRIENDS/ RELATIVES 1
OTHER (SPECIFY)______ 1

628) CHECK 618:

HOME-MADE SOLUTION MENTIONED (GO TO 629)
HOME-MADE SOLUTION NOT MENTIONED (GO TO 630)

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

DOCTOR 1
NURSE/ MIDWIFE 1
PHARMACY 1
TRADITIONAL BIRTH ATTENDANT 1
FRIENDS/ RELATIVES 1
OTHER (SPECIFY)_________ 1

630) RECORD THE TIME.

HOURS___
MINUTES____

631) CHECK 309, 313, AND 319:

ONE OR MORE CHILDREN DIED AMONG BIRTHS THAT OCCURRED SINCE JANUARY 1985
(ENTER THE LINE NUMBER FROM 309 AND NAME OF EACH BIRTH.
CHECK SURVIVAL STATUS OF EACH BIRTH FROM 313 SINCE JANUARY 1985: IF ALIVE, MOVE TO NEXT BIRTH, IF DECEASED GO TO QUESTION 632. BEGIN WITH THE LAST BIRTH.)

NO CHILD DIED AMONG BIRTHS THAT OCCURRED SINCE JANUARY 1985 (GO TO 701)

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?

ACCIDENT 1
BIRTH INJURY 2 (GO TO 635)
DISEASE 3 (GO TO 635)

634) What kind of accident?

FALL 1
DROWNING 2
TRAFFIC ACCIDENT 3
BURNS 4
POISONING 5
OTHER (SPECIFY)______ 6
DON'T KNOW 8

(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.

DISEASE(S):__________________

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?

UNABLE TO SUCK:
YES 1
NO 2

b. Unable to open mouth to cry?

UNABLE TO CRY:
YES 1
NO 2

c. Fever?

FEVER:
YES 1
NO 2

d. Rash?

RASH:
YES 1
NO 2

e. Cough?

COUGH:
YES 1
NO 2

f. Red, teary eyes?

RED, TEARY EYES:
YES 1
NO 2

g. Prolonged cough followed by vomiting?

PROLONGED COUGH FOLLOWED BY VOMITTING:
YES 1
NO 2

h. Whooping cough?

WHOOPING COUGH:
YES 1
NO 2

i. Red hair?

RED HAIR:
YES 1
NO 2

j. Swollen face and feet?

SWOLLEN FACE AND FEET:
YES 1
NO 2

k. Emaciated/ very thin?

EMACIATED:
YES 1
NO 2

l. Three or more stools per day?

THREE OR MORE STOOLS PER DAY:
YES 1
NO 2

m. Difficult and rapid breathing?

DIFFICULT AND RAPID BREATHING:
YES 1
NO 2

n. Convulsions?

CONVULSIONS:
YES 1
NO 2

637) RECORD THE TIME

HOURS___
MINUTES___

SECTION 7: FERTILITY PREFERENCES

701) CHECK 414P:

NEITHER STERILIZED (GO TO 702)
HE OR SHE STERILIZED (GO TO 706)

702) CHECK 201:

CURRENTLY MARRIED/SEPARATED (GO TO 703)
NOT CURRENTLY MARRIED (GO TO 711)

703) Now I have some questions about the future.

CHECK 322 AND MARK BOX:

NOT PREGNANT OR UNSURE____
Would you like to have a (another) child?
PREGNANT___
After the child you are expecting, would you like to have another child?
HAVE A (ANOTHER) CHILD 1
NO MORE/ NONE 2 (GO TO 709)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 709)
UNDECIDED OR DON'T KNOW 8 (GO TO 709)

704) CHECK 322 AND MARK BOX:

NOT PREGNANT OR UNSURE___
How long would you like to wait from now before the birth of a (another) child?
PREGNANT___
How long would you like to wait after the birth of the child you are expecting before the birth of another child?
DURATION:
MONTHS 1___ (GO TO 709)
YEARS 2___ (GO TO 709)
SOON/ NOW 994 (GO TO 709)
SAYS SHE CAN'T GET PREGNANT 995 (GO TO 709)
OTHER (SPECIFY)_______ 996
DON'T KNOW 998

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

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

WAITING PERIOD:
MONTHS___ (GO TO 709)

NO LIVING CHILDREN 96 (GO TO 709)
DON'T KNOW 98 (GO TO 709)

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

YES 1
NO 2 (GO TO 708)

707) Why do you regret it?

RESPONDENT WANTS ANOTHER CHILD 1
HUSBAND WANTS ANOTHER CHILD 2
SIDE EFFECTS 3
OTHER REASON (SPECIFY)_______ 4

(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?

YES 1
NO 2

(GO TO 711 FOR ALL ANSWERS)

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

YES 1
NO 2

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?

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

711) CHECK 313 AND MARK BOX:

NO LIVING CHILDREN___
If you could choose exactly the number of children to have in your whole life, how many would that be?
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?
BOYS___
GIRLS___
TOTAL ____
AS MANY AS POSSIBLE 94
DEPENDS ON GOD 95
OTHER ANSWER (SPECIFY)______ 96

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?

YES 1
NO, LITERATE 2 (GO TO 804)
NO, ILLITERATE 3 (GO TO 804)

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

PRIMARY 1
PREPARATOY 2
SECONDARY 3
INSTITUTE 4
UNIVERSITY 5
HIGHER STUDIES 6
DON'T KNOW 8

803) What was the highest grade your husband completed?

GRADE___
DON'T KNOW

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

____________________________

805) CHECK 804:

WORKS (WORKED) IN AGRICULTURE (GO TO 806)
DOES (DID) NOT WORK IN AGRICULTURE (GO TO 807)

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

HIS/FAMILY LAND 1
SOMEONE ELSE'S LAND 2

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

ONE COMMUNITY 1
MORE THAN ONE COMMUNITY 2 (GO TO 809)

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?

LIVE THERE SINCE BIRTH 96 (GO TO 812)
MONTH___
DON'T KNOW MONTH 98
YEAR___
DON'T KNOW YEAR 98

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

CITY 1
TOWN 2
VILLAGE 3

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?

YES 1 (GO TO 815)
NO 2

813) Have you ever worked since January 1985?

YES 1 (GO TO 815)
NO 2

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:

WORKED IN JANUARY 1985 (GO TO 818)
DID NOT WORK IN JANUARY 1985 (GO TO 819)

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

MONTH__
DON'T KNOW MONTH 98
YEAR__
DON'T KNOW YEAR 98

(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?

YES 1
NO 2 (GO TO 821)

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

MONTH___
DON'T KNOW MONTH 98
YEAR__
DON'T KNOW YEAR 98

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

YES (GO TO 822)
NO (GO TO 825)

822) CHECK 812: CURRENTLY WORKING?

YES (GO TO 823)
NO (GO TO 825)

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?

USUALLY 1 (GO TO 825)
SOMETIMES 2
NEVER 3

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

HUSBAND 01
OLDER CHILD(REN) 02
OTHER RELATIVES 03
NEIGHBORS 04
FRIENDS 05
SEVANTS/HIRED HELP 06
CHILD IS IN SCHOOL 07
INSTITUTIONAL CHILDCARE 08
OTHER (SPECIFY)________ 09

825) RECORD THET TIME

HOURS___
MINUTES___

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

DAY__
MONTH__
YEAR__

905) WEIGHT (in kilograms)

___________

906) LENGTH (in centimeters)

___________

907) METHOD OF MEASUREMENT

STANDING 1
LYING 2

908) A. Arm fat (in millimeters)

FAT___

B. Arm circumference (in centimeters)

ARM___

C. Head circumference (in centimeters)

HEAD___

909) DATE CHILD WEIGHED AND MEASURED

DAY___
MONTH___
YEAR___

910) RESULT

CHILD MEASURED 1
CHILD SICK 2
CHILD NOT PRESENT 3
CHILD REFUSED 4
MOTHER REFUSED 5
OTHER (SPECIFY)______ 6

911) NAME OF MEASURER: _________

NAME OF ASSISTANT:__________