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JORDAN POPULATION AND FAMILY HEALTH SURVEY 1996 WOMAN QUESTIONNAIRE

IDENTIFICATION

1. GOVERNORATE

2. DISTRICT

3. SUBDISTRICT

4. LOCALITY

5. STRATUM NUMBER

6. CENSUS BLOCK NUMBER

7. JPFHS-II CLUSTER NUMBER

8. HOUSEHOLD NUMBER

9. URBAN/RURAL

URBAN=1
RURAL=2

10. AMMAN/LARGE CITY/MEDIUM CITY/TOWN/COUNTRYSIDE

AMMAN=1
MEDIUM CITY=2
SMALL CITY=3
TOWN=4
COUNTRYSIDE=5

AMMAN ALMOST 1,000,000
MEDIUM CITY (ZARQA, RUSSAIFA, IRBID, SALT, MADABA) 50,000 - 500,000
SMALL CITY 20,000 - 49,999
TOWN 5,000 - 19,999
COUNTRYSIDE LESS THAN 5,000

11. NAME OF HOUSEHOLD HEAD

12. NAME AND LINE NUMBER OF WOMAN

INTERVIEWER VISITS

FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT

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

NEXT VISIT
DATE
TIME

SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT

NEXT VISIT
DATE
TIME

THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT

FINAL VISIT
DAY
MONTH
YEAR 1997
NAME
RESULT

TOTAL NUMBER OF VISITS

SUPERVISOR
NAME
DATE

FIELD EDITOR
NAME
DATE

OFFICE EDITOR

KEYED BY

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, did you live in Amman, in another city, in the countryside, or outside Jordan?

AMMAN 1
ANOTHER CITY 2
COUNTRYSIDE/VILLAGE 3
OUTSIDE JORDAN 4

103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?

YEARS___
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)

104. Just before you moved here, did you live in Amman, in another city, in the countryside, or outside Jordan?

AMMAN 1
ANOTHER CITY 2
COUNTRYSIDE/VILLAGE 3
OUTSIDE JORDAN 4

105. In what month and year were you born?

MONTH___
DON'T KNOW MONTH 98
YEAR ____
DON'T KNOW YEAR 9998

106. How old were you at your last birthday?
COMPARE 105 AND 106, AND CORRECT IF INCONSISTENT.

AGE IN COMPLETED YEARS____

107. Have you ever attended school?

YES 1
NO 2 (GO TO 114)

108. What is the highest (grade/form/year) you completed at that level?

GRADE____

109. What is the highest level of school you attended: basic, elementary, preparatory, vocational secondary, academic secondary, intermediate diploma, the university, or higher studies?

ELEMENTARY 01
PREPARATORY 02
BASIC 03
VOCATIONAL SECONDARY 04
ACADEMIC SECONDARY 05
INTERMEDIATE DIPLOMA 06
UNIVERSITY 07
HIGHER STUDIES 08

110. CHECK 106:

AGE 24 OR BELOW (GO TO 111)
AGE 25 OR ABOVE(GO TO 113)

111. Are you currently attending school?

YES 1 (GO TO 113)
NO 2

112. What was the main reason you stopped attending school?

GOT PREGNANT 01
GOT MARRIED 02
TO CARE FOR YOUNGER CHILDREN 03
FAMILY NEEDED HELP ON FARM OR IN BUSINESS 04
COULD NOT PAY SCHOOL FEES 05
NEEDED TO EARN MONEY 06
GRADUATED/HAD ENOUGH SCHOOLING 07
DID NOT PASS ENTRANCE EXAMS 08
DID NOT LIKE SCHOOL 09
SCHOOL NOT ACCESSIBLE/TOO FAR 10
FREQUENTLY FAILED 11
OTHER______ 96
DON'T KNOW 98

113. CHECK 108

ELEMENTARY/BASIC 1-6____
ABOVE ELEMENTARY____ (GO TO 115)

114. Can you read and understand a letter or newspaper easily, with difficulty, or not at all?

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 116)

115. How often do you read a newspaper or a magazine? Would you say:

EVERY DAY 1
3-5 TIMES A WEEK 2
ONCE OR TWICE A WEEK 3
ONCE A MONTH 4
FEW TIMES A YEAR 5
NEVER 6
DON'T KNOW 7

116. How often do you listen to the radio? Would you say:

EVERY DAY 1
AT LEAST ONCE A WEEK 2
AT LEAST ONCE A MONTH 3
HARDLY EVER 4
NEVER 5
OTHER______ 6
DON'T KNOW 7

117. How often do you watch television? Would you say:

EVERY DAY 1
AT LEAST ONCE A WEEK 2
AT LEAST ONCE A MONTH 3
HARDLY EVER 4
NEVER 5
OTHER______ 6
DON'T KNOW 7

118. What is your religion?

ISLAM 1
CHRISTIAN 2
OTHER______3

119. CHECK Q. 4 IN THE HOUSEHOLD QUESTIONNAIRE

THE WOMAN INTERVIEWED IS NOT A USUAL RESIDENT____
THE WOMAN INTERVIEWED IS A USUAL RESIDENT____ (GO TO 201)

120. Now I would like to ask about the place in which you usually live. What is the name of the place in which you usually live?

NAME OF PLACE___________

Is that Amman, another city, the countryside or outside Jordan?

AMMAN 1
ANOTHER CITY 2
COUNTRYSIDE/VILLAGE 3
OUTSIDE JORDAN 4 (GO TO 122)

121. In which governorate is that located?

GOVERNORATE CODE ___

Now I would like to ask about the household in which you usually live.

122. What is the main source of drinking water for members of your household?

PIPED WATER
PIPED INTO RESIDENCE/YARD/PLOT 11 (GO TO 124)
PUBLIC TAP 12
WELL WATER
WELL IN RESIDENCE/YARD/PLOT 21 (GO TO 124)
PUBLIC WELL 22
SURFACE WATER
SPRING 31
RIVER/STREAM 32
POND/LAKE 33
DAM 34
RAINWATER 41 (GO TO 124)
TANKER TRUCK 51 (GO TO 124)
BOTTLED WATER 52 (GO TO 124)
OTHER________96

123. How long does it take to go there, get water, and come back?

MINUTES_____
ON PREMISIS 996

124. What kind of sewage system do you have in your house?

PUBLIC NETWORK 1
DUG HOLE 2
OTHER______ 3
NO SEWAGE 4

124A. What kind of toilet facility does your household have

FLUSH TOILET
OWN FLUSH TOILET 11
SHARED FLUSH TOILET 12
PIT TOILET/LATRINE
TRADITIONAL PIT TOILET 21
NO FACILITY/BUSH/FIELD 31
OTHER______ 96

125. Does your household have:

Electricity?
YES 1
NO 2
A radio?
RADIO THAT WORKS
YES 1
NO 2
A television?
TELEVISION THAT WORKS
YES 1
NO 2
A video?
YES 1
NO 2
A telephone?
YES 1
NO 2
A refrigerator?
YES 1
NO 2
An air conditioner?
YES 1
NO 2
Solar water heater?
YES 1
NO 2
Satellite dish?
YES 1
NO 2

126. Could you describe the main material of the floor in your home?

NATURAL FLOOR
EARTH/SAND 11
RUDIMENTARY FLOOR
WOOD PLANKS 21
FINISHED FLOOR
PARQUET OR POLISHED WOOD 31
VINYL OR ASPHALT STRIPS 32
CERAMIC TILES 33
CEMENT 34
OTHER_______ 96

127. Does any member of your household own:

A bicycle?
YES 1
NO 2
A motorcycle?
YES 1
NO 2
A private car?
YES 1
NO 2
A commercial car?
YES 1
NO 2
A pickup?
YES 1
NO 2
An agricultural tractor?
YES 1
NO 2
Any other mode of transportation?
YES 1
NO 2

SECTION 2. MARRIAGE

201. PRESENCE OF OTHERS AT THIS POINT.

CHILDREN UNDER 10
YES 1
NO 2
HUSBAND
YES 1
NO 2
OTHER MALES
YES 1
NO 2
OTHER FEMALES
YES 1
NO 2

202. What is your marital status now: are you married, divorced, separated, or widowed?

MARRIED 1
DIVORCED 2 (GO TO 205)
WIDOWED 3 (GO TO 205)
SEPARATED 4 (GO TO 205

203. Does your husband have another wife (other wives) besides you?

YES 1
NO 2 (GO TO 205)

204. How many wives does he have besides you?

NUMBER_____
DON'T KNOW 8

205. Have you been married only once or more than once?

ONCE 1
MORE THAN ONCE 2

206. CHECK 205:

(MARRIED WITH A MAN ONLY ONCE) In what month and year did you start living with your husband (consummate your marriage)?

(MARRIED WITH A MAN MORE THAN ONCE) Now we will talk about your first husband. In what month and year did you start living with him (consummate your marriage)?

MONTH ___
DON'T KNOW MONTH 98
YEAR___ (GO TO 208)
DON'T KNOW YEAR 9998

207. How old were you when you started living with him (consummate your marriage)?

AGE___

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

FIRST COUSIN FROM BOTH FATHER AND MOTHER' SIDE 01
FIRST COUSIN FROM BOTH MOTHER AND FATHER' SIDE 02
FIRST COUSIN FROM FATHER' SIDE (IBN AL AMM) 03
FIRST COUSIN FROM MOTHER' SIDE (IBN AL KHAL) 04
FIRST COUSIN FROM FATHER' SIDE (IBN AL AMMA) 05
FIRST COUSIN FROM MOTHER' SIDE (IBN AL KHALA) 06
RELATIVE 09
NO RELATION 10
DON'T KNOW 98

209. DETERMINE MONTHS MARRIED SINCE JANUARY 1992. ENTER 'X' IN COLUMN 3 OF CALENDAR FOR EACH MONTH MARRIED, AND ENTER '0' FOR EACH MONTH NOT MARRIED, SINCE JANUARY 1992.

FOR WOMEN MARRIED MORE THAN ONCE: PROBE FOR DATE WHEN CURRENT MARRIAGE STARTED AND, IF APPROPRIATE, FOR STARTING AND TERMINATION DATES OF ANY PREVIOUS UNIONS.

FOR WOMEN NOT CURRENTLY MARRIED: PROBE FOR DATE WHEN LAST UNION STARTED AND FOR TERMINATION DATE AND, IF APPROPRIATE, FOR THE STARTING AND TERMINATION DATES OF ANY PREVIOUS UNIONS.

210. CHECK 202:

CURRENTLY MARRIED/SEPARATED (GO TO 211)
DIVORCED/WIDOWED (GO TO 301)

211. Does your husband live with you in this household or is he staying elsewhere?

LIVES WITH HER 1
STAYING ELSEWHERE 2

212. WRITE THE LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR HER HUSBAND. IF HE IS NOT LISTED IN THE HOUSEHOLD WRITE '00'.

LINE NUMBER______

213. In the last month were you and your husband living together all 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 215)

214. How many days was he away in the last month?

DAYS_____ (GO TO 301)

215. 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 306)

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

YES 1
NO 2 (GO TO 304)

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

SONS AT HOME______
DAUGHTERS AT HOME_____

304. 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 306)

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

SONS ELSEWHERE_____
DAUGHTERS ELSEWHERE_____

306. Have you ever given birth to a boy or a girl who was born alive but later died?

YES 1
NO 2 (GO TO 308)

IF NO, PROBE: Any baby who cried or showed signs of life but survived only a few hours or days?

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

BOYS DEAD_____
GIRLS DEAD_____

308. SUM ANSWERS TO 303, 305, AND 307, AND ENTER TOTAL.
IF NONE RECORD '00'.

TOTAL_____

309. CHECK 308: Just to make sure that I have this right: you have had in TOTAL ______ births during your life. Is that correct?

YES (GO TO 310)
NO (PROBE AND CORRECT 301-308 AS NECESSARY)

310. CHECK 308:

ONE OR MORE BIRTHS (GO TO 311)
NO BIRTHS (GO TO 327)

311. Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had.
RECORD NAMES OF ALL THE BIRTHS IN 312. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

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

NAME____

313. Were any of these births twins?

SING 1
MULT 2

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

BOY 1
GIRL 2

315. In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH_____
YEAR_____

316. Is (NAME) still alive?

YES 1
NO 2 (GO TO 319)

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

AGE IN YEARS_____

318. IF ALIVE: Is (NAME) living with you?

YES 1 (GO TO 320) (NEXT BIRTH FOR FIRSTBORN)
NO 2 (GO TO 320) (NEXT BIRTH FOR FIRSTBORN)

319. IF DEAD: How old was (NAME) when he/she died?

IF '1 YR.', PROBE: How many months old was (NAME)? RECORD DAYS IF LESS THAN ONE MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

DAYS 1 ____
MONTHS 2 ____
YEARS 3 ____

320. FROM THE YEAR OF BIRTH OF (NAME) SUBTRACT YEAR OF PREVIOUS BIRTH. IS THE DIFFERENCE 4 OR MORE?

YES 1
NO 2 (NEXT BIRTH)

321. Were there any other live births between (NAME OF PREVIOUS BIRTH and NAME)?

YES 1
NO 2

322. FROM YEAR OF INTERVIEW SUBTRACT YEAR OF LAST BIRTH. IS THE DIFFERENCE 4 YEARS OR MORE?

YES 1 (GO TO 323)
NO 2 (GO TO 324)

323. Have you had any live births since the birth of (NAME OF LAST BIRTH)?

YES 1
NO 2

324. COMPARE 308 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND PUT A TICK MARK:

NUMBERS ARE SAME (CONTINUE TO CHECKLIST)
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

CHECK:
FOR EACH 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 12 MONTHS OR 1 YR.: PROBE TO DETERMINE EXACT NUMBER OF MONTHS

325. CHECK 315 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1992. IF NONE, RECORD '0'.

BIRTHS____

326. FOR EACH BIRTH SINCE JANUARY 1992, ENTER 'B' IN THE MONTH OF BIRTH IN COLUMN 1 OF THE CALENDAR AND 'P' IN EACH OF THE 8 PRECEDING MONTHS. WRITE NAME TO THE LEFT OF THE 'B' CODE.

327. Are you pregnant now?

YES 1
NO 2 (GO TO 330)
UNSURE 8 (GO TO 330)

328. How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS. ENTER 'P'S IN COLUMN 1 OF CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR TOTAL NUMBER OF COMPLETED MONTHS.

MONTHS ____

329. 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 have any more children at all?

THEN 1
LATER 2
NOT WANT MORE CHILDREN 3

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

YES 1
NO 2 (GO TO 336)

331. When did the last such pregnancy end?

MONTH __
YEAR ____

332. CHECK 331:

LAST PREGNANCY ENDED SINCE JAN. 1992 (NEXT QUESTION)
LAST PREGNANCY ENDED BEFORE JAN. 1992 (GO TO 336)

333. How many months pregnant were you when the last pregnancy ended?

MONTHS_____

RECORD NUMBER OF COMPLETED MONTHS. ENTER 'T' IN COLUMN 1 OF CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

334. Have you ever had any other pregnancies which did not result in a live birth?

YES 1
NO 2 (GO TO 336)

335. ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER PREGNANCY BACK TO JANUARY 1992.

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

336. When did your last menstrual period start?

DATE (IF GIVEN) _______
DAYS AGO 1 ___
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___
IN MENOPAUSE 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

337. Between the first day of a woman's period and the first day of her next period, are there certain times when she has a greater chance of becoming pregnant than other times?

YES 1
NO 2
DON'T KNOW 3

338. During which times of the monthly cycle does a woman have the greatest chance of becoming pregnant?

DURING HER PERIOD 01
RIGHT AFTER HER PERIOD HAS ENDED 02
IN THE MIDDLE OF THE CYCLE 03
JUST BEFORE HER PERIOD BEGINS 04
OTHER______ 96
DON'T KNOW 98

SECTION 4. CONTRACEPTION

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.
CIRCLE CODE 1 IN 401 FOR EACH METHOD MENTIONED SPONTANEOUSLY.
THEN PROCEED DOWN TO COLUMN 402, 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 401 OR 402, ASK 403.

401. Which ways have you heard about?
402. Have you ever heard of (METHOD)?

01) PILL: Women can take a pill every day.

SPONTANEOUS YES 1
PROBED YES 2
NO 3

02) IUD: Women can have a loop or coil placed inside them by a doctor or a nurse

SPONTANEOUS YES 1
PROBED YES 2
NO 3

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

SPONTANEOUS YES 1
PROBED YES 2
NO 3

04) IMPLANTS: Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.

SPONTANEOUS YES 1
PROBED YES 2
NO 3

05) DIAPHRAGM, FOAM, JELLY: Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.

SPONTANEOUS YES 1
PROBED YES 2
NO 3

06) CONDOM: Men can put a rubber sheath on their penis during sexual intercourse.

SPONTANEOUS YES 1
PROBED YES 2
NO 3

07) FEMALE STERILIZATION: Women can have an operation to avoid having any more children.

SPONTANEOUS YES 1
PROBED YES 2
NO 3

08) MALE STERILIZATION: Men can have an operation to avoid having any more children.

SPONTANEOUS YES 1
PROBED YES 2
NO 3

09) RHYTHM, PERIODIC ABSTINENCE: Every month that a woman is sexually active she can avoid having sexual intercourse on the days of the month that she is most likely to get pregnant.

SPONTANEOUS YES 1
PROBED YES 2
NO 3

10) WITHDRAWAL: Men can be careful and pull out before climax.

SPONTANEOUS YES 1
PROBED YES 2
NO 3

11) PROLONGED BREASTFEEDING: Women can breastfeed for longer period to avoid getting pregnant.

SPONTANEOUS YES 1
PROBED YES 2
NO 3

12. Have you heard of any other methods that women or men can use to avoid pregnancy?

SPECIFY___________

403. Have you ever used (METHOD)?

01) PILL: Women can take a pill every day.

YES 1
NO 2

02) IUD: Women can have a loop or coil placed inside them by a doctor or a nurse

YES 1
NO 2

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

04) IMPLANTS: Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.

YES 1
NO 2

05) DIAPHRAGM, FOAM, JELLY: Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.

YES 1
NO 2

06) CONDOM: Men can put a rubber sheath on their penis during sexual intercourse.

YES 1
NO 2

07) FEMALE STERILIZATION: Have you ever had an operation to avoid having any more children?

YES 1
NO 2

08) MALE STERILIZATION: Have you ever had a husband who had an operation to avoid having children?

YES 1
NO 2

09) RHYTHM, PERIODIC ABSTINENCE: Every month that a woman is sexually active she can avoid having sexual intercourse on the days of the month that she is most likely to get pregnant.

10) WITHDRAWAL: Men can be careful and pull out before climax.

11) PROLONGED BREASTFEEDING: Women can breastfeed for longer period to avoid getting pregnant.

12) Have you heard of any other methods that women or men can use to avoid pregnancy?

SPECIFY___________

404. CHECK 403:

NOT A SINGLE "YES" (GO TO 405)
AT LEAST ONE "YES" (GO TO 408)

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

YES 1 (GO TO 407)
NO 2

406. ENTER "0" IN COLUMN 1 OF CALENDAR IN EACH BLANK MONTH. (GO TO 433)

407. What have you used or done?

ANSWER__________

CORRECT 403 AND 404 (AND 402 IF NECESSARY).

408. Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant.

What was the first method you ever used?

PILL 01
IUD 02
INJECTIONS 03
IMPLANTS 04
DIAPHRAGM/FOAM/JELLY 05
CONDOM 06
FEMALE STERILIZATION 07
MALE STERILIZATION 08
PERIODIC ABSTINENCE 09
WITHDRAWAL 10
PROLONGED BREASTFEEDING 11
OTHER______ 96

409. How many living children did you have at the time, if any?

NUMBER OF CHILDREN______

IF NONE, RECORD '00'.

410. CHECK 403:

WOMAN NOT STERILIZED (GO TO 411)
WOMAN STERILIZED (GO TO 413A)

411. CHECK 327

NOT PREGNANT OR UNSURE (GO TO 412)
PREGNANT (GO TO 424)

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

YES 1
NO 2 (GO TO 424)

413. Which method are you using?
413A. CIRCLE '07' FOR FEMALE STERILIZATION.

PILL 01
IUD 02 (GO TO 416A)
INJECTIONS 03 (GO TO 416B)
IMPLANTS 04 (GO TO 416C)
DIAPHRAGM/FOAM/JELLY 05 (GO TO 423)
CONDOM 06 (GO TO 416D)
FEMALE STERILIZATION 07 (GO TO 416E)
MALE STERILIZATION 08 (GO TO 416E)
PERIODIC ABSTINENCE 09 (GO TO 422)
WITHDRAWAL 10 (GO TO 423)
PROLONGED BREASTFEEDING 11 (GO TO 423)
OTHER______ 96 (GO TO 423)

414. May I see the package of pills you are now using? RECORD NAME OF BRAND IF PACKAGE IS SEEN.

PACKAGE SEEN 1
BRAND SEEN ________ (GO TO 416)
PACKAGE NOT SEEN 2

415. Do you know the brand name of the pills you are now using? RECORD NAME OF BRAND.

BRAND NAME __________
DON'T KNOW 98

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

COST (DINAR)________ (GO TO 423)
COST (PIASTRE) _________ (GO TO 423)
FREE 99996 (GO TO 423)
DON'T KNOW 99998 (GO TO 423)

416A. IUD: How much did the insertion of IUD cost you, including transportation, pap smear and IUD device?

416B. INJECTIONS: How much did this injection cost you, including transportation and medical check up?

416C. IMPLANTS: How much did the implants cost you, including transportation and medical checkup?

416D. CONDOM: How much did a package of three cost you, including transportation?

CODING A-D:

COST (DINAR) ________ (GO TO 423)
COST (PIASTRE)________ (GO TO 423)
FREE 99996 (GO TO 423)
DON'T KNOW 99998 (GO TO 423)

416E. FEMALE STERILIZATION: How much did the operation cost you including transportation and medical check up?

COST (DINAR) _________
COST (PIASTRE) _________
FREE 99996
DON'T KNOW 99998

417. Where did the sterilization take place? IF SOURCE IS HOSPITAL, HEATH CENTER, OR CLINIC, WRITE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE____________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
UNIVERSITY HOSPITAL 12
ROYAL MEDICAL SERVICES (ARMED FORCES) 13
OTHER PUBLIC _______ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
OTHER PRIVATE _______ 26
DON'T KNOW 98

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

YES 1
NO 2 (GO TO 420)

419. Why do you regret the operation?

RESPONDENT WANTS ANOTHER CHILD 01
PARTNER WANTS ANOTHER CHILD 02
SIDE EFFECTS 03
CHILD DIED 04
OTHER___________ 96

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

MONTH_____
YEAR______

421. CHECK 420:

STERILATION BEFORE JANUARY 1992: ENTER CODE FOR STERILIZATION IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND EACH MONTH BACK TO JANUARY 1992. (GO TO 429A)

STERILIZATION AFTER JANUARY 1992: ENTER CODE FOR STERILIZATION IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND IN EACH MONTH BACK TO THE DATE OF THE OPERATION. (GO TO 424)

422. How do you determine which days of your monthly cycle not to have sexual relations?

BASED ON CALENDAR 01
BASED ON BODY TEMPERATURE 02
BASED ON CERVICAL MUCUS (BILLINGS METHOD) 03
BASED ON BODY TEMPERATURE AND CERVICAL MUCUS 04
NO SPECIFIC SYSTEM 05
OTHER_______ 96

423. ENTER METHOD CODE FROM 413 IN CURRENT MONTH IN COLUMN 1 OF CALENDAR. THEN DETERMINE WHEN SHE STARTED USING METHOD THIS TIME. ENTER METHOD CODE IN EACH MONTH OF USE.
ILLUSTRATIVE QUESTIONS:

When did you start using continuously?
How long have you been using this method continuously?

424. I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years.

USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH THE MOST RECENT USE, BACK TO JANUARY 1992. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

IN COLUMN 1, ENTER CODE IN EACH MONTH OF METHOD USE OR '0' FOR NONUSE.
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?

IN COLUMN 2, ENTER CODES FOR DISCONTINUATION NEXT TO LAST MONTH OF USE.
NUMBER OF CODES IN COL. 2 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1

ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT.

ILLUSTRATIVE QUESTIONS:
COLUMN 2:
Why did you stop using the (METHOD)?
Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop for some other reason?

IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK:
How many months did it take you to get pregnant after you stopped using (METHOD)?
AND ENTER '0' IN EACH OF SUCH MONTH IN COLUMN 1

425. CHECK 413:

CIRCLE METHOD CODE:

NOT USING 00 (GO TO 431)
PILL 01
IUD 02
INJECTIONS 03
IMPLANTS 04
DIAPHRAGM/FOAM/JELLY 05
CONDOM 06
FEMALE STERILIZATION 07
MALE STERILIZATION 08
PERIODIC ABSTINENCE 09
WITHDRAWAL 10
PROLONGED BREASTFEEDING 11
OTHER METHOD 96

426A. Did you talk to your husband about (CURRENT METHOD) before starting to use it?

YES 1
NO 2

426B. Did your husband encourage or discourage your use of (CURRENT METHOD) before starting to use it?

ENCOURAGE 1
DISCOURAGE 2
NEITHER 3
DON'T KNOW 8

426C. Did you talk to your husband about (CURRENT METHOD) after starting to use it?

YES 1
NO 2

426D. Did your husband encourage or discourage your use of (CURRENT METHOD) after starting to use it?

ENCOURAGE 1
DISCOURAGE 2
NEITHER 3
DON'T KNOW 8

427. CHECK 413:

CIRCLE METHOD CODE:

PILL 01
IUD 02
INJECTIONS 03
IMPLANTS 04
DIAPHRAGM/FOAM/JELLY 05
CONDOM 06
FEMALE STERILIZATION 07 (GO TO 429A)
MALE STERILIZATION 08 (GO TO 429A)
PERIODIC ABSTINENCE 09 (GO TO 432)
WITHDRAWAL 10 (GO TO 432)
PROLONGED BREAST FEEDING 11 (GO TO 432)
OTHER METHOD 96 (GO TO 432)

428. Where did you obtain (METHOD) the last time? IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE_______
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
GOVERNMENT MCH 13
UNIVERSITY HOSPITAL/CLINIC 14
ROYAL MEDICAL SERVICES (ARMED FORCES) 15
OTHER PUBLIC ____________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR 22
PHARMACY 23
JORDANIAN ASSOCIATION OF FP AND PROTECTION (JAFPP) 24
UN RELIEF AGENCY HC 25
OTHER NGOs 26
OTHER P. MEDICAL ________ 27
OTHER SOURCE
FRIENDS/RELATIVES 31
OTHER___________36

429. Do you know another place where you could have obtained (METHOD) the last time?

YES 1
NO 2 (GO TO 434)

429A. At the time of the sterilization operation, did you know another place where you could have received the operation?

YES 1
NO 2 (GO TO 434)

430. People select the place where they get family planning services for various reasons.
What was the main reason you went to (NAME OF PLACE IN Q. 430 OR Q. 417) instead of some other place you know about?

RECORD RESPONSE AND CIRCLE CODE _________________

ACCESS-RELATED REASONS
CLOSER TO HOME 11
CLOSER TO MARKET/MARKET 12
AVAILABILITY OF TRANSPORT 13
SERVICE-RELATED REASONS
STAFF MORE COMPETENT/FRIENDLY 21
CLEANER FACILITY 22
OFFERS MORE PRIVACY 23
SHORTER WAITING TIME 24
LONGER HRS. OF OPERATION 25
USE OTHER SERVICES AT THE FACILITY 26
FEMALE PHYSICIAN 27
LOWER COST/CHEAPER 31
WANTED ANONYMITY 41
OTHER__________ 96
DON'T KNOW 98

431. What is the main reason you are not using a method of contraception to avoid pregnancy?

FERTILITY-RELATED REASONS
NOT HAVING SEX 21
INFREQUENT SEX 22
MENOPAUSAL/HYSTERECTOMY 23
SUBFECUND/ INFECUND 24
POSTPARTUM/ BREASTFEEDING 25
WANTS (MORE) CHILDREN 26
PREGNANT 27
OPPOSITION TO USE
RESPONDANT OPPOSED 31
HUSBAND OPPOSED 32
OTHER HH MEMBERS OPPOSED 33
OTHERS OPPOSED 34
RELIGIOUS PROHIBITION 35
RUMORS 36
LACK OF KNOWLEDGE
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER____________ 96
DON'T KNOW 98

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

YES 1
NO 2 (GO TO 434)

433. Where is that? IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE__________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
GOVERNMENT MCH 13
ROYAL MEDICAL SERVICES (ARMED FORCES) 14
OTHER PUBLC__________ 15
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR 22
JORDANIAN ASSOCIATION OF FP AND PROTECTION (JAFPP) 23
UN RELIEF AGENCY HC 24
OTHER NGOs 25
OTHER P. MEDICAL___________ 26
OTHER SOURCE
FRIENDS/RELATIVES 31
OTHER___________ 36

434. Have you visited a health facility for any reason in the last 12 months?

YES 1
NO 2 (GO TO 436)

435. Did any staff member at the health facility speak to you about family planning methods?

YES 1
NO 2

436. Do you think that breastfeeding can affect a woman's chance of becoming pregnant?

YES 1
NO 2 (GO TO 501)
DON'T KNOW 8

437. Do you think a woman's chance of becoming pregnant is increased or decreased by breastfeeding?

INCREASED 1 (GO TO 501)
DECREASED 2
DEPENDS 3 (GO TO 439)
DON'T KNOW 8 (GO TO 439)

438. For how many months?

NUMBER OF MONTHS _____
DON'T KNOW 98

439. CHECK 310:

ONE OR MORE BIRTHS (GO TO 440)
NO BIRTHS (GO TO 501)

440. Have you ever relied on breastfeeding as a method of avoiding pregnancy?

YES 1
NO 2 (GO TO 501)

441. CHECK 327 AND 410:

NOT PREGNANT OR UNSURE AND NOT STERILIZED (GO TO 442)
EITHER PREGNANT OR STERILIZED (GO TO 501)

442. Are you currently relying on breastfeeding to avoid getting pregnant?

YES 1
NO 2

SECTION 5A. PREGNANCY AND BREASTFEEDING

501. CHECK 325:

ONE OR MORE BIRTHS SINCE JAN. 1992 (GO TO 502)
NO BIRTHS SINCE JAN. 1992 (GO TO 565)

502. ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1992 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 2 BIRTHS, USE ADDITIONAL QUESTIONNAIRES).

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

503. LINE NUMBER FROM Q312

LINE NUMBER________

504. FROM Q312 AND Q316.

NAME_______
ALIVE (NEXT QUESTION)
DEAD (NEXT QUESTION)

505. 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 507)
LATER 2
NO MORE 3 (GO TO 507)

506. How much longer would you like to have waited?

MONTHS 1 _______
YEARS 2 ______
DON'T KNOW 998

507. When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.

HEALTH PROFESSIONALS
DOCTOR A
NURSE/MIDWIFE B
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT C
OTHER _________X
NO ONE Y (GO TO 510)

508. How many months pregnant were you when you first received antenatal care?

MONTHS _______
DON'T KNOW 98

509. How many times did you receive antenatal care during this pregnancy?

NO. OF TIMES _____
DON'T KNOW 98

510. When you were pregnant with (NAME) were you given any injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?

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

511. During this pregnancy, how many times did you get this injection?

TIMES ____
DON'T KNOW 8

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

HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVT. HOSPITAL 21
OTHER PUBLIC _______ 26
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL /CLINIC 31
OTHER PRIVATE MEDICAL________ 36
OTHER_________ 96

513. Who assisted with the delivery of (NAME)? Anyone else? PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
OTHER PERSON
TRADITIONAL BIRTH ASSISTANT C
RELATIVE/FRIEND D
OTHER__________ X
NO ONE Y

514. Up to 42 days after the birth of (NAME), did you have any of the following problems:

Long labor, that is, did your regular contractions last more than 12 hours?
YES 1
NO 2
Excessive bleeding that was so much that you feared it was life threatening?
YES 1
NO 2
A high fever with bad smelling vaginal discharge?
YES 1
NO 2
Convulsions not caused by fever?
YES 1
NO 2

515. Was (NAME) delivered by caesarian section?

YES 1
NO 2

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

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

517. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 519)

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

GRAMS FROM CARD ________ 1
GRAMS FROM RECALL _________ 2
DON'T KNOW 99998

519. (ONLY LAST CHILD) Has your period returned since the birth of (NAME)?

YES 1 (GO TO 521)
NO 2 (GO TO 522)

520. (NOT LAST CHILD) Did your period return between the birth of (NAME) and your next pregnancy?

YES 1
NO 2 (GO TO 524)

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

MONTHS______
DON'T KNOW 98

522. CHECK 327: RESPONDANT PREGNANT?

NOT PREGNANT (GO TO 523)
PREGNANT OR UNSURE (GO TO 524)

523. Have you resumed sexual relations since the birth of (NAME)?

YES 1
NO 2 (GO TO 525)

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

IF LESS THAN 30 DAYS _______ 1
MONTHS_____ 2
DON'T KNOW 998

525. Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 531)

526. How long after birth did you first put (NAME) to the breast? IF LESS THAN ONE HOUR, RECORD '00' HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS.

IMMEDIATELY 000
HOURS______ 1
DAYS _____ 2

527. CHECK 504: CHILD ALIVE?

ALIVE (GO TO 528)
DEAD (GO TO 529)

528. Are you still breastfeeding (NAME)?

YES 1 (GO TO 532)
NO 2

529. For how many months did you breastfeed (NAME)?

MONTHS _____
DON'T KNOW 98

530. Why did you stop breastfeeding (NAME)?

MOTHER ILL/WEAK 01
CHILD ILL/WEAK 02
CHILD DIED 03
NIPPLE/BREAST PROBLEM 04
NOT ENOUGH MILK 05
MOTHER WORKING 06
CHILD REFUSED 07
WEANING AGE/AGE TO STOP 08
BECAME PREGNANT 09
STARTED USING CONTRACEPTION 10
OTHER_________ 96

531. CHECK 504: CHILD ALIVE?

ALIVE (GO TO 534)
DEAD (GO BACK TO 505 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 540)

532. How many times did you breastfeed last night between sunset and sunrise? IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

NUMBER OF NIGHTTIME FEEDINGS ________

533. How many times did you breastfeed yesterday during the daylight hours? IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

NUMBER OF DAYLIGHT FEEDINGS ________

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

YES 1
NO 2
DON'T KNOW 8

535. At any time yesterday or last night was (NAME) given any of the following?

Plain water?
YES 1
NO 2
DON'T KNOW 8
Sugar water?
YES 1
NO 2
DON'T KNOW 8
Juice?
YES 1
NO 2
DON'T KNOW 8
Herbal tea?
YES 1
NO 2
DON'T KNOW 8
Anise drink (yansoon)?
YES 1
NO 2
DON'T KNOW 8
Baby formula?
YES 1
NO 2
DON'T KNOW 8
Tinned or powdered milk?
YES 1
NO 2
DON'T KNOW 8
Fresh milk?
YES 1
NO 2
DON'T KNOW 8
Any other liquids?
YES 1
NO 2
DON'T KNOW 8
Any food made from grain?
YES 1
NO 2
DON'T KNOW 8
Any food made from tuber such as potato?
YES 1
NO 2
DON'T KNOW 8
Vegetable?
YES 1
NO 2
DON'T KNOW 8
Fruit?
YES 1
NO 2
DON'T KNOW 8
Eggs, fish, or poultry?
YES 1
NO 2
DON'T KNOW 8
Meat?
YES 1
NO 2
DON'T KNOW 8
Any other solid or semi-solid foods?
YES 1
NO 2
DON'T KNOW 8

536. CHECK 535: FOOD OR LIQUID GIVEN YESTERDAY?

"YES" TO ONE OR MORE (GO TO 537)
"NO/DK" TO ALL (GO TO 538)

537. (Aside from breastfeeding,) how many times did (NAME) eat yesterday, including both meals and snacks? IF MORE THAN 7 TIMES, RECORD '7'.

NUMBER OF TIMES_______
DON'T KNOW 8

538. On how man days during the last seven days was (NAME) given any of the following:
RECORD THE NUMBER OF DAYS.

PLAIN WATER_____
MILK_____
OTHER LIQUIDS_____
FOOD MADE FROM GRAIN_____
FOOD MADE FROM TUBER_____
VEGETABLE _____
FRUIT _____
EGGS/FISH/POULTRY_____
MEAT_____
OTHER SOLID/SEMI-SOLID FOODS_____

539. GO BACK TO 505 IN NEXT COUMN; OR, IF NO MORE BIRTHS, GO TO 540.

540. ENTER LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1992 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 2 BIRTHS USE ADDITIONAL QUESTIONNAIRES)

541. LINE NUMBER FROM Q312.

LINE NUMBER_______

542. FROM Q312 AND Q316

NAME________
ALIVE (GO TO NEXT QUESTION)
DEAD (GO TO 542 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 565.)

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

YES, SEEN 1 (GO TO 545)
YES, NOT SEEN 2 (GO TO 547)
NO CARD 3

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

YES 1 (GO TO 547)
NO 2 (GO TO 547)

545. (1) COPY VACCINATION DATES FOR EACH VACCINE FROM THE CARD. (2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED.

BCG
DAY___
MONTH___
YEAR___
Polio 1
DAY___
MONTH___
YEAR___
Polio 2
DAY___
MONTH___
YEAR___
Polio 3
DAY___
MONTH___
YEAR___
Polio 4
DAY___
MONTH___
YEAR___
Polio 5
DAY___
MONTH___
YEAR___
Polio booster 1
DAY___
MONTH___
YEAR___
Polio booster 2
DAY___
MONTH___
YEAR___
Polio booster 3
DAY___
MONTH___
YEAR___
DPT 1
DAY___
MONTH___
YEAR___
DPT 2
DAY___
MONTH___
YEAR___
DPT 3
DAY___
MONTH___
YEAR___
DPT booster 1
DAY___
MONTH___
YEAR___
DPT booster 2
DAY___
MONTH___
YEAR___
DPT booster 3
DAY___
MONTH___
YEAR___
Measles 1
DAY___
MONTH___
YEAR___
Measles 2
DAY___
MONTH___
YEAR___
Hepatitis 1
DAY___
MONTH___
YEAR___
Hepatitis 2
DAY___
MONTH___
YEAR___
Hepatitis 3
DAY___
MONTH___
YEAR___

546. Has (NAME) received any vaccinations that are not recorded on this card? RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 1-5, DPT 1-3, AND/OR MEASLES VACCINE(S).

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 545)
NO 2 (GO TO 549)
DON'T KNOW 8 (GO TO 549)

547. Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases?

YES 1
NO 2 (GO TO 549)
DON'T KNOW (GO TO 549)

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

548A. A BCG vaccination against tuberculosis, that is, an injection in the left arm or shoulder that caused a scar?

YES 1
NO 2
DON'T KNOW 8

548B. Polio vaccine, that is, drops in the mouth?

YES 1
NO 2 (GO TO 548E)
DON'T KNOW 8 (GO TO 548E)

548C. How many times?

NUMBER OF TIMES____

548D. When was the first polio vaccine given, just after birth or later?

JUST AFTER BIRTH 1
LATER 2

548E. DPT vaccination, that is, an injection usually given at the same time as polio drops?

YES 1
NO 2 (GO TO 548G)
DON'T KNOW (GO TO 548G)

548F. How many times?

NUMBER OF TIMES_______

548G. An injection to prevent measles?

YES 1
NO 2
DON'T KNOW 8

549a. Has (NAME) been ill with a fever at any time in the last 2 weeks?

YES 1
NO 2
DON"T KNOW 8

549b. Has (NAME) been ill with measles?

YES 1
NO 2 (GO TO 550)
DON'T KNOW 8 (GO TO 550)

549c. How old was (NAME) when s/he had measles?

AGE______

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

YES 1
NO 2 (GO TO 554)
DON'T KNOW 8 (GO TO 554)

551. When (NAME) was ill with a cough, did he/she breathe faster than usual with short, fast breaths?

YES 1
NO 2
DON'T KNOW 8

552. Did you seek advice or treatment for the cough?

YES 1
NO 2 (GO TO 554)

553. Where did you seek advice or treatment? Anywhere else? RECORD ALL MENTIONED?

PUBLIC SECTOR
GOVT. HOSPITAL A
ROYAL MEDICAL SERVICES ARMED FORCES B
GOVT. HEALTH CENTER C
GOVT. HEALTH POST D
MOBILE CLINIC E
COMM. HEALTH WORKER F
OTHER PUBLIC__________G
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC H
PHARMACY I
PRIVATE DOCTOR J
MOBILE CLINIC K
COMM. HEALTH WORKER L
OTHER PRIVATE MEDICAL________M
OTHER SOURCE
SHOP N
TRAD. PRACTITIONER O
OTHER____________ X

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

YES 1
NO 2 (GO TO 564)
DON'T KNOW 8 (GO TO 564)

555. Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

556. On the worst day of the diarrhea, how many bowel movements did (NAME) have?

NUMBER OF BOWEL MOVEMENTS_____
DON'T KNOW 98

557. Was he/she given the same amount to drink as before the diarrhea, or more, or less?

SAME 1
MORE 2
LESS 3
DON'T KNOW 8

557A. CHECK 528: LAST CHILD STILL BREASTFED?

YES (GO TO 557B)
NO (GO TO 558)

557B. During (NAME)'s diarrhea, did you change the frequency of breastfeeding?

YES 1
NO 2 (GO TO 564)

557C. Did you increase the number of feeds, or reduce them, or did you stop completely?

INCREASED 1
REDUCED 2
STOPPED COMPLETELY 3

558. Was he/she given the same amount of food to eat as before the diarrhea, or more, or less?

SAME 1
MORE 2
LESS 3
DON'T KNOW 8

559. When (NAME) had diarrhea, was he/she given any of the following to drink?

A fluid made from a special packet called Aquacell or Paralait?
YES 1
NO 2
DK 8
Thin water gruel made from rice, carrots, wheat, etc.?
YES 1
NO 2
DK 8
Soup?
YES 1
NO 2
DK 8
Home-made sugar-salt-water solution?
YES 1
NO 2
DK 8
Milk or infant formula?
YES 1
NO 2
DK 8
Yoghurt-based drink?
YES 1
NO 2
DK 8
Water?
YES 1
NO 2
DK 8
Any other liquids?
YES 1
NO 2
DK 8

560. Was anything (else) given to treat the diarrhea?

YES 1
NO 2 (GO TO 562)
DON'T KNOW 8 (GO TO 562)

561. What was given to treat the diarrhea? Anything else? RECORD ALL MENTIONED.

PILL OR SYRUP A
INJECTION B
(I.V.) INTRAVENOUS C
HOME REMEDIES/HERBAL MEDICINES D
OTHER_________X

562. Did you seek advice for treatment for the diarrhea?

YES 1
NO 2 (GO TO 654)

563. Where did you seek advice or treatment? Anywhere else? RECORD ALL MENTIONED.

PUBLIC SECTOR
GOVT. HOSPITAL A
ROYAL MEDICAL SERVICES ARMED FORCES B
GOVT. HEALTH CENTER C
GOVT. HEALTH POST D
MOBILE CLINIC E
COMM. HEALTH WORKER F
OTHER PUBLIC__________G
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC H
PHARMACY I
PRIVATE DOCTOR J
MOBILE CLINIC K
COMM. HEALTH WORKER L
OTHER PRIVATE MEDICAL________M
OTHER SOURCE
SHOP N
TRAD. PRACTITIONER O
OTHER____________ X

564. GO BACK TO 542 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 565.

565. When a child has diarrhea, should he/she be given less to drink than usual, about the same amount, or more than usual?

LESS TO DRINK 1
ABOUT SAME AMOUNT TO DRINK 2
MORE TO DRINK 3
DON'T KNOW 8

566. When a child has diarrhea, should he/she be given less to eat than usual, about the same amount, or more than usual?

LESS TO EAT 1
ABOUT SAME AMOUNT TO EAT 2
MORE TO EAT 3
DON'T KNOW 8

567. When a child is sick with diarrhea, what signs of illness would tell you that he or she should be taken to a health facility or health worker? RECORD ALL MENTIONED.

REPEATED WATERY STOOLS A
ANY WATERY STOOLS B
REPEATED VOMITING C
ANY VOMITING D
FEVER E
MARKED THIRST G
NOT EATING/NOT DRINKING WELL H
GETTING SICKER/VERY SICK I
NOT GETTING BETTER J
OTHER________X
DON'T KNOW Z

568. When a child is sick with a cough, what signs of illness would tell you that he or she should be taken to a health facility or health worker? RECORD ALL MENTIONED.

FAST BREATHING A
DIFFICULT BREATHING B
NOISY BREATHING C
FEVER D
UNABLE TO DRINK E
NOT EATING/NOT DRINKING WELL F
GETTING SICKER/VERY SICK G
NOT GETTING BETTER H
OTHER_________X
DON'T KNOW Z

569. CHECK 559, ALL COLUMNS:

NO CHILD RECEIVED ORS (GO TO 570)
ANY CHILD RECEIVED ORS (GO TO 601)

570. Have you ever heard of a special product called Aquacell or Paralait you can get for the treatment of diarrhea?

YES 1
NO 2

SECTION 6. FERTILITY PREFERENCES

601. CHECK 413:

NEITHER STERILIZED (GO TO 602)
HE OR SHE STERILIZED (GO TO 611)

602. CHECK 327:

NOT PREGNANT OR UNSURE: 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?

PREGNANT: Now I have some questions about the future. After the child you are expecting now, would you like to have another child or would you prefer not to have any more children?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 606)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 606)
UNDECIDED/DON'T KNOW 8 (GO TO 604)

603. CHECK 327:

NOT PREGNANT OR UNSURE: How long would you like to wait before the birth of (a/another) child?

MONTHS 1 ____
YEARS 2 ____
SOON/NOW 993 (GO TO 606)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 606)
OTHER ________ 996
DON'T KNOW 998

PREGNANT: After the child you are expecting now, how long would you like to wait before the birth of another child?

MONTHS 1 ____
YEARS 2 ____
SOON/NOW 993 (GO TO 606)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 606)
OTHER ________ 996
DON'T KNOW 998

604. CHECK 327:

NOT PREGNANT OR UNSURE (GO TO 605)
PREGNANT (GO TO 607)

605. If you became pregnant in the next few weeks, would you be happy, unhappy, or would it not matter very much?

HAPPY 1
UNHAPPY 2
WOULD NOT MATTER 3

606. CHECK 412: USING A METHOD?

NOT ASKED (GO TO 607)
NOT CURRENTLY USING (GO TO 607)
CURRENTLY USING (GO TO 611)

607. Do you think you will use a method to delay or avoid pregnancy within the next 12 months?

YES 1 (GO TO 609)
NO 2
DON'T KNOW 8

608. Do you think you will use a method at any time in the future?

YES 1
NO 2 (GO TO 610)
DON'T KNOW 8 (GO TO 610)

609. Which method would you prefer to use? (AFTER ALL RESPONSES, GO TO 611)

PILL 01
IUD 02
INJECTIONS 03
IMPLANTS 04
DIAPHRAGM/FOAM/JELLY 05
CONDOM 06
FEMALE STERILIZATION 07
MALE STERILIZATION 08
PERIODIC ABSTINENCE 09
WITHDRAWAL 10
PROLONGED BREASTFEEDING 11
OTHER________ 96
UNSURE 98

610. What is the main reason that you think you will never use a method?

FERTILITY RELATED REASONS
INFREQUENT SEX 22
MENOPAUSAL/HYSTERECTOMY 23
SUBFECUND/INFECUND 24
WANTS MORE CHILDREN 25
OPPOSITION TO USE
RESPONDENT OPPOSED 31
HUSBAND OPPOSED 32
OTHER HH MEMBERS OPPOSED 33
OTHERS OPPOSED 34
RELIGIOUS PROHIBITION 35
RUMORS 36
LACK OF KNOWLEDGE
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER___________96
DON'T KNOW 98

611. CHECK 316:

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?

NUMBER_____
OTHER ________ 96 (GO TO 613)

NO LIVING CHILDREN: If you could choose exactly the number of children to have in your life, how many would that be?

NUMBER____
OTHER_________96 (GO TO 613)

612. How many of these children would you like to be boys, how many would you like to be girls and for how many would it not matter?

BOYS:
NUMBER___
OTHER _______ 96
GIRLS:
NUMBER___
OTHER _______ 96
EITHER:
NUMBER___
OTHER_______ 96

613. Would you say that you approve or disapprove of couples using a method to avoid getting pregnant?

APPROVE 1
DISAPPROVE 2
NO OPINION 3

614. Is it acceptable or not acceptable to you for information on family planning to be provided:

On the radio?
ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8
On the television?
ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 3

615. In the last six months have you heard about family planning:

On the radio?
YES 1
NO 2
On the television?
YES 1
NO 2
In a newspaper or magazine?
YES 1
NO 2
From a poster?
YES 1
NO 2
From leaflets or brochures?
YES 1
NO 2
From lectures?
YES 1
NO 2

616. From what sources do you receive information about family planning? (CIRCLE ALL RESPONSES MENTIONED) (PROBE: Any others?)

No source?
YES 1
NO 2
Government health worker?
YES 1
NO 2
Private doctor or nurse?
YES 1
NO 2
JAFPP staff?
YES 1
NO 2
Husband?
YES 1
NO 2
Friends/relatives?
YES 1
NO 2
Radio?
YES 1
NO 2
Television?
YES 1
NO 2
Print materials (newspapers, posters, etc.)
YES 1
NO 2
School, library or other academic source?
YES 1
NO 2
Community or public meetings?
YES 1
NO 2
Lectures?
YES 1
NO 2
Other, Specify ____________
YES 1
NO 2
Don't know?
YES 1
NO 2

617. CHECK 613:

YES, APPROVE FP (GO TO 617A)
NO, DISAPPROVE FP (GO TO 622)

617A. Where or from whom would you prefer to get information about family planning? (CIRCLE ONLY ONE ANSWER)

INTERPERSONAL:
GOVER'T HEALTH WORKER 01
PRIVATE DOCTOR OR NURSE 02
JAFPP STAFF 03
HUSBAND 04
OTHER RELATIVES 05
FRIENDS 06
MEDIA:
RADIO 07
TV 08
PRINT MATERIALS 09
SCHOOL, LIBRARY/ACADEMIC 10
COMMUNITY/PUBLIC MEETING 11
LECTURES 12
OTHER__________96
DON'T KNOW 98

618. In the last few months have you discussed the practice of family planning with your friends, neighbors, or relatives?

YES 1
NO 2 (GO TO 621)

619. With whom? Anyone else? RECORD ALL MENTIONED.

HUSBAND A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER F
MOTHER-IN-LAW G
FRIENDS/NEIGHBORS H
OTHER___________X

619A. Have you tried to encourage or persuade anyone to use family planning?

YES 1
NO 2

620. CHECK 202:

YES, CURRENTLY MARRIED (GO TO 621)
NO, NOT MARRIED (GO TO 701)

621. Spouses do not always agree on everything. Now I want to ask you about your husband's views on family planning. Do you think that your husband approves or disapproves of couples using a method to avoid pregnancy?

APPROVE 1
DISSAPROVE 2
DON'T KNOW 8

621A. In your opinion, who should make the decision whether to use a family planning method, your husband, you, or you and your husband?

HUSBAND 1
WOMAN 2
BOTH TOGETHER 3
DON'T KNOW 8

621B. In your family, who does make the decision whether to use a family planning method, your husband, you or you and your husband?

HUSBAND 1
WOMAN 2
BOTH TOGETHER 3
DON'T KNOW 8

622. How often have you talked to your husband about family planning in the past year?

NEVER 1
ONCE OR TWICE 2 (GO TO 622B)
MORE OFTEN 3
NOT APPLICABLE (GO TO 622B)

622A. Who usually starts the discussion about family planning, you or your husband?

WOMAN 1
HUSBAND 2
BOTH EQUALLY 3
OTHER_______4

622B. Do you approve or disapprove of these statements:

A. RELIGION: According to my religion family planning is permitted.

STRONGLY AGREE 1
AGREE 2
DISAPPROVE 3
STRONGLY DISAPPROVE 4
DON'T KNOW 8
NO RESPONSE 9

B. MOTHER'S HEALTH: Using family planning methods helps a mother regain her strength before having her next baby.

STRONGLY AGREE 1
AGREE 2
DISAPPROVE 3
STRONGLY DISAPPROVE 4
DON'T KNOW 8
NO RESPONSE 9

C. ECONOMICS: Having a small family will improve one's standard of living.

STRONGLY AGREE 1
AGREE 2
DISAPPROVE 3
STRONGLY DISAPPROVE 4
DON'T KNOW 8
NO RESPONSE 9

D. RELATIONSHIP TO PARTNERS: The use of family planning will bring the relationship of a couple closer.

STRONGLY AGREE 1
AGREE 2
DISAPPROVE 3
STRONGLY DISAPPROVE 4
DON'T KNOW 8
NO RESPONSE 9

E. CHILDREN'S HEALTH: Spacing out births protects the health of children.

STRONGLY AGREE 1
AGREE 2
DISAPPROVE 3
STRONGLY DISAPPROVE 4
DON'T KNOW 8
NO RESPONSE 9

622C. Do you think that the following people would approve or disapprove of you using a family planning method? (READ LIST)

Husband:
YES 1
NO 2
DK 8
NA 9
Mother:
YES 1
NO 2
DK 8
NA 9
Father:
YES 1
NO 2
DK 8
NA 9
Mother-in-law:
YES 1
NO 2
DK 8
NA 9
Father-in-law:
YES 1
NO 2
DK 8
NA 9
Your child:
YES 1
NO 2
DK 8
NA 9
Your friend:
YES 1
NO 2
DK 8
NA 9
Health care worker:
YES 1
NO 2
DK 8
NA 9
Your religious leader:
YES 1
NO 2
DK 8
NA 9
Local community leaders:
YES 1
NO 2
DK 8
NA 9
Other, specify:
YES 1
NO 2
DK 8
NA 9

623. 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

SECTION 7. HUSBAND'S BACKGROUND

701. CHECK 202:

CURRENTLY MARRIED (GO TO 702)
FORMERLY MARRIED/DIVORCED (GO TO 703)

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

AGE____

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

YES 1
NO 2 (GO TO 706)

704. What was the highest level of school he attended: basic, elementary, preparatory, vocational secondary, academic secondary, intermediate diploma, the university or higher studies?

ELEMENTARY 01
PREPARATORY 02
BASIC 03
VOCATIONAL SECONDARY 04
SECONDARY 05
INTERMEDIATE DIPLOMA 06
UNIVERSITY 07
HIGHER STUDIES 08
DON'T KNOW 98 (GO TO 706)

705. What was the highest (grade/form/year) he completed at that level?

GRADE___
DON'T KNOW 98

706. What is (was) your (last) husband's occupation? That is, what kind of work does (did) he mainly do?

SPECIFY___________________

707. CHECK 706:

WORKS (WORKED) IN AGRICULTURE (GO TO 708)
DOES (DID) NOT WORK IN AGRICULTURE (GO TO 709)

708. (Does/did) your husband/partner work mainly on his own land or on family land, or (does/did) he rent land, or (does/did) he work on someone else's land?

HIS LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4

709. Aside from your own housework, are you currently working?

YES 1 (GO TO 712)
NO 2

710. As you know, some women can take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business. Are you currently doing any of these things?

YES 1 (GO TO 712)
NO 2

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

YES 1
NO 2 (GO TO 726)

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

SPECIFY_______________

713. CHECK 712

WORKS IN AGRICULTURE (GO TO 714)
DOES NOT WORK IN AGRICULTURE (GO TO 715)

714. Do you work mainly on you own land or on family land, or do you rent land, or work on someone else's land?

OWN LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4

715. Do you do this work for a member of your family, for someone else, or are you self-employed?

FOR FAMILY MEMBER 1
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3

716. Do you usually work throughout the year, or do you work seasonally, or only once in a while?

THROUGHOUT THE YEAR 1 (GO TO 718)
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3 (GO TO 719)

717. During the last 12 months, how many months did you work?

NUMBER OF MONTHS__________

718. (In the months you worked,) How many days a week did you usually work?

NUMBER OF DAYS_____ (GO TO 720)

719. During the last 12 months, approximately how many days did you work?

NUMBER OF DAYS______

720. Do you earn cash for your work? PROBE: Do you make money for working?

YES 1
NO 2 (GO TO 723)

721. How much do you usually earn for this work? PROBE: Is this by the day, by the week, or by the month?

PER HOUR 1 DINAR______ PIASTRE_______
PER DAY 2 DINAR_______ PIASTRE_______
PER WEEK 3 DINAR______ PIASTRE_______
PER MONTH 4 DINAR______ PIASTRE_______
PER YEAR 5 DINAR______ PIASTRE_______
OTHER___________ 999996

722. CHECK 202:

YES, CURRENTLY MARRIED: Who mainly decides how the money will be used: you, your husband, you and your husband jointly, or someone else?

NO, NOT MARRIED: Who mainly decides how the money you earn will be used: you, someone else, or you and someone else jointly?

RESPONDENT DECIDES 1
HUSBAND DECIDES 2
JOINTLY WITH HER HUSBAND 3
SOMEONE ELSE DECIDES 4
JOINTLY WITH SOMEONE ELSE 5

723. Do you usually work at home or away from home?

HOME 1
AWAY 2

724. CHECK 316: IS A CHILD LIVING AT HOME WHO IS AGE 5 OR LESS?

YES (GO TO 725)
NO (GO TO 726)

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

RESPONDENT 01
HUSBAND 02
OLDER FEMALE CHILD 03
OLDER MALE CHILD 04
NEIGHBORS 05
FRIENDS 07
SERVANTS/HIRED HELP 08
CHILD IS IN SCHOOL 09
INSTITUTIONAL CHILDCARE 10
HAS NOT WORKED SINCE LAST BIRTH 95
OTHER_________96

726. Have you lived in only one community or in more than one community since January 1992?

ONE COMMUNITY 1
MORE THAN ONE COMMUNITY 2 (GO TO 728)

727. IN COLUMN 4 OF CALENDAR, ENTER THE APPROPRIATE CODE FOR CURRENT COMMUNITY, ('1' AMMAN, '2' ANOTHER CITY, '3' COUNTRYSIDE/VILLAGE, '4' OUTSIDE JORDAN). ALL PRECEDING MONTHS BACK TO JANUARY 1992. THEN SKIP TO 801

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

IN COLUMN 4 OF CALENDAR, ENTER 'X' IN THE MONTH AND YEAR OF THE MOVE. IN SUBSEQUENT MONTHS ENTER THE APPROPRIATE CODE FOR TYPE OF COMMUNITY, ('1' AMMAN, '2' ANOTHER CITY '3' COUNTRYSIDE/VILLAGE, '4' OUTSIDE JORDAN). CONTINUE PROBING FOR PREVIOUS COMMUNITIES, 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 Amman, a medium city, a small city, a town, or in the countryside?

SECTION 8. AIDS

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

YES 1
NO 2 (GO TO 901)

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

RADIO A
TV B
NEWSPAPERS/MAGAZINES C
PAMPHLETS/POSTERS D
HEALTH WORKERS E
LECTURES F
MOSQUES/CHURCHES G
SCHOOLS/TEACHERS H
COMMUNITY MEETINGS I
FRIENDS/RELATIVES J
WORK PLACE K

OTHER______ X

803. Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?

YES 1
NO 2 (GO TO 807)
DON'T KNOW 8 (GO TO 807)

804. What can a person do? Any other ways? RECORD ALL MENTIONED.

SAFE SEX A
ABSTAIN FROM SEX B
USE CONDOMS C
HAVE ONLY ONE SEX PARTNER D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH HOMOSEXUALS F
AVOID BLOOD TRANSFUSIONS G
AVOID INJECTIONS H
AVOID KISSING I
AVOID MOSQUITO BITES J
SEEK PROTECTION FROM TRADITIONAL HEALER K
OTHER ________W
OTHER ________X
DON'T KNOW Z

805. Is it possible for a healthy-looking person to have the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

806. Do you think that persons with AIDS almost never decease, sometimes die, or almost always die from the disease?

ALMOST NEVER 1
SOMETIMES 2
ALMOST ALWAYS 3
DON'T KNOW 8

807. Do you think your chances of getting AIDS are small, moderate, great, or no risk at all?

SMALL 1
MODERATE 2
GREAT 3
NO RISK AT ALL 4
HAS AIDS 5

SECTION 9. MATERNAL MORTALITY

901. Now I would like to ask you some questions about your brothers and sisters, that is, all of the children who were born to your natural mother, including those who are living with you, those living elsewhere, and those who have died. How many children did your mother give birth to, including yourself?

NUMBER OF BIRTHS TO NATURAL MOTHER _____
IF '01' OR ONLY CHILD (GO TO 915)

902. How many of these births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS____

903. What was the name given to your oldest (next oldest) brother or sister?

NAME______

904. Is (NAME) male or female?

MALE 1
FEMALE 2

905. Is (NAME) still alive?

YES 1
NO 2 (GO TO 907)
DON'T KNOW (GO BACK TO (NEXT OLDEST SIBLING))

906. How old is (NAME)?

AGE_____ (GO BACK TO (NEXT OLDEST SIBLING))

907. In what year did (NAME) die?

YEAR______

908. How old was (NAME) when he/she died?

AGE_____

(IF MALE OR DIED BEFORE 15 YEARS GO BACK TO NEXT OLDEST SIBLING)

909. Had (NAME) ever been married?

YES 1
NO 2 (GO BACK TO NEXT OLDEST SIBLING)

910. Was (NAME) pregnant when she died?

YES 1 (GO TO 913)
NO 2

911. Did (NAME) die during childbirth?

YES 1 (GO TO 913)
NO 2

912. Did (NAME) die within two months after the end of a pregnancy or birth?

YES 1
NO 2

913. Did (NAME) die due to complications of pregnancy or delivery?

YES 1
NO 2

914. How many children had (NAME) given birth to (before that pregnancy)?

NUMBER OF CHILDREN______

915. RECORD THE TIME.

HOUR _____
MINUTES____

SECTION 10. HEIGHT AND WEIGHT

1001. CHECK 315:

ONE OR MORE BIRTHS SINCE JAN. 1992 (GO TO 1002)
NO BIRTHS SINCE JAN. 1992 (END)

IN 1002 (COLUMNS 2 AND 3) RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY 1991 AND STILL ALIVE. IN 1003 AND 1004 RECORD THE NAME AND BIRTH DATE FOR THE RESPONDANT AND FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1992. IN 1006 AND 1008 RECORD HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN. (NOTE: ALL RESPONDENTS WITH ONE OR MORE BIRTHS SINCE JANUARY 1992 SHOULD BE WEIGHED AND MEASURED EVEN IF ALL OF THE CHILDREN HAVE DIED. IF THERE ARE MORE THAN 2 LIVING CHILDREN BORN SINCE JANUARY 1992, USE ADDITIONAL QUESTIONNAIRES).

1002. LINE NO. FROM Q. 312

LINE NO. _______

1003. NAME (FROM Q. 312 FOR CHILDREN)

NAME_______

1004. DATE OF BIRTH (FROM Q. 315, AND ASK FOR DAY OF BIRTH)

DAY____
MONTH____
YEAR_______

1005. BCG SCAR ON TOP LEFT SHOULDER

SCAR SEEN 1
NO SCAR 2

1006. HEIGHT (in centimeters)

HEIGHT_________

1007. WAS LENGTH/HEIGHT OF CHILD MEASURED LYING DOWN OR STANDING UP?

LYING 1
STANDING 2

1008. WEIGHT (in kilograms)

WEIGHT_______

1009. DATE WEIGHED AND MEASURED

DAY_____
MONTH_____
YEAR______

1010. RESULT

MEASURED 1
CHILD SICK 2
CHILD NOT PRESENT 3
CHILD REFUSED 4
MOTHER REFUSED 5
OTHER _______ 6

1011. NAME OF MEASURER_____________ NAME OF ASSISTANT______________

INTERVIEWER OBSERVATIONS

COMMENTS ABOUT RESPONDENT:
_________________________________________

COMMENTS ON SPECIFIC QUESTIONS:
_________________________________________

ANY OTHER COMMENTS:
_________________________________________

SUPERVISOR'S OBSERVATIONS
_________________________________________

NAME OF SUPERVISOR: ___________________
DATE: ____________

EDITOR'S OBSERVATIONS
__________________________________________

NAME OF EDITOR: ___________________
DATE: ____________

CALENDAR

INSTRUCTIONS:

ONLY ONE CODE SHOULD APPEAR IN ANY BOX.

FOR COLUMNS 1,3 AND 4, ALL MONTHS SHOULD BE FILLED IN.

INFORMATION TO BE CODED FOR EACH COLUMN

COL. 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE

B BIRTHS
P PREGNANCIES
T TERMINATIONS
0 NO METHOD
1 PILL
2 IUD
3 INJECTIONS
4 IMPLANTS
5 DIAPHRAGM/FOAM/JELLY
6 CONDOM
7 FEMALE STERILIZATION
8 MALE STERILIZATION
9 PERIODIC ABSTINENCE
A WITHDRAWAL
Y PROLONGED BREASTFEEDING
X OTHER___________

COL. 2: Discontinuation of Contraceptive Use

0 INFREQUENT SEX/HUSBAND AWAY
1 BECAME PREGNANT WHILE USING
2 WANTED TO BECOME PREGNANT
3 HUSBAND DISAPPROVED
4 WANTED MORE EFFECTIVE METHOD
5 HEALTH CONCERNS
6 SIDE EFFECTS
7 LACK OF ACCESS/TOO FAR
8 COST TOO MUCH
9 INCONVENIENT TO USE
F FATALISTIC
A DIFFICULT TO GET PREGNANT/MENOPAUSE
D MARITAL DISSOLUTION/SEPARATION
X OTHER__________
Z DON'T KNOW

COL. 3: Marriage

X MARRIED
0 NOT MARRIED

COL. 4: Moves and Types of Communities

X CHANGE OF COMMUNITY
1 AMMAN
2 ANOTHER CITY
3 COUNTRYSIDE/VILLAGE
4 OUTSIDE JORDAN