IDENTIFICATION

GROUP NO:__

QUESTIONNAIRE NO:___

GOVERNORATE:____

DISTRICT:____

SUBDISTRICT:____

LOCALITY:____

STRATUM:____

URBAN/RURAL:

BLOCK NO:_____

BUILDING NO:_____

HOUSING UNIT NO:_____

CLUSTER NO:_____

HOUSEHOLD NO:____

TELEPHONE NO (IF AVAILABLE):____________

NAME AND LINE NUMBER OF WOMAN: _______________

INTERVIEWER VISITS

FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT

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 2002
NAME
RESULT

TOTAL NUMBER OF VISITS

SUPERVISOR
NAME
DATE

FIELD EDITOR
NAME
DATE

OFFICE EDITOR

KEYED BY

SECTION 1. INTRODUCTION AND CONSENT

INFORMED CONSENT

Hello. My name is _____________ and I am working with THE DEPARTMENT OR STATISTICS. We are conducting a national survey about the health of women and children. We would very much appreciate your participation in this survey. I would like to ask you about your health (and the health of your children). This information will help the government to plan health services. The survey usually takes between 20 and 45 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.

Participation in this survey is voluntary and you can choose not to answer any individual questions or all of the questions. However, we hope that you will participate in this survey since your views are important.

At this time, do you want to ask me anything about the survey? May I begin the interview now?

Signature of Interviewer:__________________
Date:_________

101. RECORD THE TIME.

101A. What is your marital status now: are you married, widowed, divorced, or separated?

IF THE WOMAN IS NOT MARRIED, WIDOWED, DIVORCED, OR SEPARATED, END THE INTERVIEW, AND CORRECT MARITAL STATUS AND ELIGIBILITY IN THE HOUSEHOLD QUESTIONNAIRE

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

IF LESS THAN ONE YEAR RECORD '00' YEARS.

104. Just before you moved here, did you live in Amman City, in another city, in a separated camp, in a village, or outside Jordan?

105. In what month and year were you born?

106. How old were you at your last birthday?

COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

107. Have you ever attended school?

108. What is the highest level of school you attended: Old elementary, old preparatory, old secondary, new basic, new secondary, intermediate diploma, the university, or higher?

109. What is the highest grade you completed at that level?

114. How often do you read a Jordanian newspaper or magazine? Would you say: almost every day, 3-5 times a week, once or twice a week, once a month, few times a year, or never?

115. How often do you listen to the Jordanian radio? Would you say: almost every day, at least once a week, at least once a month, few times a year, or never?

116. How often do you watch the Jordanian television? Would you say: almost everyday, at least once a week, at least once a month, few times a year, or never?

117. What is your religion?

SECTION 2. REPRODUCTION

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

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

203. How many sons live with you?

And how many daughters live with you?

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

205. How many sons are alive but do not live with you?

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

206. Have you ever given birth to a boy or girl who was born alive but later died? IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

207. How many boys have died?

And how many girls have died?

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

209. CHECK 208:

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

210. CHECK 208:

211. Now I would like to record the names of all your births you have had during your marriage(s), whether still alive or not, starting with the first one you had.
RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

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

213. Were any of these births twins?

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

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

216. Is (NAME) still alive?

217. IF ALIVE: How old was (NAME) at his/her last birthday? RECORD AGE IN COMPLETED YEARS. IF LESS THAN 1 YEAR, RECORD '00'.

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

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

220. 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 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

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

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

223. COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:

224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 1997 OR LATER. IF NONE, RECORD '0'.

225. FOR EACH BIRTH SINCE JANUARY 1997, ENTER 'B' IN THE MONTH OF BIRTH IN COLUMN 1 OF THE CALENDAR, FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF THE PREGNANCY. (NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.) WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE.

226. Are you pregnant now?

227. 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 ND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

228. 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?

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

229A. The last time you had such pregnancy, did the pregnancy end in a miscarriage, an induced abortion, or a stillbirth?

230. When did the last such pregnancy end?

231. CHECK 230:

231A. Where did the last such pregnancy that ended in a (MISCARRIAGE/ABORTION/STILLBIRTH-FROM Q.229A) take place?

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

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.

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

234. ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH OF THE EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 1997.

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

235. Have you had any pregnancies that terminated before 1997 that did not result in a live birth?

236. When did the last such pregnancy that terminated before 1997 end?

237. When did your last menstrual period start?

238. From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant?

239. Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?

SECTION 3. CONTRACEPTION

Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid pregnancy.

CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302.

METHODS:

01=FEMALE STERILIZATION
02=MALE STERILIZATION
03=PILL
04=IUD
05=INJECTABLES
06=IMPLANTS
07=CONDOM
08=FEMALE CONDOM
09=DIAPHRAGM
10=FOAM OR JELLY
11=LACTATIONAL AMENORRHEA METHOD (LAM)
12=RHYTHM OR PERIODIC ABSTINENCE
13=WITHDRAWAL
14=EMERGENCY CONTRACEPTION
15=OTHER METHOD

301. Which ways or methods have you heard about?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?

302. Have you ever used (METHOD)?

303. CHECK 302:

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

305. ENTER '0' IN COLUMN 1 OF CALENDAR IN EACH BLANK MONTH (GO TO 328A)

306. What have you used or done?

CORRECT 302 AND 303 (AND 301 IF NECESSARY)

307. Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant. How many children did you have at that time, if any?

308. CHECK 302 (01):

309. CHECK 226:

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

311. Which method are you using?

312A. Why are you using (CURRENT METHOD)? Is it mainly for birth spacing, for limiting births, or for any other reason?

312B. Would you like to use a different method of family planning than the one you are currently using?

312C. Which method would prefer to use or to try?

312D. What is the main reason why you are not currently using your preferred method (MENTIONED IN 312C)?

312E. CHECK 311:

312F. Who inserted your IUD?

313. In what facility did the sterilization take place?
IF SOURCE IS HOSPITAL, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

314. CHECK 311:

CODE '01' CIRCLED: Before your sterilization operation, were you told that you would not be able to have any (more) children because of the operation?

CODE '01' NOT CIRCLED: Before the sterilization operation, was your husband told that he would not be able to have any (more) children because of the operation?

314A. Do you regret that (you/your husband) had the operation not to have any (more) children?

315B. Why do you regret the operation?

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

316A. For how long have you been using (CURRENT METHOD) now without stopping?
PROBE: In what month and year did you start using (CURRENT METHOD) continuously?

316B. CHECK 316/316A, 215, AND 230:

ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 316/316A:

317. CHECK 316/316A:

YEAR IS 1997 OR LATER: ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING ENTER METHOD SOURCE CODE IN COLUMN 2 OF CALENDAR IN MONTH STARTED USING (GO TO 318)

YEAR IS 1996 OR EARLIER: ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN COLUMN 1 OF CALENDAR AND EACH MONTH TO JANUARY 1997 (GO TO 327)

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

USE CALENDAR TO PROBE FOR EARLIER PERIODS OF PREGNANCY AS REFERENCE POINTS.

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

ILLUSTRATIVE QUESTIONS:
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 METHOD SOURCE CODE IN FIRST MONTH OF EACH USE.

ILLUSTRATIVE QUESTIONS:
Where did you obtain the method when you started using it?
Where did you get advice on how to use the method [for LAM, rhythm, or withdrawal]?

IN COLUMN 3, ENTER CODES FOR DISCONTINUATION NEXT TO LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 3 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1.

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

ILLUSTRATIVE QUESTIONS:
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 SUCH MONTH IN COLUMN 1

321. CHECK 311/311A: CIRCLE METHOD CODE:

322. You obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM CALENDAR) in (DATE). At that time, were you told about the side effects or problems you might have with the method?

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

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

325. CHECK 322:

CODE '1' CIRCLED: At that time, were you told about other methods of family planning that you could use?

CODE '1' NOT CIRCLED: When you obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM CALENDAR) in (DATE), were you told about other methods of family planning that you could use?

326. Were you ever told by a health or family planning worker about other methods of family planning that you could use?

327. CHECK 311/311A: CIRCLE METHOD CODE:

328. Where did you obtain (CURRENT 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.

328A. What is the main reason you are not using a method of contraception to avoid pregnancy?

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

330. Where is that? Any other place? RECORD ALL PLACES MENTIONED.

332. In the last 12 months, have you visited a health facility for care for yourself (or your children)?

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

SECTION 4A. PREGNANCY, POSTNATAL CARE, AND BREASTFEEDING

401. CHECK 224:

402. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1997 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES).

Now I would like to ask you some questions about the health of all your children born since January 1997. (We will talk about each separately)

403. LINE NUMBER FROM 212

404. FROM 212 AND 216

405. 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 not want to have any (more) children at all?

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

407. 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.

408. How many months pregnant were you when you first received antenatal care for this pregnancy?

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

410. CHECK 409:

411. How many months pregnant were you the last time you received antenatal care?

412. During this pregnancy, were any of the following done at least once?

413. Were you told about the signs of pregnancy complications?

414. Were you told to go if you had any of these complications?

415. During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?

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

417. During this pregnancy, were you given or did you buy any iron tablets or iron syrup?

418. During the whole pregnancy, for how many days did you take the tablets or syrup?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.

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

424. Was (NAME) weighed at birth?

425. How much did (NAME) weigh?
RECORD NAME FROM HEALTH CARD IF AVAILABLE.

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

PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.

IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

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

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.

428. Was (NAME) delivered by caesarian section?

428A. For the delivery of (NAME), who paid for most of the cost?

428B. Did anyone in the health facility talk to you or advise you about family planning after the delivery of (NAME)?

428C. After you left the health facility where you gave birth to (NAME), during the next months did you seek a health professional to check on your health?

429. After (NAME) was born, did a health professional check on your health?

429A. Why did not you seek a health professional check on your health after (NAME) was born?

(GO TO 434)

430. How many days or weeks after the delivery did the first check take place?

RECORD '00' DAYS IF SAME DAY.

431. Who checked on your health at the time?

PROBE FOR MOST QUALIFIED PERSON.

432. Where did this first check take place?

IF SOURCE IS A HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

432A. Did anyone in the health facility talk to you or advise you about family planning during the postnatal visit?

432B. CHECK 430: NUMBER OF DAYS/WEEKS AFTER DELIVERY:

432C. Why did you not seek earlier for health professional check on your health after (NAME) was born?

434. Has your period returned since the birth of (NAME)?

435. Did you period return between the birth of (NAME) and your next pregnancy?

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

437. CHECK 226: IS RESPONDENT PREGNANT?

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

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

440. Did you ever breastfeed (NAME)?

441. How long after birth did you first put (NAME) to the breast?

IF LESS THAN 1 HOUR, RECORD '00' HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS.

442. In the first three days after delivery, before your milk began flowing regularly, was (NAME) given anything to drink other than breast milk?

443. What was (NAME) given to drink before your milk began flowing regularly? Anything else?

RECORD ALL LIQUIDS MENTIONED.

444. CHECK 404: IS CHILD LIVING?

445. Are you still breastfeeding (NAME)?

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

447. CHECK 404: IS CHILD LIVING?

448. How many times did you breastfeed last night between sunset and sunrise?

IF ANSWER NOT IS NOT NUMERIC, PROBE FOR APPROXIMATE ANSWER.

449. How many times did you breastfeed yesterday during the daylight hours?

IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

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

451. Was sugar added to any of the foods or liquids (NAME) ate yesterday?

452. How many times did (NAME) eat solid, semisolid, or soft foods other than liquids yesterday during the day or at night?

IF 7 OR MORE TIMES, RECORD '7'

453. GO BACK TO 405 IN THE NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 454.

SECTION 4B. IMMUNIZATION, HEALTH, AND NUTRITION

454. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1997 OR LATER. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES).

455. LINE NUMBER FROM 212

456. FROM 212 AND 216

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

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

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

461. Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations received in a national immunization day campaign?

RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-4, POL. Booster 1, DPT 1-3, DPT Booster 1, HEPATITIS 1-3, Hib 1-3, MEASLES 1-2 AND/OR MMR VACCINE(S).

(GO TO 466)

462. Did (NAME) ever receive any vaccinations to prevent him/her from getting deseases, including vaccinations received in a national immunization day campaign?

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

463A. A BCG vaccination against tuberculosis, that is an injection in the arm or shoulder that usually causes a scar.

463B. Polio vaccine, that is, usually drops in the mouth or sometimes an injection given in the thigh.

463C. When was the first polio vaccine received, just after birth or later?

463D. How many times was the polio vaccine received?

463E. A DPT vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops to prevent diphtheria, pertusis, and tetanus.

463F. How many times?

463G. A vaccination to prevent Hepatitis, that is, an injection given sometimes at the same time as polio drops and DPT injection.

463H. How many times?

463I. A Hib vaccination, that is, an injection given sometimes at the same time as polio drops, DPT, and hepatitis to prevent meningitis.

463J. How many times?

463K. An injection to prevent measles.

463L. How many times?

463M. A MMR vaccination, that is, an injection given at the age of 18 months to prevent Measles, Mumps, and Rubella.

463N. CHECK 460 AND 463E: DPT INJECTION

463O. Where did (NAME) receive the first vaccination to prevent DPT?

463P. CHECK 460 AND 463F: DPT INJECTION

463Q. Where did (NAME) receive the second vaccination to prevent DPT?

463R. CHECK 460 AND 463F: DPT INJECTION

463S. Where did (NAME) receive the third vaccination to prevent DPT?

463T. CHECK 460 AND 463L: MEASLES INJECTION

463U. Where did (NAME) receive the first injection to prevent Measles?

463V. CHECK 460 AND 463L: MEASLES INJECTION

463W. Where did (NAME) receive the second injection to prevent Measles?

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

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

468. When (NAME) had an illness with a cough, did he/she breath faster than usual with short, fast breaths?

469. CHECK 466 AND 467: FEVER OR COUGH?

470. Did you seek advice or treatment for the fever/cough?

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

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.

475. Has (NAME) had diarrhea in the last 2 weeks?

476. Now I would like to know how much (NAME) was offered to drink during the diarrhea. Was he/she offered less than usual to drink, about the same amount, or more than usual to drink?

IF LESS, PROBE: Was he/she offered much less than usual or somewhat less?

477. When (NAME) had diarrhea, was he/she offered less than usual to eat, about the same amount, more than usual, or nothing to eat?

IF LESS, PROBE: Was he/she offered much less than usual to eat or somewhat less?

478. Was he or she given any of the following to drink:

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

480. What (else) was given to treat the diarrhea? Anything else? RECORD ALL TREATMENTS MENTIONED.

481. Did you seek advice or treatment for the diarrhea?

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

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.

483. GO BACK TO 456 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 486.

486. CHECK 478a, ALL COLUMNS:

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

488. CHECK 218:

489. When (your child/one of you children) is seriously ill, can you decide by yourself whether or not the child should be taken for medical treatment.

IF SAYS NO CHILD EVER SERIOUSLY ILL, ASK: If (your child/one of your children) became seriously ill, could you decide by yourself whether the child should be taken for medical treatment?

490. Now I would like to ask you some questions about medical care for you yourself.

Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem or not?

490A. Have you had a breast cancer self exam or an exam by a health specialist to detect breast cancer in the last twelve months?

491. CHECK 215 AND 218:

HAS AT LEAST ONE CHILD BORN IN 1997 OR LATER AND LIVING WITH HER (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER)

DOES NOT HAVE ANY CHILDREN BORN IN 1997 OR LATER AND LIVING WITH HER (GO TO 500)

492. Now I would like to ask you about liquids (NAME FROM Q. 491) drank over the last seven days, including yesterday.

How many days during last sevens days did (NAME FROM Q. 491) drink each of the following?

FOR EACH ITEM GIVEN AT LEAST ONCE IN THE LAST SEVEN DAYS, BEFOR PRECEDING TO THE NEXT ITEM, ASK:

In total, how many times yesterday during the day or at night did (NAME FROM Q. 491) drink (ITEM)?

IF 7 OR MORE TIMES, RECORD '7'. IF DON'T KNOW, RECORD '8'.

493. Now I would like to ask you about the types of foods (NAME FROM Q. 491) ate over the last seven days, including yesterday.

How many days during the last seven days did (NAME FROM Q. 491) eat each of the following foods either separately or combined with other food?

FOR EACH ITEM GIVEN AT LEAST ONCE IN LAST SEVEN DAYS, BEFORE PRECEDING TO THE NEXT ITEM, ASK:

In total, how many times yesterday during the day or at a night did (NAME FROM Q. 491) eat (ITEM)?

IF 7 OR MORE, RECORD '7'. IF DON'T KNOW, RECORD '8'.

SECTION 5. MARRIAGE

500. CHECK 101A

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

506. RECORD THE HUSBAND'S/PARTNER'S NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.

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

508. How many wives does he have?

510. Have you been married only once, or more than once?

511. CHECK 510

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

MARRIED 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)?

512. How old were you when you started living with him?

512A. Before you got married, was your [first] husband related to you in any way?

512B. What type of relationship was it?

513. DETERMINE MONTHS MARRIED SINCE JANUARY 1997. ENTER 'X' IN COLUMN 4 OF CALENDAR FOR EACH MONTH MARRIED, AND ENTER 'O' FOR EACH MONTH NOT MARRIED/NOT LIVING WITH A MAN, SINCE JANUARY 1997.

FOR WOMEN WITH MORE THAN ONE UNION: PROBE FOR DATE WHEN CURRENT UNION STARTED AND FOR STARTING AND TERMINATION DATES OF PREVIOUS UNIONS.

FOR WOMEN NOT CURRENTLY IN A UNION: PROBE FOR DATE WHEN LAST UNION STARTED AND FOR TERMINATION DATE AND FOR THE STARTING DATE AND TERMINATION DATES OF ANY PREVIOUS UNIONS.

513A. Did you and/or your husband have a premarital medical exam?

515. When was the last time you had sexual intercourse?

RECORD "YEARS AGO' ONLY IF LAST INTERCOURSE WAS ON OR MORE YEARS AGO. IF 12 MONTHS OR MORE, ANSWER MUST BE RECORDED IN YEARS.

516. The last time you had sexual intercourse, was a condom used?

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

525. Where is that? Any other place? (RECORD ALL SOURCES MENTIONED.)

IF SOURCE IS HOSPITAL, HEALTH CINTER, OR CLINIC, WRITE THE NAME OF THE PLACE, PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

SECTION 6. FERTILITY PREFERENCES

601. CHECK 311/311A:

602. CHECK 226:

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?

602A. Would you prefer to have a boy, a girl or does it not matter to you?

603. CHECK 226:

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

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

604. CHECK 226:

608. In the next few weeks, if you discovered that you were pregnant, would that be a big problem, a small problem, or no problem for you?

609. CHECK 310: USING A CONTRACEPTIVE METHOD?

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

611. Which contraceptive method would you prefer use?

611A. CHECK 611:

611B. Would you prefer to have the IUD inserted by a male or female health professional, or does it not matter to you?

612. What is the main reason that you think you will not use a contraceptive method at any time in the future?

614. CHECK 216:

HAS LIVING CHILDREN: If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?

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

PROBE FOR A NUMERIC RESPONSE

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

615A. How many children should a couple have before starting to use a contraceptive method?

PROBE FOR A NUMERIC RESPONSE

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

616A. CHECK 301 (01):

616B. Would you say that you approve or disapprove of woman using female sterilization to avoid getting pregnant?

616C. What is the main reason you disapprove women using female sterilization?

617. In the last 6 months have you heard about family planning:

618. CHECK 616:

618A. Where or from whom would you prefer to get information about family planning?

CIRCLE ONLY ONE ANSWER.

619. In the last 12 months, have you discussed there practice of family planning with your friends, neighbors, or relatives?

620. With whom? Anyone else? RECORD ALL PERSONS MENTIONED.

621. CHECK 101A:

622. CHECK 311/311A:

623. You have told me that you are currently using contraception. Would you say that using contraception is mainly your decision, mainly your husband's decision, or did you both decide together?

624. 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 contraceptive method to avoid pregnancy?

625. How often have you talk to your husband about family planning in the last 12 months?

626. CHECK 311/311A:

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

628. Husbands and wives do not always agree on everything. Please tell me if you think a wife is justified in refusing to have sex with her husband when:

628A. Were you ever encouraged to have more children by your mother or by your mother-in-law?

SECTION 7. HUSBAND'S BACKGROUND AND WOMAN'S WORK

701. CHECK 500:

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

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

704. What is the highest level of school he attended: Old elementary, old preparatory, old secondary, new basic, new secondary, intermediate diploma, the university, or higher?

705. What was the highest grade he completed at that level?

706A. CHECK 701

706B. Has you husband done any work in the last seven days, even for one hour? By "work", I mean any paid work, any work in a business completely or partially owned by your husband, any work in a business owned by the household without payment, or work in other business?

706C. Does your husband have any job, but he did not practice it during the last seven days for a reason such as vacation, travel, or illness?

706D. What is your husband's current occupation, that is, what kind of work does he mainly do?

706E. What is your husband's employment status: is he an employee, an employer, is he self-employed, is he working for his family without payment, or is he working for someone else without payment?

709A. Have you done any work in the last seven days, even for one hour? By "work", I mean any paid work, any work in a business completely or partially owned by yourself, any work in a business owned by the household without payment, or work in other business?

709B. Do you have any job, but you did not practice it during the last seven days for a reason such as vacation, travel, or illness?

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

710A. What is your employment status: are you an employee, an employer, are you self-employed, are you working for someone else without payment?

717. Who mainly decides how the money you earn will be used?

718. On average, how much of your houlsehold's expenditures do your earnings pay for: almost none, less than half, about half, more than half, or all?

719. Who in your family usually has the final say on the following decisions:

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

721. Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

721A. Besides the situations we just have mentioned, in your opinion, are there any other situations in which a husband is justified in hitting or beating his wife? IF YES: In what situation?

721B. Do you smoke:

721C. CHECK 701:

721D. Does your husband smoke?

SECTION 8. AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES

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

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

803. What can a person do? Anything else? RECORD ALL WAYS MENTIONED.

804. Can people reduce there chances of getting the AIDS virus by having just one sex partner who has no other partners?

805. Can a person get the AIDS virus from mosquito bites?

806. Can people reduce their chances of getting the AIDS virus by using a condom every time they have sex?

807. Can people get the AIDS virus by sharing food with a person who has AIDS?

808. Can people protect themselves from getting the AIDS virus by not having sex at all?

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

810. Do you know someone personally who has the virus that causes AIDS or someone who has died from AIDS?

811. Can the virus that causes AIDS be trasmitted from a mother to a child?

812. Can the virus that causes AIDS be transmitted from a mother to a child:

813. CHECK 500:

814. Have you ever talked about ways to prevent getting the virus that causes AIDS with your husband?

815. If a member of your family got infected with the virus that causes AIDS, would you want it to remain a secret or not?

816. If a relative of yours became sick with the virus that causes AIDS, would you be willing to care for her or him in your own household?

817. Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

818. If a man has a sexually transmitted disease, what symptoms might he have? Any others? RECORD ALL SYMPTOMS MENTIONED.

819. If a woman has a sexually transmitted disease, what symptoms might she have?

820. RECORD THE TIME.

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT:

_________________________

COMMENTS ON SPECIFIC QUESTIONS:

_________________________

ANY OTHER COMMENTS:

_________________________

SUPERVISOR'S OBSERVATIONS:

_________________________

NAME OF SUPERVISOR:________________

DATE:_________

EDITOR'S OBSERVATIONS:

______________________

NAME OF EDITOR:
__________________

DATE:
__________

INSTRUCTIONS:
ONLY ONE CODE SHOULD APPEAR IN ANY BOX.
FOR COLUMNS 1 AND 4, ALL MONTHS SHOULD BE FILLED IN.

INFORMATION TO BE CODED FOR EACH COLUMN

COLUMN 1: BIRTHS, PREGNANCIES, CONTRACETIVE USE

B=BIRTHS
P=PREGNANCIES
T=TERMINATIONS

0=NO METHOD
1=FEMALE STERILIZATION
2=MALE STERILIZATION
3=PILL
4=IUD
5=INJECTABLES
6=IMPLANTS
7=CONDOM
8=FEMALE CONDOM
9=DIAPHRAGM
J=FOAM OR JELLY
K=LACTATIONAL AMENORRHEA METHOD
L=PERIODIC ABSTINENCE
M=WITHDRAWAL
X=OTHER____________

COLUMN 2: SOURCE OF CONTRACEPTION

1=GOVT. HOSPITAL
2=GOVT. HEALTH CENTER
3=GOVT. MCH
4=UNIVERSITY HOSPITAL
5=ROYAL MEDICAL SERVICES
6=MOBILE CLINIC
7=OTHER PUBLIC
8=PVT. HOSPITAL/CLINIC
9=PRIVATE DOCTOR
A=PHARMACY
B=JAFPP
C=UNRWA
D=OTHER NGO
E=OTHER PRIVATE
F=FRIENDS/RELATIVES
X=OTHER___________

COLUMN 3: DISCONTINUATION OF CONTRACEPTIVE USE

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

COLUMN 4: MARRIAGE

X=MARRIED
0=NOT MARRIED