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The Hashemite Kingdom of Jordan
JORDAN POPULATION AND FAMILY HEALTH INTERIM SURVEY 2009

WOMEN'S QUESTIONAIRE

Survey Contents Confidential by Statistical Law

INDENTIFICATION

QUESTIONNAIRE No.: _____

GOVERNORATE: __________

DISTRICT: _________

SUB-DISTRICT: ________

LOCALITY: ________

AREA: ________

SUB-AREA: ________

STRATUM: ________

URBAN/RURAL

Urban 1
Rural 2

BLOCK No.: ___

BUILDING No.: ___________

HOUSING UNIT No.: __________

CLUSTER No: __________

HOUSEHOLD No.: ____________

TELEPHONE/MOBILE No. (if available)
____________________

NAME AND LINE NUMBER OF WOMAN: ______________________ ____

INTERVIEWER VISITS:

FIRST VISIT
DATE _______
INTERVIEWER NAME _______
RESULT* ________

NEXT VISIT:
DATE ________
TIME ________

SECOND VISIT
DATE _______
INTERVIEWER NAME _______
RESULT* _______

NEXT VISIT:
DATE _______
TIME _______

THIRD VISIT
DATE _______
INTERVIEWER NAME _______
RESULT* _______

FINAL VISIT
DAY _______
MONTH _______
YEAR 2009
INT. NUMBER _______
RESULT* _______

TOTAL NUMBER OF VISITS

*RESULT CODES

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

SUPERVISOR
NAME _____________

FIELD EDITOR
NAME _____________

OFFICE EDITOR
_____________

KEYED BY
_____________

INTRODUCTION AND CONSENT

INFORMED CONSENT

Hello. My name is __________________ and I am working with the Department of Statistics. We are conducting a national survey that asks women about the health of women and their children. We would very much appreciate your participation in this survey. This information will help the government to plan health services. The interview usually takes about 40 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shared with anyone other than members of our survey team.

Participation in this survey is voluntary, and if we should come to any question you don't want to answer, just let me know and I will go on to the next question; or you can stop the interview at any time. 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: _________

RESPONDENT AGREES TO BE INTERVIEWED 1
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

NO. 101) RECORD THE TIME.

HOUR ____
MINUTE____

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

IF THIS WOMAN IS NOT MARRIED, WIDOWED, DIVORCED, OR SEPARTED, END THE INTERVIEW, AND CORRECT MARITAL STATUS AND ELIGIBILITY IN THE HOUSEHOLD QUESTIONAIRE.

MARRIED 1
DIVORCED 2
WIDOWED 3
SEPARATED 4
NEVER MARRIED 5 (END)

104) In what month and year were you born?

MONTH __
DK MONTH 98
YEAR ____
DK YEAR 9998

105) How old were you at your last birthday?

COMPARE AND CORRECT 104 AND/OR 105 IF INCONSISTENT.

AGE IN COMPLETED YEARS __

106) Have you ever attended school?

YES 1
NO 2 (GO TO 201)

107) What is the highest level of school you attended: Old elementary, old preparatory, old secondary, new basic, new secondary, intermediate diploma, bachelor, or higher?

OLD SYSTEM
ELEMENTARY 1
PREPARATORY 2
SECONDARY 3
NEW SYSTEM
BASIC 4
SECONDARY 5
INTERMEDIATE DIPLOMA6
BACHELOR 7
HIGHER 8

108) What is the highest grade you completed at that level?

GRADE __

SECTION 2. REPRODUCTION

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

YES 1
NO 2 (SKIP TO 206)

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

YES 1
NO 2 (SKIP 204)

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

SONS ELSEWHERE __
DAUGHTERS ELSEWHERE __

204) 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 (SKIP TO 206)

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

SONS ELSEWHERE ____
DAUGHTERS ELSEWHERE ____

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?

YES 1
NO 2 (SKIP TO 208)

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

BOYS DEAD __
GIRLS DEAD __

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

TOTAL ___

209) CHECK 208:

Just to make sure that I have this right: you have had in TOTAL ____ births during your life. Is that correct?
YES (CONTINUE)
NO (PROBE AND CORRECT 201-208 AS NESSARY)

210) CHECK 208:

ONE OR MORE BIRTHS (CONTINUE)
NO BIRTHS (SKIP 226)

211) 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 BIRTHS IN 212. RECORD TWINS AD TRIPLETS ON SEPARATE LINES. (IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW).

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

BIRTH HISTORY NUMBER__
(NAME)______________________

213) Were any of these births twins?

SINGULAR 1
MULTIPLE 2

214) Is (NAME) a boy or girl?

BOY 1
GIRL 2

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

MONTH __
YEAR ____

216) Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

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

AGE IN YEARS __

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

YES 1
NO 2

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

LINE NUMBER __ (NEXT BIRTH)

220) IF DEAD: How old was (NAME) when he/she died? IF '1 YEAR', PROBE: How many months old was (NAME)? RECORD DAYS IF LESS THAN 1 MONTH: MONTHS IF LESS THAN TWO YEARS: OR YEARS

DAYS 1 _____
MONTHS 2 _____
YEARS 3 ______

221) Were there any other live births between (NMAE OF PREVIOUS BIRTH) and (NAME), including any children who died after birth?
DON'T ASK THIS QUESTION UNTIL SECOND CHILD.

YES 1 (ADD BIRTH)
NO 2 (NEXT BIRTH)

222) Have you had any live births since the birth of (NMAE OF LAST BIRTH)? IF YES, RECORD BIRTH(S) IN TABLE.

YES 1
NO 2

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

NUMBERS ARE SAME
CHECK: FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED.
FOR EACH BIRTH SINCE JANUARY 2004: MONTH AND YEAR OF BIRTH ARE 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 YEAR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS.
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

224) CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 2004 OR LATER. IF NONE, RECORD '0' AND SKIP TO 226

_____

225) FOR EACH BIRTH SINCE JANUARY 2004 ENTER 'B' IN THE MONTH OF BIRTH IN COLUMN 1 OF THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. 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 PREGNANCY. (NOTE: THE NUMBER OF 'P'S MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)

226) Are you pregnant now?

YES 1
NO 2 (SKIP TO 229)
UNSURE 8 (SKIP TO 229)

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

MONTHS ___

228) At the time you became pregnant, did you want to become pregnant then, did you want to wait till later, or did you not want to have any (more) children at all?

THEN 1
LATER 2
NOT AT ALL 3

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

YES 1
NO 2 (SKIP TO 237)

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

MISCARRIAGE 1
INDUCED ABORTION 2
STILL BIRTH 3

230) When did the last such pregnancy end?

MONTH __
YEAR_____

231) CHECK 230:

LAST PREGNANCY ENDED IN JANUARY 2004 OR LATER (CONTINUE)
LAST PREGNANCY ENDED BEFORE JANUARY 2004 (SKIP TO 237)

232) How many months pregnant were you when the last such pregnancy ended? RECORD NUMBER OF COMPLETED MONTHS. ENTER 'T' IN COLUMN 1 OF THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

NUMBER OF MONTHS ___

233) Since January 2004, have you had any other pregnancies that did not result in a live birth?

YES 1
NO 2 (SKIP TO 235)

233A) Since January 2004, how many other pregnancies that did not result in a live birth have you had?

NUMBER OF PREGNANCIES __

234) ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2004.

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

235) Did you have any miscarriages, abortions, or stillbirths that ended before 2004?

YES 1
NO 2 (SKIP TO 237)

236) When did the last such pregnancy that terminated before 2004 end?

MONTH __
YEAR ____

237) When did your last menstrual period start?

(DATE, IF GIVEN) ________
DAYS AGO 1 __
WEEKS AGO 2__
MONTHS AGO 3 __
YEARS AGO 4 __
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

SECTION 3. CONTRACEPTION

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

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

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.

1) FEMALE STERILIZATION. Women can have an operation to avoid having any more children.
YES 1
NO 2
2) MALE STERILIZATION. Men can have an operation to avoid having any more children.
YES 1
NO 2
3) PILL. Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
4) IUD. Women can have a loop or coil placed inside them by a doctor or a midwife.
YES 1
NO 2
5) INJECTABLES. Women can have an injection by a health provider that stops them from becoming pregnant usually for 3 months.
YES 1
NO 2
6) IMPLANTS. Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy usually for 3 years.
YES 1
NO 2
7) CONDOM. Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
8) FEMALE CONDOM. Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
9) LACTATIONAL AMENORRHEA METHOD (LAM)
YES 1
NO 2
10) PERIODIC ABSTINENCE. Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
11) WITHDRAWL. Man can be careful and pull out before climax
YES 1
NO 2
12) EMERGENCY CONTRACEPTION. As an emergency measure after unprotected sexual intercourse, women can take special pills at any time within five days to prevent pregnancy.
YES 1
NO 2
13) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1 (SPECIFY) ________
NO 2

302) Have you ever used (METHOD)?

1) Have you ever had an operation to avoid having any more children?
YES 1
NO 2
2) Have you ever had a husband who had an operation to avoid having any more children?
YES 1
NO 2
3) Have you ever used the pill?
YES 1
NO 2
4) Have you ever used an IUD?
YES 1
NO 2
5) Have you ever used an injectable?
YES 1
NO 2
6) Have you ever used an implant?
YES 1
NO 2
7) Have you ever used a condom?
YES 1
NO 2
8) Have you ever used a female condom?
YES 1
NO 2
9) Have you ever used a lactational amenorrhea method (lam)?
YES 1
NO 2
10) Have you ever used periodic abstinence?
YES 1
NO 2
11) Have you ever used withdrawal?
YES 1
NO 2
12) Have you ever used emergency contraception?
YES 1
NO 2
13) Have you tried any of these methods you have heard of, but it was not listed?
YES 1
NO 2

303) CHECK 302:

NOT A SINGLE "YES" (NEVER USED) (CONTINUE)
AT LEAST ONE "YES" (EVER USED) (SKIP TO 307)

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

YES 1 (SKIP 306)
NO 2

305) ENTER '0' IN COLUMN 1 OF THE CALENDAR IN EACH BLANK MONTH. (SKIP TO 401)

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 living children did you have at that time, if any? IF NONE, RECORD '00'.

NUMBER OF CHILDREN ____

308) CHECK 302 (01):

WOMAN NOT STERILIZED
WOMAN STERILIZED (SKIP TO 311A)

309) CHECK 226:

NOT PREGNANT OR UNSURE
PREGNANT (SKIP TO 322)

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

YES 1
NO 2 (SKIP TO 322)

311) Which method are you using? CIRCLE ALL MENTIONED.
IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION A
MALE STERILIZATION B
PILL C (SKIP TO 319A)
IUD D (SKIP TO 319A)
INJECTABLES E (SKIP TO 319A)
IMPLANTS F (SKIP TO 319A)
COMDOM G (SKIP TO 319A)
FEMALE CONDOM H (SKIP TO 319A)
DIAPHRAGM I (SKIP TO 319A)
FOAM/JELLY J (SKIP TO 319A)
LACTATIONAL AMEN. METHOD K (SKIP TO 319A)
PERIODIC ABSTINENCE L (SKIP TO 319A)
WITHDRAWL M (SKIP TO 319A)
OTHER (SPECIFIY) ________ X (SKIP TO 319A)

311A) CIRCLE 'A' FOR FEMALE STERILIZATION

316) In what facility did the sterilization take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

PUBLIC MEDICAL SECTOR
GOVERNMENT HOSPITAL 11
UNIVERSITY HOSPITAL 12
ROYAL MEDICAL SERVICES 13
OTHER PUBLIC (SPECIFY) _________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
OTHER PRIVATE MEDICAL(SPECIFY) _________ 26
DON'T KNOW 98

IF UNABLE TO DETERMINE HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)_________________

319) In what month and year was the sterilization performed?

MONTH ______
YEAR _______

319A) Since what month and year have you been using (CURRENT METHOD) without stopping?
PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

MONTH _______
YEAR _______

320) CHECK 319/319A, 215 AND 230:

ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OR USE OF CONTRACEPTION IN 319/319A

YES (GO BACK TO 319/319A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION)).
NO

321) CHECK 319/319A: YEAR IS 2004 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

YEAR IS 2003 OR EARLIER

ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND EACH MOTH BACK TO JANUARY 2004 THEN SKIP TO 331

322) 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 USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2004.
USE NAMES OF CHILDREN, DATES OR BIRTH, AND PERIODS OR 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 CODES FOR DISCONTINUATION NEXT TO LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 2 MUST BE THE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USER 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

331) CHECK 311/311A:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION 01 (SKIP TO 401)
MALE STERILIZATION 02 (SKIP TO 401)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
COMDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMEN. METHOD 11 (SKIP TO 401)
PERIODIC ABSTINENCE 12 (SKIP TO 401)
WITHDRAWL 13 (SKIP TO 401)
OTHER (SPECIFIY) ________ 96 (SKIP TO 401)

322) Where did you obtain (CURRENT METHOD) the last time?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

PUBLIC MEDICAL SECTOR
GOVERNMENT HOSPITAL 11 (SKIP TO 401)
GOVERNMENT HEALTH CENTER 12 (SKIP TO 401)
GOVERNMENT MCH 13 (SKIP TO 401)
UNIVERSITY HOSPITAL /CLINIC 14 (SKIP TO 401)
ROYAL MEDICAL SERVICES 15 (SKIP TO 401)
OTHER PUBLIC (SPECIFY)________ 16 (SKIP TO 401)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21 (SKIP TO 401)
PRIVATE DOCTOR 22 (SKIP TO 401)
PHARMACY 23 (SKIP TO 401)
JORDANIAN AS. OF FP AND PROTECTION (JAFPP) 24 (SKIP TO 401)
UNRWA CLINIC 25 (SKIP TO 401)
OTHER NON-GOVERNMENT ORGANIZATION 26 (SKIP TO 401)
OTHER PRIVATE MEDICAL (SPECIFY) _________ 27 (SKIP TO 401)
OTHER SOURCE
FRIEND/RELATIVE 33 (SKIP TO 401)
OTHER (SPECIFY) ___________ 96 (SKIP TO 401)

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ____________

SECTION 4. PREGNANCY AND POSTNATAL CARE

401) CHECK 224:

ONE OR MORE BIRTHS IN 2004 OR LATER
NO BIRTHS IN 2004 OR LATER (SKIP TO 601)

402) CHECK 215: ENTER IN THE TABLE THE LINE NUMBER, AND SURVIVAL STATUS OF EACH BIRTH IN 2004 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

Now I would like to ask you some questions about the health of all your children born in the last five years. (We will talk about each separately.)

403) LINE NUMBER FROM 212

_______ BIRTH

LINE NUMBER ______

404) FROM 212 AND 216

NAME __________

LIVING
DEAD

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?

THEN 1 (SKIP TO 426)
LATER 2
NOT AT ALL 3 (SKIP TO 426)

406) How much longer would you have liked to wait?

MONTH 1 ______
YEARS 2 _______
DON'T KNOW 998

426) 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

427) Was (NAME) weighed at birth?

YES 1
NO 2 (SKIP TO 448)
DON'T KNOW 8 (SKIP TO 448)

428) How much did (NAME) weight?
RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.

KG FROM CARD 1 _.___
KG FROM RECALL 2 _.___
DON'T KNOW 99998

448) Has your menstrual period returned since the birth of (NAME)?

YES 1 (SKIP TO 450)
NO 2 (SKIP TO 451)

449) Did your period return between the birth of (NAME) and your next pregnancy?
SKIP THIS QUESTION FOR THE LAST BIRTH

YES 1
NO 2 (SKIP TO 453)

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

MONTHS __
DON'T KNOW 98

451) CHECK 226: IS RESPONDENT PREGNANT?

NOT PREGNANT
PREGNANT OR UNSURE (SKIP TO 453)

452) Have you begun to have sexual intercourse again since the birth of (NAME)?

YES 1
NO 2 (SKIP TO 454)

453) For how many months after the birth of (NAME) did you not have sexual intercourse?
IF LESS THAN 1 MONTH, RECORD '00'.

MONTHS __
DON'T KNOW 98

454) Did you ever breastfeed (NAME)?

YES 1
NO 2 (SKIP TO 465)

455) 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.

IMMEDIATELY 000
HOURS 1 ___
DAYS 2 __

456) In the first three days after delivery, was (NAME) given anything to drink other than breast milk?

YES 1
NO 2 (SKIP TO 458)

457) What was (NAME) given to drink?
Anything else?
RECORD ALL LIQUIDS MENTIONED.

MILK (OTHER THAN BREAST MILK) A
PLAIN WATER B
SUGAR OR GLUCOSE WATER C
GRIPE WATER D
SUGAR-SALT-WATER SOLUTION E
FRUIT JUICE F
INFANT FORMULA G
TEA/INFUSIONS H
HONEY I
OTHER(SPECIFY) _______ X

458) CHECK 404: IS THE CHILD LIVING?

LIVING
DEAD (SKIP TO 460)

459) Are you still breastfeeding (NAME)?

YES 1 (SKIP TO 465)
NO 2

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

MONTHS __
DON'T KNOW 98

465) GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 601.

SECTION 6. MARRIAGE AND SEXUAL ACTIVITY

601) CHECK 101A:

CURRENTLY MARRIED
WIDOWED/SEPARATED/DIVORCED (SKIP TO 606)

602) Is your husband living with you now or is he staying elsewhere?

LIVING WITH HER 1
STAYING ELSEWHERE 2

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

NAME ____

LINE NUMBER __

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

YES 1
NO 2 (SKIP TO 606)

605) Including yourself, in total, how many wives does your husband have?

TOTAL NUMBER OF WIVES _
DON'T KNOW 8

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

ONLY ONCE 1
MORE THAN ONCE 2

607) CHECK 606:

MARRIED ONLY ONCE

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

MARRIED MORE THAN ONCE

Now I would like to ask about your first husband. In what month and year did you start living with him(consummate marriage)?
MONTH __
DON'T KNOW MONTH 98
YEAR ____ (SKIP TO 612)
DON'T KNOW YEAR 9998

608) How old were you when you first started living with him?

AGE ___

612) When was the last time you had sexual intercourse?

IN LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS.
IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO 1 ___
WEEKS AGO 3 ___
MONTHS AGO 2 ___
YEARS AGO 4 ____ (SKIP TO 700)

613) The last time you had sexual intercourse, was a condom used?

YES 1
NO 2

SECTION 7. FERTILITY PREFERENCES

700) CHECK 101A:

CURRENTLY MARRIED
CURRENTLY WIDOWED, DIVORCED, OR SEPARATED (SKIP TO 713)

701) CHECK 311/311A:

NEITHER STERILIZED
HE OR SHE STERILIZED (SKIP TO 713)

702) 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?
HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (SKIP TP 704)
SAYS SHE CAN'T GET PREGNANT 3 (SKIP TP 713)
UNDECIDED/DON'T KNOW AND PREGNANT 4 (SKIP TO 709)
UNDECIDED/ DON'T KNOW AND NOT PREGNANT OR UNSURE 5 (SKIP TO 708)

703) CHECK 226:

NOT PREGNANT OR UNSURE

How long would you like to wait from now 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?
MONTHS 1 __
YEARS 2 __
SOON/NOW 993 (SKIP TO 708)
SAYS SHE CAN'T GET PREGNANT 994 (SKIP TO 713)
OTHER (SPECIFY) ____________ 996 (SKIP TO 708)
DON'T KNOW 998 (SKIP TO 708)

704) CHECK 226:

PREGNANT OR UNSURE
PREGNANT (SKIP TO 709)

705) CHECK 310: USING A CONTRACEPTIVE METHOD?

NOT ASKED
NOT CURRENTLY USING
CURRENTLY USING (SKIP TO 713)

706) CHECK 703:

NOT ASKED
24 OR MORE MONTHS OR 02 OR MORE YEARS
00-23 MONTHS OR 00-01 YEAR (SKIP TO 709)

707) CHECK 702 AND 703:

WANTS TO HAVE A/ANOTHER CHILD BUT NOT BEFORE 2 YEARS

You have said that you do not want (a/another) child soon, but you are not using any method to avoid pregnancy.

Can you tell me why you are not using a method?

Any other reason?

RECORD ALL REASONS MENTIONED.

WANTS NO MORE/NONE

You have said that you do not want any (more) children, but you are not using any method to avoid pregnancy.

Can you tell me why you are not using a method?

Any other reason?

RECORD ALL REASONS MENTIONED.

FERTILITY-RELATED REASONS
NOT HAVING SEX A
INFREQUENT SEX B
MENOPAUSAL/HYSTERECTOMY C
SUBFECUND/INFECUND D
POSTPARTUM AMENORRHEIC E
BREASTFEEDING F
DIFFICULT TO GET PREGNANT G
OPPPOSITION TO USE
RESPONDENT OPPOSED H
HUSBAND OPPOSED I
OTHERS OPPOSED J
RELIGIOUS PROHIBITION K
RUMORS L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
HEALTH CONCERNS O
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COSTS TOO MUCH R
INCONVIENT TO USE S
INTERFERES WITH BODY'S NORMAL PROCESSES T
OTHER(SPECIFY) _________ X
DON'T KNOW Z

708) CHECK 310: USING A CONTRACEPTIVE METHOD?

NOT ASKED
NO, NOT CURRENTLY USING
YES, CURRENTLY USING (SKIP TO 713)

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

YES 1
NO 2 (SKIP TO 711)
DON'T KNOW 8 (SKIP TO 713)

710) Which contraceptive method would you prefer to use?

FEMALE STERILIZATION 01 (SKIP TO 713)
MALE STERILIZATION 02 (SKIP TO 713)
PILL 03 (SKIP TO 713)
IUD 04 (SKIP TO 713)
INJECTABLES 05 (SKIP TO 713)
IMPLANTS 06 (SKIP TO 713)
COMDOM 07 (SKIP TO 713)
FEMALE CONDOM 08 (SKIP TO 713)
DIAPHRAGM 09 (SKIP TO 713)
FOAM/JELLY 10 (SKIP TO 713)
LACTATIONAL AMEN. METHOD 11 (SKIP TO 713)
PERIODIC ABSTINENCE 12 (SKIP TO 713)
WITHDRAWL 13 (SKIP TO 713)
OTHER (SPECIFIY) ________ 96 (SKIP TO 713)
DK/UNSURE 98 (SKIP TO 713)

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

FERTILITY-RELATED REASONS
INFREQUENT SEX/ NO SEX 11
MENOPAUSAL/HYSTERECTOMY 12
SUBFECUND/INFECUND 13
WANTS AS MANY CHILDREN AS POSSIBLE 14
OPPPOSITION TO USE
RESPONDENT OPPOSED 21
HUSBAND OPPOSED 22
OTHERS OPPOSED 23
RELIGIOUS PROHIBITION 24
RUMORS 25
LACK OF KNOWLEDGE
KNOWS NO METHOD 31
KNOWS NO SOURCE 32
METHOD-RELATED REASONS
HEALTH CONCERNS 41
FEAR OF SIDE EFFECTS 42
LACK OF ACCESS/TOO FAR 43
COSTS TOO MUCH 44
INCONVIENT TO USE 45
INTERFERES WITH BODY'S NORMAL PROCESSES 46
OTHER(SPECIFY) _________ 96
DON'T KNOW 98

713) 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?

PROBE FOR A NUMERIC RESPONSE.

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.

NONE 00 (SKIP TO 811)
NUMBER _____
OTHER(SPECIFY) ___________ 96 (SKIP TO 811)

714) 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?

NUMBER OF BOYS ___
NUMBER OF GIRLS ____
EITHER ___
OTHER(SPECIFY) ______ 96

SECTION 8. HUSBAND'S BACKERGROUND AND WOMAN'S WORK

811) 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?

YES 1 (SKIP TO 813)
NO 2

812) 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?

YES 1
NO 2 (SKIP TP 830)

813) What is your current occupation, that is, what kind of work do you mainly do?

____________________

814) What is your employment status: are you an employee, an employer, are you self-employed, are you working for your family without payment, or are you working for someone else without payment?

EMPLOYEE 1
EMPLOYER 2
SELF-EMPLOYED 3
UNPAID FAMILY WORKER 4
UNPAID WORKER 5

830) Do you smoke: Cigarettes? Nargila?

CIGARETTE
YES 1
NO 2
NARGILA
YES 1
NO 2

1210) RECORD THE TIME.

HOUR __
MINUTE __

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:__________

CALENDAR

INSTRUCTIONS: ONLY ONE CODE SHOULD APPEAR IN ANY BOX. IN COLUMN 1, ALL MONTHS SHOULD BE FILLED IN.

INFORMATION TO BE CODED FOR EACH COLUMN.

COLUMN 1: BIRTHS, PREGNANCIES, CONTRACEPTIVES USE
BIRTHS B
PREGNANCIES P
TERMINATIONS T

NO METHOD 0
FEMALE STERILIZATION 1
MALE STERILIZATION 2
PILL 3
IUD 4
INJECTABLES 5
IMPLANTS 6
CONDOM 7
FAMLE CONDOM 8
DIAPHRAGM 9
FOAM OR JELLY J
LACTATIONAL AMENORRHEA METHOD K
PERIODIC ASTINENCE L
WITHDRAWL M
OTHER(SPECIFY) ________________ X

NOTE: In case of multiple birth which ended with live and non-live birth outcomes record BIRTH to the calendar

COLUMN 2: DISCONTINUATION OF CONTRACEPTIVE USE
INFREQUENT SEX/HUSBAND AWAY 0
BECAME PREGNANT WHILE USING 1
WANTED TO BECOME PREGNANT 2
HUSBAND DISAPPROVED 3
WANTED MORE EFFECTIVE METHOD 4
HEALTH CONCERNS 5
SIDE EFFECTS 6
LACK OF ACCESS/TOO FAR 7
COSTS TOO MUCH 8
INCONVIENT TO USE 9
FATALISTIC F
DIFFICULT TO GET PREGNANT/MENOPAUSAL A
WIDOW/DIVORCE/SEPARATION D
RAMADAN R
OTHER(SPECIFY) _____________ X
DON'T KNOW Z

2009

12 DEC 01 __
11 NOV 02 __
10 OCT 03 __
09 SEP 04 __
08 AUG 05 __
07 JUL 06 __
06 JUN 07 __
05 MAY 08 __
04 APR 09 __
03 MAR 10 __
02 FEB 11 __
01 JAN 12 __

2008

12 DEC 13 __
11 NOV 14 __
10 OCT 15 __
09 SEP 16 __
08 AUG 17 __
07 JUL 18 __
06 JUN 19 __
05 MAY 20 __
04 APR 21 __
03 MAR 22 __
02 FEB 23 __
01 JAN 24 __

2007

12 DEC 25 __
11 NOV 26 __
10 OCT 27 __
09 SEP 28 __
08 AUG 29 __
07 JUL 30 __
06 JUN 31 __
05 MAY 32 __
04 APR 33 __
03 MAR 34 __
02 FEB 35 __
01 JAN 36 __

2006

12 DEC 37 __
11 NOV 38 __
10 OCT 39 __
09 SEP 40 __
08 AUG 41 __
07 JUL 42 __
06 JUN 43 __
05 MAY 44 __
04 APR 45 __
03 MAR 46 __
02 FEB 47 __
01 JAN 48 __

2005

12 DEC 49 __
11 NOV 50 __
10 OCT 51 __
09 SEP 52 __
08 AUG 53 __
07 JUL 54 __
06 JUN 55 __
05 MAY 56 __
04 APR 57 __
03 MAR 58 __
02 FEB 59 __
01 JAN 60 __

2004

12 DEC 61 __
11 NOV 62 __
10 OCT 63 __
09 SEP 64 __
08 AUG 65 __
07 JUL 66 __
06 JUN 67 __
05 MAY 68 __
04 APR 69 __
03 MAR 70 __
02 FEB 71 __
01 JAN 72 __