WOMAN'S QUESTIONNAIRE

Survey Contents Confidential by Statistical law

IDENTIFICATION

CLUSTER NUMBER ___________

HOUSEHOLD NUMBER __

NAME OF HOUSEHOLD HEAD ____________________

NAME AND LINE NUMBER OF WOMAN __________________________ ___

TELEPHONE/MOBLIE NUMBER (IF AVAILABLE) _______________________

HOUSEHOLD SELECTED FOR CHILD DISCIPLINE AND CHILD DEVELOPMENT?

HOUSEHOLD SELECTED FOR HEALTH EXPENDITURE AND DOMESTIC VIOLENCE?

INTERVIEWER VISITS

FIRST VISIT
DATE
INTERVIWER'S NAME
RESULT*

NEXT VISIT:
DATE
TIME

SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT*

NEXT VISIT:
DATE
TIME

THIRD VISIT
DATE
INTERVIEWER'S NAME

FINAL VISIT
DAY
MONTH
YEAR
INT. NO.
RESULT*

TOTAL NUMBER OF VISITS

*RESULT CODES:

SUPERVISOR
NAME ____________
NUMBER ____

OFFICE EDITOR
NUMBER ____

INTRODUCTION AND 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 the 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?
In case you need more information about the survey, you may contact the person listed on the card that has already been given to your household.

May I begin the interview now?

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE TIME

101A) What is your marital status now: are your 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.

102) How long have you been living continuously in (NAME OF CURRENT GOVERNORATE)?

IF LESS THAN ONE YEAR, RECORD '00' YEARS.

103) Just before you moved here, did you live in another governorate?

104) Which governorate did you live in?

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, new basic, new secondary, intermediate diploma, bachelor, or higher?

109) What is the highest GRADE you completed at that level?

IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'

110) CHECK 108:

111) Now I would like you read this sentence to me.

SHOW CARD TO RESPONDENT.

IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE:
Can you read any part of this sentence to me?

112) CHECK 111:

113) Do you read a newspaper or magazine at least once a week, less than once a week, or not at all?

114) Do you listen to the radio at least once a week, less than once a week, or not at all?

115) Do you watch television at least once a week, less than once a week, or not at all?

116) Do you own a mobile or smart phone?

117) Do you own a mobile phone for any financial transactions?

118) Do you have an account in a bank or other financial institution that you yourself use?

118A) Do you have a personal credit card?

119) Have you ever used the internet?

120) In the last 12 months, have you used the internet?

IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.

121) During the last one month, how often did you use the internet: almost every day, at least once a week, less than once a week, or not at all?

123A) What is your nationality?

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?

203a) How many sons live with you?

IF NONE, RECORD '00'.

203b) And how many daughters live with you?

IF NONE, RECORD '00'.

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

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

IF NONE, RECORD '00'.

205b) And how many daughters are alive but do not live with you?

IF NONE, RECORD '00'.

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, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?

207a) How many boys have died?

IF NONE, RECORD '00'

207b) And how many girls have died?

IF NONE, RECORD '00'

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, 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 ROWS. IF THERE ARE MORE THAN 10 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW.

REPEAT QUESTIONS 212-221 FOR EACH CHILD.

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

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

214) Were any of these births twins?

215) On what day, month, and year was (NAME) born?

216) Is (NAME) still alive?

217) IF ALIVE:
How old was (NAME) at (NAME)'s last birthday?
RECORD AGE IN COMPLETED YEARS.

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 '12 MONTHS' OR '1 YR', ASK: Did (NAME) have (his/her) first birthday?

THEN ASK: Exactly how many months old was (NAME) when (he/she) died?
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), including any children who died after birth?

SKIP FIRST CHILD.

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

223) COMPARE 208 WITH NUMBER OR BIRTHS IN BIRTH HISTORY

224) CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2012-2018

225) FOR EACH BIRTH IN 2012-2018, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF COMPLETED MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OR PREGNANCY. (NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OR MONTHS THAT THE PREGNANCY LASTED.)

226) Are you pregnant now?

227) How many months pregnant are you?

RECORD NUMBER OR COMPLETED MONTHS.

ENTER 'P's IN THE CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

228) When you got pregnant, did you want to get pregnant at that time?

229) CHECK 208: TOTAL NUMBER OF BIRTHS

ONE OR MORE

NONE

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

231) When did the last such pregnancy end?

232) CHECK 231:

233) In what month and year did the preceding such pregnancy end?

234) How many months pregnant were you when that pregnancy ended?

234A) Did this pregnancy end in a miscarriage, an induced abortion, or a stillbirth?

234B) Did this (MISCARRIAGE/ABORTION/STILLBIRTH FROM Q.234A) take place in a health facility, at home, in another house, or in another place?

235) Since January 2012, have you has any other pregnancies that did not result in alive birth?

236) FOR EACH PREGNANCY THAT DID NOT END IN ALIVE BIRTH IN 2012-2018 OR LATER, ENTER 'T' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS OF PREGNANCY.
IF THERE ARE MORE THAN FOUR PREGNANCIES THAT DID NOT END IN A LIVE BIRTH, USE AN ADDITIONAL QUESTIONNAIRE STARTING ON THE SECOND LINE.

237) Did you have any miscarriages, abortions, or stillbirths that ended before 2012?

238) When did the last such pregnancy that terminated before 2012 end?

239) When did your last menstrual period start?

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

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

242) After the birth of a child, can a woman become pregnant before her menstrual period has returned?

SECTION 3. CONTRACEPTION

301) 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. 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.

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

302) CHECK 226:

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

304) Which method are you using?

RECORD ALL MENTIONED.

IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.

304A) For which main reason you do not use a modern method of contraception?

305) What is the brand name of the pills you are using?

IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

307) In what facility did the sterilization take place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

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

309) 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?

310) CHECK 308 AND 309, 215 AND 231: ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 308 OR 309

311) CHECK 308 AND 309:

312) 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 MOST RECENT USE, BACK TO JANUARY 2012. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

312A) MONTH AND YEAR OF START OF INTERVAL OF USE OR NON-USE.

312B) Between (EVENT) in (MONTH/YEAR) and (EVENT) in (MONTH/YEAR), did you or your partner use any method of contraception?

312C) Which method was that?

312D) How many months after (EVENT) in (MONTH/YEAR) did you start to use (METHOD)?

CIRCLE '95' IF RESPONDENT GIVES THE DATE OF STARTING TO USE THE METHOD.

312E) RECORD MONTH AND YEAR RESPONDENT STARTED USING METHOD.

312F) For how many months did you use (METHOD)?
CIRCLE '95' IF RESPONDENT GIVES THE DATE OF TERMINATION OF USE.

312G) RECORD MONTH AND YEAR RESPONDENT STOPPED USING METHOD.

312H) Why did you stop using (METHOD)?

312I) GO BACK TO 312A IN NEXT COLUMN; OR, IF NO MORE GAPS, GO TO 313.

313) CHECK THE CALENDAR FOR USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH

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

315) CHECK 304:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

316) You first started using (CURRENT METHOD) in (DATE FROM 309). Where did you get it at that time?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

317) CHECK 304:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

318) At the time, were you told about side effects or problems you might have with the method?

319) When you got sterilized, were you told about side effects or problems you might have with the method?

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

321) Were you told what to do if you experienced side effects or problems?

322) CHECK 318 AND 319:

ANY 'YES'

OTHER

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

324) CHECK 304:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

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

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECOT, WRITE THE NAME OF THE PLACE.

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

326A) Where is that?

Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

327) In the last 12 months, were you visited by a fieldworker?

328) Did the fieldworker talk to you about family planning?

329) CHECK 202: LIVING CHILDREN

YES

NO

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

SECTION 4. PREGNANCY AND POSTINATAL CARE

401) CHECK 224:

402) CHECK 215. RECORD THE BIRTH HISTORY NUMBER IN 403 AND THE NAME AND SURVIVAL STATUS IN 404 FOR EACH BIRTH IN 2012-2018. 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 QUESTIONNAIRE(S).

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

403) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY.

LAST BIRTH

404) FROM 212 AND 216:

405) When you got pregnant with (NAME), did you want to get pregnant at that time?

406) CHECK 208:

ONLY ONE BIRTH

MORE THAN ONE BIRTH

407) How much longer did you want to wait?

408) Did you see anyone for antenatal care for this pregnancy?

409) Whom did you see? Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

410) Where did you receive antenatal care for this pregnancy? Anywhere else?
PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

411) How many months pregnant were you when you first received antenatal care for this pregnancy?

412) How many times did you receive antenatal care during this pregnancy?

413) As part of your antennal care during this pregnancy, were any of the following done at least once:

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

415) During this pregnancy, how many times did you get a tetanus injection?

IF 7 OR MORE TIMES, RECORD '7'.

416) CHECK 415:

417) At any time before this pregnancy, did you receive any tetanus injections?

418) Before this pregnancy, did you receive any tetanus injections?

IF 7 OR MORE TIMES, RECORD '7'.

419) CHECK 418:

ONLY ONE TIME

MORE THAN ONE TIME

420) During this pregnancy, were you given or did you buy any iron tablets or iron syrup?

SHOW TABLETS/SYRUP.

421) 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.

426) When (NAME) was born, was (NAME) very large, larger than average, average, smaller than average, or very small?

427) Was (NAME) weighed at birth?

428) How much did (NAME) weigh?

RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.

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

PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.

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

429A) How much did you pay the service provider for the delivery?

IF 9994 JD OR MORE, RECORD 9994

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

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

431) How long after (NAME) was delivered did you stay there?

IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

432) Was (NAME) delivered by caesarean, that is, did they cut your belly open to take the baby out?

433) When was the decision made to have the caesarean section? Was it before or after your labor pains started?

434) Immediately after the birth, was (NAME) put on your chest?

434A) Was (NAME)'s bare skin touching your bare skin?

434B) CHECK 430: PLACE OF DELIVERY

435) I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health while you were still in the facility?

436) How long after delivery did the first check take place?

IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

437) Who checked on your health at the time?

PROBE FOR MOST QUALIFIED PERSON.

438) Now I would like to talk to you about checks on (NAME)'s health after delivery -- for example, someone examining (NAME), checking the cord, or seeing if (NAME) is OK. Did anyone check on (NAME)'s health while you were still in the facility?

439) How long after delivery was (NAME)'s health first checked?
IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

440) Who checked on (NAME)'s health at that time?
PROBE FOR MOST QUALIFIED PERSON.

441) Now I want to talk to you about what happened after you left the facility. Did anyone check on your health after you left the facility?

442) How long after delivery did that check take place?
IF LESS THAN ONE DAY, REDORS HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

443) Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.

444) Where did the check take place?
PROBE TO IDENTIFY THE TYPE OF SOURSE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

445) I would like to talk to you about checks on (NAME)'s health after you left (FACILITY IN 430). Did any health care provider check on (NAME)'s health in the two months after you left (FACILITY IN 430)?

446) How many hours, days or weeks after the birth of (NAME) did that check take place?
IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

447) Who checked on (NAME)'s health at that time?

PROBE FOR MOST QUALIFIED PERSON.

448) Where did this check of (NAME) take place?

PROBE TO IDENTIFY THAT TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PALCE.

449) I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health after you gave birth to (NAME)?

450) How long after delivery did the first check take place?

IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK. RECORD DAYS.

451) Who checked on your health at that time?

PROBE FOR MOST QUALIFIED PERSON.

452) Where did this first check take place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

453) I would like to talk to you about checks on (NAME)'s health after delivery--for example, someone examining (NAME), checking the cord, or seeing is (NAME) OK. In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on (NAME)'s health?

454) How many hours, days, or weeks after the birth of (NAME) did the first check take place?

IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

455) Who checked on (NAME)'s health at that time?

PROBE FOR MOST QUALIFIED PERSON.

456) Where did this first check of (NAME) take place>

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

457) During the first two days after (NAME)'s birth, did any health care provider do the following:

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

459) Did your menstrual period return between the birth of (NAME) and your next pregnancy?

DO NOT ASK FOR FIRST CHILD.

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

461) CHECK 226: IS RESPONDENT PREGNANT?

462) Have you had sexual intercourse since the birth of (NAME)?

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

464) Did you ever breastfeed (NAME)?

465) CHECK 404: IS CHILD LIVING?

466) 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.

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

467A) What was (NAME) given to drink?

Anything else?

RECORD ALL LIQUIDS MENTIONED

468) CHECK 404: ID CHILD LIVING?

469) Are you still breastfeeding (NAME)?

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

471) GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501A.

SECTION 5A. CHILD IMMUNIZATION (LAST BIRTH)

501A) CHECK 215 IN THE BIRTH HISTORY: ANY MORE BIRTHS IN 2014-2018?

502A) RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 212 OF THE LAST CHILD BORN IN 2014-2018.

503A) CHECK 216 FOR CHILD:

504A) Do you have a card or other document where (NAME)'s vaccinations are written down?

505A) Did you ever have a vaccination card for (NAME)?

506A) CHECK 504A:

507A) May I see the card or other document where (NAME)'s vaccinations are written down?

508A) COPY DATES FROM THE CARD OR DOCUMENT.

WRITE '44' IN 'DAY' COLUMN IF CARD OR DOCUMENT SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

509A) CHECK 508A: 'BCG' TO 'OPV Booster 1' ALL RECORDED?

510A) In addition to what is recorded on this document, did (NAME) receive any other vaccinations, including vaccinations received in immunization campaigns?

RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 508A THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

511A) Did (NAME) ever receive any vaccinations to prevent (NAME) from getting diseases, including vaccinations received in campaigns or immunization days or child health days?

512A) Has (NAME) ever received a BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

514A) Has (NAME) ever received oral polio vaccine, that is, about two drops in the mouth to prevent polio?

516A) How many times did (NAME) RECEIVE THE ORAL POLIO VACCINE?

517A) Has (NAME) ever received a pentavalent vaccination, that is, an injection given in the thigh sometimes at the same time as polio?

518A) How many times did (NAME) receive the pentavalent vaccine?

518AA) Has (NAME) ever received a Hepatitis B vaccination, that is, an injection in the thigh to prevent Hepatitis B, sometimes given at the same time as Pentavalent?

518AB) How many times did (NAME) receive the Hepatitis B vaccine?

521A) Has (NAME) ever received a rotavirus vaccination, that is, liquid in the mouth to prevent diarrhea, sometimes received at the same time as Pentavalent?

522A) How many times did (NAME) receive the rotavirus vaccine?

523A) Has (NAME) ever received a measles vaccination, that is, an injection in the arm to prevent measles?

523AA) Has (NAME) ever received a MMR vaccination, that is, an injection to prevent measles, mumps, and rubella usually given at the age of 12 months?

523AB) How many times did (NAME) receive the MMR vaccine?

526A) CONTINUE WITH 501B.

SECTION 5B. CHILD IMMUNIZATION (NEXT-TO-LAST BIRTH)

501B) CHECK 215 IN THE BIRTH HISTORY: ANY MORE BIRTHS IN 2014-2018?

502B) RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 212 OF THE NEXT-TO-LAST CHILD BORN IN 2014-2018.

503B) CHECK 216 FOR CHILD:

504B) Do you have a card or other document where (NAME)'s vaccinations are written down?

505B) Did you ever have a vaccination card for (NAME)?

506B) CHECK 504B:

507B) May I see the card or other document where (NAME)'s vaccinations are written down?

508B) COPY DATES FROM THE CARD OR DOCUMENT.
WRITE '44' IN 'DAY' COLUMN IF CARD OR DOCUMENT SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

509B) CHECK 508B: 'BCG' TO 'OPV Booster 1' ALL RECORDED?

510B) In addition to what is recorded on this document, did (NAME) receive any other vaccinations, including vaccinations received in immunization campaigns?

RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 508B THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

511B) Did (NAME) ever receive any vaccinations to prevent (NAME) from getting diseases, including vaccinations received in immunization campaigns?

512B) Has (NAME) ever received a BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

514B) Has (NAME) ever received oral polio vaccine, that is, about two drops in the mouth to prevent polio?

516B) How many times did (NAME) receive the oral polio vaccine?

517B) Has (NAME) ever received a pentavalent vaccination, that is, an injection given in the thigh sometimes at the same time as polio drops?

518B) How many times did (NAME) receive the pentavalent vaccine?

518BA) Has (NAME) ever received a Hepatitis B vaccination, that is, an injection in the thigh to prevent Hepatitis B, sometimes given at the same time as Pentavalent?

518BB) How many times did (NAME) receive the Hepatitis B vaccine?

521B) Has (NAME) ever received a rotavirus vaccination, that is, liquid in the mouth to prevent diarrhea, sometimes received at the same time as Pentavalent?

522B) How many times did (NAME) receive the rotavirus vaccine?

523B) Has (NAME) ever received a measles vaccination, that is, an injection in the arm to prevent measles?

523BA) Has (NAME) ever received a MMR vaccination, that is, an injection to prevent measles, mumps, and rubella usually given at the age of

523BB) How many times did (NAME) receive the MMR vaccine?

526B) CHECK 215 IN BIRTH HISTORY: ANY MORE BIRTHS IN 2014-2018?

SECTION 6. CHILD HEALTH AND NUTRITION

601) CHECK 224:

602) CHECK 215: RECORD THE BIRTH HISTORY NUMBER IN 603 AND THE NAME AND SURVIVAL STATUS IN 604 FOR EACH BIRTH IN 2012-2018. ASK THE WUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE(S).
Now I would like to ask some questions about your children born in the last five years. ( we will talk about watch separately.)

603) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY.

604) FROM 212 AND 216:

605) In the last six months, was (NAME) given a vitamin A dose like [this/any of these]?
SHOW COMMON TYPES CAPSULES.

606) In the last seven days, was (NAME) given iron pills, sprinkles wirh iron, or iron syrup like [this/any of these]?
SHOW COMMON TYPES OF PILLS/SPRINKLES/SYRUPS.

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

609) CHECK 469: CURRENTLY BREASTFEEDING?

YES

610) When (NAME) had diarrhea, was (NAME) given less than usual to eat, about the same amount, more than usual, or nothing to eat?

IF LESS, PROBE: Was (NAME) given much less than usual to eat or somewhat less?

611) Did you seek advice or treatment for the diarrhea from any source?

612) Where did you seek advice or treatment? Anywhere else?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE(S)

613) CHECK 612:

614) Where did you first seek advice or treatment?

USE LETTER CODE FROM 612.

615) Was (NAME) given any of the following at any time since (NAME) started having the diarrhea?

616) CHECK 615:

ANY 'YES'

ALL 'NO' OR 'DK'

617) CHECK 615:

ANY 'YES': a) What else was given to treat the diarrhea? Anything else?
ALL 'NO' OR 'DK': b) What was given to treat the diarrhea? Anything else?

RECORD ALL TREATMENTS GIVEN.

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

620) Has (NAME) has an illness with a cough at any time in the last 2 weeks?

621) Has (NAME) had fast, short, rapid breaths or difficulty breathing at any time in the last 2 weeks?

622) Was the fast or difficult breathing due to a problem in the chest or to a blocked or runny nose?

623) CHECK 618: HAD FEVER?

624) Did you seek advice or treatment for the illness from any source?

625) Where did you seek advice or treatment? Anywhere else?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE(S)

626) CHECK 625:

627) Where did you first seek advice or treatment?

USE LETTER CODE FROM 625.

628) How many days after the illness began did you first seek advice or treatment for (NAME)?
IF THE SAME DAY RECORD '00'.

629) At any time during the illness, did (NAME) take any drugs for the illness?

630) What drugs did (NAME) take? Any other drugs?
RECORD ALL MENTIONED.

646) GO BACK TO 604 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 647.

647) CHECK 615(a) AND 615(b). ALL COLUMNS:

648) Have you ever heard of a special product called Aquacell or Paralait you can get for treatment of diarrhea?

649) CHECK 215 AND 218, ALL ROWS: NUMBER OF CHILDREN BORN IN 2015-2018 LIVING WITH THE RESPONDENT

650) Now I would like to ask you about liquids or foods that (NAME FROM 649) had yesterday during the day or at night. I am interested in whether your child had the item I mention even if it was combined with other foods?

651) CHECK 650 (CATEGORIES 'g' THROUGH 'v'):

652) Did (NAME FROM 649) eat any solid, semi-solid, or soft foods yesterday during the day or at night?
IF 'YES' PROBE: What kind of solid, semi-solid, or soft foods did (NAME) eat?

653) How many times did (NAME FROM 649) eat solid, semi-solid, soft foods yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.

SECTION 7. MARRIAGE AND SEXUAL ACTIVITY

700) CHECK 101A:

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

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

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

707) Including yourself, in total, how many wives does he have?

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

710) CHECK 709:

MARRIED ONLY ONCE

MARRIED MAN MORE THAN ONCE

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

711A) Before you got married, was your (first) husband related to you in any way?

711B) What type of relation was it?

711C) CHECK 709:

MARRIED ONLY ONCE

MARRIED MORE THAN ONCE

711D) Did you have premarital medical exam?

711E) Where did you go for the premarital medical exam?

714) I would like to ask you about your recent sexual activity. When was the last time you had sexual intercourse?
IF 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.

714A) The last time you had sexual intercourse, was a condom used?

714B) Do you know of a place where a person can get condoms?

714C) Where is that? Any other place?

SECTION 8. FERTILITY PREFERENCES

800) CHECK 101A:

801) CHECK 304:

802) CHECK 226:

803) 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 like to have another child, or would you prefer not to have any more children?

804) 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?

805) CHECK 226:

NOT PREGNANT OR UNSURE

PREGNANT

806) CHECK 226:

807) CHECK 303: USING A CONTRACEPTIVE METHOD?

808) CHECK 805:

809) CHECK 714:

810) CHECK 804:

WANTS TO HAVE A/ANOTHER CHILD

WANTS NO MORE/NONE

811) CHECK 303: USING A CONTRACEPTIVE METHOD?

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

812A) Which contraceptive method would you prefer to use?

813) CHECK 216:

HAS LIVING CHILDREN

NO LIVING CHILDREN

814) 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 if it's a boy or a girl?

814A) If you could choose exactly the number of months to wait between the birth of one child and the birth of another, how many months would that be?

PROBE FOR A NUMERIC RESPONSE.

815) In the last few months have you:

816) In the last few months have you seen, heard, or read about Nathemo Al Hamel ... Khafifo Al Hemel?

817) CHECK 101A:

818) CHECK 303: USING A CONTRACEPTIVE METHOD?

819) Would you say that using contraception is mainly your decision, mainly your husband's decision, or did you both decide together?

820) Would you say that not using contraception is mainly your decision, mainly your husband's decision, or did you both decide together?

821) CHECK 304:

822) Does your husband want the same number of children that you want, or does he want more or fewer than you want?

SECTION 9. HUSBAND'S BACKGROUND AND WOMAN'S WORK

901) CHECK 101A:

902) How old was your husband on his last birthday?

903) Did your husband ever attend school?

904) What was the highest level of school he attended: primary, secondary, or higher?

905) What was the highest grade he completed at that level?

IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

906) Has your 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?

906A) Does your husband have any job, but he did not work during the last seven days for a reason such as vacation, travel, or illness?

908) What is your husband's occupation? That is, what kind of work does he mainly do?

__________________________________________________________________________________________________________________________________________________________________________
_____________________________________________________________________________________

908A) 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?

909) 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?

911) Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, maternity leave, or any other such reason?

913) What is your occupation? That is, what kind of work do you mainly do?

__________________________________________________________________________________________________________________________________________________________________________
_____________________________________________________________________________________

914) 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?

917) CHECK 101A:

918) CHECK 914:

919) Who usually decides how the money you earn will be used: you, your husband, or you and your husband jointly?

920) Would you say that the money that you earn is more than what your husband earns, less than what earns, or about the same?

921) Who usually decides how your husband's earnings will be used: you, your husband, or you and your husband jointly?

922) Who usually makes decisions about health care for yourself: you, your husband, you and your husband jointly, or someone else?

922A) Suppose in one month you experience abnormal vaginal discharge or a painful or burning sensation when urinating and you wanted to seek health care, who would make the decision regarding health care for yourself: you, your husband, you and your husband jointly, or someone else?

923) Who usually makes decisions about making major household purchases?

924) Who usually makes decisions about visits to your family or relatives?

925) Do your own this house or any other house either alone or jointly with someone else?

928) Do you own any agricultural or non-agricultural land either alone or jointly with someone else?

931) PRESENCE OR OTHERS AT THIS POINT (PRESENT AND LISTENING, PRESENT BUT NOT LISTENING, OR NOT PRESENT)

932) In your opinion, is a husband justified in hitting or beating his wife in the following situations:

SECTION 10. HIV/AIDS

1001) Now I would like to talk about something else. Have you ever heard of HIS or AIDS?

1002) HIV is the virus that can lead to AIDS. Can people reduce their chance of getting HIV by having just one uninfected sex partner who has no other sex partners?

1003) Can people get HIV from mosquito bites?

1004) Can people reduce their chance of getting HIV by using a condom every time they have sex?

1005) Can people get HIV by sharing food with a person who has HIV?

1006A) Can people get the AIDS virus by shaking hands with or hugging a person who has AIDS?

1006B) Can people get the AIDS virus by sharing razors or blades when shaving their beard or having their hair cut?

1007) Is it possible for a health-looking person to have HIV?

1008) Can HIV be transmitted from a mother to her baby:

1009) CHECK 1008:

1010) Are there any special drugs that a doctor or a nurse can give to a woman infected with HIV to reduce the risk of transmission to the baby?

1031) Do you know of a place where people can go to get an HIV test?

1032) Where is that? Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURSE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

1035) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV?

1036) Do you think children living with HIV should be allowed to attend school with children who do not have HIV?

1038) Do people talk badly about people living with HIV, or who are thought to be living with HIV?

1039) Do people living with HIV, or thought to be living with HIV, lose the respect of other people?

1040) Do you agree or disagree with the following statement. I would be ashamed if someone in my family had HIV.

1042) CHECK 1001:

HEARD ABOUT HIV OR AIDS

NOT HEARD ABOUT HIV OR AIDS

1051) If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom when they have sex?

1052) Is a wife justified in refusing to have sex with her husband when she knows he has sex with other women, or women other than his wives?

1052A) Is a wife justified in refusing to have sex with her husband when she is tired or not in the mood?

1052B) CHECK 101A:

1054) Can you say no to your husband if you do not want to have sexual intercourse?

1055) Could you ask your husband to use a condom if you wanted him to?

SECTION 11. OTHER HEALTH ISSUES

1104) Do you currently smoke cigarettes every day, some days, or not at all?

1105) On average, how many cigarettes do you currently smoke each day?

1108) Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want want to get medical advice or treatment, is each of the following a big problem or not a big problem:

1109) Are you covered by any health insurance?

1110) What types of health insurance are you covered by?
RECORD ALL INSURANCES MENTONED.

1110A) Have you performed a breast cancer self-exam to detect breast cancer in yourself within the last 12 months?

1110B) Have you had a breast cancer clinical exam to detect breast cancer in the last 12 months?

1110C) Have you ever had a mammogram?

1110D) CHECK 106: AGE

1110E) Why you never have a mammogram?

1110F) Have you ever heard of a pap smear, that is, an exam that consists of removing cells from the cervix to detect changes that can suggest the presence of cancer in a woman's womb?

1110G) Have you ever had such an exam in your life time?

EARLY CHILDHOOD DEVELOPMENT

1200)

1201) CHECK 217 AND 218: ANY CHILD 0-4 YEARS OLD LIVING WITH IS/HER MOTHER?

1202) CHECK 217 AND 218: SELECT THE YOUNGEST CHILD AGED 0-4 LIVING WITH HIS/HER MOTHER AND RECORD NAME AND LINE NUMBER

1203) READ TO THE RESPONDENT:
Now I would like to ask you some questions about (NAME OF THE CHILD FROM 1202), your youngest child living with you who is 0-4 years old.

1204) How many children's books or picture books do you have for (NAME)?

1205) I am interested in learning about the things that (NAME) plays with when (he/she) is at home.

Does (he/she) play with:

IF THE RESPONDENT SAYS 'YES' TO THE CATEGORIES ABOVE, THEN PROBE TO LEARN SPECIFICALLY WHAT THE CHILD PLAYS WITH TO ASCERTAIN THE RESPONSE.

1206) Sometimes adults taking care of children have to leave the house to go shopping, wash clothes, or for other reasons and have to leave young children.

1207) VERIFY 217: AGE OF THE CHILD

1208) VERIFY 217 AND 218: ANY CHILD AGE 3-4 LIVING WITH HIS/HER MOTHER?

1209) CHECK 217 AND 218: SELECT THE YOUNGEST CHILD AGE 3 OR 4 LIVING WITH HIS/HER MOTHER AND RECORD NAME AND LINE NUMBER

1210) Now, I would like to ask you some questions concerning (NAME OF THE CHILD IN 1209), your youngest child age 3-4 years.

1211) Does (NAME) attend any organized learning or early childhood education programme, such as a private or government facility, including kindergarten or community child care?

1212) Within the last seven days, about how many hours did (NAME) attend?

1213) In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (NAME)?

IF YES, ASK:
Who engaged in this activity with (NAME)?

1214) I would like to ask you some questions about the health and development of (NAME). Children do not all develop and learn at the same rate. For example, some walk earlier than others. These questions are related to several aspects (NAME)'s development.

Can (NAME) identify or name at least ten letters?

1215) Can (NAME) read at least four simple, popular words?

1216) Does (NAME) know the name and recognize the symbol of all numbers from 1 to 10?

1217) Can (NAME) pick up a small object with two fingers, like a stick or a root from the ground?

1218) Is (NAME) sometimes too sick to play?

1219) Does (NAME) follow simple directions on how to do something correctly?

1220) When given something to do, is (NAME) able to do it independently?

1221) Does (NAME) get along well with other children or adults?

1222) Does (NAME) kick, bite, or hit other children or adults?

1223) Does (NAME) get distracted easily?

DOMESTIC VIOLENCE MODULE

1300) CHECK COVER PAGE: WOMAN SELECTED FOR DV MODULE?

1301) CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.

1301A) READ TO THE RESPONDENT:
Now I would like to ask you questions about some other important aspects of a woman's life. You may find some of these questions very personal. However, your answers are crucial for helping to understand the condition of women in Jordan. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else in your household will know that you were asked these questions. If I ask you any question you don't want to answer, just let me know and I will go on to the next question.

1302) CHECK 101A:

1303) First, I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your (last) husband?

1304) Now I need to ask some more questions about your relationship with your (last) husband.

A. Did your (last) husband ever:

B. How often did this happen during the last 12 months: often, only sometimes, or not at all?

1305)
A. Did your (last) husband ever do any of the following things to you:

B. How often did this happen during the last 12 months: often, only sometimes, or not at all?

1306) CHECK 1305A (a-h):

1307) How long after you first got married with you (last) husband did (this/any of these things) first happen?
IF LESS THAN ONE YEAR, RECORD '00'.

1308) Did the following ever happen as a result of what your (last) husband did to you:

1309) Have you ever hit, slap, kick, or done anything else to physically hurt your (last) husband at times when he was not already beating or physically hurting you?

1310) In the last 12 months, how often have you done this to your (last) husband: often, only sometimes, or not at all?

1313) Are (Were) you afraid of your (last) husband: most of the time, sometimes, or never?

1314) CHECK 709:

1315)

A) So far we have been talking about the behavior of your (current/last) husband. How I want to ask you about the behavior of any previous husband.

B. How long ago did this last happen?

1316) From the time you were 15 years old has anyone other than (your/any) husband hit you, slapped you, kicked you, or done anything else to hurt you physically?

1317) Who has hurt you in this way? Anyone else?
RECORD ALL MENTIONED.

1318) In the last 12 months, how often has (this person/have these persons) physically hurt you: often, only sometimes, or not at all?

1319) CHECK 201, 226, AND 230:

1320) Has any one ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?

1321) Who has done any of these things to physically hurt you while you were pregnant? Anyone else?
RECORD ALL MENTIONED.

1326) CHECK 1305A(a-h), 1315A (a,b), 1316, 1320:

1327) Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?

1328) From whom have you sought help? Anyone else?
RECORD ALL MENTIONED.

1329) Have you ever told anyone about this?

1330) As far as you know, did your father ever beat your mother?

THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER ABOUT THE CONFIDENTIALITY OF HER ANSWERS. FILL OUT THE QUESTIONS BELOW WITH REFERENCE TO THE DOMESTIC VIOLENCE MODULE ONLY.

1331) DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?

1332) INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE.
__________________________________________________________________________________________________________________________________________________________________________
_____________________________________________________________________________________

1333) RECORD THE TIME.

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT INTERVIEW:

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COMMENTS ON SPECIFIC QUESTIONS:

__________________________________________________________________________________________________________________________________________________________________________
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ANY OTHER COMMENTS:

__________________________________________________________________________________________________________________________________________________________________________
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SUPERVISOR'S OBSERVATIONS

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EDITOR'S OBSERVATIONS

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CALENDAR

INSTRUCTIONS:

ONLY ONE CODE SHOULD APPEAR IN ANY BOX.
COLUMN 1 REQUIRES A CODE IN EVERY MONTH.

CODES FOR EACH COLUMN: