QUESTIONNAIRE FOR WOMEN 15-49
NAME OF COUNTY ___
NAME OF DISTRICT___
NAME OF CLAN/TOWNSHIP___
NAME OF CITY/TOWN/VILLAGE___
LDHS CLUSTER NUMBER
LDHS STRUCTURE NUMBER
HOUSEHOLD NUMBER
OTHER URBAN 2
VILLAGE 3
NAME OF HOUSEHOLD HEAD___
NAME AND LINE NUMBER OF WOMAN ___
FIRST VISIT:
DATE ___________
INTERVIEWER'S NAME ___________
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
INTERVIEWER NUMBER
RESULT
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) ________
FIELD EDITOR
NAME__
DATE__
OFFICE EDITOR
KEYED BY
SECTION 1. RESPONDENT' S BACKGROUND
INTRODUCTION AND CONSENT
Hello. My name is _______ and I am working with the Liberia Institute for Statistics and Geo-Information Services (LISGIS). We are conducting a National Demographic and Health Survey that asks women and men about various health issues. We would very much appreciate your participation in this survey. This information will help the government to plan health services. The survey interview usually takes about 45 minutes. The information you provide will be kept strictly confidential and will not be shown to other persons.
Participation in this survey is voluntary. 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; or you can stop the interview at any time.
However, we hope that you will participate in this survey since your views are important.
Do you want to ask me anything about the survey? May I begin the interview now?
Signature of interviewer: ___________
Date: _________
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (GO TO END)
101) RECORD THE TIME AT START OF INTERVIEW:
MINUTES
102) How long have you been living continuously in (NAME OF CITY, TOWN, VILLAGE)?
IF LESS THAN ONE YEAR, RECORD '00' YEARS.
ALWAYS 95 (GO TO 103A)
VISITOR 96 (GO TO 103A)
103) Just before you moved here, did you live in a city, in a town, or in a village?
TOWN 2
VILLAGE 3
103A) During the war, did you leave your house?
IF YES: Where did you go?
CIRCLE ALL MENTIONED.
STAYED WITH RELATIVES OR FRIENDS INSIDE LIBERIA B
WENT TO A CAMP C
LIVED IN THE BUSH D
WENT OUTSIDE LIBERIA E
OTHER (SPECIFY) _____________ X
104) In the last 12 months, how many times did you travel away from your home and slept away?
NONE 00 (GO TO 106)
105) In the last 12 months, have you been away from home for more than one month at a time?
NO 2
106) In what month and year were you born?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
COMPARE AND CORRECT 106 OR 107 IF INCONSISTENT.
108) Have you ever been to school?
NO 2 (GO TO 112)
109) What is the highest level of school you attended: primary, secondary, or higher?
SECONDARY 2
HIGHER 3
110) What is the highest grade level you completed at that level?
SECONDARY OR HIGHER (GO TO 115)
112) Can you read this sentence to me?
SHOW SENTENCES TO RESPONDENT.
IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?
CAN READ ONLY PART OF SENTENCE 2
CAN READ WHOLE SENTENCE 3
CAN READ, BUT NOT ENGLISH (SPECIFY LANGUAGE) ________ 4
BLIND/VISUALLY IMPAIRED 5
SENTENCES FOR READING (Q. 112):
2. Farming is hard work.
3. Parents should care for their children.
4. The rains were heavy this year.
113) Have you ever been to any program besides primary school that teaches you to read and write?
NO 2
CODE '1' OR '5' CIRCLED (GO TO 116)
115) Do you read newspapers or magazines? How many times a week do you read them: almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
116) Do you listen to the radio? How many times a week do you listen: almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
117) Do you watch TV or videos? How many times a week do you watch TV: almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
MUSLIM 2
TRADITIONAL RELIGION 3
NO RELIGION 4
OTHER (SPECIFY) ________ 6
119) What dialect do you speak (besides English)?
GBANDI 02
BELLE 03
DEY 04
GIO 05
GOLA 06
GREBO 07
KISSI 08
KPELLE 09
KRAHN 10
KRU 11
LORMA 12
MANDIGO 13
MANO 14
MENDE 15
VAI 16
NONE/ONLY ENGLISH 17
OTHER 96
201) Have you ever born?
NO 2 (GO TO 206)
202) Do you have any children you born who are living with you?
NO 2 (GO TO 204)
203) How many sons live with you? And how many daughters live with you?
IF NONE, RECORD '00'.
DAUGHTERS AT HOME
204) Do you have any children you born who are still living but who do not live with you?
NO 2 (GO TO 206)
205) How many sons are still living but do not live with you? And how many daughters are still living with you but do not live with you?
IF NONE, RECORD '00'.
DAUGHTERS ELSEWHERE
206) Have you ever born a child who was born alive and later died?
IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?
NO 2 (GO TO 208)
207) How many boys have died? And how many girls have died?
IF NONE, RECORD '00'.
GIRLS DEAD
208) SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE, RECORD '00'.
So in all, you have born ____ (TOTAL) children in your life. Is that correct?
NO (PROBE AND CORRECT 201-208 AS NECESSARY.)
NO BIRTHS (GO TO 226)
211) Now I want the names of all the children you born, whether still alive or not, starting with the first one.
RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. (IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE STARTING WITH THE SECOND ROW).
212) What is/was the name of your (first/next) child?
213) Were any of these births twins?
MULTIPLE 2
214) Is (NAME) a boy or a girl?
GIRL 2
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?
YEAR
NO 2 (GO TO 220)
217) IF LIVING: How old is (NAME)?
RECORD AGE IN COMPLETED YEARS.
218) IF LIVING: Is (NAME) living with you?
NO 2
219) IF LIVING: 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 2 YEARS; OR YEARS.
MONTHS 2
YEARS 3
221) Did you born any other child between (NAME OF PREVIOUS BIRTH) and (NAME), including any children who died after birth?
[ask for all but first child]
NO 2 (GO TO NEXT BIRTH)
222) Did you born any child since the birth of (NAME OF LAST BIRTH)? IF YES, RECORD BIRTH(S) IN TABLE.
NO 2
223) COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY AND MARK:
FOR EACH BIRTH SINCE JANUARY 2001: 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.
224) CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 2001 OR LATER. IF NONE, RECORD '0; AND CONTINUE TO QUESTION 226.
NO 2 (GO TO 229)
UNSURE 8 (GO TO 229)
228) When you got pregnant, did you want to get pregnant then, did you want to wait until later, or you didn't want to have any more children?
LATER 2
DIDN'T WANT ANY MORE 3
229) Did you ever have a pregnancy that got spoiled: miscarried, was aborted or the baby was born dead (stillbirth)?
NO 2 (GO TO 236)
230) When was the last time it happened?
YEAR
LAST SPOILED PREGNANCY ENDED BEFORE JAN. 2001 (GO TO 236)
232) How many months pregnant were you when the pregnancy ended?
233) Since January 2001, have you had any other pregnancies that got spoiled or aborted?
NO 2 (GO TO 236)
234) When did this other pregnancy end since January 2001?
YEAR
235) How many months pregnant were you when this pregnancy ended?
236) When last you saw your period?
(DATE, IF GIVEN) __________________
WEEKS AGO 2
MONTHS AGO 3
YEARS AGO 4
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996
237) When do you think a woman can get pregnant: just before her period begins, during her period, just after her period ends, or halfway between two periods?
DURING HER PERIOD 2
JUST AFTER HER PERIOD ENDS 3
HALFWAY BETWEEN TWO PERIODS 4
ANY TIME 5
OTHER (SPECIFY) ___________ 6
DON'T KNOW 8
301) Now I would like to talk about family planning or birth control. Which family planning 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 GO DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE 1 IF METHOD IS RECOGNIZED AND 2 IF NOT RECOGNIZED. THEN FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302.
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
(SPECIFY) ______________
302) Have you ever used (METHOD)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
AT LEAST ONE "YES" (EVER USED) (GO TO 307)
304) Have you ever used anything or tried any method to delay or avoid getting pregnant?
NO 2 (GO TO 333)
307) When you first started using family planning or birth control, how many living children did you have, if any?
IF NONE, RECORD '00'.
WOMAN STERILIZED (GO TO 311A)
PREGNANT (GO TO 333)
310) Are you using any family planning or birth control right now?
NO 2 (GO TO 333)
311) Which method are you using? CIRCLE ALL MENTIONED.
IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.
311A) CIRCLE 'A' FOR FEMALE STERILIZATION.
MALE STERILIZATION B (GO TO 316)
PILL C
IUD D
INJECTABLES E
IMPLANTS F
CONDOM G
FEMALE CONDOM H
RHYTHM METHOD I (GO TO 319A)
WITHDRAWAL J (GO TO 319A)
OTHER (SPECIFY) ___________ X (GO TO 319A)
315) The last time you got (HIGHEST METHOD ON LIST IN 311), how much did you pay, including the cost of the method and any doctor's fee? WRITE IN LIBERIAN DOLLARS.
FREE 99995 (GO TO 319A)
DON'T KNOW 99998 (GO TO 319A)
316) In what facility did the operation take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE) ______________________
CHURCH FACILITIES ARE CONSIDERED PRIVATE.
GOVERNMENT HEALTH CENTER 12
OTHER PUBLIC (SPECIFY) ___________ 16
FAMILY PLANNING ASSN. LIBERIA 24
OTHER PRIVATE MEDICAL (SPECIFY) ______________ 26
DON'T KNOW 98
NO 2
DONT KNOW 8
NO 2
DON'T KNOW 8
318) How much did you (your husband/partner) pay for the sterilization operation, including any fees? WRITE IN LIBERIAN DOLLARS.
FREE 99995
DON'T KNOW 99998
319) In what month and year was the operation performed?
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?
YEAR
320) CHECK 319/319A, 215 AND 230:
323) 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 (GO TO 335)
MALE STERILIZATION 02 (GO TO 335)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07 (GO TO 332)
FEMALE CONDOM 08 (GO TO 330)
RHYTHM METHOD 09 (GO TO 332A)
WITHDRAWAL 10 (GO TO 335)
OTHER METHOD 96 (GO TO 335)
327) Since you started using this family planning method, did any doctor or nurse ever tell you about side effects or problems you might have with the method?
NO 2
330) Since you started using this family planning method, did any doctor or nurse ever tell you about any other methods of family planning that you could use?
NO 2
332) Where did you get (CURRENT METHOD) the last time?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
332A) Where did you learn to use the rhythm method?
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE) _____________________________
CHURCH FACILITIES ARE CONSIDERED PRIVATE.
GOVERNMENT HEALTH CENTER 12 (GO TO 335)
GOVERNMENT HEALTH CLINIC 13 (GO TO 335)
OTHER PUBLIC (SPECIFY) __________ 16 (GO TO 335)
PHARMACY 22 (GO TO 335)
PRIVATE DOCTOR 23 (GO TO 335)
FAMILY PLANNING ASSN. LIBERIA 24 (GO TO 335)
MOBILE CLINIC 25
OTHER PRIVATE MEDICAL (SPECIFY) _________ 26 (GO TO 335)
CHURCH 32 (GO TO 335)
FRIEND/RELATIVE 33 (GO TO 335)
333) Do you know of a place where you can get a method of a family planning?
NO 2 (GO TO 335)
334) Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S)) ________________
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH CLINIC C
OTHER PUBLIC (SPECIFY) __________ D
PHARMACY F
PRIVATE DOCTOR G
FAMILY PLANNING ASSN. LIBERIA H
MOBILE CLINIC I
OTHER PRIVATE MEDICAL (SPECIFY) _________ J
CHURCH L
FRIEND/RELATIVE M
335) In the last 12 months, have you been to a health facility for care for yourself (or your children)?
NO 2 (GO TO 401)
336) Did any health worker at the health facility talk to you about family planning methods?
NO 2
SECTION 4. PREGNANCY AND POSTNATAL CARE
401) CHECK 224:
NO BIRTHS IN 2001 OR LATER (GO TO 576)
402) CHECK 215: ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2001 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
DEAD
405) When you got pregnant with (NAME), did you want to get pregnant then, did you want to wait until later, or you didn't want to have any more children at all?
LATER 2
NO MORE 3 (GO TO 407)
406) How much longer did you want to wait?
YEARS 2
DON'T KNOW 998
407) Did you see anyone for a checkup (prenatal care) for this pregnancy? IF YES: Whom did you see? Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.
[answer only for last birth.]
NURSE/MIDWIFE B
PHYSICIAN ASST. C
NO ONE Y (GO TO 414)
408) Where did you receive checkups for this pregnancy? Anywhere else?
PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S)) _________________
[answer only for last birth.]
OTHER HOME B
GOVERNMENT HEALTH CENTER D
GOVERNMENT HEALTH CLINIC E
OTHER PUBLIC (SPECIFY) __________ F
OTHER PRIVATE MEDICAL (SPECIFY) __________ H
409) How many months pregnant were you when you first received a checkup for this pregnancy?
[answer only for last birth.]
DON'T KNOW 98
410) How many times did you receive prenatal checkups during this pregnancy?
[answer only for last birth.]
DON'T KNOW 98
411) As part of your prenatal checkups during this pregnancy, did anyone ever:
[answer only for last birth.]
NO 2
NO 2
NO 2
NO 2
412) During any of your prenatal checkups, did anyone ever tell you about the danger signs in pregnancy?
[answer only for last birth.]
NO 2 (GO TO 414)
DON'T KNOW 8 (GO TO 414)
413) Did anyone ever tell you where to go if you had any of these danger signs?
[answer only for last birth.]
NO 2
DON'T KNOW 8
414) During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus or jerking after birth?
[answer only for last birth.]
NO 2 (GO TO 417)
DON'T KNOW 8 (GO TO 417)
415) During this pregnancy, how many times did you get a tetanus injection?
[answer only for last birth.]
DON'T KNOW 8
[answer only for last birth.]
OTHER
417) Before this pregnancy, did you ever receive any tetanus injection?
[answer only for last birth.]
NO 2 (GO TO 421)
DON'T KNOW 8 (GO TO 421)
418) Before this pregnancy, how many times did you receive a tetanus injection?
[answer only for last birth.]
IF 7 OR MORE TIMES, WRITE '7'.
DON'T KNOW 8
419) In what month and year did you receive the last tetanus injection before this pregnancy?
[answer only for last birth.]
DON'T KNOW 98
DON'T KNOW YEAR 9998
420) How many years ago did you receive that tetanus injection?
[answer only for last birth.]
421) During this pregnancy, were you given or did you buy any iron tablets? SHOW TABLETS.
[answer only for last birth.]
NO 2 (GO TO 423)
DON'T KNOW 8 (GO TO 423)
422) During the whole pregnancy, how many days did you take the tablets? TRY TO GET A NUMBER
[answer only for last birth.]
DON'T KNOW 998
423) During this pregnancy, did you take any worm medicine?
[answer only for last birth.]
NO 2
DON'T KNOW 8
426) During this pregnancy, did you take any medicine to keep you from getting malaria?
[answer only for last birth.]
NO 2 (GO TO 432)
DON'T KNOW 8 (GO TO 432)
427) What medicine did you take? RECORD ALL MENTIONED.
[answer only for last birth.]
CHLOROQUINE B
OTHER (SPECIFY) _________ X
DON'T KNOW Z
432) When (NAME) was born, was he/she big, normal, or small?
IF BIG: Was he/she bigger than normal or very big?
IF SMALL: Was he/she smaller than normal or very small?
BIGGER THAN NORMAL 2
NORMAL 3
SMALLER THAN NORMAL 4
VERY SMALL 5
DON'T KNOW 8
433) Was (NAME) weighed at birth?
NO 2 (GO TO 435)
DON'T KNOW 8 (GO TO 435)
434) How much did (NAME) weigh?
RECORD IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE
KG FROM RECALL 2
DON'T KNOW 99.998
435) Who delivered you? Anyone else?
PROBE FOR THE TYPE(S) OF PERSON(S) AND CIRCLE ALL MENTIONED.
IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO FIND OUT IF ANY ADULTS WERE PRESENT AT THE DELIVERY.
NURSE/MIDWIFE B
PHYSICIAN ASSIST C
RELATIVE/FRIEND E
OTHER (SPECIFY) __________ X
436) Where did you deliver (NAME)?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OF PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE) ______________
CHURCH FACILITIES ARE CONSIDERED PRIVATE.
OTHER HOME 12 (GO TO 443)
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH CLINIC 23
OTHER PUBLIC (SPECIFY) __________ 26
OTHER PRIVATE MEDICAL (SPECIFY) __________ 36
437) How long after (NAME) was delivered did you stay there?
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS 2
WEEKS 3
DON'T KNOW 998
438) Was (NAME) delivered by C-section?
NO 2
439) After (NAME) was born but before you left the health facility, did any health worker check on your health?
NO 2 (GO TO 442)
440) How long after delivery did he/she first check you?
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.
[answer only for last birth.]
DAYS 2
WEEKS 3
DON'T KNOW 998
441) Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[answer only for last birth.]
NURSE/MIDWIFE 12 (GO TO 453)
PHYSICIAN ASSISTANT 13 (GO TO 453)
TRADITIONAL MIDWIFE 21 (GO TO 453)
442) After you left the facility, did any health care provider or traditional midwife check on your health?
NO 2 (GO TO 453)
443) Why didn't you deliver in a health facility? PROBE: Any other reason?
RECORD ALL MENTIONED.
[answer only for last birth.]
FACILITY NOT OPEN B
TOO FAR/NO TRANSPORTATION C
DON'T TRUST FACILITY/POOR QUALITY SERVICE D
NO FEMALE PROVIDER AT FACILITY E
HUSBAND/FAMILY DID NOT ALLOW F
NOT NECESSARY G
NOT CUSTOMARY H
OTHER (SPECIFY) ____________ X
444) After (NAME) was born, did any health worker or traditional midwife check on your health?
NO 2 (GO TO 449)
445) How long after delivery did he/she first check you?
IF LESS THAN 1 DAY, WRITE HOURS. IF LESS THAN 1 WEEK, WRITE DAYS.
[answer only for last birth.]
DAYS 2
WEEKS 3
DON'T KNOW 998
446) Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[answer only for last birth.]
NURSE/MIDWIFE 12
PHYSICIAN ASST. 13
TRADITIONAL MIDWIFE 21
447) Where did this first check take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE) ________________
[answer only for last birth.]
OTHER HOME 12
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH CLINIC 23
OTHER PUBLIC (SPECIFY) ___________ 26
OTHER PRIVATE MEDICAL (SPECIFY) _________ 36
[answer only for last birth.]
NOT ASKED
449) During the first two months after (NAME) was born, did any health worker or traditional midwife check on the baby's health?
[answer only for last birth.]
NO 2 (GO TO 453)
DON'T KNOW 8 (GO TO 453)
450) How many hours, days or weeks after (NAME) was born, did he/she receive a checkup?
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.
[answer only for last birth.]
DAYS AFTER BIRTH 2
WEEKS AFTER BIRTH 3
DON'T KNOW 998
451) Who checked on (NAME)'s health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[answer only for last birth.]
NURSE/MIDWIFE 12
PHYSICIAN ASST. 13
TRADITIONAL MIDWIFE 21
452) Where did this first check of (NAME) take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE) ______________
[answer only for last birth.]
OTHER HOME 12
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH CLINIC 23
OTHER PUBLIC (SPECIFY) _________ 26
OTHER PRIVATE MEDICAL (SPECIFY) ___________ 36
453) During the first two months after (NAME) was born, did you receive a vitamin A dose like this? SHOW CAPSULES.
[answer only for last birth.]
NO 2
DON'T KNOW 8
454) Has your period returned since the birth of (NAME)?
[answer only for last birth.]
NO 2 (GO TO 457)
455) Did you receive your period between the birth of (NAME) and your next pregnancy?
[answer for all except last birth.]
NO 2 (GO TO 459)
456) For how many months after the birth of (NAME) did you not have your period?
DON'T KNOW 98
457) CHECK 226: IS RESPONDENT PREGNANT?
[answer only for last birth.]
PREGNANT OR UNSURE (GO TO 459)
458) Have you started men business again since the birth of (NAME)?
[answer only for last birth.]
NO 2 (GO TO 460)
459) For how many months after the birth of (NAME) did you not do men business?
DON'T KNOW 98
460) Did you ever give titi to (NAME)?
NO 2 (GO TO 467)
461) How long after you delivered did you first give (NAME) titi?
IF LESS THAN 1 HOUR, RECORD '00' HOURS.
IF LESS THAN 24 HOURS, RECORD HOURS.
OTHERWISE, RECORD DAYS.
[answer only for last birth.]
HOURS 1
DAYS 2
462) In the first three days after delivery, did anyone give (NAME) anything to drink besides titi?
[answer only for last birth.]
NO 2 (GO TO 464)
463) What was (NAME) given to drink? Anything else? RECORD ALL LIQUIDS MENTIONED.
[answer only for last birth.]
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
464) CHECK 404: IS CHILD LIVING?
[answer only for last birth.]
DEAD (GO TO 466)
465) Are you still giving titi to (NAME)?
[answer only for last birth.]
NO 2
466) For how many months did you give titi to (NAME)?
DON'T KNOW 98
STILL BF 95
DON'T KNOW 98
467) CHECK 404: IS CHILD LIVING?
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501)
468) How many times did you give titi last night?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.
[answer only for last birth.]
469) How many times did you give titi yesterday during the daytime?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.
[answer only for last birth.]
470) Did (NAME) drink anything from a bottle with a nipple yesterday or last night?
NO 2
DON'T KNOW 8
471) GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501.
SECTION 5. CHILD IMMUNIZATION AND HEALTH AND CHILD AND WOMAN'S NUTRITION
501) ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2001 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).
DEAD (GO TO 503 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 573)
504) Do you have a vaccination card for (NAME)? IF YES: May I see it please?
YES, NOT SEEN 2 (GO TO 508)
NO CARD 3
505) Did you ever have a vaccination card for (NAME)?
NO 2 (GO TO 508)
(1) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD. (2)
(2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED.
(3) IF MORE THAN 2 VITAMIN 'A' DOSES, WRITE DATES FOR MOST RECENT AND SECOND MOST RECENT DOSES.
DAY
YEAR
DAY
YEAR
DAY
YEAR
DAY
YEAR
DAY
YEAR
DAY
YEAR
DAY
YEAR
DAY
YEAR
DAY
YEAR
DAY
YEAR
DAY
YEAR
DAY
YEAR
OTHER
507) Has (NAME) received any vaccinations that are not written on this card, including vaccinations received in a national immunization day campaign?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, AND/OR MEASLES VACCINES.
NO 2 (GO TO 510)
DON'T KNOW 8 (GO TO 510)
508) Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases, including vaccinations received in a national immunization campaign?
NO 2 (GO TO 512)
DON'T KNOW 8 (GO TO 512)
509A) A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually leaves a mark?
NO 2
DON'T KNOW 8
509B) Polio vaccine, that is, drops in the mouth?
NO 2 (GO TO 509E)
DON'T KNOW 8 (GO TO 509E)
509C) The first time (NAME) got the polio vaccine, was it in the first two weeks after he/she was born or later?
LATER 2
509D) How many times did (NAME) get the polio vaccine?
509E) A DPT vaccination, that is, an injection given in the thigh, sometimes at the same time as polio drops?
NO 2 (GO TO 509G)
DON'T KNOW 8 (GO TO 509G)
509F) How many times did (NAME) get a DPT vaccination?
509G) A measles injection - that is a shot in the arm at about age 9 months or older- to prevent him/her from getting measles?
NO 2
DON'T KNOW 8
510) Were any of the vaccinations (NAME) received during the last two years given as part of a national immunization day campaign?
NO 2
NO VACCINATION IN THE LAST 2 YEARS 3
DON'T KNOW 8
512) CHECK 506: DATE SHOWN FOR VITAMIN A DOSE
NO CARD/CODE '44' FOR MOST RECENT VITAMIN A DOSE (GO TO 514)
513) According to (NAME)'s health card, he/she received a vitamin A dose like this (SHOW CAPSULE) in (DATE OF MOST RECENT DOSE FROM CARD). Has (NAME) received another vitamin A dose since then?
NO 2 (GO TO 516)
DON'T KNOW 8 (GO TO 516)
514) HAS (NAME) ever received a vitamin A dose like this? SHOW CAPSULE
NO 2 (GO TO 516)
DON'T KNOW 8 (GO TO 516)
515) Did (NAME) receive a vitamin A dose during the last six months?
NO 2
DON'T KNOW 8
516) During the last 7 days, did (NAME) take iron tablets pills like these? SHOW IRON TABLETS
NO 2
DON'T KNOW 8
517) Has (NAME) taken any worm medicine in the last six months?
NO 2
DON'T KNOW 8
518) Has (NAME) had running stomach in the last 2 weeks?
NO 2 (GO TO 533)
DON'T KNOW (GO TO 533)
519) Was there any blood in the stool?
NO 2
DON'T KNOW 8
520) When (NAME) had running stomach, was he/she given less than usual to drink, about the same amount, or more than usual to drink, including titi?
IF LESS, ASK: Was it much less than usual to drink or somewhat less?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8
521) When (NAME) had running stomach, was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, ASK: Was it much less than usual to eat or somewhat less?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8
522) Did you get treatment for the running stomach from anywhere?
NO 2 (GO TO 527)
523) Where did you get treatment from? Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
(NAME OF THE PLACE(S)) ____________________
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH CLINIC C
OTHER PUBLIC (SPECIFY) ____________ D
PHARMACY F
PRIVATE DOCTOR G
MOBILE CLINIC H
OTHER PRIVATE MEDICAL (SPECIFY) ______________ I
TRADITIONAL PRACTITIONER N
ONLY ONE CODE CIRCLED (GO TO 526)
525) Where did you go first for treatment? USE LETTER CODE FROM 523.
526) How many days after the running stomach began did you first go for treatment for (NAME)? IF THE SAME DAY, RECORD '00'.
527) Does (NAME) still have running stomach?
NO 2
DON'T KNOW 8
528) Since the running stomach began, did anyone give (NAME):
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
529) Was anything (else) given to treat the running stomach?
NO 2 (GO TO 533)
DON'T KNOW 8 (GO TO 533)
530) What (else) was given to treat the running stomach? Anything else? RECORD ALL TREATMENTS GIVEN.
FLAGYL B
ZINC C
OTHER PILL D
UNKNOWN PILL OR SYRUP E
NON-ANTIBIOTIC G
UNKNOWN INJECTION H
HOME REMEDY/HERBAL MEDICINE J
OTHER (SPECIFY) __________ X
533) Has (NAME) had fever in the last 2 weeks?
NO 2
DON'T KNOW 8
534) Has (NAME) had a cough in the last 2 weeks?
NO 2 (GO TO 537)
DON'T KNOW 8 (GO TO 537)
535) When (NAME) had a cough, did he/she breathe faster than usual with short, rapid breaths or have a hard time breathing?
NO 2 (GO TO 538)
DON'T KNOW 8 (GO TO 538)
536) Was the fast or hard time breathing due to a problem in the chest or to a blocked or runny nose?
NOSE ONLY 2 (GO TO 538)
BOTH 3 (GO TO 538)
OTHER (SPECIFY) ___________ 6 (GO TO 538)
DON'T KNOW 8 (GO TO 538)
NO OR DON'T KNOW (GO BACK TO 503 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 573)
538) When (NAME) had (fever/cough), was he/she given less than usual to drink, about the same amount, or more than usual to drink, including titi? IF LESS, ASK: Was it much less than usual to drink or somewhat less?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8
539) When (NAME) had a (fever/cough), was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat? IF LESS, ASK: Was it much less than usual to eat or somewhat less?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8
540) Did you get treatment for the fever/cough from anywhere?
NO 2 (GO TO 545)
541) Where did you get treatment from? Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S)) _________________
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH CLINIC C
OTHER PUBLIC (SPECIFY) ___________ D
PHARMACY F
PRIVATE DOCTOR G
MOBILE CLINIC H
OTHER PRIVATE MEDICAL (SPECIFY) ___________ I
TRADITIONAL PRACTITIONER N
ONLY ONE CODE CIRCLED (GO TO 544)
543) Where did you go first for treatment? USE LETTER CODE FROM 541.
544) How many days after the illness began did you first go for treatment for (NAME)? IF THE SAME DAY, RECORD '00'.
545) Does (NAME) still have (fever cough)?
COUGH ONLY 2
BOTH FEVER AND COUGH 3
NO, NEITHER 4
DON'T KNOW 8
546) During the sickness, did (NAME) take any medicine?
NO 2 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, TO 573)
DON'T KNOW 8 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, TO 573)
547) What type of medicine did (NAME) take? Any other drugs? RECORD ALL MENTIONED.
NEW MALARIA TABLET= ARTEMISININ COMBINATION
CHLOROQUINE B
AMODIAQUINE C
QUININE D
NEW MALARIA TABLET E
OTHER ANTI-MALARIAL (SPECIFY) _____________________ G
INJECTION I
PARACETEMOL K
DON'T KNOW Z
548) CHECK 547: ANY CODE A-H CIRCLED?
NO (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573)
549) Did you already have (NAME OF MEDICINE FROM 547) at home when the child got sick?
ASK SEPERATELY FOR EACH OF THE DRUGS 'A' THROUGH 'H' THE CHILD IS RECORDED AS HAVING TAKEN IN 547
IF YES FOR ANY DRUG, CIRCLE CODE FOR THAT DRUG.
IF NO FOR ALL DRUGS, CIRCLE 'Y'
CHLOROQUINE B
AMODIAQUINE C
QUININE D
NEW MALARIA TABLET E
OTHER ANTIMALARIAL G
NO DRUG AT HOME Y
572) GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573.
573) CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2001 OR LATER LIVING WITH THE RESPONDENT
574) The last time (NAME FROM 573) passed stool, what did you do with the stool?
PUT/RINSED INTO TOILET OR LATRINE 02
PUT/RINSED INTO DRAIN OR DITCH 03
THROWN INTO GARBAGE 04
BURIED 05
LEFT IN THE OPEN 06
OTHER (SPECIFY) ____________ 96
575) CHECK 528(a), ALL COLUMNS:
ANY CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 577)
576) Have you ever heard of ORS or oral rehydration salts, a medicine for running stomach?
NO 2
577) CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2003 OR LATER LIVING WITH THE RESPONDENT
578) Yesterday, during the day or night, did (NAME FROM 577) drink:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
579) Now I would like to ask you about (other) liquids or foods that (NAME FROM 577)/you may have had yesterday during the day or at night. I am interested in whether your child/you had the item even if it was combined with other foods.
Did (NAME FROM 577)/you drink (eat):
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
580) CHECK 578 (LAST CATEGORY:PORRIDGE) AND 579 (CATEGORIES d THROUGH s FOR CHILD):
NOT A SINGLE "YES" (GO TO 601)
581) How many times did (NAME FROM 577) eat any food yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.
DON'T KNOW 8
SECTION 6. MARRIAGE AND SEXUAL ACTIVITY
601) Are you currently married or living together with a man as if married?
YES, LIVING WITH A MAN 2 (GO TO 604)
NO, NOT IN UNION 3
602) Have you ever been married or lived together with a man as if married?
YES, LIVED WITH A MAN 2
NO 3 (GO TO 617)
603) What is your marital status now: are you widowed, divorced, or separated?
DIVORCED 2 (GO TO 609)
SEPARATED 3 (GO TO 609)
604) Is your husband/partner living with you now or is he staying somewhere else?
STAYING ELSEWHERE 2
605) RECORD THE HUSBAND'S/PARTNER'S NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.
LINE NUMBER
606) Does your husband/partner have other wives or does he live with other women as if married?
NO 2 (GO TO 609)
DON'T KNOW 8 (GO TO 609)
607) Including yourself, in total, how many wives or partners does your husband live with now as if married?
DON'T KNOW 98
608) Are you the first, second, ... wife?
609) Have you been married or lived with a man only once or more than once?
MORE THAN ONCE 2
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
616) How old were you when you first started living with him?
617) CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
618) Now I need to ask you some questions about men business. How old were you when you did men business for the first time?
AGE IN YEARS (GO TO 621)
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95 (GO TO 621)
AGE 25-49 (GO TO 641)
620) Do you plan to wait until you get married to do men business?
NO 2 (GO TO 641)
DON'T KNOW/UNSURE 8 (GO TO 641)
AGE 25-49 (GO TO 626)
622) The first time you did men business, did you use a condom?
NO 2
DON'T KNOW/DON'T REMEMBER 8
623) How old was the man you first did men business with?
DON'T KNOW 98
624) Was he older than you, younger than you, or about the same age as you?
YOUNGER 2 (GO TO 626)
ABOUT THE SAME AGE 3 (GO TO 626)
DON'T KNOW/DON'T REMEMBER 8 (GO TO 626)
625) Would you say he was ten or more years older than you or less than ten years older than you?
LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3
626) When was the last time you did men business?
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.
WEEKS AGO 2
MONTHS AGO 3
YEARS AGO 4 (GO TO 640)
626A) Now I want to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If I ask you any question that you don't want to answer, just let me know and we will go to the next question. (GO TO 628)
627) When was the last time you did men business with this man?
[answer only for second-to-last and third-to-last sexual partner]
WEEKS 2
MONTHS 3
628) The last time you did men business with this (second/third) man, did he use a condom?
NO 2 (GO TO 630)
629) Did he use a condom every time you did men business with him in the last 12 months?
NO 2
630) What was your relationship to this man?
IF BOYFRIEND: Were you living together as if married?
IF YES, CIRCLE '2'.
IF NO, CIRCLE '3'.
LIVE-IN PARTNER 2 (GO TO 636)
BOYFRIEND NOT LIVING WITH RESPONDENT 3
CASUAL ACQUAINTANCE 4
PROSTITUTE 5
OTHER (SPECIFY) ___________ 6
631) How long (have you done/did you do) men business with him?
IF ONLY HAD SEX WITH THIS PERSON ONCE, RECORD '01' DAYS.
MONTHS 2
YEARS 3
AGE 25-49 (GO TO 636)
DON'T KNOW 98
634) Is he older than you, younger than you, or about the same age?
YOUNGER 2 (GO TO 636)
SAME AGE 3 (GO TO 636)
DON'T KNOW 8 (GO TO 636)
635) Would you say he is ten or more years older than you or less than ten years older than you?
LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3
636) The last time you did men business with this person, did you or he drink alcohol?
NO 2 (GO TO 638)
637) Were you or your partner drunk at that time? IF YES: Who was drunk?
PARTNER ONLY 2
RESPONDENT AND PARTNER BOTH 3
NEITHER 4
638) Apart from [this person/these two people], did you do men business with any other person in the last 12 months?
[answer only for last and second-to-last sexual partner]
NO 2 (GO TO 639A)
639) In the last 12 months, how many men have you done men business with?
PROBE TO GET AN ESTIMATE.
IF MORE THAN 96, WRITE '95'.
[answer only for third-to-last sexual partner]
DON'T KNOW 98
639A) In the last 12 months, did you ever give or receive money, gifts or favors in return for doing men business?
NO 2
640) In your whole life, how many men have you done men business with?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF MORE THAN 95, WRITE '95'.
DON'T KNOW 98
641) Do you know of a place where a person can get condoms?
NO 2 (GO TO 701)
642) Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S)) __________________
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH CLINIC C
NACP D
OTHER PUBLIC (SPECIFY) _____________ E
PHARMACY G
PRIVATE DOCTOR H
FAMILY PLANNING ASSN. LIBERIA I
MOBILE CLINIC J
OTHER PRIVATE MEDICAL (SPECIFY) _______________ K
CHURCH M
FRIEND/RELATIVE N
643) If you wanted to, could you yourself get a condom?
NO 2
DON'T KNOW/UNSURE 8
SECTION 7. FERTILITY PREFERENCES
701) CHECK 311/311A:
HE OR SHE STERILIZED (GO TO 713)
NO MORE/NONE 2 (GO TO 704)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 713)
UNDECIDED/DON'T KNOW AND PREGNANT 4 (GO TO 709)
UNDECIDED/DON'T KNOW AND NOT PREGNENT OR UNSURE 5 (GO TO 708)
NO MORE/NONE 2 (GO TO 704)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 713)
UNDECIDED/DON'T KNOW AND PREGNANT 4 (GO TO 709)
UNDECIDED/DON'T KNOW AND NOT PREGNENT OR UNSURE 5 (GO TO 708)
YEARS 2
SOON/NOW 993 (GO TO 708)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 713)
AFTER MARRIAGE 995 (GO TO 708)
OTHER (SPECIFY) ___________ 996 (GO TO 708)
DON'T KNOW 998 (GO TO 708)
YEARS 2
SOON/NOW 993 (GO TO 708)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 713)
AFTER MARRIAGE 995 (GO TO 708)
OTHER (SPECIFY) ___________ 996 (GO TO 708)
DON'T KNOW 998 (GO TO 708)
PREGNANT (GO TO 709)
705) CHECK 310: USING A CONTRACEPTIVE METHOD?
NOT CURRENTLY USING
CURRENTLY USING (GO TO 713)
24 OR MORE MONTHS OR 02 OR MORE YEARS
00-23 MONTHS OR 00-01 YEAR (GO TO 709)
WANTS TO HAVE A/ANOTHER CHILD
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
SUBFECUND/INFECUND E
POSTPARTUM AMENORRHEIC F
BREASTFEEDING G
FATALISTIC H
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
KNOWS NO SOURCE N
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COSTS TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY'S NORMAL PROCESSES T
DON'T KNOW Z
WANTS NO MORE/NONE
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
SUBFECUND/INFECUND E
POSTPARTUM AMENORRHEIC F
BREASTFEEDING G
FATALISTIC H
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
KNOWS NO SOURCE N
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COSTS TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY'S NORMAL PROCESSES T
DON'T KNOW Z
708) CHECK 310: USING A CONTRACEPTIVE METHOD?
NO, NOT CURRENTLY USING
YES, CURRENTLY USING (GO TO 713)
709) Do you think you will use family planning any time in the future?
NO 2 (GO TO 711)
DON'T KNOW 8 (GO TO 713)
710) Which method would you prefer to use?
MALE STERILIZATION 02 (GO TO 713)
PILL 03 (GO TO 713)
IUD 04 (GO TO 713)
INJECTABLES 05 (GO TO 713)
IMPLANTS 06 (GO TO 713)
CONDOM 07 (GO TO 713)
FEMALE CONDOM 08 (GO TO 713)
RHYTHM METHOD 09 (GO TO 713)
WITHDRAWAL 10 (GO TO 713)
OTHER (SPECIFY) ______________ 96 (GO TO 713)
UNSURE 98 (GO TO 713)
711) Why do you think you will not use a family planning method any time in the future?
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 713)
SUBFECUND/INFECUND 24 (GO TO 713)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (GO TO 713)
HUSBAND/PARTNER OPPOSED 32 (GO TO 713)
OTHERS OPPOSED 33 (GO TO 713)
RELIGIOUS PROHIBITION 34 (GO TO 713)
KNOWS NO SOURCE 42 (GO TO 713)
FEAR OF SIDE EFFECTS 52 (GO TO 713)
LACK OF ACCESS/TOO FAR 53 (GO TO 713)
COSTS TOO MUCH 54 (GO TO 713)
INCONVENIENT TO USE 55 (GO TO 713)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 713)
DON'T KNOW 98 (GO TO 713)
712) Would you ever use a family planning method if you were married?
NO 2
DON'T KNOW 8
NUMBER
OTHER (SPECIFY) ______________ 96 (GO TO 715)
NUMBER
OTHER (SPECIFY) ______________ 96 (GO TO 715)
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 GIRLS
NUMBER EITHER
OTHER (SPECIFY) _______________ 96
715) In the last few months, have you:
NO 2
NO 2
NO 2
YES, LIVING WITH A MAN
NO, NOT IN UNION (GO TO 801)
NO CODE CIRCLED (GO TO 722)
OTHER
719) Does your husband/partner know that you are using a method of family planning?
NO 2
DON'T KNOW 8
720) Would you say that using family planning is mainly your decision, mainly your husband's/partner's decision, or did you both decide together?
MAINLY HUSBAND/PARTNER 2
JOINT DECISION 3
OTHER (SPECIFY) __________ 6
HE OR SHE STERILIZED (GO TO 801)
722) Does your husband/partner want the same number of children that you want, or does he want more or fewer than you want?
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8
SECTION 8. HUSBAND'S BACKGROUND AND WOMAN'S WORK
801) CHECK 601 AND 602:
FORMERLY MARRIED/LIVED WITH A MAN (GO TO 803)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 807)
802) How old is/was your husband/partner?
803) Did your (last) husband/partner ever go to school?
NO 2 (GO TO 806)
804) What was the highest level of school he attended: primary, secondary, or higher?
SECONDARY 2
HIGHER 3
DON'T KNOW 8 (GO TO 806)
805) What was the highest grade he completed at that level?
DON'T KNOW 98
807) Aside from your own housework, have you done any work in the last seven days?
NO 2
808) As you know, some women do jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business. In the last seven days, have you done any of these things or any other work?
NO 2
809) Do you have any job or business from which you were absent for leave, illness, vacation, maternity leave or any other such reason?
NO 2
810) Have you done any work in the last 12 months?
NO 2 (GO TO 818)
811) What is your occupation, that is, what kind of work do you mainly do?
DOES NOT WORK IN AGRICULTURE (GO TO 814)
813) Do you work mainly on your own land or on family land, or do you work on land that you rent from someone else, or do you work on someone else's land?
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
COMMUNAL LAND 5
814) Do you do this work for a member of your family, for someone else, or are you self-employed?
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3
815) Do you usually work at home or away from home?
AWAY 2
816) Do you usually work throughout the year, or do you work seasonally, or only once in a while?
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3
817) Are you paid in cash or kind for this work or are you not paid at all?
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4
NOT IN UNION (GO TO 827)
OTHER (GO TO 822)
820) Who usually decides how the money that you earn will be used: mainly you, mainly your husband/partner, or you and your husband/partner jointly?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
OTHER (SPECIFY) ____________ 6
821) Would you say that the money that you earn is more than what your husband/partner earns, less than what he earns, or about the same?
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND/PARTNER HAS NO EARNINGS 4 (GO TO 823)
DON'T KNOW 8
822) Who usually decides how your husband's/partner's earnings will be used: you, your husband/partner, or you and your husband/partner jointly?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
HUSBAND/PARTNER HAS NO EARNINGS 4
OTHER (SPECIFY) ________________ 6
823) Who usually makes decisions about whether to borrow money and how much?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6
824) Who usually makes decisions about making major purchases for the household?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6
825) Who usually makes decisions about day-to-day food purchasing and cooking arrangements?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6
826) Who usually makes decisions about visits to your family or relatives?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6
827) PRESENCE OF OTHERS AT THIS POINT (PRESENT AND LISTENING, PRESENT BUT NOT LISTENING, OR NOT PRESENT)
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
828) Sometimes a man can get annoyed or angry because of things his wife does. Do you think a husband is justified in hitting or beating his wife in the following situations:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
901) Now I would like to talk about something else. Have you ever heard of an illness called AIDS?
NO 2 (GO TO 942)
902) Can people reduce their chance of getting the AIDS virus by having just one uninfected sex partner who has no other sex partners?
NO 2
DON'T KNOW 8
903) Can people get the AIDS virus from mosquito bites?
NO 2
DON'T KNOW 8
904) Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex?
NO 2
DON'T KNOW 8
905) Can people get the AIDS virus by sharing food with a person who has AIDS?
NO 2
DON'T KNOW 8
906) Can people reduce their chance of getting the AIDS virus by not having sexual intercourse at all?
NO 2
DON'T KNOW 8
907) Can people get the AIDS virus because of witchcraft or other supernatural means?
NO 2
DON'T KNOW 8
908) Is it possible for a healthy-looking person to have the AIDS virus?
NO 2
DON'T KNOW 8
909) Can the virus that causes AIDS be transmitted from a mother to her baby:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
OTHER (GO TO 912)
911) Are there any special drugs that a doctor or a nurse can give to a woman infected with the AIDS virus to reduce the risk of transmission to the baby?
NO 2
DON'T KNOW 8
912) Have you heard about antiretroviral drugs that people infected with the AIDS virus can get from a doctor or nurse to help them live longer?
NO 2
DON'T KNOW 8
922) I don't want to know the results, but have you ever gone for an AIDS test?
NO 2 (GO TO 927)
923) When was the last time you were tested?
12-23 MONTHS AGO 2
2 OR MORE YEARS AGO 3
924) The last time you had the test, did you ask for the test, was it offered to you and you accepted, or was it required?
OFFERED AND ACCEPTED 2
REQUIRED 3
925) I don't want to know the results, but did you get the results of the test?
NO 2
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE) _____________
GOVERNMENT HEALTH CENTER 12 (GO TO 929)
GOVERNMENT HEALTH CLINIC 13 (GO TO 929)
STAND-ALONE VCT CENTER 14 (GO TO 929)
NACP 15 (GO TO 929)
OTHER PUBLIC (SPECIFY) ____________ 16 (GO TO 929)
PRIVATE DOCTOR 22 (GO TO 929)
STAND-ALONE VCT CENTER 23 (GO TO 929)
PHARMACY 24 (GO TO 929)
FAMILY PLANNING ASSN. LIBERIA 25 (GO TO 929)
MOBILE CLINIC 26 (GO TO 929)
OTHER PRIVATE MEDICAL (SPECIFY) _____________ 27 (GO TO 929)
OTHER (SPECIFY) ________ 96 (GO TO 929)
927) Do you know of a place where people can go to get tested for the AIDS virus?
NO 2 (GO TO 929)
928) Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S)) ___________________
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH CLINIC C
STAND-ALONE VCT CENTER D
NACP E
OTHER PUBLIC (SPECIFY) ____________ F
PRIVATE DOCTOR H
STAND-ALONE VCT CENTER I
PHARMACY J
FAMILY PLANNING ASSN. LIBERIA K
MOBILE CLINIC L
OTHER PRIVATE MEDICAL (SPECIFY) _____________ M
OTHER (SPECIFY) ________ X
929) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?
NO 2
DON'T KNOW 8
930) If a member of your family got infected with the AIDS virus, would you want it to remain a secret or not?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
931) If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
932) In your opinion, if a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in the school?
SHOULD NOT BE ALLOWED 2
DON'T KNOW/NOT SURE/DEPENDS 8
940) Should children age 12-14 be taught about using a condom to avoid getting AIDS?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
941) Should children age 12-14 be taught to wait until they get married to do men business in order to avoid getting AIDS?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
NO 2
NO 2
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 951)
944) CHECK 942: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?
NO (GO TO 946)
945) Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?
NO 2
DON'T KNOW 8
946) Sometimes women get a bad smelling fluid coming from their vagina. During the last 12 months, have you had a bad smelling fluid like this?
NO 2
DON'T KNOW 8
947) Sometimes women have a sore on or near their vagina. During the last 12 months, have you had a sore near your vagina?
NO 2
DON'T KNOW 8
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 951)
949) The last time you had (PROBLEM FROM 945/946/947), did you go for treatment?
NO 2 (GO TO 951)
950) Where did you go? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S)) _______________________
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH CLINIC C
STAND-ALONE VCT CENTER D
OTHER PUBLIC (SPECIFY) ____________ E
PRIVATE DOCTOR G
STAND-ALONE VCT CENTER H
PHARMACY I
FAMILY PLANNING ASSN. LIBERIA J
MOBILE CLINIC K
OTHER PRIVATE MEDICAL (SPECIFY) _____________ L
OTHER (SPECIFY) ________ X
951) Husbands and wives do not always agree on everything. If a wife knows her husband has a disease that she can get from doing men business, is she justified in refusing to do men business with him?
NO 2
DON'T KNOW 8
952) If a wife knows her husband has a disease that she can get from doing men business, is she justified in asking that they use a condom when they do men business?
NO 2
DON'T KNOW 8
953) Is a wife justified in refusing to do men business with her husband when she is tired or not in the mood?
NO 2
DON'T KNOW 8
954) Is a wife justified in refusing to do men business with her husband when she knows her husband has sex with women other than his wife?
NO 2
DON'T KNOW 8
NOT IN UNION (GO TO 958)
956) Can you say no to your husband/partner if you do not want to do men business?
NO 2
DEPENDS/NOT SURE 8
957) Could you ask your husband/partner to use a condom if you wanted him to?
NO 2
DEPENDS/NOT SURE 8
958) Now I would like to ask you about something else. As you know some women belong to bush societies, like the Sande society. Have you heard of these societies?
NO 2 (GO TO 1000)
959) Are you a member of the Sande society or a woman's bush society?
NO 2 (GO TO 1000)
960) Do you think this should continue or should it stop?
STOP 2
DOES NOT KNOW/NOT SURE 8
1000) CHECK HOUSEHOLD QUESTIONNAIRE, LAST PAGE
WOMAN NOT SELECTED (GO TO 1101)
1001) CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED.
PRIVACY NOT POSSIBLE 2 (GO TO 1030)
Now I would like to ask you questions about some other important aspects of a woman's life. I know that some of these questions are very personal. However, your answers are important for helping to understand the condition of women in Liberia. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else will know that you were asked these questions.
FORMERLY MARRIED/LIVED WITH A MAN (READ IN PAST TENSE)
NEVER MARRIED/NEVER LIVED WITH A MAN (GO TO 1014)
1003) First, I am going to ask you about some situations that happen to some women. Please tell me if these apply to your relationship with your (last) husband/partner?
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
1004) Now I need to ask some more questions about your relationship with your (last) husband/partner. If I ask any question that you do not want to answer, just let me know and we will go on to the next question.
1004A) (Does/did) your (last) husband/partner ever:
NO 2
NO 2
NO 2
1004B) CHECK 604: ASK ONLY IF RESPONDENT IS NOT A WIDOW
How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3
SOMETIMES 2
NOT AT ALL 3
SOMETIMES 2
NOT AT ALL 3
1005A) (Does/did) your (last) husband/partner ever do any of the following things to you:
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
1005B) CHECK 604: ASK ONLY IF RESPONDENT IS NOT A WIDOW
How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3
SOMETIMES 2
NOT AT ALL 3
SOMETIMES 2
NOT AT ALL 3
SOMETIMES 2
NOT AT ALL 3
SOMETIMES 2
NOT AT ALL 3
SOMETIMES 2
NOT AT ALL 3
SOMETIMES 2
NOT AT ALL 3
SOMETIMES 2
NOT AT ALL 3
SOMETIMES 2
NOT AT ALL 3
NOT A SINGLE 'YES' (GO TO 1009)
1007) How long after you first got married to/started living with your (last) husband/partner did (this/any of these things) first happen?
IF LESS THAN ONE YEAR, RECORD '00'.
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95
1008) Did the following ever happen as a result of what your (last) husband/partner did to you:
NO 2
NO 2
NO 2
1009) Have you ever hit, slapped, kicked, or done anything else to physically hurt your (last) husband/partner at times when he was not already beating or physically hurting you?
NO 2 (GO TO 1012)
RESPONDENT IS A WIDOW (GO TO 1012)
1011) In the last 12 months, how often have you done this to your husband/partner: often, only sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3
1012) Does (did) your husband/partner drink alcohol?
NO 2 (GO TO 1014)
1013) How often does (did) he get drunk: often, only sometimes, or never?
SOMETIMES 2
NEVER 3
NO 2 (GO TO 1020)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1020)
NO 2 (GO TO 1020)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1020)
1015) Who has hurt you in this way? Anyone else? RECORD ALL MENTIONED.
FATHER/STEP-FATHER B
SISTER/BROTHER C
DAUGHTER/SON D
OTHER RELATIVE E
FORMER HUSBAND/PARTNER F
CURRENT BOYFRIEND G
FORMER BOYFRIEND H
MOTHER-IN-LAW I
FATHER-IN-LAW J
OTHER IN-LAW K
TEACHER L
EMPLOYER/SOMEONE AT WORK M
POLICE/SOLDIER N
OTHER (SPECIFY) _________ X
1016) In the last 12 months, how often have you been hit, slapped, kicked, or physically hurt by this/these person(s): often, only sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3
1020) CHECK 618: EVER HAD SEX?
NEVER HAD SEX (GO TO 1025)
1021) The first time you did men business, would you say you did it because you wanted to, or because you were physically forced to do it against your will?
FORCED TO 2
REFUSED TO ANSWER/NO ANSWER 3
NO 2
REFUSED TO ANSWER/NO ANSWER 3
NO 2
REFUSED TO ANSWER/NO ANSWER 3
OTHER (GO TO 1026)
1024) CHECK 1005(h) and 1005(i):
OTHER (GO TO 1028)
1025) At any time in your life, as a child or as an adult, has anyone ever physically forced you in any way to do men business or perform any other sexual acts?
NO 2 (GO TO 1028)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1028)
1026) How old were you the first time you were forced to do men business or perform any other sexual acts?
DON'T KNOW 98
1027) Who was the person who was forcing you at that time?
FORMER HUSBAND/PARTNER 02
CURRENT/FORMER BOYFRIEND 03
FATHER 04
STEP FATHER 05
OTHER RELATIVE 06
IN-LAW 07
OWN FRIEND/ACQUAINTANCE 08
FAMILY FRIEND 09
TEACHER 10
EMPLOYER/SOMEONE AT WORK 11
POLICE/SOLDIER 12
PRIEST/RELIGIOUS LEADER 13
STRANGER 14
OTHER (SPECIFY) __________ 96
1028) As far as you know, did your father ever beat your mother?
NO 2
DON'T KNOW 8
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.
1029) 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?
YES, MORE THAN ONCE 2
NO 3
YES, MORE THAN ONCE 2
NO 3
YES, MORE THAN ONCE 2
NO 3
1030) INTERVIEWER'S COMMENTS / EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE
SECTION 11. OTHER HEALTH ISSUES
1101) Have you ever heard of an illness called tuberculosis or TB?
NO 2 (GO TO 1105)
1102) How does tuberculosis spread from one person to another? PROBE: Any other ways?
RECORD ALL MENTIONED.
BY SHARING UTENSILS B
BY TOUCHING A PERSON WITH TB C
THROUGH FOOD D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
OTHER (SPECIFY) __________ X
DON'T KNOW Z
1103) Can tuberculosis be cured?
NO 2
DON'T KNOW 8
1104) If a member of your family got tuberculosis, would you want it to remain a secret or not?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
1105) Have you had an injection for any reason in the last 12 months? IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
NONE 00 (GO TO 1109)
1106) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?
IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
NONE 00 (GO TO 1109)
1107) The last time you had an injection given to you by a health worker, where did you go to get the injection?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIAVTE MEDICAL, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE) ______________________
GOVERNMENT HEALTH CENTER 12
GOVERNMENT HEALTH CLINIC 13
OTHER PUBLIC (SPECIFY) ___________ 16
DENTAL CLINIC/OFFICE 22
PHARMACY 23
OFFICE OR HOME OF NURSE/HEALTH WORKER 24
MOBILE CLINIC 25
OTHER PRIVATE MEDICAL (SPECIFY) _______________ 26
1108) Did the person who gave you that injection take the syringe and needle from a new, unopened package?
NO 2
DON'T KNOW 8
1109) Do you currently smoke cigarettes?
NO 2 (GO TO 1111)
1110) In the last 24 hours, how many cigarettes did you smoke?
1111) Do you currently smoke or use any other type of tobacco?
NO 2 (GO TO 1113)
1112) What (other) type of tobacco do you currently smoke or use? RECORD ALL MENTIONED.
CHEWING TOBACCO B
SNUFF C
OTHER (SPECIFY) ___________ X
1113) Many things can prevent women from getting medical care for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem or not?
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
SECTION 12. YOUNG ADULT ISSUES
1201) CHECK 107:
AGE 25-49 (GOT 1301)
1202) Are you currently attending school?
NO 2 (GO TO 1204)
1203) Who is helping to pay for most of your school expenses?
PARENTS 02
RELATIVES 03
ON SCHOLARSHIP 04
HUSBAND/PARTNER 05
BOYFRIEND/LOVER 06
OTHER (SPECIFY) _____________ 96
1204) What advice would you give a female friend of yours if she got pregnant?
HAVE AN ABORTION 2
GET MARRIED 3
DO NOTHING 4
DON'T KNOW 8
OTHER (SPECIFY) ______________ 6
1205) What would you do if you got pregnant now?
IF CURRENTLY PREGNANT: What do you plan to do now that you are pregnant?
HAVE AN ABORTION 2
GET MARRIED 3
DO NOTHING 4
STERILIZED, MENOPAUSAL, SAYS SHE CAN'T GET PREGNANT 5
OTHER (SPECIFY) _________________ 6
DON'T KNOW 8
1206) Have you ever had an abortion?
NO 2 (GO TO 1209)
1207) Where was the abortion performed?
HOSPITAL 2
PRIVATE HOME 3
OTHER (SPECIFY) __________________________ 6
1208) If you got pregnant again, would you abort?
NO 2
DON'T KNOW 8
NO 2
1210) Have you tried any of the following drugs:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
1211) Do you think parents should discuss sex with their children?
NO 2
DON'T KNOW 8
SECTION 13. MATERNAL MORTALITY
1301) Now I want to ask you about your brothers and sisters, I mean all of the children born to your natural mother, including those who are living and those who have died. How many children did your mother give birth to, including you?
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 1314)
1303) How many of these births did your mother have before you were born?
1304) What is/was the name of your oldest (next oldest) brother or sister?
1305) Is (NAME) male or female?
FEMALE 2
NO 2 (GO TO 1308)
DON'T KNOW 8 (GO TO NEXT COLUMN)
1308) How many years ago did (NAME) die?
1309) How old was (NAME) when he/she died?
1310) Was (NAME) pregnant when she died?
NO 2
1311) Did (NAME) die during childbirth?
NO 2
1312) Did (NAME) die within 2 months after the end of a pregnancy or childbirth?
NO 2
1313) How many children did (NAME) born (before this pregnancy)?
IF NO MORE BROTHERS OR SISTERS, GO TO 1314.
MINUTES
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT RESPONDENT:
COMMENTS ON SPECIFIC QUESTIONS:
ANY OTHER COMMENTS:
__________________________________________
NAME OF SUPERVISOR:
DATE:
__________________________________________
NAME OF EDITOR:
DATE: