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NATIONAL SURVEY ON THE POPULATION'S FERTILITY, FAMILY PLANNING, AND HEALTH -1987

INDIVIDUAL QUESTIONNAIRE

WOMAN'S NAME: ____

I IDENTIFICATION:

1) PROVINCE OR PREFECTURE: ____

2) CIRCLE: ____

3) MUNICIPALITY: Autonomous Center/Rural Commune: ____

4) CENTER: ____

5) PRIMARY UNIT NUMBER: ____

6) SECONDARY UNIT NUMBER: ____

7) LEVEL: ____

8) HOUSEHOLD NUMBER: ____

9) WOMAN'S LINE NUMBER: ____

10) HOUSEHOLD ADDRESS: ____

II) VISITS:

11) DATE OF VISIT: ____

12) INTERVIEWER'S NAME: ____

13) RESULT*

*RESULT CODES

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

14) NEXT VISIT INDICATED:

A) DATE: ____

B) TIME: ____

MONTH: ____

YEAR: ____

INTERVIEWER CODE: ____

FINAL RESULT: ____

TOTAL NO. OF VISITS: ____

FIELD EDITED BY:

NAME: ____

DATE: ____

OFFICE EDITED BY:

NAME: ____

DATE: ____

KEYED BY:

NAME: ____

DATE: ____

KEYED BY [CODE]: ____

SECTION 1. WOMAN'S BACKGROUND

101) INTERVIEWER: RECORD THE NUMBER OF PEOPLE LISTED IN THE HOUSEHOLD SCHEDULE.

NUMBER OF PEOPLE: ____

102) INTERVIEWER: RECORD THE NUMBER OF CHILDREN AGED 5 AND UNDER LISTED IN THE HOUSEHOLD SCHEDULE WHO NORMALLY LIVE IN THE HOUSEHOLD.

NUMBER OF CHILDREN AGED 5 AND UNDER: ____

103) INTERVIEWER: RECORD THE EXACT TIME OF THE START OF THE INTERVIEW.

HOUR: ____
MINUTES: ____

104) First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in the countryside, in a town, or in a city?

LARGE CITY 1
TOWN 2
COUNTRYSIDE 3

105) How long have you been living continuously in (NAME OF TOWN, CITY, COUNTRYSIDE)?
(RECORD NAME OF LOCATION)

NAME OF LOCATION: ____
ALWAYS 97 (GO TO 107)
YEARS

106) Just before you moved here, did you live in the countryside, in a town, or in a city?

LARGE CITY 1
TOWN 2
COUNTRYSIDE 3

107) Can you please give me your family booklet, or your birth certificate, or your national identification card?

DOCUMENT OBTAINED:

NONE 1 (GO TO 109)
FAMILY BOOKLET 2
BIRTH CERTIFICATE 3
NATIONAL ID CARD 4
OTHER DOCUMENT 5

108) INTERVIEWER: RECOPY THE MONTH AND THE YEAR OF BIRTH FROM THE DOCUMENT

MONTH: ____
YEAR: ____
(GO TO 111)

109) In what month and what year were you born?

MONTH: ____
DON'T KNOW MONTH 98
YEAR: ____
DON'T KNOW YEAR 98

110) How old were you at your last birthday?
INTERVIEWER: COMPARE AND CORRECT 109 AND/OR 110 IF INCORRECT

AGE IN COMPLETED YEARS: ____

111) Have you ever attended school?

YES 1
NO 2

112) What is the highest level of school you attended: primary, secondary, or higher.

PRIMARY 1
SECONDARY 2
HIGHER 3

113) What is the highest (grade/form/year) you completed at this level?

GRADE: ____

114) INTERVIEWER: CHECK 112 AND TICK THE APPROPRIATE SPACE.

PRIMARY
SECONDARY OR HIGHER (GO TO 116)

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

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO [ILLEGIBLE])

116) Do you usually read a newspaper or magazine at least once a week?

YES 1
NO 2

117) Do you usually watch television at least once a week?

YES 1
NO 2

118) Do you usually listen to the radio every day?

YES 1
NO 2

119) What is the major source of drinking water for members of your household?

PIPED WATER TO HOME 1
PUBLIC TAP 2
WELL 3
RAINWATER TANKER 4
SPRING, [ILLEGIBLE, BUT IN OTHER SIMILAR SECTION, "STREAM"] STREAM 5
BACKWATER, LAKE 6
OTHER (SPECIFY): ____ 7

120) What is the major source of water for your household use other than drinking (e.g. handwashing, cooking) for members of your household?

PIPED WATER TO HOME 01 (GO TO 122)
WELL AT HOME 02 (GO TO 122)
RAINWATER TANKER TO DWELLING 03 (GO TO 122)
OUTSIDE WELL 04
OUTSIDE RAINWATER TANKER 05
PUBLIC FOUNTAIN 06
SPRING, STREAM 07
BACKWATER, LAKE 08
OTHER (SPECIFY): ____ 09

121) How long does it take to go there, get water, and come back?

MINUTES: ____
DELIVERED TO DWELLING 996

122) What kind of toilet facility does your household have?

INDOOR TOILET 1
PRIVATE OUTDOOR TOILET 2
COMMUNAL OUTDOOR TOILET 3
NO TOILET 4
OTHER (SPECIFY): ____ 5

123) What type of lighting do you use in this household?

ELECTRIC GRID 1
GENERATOR 2
BATTERY 3
PETROLEUM LAMP 4
GAS LAMP 5
OIL LAMP 6
CANDLE 7
OTHER (SPECIFY): ____

124) What do you use to cook food?

GAS/ELECTRIC STOVE 1
PRIMUS STOVE (GAS CAMPING STOVE) 2
COAL 3
WOOD/TWIGS 4
OTHER (SPECIFY): ____ 5

125) Does your house have:

A radio?
A television?
A video?
A refrigerator?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
VIDEO
YES 1
NO 2
REFRIGERATOR
YES 1
NO 2

126) Does any member of your household own:

A bicycle?
A motorcycle?
A car?
A truck?
A small truck?
A tractor?
A cart?
A mule/donkey?

BICYCLE
YES 1
NO 2
MOTORCYCLE
YES 1
NO 2
CAR
YES 1
NO 2
TRUCK
YES 1
NO 2
SMALL TRUCK
YES 1
NO 2
TRACTOR
YES 1
NO 2
CART
YES 1
NO 2
MULE/DONKEY
YES 1
NO 2

127) What are the floors of your dwelling made of?

TILE 1
CEMENT 2
CLAY 3
OTHER (SPECIFY): ____ 4

128) What are the walls of your dwelling made of?

STONE OR BRICK COATED WITH MORTAR 1
STONE COATED WITH EARTH 2
UNCOATED STONE OR BRICKS 3
RAMMED EARTH 4
BOARDS/SHEET METAL/BRANCHES/REEDS 5
OTHER (SPECIFY): ____ 6

129) What is the roof of your dwelling made of?

FLAGSTONE 1
BOARDS/REEDS COATED WITH EARTH 2
UNCOATED BOARDS/REEDS 3
SHEET METAL/TIN 4
BOARDS/REEDS 5
OTHER (SPECIFY): ____ 6

130) How many rooms does your household have?

ROOMS: ____

131) What is the occupation status of your dwelling?

OWNER 1
RENTER 2
FREE USAGE 3
OTHER (SPECIFY): ____ 4

132) INTERVIEWER:
CHECK IDENTIFICATION AND CIRCLE APPROPRIATE SPACE.

URBAN 1 (GO TO 201)
RURAL 2

133) Do you have a stable?

YES 1
NO 2 (GO TO 201)

134) Is the stable inside the dwelling or outside of the dwelling?

INSIDE 1
OUTSIDE 2

SECTION 2. MARRIAGE

201) Are you currently a single, married, widowed, or divorced?

MARRIED 1
WIDOWED 2 (GO TO 204)
DIVORCED 3 (GO TO 204)

202) Does your husband have any other wives besides yourself?

YES 1
NO 2 (GO TO 204)

203) How many other wives does he have?

NUMBER: ____
DON'T KNOW 8

204) How many times have you been married?

NUMBER: ____

205) In what month and year did you get married (the first time)?

FALL 21
WINTER 22
SPRING 23
SUMMER 24
MONTH OR SEASON: ____
DON'T KNOW MONTH 98
YEAR: ____ (GO TO 207)
DON'T KNOW YEAR 98

206) How old where you when you got married (the first time)?

AGE: ____

207) Is your father living?

FATHER ALIVE 1
FATHER DEAD 2

208) Is you mother living?

MOTHER ALIVE 1
MOTHER DEAD 2

209) Is your (first) father-in-law living?

FATHER-IN-LAW ALIVE 1
FATHER-IN-LAW DEAD 2
DON'T KNOW 8

210) Is your (first) mother-in-law living?

MOTHER-IN-LAW ALIVE 1
MOTHER-IN-LAW DEAD 2
DON'T KNOW 8

211) INTERVIEWER:
CHECK 207-208-209-210 AND TICK APPROPRIATE SPACE.

ALL ALIVE OR DON'T KNOW (GO TO 214)
AT LEAST ONE PARENT DEAD

212) INTERVIEWER: IN ASKING THE FOLLOWING QUESTION, RECORD THE DECEASED PARENTS
(RECORD DECEASED PARENTS)
Was your (deceased parent) alive at the time you were married (the first time)?
ALIVE:

FATHER
YES 1
NO 2
MOTHER
YES 1
NO 2
FATHER-IN-LAW
YES 1
NO 2
MOTHER-IN-LAW
YES 1
NO 2

213) INTERVIEWER:
CHECK 212 AND TICK APPROPRIATE SPACE

AT LEAST ONE PARENT ALIVE AT MARRIAGE
NO PARENT ALIVE AT MARRIAGE (GO TO 218)

214) Since you began living together, did you and your (first) husband live with any of these parents in the same household for at least 6 continuous months?

YES 1
NO 2 (GO TO 216)

215) For how many years did you live together with a parent at that time?

YEARS 1
UP TO PRESENT 97 (GO TO 218)
DON'T KNOW 98

216) INTERVIEWER: CHECK 201

CURRENTLY MARRIED
OTHER (GO TO 218)

217) Are you now living either with your parents or your husband's parents?

YES 1
NO 2

218) In how many localities have you lived for six months or more since you were first married?

NUMBER OF LOCALITIES: ____
DON'T KNOW 98

219) Is there a family relationship between yourself and your (first) husband?

PATERNAL COUSIN 1
MATERNAL COUSIN 2
OTHER RELATIVE 3
NO RELATIONSHIP 4

SECTION 3. FERTILITY AND INFANT MORTALITY

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

YES 1
NO 2 (GO TO 308)

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

YES 1
NO 2 (GO TO 305)

303) How many sons live with you?
INTERVIEWER: IF NONE, RENTER 00

SONS AT HOME: ____

304) How many daughters live with you?
INTERVIEWER: IF NONE, RENTER 00

DAUGHTERS AT HOME: ____

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

YES 1
NO 2 (GO TO 308)

306) How many sons are alive but do not live with you?
INTERVIEWER: IF NONE, RECODE '00'

SONS ELSEWHERE: ____

307) How many daughters are alive but do not live with you?
INTERVIEWER: IF NONE, RECODE '00'

DAUGHTERS ELSEWHERE: ____

308) Have you ever given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: Did you give birth to a boy or girl who only lived a few hours of a few days?

YES 1
NO 2 (GO TO 311)

309) How many boys have died?
INTERVIEWER: IF NONE, RECORD '00'

BOYS DEAD: ____

310) How many girls have died?
INTERVIEWER: IF NONE, RECORD '00'

GIRLS DEAD: ____

311) INTERVIEWER: SUM ANSWERS TO 303-304-306-307-309, AND ENTER TOTAL

TOTAL: ____

312) Just to makes sure that I have this right: you have had in total ____births during your life. Is that correct?

YES
NO (PROBE AND CORRECT 301-312 AS NECESSARY)

313) INTERVIEWER: CHECK 311 AND TICK APPROPRIATE SPACE:

ONE OR MORE BIRTHS
NO BIRTHS (GO TO 324)

314) Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had.
INTERVIEWER: RECORD NAMES OF ALL THE BIRTHS IN 315

TABLE 1. INTERVIEWER: RECORD THE CHILDREN IN ORDER STARTING WITH THE OLDEST

315) What name was given to your (first, next) baby?

(NAME): ____

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

BOY 1
GIRL 2

317) Can you please give me your family booklet or your birth certificate?

NONE 1
FAMILY BOOKLET 2
BIRTH CERTIFICATE 3
OTHER DOCUMENT 4

318) MONTH AND YEAR OF BIRTH
IF MONTH NOT KNOWN, ASK THE SEASON:

FALL 21
WINTER 22
SPRING 23
SUMMER 24
MONTH/SEASON: ____
YEAR: ____

319) Is (NAME) still alive?

YES 1
NO 2 (GO TO 322)

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

AGE: ____

321) IF ALIVE:
Is he/she living with you?

YES 1
NO 2

322) IF DEAD:
AGE AT DEATH:
RECORD AGE IN DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS, OR YEARS IF TWO YEAR OR MORE.

AGE AT DEATH: ____
DAYS: ____ 1
MONTHS: ____ 2
YEARS: ____ 3

323) INTERVIEWER: COMPARE 311 WITH NUMBER OF BIRTHS IN TABLE 1 ABOVE AND MARK.

NUMBERS ARE THE SAME (GO TO 324)
NUMBERS ARE DIFFERENT-PROBE AND RECONCILE, THEN (GO TO 324)

324) INTERVIEWER: CHECK 201

MARRIED
OTHER (GO TO 311)

325) Are you pregnant?

YES 1
NO 2 (GO TO 227)
UNSURE, DON'T KNOW 98 (GO TO 331)

326) How many months pregnant are you?

MONTHS: ____

327) Have you had an antenatal visit for this pregnancy?

YES 1
NO 2 (GO TO 332)

328) How many visits have you had?

NUMBER: ____

329) Whom did you see the first time?
INTERVIEWER: PROBE FOR TYPE OF PERSON AND RECORD THE LOCATION CODE OR MOST QUALIFIED PERSON

FREE CLINIC 1
HEALTH CENTER 2
MATERNITY 3
HOSPITAL 4
PRIVATE DOCTOR 5
TRADITIONAL BIRTH ATTENDANT 6
OTHER (SPECIFY): ____ 7

330) How many months pregnant were you at this first antenatal visit?

MONTHS: ____
DON'T KNOW 98
(GO TO 332)

331) How long ago did your last menstrual period start?

DAYS 1
WEEKS 2
MONTHS 3
BEFORE LAST PREGNANCY 995
NEVER MENSTRUATED 996
DON'T KNOW 998

332) When during her monthly cycle do you think a woman has the greatest chance of becoming pregnant?

DURING HER PERIOD 1
RIGHT AFTER HER PERIOD HAS ENDED 2
IN THE MIDDLE OF THE CYCLE 3
JUST BEFORE HER PERIOD BEGINS 4
AT ANY TIME 5
OTHER (SPECIFY): ____ 6
DON'T KNOW 8

333) INTERVIEWER: ARE THERE ANY OTHER PEOPLE INVOLVED IN THE INTERVIEW AT THIS SPECIFIC TIME?

CHILDREN UNDER 10
YES 1
NO 2
HUSBAND
YES 1
NO 2
OTHER MEN
YES 1
NO 2
OTHER WOMEN
YES 1
NO 2

SECTION 4. CONTRACEPTION

401) Now I would like to talk about a different topic. There are different traditional or modern ways or methods that a couple can use to delay or avoid pregnancy. Do you know any of these methods or have you heard of them?

INTERVIEWER:
CIRCLE CODE 1 IN 402 FOR EACH METHOD MENTIONED SPONTANEOUSLY.
NEXT READ THE DESCRIPTION FOR EACH METHOD NOT MENTIONED AND CIRCLE CODE 2 IF THE METHOD IS RECOGNIZED OR CODE 3 IF THE WOMAN DOES NOT RECOGNIZE IT.
FINALLY ASK 403 TO 405 FOR EACH METHOD RECOGNIZED BY THE WOMAN.

402) Have you ever heard of this method?

01) PILL
Women can take a pill every day to delay or avoid pregnancy.
YES, SPONTANEOUSLY 1
YES, PROBED 2
NO 3
02) IUD
Women can have a plastic or metal coil or device placed inside their uterus by a doctor (or a midwife).
YES, SPONTANEOUSLY 1
YES, PROBED 2
NO 3
03) INJECTIONS
Women can have an injection by a doctor or a midwife which stops them from becoming pregnant for several months.
YES, SPONTANEOUSLY 1
YES, PROBED 2
NO 3
04) OTHER SCIENTIFIC METHODS
Women can place a diaphragm, a sponge, suppository, jelly, or cream inside themselves before intercourse to avoid pregnancy.
YES, SPONTANEOUSLY 1
YES, PROBED 2
NO 3
05) CONDOM
Men use a condom to avoid getting the woman pregnant.
YES, SPONTANEOUSLY 1
YES, PROBED 2
NO 3
06) FEMALE STERILIZATION
Women can have an operation to avoid having any more children
YES, SPONTANEOUSLY 1
YES, PROBED 2
NO 3
07) VASECTOMY
Men can have an operation to avoid having any more children
YES, SPONTANEOUSLY 1
YES, PROBED 2
NO 3
08) PERIODIC ABSTINENCE
Some couples can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES, SPONTANEOUSLY 1
YES, PROBED 2
NO 3
09) VAGINAL DOUCHING
After sexual intercourse, some women wash themselves with water or something else to avoid getting pregnant.
YES, SPONTANEOUSLY 1
YES, PROBED 2
NO 3
10) WITHDRAWAL
Men can be careful and pull out before climax
YES, SPONTANEOUSLY 1
YES, PROBED 2
NO 3
11) PROLONGED ABSTINENCE
Some couples, not including the post-natal period of abstinence, avoid sexual intercourse for months so that the woman doesn't get pregnant.
YES, SPONTANEOUSLY 1
YES, PROBED 2
NO 3
12) OTHER METHODS
Have you heard of any other ways or methods, including traditional methods, that women or men can use to avoid pregnancy? (SPECIFY): ____
YES, SPONTANEOUSLY 1
YES, PROBED 2
NO 3

403) Have you or your husband ever used (METHOD)?

01) PILL
Women can take a pill every day to delay or avoid pregnancy.
YES 1
NO 2
02) IUD
Women can have a plastic or metal coil or device placed inside their uterus by a doctor (or a midwife).
YES 1
NO 2
03) INJECTIONS
Women can have an injection by a doctor or a midwife which stops them from becoming pregnant for several months.
YES 1
NO 2
04) OTHER SCIENTIFIC METHODS
Women can place a diaphragm, a sponge, suppository, jelly, or cream inside themselves before intercourse to avoid pregnancy.
YES 1
NO 2
05) CONDOM
Men use a condom to avoid getting the woman pregnant.
YES 1
NO 2
06) FEMALE STERILIZATION
Women can have an operation to avoid having any more children
YES 1
NO 2
07) VASECTOMY
Men can have an operation to avoid having any more children
YES 1
NO 2
08) PERIODIC ABSTINENCE
Some couples can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
09) VAGINAL DOUCHING
After sexual intercourse, some women wash themselves with water or something else to avoid getting pregnant.
YES 1
NO 2
10) WITHDRAWAL
Men can be careful and pull out before climax
YES 1
NO 2
11) PROLONGED ABSTINENCE
Some couples, not including the post-natal period of abstinence, avoid sexual intercourse for months so that the woman doesn't get pregnant.
YES 1
NO 2
12) OTHER METHODS
Have you heard of any other ways or methods, including traditional methods, that women or men can use to avoid pregnancy? (SPECIFY): ____
YES 1
NO 2

404) Where would you go to obtain (METHOD)?

01) PILL
Women can take a pill every day to delay or avoid pregnancy.
PUBLIC HOSPITAL 01
MATERNITY 02
HEALTH CENTER/REFERENCE CENTER 03
FREE CLINIC 04
HOME OR TRAVELLING VISIT 05
MOBILE TEAM 06
MOROCCAN ASSOCIATION FOR FAMILY PLANNING 07
PRIVATE CLINIC 08
PHARMACY 09
PRIVATE DOCTOR OR MIDWIFE 10
TRADITIONAL BIRTH ATTENDANT 11
RELATIVES, FRIENDS, OR NEIGHBORS 12
NO ONE 13
OTHER 14
DON'T KNOW 98
02) IUD
Women can have a plastic or metal coil or device placed inside their uterus by a doctor (or a midwife).
PUBLIC HOSPITAL 01
MATERNITY 02
HEALTH CENTER/REFERENCE CENTER 03
FREE CLINIC 04
HOME OR TRAVELLING VISIT 05
MOBILE TEAM 06
MOROCCAN ASSOCIATION FOR FAMILY PLANNING 07
PRIVATE CLINIC 08
PHARMACY 09
PRIVATE DOCTOR OR MIDWIFE 10
TRADITIONAL BIRTH ATTENDANT 11
RELATIVES, FRIENDS, OR NEIGHBORS 12
NO ONE 13
OTHER 14
DON'T KNOW 98
03) INJECTIONS
Women can have an injection by a doctor or a midwife which stops them from becoming pregnant for several months.
PUBLIC HOSPITAL 01
MATERNITY 02
HEALTH CENTER/REFERENCE CENTER 03
FREE CLINIC 04
HOME OR TRAVELLING VISIT 05
MOBILE TEAM 06
MOROCCAN ASSOCIATION FOR FAMILY PLANNING 07
PRIVATE CLINIC 08
PHARMACY 09
PRIVATE DOCTOR OR MIDWIFE 10
TRADITIONAL BIRTH ATTENDANT 11
RELATIVES, FRIENDS, OR NEIGHBORS 12
NO ONE 13
OTHER 14
DON'T KNOW 98
04) OTHER SCIENTIFIC METHODS
Women can place a diaphragm, a sponge, suppository, jelly, or cream inside themselves before intercourse to avoid pregnancy.
PUBLIC HOSPITAL 01
MATERNITY 02
HEALTH CENTER/REFERENCE CENTER 03
FREE CLINIC 04
HOME OR TRAVELLING VISIT 05
MOBILE TEAM 06
MOROCCAN ASSOCIATION FOR FAMILY PLANNING 07
PRIVATE CLINIC 08
PHARMACY 09
PRIVATE DOCTOR OR MIDWIFE 10
TRADITIONAL BIRTH ATTENDANT 11
RELATIVES, FRIENDS, OR NEIGHBORS 12
NO ONE 13
OTHER 14
DON'T KNOW 98
05) CONDOM
Men use a condom to avoid getting the woman pregnant.
PUBLIC HOSPITAL 01
MATERNITY 02
HEALTH CENTER/REFERENCE CENTER 03
FREE CLINIC 04
HOME OR TRAVELLING VISIT 05
MOBILE TEAM 06
MOROCCAN ASSOCIATION FOR FAMILY PLANNING 07
PRIVATE CLINIC 08
PHARMACY 09
PRIVATE DOCTOR OR MIDWIFE 10
TRADITIONAL BIRTH ATTENDANT 11
RELATIVES, FRIENDS, OR NEIGHBORS 12
NO ONE 13
OTHER 14
DON'T KNOW 98
06) FEMALE STERILIZATION
Women can have an operation to avoid having any more children
PUBLIC HOSPITAL 01
MATERNITY 02
HEALTH CENTER/REFERENCE CENTER 03
FREE CLINIC 04
HOME OR TRAVELLING VISIT 05
MOBILE TEAM 06
MOROCCAN ASSOCIATION FOR FAMILY PLANNING 07
PRIVATE CLINIC 08
PHARMACY 09
PRIVATE DOCTOR OR MIDWIFE 10
TRADITIONAL BIRTH ATTENDANT 11
RELATIVES, FRIENDS, OR NEIGHBORS 12
NO ONE 13
OTHER 14
DON'T KNOW 98
07) VASECTOMY
Men can have an operation to avoid having any more children
PUBLIC HOSPITAL 01
MATERNITY 02
HEALTH CENTER/REFERENCE CENTER 03
FREE CLINIC 04
HOME OR TRAVELLING VISIT 05
MOBILE TEAM 06
MOROCCAN ASSOCIATION FOR FAMILY PLANNING 07
PRIVATE CLINIC 08
PHARMACY 09
PRIVATE DOCTOR OR MIDWIFE 10
TRADITIONAL BIRTH ATTENDANT 11
RELATIVES, FRIENDS, OR NEIGHBORS 12
NO ONE 13
OTHER 14
DON'T KNOW 98
08) PERIODIC ABSTINENCE
Some couples can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
PUBLIC HOSPITAL 01
MATERNITY 02
HEALTH CENTER/REFERENCE CENTER 03
FREE CLINIC 04
HOME OR TRAVELLING VISIT 05
MOBILE TEAM 06
MOROCCAN ASSOCIATION FOR FAMILY PLANNING 07
PRIVATE CLINIC 08
PHARMACY 09
PRIVATE DOCTOR OR MIDWIFE 10
TRADITIONAL BIRTH ATTENDANT 11
RELATIVES, FRIENDS, OR NEIGHBORS 12
NO ONE 13
OTHER 14
DON'T KNOW 98
09) VAGINAL DOUCHING
After sexual intercourse, some women wash themselves with water or something else to avoid getting pregnant.
PUBLIC HOSPITAL 01
MATERNITY 02
HEALTH CENTER/REFERENCE CENTER 03
FREE CLINIC 04
HOME OR TRAVELLING VISIT 05
MOBILE TEAM 06
MOROCCAN ASSOCIATION FOR FAMILY PLANNING 07
PRIVATE CLINIC 08
PHARMACY 09
PRIVATE DOCTOR OR MIDWIFE 10
TRADITIONAL BIRTH ATTENDANT 11
RELATIVES, FRIENDS, OR NEIGHBORS 12
NO ONE 13
OTHER 14
DON'T KNOW 98

405) In your opinion, what is the main problem, if any, with using (METHOD)?

01) PILL
Women can take a pill every day to delay or avoid pregnancy.
NONE 01
COST TOO HIGH 02
STOPS/DISRUPTS PERIOD 03
HEALTH EFFECTS 04
RECOMMENDED AGAINST BY DOCTOR 05
BAD EXPERIENCE OF OTHERS 06
FAILURE/INEFFICIENT 07
FORGOT 08
DIFFICULT OR NOT PRACTICAL 09
IRREVERSIBLE 10
ACCESS PROBLEMS 11
AVAILABILITY PROBLEMS 12
OTHER 13
DON'T KNOW 98
02) IUD
Women can have a plastic or metal coil or device placed inside their uterus by a doctor (or a midwife).
NONE 01
COST TOO HIGH 02
STOPS/DISRUPTS PERIOD 03
HEALTH EFFECTS 04
RECOMMENDED AGAINST BY DOCTOR 05
BAD EXPERIENCE OF OTHERS 06
FAILURE/INEFFICIENT 07
FORGOT 08
DIFFICULT OR NOT PRACTICAL 09
IRREVERSIBLE 10
ACCESS PROBLEMS 11
AVAILABILITY PROBLEMS 12
OTHER 13
DON'T KNOW 98
03) INJECTIONS
Women can have an injection by a doctor or a midwife which stops them from becoming pregnant for several months.
NONE 01
COST TOO HIGH 02
STOPS/DISRUPTS PERIOD 03
HEALTH EFFECTS 04
RECOMMENDED AGAINST BY DOCTOR 05
BAD EXPERIENCE OF OTHERS 06
FAILURE/INEFFICIENT 07
FORGOT 08
DIFFICULT OR NOT PRACTICAL 09
IRREVERSIBLE 10
ACCESS PROBLEMS 11
AVAILABILITY PROBLEMS 12
OTHER 13
DON'T KNOW 98
04) OTHER SCIENTIFIC METHODS
Women can place a diaphragm, a sponge, suppository, jelly, or cream inside themselves before intercourse to avoid pregnancy.
NONE 01
COST TOO HIGH 02
STOPS/DISRUPTS PERIOD 03
HEALTH EFFECTS 04
RECOMMENDED AGAINST BY DOCTOR 05
BAD EXPERIENCE OF OTHERS 06
FAILURE/INEFFICIENT 07
FORGOT 08
DIFFICULT OR NOT PRACTICAL 09
IRREVERSIBLE 10
ACCESS PROBLEMS 11
AVAILABILITY PROBLEMS 12
OTHER 13
DON'T KNOW 98
05) CONDOM
Men use a condom to avoid getting the woman pregnant.
NONE 01
COST TOO HIGH 02
STOPS/DISRUPTS PERIOD 03
HEALTH EFFECTS 04
RECOMMENDED AGAINST BY DOCTOR 05
BAD EXPERIENCE OF OTHERS 06
FAILURE/INEFFICIENT 07
FORGOT 08
DIFFICULT OR NOT PRACTICAL 09
IRREVERSIBLE 10
ACCESS PROBLEMS 11
AVAILABILITY PROBLEMS 12
OTHER 13
DON'T KNOW 98
06) FEMALE STERILIZATION
Women can have an operation to avoid having any more children
NONE 01
COST TOO HIGH 02
STOPS/DISRUPTS PERIOD 03
HEALTH EFFECTS 04
RECOMMENDED AGAINST BY DOCTOR 05
BAD EXPERIENCE OF OTHERS 06
FAILURE/INEFFICIENT 07
FORGOT 08
DIFFICULT OR NOT PRACTICAL 09
IRREVERSIBLE 10
ACCESS PROBLEMS 11
AVAILABILITY PROBLEMS 12
OTHER 13
DON'T KNOW 98
07) VASECTOMY
Men can have an operation to avoid having any more children
NONE 01
COST TOO HIGH 02
STOPS/DISRUPTS PERIOD 03
HEALTH EFFECTS 04
RECOMMENDED AGAINST BY DOCTOR 05
BAD EXPERIENCE OF OTHERS 06
FAILURE/INEFFICIENT 07
FORGOT 08
DIFFICULT OR NOT PRACTICAL 09
IRREVERSIBLE 10
ACCESS PROBLEMS 11
AVAILABILITY PROBLEMS 12
OTHER 13
DON'T KNOW 98
08) PERIODIC ABSTINENCE
Some couples can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
NONE 01
COST TOO HIGH 02
STOPS/DISRUPTS PERIOD 03
HEALTH EFFECTS 04
RECOMMENDED AGAINST BY DOCTOR 05
BAD EXPERIENCE OF OTHERS 06
FAILURE/INEFFICIENT 07
FORGOT 08
DIFFICULT OR NOT PRACTICAL 09
IRREVERSIBLE 10
ACCESS PROBLEMS 11
AVAILABILITY PROBLEMS 12
OTHER 13
DON'T KNOW 98
09) VAGINAL DOUCHING
After sexual intercourse, some women wash themselves with water or something else to avoid getting pregnant.
NONE 01
COST TOO HIGH 02
STOPS/DISRUPTS PERIOD 03
HEALTH EFFECTS 04
RECOMMENDED AGAINST BY DOCTOR 05
BAD EXPERIENCE OF OTHERS 06
FAILURE/INEFFICIENT 07
FORGOT 08
DIFFICULT OR NOT PRACTICAL 09
IRREVERSIBLE 10
ACCESS PROBLEMS 11
AVAILABILITY PROBLEMS 12
OTHER 13
DON'T KNOW 98
10) WITHDRAWAL
Men can be careful and pull out before climax
NONE 01
COST TOO HIGH 02
STOPS/DISRUPTS PERIOD 03
HEALTH EFFECTS 04
RECOMMENDED AGAINST BY DOCTOR 05
BAD EXPERIENCE OF OTHERS 06
FAILURE/INEFFICIENT 07
FORGOT 08
DIFFICULT OR NOT PRACTICAL 09
IRREVERSIBLE 10
ACCESS PROBLEMS 11
AVAILABILITY PROBLEMS 12
OTHER 13
DON'T KNOW 98
11) PROLONGED ABSTINENCE
Some couples, not including the post-natal period of abstinence, avoid sexual intercourse for months so that the woman doesn't get pregnant.
NONE 01
COST TOO HIGH 02
STOPS/DISRUPTS PERIOD 03
HEALTH EFFECTS 04
RECOMMENDED AGAINST BY DOCTOR 05
BAD EXPERIENCE OF OTHERS 06
FAILURE/INEFFICIENT 07
FORGOT 08
DIFFICULT OR NOT PRACTICAL 09
IRREVERSIBLE 10
ACCESS PROBLEMS 11
AVAILABILITY PROBLEMS 12
OTHER 13
DON'T KNOW 98

406) INTERVIEWER: SEE COLUMN 403 AND CHECK THE APPROPRIATE SPACE

NOT A SINGLE YES TO 403, NEVER USED
AT LEAST ONE YES IN 403, USED CONTRACEPTION (GO TO 409)

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

YES 1
NO 2 (GO TO 450)

408) What have you used or done?
INTERVIEWER: CHECK 402 AND 403, CORRECT IF NECESSARY AND OBTAIN INFORMATION FOR 404 AND 405

IF THE METHOD SPECIFIED IS ALREADY LISTED ON TABLE 2, CIRCLE CODE 2 (YES AFTER DESCRIPTION)

(SPECIFY): ____

409) INTERVIEWER: CHECK 403 (08) AND TICK APPROPRIATE SPACE

USED PERIODIC ABSTINENCE
NEVER USED PERIODIC ABSTINENCE (GO TO 411)

410) When you last used periodic abstinence, how did you measure the days where you needed to abstain?

BASED ON CALENDAR 1
BASED ON BODY TEMPERATURE 2
BASED ON CERVICAL MUCUS (BILLINGS) METHOD 3
BASED ON BODY TEMPERATURE AND MUCUS 4
OTHER (SPECIFY): ____ 5

411) How many living children did you have when you first did something or used a method to avoid getting pregnant?
INTERVIEWER: IF NONE, ENTER 00

NUMBER OF CHILDREN: ____

412) INTERVIEWER: CHECK 403 (06-07) AND TICK:

WIFE OR HUSBAND STERILIZED (GO TO 424A)
NEITHER STERILIZED

413) INTERVIEWER:
CHECK 201 AND TICK

CURRENTLY MARRIED
WIDOWED OR DIVORCED (GO TO 456)

414) INTERVIEWER: CHECK 325 AND TICK

CURRENTLY PREGNANT (GO TO 423)
NOT PREGNANT OR NOT SURE OR DON'T KNOW

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

YES 1 (GO TO 416)
NO 2

415A) [##translator note: question in Arabic, not available on the French version of the survey]

YES 1
NO 2 (GO TO 421)

416) Which method are you using?

PILL 01 (GO TO 417)
IUD 02 (GO TO 424B)
INJECTIONS 03 (GO TO 424)
OTHER SCIENTIFIC METHOD 04 (GO TO 424)
CONDOM 05 (GO TO 424)
PERIODIC ABSTINENCE 08 (GO TO 423)
VAGINAL DOUCHING 09 (GO TO 423)
WITHDRAWAL 10 (GO TO 423)
ABSTINENCE 11 (GO TO 423)
OTHER (SPECIFY): ____ 12 (GO TO 423)

417) How much does one (packet/cycle) of pills cost you?

PRICE IN DIRHAM: ____
FREE 97
DON'T KNOW 98

418) How many days per month do you take the pill?

ONE PILL PER DAY 1
OTHER ANSWER 2 (GO TO 424)

419) How many days per month do you take the pill

EVERY DAY 1
OTHER ANSWER 2 (GO TO 424)

420) If you forget to take your pill one day, do you take it the next day, later, or not at all?

NEXT DAY 1 (GO TO 424)
LATER 2 (GO TO 424)
NOT AT ALL 3 (GO TO 424)

421) If you got pregnant in the coming weeks, would you be happy, unhappy, or indifferent?

HAPPY 1 (GO TO 423)
UNHAPPY 2
INDIFFERENT 3

422) What is the main reason that you are not using a method to avoid pregnancy?

GOT PREGNANT 1
LACK OF KNOWLEDGE 2
OPPOSED TO FAMILY PLANNING 3
HUSBAND DISAPPROVES 4
FAMILY DISAPPROVES 5
INFREQUENT SEX 6
STILL BREASTFEEDING 7
STERILIZED/MENOPAUSE 8
HEALTH PROBLEMS 9
METHOD NOT AVAILABLE 10
COSTS TO HIGH 11
RELIGION 12
FATALISTIC 13
METHODS ARE INCONVENIENT 14
OTHER (SPECIFY): ____ 15
DON'T KNOW 98

423) In the last 12 months, have you (you or your husband) visited any health care establishment to obtain advice or a method to allow you to delay or avoid pregnancy?

YES 1
NO 2 (GO TO 426)

424) Where was the last such visit to obtain advice or a method to delay or avoid pregnancy?

PUBLIC HOSPITAL 01 (GO TO 425)
MATERNITY 02 (GO TO 425)
HEALTH CENTER/REFERENCE CENTER 03 (GO TO 425)
FREE CLINIC 04 (GO TO 425)
HOME OR TRAVELLING VISIT 05 (GO TO 425)
MOBILE TEAM 06 (GO TO 425)
MOROCCAN ASSOCIATION FOR FAMILY PLANNING 07 (GO TO 425)
PRIVATE CLINIC 08 (GO TO 425)
PHARMACY 09 (GO TO 425)
PRIVATE DOCTOR/MIDWIFE 10 (GO TO 425)
TRADITIONAL BIRTH ATTENDANT 11 (GO TO 426)
RELATIVES/FRIENDS/NEIGHBORS 12 (GO TO 426)
NO ONE 13 (GO TO 426)
DON'T KNOW 98 (GO TO 426)
OTHER 15 (GO TO 426)

424A) Where did you get the tubal ligation? (or where did you husband have his vasectomy)?

PUBLIC HOSPITAL 01 (GO TO 425)
MATERNITY 02 (GO TO 425)
HEALTH CENTER/REFERENCE CENTER 03 (GO TO 425)
FREE CLINIC 04 (GO TO 425)
HOME OR TRAVELLING VISIT 05 (GO TO 425)
MOBILE TEAM 06 (GO TO 425)
MOROCCAN ASSOCIATION FOR FAMILY PLANNING 07 (GO TO 425)
PRIVATE CLINIC 08 (GO TO 425)
PHARMACY 09 (GO TO 425)
PRIVATE DOCTOR/MIDWIFE 10 (GO TO 425)
TRADITIONAL BIRTH ATTENDANT 11 (GO TO 426)
RELATIVES/FRIENDS/NEIGHBORS 12 (GO TO 426)
NO ONE 13 (GO TO 426)
DON'T KNOW 98 (GO TO 426)
OTHER 15 (GO TO 426)

424B) Where did you have you IUD inserted?

PUBLIC HOSPITAL 01 (GO TO 425)
MATERNITY 02 (GO TO 425)
HEALTH CENTER/REFERENCE CENTER 03 (GO TO 425)
FREE CLINIC 04 (GO TO 425)
HOME OR TRAVELLING VISIT 05 (GO TO 425)
MOBILE TEAM 06 (GO TO 425)
MOROCCAN ASSOCIATION FOR FAMILY PLANNING 07 (GO TO 425)
PRIVATE CLINIC 08 (GO TO 425)
PHARMACY 09 (GO TO 425)
PRIVATE DOCTOR/MIDWIFE 10 (GO TO 425)
TRADITIONAL BIRTH ATTENDANT 11 (GO TO 426)
RELATIVES/FRIENDS/NEIGHBORS 12 (GO TO 426)
NO ONE 13 (GO TO 426)
DON'T KNOW 98 (GO TO 426)
OTHER 15 (GO TO 426)

425) Was there anything in particular that you didn't like about the service you received at these establishments?

NOTHING 01
LONG WAIT 02
UNWELCOME/BAD SERVICE 03
COSTS TOO HIGH 04
FAR AND DIFFICULTY TO ACCESS 05
DIDN'T GET DESIRED METHOD OR INFORMATION 06
TOO MANY ADMINISTRATIVE ASPECTS 07
PERSONNEL NOT COMPETENT 08
DIDN'T LIKE BEING HELPED BY A MAN 09
NOT HYGIENIC 10
OTHER (SPECIFY): ____ 11

426) INTERVIEWER: CHECK 325 AND TICK APPROPRIATE SPACE

CURRENTLY PREGNANT (GO TO 451)
NOT PREGNANT, NOT PREGNANT, OR NOT SURE

427) INTERVIEWER: CHECK 403 (06-07) AND TICK APPROPRIATE SPACE

NEITHER STERILIZED
WOMAN STERILIZED (GO TO 429A)
HUSBAND STERILIZED (GO TO 430B)

428) INTERVIEWER: CHECK 415-416 AND TICK APPROPRIATE SPACE

USED IUD (GO TO 429)
OTHER (GO TO 433)

429) When you had the IUD inserted, was there anything in particular that you didn't like about the service you received at these establishments?

NOTHING 01
NO PRE-MEDICATION 02
NO ANESTHESIA 03
INSTRUMENTS PAINFUL OR NOT PROPERLY PREPARED 04
VIOLENT DISINFECTION 05
UNCOMFORTABLE POSITION 06
POOR HOSPITAL CONDITIONS 07
PRIVACY PROBLEMS 08
OTHER (SPECIFY): ____ 09

429A) When you had the tubal ligation, was there anything in particular that you didn't like about the service you received at these establishments?

NOTHING 01
NO PRE-MEDICATION 02
NO ANESTHESIA 03
INSTRUMENTS PAINFUL OR NOT PROPERLY PREPARED 04
VIOLENT DISINFECTION 05
UNCOMFORTABLE POSITION 06
POOR HOSPITAL CONDITIONS 07
PRIVACY PROBLEMS 08
OTHER (SPECIFY): ____ 09

430) INTERVIEWER: FOR THE IUD, ASK: How long have you had the IUD without removing it?

NUMBER OF MONTHS: ____
NUMBER OF YEARS: ____
(GO TO 431)

430A) INTERVIEWER: FOR THE TUBAL LIGATION, ASK: In what month and what year did you have the tubal ligation?

MONTH OR SEASON: ____
YEAR: ____
(GO TO 431A)

431) Since you had the IUD inserted, have you had any health problems or troubles, or anything else that you didn't like?

YES 1
NO 2 (GO TO 433)

431A) Since you had the tubal ligation, have you had any health problems or troubles, or anything else that you didn't like?

YES 1
NO 2 (GO TO 433)

432) What is the main problem or difficulty you've experienced?

METHOD FAILED 01
DIFFICULTY OR FREQUENCY OF SEXUAL INTERCOURSE 02
HUSBAND OPPOSED 03
BAD EXPERIENCE WITH RELATIVES/FRIENDS/NEIGHBORS 04
BAD MEDICAL OBSERVATION OR FOLLOW-UP 05
PRIVACY PROBLEMS BECAUSE OF MALE PERSONNEL 06
IRREVERSIBLE 07
INFECTED VAGINAL DISCHARGE 08
BLOODY VAGINAL DISCHARGE 09
ABDOMINAL PAIN 10
OTHER PAIN 11
CARCINOGENIC EFFECTS 12
OTHER HEALTH EFFECTS 13
OTHER (SPECIFY): ____ 14

433) INTERVIEWER: CHECK 427-428 AND TICK THE APPROPRIATE SPACE

WOMAN OR HUSBAND STERILIZED (GO TO 439)
USED IUD (GO TO 437)
OTHER

433A) INTERVIEWER: CHECK 415 AND 415A THEN TICK THE APPROPRIATE SPACE

CURRENTLY USING A CONTRACEPTIVE METHOD
NOT CURRENTLY USING A CONTRACEPTIVE METHOD (GO TO 444)

434) For how long have you used this method continuously?
(CURRENT METHOD FORM 416)

NUMBER OF MONTHS: ____
NUMBER OF YEARS: ____
SINCE LAST BIRTH 97

435) Have you encountered any problems using (CURRENT METHOD)?
(CURRENT METHOD FROM 416)

YES 1
NO 2 (GO TO 437)

436) What is the main problem or difficulty you've experienced?

METHOD FAILED/INEFFECTIVE 01
DIFFICULTY OR FREQUENCY OF SEXUAL INTERCOURSE 02
HUSBAND OPPOSED 03
STOPPED/DISRUPTED PERIOD 04
HEALTH PROBLEMS 05
FORGOT 06
DIFFICULT OR NOT PRACTICAL 07
PRIVACY CONCERNS 08
COSTS TOO MUCH 09
ACCESSIBILITY 10
AVAILABILITY PROBLEMS 11
DOESN'T LIKE BEING HELPED BY A MAN 12
OTHER (SPECIFY): ____ 13

437) Were you regularly using another method than (CURRENT METHOD) during the same month?
(CURRENT METHOD FROM 416)

YES 1
NO 2 (GO TO 439)

438) Which method are you using?

PILL 01
IUD 02
INJECTIONS 03
OTHER SCIENTIFIC METHOD 04
CONDOM 05
PERIODIC ABSTINENCE 08
VAGINAL DOUCHING 09
WITHDRAWAL 10
ABSTINENCE 11
OTHER METHOD (SPECIFY): ____ 12

439) Have you used any other method or anything else (since your last birth) before (CURRENT METHOD) to avoid getting pregnant?
(CURRENT METHOD FROM 416 OR 412)

YES 1
NO 2 (GO TO 456)

440) What method did you use before (CURRENT METHOD)?

PILL 01
IUD 02
INJECTIONS 03
OTHER SCIENTIFIC METHOD 04
CONDOM 05
PERIODIC ABSTINENCE 08
VAGINAL DOUCHING 09
WITHDRAWAL 10
ABSTINENCE 11
OTHER METHOD (SPECIFY): ____ 12

441) In what month and what year did you start using this method?
(METHOD FROM 440)

MONTH: ____
YEAR: ____

442) When did you start using this method (last method before stopping)?

MONTH: ____
YEAR: ____

443) What was the main reason that you stopped using this method?

METHOD FAILED 01 (GO TO 458)
DIFFICULTY OR FREQUENCY OF SEXUAL INTERCOURSE 02 (GO TO 458)
HUSBAND OPPOSED 03 (GO TO 458)
BAD EXPERIENCE WITH RELATIVES/FRIENDS/NEIGHBORS 04 (GO TO 458)
STOPPED PERIOD 05 (GO TO 458)
FORGOT 06 (GO TO 458)
NOT PRACTICAL 07 (GO TO 458)
COSTS TOO MUCH 08 (GO TO 458)
ACCESSIBILITY PROBLEMS 09 (GO TO 458)
AVAILABILITY PROBLEMS 10 (GO TO 458)
BAD MEDICAL OBSERVATION OR FOLLOW-UP 11 (GO TO 458)
PRIVACY PROBLEMS BECAUSE OF MALE PERSONNEL 12 (GO TO 458)
INFECTED VAGINAL DISCHARGE 13 (GO TO 458)
BLOODY VAGINAL DISCHARGE 14 (GO TO 458)
ABDOMINAL PAIN 15 (GO TO 458)
OTHER PAIN 16 (GO TO 458)
CARCINOGENIC EFFECTS 17 (GO TO 458)
OTHER HEALTH EFFECTS 18 (GO TO 458)
OTHER (SPECIFY): ____ 29 (GO TO 458)

444) INTERVIEWER: CHECK 311 AND TICK THE APPROPRIATE SPACE

AT LEAST ONE LIVE BIRTH
NO LIVE BIRTHS (GO TO 446)

445) Since you're last birth, have you done or tried any method to not get pregnant?

YES 1
NO 2 (GO TO 451)

446) What is the last method you used?

PILL 01
IUD 02
INJECTIONS 03
OTHER SCIENTIFIC METHOD 04
CONDOM 05
VASECTOMY 07
PERIODIC ABSTINENCE 08
VAGINAL DOUCHING 09
WITHDRAWAL 10
ABSTINENCE 11
OTHER METHOD (SPECIFY): ____ 12

447) In what month and what year did you start using this method?

MONTH: ____
YEAR: ____

448) For how long have you used the last method before stopping?

NUMBER OF MONTHS: ____
NUMBER OF YEARS: ____

449) What was the main reason that you stopped using this method?

METHOD FAILED 01
DIFFICULTY OR FREQUENCY OF SEXUAL INTERCOURSE 02
HUSBAND OPPOSED 03
BAD EXPERIENCE WITH RELATIVES/FRIENDS/NEIGHBORS 04
STOPPED PERIOD 05
FORGOT 06
NOT PRACTICAL 07
COSTS TOO MUCH 08
ACCESSIBILITY PROBLEMS 09
AVAILABILITY PROBLEMS 10
BAD MEDICAL OBSERVATION OR FOLLOW-UP 11
PRIVACY PROBLEMS BECAUSE OF MALE PERSONNEL 12
INFECTED VAGINAL DISCHARGE 13
BLOODY VAGINAL DISCHARGE 14
ABDOMINAL PAIN 15
OTHER PAIN 16
CARCINOGENIC EFFECTS 17
OTHER HEALTH EFFECTS 18
OTHER (SPECIFY): ____ 19

450) INTERVIEWER: CHECK 201 AND TICK:

MARRIED
WIDOWED/DIVORCED (GO TO 456)

451) Do you intend to use a method to delay or avoid pregnancy at any time in the future?

YES 1
NO 2 (GO TO 456)
DON'T KNOW 8 (GO TO 456)

452) Which method would you prefer?

PILL 01
IUD 02
INJECTIONS 03
OTHER SCIENTIFIC METHOD 04
CONDOM 05
FEMALE STERILIZATION 06
VASECTOMY 07
PERIODIC ABSTINENCE 08
VAGINAL DOUCHING 09
WITHDRAWAL 10
ABSTINENCE 11
OTHER METHOD (SPECIFY): ____ 12

453) Other than the method (from 452) that you prefer, what are some other methods that you know and do not use?
INTERVIEWER: CIRCLE MAIN UNDESIRED METHOD

PILL 01
IUD 02
INJECTIONS 03
OTHER SCIENTIFIC METHOD 04
CONDOM 05
FEMALE STERILIZATION 06
VASECTOMY 07
PERIODIC ABSTINENCE 08
VAGINAL DOUCHING 09
WITHDRAWAL 10
ABSTINENCE 11
OTHER METHOD (SPECIFY): ____ 12

454) Why do you not use them?

METHOD FAILED 01
DIFFICULTY OR FREQUENCY OF SEXUAL INTERCOURSE 02
HUSBAND OPPOSED 03
BAD EXPERIENCE WITH RELATIVES/FRIENDS/NEIGHBORS 04
STOPPED PERIOD 05
FORGOT 06
NOT PRACTICAL 07
COSTS TOO MUCH 08
IRREVERSIBLE 09
ACCESSIBILITY PROBLEMS 10
AVAILABILITY PROBLEMS 11
BAD MEDICAL OBSERVATION OR FOLLOW-UP 12
PRIVACY PROBLEMS BECAUSE OF MALE PERSONNEL 13
INFECTED VAGINAL DISCHARGE 14
BLOODY VAGINAL DISCHARGE 15
ABDOMINAL PAIN 16
OTHER PAIN 17
CARCINOGENIC EFFECTS 18
OTHER HEALTH EFFECTS 19
OTHER (SPECIFY): ____ 20

455) (METHOD FROM 452) Do you intend to use your preferred method in the next 12 months?

YES 1
NO 2
DON'T KNOW 8

456) In the last month, have you heard any information about family planning on the radio, on television, or in meetings?

YES 1
NO 2 (GO TO 458)

457) Did you hear it once or more than once?

ONCE 1
MORE THAN ONCE 2

458) Do you think it's acceptable or not to have information about family planning on the radio, on television, or in meetings?

ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 98

459) INTERVIEWER: SEE TABLE 1 (315 TO 322) AND 325 THEN TICK THE APPROPRIATE SPACE

AT LEAST ONE LIVE BIRTH FIVE YEARS OLD OR LESS, OR BORN SINCE JANUARY 1982 OR CURRENTLY PREGNANT
NO LIVE BIRTHS FIVE YEARS OLD OR LESS OR BORN SINCE JANUARY 1982 AND NOT CURRENTLY PREGNANT (GO TO 601)

INTERVIEWER: NOW GO TO 450A AND TICK IN THE FIRST COLUMN IF THE WOMAN IS CURRENTLY PREGNANT OR NOT (325), THEN RECORD IN THE ORDER OF BIRTH STARTING BY THE LAST OF THE NAMES (315) OF ALL THE CHILDREN BORN ALIVE SINCE JANUARY 1982 OR 5 YEARS OR LESS (320).

460) INTERVIEWER: SEE 406 AND TICK THE APPROPRIATE SPACE:

USED CONTRACEPTIVE METHOD (ASK 461 TO 467 FOR EACH COLUMN)
NEVER USED CONTRACEPTIVE METHOD (ASK 466 FOR EACH COLUMN)

INTRODUCE THE SUBJECT BY SAYING:
[##translator note: text is in Arabic, not French version available]

460A) CURRENTLY PREGNANT

YES (GO TO 461)
NO (GO TO MOST RECENT BIRTH)
LAST BIRTH
(NAME)

461) Before getting pregnant with (NAME) (not before preceding birth) (if there were any) did you use any contraceptive method to avoid getting pregnant?

YES 1
NO 2 (GO TO 466)

462) What was the last method you used?
LAST METHOD _____

PILL 01
IUD 02
INJECTIONS 03
OTHER SCIENTIFIC METHOD 04
CONDOM 05
VASECTOMY 07
PERIODIC ABSTINENCE 08
VAGINAL DOUCHING 09
WITHDRAWAL 10
ABSTINENCE 11
OTHER METHOD (SPECIFY): ____ 12

462A) INTERVIEWER:
CHECK: Did you use another method before the last?
RECORD CODE OF THE PRECEDING METHOD HERE
PRECEDING METHOD

NONE 00
PILL 01
IUD 02
INJECTIONS 03
OTHER SCIENTIFIC METHOD 04
CONDOM 05
VASECTOMY 07
PERIODIC ABSTINENCE 08
VAGINAL DOUCHING 09
WITHDRAWAL 10
ABSTINENCE 11
OTHER METHOD (SPECIFY): ____ 12

463) For how many months and years did you use this method?
(SEE 462)

NUMBER OF MONTHS: ___
NUMBER OF YEARS: ____

464) Did you use this method (See 462) at the time you became pregnant?

YES 1 (GO TO 467)
NO 2 (GO TO 465)

465) What is the main reason that you are not using this method?

TO GET PREGNANT 01 (GO TO NEXT COLUMN)
METHOD FAILED 02
FREQUENCY OF SEXUAL INTERCOURSE 03
HUSBAND OPPOSED 04
HEALTH CONCERNS 05
ACCESS PROBLEMS 06
AVAILABILITY PROBLEMS 07
COSTS TOO HIGH 08
DIFFICULT TO USE 09
PRIVACY PROBLEMS 10
FATALISTIC 11
OTHER (SPECIFY): ____ 12
DON'T KNOW 98

466) At the time you became pregnant, did you want to have that child then, did you want to wait until later, or did you want no (more) children at all?

THEN 01
LATER 02
NO MORE 03
(GO TO NEXT COLUMN)

467) Did you want to have this child later or not at all?

LATER 1
NOT AT ALL 2
(GO TO NEXT COLUMN)

SECTION 5. HEALTH AND BREASTFEEDING

501) INTERVIEWER: SEE TABLE 1 THEN RECORD THE LINE NUMBER (315), NAME (315) AND SURVIVAL STATE (319) OF ALL THE CHILDREN AGED 5 OR LESS OR BORN SINCE JANUARY 1982 (318).

TABLE 4: BIRTHS OCCURRING IN THE LAST FIVE YEARS

LAST BIRTH:

LINE NUMBER: ____
(NAME): ____
ALIVE
DEAD

502) When you were pregnant with (NAME), did you have an antenatal consultation?

YES 1
NO 2 (GO TO 506)

503) How many antenatal visits did you have when you were pregnant with (NAME)?

NUMBER OF VISITS: ____

504) Where did you have your first consultation?

PUBLIC 1
PRIVATE 2

505) Who did you consult on this visit, a doctor, a midwife, a nurse, or someone else?

DOCTOR 1
MIDWIFE 2
NURSE 3
TRADITIONAL BIRTH ATTENDANT 4
OTHER (SPECIFY): ____ 5

506) Did you give birth to (NAME) in a public center, in a private center, or at home?

PUBLIC 1
PRIVATE 2
HOME 3

507) Who assisted with the delivery of (NAME)?

DOCTOR 1
MIDWIFE 2
NURSE 3
TRADITIONAL BIRTH ATTENDANT 4
OTHER (SPECIFY): ____ 5

508) Have you ever feed (NAME) at the breast?

YES 1
NO 2 (GO TO 511)

509) Are you still breastfeeding (NAME)?

YES 1 (GO TO 511)
NO 2
CHILD DEAD 3

510) How many months did you breastfeed (NAME)?

MONTHS: ____
UNTIL DEATH 97

511) How many months after the birth of (NAME) did your period return?

MONTHS: ____
NOT RETURNED 96
(GO TO NEXT COLUMN)

512) INTERVIEWER: Check 508 and 509 for the last birth and tick the appropriate space

STILL BREASTFEEDING
NOT BREASTFEEDING (GO TO 518)
CHILD DEAD (GO TO 520)

513) How many times did you breastfeed last night between sundown and sunrise?

NUMBER OF TIMES: ____
AS OFTEN AS THE CHILD WANTED, WHEN CHILD CRIED 96
SLEEPS WHILE FEEDING 97

514) How many times did you breastfeed yesterday during the daylight hours?

NUMBER OF TIMES: ____
AS OFTEN AS THE CHILD WANTED, WHEN CHILD CRIED 96
ALL THE TIME 97

515) At any time yesterday or last night, was (NAME) given any of the following:

PLAIN WATER?
YES 1
NO 2
JUICE?
YES 1
NO 2
TEA?
YES 1
NO 2
POWDERED MILK?
YES 1
NO 2
COW'S MILK?
YES 1
NO 2
GOAT'S MILK?
YES 1
NO 2
CONCENTRATED MILK?
YES 1
NO 2
OTHER LIQUID?
YES 1
NO 2
GRUEL?
YES 1
NO 2
SOLID FOODS?
YES 1
NO 2

516) INTERVIEWER: CHECK 515 AND TICK THE APPROPRIATE SPACE:

AT LEAST ONE YES TO 515
NOT A SINGLE YES TO 515 (GO TO 520)

517) Were any of these given in a bottle with a nipple?

YES 1 (GO TO 520)
NO 2 (GO TO 520)

518) Why did you stop breastfeeding (NAME)?

WEANING 01 (GO TO 519)
CHILD SICK 02 (GO TO 520)
REFUSE TO SUCKLE 03 (GO TO 520)
MOTHER SICK 04 (GO TO 520)
NO MILK 05 (GO TO 520)
PREGNANT 06 (GO TO 520)
PREFER ARTIFICIAL MILK 07 (GO TO 520)
MOTHER WORKS 08 (GO TO 520)
OTHER (SPECIFY): ____ 09 (GO TO 520)

519) Before weaning (NAME), did you stop slowly or abruptly?

SLOWLY 1
ABRUPTLY 2

520) INTERVIEWER: SEE TABLE 4 THEN RECORD THE LINE NUMBER, NAME, AND SURVIVAL STATE [ILLEGIBLE] OF ALL THE CHILDREN AGE 5 AND UNDER OR BORN AFTER JANUARY 1982.

TABLE 5: BIRTHS OCCURRING IN THE LAST FIVE YEARS

LAST BIRTH:

LINE NUMBER: ____

(NAME): ____

ALIVE
DEAD (GO TO 530)

521) Do you have a vaccination card for (NAME)? May I see it?

NO CARD 1 (GO TO 523)
YES, NOT SEEN 2 (GO TO 523)
YES, SEEN

522) INTERVIEWER:
RECORD THE DATES OF THE VACCINATIONS FROM THE VACCINATION CARD.

BCG
DATE: ____
MONTH: ____
YEAR: ____
DTCOQ 1
DATE: ____
MONTH: ____
YEAR: ____
POLIO 1
DATE: ____
MONTH: ____
YEAR: ____
DTCOQ 2
DATE: ____
MONTH: ____
YEAR: ____
POLIO 2
DATE: ____
MONTH: ____
YEAR: ____
DTCOQ 3
DATE: ____
MONTH: ____
YEAR: ____
POLIO 3
DATE: ____
MONTH: ____
YEAR: ____
VITAMIN D 2/1
DATE: ____
MONTH: ____
YEAR: ____
VITAMIN D 2/2
DATE: ____
MONTH: ____
YEAR: ____
MEASLES
DATE: ____
MONTH: ____
YEAR: ____

(GO TO 524)

523) Did you have (NAME) vaccinated against:
Tuberculosis?
Dysentery-Tetanus?
Whopping Cough-Polio?

Did he/she take vitamin D?
Was he/she vaccinated against measles?

BCG
YES 1
NO 2
DTCOQ/POLIO 1
YES 1
NO 2
DTCOQ/POLIO 2
YES 1
NO 2
DTCOQ/POLIO 3
YES 1
NO 2
VITAMIN D 2 (1)
YES 1
NO 2
VITAMIN D 2 (2)
YES 1
NO 2
MEASLES
YES 1
NO 2

524) Has (NAME) had diarrhea in the last 24 hours?

YES 1 (GO TO 526)
NO 2

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

YES 1 (GO TO 526)
NO (GO TO NEXT COLUMN)
DON'T KNOW 8 (GO TO NEXT COLUMN)

526) Was (NAME) taken somewhere to treat the diarrhea (the last time)?

YES 1 (GO TO 527)
NO 2 (GO TO 528)

527) Where was he/she taken?

FREE CLINIC 1
HEALTH CENTER 2
PUBLIC HOSPITAL 3
PRIVATE DOCTOR 4
PHARMACY 5
TRADITIONAL PRACTITIONER 6
OTHER (SPECIFY): ____ 7
(GO TO 528)

528) The last time (NAME) had diarrhea, was he/she given a RVO to treat the diarrhea?

YES 1
NO 2
DON'T KNOW 8

529) Was there anything you (or somebody else) did to treat the diarrhea (the last time)?

SALT-SUGAR-WATER SOLUTION (HOMEMADE) 1
RICE WATER GRUEL 1
CARROT SOUP 1
MORE LIQUIDS 1
MORE FOOD 1
MEDICINAL PLANTS 1
SYRUP/OTHER PRODUCTS 1
PHARMACEUTICALS 1
NOTHING 1
OTHER (SPECIFY): ____ 1
(GO TO 520 NEXT COLUMN)

530) At the time he/she became sick with the illness that lead to his/her death, did he/she have any of the following symptoms:

SWELLING OF EXTREMITIES AND/OR BODY 1
EXTREME THINNESS 1
HIGH FEVER 1
DIARRHEA 1
VOMITING 1
INABILITY TO OPEN MOUTH TO EAT 1
FREQUENT AND INTENSE COUGH 1
RESPIRATORY DISTRESS 1
JAUNDICE 1
OUTBURSTS 1
CONVULSIONS (EYE REVULSION AND LOSS OF CONSCIOUSNESS) 1
STIFF BODY 1
MUSCLE CONTRACTIONS 1
ACCIDENT 1
INTOXICATION OR POISONING 1
OTHER (SPECIFY): ____ 1

531) Which illness killed him/her?

DIARRHEA 01
TUBERCULOSIS 02
RESPIRATORY ILLNESS 03
MENINGITIS 04
WHOPPING COUGH 05
TETANUS 06
MEASLES 07
DIPHTHERIA 08
TYPHOID 09
OTHER (SPECIFY): ____ 10
DON'T KNOW 98
(GO TO 520 NEXT COLUMN)

SECTION 6. FERTILITY PREFERENCES

601) INTERVIEWER:
CHECK 403 (06-07) AND TICK THE APPROPRIATE SPACE

WOMAN OR HUSBAND STERILIZED (GO TO 609)
NEITHER STERILIZED

602) INTERVIEWER: CHECK 201 AND TICK THE APPROPRIATE SPACE

MARRIED
WIDOWED OR DIVORCED (GO TO 612)

603) Now I have some questions about the future.
NOT PREGNANT OR NOT SURE: Would you like to have a (another) child?
PREGNANT: After the child you are expecting, would you like to have other children?

YES (MORE) CHILDREN 1 (GO TO 606)
NO (NO MORE CHILDREN) 2
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 612)
DON'T KNOW OR UNDECIDED 8 (GO TO 605)

604) Do you mean that you do not want to have any (more) children or that you're not sure?

NO MORE CHILDREN AT ALL 1
NOT SURE 2
(GO TO 612)

605) Are you more for the decision to have (another) child or to not have any (more) children?

YES, WANTS ANOTHER CHILD 1 (GO TO 607)
NO, DOES NOT WANT MORE CHILDREN 20(GO TO 612)
UNDECIDED OR DON'T KNOW 8 (GO TO 612)

606) Are you saying that you definitely want (another) child(ren) or that you are not sure?

DEFINITELY WANTS ANOTHER CHILD 1
UNSURE 2 (GO TO 612)

607) How long would you like to wait from now before the birth of a (another) child?

TIME OF WAIT: ____
MONTH 1 (GO TO 612)
YEAR 2 (GO TO 612)
DON'T KNOW 998 (GO TO 608)

608) INTERVIEWER: CHECK 319 BEFORE ASKING 608
How old would your youngest child be before having the next (another)?

AGE OF YOUNGEST CHILD IN YEARS: ____
NO LIVING CHILDREN 96
DON'T KNOW 98
(GO TO 612)

609) Was (NAME) delivered by caesarean section?

YES 1
NO 2

610) Do you regret having the tubal ligation to not have any (more) children?

YES 1
NO 2 (GO TO 612)

611) Would you like to have another child or do you prefer not to have any more children?

YES (WANTS ANOTHER CHILD) 1
NO (DOES NOT WANT ANOTHER CHILD) 2
UNDECIDED OR DON'T KNOW 8

612) INTERVIEWER: SEE 302 AND 306, TICK AND ASK THE APPROPRIATE QUESTION
NO LIVING CHILDREN: If you could choose exactly the number of children to have in your whole life, how many would that be?
HAS LIVING CHILDREN: If you could go back to the time you did not have any children and choose exactly the number of children to have in your whole life, how many would that be?

NUMBER: ____
BETWEEN __ AND __
UP TO GOD 96
OTHER (SPECIFY): ____ 97
DON'T KNOW 98

613) How many boys would you want and how many girls would you want?

NUMBER OF BOYS: ____
NUMBER OF GIRLS: ____
UP TO GOD 96
OTHER (SPECIFY): ____ 97
DON'T KNOW 98

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

701) INTERVIEWER:
SEE 201, THEN RELATE THE FOLLOWING QUESTIONS TO THE RESPONDENT'S CURRENT HUSBAND OR TO HER LAST HUSBAND IF SHE IS DIVORCED OR WIDOWED.
Now I would like to ask you some questions about your (last) husband's education level and job.

702) Did your husband ever attend school?

YES 1
NO 2 (GO TO 706)
DON'T KNOW 8 (GO TO 706)

703) What is the highest level of school he attended?

PRIMARY 1
SECONDARY 2
HIGHER 3
DON'T KNOW 8 (GO TO 706)

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

LAST GRADE COMPLETED: ____
DON'T KNOW 8

705) INTERVIEWER: CHECK 703 AND TICK APPROPRIATE SPACE

PRIMARY
SECONDARY OR HIGHER (GO TO 707)

706) Can (could) he read a letter or newspaper easily, with difficulty, or not at all?
CAN READ:

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3

707) What kind of work does (did) your husband/partner mainly do?
(RECORD THE SPECIFIC PROFESSION)

(PROFESSION): ____
NEVER WORKED 98

708) INTERVIEWER: CHECK 707 AND TICK APPROPRIATE SPACE;

DOES NOT WORK IN AGRICULTURE (GO TO 709)
WORKS IN AGRICULTURE (GO TO 710)
HAS NEVER WORKED (GO TO 712)

709) Does (did) he receive a regular weekly or monthly salary?

YES 1 (GO TO 712)
NO 2 (GO TO 712)
DON'T KNOW 8 (GO TO 712)

710) Does (did) your husband/partner work mainly on his or family land, or on someone else's land?

HIS/FAMILY LAND 1 (GO TO 712)
SOMEONE ELSE'S LAND 2

711) Did he mainly work to be paid in cash or in kind?

IN CASH 1
SHARECROPPER (1/5-1/4) 2
DON'T KNOW 8

712) INTERVIEWER: CHECK 201 AND TICK APPROPRIATE SPACE:

MARRIED
WIDOWED OR DIVORCED (GO TO 715)

713) In the last 12 months, has your husband taken a job where he was gone for more than one month?

YES 1
NO 2 (GO TO 715)

714) For how long was he away?

NUMBER OF MONTHS: ____

715) Before getting married (the first time), did you work regularly to make money other than work in a field or in businesses belonging to your family?

YES 1
NO 2 (GO TO 717)

716) Did you give most of the money you made to your family or did you keep most of it for yourself?
GAVE MOST TO:

HER FAMILY 1
HERSELF 2
EQUAL PARTS 3

717) Since you got married (for the first time), have you worked regularly to make money other than work in a field or in businesses belonging to your family?

YES 1
NO 2 (GO TO 719)

718) Did you give most of the money you made to your family or did you keep most of it for yourself?
GAVE MOST TO:

HER FAMILY 1
HERSELF 2
EQUAL PARTS 3

719) Aside from household work, are you currently working to earn money?

YES 1
NO 2

SECTION 8. KNOWLEDGE AND USE OF PUBLIC HEALTH SYSTEM

801) Now I would like to ask you some questions about your health and the health of your family. In the last month, have you had an illness that required care?

YES 1 (GO TO 803)
NO 2

802) In the last month, have you helped anyone with an illness in your household?

YES 1
NO 2 (GO TO 807)

803) INTERVIEWER: CHECK 801 AND 802. TICK THE APPROPRIATE SPACE THEN ASK THE CORRESPONDING QUESTION.
RESPONDENT ILL:
[##translator note: text in Arabic, not available on French version]

MEMBER OF HOUSEHOLD ILL:
[##translator note: text in Arabic, not available on French version]

INTERVIEWER: PROBE TO OBTAIN THE FIRST PLACE CONTACTED.

FREE CLINIC 01
HEALTH CENTER 02
REFERENCE CENTER 03
DIAGNOSTIC CENTER 04
PUBLIC HOSPITAL 05
PRIVATE DOCTOR 06 (GO TO 806)
PRIVATE CLINIC 07 (GO TO 806)
PHARMACY 08 (GO TO 806)
TRADITIONAL PRACTITIONER 09 (GO TO 806)
OTHER (SPECIFY): ____ 10 (GO TO 806)
NOWHERE 11 (GO TO 806)

804) Were you satisfied with the service and welcome?
Was he/she satisfied with the service and welcome?

YES 1 (GO TO 807)
NO 2

805) Why weren't you satisfied?
Why wasn't he/she satisfied?

(SPECIFY): ____ (GO TO 807)

806) Why didn't you go to a public hospital?

DIDN'T DESERVE IT 01
DIDN'T THINK OF IT 02
DOESN'T KNOW OF THEM 03
TOO FAR 04
ACCESSIBILITY PROBLEMS 05
BAD RECEPTION 06
LONG WAIT 07
NO DRUGS 08
DIDN'T TRUST IT 09
PERSONNEL INCOMPETENT 10
OTHER (SPECIFY): ____ 11

807) Please give me the name and address of the free clinic in your neighborhood.
INTERVIEWER: RECORD THE EXACT NAME AND ADDRESS OF THE FREE CLINIC, THEN GO TO THE NEXT QUESTION

NAME: ____
ADDRESS: ____
CORRECT 1
INCORRECT 2
DON'T KNOW 8 (GO TO 901)
NOT PROVIDED 9 (GO TO 901)

808) How much time does it take to walk from your dwelling to the free clinic in your neighborhood?

NUMBER OF HOURS: ____
NUMBER OF MINUTES: ____

SECTION 9. ANTHROPOMETRIC MEASUREMENTS AND CHILD'S CLINIC EXAM

901) INTERVIEWER: RECORD THE EXACT TIME

HOUR _____
MINUTE _____

902) INTERVIEWER: SEE TABLE 5 THEN RECORD THE LINE NUMBER, NAME, AND SURVIVAL STATE OF ALL CHILDREN AGED 5 AND UNDER OR BORN SINCE JANUARY 1982.

TABLE 6: BIRTHS OCCURRING IN THE LAST 5 YEARS

LAST BIRTH:

LINE NUMBER
(NAME): ____
ALIVE
DEAD

903) INTERVIEWER: SEE 318 AND RECORD THE DATE OF BIRTH

MONTH: ____
YEAR: ____

904) INTERVIEWER: SEE 524-525 AND TICK APPROPRIATE SPACE.
CHILD HAD DIARRHEA: EXAM AND RESULT
CHILD DID NOT HAVE DIARRHEA (CONTINUE)

SKIN FOLD
YES 1
NO 2
DRY TONGUE
YES 1
NO 2
DARK SHADOWS UNDER EYES
YES 1
NO 2

905) INTERVIEWER: PRECISELY RECORD THE WEIGHT, HEIGHT, AND CRANIAL CIRCUMFERENCE

WEIGHT KG, CG: ____
HEIGHT CM, MM: ____
CRANIAL CIRCUMFERENCE CM, MM: ____

906) INTERVIEWER: EXAMINE TO SEE IF THE CHILD HAS ANY EDEMAS.

NO EDEMAS 1
EDEMAS ON EXTREMITIES 2
EXTENSIVE EDEMAS 3

907) INTERVIEWER:
CHILD BORN AFTER MAY 1985 (CONTINUE)
CHILD WAS BORN BEFORE MAY 1985, ASK:
Does (NAME) hear well? Does he/she speak? Does he/she have all his/her mental faculties?

HEARS
YES 1
NO 2
SPEAKS
YES 1
NO 2
SEES
YES 1
NO 2
NORMAL CHILD
YES 1
NO 2

908) LIMPNESS PARALYSIS OF UPPER EXTREMITIES:
Does (NAME) have any upper limb paralysis (limpness)?

YES 1
NO 2

909) LIMPNESS PARALYSIS OF LOWER EXTREMITIES:
Does (NAME) have any lower limb paralysis (limpness)?

YES 1
NO 2
(GO TO NEXT COLUMN)

910) INTERVIEWER: INDICATE TIME AT THE END OF THE INTERVIEW:

HOURS: ____
MINUTES: ____

INTERVIEWER'S OBSERVATIONS

(TO BE FILLED IN AFTER COMPLETING INTERVIEW)
NAME: ____
DATE: ____

INSPECTOR'S OBSERVATIONS
SUPERVISOR: ____
DATE: ____

SUPERVISOR'S OBSERVATIONS
SUPERVISOR: ____
DATE: ____

FIELD EDITOR'S AND INPUT AGENT'S OBSERVATIONS
NAME OF FIELD EDITOR: ____
DATE: ____
NAME OF INPUT AGENT: ____
DATE: ____

SHEET "AGEVENT" [##translator note: Unable to find meeting of "agevent"]

BIRTH N
DEATH DCD
STILLBORN MN
MISCARRIAGE FC
MARRIAGE M
DIVORCE D
WIDOWHOOD W

HISTORIC CALENDAR:
1987-1962
RECUPERATION O. EDAHAB (AUGUST) 1979
GREEN MARKET (NOVEMBER 6) 1975
RAMADAN WAR (OCTOBER) 1973
DEATH OF J. ABDENNACER 1970
6 DAY WAR (JUNE) 1967