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NATIONAL POPULATION AND HEALTH SURVEY (ENPS II)
WOMAN'S QUESTIONNAIRE

IDENTIFICATION

PROVINCE OR PREFECTURE

CIRCLE

MUNICIPALITY:

AUTONOMOUS CENTER
RURAL COMMUNE

CENTER

PRIMARY UNIT NUMBER

SECONDARY UNIT NUMBER

LEVEL:

1 RABAT-CASA
2 LARGE CITY
3 CITY
4 COUNTRYSIDE

HOUSEHOLD NUMBER

HOUSEHOLD ADDRESS

INTERVIEWER VISITS:

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE
INTERVIEWER NAME
RESULT*

1 COMPLETED
2 NO HOUSEHOLD MEMBER AT HOME OR COMPETENT RESPONDENT IN HOUSEHOLD AT TIME OF VISIT
3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME
4 POSTPONED
5 REFUSED
6 DWELLING VACANT OR ADDRESS NOT A DWELLING
7 DWELLING DESTROYED
8 DWELLING NOT FOUND
9 OTHER (SPECIFY)_________

NEXT VISIT: (FOR INTERVIEWERS 1 AND 2)
DATE
TIME

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT*

TOTAL NUMBER OF VISITS

TOTAL PERSONS IN HOUSEHOLD___
TOTAL ELIGIBLE WOMEN___
TOTAL ELIGIBLE MEN___
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE

SUPERVISOR
NAME

FIELD EDITOR
NAME

OFFICE EDITOR

KEYED BY

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE TIME:

HOUR____
MINUTES____

102) 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 Rabat or Casa, in a large city, a city, or in the countryside?

RABAT OR CASA 1
OTHER LARGE CITY 2
SMALL CITY 3
COUNTRYSIDE 4

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

MONTH____
DON'T KNOW MONTH 98
YEAR____
DON'T KNOW YEAR 98

104) How old were you at your last birthday?
COMPARE AND CORRECT 103 AND/OR 104 IF INCORRECT

AGE IN COMPLETED YEARS____

105) Have you ever attended school?

YES 1
NO 2 (GO TO 109)

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

PRIMARY 1
SECONDARY 2
HIGHER 3

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

GRADE____

108) CHECK 106:

PRIMARY
SECONDARY OR HIGHER (GO TO 110)

109) 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 111)

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

YES 1
NO 2

111) Do you usually listen to the radio at least once a week?

YES 1
NO 2

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

YES 1
NO 2

113) CHECK QUESTION 4 ON HOUSEHOLD QUESTIONNAIRE

RESPONDENT NOT USUAL RESIDENT
RESPONDENT IS USUAL RESIDENT (GO TO 201)

114) Now I would like to ask about the place in which you usually live.
Do you usually live in Rabat, in Casa, in a large city, in a city, or in the countryside?
IF CITY: What city do you live in?

(NAME OF CITY)____
RABAT, CASA 1
OTHER LARGE CITY 2
SMALL CITY 3
COUNTRYSIDE 4

115) Which province is it in?

PROVINCE____

116) Now I would like to ask you about the household in which you usually live.
What is the main source of drinking water for your household?

PIPED WATER
PIPED INTO RESIDENCE/YARD/PLOT 11 (GO TO 118)
PUBLIC TAP 12
WELL WATER
WELL IN RESIDENCE/YARD/PLOT 21 (GO TO 118)
PUBLIC WELL 22
SURFACE WATER
SPRING 31
RIVER/STREAM 32
POND/LAKE 33
DAM 34
RAINWATER 41 (GO TO 118)
TANKER TRUCK 51
BOTTLED WATER 61 (GO TO 118)
OTHER (SPECIFY) 71

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

MINUTES____
ON PREMISES 996

118) Does your household get drinking water from this same source?

YES 1 (GO TO 120)
NO 2

19) What is the main source of drinking water for your household?

PIPED WATER
PIPED INTO RESIDENCE/YARD/PLOT 11
PUBLIC TAP 12
WELL WATER
WELL IN RESIDENCE/YARD/PLOT 21
PUBLIC WELL 22
SURFACE WATER
SPRING 31
RIVER/STREAM 32
POND/LAKE 33
DAM 34
RAINWATER 41
TANKER TRUCK 51
BOTTLED WATER 61
OTHER (SPECIFY) 71

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

FLUSH TOILET
FLUSH TOILET INSIDE 11
PRIVATE OUTDOOR FLUSH TOILET 12
SHARED OUTDOOR FLUSH TOILET 13
PIT TOILET/LATRINE
TRADITIONAL PIT TOILET 21
VENTILATED IMPROVED PIT (VIP) LATRINE 22
NO FACILITY/BUSH/FIELD 31
OTHER (SPECIFY) 41

121) Does your household have:

Electricity?
YES 1
NO 2
A radio?
YES 1
NO 2
A television?
YES 1
NO 2
A telephone?
YES 1
NO 2
A refrigerator?
YES 1
NO 2

122) How many rooms in your household are used for sleeping?

ROOMS____

123) Could you describe the main material of the floor in your home?

NATURAL FLOOR
EARTH/SAND 11
DUNG 12
RUDIMENTARY FLOOR
WOOD PLANKS 21
PALMS/BAMBOO 22
FINISHED FLOOR
PARQUET OR POLISHED WOOD 31
VINYL OR ASPHALT 32
TILES 33
CEMENT 34
CARPET 35
OTHER (SPECIFY)____ 41

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

FLAGSTONE 01
PLANKS/REEDS/BRANCHES WITH EARTH 02
PLANKS/REEDS/BRANCHES WITH NO EARTH 03
SHEET METAL/TIN 04
PLANKS/TILES 05
OTHER (SPECIFY)____ 06

125) What is the occupation status of the dwelling?

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

126) Does any member of your household own:

A bicycle?
YES 1
NO 2
A motorcycle or motor scooter?
YES 1
NO 2
A car?
YES 1
NO 2

SECTION 2. MARRIAGE

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

SINGLE 1 (GO TO 401)
MARRIED 2
WIDOWED 3 (GO TO 204)
DIVORCED 4 (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 98

204) Are you the first, second…wife?

NUMBER____

205) CHECK 204:

2 OR MORE MARRIAGES
1 MARRIAGE (GO TO 207)

206) How did your first marriage end?

DIVORCE 1
WIDOWHOOD 2

207) In what month and year were you married for the first time?

MONTH____
DON'T KNOW MONTH 98
YEAR____
DON'T KNOW YEAR 98

208) How old were you when you were married for the first time?

AGE____
DON'T KNOW AGE 98

209) CHECK 207 AND 208:
YEAR AND MONTH GIVEN:

YES
NO (GO TO 211)

210) CHECK CONSISTENCY OF 207 AND 208:
YEAR OF BIRTH (103) PLUS AGE OF MARRIAGE (208) EQUALS YEAR OF MARRIAGE CALCULATED
IF NECESSARY, CALCULATE YEAR OF BIRTH CURRENT YEAR MINUS CURRENT AGE (104) EQUALS YEAR OF BIRTH CALCULATED
IS THE YEAR OF MARRIAGE CALCULATED WITHIN ONE YEAR, THE SAME AS THE RECORDED YEAR OF MARRIAGE (207)

YES
NO (VERIFY AND CORRECT 207 AND 208)

211) DETERMINE THE MONTHS OF MARRIAGE SINCE JANUARY 1986 RECORD "X" IN COLUMN 6 OF CALENDAR FOR EACH MONTH OF MARRIAGE AND RECORD "O" FOR EACH MONTH OF NON-MARRIAGE SINCE JANUARY 1986.
FOR THE WIDOWED, DIVORCED, OR MARRIED MORE THAN ONCE WOMEN:
PROBE FOR THE DATE OF DIVORCE OR WIDOWHOOD, AND THE START OF ALL OTHER MARRIAGES.

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

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

213) CHECK 201:

MARRIED
WIDOWED, DIVORCED (GO TO 301)

214) Now we need some information on your sexual activity to better understand family planning and fertility.
How many times have you had sexual intercourse in the last four months?

NUMBER OF TIMES____

215) How many times a month do you usually have sexual intercourse?

NUMBER OF TIMES____

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

DAYS AGO 1
WEEKS AGO 2
MONTHS AGO 3
YEARS AGO 4
BEFORE LAST BIRTH 996

217) PRESENCE OF OTHERS AT THIS POINT:

CHILDREN UNDER 10
YES 1
NO 2
HUSBAND/PARTNER
YES 1
NO 2
OTHER MALES
YES 1
NO 2
OTHER FEMALES
YES 1
NO 2

SECTION 3. REPRODUCTION

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

YES 1
NO 2 (GO TO 306)

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 304)

303) How many sons live with you?
And how many daughters live with you?
INTERVIEWER: IF NONE, RECORD '00'

SONS AT HOME____
DAUGHTERS AT HOME____

304) 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 306)

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

SONS ELSEWHERE____
DAUGHTERS ELSEWHERE____

306) 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 308)

307) How many boys have died?
And how many girls have died?
INTERVIEWER: IF NONE, RECORD '00'

BOYS DEAD____
GIRLS DEAD____

308) INTERVIEWER: SUM ANSWERS TO 303, 305, AND 307 AND ENTER TOTAL.
IF NONE, RECORD 00

TOTAL____

309) CHECK 308:
Just to makes sure that I counted all your children, did you have in total ____ children during your life?
IF NO, PROBE AND CORRECT 301 TO 308

310) INTERVIEWER: CHECK 308:

ONE OR MORE BIRTHS
NO BIRTHS (SKIP TO 326)

311) Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had. (RECORD NAMES OF ALL THE BIRTHS IN 312. RECORD TWINS AND TRIPLES ON SEPARATE LINES)

312) What is the name of your (first, second…) child?

(NAME)____

313) RECORD THE TYPE OF BIRTH: SINGLE OR MULTIPLE

SINGLE 1
MULTIPLE 2

314) Was (NAME OF CHILD) a boy or a girl?

BOY 1
GIRL 2

315) Please give me the family booklet or the birth certificate.

NONE 1
FAMILY BOOKLET 2
BIRTH CERTIFICATE 3
OTHER DOCUMENT 4

316) In what month and year was (NAME)'s birth?
PROBE: What is he/her birthday?
In what season was he/she born?

MONTH____
YEAR____

317) Is (NAME) still alive?

YES 1
NO 2

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

AGE IN YEARS____

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

YES 1 (GO TO NEXT BIRTH)
NO 2

320) IF CHILD IS AGE 15 YEARS OR LESS:
With whom does he/she live?
IF 15 OR MORE: SKIP TO NEXT BIRTH

FATHER 1
OTHER RELATIVE 2
SOMEONE ELSE 3 (SKIP TO NEXT BIRTH)

321) IF DEAD: What was his/her age when he/she died?
IF 1 YEAR, PROBE: What was (NAME)'s age in months?
RECORD THE AGE DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS, OR YEARS COMPLETED.

DAYS 1
MONTHS 2
YEARS 3

322) COMPARE 308 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:

NUMBERS ARE THE SAME, CHECK:
FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED.
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED
FOR THE AGE AT DEATH 12 MONTHS OR 1 YEAR: PROBE TO DETERMINE THE EXACT NUMBER OF MONTHS
THE NUMBERS ARE DIFFERENT: (PROBE AND RECONCILE)

323) CHECK 316 AND RECORD THE NUMBER OF LIVE BIRTHS SINCE JANUARY 1986. IF THERE ARE NONE, RECORD 0 AND SKIP TO 325.

324) FOR EACH BIRTH AFTER JANUARY 1986, RECORD "N" FOR EACH MONTH OF BIRTH IN COLUMN 1 OF CALENDAR AND "G" FOR EACH OF THE 8 MONTHS BEFORE. RECORD THE NAME OF THE CHILD TO THE LEFT OF CODE "N".

325) BELOW THE CALENDAR, RECORD THE NAME AND DATE OF BIRTH OF LAST CHILD BORN BEFORE JANUARY 1986, IF THERE WAS ONE.

326) Are you currently pregnant?

YES 1
NO 2 (GO TO 329)
DON'T KNOW 98 (GO TO 329)

327) How many months pregnant are you?
RECORD "G" IN COLUMN 1 OF CALENDAR FOR THE MONTH OF THE INTERVIEW AND FOR EACH MONTH OF PREGNANCY.

MONTHS____

328) At the time you became pregnant did you want to become pregnant then, did you want to wait until later, or did you not want to have any more children?

THEN 1
LATER 2
NOT WANT MORE CHILDREN 3

329) Did you ever have a pregnancy end from an abortion, a miscarriage, or stillbirth?

YES 1
NO 2 (GO TO 335)

330) In what month and what year did the last such pregnancy end?

MONTH____
YEAR____

331) CHECK 330:

LAST PREGNANCY ENDED BEFORE JANUARY 1986
LAS PREGNANCY ENDED AFTER JANUARY 1986 (GO TO 335)

332) How many months pregnant were you when the pregnancy ended?
RECORD "F" IN COLUMN 1 OF CALENDAR FOR THE MONTH WHEN THE PREGNANCY ENDED, AND "G" FOR THE MONTHS OF PREGNANCY.

MONTHS____

333) Have you had any other pregnancies of this type?

YES 1
NO 2 (GO TO 335)

334) ASK THE DATES AND DURATION OF THE OTHER PREGNANCIES OF THIS TYPE UP TO JANUARY 1986. RECORD "F" IN COLUMN 1 OF CALENDAR FOR THE MONTH WHEN THE PREGNANCY ENDED, AND "G" FOR THE MONTHS OF PREGNANCY.

335) When did you last menstrual cycle start?

DAYS AGO 1
WEEKS AGO 2
MONTHS AGO 3
YEARS AGO 4
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

336) From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant if she has sexual relations?

YES 1
NO 2 (GO TO 401)
DON'T KNOW 8 (GO TO 401)

337) At what point during a woman's menstrual cycle is she more likely to get pregnant?

DURING HER PERIOD 1
RIGHT AFTER HER PERIOD HAD ENDED 2
HALFWAY BETWEEN TWO PERIODS 3
JUST BEFORE HER PERIOD BEGINS 4
ANYTIME 5
OTHER (SPECIFY)____ 6
DON'T KNOW 8

SECTION 4. CONTRACEPTION

400) CHECK 201:

SINGLE
OTHER (GO TO 401)

400A) Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy. Which ways or methods have you heard about?
CIRCLE CODE 1 IN 400B FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED.

400B) Have you ever heard of (METHOD)?

METHOD 1 Pill. PROBE: Women can take a pill every day.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3
METHOD 2 IUD. PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3
METHOD 3 Injectables. PROBE: Women can have an injection by a heath provider which stops them from becoming pregnant for several months.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3
METHOD 4 Diaphragm, foam or jelly. PROBE: Women can place a sponge, suppository, a diaphragm, a jelly, or cream in their vagina before intercourse.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3
METHOD 5 Condom. PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3
METHOD 6 Female Sterilization. PROBE: Women can have an operation to avoid having any more children
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3
METHOD 7 Male Sterilization. PROBE: Men can have an operation to avoid having any more children
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3
METHOD 8 Rhythm or Periodic abstinence. PROBE: Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3
METHOD 9 Withdrawal. PROBE: Men can be careful and pull out before climax.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3
METHOD 10: Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES, SPONTANEOUSLY (SPECIFY) 1
NO 2

400C) In the last month have you heard about family planning:

On the radio?
YES 1
NO 2
On the television?
YES 1
NO 2

400D) It is acceptable or not to you for family planning information to be provided on the radio or television?

ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8

400E) In general, do you approve or disapprove of couples using a method to avoid pregnancy?

APPROVE 1
DISAPPROVE 2

400F) If you could choose exactly the number of children to have in your whole life, how many would that be?

NUMBER _____ (GO TO 601)
OTHER (SPECIFY) 96 (GO TO 601)

401) Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy. Which ways or methods have you heard about?

CIRCLE CODE 1 IN 402 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 402, ASK 403-404 BEFORE GOING TO NEXT METHOD.

402) Have you ever heard of (method)?
READ THE DESCRIPTION OF EACH METHOD.

01) Pill: women can take a pill every day.
YES/SPONTANEOUSLY 1
YES/DESCRIPTION 2
NO 3
02) IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES/SPONTANEOUSLY 1
YES/DESCRIPTION 2
NO 3
03) Injectables: Women can have an injection by a heath provider which stops them from becoming pregnant for several months.
YES/SPONTANEOUSLY 1
YES/DESCRIPTION 2
NO 3
04) Diaphragm, foam or jelly: Women can place a sponge, suppository, a diaphragm, a jelly, or cream in their vagina before intercourse.
YES/SPONTANEOUSLY 1
YES/DESCRIPTION 2
NO 3
05) Condom: Men can put a rubber sheath on their penis before sexual intercourse.
YES/SPONTANEOUSLY 1
YES/DESCRIPTION 2
NO 3
06) Female Sterilization: Women can have an operation to avoid having any more children
YES/SPONTANEOUSLY 1
YES/DESCRIPTION 2
NO 3
07) Male Sterilization
Men can have an operation to avoid having any more children
YES/SPONTANEOUSLY 1
YES/DESCRIPTION 2
NO 3
08) Rhythm or Periodic abstinence: Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES/SPONTANEOUSLY 1
YES/DESCRIPTION 2
NO 3
09) Withdrawal: Men can be careful and pull out before climax.
YES/SPONTANEOUSLY 1
YES/DESCRIPTION 2
NO 3
10) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
(SPECIFY) ________
(SPECIFY) ________
(SPECIFY) ________
YES/SPONTANEOUSLY 1
NO 3

403) Have you ever used (method)?

01) Pill: women can take a pill every day.
YES 1
NO 2
02) IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
03) Injectables: Women can have an injection by a heath provider which stops them from becoming pregnant for several months.
YES 1
NO 2
04) Diaphragm, foam or jelly: Women can place a sponge, suppository, a diaphragm, a jelly, or cream in their vagina before intercourse.
YES 1
NO 2
05) Condom: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
06) Female Sterilization: Women can have an operation to avoid having any more children
YES 1
NO 2
07) Male Sterilization
Men can have an operation to avoid having any more children
YES 1
NO 2
08) Rhythm or Periodic abstinence: Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
09) Withdrawal: Men can be careful and pull out before climax.
YES 1
NO 2

404) Do you know where you can get (method)?

01) Pill: women can take a pill every day.
YES 1
NO 2
02) IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
03) Injectables: Women can have an injection by a heath provider which stops them from becoming pregnant for several months.
YES 1
NO 2
04) Diaphragm, foam or jelly: Women can place a sponge, suppository, a diaphragm, a jelly, or cream in their vagina before intercourse.
YES 1
NO 2
05) Condom: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
06) Female Sterilization: Women can have an operation to avoid having any more children
YES 1
NO 2
07) Male Sterilization
Men can have an operation to avoid having any more children
YES 1
NO 2
08) Rhythm or Periodic abstinence: Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2

405) CHECK 403:

NOT A SINGLE 'YES' (NEVER USED)
AT LEAST ONE 'YES' (EVER USED) (GO TO 409)

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

YES 1 (GO TO 408)
NO 2

406b) Why have you never used any method to delay or avoid getting pregnant?

HUSBAND OPPOSED 01
SIDE EFFECTS 02
HEALTH CONCERNS 03
ACCESS/AVAILABILITY 04
COST TOO MUCH 05
INCONVENIENT 06
LACK OF INFORMATION 07
DIVORCED OR WIDOWED 08
STERILE 09
WANTS CHILDREN 10
OTHER (SPECIFY) 11
DON'T KNOW 98

407) RECORD 0 FOR ALL THE MONTHS LEFT BLANK IN COLUMN 1 OF CALENDAR (GO TO 439)

408) What have you used or done?
CORRECT 403-405 (AND 402 IF NECESSARY)

409) Which is the first thing you did or the first method you used to avoid getting pregnant?

PILL 01
IUD 02
INJECTABLES 03
DIAPHRAGM/FOAM/JELLY 04
CONDOM 05
FEMALE STERILIZATION 06 (GO TO 411)
MALE STERILIZATION 07 (GO TO 411)
RHYTHM METHOD 08 (GO TO 411)
WITHDRAWAL 09 (GO TO 411)
OTHER (SPECIFY) 10 (GO TO 411)

410) Where did you obtain this method the first time?

(NAME OF PLACE)____
PUBLIC SECTOR
PUBLIC HOSPITAL 11
MATERNITY CENTER 12
HEALTH CENTER 13
FREE CLINIC 14
HOME VISIT 15
MOBILE TEAM 16
PRIVATE SECTOR
FAMILY PLANNING ASSOCIATION (AMPF) 21
CLINIC 22
PHARMACY 23
DOCTOR/MIDWIFE 24
OTHER PRIVATE
FEMALE RELATIVE/FRIEND 31
QABLA 32
OTHER (SPECIFY) 41
OTHER 98

411) How many living children did you have at that time?
IF NONE, RECORD 00

NUMBER OF CHILDREN____

412) CHECK 326:

NOT PREGNANT OR NOT SURE
PREGNANT (GO TO 431)

413) CHECK 403:

WOMAN NOT STERILIZED
WOMAN STERILIZED (GO TO 415A)

414) Are you currently doing something or using any method to delay or avoid pregnancy?

YES 1
NO 2 (GO TO 431)

415) Which method are you using?

415A) CIRCLE 'A' FOR FEMALE STERILIZATION

PILL 01
IUD 02 (GO TO 423)
INJECTABLES 03 (GO TO 423)
DIAPHRAGM/FOAM/JELLY 04 (GO TO 423)
CONDOM 05 (GO TO 423)
FEMALE STERILIZATION 06 (GO TO 421)
MALE STERILIZATION 07 (GO TO 421)
RHYTHM METHOD 08 (GO TO 426)
WITHDRAWAL 09 (GO TO 426)
OTHER (SPECIFY) 10 (GO TO 426)

416) At the time you first started using the pill, did you consult a doctor or a nurse?

YES 1
NO 2
DON'T KNOW 8

417) At the time you last got pills, did you consult a doctor or a nurse?

YES 1
NO 2

418) May I see the package of pills you are using now?
(RECORD NAME OF BRAND)

PACKAGE SEEN 1
NAME OF BRAND____ (GO TO 420)
PACKAGE NOT SEEN 2

419) Do you know the brand name of the pills you are now using?
(RECORD NAME OF BRAND)

NAME OF BRAND____
DON'T KNOW 98

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

PRICE____ (GO TO 423)
FREE 996 (GO TO 423)
DON'T KNOW 998 (GO TO 423)

421) In what month and year was the sterilization operation performed?

MONTH____
YEAR____

422) RECORD THE STERILIZATION CODE IN THE SPACE OF THE MONTH OF THE INTERVIEW IN COLUMN 1 OF CALENDAR AND EACH MONTH UNTIL THE DATE OF THE OPERATION OR UNTIL JANUARY 1986 IF THE OPERATION TOOK PLACE BEFORE 1986.

423) CHECK 415:
WAS STERILIZED: In what facility did the sterilization take place?
CURRENTLY USING ANOTHER METHOD: Where did you obtain (METHOD) last time?

(NAME OF PLACE)____
PUBLIC SECTOR
PUBLIC HOSPITAL 11
MATERNITY CENTER 12
HEALTH CENTER 13
FREE CLINIC 14
HOME VISIT 15 (GO TO 426)
MOBILE TEAM 16 (GO TO 426)
PRIVATE SECTOR
FAMILY PLANNING ASSOCIATION 21 [##TRANSLATOR NOTE: THIS IS AN OFFICIAL ORGANIZATION, AMPF (ASSOCIATION MAROCAINE DE PLANIFICATION FAMILIALE)]
CLINIC 22
PHARMACY 23
DOCTOR/MIDWIFE 24
OTHER PRIVATE
FEMALE RELATIVE/FRIEND 31 (GO TO 426)
QABLA 32 (GO TO 426) [##TRANSLATOR NOTE: THIS IS AN INDIVIDUAL/INSTITUTION RELATED TO THE ISLAMIC FAITH]
OTHER (SPECIFY) 41 (GO TO 426)
OTHER 98 (GO TO 426)
31-98 ( GO TO 426)

424) How long does it take to travel from your home to this place?
IF LESS THAN 2 HOURS, RECORD MINUTES. OTHERWISE RECORD HOURS.

MINUTES 1 ____
HOURS 2 ____
DON'T KNOW 9998

425) Is it easy or difficult to get there?

EASY 1
DIFFICULT 2

426) What is the main reason you decided to use (METHOD FORM 415) rather than another family planning method?

RECOMMENDATION FROM FAMILY PLANNING AGENTS 01
RECOMMENDATION FROM FRIENDS/RELATIVES 02
SIDE EFFECTS OF OTHER METHODS 03
CONVENIENT TO USE 04
ACCESS/AVAILABILITY 05
COST 06
WANTED A PERMANENT METHOD 07
HUSBAND'S PREFERENCE 09
WANTED MOST EFFECTIVE METHOD 10
OTHER (SPECIFY) 11
DON'T KNOW 98

427) Have you had any problems using (CURRENT METHOD)?

YES 1
NO 2 (GO TO 429)

428) What is the main problem?

HUSBAND OPPOSED 01
SIDE EFFECTS 02
HEALTH CONCERNS 03
ACCESS/AVAILABILITY 04
COST TOO MUCH 05
INCONVENIENT 06
LACK OF INFORMATION 07
STERILIZED, WANTS CHILDREN 07
OTHER (SPECIFY) 08
DON'T KNOW 98

429) CHECK 415 AND 421:

NEITHER STERILIZED
HE OR SHE STERILIZED BEFORE JANUARY 1986 (GO TO 448)
HE OR SHE STERILIZED AFTER JANUARY 1986 (GO TO 431)

430) RECORD THE METHOD CODE FROM 415 IN THE SPACE OF THE CURRENT MONTH IN COLUMN 1 OF THE CALENDAR. THEN DETERMINE WHEN SHE STARTED USING EACH METHOD THIS TIME. RECORD THE CODE OF THE METHOD IN THE SPACE OF ALL THE MONTHS OF USE.

EXAMPLES OF QUESTIONS:
WHEN DID YOU START USING THIS METHOD CONTINUOUSLY?
FOR HOW LONG HAVE YOU USED THIS METHOD CONTINUOUSLY?

431) I would like to ask you some questions about all the (other) times in the last few years during which you or your husband used a method to avoid pregnancy?

Use the calendar to determine periods before usage and periods of non-usage, starting with the most recent usage and going up to January 1986.

Use the name of the children, dates of birth, and periods of pregnancy as points of reference.

For each month in column 1, record the method code or 0 for non-usage. In column 2, record the discontinuation code next to the last month of usage.

The number of codes recorded in column 2 should be the same as the number of interruptions of usage in the contraception in column 1.

Ask why she stopped using that method. If a pregnancy followed, ask if she got pregnant without wanting to while using the method, or if she deliberately stopped to get pregnant.

Examples of questions:
Column 1:
When was the last time you used a method? What method was it?
When did you start using this method? How long after the birth of (NAME)?
For how long did you use the method?

Column 2:
Why did you stop using (method)?
Did you become pregnant while using (method), or did you stop using it to become pregnant, or for another reason?
If she deliberately stopped to become pregnant, ask:
"How many months after you stopped using (method) did you get pregnant?"
And record 0 for each of these months in column 1.

432) CHECK THE CALENDAR:

METHOD USED IN JANUARY 1986
NO METHOD USED IN JANUARY 1986 (GO TO 434)

433) I see you used (METHOD) in January 1986. When did you start using (METHOD) this time?
THIS DATE SHOULD NOT BE BEFORE THE BIRTH DATE OF A CHILD BORN BEFORE JANUARY 1986.

MONTH____
YEAR____
GO TO 438

434) I see that you did not use a contraceptive method in January 1986. Did you use a method before this date?

YES 1
NO 2 (GO TO 438)

435) CHECK 315:

HAD A BIRTH BEFORE JANUARY 1986
DID NOT HAVE A BIRTH BEFORE JANUARY 1986 (GO TO 437)

436) Did you use a method between the birth of (NAME OF LAST CHILD BEFORE JANUARY 1986) and January 1985?

YES 1
NO 2 (GO TO 438)

437) When did you stop using a method the last time, before January 1986?

MONTH____
YEAR____

438) CHECK 415:

NOT CURRENTLY USING A METHOD
CURRENTLY USING RHYTHM METHOD, WITHDRAWAL, AND OTHER TRADITIONAL METHODS (GO TO 444)
CURRENTLY USING MODERN METHOD (GO TO 448)

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

YES 1 (GO TO 441)
NO 2
DON'T KNOW 8 (GO TO 444)

440) What is the main reason you do not intend to use a method?

WANTS CHILDREN 01 (GO TO 444)
LACK OF KNOWLEDGE 02 (GO TO 444)
HUSBAND OPPOSED 03 (GO TO 444)
COST TOO MUCH 04 (GO TO 444)
SIDE EFFECTS 05 (GO TO 444)
HEALTH CONCERNS 06 (GO TO 444)
HARD TO GET METHODS 07 (GO TO 444)
RELIGION 08 (GO TO 444)
OPPOSED TO FAMILY PLANNING 09 (GO TO 444)
FATALISTIC 10 (GO TO 444)
OTHER PEOPLE OPPOSED 11 (GO TO 444)
INFREQUENT SEX 12 (GO TO 444)
DIFFICULT TO GET PREGNANT 13 (GO TO 444)
MENOPAUSE/STERILIZED 14 (GO TO 444)
INCONVENIENT 15 (GO TO 444)
OTHER (SPECIFY) 17 (GO TO 444)
DON'T KNOW 98 (GO TO 444)

441) Do you intend to use a method within the next 12 months?

YES 1
NO 2
DON'T KNOW 8

442) When you use a method, which method would you prefer to use?

PILL 01
IUD 02
INJECTABLES 03
DIAPHRAGM/FOAM/JELLY 04
CONDOM 05
FEMALE STERILIZATION 06
MALE STERILIZATION 07
RHYTHM METHOD 08 (GO TO 444)
WITHDRAWAL 09 (GO TO 444)
OTHER (SPECIFY) 10 (GO TO 444)

443) Where can you get (METHOD IN 442)?

(NAME OF PLACE) _____
PUBLIC SECTOR
PUBLIC HOSPITAL 11 (GO TO 446)
MATERNITY CENTER 12 (GO TO 446)
HEALTH CENTER 13 (GO TO 446)
FREE CLINIC 14 (GO TO 446)
HOME VISIT 15 (GO TO 448)
MOBILE TEAM 16 (GO TO 448)
PRIVATE SECTOR
FAMILY PLANNING ASSOCIATION 21 (GO TO 446)
CLINIC 22 (GO TO 446)
PHARMACY 23 (GO TO 446)
DOCTOR/MIDWIFE 24 (GO TO 446)
OTHER PRIVATE
FEMALE RELATIVE/FRIEND 31 (GO TO 448)
QABLA 32 (GO TO 448)
OTHER (SPECIFY) 41 (GO TO 448)
OTHER 98

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

YES 1
NO 2 (GO TO 448)

445) Where is that?

(NAME OF PLACE)____
PUBLIC SECTOR
PUBLIC HOSPITAL 11
MATERNITY CENTER 12
HEALTH CENTER 13
FREE CLINIC 14
HOME VISIT 15 (GO TO 448)
MOBILE TEAM 16 (GO TO 448)
PRIVATE SECTOR
FAMILY PLANNING ASSOCIATION 21
CLINIC 22
PHARMACY 23
DOCTOR/MIDWIFE 24
OTHER PRIVATE
FEMALE RELATIVE/FRIEND 31 (GO TO 448)
QABLA 32 (GO TO 448)
OTHER (SPECIFY) 41 (GO TO 448)
OTHER 98 (GO TO 448)

446) How long does it take to travel from your home to this place?
IF LESS THAN 2 HOURS, RECORD MINUTES. OTHERWISE, RECORD HOURS.

MINUTES 1 ____
HOURS 2 ____
DON'T KNOW 9998

447) Is it easy or difficult to get there?

EASY 1
DIFFICULT 2

448) In the last month, have you heard about family planning on:

The radio?
YES 1
NO 2
Television?
YES 1
NO 2

449) It is acceptable or not to you for family planning information to be provided on the radio or television?

ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8

SECTION 5A. PREGNANCY AND BREASTFEEDING

501) CHECK 323:

ONE OR MORE BIRTHS SINCE JANUARY 1986
NO BIRTHS SINCE JANUARY 1986 OR LATER (GO TO 544)

502) ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1986 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. START WITH THE LAST BIRTH. (IF THERE ARE MORE THAN THREE BIRTHS, USE ADDITIONAL FORMS).

Now I would like to ask you some more questions about the health of all your children born in the past five years. (We will talk about one child at a time).

LINE NUMBER FROM 312.

_______

FROM 312 AND 317

NAME _______

LIVING __
DEAD __

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

THEN 1 (GO TO 505)
LATER 2
NOT AT ALL 3 (GO TO 505)

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

MONTHS 1 ____
YEARS 2 ____
DON'T KNOW 998

505) When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see?
Anyone else?
RECORD ALL PERSONS SEEN.

HEATH PROFESSIONAL
DOCTOR A
MIDWIFE B
NURSE C
OTHER PERSON
TRADITIONAL TRAINED BIRTH ATTENDANT D
TRADITIONAL BIRTH ATTENDANT E
OTHER (SPECIFY) F
NO ONE G (GO TO 509)

506) Were you given an antenatal card for this pregnancy?

YES 1
NO 2
DON'T KNOW 8

507) How many months pregnant were you when you first saw someone for an antenatal check on this pregnancy?

MONTHS____
DON'T KNOW 98

508) How many antenatal visits did you have during this pregnancy?

NUMBER OF TIMES____
DON'T KNOW 98

509) When you were pregnant with (NAME) were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?

YES 1
NO 2 (GO TO 511)
DON'T KNOW 8 (GO TO 511)

510) During this pregnancy, how many times did you get this injection?

TIMES____
DON'T KNOW 8

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

HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
PUBLIC HOSPITAL 21
MATERNITY 22
BIRTHING HOUSE 23
OTHER 24
PRIVATE SECTOR
CLINIC 31
OTHER (SPECIFY) 41

512) Who assisted with the delivery of (NAME)?
Anyone else? PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.

HEATH PROFESSIONAL
DOCTOR A
MIDWIFE B
NURSE C
OTHER PERSON
TRADITIONAL TRAINED BIRTH ATTENDANT D
TRADITIONAL BIRTH ATTENDANT E
RELATIVE F
OTHER (SPECIFY) G
NO ONE H

513) Was (NAME) born on time or prematurely?

ON TIME 1
PREMATURELY 2
DON'T KNOW 8

514) Was (NAME) delivered by cesarean section?

YES 1
NO 2

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

VERY LARGE 1
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DON'T KNOW 8

516) Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 518)

517) How much did (NAME) weigh?

KILOGRAMS____
DON'T KNOW 98

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

YES 1 (GO TO 520)
NO 2

519) RECORD 'X' IN COLUMN 3 OF THE CALENDAR FOR THE MONTH FOLLOWING THE MONTH OF BIRTH AND FOR EACH MONTH UNTIL THE CURRENT MONTH (OR UNTIL THE CURRENT PREGNANCY). GO TO 521.

520) How many months after the birth of (NAME) did you not have a period?
RECORD X IN COLUMN 3 OF THE CALENDAR FOR THE NUMBER OF MONTHS WHERE HER PERIOD WAS ABSENT STARTING WITH THE MONTH AFTER THE MONTH OF BIRTH.
IF LESS THAN A MONTH WITHOUT PERIOD, RECORD 0 IN COLUMN 3 FOR THE MONTHS FOLLOWING THE MONTH OF BIRTH.

521) CHECK 326:
WOMAN PREGNANT?

NOT PREGNANT
PREGNANT OR NOT SURE (GO TO 524)

522) Have you resumed sexual intercourse since the birth of (NAME)?

YES 1 (GO TO 524)
NO 2

523) RECORD X IN COLUMN 4 OF THE CALENDAR FOR THE MONTH AFTER THE MONTH OF BIRTH AND FOR EACH MONTH AND FOR EACH MONTH UNTIL THE CURRENT MONTH. (GO TO 525)

524) For how many months after the birth of (NAME) did you not have sexual intercourse?
RECORD X IN COLUMN 4 OF THE CALENDAR FOR THE MONTH WITHOUT SEXUAL INTERCOURSE STARTING WITH THE MONTH AFTER THE MONTH OF BIRTH.
IF LESS THAN ONE MONTH WITHOUT SEXUAL INTERCOURSE, RECORD 0 IN COLUMN 4 OF THE CALENDAR FOR THE MONTH FOLLOWING THE MONTH OF BIRTH.

525) Did you ever breastfeed (NAME)?

YES 1 (GO TO 528)
NO 2

526) RECORD J IN COLUMN 5 OF THE CALENDAR FOR THE MONTH FOLLOWING THE MONTH OF BIRTH.

527) Why did you not breastfeed (NAME)?

MOTHER ILL/WEAK 01 (GO TO 538)\
CHILD ILL/WEAK 02 (GO TO 538)
CHILD DIED 03 (GO TO 538)
NIPPLE/BREAST PROBLEM 04 (GO TO 538)
NOT ENOUGH MILK 05 (GO TO 538)
MOTHER WORKING 06 (GO TO 538)
CHILD REFUSED 07 (GO TO 538)
OTHER (SPECIFY) 08 (GO TO 538)

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

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

IMMEDIATELY 000
HOURS ____ 1
DAYS ____ 2

529) CHECK 317:
CHILD ALIVE?

ALIVE
DEAD (GO TO 536)

530) Are you still breastfeeding (NAME)?

YES 1
NO 2 (GO TO 536)

531) RECORD X IN COLUMN 5 OF THE CALENDAR FOR THE MONTH FOLLOWING THE MONTH OF BIRTH, AND FOR EACH MONTH UP TO THE CURRENT MONTH.

532) How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

NUMBER OF NIGHTTIME FEEDINGS____

533) How many times did you breastfeed yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER

NUMBER OF DAYLIGHT FEEDINGS____

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

Plain water?
YES 1
NO 2
DON'T KNOW 8
Sugar water?
YES 1
NO 2
DON'T KNOW 8
Juice?
YES 1
NO 2
DON'T KNOW 8
Tea?
YES 1
NO 2
DON'T KNOW 8
Herbal tea?
YES 1
NO 2
DON'T KNOW 8
Baby formula?
YES 1
NO 2
DON'T KNOW 8
Fresh milk?
YES 1
NO 2
DON'T KNOW 8
Tinned or powdered milk?
YES 1
NO 2
DON'T KNOW 8
Other liquids?
YES 1
NO 2
DON'T KNOW 8
Any other solid or mushy foods?
YES 1
NO 2
DON'T KNOW 8

535) CHECK 534:

FOOD OR LIQUID GIVEN YESTERDAY?
YES TO ONE OR MORE (GO TO 540)
NO TO ALL (GO TO 539)

536) For how many months did you breastfeed (NAME)?
RECORD X IN COLUMN 5 OF THE CALENDAR FOR THE NUMBER OF MONTHS OF BREASTFEEDING, STARTING WITH THE MONTH AFTER THE MONTH OF BIRTH.

IF LESS THAN ONE MONTH OF BREASTFEEDING, RECORD 0 IN COLUMN 5 FOR THE MONTH AFTER THE MONTH OF BIRTH.

537) Why did you stop breastfeeding (NAME)?

MOTHER ILL/WEAK 01
CHILD ILL/WEAK 02
CHILD DIED 03
NIPPLE/BREAST PROBLEM 04
NOT ENOUGH MILK 05
MOTHER WORKING 06
CHILD REFUSED 07
WEANING AGE/AGE TO STOP 08
BECAME PREGNANT 09
STARTED USING CONTRACEPTION 10
OTHER (SPECIFY) 11

538) CHECK 317:
IS CHILD LIVING?

LIVING (GO TO 540)
DEAD

539) Was (NAME) ever given water or anything else to drink or eat (other than breastmilk)?

YES 1
NO 2 (GO TO 543)

540) How many months old was (NAME) when you started giving the following on a regular basis? IF LESS THAN 1 MONTH, RECORD 00

FORMULA OR MILK OTHER THAN BREASTMILK?
AGE IN MONTHS____
NEVER GIVEN 96
PLAIN WATER?
AGE IN MONTHS____
NEVER GIVEN 96
OTHER LIQUIDS?
AGE IN MONTHS____
NEVER GIVEN 96
ANY SOLID OR MUSHY FOOD?
AGE IN MONTHS____
NEVER GIVEN 96

541) CHECK 317:
IS CHILD LIVING?

LIVING
DEAD (GO TO 543)

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

YES 1
NO 2
DON'T KNOW 8

543) GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 544

544) CHECK 316: BIRTHS IN 1983, 84, OR 85?

YES, NAME OF LAST BIRTH BEFORE 1986 (NAME)____
NO (GO TO 549)

545) Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 547)

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

MONTHS____

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

MONTHS____
PERIOD NOT YET RETURNED 96

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

MONTHS____
SEXUAL INTERCOURSE NOT YET RESUMED 96

549) CHECK 501:

ONE OR MORE BIRTHS SINCE JANUARY 1986 (GO TO 551)
NO BIRTHS SINCE JANUARY 1986 (GO TO 601)

SECTION 5B. IMMUNIZATION AND HEALTH

551) ENTER THE LINE NUMBER AND NAME OF EACH BIRTH SINCE JANUARY 1986 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN THREE BIRTHS, USE ADDITIONAL FORMS).

LINE NUMBER FROM 312

FROM 312 AND 317

LAST BIRTH
NAME
LIVING
DEAD

NEXT-TO-LAST BIRTH
NAME
LIVING
DEAD

SECOND-FROM-LAST BIRTH
NAME
LIVING
DEAD

552) Do you have a card where (NAME'S) vaccination are written down?
IF YES: May I please see it?

YES, SEEN 1 (GO TO 554)
YES, NOT SEEN 2 (GO TO 556)
NO CARD 3

553) Have you ever had a vaccination care for (NAME)?

YES 1 (GO TO 556)
NO 2 (GO TO 556)

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

BCG
DAY____
MONTH____
YEAR____
POLIO 1
DAY____
MONTH____
YEAR____
POLIO 2
DAY____
MONTH____
YEAR____
POLIO 3
DAY____
MONTH____
YEAR____
DPT 1
DAY____
MONTH____
YEAR____
DPT 2
DAY____
MONTH____
YEAR____
DPT 3
DAY____
MONTH____
YEAR____
MEASLES
DAY____
MONTH____
YEAR____

555) Has (NAME) received any vaccinations that are not recorded on this card?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, , DPT 1-3, POLIO 1-3, AND/OR MEASLES VACCINE(S).

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 554) (GO TO 449)
NO 2 (GO TO 558)
DON'T KNOW 8 (GO TO 558)

556) Did (NAME) receive any vaccinations to prevent him/her from getting diseases?

YES 1
NO 2 (GO TO 558)
DON'T KNOW 8 (GO TO 558)

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

A BCG vaccination against tuberculosis, that is, an injection in the left shoulder that caused a scar?
YES 1
NO 2
DON'T KNOW 8
Polio vaccine, that is, drops in the mouth? IF YES: How many times?
YES, NUMBER OF TIMES 1 ____
NO 2
DON'T KNOW 8
An injection against measles?
YES 1
NO 2
DON'T KNOW 8

558) CHECK 317:
IS CHILD LIVING?

LIVING (GO TO 560)
DEAD

559) GO BACK TO 552 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, SKIP TO 590.

560) Has (NAME) had an illness with a fever at any time in the last 2 weeks?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 565)
DON'T KNOW 8 (GO TO 565)

562) Has (NAME) been ill with a cough in the last 24 hours?

YES 1
NO 2
DON'T KNOW 8

563) For how many days (has the cough lasted/did the cough last)?
IF LESS THAN 1 DAY, RECORD 00

DAYS____

564) When (NAME) was ill with a cough, did he/she breathe more rapidly than usual with a short, rapid breath?

YES 1
NO 2
DON'T KNOW 8

565) CHECK 560 AND 560: [##translator note: the original does repeat the same number here]
FEVER OR COUGH?

YES TO 560 OR 561
OTHER (GO TO 570)

566) Was anything given to treat the fever/cough?

YES 1
NO 2 (GO TO 568)
DON'T KNOW 8 (GO TO 568)

567) What was given to treat the fever/cough?
Anything else?
RECORD ALL MENTIONED.

INJECTION A
ANTIBIOTIC (PILL OR SYRUP) B
ANTIMALARIAL (PILL OR SYRUP) C
COUGH SYRUP D
OTHER PILL OR SYRUP E
UNKNOWN PILL OR SYRUP F
HOME REMEDY/HERBAL MEDICINE G
OTHER (SPECIFY) H

568) Did you seek advice or treatment for the fever/cough?

YES 1
NO 2 (GO TO 570)

569) Where did you seek advice or treatment?
Anywhere else?
RECORD ALL MENTIONED

PUBLIC SECTOR
PUBLIC HOSPITAL A
HEALTH CENTER B
FREE CLINIC C
HOME VISIT D
MOBILE TEAM E
PRIVATE SECTOR
CLINIC F
PHARMACY G
PRIVATE DOCTOR H
OTHER PRIVATE
MUSLIM SCHOLAR I
SHOP J
OTHER K

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

YES 1 (GO TO 572)
NO 2
DON'T KNOW 8

571) GO BACK TO 552 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, SKIP TO 590.

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

YES 1
NO 2
DON'T KNOW 8

573) For how many days (has the diarrhea lasted/did the diarrhea last)?
IF LESS THAN 1 DAY, RECORD 00

DAYS____

574) Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

575) CHECK 525/530:
LAST CHILD STILL BREASTFEED?

YES
NO (GO TO 578)

576) During (NAME)'s diarrhea, did you change the frequency of breastfeeding?

YES 1
NO 2 (GO TO 578)

577) Did you increase the number of breastfeeds or reduce them, or did you stop completely?

INCREASED 1
REDUCED 2
STOPPED COMPLETELY 3

578) (Aside from breastmilk) Was he/she given the same amount to drink as before the diarrhea, or more, or less?

SAME 1
MORE 2
LESS 3
DON'T KNOW 8

579) Was anything given to treat the diarrhea?

YES 1
NO 2 (GO TO 581)
DON'T' KNOW 8 (GO TO 581)

580) What was given to treat the diarrhea?
Anything else?
RECORD ALL MENTIONED.

FLUID FROM ORS PACKET A
RECOMMENDED HOME FLUID B
PILL OR SYRUP C
INJECTION D
(I.V.) INTRAVENOUS E
HOME REMEDIES/HERBAL MEDICINE F
RICE WATER GRUEL G
CARROT SOUP H
MORE LIQUIDS I
OTHER (SPECIFY) J

581) Did you seek advice or treatment for the diarrhea?

YES 1
NO 2 (GO TO 583)

582) Where did you seek advice or treatment?
Anywhere else?
RECORD ALL MENTIONED

PUBLIC SECTOR
PUBLIC HOSPITAL A
HEALTH CENTER B
FREE CLINIC C
MOBILE TEAM D
TRAVELING PERSONNEL E
PRIVATE SECTOR
CLINIC F
PHARMACY G
PRIVATE DOCTOR H
OTHER PRIVATE
MUSLIM SCHOLAR I
SHOP J
OTHER K

583) CHECK 580:
ORS FLUID FROM PACKET MENTIONED?

NO, ORS FLUID NOT MENTIONED
YES, ORS FLUID MENTIONED (GO TO 585)

584) Was (NAME) given oralyte packet when he/she had the diarrhea?

YES 1
NO 2 (GO TO 586)
DON'T KNOW 8 (GO TO 586)

585) For how many days was (NAME) given the oralyte packet?
IF LESS THAN 1 DAY, RECORD 00

DAYS____
DON'T KNOW 98

586) CHECK 580:
RECOMMENDED HOME FLUID MENTIONED?

NO, HOME FLUID NOT MENTIONED
YES, HOME FLUID MENTIONED (GO TO 588)

587) Was (NAME) given a recommended home fluid made from a salted or sugared water solution when he/she had diarrhea?

YES 1
NO 2 (GO TO 589)
DON'T KNOW 589

588) For how many days was (NAME) given the fluid made from a salted or sugared water solution?

DAYS____
DON'T KNOW 98

589) GO BACK TO 554 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 590.

590) CHECK 580 AND 584 (ALL COLUMNS):

ORS FLUID FROM PACKET GIVEN TO ANY CHILD (GO TO 594)
ORS FLUID FROM PACKET NOT GIVEN TO ANY CHILD OR 580 AND 584 NOT ASKED

591) Have you ever heard of a special product called SRO you can get for the treatment of diarrhea?

YES 1 (GO TO 593)
NO 2

592) Have you ever seen a packet like this before?
SHOW PACKET

YES 1
NO 2 (GO TO 597)

593) Have you ever prepared a solution with one of these packets to treat diarrhea in yourself or someone else?
SHOW PACKET

YES 1
NO 2 (GO TO 596)

594) The last time you prepared the oralyte packet, did you prepare the whole packet at once or only part of the packet.

WHOLE PACKET AT ONCE 1
PART OF PACKET 2 (GO TO 596)

595) How much water did you use to prepare the oralyte packet the last time you made it?

½ LITER 01
1 LITER 02
1 ½ LITER 03
2 LITERS 04
FOLLOWED PACKET INSTRUCTIONS 05
OTHER (SPECIFY) 06
DON'T KNOW 98

596) Where can you get the (local name) packet?
PROBE: Anywhere else?
RECORD ALL PLACES MENTIONED.

PUBLIC SECTOR
PUBLIC HOSPITAL A
HEALTH CENTER B
FREE CLINIC C
MOBILE TEAM D
TRAVELING PERSONNEL E
PRIVATE SECTOR
CLINIC F
PHARMACY G
PRIVATE DOCTOR H
OTHER PRIVATE
MUSLIM SCHOLAR I
SHOP J
OTHER K

597) CHECK 580 AND 587 (ALL COLUMNS):

HOME-MADE LIQUID GIVEN TO ANY CHILD
HOME-MADE FLUID NOT GIVEN TO ANY CHILD OR 580 AND 587 NOT ASKED (GO TO 601

598) Where did you learn to prepare the recommended home fluid made from (recommended ingredients) given to (NAME) when he/she had diarrhea?

PUBLIC SECTOR
PUBLIC HOSPITAL A
HEALTH CENTER B
FREE CLINIC C
MOBILE TEAM D
TRAVELING PERSONNEL E
PRIVATE SECTOR
CLINIC F
PHARMACY G
PRIVATE DOCTOR H
OTHER PRIVATE
MUSLIM SCHOLAR I
SHOP J
OTHER K

SECTION 6. MATERNAL MORTALITY

601) Now I would like to ask you some questions about your brothers and sisters, that is all of the children born to your natural mother. Please give me the names of all your brothers and sisters who are living with you, those living elsewhere and those who have died.
RECORD NAME OF ALL BROTHERS AND SISTERS. IF NO BROTHERS OR SISTERS (GO TO 701)

602) What was the name given to your first born brother or sister (born after (NAME)?
1, 2, 3, 4, etc.

603) Is (NAME) male or female?

MALE 1
FEMALE 2

604) Is (NAME) still alive?

YES 1
NO 2 (GO TO 607)
DON'T KNOW 8 (GO TO NEXT COLUMN)

605) How old is (NAME)?
IF LESS THAN 15, GO TO NEXT COLUMN

AGE____

606) Is/was he/she married?

YES 1 (GO TO NEXT COLUMN)
NO 2 (GO TO NEXT COLUMN)

607) How many years ago did (NAME) die?

YEARS AGO____

608) How old was (NAME) when he/she died?
IF MALE OR DIED BEFORE 12 YEARS OF AGE TO GO NEXT COLUMN.

AGE OF DEATH____

609) Was (NAME) married?

YES 1
NO 2 (GO TO NEXT COLUMN)

610) Was (NAME) pregnant when she died?

YES 1 (GO TO 613)
NO 2

611) Did (NAME) die during childbirth?

YES 1 (GO TO 616)
NO 2

612) Did (NAME) die within two months after the end of a pregnancy or childbirth?

YES 1
NO 2 (GO TO 614)

613) Was (NAME)'s death related to the pregnancy/delivery?

YES 1 (GO TO 616)
NO 2
DON'T KNOW 8

614) CHECK QUESTIONS 607-608: DEATH OCCURRED BETWEEN 15 AND 50 YEARS AND IN THE LAST 20 YEARS

YES
NO (GO TO 616)

615) What did (NAME) die of?

CAUSE OF DEATH____

616) How many pregnancies did (NAME) have (including the pregnancy she died during/after)?

NUMBER OF PREGNANCIES____

[##translator note: the following questions 614-617 are numbered correctly according to the form]

614) I would like to make sure I've understood. Your mother gave birth to a total of ____ children, including yourself?

YES
NO, CHECK AND CORRECT

615) Among your brothers, ____ are dead?

YES
NO (CHECK AND CORRECT)

616) Among your sisters, ____ are dead?

YES
NO (CHECK AND CORRECT)

617) Do any of your sisters (from your own mother) aged 14 years or more live in this household?

YES (CHECK WITH RESPONDENT WHICH WOMEN ELIGIBLE FOR THE HOUSEHOLD QUESTIONNAIRE ARE HER SISTERS AND RECORD THEIR LINE NUMBERS BELOW)
NO (GO TO 701)

SECTION 7. FERTILITY PREFERENCES

701) CHECK 415:

NEITHER STERILIZED
HE OR SHE STERILIZED (GO TO 707)

702) CHECK 201:

CURRENTLY MARRIED
WIDOWED OR DIVORCED (GO TO 714)

703) CHECK 326:

NOT PREGNANT OR UNSURE: Now I have some question about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?
HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 710)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 710)
UNDECIDED/DON'T KNOW (GO TO 710)
PREGNANT: Now I have some questions about the future. After the child you are expecting now, would you like to have another child, or would you prefer not to have any more children?
HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 710)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 710)
UNDECIDED/DON'T KNOW (GO TO 710)

704) CHECK 326:

NOT PREGNANT OR UNSURE :How long would you like to wait from now before the birth of (a/another) child?
MONTHS 1 (GO TO 710)
YEARS 2 (GO TO 710)
SOON/NOW 994 (GO TO 710)
SAYS SHE CAN'T GET PREGNANT 995 (GO TO 710)
OTHER (SPECIFY) 996
DON'T KNOW 998
PREGNANT: After the birth of this child you are expecting now, how long would you like to wait before the birth of another child?
MONTHS 1 (GO TO 710)
YEARS 2 (GO TO 710)
SOON/NOW 994 (GO TO 710)
SAYS SHE CAN'T GET PREGNANT 995 (GO TO 710)
OTHER (SPECIFY) 996
DON'T KNOW 998

705) CHECK 317 AND 326:
Has living child(ren) or pregnant?

YES
NO (GO TO 710)

706) CHECK 326:

NOT PREGNANT OR NOT SURE: How old would you like your youngest child to be when your next child is born?
AGE OF YOUNGEST CHILD IN YEARS (GO TO 710)
DON'T KNOW 98 (GO TO 710
PREGNANT: How old would you like the child you are expecting to be when your next child is born?
AGE OF YOUNGEST CHILD IN YEARS (GO TO 710)
DON'T KNOW 98 (GO TO 710

707) Given your present circumstances, if you had to do it over again, do you think (you/your husband) would make the same decision to have an operation not to have any more children?

YES 1
NO 2

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

YES 1
NO 2 (GO TO 712)

709) Why do you regret it?

RESPONDENT WANTS ANOTHER CHILD 1 (GO TO 712)
PARTNER WANTS ANOTHER CHILD 2 (GO TO 712)
SIDE EFFECTS 3 (GO TO 712)
OTHER REASON (SPECIFY) 4 (GO TO 712)

710) Have you and your husband ever discussed the number of children you would like to have?

YES 1
NO 2

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

SAME NUMBER 1
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8

712) CHECK 317:

HAS LIVING CHILD(REN): If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be? RECORD SINGLE NUMBER OF OTHER ANSWER.
NUMBER____
OTHER RESPONSE (SPECIFY) 96
NO LIVING CHILDREN: If you could choose exactly the number of children to have in your whole life, how many would that be? RECORD SINGLE NUMBER OF OTHER ANSWER.
NUMBER____
OTHER RESPONSE (SPECIFY) 96

713) What do you think is the best number of months or years between the birth of one child and the birth of the next child?

MONTHS 1
YEARS 2
OTHER (SPECIFY) 996

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

801) CHECK 201:

EVER MARRIED (ASK QUESTIONS ON CURRENT OR MOST RECENT HUSBAND)
SINGLE (GO TO 808)

802) Did your (last) husband ever attend school?

YES 1
NO 2 (GO TO 805)

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

PRIMARY 1
SECONDARY 2
HIGHER 3
DON'T KNOW 8 (GO TO 805)

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

GRADE____
DON'T KNOW 98

805) What kind of work does (did) your (last) husband mainly do?

OCCUPATION _____

806) CHECK 805:

WORKS (WORKED) IN AGRICULTURE
DOES (DID) NOT WORK IN AGRICULTURE (GO TO 808)

807) Does/did your husband work mainly on his own land or on family land, or does/did he rent land, or does/did he work on someone else's land?

HIS/FAMILY LAND 1
RENTED LAND 2
SOMEONE ELSE'S LAND 3

808) Since January 1986, have you lived in one location or more than one?

ONE LOCATION 1
MORE THAN ONE LOCATION 2 (GO TO 810)

809) Record (in column 7 of the calendar) the code corresponding to current location (1 RABAT-CASA, 2 LARGE CITY, 3 CITY, 4 COUNTRYSIDE).
START WITH THE MONTH OF THE INTERVIEW AND CONTINUE WITH ALL MONTHS BEFORE UP TO JANUARY 1986.

810) In what month and what year did you move to (NAME OF LOCATION OF INTERVIEW)?

Record (in column 7 of calendar) X for the month and year of the move, and for the months before, record the code corresponding to the type of location (1 RABAT-CASA, 2 LARGE CITY, 3 CITY, 4 COUNTRYSIDE).
CONTINUE DETERMINING THE PREVIOUS LOCATIONS AND RECORDING THE MOVES AND THE RESULTING TYPES OF LOCATIONS.

EXAMPLES OF QUESTIONS:
WHERE DID YOU LIVE BEFORE…?
IN WHAT MONTH AND WHAT YEAR DID YOU ARRIVE THERE?
IS THIS LOCATION A LARGE CITY, A CITY, OR A VILLAGE?

811) REFER TO THE LOCATION OF RESIDENCE IN JANUARY 1986:
When did you move to (LOCATION OF RESIDENCE IN JANUARY 1986)?

LIVED THERE SINCE BIRTH 96 (GO TO 813)
MONTH ____
DON'T KNOW MONTH 98
YEAR ____
DON'T KNOW YEAR 98

812) Is the location you came from a large city, a city, or was it in the countryside?

LARGE CITY 1
CITY 2
COUNTRYSIDE 3

813) I would like to ask you some questions about work. Aside from your own housework, are you currently working?

YES 1 (GO TO 817)
NO 2

814) As you know, some women take up 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. Are you currently doing any of these things or any other work?

YES 1 (GO TO 817)
NO 2

815) Have you worked since January 1986?

YES 1 (GO TO 817)
NO 2

816) RECORD 0 IN COLUMN 8 OF THE CALENDAR FOR EACH MONTH FROM JANUARY 1986 TO THE CURRENT MONTH (GO TO 821)

817) What is (was) your occupation, that is, what kind of work do (did) you mainly do?

OCCUPATION____

818) USE THE CALENDAR TO DETERMINE ALL OF THE PERIOD OF WORK, STARTING WITH THE CURRENT OR MOST RECENT ONE, TO JANUARY 1986. RECORD THE CODE FOR "NOT WORKING" OR FOR THE TYPE OF WORK IN COLUMN 8.

EXAMPLES OF QUESTIONS:
WHEN DID YOU START THIS WORK (AND WHEN DID YOU STOP)?
WHAT DID YOU DO BEFORE?
HOW MUCH TIME DID YOU WORK AT THAT TIME?
WERE YOU SELF-EMPLOYED OR AN EMPLOYEE?
WERE YOU PAID FOR THIS WORK?
DID YOU WORK AT HOME OR OUTSIDE OF THE HOME?

819) CHECK COLUMN 8 ON CALENDAR:

WORKED IN JANUARY 1986
NOT WORKING IN JANUARY 1986 (GO TO 821)

820) I see that you were working in January 1986.
When did you start this job?

MONTH____ (GO TO 823)
DON'T KNOW MONTH 98 (GO TO 823)
YEAR____ (GO TO 823)
DON'T KNOW YEAR 98 (GO TO 823)

821) I see that you did not work in January 1986. Did you work before January 1986?

YES 1
NO 2 (GO TO 823)

822) When did you stop your last job before January 1986?

MONTH____
DON'T KNOW MONTH 98
YEAR____
DON'T KNOW YEAR 98

823) CHECK 316/317/319: Has child born since January 1986 and living at home?

YES
NO (GO TO 827)

824) CHECK 813/814: CURRENTLY WORKING?

YES
NO (GO TO 827)

825) While you are working, do you usually have (NAME OF YOUNGEST CHILD AT HOME) with you, sometimes have him/her with you, or never have him/her with you?

USUALLY 1
SOMETIMES 2
NEVER 3

826) Who usually takes care of (NAME OF YOUNGEST CHILD AT HOME) while you are working?

HUSBAND 01
OLDER CHILD(REN) 02
OTHER RELATIVES 03
NEIGHBORS 04
FRIENDS 05
SERVANTS/HIRED HELP 06
CHILD IS IN SCHOOL 07
INSTITUTIONAL CHILDCARE 08
OTHER (SPECIFY) 09

827) RECORD THE TIME:

HOUR____
MINUTES____

SECTION 9. HEIGHT AND WEIGHT

901) CHECK 316, 317:

ONE OR MORE BIRTHS SINCE JANUARY 1986
NO BIRTHS SINCE JANUARY 1986 (END)

INTERVIEWER:
IN 902 (COLUMNS 2-4) RECORD THE LINE NUMBER OF EACH CHILD SINCE JANUARY 1986 AND STILL ALIVE.
IN 903 AND 904 RECORD THE NAME AND BIRTH DATE OF THE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1986. IN 906 AND 908 RECORD THE HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN.
(NOTE: ALL RESPONDENTS WITH ONE OR MORE BIRTHS BEFORE JANUARY 1986 SHOULD BE WEIGHED AND MEASURED EVEN IF ALL OF THE CHILDREN HAVE DIED.)
(IF THERE ARE MORE THAN 3 LIVING CHILDREN BORN SINCE JANUARY 1986, USE ADDITIONAL FORMS)

902) LINE NUMBER FROM QUESTION 312:

LINE NUMBER____

903) NAME FROM QUESTION 312 FOR CHILDREN:

NAME____

904) DATE OF BIRTH:
FROM QUESTION 105 FOR RESPONDENT
FROM QUESTION 316 FOR CHILDREN, AND ASK FOR DAY OF BIRTH

DAY____
MONTH____
YEARS____

905) BCG scar on top of left shoulder

SCAR SEEN 1
NO SCAR 2

906) HEIGHT (IN CENTIMETERS):

HEIGHT____

907) Was length/height of child measured lying down or standing up?

LYING 1
STANDING 2

908) WEIGHT (IN KILOGRAMS):

WEIGHT____

909) DATE WEIGHED AND MEASURED:

DAY____
MONTH____
YEAR____

910) RESULT:

MEASURED 1
NOT PRESENT 2
REFUSED 4
OTHER (SPECIFY) 6
CHILD MEASURED 1
CHILD SICK 2
CHILD NOT PRESENT 3
CHILD REFUSED 4
MOTHER REFUSED 5
OTHER (SPECIFY) 6

911) NAME OF MEASURER:

NAME OF ASSISTANT____

INTERVIEWER'S OBSERVATIONS (TO BE FILLED OUT AFTER COMPLETING INTERVIEW)

COMMENTS ABOUT RESPONDENT____
COMMENTS ON SPECIFIC QUESTIONS____
ANY OTHER COMMENTS____
SUPERVISOR'S OBSERVATIONS____
NAME OF SUPERVISOR DATE____
EDITOR'S OBSERVATIONS____
NAME OF EDITOR____
DATE____

INSTRUCTIONS: ONLY ONE CODE PER SPACE. FOR COLUMNS 1, 6, 7, AND 8 ALL THE MONTHS SHOULD BE FILLED OUT.

INFORMATION ON THE CODES FOR EACH COLUMN

COL. 1: BIRTHS, PREGNANCIES, CONTRACEPTION USE

[Translator note: I've left the original Code letter from the French, so that it corresponds with the codes indicated throughout the text. I left those codes as related to the French words here, because some of them don't actually correspond with the first letter of the word in French, and are arbitrary]

N BIRTHS
G PREGNANCY
F END OF PREGNANCY
0 NO METHOD
1 PILL
2 IUD
3 INJECTABLES
4 DIAPHRAGM/FOAM/JELLY
5 CONDOM
6 FEMALE STERILIZATION
7 MALE STERILIZATION
8 RHYTHM METHOD
9 WITHDRAWAL
W OTHERS (SPECIFY)
COL. 2: DISCONTINUATION OF CONTRACEPTION
1 GOT PREGNANT WHILE USING
2 WANTED TO GET PREGNANT
3 HUSBAND OPPOSED
4 SIDE EFFECTS
5 HEALTH CONCERNS
6 ACCESS/AVAILABILITY
7 WANTED MORE EFFECTIVE METHOD
8 INCONVENIENT TO USE
9 INFREQUENT SEX/HUSBAND NOT PRESENT
C COST
F FATALISTIC
A DIFFICULTY GETTING PREGNANT/MENOPAUSE
D MARRIAGE BROKE UP/SEPARATION
W OTHERS (SPECIFY)
K DON'T KNOW
COL. 3: POST-PARTUM AMENORRHEA
X PERIOD NOT RETURNED
0 LESS THAN 1 MONTH
COL 4: POST-PARTUM ABSTINENCE
X NO SEXUAL INTERCOURSE
0 LESS THAN 1 MONTH
COL 5: BREASTFEEDING
X BREASTFEEDING
0 LESS THAN 1 MONTH
J NEVER BREASTFED
COL 6: MARRIAGE/UNION
X IN A UNION (MARRIED OR LIVING TOGETHER)
0 NOT IN UNION
COL 7: MOVES AND TYPES OF LOCATIONS
X CHANGE IN LOCATION
1 LARGE CITY
2 CITY
3 VILLAGE
COL 8: TYPE OF JOB
0 DOES NOT WORK
1 PAID EMPLOYMENT, OUTSIDE OF HOME
2 PAID EMPLOYMENT, AT HOME
3 SELF-EMPLOYED, OUTSIDE OF HOME
4 SELF-EMPLOYED, AT HOME
5 UNPAID WORK, OUTSIDE OF HOME
6 UNPAID WORK, AT HOME

LAST CHILD BORN BEFORE JANUARY 1986

NAME: ____
MONTH____
YEAR____