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DEMOGRAPHIC AND HEALTH SURVEYS
(E.P.S.F.-2003)
INDIVIDUAL QUESTIONNAIRE FOR WOMEN

IDENTIFICATION

REGION ____

PROVINCE OR PREFECTURE ____

CIRCLE ____

MUNICIPALITY/RURAL MUNICIPALITY ___

OTHER CENTER ___

SURVEY DISTRICT ___

RABAT-CASA/LARGE CITY/SMALL CITY/RURAL

RABAT-CASA 1
LARGE CITY 2
SMALL CITY 3
RURAL 4

CLUSTER NUMBER ___

HOUSEHOLD NUMBER ___

HOUSEHOLD ADDRESS ___

NAME AND LINE NUMBER OF WOMAN ___

INTERVIEWER VISITS

DATE ____

INTERVIEWER'S NAME AND CODE AND RESULT

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

NEXT VISIT

DATE _____
TIME _____

FINAL VISIT

DAY _____
MONTH ______
YEAR 200__

TOTAL NUMBER OF VISITS _______

SUPERVISOR
NAME _____
DATE _____

FIELD EDITOR
NAME _____
DATE _____

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 a city, a town, or in the countryside?

RABAT, CASABLANCA 1
LARGE CITY 2
SMALL CITY 3
RURAL 4

103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
IF LESS THAN ONE YEAR, RECORD '00' YEARS.

YEARS ___
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)

104. Just before you moved here, did you live in a big city, a small city, a town, or in the countryside?

RABAT, CASABLANCA 1
SMALL CITY 2
TOWN 3
RURAL 4

105. In what month and year were you born?

MONTH ___
DON'T KNOW MONTH 98
YEAR ____
DON'T KNOW YEAR 9998

106. How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT

AGE IN COMPLETED YEARS ____________

107. Have you ever attended school?

YES 1
NO 2 (GO TO 111)

108. What is the highest level of school you attended: primary, middle or junior high school, high school, or higher education?

PRIMARY 1
PREPARATORY, SECONDARY, 1ST CYCLE 2
SECONDARY/2ND CYCLE 3
HIGHER 4

109. What is the highest grade you completed at that level?

GRADE ___

110. CHECK 109:

PRIMARY (GO TO 111)
PREPARATORY, SECONDARY OR HIGHER (GO TO 114)

111. Now I would like you to read this sentence to me.
SHOW CARD TO RESPONDENT
IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

CANNOT READ AT ALL 1
ABLE TO READ ONLY PART OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3

112. Have you ever participated in a literacy program or any other program that involves learning to read or write (not including primary school)?

YES 1
NO 2

113. CHECK 111:

CODE '2' OR '3'CIRCLED (GO TO 114)
CODE '1' CIRCLED (GO TO 115)

114. Do you read a newspaper or magazine almost every day, at least once a week, less than once a week or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3

115. Do you listen to the radio almost every day, at least once a week, less than once a week, or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

116. Do you watch television almost every day, at least once a week, less than once a week, or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

SECTION 1A. MARRIAGE

121. What is your marital status now: are you single, married, divorced, separated, or widowed?

MARRIED 1
SINGLE 2 (GO TO 300)
WIDOW 3 (GO TO 124)
DIVORCED 4 (GO TO 124)
SEPARATED 5 (GO TO 124)

122. Does your husband have any other wives besides yourself?

YES 1
NO 2 (GO TO 124)

123. How many other wives does he have?

NUMBER ____
DON'T KNOW 8

124. How many times have you been married?

NUMBER _____

125. CHECK 124:

2 OR MORE MARRIAGES (GO TO 126)
ONLY ONE MARRIAGE (GO TO 127)

126. How did your first marriage end?

DIVORCED 1
WIDOWED 2

127. In what month and year did you start living with your (first) husband or partner?

MONTH ___
DON'T KNOW MONTH 98
YEAR ____ (GO TO 129)
DON'T KNOW YEAR 9998

128. How old were you when you got married (the first time)?

AGE IN COMPLETED YEARS __________

129. Are you and your (first) husband related? I mean, are you originally from the same family?

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

SECTION 2. REPRODUCTION

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

YES 1
NO 2 (GO TO 206)

202. Do you have any sons or daughters to whom you have given birth who are not living with you?

YES 1
NO 2 (GO TO 204)

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

SONS AT HOME ___
DAUGHTERS AT HOME ____

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

YES 1
NO 2 (GO TO 206)

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

SONS ELSEWHERE ________
DAUGHTERS ELSEWHERE ________

206. Have you ever given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

YES 1
NO 2 (GO TO 208)

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

BOYS DEAD ___
GIRLS DEAD ___

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

TOTAL ____

209. CHECK 208: Just to make sure that I have this right: you have had in TOTAL __ births during your life? Is that correct?

YES (GO TO 210)
NO (PROBE AND CORRECT 201-208 AS NECESSARY)

210. CHECK 208:

ONE OR MORE BIRTHS
NO BIRTHS (GO TO 226)

211. Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had.
RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

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

NAME _______

213. Were any of these births twins?

SINGLE BIRTH 1
MULTIPLE BIRTH 2

214. Is (NAME) a boy or a girl?

BOY 1
GIRL 2

214a. Please give me (NAME)'s civil registration booklet or family registration booklet or birth certificate.

NONE 1
CIVIL REGISTRATION 2
BIRTH CERTIFICATE 3
OTHER 4

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

MONTH ____
YEAR _____

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

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

AGE IN YEARS ___________

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

YES 1
NO 2

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

LINE NUMBER ________

220. IF DEAD: How old was (NAME) when he died?

IF '1 YR', PROBE:
How many months old was (NAME)? RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

DAYS 1 _____
MONTHS 2 ______
YEARS 3 ______

221. (FOR SECOND AND LATER BIRTHS) Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?

YES 1
NO 2

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

YES 1
NO 2

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

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

224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE 1998 OR LATER.
IF NONE, RECORD '0'

______________

225. FOR EACH BIRTH SINCE JANUARY 1995, ENTER B IN THE MONTH OF BIRTH IN COLUMN 1 OF THE CALENDAR. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P'S MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.) WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE.

226. Are you pregnant now?

YES 1
NO 2 (GO TO 229)
UNSURE 3 (GO TO 229)

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

____________

228. 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 at all?

THEN 1
LATER 2
NOT AT ALL 3

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

YES 1
NO 2 (GO TO 237)

230. When did the last such pregnancy end?

MONTH ____
YEAR _____

231. CHECK 230:

LAST PREGNANCY ENDED IN JAN 1998 OR LATER (GO TO 232)
LAST PREGNANCY ENDED BEFORE JAN 1998 (GO TO 237)

232. How many months pregnant were you when the last such pregnancy ended?
RECORD THE NUMBER OF COMPLETED MONTHS. ENTER T IN COLUMN 1 OF CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND P FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

Months ________

233. Have you ever had any other pregnancies that did not result in a live birth?

YES 1
NO 2 (GO TO 237)

234. ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 1998.
ENTER T IN COLUMN 1 OF CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND P FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

235. Did you have any pregnancies that terminated before January 1998 that did not result in a live birth?

YES 1
NO 2 (GO TO 237)

236. When did the last such pregnancy that terminated before January 1998 end?

MONTH ____
YEAR _____

237. When did your last menstrual period start?

(DATE, IF GIVEN) _____________
DAYS AGO 1 _____
WEEKS AGO 2 _____
MONTHS AGO 3 ______
YEARS AGO 4 ______
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996 (GO TO 238)

237a. How old were you when you had your first period?

AGE IN YEARS ___________
DON'T KNOW/DON'T REMEMBER/UNCERTAIN 98

238. 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 301)
DON'T KNOW 8 (GO TO 301)

239. Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods.

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

SECTION 3. CONTRACEPTION

FOR NEVER-MARRIED WOMEN:
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. Do you know or have you ever heard of anything like that?

INTERVIEWER: CIRCLE CODE 1 IN 300 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 300, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED.

300) FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK:Have you ever heard of (METHOD)?

01) FEMALE STERILIZATION
Women can have an operation to avoid having any more children.
YES 1
NO 2
02) MALE STERILIZATION
Men can have an operation to avoid having any more children.
YES 1
NO 2
03) PILL
Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
04) IUD
Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
05) INJECTABLES
Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
06) IMPLANTS
Women can have several small rods placed in their left arm by a doctor or nurse, which can prevent pregnancy for one or more years.
YES 1
NO 2
07) CONDOM
Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08) DIAPHRAGM
Women can place a thin flexible disk in their vagina before intercourse.
YES 1
NO 2
09) FOAM OR JELLY
Women can place a suppository, jelly, or cream in their vagina before intercourse.
YES 1
NO 2
10) LACTATIONAL AMENORRHEA METHOD (LAM)
Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, for her menstrual period not to return.
YES 1
NO 2
11) RHYTHM OR PERIODIC ABSTINENCE
There are only few days of the month when a woman can get pregnant if she has intercourse with her husband. 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
12) WITHDRAWAL
Men can be careful and pull out before climax.
YES 1
NO 2
13) OTHER
Have you ever heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO 2

300B) If you were married would you use something to delay but not stop pregnancy?

YES 1
NO 2
DON'T KNOW 8

300C) If you had the choice, how many kids would you have your entire life? How many would you have liked to have?
PROBE FOR A NUMERIC RESPONSE.

NUMBER _____
OTHER (SPECIFY) _____ 96

300D) Out of this number you chose to have in your entire life, how many boys would you want to have and, how many girls (or does gender not making any difference to you)?

NUMBER OF BOYS ______
NUMBER OF GIRLS ______
NUMBER OF EITHER _____
OTHER (SPECIFY) ______ 96

300E) Do you approve or disapprove of the idea of men or women doing something to prevent or delay pregnancies?

APPROVE 1
DISAPPROVE 2
DON'T KNOW/UNSURE 3

300F) During this past month, did you hear or see anything related to family planning:

On the radio?
YES 1
NO 2
On the television?
YES 1
NO 2
In a newspaper in magazine?
YES 1
NO 2
Poster/pamphlet?
YES 1
NO 2

300G) During this past month, did you talk to your friends or neighbors or anyone from your family about using family planning methods?

YES 1
NO 2

FOR NEVER-MARRIED WOMEN, GO TO 601

FOR EVER-MARRIED WOMEN, ASK:

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. Do you know or have you ever heard of anything like that?

CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302.

301) FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?

302) Have you ever used (METHOD)?

01) FEMALE STERILIZATION
Women can have an operation to avoid having any more children
YES 1
NO 2
302) Have you ever had an operation to avoid having any more children?
YES 1
NO 2
02) MALE STERILIZATION
Men can have an operation to avoid having any more children.
YES 1
NO 2
302) Did your husband have this operation to avoid having any more children?
YES 1
NO 2
03) PILL
Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
04) IUD
Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
05) INJECTABLES
Women can have an injection by a nurse/midwife that stops them from becoming pregnant for one or more months.
YES 1
NO 2
06) IMPLANTS
Women can have several small rods placed in their left arm by a doctor, which can prevent pregnancy for 5 years.
YES 1
NO 2
07) CONDOM
Men can put a rubber sheath on their penis before sexual intercourse so that women do not fell pregnant
YES 1
NO 2
08) DIAPHRAGM
Women can place a sheath in their vagina (female condom) or a thin flexible disk in their vagina before intercourse to prevent pregnancy.
YES 1
NO 2
09) FOAM OR JELLY
Women can place a suppository, jelly, or cream in their vagina before intercourse to prevent pregnancy.
Yes 1
No 2
10) LACTATIONAL AMENORRHEA METHOD (LAM)
Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, so that her menstrual period does not return.
YES 1
NO 2
11) RHYTHM OR PERIODIC ABSTINENCE
Only during few days a month can a woman fell pregnant after sexual intercourse. 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
12) WITHDRAWAL
Men can be careful and pull out before climax.
YES 1
NO 2
13) OTHER
Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES (SPECIFY) ______ 1
NO 2

303) CHECK 302:

NOT A SINGLE YES (NEVER USED)
AT LEAST ONE YES (USED) (GO TO 307)

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

YES 1
NO 2 (GO TO 306)

305) IN COLUMN 1 OF THE CALENDAR, RECORD 0 FOR EACH MONTH LEFT BLANK, THEN CONTINUE TO 329.

306) What have you used or done?
CORRECT 302 AND 303 (AND 301 IF NECESSARY)

307) How many children did you have when you did something or used a method for the first time to delay or avoid getting pregnant?
IF NONE, RECORD '00'

NUMBER OF CHILDREN _________

308) CHECK 302 (01 AND 02):

WOMAN/HUSBAND NOT STERILIZED (GO TO 309)
WOMAN/HUSBAND STERILIZED (GO TO 311A)

309) CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 310)
PREGNANT (GO TO 319)

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

YES 1
NO 2 (GO TO 318)

311) Which method are you using now?
311a) CIRCLE 'A' FOR FEMALE STERILIZATION
IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD ON LIST

FEMALE STERILIZATION A
MALE STERILIZATION B
PILL C (GO TO 316A)
IUD D (GO TO 316A)
INJECTABLES E (GO TO 316A)
IMPLANTS F (GO TO 316A)
CONDOM G (GO TO 316A)
DIAPHRAGM H (GO TO 316A)
FOAM/JELLY I (GO TO 316A)
LACTATIONAL AMEN. METHOD J (GO TO 316A)
PERIODIC ABSTINENCE K (GO TO 316A)
WITHDRAWAL L (GO TO 316A)
OTHER (SPECIFY) X _______ (GO TO 316A)
DON'T KNOW X (GO TO 316A)

313) In which facility did your sterilization take place? (has your husband done the sterilization operation?)

IF SOURCE IS HOSPITAL, HEATH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) _______
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
MATERNITY 12
OTHER PUBLIC (SPECIFY) __________ 16
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC 21
DOCTOR/MID-WIFE 22
MOROCCAN ASSOCIATION FOR FAMILY PLANNING 23
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26
OTHER (SPECIFY) __________ 96
DON'T KNOW 98

314) CHECK 311:
CODE 'A' CIRCLED:
Before your sterilization operation, were you told that you would not be able to have any (more) children because of the operation?

CODE 'B' CIRCLED:
Before the sterilization operation, was your husband/partner told that he would not be able to have any (more) children because of the operation?

YES 1
NO 2
DON'T KNOW 8

316) In what month and year was your sterilization (your husband's sterilization) performed?

316a) In what month and year did you start using (CURRENT METHOD) continuously?
PROBE:
(FIRST METHOD CIRCLED IN Q311)

MONTH ____
YEAR ____

317)
CHECK 316/316A:

YEAR IS 1998 OR LATER:
RECORD THE CODE OF THE METHOD USED IN THE LINE OF THE MONTH OF THE INTERVIEW IN COLUMN 1 OF THE CALENDAR AND FOR EACH MONTH BEFORE IT TO THE MONTH WHEN THE METHOD WAS FIRST USED.

YEAR IS 1997 OR BEFORE: RECORD THE CODE OF THE METHOD USED IN THE LINE OF THE MONTH OF THE INTERVIEW IN COLUMN 1 OF THE CALENDAR AND FOR EACH MONTH BEFORE IT UP TO JANUARY 1998.
(GO TO 327)

318) I would like to talk about all the times, you and your husband did something to prevent getting pregnant these past years.

USE THE CALENDAR TO DISTINGUISH PERIODS OF USE FROM PERIODS OF NON-USE, STARTING WITH THE MOST RECENT USAGE, THEN GOING UP TO JANUARY 1998.

USE THE NAMES OF THE CHILDREN, THEIR BIRTHDATES, AND THE PREGNANCY PERIODS AS REFERENCE POINTS.

IN COLUMN 1, FOR EACH MOTH, RECORD THE CODE OF THE METHOD USED, OR 0 IF NO METHOD WAS USED.

ILLUSTRATIVE QUESTION FOR COLUMN 1:

What was the last time you did something to prevent pregnancy?
What did you do?
When did you starting doing that?

IN COLUMN 2, IN THE LINE FOLLOWING THE LAST MONTH OF USAGE OF THE METHOD, RECORD THE DISCONTINUATION CODES.

THE NUMBER OF CODES IN COLUMN 2 SHOULD BE EQUAL TO THE NUMBER OF INTERRUPTIONS OF USAGE OF THE METHOD IN COLUMN 1.

ASK THE RESPONDENT WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY OCCURRED, ASK IF SHE INVOLUNTARILY BECAME PREGNANCY WHILE USING THE METHOD, OR IF SHE VOLUNTARILY STOPPED USING THE METHOD TO BECOME PREGNANT.

ILLUSTRATIVE QUESTION FOR COLUMN 2:

How long after childbirth was it (NAME) when you started using this method?
Why did you stop using (this method)?
Did you not get pregnant while using (this method) or did you stop using it to get pregnant or do you have another reason (for stopping it)?

IF SHE VOLUNTARILY STOPPED USING THE METHOD TO BECOME PREGNANT, ASK: How long after stopping this (method) did you get pregnant?

THEN RECORD 0 IN COLUMN 1 FOR EACH OF THESE MONTHS.

318a) CHECK 310:

CURRENTLY USING (GO TO 320)
NOT CURRENTLY USING (GO TO 329)

320) Where did you first obtain this (CURRENT METHOD) when you start using it?
320a) Where did you learn to use the lactational amenorrhea method; breastfeeding up to 6 months after childbirth, so that your menstrual period does not return (where did you learn the method for counting the days of the cycle, for withdrawal)?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) ____________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
MATERNITY 12
HEALTH CENTER 13
DISPENSARY 14
HOME VISIT 15
MOBILE UNIT 16
OTHER PUBLIC (SPECIFY) __________ 16
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC 21
PHARMACY 22
DOCTOR/MID-WIFE 23
MOROCCAN ASSOCIATION FOR FAMILY PLANNING 24
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26
OTHER SOURCE
RELATIVE/FRIEND 31
MIDWIFE 32
OTHER (SPECIFY) __________ 96

321) CHECK 311/311A:
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION 01
MALE STERILIZATION 02 (GO TO 331)
PILL 03
IUD/INTRAUTERINE DEVICE 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07 (GO TO 328)
DIAPHRAGM 08 (GO TO 325)
FOAM/JELLY 09 (GO TO 325)
LACTATIONAL AMEN. METHOD 10 (GO TO 325)
PERIODIC ABSTINENCE 11 (GO TO 331)
WITHDRAWAL 12 (GO TO 331)
OTHER METHOD 96 (GO TO 331)

322) You obtained (CURRENT METHOD FROM 319) from (SOURCE OF METHOD FROM 313 OR 320). At that time, were you told about side effects or problems you might have with (CURRENT METHOD)?

YES 1 (GO TO 324)
NO 2

323) Were you ever told by a doctor, a nurse or a health planning worker about side effects or problems you might have with (CURRENT METHOD)?

YES 1
NO 2 (GO TO 325)

324) Were you told what to do if you experienced side effects or problems for using (CURRENT METHOD)?

YES 1
NO 2

325 CHECK 322:
CODE '1' CIRCLED: At that time, were you told about other methods of family planning that you could use?

CODE '1' NOT CIRCLED: When you obtained (CURRENT METHOD) from (SOURCE OF THE METHOD FROM Q 313 OR Q 320) at that time, were you told about other methods of family planning that you could use to delay but not stop pregnancy?

YES 1 (GO TO 327)
NO 2

326) Were you ever told by a doctor, a nurse or a health planning worker about side effects or problems you might have with the method?

YES 1
NO 2

327) CHECK 311/311A
CIRCLE METHOD CODE.

FEMALE STERILIZATION 01 (GO TO 331)
MALE STERILIZATION 02 (GO TO 331)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07
DIAPHRAGM 08
FOAM/JELLY 09
LACTATIONAL AMEN. METHOD 10 (GO TO 331)
PERIODIC ABSTINENCE 11 (GO TO 331)
WITHDRAWAL 112 (GO TO 331)
OTHER METHOD 96 (GO TO 331)

328) Where did you obtain (CURRENT METHOD) the last time?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) ______________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
MATERNITY 12
HEALTH CENTER 13
DISPENSARY 14
HOME VISIT 15
MOBILE UNIT 16
OTHER PUBLIC (SPECIFY) __________ 17
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC 21
PHARMACY 22
DOCTOR/MID-WIFE 23
MOROCCAN ASSOCIATION FOR FAMILY PLANNING 24
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26
OTHER SOURCE
RELATIVE/FRIEND 31
MIDWIFE 32
OTHER (SPECIFY) _________ 96

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

YES 1
NO 2

330) Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) _________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
MATERNITY B
HEALTH CENTER C
DISPENSARY D
HOME VISIT E
MOBILE UNIT F
OTHER PUBLIC (SPECIFY) ________ G
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC H
PHARMACY I
DOCTOR/MID-WIFE J
MOROCCAN ASSOCIATION FOR FAMILY PLANNING K
OTHER PRIVATE MEDICAL (SPECIFY) _______ L
OTHER SOURCE
RELATIVE/FRIEND M
MIDWIFE N
OTHER (SPECIFY) _________ X

331) In the last 12 months, were you visited by a fieldworker who talked to you about family planning?

YES 1
NO 2

332) In the last 12 months, have you visited a health facility for checking on your health (or on your children's)?

YES 1
NO 2 (GO TO 333A)

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

YES 1
NO 2

333A) CHECK 301:

KNOWS PILL (GO TO 333B)
DOESN'T KNOW PILL (GO TO 333G)

333B) What are all the contraceptive Pill brands you have ever heard of?
PROBE: What is the last brand or other brands you have heard of?

RECORD SPONTANEOUS ANSWERS. RECORD ALL MULTIPLE ANSWERS

IF NECESSARY, ASK FOR THE PACKET OF PILLS USED.

KINAT AL HILAL A
ADEPAL B (GO TO 333G)
MICRODIAL C (GO TO 333G)
STEDIRIL D (GO TO 333G)
GYNOVLAR E (GO TO 333G)
LO-FEMENAL F (GO TO 333G)
OVANON G (GO TO 333G)
NEOGYNON H (GO TO 333G)
MINIDRIL I (GO TO 333G)
MICROGYNON J (GO TO 333G)
DIANE 35 K (GO TO 333G)
MICROVAL L (GO TO 333G)
MILLIGYNON M (GO TO 333G)
EXCLUTON N (GO TO 333G)
OVRETTE O (GO TO 333G)
OTHER (SPECIFY) X ______ (GO TO 333G)
DON'T KNOW Y (GO TO 333G)

333c) If you were to compare the quality or price of the "Hilal" pill, do you believe that the Hilal pill is good, average, bad?

GOOD 1
IN THE MIDDLE 2
BAD 3
DON'T KNOW 8

333d) Do you know the store(s) where you can get the Hilal pill?

YES 1
NO 2 (GO TO 333G)
DON'T KNOW 8 (GO TO 333G)

333e) Where can you find the Hilal pill? What are these stores / locations?

RECORD SPONTANEOUS ANSWERS. RECORD ALL MULTIPLE ANSWERS

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
MATERNITY B
HEALTH CENTER C
DISPENSARY D
HOME VISIT E
MOBILE UNIT F
OTHER PUBLIC (SPECIFY) __________ G
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC H
PHARMACY I
DOCTOR/MID-WIFE J
MOROCCAN ASSOCIATION FOR FAMILY PLANNING K
OTHER PRIVATE MEDICAL (SPECIFY) ________ L
OTHER SOURCE
RELATIVE/FRIEND M
MIDWIFE N
OTHER (SPECIFY) __________ X

333F) How long does it take you to go to this location?
IF THE WOMAN KNOWS SEVERAL PRIVATE SOURCES, ASK HER TO REFER TO THE CLOSEST SOURCE.

MINUTES _____
DON'T KNOW 998

333G) CHECK 301:

KNOWS INJECTION (GO TO 333H)
DOESN'T KNOW INJECTION (GO TO 333M)

333H) What are all the injection brands you have already heard of?
RECORD SPONTANEOUS ANSWERS. RECORD ALL MULTIPLE ANSWERS

HOQNAT AL HILAL A
DEPO PROVERA B
NORISTERAT C
OTHER (SPECIFY) X
DON'T KNOW Y

333I. If you compare the quality or price of the Hilal injection, do you think the Hilal brand is good, average or bad?

GOOD 1
IN THE MIDDLE 2
BAD 3
DON'T KNOW 8

333j) Do you know the stores or the locations where you can find the Hilal pill/injection?

YES 1
NO 2 (GO TO 333M)
DON'T KNOW 8 (GO TO 333M)

333k) In which places can you find the Hilal pill?
Are there other places?

What are those places/locations?

SPONTANEOUS RESPONSES
POSSIBLE MULTIPLE RESPONSES

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
MATERNITY B
HEALTH CENTER C
DISPENSARY D
HOME VISIT E
MOBILE UNIT F
OTHER PUBLIC (SPECIFY) _________ G
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC H
PHARMACY I
DOCTOR/MID-WIFE J
MOROCCAN ASSOCIATION FOR FAMILY PLANNING K
OTHER PRIVATE MEDICAL (SPECIFY) _________ L
OTHER SOURCE
RELATIVE/FRIEND M
MIDWIFE N
OTHER (SPECIFY) __________ X

333l) How long does it take you to get to this place?
IF THE WOMAN KNOWS SEVERAL PRIVATE SOURCES, ASK HER TO REFER TO THE CLOSEST SOURCE.

MINUTES ____________
DON'T KNOW 998

333M) CHECK 301:

KNOWS IUD (GO TO 333N)
DOESN'T KNOW IUD (GO TO 341)

333N) What are all the brands of IUD you have already heard of?
RECORD SPONTANEOUS ANSWERS. RECORD ALL MULTIPLE ANSWERS

LAWLAB AL HILAL A
COPPER T 380A B (GO TO 341)
NOVA T C (GO TO 341)
GYNE T D (GO TO 341)
MULTILOAD 250 E (GO TO 341)
MULTILOAD 375 F (GO TO 341)
OTHER (SPECIFY) X _______ (GO TO 341)
DON'T KNOW Y (GO TO 341)

333O) If you compare the quality or price of the Hilal IUD, do you think the Hilal IUD is good, average, or bad?

GOOD 1
IN THE MIDDLE 2
BAD 3
DON'T KNOW 8

333P) Do you know the stores/locations where you can find the Hilal IUD?

YES 1
NO 2 (GO TO 333M)
DON'T KNOW 8 (GO TO 333M)

333Q) In which place do you find the Hilal IUD?
Are there other places?

What are those stores/places?

SPONTANEOUS RESPONSES
POSSIBLE MULTIPLE RESPONSES

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
MATERNITY B
HEALTH CENTER C
DISPENSARY D
HOME VISIT E
MOBILE UNIT F
OTHER PUBLIC (SPECIFY) _________ G
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC H
PHARMACY I
DOCTOR/MID-WIFE J
MOROCCAN ASSOCIATION FOR FAMILY PLANNING K
OTHER PRIVATE MEDICAL (SPECIFY) __________ L
OTHER SOURCE
RELATIVE/FRIEND M
MIDWIFE N
OTHER (SPECIFY) ________ X

333r) How long does it take you to get to this place?
IF THE WOMAN KNOWS SEVERAL PRIVATE SOURCES, ASK HER TO REFER TO THE CLOSEST SOURCE.

MINUTES ________
DON'T KNOW 998

SECTION 3B: FERTILITY PREFERENCES

341) CHECK 311/311A:

NEITHER STERILIZED (GO TO 342)
HE OR SHE STERILIZED (GO TO 352)

342) CHECK 226:
NOT PREGNANT OR UNSURE
Now, I have some questions about your future pregnancies: Would you like to have (a/another) child or would you prefer not to have any (more) children?

PREGNANT:
Now, I have some questions about your future pregnancies: 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 344)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 354)
UNDECIDED/DON'T KNOW AND PREGNANT 4 (GO TO 350)
UNDECIDED/DON'T KNOW AND NOT PREGNANT/UNSURE 5 (GO TO 350)

343) CHECK 226:
NOT PREGNANT OR UNSURE:
How long would you like to wait from now before the birth of (a/another) child?

PREGNANT:
After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?

MONTHS 1 _____
YEARS 2 ____
SOON/NOW 993 (GO TO 349)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 354)
AFTER MARRIAGE 995 (GO TO 354)
OTHER (SPECIFY) 996 _____ (GO TO 354)
DON'T KNOW 998 (GO TO 354)

344) CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 345)
PREGNANT (GO TO 350)

345) CHECK 310: USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 346)
NOT CURRENTLY USING (GO TO 346)
CURRENTLY USING (GO TO 348)

346) CHECK 343:

NOT ASKED (GO TO 347)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 347)
00-23 MONTHS OR 00-01 YEAR (GO TO 350)

347) CHECK 342:
WANTS TO HAVE A/ANOTHER CHILD:
You have said that you do not want (a/another) child soon, but you are not using any method to avoid pregnancy. Can you tell me why?
Any other reason?

WANTS NO MORE/NONE:
You have said that you do not want any (more) children, but you are not using any method to avoid pregnancy. Can you tell me why?
Any other reason?

RECORD ALL REASONS MENTIONED.

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

348) In the next few weeks, if you discovered that your were pregnant, would that be a big problem, a small problem, or no problem for you?

BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
SAYS SHE CAN'T GET PREGNANT/NOT HAVING SEX 4

349) CHECK 310: USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 350)
NO, NOT CURRENTLY USING (GO TO 350)
YES, CURRENTLY USING (GO TO 354)

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

YES 1
NO 2 (GO TO 352)
DON'T KNOW 8 (GO TO 352)

351) Which contraceptive method you would prefer to use?

FEMALE STERILIZATION 01 (GO TO 354)
MALE STERILIZATION 02 (GO TO 354)
PILL 03 (GO TO 354)
IUD 04 (GO TO 354)
INJECTABLES 05 (GO TO 354)
IMPLANTS 06 (GO TO 354)
CONDOM 07 (GO TO 354)
DIAPHRAGM 08 (GO TO 354)
FOAM/JELLY 09 (GO TO 354)
LACTATIONAL AMEN. METHOD 10 (GO TO 354)
PERIODIC ABSTINENCE 11 (GO TO 354)
WITHDRAWAL 12 (GO TO 354)
OTHER (SPECIFY) 96 (GO TO 354)
UNSURE 98 (GO TO 354)

352) What is the main reason that you think you will not use a contraceptive method to delay or avoid pregnancy at any time in the future?

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX/NO SEX 22 (GO TO 354)
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 354)
SUBFECUND/INFECUND 24 (GO TO 354)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (GO TO 354)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 354)
HUSBAND/PARTNER OPPOSED 32 (GO TO 354)
OTHERS OPPOSED 33 (GO TO 354)
RELIGIOUS PROHIBITION 34 (GO TO 354)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 354)
KNOWS NO SOURCE 42 (GO TO 354)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 354)
FEAR OF SIDE EFFECTS 52 (GO TO 354)
LACK OF ACCESS/TOO FAR 53 (GO TO 354)
COSTS TOO MUCH 54 (GO TO 354)
INCONVENIENT TO USE 55 (GO TO 354)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 354)
OTHER (SPECIFY) ___________ 96 (GO TO 354)
DON'T KNOW 98 (GO TO 354)

353) Would you ever use a contraceptive method If you were married to delay or avoid pregnancy?

YES 1
NO 2
DON'T KNOW 8

354) CHECK 216:
HAS LIVING CHILDREN:
If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?

NO LIVING CHILDREN:
If you could choose exactly the number of children to have in your whole life, how many would that be?

PROBE FOR A NUMERIC RESPONSE.

NUMBER ________
OTHER (SPECIFY) __________ 96 (GO TO 356)

355) Out of the (NUMBER) you would choose to have in your whole life, how many of these children would you like to be boys, how many would you like to be girls, or would the sex not matter?

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

356) Would you say that you approve or disapprove of couples using a contraceptive method to avoid getting pregnant?

APPROVE 1
DISAPPROVE 2
NO OPINION/UNSURE 3

357) In the last few months have you heard or seen anything about family planning?

On the radio?
YES 1
NO 2
On the television?
YES 1
NO 2
In a newspaper or in a magazine?
YES 1
NO 2

358) In the last few months, have you discussed the practice of family planning with your friends, neighbors or relatives?

YES 1
NO 2 (GO TO 360)

359) With whom did you talk?
Anyone else?
RECORD ALL PERSONS MENTIONED

HUSBAND A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTERS G
SON G
MOTHER-IN-LAW H
FRIEND(S)/NEIGHBOR(S) I
OTHER (SPECIFY) _________ X

360) CHECK 121:

YES, CURRENTLY MARRIED (GO TO 361)
NO, NOT IN A UNION (GO TO 367)

361) CHECK 311/311A:

AT LEAST ONE CODE CIRCLED (GO TO 362)
NO CODE CIRCLED (GO TO 363)

362) You have told me that you are currently using contraception to delay pregnancy. Would you say that using contraception is mainly your decision, mainly your husband's decision or did you both decide together?

MAINLY RESPONDENT 1
MAINLY HUSBAND 2
MUTUAL DECISION 3
OTHER (SPECIFY) __________ 6

363) Now I would like to ask you about your husband's views on family planning. Do you think that your husband approves or disapproves of couples using a contraceptive method to avoid or delay pregnancy?

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

364) How often have you talked to your husband about family planning in the past 12 months?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

365) CHECK 311/311A:

NEITHER STERILIZED (GO TO 366)
HE OR SHE STERILIZED (GO TO 367)

366) Do you think your husband wants the same number of children that you want? (boys or girls)

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

367) As you know, husband and wife do not always agree on everything. Please tell me if you think a wife is justified in refusing to have sex with her husband when:

She knows her husband has a sexually transmitted disease?
YES 1
NO 2
DON'T KNOW 8
She knows her husband has sex with other women?
YES 1
NO 2
DON'T KNOW 8
She has recently given birth (after 40 days)?
YES 1
NO 2
DON'T KNOW 8
She is tired or not in the mood?
YES 1
NO 2
DON'T KNOW 8

SECTION 4A. PREGNANCY, POSTNATAL CARE, AND BREASTFEEDING

401) CHECK 224:

ONE OR MORE BIRTHS SINCE JANUARY 1998 (GO TO 402)
NO BIRTHS SINCE JANUARY 1999 (GO TO 487)

402) Now, I would like to ask you some questions about your pregnancies ove the past five years.
ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE 1998. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES).

403) LINE NUMBER FROM 212

LINE NUMBER _______

404) FROM 212 AND 216

NAME _______
LIVING ___
DEAD ___

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

THEN 1 (GO TO 407)
LATER 2
NOT AT ALL 3 (GO TO 407)

406) How much longer would you like to have waited?

MONTHS 1 ____
YEARS 2 ____
DON'T KNOW 998

407) When you were pregnant with (NAME) did you see anyone for antenatal care?
IF YES: Whom did you see?
Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.

HEALTH PROFESSIONAL
DOCTOR A
MIDWIFE B
NURSE C
OTHER
MIDWIFE D
OTHER X
NO ONE Y (GO TO 414B)

408) How many months pregnant were you with (NAME) when you first received antenatal care for this pregnancy?

MONTHS ____
DON'T KNOW 98

408a) What was the main reason you sought antenatal care for the first time of this pregnancy with (NAME)
PROBE FOR THE MOST SIGNIFICANT REASON.

CHECK ON BABY 01
RESERVE FOR BIRTH 02
CHECK TO SEE IF SHE'S PREGNANT 03
FAMILY/OTHER INSISTED 04
ROUTINE 05
ENSURE A HEALTHY PREGNANCY 06
HAD COMPLICATIONS 07
OTHER (SPECIFY) ______ 96

409) How many times did you receive antenatal care during this pregnancy with (NAME)?

NO. OF TIMES _____
DON'T KNOW 98

409a) Did you receive antenatal care the last month of this pregnancy?

YES 1
NO 2
DON'T KNOW 8

409b) Where did you go to the last time you received antenatal care for this pregnancy with (NAME)?

HOSPITAL 01
HEALTH CENTER 02
DISPENSARY 03
CLINIC 04
PRIVATE DOCTOR 05
AT HOME 06 (GO TO 410)
OTHER (SPECIFY) _____ 96

409c) How long did it take you to arrive to the health facility the last time you went for antenatal care?

MINUTES ____
DON'T REMEMBER 998

409d) Did you walk or did you use a ride (which ride)?

ON FOOT 1
BUS/TAXI 2
PERSONAL CAR 3

OTHER (SPECIFY) ____ 6

409e) When you arrived to the place you receive antenatal care in, how long did you wait before receiving the care?

MINUTES ________
DON'T REMEMBER 998

410) CHECK 409: NUMBER OF TIMES RECEIVED ANTENATAL CARE

ONCE (GO TO 412)
MORE THAN ONCE OR DON'T KNOW (GO TO 411)

411) How many months pregnant were you the last time you received antenatal care?

MONTHS _____
DON'T KNOW 98

412) During this pregnancy with (NAME), were any of the following done?

Were you weighed?
YES 1
NO 2
DON'T KNOW 8
Was your height measured?
YES 1
NO 2
DON'T KNOW 8
Was your blood pressure measured?
YES 1
NO 2
DON'T KNOW 8
Did you give a blood sample?
YES 1
NO 2
DON'T KNOW 8
Did you give a urine sample?
YES 1
NO 2
DON'T KNOW 8
Did they measure your belly?
YES 1
NO 2
DON'T KNOW 8
Did they listen to the baby's (heartbeat)?
YES 1
NO 2
DON'T KNOW 8
Did they do an ultrasound?
YES 1
NO 2
DON'T KNOW 8
Did they do an internal exam?
YES 1
NO 2
DON'T KNOW 8
Did they talk to you about the baby's position?
YES 1
NO 2
DON'T KNOW 8

413) Were you told about the signs of pregnancy complications?

YES 1
NO 2 (GO TO 414A)
DON'T KNOW 8 (GO TO 414A)

414) Were you told where to go if you had these complications?

YES 1
NO 2
DON'T KNOW 8

414a) When you receive antenatal care for this pregnancy, did they give you information about:

The food you need to eat?
YES 1
NO 2
DON'T KNOW 8
Breastfeeding?
YES 1
NO 2
DON'T KNOW 8
Family Planning?
YES 1
NO 2
DON'T KNOW 8
Prenatal care after childbirth?
YES 1
NO 2
DON'T KNOW 8

414b) Have you ever had an injection against tetanus?

YES 1
NO 2 (GO TO 417)
DON'T KNOW 8 (GO TO 417)

414c) How many times have you been given this vaccine?

NUMBER OF TIMES ___
DON'T KNOW 8

415) During this pregnancy, were you given an injection to prevent the baby from getting tetanus?

YES 1
NO 2 (GO TO 417)
DON'T KNOW 8 (GO TO 417)

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

NUMBER OF TIMES ____
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 419)
DON'T KNOW 8 (GO TO 419)

418) During this pregnancy, how many days total did you take these iron tablets or iron syrup
If answer is not numeric, probe for approximate number of days.

NUMBER OF DAYS __________
DON'T KNOW 998

419) During this pregnancy, did you have difficulty with your vision during the daylight?

YES 1
NO 2
DON'T KNOW 8

420) During this pregnancy, did you suffer from night blindness?

YES 1
NO 2
DON'T KNOW 8

420a) During this pregnancy, did you ever have vaginal bleeding?

YES 1
NO 2 (GO TO 421A)
DON'T KNOW 8 (GO TO 421A)

420b) How much blood did you lose: a little, a lot, some?

INTENSE 1
MODERATE 2
MILD 3

420c) When you bled, was it during the first three months, the second three months or the last three months?

FIRST TRIMESTER 1
SECOND TRIMESTER 2
THIRD TRIMESTER 3
DON'T KNOW 8

420d) Did you get any treatment or seek advice for the bleeding?

YES 1
NO 2 (GO TO 421A)

420e) Who gave you this advice or treatment?
Anyone else?

DOCTOR A
NURSE/MIDWIFE B
PHARMACIST C
MIDWIFE D
MOTHER E
HUSBAND F
OTHER RELATIVE G
TRADITIONAL PRACTITIONER H
OTHER (SPECIFY) ____________ X

421a) (NAME) when you were pregnant did you get:

High blood pressure?
YES 1
NO 2
DON'T KNOW 8
Edema?
YES 1
NO 2
DON'T KNOW 8
Headache?
YES 1
NO 2
DON'T KNOW 8
Abdominal pain?
YES 1
NO 2
DON'T KNOW 8
Fever?
YES 1
NO 2
DON'T KNOW 8