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MADAGASCAR DEMOGRAPHIC AND HEALTH SURVEY WOMEN'S QUESTIONNAIRE 1992

IDENTIFICATION

FARITANY (REGION) NAME ______
FIVONDRONAMPOKOTANY (DISTRICT) NAME ______
CLUSTER NUMBER _____
HOUSEHOLD UNIT NUMBER _____

URBAN/RURAL ____

URBAN 1
RURAL 1

CITY/ADMINISTRATIVE CENTER ___

ANTANANARIVO 1
FARITANY AND ANTSIRABE ADMINISTRATIVE CENTER 2
FIVONDRONAMPOKONTANY ADMINISTRATIVE CENTER 3
FIRAISAMPOKONTANY ADMINISTRATIVE CENTER 4
RURAL 5

NAME OF HOUSEHOLD HEAD ___________
NAME AND LINE NUMBER OF WOMAN ___________

INTERVIEWER VISITS:

DATE ____
INTERVIEWER'S NAME _____

RESULT ____

1 COMPLETED
2 NOT AT HOME
3 DEFERRED
4 REFUSED
5 PARTIALLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY)

NEXT VISIT
DATE _____
TIME _____

FINAL VISIT
DAY _____
MONTH ____
YEAR ____
NAME ____
RESULT ____

TOTAL NUMBER OF VISITS _____

FIELD EDITOR
NAME ___________
DATE ___________

SUPERVISOR
NAME __________
DATE __________

OFFICE EDITOR _______
KEYED BY _______

SECTION 1. SOCIODEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENTS

101. RECORD THE TIME.

HOUR __
MINUTES ___

To begin, I would like to ask you questions about yourself and your household.

102. Until the age of 12, did you mostly live in Antananarivo-Renivohitra, in an administrative center of Faritany, in an administrative center of Fivondrona, in an administrative center of Firaisana, or in a rural setting?

CITY OF ANTANANARIVO 1
FARITANY ADMINISTRATIVE CENTER 2
FIVONDRONA ADMINISTRATIVE CENTER 3
FIRAISA ADMINISTRATIVE CENTER 4
RURAL 5

103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?

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

104. Just before you moved here, did you live in Antananarivo-Renivohitra, in an administrative center of Faritany, in an administrative center of Fivondrona, in an administrative center of Firaisana, or in a rural setting?

CITY OF ANTANANARIVO 1
FARITANY ADMINISTRATIVE CENTER 2
FIVONDRONA ADMINISTRATIVE CENTER 3
FIRAISA ADMINISTRATIVE CENTER 4
RURAL 5

105. In what month and year were you born?

MONTH ___
DOESN'T KNOW MONTH 98
YEAR ___
DOESN'T KNOW YEAR 98

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, secondary, or higher?

PRIIMARY 1
MIDDLE SCHOOL 2
HIGH SCHOOL 3
HIGHER 3

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

GRADE ____

110. CHECK 108:

PRIMARY
SECONDARY OR HIGHER (GO TO 112)

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

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 113)

112. Do you read a newspaper or magazine at least once a week?

YES 1
NO 2

113. Do you listen to the radio at least once a week?

YES 1
NO 2

114. Do you watch the television at least once a week?

YES 1
NO 2

115. What is your religion?

CATHOLIC 1
PROTESTANT 2
MUSLIM 3
TRADITIONAL 4
NOT RELIGIOUS 5
OTHER (SPECIFY) _____ 6

117. CHECK Q.4 IN THE HOUSEHOLD QUESTIONNAIRE:

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

Now I would like to ask you some questions about the place you usually live.

118. Do you usually live in Antananarivo-Renivohitra, in an administrative center of Faritany, in an administrative center of Fivondrona, in an administrative center of Firaisana, or in a rural setting?

CITY OF ANTANANARIVO 1
FARITY ADMINISTRATIVE CENTER 2
FIVONDRONA ADMINISTRATIVE CENTER 3
FIRAISA ADMINISTRATIVE CENTER 4
RURAL 5

119. In which Faritany is it? (the usual place)

ANTANANARIVO 1
FIAMARANTSOA 2
TAMATAVE (TOAMASINA) 3
MAHAJANGA 4
TULEAR 5
ANSIRANANA 6
ANTSIRABE 7

Now I would like to ask you some questions about the household in which you usually live.

120. Where does the water come from that your household uses to wash hands and dishes?

TAP WATER
PIPED INTO DWELLING/YARD/PLOT 11 (GO TO 122)
PUBLIC TAP/STANDPIPE 12
WELL WATER
WELL IN DWELLING/YARD/PLOT 21 (GO TO 122)
WELL OUTSIDE THE DWELLING/YARD/PLOT 22
SURFACE WATER
SPRING 31
RIVER 32
POND/LAKE 33
DAM 34
RAINWATER 41 (GO TO 122)
TANKER TRUCK 51
BOTTLED WATER 61 (GO TO 122)
OTHER (SPECIFY) _____ 71

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

MINUTES ___
ON SITE 996

122. For drinking water, does your household use water from the same source?

YES 1 (GO TO 124)
NO 2

123. Where does your household's drinking water come from?

TAP WATER
PIPED INTO DWELLING/YARD/PLOT 11
PUBLIC TAP/STANDPIPE 12
WELL WATER
WELL IN THE DWELLING/YARD/PLOT 21
WELL OUTSIDE TEH DWELLING/YARD/PLOT 22
SURFACE WATER
SPRING 31
RIVER 32
POND/LAKE 33
DAM 34
RAINWATER 41
TANKER TRUCK 51
BOTTLED WATER 62
OTHER (SPECIFY) ____ 71

124. What kind of toilet facility is in your household?

FLUSH TOILET
PRIVATE FLUSH TOILET 11
SHARED FLUSH TOILET 12
PIT/LATRINE
LATRINE BUCKET 21
RUDIMENTARY PIT LATRINE 22
VENTILATED PIT LATRINE 23
NO TOILET/OUTSIDE 31
OTHER (SPECIFY) ____ 41

125. Does your household have:

Electricity?
YES 1
NO 2
A sewing machine?
YES 1
NO 2
A radio?
YES 1
NO 2
A television?
YES 1
NO 2
A refrigerator?
YES 1
NO 2

126. In your household, how many rooms do you use for sleeping?

ROOMS ___

127. Can you describe the floor of your dwelling?

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

128. Does any member of this household own:

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

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 of daughters to whom you have given birth who are now 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 at birth but did not survive more than a few hours or days?

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
NO (PROBE AND CORRECT 201-209 AS NECESSARY)

210. CHECK 208:

ONE OR MORE BIRTHS
NO BIRTHS (GO TO 223)

[REPEAT QUESTION 211-220 FOR EACH SEPARATE BIRTH]

Now I would like to talk to you about all of your births, whether still alive or not, starting with the first one you had.

211. RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS ON SEPARATE LINES.

_____

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

(NAME) _____

213. Was (NAME) a single birth or part of a multiple birth?

SING 1
MULT 2

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

BOY 1
GIRL 2

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

MONTH ____
YEAR ____

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

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

AGE IN YEARS ____

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

YES 1 (GO TO NEXT BIRTH)
NO 2

219. IF CHILD IS LESS THAN 15 YEARS OLD: With whom does he/she live?
IF 15: GO TO NEXT BIRTH.

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

220. IF DEAD: How old was (NAME) when he/she died?
IF '1 YEAR', PROBE: How many months was (NAME)?

RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

DAYS 1 ___
MONTHS 2 ___
YEARS 3 ___

221. COMPARE 208 WITH NUMBER OF BIRTHS REGISTERED IN TABLE 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 CORRECT)

222. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1987.
IF NONE, RECORD '0'.

NUMBER OF BIRTHS ___

223. Are you pregnant now?

YES 1
NO 2 (GO TO 226)
UNSURE 8 (GO TO 226)

224. How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.

MONTHS ___

225. 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
NOT SURE 4

226. When did your last menstrual period start?

NUMBER OF DAYS 1 ___
NUMBER OF WEEKS 2 ___
NUMBER OF MONTHS 3 ___
NUMBER OF YEARS 4 ___
IN MENOPAUSE 994
BEFORE LAST BIRTH 995
NEVER HAD PERIOD 996

227. Between the first day of a woman's menstrual period and the first day of her next period, are there certain days when a woman is more likely to become pregnant than others?

YES 1
NO 2 (GO TO 229)
DOESN'T KNOW 8 (GO TO 229)

228. At what point in her menstrual cycle does a woman have the highest chance of becoming pregnant?

DURING HER PERIOD 1
RIGHT AFTER HER PERIOD HAS ENDED 2
MIDDLE OF HER CYCLE 3
JUST BEFORE HER PERIOD BEGINS 4
OTHER (SPECIFY) ______ 5
DOESN'T KNOW 8

229. Sometimes a woman loses her child before finishing the gestation period, either because she has a miscarriage or she has an abortion. Have you ever had a miscarriage or an abortion?

YES 1
NO 2 (GO TO 301)
NO RESPONSE 8 (GO TO 301)

230. How many miscarriages or abortions have you had?

TOTAL NUMBER ___

231. How many of those were miscarriages?

NUMBER OF MISCARRIAGES ___
NONE 00 (GO TO 233)

232. In what month and year did you last have a miscarriage?

MONTH ___
YEAR ___

233. How many of those were abortions?

NUMBER OF ABORTIONS ___
NONE 00 (GO TO 301)

234. In what month and year did you last have an abortion?

MONTH ___
YEAR ____

SECTION 3. CONTRACEPTION

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.

301. What are the ways or methods that have you heard about?

CIRCLE CODE 1 IN 302 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 302, 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 302, ASK 303-305 BEFORE CONTINUING ONTO THE NEXT METHOD.

302. 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 health provider that stops them from becoming pregnant for several months.
YES SPONTANEOUSLY 1
YES DESCRIPTION 2
NO 3
04. DIAPHRAGM, FOAM OR GEL Women can place a sponge, a suppository, a diaphragm, gel or foam inside their vagina before sexual intercourse.
YES SPONTANEOUSLY 1
YES DESCRIPTION 2
NO 3
05. CONDOM Men can put a rubber or latex 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 METHOD Couples can avoid having sexual intercourse on certain days of a woman's cycle during which she is most likely to become 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?
YES SPONTANEOUSLY (SPECIFY) ______ 1
NO 3

303. 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 health provider that stops them from becoming pregnant for several months.
YES 1
NO 2
04. DIAPHRAGM, FOAM OR GEL Women can place a sponge, a suppository, a diaphragm, gel or foam inside their vagina before sexual intercourse.
YES 1
NO 2
05. CONDOM Men can put a rubber or latex 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. Have you ever had 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 METHOD Couples can avoid having sexual intercourse on certain days of a woman's cycle during which she is most likely to become pregnant.
YES 1
NO 2
09. WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
10. OTHER METHOD (SPECIFY) _____
YES 1
NO 2

304. Do you know where one can go to procure (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 health provider that stops them from becoming pregnant for several months.
YES 1
NO 2
04. DIAPHRAGM, FOAM OR GEL Women can place a sponge, a suppository, a diaphragm, gel or foam inside their vagina before sexual intercourse.
YES 1
NO 2
05. CONDOM Men can put a rubber or latex 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 METHOD Couples can avoid having sexual intercourse on certain days of a woman's cycle during which she is most likely to become pregnant. Do you know where you can seek advice on how to practice the rhythm method?
YES 1
NO 2

305. CHECK 303:

NOT A SINGLE "YES" (NEVER USED) _____
AT LEAST ONE "YES" (EVER USED) _____ (GO TO 308)

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

YES 1
NO 2 (GO TO 324)

307. What have you used or done?
CORRECT 302-305 (AND 301 IF NECESSARY).

____

Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant.

308. How many living children did you have at that time?
IF NONE, RECORD '00'.

NUMBER OF CHILDREN ____

309. CHECK 223:

NOT PREGNANT OR UNSURE ___
PREGNANT ____ (GO TO 324)

310. CHECK 303:

WOMAN NOT STERILIZED ____
WOMAN STERILIZED ____ (GO TO 312A)

311. Are you currently doing something or using any method to delay or avoid getting pregnant?

YES 1
NO 2 (GO TO 324)

312. Which method are you currently using?

PILL 01
IUD 02 (GO TO 318)
INJECTABLES 03 (GO TO 318)
DIAPHRAGM/FOAM/JELLY 04 (GO TO 318)
CONDOM 05 (GO TO 318)
FEMALE STERILIZATION 06 (GO TO 318)
MALE STERILIZATION 07 (GO TO 318)
RHYTHM METHOD 08 (GO TO 323)
WITHDRAWAL 09 (GO TO 323)
OTHER (SPECIFY) ____ 10 (GO TO 323)

312A. CIRCLE '06' FOR FEMALE STERILIZATION.

PILL 01
IUD 02 (GO TO 318)
INJECTABLES 03 (GO TO 318)
DIAPHRAGM/FOAM/JELLY 04 (GO TO 318)
CONDOM 05 (GO TO 318)
FEMALE STERILIZATION 06 (GO TO 318)
MALE STERILIZATION 07 (GO TO 318)
RHYTHM METHOD 08 (GO TO 323)
WITHDRAWAL 09 (GO TO 323)
OTHER (SPECIFY) ____ 10 (GO TO 323)

313. At the time you began using the pill for the first time did you consult a doctor, a nurse or a certified midwife?

YES 1
NO 2
DOESN'T KNOW 8

314. The last time you obtained pills did you consult a doctor, a nurse or a certified midwife?

YES 1
NO 2

315. May I see the package of pills you are currently using?
NOTE THE NAME OF THE BRAND.

PACKAGE SEEN 1 (BRAND)______ (GO TO 317)
NAME OF THE BRAND ____ (GO TO 317)
PACKAGE NOT SEEN 2

316. Do you know the brand name of the pills you are currently using?
NOTE THE NAME OF THE BRAND

NAME OF THE BRAND ____
DOESN'T KNOW NAME 98

317. How much does a box of pills cost you?

COST ____
FREE 9996
DOESN'T KNOW 9998

318. CHECK 312:

HE/SHE IS STERILIZED
Where did the sterilization take place?

USES ANOTHER METHOD
Where did you obtain (METHOD) the last time?

NAME OF PLACE _________
PUBLIC SECTOR
HOSPITAL 11
HEALTH CENTER 12
DISPENSARY 13
MEDICAL POST 14
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR 21
PRIVATE HOSPITAL/CLINIC 22
PHARMACY 23
SP/FISA CENTER 24
OTHER PRIVATE SECTOR
SHOP 31
CHURCH 32 (GO TO 321)
FRIENDS/RELATIVES 33 (GO TO 321)
OTHER (SPECIFY) _____ 41 (GO TO 321)
DOESN'T KNOW 98 (GO TO 321)

319. How long does it take to get to this place from your house?
IF 90 MINUTES OR LESS, RECORD THE RESPONSE IN MINUTES. IF LONGER, RECORD IN HOURS.

MINUTES 1 ___
HOURS 2 ___
DOESN'T KNOW 998

320. Is it easy or difficult to get there?

EASY 1
DIFFICULT 2

321. CHECK 312:

HE/SHE IS STERILIZED ___
USES ANOTHER METHOD ____ (GO TO 323)

322. In what month and year was the sterilization performed?

MONTH ____ (GO TO 329)
YEAR ____ (GO TO 329)

323. For how many months have you been continuously using (METHOD)?
IF LESS THAN 1 MONTH, NOTE '00'.

MONTHS ___ (GO TO 329)
8 YEARS OR MORE 96 (GO TO 329)

324. Do you intend to use a method to delay or prevent pregnancy at any point in the future?

YES 1 (GO TO 326)
NO 2
UNDECIDED/DOESN'T KNOW 8 (GO TO 330)

325. What is the main reason why you do not intend on using a contraceptive method?

WANTS CHILDREN 01 (GO TO 330)
LACK OF INFORMATION 02 (GO TO 330)
PARTNER DISAPPROVES 03 (GO TO 330)
TOO EXPENSIVE 04 (GO TO 330)
SIDE EFFECTS 05 (GO TO 330)
HEALTH PROBLEMS 06 (GO TO 330)
HARD TO GET 07 (GO TO 330)
RELIGION 08 (GO TO 330)
OPPOSED TO FAMILY PLANNING 09 (GO TO 330)
FATALIST 10 (GO TO 330)
OTHER PEOPLE DISAPPROVE 11 (GO TO 330)
INFREQUENT SEXUAL ACTIVITY 12 (GO TO 330)
DIFFICULTY GETTING PREGNANT 13 (GO TO 330)
MENOPAUSAL/STERILIZED 14 (GO TO 330)
NO CONVENIENT 15 (GO TO 330)
NOT MARRIED 16 (GO TO 330)
OTHER (SPECIFY) ____ 17 (GO TO 330)
DOESN'T KNOW 98 (GO TO 330)

326. Do you intend to use a method to delay or prevent pregnancy at any point in the next 12 months?

YES 1
NO 2
DOESN'T KNOW 8

327. When you will use a method in the future, which method will you want 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 330)
WITHDRAWAL 09 (GO TO 330)
OTHER (SPECIFY) _____ 10 (GO TO 330)
NOT SURE 98 (GO TO 330)

328. Where will you go to obtain (METHOD IN 327)?

NAME OF PLACE _______________
PUBLIC SECTOR
HOSPITAL 11 (GOT TO 332)
HEALTH CENTER 12 (GO TO 332)
DISPENSARY 13 (GO TO 332)
MEDICAL POST 14 (GO TO 332)
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR 21 (GO TO 332)
PRIVATE HOSPITAL/CLINIC 22 (GO TO 332)
PHARMACY 23 (GO TO 332)
SP/FISA CENTER 24 (GO TO 332)
OTHER PRIVATE SECTOR
SHOP 31 (GO TO 332)
CHURCH 32 (GO TO 334)
FRIENDS/RELATIVES 33 (GO TO 334)
OTHER (SPECIFY) _____ 41 (GO TO 334)
DOESN'T KNOW 98

329. CHECK:

USES RHYTHM METHOD, WITHDRAWAL, OR OTHER TRADITIONAL METHOD ___
USES A MODERN METHOD ___ (GO TO 334)

330. Do you know of a place where one can get contraception?

YES 1
NO 2 (GO TO 333)

331. Where is it?

NAME OF PLACE___________
PUBLIC SECTOR
HOSPITAL 11
HEALTH CENTER 12
DISPENSARY 13
MEDICAL POST 14
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR 21
PRIVATE HOSPITAL/CLINIC 22
PHARMACY 23
SP/FISA CENTER 24
OTHER PRIVATE SECTOR
SHOP 31
CHURCH 32 (GO TO 334)
FRIENDS/RELATIVES 33 (GO TO 334)
OTHER (SPECIFY) _____ 41 (GO TO 334)
DOESN'T KNOW 98 (GO TO 334)

332. How long does it take to get to this place from your house?
IF 90 MINUTES OR LESS, RECORD THE RESPONSE IN MINUTES. IF LONGER, RECORD IN HOURS.

MINUTES 1 __
HOURS 2 __
DOESN'T KNOW 998

333. Is it easy or difficult to get there?

EASY 1
DIFFICULT 2

334. During the last month, have you heard discussion about family planning on:

The radio?
YES 1
NO 2
The television?
YES 1
NO 2

335. During the last month, have you read articles about family planning in a newspaper?

YES 1
NO 2

336. Do you find it acceptable or inacceptable that information about family planning is given on radio or television?

ACCEPTABLE 1
NOT ACCEPTABLE 2
DOESN'T KNOW 8

SECTION 4A. PREGNANCY AND BREASTFEEDING

401. CHECK 222:

AT LEAST ONE BIRTH SINCE JANUARY 1987 ___
NO BIRTHS SINCE JANUARY 1987 ____ (GO TO 501)

[REPEAT QUESTIONS 402-440 FOR EACH SEPARATE BIRTH]

402. ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS FOR EACH BIRTH SINCE JANUARY 1987 IN THE REPRODUCTION TABLE. ASK THE QUESTIONS FOR ALL BIRTHS BEGINNING WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL QUESTIONNAIRE.)

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

LINE NUMBER FROM 212:

LINE NO. ___

FROM 212 AND 216:

NAME ____
LIVING ____
DEAD ____

403. 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 405)
LATER 2
NOT AT ALL 3 (GO TO 405)
NOT SURE 4 (GO TO 405)

404. How much longer would you have liked to wait?

MONTHS 1 ___
YEARS 2 ___
DOESN'T KNOW 998

405. When you were pregnant with (NAME), did you see anyone for prenatal care for this pregnancy? Anyone else?
IF YES: Whom did you see?
CIRCLE ALL PEOPLE SEEN.

HEALTH PERSONNEL
DOCTOR A
NURSE B
MIDWIFE C
OTHER PERSON
TRAINED TRADITIONAL BRITH ASSISTANT D
TRADITONAL BIRTH ASSISTANT E
OTHER (SPECIFY) ____ F
NO ONE G (GO TO 409)

406. Did you have a prenatal notebook/logbook for this pregnancy?

YES 1
NO 2
DOESN'T KNOW 8

407. How many months pregnant were you when you first received prenatal care for this pregnancy?

MONTHS ___
DOESN'T KNOW 98

408. How many prenatal visits did you have during this pregnancy?

NUMBER OF VISITS ___
DOESN'T KNOW 98

409. During this pregnancy, 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 411)
DOESN'T KNOW 8 (GO TO 411)

410. How many times did you get this tetanus injection?

TIMES ____
DOESN'T KNOW 8

411. Where did you give birth to (NAME)?

HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
HOSPITAL 21
HEALTH CENTER 22
LOCAL HEALTH POST 23
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER (SPECIFY) _____ 41

412. Who assisted you with the delivery of (NAME)?
Anyone else?
PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.

HEALTH PERSONNEL
DOCTOR A
NURSE B
MIDWIFE C
OTHER PERSON
TRAINED TRADITIONAL BIRTH ASSISTANT D
TRADITIONAL BIRTH ASSISTANT E
RELATIVE F
OTHER (SPECIFY) ______ G
NO ONE H

413. Was (NAME) born at term or prematurely?

AT TERM 1
PERMATURELY 2
DOESN'T KNOW 8

414. Was (NAME) delivered by caesarean section?

YES 1
NO 2

415. 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
DOESN'T KNOW 8

416. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 418)

417. How much did (NAME) weigh?

KILOGRAMS ___
DOESN'T KNOW 98

418. Has your period come back since the birth of (NAME)?
[ONLY ASK FOR MOST RECENT BIRTH.]

YES 1 (GO TO 420)
NO 2 (GO TO 421)

419. Did your period come back between the birth of (NAME) and your next birth?
[ASK FOR ALL BUT MOST RECENT BIRTH.]

YES 1
NO 2 (GO TO 423)

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

MONTHS ___
DOESN'T KNOW 98

421. CHECK 223:
IS RESPONDENT PREGNANT?
[ONLY ASK FOR MOST RECENT BIRTH.]

NOT PREGNANT __
PREGNANT OR UNSURE __ (GO TO 423)

422. Have you begun to have sexual intercourse again since the birth of (NAME)?
[ONLY ASK FOR MOST RECENT BIRTH.]

YES 1
NO 2 (GO TO 424)

423. For how long after the birth of (NAME) did you not have sexual intercourse?

MONTHS___
DOESN'T KNOW 98

424. Did you breastfeed (NAME)?

YES 1 (GO TO 426)
NO 2

425. Why did you not breastfeed (NAME)?

MOTHER SICK/WEAK 01 (GO TO 435)
CHILD SICK/WEAK 02 (GO TO 435)
CHILD DIED 03 (GO TO 435)
PROBLEMS WITH BREASTS/NIPPLES 04 (GO TO 435)
NO MILK 05 (GO TO 435)
MOTHER WORKS 06 (GO TO 435)
CHILD REFUSED 07 (GO TO 435)
OTHER (SPECIFY) ____ 08 (GO TO 435)

426. How long after birth did you first put (NAME) to the breast?
[ONLY ASK FOR MOST RECENT BIRTH.]

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

IMMEDIATELY 000
HOURS 1 ___
DAYS 2 ___

427. CHECK 216: CHILD LIVING?
[ONLY ASK FOR MOST RECENT BIRTH.]

LIVING ___
DECEASED ___ (GO TO 433)

428. Are you still breastfeeding (NAME)?
[ONLY ASK FOR MOST RECENT BIRTH.]

YES 1 (GO TO 433)
NO 2

429. How many times did you breastfeed last night between sunset and sunrise?
[ONLY ASK FOR MOST RECENT BIRTH.]

IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE ANSWER.

NUMBER OF NIGHTTIME FEEDINGS ___

430. How many times did you breastfeed yesterday during the daylight hours?
[ONLY ASK FOR MOST RECENT BIRTH.]

IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE ANSWER.

NUMBER OF DAYTIME FEEDINGS ___

431. Did you give (NAME), at any moment yesterday or last night, any of the following things:
[ONLY ASK FOR MOST RECENT BIRTH.]

Water?
YES 1
NO 2
Sugar water?
YES 1
NO 2
Rice water?
YES 1
NO 2
Juice?
YES 1
NO 2
Herbal tea?
YES 1
NO 2
Baby formula?
YES 1
NO 2
Fresh milk?
YES 1
NO 2
Powdered or boxed milk?
YES 1
NO 2
Any other liquid?
YES 1
NO 2
Solid or semi-solid foods?
YES 1
NO 2

432. CHECK 431: FOOD OR LIQUID GIVEN YESTERDAY
[ONLY ASK FOR MOST RECENT BIRTH.]

"YES" FOR ONE OR MORE ___ (GO TO 437)
"NO/DOESN'T KNOW" FOR ALL ___ (GO TO 436)

433. For how many months did you breastfeed (NAME)?

MONTHS ___
UNTIL DEATH 95 (GO TO 436)

434. Why did you stop breastfeeding (NAME)?

MOTHER SICK/WEAK 01
CHILD SICK/WEAK 02
CHILD DIED 03
PROBLEMS WITH BREASTS/NIPPLES 04
NO MILK 05
MOTHER WORKS 06
CHILD REFUSED 07
WEANING AGE 08
BECAME PREGNANT 09
BEGAN USING CONTRACEPTION 10
OTHER (SPECIFY) _____ 11

435. CHECK 216:
CHILD LIVING?

LIVING ___ (GO TO 437)
DECEASED ___

436. Have you already given (NAME) water, or something else to eat or drink (besides breast milk)?

YES 1
NO 2 (GO TO 440)

437. How many months old was (NAME) when you started giving him/her the following things on a regular basis?
IF LESS THAN 1 MONTH, RECORD '00'.

Boxed milk or milk other than breast milk?
AGE IN MONTHS___
NEVER GIVEN 96
Water?
AGE IN MONTHS___
NEVER GIVEN 96
Other liquids?
AGE IN MONTHS___
NEVER GIVEN 96
Solid or semi-solid foods?
AGE IN MONTHS___
NEVER GIVEN 96

438. CHECK 216:
CHILD LIVING?

LIVING ___
DECEASED ___ (GO TO 440)

439. Did (NAME) drink anything from a bottle yesterday or last night?

YES 1
NO 2
DOESN'T KNOW 8

440. RETURN TO 403 FOR THE NEXT BIRTH; OR IF NO MORE BIRTHS, GO TO THE FIRST COLUMN OF 441.

SECTION 4B. VACCINATION AND HEALTH

[REPEAT QUESTIONS 441-449 FOR EACH SEPARATE BIRTH]

441. WRITE THE LINE NUMBER AND NAME OF EACH BIRTH SINCE JANUARY 1987 IN THE TABLE. ASK THE QUESTIONS FOR EACH BIRTH STARTING WITH THE MOST RECENT. (IF THERE ARE MORE THAN 3 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE.)

LINE NUMBER FROM 212 ___
NAME _____

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

YES, SEEN 1 (GO TO 444)
YES, NOT SEEN 2 (GO TO 446)
NO CARD 3

443. Did you ever have a vaccination card for (NAME)?

YES 1 (GO TO 446)
NO 2 (GO TO 446)

444. (1) COPY VACCINATION DATE 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 0 (POLIO GIVEN AT BIRTH)
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 ____

445. Has (NAME) received any vaccinations that are not recorded on this card?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, AND/OR MEASLES VACCINES.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 445)
NO 2 (GO TO 448)
DOESN'T KNOW 8 (GO TO 448)

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

YES 1
NO 2 (GO TO 448)
DOESN'T KNOW 8 (GO TO 448)

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

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

448. CHECK 216: CHILD LIVING?

LIVING ___ (GO TO 450)
DECEASED ___

449. RETURN TO 442 FOR THE NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 480.

[REPEAT QUESTIONS 450-460 FOR EACH SEPARATE BIRTH]

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2 (GO TO 455)
DOESN'T KNOW 8 (GO TO 455)

452. Has (NAME) has an illness with a cough at any time in the last 24 hours?

YES 1
NO 2
DOESN'T KNOW 8

453. How many days did/has the cough last/lasted?

DAYS ___

454. When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, rapid breaths?

YES 1
NO 2
DOESN'T KNOW 8

455. CHECK 450 AND 451:
FEVER OR COUGH?

"YES" IN 450 OR 451 ____
OTHER ____ (GO TO 460)

456. Was anything given to treat the fever/cough?

YES 1
NO 2 (GO TO 458)
DOESN'T KNOW 8 (GO TO 458)

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

INJECTION A
ANTIBIOTIC (PILL OR SYRUP) B
ANTI-MALARIAL (PILL OR SYRUP) C
COUGH SYRUP D
OTHER PILL OR SYRUP E
UNKNOWN PILL OR SYRUP F
HOME REMEDY/MEDICINAL PLANTS G
OTHER (SPECIFY) ____ H

458. Did you seek advice or treatment for the cough?

YES 1
NO 2 (GO TO 460)

459. Where did you seek advice or treatment?
To someone else?
RECORD ALL MENTIONED.

PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER B
DISPENSARY C
LOCAL HEALTH POST D
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR E
PRIVATE HOSPITAL/CLINIC F
PHARMACY G
OTHER LOCATION
STORE H
TRADITIONAL HEALER I
OTHER (SPECIFY) ____ J

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

YES 1 (GO TO 462)
NO 2
DOESN'T KNOW 8

461. RETURN TO 442 FOR THE NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 480.

[REPEAT QUESTIONS 462-479 FOR EACH SEPARATE BIRTH]

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

YES 1
NO 2
DOESN'T KNOW 8

463. How many days did/has the diarrhea last/lasted?
IF LESS THAN 1 DAY, RECORD '00'.

DAYS ___

464. Was there blood in the stool?

YES 1
NO 2
DOESN'T KNOW 8

465. CHECK 424/428:
LAST CHILD STILL BREASTFED?

YES 1
NO 2 (GO TO 468)

466. When (NAME) had diarrhea, did you change the number of times you nursed?

YES 1
NO 2 (GO TO 468)

467. Did you raise or lower the number of feedings, or did you stop completely?

RAISED 1
LOWERED 2
STOPPED COMPLETELY 3

468. (Other than breast milk) Did you give (NAME) about the same amount of liquid as before the diarrhea, more, or less?

SAME 1
MORE 2
LESS 3
DOESN'T KNOW 8

469. Was anything given to treat the diarrhea?

YES 1
NO 2 (GO TO 471)
DOESN'T KNOW 8 (GO TO 471)

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

ORS/ODIVA SYRUP A
RECOMMENDED HOUSE LIQUID B
ANTIBIOTIC PILL OR SYRUP C
OTHER PILL OR SYRUP D
INJECTION E
(IV) INTRAVENOUS F
HOME REMEDY/HERBAL/MEDICINAL PLANTS G
OTHER (SPECIFY) ____ H

471. Did you seek advice or treatment for the diarrhea?

YES 1
NO 2 (GO TO 473)

472. Where did you seek advice or treatment? Anywhere else?
RECORD ALL MENTIONED.

PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER B
DISPENSARY C
LOCAL HEALTH POST D
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR E
PRIVATE HOSTPITAL/CLINIC F
PHARMACY G
OTHER LOCATION
STORE I
TRADITIONAL HEALER H
OTHER (SPECIFY) ___ J

472A. How much did treatment cost your family, including the medical consultation and medications?

COST _____
FREE 99996
DOESN'T KNOW 99998

473. CHECK 470: ORS PACKET LIQUID MENTIONED

NO, ORS PACKET LIQUID NOT MENTIONED ___
YES, ORS PACKET LIQUID MENTIONED ___ (GO TO 475)

474. Did (NAME) receive SRO/ODIVA when he/she had diarrhea?

YES 1
NO 2 (GO TO 476)
DOESN'T KNOW 8 (GO TO 476)

475. For how many days did (NAME) receive ORS/ODIVA?
IF LESS THAN 1 DAY, RECORD '00'.

DAYS ____
DOESN'T KNOW 98

476. CHECK 470: RECOMMENDED HOMEMADE LIQUID MENTIONED

NO, HOUSE LIQUID NOT MENTIONED ___
YES, HOUSE LIQUID MENTIONED ___ (GO TO 478)

477. Did (NAME) receive a liquid recommended by a health care professional and prepared at home with water, sugar and salt when he/she had diarrhea?

YES 1
NO 2 (GO TO 479)
DOESN'T KNOW 8 (GO TO 479)

478. For how many days did (NAME) receive sugar water with salt added?
IF LESS THAN 1 DAY, RECORD '00'.

DAYS ___
DOESN'T KNOW 98

479. RETURN TO 442 FOR THE NEXT CHILD; OR, IF NO MORE CHILDREN, GO TO 480.

480. CHECK 470 (ALL COLUMNS) AND 474:

ORS/ODIVA SOLUTION MENTIONED ___ (GO TO 484)
ORS/ODIVA SOLUTION NOT MENTIONED OR 470 AND 474 NOT ASKED ___

481. Have you ever heard of a product called ORS/OVIDA you can get for the treatment of diarrhea?

YES 1 (GO TO 483)
NO 2

482. Have you ever seen a packet that looks like this before?
SHOW THE PACKET.

YES 1
NO 2 (GO TO 486)

483. Have you already prepared a solution using one of these packets to treat diarrhea for yourself or someone else?
SHOW THE PACKET.

YES 1
NO 2 (GO TO 485)

484. How much water did you use the last time you prepared ODIVA?

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

485. Where can you obtain an ORS/ODIVA packet?
INSIST: Nowhere else?
RECORD ALL PLACES MENTIONED.

PUBLIC SECTOR
HOSPITAL 11
HEALTH CENTER 12
DISPENSARY 13
LOCAL HEALTH POST 14
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR 21
PRIVATE HOSPITAL/CLINIC 22
PHARMACY 23
OTHER LOCATION
STORE 31
TRADITIONAL HEALER 32
FAMILY/FRIENDS 33
OTHER (SPECIFY) ____ 41
DOESN'T KNOW 98

486. CHECK 470 (ALL COLUMNS) AND 477:

HOUSE LIQUID MENTIONED ____
HOUSE LIQUID NOT MENTIONED OR 470 AND 477 NOT ASKED ___ (GO TO 501)

487. Where did you learn to prepare the recommended liquid prepared at home with water, sugar and salt that you gave to (NAME) when he/she had diarrhea?

PUBLIC SECTOR
HOSPITAL 11
HEALTH CENTER 12
DISPENSARY 13
LOCAL HEALTH POST 14
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR 21
PRIVATE HOSPITAL/CLINIC 22
PHARMACY 23
OTHER LOCATION
STORE 31
TRADITIONAL HEALER 32
OTHER (SPECIFY) ____ 41

SECTION 5. MARRIAGE

501. Have you ever been married or lived in a union with a man?

YES 1
NO 2 (GO TO 512)

502. Are you currently married or living with a man as if married, or are you widowed, divorced, or separated?

MARRIED 1
LIVING WITH A MAN 2
WIDOWED 3 (GO TO 507)
DIVORCED 4 (GO TO 507)
SEPARATED 5 (GO TO 507)

503. Does your husband/partner live with you or does he live elsewhere?

LIVES WITH HER 1
LIVES ELSEWHERE 2

504. Does your husband/partner have any wives other than you?

YES 1
NO 2 (GO TO 507)

505. How many other wives does your husband have?

NUMBER ____
DOESN'T KNOW 98 (GO TO 507)

506. Are you the first, second, third... wife?

RANK ___

507. Have you been married or lived with a man only once or more than once?

ONLY ONCE 1
MORE THAN ONCE 2

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

MONTH ___
DOESN'T KNOW MONTH 98
YEAR ___
DOESN'T KNOW YEAR 98

509. How old were you when you first started living with him?

AGE ___
DOESN'T KNOW AGE 98

510. CHECK 508 AND 509: YEAR AND MONTH GIVEN

YES ___
NO ___ (GO TO 513)

511. VERIFY COHERENCE BETWEEN YEAR OF MARRIAGE AND AGE AT MARRIAGE:

BIRTH YEAR + AGE AT MARRIAGE = _____ YEAR OF MARRIAGE?
TO CALCULATE BIRTH YEAR (IF NECESSARY):
CURRENT YEAR (92) MINUS CURRENT AGE ____ = ____ YEAR OF BIRTH
IF INCOMPATIBLE, CHECK AND CORRECT 508 AND 509 AS NEEDED.
(GO TO 513)

512. IF NEVER IN UNION: Have you ever had sexual relations?

YES 1
NO 2 (GO TO 517)

Now we need some information about your sexual activity in order to gain a better understanding of family planning and fertility.

513. How many times have you had sexual intercourse in the last four weeks?

NUMBER OF TIMES ___

514. How many times in a month do you usually have sexual intercourse?

NUMBER OF TIMES ___

515. How long has it been since the last time you had sexual intercourse?

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

516. What age were you the first time you had sexual intercourse?

AGE ___
FIRST TIME AT MARRIAGE 96

517. PRESENCE OF OTHERS AT THIS TIME:

CHILDREN UNDER 10 YEARS
YES 1
NO 2
HUSBAND
YES 1
NO 2
OTHER MALES
YES 1
NO 2
OTHER FEMALES
YES 1
NO 2

SECTION 6. FERTILITY PREFERENCES

601. CHECK 312:

NEITHER HE NOR SHE STERILIZED ___
HE OR SHE STERILIZED ___ (GO TO 607)

602. CHECK 502 AND 502:

YES, CURRENTLY MARRIED OR LIVING WITH A MAN ___
NOT MARRIED/ NOT IN UNION ___ (GO TO 614)

603. CHECK 223:

NOT PREGNANT OR UNSURE
Now I have some questions about the future. Would you like to have a/another child, or would you prefer not to have any (more) children?

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 610)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 610)
UNDECIDED/DOESN'T KNOW 8 (GO TO 610)

604. CHECK 223:

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 ___ (GO TO 610)
YEARS 2 ___ (GO TO 610)
SOON/NOW 994 (GO TO 610)
SAYS SHE CAN'T GET PREGNANT 995 (GO TO 610)
OTHER (SPECIFY) ____ 996
DOESN'T KNOW 998

605. CHECK 216 AND 223: LIVING CHILD(REN) OR PREGNANT?

YES ____
NO ____ (GO TO 610)

606. CHECK 223:

NOT PREGNANT OR NOT SURE
What age would you like your youngest child to be when the next child is born?

PREGNANT
What age would you like the child with whom you're pregnant to be when the next child is born?

AGE____ (GO TO 610)
DOESN'T KNOW AGE 98 (GO TO 610)

607. In your current situation, if you had it to do over again, do you think that you/your husband/partner would make the same decision to get sterilized?

YES 1
NO 2

608. Do you regret that you/your husband had the operation so as to not have any (more) children?

YES 1
NO 2

609. Why do you regret it?

RESPONDENT WANTS ANOTHER CHILD 1 (GO TO 617)
PARTNER WANTS ANOTHER CHILD 2 (GO TO 617)
SIDE EFFECTS 3 (GO TO 617)
OTHER REASON (SPECIFY) _____ 4 (GO TO 617)

610. Do you think your husband/partner approves or disapproves of couples that use a method to avoid becoming pregnant?

APPROVES 1
DISAPPROVES 2
DOESN'T KNOW 8

611. How many times over the last year have you discussed family planning with your husband/partner?

NEVER 1
ONE OR TWO TIMES 2
MORE OFTEN 3

612. Have you already discussed the number of children you want with your husband?

YES 1
NO 2

613. Do you think that your husband/partner 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
DOESN'T KNOW 8

614. After the birth of a child, how long should a couple wait to begin having sexual intercourse?

MONTHS 1 ___
YEARS 2 ___
OTHER (SPECIFY) _____ 996

615. Should a mother wait until she is completely done breastfeeding before restarting sexual relations or does it not matter?

WAIT 1
NO IMPORTANCE 2

616. In general, do you approve or disapprove of couples that use a method to avoid becoming pregnant?

APPROVE 1
DISAPPROVE 2

617. CHECK 214:

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?

RECORD JUST A NUMBER OR ANOTHER RESPONSE.

NUMBER __
OTHER (SPECIFY) ___ 96

618. In your opinion, what is the best interval in months or years between the birth of one child and the birth of the next child?

MONTHS 1 ___
YEARS 2 ___
OTHER (SPECIFY) ____ 996

SECTION 7. HUSBAND'S BACKGROUND AND WOMAN'S PROFESSIONAL ACTIVITY

701. CHECK 501:

MARRIED/LIVING (LIVED) WITH A MAN __(ASK THE QUESTIONS ABOUT THE CURRENT/MOST RECENT HUSBAND/PARTNER)
NEVER MARRIED AND NEVER LIVED WITH A MAN __(GO TO 706)

702. Did your (last) husband/partner ever attend school?

YES 1
NO 2 (GO TO 705)

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

PRIMARY 1
SECONDARY 2
HIGHER 3
DOESN'T KNOW 8 (GO TO 705)

704. What was the highest grade he completed at that level?

GRADE ___
DOESN'T KNOW 98

705. What is (was) your husband's/partner's principal occupation?

____

706. CHECK 705:

WORKS/WORKED IN AGRICULTURE ___
DOES/DID NOT WORK IN AGRICULTURE ___ (GO TO 708)

707. Did/Does your husband/partner work mainly on his own land or on family land, or does/did he work on land that he rents/rented from someone else, or does/did he work on someone else's land?

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

708. Aside from your own housework, are you currently working?

YES 1 (GO TO 710)
NO 2

709. 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
NO 2 (GO TO 801)

710. What is your occupation, that is, what kind of work do you do?

____

711. Do you do this work for a member of your family, for someone else, or are you self-employed?

FOR FAMILY MEMBER 1
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3

712. Do you earn a salary for this work? INSIST: Do you earn money for doing this work?

YES 1
NO 2

713. Do you usually work in the home or outside the home?

IN THE HOME 1
OUTSIDE THE HOME 2

713A. Is the work you do temporary, seasonal, or permanent?

TEMPORARY 1
SEASONAL 2
PERMANENT 3

714. CHECK 215/216/218: HAS A CHILD BORN SINCE JANUARY 1987 LIVING WITH HER?

YES____
NO ____ (GO TO 801)

715. While you work, do you usually have (NAME) with you, sometimes with you or never with you?

USUALLY 1 (GO TO 801)
SOMETIMES 2
NEVER 3

716. Who usually takes care of (NAME OF YOUNGEST CHILD IN HOUSEHOLD) while you are working?

HUSBAND/PARTNER 1
OLDER CHILD 2
OTHER RELATIVES 3
NEIGHBORS 4
FRIENDS 5
NANNY/HIRED PERSON 6
CHILD GOES TO SCHOOL 7
DAYCARE/KINDERGARTEN 8
OTHER (SPECIFY) _____ 9

SECTION 8. MATERNAL MORTALITY

801. Does one or more of your sisters (from the same mother) over the age of 14 live in this household?

YES ____ VERIFY WITH THE RESPONDENT WHICH ELIGIBLE WOMEN ON THE HOUSEHOLD QUESTIONNAIRE ARE HER SISTERS AND RECORD THEIR LINE NUMBERS HERE.

NO ____ (GO TO 802)

802. INDICATE: ONE OF THE RESPONDENT'S ELIGIBLE SISTERS WAS ALREADY INTERVIEWED ABOUT MATERNAL MORTALITY.

YES ____ WRITE THE LINE NUMBER OF THE SISTER THAT HAS ALREADY RESPONDED AND GO TO SECTION 9.

NO ____

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 including those that live with you, those that live elsewhere, and those that are deceased.

803. RECORD THE NAMES OF ALL BROTHERS AND SISTERS. IF NO BROTHERS OR SISTERS (GO TO 819)

[REPEAT QUESTIONS 804-815 FOR EACH SEPARATE BIRTH]

804. What was the name given to your oldest (next oldest) brother or sister?

______

805. Is (NAME) male or female?

MALE 1
FEMALE 2

806. Is (NAME) still alive?

YES 1
NO 2 (GO TO 809)
DOESN'T KNOW 8 (GO TO NEXT COLUMN)

807. How old is (NAME)?
IF LESS THAN 10 YEARS GO TO NEXT COLUMN

______

808. Is or was (NAME) married?

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

809. How many years ago did (NAME) die?

____

810. How old was (NAME) when he/she died? IF MALE, OR IF FEMALE AND DIED BEFORE 10 YEARS OF AGE, GO TO NEXT COLUMN.

____

811. Was (NAME) married?

YES 1
NO 2 GO TO NEXT COLUMN

812. Did (NAME) die during childbirth?

YES 1 (GO TO 815)
NO 2
DOESN'T KNOW 8

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

YES 1 (GO TO 815)
NO 2
DOESN'T KNOW 8

814. Was (NAME) pregnant when she died?

YES 1
NO 2
DOESN'T KNOW 8

815. How many children did (NAME) give birth to?

_____

GO TO NEXT COLUMN. IF NO MORE BROTHERS OR SISTERS, GO TO 816.

816. I would like to make sure I've understood. In total, your mother gave birth to ____ children, including you?

YES ______
NO ______ (VERIFY AND CORRECT)

817. Amongst your brothers, ____ have died?

YES ______
NO ______ (VERIFY AND CORRECT)

818. Amongst your sisters, ____ have died?

YES ______
NO ______ (VERIFY AND CORRECT)

819. RECORD THE TIME.

HOURS ___
MINUTES ___

SECTION 9. HEIGHT AND WEIGHT

901. CHECK 215, 216:

ONE OR MORE BIRTHS SINCE JANUARY 1986 ____
NO BIRTHS SINCE JANUARY 1986 ____ (DONE)

INTERVIEWER: IN 902 (COLUMNS 2-4) RECORD THE LINE NUMBER OF EACH LIVING CHILD BORN AFTER JANUARY 1986.

IN 903 AND 904 RECORD THE NAME AND DATE OF BIRTH OF RESPONDENT AND EACH LIVING CHILD BORN AFTER JANUARY 1986. IN 906 AND 908, RECORD THE HEIGHT AND WEIGHT OF THE RESPONDENT AND LIVING CHILDREN.
(NOTE: ALL RESPONDENTS WITH ONE OR MORE BIRTHS SINCE JANUARY 1986 MUST BE MEASURED AND WEIGHED, EVEN IF ALL OF THE CHILDREN ARE DECEASED.)

902. LINE NUMBER ACCORDING TO 212.

_____

903. NAME (ACCORDING TO 212 FOR CHILDREN)

_____

904. BIRTH DATE (FROM 103 FOR THE RESPONDENT; ACCORDING TO 215 FOR CHILDREN AND ASK FOR DATE OF BIRTH)

DAY ____
MONTH ____
YEAR ____

905. TB VACCINE SCAR ON THE TOP OF LEFT SHOULDER.

SCAR SEEN 1
SCAR NOT SEEN 2

906. HEIGHT (IN CENTIMETERS)

____

907. Were the children measured lying down or standing up?

LYING DOWN 1
STANDING UP 2

908. WEIGHT (IN KILOGRAMS)

______

909. DATE OF HEIGHT AND WEIGHT MEASUREMENT

DAY ____
MONTH ____
YEAR ____

910. RESULT:

CHILD MEASURED 1
CHILD SICK 2
CHILD ABSENT 3
CHILD REFUSED 4
MOTHER REFUSED 5
OTHER (SPECIFY) ____ 6

911. NAME OF OPERATOR: _________
NAME OF ASSISTANT: ___________

[NOTE: PAGES 220-221 ARE OMITTED FROM THIS TRANSLATION OF THE ORIGINAL DOCUMENT DUE TO LANGUAGE NOT BEING FRENCH.]