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MADAGASCAR DEMOGRAPHIC AND HEALTH SURVEY
WOMEN'S QUESTIONNAIRE 1997

IDENTIFICATION

PLACE NAME ____
NAME OF HOUSEHOLD HEAD ____
CLUSTER NUMBER ____
HOUSEHOLD UNIT NUMBER ____
REGION (FARITANY) ____

URBAN/RURAL ____

URBAN 1
RURAL 2

CITY/ADMINISTRATIVE CENTER ____

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

NAME AND LINE NO. OF FEMALE RESPONDENT ____

INTERVIEWER VISITS

INTERVIEW ONE (REPEAT FOR SECOND AND THIRD INTERVIEWS)
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 1997
INT. NUMBER ____
RESULT ____

TOTAL NUMBER OF VISITS _____

SUPERVISOR
NAME ______
DATE ______

FIELD EDITOR
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, in a rural setting, or out of the country?

CITY OF ANTANANARIVO 1
FARITANY ADMINISTRATIVE CENTER 2
FIVONDRONANA ADMINISTRATIVE CENTER 3
FIRAISANA ADMINISTRATIVE CENTER 4
RURAL 5
ABROAD 6

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, in a rural setting, or out of the country?

CITY OF ANTANANARIVO 1
FARITANY ADMINISTRATIVE CENTER 2
FIVONDRONANA ADMINISTRATIVE CENTER 3
FIRAISANA ADMINISTRATIVE CENTER 4
RURAL 5
ABROAD 6

105. In what month and year were you born?

MONTH ____
DOESN'T KNOW MONTH 98
YEAR ____
DOESN'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 114)

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

PRIMARY 1
MIDDLE SCHOOL 2
HIGH SCHOOL 3
HIGHER 4

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

GRADE ____

110. CHECK 106:

24 YEARS OR LESS OF AGE (GO TO 111)
25 OR MORE YEARS OF AGE (GO TO 113)

111. Do you currently attend school?

YES 1 (GO TO 113)
NO 2

112. What is the main reason you stopped going to school?

GOT PREGNANT 01
GOT MARRIED 02
TO WATCH YOUNGER CHILDREN 03
FAMILY NEEDED HELP IN FIELDS/AT WORK 04
COULD NOT PAY FEES 05
NEEDED TO EARN MONEY 06
SUFFICIENTLY SCHOOLED 07
FAILED AT SCHOOL 08
NO LONGER LIKED SCHOOL 09
SCHOOL INACCESSIBLE/TOO FAR 10
OTHER (SPECIFY) ______ 96
DOESN'T KNOW 98

113. CHECK 108:

PRIMARY (GO TO 114)
SECONDARY OR HIGHER (GO TO 115)

114. 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 116)

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

YES 1
NO 2

116. Do you listen to the radio at least once a day?

YES 1
NO 2

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

YES 1
NO 2

118. What is your religion?

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

120. CHECK Q.4 IN THE HOUSEHOLD QUESTIONNAIRE:

RESPONDENT IS NOT USUAL RESIDENT (GO TO 120)
RESPONDENT IS USUAL RESIDENT (GO TO 201)

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

121. What is the name of your usual place of residence?

NAME OF PLACE OF RESIDENCE _________
CITY OF ANTANANARIVO 1
FARITANY ADMINISTRATIVE CENTER 2
FIVONDRONANA ADMINISTRATIVE CENTER 3
FIRAISANA ADMINISTRATIVE CENTER 4
RURAL 5
ABROAD 6 (GO TO 123)

122. In which Faritany is it? (The usual place)

ANTANANARIVO 1
FIANARANTSOA 2
TOAMASINA 3
MAHAJANGA 4
TOLIARY 5
ANSIRANANA 6

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

123. What is the main source of drinking water for members of your household?

PIPED WATER
PIPED INTO DWELLING/YARD/PLOT 11 (GO TO 125)
PIPED TO EXTERIOR 12
PUBLIC TAP/STANDPIPE 13
WELL IN THE YARD/PLOT
EQUIPPED WITH PUMP 21 (GO TO 125)
NOT EQUIPPED WITH PUMP 22 (GO TO 125)
DRAIN WELL 23 (GO TO 125)
WELL OUTSIDE THE YARD/PLOT
EQUIPPED WITH PUMP 24
NOT EQUIPPED WITH PUMP 25
DRAIN WELL 26
SURFACE WATER
SPRING 31
RIVER 32
POND/LAKE/DAM 33
RAINWATER 41 (GO TO 125)
TANKER TRUCK 51
BOTTLED WATER 61 (GO TO 125)
OTHER (SPECIFY) _____________ 96

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

MINUTES ______
ON SITE 996

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

FLUSH TOILET 11
LATRINE 22
PAIL 23
NO TOILET/OUTSIDE 31 (GO TO 19)
OTHER (SPECIFY) ________ 96 (GO TO 19)

125A. Is the toilet facility only used by your household or do you share it with other households?

PRIVATE USE 1
SHARED USE 2

126. 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

127. Can you describe the floor of your house?

NATURAL FLOOR
EARTH/SAND 11
DUNG 12
RUDIMENTARY FLOOR
WOOD PLANKS 21
PALM/BAMBOO/MAT 22
FINISHED FLOOR
PARQUET OR POLISHED WOOD 31
VINYL OR ASPHALT STRIPS 32
CERAMIC TILES 33
CEMENT 34
CARPET 35
OTHER (SPECIFY) __________ 96

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

Now I would like to ask about all the births you have had during your life.

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

210. CHECK 208:

ONE OR MORE BIRTHS (GO TO 211)
NO BIRTHS (GO TO 227)

Now I would like to record the names of all 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.

[REPEAT 212-221 FOR EACH SEPARATE BIRTH]

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 219)

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
NO 2
GO TO NEXT BIRTH.

219. 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 _____

220. SUBTRACT THE BIRTH YEAR OF (NAME) FROM THE YEAR OF THE PREVIOUS BIRTH. IS THE DIFFERENCE FOUR OR MORE YEARS?
[NOTE: ONLY FOR BIRTHS 2 AND AFTER.]

YES 1
NO 2 (GO TO NEXT BIRTH)

221. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?
[ONLY FOR BIRTHS 2 AND AFTER]

YES 1
NO 2

[GO BACK AND REPEAT 212-221 FOR EACH ADDITIONAL BIRTH]

222. SUBTRACT THE BIRTH YEAR OF THE LAST CHILD FROM THE YEAR OF THE INTERVIEW. IS THE DIFFERENCE FOUR OR MORE YEARS?

YES 1 (GO TO 223)
NO 2 (GO TO 224)

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

YES 1
NO 2

224. COMPARE 208 WITH NUMBER OF BIRTHS REGISTERED IN TABLE ABOVE AND MARK:

NUMBERS ARE SAME (GO TO 'CHECK')
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)
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. ____

225. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1994.
IF NONE, RECORD '00'.

NUMBER OF BIRTHS ____

227. Are you pregnant now?

YES 1
NO 2 (GO TO 236)
UNSURE 8 (GO TO 236)

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

MONTHS ____

229. 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

230. Do you have difficulty seeing at nightfall?

YES 1
NO 2 (GO TO 236)

231. Do you have difficulty seeing during the day as well?

YES 1
NO 2

232. Did you have difficulty seeing at nightfall when you weren't pregnant?

YES 1
NO 2

236. When did your last menstrual period start?
RECORD THE DATE IF IT IS GIVEN.

DATE _____
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

237. 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 239)
DOESN'T KNOW 8 (GO TO 239)

238. At what point in her menstrual cycle is a woman most likely to become pregnant?

DURING HER PERIOD 01
RIGHT AFTER HER PERIOD HAS ENDED 02
MIDDLE OF HER CYCLE 03
JUST BEFORE HER PERIOD BEGINS 04
OTHER (SPECIFY) __________ 96
DOESN'T KNOW 98

239. Have you ever had an intentional abortion?

YES 1
NO 2 (GO TO 301)

240. The last time that you had an intentional abortion, did you suffer any after-effects to your health following the procedure?

YES 1
NO 2 (GO TO 301)

241. Were you obligated to ask a doctor or nurse for help because of these after-effects?

YES 1
NO 2

SECTION 3. CONTRACEPTION

Now I would like to talk about family planning and the various ways or methods that a couple can use to delay or avoid a pregnancy.

CIRCLE CODE 1 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 301 OR 302, ASK 303.

301. What are the ways or methods that have you heard about?
302. Have you ever heard of (METHOD)?

01. PILL Women can take a pill every day to avoid becoming pregnant.
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 one or more months.
YES SPONTANEOUSLY 1
YES DESCRIPTION 2
NO 3
04. IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES SPONTANEOUSLY 1
YES DESCRIPTION 2
NO 3
05. DIAPHRAGM, FOAM OR GEL Women can place a diaphragm, gel or foam inside their vagina before sexual intercourse.
YES SPONTANEOUSLY 1
YES DESCRIPTION 2
NO 3
06. CONDOM Men can put a rubber or latex sheath on their penis before sexual intercourse.
YES SPONTANEOUSLY 1
YES DESCRIPTION 2
NO 3
07. FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES SPONTANEOUSLY 1
YES DESCRIPTION 2
NO 3
08. MALE STERILIZATION Men can have an operation to avoid having any more children.
YES SPONTANEOUSLY 1
YES DESCRIPTION 2
NO 3
09. RHYTHM METHOD 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
10. WITHDRAWAL Men can be careful and pull out before climax.
YES SPONTANEOUSLY 1
YES DESCRIPTION 2
NO 3
11. Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
(SPECIFY) ________
YES 1
NO 2

303. Have you ever used (METHOD)?

01. PILL Women can take a pill every day to avoid becoming pregnant.
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 one or more months.
YES 1
NO 2
04. IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
05. DIAPHRAGM, FOAM OR GEL Women can place a diaphragm, gel or foam inside their vagina before sexual intercourse.
YES 1
NO 2
06. CONDOM Men can put a rubber or latex sheath on their penis before sexual intercourse.
YES 1
NO 2
07. 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
08. MALE STERILIZATION Men can have an operation to avoid having any more children. Have you ever had a partner who has an operation to avoid having any more children?
YES 1
NO 2
09. RHYTHM METHOD 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
10. WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
11. OTHER METHOD (SPECIFY) ____
YES 1
NO 2

304. CHECK 303:

NOT A SINGLE "YES" (NEVER USED)
AT LEAST ONE "YES" (EVER USED) (GO TO 309)

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

YES 1
NO 2 (GO TO 331)

307. What have you used or done?
CORRECT 303 AND 304 (AND 302 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.

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

NUMBER OF CHILDREN ____

309A. In what month and what year did you first use a contraceptive method to avoid getting pregnant?

MONTH ____
YEAR ____

310. The first time you used family planning, was it because you wanted another child, but not until later, or was it because you didn't want any more children at all?

WANTED CHILD LATER 1
DIDN'T WANT CHILD AT ALL 2
OTHER (SPECIFY) _____ 6

311. CHECK 303:

WOMAN NOT STERILIZED (GO TO 312)
WOMAN STERILIZED (GO TO 314A)

312. CHECK 227:

NOT PREGNANT OR UNSURE (GO TO 313)
PREGNANT (GO TO 332)

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

YES 1
NO 2 (GO TO 331)

314. Which method are you currently using?

PILL 01
IUD 02 (GO TO 326)
INJECTABLES 03 (GO TO 326)
IMPLANTS 04 (GO TO 326)
DIAPHRAGM/FOAM/JELLY 05 (GO TO 326)
CONDOM 06 (GO TO 326)
FEMALE STERILIZATION 07 (GO TO 318)
MALE STERILIZATION 08 (GO TO 318)
RHYTHM METHOD 09 (GO TO 323)
WITHDRAWAL 10 (GO TO 326)
OTHER (SPECIFY) _______ 96 (GO TO 326)

314A. CIRCLE '07' FOR FEMALE STERILIZATION.

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

PACKAGE SEEN 1
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 one box (cycle) of pills cost you?
RECORD IN 1000 MADAGASCAR FRANCS.

COST ______ (GO TO 326)
FREE 996 (GO TO 326)
DOESN'T KNOW 998 (GO TO 326)

317A. How many packets are in a box?

ONE 1
THREE 2
DOESN'T KNOW 8

318. Where did the sterilization take place?

IF IT IS A PUBLIC HOSPITAL OR A PRIVATE HOSPITAL OR CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE __________
PUBLIC SECTOR
HOSPITAL 11
HEALTH CENTER 12
DISPENSARY 13
MEDICAL POST 14
OTHER PUBLIC (SPECIFY) ______ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR 23
OTHER PRIVATE MEDICAL (SPECIFY) ______ 26
OTHER (SPECIFY) ________ 96
DOESN'T KNOW 98

319. Do you (or your husband) regret having an operation in order to have no more children?

YES 1
NO 2 (GO TO 321)

320. Why do you (does he) regret the operation?

RESPONDENT WANTS ANOTHER CHILD 01
HUSBAND/PARTNER WANTS ANOTHER CHILD 02
SIDE EFFECTS 03
CHILD DIED 04
OTHER (SPECIFY) ______ 96

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

MONTH _____ (GO TO 333A)
YEAR _______ (GO TO 333A)
DOESN'T KNOW YEAR 9998 (GO TO 333A)

323. How do you determine which days in your menstrual cycle you should not have sexual intercourse?

BASED ON CALENDAR 01
BASED ON BODY TEMPERATURE (OGINO METHOD) 02
BASED ON CERVICAL MUCUS (BILLINGS METHOD) 03
BASED ON BODY TEMP AND CERVICAL MUCUS 04
NO SPECIFIC SYSTEM 05
OTHER (SPECIFY) ______ 96

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

MONTHS ____
8 YEARS OR MORE 96

327. CHECK 314: CIRCLE THE CODE OF THE METHOD USED.

PILL 01
IUD 02
INJECTABLES 03
IMPLANTS 04
DIAPHRAGM/FOAM/JELLY 05
CONDOM 06
FEMALE STERILIZATION 07 (GO TO 329A)
MALE STERILIZATION 08 (GO TO 329A)
RHYTHM METHOD 09 (GO TO 332)
WITHDRAWAL 10 (GO TO 332)
OTHER 96 (GO TO 332)

328. Where did you last obtain (METHOD)?

IF IT IS A PUBLIC HOSPITAL OR A PRIVATE HOSPITAL OR CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE ___________
PUBLIC SECTOR
HOSPITAL 11
HEALTH CENTER 12
DISPENSARY 13
MEDICAL POST 14
OTHER PUBLIC (SPECIFY) ______ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
DOCTOR 23
PF/FISA CENTER 24
OTHER PRIVATE (SPECIFY) ______ 26
OTHER SOURCE
STORE 31
RELIGIOUS CENTER 32
RELATIVES 33
FRIENDS 34
OTHER (SPECIFY) ______ 36

329. Do you know of another place you could have gone last time to procure (METHOD)?

YES 1
NO 2 (GO TO 333A)

329A. At the time of your sterilization, did you know of another place where you could have had the same operation?

YES 1
NO 2 (GO TO 333A)

330. People choose where they go for family planning services for different reasons. What is the main reason why you went to (NAME OF PLACE IN 328 OR 318) rather than the other place you know of?

RECORD THE RESPONSE AND CIRCLE THE CODE.

ACCESSIBILITY
CLOSE TO HOME 11 (GO TO 333A)
CLOSE TO MARKET/WORK 12 (GO TO 333A)
TRANSPORTATION AVAILABLE 13 (GO TO 333A)
SERVICE-RELATED REASONS
STAFF MORE COMPETENT/LIKEABLE 21 (GO TO 333A)
CLEANER 22 (GO TO 333A)
MORE PRIVACY 23 (GO TO 333A)
SHORTER WAIT 24 (GO TO 333A)
OPEN LONGER HOURS 25 (GO TO 333A)
USES OTHER SERVICES IN THE SAME ESTABLISHMENT 26 (GO TO 333A)
COSTS LESS 31 (GO TO 333A)
WANTS ANONYMITY 41 (GO TO 333A)
OTHER (SPECIFY) _______ 96 (GO TO 333A)
DOESN'T KNOW 98 (GO TO 333A)

331. What is the main reason that you are not currently using a contraceptive method?

NOT MARRIED 11
FERTILITY-RELATED REASONS
NOT HAVING SEX 21
INFREQUENT SEX 22
MENOPAUSAL/HYSTERECTOMY 23
SUBFECOND/INFECUND 24
POSTPARTUM/BREASTFEEDING 25
WANTS (OTHER) CHILDREN 26
PREGNANT 27
OPPOSITION TO USE
RESPONDENT OPPOSED 31
HUSBAND/PARTNER OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
LACK OF KNOWLEDGE
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COSTS TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY) ______ 96
DOESN'T KNOW 98

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

YES 1
NO 2 (GO TO 334)

333. Where is it?

IF IT IS A PUBLIC HOSPITAL OR A PRIVATE HOSPITAL OR CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE __________
PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER B
DISPENSARY C
MEDICAL POST D
OTHER PUBLIC (SPECIFY) ______ X
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY F
DOCTOR G
PF/FISA CENTER H
OTHER PRIVATE (SPECIFY) ______ Y
OTHER SOURCE
STORE I
RELIGIOUS CENTER J
RELATIVES K
FRIENDS L
OTHER (SPECIFY) _______ Z

333A. CHECK 302 (06):

YES, SHE HAS HEARD OF CONDOMS ____
NO, SHE HAS NEVER HEARD OF CONDOMS ____ (GO TO 334)

333B. What brands of condoms do you know?

PROTECTOR A (GO TO 333D)
PANTHER B
PROFILTEX C
SULTAN D
STIMULEV E
COREEN (VIOLETTE) F
OTHER (SPECIFY) _____ X
DOESN'T KNOW Y

333C. Have you ever heard of the brand of condom called Protector?

YES 1
NO 2 (GO TO 334)

333D.Where have you heard of this brand?

RADIO A
TELEVISION B
POSTERS C
PACKAGES FOR SALE D
RELATIVES E
FRIENDS F
OTHER (SPECIFY) _____ X

334. In the last 12 months, were you visited by a family planning agent?

YES 1
NO 2

335. In the last 12 months, have you visited a health facility for any reason?

YES 1
NO 2 (GO TO 337)

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

YES 1
NO 2

337. Do you think that breastfeeding can influence a women's ability to become pregnant?

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

338. Do you think that breastfeeding increases or decreases a woman's chance of becoming pregnant?

INCREASES 1 (GO TO 401)
DECREASES 2
IT DEPENDS 3
DOESN'T KNOW 8

339. CHECK 210:

AT LEAST ONE BIRTH
NO BIRTHS (GO TO 401)

340. Have you previously relied on breastfeeding as a way to avoid becoming pregnant?

YES 1
NO 2 (GO TO 401)

341. CHECK 227 AND 311:

NOT PREGNANT OR NOT SURE AND NOT STERILIZED
PREGNANT OR STERILIZED (GO TO 401)

342. Are you currently relying on breastfeeding in order to avoid getting pregnant?

YES 1
NO 2

SECTION 4A. PREGNANCY AND BREASTFEEDING

401. CHECK 225:

AT LEAST ONE BIRTH SINCE JANUARY 1994
NO BIRTHS SINCE JANUARY 1994 (GO TO 465)

402. ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS FOR EACH BIRTH SINCE JANUARY 1994 IN THE REPRODUCTION TABLE. ASK THE QUESTIONS FOR ALL BIRTHS BEGINNING WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES.)

[403-439 ARE REPEATED FOR EACH BIRTH, BEGINNING WITH THE MOST RECENT BIRTH. IF MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES.]

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

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 any (more) children at all?

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

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

MONTHS 1 ____
YEARS 2 ____
DOESN'T KNOW 998

407. Did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

HEALTH PERSONNEL
DOCTOR A
NURSE B
MIDWIFE C
OTHER PERSON
TRADITIONAL BIRTH ASSISTANT C
OTHER (SPECIFY) ___________ X
NO ONE Y (GO TO 410)

408. How many months pregnant were you when you first received antenatal care for this pregnancy?

MONTHS ____
DOESN'T KNOW 98

409. How many times did you receive antenatal care during this pregnancy?

NUMBER OF TIMES _____
DOESN'T KNOW 98

410. 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 412)
DOESN'T KNOW 8 (GO TO 412)

411. During this pregnancy, how many times did you get this tetanus injection?

NUMBER OF TIMES _____
DOESN'T KNOW 8

412. 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
OTHER PUBLIC (SPECIFY) ______ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL (SPECIFY) ______ 36
OTHER (SPECIFY) _______ 96

413. 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
TRADITIONAL BIRTH ASSISTANT D
RELATIVE/FRIEND E
OTHER (SPECIFY) _______ X
NO ONE Y

414. When (NAME) was born, did you have any of the following problems:

A long labor, that is, regular contractions that lasted more than 12 hours?
YES 1
NO 2
So much blood loss that you thought your life was in danger?
YES 1
NO 2
A high fever accompanied by bad-smelling vaginal discharge?
YES 1
NO 2
Convulsions not caused by fever?
YES 1
NO 2

415. Was (NAME) delivered by caesarean section?

YES 1
NO 2

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

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

417. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 419)

418. How much did (NAME) weigh?
RECORD WEIGHT FROM HEALTH CARD, IF AVAILABLE.

GRAMS FROM CARD 1 __________
GRAMS FROM MEMORY 2 __________
DOESN'T KNOW 99998

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

YES 1 (GO TO 421)
NO 2 (GO TO 422)

420. 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 424)

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

MONTHS ____
DOESN'T KNOW 98

422. CHECK 227:
IS RESPONDENT PREGNANT?
[ONLY ASK FOR MOST RECENT BIRTH]

NOT PREGNANT
PREGNANT OR UNSURE (GO TO 424)

423. 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 425)

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

MONTHS ____
DOESN'T KNOW 998

425. Did you breastfeed (NAME)?

YES 1
NO 2 (GO TO 431)

426. 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 _____

427. CHECK 404:
CHILD LIVING?

LIVING
DECEASED (GO TO 429)

428. Are you still breastfeeding (NAME)?

YES 1 (GO TO 432)
NO 2

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

MONTHS ____
DOESN'T KNOW 98

430. Why did you stop breastfeeding (NAME)?

MOTHER SICK/WEAK 01
CHILD SICK/WEAK 02
CHILD DIED 03
PROBLEMS WITH BREASTS 04
INSUFFICIENT MILK 05
MOTHER WORKS 06
CHILD REFUSED 07
WEANING AGE 08
BECAME PREGNANT 09
BEGAN USING CONTRACEPTION 10
OTHER (SPECIFY) ______ 96

431. CHECK 404:
CHILD LIVING?

LIVING (GO TO 434)
DECEASED (GO TO 405 IN THE NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 440)

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

NUMBER OF NIGHTTIME FEEDINGS _____

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

NUMBER OF DAYTIME FEEDINGS _____

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

YES 1
NO 2
DOESN'T KNOW 8

435. Did (NAME) receive, at any moment yesterday or last night, any of the following:

Water?
YES 1
NO 2
DOESN'T KNOW 8
Sugar water?
YES 1
NO 2
DOESN'T KNOW 8
Juice?
YES 1
NO 2
DOESN'T KNOW 8
Herbal tea?
YES 1
NO 2
DOESN'T KNOW 8
Baby formula?
YES 1
NO 2
DOESN'T KNOW 8
Powdered or boxed milk?
YES 1
NO 2
DOESN'T KNOW 8
Fresh milk?
YES 1
NO 2
DOESN'T KNOW 8
Any other liquid?
YES 1
NO 2
DOESN'T KNOW 8
Rice- or wheat-based food?
YES 1
NO 2
DOESN'T KNOW 8
Cassava-based food?
YES 1
NO 2
DOESN'T KNOW 8
Leafy greens?
YES 1
NO 2
DOESN'T KNOW 8
Orange/yellow fruits or vegetables?
YES 1
NO 2
DOESN'T KNOW 8
Eggs, fish or poultry?
YES 1
NO 2
DOESN'T KNOW 8
Meat?
YES 1
NO 2
DOESN'T KNOW 8
Other solid or semi-solid foods?
YES 1
NO 2
DOESN'T KNOW 8

435A. Was oil or grease used in the preparation of one of (NAME'S) meals yesterday or last night?

YES 1
NO 2
DOESN'T KNOW 8

436. CHECK 435: FOOD OR LIQUID GIVEN YESTERDAY

"YES" FOR ONE OR MORE
"NO/DOESN'T KNOW" FOR ALL (GO TO 438)

437. Besides breast milk, how many times did (NAME) eat yesterday, including meals and snacks?
IF 7 TIMES OR MORE, RECORD '7'.

NUMBER OF TIMES ____
DOESN'T KNOW 8

438. How many days out of the last 7 days did (NAME) receive one of the following liquids or foods?
RECORD THE NUMBER OF DAYS.

Water?
DAYS ___
DOESN'T KNOW 8
Milk (other than breast milk)?
DAYS ___
DOESN'T KNOW 8
Liquids other than milk and water?
DAYS ___
DOESN'T KNOW 8
Rice-based foods?
DAYS ___
DOESN'T KNOW 8
Cassava-based foods?
DAYS ___
DOESN'T KNOW 8
Leafy greens?
DAYS ___
DOESN'T KNOW 8
Orange/yellow fruits or vegetables?
DAYS ___
DOESN'T KNOW 8
Eggs, fish, or poultry?
DAYS ___
DOESN'T KNOW 8
Meat?
DAYS ___
DOESN'T KNOW 8
Other solid or semi-solid foods?
DAYS ___
DOESN'T KNOW 8

439. RETURN TO 405 IN THE NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 440.

SECTION 4B. VACCINATION AND HEALTH

440. WRITE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1994 RECORDED IN THE REPRODUCTION TABLE. ASK THE QUESTIONS FOR EACH BIRTH STARTING WITH THE MOST RECENT. (IF THERE ARE MORE THAN 2 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE.)

[441-465 ARE REPEATED FOR EACH BIRTH, BEGINNING WITH THE MOST RECENT BIRTH. IF MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES.]

441. LINE NUMBER FROM 212.

LINE NUMBER ____

442. FROM 212 AND 216:

NAME ________
LIVING ____
DEAD ____ (GO TO 442 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 465)

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

YES, SEEN 1 (GO TO 445)
YES, NOT SEEN 3 (GO TO 447)
NO CARD 4

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

YES 1 (GO TO 447)
NO 2 (GO TO 447)

445. (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 ____

446. 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) (GO TO 449)
NO 2 (GO TO 449)
DOESN'T KNOW 8 (GO TO 449)

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

YES 1
NO 2 (GO TO 449)
DOESN'T KNOW 8 (GO TO 449)

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

448A. A BCG vaccination against tuberculosis, that is, an injection in the left arm or shoulder that causes a scar?

YES 1
NO 2
DOESN'T KNOW 8

448B. Polio vaccine, that is, drops in the mouth?

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

448C. How many times?

NUMBER OF TIMES _______

448D. When was the first polio vaccine received, just after birth or later?

JUST AFTER BIRTH 1
LATER 2

448E. A DPT vaccination, that is, an injection given at the same time as polio drops?

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

448F. How many times was a DPT vaccination received?

NUMBER OF TIMES ____

448G. A measles injection?

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2 (GO TO 453A)
DOESN'T KNOW 8 (GO TO 453A)

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2 (GO TO 453A)

453. 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
OTHER PUBLIC (SPECIFY) ________ E
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
DOCTOR I
OTHER PRIVATE MEDICAL (SPECIFY) ________ L
OTHER LOCATION
STORE M
TRADITIONAL HEALER N
OTHER (SPECIFY) __________ X

453A. Does (NAME) have difficulty seeing at nightfall?

YES 1
NO 2 (GO TO 453C)
DOESN'T KNOW 8 (GO TO 453C)

453B. Does (NAME) have difficulty seeing during the day as well?

YES 1
NO 2
DOESN'T KNOW 8

453C. Has (NAME) ever received a vitamin A dose like this one?
SHOW VITAMIN A PILL.

YES 1
NO 2 (GO TO 454)
DOESN'T KNOW 8 (GO TO 454)

453D. How long has it been since the last time (NAME) received a vitamin A pill?

MONTHS ____

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

YES 1
NO 2 (GO TO 464)
DOESN'T KNOW 8 (GO TO 464)

455. Was there blood in the stool?

YES 1
NO 2
DOESN'T KNOW 8

456. The worst day of the diarrhea, how many stools did he/she have?

NUMBER OF STOOLS ____
DOESN'T KNOW 98

457. Did (NAME) receive about the same amount of liquid as before the diarrhea?

SAME 1
MORE 2
LESS 3
DOESN'T KNOW 8

458. Did (NAME) receive about the same amount of food as before the diarrhea?

SAME 1
MORE 2
LESS 3
DOESN'T KNOW 8

458A. CHECK 427:

STILL BREASTFED
NO LONGER BREASTFED (GO TO 459)

458B. Did you breastfeed about the same number of times as before the diarrhea?

SAME 1
MORE 2
LESS 3

459. When (NAME) had diarrhea, was he/she given one of the following things to drink:

A liquid prepared from a special packet called ORS/ODIVA?
YES 1
NO 2
DOESN'T KNOW 8
A light broth made from [RICE OR OTHER GRAIN, TUBER, PLANTAIN]?
YES 1
NO 2
DOESN'T KNOW 8
Soup?
YES 1
NO 2
DOESN'T KNOW 8
Homemade water-salt-sugar solution (SSS)?
YES 1
NO 2
DOESN'T KNOW 8
Carbonated beverage other than Coca-cola?
YES 1
NO 2
DOESN'T KNOW 8
Milk or baby formula?
YES 1
NO 2
DOESN'T KNOW 8
Coca-cola?
YES 1
NO 2
DOESN'T KNOW 8
Water?
YES 1
NO 2
DOESN'T KNOW 8
Any other liquid?
YES 1
NO 2
DOESN'T KNOW 8

460. Was anything (else) given to (NAME) to treat the diarrhea?

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

461. What (else) was given to treat the diarrhea?
Anything else?
RECORD ALL TREATMENTS GIVEN.

RECOMMENDED HOUSE LIQUID (SSS) A
PILL OR SYRUP B
INJECTION C
(IV) INTRAVENOUS D
HOME REMEDY/HERBAL/TRADITIONAL MEDICINE E
OTHER (SPECIFY) ________ X

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

YES 1
NO 2 (GO TO 464)

463. 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
OTHER PUBLIC (SPECIFY) ________ E
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
DOCTOR I
OTHER PRIVATE MEDICAL (SPECIFY) ________ L
OTHER LOCATION
STORE M
TRADITIONAL HEALER N
OTHER (SPECIFY) __________ X

464. RETURN TO 442 IN THE NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 465.

465. When a child has diarrhea, should he/she be given less than usual to drink, about the same amount as usual, or more than usual?

LESS TO DRINK 1
ABOUT THE SAME 2
MORE TO DRINK 3
DOESN'T KNOW 8

466. When a child has diarrhea, should he/she be given less than usual to eat, about the same amount as usual, or more than usual?

LESS TO EAT 1
ABOUT THE SAME 2
MORE TO EAT 3
DOESN'T KNOW 8

467. When a child suffers from diarrhea, what are the signs/symptoms that let you know he/she should be brought to a health center or a health care professional?
RECORD ALL MENTIONED.

REPEATED LIQUID STOOLS A
LIQUID STOOLS B
REPEATED VOMITING C
VOMITING D
BLOOD IN STOOL E
FEVER F
PRONOUNCED THIRST G
DOESN'T EAT/DRINK WELL H
BECOMES MORE SICK/VERY SICK I
DOESN'T GET BETTER J
OTHER (SPECIFY) ______ X
DOESN'T KNOW Z

468. When a child suffers from a cough, what are the signs/symptoms that let you know he/she should be brought to a health center or a health care professional?
RECORD ALL MENTIONED.

RAPID BREATHING A
DIFFICULTY BREATHING B
NOISY BREATHING C
FEVER D
UNABLE TO DRINK E
DOESN'T EAT/DRINK WELL H
BECOMES MORE SICK/VERY SICK I
DOESN'T GET BETTER J
OTHER (SPECIFY) ______ X
DOESN'T KNOW Z

469. CHECK 459, ALL COLUMNS:

NO CHILD RECEIVED ORS PACKET ____
ANY CHILD RECEIVED ORS PACKET ____ (GO TO 501)

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

YES 1
NO 2

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

501. PRESENCE OF OTHERS AT THIS POINT:

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

502. Are you currently married or living with a man as if married?

YES, CURRENTLY MARRIED 1 (GO TO 507)
YES, LIVING WITH A MAN 2 (GO TO 507)
NO, NOT IN UNION 3

503. Do you currently have a regular sexual partner, an occasional sexual partner, or no sexual partner at all?

REGULAR SEXUAL PARTNER 1
OCCASIONAL SEXUAL PARTNER 2
NO SEXUAL PARTNER 3

504. Have you ever been married or lived with a man as if married?

YES, FORMERLY MARRIED 1
YES, LIVED WITH A MAN 2 (GO TO 511)
NO 3 (GO TO 515)

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

WIDOWED 1 (GO TO 511)
DIVORCED 2 (GO TO 511)
SEPARATED 3 (GO TO 511)

507. Is your husband/partner living with you now or is he staying elsewhere?

LIVING WITH HER 1
STAYING ELSEWHERE 2

508. Does your husband/partner have any wives or partners other than you?

YES 1
NO 2 (GO TO 511)

509. How many other wives or partners does your husband have?

NUMBER ______
DOESN'T KNOW 98 (GO TO 511)

510. Are you the first, second, ... wife?

RANK _____

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

ONLY ONCE 1
MORE THAN ONCE 2

512. CHECK 511:

MARRIED/LIVED WITH A MAN ONLY ONCE In what month and year did you start living with your husband/partner?

MARRIED/LIVED WITH A MAN MORE THAN ONCE Now we are going to talk about your first husband/partner. In what month and year did you start living with him?

MONTH ____
DOESN'T KNOW MONTH 98
YEAR ____ (GO TO 515)
DOESN'T KNOW YEAR 9998

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

AGE ____

Now I would like to ask you some questions about your sexual activity in order to gain a better understanding of certain problems related to family planning.

515. How long has it been since the last time you had sexual intercourse (if you've ever had it)?

NEVER 00 (GO TO 608)
DAYS AGO 1 ______
WEEKS AGO 2 _______
MONTHS AGO 3 _______
YEARS AGO 4 ______
BEFORE LAST BIRTH 996

516. CHECK 301 AND 302:

YES, SHE HAS HEARD OF CONDOMS. Did you use a condom during your last sexual encounter?

NO, SHE HAS NEVER HEARD OF CONDOMS. Certain men use a condom, that is, they put a rubber sheath on their penis before having sexual intercourse. Did you use a condom during your last sexual encounter?

YES 1
NO 2 (GO TO 517)
DOESN'T KNOW 8 (GO TO 517)

516A. Do you know the brand of condom your partner used the last time you had sexual intercourse? IF YES: Which one was it?

PROTECTOR 1
PANTHER 2
PROFILTEX 3
SULTAN 4
STIMULEV 5
COREEN (VIOLETTE) 6
OTHER (SPECIFY) _____ 7
DOESN'T KNOW 8

517. Do you know of a place where you can get condoms?

YES 1
NO 2 (GO TO 519)

518. Where is that?

IF IT IS A PUBLIC HOSPITAL OR A PRIVATE HOSPITAL OR CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE _______________
PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER B
DISPENSARY C
OTHER PUBLIC (SPECIFY) __________ X
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY F
DOCTOR G
PF/FISA CENTER H
OTHER PRIVATE (SPECIFY) ______ Y
OTHER SOURCE
STORE I
RELIGIOUS CENTER J
RELATIVES K
FRIENDS L
OTHER (SPECIFY) ____________ Z

519. What age were you when you had your first sexual encounter?

AGE ____
FIRST TIME WHILE MARRIED 96

520. CHECK 515:

LESS THAN 12 MONTHS SINCE LAST HAD SEXUAL INTERCOURSE ____
12 MONTHS OR MORE SINCE LAST HAD SEXUAL INTERCOURSE ____ (GO TO 601)

521. With how many different people have you had sexual intercourse in the last 12 months?

NUMBER OF PARTNERS _____
DOESN'T KNOW 96

SECTION 6. FERTILITY PREFERENCES

601. CHECK 314:

NEITHER HE NOR SHE STERILIZED
HE OR SHE STERILIZED (GO TO 612)

602. CHECK 227:

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 604)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 606)
UNDECIDED/DOESN'T KNOW 8 (GO TO 604)

603. CHECK 227:

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 606)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 606)
AFTER MARRIAGE 995 (GO TO 606)
OTHER (SPECIFY) _______ 996
DOESN'T KNOW 998

604. CHECK 227:

NOT PREGNANT OR UNSURE
PREGNANT (GO TO 607)

605. If you were to become pregnant in the next several weeks, would you be happy, not happy, or indifferent?

HAPPY 1
NOT HAPPY 2
INDIFFERENT 3

606. CHECK 313:
USING A METHOD?

NOT ASKED
NOT CURRENTLY USING
CURRENTLY USING (GO TO 612)

607. Do you think you will use a contraceptive method to delay or avoid pregnancy at any time in the next 12 months?

YES 1 (GO TO 609)
NO 2
DOESN'T KNOW 8

608. 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 610)
DOESN'T KNOW 8 (GO TO 610)

609. Which contraceptive method would you prefer to use?

PILL 01 (GO TO 612)
IUD 02 (GO TO 612)
INJECTABLES 03 (GO TO 612)
IMPLANTS 04 (GO TO 612)
DIAPHRAGM/FOAM/JELLY 05 (GO TO 612)
CONDOM 06 (GO TO 612)
FEMALE STERILIZATION 07 (GO TO 612)
MALE STERILIZATION 08 (GO TO 612)
RHYTHM METHOD 09 (GO TO 612)
WITHDRAWAL 10 (GO TO 612)
OTHER (SPECIFY) ____ 96 (GO TO 612)
DOESN'T KNOW 98

610. What is the main reason that you think you will never use a contraceptive method?

NOT MARRIED 11
FERTILITY-RELATED REASONS
NOT HAVING SEXUAL RELATIONS 21 (GO TO 612)
INFREQUENT SEX/NO SEX 22 (GO TO 612)
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 612)
SUBFECOND/INFECUND 24 (GO TO 612)
POSTPARTUM CARE/BREASTFEEDING 25 (GO TO 612)
WANT (OTHER) CHILDREN 26 (GO TO 612)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 612)
HUSBAND/PARTNER OPPOSED 32 (GO TO 612)
OTHERS OPPOSED 33 (GO TO 612)
RELIGIOUS PROHIBITION 34 (GO TO 612)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 612)
KNOWS NO SOURCE 42 (GO TO 612)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 612)
FEAR OF SIDE EFFECTS 52 (GO TO 612)
LACK OF ACCESS/TOO FAR 53 (GO TO 612)
COSTS TOO MUCH 54 (GO TO 612)
INCONVENIENT TO USE 55 (GO TO 612)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 612)
OTHER (SPECIFY) ______ 96 (GO TO 612)
DOESN'T KNOW 98 (GO TO 612)

611. Would you ever use a contraceptive method if you were married?

YES 1
NO 2
DOESN'T KNOW 8

612. 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?
PROBE FOR A NUMERIC RESPONSE.

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 614)

613. How many of these children would you like to be boys, how many would you like to be girls and for how many would the sex not matter?

BOYS ____
OTHER (SPECIFY) ______ 96
GIRLS ____
OTHER (SPECIFY) ______ 96
EITHER ____
OTHER (SPECIFY) ______ 96

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

APPROVE 1
DISAPPROVE 2
NO OPINION 3

615. In your opinion, is it appropriate or inappropriate to speak of family planning:

On the radio?
APPROPRIATE 1
INAPPROPRIATE 2
DOESN'T KNOW 8
On television?
APPROPRIATE 1
INAPPROPRIATE 2
DOESN'T KNOW 8

616. Over the last few months, have you heard or read messages about family planning:

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

617. Over the last several months, have you listened to a radio program called Sarivolana?

YES 1
NO 2 (GO TO 618)

617A. How many times over the last 12 months have you listened to this program?

LESS THAN FIVE TIMES 1
BETWEEN FIVE AND TEN TIMES 2
MORE THAN TEN TIMES 3
DOESN'T KNOW 8

618. Over the last several months, have you discussed family planning with your friends, neighbors, or relatives?

YES 1
NO 2 (GO TO 620)

619. With whom did you discuss it?
Anyone else?
RECORD ALL PERSONS MENTIONED.

HUSBAND/PARTNER A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER F
MOTHER-IN-LAW G
FRIEND(S)/NEIGHBOR(S) H
OTHER (SPECIFY) ______ X

620. CHECK 502:

YES, CURRENTLY MARRIED
YES, LIVING WITH A MAN
NO, NOT IN UNION (GO TO 701)

Spouses don't always agree on everything. Now I would like to ask you some questions about your husband's/partner's opinions on family planning.

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

APPROVES 1
DISAPPROVES 2
DOESN'T KNOW 8

622. How many times over the last 12 months have you discussed family planning with your husband/partner?

NEVER 1
ONE OR TWO TIMES 2
MORE OFTEN 3

623. 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

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

701. CHECK 502 AND 504:

CURRENTLY MARRIED/LIVING WITH A MAN
FORMERLY MARRIED/LIVING WITH A MAN (GO TO 703)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 709)

702. How old was your husband/partner on his last birthday?

AGE IN COMPLETED YEARS ____

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

YES 1
NO 2 (GO TO 706)

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

PRIMARY 1
SECONDARY 1 2
SECONDARY 2 3
HIGHER 4 (GO TO 706)

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

GRADE ____
DOESN'T KNOW 98

706. What is (was) your husband's/partner's occupation? That is, what kind of work does (did) he mainly do?

_____

707. CHECK 706:

WORKS/WORKED IN AGRICULTURE ____
DOES/DID NOT WORK IN AGRICULTURE ____ (GO TO 709)

708. 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 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4

709. Aside from your own housework, have you done any work in the last seven days?

YES 1 (GO TO 712)
NO 2

710. As you know, some women take up jobs for which they are paid in cash or kind. Some have a small business or work on the family farm or in the family business. In the last seven days, have you done any of these things or any other work?

YES 1
NO 2 (GO TO 712)

711. Have you done any work in the last 12 months?

YES 1
NO 2 (GO TO 801)

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

____

713. CHECK 712:

WORKS/WORKED IN AGRICULTURE
DOES/DID NOT WORK IN AGRICULTURE (GO TO 715)

714. Do you work mainly on your own land or on family land, or do you work on land that you rent from someone else, or do you work on someone else's land?

OWN LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4

715. 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

716. Do you usually work throughout the year, or do you work seasonally, or only once in a while?

THROUGHOUT THE YEAR 1 (GO TO 718)
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3 (GO TO 719)

717. Out of the last 12 months, how many months did you work?

NUMBER OF MONTHS ____

718. Over the last 12 months, about how many days per week did you generally work?

NUMBER OF DAYS ____ (GO TO 720)

719. Over the last 12 months, about how many days did you work?

NUMBER OF DAYS ____

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

YES 1
NO 2 (GO TO 723)

721. How much do you usually earn for this work?
INSIST: Is it by day, by week or by month?
RECORD IN MGF X 1,000.

BY HOUR 1 _____
BY DAY 2 _____
BY WEEK 3 _____
BY MONTH 4 _____
BY YEAR 5 _____
OTHER (SPECIFY) ______ 999996

722. CHECK 502:

YES, CURRENTLY MARRIED OR LIVING WITH A MAN. Who principally decides how the money you earn will be used?

NO, NOT IN UNION. Who principally decides how the money you earn will be used? ('HUSBAND/PARTNER' OMITTED IN RESPONSE SET)

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
SOMEONE ELSE AND RESPONDENT TOGETHER 5

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

IN THE HOME 1
OUTSIDE THE HOME 2

724. CHECK 217 AND 218:
HAS A CHILD UNDER SIX YEARS OLD LIVING WITH HER?

YES
NO (GO TO 801A)

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

RESPONDENT 1
HUSBAND/PARTNER 2
OLDER FEMALE CHILD 3
OLDER MALE CHILD 4
OTHER RELATIVES 5
COUSINS 6
FRIENDS 7
NANNY/HIRED PERSON 8
CHILD GOES TO SCHOOL 9
DAYCARE/KINDERGARTEN 10
HASN'T WORKED SINCE LAST BIRTH 95
OTHER (SPECIFY) _______ 96

SECTION 8. AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

801A. Have you ever heard about infections that can be transmitted through sexual contact?

YES 1
NO 2 (GO TO 801L)

801B. Which ones do you know of?
RECORD ALL MENTIONED.

SYPHILIS A
GONORRHEA B
AIDS C
CONDYLOMA (GENITAL WARTS) D
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) _____ X
DOESN'T KNOW Z

801C. CHECK 515:

HAS HAD SEXUAL INTERCOURSE
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 801L)

801D. In the last 12 months, have you had one of these infections?

YES 1
NO 2 (GO TO 801F)
DOESN'T KNOW 8 (GO TO 801F)

801E. Which infections did you have?
RECORD ALL MENTIONED.

SYPHILIS A
GONORRHEA B
AIDS C
CONDYLOMA (GENITAL WARTS) D
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) _____ X
DOESN'T KNOW Z

801F. In the last 12 months, have you had any vaginal or anal releasing/discharge?

YES 1
NO 2 (GO TO 801L)

801G. The last time you had this infection (these infections), did you seek advice or treatment, treat yourself at home, or do nothing?

SOUGHT TREATMENT 1
TREATED HERSELF 2 (GO TO 801I)
NOTHING 3 (GO TO 801I)

801H. Where did you seek advice or treatment?
RECORD ALL MENTIONED.

PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER B
DISPENSARY C
LOCAL HEALTH POST D
OTHER PUBLIC (SPECIFY) __________ X
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY F
DOCTOR G
OTHER PRIVATE (SPECIFY) ______ Y
OTHER SOURCE
STORE I
RELIGIOUS CENTER J
RELATIVES K
FRIENDS L
HEALER M
OTHER (SPECIFY) ____________ Z

801I. When you had (INFECTION(S) FROM 801E), did you inform your sexual partner(s)?

YES 1
NO 2

801J. When you had (INFECTION(S) FROM 801E), did you do anything to avoid infecting your sexual partner(s)?

YES 1
NO 2 (GO TO 801L)
PARTNER ALREADY INFECTED 8 (GO TO 801L)

801K. What did you do?

AVOIDED SEXUAL INTERCOURSE A
USED CONDOMS B
TOOK MEDICATION C
OTHER (SPECIFY) ______ X

801L. CHECK 801B:

DID NOT MENTION AIDS
MENTIONED AIDS (GO TO 802)

801M. Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 811C)

802. From which sources of information have you learned the most about AIDS?
Are there other sources?
RECORD ALL MENTIONED.

RADIO A
TELEVISION B
NEWSPAPERS/MAGAZINES C
POSTERS D
HEALTH AGENTS E
CHURCH/MOSQUE F
SCHOOL/TEACHERS G
NEIGHBORHOOD PRESENTATIONS H
RELATIVES I
FRIENDS J
WORK PLACE K
MOVIE CLUBS L
OTHER (SPECIFY) ____ X

802A. In your opinion, does AIDS exist in Madagascar?

YES 1
NO 2
DOESN'T KNOW 8

802B. In your opinion, can someone get AIDS:

By touching someone who has AIDS?
YES 1
NO 2
DOESN'T KNOW 8
By sharing food or dishes with someone who has AIDS?
YES 1
NO 2
DOESN'T KNOW 8
By a kiss from someone who has AIDS?
YES 1
NO 2
DOESN'T KNOW 8
By having sexual relations with someone who has AIDS?
YES 1
NO 2
DOESN'T KNOW 8
By mosquito bites or other insect bites/stings?
YES 1
NO 2
DOESN'T KNOW 8
By contact with the blood of someone who has AIDS?
YES 1
NO 2
DOESN'T KNOW 8
By receiving an inoculation or vaccine?
YES 1
NO 2
DOESN'T KNOW 8
By blood transfusions?
YES 1
NO 2
DOESN'T KNOW 8

803. Is there something people can do to avoid contracting AIDS?

YES 1
NO 2 (GO TO 807)
DOESN'T KNOW 8 (GO TO 807)

804. What can one do?
Anything else?
RECORD ALL MENTIONED.

ABSTAIN FROM HAVING SEX A
USE CONDOMS B
ONLY HAVE ONE PARTNER C
AVOID PROSTITUTES D
AVOID HOMOSEXUAL RELATIONS E
AVOID BLOOD TRANSFUSIONS F
AVOID INJECTIONS G
AVOID KISSING H
AVOID MOSQUITO BITES I
SEEK PROTECTION FROM TRADITIONAL HEALERS J
SEEK PROTECTION FROM ANCESTORS K
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) _____ X
DOESN'T KNOW Z

807. Is it possible for a healthy-looking person to have AIDS?

YES 1
NO 2
DOESN'T KNOW 8

808. Do you think that a person with AIDS almost never dies from it, sometimes dies from it, or almost always dies from it?

ALMOST NEVER 1
SOMETIMES 2
ALMOST ALWAYS 3
DOESN'T KNOW 8

808A. Do you think AIDS can be cured?

YES 1
NO 2
DOESN'T KNOW 8

808B. Can AIDS be passed from mother to child?

YES 1
NO 2
DOESN'T KNOW 8

808C. Do you personally know anyone who has the AIDS or has died of AIDS?

YES 1
NO 2
DOESN'T KNOW 8

809. Do you think your risk of getting AIDS is small, moderate, significant, or do you think you run no risk at all in contracting AIDS?

SMALL 1
MODERATE 2 (GO TO 809B)
SIGNIFICANT 3 (GO TO 809B)
NO RISK AT ALL 4
HAS AIDS 5 (GO TO 811A)
DOESN'T KNOW 8 (GO TO 811A)

809A. Why do you think your risk of getting AIDS is small?
Why do you think you run no risk of getting AIDS?
Are there other reasons?
RECORD ALL MENTIONED.

ABSTAINS FROM SEX A (GO TO 811A)
USES CONDOMS B (GO TO 811A)
ONLY HAS SEX WITH ONE PARTNER C (GO TO 811A)
LIMITS NUMBER OF SEXUAL PARTNERS D (GO TO 811A)
PARTNER IS FAITHFUL E (GO TO 811A)
AVOIDS BLOOD TRANSFUSIONS G (GO TO 811A)
AVOIDS INJECTIONS H (GO TO 811A)
OTHER (SPECIFY) _____ X (GO TO 811A)

809B. Why do you think your risk of getting AIDS is moderate?
Why do you think your risk of getting AIDS is significant?
Are there other reasons?
RECORD ALL MENTIONED.

DOESN'T USE CONDOMS B
HAS MORE THAN ONE PARTNER C
HAS NUMEROUS PARTNERS D
PARTNER IS UNFAITHFUL E
AVOIDS BLOOD TRANSFUSIONS G
AVOIDS INJECTIONS H
OTHER (SPECIFY) _____ X

811A. Since you've heard about AIDS, have you changed your behavior in order to avoid getting the illness?
IF YES, INSIST: What have you done? Anything else?
RECORD ALL MENTIONED.

HAD NEVER HAD SEX A
STOPPED HAVING SEX B
STARTED TO USE CONDOMS C (GO TO 901)
HAS ONE PARTNER D
REDUCED NUMBER OF PARTNERS E
OTHER (SPECIFY) ____ X
CHANGED NOTHING ABOUT SEXUAL BEHAVIOR Y
DOESN'T KNOW Z

811B. Some people use a condom during sexual intercourse to protect themselves from AIDS and other sexually transmitted infections. Have you already heard of this?

YES 1
NO 2 (GO TO 901)

811C. CHECK 515:

HAS HAD SEXUAL INTERCOURSE
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 901)

811D. Have you ever used a condom to protect yourself from illnesses such as AIDS?

YES 1
NO 2

SECTION 9. MATERNAL MORTALITY

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.

901. To how many children did your mother give birth in total, including yourself?

NATURAL MOTHER'S NUMBER OF BIRTHS ____

902. CHECK 901:

TWO OR MORE BIRTHS
ONLY ONE BIRTH (RESPONDENT) (GO TO 916)

903. How many of these births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS ____

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

NAME ____

905. Is (NAME) male or female?

MALE 1
FEMALE 2

906. Is (NAME) still alive?

YES 1
NO 2 (GO TO 908)
DOESN'T KNOW 8 (GO TO NEXT COLUMN)

907. How old is (NAME)?

AGE ____ (GO TO NEXT COLUMN)

908. In what year did (NAME) die?

YEAR _____ (GO TO 910)
DOESN'T KNOW 9998

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

YEARS ____

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

YEARS ______

911. Was (NAME) pregnant when she died?

YES 1 (GO TO 914)
NO 2

912. Did (NAME) die during childbirth?

YES 1 (GO TO 915)
NO 2
DOESN'T KNOW 8

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

YES 1 (GO TO 915)
NO 2
DOESN'T KNOW 8

914. Did (NAME) die due to complications from pregnancy or childbirth?

YES 1
NO 2
DOESN'T KNOW 8

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

NUMBER OF CHILDREN ______

[GO TO NEXT COLUMN. IF NO MORE BROTHERS OR SISTERS, GO TO 916]

916. RECORD THE TIME.

HOURS ____
MINUTES ____

SECTION 10. HEIGHT AND WEIGHT

1001. CHECK 215:

ONE OR MORE BIRTHS SINCE JANUARY 1994
NO BIRTHS SINCE JANUARY 1994 (END OF SURVEY)

1002. LINE NUMBER ACCORDING TO 212.
[FOR CHILDREN ONLY]

_____

1003. NAME

_____

1004. BIRTH DATE (ACCORDING TO 215, ASK FOR DATE OF BIRTH)
[FOR CHILDREN ONLY]

DAY ____
MONTH ____
YEAR _____

1005. TB VACCINE SCAR ON THE TOP OF LEFT SHOULDER.
[FOR CHILDREN ONLY]

SCAR SEEN 1
SCAR NOT SEEN 2

1006. HEIGHT (IN CENTIMETERS)

CM _____

1007. Was the child measured lying down or standing up?
[FOR CHILDREN ONLY]

LYING DOWN 1
STANDING UP 2

1008. WEIGHT (IN KILOGRAMS)

KG ____

1008A. FOLLOWING THE INSTRUCTIONS IN THE MANUAL, INFORM THE WOMAN OF THE BLOOD DRAW PROCEDURE THAT YOU WILL PERFORM, AND THAT SHE HAS THE RIGHT TO REFUSE IF SHE DOES NOT WANT TO HAVE THIS PROCEDURE DONE.

1008B. LEVEL SHOWN BY THE HEMOGLOBINOMETER (IN GRAMS PER DECILITER):

_____

1009. DATE OF HEIGHT AND WEIGHT MEASUREMENT:

DAY ____
MONTH ____
YEAR ____

1010. RESULT FOR MOTHER

MEASURED 1
ABSENT 3
REFUSED 4
OTHER (SPECIFY) ____ 6

RESULT FOR CHILDREN

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

1011. NAME OF OPERATOR: _________
NAME OF ASSISTANT: ___________

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN 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 ____