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DEMOGRAPHIC AND HEALTH SURVEY 2003
INDIVIDUAL MEN'S QUESTIONNAIRE

IDENTIFICATION

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

URBAN/RURAL _____

URBAN 1
RURAL 2

RESIDENCE: LARGE CITY OR OTHER CITY/RURAL? ____

CAPITAL 1
OTHER CITY 2
RURAL 3

NAME AND LINE NUMBER OF MAN ______

INTERVIEWER VISITS

FIRST INTERVIEW (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 2003
INT. NUMBER ______
RESULT ______

TOTAL NUMBER OF VISITS _____

SUPERVISOR
NAME ______
DATE ______

FIELD EDITOR
NAME ______
DATE ______

OFFICE EDITOR ______
KEYED BY ______

SECTION 1. SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENTS

INTRODUCTION AND CONSENT:

CONSENT AFTER INFORMATION

Hello. My name is ____________________ and I am working with The Department of Demographics and Social Statistics (DDSS). We are in the process of conducting a national survey on the health of men, women and children. We would very much appreciate your participation in this survey. I would like to ask you questions about your health and your family. This information will be useful to the government in order to put health services in place. The survey takes between 30 and 45 minutes. The information you will give us is strictly confidential and will not be shared with anyone.

Participation in this survey is completely voluntary and you may refuse to answer any or all of the questions. However, we hope you will participate in the survey since your views are important to us.

Do you have any questions to ask me about the survey?
May I begin the interview now?

SIGNATURE OF INTERVIEWER______
DATE ______

RESPONDENT AGREES TO BE INTERVIEWED 1
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

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 the capital ANTANANARIVO, in another city, or in a rural setting?

CAPITAL 1
OTHER CITY 2
RURAL 3

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

YEARS ______

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

104. Just before you moved here, did you live in the capital ANTANANARIVO, in another city, or in a rural setting?

CAPITAL 1
TOWN 2
RURAL 3

105. In the last 12 months, how many times have you traveled and spent the night outside of your community?

NUMBER OF TRIPS ____
HAS NOT TRAVELED 00 (GO TO 107)

106. In the last 12 months, have you been away from your community for more than a month at a time?

YES 1
NO 2

107. In what month and year were you born?

MONTH ______
DOESN'T KNOW MONTH 98
YEAR ______
DOESN'T KNOW YEAR 9998

108. How old were you at your last birthday?
COMPARE AND CORRECT 107 AND/OR 108 IF INCONSISTENT.

AGE IN COMPLETED YEARS _______

109. Have you ever attended school?

YES 1
NO 2 (GO TO 113)

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

PRIMARY 1
MIDDLE SCHOOL 2
HIGH SCHOOL 3
HIGHER 4

111. What is the highest grade you successfully completed at that level?
WRITE '0' FOR LESS THAN A YEAR COMPLETED AND '8' FOR DOESN'T KNOW.

GRADE ______
0 LESS THAN ONE YEAR COMPLETED (FOR ALL LEVELS)
PRIMARY
1 1ST GRADE
2 2ND GRADE
3 3RD GRADE
4 4TH GRADE
5 5TH GRADE
8 DOESN'T KNOW
MIDDLE SCHOOL
1 6TH GRADE
2 7TH GRADE
3 8TH GRADE
4 9TH GRADE
8 DOESN'T KNOW
HIGH SCHOOL
1 10TH GRADE
2 11TH GRADE
3 12TH GRADE
8 DOESN'T KNOW
HIGHER
1 ONE YEAR
2 TWO YEARS
3 THREE YEARS
4 FOUR YEARS
5 FIVE OR MORE YEARS
8 DOESN'T KNOW

111A. CHECK 108:

IF 24 YEARS OLD OR YOUNGER
IF 25 YEARS OLD OR OLDER (GO TO 112)

111B. Are you currently attending school?

YES 1 (GO TO 112)
NO 2

111C. What is the main reason you stopped going to school?

TO WATCH 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

112. CHECK 110:

PRIMARY
SECONDARY OR HIGHER (GO TO 116)

113. Now I would like you to read this sentence to me; read the most of it you can.
SHOW CARD TO RESPONDENT.

IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

CANNOT READ AT ALL 1
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) ______ 4

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

YES 1
NO 2

115. CHECK 113:

CODE '2', '3', OR '4' CIRCLED
CODE '1' CIRCLED (GO TO 117)

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

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

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

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

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

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

119. Do you currently have a job, whatever it may be, where you earn money?

YES 1 (GO TO 122)
NO 2

120. During the last 12 months, did you have a job, whatever it may be, where you earned money?

YES 1 (GO TO 122)
NO 2

121. During the last 12 months, what has been your principal activity?

WENT TO SCHOOL 1 (GO TO 129)
LOOKED FOR A JOB 2 (GO TO 129)
INACTIVE 3 (GO TO 129)
COULDN'T WORK/HANDICAPPED 4 (GO TO 129)
HOUSEWORK/CHILD CARE 5 (GO TO 129)
OTHER (SPECIFY) _____ 6 (GO TO 129)

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

OCCUPATION _____

123. CHECK 122:

WORKS IN AGRICULTURE
DOES NOT WORK IN AGRICULTURE (GO TO 125)

124. 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
OWN PART OF LAND 5

125. 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

126. During the last 12 months, how many months did you work?

NUMBER OF MONTHS ____

127. For this work are you paid entirely in cash, in cash and kind, entirely in kind, or are you not paid at all?

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3 (GO TO 130)
NOT PAID 4 (GO TO 130)

128. Who usually decides how the money you earn will be used?

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

129. On average, what percentage of the household expenses are paid for using the money you earn?

ALMOST NOTHING 1
LESS THAN HALF 2
ABOUT HALF 3
MORE THAN HALF 4
ALL/ALMOST ALL OF THEM 5
NONE, ALL HIS EARNINGS ARE SAVED 6

130. What is your religion?

CATHOLIC 1
PROTESTANT/MALAGASY LUTHERAN CHURCH (FLM) 2
MUSLIM 3
TRADITIONAL/ANIMIST 4
NOT RELIGIOUS/NONE 5
SECT 6
OTHER (SPECIFY) _____ 96

131A. In your family, who usually has the last word in the following decisions:

Your own health care?
RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
The purchase of important household items?
RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
The purchase of daily household items?
RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
Visiting family, friends or relatives?
RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
What food will be prepared each day?
RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6

131B. Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is it normal for a man to hit or beat his wife in the following situations:

If she goes out without telling him?
YES 1
NO 2
DOESN'T KNOW 8
If she neglects the children?
YES 1
NO 2
DOESN'T KNOW 8
If she argues with him?
YES 1
NO 2
DOESN'T KNOW 8
If she refuses to have sex with him?
YES 1
NO 2
DOESN'T KNOW 8
If she burns the food?
YES 1
NO 2
DOESN'T KNOW 8

131C. Have you ever consumed alcoholic beverages?

YES 1
NO 2 (GO TO 201)

131D. Have you ever been intoxicated after consuming alcoholic beverages?

YES 1
NO 2

131E. Over the past three months, how many days have you consumed alcoholic beverages?

NUMBER OF DAYS ____
NONE/NEVER 95 (GO TO 201)

131F. CHECK 120:

YES, HAS BEEN INTOXICATED
NO, HAS NEVER BEEN INTOXICATED (GO TO 201)

131G. Over the past three months, how many times have you been intoxicated?

NUMBER OF TIMES ____
NONE/NEVER 95

SECTION 2. REPRODUCTION

Now I would like to ask you about your children. I only want to know about children to whom you are the biological father.

201. Do you have/have you had any children?

YES 1
NO 2 (GO TO 206)

202. Do you have any sons or daughters of whom you are the father who are now living with you?

YES 1
NO 2 (GO TO 204)

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

SONS AT HOME ______
DAUGHTERS AT HOME ______

204. Do you have any sons or daughters of whom you are the father who are alive but do not live with you?

YES 1
NO 2 (GO TO 206)

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

SONS ELSEWHERE ______
DAUGHTERS ELSEWHERE ______

206. Have you ever fathered 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?

YES 1
NO 2 (GO TO 208)
DOESN'T KNOW 8 (GO TO 208)

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

BOYS DEAD ______
GIRLS DEAD ______
DOESN'T KNOW 98

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 _____ children during your life of which you are the father. Is that correct?

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

210. CHECK 208:

HAS HAD MORE THAN ONE CHILD
HAS HAD ONLY ONE CHILD (GO TO 213)
HAS HAD NO CHILDREN (GO TO 214)

210A. In what year was your last child born?

YEAR _____

210B. At the time you were expecting your last child, did you want that child at that precise time, did you want to wait longer, or did you not want a(nother) child at all?

THAT TIME 1
LATER 2
NOT AT ALL 3

211. Do all of the children you have fathered have the same biological mother?

YES 1
NO 2 (GO TO 213)

212. In all, how many women have you fathered children with?

NUMBER OF WOMEN ____

213. In what month and year was your first child born?

MONTH _____
DOESN'T KNOW MONTH 98
YEAR ____
DOESN'T KNOW YEAR 9998

Now I would like to ask you about a woman's risk of pregnancy.

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

YES 1
NO 2 (GO TO 301)
DOESN'T KNOW 8 (GO TO 301)

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

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

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.

CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 301, ASK 302.

301. Which ways or methods have you heard about?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?

01. FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES SPONTANEOUSLY 1
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
02. MALE STERILIZATION Men can have an operation to avoid having any more children.
YES SPONTANEOUSLY 1
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
03. PILL Women can take a pill every day to avoid becoming pregnant.
YES SPONTANEOUSLY 1
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
04. IUD Women can have a loop or coil placed inside them by a doctor or a nurse that prevents them from becoming pregnant for a year or longer.
YES SPONTANEOUSLY 1
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
05. INJECTIONS 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 (GO TO NEXT METHOD)
06. 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 (GO TO NEXT METHOD)
07. CONDOM Men can put a rubber or latex sheath on their penis before sexual intercourse.
YES SPONTANEOUSLY 1
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
08. FEMALE CONDOM Women can place a latex sheath in their vagina before sexual intercourse.
YES SPONTANEOUSLY 1
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
09. DIAPHRAGM Women can place a diaphragm in their vagina before sexual intercourse.
YES SPONTANEOUSLY 1
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
10. MOUSSE OR GEL Women can insert a suppository, or put gel or cream inside their vagina before sexual intercourse.
YES SPONTANEOUSLY 1
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
11. LACTATIONAL AMENORRHEA METHOD (LAM) Up until 6 months after giving birth, a woman can use a method that consists of nursing frequently, day and night, and that prevents her from getting her period again.
YES SPONTANEOUSLY 1
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
12. RHYTHM METHOD Couples can avoid pregnancy by not having sexual intercourse on the days of the month the woman is most likely to get pregnant.
YES SPONTANEOUSLY 1
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
13. WITHDRAWAL Men can be careful and pull out before climax.
YES SPONTANEOUSLY 1
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
14. EMERGENCY CONTRACEPTION A woman can take a pill in the days following sexual intercourse, up to three days after, to prevent pregnancy.
YES SPONTANEOUSLY 1
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
15. Have you heard of any other ways or methods that women or men can use to avoid pregnancy? LIST UP TO TWO METHODS.
YES 1(SPECIFY) ________
NO 2

302. Have you ever used (METHOD)?
[THIS QUESTION IS ASKED ABOUT EACH METHOD IN 301 WITH '1' OR '2' CIRCLED.]

01. FEMALE STERILIZATION Women can have an operation to avoid having any more children. Has your partner ever had an operation to avoid having children?
YES 1
NO 2
02. MALE STERILIZATION Men can have an operation to avoid having any more children. Have you ever had an operation to avoid having children?
YES 1
NO 2
03. PILL Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
04. IUD Women can have a loop or coil placed inside them by a doctor or a nurse that prevents them from becoming pregnant for a year or longer.
YES 1
NO 2
05. INJECTIONS Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
06. IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
07. CONDOM Men can put a rubber or latex sheath on their penis before sexual intercourse.
YES 1
NO 2
08. FEMALE CONDOM Women can place a latex sheath in their vagina before sexual intercourse.
YES 1
NO 2
09. DIAPHRAGM Women can place a diaphragm in their vagina before sexual intercourse.
YES 1
NO 2
10. MOUSSE OR GEL Women can insert a suppository, or put gel or cream inside their vagina before sexual intercourse.
YES 1
NO 2
11. LACTATIONAL AMENORRHEA METHOD (LAM) Up until 6 months after giving birth, a woman can use a method that consists of nursing frequently, day and night, and that prevents her from getting her period again.
YES 1
NO 2
12. RHYTHM METHOD Couples can avoid pregnancy by not having sexual intercourse on the days of the month the woman is most likely to get pregnant.
YES 1
NO 2
13. WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
14. EMERGENCY CONTRACEPTION A woman can take a pill in the days following sexual intercourse, up to three days after, to prevent pregnancy.
YES 1
NO 2
15. OTHER METHOD (SPECIFY) ______
YES 1
NO 2

303. CHECK 302:

NOT A SINGLE "YES" (NEVER USED) (GO TO 304)
AT LEAST ONE "YES" (EVER USED) (GO TO 308)

304. Have you yourself or any of your sexual partners ever used anything or tried in any way to delay or avoid getting pregnant?

YES 1
NO 2 (GO TO 310)

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

307. CHECK 302 (02):

MAN NOT STERILIZED
MAN STERILIZED (GO TO 309A)

308. Are you currently doing something or using any method to delay or avoid a pregnancy?

YES 1
NO 2 (GO TO 310)

309. Which method are you currently using?
309A. CIRCLE 'B' FOR MALE STERILIZATION.

FEMALE STERILIZATION A
MALE STERILIZATION B
PILL C
IUD D
INJECTIONS E
IMPLANTS F
CONDOM G
FEMALE CONDOM H
DIAPHRAGM I
FOAM/JELLY J
LACTATIONAL AMEN. METHOD K
RHYTHM METHOD L
WITHDRAWAL M
OTHER (SPECIFY) _______ X

Now I would like to ask you about a woman's risk of pregnancy.

310. 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 312)
DOESN'T KNOW 8 (GO TO 312)

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

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

312. Do you think that a woman who is breastfeeding her baby can become pregnant?

YES 1
NO 2
DEPENDS 3
DOESN'T KNOW 8

313. I will now read you some statements about contraception. Please tell me if you agree or disagree with each one.

A) Contraception is women's business and a man should not have to worry about it.
AGREE 1
DISAGREE 2
DOESN'T KNOW 8
B) Women who use contraception can be considered to have loose morals.
AGREE 1
DISAGREE 2
DOESN'T KNOW 8
C) Since the woman is the one who becomes pregnant, she is the one that should use contraception.
AGREE 1
DISAGREE 2
DOESN'T KNOW 8

313A. For you, what are the goals of family planning?

SPACE OUT BIRTHS A
LIMIT BIRTHS B
PRESERVE MOTHER'S HEALTH C
PRESERVE CHILD'S HEALTH D
SOCIO-ECONOMIC REASON E
OTHER (SPECIFY) _____ X

313B. Do you know the names of condom brands?
IF YES: What are the brands you know?
What other brand name do you know?

PROTECTOR/PROTECTOR PLUS A
MANIX B (GO TO 401)
INNOTEX C (GO TO 401)
PROFILTEX D (GO TO 401)
SIMPLEX E (GO TO 401)
HANSAPLAST E (GO TO 401)
PLEASURE F (GO TO 401)
WITHOUT BRAND G (GO TO 401)
OTHER (SPECIFY) _____ X (GO TO 401)
DOESN'T KNOW Z (GO TO 401)

313C. You have said that you know the condom brand Protector/Protector Plus. Where have you heard or learned of this?

RECORD ALL MENTIONED. IF THE PERSON SAYS "RADIO", ASK IF IT WAS ON THE SHOW "TOKY SY ANTOKA" OR ON THE SHOW "PROTECTOR TIMES" AND CIRCLE THE CORRESPONDING CODE.

RADIO A
SHOW "TOKY SY ANTOKA" B
SHOW "PROTECTOR TIMES" C
TELEVISION D
POSTERS E
PACKAGES FOR SALE F
RELATIVES G
FRIENDS H
DOCTORS I
TRAVELING CINEMA J
FILM "BAKAPILESY" K
T-SHIRT/HATS L
COMMUNITY VENDOR M
PSI VENDOR N
RETAIL VENDOR O
OTHER (SPECIFY) _____ X

SECTION 4. MARRIAGE AND SEXUAL ACTIVITY

401. Are you currently married or living with a woman?

YES, CURRENTLY MARRIED 1 (GO TO 405)
YES, LIVING WITH A WOMAN 2 (GO TO 405)
FIRST MARRIAGE NOT CONSUMMATED 3 (GO TO 410)
NO, NOT IN UNION 4

402. Have you ever been married or lived with a woman as if married?

YES, FORMERLY MARRIED 1
YES, LIVED WITH A WOMAN 2 (GO TO 407)
NO 3 (GO TO 410)

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

WIDOWED 1 (GO TO 407)
DIVORCED 2 (GO TO 407)
SEPARATED 3 (GO TO 407)

405. How many wives/partners do you currently have?

NUMBER OF WIVES _____

406. RECORD THE NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH OF HIS WIVES/PARTNERS. IF A WOMAN IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'. THE NUMBER OF BOXES FILLED IN SHOULD BE THE SAME AS THE NUMBER OF WIVES/SPOUSES IN 405.

NAME _________
LINE NO. _____

407. Have you been married or lived with a woman only once or more than once?

ONLY ONCE 1
MORE THAN ONCE 2

408. CHECK 407:

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

MARRIED/LIVED WITH A WOMAN MORE THAN ONCE. Now I would like to ask you about when you started living with your first wife/partner. In what month and year was that?

IF "FIRST MARRIAGE NOT CONSUMMATED", GO BACK TO 401, CIRCLE CODE "3" (GO TO 410)

MONTH ____
DOESN'T KNOW MONTH 98
YEAR ____ (GO TO 410)
DOESN'T KNOW YEAR 9998

409. How old were you when you first started living with her?

AGE IN YEARS _____

Now I need to ask you some questions about sexual activity in order to better understand certain problems of family life.

410. How old were you when you had sexual intercourse for the very first time (if you have had it)?

NEVER 00 (GO TO 420)
AGE IN YEARS _____
FIRST TIME WHEN STARTED LIVING WITH (FIRST) PARTNER 96

411. How long has it been since the last time you had sexual intercourse?
RECORD IN 'NUMBER OF YEARS' ONLY IF THE LAST TIME WAS MORE THAN A YEAR AGO. IF 12 MONTHS OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO 1 ______
WEEKS AGO 2 _______
MONTHS AGO 3 _______
YEARS AGO 4 ______ (GO TO 420)

412. The last time you had sexual intercourse, was a condom used?

YES 1
NO 2 (GO TO 412F)

412A. What is the main reason that you used a condom on this occasion?

RESPONDENT WANTED TO AVOID STI/AIDS 1
RESPONDENT WANTED TO AVOID PREGNANCY 2
RESPONDENT WANTED TO AVOID STI/AIDS AND PREGNANCY 3
DIDN'T TRUST PARTNER/SUSPECTED PARTNER OF HAVING OTHER PARTNERS 4
PARTNER ASKED/INSISTED 5
DOESN'T KNOW 6
OTHER (SPECIFY) ______ 7

412D. Did you procure these condoms or did you partner provide them?

RESPONDENT PROCURED THEM 1
PARTNER PROVIDED THEM 2 (GO TO 413)
SOMEONE ELSE PROVIDED THEM 3 (GO TO 413)

412E. How much did you pay for the condoms?
RECORD THE PRICE OF 3 CONDOMS IN MGF.

PRICE OF 3 CONDOMS/MGF _____ (GO TO 413)
GIFT/FREE 9996 (GO TO 413)

412F. What were the reasons a condom was not used during your last sexual encounter?

NOT IN THE HABIT A
PARTNER REFUSED B
DOESN'T LIKE CONDOMS C
IT REDUCES PLEASURE D
CONDOM TEARS E
CONDOM GIVES OFF A CERTAIN SMELL F
CONDOM IS NOT WELL LUBRICATED G
TRUST IN MY PARTNER H
FAITHFUL TO MY PARTNER I
AFRAID MY PARTNER SUSPECTS ME J
WE HAVE ANOTHER METHOD OF CONTRACEPTION K
CONDOMS ARE TOO EXPENSIVE L
CONDOM NOT ON HAND M
COULDN'T FIND/GET A CONDOM N
CONDOMS ARE ASSOCIATED WITH STI'S O
CONDOMS ARE ASSOCIATED WITH CONTACT WITH PROSTITUTES Q
WANT TO CONCEIVE S
OTHER (SPECIFY) _______ X
DOESN'T KNOW OF CONDOMS Z

413. What is your relationship to the woman with whom you last had sexual intercourse?
IF GIRLFRIEND OR FIANC?, ASK: Was your girlfriend/fianc? living with you at the time you last had sexual intercourse with her? IF YES, CIRCLE '1'. IF NO, CIRCLE '2'.

WIFE/LIVE-IN PARTNER 01 (GO TO 415)
GIRLFRIEND/FIANC? 02
ANOTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
CLIENT (PROSTITUTION) 06
OTHER (SPECIFY) ________ 07

414. For how long have you had sexual relations with this woman?

DAYS 1 _____
WEEKS 2 _____
MONTHS 3 _____
YEARS 4 _____

415. Have you had sexual intercourse with another woman in the last 12 months?

YES 1
NO 2 (GO TO 420)

416. The last time you had sexual intercourse with this other woman, was a condom used?

YES 1
NO 2 (GO TO 416F)

416A. What is the main reason that you used a condom on this occasion?

RESPONDENT WANTED TO AVOID STI/AIDS 1
RESPONDENT WANTED TO AVOID PREGNANCY 2
RESPONDENT WANTED TO AVOID STI/AIDS AND PREGNANCY 3
DIDN'T TRUST PARTNER/SUSPECTED PARTNER OF HAVING OTHER PARTNERS 4
PARTNER ASKED/INSISTED 5
DOESN'T KNOW 6
OTHER (SPECIFY) ______ 7

416D. Did you procure these condoms or did you partner provide them?

RESPONDENT PROCURED THEM 1
PARTNER PROVIDED THEM 2 (GO TO 417)
SOMEONE ELSE PROVIDED THEM 3 (GO TO 417)

416E. How much did you pay for the condoms?
RECORD THE PRICE OF 3 CONDOMS IN MGF.

PRICE OF 3 CONDOMS/MGF _____ (GO TO 417)
GIFT/FREE 9996 (GO TO 417)

416F. What were the reasons a condom was not used during your last sexual encounter?

NOT IN THE HABIT A
PARTNER REFUSED B
DOESN'T LIKE CONDOMS C
IT REDUCES PLEASURE D
CONDOM TEARS E
CONDOM GIVES OFF A CERTAIN SMELL F
CONDOM IS NOT WELL LUBRICATED G
TRUST IN MY PARTNER H
FAITHFUL TO MY PARTNER I
AFRAID MY PARTNER SUSPECTS ME J
WE HAVE ANOTHER METHOD OF CONTRACEPTION K
CONDOMS ARE TOO EXPENSIVE L
CONDOM NOT ON HAND M
COULDN'T FIND/GET A CONDOM N
CONDOMS ARE ASSOCIATED WITH STI'S O
CONDOMS ARE ASSOCIATED WITH CONTACT WITH PROSTITUTES Q
WANT TO CONCEIVE S
OTHER (SPECIFY) _______ X
DOESN'T KNOW OF CONDOMS Z

417. What is your relationship to this other woman?
IF GIRLFRIEND OR FIANC?, ASK: Was your girlfriend/fianc? living with you at the time you last had sexual intercourse with her? IF YES, CIRCLE '1'. IF NO, CIRCLE '2'.

WIFE/LIVE-IN PARTNER 01 (GO TO 418A)
GIRLFRIEND/FIANC? 02
ANOTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
CLIENT (PROSTITUTION) 06
OTHER (SPECIFY) ________ 07

418. For how long have you had sexual relations with this other woman?

DAYS 1 _____
WEEKS 2 _____
MONTHS 3 _____
YEARS 4 _____

418A. Besides these two women, have you had sexual intercourse with someone else in the last 12 months?

YES 1
NO 2 (GO TO 420)

418B. The last time you had sexual intercourse with this other woman, was a condom used?

YES 1
NO 2 (GO TO 418CE)

418C. What is the main reason that you used a condom on this occasion?

RESPONDENT WANTED TO AVOID STI/AIDS 1
RESPONDENT WANTED TO AVOID PREGNANCY 2
RESPONDENT WANTED TO AVOID STI/AIDS AND PREGNANCY 3
DIDN'T TRUST PARTNER/SUSPECTED PARTNER OF HAVING OTHER PARTNERS 4
PARTNER ASKED/INSISTED 5
DOESN'T KNOW 6
OTHER (SPECIFY) _____ 7

418CC. Did you procure these condoms or did you partner provide them?

RESPONDENT PROCURED THEM 1
PARTNER PROVIDED THEM 2 (GO TO 418D)
SOMEONE ELSE PROVIDED THEM 3 (GO TO 418D)

418CD. How much did you pay for the condoms?
RECORD THE PRICE OF 3 CONDOMS IN MGF.

PRICE OF 3 CONDOMS/MGF _____ (GO TO 418D)
GIFT/FREE 9996 (GO TO 418D)

418CE. What were the reasons a condom was not used during your last sexual encounter?

NOT IN THE HABIT A
PARTNER REFUSED B
DOESN'T LIKE CONDOMS C
IT REDUCES PLEASURE D
CONDOM TEARS E
CONDOM GIVES OFF A CERTAIN SMELL F
CONDOM IS NOT WELL LUBRICATED G
TRUST IN MY PARTNER H
FAITHFUL TO MY PARTNER I
AFRAID MY PARTNER SUSPECTS ME J
WE HAVE ANOTHER METHOD OF CONTRACEPTION K
CONDOMS ARE TOO EXPENSIVE L
CONDOM NOT ON HAND M
COULDN'T FIND/GET A CONDOM N
CONDOMS ARE ASSOCIATED WITH STI'S O
CONDOMS ARE ASSOCIATED WITH CONTACT WITH PROSTITUTES Q
WANT TO CONCEIVE S
OTHER (SPECIFY) _______ X
DOESN'T KNOW OF CONDOMS Z

418D. What is your relationship to this other woman?
IF GIRLFRIEND OR FIANC?, ASK: Was your girlfriend/fianc? living with you at the time you last had sexual intercourse with her? IF YES, CIRCLE '1'. IF NO, CIRCLE '2'.

WIFE/LIVE-IN PARTNER 01 (GO TO 419)
GIRLFRIEND/FIANC? 02
ANOTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
CLIENT (PROSTITUTION) 06
OTHER (SPECIFY) ______ 07

418E. For how long have you had sexual relations with this other woman?

DAYS 1 _____
WEEKS 2 _____
MONTHS 3 _____
YEARS 4 _____

419. In total, with how many people have you had sexual intercourse in the last 12 months?

NUMBER OF PARTNERS _____

419A. Have you ever paid to have sexual intercourse with a woman?

YES 1
NO 2 (GO TO 420)

419B. How long has it been since you have paid to have sexual intercourse with a woman?

DAYS 1 _____
WEEKS 2 _____
MONTHS 3 _____
YEARS 4 _____
DOESN'T REMEMBER 998

419C. The last time you paid to have sexual intercourse with a woman, was a condom used?

YES 1
NO 2

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

YES 1
NO 2 (GO TO 501)

421. Where is that?
Any other place?
RECORD ALL MENTIONED

IF IT'S A HOSPITAL, HEALTH CENTER OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAMES OF PLACES _________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
GROUND AGENT E
OTHER PUBLIC (SPECIFY) ______ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY/MEDICINE DISPERSAL CENTER H
PRIVATE DOCTOR I
MOBILE CLINIC J
GROUND AGENT K
OTHER PRIVATE (SPECIFY) _____ L
OTHER LOCATION
STORE M
CHURCH N
FRIENDS/RELATIVES O
OTHER (SPECIFY) _______ X

422. If you wanted to, could you get yourself a condom?

YES 1
NO 2
DOESN'T KNOW/UNSURE 8

SECTION 5. FERTILITY PREFERENCES

501. CHECK 401:

NOT MARRIED OR FIRST MARRIAGE NOT CONSUMMATED (GO TO 501A)
CURRENTLY MARRIED/LIVING WITH A WOMAN (GO TO 501B)

501A. CHECK 411:

LAST SEXUAL INTERCOURSE LESS THAN 12 MONTHS AGO: CODE "1" OR "2" OR "3" CIRCLED (GO TO 501B)
LAST SEXUAL INTERCOURSE 12 OR MORE MONTHS AGO: CODE "4" CIRCLED OR QUESTION 411 NOT ASKED (GO TO 502(A))

501B. Is your wife/partner (one of your wives/partners) currently pregnant?

YES 1
NO 2 (GO TO 502(A))
DOESN'T KNOW 8 (GO TO 502(A))

501C. When she became pregnant, did you want her to become pregnant at that time, did you want her to become pregnant later, or did you not want her to become pregnant at all?

AT THAT TIME 1 (GO TO 502(B))
LATER 2 (GO TO 502(B))
NOT AT ALL 3 (GO TO 502(B))

502(A). WIFE/PARTNER NOT PREGNANT/DOESN'T KNOW/NO WIFE/PARTNER. 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?

502(B). WIFE/PARTNER PREGNANT. Now I have some questions about the future. After the child you and your wife/partner 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 504)
WIFE/PARTNER CAN'T GET PREGNANT 3 (GO TO 514)
UNDECIDED/DOESN'T KNOW AND PREGNANT 4 (GO TO 510)
NOT PREGNANT OR NOT SURE 5 (GO TO 504)

503. CHECK 502:

WIFE/PARTNER NOT PREGNANT/DOESN'T KNOW/NO WIFE/PARTNER How long would you like to wait from now before the birth of (a/another) child?

WIFE/PARTNER 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 510)
SAYS WIFE CAN'T GET PREGNANT 994 (GO TO 514)
AFTER MARRIAGE 995 (GO TO 509)
OTHER (SPECIFY) _______ 996 (GO TO 508)
DOESN'T KNOW 998 (GO TO 508)

504. CHECK 502:

WIFE/PARTNER NOT PREGNANT/DOESN'T KNOW/NO WIFE/PARTNER
WIFE/PARTNER PREGNANT (GO TO 510)

505. CHECK 308:
CURRENTLY USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 506)
NOT CURRENTLY USING (GO TO 506)
CURRENTLY USING (GO TO 508)

506. CHECK 503:

NOT ASKED (GO TO 508)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 508)
00-23 MONTHS OR 00-01 YEARS (GO TO 510)

508. In the weeks to come, if you were to discover that one of your wives/partners was pregnant, would it be an important problem, a small problem, or would it not be a problem at all?

IMPORTANT PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
SAYS CAN'T GET PREGNANT/CAN'T HAVE SEX 4

509. CHECK 308:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 510)
NO, NOT CURRENTLY USING (GO TO 510)
YES, CURRENTLY USING (GO TO 514)

510. Do you think you will use a contraceptive method to delay or avoid pregnancy at any time in the near or distant future?

YES 1
NO 2 (GO TO 512)
DOESN'T KNOW 8 (GO TO 512)

511. Which contraceptive method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 514)
MALE STERILIZATION 02 (GO TO 514)
PILL 03 (GO TO 514)
IUD 04 (GO TO 514)
INJECTIONS 05 (GO TO 514)
IMPLANTS 06 (GO TO 514)
CONDOM 07 (GO TO 514)
FEMALE CONDOM 08 (GO TO 514)
DIAPHRAGM 09 (GO TO 514)
FOAM/JELLY 10 (GO TO 514)
LACTATIONAL AMEN. METHOD 11 (GO TO 514)
RHYTHM METHOD 12 (GO TO 514)
WITHDRAWAL 13 (GO TO 514)
OTHER METHOD (SPECIFY) _____ 96 (GO TO 514)
NOT SURE 98 (GO TO 514)

512. What is the main reason that you think you will not use a contraceptive method at any time in the near or distant future?

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX/NO SEX 22 (GO TO 514)
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 514)
SUBFECUND/INFECUND 24 (GO TO 514)
WANT AS MANY CHILDREN AS POSSIBLE 26 (GO TO 514)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 514)
WIFE/PARTNER OPPOSED 32 (GO TO 514)
OTHERS OPPOSED 33 (GO TO 514)
RELIGIOUS PROHIBITION 34 (GO TO 514)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 514)
KNOWS NO SOURCE 42 (GO TO 514)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 514)
FEAR OF SIDE EFFECTS 52 (GO TO 514)
LACK OF ACCESS/TOO FAR 53 (GO TO 514)
COSTS TOO MUCH 54 (GO TO 514)
INCONVENIENT TO USE 55 (GO TO 514)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 514)
OTHER (SPECIFY) ______ 96 (GO TO 514)
DOESN'T KNOW 98 (GO TO 514)

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

YES 1
NO 2
DOESN'T KNOW 8

514. CHECK 203 AND 205:

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

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

PROBE FOR A NUMERIC RESPONSE. IF "NONE", CIRCLE "00" AND GO TO 516.

NONE 00 (GO TO 516)
NUMBER _____
OTHER (SPECIFY) _____ 96 (GO TO 516)

515. 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 ____
GIRLS ____
EITHER ____
OTHER (SPECIFY) ______ 96

516. Would you say that you approve or disapprove of couples that use a method to avoid becoming pregnant?

APPROVE 1
DISAPPROVE 2
DOESN'T KNOW/NOT SURE 8

517. In the last few months have you heard about family planning:

a) On the radio?
YES 1
NO 2
b) On the radio show "TOKY SY ANTOKA"?
YES 1
NO 2
c) On television?
YES 1
NO 2
d) In newspapers or magazines?
YES 1
NO 2
e) On posters?
YES 1
NO 2
f) From peer educators?
YES 1
NO 2
g) At performances?
YES 1
NO 2
h) At the mobile cinema?
YES 1
NO 2
i) In the movie "BAKAPILESY"?
YES 1
NO 2

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

On the radio?
APPROPRIATE 1
INAPPROPRIATE 2
On television?
APPROPRIATE 1
INAPPROPRIATE 2
In newspapers or magazines?
APPROPRIATE 1
INAPPROPRIATE 2
On posters?
APPROPRIATE 1
INAPPROPRIATE 2
In brochures?
APPROPRIATE 1
INAPPROPRIATE 2
At educational or cultural performances?
APPROPRIATE 1
INAPPROPRIATE 2
At school?
APPROPRIATE 1
INAPPROPRIATE 2

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

YES 1
NO 2 (GO TO 521)

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

WIFE/PARTNER A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
COUSIN(S) F
DAUGHTER(S) G
SON(S) H
MOTHER-IN-LAW I
FATHER-IN-LAW J
FRIEND(S)/NEIGHBOR(S) K
OTHER (SPECIFY) ______ X

521. CHECK 401:

YES, CURRENTLY MARRIED (GO TO 522)
YES, LIVING WITH A WOMAN (GO TO 522)
NO, NOT IN UNION OR FIRST MARRIAGE NOT CONSUMMATED (GO TO 528)

522. CHECK 309/309A:

AT LEAST ONE CODE CIRCLED (GO TO 523)
NO CODE CIRCLED (GO TO 524)

523. You have said that you are currently using a method of contraception/family planning. Would you say that using contraception is mainly your decision, mainly your wife's (wives')/partner's (partners') decision, or a group decision made by all of you?

DECISION OF RESPONDENT 1
DECISION OF WIFE (WIVES)/PARTNER(S) 2
GROUP DECISION 3
OTHER (SPECIFY) _____ 6

Now I would like to ask you some questions about your wife's/partner's opinions on family planning.

524. Do you think that your wife (wives)/partner(s) approve(s) or disapprove(s) of couples that use a method to avoid a pregnancy?

APPROVE(S) 1
DISAPPROVE(S) 2
DOESN'T KNOW 8

525. How many times over the last 12 months have you discussed family planning with your wife (wives)/partner(s) that you live with?

NEVER 1
ONE OR TWO TIMES 2
MORE OFTEN 3

526. CHECK 309/309A:

CODE "B" NOT CIRCLED: HE IS NOT STERILIZED (GO TO 527)
CODE "B" CIRCLED: HE IS STERILIZED (GO TO 528)

527. Do you think that your wife (wives)/partner(s) want the same number of children that you want, or (does she/do they) want more or fewer than you want?

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

528. Husbands and wives don't always agree on everything. Please, tell me if you think it is normal that a woman refuses to have sexual intercourse with her husband/partner when:

She knows that her husband has a sexually transmitted infection?
YES 1
NO 2
DOESN'T KNOW 8
She knows that her husband has sexual intercourse with other women?
YES 1
NO 2
DOESN'T KNOW 8
She has recently given birth?
YES 1
NO 2
DOESN'T KNOW 8
She is tired or doesn't feel like it?
YES 1
NO 2
DOESN'T KNOW 8

SECTION 6. PARTICIPATION IN HEALTH CARE

601. CHECK 201 AND 209:

HAS ONE OR MORE CHILDREN
HAS NO CHILDREN (GO TO 617)

602. What is the name and sex of your last child?

NAME OF LAST CHILD _______
BOY 1
GIRL 2

603. In what month and year was your last child born?

MONTH ____
YEAR ______

604. Is (NAME OF LAST CHILD) currently alive?

YES 1 (GO TO 606)
NO 2
DOESN'T KNOW 3 (GO TO 606)

605. How old was (NAME OF LAST CHILD) when he/she died?
IF 1 YEAR, PROBE: How many months old was he/she when he/she died?
RECORD IN DAYS IF LESS THAN A MONTH; IN MONTHS IF LESS THAN 2 YEARS; OR IN YEARS.

DAYS 1 ____
MONTHS 2 ____
YEARS 3 ____
DOESN'T KNOW 998

606. Who is the mother of (NAME OF LAST CHILD)?
WRITE THE NAME AND LINE NUMBER OF THE MOTHER OF THE CHILD ACCORDING TO THE HOUSEHOLD QUESTIONNAIRE. IF THE MOTHER IS NOT A PART OF THE HOUSEHOLD, RECORD '00'.

NAME OF THE MOTHER OF THE LAST CHILD ______
LINE NUMBER _____

607. CHECK 603:

LAST CHILD BORN SINCE JANUARY 1998 (GO TO 608)
HAS NO CHILDREN OR LAST CHILD BORN BEFORE 1998 (GO TO 617)

608. CHECK 606:

MOTHER OF LAST CHILD DOESN'T LIVE IN HOUSEHOLD (CODE 00) (GO TO 609)

MOTHER OF LAST CHILD LIVES IN HOUSEHOLD (GO TO 610)

609. What is your relationship with (NAME OF THE MOTHER OF LAST CHILD)?

CURRENT WIFE/LIVE-IN PARTNER 01
FORMER WIFE 02
FORMER LIVE-IN PARTNER 03
FORMER PARTNER HE WAS LIVING WITH 04
REGULAR SEXUAL PARTNER 05
GIRLFRIEND/FIANC? 06
OCCASIONAL SEXUAL PARTNER 07
CHANCE ENCOUNTER 08
OTHER (SPECIFY) ______ 96

[AFTER HAVING ASKED 610A, FIRST ASK 611 AND 612 ABOUT PREGNANCY, THEN 610B, 611 AND 612 ON CHILDBIRTH, AND PROCEED IN THE SAME FASHION FOR THE COLUMN "THE SIX WEEKS AFTER CHILDBIRTH". ALL QUESTIONS CONCERN THE MOST RECENT CHILD.]

610. Now, if you could think back to the time that (NAME OF MOTHER OF LAST CHILD IN 606) was pregnant with (NAME OF LAST CHILD IN 606).

PREGNANCY:

610A) When (NAME OF MOTHER OF LAST CHILD IN 606) was pregnant with (NAME OF LAST CHILD IN 606), did she receive any prenatal advice or care from a doctor or health care professional?

YES 1
NO 2 (GO TO 612)
DOESN'T KNOW 8 (GO TO 610B IN THE NEXT COLUMN)

611. Who paid for the care, or this doctor's services?

FREE 01 (GO TO 610B)
HEALTH INSURANCE 02 (GO TO 610B)
RESPONDENT 03 (GO TO 610B)
MOTHER OF CHILD 04 (GO TO 610B)
RESPONDENT AND MOTHER OF CHILD 05 (GO TO 610B)
RESPONDENT'S FAMILY 06 (GO TO 610B)
FAMILY OF MOTHER OF CHILD 07 (GO TO 610B)
OTHER (SPECIFY) ______ 96 (GO TO 610B)

612. What are the main reasons why (NAME OF MOTHER OF LAST CHILD IN 606) did not receive prenatal advice or care from a doctor or health care professional?

NOT NECESSARY 01 (GO TO 610B)
PERSONAL CONSULTATION NOT ALLOWED 02 (GO TO 610B)
RESPONDENT DIDN'T AGREE TO IT 03 (GO TO 610B)
TOO EXPENSIVE 04 (GO TO 610B)
TOO FAR/PROBLEM WITH TRANSPORTATION 05 (GO TO 610B)
SERVICES NOT SUFFICIENT 06 (GO TO 610B)
INCOMPETENT WORKERS 07 (GO TO 610B)
OTHER (SPECIFY) ______ 96 (GO TO 610B)

CHILDBIRTH:

610B) When (NAME OF MOTHER OF LAST CHILD IN 606) gave birth to (NAME OF LAST CHILD IN 606), did she receive any assistance from a doctor or health care professional?

YES 1
NO 2 (GO TO 612)
DOESN'T KNOW 8 (GO TO 610C IN THE NEXT COLUMN)

611. Who paid for the care, or this doctor's services?

FREE 01 (GO TO 610C)
HEALTH INSURANCE 02 (GO TO 610C)
RESPONDENT 03 (GO TO 610C)
MOTHER OF CHILD 04 (GO TO 610C)
RESPONDENT AND MOTHER OF CHILD 05 (GO TO 610C)
RESPONDENT'S FAMILY 06 (GO TO 610C)
FAMILY OF MOTHER OF CHILD 07 (GO TO 610C)
OTHER (SPECIFY) ______ 96 (GO TO 610C)

612. What are the main reasons why (NAME OF MOTHER OF LAST CHILD IN 606) did not receive prenatal advice or care from a doctor or health care professional?

NOT NECESSARY 01 (GO TO 610C)
PERSONAL CONSULTATION NOT ALLOWED 02 (GO TO 610C)
RESPONDENT DIDN'T AGREE TO IT 03 (GO TO 610C)
TOO EXPENSIVE 04 (GO TO 610C)
TOO FAR/PROBLEM WITH TRANSPORTATION 05 (GO TO 610C)
SERVICES NOT SUFFICIENT 06 (GO TO 610C)
INCOMPETENT WORKERS 07 (GO TO 610C)
OTHER (SPECIFY) ______ 96 (GO TO 610C)

THE SIX WEEKS AFTER CHILDBIRTH:

610C. When (NAME OF MOTHER OF LAST CHILD IN 606) gave birth to (NAME OF LAST CHILD IN 606), did she receive any advice or care from a doctor or health care professional in the six weeks after giving birth?

YES 1
NO 2 (GO TO 612)
DOESN'T KNOW 8 (GO TO 613)

611. Who paid for the care, or this doctor's services?

FREE 01 (GO TO 613)
HEALTH INSURANCE 02 (GO TO 613)
RESPONDENT 03 (GO TO 613)
MOTHER OF CHILD 04 (GO TO 613)
RESPONDENT AND MOTHER OF CHILD 05 (GO TO 613)
RESPONDENT'S FAMILY 06 (GO TO 613)
FAMILY OF MOTHER OF CHILD 07 (GO TO 613)
OTHER (SPECIFY) ______ 96 (GO TO 613)

612. What are the main reasons why (NAME OF MOTHER OF LAST CHILD IN 606) did not receive prenatal advice or care from a doctor or health care professional?

NOT NECESSARY 01
PERSONAL CONSULTATION NOT ALLOWED 02
RESPONDENT DIDN'T AGREE TO IT 03
TOO EXPENSIVE 04
TOO FAR/PROBLEM WITH TRANSPORTATION 05
SERVICES NOT SUFFICIENT 06
INCOMPETENT WORKERS 07
OTHER (SPECIFY) ______ 96

613. During this pregnancy, did you ever accompany (NAME OF MOTHER OF LAST CHILD) when she went to a health facility for prenatal care?

YES 1
NO 2

614. CHECK 602 AND 604:

NAME OF LAST CHILD ________
LAST CHILD LIVING (GO TO 615)
LAST CHILD NOT LIVING/DOESN'T KNOW (GO TO 617)

615. Does (NAME OF LAST CHILD) live here in the household with you?

YES 1
NO 2 (GO TO 617)

616. In your household, who usually decides what to do when (NAME OF LAST CHILD) is sick? RECORD ALL GIVEN RESPONSES.

RESPONDENT A
MOTHER OF CHILD B
WIFE/PARTNER WHO IS NOT MOTHER OF CHILD C
A RELATIVE (FEMALE) D
A RELATIVE (MALE) E
OTHER (SPECIFY) ______ X
CHILD HAS NEVER BEEN SICK Y

Now I would like to talk to you about pregnancy and children's health.

617. Often, pregnancy can have complications that provoke miscarriage or even death. Concerning these complications, what are some of the signs and symptoms that a pregnancy is in danger? INSIST: Other signs or symptoms?
RECORD ALL SIGNS AND SYMPTOMS MENTIONED.

VAGINAL HEMORRHAGING A
HIGH FEVER B
ABDOMINAL PAIN C
SWELLING OF HANDS/FEET D
DIFFICULT LABOR LASTING MORE THAN 12 HOURS E
CONVULSIONS F
OTHER (SPECIFY) ______ X
DOESN'T KNOW ANY SIGNS/SYMPTOMS Y

618. When a child has diarrhea, should one give him/her less liquids than normal, the same amount, or more than normal?

LESS THAN USUAL 1
ABOUT THE SAME 2
MORE THAN USUAL 3
DOESN'T KNOW 8

619. Have you ever heard of a special product called [LOCAL NAME] that one can get to treat diarrhea?

YES 1
NO 2

Now, I would like for you to tell me about yourself.

620. Do you currently smoke cigarettes or tobacco?
IF YES: What do you smoke?
RECORD ALL MENTIONED.

YES, CIGARETTES A
YES, PIPE B
YES, OTHER TOBACCO C
NO Y

621. CHECK 620:

CODE 'A' CIRCLED
CODE 'A' NOT CIRCLED (GO TO 701)

622. In the last 24 hours, how many cigarettes have you smoked?

CIGARETTES ____

SECTION 7. AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

Now I would like to talk about something else.

701. Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 724)

702. Is there something people can do to avoid contracting AIDS or the virus that causes AIDS?

YES 1
NO 2 (GO TO 709)
DOESN'T KNOW 8 (GO TO 709)

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

ABSTAIN FROM HAVING SEX A
USE CONDOMS B
ONLY HAVE SEX WITH ONE PARTNER C
LIMIT NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PEOPLE WITH LOTS OF PARTNERS F
AVOID SAME-PARTNER SEX G
AVOID SEX WITH PEOPLE WHO USE IV DRUGS H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID KISSING K
AVOID MOSQUITOS L
SEEK PROTECTION FROM TRADITIONAL HEALERS M
AVOID SHARING RAZORS/BLADES N
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) _____ X
DOESN'T KNOW Z

704. Can people reduce their chance of getting the AIDS virus by having just one uninfected sex partner who has no other sex partners?

YES 1
NO 2
DOESN'T KNOW 8

705. Can people get the AIDS virus from mosquito bites?

YES 1
NO 2
DOESN'T KNOW 8

706. Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex?

YES 1
NO 2
DOESN'T KNOW 8

707. Can people get the AIDS virus by sharing food with a person who has AIDS?

YES 1
NO 2
DOESN'T KNOW 8

708. Can people reduce their chance of getting the AIDS virus by not having sexual intercourse at all?

YES 1
NO 2
DOESN'T KNOW 8

708A. Can people contract the AIDS virus through spells or witchcraft?

YES 1
NO 2
DOESN'T KNOW 8

709. Is it possible for a healthy-looking person to have the AIDS virus?

YES 1
NO 2
DOESN'T KNOW 8

710. Do you personally know anyone who has the AIDS virus or is sick from AIDS, or someone who has died of AIDS?

YES 1
NO 2

711. Can the virus that causes AIDS be transmitted from a mother to her baby?

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

712. When can the AIDS virus be transmitted from the mother to the child? Can it be transmitted:

During pregnancy?
YES 1
NO 2
DOESN'T KNOW 8
During delivery?
YES 1
NO 2
DOESN'T KNOW 8
By breastfeeding?
YES 1
NO 2
DOESN'T KNOW 8

712A. According to you, do you run a significant risk, moderate risk, small risk or no risk at all in contracting the virus that causes AIDS?

SIGNIFICANT 1 (GO TO 712C)
MODERATE 2 (GO TO 712C)
SMALL 3
NO RISK AT ALL 4
HAS AIDS 5 (GO TO 713)
DOESN'T KNOW 8 (GO TO 713)

712B. CHECK 712A:

SMALL RISK. Why do you think that you run a small risk of contracting the virus that causes AIDS? Are there other reasons? RECORD ALL MENTIONED.

NO RISK. Why do you think that you run no risk of contracting the virus that causes AIDS?
Are there other reasons? RECORD ALL MENTIONED.

ABSTAINS FROM SEX A (GO TO 713)
USES CONDOMS B (GO TO 713)
ONLY HAS SEX WITH ONE PARTNER C (GO TO 713)
LIMITS NUMBER OF SEXUAL PARTNERS D (GO TO 713)
PARTNER IS FAITHFUL E (GO TO 713)
AVOIDS SEX WITH PEOPLE WITH LOTS OF PARTNERS G (GO TO 713)
AVOIDS SAME-PARTNER SEX H (GO TO 713)
AVOIDS SEX WITH PEOPLE WHO USE IV DRUGS I (GO TO 713)
AVOIDS BLOOD TRANSFUSIONS J (GO TO 713)
AVOIDS INJECTIONS K (GO TO 713)
AVOIDS KISSING L (GO TO 713)
AVOIDS MOSQUITOS M (GO TO 713)
AVOIDS SHARING RAZORS/BLADES N (GO TO 713)
OTHER (SPECIFY) _____ W (GO TO 713)
OTHER (SPECIFY) _____ X (GO TO 713)
DOESN'T KNOW Z (GO TO 713)

712C. CHECK 712A:

MODERATE RISK. Why do you think that you run a moderate risk of contracting the virus that causes AIDS? Are there other reasons? RECORD ALL MENTIONED.

SIGNIFICANT RISK. Why do you think that you run a significant risk of contracting the virus that causes AIDS? Are there other reasons? RECORD ALL MENTIONED.

DOESN'T USE CONDOMS B
DOESN'T LIMIT SEX TO ONE PARTNER/UNFAITHFUL TO PARTNER C
HAS A NUMBER OF SEXUAL PARTNERS D
PARTNER IS UNFAITHFUL E
PROSTITUTES HIMSELF F
HAS SEX WITH PEOPLE WITH LOTS OF PARTNERS G
HAS SAME-PARTNER SEX H
HAS SEX WITH PEOPLE WHO USE IV DRUGS I
HAS BLOOD TRANSFUSIONS J
HAS INJECTIONS K
KISSES L
BITTEN BY MOSQUITOS M
SHARES RAZORS/BLADES N
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) _____ X
DOESN'T KNOW Z

713. CHECK 401:

YES, CURRENTLY MARRIED/LIVING WITH A WOMAN
NO, NOT CURRENTLY MARRIED/LIVING WITH A WOMAN (GO TO 715)

714. Have you already spoken with your wife/partner about ways to avoid the AIDS virus?
IF MORE THAN ONE WIFE/PARTNER, ASK QUESTION IN PLURAL FORM.

YES 1
NO 2

715. In your opinion, is it appropriate or inappropriate to speak of AIDS:

a) On the radio?
APPROPRIATE 1
INAPPROPRIATE 2
b) On television?
APPROPRIATE 1
INAPPROPRIATE 2
c) In newspapers or magazines?
APPROPRIATE 1
INAPPROPRIATE 2
d) On posters?
APPROPRIATE 1
INAPPROPRIATE 2
e) By peer educators?
APPROPRIATE 1
INAPPROPRIATE 2
f) At educational or cultural performances?
APPROPRIATE 1
INAPPROPRIATE 2
g) At school?
APPROPRIATE 1
INAPPROPRIATE 2

716. If a person learns that he/she is infected with the virus that causes AIDS, should they be allowed to keep the information secret or should they be required to share the information with the community?

CAN BE KEPT SECRET 1
TOLD TO COMMUNITY 2
DOESN'T KNOW/NOT SURE 8

717. If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?

YES 1
NO 2
DOESN'T KNOW/NOT SURE/DEPENDS 3

718. Should people infected with the AIDS virus who work with other people in shops, offices and on farms be authorized to continue their work or not?

CAN CONTINUE TO WORK 1
CANNOT CONTINUE TO WORK 2
DOESN'T KNOW/NOT SURE/DEPENDS 3

719. Should children age 12-14 be taught about using a condom to avoid getting AIDS?

YES 1
NO 2
DOESN'T KNOW/NOT SURE/DEPENDS 3

720. Have you ever been tested to see if you have the AIDS virus?

YES 1
NO 2 (GO TO 721)

720A. When was the last time you were tested for the AIDS virus?

LESS THAN 12 MONTHS AGO 1
12-23 MONTHS AGO 2
2 OR MORE YEARS AGO 3

720B. The last time you had the test, did you yourself ask for the test, was it offered to you and you accepted, or was it required?

ASKED FOR THE TEST 1
OFFERED AND ACCEPTED 2
REQUIRED 3

720C. I don't want to know the results, but did you get the results of the test?

YES 1 (GO TO 723A)
NO 2 (GO TO 723A)

721. Would you like to get tested for AIDS?

YES 1
NO 2
DOESN'T KNOW/NOT SURE 8

722. Do you know of a place where you can get tested for the AIDS virus?

YES 1
NO 2 (GO TO 724)

723. Where can you go for this test? ONLY RECORD FIRST RESPONSE.
723A. Where did you go for this test?
RECORD ALL MENTIONED.

IF IT'S A HOSPITAL, HEALTH CENTER 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
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
GROUND AGENT 15
OTHER PUBLIC (SPECIFY) ______ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
GROUND AGENT 25
OTHER PRIVATE (SPECIFY) ______ 26
OTHER SOURCE
STORE 31
CHURCH 32
RELATIVES/FRIENDS 33
OTHER (SPECIFY) _______ 96

724. Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

YES 1
NO 2 (GO TO 727)

725. What are the signs or symptoms in a man that make you think he may have a sexually transmitted infection? INSIST: Anything else? RECORD ALL MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE B
FOUL-SMELLING DISCHARGE C
BURNING DURING URINATION D
RASH/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
WEIGHT LOSS K
IMPOTENCE L
OTHER (SPECIFY) ______ W
OTHER (SPECIFY) ______ X
NO SYMPTOMS Y (GO TO 726)
DOESN'T KNOW Z (GO TO 726)

725A. If you had any of these symptoms, where would you go for advice or health care?

PUBLIC SECTOR
DISTRICT HOSPITAL II [FACILITY EQUIPPED FOR SURGERIES] 11
DISTRICT HOSPITAL I [NON-SURGICAL MEDICAL CAPABILITIES] 12
BASIC HEALTH CENTER II [BASIC HEALTH CARE, PHYSICIAN-RUN] 13
BASIC HEALTH CENTER I [BASIC HEALTH CARE, RUN BY PARA-MEDICAL OFFICER] 14
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE HEALTH CENTER 22
PHARMACY/MEDICINE DISPERSAL CENTER 23
PRIVATE DOCTOR 24
PIF/FISA CENTER 25
OTHER SOURCE
VBC AGENT 31
STORE 32
KIOSK 33
CHURCH 34
TRADITIONAL HEALER 35
RELATIVES/FRIENDS 36
OTHER (SPECIFY) _______ 96

726. What are the signs or symptoms in a woman that make you think she may have a sexually transmitted infection?
INSIST: Anything else?
RECORD ALL MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE B
FOUL-SMELLING DISCHARGE C
BURNING DURING URINATION D
RASH/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
WEIGHT LOSS K
DIFFICULTY GETTING PREGNANT/HAVING CHILDREN L
OTHER (SPECIFY) ______ W
OTHER (SPECIFY) ______ X
NO SYMPTOMS Y
DOESN'T KNOW Z

727. CHECK 410:

HAS HAD SEXUAL INTERCOURSE
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 737)

727A. CHECK 724:

KNOWS OF STI'S
DOESN'T KNOW OF STI'S (GO TO 729)

Now I would like to ask you some questions about your health in the last 12 months.

728. During the last 12 months, have you had a sexually transmitted infection?

YES 1
NO 2
DOESN'T KNOW 8

729. Sometimes men experience an abnormal discharge from their penis. During the last 12 months, have you had an abnormal discharge from your penis?

YES 1
NO 2
DOESN'T KNOW 8

730. Sometimes men have a sore or ulcer near their penis. During the last 12 months, have you had a sore or ulcer near your penis?

YES 1
NO 2
DOESN'T KNOW 8

731. CHECK 728, 729, AND 730:

HAS HAD AN INFECTION
HAS NOT HAD AN INFECTION (GO TO 737)

732. The last time you had (INFECTION FROM 728/729/730), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 734)

733. The last time you had (INFECTION FROM 728/729/730), did you do any of the following things? Did you...

Seek advice from a health care worker in a hospital or clinic?
YES 1
NO 2
Seek advice or treatment from a traditional healer?
YES 1
NO 2
Seek advice or buy medication from a pharmacy or store?
YES 1
NO 2
Seek advice from family or friends?
YES 1
NO 2

734. When you had (INFECTION FROM 728/729/730), did you inform your sexual partner(s)?

YES 1
NO 2
CERTAIN ONES/NOT ALL 3
HAS NO PARTNER 4

735. When you had (INFECTION FROM 728/729/730), did you do anything to avoid infecting your sexual partner(s)?

YES 1
NO 2 (GO TO 737)
PARTNER ALREADY INFECTED 3 (GO TO 737)

736. What did you do to avoid infecting your partner(s)? Did you...

Stop having sexual intercourse?
YES 1
NO 2
Use a condom during sexual intercourse?
YES 1
NO 2
Take medication?
YES 1
NO 2

737. Certain men are circumcised. Are you circumcised?

YES 1
NO 2

738. RECORD THE TIME.

HOURS ____
MINUTES ____

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 ______