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DEMOGRAPHIC AND HEALTH SURVEY FOR MALI - DHSM IV, 2001 WOMAN'S QUESTIONNAIRE

IDENTIFICATION

PLACE NAME____
CLUSTER NUMBER_____
CONCESSION NUMBER _____

NAME OF HEAD OF HOUSEHOLD AND HOUSEHOLD NUMBER______

REGION_____
VILLAGE_____

URBAN/RURAL?

URBAN 1
RURAL 2

BAMAKO, OTHER CITIES, OTHER VILLAGES, RURAL?

BAMAKO 1
OTHER CITIES 2
OTHER VILLAGES 3
RURAL 4

NAME AND LINE NUMBER OF THE WOMAN__

INTERVIEWER VISITS

INTERVIEWER 1 (REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE____
INTERVIEWER NAME____
RESULT ____

RESULT___

1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTIALLY FILLED OUT
6 INCAPABLE
7 OTHER (SPECIFY) _____

NEXT VISIT
DATE_____
TIME_____

FINAL VISIT
DAY____
MONTH____
YEAR 2001
INTERVIEWER____
RESULT____

TOTAL NUMBER OF VISITS ____

LANGUAGE OF QUESTIONNAIRE: FRENCH 01

LANGUAGE OF INTERVIEW:

FRENCH 01
BAMBARA/MALINKE 02
SONRAI/DJERMA 03
PEUHL/FOULFOULDE 04
MARIKA/SONINKE 05
SENOUFO 06
DOGON 07
MINIANKA 08
TAMACHECK/BELLA 09
BOBO/DAFING 10
BOZO/SONOMO 11
OTHER 96

INTERPRETER?

YES 1
NO 2

SUPERVISOR
NAME ____
DATE ____

FIELD EDITOR
NAME ____
DATE ____

OFFICE EDITOR____
KEYED BY____

SECTION 1. SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENTS

INTRODUCTION AND CONSENT STATEMENT:

CONSENT STATEMENT AFTER INFORMATION

Hello. My name is_____ and I work for the Minister of Health and the Minister of Planning. We are conducting a national survey that asks about the health of women and children. We would very much appreciate your participation in this survey. I would like to ask you questions about your health (and that of your children). This information will be useful to the government for planning health services. The interview usually takes 20-45 minutes. The information that you give us will be strictly confidential.

Participation in this survey is voluntary and you can refuse to respond to particular questions or to all of the questions. We hope, however, that you will accept to participate in this survey because your opinion is important to us.

Do you have questions about the survey?
Can I begin the interview now?

SIGNATURE OF INTERVIEWER _____
DATE _____

THE RESPONDENT ACCEPTS TO RESPOND 1 (GO TO 101)
THE RESPONDENT REFUSES TO RESPOND 2 (END OF INTERVIEW)

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 years, did you live the majority of your time in Bamako, in another city, in a village or in a rural area?
IF 'FOREIGNER', SPECIFY THE PLACE OF RESIDENCE.

BAMAKO 1
OTHER CITIES 2
OTHER VILLAGES 3
OTHER FOREIGN CITIES 4
RURAL 5
UNSPECIFIED OTHER COUNTRY 6

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

YEARS_____

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

104. Just before you moved here, did you live in a large city, a city or in a rural area?

BAMAKO 1
OTHER CITIES 2
OTHER VILLAGES 3
OTHER FOREIGN CITIES 4
RURAL 5
UNSPECIFIED OTHER COUNTRY 6

105. In which month and in which 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. Did you go to school?

YES 1
NO 2 (GO TO 111)

108. What is the highest level of school you attended: primary (first cycle), primary (second cycle), secondary (high school or technical) or superior?

PRIMARY ONE 1
PRIMARY TWO 2
SECONDARY (HIGH SCHOOL/TECHNICAL) 3
SUPERIOR 4
OTHER (SPECIFY) _____ 6

109. What is the last (year/class) that you achieved at this level?
CODE '00' FOR LESS THAN ONE YEAR COMPLETED AND '98' FOR DOESN'T KNOW.

LAST CLASS ____
00 LESS THAN ONE YEAR COMPLETED
98 DOESN'T KNOW

109A. CHECK 106:

AGE 24 YEARS OR LESS (GO TO 109B)
AGE 25 YEARS OR MORE (GO TO 110)

109B. Do you currently go to school?

YES 1 (GO TO 110)
NO 2

109C. What is the main reason why you stopped going to school?

GOT PREGNANT 01
GOT MARRIED 02
TO CARE FOR YOUNGER CHILDREN 03
FAMILY NEEDED HELP IN THE FIELD/WORK 04
COULD NOT PAY THE TUITION 05
HAD TO EARN MONEY 06
EDUCATED ENOUGH 07
FAILURE IN SCHOOL 08
NO LONGER LIKED SCHOOL 09
SCHOOL INACCESSIBLE/TOO FAR 10
OTHER (SPECIFY) _____ 96
DOESN'T KNOW 98

110. CHECK 108:

PRIMARY ONE (GO TO 111)
PRIMARY TWO OR MORE (GO TO 114)

111. Now I would like you to read this sentence out loud: read as much as you can.
SHOW THE CARD TO THE RESPONDENT.
IF THE RESPONDENT CAN NOT READ THE WHOLE PHRASE INSIST: Can you read certain parts of the phrase to me?

CANNOT READ AT ALL 1
CAN READ SOME PARTS 2
CAN READ THE WHOLE PHRASE 3
NO CARD IN THE RIGHT LANGUAGE (SPECIFY LANGUAGE) _____ 4

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

YES 1
NO 2 (GO TO 113)

112A. What kind of literacy program did you participate in?
PROBE: Any other?
RECORD ALL MENTIONED.

MEDERSA A
BAMBARA B
PEULH C
TAMACHECK D
SONGHOI E
OTHER (SPECIFY) _____ X

113. CHECK 111:

CODES '2', '3' OR '4' CIRCLED (GO TO 114)
CODE '1' CIRCLED (GO TO 115)

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

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

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

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

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

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

117. What is your religion?

MUSLIM 1
CHRISTIAN 2
ANIMIST 3
OTHER (SPECIFY) _____ 6

117A. Are you Malian?

YES 1
NO 2 (GO TO 201)

118. What is your ethnicity?

BAMBARA 01
MALINKE 02
PEUHL 03
SARAKOLE/SONINKE/MARKA 04
SONRAI 05
DOGON 06
TAMACHECK 07
SENOUFO/MINIANKA 08
BOBO 09
OTHER (SPECIFY) ____ 96

SECTION 2. REPRODUCTION

Now I would like to ask about all of 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 or daughters to whom you have given birth and who are now living with you?

YES 1
NO 2 (GO TO 204)

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

SONS ELSEWHERE ___
DAUGHTERS ELSEWHERE ___

206. Have you given birth to a son or daughter who was born alive but later died?
IF NO, PROBE: Any who cried and showed signs of live at birth but did not survive?

YES 1
NO 2 (GO TO 208)

207. How many sons have died?
And how many daughters have died?
IF NONE, RECORD '00'

SONS DEAD ____
DAUGHTERS DEAD ____

208. SUM ANSWERS TO QUESTIONS 203, 205, AND 207 AND RECORD THE TOTAL.
IF NONE, RECORD '00'

TOTAL ____

209. CHECK 208:
Just to be 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)
NONE (GO TO 226)

211. Now I would like to make a list of all your births, whether still alive or not, starting with the first one you had.

RECORD THE NAMES OF ALL THE BIRTHS IN QUESTION 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

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

NAME ____

213. Were any of these births twins?

SINGLE 1
MULTIPLE 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?

MONTH ___
YEAR ____

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

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

AGE IN YEARS ___

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

YES 1
NO 2

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

LINE NO. ___ (LAST BIRTH: GO TO NEXT BIRTH; OTHER BIRTHS: GO TO 221)

220. IF DEAD: How old was (NAME) when he/she died?
IF '1 YEAR' PROBE: How old was (NAME) in months?
RECORD IN DAYS IF LESS THAN 1 MONTH; IN MONTHS IF LESS THAN 2 YEARS; OR IN YEARS

DAYS 1 ___
MONTHS 2 ___
YEARS 3 ___

221. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME) including any children who died after birth?
[DO NOT ASK FOR LAST BIRTH]

YES 1 (ADD BIRTH)
NO 2 (GO TO NEXT BIRTH)

[Repeat lines 212-221 for each birth AND use a separate sheet for more than 12 births]

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

YES 1 (ADD THE BIRTH)
NO 2

223. COMPARE 208 WITH THE NUMBER OF BIRTH RECORDED IN THE ABOVE TABLE AND MARK:

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

224. CHECK 215 AND RECORD THE NUMBER OF BIRTHS IN 1996 OR LATER.
IF NONE, RECORD '0'.

NUMBER OF BIRTHS FROM 1996 OR LATER _____

225. FOR EACH BIRTH SINCE JANUARY 1996, WRITE 'N' IN MONTH OF BIRTH IN THE CALENDAR. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED AND WRITE 'G' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF THE PREGNANCY. (NOTE: THE NUMBER OF 'G'S MUST BE 1 LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED). RECORD THE NAME OF THE CHILD LEFT OF THE CODE 'N'.

226. Are you currently pregnant?

YES 1
NO 2 (GO TO 229)
UNSURE 8 (GO TO 229)

227. How many months pregnant are you?

RECORD THE NUMBER OF COMPLETED MONTHS. RECORD 'G' IN THE CALENDAR, BEGINNING WITH THE MONTH OF THE SURVEY AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

MONTHS ____

228. At the moment you became pregnant, did you want to become pregnant at that time, did you want to wait until later, or did you not want to have any (more) children?

THEN 1
LATER 2
NONE AT ALL 3

229. Have you ever had a pregnancy that ended in a miscarriage, abortion or still birth?

YES 1
NO 2 (GO TO 237)

230. When did the last such pregnancy end?

MONTH ___
YEAR ____

231. CHECK 230:

LAST PREGNANCY ENDED IN JAN. 1996 OR LATER (GO TO 232)
LAST PREGNANCY ENDED BEFORE JAN. 1996 (GO TO 237)

232. How many months pregnant were you when the last such pregnancy ended?
RECORD THE NUMBER OF COMPLETED YEARS. RECORD 'F' IN THE CALENDAR IN THE MONTH THE PREGNANCY ENDED AND 'G' FOR THE REMAINING COMPLETED MONTHS.

MONTHS ____

233. Have you had other pregnancies that did not end in a live birth?

YES 1
NO 2 (GO TO 237)

234. ASK THE DATE AND DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 1996. RECORD 'F' IN THE CALENDAR IN THE MONTH EACH PREGNANCY ENDED AND 'G' FOR THE REMAINING COMPLETED MONTHS,

235. Have you had a pregnancy that ended before January 1996 that did not end in a live birth?

YES 1
NO 2 (GO TO 237)

236. INDICATE THE MONTH AND YEAR THAT THE LAST NON-LIVE PREGNANCY ENDED BEFORE JANUARY 1996.

MONTH ____
YEAR ____

237. When did your last menstrual period start?
WRITE THE DATE, IF GIVEN.

DATE ___
DAYS AGO 1 ___
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___

IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE THE LAST BIRTH 995
NEVER MENSTRUATED 996

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

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

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

JUST BEFORE HER PERIOD BEGINS 1
DURING HER PERIOD 2
JUST AFTER THE END OF HER PERIOD 3
HALFWAY BETWEEN 2 PERIODS 4
OTHER (SPECIFY) _____ 6
DOESN'T KNOW 8

SECTION 3. CONTRACEPTION

Now I would like to talk to you 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 CONTINUE DOWN COLUMN 301 READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE '1' IF THE METHOD IS RECOGNIZED AND CODE '2' IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE '1' CIRCLED IN 301, ASK 302.

301. Which ways or methods have you heard about?
FOR THE METHODS SPONTANEOUSLY MENTIONED, ASK: Have you ever heard of (METHOD)?

01. FEMALE STERILIZATION: Women can have an operation to avoid having any more children.
YES 1
NO 2
02. MALE STERILIZATION: Men can have an operation to avoid having any more children.
YES 1
NO 2
03. PILL: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
04. IUD: Women can have a loop or a coil placed inside them by a doctor or a nurse to avoid becoming pregnant.
YES 1
NO 2
05. INJECTIONS: Women can have an injection by a health provider to avoid becoming pregnant during 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 sheath on their penis before sexual intercourse.
YES 1
NO 2
08. FEMALE CONDOM: Women can place a sheath in their vagina before intercourse.
YES 1
NO 2
09. DIAPHRAGM: Women can place a diaphragm in their vagina before sexual intercourse.
YES 1
NO 2
10. FOAM OR JELLY: Women can insert a suppository, jelly or lotion in their vagina before intercourse.
YES 1
NO 2
11. LACTATIONAL AMENORRHEA METHOD (LAM) Up to 6 months after a birth and before her period returns, a woman can use a method consisting of nursing her baby each time that he/she wants, day and night, without ever giving him/her any other food.
YES 1
NO 2
12. RHYTHM METHOD: Every month that a woman is sexually active she can avoid pregnancy by not having intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
13. WITHDRAWAL: Men can be careful to pull out before climax.
YES 1
NO 2
14. DAY AFTER PILL: Women can take pills days following intercourse until the third day after to avoid getting pregnant.
YES 1
NO 2
15. Have you heard of other ways or methods that women or men can use to avoid pregnancy? LIST UP TO TWO DIFFERENT METHODS.
OTHER METHOD (SPECIFY) _____
YES 1
NO 2

302. Have you ever used (METHOD)?

01. 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
02. MALE STERILIZATION: Men can have an operation to avoid having any more children. Has your partner ever had an operation to avoid having any more children?
YES 1
NO 2
03. PILL: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
04. IUD. Women can have a loop or a coil placed inside them by a doctor or a nurse to avoid becoming pregnant.
YES 1
NO 2
05. INJECTIONS: Women can have an injection by a health provider to avoid becoming pregnant during 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 sheath on their penis before sexual intercourse.
YES 1
NO 2
08. FEMALE CONDOM: Women can place a sheath in their vagina before intercourse.
YES 1
NO 2
09. DIAPHRAGM: Women can place a diaphragm in their vagina before sexual intercourse.
YES 1
NO 2
10. FOAM OR JELLY: Women can insert a suppository, jelly or lotion in their vagina before intercourse.
YES 1
NO 2
11. LACTATIONAL AMENORRHEA METHOD (LAM) Up to 6 months after a birth and before her period returns, a woman can use a method consisting of nursing her baby each time that he/she wants, day and night, without ever giving him/her any other food.
YES 1
NO 2
12. RHYTHM METHOD: Every month that a woman is sexually active she can avoid pregnancy by not having intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
13. WITHDRAWAL: Men can be careful to pull out before climax.
YES 1
NO 2
14. DAY AFTER PILL: Women can take pills days following intercourse until the third day after to avoid getting pregnant.
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 307)

304. Have you ever used anything or tried in any way to delay or avoid pregnancy?

YES 1
NO 2 (GO TO 329)

306. What did you do or use?
CORRECT 302 AND 303 (AND 301 IF NECESSARY).

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

307. How many living children did you have, if any?
IF NONE RECORD '00'

NUMBER OF CHILDREN____

308. CHECK 302 (01):

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

309. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 310)
PREGNANT (GO TO 329)

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

YES 1
NO 2 (GO TO 329)

311. What method(s) are you using?
311A. CIRCLE "A" FOR FEMALE STERILIZATION.

IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION LIST FOR HIGHEST METHOD ON THE LIST.

FEMALE STERILIZATION A (GO TO 313)
MALE STERILIZATION B (GO TO 313)
PILL C
IUD D (GO TO 316A)
INJECTIONS E (GO TO 316A)
IMPLANTS F (GO TO 316A)
CONDOM G (GO TO 316A)
FEMALE CONDOM H (GO TO 316A)
DIAPHRAGM I (GO TO 316A)
FOAM/JELLY J (GO TO 316A)
LACTATION AMEN. METHOD K (GO TO 316A)
RHYTHM METHOD L (GO TO 316A)
WITHDRAWAL M (GO TO 316A)
OTHER (SPECIFY) _____ X (GO TO 316A)

312. When you began using the pill for the first time did you consult a doctor, a midwife or a nurse?

YES 1
NO 2
DOESN'T KNOW 8

312A. When you got the pill for the last time did you consult a doctor, a midwife or a nurse?

YES 1
NO 2

312B. Can I see the pill box that currently you use?
IF THE PACKET IS SHOWN, CIRCLE THE CORRESPONDING CODE AND WRITE THE NAME.

NAME OF BRAND ____
OVRETTE 01 (GO TO 312D)
LO-FEMENAL 02 (GO TO 312D)
DUOFEM/PILPLAN 03 (GO TO 312D)
MINIPHASE 04 (GO TO 312D)
MINIDRIL 05 (GO TO 312D)
EUGYNON 06 (GO TO 312D)
MICROGYNON 07 (GO TO 312D)
CONCEPTROL 08 (GO TO 312D)
MICRO-NOVUM 09 (GO TO 312D)
ADEPAL 10 (GO TO 312D)
OTHER (SPECIFY) ____ 96 (GO TO 312D)
BOX NOT SEEN 98

312C. What is the name of the brand of pill that you currently use?
RECORD THE NAME OF THE BRAND AND CIRCLE THE CORRESPONDING CODE

NAME OF BRAND _____
OVRETTE 01
LO-FEMENAL 02
DUOFEM/PILPLAN 03
MINIPHASE 04
MINIDRIL 05
EUGYNON 06
MICROGYNON 07
CONCEPTROL 08
MICRO-NOVUM 09
ADEPAL 10
OTHER (SPECIFY) ____ 96
DOESN'T KNOW 98

312D. How much does a 3 cycle box of pills cost you?
RECORD THE AMOUNT IN FRANCS (CFA).

COST IN CFA____ (GO TO 316A)

FREE 9996 (GO TO 316A)
DOESN'T KNOW 9998 (GO TO 316A)

[IF CODES 'A' AND 'B' ARE CIRCLED IN 311, ASK 313-316/316A ONLY ABOUT FEMALE STERILIZATION.]

313. Where did the sterilization take place?

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

NAME OF THE ESTABLISHMENT_____
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
OTHER PUBLIC (SPECIFY) _____16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
DOCTOR'S OFFICE 23
MOBILE CLINIC 24
OTHER PRIVATE (SPECIFY) _____ 26
OTHER (SPECIFY) _____ 96
DOESN'T KNOW 98

314. CHECK 311:

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

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

YES 1
NO 2
DOESN'T KNOW 8

316. In which month and in which year did the sterilization occur?
316A. Since when did you begin to use (CURRENT METHOD) continuously?
PROBE: In which month and in which year did you begin to use (CURRENT METHOD) continuously?

MONTH ____
YEAR ____

317. CHECK 316/316A:

THE YEAR IS 1996 OR LATER (GO TO 319)
THE YEAR IS 1995 OR BEFORE (GO TO 327)

319. CHECK 311/311A:
CIRCLE THE CODE OF THE METHOD: IF MORE THAN ONE METHOD MENTIONED, CIRCLE THE HIGHEST METHOD CIRCLED IN THE LIST.

FEMALE STERILIZATION 01 (GO TO 322)
MALE STERILIZATION 02 (GO TO 331)
PILL 03
IUD 04
INJECTIONS 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATION AMEN. METHOD 11 (GO TO 320A)
RHYTHM METHOD 12 (GO TO 331)
WITHDRAWAL 13 (GO TO 331)
OTHER METHOD _____ 96 (GO TO 331)

320. Where did you get (CURRENT METHOD) when you started using it?
320A. Where did you learn how to use the lactational amenorrhea method?

IF THE SOURCE IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF ESTABLISHMENT_____
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
FIELD WORKER 15
OTHER PUBLIC (SPECIFY) _____16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
FIELD WORKER 25
OTHER PRIVATE (SPECIFY) _____ 26
OTHER SOURCE
SHOP 31
CHURCH 32
RELATIVES/FRIENDS 33
OTHER (SPECIFY) _____ 96

321. CHECK 311/311A:
CIRCLE THE CODE OF THE METHOD: IF MORE THAN ONE METHOD MENTIONED, CIRCLE THE HIGHEST METHOD CIRCLED IN THE LIST.

PILL 03
IUD 04
INJECTIONS 05
IMPLANTS 06
CONDOM 07 (GO TO 327)
FEMALE CONDOM 08 (GO TO 325)
DIAPHRAGM 09 (GO TO 325)
FOAM/JELLY 10 (GO TO 325)
LACTATION AMEN. METHOD 11 (GO TO 325)

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

YES 1 (GO TO 324)
NO 2

323. Were you ever told by a health or family planning worker about the side effects or problems you might have with the method?

YES 1
NO 2 (GO TO 325)

324. Did someone tell you what you should do if you experienced secondary effects or if you had problems?

YES 1
NO 2

325. CHECK 322:

CODE '1' CIRCLED: At that time were you told other methods or family planning you could use?

CODE '1' NOT CIRCLED: When you obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM 313 OR 320), did anyone talk to you about other methods of family planning that you could use?

YES 1 (GO TO 327)
NO 2

326. Were you informed by a health or family planning worker about other methods of contraception that you could use?

YES 1
NO 2

327. CHECK 311/311A:
CIRCLE THE CODE OF THE METHOD:

FEMALE STERILIZATION 01 (GO TO 331)
MALE STERILIZATION 02 (GO TO 331)
PILL 03
IUD 04
INJECTIONS 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATION AMEN. METHOD 11 (GO TO 331)
RHYTHM METHOD 12 (GO TO 331)
WITHDRAWAL 13 (GO TO 331)
OTHER METHOD _____ 96 (GO TO 331)

328. Where did you get (THE CURRENT METHOD) the last time?

IF THE SOURCE IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF ESTABLISHMENT_____
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (GO TO 331)
GOVERNMENT HEALTH CENTER 12 (GO TO 331)
FAMILY PLANNING CLINIC 13 (GO TO 331)
MOBILE CLINIC 14 (GO TO 331)
FIELD WORKER 15 (GO TO 331)
OTHER PUBLIC (SPECIFY) _____16 (GO TO 331)
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC 21 (GO TO 331)
PHARMACY 22 (GO TO 331)
PRIVATE DOCTOR 23 (GO TO 331)
MOBILE CLINIC 24 (GO TO 331)
FIELD WORKER 25 (GO TO 331)
OTHER PRIVATE (SPECIFY) _____ 26 (GO TO 331)
OTHER SOURCE
SHOP 31 (GO TO 331)
CHURCH 32 (GO TO 331)
RELATIVES/FRIENDS 33 (GO TO 331)
OTHER (SPECIFY) _____ 96 (GO TO 331)

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

YES 1
NO 2 (GO TO 331)

330. Where is this place?
Anywhere else?
RECORD ALL MENTIONED.

IF THE SOURCE IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF ESTABLISHMENT _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELD WORKER E
OTHER PUBLIC (SPECIFY) _____F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
FIELD WORKER K
OTHER PRIVATE (SPECIFY) _____ L
OTHER SOURCE
SHOP M
CHURCH N
RELATIVES/FRIENDS O
OTHER (SPECIFY) _____ X

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

YES 1
NO 2

332. In the last 12 months, have you visited a health care facility for care for yourself (or your children)?

YES 1
NO 2 (GO TO 401)

333. Did a staff member at the health facility talk to you about family planning methods?

YES 1
NO 2

SECTION 4A. PREGNANCY, POSTNATAL CARE AND BREASTFEEDING

401. CHECK 224:

ONE OR MORE BIRTHS IN 1996 OR LATER (GO TO 402)
NO BIRTHS IN 1996 OR LATER (GO TO 487)

402. WRITE THE LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH SINCE 1996. ASK THE QUESTIONS OF ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE THE LAST TWO COLUMNS OF ADDITIONAL QUESTIONNAIRES).

Now I would like to some questions about the health of all of your children born in the last five years. (We will talk about each separately).

403. LINE NUMBER FROM QUESTION 212:

LINE NO. ___

404. FROM QUESTIONS 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 time would you have liked to wait?

MONTHS 1 ___
YEARS 2 ___
DOESN'T KNOW 998

407. For the last pregnancy, did you receive prenatal care?
IF YES: Whom did you see? Anyone else?
[ASK ONLY FOR MOST RECENT BIRTH]

PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
HEALER/DOULA C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
OTHER (SPECIFY) _____ X
NO ONE Y (GO TO 415)

408. How many months pregnant were you when you had your first prenatal consultation?
[ASK ONLY FOR MOST RECENT BIRTH]

MONTHS ___
DOESN'T KNOW 98

409. How many times did you get consultation during this pregnancy?
[ASK ONLY FOR MOST RECENT BIRTH]

NUMBER OF TIMES _____
DOESN'T KNOW 98

410. CHECK 409:
NUMBER OF PRENATAL CONSULTATIONS RECEIVED?
[ASK ONLY FOR MOST RECENT BIRTH]

ONE TIME (GO TO 412)
MORE THAN ONE TIME OR DOESN'T KNOW (GO TO 411)

411. How many months were you pregnant the last time you received prenatal care?
[ASK ONLY FOR MOST RECENT BIRTH]

MONTHS _____
DOESN'T KNOW 98

412. During your pregnancy did you have the following tests at least once?
[ASK ONLY FOR MOST RECENT BIRTH]

Were you weighed?
Was your height measured?
Did they take your blood pressure?
Did you give a urine sample?
Did you give a blood sample?

WEIGHT
YES 1
NO 2
HEIGHT
YES 1
NO 2
BLOOD PRESSURE
YES 1
NO 2
URINE
YES 1
NO 2
BLOOD
YES 1
NO 2

413. Did they talk to you about signs of complications to the pregnancy?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2 (GO TO 415)
DOESN'T KNOW 8 (GO TO 415)

414. Did they tell you where to go if you had these complications?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2
DOESN'T KNOW 8

415. During the course of this pregnancy, did they give you an injection in the arm to keep the baby from getting tetanus, that is to say convulsions after birth?
[ASK ONLY FOR MOST RECENT BIRTH]

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

416. During this pregnancy, how many times did you receive this injection?
[ASK ONLY FOR MOST RECENT BIRTH]

NUMBER OF TIMES ____
DOESN'T KNOW 8

417. During this pregnancy, were you given or did you buy iron tablets or syrup containing iron?
[ASK ONLY FOR MOST RECENT BIRTH]
SHOW TABLETS/SYRUPS

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

418. During the whole pregnancy, for how many days did you take the tablets or syrup?
[ASK ONLY FOR MOST RECENT BIRTH]
IF THE ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.

DAYS ___
DOESN'T KNOW 998

419. During this pregnancy, did you have difficulty with your vision during daylight?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2
DOESN'T KNOW 8

420. During this pregnancy did you suffer from [LOCAL NAME] (night blindness)?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2
DOESN'T KNOW 8

421. During this pregnancy did you take any drugs to keep from getting malaria?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2 (GO TO 423)
DOESN'T KNOW 8 (GO TO 423)

422. What drugs did you take?
[ASK ONLY FOR MOST RECENT BIRTH]

RECORD ALL MENTIONED. IF TYPE OF DRUG IS UNKNOWN, SHOW TYPICAL ANTIMALARIAL DRUGS TO THE RESPONDENT.

FANSIDAR A
CHLOROQUINE B
AMODIAQUINE C
UNKNOWN MEDICINE D
OTHER (SPECIFY) ____ X

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

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

424. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 426)
DOESN'T KNOW 8 (GO TO 426)

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

GRAMS FROM CARD 1 ___

GRAMS FROM MEMORY 2 ___

DOESN'T KNOW 99998

426. Who assisted with the delivery of (NAME)? Anyone else?

PROBE TO THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.
IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

HEALTH PROFESSIONAL
DOCTOR A
MIDWIFE B
OBST. NURSE/HEALTH TECHNICIAN C
OTHER HEALTH CARE AGENTS
NURSE'S AIDE D
DOULA E
TRADITIONAL BIRTH ATTENDANT F
OTHER PEOPLE
RELATIVES/FRIENDS G
OTHER (SPECIFY) ____ X
NO ONE Y

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

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

NAME OF ESTABLISHMENT _____
HOME
YOUR HOME 11 (GO TO 429)
OTHER HOME 12 (GO TO 429)
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
MATERNITY/PMI (Protection maternelle et infantile, a program created in France to give free care to expecting/recent mothers) 23
OTHER PUBLIC (SPECIFY) _____ 26
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL (SPECIFY) ____ 36
COMMUNITY SECTOR
HEALTH CENTER 41
OTHER MEDICAL (SPECIFY) _____ 66
OTHER (SPECIFY) ____ 96 (GO TO 429)

428. Was (NAME) delivered by caesarean section?

YES 1 (GO TO 433)
NO 2 (GO TO 433)

429. After (NAME)'s birth, were you examined by a health professional or a village birth attendant?

YES 1
NO 2 (GO TO 433)

430. How many days after delivery did you have your first health check-up?
[ASK ONLY FOR MOST RECENT BIRTH]
RECORD '00' IF THE SAME DAY.

DAYS AFTER BIRTH 1 ___
WEEKS AFTER BIRTH 2 ___
DOESN'T KNOW 998

431. Who examined you at this time?
[ASK ONLY FOR MOST RECENT BIRTH]
PROBE FOR MOST QUALIFIED PERSON

HEALTH PROFESSIONAL
DOCTOR 11
MIDWIFE 12
OBST. NURSE/HEALTH TECHNICIAN 13
OTHER HEALTH CARE AGENTS
CAREGIVER 21
DOULA 22
TRADITIONAL BIRTH ATTENDANT 23
OTHER PEOPLE
RELATIVES/FRIENDS 31
OTHER (SPECIFY) ____ 96

432. Where did this first health exam take place?
[ASK ONLY FOR MOST RECENT BIRTH]

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

NAME OF THE ESTABLISHMENT______
HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
MATERNITY/PMI (Protection maternelle et infantile, a program created in France to give free care to expecting/recent mothers) 23
OTHER PUBLIC (SPECIFY) _____ 26
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL (SPECIFY) ____ 36
COMMUNITY SECTOR
HEALTH CENTER 41
PARA-PUBLIC SECTOR
MATERNITY/PMI 51
OTHER MEDICAL (SPECIFY) _____ 66
OTHER (SPECIFY) _____ 96

433. In the two months that followed the birth, did you receive a dose of vitamin A like this one?
[ASK ONLY FOR MOST RECENT BIRTH]
SHOW THE VIAL/PILL/SYRUP.

YES 1
NO 2

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

YES 1 (GO TO 436)
NO 2 (GO TO 437)

435. Did your period return between the birth of (NAME) and your next pregnancy?
[DO NOT ASK FOR MOST RECENT BIRTH]

YES 1
NO 2 (GO TO 439)

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

MONTHS ___
DOESN'T KNOW 98

437. CHECK 226:
IS RESPONDENT PREGNANT?
[ASK ONLY FOR MOST RECENT BIRTH]

NOT PREGNANT (GO TO 438)
PREGNANT OR UNSURE (GO TO 439)

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

YES 1
NO 2 (GO TO 440)

439. For how many months after [NAME]'s birth did you not have sexual intercourse?

MONTHS ___
DOESN'T KNOW 98

440. Did you ever breastfeed [NAME]?

YES 1
NO 2 (GO TO 447)

441. How long after birth did you first put [NAME] to the breast?
IF LESS THAN ONE HOUR RECORD '00' HOURS. IF LESS THAN 24 HOURS RECORD HOURS. OTHERWISE RECORD IN DAYS.

IMMEDIATELY 000

HOURS 1 ___
DAYS 2 ___

442. In the 3 days following birth and before your breasts began to produce milk regularly, did (NAME) drink something besides breast milk?

YES 1
NO 2 (GO TO 444)

443. What was (NAME) given to drink before your breasts began to produce milk regularly?
Anything else?
RECORD ALL LIQUIDS MENTIONED

MILK (OTHER THAN BREAST MILK) A
WATER B
SUGAR OR GLUCOSE WATER C
GRIPE WATER D
SUGAR-SALT-WATER SOLUTION E
FRUIT JUICE F
INFANT FORMULA G
TEA/BREWED LIQUID H
HONEY I
OTHER (SPECIFY) _____ X

444. CHECK 404:
LIVING CHILD?

ALIVE (GO TO 445)
DECEASED (GOT O 446)

445. Are you still breastfeeding (NAME)?

YES 1 (GO TO 448)
NO 2

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

MONTHS ___
DOESN'T KNOW 98

447. CHECK 202:
LIVING CHILD?

ALIVE (GO TO 450)
DECEASED (RETURN TO 405, FOLLOWING COLUMN, OR IF MORE BIRTHS (GO TO 454))

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

NUMBER OF NIGHTTIME FEEDINGS ___

449. Yesterday, how many times did you breastfeed during the day?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

NUMBER OF DAYTIME FEEDINGS ___

450. Did (NAME) drink something from a bottle yesterday or last night?

YES 1
NO 2
DOESN'T KNOW 8

451. Was sugar added to any food or liquid given to (NAME) yesterday?

YES 1
NO 2
DOESN'T KNOW 8

452. Yesterday, during the day or night, how many times was (NAME) fed purees or solid food or semi-solid food?
IF 7 TIMES OR MORE RECORD '7'.

NUMBER OF TIMES ___
DOESN'T KNOW 8

453. RETURN TO 405 IN THE NEXT COLUMN OR THE NEXT TO LAST COLUMN ON A NEW QUESTIONNAIRE; OR, IF NO MORE BIRTHS, GO TO 454.

SECTION 4B. VACCINATION, HEALTH AND NUTRITION

454. RECORD THE LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH IN 1996 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE THE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES).

455. LINE NUMBER FROM 212:

LINE NO. ____

456. FROM 212 AND 216:

NAME ___
LIVING (GO TO 457)
DEAD (GO TO 456, NEXT COLUMN OR IF NO MORE BIRTHS GO TO 484).

457. Did (NAME) get a dose of vitamin A, like this one, during the past 6 months?
SHOW THE VIAL/PILL/SYRUP.

YES 1
NO 2
DON'T KNOW 8

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

YES, SEEN 1 (GO TO 460)
YES, NOT SEEN 2 (GO TO 462)
NO CARD 3

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

YES 1 (GO TO 462)
NO 2 (GO TO 462)

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

BCG
DAY __
MONTH __
YEAR __
POLIO 0 (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 __
VITAMIN A (MOST RECENT)
DAY __
MONTH __
YEAR __
YELLOW FEVER
DAY __
MONTH __
YEAR __
HEPATITIS B
DAY __
MONTH __
YEAR __

461. Has (NAME) received any immunizations not recorded on this card, including vaccinations received in a national immunization day campaign?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, MEASLES, AND/OR YELLOW FEVER VACCINES.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 460) (GO TO 464)
NO 2 (GO TO 464)
DOESN'T KNOW 8 (GO TO 464)

462. Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases, including vaccinations received in a national immunization campaign?

YES 1
NO 2 (GO TO 466)
DOESN'T KNOW 8 (GO TO 466)

463. Tell me, please, if (NAME) received one of the following vaccinations:

463A. A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

YES 1
NO 2
DOESN'T KNOW 8

463B. Polio vaccine, that is, drops in the mouth?

YES 1
NO 2 (GO TO 463E)
DOESN'T KNOW 8 (GO TO 463E)

463C. Was the first vaccine for polio received right after birth or not?

JUST AFTER BIRTH 1
LATER 2

463D. How many times was the polio vaccine given?

NUMBER OF TIMES____

463E. A DPT vaccination, that is, an injection given in the thigh or arm, generally at the same time as the polio drops?

YES 1
NO 2 (GO TO 463G)
DOESN'T KNOW (GO TO 463G)

463F. How many times?

NUMBER OF TIMES____

463G. An injection against the measles?

YES 1
NO 2
DOESN'T KNOW 8

463H. A dose of vitamin A?

YES 1
NO 2
DOESN'T KNOW 8

463I. An injection against yellow fever?

YES 1
NO 2
DOESN'T KNOW 8

463J. The Hepatitis B vaccination?

YES 1
NO 2
DOESN'T KNOW 8

464. Were any of the vaccinations (NAME) received during the past two years given as part of a national immunization campaign?

YES 1
NO 2 (GO TO 466)
NO VACCINATIONS IN THE PAST 2 YEARS 3 (GO TO 466)
DOESN'T KNOW 8 (GO TO 466)

465. At which national immunization day campaigns did (NAME) receive vaccinations?
RECORD ALL MENTIONED CAMPAIGNS.

1997 CAMPAIGN (NAME) ____A
1998 CAMPAIGN (NAME) ____B
1999 CAMPAIGN (NAME) ____C
2000 CAMPAIGN (NAME) ____D

466. Has (NAME) suffered from a fever, at any moment, during the past two weeks?

YES 1
NO 2
DOESN'T KNOW 8

467. Has (NAME) suffered from a cough, at any moment, during the past two weeks?

YES 1
NO 2 (GO TO 469)
DOESN'T KNOW 8 (GO TO 469)

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

YES 1
NO 2
DOESN'T KNOW 8

469. CHECK 466 AND 467
FEVER OR COUGH?

'YES' TO 466 OR 467 (GO TO 470)
OTHER (GO TO 475)

470. Did you seek advice or treatment for the fever/cough?

YES 1
NO 2 (GO TO 472)

471. Where did you seek advice or treatment? Where else?
RECORD EVERYTHING MENTIONED.

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

NAME OF ESTABLISHMENT _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
MATERNITY/PMI C
OTHER PUBLIC (SPECIFY) _____ D
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC E
OTHER PRIVATE MEDICAL (SPECIFY) ____ F
COMMUNITY SECTOR
HEALTH CENTER G
PARA-PUBLIC SECTOR
MATERNITY/PMI H
OTHER MEDICAL (SPECIFY) ___ I
OTHER (SPECIFY) _____ X

472. CHECK 466:
HAD A FEVER?

'YES' (GO TO 473)
'NO' OR 'DOESN'T KNOW' (GO TO 475)

473. Did (NAME) take medicine for the fever?

YES 1
NO 2 (GO TO 475)
DOESN'T KNOW 8 (GO TO 475)

474. Which medicine did (NAME) take?
RECORD EVERYTHING THAT IS MENTIONED.

ASK TO SEE THE MEDICINE IF THE TYPE OF MEDICINE IS NOT KNOWN. IF THE TYPE OF MEDICINE CAN NOT BE DETERMINED, SHOW SOME COMMON ANTI-MALARIA MEDICINES TO THE RESPONDENT.

FANSIDAR A
CHLOROQUINE B
ASPIRINE C
AMODIAQUINE D
PARACETAMOL E
QUINIMAX F
OTHER (SPECIFY) ___ X
DOESN'T KNOW Z

475. Has (NAME) had diarrhea during the past two weeks?

YES 1
NO 2 (GO TO 483)
DOESN'T KNOW 8 (GO TO 483)

476. Now I would like to know how much liquid was given to (NAME) during his/her diarrhea. Did you give him/her less, about the same, or more to drink than usual?
IF LESS, PROBE: Did you give him a lot or a little less than usual to drink?

A LOT LESS 1
A LITTLE LESS 2
ABOUT THE SAME AMOUNT 3
MORE 4
NOTHING TO DRINK 5
DOESN'T KNOW 8

477. When (NAME) had diarrhea did you give him/her less to eat than usual, about the same amount, more than usual or nothing to eat?
IF LESS, PROBE: Did you give him/her a lot less to eat or a little less than usual?

A LOT LESS 1
A LITTLE LESS 2
ABOUT THE SAME AMOUNT 3
MORE 4
STOPPED FOOD 5
NEVER FED 6
DOESN'T KNOW 8

478. Did you give him/her any of the following things to drink?

a. A liquid prepared from an ORS packet?
b. A homemade liquid recommended by the government?

LIQUID ORS PACKET
YES 1
NO 2
DOESN'T KNOW 8
HOMEMADE LIQUID
YES 1
NO 2
DOESN'T KNOW 8

479. Was something (else) given to treat diarrhea?

YES 1
NO 2 (GO TO 481)
DOESN'T KNOW 8 (GO TO 481)

480. What else was given to treat diarrhea?
Something else?
RECORD EVERYTHING MENTIONED.

PILL OR SYRUP A
INJECTION B
(IV) INTRAVENOUS C
HOMEMADE REMEDIES/PLANTS D
OTHER (SPECIFY) _____ X

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

YES 1
NO 2 (GO TO 483)

482. Where did you seek advice or treatment for the diarrhea?
Anywhere else?
RECORD EVERYTHING MENTIONED.

IF IT IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, RECORD THE NAME OF THE PLACE. PROBE TO DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE(S).

PLACE NAME _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
MATERNITY/GOVERNMENT PMI C
OTHER PUBLIC (SPECIFY) _____ D
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY F
PRIVATE DOCTOR G
OTHER PRIVATE MEDICAL (SPECIFY) ____ H
COMMUNITY SECTOR
HEALTH CENTER I
PARA-PUBLIC SECTOR
MATERNITY/PMI J
OTHER MEDICAL (SPECIFY) ___ K
OTHER SOURCE
SHOP L
TRADITIONAL HEALER M
OTHER (SPECIFY) ____ X

483. RETURN TO 456 IN THE FOLLOWING COLUMN, IF NO MORE BIRTHS GO TO 484.

484. CHECK 456, ALL COLUMNS:
NUMBER OF LIVING CHILDREN BORN IN 1996 OR LATER?

ONE OR MORE (GO TO 485)
NONE (GO TO 487)

486. CHECK 478A ALL OF THE COLUMNS:

NO CHILD RECEIVED ORS PACKET OR THE QUESTION WASN'T ASKED (GO TO 487)
AT LEAST ONE CHILD RECEIVED ORS PACKET (GO TO 488)

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

YES 1
NO 2

488. CHECK 218:

ONE OR MORE CHILDREN LIVING WITH HER (GO TO 489)
NO CHILDREN LIVING WITH HER (GO TO 490)

489. When (your child/one of your children) is seriously ill, can you, yourself, decide if he should be brought somewhere for medical treatment?
IF THE RESPONDENT RESPONDS THAT NO CHILD HAS EVER BEEN SERIOUSLY ILL, ASK: If (your child/one of your children) becomes seriously ill, can you, yourself, decide if he should be brought somewhere for medical treatment?

YES 1
NO 2
IT DEPENDS 3

490. Now I would like to ask you questions about your own medical care. Different reasons can prevent women from getting advice or medical treatment for themselves. When you are sick and want advice or medical treatment, do the following things pose a problem for you or not?

Know where to go.
Get permission to go.
Get the necessary money for the treatment.
Distance to a medical establishment
Need to take a mode of transport.
Not wanting to go alone.
Concern that there are no female personnel.

WHERE TO GO
A BIG PROBLEM 1
NO PROBLEM 2
PERMISSION
A BIG PROBLEM 1
NO PROBLEM 2
MONEY
A BIG PROBLEM 1
NO PROBLEM 2
DISTANCE
A BIG PROBLEM 1
NO PROBLEM 2
TRANSPORTATION
A BIG PROBLEM 1
NO PROBLEM 2
GOING ALONE
A BIG PROBLEM 1
NO PROBLEM 2
FEMALE PERSONNEL
A BIG PROBLEM 1
NO PROBLEM 2

491. CHECK 215 AND 218:

AT LEAST ONE CHILD BORN IN 1998 OR LATER AND LIVING WITH HER:
RECORD THE NAME OF THE CHILD LIVING WITH HER (GO TO 492)

(NAME) ____
NO CHILD BORN IN 1998 OR LATER LIVING WITH HER (GO TO 494)

492. Now I would like to ask you what liquid [NAME IN 491] drank during the past 7 days including yesterday. How many days, during the past 7 days, did [NAME IN 491] drink one or more of the following liquids?

FOR EACH LIQUID CONSUMED, AT LEAST ONE TIME, IN THE PAST 7 DAYS, ASK:
In all, during the day or night how many times did [NAME IN 491] did he/she drink:

a. Water?
b. Baby formula?
c. Any other type of milk, like milk from a container, in powder, or fresh milk from an animal?
d. Fruit juice?
e. Other liquids such as sugar water, tea, coffee, carbonated drinks, or broths?

IF 7 OR MORE TIMES, RECORD '7'.
IF DOESN'T KNOW, RECORD '8'

WATER
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT NUMBER OF TIMES ___
BABY FORMULA
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT NUMBER OF TIMES ___
ANY OTHER TYPE OF MILK
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT NUMBER OF TIMES ___
d. FRUIT JUICE
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT NUMBER OF TIMES ___
e. OTHER LIQUIDS
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT NUMBER OF TIMES ___

493. Now I would like to ask you what food(s) [NAME IN 491] was given during the past 7 days, including yesterday. How many days, during the past 7 days, [NAME IN 491] did he/she get the following foods?

FOR EACH FOOD GIVEN, AT LEAST ONE TIME, IN THE PAST 7 DAYS, ASK: In total, during the day and night yesterday how many times did [NAME IN 491] get:

a. Any food prepared with grains (for example: rice, corn, millet, sorghum, oatmeal or other grains)?
b. Pumpkin, yam or yellow or red squash, carrots, or red sweet potatoes?
c. Other foods from roots (for ex: potatoes, white yams, manioc, white sweet potatoes, or other local foods from roots)?
d. Any green leafy vegetables?
e. Mango, papaya (or other fruits rich in vitamin A)?
f. Any other fruit or vegetable? (ex: banana, apple, apple sauce, green beans, avocado, tomato)?
g. Meat, poultry, fish, shellfish, eggs?
h. Other legume foods (ex: lentils, beans, soy, or nuts)?
i. Cheese or yogurt?
j. Any food prepared with oil, fat or butter?

IF 7 TIMES OR MORE, RECORD '7'.
IF DOESN'T KNOW, RECORD '8'.

a. GRAINS
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT NUMBER OF TIMES ___
b. PUMPKIN, YAMS, SQUASH, ETC.
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT NUMBER OF TIMES ___
c. OTHER FOODS FROM ROOTS
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT NUMBER OF TIMES ___
d. GREEN LEAFY VEGETABLES
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT NUMBER OF TIMES ___
e. MANGO OR PAPAYA
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT NUMBER OF TIMES ___
f. OTHER FRUITS/VEGETABLES
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT NUMBER OF TIMES ___
g. MEAT, POULTRY, FISH, SHELLFISH, EGGS
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT NUMBER OF TIMES ___
h. OTHER LEGUMES
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT NUMBER OF TIMES ___
i. CHEESE OR YOGURT
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT NUMBER OF TIMES ___
j. FOOD WITH OIL, BUTTER, OR FAT
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT NUMBER OF TIMES ___

494. Did you sleep under a mosquito net last night?

YES 1
NO 2

495. The last time you prepared a meal for your family did you wash your hands before beginning?

YES 1
NO 2
HAS NEVER PREPARED A MEAL 3

499F. During the past 3 months, have you had an injection for any reason?

YES 1
NO 2 (GO TO 501)

499G. During the past 3 months how many injections did you have?

NUMBER OF INJECTIONS___
EACH DAY 95

499H. The last time you had an injection, who gave it to you?

HEALTH PROFESSIONAL 1
PHARMACIST 2
TRADITIONAL HEALER 3
FRIEND/RELATIVE 4
RESPONDENT HERSELF 5
OTHER (SPECIFY) ____ 6

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

501. Are you currently married or do you live with a man?

YES, CURRENTLY MARRIED 1 (GO TO 505)
YES, LIVING WITH A MAN 2 (GO TO 505)
FIRST UNION NOT CONSUMMATED 3 (GO TO 514)
NO, NOT IN UNION 4

502. Have you ever been married or lived together with a man?

YES HAS BEEN MARRIED 1
YES, HAS LIVED WITH A MAN 2 (GO TO 510)
NO 3 (GO TO 514)

504. What is your current marital status: are you widowed, divorced or separated?

WIDOWED 1 (GO TO 510)
DIVORCED 2 (GO TO 510)
SEPARATED 3 (GO TO 510)

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

LIVE TOGETHER 1
LIVES ELSEWHERE 2

506. RECORD THE HUSBAND'S/PARTNER'S NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.

NAME ___
LINE NO. ___

507. Besides yourself, does your husband/partner have other wives or does he live with other women as if he were married?

YES 1
NO 2 (GO TO 510)

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

NUMBER OF WIVES OR PARTNERS ____
DOESN'T KNOW 98 (GO TO 510)

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

RANK___

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

ONLY ONCE 1
MORE THAN ONCE 2

511. CHECK 510:

MARRIED/HAS LIVED WITH ONE MAN ONLY ONCE: In which month and in which year did you begin to live with your husband/partner?

MARRIED/HAS LIVED WITH 1 MAN MORE THAN ONCE: I would like to ask about when you started living with your first husband/partner. In what month and year was that?

IF FIRST UNION WAS NOT CONSUMMATED, RETURN TO 501. CIRCLE CODE '3' AND GO TO 514.

MONTH ___
DOESN'T KNOW MONTH 98
YEAR ___ (GO TO 514)
DOESN'T KNOW YEAR 9998

512. How old were you when you began living with him?

AGE IN YEARS ___

Now I need to ask you some questions about sexual activity in order to gain a better understanding of important life issues.

514. How old were you when you had sexual intercourse for the first time?

NEVER 00 (GO TO 524)

AGE IN YEARS ___

FIRST TIME AFTER BEGINNING TO LIVE WITH (FIRST) HUSBAND/PARTNER 96

515. How long ago did you last have sex?
RECORD YEARS ONLY IF RECENT SEXUAL RELATIONS WAS A YEAR AGO OR LONGER. IF 12 MONTHS OR LONGER, THE ANSWER SHOULD BE RECORDED IN YEARS.

NUMBER OF DAYS 1 ____
NUMBER OF WEEKS 2 ____
NUMBER OF MONTHS 3 ____
NUMBER OF YEARS 4 ____ (GO TO 524)

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

YES 1
NO 2 (GO TO 517)

516A. What was the main reason why you used a condom at this time?

RESPONDENT WANTS TO AVOID GETTING STD'S/AIDS 1
RESPONDENT WANTS TO AVOID GETTING PREGNANT 2
RESPONDENT WANTS TO AVOID BOTH STD'S/AIDS AND PREGNANCY 3
DID NOT TRUST PARTNER/SUSPECTED THAT PARTNER HAD OTHER PARTNERS 4
PARTNER INSISTED 5
DOESN'T KNOW 6
OTHER (SPECIFY) _____ 7

517. What is your relationship with this man with whom you last had sexual intercourse?
IF BOYFRIEND OR FIANCÉ ASK: Did your boyfriend/fiancé live with you the last time you had sex with him? IF 'YES', RECORD '1'. IF 'NO', RECORD '2'.

IT'S MY PARTNER HUSBAND/CO-HABITING PARTNER 1 (GO TO 519)
IT'S MY BOYFRIEND/FIANCÉ 2
IT'S ANOTHER FRIEND 3
IT'S AN OCCASIONAL ENCOUNTER 4
IT'S A RELATIVE 5
IT'S A CLIENT (PROSTITUTION) 6
OTHER (SPECIFY) ____ 7

518. How long have you been having sexual intercourse with this man?

NUMBER OF DAYS 1 __
NUMBER OF WEEKS 2 __
NUMBER OF MONTHS 3 __
NUMBER OF YEARS 4 __

519. During the last 12 months, did you have sexual intercourse with another man?

YES 1
NO 2 (GO TO 524)

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

YES 1
NO 2 (GO TO 521)

520A. What was the main reason why you used a condom at this time?

RESPONDENT WANTS TO AVOID GETTING STD'S/AIDS 1
RESPONDENT WANTS TO AVOID GETTING PREGNANT 2
RESPONDENT WANTS TO AVOID BOTH STD'S/AIDS AND PREGNANCY 3
DID NOT TRUST PARTNER/SUSPECTED THAT PARTNER HAD OTHER PARTNERS 4
PARTNER INSISTED 5
DOESN'T KNOW 6
OTHER (SPECIFY) ____ 7

521. What is your relationship with this man with whom you last had sexual intercourse?
IF BOYFRIEND OR FIANCÉ ASK: Did your boyfriend/fiancé live with you the last time you had sex with him? IF 'YES', RECORD '1'. IF 'NO', RECORD '2'.

IT'S MY PARTNER HUSBAND/CO-HABITING PARTNER 1 (GO TO 522A)
IT'S MY BOYFRIEND/FIANCÉ 2
IT'S ANOTHER FRIEND 3
IT'S AN OCCASIONAL ENCOUNTER 4
IT'S A RELATIVE 5
IT'S A CLIENT (PROSTITUTION) 6
OTHER (SPECIFY) _____7

522. How long have you been having sexual intercourse with this man?

NUMBER OF DAYS 1 ___
NUMBER OF WEEKS 2 ___
NUMBER OF MONTHS 3 ___
NUMBER OF YEARS 4 ___

522A. Apart from this/these two person(s) did you have sexual intercourse with anyone else during the past 12 months?

YES 1
NO 2 (GO TO 524)

522B. The last time you had sexual intercourse with this other man, was a condom used?

YES 1
NO 2 (GO TO 522D)

522C. What was the main reason why you used a condom at this time?

RESPONDENT WANTS TO AVOID GETTING STD'S/AIDS 1
RESPONDENT WANTS TO AVOID GETTING PREGNANT 2
RESPONDENT WANTS TO AVOID BOTH STD'S/AIDS AND PREGNANCY 3
DID NOT TRUST PARTNER/SUSPECTED THAT PARTNER HAD OTHER PARTNERS 4
PARTNER INSISTED 5
DOESN'T KNOW 6
OTHER (SPECIFY) ____ 7

522D. What is your relationship with this man with whom you last had sexual intercourse?
IF BOYFRIEND OR FIANCÉ ASK: Did your boyfriend/fiancé live with you the last time you had sex with him? IF 'YES', RECORD '1'. IF 'NO', RECORD '2'.

IT'S MY PARTNER HUSBAND/CO-HABITING PARTNER 1 (GO TO 523)
IT'S MY BOYFRIEND/FIANCÉ 2
IT'S ANOTHER FRIEND 3
IT'S AN OCCASIONAL ENCOUNTER 4
IT'S A RELATIVE 5
IT'S A CLIENT (PROSTITUTION) 6
OTHER (SPECIFY) _____7

522E. How long have you been having sexual intercourse with this man?

NUMBER OF DAYS 1 ___
NUMBER OF WEEKS 2 __
NUMBER OF MONTHS 3 __
NUMBER OF YEARS 4 __

523. In all, how many different people did you have sexual intercourse with during the past 12 months?

NUMBER OF PARTNERS ___

524. Do you know a place where one could procure condoms?

YES 1
NO 2 (GO TO 601)

525. Where is this?
Anywhere else?
RECORD ALL MENTIONED.

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

NAME OF PLACE_____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MATERNITY/PMI D
MOBILE CLINIC E
FIELD WORKER F
OTHER PUBLIC (SPECIFY) ____G
MEDICAL PRIVATE SECTOR
CLINIC H
PHARMACY I
PRIVATE DOCTOR J
FIELD WORKER K
OTHER PRIVATE MEDICAL (SPECIFY) ____ L
COMMUNITY SECTOR
HEALTH CENTER M
HEALTH CARE WORKER N
ADBC/DOULA/BIRTH ASSISTANT/HEALTH AIDE O
PARA-PUBLIC SECTOR
INPS/SMIE (NATIONAL INSTITUTE OF SOCIAL FUNDS/INTER-ENTERPRISE MEDICAL CENTER) P
MUTEC (EDUCATION AND CULTURE WORKERS MUTUAL) Q
OTHER (SPECIFY) ___ R
OTHER SOURCE
SHOP/MARKET S
TRADITIONAL HEALER T
CHURCH U
RELATIVES/FRIENDS V
OTHER (SPECIFY) ___ X

526. If you wanted to, could you procure a condom?

YES 1
NO 2
DOESN'T KNOW/UNSURE 8

SECTION 6. FERTILITY PREFERENCES

601. CHECK 311/311A:

NEITHER STERILIZED (GO TO 602)
HE OR SHE STERILIZED (GO OT 614)

602. CHECK 226:

NOT PREGNANT OR NOT SURE. Now I have a few questions about the future. Would you like to have (a/another) child, or would you prefer not to have (other) children at all?

PREGNANT. Now I have a few questions about the future. After the child that you are expecting, would you like to have (a/another) child, or would you prefer not to have (other) children at all?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 604)
SAYS SHE CAN NOT GET PREGNANT 3 (GO TO 614)
NOT SURE/DOESN'T KNOW AND PREGNANT 4 (GO TO 610)
NOT PREGNANT AND NOT SURE 5 (GO TO 608)

603. CHECK 226:

NOT PREGNANT OR NOT SURE. 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, how long would you like to wait from now before the birth of another child?

MONTHS 1 ___
YEARS 2 ___

SOON/NOW 993 (GO TO 609)
SAYS SHE CANNOT GET PREGNANT 994 (GO TO 614)
AFTER MARRIAGE 995 (GO TO 609)
OTHER (SPECIFY) ___ 996 (GO TO 609)
DOESN'T KNOW 998 (GO TO 609)

604. CHECK 226:

NOT PREGNANT OR NOT SURE (GO TO 605)
PREGNANT (GO TO 610)

605. CHECK 310:
USES A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 606)
DOES NOT CURRENTLY USE (GO TO 606)
CURRENTLY USES (GO TO 608)

606. CHECK 603:

NOT ASKED (GO TO 607)
24 MONTHS OR MORE OR 2 YEARS OR MORE (GO TO 607)
00-23 MONTHS OR 00-01 YEARS (GO TO 610)

607. CHECK 602:

WANTS A/ANOTHER CHILD. You said that, right now, you do not want to have a/another child, but you do not use a method of avoiding pregnancy. Could you tell me why?
Another reason?

DOES NOT WANT A/ANOTHER CHILD. You said that you do not want to have a/another child, but you do not use a method of avoiding pregnancy. Could you tell me why?
Another reason?

RECORD ALL THE REASONS MENTIONED.

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

608. In the coming weeks, if you discover that you are pregnant would this be a big problem, a small problem or not a problem at all?

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

609. CHECK 310:
CURRENTLY USES A METHOD?

NOT ASKED (GO TO 610)
DOES NOT CURRENTLY USE (GO TO 610)
CURRENTLY USES (GO TO 614)

610. Do you think that, in the near or distant future you will use a method to delay or avoid a pregnancy?

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

611. Which method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 614)
MALE STERILIZATION 02 (GO TO 614)
PILL 03 (GO TO 614)
IUD 04 (GO TO 614)
INJECTIONS 05 (GO TO 614)
IMPLANTS 06 (GO TO 614)
CONDOM 07 (GO TO 614)
FEMALE CONDOM 08 (GO TO 614)
DIAPHRAGM 09 (GO TO 614)
FOAM/JELLY 10 (GO TO 614)
LACTATION AMEN. METHOD 11 (GO TO 614)
RHYTHM METHOD 12 (GO TO 614)
WITHDRAWAL 13 (GO TO 614)
OTHER METHOD (SPECIFY) ____ 96 (GO TO 614)
UNSURE 98 (GO TO 614)

612. What is the main reason that you think that you will not use a contraception method at any time in the future?

NOT MARRIED 11
FERTILITY-RELATED REASONS
NOT HAVING SEX/INFREQUENT SEX 22 (GO TO 614)
MENOPAUSE/HYSTERECTOMY 23 (GO TO 614)
SUB-FECUND/STERILE 24 (GO TO 614)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (GO TO 614)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 614)
HUSBAND/PARTNER OPPOSED 32 (GO TO 614)
OTHER PERSONS OPPOSED 33 (GO TO 614)
RELIGIOUS PROHIBITION 34 (GO TO 614)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 614)
KNOWS NO SOURCE 42 (GO TO 614)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 614)
FEAR OF SIDE EFFECTS 52 (GO TO 614)
LACK OF ACCESS/TOO FAR 53 (GO TO 614)
COSTS TOO MUCH 54 (GO TO 614)
INCONVENIENT TO USE 55 (GO TO 614)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 614)
OTHER (SPECIFY) ____ 96 (GO TO 614)
DOESN'T KNOW 98 (GO TO 614)

613. Would you use a contraceptive method if you were married?

YES 1
NO 2
DOESN'T KNOW 8

614. CHECK 216:

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

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

PROBE FOR A NUMERIC RESPONSE.
IF NONE, CIRCLE '00' AND GO TO 616.

NONE 00 (GO TO 616)

NUMBER __

OTHER (SPECIFY) ____ 96 (GO TO 616)

615. 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?

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

616. Would you say that you approve or disapprove if couples using a method to avoid getting pregnant?

APPROVE 1
DISAPPROVE 2
DOESN'T KNOW/NOT SURE 3

617. During the last few months, have you heard about family planning:

On the radio?
On the television?
In newspapers or magazines?
On a poster?
On a flier or brochure?
Cultural organization?
School?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPERS OR MAGAZINES
YES 1
NO 2
POSTER
YES 1
NO 2
FLIER OR BROCHURE
YES 1
NO 2
CULTURAL ORGANIZATION
YES 1
NO 2
SCHOOL
YES 1
NO 2

618. In your opinion, is it okay or not okay to talk about family planning:

On the radio?
On the television?
In newspapers or magazines?
On a poster?
On a flier or brochure?
Cultural/educational organization?
School?

RADIO
OKAY 1
NOT OKAY 2
TELEVISION
OKAY 1
NOT OKAY 2
NEWSPAPERS OR MAGAZINES
OKAY 1
NOT OKAY 2
POSTER
OKAY 1
NOT OKAY 2
FLIER OR BROCHURE
OKAY 1
NOT OKAY 2
CULTURAL/EDUCATIONAL ORGANIZATION
OKAY 1
NOT OKAY 2
SCHOOL
OKAY 1
NOT OKAY 2

619. During the past 12 months, have you discussed the practice of family planning with your friends, neighbors, or relatives?

YES 1
NO 2 (GO TO 621)

620. With whom did you discuss this?
Anyone else?
RECORD EVERYTHING MENTIONED.

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

621. CHECK 501:

YES, CURRENTLY MARRIED (GO TO 622)
YES, LIVES WITH A MAN (GO TO 622)
NO, NOT IN A UNION OR FIRST UNION NOT CONSUMMATED (GO TO 628)

622. CHECK 311/311A:

AT LEAST ONE CODE CIRCLED (GO TO 623)
NO CODE CIRCLED (GO TO 624)

623. You said that you are currently using a method of contraception. Could you tell me if using of this method is mainly your own decision, or that of your partner/husband, or a joint decision?

MAINLY RESPONDENT'S DECISION 1
MAINLY PARTNER/HUSBAND'S DECISION 2
JOINT DECISION 3
OTHER (SPECIFY) ____ 6

Now I would like to ask you about your partner/husband's opinions about family planning.

624. Do you think that your partner/husband approves or disapproves of couples using methods to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DOESN'T KNOW 8

625. How many times during the past 12 months did you speak with your partner/husband about family planning?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

626. CHECK 311/311A:

NEITHER HE NOR SHE IS STERILIZED (GO TO 627)
HE OR SHE IS STERILIZED (GO TO 628)

627. Does your husband want the same number of children that you want, or does he want more of fewer than you want?

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

628. Husbands and wives do not always agree on everything. Please, tell me if you think it is legitimate for a wife to refuse to have sexual intercourse with her husband when:

She knows that her husband has a sexually transmitted infection?
She knows that her husband has sexual intercourse with other women besides his wives?
She recently gave birth?
She is tired or not in the mood for it?

HE HAS AN STD
YES 1
NO 2
DOESN'T KNOW 8
OTHER WOMEN
YES 1
NO 2
DOESN'T KNOW 8
RECENT BIRTH
YES 1
NO 2
DOESN'T KNOW 8
TIRED/NOT IN THE MOOD
YES 1
NO 2
DOESN'T KNOW 8

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

701. CHECK 501 AND 502:

CURRENTLY MARRIED/LIVES WITH A MAN (GO TO 702)
HAS BEEN MARRIED/HAS LIVED WITH A MAN (GO TO 703)
NOT IN UNION/FIRST MARRIAGE NOT CONSUMMATED (GO TO 707)

702. How old was your husband at his last birthday?

AGE IN COMPLETED YEARS ___

703. Did your (last) husband attend school?

YES 1
NO 2 (GO TO 706)

704. What was the highest level of school that he achieved: primary 1 (first cycle), primary 2 (second cycle), secondary (high school or technical) or superior?

PRIMARY 1 (FIRST CYCLE) 1
PRIMARY 2 (SECOND CYCLE) 2
SECONDARY (HIGH SCHOOL/TECH) 3
SUPERIOR 4
OTHER (SPECIFY) _____ 6
DOESN'T KNOW 8 (GO TO 706)

705. What was the last (year/class) that he achieved at this level?

CLASS/YEAR ___
DOESN'T KNOW 98

706. CHECK 701:

CURRENTLY MARRIED/LIVES WITH A MAN. What is your husband/partner's occupation?
That is, what kind of work does he mainly do?

HAS BEEN MARRIED/HAS LIVED WITH A MAN. What was your last husband/partner's occupation? That is, what kind of work did he mainly do?

OCCUPATION _____

707. Aside from your housework, do you currently work?

YES 1 (GO TO 710)
NO 2

708. As you know, some women take up jobs for which they are paid in cash or in kind. Others sell things, have a small business or work on the family farm or in a family business.
Do you currently do something like this or any other work?

YES 1 (GO TO 710)
NO 2

709. Did you do any type of work during the past 12 months?

YES 1
NO 2 (GO TO 719)

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

OCCUPATION _____

711. CHECK 710:

WORKS IN AGRICULTURE (GO TO 712)
DOES NOT WORK IN AGRICULTURE (GO TO 713)

712. Do you work mainly on your own land or on family land, or did 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
OTHER (SPECIFY) _____ 6 (GO TO 714)

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

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

714. Do you usually work at home or away from home?

HOME 1
AWAY 2

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

THROUGHOUT THE YEAR 1
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3

716. Are you paid in cash or in kind for this work or are you not paid at all?

CASH ONLY 1
MONEY AND KIND 2
IN KIND ONLY 3 (GO TO 719)
NOT PAID 4 (GO TO 719)

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

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

718. On average, how much of your household's expenses are paid by what you earn: almost nothing, less than half, about half, more than half or all?

ALMOST NONE 1
LESS THAN HALF 2
ABOUT HALF 3
MORE THAN HALF 4
ALL 5
NONE, ALL EARNINGS ARE KEPT 6

719. In your family who generally has the last word in the following decisions:

Your own healthcare?
The purchase of major things for the household?
Purchase of things for daily household needs?
Visits to family or parents?
What food will be prepared each day?

HEALTHCARE
THE RESPONDENT HERSELF 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE TOGETHER 5
DECISION NOT MADE/NOT APPLICABLE 6
PURCHASE OF MAJOR THINGS
THE RESPONDENT HERSELF 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE TOGETHER 5
DECISION NOT MADE/NOT APPLICABLE 6
PURCHASE OF DAILY THINGS
THE RESPONDENT HERSELF 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE TOGETHER 5
DECISION NOT MADE/NOT APPLICABLE 6
VISITS TO FAMILY
THE RESPONDENT HERSELF 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE TOGETHER 5
DECISION NOT MADE/NOT APPLICABLE 6
PREPARED FOOD
THE RESPONDENT HERSELF 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE TOGETHER 5
DECISION NOT MADE/NOT APPLICABLE 6

720. PRESENCE OF OTHER PEOPLE AT THIS TIME (PERSONS PRESENT AND ARE LISTENING, PRESENT BUT ARE NOT LISTENING, OR NOT PRESENT)

CHILDREN LESS THAN 10 YEARS OLD
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 8
HUSBAND
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 8
OTHER MEN
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 8
OTHER WOMEN
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 8

721. Sometimes a husband can get upset or angry because a certain things his wife does. In your opinion, is it legitimate that a husband beat or hit his wife in the following situations:

If she goes out without telling him?
If she neglects her children?
If she argues with him?
If she refuses to have sexual intercourse with him?
If she burns the food?

GOES OUT
YES 1
NO 2
DOESN'T KNOW 8
NEGLECTS CHILDREN
YES 1
NO 2
DOESN'T KNOW 8
ARGUES
YES 1
NO 2
DOESN'T KNOW 8
REFUSES SEX
YES 1
NO 2
DOESN'T KNOW 8
BURNS FOOD
YES 1
NO 2
DOESN'T KNOW 8

SECTION 8. AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES

Now I would like to talk to you about something else.

801. Have you ever heard of a disease called AIDS?

YES 1
NO 2 (GO TO 817)

802. Is there something people can do to avoid getting the virus that causes AIDS?

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

803. What can a person do?
Anything else?
RECORD EVERYTHING CITED.

ABSTAIN FROM SEX A
USE CONDOMS B
LIMIT TO ONE PARTNER/STAY LOYAL TO ONE PARTNER C
LIMIT THE NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PERSONS WITH MULTIPLE PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH THOSE WHO INJECT THEMSELVES WITH DRUGS H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID SHARING THE SAME BLADES/RAZORS K
AVOID KISSING L
AVOID MOSQUITO BITES M
SEEK PROTECTION FROM A TRADITIONAL HEALER N
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) _____ X
DOESN'T KNOW Z

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

YES 1
NO 2
DOESN'T KNOW 8

805. Can people get AIDS from mosquito bites?

YES 1
NO 2
DOESN'T KNOW 8

806. Can people reduce their risk of getting aids by using a condom every time they have sex?

YES 1
NO 2
DOESN'T KNOW 8

807. Can people get AIDS by sharing food with someone who has AIDS?

YES 1
NO 2
DOESN'T KNOW 8

808. Can people protect themselves from AIDS by completely abstaining from sexual intercourse?

YES 1
NO 2
DOESN'T KNOW 8

809. Is it possible that a person who appears to be healthy, in fact, has AIDS virus?

YES 1
NO 2
DOESN'T KNOW 8

810. Do you know anyone who has the AIDS virus or who died of AIDS?

YES 1
NO 2

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

YES 1
NO 2 (GO TO 813)
DOESN'T KNOW 8 (GO TO 813)

812. The virus that causes AIDS can be transmitted from mother to her baby:

During the pregnancy?
During birth?
During breastfeeding?

PREGNANCY
YES 1
NO 2
DOESN'T KNOW 8
BIRTH
YES 1
NO 2
DOESN'T KNOW 8
BREASTFEEDING
YES 1
NO 2
DOESN'T KNOW 8

813. CHECK 501:

CURRENTLY MARRIED/LIVES WITH A MAN (GO TO 814)
NO, NOT IN UNION OR FIRST UNION NOT CONSUMMATED (GO TO 815A)

814. Have you ever spoken about ways to avoid getting the AIDS virus with (your husband/ the man with whom you live)?

YES 1
NO 2

815A. In your opinion, is it okay or not okay to talk about AIDS:

On the radio?
On the television?
In newspapers or magazines?
On a poster?
On a flier or brochure?
Cultural/educational organization?
School?

RADIO
OKAY 1
NOT OKAY 2
TELEVISION
OKAY 1
NOT OKAY 2
NEWSPAPERS OR MAGAZINES
OKAY 1
NOT OKAY 2
POSTER
OKAY 1
NOT OKAY 2
FLIER OR BROCHURE
OKAY 1
NOT OKAY 2
CULTURAL/EDUCATIONAL ORGANIZATION
OKAY 1
NOT OKAY 2
SCHOOL
OKAY 1
NOT OKAY 2

815B. If a person learns that he/she was infected with the AIDS virus, should this person be allowed to keep his/her state secret or should this information be communicated to the community?

CAN BE KEPT SECRET 1
COMMUNICATED TO THE COMMUNITY 2
DOESN'T KNOW/UNSURE 8

816. If a member of your family became sick with the AIDS virus, would you be willing to take care of him/her in your own household?

YES 1
NO 2
DOESN'T KNOW/UNSURE/IT DEPENDS 8

817A. In your opinion, if a teacher has the AIDS virus but is not sick, should she/he be able to continue teaching in the school?

SHOULD BE ALLOWED 1
SHOULD NOT BE ALLOWED 2
DOESN'T KNOW/UNSURE/IT DEPENDS 8

817B. Should children age 12-14 be taught about using a condom to avoid getting the AIDS virus?

YES 1
NO 2
DOESN'T KNOW/UNSURE/IT DEPENDS 8

817C. Have you ever been tested for the AIDS virus?

YES 1 (GO TO 817FX)
NO 2

817D. Would you like to have a test for the AIDS virus?

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

817E. Do you know of a place where you can get tested for the AIDS virus?

YES 1
NO 2 (GO TO 817)

817F. Where can you go for a test for the AIDS virus?
817X Where did you go for this test?

RECORD EVERYTHING MENTIONED.

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

NAME(S) OF PLACE(S) ____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
PMI (protection maternelle et infantile) /MATERNITY D
MOBILE CLINIC E
FIELD WORKER F
OTHER PUBLIC (SPECIFY) _____ G
MEDICAL PRIVATE SECTOR
CLINIC H
PHARMACY I
PRIVATE DOCTOR J
FIELD WORKER K
OTHER PRIVATE MEDICAL (SPECIFY) ____ L
COMMUNITY SECTOR
HEALTH CENTER M
HEALTH WORKER N
ADBC/DOULA/BIRTH ASSISTANT/HEALTH AIDE O
PARA-PUBLIC SECTOR
INPS/CMIE (NATIONAL INSTITUTE OF SOCIAL FUNDS/INTER-ENTERPRISE MEDICAL CENTER) P
MUTEC (EDUCATION AND CULTURE WORKERS MUTUAL) Q
OTHER (SPECIFY) ____ R
OTHER SOURCE
SHOP/MARKET S
TRADITIONAL HEALER T
CHURCH U
RELATIVES/FRIENDS V
OTHER (SPECIFY) ___ X

817. Apart from AIDS have you heard about other diseases that can be transmitted through sexual contact?

YES 1
NO 2 (GO TO 820A)

818. When a man has a sexually transmitted infection, which symptom could he have?
Are there other symptoms?
RECORD ALL MENTIONED

ABDOMINAL PAIN A
GENITAL DISCHARGE B
FOUL-SMELLING DISCHARGE C
BURNING URINATION D
GENITAL REDNESS/INFLAMMATION E
GENITAL SWELLING F
GENITAL SORE/ULCER 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
DOESN'T KNOW Z

819. When a woman has a sexually transmitted infection, which symptom could she have?
Are there other symptoms?
RECORD ALL MENTIONED

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

820A. CHECK 514:

HAS HAD SEXUAL INTERCOURSE (GO TO 820AA)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 901)

820AA. CHECK 817:

HAS HEARD ABOUT SEXUALLY TRANSMITTED DISEASES (GO TO 820B)
HAS NOT HEARD ABOUT SEXUALLY TRANSMITTED DISEASES (GO TO 820C)

820B. Now I would like to ask you about your health in the last 12 months. During the last 12 months have you had a disease which you got from sexual contact?

YES 1
NO 2
DOESN'T KNOW 8

820C. Sometimes a woman has a (bad smelling) abnormal genital discharge. During the last 12 months have you had a (bad smelling) genital discharge?

YES 1
NO 2
DOESN'T KNOW 8

820D. Sometimes women have a genital sore or ulcer. During the past 12 months have you had a genital sore or ulcer?

YES 1
NO 2
DOESN'T KNOW 8

820E. CHECK 820B, 820C AND 820D:

HAS HAD AN INFECTION (GO TO 820F)
HAS NOT HAD AN INFECTION (GO TO 901)

820F. The last time you had (INFECTION MENTIONED IN 820B/820C/820D), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 820H)

820G. The last time you had (INFECTION MENTIONED IN 820B/820C/820D), did you do one of the following things? Did you...

Visit a clinic, hospital or private doctor?
Consult a traditional healer?
Seek advice or buy medicine in a shop or pharmacy?
Seek advice from friends or relatives?

CLINIC/HOSPITAL
YES 1
NO 2
TRADITIONAL HEALER
YES 1
NO 2
SHOP/PHARMACY
YES 1
NO 2
FRIENDS/RELATIVES
YES 1
NO 2

820H. The last time you had (INFECTION MENTIONED IN 820B/820C/820D), did you tell the man/men with whom you had sexual intercourse?

YES 1
NO 2
SOME MEN/NOT ALL 3

820I. The last time you had (INFECTION MENTIONED IN 820B/820C/820D), did you do something to avoid infecting your sexual partner(s)?

YES 1
NO 2 (GO TO 901)
PARTNER(S) ALREADY INFECTED 3 (GO TO 901)

820J. What did you do to avoid infecting you partner(s)? Did you…

a. Stop having sexual intercourse?
b. Use a condom during sexual intercourse?
c. Take medicine?

STOP SEX
YES 1
NO 2
USE CONDOM
YES 1
NO 2
TAKE MEDICINE
YES 1
NO 2

SECTION 9. FEMALE CIRCUMCISION

Now, I would like to ask you about a subject relating to women's health.

901. Have you ever heard of female circumcision?

YES 1 (GO TO 903)
NO 2

902. In certain countries including Mali, there is a practice that involves cutting a part of the external genitals of girls. Have you heard of this practice?

YES 1
NO 2 (GO TO 1001)

903. Were you circumcised?

YES 1
NO 2 (GO TO 909)

Now, I would like to ask you some questions about what was done at that time.

904. Did someone cut something in the genital area?

YES 1 (GO TO 906)
NO 2
DOESN'T KNOW 8

905. Did they just make a laceration in your genitals without cutting anything off?

YES 1
NO 2
DOESN'T KNOW 8

906. Did they close the area of your vagina with stitches?

YES 1
NO 2
DOESN'T KNOW 8

907. How old were you when you underwent this practice?
IF THE RESPONDENT DOESN'T KNOW THE EXACT AGE, TRY TO GET AN ESTIMATE.

AGE IN YEARS COMPLETED____

DURING CHILDHOOD 95
DOESN'T KNOW 98

908. Who performed your circumcision?

TRADITIONAL
TRADITIONAL FEMALE CIRCUMCISER 11
TRADITIONAL MIDWIFE 12
OTHER TRADITIONAL (SPECIFY) _____ 16
HEALTH PROFESSIONAL
DOCTOR 21
NURSE/MIDWIFE 22
OTHER HEALTH PROFESSIONAL (SPECIFY) _____ 26
DOESN'T KNOW 98

909. CHECK 214 AND 216:

AT LEAST ONE LIVING DAUGHTER (GO TO 910)
NO LIVING DAUGHTER (GO TO 919)

910. Have some of your daughters undergone this kind of practice?
IF YES: How many?

NUMBER CIRCUMCISED ___
NO DAUGHTER CIRCUMCISED 95 (GO TO 918)

911. Which one of your daughters was most recently circumcised?
CHECK 212 AND RECORD THE LINE NUMBER OF THE DAUGHTER

NAME OF DAUGHTER ___
LINE NUMBER OF THE DAUGHTER FROM 212 ___

I would now like to ask you some questions about what was done to (NAME OF THE DAUGHTER from 911) at that time.

912. Did someone remove part of her genitals?

YES 1 (GO TO 914)
NO 2
DOESN'T KNOW 8

913. Did someone just slash her genitals without removing anything?

YES 1
NO 2
DOESN'T KNOW 8

914. Was her vagina closed by a stitch?

YES 1
NO 2
DOESN'T KNOW 8

915. How old was (NAME OF THE DAUGHTER from 911) at the time of the circumcision?
IF THE RESPONDENT DOESN'T KNOW THE AGE, PROBE TO GET AN ESTIMATE.

AGE IN COMPLETED YEARS ___

DURING CHILDHOOD 95
DOESN'T KNOW 98

916. Who performed the circumcision?

TRADITIONAL
TRADITIONAL FEMALE CIRCUMCISER 11
TRADITIONAL MIDWIFE 12
OTHER TRADITIONAL (SPECIFY) _____ 16
HEALTH PROFESSIONAL
DOCTOR 21
NURSE/MIDWIFE 22
OTHER HEALTH PROFESSIONAL (SPECIFY) _____ 26
DOESN'T KNOW 98

917. Did you notice at the time someone cut (NAME OF THE DAUGHTER FROM 911)'s genitals one of the following problems?

Excessive bleeding?
Difficulty urinating or retaining urine?
Swelling in the genital area?
Infection in the genital area/the wound not correctly scarred?

EXCESSIVE BLEEDING
YES 1 (GO TO 919)
NO 2 (GO TO 919)
DOESN'T KNOW 8 (GO TO 919)
DIFFICULTY URINATING/RETENTION URINE
YES 1 (GO TO 919)
NO 2 (GO TO 919)
DOESN'T KNOW 8 (GO TO 919)
SWELLING
YES 1 (GO TO 919)
NO 2 (GO TO 919)
DOESN'T KNOW 8 (GO TO 919)
INFECTION/INCORRECT SCARRING
YES 1 (GO TO 919)
NO 2 (GO TO 919)
DOESN'T KNOW 8 (GO TO 919)

918. In the future, do you intend to have your daughters circumcised?

YES 1
NO 2
DOESN'T KNOW 8

919. What are the advantages to circumcising a girl?
PROBE: other advantages?
RECORD ALL MENTIONED.

BETTER HYGIENE A
SOCIAL RECOGNITION B
BETTER CHANCE FOR MARRIAGE C
PRESERVATION OF VIRGINITY/PREVENT SEXUAL INTERCOURSE BEFORE MARRIAGE D
MORE SEXUAL PLEASURE FOR THE MAN E
RELIGIOUS NECESSITY F
OTHER (SPECIFY) ____ X
NO ADVANTAGE Y

920. What are the advantages of girls not being circumcised?
PROBE: anything else?
RECORD ALL MENTIONED

FEWER HEALTH PROBLEMS A
AVOIDING THE SUFFERING B
MORE SEXUAL PLEASURE FOR HER C
MORE PLEASURE FOR THE MAN D
IN ACCORDANCE WITH RELIGION E
OTHER (SPECIFY) ____ X
NO ADVANTAGE Y

921. Do you think this practice is a way for preventing girls from having sexual intercourse before marriage or do you think, on the contrary, that this has no effect?

PREVENTS SEX 1
NO EFFECT 2
DOESN'T KNOW 8

922. Do you think that this practice is required by your religion?

YES 1
NO 2
DOESN'T KNOW 8

923. Do you think that this practice should be maintained or that it should disappear?

MAINTAINED 1
DISAPPEAR 2
IT DEPENDS 3
DOESN'T KNOW 8

924. Do you think that men want this practice to be preserved or do you think they favor abandoning it?

PRESERVED 1
ABANDONED 2
IT DEPENDS 3
DOESN'T KNOW 8

SECTION 10. MATERNAL MORTALITY

Now I would like to ask you some questions about your brothers and sisters, that is to say about all of the children born to your biological mother, including those who live with you, those who live elsewhere and those who died.

1001. To how many children, including yourself, did your mother give birth?

MOTHER'S NUMBER OF BIRTHS____

1002. CHECK 1001:

TWO OR MORE BIRTHS (GO TO 1003)
ONLY ONE BIRTH (THE RESPONDENT) (GO TO 1014)

1003. How many births did your mother have before your birth?

NUMBER OF PRECEDING BIRTHS ____

[ASK QUESTIONS 1004-1013 FOR ALL BIRTHS OF RESPONDENT'S MOTHER]

1004. What name was given to your oldest brother or sister (or the next)?

NAME ___

1005. Is (NAME) male or female?

MALE 1
FEMALE 2

1006. Is (NAME) still alive?

YES 1
NO 2 (GO TO 1008)
DOESN'T KNOW 8 (GO TO NEXT BIRTH)

1007. How old is (NAME)?

AGE ___ (GO TO NEXT BIRTH)

1008. How many years has (NAME) been deceased?

YEARS____

1009. How old was (NAME) when he/she died?
IF MAN, OR IF WOMAN DECEASED BEFORE THE AGE OF 12 YEARS GO TO NEXT BIRTH.

AGE ___

1010. Was (NAME) pregnant when she died?

YES 1(GO TO 1013)
NO 2

1011. Did (NAME) die during childbirth?

YES 1 (GO TO 1013)
NO 2

1012. Did (NAME) die in the two months following a pregnancy or birth?

YES 1
NO 2

1013. To how many children did (NAME) give birth to during her life (before this pregnancy)?

NUMBER ___ (GO TO NEXT BIRTH; IF NO MORE BROTHERS OR SISTERS, GO TO 1014)

1014. RECORD THE TIME:

HOURS ___
MINUTES ___

INTERVIEWER'S OBSERVATIONS

FILL OUT AFTER ENDING THE INTERVIEW.

COMMENTS ABOUT THE RESPONDENT ______
COMMENTS ON PARTICULAR QUESTIONS ______
OTHER COMMENTS ______

SUPERVISOR'S OBSERVATIONS ______
NAME______
DATE______

FIELD EDITOR'S OBSERVATIONS ______
NAME______
DATE______

CALENDAR

INSTRUCTIONS: ONLY ONE CODE PER BOX.

BIRTHS AND PREGNANCIES:

N BIRTH
G PREGNANCY
F END OF PREGNANCY

2001:

12 DEC 01____
11 NOV 02____
10 OCT 03____
09 SEPT 04____
08 AUG 05____
07 JUL 06____
06 JUN 07____
05 MAY 08____
04 APR 09____
03 MAR 10____
02 FEB 11____
01 JAN 12____

2000:

12 DEC 13____
11 NOV 14____
10 OCT 15____
09 SEPT 16____
08 AUG 17____
07 JUL 18____
06 JUN 19____
05 MAY 20____
04 APR 21____
03 MAR 22____
02 FEB 23____
01 JAN 24____

1999:

12 DEC 25____
11 NOV 26____
10 OCT 27____
09 SEPT 28____
08 AUG 29____
07 JUL 30____
06 JUN 31____
05 MAY 32____
04 APR 33 ____
03 MAR 34____
02 FEB 35____
01 JAN 36____

1998:

12 DEC 37____
11 NOV 38____
10 OCT 39____
09 SEPT 40____
08 AUG 41____
07 JUL 42____
06 JUN 43____
05 MAY 44____
04 APR 45____
03 MAR 46____
02 FEB 47____
01 JAN 48____

1997:

12 DEC 49____
11 NOV 50____
10 OCT 51____
09 SEPT 52____
08 AUG 53____
07 JUL 54____
06 JUN 55____
05 MAY 56____
04 APR 57____
03 MAR 58____
02 FEB 59____
01 JAN 60____

1996:

12 DEC 61____
11 NOV 62____
10 OCT 63____
09 SEPT 64____
08 AUG 65____
07 JUL 66____
06 JUN 67____
05 MAY 68____
04 APR 69____
03 MAR 70____
02 FEB 71____
01 JAN 72____