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DEMOGRAPHIC AND HEALTH SURVEY FOR MALI --DHSM IV, 2006
WOMAN'S QUESTIONNAIRE

PLANNING AND STATISTICAL UNIT/M-HEALTH
NATIONAL DEPARTMENT OF STATISTICS AND INFORMATION
REPUBLIC OF MALI

IDENTIFICATION:

PLACE NAME__
FULL NAME OF HEAD OF THE HOUSEHOLD ____
COMMUNE__
CLUSTER NUMBER___
HOUSEHOLD NUMBER______
ADMINISTRATIVE REGION ____

URBAN/RURAL ____

URBAN 1
RURAL 2

ARRONDISSEMENT__

BAMAKO 1
OTHER CITIES 2
OTHER VILLAGES 3
RURAL 4_____

LAST/FIRST NAME AND LINE NUMBER OF WOMAN__

WOMAN SELECTED FOR HOUSEHOLD RELATIONSHIPS?

YES 1
NO 2

HOUSEHOLD SELECTED FOR MEN'S SURVEY?

CHECK THE KISH TABLE IN THE HOUSEHOLD QUESTIONNAIRE.
CHECK THE COVER PAGE OF THE HOUSEHOLD QUESTIONNAIRE (FOR Q542 AND Q543)

YES 1
NO 2

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 [FOR INTERVIEWERS 1 AND 2]
DATE__
TIME__

FINAL VISIT
DAY__
MONTH__
YEAR 2006
INTERVIEWER__
RESULT__

Total Number of Visits____

LANGUAGE OF QUESTIONNAIRE

FRENCH 1

LANGUAGE OF INTERVIEW__

FRENCH 01
BAMBARA/MALINKE 02
SONRAI/DJERMA 03
PEUHL/FOULFOULDE 04
SENOUFO 05
MARIKA/SONINKE 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:

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 30-45 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 the country.

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

Signature of interviewer__ Date__

THE RESPONDENT ACCEPTS TO RESPOND 1 (CONTINUE)
THE RESPONDENT REFUSES TO RESPOND 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 years, did you like the majority of the time in Bamako, in another capital, in a city or in a rural area?
IF IT'S A CITY OR CAPITAL, ASK FOR THE NAME OF THE CITY.

NAME ____
BAMAKO 1
CAPITAL OTHER COUNTRY 2
OTHER CITIES 3
RURAL AREA 4

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

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

104. Just before you moved here, did you live in Bamako, another capital, a city, or village?
IF A CITY, ASK THE NAME OF THE CITY

NAME _____
BAMAKO 1
CAPITAL OTHER COUNTRY 2
OTHER CITIES 3
RURAL AREA 4

105. In which month and in which year were you born?

MONTH __
DOESN'T KNOW MONTH 98
YEAR 19__
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 1 1
PRIMARY 2 2
SECONDARY (HIGH SCHOOL/TECHNICAL) 3
SUPERIOR 4

109. What is the last (year/grade) that you achieved at this level?

YEAR/GRADE __

110. CHECK 108:

PRIMARY 1 (GO TO 111)
PRIMARY 2 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. (3)

IF THE RESPONDENT CAN NOT READ THE WHOLE PHRASE INSIST: Can you read certain parts of the phrase to me?

CAN NOT READ AT ALL 1
CAN READ SOME PARTS 2
CAN READ THE WHOLE PHRASE 3
NO CARD IN THE RIGHT LANGUAGE (SPECIFY LANGUAGE)__4
BLIND 5

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

YES 1
NO 2

113. CHECK 111:

CODE '2', '3' OR '4' CIRCLED (CONTINUE TO 114)
CODE '1' OR '5' 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. During the past 12 months, how many times have you traveled outside of your locality and slept somewhere besides your home?

NUMBER OF TRIPS __
NEVER__00 (GO TO 119)

118. During the past 12 months have you been outside of your locality during more than a month at a time?

YES 1
NO 2

119. What is your religion?

MUSLIM 1
CHRISTIAN 2
ANIMIST 3
NO RELIGION 4
OTHER (SPECIFY) __5

121. What is your ethnicity (for Malians)/your nationality (for foreigners)?

ETHNICITY CODE (for Malians)
BAMBARA 01
MALINKE 02
PEUHL 03
SARAKOLE/MARKA 04
SONRA? 05
DOGON 06
TAMACHEK 07
S?NOUGO/MINIANKA 08
BOBO 09
OTHER (SPECIFY)__96
NATIONALITY CODE (for Foreigners)
CEDEAO COUNTRY 10
OTHER AFRICAN COUNTRY 11
OTHER NATIONALITIES 12

122. What language do you mostly speak at home?

BAMBARA 01
MALINKE 02
PEUHL 03
SARAKOLE/MARKA 04
SONRA? 05
DOGON 06
TAMACHEK 07
S?NOUGO/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__

207A. Do you have other children who were born alive but died after a few minutes, a few hours, or a few days?

YES 1
NO 2 (GO TO 208)

207B. CORRECT 207 THEN CONTINUE TO 208.

208. SUM ANSWERS TO Q.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 BIRTH (GO TO 211)
NONE (GO TO 226)

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

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

[REPEAT 212-221 FOR EACH BIRTH, USE SEPARATE SHEET FOR MORE THAN 12 BIRTHS]

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

NAME__

213. Were any of these births twins?

SING 1
MULT 2

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

BOY 1
GIRL 2

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

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. ___ GO TO NEXT BIRTH. 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?
[SKIP FIRST BIRTH]

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

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

YES 1 (ADD THE BIRTH TO Q. 212)
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__
NO __ (PROBE AND RECONCILE)
NUMBERS ARE DIFFERENT (PROBE AND CORRECT)

224. CHECK 215 AND RECORD THE NUMBER OF BIRTHS IN 2001 OR LATER. IF NONE, RECORD '0'

225. FOR EACH BIRTH SINCE JANUARY 2001, 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". (SEE THE INSTRUCTIONS AT THE END OF THE QUESTIONNAIRE)

226. Are you currently pregnant?

YES 1
NO 2 (GO TO 229)
NOT SURE 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
NOT 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. 2001 OR LATER (GO TO 232)
LAST PREGNANCY ENDED BEFORE JAN. 2001 (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 2001.

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 2001 that did not end in a live birth?

YES 1
NO 2 (GO TO 237)

236. When did the last such birth end before 2001?

MONTH__
YEAR__

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

DATE _____
DAYS AGO 1__
WEEKS AGO 2___
MOTHS 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 240)
DOESN'T KNOW 8 (GO TO 240)

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 TWO PERIODS 4
OTHER (SPECIFY)__6
DOESN'T KNOW 8

240. Are there children who mainly depend on you?

YES 1
NO 2 (GO TO 301)

241. Among the children who mainly depend on you, are there some who are less than 18 years?

YES 1
NO 2 (GO TO 301)

I would now like to talk to you about the children under 18 years who mainly depend on you.

242. Are there or have you made arrangements for someone to take care of these children if you get sick or in the case that you could no longer take care of them?

YES 1
NO 2
NOT SURE 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 ON LINE 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 methods have you heard about? FOR THE METHODS SPONTANEOUSLY MENTIONED, ASK: Have ever heard about (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. COMPRESS, FOAM, JELLY Women can insert a compress, 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?
YES 1(SPECIFY)__
(SPECIFY)__
NO 2

302. Have you ever used (METHOD)?

01. FEMALE STERILIZATION Women can have an operation to avoid having any more children. Have you 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. Have you ever had a partner who 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. COMPRESS, FOAM, JELLY Women can insert a compress, 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 (GO TO 329)
NO 2

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 NOT SURE (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?

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 319A)
WITHDRAWAL M
OTHER (SPECIFY)__X

311A. CIRCLE "A" FOR FEMALE STERILIZATION.

312. Why do you use the pill rather than another method?

COSTS LESS 01
EASIER TO OBTAIN 02
PRESCRIBED TO ME 03
MORE EFFECTIVE 04
NO SIDE EFFECTS 05
I LIKE IT 06
ONLY METHOD I KNOW 07
REVERSIBLE METHOD 08
OTHER (SPECIFY)__96

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

PILPAN 01 (GO TO 312C)
OVRETTE 02 (GO TO 312C)
LO FEMENAL 03 (GO TO 312C)
MINIDRIL 04 (GO TO 312C)
STEDIRIL 05 (GO TO 312C)
ADEPAL 06 (GO TO 312C)
MICROGYNON 07 (GO TO 312C)
OTHER (SPECIFY)__96 (GO TO 312C)
BOX NOT SEEN 98

312B. What is the name of the brand of pill that you currently use?

PILPAN 01
OVRETTE 02
LO FEMENAL 03
MINIDRIL 04
STEDIRIL 05
ADEPAL 06
MICROGYNON 07
OTHER (SPECIFY)__96
DOESN'T KNOW 98

312C. How much does a 3 cycle box of pills cost you?

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

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
NATIONAL HOSPITAL 11
REGIONAL HOSPITAL 12
CSREF (heath referral center)13
PMI (protection maternelle et infantile - a program created in France to give free care to expecting/recent mothers) /MATERNITY 14
CSCOM (Centre de Sant? Communitaire) Community Health Center 15
OTHER PUBLIC (SPECIFY)__18
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC 21
DOCTOR'S OFFICE 23
HEALTH WARD 24
PHARMACY 25
MOBILE CLINIC 26
OTHER PRIVATE (SPECIFY)__28
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?

MONTH_____
YEAR ______

316A. Since when did you begin to use (METHOD CITED FIRST IN Q.311) continuously?
PROBE: In which month and which year did you begin to use (METHOD CITED FIRST IN Q.311) continuously?

MONTH __
YEAR__

316B. CHECK 316/316A, 215 AND 230:

WAS THERE IN 215 A BIRTH OR IN 230 A PREGNANCY ENDED BY A MISCARRIAGE, AND ABORTION OR A STILL BIRTH AFTER THE MONTH AND YEAR OF THE BEGINNING OF USING CONTRACEPTION IN 316/316A?

IF YES: RETURN TO 316/316A TO CORRECT, PROBE TO RECORD THE MONTH AND YEAR OF THE BEGINNING OF CONTINUOUS USE OF THE CURRENT METHOD (THE DATE MUST BE AFTER THAT OF THE LAST BIRTH OR PREGNANCY)

YES__
NO__

317. CHECK 316/316A:

THE YEAR IS 2002 OR LATER (GO TO 319)
THE YEAR IS 2001 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 ON THE LIST IN 311/311A.

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?

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
NATIONAL HOSPITAL 11
REGIONAL HOSPITAL 12
CSREF (heath referral center) 13
PMI (protection maternelle et infantile - a program created in France to give free care to expecting/recent mothers) /MATERNITY 14
CSCOM (Centre de Sant? Communitaire) Community Health Center 15
OTHER PUBLIC (SPECIFY)__18
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC 21
DOCTOR'S OFFICE 23
HEALTH WARD 24
PHARMACY 25
MOBILE CLINIC 26
OTHER PRIVATE (SPECIFY)__28
OTHER SOURCE
SHOP 31
BAR/NIGHTCLUB 32
KIOSK 33
VENDER 34
ADBC (AGENTS DE DISTRIBUTION ? BASE COMMUNAUTAIRE) -MOBILE COMMUNITY HEALTH DISTRIBUTION 35
FRIEND/ACQUAINTANCE/RELATIVE 36
OTHER (SPECIFY)__96

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 SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF ESTABLISHMENT__
PUBLIC SECTOR
NATIONAL HOSPITAL 11
REGIONAL HOSPITAL 12
CSREF (heath referral center) 13
PMI (protection maternelle et infantile - a program created in France to give free care to expecting/recent mothers) /MATERNITY 14
CSCOM (Centre de Sant? Communitaire) Community Health Center 15
OTHER PUBLIC (SPECIFY)__18
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC 21
DOCTOR'S OFFICE 23
HEALTH WARD 24
PHARMACY 25
MOBILE CLINIC 26
OTHER PRIVATE (SPECIFY)__28
OTHER SOURCE
SHOP 31
BAR/NIGHTCLUB 32
KIOSK 33
VENDER 34
ADBC (AGENTS DE DISTRIBUTION ? BASE COMMUNAUTAIRE) -MOBILE COMMUNITY HEALTH DISTRIBUTION 35
FRIEND/ACQUAINTANCE/RELATIVE 36
OTHER (SPECIFY)__96

321. CHECK 311/311A:

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

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 Q.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 Q. 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:
IF MORE THAN ONE METHOD CIRCLED IN 311/311A, CIRCLE THE HIGHEST METHOD CIRCLED ON THE LIST IN 311/311A.

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
NATIONAL HOSPITAL 11 (GO TO 331)
REGIONAL HOSPITAL 12 (GO TO 331)
CSREF (heath referral center)13 (GO TO 331)
PMI (protection maternelle et infantile - a program created in France to give free care to expecting/recent mothers) /MATERNITY 14 (GO TO 331)
CSCOM (Centre de Sant? Communitaire) Community Health Center 15 (GO TO 331)
OTHER PUBLIC (SPECIFY)__18 (GO TO 331)
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC 21 (GO TO 331)
DOCTOR'S OFFICE 23 (GO TO 331)
HEALTH WARD 24 (GO TO 331)
PHARMACY 25 (GO TO 331)
MOBILE CLINIC 26 (GO TO 331)
OTHER PRIVATE (SPECIFY)__28 (GO TO 331)
OTHER SOURCE
SHOP 31 (GO TO 331)
BAR/NIGHTCLUB 32 (GO TO 331)
KIOSK 33 (GO TO 331)
AMBULENT SALESPERSON 34 (GO TO 331)
ADBC (AGENTS DE DISTRIBUTION ? BASE COMMUNAUTAIRE) - MOBILE COMMUNITY HEALTH DISTRIBUTION) 35 (GO TO 331)
FRIEND/ACQUAINTANCE/RELATIVE 36 (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? Any other place?

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.

RECORD ALL PLACES MENTIONED.

NAME OF ESTABLISHMENT__
PUBLIC SECTOR
NATIONAL HOSPITAL A
REGIONAL HOSPITAL B
CSREF (heath referral center) C
MATERNITY D
CSCOM (Centre de Sant? Communitaire) Community Health Center E
OTHER PUBLIC (SPECIFY)__F
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC G
DOCTOR'S OFFICE H
HEALTH WARD I
PHARMACY J
MOBILE CLINIC K
OTHER PRIVATE (SPECIFY)__L
OTHER SOURCE
SHOP M
BAR/NIGHTCLUB N
KIOSK O
AMBULENT SALESPERSON P
ADBC AGENTS DE DISTRIBUTION ? BASE COMMUNAUTAIRE (MOBILE COMMUNITY HEALTH DISTRIBUTION Q
FRIEND/ACQUAINTANCE/RELATIVE R
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 BREAST FEEDING

401. CHECK 224:

ONE OR MORE BIRTHS IN 2001 OR LATER (GO TO 402)
NO BIRTHS IN 2001 OR LATER (GO TO 487)

402. WRITE THE LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH IN 2001 OR LATER. ASK THE QUESTIONS OF ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE THE LAST TWO COLUMNS OF ADDITIONAL QUESTIONNAIRES)

[REPEAT QUESTIONS 403-453 FOR ALL ELIGIBLE BIRTHS]

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 LINE Q212

LINE NUMBER __

404. CHECK 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?
[ONLY FOR MOST RECENT BIRTH]

PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED. IF NONE, CIRCLE CODE 'Y'

HEALTH PROFESSIONAL
DOCTOR A
MIDWIFE B
OBSTETRICIAN NURSE C
OTHER NURSE D
OTHER PERSON
DOULA E
TRADITIONAL BIRTH ATTENDENT F
OTHER (SPECIFY)__X
NO ONE Y (GO TO 415)

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

MONTHS__
DOESN'T KNOW 98

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

NUMBER OF TIMES__
DOESN'T KNOW 98

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

ONE TIME__ (GO TO 412)
MORE THAN ONE TIME__ (GO TO 411)

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

MONTHS__
DOESN'T KNOW 98

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

YES 1
NO 2 (GO TO 416B)
DOESN'T KNOW (GO TO 416B)

416. How many times during this pregnancy did you have this injection?
[ONLY FOR MOST RECENT BIRTH]

NUMBER OF TIMES__
DOESN'T KNOW 8

416A. CHECK 416:
[ONLY FOR MOST RECENT BIRTH]

TWO OR MORE TIMES__ (GO TO 417)
OTHER__ (GO TO 416B)

416B. Have you had at any time before this pregnancy an injection to protect against tetanus?
[ONLY FOR MOST RECENT BIRTH]

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

416C. Before this pregnancy, how many times did you receive an injection against tetanus?
[ONLY FOR MOST RECENT BIRTH]

IF 7 TIMES OR MORE RECORD '7'.

TIMES__
DOESN'T KNOW 8

416D. In which month and in which year before this pregnancy did you receive your last injection?
[ONLY FOR MOST RECENT BIRTH]

MONTH__
DOESN'T KNOW MONTH 98
YEAR __ (GO TO 417)
DOESN'T KNOW YEAR 9998

416E. How many years ago did you receive this injection against tetanus?
[ONLY FOR MOST RECENT BIRTH]

YEARS__

417. During this pregnancy, were you given or did you buy iron tablets?
[ONLY FOR MOST RECENT BIRTH]

SHOW TABLETS.

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?
[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?
[ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2
DOESN'T KNOW 8

420. During this pregnancy did you suffer from night blindness?
[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?
[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?
[ONLY FOR MOST RECENT BIRTH]

RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO THE RESPONDENT.

FANSIDAR/MALOXINE/SP A
CHLOROQUINE B
AMODIAQUINE C
QUININE D
TRADITIONAL MEDICINE E
UNKNOWN MEDICINE Z
OTHER (SPECIFY)__X

422A CHECK 422:
TYPE OF MEDICINE TAKEN FOR MALARIA PREVENTION?
[ONLY FOR MOST RECENT BIRTH]

CODE "A" CIRCLED (GO TO 422B)
CODE "A" NOT CIRCLED (GO TO 422E)

422B. How many times did you take this medicine during this pregnancy?
[ONLY FOR MOST RECENT BIRTH]

NO. OF TIMES__

422C. CHECK 407:
PRENATAL CARE DURING THIS PREGNANCY?
[ONLY FOR MOST RECENT BIRTH]

CODE "A," "B," OR "C" CIRCLED (GO TO 422D)
OTHER CODE CIRCLED (GO TO 422E)

422D. When you were pregnant with (NAME), did you get the medicine SULFADOXINE-PYRIM during a prenatal visit, during another visit in a health facility, or from another source?
[ONLY FOR MOST RECENT BIRTH]

PRENATAL VISIT 1
OTHER MEDICAL VISIT 2
OTHER SOURCE (SPECIFIY)__6

422E. CHECK 422:
TYPE OF MEDICINE TAKEN DURING PREGNANCY FOR MALARIA PREVENTION?
[ONLY FOR MOST RECENT BIRTH]

CODE "B" CIRCLED (GO TO 422F)
CODE "B" NOT CIRCLED (GO TO 423)

422F. How many times did you take the medicine CHLOROQUINE during this pregnancy?
[ONLY FOR MOST RECENT BIRTH]

NO. OF TIMES___

422G. CHECK 407:
PRENATAL CARE DURING THIS PREGNANCY?
[ONLY FOR MOST RECENT BIRTH]

CODE "A," "B" OR "C" CIRCLED (GO TO 422H)
OTHER CODE CIRCLED (GO TO 423)

422H. When you were pregnant with (NAME), did you get the medicine CHLOROQUINE during a prenatal visit, during another visit in a health facility, or from another source?
[ONLY FOR MOST RECENT BIRTH]

PRENATAL VISIT 1
OTHER MEDICAL VISIT 2
OTHER SOURCE (SPECIFY)__6

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 425A)
DOESN'T KNOW 8 (GO TO 425A)

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

425A. Does (NAME) have a birth certificate?
IF NO PROBE: Was the birth of (NAME) registered with the state?

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

425B. Why wasn't the birth of (NAME) registered?

COST 1
DISTANCE 2
LATENESS 3
NOT INFORMED 4
NOT NECESSARY 5
OTHER (SPECIFY) __ 6
DOESN'T KNOW 8

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 C
OTHER NURSE D
OTHER PERSON
DOULA E
TRADITIONAL BIRTH ATTENDANT F
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 AND SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF THE ESTABLISHMENT ___
HOME
YOUR HOME 11 (GO TO 429)
OTHER HOME 12 (GO TO 429)
PUBLIC SECTOR
HOSPITAL 21
CSREF (heath referral center) 22
CSCOM (Centre de Sant? Communitaire) Community Health Center 23
OTHER PUBLIC (SPECIFY)__26
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC 31
PRIVATE MATERNITY 32
OTHER PRIVATE MEDICAL (SPECIFY)__36
OTHER (SPECIFY)__96

427A. At the time of (NAME)'s birth did you have any of the following problems:

A long labor, in other words regular contractions lasting more than 12 hours?
Enough bleeding that you thought that your life was in danger?
A high fever accompanied with bad smelling vaginal discharge?
Convulsions not caused by fever?

LONG LABOR
YES 1
NO 2
A LOT OF BLEEDING
YES 1
NO 2
HIGH FEVER WITH VAGINAL DISCHARGE
YES 1
NO 2
CONVULSIONS
YES 1
NO 2

428. Was (NAME) delivered by caesarean section?

YES 1 (GO TO 433 FOR MOST RECENT BIRTH AND TO 435 FOR PREVIOUS BIRTHS)
NO 2 (GO TO 433 FOR MOST RECENT BIRTH AND TO 435 FOR PREVIOUS BIRTHS)

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

YES 1
NO 2 (GO TO 433 ONLY FOR MOST RECENT BIRTH)

430. How many days after delivery did you have your first health check-up?
[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?
[ONLY FOR MOST RECENT BIRTH]

PROBE FOR MOST QUALIFIED PERSON.

HEALTH PROFESSIONAL
DOCTOR 11
MIDWIFE 12
OBST. NURSE 13
OTHER NURSE 14
OTHER PERSON
DOULA 21
TRADITIONAL BIRTH ATTENDANT 22
OTHER (SPECIFY)__96

432. Where did this first health exam take place?
[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 TYOE AND SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF THE ESTABLISHMENT__
HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
HOSPITAL 21
CSREF (heath referral center) 22
CSCOM (Centre de Sant? Communitaire) Community Health Center 23
OTHER PUBLIC (SPECIFY)__26
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL (SPECIFY)__36
OTHER (SPECIFY)__96

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

SHOW THE PILL.

YES 1
NO 2
DOESN'T KNOW 8

434. Has your period returned since the birth of (NAME)?
[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?

YES 1
NO 2 (GO TO 439)
MULTIPLE BIRTH 3 (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?

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

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

MONTHS__
DOESN'T KNOW 98

440. Did you 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 three 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/QUINQUELIBA H
HONEY I
OTHER (SPECIFY)__X

444. CHECK 404: LIVING CHILD?

ALIVE__ (GO TO 445)
DECEASED__ (GO TO 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 MARK '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 2001 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE THE LAST 2 LINES OF ADDITIONAL QUESTIONNAIRES).

[REPEAT QUESTIONS 455-483 FOR ALL ELIGIBLE BIRTHS]

455. CHECK LINE NUMBER FROM 212:

LINE NUMBER__

456. CHECK 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 PILL

YES 1
NO 2
DOESN'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 1 (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
DAY__
MONTH__
YEAR__
DPT 2
DAY__
MONTH__
YEAR__
DPT 3
DAY__
MONTH__
YEAR__
MEASLES
DAY__
MONTH__
YEAR__
YELLOW FEVER
DAY__
MONTH__
YEAR__
VITAMIN A (MOST RECENT)
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
DOESN'T KNOW 8

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 buttocks, 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 (GO TO 464)
DOESN'T KNOW 8 (GO TO 464)

463H. An injection against yellow fever?

YES 1
NO 2
DOESN'T KNOW 3

463I. The Hepatitis B vaccination?

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

463I. How many times?

NUMBER OF TIMES__

464. Were any of the vaccinations that (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 TWO YEARS 3 (GO TO 466)
DOESN'T KNOW 88 (GO TO 466)

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

NAME OF CAMPAIGN:

CAMP 1:__A
CAMP 2:__B
CAMP 3:__C
CAMP 4:__D
CAMP 5:__E
OTHER:__X

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.

PUBLIC SECTOR
NATIONAL HOSPITAL A
REGIONAL HOSPITAL B
CSREF (heath referral center) C
CSCOM (Centre de Sant? Communitaire) Community Health Center D
MATERNITY E
OTHER PUBLIC (SPECIFY) __F
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC G
DOCTOR'S OFFICE H
PHARMACY I
COMMUNITY HEALTH WORKER J
OTHER PRIVATE (SPECIFY) __K
OTHER SOURCE
AMBULENT SALESPERSON L
SHOP M
TRADITIONAL PRACTIONER N
OTHER (SPECIFY) __X

472. CHECK 466:
HAD A FEVER?

YES TO 466 (GO TO 472A)
NO OR DOESN'T KNOW TO 466 (GO TO 475)

472A. Does (NAME) have a fever currently?

YES 1
NO 2
DOESN'T KNOW 8

472B. Did (NAME) have convulsions at any time during the past two weeks?

YES 1
NO 2
DOESN'T KNOW 8

472C. CHECK 466 AND 472B:
FEVER OR CONVULSIONS?

YES TO 466 OR 472B (GO TO 473)
OTHER (GO TO 475)

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

YES 1
NO 2 (GO TO 474R)
DOESN'T KNOW 8 (GO TO 474R)

474. Which medicine did (NAME) take?

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.
RECORD EVERYTHING THAT IS MENTIONED.

ANTI-MALARIA
FANSIDAR/MALOXINE/SP A
CHLOROQUINE B
AMODIAQUINE/CAMOQUIN C
QUININE D
TRADITIONAL MEDICINE E
OTHER
COARTEM F
ARSUMAX G
ARTEMETERS H
ASPIRIN/PARACETAMOL I
PANADOL J
IBUPROFEN/ACETAMINOPHEN K
OTHER (SPECIFY) __X
DOESN'T KNOW Z

474A. Did (NAME) have an injection or suppository to treat the fever/convulsions?

INJECTION A
SUPPOSITORY B
NEITHER Y
DOESN'T KNOW Z

474B. CHECK 474:
TYPE OF MEDICINE?

CODE "A" CIRCLED (GO TO 474C)
CODE "A" NOT CIRCLED (GO TO 474F)

474C. How long after the beginning of the fever/convulsions did (NAME) begin to take Fansidar/Maloxine?

SAME DAY 0
THE NEXT DAY 1
TWO DAYS AFTER 2
THREE DAYS OR MORE AFTER THE FEVER 3
DOESN'T KNOW 8

474D. For how many consecutive days did (NAME) take Fansidar/Maloxine?
IF MORE THAN 7 DAYS, RECORD '7'.

DAYS__
DOESN'T KNOW 8

474E. Did you have the Fansidar/Maloxine at home, or did you get it from another source?
IF MORE THAN ONE SOURCE IS MENTIONED, ASK: Where did you get the Fansidar/Maloxine the first time?

AT HOME 1
OTHER SOURCE 2
DOESN'T KNOW 8

474F. CHECK 474: TYPE OF MEDICINE?

CODE "B" CIRCLED (GO TO 474G)
CODE "B" NOT CIRCLED (GO TO 474J)

474G. How long after the beginning of (the fever/convulsions) did (NAME) begin to take Chloroquine?

SAME DAY 1
THE NEXT DAY 2
TWO DAYS AFTER 3
THREE DAYS OR MORE AFTER THE FEVER 4
DOESN'T KNOW 8

474H. For how many consecutive days did (NAME) take Chloroquine?
IF MORE THAN 7 DAYS, RECORD '7'.

DAYS__
DOESN'T KNOW 8

474I. Did you have the Chloroquine at home, or did you get it from another source?
IF MORE THAN ONE SOURCE IS MENTIONED, ASK: Where did you get the Chloroquine the first time?

AT HOME 1
OTHER SOURCE 2
DOESN'T KNOW 8

474J. CHECK 474:
TYPE OF MEDICINE?

CODE "C" CIRCLED (GO TO 474K)
CODE "C" NOT CIRCLED (GO TO 474N)

474K. How long after the beginning of (the fever/convulsions) did (NAME) begin to take
Amodiaquin/CAMOQUIN?

SAME DAY 0
THE NEXT DAY 1
TWO DAYS AFTER 2
THREE DAYS OR MORE AFTER THE FEVER 3
DOESN'T KNOW 8

474L. For how many consecutive days did (NAME) take Amodiaquin/CAMOQUIN?
IF MORE THAN 7 DAYS, RECORD '7'.

DAYS__
DOESN'T KNOW 8

474M. Did you have the Amodiaquin/CAMOQUIN at home, or did you get it from another source?
IF MORE THAN ONE SOURCE IS MENTIONED, ASK: Where did you get the Amodiaquin/CAMOQUIN the first time?

AT HOME 1
OTHER SOURCE 2
DOESN'T KNOW 8

474N. CHECK 474:
TYPE OF MEDICINE?

CODE "D" CIRCLED (GO TO 474O)
CODE "D" NOT CIRCLED (GO TO 474R)

474O. How long after the beginning of (the fever/convulsions) did (NAME) begin to take
Quinine?

SAME DAY 1
THE NEXT DAY 2
TWO DAYS AFTER 3
THREE DAYS OR MORE AFTER THE FEVER 4
DOESN'T KNOW 8

474P. For how many consecutive days did (NAME) take Quinine?
IF MORE THAN 7 DAYS, RECORD '7'.

DAYS__
DOESN'T KNOW 8

474Q. Did you have the Quinine at home, or did you get it from another source?
IF MORE THAN ONE SOURCE IS MENTIONED, ASK: Where did you get the Quinine the first time?

AT HOME 1
OTHER SOURCE 2
DOESN'T KNOW 8

474R. Was something else done to treat (NAME)'s (fever/convulsions)?

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

474S. What was done to treat (NAME)'s (fever/convulsions)
Something else?
RECORD EVERYTHING MENTIONED.

CONSULTED A TRADITIONAL HEALER A
SWABBED WITH MOIST COMPRESSES B
GIVEN MEDICINAL PLANTS C
OTHER (SPECIFY) __X

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

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

Now I would like to know how much liquid was given to (NAME) during his/her diarrhea.

476. Did you give him/her less or more to drink than usual?
IF LESS: 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: 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?

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). RECORD EVERYTHING MENTIONED.

PLACE NAME__
PUBLIC SECTOR
NATIONAL HOSPITAL A
REGIONAL HOSPITAL B
CSREF (heath referral center) C
CSCOM (Centre de Sant? Communitaire) Community Health Center E
MATERNITY F
OTHER PUBLIC (SPECIFY) __
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
DOCTOR'S OFFICE I
COMMUNITY HEALTH WORKER K
OTHER PRIVATE (SPECIFY) __L
OTHER SOURCE
SHOP M
TRADITIONAL HEALER N
OTHER (SPECIFY) __X

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

484. CHECK 215 AND 218, ALL LINES:
NUMBER OF CHILDREN BORN IN 2001 OR LATER AND LIVING WITH THE RESPONDENT.

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

485. What do you usually do with the excrements of your (youngest) child when he/she does not use the toilet facility?

ALWAYS USES THE TOILET/LATRINE 01
THROW IT IN THE TOILET/LATRINE 02
THROW IT OUTSIDE OF THE DWELLING 03
THROW IT OUTSIDE OF THE YARD 04
BURY IT IN THE YARD 05
GET RID OF IT BY WASHING IT AWAY WITH WATER 06
USE DISPOSABLE DIAPERS 07
USE WASHABLE DIAPERS 08
DO NOT GET RID OF IT 09
OTHER (SPECIFY) __96

486. CHECK 478A ALL OF THE COLUMNS:

NO CHILD RECEIVED ORS PACKET OR THE QUESTION WASN'T ASKED (GO TO 487)
A CHILD RECEIVED ORS PACKETS (GO TO 487A)

487. Have you ever heard of a special product called ORS, for example Orasel/ken?yaji, that you can get to treat diarrhea?
SHOW THE PACKET OF ORS.

YES 1
NO 2 (GO TO 488)

487A. Do you have an ORS packet at home?

YES 1
NO 2 (GO TO 488)

487B. Can I see the ORS packet that you have?
LOOK FOR THE BRAND OF THE ORS PACKET.

KENEJA JI 1 (GO TO 487D)
ORS 2 (GO TO 487D)
ORS ORANGE MULTI M 3 (GO TO 487D)
ORS UNICEF 4 (GO TO 487D)
OTHER (SPECIFY) __6
PACKET NOT SEEN 8

487C. Do you know the brand name of ORS that you currently have?

KENEJA JI 1
ORS 2
ORS ORANGE MULTI M 3
ORS UNICEF 4
OTHER (SPECIFY) __6
DOESN'T KNOW 8

487D. How much did the ORS packet that you currently have cost you?

COST__
FREE 995
DOESN'T KNOW 998

488. CHECK 318:

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

Now I would like to ask you questions about your own medical care.

490. 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.
Not having a medical establishment nearby.
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
NOT A BIG PROBLEM 2
PERMISSION
A BIG PROBLEM 1
NOT A BIG PROBLEM 2
MONEY
A BIG PROBLEM 1
NOT A BIG PROBLEM 2
DISTANCE
A BIG PROBLEM 1
NOT A BIG PROBLEM 2
TRANSPORTATION
A BIG PROBLEM 1
NOT A BIG PROBLEM 2
GOING ALONE
A BIG PROBLEM 1
NOT A BIG PROBLEM 2
FEMALE PERSONNEL
A BIG PROBLEM 1
NOT A BIG PROBLEM 2

491. CHECK 215 AND 218:

AT LEAST ONE CHILD BORN IN 2004 OR LATER AND LIVING WITH HER.
RECORD THE NAME OF THE CHILD LIVING WITH HER
NAME_____ (GO TO 492)
NO CHILD BORN IN 2004 OR LATER LIVING WITH HER (GO TO 495)

Now I would like to ask you what liquid [NAME IN Q.491] drank during the past 7 days including yesterday.

492. How many days, during the past 7 days, did [NAME IN Q.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 Q.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'

A) WATER
NUMBER OF DAYS IN THE PAST 7 DAYS__
YESTERDAY/LAST NIGHT NUMBER OF TIMES__
B) BABY FORMULA
NUMBER OF DAYS IN THE PAST 7 DAYS__
YESTERDAY/LAST NIGHT NUMBER OF TIMES__
C) 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__

Now I would like to ask you what food(s) [NAME IN Q.491] was given during the past 7 days, including yesterday.

493. How many days, during the past 7 days, [NAME IN Q.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 Q.491] get:

A) Rice, corn, millet, sorghum or other grains?
B) Pumpkin, yam or yellow or red squash, carrots, or red sweet potatoes?
C) Other foods from roots (ex: potatoes, white yam, manioc, white sweet potatoes, other local foods from roots)?
D) Any green leafy vegetables?
E) Mango, papaya?
F) Any other fruit or vegetable? (ex: banana, apple, apple sauce, green beans, avocado, tomato)?
G) Meat, poultry, fish, shellfish, eggs?
H) Other vegetable 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) RICE OR OTHER GRAINS
NUMBER OF DAYS IN THE PAST 7 DAYS__
YESTERDAY/LAST NIGHT NUMBER OF TIMES__
B) PUMPKIN, SQUASH, OR RED SWEET POTATOES
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 FRUIT OR VEGETABLE
NUMBER OF DAYS IN THE PAST 7 DAYS__
YESTERDAY/LAST NIGHT NUMBER OF TIMES__
G) MEAT, POULTRY, FISH, EGGS
NUMBER OF DAYS IN THE PAST 7 DAYS__
YESTERDAY/LAST NIGHT NUMBER OF TIMES__
H) OTHER VEGETABLE FOODS (I.E., NUTS)
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) OTHER FOOD PREPARED WITH BUTTER, OIL, OR FAT
NUMBER OF DAYS IN THE PAST 7 DAYS__
YESTERDAY/LAST NIGHT NUMBER OF TIMES__

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

496. Do you currently smoke cigarettes or chew tobacco?
IF YES: What do you usually smoke/chew?
RECORD EVERYTHING MENTIONED.

YES CIGARETTES A
YES, PIPE B (GO TO 499B)
YES OTHER TOBACCO C (GO TO 499B)
NO Y (GO TO 499B)

498. In the past 24 hours, how many cigarettes did you smoke?

CIGARETTES__

498A. In the past 24 hours, how many pinches did you take?

PINCHES__

I would now like to ask you a few questions about your health during the past 6 months.

499B. During the past 6 months, have you had an injection for any reason?
IF YES: How many injections did you have?

IF THE NUMBER OF INJECTIONS IS MORE THAN 94 OR IF THE INJECTIONS WERE DAILY DURING 3 MONTHS OR MORE, RECORD '95'.
IF THE RESPONSE IS NOT NUMERIC, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS__
NONE 00 (GO TO 499F)

499C. Among these injections, how many were given by a doctor, nurse, pharmacist, dentist or other health worker?

IF THE NUMBER OF INJECTIONS IS MORE THAN '94', OR IF THE INJECTIONS WERE DAILY DURING 3 MONTHS OR MORE, RECORD '95'.
IF THE RESPONSE IS NOT NUMERIC, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS__
NONE 00 (GO TO 499F)

499D. The last time you had an injection, where did you go to get it?

PUBLIC SECTOR
HOSPITAL 11
HEALTH CENTER 12
HEALTH POST 13
OTHER PUBLIC (SPECIFY)__16
PRIVATE SECTOR MEDICAL
PRIVATE HOSPITAL/CLINIC/DOCTOR 21
DENTIST 22
PHARMACY 23
PRIVATE OFFICE/NURSE'S HOME/HEALTH WORKER 24
OTHER PRIVATE MEDICAL (SPECIFY) __26
OTHER PLACE
HOME 31
OTHER (SPECIFY) __ 96

499E. The last time you had an injection, did the person who administered the shot take the syringe or needle from a new unopened package?

YES 1
NO 2
DOESN'T KNOW 8

499F. From when you woke up yesterday morning until sunset (24h), did you consume any foods prepared with industrial oil?

YES 1
NO 2 (GO TO 499H)
DOESN'T KNOW/NR 8 (GO TO 499K)

499G. Which industrial oil did you consume?

HUICOME (PRODUCED AT KOULIKORO), THAT IS CALLED SOLEOR A
DINOR B
BENI/PALIMOR/MR CHEF C
OTHERS (SPECIFY) __X
DOESN'T KNOW Y

499H. Is this consummation or non-consummation of foods with industrial oil usual?

YES 1
NO 2
DOESN'T KNOW/NR 8

499I. CHECK 499F:

NO, DID NOT CONSUME (GO TO 499J)
YES, CONSUMED INDUSTRIAL OIL (GO TO 499K)

499J. What is the main reason why you did not consume foods prepared with industrial oil since yesterday?

OIL NOT AVAILABLE 1
OIL TOO EXPENSIVE 2
DOESN'T LIKE THE FLAVOR 3
OTHER (SPECIFY) __6

499K. In the past 7 days, how many days did you consume foods prepared with industrial oil?
IF DOESN'T KNOW (DK) OR DOES NOT RESPOND (NR), RECORD '8'.

NUMBER OF DAYS__

499L. Do you consume industrial oil all the time, during the rainy season, after harvests, during the dry season, only during parties or at a different time (specify)?

ALL THE TIME 1
DURING THE RAINY SEASON 2
AFTER HARVESTS 3
DURING THE DRY SEASON 4
ONLY DURING PARTIES 5
OTHER (SPECIFY) __6

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

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

YES, CURRENTLY MARRIED 1 (GO TO 504)
YES, CURRENTLY LIVING WITH A MAN 2 (GO TO 504)
NO, NOT IN UNION 3

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

YES HAS BEEN MARRIED 1
YES, HAS LIVED WITH A MAN 2 (GO TO 510)
NO 3 (GO TO 518)

503. 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)

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

LIVE TOGETHER 1
LIVES ELSEWHERE 2

505. 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.__

506. How old was your husband/partner at his last birthday?

AGE IN COMPLETED YEARS__

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)
DOESN'T KNOW 8 (GO TO 510)

508. Counting yourself, how many wives or partners does your husband currently have?

NUMBER OF WIVES OR PARTNERS__
DOESN'T KNOW 98

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 1 MAN ONLY ONCE.
In which month and in which year did you begin to live with your husband/partner?

MONTH__
DOESN'T KNOW MONTH 98
YEAR__ (GO TO 512A)
DOESN'T KNOW YEAR 9998

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?

MONTH__
DOESN'T KNOW MONTH 98
YEAR__ (GO TO 512A)
DOESN'T KNOW YEAR 9998

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

AGE __

512A. Who mainly chose your husband/partner?

RESPONDENT HERSELF 1
FATHER/MOTHER 2
UNCLE/AUNT 3
BROTHER/SISTER 4
OTHER (SPECIFY) __6

513. CHECK 503: IS THE RESPONDENT CURRENTLY A WIDOW?

NOT ASKED OR NOT WIDOW (GO TO 514)
WIDOW (GO TO 516)

514. CHECK 510:

MARRIED MORE THAN ONCE (GO TO 515)
MARRIED ONCE (GO TO 518)

515. How did your last union/marriage end?

DEATH/WIDOWHOOD 1
DIVORCE 2 (GO TO 518)
SEPARATION 3 (GO TO 518)

516. Who got the largest part of the belongings your husband possessed?

RESPONDENT 1 (GO TO 518)
OTHER SPOUSE 2
CHILDREN OF THE HUSBAND 3
FAMILY OF THE HUSBAND 4
OTHER (SPECIFY) __5
NO BELONGINGS 6

517. Did you receive goods or valuables from your last husband?

YES 1
NO 2

518. CHECK THE PRESENCE OF OTHER PEOPLE
BEFORE CONTINUING, DO YOUR BEST TO GO TO A PRIVATE PLACE.

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

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

NEVER 00
AGE IN YEARS__(GO TO 521)
FIRST TIME AFTER BEGINNING TO LIVE WITH (FIRST) HUSBAND/PARTNER 95 (GO TO 521)

520. Do you intend to wait until marriage to start having sex?

YES 1 (GO TO 544)
NO 2 (GO TO 544)
DOESN'T KNOW/NOT SURE 8 (GO TO 544)

521. CHECK 106:

15-24 YEARS (GO TO 522)
25-49 YEARS (GO TO 526)

522. The first time you had sexual intercourse, was a condom used?

YES 1
NO 2
DOESN'T KNOW/DOESN'T REMEMBER 8

523. How old was the person with whom you had sexual intercourse for the first time?

AGE OF PARTNER__ (GO TO 526)
DOESN'T KNOW 98

524. Was this person older than you, younger or about the same age?

OLDER 1
YOUNGER 2 (GO TO 526)
SAME AGE 3 (GO TO 526)
DOESN'T KNOW/DOESN'T REMEMBER 8 (GO TO 526)

525. Would you say that this person was more than 10 years older than you or less than 10 years older than you?

10 YEARS OR MORE 1
LESS THAN 10 YEARS 2
OLDER, DOESN'T KNOW HOW MUCH 3

526. When did you last have sexual intercourse?
IF IT WAS 12 MONTHS AGO OR MORE, THE ANSWER MUST BE CONVERTED AND RECORDED IN YEARS.

IT WAS...DAYS AGO 1__
IT WAS...WEEKS AGO 2__
IT WAS...MONTHS AGO 3__
IT WAS...YEARS AGO 4__ (GO TO 539)

[ASK QUESTIONS 527-536 FOR THE PAST THREE PARTNERS]

527. Was a condom used the last time you had sexual intercourse with this (second, third) person?

YES 1
NO 2 (GO TO 529)

528. Did you use a condom each time you had sexual intercourse during the past 12 months?

YES 1
NO 2

529. The last time you had sexual intercourse with this (second, third) person, had you consumed alcohol?

YES 1
NO 2 (GO TO 531)

530. Was this person or were you yourself drunk at that time?
IF YES: who was drunk?

ONLY THE RESPONDENT 1
ONLY THE PARTNER 2
THE RESPONDENT AND HER PARTNER 3
NEITHER 4

531. What was your relationship with this person with whom you had sexual intercourse?
IF BOYFRIEND: Did you live together as if you were married?

IF YES, CIRCLE '02'
IF NO, CIRCLE '03'

HUSBAND 01 (GO TO 537)
PARTNER LIVING WITH RESPONDENT 02 (GO TO 537)
BOYFRIEND NOT LIVING WITH RESPONDENT 03
CAUSAL ACQUAINTANCE 04
PROSTITUTE 05
OTHER (SPECIFY) __96

532. For how long have you had/did you have sexual intercourse with this person?
IF THE RESPONDENT ONLY HAD SEX ONCE WITH THIS PERSON, RECORD '01' DAY.

DAYS 1__
MONTHS 2__
YEARS 3__

533. CHECK 106:

15-24 YEARS (GO TO 534)
25-49 YEARS (GO TO 537)

534. How old is this person?

PARTNER'S AGE__ (GO TO 537)
DOESN'T KNOW 98

535. Was this person older than you, younger or about the same age?

OLDER 1
YOUNGER 2 (GO TO 537)
SAME AGE 3 (GO TO 537)
DOESN'T KNOW 8 (GO TO 537)

536. Would you say that this person was more than 10 years older than you or less than 10 years older than you?

10 YEARS OR MORE 1
LESS THAN 10 YEARS 2
OLDER, DOESN'T KNOW HOW MUCH 3

537. Apart from this/these two person(s) did you have sexual intercourse with anyone else during the past 12 months?
[REPEAT QUESTION FOR PAST TWO PARTNERS]

YES 1 (RETURN TO 527)
NO 2 (GO TO 539)

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

IN THE CASE OF A NON-NUMERIC RESPONSE, PROBE TO GET AN ESTIMATE.
IF THE NUMBER IS MORE THAN '95', WRITE '95.'

NUMBER OF PARTNERS __
DOESN'T KNOW 98

539. In all, how many different people did you have sexual intercourse with in your life?

IN THE CASE OF A NON-NUMERIC RESPONSE, PROBE TO GET AN ESTIMATE.
IF THE NUMBER IS MORE THAN '95', WRITE '95.'

NUMBER OF PARTNERS __
DOESN'T KNOW 98

540. CHECK THE COVER PAGE: HOUSEHOLD SELECTED FOR MAN'S SURVEY?

NO (GO TO 541)
YES (GO TO 544)

541. CHECK THE PRESENCE OF OTHER PEOPLE
DO NOT CONTINUE IF YOU ARE NOT IN PRIVATE WITH THE RESPONDENT.

PRIVACY ACHIEVED 1
PRIVACY IMPOSSIBLE 2 (GO TO 544)

542. The first time that you had sexual intercourse, would you say that you wanted to have sexual intercourse or were you forced against your will?

YES 1
NO 2
REFUSED TO RESPOND/NO RESPONSE 3

543. During the past 12 months, did someone force you to have sexual intercourse against your will?

YES 1
NO 2
REFUSED TO RESPOND/NO RESPONSE 3

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

YES 1
NO 2 (GO TO 601)

545. Where is this?
Any other place?

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

RECORD ALL PLACES MENTIONED.

NAME OF PLACE__
PUBLIC SECTOR
NATIONAL HOSPITAL A
REGIONAL HOSPITAL B
CSREF (heath referral center) C
PMI (protection maternelle et infantile-a program created in France to give free care to expecting/recent mothers) /MATERNITY D
CSCOM (Centre de Sant? Communitaire) Community Health Center E
OTHER PUBLIC (SPECIFY) __F
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR G
PHARMACY H
HEALTHCARE WORKER J
OTHER PRIVATE MEDICAL (SPECIFY) __K
OTHER SOURCE
SHOP L
BAR/NIGHTCLUB M
KIOSK N
AMBULANT SALESPERSON O
FRIEND/ACQUAINTANCE/RELATIVE P
OTHER (SPECIFY) __X

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

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

547. CHECK 527 ALL THE COLUMNS:

AT LEAST ONE "YES" (GO TO 548)
OTHER (GO TO 601)

548. Where did you get the condoms last time?

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

NAME OF PLACE__
PUBLIC SECTOR
NATIONAL HOSPITAL 11
REGIONAL HOSPITAL 12
CSREF (heath referral center) 13
PMI (protection maternelle et infantile - a program created in France to give free care to expecting/recent mothers) /MATERNITY 14
CSCOM (Centre de Sant? Communitaire) Community Health Center 15
OTHER PUBLIC (SPECIFY) __16
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
HEALTHCARE WORKER 23
OTHER PRIVATE MEDICAL (SPECIFY) __26
OTHER SOURCE
SHOP 31
BAR/NIGHTCLUB 32
KIOSK 33
AMBULENT SALESPERSON 34
FRIEND/ACQUAINTANCE/RELATIVE 35
HOTEL/MOTEL 36
PARTNER HAD THE CONDOM 41 (GO TO 601)
OTHER (SPECIFY) __96
DOESN'T KNOW 98

549. Do you know the brand name of the condoms that you used last time?

PROTECTOR 1
MANNIX 2
INNOTEX 3
PRESA 4
OTHER (SPECIFY) __6
DOESN'T KNOW 8

550. The last time you bought condoms, how many did you buy?

NUMBER OF CONDOMS__
DOESN'T KNOW 98
NEVER BOUGHT CONDOMS 99 (GO TO 601)

551. How much did you pay?

COST__
DOESN'T KNOW 9998

SECTION 6. FERTILITY PREFERENCES

601. CHECK 311/311A:

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

Now I have a few questions about the future.

602. CHECK 226:

NOT PREGNANT OR NOT SURE
Would you like to have (a/another) child, or would you prefer not to have (other) children at all?

PREGNANT
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 CANNOT GET PREGNANT 3 (GO TO 614)
NOT SURE/DOESN'T KNOW:
AND PREGNANT 4 (GO TO 610)
AND NOT PREGNANT/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 (a/another) child?

MONTHS 1__
YEARS 2__
SOON/NOW 993 (GO TO 609)
SAYS SHE CAN NOT 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 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 YEAR (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 AMENORRHEIC 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 major problem, a minor problem or not a problem at all?

MAJOR PROBLEM 1
MINOR PROBLEM 3
NO PROBLEM 3
SAYS SHE CAN NOT GET PREGNANT/ IS NOT HAVING SEX 4

609. CHECK 310:
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 (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)
NOT SURE 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 22 (GO TO 614)
INFREQUENT SEX 23 (GO TO 614)
MENOPAUSE/HYSTERECTOMY 23 (GO TO 614)
SUBFECUND/STERIL 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.

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?

BOYS
NUMBER__
GIRLS
NUMBER__
EITHER
NUMBER__
OTHER (SPECIFY) ___96

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

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

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?

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

619. During the past few 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
DAUGHTER(S) F
SON(S) G
STEP MOTHER(S)/MOTHER(S) IN LAW H
FRIEND(S)/NEIGHBOR(S) I
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 (GO TO 628)

622. CHECK 311/311A:

A 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 the use of this method is mainly your own decision, or that of your partner/husband, or a joint decision?

RESPONDENT'S DECISION 1
PARTNER/HUSBAND'S DECISION 2
JOINT DECISION 3
OTHER (SPECIFY) __6

624. Now I would like to ask you about your partner/husband's opinions about family planning.
Do you think that your partner/husband approves or disapproves of using methods to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DOESN'T KNOW 8

625. How many times during the past year 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 STERILIZED (GO TO 627)
HE OR SHE 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 and not in the mood for it?

HE HAS AN STI
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

629. When a wife knows that her husband has an infection transmittable by sexual contact, is she justified in asking that they use a condom during intercourse?

YES 1
NO 2
DOESN'T KNOW 8

630. CHECK 501:

CURRENTLY MARRIED/IN UNION (GO TO 631)
NOT IN UNION (GO TO 701)

631. Can you refuse sexual intercourse with your husband when you don't want to have it?

YES 1
NO 2
IT DEPENDS/NOT SURE 8

632. Can you ask that your husband use a condom if you want him to use one?

YES 1
NO 2
IT DEPENDS/NOT SURE 8

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

701. CHECK 501 AND 502:

CURRENTLY MARRIED/LIVES WITH A MAN (GO TO 703)
HAS BEEN MARRIED/HAS LIVED WITH A MAN (GO TO 703)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 707)

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
DOESN'T KNOW 8 (GO TO 706)

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

GRADE/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?

______

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 (GO TO 719)

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

______

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
COMMUNITY'S LAND 5
OTHER (SPECIFY) __6

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?

OWN 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
FOOD PREPARED DAILY
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
PRESENT AND ARE LISTENING 1
PRESENT BUT ARE NOT LISTENING 2
NOT PRESENT 8
HUSBAND
PRESENT AND ARE LISTENING 1
PRESENT BUT ARE NOT LISTENING 2
NOT PRESENT 8
OTHER MEN
PRESENT AND ARE LISTENING 1
PRESENT BUT ARE NOT LISTENING 2
NOT PRESENT 8
OTHER WOMEN
PRESENT AND ARE LISTENING 1
PRESENT BUT ARE NOT LISTENING 2
NOT PRESENT 8

721. Sometimes the husband is 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
NEGL. 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 HIV/AIDS

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 844)

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

YES 1
NO 2
DOESN'T KNOW 8

803. Can people get AIDS from mosquito bites?

YES 1
NO 2
DOESN'T KNOW 8

804. 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

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

807. Can people get AIDS by witchcraft or other supernatural means?

YES 1
NO 2
DOESN'T KNOW 8

808. Is there something (else) that a person can do to avoid or reduce their risks of contracting the virus that causes AIDS?

YES 1
NO 2 (GO TO 810)
DOESN'T KNOW 8 (GO TO 810)

809. 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

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

YES 1
NO 2
DOESN'T KNOW 8

811. Can the virus that causes AIDS 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

812. CHECK 811:

AT LEAST ONE 'YES' (GO TO 813)
OTHER (GO TO 814)

813. Are there any special drugs that a doctor or nurse can give to a woman infected with the AIDS virus to reduce the risk transmission to the baby?

YES 1
NO 2
DOESN'T KNOW 8

814. Are there any special drugs that a doctor or nurse can give people infected with the AIDS virus?

YES 1
NO 2
DOESN'T KNOW 8

815. CHECK 215:

LAST BIRTH SINCE JANUARY 2004 (GO TO 816)
NO BIRTHS (GO TO 824)
LAST BIRTH BEFORE JANUARY 2004 (GO TO 824)

816. CHECK 407:

SAW SOMEONE FOR PRENATAL CARE (GO TO 817)
DIDN'T SEE ANYONE (GO TO 824)

Now I would like to ask you some questions about your last birth. You told me that you saw someone for prenatal care during this pregnancy.

817. During one of these prenatal visits for this pregnancy, did anyone talk to you about the following subjects?

Babies getting the AIDS virus from their mothers?
Things you can do to prevent getting the AIDS virus?
Getting tested for the AIDS virus?

AIDS FROM MOTHER
YES 1
NO 2
DOESN'T KNOW 8
THINGS TO DO
YES 1
NO 2
DOESN'T KNOW 8
TESTED FOR AIDS
YES 1
NO 2
DOESN'T KNOW 8

818. Were you offered a test for the AIDS virus as part of your prenatal care?

YES 1
NO 2

819. I do not want to know the results, but were you tested for the AIDS virus as part of your prenatal care?

YES 1
NO 2 (GO TO 824)

820. I do not want to know the results, but did you get the results of the test?

YES 1
NO 2

821. Where was the test done?

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

PLACE NAME___
PUBLIC SECTOR
NATIONAL REF LAB 11
NATIONAL HOSPITAL 12
REGIONAL HOSPITAL 13
CSREF (heath referral center) 14
CSCOM (Centre de Sant? Communitaire) Community Health Center 15
OTHER PUBLIC (SPECIFY) __16
PRIVATE MEDICAL SECTOR
CESAC (AIDS treatment center in Mali) 21
VCT 22
OTHER PRIVATE MEDICAL (SPECIFY) __26
OTHER (SPECIFY) __96

822. Have you been tested for the AIDS virus since you were tested during your pregnancy?

YES 1 (GO TO 825)
NO 2

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

LESS THAN 12 MONTHS AGO 1 (GO TO 831)
BETWEEN 12 AND 23 MONTHS 2 (GO TO 831)
2 OR MORE YEARS AGO 3 (GO TO 831)

824. I don't want to know the results, but have you ever been tested for the AIDS virus?

YES 1
NO 2 (GO TO 829)

825. When did you last get tested for the AIDS virus?

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

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

ASKED FOR TEST 1
TEST OFFERED AND ACCEPTED 2
REQUIRED 3

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

YES 1
NO 2

828. Where was the test done?

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

PLACE NAME___
PUBLIC SECTOR
NATIONAL REF LAB 11 (GO TO 831)
NATIONAL HOSPITAL 12 (GO TO 831)
REGIONAL HOSPITAL 13 (GO TO 831)
CSREF (heath referral center) 14 (GO TO 831)
CSCOM (Centre de Sant? Communitaire) Community Health Center 15 (GO TO 831)
OTHER PUBLIC (SPECIFY) __16 (GO TO 831)
PRIVATE MEDICAL SECTOR
CESAC (AIDS treatment center in Mali) 21 (GO TO 831)
VCT 22 (GO TO 831)
OTHER PRIVATE MEDICAL (SPECIFY) __26 (GO TO 831)
OTHER (SPECIFY) __96 (GO TO 831)

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

YES 1
NO 2 (GO TO 831)

830. Where is this?
Is there another place?

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

RECORD ALL PLACES MENTIONED.

PLACE NAME___
PUBLIC SECTOR
NATIONAL REF LAB A
NATIONAL HOSPITAL B
REGIONAL HOSPITAL C
CSREF (heath referral center) D
CSCOM (Centre de Sant? Communitaire) Community Health Center F
OTHER PUBLIC (SPECIFY) __G
PRIVATE MEDICAL SECTOR
CESAC (AIDS treatment center in Mali) H
VCT I
OTHER PRIVATE MEDICAL (SPECIFY) __J
OTHER (SPECIFY) __X

831. Would you buy fresh vegetables from a shopkeeper or vendor if you knew the person had the AIDS virus?

YES 1
NO 2
DOESN'T KNOW 8

832. If a member of your family had the AIDS virus would you like it to remain a secret or not?

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

833. If a member of your family become 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/NOT SURE/IT DEPENDS 8

834A. In your opinion, if a female teacher has the AIDS virus but is not sick, should she be able to continue teaching in the school?

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

834B. In your opinion, if a male teacher has the AIDS virus but is not sick, should he be able to continue teaching in the school?

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

835. Do you personally know someone who has been denied health service in the last 12 months because he or she is suspected to have the AIDS virus?

YES 1
NO 2
DOESN'T KNOW ANYONE WITH AIDS 8 (GO TO 840)

836. Do you personally know someone who has been denied involvement in social events, religious services or community events in the last 12 months because he or she is suspected to have the AIDS virus?

YES 1
NO 2

837. Do you personally know someone who has been verbally abused or teased in the last 12 months because he or she is suspected to have the AIDS virus?

YES 1
NO 2

838. CHECK 835, 836 AND 837:

NO 'YES' (GO TO 839)
AT LEAST ONE 'YES' (GO TO 840)

839. Do you know someone who is suspected to have or has the AIDS virus?

YES 1
NO 2

840. Do you agree or disagree with the following statement: People with the AIDS virus should be ashamed of themselves.

AGREE 1
DISAGREE 2
DOESN'T KNOW/ NO OPINION 8

841. Do you agree or disagree with the following statement: People with the AIDS virus should be blamed for bringing the disease into the community.

AGREE 1
DISAGREE 2
DOESN'T KNOW/ NO OPINION 8

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

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

843. Should children age 12-14 be taught to wait until they get married to have sex to avoid getting AIDS?

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

844. Do you think that young men should wait until marriage to have sexual intercourse?

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

845. Do you think that young women should wait until marriage to have sexual intercourse?

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

846. Do you think that married men should only have sexual intercourse with their wives?

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

847. Do you think that most of the men you know only have sexual intercourse with their wives?

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

848. Do you think that married women should only have sexual intercourse with their husband?

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

849. Do you think that most of the women that you know only have sexual intercourse with their husband?

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

850. CHECK 801:

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

NOT HEARD ABOUT AIDS
Have you heard about infections that can be transmitted through sexual contact?

YES 1
NO 2 (GO TO 853)

851. 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

852. When a woman has a sexually transmitted infection, which symptom could she have?
Are there other symptoms?

RECORD ALL MENTIONED

ABDOMINAL PAIN A
VAGINAL 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

853. CHECK 519:

HAS HAD SEXUAL INTERCOURSE (GO TO 854)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 901A)

854. CHECK 850:

HAS HEARD ABOUT SEXUALLY TRANSMITTED DISEASES (GO TO 855)
HAS NOT HEARD ABOUT SEXUALLY TRANSMITTED DISEASES (GO TO 856)

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

855. During the last 12 months have you had a disease which you got from sexual contact?

YES 1
NO 2
DOESN'T KNOW 8

856. 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

857. 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

858. CHECK 855, 856 AND 857

HAS HAD AN INFECTION (AT LEAST ONE 'YES') (GO TO 859)
HAS NOT HAD AN INFECTION OR DOESN'T KNOW (GO TO 901A)

859. The last time you had (PROBLEM MENTIONED IN 855/856/857) did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 861)

860. Where did you go?
Was there another place?
RECORD ALL MENTIONED.

PUBLIC SECTOR
NATIONAL HOSPITAL A
REGIONAL HOSPITAL B
CSREF (heath referral center) C
PMI (protection maternelle et infantile - a program created in France to give free care to expecting/recent mothers) /MATERNITY D
CSCOM (Centre de Sant? Communitaire) Community Health Center E
PHARMACY F
OTHER PUBLIC (SPECIFY) __G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR H
PHARMACY I
STI CENTER J
HEALTH WORKER L
OTHER PRIVATE MEDICAL (SPECIFY) __M
OTHER SOURCE
TRADITIONAL HEALER N
SHOP O
OTHER (SPECIFY) __X

861. The last time you had (PROBLEM MENTIONED IN 855/856/857) did your partner seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 901A)
DOESN'T KNOW 8 (GO TO 901A)

862. Where did he go?
Was there another place?
RECORD ALL MENTIONED.

PUBLIC SECTOR
NATIONAL HOSPITAL A
REGIONAL HOSPITAL B
CSREF (heath referral center) C
PMI (protection maternelle et infantile-a program created in France to give free care to expecting/recent mothers) /MATERNITY D
CSCOM (Centre de Sant? Communitaire) Community Health Center E
PHARMACY F
OTHER PUBLIC (SPECIFY) __G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR H
PHARMACY I
STI CENTER J
HEALTH WORKER L
OTHER PRIVATE MEDICAL (SPECIFY) __M
OTHER SOURCE
TRADITIONAL HEALER N
SHOP O
OTHER (SPECIFY) __X
DOESN'T KNOW Z

SECTION 9A. FEMALE CIRCUMCISION

901A. I would now like that we speak of another thing.

901B. Have you ever heard of female circumcision?

YES 1 (GO TO 903)
NO 2

902. In certain countries 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 925)

903. Were your external genitals cut?

YES 1
NO 2 (GO TO 909)

I would now 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?
IF YES, RETURN TO 904 CHECK AND CHANGE IF NECESSARY.

YES 1
NO 2
DOESN'T KNOW 8

906. Did they somehow close your vaginal area?

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 PROFESSIONSAL
DOCTOR 21
NURSE 22
MIDWIFE 23
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?

NAME OF DAUGHTER__
CHECK 212 AND RECORD THE LINE NUMBER OF THE 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 somehow closed?

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
AGE IN COMPLETED MONTHS __
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 22
MIDWIFE 23
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)
DIF. URINATING/RETAINING 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 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 are favorable to abandoning it?

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

SECTION 9B. FISTULA

925. Do you know about an illness called "fistula," that is to say the "urine illness?"

YES 1
NO 2 (GO TO 1001A)

926A. What, in your opinion, are the causes of this illness?

WITCHCRAFT OR MYSTICAL CHARMS A
EVIL SPELLS, FATE B
TOO YOUNG TO GIVE BIRTH C
TOO OLD TO GIVE BIRTH D
TOO THIN TO SUPPORT A PREGNANCY E
TOO MANY SUCCESSIVE BIRTHS F
FREQUENT ILLNESS DURING THE PREGNANCY G
BIRTH OF A LARGE BABY H
BIRTH AT HOME WITHOUT MEDICAL ASSISTANCE I
WILL OF GOD J
OTHERS (SPECIFY) __ X
DOESN'T KNOW Y

926B. What are the main manifestations of this illness?

CONTINUOUS WEIGHT LOSS A
INVOLUNTARY URINATION B
INVOLUNTARY BOWEL MOVEMENTS C
BOTH INVOLUNTARY URINATION AND BOWEL MOVEMENTS D
CONSTANTLY WET E
NAUSEATING ODORS F
DIFFICULTY MOVING G

927. Is it possible to treat this illness and to heal it?

YES 1
NO 2

928. Have you ever contracted this illness?

YES 1
NO 2 (GO TO 935)

929. If yes, how, in your opinion, did you contract it?

_____

930. Where are you going/did you go for treatment?

HEALTH CENTER A
MATERNITY B
HOSPITAL G
PRIVATE CLINIC D
OTHER MEDICAL STRUCTURE (SPECIFY) __E
TRADITIONAL TREATMENTS IN THE VILLAGE F
NO TREATMENT Y (GO TO 935)

930A. CHECK 930:

IF ONE OF THE CODE "A" TO "E' IS CIRCLED (GO TO 931)
IF ONLY "F" IS CIRCLED (GO TO 934B)

931. IF you are undergoing or have undergone treatment for your fistula in a modern health center, how many surgical operations did you undergo?

NUMBER __
IF NONE 00 (GO TO 933B)

932A. In your opinion was this or the last surgical operation a success?

YES 1
NO 2 (GO TO 933A)

932B. Why do you think that this operation succeeded?

NO MORE LOSS OF URINE A
RETURN TO NORMAL DAILY ACTIVITIES B
FEELING BETTER, FEELING RELIEF C
RETURN TO FAMILY LIFE D

932C. For how long were you/have you been undergoing treatments?

NUMBER OF MONTHS 1__ (GO TO 935)
NUMBER OF YEARS 2__ (GO TO 935)

933A. Why do you think this operation did not succeed?

AGGRAVATION: INVOLUNTARY LOSS OF URINE TOO OFTEN A
NO AMELIORATION B
EXCESSIVE PAIN C
INTERNMENT IN MEDICAL FACILITY D
ANOTHER OPERATION PLANNED E

933B. For how long have you been undergoing treatments?

NUMBER OF MONTHS 1__
NUMBER OF YEARS 2__

934A. CHECK 930 AND 931:

IF THE CODE F IS CIRCLED OR 931 EQUALS 00 (GO TO 934B)
IF THE CODE F IS NOT CIRCLED AND 931 IS NOT 00 (GO TO 935)

934B. What are the results of these treatments today?

AGGRAVATION 1
NO AMELIORATION 2
SIGNIFICANT AMELIORATION 3
PARTIAL CURE 4
COMPLETE CURE 5
DURATION OF TREATMENT TOO SHORT TO JUDGE 6
NO OPINION 7

934C. For how long were you/have you been undergoing treatments?

NUMBER OF MONTHS 1__
NUMBER OF YEARS 2__

935. In your opinion, can fistulas be prevented by adopting the following behaviors?

A) Avoid early marriages of adolescents less than 18 years.
YES 1
NO 2
DOESN'T KNOW 3
B) Encourage schooling for the young girl
YES 1
NO 2
DOESN'T KNOW 3
C) Avoid early pregnancies
YES 1
NO 2
DOESN'T KNOW 3
D) Avoid too many pregnancies
YES 1
NO 2
DOESN'T KNOW 3
E) Avoid having pregnancies too close together
YES 1
NO 2
DOESN'T KNOW 3

936. In your opinion can fistulas be avoided by adopting the following behaviors in the case of pregnancy?

A) Get prenatal care in a health center
YES 1
NO 2
DOESN'T KNOW 3
B) Give birth in a hospital facility or in a maternity
YES 1
NO 2
DOESN'T KNOW 3
C) Have postnatal care
YES 1
NO 2
DOESN'T KNOW 3
D) Participate in family planning meetings
YES 1
NO 2
DOESN'T KNOW 3
E) Avoid doing the most demanding house work (getting water, wood, etc.)
YES 1
NO 2
DOESN'T KNOW 3
F) Avoid taking traditional medicinal potions
YES 1
NO 2
DOESN'T KNOW 3

937A. CHECK QUESTION 930:

IF CODE 'Y' IS CIRCLED (GO TO 937B)
IF CODE 'Y' IS NOT CIRCLED (GO TO 938)

937B. Why did you not get care?

INFORMATION PROBLEMS A
INCURABLE ILLNESS B
WITCHCRAFT C
LACK OF FAMILY SUPPORT D
LACK OF MONEY E
NO OPINION F

938. Do you know (other) women who suffer or have suffered from fistulas?

YES 1
NO 2 (GO TO 1001A)

939. If yes, how many women?

NUMBER OF WOMEN__

940. Could you tell me where they currently live (locality, commune and region)?

______

SECTION 10. RELATIONSHIPS IN THE HOUSEHOLD

1001A. CHECK THE COVER PAGE:

THE WOMEN THAT YOU ARE SURVEYING WAS SELECTED FOR THE RELATIONSHIPS IN THE HOUSEHOLD?

IF YES (GO TO 1001B)
IF NO (GO TO 1101A)

1001B. CHECK THE PRESENCE OF OTHER PEOPLE
DO NOT CONTINUE UNTIL YOU ARE COMPLETELY IN PRIVATE.

CIRCLE THE CODE CORRESPONDING TO THE SITUATION AND FOLLOW THE SKIP INSTRUCTIONS:

YOU ARE IN PRIVATE 1 (CONTINUE)
IMPOSSIBLE TO BE IN PRIVATE 2 (GO TO 1028)

READ TO ALL OF THE RESPONDENTS:

Now I would like to ask you some questions about certain aspects of the relationship within the couple. I know that some of the questions are very personal. However, your answers are very important to help us understand the situation of women in Mali. I guarantee that your answers will be completely confidential and will not be repeated to anyone. I also would like to inform you that you are the only one in your household to whom these questions will be asked and that no one will know that we asked you these questions. If someone comes in while we are talking, we will change subjects.

1002. CHECK 501, 502, AND 504:

CURRENTLY IN UNION OR LIVES WITH A MAN (GO TO 1003)
DIVORCED/WIDOW/SEPARATED (GO TO 1003)
NEVER HAS BEEN IN UNION/NEVER LIVED WITH A MAN (GO TO 1014)

1003. When two people are married or live together, they share good and bad times. In your relationship with your (last) husband/partner (did/do) the following things happen often, sometimes or never?

A) He usually (spends/spent) his free time with you?
B) He (consults/consulted) you about different household issues?
C) He (is/was) affectionate with you?
D) He (respects/respected) and (takes/took) your wishes into consideration.

FREE TIME
OFTEN 1
SOMETIMES 2
NEVER 3
CONSULT
OFTEN 1
SOMETIMES 2
NEVER 3
AFFECTION
OFTEN 1
SOMETIMES 2
NEVER 3
RESPECT
OFTEN 1
SOMETIMES 2
NEVER 3

Now I would like to ask you some questions about the situations women could come across.

1004. Please tell me if the following things are applicable to your relationship with your (last) husband/partner?

A) He (is/was) jealous when you (talk/talked) to other men?
B) He often (accuses/accused) you of being unfaithful?
C) He (does/did) not let you see your female friends?
D) He (tries/tried) to limit your contact with your family of origin?
E) He (insists/insisted) knowing where you (are/were) all the time?
F) He (does/did) not trust you with money?
G) He (keeps/kept) you from having a job or he does not think you should work?

JEALOUS
YES 1
NO 2
DOESN'T KNOW 3
ACCUSE
YES 1
NO 2
DOESN'T KNOW 3
SEE FRIENDS
YES 1
NO 2
DOESN'T KNOW 3
VISIT FAMILY
YES 1
NO 2
DOESN'T KNOW 3
WHERE YOU ARE
YES 1
NO 2
DOESN'T KNOW 3
MONEY
YES 1
NO 2
DOESN'T KNOW 3
JOB
YES 1
NO 2
DOESN'T KNOW 3

1005. Now, if you allow it, I would like to ask you some questions about your relationship with your (last) husband.

5A. Has you (last) husband/partner ever:

A) told you or did something to you to humiliate you in front of other people?
YES 1 (GO TO 5B)
NO 2
B) threatened you or someone close to you?
YES 1 (GO TO 5B)
NO 2 (GO TO 1006)

5B. How many times did this happen during the last 12 months?

A) told you or did something to you to humiliate you in front of other people?
NUMBER OF TIMES__
IF WIDOW, DIV, SEPARATED 95
B) threatened you or someone close to you?
NUMBER OF TIMES__
IF WIDOW, DIV, SEPARATED 95

1006. Now, if you allow it, I would like to ask you some other questions about your relationship with your (last) husband.

6A. Has your (last) husband or partner ever:

A) pushed you, shaken you or thrown something at you?
YES 1 (GO TO 6B)
NO 2
B) slapped you or twisted your arm?
YES 1 (GO TO 6B)
NO 2
C) punched you or hit you with something that could injure you?
YES 1 (GO TO 6B)
NO 2
D) kicked you or dragged you on the ground?
YES 1 (GO TO 6B)
NO 2
E) tried to strangle or burn you?
YES 1 (GO TO 6B)
NO 2
F) threatened you with a knife, a gun or another type of weapon?
YES 1 (GO TO 6B)
NO 2
G) attacked you with a knife, a gun or another kind of weapon?
YES 1 (GO TO 6B)
NO 2
H) physically forced you to have sexual intercourse even when you didn't want to?
YES 1 (GO TO 6B)
NO 2
I) forced you to do sexual acts that you did not want to do?
YES 1 (GO TO 6B)
NO 2

6B. How many times did this happen during the last 12 months?

A) pushed you, shaken you or thrown something at you?
NUMBER OF TIMES__
IF WIDOW, DIV, SEPARATED 95
B) slapped you or twisted your arm?
NUMBER OF TIMES__
IF WIDOW, DIV, SEPARATED 95
C) punched you or hit you with something that could injure you?
NUMBER OF TIMES__
IF WIDOW, DIV, SEPARATED 95
D) kicked you or dragged you on the ground?
NUMBER OF TIMES__
IF WIDOW, DIV, SEPARATED 95
E) tried to strangle or burn you?
NUMBER OF TIMES__
IF WIDOW, DIV, SEPARATED 95
F) threatened you with a knife, a gun or another type of weapon?
NUMBER OF TIMES__
IF WIDOW, DIV, SEPARATED 95
G) attacked you with a knife, a gun or another kind of weapon?
NUMBER OF TIMES__
IF WIDOW, DIV, SEPARATED 95
H) physically forced you to have sexual intercourse even when you didn't want to?
NUMBER OF TIMES__
IF WIDOW, DIV, SEPARATED 95
I) forced you to do sexual acts that you did not want to do?
NUMBER OF TIMES__
IF WIDOW, DIV, SEPARATED 95

1007. CHECK 1006:

IF AT LEAST ONE 'YES' (GO TO 1008)
NO 'YES' (GO TO 1009A)

1008. How long after your (marriage/union/beginning of cohabitation) with your (last) husband/partner did this/these behaviors begin?

NUMBER OF YEARS__
BEFORE MARRIAGE/UNION 95
AFTER SEPARATION/DIVORCE 96

1009.

9A. After any deliberate such behavior on the part of your husband/partner did you have any of the following problems?

A) Having bruises and lumps?
YES 1 (GO TO 9B)
NO 2
B) Having a wound, fracture or sprain?
YES 1 (GO TO 9B)
NO 2
C) Having gone to a doctor or health center because of something your (last) husband/partner did to you?
YES 1 (GO TO 9B)
NO 2 (GO TO 1009A)

9B. How many times during the last 12 months did this happen?

A) Having bruises and lumps?
NUMBER OF TIMES__
IF WIDOW, DIV, OR SEPARATED 95
B) Having a wound, fracture or sprain?
NUMBER OF TIMES__
IF WIDOW, DIV, OR SEPARATED 95
C) Having gone to a doctor or health center because of something your (last) husband/partner did to you?
NUMBER OF TIMES__
IF WIDOW, DIV, OR SEPARATED 95

1009A. Have you ever done anything to humiliate or threaten your last husband/partner in front of other people?

YES 1
NO 2 (GO TO 1010)

1009B. How long after your (marriage/union/beginning of cohabitation) with your (last) husband/partner did this/these behaviors begin?

NUMBER OF YEARS__
BEFORE MARRIAGE/UNION 95
AFTER SEPARATION/DIVORCE 96

1010. Have you ever fought, hit, kicked or done something else to physically attack your (last) husband/partner when he neither beat nor physically attacked you?

YES 1
NO 2 (GO TO 1012)

1011. During the last 12 months, how many times have you beaten, slapped, kicked, or did something else to physically attack your (last) husband/partner when he neither beat nor physically attacked you?

NUMBER OF TIMES ____
IF WIDOWED, DIVORCED, OR SEPARATED 95

1012. Did/does your (last) husband drink alcohol?

YES 1
NO 2 (GO TO 1014)

1013. Is/was he drunk very often, only sometimes, or never?

VERY OFTEN 1
SOMETIMES 2
NEVER 3

1014. CHECK 1002:

MARRIED/LIVES WITH A MAN/SEPARATED/DIVORCED
Since the age of 15 years, has someone besides your (current/last) husband/partner beaten, slapped, kicked you or did something to physically attack you?

NEVER MARRIED/NEVER BEEN IN UNION
Since the age of 15 years, has someone beaten, slapped, kicked you or did something to physically attack you?

YES 1
NO 2 (GO TO 1019)
NO RESPONSE 3 (GO TO 1019)

1015. Who physically attacked you?
Someone else?
CIRCLE ALL MENTIONED.

MOTHER A
FATHER B
FATHER'S NEW WIFE C
MOTHER'S NEW HUSBAND/PARTNER D
SISTER E
BROTHER F
DAUGHTER G
SON H
EX-HUSBAND/EX-PARTNER I
CURRENT FRIEND/ SEXUAL PARTNER J
FORMER FRIEND/SEXUAL PARTNER K
MOTHER-IN-LAW L
FATHER-IN-LAW M
OTHER FEMALE RELATIVES IN LAW N
OTHER MALE RELATIVES IN LAW O
FEMALE FRIENDS P
MALE FRIENDS Q
INSTRUCTOR R
EMPLOYER S
STRANGER T
OTHERS (SPECIFY) __X

1016: CHECK 1015:

MORE THAN ONE PERSON MENTIONED (GO TO 1017)
ONLY ONE PERSON MENTIONED (GO TO 1018)

1017. Who is the person who has most often beaten, slapped, kicked or did something to physically attack you?

MOTHER 01
FATHER 02
FATHER'S NEW WIFE 03
MOTHER'S NEW HUSBAND/PARTNER 04
SISTER 05
BROTHER 06
DAUGHTER 07
SON 08
EX-HUSBAND/EX-PARTNER 09
CURRENT FRIEND/ SEXUAL PARTNER 10
FORMER FRIEND/SEXUAL PARTNER 11
MOTHER-IN-LAW 12
FATHER-IN-LAW 13
OTHER FEMALE RELATIVES IN LAW 14
OTHER MALE RELATIVES IN LAW 15
FEMALE FRIENDS 16
MALE FRIENDS 17
INSTRUCTOR 18
EMPLOYER 19
STRANGER 20
OTHERS (SPECIFY) __96

1018. During the last 12 months, how many times did this person beat, slap, kick or done something to physically attack you?

NUMBER OF TIMES__
IF WIDOW, DIV. OR SEPARATED 95

1019. CHECK 201, 226 AND 229:
LIVE BIRTHS, STATE OF PREGNANCY AND STILL BIRTHS

AT LEAST ONE PREGNANCY (GO TO 1020)
NEVER PREGNANT [201=2, 226=2 OR 8 AND 229=2] (GO TO 1022)

1020. Has anyone ever beaten, slapped, kicked or did something to physically attack you during (a/this) pregnancy?

YES 1
NO 2 (GO TO 1022)

1021. Who physically attacked you during a pregnancy?
Someone else?
CIRCLE ALL MENTIONED.

MOTHER A
FATHER B
FATHER'S NEW WIFE C
MOTHER'S NEW HUSBAND/PARTNER D
SISTER E
BROTHER F
DAUGHTER G
SON H
EX-HUSBAND/EX -PARTNER I
CURRENT FRIEND/ SEXUAL PARTNER J
FORMER FRIEND/SEXUAL PARTNER K
MOTHER-IN-LAW L
FATHER-IN-LAW M
OTHER FEMALE RELATIVES IN LAW N
OTHER MALE RELATIVES IN LAW O
FEMALE FRIENDS P
MALE FRIENDS Q
INSTRUCTOR R
EMPLOYER S
STRANGER T
OTHERS (SPECIFY) __X

1022. CHECK 1006, 1009, 1014 AND 1020:

AT LEAST ONE 'YES' (GO TO 1023)
NO 'YES' (GO TO 1026)

1023. Did you try to get help?

YES 1
NO 2 (GO TO 1025)

1024. From whom did you seek help?
Someone else?
CIRCLE ALL MENTIONED.

MOTHER A (GO TO 1026)
FATHER B (GO TO 1026)
SISTER C (GO TO 1026)
BROTHER D (GO TO 1026)
CURRENT HUSBAND/PARTNER E (GO TO 1026)
FORMER HUSBAND/PARTNER F (GO TO 1026)
MOTHER-IN-LAW G (GO TO 1026)
FATHER-IN-LAW H (GO TO 1026)
OTHER FEMALE RELATIVES IN LAW I (GO TO 1026)
OTHER MALE RELATIVES IN LAW J (GO TO 1026)
FRIENDS K (GO TO 1026)
NEIGHBORS L (GO TO 1026)
INSTRUCTOR M (GO TO 1026)
EMPLOYER N (GO TO 1026)
RELIGIOUS AUTHORITY O (GO TO 1026)
DOCTOR/HEALTH WORKER P (GO TO 1026)
POLICE Q (GO TO 1026)
LAWYER/LAW MAN R (GO TO 1026)
TRADITIONAL AUTHORITY S (GO TO 1026)
SOCIAL SERVICE T (GO TO 1026)
WOMEN'S ASSOCIATION U (GO TO 1026)
OTHERS (SPECIFY) __X (GO TO 1026)

1025. What is the main reason why you never sought help?

DOESN'T KNOW WHERE TO GO 01
USELESS/NO NEED 02
PART OF LIFE 03
FEAR OF DIVORCE/SEPARATION 04
FEAR OF BEING BEATEN 05
FEAR OF CREATING PROBLEMS FOR THE AGGRESSOR 06
EMBARRASSED 07
DOESN'T WANT TO DISHONOR THE FAMILY 08
OTHERS (SPECIFY) __96

1026. To your knowledge, did your father ever beat your mother?

YES 1
NO 2
DOESN'T KNOW 8

1026A. Did you know of a service that educates and supports women in difficulty?

YES 1
NO 2
DOESN'T KNOW 8

THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER THAT HER RESPONSES ARE CONFIDENTIAL. RESPOND TO THE QUESTIONS BELOW ONLY WITH REGARDS TO THE PART OF THE INTERVIEW CONCERNING HOUSEHOLD RELATIONSHIPS.

1027. DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE ONE OF THE PEOPLE LISTED TRIED TO LISTEN TO INTERVENE IN ANY WAY?

HUSBAND
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3
OTHER MALE ADULTS
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3
FEMALE ADULTS
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3

1028. INTERVIEWER'S COMMENTARY:

IF SECTION 10 COULD NOT BE DONE, EXPLAIN THE REASONS ____

SECTION 11. 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.

1101A. Did your mother give birth to other children besides yourself?

YES 1
NO 2 (GO TO 1101H)

1101B. How many boys did your mother have that are still alive?

LIVING BOYS__

1101C. Besides you, how many girls did your mother have that are still alive?

LIVING GIRLS__

1101D. How many boys did your mother have who are deceased?

DECEASED BOYS__

1101E. How many girls did your mother have who are deceased?

DECEASED GIRLS__

1101F. Did your mother give birth to other children whom you don't know to be living or deceased?

YES 1
NO 2 (GO TO 1101H)

1101G. How many other children did your mother give birth whom you don't know to be living or deceased?

OTHER CHILDREN__

1101H. ADD THE ANSWERS TO 1101B, C, D, E, AND G. ADD 1(THE RESPONDENT) TO THE TOTAL:

TOTAL__

1101I. Just to be sure that I understand, including yourself, your mother gave birth to __ children in all. Is this correct?

YES (GO TO 1102)
NO PROBE AND CORRECT 1101A-1101H AS NECESSARY

1102. CHECK 1101I:

TWO OR MORE BIRTHS (GO TO 1103)
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 1114)

1103. How many of these births did your mother have before your own birth?

NUMBER OF PREVIOUS BIRTHS__

Now I would like to make a list of all your brothers and sisters, whether or not they are still alive, beginning with the oldest.

RECORD THE NAME OF ALL OF THE BROTHERS AND SISTERS. REPEAT QUESTIONS 1104-1113 FOR ALL BIRTHS

1104. What name was given to your oldest brother or sister (or the next)?

NAME __

1105. Is (NAME) male or female?

MALE 1
FEMALE 2

1106. Is (NAME) still alive?

YES 1
NO 2 (GO TO 1108)
DOESN'T KNOW 8 (GO TO NEXT BIRTH)

1107. How old is (NAME)?

AGE__ (GO TO NEXT BIRTH)

1108. How many years has (NAME) been deceased?

YEARS__

1109. How old was (NAME) when he/she died?

IF DOESN'T KNOW, PROBE: Did (NAME) die before the age of 12 years?
IF YES, RECORD '95.'
IF NO, ASK OTHER QUESTIONS TO GET AN ESTIMATE. FOR EXAMPLE: Did (NAME) die before getting married?

AGE__

IF MAN, OR IF WOMAN DECEASED BEFORE THE AGE OF 12 YEARS GO TO NEXT
BIRTH.

1110. Was (NAME) pregnant when she died?

YES (GO TO 1113)
NO 2

1111. Did (NAME) die during childbirth?

YES 1 (GO TO 1113)
NO 2

1112. Did (NAME) die in the two months following a pregnancy or birth?

YES 1
NO 2

1113. To how many children did (NAME) give birth during her life?

NUMBER__ (GO TO NEXT BIRTH)
IF NO MORE BROTHERS OR SISTERS, (GO TO 1114)

1114. RECORD THE TIME:

HOURS__
MINUTES__

INTERVIEWER'S OBSERVATIONS:

FILL OUT AFTER HAVING ENDED THE INTERVIEW

COMMENTS ABOUT THE RESPONDENT ____

COMMENTS ON PARTICULAR QUESTIONS ____

OTHER COMMENTS ____

SUPERVISOR'S OBSERVATIONS ____
SUPERVISOR'S NAME____
DATE____

FIELD EDITOR'S OBSERVTIONS ____
FIELD EDITOR'S NAME____
DATE____

CALENDAR

INSTRUCTIONS: ONLY ONE CODE PER BOX.
BIRTHS AND PREGNANCIES:

N BIRTH
G PREGNANCY
F END OF PREGNANCY
2006
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__
2005
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__
2004
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__
2003
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__
2002
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__
2001
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__