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DEMOGRAPHIC AND HEALTH SURVEY IN MALI (EDSM-V, 2012)
WOMAN'S QUESTIONNAIRE


COMMITTEE OF PLANNING AND STATISTICS/MINISTRY OF HEALTH
NATIONAL OFFICE OF STATISTICS AND INFORMATION
REPUBLIC OF MALI

IDENTIFICATION

NAME OF PLACE____________
CLUSTER NUMBER_______
LAST NAME AND FIRST NAME OF HEAD OF HOUSEHOLD_______________
PLOT NUMBER_______
HOUSEHOLD NUMBER__________
REGION____________

URBAN/RURAL MILIEU

URBAN 1
RURAL 2

BAMAKO, OTHER CITIES, OTHER TOWNS, RURAL

BAMAKO 1
OTHER CITIES 2
OTHER TOWNS 3
RURAL 4

WOMAN'S FIRST AND LAST NAME AND LINE NUMBER

NAME___________
LINE NUMBER____

WOMAN SELECTED FOR DOMESTIC VIOLENCE IN HOUSEHOLD?
CHECK KISH SELECTION TABLE ON THE HOUSEHOLD QUESTIONNAIRE

YES 1
NO 2

HOUSEHOLD SELECTED FOR MEN'S SURVEY
(CHECK COVER PAGE OF HOUSEHOLD QUESTIONNAIRE) (FOR Q542 AND 543)

YES 1
NO 2

INTERVIEWER VISITS

(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE________
INTERVIEWER'S NAME____________
RESULT*______________

NEXT VISIT
DATE________
TIME__________

FINAL VISIT
DAY____
MONTH____
YEAR 2012
INTERVIEWER______
RESULT____

TOTAL NO. OF VISITS________

*RESULTS CODE:

1COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) ____________

LANGUAGE OF QUESTIONNAIRE: FRENCH

1 FRENCH
2 BAMBARA
3 SONRAI
4 PEULH

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/SOMONO 11
OTHER 96

INTERPRETER

YES 1
NO2

SUPERVISOR
NAME____________
DATE______________

FIELD EDITOR
NAME_____________
DATE____________

OFFICE EDITOR_______

KEYED BY__________

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

Hello. My name is _______. I am working with INFO-STAT, which is executing this survey in collaboration with the Committee of Planning and Statistics (CPS) of the Ministry of Health and the National Office of Statistics and Information (INSTAT). We are conducting a survey about health all over Mali. The information we collect will help the government to improve health services. Your household was selected for this survey. The questions usually take between 30 to 60 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You are not obligated to participate in this survey, but we hope you will agree to participate because your opinion is very important. If it happens that I ask you any question you don't want to answer, tell me and I will pass onto the next question; you can also stop the interview at any moment.

If you would like more information about the survey, you may contact the person listed on the card that has already been given to your household.

Do you have any questions?
May I begin the interview?

SIGNATURE OF INTERVIEWER______________ DATE_________

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

101) RECORD THE TIME

HOUR___________
MINUTES___________

102) In what month and year were you born?

MONTH_____
DON'T KNOW MONTH 98
YEAR______
DON'T KNOW YEAR 9998

103) How old were you at your last birthday?
COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT

AGE IN COMPLETED YEARS_________

104) Have you attended school?

YES 1
NO 2 (GO TO 108)

105) What is the highest level of school you achieved: fundamental 1 (1st cycle), fundamental 2 (2nd cycle), secondary (high school or technical school), or higher?

FUNDAMENTAL (1ST CYCLE) 1
FUNDAMENTAL (2ND CYCLE) 2
SECONDARY (HIGH SCHOOL OR TECHNICAL SCHOOL) 3
HIGHER 4

106) What is the highest (grade/form/year) you completed at this level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD 00

GRADE/FORM/YEAR_________

107) CHECK 105:

FUNDAMENTAL 1 (1ST CYCLE) (GO TO 108)
FUNDAMENTAL 2 (2ND CYCLE) OR HIGHER (GO TO 110)

108) Now I would like you to read this sentence to me.

SHOW CARD TO RESPONDENT
IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE:

Can you read a part of the sentence to me?

CANNOT READ AT ALL 1
ABLE TO READ ONLY PARTS OF THE SENTENCE 2
ABLE TO READ THE WHOLE SENTENCE 3
NO CARD WITH LANGUAGE OF THE RESPONDENT (SPECIFY LANGUAGE) _____________ 4
BLIND/VISUALLY IMPAIRED 5

109) CHECK 108:

CODE '2', '3', OR '4' CIRCLED (GO TO 110)
CODE '1' OR '5' CIRCLED (GO TO 111)

110) Do you read a newspaper or magazine at least once a week, less than once a week or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

111) Do you listen to the radio at least once a week, less than once a week or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

112) Do you watch television at least once a week, less than once a week, or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

113) What religion do you practice?

MUSLIM 1
CHRISTIAN 2
METHODIST 3
EVANGELICAL 4
OTHER CHRISTIAN RELIGION 5
ANIMIST 6
OTHER RELIGIONS 7
NO RELIGION 8

114) What is your ethnicity?

ETHNIC CODE (FOR MALIANS)
BAMBARA 01
MALINKE 02
PEULH 03
SARAKOLE/SONINKE/MARKA 04
SONRAI 05
DOGON 06
TAMACHEK/BELLA 07
SENOUFO/MINIANKA 08
BOBO 09
OTHER (SPECIFY) _____________ 96
NATIONALITY CODES (FOR FOREIGNERS)
COUNTRIES PART OF THE ECONOMIC COMMUNITY OF WEST AFRICAN STATES (CEDEAO) 10
OTHER AFRICAN COUNTRIES 11
OTHER NATIONALITIES 12

115) In the last 12 months, how many times have you slept away from home for one or more nights?

NUMBER OF TIMES________
NONE 00 (GO TO 201)

116) In the last 12 months, have you been away from home for more than one month at a time?

YES 1
NO 2

SECTION 2. REPRODUCTION

201) Now I would like to ask you about all the births you have had during your life. Have you already given birth to children?

YES 1
NO 2 (GO TO 206)

202) Do you have any sons or daughters to whom you have given birth who currently live with you?

YES 1
NO 2 (GO TO 204)

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

SONS AT HOME____________
DAUGHTERS AT HOME____________

204) Do you have any sons or daughters to whom you have given birth who are still alive but do not live with you?

YES 1
NO 2 (GO TO 206)

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

SONS ELSEWHERE___________
DAUGHTERS ELSEWHERE___________

206) Have you ever given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

YES 1
NO 2 (GO TO 208)

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

BOYS DEAD_________
GIRLS DEAD__________

208) SUM ANSWERS TO 203, 205, AND 207 AND ENTER TOTAL.
IF NONE, RECORD 00

TOTAL BIRTHS_________

209) CHECK 208:
Just to makes sure that I have this right: you have had in total ____births during your life. Is that correct?

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

210) CHECK 208:

ONE OR MORE BIRTHS (GO TO 211)
NO BIRTHS (GO TO 226)

211) Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had.
RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE ROWS. (IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW.)

212) What name was given to you (FIRST/NEXT) baby?

NAME________

213) Is (NAME) a boy or a girl?

BOY 1
GIRL 2

214) Were any of these births twins?

SINGLE 1
MULTIPLE 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 CHILD NOT LISTED IN HOUSEHOLD)

LINE NUMBER________

GO TO NEXT BIRTH/ Q. 221

220) IF DEAD: How old was (NAME) when he/she died?
IF '1 YR', PROBE: How many months old was (NAME)?
RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS, OR 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?

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

(REPEAT QUESTIONS 212-221 FOR ALL BIRTHS)

222) Have you had any live births since the birth of (NAME OF LAST BIRTH)?
IF YES, RECORD BIRTHS IN TABLE.

YES 1
NO 2

223) COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK.

NUMBERS ARE THE SAME (GO TO 224)
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

224) CHECK 215:
ENTER THE NUMBER OF BIRTHS IN 2007 OR LATER.

NUMBER OF BIRTHS_______ (GO TO 225)
NONE 0 (GO TO 226)

225) C:
FOR EACH BIRTH SINCE JANUARY 2007, ENTER "N" IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE CODE "N" FOR EACH BIRTH. ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD "G" IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF THE PREGNANCY. (NOTE: THE NUMBER OF GS MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)

226) Are you pregnant now?

YES 1
NO 2 (GO TO 230)
UNSURE 8 (GO TO 230)

227) How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.
C: ENTER G's IN THE CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

MONTHS______

228) When you became pregnant, did you want to get pregnant at that time?

YES 1 (GO TO 230)
NO 2

229) Did you want to have a baby later on or did you not want any (more) children?

LATER 1
NO MORE 2

230) Have you ever had a pregnancy that miscarried, was aborted, or ended in a stillbirth?

YES 1
NO 2 (GO TO 238)

230A) Among these terminated pregnancies, were there any:

Miscarriages?
Abortions?
Stillbirths?

MISCARRIAGES
YES 1
NO 2
ABORTIONS
YES 1
NO 2
STILLBIRTHS
YES 1
NO 2

231) When did the last pregnancy of this type end?

MONTH____________
YEAR___________

232) CHECK 231:

LAST PREGNANCY ENDED IN JAN 2007 OR LATER
LAST PREGNANCY ENDED BEFORE JAN. 2007 (GO TO 238)

233) How many months pregnant were you when the last such pregnancy ended?
C: RECORD THE NUMBER OF COMPLETED MONTHS. ENTER "F" IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND "G" FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

MONTHS___________

234) Since January 2007, have you had any other pregnancies that did not result in a live birth?

YES 1
NO 2 (GO TO 236)

235) ASK THE DATE AND DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2007.
C: ENTER "F" IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND "G" FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

236) Did you have any miscarriages, abortions or stillbirths that ended before 2007?

YES 1
NO 2 (GO TO 238)

237) When did the last pregnancy of this type that terminated before 2007 end?

MONTH_____
YEAR______

238) When did you last menstrual period start?

_____________ (DATE, IF GIVEN)
DAYS AGO 1 ____
WEEKS AGO 3 ____
MONTHS AGO 2 ____
YEARS AGO 4 ____
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

239) From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant?

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

240) Is this time just before the period begins, during the period, right after the period has ended, or halfway between two periods?

JUST BEFORE THE PERIOD BEGINS 1
DURING THE PERIOD 2
RIGHT AFTER THE PERIOD HAD ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY) _______________ 6
DON'T KNOW 8

SECTION 3. CONTRACEPTION

301) Now I would like to talk about family planning-the various ways or methods that a couple can use to delay or avoid a pregnancy. What methods have you already heard about?

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) IUD: Women can have a coil placed inside their uterus by a doctor or a nurse.
YES 1
NO 2
04) INJECTABLES: Women can have an injection by a heath provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
05) IMPLANTS: Women can have one or more 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
06) PILL: Women can take a pill every day to avoid becoming pregnant.
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 sexual intercourse.
YES 1
NO 2
09A) BEADS (CYCLE BEADS OR FIXED DAY METHOD): A woman uses a string of colored beads to know which days she could get pregnant. On the days she could get pregnant, she uses a condom or does not have sexual intercourse.
YES 1
NO 2
09) LACTATIONAL AMENORRHEA METHOD (LAM): Up to 6 months after childbirth, and when her menstrual period has not returned, a woman can use a method that requires that she breastfeeds whenever the child asks, day and night, without giving him any other food.
YES 1
NO 2
10) RHYTHM METHOD: To avoid a pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.
YES 1
NO 2
11) WITHDRAWAL: Men can be careful and pull out before climax.
YES 1
NO 2
12) EMERGENCY CONTRACEPTION: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
YES 1
NO 2
13) Have you heard of any other ways or methods that a woman or man can use to avoid pregnancy?
YES 1 (SPECIFY) ________
NO 2

302) CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 303)
PREGNANT (GO TO 311)

303) Are you currently doing something or using any method to delay or avoid getting pregnant?

YES 1
NO 2 (GO TO 311)

304) Which method are you using?
CIRCLE ALL MENTIONED. IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION A (GO TO 307)
MALE STERILIZATION B (GO TO 307)
IUD C (GO TO 308A)
INJECTABLES D (GO TO 308A)
IMPLANTS E (GO TO 308A)
PILL F
CONDOM G (GO TO 306)
FEMALE CONDOM H (GO TO 308A)
DIAPHRAGM I (GO TO 308A)
SUPPOSITORY/FOAM/JELLY J (GO TO 308A)
CYCLE BEADS K (GO TO 308A)
LACTATIONAL AMEN. METHOD L (GO TO 308A)
RHYTHM METHOD M (GO TO 308A)
WITHDRAWAL N (GO TO 308A)
OTHER MODERN METHOD X (GO TO 308A)
OTHER TRADITIONAL METHOD Y

305) What is the brand name of the pills you are using?
IF DON'T KNOW BRAND, ASK TO SEE THE PACKAGE.

PILPLAN 01
OVRETTE 02
LO FEMENAL 03
MINIDRIL 04
STEDIRIL 05
ADEPAL 06
MICROGYNON 07
OTHER (SPECIFY) __________ 96
DON'T KNOW 98
(ALL GO TO 308A)

306) What is the brand name of the condoms you are using?
IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

PRUDENCE 01
PROTECTOR 02
KAMASSOUTRA 03
IPPF 04
OTHER (SPECIFY) _________ 96
DON'T KNOW 98
(ALL GO TO 308A)

307) In what facility did the sterilization take place?
PROBE TO IDENTIFY THE TYPE OF PLACE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

(NAME OF PLACE)____________
PUBLIC SECTOR
NATIONAL HOSPITAL 11
REGIONAL HOSPITAL 12
REFERRAL HEALTH CENTER (CSREF) 13
COMMUNITY HEALTH CENTER (CSCOM) 14
OTHER PUBLIC (SPECIFY) ______ 16
PRIVATE SECTOR
PRIVATE CLINIC/OFFICE 21
PRIVATE HEALTH CARE OFFICE 22
TREATMENT ROOM 23
PHARMACY 24
OTHER PRIVATE (SPECIFY) ___________ 26
OTHER (SPECIFY) ________ 96
DON'T KNOW 98

308) In what month and year was the sterilization performed?
308A) Since what month and year did you start using (CURRENT METHOD) without stopping?
PROBE: For how long have you been using (CURRENT METHOD FIRST MENTIONED) now without stopping?

MONTH_____
YEAR_______

309) CHECK 308/308A, 215, 231:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 308/308A.

YES (GO BACK TO 308/308A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION).)
NO

310) CHECK 308/308A

YEAR IS 2007 (6) OR LATER C (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN CALENDAR AND IN EACH MONTH BACK TO THE DATE OF THE BEGINNING OF USAGE.) (GO TO 332)
YEAR IS 2006 (7) OR EARLIER C (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2007 (6)) (GO TO 332)

311) I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years.

USE CALENDAR FOR REFERENCE OF TIMES OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2007 (6)
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

C: IN COLUMN 1, ENTER THE CODE FOR THE METHOD USED OR USE CODE "0" FOR NONUSE IN EACH BLANK MONTH.

ILLUSTRATIVE QUESTIONS:
When was the last time you used a method? Which method was that?
When did you start using that method? How long after the birth of (NAME)?
How long did you use the method afterwards?

IN COLUMN 2, ENTER CODES FOR DISCONTINUATION NEXT TO THE LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 2 MUST BE THE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1.

ASK WHY SHE STOPPED USING THE METHOD. IF PREGNANCY FOLLOWED THE INTERRUPTION, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT.

ILLUSTRATIVE QUESTIONS:
Why did you stop using the (METHOD)? Did you become pregnant while using (METHOD), did you stop to get pregnant, or did you stop for some other reason?
IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK: How many months did it take you to get pregnant after you stopped using (METHOD)? AND ENTER "0" IN EACH SUCH MONTH IN COLUMN 1.

312) CHECK THE CALENDAR FOR USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH.

NO METHOD USED (GO TO 313)
ANY METHOD USED (GO TO 314)

313) Have you already used something or tried in any way to delay or avoid getting pregnant?

YES 1 (GO TO 324)
NO 2 (GO TO 324)

314) CHECK 304:
CIRCLE METHOD CODE.
IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR THE FIRST METHOD IN LIST.

NO CODE CIRCLED 00 (GO TO 324)
FEMALE STERILIZATION 01 (GO TO 317A)
MALE STERILIZATION 02 (GO TO 326)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
SUPPOSITORY/FOAM/JELLY 10
CYCLE BEADS 11
LACTATIONAL AMEN. METHOD 12 (GO TO 315A)
RHYTHM METHOD 12 (GO TO 315A)
WITHDRAWAL 14 (GO TO 326)
OTHER MODERN METHOD 95 (GO TO 326)
OTHER TRADITIONAL METHOD 96 (GO TO 326)

315) You first started using (CURRENT METHOD) in (DATE FROM 308/308A). Where did you get it at that time?

315A) Where did you learn how to use the rhythm/lactational amenorrhea method?
PROBE TO IDENTITY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)______________
PUBLIC SECTOR
NATIONAL HOSPITAL 11
REGIONAL HOSPITAL 12
REFERRAL HEALTH CENTER (CSREF) 13
FREE CLINIC/MATERNITY 14
COMMUNITY HEALTH CENTER (CSCOM) 15
OTHER PUBLIC (SPECIFY) _____________ 16
PRIVATE SECTOR
PRIVATE CLINIC/OFFICE 21
PRIVATE HEALTH CARE OFFICE 22
TREATMENT ROOM 23
PHARMACY 24
COMMUNITY BASED AGENT 25
OTHER PRIVATE (SPECIFY) ________ 26
OTHER SOURCE
SHOP 31
BAR/NIGHTCLUB 32
KIOSK 33
TRAVELING VENDOR 34
FRIEND/ACQUAINTANCE/RELATIVES 35
OTHER (SPECIFY) __________ 96

316) CHECK 304:
CIRCLE METHOD CODE:
IF THERE IS MORE THAN ONE CODE CIRCLED IN 304, CIRCLE HIGHEST METHOD IN LIST.

IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07 (GO TO 323)
FEMALE CONDOM 08 (GO TO 320)
DIAPHRAGM 09 (GO TO 320)
SUPPOSITORY/FOAM/JELLY 10 (GO TO 320)
CYCLE BEADS 11 (GO TO 320)
LACTATIONAL AMEN. METHOD 12 (GO TO 326)
RHYTHM METHOD 13 (GO TO 326)

317) At that time, where you told about side effects or problems you might have with the method?

317A) When you got sterilized, were you told about side effects or problems you might have with the method?

YES 1 (GO TO 319)
NO 2

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

YES 1
NO 2 (GO TO 320)

319) Were you told what to do if you experienced side effects or problems?

YES 1
NO 2

320) CHECK 317:

CODE 1 CIRCLED- At that time, were you told about other methods of family planning that you could use?

CODE '1' NOT CIRCLED-When you obtained (CURRENT METHOD FROM 314) from (SOURCE OF METHOD FROM 307 OR 315), were you told about other methods of family planning that you could use?

YES 1 (GO TO 322)
NO 2

321) Were you ever told by a health or family planning worker about other methods of family planning that you could use?

YES 1
NO 2

322) CHECK 304:
CIRCLE METHOD CODE.
IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION 01 (GO TO 326)
MALE STERILIZATION 02 (GO TO 326)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
SUPPOSITORY/FOAM/JELLY 10
CYCLE BEADS 11
LACTATIONAL AMEN. METHOD 12 (GO TO 326)
RHYTHM METHOD 13 (GO TO 326)
WITHDRAWAL 14 (GO TO 326)
OTHER MODERN METHOD 95 (GO TO 326)
OTHER TRADITIONAL METHOD 96 (GO TO 326)

323) Where did you obtain (current method) the last time?
PROBE TO IDENTITY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)_____________
PUBLIC SECTOR
NATIONAL HOSPITAL 11 (GO TO 326)
REGIONAL HOSPITAL 12 (GO TO 326)
REFERRAL HEALTH CENTER (CSREF) 13 (GO TO 326)
FREE CLINIC/MATERNITY 14 (GO TO 326)
COMMUNITY HEALTH CENTER (CSCOM) 15 (GO TO 326)
OTHER PUBLIC (SPECIFY) ________ 16 (GO TO 326)
PRIVATE SECTOR
PRIVATE CLINIC/OFFICE 21 (GO TO 326)
PRIVATE HEALTH CARE OFFICE 22 (GO TO 326)
TREATMENT ROOM 23 (GO TO 326)
PHARMACY 24 (GO TO 326)
COMMUNITY BASED AGENT 25 (GO TO 326)
OTHER PRIVATE (SPECIFY) ________ 26 (GO TO 326)
OTHER SOURCE
SHOP 31 (GO TO 326)
BAR/NIGHTCLUB 32 (GO TO 326)
KIOSK 33 (GO TO 326)
TRAVELING VENDOR 34 (GO TO 326)
FRIEND/ACQUAINTANCE/RELATIVES 35 (GO TO 326)
OTHER (SPECIFY) _________ 96 (GO TO 326)

324) Do you know of a place where you can obtain a method of family planning?

YES 1
NO 2 (GO TO 326)

325) Where is that?
Any other place?
PROBE TO IDENTITY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S))_____________
PUBLIC SECTOR
NATIONAL HOSPITAL 11
REGIONAL HOSPITAL 12
REFERRAL HEALTH CENTER (CSREF) 13
FREE CLINIC/MATERNITY 14
COMMUNITY HEALTH CENTER (CSCOM) 15
OTHER PUBLIC_______ (SPECIFY) 16
PRIVATE SECTOR
PRIVATE CLINIC/OFFICE 21
PRIVATE HEALTH CARE OFFICE 22
TREATMENT ROOM 23
PHARMACY 24
COMMUNITY BASED AGENT 25
OTHER PRIVATE______ (SPECIFY) 26
OTHER SOURCE
SHOP 31
BAR/NIGHTCLUB 32
KIOSK/APRON 33
TRAVELING VENDOR 34
FRIEND/ACQUAINTANCE/RELATIVES 35
OTHER___________ (SPECIFY) 96

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 401)

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

YES 1
NO 2

SECTION 4. PREGNANCY AND POSTNATAL CARE

401) CHECK 224:

ONE OR MORE BIRTHS IN 2007 OR LATER (GO TO 402)
NO BIRTHS IN 2007 OR LATER (GO TO 556)

402) CHECK 215: ENTER IN THE TABLE THE BIRTH HISTORY LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2007 OR LATER. ASK THE QUESTIONS ABOUT ALL THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

Now I would like to ask some questions about your children born in the last five years. (We will talk about one child at a time).

403) BIRTH HISTORY LINE NUMBER FROM 212 IN BIRTH HISTORY

LAST BIRTH HISTORY LINE NUMBER________

404) FROM QUESTIONS 212 AND 216

NAME________
LIVING
DEAD

405) When you got pregnant with (NAME), did you want to get pregnant at that time?

YES 1 (GO TO 408)
NO 2

406) Did you want to have a baby later on, or did you not want any (more) children?

LATER 1
NO MORE 2 (GO TO 408)

407) How much longer did you want to wait?

MONTHS_______ 1
YEARS______ 2
DON'T KNOW 998

408) Did you see anyone for antenatal care for this pregnancy?

YES 1
NO 2 (GO TO 415)

409) Who did you consult with?
Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

HEATH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
OTHER NURSE/MIDWIFE C
OTHER PERSONNEL
MATRON/TRAINED BIRTH ATTENDANT D
TRADITIONAL BIRTH ATTENDANT E
OTHER _________ (SPECIFY) X

410) Where did you receive this antenatal care for this pregnancy?
Anywhere else?
PROBE TO IDENTITY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S))_____________
HOME

YOUR HOME A
OTHER HOME B