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MYANMAR DEMOGRAPHIC AND HEALTH SURVEY 2015-16 WOMEN'S QUESTIONNAIRE

MINISTRY OF HEALTH AND SPORTS


IDENTIFICATION

STATE/REGION______

DISTRICT_____

TOWNSHIP_____

WARD/VILLAGE TRACT____

CLUSTER NUMBER____

HOUSEHOLD NUMBER____

LINE NUMBER OF WOMAN___

WOMAN SELECTED FOR DOMESTIC VIOLENCE MODULE

YES 1
NO 2


INTERVIEWER VISITS

FIRST VISIT
DATE___
INTERVIEWER'S NAME___
RESULT___

NEXT VISIT:
DATE___
TIME___

SECOND VISIT
DATE___
INTERVIEWER'S NAME___
RESULT___

NEXT VISIT:
DATE___
TIME___

THIRD VISIT
DATE___
INTERVIEWER'S NAME___
RESULT___

FINAL VISIT
DAY___
MONTH___
YEAR___
INT. NO.____
RESULT____

TOTAL NUMBER OF VISITS___

*RESULTS CODES:

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

LANGUAGE OF INTERVIEW

MYANMAR 1
ENGLISH 2
OTHER_____ 6

NATIVE LANGUAGE OF RESPONDENT

MYANMAR 1
ENGLISH 2
OTHER____ 6

TRANSLATOR USED?

YES 1
NO 2

SUPERVISOR

NAME_____

FIELD EDITOR

NAME_____

KEYED BY____


SECTION 1. RESPONDENT'S BACKGROUND

INFORMED CONSENT
Mingalabar. My name is (NAME). I am working with the Ministry of Health and Sports. We are conducting a survey about health all over Myanmar. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 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 don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.
In case you need 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 now?

SIGNATURE OF INTERVIEWER_____

DATE____

CONSENT

RESPONDENT AGREES TO BE INTERVIEWED 1 (CONTINUE TO 101)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END INTERVIEW)

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 ever attended school?

YES 1
NO 2 (SKIP TO 108)

106) What is the highest grade you completed?
IF COMPLETED LESS THAN GRADE ONE, RECORD '00'.

GRADE__

107) CHECK 106:

GRADE 5 OR LOWER__ (CONTINUE TO 108)
GRADE 6 OR HIGHER___ (SKIP 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 any part of the sentence to me?

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

109) CHECK 108:

CODE '2', '3', OR '4' CIRCLED___ (CONTINUE TO 110)
CODE '1' OR '5' CIRCLED___ (SKIP 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

115A) Have you changed your usual place of residence compared with this time last year?

YES 1
NO 2 (SKIP TO 115D)

115B) Please tell me where you were living one year ago (state/region)?

STATE/REGION___
OTHER COUNTRY 00 (SKIP TO 201)

115C) Was it an urban or rural are?

URBAN 1
RURAL 2

115D) How many times have you moved residence in the past 5 years?

NUMBER OF TIMES___
NOT MOVED IN 5 YEARS 00 (SKIP TO 201)

115E) Can you tell me the other locations (state/region) you have lived in the past 5 years?
PLEASE PROVIDE THE 3 MOST RECENT LOCATIONS.

a. LOCATION___
STATE/REGION___
b. LOCATION___
STATE/REGION___
c. LOCATION___
STATE/REGION___


SECTION 2. REPRODUCTION

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

YES 1
NO 2 (SKIP TO 206)

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

YES 1
NO 2 (SKIP TO 204)

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

SONS AT HOME___
DAUGHTERS AT HOME___

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

YES 1
NO 2 (SKIP 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?

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 (SKIP 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 make sure that I have this right, you have had in TOTAL ___ births during your life. Is that correct?

YES___ (CONTINUE TO 210)
NO___ (PROBE AND CORRECT 201-208 AS NECESSARY)

210) CHECK 208:

ONE OR MORE BIRTHS___ (CONTINUE TO 211)
NO BIRTHS___ (SKIP 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 your (first/next) baby?
RECORD NAME___
BIRTH HISTORY NUMBER

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

BOY 1
GIRL 2

214) Were any of these births twins?

SING 1
MULT 2

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

MONTH___
YEAR___

216) Is (NAME) still alive?

YES 1
NO 2 (SKIP 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).

HOSUEHOLD LINE NUMBER___ (SKIP TO 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)

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

YES 1
NO 2

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

NUMBERS ARE SAME___ (CONTINUE TO 224)
NUMBERS ARE DIFFERENT___ (PROBE AND RECONCILE)

224) CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2010 OR LATER.

NUMBER OF BIRTHS__
NONE 0 (SKIP TO 226)

225) FOR EACH BIRTH SINCE JANUARY 2010, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)

226) Are you pregnant now?

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

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

MONTHS___

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

YES 1 (SKIP TO 230)
NO 2

229) Did you 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 stillbirth?

YES 1
NO 2 (SKIP TO 238)

231) When did the last such pregnancy end?

MONTH___
YEAR___

232) CHECK 231:

LAST PREGNANCY ENDED IN JAN. 2010 OR LATER__(CONTINUE TO 233)
LAST PREGNANCY ENDED BEFORE JAN. 2010__ (SKIP TO 238)

233) How many months pregnant were you when the last such pregnancy ended?
RECORD THE NUMBER OF COMPLETED MONTHS. ENTER 'T' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

MONTHS___

234) Since January 2010, have you had any other pregnancies that did not result in a live birth?

YES 1
NO 2 (SKIP TO 236)

235) ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2010.
ENTER 'T' IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

236) Did you have any miscarriages, abortions, or stillbirths that ended before 2010?

YES 1
NO 2 (SKIP TO 238)

237) When did the last such pregnancy that terminated before 2010 end?

MONTH___
YEAR___

238) When did your last menstrual period start? _______(DATE, IF GIVEN)

DAYS AGO___ 1
WEEKS AGO___ 2
MONTHS AGO___ 3
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 (SKIP TO 301)
DON'T KNOW 8 (SKIP TO 301)

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

JUST BEFORE HER PERIOD BEGINS 1
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER____(SPECIFY) 6
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. Have you ever heard of (METHOD)?

METHOD 1 Female Sterilization. PROBE: Women can have an operation to avoid having any more children.
YES 1
NO 2
METHOD 2 Male sterilization. PROBE: Men can have an operation to avoid having any more children.
YES 1
NO 2
METHOD 3 IUD. PROBE: Women can have a loop or coil placed inside them by a doctor or nurse.
YES 1
NO 2
METHOD 4 Injectables. PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
METHOD 5 Implants. PROBE: 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
METHOD 6 Pill. PROBE: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
METHOD 7 Condom. PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
METHOD 8 Female condom. PROBE: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
METHOD 9 Lactational Amenorrhea Method (LAM).
YES 1
NO 2
METHOD 10 Rhythm Method. PROBE: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.
YES 1
NO 2
METHOD 11 Withdrawal. PROBE: Men can be careful and pull out before climax.
YES 1
NO 2
METHOD 12 Emergency Contraception. PROBE: As an emergency measure, within three/five days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
YES 1
NO 2
METHOD 13 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1 ____(SPECIFY)
NO 2

302) CHECK 226:

NOT PREGNANT OR UNSURE___ (CONTINUE TO 303)
PREGNANT___ (SKIP TO 311)

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

YES 1
NO 2 (SKIP TO 311)

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

FEMALE STERILIZATION A (SKIP TO 307)
MALE STERILIZATION B (SKIP TO 307)
IUD C (SKIP TO 308A)
INJECTABLES D (SKIP TO 308A)
IMPLANTS E (SKIP TO 308A)
PILL F (CONTINUE TO 305)
CONDOM G (SKIP TO 306)
FEMALE CONDOM H (SKIP TO 306)
DIAPHRAGM I (SKIP TO 308A)
FOAM/JELLY J (SKIP TO 308A)
LACTATIONAL AMEN. METHOD K (SKIP TO 308A)
RHYTHM METHOD L (SKIP TO 308A)
WITHDRAWAL M (SKIP TO 308A)
OTHER MODERN METHOD X (SKIP TO 308A)
OTHER TRADITIONAL METHOD Y (SKIP TO 308A)

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

MICROGYNON 01
ORAL CON F 02
OK PILLS 03
FINGERS 04
SURE 05
OTHER___(SPECIFY) 96
DON'T KNOW 98
(SKIP TO 308A REGARDLESS OF RESPONSE)

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

AHPHAW 01
LUSOE 02
FEEL (FEMALE CONDOM) 03
OTHER___(SPECIFY) 96
DON'T KNOW 98
(SKIP TO 308A REGARDLESS OF RESPONSE)

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

PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER (RHC) 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
OTHER PUBLIC SECTOR___(SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR'S OFFICE 23
MOBILE CLINIC 24
OTHER PRIVATE MEDICAL SECTOR___(SPECIFY) 26
OTHER___(SPECIFY) 96
DON'T KNOW 98

307A) CHECK 304:
CODE 'A' CIRCLED___: Before your sterilization operation, were you told that you would not be able to have any (more) children because of the operation?
CODE 'A' NOT CIRCLED___: Before the sterilization 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
DON'T KNOW 8

308) In what month and year was the sterilization performed?

MONTH___
YEAR___

308A) Since what month and year have you been using (CURRENT METHOD) without stopping?
PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

MONTH___
YEAR___

309) CHECK 308/308A, 215 AND 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___ (CONTINUE TO 310)

310) CHECK 308/308A:

YEAR IS 2010 OR LATER___: ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING. (THEN CONTINUE TO 311.)
YEAR IS 2009 OR EARLIER___: ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2010. (THEN SKIP TO 322)

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 TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2010.
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.
IN COLUMN 1, ENTER METHOD USE CODE OR '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 then?
IN COLUMN 2, ENTER CODES FOR DISCONTINUATION NEXT TO THE LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 2 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1.

ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, 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), or 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___(CONTINUE TO 313)
ANY METHOD USED___(CONTINUE TO 314)

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

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

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

NO CODE CIRCLED 00 (SKIP TO 324)
FEMALE STERILIZATION 01 (SKIP TO 317A)
MALE STERILIZATION 02 (SKIP TO 326)
IUD 03 (CONTINUE TO 315)
INJECTABLES 04 (CONTINUE TO 315)
IMPLANTS 05 (CONTINUE TO 315)
PILL 06 (CONTINUE TO 315)
CONDOM 07 (CONTINUE TO 315)
FEMALE CONDOM 08 (CONTINUE TO 315)
DIAPHRAGM 09 (CONTINUE TO 315)
FOAM/JELLY 10 (CONTINUE TO 315)
LACTATIONAL AMEN. METHOD 11 (SKIP TO 315A)
RHYTHM METHOD 12 (SKIP TO 315A)
WITHDRAWAL 13 (SKIP TO 326)
OTHER MODERN METHOD 95 (SKIP TO 326)
OTHER TRADITIONAL METHOD 96 (SKIP 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 IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR. WRITE THE NAME OF THE PLACE._____ (NAME OF PLACE)

PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER (RHC) 12
GOVT. HEALTH POST (SUB-CENTER) 13
VILLAGE HEALTH WORKER 14
MOBILE CLINIC 15
UHC/MCH CENTER 16
OTHER PUBLIC SECTOR____(SPECIFY) 17
NON-GOVERNMENT SECTOR
MARIE STOPES 21
MYANMAR RED CROSS SOCIETY 22
PSI/M (SUN) 23
MMA 24
OTHER NGO SECTOR___(SPECIFY) 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PHARMACY 32
PRIVATE DOCTOR 33
MOBILE CLINIC 34
FIELDWORKER 35
OTHER PRIVATE MEDICAL SECTOR____(SPECIFY) 36
OTHER SOURCE
SHOP 41
FRIEND/RELATIVE 42
OTHER___(SPECIFY) 96

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

IUD 03 (CONTINUE TO 317)
INJECTABLES 04 (CONTINUE TO 317)
IMPLANTS 05 (CONTINUE TO 317)
PILL 06 (CONTINUE TO 317)
CONDOM 07 (SKIP TO 323)
FEMALE CONDOM 08 (SKIP TO 320)
DIAPHRAGM 09 (SKIP TO 320)
FOAM/JELLY 10 (SKIP TO 320)
LACTATIONAL AMEN. METHOD 11 (SKIP TO 326)
RHYTHM NETHOD 12 (SKIP TO 326)

317) At that time, were you told about side effects or problems you might have with the method?
317A) when you sterilized, were you told about the side effects or problems you might have with the method?

YES 1 (SKIP 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 (SKIP TO 320)

319) Were you told what to do if you experience 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 (SKIP 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 (SKIP TO 326)
MALE STERILIZATION 02 (SKIP TO 326)
IUD 03 (CONTINUE TO 323)
INJECTABLES 04 (CONTINUE TO 323)
IMPLANTS 05 (CONTINUE TO 323)
PILL 06 (CONTINUE TO 323)
CONDOM 07 (CONTINUE TO 323)
FEMALE CONDOM 08 (CONTINUE TO 323)
DIAPHRAGM 09 (CONTINUE TO 323)
FOAM/JELLY 10 (CONTINUE TO 323)
LACTATIONAL AMEN. METHOD 11 (SKIP TO 326)
RHYTHM METHOD 12 (SKIP TO 326)
WITHDRAWAL 13 (SKIP TO 326)
OTHER MODERN METHOD 95 (SKIP TO 326)
OTHER TRADITIONAL METHOD 96 (SKIP TO 326)

323) Where did you obtain (CURRENT METHOD) the last time?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO IDENTIFY IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF PLACE. ____(NAME OF PLACE)
(SKIP TO 326 REGARDLESS OF RESPONSE)

PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER (RHC) 12
GOVT. HEALTH POST (SUB-CENTER) 13
VILLAGE HEALTH WORKER 14
MOBILE CLINIC 15
UHC/MCH CENTER 16
OTHER PUBLIC SECTOR___(SPECIFY) 17
NON-GOVERNMENT SECTOR
MARIE STOPES 21
MYANMAR RED CROSS SOCIETY 22
PSI/M (SUN) 23
MMA 24
OTHER NGO SECTOR___(SPECIFY) 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PHARMACY 32
PRIVATE DOCTOR 33
MOBILE CLINIC 34
FIELDWORKER 35
OTHER PRIVATE MEDICAL SECTOR___(SPECIFY) 36
OTHER SOURCE
SHOP 41
FRIEND/RELATIVE 42
OTHER___(SPECIFY) 96

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

YES 1
NO 2 (SKIP TO 326)

325) Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE WHETHER PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.___(NAME OF PLACE(S))

PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER (RHC) B
GOVT. HEALTH POST (SUB-CENTER) C
VILLAGE HEALTH WORKER D
MOBILE CLINIC E
UHC/MCH CENTER F
OTHER PUBLIC SECTOR___(SPECIFY) G
NON-GOVERNMENT SECTOR
MARIE STOPES H
MYANMAR RED CROSS SOCIETY I
PSI/M (SUN) J
MMA K
OTHER NGO SECTOR___(SPECIFY) L
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC M
PHARMACY N
PRIVATE DOCTOR O
MOBILE CLINIC P
FIELDWORKER Q
OTHER PRIVATE MEDICAL SECTOR___(SPECIFY) R
OTHER SOURCE
SHOP S
FRIEND/RELATIVE T
OTHER___(SPECIFY) X

326) In the last 12 months, were you visited by AMW, CHW, or CSG who talked to you about family planning?

YES 1
NO 2

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

YES 1
NO 2 (SKIP 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 2010 OR LATER___ (CONTINUE TO 402)
NO BIRTHS IN 2010 OR LATER___ (SKIP TO 556)

402) CHECK 215: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2010 OR LATER. ASK THE QUESTIONS ABOUT ALL OF 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 each separately.)

403) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY (LAST BIRTH, NEXT-TO-LAST BIRTH, AND SECOND-FROM-LAST BIRTH)

BIRTH HISTORY NUMBER___

404) FROM 212 AND 216

NAME___
LIVING__ (CONTINUE TO 405)
DEAD__ (CONTINUE TO 405)

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

YES 1 (SKIP 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 (SKIP TO 408)

407) How much longer did you want to wait?

MONTHS___ 1
YEARS___ 2
DON'T KNOW 998

FOR QUESTIONS 408 - 423, ASK ONLY FOR LAST BIRTH

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

YES 1
NO 2 (SKIP TO 415)

409) Whom did you see? Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE/LHV B
AUXILIARY MIDWIFE C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
COMMUNITY/VILLAGE HEALTH WORKER E
OTHER___(SPECIFY) X

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

HOME
HOME A
OTHER B
PUBLIC SECTOR
GOVT. HOSPITAL C
GOVT. HEALTH CENTER (RHC) D
GOVT. HEALTH POST SUB-CENTER E
MOBILE CLINIC F
UHC/MCH CENTER G
OTHER PUBLIC SECTORY___(SPECIFY) H
NGO
MARIE STOPES I
MYANMAR RED CROSS J
PSI/M (SUN) K
MMA L
OTHER NGO SECTOR___(SPECIFY) M
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC N
OTHER PRIVATE MED. SECTOR___(SPECIFY) O
OTHER___(SPECIFY) X

411) How many months pregnant were you when you first received antenatal care for this pregnancy?

MONTHS___
DON'T KNOW 98

412) How many times did you receive antenatal care during this pregnancy?

NUMBER OF TIMES___
DON'T KNOW 98

413) As part of your antenatal care during this pregnancy, were any of the following done at least once:

Was your blood pressure measured?
YES 1
NO 2
Did you give a urine sample?
YES 1
NO 2
Did you give a blood sample?
YES 1
NO 2

414) During (any of) your antenatal care visit(s), were you told about things to look out for that might suggest problems with the pregnancy?

YES 1
NO 2
DON'T KNO 8

415) During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?

YES 1
NO 2 (SKIP TO 418)
DON'T KNOW 8 (SKIP TO 418)

416) During this pregnancy, how many times did you get a tetanus injection?

TIMES___
DON'T KNOW 8

417) CHECK 416:

2 OR MORE TIMES___(SKIP TO 421)
OTHER___(CONTINUE TO 418)

418) At any time before this pregnancy, did you receive any tetanus injections?

YES 1
NO 2 (SKIP TO 421)
DON'T KNOW 8 (SKIP TO 421)

419) Before this pregnancy, how many times did you receive a tetanus injection?
IF 7 OR MORE TIMES, RECORD '7'.

TIMES___
DON'T KNOW 8

420) How many years ago did you receive the last tetanus injection before this pregnancy?

YEARS AGO___

421) During this pregnancy, were you given or did you buy any iron tablets or iron syrup?
SHOW TABLETS/SYRUP.

YES 1
NO 2 (SKIP TO 423)
DON'T KNOW 8 (SKIP TO 423)

422) During the whole pregnancy, for how many days did you take the tablets or syrup?
IF NUMBER IF NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.

DAYS___
DON'T KNOW 998

423) During this pregnancy, did you take any drug for intestinal worms?

YES 1
NO 2
DON'T KNOW 8

430) 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
DON'T KNOW 8

431) Was (NAME) weighed at birth?

YES 1
NO 2 (SKIP TO 433)
DON'T KNOW 8 (SKIP TO 433)

432) How much did (NAME) weight?
RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.

KG FROM CARD____ 1
KG FROM RECALL____ 2
DON'T KNOW 99998

433) Who assisted with the delivery of (NAME)? Anyone else?
PROBE FOR 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 PERSONNEL
DOCTOR A
NURSE/MIDWIFE/LHV B
AUXILIARY MIDWIFE C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
COMMUNITY/VILLAGE HEALTH WORKER E
OTHER___(SPECIFY) X
NO ONE ASSISTED Y

434) Where did you give birth to (NAME)?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO IDENTIFY IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE. ____(NAME OF PLACE)

HOME
YOUR HOME 11 (SKIP TO 438)
OTHER HOME 12 (SKIP TO 438)
PUBLIC SECTOR
GOVT. HOSPITAL 21
GOVT. HEALTH CENTER (RHC) 22
GOVT. HEALTH POST SUB-CENTER 23
MOBILE CLINIC 24
UHC/MCH CENTER 25
OTHER PUBLIC SECTOR___(SPECIFY) 26
NGO
MARIE STOPES 31
MYANMAR RED CROSS 32
PSI/M (SUN) 33
MMA 34
OTHER NGO SECTOR___(SPECIFY) 36
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC 41
PVT. MATERNITY HOME 42
MMCWA MATERNITY HOME 43
OTHER PRIVATE MED. SECTOR___(SPECIFY) 46
OTHER___(SPECIFY) 96 (SKIP TO 438)

434A) How long after (NAME) was delivered did you stay there?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS___ 1
DAYS___ 2
WEEKS____ 3
DON'T KNOW 998

435) Was (NAME) delivered by caesarean, that is, did they cut your belly open to take the baby out?

YES 1
NO 2

436) I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health while you were still in the facility?

YES 1 (SKIP TO 439)
NO 2

437) Did anyone check on your health after you left the facility?

YES 1 (SKIP TO 439)
NO 2 (SKIP TO 442)

438) I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health after you gave birth to (NAME)?

YES 1
NO 2 (SKIP TO 442)

439) Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE LHV 12
AUXILIARY MIDWIFE 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY/VILLAGE HEALTH WORKER 22
OTHER___(SPECIFY) 96

440) How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS___ 1
DAYS___ 2
WEEKS___ 3
DON'T KNOW 998

442) In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on his/her health?

YES 1
NO 2 (SKIP TO 446)
DON'T KNOW 8 (SKIP TO 446)

443) How many hours, days or weeks after the birth of (NAME) did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

HRS AFTER BIRTH___ 1
DAYS AFTER BIRTH___ 2
WKS AFTER BIRTHS___ 3
DON'T KNOW 998

444) Who checked on (NAME)'s health at that time?
PROBE FOR MOST QUALIFIED PERSON

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE LHV 12
AUXILIARY MIDWIFE 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY/VILLAGE HEALTH WORKER 22
OTHER___(SPECIFY) 96

445) Where did this first check of (NAME) take palce?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.______ (NAME OF PLACE)

HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVT. HOSPITAL 21
GOVT. HEALTH CENTER (RHC) 22
GOVT. HEALTH POST SUB-CENTER 23
MOBILE CLINIC 24
UHC/MCH CENTER 25
OTHER PUBLIC SECTOR___(SPECIFY) 26
NGO
MARIE STOPES 31
MYANMAR RED CROSS 32
PSI/M (SUN) 33
MMA 34
OTHER NGO SECTOR___(SPECIFY) 36
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC 41
PVT. MATERNITY HOME 42
MMCWA MATERNITY HOME 43
OTHER PRIVATE MED. SECTOR___(SPECIFY) 46
OTHER___(SPECIFY) 96

446) In the first two months after delivery, did you receive a vitamin A dose like (this/any of these)?
SHOW COMMON TYPES OF AMPULES/CAPSULES.

YES 1
NO 2
DON'T KNOW 8

447) Has your menstrual period returned since the birth of (NAME)?

YES 1 (SKIP TO 449)
NO 2 (SKIP TO 450)

448) Did your period return between the birth of (NAME) and your next pregnancy?

YES 1
NO 2 (SKIP TO 452)

449) For how many months after the birth of (NAME) did you not have a period?

MONTH___
DON'T KNOW 98

450) CHECK 226: IS RESPONDENT PREGNANT?

NOT PREGNANT___ (CONTINUE TO 451)
PREGNANT OR UNSURE___ (SKIP TO 452)

451) Have you had sexual intercourse since the birth of (NAME)?

YES 1
NO 2 (SKIP TO 453)

452) For how many months after the birth of (NAME) did you not have sexual intercourse?

MONTHS___
DON'T KNOW 98

453) Did you ever breastfeed (NAME)?

YES 1 (SKIP TO 455)
NO 2

454) CHECK 404: IS CHILD LIVING?

LIVING___ (SKIP TO 46)
DEAD___ (GO BACK TO 405 IN NEXT COLUMN; OF IF NO MORE BIRTHS, GO TO 501)

455) How long after birth did you first put (NAME) to the breast?
IF LESS THAN 1 HOUR, RECORD '00' HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS.

IMMEDIATELY 000
HOURS___ 1
DAYS___ 2

456) In the first three days after delivery, was (NAME) given anything to drink other than breast milk?

YES 1
NO 2 (SKIP TO 458)

457) What was (NAME) given to drink? Anything else?
RECORD ALL LIQUIDS MENTIONED.

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

458) CHECK 404: IS CHILD LIVING?

LIVING___ (CONTINUE TO 459)
DEAD___ (GO BACK TO 405 IN NEXT COLUMN; OR, OF NO MORE BIRTHS, GO TO 501)

459) Are you still breastfeeding (NAME)?

YES 1
NO 2

460) Did (NAME) drink anything from a bottle with a nipple yesterday or last night?

YES 1
NO 2
DON'T KNOW 8

461) GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRHTS, GO TO 501.


SECTION 5A. CHILD IMMUNIZATION, HEALTH AND NUTRITION

501) ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2010 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES.)

502) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

BIRTH HISTORY NUMBER___

503) FROM 212 AND 216

NAME___
LIVING__(CONTINUE TO 504)
DEAD__(GO TO 503 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 553)

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

YES, SEEN 1 (SKIP TO 506)
YES, NOT SEEN 2 (SKIP TO 509)
NO CARD 3

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

YES 1 (SKIP TO 509)
NO 2 (SKIP TO 509)

506) COPY DATES FROM THE CARD. WRITE '44' IN 'DAY' COLUMN IF CACRD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

BCG
DAY__
MONTH___
YEAR___
HEP B0 (GIVEN AT BIRTH)
DAY__
MONTH___
YEAR___
POLIO 1
DAY__
MONTH___
YEAR___
POLIO 2
DAY__
MONTH___
YEAR___
POLIO
DAY__
MONTH___
YEAR___
DPT 1/ PENTAVALENT 1
DAY__
MONTH___
YEAR___
DPT 2 / PENTAVALENT 2
DAY__
MONTH___
YEAR___
PENTAVALENT 3
DAY__
MONTH___
YEAR___
HEP B 1
DAY__
MONTH___
YEAR___
HEP B 2
DAY__
MONTH___
YEAR___
HEP B 3
DAY__
MONTH___
YEAR___
MEASLES 1
DAY__
MONTH___
YEAR___
MEASLES 2
DAY__
MONTH___
YEAR___
VITAMIN A (MOST RECENT)
DAY__
MONTH___
YEAR___

507) CHECK 506:

BCG TO MEASLES 2 ALL RECORDED___ (GO TO 511)
OTHER__ (CONTINUE TO 508)

508) Has (NAME) had any vaccinations that are not recorded on this card, including vaccinations given in a national immunization day campaign?
RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 506 THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 506) (SKIP TO 511)
NO 2 (SKIP TO 511)
DON'T KNOW 8 (SKIP TO 511)

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

YES 1
NO 2 (SKIP TO 511)
DON'T KNOW 8 (SKIP TO 511)

510) Please tell me if (NAME) had any of the following vaccinations:

510A) A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?
YES 1
NO 2
DON'T KNOW 8
510B) Within 24 hours after birth, did (NAME) receive a Hepatitis B vaccination, that is an injection in the thigh to prevent Hepatitis B?
YES 1
NO 2
DON'T KNOW 8
510C) Polio vaccine, that is, drops in the mouth?
YES 1
NO 2 (SKIP TO 510E)
DON'T KNOW 8 (SKIP TO 510E)
510D) How many times was the polio vaccine given?
NUMBER OF TIMES____
510E) A DPT/PENTAVALENT vaccination, that is, an injection given in the thigh, sometimes at the same time as the polio drops?
YES 1
NO 2 (SKIP TO 510G)
DON'T KNOW 8 (SKIP TO 510G)
510F) How many times was the DPT/PENTAVALENT vaccination?
NUMBER OF TIMES___
510G) A HEP B vaccination, that is, an injection given in the thigh, to prevent him/her from getting hepatitis?
YES 1
NO 2 (SKIP TO 501I)
DON'T KNOW 8 (SKIP TO 501I)
510H) How many times was the HEP B vaccination given?
NUMBER OF TIMES___
510I) A measles injection or on MMR/MR injection - that is, a shot in the arm at the age of 9 months or older - to prevent him/her from getting?
YES 1
NO 2 (SKIP TO 511)
DON'T KNOW 8 (SKIP TO 511)
511J) How many times did (NAME) receive the measles vaccine?
NUMBER OF TIMES___

511) Within the last six months, was (NAME) given a vitamin A dose like (this/any of these)?
SHOW COMMON TYPES OF CAPSULES.

YES 1
NO 2
DON'T KNOW 8

512) In the last seven days, was (NAME) given sprinkles with iron or any micronutrient powder like (this/any of these)?
SHOW COMMON TYPES OF SPRINKLES/SACHETS.

YES 1
NO 2
DON'T KNOW 8

512A) In the last seven days, was (NAME) given multi vitamin syrups?

YES 1
NO 2
DON'T KNOW 8

513) Was (NAME) given any drug for
worms in the last six months?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 525)
DON'T KNOW 8 (SKIP TO 525)

515) Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

516) Now I would like to know how much (NAME) was given to drink during the diarrhea (including breastmilk). Was he/she given less than usual to drink, about the same amount, or more than usual to drink?
IF LESS: PROBE: Was he/she given much less than usual to drink or somewhat less?

MUCH LESS 1
SOMEHWAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8

517) When (NAME) had diarrhea, was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8

518) Did you seek advice or treatment for diarrhea from any source?

YES 1
NO 2 (SKIP TO 522)

519) Where did you seek advice or treatment? Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.____(NAME OF PLACE(S))

PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER (RHC) B
GOVT. HEALTH POST (SUB-CENTER) C
VILLAGE HEALTH WORKER D
MOBILE CLINIC E
UHC/MCH CENTER F
TRADITIONAL MED. CLINIC G
OTHER PUBLIC SECTOR___(SPECIFY) H
NON-GOVERNMENT SECTOR
MARIE STOPES I
MYANMAR RED CROSS SOCIETY J
PSI/M (SUN) K
MMA L
OTHER PUBLIC SECTOR___(SPECIFY) M
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC N
PHARMACY O
PVT DOCTOR P
MOBILE CLINIC Q
TRADITIONAL MED. CLINIC R
OTHER PRIVATE MEDICAL SECTOR___(SPECIFY) S
OTHER SOURCE
SHOP T
TRADITIONAL PRACTITIONER U
MARKET V
OTHER___(SPECIFY) X

520) CHECK 519:

TWO OR MORE CODES CIRCLED___ (CONTINUE TO 521)
ONLY ONE CODE CIRCLED___ (SKIP TO 522)

521) Where did you first seek advice or treatment?
USE LETTER CODE FROM 519.

FIRST PLACE___

522) Was he/she given any of the following to drink at any time since he/she started having the diarrhea:

a) A fluid from a special packet called ORS (ORASEL, MFP)
YES 1
NO 2
DON'T KNOW 8
c) A government-recommended homemade fluid?
YES 1
NO 2
DON'T KNOW 8

523) Was anything (else) given to treat the diarrhea?

YES 1
NO 2 (SKIP TO 525)
DON'T KNOW 8 (SKIP TO 525)

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

PILL OR SYRUP
ANTIBIOTIC A
ANTIMOTILITY B
ZING C
OTHER (NOT ANTI-BIOTIC, ANTIMOTILITY, OR ZINC) D
UNKNOWN PILL OR SYRUP E
INJECTION
ANTIBIOITIC F
NON-ANTIBIOTIC G
UNKNOWN INJECTION H
(IV) INTRAVENOUS I
HOME REMEDY/HERBAL MEDICINE J
OTHER_____ (SPECIFY) X

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

YES 1
NO 2 (SKIP TO 527)
DON'T KNOW 8 (SKIP TO 527)

526) At any time during the illness, did (NAME) have blood taken from his/her finger or heel for testing?

YES 1
NO 2
DON'T KNOW 8

527) Has (NAME) had an illness with a cough at any time in the last 2 weeks?

YES 1
NO 2 (SKIP TO 530)
DON'T KNOW 8 (SKIP TO 530)

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

YES 1
NO 2 (SKIP TO 531)
DON'T KNOW 8 (SKIP TO 531)

529) Was the fast or difficult breathing due to a problem (tightness) in the chest or to a blocked or runny nose?

CHEST ONLY 1 (SKIP TO 531)
NOSE ONLY 2 (SKIP TO 531)
BOTH 3 (SKIP TO 531)
OTHER___ (SPECIFY) 6 (SKIP TO 531)
DON'T KNOW 8 (SKIP TO 531)

530) CHECK 525: HAD FEVER?

YES___(CONTINUE TO 531)
NO OR DK___(GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

531) Now I would like to know how much (NAME) was given to drink (including breastmilk) during the illness with a (fever/cough). Was he/she given less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8

532) When (NAME) had a (fever/cough), was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8

533) Did you seek advice or treatment for the illness from any source?

YES 1
NO 2 (SKIP TO 537)

534) Where did you seek advice or treatment? Anywhere else? PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.___(NAME OF PLACE(S))

PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER (RHC) B
GOVT. HEALTH POST (SUB-CENTER) C
VILLAGE HEALTH WORKER D
MOBILE CLINIC E
UHC/MCH CENTER F
TRADITIONAL MED. CLINIC G
OTHER PUBLIC SECTOR___(SPECIFY) H
NON-GOVERNMENT
MARIE STOPES I
MYANMAR RED CROSS J
PSI/M (SUN) K
MMA L
OTHER PUBLIC SECTOR___(SPECIFY) M
PRIVATE MEDICAL SECTOR
PVT HOSPITAL/CLINIC N
PHARMACY O
PVT DOCTOR P
MOBILE CLINIC Q
TRADITIONAL MED. CLINIC R
OTHER PRIVATE MEDICAL SECTOR___(SPECIFY) S
OTHER SOURCE
SHOP T
TRADITIONAL PRACTITIONER U
MARKET V
OTHER___(SPECIFY) X

535) CHECK 534:

TWO OR MORE CODES CIRCLED__ (CONTINUE TO 536)
ONLY ONE CODE CIRCLED___(SKIP TO 537)

536) Where did you first seek advice or treatment?
USE LETTER CODE FROM 534.

FIRST PLACE___

537) At any time during the illness, did (NAME) take any drugs for the illness?

YES 1
NO 2
DON'T KNOW 8
(NO OR DON'T KNOW: GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

538) What drugs did (NAME) take? Any other drugs? RECORD ALL MENTIONED.

ANTIMALARIAL DRUGS
SP/FANSIDAR A
CHLOROQUINE B
AMODIAQUINE C
QUININE PILLS D
QUININE INJECTION/IV E
ARTEMISININ COMBINATION THERAPY F
ARTESUNATE MONOTHERAPY PILLS G
ARTESUNATE MONOTHERAPY INJECTION H
OTHER ANTIMALARIAL___(SPECIFY) I
ANTIBIOTIC DRUGS
PILLS/SYRUP J
INJECTION K
OTHER DRUGS
BUSPRO L
PARACETAMOL M
IBUPROFEN N
OTHER___(SPECIFY) X
DON'T KNOW Z

539) CHECK 538: ANY CODE A-I CIRCLED?

YES__(CONTINUE TO 540)
NO___(GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

540) CHECK 538: SP/FANSIDAR ('A') GIVEN

CODE 'A' CIRCLED ___ (CONTINUE TO 541)
CODE 'A' NOT CIRCLED___ (SKIP TO 542)

541) How long after the fever started did (NAME) first take (SP/Fansidar)?

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

542) CHECK 538: CHLOROQUINE ('B') GIVEN

CODE 'B' CIRCLED___(CONTINUE TO 543)
CODE 'B' NOT CIRCLED___ (SKIP TO 544)

543) How long after the fever started did (NAME) first take chloroquine?

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

544) CHECK 538: AMODIAQUINE 'C' GIVEN

CODE 'C' CIRCLED___ (CONTINUE TO 545)
CODE 'C' NOT CIRCLED___(SKIP TO 546)

545) How long after the fever started did (NAME) first take amodiaquine?

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

546) CHECK 538: QUININE ('D' OR 'E') GIVEN

CODE 'D' OR 'E' CIRCLED___ (CONTINUE TO 547)
CODE 'D' OR 'E' NOT CIRCLED___(SKIP TO 548)

547) How long after the fever did (NAME) first take quinine?

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

548) CHECK 538: COMBINATION WITH ARTEMISININ 'F' GIVEN

CODE 'F' CIRCLED___ (CONTINUE TO 549)
CODE 'F' NOT CIRCLED___(SKIP TO 549A)

549) How long after fever did (NAME) first take (COMBINATION WITH AREMISININ)?

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

549A) CHECK 538: ARTESUNATE MONOTHERAPY ('G' OR 'H') GIVEN

CODE 'G' OR 'H' CIRCLED___ (CONTINUE TO 549B)
CODE 'G' OR 'H' NOT CIRCLED___ (SKIP TO 550)

549B) How long after the fever started did (NAME) first take (ARTESUNATE MONOTHERAPY)?

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

550) CHECK 538: OTHER ANIMALARIAL ('I') GIVEN

CODE 'I' CIRCLED__(CONTINUE TO 551)
CODE 'I' NOT CIRCLED__(GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

551) How long after the fever started did (NAME) first take (OTHER ANTIMALARIAL)?

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

552) GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553.

553) CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2010 OR LATER LIVING WITH RESPONDENT

ONE OR MORE___(RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE WITH 554____(NAME))
NONE___(SKIP TO 556)

554) The last time (NAME FROM 553) passed stools, what was down to dispose of the stools?

CHILD USED TOILET OR LATRINE 01
PUT/RINSED INTO TOILET OR LATRINE 02
PUT/RINSED INTO DRAIN OR DITCH 03
THROWN INTO GARBAGE 04
BURIED 05
LEFT IN THE OPEN 06
OTHER___(SPECIFY) 96

555) CHECK 522(a), ALL COLUMNS

NO CHILD RECEIVED FLUID FROM ORS PACKET___(CONTINUE TO 556)
ANY CHILD RECEIVED FLUID FROM ORS PACKET___(SKIP TO 556A)

556) Have you ever heard of a special product called ORS (ORASEL, MFP) you can get for the treatment of diarrhea?

YES 1
NO 2

556A) Sometimes children have severe illness and should be taken immediately to a health facility. What types of symptoms would cause you to take your child to a health facility right away? Any other symptoms?

CHILD NOT ABLE TO DRINK OR BREASTFEED A
CHILD BECOMES SICKER B
CHILD DEVELOPS A FEVER C
CHILD HAS FAST BREATHING D
CHILD HAS DIFFICULT BREATHING E
CHILD HAS BLOOD IN STOOL F
CHILD IS DRINKING POORLY G
CHILD DEVELOPS RASHES H
CHILD HAS DIARRHEA I
OTHER___(SPECIFY) X

557) CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2013 OR LATER LIVING WITH RESPONDENT

ONE OR MORE___(RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE TO 558 ____(NAME))
NONE___(SKIP TO 562)

558) Now I would like to ask you about liquids or foods that (NAME FROM 557) had yesterday during the day or at night. I am interested in whether your child had the item I mention even if it was combined with other foods. Did (NAME FROM 557) (drink/eat):

a) Plain water?
YES 1
NO 2
DON'T KNOW 8
b) Juice or juice drinks?
YES 1
NO 2
DON'T KNOW 8
c) Clear broth?
YES 1
NO 2
DON'T KNOW 8
d) Milk such as tinned, powdered, or fresh animal milk? IF YES: How many times did (NAME) drink milk? IF 7 OR MORE TIMES, RECORD '7'.
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES DRANK MILK___
e) Infant formula (Lactogen)? IF YES: How many times did (NAME) drink infant formula? IF 7 OR MORE TIMES, RECORD '7'.
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES DRANK FORMULA___
f) Any other liquids?
YES 1
NO 2
DON'T KNOW 8
g) Yogurt? IF YES: How many times did (NAME) eat yoqurt? IF 7 OR MORE TIMES, RECORD '7'.
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES ATE YOGURT___
h) Any commercially fortified baby food like Cerelac?
YES 1
NO 2
DON'T KNOW 8
i) Bread, rice, noodles, porridge, or other foods made from grains?
YES 1
NO 2
DON'T KNOW 8
j) Pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside?
YES 1
NO 2
DON'T KNOW 8
k) White potatoes, white yams, manioc, cassava, or any other foods made from roots?
YES 1
NO 2
DON'T KNOW 8
l) Any dark green, leafy vegetables?
YES 1
NO 2
DON'T KNOW 8
m) Ripe mangoes, papayas etc?
YES 1
NO 2
DON'T KNOW 8
n) Any other fruits or vegetables?
YES 1
NO 2
DON'T KNOW 8
o) Liver, kidney, heart, or other organ meats?
YES 1
NO 2
DON'T KNOW 8
p) Any meat, such as beef, pork, lamb, goat, chicken, or duck?
YES 1
NO 2
DON'T KNOW 8
q) Eggs?
YES 1
NO 2
DON'T KNOW 8
r) Fresh or dried fish or shellfish?
YES 1
NO 2
DON'T KNOW 8
s) Any foods made from beans, peas, lentils, or nuts?
YES 1
NO 2
DON'T KNOW 8
t) Cheese or other food made from milk?
YES 1
NO 2
DON'T KNOW 8
u) Any other solid, semi-solid, or soft food?
YES 1
NO 2
DON'T KNOW 8

559) CHECK 558 (CATEGORIES "g" through "u"):

NOT A SINGLE YES___(CONTINUE TO 560)
AT LEAST ONE "YES"___(SKIP TO 561)

560) Did (NAME) eat any solid, semi-solid, or soft foods yesterday during the day or at night?
IF 'YES' PROBE: What kind of solid, semi-solid or soft foods did (NAME) eat?

YES 1 (GO BACK TO 558 TO RECORD FOOD EATEN YESTERDAY)
NO 2 (SKIP TO 562)

561) How many times did (NAME FROM 557) eat solid, semi-solid, or soft foods yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.

NUMBER OF TIMES___
DON'T KNOW 8


SECTION 5B. EARLY CHILDHOOD DEVELOPMENT

562) CHECK 217 AND 218: ANY CHILD 0-4 YEARS OLD LIVING WITH HIS/HER MOTHER?

YES__(CONTINUE TO 563)
NO__(SKIP TO 601)

563) CHECK 217 AND 219: SELECT THE OLDEST CHILD AGED 0-4 LIVING WITH HIS/HER MOTHER AND RECORD NAME AND LINE NUMBER

NAME OF THE OLDEST CHILD FROM Q.212____
LINE NUMBER OF THE OLDEST CHILD FROM Q. 219____

564) READ TO THE RESPONDENT: Now I would like to ask you some questions about (NAME OF THE CHILD FROM 563), your oldest child living with you who is 0-4 years old.

565) How many children's books or picture books do you have for (NAME)?

NONE 00
NUMBER OF BOOKS FOR CHILD___
TEN BOOKS OR MORE 10

566) Does he/she play with:

a) homemade toys (such as dolls, cars, or other toys made at home)?
YES 1
NO 2
DON'T KNOW 8
b) toys from a shop or manufactured toys?
YES 1
NO 2
DON'T KNOW 8
c) household objects (such as bowls or pots) or objects found outside (such as sticks, rocks, animal shells or leaves)?
YES 1
NO 2
DON'T KNOW 8

567) Sometimes adults taking care of children have to leave the house to go shopping, wash clothes, or for other reasons and have to leave young children. On how many days in the past week was (NAME):

a) left alone for more than one hour?
NUMBER OF DAYS LEFT ALONE FOR MORE THAN ONE HOUR___
b) left in the care of another child, that is, someone less than 10 years old, for more than an hour?
NUMBER OF DAYS LEFT TO ANOTHER CHILD FOR MORE THAN AN HOUR____
IF 'NONE', WRITE '0'. IF 'DON'T KNOW' WRITE '8'.

568) VERIFY 217: AGE OF THE CHILD

CHILD 3 OR 4 YEARS OLD___(CONTINUE TO 569)
CHILD 0, 1, OR 2 YEARS OLD___(SKIP TO 601)

569) Does (NAME) attend any organized learning or early childhood education programme, such as a private or government facility, including kindergarten or community child care?

YES 1
NO 2 (SKIP TO 571)
DON'T KNOW 8 (SKIP TO 571)

570) Within the last seven days, about how many hours did (NAME) attend?

NUMBER OF HOURS___

571) In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (NAME)? IF YES, ASK: Who engaged in this activity with (NAME)? CIRCLE ALL THAT APPLY.

a) Read books or to look at picture books with (NAME)?
MOTHER A
FATHER B
OTHER X
NO ONE Y
b) Told stories to (NAME)?
MOTHER A
FATHER B
OTHER X
NO ONE Y
c) Sang songs to (NAME) or with (NAME), including lullabies?
MOTHER A
FATHER B
OTHER X
NO ONE Y
d) Took (NAME) outside of the home, compound, yard or enclosure?
MOTHER A
FATHER B
OTHER X
NO ONE Y
e) Played with (NAME)?
MOTHER A
FATHER B
OTHER X
NO ONE Y
f) Named, counted, or drew things to or with (NAME)?
MOTHER A
FATHER B
OTHER X
NO ONE Y


SECTION 6. MARRIAGE AND SEXUAL ACTIVITY

601) Are you currently married?

YES, CURRENTLY MARRIED 1 (SKIP TO 604)
NO, NOT IN UNION 2

602) Have you ever been married?

YES, FORMERLY MARRIED 1
NO 2 (SKIP TO 612)

603) What is your marital status now: are you widowed, divorced, or separated?

WIDOWED 1
DIVORCED 2
SEPARATED 3
(SKIP TO 609 REGARDLESS OF RESPONSE)

604) Is your husband living with you now or is he staying elsewhere?

LIVING WITH HER 1
STAYING ELSEWHERE 2

605) RECORD THE HUSBAND'S LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.

LINE NO.____

606) Does your husband have other wives or does he live with other women as if married?

YES 1
NO 2 (SKIP TO 609)
DON'T KNOW 8 (SKIP TO 609)

607) Including yourself, in total, how many wives or live-in partners does he have?

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNERS___
DON'T KNOW 98

608) Are you the first, second, ... wife?

RANK___

609) Have you been married only once or more than once?

ONLY ONCE 1
MORE THAN ONCE 2

610) CHECK 609:

MARRIED ONLY ONCE___: In what month and year did you start living with your husband?
MARRIED MORE THAN ONCE___: Now I would like to ask about your first husband. In what month and year did you start living with him?
MONTH___
DON'T KNOW MONTH 98
YEAR____ (SKIP TO 612)
DON'T KNOW YEAR 9998

611) How old were you when you first started living with him?

AGE___

612) CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

613) Now I would like to ask some questions about sexual activity in order to gain a better understanding of some important life issues.
How old were you when you had sexual intercourse for the very first time?

NEVER HAD SEXUAL INTERCOURSE 00 (SKIP TO 628)
AGE IN YEARS___
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND 95

614) Now I would like to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question.

615) When was the last time you had sexual intercourse?
IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO 1____
WEEKS AGO 2____
MONTHS AGO 3____
YEARS AGO 4____

628) PRESENCE OF OTHERS DURING THIS SECTION

CHILDREN UNDER 10 YEARS
YES 1
NO 2
MALE ADULTS
YES 1
NO 2
FEMALE ADULTS
YES 1
NO 2

629) Do you know of a place where a person can get male condoms?

YES 1
NO 2 (SKIP TO 632)

630) Where is that? Any other place? PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE._____(NAME OF PLACE(S))

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER (RHC) B
GOVT. HEALTH POST (SUB-CENTER) C
VILLAGE HEALTH WORKER D
MOBILE CLINIC E
UHC/MCH CENTER F
OTHER PUBLIC SECTOR____(SPECIFY) G
NON-GOVERNMENT SECTOR
MARIE STOPES H
MYANMAR RED CROSS SOCIETY I
PSI/M (SUN) J
MMA K
OTHER NGO SECTOR____(SPECIFY) L
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC M
PHARMACY N
PRIVATE DOCTOR O
MOBILE CLINIC P
FIELDWORKER Q
OTHER PRIVATE MEDICAL SECTOR____(SPECIFY) R
OTHER SOURCE
SHOP S
BETELNUT SHOP T
FRIENDS/RELATIVES U
OTHER______(SPECIFY) X

631) If you wanted to, could you yourself get a condom?

YES 1
NO 2
DON'T KNOW/UNSURE 8

632) Do you know of a place where a person can get female condoms?

YES 1
NO 2 (SKIP TO 701)

633) Where is that? Any other place? PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE._____(NAME OF PLACE(S))

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER (RHC) B
GOVT. HEALTH POST (SUB-CENTER) C
VILLAGE HEALTH WORKER D
MOBILE CLINIC E
UHC/MCH CENTER F
OTHER PUBLIC SECTOR____(SPECIFY) G
NON-GOVERNMENT SECTOR
MARIE STOPES H
MYANMAR RED CROSS SOCIETY I
PSI/M (SUN) J
MMA K
OTHER NGO SECTOR____(SPECIFY) L
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC M
PHARMACY N
PRIVATE DOCTOR O
MOBILE CLINIC P
FIELDWORKER Q
OTHER PRIVATE MEDICAL SECTOR____(SPECIFY) R
OTHER SOURCE
SHOP S
BETELNUT SHOP T
FRIENDS/RELATIVES U
OTHER______(SPECIFY) X

634) If you wanted to, could you yourself get a female condom?

YES 1
NO 2
DON'T KNOW/UNSURE 8


SECTION 7. FERTILITY PREFERENCES

701) CHECK 304:

NEITHER STERILIZED___(CONTINUE TO 702)
HE OR SHE STERILIZED__(SKIP TO 712)

702) CHECK 226:

PREGNANT___(CONTINUE TO 703)
NOT PREGNANT OR UNSURE___(SKIP TO 704)

703) Now I have some questions about the future. After the child you are expecting now, would you like to have another child, or would you prefer to not have any more children?

HAVE ANOTHER CHILD (SKIP TO 705)
NO MORE 2 (SKIP TO 711)
UNDECIDED/DON'T KNOW (SKIP TO 711)

704) Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (SKIP TO 707)
SAYS SHE CAN'T GET PREGNANT 3 (SKIP TO 712)
UNDECIDED/DON'T KNOW 8 (SKIP TO 710)

705) CHECK 226:

NOT PREGNANT OR UNSURE___: How long would you like to wait from now before the birth of (a/another) child?
PREGNANT___: After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?
MONTHS 1 ____
YEARS 2 ____
SOON/NOW 993 (SKIP TO 710)
SAYS SHE CAN'T GET PREGNANT 994 (SKIP TO 712)
AFTER MARRIAGE 995 (SKIP TO 710)
OTHER___(SPECIFY) 996 (SKIP TO 710)
DON'T KNOW 998 (SKIP TO 710)

706) CHECK 226:

NOT PREGNANT OR UNSURE___(CONTINUE TO 707)
PREGNANT___(SKIP TO 711)

707) CHECK 303: USING A CONTRACEPTIVE METHOD?

NOT CURRENTLY USING___(CONTINUE TO 708)
CURRENTLY USING___(SKIP TO 712)

708) CHECK 705:

NOT ASKED___(CONTINUE TO 709)
24 OR MORE MONTHS OR 02 OR MORE YEARS___(CONTINUE TO 709)
00-23 MONTHS OR 00-01 YEAR___(SKIP TO 711)

709) CHECK 704:

WANTS TO HAVE A/ANOTHER CHILD___: You have said that you do not want (a/another) child soon. Can you tell me why you are not using a method to prevent pregnancy? Any other reason?
WANTS NO MORE/NONE___: You have said that you do not want any (more) children. Can you tell me why you are not using a method to prevent pregnancy? Any other reason?
RECORD ALL REASONS MENTIONED
NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
CAN'T GET PREGNANT E
NOT MENSTRUATED SINCE LAST BIRTH F
BREASTFEEDING G
UP TO GOD/FATALISTIC H

OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L

LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N

METHOD-RELATED REASONS
SIDE EFFECTS/HEALTH CONCERNS O
LACK OF ACCESS/TOO FAR P
COSTS TOO MUCH Q
PREFERRED METHOD NOT AVAILABLE R
NO METHOD AVAILABLE S
INCONVENIENT TO USE T
INTERFERES WITH BODY'S NORMAL PROCESSES U

OTHER___(SPECIFY) X
DON'T KNOW Z

710) CHECK 303: USING A CONTRACEPTIVE METHOD?

NOT ASKED___ (CONTINUE TO 711)
NO, NOT CURRENTLY USING___ (CONTINUE TO 711)
YES, CURRENTLY USING___ (SKIP TO 712)

711) Do you think you will use a contraceptive method to delay or avoid pregnancy at any time in the future?

YES 1
NO 2
DON'T KNOW 8

712) CHECK 216:

HAS LIVING CHILDREN___: If you could go back to the time you did not have any children and could choose the exact 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 REPSONSE.
NONE 00 (SKIP TO 714)
NUMBER___
OTHER___(SPECIFY) 96 (SKIP TO 714)

713) How many of these children would you like to be boys, how many would you like to be girls, and for how many would it not matter if it's a boy or a girl?

NUMBER OF BOYS___
NUMBER OF GIRLS___
NUMBER OF EITHER___
OTHER___(SPECIFY) 96

714) In the last few months have you:

Heard about family planning on the radio?
YES 1
NO 2
Seen anything about family planning on the television?
YES 1
NO 2
Read about family planning in a newspaper or magazine?
YES 1
NO 2
Seen or read about family planning in internet?
YES 1
NO 2
Read about family planning in billboard?
YES 1
NO 2

716) CHECK 601:

YES CURRENTLY MARRIED___ (CONTINUE TO 717)
NO, NOT IN UNION___ (SKIP TO 801)

717) CHECK 303: USING A CONTRACEPTIVE METHOD?

CURRENTLY USING___ (CONTINUE TO 718)
NOT CURRENTLY USING OR NOT ASKED___ (SKIP TO 720)

718) Would you say that using contraception is mainly your decision, mainly your (husband's/partner's) decision, or did you both decide together?

MAINLY RESPONDENT 1
MAINLY HUSBAND/PARTNER 2
JOINT DECISION 3
OTHER___(SPECIFY) 6

719) CHECK 304:

NEITHER STERILIZED___(CONTINUE TO 720)
HE OR SHE STERILIZED___(SKIP TO 801)

720) Does your (husband/partner) want the same number of children that you want, or does he want more or fewer than you want?

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


SECTION 8. HUSBAND'S BACKGROUND AND WOMAN'S WORK

801) CHECK 601 AND 602:

CURRENTLY MARRIED___(CONTINUE TO 802)
FORMERLY MARRIED___ (SKIP TO 803)
NEVER MARRIED___(SKIP TO 807)

802) How old was your husband on his last birthday?

AGE IN COMPLETED YEARS___

803) Did your (last) husband ever attend school?

YES 1
NO 2 (SKIP TO 806)

805) What was the highest grade he completed? IF COMPLETED LESS THAN GRADE ONE, RECORD '00'.

GRADE___
DON'T KNOW 98

806) CHECK 801:

CURRENTLY MARRIED___: What is your husband's occupation? That is, what kind of work does he mainly do?
FORMERLY MARRIED___: What was your (last) husband's occupation? That is, what kind of work did he mainly do?
____(SPECIFY)

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

YES 1 (SKIP TO 811)
NO 2

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

YES 1 (SKIP TO 811)
NO 2

809) Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, maternity leave, or any other such reason?

YES 1 (SKIP TO 811)
NO 2

810) Have you done any work in the last 12 months?

YES 1
NO 2 (SKIP TO 815)

811) What is your occupation, that is, what kind of work do you mainly do?

___(SPECIFY)

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

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

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

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

814) Are you paid in cash or kind for this work or are you not paid at all?

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4

815) CHECK 601:

CURRENTLY MARRIED___(CONTINUE TO 816)
NOT IN UNION___ (SKIP TO 823

816) CHECK 814:

CODE 1 OR 2 CIRCLED___(CONTINUE TO 817)
OTHER___(SKIP TO 819)

817) Who usually decides how the money you earn will be used: you, your husband, or you and your husband jointly?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
OTHER___(SPECIFY) 6

818) Would you say that the money you earn is more than what your husband earns, less than what he earns, or about the same?

MORE THAN HIM 1
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND HAS NO EARNINGS 4 (SKIP TO 820)
DON'T KNOW 8

819) Who usually decides how your husband's earnings will be used: you, your husband, or you and your husband jointly?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
HUSBAND HAS NO EARNINGS 4
OTHER___(SPECIFY) 6

820) Who usually makes decisions about health care for yourself: you, your husband, you and your husband jointly, or someone else?

RESPONDENT 1
HUSBAND 2
HUSBAND AND RESPONDENT JOINTLY 3
SOMEONE ELSE 4
OTHER 6

821) Who usually makes decisions about making major household purchases?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
OTHER 6

822) Who usually makes decisions about visits to your family or relatives?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
OTHER 6

822A) Who usually makes decisions regarding the wellbeing of children?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
OTHER 6

823) Do you own this or any other house either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4

824) Do you own any land either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4

825) PRESENT OF OTHERS AT THIS POINT (PRESENT AND LISTENING, PRESENT BUT NOT LISTENING, OR NOT PRESENT)

CHILDREN
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
HUSBAND
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
OTHER MALES
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
OTHER FEMALES
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3

826) In your opinion, is a husband justified in hitting or beating his wife in the following situations:

If she goes out without telling him?
YES 1
NO 2
DON'T KNOW 8
If she neglects the children?
YES 1
NO 2
DON'T KNOW 8
If she argues with him?
YES 1
NO 2
DON'T KNOW 8
If she refuses to have sex with him?
YES 1
NO 2
DON'T KNOW 8
If she burns the food?
YES 1
NO 2
DON'T KNOW 8
If she refuses to use contraception?
YES 1
NO 2
DON'T KNOW 8
If she is involved in too much social activities?
YES 1
NO 2
DON'T KNOW 8


SECTION 9. HIV/AIDS

901) Now I would like to talk about something else. Have you ever heard of an illness called AIDS?

YES 1
NO 2 (SKIP TO 937)

902) Can people reduce their chance of getting HIV by having just one uninfected sex partner who has no other sex partners?

YES 1
NO 2
DON'T KNOW 8

903) Can people get HIV from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

904) Can people reduce their chance of getting HIV by using a condom every time they have sex?

YES 1
NO 2
DON'T KNOW 8

905) Can people get HIV by sharing food with a person who has AIDS?

YES 1
NO 2
DON'T KNOW 8

906) Can people get HIV because of witchcraft of other supernatural means?

YES 1
NO 2
DON'T KNOW 8

907) Is it possible for a healthy-looking person to have HIV?

YES 1
NO 2
DON'T KNOW 8

908) Can HIV be transmitted from a mother to her baby:

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

909) CHECK 908:

AT LEATS ONE 'YES'___(CONTINUE TO 910)
OTHER___(SKIP TO 911)

910) Are there any special drugs that a doctor or nurse can give to a woman infected with HIV to reduce the risk of transmission to the baby?

YES 1
NO 2
DON'T KNOW 8

911) CHECK 208 AND 215:

LAST BIRTH SINCE JANUARY 2013___(CONTINUE TO 912)
LAST BIRTH BEFORE JANUARY 2013___(SKIP TO 926)
NO BIRTHS___(SKIP TO 926)

912) CHECK 408 FOR LAST BIRTH:

HAD ANTENATAL CARE___(CONTINUE TO 913)
NO ANTENATAL CARE___(SKIP TO 920)

913) CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

914) During any of the antenatal visits for your last birth were you given any information about:

Babies getting HIV from their mother?
YES 1
NO 2
DON'T KNOW 8
Things that you can do to prevent getting HIV?
YES 1
NO 2
DON'T KNOW 8
Getting tested for HIV?
YES 1
NO 2
DON'T KNOW 8

915) Were you offered a test for HIV as part of your antenatal care?

YES 1
NO 2

916) I don't want to know the results, but were you tested for HIV as part of your antenatal care?

YES 1
NO 2

917) Where was the test done? PROBE TO IDENTIFY THE TYPE OF SOURCE
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.____(NAME OF PLACE)

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVT. HEALTH CENTER (RHC) 12
GOVT. HEALTH POST (SUB-CENTER) 13
STAND-ALONE VCT CENTER 14
FAMILY PLANNING CLINIC 15
MOBILE CLINIC 16
FIELDWORKER 17
SCHOOL BASED CLINIC 18
OTHER PUBLIC SECTOR____(SPECIFY) 19
NGO
MARIE STOPES 21
MYANMAR RED CROSS SOCIETY 22
PSI/M (SUN) 23
MMA 24
OTHER NGO SECTOR___(SPECIFY) 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 31
STAND-ALONE VCT CENTER 32
PHARMACY 33
MOBILE CLINIC 34
DIAGNOSTIC LABORATORY 35
OTHER PRIVATE MEDICAL SECTOR____(SPECIFY) 36
OTHER SOURCE
HOME 41
CORRECTIONAL FACILITY 42
OTHER___(SPECIFY) 96

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

YES 1
NO 2 (SKIP TO 924)

919) All women are supposed to receive counseling after being tested. After you were tested, did you receive counseling?

YES 1 (SKIP TO 924)
NO 2 (SKIP TO 924)
DON'T KNOW 8 (SKIP TO 924)

920) CHECK 434 FOR LAST BIRTH:

ANY CODE 21-36 CIRCLED___(CONTINUE TO 921)
OTHER___(SKIP TO 926)

921) Between the time you went for delivery but before the baby was born, were you offered a test for HIV?

YES 1
NO 2

922) I don't want to know the results, but were you tested for HIV at that time?

YES 1
NO 2 (SKIP TO 926)

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

YES 1
NO 2

924) Have you been tested for HIV since that time you were tested during your pregnancy?

YES 1 (SKIP TO 927)
NO 2

925) How many months ago was your most recent HIV test?

MONTHS AGO___
TWO OR MORE YEARS 95
(SKIP TO 932 REGARDLESS OF RESPONSE)

926) I don't want to know the results, but have you ever been tested to see if you have HIV?

YES 1
NO 2 (SKIP TO 930)

927) How many months ago was your most recent HIV test?

MONTHS AGO___
TWO OR MORE YEARS 95

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

YES 1
NO 2

929) Where was the test done? PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.____(NAME OF PLACE)

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVT. HEALTH CENTER (RHC) 12
GOVT. HEALTH POST (SUB-CENTER) 13
STAND-ALONE VCT CENTER 14
FAMILY PLANNING CLINIC 15
MOBILE CLINIC 16
FIELDWORKER 17
SCHOOL BASED CLINIC 18
OTHER PUBLIC SECTOR____(SPECIFY) 19
NGO
MARIE STOPES 21
MYANMAR RED CROSS SOCIETY 22
PSI/M (SUN) 23
MMA 24
OTHER NGO SECTOR___(SPECIFY) 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 31
STAND-ALONE VCT CENTER 32
PHARMACY 33
MOBILE CLINIC 34
DIAGNOSTIC LABORATORY 35
OTHER PRIVATE MEDICAL SECTOR____(SPECIFY) 36
OTHER SOURCE
HOME 41
CORRECTIONAL FACILITY 42
OTHER___(SPECIFY) 96

930) Do you know of a place where people can go to get tested for HIV?

YES 1
NO 2 (SKIP TO 932)

931) Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.___(NAME OF PLACE(S))

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER (RHC) B
GOVT. HEALTH POST (SUB-CENTER) C
STAND-ALONE VCT CENTER D
FAMILY PLANNING CLINIC E
MOBILE CLINIC F
FIELDWORKER G
OTHER PUBLIC SECTOR____(SPECIFY) H
NGO
MARIE STOPES I
MYANMAR RED CROSS SOCIETY J
PSI/M (SUN) K
MMA L
OTHER NGO SECTOR___(SPECIFY) M
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR N
STAND-ALONE VCT CENTER O
PHARMACY P
MOBILE CLINIC Q
DIAGNOSTIC LABORATORY R
OTHER PRIVATE MEDICAL SECTOR____(SPECIFY) S
OTHER___(SPECIFY) X

932) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV?

YES 1
NO 2
DON'T KNOW 8

933) If a member of your family got infected with HIV, would you want it to remain a secret or not?

YES, REMAIN A SECRET 1
NO 2
DK/NOT SURE/DEPENDS 8

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

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

935) In your opinion, if a female teacher has HIV but is not sick, should she be allowed to continue teaching in the school?

SHOULD BE ALLOWED 1
SHOULD NOT BE ALLOWED 2
DK/NOT SURE/DEPENDS 8

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

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

937) CHECK 901:

HEARD ABOUT AIDS___: Apart from AIDS, have you heard about other infections 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

938) CHECK 613:

HAS HAD SEXUAL INTERCOURSE___(CONTINUE TO 939)
NEVER HAD SEXUAL INTERCOURSE___(SKIP TO 946)

939) CHECK 937: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES___(CONTINUE TO 940)
NO___(SKIP TO 941)

940) Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?

YES 1
NO 2
DON'T KNOW 8

941) Sometimes women experience a bad-smelling abnormal genital discharge. During the last 12 months, have you had a bad-smelling abnormal genital discharge?

YES 1
NO 2
DON'T KNOW 8

942) Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

YES 1
NO 2
DON'T KNOW 8

943) CHECK 940, 941, AND 942:

HAS HAD AN INFECTION (ANY 'YES')___(CONTINUE TO 944)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW___(SKIP TO 946)

944) The last time you had (PROBLEM FROM 940/941/942), did you seek any kind of advice or treatment?

YES 1
NO 2 (SKIP TO 946)

945) Where did you go? Any other place? PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE. ____(NAME OF PLACE(S))

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER (RHC) B
GOVT. HEALTH POST (SUB-CENTER) C
STAND-ALONE VCT CENTER D
FAMILY PLANNING CLINIC E
MOBILE CLINIC F
FIELDWORKER G
OTHER PUBLIC SECTOR___(SPECIFY) H
NGO
MARIE STOPES I
MYANMAR RED CROSS SOCIETY J
PSI/M (SUN) K
MMA L
OTHER NGO SECTOR___(SPECIFY) M
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR N
STAND-ALONE VCT CENTER O
PHARMACY P
MOBILE CLINIC Q
FIELDWORKER R
OTHER PRIVATE MEDICAL SECTOR___(SPECIFY) S
OTHER SOURCE
SHOP T
OTHER____(SPECIFY) X

946) If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom when they have sex?

YES 1
NO 2
DON'T KNOW 8

947) Is a wife justified in refusing to have sex with her husband when she knows he has sex with other women?

YES 1
NO 2
DON'T KNOW 8

948) CHECK 601:

CURRENTLY MARRIED___(CONTINUE TO 949)
NOT IN UNION___(SKIP TO 1001)

949) Can you say no to your (husband/partner) if you do not want to have sexual intercourse?

YES 1
NO 2
DEPENDS/NOT SURE 8

950) Could you ask your (husband/partner) to use a condom if you wanted him to?

YES 1
NO 2
DON'T KNOW 8


SECTION 10. OTHER HEALTH ISSUES

1001) Now I would like to ask you some questions relating to health matters. Have you had an injection for any reason in the last 12 months?
IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS___
NONE 00 (SKIP TO 1004)

1002) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?
IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS___
NONE 00 (SKIP TO 1004)

1003) The last time you got an injection from a health provider, did he/she take the syringe and needle from a new, unopened package?

YES 1
NO 2
DON'T KNOW 8

1003A) CHECK 210:

ONE OR MORE BIRTHS___(CONTINUE TO 1003B)
NONE___(SKIP TO 1004)

1003B) Have you ever experienced signs of uterine prolapse?

YES 1
NO 2 (SKIP TO 1004)

1003C) How did you manage your condition of prolapse?

USED PASSERY RING A
HAD AN OPERATION B
CONSULTED HEALTH WORKER C
TRIED TRADITIONAL METHODS D
INSERTED OBJECTS TO HOLD E
KEPT QUIET/DID NOTHING F
OTHER____(SPECIFY) X

1004) Do you currently smoke cigarettes?

YES 1
NO 2 (SKIP TO 1006)

1005) In the last 24 hours, how many cigarettes did you smoke?

NUMBER OF CIGARETTES___

1006) Do you currently smoke or use any (other) type of tobacco?

YES 1
NO 2 (SKIP TO 1007A)

1007) What (other) type of tobacco do you currently smoke or use? RECORD ALL MENTIONED.

PIPE/CIGAR/CHEROOT A
CHEWING TOBACCO B
SNUFF C
OTHER___(SPECIFY) X

1007A) Do you currently chew betel nuts?

YES 1
NO 2 (1007C)

1007B) In the last 24 hours, how many pieces did you chew?

NUMBER OF PIECES___

1007C) Have you ever heard of an illness called tuberculosis or TB?

YES 1
NO 2 (SKIP TO 1008)

1007D) How does tuberculosis spread from one person to another? PROBE: Any other ways? [CIRCLE ALL MENTIONED]

THROUGH THEH AIR WHEN COUGHING OR SNEEZING A
BY SHARING UTENSILS B
BY TOUCHING A PERSON WITH TB C
THROUGH SHARING FOOD D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
OTHER___(SPECIFY) X
DON'T KNOW Z

1007E) Can tuberculosis be cured?

YES 1
NO 2 (SKIP TO 1007G)
DON'T KNOW 8 (SKIP TO 1007G)

1007F) What is the duration of treatment of TB now a days? [IF MORE THAN 7 MONTHS, RECORD 7]

MONTHS___
DON'T KNOW 8

1007G) Have you ever been told by a doctor/nurse or other health workers that you have / had tuberculosis?

YES 1
NO 2
DON'T KNOW 8

1008) Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem or not?

Getting permission to go to the doctor?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Getting money needed for advice or treatment?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
The distance to the health facility?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Not wanting to go alone?
BIG PROBLEM 1
NOT A BIG PROBLEM 2

1009) Are you covered by any health insurance?

YES 1
NO 2 (SKIP TO 1101)

1010) What type of health insurance are you covered by? RECORD ALL MENTIONED.

MUTUAL HEALTH ORGANIZATION/COMMUNITY-BASED HEALTH INSURANCE A
HEALTH INSURANCE PROVIDED THROUGH EMPLOYER B
SOCIAL SECURITY C
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D
OTHER____(SPECIFY) X


SECTION 11. MATERNAL MORTALITY

1101) Now I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your natural mother, including those who are living with you, those living elsewhere and those who have died. How many children did your mother give birth to, including you?

NUMBER OF BIRTHS TO NATURAL MOTHER___

1102) CHECK 1101:

TWO OR MORE BIRTHS____(CONTINUE TO 1103)
ONLY ONE BIRTH (RESPONDENT ONLY)___(SKIP TO 1200)

1103) How many births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS__

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

NAME___

1105) Is (NAME) male or female?

MALE 1
FEMALE 2

1106) Is (NAME) still alive?

YES 1
NO 2 (GO TO 1108)
DON'T KNOW 8 (GO TO (COLUMN 2))

1107) How old is (NAME)?

AGE___(GO TO COLUMN 2)

1108) How many years ago did (NAME) die?

____

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

____ IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO (2)

1110) Was (NAME) pregnant when she died?

YES 1 (GO TO 1113)
NO 2

1111) Did (NAME) die during childbirth?

YES 1 (GO TO 1113)
NO 2

1112) Did (NAME) die within two months after the end of a pregnancy or childbirth?

YES 1
NO 2

1113) How many live birth children did (NAME) give birth to during her lifetime?

_____

IF NO MORE BROTHERS OR SISTERS, GO TO NEXT SECTION.


12. DOMESTIC VIOLENCE MODULE

1200) CHECK HOUSEHOLD QUESTIONNAIRE - Q. 162 AND COVER PAGE OF WOMAN QUESTIONNAIRE

WOMAN SELECTED FOR THIS SECTION___(CONTINUE TO 1201)
WOMAN NOT SELECTED___(SKIP TO 1233)

1201) CHECK FOR PRESENCE OF OTHERS: DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.

PRIVACE OBTAINED 1 (CONTINUE)
PRIVACY NOT POSSIBLE 2 (SKIP TO 1232)

READ TO THE RESPONDENT: Now I would like to ask you questions about some other important aspects of a woman's life. You may find some of these questions very personal. However, your answers are crucial for helping to understand the condition of women in Myanmar. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else in your household will know that you were asked these questions.

1202) CHECK 601 AND 602:

CURRENTLY MARRIED___(CONTINUE TO 1203)
FORMERLY MARRIED (READ IN PAST TENSE AND USE 'LAST' WITH HUSBAND___(CONTINUE TO 1203)
NEVER MARRIED___(SKIP TO 1216)

1203) First I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your (last) husband?

a) He (is/was) jealous or angry if you (talk/talked) to other men?
YES 1
NO 2
DON'T KNOW 8
b) He frequently (accuses/accused) you of being unfaithful?
YES 1
NO 2
DON'T KNOW 8
c) He (does/did) not permit you to meet with your female friends?
YES 1
NO 2
DON'T KNOW 8
d) He (tries/tried) to limit your contact with your family?
YES 1
NO 2
DON'T KNOW 8
e) He (insists/insisted) on knowing where you (are/were) at all times?
YES 1
NO 2
DON'T KNOW 8

1204) Now I need to ask some more questions about your relationship with your (last) husband.
Did your last husband ever:

a) say or do something to humiliate you in front of others?
YES 1
NO 2 (GO TO 1204b)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
b) threaten to hurt or harm you or someone you care about?
YES 1
NO 2 (GO TO 1204c)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
c) insult you or make you feel bad about yourself?
YES 1
NO 2 (GO TO 1205a)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3

1205) A: Did your (last) husband ever do any of the following things to you:
B: How often did this happen during the last 12 months: often, only sometimes, or not at all?

a) push you, shake you, or throw something at you?
YES 1
NO 2 (GO TO 1205b)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
b) slap you?
YES 1
NO 2 (GO TO 1205c)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
c) twist your arm or pull your hair?
YES 1
NO 2 (GO TO 1205d)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
d) punch you with his fist or something that could hurt you?
YES 1
NO 2 (GO TO 1205e)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
e) kick you, drag you, or beat you up?
YES 1
NO 2 (GO TO 1205f)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
f) try to choke you or burn you on purpose?
YES 1
NO 2 (GO TO 1205g)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
g) threaten or attack you with a knife, gun, or other weapon?
YES 1
NO 2 (GO TO 1205h)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
h) physically force you to have sexual intercourse with him when you did not want to?
YES 1
NO 2 (GO TO 1205i)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
i) physically force you to perform any other sexual acts you did not want to?
YES 1
NO 2 (GO TO 1205j)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
j) force you with threats or in any other way to perform sexual acts you did not want to?
YES 1
NO 2 (GO TO 1206)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3

1206) CHECK 1205A (a-j):

AT LEAST ONE 'YES'___(CONTINUE TO 1207)
NOT A SINGLE 'YES'___(SKIP TO 1209)

1207) How long after you first (got married/started living together) with your (last) (husband/partner) did (this/any of these things) first happen?
IF LESS THAN ONE YEAR, RECORD '00'.

NUMBER OF YEARS___
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95

1208) Did the following ever happen as a result of what your (last) husband did to you:

a) You had cuts, bruises, or aches?
YES 1
NO 2
b) You had eye injuries, sprains, dislocations, or burns?
YES 1
NO 2
c) You had deep wounds, broken bones, broken teeth, or any other serious injury?
YES 1
NO 2

1209) Have you ever hit, slapped, kicked, or done anything else to physically hurt your (last) husband at times when he was not already beating or physically hurting you?

YES 1
NO 2 (SKIP TO 1211)

1210) In the last 12 months, how often have you done this to your (last) husband: often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1211) Does (did) your (last) husband drink alcohol?

YES 1
NO 2 (SKIP TO 1213)

1212) How often does (did) he get drunk: often, only sometimes, or never?

OFTEN 1
SOMETIMES 2
NEVER 3

1213) Are (Were) you afraid of your (last) husband: most of the time, sometimes, or never?

MOST OF THE TIME AFRAID 1
SOMETIMES AFRAID 2
NEVER AFRAID 3

1214) CHECK 609:

MARRIED MORE THAN ONCE____(CONTINUE TO 1215)
MARRIED ONLY ONCE___(SKIP TO 1216)

1215) A: So far we have been talking about the behavior of your (current/last) husband. Now I want to ask you about the behavior of any previous husband.

a) Did any previous husband ever hit, slap, kick, or do anything else to hurt you physically?
YES 1
NO 2 (SKIP TO 1215b)
How long ago did this last happen?
0-11 MONTHS AGO 1
12+ MONTHS AGO 2
DON'T REMEMBER 3
b) Did any previous husband physically force you to have intercourse or perform any other sexual acts against your will?
YES 1
NO 2 (SKIP TO 1216)
How long ago did this happen?
0-11 MONTHS AGO 1
12+ MONTHS AGO 2
DON'T REMEMBER 3

1216) CHECK 601 AND 602:

EVER MARRIED___: From the time you were 15 years old has anyone other than (your/any) husband hit you, slapped you, kicked you, or done anything else to hurt you physically?
NEVER MARRIED___: From the time you were 15 years old has anyone hit you, slapped you, kicked you, or done anything else to hurt you physically?
YES 1
NO 2 (SKIP TO 1219)
REFUSED TO ANSWER/NO ANSWER 3 (SKIP TO 1219)

1217) Who has hurt you in this way? Anyone else? RECORD ALL MENTIONED

_____(SPECIFY)

1218) In the last 12 months, how often has (this person/have these persons) physically hurt you: often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1219) CHECK 201, 226, AND 230:

EVER BEEN PREGNANT (YES ON 201 OR 226 OR 230)____(CONTINUE TO 1220)
NEVER BEEN PREGNANT___(SKIP TO 1222)

1220) Has anyone ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?

YES 1
NO 2 (SKIP TO 1222)

1221) Who has done any of these things to physically hurt you while you were pregnant? Anyone else? RECORD ALL MENTIONED.

_____(SPECIFY)

1222) CHECK 601 AND 602:

EVER MARRIED___(CONTINUE TO 1222A)
NEVER MARRIED___(SKIP TO 1222B)

1222A) Now I want to ask you about things that may have been done to you by someone other than (your/any) husband. At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?

YES 1 (SKIP TO 1223)
NO 2 (SKIP TO 1224A)
REFUSED TO ANWER/NO ANSWER 3 (SKIP TO 1224A)

1222B) At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?

YES 1
NO 2 (SKIP TO 1226)
REFUSED TO ANWER/NO ANSWER 3 (SKIP TO 1226)

1223) Who was the person who was forcing you the very first time this happened?

____(SPECIFY)

1224) CHECK 601 AND 602:

EVER MARRIED___: In the last 12 months, has anyone other than (your/any) husband physically forced you to have sexual intercourse when you did not want to?
NEVER MARRIED___: In the last 12 months has anyone physically forced you to have sexual intercourse when you did not want to?
YES 1 (SKIP TO 1225)
NO 2 (SKIP TO 1225)

1224A) CHECK 1205A (h-j) and 1215A(b)

AT LEAST ONE 'YES'___ (CONTINUE 1225)
NOT A SINGLE 'YES'___ (SKIP TO 1226)

1225) CHECK 601 AND 602:

EVER MARRIED___: How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts by anyone, including (your/any) husband/partner?
NEVER MARRIED___: How old were you the first first time you were forced to have sexual intercourse or perform any other sexual acts?
AGE IN COMPLETED YEARS___
DON'T KNOW 98

1226) CHECK 1205A (a-j), 1215A (a,b), 1216, 1220, 1222A, AND 1222B:

AT LEAT ONE 'YES'___(CONTINUE TO 1227)
NOT A SINGLE 'YES'___(SKIP TO 1230)

1227) Thinking about what you yourself have experiences among the different things we have been talking about, have you ever tried to seek help?

YES 1
NO 2 (SKIP TO 1229)

1228) From whom have you sought help? Anyone else? RECORD ALL MENTIONED. SKIP TO 1230 REGARDLESS OF RESPONSE.

OWN FAMILY A
HUSBAND'S/PARTNER'S FAMILY B
CURRENT/FORMER HUSBAND/PARTNER C
CURRENT/FORMER BOYFRIEND D
FRIEND E
NEIGHBOR F
RELIGIOUS LEADER G
DOCTOR/MEDICAL PERSONNEL H
POLICE I
LAWYER J
SOCIAL SERVICE ORGANIZATION K
OTHER___(SPECIFY) X

1229) Have you ever told any one about this?

YES 1
NO 2

1230) As far as you know, did your father ever beat your mother?

YES 1
NO 2
DON'T KNOW 8

THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER ABOUT THE CONFIDENTIALITY OF HER ANSWERS. FILL OUT THE QUESTIONS BELOW WITH REFERENCE TO THE DOMESTIC VIOLENCE MODULE ONLY.

1231) DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?

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

1232) INTERVIEWER'S COMMENTS / EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE_____(FILL IN)

1233) RECORD THE TIME.

HOUR___
MINUTES___

INTERVIEWER'S OBSERVATIONS
(TO BE FILLED IN AFTER COMPLETING INTERVIEW)
COMMENTS ABOUT RESPONDENT: (FILL IN)
COMMENTS ON SPECIFIC QUESTIONS: (FILL IN)
ANY OTHER COMMENTS: (FILL IN)

SUPERVISOR'S OBSERVATIONS
(FILL IN)
NAME OF SUPERVISOR:____
DATE:_____

EDITOR'S OBSERVATIONS
(FILL IN)
NAME OF SUPERVISOR:____
DATE:___

INSTRUCTIONS: ONLY ONE CODE SHOULD APPEAR IN ANY BOX. COLUMN 1 REQUIRES A CODE IN EVERY MONTH.

INFORMATION TO BE CODED FOR EACH COLUMN

COLUMN 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE

B BIRTHS
P PREGNANCIES
T TERMINATIONS
0 NO METHOD
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 IUD
4 INJECTABLES
5 IMPLANTS
6 PILL
7 CONDOM
8 FEMALE CONDOM
9 DIAPHRAGM
J FOAM OR JELLY
K LACTATIONAL AMENORRHEA METHOD
L RHYTHM METHOD
M WITHDRAWAL
X OTHER MODERN METHOD
Y OTHER TRADITIONAL METHOD

COLUMN 2: DISCONTINUATION OF CONTRACEPTIVE USE

0 INFREQUENT SEX/HUSBAND AWAY
1 BECAME PREGNANT WHILE USING
2 WANTED TO BECOME PREGNANT
3 HUSBAND/PARTNER DISAPPROVED
4 WANTED MORE EFFECTIVE METHOD
5 SIDE EFFECTS/HEALTH CONCERNS
6 LACK OF ACCESS/TOO FAR
7 COSTS TOO MUCH
8 INCONVENIENT TO USE
F UP TO GOD/FATALISTIC
A DIFFICULT TO GET PREGNANT/MENOPAUSAL
D MARITAL DISSOLUTION/SEPARATION
X OTHER____(SPECIFY)
Z DON'T KNOW