IDENTIFICATION

REGION/DISTRICT_____________

TA/STA/TOWN______________

ENUMERATION AREA _____________

VILLAGE OR PLACE______________

MDHS CLUSTER NUMBER___________

HOUSEHOLD NUMBER _______________

URBAN/RURAL ____________

NAME AND LINE NUMBER OF MAN _____________

NAME AND LINE NUMBER OF WIFE # 1____________

NAME AND LINE NUMBER OF WIFE # 2____________

NAME AND LINE NUMBER OF WIFE # 3____________
(NOTE: include only wives in household)

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE ___
INTERVIEWER'S NAME ___
RESULT* ___

NEXT VISIT:
DATE__
TIME__

FINAL VISIT:
DAY __
MONTH __
YEAR __
NAME __
RESULT__

TOTAL NUMBER OF VISITS__

FIELD EDITED BY:
NAME ___
DATE ___

OFFICE EDITED BY:
NAME ___
DATE ___

KEYED BY:
NAME ___
DATE ___

SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD THE TIME.

102. First I would like to ask some questions about you and your household. For most of the time until you were about 12 years old, did you live in a city, in a town, or in a village?

103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?

104. Just before you moved here, did you live in a city, in a town, or in a village?

105. In what month and year were you born?

106. How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

107. Have you ever attended school?

108. What is the highest level of school you attended: primary, secondary, or higher?

109. How many years of school did you complete at that level?

110. CHECK 108:

111. Are you able to read and understand English or Chichewa easily, with difficulty or not at all?

112. Do you usually read a newspaper or magazine at least once a week?

113. Do you usually listen to a radio at least once a week?

114. What kind of work do you mainly do?

115. CHECK 114:

116. Do you work mainly on your own land or family's land, or on land that you rent, or on someone else's land?

117. CHECK Q. 4 IN THE HOUSEHOLD QUESTIONNAIRE:

118. Now I would like to ask about the place in which you usually live. Do you usually live in a city, in a town, or in a village?

119. In which region is that located?

120. What is the source of water your household uses for handwashing and dishwashing?

121. How long does it take to go there, get water and come back?

122. Does your household get drinking water from this same source?

123. What is the source of drinking water for members of your household?

124. What kind of toilet facility does your household have?

125. Does your household have:

126. How many rooms in all the dwelling units of your household are used for sleeping?

127. Does any member of your household own:

128A. At your own house, what is the main material that the floor is made from?
NOTE: IF HIS HOUSEHOLD LIVES IN MORE THAN ONE DWELLING UNIT AND THE DWELLING UNITS DIFFER IN FLOOR MATERIALS, ASK FOR THE FLOOR MATERIAL OF THE DWELLING OF THE HEAD OF HOUSEHOLD.

128B. At your own house, what is the main material that the roof is made from?

SECTION 2. MARRIAGE

201. Have you ever been married or lived with a woman?

202. Are you now married or living with a woman, or are you now widowed, divorced or no longer living together?

203. How many wives do you have?
CHECK CONSISTENCY WITH COVER PAGE.

204. In what month and year did you start living with your (first) wife/partner?

205. How old were you when you started living with her?

206. CHECK 204 AND 205:
YEAR AND AGE GIVEN?

207. CHECK CONSISTENCY OF 204 AND 205:

YEAR OF BIRTH (105) ___
PLUS +
AGE AT MARRIAGE (205) ___
=
CALCULATED YEAR OF MARRIAGE ___

IS THE CALCULATED YEAR OF MARRIAGE WITHIN ONE YEAR OF THE REPORTED YEAR OF MARRIAGE (204)?

SECTION 3. METHODS OF CHILDSPACING

301. Now I would like to talk about childspacing - the various ways or methods that a couple can use to delay or avoid a pregnancy. Which ways or methods have you heard about?

CIRCLE CODE 1 IN 302 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.
CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 302, ASK 303-304 BEFORE PROCEEDING TO THE NEXT METHOD.

302. Have you ever heard of (METHOD)?
READ DESCRIPTION OF EACH METHOD.

303. Have you ever used (METHOD) with any partner?

304. Do you know where a person could go to get (METHOD)?

305. CHECK 303:

306. Have you or (your wife/partner) ever tried in any way to delay or avoid having a baby?

307. What have you used or done?
CORRECT 303-305(AND 302 IF NECESSARY).

308. CHECK 303:

309. Are you or your wife (or partner) currently doing something or using any method to delay or avoid having a baby?

310. Which method are you using?
310A. DO NOT ASK THE QUESTION BELOW IF MAN NOT STERILIZED.
You have said that you had an operation that keeps you from ever making a woman pregnant. Is that correct?
IF RESPONENT SAYS "NO", CORRECT 303-305 (AND 302 IF NECESSARY).
IF RESPONDENT SAYS "YES", CIRCLE '07' FOR MALE STERILIZATION.

311. CHECK 310:

SHE/HE STERILIZED: Where did the sterilization take place?

USING ANOTHER METHOD: Where did you obtain (METHOD) the last time?

312. How long does it take to travel from your home to this place?
IF LESS THAN 2 HOURS, RECORD MINUTES. OTHERWISE, RECORD HOURS.

313. Is it easy or difficult to get there?

314. CHECK 310:

315. In what month and year was the sterilization operation performed?

316. For how many months have you been using (CURRENT METHOD) continuously?
IF LESS THAN 1 MONTH, RECORD '00'.

317. Do you intend to use a method to delay or avoid pregnancy at any time in the future?

318. What is the main reason you do not intend to use a method?

319. Do you intend to use a method within the next 12 months?

320. When you start using a method, which method would you prefer to use?

321. Where can you get (METHOD MENTIONED IN 320)?

322. CHECK 310:

323. Do you know of a place where you can obtain a method of childspacing?

324. Where is that?

325. How long does it take to travel from your home to this place?
IF LESS THAN 2 HOURS, RECORD MINUTES. OTHERWISE, RECORD HOURS.

326. Is it easy or difficult to get there?

327. In the last month, have you heard a message about childspacing on the radio?

328. Is it acceptable or not acceptable to you for childspacing information to be provided on the radio?

329. CHECK 302 (CONDOM):

330. Have you seen or heard any advertisement in the last month about the condom?

331. Where did you see or hear the advertisement?
CIRCLE ALL MENTIONED

332. CHECK 310:

333. Where can someone go to get condoms?

SECTION 4. FERTILITY PREFERENCES

401. How many own sons do you have who are still alive?
IF NONE, RECORD '00'.

402. How many own daughters do you have who are still alive?
IF NONE, RECORD '00'.

403. CHECK 310:

404. Now I have some questions about the future.
Would you like to have another (a) child or would you prefer to have (no more children/no children)?

405. How long would you like to wait before the birth of another (a) child?

406. Given your present circumstances, if you had to do it over again, do you think (you/your wife or partner) would make the same decision to have an operation not to have any more children?

407. Do you regret that (you/your wife or partner) had the operation not to have any (more) children?

408. Why do you regret it?

409. CHECK 202:

410. Do you think that your (wife/partner) approves or disapproves of couples using a method to avoid pregnancy?

411. How often have you talked to your (wife/partner) about childspacing in the past year?

412. Have you and your (wife/partner) ever discussed the number of children you would like to have?

413. Do you think your (wife/partner) wants the same number of children that you want, or does she want more or fewer than you want?

414. How long should a couple wait before starting sexual intercourse after the birth of a baby?

415. Should a mother wait until she has completely stopped breastfeeding before starting to have sexual relations again, or doesn't it matter?

416. In general, do you approve or disapprove of couples using a method to avoid getting pregnant?

417. CHECK 401 AND 402:

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

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

418. What do you think is the best number of months or years between the birth of one child and the birth of the next child?

SECTION 5. AIDS KNOWLEDGE

501. Now I have a few questions about a very important topic. Have you heard of an illness called AIDS?

502. From which sources of information or persons have you heard about AIDS in the last month?
CIRCLE ALL MENTIONED.

503. How is AIDS transmitted?
CIRCLE ALL MENTIONED.

504. Do you think that you can get AIDS from:

505. Is it possible for a healthy looking person to be infected with the AIDS virus?

506. Is it possible for a woman who has the AIDS virus to give birth to a child with the AIDS virus?

507. Can a person protect herself or himself from getting AIDS?

508. How can a person protect herself or himself from getting AIDS?
CIRCLE ALL MENTIONED.

509. If your relative is suffering with AIDS, who would you prefer to care for him or her?

SECTION 6. MATERNAL MORTALITY

601. 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 yourself?

602. CHECK 601:

603. How many of these births did your mother have before you were born?

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

605. Is (NAME) male or female?

606. Is (NAME) still alive?

607. How old is (NAME)?

608. How many years ago did (NAME) die?

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

610. Was (NAME) pregnant when she died?

611. Did (NAME) die during childbirth?

612. Did (NAME) die within six weeks after the end of a pregnancy or childbirth?

613. How many children had (NAME) given birth to before that pregnancy?

614. RECORD THE TIME.

INTERVIEWER'S OBSERVATIONS

(To be filled in after completing interview)

Comments About Respondent:____________________________

Comments on Specific Questions:____________________________

Any Other Comments:____________________________

SUPERVISOR'S OBSERVATIONS____________________________

Name of Supervisor: ___________
Date: ____________

EDITOR'S OBSERVATIONS___________________________