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DEMOGRAPHIC AND HEALTH SURVEYS - MOZAMBIQUE 2003 - WOMEN'S QUESTIONNAIRE

IDENTIFICATION

NAME OF HOUSEHOLD HEAD______
PLACE NAME ______
PROVINCE______

URBAN/RURAL

URBAN 1
RURAL 2

CLUSTER NUMBER ______
HOUSEHOLD NUMBER______

NAME AND LINE NUMBER OF WOMAN______

INTERVIEWER VISITS

FIRST INTERVIEW (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE_____
INTERVIEWER'S NAME______

RESULT ______

COMPLETED 01
ABSENT 02
REFUSED COMPLETELY 03
REFUSED DURING INTERVIEW 04
PARTLY COMPLETED/INCOMPLETE 05
INCAPACITATED 06
OTHER (SPECIFY) ______ 96

NEXT VISIT
DATE_____
TIME_____

FINAL VISIT
DAY_____
MONTH_____
YEAR 2003
CODE_____
RESULT______

TOTAL NUMBER OF VISITS______

SUPERVISOR
NAME_____
DATE_____

FIELD EDITOR
NAME_____
DATE_____

OFFICE EDITOR_____

KEYED BY_____
RE-KEYED BY_____

SECTION 1: RESPONDENT'S BACKGROUND

101. RECORD THE TIME:

HOUR_____
MINUTES____

102. For most of the time until you were 12 years old, did you live in a city, village or rural area?

CITY 1
VILLAGE 2
RURAL AREA 3

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

YEARS____

ALWAYS_____ 95 (GO TO 105)
VISITOR____ 96 (GO TO 105)

104. Before you moved here, did you live in a city, village or rural area?

CITY 1
VILLAGE 2
RURAL AREA 3

105. In what month and year were you born?

MONTH_____
DOESN'T KNOW MONTH 98
YEAR_____
DOESN'T KNOW YEAR 9998

106. How old are you?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT

AGE COMPLETED IN YEARS ______

107. Have you attended school?

YES 1 (GO TO 108)
NO 2

107A. Have you attended a literacy course?

YES 1 (GO TO 111)
NO 2 (GO TO 111)

108. What is the highest level of school you attended?

LITERACY 00
PRIMARY EP1 01
PRIMARY EP2 02
SECONDARY ESG1 03
SECONDARY ESG2 04
TECHNICAL ELEMENTARY 05
TECHNICAL BASIC 06
TECHNICAL ADVANCED 07
TEACHER PREP 08
HIGHER 09

109. What is the highest grade you completed at that level?

GRADE_____

109A. CHECK 106 IF AGE 24 OR LESS:

AGE 24 OR YOUNGER (GO TO 109B)
AGE 25 OR OLDER (GO TO 110)

109B. Are you currently attending school?

YES 1 (GO TO 110)
NO 2

109C. What was the main reason you stopped attending school?

GOT PREGNANT 01
GOT MARRIED 01
TO CARE FOR YOUNGER CHILDREN 03
TO HELP FAMILY ON FARM/PLANTATION OR IN BUSINESS 04
DOESN'T HAVE MONEY 05
NEEDED TO EARN MONEY 06
HAD ENOUGH SCHOOLING 07
DID NOT PASS ENTRANCE EXAMS 08
DOESN'T LIKE TO STUDY 09
SCHOOL NOT ACCESSIBLE/TOO FAR 10
LACK OF SCHOOL/THERE IS NOT ENOUGH SPACES IN SCHOOL 11
FAMILY DISLOCATED DURING FLOODING 12
GRADUATED 13
OTHER (SPECIFY) _____ 96
DOESN'T KNOW 98

110. CHECK 108 IF SCHOOL LEVEL IS PRIMARY EP1 OR BELOW:

PRIMARY EP1 OR BELOW (GO TO 111)
PRIMARY EP2 OR HIGHER (GO TO 114)

111. 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 (GO TO 115)
ABLE TO READ ONLY PART OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) _______ 4
BLIND 5 (GO TO 116)

114. How many times a week do you read the newspaper?

EVERYDAY 1
ALMOST EVERYDAY 2
ONCE A WEEK 3
SOMETIMES 4
NEVER 5

115. How many times a week do you watch television?

EVERYDAY 1
ALMOST EVERYDAY 2
ONCE A WEEK 3
SOMETIMES 4
NEVER 5

116. How many times a week do you listen to the radio?

EVERYDAY 1
ALMOST EVERYDAY 2
ONCE A WEEK 3
SOMETIMES 4
NEVER 5

118. Do you profess a religion?

YES 1
NO 2 (GO TO 119)

118A. What is your religion?

CATHOLIC 01
MUSLIM 02
ZION 03
PROTESTANT/EVANGELICAL 04
ANIMISM 05
OTHER (SPECIFY) _____ 96

118B. How often do you go to the church/mosque?

ONCE A MONTH 1
MORE THAN ONCE A MONTH 2
ONLY DURING HOLIDAY 3
NEVER 4

119. What language did you grow up speaking?

PORTUGUESE 01
EMAKHUWA 02
XINCHANGANA 03
ELOMWE 04
CISENA 05
ECHUWABO 06
SHONA 07
OTHER (SPECIFY) _____96

SECTION 2. REPRODUCTION

Now I would like to ask about all the births you have had during your life (and if the children are still alive).

201. Have you ever given birth to a boy?
IF ANSWER NO, ASK: Have you ever given birth to a girl?

YES 1
NO 2 (GO TO 206)

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

YES 1
NO 2 (GO TO 204)

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

SONS AT HOME ____
DAUGHTERS AT HOME_____

204. Do you have any sons or daughters to whom you have given birth who live in another place?

YES 1
NO 2 (GO TO 206)

205. How many sons are living somewhere else?
And how many daughters are living somewhere else?
IF NONE, RECORD '00'.

SONS ELSEWHERE_____
DAUGHTERS ELSEWHERE_____

206. Have you ever given birth to a boy or a girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but survived only a few hours or days?

YES 1
NO 2 (GO TO 208)

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

BOYS DEAD____
GIRLS DEAD____

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

TOTAL______

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 (GO TO 210)
NO (PROBE AND CORRECT 202-208 AS NECESSARY)

210. CHECK 208:

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

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

211. RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. PROBE IF SHE HAD/HAS TWINS OR TRIPLETS, CIRCLE 213 FOR REFERENCE

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

NAME____

213. Were any of these births twins?

SING 1
MULT 2

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

MALE 1
FEMALE 2

215. In what month and year was (NAME) born?

MONTH____
YEAR____

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

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

AGE IN YEARS_____

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

YES 1
NO 2

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

LINE NUMBER_____ (GO TO NEXT BIRTH)

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

DAYS 1 _____
MONTHS 2 _____
YEARS 3 _____

221. Have you had any other birth between the birth of (NAME) and the preceding birth?

YES 1
NO 2

222. Have you had any live births since the birth of (NAME OF LAST BIRTH)?
IF ANSWER IS 'YES', ASK AND RECORD IN THE HISTORY OF BIRTHS SECTION.

YES 1
NO 2

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

NUMBERS ARE THE SAME (GO TO 223A)
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

223A. CHECK:

FOR EACH BIRTH: YEAR OF BIRTH AGE IS RECORDED (FROM 215) ____
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED (FROM 217) ____
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED (FROM 220) ____

223B. FOR AGE AT DEATH '12 MONTHS' OR '1 YEAR', RECORD NAME. IF THERE ARE NO DEATHS, GO TO 224.

NAME________

223C. How many months old was (NAME) when s/he died?
IF DIFFERENT, CORRECT 220 FOR (NAME).

MONTHS OLD_______

224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN JANUARY 1998.
IF NONE, RECORD '0' AND GO TO 226.

NUMBER OF BIRTHS______

225. FOR EACH BIRTH SINCE JANUARY 1998, ENTER 'N' IN THE MONTH OF BIRTH IN COLUMN 1 OF THE CALENDAR. ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'G' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'G's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.) WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'N' CODE.

226. Are you pregnant now?

YES 1
NO 2 (GO TO 229)
DOESN'T KNOW 8 (GO TO 229)

227. How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.

MONTHS________

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

THEN 1
LATER 2
NOT AT ALL 3

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

YES 1
NO 2 (GO TO 237)

230. In what month and year did the last such pregnancy end?

MONTH____
YEAR_____

231. CHECK 230:

LAST PREGNANCY ENDED IN JANUARY 1998 OR LATER (GO TO 232)
LAST PREGNANCY ENDED BEFORE JANUARY 1998 (GO TO 237)

232. How many months pregnant were you when the last pregnancy ended?
RECORD NUMBER OF COMPLETED MONTHS.

MONTHS_______

232A. ENTER 'T' IN COLUMN 1 OF CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'G' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

233. Have you ever had any other pregnancies that did not result in a live birth, after January 1998?

YES 1
NO 2 (GO TO 237)

234. ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 1998. ENTER 'T' IN COLUMN 1 OF CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'G' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

235. Did you have any pregnancies that terminated before 1998 that did not result in a live birth?

YES 1
NO 2 (GO TO 237)

236. In what year and month did the last such pregnancy that terminated before 1998 end?

MONTH_____
YEAR_____

237. 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 THE LAST BIRTH 995
NEVER MENSTRUATED 996

SECTION 3. CONTRACEPTION

Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid pregnancy.

301. Which ways or methods have you heard about?
CIRCLE CODE '1' IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY.
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you heard of (METHOD)?

THEN CIRCLE CODE '1' FOR EACH KNOWN METHOD OTHERWISE CIRCLE CODE '2' AND CONTINUE WITH NEXT METHOD NOT MENTIONED SPONTANEOUSLY.
FOR EACH RECOGNIZED METHOD, ASK QUESTION 302.

01) FEMALE STERILIZATION. (Tubal ligation). Women can have an operation to avoid having any more children.
YES 1
NO 2 (GO TO NEXT METHOD)
02) MALE STERILIZATION. (Vasectomy). Men can have an operation to avoid having any more children.
YES 1
NO 2 (GO TO NEXT METHOD)
03) PILL. Women can take pill every day to avoid pregnancy
YES 1
NO 2 (GO TO NEXT METHOD)
04) IUD. Women can have a loop or coil placed inside them by a doctor or a nurse to avoid pregnancy
YES 1
NO 2 (GO TO NEXT METHOD)
05) INJECTABLES. Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO 2 (GO TO NEXT METHOD)
06) CONDOM. Men can put a rubber sheath on their penis during sexual intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
07) DIAPHRAGM. Women can place a diaphragm inside themselves before intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
08) FOAM, JELLY OR SPONGE. Women can place a sponge, suppository, jelly or cream inside themselves before intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
09) LACTATIONAL AMENORRHEA METHOD (LAM). Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.
YES 1
NO 2 (GO TO NEXT METHOD)
10) PERIODIC ABSTINENCE. Every month that a woman is sexually active, she can avoid having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2 (GO TO NEXT METHOD)
11) WITHDRAWAL. Men can be careful and pull out before climax, ejaculating outside of the vagina.
YES 1
NO 2 (GO TO NEXT METHOD)
12) OTHER METHODS. Couples can use other methods or ways to avoid pregnancy. Have you heard of any other ways or methods that women or men can use to avoid pregnancy? LIST UP TO TWO METHODS.
(SPECIFY) ____
YES 1
NO 2

302. Have you ever used (METHOD)?

01) FEMALE STERILIZATION. (Tubal ligation). Women can have an operation to avoid having any more children. Have you ever had an operation to avoid having any (more) children?
YES 1
NO 2
02) MALE STERILIZATION. (Vasectomy). Men can have an operation to avoid having any more children. Has your spouse/partner ever had an operation to avoid having any (more) children?
YES 1
NO 2
03) PILL. Women can take pill every day to avoid pregnancy
YES 1
NO 2
04) IUD. Women can have a loop or coil placed inside them by a doctor or a nurse to avoid pregnancy
YES 1
NO 2
05) INJECTABLES. Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO 2
06) CONDOM. Men can put a rubber sheath on their penis during sexual intercourse.
YES 1
NO 2
07) DIAPHRAGM. Women can place a diaphragm inside themselves before intercourse.
YES 1
NO 2
08) FOAM, JELLY OR SPONGE. Women can place a sponge, suppository, jelly or cream inside themselves before intercourse.
YES 1
NO 2
09) LACTATIONAL AMENORRHEA METHOD (LAM). Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.
YES 1
NO 2
10) PERIODIC ABSTINENCE. Every month that a woman is sexually active, she can avoid having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
11) WITHDRAWAL. Men can be careful and pull out before climax, ejaculating outside of the vagina.
YES 1
NO 2
12) OTHER METHODS (SPECIFY) ____
YES 1
NO 2

303. CHECK 302:

NOT A SINGLE 'YES' (NEVER USED) (GO TO 304)
AT LEAST ONE 'YES' (EVER USED) (GO TO 307)

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

YES 1
NO 2 (GO TO 329)

306. What have you used or done?
CORRECT 302 AND 303 (AND 301 IF NECESSARY).

307. When you used a method to avoid pregnancy for the first time, how many living children did you have at that time?
IF NONE, RECORD '00'.

NUMBER OF CHILDREN____

308. CHECK 302(1):

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

309. CHECK 226:

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

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

YES 1
NO 2 (GO TO 329)

311. Which method are you using?
311A. CIRCLE 'A' FOR FEMALE STERILIZATION
RECORD ALL ANSWERS

FEMALE STERILIZATION A
MALE STERILIZATION B
PILL C (GO TO 316A)
IUD D (GO TO 316A)
INJECTABLES E (GO TO 316A)
CONDOM F (GO TO 316A)
DIAPHRAGM G (GO TO 316A)
FOAM, JELLY, SPONGE H (GO TO 316A)
LACTATIONAL AMEN. METHOD I (GO TO 316A)
PERIODIC ABSTINENCE J (GO TO 316A)
WITHDRAWAL K (GO TO 316A)
OTHER METHODS (SPECIFY) ______ X (GO TO 316A)

313. Where did the operation to stop having children/sterilization take place?

IF SOURCE IS HOSPITAL, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE____
PUBLIC SECTOR
CENTRAL HOSPITAL 11
PROVINCIAL/GENERAL HOSPITAL 12
RURAL HOSPITAL 13
HEALTH CENTER 14
MOBILE CLINIC 15
OTHER (SPECIFY) ____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL 21
PRIVATE CLINIC 22
PRIVATE DOCTOR 23
PRIVATE NURSE 24
OTHER PRIVATE MEDICAL (SPECIFY) ____ 26
OTHER (SPECIFY) _____96
DOESN'T KNOW 98

314. CHECK 311:

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

CODE 'B' CIRCLED OR MARKED MALE STERILIZATION: 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
DOESN'T KNOW 8

315. Do you regret that (you/ your husband) had the operation not to have any (more) children?

YES 1
NO 2
DOESN'T KNOW 8

316. In what month and year was the sterilization performed?

MONTH_____
YEAR______

316A. For how long have you been using (CURRENT METHOD) now without stopping?

NOTE: THIS DATE MUST BE AFTER LAST BIRTH OR PREGNANCY. IF DATE WAS BEFORE THE LAST BIRTH OR LAST PREGNANCY, CORRECT IF NECESSARY.

MONTH_____
YEAR______

317. CHECK 316/316A:

YEAR IS 1998 OR LATER (GO TO 319)
YEAR IS BEFORE JANUARY 1998 (GO TO 327)

319. CHECK 311/311A:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION 01 (GO TO 322)
MALE STERILIZATION 02 (GO TO 331)
PILL 03
IUD 04
INJECTABLES 05
CONDOM 06
DIAPHRAGM 07
FOAM, JELLY, SPONGE 08
LACTATIONAL AMEN. METHOD 09 (GO TO 320A)
PERIODIC ABSTINENCE 10 (GO TO 331)
WITHDRAWAL 11 (GO TO 331)
OTHER METHODS (SPECIFY) ______ 96 (GO TO 331)

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

IF SOURCE IS HOSPITAL, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE_____
PUBLIC SECTOR
CENTRAL HOSPITAL 11
PROVINCIAL/GENERAL HOSPITAL 12
RURAL HOSPITAL 13
HEALTH CENTER 14
MOBILE CLINIC 15
OTHER (SPECIFY) ____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL 21 (GO TO 321A)
PRIVATE CLINIC 22 (GO TO 321A)
PRIVATE DOCTOR 23 (GO TO 321A)
PRIVATE NURSE 24 (GO TO 321A)
PHARMACY 25 (GO TO 321A)
OTHER PRIVATE MEDICAL (SPECIFY) ____ 26 (GO TO 321A)
OTHER SOURCE
SHOP 31 (GO TO 321A)
CHURCH 32 (GO TO 321A)
FRIEND/RELATIVE 33 (GO TO 321A)
TRADITIONAL HEALER 34 (GO TO 321A)
PARTNER 35 (GO TO 321A)
MEDICAL STAFF IN THE NEIGHBORHOOD 36 (GO TO 321A)
STAND/BOOTH INFORMATION 37 (GO TO 321A)
STORE 38 (GO TO 321A)
BAR/DISCOTHEQUE 39(GO TO 321A)
ADOLESCENTE SPECIAL SERVICES 40 (GO TO 321A)
OTHER (SPECIFY) ____96 (GO TO 321A)

321. In which district or province is the health center located?

DISTRICT ______
PROVINCE______

321A. CHECK 319:
CIRCLE THE METHOD CODE THAT IS CURRENTLY USED.

PILL 03
IUD 04
INJECTABLES 05
CONDOM 06 (GO TO 328)
DIAPHRAGM 07 (GO TO 325)
FOAM, JELLY, SPONGE 08 (GO TO 325)
LACTATIONAL AMEN. METHOD 09 (GO TO 325)

322. You obtained (CURRENT METHOD FROM 319) from (SOURCE OF METHOD FROM 313 OR 320): At that time, were you told about side effects or problems you might have with the method?

YES 1 (GO TO 324)
NO 2

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

YES 1
NO 2 (GO TO 325)

324. Were you told what to do if you experienced side effects or problems?

YES 1
NO 2

325. CHECK 322:

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 the current method, were you told about other methods of family planning that you could use?

YES 1 (GO TO 327)
NO 2

326. Were you ever told by a health or family planning worker about other methods of family planning you could use?

YES 1
NO 2

327. CHECK 311/311A:
CIRCLE METHOD CODE. IF USED VARIOUS METHODS MARK THE ONE CLOSER TO THE TOP.

FEMALE STERILIZATION 01 (GO TO 331)
MALE STERILIZATION 02 (GO TO 331)
PILL 03
IUD 04
INJECTABLES 05
CONDOM 06
DIAPHRAGM 07
FOAM, JELLY, SPONGE 08
LACTATIONAL AMEN. METHOD 09 (GO TO 331)
PERIODIC ABSTINENCE 10 (GO TO 331)
WITHDRAWAL 11 (GO TO 331)
OTHER METHODS (SPECIFY) ______ 96 (GO TO 331)

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

IF SOURCE IS HOSPITAL, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE______
PUBLIC SECTOR
CENTRAL HOSPITAL 11 (GO TO 331)
PROVINCIAL/GENERAL HOSPITAL 12 (GO TO 331)
RURAL HOSPITAL 13 (GO TO 331)
HEALTH CENTER 14 (GO TO 331)
MOBILE CLINIC 15 (GO TO 331)
OTHER (SPECIFY) ____ 16 (GO TO 331)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL 21 (GO TO 331)
PRIVATE CLINIC 22 (GO TO 331)
PRIVATE DOCTOR 23 (GO TO 331)
PRIVATE NURSE 24 (GO TO 331)
PHARMACY 25 (GO TO 331)
OTHER PRIVATE MEDICAL (SPECIFY) ____ 26 (GO TO 331)
OTHER SOURCE
SHOP 31 (GO TO 331)
CHURCH 32 (GO TO 331)
FRIEND/RELATIVE 33 (GO TO 331)
MEDICAL STAFF IN THE NEIGHBORHOOD 34 (GO TO 331)
PARTNER 35 (GO TO 331)
STAND/BOOTH INFORMATION 36 (GO TO 331)
STORE 37 (GO TO 331)
TRADITIONAL HEALER 38 (GO TO 331)
BAR/DISCOTHEQUE 39 (GO TO 331)
ADOLESCENTE SPECIAL SERVICES 40 (GO TO 331)
OTHER (SPECIFY) ____96 (GO TO 331)

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

YES 1
NO 2 (GO TO 331)

330. Where is that?
Any other place?
RECORD ALL PLACES MENTIONED.

IF SOURCE IS HOSPITAL, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE_______
PUBLIC SECTOR
CENTRAL HOSPITAL A
PROVINCIAL/GENERAL HOSPITAL B
RURAL HOSPITAL C
HEALTH CENTER D
MOBILE CLINIC E
OTHER (SPECIFY) ____ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL G
PRIVATE CLINIC H
PRIVATE DOCTOR I
PRIVATE NURSE J
PRIVATE PHARMACY K
OTHER PRIVATE MEDICAL (SPECIFY) ___ L
OTHER SOURCE
SHOP M
CHURCH N
FRIENDS/RELATIVES O
OTHER (SPECIFY) ______ X

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 401)

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

YES 1
NO 2

SECTION 4A. PREGNANCY AND BREASTFEEDING

401. CHECK 224:

ONE OR MORE BIRTHS SINCE JANUARY 1998 (GO TO 402)
NO BIRTHS SINCE JANUARY 1998 (GO TO 487)

402. ENTER THE LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1998 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL QUESTIONNAIRES)

Now I would like to ask you some more questions about the health of all your children born in the past five years. (We will talk about one child at a time).

403. LINE NUMBER FROM QUESTION 212:

LINE NUMBER______
NAME_______

404. FROM QUESTION 216:

ALIVE____ (GO TO 405)
DEAD___ (GO TO 405)

405. At the time you became pregnant with (NAME), did you want to become pregnant then, did you want to wait until later, or did you not want to have any more children at all?

THEN 1 (FOR MOST RECENT BIRTH, GO TO 407; FOR OTHERS, GO TO 425)
LATER 2
NO MORE CHILDREN 3 (FOR MOST RECENT BIRTH, GO TO 407; FOR OTHERS, GO TO 425)

406. How much longer would you like to have waited?
RECORD ANSWER AS GIVEN BY THE INTERVIEWEE.

MONTHS 1 _____
YEARS 2 _____

DOESN'T KNOW 998

407. When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else?
[ASK ONLY FOR MOST RECENT BIRTH]

PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.

HEALTH PROFESSIONAL
DOCTOR A
NURSE B
MIDWIFE C
OTHER PERSON
TRADITIONAL MIDWIFE D
OTHER (SPECIFY) ______X
DID NOT HAVE AN ANTENATAL APPOINTMENT Y (GO TO 415)

407A. Where did you have your antenatal care appointment(s)? Anywhere else?
RECORD ALL PLACES MENTIONED.
[ASK ONLY FOR MOST RECENT BIRTH]

IF SOURCE IS HOSPITAL, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE______
PUBLIC SECTOR
CENTRAL HOSPITAL A
PROVINCIAL/GENERAL HOSPITAL B
RURAL HOSPITAL C
HEALTH CENTER D
MOBILE CLINIC E
OTHER (SPECIFY) ____ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL G
PRIVATE CLINIC H
PRIVATE DOCTOR'S OFFICE I
PRIVATE NURSE J
OTHER PRIVATE MEDICAL (SPECIFY) _____ L
OTHER (SPECIFY) ______ X

408. How many months pregnant were you when you first received antenatal care?
RECORD '00' IF LESS THAN A MONTH OF PREGNANCY.
[ASK ONLY FOR MOST RECENT BIRTH]

MONTHS_____
DOESN'T KNOW 98

409. How many antenatal appointments did you have during this pregnancy?
[ASK ONLY FOR MOST RECENT BIRTH]

NUMBER OF TIMES____
DOESN'T KNOW 98

410. CHECK 409:
NUMBER OF TIMES RECEIVED ANTENATAL CARE
[ASK ONLY FOR MOST RECENT BIRTH]

TWICE OR MORE (GO TO 411)
ONLY ONCE (GO TO 412)

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

MONTHS____
DOESN'T KNOW 98

412. During this pregnancy (NAME's pregnancy), were any of the following done at least once?
[ASK ONLY FOR MOST RECENT BIRTH]

A. Were you weighed?
B. Was the baby's heartbeat listened to?
C. Was your blood pressure measured?
D. Did you give a urine sample?
E. Did you give a blood sample?
F. Was you belly measured?
G. Was your height measured?

WEIGHED
YES 1
NO 2
DOESN'T KNOW/DOESN'T REMEMBER 8
LISTENED TO HEARTBEAT
YES 1
NO 2
DOESN'T KNOW/DOESN'T REMEMBER 8
BLOOD PRESSURE MEASURED
YES 1
NO 2
DOESN'T KNOW/DOESN'T REMEMBER 8
URINE SAMPLE
YES 1
NO 2
DOESN'T KNOW/DOESN'T REMEMBER 8
BLOOD SAMPLE
YES 1
NO 2
DOESN'T KNOW/DOESN'T REMEMBER 8
BELLY MEASURED
YES 1
NO 2
DOESN'T KNOW/DOESN'T REMEMBER 8
HEART MEASURED
YES 1
NO 2
DOESN'T KNOW/DOESN'T REMEMBER 8

413. Were you told about the signs of pregnancy complications during any of your antenatal appointments?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2 (GO TO 414A)
DOESN'T KNOW (GO TO 414A)

414. Were you told where to go if you had these complications?
[ASK ONLY FOR MOST RECENT BIRTH]

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

414A. During (NAME)'s pregnancy, did you receive information about STD's and HIV/AIDS during any of your antenatal appointments?
[ASK ONLY FOR MOST RECENT BIRTH]

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

415. When you were pregnant with (NAME) were you given an injection in the arm to prevent the baby from getting tetanus?
[ASK ONLY FOR MOST RECENT BIRTH]

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

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

NUMBER OF TIMES____
DOESN'T KNOW 8

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

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

418. During the whole pregnancy, for how many days did you take the tablets or syrup?
IF ANSWER IS NOT NUMERIC ASK: How many days or months?
[ASK ONLY FOR MOST RECENT BIRTH]

NUMBER OF DAYS_____
DOESN'T KNOW 998

419. During this pregnancy, did you have:
[ASK ONLY FOR MOST RECENT BIRTH]

A. Swelling of the foot?
B. Cloudy vision?
C. Headaches?
D. Fainting?
E. Vaginal discharge?
F. Painful/burning urination?
G. Bleeding?

SWELLING OF THE FOOT
YES 1
NO 2
DOESN'T KNOW/DOESN'T REMEMBER 8
CLOUDY VISION
YES 1
NO 2
DOESN'T KNOW/DOESN'T REMEMBER 8
HEADACHES
YES 1
NO 2
DOESN'T KNOW/DOESN'T REMEMBER 8
FAINTING
YES 1
NO 2
DOESN'T KNOW/DOESN'T REMEMBER 8
VAGINAL DISCHARGE
YES 1
NO 2
DOESN'T KNOW/DOESN'T REMEMBER 8
PAINFUL/BURNING URINATION
YES 1
NO 2
DOESN'T KNOW/DOESN'T REMEMBER 8
BLEEDING
YES 1
NO 2
DOESN'T KNOW/DOESN'T REMEMBER 8

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

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

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

424. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 425A)
DOESN'T KNOW (GO TO 425A)

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

GRAMS FROM CARD 1 ____
GRAMS FROM RECALL 2 ____

DOESN'T KNOW 99998

425A. Was (NAME) registered in the Office of Vital Records?

YES 1
NO 2
DOESN'T KNOW 8

425B. Who assisted with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.

HEALTH PROFESSIONAL
DOCTOR A
NURSE B
MIDWIFE C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
FRIENDS/RELATIVES E
OTHER (SPECIFY) ______X
NO ONE Y

426. Around the time of the birth of (NAME) did you have any of the following problems:

A. Did your regular contractions last more than 12 hours?
B. Excessive bleeding that was so much that you feared it was life threatening?
C. A high fever with bad smelling vaginal discharge?
D. convulsions not caused by fever?

CONTRACTIONS MORE THAN 12 HOURS
YES 1
NO 2
DOESN'T KNOW/DOESN'T REMEMBER 8
EXCESSIVE BLEEDING
YES 1
NO 2
DOESN'T KNOW/DOESN'T REMEMBER 8
HIGH FEVER AND VAGINAL DISCHARGE
YES 1
NO 2
DOESN'T KNOW/DOESN'T REMEMBER 8
CONVULSIONS
YES 1
NO 2
DOESN'T KNOW/DOESN'T REMEMBER 8

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

IF SOURCE IS HOSPITAL, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

RECORD ALL PLACES MENTIONED.

NAME OF PLACE_________
PUBLIC SECTOR
CENTRAL HOSPITAL 11
PROVINCIAL HOSPITAL 12
HOSPITAL IN RURAL AREA 13
HEALTH CENTER 14
MOBILE CLINIC 15
OTHER (SPECIFY) _____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL 21
PRIVATE CLINIC 22
PRIVATE DOCTOR 23
PRIVATE NURSE 24
PRIVATE PHARMACY 25
OTHER PRIVATE MEDICAL (SPECIFY) _____26
HOME
YOUR HOME 41 (GO TO 429)
TRADITIONAL MIDWIFE'S HOME 42 (GO TO 429)
MIDWIFE/NURSE'S HOME 43 (GO TO 429)
OTHER (SPECIFY) _____96 (GO TO 429)

428. Was (NAME) delivered by natural birth, natural vacuum-assisted vaginal delivery (VE) or caesarean section?

NATURAL BIRTH 1 (FOR MOST RECENT BIRTH, GO TO 433; FOR OTHERS, GO TO 435)

NATURAL VACUUM-ASSISTED DELIVERY 2 (FOR MOST RECENT BIRTH, GO TO 433; FOR OTHERS, GO TO 435)

CAESAREAN SECTION 3 (FOR MOST RECENT BIRTH, GO TO 433; FOR OTHERS, GO TO 435)

429. After (NAME) was born, did a health professional or a traditional birth attendant check on your health?

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

430. How many days or weeks after delivery did the first check take place?
RECORD THE ANSWER IN THE PRECISE GIVEN TIME.
[ASK FOR MOST RECENT BIRTH ONLY]

DAYS AFTER DELIVERY 1_____
WEEKS AFTER DELIVERY 2____

DOESN'T KNOW 998

430A. When you had your post-delivery appointment, did you have any problem related to delivery?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 431)

430B. What type of problem? Any other problem?
RECORD ALL ANSWERS MENTIONED.
[ASK FOR MOST RECENT BIRTH ONLY]

VAGINAL BLEEDING A
FEVER WITH HIGH TEMPERATURE B
VAGINAL DISCHARGE C
VARICOSE VEINS D
OTHER (SPECIFY) _____X

431. Who checked on your health at that time?
[ASK FOR MOST RECENT BIRTH ONLY]

HEALTH PROFESSIONAL
DOCTOR 11
NURSE 12
MIDWIFE 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
OTHER (SPECIFY) _____96

432. Where did the first check take place?
RECORD ALL PLACES MENTIONED.
[ASK FOR MOST RECENT BIRTH ONLY]

IF SOURCE IS HOSPITAL, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE________
PUBLIC SECTOR
CENTRAL HOSPITAL 11
PROVINCIAL HOSPITAL 12
RURAL HOSPITAL 13
HEALTH CENTER 14
MOBILE CLINIC 15
OTHER (SPECIFY) _____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL 21
PRIVATE CLINIC 22
PRIVATE DOCTOR 23
PRIVATE NURSE 24
PRIVATE PHARMACY 25
OTHER PRIVATE MEDICAL (SPECIFY) _____26
HOME
RESPONDENT'S HOME 41
TRADITIONAL MIDWIFE'S HOME 42
MIDWIFE/NURSE'S HOME 43
OTHER (SPECIFY) _____96

433. In the first eight weeks after delivery, did you receive a vitamin A does like this?
SHOW CAPSULE.
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2

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

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

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

YES 1
NO 2 (GO TO 439)

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

MONTHS_____
DOESN'T KNOW 98

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

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

438. Have you resumed sexual relations since the birth of (NAME)?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 440)

439. For how many months after the birth of (NAME) did you not have sexual relations?
IF LESS THAN A MONTH, RECORD '00'.

MONTHS_____
DOESN'T KNOW 98

440. Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 447)

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

IMMEDIATELY 000

HOURS 1_____
DAYS 2_____

442. In the first three days after delivery, before your milk began flowing regularly, was (NAME) given anything to drink other than breast milk?

YES 1
NO 2 (GO TO 444)

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

MILK (OTHER THAN BREAST MILK) A
PLAIN WATER B
SUGAR OR GLUCOSE WATER C
SUGAR WATER SOLUTION D
FRUIT JUICE E
INFANT FORMULA F
TEA G
HONEY H
OTHER (SPECIFY) _____X

444. CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 445)
DEAD (GO TO 446)

445. Are you still breastfeeding (NAME)?

YES 1 (GO TO 448)
NO 2

446. For how many months did you breastfeed (NAME)?
IF LESS THAN A MONTH, RECORD '00'.

MONTHS_____
DOESN'T KNOW 98

447. CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 450)
DEAD (GO BACK TO 405 IN NEXT COLUMN, OR, IF NO MORE BIRTHS, GO TO 454)

448. How many times did you breastfeed since 6 pm yesterday until 6 am today?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

NUMBER OF FEEDINGS____

449. Yesterday, how many times did you breastfeed since 6 am until 6 pm?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

NUMBER OF FEEDINGS____

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

YES 1
NO 2
DOESN'T KNOW 8

451. Was sugar added to any of the foods or liquids that (NAME) ate or drank yesterday?

YES 1
NO 2
DOESN'T KNOW 8

451A. How many times did (NAME) eat solid, semisolid, or soft foods other than liquids yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.

NUMBER OF TIMES______
DOESN'T KNOW 8

452. Now I would like to ask about the liquids (NAME) had during the last seven days including yesterday.

FOR EACH LIQUID, ASK FIRST QUESTION 452A FOR LIQUIDS DRUNK "DURING THE LAST 7 DAYS" AND THEN ASK QUESTION 452B FOR LIQUIDS DRUNK "LAST NIGHT/YESTERDAY".

IF DID NOT HAVE ANY OF THE LIQUIDS MENTIONED BELOW, RECORD '0'. IF HAD A LIQUID 7 OR MORE TIMES, RECORD '7'. IF DOES NOT KNOW, RECORD '8'.

452A: LAST 7 DAYS: How many days during the last seven days did (NAME) drink:
[ASK FOR MOST RECENT BIRTH ONLY]

A. Plain water?
B. Infant formula?
C. Milk (other than breast milk?
D. Fruit juice?
E. Tea (including herbal tea)?
F. Other liquids different from water or milk?

PLAIN WATER
NUMBER OF DAYS___
INFANT FORMULA
NUMBER OF DAYS___
MILK
NUMBER OF DAYS___
FRUIT JUICE
NUMBER OF DAYS___
TEA
NUMBER OF DAYS___
OTHER LIQUIDS
NUMBER OF DAYS___

452B: LAST NIGHT/YESTERDAY: How many times in total during yesterday or last night did (NAME) drink:
[ASK FOR MOST RECENT BIRTH ONLY]

A. Plain water?
B. Infant formula?
C. Milk (other than breast milk?
D. Fruit juice?
E. Tea (including herbal tea)?
F. Other liquids different from water or milk?

PLAIN WATER
NUMBER OF TIMES ___
INFANT FORMULA
NUMBER OF TIMES ___
MILK
NUMBER OF TIMES ___
FRUIT JUICE
NUMBER OF TIMES___
TEA
NUMBER OF TIMES___
OTHER LIQUIDS
NUMBER OF TIMES___

453. Now I would like to ask about the foods (NAME) had during the last seven days including yesterday.

FOR EACH FOOD ASK FIRST QUESTION 453A FOR FOOD CONSUMED "DURING THE LAST 7 DAYS" AND THEN ASK QUESTION 452B FOR FOOD CONSUMED "LAST NIGHT/YESTERDAY".

IF DID NOT HAVE ANY OF THE FOODS MENTIONED BELOW, RECORD '0'. IF CONSUMED ANY OF THE FOODS 7 OR MORE TIMES, RECORD '7'. IF DOES NOT KNOW, RECORD '8'.

453A. LAST 7 DAYS: How many days during the last seven days did (NAME) eat or consume any of the foods separately or in combination:
[ASK ONLY FOR MOST RECENT BIRTH]

A. Rice, corn, sorghum, spaghetti, cookies, rice or corn cake/bread or any other food made out of any other cereal?
B. Carrots, squash, yams?
C. Food made out of roots or tubers (manioc or potatoes)?
D. Dark leafy greens (lettuce, green beans, collard greens, carrot leaves, etc.)?
E. Ripe mango, ripe papaya, etc.?
F. Other fruits and vegetables (bananas, apples, tomatoes, limes, oranges, tangerine, guava, grapes, cauliflower)?
G. Beef, chicken, fish, eggs, (animal giblets such as liver, kidneys, heart)?
H. Beans (red, black, white, brown, lentils, soy)?
I. Cheese, yogurt, cream?
J. Any food made with oil, lard, margarine, peanut butter or sesame seed butter?

RICE CORN, RICE, OR ANY FOOD MADE OF ANY OTHER CEREAL
NUMBER OF DAYS___
CARROTS, SQUASH, YAMS
NUMBER OF DAYS___
ROOTS OR TUBERS
NUMBER OF DAYS___
DARK LEAFY GREENS
NUMBER OF DAYS___
MANGO OR PAPAYA
NUMBER OF DAYS___
OTHER FRUITS OR VEGETABLES
NUMBER OF DAYS___
BEEF, CHICKEN, FISH, EGGS
NUMBER OF DAYS___
BEANS
NUMBER OF DAYS___
CHEESE, YOGURT, CREAM
NUMBER OF DAYS___
FOOD MADE OUT OF OIL, LARD, MARGARINE, PEANUT BUTTER, OR SESAME SEED BUTTER
NUMBER OF DAYS___

453B. LAST NIGHT/YESTERDAY: How many times in total during yesterday or last night did (NAME) eat or consume any of these foods:
[ASK ONLY FOR MOST RECENT BIRTH]

A. Rice, corn, sorghum, spaghetti, cookies, rice or corn cake/bread or any other food made out of any other cereal?
B. Carrots, squash, yams?
C. Food made out of roots or tubers (manioc or potatoes)?
D. Dark leafy greens (lettuce, green beans, collard greens, carrot leaves, etc.)?
E. Ripe mango, ripe papaya, etc.?
F. Other fruits and vegetables (bananas, apples, tomatoes, limes, oranges, tangerine, guava, grapes, cauliflower)?
G. Beef, chicken, fish, eggs, (animal giblets such as liver, kidneys, heart)?
H. Beans (red, black, white, brown, lentils, soy)?
I. Cheese, yogurt, cream?
J. Any food made with oil, lard, margarine, peanut butter or sesame seed butter?

RICE CORN, RICE, OR ANY FOOD MADE OF ANY OTHER CEREAL
NUMBER OF TIMES___
CARROTS, SQUASH, YAMS
NUMBER OF TIMES___
ROOTS OR TUBERS
NUMBER OF TIMES___
DARK LEAFY GREENS
NUMBER OF TIMES___
MANGO OR PAPAYA
NUMBER OF TIMES___
OTHER FRUITS OR VEGETABLES
NUMBER OF TIMES___
BEEF, CHICKEN, FISH, EGGS
NUMBER OF TIMES___
BEANS
NUMBER OF TIMES___
CHEESE, YOGURT, CREAM
NUMBER OF TIMES___
FOOD MADE OUT OF OIL, LARD, MARGARINE, PEANUT BUTTER, OR SESAME SEED BUTTER
NUMBER OF TIMES___

453C. GO BACK TO Q. 405 IN NEXT COLUMN, OR IF NO MORE BIRTHS, GO TO 454.

SECTION 4B. IMMUNIZATION AND HEALTH

454. ENTER LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1998 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS, BEGINNING WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL QUESTIONNAIRES).

455. LINE NUMBER FROM QUESTION 212:

LINE_____
NAME_____

456. CHECK 216:
LIVING OR DEAD?

ALIVE (GO TO 457)
DEATH (GO TO 456 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 484)

457. Did (NAME) receive a vitamin A like this during the last 6 months?
SHOW CAPSULE.

YES 1
NO 2
DOESN'T KNOW 8

458. Do you have the vaccination card of (NAME)?
IF YES: May I see it please?

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

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

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

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

BCG
DAY ____
MONTH ____
YEAR ____
POLIO 0
DAY ____
MONTH ____
YEAR ____
DPT 1
DAY ____
MONTH ____
YEAR ____
POLIO 1
DAY ____
MONTH ____
YEAR ____
DPT 2
DAY ____
MONTH ____
YEAR ____
POLIO 2
DAY ____
MONTH ____
YEAR ____
DPT 3
DAY ____
MONTH ____
YEAR ____
POLIO 3
DAY ____
MONTH ____
YEAR ____
MEASLES
DAY ____
MONTH ____
YEAR ____
VITAMIN A
DAY ____
MONTH ____
YEAR ____

461. Has (NAME) received any vaccinations that are not recorded on this card?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0, POLIO 1-3, DPT 1-3 MEASLES AND/OR HEPATITIS B VACCINE(S).

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

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

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

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

463A. A BCG vaccination against tuberculosis, that is, an injection in the arm that leaves a scar?

YES 1
NO 2
DOESN'T KNOW 8

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

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

463C. When was the first polio vaccine given, just after birth or later?

JUST AFTER BIRTH 1
LATER 2

463D. How many times?

NUMBER OF TIMES____
DOESN'T KNOW 8

463E. DPT (triplex) vaccination, that is, an injection usually given at the same time as polio drops?

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

463F. How many times?

NUMBER OF TIMES____
DOESN'T KNOW 8

463G. A MEASLES vaccine, that is, an injection in the arm to prevent measles?

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2 (GO TO 467)
DOESN'T KNOW 8 (GO TO 467)

465A. Does (NAME) have a fever now?

YES 1
NO 2
DOESN'T KNOW 8

466. Now I would like to know what you did once you noticed that (NAME) had a fever:

466A1. What was the first thing you did?

GAVE (NAME) HOME REMEDY 01
WENT TO THE PHARMACY TO BUY MEDICINE WITHOUT PRESCRIPTION 02
TOOK (NAME) TO A HEALTH CENTER 03
TOOK (NAME) TO A COMMUNITY HEALTH WORKER 04
TOOK (NAME) TO A TRADITIONAL HEALER 05
GAVE (NAME) NATURAL HERBS AT HOME 06
OTHER (SPECIFY) ____ 96
DID NOT DO ANYTHING 07
DOESN'T KNOW 98

466A2. What was the second thing you did?

GAVE (NAME) HOME REMEDY 01
WENT TO THE PHARMACY TO BUY MEDICINE WITHOUT PRESCRIPTION 02
TOOK (NAME) TO A HEALTH CENTER 03
TOOK (NAME) TO A COMMUNITY HEALTH WORKER 04
TOOK (NAME) TO A TRADITIONAL HEALER 05
GAVE (NAME) NATURAL HERBS AT HOME 06
OTHER (SPECIFY) ____ 96
DID NOT DO ANYTHING 07
DOESN'T KNOW 98

466A3. What was the third thing you did?

GAVE (NAME) HOME REMEDY 01
WENT TO THE PHARMACY TO BUY MEDICINE WITHOUT PRESCRIPTION 02
TOOK (NAME) TO A HEALTH CENTER 03
TOOK (NAME) TO A COMMUNITY HEALTH WORKER 04
TOOK (NAME) TO A TRADITIONAL HEALER 05
GAVE (NAME) NATURAL HERBS AT HOME 06
OTHER (SPECIFY) ____ 96
DID NOT DO ANYTHING 07
DOESN'T KNOW 98

466B. CHECK 466A1, 466A2 AND 466A3:
HOME REMEDIES OR DRUGS FROM PHARMACY WITHOUT PRESCRIPTION.

CODE '01' OR '02' IN 466 (GO TO 466C1)
OTHER ANSWER IN 466 (GO TO 467)

466C1. For the following drugs please tell me if (NAME) took any of them immediately after having fever or how many days after:

A. Chloroquine?
B. Fansidar (sulfadoxine and pyrimethamine)?
C. Quinine?

TYPE OF DRUG:

CHLOROQUINE A
FANSIDAR B
QUININE C

HOW MANY DAYS AFTER FEVER:

CHLOROQUINE
SAME DAY 1
ONE DAY AFTER 2
TWO DAYS AFTER 3
THREE OR MORE DAYS AFTER 4
FANSIDAR
SAME DAY 1
ONE DAY AFTER 2
TWO DAYS AFTER 3
THREE OR MORE DAYS AFTER 4
QUININE
SAME DAY 1
ONE DAY AFTER 2
TWO DAYS AFTER 3
THREE OR MORE DAYS AFTER 4

466C2. Any other medicine/drugs?
CIRCLE ALL ANSWERS MENTIONED.

ASPIRIN D
PARACETAMOL/ACETAMINOPHEN E
OTHER (SPECIFY) _______X
NONE Z

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

YES 1 (GO TO 468)
NO 2
DOESN'T KNOW 8

467A. CHECK 464:
HAD FEVER?

YES (GO TO 470B)
NO (GO TO 475)

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2 (GO TO 475)

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

YES 1
NO 2 (GO TO 475)

471. Where did you seek advice or treatment? Anywhere else?
RECORD ALL PLACES MENTIONED.

IF SOURCE IS HOSPITAL, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE_____
PUBLIC SECTOR
CENTRAL HOSPITAL A
PROVINCIAL HOSPITAL B
RURAL HOSPITAL C
HEALTH CENTER D
MOBILE CLINIC E
OTHER (SPECIFY) _____ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL G
PRIVATE CLINIC H
PRIVATE DOCTOR I
PRIVATE NURSE J
PRIVATE PHARMACY K
OTHER PRIVATE MEDICAL (SPECIFY) _____ L
OTHER SOURCE
SHOP M
CHURCH N
TRADITIONAL HEALER O
OTHER (SPECIFY) ______ X

475. Has (NAME) has diarrhea in the last two weeks?

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

475A. Was there any blood in the stools?

YES 1
NO 2
DOESN'T KNOW 8

475B. On the worst day of the diarrhea, how many bowel movements did (NAME) have?

NUMBER OF TIMES _____
DOESN'T KNOW 98

476. Was he/she given the same amount to drink as before the diarrhea, or more, or less?
IF GIVEN LESS LIQUID THAN NORMAL, ASK: Was s/he given much less than usual or somewhat less?

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

477. Was he/she given the same amount of food to eat as before the diarrhea, or more, or less?
IF LESS, PROBE: Was she/he given much less than usual to eat or somewhat less?

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

477A: CHECK 445:
STILL BREASTFEEDING?

YES (GO TO 477B)
NO (GO TO 478)

477B. When (NAME) had diarrhea, did you continue breastfeeding him/her?

YES 1
NO 2

478. When (NAME) had diarrhea, was he/she given any of the following to drink:

A. A fluid called 'Mixture' (salts ORS)?
B. Homemade sugar-salt-water solution?

ORS SOLUTION
YES 1
NO 2
DOESN'T KNOW 8
HOMEMADE SUGAR-SALT WATER SOLUTION
YES 1
NO 2
DOESN'T KNOW 8

479. Was anything (else) given to treat the diarrhea?

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

480. What was given to treat the diarrhea? Anything else?
RECORD ALL MENTIONED.

PILLS OR SYRUP A
INJECTIONS B
(I.V) INTRAVENOUS C
THIN WATERY GRUEL MADE FROM RICE D
ANY FOOD MADE FROM CEREALS E
HERBAL TEA F
POWDERED/FRESH MILK G
TEA, FRUIT JUICE OR COCONUT WATER H
HOME REMEDIES/HERBAL MEDICINES I
OTHER (SPECIFY) ______ X

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

YES 1
NO 2 (GO TO 483)

482. Where did you seek advice or treatment? Anywhere else?
RECORD ALL MENTIONED.

IF SOURCE IS HOSPITAL, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE______
PUBLIC SECTOR
CENTRAL HOSPITAL A
PROVINCIAL/GENERAL HOSPITAL B
HOSPITAL IN RURAL AREA C
HEALTH CENTER D
MOBILE CLINIC E
OTHER (SPECIFY) _____ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL G
PRIVATE CLINIC H
PRIVATE DOCTOR I
PRIVATE NURSE J
PRIVATE PHARMACY K
OTHER PRIVATE MEDICAL (SPECIFY) _____ L
OTHER SOURCE
SHOP M
CHURCH N
TRADITIONAL HEALER O
OTHER (SPECIFY) ______ X

483. GO BACK TO 456 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 484.

484. CHECK 215 AND 218:
NUMBER OF CHILDREN BORN SINCE JANUARY 1998 OR LATER LIVING WITH THE RESPONDENT?

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

485. What is usually done to dispose of your (youngest) child's stools when she/he does not use the latrine?

CHILD ALWAYS USE TOILET/LATRINE 01
THROW IN THE TOILET/LATRINE 02
THROW IN THE GARBAGE CAN 03
THROW OUTSIDE THE YARD 04
BURY IN THE YARD 05
STAYS THERE/NOT DISPOSED OF 06
USE DIAPERS 07
OTHER (SPECIFY) ____ 96

486. CHECK 478A, ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 487)
ANY CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 488)

487. Have you ever heard of a special product called Oral Rehydration Salts or oral mixture you can get for the treatment of diarrhea?

YES 1
NO 2

488. CHECK 218:

HAS ONE OR MORE CHILDREN LIVING WITH HER (GO 488A)
HAS NO CHILDREN LIVING WITH HER (GO TO 489)

488A. When (your child/one of your children) is seriously ill, can you decide by yourself whether or not the child should be taken for medical treatment?

IF SAYS NO CHILD EVER SERIOUSLY ILL, ASK: If (your child/one of your children) became seriously ill, could you decide by yourself whether or not the child should be taken for medical treatment?

YES 1
NO 2
DEPENDS 3

489. 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?

A. Knowing where to go?
B. Getting permission to go?
C. Getting money needed for treatment?
D. The distance to the health facility?
E. Having to take transport?
F. Not wanting to go alone?
G. Concern that there may not be a female health provider?

KNOWING WHERE TO GO
BIG PROBLEM 1
NOT A BIG PROBLEM 2
GETTING PERMISSION TO GO
BIG PROBLEM 1
NOT A BIG PROBLEM 2
GETTING NECESSARY MONEY
BIG PROBLEM 1
NOT A BIG PROBLEM 2
DISTANCE TO FACILITY
BIG PROBLEM 1
NOT A BIG PROBLEM 2
TAKING TRANSPORT
BIG PROBLEM 1
NOT A BIG PROBLEM 2
NOT WANTING TO GO ALONE
BIG PROBLEM 1
NOT A BIG PROBLEM 2
CONCERN OF NO FEMALE HEALTH PROVIDER
BIG PROBLEM 1
NOT A BIG PROBLEM 2

490A. When a child is sick with fever, what signs of illness would tell you that he or she should be taken to a health facility or health worker? Any other signs/symptoms?
CIRCLE ALL ANSWERS MENTIONED.

HIGH TEMPERATURE FEVER A
CHILD DOES NOT EAT/DRINK/NURSE B
WEAKNESS/VERY ILL C
CONVULSIONS D
WHITE HAND/PALM E
OTHER (SPECIFY) _____ X
DOESN'T KNOW Z

490B. When a child has diarrhea, should he/she be given less to drink than usual, about the same amount, or more than usual?

LESS TO DRINK 1
ABOUT THE SAME AMOUNT 2
MORE TO DRINK 3
DOESN'T KNOW 8

490C. When a child has diarrhea, should he/she be given less to eat than usual, about the same amount, or more than usual?

LESS TO EAT 1
ABOUT THE SAME AMOUNT 2
MORE TO EAT 3
DOESN'T KNOW 8

490D. When a child is sick with diarrhea, what signs of illness would tell you that he or she should be taken to a health facility or health worker? Any other signs/symptoms?
RECORD ALL MENTIONED.

REPEATED WATERY STOOLS A
ANY WATERY STOOLS B
REPEATED VOMITING C
ANY VOMITING D
BLOOD IN STOOLS E
FEVER F
MARKED THIRST G
NOT EATING/NOT DRINKING WELL H
GETTING SICKER/VERY SICK I
AGITATED/ IRRITABLE J
OTHER (SPECIFY) ______ X
DOESN'T KNOW Z

490E. When a child is sick with a cough, what signs of illness would tell you that he or she should be taken to a health facility or health worker? Any other signs/symptoms?
RECORD ALL MENTIONED.

RAPID BREATHING A
DIFFICULTY BREATHING B
NOISY BREATHING C
FEVER D
UNABLE TO DRINK/TO NURSE E
NOT EATING/NOT DRINKING WELL F
GETTING SICKER/VERY SICK G
NOT GETTING BETTER H
CONVULSIONS I
NOISY BREATHING J
VERY SKINNY CHILD K
OTHER (SPECIFY) ______ X
DOESN'T KNOW Z

491. Do you sleep under a hammock/bed net?

YES 1
NO 2 (GO TO 496)

492. How long have you been using the hammock/bed net?
IF LESS THAN 1 MONTH, RECORD '00'. RECORD IN MONTHS IF 3 YEARS OR LESS.

MONTHS_____
MORE THAN 3 YEARS 95
DOESN'T REMEMBER 98

493. Has the hammock/bed net been immersed in mosquito repellent liquid?

YES 1
NO 2 (GO TO 495)
DOESN'T KNOW 8 (GO TO 495)

494. How long ago was the hammock/bed net immersed in mosquito repellent liquid?
IF LESS THAN 1 MONTH, RECORD '00'. RECORD IN MONTHS IF 3 YEARS OR LESS.

MONTHS_____
MORE THAN 3 YEARS 95
DOESN'T REMEMBER 98

495. Did you sleep under a hammock/bed net last night?

YES 1
NO 2

495A. Besides sleeping under a hammock/bed net what other methods do you use to prevent mosquito bites?

FUMIGATION WITH PESTICIDES 1
PLANTS/HERBS 2
NO METHOD 3
OTHER (SPECIFY) ______6

496. Do you currently smoke cigarettes or tobacco?
IF YES: What type of tobacco do you smoke?
CIRCLE ALL TYPES MENTIONED

YES, CIGARETTES A
YES, PIPE B
YES, OTHER TOBACCO C
NO Y (GO TO 407)

496A. CHECK 496:

CODE 'A' CIRCLED (GO TO 496B)
CODE 'A' NOT CIRCLED (GO TO 497)

496B. In the last 24 hours, how many cigarettes did you smoke?

CIGARETTES______

497. Have you ever consumed an alcoholic beverage?

YES 1
NO 2 (GO TO 500)

497A. In the last three months, how many days did you consume alcohol?
IF ANSWER IS 'EVERYDAY', RECORD '90'.

NUMBER OF DAYS___
NEVER 95

498. Have you ever been drunk?

YES 1
NO 2 (GO TO 500)

498A. CHECK 497A:

CONSUMED ALCOHOL AT LEAST ONCE (GO TO 499)
NEVER CONSUMED ALCOHOL (GO TO 500)

499. In the last three months, how many times did you get drunk?

NUMBER OF TIMES______
NEVER 95

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

500. PRESENCE OF OTHERS AT THIS POINT:
RECORD ALL ANSWERS.

CHILDREN UNDER 10
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
HUSBAND/PARTNER
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

501. Are you currently married or living with a man?

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

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

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

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

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

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

LIVES WITH HER 1
STAYING ELSEWHERE 2

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

NAME_________
LINE NUMBER________

507. Does your husband/partner have any other wives besides yourself?

YES 1
NO 2 (GO TO 510)
DOESN'T KNOW 8 (GO TO 510)

508. How many other wives does he have?

NUMBER_____
DOESN'T KNOW 98 (GO TO 510)

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

RANK ____

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

ONCE 1
MORE THAN ONCE 2

511. CHECK 510:

MARRIED/LIVED WITH A MAN ONLY ONCE: In what month and year did you start living with your husband/partner?

MARRIED/LIVED WITH A MAN MORE THAN ONCE: Now we will talk about your first husband/partner. In what month and year did you start living with your husband/partner?

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

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

AGE_______

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

514. How old were you when you first had sexual intercourse (if ever)?

NEVER 00 (GO TO 524)
AGE IN YEARS _____
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95

514A. CHECK 106 IF WOMAN HAS BETWEEN 15-24 YEARS OF AGE:

SHE IS BETWEEN 15-24 YEARS OF AGE (GO TO 514B)
SHE IS BETWEEN 25-49 YEARS OF AGE (GO TO 515)

514B. The first time you had sexual intercourse, was a condom used?

YES 1
NO 2

515. When was the last time you had sexual intercourse?
IF ANSWER IS LESS THAN 12 MONTHS, RECORD IN MONTHS. IF 12 OR MORE MONTHS, RECORD IN YEARS. IF SEXUAL INTERCOURSE HAPPENED THAT DAY, RECORD '00'.

DAYS AGO 1____
WEEKS AGO 2___
MONTHS AGO 3____
YEARS AGO 4_____ (GO TO 524)

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

YES 1
NO 2 (GO TO 517)

516A. What was the main reason you or your partner used a condom?

WANTED TO PREVENT FROM STD/AIDS 01
WANTED TO AVOID PREGNANCY 02
WANTED TO PREVENT OR AVOID PREGNANCY AND STD/AIDS 03
DID NOT TRUST PARTNER/ FELT THAT PARTNER HAD OTHER SEXUAL PARTNERS 04
PARTNER ASK/INSISTED IN USING IT 05
OTHER (SPECIFY) _____96
DOESN'T KNOW 98

517. What is your relationship to the man with whom you last had sex?
IF MAN IS 'BOYFRIEND' OR 'FIANC?', ASK: Was your boyfriend/fianc? living with you when you last had sex?
IF YES, CIRCLE '01', IF NO, CIRCLE '03'

SPOUSE/COHABITING PARTNER 01 (GO TO 519)
EX-SPOUSE/EX-COHABITING PARTNER 02
BOYFRIEND/FIANC? 03
FRIEND/OCCASIONAL PARTNER 04
RELATIVE 05
CLIENT 06
OTHER (SPECIFY) _____96

517A. CHECK 106:
WOMAN IS 15-19 YEARS OF AGE?

15-19 YEARS OF AGE (GO TO 517B)
20-49 YEARS OF AGE (GO TO 518)

517B. In your last sexual relation, was the man younger, about the same age, or older than you?
IF OLDER: Do you think he was less or more than 10 years older?

YOUNGER 1
ABOUT THE SAME AGE 2
LESS THAN 10 YEARS OLDER 3
MORE THAN 10 YEARS OLDER 4
OLDER, BUT AGE IS UNKNOWN 5
DOESN'T KNOW 8

518. For how long have you had sexual relations with this man?
IF ANSWER IS LESS THAN 12 MONTHS, RECORD IN MONTHS/WEEKS OR DAYS. IF 12 OR MORE MONTHS, RECORD IN YEARS. IF SEXUAL INTERCOURSE WITH THAT MAN HAPPENED ONCE, RECORD '01' IN DAYS.

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

519. Have you had sex with any other man in the last 12 months?

YES 1
NO 2 (GO TO 524)

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

YES 1
NO 2 (GO TO 521)

520A. What was the main reason you or your partner used a condom?

WANTED TO PREVENT FROM STD/AIDS 01
WANTED TO AVOID PREGNANCY 02
WANTED TO PREVENT OR AVOID PREGNANCY AND STD/AIDS 03
DID NOT TRUST PARTNER/ FELT THAT PARTNER HAD OTHER SEXUAL PARTNERS 04
PARTNER ASK/INSISTED IN USING IT 05
OTHER (SPECIFY) _____96
DOESN'T KNOW 98

521. What is (was) your relationship to that man with whom you had sex?
IF MAN IS 'BOYFRIEND' OR 'FIANC?', ASK: Was your boyfriend/fianc? living with you when you last had sex?

IF YES, CIRCLE '01', IF NO, CIRCLE '03'.

SPOUSE/COHABITING PARTNER 01 (GO TO 522A)
EX-SPOUSE/EX-COHABITING PARTNER 02
BOYFRIEND/FIANC? 03
FRIEND/OCCASIONAL PARTNER 04
RELATIVE 05
CLIENT 06
OTHER (SPECIFY) _____96

521A. CHECK 517A:
WOMAN IS 15-19 YEARS OF AGE?

15-19 YEARS OF AGE (GO TO 521B)
20-49 YEARS OF AGE (GO TO 522)

521B. In your last sexual relation, was the man younger, about the same age, or older than you?
IF OLDER: Do you think he was less or more than 10 years older?

YOUNGER 1
ABOUT THE SAME AGE 2
LESS THAN 10 YEARS OLDER 3
MORE THAN 10 YEARS OLDER 4
OLDER, BUT AGE IS UNKNOWN 5
DOESN'T KNOW 8

522. For how long have you had sexual relations with this other man?
IF ANSWER IS LESS THAN 12 MONTHS, RECORD IN MONTHS/WEEKS OR DAYS. IF 12 OR MORE MONTHS, RECORD IN YEARS. IF SEXUAL INTERCOURSE WITH THAT MAN HAPPENED ONCE, RECORD '01' IN DAYS.

DAYS 1____
WEEKS 2___
MONTHS 3____
YEARS 4_____

522A. Besides these two men, have you had sex with any other man in the last 12 months?

YES 1
NO 2 (GO TO 524)

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

YES 1
NO 2 (GO TO 522D)

522C. What was the main reason you or your partner used a condom?

WANTED TO PREVENT FROM STD/AIDS 01
WANTED TO AVOID PREGNANCY 02
WANTED TO PREVENT OR AVOID PREGNANCY AND STD/AIDS 03
DID NOT TRUST PARTNER/ FELT THAT PARTNER HAD OTHER SEXUAL PARTNERS 04
PARTNER ASK/INSISTED IN USING IT 05
OTHER (SPECIFY) _____96
DOESN'T KNOW 98

522D. What is your relationship to that (third) man with whom you had sex?
IF MAN IS 'BOYFRIEND' OR 'FIANC?', ASK: Was your boyfriend/fianc? living with you when you last had sex?

IF YES, CIRCLE '01', IF NO, CIRCLE '03'.

SPOUSE/COHABITING PARTNER 01 (GO TO 523)
EX-SPOUSE/EX-COHABITING PARTNER 02
BOYFRIEND/FIANC? 03
FRIEND/OCCASIONAL PARTNER 04
RELATIVE 05
CLIENT 06
OTHER (SPECIFY) _____96

522E. CHECK 517A:
WOMAN IS 15-19 YEARS OF AGE?

15-19 YEARS OF AGE (GO TO 522F)
20-49 YEARS OF AGE (GO TO 522G)

522F. In your last sexual relation, was the man younger, about the same age, or older than you?
IF OLDER: Do you think he was less or more than 10 years older?

YOUNGER 1
ABOUT THE SAME AGE 2
LESS THAN 10 YEARS OLDER 3
MORE THAN 10 YEARS OLDER 4
OLDER, BUT AGE IS UNKNOWN 5
DOESN'T KNOW 8

522G. For how long have you had sexual relations with this man?
IF ANSWER IS LESS THAN 12 MONTHS, RECORD IN MONTHS/WEEKS OR DAYS. IF 12 OR MORE MONTHS, RECORD IN YEARS. IF SEXUAL INTERCOURSE WITH THAT MAN HAPPENED ONCE, RECORD '01' IN DAYS.

DAYS 1____
WEEKS 2___
MONTHS 3____
YEARS 4_____

523. In the last 12 months, with how many men did you have sexual intercourse?

NUMBER OF PARTNERS_____

524. Do you know of a place where you can get condoms (for purchase or for free)?

YES 1
NO 2 (GO TO 601)

525. Where is that?
Any other place?
RECORD ALL SOURCES MENTIONED.

IF SOURCE IS HOSPITAL, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE____
PUBLIC SECTOR
CENTRAL HOSPITAL A
PROVINCIAL/GENERAL HOSPITAL B
RURAL HOSPITAL C
HEALTH CENTER D
MOBILE CLINIC E
OTHER (SPECIFY) _____ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL G
PRIVATE CLINIC H
PRIVATE DOCTOR I
PRIVATE NURSE J
PRIVATE PHARMACY K
OTHER PRIVATE MEDICAL (SPECIFY) _____ L
OTHER SOURCE
SHOP M
CHURCH N
MEDICAL STAFF IN THE NEIGHBORHOOD O
STAND/BOOTH INFORMATION P
STORE Q
BAR/DISCOTHEQUE R
ADOLESCENTE SPECIAL SERVICES S
OTHER (SPECIFY) ____X

526. If you wanted to acquire condoms, would it be difficult?

YES 1
NO 2 (GO TO 601)

526A. What would the difficulty be? Anything else?
CIRCLE ALL ANSWERS MENTIONED.

DISTANCE A
SHAME B
INSUFFICIENT QUANTITY C
LACK OF MONEY D
OTHER (SPECIFY) ______ X

SECTION 6. FERTILITY PREFERENCES

601. CHECK 311 AND 311A:
IS RESPONDENT OR SPOUSE/PARTNER STERILIZED?

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

602. CHECK 226:

NOT PREGNANT OR UNSURE: 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?

PREGNANT: 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 not to have any more children?

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

603. CHECK 602:

NOT PREGNANT OR UNSURE: How long would you like to wait from now before the birth of (a/another) child?

PREGNANT: After the child you are expecting now, how long would you like to wait from now before the birth of another child?

MONTHS 1 ____
YEARS 2 ____

NOW 993 (GO TO 609)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 614)
AFTER MARRIAGE 995 (GO TO 609)
OTHER (SPECIFY) _____996 (GO TO 609)
DOESN'T KNOW 998 (GO TO 609)

604. CHECK 602:

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

605. CHECK 310:
USING A METHOD?

NOT ASKED (GO TO 606)
NOT CURRENTLY USING (GO TO 606)
CURRENTLY USING (GO TO 608)

606. CHECK 603:

NOT ASKED/ 24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 607)
00-23 MONTHS OR 00-02 YEARS (GO TO 610)

607. CHECK 602:

WANTS TO HAVE A/ANOTHER CHILD (OR RESPONSE TO 602 IS '1') You have said that you do not want (a/another) child soon, but you are not using any method to avoid pregnancy. Can you tell me why? Any other reason?

WANTS NO MORE/NONE: You have said that you do not want any (more) children, but you are not using any method to avoid pregnancy. Can you tell me why? Any other reason?

RECORD ALL REASONS MENTIONED.

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

608. In the next few weeks, if you discovered that you were pregnant, would that be a big problem, a small problem or no problem for you?

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

609. CHECK 310:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 610)
NO, NOT CURRENTLY USING (GO TO 610)
YES, CURRENTLY USING (GO TO 614)

610. Do you think you will use a method to delay or avoid pregnancy any time in the future?

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

611. Which method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 614)
MALE STERILIZATION 02 (GO TO 614)
PILL 03 (GO TO 614)
IUD 04 (GO TO 614)
INJECTABLES 05 (GO TO 614)
CONDOM 06 (GO TO 614)
DIAPHRAGM 07 (GO TO 614)
FOAM/JELLY 08 (GO TO 614)
LACTATIONAL AMEN. METHOD 09 (GO TO 614)
PERIODIC ABSTINENCE 10 (GO TO 614)
WITHDRAWAL 11 (GO TO 614)
OTHER METHODS (SPECIFY) ______ 96 (GO TO 614)
UNSURE 98 (GO TO 614)

612. What is the main reason that you think you will not use a method?

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX 22 (GO TO 614)
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 614)
INFECUND/STERILE 24 (GO TO 614)
WANTS MORE CHILDREN 25 (GO TO 614)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 614)
HUSBAND OPPOSED 32 (GO TO 614)
OTHERS OPPOSED 33 (GO TO 614)
RELIGIOUS PROHIBITION 34 (GO TO 614)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 614)
KNOWS NO SOURCE 42 (GO TO 614)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 614)
SIDE EFFECTS 52 (GO TO 614)
LACK OF ACCESS/TOO FAR 53 (GO TO 614)
COSTS TOO MUCH 54 (GO TO 614)
INCONVENIENT TO USE 55 (GO TO 614)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 614)
OTHER (SPECIFY) ______96 (GO TO 614)
DOESN'T KNOW 98 (GO TO 614)

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

YES 1
NO 2
DOESN'T KNOW 8

614. CHECK 216:

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

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

PROBE FOR A NUMERIC RESPONSE.

NONE 00 (GO TO 616)
NUMBER____
OTHER (SPECIFY) ______96 (GO TO 616)

615. How many of these children would you like to be boys, how many would you like to be girls and for how many would it not matter?

NUMBER OF BOYS____
NUMBER OF GIRLS ____
NUMBER OF EITHER GENDER ____
OTHER (SPECIFY) ____96

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

APPROVE 1
DISAPPROVE 2
NO OPINION/DOESN'T KNOW 3

617. Is it acceptable or not acceptable to you that the information on family planning is provided:

A. On the radio?
B. On the television?
C. In a newspaper or magazine?

RADIO
ACCEPTABLE 1
NOT ACCEPTABLE 2
DOESN'T KNOW 8
TELEVISION
ACCEPTABLE 1
NOT ACCEPTABLE 2
DOESN'T KNOW 8
NEWSPAPER OR MAGAZINE
ACCEPTABLE 1
NOT ACCEPTABLE 2
DOESN'T KNOW 8

618. In the last 6 months have you heard about family planning:

A. On the radio?
B. On the television?
C. In a newspaper or magazine?
D. From a poster?
E. From leaflets or brochures?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER OR MAGAZINE
YES 1
NO 2
POSTER
YES 1
NO 2
LEAFLETS OR BROCHURES
YES 1
NO 2

619. In the last 6 months, have you discussed the practice of family planning with your female friends, neighbors, or relatives?

YES 1
NO 2 (GO TO 621)

620. With whom? Anyone else?
RECORD ALL MENTIONED.

HUSBAND/PARTNER A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
AUNT/UNCLE F
DAUGHTER G
MOTHER-IN-LAW H
MEDICAL STAFF I
DOCTOR J
TEACHER/PROFESSOR K
FRIENDS/NEIGHBORS L
PRIEST M
OTHER (SPECIFY) ______X

621. CHECK 501:

YES, CURRENTLY MARRIED (GO TO 622)
YES, LIVING WITH A MAN (GO TO 622)
NO, NOT IN UNION (GO TO 628)

622. CHECK 311 AND 311A:

ANY CODE CIRCLED (GO TO 623)
NO CODE CIRCLED (GO TO 624)

623. You have told me that you are currently using contraception. 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

Now I want to ask you about your husband's/partner's views on family planning:

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

APPROVES 1
DISAPPROVES 2
DOESN'T KNOW 8

625. How often have you talked to your husband/partner about family planning in the past year?

NEVER 1
ONCE OR TWICE 2
FREQUENTLY 3

626. CHECK 311/311A:
RESPONDENT AND/OR SPOUSE/PARTNER STERILIZED?

NEITHER STERILIZED (GO TO 627)
HE OR SHE STERILIZED (GO TO 628)

627. Do you think your husband/partner wants 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
DOESN'T KNOW 8

628. Husbands and wives do not always agree on everything. Please tell me if you think a wife is justified in refusing to have sex with her husband when:

A. She has recently given birth?
B. She is tired or not in the mood?
C. She knows her husband has sex with other women?
D. She knows her husband has a sexually transmitted disease?

RECENTLY GAVE BIRTH
YES 1
NO 2
DOESN'T KNOW 8
TIRED OR NOT IN THE MOOD
YES 1
NO 2
DOESN'T KNOW 8
HUSBAND HAS SEX WITH OTHER WOMEN
YES 1
NO 2
DOESN'T KNOW 8
HUSBAND HAS SEXUALLY TRANSMITTED DISEASE
YES 1
NO 2
DOESN'T KNOW 8

629. When a wife knows that her husband/partner has a sexually transmitted disease, do you think it is appropriate for her to ask her husband/partner to use a condom?

YES 1
NO 2
DOESN'T KNOW 8

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

701. CHECK 501 AND 502:

CURRENTLY MARRIED/LIVING WITH A MAN (501 IS '1' OR '2') (GO TO 702)
FORMERLY MARRIED/LIVED WITH A MAN (502 IS '1' OR '2') (GO TO 703)
NEVER MARRIED AND NEVER IN UNION/SINGLE (502 IS '3') (GO TO 707)

702. How old is your husband/partner?

AGE____

703. Did your (last) husband/partner ever attend school?

YES 1
NO 2 (GO TO 706)

704. What was the highest level of school he attended?

LITERACY 00
PRIMARY EP1 01
PRIMARY EP2 02
SECONDARY ESG1 03
SECONDARY ESG2 04
TECHNICAL ELEMENTARY 05
TECHNICAL BASIC 06
TECHNICAL ADVANCED 07
TEACHER PREP 08
HIGHER 09
DOESN'T KNOW 98 (GO TO 706)

705. What was the highest grade he completed at that level?

GRADE_____
DOESN'T KNOW 98

706. CHECK 701:

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

FORMERLY MARRIED/LIVED WITH A MAN: What was your (last) husband's/partner's occupation? That is, what kind of work did he mainly do?

OCCUPATION_____

706A. CHECK 706:

WORKS/WORKED IN AGRICULTURE (GO TO 706B)
DOES/DID NOT WORK IN AGRICULTURE (GO TO 707)

706B. Does/did your husband/partner work mainly on his own land, on family land, or does/did he rent land, or does/did he work on someone else's land?

HIS LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4

707. Aside from your housework, are you currently working?

YES 1 (GO TO 710)
NO 2

708. As you know, some women take up jobs for which they are paid in cash or kind. Others sell thing, have a small business or work on the family farm or in the family business. During the past seven days, have you done any of these things or any other work?

YES 1 (GO TO 710)
NO 2

709. Have you done any work in the last 12 months?

YES 1
NO 2 (GO TO 719)

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

OCCUPATION______

711. CHECK 710:

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

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

OWN LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4

713. Who do you work for?

GOVERNMENT 01
PUBLIC SECTOR 02
PRIVATE SECTOR 03
OWN BUSINESS 04
FOR FAMILY MEMBERS 05
FOR SOMEONE ELSE 06
OTHER BUSINESS 07
COOPERATIVE 08
OTHER (SPECIFY) _____ 96

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

HOME 1
AWAY 2

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

THROUGHOUT THE YEAR 1 (GO TO 715C)
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3 (GO TO 715B)

715A. During the last 12 months, how many months did you work?

NUMBER OF MONTHS _____ (GO TO 715C)

715B. During the last 30 days, how many days did you work?

NUMBER OF DAYS____ (GO TO 716)

715C. During the last 12 months, approximately how many days on average did you work each week?

NUMBER OF DAYS___

716. Are you paid or do you earn 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 (GO TO 719)
NOT PAID 4 (GO TO 719)

717. CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN: Usually who mainly decides how the money you earn will be used: you, your husband/partner, you and your husband/partner jointly, someone else or you and someone else jointly?

NEVER MARRIED AND NEVER IN UNION/SINGLE: Usually who mainly decides how the money you earn will be used: you, someone else or you and someone else jointly?

RESPONDENT DECIDES 1
HUSBAND/PARTNER DECIDES 2
JOINTLY WITH HUSBAND/PARTNER 3
SOMEONE ELSE DECIDES 4
JOINTLY WITH SOMEONE ELSE 5

718. On average, how much of your household's expenditures do your earnings pay for: almost none, less than half, about half, more than half, or all?

ALMOST NONE 1
LESS THAN HALF 2
ABOUT HALF 3
MORE THAN HALF 4
ALL 5
NONE, HER INCOME IS ALL SAVED 6

719. Who in your family usually has the final say on the following decisions:

A. Your own health care?
B. Making large household purchases?
C. Making household purchases for daily needs?
D. Visits to family or relatives?
E. What food you should cook every day?

OWN HEALTH CARE
RESPONDENT 1
HUSBAND/PARTNER 2
JOINTLY WITH HUSBAND/PARTNER 3
SOMEONE ELSE 4
JOINTLY WITH SOMEONE ELSE 5
DECISION NOT MADE 6
LARGE HOUSEHOLD PURCHASES
RESPONDENT 1
HUSBAND/PARTNER 2
JOINTLY WITH HUSBAND/PARTNER 3
SOMEONE ELSE 4
JOINTLY WITH SOMEONE ELSE 5
DECISION NOT MADE 6
DAILY NEED PURCHASES
RESPONDENT 1
HUSBAND/PARTNER 2
JOINTLY WITH HUSBAND/PARTNER 3
SOMEONE ELSE 4
JOINTLY WITH SOMEONE ELSE 5
DECISION NOT MADE 6
VISITS TO FAMILY OR RELATIVES
RESPONDENT 1
HUSBAND/PARTNER 2
JOINTLY WITH HUSBAND/PARTNER 3
SOMEONE ELSE 4
JOINTLY WITH SOMEONE ELSE 5
DECISION NOT MADE 6
FOOD COOKED EVERY DAY
RESPONDENT 1
HUSBAND/PARTNER 2
JOINTLY WITH HUSBAND/PARTNER 3
SOMEONE ELSE 4
JOINTLY WITH SOMEONE ELSE 5
DECISION NOT MADE 6

720. PRESENCE OF OTHERS AT THIS POINT (PRESENT AND LISTENING, PRESENT BUT NOT LISTENING, OR NOT PRESENT)

CHILDREN UNDER 10
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
HUSBAND/PARTNER
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

721. Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

A. If she goes out without telling him?
B. If she neglects the children?
C. If she argues with him?
D. If she refuses to have sex with him?
E. If she burn the food?

GOES OUT
YES 1
NO 2
NEGLECTS CHILDREN
YES 1
NO 2
ARGUES WITH HIM
YES 1
NO 2
REFUSES SEX
YES 1
NO 2
BURNS FOOD
YES 1
NO 2

722. CHECK 217/218:
IS A CHILD LIVING AT HOME WHO IS AGE 5 OR LESS?

YES (GO TO 723)
NO (GO TO 801)

723. CHECK 710:
HAS (HAD) AN OCCUPATION?

YES, HAS AN OCCUPATION (GO TO 724)
NO, DOES NOT HAVE AN OCCUPATION (GO TO 801)

724. Who usually takes care of (NAME OF YOUNGEST CHILD AT HOME) while you are working?

RESPONDENT 01
HUSBAND/PARTNER 02
OLDER FEMALE CHILD 03
OLDER MALE CHILD 04
OTHER RELATIVES 05
NEIGHBORS 06
FRIENDS 07
SERVANTS/HIRED HELP 08
INSTITUTIONAL CHILDCARE 09
HAS NOT WORKED SINCE LAST BIRTH 95
OTHER (SPECIFY) ______ 96

SECTION 8. HIV/AIDS

801. Have you ever heard of an illness called HIV/AIDS?

YES 1
NO 2 (GO TO 817)

801A. From which sources of information have you learned most about HIV/AIDS?
Any other sources?
RECORD ALL MENTIONED.

RADIO A
TELEVISION B
NEWSPAPER OR MAGAZINE C
PAMPHLETS/POSTER D
HEALTH WORKERS E
MOSQUES/CHURCHES F
SCHOOL/TEACHERS G
COMMUNITY MEETINGS/CONFERENCES H
FRIENDS/RELATIVES I
WORKPLACE J
HEALTH POST K
HOSPITAL/HEALTH CENTER L
HEALTH ASSISTANT M
PRIVATE CLINIC N
ADOLESCENTE SPECIAL SERVICES O
OTHER (SPECIFY) _____ X

801B. Do you think that HIV/AIDS has a cure?

YES 1
NO 2 (GO TO 801D)
DOESN'T KNOW (GO TO 801D)

801C. How can it be cured?
RECORD ALL ANSWERS MENTIONED.

SEXUAL RELATIONS WITH A CHILD/VIRGIN A
MEDICINES/DRUGS B
TRADITIONAL HEALER/MEDICINES C
OTHER (SPECIFY) ______ X

801D. Do you think that HIV/AIDS is a mortal illness?

YES 1
NO 2
UNSURE 3
DOESN'T KNOW 8

801E. Do you think that the risk of you contracting HIV/AIDS is low, moderate, high or no risk at all?

NO RISK AT ALL 1
LOW RISK 2
MODERATE RISK 3
HIGH RISK 3
DOESN'T KNOW 8

802. Do you know how a person can avoid getting HIV/AIDS or the virus that cause AIDS?

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

803. What can a person do to avoid the risk of contracting HIV/AIDS? Any other ways?
RECORD ALL MENTIONED.

ABSTAIN FROM SEX A
USE CONDOMS B
HAVE ONLY ONE PARTNER C
LIMIT NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH HOMOSEXUALS E
AVOID BLOOD TRANSFUSIONS F
AVOID BLOOD DONATION G
ONLY USE STERILIZED/DISPOSABLE SYRINGES H
AVOID KISSING I
AVOID INFECTED PEOPLE J
AVOID SEX WITH PROSTITUTES K
AVOID USING PUBLIC TOILET/LATRINE L
OTHER (SPECIFY) ______ W
OTHER (SPECIFY) ______ X
DOESN'T KNOW Z

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

YES 1
NO 2
DOESN'T KNOW 8

805. Can people get the AIDS virus from mosquito bites?

YES 1
NO 2
DOESN'T KNOW 8

806. Can people reduce their chances of getting the AIDS virus by using a condom every time they have sex?

YES 1
NO 2
DOESN'T KNOW 8

807. Can people get the HIV/AIDS virus by sharing food with a person who has AIDS?

YES 1
NO 2
DOESN'T KNOW 8

808. Can people avoid the HIV/AIDS virus by abstaining from sex?

YES 1
NO 2
DOESN'T KNOW 8

809. Is it possible for a healthy-looking person to have the HIV/AIDS virus?

YES 1
NO 2
DOESN'T KNOW 8

810. Do you know someone personally who has the virus that causes AIDS or someone who died of HIV/AIDS?

YES 1
NO 2

811. Can the virus that causes HIV/AIDS be transmitted from mother to a child?

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

812. Can the virus that causes HIV/AIDS be transmitted from mother to a child:

A. During pregnancy?
B. During delivery?
C. By breastfeeding?

DURING PREGNANCY
YES 1
NO 2
DOESN'T KNOW 8
DURING DELIVERY
YES 1
NO 2
DOESN'T KNOW 8
BY BREASTFEEDING
YES 1
NO 2
DOESN'T KNOW 8

812A1. Can a mother infected with the HIV/AIDS virus avoid transmitting it to her child by taking appropriate drugs during pregnancy?

YES 1
NO 2
DOESN'T KNOW 8

813. CHECK 501:

YES, CURRENTLY MARRIED/ LIVING WITH A MAN (GO TO 814)
NO, NOT IN UNION (GO TO 814A)

814. Have you ever talked about ways to prevent getting the virus that causes HIV/AIDS with your husband/partner?

YES 1
NO 2

814A. In your opinion is it acceptable or not acceptable to provide information on AIDS by means of:

A1. The radio?
A2. The television?
A3. The newspaper?

RADIO
ACCEPTABLE 1
NOT ACCEPTABLE 2
TELEVISION
ACCEPTABLE 1
NOT ACCEPTABLE 2
NEWSPAPER
ACCEPTABLE 1
NOT ACCEPTABLE 2

814B. If you knew that the produce vendor has the HIV/AIDS virus, would you buy his/her products?

YES 1
NO 2
DOESN'T KNOW 8

815. If a member of your family got infected with the virus that causes HIV/AIDS, would you want it to remain a secret or not?

YES 1
NO 2
DOESN'T KNOW 8

816. If a relative of yours became sick with the virus that causes HIV/AIDS, would you be willing to care for her or him in your own household?

YES 1
NO 2
DOESN'T KNOW 8

816A. If a teacher had the virus that causes HIV/AIDS but is not sick, can s/he continue teaching in school?

YES 1
NO 2
DOESN'T KNOW 8

816B. Should you talk to your children ages 12-14 about the use of condoms to prevent AIDS?

YES 1
NO 2
DOESN'T KNOW 8

816C. I am not interested in knowing the result, but have you ever had an AIDS test?

YES 1
NO 2 (GO TO 816D)

816C1. When was the last time you were tested for AIDS?

LESS THAT 12 MONTHS 1
12-23 MONTHS 2
2 OR MORE YEARS 3

816C2. The last time you were tested for AIDS, was it voluntarily, was it recommended by someone else, or were you forced to do it?

VOLUNTARY 1
RECOMMENDED 2
FORCED 3

816C3. I am not interesting in knowing the result, but did you get the results of that test?

YES 1
NO 2 (GO TO 816G)

816C4. Did you received any advice?

YES 1 (GO TO 816G)
NO 2 (GO TO 816G)

816D. Would you like to be tested for AIDS?

YES 1
NO 2

816E. Do you know a place where you can be tested for AIDS?

YES 1
NO 2 (GO TO 817)

816F. Where is that?

IF SOURCE IS HOSPITAL, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE__________
PUBLIC SECTOR
CENTRAL HOSPITAL 11
PROVINCIAL/GENERAL HOSPITAL 12
HOSPITAL IN RURAL AREA 13
HEALTH CENTER 14
GATV (Office for Advice and Voluntary Testing of HIV/AIDS) 15
OTHER (SPECIFY) ____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL 21
PRIVATE CLINIC 22
PRIVATE DOCTOR 23
PRIVATE NURSE 24
PRIVATE PHARMACY 25
OTHER PRIVATE MEDICAL (SPECIFY) ____26
OTHER (SPECIFY) ______ 96

816G. Where did you go to get tested?

IF SOURCE IS HOSPITAL, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE__________
PUBLIC SECTOR
CENTRAL HOSPITAL 11
PROVINCIAL/GENERAL HOSPITAL 12
HOSPITAL IN RURAL AREA 13
HEALTH CENTER 14
GATV (Office for Advice and Voluntary Testing of HIV/AIDS) 15
OTHER (SPECIFY) ____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL 21
PRIVATE CLINIC 22
PRIVATE DOCTOR 23
PRIVATE NURSE 24
PRIVATE PHARMACY 25
OTHER PRIVATE MEDICAL (SPECIFY) _____26
OTHER (SPECIFY) ______ 96

817. Apart from HIV/AIDS, have you heard about other infections that can be transmitted through sexual contact?

YES 1
NO 2 (GO TO 819)

818. If a MAN has a sexually transmitted disease (STD), what symptoms might he have?
Any others?
(DO NOT READ THE ANSWERS) RECORD ALL SYMPTOMS MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE/DRIPPING B
BURNING PAIN ON URINATION C
REDNESS/INFLAMMATION IN GENITAL AREA D
SWELLING IN GENITAL AREA E
GENITAL SORES/ULCERS/WARTS F
BLOOD IN URINE G
LOSS OF WEIGHT H
IMPOTENCE I
OTHER (SPECIFY) ______ W
OTHER (SPECIFY) ______ X
NO SYMPTOMS Y
DOESN'T KNOW Z

818A. If a WOMAN has a sexually transmitted disease (STD), what symptoms might she have? Any others?
(DO NOT READ THE ANSWERS) RECORD ALL SYMPTOMS MENTIONED.

ABDOMINAL PAIN A
VAGINAL DISCHARGE/DRIPPING B
BURNING PAIN ON URINATION C
REDNESS/INFLAMMATION IN GENITAL AREA D
SWELLING IN GENITAL AREA E
GENITAL SORES/ULCERS/WARTS F
BLOOD IN URINE G
LOSS OF WEIGHT H
HARD TO GET PREGNANT/HAVE A CHILD I
OTHER (SPECIFY) ______ W
OTHER (SPECIFY) ______ X
NO SYMPTOMS Y
DOESN'T KNOW Z

819. CHECK 514:
HAS RESPONDENT HAD SEXUAL RELATIONS?

HAS HAD SEXUAL RELATIONS (GO TO 819A)
NEVER HAD SEXUAL RELATIONS (GO TO 901)

819A. CHECK 817:
DOES RESPONDENT KNOW ABOUT STD'S?

KNOWS ABOUT STD'S (GO TO 819B)
DOES NOT KNOW ABOUT STD'S (GO TO 819C)

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

819B. Have you had any sexually transmitted disease (STD) during the last 12 months?

YES 1
NO 2
DOESN'T KNOW 8

819C. During the last 12 months, have you had any burning pain in urination or vaginal discharge?

YES 1
NO 2
DOESN'T KNOW 8

819D. During the last 12 months, have you had any sores, ulcers or warts in the genital or anal area?

YES 1
NO 2
DOESN'T KNOW 8

819E. CHECK 819B, 819C, AND 819D:

CODE '1' CIRCLED AT LEAST ONCE (GO TO 819F)
CODE '1' NOT CIRCLED (GO TO 901)

819F. The last time you had those problems (PROBLEMS MENTIONED IN 819B, 819C, AND 819D), did you seek advice or treatment?

YES 1
NO 2 (GO TO 821A)

820. The last time you had those problems (PROBLEMS MENTIONED IN 819B, 819C, AND 819), did you do any of the following:

A. Did you seek advice or treatment in a hospital, clinic or private clinic?
B. Did you seek advice or treatment/medicine from a traditional healer?
C. Did you seek advice or treatment/medicine from a pharmacy?
D. Did you seek advice or treatment with friends and relatives?

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

821A. When you had those problems, did you tell your sexual partner(s) about it?

YES 1
NO 2
NOT EVERYONE/ONLY SOME 3
DOES NOT HAVE A PARTNER 4 (GO TO 901)

821B.When you had those problems did you do anything to avoid transmitting them to your sexual partner?

YES 1
NO 2 (GO TO 901)
HUSBAND/PARTNER IS INFECTED 3 (GO TO 901)

822. What did you do to avoid transmitting those problems to your partner?

A. Stopped having sexual relations?
B. Used a condom?
C. Took medicine/drugs?

STOPPED HAVING SEXUAL RELATIONS
YES 1
NO 2
USED CONDOM
YES 1
NO 2
TOOK MEDICINE/DRUGS
YES 1
NO 2

SECTION 9. MATERNAL DEATH RATE

Now I would like to ask you questions about your brothers and sisters, that is, all of the children born from your mother, including those that live with you, those that do not live with you, or have died.

901. How many children did you mother have?

NUMBER OF CHILDREN FROM BIOLOGICAL MOTHER ______

902. CHECK 901:

TWO OR MORE BORN (GO TO 903)
ONLY ONE BORN (ONLY THE RESPONDENT) (GO TO 916)

903. Of all of the children, how many were born before you?

NUMBER OF CHILDREN BORN BEFORE HER______

904. What is the name of your older....next sister or brother?

NAME_______

905. Is (NAME) male or female?

MALE 1
FEMALE 2

906. Is (NAME) alive?

YES 1
NO 2 (GO TO 908)
DOESN'T KNOW 8 (GO TO NEXT CHILD)

907. How old is (NAME)?

AGE____ (GO TO NEXT CHILD)

908. In which year did (NAME) die?

YEAR____ (GO TO 910)
DOESN'T KNOW 9998

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

YEARS____

910. How old was (NAME) when s/he died?

AGE___ (IF MAN OR IF GIRL THAT DIED BEFORE THE AGE OF 12, GO TO NEXT BIRTH)

911. When (NAME) died, was she pregnant?

YES 1 (GO TO 914A)
NO 2

912. Did (NAME) died during labor?

YES 1 (GO TO 914A)
NO 2

913. Did (NAME) die two months after being pregnant or after labor?

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

914. Did she die because of labor or pregnancy complications?

YES 1
NO 2
DOESN'T KNOW 8

914A. Did (NAME) die at home, in route to the health center, in the health center or somewhere else?

HOME 1
IN ROUTE 2
IN THE HEALTH CENTER 3
OTHER (SPECIFY) _____ 6
DOESN'T KNOW 8

914B. Was (NAME) living in this household?

YES 1
NO 2
DOESN'T KNOW 8

915. During her life, how many children did (NAME) have?

NUMBER OF CHILDREN____

916. DATE AND TIME

HOUR ______
MINUTES______

PREGNANCY CALENDAR

INSTRUCTIONS: ONLY ONE CODE SHOULD APPEAR IN ANY BOX.

CODES FOR BIRTHS AND PREGNANCIES:

B BIRTHS
P PREGNANCIES
T TERMINATIONS
2003
12 DEC ___ 01
11 NOV ___02
10 OCT ___03
09 SEP ___04
08 AGO__05
07 JUL ___06
06 JUN ___07
05 MAY ___08
04 APR ___09
03 MAR ___10
02 FEB ___11
01 JAN ___12
2002
12 DEC ___ 13
11 NOV ___14
10 OCT ___15
09 SEP ___16
08 AGO__17
07 JUL ___18
06 JUN ___19
05 MAY ___20
04 APR ___21
03 MAR ___22
02 FEB ___23
01 JAN ___24
2001
12 DEC ___ 25
11 NOV ___26
10 OCT ___27
09 SEP ___28
08 AGO__29
07 JUL ___30
06 JUN ___31
05 MAY ___32
04 APR ___33
03 MAR ___34
02 FEB ___35
01 JAN ___36
2000
12 DEC ___ 37
11 NOV ___38
10 OCT ___39
09 SEP ___40
08 AGO__41
07 JUL ___42
06 JUN ___43
05 MAY ___44
04 APR ___45
03 MAR ___46
02 FEB ___47
01 JAN ___48
1999
12 DEC ___ 49
11 NOV ___50
10 OCT ___51
09 SEP ___52
08 AGO__53
07 JUL ___54
06 JUN ___55
05 MAY ___56
04 APR ___57
03 MAR ___58
02 FEB ___59
01 JAN ___60
1998
12 DEC ___ 61
11 NOV ___62
10 OCT ___63
09 SEP ___64
08 AGO__65
07 JUL ___66
06 JUN ___67
05 MAY ___68
04 APR ___69
03 MAR ___70
02 FEB ___71
01 JAN ___72

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW.

COMMENTS ABOUT RESPONDENT_____

COMMENTS ON SPECIFIC QUESTIONS_____

ANY OTHER COMMENTS_____

SUPERVISOR'S OBSERVATIONS_____
NAME _____
DATE _____

EDITOR'S OBSERVATIONS_____
NAME _____
DATE _____