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

IDENTIFICATION

NAME OF HOUSEHOLD HEAD______
PLACE NAME______
PROVINCE______

URBAN/RURAL______

URBAN 1
RURAL 2

CLUSTER NUMBER (IDS I.D.)______
HOUSEHOLD NUMBER______

NAME AND LINE NUMBER OF MEN ______

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE______
INTERVIEWER'S NAME______

RESULT______

01 COMPLETED
02 ABSENCE OF QUALIFIED PERSON
03 POSTPONED
04 REFUSED
05 INCOMPLETE
06 DISABLED
96 OTHER (SPECIFY) _____

NEXT VISIT
DATE______
TIME______

FINAL VISIT
DAY______
MONTH______
YEAR 2003
NAME______
RESULT______

TOTAL NUMBER OF VISITS______

SUPERVISOR
NAME______
DATE______

FIELD EDITOR
NAME______
DATE______

OFFICE EDITOR
NAME ______
DATE ______

KEYED BY______
REKEYED 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 were you at your last birthday?
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 24 YEARS OLD OR LESS:

24 YEARS OLD OR YOUNGER (GO TO 109B)
25 YEARS OLD 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?

WIFE/PARTNER GOT PREGNANT 01
GOT MARRIED 02
TO CARE FOR YOUNGER CHILDREN 03
FAMILY NEEDED HELP ON FARM/PLANTATION OR IN BUSINESS 04
DIDN'T HAVE MONEY 05
NEEDED TO EARN MONEY 06
HAD ENOUGH SCHOOLING 07
DID NOT PASS ENTRANCE EXAMS 08
DIDN'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 112)

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 113)
ABLE TO READ ONLY PART OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE 4 (SPECIFY LANGUAGE) ______
BLIND 5 (GO TO 114)

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

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

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

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

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

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

115. Do you profess a religion?

YES 1
NO 2 (GO TO 118)

116. What is your religion?

CATHOLIC 01
PROTESTANT/EVANGELICAL 02
MUSLIM 03
ZION 04
ANIMISM 05
OTHER (SPECIFY) _____96

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

ONCE A MONTH 1
MORE THAN ONCE A MONTH 2
ONLY DURING HOLIDAY 3
DO NOT GO AT ALL 4

118. What language did you grow up speaking?

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

119. Are you currently working?

YES 1 (GO TO 122)
NO 2

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

YES 1
NO 2 (GO TO 122)

121. What have you mainly done during the last 12 months?

STUDY 01 (GO TO 129)
LOOK FOR A JOB 02 (GO TO 129)
RETIRED 03 (GO TO 129)
DISABLE/SICK 04 (GO TO 129)
DOMESTIC WORK 05 (GO TO 129)
OTHER OCCUPATION (SPECIFY) ____ 96 (GO TO 129)

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

OCCUPATION____

123. CHECK 122 IF RESPONDENT WORKS IN AGRICULTURE:

WORKS IN AGRICULTURE (GO TO 124)
DOES NOT WORK IN AGRICULTURE (GO TO 125)

124. Do you mainly work 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

125. During the last 12 months, approximately how many months did you work?

NUMBER OF MONTHS___

126. 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 129)
NOT PAID 4 (GO TO 129)

127. 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?

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

128. 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

129. During the last 12 months, how many times did you spend the night somewhere else (outside your community)?

NUMBER OF PLACES____
NONE 00 (GO TO 201)

130. During the last 12 months, were you somewhere else for more than a month?

YES 1
NO 2

SECTION 2. REPRODUCTION

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

201. Do you have any children (male or female)?
IF RESPONDENT SAYS NO, ASK: Did you ever have a daughter that was born alive?

YES 1
NO 2 (GO TO 206)
DOESN'T KNOW 8 (GO TO 206)

202. Do you have any sons or daughters 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 that do not live with you?

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 had 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)
DOESN'T KNOW 8 (GO TO 208)

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

BOYS DEAD____
GIRLS DEAD____

208. Besides all of the children you have mentioned, have you:

a) Fathered other sons or daughters but are not legally recognized as your own or do not have your last name?
b) Fathered other sons or daughters that are not alive anymore but are not legally recognized as your own or do not have your last name?

THERE ARE NO MORE CHILDREN (GO TO 209)
THERE IS SOME CHILDREN (CHECK AND CORRECT 201-207 IF NECESSARY)

209. SUM ALL ANSWERS FROM Q. 203, 205 AND 207, THEN RECORD THE TOTAL.
IF NONE, RECORD '00'.

TOTAL_____

209A. CHECK 209: TOTAL NUMBER OF CHILDREN
Just to make sure that I have this right: you have had in TOTAL _____children during your life. Is that correct?

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

210. CHECK 209 IF ONE OR MORE LIVING BIRTHS:

ONE OR MORE LIVING BIRTHS (GO TO 211)
ONE LIVING BIRTH (GO TO 213)
NO LIVING BIRTHS (GO TO 301)

211. The children you have are with the same wife/partner?

YES 1 (GO TO 213)
NO 2

212. In total, with how many women/partners do you have children?

NUMBER OF WOMEN/PARTNERS______

213. How old were you when your first child was born?

AGE (IN YEARS) _______

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. Couples can avoid having sexual intercourse on the days of the month the woman 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.
YES 1 (SPECIFY)______
NO 2

302. Have you ever used (METHOD)?

02) MALE STERILIZATION. (Vasectomy). Men 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
06) CONDOM. Men can put a rubber sheath on their penis during sexual intercourse.
YES 1
NO 2
10) PERIODIC ABSTINENCE. Couples can avoid having sexual intercourse on the days of the month the woman 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 METHOD(S). (SPECIFY) ______
LIST UP TO TWO METHODS.
YES 1
NO 2

305. Do you think that a woman that is breastfeeding can get pregnant?

YES 1
NO 2
DEPENDS 3
DOESN'T KNOW 8

306. Do you agree or disagree with the following:

A. Family planning/contraception is the responsibility of the woman, and men should not worry about it.
AGREE 1
DISAGREE 2
DOESN'T KNOW 8
B. Women who use contraceptives can become promiscuous.
AGREE 1
DISAGREE 2
DOESN'T KNOW 8
C. Women should be the ones using contraception, because they are the ones that get pregnant.
AGREE 1
DISAGREE 2
DOESN'T KNOW 8

307. CHECK 301(2) AND 302(2): KNOWLEDGE AND USE OF MALE STERILIZATION

KNOWS ABOUT MALE STERILIZATION BUT NOT STERILIZED (GO TO 308)
OTHER (GO TO 401)

308. After having all the children you want, would you consider getting sterilized?

WOULD CONSIDER 1 (GO TO 401)
NO 2
DEPENDS/UNSURE 3 (GO TO 401)
STERILIZED WIFE 4 (GO TO 401)

309. Why wouldn't you prefer male sterilization?
PROBE: Any other reason?
RECORD ALL ANSWERS MENTIONED.

WHEN RELIGION PROHIBITS IT A
IS BAD FOR MEN'S HEALTH B
UNSAFE METHOD C
PREFERS OTHER METHODS D
COULD WANT MORE CHILDREN/COULD HAVE MORE CHILDREN IF SOME DIE E
COULD MARRY AGAIN F
COULD LOSE SALARY G
COULD LOSE SEXUAL DRIVE H
COULD LOSE MASCULINITY I
CONTRACEPTION IS WOMEN'S RESPONSIBILITY J
OTHER (SPECIFY) _____ X

SECTION 4. MARITAL STATUS AND SEXUAL ACTIVITY

401. Are you currently married or living with a woman?

YES, CURRENTLY MARRIED 1
YES, LIVING WITH A WOMAN 2 (GO TO 404)
NO, NOT IN UNION 3 (GO TO 406)

402. How many wives do you have?

NUMBER_____

403. Do women live with you as if they were your wives?

YES 1
NO 2 (GO TO 405)

404. Do you live with (one woman) or more than (one women) as if they were your wives?
IF ONLY ONE WIFE RECORD '01'. IF MORE THAN ONE, ASK: How many wives do you have?

NUMBER OF WIVES/PARTNERS _____

405. Besides the women you have mentioned, do you currently have a regular sexual partner, an occasional sexual partner, or no sexual partner at all?

REGULAR SEXUAL PARTNER(S) 1 (GO TO 409)
OCCASIONAL SEXUAL PARTNER(S) 2 (GO TO 409)
REGULAR AND OCCASIONAL SEXUAL PARTNER(S) 3 (GO TO 409)
NO SEXUAL PARTNER 4 (GO TO 409)

406. Do you currently have a regular sexual partner, an occasional sexual partner, or no sexual partner at all?

REGULAR SEXUAL PARTNER(S) 1
OCCASIONAL SEXUAL PARTNER(S) 2
REGULAR AND OCCASIONAL SEXUAL PARTNER(S) 3
NO SEXUAL PARTNER 4

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

YES, FORMERLY MARRIED 1
YES, LIVED WITH A WOMAN 2 (GO TO 411)
BOTH 3
NO 8 (GO TO 416)

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

WIDOWED 1 (GO TO 411)
DIVORCED 2 (GO TO 411)
SEPARATED 3 (GO TO 411)

409. RECORD LINE NUMBER OF WIFE (WIVES) ACCORDING TO QUESTIONS 402 AND 404 FROM THE HOUSEHOLD QUESTIONNAIRE. IF ONE WIFE DOES NOT LIVE IN THE SAME HOUSEHOLD, RECORD '00'. THE NUMBER OF BOXES MUST CONTAIN EQUAL NUMBER OF WIVES.

CHECK 402 AND 404: NUMBER OF WIVES/PARTNERS:

SUM OF 402 AND 404 IS '1': Please, tell me the name of your wife/partner:

SUM OF 402 AND 404 IS GREATER THAN 1: Please, tell me the names of your wives/partners starting with the first one.

NAME OF WIFE (WIVES)/PARTNER(S) _____
HOUSEHOLD QUESTIONNAIRE LINE NUMBER_____ (FOR EACH WIFE)
WIFE 1
PARTNER 2

410. CHECK 409: NUMBER OF WIVES/PARTNERS

ONLY ONE WIFE/PARTNER (GO TO 411)
MORE THAN ONE WIFE/PARTNER (GO TO 412)

411. Have you been married or lived with a woman only once, or more than once?

ONCE 1 (GO TO 414)
MORE THAN ONCE 2 (GO TO 413)

412. Besides the women you have mentioned, have you ever been married or lived with a woman as a wife?

YES 1
NO 2 (GO TO 414)

413. In total, how many women as wives have you lived with?

NUMBER OF WOMEN________

414. CHECK 409 AND 411:

MARRIED/LIVED WITH A WOMAN ONLY ONCE OR 411 ANSWER IS '1': In what month and year did you start living with your wife/partner?

OTHERS: Now we will talk about your first wife/partner. In what month and year did you start living with her?

MONTH_____
DOESN'T KNOW MONTH 98
YEAR_____ (GO TO 416)
DOESN'T KNOW YEAR 9998

415. 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.

416. How old were you when you first had sexual intercourse?

NEVER HAD IT 00 (GO TO 448)

AGE IN YEARS _____

FIRST TIME WHEN MARRIED 95

416A. CHECK FROM QUESTION 106 IF SHE IS BETWEEN 15-24 YEARS OF AGE:

SHE IS BETWEEN 15-24 YEARS OF AGE (GO TO 416B)
SHE IS BETWEEN 25-64 YEARS OF AGE (GO TO 417)

416B. The first time you had sex, was a condom used?

YES 1
NO 2

417. When was the last time you had sexual intercourse?

IF ANSWER IS LESS THAN 12 MONTHS AGO RECORD DAYS OR MONTHS GIVEN BY THE RESPONDENT. IF MORE THAN 12 MONTHS AGO RECORD IN YEARS. IF HAD SEX THAT DAY, RECORD '00'.

DAYS AGO 1 ____
WEEKS AGO 2 ____
MONTHS AGO 3____
YEARS AGO 4____ (GO TO 445)

418. The last time you had sex, was a condom used?

YES 1
NO 2 (GO TO 420)

419. What was the main reason for using a condom?

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

420. CHECK 302 (02) IF INTERVIEWEE IS STERILIZED:

STERILIZED (GO TO 421)
NOT STERILIZED (GO TO 424)

421. CHECK 419: CONDOM USED TO AVOID PREGNANCY:

CODE '02' OR '03': During the last time you had a sexual relation, did you and your partner use another method besides the condom to avoid pregnancy?

OTHER: During the last time you had a sexual relation with a woman, did you and your partner use any method to avoid pregnancy?

YES 1
NO 2 (GO TO 423)
DOESN'T KNOW 8 (GO TO 424)

422. Which method did you use?
IF USED VARIOUS METHODS, MARK THE ONE CLOSER TO THE TOP.

FEMALE STERILIZATION 01 (GO TO 424)
MALE STERILIZATION 02 (GO TO 424)
PILL 03 (GO TO 424)
IUD 04 (GO TO 424)
INJECTABLES 05 (GO TO 424)
CONDOM 06 (GO TO 424)
DIAPHRAGM 07 (GO TO 424)
FOAM, JELLY, SPONGE 08 (GO TO 424)
LACTATIONAL AMEN. METHOD 09 (GO TO 424)
PERIODIC ABSTINENCE 10 (GO TO 424)
WITHDRAWAL 11 (GO TO 424)
OTHER METHODS (SPECIFY) _____ 96 (GO TO 424)
DOESN'T KNOW 98 (GO TO 424)

423. CHECK 419: CONDOM USED TO AVOID PREGNANCY (CODE '02' OR '03')

YES (GO TO 424)
OTHER (GO TO 423A)

423A. What is the main reason that you think you will not use a method?

OCCASIONAL PARTNER/ DOES NOT MATTER 11
IS WOMEN'S RESPONSIBILITY 12
USE CONDOM TO PREVENT STD/AIDS 13
FERTILITY-RELATED REASONS
INFREQUENT SEX 22
MENOPAUSAL/HYSTERECTOMY 23
MAN OR WOMAN INFECUND/STERILE 24
WANTS MORE CHILDREN 25
PREGNANT WOMEN/PARTNER 26
WOMEN/PARTNER IS BREASTFEEDING 27
OPPOSITION TO USE
RESPONDENT OPPOSED 31
WIFE OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
LACK OF KNOWLEDGE
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COSTS TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY) _____96
DOESN'T KNOW 98

424. What is your relationship to the woman with whom you last had sex?
IF WOMAN IS 'GIRLFRIEND' OR 'FIANCÉ', ASK: Was your girlfriend/fiancé living with you when you last had sex?
IF YES, CIRCLE '1', IF NO, CIRCLE '2'

SPOUSE/COHABITING PARTNER 01 (GO TO 426)
GIRLFRIEND/FIANCÉ 02
FRIEND 03
OCCASIONAL PARTNER 04
RELATIVE 05
PROSTITUTE 06
OTHER (SPECIFY) _____96

425. For how long have you had sexual relations with this woman?
IF SEXUAL INTERCOURSE WITH THAT WOMAN HAPPENED ONCE, RECORD '01' IN DAYS.

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

426. Have you had sex with any other woman in the last 12 months?

YES 1
NO 2 (GO TO 445)

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

YES 1
NO 2 (GO TO 429)

428. What was the main reason you 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 ASKED/INSISTED IN USING IT 05
OTHER (SPECIFY) _____96
DOESN'T KNOW 98

429. CHECK 302(2) IF RESPONDENT IS NOT STERILIZED:

MAN NOT STERILIZED (GO TO 430)
MAN STERILIZED (GO TO 433)

430. CHECK 428: CONDOM USED TO AVOID PREGNANCY:

CODE '02' OR '03': During the last time you had a sexual relation, did you and your partner use another method besides the condom to avoid pregnancy?

OTHER: During the last time you had a sexual relation, did you and your partner use any method to avoid pregnancy?

YES 1
NO 2 (GO TO 432)
DOESN'T KNOW 8 (GO TO 433)

431. Which method did you use?
IF USED VARIOUS METHODS MARK THE ONE CLOSER TO THE TOP.

FEMALE STERILIZATION 01 (GO TO 433)
MALE STERILIZATION 02 (GO TO 433)
PILL 03 (GO TO 433)
IUD 04 (GO TO 433)
INJECTABLES 05 (GO TO 433)
CONDOM 06 (GO TO 433)
DIAPHRAGM 07 (GO TO 433)
FOAM, JELLY, SPONGE 08 (GO TO 433)
LACTATIONAL AMEN. METHOD 09 (GO TO 433)
PERIODIC ABSTINENCE 10 (GO TO 433)
WITHDRAWAL 11 (GO TO 433)
OTHER METHODS (SPECIFY) ______ 96 (GO TO 433)
DOESN'T KNOW 98 (GO TO 433)

432. CHECK 428:
CONDOM USED TO AVOID PREGNANCY (CODE '02' OR '03'):

YES (GO TO 433)
OTHER (GO TO 432A)

432A. What is the main reason that you think you will not use a method?

OCCASIONAL PARTNER/ DOES NOT MATTER 11
IS WOMEN'S RESPONSIBILITY 12
USE CONDOM TO PREVENT STD/AIDS 13
FERTILITY-RELATED REASONS
INFREQUENT SEX 22
MENOPAUSAL/HYSTERECTOMY 23
MAN OR WOMAN INFECUND/STERILE 24
WANTS MORE CHILDREN 25
PREGNANT WOMEN/PARTNER 26
WOMEN/PARTNER IS BREASTFEEDING 27
OPPOSITION TO USE
RESPONDENT OPPOSED 31
WIFE OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
LACK OF KNOWLEDGE
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY) ______96
DOESN'T KNOW 98

433. What is (was) your relationship to the (other) woman with whom you last had sex?
IF WOMAN IS 'GIRLFRIEND' OR 'FIANCÉ', ASK: Was your girlfriend/fiancé living with you when you last had sex?
IF YES, CIRCLE '1' IF NO, CIRCLE '2'.

SPOUSE/COHABITING PARTNER 01 (GO TO 435)
GIRLFRIEND/FIANCÉ 02
FRIEND 03
OCCASIONAL PARTNER 04
RELATIVE 05
PROSTITUTE 06
OTHER (SPECIFY) _____96

434. For how long have you had sexual relations with that woman?
IF SEXUAL INTERCOURSE WITH THAT WOMAN HAPPENED ONCE, RECORD '01' IN DAYS.

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

435. Besides those women, have you had sex with any other woman in the last 12 months?

YES 1
NO 2 (GO TO 445)

436. The last time you had sexual intercourse with that woman, was a condom used?

YES 1
NO 2 (GO TO 438)

437. What was the main reason you 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 ASKED/INSISTED IN USING IT 05
OTHER (SPECIFY) _____96
DOESN'T KNOW 98

438. CHECK 302 (02) IF INTERVIEWEE IS STERILIZED:

NOT STERILIZED (GO TO 439)
STERILIZED (GO TO 442)

439. CHECK 437:
CONDOM USED TO AVOID PREGNANCY:

CODE '02' OR '03': During the last time you had a sexual relation, did you and your partner use another method besides the condom to avoid pregnancy?

OTHER: During the last time you had a sexual relation, did you and your partner use any method to avoid pregnancy?

YES 1
NO 2 (GO TO 441)
DOESN'T KNOW 8 (GO TO 442)

440. Which method did you use?
IF USED VARIOUS METHODS, MARK THE ONE CLOSER TO THE TOP.

FEMALE STERILIZATION 01 (GO TO 442)
MALE STERILIZATION 02 (GO TO 442)
PILL 03 (GO TO 442)
IUD 04 (GO TO 442)
INJECTABLES 05 (GO TO 442)
CONDOM 06 (GO TO 442)
DIAPHRAGM 07 (GO TO 442)
FOAM, JELLY, SPONGE 08 (GO TO 442)
LACTATIONAL AMEN. METHOD 09 (GO TO 442)
PERIODIC ABSTINENCE 10 (GO TO 442)
WITHDRAWAL 11 (GO TO 442)
OTHER METHODS (SPECIFY) _____ 96 (GO TO 442)
DOESN'T KNOW 98 (GO TO 442)

441. CHECK 437:
CONDOM USED TO AVOID PREGNANCY (CODE '02' OR '03')

YES (GO TO 442)
OTHER (GO TO 441A)

441A. What is the main reason that you think you will not use a method?

OCCASIONAL PARTNER/ DOES NOT MATTER 11
IS WOMEN'S RESPONSIBILITY 12
USE CONDOM TO PREVENT STD/AIDS 13
FERTILITY-RELATED REASONS
INFREQUENT SEX 22
MENOPAUSAL/HYSTERECTOMY 23
MAN OR WOMAN INFECUND/STERILE 24
WANTS MORE CHILDREN 25
PREGNANT WOMEN/PARTNER 26
WOMEN/PARTNER IS BREASTFEEDING 27
OPPOSITION TO USE
RESPONDENT OPPOSED 31
WIFE OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
LACK OF KNOWLEDGE
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY) ______96
DOESN'T KNOW 98

442. What is (was) your relationship to the (third) woman with whom you last had sex?
IF WOMAN IS 'GIRLFRIEND' OR 'FIANCÉ', ASK: Was your girlfriend/fiancé living with you when you last had sex?
IF YES, CIRCLE '1', IF NO, CIRCLE '2'

SPOUSE/COHABITING PARTNER 01 (GO TO 444)
GIRLFRIEND/FIANCÉ 02
FRIEND 03
OCCASIONAL PARTNER 04
RELATIVE 05
PROSTITUTE 06
OTHER (SPECIFY) _____96

443. For how long have you had sexual relations with that (third) woman?
IF SEXUAL INTERCOURSE WITH THAT WOMAN HAPPENED ONCE, RECORD '01' IN DAYS.

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

444. In total, with how many women have you had sex in the last 12 months?

NUMBER OF PARTNERS____

445. Have you ever paid for a sexual relation with a woman?

YES 1
NO 2 (GO TO 448)

446. When was the last time you paid for a sexual relation with a woman?

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

447. The last time you paid for a sexual relation with a woman, was a condom used?

YES 1
NO 2

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

YES 1
NO 2 (GO TO 451)

449. 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
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
FRIENDS/RELATIVES O
TRADITIONAL HEALER P
PARTNER Q
MEDICAL STAFF IN THE NEIGHBORHOOD R
STAND/BOOTH INFORMATION S
STORE T
BAR/DISCOTHEQUE U
ADOLESCENT SPECIAL SERVICES V
OTHER (SPECIFY) ____X

450. If you wanted a condom, can you obtain it?

YES 1
NO 2
DOESN'T KNOW 8

451. CHECK 302(06), 416B, 418, 427, 436 AND 447:
USE OF CONDOM:

AT LEAST ONE "YES" (GO TO 452)
OTHER (GO TO 456)

452. How old were you when you first used a condom?

AGE IN YEARS ________
DOESN'T REMEMBER 98

453. What was the main reason for using a condom during the first time?
ASK: Any other reason?
RECORD ALL ANSWERS MENTIONED.

WANTED TO PREVENT STD/AIDS A
WANTED TO AVOID PREGNANCY B
WANTED TO PREVENT STD/AIDS AND AVOID PREGNANCY C
DID NOT TRUST PARTNER/ FELT THAT PARTNER HAD OTHER PARTNERS D
PARTNER WANTED/INSISTED IN USING IT E
OTHER (SPECIFY) _____X
DOESN'T KNOW Z

454. Have you ever had any problems using a condom?

YES 1
NO 2 (GO TO 456)

454A. What was the problem?
ASK: Any other problem?
RECORD ALL ANSWERS MENTIONED.

DIFFICULT TO USE A
DIFFICULT TO PUT ON/TAKE OFF B
AFFECT THE LOVE ENVIRONMENT C
DECREASES PLEASURE D
PARTNER DOES NOT LIKE IT E
IS INCONVENIENT F
CONDOM BREAKS G
WIFE/PARTNER IS PREGNANT H
OTHER (SPECIFY) _____ X

456. Do you agree or disagree with the following:

A. Using a condom decreases sexual pleasure for man.
AGREE 1
DISAGREE 2
DOESN'T KNOW 8
B. The use of condom is very inconvenient.
AGREE 1
DISAGREE 2
DOESN'T KNOW 8
C. The condom can be re-used.
AGREE 1
DISAGREE 2
DOESN'T KNOW 8
D. Condom prevents diseases.
AGREE 1
DISAGREE 2
DOESN'T KNOW 8
E. Is embarrassing buying condoms.
AGREE 1
DISAGREE 2
DOESN'T KNOW 8
F. Women do not have the right to ask partners to use condoms.
AGREE 1
DISAGREE 2
DOESN'T KNOW 8

SECTION 5. FERTILITY PREFERENCES

501. CHECK 409:
HAS ONE OR MORE WIVES/PARTNERS:

HAS ONE WIFE/PARTNER (GO TO 502)
HAS MORE THAN ONE WIFE/PARTNER (GO TO 502)
QUESTION NOT ASKED (GO TO 505)

502. Is your wife/partner (or any of your partners) pregnant at this moment?

YES 1
NO 2
UNSURE 3

503. CHECK 502:

WIFE/PARTNER 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?

WIFE/PARTNER PREGNANT: Now I have some questions about the future. After the child you and your wife/partner 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 505)
WIFE (WIVES)/PARTNER(S) CAN'T GET PREGNANT 3 (GO TO 505)
UNDECIDED/DOESN'T KNOW 8 (GO TO 505)

504. How long do you want to wait after this child is born to have other?

MONTHS 1____
YEARS 2_____

NOW 993
AFTER MARRIAGE 995
OTHER (SPECIFY) ____996
DOESN'T KNOW 998

505. CHECK 203-205:

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 507)

NUMBER____

OTHER (SPECIFY) _____96 (GO TO 507)

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

NUMBER OF BOYS____
NUMBER OF GIRLS____
NUMBER OF EITHER____
OTHER (SPECIFY) ______96

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

APPROVE 1
DISAPPROVE 2
DOESN'T KNOW/INDIFFERENT 8

508. In the last month 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

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

YES 1
NO 2 (GO TO 512)

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

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

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

YES 1
NO 2

SECTION 6. HEALTH CARE PARTICIPATION

601. CHECK 209: ONE OR MORE CHILDREN:

HAS ONE OR MORE CHILDREN (GO TO 602)
DOES NOT HAVE CHILDREN (GO TO 617)

602. What is your last child's name and sex?

NAME______
MALE 1
FEMALE 2

603. In which month and year was (NAME) born?

MONTH____
YEAR____

604. Is (NAME) alive?

YES 1 (GO TO 606)
NO 2
DOESN'T KNOW 8 (GO TO 606)

605. 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; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

DAYS 1 _____
MONTHS 2 _____
YEARS 3 _____
DOESN'T KNOW 998

606. What is the name of (NAME)'s mother?
RECORD MOTHER'S NAME AND THE LINE NUMBER FROM HOUSEHOLD QUESTIONNAIRE.

IF MOTHER IS NOT LISTED IN HOUSEHOLD QUESTIONNAIRE, RECORD '00'.

MOTHER'S NAME________
LINE NUMBER FROM HOUSEHOLD QUESTIONNAIRE _____

607. CHECK 603:
IF (LAST) CHILD WAS BORN IN 1998 OR AFTER:

(LAST) CHILD BORN IN 1998 OR LATER (GO TO 608)
(LAST) CHILD BORN IN 1997 OR BEFORE (GO TO 617)

608. CHECK 606:

LINE NUMBER IS '00' (GO TO 609)
OTHER LINE NUMBER (GO TO 610)

609. What is your relation to (NAME)'s mother?

SPOUSE/COHABITING PARTNER 01
EX-SPOUSE/EX-COHABITING PARTNER 02
GIRLFRIEND/FIANCÉ 03
FRIEND 04
REGULAR PARTNER 05
OCCASIONAL PARTNER 06
RELATIVE 07
OTHER (SPECIFY) _____96

ASK QUESTIONS 610-612 FIRST DURING PREGNANCY, DURING DELIVERY AND 6 WEEKS OR LATER. ALL QUESTIONS ARE RELATED TO THE LAST BIRTH.

CHECK 602: CHILD'S NAME__________
CHECK 606: MOTHER'S NAME ________

610. Now think when (NAME'S MOTHER) was pregnant of (NAME):

DURING PREGNANCY:
610A) Did (NAME'S MOTHER) have an antenatal appointment when she was pregnant?

YES 1 (GO TO 611)
NO 2 (GO TO 612)
DOESN'T KNOW 8 (GO TO 610B)

DURING DELIVERY:
610B) Did a health worker help (NAME'S MOTHER) during delivery?

YES 1 (GO TO 611)
NO 2 (GO TO 612)
DOESN'T KNOW 8 (GO TO 610C)

SIX WEEKS AFTER DELIVERY:
610C) Did (NAME'S MOTHER) had an postnatal appointment six weeks after delivery?

YES 1 (GO TO 611)
NO 2 (GO TO 612)
DOESN'T KNOW 8 (GO TO 613)

611. Who pays for that care?

DURING PREGNANCY:
FREE 01 (GO TO NEXT COLUMN 610B)
INSURANCE 02 (GO TO NEXT COLUMN 610B)
INTERVIEWEE 03 (GO TO NEXT COLUMN 610B)
CHILD'S MOTHER 04 (GO TO NEXT COLUMN 610B)
BOTH INTERVIEWEE AND MOTHER 05 (GO TO NEXT COLUMN 610B)
INTERVIEWEE'S RELATIVES 06 (GO TO NEXT COLUMN 610B)
MOTHER'S RELATIVES 07 (GO TO NEXT COLUMN 610B)
OTHER (SPECIFY) ____96 (GO TO NEXT COLUMN 610B)
DURING DELIVERY:
FREE 01 (GO TO NEXT COLUMN 610C)
INSURANCE 02 (GO TO NEXT COLUMN 610C)
INTERVIEWEE 03 (GO TO NEXT COLUMN 610C)
CHILD'S MOTHER 04 (GO TO NEXT COLUMN 610C)
BOTH INTERVIEWEE AND MOTHER 05 (GO TO NEXT COLUMN 610C)
INTERVIEWEE'S RELATIVES 06 (GO TO NEXT COLUMN 610C)
MOTHER'S RELATIVES 07 (GO TO NEXT COLUMN 610C)
OTHER (SPECIFY) _____96 (GO TO NEXT COLUMN 610C)
6 WEEKS AFTER DELIVERY:
FREE 01 (GO TO 613)
INSURANCE 02 (GO TO 613)
INTERVIEWEE 03 (GO TO 613)
CHILD'S MOTHER 04 (GO TO 613)
BOTH INTERVIEWEE AND MOTHER 05 (GO TO 613)
INTERVIEWEE'S RELATIVES 06 (GO TO 613)
MOTHER'S RELATIVES 07 (GO TO 613)
OTHER (SPECIFY) _____96 (GO TO 613)

612. What was the reason (NAME'S MOTHER) did not have an antenatal appointment or health care during pregnancy, delivery and six weeks after delivery?

DURING PREGNANCY
IT WAS NOT NECESSARY 01 (GO TO NEXT COLUMN 610B)
IS NOT COMMON 02 (GO TO NEXT COLUMN 610B)
INTERVIEWEE DID NOT ALLOW IT 03 (GO TO NEXT COLUMN 610B)
TOO EXPENSIVE 04 (GO TO NEXT COLUMN 610B)
TOO FAR/LACK OF TRANSPORTATION 05 (GO TO NEXT COLUMN 610B)
BAD SERVICES 06 (GO TO NEXT COLUMN 610B)
LACK OF KNOWLEDGE 07 (GO TO NEXT COLUMN 610B)
OTHER (SPECIFY) _____96 (GO TO NEXT COLUMN 610B)
DURING DELIVERY
IT WAS NOT NECESSARY 01 (GO TO NEXT COLUMN 610C)
IS NOT COMMON 02 (GO TO NEXT COLUMN 610C)
INTERVIEWEE DID NOT ALLOW IT 03 (GO TO NEXT COLUMN 610C)
TOO EXPENSIVE 04 (GO TO NEXT COLUMN 610C)
TOO FAR/LACK OF TRANSPORTATION 05 (GO TO NEXT COLUMN 610C)
BAD SERVICES 06 (GO TO NEXT COLUMN 610C)
LACK OF KNOWLEDGE 07 (GO TO NEXT COLUMN 610C)
OTHER (SPECIFY) _____96 (GO TO NEXT COLUMN 610C)
SIX WEEKS AFTER DELIVERY
IT WAS NOT NECESSARY 1
IS NOT COMMON 02
INTERVIEWEE DID NOT ALLOW IT 03
TOO EXPENSIVE 04
TOO FAR/LACK OF TRANSPORTATION 05
BAD SERVICES 06
LACK OF KNOWLEDGE 07
OTHER (SPECIFY) _____96

613. When (NAME'S MOTHER) was pregnant, did you talk to a health worker about her pregnancy/health in general?

YES 1
NO 2

614. CHECK 602 AND 604:

NAME OF LAST CHILD ___________
(LAST) CHILD ALIVE (GO TO 615)
(LAST) CHILD DEAD, DOESN'T KNOW (GO TO 617)

615. Does (NAME) live with you?

YES 1
NO 2 (GO TO 617)

616. In your household, who usually decides what to do when (NAME) gets sick?
PROBE: Anyone else?
RECORD ALL ANSWERS MENTIONED.

INTERVIEWEE A
CHILD'S MOTHER B
STEPMOTHER C
FEMALE RELATIVE D
MALE RELATIVE E
OTHER (SPECIFY) _____X
CHILD WAS NEVER SICK Y

Now I would like to know about the pregnancy and the child's health care:

617. Sometimes a pregnancy can have complications and the mother or the child could die. What signs or symptoms tell you that a pregnancy can be difficult?
PROBE: Any other symptoms?
RECORD ALL ANSWERS MENTIONED.

VAGINAL DISCHARGE A
HIGH TEMPERATURE FEVER B
ABDOMINAL PAIN C
SWOLLEN FEET/HANDS D
LONG DELIVERY PROCESS E
CONVULSIONS F
OTHER (SPECIFY) _____X
DOESN'T KNOW ANY SIGNS OR SYMPTOMS Z

618. 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

619. Have you ever heard about a fluid called 'Mixture' (salts ORS) that is given to children to treat diarrhea?

YES 1
NO 2

625. Some people are circumcised. Are you circumcised?

YES 1
NO 2 (GO TO 629)
DOESN'T KNOW 8 (GO TO 632)

626. How old were you when you were circumcised?

AGE____

627. Was circumcision performed by traditional methods or by a doctor?

TRADITIONAL METHOD 1
DOCTOR 2
DOESN'T KNOW 8

628. What was the reason to get circumcised?

TRADITION/RELIGION 01(GO TO 632)
HEALTH/HYGIENE 02 (GO TO 632)
SEXUAL SATISFACTION 03 (GO TO 632)
IS EASIER TO USE A CONDOM 04 (GO TO 632)
OTHER (SPECIFY) ____96 (GO TO 632)
DOESN'T KNOW 98 (GO TO 632)

629. Would you be interested in getting circumcised if the process was safe and affordable?

YES 1
NO 2 (GO TO 631)
DOESN'T KNOW 8 (GO TO 632)

630. Why?

TRADITION/RELIGION 01(GO TO 632)
HEALTH/HYGIENE 02 (GO TO 632)
SEXUAL SATISFACTION 03 (GO TO 632)
IS EASIER TO USE A CONDOM 04 (GO TO 632)
OTHER (SPECIFY) ____96 (GO TO 632)
DOESN'T KNOW 98 (GO TO 632)

631. Why wouldn't you be interested in circumcision?

TRADITION/RELIGION 01
DOESN'T WANT IT 02
SEXUAL SATISFACTION 03
IS EASIER TO USE A CONDOM 04
TOO EXPENSIVE 05
IS PAINFUL 06
OTHER (SPECIFY) ____96
DOESN'T KNOW 98

632. Do you currently smoke or consume any type of tobacco?
IF 'YES': What type?
RECORD ALL ANSWERS MENTIONED.

YES, CIGARETTES A
YES, PIPE B
YES, OTHER TYPE OF TOBACCO C
NO Y (GO TO 635)

633. CHECK 632:

CODE 'A' CIRCLED (GO TO 634)
CODE 'A' NOT CIRCLED (GO TO 635)

634. During the last 24 hours, how many cigarettes have you smoked?

NUMBER OF CIGARETTES______

635. Have you ever consumed an alcoholic beverage?

YES 1
NO 2 (GO TO 701)

636. During the last three months, how many days a week did you consume alcohol?
IF ANSWER IS EVERYDAY, RECORD '90'.

NUMBER OF DAYS A WEEK ______
NONE 95

637. Have you ever been drunk?

YES 1
NO 2 (GO TO 701)

638. CHECK 636:

CONSUMED ALCOHOL AT LEAST ONE DAY (GO TO 639)
NONE (GO TO 701)

639. During the last three months, how many times were you drunk?

NUMBER OF TIMES_______
NONE 95

SECTION 7. HIV/AIDS

701. Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 724)

701A. From which sources of information have you learned most about 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/PARTNERS I
WORKPLACE J
HEALTH POST K
HEALTH CENTER/HOSPITAL L
HEALTH ACTIVIST M
PRIVATE CLINIC N
ADOLESCENT SPECIAL SERVICES O
OTHER (SPECIFY) ______ X

701B. Do you think that HIV/AIDS has a cure?
RECORD ALL ANSWERS MENTIONED.

YES 1
NO 2 (GO TO 701D)
DOESN'T KNOW 8 (GO TO 701D)

701C. 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

701D. Do you think that HIV/AIDS is a mortal illness?

YES 1
NO 2
UNSURE 3
DOESN'T KNOW 8

701E. Do you think that the risk of you contracting HIV/AIDS is low, moderate, high or not at risk at all?

NO RISK AT ALL 1
LOW RISK 2
MODERATE RISK 4
HIGH RISK 5
DOESN'T KNOW 8

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

YES 1
NO 2 (GO TO 709)
DOESN'T KNOW 8 (GO TO 709)

703. What can a person do to avoid the risk of contracting 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) ______ X

704. 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

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

YES 1
NO 2
DOESN'T KNOW 8

706. 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

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

YES 1
NO 2
DOESN'T KNOW 8

708. Can people avoid the AIDS virus by abstaining from sex?

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2

711. Can the virus that causes AIDS be transmitted from mother to a child?

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

712. Can the virus that causes AIDS be transmitted from mother to a child:

A. During pregnancy?
YES 1
NO 2
DOESN'T KNOW 8
B. During delivery?
YES 1
NO 2
DOESN'T KNOW 8
C. By breastfeeding?
YES 1
NO 2
DOESN'T KNOW 8

712A. Can a mother infected with the AIDS virus avoid transmitting it to her child by taking appropriate drugs during pregnancy?

YES 1
NO 2
DOESN'T KNOW 8

713. CHECK 401 IF CURRENTLY MARRIED/IN A CIVIL UNION:

YES, CURRENTLY MARRIED/IN A CIVIL UNION (GO TO 714)
NO, NOT IN A CIVIL UNION (GO TO 715)

714. Have you ever talked about ways to prevent getting the virus that causes AIDS with your wife/partner?
IF MAN HAS MORE THAN ONE WIFE/PARTNER, ASK FOR WHICH ONE OF THEM.

YES 1
NO 2

715. In your opinion is it acceptable or not acceptable to provide information on family planning by means of:

A. On the radio?
B. On the television?
C. In the newspaper?

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

715A. If you knew that the produce vendor has the AIDS virus, would you buy his/her products?

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

718. If a teacher had the virus that caused AIDS but was not sick, could s/he continue teaching in school?

YES 1
NO 2
DOESN'T KNOW 8

719. Can you talk to your children ages 12-14 about the use of condoms to prevent AIDS?

YES 1
NO 2
DOESN'T KNOW 8

720. I am not interested in knowing the results, but have you ever had an AIDS test?

YES 1
NO 2 (GO TO 721)

720A. When was the last time you were tested for AIDS?

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

720B. 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

720C. I am not interested in knowing the results, but did you get the results of that test?

YES 1
NO 2 (GO TO 723A)

720D. Did you receive any advice?

YES 1 (GO TO 723A)
NO 2 (GO TO 723A)

721. Would you like to be tested for AIDS?

YES 1
NO 2

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

YES 1
NO 2 (GO TO 724)

723. Where is that?
723A. 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
RURAL HOSPITAL 13
HEALTH CENTER 14
GATV (Office for Advice and Voluntary Testing of HIV/AIDS) 15
OTHER PUBLIC SECTOR (SPECIFY) ____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL 21
PRIVATE CLINIC 22
PRIVATE DOCTOR 23
PRIVATE PHARMACY 24
PRIVATE LABORATORY 25
OTHER PRIVATE MEDICAL (SPECIFY) ___26

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

YES 1
NO 2 (GO TO 727)

725. 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 DURING 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

726. 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 IN 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

727. CHECK 416:
HAVE YOU HAD SEXUAL RELATIONS?

HAD SEXUAL RELATIONS (GO TO 727A)
NEVER HAD SEXUAL RELATIONS (GO TO 801)

727A. CHECK 724:
DO YOU KNOW ABOUT STD?

KNOWS ABOUT STD (GO TO 728)
DOES NOT KNOW ABOUT STD (GO TO 729)

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

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

YES 1
NO 2
DOESN'T KNOW 8

729. Sometimes, the male penis can release an abnormal amount of discharge. During the last 12 months, have you had any abnormal secretion?

YES 1
NO 2
DOESN'T KNOW 8

730. 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

731. CHECK 728, 729, AND 730:

AT LEAST ONE 'YES' (GO TO 732)
NOT ONE 'YES' (GO TO 801)

732. The last time you had those problems (PROBLEMS MENTIONED IN 728, 729, AND 730), did you seek advice or treatment?

YES 1
NO 2 (GO TO 734)

733. The last time you had those problems (PROBLEMS MENTIONED IN 728, 729, AND 730), did you do any of the following:

A. Did you seek advice or treatment in a hospital, clinic or private clinic?
YES 1
NO 2
B. Did you seek advice or treatment/medicine from a traditional healer?
YES 1
NO 2
C. Did you seek advice or treatment/medicine from a pharmacy?
YES 1
NO 2
D. Did you seek advice or treatment with friends and relatives?
YES 1
NO 2

734. 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 PARTNER(S) 4 (GO TO 801)

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

YES 1
NO 2 (GO TO 801)
WIFE/PARTNER IS INFECTED 3 (GO TO 801)

736. 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 SEXUAL RELATIONS
YES 1
NO 2
USED CONDOM
YES 1
NO 2
TOOK MEDICINE/DRUGS
YES 1
NO 2

SECTION 8. ATTITUDE TOWARDS WOMEN

801. Who should have the last word in the following decisions: the husband, the wife or both:

A. Making large household purchases?
HUSBAND/RESPONDENT 1
WIFE/PARTNER 2
JOINTLY WITH WIFE/PARTNER 3
NOT SURE 8
B. Making purchases for daily needs?
HUSBAND/RESPONDENT 1
WIFE/PARTNER 2
JOINTLY WITH WIFE/PARTNER 3
NOT SURE 8
C. Visits to family or relatives?
HUSBAND/RESPONDENT 1
WIFE/PARTNER 2
JOINTLY WITH WIFE/PARTNER 3
NOT SURE 8
D. Food for daily consumption?
HUSBAND/RESPONDENT 1
WIFE/PARTNER 2
JOINTLY WITH WIFE/PARTNER 3
NOT SURE 8
E. Uses for wife's salary?
HUSBAND/RESPONDENT 1
WIFE/PARTNER 2
JOINTLY WITH WIFE/PARTNER 3
NOT SURE 8
F. How many children to have and when to have them?
HUSBAND/RESPONDENT 1
WIFE/PARTNER 2
JOINTLY WITH WIFE/PARTNER 3
NOT SURE 8

802. Sometimes the husband or partner gets upset about things that the wife/partner does. In your opinion, is the husband/partner justified in hitting his wife/partner?

A. If she leaves the house without notice?
YES 1
NO 2
NOT SURE/DEPENDS 8
B. If she is negligent in caring for the children?
YES 1
NO 2
NOT SURE/DEPENDS 8
C. If she argues with him?
YES 1
NO 2
NOT SURE/DEPENDS 8
D. If she refuses to have sexual relations with him?
YES 1
NO 2
NOT SURE/DEPENDS 8
E. If she burns the food?
YES 1
NO 2
NOT SURE/DEPENDS 8

803. When a wife knows that her husband has a sexually transmitted infection, is she justified in pressuring him to use a condom?

YES 1
NO 2
NOT SURE 8

804. Husbands and wives do not always agree on everything. Can you tell me if a woman is justified in refusing to have sexual relations with her husband when:

A. She feels tired and is not in the mood?
YES 1
NO 2
NOT SURE/DEPENDS 8
B. She has recently given birth?
YES 1
NO 2
NOT SURE/DEPENDS 8
C. She knows that her husband had sex with other women?
YES 1
NO 2
NOT SURE/DEPENDS 8
D. She knows that her husband has a sexually transmitted infection?
YES 1
NO 2
NOT SURE/DEPENDS 8

805. Do you think that if a woman refuses to have sex with her husband when he wants her to, he should have the right to:

A. Get mad and repress her?
YES 1
NO 2
NOT SURE/DEPENDS 8
B. Refuse to provide her money or other financial assistance?
YES 1
NO 2
NOT SURE/DEPENDS 8
C. Force her to have sex against her will?
YES 1
NO 2
NOT SURE/DEPENDS 8
D. Have sex with other women?
YES 1
NO 2
NOT SURE/DEPENDS 8

806. WRITE DOWN THE TIME:

HOUR ______
MINUTES ________

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 _____