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DEMOGRAPHIC AND HEALTH SURVEYS-MOZAMBIQUE 2011-WOMAN'S QUESTIONNAIRE

IDENTIFICATION

NAME OF HOUSEHOLD HEAD_______

PLACE NAME ________

PROVINCE_______

URBAN/RURAL

URBAN 1
RURAL 2

NAME AND NUMBER OF ENUMERATION AREA (DHS I.D.)_____

HOUSEHOLD NUMBER_______

NAME AND LINE NUMBER OF WOMAN_______

WOMAN SELECTED FOR DOMESTIC VIOLENCE MODULE___

INTERVIEWER VISITS

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

RESULT________

COMPLETED 1
ABSENT 2
POSTPONED 3
REFUSED COMPLETELY 4
REFUSED DURING INTERVIEW 5
PARTLY COMPLETED/INCOMPLETE 6
INCAPACITATED 7
OTHER (SPECIFY) ________ 8

NEXT VISIT: (FOR INTERVIEWERS 1 AND 2)
DATE_________
TIME_________

FINAL VISIT
DAY_________
MONTH_________
YEAR 2011
CODE_________
RESULT_________

TOTAL NUMBER OF VISITS_________

SUPERVISOR
NAME_________
DATE_________

SECTION 1: RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

Good morning/afternoon. My name is _________(SAY YOUR NAME) and I am working with the INE (NATIONAL INSTITUTE OF STATISTICS) and here is my identification (SHOW YOUR ID BADGE). We are conducting a survey about health all over the country. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 30 to 45 minutes to complete. All of the answers you give will be kept strictly confidential and will not be shared with anyone other than members of our survey team. We hope that you will participate in this survey since your views are important. If I ask you a question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.

In case that you need more information about the survey, you may contact the province delegate of Statistics.

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

SIGNATURE OF INTERVIEWER:____________ DATE:________________

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

101. RECORD THE TIME

HOUR_____
MINUTES____

102. In what month and year were you born?

MONTH ____
DON'T KNOW MONTH 98
YEAR ____
DON'T KNOW YEAR 9998

103. How old were you at your last birthday?
COMPARE AND CORRECT 102 AND/OR 03 IF INCONSISTENT

AGE IN COMPLETED YEARS_____

104. Have you ever attended school?

YES 1
NO 2 (GO TO 108)

105. 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

106. What is the highest grade/year you completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'

GRADE/YEAR_____

107. CHECK 105:

PRIMARY (GO TO 108)
SECONDARY OR HIGHER (GO TO 110)

108. Now I would like you to read this sentence to me.
SHOW CARD TO RESPONDENT. IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

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

109. CHECK 108:

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

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

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

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

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

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

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

113. What is your religion?

CATHOLIC 01
MUSLIM 02
ZION 03
EVANGELICAL/PENTECOSTAL 04
ANGLICAN 05
NO RELIGION 06 (GO TO 114)
OTHER (SPECIFY) _____96

113A. 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

114. What language did you grow up speaking?

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

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

NUMBER OF TIMES____
NONE 00 (GO TO 201)

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

YES 1
NO 2

SECTION 2. REPRODUCTION

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

YES 1
NO 2 (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 BIRTHS______

209. CHECK 208:
Just to make sure that I have this right: you have had in TOTAL _____births during your life. Is that correct?

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

210. CHECK 208:

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

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

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

NAME____

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

MALE 1
FEMALE 2

214. Is (NAME) a twin?

SING 1
MULT 2

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

MONTH____
YEAR____

216. Is (NAME) still alive?

YES 1
NO 2 (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 YR', 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. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME), including any children who died after birth?

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

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

YES 1
NO 2

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

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

224. CHECK 215:
ENTER THE NUMBER OF BIRTHS IN 2006 OR LATER.

NUMBER OF BIRTHS______
NONE 0 (GO TO 226)

225. FOR EACH BIRTH SINCE JANUARY 2006, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.) WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE.

226. Are you pregnant now?

YES 1
NO 2 (GO TO 230)
DON'T KNOW 8 (GO TO 230)

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

MONTHS________

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

YES 1 (GO TO 230)
NO 2

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

LATER 1
NO MORE 2

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

YES 1
NO 2 (GO TO 238)

231. When did the last such pregnancy end?

MONTH____
YEAR_____

232. CHECK 231:

LAST PREGNANCY ENDED IN JANUARY 2006 OR LATER (GO TO 233)
LAST PREGNANCY ENDED BEFORE JANUARY 2006 (GO TO 238)

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

MONTHS_______

234. Have you ever had any other pregnancies that did not result in a live birth, after January 2006?

YES 1
NO 2 (GO TO 236)

235. ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2006. ENTER 'T' IN CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

236. Did you have any pregnancies (miscarriages, abortions or stillbirths) that terminated before 2006, that did not result in a live birth?

YES 1
NO 2 (GO TO 238)

237. In what year and month did the last such pregnancy that terminated before 2006 end?

MONTH_____
YEAR_____

238. When did your last menstrual period start?

(DATE, IF GIVEN)____
DAYS AGO 1___
WEEKS AGO 2___
MONTHS AGO 3____
YEARS AGO 4_____

IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE THE LAST BIRTH 995
NEVER MENSTRUATED 996

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

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

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

JUST BEFORE HER PERIOD 1
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY)____ 5
DON'T KNOW 8

SECTION 3. CONTRACEPTION

301. Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid pregnancy. Which ways or methods have you heard about?
For methods not mentioned spontaneously, ask: Have you heard of (METHOD)?

01) Female Sterilization (Tubal ligation). PROBE: Women can have an operation to avoid having any more children.
YES 1
NO 2
02) Male Sterilization (Vasectomy). PROBE: Men can have an operation to avoid having any more children.
YES 1
NO 2
03) IUD. PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse to avoid pregnancy
YES 1
NO 2
04) Injectables. PROBE: Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO 2
05) Implants. PROBE: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
06) Pill. PROBE: Women can take pill every day to avoid pregnancy.
YES 1
NO 2
07) Condom. PROBE: Men can put a rubber sheath on their penis during sexual intercourse.
YES 1
NO 2
08) Female Condom. PROBE: Women can place a sheath on their vagina before sexual intercourse.
YES 1
NO 2
09) Lactational Amenorrhea Method (LAM). PROBE: 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. PROBE: 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. PROBE: Men can be careful and pull out before climax ejaculating outside of the vagina.
YES 1
NO 2
12) Emergency Contraception. PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
YES 1
NO 2
13) Diaphragm. PROBE: Women can place a diaphragm, inside themselves before intercourse.
YES 1
NO 2
14) Other Methods. PROBE: 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. CHECK 226:

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

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

YES 1
NO 2 (GO TO 311)

304. Which method are you using?

CIRCLE ALL MENTIONED.

IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.

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

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

MICROGENON 1 (GO TO 308A)
MICROLUT 2 (GO TO 308A)
OTHER (SPECIFY)____6 (GO TO 308A)
DON'T KNOW 8 (GO TO 308A)

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

JEITO A (GO TO 308A)
TRUST B (GO TO 308A)
DUREX C (GO TO 308A)
CONDOMI D (GO TO 308A)
MANOBRA E (GO TO 308A)
CONFIANÇA F (GO TO 308A)
PRODENCE G (GO TO 308A)
KAMA SUTRA H (GO TO 308A)
OTHER (SPECIFY)____X (GO TO 308A)
DON'T KNOW Z (GO TO 308A)

307. In what facility did the sterilization take place?
IF SOURCE IS HOSPITAL, OR HEALTH CENTER, 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/POST 14
MOBILE CLINIC 15
OTHER (SPECIFY)____ 16
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC 21
PRIVATE DOCTOR 22
PRIVATE NURSE 23
PHARMACY 24
OTHER (SPECIFY)____96
DON'T KNOW 98

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

MONTH___
YEAR___

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

YES (GO BACK TO 308/308A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION))
NO (GO TO 310)

310. CHECK 308/308A:

YEAR IS 2006 OR LATER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING)

YEAR IS 2005 OR EARLIER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO JANUARY 2006) (GO TO 322)

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

USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2006. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

IN COLUMN 1, ENTER METHOD USE CODE OR '0' FOR NON USE IN EACH BLANK MONTH.

ILLUSTRATIVE QUESTIONS:

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

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

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

ILLUSTRATIVE QUESTIONS:
Why did you stop using the (METHOD)? Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop for some other reason?

IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK: how many months did it take you to get pregnant after you stop using (METHOD)? AND ENTER '0' IN EACH SUCH MONTH IN COLUMN 1.

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

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

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

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

314. CHECK 304:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

NO CODE CIRCLED 00 (GO TO 324)
FEMALE STERILIZATION 01 (GO TO 317A)
MALE STERILIZATION 02 (GO TO 326)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMEN. METHOD 11 (GO TO 315A)
PERIODIC ABSTINENCE 12 (GO TO 315A)
WITHDRAWAL 13 (GO TO 326)
OTHER MODERN METHOD 95 (GO TO 326)
OTHER TRADITIONAL METHODS 96 (GO TO 326)

315. Where did you get the (CURRENT METHOD) the first time you used it?
315A. Where did you learn how to use the lactational amenorrhea method?

PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)___________
PUBLIC SECTOR
CENTRAL HOSPITAL 11
PROVINCIAL/GENERAL HOSPITAL 12
RURAL HOSPITAL 13
HEALTH CENTER/POST 14
MOBILE CLINIC 15
PHARMACY 16
OTHER (SPECIFY)____ 17
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC 21
PRIVATE DOCTOR 22
PRIVATE NURSE 23
PHARMACY 24
SHOP 25
GAS STATION 26
BAR/DISCOTHEQUE 27
INFORMATION STAND/BOOTH 28
OTHER (SPECIFY)___29
OTHER SOURCE
SCHOOL 31
MARKET/STORE 32
CHURCH 33
FRIEND/RELATIVE 34
TRADITIONAL HEALER 35
ADOLESCENT SPECIAL SERVICES 36
OTHER (SPECIFY)____96

316. CHECK 304:

CIRCLE METHOD CODE:

IF MORE THAN ONE CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
MALE STERILIZATION 07 (GO TO 323)
FEMALE STERILIZATION 08 (GO TO 320)
DIAPHRAGM 09 (GO TO 320)
FOAM/JELLY 10 (GO TO 320)
LACTATIONAL AMEN. METHOD 11 (GO TO 326)
PERIODIC ABSTINENCE 12 (GO TO 326)

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

YES 1 (GO TO 319)
NO 2

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

YES 1
NO 2 (GO TO 320)

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

YES 1
NO 2

320. CHECK 317/317A:

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

CODE '1' NOT CIRCLED: When you obtained (CURRENT METHOD) were you told about other methods of family planning that you could use?

YES 1 (GO TO 322)
NO 2

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

YES 1
NO 2

322. CHECK 304:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

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

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

PROBE TO IDENTIFY THE TYPE OF SOURCE

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

(NAME OF PLACE)_______
PUBLIC SECTOR
CENTRAL HOSPITAL 11 (GO TO 326)
PROVINCIAL/GENERAL HOSPITAL 12 (GO TO 326)
RURAL HOSPITAL 13 (GO TO 326)
HEALTH CENTER/POST 14 (GO TO 326)
MOBILE CLINIC 15 (GO TO 326)
PHARMACY 16 (GO TO 326)
OTHER (SPECIFY)____ 17 (GO TO 326)
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC 21 (GO TO 326)
PRIVATE DOCTOR 22 (GO TO 326)
PRIVATE NURSE 23 (GO TO 326)
PHARMACY 24 (GO TO 326)
SHOP 25 (GO TO 326)
GAS STATION 26 (GO TO 326)
BAR/DISCOTHEQUE 27 (GO TO 326)
INFORMATION STAND/BOOTH 28 (GO TO 326)
OTHER (SPECIFY)____29 (GO TO 326)
OTHER SOURCE
SCHOOL 31 (GO TO 326)
MARKET/STORE 32 (GO TO 326)
CHURCH 33 (GO TO 326)
FRIEND/RELATIVE 34 (GO TO 326)
TRADITIONAL HEALER 35 (GO TO 326)
ADOLESCENT SPECIAL SERVICES 36 (GO TO 326)
OTHER (SPECIFY)____96 (GO TO 326)

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

YES 1
NO 2 (GO TO 326)

325. Where is that? Any other place?

IF SOURCE IS HOSPITAL, HEALTH CENTER OR CLINIC, WRITHE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

RECORD ALL PLACES MENTIONED.

(NAME OF PLACE(S))_________
PUBLIC SECTOR
CENTRAL HOSPITAL A
PROVINCIAL/GENERAL HOSPITAL B
RURAL HOSPITAL C
HEALTH CENTER/POST D
MOBILE CLINIC E
PHARMACY F
OTHER (SPECIFY)____G
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC H
PRIVATE DOCTOR I
PRIVATE NURSE J
PRIVATE PHARMACY K
SHOP L
GAS STATION M
BAR/DISCOTHEQUE N
INFORMATION STAND/BOOTH O
OTHER (SPECIFY)___ P
OTHER SOURCE
SCHOOL Q
MARKET/STORE R
CHURCH S
FRIEND/RELATIVE T
TRADITIONAL HEALER U
ADOLESCENT SPECIAL SERVICES V
OTHER (SPECIFY)____X

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 401)

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

YES 1
NO 2

SECTION 4. PREGNANCY AND POSTNATAL CARE

401. CHECK 224:

ONE OR MORE BIRTHS IN 2006 OR LATER (GO TO 402)
NO BIRTHS IN 2006 OR LATER (GO TO 556)

402. CHECK 215: ENTER THE LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH IN 2006 OR LATER IN THE TABLE.
ASK THE QUESTIONS ABOUT ALL THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OR 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 Q. 212 IN BIRTH HISTORY.

BIRTH HISTORY NUMBER______

404. FROM 212 AND 216:

NAME_____
LIVING (GO TO 405)
DEAD (GO TO 405)

405. At the time you became pregnant with (NAME), did you want to get pregnant at that time?

YES 1 (GO TO 408)
NO 2

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

LATER 1
NO MORE 2 (GO TO 408)

407. How much longer did you want to wait?

MONTHS 1 _____
YEARS 2 _____

DON'T KNOW 998____

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

YES 1
NO 2 (GO TO 415)

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

HEALTH PERSONNEL
DOCTOR A
NURSE B
MIDWIFE C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
OTHER (SPECIFY) ______X

410. Where did you receive antenatal care for this pregnancy? Anywhere else?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

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

411. How many months pregnant were you when you first received antenatal care?

MONTHS_____
DON'T KNOW 98

412. How many antenatal appointments did you have during this pregnancy?

NUMBER OF TIMES____
DON'T KNOW 98

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

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

414. During (any of) your antenatal care visit(s), were you told about the signs of pregnancy complications?

YES 1
NO 2
DON'T KNOW 8

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

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

416. During this pregnancy, how many times did you get a tetanus injection?
IF 7 OR MORE TIMES, RECORD '7'

NUMBER OF TIMES____
DON'T KNOW 8

417. CHECK 416:

2 OR MORE TIMES (GO TO 421)
OTHER (GO TO 418)

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

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

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

TIMES ______
DON'T KNOW 8

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

YEARS AGO ___

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

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

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

NUMBER OF DAYS_____
DON'T KNOW 998

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

YES 1
NO 2
DON'T KNOW 8

424. During this pregnancy, did you take any drugs to keep you from getting malaria?

YES 1
NO 2 (GO TO 430)
DON'T KNOW 8 (GO TO 430)

425. What drugs did you take?
RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.

SP/FANSIDAR A
CHLOROQUINE B
OTHER (SPECIFY) ______X
DON'T KNOW Z

426. CHECK 425:
DRUGS TAKEN FOR MALARIA PREVENTION

CODE 'A' CIRCLED (GO TO 427)
CODE 'A' NOT CIRCLED (GO TO 430)

427. How many times did you take (SP/Fansidar) during this pregnancy?

TIMES___

428. CHECK 409:
ANTENATAL CARE FROM HEALTH PERSONNEL DURING THIS PREGNANCY.

CODE 'A', 'B' OR 'C' CIRCLED (GO TO 429)
OTHER (GO TO 430)

429. Did you get the (SP/Fansidar) during any antenatal care visit, during another visit to a health facility or from another source?

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6

430. 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
DON'T KNOW 8

431. Was (NAME) weighed at birth?

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

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

KILOGRAMS FROM CARD 1____
KILOGRAMS FROM RECALL 2____

DON'T KNOW 9998

433. Who assisted with the delivery of (NAME)? Anyone else?

PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.
IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

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

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

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)________
HOME
YOUR HOME 11 (GO TO 438)
OTHER HOME 12 (GO TO 438)
PUBLIC SECTOR
CENTRAL HOSPITAL 21
PROVINCIAL/GENERAL HOSPITAL
RURAL HOSPITAL 22
HEALTH CENTER/POST 23
OTHER (SPECIFY)____ 26
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC 31
PRIVATE DOCTOR'S OFFICE 32
OTHER PRIVATE MEDICAL (SPECIFY)___36
OTHER (SPECIFY)___96 (GO TO 438)

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

YES 1
NO 2

436. Before you were discharged after (NAME) was born, did anyone check on your health while you were still in the facility?

YES 1 (GO TO 439)
NO 2

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

YES 1 (GO TO 439)
NO 2 (GO TO 446)

438. After (NAME) was born, did anyone check on your health?

YES 1
NO 2 (GO TO 442)

439. Who checked on your health after delivery?

HEALTH PERSONNEL
DOCTOR 11
NURSE 12
MIDWIFE 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
OTHER (SPECIFY)___ 96

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

HOURS 1__
DAYS 2__
WEEKS 3__

DON'T KNOW 998

441. CHECK 437:

YES (GO TO 446)
NOT ASKED (GO TO 442)

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

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

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

HOURS 1___
DAYS 2___
WEEKS 3___

DON'T KNOW 998

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

HEALTH PERSONNEL
DOCTOR 11
NURSE 12
MIDWIFE 13
OTHER 14
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
FRIEND/RELATIVE 22
OTHER (SPECIFY)____96

445. Where did this first check of (NAME) take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)________
HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
CENTRAL HOSPITAL 21
PROVINCIAL/GENERAL HOSPITAL
RURAL HOSPITAL 22
HEALTH CENTER/POST 23
OTHER (SPECIFY)____ 26
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC 31
PRIVATE DOCTOR'S OFFICE 32
OTHER PRIVATE MEDICAL (SPECIFY)___36
OTHER (SPECIFY)___96

446. In the first two months after delivery, did you receive a vitamin A does like this?
SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS

YES 1
NO 2
DON'T KNOW 8

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

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

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

YES 1
NO 2 (GO TO 452)

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

MONTHS_____
DON'T KNOW 98

450. CHECK 226:
IS RESPONDENT PREGNANT?

NOT PREGNANT (GO TO 451)
PREGNANT OR UNSURE (GO TO 452)

451. Have you resumed sexual relations since the birth of (NAME)?

YES 1
NO 2 (GO TO 453)

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

MONTHS_____
DON'T KNOW 98

453. Did you ever breastfeed (NAME)?

YES 1 (GO TO 455)
NO 2

454. CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 460)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 501)

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

IMMEDIATELY 000

HOURS 1_____
DAYS 2______

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

YES 1
NO 2 (GO TO 458)

457. 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 WATER SOLUTION C
SUGAR OR GLUCOSE WATER D
FRUIT JUICE E
INFANT FORMULA F
TEA G
HONEY H
OTHER (SPECIFY)___X

458. CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 459)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 501)

459. Are you still breastfeeding (NAME)?

YES 1
NO 2

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

YES 1
NO 2
DON'T KNOW 8

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

SECTION 5. CHILD IMMUNIZATION, HEALTH AND NUTRITION

501. ENTER LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH IN 2006 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS, BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

502. LINE NUMBER FROM Q. 212

LINE NUMBER _____

503. FROM Q. 212 AND Q. 216

NAME______
LIVING (GO TO 504)
DEAD (GO TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

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

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

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

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

506. (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 (POLIO GIVEN AT BIRTH)
DAY____
MONTH____
YEAR____
DPT/HEPATITIS B 1
DAY____
MONTH____
YEAR____
POLIO 1
DAY____
MONTH____
YEAR____
DTP/HEPATITIS B 2
DAY____
MONTH____
YEAR____
POLIO 2
DAY____
MONTH____
YEAR____
DTP/HEPATITIS B 3
DAY____
MONTH____
YEAR____
POLIO 3
DAY____
MONTH____
YEAR____
MEASLES
DAY____
MONTH____
YEAR____
VITAMIN A (MOST RECENT)
DAY____
MONTH____
YEAR____

507. CHECK 506:

BCG TO MEASLES ALL RECORDED (GO TO 511)
OTHER (GO TO 508)

508. Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations received in a national immunization day campaign?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3 AND/OR MEASLES AND VITAMIN A VACCINE(S).

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

509. 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 511)
DON'T KNOW 8 (GO TO 511)

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

510A. A BCG vaccination against tuberculosis, that is an injection in the arm that leaves a scar?

YES 1
NO 2
DON'T KNOW 8

510B. POLIO vaccine, that is drops in the mouth?

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

510C. Was the first POLIO vaccine received in the first two weeks after birth or later?

FIRST TWO WEEKS 1
LATER 2

510D. How many times was the POLIO vaccine received?

NUMBER OF TIMES____

510E. TETRAVALENT/PENTA (DPT/ Hep. B), that is, an injection given at the same time as polio drops?

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

510F. How many times was TETRAVALENT (DPT/Hep. B) received?

NUMBER OF TIMES____

510G. A MEASLES injection or an MMR injection, that is, a shot in the arm to prevent him/her from getting measles?

YES 1
NO 2
DON'T KNOW 8

511. Within the last six months, has (NAME) received a vitamin A dose?
SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

512. In the last seven days, did (NAME) take iron pills, sprinkles with iron, or iron syrup (like this/any of these)?
SHOW COMMON TYPES OF PILLS/SPRINKLES/SYRUPS

YES 1
NO 2
DON'T KNOW 8

513. Has (NAME) taken any drug for intestinal worms in the last six months?

YES 1
NO 2
DON'T KNOW 8

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

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

515. Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

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

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

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

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

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

YES 1
NO 2 (GO TO 522)

519. Where did you seek advice or treatment?
Anywhere else?
RECORD ALL RESPONSES

(NAME OF PLACE)________
PUBLIC SECTOR
HEALTH CENTER A
MOBILE CLINIC B
OTHER: (SPECIFY)____ C
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC D
PRIVATE PHARMACY E
PRIVATE DOCTOR F
OTHER PRIVATE MEDICAL (SPECIFY)___ G
OTHER SOURCE
SHOP H
TRADITIONAL HEALTH HEALER I
MEDICAL STAFF IN THE NEIGHBORHOOD J
OTHER (SPECIFY) ______ X

520. CHECK 519:

TWO OR MORE CODES CIRCLED (GO TO 521)
ONLY ONE CODE CIRCLED (GO TO 522)

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

FIRST PLACE_____

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

a) A fluid made from a special packet called Oral Rehydration Salts (ORS)?
YES 1
NO 2
DON'T KNOW 8
b) A home-made sugar-salt-water solution?
YES 1
NO 2
DON'T KNOW 8
c) Rice water?
YES 1
NO 2
DON'T KNOW 8

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

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

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

PILLS/SYRUP A
INJECTION B
(I.V) INTRAVENOUS C
HOME REMEDIES/HERBAL MEDICINES D
OTHER (SPECIFY) ______ X

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

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

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

YES 1
NO 2
DON'T KNOW 8

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

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

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

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

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

CHEST ONLY 1 (GO TO 531)
NOSE ONLY 2 (GO TO 531)
BOTH 3 (GO TO 531)
OTHER (SPECIFY) ______ 6 (GO TO 531)
DON'T KNOW 8 (GO TO 531)

530. CHECK 525:
HAD FEVER?

YES (GO TO 531)
NO OR DON'T KNOW (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS GO TO 553)

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

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

532. When (NAME) had a (fever/cough), was he/she given less than usual to eat, about the same amount, or more than usual to eat? 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
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 537)

534. Where did you seek advice or treatment?
Anywhere else?
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

RECORD ALL RESPONSES.

(NAME OF PLACE)______
PUBLIC SECTOR
HEALTH CENTER A
MOBILE CLINIC B
OTHER (SPECIFY)____ C
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC D
PRIVATE PHARMACY E
PRIVATE DOCTOR F
OTHER PRIVATE MEDICAL (SPECIFY)___ G
OTHER SOURCE
SHOP H
TRADITIONAL HEALTH HEALER I
MEDICAL STAFF IN THE NEIGHBORHOOD J
OTHER (SPECIFY) ______ X

535. CHECK 534:

TWO OR MORE CODES CIRCLED (GO TO 536)
ONLY ONE CODE CIRCLED (GO TO 537)

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

FIRST PLACE_____

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

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

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

ANTIMALARIAL DRUGS
SP/FANSIDAR A
CHLOROQUINE B
AMODIAQUINE C
QUININE D
COMBINATION WITH ARTEMISININ E
COARTEM F
OTHER ANTIMALARIAL (SPECIFY)___G
ANTIBIOTIC DRUGS
PILL/SYRUP H
INJECTION I
OTHER DRUGS
ASPIRIN J
ACETAMINOPHEN K
IBUPROFEN L
OTHER (SPECIFY)___X
DON'T KNOW Z

539. CHECK 538:
ANY CODE A-G CIRCLED?

YES (GO TO 540)
NO (GO BACK TO 503 IN NEXT COLUMN, OR IF NO MORE BIRTHS GO TO 553)

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

CODE 'A' CIRCLED (GO TO 541)
CODE 'A' NOT CIRCLED (GO TO 542)

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

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

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

CODE 'B' CIRCLED (GO TO 543)
CODE 'B' NOT CIRCLED (GO TO 544)

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

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

544. CHECK 538:
AMODIAQUINE ('C') GIVEN

CODE 'C' CIRCLED (GO TO 545)
CODE 'C' NOT CIRCLED (GO TO 546)

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

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

546. CHECK 538:
QUININE ('D') GIVEN

CODE 'D' CIRCLED (GO TO 547)
CODE 'D' NOT CIRCLED (GO TO 548)

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

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

548. CHECK 538:
COMBINATION WITH ARTEMISININ ('E') GIVEN

CODE 'E' CIRCLED (GO TO 549)
CODE 'E' NOT CIRCLED (GO TO 550)

549. How long after the fever started did (NAME) first take (COMBINATION WITH ARTEMISININ)?

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

549A. CHECK 538:
COARTEM GIVEN?

CODE 'F' CIRCLED (GO TO 549B)
CODE 'F' NOT CIRCLED (GO TO 550)

549B. How long after the fever started did (NAME) first take COARTEM?

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

550. CHECK 538:
OTHER ANTIMALARIAL ('G') GIVEN?

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

551. How long after the fever started did (NAME) first take (other antimalarial)?

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

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

553. CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2006 OR LATER LIVING WITH THE RESPONDENT

ONE OR MORE (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER (AND CONTINUE WITH 554))
(NAME)____
NONE (GO TO 556)

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

CHILD USED TOILET OR LATRINE 01
PUT/RINSED INTO TOILET OR LATRINE 02
THROWN INTO GARBAGE 03
PUT/RINSED INTO DRAIN OR DITCH 04
BURIED 05
LEFT IN THE OPEN 06
OTHER (SPECIFY)___96

555. CHECK 522(a) AND 522(b), ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID (GO TO 556)
ANY CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID (GO TO 557)

556. Have you ever heard of a special product called (Oral Rehydration Salts) you can get for the treatment of diarrhea?

YES 1
NO 2

557. CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2008 OR LATER LIVING WITH THE RESPONDENT

ONE OR MORE (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER (AND CONTINUE WITH 558))
(NAME)____
NONE (GO TO 601)

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

Did (NAME FROM 557) (drink/eat):

a) Plain water?
YES 1
NO 2
DON'T KNOW 8
b) Juice or juice drinks?
YES 1
NO 2
DON'T KNOW 8
c) Clear broth
YES 1
NO 2
DON'T KNOW 8
d) Milk such as tinned, powdered or fresh animal milk?
YES 1
NO 2
DON'T KNOW 8
IF YES: How many times did (NAME) drink milk?
IF 7 OR MORE TIMES, RECORD '7'
NUMBER OF TIMES DRANK MILK___
e) Infant formula?
YES 1
NO 2
DON'T KNOW 8
IF YES: How many times did (NAME) drink infant formula?
IF 7 OR MORE TIMES, RECORD '7'
NUMBER OF TIMES DRANK INFANT FORMULA ___
f) Any other liquids?
YES 1
NO 2
DON'T KNOW 8
g) Yogurt?
YES 1
NO 2
DON'T KNOW 8
IF YES: How many times did (NAME) eat yogurt?
IF 7 OR MORE TIMES, RECORD '7'
NUMBER OF TIMES DRANK YOGURT___
h) Any Cerelac?
YES 1
NO 2
DON'T KNOW 8
i) Rice, corn, wheat, noodles, or other foods made from grains?
YES 1
NO 2
DON'T KNOW 8
j) Chayote squash, carrots, squash, or sweet potatoes that are yellow or orange inside?
YES 1
NO 2
DON'T KNOW 8
k) White potatoes, white yams, manioc, cassava, or any other foods made from roots?
YES 1
NO 2
DON'T KNOW 8
l) Any dark green, leafy vegetables?
YES 1
NO 2
DON'T KNOW 8
m) Ripe mangoes or papayas?
YES 1
NO 2
DON'T KNOW 8
n) Any other fruits or vegetables (ripe banana, apple, tomato, limes, orange, tangerine, guava, grapes, cauliflower)?
YES 1
NO 2
DON'T KNOW 8
o) Liver, kidney, heart or other organ meats?
YES 1
NO 2
DON'T KNOW 8
p) Any meat, such as beef, pork, lamb, goat, chicken, or duck?
YES 1
NO 2
DON'T KNOW 8
q) Eggs?
YES 1
NO 2
DON'T KNOW 8
r) Fresh or dried fish or shellfish?
YES 1
NO 2
DON'T KNOW 8
s) Any foods made from beans, peas, lentils, or nuts?
YES 1
NO 2
DON'T KNOW 8
t) Cheese, yogurt or other food made from milk?
YES 1
NO 2
DON'T KNOW 8
u) Palm oil, any oils, fats or butter, or foods made with any of these?
YES 1
NO 2
DON'T KNOW 8
v) Any other solid, semi-solid, or soft food?
YES 1
NO 2
DON'T KNOW 8

559. CHECK 558 (CATEGORIES "g" THROUGH "v")

AT LEAST ONE 'YES' OR ALL 'DON'T KNOW' (GO TO 561)
NOT A SINGLE 'YES' (GO TO 560)

560. Did (NAME) eat any solid, semi-solid, or soft foods yesterday during the day or at night?

YES 1 (GO BACK TO 558 TO RECORD FOOD EATEN YESTERDAY)
NO 2 (GO TO 601)
DON'T KNOW 8 (GO TO 601)

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

NUMBER OF TIMES____
DON'T KNOW 8

SECTION 6. MARRIAGE AND SEXUAL ACTIVITY

601. Are you currently married or living together with a man as if married?

YES, CURRENTLY MARRIED 1 (GO TO 604)
YES, LIVING WITH A MAN 2 (GO TO 604)
NO, NOT IN UNION 3

602. Have you ever been married or lived together with a man as if married?

YES, FORMERLY MARRIED 1
YES, LIVED WITH A MAN 2
NO 3 (GO TO 612)

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

WIDOWED 1 (GO TO 609)
DIVORCED 2 (GO TO 609)
SEPARATED 3 (GO TO 609)

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

605. 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________

606. Does your husband/partner have any other wives or does he live with other women as if married?

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

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

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

608. Are you the first, second… wife?

RANK_______

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

ONCE 1
MORE THAN ONCE 2

610. CHECK 609:

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: In what month and year did you start living with your first husband/partner?

MONTH_____
DON'T KNOW MONTH 98
YEAR_____ (GO TO 612)
DON'T KNOW YEAR 9998

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

AGE_______

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

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

NEVER HAD SEXUAL INTERCOURSE 00 (GO TO 628)
AGE IN YEARS ______
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95

614. Now I would like to ask some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone.

615. When was the last time you had sexual intercourse?
IF ANSWER IS IN LESS THAN 12 MONTHS, RECORD IN DAYS, WEEKS OR MONTHS. IF IS 12 OR MORE MONTHS RECORD IN YEARS. IF SAME DAY OR LAST NIGHT, RECORD '00' IN "DAYS AGO".

DAYS AGO 1____
WEEKS AGO 2___
MONTHS AGO 3____
YEARS AGO 4_____ (GO TO 627)

616. When was the last time you had sexual intercourse with this person?

DAYS 1 ____
WEEKS 2_____
MONTHS 3____

617. The last time you had sexual intercourse (with this second/third person), was a condom used?

YES 1
NO 2 (GO TO 619)

618. Did you use a condom every time you had sexual intercourse with this person in the last 12 months?

YES 1
NO 2

619. What was your relationship to this person with whom you had sexual intercourse?
IF BOYFRIEND: Were you living together as if married?
IF YES, CIRCLE '2'. IF NO, CIRCLE '3'

HUSBAND 1
LIVE-IN PARTNER 2
BOYFRIEND NOT LIVING WITH RESPONDENT 3 (GO TO 622)
CASUAL ACQUAINTANCE 4 (GO TO 622)
PROSTITUTE 5 (GO TO 622)
OTHER (SPECIFY)_____ 6 (GO TO 622)

620. CHECK 609:

MARRIED ONLY ONCE (GO TO 621)
MARRIED MORE THAN ONCE (GO TO 622)

621. CHECK 613:

FIRST TIME WHEN STARTED LIVING WITH FIRST HUSBAND (GO TO 623)
OTHER (GO TO 622)

622. How long ago did your first have sexual intercourse with this (second/third) person?

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

623. How many times during the last 12 months did you have sexual intercourse with this person?
IF NUMBER OF TIMES IS 95 OR MORE, WRITE '95'

NUMBER OF TIMES__

623A. Do you expect to have sexual intercourse with this person again?

YES 1
NO 2
UNSURE/DON'T KNOW 8

624. How old is this person?

AGE OF PARTNER______
DON'T KNOW 98

625. Apart from (this person/these two people), have you had sexual intercourse with any other person in the last 12 months?

YES 1 (GO BACK TO 616 IN NEXT COLUMN)
NO 2 (GO TO 627)

625A. How many partners do you currently have?

NUMBER OF PARTNERS_____
DON'T KNOW 98

626. In total, with how many different people have you had sexual intercourse in the last 12 months?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'

NUMBER OF PARTNERS LAST 12 MONTHS_____
DON'T KNOW 98

627. In total, with how many different people have you had sexual intercourse in your lifetime?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'

NUMBER OF PARTNERS IN LIFETIME_____
DON'T KNOW 98

628. BEFORE CONTINUING CHECK FOR THE PRESENCE OF OTHERS DURING THE SECTION

MALE ADULTS
YES 1
NO 2
FEMALE ADULTS
YES 1
NO 2
BOYS
YES 1
NO 2
GIRLS
YES 1
NO 2
CHILDREN
YES 1
NO 2

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

YES 1
NO 2 (GO TO 701)

630. Where is that? Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)_____
PUBLIC SECTOR
CENTRAL HOSPITAL A
PROVINCIAL/GENERAL HOSPITAL B
RURAL HOSPITAL C
HEALTH CENTER/POST D
MOBILE CLINIC E
PHARMACY F
OTHER (SPECIFY)____ G
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC H
PRIVATE DOCTOR I
PRIVATE NURSE J
PRIVATE PHARMACY K
SHOP L
GAS STATION M
BAR/ DISCOTHEQUE N
INFORMATION STAND/BOOTH O
OTHER (SPECIFY)____P
OTHER SOURCE
SCHOOL Q
MARKET/STORE R
CHURCH S
FRIEND/RELATIVE T
TRADITIONAL HEALER U
ADOLESCENT SPECIAL SERVICES V
OTHER (SPECIFY)____X

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

YES 1
NO 2
DON'T KNOW 8

SECTION 7. FERTILITY PREFERENCES

701. CHECK 304:

NEITHER STERILIZED (GO TO 702)
HE OR SHE STERILIZED (GO TO 712)

702. CHECK 226:

PREGNANT (GO TO 703)
NOT PREGNANT OR UNSURE (GO TO 704)

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

HAVE ANOTHER CHILD 1 (GO TO 705)
NO MORE 2 (GO TO 711)
UNDECIDED/DON'T KNOW 8 (GO TO 711)

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

HAVE (A/ANOTHER) CHILD 1
NO MORE 2 (GO TO 707)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 712)
UNDECIDED/DON'T KNOW 8 (GO TO 710)

705. CHECK 226:

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

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

MONTHS 1_____
YEARS 2____

SOON/NOW 993 (GO TO 710)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 712)
AFTER MARRIAGE 995 (GO TO 710)
OTHER (SPECIFY) ______ 996 (GO TO 710)
DON'T KNOW 998 (GO TO 710)

706. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 707)
PREGNANT (GO TO 711)

707. CHECK 303:

NOT CURRENTLY USING (GO TO 708)
CURRENTLY USING (GO TO 712)

708. CHECK 705:

NOT ASKED (GO TO 709)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 709)
00-23 MONTHS OR 00-01 YEAR (GO TO 711)

709. CHECK 703 AND 704:

WANTS TO HAVE A/ANOTHER CHILD: 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 you are not using a method? Any other reason?

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

RECORD ALL REASONS MENTIONED.

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

710. CHECK 303:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 711)
NO, NOT CURRENTLY USING (GO TO 711)
YES, CURRENTLY USING (GO TO 712)

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

YES 1
NO 2
DON'T KNOW 8

712. CHECK 216:

HAS LIVING CHILDREN: If you could go back to the time you did not have any children and could choose 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 714)
NUMBER____
OTHER (SPECIFY) ______96 (GO TO 714)

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

NUMBER OF BOYS____
OTHER (SPECIFY) ______96
NUMBER OF GIRLS_____
OTHER (SPECIFY) ______96
NUMBER OF EITHER_____
OTHER (SPECIFY) ______96

714. In the last few months have you:

Heard about family planning on the radio?
YES 1
NO 2
Seen anything about family planning on the television?
YES 1
NO 2
Read about family planning in a newspaper or magazine?
YES 1
NO 2
Read about family planning from a poster?
YES 1
NO 2
Read about family planning from leaflets or brochures?
YES 1
NO 2

716. CHECK 601:

YES CURRENTLY MARRIED (GO TO 717)
YES, LIVING WITH A MAN (GO TO 717)
NO, NOT IN UNION (GO TO 801)

717. CHECK 303:

NOT CURRENTLY USING (GO TO 718)
CURRENTLY USING (GO TO 720)

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

MAINLY RESPONDENT 1
MAINLY HUSBAND/PARTNER 1
JOINT DECISION 3
OTHER (SPECIFY)_____6

719. CHECK 304:

NEITHER STERILIZED (GO TO 720)
HE OR SHE STERILIZED (GO TO 801)

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

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

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

801. CHECK 601 AND 602:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 802)
FORMERLY MARRIED/LIVED WITH A MAN (GO TO 803)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 807)

802. How old was your husband/partner on his last birthday?

AGE IN COMPLETED YEARS____

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

YES 1
NO 2 (GO TO 806)

804. 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
DON'T KNOW 98 (GO TO 806)

805. What was the highest grade he completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'

GRADE____
DON'T KNOW 98

806. CHECK 801:

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

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

OCCUPATION________________

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

YES 1 (GO TO 811)
NO 2

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

YES 1 (GO TO 811)
NO 2

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

YES 1 (GO TO 811)
NO 2

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

YES 1
NO 2 (GO TO 815)

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

OCCUPATION____________________

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

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

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

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

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

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

815. CHECK 601:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 816)
NOT IN UNION (GO TO 823)

816. CHECK 814:

CODE '1' OR '2' CIRCLED (GO TO 817)
OTHER (GO TO 819)

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
OTHER (SPECIFY)_____6

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

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

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
HUSBAND/PARTNER HAS NO EARNINGS 4
OTHER (SPECIFY)_____6

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) 6

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) 6

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) 6

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

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

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

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

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

CHILDREN YOUNGER THAN 10
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
HUSBAND
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
OTHER MALES
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
OTHER FEMALES
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3

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

If she goes out without telling him?
YES 1
NO 2
DON'T KNOW 8
If she neglects the children?
YES 1
NO 2
DON'T KNOW 8
If she beats the children?
YES 1
NO 2
DON'T KNOW 8
If she argues with him?
YES 1
NO 2
DON'T KNOW 8
If she refuses to have sex with him?
YES 1
NO 2
DON'T KNOW 8
If she burns the food?
YES 1
NO 2
DON'T KNOW 8

SECTION 9. HIV/AIDS

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

YES 1
NO 2 (GO TO 937)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

906. Can people avoid the AIDS virus because of witchcraft or other supernatural means?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

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

909. CHECK 908:

AT LEAST ONE 'YES' (GO TO 910)
OTHER (GO TO 911)

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

YES 1
NO 2
DON'T KNOW 8

911. CHECK 208 AND 215:

LAST BIRTH SINCE JANUARY 2009 (GO TO 912)
NO BIRTHS (GO TO 926)
LAST BIRTH BEFORE JANUARY 2009 (GO TO 926)

912. CHECK 408 FOR LAST BIRTH:

HAD ANTENATAL CARE (GO TO 913)
NO ANTENATAL CARE (GO TO 920)

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

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

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

915. Were you offered a test for the AIDS virus as part of your antenatal care?

YES 1
NO 2

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

YES 1
NO 2 (GO TO 920)

917. Where was the test done?

GATV (Office for Advice and Voluntary Testing of HIV/AIDS)/ATS 01
HOSPITAL/HEALTH CENTER 02
BLOOD DONATION BOOTH 03
PRIVATE CLINIC/LABORATORY 04
SAAJ 05
GATV/ATS STANDS 06
PTV 07
COMMUNITY ATS 08
OTHER (SPECIFY)____ 96

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

YES 1
NO 2 (GO TO 924)

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

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

920. CHECK 434 FOR LAST BIRTH:

ANY CODE 21-36 CIRCLED (GO TO 921)
OTHER (GO TO 926)

921. Between the time you went for delivery but before the baby was born, were you offered a test for the AIDS virus?

YES 1
NO 2

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

YES 1
NO 2 (GO TO 926)

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

YES 1
NO 2

924. Have you been tested for the AIDS virus since that time you were tested during your pregnancy?

YES 1
NO 2 (GO TO 927)

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

MONTHS AGO______ (GO TO 932)
TWO OR MORE YEARS 96 (GO TO 932)

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

YES 1
NO 2 (GO TO 930)

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

MONTHS AGO___
TWO OR MORE YEARS 96

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

YES 1
NO 2

929. Where was the test done?

GATV (Office for Advice and Voluntary Testing of HIV/AIDS)/ATS 11 (GO TO 932)
HOSPITAL/HEALTH CENTER 12 (GO TO 932)
BLOOD DONATION BOOTH 13 (GO TO 932)
PRIVATE CLINIC/LABORATORY 14 (GO TO 932)
SAAJ 15 (GO TO 932)
GATV/ATS STANDS 16 (GO TO 932)
PTV 17 (GO TO 932)
COMMUNITY ATS 18 (GO TO 932)
OTHER (SPECIFY)____ 96 (GO TO 932)

930. Do you know of a place where people can go get tested for the AIDS virus?

YES 1
NO 2 (GO TO 932)

931. Where is that?

GATV (Office for Advice and Voluntary Testing of HIV/AIDS)/ATS A
HOSPITAL/HEALTH CENTER B
BLOOD DONATION BOOTH C
PRIVATE CLINIC/LABORATORY D
SAAJ E
GATV/ATS STANDS F
PTV G
COMMUNITY ATS H
OTHER (SPECIFY)____ X

932. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

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

YES, REMAIN A SECRET 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

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

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

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

SHOULD BE ALLOWED 1
SHOULD NOT BE ALLOWED 2
DON'T KNOW/NOT SURE/DEPENDS 8

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

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

937. CHECK 901:

HEARD ABOUT AIDS: Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

NOT HEARD ABOUT AIDS: Have you heard about other infections that can be transmitted through sexual contact?

YES 1
NO 2

938. CHECK 613:

HAS HAD SEXUAL INTERCOURSE (GO TO 939)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 946)

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

YES (GO TO 940)
NO (GO TO 941)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

943. CHECK 940, 941 AND 942:

HAS HAD AN INFECTION (ANY 'YES') (GO TO 944)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 946)

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

YES 1
NO 2 (GO TO 946)

945. Where did you seek advice or treatment?

PUBLIC SECTOR
CENTRAL HOSPITAL 11
PROVINCIAL/GENERAL HOSPITAL 12
RURAL HOSPITAL 13
HEALTH CENTER/POST 14
MOBILE CLINIC 15
OTHER (SPECIFY)____ 16
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC 21
PRIVATE DOCTOR 22
PRIVATE NURSE 23
PHARMACY 24
OTHER (SPECIFY) ______ 96
OTHER SOURCE
MARKET/STORE 31
TRADITIONAL HEALER 32
INFORMATION STAND/BOOTH 33
ADOLESCENT SPECIAL SERVICES 34
OTHER (SPECIFY)____

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

948. CHECK 601:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 949)
NOT IN UNION (GO TO 1001)

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

YES 1
NO 2
DEPENDS/NOT SURE 8

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

YES 1
NO 2
DEPENDS/NOT SURE 8

SECTION 10. OTHER HEALTH ISSUES

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

NUMBER OF INJECTIONS_____
NONE 00 (GO TO 1004)

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

NUMBER OF INJECTIONS_____
NONE 00 (GO TO 1004)

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

YES 1
NO 2
DON'T KNOW 8

1004. Do you currently smoke cigarettes?

YES 1
NO 2 (GO TO 1006)

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

NUMBER OF CIGARETTES______

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

YES 1
NO 2 (GO TO 1008)

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

PIPE A
HAND ROLLED CIGARETTE B
CIGAR C
SNUFF D
OTHER (SPECIFY) ______X

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

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

1009. Are you covered by any health insurance?

YES 1
NO 2 (GO TO 1101)

SECTION 11. MATERNAL MORTALITY

1101. 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 who are living with you, those living elsewhere and those who have died. How many boys did your mother give birth to, including you?

NUMBER OF BIRTHS TO NATURAL MOTHER___

1102. CHECK 1101:

TWO OR MORE BIRTHS (GO TO 1103)
ONLY ONE BIRTH (ONLY THE WOMEN [RESPONDENT]) (GO TO 1200)

1103. How many of these births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS______

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

NAME_____________

1105. Is (NAME) male or female?

MALE 1
FEMALE 2

1106. Is (NAME) alive?

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

1107. How old is (NAME)?

AGE__ (GO TO NEXT SIBLING)

1108. In what year did (NAME) die?

YEAR _____ (GO TO 1110)
DON'T KNOW 99998

1109. How many years ago did (NAME) die?

YEARS_____

1110. How old was (NAME) when s/he died?

AGE________ (IF MALE OR FEMALE THAT DIED BEFORE 12 YEARS OF AGE GO TO NEXT SIBLING)

1111. Was (NAME) pregnant when she died?

YES 1 (GO TO 1114A)
NO 2

1112. Did (NAME) died during labor?

YES 1 (GO TO 1114A)
NO 2

1113. Did (NAME) die two months after being pregnant or after labor?

YES 1 (GO TO 1114A)
NO 2
DON'T KNOW 8

1114. Did she die due to pregnancy complications, miscarriage, or labor?

YES 1
NO 2
DON'T KNOW 8

1114A. Did (NAME) die at home, on the way to the hospital, in the hospital or in another place?

HOME 1
ON THE WAY TO THE HOSPITAL 2
HOSPITAL 3
OTHER (SPECIFY)____ 6
DON'T KNOW 8

1114B. Did (NAME) live in this household?

YES 1
NO 2
DON'T KNOW 8

1115. How many live-born children did (NAME) give birth to during her lifetime?

NUMBER OF CHILDREN__________

1116. ANY OTHER DEAD BROTHER/SISTER:

YES 1 (GO TO 1108)
NO 2 (GO TO 1200)

SECTION 12. DOMESTIC VIOLENCE MODULE

1200. CHECK HOUSEHOLD QUESTIONNAIRE:

WOMAN SELECTED FOR THIS SECTION (GO TO 1200)
WOMAN NOT SELECTED (GO TO 1234)

1201. CHECK FOR PRESENCE OF OTHERS:

DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED.

PRIVACY OBTAINED 1
READ TO THE RESPONDENT: Now I would like to ask you questions about some important aspects about domestic violence. I know that some of these questions are very personal. However, your answers are crucial for helping to understand the condition of women in Mozambique. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else will know that you were asked these questions. If someone comes during our interview we will change the topic of what we are talking. (GO TO 1202)
PRIVACY NOT POSSIBLE 2 (GO TO 1233)

1202. CHECK 601 AND 602:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 1203)
FORMERLY MARRIED/LIVED WITH A MAN (GO TO 1203)
NEVER MARRIED/NEVER LIVED WITH A MAN (GO TO 1213)

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

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

1204. Now if you will permit me, I would like to ask some more questions about your relationship with your (last) husband/partner. If we come to a question that you do not want to answer, tell me and we will go to the next question.

A. (Does/did) your (last) husband/partner ever:

a) Say or do something to humiliate you in front of others?
YES 1
NO 2
b) Threaten to hurt or harm you or someone close to you?
YES 1
NO 2
c) Insult you or make you feel bad about yourself?
YES 1
NO 2

B. How often did this happen during the last 12 months: often, only sometimes, rarely, or not at all?

a) Say or do something to humiliate you in front of others?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
NEVER 4
b) Threaten to hurt or harm you or someone close to you?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
NEVER 4
c) Insult you or make you feel bad about yourself?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
NEVER 4

1205. A. (Does/did) your (last) husband/partner ever:

a) Push you, shake you, or throw something at you?
YES 1
NO 2
b) Slap you?
YES 1
NO 2
c) Twist your arm or pull your hair?
YES 1
NO 2
d) Punch you with his fist or with something that could hurt you?
YES 1
NO 2
e) Kick you, drag you or beat you up?
YES 1
NO 2
f) Try to choke you or burn you on purpose?
YES 1
NO 2
g) Threaten or attack you with a knife, gun or any other weapon?
YES 1
NO 2
h) Physically force you to have sexual intercourse with him even when you did not want to?
YES 1
NO 2
i) Force you to perform any sexual acts you did not want to?
YES 1
NO 2

B. How often did this happen during the last 12 months: often, sometimes, rarely, or not at all?

a) Push you, shake you, or throw something at you?
OFTEN 1
SOMETIMES 2
RARELY 3
NEVER 4
b) Slap you?
OFTEN 1
SOMETIMES 2
RARELY 3
NEVER 4
c) Twist your arm or pull your hair?
OFTEN 1
SOMETIMES 2
RARELY 3
NEVER 4
d) Punch you with his fist or with something that could hurt you?
OFTEN 1
SOMETIMES 2
RARELY 3
NEVER 4
e) Kick you, drag you or beat you up?
OFTEN 1
SOMETIMES 2
RARELY 3
NEVER 4
f) Try to choke you or burn you on purpose?
OFTEN 1
SOMETIMES 2
RARELY 3
NEVER 4
g) Threaten or attack you with a knife, gun or any other weapon?
OFTEN 1
SOMETIMES 2
RARELY 3
NEVER 4
h) Physically force you to have sexual intercourse with him even when you did not want to?
OFTEN 1
SOMETIMES 2
RARELY 3
NEVER 4
i) Force you to perform any sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
RARELY 3
NEVER 4

1206. CHECK:

AT LEAST ONE 'YES' (GO TO 1207)
NOT A SINGLE 'YES' (GO TO 1209)

1207. How long after you first got married to/started living with your (last) husband/partner did (this/any of these things) first happen?
IF LESS THAN 1 YEAR, RECORD '00'.

NUMBER OF YEARS_______
BEFORE MARRIAGE/STARTED LIVING TOGETHER 95

1208. Did the following ever happen as a result of what your husband/partner did to you:

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

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

YES 1
NO 2 (GO TO 1211)

1210. How often did this happen during the last 12 months: often, only sometimes, rarely or not at all?

OFTEN 1
SOMETIMES 2
RARELY 3
NOT AT ALL 3

1211. Does (did) your husband/partner drink beer, wine, or any other alcoholic beverage?

YES 1
NO 2 (GO TO 1213)

1212. During the course of a month how often does (did) he get drink alcohol: often, only sometimes, rarely or not at all?

OFTEN 1
SOMETIMES 2
RARELY 3
NEVER 4

1212A. Some men can be violent when they drink alcohol and become drunk. Has your husband/partner, during the last 12 months, become violent after drinking alcoholic beverages?

YES 1
NO 2 (GO TO 1213)

1212B. In the last 12 months how many times did your husband/partner become violent after drinking alcoholic beverages: often, only sometimes, rarely or not at all?

OFTEN 1
SOMETIMES 2
RARELY 3
NEVER 4

1213. CHECK 601 AND 602:

EVER MARRIED/LIVED WITH A MAN: From the time you were 15 years old, has anyone other than your (current/last) husband/partner hit, slapped, kicked or done anything else to hurt you physically?

NEVER MARRIED/NEVER LIVED WITH A MAN: From the time you were 15 years old, has anyone hit, slapped, kicked or done anything else to hurt you physically?

YES 1
NO 2 (GO TO 1216)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1216)

1214. Who has hurt you in this way? Anyone else?
RECORD ALL MENTIONED.

MOTHER/STEP-MOTHER A
FATHER/STEP-FATHER B
SISTER/ BROTHER C
DAUGHTER/ SON D
OTHER RELATIVE E
FORMER HUSBAND/PARTNER F
CURRENT BOYFRIEND G
FORMER BOYFRIEND H
MOTHER-IN-LAW/FATHER-IN-LAW I
OTHER IN-LAW J
TEACHER K
EMPLOYER L
POLICE/SOLDIER M
OTHER (SPECIFY)___ X

1215. In the past 12 months, how often were you hit, slapped, kicked or hurt physically by this (these) person(s): often, only sometimes, rarely or not at all?

OFTEN 1
SOMETIMES 2
RARELY 3
NEVER 4

1216. CHECK 201 AND 226:

EVER BEEN PREGNANT ('YES' TO 201 OR 226) (GO TO 1217)
NEVER BEEN PREGNANT (GO TO 1219)

1217. Has anyone ever hit, slapped, kicked or done anything else to hurt you physically while you were pregnant?

YES 1
NO 2 (GO TO 1219)

1218. Who has done any of these things to physically hurt you while you were pregnant? Anyone else?
RECORD ALL MENTIONED.

CURRENT HUSBAND/PARTNER A
MOTHER/STEP-MOTHER B
FATHER/STEP-FATHER C
SISTER/BROTHER D
DAUGHTER/ SON E
OTHER RELATIVE F
FORMER HUSBAND/PARTNER G
CURRENT BOYFRIEND H
FORMER BOYFRIEND I
MOTHER-IN-LAW/FATHER-IN-LAW J
OTHER IN-LAW K
TEACHER L
EMPLOYER M
POLICE/SOLDIER N
OTHER (SPECIFY)___ X

1219. CHECK 613:

HAS HAD SEX (GO TO 1220)
NEVER HAD SEX (GO TO 1224)

1220. The first time you had sexual intercourse, would you say that you had it because you wanted to, or because you were forced to have it against your will?

WANTED TO 1
FORCED TO 2
REFUSED TO ANSWER/NO RESPONSE 3

1221. CHECK 601 AND 602:

EVER MARRIED/LIVED WITH A MAN: In the last 12 months, has anyone other than your (current/last) husband/partner forced you to have sexual intercourse against your will?

NEVER MARRIED/NEVER LIVED WITH A MAN: In the last 12 months, has anyone forced you to have sexual intercourse against your will?

YES 1
NO 2
REFUSED TO ANSWER/NO RESPONSE 3

1222. CHECK 1220 AND 1221:

1220 = '1' OR '3' AND 1221 = '2' OR '3' (GO TO 1223)
OTHER (GO TO 1225)

1223. CHECK '1205(h)' AND 1205(i):

1205(h) IS NOT '1' AND 1205(i) IS NOT '1' (GO TO 1224)
OTHER (GO TO 1227)

1224. At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts?

YES 1
NO 2 (GO TO 1227)
REFUSED TO ANSWER/NO RESPONSE 3 (GO TO 1227)

1225. How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts?

AGE IN COMPLETED YEARS_____
DON'T KNOW 98

1226. Who was the person who was forcing you at that time?

CURRENT HUSBAND/PARTNER 01
FORMER HUSBAND/PARTNER 02
CURRENT/FORMER BOYFRIEND 03
FATHER 04
FATHER-IN-LAW 05
OTHER RELATIVES 06
OTHER IN-LAW 07
FRIEND/ACQUAINTANCE 08
FAMILY FRIEND 09
TEACHER 10
EMPLOYER 11
POLICE/SOLDIER 12
PASTOR/RELIGIOUS LEADER 13
STRANGER 14
OTHER (SPECIFY)___ 96

1226A. Were you forced to have sexual intercourse or perform any other sexual acts often, only sometimes, rarely or not at all?

OFTEN 1
SOMETIMES 2
RARELY 3
NEVER 4

1226B. Did you seek medical help after (the last time) you were forced to have sexual intercourse or perform any other sexual acts?

YES 1
NO 2 (GO TO 1227)

1226C. How long after you were forced to have sexual intercourse did you seek medical help?

SAME DAY 1
ONE DAY AFTER 2
TWO DAYS AFTER 3
THREE DAYS AFTER 4
FOUR OR MORE DAYS AFTER 5

1227. CHECK 1205A, 1213, 1217, 1221 AND 1224:

AT LEAST ONE 'YES' OR 1220=2 (GO TO 1228)
NOT A SINGLE 'YES' AND 1220 IS DIFFERENT FROM '2' (GO TO 1231)

1228. Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help to stop (the/these) person(s) from doing this to you again?

YES 1
NO 2 (GO TO 1229A)

1229. From whom have you sought help? Anyone else?
RECORD ALL MENTIONED.

OWN FAMILY A (GO TO 1231)
HUSBAND'S/PARTNER'S FAMILY B (GO TO 1231)
CURRENT/LAST/LATE HUSBAND/PARTNER C (GO TO 1231)
CURRENT/FORMER BOYFRIEND D (GO TO 1231)
FRIEND E (GO TO 1231)
NEIGHBOR F (GO TO 1231)
RELIGIOUS LEADER G (GO TO 1231)
DOCTOR/MEDICAL PERSONNEL H (GO TO 1231)
POLICE I (GO TO 1231)
LAWYER J (GO TO 1231)
SOCIAL SERVICE ORGANIZATION K (GO TO 1231)
TRADITIONAL HEALER L (GO TO 1231)
OTHER (SPECIFY)___ X (GO TO 1231)

1229A. What was the reason you did not seek any help?
RECORD ALL MENTIONED.

FEAR OF RETALIATION A
THOUGHT THAT THE VIOLENCE WOULD NEVER OCCUR AGAIN B
FEAR OF ABANDONMENT BY HUSBAND/PARTNER C
THOUGHT YOU COULD PROTECT YOURSELF ALONE D
DID NOT THINK THAT OTHER PEOPLE COULD HELP E
DOES NOT TRUST AUTHORITIES F
OTHER (SPECIFY)___ X

1230. Have you ever told anyone else about this?

YES 1
NO 2

1231. As far as you know, did your father ever beat your mother?

YES 1
NO 2
DON'T KNOW 8

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

1232. DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?

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

1233. INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE____________________________________________

1234. RECORD TIME

HOURS _____
MINUTES____

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENT ABOUT THE RESPONDENT: __________

COMMENTS ON SPECIFIC QUESTIONS __________

ANY OTHER COMMENTS________

SUPERVISOR'S OBSERVATIONS________________

Name of Supervisor:__________________
Date:________

EDITOR'S OBSERVATIONS________________________________________

Name of Editor:__________________
Date:________

CALENDAR

INSTRUCTIONS: ONLY ONE CODE SHOULD APPEAR IN ANY BOX. ALL MONTHS SHOULD BE FILLED IN.

INFORMATION TO BE CODED FOR EACH COLUMN

COLUMN 1: BIRTHS AND PREGNANCIES, CONTRACEPTIVE USE

B BIRTHS
P PREGNANCIES
T TERMINATIONS

0 NO METHOD
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 IUD
4 INJECTABLES
5 IMPLANTS
6 PILL
7 CONDOM
8 FEMALE CONDOM
9 DIAPHRAGM,
J FOAM OR JELLY
K LACTATIONAL AMENORRHEA METHOD
L RHYTHM, PERIODIC ABSTINENCE
M WITHDRAWAL
K EMERGENCY CONTRACEPTION
X OTHER METHODS (SPECIFY) ______
Y OTHER TRADITIONAL METHODS (SPECIFY) ______

COLUMN 2: NOT USING CONTRACEPTIVE METHODS

0 IRREGULAR SEXUAL RELATIONS/ABSENT PARTNER
1 GOT PREGNANT WHILE USING A METHOD
2 STOPPED METHOD TO GET PREGNANT
3 HUSBAND/PARTNER REFUSED TO USE A METHOD
4 WANTED A MORE EFFICIENT METHOD
5 SECONDARY EFFECTS
6 NOT ACCESSIBLE/LONG DISTANCE
7 HIGH PRICE
8 INCONVENIENT METHOD
F UP TO GOD
A DIFFICULT TO GET PREGNANT/IN MENOPAUSE
D DIVORCED/SEPARATED/WIDOW
X OTHER (SPECIFY) ______
Z DON'T KNOW
2011
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
2010
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
2009
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
2008
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
2007
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
2006
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