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DEMOGRAPHIC AND HEALTH SURVEYS-MOZAMBIQUE 2011-MAN'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 MAN_______

HOUSEHOLD SELECTED TO INTERVIEW MEN____

MAN 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 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
DON'T KNOW 98

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 the 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

113B. 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 children you have had/fathered during your life (and if the children are still alive). Do you have any children (male or female)?

YES 1
NO 2 (GO TO 206)
DON'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)
DON'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. SUM ANSWERS TO 203, 205, AND 207 AND RECORD THE TOTAL. IF NONE, RECORD '00'

TOTAL CHILDREN____

209. CHECK 208 IF ONE OR MORE BORN ALIVE:

HAS HAD MORE THAN ONE CHILD (GO TO 210)
HAS HAD ONLY ONE CHILD (GO TO 212)
HAS NOT HAD ANY CHILDREN (GO TO 301)

210. Did all of the children you have fathered have the same biological mother?

YES 1 (GO TO 212)
NO 2

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

NUMBER OF WOMEN/PARTNERS______

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

AGE (IN YEARS) _______

213. CHECK 203 AND 205:

AT LEAST ONE LIVING CHILD (GO TO 214)
NO LIVING CHILDREN (GO TO 301)

214. How many years old is your (youngest) child?

AGE IN YEARS______

215. CHECK 214:

(YOUNGEST) CHILD IS AGE 0-2 YEARS (GO TO 216)
OTHER (GO TO 301)

216. What is the name of your (youngest) child?
WRITE NAME OF (YOUNGEST) CHILD.

(NAME OF (YOUNGEST) CHILD) ________

217. When (NAME)'s mother was pregnant with (NAME), did she have any antenatal check-ups?

YES 1
NO 2 (GO TO 219)
DON'T KNOW 8 (GO TO 219)

218. Were you ever present during any of those antenatal check-ups?

PRESENT 1
NOT PRESENT 2

219. Was (NAME) born in a hospital or health facility?

HOSPITAL/HEALTH FACILITY 1 (GO TO 221)
OTHER (SPECIFY) ___ 2

220. When a child has diarrhea, how much should he or she be given to drink: more than usual, the same amount as usual, less than usual, or should he or she not be given anything to drink at all?

MORE THAN USUAL 1
ABOUT THE SAME 2
LESS THAN USUAL 3
NOTHING TO DRINK 4
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. 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. 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 on posters?
YES 1
NO 2
Read about family planning in pamphlets or brochures?
YES 1
NO 2

303. In the last few months have you discussed the practice of family planning with a health worker or health professional?

YES 1
NO 2

304. Now I would like to ask you about a woman's risk of pregnancy. From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant if she has sexual relations?

YES 1
NO 2 (GO TO 306)
DON'T KNOW 8 (GO TO 306)

305. 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

306. I will now read some sentences about contraception. Please tell me if you agree or disagree with each one.

a) Contraception is women's business and men should not have to worry about it.
AGREE 1
DISAGREE 2
DON'T KNOW 8
b) Women who use contraception may become promiscuous.
AGREE 1
DISAGREE 2
DON'T KNOW 8

307. CHECK 301 (07):
KNOWS MALE CONDOM

YES (GO TO 308)
NO (GO TO 401)

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

YES 1
NO 2 (GO TO 401)

309. Where is that? Any other 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)______
PUBLIC SECTOR
CENTRAL HOSPITAL A
PROVINCIAL/GENERAL HOSPITAL B
RURAL HOSPITAL C
HEALTH CENTER/POST D
PHARMACY E
MOBILE CLINIC F
OTHER (SPECIFY)____ G
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC H
PRIVATE DOCTOR I
PRIVATE NURSE J
PRIVATE PHARMACY K
OTHER (SPECIFY)____L
OTHER SOURCE
MARKET/STORE M
CHURCH N
SCHOOL O
FRIEND/RELATIVE P
TRADITIONAL HEALER Q
PARTNER R
INFORMATION STAND/BOOTH S
SHOP T
BAR/ DISCOTHEQUE U
GAS STATION V
ADOLESCENT SPECIAL SERVICES Z
OTHER (SPECIFY)____X

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

YES 1
NO 2
DON'T KNOW 3

SECTION 4. MARRIAGE AND SEXUAL ACTIVITY

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

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

402. Have you ever been married or lived together with a woman as if married?

YES, FORMERLY MARRIED 1
YES, LIVED WITH A WOMAN 2
YES, BOTH
NO 4 (GO TO 413)

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

WIDOWED 1 (GO TO 410)
DIVORCED 2 (GO TO 410)
SEPARATED 3 (GO TO 410)

404. Is your wife/partner living with you now or is she staying elsewhere?

LIVES WITH HIM 1
STAYING ELSEWHERE 2

405. Do you have more than one wife or woman you live with as if married?

YES 1
NO 2 (GO TO 407)

406. Altogether, how many wives do you have or other partners do you live with as if married?

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNERS________

407. CHECK 405:

ONE WIFE/PARTNER: Please, tell me the name of your wife/partner (the woman you are living with as if married)

MORE THAN ONE WIFE/PARTNER: Please, tell me the names of each of your current wives/partners (and/or each woman you are living with as if married).

RECORD THE NAME AND THE LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH WIFE AND LIVE-IN PARTNER. IF A WOMAN IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'. ASK 408 FOR EACH WIFE/PARTNER.

NAME_______
LINE NUMBER_______

408. How old was (NAME) on her last birthday?

AGE (IN COMPLETED YEARS)______

409. CHECK 407:

ONE WIFE/PARTNER (GO TO 410)
MORE THAN ONE WIFE/PARTNER (GO TO 411A)

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

ONLY ONCE 1
MORE THAN ONCE 2 (GO TO 411A)

411. In what month and year did you start living with your (wife/partner)?
411A. Now I would like to ask a question about your first wife/partner. In what month and year did you start living with your first wife/partner?

MONTH_____
DON'T KNOW MONTH 98
YEAR_____ (GO TO 413)
DON'T KNOW YEAR 9998

412. How old were you when you first started living with her?

AGE_____

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

414. Now I would like 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 501)
AGE IN YEARS_____
FIRST TIME WHEN STARTED LIVING WITH (FIRST) WIFE/PARTNER 95

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

416. When was the last time you had sexual intercourse?
IF ANSWER IS IN LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS. IF IS 12 OR MORE MONTHS ANSWER MUST BE RECORDED IN YEARS. IF ANSWER IS SAME DAY, RECORD '00'.

DAYS AGO 1____
WEEKS AGO 2___
MONTHS AGO 3____
YEARS AGO 4_____ (GO TO 430)

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

DAYS 1 ____
WEEKS 2_____
MONTHS 3____

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

YES 1
NO 2 (GO TO 420)

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

YES 1
NO 2

420. What was your relationship to this (second/third) person with whom you had sexual intercourse? IF GIRLFRIEND: Were you living together as if married?
IF YES, CIRCLE '2', IF NO, CIRCLE '3'

WIFE 1
LIVE-IN PARTNER 2
GIRLFRIEND NOT LIVING WITH RESPONDENT 3 (GO TO 423)
CASUAL ACQUAINTANCE 4 (GO TO 423)
PROSTITUTE 5 (GO TO 423)
OTHER (SPECIFY)_____ 6 (GO TO 423)

421. CHECK 410:

MARRIED ONLY ONCE (GO TO 422)
MARRIED MORE THAN ONCE (GO TO 423)

422. CHECK 414:

FIRST TIME WHEN STARTED WITH LIVING FIRST WIFE (GO TO 424)
OTHER (GO TO 423)

423. How long ago (have you had/did you have) a sexual relationship with this (second/third) person?
IF ONLY MORE THAN 95 TIMES, RECORD '95'.

DAYS 1 ___
MONTHS 2____
YEARS 3____

424. How many times during the last 12 months did you have sexual intercourse with this person?

NUMBER OF TIMES___

425. How old was this person?

AGE OF PARTNER____
DON'T KNOW 98

426. 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 417 IN NEXT COLUMN)
NO 2 (GO TO 428)

427. 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

428. CHECK 420 (ALL COLUMNS):

AT LEAST ONE PARTNER IS PROSTITUTE (GO TO 429)
NO PARTNERS ARE PROSTITUTES (GO TO 430)

429. CHECK 420 AND 418 (ALL COLUMNS):

CONDOM USED WITH EVERY PROSTITUTE (GO TO 433)
OTHER (GO TO 434)

430. In the last 12 months, did you pay anyone in exchange for having sexual intercourse?

YES 1 (GO TO 432)
NO 2

431. Have you ever paid anyone in exchange for having sexual intercourse?

YES 1
NO 2 (GO TO 434)

432. The last time you paid someone in exchange for having sexual intercourse, was a condom used?

YES 1
NO 2 (GO TO 434)

433. Was a condom used during sexual intercourse every time you paid someone in exchange for having sexual intercourse in the last 12 months?

YES 1
NO 2
DON'T KNOW 8

434. 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

435. CHECK 418, MOST RECENT PARTNER (FIRST COLUMN):

CONDOM USED (GO TO 436)
NOT ASKED (GO TO 438)
NO CONDOM USED (GO TO 438)

436. You told me that a condom was used the last time you had sex. Do you know the brand name of the condom used at that time?
IF BRAND IS NOT KNOWN, ASK TO SEE PACKAGE.
RECORD ALL MENTIONED.

JEITO A
TRUST B
DUREX C
CONDOMI D
MANOBRA E
CONFIAN??A F
PRODENCE G
KAMA SUTRA H
OTHER (SPECIFY)____X
DON'T KNOW Y

437. From where did you obtain the condoms the last time? Any other 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(S))________
PUBLIC SECTOR
CENTRAL HOSPITAL 11
PROVINCIAL/GENERAL HOSPITAL 12
RURAL HOSPITAL 13
HEALTH CENTER/POST 14
MOBILE CLINIC15
PHARMACY 16
OTHER (SPECIFY)____ 17
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC 21
PRIVATE DOCTOR 22
PRIVATE NURSE 23
PRIVATE PHARMACY 24
STORE 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)____X

438. The last time you had sex did you or your partner use any method (other than a condom to avoid or prevent a pregnancy?

YES 1
NO 2 (GO TO 501)
DON'T KNOW 8 (GO TO 501)

439. What method did you or your partner use?
PROBE: Did you or your partner use any other method to prevent pregnancy?
RECORD ALL MENTIONED.

FEMALE STERILIZATION A
MALE STERILIZATION B
IUD C
INJECTABLES D
IMPLANTS E
PILL F
MALE CONDOM G
FEMALE CONDOM H
LACTATIONAL AMEN. METHOD I
PERIODIC ABSTINENCE J
WITHDRAWAL K
EMERGENCY CONTRACEPTIVE L
DIAPHRAGM M
OTHER METHODS N
DON'T KNOW X

SECTION 5 FERTILITY PREFERENCES

501. CHECK 401:

CURRENTLY MARRIED OR LIVING WITH A PARTNER (GO TO 502)
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER (GO TO 509)

502. CHECK 439:

MAN NOT STERILIZED (GO TO 503)
MAN STERILIZED (GO TO 509)

503. Is your wife/partner (Are any of your wives/partners) currently pregnant?

YES 1
NO 2 (GO TO 505)
DON'T KNOW 8 (GO TO 505)

504. 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 (GO TO 506)
NO MORE/NONE 2 (GO TO 509)
UNDECIDED/DON'T KNOW 8 (GO TO 509)

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

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 509)
WIFE/PARTNER CAN'T GET PREGNANT 3 (GO TO 509)
WIFE/PARTNER STERILIZED 4 (GO TO 509)
UNDECIDED/DON'T KNOW 8 (GO TO 509)

506. CHECK 407:

ONE WIFE/PARTNER (GO TO 507)
MORE THAN ONE WIFE/PARTNER (GO TO 508)

507. CHECK 503:

WIFE/PARTNER NOT PREGNANT OR DON'T KNOW: How long would you like to wait from now before the birth of (a/another) child?

WIFE/PARTNER 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___ (GO TO 509)
YEARS 2____ (GO TO 509)

SOON/NOW 993 (GO TO 509)
COUPLE INFECUND 993 (GO TO 509)
OTHER (SPECIFY)____ 996 (GO TO 509)
DON'T KNOW 998 (GO TO 509)

508. How long would you like to wait from now before the birth of (a/another) child?

MONTHS 1____
YEARS 2_____

SOON/NOW 993
HE/ALL HIS WIVES/PARTNERS ARE INFECUND 994
OTHER: (SPECIFY)____996
DON'T KNOW 998

509. CHECK 203 AND 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 601)
NUMBER____
OTHER (SPECIFY) ______96 (GO TO 601)

510. 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____(BOYS)
OTHER (SPECIFY) ______96
NUMBER ____ (GIRLS)
OTHER (SPECIFY) ______96
NUMBER _____ (EITHER)
OTHER (SPECIFY) ______96

SECTION 6. EMPLOYMENT AND GENDER ROLES

601. Have you done any work in the last seven days?

YES 1 (GO TO 604)
NO 2

602. 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, or any other such reason?

YES 1 (GO TO 604)
NO 2

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

YES 1
NO 2 (GO TO 610)

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

OCCUPATION____________________

605. 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

606. 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
NOT PAID 4

607. CHECK 401:

CURRENTLY MARRIED OR LIVING WITH A PARTNER (GO TO 608)
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER (GO TO 612)

608. CHECK 606:

CODE '1' OR '2' CIRCLED (GO TO 609)
OTHER (GO TO 610)

609. Who usually decides how the money you earn will be used: mainly you, mainly your (wife (wives)/partner(s)), you and your (wife (wives)/partner(s)) jointly?

RESPONDENT 1
WIFE (WIVES)/PARTNER(S) 2
RESPONDENT AND WIFE (WIVES)/PARTNER(S) JOINTLY 3
OTHER (SPECIFY)_____6

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

RESPONDENT 1
WIFE (WIVES)/PARTNER(S) 2
RESPONDENT AND WIFE (WIVES)/PARTNER(S) JOINTLY 3
SOMEONE ELSE DECIDES 4
OTHER (SPECIFY) 6

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

RESPONDENT 1
WIFE (WIVES)/PARTNER(S) 2
RESPONDENT AND WIFE (WIVES)/PARTNER(S) JOINTLY 3
SOMEONE ELSE DECIDES 4
OTHER (SPECIFY) 6

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

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

613. 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

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

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

SECTION 7. HIV/AIDS

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

YES 1
NO 2 (GO TO 723)

702. 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

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

YES 1
NO 2
DON'T KNOW 8

704. 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

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

a) During pregnancy?
YES 1
NO 2
DON'T KNOW 8
b) During delivery?
YES 1
NO 2
DON'T KNOW 8
c) By breastfeeding?
YES 1
NO 2
DON'T KNOW 8

709. CHECK 708:

AT LEAST ONE 'YES' (GO TO 710)
OTHER (GO TO 711)

710. 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

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

712. 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 716)

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

MONTHS AGO___
TWO OR MORE YEARS 96

714. 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

715. Where was the test done?

GATV (Office for Advice and Voluntary Testing of HIV/AIDS)/ATS 11 (GO TO 718)
HOSPITAL/HEALTH CENTER 12 (GO TO 718)
BLOOD DONATION BOOTH 13 (GO TO 718)
PRIVATE CLINIC/LABORATORY 14 (GO TO 718)
SAAJ 15 (GO TO 718)
GATV/ATS STANDS 16 (GO TO 718)
PTV 17 (GO TO 718)
COMMUNITY ATS 18 (GO TO 718)
OTHER (SPECIFY)____ 19 (GO TO 718)

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

YES 1
NO 2 (GO TO 718)

717. 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)____ I

718. 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

719. 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

720. 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

721. 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

722. 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

723. CHECK 701:

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

724. CHECK 414:

HAS HAD SEXUAL INTERCOURSE (GO TO 725)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 732)

725. CHECK 723:
HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES (GO TO 726)
NO (GO TO 727)

726. 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

727. Sometimes men experience a bad smelling abnormal discharge from their penis. During the last 12 months, have you had a bad smelling abnormal discharge from your penis?

YES 1
NO 2
DON'T KNOW 8

728. Sometimes men have a sore or ulcer near their penis. During the last 12 months, have you had a sore or ulcer near your penis?

YES 1
NO 2
DON'T KNOW 8

729. CHECK 726, 727 AND 728:

HAS HAD AN INFECTION (ANY 'YES') (GO TO 730)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 732)

730. The last time you had those problems (PROBLEMS MENTIONED IN 726/727/278), did you seek advice or treatment?

YES 1
NO 2 (GO TO 732)

731. Where did you seek advice or treatment? 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) _______
PUBLIC SECTOR
CENTRAL HOSPITAL A
PROVINCIAL/GENERAL HOSPITAL B
RURAL HOSPITAL B
HEALTH CENTER/POST D
PHARMACY E
MOBILE CLINIC F
OTHER (SPECIFY)____ G
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC H
PRIVATE DOCTOR I
PRIVATE NURSE J
PHARMACY K
OTHER (SPECIFY) ______ L
OTHER SOURCE
MARKET/STORE M
CHURCH N
SCHOOL O
FRIEND/RELATIVE P
TRADITIONAL HEALER Q
PARTNER R
INFORMATION STAND/BOOTH S
SHOP T
BAR/ DISCOTHEQUE U
GAS STATION V
ADOLESCENT SPECIAL SERVICES Z
OTHER (SPECIFY)____X

732. 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

733. 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

SECTION 8. OTHER HEALTH ISSUES

801. Some people are circumcised. Are you circumcised?

YES 1
NO 2 (GO TO 805)
DON'T KNOW 8 (GO TO 805)

802. How old were you when you were circumcised?

AGE IN COMPLETED YEARS____

DURING CHILDHOOD (LESS THAN 5 YEARS OLD) 996
DON'T KNOW 998

803. Who did the circumcision?

TRADITIONAL PRACTITIONER/FAMILY/FRIEND 1
HEALTH WORKER/PROFESSIONAL 2
OTHER (SPECIFY)___3
DON'T KNOW 8

804. Where was it done?

HEALTH FACILITY 1
HOME OF HEALTH WORKER/PROFESSIONAL 2
CIRCUMCISION DONE AT HOME 3
RITUAL SITE 4
OTHER (SPECIFY)___5
DON'T KNOW 8

805. 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 808)

806. Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?
IF NUMBER OF INJECTIONS IS 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 808)

807. Did the person who gave you that injection take the syringe and needle from a new, unopened package?

YES 1
NO 2
DON'T KNOW 8

808. Do you currently smoke cigarettes?

YES 1
NO 2 (GO TO 810)

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

NUMBER OF CIGARETTES______

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

YES 1
NO 2 (GO TO 812)

811. 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

814. Are you covered by any medical assistance or health insurance?

YES 1
NO 2

SECTION 12. DOMESTIC VIOLENCE MODULE

1200. CHECK COVER PAGE:

MAN SELECTED FOR THIS SECTION (GO TO 1201)
MAN NOT SELECTED (GO TO 1234)

1201. CHECK FOR PRESENCE OF OTHERS:

DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED. RECORD THE CORRECT CODE AND FOLLOW THE INSTRUCTIONS

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 men 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.
PRIVACY NOR POSSIBLE 2 (GO TO 1233)

1202. CHECK 401 AND 402:

CURRENTLY MARRIED/LIVING WITH A WOMAN (GO TO 1203)
DIVORCED/SEPARATED (GO TO 1203)
NEVER MARRIED/NEVER LIVED WITH A WOMAN (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) wife/partner?

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

1204. Now if you will permit me, I need to ask some more questions about your relationship with your (last) wife/partner.

A. (Does/did) your (last) wife/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
RARELY 3
NOT AT ALL 4
NOT APPLICABLE 5
b) Threaten to hurt or harm you or someone close to you?
OFTEN 1
SOMETIMES 2
RARELY 3
NOT AT ALL 4
NOT APPLICABLE 5
c) Insult you or make you feel bad about yourself?
OFTEN 1
SOMETIMES 2
RARELY 3
NOT AT ALL 4
NOT APPLICABLE 5

1205. A. (Does/did) your (last) wife/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, only sometimes, rarely, or not at all?

a) Push you, shake you, or throw something at you?
OFTEN 1
SOMETIMES 2
RARELY 3
NOT AT ALL 4
b) Slap you?
OFTEN 1
SOMETIMES 2
RARELY 3
NOT AT ALL 4
c) Twist your arm or pull your hair?
OFTEN 1
SOMETIMES 2
RARELY 3
NOT AT ALL 4
d) Punch you with his fist or with something that could hurt you?
OFTEN 1
SOMETIMES 2
RARELY 3
NOT AT ALL 4
e) Kick you, drag you or beat you up?
OFTEN 1
SOMETIMES 2
RARELY 3
NOT AT ALL 4
f) Try to choke you or burn you on purpose?
OFTEN 1
SOMETIMES 2
RARELY 3
NOT AT ALL 4
g) Threaten or attack you with a knife, gun or any other weapon?
OFTEN 1
SOMETIMES 2
RARELY 3
NOT AT ALL 4
h) Physically force you to have sexual intercourse with him even when you did not want to?
OFTEN 1
SOMETIMES 2
RARELY 3
NOT AT ALL 4
i) Force you to perform any sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
RARELY 3
NOT AT ALL 4

1206. CHECK 1205A:

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) wife/partner did (this/any of these things) first happen?
IF LESS THAN 1 YEAR, RECORD '00'.

NUMBER OF YEARS_______
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95

1208. Did the following ever happen as a result of what your (last) wife/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 (last) wife/partner at times when she was not already beating or physically hurting you?

YES 1
NO 2 (GO TO 1211)

1210. In the last 12 months, how many times have you done this to your wife/partner: many times, sometimes, rarely, never?

MANY TIMES 1
SOMETIMES 2
RARELY 3
NEVER 4

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

YES 1
NO 2 (GO TO 1213)

1212. During the last month how often does (did) she get drunk: often, only sometimes, rarely or not at all?

OFTEN 1
SOMETIMES 2
RARELY 3
NEVER 4

1212A. Some woman can be violent when they drink alcohol or are drunk. Has your wife/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 wife/partner became violent after drinking alcoholic beverages: often, only sometimes, rarely or not at all?

OFTEN 1
SOMETIMES 2
RARELY 3
NEVER 4

1213. CHECK 401 AND 202:

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

NEVER MARRIED/NEVER LIVED WITH A WOMAN: 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 1219)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1219)

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 WIFE/PARTNER F
CURRENT GIRLFRIEND G
FORMER GIRLFRIEND/ CURRENT SEXUAL PARTNER H
MOTHER-IN-LAW I
FATHER-IN-LAW J
OTHER IN-LAW K
TEACHER L
EMPLOYER M
POLICE/SOLDIER N
OTHER (SPECIFY)___ X

1215. In the past 12 months, how often were you hit, slapped, kicked or hurt physically: often, only sometimes, rarely or not at all?

OFTEN 1
SOMETIMES 2
RARELY 3
NEVER 4

1219. CHECK 414:

HAS HAD SEXUAL INTERCOURSE (GO TO 1220)
HAS NOT HAD SEXUAL INTERCOURSE (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 401 AND 402:

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

NEVER MARRIED/NEVER LIVED WITH A WOMAN: 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 1025(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 WIFE/PARTNER 01
FORMER WIFE/PARTNER 02
CURRENT/FORMER GIRLFRIEND 03
MOTHER 04
MOTHER-IN-LAW 05
OTHER RELATIVES 06
OTHER IN-LAW 07
OWN 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 for 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 for 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 THAN '2' (GO TO 1231)

1228. Thinking about what you yourself have experienced among 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)
WIFE/PARTNER'S FAMILY B (GO TO 1231)
CURRENT/LAST/LATE WIFE/PARTNER C (GO TO 1231)
CURRENT/FORMER GIRLFRIEND D (GO TO 1231)
FRIEND E (GO TO 1231)
NEIGHBOR F (GO TO 1231)
RELIGIOUS LEADER G (GO TO 1231)
DOCTORAL/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 Y (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 WIFE/PARTNER C
THOUGHT YOU COULD PROTECT YOURSELF ALONE E
DID NOT THINK THAT OTHER PEOPLE COULD HELP F
DOES NOT TRUST AUTHORITIES G
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 HIS COOPERATION AND REASSURE HIM ABOUT THE CONFIDENTIALITY OF HIS 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?

WIFE/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

Comments about the interview:__________________

Comments on Specific Questions:_________________
Any other comments:___________

SUPERVISOR'S OBSERVATIONS_______________________________________

Name of Supervisor:__________________
Date:________

EDITOR'S OBSERVATIONS________________________________________

Name of Editor:__________________
Date:________