IDENTIFICATION:

PLACE NAME ___
NAME OF HOUSEHOLD HEAD ___

CONCESSION NUMBER ___
HOUSEHOLD NUMBER ___
CLUSTER NUMBER ___

DEPARTMENT ___
DISTRICT ___
COUNTY ___

URBAN/RURAL:

NIAMEY/OTHER CITY/RURAL:

UNICEF INTERVENTION ZONE:

WOMAN'S NAME AND LINE NUMBER:

INTERVIEWER VISITS

INTERVIEWER 1:
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
DAY__
MONTH__
YEAR__
INTERVIEWER NAME___
RESULTS___

RESULT CODES:

NEXT VISIT [FOR INTERVIEWERS 1 AND 2]:
DATE__
TIME__

FINAL VISIT:
DAY__
MONTH__
YEAR 19__
INTERVIEWER__
RESULT__

TOTAL NUMBER OF VISITS ___

FRENCH QUESTIONNAIRE 1

LANGUAGE OF INTERVIEW:

INTERPRETER:

SUPERVISOR
NAME ___
DATE ___

FIELD EDITOR
NAME ___
DATE ___

OFFICE EDITOR ___
KEYED BY ___

SECTION 1. SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENT

101) RECORD THE TIME.

102) To begin, I would like to ask you questions about yourself and your household.

Until the age of 12 years, did you live for the majority of the time in Niamey, in another capital, in a large city in Niger or abroad, or in a rural area in Niger or abroad?

103) How long have you been living continuously in (NAME OF CURRENT CITY/VILLAGE OF RESIDENCE)?

104) Just before you moved here, did you live in Niamey, another capital, a city, or village?

105) In which month and in which year were you born?

106) How old were you at your last birthday?

COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

107) Did you go to school?

108) What is the highest level of school you attended: primary, secondary (first cycle), secondary (second cycle), or higher?

109) What is the last (year/class) that you achieved at this level?

110) CHECK 106:

111) Do you currently go to school?

112) What is the main reason that you stopped going to school?

113) CHECK 108:

114) Can you understand a letter or newspaper easily, with difficulty, or not at all?

115) Do you usually read a newspaper or magazine at least once a week?

116) Do you usually listen to the radio at least once a day?

117) Do you usually watch television at least once a week?

118) What is your religion?

119) What is your ethnicity?

120) CHECK 4 IN THE HOUSEHOLD SURVEY:

121) Now I would like to ask you some questions about the place where you usually live.

What is the name of your usual place of residence?

Is it Niamey, another capital, a large city in Niger or in a foreign country, a small city in Niger or in a foreign country, or the countryside in Niger or in a foreign country?

122) In which county is this situated?

123) What is the main source of water for members of your household?

124) How long does it take to go there, get water, and come back?

125) What kind of toilet facility do the majority of the members of your household use?

126) Does your household have:

Electricity? (NIGELEC, group or solar panel)
A radio?
A television?
A telephone?
A refrigerator or freezer?

127) Can you describe the floor of your home?

128) Is there anyone in your household who owns a:

A bicycle?
A moped or motorcycle?
A car?
A cart?

SECTION 2. REPRODUCTION

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

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

203) How many sons live with you?
How many daughters live with you?

IF NONE, RECORD '00'.

204) Do you have any sons or daughters to whom you have given birth and who are alive but do not live with you?

205) How many sons are alive but do not live with you?
How many daughters are alive but do not live with you?

IF NONE, RECORD '00'.

206) Have you given birth to a son or daughter who was born alive but later died?

IF NO, PROBE: Any child who cried and showed signs of life at birth but did not survive?

207) How many sons have died?
And how many daughters have died?

IF NONE, RECORD '00'.

208) SUM ANSWERS TO QUESTIONS 203, 205, AND 207 AND RECORD THE TOTAL.

IF NONE, RECORD '00'.

209) CHECK 208:

Just to be sure that I have this right:

You have had in total ___ births during your life. Is that correct?

210) CHECK 208:

211) Now I would like to make a list of all of your births, whether still alive or not, starting with the first one you had.

RECORD THE NAMES OF ALL THE BIRTHS IN QUESTIONS 212.

RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

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

213) Were any of these births twins?

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

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

PROBE: What is his/her birthday?

216) Is (NAME) still alive?

217) IF ALIVE:

How old was (NAME) at his/her last birthday?

RECORD AGE IN COMPLETED YEARS.

218) IF ALIVE:

Is (NAME) living with you?

219) IF DECEASED: How old was (NAME) when he/she died?

IF '1 YEAR', PROBE: How old was (NAME) in months?

RECORD IN DAYS IF LESS THAN 1 MONTH, IN MONTHS IF LESS THAN 2 YEARS, OR IN YEARS.

220) SUBTRACT THE BIRTH YEAR OF THE PRECEDING BIRTH FROM THAT OF (NAME). IS THE DIFFERENCE 4 YEARS OR MORE?

221) Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?

222) SUBTRACT THE BIRTH YEAR OF THE LAST CHILD FROM THE YEAR OF THE INTERVIEW. IS THE DIFFERENCE 4 YEARS OR MORE?

223) Have you had any other live births since the birth of (NAME OF LAST BIRTH)?

224) COMPARE 208 WITH THE NUMBER OF BIRTHS RECORDED IN THE ABOVE COLUMNS AND MARK:

225) CHECK 215 AND RECORD THE NUMBER OF BIRTHS SINCE JANUARY 1995.

IF NONE, RECORD '0'.

227) Are you currently pregnant?

228) How many months pregnant are you?

RECORD THE NUMBER OF COMPLETED MONTHS.

229) At the moment you became pregnant, did you want to become pregnant at that time, did you want to wait until later, or did you not want to have any (more) children?

236) When did your last menstrual period start?

(RECORD THE DATE IF IT IS GIVEN)

237) From the first day of a woman's menstrual period to the first day of her next menstrual period, are there certain days when a woman is more likely to become pregnant if she has sexual intercourse?

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

SECTION 3. CONTRACEPTION

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

CIRCLE EACH METHOD WITH WHICH THE RESPONDENT IS FAMILIAR. ONLY CIRCLE METHODS ANSWERED SPONTANEOUSLY.

CONTINUE DOWN COLUMN 302 READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 FOR METHODS WITH WHICH THE RESPONDENT IS FAMILIAR. CIRCLE CODE 3 FOR METHODS WITH WHICH THE RESPONDENT IS UNFAMILIAR.

301) What methods have you heard about?

302) Have you ever heard about (METHOD)?

303) FOR EACH METHOD WITH CODE 1 CIRCLED IN 301 OR 302, ASK 303.

Have you ever used (METHOD)?

304) CHECK 303:

305) Have you ever used anything or tried in any way to delay or avoid pregnancy?

307) What did you do or use?

CORRECT 303 AND 304 (AND 302 IF NECESSARY).

309) How many living children did you have when you began to use a contraceptive method, if any?

IF NONE RECORD '00'.

310) The first time you used family planning was it because you wanted to have another child, but you wanted it later, or was it because you did not want any more children at all?

311) CHECK 303:

312) CHECK 227:

313) Are you currently doing something or using any method to delay or avoid getting pregnant?

314) What method(s) are you using?

IF MORE THAN ONE METHOD IS MENTIONED, FOLLOW THE SKIP INSTRUCTIONS FOR WHICHEVER METHOD IS HIGHEST ON THE LIST.

314A) CIRCLE '07' FOR FEMALE STERILIZATION.

315) Can I see the pill box that you currently you use?

RECORD THE BRAND IF THE PACKET IS SHOWN

316) Do you know the brand of the pill that you are currently using?

RECORD THE BRAND

317) How much does a 3 cycle box of pills cost you?

318) Where did the sterilization take place?

IF IT IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE TYPE AND SECTOR, AND CIRCLE THE APPROPRIATE CODE.

319) Do you (or your husband) regret having an operation to no longer have children?

320) Why do you regret the operation?

321) In which month and in which year did the sterilization occur?

323) How do you determine the days of your menstrual cycle during which you should not have sexual intercourse?

326) Since when did you begin to use (METHOD) continuously?

IF LESS THAN 1 MONTH, RECORD '00'.

327) CHECK 314:

CIRCLE THE CODE OF THE METHOD USED.

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

IF THE SOURCE IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT.
PROBE TO DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE.

329) Do you know of another place where you could have gotten your (METHOD) the last time?

329A) At the time of your sterilization, did you know of another place where you could have undergone the same operation?

330) People choose a certain place where to procure family planning services for different reasons. What is the main reason why you went to (NAME OF THE PLACE FROM 328 OR 318) rather than another place that you know of?

RECORD THE RESPONSE AND CIRCLE THE CODE

331) What is the main reason why you do not use a method to avoid pregnancy?

332) Do you know a place where you can get a method of contraception?

333) Where is that?

IF THE SOURCES IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE.

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

335) In the last 12 months, have you visited a health care facility for any reason?

336) Did a staff member at the health facility talk to you about family planning methods?

337) Do you think that breastfeeding can influence the chances for a woman to get pregnant?

338) Do you think that breastfeeding increases or decreases the chances for a woman to get pregnant?

339) CHECK 210:

340) Have you ever counted on breastfeeding as a way to avoid getting pregnant?

341) CHECK 227 AND 311:

342) Do you currently count on breastfeeding to avoid getting pregnant?

SECTION 4A. PREGNANCY, POSTNATAL CARE AND BREAST FEEDING

401) CHECK 225:

402) WRITE THE LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH SINCE JAN 1995 (RECORDED IN THE REPRODUCTION TABLE). ASK THE QUESTIONS OF ALL OF THESE BIRTHS. BEGIN WITH THE MOST RECENT BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE).

Now I would like to ask you some questions about the health of all of your children born in the last three years. We will talk about each separately.

403) LINE NUMBER FROM QUESTION 212:

404) FROM QUESTION 212 AND QUESTION 216:

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

406) How much time would you have liked to wait?

407) When you were pregnant with (NAME), did you receive prenatal care?

IF YES: Whom did you see?

PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

408) How many months pregnant were you when you had your first prenatal consultation?

409) How many times did you get consultation during this pregnancy?

410) When you were pregnant with (NAME), did they give you an injection in the arm to keep the baby from getting tetanus, that is to say, convulsions after birth?

411) How many times during this pregnancy did you have this injection?

411A) During this pregnancy, were you given or did you buy iron tablets?

412) Where did you give birth to (NAME)?

413) Who assisted with the delivery of (NAME)?

Anyone else?

PROBE TO 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.

414) At the time of (NAME)'s birth did you have any of the following problems:

A long labor, in other words regular contractions lasting more than 12 hours?
Enough bleeding that you thought that your life was in danger?
A high fever accompanied with bad smelling vaginal discharge?
Convulsions not caused by fever?

415) Was (NAME) delivered by caesarean section?

416) When (NAME) was born was s/he:

417) Was (NAME) weighed at birth?

418) How much did (NAME) weigh?

RECORD THE WEIGHT WRITTEN ON THE HEALTH CARD, IF AVAILABLE.

418A) After (NAME)'s birth, did you see someone for postnatal consolations?

IF YES: Who did you see?

Anyone else?

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

(ASK ONLY FOR MOST RECENT BIRTH)

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

(FOR PREGNANCIES OTHER THAN MOST RECENT)

421) For how many months after the birth of (NAME) did you not have your period?

422) CHECK 227: IS RESPONDENT PREGNANT?

423) Have you begun to have sexual intercourse since the birth of (NAME)?

(ONLY FOR MOST RECENT BIRTH)

424) For how many months after (NAME)'s birth did you not have sexual intercourse?

425) Did you breastfeed (NAME)?

426) How long after birth did you first put (NAME) to the breast?

IF LESS THAN ONE HOUR RECORD '00' HOURS. IF LESS THAN 24 HOURS RECORD NUMBER OF HOURS. OTHERWISE RECORD IN DAYS.

426A) After (NAME)'s birth, that is to say in the hours or days following his/her birth, did you give him/her water or any other liquid other than breast milk to drink?

426B) How long after (NAME)'s birth did you first give him/her water or any other liquid (other than breast milk) to drink?

IF LESS THAN ONE HOUR RECORD '00' HOURS. IF LESS THAN 24 HOURS RECORD NUMBER OF HOURS. OTHERWISE RECORD IN DAYS.

426C) CHECK 425: CHILD WAS BREASTFED?

427) CHECK 404: CHILD LIVING?

428) Are you still breastfeeding (NAME)?

429) For how many months did you breastfeed (NAME)?

430) Why did you stop breastfeeding (NAME)?

431) CHECK 404: CHILD ALIVE?

432) How many times did you breastfeed last night between sunset and sunrise?

IF ANSWER IS NOT NUMERIC PROBE FOR APPROXIMATE NUMBER.

433) Yesterday, how many times did you breastfeed during the day?

IF ANSWER IS NOT NUMERIC PROBE FOR APPROXIMATE NUMBER.

434) Did (NAME) drink something from a bottle yesterday or last night?

435) Was (NAME) given (at any time yesterday or last night) one of the following things:

Water?
Sugar water?
Fruit juice?
Herbal tea?
Baby food?
Tinned or powdered milk?
Fresh milk?
Other liquids?
Grain-based foods (wheat, corn, rice, sorghum, millet in the form of bouillon, bread or pasta)?
Tuber-based food (manioc, yam, taro, potato, sweet potato)?
Eggs, fish or poultry?
Meat?
Other solid or semi-solid foods?

436) CHECK 435: FOOD OR LIQUID GIVEN YESTERDAY?

437) (Besides breast milk) how many times did (NAME) eat yesterday, including meals and snacks?

(IF 7 OR MORE TIMES RECORD '7')

438) How many days during the last 7 days did (NAME) receive one of the following liquids or foods:

Water?
Milk (other than breast milk)?
Liquids other than water or milk?
Wheat, corn, rice, sorghum or millet based foods?
Manioc, yam, potato or sweet potato based foods?
Eggs, fish or poultry?
Meat?
Other solid or semi-solid foods?

RECORD THE NUMBER OF DAYS. IF DON'T KNOW, RECORD '8'.

438A) How many days during the last 7 days did (NAME) receive one of the following foods:

Leaves?
Carrots?
Mangoes?
Papaya?
Melon?

RECORD THE NUMBER OF DAYS. IF DON'T KNOW, RECORD '8'.

439) RETURN TO 405 FOR NEXT BIRTH, OR IF NO MORE BIRTHS, GO TO 440.

SECTION 4B. VACCINATION, HEALTH AND NUTRITION

440) RECORD THE LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH SINCE JAN. 1995 IN THE REPRODUCTION TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE).

441) LINE NUMBER FROM 212:

442) FROM 212 AND 216:

443) Do you have a card where (NAME)'s vaccinations are written down?

IF YES: May I see it please?

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

445)
(1) COPY THE DATES FOR EACH VACCINATION FROM THE CARD.
(2) WRITE '44' IN 'DAY' COLUMN IF THE CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED.

446) Has (NAME) received any immunizations 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, MEASLES, AND/OR YELLOW FEVER VACCINES.

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

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

448A) BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

448B) Polio vaccine, that is, drops in the mouth?

448C) How many times?

448D) Was the first vaccine for polio received right after birth or not?

448E) A DPT vaccination, that is, an injection given in the thigh or buttocks, generally at the same time as the polio drops?

448F) How many times?

448G) An injection against measles?

448H) An injection against yellow fever?

448I) CHECK 445: AT LEAST ONE DOSE OF VITAMIN A RECORDED ON THE CARD

448J) Did (NAME) receive a capsule like this one?

SHOW VITAMIN A CAPSULE

IF YES: How many times?

449) Has (NAME) suffered from a fever, at any moment, during the past two weeks?

450) Has (NAME) suffered from a cough, at any moment, during the past two weeks?

451) When (NAME) had a cough, did he/she breathe faster than usual with short, rapid breaths?

452) Did you seek advice or treatment for the fever/cough?

453) Where did you seek advice or treatment?

Anywhere else?

RECORD ALL MENTIONED.

454) Has (NAME) had diarrhea during the past two weeks?

455) Was there blood in the stool?

456) On the worst day of diarrhea how many bowel movements did (NAME) have?

457) During his/her diarrhea, did (NAME) get less or more to drink than before the diarrhea?

458) During his/her diarrhea, did (NAME) get less or more to eat than before the diarrhea?

459) When (NAME) had diarrhea, was s/he given any of the following things:

A liquid prepared from a special packet called ORS?
A light broth made from rice?
Soup or puree?
Salt - sugar water?
Tree bark tea?
Milk or baby formula?
Yogurt based drink?
Tea made from guava or papaya tree leaves?
Water?
Any other liquid?

460) Was something (else) given to treat diarrhea?

461) What was given to treat diarrhea?

Anything else?

RECORD EVERYTHING MENTIONED

462) Did you seek advice or treatment for the diarrhea?

463) Where did you seek advice or treatment for the diarrhea?

Anywhere else?

RECORD EVERYTHING MENTIONED

464) RETURN TO 442 IN THE FOLLOWING COLUMN; IF NO MORE BIRTHS, GO TO 465.

465) When a child has diarrhea, should s/he be given less to drink than usual, the same amount or more than usual?

466) When a child has diarrhea should s/he be given less to eat than usual, the same amount or more than usual?

466A) When a child has diarrhea, should s/he be breastfed less than usual, the same amount, or more than usual?

467) When a child suffers from diarrhea, what symptoms indicate that s/he must be brought to a health facility or to a healthcare worker?

RECORD ALL THAT IS MENTIONED

468) When a child suffers a cough, what symptoms indicate that s/he must be brought to a health facility or to a healthcare worker?

RECORD ALL THAT ARE MENTIONED

469) CHECK 459, ALL COLUMNS

470) Have you ever heard of a product that can be obtained to treat diarrhea called ORS?

471) RECORD IF THE RESPONDENT HAS A GOITER

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

501) PRESENCE OF OTHER PEOPLE AT THIS TIME

502) Are you currently married or do you live with a man as if you were married?

503) Do you currently have a regular sexual partner or an occasional sexual partner or no sexual partner at all?

504) Have you ever been married or lived with a man as if married?

506) What is your current marital status: are you widowed, divorced or separated?

507) Is your husband/partner living with you now or is he staying elsewhere?

507A) RECORD THE HUSBAND'S PARTNER'S LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.

508) Besides yourself, does your husband/partner have other wives or does he live with other women as if he were married?

509) How many wives or partners does your husband have?

510) Are you the first, second... wife?

511) Have you been married or lived with a man only once or more than once?

512) CHECK 511:

IF MARRIED AND HAS LIVED WITH A MAN ONLY ONCE:
In which month, and in which year, did you begin to live with your husband/partner? That is to say, when did you consummate your union?

IF MARRIED AND HAS LIVED WITH A MAN MORE THAN ONCE:
I would like to ask about when you started living with your first husband/partner. In what month and year was that? That is to say, have you consummated your first union?

IF UNION NOT CONSUMMATED, RETURN TO 502. CORRECT THEN CIRCLE '3', FOLLOW THE PATH.

513) How old were you when you began living with him?

514A) CHECK 502:

515) Now I would like to ask you some questions about sexual activity in order to gain a better understanding of certain problems with respect to family planning.

How long has it been since the last time you had sexual intercourse with your husband/the man you live with?

515A) CHECK 301 AND 302:

IF RESPONDENT KNOWS ABOUT CONDOMS:
Was a condom used the last time you had sexual intercourse with your husband/the man with whom you live?

IF RESPONDENT DOESN'T KNOW ABOUT CONDOMS:
Some men use a condom that is to say that they put a rubber sheath on their penis before having sexual intercourse. Was a condom used the last time you had sexual intercourse with your husband/the man with whom you live?

515B) Have you had sexual intercourse with someone besides your husband/partner in the last 12 months?

515C) When did you last have sexual intercourse with someone else besides your husband/the man with whom you live?

515D) Was a condom used on this occasion?

515E) During the last 12 months with how many different people besides your husband/the man with whom you live did you have sexual intercourse?

515F) Now I would like to ask you some questions about sexual activity in order to gain a better understanding of certain problems with respect to family planning.

How long has it been since the last time you had sexual intercourse (if you've already had it)?

515G) CHECK 301 AND 302:

IF RESPONDENT KNOWS ABOUT CONDOMS:
Was a condom used the last time you had sexual intercourse with your husband/the man with whom you live?

IF RESPONDENT DOESN'T KNOW ABOUT CONDOMS:
Some men use a condom, that is to say that they put a rubber sheath on their penis before having sexual intercourse. Was a condom used the last time you had sexual intercourse with your husband/the man with whom you live?

515H) CHECK 515F:

515I) During the last 12 months with how many different people did you have sexual intercourse?

517) Do you know of a place where you could get condoms?

518) Where is this?

IF THE PLACE IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE.

519) How old were you the first time you have sexual intercourse?

SECTION 5B. TRADITIONAL PRACTICES

551) In Niger, as in other countries, there is a practice that involves removing a part of the genital organs of young girls or young women. Have you heard of this practice?

552) Did you undergo this practice?

553) What is the practice you underwent called?

PROBE TO DETERMINE THE EXACT NAME OF THIS TYPE OF PRACTICE. IF GIVEN IN THE NATIONAL LANGUAGE, RECORD IT AS ACCURATELY AS POSSIBLE. DO NOT TRANSLATE.

554) How old were you when you underwent this (NAME OF PRACTICE)?

555) Who performed your (NAME OF PRACTICE)?

556) At the time of your (NAME OF PRACTICE), did they entirely or partially sew the area of your vagina closed?

557) At the time of your first menstrual period or of your first sexual intercourse, did they make an incision to reopen your vaginal area?

558) CHECK 214 AND 216:

559) Has (NAME OF OLDEST DAUGHTER) undergone this practice?

560) What is the practice your daughter underwent called?

PROBE TO DETERMINE THE EXACT NAME OF THIS TYPE OF PRACTICE. IF GIVEN IN THE NATIONAL LANGUAGE, RECORD IT AS ACCURATELY AS POSSIBLE. DO NOT TRANSLATE.

561) How old was she when she underwent this (NAME OF PRACTICE)?

562) Who performed the (NAME OF PRACTICE)?

563) Did anyone object to the (NAME OF PRACTICE) when it was performed on (NAME OF THE OLDEST DAUGHTER)?

564) Do you intend to have the (NAME OF PRACTICE) done to (NAME OF OLDEST DAUGHTER)?

565) Do you thing that someone in your entourage (family/friend/neighbor) could, in spite of your opposition, have (NAME OF PRACTICE) done to your daughter?

566) Do you think that this type of practice should continue that it should be stopped?

567) Why do you think that this type of practice should continue?

What other reason?

RECORD ALL REASONS MENTIONED

568) What do you mean by GOOD TRADITION/CUSTOM AND TRADITION?

RECORD ALL REASONS MENTIONED

569) Why do you think this type of tradition should be stopped?

What other reason?

RECORD ALL REASONS MENTIONED

570) What do you mean by BAD TRADITION?
RECORD ALL MENTIONED.

SECTION 6. FERTILITY PREFERENCES

600) CHECK 515F:

601) CHECK 314:

602) CHECK 227:

IF RESPONDENT IS NOT PREGNANT OR NOT SURE:
Now I have a few questions about the future. Would you like to have (a/another) child, or would you prefer not to have (other) children at all?

IF RESPONDENT IS PREGNANT:
Now I have a few questions about the future. After the child that you are expecting, would you like to have (a/another) child, or would you prefer not to have (other) children at all?

603) CHECK 227:

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

IF RESPONDENT IS PREGNANT:
After the birth of the child you are expecting, how long would you like to wait from now before the birth of (a/another) child?

604) CHECK 227:

605) If you got pregnant in the next few weeks, would you be happy, unhappy, or would you be neutral?

606) CHECK 313: USES METHOD?

607) Do you think that you will use a method to delay or avoid a pregnancy in the next 12 months?

608) Do you think that you will use a method to delay or avoid a pregnancy in the future?

608A) In order to use a method of contraception, will you have to ask permission from your husband/partner or will you make the decision by yourself, without talking to him about it?

609) Which method would you prefer to use?

610) What is the main reason that you think that you will never use a contraception method?

611) Would you use a contraceptive method if you were married?

611A) When you began to use your method of contraception did you have to ask permission from your husband/partner or did you make the decision by yourself without talking to him about it?

612) CHECK 216:

IF RESPONDENT HAS LIVING CHILD:
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?

IF RESPONDENT HAS NO LIVING CHILD:
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.

613) 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?

614) In general, would you say that you approve or disapprove of couples who use a method to avoid getting pregnant?

615) Do think it is acceptable that information about family planning is given:

On the radio?
On the television?

616) During the last few months, have you heard about family planning:

On the radio?
On the television?
In a newspaper or magazine?
On a poster?
In a flier or brochure?

618) During the past few months, have you discussed the practice of family planning with your friends, neighbors, or relatives?

619) With whom did you discuss this?

Anyone else?

RECORD ANYONE MENTIONED.

620) CHECK 502:

621) Spouses/partners do not agree on everything. I would like to ask you questions about your husband/partner's opinions on family planning.

Do you think that your partner/husband approves or disapproves of using methods to avoid pregnancy?

622) How many times during the past year did you speak with your partner/husband about family planning?

623) Do you think that your husband wants the same number of children that you want, or do you think that he wants more or fewer than you do?

SECTION 7. SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE HUSBAND AND WOMAN'S PROFESSIONAL ACTIVITY

701) CHECK 501 AND 502:

702) How old was your husband at his last birthday?

703) Did your (last) husband attend school?

704) What was the highest level of school that he achieved: primary, secondary (first cycle), secondary (second cycle) or higher?

705) What was the last (year/class) that he achieved at this level?

706) What is (was) your husband/partner's primary job; that is to say, what kind of work does he do (did he do)?

707) CHECK 706:

708) Does/did he work mainly on your own land or on family land, or does/did he work on land that he rents/rented from someone else, or does/did he work on someone else's land?

709) Aside from your housework, do you currently work?

710) As you know, some women take up jobs for which they are paid in cash or in kind. Others sell things, have a small business or work on the family farm or in a family business.

Do you currently do something like this or any other work?

711) Did you do any type of work during the past 12 months?

712) What is your occupation, that is, what kind of work do you mainly do?

713) CHECK 712:

714) Do you work mainly on your own land or on family land, or did you work on land that you rent from someone else, or do you work on someone else's land?

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

716) Do you usually work throughout the year, seasonally or only once in a while?

717) During the last 12 months, how many months did you work?

720) Do you get a salary for this work?

PROBE: Do you get money for this work?

722) CHECK 502:

CURRENTLY MARRIED OR LIVING WITH A MAN:
Who mainly decides how the money you earn will be used: you, your husband/partner, you with your husband/partner or someone else?

NO, NOT IN UNION:
Who mainly decides how the money you earn will be used: you, someone else or you with someone else?

723) Do you usually work at home or away from home?

724) CHECK 217 AND 218: HAS A CHILD UNDER 6 YEARS LIVING WITH HER?

725) Who usually takes care of (NAME OF THE YOUNGEST CHILD AT HOME) while you work?

726) CHECK 502:

727) During the past 12 months, did your husband/partner leave the place he usually lives in to work elsewhere?

728) Where did he go to work?

IF MULTIPLE PLACES ARE MENTIONED, RECORD THE MAIN ONE.

729) How long did he stay in (PLACE CITED IN 728) for his work?

SECTION 8. SEXUALLY TRANSMITTED INFECTIONS AND AIDS

801A) Have you ever heard about infections that can be transmitted through sexual contact?

801B) Which illnesses do you know of?

RECORD EVERYTHING MENTIONED.

801C) CHECK 515:

801D) During the last 12 months, have you had one of these illnesses?

801E) Which illnesses have you had?

RECORD EVERYTHING MENTIONED.

801F) The last time you had (ILLNESSES FROM 801E), did you seek advice or treatment?

801G) Where seek advice or treatment?

Was there another place?

RECORD ALL MENTIONED.

801H) When you had (PROBLEM MENTIONED IN 801E) did you tell your partner?

801I) When you had (PROBLEM MENTIONED IN 801E) did you do anything to avoid infecting your partner?

801J) What did you do?

RECORD EVERYTHING MENTIONED.

801K) CHECK 801B:

801L) Have you heard of an illness called AIDS?

802) From which sources have you learned the most about AIDS?

802B) How can someone get AIDS?

Any other source?

RECORD ALL MENTIONED.

803) Is there something that a person can do to avoid contracting AIDS?

804) What can a person do?

Anything else?

RECORD EVERYTHING MENTIONED.

807) Is it possible that a person who appears to be healthy can in fact have the AIDS virus?

808) Do you think a person infected with AIDS never dies from this illness, dies sometimes from this illness, or nearly always dies from this illness?

808A) Can AIDS be cured?

808B) Can AIDS be transmitted from mother to her baby?

808C) Do you know someone who has AIDS or who has died of AIDS?

809) Do you think your risk of catching AIDS is small, average, or strong or do you think that you have no risk of catching AIDS?

809B) Why do you think that you (ARE NOT AT RISK/HAVE A SMALL RISK) of catching AIDS?

What other reason?

RECORD EVERYTHING MENTIONED.

809C) Why do you think that you (HAVE AN AVERAGE/A STRONG RISK) of catching AIDS?

What other reason?

RECORD EVERYTHING MENTIONED.

811A) Since hearing about AIDS, have you changed your behavior to avoid contracting AIDS?

IF YES: What have you done?

RECORD EVERYTHING MENTIONED.

811B) Has knowing about AIDS changed your decision to have sexual intercourse or your sexual behavior?

IF YES: In what way?

RECORD EVERYTHING MENTIONED.

811C) Certain people use a condom during sexual intercourse to avoid contracting AIDS or other sexually transmitted illnesses. Have you heard of this?

811D) CHECK 515 AND 515F:

811E) It is possible that we have already talked about this. Have you ever used a condom during sexual intercourse to avoid contracting AIDS or other sexually transmitted illnesses?

811F) During the last 12 months, have you given or received money, gifts or favors in exchange for sexual intercourse?

812) RECORD THE TIME:

SECTION 9. HEIGHT AND WEIGHT

901) CHECK 215:

IN 902 (COLUMNS 2 AND 3) RECORD THE LINE NUMBER OF EACH CHILD BORN SINCE JAN. 1995 AND OF THOSE WHO ARE STILL ALIVE. IN 903 AND 904, RECORD THE NAME AND BIRTH DATE OF THE RESPONDENT AND ALL OF HER LIVING CHILDREN BORN SINCE JAN. 1995. IN 906 AND 908 RECORD THE WEIGHT AND HEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN.
(NOTE: ALL OF THE RESPONDENTS WHO GAVE BIRTH SINCE JAN. 1995 MUST BE WEIGHED AND MEASURED EVEN IF ALL THEIR CHILDREN ARE DECEASED. IF THERE ARE MORE THAN 2 CHILDREN WHO HAVE BEEN BORN SINCE JAN. 1995 AND WHO ARE STILL ALIVE, USE AN ADDITIONAL QUESTIONNAIRE).

902) LINE NUMBER ACCORDING TO QUESTION 212:
(FOR CHILDREN ONLY)

903) NAME:

904) BIRTH DATE ACCORDING TO QUESTION 215, AND ASK THE BIRTHDAY.
(FOR CHILDREN ONLY)

905) BCG SCAR ON THE SIDE OF THE LEFT ARM:
(FOR CHILDREN ONLY)

906) HEIGHT (IN CENTIMETERS)

907) WAS THE CHILD MEASURED LYING DOWN OR STANDING UP?
(FOR CHILDREN ONLY)

908) WEIGHT (IN KG)

909) DATE OF WEIGHING AND MEASUREMENT

910) RESULT:

911)

INTERVIEWER'S OBSERVATIONS

Comments about the respondent ___
Comments on particular Questions ___
Other comments ___

Supervisor's Observations ___

Supervisor's Name ___
Date ___

Field Editor's Observations ___

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