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REPUBLIC OF NIGER
DEMOGRAPHIC AND HEALTH SURVEY
WOMEN'S SURVEY 1998

IDENTIFICATION:

PLACE NAME ___
NAME OF HOUSEHOLD HEAD ___

CONCESSION NUMBER ___
HOUSEHOLD NUMBER ___
CLUSTER NUMBER ___

DEPARTMENT ___
DISTRICT ___
COUNTY ___

URBAN/RURAL:

URBAN 1
RURAL 2

NIAMEY/OTHER CITY/RURAL:

NIAMEY 1
OTHER CITY 2
RURAL 3

UNICEF INTERVENTION ZONE:

YES 1
NO 2
COMMON ZONE 3

WOMAN'S NAME AND LINE NUMBER:

NAME: ___
LINE NUMBER: ___

INTERVIEWER VISITS

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

RESULT CODES:

1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTIALLY FILLED OUT
6 INCAPABLE
7 OTHER (SPECIFY): ___

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:

FRENCH 1
HAOUSSA 2
ZARMA 3
TAMASHEQ 4
FULFUDE 5
OTHER 6

INTERPRETER:

YES 1
NO 2

SUPERVISOR
NAME ___
DATE ___

FIELD EDITOR
NAME ___
DATE ___

OFFICE EDITOR ___
KEYED BY ___

SECTION 1. SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENT

101) RECORD THE TIME.

HOUR: ___
MINUTES: ___

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?

NIAMEY/OTHER CAPITAL 1
LARGE CITY IN NIGER/OTHER COUNTRY 2
SMALL CITY IN NIGER/OTHER COUNTRY 3
COUNTRYSIDE IN NIGER/OTHER COUNTRY 4

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

NUMBER OF YEARS: ___
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)

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

NIAMEY/OTHER CAPITAL 1
LARGE CITY IN NIGER/OTHER COUNTRY 2
SMALL CITY IN NIGER/OTHER COUNTRY 3
COUNTRYSIDE IN NIGER/OTHER COUNTRY 4

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

MONTH: ___
DON'T KNOW MONTH 98
YEAR: ___
DON'T KNOW YEAR 9998

106) How old were you at your last birthday?

COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

AGE IN COMPLETED YEARS: ___

107) Did you go to school?

YES 1
NO 2 (GO TO 114)

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

PRIMARY 1
SECONDARY (FIRST CYCLE) 2
SECONDARY (SECOND CYCLE) 3
HIGHER 4

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

PRIMARY
00 LESS THAN 1 YEAR FINISHED
01 CI
02 CP
03 CE1
04 CE2
05 CM1
06 CM2
98 DON'T KNOW
SECONDARY FIRST CYCLE
00 LESS THAN 1 YEAR FINISHED
01 SIXTH GRADE
02 FIFTH GRADE
03 FOURTH GRADE
04 THIRD GRADE
98 DON'T KNOW
SECONDARY SECOND CYCLE
00 LESS THAN 1 YEAR FINISHED
01 SECOND GRADE
02 FIRST GRADE
03 FINAL GRADE
98 DON'T KNOW
SUPERIOR
00 LESS THAN 1 YEAR FINISHED
01 FIRST YEAR
02 2 OR MORE YEARS
98 DON'T KNOW

110) CHECK 106:

24 YEARS OLD OR LESS: ___
25 YEARS OLD OR MORE: ___ (GO TO 113)

111) Do you currently go to school?

YES 1 (GO TO 113)
NO 2

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

GOT PREGNANT 01
GOT MARRIED 02
TO TAKE CARE OF YOUNGER CHILDREN 03
FAMILY NEEDED HELP IN THE FIELDS OR WITH WORK 04
COULD NOT PAY THE FEES 05
HAD TO EARN MONEY 06
SUFFICIENTLY EDUCATED 07
FAILURE AT SCHOOL 08
DIDN'T LIKE SCHOOL 09
SCHOOL INACCESSIBLE OR TOO FAR AWAY 10
INSTRUCTED BY RELATIVES 11
OTHER (SPECIFY): ___ 96
DON'T KNOW 98

113) CHECK 108:

PRIMARY: ___
SECONDARY OR MORE: ___ (GO TO 115)

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

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 116)

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

YES 1
NO 2

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

YES 1
NO 2

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

YES 1
NO 2

118) What is your religion?

MUSLIM 1
CHRISTIAN 2
OTHER (SPECIFY): ___ 6

119) What is your ethnicity?

ARAB 01
DJERMA 02
GOURMANTCHEE 03
HAOUSSA 04
KANOURI 05
MOSSI 06
PEUL 07
TOUAREG 08
TOUBOU 09
OTHER (SPECIFY): ___ 96

120) CHECK 4 IN THE HOUSEHOLD SURVEY:

THE RESPONDENT IS NOT A USUAL RESIDENT: ___
THE RESPONDENT IS A USUAL RESIDENT: ___ (GO TO 201)

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?

NAME OF PLACE OF USUAL RESIDENCE: ___
NIAMEY/OTHER CAPITAL 1
LARGE CITY IN NIGER/OTHER COUNTRY 2
SMALL CITY IN NIGER/OTHER COUNTRY 3
COUNTRYSIDE IN NIGER/OTHER COUNTRY 4

122) In which county is this situated?

AGADEZ/TAHOUA 01
DIFFA/ZINDER 02
DOSSO 03
MARADI 04
TILLABERY 05
NIAMEY 06
FOREIGN COUNTRY 07

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

PIPED WATER
PIPED INTO THE DWELLING/YARD/PLOT 11 (GO TO 125)
PUBLIC TAP/STANDPIPE 12
OPEN WELL
OPEN WELL IN THE DWELLING/YARD/PLOT 21 (GO TO 125)
COVERED PUBLIC CEMENT WELL 23
TRADITIONAL PUBLIC WELL 24
PROTECTED PUBLIC WELL 25
SURFACE WATER
SPRING 31
RIVER/STREAM/CREEK 32
SWAMP/LAKE 33
DAM 34
RAINWATER 41 (GO TO 125)
TANKER 51 (GO TO 125)
BOTTLED WATER 61 (GO TO 125)
OTHER (SPECIFY): ___ 96

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

MINUTES: ___
ON SITE 996

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

FLUSH TOILET
PERSONAL FLUSH TOILET 11
COMMUNAL FLUSH TOILET 12
PIT/LATRINE
RUDIMENTARY PIT 21
VENTILATED IMPROVED PIT/LATRINE 22
NO FACILITY/BUSH/FIELD 31
OTHER (SPECIFY): ___ 96

126) Does your household have:

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

ELECTRICITY
YES 1
NO 2
RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
TELEPHONE
YES 1
NO 2
REFRIGERATOR OR FREEZER
YES 1
NO 2

127) Can you describe the floor of your home?

NATURAL MATERIAL FLOOR
EARTH/SAND 11
DUNG 12
RUDIMENTARY FLOOR
BOARDS 21
FINISHED FLOOR
TILE 31
CEMENT 32
CARPET 33
OTHER (SPECIFY): ___ 96

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

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

BICYCLE
YES 1
NO 2
MOPED OR MOTORCYCLE
YES 1
NO 2
CAR
YES 1
NO 2
CART
YES 1
NO 2

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?

YES 1
NO 2 (GO TO 206)

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

YES 1
NO 2 (GO TO 204)

203) How many sons live with you?
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 and who are alive but do not live with you?

YES 1
NO 2 (GO TO 206)

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'.

SONS ELSEWHERE: ___
DAUGHTERS ELSEWHERE: ___

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?

YES 1
NO 2 (GO TO 208)

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

IF NONE, RECORD '00'.

SONS DECEASED: ___
DAUGHTERS DECEASED: ___

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

IF NONE, RECORD '00'.

TOTAL: ___

209) CHECK 208:

Just to be sure that I have this right:

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

YES: ___
NO: ___ (PROBE AND CORRECT 201-208 AS NECESSARY)

210) CHECK 208:

ONE OR MORE BIRTHS: ___
NO BIRTHS: ___ (GO TO 227)

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?

NAME: ___

213) Were any of these births twins?

SINGLE 1
MULTIPLE 2

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

BOY 1
GIRL 2

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

PROBE: What is his/her birthday?

MONTH: ___
YEAR: ___

216) Is (NAME) still alive?

YES 1
NO 2 (GO TO 219)

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 (GO TO NEXT BIRTH FOR FIRST BIRTH, GO TO 220 FOR ALL OTHERS)

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.

DAYS: ___ 1
MONTHS: ___ 2
YEARS: ___ 3

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

YES 1
NO 2 (GO TO NEXT BIRTH)

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 224)

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

YES 1
NO 2

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

NUMBERS ARE THE SAME: ___
FOR EACH BIRTH, CHECK THAT THE YEAR OF BIRTH IS RECORDED: ___
FOR EVERY LIVING CHILD, CHECK THAT THE CURRENT AGE IS RECORDED: ___
FOR EACH DECEASED CHILD, CHECK THAT THE AGE AT DEATH IS RECORDED: ___
FOR AGE OF DEATH 12 MONTHS OR LESS, PROBE TO DETERMINE THE EXACT AGE OF DEATH: ___
NUMBERS ARE DIFFERENT: ___ (PROBE AND RECONCILE)

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

IF NONE, RECORD '0'.

BIRTHS: ___

227) Are you currently pregnant?

YES 1
NO 2 (GO TO 236)
NOT SURE 8 (GO TO 236)

228) How many months pregnant are you?

RECORD THE NUMBER OF COMPLETED MONTHS.

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?

AT THAT TIME 1
LATER 2
NOT AT ALL 3

236) When did your last menstrual period start?

(RECORD THE DATE IF IT IS GIVEN)

DATE: _____
NUMBER OF DAYS: ___ 1
NUMBER OF WEEKS: ___ 2
NUMBER OF MONTHS: ___ 3
NUMBER OF YEARS: ___ 4
IN MENOPAUSE/HAS HAD A HYSTERECTOMY 994
BEFORE THE LAST BIRTH 995
NEVER MENSTRUATED 996

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?

YES 1
NO 2 (GO TO 301)
DON'T KNOW 8 (GO TO 301)

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

DURING HER PERIOD 01
JUST AFTER THE END OF HER PERIOD 02
IN THE MIDDLE OF THE CYCLE 03
JUST BEFORE HER PERIOD BEGINS 04
OTHER (SPECIFY): ___ 96
DON'T KNOW 98

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)?

01. PILL: Women can take a pill every day to avoid becoming pregnant.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3 (GO TO 02)
02. IUD: Women can have a loop or a coil placed inside them by a doctor or a nurse to avoid becoming pregnant.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3 (GO TO 03)
03. INJECTIONS: Women can have an injection by a health provider to avoid becoming pregnant during one or more months.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3 (GO TO 04)
04. IMPLANTS: Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3 (GO TO 05)
05. DIAPHRAGM, FOAM, OR VAGINAL SUPPOSITORY: Women can insert a diaphragm, foam or suppository in their vagina before intercourse.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3 (GO TO 06)
06. CONDOM: Men can put a rubber sheath on their penis before sexual intercourse.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3 (GO TO 07)
07. FEMALE STERILIZATION: Women can have an operation to avoid having any more children.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3 (GO TO 08)
08. MALE STERILIZATION: Men can have an operation to avoid having any more children.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3 (GO TO 09)
09. RHYTHM METHOD: Every month that a woman is sexually active she can avoid pregnancy by not having intercourse on the days of the month she is most likely to get pregnant.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3 (GO TO 10)
10. WITHDRAWAL: Men can be careful and pull out before climax.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3 (GO TO 11)
11. Have you heard of other ways or methods that women or men can use to avoid pregnancy?
YES (SPECIFY): ___ 1
NO 3

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

Have you ever used (METHOD)?

01. PILL
YES 1
NO 2
02. IUD
YES 1
NO 2
03. INJECTIONS
YES 1
NO 2
04. IMPLANTS
YES 1
NO 2
05. DIAPHRAGM, FOAM, OR A VAGINAL SUPPOSITORY
YES 1
NO 2
06. CONDOM
YES 1
NO 2
07. FEMALE STERILIZATION: Have you had an operation to avoid having any more children?
YES 1
NO 2
08. MALE STERILIZATION: Have you had a partner who had an operation to avoid having any more children?
YES 1
NO 2
09. RHYTHM METHOD
YES 1
NO 2
10. WITHDRAWAL
YES 1
NO 2
11. Have you heard of other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO 2

304) CHECK 303:

NOT A SINGLE 'YES' (NEVER USED): ___
AT LEAST ONE 'YES' (HAS USED): ___ (GO TO 309)

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

YES 1
NO 2 (GO TO 331)

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'.

NUMBER OF CHILDREN: ___

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?

WANTED A CHILD LATER 1
DID NOT WANT ANYMORE CHILDREN 2
OTHER (SPECIFY): ___ 6

311) CHECK 303:

WOMAN NOT STERILIZED: ___
WOMAN STERILIZED: ___ (GO TO 314A)

312) CHECK 227:

NOT PREGNANT OR NOT SURE: ___
PREGNANT: ___ (GO TO 332)

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

YES 1
NO 2 (GO TO 331)

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.

PILL 01
IUD 02 (GO TO 326)
INJECTIONS 03 (GO TO 326)
IMPLANTS 04 (GO TO 326)
DIAPHRAGM/FOAM/VAGINAL SUPPOSITORY 05 (GO TO 326)
CONDOM 06 (GO TO 326)
FEMALE STERILIZATION 07 (GO TO 318)
MALE STERILIZATION 08 (GO TO 318)
RHYTHM METHOD 09 (GO TO 323)
WITHDRAWAL 10 (GO TO 326)
OTHER (SPECIFY): ___ 96 (GO TO 326)

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

RECORD THE BRAND IF THE PACKET IS SHOWN

BOX IS SEEN 1 (GO TO 317)
BRAND: ___ (GO TO 317)
BOX NOT SEEN 2

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

RECORD THE BRAND

BRAND NAME: ___
DON'T KNOW 98

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

COST: ___ (GO TO 326)
FREE 9996 (GO TO 326)
DON'T KNOW 9998 (GO TO 326)

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.

NAME OF THE ESTABLISHMENT: ___
PUBLIC SECTOR
HOSPITAL 11
INTEGRATED HEALTH CENTER 12
MATERNITY WARD 13
HEALTH HUT 14
OTHER PUBLIC (SPECIFY): ___16
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC 21
PRIVATE DOCTOR'S OFFICE 23
PRIVATE NURSE 24
OTHER PRIVATE (SPECIFY): ___ 26
OTHER (SPECIFY): ___ 96
DOESN'T KNOW 98

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

YES 1
NO 2 (GO TO 321)

320) Why do you regret the operation?

RESPONDENT WANTS ANOTHER CHILD 01
HUSBAND/PARTNER WANTS ANOTHER CHILD 02
SECONDARY EFFECTS 03
CHILD DIED 04
OTHER (SPECIFY): ___96

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

MONTH: ___
YEAR: ___ (GO TO 327)

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

BASED ON THE CALENDAR 01
BASED ON BODY TEMPERATURE (OGINO METHOD) 02
BASED ON CERVICAL MUCUS (BILLINGS METHOD) 03
BASED ON BODY TEMPERATURE AND ON CERVICAL MUCUS 04
NO SPECIFIC SYSTEM 05
OTHER (SPECIFY): ___ 96

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

IF LESS THAN 1 MONTH, RECORD '00'.

MONTHS: ___
8 YEARS OR MORE 96

327) CHECK 314:

CIRCLE THE CODE OF THE METHOD USED.

PILL 01
IUD 02
INJECTIONS 03
IMPLANTS 04
DIAPHRAGM/FOAM/VAGINAL SUPPOSITORY 05
CONDOM 06
FEMALE STERILIZATION 07 (GO TO 329A)
MALE STERILIZATION 08 (GO TO 329A)
RHYTHM METHOD 09 (GO TO 332)
WITHDRAWAL 10 (GO TO 332)
OTHER (SPECIFY): ___ 96 (GO TO 332)

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.

NAME OF ESTABLISHMENT: ___
PUBLIC SECTOR
HOSPITAL 11
INTEGRATED HEALTH CENTER 12
MATERNITY WARD 13
HEALTH HUT 14
CONSULTATION AT A FAIR 15
OTHER PUBLIC (SPECIFY): ___ 16
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC 21
PHARMACY 22
PRIVATE DOCTOR'S OFFICE 23
HEALTHCARE WORKER 25
OTHER PRIVATE MEDICAL (SPECIFY): ___ 26
OTHER SOURCE
"PHARMACY ON THE GROUND" (LOCATED IN A LOCAL MARKET) 31
TRADITIONAL PRACTITIONERS 32
FRIENDS/RELATIVES 33
OTHER (SPECIFY): ___ 36

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?

YES 1
NO 2 (GO TO 334)

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

_____
ACCESSIBILITY
CLOSE TO HOME 11 (GO TO 334)
CLOSE TO THE MARKET/WORK 12 (GO TO 334)
AVAILABLE TRANSPORTATION 13 (GO TO 334)
REASONS RELATING TO SERVICE
MORE COMPETENT/LIKEABLE PERSONNEL 21 (GO TO 334)
CLEANER 22 (GO TO 334)
MORE INTIMATE 23 (GO TO 334)
SHORT WAIT 24 (GO TO 334)
OPEN LONGER 25 (GO TO 334)
USES OTHER SERVICES IN THE SAME ESTABLISHMENT 26 (GO TO 334)
LOWER COST/LESS EXPENSIVE 31 (GO TO 334)
WANTS TO BE ANONYMOUS 41 (GO TO 334)
OTHER (SPECIFY): ___ 96 (GO TO 334)
DON'T KNOW 98 (GO TO 334)

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

FERTILITY REASONS
NO SEXUAL INTERCOURSE 21
INFREQUENT SEXUAL INTERCOURSE 22
MENOPAUSE/HYSTERECTOMY 23
SUB FERTILE/STERILE 24
POST-PARTUM/BREASTFEEDING 25
WANTS (OTHER) CHILDREN 26
PREGNANT 27
OPPOSITION TO USE
RESPONDENT OPPOSED 31
PARTNER OPPOSED 32
OTHER PEOPLE OPPOSED 33
RELIGIOUS INTERDICTION 34
LACK OF KNOWLEDGE
DOES NOT KNOW A METHOD 41
DOES NOT KNOW A SOURCE 42
METHOD RELATED REASONS
HEALTH PROBLEMS 51
FEAR OF SECONDARY EFFECTS 52
NOT ACCESSIBLE/TOO FAR 53
TOO EXPENSIVE 54
NOT PRACTICAL TO USE 55
INTERFERES WITH BODILY FUNCTIONS 56
OTHER (SPECIFY): ___ 96
DON'T KNOW 98

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

YES 1
NO 2 (GO TO 334)

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.

NAME OF ESTABLISHMENT: ___
PUBLIC SECTOR
HOSPITAL 11
INTEGRATED HEALTH CENTER 12
MATERNITY WARD 13
HEALTH HUT 14
CONSULTATION AT A FAIR 15
OTHER PUBLIC (SPECIFY): ___ 16
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC 21
PHARMACY 22
PRIVATE DOCTOR'S OFFICE 23
HEALTHCARE WORKER 25
OTHER PRIVATE MEDICAL (SPECIFY): ___ 26
OTHER SOURCE
"PHARMACY ON THE GROUND" (LOCATED IN A LOCAL MARKET) 31
TRADITIONAL PRACTITIONERS 32
FRIENDS/RELATIVES 33
OTHER (SPECIFY): ___ 36

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 337)

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 401)
DON'T KNOW 8

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

INCREASES 1 (GO TO 401)
DECREASES 2
IT DEPENDS 3
DON'T KNOW 8

339) CHECK 210:

AT LEAST ONE BIRTH: ___
NO BIRTHS: ___ (GO TO 401)

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

YES 1
NO 2 (GO TO 401)

341) CHECK 227 AND 311:

NOT PREGNANT OR NOT SURE AND NOT STERILIZED: ___
PREGNANT OR STERILIZED: ___ (GO TO 401)

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

YES 1
NO 2

SECTION 4A. PREGNANCY, POSTNATAL CARE AND BREAST FEEDING

401) CHECK 225:

ONE OR MORE BIRTHS SINCE JAN 1995: ___
NO BIRTHS SINCE JAN 1995: ___ (GO TO 465)

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:

LINE NUMBER: ___

404) FROM QUESTION 212 AND QUESTION 216:

NAME: ___
LIVING: ___
DEAD: ___

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

THEN 1 (GO TO 407)
LATER 2
NOT AT ALL 3 (GO TO 407)

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

MONTHS: ___ 1
YEARS: ___ 2
DON'T KNOW 998

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.

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
TRAINED TRADITIONAL BIRTH ATTENDANT/DOULA C
OTHER PERSON
UNTRAINED TRADITIONAL BIRTH ATTENDANT D
OTHER (SPECIFY): ___ X
NO ONE Y (GO TO 410)

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

MONTHS: ___
DON'T KNOW 98

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

NUMBER OF TIMES: ___
DON'T KNOW 98

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?

YES 1
NO 2 (GO TO 411A)
DON'T KNOW 8 (GO TO 411A)

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

NUMBER OF TIMES: ___
DON'T KNOW 8

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

YES 1
NO 2

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

HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
HOSPITAL 21
MATERNITY 22
INTEGRATED HEALTH CENTER 23
HEALTH HUT 24
OTHER PUBLIC (SPECIFY): ___ 26
PRIVATE MEDICAL SECTOR
CLINIC 31
OTHER PRIVATE MEDICAL (SPECIFY): ___ 36
OTHER (SPECIFY): ___ 96

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.

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
TRAINED TRADITIONAL BIRTH ATTENDANT/DOULA C
OTHER PERSON
UNTRAINED TRADITIONAL BIRTH ATTENDANT D
OTHER (SPECIFY): ___ X
NO ONE Y

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?

LONG LABOR
YES 1
NO 2
A LOT OF BLEEDING
YES 1
NO 2
HIGH FEVER WITH VAGINAL DISCHARGE
YES 1
NO 2
CONVULSIONS
YES 1
NO 2

415) Was (NAME) delivered by caesarean section?

YES 1
NO 2

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

VERY LARGE 1
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DON'T KNOW 8

417) Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 418A)

418) How much did (NAME) weigh?

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

GRAMS FROM CARD: ___ 1
GRAMS FROM MEMORY: ___ 2
DON'T KNOW 99998

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

IF YES: Who did you see?

Anyone else?

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
TRAINED TRADITIONAL BIRTH ATTENDANT/DOULA C
OTHER PERSON
UNTRAINED TRADITIONAL BIRTH ATTENDANT D
OTHER (SPECIFY): ___ X
NO ONE Y

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

(ASK ONLY FOR MOST RECENT BIRTH)

YES 1 (GO TO 421)
NO 2 (GO TO 422)

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

(FOR PREGNANCIES OTHER THAN MOST RECENT)

YES 1
NO 2 (GO TO 424)

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

MONTHS: ___
DON'T KNOW 98

422) CHECK 227: IS RESPONDENT PREGNANT?

NOT PREGNANT: ___
PREGNANT OR NOT SURE: ___ (GO TO 424)

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

(ONLY FOR MOST RECENT BIRTH)

YES 1
NO 2 (GO TO 425)

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

MONTHS: ___
DON'T KNOW 98

425) Did you breastfeed (NAME)?

YES 1
NO 2 (GO TO 426A)

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.

IMMEDIATELY 000
HOURS: ___ 1
DAYS: ___ 2

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?

YES 1
NO 2 (GO TO 426C)

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.

IMMEDIATELY 000
HOURS: ___ 1
DAYS: ___ 2

426C) CHECK 425: CHILD WAS BREASTFED?

YES: ___
NO: ___ (GO TO 431)

427) CHECK 404: CHILD LIVING?

ALIVE: ___
DECEASED: ___ (GO TO 429)

428) Are you still breastfeeding (NAME)?

YES 1 (GO TO 432)
NO 2

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

MONTHS: ___
DON'T KNOW 98

430) Why did you stop breastfeeding (NAME)?

MOTHER ILL/WEAK 01
CHILD ILL/WEAK 02
CHILD DIED 03
BREAST PROBLEMS 04
INSUFFICIENT MILK 05
MOTHER WORKS 06
CHILD REFUSED 07
WEANING AGE 08
GOT PREGNANT 09
BEGAN TO USE CONTRACEPTION 10
OTHER (SPECIFY): ___ 96

431) CHECK 404: CHILD ALIVE?

ALIVE: ___ (GO TO 434)
DECEASED: ___ (RETURN TO 405 FOR NEXT BIRTH, OR IF NO MORE BIRTHS, GO TO 440)

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

IF ANSWER IS NOT NUMERIC PROBE FOR APPROXIMATE NUMBER.

NUMBER OF NIGHTTIME FEEDINGS: ___

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

IF ANSWER IS NOT NUMERIC PROBE FOR APPROXIMATE NUMBER.

NUMBER OF DAYTIME FEEDINGS: ___

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

YES 1
NO 2
DON'T KNOW 8

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?

WATER
YES 1
NO 2
DON'T KNOW 8
SUGAR WATER
YES 1
NO 2
DON'T KNOW 8
FRUIT JUICE
YES 1
NO 2
DON'T KNOW 8
HERBAL TEA
YES 1
NO 2
DON'T KNOW 8
BABY FOOD
YES 1
NO 2
DON'T KNOW 8
POWDERED OR CANNED MILK
YES 1
NO 2
DON'T KNOW 8
FRESH MILK
YES 1
NO 2
DON'T KNOW 8
OTHER LIQUIDS
YES 1
NO 2
DON'T KNOW 8
GRAIN-BASED FOODS
YES 1
NO 2
DON'T KNOW 8
TUBER-BASED FOOD
YES 1
NO 2
DON'T KNOW 8
EGGS, FISH OR POULTRY
YES 1
NO 2
DON'T KNOW 8
MEAT
YES 1
NO 2
DON'T KNOW 8
OTHER SOLID OR SEMI-SOLID FOODS
YES 1
NO 2
DON'T KNOW 8

436) CHECK 435: FOOD OR LIQUID GIVEN YESTERDAY?

"YES" TO 1 OR MORE: ___
"NO/DON'T KNOW" TO ALL: ___ (GO TO 438)

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

(IF 7 OR MORE TIMES RECORD '7')

NUMBER OF TIMES: ___
DON'T KNOW 8

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'.

WATER: ___
MILK: ___
OTHER LIQUIDS: ___
CEREAL BASED FOODS: ___
TUBER BASED FOODS: ___
EGGS/FISH/POULTRY: ___
MEAT: ___
OTHER SOLID/SEMI-SOLID: ___

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'.

LEAVES: ___
CARROTS: ___
MANGOS: ___
PAPAYAS: ___
MELON: ___

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:

LINE NUMBER: ___

442) FROM 212 AND 216:

NAME: ___
LIVING: ___
DECEASED: ___ (GO TO 442 IN THE NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 465)

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

IF YES: May I see it please?

YES, SEEN 1 (GO TO 445)
YES, NOT SEEN 2 (GO TO 447)
NO CARD 3

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

YES 1 (GO TO 447)
NO 2 (GO TO 447)

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.

BCG
DAY: ___
MONTH: ___
YEAR: ___
POLIO 0 (GIVEN AT BIRTH)
DAY: ___
MONTH: ___
YEAR: ___
POLIO 1
DAY: ___
MONTH: ___
YEAR: ___
POLIO 2
DAY: ___
MONTH: ___
YEAR: ___
POLIO 3
DAY: ___
MONTH: ___
YEAR: ___
DPT 1
DAY: ___
MONTH: ___
YEAR: ___
DPT 2
DAY: ___
MONTH: ___
YEAR: ___
DPT 3
DAY: ___
MONTH: ___
YEAR: ___
MEASLES
DAY: ___
MONTH: ___
YEAR: ___
YELLOW FEVER
DAY: ___
MONTH: ___
YEAR: ___
VITAMIN A1 (VIOLET MICRONUTRIENT CARD)
DAY: ___
MONTH: ___
YEAR: ___
VITAMIN A2 (VIOLET MICRONUTRIENT CARD)
DAY: ___
MONTH: ___
YEAR: ___

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.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 445, THEN GO TO 448I)
NO 2 (GO TO 448I)
DON'T KNOW 8 (GO TO 448I)

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

YES 1
NO 2 (GO TO 448J)
DON'T KNOW 8 (GO TO 448J)

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?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 448E)
DON'T KNOW 8 (GO TO 448E)

448C) How many times?

NUMBER OF TIMES: ___

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

JUST AFTER BIRTH 1
LATER 2

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

YES 1
NO 2 (GO TO 448G)
DON'T KNOW 8 (GO TO 448G)

448F) How many times?

NUMBER OF TIMES: ___

448G) An injection against measles?

YES 1
NO 2
DON'T KNOW 8

448H) An injection against yellow fever?

YES 1
NO 2
DON'T KNOW 3

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

NO: ___
YES: ___ (GO TO 449)

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

SHOW VITAMIN A CAPSULE

IF YES: How many times?

YES 1
NO 2 (GO TO 449)
DON'T KNOW 8 (GO TO 449)
NUMBER OF TIMES: ___

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 454)
DON'T KNOW 8 (GO TO 454)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 454)

453) Where did you seek advice or treatment?

Anywhere else?

RECORD ALL MENTIONED.

PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER B
MATERNITY WARD C
HEALTH HUT D
CONSULTATION AT A FAIR E
OTHER PUBLIC (SPECIFY): ___ F
PRIVATE SECTOR
PRIVATE CLINIC G
PHARMACY H
PRIVATE DOCTOR'S OFFICE I
HEALTHCARE WORKER J
OTHER PRIVATE (SPECIFY): ___ K
OTHER SOURCE
FIELD PHARMACY L
TRADITIONAL HEALERS M
FRIENDS/FAMILY N
OTHER (SPECIFY): ___ X

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

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

455) Was there blood in the stool?

YES 1
NO 2
DON'T KNOW 8

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

NUMBER OF BOWEL MOVEMENTS: ___
DON'T KNOW 98

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

SAME 1
MORE 2
LESS 3
DON'T KNOW 8

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

SAME 1
MORE 2
LESS 3
DON'T KNOW 8

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?

ORS
YES 1
NO 2
DON'T KNOW 8
LIGHT BROTH
YES 1
NO 2
DON'T KNOW 8
SOUP
YES 1
NO 2
DON'T KNOW 8
SALT/SUGAR WATER
YES 1
NO 2
DON'T KNOW 8
BARK TEA
YES 1
NO 2
DON'T KNOW 8
MILK/BABY FORMULA
YES 1
NO 2
DON'T KNOW 8
YOGURT DRINK
YES 1
NO 2
DON'T KNOW 8
GUAVA/PAPAYA TEA
YES 1
NO 2
DON'T KNOW 8
WATER
YES 1
NO 2
DON'T KNOW 8
OTHER LIQUIDS
YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 462)
DON'T KNOW 8 (GO TO 462)

461) What was given to treat diarrhea?

Anything else?

RECORD EVERYTHING MENTIONED

SALT-SUGAR WATER A
PILL OR SYRUP B
INJECTION C
(IV) INTRAVENOUS D
TRADITIONAL REMEDIES/HERBAL MEDICINES E
OTHER (SPECIFY): ___ X

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

YES 1
NO 2 (GO TO 464)

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

Anywhere else?

RECORD EVERYTHING MENTIONED

PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER B
MATERNITY WARD C
HEALTHCARE WORKER D
CONSULTATION AT A FAIR E
OTHER PUBLIC (SPECIFY): ___ F
PRIVATE SECTOR
PRIVATE CLINIC G
PHARMACY H
PRIVATE DOCTOR'S OFFICE I
HEALTHCARE WORKER J
OTHER PRIVATE (SPECIFY): ___ K
OTHER SOURCE
FIELD PHARMACY L
TRADITIONAL HEALERS M
FRIENDS/FAMILY N
OTHER (SPECIFY): ___ X

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?

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

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

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

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

BREASTFED LESS 1
ABOUT THE SAME AMOUNT 2
BREASTFED MORE 3
DON'T KNOW 8

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

REPEATED LIQUID BOWEL MOVEMENTS A
LIQUID BOWEL MOVEMENTS B
REPEATED VOMITING C
VOMITING D
BLOOD IN STOOL E
FEVER F
STRONG THIRST G
DOESN'T EAT/DRINK WELL H
BECOMES SICKER/VERY ILL I
DOESN'T GET BETTER J
OTHER (SPECIFY): ___ X
DON'T KNOW Z

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

RAPID RESPIRATION A
DIFFICULTY BREATHING B
LOUD RESPIRATION C
FEVER D
UNABLE TO DRINK E
DOESN'T EAT/DRINK WELL H
BECOMES SICKER/VERY ILL I
DOESN'T GET BETTER J
OTHER (SPECIFY): ___ X
DON'T KNOW Z

469) CHECK 459, ALL COLUMNS

NO CHILD HAS RECEIVED ORS: ___
AT LEAST ONE CHILD HAS RECEIVED ORS: ___ (GO TO 501)

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

YES 1
NO 2

471) RECORD IF THE RESPONDENT HAS A GOITER

YES 1
NO 2
DON'T KNOW 8

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

501) PRESENCE OF OTHER PEOPLE AT THIS TIME

CHILDREN UNDER 10 YEARS
YES 1
NO 2
HUSBAND/PARTNER
YES 1
NO 2
OTHER MEN
YES 1
NO 2
OTHER WOMEN
YES 1
NO 2

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

YES, CURRENTLY MARRIED 1 (GO TO 507)
YES, CURRENTLY LIVING WITH A MAN 2 (GO TO 507)
NO, NOT IN UNION 3

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

REGULAR SEXUAL PARTNER 1
OCCASIONAL SEXUAL PARTNER 2
NO SEXUAL PARTNER 3

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

YES, HAS BEEN MARRIED 1
YES, HAS LIVED WITH A MAN 2 (GO TO 511)
NO 3 (GO TO 515F)

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

WIDOWED 1 (GO TO 511)
DIVORCED 2 (GO TO 511)
SEPARATED 3 (GO TO 511)

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

LIVE TOGETHER 1
LIVES ELSEWHERE 2

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

LINE NUMBER: ___

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

YES 1
NO 2 (GO TO 511)

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

NUMBER: ___
DON'T KNOW 98 (GO TO 511)

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

RANK: ___

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

ONLY ONCE 1
MORE THAN ONCE 2

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.

MONTH: ___
DON'T KNOW MONTH 98
YEAR: ___ (GO TO 514A)
DON'T KNOW YEAR 9998

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

AGE: ___

514A) CHECK 502:

CURRENTLY MARRIED OR LIVING WITH A MAN: ___
NOT IN UNION: ___ (GO TO 515F)

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?

NUMBER OF DAYS: ___ 1
NUMBER OF WEEKS: ___ 2
NUMBER OF MONTHS: ___ 3
NUMBER OF YEARS: ___ 4
BEFORE THE LAST BIRTH 996

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?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 517)

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

NUMBER OF DAYS: ___ 1
NUMBER OF WEEKS: ___ 2
NUMBER OF MONTHS: ___ 3
NUMBER OF YEARS: ___ 4
BEFORE THE LAST BIRTH 996

515D) Was a condom used on this occasion?

YES 1
NO 2
DON'T KNOW 8

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?

NUMBER OF PEOPLE: ___ (GO TO 517)
DON'T KNOW 8 (GO TO 517)

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)?

NEVER 000 (GO TO 551)
NUMBER OF DAYS: ___ 1
NUMBER OF WEEKS: ___ 2
NUMBER OF MONTHS: ___ 3
NUMBER OF YEARS: ___ 4
BEFORE THE LAST BIRTH 996

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?

YES 1
NO 2
DON'T KNOW 8

515H) CHECK 515F:

LESS THAN 12 MONTHS SINCE LAST SEXUAL INTERCOURSE: ___
12 MONTHS OR MORE SINCE THE LAST SEXUAL INTERCOURSE: ___ (GO TO 517)

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

NUMBER OF PEOPLE: ___
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 519)

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.

NAME OF PLACE: ___
PUBLIC SECTOR
HOSPITAL 11
INTEGRATED HEALTH CENTER 12
MATERNITY WARD 13
HEALTH CHECK 14
CONSULTATION AT A FAIR 15
OTHER PUBLIC (SPECIFY): ___ 16
PRIVATE SECTOR
PRIVATE CLINIC 21
PHARMACY 22
PRIVATE DOCTOR'S OFFICE 23
HEALTHCARE WORKER 24
OTHER PRIVATE (SPECIFY): ___ 26
OTHER SOURCE
FIELD PHARMACY 31
TRADITIONAL HEALERS 32
FRIENDS/FAMILY 33
OTHER (SPECIFY): ___ 36

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

AGE: ___
FIRST TIME WHEN MARRIED 96

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?

YES 1
NO 2 (GO TO 600)

552) Did you undergo this practice?

YES 1
NO 2 (GO TO 558)

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)?

AGE: ___
DON'T KNOW 98

555) Who performed your (NAME OF PRACTICE)?

DOCTOR 01
NURSE/MID-WIFE 02
DOULA 03
TRADITIONAL BIRTH ATTENDANT 04
TRADITIONAL PRACTITIONER 05
OTHER (SPECIFY): ___ 96
DON'T KNOW 98

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

YES 1
NO 2

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?

YES 1
NO 2

558) CHECK 214 AND 216:

AT LEAST ONE LIVING DAUGHTER: ___
NO LIVING DAUGHTER: ___ (GO TO 566)

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

YES 1
NO 2 (GO TO 564)
NOT YET 8 (GO TO 564)

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)?

AGE ___
DON'T KNOW 98

562) Who performed the (NAME OF PRACTICE)?

DOCTOR 01
NURSE/MID-WIFE 02
DOULA 03
TRADITIONAL BIRTH ATTENDANT 04
TRADITIONAL PRACTITIONER 05
OTHER (SPECIFY): ___ 96
DON'T KNOW 98

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

RESPONDENT A (GO TO 566)
RESPONDENT'S HUSBAND B (GO TO 566)
RESPONDENT'S MOTHER/MOTHER-IN-LAW C (GO TO 566)
OTHER RELATIVE OF THE MOTHER D (GO TO 566)
OTHER (SPECIFY): ___ X (GO TO 566)
NO ONE Y (GO TO 566)

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

YES 1 (GO TO 566)
NO 2
DON'T KNOW 8 (GO TO 566)

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?

YES 1
NO 2
DON'T KNOW 8

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

CONTINUED 1
STOPPED 2 (GO TO 569)
DON'T KNOW 8 (GO TO 600)

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

What other reason?

RECORD ALL REASONS MENTIONED

GOOD TRADITION A
CUSTOM AND TRADITION B
RELIGIOUS NECESSITY C (GO TO 600)
HYGIENE D (GO TO 600)
BETTER CHANCE OF MARRIAGE E (GO TO 600)
MORE PLEASURE FOR HUSBAND F (GO TO 600)
PRESERVATION OF VIRGINITY/AVOID IMMORALITY G (GO TO 600)
OTHER (SPECIFY): ___ X (GO TO 600)
DON'T KNOW Y (GO TO 600)

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

RECORD ALL REASONS MENTIONED

CUSTOM AND TRADITION B (GO TO 600)
RELIGIOUS NECESSITY C (GO TO 600)
HYGIENE D (GO TO 600)
BETTER CHANCE OF MARRIAGE E (GO TO 600)
MORE PLEASURE FOR HUSBAND F (GO TO 600)
PRESERVATION OF VIRGINITY/AVOID IMMORALITY G (GO TO 600)
OTHER (SPECIFY): ___ X (GO TO 600)
DON'T KNOW Y (GO TO 600)

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

What other reason?

RECORD ALL REASONS MENTIONED

BAD TRADITION A
AGAINST RELIGION B (GO TO 600)
MEDICAL COMPLICATIONS C (GO TO 600)
OWN PAINFUL EXPERIENCE D (GO TO 600)
AGAINST WOMEN'S DIGNITY E (GO TO 600)
PREVENTS SEXUAL SATISFACTION F (GO TO 600)
OTHER (SPECIFY): ___ X (GO TO 600)
DON'T KNOW Y (GO TO 600)

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

AGAINST RELIGION B
MEDICAL COMPLICATIONS C
OWN PAINFUL EXPERIENCE D
AGAINST WOMEN'S DIGNITY E
PREVENTS SEXUAL SATISFACTION F
OTHER (SPECIFY): ___ X
DON'T KNOW Y

SECTION 6. FERTILITY PREFERENCES

600) CHECK 515F:

HAS ALREADY HAD SEXUAL INTERCOURSE OR 515F NOT ASKED: ___
HAS NEVER HAD SEXUAL INTERCOURSE: ___ (GO TO 608)

601) CHECK 314:

NEITHER STERILIZED: ___
HE OR SHE STERILIZED: ___ (GO TO 612)

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?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 606)
SAYS SHE CANNOT GET PREGNANT 3 (GO TO 606)
NOT SURE/DON'T KNOW 8 (GO TO 604)

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?

MONTHS: ___ 1
YEARS: ___ 2
SOON/NOW 993 (GO TO 606)
SAYS SHE CANNOT GET PREGNANT 994 (GO TO 606)
AFTER MARRIAGE 995
OTHER (SPECIFY): ___ 996
DON'T KNOW 998

604) CHECK 227:

IF RESPONDENT IS NOT PREGNANT OR NOT SURE: ___
IF RESPONDENT IS PREGNANT: ___ (GO TO 607)

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

HAPPY 1
UNHAPPY 2
NEUTRAL 3

606) CHECK 313: USES METHOD?

NOT ASKED: ___
DOES NOT CURRENTLY USE: ___
CURRENTLY USES: ___ (GO TO 611A)

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

YES 1 (GO TO 608A)
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 610)
DON'T KNOW 8 (GO TO 610)

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?

ASK PERMISSION 1
BY HERSELF, WITHOUT TALKING ABOUT IT 2
DON'T KNOW 8

609) Which method would you prefer to use?

PILL 01 (GO TO 612)
IUD 02 (GO TO 612)
INJECTIONS 03 (GO TO 612)
IMPLANTS 04 (GO TO 612)
DIAPHRAGM/JELLY/VAGINAL SUPPOSITORY 05 (GO TO 612)
CONDOM 06 (GO TO 612)
FEMALE STERILIZATION 07 (GO TO 612)
MALE STERILIZATION 08 (GO TO 612)
RHYTHM METHOD 09 (GO TO 612)
WITHDRAWAL 10 (GO TO 612)
OTHER METHOD (SPECIFY): ___ 96 (GO TO 612)
NOT SURE 98 (GO TO 612)

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

NOT MARRIED 11
FERTILITY-RELATED REASONS
NOT HAVING SEX 21 (GO TO 612)
INFREQUENT SEX 22 (GO TO 612)
MENOPAUSE/HYSTERECTOMY 23 (GO TO 612)
SUB FECUND/STERILE 24 (GO TO 612)
POST-PARTUM/BREAST FEEDING 25 (GO TO 612)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (GO TO 612)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 612)
HUSBAND/PARTNER OPPOSED 32 (GO TO 612)
OTHER PERSONS OPPOSED 33 (GO TO 612)
RELIGIOUS PROHIBITION 34 (GO TO 612)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 612)
KNOWS NO SOURCE 42 (GO TO 612)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 612)
FEAR OF SIDE EFFECTS 52 (GO TO 612)
LACK OF ACCESS/TOO FAR 53 (GO TO 612)
COSTS TOO MUCH 54 (GO TO 612)
INCONVENIENT TO USE 55 (GO TO 612)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 612)
OTHER (SPECIFY): ___ 96 (GO TO 612)
DON'T KNOW 98 (GO TO 612)

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

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

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?

ASKED PERMISSION 1
MADE DECISION BY HERSELF 2
OTHER (SPECIFY): ___6

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.

NUMBER: ___
OTHER (SPECIFY): ___96 (GO TO 614)

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?

BOYS
NUMBER: ___
OTHER (SPECIFY): ___ 96
GIRLS
NUMBER: ___
OTHER (SPECIFY): ___ 96
EITHER
NUMBER: ___
OTHER (SPECIFY): ___ 96

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

APPROVE 1
DISAPPROVE 2
NO OPINION 8

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

On the radio?
On the television?

RADIO
ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8
TELEVISION
ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8

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?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
JOURNAL OR MAGAZINE
YES 1
NO 2
POSTER
YES 1
NO 2
BROCHURES OR FLIERS
YES 1
NO 2

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

YES 1
NO 2 (GO TO 620)

619) With whom did you discuss this?

Anyone else?

RECORD ANYONE MENTIONED.

HUSBAND/PARTNER A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER F
MOTHER IN LAW G
FRIENDS(S)/NEIGHBOR(S) H
OTHER (SPECIFY): ___ X

620) CHECK 502:

YES, CURRENTLY MARRIED: ___
YES, LIVES WITH A MAN: ___
NO, NOT IN A UNION: ___ (GO TO 701)

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?

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

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

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

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?

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

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

701) CHECK 501 AND 502:

CURRENTLY MARRIED/LIVES WITH A MAN: ___
HAS BEEN MARRIED/HAS LIVED WITH A MAN: ___ (GO TO 703)
NEVER MARRIED AND NEVER LIVED WITH A MAN: ___ (GO TO 709)

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

AGE: ___

703) Did your (last) husband attend school?

YES 1
NO 2 (GO TO 706)

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

PRIMARY 1
SECONDARY (FIRST CYCLE) 2
SECONDARY (SECOND CYCLE) 3
HIGHER 4
DON'T KNOW 8

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

PRIMARY
00 LESS THAN 1 YEAR FINISHED
01 CI
02 CP
03 CE1
04 CE2
05 CM1
06 CM2
98 DON'T KNOW
SECONDARY FIRST CYCLE
00 LESS THAN 1 YEAR FINISHED
01 SIXTH GRADE
02 FIFTH GRADE
03 FOURTH GRADE
04 THIRD GRADE
98 DON'T KNOW
SECONDARY SECOND CYCLE
00 LESS THAN 1 YEAR FINISHED
01 SECOND GRADE
02 FIRST GRADE
03 FINAL GRADE
98 DON'T KNOW
HIGHER
00 LESS THAN 1 YEAR FINISHED
01 FIRST YEAR
02 2 OR MORE YEARS
98 DON'T KNOW

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:

WORKS (WORKED) IN AGRICULTURE: ___
DID NOT WORK IN AGRICULTURE: ___ (GO TO 709)

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?

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

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

YES 1 (GO TO 712)
NO 2

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?

YES 1 (GO TO 712)
NO 2

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

YES 1
NO 2 (GO TO 726)

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

__________

713) CHECK 712:

WORKS IN AGRICULTURE: ___
DOES NOT WORK IN AGRICULTURE: ___ (GO TO 715)

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?

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

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

FOR A FAMILY MEMBER 1
FOR SOMEONE ELSE 2
FOR HERSELF 3

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

THROUGHOUT THE YEAR 1 (GO TO 720)
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3 (GO TO 720)

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

NUMBER OF MONTHS: ___

720) Do you get a salary for this work?

PROBE: Do you get money for this work?

YES 1
NO 2 (GO TO 723)

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?

THE RESPONDENT HERSELF 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE 5

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

HOME 1
AWAY 2

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

YES: ___
NO: ___ (GO TO 726)

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

RESPONDENT 01
HUSBAND/PARTNER 02
CHILD-OLDER GIRL 03
CHILD-OLDER BOY 04
OTHER RELATIVES 05
NEIGHBORS 06
FRIENDS 07
DOMESTIC WORKER/OTHER HIRED PERSON 08
CHILD GOES TO SCHOOL 09
CHILDCARE/KINDERGARTEN 10
LAST BIRTH 95
OTHER (SPECIFY): ___ 96

726) CHECK 502:

YES, CURRENTLY MARRIED: ___
YES, LIVES WITH A MAN: ___
NO, NOT IN UNION: ___ (GO TO 801A)

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

YES 1
NO 2 (GO TO 801A)

728) Where did he go to work?

IF MULTIPLE PLACES ARE MENTIONED, RECORD THE MAIN ONE.

NIAMEY 01
OTHER CITY IN NIGER 02
RURAL NIGER 03
ABIDJAN 04
ACCRA/LAGOS 05
OTHER AFRICAN CAPITAL 06
OTHER AFRICAN CITY OR RURAL AREA 07
EUROPE/USA 08
OTHER (SPECIFY): ___ 96
DON'T KNOW 98

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

LESS THAN 3 MONTHS 1
BETWEEN 3 AND 6 MONTHS 2
6 MONTHS OR MORE 3
IS STILL ABSENT 4
DON'T KNOW 8

SECTION 8. SEXUALLY TRANSMITTED INFECTIONS AND AIDS

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

YES 1
NO 2 (GO TO 801K)

801B) Which illnesses do you know of?

RECORD EVERYTHING MENTIONED.

SYPHILIS A
GONORRHEA B
AIDS C
GENITAL WARTS/GENITAL TUMOR D
OTHER (SPECIFY): ___ W
OTHER (SPECIFY): ___X
DON'T KNOW Z

801C) CHECK 515:

HAS HAD SEXUAL INTERCOURSE: ___
HAS NEVER HAD SEXUAL INTERCOURSE: ___ (GO TO 801K)

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

YES 1
NO 2 (GO TO 801K)
DON'T KNOW 8 (GO TO 801K)

801E) Which illnesses have you had?

RECORD EVERYTHING MENTIONED.

SYPHILIS A
GONORRHEA B
AIDS C
GENITAL WARTS/GENITAL TUMOR D
OTHER (SPECIFY): ___ X
DON'T KNOW Z

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

YES 1
NO 2 (GO TO 801H)

801G) Where seek advice or treatment?

Was there another place?

RECORD ALL MENTIONED.

PUBLIC SECTOR
HOSPITAL A
INTEGRATED HEALTH CENTER B
MATERNITY WARD C
HEALTH HUT D
CONSULTATION AT A FAIR E
OTHER PUBLIC (SPECIFY): ___ F
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC G
PHARMACY H
PRIVATE DOCTOR'S OFFICE I
HEALTHCARE WORKER J
OTHER PRIVATE MEDICAL (SPECIFY): ___ K
OTHER SOURCE
FIELD PHARMACY L
TRADITIONAL PRACTITIONER M
FRIENDS/RELATIVES N
OTHER (SPECIFY): ___ X
DON'T KNOW Z

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 801K)
PARTNER ALREADY INFECTED 3 (GO TO 801K)

801J) What did you do?

RECORD EVERYTHING MENTIONED.

NO SEXUAL INTERCOURSE A
USED CONDOMS B
TOOK MEDICINE C
OTHER (SPECIFY): ___X

801K) CHECK 801B:

DID NOT MENTION AIDS: ___
MENTIONED AIDS: ___ (GO TO 802)

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

YES 1
NO 2 (GO TO 811C)

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

RADIO A
TELEVISION B
NEWSPAPERS/MAGAZINES C
BROCHURES/POSTERS D
HEALTHCARE WORKERS E
MOSQUES/CHURCHES F
SCHOOL/INSTRUCTORS G
COMMUNITY ENCOUNTERS H
FRIENDS/RELATIVES I
WORKPLACE J
OTHER (SPECIFY): ___X

802B) How can someone get AIDS?

Any other source?

RECORD ALL MENTIONED.

SEXUAL INTERCOURSE A
NOT USING CONDOMS C
SEXUAL INTERCOURSE WITH MULTIPLE PARTNERS E
SEXUAL INTERCOURSE WITH PROSTITUTES G
SEXUAL INTERCOURSE WITH HOMOSEXUALS H
BLOOD TRANSFUSIONS I
INJECTIONS J
FROM MOTHER TO CHILD K
KISSING L
MOSQUITO BITES M
LIVING WITH SOMEONE WITH AIDS N
DIRTY BLADES, SCISSORS, KNIVES P
OTHER (SPECIFY): ___ X
DON'T KNOW Z

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

YES 1
NO 2 (GO TO 807)
DON'T KNOW 8 (GO TO 807)

804) What can a person do?

Anything else?

RECORD EVERYTHING MENTIONED.

ABSTAIN FROM SEX B
USE CONDOMS C
LIMIT TO ONE PARTNER D
BE LOYAL F
AVOID SEX WITH PROSTITUTES G
AVOID SEX WITH HOMOSEXUALS H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID KISSING L
AVOID MOSQUITO BITES M
AVOID LIVING WITH AN AIDS PATIENT N
SEEK PROTECTION FROM A TRADITIONAL HEALER O
AVOID DIRTY BLADES/SCISSORS/KNIVES P
OTHER (SPECIFY): ___ X
DON'T KNOW Z

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

YES 1
NO 2
DON'T KNOW 8

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?

ALMOST NEVER 1
SOMETIMES 2
NEARLY ALWAYS 3
DON'T KNOW 8

808A) Can AIDS be cured?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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?

SMALL 1
AVERAGE 2 (GO TO 809C)
STRONG 3 (GO TO 809C)
NO RISK 4

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

What other reason?

RECORD EVERYTHING MENTIONED.

ABSTAIN FROM SEX B (GO TO 811A)
USE CONDOMS C (GO TO 811A)
ONLY ONE PARTNER D (GO TO 811A)
PARTNER IS LOYAL F (GO TO 811A)
NO SEX WITH HOMOSEXUALS H (GO TO 811A)
NO BLOOD TRANSFUSIONS I (GO TO 811A)
NO INJECTIONS J (GO TO 811A)
AVOIDS DIRTY BLADES/SCISSORS/KNIVES P (GO TO 811A)
OTHER (SPECIFY): ___ X (GO TO 811A)

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

What other reason?

RECORD EVERYTHING MENTIONED.

DOESN'T USE CONDOMS C
MORE THAN ONE SEXUAL PARTNER D
MANY SEXUAL PARTNERS E
PARTNER IS NOT LOYAL F
SEX WITH HOMOSEXUALS H
HAD BLOOD TRANSFUSIONS I
HAD INJECTIONS J
USED DIRTY BLADES/SCISSORS/KNIVES P
OTHER (SPECIFY): ___ X

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

IF YES: What have you done?

RECORD EVERYTHING MENTIONED.

DID NOT BEGIN TO HAVE SEX A (GO TO 811C)
STOPPED HAVING SEX B (GO TO 811C)
BEGAN TO USE CONDOMS C (GO TO 811C)
ONLY ONE SEXUAL PARTNER D (GO TO 811C)
LIMITED SEXUAL PARTNERS E (GO TO 811C)
ASKED PARTNER TO BE LOYAL F (GO TO 811C)
STOPPED HAVING SEX WITH HOMOSEXUALS H (GO TO 811C)
NO BLOOD TRANSFUSIONS I
NO INJECTIONS J
AVOIDED DIRTY BLADES/SCISSORS/KNIVES P
OTHER (SPECIFY): ___ X
NO CHANGE Y

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

IF YES: In what way?

RECORD EVERYTHING MENTIONED.

DID NOT BEGIN TO HAVE SEX A
STOPPED HAVING SEX B
BEGAN TO USE CONDOMS C
RESTRICTED TO ONE SEXUAL PARTNER D
REDUCED NUMBER OF PARTNERS E
OTHER (SPECIFY): ___ X
NO CHANGE IN SEXUAL BEHAVIOR Y

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

YES 1
NO 2 (GO TO 811F)

811D) CHECK 515 AND 515F:

HAS HAD SEXUAL INTERCOURSE: ___
HAS NEVER HAD SEXUAL INTERCOURSE: ___ (GO TO 812)

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?

YES 1
NO 2

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

YES 1
NO 2

812) RECORD THE TIME:

HOUR: ___
MINUTES: ___

SECTION 9. HEIGHT AND WEIGHT

901) CHECK 215:

ONE OR MORE BIRTHS SINCE JAN. 1995: ___
NO BIRTHS SINCE JAN. 1995: ___ (GO TO END)

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)

DAY: ___
MONTH: ___
YEAR: ___

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

SCAR SEEN 1
NO SCAR 2

906) HEIGHT (IN CENTIMETERS)

_____

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

LYING 1
STANDING 2

908) WEIGHT (IN KG)

____

909) DATE OF WEIGHING AND MEASUREMENT

DAY: ___
MONTH: ___
YEAR: ___

910) RESULT:

RESPONDENT
MEASURED 1
ABSENT 3
REFUSED 4
OTHER (SPECIFY): ___ 6
CHILDREN
CHILD MEASURED 1
CHILD ILL 2
CHILD ABSENT 3
CHILD REFUSED 4
MOTHER REFUSED 5
OTHER (SPECIFY): ___ 6

911)

NAME OF MEASURER: ___
NAME OF ASSISTANT: ___

INTERVIEWER'S OBSERVATIONS

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

Supervisor's Observations ___

Supervisor's Name ___
Date ___

Field Editor's Observations ___

Field Editor's Name ___
Date ___