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NIGERIA DEMOGRAPHIC AND HEALTH SURVEY
INDIVIDUAL QUESTIONNAIRE--ENGLISH

IDENTIFICATION

PLACE NAME _________________________
NAME OF RESPONDENT __________________________
CLUSTER NUMBER __
HOUSEHOLD NUMBER __
STATE __

URBAN/RURAL __

urban=l
rural=2

CITY/TOWN/RURAL __

city=l
town=2
rural(village)=3

NAME AND LINE NUMBER OF WOMAN ____________ ___

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE __________
INTERVIEWER'S NAME ___________
RESULT* _____________

RESULT ____

1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 OTHER (SPECIFY) ____________

NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE __________
TIME ___________

FINAL VISIT
DAY ____
MONTH ____
YEAR ___
INTERVIEWER'S NAME ____
RESULT* _____

TOTAL NO. OF VISITS __

LANGUAGE OF QUESTIONNAIRE

1 HAUSA
2 YORUBA
3 IGBO
4 EFIK
5 KANURI
6 TIV
7 ENGLISH
8 OTHER (SPECIFY) __________

LANGUAGE OF INTERVIEW

1 HAUSA
2 YORUBA
3 IGBO
4 EFIK
5 KANURI
6 TIV
7 ENGLISH
8 OTHER (SPECIFY) __________

NATIVE LANGUAGE OF RESPONDENT

1 HAUSA
2 YORUBA
3 IGBO
4 EFIK
5 KANURI
6 TIV
7 ENGLISH
8 OTHER (SPECIFY) __________

TRANSLATOR USED __

YES 1
NO 2

FIELD EDITED BY
NAME ________
DATE ________

OFFICE EDITED BY
NAME ________
DATE ________

KEYED BY
NAME ________ __
DATE ________

SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD THE TIME.

HOUR _______
MINUTES _______

102. First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in a city, in a town, or in a rural village?

CITY 1
TOWN 2
RURAL VILLAGE 3

103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?

YEARS ___

ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)

104. Just before you moved here, did you live in a city, in a town, or in a rural village?

CITY 1
TOWN 2
RURAL VILLAGE 3

105. In what month and year were you born?

MONTH ___
DON'T KNOW MONTH 98
YEAR 19__
DON'T KNOW YEAR 98

106. How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

AGE IN COMPLETED YEARS ___

107. Have you ever attended school?

YES 1
NO 2 (GO TO 111)

108. What is the highest level of school you attended: primary, secondary, or higher?

PRIMARY 1
SECONDARY 2
HIGHER 3

109. What is the highest (class/form/year) you completed at that level?

CLASS __

110. CHECK 108:

PRIMARY (GO TO 111)
SECONDARY OR HIGHER (GO TO 112)

111. Can you read and understand a letter or newspaper easily, with difficulty, or not at all?

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3

112. Do you usually listen to a radio at least once a week?

YES 1
NO 2

113. Do you usually watch television at least once a week?

YES 1
NO 2

114. What is the source of water your household uses for handwashing and dishwashing?

PIPED INTO RESIDENCE 01 (GO TO 116)
PIPED INTO YARD OR PLOT 02 (GO TO 116)
PUBLIC TAP 03
WELL WITH HANDPUMP 04
WELL WITHOUT HANDPUMP 05
RIVER, SPRING, SURFACE WATER 06
TANKER TRUCK, OTHER VENDOR 07
RAINWATER 08
OTHER (SPECIFY)_______ 09

115. How long does it take to go there, get water, and come back?

MINUTES ___
ON PREMISES 996

116. Does your household get drinking water from this same source?

YES 1 (GO TO 118)
NO 2

117. What is the source of drinking water for members of your household?

PIPED INTO RESIDENCE 01 (GO TO 116)
PIPED INTO YARD OR PLOT 02 (GO TO 116)
PUBLIC TAP 03
WELL WITH HANDPUMP 04
WELL WITHOUT HANDPUMP 05
RIVER, SPRING, SURFACE WATER 06
TANKER TRUCK, OTHER VENDOR 07
RAINWATER 08
OTHER (SPECIFY)_______ 09

118. What kind of toilet facility does your household have?

FLUSH 1
BUCKET 2
PIT 3
OTHER (SPECIFY)_______ 4
NO FACILITIES 5

119. Does your household have:

Electricity?
A radio?
A television?
A refrigerator?

ELECTRICITY
YES 1
NO 2
RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
REFRIGERATOR
YES 1
NO 2

120. How many rooms in your household are used for sleeping?

ROOMS ___

121. MAIN MATERIAL OF THE FLOOR.
(RECORD OBSERVATION.)

PARQUET OR POLISHED WOOD 1
VINYL OR ASPHALT STRIPS 2
CERAMIC TILES 3
WOOD PLANKS 4
CEMENT 5
ANIMAL DUNG 6
EARTH/SAND 7
OTHER (SPECIFY) ______ 8

122. Does any member of your household own:

A clock or watch?
A donkey, horse, or camel?
A canoe?
A bicycle?
A motorcycle?
A car?

CLOCK OR WATCH
YES 1
NO 2
DONKEY/HORSE/CAMEL
YES 1
NO 2
CANOE
YES 1
NO 2
BICYCLE
YES 1
NO 2
MOTORCYCLE
YES 1
NO 2
CAR
YES 1
NO 2

123. What religion do you belong to?

PROTESTANTISM 1
CATHOLICISM 2
ISLAM 3
TRADITIONAL RELIGION 4
NO RELIGION 5
OTHER (SPECIFY)________ 6

SECTION 2. REPRODUCTION

201. I would like to ask about all the children with whom God has blessed you. Please do not feel that I am counting your children, but it is very important to obtain complete information on childbearing in Nigeria. God will certainly bless and protect your children. Now I would like to ask about all the births you have had during your life.
Have you ever given birth?

YES 1
NO 2 (GO TO 206)

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

YES 1
NO 2 (GO TO 204)

203. How many sons live with you? And how many daughters live with you?
IF NONE, ENTER '00'.

SONS AT HOME _____
DAUGHTERS AT HOME ______

204. Do you have any sons or daughters you have given birth to 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? And how many daughters are alive but do not live with you?
IF NONE, ENTER '00'.

SONS ELSEWHERE ____
DAUGHTERS ELSEWHERE ____

206. It does happen that sometimes children die. I pray that this never happens to you. If it already has, may it never happen again to you. It may be very painful to talk about and we are very sorry to bring back these bad memories, but it will help the government to take measures to improve the health of the mothers so that all babies born are blessed with life. Have you ever given birth to a boy or a girl who was born alive but later died?
IF NO, PROBE: Any boy or girl who cried or showed any sign of life but only survived a few hours or days?

YES 1
NO 2 (GO TO 208)

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

BOYS DEAD ___
GIRLS DEAD ___

208. SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL.
IF NONE, ENTER '00'.

TOTAL ___

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

YES (GO TO 210)
NO (PROBE AND CORRECT 201-209 AS NECESSARY)

210. CHECK 208:

ONE OR MORE BIRTHS (GO TO 211)
NO BIRTHS (GO TO 223)

211. Now I would like to talk to you about all of your births, whether still alive or not, starting with the first one you had.
(RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES).

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

(NAME) ___________

213. RECORD SINGLE OR MULTIPLE BIRTH STATUS.

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? OR: In what season?

MONTH __________
YEAR __________

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

217. IF ALIVE: How old was (NAME) at his/her last birthday?
RECORD AGE IN COMPLETED YEARS.

AGE IN YEARS __

218. IF ALIVE: Is (NAME) living with you?

YES 1 (GO TO NEXT BIRTH)
NO 2

219. IF LESS THAN 15 YEARS. OF AGE: With whom does he/she live?
IF MORE THAN 15 YRS. OF AGE: GO TO NEXT BIRTH.

FATHER 1
OTHER RELATIVE 2
SOMEONE ELSE 3

(GO TO NEXT BIRTH IF MORE THAN ONE BIRTH OR GO TO 221)

220. IF DEAD: How old was he/she when he/she died?
IF '1 YEAR.', PROBE: How many months old was (NAME)?
RECORD DAYS IF LESS THAN 1 MONTH, MONTHS IF LESS THAN 2 YEARS, OR YEARS.

DAYS 1 ____
MONTHS 2 ____
YEARS 3 ____

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

NUMBERS ARE DIFFERENT (PROBE AND RECONCILE THEN GO TO 222)
NUMBERS ARE SAME (GO TO 222)

222. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1985.
IF NONE, ENTER 0.

223. Are you pregnant now?

YES 1
NO 2 (GO TO 226)
UNSURE 8 (GO TO 226)

224. How many months pregnant are you?

MONTHS _______

225. At the time you became pregnant, did you want to become pregnant then, did you want to wait until later, or did you not want to become pregnant at all?

THEN 1
LATER 2
NOT AT ALL 3

226. When did your last menstrual period start?

DAYS AGO 1 __
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___

BEFORE LAST BIRTH 994
NEVER MENSTRUATED 995
IN MENOPAUSE 996

227. Between the first day of a woman's period and the first day of her next period, when do you think she has the greatest chance of becoming pregnant?
PROBE: Which days of a woman's monthly cycle does she have to be careful to avoid becoming pregnant?

DURING HER PERIOD 1
RIGHT AFTER HER PERIOD HAS ENDED 2
IN THE MIDDLE OF THE CYCLE 3
JUST BEFORE HER PERIOD BEGINS 4
AT ANY TIME 5
OTHER (SPECIFY) _____ 6
DON'T KNOW 8

SECTION 3. CONTRACEPTION

301. Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy. Which ways or methods have you heard about?

CIRCLE CODE 1 IN 302 FOR EACH METHOD MENTIONED SPONTANEOUSLY.
THEN PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.
CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED.
THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 302, ASK 303-304 BEFORE PROCEEDING TO THE NEXT METHOD.

302. Have you ever heard of (METHOD)?
READ DESCRIPTION OF EACH METHOD.

METHOD 01 PILL Women can take a pill every day.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
METHOD 02 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES/SPONT 1
YES/PROBED 2
NO 3(GO TO NEXT METHOD)
METHOD 03 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES/SPONT 1
YES/PROBED 2
NO 3(GO TO NEXT METHOD)
METHOD 04 FOAMING TABLETS Women can place a foaming tablet or pill inside them before intercourse.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
METHOD 05 DIAPHRAGM, FOAM, JELLY Women can place a sponge, diaphragm, jelly or cream inside them before intercourse.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
METHOD 06 DUREX OR CONDOM Men can use a rubber sheath during sexual intercourse.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
METHOD 07 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
METHOD 08 MALE STERILIZATION Men can have an operation to avoid having any more children.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
METHOD 09 RHYTHM Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
METHOD 10 WITHDRAWAL Men can be careful and pull out before climax.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
METHOD 11 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES/SPONT 1 (SPECIFY) ____
NO 3 (GO TO NEXT METHOD)

303. Have you ever used (METHOD)?

METHOD 01 PILL Women can take a pill every day.
YES 1
NO 2
METHOD 02 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
METHOD 03 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO 2
METHOD 04 FOAMING TABLETS Women can place a foaming tablet or pill inside them before intercourse.
YES 1
NO 2
METHOD 05 DIAPHRAGM, FOAM, JELLY Women can place a sponge, diaphragm, jelly or cream inside them before intercourse.
YES 1
NO 2
METHOD 06 DUREX OR CONDOM Men can use a rubber sheath during sexual intercourse.
YES 1
NO 2
METHOD 07 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
Have you ever had an operation to avoid having any more children?
YES 1
NO 2
METHOD 08 MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1
NO 2
METHOD 09 RHYTHM Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant.
YES 1
NO 2
METHOD 10 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
METHOD 11 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO 2

YES 1
NO 2

304. Do you know where a person could go to get (METHOD)?

METHOD 01 PILL Women can take a pill every day.
YES 1
NO 2
METHOD 02 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
METHOD 03 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO 2
METHOD 04 FOAMING TABLETS Women can place a foaming tablet or pill inside them before intercourse.
YES 1
NO 2
METHOD 05 DIAPHRAGM, FOAM, JELLY Women can place a sponge, diaphragm, jelly or cream inside them before intercourse.
YES 1
NO 2
METHOD 06 DUREX OR CONDOM Men can use a rubber sheath during sexual intercourse.
YES 1
NO 2
METHOD 07 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES 1
NO 2
METHOD 08 MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1
NO 2
METHOD 09 RHYTHM Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant: Do you know where a person can obtain advice on how to use the rhythm method?
YES 1
NO 2

305. CHECK 303:

NOT A SINGLE 'YES' (NEVER USED) (GO TO 306)
AT LEAST ONE 'YES' (EVER USED) (GO TO 308)

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

YES (GO TO 307)
NO (GO TO 328)
307. What have you used or done?
CORRECT 303-305 (AND 302 IF NECESSARY).

308. Now I would like to ask you about the time when you first did something or used a method to avoid getting pregnant. How many living children did you have at that time, if any?
IF NONE, ENTER '00'.

NUMBER OF CHILDREN _____

309. CHECK 223:

NOT PREGNANT OR UNSURE (GO TO 310)
PREGNANT (GO TO 328)

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

YES 1
NO 2 (GO TO 328)

311. Which method are you using?

PILL 01
IUD 02 (GO TO 319)
INJECTIONS 03 (GO TO 319)
FOAMING TABLETS 04 (GO TO 317)
DIAPHRAGM/FOAM/JELLY 05 (GO TO 319)
DUREX OR CONDOM 06 (GO TO 317)
FEMALE STERILIZATION 07 (GO TO 319)
MALE STERILIZATION 08 (GO TO 319)
RHYTHM 09 (GO TO 326)
WITHDRAWAL 10 (GO TO 326)
OTHER (SPECIFY) _________ 11 (GO TO 326)

312. At the time you first started using the pill, did you consult a doctor or a nurse?

YES 1
NO 2
DON'T KNOW 8

313. At the time you last got pills, did you consult a doctor or a nurse?

YES 1
NO 2

314. May I see the package of pills you are using now?
(RECORD NAME OF BRAND.)

PACKAGE SEEN 1 (GO TO 316)
BRAND NAME ____________ ___ (GO TO 316)
PACKAGE NOT SEEN 2

315. Do you know the brand name of the pills you are now using?
(RECORD NAME OF BRAND.)

BRAND NAME ________ __
DON'T KNOW 98

316. How much does one packet of pills cost you?

COST __.__ (GO TO 319)

FREE 9996 (GO TO 319)
DON'T KNOW 9998 (GO TO 319)

317. How much does one (condom/foaming tablet) cost you?

COST __.__

FREE 9996
DON'T KNOW 9998

318. What is the average number of (condoms/foaming tablets) you use in one month?

NUMBER ________
DON'T KNOW 98

319. CHECK 311 AND MARK BOX:

SHE/HE STERILIZED: Where did the sterilization take place?

USING ANOTHER METHOD: Where did you obtain (METHOD) the last time?

(NAME OF PLACE) __________
HOSPITAL 01
HEALTH CENTER, MATERNITY CENTER, FAMILY PLANNING CLINIC, OR HEALTH CLINIC POST 02
DOCTOR 03 (GO TO 321)
PLANNED PARENTHOOD FED. CLINIC 04 (GO TO 322)
PRIVATE CLINIC 05 (GO TO 322)
PHARMACY 06 (GO TO 322)
PATENT MEDICINE SHOP 07 (GO TO 322)
MARKET 08 (GO TO 322)
HUSBAND'S PLACE OF WORK 09 (GO TO 324)
YOUR PLACE OF WORK 10 (GO TO 324)
CHURCH 11 (GO TO 324)
FRIENDS/RELATIVES 12 (GO TO 324)
OTHER (SPECIFY) _______________ 13 (GO TO 324)
DON'T KNOW 98 (GO TO 324)

320. Was this place operated by the government, a mission, or by a private organization?

GOVERNMENT 1 (GO TO 322)
MISSION 2 (GO TO 322)
PRIVATE ORGANIZATION 3 (GO TO 322)
DON'T KNOW 8 (GO TO 322)

321. Was the method given at a government facility, a mission, or at the doctor's private practice?

GOVERNMENT 1
MISSION 2
PRIVATE PRACTICE 3
DON'T KNOW 8

322. How long does it take to travel from your home to this place?

MINUTES 1___
HOURS 2 __

DON'T KNOW 998

323. Is it easy or difficult to get there?

EASY 1
DIFFICULT 2

324. CHECK 311:

SHE/HE STERILIZED (GO TO 325)
USING ANOTHER METHOD (GO TO 326)

325. In what month and year was the sterilization operation done?

MONTH __ (GO TO 327)
YEAR __ (GO TO 327)

326. For how many months have you been using (CURRENT METHOD) continuously?

MONTHS ___

327. What is the main reason you are using a method of family planning?

SPACE BIRTHS 1 (GO TO 339)
STOP CHILDBEARING 2 (GO TO 339)
ECONOMIC COSTS 3 (GO TO 339)
HEALTH 4 (GO TO 339)
OTHER (SPECIFY) ________ 5 (GO TO 339)

328. Do you intend to use a method to avoid pregnancy at any time in the future?

YES 1 (GO TO 330)
NO 2
DON'T KNOW 8 (GO TO 333)

329. What is the main reason you do not intend to use a method?

WANTS CHILDREN 01 (GO TO 333)
LACK OF KNOWLEDGE 02 (GO TO 333)
FATALISTIC 03 (GO TO 333)
COST TOO MUCH 04 (GO TO 333)
SIDE EFFECTS 05 (GO TO 333)
HEALTH CONCERNS 06 (GO TO 333)
HARD TO GET METHODS 07 (GO TO 333)
RELIGION 08 (GO TO 333)
OPPOSED TO FAMILY PLANNING 09 (GO TO 333)
PARTNER OPPOSED TO FP 10 (GO TO 333)
OTHER PEOPLE OPPOSED TO FP 11 (GO TO 333)
INFREQUENT SEX 12 (GO TO 333)
DIFFICULT TO GET PREGNANT 13 (GO TO 333)
MENOPAUSAL/HAD HYSTERECTOMY 14 (GO TO 333)
INCONVENIENT 15 (GO TO 333)
NOT MARRIED 16 (GO TO 333)
OTHER (SPECIFY) ______ 17 (GO TO 333)
DON'T KNOW 98 (GO TO 333)

330. Do you intend to use a method within the next 12 months?

YES 1
NO 2
DON'T KNOW 8

331. When you use a method, which method would you prefer to use?

PILL 01
IUD 02
INJECTIONS 03
FOAMING TABLETS 04
DIAPHRAGM/FOAM/JELLY 05
DUREX OR CONDOM 06
FEMALE STERILIZATION 07
MALE STERILIZATION 08
RHYTHM 09 (GO TO 333)
WITHDRAWAL 10 (GO TO 333)
OTHER (SPECIFY) _________ 11 (GO TO 333)
UNSURE 98 (GO TO 333)

332. Where can you get (METHOD MENTIONED IN 331)?

(NAME OF PLACE) __________
HOSPITAL 01 (GO TO 335)
HEALTH CENTER, MATERNITY CENTER, FAMILY PLANNING CLINIC, OR HEALTH CLINIC POST 02 (GO TO 335)
DOCTOR 03 (GO TO 336)
PLANNED PARENTHOOD FED. CLINIC 04 (GO TO 337)
PRIVATE CLINIC 05 (GO TO 337)
PHARMACY 06 (GO TO 337)
PATENT MEDICINE SHOP 07 (GO TO 337)
MARKET 08 (GO TO 337)
HUSBAND'S PLACE OF WORK 09 (GO TO 337)
YOUR PLACE OF WORK 10 (GO TO 337)
CHURCH 11 (GO TO 337)
FRIENDS/RELATIVES 12 (GO TO 337)
OTHER (SPECIFY) _______________ 13 (GO TO 337)
DON'T KNOW 98

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

YES 1
NO 2 (GO TO 339)

334. Where is that?

(NAME OF PLACE) __________
HOSPITAL 01
HEALTH CENTER, MATERNITY CENTER, FAMILY PLANNING CLINIC, OR HEALTH CLINIC POST 02
DOCTOR 03 (GO TO 336)
PLANNED PARENTHOOD FED. CLINIC 04 (GO TO 337)
PRIVATE CLINIC 05 (GO TO 337)
PHARMACY 06 (GO TO 337)
PATENT MEDICINE SHOP 07 (GO TO 337)
MARKET 08 (GO TO 337)
HUSBAND'S PLACE OF WORK 09 (GO TO 337)
YOUR PLACE OF WORK 10 (GO TO 337)
CHURCH 11 (GO TO 337)
FRIENDS/RELATIVES 12 (GO TO 337)
OTHER (SPECIFY) _______________ 13 (GO TO 337)
DON'T KNOW 98 (GO TO 339)

335. Is this place operated by the government, a mission, or by a private organization?

GOVERNMENT 1 (GO TO 337)
MISSION 2 (GO TO 337)
PRIVATE ORGANIZATION 3 (GO TO 337)
DON'T KNOW 8 (GO TO 337)

336. Is the doctor at a government facility, a mission, or at a private office?

GOVERNMENT 1
MISSION 2
PRIVATE OFFICE 3
DON'T KNOW 8

337. How long does it take to travel from your home to this place?

MINUTES 1___
HOURS 2 __

DON'T KNOW 998

338. Is it easy or difficult to get there?

EASY 1
DIFFICULT 2

339. Who would you talk to if you wanted to get factual information about using a contraceptive method?

VILLAGE HEALTH WORKER 01
HEALTH CLINIC/POST 02
HEALTH CENTER 03
HOSPITAL 04
PRIVATE DOCTOR 05
FAMILY PLANNING CLINIC 06
MOTHER 07
MOTHER-IN-LAW 08
FEMALE FRIEND 09
MALE FRIEND 10
HUSBAND/PARTNER 11
OTHER (SPECIFY) _______ 12

340. Who would you talk to if you wanted to get personal advice about using a contraceptive method?

VILLAGE HEALTH WORKER 01
HEALTH CLINIC/POST 02
HEALTH CENTER 03
HOSPITAL 04
PRIVATE DOCTOR 05
FAMILY PLANNING CLINIC 06
MOTHER 07
MOTHER-IN-LAW 08
FEMALE FRIEND 09
MALE FRIEND 10
HUSBAND/PARTNER 11
OTHER (SPECIFY) _______ 12

341. In the last month have you heard a message about family planning on the radio or television?

YES 1
NO 2

342. Is it acceptable or not acceptable to you for family planning information to be provided on the radio or television?

ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 3

SECTION 4A. PREGNANCY AND BREASTFEEDING

401. CHECK 222:

ONE OR MORE LIVE BIRTHS SINCE JANUARY 1985 (GO TO 402)
NO LIVE BIRTHS SINCE JANUARY 1985 (GO TO 501)

402. ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1985 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL FORMS).
Now I would like to ask you some more questions about the health of children you had in the past 5 years. (We will talk about one child at a time.)

LINE NUMBER FROM Q.212

LINE NUMBER _____

FROM Q.212 AND Q.216

NAME _______
ALIVE (GO TO 403)
DEAD (GO TO 403)

403. 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 want no more children at all?

THEN 1 (GO TO 405)
LATER 2
NO MORE 3 (GO TO 405)

404. How much longer would you like to have waited?

MONTHS 1 __
YEARS 2 __

DON'T KNOW 998

405. When you were pregnant with (NAME), did you see anyone for an antenatal check on this pregnancy?
IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.

DOCTOR 1
NURSE/MIDWIFE/COMMUNITY HEALTH OFFICER 1
AUXILIARY MIDWIFE/COMMUN. HEALTH ASSISTANT 1
VILLAGE HEALTH WORKER 1
TRAINED (TRADITIONAL) BIRTH ATTENDANT 1
TRADITIONAL BIRTH ATTENDANT 1
OTHER (SPECIFY) ________ 1
NO ONE 1 (GO TO 409)

406. Were you given an antenatal card for this pregnancy?

YES 1
NO 2
DON'T KNOW 8

407. How many months pregnant were you when you first saw someone for an antenatal check on this pregnancy?

MONTHS _____
DON'T KNOW 98

408. How many antenatal visits did you have during this pregnancy?

NUMBER OF VISITS _____

409. When you were pregnant with (NAME) were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?

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

410. How many times did you get this injection?

TIMES __
DON'T KNOW 8

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

YOUR HOME 01
HOME OF RELATIVE OR FRIEND 02
HOME OF VILLAGE HEALTH WORKER 03
HOME OF TRADITIONAL BIRTH ATTENDANT 04
HEALTH CLINIC/POST 05
HEALTH CENTER 06
MATERNITY CENTER 07
HOSPITAL 08
OTHER (SPECIFY) ________ 09

412. Who assisted with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.

DOCTOR 1
NURSE/MIDWIFE/COMMUNITY HEALTH OFFICER 1
AUXILIARY MIDWIFE/COMMUN. HEALTH ASSISTANT 1
VILLAGE HEALTH WORKER 1
TRAINED (TRADITIONAL) BIRTH ATTENDANT 1
TRADITIONAL BIRTH ATTENDANT 1
OTHER (SPECIFY) ________ 1
NO ONE 1

413. Was (NAME) born on time or prematurely?

ON TIME 1
PREMATURELY 2
DON'T KNOW 8

414. Was (NAME) delivered by caesarian section?

YES 1
NO 2

415. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 417)

416. How much did (NAME) weigh?

KILOGRAMS __.__
DON'T KNOW 98

417. When (NAME) was born, was he/she very large, larger than average, average, smaller than average, or very small?

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

418. Has your period returned since the birth of (NAME)?
[FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 420)

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

MONTHS ______
DON'T KNOW 98

420. IF PREGNANT CIRCLE '3', OTHERWISE ASK:
Have you resumed sexual relations since the birth of (NAME)?
[FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 422)
PREGNANT 3

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

MONTHS ______
DON'T KNOW 98

422. Did you ever breastfeed (NAME)?

YES 1 (GO TO 424)
NO 2

423. Why did you not breastfeed (NAME)?

MOTHER ILL/WEAK 1 (GO TO 434)
CHILD ILL/WEAK 2 (GO TO 434)
CHILD DIED 3 (GO TO 434)
NIPPLE/BREAST PROBLEM 4 (GO TO 434)
NO MILK 5 (GO TO 434)
WORKING 6 (GO TO 434)
CHILD REFUSED 7 (GO TO 434)
OTHER (SPECIFY) _________ 8 (GO TO 434)

424. Did you feed (NAME) colostrum from the breast or wait until colostrum had passed?
[FOR LAST BIRTH ONLY]

FED COLOSTRUM 1 (GO TO 426)
WAITED 2
DON'T KNOW 8 (GO TO 426)

425. While you waited for colostrum to pass, what did you feed (NAME)?
[FOR LAST BIRTH ONLY]

PLAIN WATER 1
SUGAR/GLUCOSE WATER 2
BABY FORMULA 3
FRESH MILK 4
SOYA MILK 5
OTHER (SPECIFY) _________ 6

426. How long after birth did you first put (NAME) to the breast?
RECORD IN DAYS IF MORE THAN 24 HOURS
[FOR LAST BIRTH ONLY]

IMMEDIATELY 000

HOURS 1 ______
DAYS 2 ______

427. IF DEAD CIRCLE '3', OTHERWISE ASK:
Are you still breastfeeding (NAME)?
[FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 432)
DEAD 3

428. How many times did you breastfeed last night between sundown and sunup?
(IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NO.)
[FOR LAST BIRTH ONLY]

NUMBER OF NIGHTTIME FEEDINGS ______

429. How many times did you breastfeed yesterday during the daylight hours?
(IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NO.)
[FOR LAST BIRTH ONLY]

NUMBER OF DAYLIGHT FEEDINGS _________

430. At any time yesterday or last night was (NAME) given any of the following:
[FOR LAST BIRTH ONLY]

Plain water?
Sugar water?
Juice?
Herbal tea?
Baby formula?
Fresh milk?
Soya milk?
Any solid or mushy food, such as mashed banana or mashed grain?

PLAIN WATER
YES 1
NO 2
SUGAR WATER
YES 1
NO 2
JUICE
YES 1
NO 2
HERBAL TEA
YES 1
NO 2
BABY FORMULA
YES 1
NO 2
FRESH MILK
YES 1
NO 2
SOYA MILK
YES 1
NO 2
SOLID/MUSHY FOOD
YES 1
NO 2

431. CHECK 430:
FOOD OR LIQUID GIVEN YESTERDAY?
[FOR LAST BIRTH ONLY]

YES TO ONE OR MORE (GO TO 436)
NO TO ALL (GO TO 435)

432. For how many months did you breastfeed (NAME)?

MONTHS _________
UNTIL DIED 96 (GO TO 435)

433. Why did you stop breastfeeding (NAME)?

MOTHER ILL/WEAK 01
CHILD ILL/WEAK 02
CHILD DIED 03
NIPPLE/BREAST PROBLEM 04
NO MILK 05
WORKING 06
CHILD REFUSED 07
WEANING AGE 08
BECAME PREGNANT 09
OTHER (SPECIFY) _________ 10

434. CHECK 216:
CHILD ALIVE?

ALIVE (GO TO 436)
DEAD (GO TO 435)

435. Was (NAME) ever given any water, or something else to drink or eat (other than breastmilk)?

YES 1
NO 2 (GO TO 438)

436. How many months old was (NAME) when you started giving the following on a regular basis?:

Fomula or milk other than breastmilk, such as soya milk?
AGE IN MONTHS __
NOT GIVEN 96
Water or other liquids?
AGE IN MONTHS __
NOT GIVEN 96
Any solid or mushy food, such as mashed banana or mashed grain?
AGE IN MONTHS __
NOT GIVEN 96

437. IF DEAD CIRCLE '3', OTHERWISE ASK:
Did (NAME) drink anything from a bottle with a nipple yesterday or last night?
[FOR LAST BIRTH ONLY]

YES 1
NO 2
DEAD 3
DON'T KNOW 8

438. GO BACK TO 403 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO FIRST COLUMN OF 439.

SECTION 4B. IMMUNIZATION AND HEALTH

439. ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1985 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL FORMS).

LINE NUMBER FROM Q.212

LINE NUMBER _____

FROM Q.212 AND Q.216

NAME ________ __
ALIVE (GO TO 440)
DEAD (GO TO 440)

440. Do you have a health card where (NAME'S) vaccinations are written down?
IF YES: May I see it, please?

YES, SEEN 1 (GO TO 442)
YES, NOT SEEN 2 (GO TO 444)
NO CARD 3

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

YES 1 (GO TO 444)
NO 2 (GO TO 444)

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

BCG
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 ____

443. Has (NAME) received any vaccinations that are not recorded on this card?

YES 1 (PROBE FOR VACCINATIONS, AND WRITE '66' IN THE CORRESPONDING DAY COLUMN) (GO TO 446)
NO 2 (GO TO 446)
DON'T KNOW 8 (GO TO 446)

444. Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases?

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

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

A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that left a scar?
YES 1
NO 2
DON'T KNOW 8
Polio vaccine, that is, drops in the mouth?
YES 1
NO 2
DON'T KNOW 8
If YES: How many times?
NUMBER OF TIMES _____
An injection against measles?
YES 1
NO 2
DON'T KNOW 8

446. CHECK 216:
CHILD ALIVE?

ALIVE (GO TO 448)
DEAD (GO TO 447)

447. GO BACK TO 440 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 482.

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 452)
DON'T KNOW 8 (GO TO 452)

450. How long did the cough last?

DAYS ____ (IF LESS THAN 1 DAY, RECORD '00')

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

YES 1
NO 2
DON'T KNOW 8

452. CHECK 448 AND 449:
FEVER OR COUGH?

'YES' IN EITHER 448 OR 449 (GO TO 453)
OTHER (GO TO 462)

453. Did you seek advice or treatment for the fever/cough?

YES 1
NO 2 (GO TO 462)

454. When you perceived that (NAME) was ill, who began treatment?

VILLAGE HEALTH WORKER 01
HEALTH CLINIC/POST 02
HEALTH CENTER 03
HOSPITAL 04
PRIVATE DOCTOR 05
TRADITIONAL/SPIRITUAL HEALER 06
VILLAGE CHEMIST AT PATENT MEDICINE SHOP 07
PHARMACY 08
MYSELF/RELATIVES 09
OTHER (SPECIFY) _______ 10

455. Was this treatment given at home or away from home?

AT HOME/COMPOUND 1 (GO TO 458)
AWAY FROM HOME 2

456. How much time did it take to go to this place?

MINUTES 1 ___
HOURS 2 ___

457. How much did it cost to travel to this place?

COST __.__
NO COST 9996

458. How much did it cost for the treatment obtained at this place?
(RECORD CASH OR CASH EQUIVALENT OF NON-CASH PAYMENTS)

CASH 1 __.__
CASH EQUIVALENT 2 __.__

NO COST 999996

459. What was given to treat the fever/cough, if anything? Anything else?
(CIRCLE EACH MENTIONED)

NOTHING GIVEN 1
INJECTION 1
ANTIBIOTIC (PILL OR SYRUP) 1
ANTIMALARIAL (PILL OR SYRUP) 1
COUGH SYRUP 1
OTHER PILL OR SYRUP 1
UNKNOWN PILL OR SYRUP 1
HOME REMEDY/ HERBAL MEDICINE 1
OTHER (SPECIFY) _____________ 1

460. If you purchased drugs or other preparations for (NAME)'s treatment, where did you buy them?

VILLAGE HEALTH WORKER 01
HEALTH CLINIC/POST 02
HEALTH CENTER 03
HOSPITAL 04
PRIVATE DOCTOR 05
TRADITIONAL/SPIRITUAL HEALER 06
VILLAGE CHEMIST AT PATENT MEDICINE SHOP 07
PHARMACY 08
NO DRUGS PURCHASED 09
OTHER (SPECIFY) _______ 10

461. What was the most important reason why you chose to go to this source of care?

LOWER TRANSPORTATION COSTS 1
LOWER TREATMENT COSTS 2
SHORTER WAITING TIME AT FACILITY 3
BETTER QUALITY CARE 4
GREATER AVAILABILITY OF DRUGS 5
SHORTER TRAVEL TIME TO SOURCE OF CARE 6
NO ALTERNATIVE SOURCE OF CARE 7
OTHER (SPECIFY)_______ 8

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

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

463. GO BACK TO 440 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 482.

464. Has (NAME) had diarrhea in the last 24 hours?

YES 1
NO 2
DON'T KNOW 8

465. How long has the diarrhea lasted/did the diarrhea last?

DAYS ___ (IF LESS THAN 1 DAY, ENTER '00')

466. Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

467. What do you think may be the reason (NAME) had diarrhea?

TEETHING 1
CONTAMINATED FOOD/WATER 2
OTHER (SPECIFY) __________ 3
DON'T KNOW 8

468. Do you think (NAME'S) diarrhea was not dangerous to his/her health, or was it slightly or very dangerous?

NOT DANGEROUS 1
SLIGHTLY DANGEROUS 2
VERY DANGEROUS 3
DON'T KNOW 8

469. CHECK 427:
LAST CHILD STILL BREASTFED?

YES (GO TO 470)
NO (GO TO 472)

470. When (NAME) had diarrhea, did you change the frequency of breastfeeding?

YES
NO (GO TO 472)

471. During the diarrhea, did you increase the number of feeds or reduce them, or did you stop completely?

INCREASED 1
REDUCED 2
STOPPED COMPLETELY 3

472. (Aside from breastmilk) Was he/she given the same amount to drink as before the diarrhea, or more, or less?

SAME 1
MORE 2
LESS 3
DON'T KNOW 8

473. Was (NAME) given a fluid made from a special packet?

YES 1
NO 2
DON'T KNOW 8

474. Was (NAME) given a recommended home-made fluid made from sugar, salt and water?

YES 1
NO 2
DON'T KNOW 8

475. CHECK 473 AND 474:
CHILD GIVEN FLUID FROM PACKET (473) AND/OR RECOMMENDED HOME-MADE FLUID (474)?

YES GIVEN FLUID (PKT./HOME) (GO TO 476)
NO FLUID (GO TO 477)

476. For how many days was (NAME) given this fluid?

DAYS _____
DON'T KNOW 98

477. Was anything given for the diarrhea (other than this fluid)?

YES 1
NO 2 (GO TO 479)
DON'T KNOW 8 (GO TO 479)

478. What was given to treat the diarrhea? Anything else?
(CIRCLE EACH MENTIONED)

INJECTION 1
ANTIBIOTIC (PILL OR SYRUP) 1
OTHER PILL OR SYRUP 1
(I.V.) INTRAVENOUS 1
UNKNOWN PILL OR SYRUP 1
HOME REMEDY/ HERBAL MEDICINE 1
OTHER (SPECIFY) _____________ 1

479. Did you seek advice or treatment for the diarrhea?

YES 1
NO 2 (GO TO 481)

480. From whom did you seek advice or treatment? Anyone else?
(CIRCLE EACH MENTIONED)

VILLAGE HEALTH WORKER 1
HEALTH CLINIC/POST 1
HEALTH CENTER 1
HOSPITAL 1
PRIVATE DOCTOR 1
TRADITIONAL/SPIRITUAL HEALER 1
VILLAGE CHEMIST AT PATENT MEDICINE SHOP 1
PHARMACY 1
OTHER (SPECIFY) _______ 1

481. GO BACK TO 440 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 482.

482. CHECK 473:

ORS SOLUTION MENTIONED (ANY YES IN 473) (GO TO 484)
ORS SOLUTION NOT MENTIONED OR 473 NOT ASKED (GO TO 483)

483. Have you ever seen a packet like this before?
(SHOW PACKET)

YES 1
NO 2 (GO TO 487)

484. Have you ever prepared a solution with one of these packets to treat diarrhea in yourself or someone else?
(SHOW PACKET)

YES 1
NO 2 (GO TO 486)

485. How much water did you use to prepare (LOCAL NAME)?

SOFT DRINK BOTTLES 1 __
BEER BOTTLES 2 __
CUPS 3 __

FOLLOWED PACKAGE INSTRUCTIONS 95
OTHER (SPECIFY) __________ 96
DON'T KNOW 98

486. Where can you get the (LOCAL NAME) packet?
PROBE: Anywhere else?
(CIRCLE ALL PLACES MENTIONED)

VILLAGE HEALTH WORKER 1
HEALTH CLINIC/POST 1
HEALTH CENTER 1
HOSPITAL 1
PRIVATE DOCTOR 1
TRADITIONAL/SPIRITUAL HEALER 1
VILLAGE CHEMIST AT PATENT MEDICINE SHOP 1
PHARMACY 1
OTHER (SPECIFY) _______ 1
DON'T KNOW 1

487. CHECK 473:

RECOMMENDED HOME-MADE FLUID MENTIONED (AND YES IN 474) (GO TO 489)
RECOMMENDED HOME-MADE FLUID NOT MENTIONED OR 474 NOT ASKED (GO TO 488)

488. Have you ever prepared a recommended home-made fluid made from sugar, salt and water to treat diarrhea in yourself or someone else?
SHOW SACHETS.

YES 1
NO 2 (GO TO 501)

489. Who taught you to prepare the home fluid made from sugar, salt and water?

VILLAGE HEALTH WORKER 01
HEALTH CLINIC/POST 02
HEALTH CENTER 03
HOSPITAL 04
PRIVATE DOCTOR 05
TRADITIONAL/SPIRITUAL HEALER 06
VILLAGE CHEMIST AT PATENT MEDICINE SHOP 07
PHARMACY 08
IMMUNIZATION CARD 09
OTHER (SPECIFY) _______ 10
DON'T KNOW 98

490. How much water did you use to prepare the home fluid?

SOFT DRINK BOTTLES 1 __
BEER BOTTLES 2 __
CUPS 3 __

OTHER (SPECIFY) __________ 96
DON'T KNOW 98

491. How much sugar did you use to prepare the home fluid?

CUBES 1 __
TEASPOONS 2 __

OTHER (SPECIFY) __________ 996
DON'T KNOW 998

492. How much salt did you use to prepare the home fluid?

1 TEASPOON 1
2 TEASPOONS 2
3 TEASPOONS 3
OTHER (SPECIFY) __________ 4
DON'T KNOW 8

493. Do you consider the home fluid effective for treating diarrhea?

YES 1
NO 2
DON'T KNOW 8

SECTION 5. MARRIAGE

501. Have you ever been married or lived with a man?

YES 1
NO 2 (GO TO 510)

502. Are you now married or living with a man, or are you now widowed, divorced or no longer living together?

MARRIED 1
LIVING TOGETHER 2 (GO TO 504)
WIDOWED 3 (GO TO 507)
DIVORCED 4 (GO TO 507)
NO LONGER LIVING TOGETHER 5 (GO TO 507)

503. Does your husband/partner live with you or does he live elsewhere?

LIVES WITH HER 1
LIVES ELSEWHERE 2

504. Does your husband/partner have any other wives besides yourself?

YES 1
NO 2 (GO TO 507)
DON'T KNOW 8 (GO TO 507)

505. How many other wives does he have?

NUMBER ___
DON'T KNOW 98 (GO TO 507)

506. Are you the first, second, ... wife?

RANK ___

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

ONCE 1
MORE THAN ONCE 2

508. How old were you when you started living with your (first) husband or partner?

AGE ____

509. In what month and year did you start living with him?

MONTH ___ (GO TO 511)
DON'T KNOW MONTH 98 (GO TO 511)
YEAR ____ (GO TO 511)
DON'T KNOW YEAR 98 (GO TO 511)

510. IF NEVER IN UNION: Have you ever had sexual intercourse?

YES 1
NO 2 (GO TO 515)

511. Now we need some details about your sexual activity in order to get a better understanding of contraception and fertility. How many times did you have sexual intercourse in the last four weeks?

TIMES __

512. How many times a month do you usually have sexual intercourse?

TIMES __

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

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

BEFORE LAST BIRTH 996

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

AGE __
FIRST TIME WHEN MARRIED 96

515. PRESENCE OF OTHERS AT THIS POINT.

CHILDREN UNDER 10
YES 1
NO 2
HUSBAND
YES 1
NO 2
OTHER MALES
YES 1
NO 2
OTHER FEMALES
YES 1
NO 2

SECTION 6. FERTILITY PREFERENCES

601. CHECK 311:

NEITHER STERILIZED (GO TO 602)
HE OR SHE STERILIZED (GO TO 606)

602. CHECK 501 AND 502:

CURRENTLY MARRIED OR LIVING TOGETHER (GO TO 603)
NOT CURRENTLY IN UNION (GO TO 613)

603. CHECK 223 AND MARK BOX:

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

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

HAVE A (ANOTHER) CHILD 1
NO MORE 2 (GO TO 609)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 609)
UNDECIDED OR DON'T KNOW 8 (GO TO 609)

604. CHECK 223 AND MARK BOX:

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

PREGNANT: How long would you like to wait after the birth you are expecting before the birth of another child?

MONTHS 1 ___ (GO TO 609)
YEARS 2 ___ (GO TO 609)

SOON/NOW 994 (GO TO 609)
SAYS SHE CAN'T GET PREGNANT 995 (GO TO 609)
OTHER (SPECIFY) _____ 996
DON'T KNOW 998

605. CHECK 216:
IF NO LIVING CHILDREN, CIRCLE '96', OTHERWISE ASK:
How old would you like your youngest child to be before having another child?

AGE OF YOUNGEST YEARS ____ (GO TO 609)

NO LIVING CHILDREN 96 (GO TO 609)
DON'T KNOW 98 (GO TO 609)

606. Do you regret that you (your husband) had the operation not to have any (more) children?

YES 1
NO 2 (GO TO 608)

607. Why do you regret it?

WANTS ANOTHER CHILD 1 (GO TO 613)
OTHER REASON _________ 2 (GO TO 613)

608. Given your present circumstances, if you had to do it over again, do you think you would make the same decision to have a sterilization?

YES 1 (GO TO 613)
NO 2 (GO TO 613)

609. Do you think that your husband/partner approves or disapproves of couples using a method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

610. How often have you talked to your husband/partner about family planning in the past year?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

611. Have you and your husband/partner ever discussed the number of children you would like to have?

YES 1
NO 2

612. Do you think your husband/partner wants the same number of children that you want, or does he want more or fewer than you want?

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

613. How long should a couple wait before starting sexual intercourse after the birth of a baby?

MONTHS 1 __
YEARS 2 __

OTHER (SPECIFY) ________ 996

614. Should a mother wait until she has completely stopped breastfeeding before starting to have sexual relations again, or doesn't it matter?

WAIT 1
DOESN'T MATTER 2

615. In general, do you approve or disapprove of couples using a method to avoid pregnancy?

APPROVE 1
DISAPPROVE 2

616. CHECK 216 AND MARK BOX:

NO LIVING CHILDREN: If you could choose exactly the number of children to have in your whole life, how many would that be?

HAS LIVING CHILDREN: If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?

RECORD SINGLE NUMBER OR OTHER ANSWER.

NUMBER ______

UP TO GOD 95
OTHER (SPECIFY) ____________96

SECTION 7. HUSBAND'S BACKGROUND AND WOMAN'S WORK

701. CHECK 501:

EVER MARRIED OR LIVED TOGETHER (ASK QUESTIONS ABOUT CURRENT OR MOST RECENT HUSBAND/PARTNER) (GO TO 702)
NEVER MARRIED, NEVER LIVED TOGETHER (GO TO 708)

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

YES 1
NO 2 (GO TO 705)

703. What was the highest level of school he attended: primary, secondary, or higher?

PRIMARY 1
SECONDARY 2
HIGHER 3
DON'T KNOW 8 (GO TO 705)

704. What was the highest (class, form, year) he completed at that level?

CLASS ____
DON'T KNOW 98

705. What kind of work does (did) your (last) husband/partner mainly do?

OCCUPATION________________

706. CHECK 705:

WORKS (WORKED) IN AGRICULTURE (GO TO 707)
DOES (DID) NOT WORK IN AGRICULTURE (GO TO 708)

707. (Does/Did) your husband/partner work mainly on his own land or family land, or (does/did) he rent land, or (does/did) he work on someone else's land?

HIS/FAMILY LAND 1
RENTED LAND 2
SOMEONE ELSE'S LAND 3

708. As you know, many women work - I mean aside from doing their own housework. Some take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business. Are you currently doing any such work?

YES 1
NO 2 (GO TO 716)

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

OCCUPATION______________

710. In your work, are you an employee, self-employed, or an employer?

EMPLOYEE 1
SELF-EMPLOYED 2
EMPLOYER 3

711. Do you earn cash for this work?

YES 1
NO 2

712. Do you do this work at home or away from home?

HOME 1
AWAY 2

713. CHECK 215/216/218:
HAS CHILD BORN SINCE JANUARY 1985 AND LIVING AT HOME?

YES (GO TO 714)
NO (GO TO 716)

714. While you are working, do you usually have (NAME OF YOUNGEST CHILD AT HOME) with you, sometimes have him/her with you, or never have him/her with you?

USUALLY 1 (GO TO 716)
SOMETIMES 2
NEVER 3

715. Who usually takes care of (NAME OF YOUNGEST CHILD AT HOME) while you are working?

HUSBAND 01
OLDER CHILD (REN) 02
OTHER RELATIVES 03
NEIGHBORS 04
FRIENDS 05
SERVANTS/HIRED HELP 06
CHILD IS IN SCHOOL 07
INSTITUTIONAL CHILDCARE 08
OTHER (SPECIFY) ________ 09

716. RECORD THE TIME

HOUR __
MINUTES __

SECTION 8. WEIGHT AND LENGTH

801. CHECK 215/216:

ONE OR MORE LIVING CHILDREN BORN SINCE JANUARY 1985
INTERVIEWER: IN 802-804, RECORD THE LINE NUMBERS, NAMES, AND BIRTH DATES OF ALL LIVING CHILDREN BORN SINCE JANUARY 1, 1985 STARTING WITH THE YOUNGEST CHILD. RECORD WEIGHT AND LENGTH IN 805 AND 806.
NO LIVING CHILDREN BORN SINCE JANUARY 1985 (END)

802. LINE NO. FROM Q.212

LINE NUMBER___

803. NAME FROM Q.212

NAME___________

804. DATE OF BIRTH FROM Q.215 AND ASK FOR DAY

DAY ___
MONTH ___
YEAR ___

805. WEIGHT (in kg.)

WEIGHT____.__

806. LENGTH (in cm.)

LENGTH____.__

807. BCG SCAR ON ARM OR SHOULDER

SCAR SEEN 1
NO SCAR 2

808. DATE CHILD WEIGHED AND MEASURED

DAY ___
MONTH ___
YEAR __

809. RESULT

CHILD MEASURED 1
CHILD SICK 2
CHILD NOT PRESENT 3
CHILD REFUSED 4
MOTHER REFUSED 5
OTHER (SPECIFY) _________ 6

810. NAME OF MEASURER AND ASSISTANT
NAME OF MEASURER:_________

NAME OF ASSISTANT: _________

INTERVIEWER'S OBSERVATIONS

(To be filled in after completing interview)

Comments about respondent:________________________________

Comments about specific questions:_________________________________

Any other comments: _________________________________

SUPERVISOR'S OBSERVATIONS:_________________________________

Name of Supervisor: ________________
Date: _________________

EDITOR'S OBSERVATIONS:_________________________________

Name of Field Editor: __________________
Date: _____________

Name of Keyer: _____________________
Date: ____________