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FEDERAL REPUBLIC OF NIGERIA
NATIONAL POPULATION COMMISSION
1999 DEMOGRAPHIC AND HEALTH SURVEY
INDIVIDUAL QUESTIONNAIRE FOR MEN

IDENTIFICATION

STATE NAME ___
LOCAL GOVT. AREA ___
LOCALITY NAME ___
ENUMERATION AREA ___

URBAN/RURAL ___

Urban = 1
Rural = 2

LARGE TOWN/MEDIUM TOWN/SMALL TOWN/VILLAGE ___

(Large Towns are places with over 1 million population; Medium Towns are places with between 50,000 and 1 million population; Small Towns are places both between 20,000 and 50,000 population while places with less than 20,000 are villages.)

Large Town = 1
Medium Town = 2
Small Town = 3
Village = 4

BUILDING NUMBER ___
HOUSEHOLD NAME/NUMBER ___

NAME AND LINE NUMBER OF MAN IN HOUSEHOLD SCHEDULE __

INTERVIEWER'S VISITS

FIRST VISIT
DATE __________
INTERVIEWER’S NAME ___________
RESULT _____________

1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 DWELLING DESTROYED
8 OTHER (SPECIFY) ___________

NEXT VISIT
DATE __________
TIME ___________

FINAL VISIT
DAY ____
MONTH ____
YEAR ____
NAME ____
RESULT _____

TOTAL NO. OF VISITS __

SUPERVISOR
NAME ________ ___
DATE ________

FIELD EDITOR
NAME ________ ___
DATE ________

OFFICE EDITOR_____

KEYED BY_____

SECTION 1. RESPONDENT’S BACKGROUND

101. RECORD THE TIME (START OF INTERVIEW).

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 large town, medium town, small town, or in the village?

LARGE TOWN 1
MEDIUM TOWN 2
SMALL TOWN 3
VILLAGE 4

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 large town, medium town, small town, or in the village?

LARGE TOWN 1
MEDIUM TOWN 2
SMALL TOWN 3
VILLAGE 4

105. In what month and year were you born?

MONTH _____
DON’T KNOW MONTH 98
YEAR ______
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
OTHER (SPECIFY) ___________ 4

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

GRADE (YEAR) _______

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 (GO TO 113)

112. Do you usually read a newspaper or magazine at least once a week?

YES 1
NO 2

113. Do you usually listen to radio every day?

YES 1
NO 2

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

YES 1
NO 2

115. Are you currently working?

YES 1 (GO TO 117)
NO 2

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

YES 1
NO 2 (GO TO 124)

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

______________ ___

118. CHECK 117:

WORK IN AGRICULTURE (GO TO 119)
DOES NOT WORK IN AGRICULTURE (GO TO 120)

119. Do you work mainly on your own land or on family land, or do you rent land, or work on someone else’s land?

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

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

FOR FAMILY MEMBER 1
FOR SOMEONE ELSE 2
SELF EMPLOYED 3

121. Do you usually work at this job throughout the year, or do you work seasonally, or only once in a while?

THROUGHOUT THE YEAR 1 (GO TO 123)
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3

122. During the last 12 months, how many months did you work at this job?

NUMBER OF MONTHS ___

123. How much do you earn for this work?
PROBE: Is this by the hour, by the day, by the week, by the month or by the year?

PER HOUR 1 __
PER DAY 2 __
PER WEEK 3 __
PER MONTH 4 __
PER YEAR 5 __
OTHER (SPECIFY) _____________ 99996

124. What is your religion?

CATHOLIC 1
PROTESTANT 2
OTHER CHRISTIAN 3
ISLAM 4
TRADITIONALIST 5
OTHER (SPECIFY) ________ 6

125. What is your ethnic group?

________________

SECTION 2. REPRODUCTION

201. Now I would like to ask about your children. I am interested only in the children that are biologically yours. Have you ever had children?

YES 1
NO 2 (GO TO 206)

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

YES 1
NO 2 (GO TO 204)

203. How many sons live with you? And how many daughters live with you?
IF NONE, RECORD ‘00’.

SONS AT HOME _______
DAUGHTERS AT HOME ______

204. Do you have any sons or daughters 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, RECORD ‘00’.

SONS ELSEWHERE ____
DAUGHTERS ELSEWHERE _____

206. Have you ever given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but survived only a few hours or days?

YES 1
NO 2 (GO TO 208)

207. How many boys have died? And how many girls have died?
IF NONE, RECORD ‘00’.

BOYS DEAD ______
GIRLS DEAD ______

208. SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL.
IF NONE, RECORD ‘00’.

TOTAL ___

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

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

210. CHECK 208:

HAS HAD CHILDREN (GO TO 210A)
HAS NEVER HAD CHILDREN (GO TO 301)

210A. In what month and year was your last child born?

MONTH __
YEAR __

210B. CHECK 201A, LAST CHILD:

BORN SINCE JANUARY 1996 (GO TO 211)
BEFORE JANUARY 1996 (GO TO 301)

211. When you were expecting your last born child, did you want to have the child then, did you want to wait until later, or did you not want to have any (more) children at all?

THEN 1
LATER 2
NOT AT ALL 3

SECTION 3. CONTRACEPTION

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.
CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY.
THEN PROCEED DOWN COLUMN 302, 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 301 OR 302, ASK 303.

301. Which ways or methods have you heard about?

METHOD 01 PILL Women can take a pill every day.
SPONTANEOUS YES 1
METHOD 02 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
SPONTANEOUS YES 1
METHOD 03 INJECTABLES Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
SPONTANEOUS YES 1
METHOD 04 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.
SPONTANEOUS YES 1
METHOD 05 DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.
SPONTANEOUS YES 1
METHOD 06 CONDOM Men can put a rubber sheath on their penis for sexual intercourse.
SPONTANEOUS YES 1
METHOD 07 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
SPONTANEOUS YES 1
METHOD 08 MALE STERILIZATION Men can have an operation to avoid having any more children.
SPONTANEOUS YES 1
METHOD 09 RHYTHM, PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid having sexual intercourse on the days of the month she is most likely to get pregnant.
SPONTANEOUS YES 1
METHOD 10 WITHDRAWAL Men can be careful and pull out before climax.
SPONTANEOUS YES 1
METHOD 11 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
SPONTANEOUS YES 1 (SPECIFY) ______________

302. Have you ever heard of (METHOD)?

METHOD 01 PILL Women can take a pill every day.
PROBED YES 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.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 03 INJECTABLES Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 04 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 05 DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 06 CONDOM Men can put a rubber sheath on their penis for sexual intercourse.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 07 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 08 MALE STERILIZATION Men can have an operation to avoid having any more children.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 09 RHYTHM, PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid having sexual intercourse on the days of the month she is most likely to get pregnant.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 10 WITHDRAWAL Men can be careful and pull out before climax.
PROBED YES 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?
NO 3

303. Have you ever used (METHOD)?

METHOD 01 PILL Women can take a pill every day.
YES 1
NO, DOES NOT KNOW 2
METHOD 02 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO, DOES NOT KNOW 2
METHOD 03 INJECTABLES Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO, DOES NOT KNOW 2
METHOD 04 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.
YES 1
NO, DOES NOT KNOW 2
METHOD 05 DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.
YES 1
NO, DOES NOT KNOW 2
METHOD 06 CONDOM Men can put a rubber sheath on their penis for sexual intercourse.
YES 1
NO, DOES NOT KNOW 2
METHOD 07 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
Have you ever had a partner who had an operation to avoid having children?
YES 1
NO, DOES NOT KNOW 2
METHOD 08 MALE STERILIZATION Men 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, DOES NOT KNOW 2
METHOD 09 RHYTHM, PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO, DOES NOT KNOW 2
METHOD 10 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO, DOES NOT KNOW 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

304. CHECK 303:

NOT A SINGLE ‘YES’ (NEVER USED) (GO TO 305)
AT LEAST ONE ‘YES’ (EVER USED) (GO TO 307)

305. Have you or any of your wives/partners ever used anything or tried in any way to delay or avoid getting pregnant?

YES 1
NO 2 (GO TO 309)

306. What have you used or done?
CORRECT 303 AND 304 (AND 302 IF NECESSARY).

___________________

307. Are you or your wife (wives)/partner(s) doing something or using a method to delay or avoid a pregnancy?

YES 1
NO 2 (GO TO 309)

308. Which method are you using?

PILL 01 (GO TO 401)
IUD 02 (GO TO 401)
INJECTABLES 03 (GO TO 401)
IMPLANTS 04 (GO TO 401)
DIAPHRAGM/FOAM/JELLY 05 (GO TO 401)
CONDOM/FEMIDOM 06 (GO TO 401)
FEMALE STERILIZATION 07 (GO TO 401)
MALE STERILIZATION 08 (GO TO 401)
PERIODIC ABSTINENCE 09 (GO TO 401)
WITHDRAWAL 10 (GO TO 401)
OTHER (SPECIFY) _________ 96 (GO TO 401)

309. What is the main reason you are not using a method of contraception to avoid pregnancy?

NOT MARRIED 11
FERTILITY-RELATED REASONS
NOT HAVING SEX 21
INFREQUENT SEX 22
MENOPAUSAL/HYSTERECTOMY 23
WIFE SUBFECUND/INFECUND 24
POSTPARTUM/BREASTFEEDING 25
WANTS (MORE) CHILDREN 26
WIFE PREGNANT 27
OPPOSITION TO USE
RESPONDENT OPPOSED 31
WIFE/PARTNER OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
LACK OF KNOWLEDGE
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY’S NORMAL PROCESSES 56
UP TO THE WOMAN TO USE 61
OTHER (SPECIFY) _____ 96
DOES NOT KNOW 98

SECTION 4. MARRIAGE

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

YES, CURRENTLY MARRIED 1
YES, LIVING WITH A WOMAN 2 (GO TO 402A)
NO, NOT IN UNION 3 (GO TO 404)

402. How many wife/wives do you have?

NO. OF WIVES

402A. How many women are you living with as if you are married?

NO. OF WOMEN

403. WRITE THE LINE NUMBERS FROM THE HOUSEHOLD QUESTIONNAIRE FOR HIS WIFE/WIVES.
IF A WIFE DOES NOT LIVE IN THE HOUSEHOLD, WRITE ‘00’.
THE NUMBER OF BOXES FILLED MUST EQUAL THE NUMBER OF WIVES.

LINE NUMBER___

404. Do you currently have a regular sexual partner, an occasional sexual partner, multiple sexual partner, or no sexual partner at all?

REGULAR SEXUAL PARTNER 1
OCCASIONAL SEXUAL PARTNER 2
NO SEXUAL PARTNER 3
MULTIPLE SEXUAL PARTNER 4

405. Have you ever been married or lived with a woman?

YES, FORMERLY MARRIED 1
YES, LIVED WITH A WOMAN 2 (GO TO 407)
NO 3 (GO TO 410)

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

WIDOWED 1
DIVORCED 2
SEPARATED 3

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

ONCE 1
MORE THAN ONCE 2

408. CHECK 407:

MARRIED/LIVED WITH A WOMAN ONLY ONCE: In what month and year did you start living with your wife/woman?

MARRIED/LIVED WITH WOMAN MORE THAN ONCE: Now we will talk about your first wife/woman you lived with. In what month and year did you start living with her?

MONTH __
DOES NOT KNOW MONTH 98
YEAR __ (GO TO 410)
DOES NOT KNOW YEAR 98

409. How old were you when you started living with her?

AGE ____

410. Now I need to ask you some questions about sexual activities in order to gain a better understanding of some family planning issues. When was the last time you had sexual intercourse (if ever)?

NEVER 000 (GO TO 509)

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

BEFORE LAST BIRTH 996 __

411. CHECK 301 AND 302:

KNOWS CONDOM: The last time you had sex, was a condom used?

DOES NOT KNOW CONDOM: Some men use a condom, which means that they put a rubber sheath on their penis for sexual intercourse. The last time you had sex, was a condom used?

YES 1
NO 2

412. Do you know of a place where you can get condom?

YES 1
NO 2 (GO TO 414)

413. Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) __________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
COMMUNITY HEALTH WORKER 15
OTHER PUBLIC (SPECIFY) ______ 16

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY/PMS 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
COMMUNITY HEALTH WORKER 25
OTHER PRIVATE MEDICAL (SPECIFY) ______ 26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
NGO 34
OTHER (SPECIFY) __________________ 36

414. CHECK 401:

CURRENTLY MARRIED/LIVING WITH A WOMAN: In the last 12 months, how many different persons have you had sex with other than your (wife/wives/women you are living with)?

NO, NOT IN UNION: In the last 12 months, how many different persons have you had sex with?

NUMBER __

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

AGE __
FIRST TIME WHEN MARRIED 96

SECTION 5. FERTILITY PREFERENCES

501. CHECK 401:

NO, NOT IN UNION (GO TO 502)
CURRENTLY MARRIED OR LIVING WITH A WOMAN (GO TO 503)

502. CHECK 404:

REGULAR SEXUAL PARTNER (GO TO 503)
OCCASIONAL SEXUAL PARTNER (GO TO 503)
MULTIPLE SEXUAL PARTNERS (GO TO 503)
NO SEXUAL PARTNER (GO TO 505A)

503. Is your wife (or one of your wives)/partner pregnant now?

YES 1
NO 2 (GO TO 505A)
UNSURE 3 (GO TO 505A)

504. When she became pregnant, did you want her to become pregnant then, did you want her to wait until later, or did you not want this pregnancy at all?

THEN 1 (GO TO 505B)
LATER 2 (GO TO 505B)
NOT AT ALL 3 (GO TO 505B)

505A. WIFE/PARTNER NOT PREGNANT OR UNSURE OR NO WIFE/PARTNER: Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 507)
SAYS WIFE CAN’T GET PREGNANT 3 (GO TO 507)
SAYS HE CAN’T HAVE ONE ANY MORE 4 (GO TO 507)
UNDECIDED/DON’T KNOW 8 (GO TO 507)

505B. WIFE/PARTNER PREGNANT: Now I have some questions about the future.
After the child you are expecting now, would you like to have another child, or would you prefer not to have any more children?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 507)
SAYS WIFE CAN’T GET PREGNANT 3 (GO TO 507)
SAYS HE CAN’T HAVE ONE ANY MORE 4 (GO TO 507)
UNDECIDED/DON’T KNOW 8 (GO TO 507)

506. CHECK 503:

WIFE/PARTNER NOT PREGNANT OR UNSURE NO WIFE/PARTNER: How long would you like to wait from now before the birth of (a/another) child?

WIFE/PARTNER PREGNANT: After the child your wife/partner is expecting, how long would you like to wait before the birth of another child?

MONTHS 1 ___
YEARS 2 ___

SOON/NOW 993
SAYS WIFE CAN’T GET PREGNANT 994
AFTER MARRIAGE 995
OTHER (SPECIFY) _____ 996
DOES NOT KNOW 998

507. CHECK 308:
USING A METHOD?

NOT ASKED (GO TO 508)
NOT CURRENTLY USING (GO TO 508)
CURRENTLY USING (GO TO 512)

508. Do you think you will use a method to delay or avoid pregnancy within the next 12 months?

YES 1 (GO TO 510)
NO 2
DOES NOT KNOW 8

509. Do you think you will use a method at any time in the future?

YES 1
NO 2 (GO TO 511)
DOES NOT KNOW 8 (GO TO 511)

510. Which method would you prefer to use?

PILL 01 (GO TO 512)
IUD 02 (GO TO 512)
INJECTABLES 03 (GO TO 512)
IMPLANTS 04 (GO TO 512)
DIAPHRAGM/FOAM/JELLY 05 (GO TO 512)
CONDOM/FEMIDOM 06 (GO TO 512)
FEMALE STERILIZATION 07 (GO TO 512)
MALE STERILIZATION 08 (GO TO 512)
PERIODIC ABSTINENCE 09 (GO TO 512)
WITHDRAWAL 10 (GO TO 512)
OTHER (SPECIFY) _________ 96 (GO TO 512)
UNSURE 98 (GO TO 512)

511. What is the main reason that you think you will never use a method?

NOT CURRENTLY MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX 22
MENOPAUSAL/HYSTERECTOMY 23
WIFE SUBFECUND/INFECUND 24
WANTS MORE CHILDREN 26
OPPOSITION TO USE
RESPONDENT OPPOSED 31
WIFE OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
LACK OF KNOWLEDGE
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY’S NORMAL PROCESSES 56
UP TO THE WOMAN TO USE 61
OTHER (SPECIFY) _____ 96
DON’T KNOW 98

512. CHECK 204:

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

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

NUMBER ____
OTHER (SPECIFY) ____ 96 (GO TO 514)

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

NUMBER OF BOYS ___
OTHER (SPECIFY) ______ 96
NUMBER OF GIRLS
OTHER (SPECIFY) ______ 96
NUMBER OF EITHER SEX ___
OTHER (SPECIFY) ______ 96

514. Would you say that you approve or disapprove of couples using a method to avoid getting pregnant?

APPROVE 1
DISAPPROVE 2
NO OPINION 3

515. Is it acceptable or not acceptable to you for information on family planning to be provided:

On the radio?
On the television?

RADIO
ACCEPTABLE 1
NOT ACCEPTABLE 2
DOES NOT KNOW 8
TELEVISION
ACCEPTABLE 1
NOT ACCEPTABLE 2
DOES NOT KNOW 8

516. In the last few months, have you heard about family planning:

On the radio?
On the television?
In a newspaper?
From a poster?
From leaflets or brochures?
From Town Crier?
Any Other (SPECIFY) ____________

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER OR MAGAZINE
YES 1
NO 2
POSTER
YES 1
NO 2
LEAFLETS OR BROCHURES
YES 1
NO 2
TOWN CRIER
YES 1
NO 2
OTHER ____________________ X

517. In the last few months, have you heard about any message on Radio/TV on condom use?
517B. If Yes, (Specify) _______________

YES 1
NO 2

518. In the last few months, have you discussed the practice of family planning with your spouse/partner, friends, neighbors, or relatives?

YES 1
NO 2 (GO TO 520)

519. With whom? Anyone else?
RECORD ALL MENTIONED.

WIFE/PARTNER A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER F
MOTHER-IN-LAW G
FRIENDS/NEIGHBORS H
SON I
OTHER (SPECIFY) _______X

520. CHECK 401:

CURRENTLY MARRIED (GO TO 521)
LIVING WITH A WOMAN (GO TO 521)
NOT IN UNION (GO TO 601)

521. Spouse/partners do not always agree on everything. Now I want to ask you about your wife’s/the woman’s you live with views on family planning. Do you think that your wife/the woman you live with approves or disapproves of couples using a method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DOES NOT KNOW 8

522. How often have you talked to your wife/the woman you live with about family planning in the past year?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

523. Do you think your wife/the woman you live with wants the same number of children that you want, or does she want more or fewer than you want?

SAME NUMBER 1
MORE CHILDREN 2
FEWER CHILDREN 3
DOES NOT KNOW 8

524. Who decides on the number of children you want to have?

HUSBAND ONLY 1
WIFE ONLY 2
HUSBAND/WIFE 3
MOTHER-IN-LAW 4
FATHER-IN-LAW 5
OTHER (SPECIFY) _____________ 6

SECTION 6. AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES

601A. Have you heard about diseases that can be transmitted through sexual intercourse?

YES 1
NO 2 (GO TO 601F)

601B. Which diseases do you know?
RECORD ALL RESPONSES.

SYPHILIS A
GONORRHEA B
AIDS C
GENITAL WARTS/CONDYLOMATA D
OTHER (SPECIFY) __________ W
OTHER (SPECIFY) __________ X
DOES NOT KNOW Z

601C. CHECK 410 AND 410F:

HAS HAD SEXUAL INTERCOURSE (GO TO 601D)
HAS NEVER HAD SEXUAL INTERCOURSE (GO TO 601F)

601D. During the last twelve months, did you have any of these diseases?

YES 1
NO 2 (GO TO 601F)
DOES NOT KNOW 8 (GO TO 601F)

601E. Which of the diseases did you have?
RECORD ALL RESPONSES.

SYPHILIS A
GONORRHEA B
AIDS C
GENITAL WARTS/CONDYLOMATA D
OTHER (SPECIFY) __________ W
OTHER (SPECIFY) __________ X
DOES NOT KNOW Z

601F. During the last 12 months, did you have a discharge from your penis?

YES 1
NO 2
DOES NOT KNOW 8

60lG. During the last 12 months, did you have a sore or ulcer on your penis?

YES 1
NO 2
DOES NOT KNOW 8

601H. CHECK 601E, 601F AND 601G:

HAD ONE OR MORE DISEASES (GO TO 601I)
NONE OF THE DISEASES (GO TO 601N)

601I. The last time you had (DISEASE FROM 601E/DISCHARGE/SORE) did you seek advice or treatment?

YES 1
NO 2 (GO TO 601J)

601J. Where did you seek advice or treatment?
ANY OTHER PLACE OR PERSON.
RECORD ALL MENTIONED.

PUBLIC SECTOR
GOVT. HOSPITAL A
HEALTH CENTER B
FP CLINIC C
MOBILE CLINIC D
DISPENSARY E
OTHER PUBLIC SECTOR F
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL G
PHARMACY/PMS H
PRIVATE DOCTOR I
MOBILE CLINIC J
OTHER MED. PRIVATE SECTOR K
OTHER (SPECIFY) _____________ X
SHOP L
RELATIVE/FRIEND M
TRADITIONAL HEALER N
NGO P
OTHER (SPECIFY) _______________ X
DOES NOT KNOW Z

601JA. CHECK 410 AND 410F:

HAS HAD SEXUAL INTERCOURSE (GO TO 601K)
HAS NEVER HAD SEXUAL INTERCOURSE (GO TO 601N)

601K. When you had (DISEASES FROM 601E/DISCHARGE/SORE) did you inform your partner(s)?

YES 1
NO 2

601L. When you had (DISEASES FROM 601E/DISCHARGE/SORE) did you do something not to infect your partner(s)?

YES 1
NO 2 (GO TO 601N)
PARTNER ALREADY INFECTED 3 (GO TO 601N)

601M. What did you do?
RECORD ALL MENTIONED.

NO SEXUAL INTERCOURSE A
USED CONDOMS B
TOOK MEDICINES C
REFER PARTNER TO HEALTH WORKER D
OTHER (SPECIFY) ________________ X

601N. CHECK 601B:

DID NOT MENTION ‘AIDS’ (GO TO 601P)
MENTIONED ‘AIDS’ (GO TO 602)

601P. Have you ever heard of a disease called ‘AIDS’?

YES 1
NO 2 (GO TO 611C)

602. From which sources of information have you learned most about AIDS?
ANY OTHER SOURCES?
RECORD ALL MENTIONED.

RADIO A
TELEVISION B
NEWSPAPERS/MAGAZINES C
PAMPHLETS/POSTERS D
HEALTH WORKERS E
MOSQUES/CHURCHES F
SCHOOLS/TEACHERS G
COMMUNITY MEETINGS H
FRIENDS/RELATIVES I
WORKPLACE J
OTHER (SPECIFY) ________________ X

602B. How can a person get AIDS?
ANY OTHER WAYS?
RECORD ALL MENTIONED.

SEXUAL INTERCOURSE A
SEXUAL INTERCOURSE WITH MULTIPLE PARTNERS B
SEX WITH PROSTITUTES C
NOT USE CONDOM D
HOMOSEXUAL CONTACT E
BLOOD TRANSFUSION F
INJECTIONS G
KISSING H
MOSQUITO BITES I
SCARIFICATION/CIRCUMCISION J
OTHER (SPECIFY) _______________ W
OTHER (SPECIFY) _______________ X
DOES NOT KNOW Z

603. Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?

YES 1
NO 2 (GO TO 607)
DOES NOT KNOW 8 (GO TO 607)

604. What can a person do?
ANY OTHER WAYS?
RECORD ALL MENTIONED.

SAFE SEX A
ABSTAIN FROM SEX B
USE CONDOMS C
HAVE ONLY ONE SEX PARTNER D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH HOMOSEXUALS F
ENSURE SAFE BLOOD TRANSFUSIONS G
ENSURE INJECTIONS WITH STERILIZED NEEDLES H
ENSURE CIRCUMCISION WITH CLEAN BLADES/KNIVES I
AVOID KISSING J
AVOID MOSQUITO BITES K
SEEK PROTECTION FROM TRADITIONAL HEALER L
OTHER (SPECIFY) _______________ M
OTHER (SPECIFY) _______________ X
DON’T KNOW Z

605. CHECK 604:

MENTION ‘SAFE SEX’ (GO TO 606)
DID NOT MENTION ‘SAFE SEX’ (GO TO 607)

606. What does ‘safe sex’ mean to you?
RECORD ALL MENTIONED.

ABSTAIN FROM SEX B
USE CONDOMS C
AVOID MULTIPLE SEX PARTNER D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH HOMOSEXUALS F
OTHER (SPECIFY) ___________ X
DOES NOT KNOW Z

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

YES 1
NO 2
DOES NOT KNOW 8

608. Do you think that persons with AIDS almost never die from the disease, sometimes die, or almost always die from the disease?

ALMOST NEVER 1
SOMETIMES 2
ALMOST ALWAYS 3
DOES NOT KNOW 8

608A. Can AIDS be cured?

YES 1
NO 2
DOES NOT KNOW 8

608B. Can AIDS be transmitted from mother to child?

YES 1
NO 2
DOES NOT KNOW 8

608C. Do you personally know someone who has AIDS or has died of AIDS?

YES 1
NO 2
DOES NOT KNOW 8

608D. What can an infected mother do to avoid transmitting AIDS to her unborn child?

TAKE MEDICATION LIKE AZT 1
SHOULD NOT BREASTFEED 2
DOES NOT KNOW 8

609. Do you think your chances of getting AIDS are small, moderate, great, or no risk at all?

SMALL 1
MODERATE 2 (GO TO 609C)
GREAT 3 (GO TO 609C)
NO RISK AT ALL 4
HAS AIDS 5 (GO TO 611A)

609B. Why do you think that you have (NO RISK/A SMALL CHANCE) of getting AIDS?
ANY OTHER REASONS?
RECORD ALL MENTIONED.

ABSTAIN FROM SEX B (GO TO 611A)
USE CONDOMS C (GO TO 611A)
HAVE ONLY ONE SEX PARTNER D (GO TO 611A)
LIMITED NUMBER OF SEX PARTNERS E (GO TO 611A)
AVOID SEX WITH PROSTITUTES F (GO TO 611A)
SPOUSE HAS NO OTHER PARTNER G (GO TO 611A)
NO HOMOSEXUAL CONTACT H (GO TO 611A)
ENSURE SAFE BLOOD TRANSFUSION I (GO TO 611A)
ENSURE INJECTION WITH STERILIZED NEEDLES J (GO TO 611A)
OTHER (SPECIFY) _______________ X (GO TO 611A)

609C. Why do you think that you have a (MODERATE/GREAT) chance of getting AIDS?
ANY OTHER REASONS?
RECORD ALL MENTIONED.

DO NOT USE CONDOMS C
MORE THAN ONE SEXUAL PARTNER D
SEX WITH PROSTITUTES E
SPOUSE HAS OTHER PARTNER(S) F
HOMOSEXUAL CONTACT G
HAD BLOOD TRANSFUSION H
HAD INJECTIONS I
OTHERS (SPECIFY) ________ W
OTHERS (SPECIFY) ________ X

611A. Since you heard of AIDS, have you changed your behaviour to prevent getting AIDS?
IF YES, WHAT DID YOU DO?
RECORD ALL MENTIONED

DIDN’T START SEX A (GO TO 611C)
STOPPED ALL SEX B (GO TO 611C)
STARTED USING CONDOMS C (GO TO 611C)
RESTRICTED SEX TO ONE PARTNER D (GO TO 611C)
REDUCED NUMBER OF PARTNERS E (GO TO 611C)
AVOID SEX WITH PROSTITUTES F (GO TO 611C)
ASK SPOUSE TO BE FAITHFUL G (GO TO 611C)
NO MORE HOMOSEXUAL CONTACTS H (GO TO 611C)
ENSURE INJECTIONS WITH STERILIZED NEEDLE J
OTHER (SPECIFY) ________ X
OTHER (SPECIFY) ________ X
NO BEHAVIOUR CHANGE Y

611B. Has your knowledge of AIDS influenced or changed your decisions about having sex or your sexual behavior?
IF YES, IN WHAT WAY?
RECORD ALL MENTIONED.

DIDN’T START SEX A
STOPPED ALL SEX B
STARTED USING CONDOMS C
RESTRICTED SEX TO ONE PARTNER D
REDUCED NUMBER OF PARTNERS E
AVOID SEX WITH PROSTITUTES F
NO MORE HOMOSEXUAL CONTACTS G
ASK SPOUSE TO BE FAITHFUL H
OTHER (SPECIFY) ________ X
NO BEHAVIOUR CHANGE Y
DOES NOT KNOW Z

611C. Some people use a condom for sexual intercourse to avoid getting AIDS or other sexually transmitted infection? Have you ever heard of this?

YES 1
NO 2 (GO TO 611F)

611D. CHECK 401 AND 401F:

HAS HAD SEXUAL INTERCOURSE (GO TO 611E)
HAS NEVER HAD SEXUAL INTERCOURSE (GO TO 701)

611E. We may already have talked about this. Have you ever used a condom for sex to avoid getting or transmitting disease, such as AIDS?

YES 1
NO 2

611G. Have you given or received money, gifts or favors in return for sex at any time in the last 12 months?

YES 1
NO 2

611H. If yes, was a condom used?

YES 1
NO 2

SECTION 7. MATERNAL MORTALITY

701. Now I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your natural mother, including those who are living with you, those living elsewhere and those who have died. How many children did your mother give birth to, including you?

NUMBER OF BIRTHS TO NATURAL MOTHER __

702. CHECK 901:

TWO OR MORE BIRTHS (GO TO 703)
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 716)

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

NUMBER OF PRECEDING BIRTHS __

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

NAME ________________

705. Is (NAME) male or female?

MALE 1
FEMALE 2

706. Is (NAME) still alive?

YES 1
NO 2 (GO TO 708)
DON’T KNOW 8 (GO TO NEXT SIBLINGS)

707. How old is (NAME)?

NAME_____________ (GO TO NEXT SIBLINGS)

708. In what year did (NAME) die?

YEAR___ (GO TO 710)
DON’T KNOW 98

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

YEARS___

710. How old was (NAME) when he/she died?

AGE___ (IF MALE OR DIED BEFORE 10 YEARS OF AGE, GO TO NEXT SIBLINGS)

711. Was (NAME) pregnant when she died?

YES 1 (GO TO 714)
NO 2

712. Did (NAME) die during childbirth?

YES 1 (GO TO 715)
NO 2

713. Did (NAME) die within two months after the end of a pregnancy or childbirth?

YES 1
NO 2 (GO TO 715)

714. Was her death due to complications of pregnancy or childbirth?

YES 1
NO 2

715. How many children did (NAME) give birth to during her lifetime?

NUMBER OF CHILDREN___

IF NO MORE BROTHERS OR SISTERS, GO TO 716

716. RECORD THE TIME (END OF INTERVIEW)

HOUR ___
MINUTES ___

INTERVIEWER’S OBSERVATIONS

(To be filled in after completing interview)

Comments about Respondent:
________________________________

Comments on Specific Questions:
_________________________________

Any other Comments:
_________________________________

SUPERVISOR’S OBSERVATIONS
_________________________________

Name of Supervisor: ________________
Date: _________________

EDITOR’S OBSERVATIONS
_________________________________

Name of Editor: ________________
Date: _________________