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NEPAL DEMOGRAPHIC AND HEALTH SURVEY 2001
MAN'S QUESTIONNAIRE
FOR EVER MARRIED MEN AGE 15-59

IDENTIFICATION

NAME AND CODE OF DISTRICT __________________
NAME AND CODE OF VILLAGE/MUNICIPALITY ____________________

WARD NUMBER ___
CLUSTER NUMBER ___

HOUSEHOLD NUMBER ________________

CITY 1
TOWN 2
COUNTRYSIDE 3

NAME OF HOUSEHOLD HEAD _________________
NAME AND LINE NUMBER OF MAN _______________

INTERVIEWER VISITS

DATE

DAY __
MONTH __
YEAR ____

INTERVIEWER'S NAME ______
INT. CODE __

RESULT *

*RESULT CODES

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

LANGUAGE

LANGUAGE OF QUESTIONNAIRE: ENGLISH
LANGUAGE OF INTERVIEW *** _______________

HOME LANGUAGE OF RESPONDENT *** ____________

*** LANGUAGE CODES

1 NEPALI
2 BHOJURI
3 MAITHILI
4 THARU
5 OTHER

WAS A TRANSLATOR USED?

YES 1
NO 2

SUPERVISOR

NAME ________
DATE _________

FIELD EDITOR

NAME __________
DATE ___________

OFFICE EDITOR __

KEYED BY __

SECTION 1. RESPONDEN'T BACKGROUND

INFORMED CONSENT

Hello. My name is __________________ and I am working with the Ministry of Health. We are conducting a national survey about the health of people in Nepal. We would very much appreciate your participation in this survey. I would like to ask you about your health (and the health of your children). This information will help the government to plan health services. The survey usually takes between 20 and 30 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.

Participation in this survey is voluntary and you can choose not to answer any individual questions or all of the questions. However, we hope that you will participate in this survey since your views are important.

At this time, do you want to ask me anything about the survey? May I begin the interview now?

Signature of interviewer: _____________________ Date: _____________
RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 101)
RESPONENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

101. RECORD THE TIME.

HOUR __
MINUTES __

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

CITY 1
TOWN 2
COUNTRYSIDE 3

103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
IF LESS THAN ONCE YEAR, RECORD '00' YEARS.

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 the countryside?

CITY 1
TOWN 2
COUNTRYSIDE 3

105. In what month and 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. Have you ever attended school?

YES 1
NO 2 (GO TO 110)

108. What is the highest grade you completed?

GRADE __

109. CHECK 108:

GRADE 5 OR BELOW (GO TO 110)
GRADE 6 AND ABOVE (GO TO 113)

110. Now I would like you to read out loud as much of this sentence as you can.
SHOW CARD TO RESPONDENT. IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of this sentence to me?

CANNOT READ AT ALL 1
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) _____________ 4

111. Have you ever participated in a literacy program or any other program that involves learning to read or write (not including primary school)?

YES 1
NO 2

112. CHECK 110:

CODE '2', '3' OR '4' CIRCLED (GO TO 113)
CODE '1' CIRCLED (GO TO 114)

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

YES 1
NO 2

114. Do you usually listen to the radio every day?

YES 1
NO 2

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

YES 1
NO 2

116. What is your religion?

HINDU 1
BUDDHIST 2
MUSLIM 3
CHRISTIAN 4
OTHER (SPECIFY) _____ 6

117. What is your caste?
WRITE CASTE IN SPACE PROVIDED. DO NOT FILL BOX. CODE WILL BE ENTERED BY FIELD EDITOR.

CASTE ______________

118. Are you currently married or are you widowed, divorced or separated?

CURRENTLY MARRIED 1
WIDOWED 2 (GO TO 124)
DIVORCED 3 (GO TO 124)
SEPARATED 4 (GO TO 124)

119. Is your wife living with you now or is she staying elsewhere?

LIVING WITH HIM 1 (GO TO 121)
STAYING ELSEWHERE 2

120. How long has she been away without coming back?
IF LESS THAN 1 MONTH, WRITE '00'.

MONTHS __
MORE THAN 2 YEARS 95
DOES NOT KNOW 98

121. RECORD THE WIFE'S NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF SHE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.

NAME ____________
LINE NO. ____

122. Do you have more than one wife?

YES 1
NO 2 (GO TO 124)

123. How many wives do you have?

NUMBER __ (GO TO 125)
DON'T KNOW 98 (GO TO 125)

124. Have you been married only once, or more than once?

ONCE 1
MORE THAN ONCE 2

125. How old were you when you (first) got married?

AGE __

126. CHECK 122 OR 124:

MARRIED ONLY ONCE
In what month and year did you start living with your wife?
MARRIED MORE THAN ONCE
Now we will talk about your first wife.
In what month and year did you start living with her?
MONTH __
DON'T KNOW MONTH 98
YEAR ____ (GO TO 128)
DON'T KNOW YEAR 9998
HAS NOT STARTED LIVING WITH HER 9996 (END)

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

PROMPT: At guana?
AGE __

128. Now I would like to ask you about any children you have had. I am interested only in the children that are biologically yours. Have you fathered any children?

YES 1
NO 2 (GO TO 301)

129. In total, how many children do you have that you have fathered?

TOTAL LIVING CHILDREN __

130. Have any of your children died? In total, how many children have you fathered that have died?

NUMBER THAT DIED __

THERE IS NO SECTION 2.

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 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT METNIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302.

301. Which ways or methods have you heard about?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK:
Have you ever heard of (METHOD)?

01 FEMALE STERILIZATION Women can have an operation to avoid having any more children (also known as tubal ligation).
YES 1
NO 2
02 MALE STERILIZATION Men can have an operation to avoid having any more children (also known as a vasectomy).
YES 1
NO 2
03 PILL Women can take a pill every day to avoid becoming pregnant (ex. Nilocon).
YES 1
NO 2
04 IUD Women can have a loop or coil placed inside them by a doctor or a nurse (ex. Copper-T, Loop).
YES 1
NO 2
05 INJECTABLES Women can have an injection by a health provider which stops them from becoming pregnant for one or more months (ex. Sangini/Depo Provera).
YES 1
NO 2
06 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 (also known as NORPLANT).
YES 1
NO 2
07 CONDOM Men can put a rubber sheath on their penis before sexual intercourse (ex. Daal).
YES 1
NO 2
08 FOAM OR JELLY Women can place a suppository, foaming tablets, jelly, or cream in their vagina before intercourse (ex. Kamal).
YES 1
NO 2
09 RHYTHM OR PERIODIC ABSTINENCE Every month that a woman is sexually active, she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
10 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
11 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
(SPECIFY) ______________________
(SPECIFY) _______________________
NO 2

302. Have you ever used (METHOD)?

01 FEMALE STERILIZATION Women can have an operation to avoid having any more children (also known as tubal ligation).
Has your wife ever had an operation to avoid having any more children?
YES 1
NO 2
02 MALE STERILIZATION Men can have an operation to avoid having any more children (also known as a vasectomy).
Have you ever had an operation to avoid having any more children?
YES 1
NO 2
03 PILL Women can take a pill every day to avoid becoming pregnant (ex. Nilocon).
YES 1
NO 2
04 IUD Women can have a loop or coil placed inside them by a doctor or a nurse (ex. Copper-T, Loop).
YES 1
NO 2
05 INJECTABLES Women can have an injection by a health provider which stops them from becoming pregnant for one or more months (ex. Sangini/Depo Provera).
YES 1
NO 2
06 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 (also known as NORPLANT).
YES 1
NO 2
07 CONDOM Men can put a rubber sheath on their penis before sexual intercourse (ex. Daal).
YES 1
NO 2
08 FOAM OR JELLY Women can place a suppository, foaming tablets, jelly, or cream in their vagina before intercourse (ex. Kamal).
YES 1
NO 2
09 RHYTHM OR PERIODIC ABSTINENCE Every month that a woman is sexually active, she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
10 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
11 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
SPECIFIED METHOD
YES 1
NO 2

SPECIFIED METHOD
YES 1
NO 2

303. CHECK 301 (01), 301 (04), AND 301 (05):

KNOWS ABOUT FEMALE STER., INJECTION, OR IUD (GO TO 304)
DOES NOT KNOW OF ANY OF THE 3 METHODS (GO TO 308)

304. Now I want to talk to you about contraceptive methods that women can use to delay or avoid becoming pregnant.

CHECK 301 (05):
KNOWS INJECTABLES
YES (CONTINUE WITH QUESTIONS FOR THIS METHOD)
NO (GO TO 304 IN NEXT COLUMN)
CHECK 301 (04):
KNOWS IUD
YES (CONTINUE WITH QUESTIONS FOR THIS METHOD)
NO (GO TO 304 IN NEXT COLUMN)
CHECK 301 (01):
KNOWS FEMALE STERILIZATION
YES (CONTINUE WITH QUESTIONS FOR THIS METHOD)
NO (GO TO 304 IN NEXT COLUMN)

305. In your opinion, is (METHOD) a good method for a couple to use if they want to plan their family?

YES 1
NO 2 (GO TO 307)
DEPENDS/UP TO THEM 3 (GO TO 304 IN NEXT COLUMN; OR, IF NO MORE COLUMNS, GO TO 308)

306.Why do you think (METHOD) is a good method for a couple to use if they want to plan their family?
RECORD ALL REASONS MENTIONED.

SIMPLE TO USE A (GO TO 304 IN NEXT COLUMN; OR, IF NO MORE COLUMNS GO TO 308)
EFFECTIVE B (GO TO 304 IN NEXT COLUMN; OR, IF NO MORE COLUMNS GO TO 308)
AFFORDABLE C (GO TO 304 IN NEXT COLUMN; OR, IF NO MORE COLUMNS GO TO 308)
NO/FEW SIDE EFFECTS D (GO TO 304 IN NEXT COLUMN; OR, IF NO MORE COLUMNS GO TO 308)
CAN STOP WHEN CHILDREN DESIRED E (GO TO 304 IN NEXT COLUMN; OR, IF NO MORE COLUMNS GO TO 308)
LASTS FOR SEVERAL MONTHS F (GO TO 304 IN NEXT COLUMN; OR, IF NO MORE COLUMNS GO TO 308)
OTHER (SPECIFY) _______ X (GO TO 304 IN NEXT COLUMN; OR, IF NO MORE COLUMNS GO TO 308)
DON'T KNOW Y (GO TO 304 IN NEXT COLUMN; OR, IF NO MORE COLUMNS GO TO 308)

307. Why do you think (METHOD) is not a good method for a couple to use if they want to plan their family?
RECORD ALL REASONS MENTIONED.

TOO EXPENSIVE A (GO TO 304 IN NEXT COLUMN; OR, IF NO MORE COLUMNS GO TO 308)
AGAINST RELIGION B (GO TO 304 IN NEXT COLUMN; OR, IF NO MORE COLUMNS GO TO 308)
MAY HARM WOMEN'S HEALTH C (GO TO 304 IN NEXT COLUMN; OR, IF NO MORE COLUMNS GO TO 308)
HAS SIDE EFFECTS D (GO TO 304 IN NEXT COLUMN; OR, IF NO MORE COLUMNS GO TO 308)
INCREASES PROMISCUITY E (GO TO 304 IN NEXT COLUMN; OR, IF NO MORE COLUMNS GO TO 308)
CAN CAUSE STERILITY F (GO TO 304 IN NEXT COLUMN; OR, IF NO MORE COLUMNS GO TO 308)
METHOD CAN FAIL G (GO TO 304 IN NEXT COLUMN; OR, IF NO MORE COLUMNS GO TO 308)
NO MENSTRUATION H (GO TO 304 IN NEXT COLUMN; OR, IF NO MORE COLUMNS GO TO 308)
INVOLVES DOCTORS/MEDICAL PERSONNEL I (GO TO 304 IN NEXT COLUMN; OR, IF NO MORE COLUMNS GO TO 308)
OTHER (SPECIFY) ___________ X (GO TO 304 IN NEXT COLUMN; OR, IF NO MORE COLUMNS GO TO 308)
DON'T KNOW Y (GO TO 304 IN NEXT COLUMN; OR, IF NO MORE COLUMNS GO TO 308)

308. CHECK 302 (02):

MAN NOT STERILIZED (GO TO 309)
MAN STERILIZED (GO TO 310A)

309. Are you or your wife currently doing something or using any method to delay or avoid getting pregnant?

YES 1
NO 2 (GO TO 311)

310. Which method are you using?
310A. CIRCLE 'B' FOR MALE STERILIZATION.
IF MORE THAN ONE METHOD MENTIONED, CIRCLE ALL METHODS MENTIONED.

FEMALE STERILIZATION A
MALE STERILIZATION B
PILL C
IUD D
INJECTABLES E
IMPLANTS F
CONDOM G
FOAM/JELLY H
PERIODIC ABSTINENCE I
WITHDRAWAL J
OTHER (SPECIFY) _______ X

311. CHECK 301 (07) AND 302 (07):

HAS HEARD OF AND USED CONDOMS (GO TO 312)
HAS HEARD OF CONDOMS BUT HAS NEVER USED THEM (GO TO 318)
HAS NOT HEARD OF CONDOMS (GO TO 319)

312. Now I would like to talk to you about condoms.
How old were you when you used a condom for the first time?

AGE AT FIRST USE __
DOES NOT REMEMBER 98

313. Why did you use a condom that first time?
Any other reason?
CIRCLE ALL MENTIONED.

TO AVOID PREGNANCY A
TO AVOID GETTING HIV/AIDS B
TO AVOID GETTING STDS C
TO AVOID INFECTING WIFE/PARTNER D
PARTNER INSISTED E
OTHER (SPECIFY) ________ X

314. Now when you have sex, do you use a condom every time, sometimes, or not at all?

EVERY TIME 1 (GO TO 316)
SOMETIMES 2
NOT AT ALL 3 (GO TO 316)
NOT HAVING SEX 4 (GO TO 316)

315. When do you use a condom?
PROBE: Any other times?
RECORD ALL MENTIONED.

ON PARTNER'S FERTILE DAYS A
DURING PARTNER'S MENSTRUATION B
WHEN NOT USING SOME OTHER METHOD C
WITH WIFE/REGULAR PARTNER D
WITH A STRANGER E
WITH A SEX WORKER F
WITH ANYONE OTHER THAN WIFE G
OTHER (SPECIFY) ______ X

316. Have you ever experienced any problems with using condoms?
IF YES: What problems?
PROBE: Any other problems?
RECORD ALL MENTIONED.

TOO EXPENSIVE A
EMBARRASSING TO BUY B
DIFFICULT TO DISPOSE OF C
DIFFICULT TO PUT ON/TAKE OFF D
SPOILS THE MOOD E
REDUCES PLEASURE F
WIFE/PARTNER DOES NOT LIKE G
WIFE/PARTNER GOT PREGNANT H
INCONVENIENT TO USE/MESSY I
CONDOM BROKE J
OTHER (SPECIFY) _______ X
NO PROBLEM Y

317. Where do you usually obtain condoms?
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 _______________
GOVERNMENT SECTOR
GOVT. HOSPITAL/CLINIC 11
PRIMARY HEALTH CARE CENTER/HEALTH CENTER 12
HEALTH POST 13
SUB-HEALTH POST 14
PHC OUTREACH CLINIC 15
FCHV 17
CONDOM BOX 18
OTHER GOVT. (SPECIFY) ___________ 16
NON-GOVT. (NGO) SECTOR
FP ASSN. OF NEPAL 21
MARIE STOPES 22
ADRA 23
NEPAL RED CROSS 24
OTHER (NGO) (SPECIFY) _________ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME 31
PHARMACY 32
OTHER PRIVATE (SPECIFY) ______________ 36
OTHER SOURCE
SHOP 41
FRIEND/RELATIVE 42

OTHER (SPECIFY) _____ 96

318. I am going to read you some statements about condoms. Please tell me if you agree or disagree with each statement:

a. Condoms reduce a man's pleasure.
AGREE 1
DISAGREE 2
DON'T KNOW 8
b. A condom is very inconvenient to use.
AGREE 1
DISAGREE 2
DON'T KNOW 8
c. A condom can be reused.
AGREE 1
DISAGREE 2
DON'T KNOW 8
d. A condom protects against disease.
AGREE 1
DISAGREE 2
DON'T KNOW 8
e. A woman has no right to tell a man to use a condom.
AGREE 1
DISAGREE 2
DON'T KNOW 8

319. CHECK 302 (02) AND 302 (02)

HAS HEARD OF MALE STERILIZATION BUT IS NOT STERILIZED (GO TO 320)
HE IS STERILIZED (GO TO 321)
HAS NOT HEARD OF MALE STERILIZATION (GO TO 327)

320. Once you have all the children you want, would you yourself ever consider getting sterilized?

YES, WOULD CONSIDER 1 (GO TO 325)
NO, WOULD NOT 2 (GO TO 326)
UNSURE/DEPENDS 3 (GO TO 325)
WIFE ALREADY STERILIZED/NO NEED 4 (GO TO 327)

321. Before your sterilization operation, were you told that you would not be able to have any more children because of the operation?

YES 1
NO 2
DON'T KNOW 8

322. Do you regret that you had the operation?

YES 1
NO 2 (GO TO 324)

323. Why do you regret the operation?

RESPONDENT WANTS ANOTHER CHILD 01
WIFE WANTS ANOTHER CHILD 02
SIDE EFFECTS 03
MARITAL STATUS HAS CHANGED 04
OPERATION FAILED 05
CHILD DIED 06
OTHER (SPECIFY) ______ 96

324. In what month and year was the sterilization performed?

MONTH __
YEAR ____

325. In your opinion, what are some of the advantages of male sterilization?
PROBE: Any other advantages?
RECORD ALL MENTIONED.

PUTS MAN IN CONTROL A (GO TO 327)
EFFECTIVE METHOD B (GO TO 327)
OPERATION IS SAFE C (GO TO 327)
SAFER THAN FEMALE STERILIZATION D (GO TO 327)
AFFORDABLE (FREE OF CHARGE) E (GO TO 327)
LESS EXPENSIVE THAN FEMALE STERILIZATION F (GO TO 327)
OPERATION IS SIMPLE G (GO TO 327)
GIVES MAN FREEDOM H (GO TO 327)
OTHER (SPECIFY) _________ X (GO TO 327)

326. Why would you never consider getting sterilized?
PROBE: Any other reason?
RECORD ALL MENTIONED.

AGAINST RELIGION A (GO TO 327)
EFFECTIVE METHOD B (GO TO 327)
OPERATION IS SAFE C (GO TO 327)
SAFER THAN FEMALE STERILIZATION D (GO TO 327)
AFFORDABLE (FREE OF CHARGE) E (GO TO 327)
LESS EXPENSIVE THAN FEMALE STERILIZATION F (GO TO 327)
OPERATION IS SIMPLE G (GO TO 327)
GIVES MAN FREEDOM H (GO TO 327)
OTHER (SPECIFY) ___________ X (GO TO 327)

326. Why would you never consider getting sterilized?
PROBE: Any other reason?
RECORD ALL MENTIONED.

AGAINST RELIGION A
BAD FOR MAN'S HEALTH B
OPERATION IS NOT SAFE C
LESS INTRUSIVE WAYS AVAILABLE D
MAY WANT ANOTHER CHILD E
MAY RE-MARRY SOME DAY F
LOSS OF WAGES G
LOSS OF SEXUAL FUNCTION H
LOSS OF MANLINESS I
OTHER (SPECIFY) ________ X

327. I am going to read you some statements about contraception. Please tell me if you agree or disagree with each statement:

a. Contraception is women's business and a man should not have to worry about it.
AGREE 1
DISAGREE 2
DON'T KNOW 8
b. Women who are sterilized may become promiscuous.
AGREE 1
DISAGREE 2
DON'T KNOW 8
c. Being sterilized for a man is the same as castration.
AGREE 1
DISAGREE 2
DON'T KNOW 8
d. A woman is the one who gets pregnant so she should be the one to get sterilized.
AGREE 1
DISAGREE 2
DON'T KNOW 8

SECTION 4. HEALTH

401. Now I would like to ask you some questions about how to know when an illness is serious and requires treatment.
Sometimes a pregnancy can have problems that lead to miscarriage or death. What are signs that indicate that a pregnant woman is having serious problems and should be taken to a health facility?
PROBE: Any other signs or symptoms?
DO NOT READ CODES.
CIRCLE ALL MENTIONED.

VAGINAL BLEEDING A
HIGH FEVER B
ABDOMINAL PAIN C
SWELLING OF HANDS AND FEET D
DIFFICULT LABOR FOR MORE THAN 12 HOURS E
CONVULSIONS F
OTHER (SPECIFY) _____________ X
DON'T KNOW ANY SIGNS Z

402. When a child is sick with a cough, what signs of illness would tell you that he or she should be taken to a health facility?
PROBE: Any other signs or symptoms?
DO NOT READ OUT CODES.
CIRCLE ALL MENTIONED.

RAPID BREATHING A
DIFFICULT BREATHING B
NOISY BREATHING C
FEVER D
UNABLE TO DRINK OR SWALLOW E
NOT EATING OR DRINKING WELL F
OTHER (SPECIFY) _____________ X
DON'T KNOW ANY SIGNS Z

403. When a child is sick with diarrhea, what signs of illness would tell you that he or she should be taken to a health facility?
PROBE: Any other signs or symptoms?
DO NOT READ CODES.
CIRCLE ALL MENTIONED.

REPEATED WATERY STOOLS A
ANY WATERY STOOLS B
REPEATED VOMITING C
ANY VOMITING D
BLOOD IN STOOLS E
FEVER F
EXTREME THIRST G
NOT EATING OR DRINKING WELL H
NOT GETTING BETTER I
OTHER (SPECIFY) _______ X
DON'T KNOW ANY SIGNS Z

404. When a child has diarrhea, should he or she be given less to drink than usual, about the same amount or more than usual?

LESS THAN USUAL 1
ABOUT THE SAME 2
MORE 3
DON'T KNOW 8

405. Do you smoke cigarettes or bidis or tobacco?

YES, CIGARETTES/BIDIS A
YES, PIPE B
YES, OTHER TOBACCO C
NO Y

406. CHECK 405:

CODE 'A' CIRCLED (GO TO 407)
CODE 'A' NOT CIRCLED (GO TO 409)

407. In the last 24 hours, how many cigarettes/bidis did you smoke?

CIGARETTES/BIDIS __

408. How old were you when you first started smoking?

AGE __

409. Have you ever drunk an alcohol-containing beverage?

YES 1
NO 2 (GO TO 501)

410. In the last 7 days, on how many days did you drink an alcohol-containing beverage?
IF NONE, WRITE '00'.

NUMBER OF DAYS __

SECTION 5. FERTILITY PREFERENCES

501. CHECK 118:

CURRENTLY MARRIED (GO TO 502)
WIDOWED, DIVORCED, SEPARATED (GO TO 509)

502. CHECK 302 (02):

RESPONDENT IS NOT STERILIZED (GO TO 503A)
HE IS STERILIZED (GO TO 509)

503A. Is any of your wife(s) currently pregnant?

YES 1
NO 2
UNSURE/DON'T KNOW 8

503. CHECK 503A:

WIFE(S) 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?
WIFE(S) 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 505)
WIFE(S) INFECUND/STERILIZED 3 (GO TO 505)
UNDECIDED/DON'T KNOW 4 (GO TO 505)

504. CHECK 503A:

WIFE(S) 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?
WIFE(S) 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 505)
WIFE(S) INFECUND/STERILIZED 3 (GO TO 505)
UNDECIDED/DON'T KNOW 4 (GO TO 505)

505. CHECK 310/310A

NOT USING ANY METHOD (GO TO 506)
CURRENTLY USING A METHOD (GO TO 509)

506. Do you think you will use a method or delay or avoid pregnancy at any time in the future?

YES 1
NO 2 (GO TO 508)
DON'T KNOW 8 (GO TO 508)

507. Which method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 509)
MALE STERILIZATION 02 (GO TO 509)
PILL 03 (GO TO 509)
IUD 04 (GO TO 509)
INJECTABLES 05 (GO TO 509)
IMPLANTS 06 (GO TO 509)
CONDOM 07 (GO TO 509)
FOAM/JELLY 08 (GO TO 509)
PERIODIC ABSTINENCE 09 (GO TO 509)
WITHDRAWAL 10 (GO TO 509)
OTHER (SPECIFY) ______ 96 (GO TO 509)
UNSURE 98 (GO TO 509)

508. What is the main reason that you think you will not use a method at any time in the future?

FERTILITY-RELATED REASONS
INFREQUENT SEX/NO SEX 22
WIFE(S) MENOPAUSAL/HYSTERECTOMY 23
COUPLE SUBFECUND/INFECUND 24
WANTS AS MANY CHILDREN AS POSSIBLE 26
OPPOSITION TO USE
RESPONDENT OPPOSED 31
WIFE(S) OPPOSED 32
OTHER 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
OTHER (SPECIFY) _____ 96
DON'T KNOW 98

509. CHECK 129:

HAS LIVING CHILDREN
If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?
NO LIVING CHILDREN
If you could choose exactly the number of children to have in your whole life, how many would that be?
PROBE FOR A NUMERIC RESPONSE.
NUMBER __
OTHER (SPECIFY) _______ 96 (GO TO 511)

510. 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?

NUMBER
BOYS __
GIRLS __
EITHER __
OTHER (SPECIFY) _______ 96

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

APPROVE 1
DISAPPROVE 2
DON'T KNOW/UNSURE 3

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

On the radio?
YES 1
NO 2
On the television?
YES 1
NO 2
In a newspaper or magazine?
YES 1
NO 2
In street drama?
YES 1
NO 2

513. In the last few months have you heard the following programs on the radio:

Jana Swastha Karyakram?
YES 1
NO 2
Ghanti Heri Had Nilaun, the drama?
YES 1
NO 2
Ghanti Heri Had Nilain, the song?
YES 1
NO 2
Shriman SHrimatile Pariwarbare Kurakani Gareko Chhoto Radio Natak?
YES 1
NO 2

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

YES 1
NO 2 (GO TO 516)

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

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

516. CHECK 118:

CURRENTLY MARRIED (GO TO 517)
WIDOWED, DIVORCED, SEPARATED (GO TO 523)

517. CHECK 310/310A:

ANY CODE CIRCLED (GO TO 518)
NO CODE CIRCLED (GO TO 519)

518. You have told me that you are currently using contraception. Would you say that using contraception is mainly your decision, mainly your wife's decision, or did you both decide together?

MAINLY RESPONDENT 1
MAINLY WIFE'S 2
JOINT DECISION 3
OTHER (SPECIFY) ______ 6

519. Now I want to ask you about your wife's views on family planning.
Do you think that your wife approves or disapproves of couples using a method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

520. How often have you talked to your wife about family planning in the past year?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

521. CHECK 310/310A:

NEITHER STERILIZED (GO TO 522)
HE OR SHE STERILIZED (GO TO 523)

522. Do you think your wife 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
DON'T KNOW 8

523. Husbands and wives do not always agree on everything. Please tell me if you think a wife is justified in refusing to have sex with her husband when:

She is tired or not in the mood?
YES 1
NO 2
DON'T KNOW 8
She has recently given birth?
YES 1
NO 2
DON'T KNOW 8
She knows her husband has sex with other women?
YES 1
NO 2
DON'T KNOW 8
She knows her husband has a sexually transmitted disease?
YES 1
NO 2
DON'T KNOW 8

SECTION 6. WORK

601. Are you currently working?

YES 1 (GO TO 604)
NO 2

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

YES 1 (GO TO 604)
NO 2

603. What have you been doing most of the time during the last 12 months?

GOING TO SCHOOL/STUDYING 1 (GO TO 611)
LOOKING FOR WORK 2 (GO TO 611)
INACTIVE 3 (GO TO 611)
COULD NOT WORK/HANDICAPPED 4 (GO TO 611)
OTHER (SPECIFY) _________ 6 (GO TO 611)

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

________________________________

605. CHECK 604:

WORKS IN AGRICULTURE (GO TO 606)
DOES NOT WORK IN AGRICULTURE (GO TO 607)

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

OWN LAND/FAMILY LAND 1
RENTED LAND/TENANCY 2
SOMEONE ELSE'S LAND 3

607. Are you self-employed, employed by someone else, or do you do this work for a member of your family?

SELF-EMPLOYED 1
BY SOMEONE ELSE 2
FOR FAMILY MEMBER 3

608. Do you usually work throughout the year, or do you work seasonally or only once in a while?

THROUGHOUT THE YEAR 1
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3

609. Are you paid in cash or kind for this work or are you not paid at all?

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3 (GO TO 611)
NOT PAID 4 (GO TO 611)

610. On average, how much of your household's expenditures do your earnings pay for: almost none, less than half, about half, more than half, or all?

ALMOST NONE 1
LESS THAN HALF 2
ABOUT HALF 3
MORE THAN HALF 4
ALL 5
NONE, HIS INCOME IS ALL SAVED 6

611. Who in your family usually has the final say on the following decisions:

Your wife's health care?
RESPONDENT 1
WIFE 2
RESPONDENT AND WIFE JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
Making large household purchases?
RESPONDENT 1
WIFE 2
RESPONDENT AND WIFE JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
Making household purchases for daily needs?
RESPONDENT 1
WIFE 2
RESPONDENT AND WIFE JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
Visits to family, friends, or relatives?
RESPONDENT 1
WIFE 2
RESPONDENT AND WIFE JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
What food should be cooked each day?
RESPONDENT 1
WIFE 2
RESPONDENT AND WIFE JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6

612. Sometimes a husband is annoyed or angered by things which his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

If she goes out without telling him?
YES 1
NO 2
DON'T KNOW 8
If she neglects the children?
YES 1
NO 2
DON'T KNOW 8
If she argues with him?
YES 1
NO 2
DON'T KNOW 8
If she refuses to have sex with him?
RESPONDENT 1
WIFE 2
RESPONDENT AND WIFE JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
If she burns the food?
RESPONDENT 1
WIFE 2
RESPONDENT AND WIFE JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6

SECTION 7. AIDS AND SEXUAL BEHAVIOR

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

YES 1
NO 2 (GO TO 710)

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

YES 1
NO 2 (GO TO 706)
DON'T KNOW 8 (GO TO 706)

703. What can a person do? Anything else?
RECORD ALL MENTIONED.

ABSTAIN FROM SEX A
USE CONDOMS B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER C
LIMIT NUMBER OF SEX PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH PERSONS WHO INJECT DRUGS INTRAVENOUSLY H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID KISSING K
AVOID MOSQUITO BITES L
SEEK PROTECTION FROM TRADITIONAL HEALER M
AVOID SHARING RAZORS/BLADES N
AVOID SEX WITH SOMEONE WHO HAS AIDS O
OTHER (SPECIFY) _________ X
OTHER (SPECIFY) _________ Y
DON'T KNOW Z

704. Can people protect themselves from getting the AIDS virus by having just one sex partner who has no other partners?

YES 1
NO 2
DON'T KNOW 8

705. Can people protect themselves from getting the AIDS virus by using a condom every time they have sex?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

707. Can the virus that causes AIDS be transmitted from a mother to a child?

YES 1
NO 2
DON'T KNOW 8

708. CHECK 118:

CURRRENTLY MARRIED (GO TO 709)
WIDOWED, DIVORCED, SEPARATED (GO TO 710)

709. Have you ever talked about ways to prevent getting the virus that causes AIDS with your wife?

YES 1
NO 2

710. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues.
How old were you when you first had sexual intercourse?

NEVER 00 (GO TO 733)
AGE IN YEARS __
FIRST TIME WHEN STARTED LIVING WITH (FIRST) WIFE 96

711. When was the last time you had sexual intercourse?
RECORD 'YEARS AGO' ONLY IF LAST INTERCOURSE WAS ONE OR MORE YEARS AGO.

DAYS AGO 1 __
WEEKS AGO 2 __
MONTHS AGO 3 __
YEARS AGO 4 __ (GO TO 733)

712. The last time you had sexual intercourse, did you use a condom?

YES 1
NO 2 (GO TO 714)

713. What is the main reason you used a condom on that occasion?

TO AVOID PREGNANCY 1 (GO TO 718)
TO AVOID GETTING HIV/AIDS (GO TO 718)
TO AVOID GETTING STDS 3 (GO TO 718)
TO AVOID INFECTING WIFE/PARTNER 4 (GO TO 718)
WIFE/PARTNER INSISTED 5 (GO TO 718)
OTHER (SPECIFY) __________ 6 (GO TO 718)

714. CHECK 302 (02):

RESPONDENT NOT STERILIZED (GO TO 715)
RESPONDENT STERILIZED (GO TO 718)

715. The last time you had sexual intercourse, did you or your wife/partner do something or use any method to avoid a pregnancy?

YES 1
NO 2 (GO TO 717)
DOES NOT KNOW/UNSURE 8 (GO TO 718)

716. What method did you or she use on that occasion?

FEMALE STERILIZATION 01 (GO TO 718)
PILL 03 (GO TO 718)
IUD 04 (GO TO 718)
INJECTABLES 05 (GO TO 718)
IMPLANTS 06 (GO TO 718)
FOAM/JELLY 08 (GO TO 718)
RHYTHM/PERIODIC ABSTINENCE 09 (GO TO 718)
WITHDRAWAL 10 (GO TO 718)
OTHER (SPECIFY) ________ 96 (GO TO 718)

717. What is the main reason you did not use a method to avoid pregnancy?

FERTILITY-RELATED REASONS
CASUAL SEX PARTNER 11
WIFE/PARTNER IS MENOPAUSAL, HAD HYSTERECTOMY 23
COUPLE SUBFECUND/INFECUND 24
WIFE/PARTNER WAS PREGNANT 25
WIFE/PARTNER RECENTLY DELIVERED AND NOT YET MENSTRUATING 26
WIFE/PARTNER WAS BREASTFEEDING 27
WANTED (MORE) CHILDREN 28
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
OTHER (SPECIFY) _____ 96
DOES NOT KNOW 98

718. What is your relationship to the woman with whom you last had sex?

WIFE/COHABITING PARTNER 1 (GO TO 720)
WOMAN IS GIRLFRIEND/FINANCE 2
OTHER FRIEND 3
CASUAL ACQUINTANCE 4
COMMERCIAL SEX WORKER 5
OTHER (SPECIFY) _________ 6

719. For how long have you had a sexual relationship with this woman?

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

720. Have you had sex with any other woman in the last 12 months?

YES 1
NO 2 (GO TO 730)

721. The last time you had sexual intercourse with another woman, did you use a condom?

YES 1
NO 2 (GO TO 723)

722. What is the main reason you used a condom on that occasion?

TO AVOID PREGNANCY 1 (GO TO 727)
TO AVOID GETTING HIV/AIDS 2 (GO TO 727)
TO AVOID GETTING STDS 3 (GO TO 727)
TO AVOID INFECTING WIFE/PARTNER 4 (GO TO 727)
WIFE/PARTNER INSISTED 5 (GO TO 727)
OTHER (SPECIFY) _________ 6 (GO TO 727)

723. CHECK 302 (02):

RESPONDENT NOT STERILIZED (GO TO 724)
RESPONDENT STERILIZED (GO TO 727)

724. The last time you had sexual intercourse, with this other woman, did you or she do something or use any method to avoid a pregnancy?

YES 1
NO 2 (GO TO 726)
DOES NOT KNOW/UNSURE 8 (GO TO 727)

725. What method did you or she use on that occasion?

FEMALE STERILIZATION 01 (GO TO 727)
PILL 03 (GO TO 727)
IUD 04 (GO TO 727)
INJECTABLES 05 (GO TO 727)
IMPLANTS 06 (GO TO 727)
FOAM/JELLY 08 (GO TO 727)
RHYTHM/PERIODIC ABSTINENCE 09 (GO TO 727)
WITHDRAWAL 10 (GO TO 727)
OTHER (SPECIFY) _____ 96 (GO TO 727)

726. What is the main reason you did not use a method to avoid pregnancy?

FERTILITY-RELATED REASONS
CASUAL SEX PARTNER 11
WIFE/PARTNER IS MENOPAUSAL, HAD HYSTERECTOMY 23
COUPLE SUBFECUND/INFECUND 24
WIFE/PARTNER WAS PREGNANT 25
WIFE/PARTNER RECENTLY DELIVERED AND NOT YET MENSTRUATING 26
WIFE/PARTNER WAS BREASTFEEDING 27
WANTED (MORE) CHILDREN 28
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
OTHER (SPECIFY) _____ 96
DOES NOT KNOW 98

727. What is your relationship to this woman?

WIFE/COHABITING PARTNER 1 (GO TO 729)
WOMAN IS GIRLFRIEND/FIANCE 2
OTHER FRIEND 3
CASUAL ACQUAINTANCE 4
COMMERCIAL SEX WORKER 5
OTHER (SPECIFY) ________ 6

728. For how long have you had a sexual relationship with this woman?

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

729. In total, with how many people have you had sex in the last 12 months?

NUMBER OF PARTNERS __

730. Have you ever paid for sex?

YES 1
NO 2 (GO TO 733)

731. How long ago was the last time you paid for sex?

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

732. The last time that you paid for sex, did you use a condom?

YES 1
NO 2

733. CHECK 317:

SOURCE FOR CONDOM NOT CIRCLED (GO TO 734)
SOURCE FOR CONDOM CIRCLED (GO TO 736)

734. Do you know of a place where one can get condoms?

YES 1
NO 2 (GO TO 736)

735. 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 _______________

Any other place?
RECORD ALL MENTIONED.

GOVERNMENT SECTOR
GOVT. HOSPITAL/CLINIC A
PRIMARY HEALTH CARE CENTER/HEALTH CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH CLINIC E
FCHV F
CONDOM BOX G
OTHER GOVT. (SPECIFY) _________ H
NON-GOVT. (NGO) SECTOR
FP ASSN. OF NEPAL I
MARIE STOPES J
ADRA K
NEPAL RED CROSS L
OTHER NGO (SPECIFY) _______ M
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC, NURSING HOME N
PHARMACY O
OTHER PRIVATE (SPECIFY) _____ P
OTHER SOURCE
SHOP Q
FRIEND/RELATIVE R

OTHER (SPECIFY) ________ X

736. RECORD THE TIME.

HOUR __
MINUTES __

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT: __________________________________________

COMMENTS ON SPECIFIC QUESTIONS: __________________________________________

ANY OTHER COMMENTS: _____________________________________________________

EDITOR'S OBSERVATIONS: _________________________________

NAME OF THE EDITOR: ____________
DATE: ___________

SUPERVISOR'S OBSERVATIONS: _________________________________

NAME OF SUPERVISOR: _____________________
DATE: ________________

SENTENCES FOR LITERACY TEST

1. Parents love their children.
2. Farming is hard work.
3. The child is reading a book.
4. Children should go to school.
5. Boys and girls are equal.