Data Cart

Your data extract

0 variables
0 samples
View Cart


NEPAL DEMOGRAPHIC AND HEALTH SURVEY 2006 WOMAN'S QUESTIONNAIRE

IDENTIFICATION

NAME AND CODE OF DISTRICT

NAME AND CODE OF VILLAGE/MUNICIPALITY

WARD NUMBER

CLUSTER NUMBER

HOUSEHOLD NUMBER

CITY/TOWN/RURAL

CITY 1
TOWN 2
RURAL 3

NAME AND LINE NUMBER OF WOMAN

NAME OF HOUSEHOLD HEAD

WOMAN ELIGIBLE FOR VERBAL AUTOPSY QUESTIONNAIRE

YES 1
NO 2

INTERVIEWER VISITS

FIRST VISIT
DATE
INTERVIEWER NAME
RESULT*

NEXT VISIT:
DATE
TIME

SECOND VISIT
DATE
INTERVIEWER NAME
RESULT*

NEXT VISIT:
DATE
TIME

THIRD VISIT
DATE
INTERVIEWER NAME
RESULT*

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT*

TOTAL NUMBER OF VISITS

*RESULT CODES

1 COMPLETED
2 NO HOUSEHOLD MEMBER AT HOME OR COMPETENT RESPONDENT IN HOUSEHOLDAT TIME OF VISIT
3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME
4 POSTPONED
5 REFUSED
6 DWELLING VACANT OR ADDRESS NOT A DWELLING
7 DWELLING DESTROYED
8 DWELLING NOT FOUND
9 OTHER (SPECIFY)_________

LANGUAGE OF QUESTIONNAIRE

ENGLISH 5

LANGUAGE OF INTERVIEW

NATIVE LANGUAGE OF RESPONDENT

TRANSLATOR USED

YES 1
NO 2

LANGUAGE CODES

NEPAL 1
BHOJPURI 2
MAITHILI 3
THARU 4
OTHER 5

SUPERVISOR

NAME ____
DATE ____

FIELD EDITOR

NAME ____
DATE ____

OFFICE EDITOR

___

KEYED BY

___

SECTION 1. RESPONDENT'S BACKGROUND
INTRODUCTION AND CONSENT

Hello. My name is _______________________________________ and I am working with the MINISTRY OF HEALTH AND POPULATION. We are conducting a national survey that asks women (and men) about various health issues. We would very much appreciate your participation in this survey. This information will help the government to plan health services. The survey usually takes about 1 hour 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 if we should come to any question you don't want to answer, just let me know and
I will go on to the next question; or you can stop the interview at any time. 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 (CONTINUE)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

101. RECORD TIME

HOUR ___
MINUTES __

101A. COLLECT ANY RELEVANT DOCUMENTS THAT MAY HAVE INFORMATION ON THE RESPONDENT'S AGE AND HER CHILDREN'S AGE AND IMMUNISATIONS.

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

YEARS ___
ALWAYS 95 (GO TO 104)
VISITOR 96 (GO TO 104)

103. Just before you moved here, did you live in a city, in a town, or in the country side?

CITY 1
TOWN 2
COUNTRY SIDE 3

104. Have you travelled away from your home community at any time in the last 12 months? IF LESS THAN 1 MONTH RECORD '00'.

NUMBER OF MONTHS __

105. How many months in total have you been away in the last 12 months? IF LESS THAN 1 MONTH RECORD '00'.

NUMBER OF MONTHS ___

106. Where have you travelled in the last 12 months?
PROBE: Anywhere else? RECORD ALL PLACES MENTIONED. IF INDIA, WRITE NAME OF STATE/CITY. IF OTHER THAN INDIA AND NEPAL, WRITE NAME OF THE COUNTRY.

NEPAL A
INDIA (SPECIFY CITY/STATE) B
OTHER (SPECIFY COUNTRY) X

107. In what month and year were you born?

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

108. How old were you at your last birthday? COMPARE AND CORRECT 107 AND/OR 108 IF INCONSISTENT.

AGE IN COMPLETED YEARS ___

109. Have you ever attended school?

YES 1
NO 2 (GO TO 112)

110.What is the highest grade you completed?

GRADE ___

111. CHECK 110:

GRADE 5 OR LOWER (CONTINUE)
GRADE 6 OR HIGHER (GO TO 115)

112. Now I would like to you to read this sentence to me.
SHOW CARD TO RESPONDENT. IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the 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
BLIND/VISUALLY IMPAIRED 5

113. 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

114. CHECK 112

CODE '2', '3', OR '4' CIRCLED (CONTINUE)
CODE '1' OR '5' CIRCLED (GO TO 116)

115. Do you read a newspaper of magazine almost every day, at least once a week, less than once a week or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

116. Do you listen to the radio almost every day, at least once a week, less than once a week or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

117. Do you watch television almost every day, at least once a week, less than once a week or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

118. What is your religion?

HINDU 1
BUDDHIST 2
MUSLIM 3
KIRAT 4
CHRISTIAN 5
OTHER (SPECIFY) ___ 6

119. What is your caste/ethnicity? WRITE CASTE/ETHNICITY ON LINE PROVIDED. LEAVE BOX BLANK. CODE WILL BE FILLE DBY FIELD EDITOR.

CASTE/ETHNICITY ____

SECTION 2. REPRODUCTION

201. Now I would like to ask you about all the pregnancies that you have had during your life. By this I mean all the children born to you whether they were born alive or dead, whether they are still living or not, whether they live with you or somewhere else, and all the pregnancies that you have had that did not result in a live birth. I understand that it is not easy to talk about children who have died, or pregnancies that ended before full term, but it is important that you tell us about all of them, so that the government can develop programs to improve children's health.

202. First 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 207)

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

YES 1
NO 2 (GO TO 205)

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

SONS AT HOME ___
DAUGHTERS AT HOME ___

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

YES 1
NO 2 (GO TO 207)

206. 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 __

207. Have you ever given birth to a boy or a girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

YES 1
NO 2 (GO TO 209)

208. How many boys have died? And how many girls have died? IF NONE, RECORD '00'.

BOYS DEAD ___
GIRLS DEAD ___

209. Women sometimes have pregnancies that do not result in a live born child. That is, a pregnancy can end in a miscarriage, or the child can be born dead. Have you ever had a pregnancy that did not end in a live birth?

YES 1
NO 2 (GO TO 211)

210. How many pregnancies have you had that did not end in live birth?

PREGNANCY LOSSES ___

211. SUM ANSWERS TO 204, 206, 208, AND 210 AND ENTER TOTAL. IF NONE, RECORD '00'.

TOTAL ___

212. CHECK 211: Just to make sure that I have this right: you have had in TOTAL ___ pregnancies during your life. Is that correct?

YES (CONTINUE)
NO (PROBE AND CORRECT 202-211 AS NECESSARY)

213. CHECK 211:

ONE OR MORE PREGNANCIES (CONTINUE)
NO PREGNANCIES (GO TO 236)

214. Now I would like to record all your pregnancies, whether born alive, born dead, or lost before full term, starting with the first one you had. RECORD ALL THE PREGNANCIES IN 216. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. (IF THERE ARE MORE THAN 10 PREGNANCIES, USE AN ADDITIONAL QUESTIONNAIRE STARTING WITH THE SECOND ROW).

215.

LINE NO. ___

216. Think back to your first pregnancy. Was that a single or multiple pregnancy?

SINGLE 1
MULTIPLE 2

217. Was the baby born alive, born dead, or lost before birth?

BORN ALIVE 1 (SKIP TO 219)
BORN DEAD 2
LOST BEFORE FULL TERM 3 (SKIP TO 228)

218. Did that baby cry, move, or breathe when it was born?

YES 1
NO 2 (GO TO 228)

219. What name was given to the child?

NAME ____

220. Is (NAME) a boy or a girl?

BOY 1
GIRL 2

221. In what month and year was name born?

MONTH ___
YEAR ____

222. Is (NAME) still alive?

YES 1
NO 2 (GO TO 226)

223. IF BORN ALIVE AND STILL LIVING: How old was (NAME) at his/her last birthday? RECORD AGE IN COMPLETED YEARS.

AGE IN YEARS ____

224. IF BORN ALIVE AND STILL LIVING: Is (NAME) living with you?

YES 1
NO 2

225. IF BORN ALIVE AND STILL LIVING: RECORD HOUSEHOLD LINE NUMBER OF CHILD (RECORD'00' IF CHILD NOT LISTED IN HOUSEHOLD.)

LINE NUMBER ___ (NEXT PREGNANCY)

226. IF BORN ALIVE BUT NOW DEAD: How old was (NAME) when he/she died?
IF '1 YR'', PROBE: How many months old was (NAME)? RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

DAYS 1 __
MONTHS 2 ___ (SKIP TO 227)
YEARS 3 ___

226A. IF BORN ALIVE BUT NOW DEAD: IF AGE AT DEATH IS REPORTED AS 5 YEARS OR LESS PROBE FOR EXACT NUMBER OF MONTHS AT DEATH. FOR AGE AT DEATH MORE THAN 5 YEARS, FOLLOW SKIP AS SHOWN.

MONTH ___ (NEXT PREGNANCY)

227. IF BORN ALIVE BUT NOW DEAD: In what month and year did (NAME) die?

MONTH __
YEAR ___ (NEXT PREGNANCY)

228. IF BORN DEAD OR LOST BEFORE BIRTH: In what month and year did this pregnancy end?

MONTH __
YEAR ___

229. IF BORN DEAD OR LOST BEFORE BIRTH: How many months did this pregnancy last? RECORD IN COMPLETED MONTHS.

MONTHS ___

230. IF BORN DEAD OR LOST BEFORE BIRTH: Did you or someone else do something to end this pregnancy?

YES 1
NO 2

231. IF BORN DEAD OR LOST BEFORE BIRTH: Were there any other pregnancies between the previous pregnancy and this pregnancy?

YES 1 (ADD PREG.)
NO 2 (NEXT PREG.)

232. Have you had any pregnancy since the last pregnancy mentioned? IF YES, RECORD PREGNANCY(S) IN TABLE.

YES 1
NO 2

233. COMPARE 211 WITH NUMBER OF PREGNANCIES IN HISTORY ABOVE AND MARK:

NUMBERS ARE SAME (CONTINUE)
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

CHECK:

FOR EACH PREGNANCY: YEAR OF IS RECORDED IN 221, 227, AND 228. __
FOR EACH BIRTH SINCE BAISAKH 2057: MONTH AND YEAR OF BIRTH ARE RECORDED __
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED IN 223. __
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED IN 226. __
FOR AGE AT DEATH 12 MONTHS OR 1 YEAR: PROBE TO DETERMINE EXACT __

223A. CHECK 228 AND 229 AND ENTER THE NUMBER OF STILL BIRTH SIN 2057 OR LATER AND THE PREGNANCY LASTED FOR 7 MONTHS OR MORE. IF NONE, RECORD '0'

223B. CHECK 226, 226A AND 227 AND ENTER THE NUMBER OF DEATHS AT AGE 0-59 MONTHS IN 2057 OR LATER. IF NONE, RECORD '0'.

233C. CHECK 223A AND 233B. IF ONE OR MORE READ THE FOLLOWING STATEMENT: We would like to get more information on the circumstances around the deaths of young children so that the government can provide services to help reduce these deaths. We would like to come back and talk with you about your child(ren's) death. Is this okay?

234. CHECK 221. AND ENTER THE NUMBER OF BIRTHS IN 2057 OR LATER. IF NONE, RECORD'0'.

235. FOR EACH BIRTH SINCE BAISAKH 2057, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE RIGHT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.) CHECK 228 FOR EACH PREGNANCY THAT DID NOT END IN A LIFE BIRTH. CHECK 230.
IF YES (CODE '1' CIRCLED), ENTER 'A' FOR ABORTION OR 'T' (IF CODE '2' CIRCLED) FOR MISCARRIAGE OR STILLBIRTH, IN CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS OF PREGNANCY.

236. Are you pregnant now?

YES 1
NO 2 (GO TO 238A)
UNSURE 8 (GO TO 238A)

237. How many months pregnant are you? RECORD NUMBER OF COMPLETED MONTHS. ENTER 'P'S IN THE CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

MONTHS ___

238. 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 have any (more) children at all?

THEN 1
LATER 2
NOT AT ALL 3

238A. CHECK 228

WOMAN HAVING MISCARRIAGE/ABORTION (CONTINUE)
WOMAN NOT HAVING MISCARRIAGE/ABORTION (GO TO 239)

238B. Did you suffer any complications from your last miscarriage/abortion?

YES 1
NO 2

238C. Did you have your uterus cleaned at a health facility?

YES 1
NO 2

239. When did your last menstrual period start?

DATE, IF GIVEN ____
DAYS AGO 1 ___
WEEKS AGO 2 ____
MONTHS AGO 3 ___
YEARS AGO 4 ___
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

240. From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant if she has sexual relations?

YES 1
NO 2 (GO TO 241A)
DON'T KNOW 8 (GO TO 241A)

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

JUST BEFORE HER PERIOD BEGINS 1
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY) ___
DON'T KNOW 8

241A. Is abortion legal in Nepal?

YES 1
NO 2
DON'T KNOW 8

241B. Do you know of a place where a woman can go to get an abortion?

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

241C. Where is that? Any other place? PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE. NAME OF THE PLACE(S) ____

PUBLIC SECTOR
GOV. HOSPITAL/CLINIC A
PHC CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH E
FCHV F
OTHER GOV. (SPECIFY) __ G
NON-GOVT. (NGO) SECTOR
FPAN H
MARIE STOPES I
ADRA J
NEPAL RED CROSS K
UMN L
OTHER NGO (SPECIFY) __ M
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC N
NURSING HOME O
PHARMACY P
PRIVATE DOCTOR Q
OTHER PRIVATE MEDICAL (SPECIFY) ____
OTHER SOURCE
TBA S
OTHER (SPECIFY) ____ X

SECTION 3A. MARRIAGE AND COHABITATION

301. What is your current marital status?

CURRENTLY MARRIED 1
MARRIED, GAUNA NOT PERFORMED 2 ( GO TO 305)
WIDOWED 3 (GO TO 307)
DIVORCED 4 (GO TO 307)
SEPARATED 5 (GO TO 307)
NEVER MARRIED 6 (GO TO 312)

302. Are you living with your husband now or is he staying elsewhere?

LIVING WITH HUSBAND 1 (GO TO 304)
STAYING ELSEWHERE 2

303. For how long have you and your husband not been living together? IF LESS THAN 1 YEAR, RECORD MONTHS, OTHERWISE RECORD IN COMPLETED YEARS.

MONTHS 1 ___
YEARS 2 ___

304. RECORD THE HUSBAND'S NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD'00'.

NAME ___
LINE NO __

305. Besides yourself, does your husband have other wives?

YES 1
NO 2 (GO TO 307)
DON'T KNOW 8 (GO TO 307)

306. How many other wives does your husband have?

NUMBER OF WIVES ___
DON'T KNOW 98

307. Have you been married only once or more than once?

ONLY ONCE 1
MORE THAN ONE 2 (GO TO 308A)

308. In what month and year did you get married?

MONTH ___
DON'T KNOW MONTH 98
YEAR ____ (GO TO 310)
DON'T KNOW YEAR 9998

308A. Now I would like to ask about when you married your first husband. In what month and year was that?

MONTH __
DON'T KNOW MONTH 98
YEAR ___ (GO TO 310)
DON'T KNOW YEAR 9998

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

AGE ___

310. CHECK 307:
MARRIED ONLY ONCE: In what month and year did you start living with your husband?
MARRIED MORE THAN ONCE: Now I would like to ask about when you started living with your first husband. In what month and year was that?

MONTH ___
DON'T KNOW MONTH 98
YEAR ___ (GO TO 312)
DON'T KNOW YEAR 9998
HAS NOT STARTED LIVING WITH HIM 9996 (GO TO 312)

311. How old were you when you first started living with him? PROMPT: At gauna?

AGE ___

312. CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

313. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some important life issues. How old were you when you had sexual intercourse for the very first time?

NEVER HAD SEXUAL INTERCOURSE 00
AGE IN YEARS ___ (GO TO 314)
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND 95 (GOT O 314)

313A. Do you intend to wait until you get married or until gauna has taken place to have sexual intercourse for the first time?

YES 1
NO 2
DON'T KNOW/UNSURE 8

SECTION 3B. CONTRACEPTION

313. 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?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?
CIRCLE CODE 1 IN 314 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 314, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED.
PERFORM THE CHECK IN 315. IF '00' IS NOT CIRCLED IN 313,
THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 314, ASK 316.

01. FEMALE STERILIZATION Women can have 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.
YES 1
NO 2
03. PILL Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
04. IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
05. INJECTABLES Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
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.
YES 1
NO 2
07. CONDOM Men can put a rubber sheath on their penis before sexual intercourse
YES 1
NO 2
08. RHYTHM METHOD. 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
09. WITHDRAWAL Men can be careful and pull out before climax
YES 1
NO 2 (CONTINUE)
10. EMERGENCY CONTRACEPTION As an emergency measure after unprotected sexual intercourse, women can take special pills at any time within three days to prevent pregnancy.
YES 1
NO 2 (CONTINUE)
11. Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1 (SPECIFY) ___
NO 2

315. CHECK 313:

CODE '00' CIRCLED (SKIP TO 319)
CODE '00' NOT CIRCLED (GO TO 316 FOR KNOWN METHODS)

316. Have you ever used (METHOD)?

01. FEMALE STERILIZATION: Have you ever had an operation to avoid having any more children?
YES 1
NO 2
02. MALE STERILIZATION: Have you ever had a partner who 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.
YES 1
NO 2
04. IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
05. INJECTABLES Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
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.
YES 1
NO 2
07. CONDOM Men can put a rubber sheath on their penis before sexual intercourse
YES 1
NO 2
08. RHYTHM METHOD. 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
09. WITHDRAWAL Men can be careful and pull out before climax
YES 1
NO 2
10. EMERGENCY CONTRACEPTION As an emergency measure after unprotected sexual intercourse, women can take special pills at any time within three days to prevent pregnancy.
YES 1
NO 2
11. (OTHER)
YES 1
NO 2

317. CHECK 316:

NOT A SINGLE "YES" (NEVER USED) (CONTINUE)
AT LEAST ONE "YES" (EVER USED) (GO TO 321)

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

YES 1 (GO TO 32)
NO 2

319. ENTER '0; IN THE CALENDAR IN EACH BLANK MONTH. (GO TO 345)

320. What have you used or done? CORRECT 316 AND 317 (AND 314 IF NECESSARY)

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

NUMBER OF CHILDREN ____

322. CHECK 316 (01):

WOMAN NOT STERILIZED (CONTINUE)
WOMAN STERILIZED (GO TO 325A)

323. CHECK 236:

NOT PREGNANT OR UNSURE (CONTINUE)
PREGNANT (GO TO 334)

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

YES 1
NO 2 (GO TO 334)

325. Which method are you using? CIRCLE ALL MENTIONED. IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD ON LIST. CIRCLE 'A' FOR FEMALE STERILIZATION.

FERMALE STERILIZATION A
MALE STERILIZATION B
PILL C
IUD D
INJECTABLES E
IMPLANTS F
CONDOM G
DIAPHRAGM I
FOAM/JELLY J
RHYTHM METHOD L (GO TO 331A)
WITHDRAWAL M (GO TO 331A)
OTHER (SPECIFY) ___ X (GO TO 331A)

326. The last time you obtained (HIGHEST METHOD ON LIST IN 325), how much did you pay in total, including the cost of the method and any consultation you may have had?

COST ___
FREE 9995
DON'T KNOW 9998

326A. CHECK 325/325A:

WOMAN/MAN STERILIZED/CODE A OR B CIRCLED (CONTINUE)
WOMAN/MAN NOT STERILIZED (GO TO 331A)

327. In what facility did the sterilization take place? PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE
THE NAME OF THE PLACE.

(NAME OF PLACE) ___
PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC 11
PHC CENTER 12
MOBILE CLINIC 13
OTHER GOVT. (SPECIFY) __ 16
NON-GOVT (NGO) SECTOR
FPAN 21
MARIE STOPES 22
ADRA 23
NEPAL RED CROSS 24
UMN 25
OTHER NGO (SPECIFY) ___ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME 31
OTHER PRIVATE MEDICAL (SPECIFY) ___ 36
OTHER (SPECIFY) ___ 96
DON'T KNOW 98

328. CHECK 325/325A:

CODE A CIRCLED: 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

CODE A NOT CIRCLED: Before the sterilization operation, was your husband/partner told that he would not be able to have any(more) children because of the operation?

YES 1
NO 2
DON'T KNOW 8

329. Do you regret that you/your husband had the operation?

YES 1
NO 2 (GO TO 331)

330. Why do you regret the operation?

RESPONDENT WANTS ANOTHER CHILD 1
HUSBAND WANTS ANOTHER CHILD 2
SIDE EFFECTS 3
MARITAL STATUS HAS CHANGED 4
OPERATION FAILED 5
CHILD DIED 7
OTHER (SPECIFY) ___ 6

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

MONTH __
YEAR __

331A. Since what month and year have you been using (CURRENT METHOD) without stopping? PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

MONTH __
YEAR__

332. CHECK 331/331A, 221 AND 228: ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 331/331A. GO BACK TO 331/331A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINOUS CHECK OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION).

YES (GO TO 331/331A)
NO (GO TO 333)

333. CHECK 331/331A:

YEAR IS 2057 OR LATER: ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING. THEN CONTINUE WITH 334.

YEAR IS 2056 OR EARLIER: ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO BAISAKH 2057. THEN SKIP TO 343.

334. I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years.
USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO BAISAKH 2057.
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.
ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.
ILLUSTRATIVE QUESTIONS:
When was the last time you used a method?
Which method was that?
When did you start using that method?
How long after the birth of (NAME)?
How long did you use the method then?

335. CHECK 325/325A: CIRCLE METHOD CODE: IF MORE THAN ONE METHOD CODE CIRCLED IN 325/325A, CIRCLE CODE FOR HIGHES TMETHOD IN LIST.

NO CODE CIRCLED 00 (GO TO 345)
FEMALE STERILIZATION 01 (GO TO 338)
MALE STERILIZATION 02 (GO TO 347)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOMS 07
DIAPHRAGM 09
FOAM/JELLY 10
RHYTHM METHOD 12 (GO TO 336A)
WITHDRAWAL 13 (GO TO 347)
OTHER METHOD 96 (GO TO 347)

336. Where did you obtain (CURRENT METHOD) when you started using it? Where did you learn to use the rhythm method? IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, OR CLINIC, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) ___
PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC 11
PHC CENTER 12
HEALTH POST 13
SUB-HELATH POST 14
PHC OUTREACH 15
MOBILE CLINIC 17
FCHV 18
CONDOM BOX 19
OTHER GOVT. (SPECIFY) ____
NON-GOVT. (NGO) SECTOR
FPAN 21
MARIE STOPES 22
ADRA 23
NEPAL RED CROSS 24
UMN 25
OTHER NGO. (SPECIFY) ___ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME 31
PHARMACY 32
OTHER PRIVATE MEDICAL (SPECIFY) ___ 36
OTHER SOURCE
SHOP 41
FRIEND/RELATIVE 42
OTHER (SPECIFY) ___ 96

337. CHECK 325/325A: CIRCLE METHOD CODE: IF MORE THAN ONE METHOD CODE CIRCLED IN 325/325A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07 (GO TO 344)
DIAPHRAGM 09 (GO TO 341)
FOAM/JELLY 10 (GO TO 341)
RHYTHM METHOD 12 (GO TO 341)

338. You obtained (CURRENT METHOD FROM 335) from (SOURCE OF METHOD FROM 327 OR 336) in (DATE FROM 331/331A). At that time, were you told about side effects or problems you might have with the method?

YES 1 (GO TO 340)
NO 2

339. Were you ever told by a health or family planning worker about side effects or problems you might have with the method?

YES 1
NO 2 (GO TO 341)

340. Were you told what to do if you experienced side effects or problems?

YES 1
NO 2

341. CHECK 338:

CODE 1 CIRCLED: At that time, were you told about other methods of family planning that you could use?
CODE 1 NOT CIRCLED: When you obtained (CURRENT METHOD FROM 335) from (SOURCE OF METHOD FROM 327 OR 336) were you told about other methods of family planning that you could use?
YES 1 (GO TO 343)
NO 2

342. Were you ever told by a health or family planning worker about other methods of family planning that you could use?

YES 1
NO 2

343. CHECK 325/325A: CIRCLE METHOD CODE: IF MORE THAN ONE METHOD CODE CIRCLED IN 325/325A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION 01 (GO TO 347)
MALE STERILIZATION 02 (GO TO 347)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07
DIAPHRAGM 09
FOAM/JELLY 10
RHYTHM METHOD 12 (GO TO 347)
WITHDRAWAL 13 (GO TO 347)
OTHER METHOD 96 (GO TO 347)

344. Where did you obtain (CURRENT METHOD) the last time? PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE ___
PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC 11
PHYC CENTER 12
HEALTH POST 13
SUB-HEALTH POST 14
PHC OUTREACH 15
MOBILE CLINIC 17
FCHV 18
CONDOM BOX 19
OTHER GOVT. (SPECIFY) ___ 16
NON-GOVT. (NGO) SECTOR
FPAN 21
MARIE STOPES 22
ADRA 23
NEPAL RED CROSS 24
UMN 25
OTHER NGO. (SPECIFY) ___ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME 31
PHARMACY 32
PRIVATE DOCTOR 33
OTHER PRIVATE MEDICAL (SPECIFY) ___ 36
OTHER SOURCE
SHOP 41
FRIEND/RELATIVE 42
OTHER (SPECIFY) ___ 96

344A. How long did it take you to travel from your house to this place?

MINUTES 1 ___ (GO TO 347)
HOURS 2 __ (GO TO 347)
DON'T KNOW 998 (GO TO 347)

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

YES 1
NO 2 (GO TO 347)

346. Where is that? Any other place? PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) ___
PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC A
PHC CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH E
MOBILE CLINIC F
FCHV G
CONDOM BOX H
OTHER GOVT. (SPECIFY) ___ I
NON-GOVT. (NGO) SECTOR
FPAN J
MARIE STOPES K
ADRA L
NEPAL RED CROSS M
UMN N
OTHER NGO. (SPECIFY) ___ O
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME P
PHARMACY Q
PRIVATE DOCTOR R
OTHER PRIVATE MEDICAL (SPECIFY) __ S
OTHER SOURCE
SHOP T
FRIEND/RELATIVE U
OTHER (SPECIFY) __ X

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

YES 1
NO 2

348. In the last 12 months, have you visited a health facility for care for yourself (or your children)?

YES 1
NO 2 (GO TO 401)

349. Did any staff at the health facility speak to you about family planning methods?

YES 1
NO 2

SECTION 4. PREGNANCY AND POSTNATAL CARE

401. CHECK 234:

ONE OR MORE BIRTHS IN 2057 OR LATER (CONTINUE)
NO BIRTHS IN 2057 OR LATER (GO TO 548)

402. CHECK 221: ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2057 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).
Now I would like to ask you some questions about the health of all your children born in the last five years. (We will talk about each separately.)

403. LINE NUMBER FROM 215

404. FROM 219 AND 222

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

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

406. How much longer would you have liked to wait?

MONTHS 1 ___
YEARS 2 ___
DON'T KNOW 998

407. Did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see?
Anyone else? PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE B
HEALTH ASST./HLTH. WKR C
MCH WORKER D
VHW E
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT F
FCHV G
OTHER (SPECIFY) __ X
NO ONE Y (GO TO 413A)

407A. CHECK 407

FCHV NOT CIRCLED (CONTINUE)
FCHV CIRCLED (GO TO 408)

407B. Did you discuss your pregnancy with an FCHV?

YES 1
NO 2

408. Where did you receive antenatal care for this pregnancy?
Anywhere else?
PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) ___
HOME
YOUR HOME A
OTHER HOME B
GOVT. SECTOR
GOVT. HOSPITAL C
PHC CENTER D
HEALTH POST E
SUB-HEALTH F
PHC OUTREACH G
OTHER GOVT. (SPECIFY) ___ H
NON-GOVT. (NGO)
UMN/RED CROSS HOSPITAL I
OTHER NGO (SPECIFY) __ J
PRIVATE MED. SECTOR PVT. HOSPITAL/CLINIC/NURSING HOME K
OTHER PRIVATE MED (SPECIFY) __ L
OTHER (SPECIFY) __ X

409. How many months pregnant were you when you first received antenatal care for this pregnancy?

MONTHS ___
DON'T KNOW 98

410. How many times did you receive antenatal care during this pregnancy?

NUMBER OF TIMES __
DON'T KNOW 98

411. As part of your antenatal care during this pregnancy, were any of the following done at least once?
Were you weighed?
Was your blood pressure measured?
Did you give a urine sample?
Did you give a blood sample?

WEIGHT
YES 1
NO 2
BP
YES 1
NO 2
URINE
YES 1
NO 2
BLOOD
YES 1
NO 2

412. During (any of) your antenatal care visit(s). were you advised to use a skilled birth attendant?

YES 1
NO 2
DON'T KNOW 8

412A. During (any of) your antenatal care visit(s), were you told about the signs of pregnancy complications?

YES 1
NO 2 (SKIP TO 413B)
DON'T KNOW 8 (SKIP TO 413B)

413. Were you told where to go if you had any of these complications?

YES 1 (IS THERE A SKIP ARROW TO 413B?)
NO 2
DON'T KNOW 8

413A. Did you discuss your pregnancy with an FCHV?

YES 1
NO 2

413B. What kind of preparation did you make beforehand for the delivery of (NAME)? Anything else? CIRCLED ALL MENTIONED.

SAVED MONEY A
ARRANGED FOR TRANSPORT B
FOUND BLOOD DONOR C
CONTACTED WKR TO HELP WITH DELIVERY D
BOUGHT SAFE DELIVERY KIT E
OTHER (SPECIFY) ___ X
NO PREPARATION Y

414. During this pregnancy, were you given an injection in the arm to prevent you and the baby from getting tetanus?

YES 1
NO 2 (SKIP TO 416)
DON'T KNOW 8 (SKIP TO 416)

415. During this pregnancy, how many times did you get this tetanus injection? IF MORE THAN 7, WRITE '7'.

TIMES __
DON'T KNOW 8

416. During this pregnancy, were you given or did you buy any iron/folic acid tablets? SHOW TABLETS.

YES 1
NO 2 (SKIP TO 418)
DON'T KNOW 8 (SKIP TO 418)

417. During the whole pregnancy. for how many days did you take the tablets? IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.

DAYS ___
DON'T KNOW 998

418. During this pregnancy, did you take any drug for intestinal worms?

YES 1
NO 2
DON'T KNOW 8

419. During this pregnancy, did you have difficulty with your vision during daylight?

YES 1
NO 2
DON'T KNOW 8

420. During this pregnancy, did you suffer from night blindness (ratandho) [USE LOCAL TERM]?

YES 1
NO 2
DON'T KNOW 8

421. 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

422. Was (NAME) weighted at birth?

YES 1
NO 2 (SKIP TO 424)
DON'T KNOW 8 (SKIP TO 424)

423. How much did (NAME) weigh? RECORD WEIGHT IN KILGRAMS FROM HEALTH CARD, IF AVAILABLE.

KG FROM CARD __. __
KG FROM RECALL __. ___
DON'T KNOW 99.8

424. Who assisted with the delivery of (NAME)?
Anyone else? PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED. IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE B
HEALTH ASST./HLT. WRK C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
FCHV E
RELATIVE/FRIEND F
OTHER (SPECIFY) ___ X
NO ONE Y

425. Where did you give birth to (NAME)? PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ____
HOME
YOUR HOME 11 (SKIP TO 432)
OTHER HOME 12 (SKIP TO 432)
GOVT. SECTOR
GOVT. HOSPITAL 21
PHC CENTER 22
HEALTH POST 23
SUB-HEALTH POST 24
OTHER GOVT. (SPECIFY) ___ 26
NON-GOVT. SECTOR
UMN/RED CROSS 31
OTHER GOVT. (SPECIFY) ___ 36
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC 41
OTHER PRIVATE MED. (SPECIFY) ___ 46
OTHER (SPECIFY) ___ 96 (SKIP TO 432)

425A. Did you receive a blood transfusion at this facility when (NAME) was born?

YES 1
NO 2

426. How long after (NAME) was delivered did you stay there? IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1 __
DAYS 2 __
WEEKS 3 ___
DON'T KNOW 998

427. Was (NAME) delivered by caesarean section?

YES 1
NO 2

428. Before you were discharged after (NAME) was born, did any health care provider check on your health?

YES 1
NO 2 (SKIP TO 431)

429. How long after delivery did the first check take place? IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK RECORD DAYS.

HOURS 1 __
DAYS 2 __
WEEKS 3 __
DON'T KNOW 998

430. Who checked on your health at that time? PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL (GO TO 431A)
DOCTOR 11 (GO TO 431A)
NURSE/MIDWIFE 12 (GO TO 431A)
HEALTH ASST./ AHW 13 (GO TO 431A)
MCH WORKER 14 (GO TO 431A)
VHW 15 (GO TO 431A)
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21 (GO TO 431A)
OTHER (SPECIFY) ___ 96 (GO TO 431A)

431. After you were discharged, did any health care provider or traditional birth attendant check on your health?

YES 1 (SKIP TO 434)
NO 2 (SKIP TO 442)

431A. As part of your postnatal care, were you examined for pelvic discharge or normal involution of uterus or abnormality of the lochia or bleeding?

YES 1 (SKIP TO 442)
NO 2 (SKIP TO 442)

432.Why didn't you deliver in a health facility? PROBE: Any other reason? RECORD ALL MENTIONED.

COST TOO MUCH A
FACILITY NOT OPEN B
TOO FAR/NO TRANSPORTATION C
DON'T TRUST FACILITY/POOR QUALITY SERVICE D
NO FEMALE PROVIDER AT FACILITY E
HUSBAND/FAMILY DID NOT ALLOW F
SECURITY CONCERNS G
NOT NECESSARY H
NOT CUSTOMARY I
OTHER (SPECIFY) ___ X

432A. Was a special safe delivery kit used? SHOW SAFE DELIVERY KIT MARKETED BY CRS.

YES 1 (SKIPT O 432C)
NO 2
DON'T KNOW 8

432B. When (NAME) was born, what instrument was used to cut the umbilical cord?

NEW/BOILED BLADE 1
USED BLADE 2
KNIFE 3
HASIYA 4
KHUKURI 5
SCISSORS 7
OTHER (SPECIFY) ___ 6
DON'T KNOW 8

432C. Was anything placed on the slump after the umbilical cord was cut?

YES 1
NO 2
DON'T KNOW 8

432D. Was (NAME) wrapped in cloth before the placenta was delivered?

YES 1
NO 2
DON'T KNOW 8

432F. How long after delivery was (NAME) bathed for the first time? IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1 __
DAYS 2 ___
WEEKS 3 ___
DON'T KNOW 998

433. After (NAME) was born, did any health care provider of a traditional birth attendant check on your health?

YES 1
NO 2 (SKIP TO 438)

434. How long after delivery did the first check take place? IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK RECORD DAYS.

HOURS 1 __
DAYS 2 ___
WEEKS 3 ___
DON'T KNOW 998

435. Who checked on your health at that time? PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
HEALTH ASST./AHW 13
MCH WORKER 14
VHW 15
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
OTHER (SPECIFY) ___ 96

436. Where did this first check take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE NAME OF THE PLACE.

NAME OF PLACE ____
HOME
YOUR HOME 11
OTHER HOME 12
GOVT. SECTOR
GOVT. HOSPITAL 21
PHC CENTER 22
HEALTH POST 23
SUB-HEALTH 24
PHC OUTREACH 25
OTHER GOVT. (SPECIFY) ___ 26
NON-GOVT. SECTOR
UMN/RED CROSS 31
OTHER GOVT. (SPECIFY) __ 36
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC 41
OTHER PRIVATE MED (SPECIFY) ___ 46
OTHER (SPECIFY) ___ 96

436A. As part of your postnatal care, were you examined for pelvic discharge or normal involution of the uterus or abnormality of the lochia or bleeding?

YES 1
NO 2

437. CHECK 431:

YES (SKIP TO 442)
NOT ASKED (CONTINUE)

438. In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on his/her health?

YES 1
NO 2 (SKIP TO 442)
DON'T KNOW 8 (SKIP TO 442)

439. How many hours, days or weeks after the birth of (NAME) did the first check take place? IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

HRS AFTER BIRTH 1 ___
DAYS AFTER BIRTH 2 ___
WKS AFTER BIRTH 3 ___
DON'T KNOW 998

440. Who checked on (NAME)'s health at that time? PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
HEALTH ASST./AHW 13
MCH WORKER 14
VHW 15
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
OTHER (SPECIFY) ___ 96

441. Where did this first check of (NAME) take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE NAME OF THE PLACE.

NAME OF PLACE ____
HOME
YOUR HOME 11
OTHER HOME 12
GOVT. SECTOR
GOVT. HOSPITAL 21
PHC CENTER 22
HEALTH POST 23
SUB-HEALTH 24
PHC OUTREACH 25
OTHER GOVT. (SPECIFY) ___ 26
NON-GOVT. SECTOR
UMN/RED CROSS 31
OTHER GOVT. (SPECIFY) __ 36
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC 41
OTHER PRIVATE MED (SPECIFY) ___ 46
OTHER (SPECIFY) ___ 96

442. In the first two months after delivery, did you receive a vitamin A dose (like this/any of these)? SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

442A. After delivery were you given or did you buy any iron/folic acid tablets? SHOW TABLETS.

YES 1
NO 2 (SKIP TO 443)
DON'T KNOW 8 (SKIP TO 443)

442B. After delivery, for how many days did you take the tablets? IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBERS OF DAYS.

DAYS __
DON'T KNOW 98

443. Has your menstrual period returned since the birth of (NAME)?

YES 1 (SKIP TO 445)
NO 2 (SKIP TO 446)

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

YES 1
NO 2 (SKIP TO 448)

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

MONTHS __
DON'T KNOW 98

446. CHECK 236: IS RESPONDENT PREGNANT?

NOT PREGNANT (CONTINUE)
PREGNANT OR UNSURE (SKIP TO 448)

447. Have you begun to have sexual intercourse again since the birth of (NAME)?

YES 1
NO 2 (SKIP TO 449)

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

MONTHS ___
DON'T KNOW 98

449. Did you ever breastfeed (NAME)?

YES 1
NO 2 (SKIP TO 456)

450. How long after birth did you first put (NAME) to the breast? IF LESS THAN 1 HOUR, RECORD '00' HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS

IMMEDIATELY 000
HOURS 1 __
DAYS 2 ___

451. In the first three days after delivery, was (NAME) given anything to drink other than breast milk?

YES 1
NO 2 (SKIP TO 453)

452. What was (NAME) given to drink? Anything else? RECORD ALL LIQUIDS MENTIONED.

MILK (OTHER THAN BREAST MILK) A
PLAIN WATER B
SUGAR OR GLUCOSE WATER C
GRIBE WATER D
SUGAR-SALT-WATER SOLUTION E
FRUIT JUICE F
INFANT FORUMULA G
TEA/INFUSIONS H
HONEY I
OTHER (SPECIFY) ___ X

453. CHECK 404: IS CHILD LIVING?

LIVING (CONTINUE)
DEAD (SKIP TO 455)

454. Are you still breastfeeding (NAME)?

YES 1 (SKIP TO 457)
NO 2

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

MONTHS __
DON'T KNOW 98

456. CHECK 404: IS CHILD LIVING?

LIVING (SKIP TO 459)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 501)

457. How many times did you breastfeed last night between sunset and sunrise? IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

NUMBER OF NIGHTTIME FEEDINGS __

458. How many times did you breastfeed yesterday during the daylight hours? IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER

NUMBER OF DAYLIGHT FEEDINGS ___

459. Did (NAME) drink anything from a bottle with a nipple yesterday or last night?

YES 1
NO 2
DON'T KNOW 8

460. GO BACK TO 405 IN NEXT COLUMN OR IF NO MORE BIRTHS, GO TO 501.

SECTION 5. CHILD IMMUNIZATION AND HEALTH AND CHILD'S AND WOMAN'S NUTRITION

501. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2057 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

502. LINE NUMBER FROM 215

503. FROM 219 AND 222

NAME ___

LIVING (CONTINUE)
DEAD (GO TO 503 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 545)

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

YES, SEEN 1 (SKIP TO 506)
YES, NOT SEEN 2 (SKIP TO 508)
NO CARD 3

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

YES 1 (SKIP TO 508)
NO 2 (SKIP TO 508)

506. 1. COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD. 2. WRITE '44' IN 'DAY' COLUMN IF CARD WHOS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED. 3. IF HEP. B IS GIVEN IN COMBINATION WITH DPT. RECORD SEPARATELY FOR BOTH DPT AND HEP. B.

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__
HEP. B 1
DAY __ MONTH __ YEAR__
HEP. B 2
DAY __ MONTH __ YEAR__
HEP. B 3
DAY __ MONTH __ YEAR__
MEASLES
DAY __ MONTH __ YEAR__

507. Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations received in a national immunization day campaign?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, HEP. B 1-3 AND/OR MEASLES VACCINES.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 506 (SKIP TO 510)
NO 2 (SKIP TO 510)
DON'T KNOW 3 (SKIP TO 510)

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

YES 1
NO 2 (SKIP TO 512)
DON'T KNOW 8 (SKIP TO 512)

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

509A. A BCG vaccination against tuberculosis, that is, an injection in the right arm that usually causes a scar?

YES 1
NO 2
DON'T KNOW 8

509B. Polio vaccine, that is, drops in the mouth?

YES 1
NO 2 (SKIP TO 509D)
DON'T KNOW 8 (SKIP TO 509D)

509C. How many times was the polio vaccine received?

NUMBER OF TIMES ___

509D. A DPT vaccination, that is, an injection given in the left thigh, sometimes given at the same time as polio drops?

YES 1
NO 2 (SKIP TO 509F)
DON'T KNOW (SKIP TO 509F)

509E. How many times was a DPT vaccination received?

NUMBER OF TIMES ___

509F. A HEP. B vaccination, that is, an injection given in the right thigh, sometimes given at the same time as DPT?

YES 1
NO 2 (SKIP TO 509H)
DON'T KNOW 8 (SKIP TO 509H)

509G. How many times was a HEP. B vaccination received?

NUMBER OF TIMES ___

509H. A measles injection, that is, a shot in the arm at the age of 9 months or older, to prevent him/her from getting measles?

YES 1
NO 2
DON'T KNOW 8

510. Were any of the vaccinations (NAME) received during the last two years given as part of a national immunization day campaign?

YES 1
NO 2 (SKIP TO 512)
NO VACCINATION IN THE LAST 2 YRS. 3 (SKIP TO 512)
DON'T KNOW 8 (SKIP TO 512)

511. At which national immunization day campaigns did (NAME) receive the polio vaccinations? RECORD ALL CAMPAIGNS MENTIONED.

MARG 2061 A
PAUSH 2061 B
MOP-UP C
NOT GIVEN D

511A. At which national immunization day campaigns did (NAME) receive the measles injections? RECORD ALL CAMPAIGNS MENTIONED.

ASWIN 2061 A
PAUSH 2061 B
CHAITRA 2061 C
NOT GIVEN D

512. Do you remember the recent vitamin A capsule distribution? IF NO, ASK: Does anyone in the household remember the event? SPEAK TO THAT PERSON.

YES 1
NO 2 (SKIP TO 515)
DON'T KNOW 8 (SKIP TO 515)

513. Did (NAME) receive a vitamin A capsule during the event in Kartik/Baisakh? IF THE INTERVIEW IS BEFORE BAISAKH, ASK ABOUT KARTIK. IF THE INTERVIEW IS AFTER BAISAKH, ASK ABOUT BAISAKH.

YES 1
NO 2 (SKIP TO 515)
DON'T KNOW 8 (SKIP TO 515)

514. Please tell me what happened when you took (NAME) for vitamin A? IF MENTIONS SPONTANEOUSLY, CIRCLE CODE '1'. FOR ALL NOT MENTIONED, PROBE AND CIRCLE '2' IF YES AND '8' IF NO OR DON'T KNOW, SHOW CAPSULE

RED CAPSULE
YES SPN. 1
YES PR 2
NO DK. 8
CAPSULE WAS CUT
YES SPN. 1
YES PR 2
NO DK. 8
CHILD'S NAME WRITTEN
YES SPN. 1
YES PR 2
NO DK. 8
CENTRAL SITE
YES SPN. 1
YES PR 2
NO DK. 8

515. Has (NAME) taken any drug for intestinal worms in the last six months (including any deworming tablet given during the vitamin A distribution?)

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 529)
DON'T KNOW 8 (SKIP TO 529)

517. Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

518. Now I would like to know how much (NAME) was given to drink during the diarrhea (including breastmilk). Was he/she given less than usual to drink, about the same amount, or more than usual to drink? IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8

519. When (NAME) had diarrhea, was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat? IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8

520. Did you seek advice or treatment for the diarrhea from any source?

YES 1
NO 2 (SKIP TO 524A)

521. Where did you seek advice or treatment? Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) __
GOVT. SECTOR
GOVT HOSPITAL/CLINIC A
PHC CENTER B
HEALTH POST C
SUB-HTH POST D
PHC OUTREACH CLINIC E
FCHV F
OTHER GOVT. SPECIFY ___ G
NON-GOVT. (NGO) SECT.
UMN/RED CROSS H
OTHER NGO. (SPECIFY) __ I
PRIVATE MED. SECTOR
PVT. HOSPITAL J
CLINIC/NURSING HOME K
PHARMACY L
OTHER PRIVATE MED. (SPECIFY) __ M
OTHER SOURCE
SHOP N
TRADITIONAL PRACTITIONER O
OTHER (SPECIFY) ___ X

521A. CHECK 521:

FCHV NOT CIRCLED (CONTINUE)
FCHV CIRCLED (SKIP TO 521C)

521B. Did you seek advice or treatment from an FCHV?

YES 1
NO 2

521C. CHECK 521:

PHARM. CIRCLED (CONTINUE)
PHARM. NOT CIRCLED (SKIP TO 522)

521D. At the pharmacy:

a. Was (NAME) examined?
YES 1
NO 2
DON'T KNOW 8
b. Did you get advice on type of medication to buy?
YES 1
NO 2
DON'T KNOW 8
c. Did you know exactly what medication to buy and only went there to buy it?
YES 1
NO 2
DON'T KNOW 8

522. CHECK 521:

TWO OR MORE CODES CIRCLED (CONTINUE)
ONLY ONE CODE CIRCLED (SKIP TO 524)

523. Where did you first seek advice or treatment? USE LETTER CODE FROM 521.

FIRST PLACE __

524. How many days after the diarrhea began did you first seek advice or treatment for (NAME)? IF THE SAME DAY, RECORD '00'.

DAYS ___ (SKIP TO 525)

524A. Did you seek advice or treatment from an FCHV?

YES 1
NO 2

525. Does (NAME) still have diarrhea?

YES 1
NO 2
DON'T KNOW 8

526. Was he/she given a fluid made from a special packet such as Jeevan Jal/Navajeevan to drink?

YES 1
NO 2
DON'T KNOW 8

527. Was anything (else) given to treat the diarrhea?

YES 1
NO 2 (SKIP TO 529)
DON'T KNOW 8 (SKIP TO 529)

528. What (else) was given to treat the diarrhea? Anything else? RECORD ALL TREATMENTS GIVEN.

PILL OR SYRUP
ANTIBIOTIC A
ANTIMOTILITY B
ZINC C
OTHER (NOT ANTIBIOTIC, ANTIMOTILITY, OR ZINC) D
UNKNOWN PILL OR SYRUP E
INJECTION
ANTIBIOTIC F
NON-ANTIBIOTIC G
UNKNOWN INJECTION H
(IV) INTRAVENOUS I
HOME REMEDY/HERBAL MEDICENE J
OTHER (SPECIFY) ___ X

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

YES 1
NO 2
DON'T KNOW 8

530. Has (NAME) had an illness with a cough at any time in the last 2 weeks?

YES 1
NO 2 (SKIP TO 533)
DON'T KNOW 8 (SKIP TO 533)

531. When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, rapid breaths or have difficulty breathing?

YES 1
NO 2 (SKIP TO 534)
DON'T KNOW 8 (SKIP TO 534)

532. Was the fast or difficult breathing due to a problem in the chest or to a blocked or running nose?

CHEST ONLY 1 (SKIP TO 534)
NOSE ONLY 2 (SKIP TO 534)
BOTH 3 (SKIP TO 534)
OTHER (SPECIFY) ___ 6 (SKIP TO 534)
DON'T KNOW 8 (SKIP TO 534)

533. CHECK 529: HAD FEVER?

YES (CONTINUE)
NO OR DK (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE THAN BIRTHS, GO TO 545)

534. Now I would like to know how much (NAME) was given to drink (including breastmilk) during the illness with a (fever/cough). Was he/she given less than usual to drink, about the same amount, or more than usual to drink? IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8

535. When (NAME) had a (fever/cough), was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat? IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8

536. Did you seek advice or treatment for the illness from any source?

YES 1
NO 2 (SKIP TO 540A)

537. Where did you seek advice or treatment? Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) ___
GOVT. SECTOR
GOVT HOSPITAL/CLINIC A
PHC CENTER B
HEALTH POST C
SUB-HTH POST D
PHC OUTREACH E
FCHV F
OTHER GOVT. (SPECIFY) ___ G
NON-GOVT. (NGO) SECT.
UMN/RED CROSS H
OTHER GOVT. (SPECIFY) ___ I
PRIVATE MED. SECTOR
PVT. HOSPITAL J
CLINIC/NURSING HOME K
PHARMACY L
OTHER PRIVATE MED. (SPECIFY) ___ M
OTHER SOURCE
SHOP N
TRADITIONAL PRACTITIONER O
OTHER (SPECIFY) ___ X

537A. CHECK 537:

FCHV NOT CIRCLED (CONTINUE)
FCHV CIRCLED (SKIP TO 537C)

537B. Did you seek advice or treatment from an FCHV?

YES 1
NO 2

537C. CHECK 537:

PHARM. CIRCLED (CONTINUE)
PHARM. NOT CIRCLED (SKIP TO 538)

537D. At the pharmacy:

a. Was (NAME) examined?
YES 1
NO 2
DK 8
b. Did you get advice on type of medication to buy?
YES 1
NO 2
DK 8
c. Did you know exactly what medication to buy and only went there to buy it?
YES 1
NO 2
DK 8

538. CHECK 537:

TWO OR MORE CODES CIRCLED
ONLY ONE CODE CIRCLED (SKIP TO 540)

539. Where did you first seek advice or treatment? USE LETTER CODE FROM 537.

FIRST PLACE ___

540. How many days after the illness began did you first seek advice or treatment for (NAME)? IF THE SAME DAY, RECORD '00'.

DAYS ___ (SKIP TO 541)

541. Is (NAME) still sick with a (fever/cough)?

FEVER ONLY 1
COUGH ONLY 2
BOTH FEVER AND COUGH 3
NO, NEITHER 4
DON'T KNOW 8

542. At any time during the illness, did (NAME) take any drugs for the illness?

YES 1
NO 2 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 545)
DON'T KNOW 8 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 545)

543. What drugs did (NAME) take? Any other drugs? RECORD ALL MENTIONED.

ANTIMALARIAL DRUGS
CHLOROQUINE A
PRIMAQUINE B
QUININE C
OTHER (SPECIFY) __ D
ANTIBIOTIC DRUGS
COTERIMOXAZOLE E
AMOXYCILLIN F
CIPROFLOXACIN G
PROCAINE PENICILLIN INJECTION H
OTHER DRUGS
PARACETAMOL I
IBUPROFEN J
COUGH SYRUP K
OTHER (SPECIFY) ___ X
DON'T KNOW Z

544. GO BACK TO 503 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 545)

545. CHECK 221 AND 224, ALL ROWS: NUMBER OF CHILDREN BORN IN 2057 OR LATER LIVING WITH THE RESPONDENT.

ONE OR MORE (CONTINUE)
NONE (GO TO 548)

546. The last time (NAME OF YOUNGEST CHILD) passed stools, what was done to dispose of the stools?

CHILD USED TOILET OR LATRINE 01
PUT/RINSED INTO TOILET OR LATRINE 02
PUT/RINSED INTO DRAIN OR DITCH 03
THROWN INTO GARBAGE 04
BURIED 05
LEFT IN THE OPEN 06
OTHER (SPECIFY) ___ 96

547. CHECK 525, ALL COLUMNS:

NO CHILD RECEIVED JEEVAN JAL OR NAVAJEEVAN OR OTHER ORS OR NOT ASKED (CONTINUE)
ANY CHILD RECEIVED JEEVAN JAL OR NAVAJEEVAN OR OTHER ORS (GO TO 549)

548. Have you ever heard of a special product called Jeevan Jal or Navajeevan you can get for the treatment of diarrhea?

YES 1 (GO TO 549)
NO 2 (GO TO 549)

548A. Have you ever seen a packet like this? SHOW PACKET OF JEEVAN JAL OR NAVAJEEVAN OR OTHER TYPES OF ORS.

YES 1
NO 2

549. CHECK 221 AND 224, ALL ROWS:
HAS AT LEAST ONE CHILD BORN IN 2059 OR LATER AND LIVING WITH HER: RECORD NAME OF YOUNGEST CHILD LIVING WITH HER (AND CONTINUE WITH 550)
DOES NOT HAVE ANY CHILDREN BORN IN 2059 OR LATER AND LIVING WITH HER (GO TO 601)

NAME ___

550. Now I would like to ask you about liquids or foods (NAME FROM 549) had yesterday during the day or at night. Did (NAME FROM 549) (drink/eat):

PLAIN WATER
YES 1
NO 2
DK 8
FORMULA
YES 1
NO 2
DK 8
BABY CEREAL
YES 1
NO 2
DK 8
OTHER PORRIDGE/GRUEL
YES 1
NO 2
DK 8

551. Now I would like to ask you about (other) liquids or foods that (NAME FROM 549)/you may have had yesterday during the day or at night. I am interested in whether your child/you had the item even if it was combined with other foods.
Did (NAME FROM 549)/you drink (eat):

a. Milk such as tinned, powdered, or fresh animal milk?

CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8

b. Tea or coffee?

CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8

c. Any other liquids?

CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8

d. Any food such as roti or porridge, made from grains, like rice, millet, wheat, maize, buckwheat or barley?

CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8

e. Pumpkin, carrots, squash or sweet potatoes (shakharkhanda) that are yellow or orange inside?

CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8

f. White potatoes, white yams, colocasia, or any other foods made from roots?

CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8

g. Any dark green, leafy vegetables such as colocasia leaves, spinach, amaranth leaves, mustard leaves, swiss chard?

CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8

h. Ripe mangoes, papayas, apricot, persimmon?

CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8

i. Any other fruits or vegetables such as banana, apple, guava, amala, orange, tomatoes?

CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8

j. Liver, kidney, heart or other organ meats?

CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8

k. Chicken, goat, lamb, buffalo, pork, duck or any other meat?

CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8

l. Eggs?

CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8

m. Fresh or dried fish or shellfish?

CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8

n. Any foods made from beans, peas, lentils (daal) or nuts?

CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8

o. Cheese, yogurt or other milk products?

CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8

p. Any ghee, oil, fats, or butter, or foods made with any of these?

CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8

q. Any sugary foods such as chocolates, sweets, candies, pastries, cakes, or biscuits?

CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8

r. Any other solid or semi-solid food?

CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8

552. CHECK 550 (LAST 2 CATEGORIES: BABY CEREALS OR OTHER PORRIDGE/GRUEL) AND 551 (CATEGORIES d THROUGH r FOR CHILD):

AT LEAST ONE 'YES' (CONTINUE)
NOT A SINGLE "YES" (GO TO 601)

553. How many times did (NAME FROM 549) eat solid, semisolid, or soft foods yesterday during the day or at night? IF 7 OR MORE TIMES, RECORD '7'.

NUMBER OF TIMES ___
DON'T KNOW 8

SECTION 6. SEXUAL LIFE

601. CHECK 313:

HAS NOT HAD SEXUAL INTERCOURSE (313 = 00) (GO TO 617)
HAS HAD SEXUAL INTERCOUSE (CONTINUE)

READ TO RESPONDENTS: Now I need to ask you some more questions about relationships and sexual life. Once again, let me assure you that your answers are completely confidential. If we should come to any question that you don't want to answer, just let me know and I will skip to the next question.

602. CHECK 108:

15-24 YEARS OLD (CONTINUE)
25-49 YEARS OLD (GO TO 606)

603. How old was the person you first had sexual intercourse with?

AGE OF PARTNER ___ (GO TO 604A)
DON'T KNOW 98

604. Would you say this person was ten or more years older than you?

YES 1
NO 2
DON'T KNOW 8

604A. What was this person's relationship to you?

HUSBAND 01
LIVE-IN PARTNER 02
BOYFRIEND NOT LIVING WITH RESPONDENT 03
RELATIVE 04
CASUAL ACQUAINTANCE 05
SEX WORKER 06
OTHER (SPECIFY) ___ 96

605. The first time you had sexual intercourse, was a condom used?

YES 1
NO 2
DON'T KNOW/DON'T REMEMBER 8

606. When was the last time you had sexual intercourse? IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS, OR MONTHS AGO. IF 12 MONTHS OR MORE, ANSWER MUST BE RECORDED IN YEARS AGO.

DAYS AGO 1 __ (GO TO 608)
WEEKS AGO 2 __ (GO TO 608)
MONTHS AGO 3 __ (GO TO 608)
YEARS AGO 4 (GO TO 617)

607. When was the last time you had sexual intercourse with this other person?

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

608. The last time you had sexual intercourse (with this other person), was a condom used?

YES 1
NO 2 (SKIP TO 610)

609. Did you use a condom every time you had sexual intercourse with person in the last 12 months?

YES 1
NO 2

610. What was this person's relationship to you?

HUSBAND 01 (SKIP TO 615)
LIVE-IN PARTNER 02 (SKIP TO 615)
BOYFRIEND NOT LIVING WITH RESPONDENT 03
RELATIVE 04
CASUAL ACQUAINTANCE 05
SEX WORKER CLIENT 06
OTHER (SPECIFY ) ___ 96

611. For how long (have you had/did you have) a sexual relationship with this person? IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAYS.

DAYS 1 __
MONTHS 2 __
YEARS 3 ___

612. CHECK 108:

15-24 YEARS OLD (CONTINUE)
25-49 YEARS OLD (SKIP TO 615)

613. How old is this person?

AGE OF PARTNER __ (SKIP TO 615)
DON'T KNOW 98

614. Would you say this person is ten or more years older than you?

YES 1
NO 2
DON'T KNOW 8

615. Apart from this person, have you had sexual intercourse with any other person in the last 12 months?

YES 1 (GO BACK TO 607 IN NEXT COLUMN)
NO (SKIP TO 617)

616. In total, with how many different people have you had sexual intercourse in the last 12 months? IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF PARTNERS IN LAST 12 MONTHS __
DON'T KNOW 98

617. Do you know of a place where a person can get condoms?

YES 1
NO 2 (GO TO 701)

618. Where is that? Any other place? IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE(S).

NAME OF PLACE __
PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC A
PHC CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH E
MOBILE LCINIC F
FCHV G
OTHER GOVT. (SPECIFY) __ H
NON-GOVT. (NGO) SECTOR
FPAN I
MARIE STOPES J
ADRA K
NEAL REDCROSS L
UMN M
OTHER NGO. (SPECIFY) ___ N
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME O
PHARMACY P
OTHER PRIVATE MEDCIAL (SPECIFY) ___ Q
OTHER SOURCE
SHOP R
FRIEND/RELATIVE S
OTHER (SPECIFY) ___ T
OTHER (SPECIFY) ___ X

619. If you wanted to, could you yourself get a condom?

YES 1
NO 2
DON'T KNOW/UNSURE 8

SECTION 7. FERTILITY PREFERENCES

701. CHECK 301:

NEVER MARRIED/WIDOWED/DIVORCED/SEPARATED (GO TO 713)
OTHER (CODE 1 AND 2) (CONTINUE)

702. CHECK 325/325A:

CODE '1' OR CODE'B' CIRCLED (GO TO 713)
OTHER (CONTINUE)

703. CHECK 236:
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 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 705)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 713)
UNDECIDED/DON'T KNOW AND PREGNANT 4 (GO TO 710)
UNDECIDED/DON'T KNOW AND NOT PREGNANT OR UNSURE 5 (GO TO 709)

704. CHECK 236:
NOT PREGNANT OR UNSURE: How long would you like to wait from now before the birth of (a/another) child?
PREGNANT: After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?

MONTHS 1 __
YEARS 2 __
SOON/NOW 993 (GO TO 709)
SAYS SHE CAN'T GET PREGNANT 94 (GO TO 713)
AFTER GAUNA 995) (GO TO 709)
OTHER (SPECIFY) __ 996 (GO TO 709)
DON'T KNOW 998 (GO TO 709)

705. CHECK 236:

NOT PREGNANT OR UNSURE (CONTINUE)
PREGNANT (GO TO 709)

706. CHECK 324: USING A CONTRACEPTIVE METHOD?

NOT ASKED (CONTINUE)
NOT CURRENTLY USING (CONTINUE)
CURRENLTY USING (GO TO 713)

707. CHECK 704:

NOT ASKED (CONTINUE)
24 OR MORE MONTHS OR 02 MORE YEARS (CONTINUE)
00-23 MONTHS OR 00-01 YEAR (GO TO 710)

708. CHECK 703:
WANTS TO HAVE A/ANOTHER CHILD: You have said that you do not want (a/another) child soon, but you are not using any method to avoid pregnancy. Can you tell me why you are not using a method? Any other reason?
WANTS NO MORE/NONE: You have said you do not want any (more) children, but you are not using any method to avoid pregnancy. Can you tell me why you are not using a method? Any other reason?

FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFRQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
SUBFECUND/INFECUND E
POSTPARTUM AMENORRHEIC F
BREASTFEEDING G
FATALISTIC/UP TO GOD H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
HEALTH CONCERNS O
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COSTS TOO MUCH R
INCONVENIENT TO USE S
INTERFEREW WITH BODY'S NORMAL PROCESSES T
DON'T LIKE EXISTING METHODS U
OTHER (SPECIFY) __ X
DON'T KNOW Z

709. CHECK 324: USING A CONTRACEPTIVE METHOD?

NOT ASKED (CONTINUE)
NO, NOT CURRENLTY USING (CONTINUE)
YES, CURRENLTY USING (GO TO 713)

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

YES 1
NO 2 (GO TO 712)
DON'T KNOW 8 (GO TO 713)

711. Which contraceptive method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 713)
MALE STERILIZATION 02 (GO TO 713)
PILL 03 (GO TO 713)
IUD/LOOP 04 (GO TO 713)
INJECTABLES 05 (GO TO 713)
IMPLANTS 06 (GO TO 713)
CONDOM 07 (GO TO 713)
FEMALE CONDOM 08 (GO TO 713)
DIAPHRAGM 09 (GO TO 713)
FOAM/JELLY 10 (GO TO 713)
RHYTHM METHOD 11 (GO TO 713)
WITHDRAWAL 12 (GO TO 713)
OTHER (SPECIFY) __ 96 (GO TO 713)
UNSURE 98 (GO TO 713)

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

FERTILITY-RELATED REASONS
INFREQUENT SEX/NO SEX 11
MENOPAUSLA/HYSTERECTOMY 12
SUBFECUND/INFECUND 13
FATALISTIC 14
WANTS AS MANY CHILDREN AS POSSIBLE 15
OPPOSITION TO USE
RESPONDENT OPPOSED 21
HUSBAND OPPOSED 22
OTHERS OPPOSED 23
RELIGIOUS PROHIBITION 24
LACK OF KNOWELDGE
KNOWS NO METHOD 31
KNOWS NO SOURCE 32
METHOD-RELATED REASONS
HEALTH CONCERNS 41
FEAR OF SIDE EFFECTS 42
LACK OF ACCESS/TOO FAR 43
COSTS TOO MUCH 44
INCONVENIENT TO USE 45
INTERFERES WITH BODY'S NORMAL PROCESSES 46
OTHER (SPECIFY) __ 96
DON'T KNOW 98

713. CHECK 222:
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?

NONE 00 (GO TO 715)
NUMBER __
OTHER (SPECIFY) __ 96 (GO TO 715)

714. 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 OF BOYS __
NUMBER OF GIRLS __
NUMBER OF EITHE R__
OTHER (SPECIFY) ___ 96

715. In the last few months have you heard or seen any message about family planning: On radio, on television, in a newspaper, magazine or brochure, on a poster, hoarding board or billboard, street dramas?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER/MAG./BROCH.
YES 1
NO 2
POSTER/HBOARD
YES 1
NO 2
STREET DRAMAS
YES 1
NO 2

716. CHECK 301:

CURRENTLY MARRIED (CONTINUE)
OTHER (GO TO 801)

717. CHECK 325/325A:

CODE 'B' OR 'G' OR 'M' CIRCLED (SKIP TO 719)
NO CODE CIRCLED (GO TO 719A)
OTHER (CONTINUE)

718. Does your husband know you are using a method of family planning?

YES 1
NO 2
DON'T KNOW 8

719. Would you say that using contraception is mainly your decision, mainly your husband's decision, or did you both decide together?

MAINLY RESPONDENT 1
MAINLY HUSBAND 2
JOINT DECISION 3
OTHER (SPECIFY) ___ 6

719A. Now I want to ask you about your husband's views on family planning. Do you think your husband approves or disapproves of couples using a method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

719B. How often have you talked to your husband about family planning in the past year?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

720. CHECK 325/325A:

CODE 'A' OR CODE 'B' CIRCLED (GO TO 801)
OTHER (CONTINUE)

721. Does your husband want 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

SECTION 8. HUSBAND'S BACKGROUND AND WOMAN'S WORK

801. CHECK 301:

CURRENTLY MARRIED (CONTINUE)
NEVER MARRIED (GO TO 806)
OTHER (GO TO 803)

802. How old was your husband on his last birthday?

AGE IN COMPLETED YEARS __

803. Did your (last) husband ever attend school?

YES 1
NO 2 (SKIP TO 805)

804. What was the highest grade he completed?

GRADE __
DON'T KNOW 98

805. CHECK 801:
CURRENTLY MARRIED: What is your husband's occupation? That is, what kind of work does he mainly do?
OTHER: What was your (last) husband's occupation? That is, what kind of work did he mainly do?

_______

806. Aside from your own housework, have you done any work in the last seven days?

YES 1 (GO TO 810)
NO 2

807. As you know, some women 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. In the last seven days, have you done any of these things or any other work?

YES 1 (GO TO 810)
NO 2

808. Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, maternity leave or any other such reason?

YES 1 (GO TO 810)
NO 2

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

YES 1
NO 2 (GO TO 817)

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

___

811. CHECK 810:

WORKS IN AGRICULTURE (CONTINUE)
DOES NOT WORK IN AGRICULTURE (GO TO 813)

812. 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 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4

813. 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

814. Do you usually work at home or away from home?

HOME 1
AWAY 2

815. 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

816. 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
NOT PAID 4

817. CHECK 301:

CURRENTLY MARRIED (CONTINUE)
OTHER (GO TO 822)

818. CHECK 816:

CODE 1 OR 2 CIRCLED (CONTINUE)
OTHER (GO TO 821)

819. Who usually decides how the money that you earn will be used: you, your husband, or you and your husband jointly?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JJOINTLY 3
OTHER (SPECIFY) ___ 6

820. Would you say that the money that you earn is more than what your husband earns, less than what he earns, or about the same?

MORE THAN HIM 1
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND DOESN'T BRING IN ANY MONEY 4 (GO TO 822)
DON'T KNOW 8

821. Who usually decides how your husband's earnings will be used: you, your husband, or you and your husband jointly?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
HUSBAND HAS NO EARNINGS 4
OTHER (SPECIFY) ___ 6

822. Who usually makes decisions about health care for yourself?

SELF 1
HUSBAND 2
BOTH 3
SOMEONE ELSE 4
OTHER 6

823. Who usually makes decisions about making major household purchases?

SELF 1
HUSBAND 2
BOTH 3
SOMEONE ELSE 4
OTHER 6

824. Who usually makes decisions about making purchases for daily household needs?

SELF 1
HUSBAND 2
BOTH 3
SOMEONE ELSE 4
OTHER 6

825. Who usually makes decisions about visits to your family or relatives?

SELF 1
HUSBAND 2
BOTH 3
SOMEONE ELSE 4
OTHER 6

826. PRESENCE OF OTHERS AT THIS POINT (PRESENT AND LISTENING, PRESENT BUT NOT LISTENING, OR NOT PRESENT)

CHILDREN LESS THAN 10
PRES/LISTENING 1
PRES/NOT LISTEN 2
NOT PRES. 3
HUSBAND
PRES/LISTENING 1
PRES/NOT LISTEN 2
NOT PRES. 3
OTHER MALES
PRES/LISTENING 1
PRES/NOT LISTEN 2
NOT PRES. 3
OTHER FEMALES
PRES/LISTENING 1
PRES/NOT LISTEN 2
NOT PRES. 3

827. Sometimes a husband is annoyed or angered by things that 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?
If she neglects the children?
If she argues with him?
If she refuses to have sex with him?
If she burns the food?

GOES OUT
YES 1
NO 2
DON'T KNOW 8
NEGL. CHILDREN
YES 1
NO 2
DON'T KNOW 8
ARGUES
YES 1
NO 2
DON'T KNOW 8
REFUSES SEX
YES 1
NO 2
DON'T KNOW 8
BURNS FOOD
YES 1
NO 2
DON'T KNOW 8

SECTION 9. HIV/AIDS

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

YES 1
NO 2 (GO TO 915)

902. Can people reduce their chance of getting the AIDS virus by having just one uninfected sex partner who has sexual intercourse with no other partners?

YES 1
NO 2
DON'T KNOW 8

903. Can people get the AIDS virus from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

904. Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex?

YES 1
NO 2
DON'T KNOW 8

905. Can people get the AIDS virus by sharing food with a person who has AIDS?

YES 1
NO 2
DON'T KNOW 8

906. Can people reduce their chance of getting the AIDS virus by not having sexual intercourse at all?

YES 1
NO 2
DON'T KNOW 8

907. Can people get the AIDS virus by touching someone who has AIDS?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

908A. Have you ever been tested to see if you have the AIDS virus?

YES 1
NO 2 (GO TO 909)
DON'T KNOW 8 (GO TO 909)

908B. Did you test positive for the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

909. Do you know of a place where people can go to get tested for the AIDS virus?

YES 1
NO 2 (GO TO 911)

910. Where is that? Any other place? PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE __
GOVT. SECTOR
GOVERNMENT HOSPITAL A
VCT CENTER B
OTHER GOVT. (SPECIFY) ___ C
NON-GOVT. SECTOR
FPAN D
AMDA E
INF F
NEPAL RED CROSS G
OTHER NON-GOVT. (SPECIFY) ___ H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR I
OTHER PRIVATE MEDICAL (SPECIFY) ___ J
OTHER (SPECIFY) ___ X

911. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

912. If a member of your family got infected with the AIDS virus, would you want it to remain a secret or not?

YES REMAIN A SECRET 1
NO 2
DK/NOT SURE/DEPENDS 8

913. If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

914. In your opinion, if a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in the school?

SHOULD BE ALLOWED 1
SHOULDN'T BE ALLOWED 2
DK/NOT SURE/DEPENDS 8

915. CHECK 901:
HEARD ABOUT AIDS: Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?
NOT HEARD ABOUT AIDS: Have you heard about infections that can be transmitted through sexual contact?

YES 1
NO 2

916. CHECK 313:

HAS HAD SEXUAL INTERCOUSE (CONTINUE)
HAS NOT HAD SEXUAL INTERCOUSE (GO TO 924)

917. CHECK 915: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES (CONTINUE)
NO (GO TO 919)

918. Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?

YES 1
NO 2
DON'T KNOW 8

919. Sometimes women experience a bad smelling abnormal genital discharge. During the last 12 months, have you had a bad smelling abnormal genital discharge?

YES 1
NO 2
DON'T KNOW 8

920. Sometimes women have a genital sore or ulcer. During the last 12 months have you had a genital sore or ulcer?

YES 1
NO 2
DON'T KNOW 8

921. CHECK 918, 919, AND 92:

HAS HAD AN INFECTION (ANY "YES") (CONTINUE)
HAS NOT HAD AN INFECTION OR DOES NNOT KNOW (GO TO 924)

922. The last time you had (PROBLEM FROM 918/919/920). Did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 924)

923. Where did you go?
Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) ___
GOVT. SECTOR
GOVERNMENT HOSPITAL A
PRIMARY HEALTH CARE B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH E
FAMILY PLANNING CLINIC F
MOBILE CLINIC G
FIELD WORKER H
OTHER GOVT. (SPECIFY) ___ I
NON-GOVT. SECTOR
FPAN J
AMDA K
INF L
NEPAL RED CROSS M
UMN N
OTHER NON-GOVT. (SPECIFY) ___ O
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR P
OTHER PRIVATE MEDICAL (SPECIFY) ___ Q
OTHER SOURCE
OTHER (SPECIFY) ___ X

924. If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in refusing to have sex with him?

YES 1
NO 2
DON'T KNOW 8

925. Is a wife 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

926. Is a wife justified in refusing to have sex with her husband when she knows her husband has sex with other women?

YES 1
NO 2
DON'T KNOW 8

SECTION 10. OTHER HEALTH ISSUES

1001. Have you ever heard of an illness called tuberculosis or TB?

YES 1
NO 2 (GO TO 1005A)

1002. How does tuberculosis spread from one person to another?
PROBE: Any other ways? RECORD ALL MENTIONED

THROUGH THE AIR WHEN COUGHING OR SNEEZING A
THROUGH SHARING UTENSILS B
THORUGH TOUCHING A PERSON WITH TB C
THROUGH FOOD D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
THROUGH SPIT G
OTHER (SPECIFY) ___ X
DON'T KNOW Z

1003. Can tuberculosis be cured?

YES 1
NO 2
DON'T KNOW 8

1004. If a member of your family got tuberculosis, would you want it to remain a secret or not?

YES, REMAIND A SECRET 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

1005A. Do you have a tetanus injection card (s)? IF YES: May I see it please?

YES, SEEN 1
YES, NOT SEEN 2 (GO TO 1005C)
NO CARD 3 (GO TO 1005C)

1005B.
(1) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD(S).
(2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED.

TT1
DAY __ MONTH __ YEAR __ (GO TO 10053)
TT2
DAY __ MONTH __ YEAR __ (GO TO 10053)
TT3
DAY __ MONTH __ YEAR __ (GO TO 10053)
TT4
DAY __ MONTH __ YEAR __ (GO TO 10053)
TT5
DAY __ MONTH __ YEAR __ (GO TO 10053)

1005C. CHECK 414:

HAS NOT RECEIVED TETANUS INJECTION OR NOT ASKED (CONTINUE)
HAS RECEIVED TETANUS INJECTION (GO TO 1005E)

1005D. Have you ever received a tetanus injection?

YES 1
NO 2 (GO TO 1005F)

1005E. How many tetanus injections have you received in your life time?

NUMBER ___
DON'T KNOW 98

1005F. CHECK 213:

ONE OR MORE BIRTHS (CONTINUE)
NO BIRTHS (GO TO 1006)

1005G. Have you ever experienced signs of uterine prolapse (Patheghar Khasne/Ang Khasne)?

YES 1
NO 2

1006. Do you currently smoke cigarettes?

YES 1
NO 2 (GO TO 1006)

1007. In the last 24 hours, how many cigarettes did you smoke?

CIGARETTES ___

1008. Do you currently smoke or use any other type of tobacco?

YES 1
NO 2 (GO TO 1010)

1009. What (other) type of tobacco do you currently smoke or use? RECORD ALL MENTIONED.

PIPE A
CHEWING TOBACCO B
SNUFF C
OTHER (SEPCIFY) ___ X

1010. Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem or not?
Getting permission to go?
Getting money needed for treatment?
The distance to the health facility?
Having to take transport?
Not wanting to go alone?
Concern about security?
Concern that there may not be a female health provider?
Concern that there may not be any health provider?
Concern that there may be no drugs available?

PERMISSION TO GO
BIG PROBLEM 1
NOT A BIG PROBLEM 2
GETTING MONEY
BIG PROBLEM 1
NOT A BIG PROBLEM 2
DISTANCE
BIG PROBLEM 1
NOT A BIG PROBLEM 2
TAKING TRANSPORT
BIG PROBLEM 1
NOT A BIG PROBLEM 2
GO ALONE
BIG PROBLEM 1
NOT A BIG PROBLEM 2
SECURITY
BIG PROBLEM 1
NOT A BIG PROBLEM 2
NO FEMALE PROVIDER
BIG PROBLEM 1
NOT A BIG PROBLEM 2
NO PROVIDER
BIG PROBLEM 1
NOT A BIG PROBLEM 2
NO DRUGS
BIG PROBLEM 1
NOT A BIG PROBLEM 2

1010A. In the last few months have you heard or seen the following programs on the radio and/or television:
Jana Swastha Radio Karyakram? Sewa Nai Dharma Ho?
Gyan Nai Shakti Ho?
Hamro Swastha Radio Karyakram?
Jeevan Chakra?
Teli-Swastha Karyakram?
Ek Apaas Ka Kura?
Sathi Sanga Manka Kura?
Desh Pardesh?

JANA SWASTHA
YES 1
NO 2
SEWA NAI DHARMA
YES 1
NO 2
GYAN NAI SHAKTI
YES 1
NO 2
HAMRO SWASTHA
YES 1
NO 2
JEEVAN CHAKRA
YES 1
NO 2
TELI-SWASTHA
YES 1
NO 2
EK APAAS KA KURA
YES 1
NO 2
SATHI SANGA MANKA
YES 1
NO 2
DESH PARDESH
YES 1
NO 2

1011. Did you use a soap for any purpose yesterday?

YES 1
NO 2 (GO TO 1101)

1012. For what purpose did you use soap? Any other purpose? RECORD ALL MENTIONED.

HANDWASHING A
WASHING OWN BODY B
WASHING CHILD'S HAND C
WASHING CHILD'S BODY D
WASHING CLOTHES E
OTHER X

1013. CHECK 1012:

CODE 'A' CIRCLED (CONTINUE)
CODE 'A' NOT CIRCLED (GO TO 1101)

1014. How many times did you wash your hands with soap yesterday? IF MORE THAN 7 TIMES, RECORD '7'.

TIMES __
DON'T KNOW 8

SECTION 11. MATERNAL MORTALITY

1101. 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 ___

1102. CHECK 1101:

TWO OR MORE BIRTHS (CONTINUE)
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 1114)

1103. How many of these births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS ___

1104. What was the name given to your oldest (next oldest) brother or sister?

___

1105. Is (NAME) male or female?

MALE 1
FEMALE 2

1106. Is (NAME) still alive?

YES 1
NO 2 (GO TO 1108)
DK 8 (GO TO NEXT)

1107. How old is (NAME)?

___ GO TO NEXT

1108. How many years ago did (NAME) die?

___ IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO NEXT

1109. How old was (NAME) when he/she died?

___ IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO NEXT

1110. Was (NAME) pregnant when she died?

YES 1 (GO TO 1113)
NO 2

1111. Did (NAME) die during childbirth?

YES 1 (GO TO 1113)
NO 2

1112. Did (NAME) die within two months after the end of a pregnancy or childbirth?

YES 1
NO 2

1113. How many live born children did (NAME) give birth to during her lifetime (before this pregnancy)?

___

IF NO MORE BROTHERS OR SISTERS, GO TO 1114

1114. 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: _________

SUPERVISOR'S OBSERVATION _____________

NAME OF SUPERVISOR: ________

DATE: ____________

EDITOR'S OBSERVATIONS ___________

NAME OF EDITOR: __________

DATE: _________