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NEPAL DEMOGRAPHIC AND HEALTH SURVEY 2006 MAN'S QUESTIONNAIRE

IDENTIFICATION

NAME AND CODE OF DISTRICT

NAME AND CODE OF VILLAGE/MUNICIPALTY

WARD NUMBER

CLUSTER NUMBER

CITY/TOWN/RURAL

CITY = 1
TOWN = 2
RURAL = 3

NAME AND LINE NUMBER OF MAN

NAME OF HOUSEHOLD HEAD

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

___

INTRODUCTION AND CONSENT

Hello. My name is _______________________________________ and I am working with the MINISTRY OF HEALTH AND POPULATION. We are conducting a national survey about various health issues. We would very much appreciate your participation in this survey.
The survey usually takes between 20 and 30 minutes to complete.
As part of the survey we would first like to ask some questions about your household. All of the answers you give will be confidential. Participation in the survey is completely voluntary. 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 you will participate in the 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 THE TIME.

HOUR ___ MINUTES ___

102. HOW LONG HAVE YOU BEEN LIVING CONTINOUSLY 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 countryside?

CITY 1
TOWN 2
COUNTRYSIDE 3

104. Have you travelled away from your home community at any time in the last 12 months?

YES 1
NO 2

105. How many months in total have you been 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

NEPAL A
INDIA (SPECIFY CITY/STATE) ____ B
OTHER (SPECITY 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 106 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 (GO TO 112)
GRADE 6 OR HIGHER (GO TO 115)

112. Now I would like 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 IMPARED 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 (GO TO 115)
CODE '1' OR '5' CIRCLED (GO TO 116)

115. Do you read a newspaper or 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
KRAT 4
CHRISTIAN 5
OTHER (SPECIFY) ___

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

CASTE/ETHNICITY ____

SECTION 2. REPRODUCTION

201. Now I would like to ask about any children you have had during your life. I am interested in all of the children that are biologically yours, even if they are not legally yours or do not have your last name. Have you ever fathered any children with any woman?

YES 1
NO 2 (GO TO 206)
DON'T KNOW 8 (GO TO 206)

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

YES 1
NO 2 (GO TO 204)

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

SONS AT HOME ___
DAUGHTERS AT HOME ___

204. Do you have any sons or daughters that you have fathered who are alive but do not live with you?

YES 1
NO 2 (GO TO 206)

205. How many sons are alive but do not live with you? And how many daughters are live but do not live with you? (IF NONE, RECORD '00').

SONS ELSEWHERE ___
DAUGHTERS ELSEWEHRE ___

206. Have you ever fathered a son or a daughter 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 208)
DON'T KNOW 8 (GO TO 208)

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

BOYS DEAD ___
GIRLS DEAD ___

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

TOTAL CHILDREN ___

209. CHECK 208:

HAS MORE THAN ONE CHILD (GO TO 210)
HAS HAD ONLY ONE CHILD (GO TO 212)
HAS NOT HAD ANY CHILDREN (GO TO 301)

210. Did all of the children you have fathered have the same biological mother?

YES 1 (GO TO 212)
NO 2

211. In all, how many women have you fathered children with?

NUMBER OF WOMEN ___

212. How old were you when your (first) child was born?

AGE IN YEARS ___

212A. CHECK 203 AND 205:

AT LEAST ONE LIVING CHILD (GO TO 213)
NO LIVING CHILDREN (GO TO 301)

213. How many years old is your (youngest) child?

AGE IN YEARS ___

214. CHECK 213:

(YOUNGEST) CHILD IS AGE 0-3 YEARS (GO TO 215)
OTHER (GO TO 301)

215. What is the name of your (youngest) child? WRITE NAME OF (YOUNGEST) CHILD.

NAME OF (YOUNGEST) CHILD ___

216. When (NAME)'s mother was pregnant with (NAME) did she have any antenatal check-ups?

YES 1
NO 2 (GO TO 218)
DON'T KNOW 3 (GO TO 218)

217. Were you present during any antenatal check-up?

PRESENT 1
NOT PRESENT 2

217A. Were you ever told what to do if (NAME)'s mother had any pregnancy complication?

YES 1
NO 2

217B. At any time during the pregnancy did any health provider or health worker speak to you about:
a. The importance of delivering the baby in a hospital or health facility?
b. The importance of proper nutrition for the mother during pregnancy?
c. Family planning or delaying your next child?

DELIVER ADVICE
YES 1
NO 2
NUTRITION ADVICE
YES 1
NO 2
FAMILY PLANNING
YES 1
NO 2

218. Was (NAME) born in a hospital or a health facility?

HOSPITAL/HEALTH FACILITY 1 (GO TO 219A)
OTHER 2

219. What was the main reason why (NAME)'s mother did not deliver in a hospital or health facility?

COST TOO MUCH 01
FACILITY CLOSED 02
TOO FAR/NO TRANSPORTATION 03
DON'T TRUST FACILITY/POOR QUALITY SERVICE 04
NO FEMALE PROVIDER 05
NOT THE FIRST CHILD 06
SECURITY CONCERNS CHILD'S MOTHER DID NOT THINK IT WAS NECESSARY 08
HE DID NOT THINK IT WAS NECESSARY 09
FAMILY DID NOT THINK IT WAS NECESSARY 10
OTHER (SPECIFY) ___ 96
DON'T KNOW 98

219A. What kind of preparation did you make beforehand for the delivery of (NAME)? Anything else? CIRCLE ALL MENTIONED.

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

220. When a child has diarrhea, how much should he or she be given to drink: more than usual, the same amount as usual, less than usual, or should he or she not be given anything to drink at all?

MORE THAN USUAL 1
ABOUT THE SAME 2
LESS THAN USUAL 3
NOTHING TO DRINK 4
DON'T KNOW 8

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
Which ways or methods have you heard about?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?
CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY
THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED 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.

302. Have you ever used (METHOD)?

01. FEMALE STERILIZATION Women can have an operation to avoid having any more children

YES 1
NO 2 (GO TO 02)

02. MALE STERILIZATION Men can have an operation to avoid having any more children.

YES 1
NO 2 (GO TO 03)

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.

YES 1
NO 2 (GO TO 04)

04. IUD Women can have a loop or coil placed inside them by a doctor or a nurse.

YES 1
NO 2 (GO TO 05)

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 (GO TO 06)

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 (GO TO 07)

07. CONDOM Men can put a rubber sheath on their penis before sexual intercourse.

YES 1
NO 2 (GO TO 08)

Have you ever had an operation to avoid having any more children?

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 (GO TO 09)

Have you ever had an operation to avoid having any more children?

YES 1
NO 2

09. WITHDRAWAL Men can be careful and pull out before climax.

YES 1
NO (GO TO 10)

Have you ever had an operation to avoid having any more children?

YES 1
NO 2

10. EMERGENCY CONTRACEPTION Women can take pills up to three days after sexual intercourse to avoid becoming pregnant.

YES 1
NO 2 (GO TO 11)

11. Have you heard of any other ways or methods that women or men can use to avoid pregnancy?

YES 1 (SPECIFY) ___
NO 2

303. CHECK 302 (02) RESPONDENT IS STERILIZED

YES (GO TO 304)
NO (GO TO 310)

304. Now I would like to talk about when you were sterilized.
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 11
PHC CENTER 12
MOBILE CLINIC 13
OTHER PUBLIC (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
OTHER PRIVATE MEDICAL (SPECIFY) ___ 36
OTHER (SPECIFY)___ 96
DON'T KNOW 98

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

MONTH __
YEAR ___

306. How much did you pay in total for the sterilization, including any consultation you may have had?

COST ___
FREE 9995
DON'T KNOW 9998

307. 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

308. Do you regret that you had the operation?

YES 1
NO 2 (GO TO 310)
DON'T KNOW 8

309. Why do you regret that you had the operation?

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

310. In the last few months have you heard or seen any message about family planning:
a. On the radio?
b. On the television?
c. In a newspaper, magazine or brochure?
d. On a poster or billboard?
e. Street drama?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER OR MAGAZINE
YES 1
NO 2
POSTER/BILLBOARD
YES 1
NO 2
STREET DRAMAS
YES 1
NO 2

311. In the last few months, have you discussed the practice of family planning with a health worker or health professional?

YES 1
NO 2

312. Now I would like to ask you about a woman's risk of pregnancy. 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 314)
DON'T KNOW (GO TO 314)

313. Is this time just before her period, 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) ___ 6
DON'T KNOW 8

314. Do you think that a woman who is breast feeding her baby can become pregnant?

YES 1
NO 2
DEPENDS 3
DON'T KNOW 8

315. I will now read you some statements about contraception. Please tell me if you agree or disagree with each one.
a) Contraception is women's business and a man should not have to worry about it.
b) Women who use contraception may become promiscuous.
c) Being sterilized for a man is the same as castration.

CONTRACEPTION WOMAN'S BUSINESS
AGREE 1
DISAGREE 2
DK 8
WOMAN MAY BECOME PROMISCUOUS
AGREE 1
DISAGREE 2
DK 8
CASTRATION
AGREE 1
DISAGREE 2
DK 8

316. CHECK 301 (07) KNOWS MALE CONDOM

YES (GO TO 317)
NO (GO TO 401)

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

YES 1
NO 2 (GO TO 401)

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

(NAME OF PLACE(S)) ___
PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC A
PHC CENTER B
HEALTH POST C
SUB-HEALTH PO D
PHC OUTREACH 3
MOBILE CLNIIC G
FCHV G
OTHER PUBLIC (SPECIFY) ___ H
NON-GOVT. (NGO) SECTOR
FPAN I
MARIE STOPES J
ADRA K
NEPAL RED CROSS L
UMN M
OTHER NGO. (SPECIFY) ___ N
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITTAL/CLINIC/NURSING HOME O
PHARMACY P
OTHER PRIVATE MEDICAL (SPECIFY) Q
OTHER SOURCE
SHOP R
FRIENDS/RELATIVES S
OTHER (SPECIFY) T
OTHER (SPECIFY) X

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

YES 1
NO 2

SECTION 4. MARRIAGE AND SEXUAL LIFE

401. What is your current marital status?

CURRENTLY MARRIED 1
MARRIED, GAUNA NOT PERFORMED 2 (GO TO 407)
WIDOWED 3 (GO TO 407)
DIVORCED 4 (GO TO 407)
SEPARATED 5 (GO TO 407)
NEVER MARRIED 6 (GO TO 414)

402. Do you currently have one wife or more than one wife?
IF ONLY ONE WIFE, RECORD '01'. IF MORE THAN ONE, ASK: How many wives do you currently have?

NUMBER OF WIVES ___

403. WRITE THE LINE NUMBERS FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH WIFE. IF A WIFE IS NOT LISTED IN THE HOUSEHOLD SCHEDULE, RECORD '00' IN THE LINE NUMBER BOXES.
THE NUMBER OF LINES FILLED IN MUST BE EQUAL TO THE NUMBER OF WIVES.
(IF RESPONDENT HAS MORE THAN FOUR WIVES, USE ADDITIONAL QUESTIONNAIRE(S).)

CHECK 402:

ONLY ONE WIFE: Please tell me the name of your wife.
MORE THAN ONE WIFE: Please tell me the name of each of your wives, starting with the one you married with first.
WIFE NUMBER __
NAME __
LINE NUMBER IN HOUSEHOLD SCHEDULE ___

404. Are you living with your wife/wives now, or is she/are they staying elsewhere?

LIVING WITH WIFE/AT LEAST ONE WIFE 1 (GO TO 406)
NOT LIVING WITH WIFE/ANY WIVES 2

405. For how long have you not been living with your wife/any of your wives? IF LESS THAN 1 YEAR, RECORD MONTHS; OTHERWISE RECORD COMPLETED YEARS

MONTHS __ 1
YEARS __ 2

406. CHECK 402.

ONLY ONE WIFE: Have you ever been married to any woman other than your current wife?
MORE THAN ONE WIFE: Have you ever been married to any other woman in addition to those you have told me about?

YES 1 (GO TO 408)
NO (GO TO 408)

407. Have you been married once or more than once?

ONCE 1 (GO TO 409)
MORE THAN ONCE 2 (GO TO 409A)

408. CHECK 402 AND 406:

IF 402=01 AND 407= '2' (GO TO 409)
OTHER (GO TO 409A)

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

MONTH __
DON'T KNOW MONTH 98
YEAR __ (GO TO 411)
DON'T KNOW YEAR 9998

409A. Now I would like to ask about when you married your first wife. In what month and year was that?

MONTH __
DON'T KNOW MONTH 98
YEAR __ (GO TO 411)
DON'T KNOW YEAR 9998

410. How old were you when you first got married?

AGE ___

411. CHECK 401:

MARRIED, GAUNA NOT PERFORMED (GO TO 414)
OTHER (GO TO 412)

412. CHECK 402 AND 406 AND, IF 402 AND 406 NOT ASKED,

IF MARRIED ONLY ONCE (402=01 AND 406='2') OR (407='1')
In what month and year did you start living with your wife?

IF MARRIED MORE THAN ONCE (402>01 OR 406='1') OR (407 = '2')
Now I would like to ask about when you started living with your first wife. In what month and year was that?

MONTH __
DON'T KNOW MONTH 98
YEAR ___ (GO TO 415)
DON'T KNOW YEAR 9998

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

AGE ___ 415

414. CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY. Now I need to ask you some questions about sexual
life in order to gain a better understanding of some important life issues. Let me assure you again that your answers are completely confidential and will not be told to anyone. If you do not want to answer, just let me know and I will skip to the next question. Have you ever had sexual intercourse?

YES 1
NO 2 (GO TO 416)

415. CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY. (Now I need to ask you some questions about sexual life in order to gain a better understanding of some important life issues. Let me assure you again that your answers are completely confidential and will not be told to anyone. If you do not want to answer, just let me know and I will skip to the next question.) How old were you when you had sexual intercourse for the very first time?

NEVER HAD SEXUAL INTERCOURSE 00 (GO TO 417)
AGE IN YEARS ___ (GO TO 418)
FIRST TIME WHEN STARTED LIVING WITH (FIRST) WIFE 95 (GO TO 418)

416. CHECK 401

NEVER MARRIED/GAUNA NOT PERFORMED (GO TO 417)
OTHER (GO TO 501)

417. Do you intend to wait until you get married/after gauna to have sexual intercourse for the first time?

YES 1
NO 2
DON'T KNOW/UNSURE 8

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

YES 1
NO 2

418A. What was this person's relationship to you?
IF GIRLFRIEND: Were you living together as if married? IF YES, CIRCLE '02'. IF NO, CIRCLE '03'.

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

419. When was the last time you had sexual intercourse? IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS, OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO ___ 1 (GO TO 422)
WEEKS AGO ___ 2 (GO TO 422)
MONTHS AGO ___ 3 (GO TO 422)
YEARS AGO ___ 4 (GO TO 435)

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

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

422. The last time you had sexual intercourse (with this second/third person), was a condom used?

YES 1
NO 2

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

YES 1
NO 2

424. What was this (second/third) person's relationship to you? IF GIRLFRIEND: Were you living together as if married? IF YES, CIRCLE '02'. IF NO, CIRCLE '03'.

WIFE 01 (SKIP TO 428)
LIVE-IN PARTNER 02 (SKIP TO 428)
GIRLFRIEND NOT LIVING WITH RESPONDENT 03
RELATIVE 04
CASUAL ACQUAINTANCE 05
PROSTITUTE 06
OTHER (SPECIFY) ___ 96

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

DAYS __ 1
MONTHS __ 2
YEARS __ 3

426. The last time you had sexual intercourse with this (second/third) person, did you or this person drink alcohol?

YES 1
NO 2 (SKIP TO 428)

427. Were you or your partner drunk at that time? IF YES: Who was drunk?

RESPONDENT ONLY 1
PARTNER ONLY 2
RESPONDENT AND PARTNER BOTH 3
NEITHER 4

428. Apart from [this person/these two people], have you had sexual intercourse with any other person in the last 12 months? IF FILLING FOR THIRD-TO-LAST SKIP THIS QUESTION.

YES 1 (GO TO 421 IN NEXT COLUMN)
NO 2 (SKIP TO 432)

429. 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. IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95.'

NUMBER OF PARTNERS IN LAST 12 MONTHS ___
DON'T KNOW 96

430. CHECK 424 (ALL COLUMNS):

AT LEAST ONE PARTNER IS PROSTITUTE (GO TO 431)
NO PARTNERS ARE PROSTITUTE (GO TO 432)

431. CHECK 422 AND 424 (ALL COLUMNS:

CONDOM USED WITH EVERY PROSTITUTE (GO TO 434)
OTHER (GO TO 435)

432. In the last 12 months, did you pay anyone in exchange for having sexual intercourse?

YES 1
NO 2 (GO TO 435)

433. The last time you paid someone in exchange for having sexual intercourse, was a condom used?

YES 1
NO 2 (GO TO 435)

434. Was a condom used during sexual intercourse every time you paid someone in exchange for having sexual intercourse in the last 12 months?

YES 1
NO 2
DK 8

435. In total, with how many different people have you had sexual intercourse in your lifetime? IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95.'

NUMBER OF PARTNERS IN LIFETIME ___
DON'T KNOW 98

436. CHECK 422, MOST RECENT PARTNER (FIRST COLUMN):

CONDOM USED (GO TO 437)
NO CONDOM USED OR NOT ASKED (GO TO 442)

437. You told me that a condom was used the last time you had sex. May I see the package of condoms you were using at the time? RECORD NAME OF BRAND IF PACKAGE SEEN.

PACKAGE SEEN 1 (GO TO 438A)
BRAND NAME (SPECIFY) ___
DOES NOT HAVE/NOT SEEN 2

438. Do you know the brand name of the condom used at that time? RECORD NAME OF BRAND.

BRAND NAME (SPECIFY) ___
DON'T KNOW 98

438A. Which condom brand do you use regularly?

DHAAL 1
PANTHER 2
NUMBER 1 3
JODI 4
OTHER (SPECIFY) ___ 6

439. How many condoms did you get the last time?

NUMBER OF CONDOMS ___
DON'T KNOW 998

439A. How many of the condoms you got last time did you use?

NUMBER OF CONDOMS USED ___
DON'T KNOW 998

440. The last time you obtained the condoms, how much did you pay in total, including the cost of the method and any consultation you may have had?

COST ___
FREE 995
DON'T KNOW 998

441. From where did you obtain the condom the last time? PROBE TO IDENTIFY 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
GOVERNMENT HOSPITAL 11
PHC CENTER 12
HEALTH POST 13
SUB-HELATH POST 14
PHC OUTREACH 15
MOBILE CLINCI 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
OTHER PRIVATE MEDICAL (SPECIFY) ___ 36
OTHER SOURCE
SHOP 41
FRIENDS/RELATIVES 42
OTHER (SPECIFY) ___ 46

442. CHECK 302 (02): RESPONDENT EVER STERILIZED

YES (GO TO 501)
NO (GO TO 443)

443. The last time you had sex did you or your partner use any method (other than a condom) to avoid or prevent a pregnancy?

YES 1
NO 2 (GO TO 501)
DON'T KNOW (GO TO 501)

444. What method di you or your partner use? PROBE: Did you use any other method to prevent pregnancy? RECORD ALL MENTIONED

FEMALE STERILIZATION A
PILL B
IUD C
INJECTABLES D
IMPLANTS E
FEMALE CONDOM F
DIAPHRAGM G
FOAM/JELLY H
RHYTHM METHOD I
WITHDRAWAL J
OTHER (SPECIFY) ___ X

SECTION 5: FEMALE PREFERENCES

501. CHECK 401:

CURRENTLY MARRIED (GO TO 502)
GAUNA NOT PERFORMED (GO TO 504)
OTHER (GO TO 506)

502. CHECK 302(02): EVER STERILIZED?

YES (GO TO 506)
NO (GO TO 503)

503. CHECK 402:

HAS ONE WIFE: Is your wife currently pregnant?

YES 1
NO 2
DK 8

HAS MORE THAN ONE WIFE:
Are any of your wives currently pregnant?

YES 1
NO 2
DK 8

504. CHECK 503:

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

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 506)
COUPE INFECUND 3 (GO TO 506)
WIFE (WIVES) STERILIZED 4 (GO TO 506)
UNDECIDED/DON'T KNOW 5 (GO TO 506)

WIFE(WIVES) PREGNANT: Now I have some questions about the future.
After the child(ren) you and your (wife(wives) 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 506)
COUPE INFECUND 3 (GO TO 506)
WIFE (WIVES) STERILIZED 4 (GO TO 506)
UNDECIDED/DON'T KNOW 5 (GO TO 506)

505. CHECK 503:

NO WIFE PREGNANT OR UNSURE: How long would you like to wait from now before the birth of (a/another) child?

MONTHS __ 1
YEARS __ 2
SOON/NOW 993
COUPLE INFECUND 994
AFTER GAUNA 995
OTHER (SPECIFY) ___ 996
DON'T KNOW 998

WIFE(WIVES) 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
COUPLE INFECUND 994
AFTER GAUNA 995
OTHER (SPECIFY) ___ 996
DON'T KNOW 998

506. CHECK 203 AND 205:

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? PROBE FOR A NUMERIC RESPONSE.

NONE 00 (GO TO 601)
NUMBER ___
OTHER (SPECIFY) ___ 96 (GO TO 601)

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.

NONE 00 (GO TO 601)
NUMBER ___
OTHER (SPECIFY) ___ 96 (GO TO 601)

507. 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 EITHER ___
OTHER (SPECIFY) ___ 96

SECTION 6. EMPLOYMENT AND GENDER ROLES

601. Have you done any work in the last seven days?

YES 1 (GO TO 604)
NO 2

602. 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, or any other such reason?

YES 1 (GO TO 604)
NO 2

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

YES 1
NO 2 (GO TO 613)

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

____
____
____

605. CHECK 604

WORKS IN AGRICULTURE (GO TO 606)
DOESN'T 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 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4

607. 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

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
NOT PAID 4

610. CHECK 402:

ONE OR MORE WIVES (GO TO 611)
QUESTION NO ASKED (GO TO 613)

611. CHECK 609:

CODE 1 OR 2 CIRCLED (GO TO 612)
OTHER (GO TO 613)

612. Who decides how the money you earn will be used: mainly you, mainly your (wife/wives), or you and your (wife/wives) jointly?

RESPONDENT 1
WIFE(WIVES) 2
RESPONDENT AND WIFE (WIVES JOINTLY 3
OTHER (SPECIFY) ___ 6

613. In a couple, who do you think should have the greater say in each of the following decisions: the husband, the wife or both equally:

a) Making large household purchases?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
b) making small daily household purchases?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
c) deciding when to visit the wife's family or relatives?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
d) deciding what to do with the money she earns for her work?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
e) deciding how many children to have?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8

614. I will now read you some statements about pregnancy. Please tell me if you agree or disagree with them.

a) Childbearing is a women's concern and there is no need for the father to get involved.
AGREE 1
DISAGREE 2
DK 8
b) It is crucial for the mother's and child's health that a woman have assistance from a doctor or nurse at delivery.
AGREE 1
DISAGREE 2
DK 8

615. 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?
YES 1
NO 2
DK 8
If she neglects the children?
YES 1
NO 2
DK 8
If she argues with him?
YES 1
NO 2
DK 8
If she refuses to have sex with him?
YES 1
NO 2
DK 8
If she burns the food?
YES 1
NO 2
DK 8

616. Do you think that if a woman refuses to have sex with her husband when he wants her to, he has the right to???.

a) Get angry and reprimand her?
YES 1
NO 2
DON'T KNOW/DEPENDS 8
b) Refuse to give her money or other means of support?
YES 1
NO 2
DON'T KNOW/DEPENDS 8
c) Use force and have sex with her even if she doesn't want to?
YES 1
NO 2
DON'T KNOW/DEPENDS 8
d) Go ahead and have sex with another woman?
YES 1
NO 2
DON'T KNOW/DEPENDS 8

SECTION 7. HIV/AIDS

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 715)

702. Can people reduce their chances 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

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

YES 1
NO 2
DON'T KNOW 8

704. Can people reduce their chances of getting the ADIS virus by using a condom every time they have sex?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

706. 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

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 711)

710. 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 GOVT. (SPECIFY) ___
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR I
OTHER PRIVATE MEDICAL (SPECIFY) ___ J
OTHER (SPECIFY) ___ X

711. 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

712. 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

713. 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

714. 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
SHOULD NOT BE ALLOWED 2
DK/NOT SURE/DEPENDS 8

715. CHECK 701:

HEARD ABOUT AIDS: Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

YES 1
NO 2

NOT HEARD ABOUT AIDS: Have you heard about infections that can be transmitted through sexual contact?

YES 1
NO 2

716. CHECK 414 AND 415:

HAS HAD SEXUAL INTERCOURSE (GO TO 717)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 724)

717. CHECK 715: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INECTIONS

YES (GO TO 718)
NO (GO TO 719)

718. 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

719. Sometimes men experience an abnormal discharge from their penis. During the last 12 months, have you had an abnormal discharge from your penis?

YES 1
NO 2
DON'T KNOW 8

720. Sometimes men have a sore or ulcer near their penis. During the last 12 months, have you had a sore or ulcer near your penis?

YES 1
NO 2
DON'T KNOW 8

721. CHECK 718, 719, AND 720:

HAS HAD ANY INFECTION (GO TO 722)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 724)

722. The last time you had (PROBLEM FROM 736/737/738), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 724)

723. 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
FIELDWORKER 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 (SPECIFY) ___ X

724. 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

725. 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

726. 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 8. OTHER HEALTH ISSUES

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

YES 1
NO 2 (GO TO 805)

802. 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
THROUGH 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

803. Can tuberculosis be cured?

YES 1
NO 2
DON'T KNOW 8

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

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

805. Do you currently smoke cigarettes?

YES 1
NO 2 (GO TO 807)

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

CIGARETTES ___

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

YES 1
NO 2 (GO TO 809)

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

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

809. In the last few months have you heard or seen the following programs on the radio and/or television:

Jana Swastha Radio Karyakram?
YES 1
NO 2
Sewa Nai Dharma Ho?
YES 1
NO 2
Gyan Nai Shakti Ho?
YES 1
NO 2
Hamro Swastha Radio Karyakram?
YES 1
NO 2
Jeevan Chakra?
YES 1
NO 2
Teli-Swastha Karyakram?
YES 1
NO 2
Ek Apaas Ka Kura?
YES 1
NO 2
Sathi Sanga Manka Kura?
YES 1
NO 2
Desh Pardesh?
YES 1
NO 2

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: _________