IDENTIFICATION

NAME AND CODE OF DISTRICT

NAME AND CODE OF VILLAGE/MUNICIPALITY

WARD NUMBER

NAME OF HOUSEHOLD HEAD

CLUSTER NUMBER

HOUSEHOLD NUMBER

NAME AND LINE NUMBER OF WOMAN

CHECK COVER PAGE OF HOUSEHOLD QUESTIONNAIRE. HOUSEHOLD SELECTED FOR MAN'S SURVEY/DV MODULE?

CHECK HOUSEHOLD QUESTIONNAIRE DVH01. WOMAN SELECTED FOR DV MODULE?

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

LANGUAGE OF QUESTIONNAIRE**

LANGUAGE OF INTERVIEW

NATIVE LANGUAGE OF RESPONDENT

TRANSLATOR USED

LANGUAGE CODES

SUPERVISOR

OFFICE EDITOR

KEYED BY

INTRODUCTION AND CONSENT

Hello. My name is _______________________________________. I am working with Ministry of Health. We are conducting a survey about health and other topics all over Nepal. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 60 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. No part of this interview is being recorded in tape or video. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you 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.
Do you have any questions?
May I begin the interview now?

SIGNATURE OF INTERVIEWER__________________________________DATE_________

SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD THE TIME.

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

103. Just before you moved here, did you live in a city or in a rural area?

104. Before you moved here, which district did you live in?

105. In what month and year were you born?

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

107. Have you ever attended school?

109. What is the highest grade you have completed? IF COMPLETED LESS THAN ONE GRADE, RECORD '00'

110. CHECK 109:

111. 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?

112. CHECK 111:

113. Do you read a newspaper or magazine at least once a week, less than once a week or not at all?

114. Do you listen to the radio at least once a week, less than once a week or not at all?

115. Do you watch television at least once a week, less than once a week or not at all?

116. Do you own a mobile telephone?

117. Do you use your mobile phone for any financial transaction?

118. Do you have an account in a bank or other financial institution that you yourself use?

119. Have you ever used the internet?

120. In the last 12 months, have you used the internet?
IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.

121. During the last one month, how often did you use the internet: almost every day, at least once a week, less than once a week, or not at all?

122. What is your religion?

123. What is your caste/ethnicity? WRITE CASTE/ETHNICITY ON THE LINE

124. In the last 12 months, how many times have you been away from home for one or more nights?

125. In the last 12 months, have you been away from home for more than one month at a time?

SECTION 2. REPRODUCTION

200. 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.

201. First I would like to ask about all the births you have had during your life. Have you ever given birth?

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

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

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

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

206. 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, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?

207AA. 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?

207BB. How many pregnancies have you had that did not end in a live birth?

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

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

210. CHECK 208:

211. 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 PREGNANCIES IN 212-221. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.
IF THERE ARE MORE THAN 10 PREGNANCIES, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW.

212. PREGNANCY HISTORY LINE NUMBER

212A. Think back to your first pregnancy. Was that a single or multiple pregnancy?

212B. Was the baby born alive, born dead, or lost before birth?

212C. Did that baby cry, move or breathe when it was born?

212D. What name was given to the child? RECORD NAME.

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

215. On what day, month and year was (NAME) born? PROBE: When is his/her birthday?

216. Is (NAME) still alive?

IF BORN ALIVE AND STILL LIVING

217. How old was (NAME) at (NAME)'s last birthday? RECORD AGE IN COMPLETED YEARS.

218. Is (NAME) living with you?

219. RECORD HOUSEHOLD LINE NUMBER OF CHILD. RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD.

IF BORN ALIVE AND NOW DEAD

220. How old was (NAME) when (he/she) died?
IF '12 MONTHS' OR '1 YR', ASK: Did (NAME) have (his/her) first birthday?
THEN ASK: Exactly how many months old was (NAME) when (he/she) died?
RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

220AA. On what day, month, and year did (NAME) die?

IF BORN DEAD OR LOST BEFORE BIRTH

220AB. On what day, month, and year did this pregnancy end?

220AC. How many months did this pregnancy last? RECORD IN COMPLETED MONTHS.

220AD. Did you or someone else do something to end this pregnancy?

221. Were there any other pregnancies between the previous pregnancy and this pregnancy?

222. Have you had any pregnancies since the last pregnancy mentioned?

223. COMPARE 208 WITH NUMBER OF PREGNANCIES IN PREGNANCY HISTORY

223A. CHECK 220AB AND 220AC AND ENTER THE NUMBER OF STILLBIRTHS IN 2068 OR LATER AND THE PREGNANCY LASTED FOR 7 MONTHS OR MORE, IF NONE, RECORD '0'.

223B. CHECK 220, AND 220AA AND ENTER THE NUMBER OF DEATHS AT AGE 0-3 MONTHS IN 2068 OR LATER. IF NONE, RECORD '0'.

223C. CHECK 223A AND 223B:

223D. 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?

224. CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2068-2073. IF NONE, RECORD '0'.

225. FOR EACH BIRTH IN 2068-2073, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF COMPLETED 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 220AC FOR EACH PREGNANCY THAT DID NOT END IN A LIVE BIRTH. CHECK 220AD. IF YES (CODE '1' CIRCLED), ENTER 'A' FOR ABORTION OR 'C' (IF CODE '2' CIRCLED) FOR MISCARRIAGE
OR `S' FOR STILLBIRTH, IN CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS OF PREGNANCY.
IF THERE ARE MORE THAN FOUR PREGNANCIES THAT DID NOT END IN A LIVE BIRTH, USE AN ADDITIONAL QUESTIONNAIRE STARTING ON THE SECOND LINE."

226. Are you pregnant now?

227. 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.

228. When you got pregnant, did you want to get pregnant at that time?

229. CHECK 208: TOTAL NUMBER OF BIRTHS:
ONE OF MORE: Did you want to have a baby later on or did you not want any more children?
NONE: Did you want to have a baby later on or did you not want any children?

229A. CHECK 220AB, 220AC AND 220AD:

229B. What was the main reason you decided to have this (last) abortion?

229C. What did you do to end this pregnancy?

229D. Who did you see to get this done?

229E. Where did you go to get this done?

229F. Did anyone talk to you about family planning methods during your post abortion visit?

229G. Did you use any contraceptives within two weeks of abortion?

229H. Is abortion legal in Nepal?

229I. What are the conditions under which a woman can have an abortion in Nepal?

229J. Do you know of a place where a woman can go to get a safe abortion?

229K. Where is that place?
Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODES (S). IF UNABLE TO DETERMINE IF PUBLIC OF PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

229L. From where did you receive information on safe abortion services?

239. When did your last menstrual period start?

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

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

242. After the birth of a child, can a woman become pregnant before her menstrual period has returned?

SECTION 3. CONTRACEPTION

301. Now I would like to talk about family planning -- the various ways or methods that a couple can use to delay or avoid a pregnancy. Have you ever heard of (METHOD)?

302. CHECK 226:

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

304. Which method are you using? RECORD ALL MENTIONED. IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.

305. What is the brand name of the pills you are using? IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

306. What is the brand name of the condoms you are using? IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

307. In what facility did the sterilization take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OF PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

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

309. 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?

310. CHECK 308 AND 309, 215 AND 220AB ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 308 OR 309.

311. CHECK 308 and 309:

312. 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 SAISAKH 2068. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

312A. MONTH AND YEAR OF START OF INTERVAL OR USE OR NON-USE.

312B. Between (EVENT) in (MONTH/YEAR) and (EVENT) in (MONTH/YEAR), did you or your partner use any method of contraception?

312C. Which method was that?

312D. How many months after (EVENT) in (MONTH/YEAR) did you start to use (METHOD)? CIRCLE 95 IF RESPONDENT GIVES THE DATE OF STARTING TO USE THE METHOD.

312E. RECORD MONTH AND YEAR RESPONDENT STARTED USING METHOD.

312F. For how many months did you use (METHOD)? CIRCLE 95 IF RESPONDENT GIVES THE DATE OF TERMINATION OF USE.

312G. RECORD MONTH AND YEAR RESPONDENT STOPPED USING METHOD.

312H. Why did you stop using (METHOD)?

312I. GO BACK TO 312A IN NEXT COLUMN; OR, IF NO MORE GAPS, GO TO 312J.

312J. Have you ever used emergency contraception?

312K. What is the reason for using emergency contraception?

312L. How many times did you use emergency contraception during the last 12 months?

312M. When was the last time you used emergency contraception?

313. CHECK THE CALENDAR FOR USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH.

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

315. CHECK 304: CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

316. You first started using (CURRENT METHOD) in (DATE FROM 309). Where did you get it at that time? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OF PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

317. CHECK 304:
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 304. CIRCLE CODE FOR HIGHEST METHOD IN LIST.

318. At that time, were you told about side effects or problems you might have with the method?

319. When you got sterilized were you told about side effects or problems you might have with the method?

320. Were you ever told by a health worker/health volunteer about side effects or problems you might have with the method?

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

322. CHECK 318 AND 319:
ANY YES: At that time, were you told about other methods of family planning that could use?
OTHER: When you obtained (CURRENT METHOD FROM 315) from (SOURCE OF METHOD FROM 307 OR 316), were you told about other methods of family planning that you could use?

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

324. CHECK 304: CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 304: CIRCLE CODE FOR HIGHEST METHOD IN LIST.

325.Where did you obtain (CURRENT METHOD) the last time?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

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

327. In the last 12 months, were you visited by a fieldworker (FCHV)?

328. Did the fieldworker talk to you about family planning?

329. CHECK 202: LIVING CHILDREN
YES: In the last 12 months have you visited a health facility for care for yourself or your children?
NO: In the last 12 months, have you visited a health facility for care for yourself?

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

SECTION 4. PREGNANCY AND POSTNATAL CARE

401. CHECK 224:

402. CHECK 215. RECORD THE PREGNANCY HISTORY NUMBER IN 403 AND THE NAME AND SURVIVAL STATUS IN 404 FOR EACH BIRTH IN 2068-2073. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE(S).
Now I would like to ask some questions about your children born in the last five years. (We will talk about each separately.)

403. PREGNANCY HISTORY NUMBER FROM 212 IN PREGNANCY HISTORY.

404. FROM 212D AND 216:

405. When you got pregnant with (NAME), did you want to get pregnant at that time?

406. CHECK 203, 205, 207:
ONLY ONE BIRTH: Did you want to have a baby later on, or did you not want any children?
MORE THAN ONE BIRTH: Did you want to have a baby later on, or did you not want any more children?

407. How much longer did you want to wait?

408. Did you see anyone for antenatal care for this pregnancy?

409. Whom did you see? Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL

410. Where did you receive antenatal care for this pregnancy? Anywhere else?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

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

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

412A. Did you receive antenatal checkup in the following months during this pregnancy?
a) When you were 4 months pregnant?
b) When you were 6 months pregnant?
c) When you were 8 months pregnant?
d) When you were 9 months pregnant?

413. As part of your antenatal care during this pregnancy, were any of the following done at least once:
a) Was your blood pressure measured?
b) Did you give a urine sample?
c) Did you give a blood sample?

413D. During (any of) your antenatal care visit(s), were you advised on the following:
a) To use skilled birth attendant?
b) To have institutional delivery?

413E. During (any of) your antenatal care visit(s), were you told about things to look out for that might suggest problems with the pregnancy?

413F. Were you told where to go if you had any problems with the pregnancy?

413G. Were you told that you have to get postnatal checkup after delivery?

413H. What kind of preparation did you or your family make beforehand for the delivery of (NAME)? Anything else?
CIRCLE ALL MENTIONED.

414. During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?

415. During this pregnancy, how many times did you get a tetanus injection?

416. CHECK 415:

417. At any time before this pregnancy, did you receive any tetanus injections?

418. Before this pregnancy, how many times did you receive a tetanus injection? IF 7 OR MORE TIMES, RECORD '7'.

419. CHECK 418:
ONLY ONE: How many years ago did you receive that tetanus injection?
MORE THAN ONE: How many years ago did you receive the last tetanus injection prior to this pregnancy?

420. During this pregnancy, were you given or did you buy any iron tablets? SHOW TABLETS.

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

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

426. When (NAME) was born, was (NAME) very large, larger than average, average, smaller than average, or very small?

427. Was (NAME) weighed at birth?

428. How much did (NAME) weigh? Record weight in kilograms from health card, if available.

429. 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.

429A. While you were in labor (i.e. before the baby was born), were you given an injection or was medicine given through an IV drip?

429B. What were you told the medicine was for?

429C. Immediately after delivery of (NAME) did you receive an injection in the thigh or buttock?

429D. Were you told why you were given that injection?

429E. Did you receive Matri-Surakschya Chakki tablets that can be taken to reduce bleeding after childbirth? Probe: Did you receive tablets like this (SHOW TABLET)?

429F. When (NAME) was born, did you take the Matri-Surakschya Chakki tablets that you received?

430. Where did you give birth to (NAME)? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

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

431A. Did you receive cash incentive for transportation from the facility after the delivery of (NAME)?

431B. Did the facility charge you any amount for the delivery of (NAME)?

431C. How long did you take you to reach the facility for delivery of (NAME)?

432. Was (NAME) delivered by caesarean, that is, did they cut your belly open to take the baby out?

433. When was the decision made to have the caesarean section? Was it before or after your labor pains started?

434. Immediately after the birth, was (NAME) put directly on the bare skin of your chest?

434A. Was (NAME) dried before the placenta was delivered?

434B. Was (NAME) wrapped in cloth before the placenta was delivered?

434C. 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.

434D. Was anything placed on the slump after the umbilical cord was cut?

434E. What was placed on the stump?

434F. CHECK 4343: SUBSTANCE ON STUMP

434G. Was NAVI MALAM applied to the stump at any time?
SHOW SAMPLE OR PHOTOGRAPH

434H. How long after the cord was cut was NAVI MALAM first applied? IF LESS THAN 1 HOUR, RECORD HOURS; IF LESS THAN 24 HOURS, RECORD HOURS; OTHERWISE RECORD DAYS.

434I. CHECK 430: PLACE OF DELIVERY

435. I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health while you were still in the facility?

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

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

437A. Did this person talk to you about using a family planning method?

438. Now I would like to talk to you about checks on (NAME)'s health after delivery for example, someone examining (NAME), checking the cord, or seeing if (NAME) is OK. Did anyone check on (NAME)'s health while you were still in the facility?

439. How long after delivery was (NAME)'s health first checked? IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

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

441. Now I want to talk to you about what happened after you left the facility. Did anyone check on your health after you left the facility?

442. How long after delivery did that check take place? IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

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

444. Where did the check take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

444A. Now I want to talk to you about all the checkup (including 436 and 442) you might have received within the two months of delivery. Did you receive these checkup in the following time period?
a) Within 24 hours?
b) After 24 hours but within 72 hours?
c) After 72 hours but within 7 days?

445. I would like to talk to you about checks on (NAME)'s health after you left (FACILITY IN 430). Did any health care provider or a traditional birth attendant check on (NAME)'s health in the two months after you left (FACILITY IN 430)?

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

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

448. Where did this check of (NAME) take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETEMRINE IF PUBLIC OR PRIVATE SECOR, WRITE THE NAME OF THE PLACE.

448A. Was a special clean delivery kit used? SHOW CLEAN DELIVERY KIT MARKETED BY CRS

448B. When (NAME) was born, what instrument was used to cut the umbilical cord?

448C. Why didn't you deliver in a health facility?

449. I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health after you gave birth to (NAME)?

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

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

451A. Did this person talk to you about using a family planning method?

452. Where did this first check take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIAVE SECTOR. WRITE THE NAME OF THE PLACE.

452A. Now I want to talk to you about all the checkup (including 450) you might have received within the two months of delivery. Did you receive these checkup in the following time period?
a) Within 24 hours?
b) After 24 hours but within 72 hours?
c) After 72 hours but within 7 days?

453. I would like to talk to you about checks on (NAME)'s health after delivery -- for example, someone examining (NAME), checking the cord, or seeing if (NAME) is OK. In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on (NAME)'s health?

454. 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.

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

456. Where did this first check of (NAME) take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

457. During the first two days after (NAME)'s birth, did any health care provider do the following:
a) Examine the cord?
b) Measure (NAME)'s temperature?
c) Counsel you on danger signs for newborns?
ca) Observe (NAME) for danger signs?
d) Counsel you on breastfeeding?
e) Observe (NAME) breastfeeding?

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

459. NEXT TO LAST BIRTH: Did your period return between the birth of (NAME) and your next pregnancy?

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

461. CHECK 226: IS RESPONDENT PREGNANT?

462. Have you had sexual intercourse since the birth of (NAME)?

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

464. Did you ever breastfeed (NAME)?

465. CHECK 404: IS CHILD LIVING?

466. 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.

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

468. CHECK 404: IS CHILD LIVING?

469. Are you still breastfeeding (NAME)?

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

471. GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501A.

SECTION 5A. CHILD IMMUNIZATION STATUS (LAST BIRTH)

501A. CHECK 215 IN THE PREGNANCY HISTORY: ANY MORE BIRTHS IN 2070-2073?

502A. RECORD THE NAME AND PREGNANCY HISTORY NUMBER FROM 212D AND 212 OF THE NEXT-TO-LAST CHILD BORN IN 2070-2073.

503A. CHECK 216 FOR CHILD:

504A. Do you have a card or other document where (NAME)'s vaccinations are written down?

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

506A. CHECK 504A:

507A. May I see the card or other document where (NAME)'s vaccinations are written down?

508A. COPY DATES FROM THE CARD. WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

509A. CHECK 508A: 'BCG' TO 'MEASLES RUBELLA (MR)' ALL RECORDED?

510A. In addition to what is recorded on (this document/these documents), did (NAME) receive any other vaccinations, including vaccinations received in campaigns or immunization days?
RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 508B THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

511A. Did (NAME) ever receive any vaccinations to prevent (NAME) from getting diseases, including vaccinations received in campaigns or immunization days?

512A. Has (NAME) ever received a BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

514A. Has (NAME) ever received oral polio vaccine, that is, about two drops in the mouth to prevent polio?

516A. How many times did (NAME) received the oral polio vaccine?

517A. Has (NAME) ever received a DPT/pentavalent vaccination, that is, an injection given in the thigh sometimes at the same time as polio drops?

518A. How many times did (NAME) receive DPT/pentavalent vaccine?

519A. Has (NAME) ever received a pneumococcal/PCV vaccination, that is, an injection in the thigh to prevent pneumonia?

520A. How many times did (NAME) receive the pneumococcal/PCV vaccine?

521A. Has (NAME) ever received an inactivated polio vaccine (IPV), that is, an injection in the thigh to prevent polio?

523A. Has (NAME) ever received a measles rubella (MR) vaccination, that is, an injection in the arm to prevent measles?

526A. CONTINUE WITH 501B.

SECTION 5B. CHILD IMMUNIZIATION STATUS (NEXT-TO-LAST BIRTH)

501B. CHECK 215 IN THE PREGNANCY HISTORY: ANY MORE BIRTHS IN 2070-2073?

502B. RECORD THE NAME AND PREGNANCY HISTORY NUMBER FROM 212D AND 212 OF THE NEXT-TO-LAST CHILD BORN IN 2070-2073.

503B. CHECK 216 FOR CHILD:

504B. Do you have a card or other document where (NAME)'s vaccinations are written down?

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

506B. CHECK 504B:

507B. May I see the card or other document where (NAME)'s vaccinations are written down?

508B. COPY DATES FROM THE CARD. WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

509B. CHECK 508B: 'BCG' TO 'MEASLES RUBELLA (MR)' ALL RECORDED?

510B. In addition to what is recorded on (this document/these documents), did (NAME) receive any other vaccinations, including vaccinations received in campaigns or immunization days?
RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 508B THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

511B. Did (NAME) ever receive any vaccinations to prevent (NAME) from getting diseases, including vaccinations received in campaigns or immunization days?

512B. Has (NAME) ever received a BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

514B. Has (NAME) ever received oral polio vaccine, that is, about two drops in the mouth to prevent polio?

516B. How many times did (NAME) receive the oral polio vaccine?

517B. Has (NAME) ever received a DPT/pentavalent vaccination, that is, an injection given in the thigh sometimes at the same time as polio drops?

518B. How many times did (NAME) receive the DPT/pentavalent vaccine?

519B. Has (NAME) ever received a pneumococcal/PCV vaccination, that is, an injection in the thigh to prevent pneumonia?

520B. How many times did (NAME) receive the pneumococcal/PCV vaccine?

521Ba. Has (NAME) ever received an inactivated polio vaccine (IPV), that is, an injection in the thigh to prevent polio?

523B. Has (NAME) ever received a measles rubella (MR) vaccination, that is, an injection in the arm to prevent measles?

526B. CHECK 215 IN PREGNANCY HISTORY: ANY MORE BIRTHS IN 2070-2073?

SECTION 6. CHILD HEALTH AND NUTRITION

601. CHECK 224:

602. CHECK 215: RECORD THE PREGNANCY HISTORY NUMBER IN 603 AND THE NAME AND SURVIVAL STATUS IN 604 FOR EACH BIRTH IN 2068-2073. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE(S).
Now I would like to ask some questions about your children born in the last five years. (We will talk about each separately.)

603. PREGNANCY HISTORY NUMBER FROM 212 IN PREGNANCY HISTORY.

604. FROM 212D AND 216:

605. In the last six months (Falgun/Kartik), was (NAME) given a vitamin A dose like this? IF THE INTERVIEW IS BEFORE KARTIK, ASK ABOUT FALGUN, IF THE INTERVIEW IS AFTER KARTIK, ASK ABOUT KARTIK, SHOW THE CAPSULES.

605A. At the recent national immunization day campaign (Mangshir 2072) did (NAME) receive the following vaccines?
a) Oral polio vaccine?
b) Measles rubella vaccine?

606. In the last seven days, was (NAME) given iron pills, sprinkles with iron, or iron syrup like [this/any of these]? SHOW COMMON TYPES OF PILLS/SPRINKLES/SYRUPS.

607. Was (NAME) given any drug for intestinal worms in the last six months?

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

609. CHECK 464: EVER BREASTFED?

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

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

612. Where did you seek advice or treatment? Anywhere else? PROBE TO IDENTIFY THE TYPE OF SOUREC. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE(S).

613. CHECK 612:

614. Where did you first seek advice or treatment? Use letter code from 612.

615. Was (NAME) given any of the following at any time since (NAME) started having the diarrhea:
a) A fluid made from a special packet called Jeevan Jal/Navajeevan/Orestal?
c) Homemade remedies (maad, daal soup)?
d) Zinc tablets?

615E. CHECK 615: GIVEN ZINC?

615F. How many days was (NAME) given zinc?

616. CHECK 615:
ANY YES: Was anything else given to treat the diarrhea?
ALL NO OR DK: Was anything given to treat the diarrhea?

617. CHECK 615:
ANY YES: What else was given to treat the diarrhea? Anything else?
ALL NO OR DK: What was given to treat the diarrhea? Anything else?
RECORD ALL TREATMENTS GIVEN

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

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

621. Has (NAME) had fast, short, rapid breaths or difficulty breathing at any time in the last 2 weeks?

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

623. CHECK 618: HAD FEVER?

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

625. Where did you seek advice or treatment? Anywhere else? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

626. CHECK 625:

627. Where did you first seek advice or treatment? USE LETTER CODE FROM 625.

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

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

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

630A. How many days after the illness began did you first give medicine to (NAME)? IF THE SAME DAY RECORD '00'.

646. GO BACK TO 604 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 647.

647. CHECK 615(a) ALL COLUMNS:

648. Have you ever heard of a special product called Jeevan Ja/Navajeevan/Orestal you can get for the treatment of diarrhea? SHOW ORS PACKAGE

649. CHECK 215 AND 218, ALL ROWS: NUMBER OF CHILDREN BORN IN 2071-2073 LIVING WITH THE RESPONDENT

650. Now I would like to ask you about liquids or foods that (NAME FROM 649) had yesterday during the day or at night. I am interested in whether your child had the item I mention even if it was combined with other foods. Did (NAME FROM 649) drink or eat:

651. CHECK 650 (CATEGORIES 'g' THROUGH 'u'):

652. Did (NAME FROM 649) eat any solid, semi-solid, or soft foods yesterday during the day or at night?
IF 'YES' PROBE: What kind of solid, semi-solid or soft foods did (NAME) eat?

653. How many times did (NAME FROM 649) eat solid, semi-solid, or soft foods yesterday during the day or at night? IF 7 OR MORE TIMES, RECORD 7.

653A. Now I would like to ask you about foods that you had yesterday during the day or at night. I am interested in whether you had the item I mention even if it was combined with other foods.
Did you drink or eat:

653B. CHECK 224:

653C. Have you been counseled by any health related professional (including FCHV) about Maternal, Infant and Young Child Nutrition (MIYCN) in the last 6 months?

653D. Who gave you this advice/counseling on nutrition?

653E. When did you receive the advice or counseling?

653F. What were you counseled on?

653G. Is there growth monitoring promotion in this ward (at your closest health facility)?

653H. Where did you attend the growth monitoring promotion sessions?

653I. Was there individual nutrition and health counseling at the growth monitoring session?

653J. Did the health worker explain how to interpret the growth chart? SHOW GROWTH CHART

653K. Was weight taken at the following health contacts?
a) at birth?
b) at immunization?
c) at vitamin A distribution?
d) at sick child visit?
f) other contacts?

653L: CHECK 649

654. The last time (NAME FROM 649) passed stools, what was done to dispose of the stools?

SECTION 7. MARRIAGE AND SEXUAL ACTIVITY

701. Are you currently married or living together with a man as if married?

702. Have you ever been married or lived together with a man as if married?

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

704. Is your (husband/partner) living with you now or is he staying elsewhere?

704A. For how long have you and your husband not been living together? IF LESS THAN 1 YEAR, ANSWER MUST BE RECORDED IN MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

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

706. Does your (husband/partner) have other wives or does he live with other women as if married?

707. Including yourself, in total, how many wives or live-in partners does he have?

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

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

709A. Has your marriage been registered?

710. CHECK 709:
MARRIED/LIVED WITH A MAN ONLY ONCE: In what month and year did you start living with your (husband/partner)?
MARRIED/LIVED WITH A MAN MORE THAN ONCE: Now I would like to ask about your first (husband/partner). In what month and year did you start living with him?

711. How old were you when you first started living with him?

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

713. Now I would like to ask some questions about sexual activity 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 we should come to any question that you don't want to answer, just let me know and we will go to the next question. How old were you when you had sexual intercourse for the very first time?

714. I would like to ask you about your recent sexual activity. 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.

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

716. The last time you had sexual intercourse with this person, was a condom used?

717. Was a condom used every time you had sexual intercourse with this person in the last 12 months?

718. What was your relationship to this person with whom you had sexual intercourse?
IF BOYFRIEND: Were you living together as if married? IF YES, RECORD '2', IF NO, RECORD '3'.

719. How long ago did you first have sexual intercourse with this person?

720. How many times during the last 12 months did you have sexual intercourse with this person?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF TIMES IS 95 OR MORE, RECORD '95'.

721. How old is this person?

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

723. 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 95 OR MORE, RECORD '95'.

724. CHECK 106:

725. CHECK 701:

726. In the past 12 months have you had sex or been sexually involved with anyone because he gave you or told you he would give you gifts, cash, or anything else?

727. 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 95 OR MORE, RECORD '95'.

728. CHECK 716, MOST RECENT PARTNER (FIRST COLUMN):

729. You told me that a condom was used the last time you had sex. What is the brand name of the condom used at that time?
IF BRAND NOT KNOWN, ASK TO SEE THE PACKAGE.

730. From where did you obtain the condom the last time? PROBE TO IDENTIFY TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

731. PRESENCE OF OHTERS DURING THIS SECTION.

SECTION 8. FERTILITY PREFERENCES

801. CHECK 304:

802. CHECK 226:

803. 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?

804. 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?

805. CHECK 226:
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 child you are expecting now, how long would you like to wait before the birth of another child?

806. CHECK 226:

807. CHECK 303: USING A CONTRACEPTIVE METHOD?

808. CHECK 805:

809. CHECK 714:

810. CHECK 804:
WANTS TO HAVE A/ANOTHER CHILD: You have said that you do not want (a/another child soon. Can you tell me why you are not using a method to prevent pregnancy? Any other reason?
WANTS NO MORE/NONE: You have said that you do not want any (more) children. Can you tell me why you are not using a method to prevent pregnancy? Any other reason?
RECORD ALL REASONS MENTIONED

811. CHECK 303: USING A CONTRACEPTIVE METHOD?

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

813. CHECK 216:
HAS LIVING CHILDREN: If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?
NO LIVING CHILDREN: If you could choose exactly the number of children to have in your whole life, how many would that be?
PROBE FOR NUMERIC RESPONSE.

814. How many of these children would you like to be boys, how many would you like to be girls and for how many would it not matter if it's a boy or a girl?

815. In the last few months have you:
a) Heard about family planning on the radio?
b) Seen anything about family planning on the television?
c) Read about family planning in a newspaper or magazine?
d) Received a voice or text message about family planning on a mobile phone?
e) Read about family planning in brochure or flipchart?
f) Seen message on family planning in a poster, hoarding board or billboard?
g) Read/seen message in the internet?
h) Seen street dramas on family planning?
i) Heard from mother's group/teachers?
j) Heard from FCHVs?

817. CHECK 701:

818. CHECK 303: USING A CONTRACEPTIVE METHOD?

819. Would you say that using contraception is mainly your decision, mainly your (husband's/partner's) decision, or did you both decide together?

820. Would you say that not using contraception is mainly your decision, mainly your (husband's/partner's) decision, or did you both decide together?

821. CHECK 304:

822. Does your (husband/partner) want the same number of children that you want, or does he want more or fewer than you want?

SECTION 9. HUSBAND'S BACKGROUND AND WOMAN'S WORK

901. CHECK 701:

902. How old was your (husband/partner) on his last birthday?

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

905. What was the highest grade he completed? IF COMPLETED LESS THAN ONE GRADE, RECORD '00'.

906. Has your (husband/partner) done any work in the last 7 days?

907. Has your (husband/partner) done any work in the last 12 months?

908. What is your (husband's/partner's) occupation? That is, what kind of work does he mainly do?

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

910. 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?

911. 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?

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

913. What is your occupation? That is, what kind of work do you mainly do?

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

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

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

916A. Would you say women are paid less, equal, or more than men for the same job in your locality?

917. CHECK 701:

918. CHECK 916:

919. Who usually decides how the money you earn will be used: you, your (husband/partner), or you and your (husband/partner) jointly?

920. Would you say that the money that you earn is more than what your (husband/partner) earns, less than what they earn, or about the same?

921. Who usually decides how your (husband's/partner's) earnings will be used: you, your (husband/partner), or you and your (husband/partner) jointly?

922. Who usually makes decisions about health care for yourself: you, your (husband/partner), you and your (husband/partner) jointly, or someone else?

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

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

924A. Who usually makes decisions about your children's education?

924B. Who decides how your inherited asset (pewa) is used?

925. Do you own this or any other house either alone or jointly with someone else?

926. Do you have a title deed for any house you own?

928. Do you own any agricultural or non-agricultural land either alone or jointly with someone else?

929. Do you have a title deed for any land you own?

930A. Do you know the following about your household?
a) How much property/land owned?
b) Under whose name it is registered?

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

932. In your opinion, is a husband justified in hitting or beating his wife in the following situations:
a) If she goes out without telling him?
b) If she neglects the children?
c) If she argues with him?
d) If she refuses to have sex with him?
e) If she burns the food?
f) If she brings less or brings no dowry?

SECTION 10. HIV/AIDS

1001. Now I would like to talk about something else. Have you ever heard of HIV or AIDS?

1002. HIV is the virus that can lead to AIDS. Can people reduce their chance of getting HIV by having just one uninfected sex partner who has no other sex partners?

1003. Can people get HIV from mosquito bites?

1004. Can people reduce their chance of getting HIV by using a condom every time they have sex?

1005. Can people get HIV by sharing food with a person who has HIV?

1006. Can people get the AIDS virus by touching someone who has AIDS?

1007. Is it possible for a healthy-looking person to have HIV?

1008. Can HIV be transmitted from an infected mother to her baby:
a) During pregnancy?
b) During delivery?
c) By breastfeeding?

1009. CHECK 1008:

1010. Are there any special drugs that a doctor or a nurse can give to a woman infected with HIV to reduce the risk of transmission to the baby?

1011. CHECK 208 AND 215:

1012. CHECK 408 FOR LAST BIRTH:

1013. CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

1014. During any of the antenatal visits for your last birth were you given any information about:
a) Babies getting HIV from their mother?
b) Things that you can do to prevent getting HIV?
c) Getting tested for HIV?

1015. Were you offered a test for HIV as part of your antenatal care?

1016. I don't want to know the results, but were you tested for HIV as part of your antenatal care?

1017. Where was the test done/ PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

1018. I don't want to know the results, but did you get the results of the test?

1019. All women are supposed to receive counseling after being tested. After you were tested, did you receive counseling?

1024. CHECK 1016:

1025. Have you been tested for HIV since that time you were tested during your pregnancy?

1026. How many months ago was your most recent HIV test?

1027. I don't want to know the results, but have you ever been tested for HIV?

1028. How many months ago was your most recent HIV test?

1029. I don't want to know the results, but did you get the results of the test?

1030. Where was the test done? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

1031. Do you know of a place where people can go to get an HIV test?

1032. Where is that? Any other place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

1032A. Do you think there is a treatment for HIV?

1032B. Do you know from where HIV treatment (Anti Retroviral Treatment) can be received?

1035. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV?

1036. Do you think children living with HIV should be allowed to attend school with children who do not have HIV?

1037. Do you think people hesitate to take an HIV test because they are afraid of how other people will react if the test result is positive for HIV?

1038. Do people talk badly about people living with HIV, or who are thought to be living with HIV?

1039. Do people living with HIV, or thought to be living with HIV, lose the respect of other people?

1040. Do you agree or disagree with the following statement: I would be ashamed if someone in my family had HIV.

1041. Do you fear that you could get HIV if you come into contact with the saliva of a person living with HIV?

1042. CHECK 1001:
HEARD ABOUT HIV OR AIDS: Apart from HIV, have you heard about other infections that can be transmitted through sexual contact?
NOT HEARD ABOUT HIV OR AIDS: Have you heard about infections that can be transmitted through sexual contact?

1043. CHECK 713:

1044. CHECK 1042: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

1045. 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?

1046. Sometimes women experience a bad-smelling abnormal genital discharge. During the last 12 months, have you had a bad-smelling abnormal genital discharge?

1047. Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

1048. CHECK 1045, 1046, AND 1047:

1049. The last time you had (PROBLEM FROM 1045/1046/1047), did you seek any kind of advice or treatment?

1050. Where did you go? Any other place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

1051. If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that hey use a condom when they have sex?

1052. Is a wife justified in refusing to have sex with her husband when she knows he has sex with other women?

1053. CHECK 701:

1054. Can you say no to your (husband/partner) if you do not want to have sexual intercourse?

1055. Could you ask your (husband/partner) to use a condom if you wanted him to?

SECTION 11. OTHER HEALTH ISSUES

1101. Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?
IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

1102. Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?
IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

1103. The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?

1104. Do you currently smoke cigarettes every day, some days, or not at all?

1105. On average, how many cigarettes do you currently smoke each day?

1106. Do you currently smoke or use any other type of tobacco every day, some days, or not at all?

1107. What other type of tobacco do you currently smoke or use? RECORD ALL MENTIONED.

1107A. Have you ever heard of an illness called tuberculosis or TB?

1107B. What are the common symptoms of TB? RECORD ALL MENTIONED.

1107C. How does tuberculosis spread from one person to another? RECORD ALL MENTIONED.

1107D. If you were sick with TB, where would you prefer to seek care? RECORD ALL MENTIONED.

1107E. If a member of your family got tuberculosis, would you want it to remain a secret or not?

1108. 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 a big problem:
a) Getting permission to go to the doctor/health service provider?
b) Getting money needed for advice or treatment?
c) The distance to the health facility?
d) Not wanting to go alone?
e) No female health service provider available in the health facility

1108A. In the last three months have you heard or seen the following programs on the radio and/or television:
a) Jana Swastha Radio Karyakram?
b) Janasankhya Chetana ka Sworeharu Radio Karyakram?
c) Jeevan Chakra TV Karyakram?
d) Thorai bhaye pugi sari TV Karyakram?
e) Sathi Sanga Manka Kura Radio Karyakram?
f) Bhanchin Aama Radio Karyakram?
g) Bhandai Sundai Radio Karyakram?
h) Pariwar Niyojan, SMART Bancha Jeevan TV/Radio Karyakram?
i) Navimalam TV/Radio Karyakram?

1108B. Is there a health mother's group in this ward?

1108C. In the past 6 months, how many health mother's group meetings have you participated in?

1108D. What issues are discussed during the health mother's group meetings? RECORD ALL MENTIONED.

SECTION 12. ADULT AND MATERNAL MORTALITY MODULE

1212. LIST THE BROTHERS AND SISTERS ACCORDING TO ORDER NUMBER IN 1201. ASK 1214 TO 1225 FOR ONE BROTHER OR SISTER BEFORE ASKING ABOUT THE NEXT BROTHER OR SISTER. IF THERE ARE MORE THAN 12 BROTHERS AND SISTERS, USE AN ADDITIONAL QUESTTIONAIRE.

1213. NAME OF BROTHER OR SISTER

1214. Is (NAME) male or female?

1215. Is (NAME) still alive?

1216. How old is (NAME)?

1217. How many years ago did (NAME) die?

1218. How old was (NAME) when (he/she) died? IF DON'T KNOW. PROBE AND ASK ADDITIONAL QUESTIONS TO GET AN ESTIMATE.

1219. Was (NAME) pregnant when she died?

1220. Did (NAME) die during childbirth?

1221. Did (NAME) die within two months after the end of a pregnancy or childbirth?

1222. How many days after the end of the pregnancy did (NAME) die?

1223. Was (NAME)'s death due to intentional self harm?

1224. Was (NAME)'s death due to an act of harm or violence by others?

1225. Was (NAME)'s death due to an accidental injury or poisoning (including natural calamities) not inflected by self or others?

SECTION 13. DOMESTIC VIOLENCE MODULE

1300. CHECK COVER PAGE: WOMAN SELECTED FOR DV MODULE?

1301. CHECK FOR PRESENCE OF OTHERS: DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.

1301A. READ TO RESPONDENT:
Now I would like to ask you questions about some other important aspects of a woman's life. You may find some of these questions very personal. However, your answers are crucial for helping to understand the condition of women in [COUNTRY]. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else in your household will know that you were asked these questions. If I ask you any question you don't want to answer, just let me know and I will go on to the next question.

1302. CHECK 701 AND 702:

1303. First, I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your (last) (husband/partner)?
a) He (is/was) jealous or angry if you (talk/talked) to other men?
b) He frequently (accuses/accused) you of being unfaithful?
c) He (does/did) not permit you to meet your female friends?
d) He (tries/tried) to limit your contact with your family?
e) He (insists/insisted) on knowing where you (are/were) at all times?

1304A. Now I need to ask some more questions about your relationship with your (last)(husband/partner).
Did your (last)(husband/partner) ever:

1304B. How often did this happen during the last 12 months: often, only sometimes, or not at all?

1305A. Did your (last) (husband/partner) ever do any of the following things to you:

1305B. How often did this happen during the last 12 months: often, only sometimes, or not at all?

1306. CHECK 13051 (A-J):

1307. How long after you first (got married/started living together) with your (last) (husband/partner) did (this/any of these things) first happen?
IF LESS THAN ONE YEAR, RECORD '00'.

1308. Did the following ever happen as a result of what your (last) (husband/partner) did to you:

a) You had cuts, bruises, or aches?

b) You had eye injuries, sprains, dislocations, or burns?

c) You had deep wounds, broken bones, broken teeth, or any other serious injury?

1309. Have you ever hit, slapped, kicked, or done anything else to physically hurt your (last) (husband/partner) at times when he was not already beating or physically hurting you?

1310. In the last 12 months, how often have you done this to your (last) (husband/partner): often, only sometimes, or not at all?

1311. Does (did) your (last) (husband/partner) drink alcohol?

1312. How often does (did) he get drunk: often, only sometimes, or never?

1313. Are (Were) you afraid of your (last) (husband/partner): most of the time, sometimes, or never?

1314. CHECK 709:

1315A. So far we have been talking about the behavior of your (current/last) (husband/partner). Now I want to ask you about the behavior of any previous (husband/partner).

1315B. How long ago did this happen?

1316. CHECK 701 AND 702:
EVER MARRIED/EVER LIVED WITH A MAN: From the time you were 15 years old has anyone other than (your/any) (husband/partner) hit you, slapped you, kicked you, or done anything else to hurt you physically?
NEVER MARRIED/NEVER LIVED WITH A MAN: From the time you were 15 years old has anyone hit you, slapped you, kicked you, or done anything else to hurt you physically?

1317. Who has hurt you in this way? Anyone else? RECORD ALL MENTIONED.

1318. In the last 12 months, how often has (this person/have these persons) physically hurt you: often, only sometimes, or not at all?

1319. CHECK 201, 207AA, AND 226:

1320. Has anyone ever hit, slapped, kicked or done anything else to hurt you physically while you were pregnant?

1321. Who has done any of these things to physically hurt you while you were pregnant? Anyone else? RECORD ALL MENTIONED.

1322. CHECK 701 AND 702:

1322A. Now I want to ask you about things that may have been done to you by someone other than (your/any) (husband/partner). At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?

1322B. At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?

1323. Who was the person who was forcing you the very first time this happened?

1324. CHECK 701 AND 702:
EVER MARRIED/EVER LIVED WITH A MAN: In the last 12 months, has anyone other than (your/any) (husband/partner) physically forced you to have sexual intercourse when you did not want to?
NEVER MARRIED/NEVER LIVED WITH A MAN: In the last 12 months has anyone physically forced you to have sexual intercourse when you did not want to?

1324A. CHECK 1305A (h-j) and 1315A(b)

1325. CHECK 701 AND 702:
EVER MARRIED/EVER LIVED WITH A MAN: How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts by anyone, including (your/any) husband/partner?
NEVER MARRIED/NEVER LIVED WITH A MAN: How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts?

1326. CHECK 1305A (a-j), 1315A (a,b), 1316, 1320, 1322A, AND 1322B:

1327. Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?

1328. From whom have you sought help? Anyone else? RECORD ALL MENTIONED.

1329. Have you ever told anyone about this?

1330. As far as you know, did your father ever beat your mother?

1330AA. CHECK 701 AND 702:

1330A. Have you ever experienced the following?
a) Not given enough food to eat?
b) Not cared for when you were too ill?
c) Asked to go for forced abortion?
d) Threatened with divorce by husband or in-laws?
e) Asked to go for forced divorce?
f) Abused for not bearing a son?
g) Abused for using a family planning method?

THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER ABOUT THE CONFIDENTIALITY OF HER ANSWERS. FILL OUT THE QUESTIONS BELOW WITH REFERENCE TO DOMESTIC VIOLENCE.

1331. DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAM INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?

1332. INTERVIEWR'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE.

1332A. Thank you for taking the time to answer these questions. We would like to get additional information on childbearing and contraception in order to find better ways to help couples in Nepal achieve their family goals. Another member of our team may return in a few days to ask you a few additional questions about these topics. Is it okay for another member of our team to contact you about participating? Your responses will remain confidential.

1333. RECORD THE TIME.

INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT INTERVIEW:

COMMENTS ON SPECIFIC QUESTIONS:

ANY OTHER COMMENTS:

SUPERVISOR'S OBSERVATIONS