Data Cart

Your data extract

0 variables
0 samples
View Cart

NEPAL DEMOGRAPHIC AND HEALTH SURVEY 2016 WOMAN'S QUESTIONNAIRE

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?

YES 1
NO 2

CHECK HOUSEHOLD QUESTIONNAIRE DVH01. WOMAN SELECTED FOR DV MODULE?

YES 1
NO 2

INTERVIEWER VISITS

FIRST VISIT
DATE
INTERVIEWER NAME
RESULT*

NEXT VISIT:
DATE
TIME

SECOND VISIT
DATE
INTERVIEWER NAME
RESULT*

NEXT VISIT:
DATE
TIME

THIRD VISIT
DATE
INTERVIEWER NAME
RESULT*

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT*

TOTAL NUMBER OF VISITS

*RESULT CODES

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

LANGUAGE OF QUESTIONNAIRE**

ENGLISH 01

LANGUAGE OF INTERVIEW

NATIVE LANGUAGE OF RESPONDENT

TRANSLATOR USED

YES 1
NO 2

LANGUAGE CODES

ENGLISH 01
NEPALI 02
MAITHALI 03
BHOJPURI 04
OTHER 05

SUPERVISOR

NAME ___
NUMBER ___

OFFICE EDITOR

NUMBER __

KEYED BY

NUMBER ___

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_________

RESPONDENT AGREES TO BE INTERVIEWED 1 (CONTINUE)
RESPONDENT DOESN'T AGREE TO BE INTERVIEWED 2 (END)

SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD THE TIME.

HOURS___
MINUTES___

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.

YEARS___
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)

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

URBAN 1
RURAL 2

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

DISTRICT NAME____
OUTSIDE OF NEPAL 96

105. In what month and year were you born?

MONTH____
DON'T KNOW MONTH 98
YEAR ____
DON'T KNOW YEAR 9998

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

AGE IN COMPLETED YEARS ___

107. Have you ever attended school?

YES 1
NO 2 (GO TO 111)

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

GRADE____

110. CHECK 109:

GRADE 9 OR LOWER (CONTINUE)
SLC AND ABOVE (GO TO 113)

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?

CANNOT READ AT ALL 1
ABLE TO READ ONLY PART OF THE SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE)____ 4
BLIND/VISUALLY IMPAIRED 5

112. CHECK 111:

CODE 2,3, OR 4 CIRCLED (CONTINUE)
CODE 1 OR 5 CIRCLED (GO TO 114)

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

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

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

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

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

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

116. Do you own a mobile telephone?

YES 1
NO 2 (GO TO 118)

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

YES 1
NO 2

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

YES 1
NO 2

119. Have you ever used the internet?

YES 1
NO 2 (GO TO 122)

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

YES 1
NO 2 (GO TO 122)

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?

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

122. What is your religion?

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

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

CASTE/ETHNICITY _____

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

NUMBER OF TIMES ___
NONE 00 (GO TO 201)

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

YES 1
NO 2

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?

YES 1
NO 2 (GO TO 206)

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

YES 1
NO 2 (GO TO 204)

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

A) SONS AT HOME _____
B) DAUGHTERS AT HOME ____

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

YES 1
NO 2 (GO TO 206)

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'.

A) SONS ELSEWHERE ____
B) DAUGHTERS ELSEWHERE ___

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?

YES 1
NO 2 (GO TO 208)

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?

YES 1
NO 2 (GO TO 208)

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

PREGNANCY LOSSES ____

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

TOTAL PREGNANCIES ___

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

YES (CONTINUE)
NO (PROBE AND CORRECT 201-208 AS NECESSARY.)

210. CHECK 208:

ONE OR MORE PREGNANCIES (CONTINUE)
NO PREGNANCY (GO TO 226)

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

LINE NUMBER ___

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

SINGLE 1
MULTIPLE 2

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

BORN ALIVE 1 (SKIP TO 212D)
BORN DEAD 2
LOST BEFORE FULL TERM 3 (SKIP TO 220AB)

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

YES 1
NO 2 (SKIP TO 220AB)

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

NAME ____

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

BOY 1
GIRL 2

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

DAY __
MONTH __
YEAR ____

216. Is (NAME) still alive?

YES 1
NO 2 (SKIP TO 220)

IF BORN ALIVE AND STILL LIVING

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

AGE IN YEARS ___

218. Is (NAME) living with you?

YES 1
NO 2

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

HOUSEHOLD LINE NUMBER ___ (GO TO NEXT PREGNANCY)

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.

DAYS 1 ___
MONTHS 2 ___
YEARS 3 ___

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

DAY __
MONTH __
YEAR ___ (GO TO NEXT PREGNANCY)

IF BORN DEAD OR LOST BEFORE BIRTH

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

DAY __
MONTH __
YEAR ___

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

MONTHS ___

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

YES 1
NO 2

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

YES 1 (ADD PREGNANCY)
NO 2 (NEXT PREGNANCY)

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

YES 1 (RECORD PREGNANCIE SIN TABLE)
NO 2

223. COMPARE 208 WITH NUMBER OF PREGNANCIES IN PREGNANCY HISTORY

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

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'.

NUMBER OF STILLBIRTHS

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

NUMBER INFANT DEATHS ___

223C. CHECK 223A AND 223B:

IF ONE OR MORE (CONTINUE)
IF NONE (SKIP TO 224)

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?

YES 1
NO 2
UNSURE 8

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

NUMBER OF BIRTHS ___

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?

YES 1
NO 2 (GO TO 229A)
UNSURE 8 (GO TO 229A)

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.

MONTHS ___

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

YES 1 (GO TO 229A)
NO 2

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?

LATER 1
NO MORE/NONE 2

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

HAD ABORTION SINCE 2068-2073 (CONTINUE)
DID NOT HAVE ABORTION SINCE (GO TO 229H)

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

HEALTH OF MOTHER 01
NO MONEY TO TAKE CARE OF BABY 02
WANTED TO DELAY CHILDBEARING 03
DID NOT WANT ANYMORE CHILDREN 04
WANTED TO SPACE CHILD BIRTH 05
HUSBAND/PARTNER DID NOT WANT CHILD 06
OTHER (SPECIFY)___ 96

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

MEDICAL ABORTION 01
MVA AND CAC 02
D AND E/D AND C 03
EVA (ELECTRIC VACUUM ASPIRATION) 04
DRANK HOME REMEDIES 05
HERBAL ANEMA 06
INSERTED HERBS/SUBSTANCE IN VAGINA 07
CATHETER 08
OTHER (SPECIFY) ___ 96

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

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
HEALTH ASST/HLTH. WKR C
MCH WORKER D
VHW E
OTHER PERSON
PHARMACIST/CHEMICAL SELLER F
TRADITIONAL BIRTH ATTENDANT G
FCHV H
RELATIVE/FRIEND I
TRADITIONAL PRACTITIONER J
OTHER (SPECIFY) ___ X
NO ONE Y

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

HOME
YOUR HOME A
OTHER HOME B
GOVT. SECTOR
GOVT. HOSPITAL C
PHC CENTER (SPECIFY) ___ D
HEALTH POST/SUB-HEALTH POST E
PHC OUTREACH F
OTHER GOVT. (SPECIFY) __ G
NON-GOVT. (NGO)
MARIE STOPES H
FPAN (SPECIFY) ___ I
OTHER NGO (SPECIFY) ___ J
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC NURSING HOME (SPECIFY) __ K
OTHER PRIVATE MED. (SPECIFY) ___ L
OTHER (SPECIFY) ____ X

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2

229H. Is abortion legal in Nepal?

YES 1
NO 2 (SKIP TO 229J)
DON'T KNOW 8 (SKIP TO 229J)

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

PREGNANCY OF 12 WEEKS OR LESS GESTATION FOR ANY WOMAN A
PREGNANCY OF 18 WEEKS IF IT IS A RESULT OF RAPE OR INCEST B
PREGNANCY OF ANY DURATION IF LIFE OF MOTHER IS AT RISK C
PREGNANCY OF ANY DURATION IF MOTHER'S PHYSICAL AND MENTAL HEALTH IS AT RISK D
FETUS IS DEFORMED E
IF ONE HAS TOO MANY CHILDREN F
OTHER (SPECIFY) ___ X
DON'T KNOW Z

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

YES 1
NO 2 (SKIP TO 239)

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.

NAME OF PLACE ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
PRIMARY HEALTH CARE CENTER B
HEALTH POST/SUB-HEALTH POST C
PHC OUTREACH CLINIC D
MOBILE CAMP E
FCHV F
SATELLITE CLINIC G
OTHER PUBLIC FACILITIES (SPECIFY) __ H
NON-GOVT. (NGO) SECTOR
FPAN I
MARIE STOPES J
OTHER NGO FACILITIES (SPECIFY) ___ K
PRIVATE MEDICLA SECTOR
PRIVATE HOSPITAL/NURSING HOME L
PRIVATE CLINIC M
PHARMACY N
OTHER PRIVATE MEDICAL FACILITIES (SPECIFY) ___ O
OTHER SOURCE
TBA P
OTHER (SPECIFY) ___ X

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

FRIENDS A
FAMILY MEMBERS B
HEALTH PROVIDERS C
PHARMACIST D
FCHV E
RADIO F
TELEVISION G
INTERNET H
NEWSPAPER I
POSTER/BILLBOARDS J
PAMPHLETS/IEC/SBCC MATERIALS K
WOMEN'S GROUP/MOTHER'S GROUP L
OTHER (SPECIFY) ___ X

239. When did your last menstrual period start?

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

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

YES 1
NO 2 (GO TO 242)
DON'T KNOW 8 (GO TO 242)

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

JUST BEFORE HER PERIOD BEGINS 1
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY) ___ 6
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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)?

01. Female Sterilization. PROBE: Women can have an operation to avoid having any more children.
YES 1
NO 2
02. Male Sterilization. PROBE: Men can have an operation to avoid having any more children.
YES 1
NO 2
03. IUCD. PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
04. Injectables. PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
05. Implants. PROBE: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for three to five years.
YES 1
NO 2
06. Pill. PROBE: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
07. Condom. PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
09. Emergency Contraception. PROBE: As an emergency measure within five days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy (like I-Pill, E-CON)
YES 1
NO 2
11. Lactational Amenorrhea Method (LAM). PROBE: Up to six months after childbirth, before the menstrual period has returned, women use a method requiring frequent breastfeeding day and night.
YES 1
NO 2
12. Rhythm Method. PROBE: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.
YES 1
NO 2
13. Withdrawal. PROBE: Men can be careful and pull out before climax.
YES 1
NO 2
14. Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES, MODERN METHOD (SPECIFY) ____ A
YES, TRADITIONAL METHOD (SPECIFY) ____ B
NO Y

302. CHECK 226:

NOT PREGNANT OR UNSURE (CONTINUE)
PREGNANT (GO TO 312)

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

YES 1
NO 2 (GO TO 312)

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

FEMALE STERILIZATION A (GO TO 307)
MALE STERILIZATION B (GO TO 307)
IUCD C (GO TO 309)
INJECTABLES D (GO TO 309)
IMPLANTS E (GO TO 309)
PILL F
CONDOM G (GO TO 306)
EMERGENCY CONTRACEPTION I (GO TO 309)
LACTATIONAL AMENORRHEA METHOD K (GO TO 309)
RHYTHM METHOD L (GO TO 309)
WITHDRAWAL M (GO TO 309)
OTHER MODERN METHOD X (GO TO 309)
OTHER TRADITIONAL METHOD Y (GO TO 309)

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

NILOCON WHITE 01 (GO TO 309)
SUNAULO GULAPH 02 (GO TO 309)
FEMINYL 03 (GO TO 309)
FEMICON 04 (GO TO 309)
OK PILLS 05 (GO TO 309)
MOHP-NO BRAND 06 (GO TO 309)
OTHER (SPECIFY) ___ 96 (GO TO 309)
DON'T KNOW 98 (GO TO 309)

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

DHAAL 01 (GO TO 309)
PANTHER 02 (GO TO 309)
DZIRE 03 (GO TO 309)
KAMASUTRA 04 (GO TO 309)
JODI 05 (GO TO 309)
NUMBER 1 06 (GO TO 309)
BLACK COBRA 07 (GO TO 309)
MOHP-NO BRAND 08 (GO TO 309)
OTHER (SPECIFY) ___ 95 (GO TO 309)
DON'T KNOW 98 (GO TO 309)

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.

NAME OF PLACE ____
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
PRIMARY HEALTH CARE CENTER 12
INSTITUTIONALIZED FAMILY PLANNING CLINICS 13
MOBILE CAMP 14
OTHER PUBLIC FACILITIES (SPECIFY) ___ 16
NON-GOVT. (NGO) SECTOR
FPAN 21
MARIE STOPES 22
OTHER NGO FACILITIES (SPECIFY) ___ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/NURSING HOME 31
PRIVATE CLINIC 32
OTHER PRIVATE MEDICAL FACILITIES (SPECIFY) ___ 36
OTHER (SPECIFY) ___ 96
DON'T KNOW 98

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

MONTH ___ (GO TO 310)
YEAR ____ (GO TO 310)

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?

MONTH ___
YEAR ___

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.

NO (CONTINUE)
YES (GO BACK TO 308 OR 309, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINOUS USE OF CURRENT METHOD, MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION).

311. CHECK 308 and 309:

YEAR IS 2068-2073: ENTER CODE FOR MEHTOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING THEN CONTINUE.
YEAR IS 2067 OR EARLIER: ETNER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO SAISAKH 2068. THEN SKIP TO 324

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.

MONTH __
YEAR ____

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

YES 1
NO 2 (SKIP TO 312I)

312C. Which method was that?

METHOD CODE __

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.

IMMEDIATELY 00 (SKIP TO 312F)
MONTHS ___ (SKIP TO 312F)
DATE GIVEN 95

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

MONTH ___
YEAR ____

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

MONTHS ___ (SKIP TO 312H)
DATE GIVEN 95

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

MONTH ___
YEAR ____

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

REASON STOPPED ___

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

312J. Have you ever used emergency contraception?

YES 1
NO 2 (GO TO 313)

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

DID NOT WANT TO GET PREGNANT A
HAD CASUAL SEX WITH KNOWN PERSON B
FORCED TO HAVE SEX C
HAD EXTRA MARITAL RELATIONSHIP D
OTHER (SPECIFY) ___ X
DON'T KNOW Z

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

TIMES ___

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

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

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

NO METHOD USED (CONTINUE)
ANY METHOD USED (GO TO 315)

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

YES 1 (GO TO 326)
NO 2 (GO TO 326)

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

NO CODE CIRCLED 00 (GO TO 326)
FEMALE STERILIZATION 01 (GO TO 319)
MALE STERILIZATION 02 (GO TO 327)
IUCD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07
EMERGENCY CONTRACEPTION 09
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 323)
RHYTHM METHOD 12 (GO TO 323)
WITHDRAWAL 13 (GO TO 323)
OTHER MODERN METHOD 95
OTHER TRADITIONAL METHOD 96

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.

NAME OF PLACE ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC 11
PRIMARY HEALTH CARE CENTER 12
HEALTH POST/SUB-HEALTH POST 13
PHC OUTREACH CLINIC 14
MOBILE CAMP 15
FCHV 16
SATELLITE CLINIC 17
OTHER PUBLIC FACILITIES (SPECIFY) ___ 18
NON-GOVT. (NGO) SECTOR
FPAN 21
MARIE STOPES 22
OTHER NGO FACILITIES (SPECIFY) ___ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/NURSING HOME 31
PRIVATE CLINIC 32
PHARMACY 33
SANGINI OUTLET 34
OTHER PRIVATE MEDICAL FACILITIES (SPECIFY) ___ 36
OTHER SOURCE
SHOP 41
FRIEND/RELATIVE 42
OTHER (SPECIFY) ___ 96

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

IUCD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07 (GO TO 323)
EMERGENCY CONTRACEPTION 09 (GO TO 322)
OTHER MODERN METHOD 95 (GO TO 322)
OTHER TRADITIONAL METHOD 96 (GO TO 323)

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

YES 1 (GO TO 321)
NO 2 (GO TO 320)

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

YES 1 (GO TO 321)
NO 2

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

YES 1
NO 2 (GO TO 322)

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

YES 1
NO 2

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?

YES 1 (GO TO 324)
NO 2

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

YES 1
NO 2

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

FEMALE STERILIZATION 01 (GO TO 327)
MALE STERILIZATION 02 (GO TO 327)
IUCD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07
EMERGENCY CONTRACEPTION 09
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 327)
RHYTHM METHOD 12 (GO TO 327)
WITHDRAWAL 13 (GO TO 327)
OTHER MODERN METHOD 95
OTHER TRADITIONAL METHOD 96 (GO TO 327)

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.

NAME OF PLACE ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC 11 (GO TO 327)
PRIMARY HEALTH CARE CENTER 12 (GO TO 327)
HEALTH POST/SUB-HEALTH POST 13 (GO TO 327)
PHC OUTREACH CLINIC 14 (GO TO 327)
MOBILE CAMP 15 (GO TO 327)
FCHV 16 (GO TO 327)
SATELLITE CLINIC 17 (GO TO 327)
OTHER PUBLIC FACILITIES (SPECIFY) ___ 18 (GO TO 327)
NON-GOVT. (NGO) SECTOR
FPAN 21 (GO TO 327)
MARIE STOPES 22 (GO TO 327)
OTHER NGO FACILITIES (SPECIFY) ___ 26 (GO TO 327)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/NURSING HOME 31 (GO TO 327)
PRIVATE CLINIC 32 (GO TO 327)
PHARMACY 33 (GO TO 327)
SANGINI OUTLET 34 (GO TO 327)
OTHER PRIVATE MEDICAL FACILITIES (SPECIFY) ___ 36 (GO TO 327)
OTHER SOURCE
SHOP 41 (GO TO 327)
FRIEND/RELATIVE 42 (GO TO 327)
OTHER (SPECIFY) ___ 96 (GO TO 327)

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 329)

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

YES 1
NO 2

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?

YES 1
NO 2 (GO TO 401)

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

YES 1
NO 2

SECTION 4. PREGNANCY AND POSTNATAL CARE

401. CHECK 224:

ONE OR MORE BIRTHS IN 2068-2073 (CONTINUE)
NO BIRTHS IN 2068-2073 (GO TO 648)

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.

PREGNANCY HISTORY NUMBER ___

404. FROM 212D AND 216:

NAME ___
LIVING (CONTINUE)
DEAD (CONTINUE)

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

YES 1 (SKIP TO 408)
NO 2

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?

LATER 1
NO MORE/NONE 2 (SKIP TO 408)

407. How much longer did you want to wait?

MONTHS 1 ___
YEARS 2 ___
DON'T KNOW 998

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

YES 1
NO 2 (SKIP TO 413H)

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

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE B
HEALTH ASST./AHW C
MCH WORKER D
VHW E
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT F
FCHV G
OTHER (SPECIFY) ____ X

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.

NAME OF PLACE ____
HOME
HER HOME A
OTHER HOME B
PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC C
PHC CENTER D
HEALTH POST/SUB-HEALTH POST E
PHC OUTREACH CLINIC F
OTHER PUBLIC FACILITIES (SPECIFY) ____ G
NON-GOVT. (NGO)
FPAN H
MARIE STOPES I
OTHER NGO FACILIITES (SPECIFY) ____ J
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/NURSING HOME K
PRIVATE CLINIC L
OTHER PRIVATE MEDICAL FACILITIES (SPECIFY) ___ M
OTHER (SPECIFY) ___ X

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

MONTHS ___
DON'T KNOW 98

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

NUMBER OF TIMES __
DON'T KNOW 98

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?

A) 4 MONTHS
YES 1
NO 2
B) 6 MONTHS
YES 1
NO 2
C) 8 MONTHS
YES 1
NO 2
D) 9 MONTHS
YES 1
NO 2

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?

A) BP
YES 1
NO 2
B) URINE
YES 1
NO 2
C) BLOOD
YES 1
NO 2

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?

A) SBA
YES 1
NO 2
B) INSTITUTIONAL DELIVERY
YES 1
NO 2

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?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW

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

SAVED MONEY A
ARRANGED FOR TRANSPORT B
LOOKED FOR BLOOD DONOR C
CONTACTED HEALTH WORKER TO HELP WITH DELIVERY D
BOUGHT SAFE DELIVERY KIT E
ARRANGED FOOD F
ARRANGED CLOTHES G
OTHER (SPECIFY) ___ X
NO PREPARATION Y

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

YES 1
NO 2 (SKIP TO 417)
DON'T KNOW 8 (SKIP TO 417)

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

TIMES ___
DON'T KNOW 8

416. CHECK 415:

2 OR MORE TIMES (SKIP TO 420)
OTHER (CONTINUE)

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

YES 1
NO 2 (SKIP TO 420)
DON'T KNOW 8 (SKIP TO 420)

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

TIMES ___
DON'T KNOW 8

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?

YEARS AGO ___

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

YES 1
NO 2 (SKIP TO 422)
DON'T KNOW 8 (SKIP TO 422)

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.

DAYS ___
DON'T KNOW 998

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

YES 1
NO 2
DON'T KNOW 8

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

VERY LARGE 1
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DON'T KNOW 8

427. Was (NAME) weighed at birth?

YES 1
NO 2 (SKIP TO 429)
DON'T KNOW 8 (SKIP TO 429)

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

KG FROM CARD 1 __. ____
KG FROM RECALL 2 __. ____
DON'T KNOW 99998

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.

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE B
HEALTH ASSISTANT/AHW C
MCHW D
VHW E
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT F (SKIP TO 429 E)
FCHV G
RELATIVE/FRIEND H
OTHER (SPECIFY) ___ X
NO ONE ASSISTED Y

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?

YES 1
NO 2 (SKIP TO 429C)
DON'T KNOW 8 (SKIP TO 429C)

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

SPEED UP LABOR 1
PREVENT INJECTION 2
TOLD NOTHING 3
OTHER (SPECIFY) ___ 6
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 429E)
DON'T KNOW 8 (SKIP TO 429)

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

YES 1 (SKIP TO 430)
NO 2 (SKIP TO 430)

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)?

YES 1
NO 2 (SKIP TO 430)
DON'T KNOW 8 (SKIP TO 430)

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

YES 1
NO 2

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.

NAME OF PLACE ___
HOME
HER HOME 11 (SKIP TO 434)
OTHER HOME 12 (SKIP TO 434)
PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC 21
PHC CENTER 22
HEALHT POST/SUB-HEALTH POST 23
PHC OUTREACH CLINIC 24
OTHER PUBLIC FACILITIES (SPECIFY) ___ 26
NON-GOVT. (NGO)
FPAN 31
MARIE STOPES 32
OTHER NGO FACILITIES (SPECIFY) ___ 36
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/NURSING HOME 41
PRIVATE CLINIC 42
OTHER PRIVATE MEDICAL FACILITIES (SPECIFY) ___ 46
OTHER (SPECIFY) ___ 96 (SKIP TO 434)

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.

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

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

MINUTES ___
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 434)

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

BEFORE 1
AFTER 2

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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.

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

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

YES 1
NO 2 (SKIP TO 434)
DON'T KNOW 8 (SKIP TO 434I)

434E. What was placed on the stump?

OIL A
ASH B
VERMILON C
OINTMENT/POWDER D
ANIMAL DUNG E
TURMERIC F
GHEE G
CHLOROHEXIDINE (NAVI MALAM/KAWACH) H
METHYLATED SPIRIT I
LOCAL HERBS J
OTHER (SPECIFY) ___ X
DON'T KNOW Z

434F. CHECK 4343: SUBSTANCE ON STUMP

CODE H NOT CIRCLED (CONTINUE)
CODE H CIRCLED (SKIP TO 434H)

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

YES 1
NO 2 (SKIP TO 434I)
DON'T KNOW 8 (SKIP TO 434I)

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.

HOURS 1 __
DAYS 2 __
DON'T KNOW 998

434I. CHECK 430: PLACE OF DELIVERY

CODE 11, 12 OR 96 CIRCLED (SKIP TO 448A)
OTHER (CONTINUE)

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?

YES 1
NO 2 (SKIP TO 438)

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.

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

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

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
HEALTH ASST./ AHW 13
MCH WORKER 14
VHW 15
OTHER PERSON
TRADIITONAL BIRTH ATTENDANT 21
FCHV 22
OTHER (SPECIFY) ___ 96

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

YES 1
NO 2
DON'T KNOW 8

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?

YES 1
NO 2 (SKIP TO 441)
DON'T KNOW 8 (SKIP TO 441)

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.

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

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

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
HEALTH ASST./AHW 13
MCH WORKER 14
VHW 15
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
FCHV 22
OTHER (SPECIFY) ___ 96

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?

YES 1
NO 2 (SKIP TO 445)

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

HOURS 1 __
DAYS 2 __
WEEKS 3 __

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

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
HEALTH ASST./AHW 13
MCH WORKER 14
VHW 15
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
FCHV 22
OTHER (SPECIFY) ___ 96

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

NAME OF PLACE ___
HOME
HER HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC 21
PHC CENTER 22
HEALTH POST/SUB-HEALTH POST 23
PHC OUTREACH CLINIC 24
OTHER PUBLIC FACILITIES (SPECIFY) ___ 26
NON-GOVT. (NGO)
FPAN 31
MARIE STOPES 32
OTHER NGO FACILITIES (SPECIFY) ___ 36
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/NURSING HOME 41
PRIVATE CLINIC 42
OTHER PRIVATE MEDICAL FACILITIES (SPECIFY) ___ 46
OTHER (SPECIFY) ___ 96

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?

WITHIN 24 HOURS
YES 1
NO 2
24-72 HOURS
YES 1
NO 2
72 HOURS -- 7 DAYS
YES 1
NO 2

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)?

YES 1
NO 2 (SKIP TO 457)
DON'T KNOW 8 (SKIP TO 457)

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.

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

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

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
HEALTH ASST./AHW 13
MCH WORKER 14
VHW 15
OTHER PERSON
TRADIITONAL BIRTH ATTENDANT 21
FCHV 22
OTHER (SPECITY) ___ 96

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.

NAME OF PLACE __
HOME
HER HOME 11 (SKIP TO 457)
OTHER HOME 12 (SKIP TO 457)
PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC 21 (SKIP TO 457)
PHC CENTER 22 (SKIP TO 457)
HEALTH POST/SUB-HEALTH POST 23 (SKIP TO 457)
PHC OUT REACH CLINIC 24 (SKIP TO 457)
OTHER PUBLIC FACILITIES (SPECIFY) ___ 26 (SKIP TO 457)
NON-GOVT. (NGO)
FPAN 31 (SKIP TO 457)
MARIE STOPES 32 (SKIP TO 457)
OTHER NGO FACILITIES (SPECIFY) ___ 36 (SKIP TO 457)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/NURSING HOME 41 (SKIP TO 457)
PRIVATE CLINIC 42 (SKIP TO 457)
OTHER PRIVATE MEDICAL FACILITIES ___ 46 (SKIP TO 457)
OTHER (SPECIFY) ___ 96 (SKIP TO 457)

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

YES 1 (SKIP TO 448C))
NO 2
DON'T KNOW 8

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

NEW/BOILED BLADE A
USED BLADE B
KNIFE C
HASIYA D
KHUKURI E
SCISSORS F
OTHER (SPECIFY) ___ X
DON'T KNOW Z

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

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

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)?

YES 1
NO 2 (SKIP TO 453)

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.

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

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

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
HEALTH ASST./ AHW 13
MCH WORKER 14
VHW 15
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
FCHV 22
OTHER (SPECIFY) ___ 96

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

YES 1
NO 2
DON'T KNOW 8

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.

NAME OF PLACE __
HOME
HER HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC 21
PHC CENTER 22
HEALTH POST/SUB-HEALTH POST 23
PHC OUTREACH CLINIC 24
OTHER PUBLIC FACILITIES (SPECIFY) ___ 26
NON-GOVT. (NGO)
FPAN 31
MARIE STOPES 32
OTHER NGO FACILITIES (SPECIFY) ___ 36
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/NURSING HOME 41
PRIVATE CLINIC 42
OTHER PRIVATE MEDICAL FACILITIES (SPECIFY) ___ 46
OTHER (SPECIFY) ___ 96

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?

WITHIN 24 HOURS
YES 1
NO 2
24 -- 72 HOURS
YES 1
NO 2
72 HOURS -- 7 DAYS
YES 1
NO 2

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?

YES 1
NO 2 (SKIP TO 457)
DON'T KNOW 8 (SKIP TO 457)

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.

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

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

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
HEALTH ASST./ AHW 13
MCH WORKER 14
VHW 15
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
FCHV 22
OTHER (SPECIFY) ___ 96

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.

NAME OF PLACE __
HOME
HER HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC 21
PHC CENTER 22
HEALTH POST/SUB-HEALTH POST 23
PHC OUTREACH CLINIC 24
OTHER PUBLIC FACILITIES (SPECIFY) ___ 26
NON-GOVT. (NGO)
FPAN 31
MARIE STOPES 32
OTHER NGO FACILITIES (SPECIFY) ___ 36
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/NURSING HOME 41
PRIVATE CLINIC 42
OTHER PRIVATE MEDICAL FACILITIES (SPECIFY) ___ 46
OTHER (SPECIFY) ___ 96

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?

A) CORD
YES 1
NO 2
DK 8
B) TEMP
YES 1
NO 2
DK 8
C) SIGNS
YES 1
NO 2
DK 8
CA) OBSERVE SIGNS
YES 1
NO 2
DK 8
D) COUNSEL BREAST FEEDING
YES 1
NO 2
DK 8
E) OBSERVE BREASTFEEDING
YES 1
NO 2
DK 8

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

YES 1 (SKIP TO 460)
NO 2 (SKIP TO 461)

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?

MONTHS __
DON'T KNOW 98

461. CHECK 226: IS RESPONDENT PREGNANT?

NOT PREGNANT (CONTINUE)
PREGNANT OR UNSURE (SKIP TO 463)

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

YES 1
NO 2 (SKIP TO 464)

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

MONTHS __
DON'T KNOW 98

464. Did you ever breastfeed (NAME)?

YES 1 (SKIP TO 466)
NO 2

465. CHECK 404: IS CHILD LIVING?

LIVING (SKIP TO 470)
DEAD (GO TO 471)

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.

IMMEDIATELY 000
HOURS 1 __
DAYS 2 __

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

YES 1
NO 2

468. CHECK 404: IS CHILD LIVING?

LIVING (CONTINUE)
DEAD (GO TO 471)

469. Are you still breastfeeding (NAME)?

YES 1
NO 2

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

YES 1
NO 2
DON'T KNOW 8

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.

NAME OF NEXT-TO LAST BIRTH ___
PREGNANCY HISTORY NUMBER __

503A. CHECK 216 FOR CHILD:

LIVING (CONTINUE)
DEAD (GO TO 501B)

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

YES, HAS ONLY A CARD 1 (GO TO 507A)
YES, HAS ONLY ANOTHER DOCUMENT 2
YES, HAS CARD AND OTHER DOCUMENT 3 (GO TO 507A)
NO, NO CARD AND NO OTHER DOCUMENT 4

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

YES 1
NO 2

506A. CHECK 504A:

CODE '2' CIRCLED (CONTINUE)
CODE '4' CIRCLED (GO TO 511A)

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

YES, ONLY CARD SEEN 1
YES, ONLY OTHER DOCUMENT SEEN 2
YES, CARD AND OTHER DOCUMENT SEEN 3
NO CARD AND NO OTHER DOCUMENT SEEN 4 (GO TO 511A)

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

BCG
DAY __
MONTH __
YEAR ____
ORAL POLIO VACCINE (OPV) 1
DAY __
MONTH __
YEAR ____
ORAL POLIO VACCINE (OPV) 2
DAY __
MONTH __
YEAR ____
ORAL POLIO VACCINE (OPV) 3
DAY __
MONTH __
YEAR ____
DPT-HEP. B-HIB (PENTAVALENT) 1
DAY __
MONTH __
YEAR ____
DPT-HEP. B-HIB (PENTAVALENT) 2
DAY __
MONTH __
YEAR ____
DPT-HEP. B-HIB (PENTAVALENT) 3
DAY __
MONTH __
YEAR ____
PNEUMOCOCCAL (PCV) 1
DAY __
MONTH __
YEAR ____
PNEUMOCOCCAL (PCV) 2
DAY __
MONTH __
YEAR ____
PNEUMOCOCCAL (PCV) 3
DAY __
MONTH __
YEAR ____
INACTIVATED POLIO VACCINE (IPV)
DAY __
MONTH __
YEAR ____
MEASLES RUBELLA(MR)
DAY __
MONTH __
YEAR ____
VITAMIN A (MOST RECENT)
DAY __
MONTH __
YEAR ____

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

NO (CONTINUE)
YES (GO TO 526A)

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.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN THEN SKIP TO 526A)
NO 2 (GO TO 526A)
DON'T KNOW 8 (GO TO 526A)

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

YES 1
NO 2 (GO TO 526A)
DON'T KNOW 8 (GO TO 526A)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 517A)
DON'T KNOW 8 (GO TO 517A)

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

NUMBER OF TIMES __

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?

YES 1
NO 2 (GO TO 519A)
DON'T KNOW 8 (GO TO 519A)

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

NUMBER OF TIMES___

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

YES 1
NO 2 (GO TO 521A)
DON'T KNOW 8 (GO TO 521A)

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

NUMBER OF TIMES ___

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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?

MORE BIRTHS IN 2070-2073 (CONTINUE)
NO MORE BIRTHS IN 2070-2073 (GO TO 601)

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

NAME OF NEXT-TO LAST BIRTH ___
PREGNANCY HISTORY NUMBER __

503B. CHECK 216 FOR CHILD:

LIVING (CONTINUE)
DEAD (GO TO 526B)

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

YES, HAS ONLY A CARD 1 (GO TO 507B)
YES, HAS ONLY AN OTHER DOCUMENT 2
YES, HAS CARD AND OTHER DOCUMENT 3 (GO TO 507B)
NO, NO CARD AND NO OTHER DOCUMENT 4

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

YES 1
NO 2

506B. CHECK 504B:

CODE 2 CIRCLED (CONTINUE)
CODE 4 CIRCLED (GO TO 511B)

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

YES, ONLY CARD SEEN 1
YES, ONLY OTHER DOCUMENT SEEN 2
YES, CARD AND OTHER DOCUMENT SEEN 3
NO CARD AND NO OTHER DOCUMENT SEEN 4 (GO TO 511B)

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

BCG
DAY __
MONTH __
YEAR ____
ORAL POLIO VACCINE (OPV) 1
DAY __
MONTH __
YEAR ____
ORAL POLIO VACCINE (OPV) 2
DAY __
MONTH __
YEAR ____
ORAL POLIO VACCINE (OPV) 3
DAY __
MONTH __
YEAR ____
DPT-HEP. B-HIB (PENTAVALENT) 1
DAY __
MONTH __
YEAR ____
DPT-HEP. B-HIB (PENTAVALENT) 2
DAY __
MONTH __
YEAR ____
DPT-HEP. B-HIB (PENTAVALENT) 3
DAY __
MONTH __
YEAR ____
PNEUMOCOCCAL (PCV) 1
DAY __
MONTH __
YEAR ____
PNEUMOCOCCAL (PCV) 2
DAY __
MONTH __
YEAR ____
PNEUMOCOCCAL (PCV) 3
DAY __
MONTH __
YEAR ____
INACTIVATED POLIO VACCINE (IPV)
DAY __
MONTH __
YEAR ____
MEASLES RUBELLA(MR)
DAY __
MONTH __
YEAR ____
VITAMIN A (MOST RECENT)
DAY __
MONTH __
YEAR ____

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

NO (CONTINUE)
YES (GO TO 526B)

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.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN THEN SKIP TO 526B)
NO 2 (GO TO 526B)
DON'T KNOW 8 (GO TO 526B)

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

YES 1
NO 2 (GO TO 526B)
DON'T KNOW 8 (GO TO 526B)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 517B)
DON'T KNOW 8 (SKIP TO 517B)

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

NUMBER OF TIMES __

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?

YES 1
NO 2 (GO TO 519B)
DON'T KNOW 8 (GO TO 519B)

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

NUMBER OF TIMES __

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

YES 1
NO 2 (SKIP TO 521Ba)
DON'T KNOW 8 (SKIP TO 521Ba)

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

NUMBER OF TIMES __

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

MORE BIRTHS IN 2070-2073 (GO TO 502B IN AN ADDITIONAL QUESTIONNAIRE)
NO MORE BIRTHS IN 2070-2073 (GO TO 601)

SECTION 6. CHILD HEALTH AND NUTRITION

601. CHECK 224:

ONE OR MORE BIRTHS IN 2068-2073 (CONTINUE)
NO BIRTHS IN 2068-2073 (GO TO 648)

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.

PREGNANCY HISTORY NUMBER __

604. FROM 212D AND 216:

NAME ___
LIVING (CONTINUE)
DEAD (SKIP TO 646)

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.

YES 1
NO 2
DON'T KNOW 8

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

OPV
YES 1
NO 2
DON'T KNOW 8
MR
YES 1
NO 2
DON'T KNOW 8

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.

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 618)
DON'T KNOW 8 (SKIP TO 618)

609. CHECK 464: EVER BREASTFED?

YES: Now I would like to know
how much (NAME) was given to drink during the diarrhea including breastmilk. Was (NAME) given less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was (NAME) given much less than usual to drink or somewhat less?
NO: Now I would like to know
how much (NAME) was given to drink during the diarrhea. Was (NAME) given less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was (NAME) given much less than usual to drink or somewhat less?
MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8

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?

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

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

YES 1
NO 2 (SKIP TO 615)

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).

NAME OF PLACE ___
PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC A
PHC CENTER B
HEALTH POST/SUB-HEALTH POST C
PHC OUTREACH CLINIC D
FCHV E
OTHER PUBLIC FACILITIES (SPECIFY) ___ F
NON-GOVT. (NGO)
FPAN G
MARIE STOPES H
OTHER NGO FACILITIES (SPECIFY) ___ I
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/NURSING HOME J
PRIVATE CLINIC K
PHARMACY L
OTHER PRIVATE MEDICAL FACILITIES (SPECIFY) ___ M
OTHER SOURCE
SHOP N
TRADITIONAL PRACTITIONER O
OTHER (SPECIFY) ___ X

613. CHECK 612:

TWO OR MORE CODES CIRCLED (CONTINUE)
ONLY ONE CODE CIRCLED (SKIP TO 615)

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

FIRST PLACE __

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?

A) FLUID FROM ORS
YES 1
NO 2
DK 8
C) HOMEMADE FLUID
YES 1
NO 2
DK 8
D) ZINC
YES 1
NO 2
DK 8

615E. CHECK 615: GIVEN ZINC?

CODE 1 CIRCLED IN (d) (CONTINUE)
CODE 1 NOT CIRCLED IN (d) (SKIP TO 616)

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

DAYS __
DON'T KNOW

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

YES 1
NO 2 (SKIP TO 618)
DON'T KNOW (SKIP TO 618)

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

PILL OR SYRUP
ANTIBIOTIC A
ANTIMOTILITY B
OTHER (NOT ANTIBIOTIC OR ANTIMOTILITY) C
UNKNOWN PILL OR SYRUP D
INJECTION
ANTIBIOTIC E
NON-ANTIBIOTIC F
UNKNOWN INJECTION G
(IV) INTRAVENOUS H
HERBAL MEDICINE I
OTHER (SPECIFY) ___ X

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 623)
DON'T KNOW 8 (SKIP TO 623)

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

CHEST ONLY 1 (SKIP TO 624)
NOSE ONLY 2 (SKIP TO 624)
BOTH 3 (SKIP TO 624)
OTHER (SPECIFY) ___ 6 (SKIP TO 624)
DON'T KNOW 8 (SKIP TO 624)

623. CHECK 618: HAD FEVER?

YES (CONTINUE)
NO OR DK (SKIP TO 646)

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

YES 1
NO 2 (SKIP TO 629)

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.

NAME OF PLACE __
PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC A
PHC CENTER B
HEALTH POST/SUB-HEALTH POST C
PHC OUTREACH CLINIC D
FCHV E
OTHER PUBLIC FACILITIES (SPECITY) ___ F
NON-GOVT. (NGO)
FPAN G
MARIE STOPES H
OTHER NGO FACILITIES (SPECIFY) __ I
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/NURSING HOME J
PRIVATE CLINIC K
PHARMACY L
OTHER PRIVATE MEDICAL FACILITIES (SPECIFY) ___ M
OTHER SOURCE
SHOP N
TRADITIONAL PRACTITIONER O
OTHER (SPECIFY) __ X

626. CHECK 625:

TWO OR MORE CODES CIRCLED (CONTINUE)
ONLY ONE CODE CIRCLED (SKIP TO 628)

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

FIRST PLACE __

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

DAYS __

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

YES 1
NO 2 (SKIP TO 646)
DON'T KNOW 8 (SKIP TO 646)

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

ANTIMALARIAL DRUGS
ARTEMISININ COMBINATION THERAPY (ACT) A
SP/FANSIDAR B
CHOROQUINE C
AMODIAQUINE D
QUINNE PILLS E
INJECTION/IV F
ARTESUNATE RECTAL G
INJECTION/IV H
OTHER ANTIMALARIAL (SPECIFY) ___ I
ANTIBIOTIC DRUGS
AMOXYCILLIN J
AZITHROMYCIN K
CEPHALOSPRIN L
OTHER ANTIBIOTICS M
INJECTION/IV N
OTHER DRUGS
PARACETAMOL O
IBUPROFEN P
COUGH SYRUP Q
OTHER (SPECIFY) ___ X
DON'T KNOW Z

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

DAYS ___

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

647. CHECK 615(a) ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET (CONTINUE)
ANY CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 649)

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

YES 1
NO 2

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

ONE OR MORE (NAME OF YOUNGEST CHILD LIVING WITH HER (CONTINUE))
NONE (GO TO 653B)

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:

A) PLAIN WATER
YES 1
NO 2
DK 8
B) JUICE OR JUICE DRINKS
YES 1
NO 2
DK 8
C) CLEAR BROTH
YES 1
NO 2
DK 8
D) MILK
YES 1
NUMBER OF TIMES DRANK ___
NO 2
DK 8
E) INFANT FORMULA
YES 1
NUMBER OF TIMES DRANK __
NO 2
DK 8
F) OTHER LIQUIDS
YES 1
NO 2
DK 8
G) YOGURT
YES 1
NUMBER OF TIMES ATE __
NO 2
DK 8
H) FORTIFIED BABY FOOD
YES 1
NO 2
DK 8
I) ROTI, RICE, MAIZE, MILLET, NOODLES, PORRIDGE, OTHER FOODS MADE OF GRAINS
YES 1
NO 2
DK 8
J) PUMPKIN, CARROTS, SQUASH, OR SWEET POTATOES THAT ARE YELLOW OR ORANGE INSIDE
YES 1
NO 2
DK 8
K) WHITE POTATOES, WHITE YAMS, COLOCASIA, OR ANY OTHER FOODS MADE FROM ROOTS
YES 1
NO 2
DK 8
L) ANY DARK GREEN, LEAFY VEGETABLES
YES 1
NO 2
DK 8
M) RIPE MANGOES, PAPAYAS, OR APRICOT
YES 1
NO 2
DK 8
N) ANY OTHER FRUITS OR VEGETABLES
YES 1
NO 2
DK 8
O) LIVER, KIDNEY, HEART, OR OTHER ORGAN MEATS
YES 1
NO 2
DK 8
P) ANY MEAT
YES 1
NO 2
DK 8
Q) EGGS
YES 1
NO 2
DK 8
R) FRESH OR DRIED FISH OR SHELLFISH
YES 1
NO 2
DK 8
S) FOODS MADE FROM BEANS, PEAS, LENTILS, OR NUTS
YES 1
NO 2
DK 8
T) CHEESE OR OTHER FOODS MADE FROM MILK
YES 1
NO 2
DK 8
U) ANY OTHER SOLID, SEMI-SOLID, OR SOFT FOODS
YES 1
NO 2
DK 8

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

NOT A SINGLE YES (CONTINUE)
AT LEAST ONE YES (GO TO 653)

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?

YES 1 (GO BACK TO 650 TO RECORD FOOD EATEN YESTERDAY THEN CONTINUE TO 653)
NO 2 (GO TO 653A)

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.

NUMBER OF TIMES __
DON'T KNOW 8

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:

CEREALS
YES 1
NO 2
DK 8
VITAMIN A RICH VEGETABLES AND TUBERS
YES 1
NO 2
DK 8
WHITE TUBERS AND ROOTS OR OTHER STARCHY FOODS
YES 1
NO 2
DK 8
DARK GREEN LEAFY VEGETABLES
YES 1
NO 2
DK 8
VITAMIN A RICH FRUITS
YES 1
NO 2
DK 8
OTHER VEGETABLES
YES 1
NO 2
DK 8
OTHER FRUITS
YES 1
NO 2
DK 8
ORGAN MEATS
YES 1
NO 2
DK 8
MEAT
YES 1
NO 2
DK 8
EGGS
YES 1
NO 2
DK 8
FISH
YES 1
NO 2
DK 8
BEANS, PEAS, OR LENTILS
YES 1
NO 2
DK 8
MILK AND MILK PRODUCTS
YES 1
NO 2
DK 8
NUTS AND SEEDS
YES 1
NO 2
DK 8
OILS AND FAT
YES 1
NO 2
DK 8
SWEETS
YES 1
NO 2
DK 8
TEA/COFFEE
YES 1
NO 2
DK 8
ANY OTHER FOOD
YES 1
NO 2
DK 8

653B. CHECK 224:

ONE OR MORE BIRTHS IN 2068-2073 (CONTINUE)
NO BIRTHS IN 2068-2073 (GO TO 701)

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?

YES 1
NO 2 (GO TO 653G)

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

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE/ANM B
HEALTH ASSISTANT/AHW C
MCHW D
VHW E
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT F
FCHV G
MOTHER'S GROUP H
SOCIAL MOBILIZER I
TRADITIONAL HEALERS J
OTHER (SPECIFY) ___ X

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

DURING ANC VISIT A
DURING PNC VISIT B
VISIT TO HEALTH FACILITY C
DURING FCHV HOME VISIT D
DURING HEALTH MOTHER'S GROUP MEETING E
OTHER (SPECIFY) ___ X

653F. What were you counseled on?

NEED FOR PREGNANT WOMEN TO GET SUFFICIENT REST A
PREGNANT WOMEN EAT HEALTH B
PREGNANT WOMAN SHOULD EAT ONE EXTRA MEAL PER DAY C
PREGNANT WOMEN SHOULD TAKE RECOMMENDED DOSE (180 DAYS) OF IRON TABLETS D
BREASTFEED WITHIN ONE HOUR OF BIRTH E
EXCLUSIVELY BREASTFEED INFANTS FOR 6 MONTHS AFTER BIRTH F
TIMING AND INTRODUCTION OF COMPLEMENTARY FOOD AND CONTINUE BREASTFEEDING FOR UP TO 2 YEARS G
OTHER (SPECIFY) ___ X

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

YES 1
NO 2 (GO TO 653L)

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

PHC OUTREACH CLINIC 1
HEALTH FACILITY 2
OTHER (SPECIFY) __ 6
DID NOT PARTICIPATE 7 (GO TO 653L)
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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?

AT BIRTH
YES 1
NO 2
IMMUNIZATION
YES 1
NO 2
VITAMIN A DISTRIBUTION
YES 1
NO 2
SICK CHILD VISITS
YES 1
NO 2
OTHER (SPECIFY) ___
YES 1
NO 2

653L: CHECK 649

ONE OR MORE (CONTINUE)
NONE (GO TO 701)

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

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

SECTION 7. MARRIAGE AND SEXUAL ACTIVITY

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

YES CURRENTLY MARRIED 1 (GO TO 704)
YES, LIVING WITH A MAN 2 (GO TO 704)
NO, NOT IN UNION 3

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

YES, FORMERLY MARRIED 1
YES, LIVED WITH A MAN 2
NO 3 (GO TO 712)

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

WIDOWED 1 (GO TO 709)
DIVORCED 2 (GO TO 709)
SEPARATED 3 (GO TO 709)

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

LIVING WITH HER 1 (GO TO 705)
STAYING ELSEWHERE 2

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.

MONTHS 1 __
YEARS 2 __

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'.

NAME ___
LINE NO. __

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

YES 1
NO 2 (GO TO 709)
DON'T KNOW 8 (GO TO 709)

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

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNERS __
DON'T KNOW 98

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

RANK __

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

ONLY ONCE 1
MORE THAN ONCE 2

709A. Has your marriage been registered?

YES 1
NO 2

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?

MONTH __
DON'T KNOW MONTH 98
YEAR ____ (GO TO 712)
DON'T KNOW YEAR 9998 (GO TO 712)

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

AGE __

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?

NEVER HAD SEXUAL INTERCOURSE 00 (GO TO 731)
AGE IN YEARS __

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.

DAYS AGO 1 __ (GO TO 716)
WEEKS AGO 2 __ (GO TO 716)
MONTHS AGO 3 __ (GO TO 716)
YEARS AGO 4 __ (GO TO 727)

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

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

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

YES 1
NO 2 (SKIP TO 718)

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

YES 1
NO 2

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'.

HUSBAND 1
LIVE-IN PARTNER 2
BOYFRIEND NOT LIVING WITH RESPONDENT 3
CASUAL ACQUAINTANCE 4
CLIENT/SEX WORKER 5
OTHER (SPECIFY) ___ 6

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

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

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'.

NUMBER OF TIMES __

721. How old is this person?

AGE OF PARTNER __
DON'T KNOW 98

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

YES 1 (GO BACK TO 715 IN NEXT COLUMN)
NO 2 (SKIP TO 724)

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'.

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

724. CHECK 106:

AGE 15-24 (CONTINUE)
AGE 25-49 (GO TO 727)

725. CHECK 701:

NOT IN A UNION (CONTINUE)
CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 727)

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?

YES 1
NO 2

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'.

NUMBER OF PARTNERS IN LIFETIME __
DON'T KNOW 98

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

YES, CONDOM USED (CONTINUE)
NO, CONDOM NOT USED (GO TO 731)
NOT ASKED (GO TO 731)

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.

DHAAL 01
PANTHER 02
DZIRE 03
KAMASUTRA 04
JODI 05
NUMBER 1 06
BLACK COBRA 07
MOHP-NO BRAND 08
OTHER (SPECIFY) ___ 96
DON'T KNOW 98

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.

NAME OF PLACE ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC 11
PRIMARY HEALTH CARE CENTER 12
HEALTH POST/SUB-HEALTH POST 13
PHC OUTREACH CLINIC 14
MOBILE CAMP 15
FCHV 16
OTHER PUBLIC FACILITIES (SPECIFY) __ 17
NON-GOVT. (NGO) SECTOR
FPAN 21
MARIE STOPES 22
OTHER NGO FACILITIES (SPECIFY) ___ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/NURSING HOME 31
PRIVATE CLINIC 32
PHARMACY 33
SANGINI OUTLET 34
OTHER PRIVATE MEDICAL FACILITIES (SPECIFY) __ 36
OTHER SOURCE
SHOP 41
FRIEND/RELATIVE 42
OTHER (SPECIFY) ___ 96
DON'T KNOW 98

731. PRESENCE OF OHTERS DURING THIS SECTION.

CHILDREN LESS THAN 10
YES 1
NO 2
MALE ADULTS
YES 1
NO 2
FEMALE ADULTS
YES 1
NO 2

SECTION 8. FERTILITY PREFERENCES

801. CHECK 304:

NEITHER STERILIZED (CONTINUE)
NOT ASKED (CONTINUE)
HER OR SHE STERILIZED (GO TO 813)

802. CHECK 226:

PREGNANT (CONTINUE)
NOT PREGNANT OR UNSURE (GO TO 804)

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?

HAVE ANOTHER CHILD 1 (GO TO 805)
NO MORE 2 (GO TO 812)
UNDECIDED/DON'T KNOW 8 (GO TO 812)

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?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 807)
SAYS SHE CAN' TGET PREGNANT 3 (GO TO 813)
UNDECIDED/DON'T KNOW 8 (GO TO 811)

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?

MONTH 1 __
YEARS 2 __
SOON/NOW 993 (GO TO 811)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 813)
AFTER MARRIAGE 995 (GO TO 811)
OTHER (SPECIFY) __ 996 (GO TO 811)
DON'T KNOW 998 (GO TO 811)

806. CHECK 226:

NOT PREGNANT OR UNSURE (CONTINUE)
PREGNANT (GO TO 812)

807. CHECK 303: USING A CONTRACEPTIVE METHOD?

NOT CURRENTLY USING (CONTINUE)
CURRENTLY USING (GO TO 813)

808. CHECK 805:

24 OR MORE MONTHS OR 02 OR MORE YEARS (CONTINUE)
NOT ASEKD (CONTINUE)
00-23 MONTHS OR 00-01 YEAR (GO TO 812)

809. CHECK 714:

DAYS, WEEKS OR MONTHS AGO (CONTINUE)
YEARS AGO (GO TO 811)
NOT ASKED (GO TO 811)

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

NOT MARRIED A
FERTILITY RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
HUSBAND AWAY D
MENOPAUSAL/HYSTERECTOMY E
CAN'T GET PREGNANT F
NOT MENSTRUATED SINCE LAST BIRTH G
BREASTFEEDING H
UP TO GOD/FATALISTIC I
OPPOSITION TO USE
RESPONDENT OPPOSED J
HUSBAND/PARTNER OPPOSED K
OTHERS OPPOSED L
RELIGIOUS PROHIBITION M
LACK OF KNOWLEDGE
KNOWS NO METHOD N
KNOWS NO SOURCE O
METHOD-RELATED REASONS
SIDE EFFECTS/HEALTH CONCERNS P
LACK OF ACCESS/TOO FAR Q
COSTS TOO MUCH R
PREFERRED METHOD NOT AVAILABLE S
NO METHOD AVAILABLE T
INCONVENIENT TO USE U
INTERFERES WITH BODY'S NORMAL PROCESSES V
OTHER (SPECIFY) ___ X
DON'T KNOW Z

811. CHECK 303: USING A CONTRACEPTIVE METHOD?

NOT ASKED (CONTINUE)
NO, NOT CURRENTLY USING (CONTINUE)
YES, CURRENTLY USING (GO TO 813)

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

YES 1
NO 2
DON'T KNOW 8

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.

NONE 00 (GO TO 815)
NUMBER __
OTHER (SPECIFY) __ 96 (GO TO 815)

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?

BOYS ___
GIRLS ___
EITHER ___
OTHER (SPECIFY) ___ 96

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?

A) RADIO
YES 1
NO 2
B) TELEVISION
YES 1
NO 2
C) NEWSPAPER OR MAGAZINE
YES 1
NO 2
D) MOBILE PHONE
YES 1
NO 2
E) BROCHURE OR FLIPCHART
YES 1
NO 2
F) POSTER, HOARDING BOARD
YES 1
NO 2
G) INTERNET/WEBSITE
YES 1
NO 2
H) STREET DRAMA
YES 1
NO 2
I) MOTHER'S GROUP/TEACHER
YES 1
NO 2
J) FCHV
YES 1
NO 2

817. CHECK 701:

YES, CURRENTLY MARRIED (CONTINUE)
YES, LIVING WITH A MAN (CONTINUE)
NO, NOT IN UNION (GO TO 901)

818. CHECK 303: USING A CONTRACEPTIVE METHOD?

CURRENTLY USING (CONTINUE)
NOT ASKED (GO TO 822)
NOT CURRENTLY USING (GO TO 820)

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

MAINLY RESPONDENT 1 (GO TO 821)
MAINLY HUSBAND/PARTNER 2 (GO TO 821)
JOINT DECISION 3 (GO TO 821)
OTHER (SPECIFY) ___ 6 (GO TO 821)

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?

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

821. CHECK 304:

NEITHER ARE STERILIZED (CONTINUE)
NOT ASKED (CONTINUE)
HE OR SHE ARE STERILIZED (GO TO 901)

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

SAME NUMBER 1
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8

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

901. CHECK 701:

CURRENLTY MARRIED/LIVING WITH A MAN (CONTINUE)
NOT IN UNION (GO TO 909)

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

AGE IN COMPLETED YEARS __

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

YES 1
NO 2 (GO TO 906)

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

GRADE __
DON'T KNOW 98

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

YES 1 (GO TO 908)
NO 2
DON'T KNOW 8

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

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

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?

YES 1 (GO TO 913)
NO 2

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?

YES 1 (GO TO 913)
NO 2

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?

YES 1 (GO TO 913)
NO 2

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

YES 1
NO 2 (GO TO 916A)

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?

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

915. 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

916. 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

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

LESS 1
EQUAL 2
MORE 3
NOT SURE 4
DON'T KNOW 8

917. CHECK 701:

CURRENLTY MARRIED/LIVING WITH A MAN (CONTINUE)
NOT IN UNION (GO TO 925)

918. CHECK 916:

CODE 1 OR 2 CIRCLED (CONTINUE)
OTHER (GO TO 921)

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
OTHER (SPECIFY) ___ 6

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?

MORE THAN HIM 1
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND/PARTNER HAS NO EARNINGS 4 (GO TO 922)
OTHER (SPECIFY) ___ 6

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?

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

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6

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

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4 (GO TO 928)

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

YES 1
NO 2
DON'T KNOW 8

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

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4 (GO TO 930A)

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

YES 1
NO 2
DON'T KNOW 8

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

A) OWNERSHIP
YES 1
NO 2
NO LAND/PROPERTY 3
B) REGISTRATION
YES 1
NO 2
NO LAND/PROPERTY 3

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

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

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?

A) GOES OUT
YES 1
NO 2
DK 8
B) NEGLECTS CHILDREN
YES 1
NO 2
DK 8
C) ARGUES
YES 1
NO 2
DK 8
D) REFUSES SEX
YES 1
NO 2
DK 8
E) BURNS FOOD
YES 1
NO 2
DK 8
F) LESS/NO DOWRY
YES 1
NO 2
DK 8

SECTION 10. HIV/AIDS

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

YES 1
NO 2 (GO TO 1042)

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?

YES 1
NO 2
DON'T KNOW 8

1003. Can people get HIV from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

A) DURING PREGNANCY
YES 1
NO 2
DK 8
B) DURING DELIVERY
YES 1
NO 2
DK 8
C) BREASTFEEDING
YES 1
NO 2
DK 8

1009. CHECK 1008:

AT LEAST ONE 'YES' (CONTINUE)
OTHER (GO TO 1011)

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?

YES 1
NO 2
DON'T KNOW 8

1011. CHECK 208 AND 215:

LAST BIRTH IN 2071-2073 (CONTINUE)
LAST BIRTH IN 2070 OR EARLIER (GO TO 1027)
NO BIRTHS (GO TO 1027)

1012. CHECK 408 FOR LAST BIRTH:

NO ANTENATAL CARE (CONTINUE)
NO ANTENATAL CARE (GO TO 1024)

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?

A) HIV FROM MOTHER
YES 1
NO 2
DK 8
B) THINGS TO DO
YES 1
NO 2
DK 8
C) TESTED FOR HIV
YES 1
NO 2
DK 8

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

YES 1
NO 2

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

YES 1
NO 2

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.

NAME OF PLACE __
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
PRIMARY HEALTH CARE CENTER 12
OTHER PUBLIC FACILITIES (SPECIFY) ___ 16
NON-GOVT. (NGO) SECTOR
FPAN 21
MARIE STOPES 22
OTHER NGO FACILITIES (SPECIFY) __ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/NURSING HOME 31
PRIVATE CLINIC 32
STAND-ALONE HTC/VCT CENTER 33
PHARMACY 34
MOBILE HTC/VCT SERVICES 35
OTHER PRIVATE MEDICAL FACILITIES (SPECIFY) __ 36
OTHER SOURCE
HOME 41
WORKPLACE 42
CORRECTIONAL FACILITY 43
OTHER (SPECIFY) ___ 96

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

YES 1
NO 2 (GO TO 1024)

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

YES 1
NO 2
DON'T KNOW 8

1024. CHECK 1016:

YES (CONTINUE)
NO OR NOT ASKED (GO TO 1027)

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

YES 1 (GO TO 1028)
NO 2

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

MONTHS AGO __ (GO TO 1032A)
TWO OR MORE YEARS 95 (GO TO 1032A)

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

YES 1
NO 2 (GO TO 1031)

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

MONTHS AGO __
TWO OR MORE YEARS 95

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

YES 1
NO 2

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.

NAME OF PLACE ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (GO TO 1032A)
PRIMARY HEALTH CARE CENTER 12 (GO TO 1032A)
OTHER PUBLIC FACILITIES (SPECIFY) ___ 16 (GO TO 1032A)
NON-GOVT. (NGO) SECTOR
FPAN 21 (GO TO 1032A)
MARIE STOPES 22 (GO TO 1032A)
OTHER NGO FACILITIES (SPECIFY) ___ 26 (GO TO 1032A)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME 31 (GO TO 1032A)
PRIVATE CLINIC 32 (GO TO 1032A)
STAND-ALONE HTC/VCT CENTER 33 (GO TO 1032A)
PHARAMACY 34 (GO TO 1032A)
OTHER PRIVATE MEDICAL FACILITIES (SPECIFY) ___ 36 (GO TO 1032A)
OTHER SOURCE
HOME 41
WORKPLACE 42
CORRECTIONAL FACILITY 43
OTHER (SPECIFY) ___ 96

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

YES 1
NO 2 (GO TO 1032A)

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.

NAME OF PLACE __
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
PRIMARY HEALTH CARE CENTER B
OTHER PUBLIC FACILITIES (SPECIFY) ___ D
NON-GOVT. (NGO) SECTOR
FPAN E
MARIE STOPES F
OTHER NGO FACILITIES (SPECIFY) ___ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR H
PRIVATE CLINIC I
STAND-ALONE HTC/VCT CENTER J
PHARMACY K
MOBILE HTC/VCT SERVICES L
OTHER PRIVATE MEDICAL FACILITIES (SPECIFY) ___ M
OTHER (SPECIFY) ___ X

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

YES 1
NO 2 (GO TO 1035)
DON'T KNOW/NOT SURE 8 (GO TO 1035)

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

YES 1
NO 2

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

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

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

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

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?

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

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

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

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

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

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

AGREE 1
DISAGREE 2
DON'T KNOW/NOT SURE/DEPENDS 8

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

YES 1
NO 2
SAYS SHE HAS HIV 3
DON'T KNOW/NOT SURE/DEPENDS 8

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?

YES 1
NO 2

1043. CHECK 713:

HAS HAD SEXUAL INTERCOURSE (CONTINUE)
NEVER HAD SEXUAL INTERCOURSE (GO TO 1051)

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

YES (CONTINUE)
NO (GO TO 1046)

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?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

1048. CHECK 1045, 1046, AND 1047:

HAS HAD AN INFECTION (ANY 'YES') (CONTINUE)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 1051)

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

YES 1
NO 2 (GO TO 1051)

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.

NAME OF PLACE ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
PRIMARY HEALTH CARE CENTER B
HEALTH POST/SUB-HEALTH POST C
PHC OUTREACH CLINIC D
MOBILE CAMP E
SATELLITE CLINIC F
OTHER PUBLIC FACILITIES (SPECIFY) ___ G
NON-GOVT. (NGO) SECTOR
FPAN H
MARIE STOPES I
OTHER NGO FACILITIES (SPECIFY) __ J
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/NURISNG HOME K
PRIVATE CLINIC L
PHARMACY M
OTHER PRIVATE MEDICAL FACILITIES (SPECIFY) ___ N
OTHER SOURCE
SHOP O
OTHER (SPECIFY) ___ X

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?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

1053. CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN (CONTINUE)
NOT IN UNION (GO TO 1101)

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

YES 1
NO 2
DEPENDS/NOT SURE 8

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

YES 1
NO 2
DEPENDS/NOT SURE 8

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.

NUMBER OF INJECTIONS __
NONE 00 (GO TO 1104)

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.

NUMBER OF INJECTIONS __
NONE 00 (GO TO 1104)

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?

YES 1
NO 2
DON'T KNOW 8

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

EVERY DAY 1
SOME DAYS 2 (GO TO 1106)
NOT AT ALL 3 (GO TO 1106)

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

NUMBER OF CIGARETTES __

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

EVERY DAY 1
SOME DAYS 2
NOT AT ALL 3 (GO TO 1107A)

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

PIPES FULL OF TOBACCO/SULPHA, CHILUM A
CIGARS B
WATER PIPE C
SNUFF BY MOUTH D
SNUFF BY NOSE E
CHEWING TOBACCO F
BETEL QUID WITH TOBACCO G
OTHER (SPECIFY) ___ X

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

YES 1
NO 2 (GO TO 1108)

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

COUGH FOR MORE THAN 2 WEEKS A
FEVER IN THE EVENING SB
CHEST PAIN C
LOSS OF WEIGHT D
LOSS OF APPETITE E
HEMOPTYSIS F
OTHER (SPECIFY) ___ X
DON'T KNOW Z

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

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

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

PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
PRIMARY HEALTH CARE CENTER B
HEALTH POST/SUB-HEALTH POST C
PHC OUTREACH CLINIC D
MOBILE CAMP E
FCHV F
OTHER (SEPCIFY) ___ G
NON-GOVT. (NGO) SECTOR
FPAN H
MARIE STOPES I
OTHER NGO FACILITIES (SPECIFY) ___ J
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/NURSING HOME K
PRIVATE CLINIC L
PHARMACY M
OTHER PRIVATE MEDICAL FACILITIES (SPECIFY) __ N
OTHER SOURCE
SHOP O
FRIEND/RELATIVE P
TRADITIONAL HEALER Q
OTHER (SPECFIFY) ___ X
DON'T KNOW Z

1107E. 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/UNSURE 8

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

A) PERMISSION TO GO
BIG PROBLEM 1
NOT A BIG PROBLEM 2
B) GETTING MONEY
BIG PROBLEM 1
NOT A BIG PROBLEM 2
C) DISTANCE
BIG PROBLEM 1
NOT A BIG PROBLEM 2
D) GO ALONE
BIG PROBLEM 1
NOT A BIG PROBLEM 2
E) FEMALE PROVIDER
BIG PROBLEM 1
NOT A BIG PROBLEM 2

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?

A) JANA SWASTHA
YES 1
NO 2
B) JANASANKHYA
YES 1
NO 2
C) JEEVAN CHAKRA
YES 1
NO 2
D) THORAI BHAYA
YES 1
NO 2
E) SATHI SANGA MANKA
YES 1
NO 2
F) BHANCHIN AAMA
YES 1
NO 2
G) BHANDAI SUNDAI
YES 1
NO 2
H) SMART BANCHA JEEVAN
YES 1
NO 2
I) NAVIMALAM
YES 1
NO 2

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

YES 1
NO 2 (GO TO 1201)
DON'T KNOW 8 (GO TO 1201)

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

NUMBER OF MEETINGS __

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

RECEIVED INFORMATION OF CHILD FEEDING A
RECEIVED INFORMATION ON FOOD/COOKING B
RECEIVED INFORMATION ON GARDENING C
RECEIVED INFORMATION ON POULTRY D
RECEIVED INFORMATION ON PROCESSING E
RECEIVED INFORMATION ON REPRODUCTIVE HEALTH/WOMEN'S HEALTH CARE F
WATCH DEMONSTRATION ON COOKING G
DISCUSS ABOUT NUTRITION H
DISCUSS GENDER ISSUES I
DISCUSS ABOUT HANDWASHING J
DISCUSS ABOUT TOILET K
DISCUSS ABOUT FAMILY PLANNING L
DISCUSS ABOUT DIARRHEA M
OTHER (SPECIFY) __ X
DON'T KNOW Z

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

NAME ____

1214. Is (NAME) male or female?

MALE 1
FEMALE 2

1215. Is (NAME) still alive?

YES 1
NO 2 (GO TO 1217)
DK (GO TO NEXT BROTHER OR SISTER)

1216. How old is (NAME)?

___ (GO TO NEXT BROTHER OR SISTER)

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.

AGE ____
(IF MALE OR DIED BEFORE 12 YEARS OF AGE, GO TO 1223)

1219. Was (NAME) pregnant when she died?

YES 1 (GO TO 1223)
NO 2

1220. Did (NAME) die during childbirth?

YES 1 (GO TO NEXT BROTHER/SISTER)
NO 2

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

YES 1
NO 2 (GO TO 1223)

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

___

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

YES 1 (GO TO NEXT BROTHER/SISTER)
NO 2

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

YES 1 (GO TO NEXT BROTHER/SISTER)
NO 2

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

YES 1 (GO TO NEXT, IF NO MORE BROTHERS OR SISTERS, GO TO 1300)
NO 2 (GO TO NEXT, IF NO MORE BROTHERS OR SISTERS, GO TO 1300)

SECTION 13. DOMESTIC VIOLENCE MODULE

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

WOMAN SELECTED FOR THIS SECTION (CONTINUE)
WOMAN NOT SELECTED (GO TO 1333)

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

PRIVACY OBTAINED 1
PRIVACY NOT POSSIBLE 2 (GO TO 1332)

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:

CURRENTLY MARRIED/LIVING WITH A MAN (CONTINUE)
FORMERLY MARRIED/LIVED WITH A MAN (READ IN PAST TENSE AND USE 'LAST' WITH 'HUSBAND/PARTNER') (CONTINUE)
NEVER MARRIED/NEVER LIVED WITH A MAN (GO TO 1316)

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?

JEALOUS
YES 1
NO 2
DK 8
ACCUSES
YES 1
NO 2
DK 8
NOT MEET FRIENDS
YES 1
NO 2
DK 8
NO FAMILY
YES 1
NO 2
DK 8
WHERE YOU ARE
YES 1
NO 2
DK 8

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

a. say or do something to humiliate you in front of others?
YES 1 (GO TO 1304B)
NO 2
B) threaten to hurt or harm you or someone you care about?
YES 1 (GO TO 1304B)
NO 2
c) insult you or make you feel bad about yourself?
YES 1 (GO TO 1304B)
NO 2

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

a. say or do something to humiliate you in front of others?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b. threaten to hurt or harm you or someone you care about?
OFTEN 1 SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c. insult you or make you feel bad about yourself?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

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

a. push you, shake you, or throw something at you?
YES 1 (GO TO 1305B)
NO 2
b. slap you?
YES 1 (GO TO 1305B)
NO 2
c. twist your arm or pull your hair?
YES 1 (GO TO 1305B)
NO 2
d. punch you with his fist or with something that could hurt you?
YES 1 (GO TO 1305B)
NO 2
e. kick you, drag you, or beat you up?
YES 1 (GO TO 1305B)
NO 2
f. try to choke you or burn you on purpose?
YES 1 (GO TO 1305B)
NO 2
g. threaten or attack you with a knife, gun, or other weapon?
YES 1 (GO TO 1305B)
NO 2
h. physically force you to have sexual intercourse with him when you did not want to?
YES 1 (GO TO 1305B)
NO 2
i. physically force you to perform any other sexual acts you did not want to?
YES 1 (GO TO 1305B)
NO 2
j. force you with threats or in any other way to perform sexual acts you did not want to?
YES 1 (GO TO 1305B)
NO 2

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

a. push you, shake you, or throw something at you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b. slap you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c. twist your arm or pull your hair?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
d. punch you with his fist or with something that could hurt you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
e. kick you, drag you, or beat you up?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
f. try to choke you or burn you on purpose?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
g. threaten or attack you with a knife, gun, or other weapon?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
h. physically force you to have sexual intercourse with him when you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
i. physically force you to perform any other sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
j. force you with threats or in any other way to perform sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

1306. CHECK 13051 (A-J):

AT LEAST ONE YES (CONTINUE)
NOT A SINGLE YES (GO TO 1309)

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'.

NUMBER OF YEARS __
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95

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?

YES 1
NO 2

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

YES 1
NO 2

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

YES 1
NO 2

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?

YES 1
NO 2 (GO TO 1311)

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

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

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

YES 1
NO 2 (GO TO 1313)

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

OFTENS 1
SOMETIMES 2
NEVER 3

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

MOST OF THE TIME AFRAID 1
SOMETIMES AFRAID 2
NEVER AFRAID 3

1314. CHECK 709:

MARRIED MORE THAN ONCE (CONTINUE)
MARRIED ONLY ONCE (GO TO 1316)

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).

a. Did any previous (husband/partner) ever hit, slap, kick, or do anything else to hurt you physically?
YES 1 (GO TO 1315B)
NO 2
b. Did any previous (husband/partner) physically force you to have intercourse or perform any other sexual acts against your will?
YES 1 (GO TO 1315B)
NO 2

1315B. How long ago did this happen?

a. Did any previous (husband/partner) ever hit, slap, kick, or do anything to hurt you physically?
0-11 MONTHS AGO 1
12 OR MORE MONTHS AGO 2
DON'T REMEMBER 3
b. Did any previous (husband/partner) physically force you to have intercourse or perform any other sexual acts against your will?
0-11 MONTHS AGO 1
12 OR MORE MONTHS AGO 2
DON'T REMEMBER 3

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?

YES 1
NO 2 (GO TO 1319)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1319)

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

MOTHER/STEP-MOTHER A
FATHER/STEP-FATHER B
SISTER/BROTHER C
DAUGHTER/SON D
OTHER RELATIVE E
CURRENT BOYFRIEND F
FORMER BOYFRIEND G
MOTHER-IN-LAW H
FATHER-IN-LAW I
OTHER IN-LAW J
TEACHER K
EMPLOYER/SOMEONE AT WORK L
POLICE/SOLDIER M
OTHER (SPECIFY) ___ X

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

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1319. CHECK 201, 207AA, AND 226:

EVER BEEN PREGNANT (YES ON 201 OR 207AA OR 226) (CONTINUE)
NEVER BEEN PREGNANT (GO TO 1322)

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

YES 1
NO 2 (GO TO 1322)

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

CURRENT HUSBAND/PARTNER A
MOTHER/STEP-MOTHER B
FATHER/STEP-MOTHER C
SISTER/BROTHER D
DAUGHTER/SON E
OTHER RELATIVE F
FORMER HUSBAND/PARTNER G
CURRENT BOYFRIEND H
FORMER BOYFRIEND I
MOTHER-IN-LAW J
FATHER-IN-LAW K
OTHER IN-LAW L
TEACHER M
EMPLOYER/SOMEONE AT WORK N
POLICE/SOLDIER O
OTHER (SPECIFY) ___ X

1322. CHECK 701 AND 702:

EVER MARRIED/EVER LIVED WITH A MAN (CONTINUE)
NEVER MARRIED/NEVER LIVED WITH A MAN (GO TO 1322B)

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?

YES 1 (GO TO 1323)
NO 2 (GO TO 1324A)
REFUSED TO ANSWER/NO ANSWER (GO TO 1324A)

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?

YES 1
NO 2 (GO TO 1326)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1326)

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

CURRENT HUSBAND/PARTNER 01
FORMER HUSBAND/PARTNER 02
CURRENT/FORMER BOYFRIEND 03
FATHER/STEP FATHER 04
BROTHER/STEP BROTHER 15
OTHER RELATIVE 06
IN-LAW 07
OWN FRIEND/ACQUAINTANCE 08
FAMILY FRIEND 09
TEACHER 10
EMPLOYER/SOMEONE AT WORK 11
POLICE/SOLDIER 12
PRIEST/RELIGIOUS LEADER 13
STRANGER 14
OTHER (SPECIFY) ___ 96

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?

YES 1 (GO TO 1325)
NO 2 (GO TO 1325)

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

AT LEAST ONE YES (CONTINUE)
NOT A SINGLE YES (GO TO 1326)

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?

AGE IN COMPLETED YEARS __
DON'T KNOW 98

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

AT LEAST ONE YES (CONTINUE)
NOT A SINGLE YES (GO TO 1330)

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

YES 1
NO 2 (GO TO 1329)

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

OWN FAMILY A (GO TO 1330)
HUSBAND'S/PARTNER'S FAMILY B (GO TO 1330)
CURRENT/FORMER HUSBAND/PARTNER C (GO TO 1330)
CURRENT/FORMER BOYFRIEND D (GO TO 1330)
FRIEND E (GO TO 1330)
NEIGHBOR F (GO TO 1330)
RELIGIOUS LEADER G (GO TO 1330)
DOCTOR/MEDICAL PERSONNEL H (GO TO 1330)
POLICE I (GO TO 1330)
LAWYER J (GO TO 1330)
SOCIAL SERVICE ORGANIZATION K (GO TO 1330)
GBV WATCH GROUP L (GO TO 1330)
MOTHER'S GROUP M (GO TO 1330)
ONE STOP CRISIS MANAGEMENT CENTER N (GO TO 1330)
OTHER (SPECIFY) ___ X (GO TO 1330)

1329. Have you ever told anyone about this?

YES 1
NO 2

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

YES 1
NO 2
DON'T KNOW 8

1330AA. CHECK 701 AND 702:

EVER MARRIED/EVER LIVED WITH A MAN (CONTINUE)
NEVER MARRIED/NEVER LIVED WITH A MAN (GO TO 1331)

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?

A) NOT ENOUGH TO EAT
YES 1
NO 2
B) NOT CARED WHEN ILL
YES 1
NO 2
C) FORCED ABORTION
YES 1
NO 2
D) THREATENED DIVORCE
YES 1
NO 2
E) FORCED DIVORCE
YES 1
NO 2
F) ABUSED FOR NO SON
YES 1
NO 2
G) USING FAMILY PLANNING
YES 1
NO 2

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?

HUSBAND
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3
OTHER MALE ADULT
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3
FEMALE ADULT
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3

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.

YES 1
NO 2

1333. RECORD THE TIME.

HOURS ___
MINUTES ___

INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT INTERVIEW:

_____
_____
_____

COMMENTS ON SPECIFIC QUESTIONS:

_____
_____
_____

ANY OTHER COMMENTS:

_____
_____
_____
SUPERVISOR'S OBSERVATIONS
____
____
____