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NEPAL DEMOGRAPHIC AND HEALTH SURVEY 2016 MAN'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 MAN

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 30 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 DOES NOT AGREE TO BE INTERVIEWED 2 (END)

SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD 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 CAN'T 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 IMPARED 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 transactions?

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?

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

123. What is your caste/ethnicity?

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

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

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

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

YES 1
NO 2 (GO TO 204)

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

SONS AT HOME ___
DAUGHTERS AT HOME ___

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

YES 1
NO 2 (GO TO 206)

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

SONS ELSEWHERE___
DAUGHTERS ELSEWHERE ___

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

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

BOYS DEAD___
GIRLS DEAD___

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

TOTAL CHILDREN___

209. CHECK 208:

HAS MORE THAN ONCE CHILD (CONTINUE)
HAS NOT HAD ANY CHILDREN (GO TO 301)
HAS ONLY ONE CHILD (GO TO 211)

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

YES 1
NO 2

211. CHECK 208:
HAS MORE THAN ONE CHILD:
How old were you when your first child was born?

HAS ONLY ONE CHILD:
How old were you when your child was born?

AGE IN YEARS___

212. CHECK 203 AND 205:

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

213. CHECK 203 AND 205:
MORE THAN ONE LIVING CHILD:
How old is your youngest child?

ONLY ONE LIVING CHILD:
How old is your child?

AGE IN YEARS____

214. CHECK 213:

(YOUNGEST) CHILD IS AGE 0-2 YEARS (CONTINUE)
(YOUNGEST) CHILD IS AGE 3 OR OLDER (GO TO 301)

215. CHECK 203 AND 205:
MORE THAN ONE LIVING CHILD:
What is the name of your youngest child?

ONLY ONE LIVING CHILD:
What is the name of your child?

NAME OF (YOUNGEST) CHILD_____

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

YES 1
NO 2 (GO TO 218)
DON'T KNOW 8 (GO TO 218)

217. Were you ever present during any of those antenatal check-ups?

PRESENT 1
NOT PRESENT 2

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

HOSPITAL/HEALTH FACILITY 1
OTHER 2

219. When a child has diarrhea, how much should he or she be given to drink: more than usual, about the same as usual, less than usual, or nothing to drink at all?

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

SECTION 3. CONTRACEPTION

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 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 can 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. 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?

RADIO

YES 1
NO 2

TELEVISION

YES 1
NO 2

NEWSPAPER OR MAGAZINE

YES 1
NO 2

MOBILE PHONE

YES 1
NO 2

BROCHURE OR FLIPCHART

YES 1
NO 2

POSTER, HOARDING BOARD

YES 1
NO 2

INTERNET/WEBSITE

YES 1
NO 2

STREET DRAMA

YES 1
NO 2

MOTHER'S GROUP/TEACHERS

YES 1
NO 2

FCHV

YES 1
NO 2

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

YES 1
NO 2

304. Now I would like to ask you about a woman's risk of pregnancy. From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant when she has sexual relations?

YES 1
NO 2 (GO TO 306)
DON'T KNOW (GO TO 306)

305. 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

306. 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

307. I will now read you some statements about contraception. Please tell me if you agree or disagree with each one.
a) Contraception is a woman's concern and a man should not have to worry about it.
b) Women who use contraception may become promiscuous.

a) CONTRACEPTION WOMAN'S CONCERN

AGREE 1
DISAGREE 2
DK 8

b) WOMEN MAY BECOME PROMISCUOUS

AGREE 1
DISAGREE 2
DK 8

SECTION 4. MARRIAGE AND SEXUAL ACTIVITY

401. Are you currently married or living together with a woman as if married?

YES, CURRENTLY MARRIED 1 (GO TO 404)
YES, LIVING WITH A WOMAN 2 (GO TO 404)
NO, NOT IN UNION 3

402. Have you ever been married or lived together with a woman as if married?

YES, FORMERLY MARRIED 1
YES, LIVED WITH A WOMAN 2
NO (GO TO 413)

403. What is your marital status now; are you widowed, divorced, or separated?

WIDOWED 1 (GO TO 410)
DIVORCED 2 (GO TO 410)
SEPARATED 3 (GO TO 410)

404. Is your (wife/partner) living with you now or is she staying elsewhere?

LIVING WITH HIM 1
STAYING ELSEWHERE 2

405. Do you have other wives or do you live with other women as if married?

YES (MOR ETHAN ONE WIFE) 1
NO (ONLY ONE WIFE) 2 (GO TO 407)

406. Altogether, how many wives or live-in partners do you have?

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNERS ____

407. CHECK 405:
ONE WIFE/PARTNER
a) Please tell me the name of (your wife/the woman you are living with as if married)

MORE THAN ONE WIFE/PARTNER
b) Please tell me the name of each of your wives or each woman you are living with as if married.

RECORD THE NAME AND THE LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH WIFE AND LIVE-IN PARTNER. IF A WOMAN IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'. ASK 408 FOR EACH PERSON.

NAME____
LINE NO. _____

408. How old was (NAME) on her last birthday?

AGE ____

409. CHECK 407:

ONE WIFE/PARTNER (CONTINUE)
MORE THAN ONE WIFE/PARTNER (GO TO 411)

410. Have you been married or lived with a woman only once or more than once?

MORE THAN ONCE 1
ONLY ONCE 2

411. CHECK 405 AND 410:
BOTH ARE CODE '2':
a) In what month and year did you start living with your (wife/partner)?

OTHER:
b) Now I would like to ask about your first (wife/partner). In what month and year did you start living with her?

MONTH___
DON'T KNOW MONTH 98
YEAR____ (GO TO 413)
DON'T KNOW YEAR 9998

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

AGE ___

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

414. 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 501)
AGE IN YEARS ___

415. Now 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 417)
WEEKS AGO 2 (GO TO 417)
MONTHS AGO 3 (GO TO 417)
YEARS AGO 4 (GO TO 427)

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

DAYS AGO 1
WEEKS AGO 2
MONTHS AGO 3

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

YES 1
NO 2 (SKIP TO 419)

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

YES 1
NO 2

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

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

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

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

421. 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 ___

422. How old is this person?

AGE OF PARTNER___
DON'T KNOW 98

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

YES 1 (GO BACK TO 416 IN NEXT COLUMN)
NO 2 (SKIP TO 425)

424. 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 IN LAST 12 MONTHS____
DON'T KNOW 98

425. CHECK 419 (ALL COLUMNS):

AT LEAST ONE PARTNER IS A SEX WORKER (CONTINUE)
NO PARTNERS ARE SEX WORKERS (GO TO 427)

426. CHECK 419 AND 417 (ALL COLUMNS):

CONDOM USED WITH EVERY SEX WORKER (GO TO 430)
OTHER (GO TO 431)

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

YES 1 (GO TO 429)
NO 2

428. Have you ever paid anyone in exchange for having sexual intercourse?

YES 1 (GO TO 431)
NO 2 (GO TO 431)

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

YES 1
NO 2 (GO TO 431)

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

YES 1
NO 2
DON'T KNOW 8

431. In the past 12 months have you given any gifts or other goods in order to have sex or to become sexually involved with anyone?

YES 1 (GO TO 433)
NO 2

432. Have you ever given any gifts or other goods in order to have sex or to become sexually involved with anyone?

YES 1
NO 2

433. 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

434. CHECK 417: MOST RECENT PARTNER (FIRST COLUMN)

CONDOM USED (CONTINUE)
NO CONDOM USED (GO TO 438)
NOT ASKED (GO TO 438)

435. 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

436. 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
SATELLITE CLINIC 17
OTHER PUBLIC SECTOR (SPECIFY)___ 18
NON-GOVT. (NGO) SECTOR
FPAN 21
MARIE STOPES 22
OTHER NGO SECTOR (SPECIFY) ___ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/NURSING HOME 31
PRIVATE CLINIC 32
PHARMACY 33
SANGINI OUTLET 34
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ___ 36
OTHER SOURCE
SHOP 41
FRIEND/RELATIVE 42
OTHER (SPECIFY) ____ 96
DON'T KNOW 98

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

YES 1 (GO TO 439)
NO 2 (GO TO 440)
DON'T KNOW 8 (GO TO 440)

438. The last time you had sex did you or your partner use any method to avoid or prevent a pregnancy?

YES 1
NO 2 (GO TO 440)
DON'T KNOW 8 (GO TO 440)

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

FEMALE STERILIZATION A (GO TO 501)
MALE STERILIZATION B (GO TO 501)
IUD C (GO TO 501)
INJECTABLES D (GO TO 501)
IMPLANTS E (GO TO 501)
PILL F (GO TO 501)
CONODOM G (GO TO 501)
EMERGENCY CONTRACEPTION I (GO TO 501)
LACTATIONAL AMENORRHEA METHOD K (GO TO 501)
RHYTHM METHOD L (GO TO 501)
WITHDRAWAL M (GO TO 501)
OTHER MODERN METHOD X (GO TO 501)
OTHER TRADITIONAL METHOD Y (GO TO 501)

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

YES 1
NO 2

SECTION 5. FERTILITY PREFERENCES

510. Now I have some questions about the future. After the (child/children) you and your (wives/partners) are expecting now, would you like to have another child, or would you prefer to not have any more children?

HAVE ANOTHER CHILD 1
NO MORE 2 (GO TO 514)
UNDECIDED/DON'T KNOW 8 (GO TO 514)

511. After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?

MONTHS 1 __ (GO TO 514)
YEARS 2 ___ (GO TO 514)
SOON/NOW 993 (GO TO 514)
OTHER (SPECIFY) ___ 996 (GO TO 514)
DON'T KNOW 998 (GO TO 514)

512. CHECK 208:
HAS FATHERED CHILDREN
a) Now I have some questions about the future. Would you like to have another child, or would you prefer not to have any more children?

HAS NOT FATHERED CHILDREN
b) Now I have some questions about the future. Would you like to have a child, or would you prefer not to have any children?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 514)
SAYS COUPLE CAN'T GET PREGNANT 3 (GO TO 514)
(WIFE/WIVES/PARTNER(S)) STERILIZED 4 (GO TO 514)
UNDECIDED/DON'T KNOW 8 (GO TO 514)

513. CHECK 208:
HAS FATHERED CHILDREN
a) How long would you like to wait from now before the birth of another child?

HAS NOT FATHERED CHILDREN
b) How long would you like to wait from now before the birth of a child?

MONTHS 1 __
YEARS 2 __
SOON/NOW 993
SAYS COUPLE CAN'T GET PREGNANT 994
OTHER (SPECIFY) ___ 996
DON'T KNOW 998

514. CHECK 203 AND 205:
HAS LIVING CHILDREN
a) 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
b) 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 601)
NUMBER __
OTHER (SPECIFY) ___ 96 (GO TO 601)

515. 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?

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

SECTION 6. EMPLOYMENT AND GENDER ROLES

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

YES 1 (GO TO 604)
NO 2

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

YES 1 (GO TO 604)
NO 2

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

YES 1
NO 2 (GO TO 606A)

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

___

605. 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

606. 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

606A. 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

607. CHECK 401:

CURRENTLY MARRIED OR LIVING WITH A PARTNER (CONTINUE)
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER (GO TO 612)

608. CHECK 606:

CODE '1' OR '2' CIRCLED (CONTINUE)
OTHER (GO TO 610)

609. Who usually decides how the money you earn will be used; you, your (wife/partner) or you and your (wife/partner) jointly?

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

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

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

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

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

611A. Who usually makes decisions about your children's education?

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

612. 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 615)

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

YES 1
NO 2
DON'T KNOW 8

615. 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 JOINLY 3
DOES NOT OWN 4 (GO TO 618)

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

YES 1
NO 2
DON'T KNOW 8

618. 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?

GOES OUT
YES 1
NO 2
DK 8
NEGLECTS CHILDREN
YES 1
NO 2
DK 8
ARGUES
YES 1
NO 2
DK 8
REFUSES SEX
YES 1
NO 2
DK 8
BURNS FOOD
YES 1
NO 2
DK 8
LESS/NO DOWRY
YES 1
NO 2
DK 8

SECTION 7. HIV/AIDS

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

YES 1
NO 2 (GO TO 727)

702. 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

703. Can people get HIV from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

704. 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

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

708. Can HIV be transmitted from a mother to her baby:
a) During pregnancy?
b) During delivery?
c) By breast feeding?

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

709. CHECK 708:

AT LEAST ONE 'YES' (CONTINUE)
OTHER (GO TO 711)

710. 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

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

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

YES 1
NO 2 (GO TO 716)

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

MONTHS AGO ___
TWO OR MORE YEARS 95

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

YES 1
NO 2

715. 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 717A)
PRIMARY HEALTH CARE CENTER 12 (GO TO 717A)
OTHER PUBLIC FACILITIES (SPECIFY) ___ 16 (GO TO 717A)
NON-GOVT. (NGO) SECTOR (GO TO 717A)
FPAN 21 (GO TO 717A)
MARIE STOPES 22 (GO TO 717A)
OTHER NGO FACILITIES (SPECIFY) ___ 26 (GO TO 717A)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/NURSING HOME 31 (GO TO 717A)
PRIVATE CLINIC 32 (GO TO 717A)
STAND-ALONE HTC/VCT CENTER 33 (GO TO 717A)
PHARMACY 34 (GO TO 717A)
MOBILE HTC/VCT SERVICES 35 (GO TO 717A)
OTHER PRIVATE MEDICAL FACILITIES (SPECIFY)___ 36 (GO TO 717A)
OTHER SOURCE
HOME 41 (GO TO 717A)
WORKPLACE 42 (GO TO 717A)
CORRECTIONAL FACILITY 43 (GO TO 717A)
OTHER (SPECIFY) ___ 96 (GO TO 717A)

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

YES 1
NO 2 (GO TO 717A)

717. 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 CENTER B
OTHER PUBLIC FACILITIES (SPECIFY) ___ D
NON-GOVT. (NGO) SECTOR
FPAN 3
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

717A. Do you think there is a treatment for HIV?

YES 1
NO 2 (GO TO 720)
DON'T KNOW/NOT SURE 8 (GO TO 720)

717B. Do you know from where HIV treatment (Anti-Retroviral Treatment) can be received?

YES 1
NO 2

720. 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

721. 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

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

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

723. 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

724. 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

725. 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

726. 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 HE HAS HIV 3
DON'T KNOW/NOT SURE/DEPENDS 8

727. CHECK 701:
HEARD ABOUT HIV OR AIDS
a) Apart from HIV, have you heard about other infections that can be transmitted through sexual contact?

NOT HEARD ABOUT HIV OR AIDS
b) Have you heard about infections that can be transmitted through sexual contact?

YES 1
NO 2

728. CHECK 414:

HAS HAD SEXUAL INTERCOURSE (CONTINUE)
NEVER HAD SEXUAL INTERCOURSE (GO TO 736)

729. CHECK 727: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES (CONTINUE)
NO (GO TO 731)

730. 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

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

733. CHECK 730, 731 AND 732:

HAS HAD AN INFECTION (ANY 'YES') (CONTINUE)
HAS NOT HAD AN INFECTION OR DOESN'T KNOW (GO TO 736)

734. The last time you had (PROBLEM FROM 730/731/732) did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 736)

735. 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/SUBHEALTH 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/NURSING HOME K
PRIVATE CLINIC L
PHARMACY M
OTHER PRIVATE MEDICAL FACILITIES (SPECIFY) ___ N
OTHER SOURCE
SHOP O
OTHER (SPECIFY) ___ X

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

YES 1
NO 2
DON'T KNOW 8

737. 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

SECTION 8. OTHER HEALTH ISSUES

805. 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 808)

806. 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 808)

807. 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

808. Do you currently smoke tobacco every day, some days, or not at all?

EVERY DAY 1 (GO TO 811)
SOME DAYS 2
NOT AT ALL 3 (GO TO 810)

809. In the past, have you smoked tobacco every day?

YES 1 (GO TO 812)
NO 2 (GO TO 812)

810. In the past, have you ever smoked tobacco every day, some days, or not at all?

EVERY DAY 1 (GO TO 813)
SOME DAYS 2 (GO TO 813)
NOT AT ALL 3 (GO TO 813)

811. On average, how many of the following products do you currently smoke each day? Also, let me know if you use the product, but not every day.
IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY DAY, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.
a) Manufactured cigarettes?
b) Hand-rolled cigarettes?
d) Pipes full of tobacco?
e) Cigars, cheroots, or cigarillos?
f) Number of water pipe sessions?
g) Any others? (SPECIFY) ___

A) MANUFACTURED CIGARETTES
NUMBER DAILYS ___ (GO TO 813)
B) HAND-ROLLED CIGARETTES
NUMBER DAILYS ___ (GO TO 813)
D) PIPES FULL OF TOBACCO
NUMBER DAILYS ___ (GO TO 813)
E) CIGARS, CHEROOTS, OR CIGARILLOS
NUMBER DAILYS ___ (GO TO 813)
F) NUMBER OF WATER PIPE SESSIONS
NUMBER DAILYS ___ (GO TO 813)
G) OTHERS
NUMBER DAILYS ___ (GO TO 813)

812. On average, how many of the following products do you currently smoke each week? Also, let me know if you use the product, but not every week.
IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY WEEK, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.
a) Manufactured cigarettes?
b) Hand-rolled cigarettes?
d) Pipes full of tobacco?
e) Cigars, cheroots, or cigarillos?
f) Number of water pipe sessions?
g) Any others? (SPECIFY) ___

A) MANUFACTURED CIGARETTES
NUMBER WEEKLY ___
B) HAND-ROLLED CIGARETTES
NUMBER WEEKLY ___
D) PIPES FULL OF TOBACCO
NUMBER WEEKLY ___
E) CIGARS, CHEROOTS, OR CIGARILLOS
NUMBER WEEKLY ___
F) NUMBER OF WATER PIPE SESSIONS
NUMBER WEEKLY ___
G) OTHERS
NUMBER WEEKLY ___

813. Do you currently use smokeless tobacco every day, some days, or not at all?

EVERY DAY 1
SOME DAYS (GO TO 815)
NOT AT ALL 3 (GO TO 815F)

814. On average, how many times a day do you use the following products? Also, let me know if you use the product, but not every day.
IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY DAY, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.
a) Snuff, by mouth?
b) Snuff, by nose?
c) Chewing tobacco?
d) Betel quid with tobacco?
e) Any others? (SPECIFY) ___

A) SNUFF, BY MOUTH
TIMES DAILY ___ (GO TO 815F)
B) SNUFF, BY NOSE
TIMES DAILY ___ (GO TO 815F)
C) CHEWING TOBACCO
TIMES DAILY ___ (GO TO 815F)
D) BETEL QUID WITH TOBACCO
TIMES DAILY ___ (GO TO 815F)
E) ANY OTHERS
TIMES DAILY ___ (GO TO 815F)

815. On average, how many times a week do you use the following products? Also, let me know if you use the product, but not every week.
IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY WEEK, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.
a) Snuff, by mouth?
b) Snuff, by nose?
c) Chewing tobacco?
d) Betel quid with tobacco?
e) Any others? (SPECIFY) ___

A) SNUFF, BY MOUTH
TIMES WEEKLY ___
B) SNUFF, BY NOSE
TIMES WEEKLY ___
C) CHEWING TOBACCO
TIMES WEEKLY ___
D) BETEL QUID WITH TOBACCO
TIMES WEEKLY ___
E) ANY OTHERS
TIMES WEEKLY ___

815F. Have you ever heard of an illness called tuberculosis or TB?

YES 1
NO 2 (GO TO 815K)

815G. What are the common symptoms of TB? RECORD ALL MENTIONED

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

815H. How does tuberculosis spread from one person to another? RECORD ALL MENTIONED

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

815I. 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 (SPECIFY) __ 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 (SPECIFY) ___ X
DON'T KNOW Z

815J. 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

815K. 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

818 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

____