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PAKISTAN DEMOGRAPHIC AND HEALTHY SURVEY
WOMAN'S QUESTIONNAIRE - URDU-ENGLISH

IDENTIFICATION

PLACE NAME_______________
NAME OF HOUSEHOLD____________
PROVINCE ____

URBAN/RURAL

URBAN 1
RURAL 2

MAJOR CITY/DIVISION/DISTRICT ____
CLUSTER NUMBER ___
HOUSEHOLD NUMBER ___

MAJOR CITY/SMALL CITY, TOWN/VILLAGE

MAJOR CITY 1
SMALL CITY, TOWN 2
VILLAGE 3

NAME AND LINE NUMBER OF WOMEN______________
NAME AND LINE NUMBER OF HUSBAND (IF ELIGIBLE)

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)

INTERVIEWER'S NAME: ______
DATE: ______
RESULT* _____

*RESULT CODES

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

NEXT VISIT:
DATE _____
TIME ______

FINAL VISIT:
DAY ____
MONTH ___
YEAR ____
NAME ____
RESULT ____

TOTAL NUMBER OF VISITS ______

LANGUAGE OF QUESTIONNAIRE:

01 URDU
02 PUNJABI
03 SINDHI
04 PUSHTO
05 BALUCHI
06 BROHI
07 SIRAIKI
08 OTHER (SPECIFY) _______

LANGUAGE OF INTERVIEW:

01 URDU
02 PUNJABI
03 SINDHI
04 PUSHTO
05 BALUCHI
06 BROHI
07 SIRAIKI
08 OTHER (SPECIFY) _______

NATIVE LANGUAGE OF RESPONDENT:

01 URDU
02 PUNJABI
03 SINDHI
04 PUSHTO
05 BALUCHI
06 BROHI
07 SIRAIKI
08 OTHER (SPECIFY) _______

TRANSLATOR USED

YES 1
NO 2

FIELD EDITED BY
NAME _____
DATE _____

OFFICE EDITED BY
NAME _____
DATE _____

KEYED BY
NAME _____
DATE _____

KEYED BY ____

QUESTIONS AND FILTERS

101. RECORD THE CURRENT TIME

HOURS____
MINUTES____

102. First, I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in a city or a village?

CITY 1
VILLAGE 2

103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?

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

104. Just before you moved here, did you live in a city or in a village?

CITY 1
VILLAGE 2

105. In what month and year were you born?

MONTH_________
DON'T KNOW MONTH 98
YEAR__________
DON'T KNOW YEAR 98

106. How old are you in completed years?

AGE IN COMPLETED YEARS___________

107. Are you now married, widowed, divorced, or separated?

MARRIED 1
HAS MARRIAGE CONTRACT, BUT NEVER LIVED TOGETHER 2
WIDOWED 3
DIVORCED 4
SEPARATED 5
NEVER MARRIED 6 (END INTERVIEW)

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

ONCE 1
MORE THAN ONCE 2

109. CHECK 107 AND 108:

MARRIED ONCE AND NEVER LIVED WITH HUSBAND (END INTERVIEW)
ANY OTHER MARITAL STATUS (GO TO 110)

110. Have you ever attended school?

YES 1
NO 2 (GO TO 114)

111. What is the highest level of school you attended?

PRIMARY 1
MIDDLE 2
SECONDARY 3
HIGHER 4

112. What is the highest class you completed at that level?

CLASS______________

113. CHECK 111:

PRIMARY (GO TO 114)
MIDDLE OR ABOVE (GO TO 116)

114. Can you read and understand a letter or newspaper easily, with difficulty, or not at all?

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 117)

115. Can you write a simple letter?

YES 1
NO 2

116. Do you usually read a newspaper or magazine at least once a week?

YES 1
NO 2

117. Do you usually listen to a radio at least once a week?

YES 1
NO 2

118. Do you usually live watch television at least once a week?

YES 1
NO 2

119. CHECK HOUSEHOLD QUESTIONNAIRE, COLUMN (4):

WOMAN IS A VISITOR (CODED '2' IN COL. 4) (GO TO 120)
WOMAN IS USUAL RESIDENT (CODED '1' IN COL. 4) (GO TO 201)

120. Now let's talk about the household where you usually live. What is the source of water your household uses for handwashing and dishwashing?

PIPED INTO RESIDENCE 01
PIPED INTO PROPERTY 02
PUBLIC TAP 03
WELL WITH HANDPUMP/TUBE WELL 04
WELL WITHOUT PUMP 05
RIVER, KAREZ, SPRING, CANAL, SURFACE WATER 06
TANKER TRUCK, OTHER VENDOR 07
RAINWATER 08
OTHER_________________ 09

121. How long does it take to go there, get water, and come back?

MINUTES________
ON PREMISES 996

122. Does your household get drinking water from this same source?

YES 1 (GO TO 124)
NO 2

123. What is the source of drinking water for members of your household?

PIPED INTO RESIDENCE 01
PIPED INTO PROPERTY 02
PUBLIC TAP 03
WELL WITH HANDPUMP/TUBE WELL 04
WELL WITHOUT PUMP 05
RIVER, KAREZ, SPRING, CANAL, SURFACE WATER 06
TANKER TRUCK, OTHER VENDOR 07
RAINWATER 08
OTHER_________________ 09

124. What kind of toilet facility does your household have?

FLUSH 1
BUCKET 2
PIT 3
OTHER _______4

125. Does your household have:

ELECTRICITY
YES 1
NO 2
A RADIO
YES 1
NO 2
A TELEVISION
YES 1
NO 2
A FRIDGE
YES 1
NO 2
A ROOM COOLER
YES 1
NO 2
WASHING MACHINE
YES 1
NO 2
WATER PUMP
YES 1
NO 2

126. Does any member of your household own:

A BICYCLE
YES 1
NO 2
A MOTORCYCLE
YES 1
NO 2
A CAR, VAN, TRACTOR
YES 1
NO 2

127. How many rooms in your household are used for sleeping?

ROOMS__________

128. What material are the outer walls of your house made of?

BAKED BRICKS/CEMEMTED BLOCKS/CEMENT 1
UNBAKED BRICKS AND MUD 2
WOOD/BAMBOO 3
OTHER__________ 4

129. What material is the roof of your house made of?

RCC/RBC 1
T-IRON/WOOD/BRICK 2
ASBESTOS/IRON SHEETS 3
WOOD/BAMBOO 4
OTHER__________5

130. What province do you usually live in?

PUNJAB 1
SINDH 2
NWFP 3
BALUCHISTAN 4
ISLAMABAD 5
OTHER AREAS OF PAKISTAN 6
OUTSIDE PAKISTAN 7

131. Is the place that you usually live a city or a village?

CITY 1
VILLAGE 2

SECTION 2: REPRODUCTION

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

SONS AT HOME___________
DAUGHTERS AT HOME__________

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

YES 1
NO 2 (GO TO 206)

205. How many sons are alive but do not live with you? And how many daughters are alive but do not live with you?

SONS ELSEWHERE_______
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 or showed any sign of life but only survived a few hours or days?

YES 1
NO 2 (GO TO 208)

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

BOYS DEAD_________
GIRLS DEAD__________

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

TOTAL_____________

209. CHECK 208: Just to make sure that I have this right: you have had in TOTAL_______ live births during your life. Is that correct?

YES (GO TO 210)
NO (PROBE AND CORRECT 201-209 AS NECESSARY)

210. CHECK 208:

ONE OR MORE BIRTHS (GO TO 211)
NO BIRTHS (GO TO 223)

211. Now I would like to talk to you about all of your births, whether still alive or not, starting with the first one you had. (RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES).

212. What name was given to your (first, next) baby?

LINE NO. ____________

213. RECORD SINGLE OR MULTIPLE BIRTH STATUS

SING 1
MULT 2

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

BOY 1
GIRL 2

215. In what month and year was (NAME) born? PROBE: What is his/her birthday? OR: In what season was he/she born?

MONTH_______
YEAR_________

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

217. IF ALIVE: How old is (NAME) in completed years?

AGE IN YEARS__________

218. IF ALIVE: Is (NAME) living with you?

YES 1 (GO TO NEXT BIRTH)
NO 2

219. IF LESS THAN 15 YRS. OF AGE: With whom does he/she live? (IF AGE 15+: GO TO NEXT BIRTH)

FATHER 1 (NEXT BIRTH)
OTHER RELATIVE 2 (NEXT BIRTH)
SOMEONE ELSE 3 (NEXT BIRTH)

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

DAYS 1__________
MONTHS 2_________
YEARS 3___________

221. COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:

NUMBERS ARE THE SAME: CHECK:
FOR EACH LIVE BIRTH: YEAR OF BIRTH IS RECORDED
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED
FOR EACH BIRTH INTERVAL UNDER 3 YEARS, EXPLANATION IS GIVEN
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED
FOR AGE AT DEATH 1 YEAR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

222. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1986, IF NONE ENTER '0'.

NUMBER OF BIRTHS _________

223. CHECK 107:

CURRENTLY MARRIED (CODE 1 IN 107) (GO TO 224)
NOT CURRENTLY MARRIED (CODE 2-5 IN 107) (GO TO 227)

224. Are you pregnant now?

YES 1
NO 2
UNSURE 8 (GO TO 227)

225. How many months pregnant are you?

MONTHS_________

226. At the time you became pregnant, did you want to become pregnant then, did you want to wait until later, or did you not want to become pregnant at all?

THEN 1
LATER 2
NOT AT ALL 3

227. When did your last menstrual period start?

DAYS AGO 1 ____
WEEKS AGO 2 _____
MONTHS AGO 3 _______
YEARS AGO 4 ________
IN MENOPAUSE 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

228. Between the first day of a woman's period and the first of her next period, are there certain times when she has a greater chance of becoming pregnant than other times?

YES 1
NO 2 (GO TO 301)
DON'T KNOW 3 (GO TO 301)

229. During which times of the month does a woman have the greatest chance of becoming pregnant?

DURING HER PERIOD 1
RIGHT AFTER HER PERIOD HAS ENDED 2
IN THE MIDDLE OF THE CYCLE 3
JUST BEFORE HER PERIOD BEGINS
AT ANY TIME 5
OTHER________ 6
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. Which ways or methods have you heard about?
CIRCLE CODE 1 IN 302 FOR EACH METHOD MENTIONED SPONTANEOUSLY.
THEN PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.
CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED.
THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 302, ASK 303-304 BEFORE PROCEEDING TO THE NEXT METHOD.

302. Have you ever heard of (METHOD)?
READ DESCRIPTION OF EACH METHOD

01. PILL, women can take a pill every day.
YES, SPONTANEOUS 1
YES, PROBED 2
NO 3
02. IUD, Women can have a loop or coil placed inside them by a doctor or a nurse.
YES, SPONTANEOUS 1
YES, PROBED 2
NO 3
03. INJECTIONS, Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES, SPONTANEOUS 1
YES, PROBED 2
NO 3
04. DIAPHRAGM, FDAM, JELLY, Women can place a sponge, suppository, diaphragm, jelly, or cream in side them before intercourse.
YES, SPONTANEOUS 1
YES, PROBED 2
NO 3
05. CONDOM, Men can use a rubber sheath during sexual intercourse.
YES, SPONTANEOUS 1
YES, PROBED 2
NO 3
06. FEMALE STERILIZATION, Women can have an operation to avoid having any more children.
YES, SPONTANEOUS 1
YES, PROBED 2
NO 3
07. MALE STERILIZATION, Men can have an operation to avoid having any more children.
YES, SPONTANEOUS 1
YES, PROBED 2
NO 3
08. PERIODIC ABSTINENCE, Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant.
YES, SPONTANEOUS 1
YES, PROBED 2
NO 3
09. WITHDRAWAL, men can be careful and pull out before climax.
YES, SPONTANEOUS 1
YES, PROBED 2
NO 3
10. Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES, SPONTANEOUS 1 (SPECIFY) ______
NO 2

303. Have you ever used (METHOD)?

01. PILL, women can take a pill every day.
YES 1
NO 2
02. IUD, Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
03. INJECTIONS, Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO 2
04. DIAPHRAGM, FDAM, JELLY, Women can place a sponge, suppository, diaphragm, jelly, or cream in side them before intercourse.
YES 1
NO 2
05. CONDOM, Men can use a rubber sheath during sexual intercourse.
YES 1
NO 2
06. FEMALE STERILIZATION, Women can have an operation to avoid having any more children. Have you ever had an operation to avoid having any more children?
YES 1
NO 2
07. MALE STERILIZATION, Men can have an operation to avoid having any more children.
YES 1
NO 2
08. PERIODIC ABSTINENCE, Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant
YES 1
NO 2
09. WITHDRAWAL, men can be careful and pull out before climax.
YES 1
NO 2
10. Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO 2

304. Do you know where a person could go to get (METHOD)?

01. PILL, women can take a pill every day.
YES 1
NO 2
02. IUD, Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
03. INJECTIONS, Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO 2
04. DIAPHRAGM, FOAM, JELLY, Women can place a sponge, suppository, diaphragm, jelly, or cream in side them before intercourse.
YES 1
NO 2
05. CONDOM, Men can use a rubber sheath during sexual intercourse.
YES 1
NO 2
06. FEMALE STERILIZATION, Women can have an operation to avoid having any more children. Have you ever had an operation to avoid having any more children?
YES 1
NO 2
07. MALE STERILIZATION, Men can have an operation to avoid having any more children.
YES 1
NO 2
08. PERIODIC ABSTINENCE, Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant. Do you know where a person can obtain advice on how to use periodic abstinence?
YES 1
NO 2

305. CHECK 303:

NOT A SINGLE 'YES' (NEVER USED) (GO TO 306)
AT LEAST ONE 'YES' (EVER USED) (GO TO 308)

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

YES 1
NO 2 (GO TO 337)

307. What have you used or done?
CORRECT 303-305 (AND 302 IF NECESSARY).

308. Now I would like to ask you about the time when you first did something or used a method to avoid getting pregnant. What method did you use at that time?

PILL 01
IUD 02
INJECTIONS 03
DIAPHRAGM/FOAM/JELLY 04
CONDOM 05
FEMALE STERILIZATION 06
MALE STERILIZATION 07
PERIODIC ABSTINENCE 08
WITHDRAWAL 09
OTHER (SPECIFY) ____ 10

309. How many living children did you have at that time if any?

NUMBER OF CHILDREN _____________

310. CHECK 303(01):
EVER USED PILL?

YES (GO TO 311)
NO (GO TO 317)

311. At the time you first started using the pill, did you consult a doctor, a nurse, or a family planning worker?

YES 1
NO 2 (GO TO 317)

312. When you met with that person, did you already have a preference for a particular method of family planning?

YES 1
NO 2 (GO TO 314)

313. Which method was that?

PILL 01
IUD 02
INJECTIONS 03
DIAPHRAGM/FOAM/JELLY 04
CONDOM 05
FEMALE STERILIZAITON 06
MALE STERILIZATION 07
PERIODIC ABSTINENCE 08
WITHDRAWAL 09
OTHER (SPECIFY) ____ 10

314. Did the provider talk to you about any methods other than the pill?

YES 1
NO 2 (GO TO 317)

315. Which method or methods?

PILL 1
IUD 1
INJECTIONS 1
DIAPHRAGM/FOAM/JELLY 1
CONDOM 1
FEMALE STERILIZAITON 1
MALE STERILIZATION 1
PERIODIC ABSTINENCE 1
WITHDRAWAL 1
OTHER (SPECIFY) ___ 1

316. Were you satisfied with the information you got from the provider on the method(s) you discussed or not?

YES 1
NO 2

317. CHECK 224:

NOT PREGNANT OR UNSURE (GO TO 318)
PREGNANT (GO TO 337)

318. CHECK 107:

CURRENTLY MARRIED (CODE 1 IN 107) (GO TO 319)
NOT CURRENTLY MARRIED (CODE 2-5 IN 107) (GO TO 343)

319. CHECK 303 (06):

WOMAN NOT STERILIZED (GO TO 320)
WOMAN STERILIZED (GO TO 322A)

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

YES 1 (GO TO 322)
NO 2

321. What is the main reason you are not using a method to delay or avoid getting pregnant?

WANTS (MORE) CHILDREN 01 (GO TO 337)
LACK OF KNOWLEDGE 02
HUSBAND OPPOSED 03
COST TOO MUCH 04
WORRY ABOUT SIDE EFFECTS 05
HEALTH CONCERNS 06
HARD TO GET METHODS 07
RELIGION 08
OPPOSED TO FAMILY PLANNING 09
FATALISTIC 10
OTHER PEOPLE OPPOSED 11
INFREQUENT SEX 12
DIFFICULT TO GET PREGNANT 13
MENOPAUSAL/ HAD HYSTERECTOMY 14
INCONVENIENT 15
HUSBAND ABSENT 17
BREASTFEEDING 18
OTHER (SPECIFY) ____19
DON'T KNOW 98 (GO TO 337)

322. Which method are you using?
322A. CIRCLE '06' FOR FEMALE STERILIZATION

PILL 01
IUD 02 (GO TO 330)
INJECTIONS 03 (GO TO 330)
DIAPHRAGM/FOAM/JELLY 04 (GO TO 331)
CONDOM 05 (GO TO 327)
FEMALE STERILIZATION 06 (GO TO 330)
MALE STERILIZATION 07 (GO TO 330)
PERIODIC ABSTINENCE 08 (GO TO 336)
WITHDRAWAL 09
OTHER (SPECIFY) _____ 10 (GO TO 336)

323. At the time you last got pills, did you consult a doctor, a nurse, or a family planning worker?

YES 1
NO 2

324. May I see the package of pills you are using now? (RECORD NAME OF BRAND.)

PACKAGE SEEN 1 (GO TO 326)
BRAND NAME_______ (GO TO 326)
PACKAGE NOT SEEN 2

325. Do you know the brand name of the pills you are now using? (RECORD NAME OF BRAND.)

BRAND NAME_________
DON'T KNOW 98

326. How much does one packet of pills cost you?

RUPEES_______(GO TO 331)
FREE 9996
DON'T KNOW 9998 (GO TO 331)

327. May I see the package of condoms you are using now? (RECORD NAME OF BRAND.)

PACKAGE SEEN 1 (GO TO 329)
BRAND NAME_______ (GO TO 329)
PACKAGE NOT SEEN 2

328. Do you know the brand name of the condoms you are now using? (RECORD NAME OF BRAND.)

BRAND NAME________
DON'T KNOW 98

329. How much does on condom cost you?

RUPEES________ (GO TO 331)
FREE 9996
DON'T KNOW 9998 (GO TO 331)

330. How much did it cost for the IUD insertion/sterilization operation/last injection?

RUPEES__________
FREE 999996
DON'T KNOW 999998

331. CHECK 322:

SHE/HE STERILIZED: Where did the sterilization take place?
USING ANOTHER METHOD: Where did you obtain (METHOD) the last time?

NAME OF HOSPITAL, CLINIC, OR CENTER, IF CODE 01-05 ____________
GOVERNMENT HOSPITAL/RHSC 01
RHC/BHU/GOVERNMENT CLINIC 02
FAMILY WELFARE CENTER 03
NGO CENTER 04
PRIVATE HOSPITAL OR CLINIC 05
MOBILE CLINIC/EXTENSION TEAM 06 (GO TO 334)
FIELD WORKER 07 (GO TO 334)
PRIVATE DOCTOR 08
HAKIM/HOMOEOPATH 09
DRUGSTORE 10
SHOP (OTHER THAN DRUGSTORE) 11
TRADITIONAL BIRTH ATTENDANT 12
FRIENDS/RELATIVES 13 (GO TO 334)
OTHER (SPECIFY) _________ 14
DON'T KNOW 98 (GO TO 334)

332. How long does it take to travel from your home to this place?
IF LESS THAN 60 MINUTES, RECORD MINUTES. OTHERWISE, RECORD HOURS.

MINUTES 1_______________
HOURS 2_________________
DON'T KNOW 998

333. Is it easy or difficult to get there?

EASY 1
DIFFICULT 2

334. CHECK 322:

SHE/HE STERILIZED (GO TO 335)
USING ANOTHER METHOD (GO TO 336)

335. In what month and year was the sterilization operation performed?

MONTH_______________
YEAR_________________ (GO TO 347)

336. For how many months have you been using (CURRENT METHOD) continuously?
IF LESS THAN 1 MONTH, RECORD '00'.

MONTHS_____ (GO TO 347)
8 YEARS OR LONGER 96 (GO TO 347)

337. Do you intend to use a method to delay or avoid pregnancy at any time in the future?

YES 1 (GO TO 340)
NO 2
DON'T KNOW 8 (GO TO 343)

338. What is the main reason you do not intend to use a method?

WANTS CHILDREN 01 (GO TO 343)
LACK OF KNOWLEDGE 02 (GO TO 343)
HUSBAND OPPOSED 03
COST TO MUCH 04 (GO TO 343)
WORRY ABOUT SIDE EFFECTS 05
HEALTH CONCERNS 06
HARD TO GET METHOD 07 (GO TO 343)
RELIGION 08
OPPOSED TO FAMILY PLANNING 09 (GO TO 343)
FATALISTIC 10
OTHER PEOPLE OPPOSED 11
INFREQUENT SEX 12 (GO TO 343)
DIFFICULT TO GET PREGNANT 13
MENOPAUSAL/HAD MYSTERECTOMY 14
INCONVEINENT 15
NOT CURRENTLY MARRIED 16
OTHER (SPECIFY) ______ 17
DON'T KNOW 98 (GO TO 343)

339. If the decision were entirely up to you, would you want to use a method to delay or avoid a pregnancy at any time in the future?

YES 1 (GO TO 343)
NO 2
DON'T KNOW 3 (GO TO 343)

340. Do you intend to use a method within the next 12 months?

YES 1
NO 2
DON'T KNOW 8

341. When you use a method, which method would you prefer to use?

PILL 01
IUD 02
INJECTIONS 03
DIAPHRAGM/FOAM/JELLY 04
CONDOM 05
FEMALE STERILIZAITON 06
MALE STERILIZATION 07
PERIODIC ABSTINENCE 08
WITHDRAWAL 09
OTHER (SPECIFY) _____ 10
UNSURE 98 (GO TO 343)

342. Where can you get (METHOD MENTIONED IN 341)?

NAME OF HOSPITAL, CLINIC OR CENTER, IF CODE 01-05 ________
GOVERNMENT/HOSPITAL/RHSC 01 (GO TO 345)
RHC/BHU/GOVERNMENT CLINIC 02
FAMILY WELFARE CENTER 03
NGO CENTER 04
PRIVATE HOSPITAL OR CLINIC 05 (GO TO 345)
MOBILE CLINIC/EXTENSION TEAM 06 (GO TO 347)
FIELD WORKER 07 (GO TO 347)
PRIVATE DOCTOR 08 (GO TO 345)
HAKIM/HOMOEOPATH 09
DRUGSTORE 10
SHOP (OTHER THAN DRUGSTORE) 11
TRADITIONAL BIRTH ATTENDEANT 12 (GO TO 345)
FREINDS/RELATIVES 13 (GO TO 347)
OTHER (SPECIFY) _____ 14 (GO TO 347)
DON'T KNOW 98

343. Do you know of a source where you can obtain a method of family planning?

YES 1
NO 2 (GO TO 347)

344. What source is that?

NAME OF HOSPITAL, CLINIC OR CENTER, IF CODE 01-05 __________
GOVERNMENT/HOSPITAL/RHSC 01
RHC/BHU/GOVERNMENT CLINIC 02
FAMILY WELFARE CENTER 03
NGO CENTER 04
PRIVATE HOSPITAL OR CLINIC 05
MOBILE CLINIC/EXTENSION TEAM 06 (GO TO 347)
FIELD WORKER 07 (GO TO 347)
PRIVATE DOCTOR 08
HAKIM/HOMOEOPATH 09
DRUGSTORE 10
SHOP (OTHER THAN DRUGSTORE) 11
TRADITIONAL BIRTH ATTENDANT 12
FRIENDS/RELATIVES 13 (GO TO 347)
OTHER (SPECIFY) _____ 14 (GO TO 347)

345. How long does it take to travel from your home to this place?
IF LESS THAN 60 MINUTES, RECORD MINUTES. OTHERWISE, RECORD HOURS.

MINUTES 1________
HOURS 2______
DON'T KNOW 998

346. Is it easy or difficult to get there?

EASY 1
DIFFICULT 2
DON'T KNOW 8

347. In the last month, have you heard a message about family planning on:

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2

348. CHECK 347:

HEARD MESSAGE (ANY 'YES' IN 347) (GO TO 349)
NOT HEARD MESSAGE (GO TO 350)

349. Do you think that the message you heard was effective or not effective in persuading couples to use family planning?

EFFECTIVE 1
NOT EFFECTIVE 2
DON'T KNOW 8

350. Is it acceptable to you or not for family planning information to be provided on the radio or television?

ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8

SECTION 4A. PREGNANCY AND BREASTFEEDING

401. CHECK 222:

ONE OR MORE BIRTHS SINCE JAN. 1986 (GO TO 402)
NO BIRTHS SINCE JAN. 1986 (GO TO 501)

402. ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1986 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL FORMS).

Now I would like to ask you some more questions about the health of children you had in the past five years. (We will talk about one child at a time.)

LINE NUMBER FROM Q. 212 ___________

FROM Q. 212 AND Q. 216

NAME________
ALIVE ___
DEAD ____

403. At the time you became pregnant with (NAME), did you want to become pregnant then, did you want to wait until later or did you want no more children at all?

THEN 1 (GO TO 405)
LATER 2
NO MORE 3 (GO TO 405)

404. How much longer would you like to have waited?
(RECORD MONTHS OR YEARS)

MONTHS 1_____
YEARS 2_______
DON'T KNOW 998

405. When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy? IF YES: Whom did you see? Anyone else?
CIRCLE ALL PERSONS SEEN ON ANY VISIT.

DOCTOR 1
NURSE 1
LADY HEALTH VISITOR 1
FAMILY WELFARE WORKER 1
TRAINED (TRADITIONAL) BIRTH ATTENDANT 1
TRADITIONAL BIRTH ATTENDANT 1
OTHER (SPECIFY) ____ 1
NO ONE 1 (GO TO 409)

406. Were you given an antenatal card for this pregnancy?

YES 1
NO 2
DON'T KNOW 8

407. How many months pregnant were you when you first saw someone for an antenatal check on that pregnancy?

MONTHS______
DON'T KNOW 98

408. How many antenatal visits did you have during that pregnancy?

NUMBER OF VISITS____
DON'T KNOW 98 (GO TO 411)

409. Did anyone advise you to eat more food than usual during that pregnancy?

YES 1
NO 2

410. Were you weighed at any time during that pregnancy?

YES 1
NO 2

411. When you were pregnant with (NAME) were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?

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

412. How many times did you get this injection?

TIMES_____
DON'T KNOW 8

413. Where did you give birth to (NAME)?

YOUR HOME 01
OTHER HOME 02
GOVERNMENT HOSPITAL 03
RHC/BHU/GOV'T CLINIC 04
PRIVATE HOSPITAL/CLINIC 05
OTHER (SPECIFY) ______ 06

414. Who delivered (NAME) or assisted with the delivery? Anyone else? (CIRCLE ALL PERSONS ASSISTING)

DOCTOR 1
NURSE 1
LADY HEALTH VISITOR 1
FAMILY WELFARE WORKER 1
TRAINED (TRADITIONAL) BIRTH ATTENDANT 1
TRADITIONAL BIRTH ATTENDANT 1
OTHER (SPECIFY) _____ 1
NO ONE 1 (GO TO 416)

415. How long were you in labor?

HOURS_________
DON'T KNOW 98

416. Was (NAME) born on time or prematurely?

ON TIME 1
PREMATURELY 2
DON'T KNOW 8

417. Was (NAME) delivered by caesarian section?

YES 1
NO 2

418. Was (NAME) weighed at birth?

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

419. How much did (NAME) weigh?

KG 1_______
POUNDS 2______
DON'T KNOW 99998

420. When (NAME) was born, was he/she: very large, larger than average, average, smaller than average, or very small?

VERY LARGE 1
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DON'T KNOW 8 (GO TO 422)

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

YES 1 (GO TO 423)
NO 2 (GO TO 424)

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

YES 1
NO 2 (GO TO 426)

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

MONTHS_____
DON'T KNOW 98 (GO TO 426)

424. CHECK 224:
RESPONDENT PREGNANT?

PREGNANT (GO TO 426)
NOT PREGNANT (GO TO 425)

425. Have you resumed sexual relations since the birth of (NAME)?

YES 1
NO 2 (GO TO 427)

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

DAYS 1______
MONTHS 2_____
DON'T KNOW 998

427. Did you ever breastfeed (NAME)?

YES 1 (GO TO 430)
NO 2

428. Who suggested that you should not breastfeed (NAME)?

OWN DECISION 01
MOTHER 02
MOTHER-IN-LAW 03
HUSBAND 04
DOCTOR 05
OTHER HEALTH WORKER 06
TRADITIONAL BIRTH ATTENDANT 07
OTHER (SPECIFY) _____ 08

429. Why did you not breastfeed (NAME)?

MOTHER ILL/WEAK 01 (GO TO 438)
CHILD ILL/WEAK 02
CHILD DIED 03
NIPPLE/BREAST PROBLEM 04
INSUFFICIENT MILK 05
WORKING 06
CHILD REFUSED 07
MAINTAIN BEAUTY 08
OTHER (SPECIFY) _____ 09 (GO TO 438)

430. 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 (GO TO 432)
HOURS 1____________
DAYS 2___________

431. What was (NAME) fed before you put (him/her) to the breast?
(CIRCLE ALL MENTIONED)

WATER 1
GNUTTI 1
HONEY 1
SUGAR 1
OTHER (SPECIFY) _____1

432. CHECK 216:
CHILD ALIVE?

ALIVE (GO TO 433)
DEAD (GO TO 436)

433. Are you still breastfeeding (NAME)?

YES 1
NO 2 (GO TO 436)

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

NUMBER OF NIGHTTIME FEEDINGS_______________

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

NUMBER OF DAYLIGHT FEEDINGS_______________ (GO TO 439)

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

MONTHS______
UNTIL DIED 95 (GO TO 445)

437. What is the main reason that you stopped breastfeeding?

MOTHER ILL/WEAK 01
CHILD ILL/WEAK 02
CHILD DIED 03
NIPPLE/BREAST PROBLEM 04
INSUFFICIENT MILK 05
WORKING 06
CHILD REFUSED 07
WEANING AGE 08
BECAME PREGNANT 09
OTHER (SPECIFY)_____ 10

438. CHECK 216:
CHILD ALIVE?

ALIVE (GO TO 446)
DEAD (GO TO 445)

439. At any time yesterday or last night was (NAME) given any of the following? IF YES: How many times?

Plain Water?
YES 1
NO 2
NUMBER OF TIMES ______
Ghutti?
YES 1
NO 2
NUMBER OF TIMES ______
Sugar or honey water?
YES 1
NO 2
NUMBER OF TIMES ______
Juice?
YES 1
NO 2
NUMBER OF TIMES ______
Herbal tea?
YES 1
NO 2
NUMBER OF TIMES ______
Gripe Water?
YES 1
NO 2
NUMBER OF TIMES ______
Baby formula?
YES 1
NO 2
NUMBER OF TIMES ______
Fresh milk?
YES 1
NO 2
NUMBER OF TIMES ______
Tinned or powdered milk?
YES 1
NO 2
NUMBER OF TIMES ______
Other liquids, such as fennel water or cardamom water?
YES 1
NO 2
NUMBER OF TIMES ______
Any solid or mushy food?
YES 1
NO 2
NUMBER OF TIMES ______

440. CHECK 439:
FOOD OR LIQUID GIVEN YESTERDAY?

YES TO ONE OR MORE (GO TO 441)
NO TO ALL (GO TO 442)

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

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

442. Was (NAME) ever given anything to drink from a bottle with a nipple?

YES 1
NO 2 (GO TO 444)
DON'T KNOW 8 (GO TO 444)

443. How many months old was (NAME) when he/she started drinking from a bottle with a nipple on a regular basis?

AGE IN MONTHS_________ (GO TO 446)
NEVER GIVEN REGULARLY 96 (GO TO 446)

444. CHECK 439:
FOOD OR LIQUID GIVEN YESTERDAY?

YES TO ONE OR MORE (GO TO 446)
NO TO ALL (GO TO 445)

445. Was (NAME) ever given any water, or something else to drink or eat (other than breastmilk)?

YES 1
NO 2 (GO TO 449)

446. How many months old was (NAME) when you started giving the following on a regular basis? IF LESS THAN 1 MONTH, RECORD '00'.

Formula or milk other than breastmilk?
AGE IN MONTHS______
NOT GIVEN 96
Water?
AGE IN MONTHS_____
NOT GIVEN 96
Other liquids?
AGE IN MONTHS______
NOT GIVEN 96
Any solid or mushy food?
AGE IN MONTHS______
NOT GIVEN 96

447. CHECK 446:
AGE IN MONTHS GIVEN FOR SOLID OR FOOD?

YES (GO TO 448)
NO (GO TO 449)

448. How many months old was (NAME) when you started giving him/her solid or mushy foods every day?

AGE IN MONTHS______
NOT GIVEN 96

449. GO BACK TO 403 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 450

SECTION 4B. IMMUNIZATION AND HEALTH.

450. ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1986 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL FORMS)

LINE NUMBER FROM Q. 212 ___________

FROM Q. 212 AND Q. 216

NAME_________
ALIVE___
DEAD___

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

YES, SEEN 1 GO TO 453)
YES, NOT SEEN 2 (GO TO 455)
NO CARD 3

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

YES 1 GO TO 455)
NO 2 (GO TO 455)

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

BCG
DAY ____
MONTH ____
YEAR _____
POLIO 0 (AT BIRTH)
DAY ____
MONTH ____
YEAR _____
POLIO 1
DAY ____
MONTH ____
YEAR _____
POLIO 2
DAY ____
MONTH ____
YEAR _____
POLIO 3
DAY ____
MONTH ____
YEAR _____
OPT 1
DAY ____
MONTH ____
YEAR _____
OPT 2
DAY ____
MONTH ____
YEAR _____
OPT 3
DAY ____
MONTH ____
YEAR _____
MEASLES
DAY ____
MONTH ____
YEAR _____

454. Has (NAME) received any vaccinations that are not recorded on this card?

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 453) (GO TO 457)
NO 2
DON'T KNOW 8 (GO TO 457)

455. Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases?

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

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

A BCG vaccination against tuberculosis, that is, an injection in the arm that left a scar?
YES 1
NO 2
DON'T KNOW 8
Polio vaccine, that is, drops in the mouth?
YES 1
NO 2
DON'T KNOW 8
IF YES: How many times?
NUMBER OF TIMES_______
An injection against measles?
YES 1
NO 2
DON'T KNOW 8

457. CHECK 216: CHILD ALIVE?

ALIVE(GO TO 462)
DEAD(GO TO 458)

458. Did a doctor or a health worker tell you about the cause of death of (NAME)?

YES 1
NO 2 (GO TO 460)

459. What did they say was the cause of death?

FEVER 1
DIARRHEA 1
COUGH 1
MEASLES 1
VOMITING 1
CONVULSIONS 1
OTHER (SPECIFY) ______ (GO TO 461)

460. What do you believe was the cause of death of (NAME)?

FEVER 1
DIARRHEA 1
COUGH 1
MEASLES 1
VOMITING 1
CONVULSIONS 1
OTHER (SPECIFY) _____

461. GO BACK TO 451 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 490

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

YES 1
NO 2
DON'T KNOW 8

463. Has (NAME) been ill with a cough at any time in the last two weeks?

YES 1
NO 2 (GO TO 467)
DON'T KNOW 8 (GO TO 467)

464. Has (NAME) been ill with a cough in the last 24 hours?

YES 1
NO 2
DON'T KNOW 8

465. For how many days (has the cough lasted/did the cough last)?

DAYS_________

466. When (NAME) had the illness with a cough, did he/she breathe faster than usual with short, rapid breaths?

YES 1
NO 2
DON'T KNOW 8

467. CHECK 462 AND 463:
FEVER OR COUGH?

'YES' IN EITHER 462 OR 463 (GO TO 468)
OTHER (GO TO 471)

468. What was given to treat the fever/cough if anything?

NO TREATMENT 1
INJECTION 1
ANTIBIOTIC(PILL OR SYRUP) 1
ANTIMALARIAL(PILL OR SYRUP) 1
COUGH SYRUP 1
OTHER PILL OR SYRUP 1
UNKNOWN PILL OR SYRUP 1
HOME REMEDY/HERBAL MEDICINE 1
OTHER (SPECIFY) ______1

469. Did you seek advice or treatment for the fever/cough?

YES 1
NO 2 (GO TO 471)

470. From whom did you seek advice or treatment?

GOVERNMENT HOSPITAL 1
RNC/BHU/GOVT CLINIC 1
PRIVATE HOSPITAL/CLINIC 1
PRIVATE DOCTOR 1
FAMILY WELFARE WORKER 1
LADY HEALTH VISITOR 1
HOMEOPATH 1
HAKIM 1
FAITH HEALER 1
DRUGSTORE 1
SHOP(OTHER THAN DRUGSTORE) 1
OTHER (SPECIFY) _____ 1

471. Has (NAME) had diarrhea in the last two weeks?

YES 1 (GO TO 473)
NO 2
DON'T KNOW 8

472. GO BACK TO 451 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 490

473. Has (NAME) had diarrhea in the last 24 hours?

YES 1
NO 2
DON'T KNOW 8

474. For how many days (has the diarrhea lasted/did the diarrhea last)?

DAYS_____

475. Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8 (GO TO 479)

476. CHECK 427/433: LAST CHILD STILL BREASTFEED?

YES (GO TO 477)
NO (GO TO 479)

477. During (NAME)'s diarrhea, did you change the frequency of breastfeeding?

YES 1
NO 2 (GO TO 479)

478. Did you increase the frequency of breastfeeding or reduce the frequency or did you stop completely?

INCREASE 1
REDUCED 2
STOPPED COMPLETELY 3

479. (Aside from breastmilk) Was (NAME) given the same amount to drink as before the diarrhea, or more, or less?

SAME 1
MORE 2
LESS 3
DON'T KNOW 8

480. Was (NAME) given the same amount of food as before the diarrhea, or more, or less?

SAME 1
MORE 2
LESS 3
DON'T KNOW 8

481. Was (NAME) given a fluid made from a special packet?

SAME 1
MORE 2
DON'T KNOW 8

482. Was (NAME) given any of the following during the diarrhea?

Rice water?
SAME 1
MORE 2
DON'T KNOW 8
Lasai?
SAME 1
MORE 2
DON'T KNOW 8
A home-made fluid made from sugar, salt and water?
SAME 1
MORE 2
DON'T KNOW 8
Any other home-made fluids?
SAME 1
MORE 2
DON'T KNOW 8

483. CHECK 481 AND 482: CHILD GIVEN FLUID PACKET (481) AND/OR ANY HOME MADE FLUID (482)?

YES GIVEN FLUID(PACKET/HOME) (GO TO 484)
NO FLUID (GO TO 485)

484. For how many days was (NAME) given this fluid?

DAYS__________
DON'T KNOW 98

485. Was anything given for the diarrhea (other than this fluid)?

YES 1
NO 2 (GO TO 487)
DON'T KNOW 8 (GO TO 487)

486. What was given to treat the diarrhea?

ANITBIOTIC PILL OR SYRUP 1
OTHER PILL OR SYRUP 1
UNKNOWN PILL OR SYRUP 1
INJECTION 1
(I.V.) INTRAVENOUS 1
HOME REMEDIES/HERBAL MEDICINES 1
OTHER (SPECIFY) _____ 1

487. Did you seek any advice or treatment for the diarrhea?

YES 1
NO 2 (GO TO 489)

488. From whom did you seek advice or treatment?

GOVERNMENT HOSPITAL 1
RNC/BHU/GOVT CLINIC 1
PRIVATE HOSPITAL/CLINIC 1
PRIVATE DOCTOR 1
FAMILY WELFARE WORKER 1
LADY HEALTH VISITOR 1
HOMEOPATH 1
HAKIM 1
FAITH HEALER 1
DRUGSTORE 1
SHOP(OTHER THAN DRUGSTORE) 1
OTHER (SPECIFY) _____ 1

489. GO BACK TO 451 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 490

490. CHECK 481:

ORS SOLUTION MENTIONED (ANY 'YES' IN 481) (GO TO 493)
ORS SOLUTION NOT MENTIONED OR 481 NOT ASKED (GO TO 491)

491. Have you ever heard of a special product called ORS or Nimkol (or LOCAL NAME) you can get for the treatment of diarrhea?

YES 1 (GO TO 493)
NO 2

492. Have you ever seen a packet like this before?

YES 1
NO 2 (GO TO 501)

493. Have you ever prepared a solution with one of these packets to treat diarrhea in yourself or someone else?

YES 1
NO 2 (GO TO 496)

494. Did you prepare the whole packet at once or only part of the packet?

WHOLE PACKET AT ONCE 1
ONLY PART OF PACKET 2 (GO TO 496)

495. How much water did you use to prepare (LOCAL NAME)?

100 ML. GLASSES/CUPS 1_______
200 ML. GLASSES/CUPS 2_______
250 ML. GLASSES/CUPS 3_______
500 ML. GLASSES/CUPS 4_______
UNKNOWN SIZE GLASSES/CUPS 5_______

1 SEER CONTAINER 990
1/2 SEER CONTAINER 991
1/4 SEER CONTAINER 992
OTHER (SPECIFY) ______ 996
DON'T KNOW 998

496. Where can you get the (LOCAL NAME) packet?

GOVERNMENT HOSPITAL 1
RHC/BHU/GOVERNMENT CLINIC 1
PRIVATE HOSPITAL/CLINIC 1
PRIVATE DOCTOR 1
FAMILY WELFARE WORKER 1
LADY HEALTH VISITOR 1
HAKIM/HOMEOPATH 1
DRUGSTORE 1
SHOP (OTHER THAN DRUGSTORE) 1
OTHER (SPECIFY) _____ 1
DON'T KNOW 1

497. CHECK 482:

SUGAR/SALT/WATER FLUID MENTIONED (ANY 'YES' IN 482) (GO TO 498)
SUGAR/SALT/WATER FLUID NOT MENTIONED OR 482 NOT ASKED (GO TO 501)

498. Who taught you to prepare the home-made fluid made from sugar, salt and water?

GOVERNMENT HOSPITAL 01
RHC/BHU/GOVERNMENT CLINIC 02
PRIVATE HOSPITAL/CLINIC 03
PRIVATE DOCTOR 04
FAMILY WELFARE WORKER 05
LADY HEALTH VISITOR 06
HOMEOPATH 07
HAKIM 08
IMMUNIZATION TEAM MEMBER 09
DRUGSTORE 10
SHOP (OTHER THAN DRUGSTORE) 11
RADIO/TV 12
FRIEND/RELATIVE 13
OTHER (SPECIFY) ______ 14

SECTION 5. MARRIAGE

501. CHECK 107:

CURRENTLY MARRIED (CODE 1 IN 107) (GO TO 502)
NOT CURRENTLY MARRIED (CODE 2-5 IN 107) (GO TO 509)

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

LIVING WITH HIM 1
STAYING ELSEWHERE 2 (GO TO 504)

503. In the last four weeks, were you and your husband always living together or were you apart some of the time or all of the time?

ALWAYS LIVING TOGETHER 1 (GO TO 506)
APART SOME OF THE TIME 2
APART ALL OF THE TIME 3 (GO TO 506)

504. During the last four weeks, were you and your husband apart all of the time or did you stay together any of the time?

APART ALL OF THE TIME 1
STAYED TOGETHER SOME OF TIME 2 (GO TO 506)

505. For how long have you and your husband been living apart?

MONTHS 1____
YEARS 2______

506. Does your husband have any other wives besides yourself?

YES 1
NO 2 (GO TO 509)

507. How many other wives does he have?

NUMBER___
DON'T KNOW 8 (GO TO 509)

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

RANK____

509. (Is/was) there a blood relationship between you and your husband?

YES 1
NO 2 (GO TO 511)

510. What type of relationship (is/was) it?

FIRST COUSIN ON FATHER'S SIDE 1
FIRST COUSIN ON MOTHER'S SIDE 2
SECOND COUSIN 3
OTHER RELATION (SPECIFY) ______ 4

511. How old were you when you started living with your (first) husband?

AGE___________

512. In what month and year did you start living with him?
COMPARE 511 AND 512 WITH 105 AND 106. MAKE CORRECTIONS IF INCONSISTENT.

MONTH_____
DON'T KNOW MONTH 98

YEAR_______
DON'T KNOW YEAR 98

513. PRESENCE OF OTHERS AT THIS POINT.

CHILD(REN) UNDER 10
YES 1
NO 2
HUSBAND
YES 1
NO 2
OTHER MALE(S)
YES 1
NO 2
MOTHER-IN-LAW
YES 1
NO 2
OTHER FEMALE(S)
YES 1
NO 2

SECTION 6. FERTILITY PREFERENCES

601. CHECK 322:

NEITHER STERILIZED (GO TO 602)
HE OR SHE STERILIZED (GO TO 608)

602. CHECK 107:

CURRENTLY MARRIED (CODE 1 IN 107) (GO TO 603)
NOT CURRENTLY MARRIED (CODE 2-5 IN 107) (GO TO 615)

603. CHECK 224:

NOT PREGANT OR UNSURE: Now I have some questions about the future. Would you like to have (a/another) child or would you prefer not to have any (more) children?

PREGNANT: Now I have some questions about the future. After the child you are expecting, would you like to have another child or would you prefer not to have any more children?

HAVE A (ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 611)
SAYS SHE CAN'T GET PREGNANT 3
UP TO GOD 4
UNDECIDED OR DON'T KNOW 8 (GO TO 611)

604. Would you prefer your next child to be a boy or a girl or doesn't it matter?

BOY 1
GIRL 2
DOESN'T MATTER 3

605. CHECK 224:

NOT PREGNANT OR UNSURE: How long would you like to wait from now before the birth of (a/another) child?

PREGNANT: How long would you like to wait after the birth of the child you are expecting before the birth of another child?

MONTHS 1______(GO TO 611)
YEARS 2________
SOON/NOW 994
SAYS SHE CAN'T GET PREGNANT 995 (GO TO 611)
OTHER (SPECIFY) _____ 996
DON'T KNOW 998

606. CHECK 216 AND 224:
HAS LIVING CHILDREN OR PREGNANT?

YES (GO TO 608)
NO (GO TO 611)

607. CHECK 224:

NOT PREGNANT OR UNSURE: How old would you like your youngest child to be when your next child is born?

PREGNANT: How old would you like the child you are expecting to be when your next child is born?

AGE OF YOUNGEST YEARS _________(GO TO 611)
DON'T KNOW 98 (GO TO 611)

608. Do you regret that (you/your husband) had the operation not to have any (more) children?

YES 1
NO 2 (GO TO 610)

609. Why do you regret it?

RESPONDENT WANTS ANOTHER CHILD 1 (GO TO 615)
HUSBAND WANTS ANOTHER CHILD 2
SIDE EFFECTS 3
OTHER REASON (SPECIFY) ______ 4 (GO TO 615)

610. Given your present circumstances, if you had to do it over again, do you think you would make the same decision to have a sterilization?

YES 1 (GO TO 615)
NO 2 (GO TO 615)

611. Do you think that your husband approves or disapproves of couples using a method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

612. How often have you and your husband talked about family planning in the past year?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

613. Have you and your husband ever discussed the number of children you would like to have?

YES 1
NO 2

614. Do you think your husband wants 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

615. How long should a husband and wife wait before starting sexual intercourse after the birth of a baby?

DAYS 1_______
MONTHS 2______
YEARS 3_________
OTHER (SPECIFY) _____ 996

616. Should a mother wait until she has completely stopped breastfeeding before starting to have sexual relations again, or doesn't it matter?

WAIT 1
DOESN'T MATTER 2

617. In general, do you approve or disapprove of couples using a method to avoid pregnancy?

APPROVE 1
DISAPPROVE 2

618. CHECK 216:

NO LIVING CHILDREN: If you could choose exactly the number of children to have in your whole life, how many would that be?

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?

NUMBER OF CHILDREN _______
UP TO GOD, ALLAH 95 (GO TO 620)
OTHER ANSWER (SPECIFY) _____ 96 (GO TO 620)

619. How many of these children would you like to be boys and how many would you like to be girls?

NUMBER OF BOYS ________
NUMBER OF GIRLS_______
NUMBER OF EITHER______
UP TO GOD, ALLAH 999995
OTHER (SPECIFY) ______ 999996

620. We would like to know how much schooling you would like your children to have. (IF NOT STERILIZED: Consider the children you already have and also any children that you might have in the future). First, let's talk about sons. What is the highest level of school that you would like any of your sons to attend?

NONE 1
PRIMARY SCHOOL 2
MIDDLE SCHOOL 3
SECONDARY SCHOOL 4
HIGHER 5
OTHER (SPECIFY) ____ 6
DON'T KNOW 8

621. And how about daughters? What is the highest level of schooling that you would like any of your daughters to attend?

NONE 1
PRIMARY SCHOOL 2
MIDDLE SCHOOL 3
SECONDARY SCHOOL 4
HIGHER 5
OTHER (SPECIFY) _____ 6
DON'T KNOW 8

622. What do you think is the ideal age at marriage for boys?

IDEAL AGE IN YEARS______
OTHER (SPECIFY) _____ 96

623. And what is the ideal age at marriage for girls?

IDEAL AGE IN YEARS______
OTHER (SPECIFY) ____ 96

624. If you needed to go to a health clinic or a hospital, could you go by yourself or would you need to be accompanied by someone?

COULD GO BY SELF 1
WOULD NEED TO BE ACCOMPANIED 2
IT DEPENDS 3

701. CHECK 107:

CURRENTLY MARRIED (CODE 1 IN 107) (GO TO 702)
NOT CURRENTLY MARRIED (CODE 2-5 IN 107) (GO TO 703)

702. How old is you husband in completed years?

AGE IN COMPLETED YEARS________
DON'T KNOW 98_________

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

YES 1
NO 2 (GO TO 706)

704. What was the highest level of school he attended: primary, middle, secondary, or higher?

PRIMARY 1
MIDDLE 2
SECONDARY 3
HIGHER 4
DON'T KNOW 8 (GO TO 706)

705. What was the highest class he completed at that level?

CLASS____
DON'T KNOW 98

706. What kind of work (did) your (last) husband mainly do?

OCCUPATION________________

707. CHECK 706:

WORKS (WORKED) IN AGRICULTURE (GO TO 708)
DOES (DID) NOT WORK IN AGRICULTURE (GO TO 709)

708. (Does/did) your husband work mainly on his own land or family land, or (does/did) he rent land, or (does/did) he work on someone else's land?

HIS/FAMILY LAND 1
RENTED LAND 2
SOMEONE ELSE'S LAND 3

709. Aside from your own housework, are you currently working?

YES 1 (GO TO 712)
NO 2

710. 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.
Are you currently doing any of these things or any other work?

YES 1 (GO TO 712)
NO 2

711. If you could find a suitable job, would you like to work?

YES 1 (GO TO 719)
NO 2
DON'T KNOW 8 (GO TO 719)

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

OCCUPATION_____________________

713. In your current work, do you 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

714. Do you earn cash for this work?
PROBE: Do you make money for working?

YES 1
NO 2

715. Do you do this work at home or away from home?

HOME 1
AWAY 2

716. CHECK 215/216/218: HAS CHILD BORN SINCE JAN. 1986 AND LIVING AT HOME?

YES (GO TO 717)
NO (GO TO 719)

717. While you are working, do you usually have (NAME OF YOUNGEST CHILD AT HOME) with you, sometimes have him/her with you, or never have him/her with you?

USUALLY 1 (GO TO 719)
SOMETIMES 2
NEVER 3

718. Who usually takes care of (NAME OF YOUNGEST CHILD AT HOME) while you are working?

HUSBAND 01
OLDER CHILD(REN) 02
GRANDPARENTS 03
OTHER RELATIVES 04
NEIGHBORS 05
FRIENDS 06
SERVANTS/HIRED HELP 07
CHILD IS IN SCHOOL 08
INSTITUTIONAL CHILDCARE 09
OTHER (SPECIFY)__ 10

719. Did you work at any time before you (first) got married?

YES 1
NO 2

720. Did you work just after you (first) got married?

YES 1
NO 2

721. CHECK 709/710/719/720:

EVER WORKED (ANY 'YES' IN 709/710/719/720) (GO TO 722)
NEVER WORKED (GO TO 724)

722. How old were you when you first started working?

AGE IN COMPLETED YEARS_____

723. Why did you start working initially?

FINANCIAL NEED 1
SUPPLEMENT FAMILY'S INCOME 1
PERSONAL FULFILLMENT 1
HUSBAND DIED/BECAME ILL 1
SUBSEQUENT TO DIVORCE/SEPARATION 1
OTHER (SPECIFY)___ 1

724. RECORD THE CURRENT TIME

HOURS _______
MINUTES______

SECTION 8. HEIGHT AND WEIGHT

801. CHECK 215, 216:

ONE OR MORE LIVING CHILDREN BORN SINCE JAN. 1986 (GO TO 802)
NO LIVING CHILDREN BORN SINCE JAN. 1986 (END)

INTERVIEWER: IN 802-804, RECORD THE LINE NUMBERS, NAMES AND BIRTH DATES OF ALL LIVING CHILDREN BORN SINCE JANUARY 1, 1986 STARTING WITH THE YOUNGEST CHILD. THEN RECORD 805-811 FOR EACH CHILD.

802. LINE NO. FROM Q. 212

LINE NUMBER______

803. NAME FROM Q. 212

NAME ______

804. DATE OF BIRTH FROM Q. 215

BIRTH DATE _______

805. HEIGHT (in cm.)

_____ CM

806. HEIGHT: LYING OR STANDING

LYING 1
STANDING 2

807. WEIGHT (in kg.)

______ KG

808. ARM CIRCUMFERENCE (in cm.)

_____ CM

809. BCG SCAR ON ARM

SCAR SEEN 1
NO SCAR 2

810. DATE CHILD WEIGHED AND MEASURED

DAY _______
MONTH_______
YEAR_____

811. RESULTS:

CHILD MEASURED 1
CHILD SICK 2
CHILD NOT PRESENT 3
CHILD REFUSED 4
MOTHER REFUSED 5
OTHER 6 (SPECIFY)____

812. NAME OF MEASURER: __________
NAME OF ASSISTANT: ___________