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NATIONAL INSTITUTE OF POPULATION STUDIES
PAKISTAN DEMOGRAPHIC AND HEALTH SURVEY
EVER-MARRIED WOMAN'S QUESTIONNAIRE

IDENTIFICATION

PROVINCE

PUNJAB 1
SINDH 2
NWFP 3
BALOCHISTAN 4
FATA 5

DISTRICT __

TEHSIL __

CLUSTER NUMBER __

HOUSEHOLD NUMBER ___

IS HOUSEHOLD SELECTED FOR:

SHORT 1
WOMAN 2
VERBAL AUTOPSY 3
WOMAN AND VERBAL AUTOPSY 4

NAME OF HOUSEHOLD HEAD ___

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE __
INTERVIEWERS NAME ___
RESULT* __

*RESULT CODES:
1 COMPLETED
2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME
3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME
4 POSTPONED
5 REFUSED
6 DWELLING VACANT OR ADDRESS NOT A DWELLING
7 DWELLING DESTROYED
8 DWELLING NOT FOUND
9 OTHER (SPECIFY) ___

NEXT VISIT
DATE ______
TIME ________

FINAL VISIT
DAY __
MONTH __
YEAR ___
INT. NUMBER ___
RESULT* __

TOTAL NUMBER OF VISITS __

TOTAL PERSONS IN HOUSEHOLD __

DEATHS UNDER 5/SBs FROM Q. 38 __

FEMALE DEATHS AGE 12-49 FROM Q. 39 __

LINE NO. OF RESPONDENT __

LANGUAGE OF QUESTIONNAIRE: URDU

SUPERVISOR
NAME__
DATE__

FIELD EDITOR
NAME__
DATE__

OFFICE EDITOR__

KEYED BY __

SIGNATURE OF INTERVIEWER: ___________
DATE: ___________

RESPONDENT AGREES TO BE INTERVIEWED 1
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE TIME.

HOUR ___
MINUTES __

102) In what month and year were you born?

MONTH __
DON'T KNOW MONTH 98

YEAR __
DON'T KNOW YEAR 9998

103) How old are you?
COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT

AGE IN COMPLETED YEAR __

104) What is your current marital status? Are you married, Godforbid widowed, divorced, or separated?

MARRIED 1
WIDOWED 2 (GO TO 107)
DIVORCED 3 (GO TO 107)
SEPARATED 4 (GO TO 107)
NEVER MARRIED 5 (END)

105) Is your husband usually living with you now or is he staying elsewhere?

LIVING WITH HER 1
STAY ELSEWHERE 2

106) Does your husband have other wives?

YES 1
NO 2
DON'T KNOW 8

107) Is/was there a blood relationship between you and your husband?

YES 1
NO 2 (GO TO 109)

108) 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 RELATIONSHIP 6

109) Have you been married only once or more than once?

ONLY ONCE 1
MORE THAN ONCE 2

110) CHECK 109:

MARRIED ONLY ONCE: In what month and year did you start living with your husband?
MARRIED/MORE THAN ONCE: Now I would like to ask about when you started living with your first husband. In what month and year was that?

MONTH __
DON'T KNOW MONTH 98

YEAR __
DON'T KNOW YEAR 9998

111) How old were you when you first started living with him?

AGE __

112) Have you ever attended school?

YES 1
NO 2 (GO TO 115)

113) What is the highest class you completed?
WRITE '00' IF LESS THAN CLASS ONE;
WRITE '16' = IF MA, MPHIL, PHD, MBBS, BSC/4YEARS

CLASS __

114) CHECK 113

CLASS 00-08 __
CLASS 09 OR HIGHER __ (GO TO 116)

115) 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
CAN READ ONLY PARTS OF SENTENCE 2
CAN READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) 4
BLIND/VISUALLY IMPAIRED 5

116) What is your mother tongue?

URDU 01
PUNJABI 02
SINDHI 03
PUSHTO 04
BALOCHI 05
ENGLISH 06
BARAUHI 07
SIRAIKI 08
KASHMIRI 09
PAHARI 10
POTOWARI 12
MARWARI 13
FARSI 14
OTHER 96

SECTION 2. REPRODUCTION

201) Now I would like to ask you 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 you? And how many daughters live you with?
IF NONE, RECORD '00'

SONS AT HOME __
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) How many sons are alive but do not live with you? And how many daughters are alive but do not live with you?
IF NONE, RECORD '00'

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 signs of live but did not survive?

YES 1
NO 2 (GO TO 208)

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

BOYS DEAD __
GIRLS DEAD __

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

TOTAL __

209) CHECK 208:
Just to make sure that I have this right: you have had in TOTAL __ births during your like. Is that correct?

YES __
NO __ PROBE AND CORRECT 201-208 AS NECESSARY.

210) CHECK 208:

ONE OR MORE BIRTHS __
NO BIRTHS __ (GO TO 226)

211) Now I would like to record the names of all your births, whether still alive or not, starting with the last one you had. RECORD THE NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. (IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE FIRST ROW)

212) What name was given to your last (next-to-last) baby?

____ (NAME)

213) Were any of the births twins?

SING 1
MULT 2

214) Is (NAME) a boy or girl?

BOY 1
GIRL 2

215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?
RECORD MONTHS 1 THROUGH 12
OR SEASONS

MONTH _____

WINTER 21
SPRING 22
SUMMER 23
MONSOON 24
AUTUMN 25
DON'T KNOW 98

216) Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

217) IF ALIVE: How old is (NAME)?
WRITE AGE IN COMPLETED YEARS. WRITE '00' IF UNDER 1.

AGE IN YEARS __

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

YES 1
NO 2

219) IF ALIVE: RECORD HOUSEHOLD LINE NUMBER OF CHILD (RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD).

LINE NUMBER __ (GO TO 222)

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

DAYS 1 __
MONTHS 2 __
YEARS 3 __

221) IF DEAD: Where did (NAME) die?

HOME 1
HOSPITAL 2
OTHER 6

222) Were there any other livebirths between (NAME) and (NAME OF PREVIOUS BIRTH), including any children who died after birth?

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

223) Have you had any live births since the birth of (NAME OF LAST BIRTH)?
IF YES, WRITE BIRTH(S) IN TABLE.

YES 1
NO 2

224) COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:

NUMBER ARE SAME __
CHECK 215: FOR EACH BIRTH SINCE JANUARY 2001: MONTH AND YEAR OF BIRTH ARE RECORDED
CHECK 217: FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED
CHECK 220: FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED
CHECK 220: FOR AGE AT DEATH 12 MONTHS OR 1 YEAR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS
NUMBERS ARE DIFFERENT __ (PROBE AND RECONCILE)

225) CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 2001 OR LATER.
IF NONE, RECORD '0' AND GO TO 226.

NUMBER OF BIRTHS_____

226) Are you pregnant now?

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

227) How many months pregnant are you?

MONTHS __

228) 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 have any (more) children at all?

THEN 1
LATER 2
NOT AT ALL 3

229) Have you ever had a pregnancy that miscarried, was aborted, or ended in a stillbirth?

YES 1
NO 2 (GO TO 234)

230) When did the last such pregnancy end?
PROBE TO ASK BETWEEN WHICH BIRTHS, ETC.

MONTH __
YEAR ____

231) CHECK 230:

LAST PREGNANCY ENDED IN JANUARY 2001 OR LATER __
LAST PREGNANCY ENDED BEFORE JANUARY 2001 __ (GO TO 234)

232) How many months pregnant were you when the last such pregnancy ended?

MONTHS __

233) Since January 2001, how many pregnancies have you had that did not result in a live birth. How many of these pregnancies were miscarried, aborted or ended in a still birth?
IF 7 OR MORE, RECORD '7'

NUMBER OF MISCARRIAGES __
NUMBER OF ABORTIONS __
NUMBER OF STILLBIRTHS __

234) When did your last menstrual period start?
IF LESS THAN A WEEK, RECORD DAYS. IF ONE WEEK AND LESS THAN ONE MONTH, RECORD WEEKS. IF ONE MONTH AND LESS THAN A YEAR, RECORD MONTHS. IF YEAR OR MORE RECORD YEARS.

____(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

235) Do you know about any problems or complications a woman can have during pregnancy or delivery or after delivery?

YES 1
NO 2 (GO TO 301)

236) What complications or problems do you know about?

____________

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 way or methods have you heard about?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK:
Have you ever heard of (METHOD)?

CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD S RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302.

01 FEMALE STERILIZATION. Women can have an operation to avoid having any more pregnancies.
YES 1
NO 2
02 MALE STERILIZATION. Men can have an operation to avoid having any more pregnancies.
YES 1
NO 2
03 PILL. Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
04 IUD. Women can have a loop or coil placed inside them by a doctor or a trained health worker.
YES 1
NO 2
05 INJECTABLES. Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
06 IMPLANTS. Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
07 CONDOM. Men can put a rubber sheath on their organ before sexual intercourse.
YES 1
NO 2
08 RHYTHM METHOD. Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
09 WITHDRAWAL, AZAL. Men can be careful and pull out before ejaculation.
YES 1
NO 2
10 EMERGENCY CONTRACEPTION. Women can take pills up to five days after sexual intercourse to avoid becoming pregnant.
YES 1
NO 2
11 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1 _______ (SPECIFY)
NO 2

302) Have you ever used (METHOD)?

01 FEMALE STERILIZATION. Women can have an operation to avoid having any more pregnancies.
YES 1
NO 2
02 MALE STERILIZATION. Men can have an operation to avoid having any more pregnancies.
YES 1
NO 2
03 PILL. Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
04 IUD. Women can have a loop or coil placed inside them by a doctor or a trained health worker.
YES 1
NO 2
05 INJECTABLES. Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
06 IMPLANTS. Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
07 CONDOM. Men can put a rubber sheath on their organ before sexual intercourse.
YES 1
NO 2
08 RHYTHM METHOD. Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
09 WITHDRAWAL, AZAL. Men can be careful and pull out before ejaculation.
YES 1
NO 2
10 EMERGENCY CONTRACEPTION. Women can take pills up to five days after sexual intercourse to avoid becoming pregnant.
YES 1
NO 2
11 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1 _______ (SPECIFY)
NO 2

303) CHECK 302:

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

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

YES 1
NO 2 (GO TO 322)

305) What have you used or done?

CORRECT 302 AND 303 (AND 301 IF NECESSARY)

306) CHECK 104:

CURRENTLY MARRIED __
WIDOWED, DIVORCED, OR SEPARATED __ (GO TO 322)

307) CHECK 302 (01):

WOMAN NOT STERILIZED __
WOMAN STERILIZED __ (GO TO 310)

308) CHECK 226:

NOT PREGNANT OR UNSURE __
PREGNANT __ (GO TO 332)

309) Are you currently doing something or using any method to delay or avoid getting pregnant?

YES 1
NO 2 (GO TO 332)

310) Which method are you using?
CIRCLE ALL MENTIONED.
IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD ON LIST.

FEMALE STERILIZATION 1 (GO TO 316)
MALE STERILIZATION 2 (GO TO 316)
PILL 3
IUD 4 (GO TO 316)
INJECTABLES 5 (GO TO 314)
IMPLANTS 6 (GO TO 316)
CONDOM 7
RHYTHM 8 (GO TO 321)
WITHDRAWAL 9 (GO TO 321)
OTHER (SPECIFY) X (GO TO 321)

311) May I see the package of pills/condoms you are now using?
RECORD NAME OF BRAND IF PACKAGE SEEN.

PACKAGE SEEN 1 (GO TO 313)
BRAND NAME (SPECIFY) ___ (GO TO 313)
PACKAGE NOT SEEN 2

312) Do you know the brand name of the (pills/condoms) you are using?
RECORD THE NAME OF BRAND

BRAND NAME (SPECIFY) ____
DON'T KNOW 998

313) How many (pill cycles/condoms) did you or your husband get the last time?

NUMBER OF PILL CYCLES/CONDOMS ___ (GO TO 316)
DON'T KNOW 998 (GO TO 316)

314) Can you tell me the name of the injection you are using?

BRAND NAME (SPECIFY) __
DON'T KNOW 8

315) Please tell me for how many weeks one injection is effective.

NUMBER OF WEEKS __
DON'T KNOW 8

316) The last time you obtained (CURRENT METHOD), how much did you pay in total, including the cost of the method and any consultation you may have had?
IF STERILIZED: How much did you or your husband pay for the sterilization, including any consultation?

NOTHING, FREE 0000
RS. _____
RS 1000+ 9995
DON'T KNOW 9998

317) Where did you obtain (CURRENT METHOD) the last time?
IF STERILIZED: Where did the sterilization take place?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR FWC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

________(NAME OF PLACE)

ONLY FOR MODERN METHOD

PUBLIC SECTOR
GOVT. HOSPITAL/RHSC 11
RURAL HEALTH CENTRE, MCH 12
FAMILY WELFARE CENTRE 13
MOBILE SERVICE CAMP 14
LADY HEALTH WORKER 15
LH VISITOR 16
BASIC HEALTH UNIT 17
MALE MOBILIZER 18
OTHER PUBLIC (SPECIFY) ____ 19
PRIVATE/NGO MEDICAL SECTOR
PRIVATE/NGO HOSPITAL/CLINIC 21
PHARMACY, CHEMISTS 22
PRIVATE DOCTOR 23
HOMEOPATH 24
DISPENSER/COMPOUNDER 25
OTHER PRVATE MEDICAL (SPECIFY) __ 26
OTHER SOURCE
SHOP (NOT PHARMACY/CHEMIST) 31
FRIEND/RELATIVE 32
HAKIM 32
DAI, TRAD, BIRTH ATTENDANT 34
PUSHCART 35
OTHER (SPECIFY) ___ 96
DON'T KNOW 98

318) At the time you obtained (CURRENT METHOD) from the above source, were you told about side effects or problems you might have with the method?

YES 1
NO 2 (GO TO 320)

319) Were you ever told what to do if you experienced side effects or problems?

YES 1
NO 2

320) Were you ever told about other methods of family planning that you could use?

YES 1
NO 2

321) Since what month or year have you been using (CURRENT METHOD) without stopping?
IF STERILIZED: In what month and year was the sterilization performed?
PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

MONTH ___ (GO TO 324)
YEAR ____ (GO TO 324)

322) Do you know of a place where you can obtain a method of family planning?

YES 1
NO 2 (GO TO 324)

323) Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR FWC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
________(NAME OF PLACE)
RECORD ALL PLACES MENTIONED.

PUBLIC SECTOR
GOVT. HOSPITAL/RHSC 11
RURAL HEALTH CENTRE, MCH 12
FAMILY WELFARE CENTRE 13
MOBILE SERVICE CAMP 14
LADY HEALTH WORKER 15
LH VISITOR 16
BASIC HEALTH UNIT 17
MALE MOBILIZER 18
OTHER PUBLIC (SPECIFY) ____ 19
PRIVATE/NGO MEDICAL SECTOR
PRIVATE/NGO HOSPITAL/CLINIC 21
PHARMACY, CHEMISTS 22
PRIVATE DOCTOR 23
HOMEOPATH 24
DISPENSER/COMPOUNDER 25
OTHER PRVATE MEDICAL (SPECIFY) __ 26
OTHER SOURCE
SHOP (NOT PHARMACY/CHEMIST) 31
FRIEND/RELATIVE 32
HAKIM 32
DAI, TRAD, BIRTH ATTENDANT 34
PUSHCART 35
OTHER (SPECIFY) ___ 96

324) In the last 12 months, were you visited by a fieldworker of a Lady Health Worker who talked to you about family planning?

YES 1
NO 2 (GO TO 327)

325) Did you receive any care and help from this woman?

YES 1
NO 2 (GO TO 327)

326) What type of help did you receive?
CIRCLE ALL MENTIONED.

INFORMATION A
CONTRACEPTIVE SUPPLIES B
REFERRED TO HEALTH/FP FACILITY C
TREATMENT OR SIDE EFFECTS D
OTHER (SPECIFY) ____ X

327) In the last month, have you heard a message about family planning on:

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2

328) CHECK 327:

HEARD MESSAGE (ANY YES IN 327) __
NOT HEARD MESSAGE __ (GO TO 401)

329) What messages did it convey to you?
RECORD ALL MENTIONED.

LIMITING THE FAMILY A
HIGHER AGE AT MARRIAGE B
SPACING OF CHILDREN C
USE OF CONTRACEPTIVES D
WELFARE OF FAMILY E
MATERNAL AND CHILD HEALTH F
LESS CHILDREN MEAN PROSPEROUS LIFE G
MORE CHILDREN MEAN POVERTY AND STARVATION H
IMPORTANCE OF BREASTFEEDING I
OTHER-1 (SPECIFY) ___ X
OTHER-2 (SPECIFY) ___ Y
DON'T KNOW/NOT REMEMBER Z

330) 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

SECTION 4. PREGNANCY, LABOUR/DELIVERY AND POSTNATAL CARE

401) CHECK 225:

ON OR MORE LIVE BIRTHS IN 2001 OR LATER __
NO LIVE BIRTHS IN 2001 OR LATER __ (GO TO 601)

402) ENTER IN THE TABLE THE BIRTH NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2001 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEING WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).
Now I would like to ask you some questions about the health of all your children born since January 2001. (We will talk about each separately).

403) BIRTH NUMBER FROM 212

BIRTH NO. ___

404) FROM 212 AND 216

NAME ___
LIVING __
DEAD __

405) At the time you became pregnant wit (NAME), did you want to become pregnant then, did you want to wait until later, or did you not want to have any (more) children at all?

THEN 1 (FOR LAST BIRTH, GO TO 407; FOR ALL OTHER BIRTHS, GO TO 444)
LATER 2
NOT AT ALL 3 (FOR LAST BIRTH, GO TO 407; FOR ALL OTHER BIRTHS, GO TO 444)

406) How much longer would you have liked to wait?

MONTHS 1 __
YEARS 2 __
DON'T KNOW 998

407) Did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.
[ONLY ASKED FOR MOST RECENT PREGNANCY]

HEALTH PERSON
DOCTOR A
NURSE/MIDWIFE/LHV B
OTHER PERSON
DAI-TBA C
LADY H. WORKER D
HOMEOPATH E
HAKIM F
DISPENSER/COMPOUNDER G
OTHER (SPECIFY) ____ X
NO ONE Y (GO TO 417)

408) Where did you receive antenatal care for this pregnancy? Anywhere else?
FOR ANY HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE.
PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND RECORD ALL MENTIONED.
[ONLY ASKED FOR MOST RECENT PREGNANCY]

HOME
YOUR HOME A
OTHER HOME B
PUBLIC SECTOR
GOVT. HOSPITAL C
RHC/MCH D
BHU/FWC E
OTHER PUBLIC (SPECIFY) ___ F
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC H
PVT. DOCTOR I
HOMEOPATH J
DISPENSER/COMPOUNDER K
OTHER PRIVATE MED. (SPECIFY) ___ L
HAKIM M
OTHER (SPECIFY) ___ X

409) The first time you went for antenatal care, did you go because you had a problem or did you go just for a checkup?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

FOR PROBLEM 1
FOR CHECKUP ONLY 2

410) How many months pregnant were when you first received antenatal care for this pregnancy?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

MONTHS __
DON'T KNOW 98

411) How much did you pay for the first antenatal visit?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

NOTHING/FREE 0000
Rs. ____
Rs. 10000+ 9995
DON'T KNOW 9998

412) How many time did you receive antenatal care during this pregnancy?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

NUMBER OF TIMES __
DON'T KNOW 98

413) As part of your antenatal care during this pregnancy, were any of the following measures taken at least once?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

Were you weighed?
YES 1
NO 2
Was your blood pressure measured?
YES 1
NO 2
Did you get a urine test?
YES 1
NO 2
Did you get a blood test?
YES 1
NO 2
Did you have an ultra sound exam?
YES 1
NO 2

414) Do you know your blood group?

YES 1
NO 2

415) During any antenatal care visit, were you told about the signs of pregnancy complications?

YES 1
NO 2 (GO TO 418)
DON'T KNOW 8 (GO TO 418)

416) During any antenatal care visit, were you told where to go if you had any of these complications?

YES 1 (GO TO 418)
NO 2
DON'T KNOW 8 (GO TO 418)

417) Why didn't you see anyone for an antenatal check-up?
CIRCLE ALL CODES MENTIONED.

NOT NECESSARY A
COSTS TOO MUCH B
TOO FAR C
NO TRANSPORT D
NO ONE TO GO WITH E
SERVICE NOT GOOD F
NO TIME TO GO G
DID NOT KNOW WHERE TO GO H
DID NOT WANT TO SEE A MALE DOCTOR I
LONG WAITING TIME J
NOT ALLOWED TO GO K
OTHER ____ X

418) When you were pregnant with (NAME), did anyone talk to you about how to have a safe delivery? I mean things like using a safe delivery kit or a clean blade to cut the baby's cord or asking the person who helps you to wash their hands?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

YES 1
NO 2
DON'T KNOW 8

419) During this pregnancy, were you given an injection in the buttocks or your arm to prevent the baby from getting tetanus, that is, convulsions after birth?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

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

420) During this pregnancy, how many times did you get this tetanus injection?

TIMES __
DON'T KNOW 8

421) CHECK 420:

2 OR MORE TIMES __ (GO TO 426)
OTHER __

422) At any time before this pregnancy, did you receive any tetanus injections, either to protect yourself or another baby?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

YES 1
NO 2 (GO TO 426)
DON'T KNOW 8 (GO TO 426)

423) Before this pregnancy, how many other times did you receive a tetanus injection?
IF 7 OR MORE TIMES, RECORD '7'
[ONLY ASKED FOR MOST RECENT PREGNANCY

TIMES __
DON'T KNOW 8

424) In what month and year did you receive the last tetanus injection before this pregnancy?
ASK TO SEE THE CHILD HEALTH/IMMUNIZATION CARD. CHECK TETANUS INJECTIONS FOR MOTHER.

MONTH __
DON'T KNOW MONTH 98

YEAR ____ (GO TO 426)
DON'T KNOW YEAR 9998

425) How many years ago did you receive that tetanus injection?

YEARS AGO __

426) During this pregnancy, were you given or did you buy any iron tablets or iron syrup?
SHOW TABLETS/SYRUP
[ONLY ASKED FOR MOST RECENT PREGNANCY]

YES 1
NO 2 (GO TO 428)
DON'T KNOW 8 (GO TO 428)

427) During the whole pregnancy, for how many days did you take the tablets or syrup?
IF ANSWER NOT NUMERIC, ASK FOR APPROXIMATE NUMBER.
[ONLY ASKED FOR MOST RECENT PREGNANCY]

DAYS __
DIDN'T TAKE 997
DON'T KNOW 998

428) During this pregnancy, were you given or did you take calcium tablets?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

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

429) During the whole pregnancy for how many days did you take the tablets?

DAYS __
DIDN'T TAKE 997
DON'T KNOW 998

430) During this pregnancy, did you have difficulty with your vision during daylight?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

YES 1
NO 2
DON'T KNOW 8

431) During this pregnancy, did you suffer from night blindness?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

YES 1
NO 2
DON'T KNOW 8

432) During this pregnancy, did you suffer from malaria?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

YES 1
NO 2 (GO TO 435)
DON'T KNOW 8 (GO TO 435)

433) Did you receive treatment for malaria during the pregnancy?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

YES 1
NO 2 (GO TO 435)

434) Where did you receive treatment for the malaria during this pregnancy?
IF MORE THAN ONE PLACE, ASK FOR THE MAIN ONE.
[ONLY ASKED FOR MOST RECENT PREGNANCY]

HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVT. HOSPITAL 21
RHC/MCH 22
BHU/FWC 23
LH WORKER 24
OTHER PUBLIC (SPECIFY) ____ 26
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC 31
PVT. DOCTOR 32
HOMEOPATH/DISPENSER 33
COMPOUNDER 34
HAKIM 35
OTHER PRIVATE MED. (SPECIFY) ___ 36
OTHER (SPECIFY) ___ 96

435) When you were pregnant with (NAME), did you have any of the following problems?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

Severe headaches?
YES 1
NO 2
Blurred vision?
YES 1
NO 2
Swelling of your hands?
YES 1
NO 2
Swelling of your face?
YES 1
NO 2
Vaginal bleeding/spotting?
YES 1
NO 2
Fits or convulsions?
YES 1
NO 2
Epigastric pains?
YES 1
NO 2

436) CHECK 435:

ANY YES __
ALL NO __ (GO TO 442)

437) Were any of these problems so severe that you were afraid you might die?

YES 1
NO 2
DO NOT REMEMBER 8

438) Did you seek advice or treatment for the problem(s)?
IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE/LHV B
OTHER PERSON
DAI-TBA C
LADY. H WORKER D
HOMEOPATH E
HAKIM F
DISPENSER/COMPOUNDER G
OTHER (SPECIFY) ___ X
NO ONE Y (GO TO 441)

439) Where did you seek treatment for the problem(s)? Anywhere else?
PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND RECORD ALL MENTIONED.

HOME
YOUR HOME A
OTHER HOME B
PUBLIC SECTOR
GOVT. HOSPITAL C
RHC/MCH D
BHU/FWC E
OTHER PUBLIC (SPECIFY) ___ F
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC H
PVT. DOCTOR I
HOMEOPATH J
DISPENSER/COMPOUNDER K
HAKIM L
OTHER PRIVATE MED. (SPECIFY) ___ M
OTHER (SPECIFY) ___ X

440) How long after you first started having the (first) problem did you seek advice or treatment?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ON WEEK, RECORD DAYS. IF MORE THAN ONE WEEK, RECORD WEEKS.

HOURS 1 __ (GO TO 442)
DAYS 2 __ (GO TO 442)
WEEKS 2 __ (GO TO 442)
DON'T REMEMBER 998 (GO TO 442)

441) Why didn't you see anyone for the problem(s)?
RECORD ALL MENTIONED.
[ONLY ASKED FOR MOST RECENT PREGNANCY]

NOT NECESSARY A
COSTS TOO MUCH B
TOO FAR C
NO TRANSPORT D
NO ONE TO GO WITH E
SERVICE NOT GOOD F
NO TIME TO GO G
DID NOT KNOW WHERE TO GO H
DID NOT WANT TO SEE A MALE DOCTOR I
LONG WAITING TIME J
NOT ALLOWED TO GO K
OTHER (SPECIFY) ___ X

442) During this pregnancy, did you and your husband discuss where you would deliver?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

YES 1
NO 2
CANNOT REMEMBER 8

443) During this pregnancy, did you set aside any money in case of an emergency?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

YES 1
NO 2
CANNOT REMEMBER 8

444) 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

445) Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 447)
DON'T KNOW 8 (GO TO 447)

446) 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 99.998

447) Who assisted with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE OR PERSON AND RECORD ALL MENTIONED.
IF RESPONDENT SAYS NO ONE ASSISTED, ASK IF ANY ADULTS WERE PRESENT AT THE DELIVERY.

HEALTH PERSON
DOCTOR A
NURSE/MIDWIFE/LHV B
OTHER PERSON
DAI-TBA C
LADY H. WORKER D
HOMEOPATH E
HAKIM F
RELATIVE/FRIEND (NOT A DAI) G
OTHER (SPECIFY)___ X
NO ONE Y

448) Were you given an injection to induce labour to deliver (NAME)?

YES 1
NO 2
DON'T KNOW 8

449) Where did you give birth to (NAME)?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

__________ (NAME OF PLACE)
HOME
YOUR HOME 11 (FOR MOST RECENT PREGNANCY, GO TO 458; FOR ALL OTHERS, GO TO 464)
OTHER HOME 12 (FOR MOST RECENT PREGNANCY, GO TO 458; FOR ALL OTHERS, GO TO 464)
PUBLIC SECTOR
GOVT. HOSPITAL 21
RHC/MCH 22
OTHER PUBLIC (SPECIFY) ___ 26
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC 31
OTHER PRIVATE MED. (SPECIFY) ___ 36
OTHER (SPECIFY) ____ 96 (FOR MOST RECENT PREGNANCY, GO TO 458; FOR ALL OTHERS, GO TO 464)

450) Why did you deliver at the hospital/health centre?

______________

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

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

452) Was (NAME) delivered by caesarean section?

YES 1
NO 2

453) In total, how much did you pay for the delivery, including doctors' fees, facility costs and medicines?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

NOTHING, FREE 0000
Rs. _____
Rs. 10000+ 9995
DON'T KNOW 9998

454) Before you were discharged after (NAME) was born, did any health personnel check on your health?

YES 1
NO 2 (FOR MOST RECENT PREGNANCY, GO TO 457; FOR ALL OTHERS, GO TO 482)

455) How many hours, days or weeks after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS. IF MORE THAN ONE WEEK, RECORD WEEKS.
[ONLY ASKED FOR MOST RECENT PREGNANCY]

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

456) Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[ONLY ASKED FOR MOST RECENT PREGNANCY]

HEALTH PERSONNEL
DOCTOR 11 (GO TO 472)
NURSE/MIDWIFE/LHV 12 (GO TO 472)
OTHER PERSON
DAI-TBA 21 (GO TO 472)
LADY H. WORKER 22 (GO TO 472)
HOMEOPATH 23 (GO TO 472)
HAKIM 24 (GO TO 472)
OTHER (SPECIFY) ____ 96 (GO TO 472)

457) After you were discharged, did any health care provider or a traditional birth attendant check on your health?

YES 1 (FOR MOST RECENT PREGNANCY, GO TO 465; FOR ALL OTHERS, GO TO 482)
NO 2 (FOR MOST RECENT PREGNANCY, GO TO 472; FOR ALL OTHERS, GO TO 482)

458) Why didn't you deliver in a health facility?
PROBE: Any other reason?
RECORD ALL MENTIONED.
[ONLY ASKED FOR MOST RECENT PREGNANCY]

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
NO TIME/BABY CAME TOO FAST I
OTHER (SPECIFY) ____ X

459) In total, how much did you pay for the delivery?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

NOTHING, FREE 0000
Rs. ____
Rs. 10000+ 9995
DON'T KNOW 9998

460) Was a safe delivery kit used during this delivery?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

YES 1
NO 2
DOES NOT KNOW 8

461) What was used to TIE the umbilical cord?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

UNBOILED THREAD 1
BOILED THREAD 2
WASHED CLAMPS 3
UNWASHED CLAMPS 4
HAIR 5
OTHER ___ 6

462) What was used to CUT the umbilical cord?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

NEW RAZOR BLADE 1
OLD RAZOR BLADE 2
SCISSORS 3
KNIFE 4
TOKA, CHOPPER 5
OTHER ___ 6

463) Was the instrument boiled before using or not boiled?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

BOILED 1
NOT BOILED 2
DON'T KNOW 8

464) After (NAME) was born, did any health care provider or a traditional birth attendant check on your health?

YES 1
NO 2 (FOR MOST RECENT PREGNANCY, GO TO 468)

465) How many hours, day or weeks after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS. IF ONE WEEK OR MORE, RECORD WEEKS.
[ONLY ASKED FOR MOST RECENT PREGNANCY]

HOURS __
DAYS __
WEEKS __
DON'T KNOW 8

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

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE/LHV 12
OTHER PERSON
DAI-TBA 21
LADY H. WORKER 22
HOMEPATH 23
DISPENSER/COMPOUNDER 25
OTHER (SPECIFY) ___ 96

467) Where did this first check take place?
IF SOURCE IS A HOSPITAL, HEALTH CENTER, OR CLINIC, RECORD THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE

HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVT. HOSPITAL 21
RHC/MCH 22
BHU/FWC 23
OTHER PUBLIC (SPECIFY) ___ 26
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC 31
OTHER PRIVATE MED. (SPECIFY)__ 36
OTHER (SPECIFY) ___ 96

468) In the two months after (NAME) was born, did any health care provider or dai or a LHW or hakim check on his/her health?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

YES 1
NO 2 (GO TO 472)
DON'T KNOW 8 (GO TO 472)

469) 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. IF ONE WEEK OR MORE, RECORD WEEKS.
[ONLY ASKED FOR THE MOST RECENT PREGNANCY]

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

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

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE/LHV 12
OTHER PERSON
DAI-TBA 21
LADY H. WORKER 22
HOMEOPATH 23
HAKIM 24
OTHER (SPECIFY) __ 96

471) Where did the first check of (NAME) take place?
IF SOURCE IS A HOSPITAL, HEALTH CENTER, OR CLINIC, RECORD THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE

HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVT. HOSPITAL 21
RHC/MCH 22
BHU/FWC 23
OTHER PUBLIC (SPECIFY) ___ 26
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC 31
OTHER PRIVATE MED. (SPECIFY)__ 36
OTHER (SPECIFY) ___ 96

472) How long after birth was (NAME) first bathed?
IF LESS THAN 1 HOUR, RECORD '00' HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. IF ONE DAY OR MORE, RECORD DAYS.
[ONLY ASKED FOR MOST RECENT PREGNANCY]

IMMEDIATELY 000
HOURS 1 ___
DAYS 2 ___
DON'T KNOW 998

473) During the delivery or in the 40-day period after the delivery of (NAME), did you experience any of the following problems?
[ONLY ASKED FOR THE MOST RECENT PREGNANCY]

Severe headaches?
YES 1
NO 2
Blurred vision?
YES 1
NO 2
Swelling of your hands?
YES 1
NO 2
Swelling of your face?
YES 1
NO 2
High fever?
YES 1
NO 2
Fits or convulsions?
YES 1
NO 2
Labor for more than 12 hours?
YES 1
NO 2
Baby's feet came first?
YES 1
NO 2
Placenta came first?
YES 1
NO 2
Continuous dribbling of urine even during sleep?
YES 1
NO 2
Bad-smelling vaginal discharge?
YES 1
NO 2
Inability to control emotions?
YES 1
NO 2
Heavy vaginal bleeding?
YES 1
NO 2

473A) IF YES: When did you experience this?

IMMEDIATELY AFTER BIRTH OF BABY 0
IN THE FIRST 24 HOURS 1
LATER 2

474) CHECK 473:

ANY YES __
ALL NO __ (GO TO 480)

475) Were any of these problems so severe that you were afraid you might die?

YES 1
NO 2
CANNOT REMEMBER 8

476) Did you seek advice or treatment for the problem(s)?
IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.

HEALTH PERSON
DOCTOR A
NURSE/MIDWIFE/LHV B
OTHER PERSON
DAI-TBA C
LADY H. WORKER D
HOMEOPATH E
HAKIM F
OTHER (SPECIFY) ___ X
NO ONE Y (GO TO 479)

477) Where did you seek treatment for the problem(s)? Anywhere else?
PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND RECORD ALL MENTIONED.

HOME
YOUR HOME A
OTHER HOME B
PUBLIC SECTOR
GOVT. HOSPITAL C
RHC/MCH D
BHU/FWC E
OTHER PUBLIC (SPECIFY) ____ F
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC H
PVT. DOCTOR I
HOMEOPATH J
DISPENSER/COMPOUNDER K
OTHER PRIVATE MED. (SPECIFY) ___ M
OTHER (SPECIFY) ___ X

478) How long after you first started having the problem did you seek advice or treatment?
IF LESS THAN 1 HOUR, RECORD '00' HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. IF LESS THAN 7 DAYS, RECORD DAYS. OTHERWISE WEEKS.

HOURS 1 __ (GO TO 480)
DAYS 2 __ (GO TO 480)
WEEKS 3 __ (GO TO 480)
DON'T KNOW 998 (GO TO 480)

479) Why didn't you see anyone for the problem(s)?
CIRCLE ALL MENTIONED.

NOT NECESSARY A
COSTS TOO MUCH B
FACILITY TOO FAR AWAY C
NO TRANSPORT D
NO ONE TO GO WITH E
SERVICE NOT GOOD F
NO TIME TO GO G
DID NOT KNOW WHERE TO GO I
DID NOT WANT TO SEE A MALE DOCTOR I
LONG WAITING TIME J
NOT ALLOWED TO GO K
OTHER ____ X

480) In the first two months after deliver, did you receive a vitamin A does like this?
SHOW AMPULES/CAPSULES/SYRUP
[ONLY ASKED FOR MOST RECENT PREGNANCY]

YES 1
NO 2

481) Has you menstrual period returned since the birth of (NAME)?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

YES 1 (GO TO 483)
NO 2 (GO TO 484)

482) Did your period return between the birth of (NAME) and your next pregnancy?
[NOT ASKED FOR MOST RECENT PREGNANCY]

YES 1
NO 2 (GO TO 486)

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

MONTHS ___
DON'T KNOW 98

484) CHECK 226: IS RESPONDENT PREGNANT?

NOT PREGNANT __
PREGNANT OR UNSURE __ (GO TO 486)

485) Have you resumed sexual relations since the birth of (NAME)?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

YES 1
NO 2 (GO TO 487)

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

MONTHS __
DON'T KNOW 98

487) Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 495)

488) 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.
[ONLY ASKED FOR MOST RECENT PREGNANCY]

IMMEDIATELY 000
HOURS 1 __
DAYS 2 __

489) Did you give the (NAME) the thick milk (colostrum) that comes first or did you discard it?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

GAVE COLOSTRUM 1
DISCARDED IT 2
DO NOT REMEMBER 8

490) In the first three days after delivery, was (NAME) given anything to drink other than breast milk?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

YES 1
NO 2 (GO TO 492)

491) What was (NAME) given to drink? Anything else?
RECORD ALL LIQUIDS MENTIONED.
[ONLY ASKED FOR MOST RECENT PREGNANCY]

MILK (OTHER THAN BREAST MILK) A
PLAIN WATER B
HONEY OR SUGAR WATER C
GHEE, BUTTER D
FRUIT JUICE E
INFANT FORMULA F
GHUTEE G
GREEN TEA H
OTHER (SPECIFY) ___ X

492) CHECK 404: IS CHILD LIVING?

LIVING __
DEAD __ (GO TO 494)

493) Are you still breastfeeding (NAME)?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

YES 1 (GO TO 494)
NO 2

494) For how many months did you breastfeed (NAME)?
IF LESS THAN ONE MONTH, RECORD '00'

MONTHS __
DON'T KNOW 98

495) CHECK 404: IS CHILD LIVING?

LIVING __ (GO TO 498)
DEAD __ (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501)

496) 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 __

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

NUMBER OF DAYLIGHT FEEDINGS __

498) Yesterday or last night, did (NAME) eat or drink:

Plain water?
YES 1
NO 2
Baby formula or other milk?
YES 1
NO 2
Juice, soda, tea, rice water?
YES 1
NO 2
Any mushy or solid food?
YES 1
NO 2

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

YES 1
NO 2
DON'T KNOW 8

499A) GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501.

SECTION 5. CHILD VACCINATION, HEALTH AND NUTRITION

501) ENTER IN THE TABLE THE BIRTH NUMBER, NAME AND SURVIVAL STATUS OF EACH LIVE BIRTH IN 2001 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MOE THAN 3 BIRTHS, USE LAST 2 COLUMN OF ADDITIONAL QUESTIONNAIRES).

502) BIRTH NUMBER FROM 212

____

503) FROM 212 AND 216

NAME ___
LIVING __
DEAD __ (GO TO 503 IN NEXT COLUMN, IF NO MORE BIRTHS, GO TO 601)

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

YES, SEEN 1 (GO TO 506)
YES, NOT SEEN 2 (GO TO 508)
NO CARD 3

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

YES 1 (GO TO 508)
NO 2 (GO TO 508)

506) (1) COPY DATE OF BIRTH IF GIVEN. IF NOT ON CARD, LEAVE IT BLANK.
(2) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD
(3) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BIT NO DATE IS RECORDED.

BIRTH
DAY __
MONTH __
YEAR __
BCG
DAY __
MONTH __
YEAR __
POLIO 0 (POLIO GIVEN AT BIRTH)
DAY __
MONTH __
YEAR __
POLIO 1
DAY __
MONTH __
YEAR __
POLIO 2
DAY __
MONTH __
YEAR __
POLIO 3
DAY __
MONTH __
YEAR __
DPT 1
DAY __
MONTH __
YEAR __
DPT 2
DAY __
MONTH __
YEAR __
DPT 3
DAY __
MONTH __
YEAR __
HBV 1
DAY __
MONTH __
YEAR __
HBV 2
DAY __
MONTH __
YEAR __
HBV 3
DAY __
MONTH __
YEAR __
MEASLES
DAY __
MONTH __
YEAR __

507) Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations received in a national immunization day campaign?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, OR MEASLES VACCINES.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 506) (GO TO 510)
NO 2 (GO TO 510)
DON'T KNOW 8 (GO TO 510)

508) Did (NAME) receive any vaccinations to prevent him/her from getting diseases, including vaccinations received in a national immunization campaign?

YES 1
NO 2 (GO TO 511)
DON'T KNOW 8 (GO TO 511)

509) Please tell me if (NAME) received any of the following vaccinations:

509A) 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

509B) Polio vaccine, that is, drops in the mouth?

YES 1
NO 2 (GO TO 509E)
DON'T KNOW 8 (GO TO 509E)

509C) Was the first time polio drops were received in the first 2 weeks after birth or later?

FIRST 2 WEEKS 1
LATER 2

509D) How many times was the polio vaccine received?
IF 7 OR MORE TIMES, RECORD 7.

NUMBER OF TIMES __

509E) A DPT vaccination, that is, an injection given in the thigh or buttocks, (sometimes at the same time as the polio drops)?

YES 1
NO 2 (GO TO 509G)
DON'T KNOW 8 (GO TO 509G)

509F) How many times was a DPT vaccination received?

NUMBER OF TIMES __

509G) A hepatitis HBV vaccination, that is an injection given in the thigh or buttocks, sometimes at the same time as polio drops?

YES 1
NO 2 (GO TO 509I)
DON'T KNOW 8 (GO TO 509I)

509H) How many times was an HBV vaccination received?

NUMBER OF TIMES ___

509I) An injection to prevent measles?

YES 1
NO 2
DON'T KNOW 8

510) Did (NAME) ever receive a polio vaccine (drops in the mouth) during a national immunization campaign?
IF YES, CHECK 506 OR 509D OR MORE.

YES 1
NO 2

511) Has (NAME) ever received a vitamin A dose like this?
SHOW VIT.A CAPSULES

YES 1
NO 2 (GO TO 513)
DON'T KNOW 8 (GO TO 513)

512) How many months ago did (NAME) take the last dose?
PUT '00' IF LESS THAN 1 MONTH

MONTHS AGO __
DON'T KNOW 98

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

YES 1
NO 2 (GO TO 525)
DON'T KNOW 8 (GO TO 525)

514) Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

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

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

516) How many times did (NAME) pass stool in the last 24 hours?

NUMBER OF STOOLS __

517) Now I would like to know how much (NAME) was given to drink during the diarrhea. Was he/she given less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was he/she 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

518) When (NAME) had diarrhea, was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, PROBE: Was he/she 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

519) Did you seek advice or treatment for the diarrhea from any source?

YES 1
NO 2 (GO TO 522)

520) Where did you seek advice or treatment? Anywhere else?
FOR ANY HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE.
PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND RECORD ALL MENTIONED.

PUBLIC SECTOR
GOVT. HOSPITAL A
RHC/MCH B
BHU/FWC C
LADY H. WORKER D
OTHER PUBLIC (SPECIFY) ___ E
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC F
CHEMIST G
PVT. DOCTOR H
HOMEOPATH I
DISPENSER/COMPOUNDER J
OTHER PRIVATE MED. (SPECIFY) ___ K
OTHER SOURCE
SHOP L
HAKIM M
DAI, TBA N
OTHER (SPECIFY) ___ X

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

DAYS ___

522) Was he/she given any of the following to drink at any time since he/she started having the diarrhea:

522A) A fluid made from a special packet called ORS or Nimkol?
YES 1
NO 2
DON'T KNOW 8
522B) A drink made at home with sugar, salt and water?
YES 1
NO 2
DON'T KNOW 8

523) Was anything (else) given to treat the diarrhea?

YES 1
NO 2 (GO TO 525)
DON'T KNOW 8 (GO TO 525)

524) What (else) was given to treat the diarrhea? Anything else?
RECORD ALL TREATMENTS GIVEN.

PILL/SYRUP A
INJECTION B
IV DRIP C
HOME REMEDY/HERBAL MEDICINE/ISPAGHOL D
OTHER (SPECIFY) __ X

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 529)
DON'T KNOW 8 (GO TO 529)

527) When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, rapid breaths or have difficulty breathing?

YES 1
NO 2 (GO TO 530)
DON'T KNOW 8 (GO TO 530)

528) Were these breathing symptoms due to a problem in the chest or to a blocked or runny nose?

CHEST ONLY 1 (GO TO 530)
NOSE ONLY 2 (GO TO 530)
BOTH 3 (GO TO 530)
OTHER (SPECIFY) ___ 6 (GO TO 530)
DON'T KNOW 8 (GO TO 530)

529) CHECK 525: HAD FEVER?

YES __
NO OR DON'T KNOW __ (GO TO 503 IN NEXT COLUMN, OR, IF NO MORE BIRTHS, TO 601)

530) Now I would like to know how much (NAME) was given to drink during the illness with a fever/cough. Was he/she given less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was he/she 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

531) When (NAME) had a fever/cough, was he/she given less than usual to eat, about the same, more than usual, or nothing to eat?
IF LESS, PROBE: Was he/she 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

532) Did you seek advice or treatment for the illness from any source?

YES 1
NO 2 (GO TO 535)

533) Where did you seek advice or treatment? Anywhere else?
FOR ANY HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE.
PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND RECORD ALL MENTIONED.

PUBLIC SECTOR
GOVT. HOSPITAL A
RHC/MCH B
BHU/FWC C
LADY H. WORKER D
OTHER PUBLIC (SPECIFY) ___ E
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC F
PHARMACY G
PVT. DOCTOR H
HOMEOPATH I
DISPENSER/COMPOUNDER J
OTHER PRIVATE MED. (SPECIFY) ___ K
OTHER SOURCE
SHOP L
HAKIM M
DAI, TBA N
OTHER (SPECIFY) __ X

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

DAYS ___

535) At any time during the illness, did (NAME) take any medicine for the illness?

YES 1
NO 2 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 601)
DON'T KNOW 8 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 601)

537) What medicine did (NAME) take? Any other medicine?
RECORD ALL MENTIONED.

ANTIMALARIAL DRUGS
QUININE A
CHLOROQUINE B
FANSIDAR/SP C
OTHER ANTIMALARIAL DRUGS (SPECIFY) __ D
ANTIBIOTIC
PILL/SYRUP E
INJECTION F
OTHER DRUGS
ASPIRIN G
PARACETEMOL/CALPOL H
BRUFEN I
COUGH DRUGS
PILL/SYRUP J
OTHER (SPECIFY) ___ X
DON'T KNOW Z

538) Was any medicine prescribed by a doctor, nurse, pharmacist, or other health practitioner?

YES 1
NO 2

539) CHECK 537: ANY CODE A-D CIRCLED?

YES __
NO __ (GO TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, TO 601)

540) How long after the fever started did (NAME) first take the medicine?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER 2
THREE DAYS AFTER 3
FOUR OR MORE DAYS AFTER 4
DON'T KNOW 8

541) For how many days did (NAME) take the medicine?
IF 7 DAYS OR MORE, RECORD 7.

DAYS__
DON'T KNOW 8

542) GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 601.

SECTION 6. FERTILITY PREFERENCES

601) CHECK 104:

CURRENTLY MARRIED __
WIDOWED, DIVORCED, SEPARATED __ (GO TO 612)

602) CHECK 310:

NEITHER STERILIZED __
HE OR SHE STERILIZED __ (GO TO 612)

603) CHECK 226:
NOT PREGNANT 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 now expecting now, would you like to have another child, or would you prefer to have any more children?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 605)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 612)
UNDECIDED/DON'T KNOW AND PREGNANT 4 (GO TO 610)
UNDECIDED/DON'T KNOW AND NOT PREGNANT 5 (GO TO 609)

604) 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 the child you are expecting now, how long would you like to wait before the birth of another child?

MONTHS 1 __
YEARS 2 __
SOON/NOW 993 (GO TO 609)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 612)
OTHER (SPECIFY) __ 996 (GO TO 609)
DON'T KNOW 998 (GO TO 609)

605) CHECK 226:

NOT PREGNANT OR UNSURE __
PREGNANT __ (GO TO 610)

606) CHECK 309:

NOT ASKED __
NOT CURRENTLY USING __
CURRENTLY USING __ (GO TO 612)

607) CHECK 604:

NOT ASKED __
24 OR MORE MONTHS OR 02 OR MORE YEARS __
00-23 MONTHS OR 00-01 YEAR __ (GO TO 610)

608) CHECK 603:
WANTS TO HAVE A/ANOTHER CHILD (CODE 1): You have said that you do not want (a/another) child soon, but you are not using any method to avoid pregnancy. Can you tell me why you are not using a method? Any other reason?

WANTS NO MORE/NONE (CODE 2): You have said that you do not want any (more) children, but you are not using any method to avoid pregnancy. Can you tell me why you are not using a method? Any other reason?
CIRCLE ALL MENTIONED.

FERTILITY RELATED REASONS
INFREQUENT SEX/NO SEX A
MENOPAUSAL/HYSTERECTOMY B
INFERTILE/CAN'T GET PREGNANT C
NO MENSTRUATION AFTER BIRTH D
BREASTFEEDING E
UP TO GOD, CAN'T CONTROL F
OPPOSITION TO USE
RESPONDENT OPPOSED G
HUSBAND OPPOSED H
OTHERS OPPOSED I
AGAINST RELIGION J
LACK OF KNOWLEDGE
KNOWS NO METHOD K
KNOWS NO SOURCE L
METHOD-RELATED REASONS
HEALTH CONCERNS M
FEAR OF SIDE EFFECTS N
LACK OF ACCESS/TOO FAR O
COSTS TOO MUCH P
INCONVENIENT TO USE Q
INTERFERES WITH BODY'S NORMAL PROCESSES R
OTHER (SPECIFY) __ X
DON'T KNOW Z

609) CHECK 309:

NOT ASKED __
NO, NOT CURRENTLY USING __
YES, CURRENTLY USING __ (GO TO 612)

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

YES 1 (GO TO 612)
NO 2
DON'T KNOW 8

611) What is the main reason that you think you will not use a contraceptive method at any time in the future?

FERTILITY RELATED REASONS
INFREQUENT SEX/NO SEX A
MENOPAUSAL/HYSTERECTOMY B
INFERTILE/CAN'T GET PREGNANT C
NO MENSTRUATION AFTER BIRTH D
BREASTFEEDING E
UP TO GOD, CAN'T CONTROL F
OPPOSITION TO USE
RESPONDENT OPPOSED G
HUSBAND OPPOSED H
OTHERS OPPOSED I
AGAINST RELIGION J
LACK OF KNOWLEDGE
KNOWS NO METHOD K
KNOWS NO SOURCE L
METHOD-RELATED REASONS
HEALTH CONCERNS M
FEAR OF SIDE EFFECTS N
LACK OF ACCESS/TOO FAR O
COSTS TOO MUCH P
INCONVENIENT TO USE Q
INTERFERES WITH BODY'S NORMAL PROCESSES R
OTHER (SPECIFY) __ X
DON'T KNOW Z

612) 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 A NUMERIC RESPONSE.

NONE 00 (GO TO 614)
NUMBER __
OTHER (SPECIFY) ___ 96 (GO TO 614)

613) How many of these children would you like to be boys, how many would you like to be girls and for how many would the sex not matter?

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

614) CHECK 104:

CURRENTLY MARRIED __
WIDOWED, DIVORCED, SEPARATED __ (GO TO 617)

615) CHECK 310:

NEITHER STERILIZED __
HE OR SHE STERILIZED __ (GO TO 617)

616) 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

617) PRESENCE OF OTHERS AT THIS POINT:

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

SECTION 7. HUSBAND'S BACKGROUND AND WOMAN'S WORK

701) CHECK 104:

CURRENTLY MARRIED (GO TO 702)
WIDOWED, DIVORCED, SEPARATED (GO TO 703)

702) How old is you husband?

AGE IN COMPLETED YEARS __

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

YES 1
NO 2 (GO TO 705)

704) What was the highest class he completed?
WRITE '00' IF LESS THAN CLASS ONE; WRITE '16' IF MA, MPHIL, PHD, MBBS, BSC(4 YEARS)

CLASS __
DON'T KNOW 98

705) CHECK 701:
CURRENTLY MARRIED: What is your husband's occupation? That is, what kind of work does he mainly do?
WIDOWED, DIVORCED, OR SEPARATED: What was your (last) husband's occupation? That is, what kind of work did he mainly do?

OCCUPATION____________

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

YES 1 (GO TO 709)
NO 2

707) As you know, some women take us 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 709)
NO 2

708) 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
NO 2 (GO TO 710)

709) Do you receive money for the work you do?

YES 1 (GO TO 712)
NO 2 (GO TO 712)

710) If you could find a suitable job, would you like to work?

YES 1
NO 2

711) Have you done any work in the last 12 months?

YES 1
NO 2 (GO TO 713)

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

OCCUPATION____

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

YES 1
NO 2

714) Did you work after you (first) got married?

YES 1
NO 2

SECTION 8. HIV/AIDS

801) Now I would like to talk about something else. Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 814)

802) Can people reduce their chance of getting the AIDS virus by staying faithful to just one partner?

YES 1
NO 2
DON'T KNOW 8

803) Can people get the AIDS virus from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

804) Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex?

YES 1
NO 2
DON'T KNOW 8

805) Can people get the AIDS virus by sharing food with a person who has AIDS?

YES 1
NO 2
DON'T KNOW 8

806) Can people reduce their chance of getting the AIDS virus by not having sexual intercourse at all?

YES 1
NO 2
DON'T KNOW 8

807) Can people get the AIDS virus because of witchcraft or other supernatural means?

YES 1
NO 2
DON'T KNOW 8

808) Is it possible for a healthy-looking person to have the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

809) Do you know someone personally who has the virus that causes AIDS or someone who has died from AIDS?

YES 1
NO 2

810) Can the virus that causes AIDS be transmitted from a mother to a child:

During pregnancy?
YES 1
NO 2
DON'T KNOW 8
During delivery?
YES 1
NO 2
DON'T KNOW 8
By breastfeeding?
YES 1
NO 2
DON'T KNOW 8

811) Have you ever talked about ways to prevent getting the virus that causes AIDS with your (former) husband?

YES 1
NO 2
DON'T KNOW 8

812) God forbid if a member of your family got infected with the virus that causes AIDS, would you want it to remain a secret or not?

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

813) God forbid if a relative of yours became sick with the virus that causes AIDS, would you be willing to care for her or him in your own household?

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

814) Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

YES 1
NO 2 (GO TO 901)

815) Could you kindly tell me some signs of these infections that you know about?
RECORD ALL MENTIONED.

WOUND WITHOUT PAIN A
WOUND WITH PAIN B
WOUND, PAIN WITH LOTS OF PIMPLES C
PUS LIKE DISCHARGE D
DARK PUS LIKE DISCHARGE E
SOUR MILK LIKE THICK DISCHARGE F
SPONGE LIKE DISCHARGE G
DISCHARGE WITH BAD ODOUR/DIRTY WATER H
OTHER-1 (SPECIFY) __ X
OTHER-2 (SPECIFY) __ Y

SECTION 9. OTHER HEALTH RELATED ISSUES

901) Have you ever heard of an illness called tuberculosis or TB?

YES 1
NO 2 (GO TO 906)

902) How does TB spread from one person to another?
PROBE: Any other ways?
RECORD ALL MENTIONED.

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

903) Can TB be cured?

YES 1
NO 2 (GO TO 905)
DON'T KNOW 8 (GO TO 905)

904) What is the duration of treatment of TB now a days?
IF MORE THAN 7 MONTHS, RECORD 7

MONTHS __
DON'T KNOW 8

905) Have you ever been told by a doctor or nurse or LHV that God forbid you have/had TB?

YES 1
NO 2
DON'T KNOW 8

906) CHECK 212:

ONE OR MORE LIVE BIRTH __
NO LIVE BIRTHS __ (GO TO 911)

907) Sometimes a women can have a problem, usually after a difficult childbirth, such that she continuously dribbles urine even during sleep that wets her clothes too and/or leaks stool from her vagina. Have you ever experienced this problem?

YES, DRIBBLING OF URINE 1
YES, STOOL COMING FROM VAGINA 2
YES, BOTH 3
NO 4 (GO TO 911)
DON'T KNOW 8 (GO TO 911)

908) Do you still have this problem?

YES 1
NO 2

909) Please tell me how did this problem start:

AFTER A DIFFICULT CHILDBIRTH 1
AFTER A RAPE/SEXUAL ASSAULT 2
OTHER (SPECIFY) ____ 6

910) What happened to baby?

LIVE BIRTH:
DIED IN SEVEN DAYS 1
DIED AFTER SEVEN DAYS 2
STILL LIVING 3
STILL BIRTH 4

911) Now I would like to ask you some questions relating to other 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 IF GREATER THAN 90, 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 915)

912) Among these injections, how many were given by a doctor, burse, pharmacist, dentist, LHV or any other health worker?
IF NUMBER OF INJECTIONS IF GREATER THAN 90, 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 915)

913) The last time you had an injection from where did you obtain the syringe?
IF SOURCE IS HOSPITAL, HEALTH CENTER OR CLINIC, WRITE THE NAME OF THE SOURCE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. IF SYRINGE WAS PURCHASED FROM A CHEMIST CODE '23'

PUBLIC SECTOR
GOVT. HOSPITAL/RHSC 11
RHC/MCH 12
BHU/FWC 13
MOBILE SERVICE CAMP 14
LADY HEALTH WORKER/HEALTH HOUSE 15
OTHER PUBLIC (SPECIFY) ___ 16
PRIVATE MED. SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR 21
DENTAL CLINIC/OFFICE 22
CHEMIST 23
OFFICE OR HOME OR NURSE/HEALTH WORKER 24
DISPENSER/COMPOUNDER 25
OTHER PRIVATE MEDICAL (SPECIFY) ___ 26
OTHER PLACE AT HOME 31
OTHER (SPECIFY) ___ 96

914) Did the person who gave you that injection take the syringe and needle from a new, unopened package?

YES 1
NO 2
DON'T KNOW 8

915) Do you think that one can protect herself/himself from getting Hepatitis B, C and HIV AIDS if:

915A) A syringe and needle from a new unopened packet is used whole giving an injection?
YES 1
NO 2
DON'T KNOW 8
915B) If need be, blood tested for hepatitis B, C and HIV AIDS virus is transfused?
YES 1
NO 2
DON'T KNOW 8

916) RECORD THE TIME.

HOUR __
MINUTES __