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NATIONAL INSTITUTE OF POPULATION STUDIES
PAKISTAN DEMOGRAPHIC AND HEALTH SURVEY 2012-13
EVER-MARRIED WOMAN'S QUESTIONNAIRE

IDENTIFICATION

PROVIDENCE/REGION

PUNJAB 1
SINDH 2
KPK 3
BALOCHISTAN 4
GB 5
ICT 6

DISTRICT___

TEHSIL____

CLUSTER NUMBER __

HOUSEHOLD NUMBER

LARGE CITY 1
SMALL CITY 2
TOWN 3
RURAL 4

NAME OF HOUSEHOLD HEAD___

NAME AND LINE NUMBER OF WOMAN____

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)

DATE___
INTERVIEWER'S NAME__
RESULT*__
NEXT VISIT__

FINAL VISIT
DAY__
MONTH__
YEAR____
INT. NUMBER__
RESULT*

*RESULT CODES:
1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER ___(SPECIFY)

TOTAL NUMBER OF VISITS __

LANGUAGE OF QUESTIONNAIRE: ENGLISH

LANGUAGE OF INTERVIEWER*___

LANGUAGE WOMEN SPEAKS AT HOME*___

URDU 1
PUNJABI 2
SINDHI 3
PUSHTO 4
BALUCHI 5
ENGLISH 6
BARUHI 7
SARAIKI 8
OTHER 9 ___(SPECIFY)

SUPERVISOR
NAME___

FIELD EDITOR
NAME__

OFFICE EDITOR__

KEYED BY__

INFORMED CONSENT

Assalamo Alaikum. My name is ___. I am working with NIPS. We are conducting a survey about health all over Pakistan. The information we collect will help the government to plan health services. You household is selected for the survey. The questions usually take about 45 to 60 minutes. All of the answers you give will be confidential and will not be shared with anyone other than the members of our survey team. You don't have to be in this survey, but we hope you will agree to answer the questions since your views are important. If I ask any questions you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.
In case you need more information about the survey, you may contact the person listed on the card that has already been given to your household.
Do you have any questions? May I begin the interview now?

SIGNATURE OF INTERVIEWER _______
DATE _______

RESPONDENT AGREES TO BE INTERVIEWED 1 (CONTINUE TO SURVEY)
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 were you at your last birthday?
COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT

AGE IN COMPLETED YEARS___

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

MARRIED 1
WIDOWED 2 (GO TO 110)
DIVORCED 3 (GO TO 110)
SEPARATED 4 (GO TO 110)
NEVER MARRIED 5 (END)

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

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

NAME___
LINE NO.__

107) Does your husband have other wives?

YES 1
NO 2 (GO TO 110)
DON'T KNOW (GO TO 110)

108) Including yourself, in total, how many wives does he have?

TOTAL NUMBER OF WIVES ___
DON'T KNOW 8

109) Are you the first, second, ...wife?

RANK __
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 112)

111) 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

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

ONLY ONCE 1
MORE THAN ONCE 2

113) While getting married, did you have a say in choosing your (first) husband?

YES 1
NO 2

114) CHECK 112:
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 you about your first husband. In what month and year did you start living with him?

MONTH __
DON'T KNOW MONTH 98

YEAR __ (GO TO 116)
DON'T KNOW YEAR 9998

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

AGE__

116) Have you ever attended school?

YES 1
NO 2 (GO TO 119)

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

CLASS___

118) CHECK 117:

CLASS 00-08 (GO TO 119)
CLASS 09 OR HIGHER (GO TO 121)

119) Now I would like you to read this sentence to me.
SHOW CARD TO RESPONDENT.
IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE:
Can you read any part of the sentence to me?

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

120) CHECK 119:

CODE '2', '3', OR '4' CIRCLED (GO TO 121)
CODE '1' OR '5' CIRCLED (GO TO 122)

121) Do you read a newspaper or magazine daily, at least once a week, occasionally, or not at all?

DAILY 1
AT LEAST ONCE A WEEK 2
OCCASIONALLY 3
NOT AT ALL 4

122) Do you listen to the radio daily, at least once a week, occasionally, or not at all?

DAILY 1
AT LEAST ONCE A WEEK 2
OCCASIONALLY 3
NOT AT ALL 4

123) Do you watch television daily, at least once a week, occasionally or not at all?

DAILY 1
AT LEAST ONCE A WEEK 2
OCCASIONALLY 3
NOT AT ALL 4

124) What is your mother tongue?

URDU 01
PUNJABI 02
SINDHI 03
PUSHTO 04
BALOCHI 05
ENGLISH 06
BARAUHI 07
SIRAIKI 08
HINKO 09
KASHMIRI 10
SHINA 11
BRUSHASKI 12
WAKHI 13
CHITRALI/KHWAR 14
BALTI 15
PAHARI 16
POTOWARI 17
MARWARI 18
FARSI 19
OTHER 96

SECTION 2. REPRODUCTION

200) Now I would like to ask you about all the pregnancies that you have had during your life. By this I mean all the children born to you whether they were born alive or dead, whether they are still living or not, whether they live with you or somewhere else, and all the pregnancies that you have had that did not result in a live birth. I understand that it is not easy to talk about children who have died, or pregnancies that ended before full term, but it is important that you tell us about all of them, so that the government can develop programs to improve children's health.

201) 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 you?
And how many daughters live with you?
IF NONE, RECORD '00'.

SONS AT HOME __
DAUGHTERS AT HOME___

204) Do you have any sons or daughters 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 life 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) Women sometimes have pregnancies that do not result in a live born child. That is, a pregnancy can end in a miscarriage, aborted or the child can be born dead. Have you ever had a pregnancy that did not end in a live birth?

YES 1
NO 2 (GO TO 210)

209) Have many pregnancies have you had that did not end in a live birth?

PREGNANCY LOSSES __

210) SUM ANSWERS TO 203, 205, 207, AND 209, AND ENTER TOTAL.
IF NONE, RECORD '00'.

TOTAL PREGNANCIES ___

211) CHECK 210:
Just to make sure that I have this right: you have had in TOTAL ___ pregnancies during your life. Is that correct?

YES (GO TO 212)
NO (PROBE AND CORRECT 201-210 AS NECESSARY)

212) CHECK 210:

ONE OR MORE PREGNANCIES (GO TO 213)
NO PREGNANCY (GO TO 234)

213) Now I would like to record all your pregnancies, whether born alive, born dead, or lost before full term, starting with the first one you had.
RECORD ALL THE PREGNANCIES IN 215. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. (IF THERE ARE MORE THAN 12 PREGNANCIES, USE AN ADDITIONAL QUESTIONNAIRE STARTING WITH THE SECOND ROW).

214) PREGNANCY HISTORY NUMBER

________

215) Think back to your first pregnancy. The pregnancy which was first after your (first) marriage? Was that a single or multiple pregnancy?

SING 1
MULT 2
DON'T KNOW 8

216) Was the baby born alive or dead or lost before birth?

BORN ALIVE 1 (GO TO 218)
BORN DEAD 2
LOST BEFORE FULL TERM 3 (GO TO 226)

217) Did that baby cry, move, or breathe when it was born?

YES 1
NO 2 (GO TO 226)

218) What name was given to the child?
(RECORD 'BABY 1, BABY 2, ) IN CASE NO NAME WAS GIVEN)

NAME ____

219) Is (NAME) a boy or a girl?

BOY 1
GIRL 2

220) In what month and year was (NAME) born?
PROBE: When is his/her birthday?

MONTH ___
YEAR ___

221) Is (NAME) still alive?

YES 1
NO 2 (GO TO 225)

IF BORN ALIVE AND STILL LIVING:
222) How old was (NAME) at his/her last birthday?
RECORD AGE IN COMPLETED YEARS.

AGE IN YEARS___

223) Is (NAME) living with you?

YES 1
NO 2

224) RECORD HOUSEHOLD LINE NUMBER OF CHILD
(RECORD '00' IF CHILD IS NOT LISTED IN HOUSEHOLD)

HOUSEHOLD LINE NUMBER __ (GO TO 229)

IF DEAD:
225) 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 __
(GO TO 229)

IF BORN DEAD OR LOST BEFORE BIRTH:
226) In what month and year did this pregnancy end?

MONTH __
YEAR __

227) How many months did this pregnancy last?
CHECK 217 IF CODE 2 GO TO 229 RECORD IN COMPLETED MONTHS

MONTHS __

228) Did you or someone else do something to end this pregnancy?

YES 1
NO 2

229) Were there any other pregnancies between the previous pregnancy and this pregnancy?

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

230) Have you had any pregnancies since the last pregnancy mentioned?
IF YES, RECORD PREGNANCY(S) IN TABLE.

YES 1
NO 2

231) COMPARE 210 WITH NUMBER OF PREGNANCIES IN HISTORY ABOVE AND MARK:

NUMBERS ARE SAME
NUMBER ARE DIFFERENT (PROBE AND RECONCILE)

232) CHECK 220 AN ENTER THE NUMBER OF BIRTHS IN 2007 OR LATER.

NUMBER OF BIRTHS __
NONE 0 (GO TO 234)

233) FOR EACH BIRTH SINCE JANUARY 2007, ENTER 'B' IN THE MONTH OF BIRTH IN CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THE PREGNANCY LASTED.) CHECK 227 FOR EACH PREGNANCY THAT DID NOT END IN A LIVE BIRTH. CHECK 228. IF YES (CODE '1' CIRCLED), ENTER 'A' FOR ABORTION OR 'C' (IF CODE '2' CIRCLED) FOR MISCARRIAGE OR 'S' FOR STILLBIRTH, IN CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOP THE REMAINING NUMBER OF COMPLETED MONTHS OF PREGNANCY.

234) Are you pregnant now?

YES 1
NO 2 (GO TO 238)
DON'T KNOW (GO TO 238)

235) How many months pregnant are you?
RECORD THE NUMBER OF COMPLETED MONTHS
ENTER 'P' IN THE CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

MONTHS __

236) When you got pregnant, did you want to get pregnant at that time?

YES 1 (GO TO 238)
NO 2

237) Did you want to have a baby later on or did you not want to have any (more) children?

LATER 1
NO MORE 2

238) When did your last menstrual cycle start?

Date, if given ______
DAYS AGO 1 __
WEEKS AGO 2__
MONTHS AGO 3__
YEARS AGO 4__
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

239) From one menstrual period to the next, are there certain days when a woman is more likely to get pregnant?

YES 1
NO 2 (GO TO 301)
DON'T KNOW 8 (GO TO 301)

240) Is this time just before her period begins, during her period, right after her period had ended, or halfway between two periods?

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

SECTION 3. CONTRACEPTION

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

301A) Have you ever used (METHOD)?

PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 ID NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 301A.

01. Female Sterilization. PROBE: Women can have an operation to avoid having any more children.
Have you ever had an operation to avoid any more pregnancies?
YES 1
NO 2
02. Male Sterilization. PROBE: Men can have an operation to avoid having any more children
Has your husband ever had an operation to avoid having any more pregnancies?
YES 1
NO 2
03. IUD. PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1 ___(SPECIFY)
NO 2
04. Injectables. PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1 ___(SPECIFY)
NO 2
05.Implants. PROBE: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1 ___(SPECIFY)
NO 2
06. Pill. PROBE: Women can take a pill every day to avoid becoming pregnant.
YES 1 ___(SPECIFY)
NO 2
07. Condom. PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1 ___(SPECIFY)
NO 2
08. Standard Days Method. PROBE: A woman uses a string of colored beads to know the days she can get pregnant. On the days she can get pregnant, they use a condom or does not have sexual intercourse under 6-month and her monthly bleeding has not returned.
YES 1 ___(SPECIFY)
NO 2
09. Lactational Amen. Method (LAM)
YES 1 ___(SPECIFY)
NO 2
10. Rhythm Method. PROBE: 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 ___(SPECIFY)
NO 2
11. Withdrawal, Azal. PROBE: Men can be careful and pull out before climax.
YES 1 ___(SPECIFY)
NO 2
12. Emergency Contraception. PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
YES 1 ___(SPECIFY)
NO 2
13. Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1 ___(SPECIFY)
NO 2

302) CHECK 301A:

NOT A SINGLE "YES" (NEVER USED) (GO TO 303)
AT LEAST ONE "YES" (EVER USED) (GOT TO 305)

303) Have you ever used anything or tried in any way to delay or avoid getting pregnant?
ON CALENDAR, ENTER '0' IN COLUMN 1 FOR EVERY NON USE AND PROCEED

YES 1
NO 2 (GO TO 333)

304) What have you used or done?
CORRECT 301 AND 301A (AND 302 IF NECESSARY).

305) CHECK 104:

CURRENTLY MARRIED (GO TO 306)
WIDOWED, DIVORCED, OR SEPARATED (GO TO 316)

306) CHECK 301A (01)

WOMAN NOT STERILIZED (GO TO 307)
WOMAN STERILIZED (GO TO 309)

307) CHECK 234:

NOT PREGNANT OR UNSURE (GO TO 308)
PREGNANT (GO TO 316)

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

YES 1
NO 2 (GO TO 316)

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

FEMALE STERILIZATION A (GO TO 312)
MALE STERILIZATION B (GO TO 312)
IUD C (GO TO 313A)
INJECTABLES D (GO TO 313A)
IMPLANTS E (GO TO 313A)
PILL F
CONDOM G (GO TO 311)
SDM H (GO TO 313A)
LACTATIONAL AMEN. METHOD I (GO TO 313A)
RHYTHM METHOD J (GO TO 313A)
WITHDRAWAL K (GO TO 313A)
OTHER MODERN METHOD X (GO TO 313A)
OTHER TRADITIONAL METHOD Y (GO TO 313A)

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

NOVA PILLS 01
FAMILA 28 02
LO FEMENAL 03
OTHER ___(SPECIFY) 96
DON'T KNOW 98

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

SATHI 01 (GO TO 313A)
TOUCH 02 (GO TO 313A)
OTHER __(SPECIFY) 96 (GO TO 313A)
DON'T KNOW 98 (GO TO 313A)

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

PUBLIC SECTOR
GOVT HOSPITAL/RHSC 11
RURAL HEALTH CENTRE 12
MCH 13
OTHER PUBLIC ___(SPECIFY) 16
PRIVATE/NGO MEDICAL SECTOR
PRIVATE/NGO HOSPITAL/CLINIC 21
OTHER PRIVATE MEDICAL ___(SPECIFY) 26
OTHER ___(SPECIFY)

313) In what month and year was the sterilization performed?

MONTH__
YEAR__

313A) Since what month and year have you been using (CURRENT METHOD) without stopping?
PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

MONTH__
YEAR__

314) CHECK 313/313A, 220 AND 226:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 313/313A

YES [GO BACK TO 313/313A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OF PREGNANCY TERMINATION)]
NO (GO TO 315)

315) CHECK 313/313A:

YEAR IS 2007 OR LATER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING)
YEAR IS 2006 OR EARLIER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2007. THEN GO TO 331)

316) I would like to ask you some questions about the times you and your husband may have used a method to avoid getting pregnant during the last few years.
USE CALENDAR TO PROBE FOR EARLIER PERIOD OF USE AND NONUSE, STARTING WITH THE MOST RECENT USE, BACK TO JANUARY 2007.
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

IN COLUMN 1, ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.
ILLUSTRATIVE QUESTIONS:
When was the last time you used a method? Which method was that?
When did you start using that method? How long after the birth of (NAME)?
How long did you use the method then?

IN COLUMN 2, ENTER CODES FOR DISCONTINUATION NEXT TO THE LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 2 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1.
ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT.
ILLUSTRATIVE QUESTIONS:
Why did you stop using the (METHOD)? Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop for some other reason?
IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK: How many months did it take you to get pregnant after you stopped using (METHOD)? AND ENTER '0' IN EACH SUCH MONTH IN COLUMN 1.

317) CHECK 309:
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 309, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

NO CODE CIRCLED 00 (GO TO 33)
FEMALE STERILIZATION 01 (GO TO 320A)
MAKE STERILIZATION 02 (GO TO 335)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07
SDM 08 (GO TO 318A)
LACTATIONAL AMEN. METHOD (LAM) 09 (GO TO 318A)
RHYTHM METHOD 10 (GO TO 318A)
WITHDRAWAL 11 (GO TO 335)
OTHER MODERN METHOD 95 (GO TO 335)
OTHER TRADITIONAL METHOD 96 (GO TO 335)

318) You first started using (CURRENT METHOD) in (DATE FROM 313/313A). Where did you get it at that time?

318A) Where did you learn about LAM being a method of contraception/ how to use the SDM/ rhythm method?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
_____

PUBLIC SECTOR
GOVT. HOSPITAL/RHSA 11
RURAL HEALTH CENTRE 12
FAMILY WELFARE CENTRE/FWW 13
MCH 14
DISPENSORY 15
MOBILE SERVICE CAMP/UNIT 16
LADY HEALTH WORKER 17
LH VISITOR 18
BASIC HEALTH UNIT 19
MALE MOBILIZER 20
FWA 21
OTHER PUBLIC (SPECIFY) ___ 26
PRIVATE/NGO MEDICAL SECTOR
PRIVATE/NGO HOSPITAL/CLINIC 31
PHARMACY, CHEMISTS 32
PRIVATE DOCTOR 33
HOMEOPATH 34
DISPENSER/COMPOUNDER 35
OTHER PRIVATE MEDICAL (SPECIFY) ___ 36
OTHER SOURCE
SHOP (NOT PHARMACY/CHEMIST) 41
FRIEND/RELATIVE 42
HAKIM 43
DAI, TRAD, BIRTH ATTENDANT 44
OTHER (SPECIFY) ___ 96
DON'T KNOW 98

319) CHECK 309:
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 309, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07 (GO TO 332)
SDM 08 (GO TO 332)
LACTATIONAL AMEN. METHOD 09 (GO TO 335)
RHYTHM METHOD 10 (GO TO 335)

320) At the time, were you told about the side effects or problems you might have with the method?

YES 1 (GO TO 332)
NO 2

320A) When you got sterilized, were you told about the side effects or problems you might have with the method?

YES 1 (GO TO 332)
NO 2

321) Were you ever told by a health or family planning worker about the side effects or problems you might have with this method?

YES 1
NO 2 (GO TO 323)

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

YES 1
NO 2

323) Have you ever experienced side effects with your current family planning method?

YES 1
NO 2 (GO TO 329)

324) What major side effects did you experience? Any others?
[CIRCLE ALL MENTIONED]

OBESITY/WEIGHT GAIN A
HEADACHE B
NAUSEA/DIZZINESS C
EXCESSIVE BLEEDING D
SPOTTING E
IRREGULAR MENSES/NO MENSES F
DEPRESSION G
OTHERS (SPECIFY) ___ X
NO ONE Y

325) Did you seek any kind of treatment or medical advice for the side effects?

YES 1
NO 2 (GO TO 328)

326) From who did you receive treatment?
[CIRCLE ALL MENTIONED]

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

327) From where did you receive treatment?
[CIRCLE ALL MENTIONED]

PUBLIC SECTOR
GOVT. HOSPITAL/RHSA A
RURAL HEALTH CENTRE B
FAMILY WELFARE CENTRE/FWW C
MCH D
DISPENSORY E
MOBILE SERVICE CAMP/UNIT F
LADY HEALTH WORKER G
LH VISITOR H
BASIC HEALTH UNIT I
MALE MOBILIZER J
FWA K
OTHER PUBLIC (SPECIFY) ___ L
PRIVATE/NGO MEDICAL SECTOR
PRIVATE/NGO HOSPITAL/CLINIC M
PHARMACY, CHEMISTS N
PRIVATE DOCTOR O
HOMEOPATH P
DISPENSER/COMPOUNDER Q
OTHER PRIVATE MEDICAL (SPECIFY) ___ R
OTHER SOURCE
SHOP (NOT PHARMACY/CHEMIST) S
FRIEND/RELATIVE T
HAKIM U
DAI, TRAD, BIRTH ATTENDANT V
OTHER (SPECIFY) ___ X
DON'T KNOW Z

328) Why did you not seek any treatment for side effects?

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
LADY DOCTOR WAS NOT AVAILABLE I
LONG WAITING TIME J
NOT ALLOWED TO GO K
OTHERS (SPECIFY) ___ X

329) CHECK 320:
CODE '01' CIRCLED:
At that time, were you told about other methods of family planning that you could use?

CODE '01' NOT CIRCLED:
When you obtained (CURRENT METHOD FROM 317) from (SOURCE OF METHOD FROM 312 OR 318), were you told about other methods of family planning that you could use?

YES 1 (GO TO 332)
NO 2

330) Were you ever told by a health or family planning worker about other methods of family planning that you could use?

YES 1
NO 2

331) CHECK 309:
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 309, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION 01 (GO TO 335)
MALE STERILIZATION 02 (GO TO 335)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07
SDM 08
LACTATIONAL AMEN. METHOD 09 (GO TO 335)
RHYTHM METHOD 10 (GO TO 335)
WITHDRAWAL 11 (GO TO 335)
OTHER MODERN METHOD 95 (GO TO 335)
OTHER TRADITIONAL METHOD 96 (GO TO 335)

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

PUBLIC SECTOR
GOVT. HOSPITAL/RHSC 11 (GO TO 335)
RURAL HEALTH CENTRE, MCH 12 (GO TO 335)
MCH 13 (GO TO 335)
FAMILY WELFARE CENTRE/FWW 14 (GO TO 335)
MOBILE SERVICE CAMP 15 (GO TO 335)
LADY HEALTH WORKER 16 (GO TO 335)
LH VISITOR 17 (GO TO 335)
BASIC HEALTH UNIT 18 (GO TO 335)
MALE MOBILIZER 19 (GO TO 335)
FWA 20 (GO TO 335)
OTHER PUBLIC (SPECIFY)___ 21 (GO TO 335)
PRIVATE/NGO MEDICAL SECTOR
PRIVATE/NGO HOSPITAL/CLINIC 22 (GO TO 335)
PHARMACY, CHEMISTS 23 (GO TO 335)
PRIVATE DOCTOR 24 (GO TO 335)
HOMEOPATH 25 (GO TO 335)
DISPENSER/COMPOUNDER 26 (GO TO 335)
OTHER PRIVATE MEDICAL (SPECIFY)___ (GO TO 335)
OTHER SOURCE
SHOP (NOT PHARMACY/CHEMIST) 31 (GO TO 335)
FRIEND/RELATIVE 32 (GO TO 335)
HAKIM 33 (GO TO 335)
DAI, TRAD, BIRTH ATTENDANT 34 (GO TO 335)
OTHER (SPECIFY)____96 (GO TO 335)
DON'T KNOW 98 (GO TO 335)

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

YES 1
NO 2 (GO TO 335)

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

PUBLIC SECTOR
GOVT. HOSPITAL/RHSC A
RURAL HEALTH CENTRE, MCH B
MCH C
FAMILY WELFARE CENTRE/FWW D
MOBILE SERVICE CAMP E
LADY HEALTH WORKER F
LH VISITOR G
BASIC HEALTH UNIT H
MALE MOBILIZER I
FWA J
OTHER PUBLIC (SPECIFY) ____ K
PRIVATE/NGO MEDICAL SECTOR
PRIVATE/NGO HOSPITAL/CLINIC L
PHARMACY, CHEMISTS M
PRIVATE DOCTOR N
HOMEOPATH O
DISPENSER/COMPOUNDER P
OTHER PRIVATE MEDICAL (SPECIFY) ___ Q
OTHER SOURCE
SHOP (NOT PHARMACY/CHEMIST) R
FRIEND/RELATIVE S
HAKIM T
DAI, TRAD, BIRTH ATTENDANT U
OTHER (SPECIFY) ___ X

335) Do you know that LHW is present in your area?

YES 1
NO 2 (GO TO 339)
DON'T KNOW 8 (GO TO 339)

336) In the last 12 months, were you visited by a LHW who talked to you about family planning?

YES 1
NO 2 (GO TO 339)

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

YES 1
NO 2 (339)

338) What type of help did you receive?
[CIRCLE ALL MENTIONED]

INFORMATION ON MOTHER AND CHILD HEALTH A
CONTRACEPTIVE SUPPLIES B
REFERRED TO HEALTH/FP FACILITY C
TREATMENT OF SIDE EFFECTS D
VACCINATION E
TREATMENT OF MINOR AILMENT F
TREATMENT FOR MOTHER AND CHILD G
OTHER(SPECIFY)___ X

339) In the last 12 months, have you visited a health facility for care for yourself (oy your children)?

YES 1
NO 2 (GO TO 341)

340) Did any staff member at the health facility speak to you about family planning methods?

YES 1
NO 2

341) Do you know of any service outlet that provide family planning services?

YES 1
NO 2 (GO TO 401)

342) Have you ever visited any service outlet that provide family planning services?

YES 1
NO 2 (GO TO 345)

343) Usually which service outlet do you visit?

GOVT. HOSPITAL/CLINIC/RHSC 1
PRIVATE/NGO HOSPITAL/CLINIC 2
OTHERS (SPECIFY) ____ 6

344) Are you satisfied with the following services of that service outlet?

PROVISION OF CONTRACEPTIVES
YES 1
NO 2
DON'T KNOW 8
FOLLOW-UP CARE
YES 1
NO 2
DON'T KNOW 8
INFECTION PREVENTION
YES 1
NO 2
DON'T KNOW 8
COUNSELING SERVICES
YES 1
NO 2
DON'T KNOW 8
TIMELY TREATMENT
YES 1
NO 2
DON'T KNOW 8
ATTITUDE OF STAFF
YES 1
NO 2
DON'T KNOW 8
PUNCTUALITY MAINTAINED BY STAFF
YES 1
NO 2
DON'T KNOW 8
TIMELY REFERRING
YES 1
NO 2
DON'T KNOW 8
COOPERATIVE
YES 1
NO 2
DON'T KNOW 8
HANDLE COMPLICATIONS PROMPTLY
YES 1
NO 2
DON'T KNOW 8
OTHERS (SPECIFY) ____
YES 1
NO 2
DON'T KNOW 8

(GO TO 401)

345) What was the reason for not visiting FP services outlets?

SERVICES PROVIDED AT THEIR DOOR STEPS A
PREFERRED TO GO TO OTHER SERVICE PROVIDERS B
DUE TO UNDESIRABLE LOCATIONS C
NO NEED TO VISIT THE CENTRE D
UNAWARE ABOUT THE SERVICE AVAILABLE AT THE CENTRE E
WANTED MORE CHILDREN F
OTHERS (SPECIFY)___ X

401) CHECK 232:

ONE OR MORE BIRTHS IN JANUARY 2007 OR LATER (GO TO 402)
NO BIRTHS IN JANUARY 2007 OR LATER (GO TO 601)

402) CHECK 214: ENTER IN THE TABLE THE PREGNANCY HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN JAN. 2007 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE MOST RECENT BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).
Now I would like to ask some questions about your children born in January 2007 and later. (We will talk about each separately.)

403) PREGNANCY HISTORY NUMBER FROM 214 IN PREGNANCY HISTORY

_________

404) FROM 218 AND 221

NAME ____

LIVING __
DEAD __

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

YES 1 (FOR MOST RECENT PREGNANCY, GO TO 408; FOR ALL OTHER PREGNANCIES, GO TO 424)
NO 2

406) Did you want to have a baby later on, or did you not want any (more) children?

LATER 1
MO MORE 2 (FOR MOST RECENT PREGNANCY, GO TO 408; FOR ALL OTHER PREGNANCIES, GO TO 424)

407) How much longer did you want to wait?

MONTHS __
YEARS __
DON'T KNOW 998

408) Did you see anyone for antenatal care for this pregnancy?
[ONLY ASKED FOR MORE RECENT PREGNANCY]

YES 1
NO 2 (GO TO 415)

409) Whom did you see? Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.
[ONLY ASKED FOR MOST RECENT PREGNANCY]

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

410) Where did you receive antenatal care for this pregnancy? Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE, WRITE THE NAME OF THE PLACE. ____
[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 OR CLINIC .G
PVT. DOCTOR .H
HOMEOPATH .I
DISPENSER/COMPOUNDER .J
OTHER PRIVATE MED. (SPECIFY)___ .K
HAKIM .L
OTHER (SPECIFY) .X

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

MONTHS __
DON'T KNOW 98

412) How many times did you receive antenatal care for 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 done at least once?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

BLOOD PRESSURE MEASURED
YES 1
NO 2
WEIGHED
YES 1
NO 2
URINE SAMPLE
YES 1
NO 2
BLOOD SAMPLE
YES 1
NO 2
ULTRASOUND EXAM
YES 1
NO 2

414) During (any of) your antenatal care visit(s), were you told about things to look out for that might suggest problems with the pregnancy?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

YES 1
NO 2
DON'T KNOW 8

415) 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 418)
DON'T KNOW 8

416) During this pregnancy, how many times did you get a tetanus injection?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

TIMES __
DON'T KNOW 8

417) CHECK 416:
[ONLY ASKED FOR MOST RECENT PREGNANCY]

2 OR MORE TIMES (GO TO 421)
OTHER (GO TO 418)

418) At any time before this pregnancy, did you receive any tetanus injections?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

YES 1
NO 2 (GO TO 421)
DON'T KNOW 8

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

TIMES ___
DON'T KNOW 8

420) How many years ago did you receive the last tetanus injection before this pregnancy?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

YEARS AGO ___

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

YES 1
NO 2 (GO TO 423)
DON'T KNOW 8

422) During the whole pregnancy, for how many days did you take the tablets or syrup?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.

DAYS ___
NOT TAKEN 997
DON'T KNOW 998

423) During this pregnancy, did you take any drug for intestinal worms?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

YES 1
NO 2
DON'T KNOW 8

424) 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

425) Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 427)
DON'T KNOW 8

426) How much did (NAME) weigh at birth?
RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.

KG FROM CARD ___
KG FROM RECALL ___
DON'T KNOW 99998

427) Who assisted with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.
IF RESPONDENTS SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

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

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

HOME
YOUR HOME 11 (FOR MOST RECENT BIRTH, GO TO 433; FOR ALL OTHER BIRTHS, GO TO 442)
OTHER HOME 12 (FOR MOST RECENT BIRTH, GO TO 433; FOR ALL OTHER BIRTHS, GO TO 442)
PUBLIC SECTOR
GOVT. HOSPITAL 21
RHC/MCH 22
OTHER PUBLIC (SPECIFY)___ 26
PRIVATE MED. SECTOR
PBT. HOSPITAL/CLINIC 31
OTHER PRIVATE MED. (SPECIFY)___ 36
OTHER (SPECIFY) ___ 96 (FOR MOST RECENT BIRTH, GO TO 433; FOR ALL OTHER BIRTHS, GO TO 442)

429) How long after (NAME) was delivered did you stay there?
[ONLY ASKED FOR THE MOST RECENT BIRTH]
IF LESS THAN ONE DAY, RECORD IN HOURS.
IF LESS THAN ONE WEEK, RECORD IN DAYS.
IF ONE WEEK OR MORE, RECORD IN WEEKS.

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

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

YES 1
NO 2

431) I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health while you were still in the facility?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

YES 1 (GO TO 434)
NO 2

432) Did anyone check on your health after you left the facility?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

YES 1 (GO TO 434)
NO 2 (GO TO 436)

433) I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health after you gave birth to (NAME)?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

YES 1
NO 2 (GO TO 436)

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

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE/LHV 12
OTHER PERSON
DAI-TBA 21
FWW 22
LADY H. WORKER 23
HOMEOPATH 24
HAKIM 25
DISPENSER/COMPOUNDER 26
OTHER (SPECIFY)___ 96

435) How long 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.

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

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

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

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

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

438) Who checked on (NAME)'s health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[ONLY ASKED FOR MOST RECENT PREGNANCY]

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE/LHV 12
OTHER PERSON
DAI-TBA 21
FWW 22
LADY H. WORKER 23
HOMEOPATH 24
HAKIM 25
DISPENSER/COMPOUNDER 26
OTHER (SPECIFY)___ 96

439) Where did this first check of (NAME) take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE. ___
[ONLY ASKED FOR MOST RECENT PREGNANCY]

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

440) In the first two months after delivery, did you receive a vitamin A dose like (this/any of these)?
SHOW COMMON TYPES OF CAPSULES.
[ONLY ASKED FOR MOST RECENT PREGNANCY]

YES 1
NO 2
DON'T KNOW 8

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

YES 1 (GO TO 443)
NO 2 (GO TO 444)

442) Did your period return between the birth of (NAME) and your next pregnancy?
[ASKED FOR ALL PREGNANCIES EXPECT MOST RECENT]

YES 1 (GO TO 446)
NO 2 (GO TO 446)

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

MONTHS __
DON'T KNOW 98

444) CHECK 234:
IS RESPONDENT PREGNANT?

NOT PREGNANT___(GO TO 445)
PREGNANT OR UNSURE __ (GO TO 446)

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

YES 1
NO 2 (GO TO 447)

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

MONTHS __
DON'T KNOW 98

447) Did you ever breastfeed (NAME)?

YES 1 (GO TO 449)
NO 2

448) CHECK 404: IS CHILD LIVING?

LIVING __ (GO TO 454)
DEAD __ (GO BACK TO 405 IN NEXT COLUMN; OR IF NO MORE BIRTHS GO TO 501)

449) How long after birth did you first put (NAME) to the breast?
IF LESS THAN 1 HOUR, RECORD '00' HOURS.
IF LESS THAN 24 HOURS, RECORD HOURS.
OTHERWISE, RECORD DAYS.

IMMEDIATELY 000
HOURS 1 __
DAYS 2 __

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

YES 1
NO 2 (GO TO 452)

451) What was (NAME) given to drink? Anything else?
RECORD ALL LIQUIDS MENTIONED.

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
GRIPE WATER I
OTHER (SPECIFY) X

452) CHECK 404: IS CHILD LIVING?

LIVING __ (GO TO 453)
DEAD __ (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501)

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

YES 1
NO 2

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

YES 1
NO 2
DON'T KNOW 8

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

501) ENTER IN THE TABLE THE PREGNANCY HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN JANUARY 2007 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE THE LAST TWO COLUMNS OF ADDITIONAL QUESTIONNAIRES).

502) PREGNANCY HISTORY NUMBER FROM 214 IN BIRTH HISTORY

___

503) FROM 218 AND 221

LIVING __ (GO TO 504)
DEAD __ (GO TO 503 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 536)

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 509)
NO CARD 3

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

YES 1 (GO TO 509)
NO 2

506) 1) COPY DATE OF BIRTH IF GIVEN. IF NOT ON CARD, LEAVE IT BLANK.
2) COPY DATES FROM THE CARD.
3) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

BIRTH
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 __
COMBO1 = 1/ PENTA1 = 2/DPT1=3
DAY __
MONTH __
YEAR __
COMBO2 = 1/PENTA2=2/DPT2=3
DAY __
MONTH __
YEAR __
COMBO3 = 1/PENTA3=2/DPT3=3
DAY __
MONTH __
YEAR __

Is COMBO or PENTA Circled?

YES __ (GO TO MEASLES)
NO __ (CONTINUE WITH HBV 1)
HBV 1
DAY __
MONTH __
YEAR __
HBV 2
DAY __
MONTH __
YEAR __
HBV 3
DAY __
MONTH __
YEAR __
MEASLES
DAY __
MONTH __
YEAR __
VITAMIN A (MOST RECENT)
DAY __
MONTH __
YEAR __

507) CHECK 506:

BCG TO MEASLES ALL RECORDED __ (GO TO 511)
OTHER __

508) Has (NAME) had any vaccinations that are not recorded on this card, including vaccinations given in a national immunization day campaign?
RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 506 THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' ON THE CORRESPONDING DAY COLUMN IN 506) (GO TO 511)
NO 2 (GO TO 511)
DON'T KNOW 8 (GO TO 511)

509) Did (NAME) ever have any vaccinations to prevent him/her from getting diseases, including vaccinations received in a national immunization day campaign?

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

510) Please tell me if (NAME) had any of the following vaccinations:

510A) 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
510B) Polio vaccine, that is, drops in the mouth?
YES 1
NO 2 (GO TO 510E)
DON'T KNOW 8 (GO TO 510E)
510C) Was the first polio vaccine given in the first two weeks after births or later?
FIRST 2 WEEKS 1
LATER 2
510D) How many times was the polio vaccine given?
NUMBER IF TIMES __
510E) A DPT/COMBO/PENTA 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 510G)
DON'T KNOW 8 (GO TO 510G)
510F) How many times was the DPT/COMBO/PENTA vaccination given?
NUMBER OF TIMES __
510G) 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 510I)
DON'T KNOW 8 (GO TO 510I)
510H) How many times was an HBV vaccination received?
NUMBER OF TIMES __
510I) A measles injection or an MMR injection-that is, a shot in the arm at the age of 9 months or older-to prevent him/her from getting measles?
YES 1
NO 2
DON'T KNOW 8

511) Within the last six months, was (NAME) given a vitamin A dose like (this/any of these)?
SHOW COMMON TYPES OF CAPSULES.

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 523)
DON'T KNOW 8

515) Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

516) Now I would like to know how much (NAME) was given to drink during the diarrhea (including breastmilk).
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

517) When (NAME) has 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

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

YES 1
NO 2 (GO TO 520)

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

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

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

FLUID MADE FROM A SPECIAL PACKET CALLED NIMKOL/ORS?
YES 1
NO 2
DON'T KNOW 8
A DRINK MADE AT HOME WITH SUGAR, SALT, AND WATER?
YES 1
NO 2
DON'T KNOW 8

521) Was anything else given to treat the diarrhea?

YES 1
NO 2 (GO TO 523)
DON'T KNOW 8 (GO TO 523)

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

PILL OR SYRUP
ANTIBIOTIC A
ANTIMOTILITY B
ZINC C
OTHER D
UNKNOWN PILL OR SYRUP E
INJECTION
ANTIBIOTIC F
NON-ANTIBIOTIC G
UNKNOWN INJECTION H
(IV) INTRAVENOUS 1
HOME REMEDY
RICE STARCH K
MINT EXTRACT L
OTHER (SPECIFY) __ X

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

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

524) At any time during the illness, did (NAME) have blood taken from his/her finger or heel for testing?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 528)
DON'T KNOW 8 (GO TO 528)

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

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

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

CHEST ONLY 1 (GO TO 529)
NOSE ONLY 2 (GO TO 529)
BOTH 3 (GO TO 529)
OTHER (SPECIFY) ___ 6 (GO TO 529)
DON'T KNOW 8 (GO TO 529)

528) CHECK 523: HAD FEVER?

YES __ (GO TO 529)
NO OR DON'T KNOW __ (GO TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 536)

529) Now I would like to know how much (NAME) was given to drink (including breast milk) 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

530) When (NAME) had a (fever/cough) 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

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

YES 1
NO 2 (GO TO 533)

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

PUBLIC SECTOR
GOVT. HOSPTIAL 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
COMPOUNDER J
OTHER PRIVATE MED. (SPECIFY)___ K
OTHER SOURCE
SHOP L
HAKIM M
DAI, TBA N
OTHER (SPECIFY) ___ X

533) At any time during the illness, did (NAME) take any drugs for the illness?

YES 1
NO 2 (GO BACK TO 502 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 536)
DON'T KNOW 8 (GO BACK TO 502 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 536)

534) What drugs did (NAME) take? Any other drugs?
[CIRCLE ALL MENTIONED]

ANTIMALARIAL DRUGS
SP/FANSIDAR A
CHLORIQUINE B
AMODIAQUINE C
QUININE D
ARTEMISININ COMBINATION E
OTHER ANTIMALARIAL (SPECIFY) ___ F
ANTIBIOTIC DRUGS
PILL/SYRUP G
INJECTION H
OTHER DRUGS
PONSTAN I
PARACETAMOL J
IBPUPROFEN K
COUGH SYRUP L
OTHER (SPECIFY) ___ X
DON'T KNOW Z

535) GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 536)

536) CHECK 220 AND 223, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2010 OR LATER LIVING WITH THE RESPONDENT

ONE OR MORE (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE WITH 537)
______ (NAME)
NONE ___ (GO TO 601)

537) Now I would like to ask you about liquids or foods that (NAME FROM 536) had yesterday during the day or at night. I am interested in whether your child had the item I mention even if it was combined with other foods.

Did (NAME FROM 536) (drink/eat):

a) Plain water?
YES 1
NO 2
DON'T KNOW 8
B) Juice or juice drinks?
YES 1
NO 2
DON'T KNOW 8
c) Clear broth?
YES 1
NO 2
DON'T KNOW 8
d) Milk such as tinned, powdered, or fresh animal milk?

IF YES: How many times did (NAME) drink milk?
IF 7 OR MORE TIMES, RECORD '7'

YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES DRANK MILK __
e) Infant formula?

IF YES: How many times did (NAME) drink infant formula?
IF 7 OR MORE TIMES, RECORD '7'

YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES DRANK FORMULA ___
f) Any other liquids?
YES 1
NO 2
DON'T KNOW 8
g) Yogurt?

IF YES: How many times did (NAME) eat yogurt?
IF 7 OR MORE TIMES, RECORD '7'

YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES ATE YOGURT __
h) Any [Nestle, Cerelac, Nestum, Farex]? ASK TO SEE PACKAGE
YES 1
NO 2
DON'T KNOW 8
i) Bread, roti, rice, noodles, kichrei, daliya, sewaian, sagudana, or other foods made from grains?
YES 1
NO 2
DON'T KNOW 8
j) Pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside?
YES 1
NO 2
DON'T KNOW 8
k) White potatoes, white yams, cassava, arvi, kachalu, or any other foods made from roots?
YES 1
NO 2
DON'T KNOW 8
l) Any dark green, leafy vegetables, like kale, etc.? palik, sarsoon, bathu, chulai, kachanar, chana ka sag, phalian.
YES 1
NO 2
DON'T KNOW 8
m) Ripe mangoes, papayas, peach, apricot?
YES 1
NO 2
DON'T KNOW 8
n) Any other fruits or vegetables? Cabbage, cauliflower, brinjal, apple, banana, pomegranate, plum.
YES 1
NO 2
DON'T KNOW 8
o) Liver, kidney, heart, or other organ meats?
YES 1
NO 2
DON'T KNOW 8
p) Any meat, such as beef, lamb, mutton, chicken, or duck?
YES 1
NO 2
DON'T KNOW 8
q) Eggs?
YES 1
NO 2
DON'T KNOW 8
r) Fresh or dried fish or shellfish?
YES 1
NO 2
DON'T KNOW 8
s) Any foods made from beans, peas, lentils, or nuts?
YES 1
NO 2
DON'T KNOW 8
t) Cheese or other food made from milk?
YES 1
NO 2
DON'T KNOW 8
u) Any other solid, semi-solid, or soft food?
YES 1
NO 2
DON'T KNOW 8

538) CHECK 537 (CATEGORIES "g" THROUGH "u")

NOT A SINGLE "YES" (GO TO 539)
AT LEAST ONE "YES" (GO TO 540)

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

YES 1 (GO BACK TO 527 TO RECORD FOOD EATEN YESTERDAY)
NO 2 (GO TO 601)

540) How many times did (NAME FROM 536) eat solid, semi-solid or soft foods yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'

NUMBER OF TIMES __
DON'T KNOW 8

SECTION 6. FERTILITY PREFERENCES

601) CHECK 104:

CURRENTLY MARRIED (GO TO 602)
WIDOWED, DIVORCED, OR SEPARATED (GO TO 613)

602) CHECK 309:

NEITHER STERILIZED (GO TO 603)
HE OR SHE STERILIZED (GO TO 613)

603) CHECK 234:

PREGNANT (GO TO 604)
NOT PREGNANT OR UNSURE (GO TO 605)

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

HAVE ANOTHER CHILD 1 (GO TO 606)
NO MORE (GO TO 612)
UNDECIDED/DON'T KNOW (GO TO 612)

605) Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 608)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 613)
UNDECIDED/DON'T KNOW 8 (GO TO 611)

606) CHECK 234:
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 611)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 613)
OTHER (SPECIFY)___ 996 (GO TO 611)
DON'T KNOW 998 (GO TO 611)

607) CHECK 234:

NOT PREGNANT OR UNSURE __ (GO TO 608)
PREGNANT __ (GO TO 612)

608) CHECK 308: USING A CONTRACEPTIVE METHOD?

NOT ASKED __ (GO TO 609)
NOT CURRENTLY USING __ (GO TO 609)
CURRENTLY USING __ (GO TO 613)

609) CHECK 606:

NOT ASKED __ (GO TO 610)
24 OR MORE MONTHS OR 02 OR MORE YEARS __ (GO TO 610)
00-23 MONTHS OR 00-01 YEAR __ (GO TO 612)

610) CHECK 604 AND 605:
WANTS TO HAVE A/ANOTHER CHILD _
You have said that you do not want (a/another) child soon. Can you tell me why you are not using a method to prevent pregnancy? Any other reason?
WANTS NO MORE/NONE _
You have said that you do not want any (more) children. Can you tell me why you are not using a method to prevent pregnancy? Any other reason?
[CIRCLE ALL MENTIONED]

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

611) CHECK 308: USING A CONTRACEPTIVE METHOD?

NOT ASKED __ (GO TO 611A)
NO, NOT CURRENTLY USING __ (GO TO 611A)
YES, CURRENTLY USING __ (GO TO 613)

611A) CHECK FOR PRESENCE OF OTHERS BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

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

YES 1
NO 2
DON'T KNOW 8

613) CHECK 221:
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 615)
NUMBER __
OTHER (SPECIFY) __ 96 (GO TO 615)

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

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

615) In the last few months have you:

Heard about family planning on the radio?
YES 1
NO 2
Seen anything about family planning on the television?
YES 1
NO 2
Read about family planning in a newspaper or magazine?
YES 1
NO 2

616) CHECK 615:

HEARD MESSAGE __ (ANY YES IN 615)
NOT HEARD MESSAGE __ (GO TO 619)

617) What messages did it convey to you? Anything else?
[CIRCLE 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

618) 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

619) CHECK 104:

CURRENTLY MARRIED __ (GO TO 620)
WIDOWED, DIVORCED OR SEPARATED __ (GO TO 701)

620) CHECK 309: USING A CONTRACEPTIVE METHOD?

CURRENTLY USING __ (GO TO 621)
NOT CURRENTLY USING OR NOT ASKED __ (GO TO 623)

621) Would you say that using contraception is mainly your decision, mainly your husband's decision, or did you both decide together?

MAINLY RESPONDENT 1
MAINLY HUSBAND 2
JOINT DECISION 3
OTHER (SPECIFY) __ 6

622) CHECK 309:

NEITHER STERILIZED __ (GO TO 623)
HE OR SHE STERILIZED __ (GO TO 701)

623) Does your husband want the same number of children that you want, or does he want more or fewer than you want?

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

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

701) CHECK 104:

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

702) How old was your husband on his last birthday?

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?
IF COMPLETED LESS THAN CLASS ONE, WTIRE '00'
IF MA, MPHIL, PHD, MBBS, OR BSC/4 YEARS, WRITE '16'

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?
FORMERLY MARRIED:
What was your (last) husband's occupation? That is, what kind of work did he mainly do?

___________

705A) Aside from housework, women work for cash or kind, did you work for cash or kind at any time before you (first) got married?

YES 1
NO 2

705B) Did you work after you (first) got married?

YES 1
NO 2 (GO TO 706)

705C) When did you start work after (first) marriage?
IF LESS THAN ONE YEAR, WRITE '00'

YEARS ____

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

YES 1 (GO TO 710)
NO 2

707) As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business.
In the last seven days, have you done any of these things or any other work?

YES 1 (GO TO 710)
NO 2

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

YES 1
NO 2 (GO TO 715)

710) What is your occupations, that is, what kind of work do you mainly do?

_______

711) Do you do this woke for a member of your family, someone else, or are you self-employed?

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

712) Do you usually work throughout the year, or do you work seasonally, or only once and a while?

THROUGHOUT THE YEAR 1
SEASONALLY/PART OD THE YEAR 2
ONCE IN A WHILE 3

713) Do you work at home or away from home?

AT HOME 1
AWAY FROM HOME 2

714) Are you paid in cash or cash and kind both or kind only for this work or are you not paid at all?

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4

715) CHECK 104:

CURRENTLY MARRIED (GO TO 716)
WIDOWED, DIVORCED OR SEPARATED (GO TO 723)

716) CHECK 714:

CODE 1 OR 2 CIRCLED (GO TO 717)
OTHER (GO TO 719)

717) Who usually decides how the money you earn will be used: you, your husband, or you and your husband jointly or someone else?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
FAMILY ELDERS 4
SOMEONE ELSE 6

718) Would you say that the money that you earn is more than what your husband earns, less than what he earns, or about the same?

MORE THAN HIM 1
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND HAS NO EARNINGS 4 (GO TO 720)
DON'T KNOW 8

719) Who usually decides how your husband's earning will be used: you, your husband, or you and your husband jointly or someone else?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
HUSBAND HAS NO EARNINGS 4
FAMILY ELDERS 5
SOMEONE ELSE 6

720) Who usually makes decisions about health care for yourself: you, your husband, you and your husband jointly, or someone else?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
HUSBAND HAS NO EARNINGS 4
FAMILY ELDERS 5
SOMEONE ELSE 6

721) Who usually makes decisions about making major household purchases: you, your husband, you and your husband jointly, or someone else?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
HUSBAND HAS NO EARNINGS 4
FAMILY ELDERS 5
SOMEONE ELSE 6

722) Who usually makes decisions about visits to your family or relatives: you, your husband, you and your husband jointly, or someone else?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
HUSBAND HAS NO EARNINGS 4
FAMILY ELDERS 5
SOMEONE ELSE 6

723) Do you own this or any other house either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2 (GO TO 725)
BOTH ALONE AND JOINTLY 3 (GO TO 725)
DOES NOT OWN 4 (GO TO 725)

724) Do you have the autonomy to sell the house you own?

YES 1
NO 2

725) Do you own any land either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2 (GO TO 727)
BOTH ALONE AND JOINTLY 3 (GO TO 727)
DOES NOT OWN 4 (GO TO 727)

726) Do you have the autonomy to sell the land you own?

YES 1
NO 2

727) PRESENCE OF OTHERS AT THIS POINT (PRESENT AND LISTENING, PRESENT AND NOT LISTENING, OR NOT PRESENT)

a) CHILDREN UNDER 10
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 3
b) HUSBAND
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 3
c) OTHER MALES
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 3
d) OTHER FEMALES
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 3

728) In your opinion, is a husband justified in hitting or beating his wife in the following situations:

a) If she goes out without telling him?
YES 1
NO 2
DON'T KNOW 8
b) If she neglects the children?
YES 1
NO 2
DON'T KNOW 8
c) If she argues with him?
YES 1
NO 2
DON'T KNOW 8
d) If she burns the food?
YES 1
NO 2
DON'T KNOW 8
e) If she neglects the in-laws?
YES 1
NO 2
DON'T KNOW 8
f) If she refused to have sex with him?
YES 1
NO 2
DON'T KNOW 8

729) CHECK 104:

CURRENTLY MARRIED _ (GO TO 730)
WIDOWED, DIVORCED OR SEPARATED _ (GO TO 801)

730) Now I would like to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question.
When was the last time you had sexual intercourse?
IF LESS THAN ONE WEEK, RECORD DAYS
IF LESS THAN ONE MONTH, RECORD WEEKS
IF LESS THAN 12 MONTHS, RECORD MONTHS
IF 12 MONTHS OR MORE, RECORD YEARS

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

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 817)

802) Can people reduce their chance of getting the AIDS virus by having just one uninfected sex partner who has no other sex partners?

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 NOW 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 get the AIDS virus because of witchcraft or other supernatural means?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

808) Can the virus that causes AIDS be transmitted from a mother to her baby:

a) during pregnancy?
YES 1
NO 2
DON'T KNOW 8
b) during delivery?
YES 1
NO 2
DON'T KNOW 8
c) by breastfeeding?
YES 1
NO 2
DON'T KNOW 8

809) CHECK 808:

AT LEAST ONE 'YES' (GO TO 810)
OTHER (GO TO 811)

810) Are there any special drugs that a doctor or nurse can give to a woman infected with the AIDS virus to reduce the risk of transmission to the baby?

YES 1
NO 2
DON'T KNOW 8

811) Do you know of a place where people can go to get tested for the AIDS virus?

YES 1
NO 2 (GO TO 813)

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

NAME OF PLACE_____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
STAND-ALONE VCT CENTER C
OTHER PUBLIC SECTOR (SPECIFY) ___ D
PRIVATE MEDICAL SECTOR
PRIVATE HOSIPTAL/CLINIC/PRIVATE DOCTOR E
STAND-ALONE VCT CENTER F
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)___G
OTHER (SPECIFY)___ X

813) Would you but fresh vegetables from a shopkeeper or vender of you knew this person had the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

814) If a member of your family got infected with the AIDS virus, would you want it to remain a secret or not?

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

815) If a member of your family became sick with AIDS, would you be willing to care for him or her in your own household?

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

816) In your opinion, if a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in the school?

SHOULD BE ALLOWED 1
SHOULD NOT BE ALLOWED 2
DON'T KNOW/NOT SURE/DEPENDS 8

817) CHECK 801:
HEARD ABOUT AIDS:
Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?
NOT HEARD ABOUT AIDS:
Have you heard of any infections that can be transmitted through sexual contact?

YES 1
NO 2

818) CHECK 817: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES 1
NO 2 (GO TO 820)

819) Now I would like to ask you about some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

822) CHECK 819, 820, AND 821:

HAS HAD AN INFECTION (ANY 'YES') __ (GO TO 823)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW __ (GO TO 901)

823) The last time you had (PROBLEM FROM 819/820/821), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 901)

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

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
MONILE CLINIC E
FIELDWORKER F
OTHER PUBLIC SECTOR (SPECIFY) ___ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR H
STAND-ALONE DOCTOR I
PHARMACY J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)____ M
OTHER SOURCE
SHOP N
OTHER (SPECIFY)___ X

SECTION 9. OTHER HEALTH ISSUES

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

YES 1
NO 2 (GO TO 906)

902) How does tuberculosis spread from one person to another?
PROBE: Any other ways?
[CIRCLE ALL MENTIONED]

THROUGH THE AIR WHEN COUGHING OR SNEEZING A
BY SHARING UTENSILS 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 tuberculosis 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 tuberculosis?

YES 1
NO 2
DON'T KNOW 8

906) Have you ever heard of an illness called Hepatitis B or C?

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

907) Is there anything a person can do to avoid getting Hepatitis B or C?

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

908) What can a person do to avoid getting Hepatitis B or C?
PROBE: Any other ways?
[CIRCLE ALL MENTIONED]

SAFE SEX 1
SAFE BLOOD TRANSFER B
DISPOSABLE SYRINGE C
AVOID CONTAMINATED FOOD/WATER D
AVOID CONTACT WITH INFECTED PERSONS E
MAKING SURE THAT THE INSTRUMENTS OR DENTISTS ARE PROPERLY STERILZED F
OTHERS (SEPCIFY) __ X
NO RESPONSE Y
DON'T KNOW Z

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

NUMBER OF INJECTIONS __
NONE 00 (GO TO 912)

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

NUMBER OF INJECTIONS __
NONE 00 (GO TO 912)

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

YES 1
NO 2
DON'T KNOW 8

912) Do you presently smoke cigarettes?

YES 1
NO 2 (GO TO 914)

913) In the last 24 hours, how many cigarettes did you smoke?

NUMBER OF CIGARETTES ___

914) Do you presently smoke or use any other type of tobacco?

YES 1
NO 2 (GO TO 916)

915) What (other) type of tobacco do you currently smoke or use?
[CIRCLE ALL MENTIONED]

PIPE A
CHEWING TOBACCO/NUSWAR B
SNUFF C
HUKAA/SHEESHA D
OTHER (SPECIFY)___ X

916) Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem or not?

a) Getting permission to go to the doctor?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
B) Getting money need for advice or treatment?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
c) The distance to the health facility?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
d) Not wanting to go alone?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
e) Management of Transport
BIG PROBLEM 1
NOT A BIG PROBLEM 2

SECTION 10. DOMESTIC VIOLENCE

1001) CHECK THE HOUSEHOLD QUESTIONNAIRE, Q36 AND IDENTIFICATION OF WOMAN QUESTIONNAIRE.

WOMAN SELECTED FOR THIS SECTION _ (GO TO 1002)
WOMAN NOT SELECTED _ (GO TO 1031)

1002) CHECK FOR PRESENSE OF OTHERS:
DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.

PRIVACY OBTAINED 1
PRIVACY NOT POSSIBLE 2 (GO TO 1030)

READ TO THE RESPONDENT:
Now I would like to ask you some questions about some other important aspects of a woman's life. You may find some of these questions very personal. However, your answers are crucial for helping to understand the condition of women in Pakistan. Let me assure you that your answers are completely confidential and will not be told to any one and no one else in your household will know that you were asked these questions.

1003) CHECK 104:

CURRENTLY MARRIED 1
FORMERLY MARRIED 2 (REAS IN PAST TENSE AND USE 'LAST' WITH 'HUSBAND')

1004) First, I am going to ask you about some situations which happen to some women. Please tell me if:

a) He (is/was) jealous or angry if you (talk/talked) to other men?
YES 1
NO 2
DON'T KNOW 8
b) He frequently (accuses/accused) you of being unfaithful?
YES 1
NO 2
DON'T KNOW 8
c) He (does/did) not permit you to meet you female friends?
YES 1
NO 2
DON'T KNOW 8
d) He (tries/tried) to limit your contact with your family?
YES 1
NO 2
DON'T KNOW 8
e) He (insists/insisted) on know where you (are/were) at all times?
YES 1
NO 2
DON'T KNOW 8

1005) Now I need to ask some more questions about your relationship with your (last) husband.
A. Did your (last) husband ever:
B. How often did this happen during the last 12 months: often, only sometimes, or not at all?

a) say or do something to humiliate you in front of others?

YES 1
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
NO 2

b) threaten to hurt or harm you or someone you care about?

YES 1
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
NO 2

c) insult you or make you feel bad about yourself?

YES 1
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
NO 2

1006)
A. Did your (last) husband:
B. How often did this happen in the last 12 months: often, only sometimes, or not at all?

a) push you, shake you, or throw something at you?

YES 1
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
NO RESPONSE 4
NO 2

b) slap you?

YES 1
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
NO RESPONSE 4
NO 2

c) twist your arm or pull your hair?

YES 1
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
NO RESPONSE 4
NO 2

d) punch you with his fist or with something that could hurt you?

YES 1
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
NO RESPONSE 4
NO 2

e) kick you, drag you, or beat you up?

YES 1
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
NO RESPONSE 4
NO 2

f) try to choke you or burn you on purpose?

YES 1
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
NO RESPONSE 4
NO 2

g) threaten to attack you with a knife, gun, or other weapon?

YES 1
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
NO RESPONSE 4
NO 2

1007) CHECK 1006 (a-g):

AT LEAST ONE 'YES' __ (GO TO 1008)
NOT A SINGLE 'YES' __ (GO TO 1010)

1008) How long after you first got married with your (last) husband did (this/any of these things) first happen?
IF LESS THAN ONE YEAR, RECORD '00'.

NUMBER OF YEARS ___

1009) Did the following happen as a result of what our (last) husband did to you:

a) You had cuts, bruises, or aches?
YES 1
NO 2
b) You had eye injuries, sprains, dislocations, or burns?
YES 1
NO 2
c) You had deep wounds, broken bones, broken teeth, or any other serious injury?
YES 1
NO 2

1010) Have you ever hit, slapped, kicked, or done anything else to physically hurt your (last) husband at times when he was not already beating or physically hurting you?

YES 1
NO 2 (GO TO 1012)

1011) In the last 12 months, how often have you done this to your (last) husband: often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1012) Does (did) your (last) husband drink alcohol or consume other drugs?

YES 1
NO 2 (GO TO 1014)

1013) How often does he get drunk or high on drugs: often, only sometimes, or never?

OFTEN 1
ONLY SOMETIMES 2
NEVER 3

1014) Are (were) you afraid of your (last) husband: most of the time, sometimes, or never?

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

1015) CHECK 112:

MARRIED MORE THAN ONCE __ (CONTINUE TO 1016)
MARRIED ONLY ONCE __ (GO TO 1017)

1016) A. So far we have been talking about the behavior of your (current/last) husband. Now I want to ask you about the behavior of any previous husband.
Did any previous husband ever hit, slap, kick, or do anything else to hurt you physically?
B. How long ago did this happen?

YES 1
0-11 MONTHS AGO 1
12+ MONTHS AGO 2
DON'T REMEMBER 3
NO 2

1017) From the time you were 15 years old has anyone other than (your/any) husband hit you, slapped you, kicked you, or done anything else to physically hurt you?

YES 1
NO 2 (GO TO 1020)
REFUSED TO ANSWER/NO ANSWER (GO TO 1020)

1018) Who has hurt you in this way? Anyone else?
[CIRCLE ALL MENTIONED]

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

1019) In the last 12 months, how often has (this person/have these people) physically hurt you: often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1020) CHECK 201, 208, AND 234:

EVER BEEN PREGNANT (YES ON 201 OR 208 OR 234) (CONTINUE TO 1021)
NEVER BEEN PREGNANT (GO TO 1023)

1021) Has anyone ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?

YES 1
NO 2 (GO TO 1023)

1022) Who has done any of these things to physically hurt you while you were pregnant? Anyone else?
[CIRCLE ALL MENTIONED]

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

1023) CHECK 1006 (a-g), 1016, 1017, AND 1021:

AT LEAST ONE 'YES' __ (CONTINUE TO 1024)
NOT A SINGLE 'YES' __ (GO TO 1027)

1024) Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?

YES 1
NO 2 (GO TO 1026)

1025) From whom have you sought help? Anyone else?
[CIRCLE ALL MENTIONED]

OWN FAMILY A (GO TO 1027)
HUSBAND FAMILY B (GO TO 1027)
CURRENT/FORMER HUSBAND C (GO TO 1027)
FRIEND D (GO TO 1027)
NEIGHBOR E (GO TO 1027)
RELIGIOUS LEADER F (GO TO 1027)
DOCTOR/MEDICAL PERSONNEL G (GO TO 1027)
POLICE H (GO TO 1027)
LAWYER I (GO TO 1027)
SOCIAL SERVICE ORGANIZATION J (GO TO 1027)
OTHER (SPECIFY) ____ X

1026) Have you ever told anyone able this?

YES 1
NO 2

1027) As far as you know, did you father ever beat your mother?

YES 1
NO 2
DON'T KNOW 8

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

1028) DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?

a) HUSBAND
YES 1
YES, MORE THAN ONCE 2
NO 3
b) OTHER MALE ADULT
YES 1
YES, MORE THAN ONCE 2
NO 3
c) FEMALE ADULT
YES 1
YES, MORE THAN ONCE 2
NO 3

1029) INTERVIEWERS COMMENTS ON COMPLETING THE DOMESTIC VIOLENCE MODULE

___________

1030) INTERVIEWERS COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE

_________________________

1031) RECORD THE END TIME

HOUR __
MINUTES ___