IDENTIFICATION

PROVIDENCE/REGION

DISTRICT___

TEHSIL____

CLUSTER NUMBER __

HOUSEHOLD NUMBER

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*

TOTAL NUMBER OF VISITS __

LANGUAGE OF QUESTIONNAIRE: ENGLISH

LANGUAGE OF INTERVIEWER*___

LANGUAGE WOMEN SPEAKS AT HOME*___

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 _______

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE TIME

102) In what month and year were you born?

103) How old were you at your last birthday?
COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT

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

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

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

107) Does your husband have other wives?

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

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

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

111) What type of relationship is/was it?

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

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

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?

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

116) Have you ever attended school?

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'

118) CHECK 117:

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?

120) CHECK 119:

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

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

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

124) What is your mother tongue?

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?

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

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

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

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'.

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?

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

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?

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

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

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

212) CHECK 210:

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?

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

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

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

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

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

221) Is (NAME) still alive?

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

223) Is (NAME) living with you?

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

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.

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

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

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

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

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

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

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

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?

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.

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

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

238) When did your last menstrual cycle start?

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

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

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.

302) CHECK 301A:

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

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

305) CHECK 104:

306) CHECK 301A (01)

307) CHECK 234:

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

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

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

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

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. ____

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

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?

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

315) CHECK 313/313A:

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.

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.
_____

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

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

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

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

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

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

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

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

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

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

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

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?

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

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

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 ____

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

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
______

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

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

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

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

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

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

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

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

343) Usually which service outlet do you visit?

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

(GO TO 401)

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

401) CHECK 232:

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

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

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

407) How much longer did you want to wait?

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

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

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]

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

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

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]

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]

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]

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

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

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

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'

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

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]

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.

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

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

425) Was (NAME) weighed at birth?

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

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.

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. ____

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.

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

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]

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

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]

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

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.

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]

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.

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

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]

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]

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

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

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

444) CHECK 234:
IS RESPONDENT PREGNANT?

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

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

447) Did you ever breastfeed (NAME)?

448) CHECK 404: IS CHILD LIVING?

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.

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

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

452) CHECK 404: IS CHILD LIVING?

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

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

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

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

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

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.

Is COMBO or PENTA Circled?

507) CHECK 506:

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.

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

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

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

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.

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

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

515) Was there any blood in the stools?

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?

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?

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

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.
____

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

521) Was anything else given to treat the diarrhea?

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

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

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

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

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

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

528) CHECK 523: HAD FEVER?

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?

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?

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

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 .
____

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

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

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

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):

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

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

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

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

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?

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'

SECTION 6. FERTILITY PREFERENCES

601) CHECK 104:

602) CHECK 309:

603) CHECK 234:

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?

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?

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?

607) CHECK 234:

608) CHECK 308: USING A CONTRACEPTIVE METHOD?

609) CHECK 606:

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]

611) CHECK 308: USING A CONTRACEPTIVE METHOD?

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?

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

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?

615) In the last few months have you:

616) CHECK 615:

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

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

619) CHECK 104:

620) CHECK 309: USING A CONTRACEPTIVE METHOD?

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

622) CHECK 309:

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

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

701) CHECK 104:

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

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

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'

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?

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

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

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

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?

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

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?

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

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

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

715) CHECK 104:

716) CHECK 714:

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

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?

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

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

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

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

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

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

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

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

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

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

729) CHECK 104:

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

SECTION 8. HIV/AIDS

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

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

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

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

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

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

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

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

809) CHECK 808:

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?

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

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.

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

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

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?

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?

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?

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

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?

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

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

822) CHECK 819, 820, AND 821:

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

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.
_____

SECTION 9. OTHER HEALTH ISSUES

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

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

903) Can tuberculosis be cured?

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

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

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

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

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

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.

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.

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?

912) Do you presently smoke cigarettes?

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

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

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

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?

SECTION 10. DOMESTIC VIOLENCE

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

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

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:

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

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?

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

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

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?

b) slap you?

c) twist your arm or pull your hair?

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

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

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

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

1007) CHECK 1006 (a-g):

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'.

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

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?

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

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

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

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

1015) CHECK 112:

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?

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?

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

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

1020) CHECK 201, 208, AND 234:

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

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

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

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

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

1026) Have you ever told anyone able this?

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

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?

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