PAKISTAN
NATIONAL INSTITUTE OF POPULATION STUDIES

IDENTIFICATION

PROVINCE/REGION

DISTRICT ________

TEHSIL _______

NAME OF HOUSEHOLD HEAD ______

CLUSTER NUMBER ______

HOUSEHOLD NUMBER _________

NAME AND LINE NUMBER OF WOMAN _______

CHECK COVER PAGE OF HOUSEHOLD QUESTIONNAIRE: HOUSEHOLD SELECTED FOR DV MODULE?

CHECK HOUSEHOLD QUESTIONNAIRE Q.44: WOMAN SELECTED FOR DOMESTIC VIOLENCE MODULE?

INTERVIEWER VISITS

FIRST VISIT
DATE _______
INTERVIWER'S NAME _______
RESULT ______

NEXT VISIT DATE _____
TIME ______

SECOND VISIT
DATE _______
INTERVIWER'S NAME _______
RESULT ______

NEXT VISIT DATE _____
TIME ______

THIRD VISIT
DATE _______
INTERVIWER'S NAME _______
RESULT ______

NEXT VISIT DATE _____
TIME ______

FINAL VISIT
DAY _____
MONTH ______
YEAR _____
INT. NO. _______
RESULT _______

TOTAL NUMBER OF VISITS _________

LANGUAGE OF QUESTIONNAIRE** 01
LANGUAGE OF QUESTIONNAIRE** ENGLISH
LANGUAGE OF INTERVIEW** ______
NATIVE LANGUAGE OF RESPONDENT** __________

TRANSLATOR USED

**LANGUAGE CODES

SUPERVISOR
NAME ________
NUMBER ___________

FIELD EDITOR
NAME _______
NUMBER ______

KEYED BY
NUMBER _________

INTRODUCTION AND CONSENT

Asalum-o-Alaikum. My name is _________. I am working with National Institute of Population Studies. We are conducting a survey about health and other topics all over Pakistan. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 60 to 90 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since yours views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.

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

105) In what month and year were you born?

106) How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

107) Have you ever attended school?

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

110) CHECK 109:

111) 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?

112) CHECK 111:

113) Do you read a newspaper or magazine at least once a week, less than once a week or not at all?

114) Do you listen to the radio at least once a week, less than once a week, or not at all?

115) Do you watch television at least once a week, less than once a week, or not at all?

116) Do you own a mobile telephone?

117) Do you use your mobile phone for any financial transactions?

118) Do you have an account in a bank or other financial institution that you yourself use?

119) Have you ever used the internet?

120) In the last 12 months, have you used the internet?
IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.

121) During the last one month, how often did you use the internet: almost every day, at least once a week, less than once a week, or not at all?

121A) 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) First 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?

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

203B) 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?

205A) How many sons are alive but do not live with you?
IF NONE, RECORD '00.'

205B) 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 girl who was born alive but later died?
IF NO, PROBE: Any baby who cried, who made any movement, sound, or effort to breathe, or who showered any other signs of life even if for a very short time?

207A) How many boys have died?
IF NONE, RECORD '00.'

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

207AA) Women sometimes have pregnancies that do not result in a live born child. That is, a pregnancy can end in miscarriage, or the child can be born dead. Have you ever had a pregnancy that did not end in a live birth?

207BB) How many pregnancies have you had that did not end in a live birth?

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

209) CHECK 208: Just to make sure that I have this right. You have had in TOTAL ______ pregnancies during your life. Is that correct?

210) CHECK 208:

211) 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 NAMES OF ALL THE PREGNANCIES IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE ROWS. IF THERE ARE MORE THAN 10 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW.

212) PREGNANCY HISTORY NUMBER

212A) Think back to your first pregnancy. Was that a single or multiple pregnancy?

212B) Was the baby born alive, born dead, or lost before birth?

212C) Did that baby cry, move, or breathe when it was born?

212D) What name was given to the child? RECORD NAME.

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

215) On what day, month, and year was (NAME) born? PROBE: When is his/her birthday?

216) Is (NAME) still alive?

217) IF ALIVE: How old was (NAME) at (NAME)'s last birthday? RECORD AGE IN COMPLETED YEARS.

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

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

220) IF DEAD: How old was (NAME) when s/he died?
IF '12 MONTHS' OR '1 YEAR,' ASK: Did (NAME) have his/her first birthday?
THEN ASK: Exactly how many months old was (NAME) when s/he died?
RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

IF BORN DEAD OR LOST BEFORE BIRTH 220AB)--220AD)

220AB) On what day, month, and year did this pregnancy end?

220AC) How many months did this pregnancy last?
RECORD IN COMPLETED MONTHS.

220AD) Did you or someone else do something to end this pregnancy?

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

222) Have you had any pregnancies since the last pregnancy mentioned?

223) COMPARE 208 WITH NUMBER OF PREGNANCIES IN PREGNANCY HISTORY.

224) CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2012-2018. IF NONE, RECORD '0.'

225) FOR EACH BIRTH IN 2012-2018, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF COMPLETED 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 THAT THE PREGNANCY LASTED.)

CHECK 220AC FOR EACH PREGNANCY THAT DID NOT END IN A LIVE BIRTH. CHECK 220AD. 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' FOR THE REMAINING NUMBER OF COMPLETED MONTHS OF PREGNANCY.

IF THERE ARE MORE THAN FOUR PREGNANCIES THAT DID NOT END IN A LIVE BIRTH, USE AN ADDITIONAL QUESTIONAIRRE STARTING ON THE SECOND LINE.

226) Are you pregnant now?

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

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

229 CHECK 208: TOTAL NUMBER OF BIRTHS

229A) CHECK 220AB, 220AC, AND 220AD

229B) You mentioned that you had a pregnancy that (MISCARRIED/ABORTED/ENDED IN A STILLBIRTH) in the last 5 years. Now I would like to ask you about the last such pregnancy that ended. Did you seek health care (advice and treatment) after such pregnancy ended?

229C) From whom did you seek health care (advice and treatment)? Anyone else?

239) When did your last menstrual period start?

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

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

242) After the birth of a child, can a woman become pregnant before her menstrual period has returned?

SECTION 3. CONTRACEPTION

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

301A) Did you hear about any family planning methods before you marriage?

302) CHECK 226:

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

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

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

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

307) 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.

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

309) 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?

310) CHECK 308 AND 309, 215 AND 220AB: ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 308 OR 309

311) CHECK 308 AND 309:

312) I would like to ask you some questions about the times you or your husband may have used a method to avoid getting pregnant during the last few years.

USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2012. 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:

IN COLUMN 2, ENTER CODES FOR DISCOUNTINUATION 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:

313) CHECK THE CALENDAR FOR USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH

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

315) CHECK 304: CIRCLE METHOD CODE.
IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

316) You first started using (CURRENT METHOD) in (DATE FROM 309). Where did you get it at that time? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

317) CHECK 304: CIRCLE METHOD CODE.
IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

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

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

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

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

322) CHECK 318 AND 319:

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

323A) Were you advised by a health or family planning worker about the following:

324) CHECK 304: CIRCLE METHOD CODE.
IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

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

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

327) In the last 12 months, were you visited by an LHW?

328) Did the LHW talk to you about family planning?

329) CHECK 202: CHILDREN LIVING WITH RESPONDENT.

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

SECTION 4. PREGNANCY AND POSTNATAL CARE

401) CHECK 224:

402) CHECK 215. RECORD THE BIRTH HISTORY NUMBER IN 403 AND THE NAME AND SURVIVAL STATUS IN 404 FOR EACH BIRTH IN 2012-2018. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. IF THERE ARE MORE THAN 24 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE(S).

Now I would like to ask some questions about your children born in the last five years. (We will talk about separately).

403) PREGNANCY HISTORY NUMBER FROM 212 IN PREGNANCY HISTORY.

404) FROM 212D AND 216:

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

406) CHECK 203, 205, AND 207:

407) How much longer did you want to wait?

408) Did you see anyone for antenatal care for this pregnancy?

409) Whom did you see? Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

409A) Were you satisfied with the service provided?

410) Where did you receive antenatal care for this pregnancy? Anywhere else? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

411) How many months pregnant were you when you first received antenatal care for this pregnancy?

412) How many times did you receive antenatal care during this pregnancy?

413) As part of your antenatal care during this pregnancy, were any of the following done at least once:

413A) During (any of) your antenatal care visit(s), were you advised on the following:

414) During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?

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

416) CHECK 415:

417) At any time before this pregnancy, did you receive any tetanus injections?

418) Before this pregnancy, how many times did you receive a tetanus injection?
IF 7 OR MORE TIMES, RECORD '7.'

419) CHECK 418:

420) During this pregnancy, were you given or did you buy any iron tablets or iron syrup? SHOW TABLETS/SYRUP.

421) 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.

422) During this pregnancy, did you take any drug for intestinal worms?

426) When (NAME) was born, was (NAME) very large, larger than average, smaller than average, or very small?

427) Was (NAME) weighed at birth?

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

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

430) 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.

431) How long after (NAME) was delivered did you stay there? IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEKK, RECORD DAYS.

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

433) When was the decision made to have the caesarean section? Was it before or after your labor pains started?

434) Immediately after the birth, was (NAME) put on your chest?

434A) Was (NAME)'s bare skin touching your bare skin?

434B) CHECK 430: PLACE OF DELIVERY

435) 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?

436) How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

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

437A) Did this person talk to you about using a family planning method?

438) Now I would like to talk to you about checks on (NAME)'s health after delivery--for example, someone examining (NAME), checking the cord, or seeing if (NAME) is okay. Did anyone check on (NAME)'s health while you were still in the facility?

439) How long after delivery was (NAME)'s health first checked? IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

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

441) Now I want to talk to you about what happened after you left the facility. Did anyone check on your health after you left the facility?

442) How long after delivery did that check take place?
IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

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

443A) Did this person talk to you about using a family planning method?

444) Where did the check take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

445) I would like to talk to you about checks on (NAME)'s health after you left (FACILITY IN 430). Did any health care provider or a traditional birth attendant check on (NAME)'s health in the two months after you left (FACILITY IN 430).

446) How many hours, days, or weeks after the birth of (NAME) did that check take place?
IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

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

448) Where did this check of (NAME) take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

449) 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)?

450) How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

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

451A) Did this person talk to you about using a family planning method?

452) Where did this first check take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

453) I would like to talk to you about checks on (NAME)'s health after delivery--for example, someone examining (NAME), checking the cord, or seeing if (NAME) if okay. In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on (NAME)'s health?

454) How many hours, days, or weeks after the birth of (NAME) did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

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

456) Where did this first check of (NAME) take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

457) During the first two days after (NAME)'s birth, did any health care provider do the following:

458) Has your menstrual period returned since the birth of (NAME)?

459) FOR NEXT-TO-LAST BIRTH: Did your period return between the birth of (NAME) and your next pregnancy?

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

461) CHECK 226: IS RESPONDENT PREGNANT?

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

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

464) Did you ever breastfeed (NAME)?

465) CHECK 404: IS CHILD LIVING?

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

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

468) CHECK 404: IS CHILD LIVING?

469) Are you still breastfeeding (NAME)?

469A) Why did you (not breastfeed) stop breastfeeding (NAME)?

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

471) FOR LAST BIRTH: GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501A.

FOR NEXT-TO-LAST BIRTH: GO BACK TO 405 IN NEXT-TO-LAST COLUMN OF NEW QUESTIONNAIRE; OR, IF NO MORE BIRTHS, GO TO 501A.

SECTION 5A. CHILD IMMUNIZATION (LAST BIRTH)

501A) CHECK 215 IN THE PREGNANCY HISTORY: ANY BIRTHS IN 2014-2018?

502A) RECORD THE NAME OF PREGNANCY HISTORY NUMBER FROM 212D AND 212 OF THE LAST CHILD BORN IN 2014-2018.

503A) CHECK 216 FOR CHILD:

504A) Do you have a card or other document where (NAME)'s vaccinations are written down?

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

506A) CHECK 504A:

507A) May I see the card or other document where (NAME)'s vaccinations are written down?

508A) COPY DATES FROM THE CARD. WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

509A) CHECK 508A: 'BCG' TO 'MMR' ALL RECORDED?

510A) In addition to what is recorded on (this document/these documents), did (NAME) receive any other vaccinations, including vaccinations received in national immunization day campaign? RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 508A THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

511A) Did (NAME) ever receive any vaccinations to prevent (NAME) from getting diseases, including vaccinations received in national immunization day campaign?

512A) Has (NAME) ever received a BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

514A) Has (NAME) ever received oral polio vaccine, that is, about two drops in the mouth to prevent polio?

515A) Did (NAME) receive the first oral polio vaccine in the first two weeks after birth or later?

516A) How many times did (NAME) receive the oral polio vaccine? RECORD 7 IF MORE THAN 7.

517A) Has (NAME) ever received a pentavalent vaccination, that is, an injection given in the thigh sometimes at the same time as polio drops?

518A) How many times did (NAME) receive the pentavalent vaccine?

519A) Has (NAME) ever received a pneumococcal vaccination, that is, an injection in the thigh to prevent pneumonia?

520A) How many times did (NAME) receive the pneumococcal vaccine?

521A) Has (NAME) ever received an inactivated polio vaccine (IPV), that is, an injection in the thigh to prevent polio?

523A) Has (NAME) ever received a measles (Measles/MMR) vaccination, that is, an injection in the arm to prevent measles?

524A) How many times did (NAME) receive the measles (Measles/MMR) vaccine?

525A) In the last 7 days was (NAME) given:

526A) CONTINUE WITH 501B.

SECTION 5B. CHILD IMMUNIZATION (NEXT-TO-LAST BIRTH)

501B) CHECK 215 IN THE PREGNANCY HISTORY: ANY MORE BIRTHS IN 2014-2018?

502B) RECORD THE NAME AND PREGNANCY HISTORY NUMBER FROM 212D AND 212 OF THE NEXT-TO-LAST CHILD BORN IN 2014-2018.

503B) CHECK 216 FOR CHILD

504B) Do you have a card or other document where (NAME)'s vaccinations are written down?

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

506B) CHECK 504B:

507B) May I see the card or other document where (NAME)'s vaccinations are written down?

508B) COPY DATES FROM THE CARD. WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

509B) CHECK 508B: 'BCG' TO 'MMR' ALL RECORDED?

510B) In addition to what is recorded on (this document/these documents), did (NAME) receive any other vaccinations, including vaccinations received in national immunization day campaign? RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 508A THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

511B) Did (NAME) ever receive any vaccinations to prevent (NAME) from getting diseases, including vaccinations received in national immunization day campaign?

512B) Has (NAME) ever received a BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

514B) Has (NAME) ever received oral polio vaccine, that is, about two drops in the mouth to prevent polio?

515B) Did (NAME) receive the first oral polio vaccine in the first two weeks after birth or later?

516B) How many times did (NAME) receive the oral polio vaccine? RECORD 7 IF MORE THAN 7.

517B) Has (NAME) ever received a pentavalent vaccination, that is, an injection given in the thigh sometimes at the same time as polio drops?

518B) How many times did (NAME) receive the pentavalent vaccine?

519B) Has (NAME) ever received a pneumococcal vaccination, that is, an injection in the thigh to prevent pneumonia?

520B) How many times did (NAME) receive the pneumococcal vaccine?

521B) Has (NAME) ever received an inactivated polio vaccine (IPV), that is, an injection in the thigh to prevent polio?

523B) Has (NAME) ever received a measles (Measles/MMR) vaccination, that is, an injection in the arm to prevent measles?

524B) How many times did (NAME) receive the measles (Measles/MMR) vaccine?

525B) In the last 7 days was (NAME) given:

526B) CHECK 215 IN PREGNANCY HISTORY: ANY MORE BIRTHS IN 2014-2018?

SECTION 6. CHILD HEALTH AND NUTRITION

601) CHECK 224:

602) CHECK 215: RECORD THE PREGNANCY HISTORY NUMBER IN 603 AND THE NAME AND SURVIVAL STATUS IN 604 FOR EACH BIRTH IN 2012-2018. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE(S).

Now I would like to ask some questions about your children born in the last five years. (We will talk about each separately.)

603) PREGNANCY HISTORY NUMBER FROM 212 IN PREGNANCY HISTORY.

604) FROM 212D AND 216:

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

606) 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 CAPSULES.

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

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

609) CHECK 469: CURRENTLY BREASTFEEDING?

610) When (NAME) had diarrhea, was (NAME) given less than usual to eat, about the same amount, more than usual, or nothing to eat? IF LESS, PROBE: Was (NAME) given much less than usual to eat or somewhat less?

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

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

613) CHECK 612:

614) Where did you first seek advice or treatment?
USE LETTER CODE FROM 612.

615) Was (NAME) given any of the following at any time since (NAME) started having the diarrhea:

616) CHECK 615:

617) CHECK 615:

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

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

621) Has (NAME) had fast, short, rapid breaths or difficulty breathing at any time in the last 2 weeks?

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

623) CHECK 618: HAD FEVER?

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

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

626: CHECK 625:

627) Where did you first seek advice or treatment?
USE LETTER CODE FROM 625.

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

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

630) What drugs did (NAME) take? Any other drugs?
RECORD ALL MENTIONED.

646) IF LAST BIRTH: GO BACK TO 604 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 647.
IF NEXT-TO-LAST BIRTH: GO TO 604 IN NEXT-TO-LAST COLUMN OF NEW QUESTIONNAIRE; OR, IF NO MORE BIRTHS, GO TO 647.

647) CHECK 615(a) AND 615(b), ALL COLUMNS:

648) Have you ever heard of a special product called Nimkol/ORS OR PRE-PACKAGED ORS LIQUID you can get for the treatment of diarrhea?

649) CHECK 215 AND 218, ALL ROWS: NUMBER OF CHILDREN BORN IN 2015-2018 LIVING WITH THE RESPONDENT

650) Now I would like to ask you about liquids or foods that (NAME FROM 649) 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.

651) CHECK 650 (CATEGORIES 'G' THROUGH 'U'):

652) Did (NAME FROM 649) 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?

653) How many times did (NAME FROM 649) eat solid, semi-solid, or soft foods yesterday during the day or night?
IF 7 OR MORE TIMES, RECORD '7.'

654) The last time (NAME FROM 649) passed stools, what was done to dispose of the stools?

SECTION 7. MARRIAGE AND SEXUAL ACTIVITY

701) Are you currently married?

703) What is your marital status now: are you widowed, divorced, or separated?

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

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

706) Does your husband have other wives?

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

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

708A) Is/was there a blood relationship between you and your husband?

708B) What type of relationship (is/was) it?

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

710) CHECK 709:

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

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

713) Now I would like to ask some questions about sexual activity in order to gain a better understanding of some important life issues. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question. How old were you when you had sexual intercourse for the very first time?

713A) CHECK 701:

714) I would like to ask you about your recent sexual activity. When was the last time you had sexual intercourse?
IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS, OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

SECTION 8. FERTILITY PREFERENCES

801) CHECK 304:

802) CHECK 226:

803) 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?

804) 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?

805) CHECK 226:

806) CHECK 226:

807) CHECK 303: USING A CONTRACEPTIVE

808) CHECK 805:

809) CHECK 714:

810) CHECK 804:

811) CHECK 303: USING A CONTRACEPTIVE

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

813) CHECK 216:

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

815) In the last few months have you:

815A) CHECK 815:

816) What messages did it convey to you? Anything else?
RECORD ALL MENTIONED.

816A) Do you think that the message you heard was effective or not effective in encouraging couples to use family planning?

817) CHECK 701:

818) CHECK 303: USING A CONTRACEPTIVE

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

820) Would you say that not using contraception is mainly your decision, mainly your husband's decision, or did you both decide together?

821) CHECK 304:

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

SECTION 9. HUSBAND'S BACKGROUND AND WOMAN'S WORK

901) CHECK 701:

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

903) Did your husband ever attend school?

905) What was the highest class he completed?
IF COMPLETED LESS THAN CLASS ONE, RECORD '00'. IF MA, MPHIL, PHD, MBBS, OR BSC/4 YEAR, WRITE '16.'

906) Has your husband done any work in the last 7 days?

907) Has your husband done any work in the last 12 months?

908) What is your husband's occupation? That is, what kind of work does he mainly do?

908A) Aside from housework, women work for cash or kind, did you work for cash or kind at any time before you (first) got married?

908B) Did you work after you (first) got married?

908C) When did you start work after (first) marriage? IF LESS THAN ONE YEAR, WRITE '00'

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

910) 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 a family farm or in the family business. In the last seven days, have you done any of these things or any other work?

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

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

913) What is your occupation? That is, what kind of work do you mainly do?

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

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

915A) Do you work at home or away from home?

916) Are you paid in cash or kind for this work or are you not paid at all?

917) CHECK 701:

918) CHECK 916:

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

920) 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?

921) Who usually decides how your husband's earnings will be used: you, your husband, or you and your husband jointly?

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

923) Who usually makes decisions about making major household purchases?

924) Who usually makes decisions about visits to your family or relatives?

924A) Did you inherit any land or house?

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

926) Do you have a title deed for any house you own?

927) Is your name on the title deed?

927A) Do you have the autonomy to sell the house you own?

928) Do you own any agricultural or non-agricultural land either alone or jointly with someone else?

929) Do you have a title deed for any land you own?

930) Is your name on the title deed?

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

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

SECTION 10. HIV/AIDS

1001) Now I would like to talk about something else. Have you ever heard of HIV or AIDS?

1002) HIV is the virus that can lead to AIDS. Can people reduce their chance of getting HIV by having just one uninfected sex partner who has no other sex partners?

1003) Can people get HIV from mosquito bites?

1004) Can people reduce their chance of getting HIV by using a condom every time they have sex?

1005) Can people get HIV by sharing food with a person who has HIV?

1006) Can people get HIV by witchcraft or other supernatural means?

1007) Is it possible for a healthy-looking person to have HIV?

1008) Can HIV be transmitted from a mother to a baby:

1009) CHECK 1008:

1010) Are there any special drugs that a doctor or a nurse can give a woman infected with HIV to reduce the risk of transmission to the baby?

1027) I don't want to know the results, but have you ever been tested for HIV?

1028) How many months ago was your most recent HIV test?

1029) I don't want to know the results, but did you get the results of the test?

1030) Where was the test done?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

1031) Do you know of a place where people can go to get an HIV test?

1032) Where is that? Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

1032A) Do you think there is a treatment for HIV?

1032B) Do you know from where HIV treatment (Anti Retroviral Treatment) can be received?

1035) Would you buy fresh vegetables from a shopkeeper or vendor if you know that this person had HIV?

1036) Do you think children living with HIV should be allowed to attend school with children who do not have HIV?

1037) Do you think people hesitate to take an HIV test because they are afraid of how other people will react if the test result is positive for HIV?

1038) Do people talk badly about people living with HIV, or who are thought to be living with HIV?

1039) Do people living with HIV, or thought to be living with HIV, lose the respect of other people?

1039A) Do people living with HIV get discriminatory treatment from the health service providers?

1040) Do you agree or disagree with the following statement: I would be ashamed if someone in my family had HIV.

1041) Do you fear that you could get HIV if you come into contact with the saliva of a person living with HIV?

1042) CHECK 1001:

1043) CHECK 713:

1044) CHECK 1042: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

1045) Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?

1046) Sometimes women experience a bad-smelling abnormal genital discharge. During the last 12 months, have you had a bad-smelling abnormal genital discharge?

1047) Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

1048) CHECK 1045, 1046, AND 1047:

1049) The last time you had (PROBLEM FROM 1045/1046/1047), did you seek any kind of advice or treatment?

1050) Where did you go? Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

1051) If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom when they have sex?

1052) Is a wife justified in refusing to have sex with her husband when she knows he has sex with women other than his wives?

1052) CHECK 701:

1054) Can you say no to your husband if you do not want to have sexual intercourse?

1055) Could you ask your husband to use a condom if you wanted him to?

SECTION 11. OTHER HEALTH ISSUES

1101) Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months? IF YES: How many injections have you had? IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90.' IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

1102) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker? IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90.' IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

1103) The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?

1104) Do you currently smoke cigarettes every day, some days, or not at all?

1105) On average, how many cigarettes do you currently smoke each day?

1106) Do you currently smoke or use any other type of tobacco every day, some days, or not at all?

1107) What other type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED.

1107A) Do you currently use any types of drugs?

1107B) Have you ever heard of an illness called tuberculosis or TB?

1107C) How does tuberculosis spread from one person to another? Any other ways? RECORD ALL MENTIONED.

1107D) Can tuberculosis be cured?

1107E) What is the duration of treatment of TB now a days? IF MORE THAN 7 MONTHS, RECORD 7.

1107F) Have you ever been told by a doctor or nurse or LHV that god forbid you have/had tuberculosis?

1107G) Have you ever heard of an illness called Hepatitis B or C?

1107H) Is there anything a person can do to avoid getting Hepatitis B or C?

1107I) What can a person do to avoid getting Hepatitis B or C? Any other ways?
RECORD ALL
MENTIONED.

1107J) I don't want to know the results, but have you ever been tested for Hepatitis B or C?

1107K) How many months ago was your most recent test for Hepatitis B or C?

1108) 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 big problem:

1109) Are you covered by any health insurance?

1110) What type of health insurance are you covered by? RECORD ALL MENTIONED.

1110A) Do you receive any cash/kind benefit from Benazir Income Support Program through government of Pakistan?

SECTION 12. DOMESTIC VIOLENCE MODULE

1200) CHECK COVER PAGE: WOMAN SELECTED FOR DV MODULE?

WOMAN SELECTED FOR THIS SECTION (CONTINUE)
WOMAN NOT SELECTED (GO TO 1233)

1201) CHECK FOR PRESENCE OF OTHERS: DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.

1201A) READ TO THE RESPONDENT:
Now I would like to ask you 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 anyone and no one else in your household will know that you were asked these questions. If I ask you any question you don't want to answer, just let me know and I will go on to the next question.

1202) CHECK 701:

CURRENTLY MARRIED (CONTINUE)
WIDOWED, DIVORCED, SEPARATED (READ IN PAST TENSE AND USE 'LAST' WITH 'HUSBAND')

1203) First, I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your (last) husband?

1204) Now I need to ask some more questions about your relationship with your (last) husband.

Did your (last) husband ever:

1205) Did you (last) husband ever do any of the following things to you:

1206) CHECK 1205(a-j):

1207) 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.'

1208) Did the following ever happen as a result of what your (last) husband did to you:

1209) 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?

1210) In the last 12 months, how often have you done this to your (last) husband: often, only sometimes, or not at all?

1211) Does (did) your (last) husband drink alcohol or consume other drugs?

1212) How often does (did) he get drunk or high on drugs: often, only sometimes, or never?

1213) Are (were) you afraid of your (last) husband: most of the time, sometimes, or never?

1214) CHECK 709:

MARRIED MORE THAN ONCE (CONTINUE)
MARRIED ONLY ONCE (GO TO 1216)

1215) So far we have been talking about the behavior of your (last) husband. Now I want to ask you about the behavior of any previous husband.

1216) 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 hurt you physically?

1217) Who has hurt you in this way? Anyone else?
RECORD ALL MENTIONED.

1218) In the last 12 months, how often has (this person/have these persons) physically hurt you: often, only sometimes, or not at all?

1219) CHECK 201, 207AA, AND 226:

EVER BEEN PREGNANT (ANY 'YES' ON 201 OR 207AA OR 226) (CONTINUE)
NEVER BEEN PREGNANT (GO TO 1222A)

1220) Has any one ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?

1221) Who has done any of these things to physically hurt you while you were pregnant? Anyone else?
RECORD ALL MENTIONED.

1221A) As a consequence of this did you suffer from abortion, miscarriage, stillbirth, or had any other health problems?

1222A) Now I want to ask you about things that may have been done to you by someone other than (your/any) husband. At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?

1223) Who was the person who was forcing you the very first time this happened?

1224) In the last 12 months, has anyone other than (your/any) husband physically forced you to have sexual intercourse when you did not want to?

1224A) CHECK 1205A (h-j) AND 1215A(b)
AT LEAST ONE 'YES' (CONTINUE)
NOT A SINGLE 'YES' (GO TO 1226)

1225) How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts by anyone, including (your/any) husband?

1226) CHECK 1205A (a-j), 1215A (a,b), 1216, 1220, AND 1222A:

AT LEAST ONE 'YES' (CONTINUE)
NOT A SINGLE 'YES' (GO TO 1230)

1227) Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?

1228) From whom have you sought help? Anyone else?
RECORD ALL MENTIONED.

1228A) Were you satisfied with the help provided?

1228B) What were the reasons that made you seek help?

1228C) Did you face any consequences due to seeking help?

1229) Have you ever told any one about this?

1229A) What were the reasons for not seeking help?

1229B) Did you have to face any consequences due to this violence?

1230) As far as you know, did your 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.

1231) DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?

1232) INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE.

_________________________________

1233) RECORD THE TIME

INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT INTERVIEW: ______________________

COMMENTS ON SPECIFIC QUESTIONS: _______________________

ANY OTHER COMMENTS: ______________________

SUPERVISOR'S OBSERVATIONS:___________________

EDITOR'S OBSERVATIONS ______________________