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PAKISTAN DEMOGRAPHIC AND HEALTH SURVEY 2017-18
EVER-MARRIED WOMAN'S QUESTIONNAIRE

PAKISTAN
NATIONAL INSTITUTE OF POPULATION STUDIES

IDENTIFICATION

PROVINCE/REGION

PUNJAB 1
SINDH 2
KPK 3
BALOCHISTAN 4
GB 5
ICT 6
AJK 7
FATA 8

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?

YES 1
NO 2

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

YES 1
NO 2

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 _________

*RESULT CODES

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

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

TRANSLATOR USED

YES 1
NO 2

**LANGUAGE CODES

ENGLISH 01
URDU 02
SINDHI 03
PUNJABI 04
SARAIKI 05
BALUCHI 06
PUSHTO 07
OTHER 08

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 ___________

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

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE TIME

HOURS ________
MINUTES _______

105) In what month and year were you born?

MONTH ________
DON'T KNOW MONTH 98
YEAR ______
DON'T KNOW YEAR 9998

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

AGE IN COMPLETED YEARS _____

107) Have you ever attended school?

YES 1
NO 2 (GO TO 111)

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.'

CLASS _______

110) CHECK 109:

CLASS 00-09 (CONTINUE)
CLASS 10 OR HIGHER (GO TO 113)

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?

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

112) CHECK 111:

CODE '2,' '3,' OR '4' CIRCLED
CODE '1' OR '5' CIRCLED (GO TO 114)

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

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

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

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

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

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

116) Do you own a mobile telephone?

YES 1
NO 2 (GO TO 118)

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

YES 1
NO 2

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

YES 1
NO 2

119) Have you ever used the internet?

YES 1
NO 2 (GO TO 121A)

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

YES 1
NO 2 (GO TO 121A)

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?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

121A) What is your mother tongue?

URDU 01
PUNJABI 02
SINDHI 03
PUSHTO 04
BALOCHI 05
ENGLISH 06
BARAUHI 07
SIRAIKI 08
HINDKO 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) First 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)

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

SONS AT HOME ___________

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

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)

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

SONS ELSEWHERE _______

205B) And how many daughters are alive but do not live with you?
IF NONE, RECORD '00.'

DAUGHTERS ELSEWHERE ______

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?

YES 1
NO 2 (GO TO 207AA)

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

BOYS DEAD _______

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

GIRLS DEAD _________

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?

YES 1
NO 2 (GO TO 208)

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

PREGNANCY LOSSES ______

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

TOTAL PREGNANCIES ________

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

YES 1
NO 2 (PROBE AND CORRECT 201-208 AS NECESSARY)

210) CHECK 208:

ONE OR MORE PREGNANCIES
NO PREGNANCIES (GO TO 226)

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?

SINGLE 1
MULTIPLE 2

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

BORN ALIVE 1 (GO TO 212D)
BORN DEAD 2
LOST BEFORE FULL TERM 3 (GO TO 220AB)

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

YES 1
NO 2 (GO TO 220AB)

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

NAME ___________

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

BOY 1
GIRL 2

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

DAY _______
MONTH _______
YEAR _________

216) Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

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

AGE IN YEARS _______

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

YES 1
NO 2

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

HOUSEHOLD LINE NUMBER ________ (GO TO 221)

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.

DAYS 1 ______
MONTHS 2 _______
YEARS 3 _______
(GO TO 221)

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

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

DAY ________
MONTH ______
YEAR _______

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

MONTHS ______

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

YES 1
NO 2

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

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

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

YES 1 (RECORD BIRTH(S) IN TABLE)
NO 2

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

NUMBERS ARE SAME (CONTINUE)
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

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

NUMBER OF BIRTHS _____

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?

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

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.

MONTHS _____

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

YES 1 (GO TO 229A)
NO 2

229 CHECK 208: TOTAL NUMBER OF BIRTHS

ONE OR MORE: a) Did you want to have a baby later on or did you not want any more children?

NONE: b) Did you want to have a baby later on or did you not want any children?
LATER 1
NO MORE/NONE 2

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

HAD ABORTION OR MISCARRIAGE OR STILLBIRTH SINCE JANUARY 2012 (CONTINUE)
DID NOT HAVE ABORTION OR MISCARRIAGE OR STILLBIRTH SINCE JANUARY 2012 (GO TO 239)

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?

YES 1
NO 2 (GO TO 239)

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

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE/LHV B
OTHER PERSON
DAI-TBA C
LADY HEALTH WORKER D
HOMEOPATH E
HAKIM F
DISPENSER/COMPOUNDER G
OTHER (SPECIFY) _________ X

239) When did your last menstrual period 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

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

YES 1
NO 2 (GO TO 242)
DON'T KNOW 8 (GO TO 242)

241) Is this time just before her period begins, during her period, right after her period has 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 TWO PERIODS 4

OTHER (SPECIFY) ________ 6
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

SECTION 3. CONTRACEPTION

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

METHOD 1: FEMALE STERILIZATION. Woman can have an operation to avoid having any more children.
YES 1
NO 2
METHOD 2: MALE STERILIZATION. Man can have an operation to avoid having any more children.
YES 1
NO 2
METHOD 3: IUD. Women can have a loop or coil placed inside them by a doctor or a nurse which can prevent pregnancy up to ten years.
YES 1
NO 2
METHOD 4: INJECTABLES. Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
METHOD 5: IMPLANTS. Women can have one or more small rods placed in their upper arm by a doctor, nurse, or LHV which can prevent pregnancy up to five years.
YES 1
NO 2
METHOD 6: PILL. Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
METHOD 7: CONDOM. Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
METHOD 8: EMERGENCY CONTRACEPTION. As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
YES 1
NO 2
METHOD 9: STANDARD DAYS METHOD. A woman uses a string of colored beads to know the days she can get pregnant. On the days she can get pregnant, she uses a condom or does not have sexual intercourse.
YES 1
NO 2
METHOD 10: LACTATIONAL AMENORRHEA METHOD (LAM). Up to six months after childbirth, before the menstrual period has returned, women use a method requiring frequent breastfeeding day and night.
YES 1
NO 2
METHOD 11: RHYTHM METHOD. To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.
YES 1
NO 2
METHOD 12: WITHDRAWAL. Men can be careful and pull out before climax.
YES 1
NO 2
METHOD 13: Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES, MODERN METHOD (SPECIFY) ____________ A
YES, TRADITIONAL METHOD (SPECIFY) __________ B
NO Y

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

YES 1
NO 2

302) CHECK 226:

NOT PREGNANT OR UNSURE (CONTINUE)
PREGNANT (GO TO 312)

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

YES 1
NO 2 (GO TO 312)

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

FEMALE STERILIZATION (GO TO 307)
MALE STERILIZATION (GO TO 307)
IUD (GO TO 309)
INJECTABLES (GO TO 309)
IMPLANTS (GO TO 309)
PILL F
CONDOM G (GO TO 306)
EMERGENCY CONTRACEPTION I (GO TO 309)
STANDARD DAYS METHOD J (GO TO 309)
LACTATIONAL AMENORRHEA METHOD K (GO TO 309)
RHYTHM METHOD L (GO TO 309)
WITHDRAWAL M (GO TO 309)
OTHER MODERN METHOD X (GO TO 309)
OTHER TRADITIONAL METHOD Y (GO TO 309)

305) 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 (GO TO 309)
FAMILA 28 02 (GO TO 309)
LO FEMENAL (GO TO 309)
OTHER (SPECIFY) ________ 96 (GO TO 309)
DON'T KNOW 98 (GO TO 309)

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

SATHI 01 (GO TO 309)
TOUCH 02 (GO TO 309)
JOSH 03 (GO TO 309)
PRUDENCE 04 (GO TO 309)
OTHER (SPECIFY) ________ 96 (GO TO 309)
DON'T KNOW 98 (GO TO 309)

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.

NAME OF PLACE _____

PUBLIC SECTOR
FAMILY HEALTH CLINIC/RHSC 11
GOVERNMENT HOSPITAL 12
OTHER PUBLIC SECTOR (SPECIFY) _________ 16
PRIVATE/NGO MEDICAL SECTOR
PRIVATE/NGO HOSPITAL/CLINIC 21
PRIVATE DOCTOR'S CLINIC 22
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _______ 26
OTHER (SPECIFY) _________ 96
DON'T KNOW 98

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

MONTH _______
YEAR ______

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?

MONTH ______
YEAR ______

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

NO (CONTINUE)
YES: GO BACK TO 308 OR 309, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION).

311) CHECK 308 AND 309:

YEAR IS 2012-2018: ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING. THEN CONTINUE

YEAR IS 2011 OR EARLIER: ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2012. THEN GO TO 324.

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:

a) When was the last time you used a method? Which method was that?
b) When did you start using that method? How long after the birth of (NAME)?
c) How long did you use the method then?

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:

a) 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?
b) 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.

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

NO METHOD USED (CONTINUE)
ANY METHOD USED (GO TO 315)

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

YES 1 (GO TO 326)
NO 2 (GO TO 326)

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

NO CODE CIRCLED 00 (GO TO 326)
FEMALE STERILIZATION 01 (GO TO 319)
MALE STERILIZATION 02 (GO TO 327)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07
EMERGENCY CONTRACEPTION 09
STANDARD DAYS METHOD 10
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 323)
RHYTHM METHOD 12 (GO TO 323)
WITHDRAWAL 13 (GO TO 323)
OTHER MODERN METHOD 95
OTHER TRADITIONAL METHOD 96

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.

NAME OF PLACE __________

PUBLIC SECTOR
FAMILY HEALTH CLINIC/RHSC 11
FAMILY WELFARE CENTRE/FWW 12
MOBILE SERVICE CAMP/UNIT 13
MALE MOBILIZER 14
GOVERNMENT HOSPITAL 15
RURAL HEALTH CENTER 16
BASIC HEALTH UNIT 17
MCH CENTER 18
DISPENSORY 19
LADY HEALTH WORKER 20
LADY HEALTH VISITOR 21
COMMUNITY MIDWIFE 22
OTHER PUBLIC SECTOR (SPECIFY) __________ 26
PRIVATE/NGO MEDICAL SECTOR
PRIVATE/NGO HOSPITAL/CLINIC 31
PRIVATE DOCTOR 32
PHARMACY/MEDICAL STORE 33
HOMEOPATH 34
DISPENSER/COMPOUNDER 35
OTHER PRIVATE SECTOR (SPECIFY) _________ 36
OTHER SOURCE
SHOP (NOT PHARMACY/CHEMIST) 41
FRIEND/RELATIVE 42
HAKIM 43
DAI, TRADITIONAL BIRTH ATTENDANT 44
OTHER (SPECIFY) ______ 96

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

IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07 (GO TO 323)
EMERGENCY CONTRACEPTION 09 (GO TO 322)
STANDARD DAYS METHOD 10 (GO TO 322)
OTHER MODERN METHOD 95 (GO TO 322)
OTHER TRADITIONAL METHOD 96 (GO TO 323)

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

YES 1 (GO TO 321)
NO 2 (GO TO 320)

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

YES 1 (GO TO 321)
NO 2

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

YES 1
NO 2 (GO TO 322)

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

YES 1
NO 2

322) CHECK 318 AND 319:

ANY 'YES': a) At that time, were you told about other methods of family planning that you could use?

OTHER: b) When you obtained (CURRENT METHOD FROM 315) from (SOURCE OF METHOD FROM 307 OR 316), were you told about other methods of family planning that you could use?
YES 1 (GO TO 323A)
NO 2

323) 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

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

a) Help you in selecting a method?
YES 1
NO 2
b) Explained how to use the selected method?
YES 1
NO 2

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

FEMALE STERILIZATION 01 (GO TO 327)
MALE STERILIZATION 02 (GO TO 327)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07
EMERGENCY CONTRACEPTION 09
STANDARD DAYS METHOD 10
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 327)
RHYTHM METHOD 12 (GO TO 327)
WITHDRAWAL 13 (GO TO 327)
OTHER MODERN METHOD 95
OTHER TRADITIONAL METHOD 96 (GO TO 327)

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.

NAME OF PLACE _______

PUBLIC SECTOR
FAMILY HEALTH CLINIC/RHSC 11 (GO TO 327)
FAMILY WELFARE CENTER/FWW 12 (GO TO 327)
MOBILE SERVICE CAMP/UNIT 13 (GO TO 327)
MALE MOBILIZER 14 (GO TO 327)
GOVERNMENT HOSPITAL 15 (GO TO 327)
RURAL HEALTH CENTER 16 (GO TO 327)
BASIC HEALTH UNIT 17 (GO TO 327)
MCH CENTER 18 (GO TO 327)
DISPENSORY 19 (GO TO 327)
LADY HEALTH WORKER 20 (GO TO 327)
LADY HEALTH VISITOR 21 (GO TO 327)
COMMUNITY MIDWIFE 22 (GO TO 327)

OTHER PUBLIC SECTOR (SPECIFY) _________ 26 (GO TO 327)
PRIVATE/NGO MEDICAL SECTOR
PRIVATE/NGO HOSPITAL/CLINIC 31 (GO TO 327)
PRIVATE DOCTOR 32 (GO TO 327)
PHARMACY/MEDICAL STORE 33 (GO TO 327)
HOMEOPATH 34 (GO TO 327)
DISPENSER/COMPOUNDER 35 (GO TO 327)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) __________ 36 (GO TO 327)
OTHER SOURCE
SHOP (NOT PHARMACY/CHEMIST) 41 (GO TO 327)
FRIEND/RELATIVE 42 (GO TO 327)
HAKIM 43 (GO TO 327)
DAI, TRAD. BIRTH ATTENDANT 44 (GO TO 327)
OTHER (SPECIFY) ________ 96 (GO TO 327)

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 329)

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

YES 1
NO 2

329) CHECK 202: CHILDREN LIVING WITH RESPONDENT.

YES: a) In the last 12 months, have you visited a health facility for care for yourself or your children?

NO: b) In the last 12 months, have you visited a health care facility for yourself?
YES 1
NO 2 (GO TO 401)

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

YES 1
NO 2

SECTION 4. PREGNANCY AND POSTNATAL CARE

401) CHECK 224:

ONE OR MORE BIRTHS IN 2012-2018 (CONTINUE)
NO BIRTHS IN 2012-2018 (GO TO 648)

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.

PREGNANCY HISTORY NUMBER _____

404) FROM 212D AND 216:

NAME ______
LIVING __
DEAD ___

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

YES 1 (GO TO 408 IF LAST BIRTH, GO TO 426 IF NEXT-TO-LAST BIRTH)
NO 2

406) CHECK 203, 205, AND 207:

ONLY ONE BIRTH: a) Did you want to have a baby later on, or did you not want any children?

MORE THAN ONE BIRTH: b) Did you want to have a baby later on, or did you not want any more children?
LATER 1
NO MORE 2 (GO TO 408 IF LAST BIRTH, GO TO 426 IF NEXT-TO-LAST BIRTH)

407) How much longer did you want to wait?

MONTHS 1 ______
YEARS 2 ____
DON'T KNOW 998

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

YES 1
NO 2 (GO TO 414)

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

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE/LHV B
OTHER PERSON
DAI-TBA C
LADY H. WORKER D
HOMEOPATH E
HAKIM F
DISPENSER/COMPOUNDER G
OTHER (SPECIFY) _______ X

409A) Were you satisfied with the service provided?

YES 1
NO 2

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.

NAME OF PLACE ______

HOME
HER HOME A
OTHER HOME B
PUBLIC SECTOR
GOVT. HOSPITAL C
RHC/MCH D
BHU E
CMW F
OTHER PUBLIC SECTOR (SPECIFY) ______ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC H
PVT. DOCTOR I
HOMEOPATH J
DISPENSER/COMPOUNDER K
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _______ L
HAKIM M
OTHER (SPECIFY) _______ X

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

MONTHS _____
DON'T KNOW 98

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

a) Was your blood pressure measured?
YES 1
NO 2
b) Did you give a urine sample?
YES 1
NO 2
c) Did you give a blood sample?
YES 1
NO 2

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

a) Early initiation of breast feeding?
YES 1
NO 2
b) Exclusive breastfeeding?
YES 1
NO 2
c) Balanced diet during pregnancy?
YES 1
NO 2

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

YES 1
NO 2 (GO TO 417)
DON'T KNOW (GO TO 417)

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

TIMES _____
DON'T KNOW 8

416) CHECK 415:

2 OR MORE TIMES (GO TO 420)
OTHER (CONTINUE)

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

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

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

TIMES ______
DON'T KNOW 8

419) CHECK 418:

ONLY ONE: a) How many years ago did you receive that tetanus injection?

MORE THAN ONE: b) How many years ago did you receive that last tetanus injection prior to this pregnancy?
YEARS AGO ______

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

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

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.

DAYS _____
DON'T KNOW 998

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

YES 1
NO 2
DON'T KNOW 8

426) When (NAME) was born, was (NAME) very large, larger than 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

427) Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 429)
DON'T KNOW (GO TO 429)

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

KG FROM CARD __._________ 1
KG FROM RECALL ___.________ 2
DON'T KNOW 99998

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.

HEALTH PERSONNEL
DOCTOR A
NURSE B
MIDWIFE C
LHV D
CMW E
OTHER PERSON
DAI/TRADITIONAL BIRTH ATTENDANT F
FAMILY WELFARE WK G
LADY H. WORKER H
HOMEOPATH I
HAKIM J
RELATIVE/FRIEND K
OTHER (SPECIFY) __________ X
NO ONE ASSISTED Y

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.

NAME OF PLACE _________

HOME
HER HOME 11 (GO TO 434)
OTHER HOME 12 (GO TO 434)
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
RHC/MC 22
BHU 23
CMW 24
OTHER PUBLIC SECTOR (SPECIFY) ______ 26
PRIVATE MEDICAL CENTER
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL CENTER (SPECIFY) ________ 36
OTHER (SPECIFY) _______ 96 (GO TO 434)

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.

HOURS 1 ______
DAYS 2 _____
WEEKS 3 ______
DON'T KNOW 998

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

YES 1
NO 2 (GO TO 434)

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

BEFORE 1
AFTER 2

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

YES 1
NO 2 (GO TO 434B IF LAST BIRTH, GO TO 459 IF SECOND-TO-LAST BIRTH)

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

YES 1
NO 2
DON'T KNOW 8

434B) CHECK 430: PLACE OF DELIVERY

CODE 11, 12, OR 96 CIRCLED (GO TO 449)
OTHER (CONTINUE)

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?

YES 1
NO 2 (GO TO 438)

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.

HOURS 1 ______
DAYS 2 ______
WEEKS 3 _______
DON'T KNOW 998

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

HEALTH PERSONNEL
DOCTOR 11
NURSE 12
MIDWIFE 13
LHV 14
CMW 15
OTHER PERSON
DAI-TBA 21
FWW 22
LADY H. WORKER 23
HOMEOPATH 24
HAKIM 25
DISPENSER/COMPOUNDER 26
OTHER (SPECIFY) _________ 96

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

YES 1
NO 2

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?

YES 1
NO 2 (GO TO 441)
DON'T KNOW 8 (GO TO 441)

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.

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

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

HEALTH PERSONNEL
DOCTOR 11
NURSE 12
MIDWIFE 13
LHV 14
CMW 15
OTHER PERSON
DAI-TBA 21
FWW 22
LADY H. WORKER 23
HOMEOPATH 24
HAKIM 25
DISPENSER/COMPOUNDER 26
OTHER (SPECIFY) _________ 96

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?

YES 1
NO 2 (GO TO 445)

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

HOURS 1 ______
DAYS 2 ____
WEEKS 3 ____
DON'T KNOW 998

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

HEALTH PERSONNEL
DOCTOR 11
NURSE 12
MIDWIFE 13
LHV 14
CMW 15
OTHER PERSON
DAI-TBA 21
FWW 22
LADY H. WORKER 23
HOMEOPATH 24
HAKIM 25
DISPENSER/COMPOUNDER 26
OTHER (SPECIFY) _________ 96

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

YES 1
NO 2

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.

NAME OF PLACE _________

HOME
HER HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
RHC/MC 22
BHU 23
CMW 24
OTHER PUBLIC SECTOR (SPECIFY) ______ 26
PRIVATE MEDICAL CENTER
PRIVATE HOSPITAL/CLINIC 31

OTHER PRIVATE MEDICAL CENTER (SPECIFY) ________ 36
OTHER (SPECIFY) _______ 96

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).

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

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.

HOURS 1 _____
DAYS 2 _____
WEEKS 3 _______
DON'T KNOW 998

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

HEALTH PERSONNEL
DOCTOR 11
NURSE 12
MIDWIFE 13
LHV 14
CMW 15
OTHER PERSON
DAI-TBA 21
FWW 22
LADY H. WORKER 23
HOMEOPATH 24
HAKIM 25
DISPENSER/COMPOUNDER 26
OTHER (SPECIFY) _________ 96

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.

NAME OF PLACE ________

HOME
HER HOME 11 (GO TO 457)
OTHER HOME 12 (GO TO 457)
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21 (GO TO 457)
RHC/MC 22 (GO TO 457)
BHU 23 (GO TO 457)
CMW 24 (GO TO 457)
OTHER PUBLIC SECTOR (SPECIFY) ______ 26 (GO TO 457)
PRIVATE MEDICAL CENTER
PRIVATE HOSPITAL/CLINIC 31 (GO TO 457)
OTHER PRIVATE MEDICAL CENTER (SPECIFY) ________ 36 (GO TO 457)
OTHER (SPECIFY) _______ 96 (GO TO 457)

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)?

YES 1
NO 2 (GO TO 453)

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.

HOURS 1 _____
DAYS 2 _____
WEEKS 3 _______
DON'T KNOW 998

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

HEALTH PERSONNEL
DOCTOR 11
NURSE 12
MIDWIFE 13
LHV 14
CMW 15
OTHER PERSON
DAI-TBA 21
FWW 22
LADY H. WORKER 23
HOMEOPATH 24
HAKIM 25
DISPENSER/COMPOUNDER 26
OTHER (SPECIFY) _________ 96

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

YES 1
NO 2

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.

NAME OF PLACE ________

HOME
HER HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
RHC/MC 22
BHU 23
CMW 24
OTHER PUBLIC SECTOR (SPECIFY) ______ 26
PRIVATE MEDICAL CENTER
PRIVATE HOSPITAL/CLINIC 31

OTHER PRIVATE MEDICAL CENTER (SPECIFY) ________ 36
OTHER (SPECIFY) _______ 96

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?

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

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.

HOURS 1 _____
DAYS 2 _____
WEEKS 3 _______
DON'T KNOW 998

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

HEALTH PERSONNEL
DOCTOR 11
NURSE 12
MIDWIFE 13
LHV 14
CMW 15
OTHER PERSON
DAI-TBA 21
FWW 22
LADY H. WORKER 23
HOMEOPATH 24
HAKIM 25
DISPENSER/COMPOUNDER 26
OTHER (SPECIFY) _________ 96

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.

NAME OF PLACE ________

HOME
HER HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
RHC/MC 22
BHU 23
CMW 24

OTHER PUBLIC SECTOR (SPECIFY) ______ 26
PRIVATE MEDICAL CENTER
PRIVATE HOSPITAL/CLINIC 31

OTHER PRIVATE MEDICAL CENTER (SPECIFY) ________ 36
OTHER (SPECIFY) _______ 96

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

a) Examine the cord?
YES 1
NO 2
DON'T KNOW 8
b) Measure (NAME)'s temperature?
YES 1
NO 2
DON'T KNOW 8
c) Counsel you on danger signs for newborns?
YES 1
NO 2
DON'T KNOW 8
d) Counsel you on breastfeeding?
YES 1
NO 2
DON'T KNOW 8
e) Observe (NAME) breastfeeding?
YES 1
NO 2
DON'T KNOW 8

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

YES 1 (GO TO 460)
NO 2 (GO TO 461)

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

YES 1
NO 2 (GO TO 463)

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

MONTHS ____
DON'T KNOW 98

461) CHECK 226: IS RESPONDENT PREGNANT?

NOT PREGNANT (CONTINUE)
PREGNANT OR UNSURE (GO TO 464)

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

YES 1
NO 2 (GO TO 464)

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

MONTHS ______
DON'T KNOW 98

464) Did you ever breastfeed (NAME)?

YES 1 (GO TO 466)
NO 2

465) CHECK 404: IS CHILD LIVING?

LIVING (GO TO 469A)
DEAD (GO TO 417)

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.

IMMEDIATELY 000
HOURS 1 ____
DAYS 2 ____

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

YES 1
NO 2

468) CHECK 404: IS CHILD LIVING?

LIVING (CONTINUE)
DEAD (GO TO 471)

469) Are you still breastfeeding (NAME)?

YES 1 (GO TO 470)
NO 2

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

CHILD HAS GROWN 1
HEALTH PROBLEM 2
CHILD CANNOT SUCKLE 3
MOTHER GO FOR WORK 4
MOTHER'S FIGURE CONCERN 5
OTHER (SPECIFY) ________ 6

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

YES 1
NO 2
DON'T KNOW 8

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?

ONE OR MORE BIRTHS IN 2014-2018 (CONTINUE)
NO BIRTHS IN 2014-2018 (GO TO 601)

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

NAME OF LAST BIRTH _______
PREGNANCY HISTORY NUMBER _____

503A) CHECK 216 FOR CHILD:

LIVING (CONTINUE)
DEAD (GO TO 501B)

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

YES, HAS ONLY A CARD 1 (GO TO 507A)
YES, HAS ONLY AN OTHER DOCUMENT 2
YES, HAS CARD AND OTHER DOCUMENT 3 (GO TO 507A)
NO, NO CARD AND NO OTHER DOCUMENT 4

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

YES 1
NO 2

506A) CHECK 504A:

CODE '2' CIRCLED (CONTINUE)
CODE '4' CIRCLED (GO TO 511A)

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

YES, ONLY CARD SEEN 1
YES, ONLY OTHER DOCUMENT SEEN 2
YES, CARD AND OTHER DOCUMENT SEEN 3
NO CARD AND NO OTHER DOCUMENT SEEN 4 (GO TO 511A)

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

BCG
DAY ___
MONTH ____
YEAR _____
ORAL POLIO VACCINE (OPV) 0 (BIRTH DOSE)
DAY ___
MONTH ____
YEAR _____
OPV 1
DAY ___
MONTH ____
YEAR _____
OPV 2
DAY ___
MONTH ____
YEAR _____
OPV 3
DAY ___
MONTH ____
YEAR _____
DPT-HEP.B-HIB (PENTAVALENT) 1
DAY ___
MONTH ____
YEAR _____
DPT-HEP.B-HIB (PENTAVALENT) 2
DAY ___
MONTH ____
YEAR _____
DPT-HEP.B-HIB (PENTAVALENT) 3
DAY ___
MONTH ____
YEAR _____
PNEUMOCOCCAL 1
DAY ___
MONTH ____
YEAR _____
PNEUMOCOCCAL 2
DAY ___
MONTH ____
YEAR _____
PNEUMOCOCCAL 3
DAY ___
MONTH ____
YEAR _____
INACTIVATED POLIO VACCINE (IPV)
DAY ___
MONTH ____
YEAR _____
MEASLES
DAY ___
MONTH ____
YEAR _____
MEASLES, MUMPS, AND RUBELLA (MMR)
DAY ___
MONTH ____
YEAR _____
VITAMIN A (MOST RECENT)
DAY ___
MONTH ____
YEAR _____

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

NO (CONTINUE)
YES (GO TO 525A)

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.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 508A THEN WRITE '00' IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINATIONS NOT GIVEN, THEN SKIP TO 525A)

NO 2 (WRITE '00' IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINATIONS NOT GIVEN, THEN GO TO 525A)

DON'T KNOW 8 (WRITE '00' IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINATIONS NOT GIVEN, THEN GO TO 525A)

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

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

512A) Has (NAME) ever received 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

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

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

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

FIRST TWO WEEKS 1
LATER 2

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

NUMBER OF TIMES _______

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

YES 1
NO 2 (GO TO 519A)
DON'T KNOW 8 (GO TO 519A)

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

NUMBER OF TIMES _____

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

YES 1
NO 2 (GO TO 521A)
DON'T KNOW (GO TO 521A)

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

NUMBER OF TIMES _______

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 425A)
DON'T KNOW 8 (GO TO 425A)

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

NUMBER OF TIMES ______

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

a) BABY ACTIVE?
YES 1
NO 2
DON'T KNOW 8
b) PLUMPY'NUT?
YES 1
NO 2
DON'T KNOW 8
c) PLUMPY'DOZ?
YES 1
NO 2
DON'T KNOW 8

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?

MORE BIRTHS IN 2014-2018 (CONTINUE)
NO MORE BIRTHS IN 2014-2018 (GO TO 601)

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

NAME OF NEXT TO LAST BIRTH _________
PREGNANCY HISTORY NUMBER _________

503B) CHECK 216 FOR CHILD

LIVING (CONTINUE)
DEAD (GO TO 526B)

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

YES, ONLY HAS A CARD 1 (GO TO 507B)
YES, HAS ONLY AN OTHER DOCUMENT 2
YES, HAS CARD AND OTHER DOCUMENT 3 (GO TO 507B)
NO, NO CARD AND NO OTHER DOCUMENT 4

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

YES 1
NO 2

506B) CHECK 504B:

CODE '2' CIRCLED (CONTINUE)
CODE '4' CIRCLED (GO TO 511B)

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

YES, ONLY CARD SEEN 1
YES, ONLY OTHER DOCUMENT SEEN 2
YES, CARD AND OTHER DOCUMENT SEEN 3
NO CARD AND NO OTHER DOCUMENT SEEN 4 (GO TO 511B)

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

BCG
DAY ___
MONTH ____
YEAR _____
ORAL POLIO VACCINE (OPV) 0 (BIRTH DOSE)
DAY ___
MONTH ____
YEAR _____
OPV 1
DAY ___
MONTH ____
YEAR _____
OPV 2
DAY ___
MONTH ____
YEAR _____
OPV 3
DAY ___
MONTH ____
YEAR _____
DPT-HEP.B-HIB (PENTAVALENT) 1
DAY ___
MONTH ____
YEAR _____
DPT-HEP.B-HIB (PENTAVALENT) 2
DAY ___
MONTH ____
YEAR _____
DPT-HEP.B-HIB (PENTAVALENT) 3
DAY ___
MONTH ____
YEAR _____
PNEUMOCOCCAL 1
DAY ___
MONTH ____
YEAR _____
PNEUMOCOCCAL 2
DAY ___
MONTH ____
YEAR _____
PNEUMOCOCCAL 3
DAY ___
MONTH ____
YEAR _____
INACTIVATED POLIO VACCINE (IPV)
DAY ___
MONTH ____
YEAR _____
MEASLES
DAY ___
MONTH ____
YEAR _____
MEASLES, MUMPS, AND RUBELLA (MMR)
DAY ___
MONTH ____
YEAR _____
VITAMIN A (MOST RECENT)
DAY ___
MONTH ____
YEAR _____

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

NO (CONTINUE)
YES (GO TO 525B)

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.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 508A THEN WRITE '00' IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINATIONS NOT GIVEN, THEN SKIP TO 525B)

NO 2 (WRITE '00' IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINATIONS NOT GIVEN, THEN GO TO 525B)

DON'T KNOW 8 (WRITE '00' IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINATIONS NOT GIVEN, THEN GO TO 525B)

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

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

512B) Has (NAME) ever received 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

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

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

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

FIRST TWO WEEKS 1
LATER 2

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

NUMBER OF TIMES _______

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

YES 1
NO 2 (GO TO 519B)
DON'T KNOW 8 (GO TO 519B)

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

NUMBER OF TIMES _____

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

YES 1
NO 2 (GO TO 521B)
DON'T KNOW (GO TO 521B)

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

NUMBER OF TIMES _______

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 425B)
DON'T KNOW 8 (GO TO 425B)

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

NUMBER OF TIMES ______

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

a) BABY ACTIVE?
YES 1
NO 2
DON'T KNOW 8
b) PLUMPY'NUT?
YES 1
NO 2
DON'T KNOW 8
c) PLUMPY'DOZ?
YES 1
NO 2
DON'T KNOW 8

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

MORE BIRTHS IN 2014-2018 (GO TO 502B IN AN ADDITIONAL QUESTIONNAIRE)
NO MORE BIRTHS IN 2014-2018 (GO TO 601)

SECTION 6. CHILD HEALTH AND NUTRITION

601) CHECK 224:

ONE OR MORE BIRTHS IN 2012-2018 (CONTINUE)
NO BIRTHS IN 2012-2018 (GO TO 648)

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.

LAST BIRTH PREGNANCY HISTORY NUMBER _____

604) FROM 212D AND 216:

NAME _____
LIVING (CONTINUE)
DEAD (GO TO 646)

605) In 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

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.

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 618)
DON'T KNOW (GO TO 618)

609) CHECK 469: CURRENTLY BREASTFEEDING?

YES: a) Now I would like to know how much (NAME) was given to drink during the diarrhea including breastmilk. Was (NAME) given less than usual to drink, about the same amount, or more than usual to drink? IF LESS, PROBE: Was (NAME) given much less than usual to drink or somewhat less?

NO: b) Now I would like to know how much (NAME) was given to drink during the diarrhea. Was (NAME) given less than usual to drink, about the same amount, or more than usual to drink? IF LESS, PROBE: Was (NAME) 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

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?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 615)

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).

NAME OF PLACE(S) _______

PUBLIC SECTOR
GOVT. HOSPITAL A
RHC/MCH B
BHU C
LADY H. WORKER D
OTHER PUBLIC SECTOR (SPECIFY) ______ E
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC F
CHEMIST/MEDICAL STORE G
PRIVATE DOCTOR H
HOMEOPATH I
DISPENSER/COMPOUNDER J
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _______ K
OTHER SOURCE
SHOP L
HAKIM M
DAI, TBA N
CMW O
OTHER (SPECIFY) _________ X

613) CHECK 612:

TWO OR MORE CODES CIRCLED (CONTINUE)
ONLY ONE CODE CIRCLED (GO TO 615)

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

FIRST PLACE ____

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

a) A fluid made from a special packet called Nimkol/ORS?
YES 1
NO 2
DON'T KNOW 8
b) A pre-packaged ORS liquid?
YES 1
NO 2
DON'T KNOW 8
c) A government-recommended homeade fluid?
YES 1
NO 2
DON'T KNOW 8
d) Zinc tablets or syrup?
YES 1
NO 2
DON'T KNOW 8

616) CHECK 615:

ANY 'YES': a) Was anything else given to treat the diarrhea?

ALL 'NO' OR 'DON'T KNOW': b) Was anything given to treat the diarrhea?
YES 1
NO 2 (GO TO 618)
DON'T KNOW 8 (GO TO 618)

617) CHECK 615:

ANY 'YES': a) What else was given to treat the diarrhea? Anything else? RECORD ALL TREATMENTS.

ALL 'NO' OR 'DON'T KNOW': b) What was given to treat the diarrhea? Anything else? RECORD ALL TREATMENTS.
PILL OR SYRUP
ANTIBIOTIC A
ANTIMOTILITY B
OTHER (NOT ANTIBIOTIC OR ANTIMOTILITY) C
UNKNOWN PILL OR SYRUP D
INJECTION
ANTIBIOTIC E
NON-ANTIBIOTIC F
UNKNOWN INJECTION G
IV (INTRAVENOUS) H
HOME REMEDY/HERBAL MEDICINE I
RICE STARCH J

OTHER (SPECIFY) ___________ X

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 623)
DON'T KNOW 8 (GO TO 623)

622) 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 624)
NOSE ONLY 2 (GO TO 624)
BOTH 3 (GO TO 624)
OTHER (SPECIFY) _______ 6 (GO TO 624)
DON'T KNOW 8 (GO TO 624)

623) CHECK 618: HAD FEVER?

YES (CONTINUE)
NO OR DON'T KNOW (GO TO 646)

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

YES 1
NO 2 (GO TO 629)

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).

NAME OF PLACE(S) _________

PUBLIC SECTOR
GOVT. HOSPITAL A
RHC/MCH B
BHU C
LADY H. WORKER D
OTHER PUBLIC SECTOR (SPECIFY) ______ E
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC F
CHEMIST/MEDICAL STORE G
PRIVATE DOCTOR H
HOMEOPATH I
DISPENSER/COMPOUNDER J
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _______ K
OTHER SOURCE
SHOP L
HAKIM M
DAI, TBA N
CMW O
OTHER (SPECIFY) _________ X

626: CHECK 625:

TWO OR MORE CODES CIRCLED (CONTINUE)
ONLY ONE CODE CIRCLED (GO TO 628)

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

FIRST PLACE ______

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

DAYS ______

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

YES 1
NO 2 (GO TO 646)
DON'T KNOW 8 (GO TO 646)

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

ANTIMALARIAL DRUGS
ARTEMISININ COMBINATION THERAPY (ACT) A
SP/FANSIDAR B
CHLOROQUIN C
AMODIAQUINE D
QUININE PILLS E
QUININE INJECTION/IV F
ARTESUNATE RECTAL G
ARTESUNATE INJECTION/IV H
OTHER ANTIMALARIAL (SPECIFY) _______ I
ANTIBIOTIC DRUGS
PILL/SYRUP J
INJECTION/IV K
OTHER DRUGS
PONSTAN L
PARACETAMOL M
IBUPROFEN N
COUGH SYRUP O
OTHER (SPECIFY) ______ X
DON'T KNOW Z

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:

NO CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID/QUESTION NOT ASKED (CONTINUE)
ANY CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID (GO TO 649)

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?

YES 1
NO 2

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

ONE OR MORE:
NAME OF YOUNGEST CHILD LIVING WITH HER _________

NONE (GO TO 701)

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.

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 ____
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 ____
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 ____
h) Nestle, Cerelac, Nestum, Farex, etc?
YES 1
NO 2
DON'T KNOW 8
i) Bread, roti, rice, noodles, kicheri, daliya, sewain, sagudana, porridge, 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, leady vegetables like kale, palak, sarsoon, bathu, chulai, kechanar, chana ka sag, phalian etc?
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 (like cabbage, cauliflower, brinjal, apple, banana, pomegranate, plum etc)?
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

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

NOT A SINGLE YES (CONTINUE)
AT LEAST ONE YES (GO TO 653)

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?

YES 1 (GO BACK TO 650 TO RECORD FOOD EATEN YESTERDAY, THEN GO TO 653)
NO 2 (GO TO 654)

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.'

NUMBER OF TIMES __
DON'T KNOW 8

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

CHILD USED TOILET OR LATRINE 01
PUT/RINSED INTO TOILET OR LATRINE 02
PUT/RINSED INTO DRAIN OR DITCH 03
THROWN INTO GARBAGE 04
BURIED 05
LEFT IN THE OPEN 06
OTHER (SPECIFY) _______ 96

SECTION 7. MARRIAGE AND SEXUAL ACTIVITY

701) Are you currently married?

YES 1 (GO TO 704)
NO 2

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

WIDOWED 1 (GO TO 708A)
DIVORCED 2 (GO TO 708A)
SEPARATED 3 (GO TO 708A)

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

705) 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. ___

706) Does your husband have other wives?

YES 1
NO 2 (GO TO 708A)
DON'T KNOW 8 (GO TO 708A)

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

TOTAL NUMBER OF WIVES ____
DON'T KNOW 98

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

RANK __

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

YES 1
NO 2 (GO TO 709)

708B) 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

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

ONLY ONCE 1
MORE THAN ONCE 2

710) CHECK 709:

MARRIED/LIVED WITH A MAN ONLY ONCE: a) In what month and year did you start living with your husband?

MARRIED/LIVED WITH A MAN MORE THAN ONCE: b) Now I would like to ask about your first husband. In what month and year did you start living with him?
MONTH _____
DON'T KNOW MONTH 98
YEAR ____ (GO TO 712)
DON'T KNOW YEAR 9998

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

AGE ___

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?

NEVER HAD SEXUAL INTERCOURSE 00 (GO TO 801)
AGE IN YEARS ______

713A) CHECK 701:

CURRENTLY MARRIED (CONTINUE)
WIDOWED, DIVORCED, OR SEPARATED (GO TO 813)

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.

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

SECTION 8. FERTILITY PREFERENCES

801) CHECK 304:

NEITHER STERILIZED (CONTINUE)
HE OR SHE IS STERILIZED (GO TO 813)

802) CHECK 226:

PREGNANT (CONTINUE)
NOT PREGNANT OR UNSURE (GO TO 804)

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?

HAVE ANOTHER CHILD 1 (GO TO 805)
NO MORE (GO TO 812)
UNDECIDED/DON'T KNOW (GO TO 812)

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?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 807)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 813)
UNDECIDED/DON'T KNOW 4 (GO TO 8110

805) CHECK 226:

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

PREGNANT: b) 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 811)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 813)
OTHER (SPECIFY) 996 (GO TO 811)
DON'T KNOW 998 (GO TO 811)

806) CHECK 226:

NOT PREGNANT OR UNSURE (CONTINUE)
PREGNANT (GO TO 812)

807) CHECK 303: USING A CONTRACEPTIVE

NOT CURRENTLY USING (CONTINUE)
CURRENTLY USING (GO TO 813)

808) CHECK 805:

'24' OR MORE MONTHS OR '02' OR MORE YEARS (CONTINUE)
NOT ASKED (CONTINUE)
'00-23' MONTHS OR '00-01' YEAR (GO TO 812)

809) CHECK 714:

DAYS, WEEKS OR MONTHS AGO (CONTINUE)
YEARS AGO (GO TO 811)
NOT ASKED (GO TO 811)

810) CHECK 804:

WANTS TO HAVE ANOTHER CHILD: a) 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? RECORD ALL REASONS MENTIONED.

WANTS NO MORE/NONE: b) 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? RECORD ALL REASONS MENTIONED.
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
CAN'T GET PREGNANT E
NOT MENSTRUATED SINCE LAST BIRTH F
BREASTFEEDING G
UP TO GOD/FATALISTIC H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
SIDE EFFECTS/HEALTH CONCERNS O
LACK OF ACCESS/TOO FAR P
COSTS TOO MUCH Q
PREFERRED METHOD NOT AVAILABLE R
NO METHOD AVAILABLE S
INCONVENIENT TO USE T
INTERFERES WITH BODY'S NORMAL PROCESS U
OTHER (SPECIFY) _____ X
DON'T KNOW Z

811) CHECK 303: USING A CONTRACEPTIVE

NOT ASKED (CONTINUE)
NO, NOT CURRENTLY USING (CONTINUE)
YES, CURRENTLY USING (GO TO 813)

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

YES 1
NO 2
DON'T KNOW 8

813) CHECK 216:

HAS LIVING CHILDREN: a) 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? PROBE FOR A NUMERIC RESPONSE.

NO LIVING CHILDREN: b) 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 815)
NUMBER ____
OTHER (SPECIFY) _________ 96 (GO TO 815)

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?

NUMBER BOYS _____
NUMBER GIRLS ___
EITHER ____
OTHER (SPECIFY) _________ 96

815) In the last few months have you:

a) Heard about family planning on the radio?
YES 1
NO 2
b) Seen anything about family planning on the television?
YES 1
NO 2
c) Read about family planning in a newspaper or magazine?
YES 1
NO 2
d) Received a voice or text message about family planning on a mobile phone?
YES 1
NO 2

815A) CHECK 815:

HEARD ANY MESSAGE (ANY YES IN 815) (CONTINUE)
NOT HEARD MESSAGE (GO TO 817)

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

LIMITING THE FAMILY A
DISADVANTAGES OF GETTING MARRIED AT A YOUNG AGE B
SPACING BIRTHS C
USE OF CONTRACEPTION D
WELFARE OF FAMILY E
MATERNAL AND CHILD HEALTH F
LESS CHILDREN MEANS PROSPEROUS LIFE G
MORE CHILDREN MEANS POVERTY AND STARVATION H
IMPORTANCE OF BREASTFEEDING I
IMPORTANCE OF GIRLS' EDUCATION J
REDUCTION IN MATERNAL DEATHS K
OTHER (SPECIFY) ________ X
DON'T KNOW/DO NOT REMEMBER Z

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

EFFECTIVE 1
NOT EFFECTIVE 2
DON'T KNOW 8

817) CHECK 701:

CURRENTLY MARRIED (CONTINUE)
WIDOWED, DIVORCED, OR SEPARATED (GO TO 901)

818) CHECK 303: USING A CONTRACEPTIVE

CURRENTLY USING (CONTINUE)
NOT CURRENTLY USING (GO TO 820)
NOT ASKED (GO TO 822)

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

MAINLY RESPONDENT 1 (GO TO 821)
MAINLY HUSBAND 2 (GO TO 821)
JOINT DECISION 3 (GO TO 821)
OTHER (SPECIFY) 6 (GO TO 821)

820) Would you say that not 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

821) CHECK 304:

NEITHER ARE STERILIZED (CONTINUE)
HE OR SHE IS STERILIZED (GO TO 901)

822) 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 9. HUSBAND'S BACKGROUND AND WOMAN'S WORK

901) CHECK 701:

CURRENTLY MARRIED (CONTINUE)
WIDOWED, DIVORCED, OR SEPARATED (GO TO 908A)

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

AGE IN COMPLETED YEARS _______

903) Did your husband ever attend school?

YES 1
NO 2 (GO TO 906)

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.'

CLASS ____
DON'T KNOW 98

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

YES 1 (GO TO 908)
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 908A)
DON'T KNOW 8 (GO TO 908A)

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?

YES 1
NO 2

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

YES 1
NO 2 (GO TO 909)

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

YEARS ________

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

YES 1 (GO TO 913)
NO 2

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?

YES 1 (GO TO 913)
NO 2

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?

YES 1 (GO TO 913)
NO 2

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

YES 1
NO 2 (GO TO 917)

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?

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

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

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

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

AT HOME 1
AWAY FROM HOME 2

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

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

917) CHECK 701:

CURRENTLY MARRIED (CONTINUE)
WIDOWED, DIVORCED, OR SEPARATED (GO TO 925)

918) CHECK 916:

CODE '1' OR '2' CIRCLED (CONTINUE)
OTHER (GO TO 921)

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

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
OTHER (SPECIFY) _______ 6

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?

MORE THAN HIM 1
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND HAS NO EARNINGS 4 (GO TO 922)
DON'T KNOW 8

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

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
HUSBAND HAS NO EARNINGS 4
OTHER (SPECIFY) _______ 6

922) 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
SOMEONE ELSE 4
OTHER (SPECIFY) _______ 6

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

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) _______ 6

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

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) _______ 6

924A) Did you inherit any land or house?

YES, AGRICULTURAL LAND 1
YES, NON-AGRICULTURAL LAND 2
YES, RESIDENTIAL PLOT 3
YES, HOUSE 4
NO 5

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

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4 (GO TO 928)

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

YES 1
NO 2 (GO TO 928)
DON'T KNOW 8 (GO TO 928)

927) Is your name on the title deed?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2

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

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 8 (GO TO 931)

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

YES 1
NO 2 (GO TO 931)
DON'T KNOW 8 (GO TO 931)

930) Is your name on the title deed?

YES 1
NO 2
DON'T KNOW 8

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

CHILDREN UNDER 10
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 3
HUSBAND
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 3
OTHER MALES
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 3
OTHER FEMALES
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 3

932) 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 refuses to have sex with him?
YES 1
NO 2
DON'T KNOW 8
e) If she burns the food?
YES 1
NO 2
DON'T KNOW 8
f) If she neglects the in-laws?
YES 1
NO 2
DON'T KNOW 8

SECTION 10. HIV/AIDS

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

YES 1
NO 2 (GO TO 1042)

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?

YES 1
NO 2
DON'T KNOW 8

1003) Can people get HIV from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

1008) Can HIV be transmitted from a mother to a 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

1009) CHECK 1008:

AT LEAST ONE 'YES' (CONTINUE)
OTHER (GO TO 1027)

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?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 1031)

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

MONTHS AGO _____
TWO OR MORE YEARS AGO 95

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

YES 1
NO 2

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.

NAME OF PLACE ___________

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (GO TO 1035)
GOVERNMENT HEALTH CENTER 12 (GO TO 1035)
STAND-ALONE HTC CENTER 13 (GO TO 1035)
OTHER PUBLIC SECTOR (SPECIFY) ______ 16 (GO TO 1035)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 21 (GO TO 1035)
STAND-ALONE HTC CENTER 22 (GO TO 1035)
PHARMACY 23 (GO TO 1035)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ________ 26 (GO TO 1035)
OTHER SOURCE
HOME 31 (GO TO 1035)
WORKPLACE 32 (GO TO 1035)
OTHER (SPECIFY) _____________ 96 (GO TO 1035)

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

YES 1
NO 2 (GO TO 1035)

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.

NAME OF PLACE ___________

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
STAND-ALONE HTC CENTER C
OTHER PUBLIC SECTOR (SPECIFY) _________ D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR E
STAND-ALONE HTC CENTER F
PHARMACY G
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _______ H
OTHER (SPECIFY) _______ X

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

YES 1
NO 2 (GO TO 1035)
DON'T KNOW/NOT SURE/DEPENDS 8 (GO TO 1035)

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

YES 1
NO 2

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

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

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

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

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?

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

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

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

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

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

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

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

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

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

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

YES 1
NO 2
SAYS SHE HAS HIV 3
DON'T KNOW/NOT SURE/DEPENDS 8

1042) CHECK 1001:

HEARD ABOUT HIV AIDS: a) Apart from HIV, have you heard about other infections that can be transmitted through sexual contact?

NOT HEARD ABOUT HIV OR AIDS: b) Have you heard about infections that can be transmitted through sexual contact?
YES 1
NO 2

1043) CHECK 713:

HAS HAD SEXUAL INTERCOURSE (CONTINUE)
HAS NEVER HAD SEXUAL INTERCOURSE (GO TO 1051)

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

YES (CONTINUE)
NO (GO TO 1046)

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?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

1047) 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

1048) CHECK 1045, 1046, AND 1047:

HAS HAD AN INFECTION (ANY 'YES') (CONTINUE)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 1051)

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

YES 1
NO 2 (GO TO 1051)

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.

NAME OF PLACE ____________

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
STAND-ALONE HTC CENTER C
FAMILY PLANNING CLINIC D
MOBILE HTC SERVICES E
OTHER PUBLIC SECTOR (SPECIFY) _________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR G
STAND-ALONE HTC CENTER H
PHARMACY I
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ________ J
OTHER SOURCE
SHOP K
OTHER (SPECIFY) _________ X

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?

YES 1
NO 2
DON'T KNOW 8

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?

YES 1
NO 2
DON'T KNOW 8

1052) CHECK 701:

CURRENTLY MARRIED (CONTINUE)
WIDOWED, DIVORCED, SEPARATED (GO TO 1101)

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

YES 1
NO 2
DEPENDS/NOT SURE 8

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

YES 1
NO 2
DEPENDS/NOT SURE 8

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.

NUMBER OF INJECTIONS ________
NONE 00 (GO TO 1104)

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.

NUMBER OF INJECTIONS _________
NONE 00 (GO TO 1104)

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?

YES 1
NO 2
DON'T KNOW 8

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

EVERY DAY 1
SOME DAYS 2 (GO TO 1106)
NOT AT ALL 3 (GO TO 1106)

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

NUMBER OF CIGARETTES __________

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

EVERY DAY 1
SOME DAYS 2
NOT AT ALL 3 (GO TO 1107A)

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

PIPES FULL OF TOBACCO A
WATER PIPE/HUKAA/SHEESHA B
SNUFF BY MOUTH C
SNUFF BY NOSE D
CHEWING TOBACCO/NUSWAR E
BETEL QUID/PAAN WITH TOBACCO F
OTHER (SPECIFY) __________ X

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 1107G)

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

THROUGH THE AIR WHEN COUGHING OR SNEEZING A
BY SHARING UTENSIL 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

1107D) Can tuberculosis be cured?

YES 1
NO 2 (GO TO 1107F)
DON'T KNOW 8 (GO TO 1107F)

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

MONTHS _________
DON'T KNOW 8

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 1108)

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

YES 1
NO 2 (GO TO 1107J)
DON'T KNOW 8 (GO TO 1107J)

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

PRACTICE SAFE SEX A
SAFE BLOOD TRANSFER B
USE DISPOSABLE SYRINGE C
AVOID CONTAMINATED FOOD/WATER D
AVOID CONTACT WITH INFECTED PERSON E
ENSURE INSTRUMENTS OF DENTISTS ARE PROPERLY STERILIZED F
OTHER (SPECIFY) _________ X
DON'T KNOW Z

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

YES 1
NO 2 (GO TO 1108)

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

MONTHS ________
TWO OR MORE YEARS 95

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:

a) Getting permission to go to the doctor?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
b) Getting money needed 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

1109) Are you covered by any health insurance?

YES 1
NO 2 (GO TO 1110A)

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

MUTUAL HEALTH ORGANIZATION/COMMUNITY-BASED HEALTH INSURANCE A
HEALTH INSURANCE THROUGH EMPLOYER B
SEHAT SAHULAT C
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D
OTHER (SPECIFY) _________ X

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

YES 1
NO 2

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.

PRIVACY OBTAINED 1
PRIVACY NOT POSSIBLE 2 (GO TO 1232)

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?

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 your 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 knowing where you (are/were) at all times?
YES 1
NO 2
DON'T KNOW 8

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

Did your (last) husband ever:

a) Say or do something to humiliate you in front of others?
YES 1
NO 2 (GO TO b)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b) Threaten to hurt or harm you or someone you care about?
YES 1
NO 2 (GO TO c)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c) Insult you or make you feel bad about yourself?
YES 1
NO 2 (GO TO 1205)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

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

a) push you, shake you, or throw something at you?
YES 1
NO 2 (GO TO b)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b) slap you?
YES 1
NO 2 (GO TO c)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c) twist your arm or pull your hair?
YES 1
NO 2 (GO TO d)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
d) punch you with his fist or with something that could hurt you?
YES 1
NO 2 (GO TO e)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
e) kick you, drag you, or beat you up?
YES 1
NO 2 (GO TO f)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
f) try to choke you or burn you on purpose?
YES 1
NO 2 (GO TO g)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
g) threaten or attack you with a knife, gun, or other weapon?
YES 1
NO 2 (GO TO h)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
h) physically force you to have sexual intercourse with him when you did not want to?
YES 1
NO 2 (GO TO i)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
i) physically force you to perform any other sexual acts you did not want?
YES 1
NO 2 (GO TO j)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
j) force you with threats or in any other way to perform sexual acts you did not want to?
YES 1
NO 2 (GO TO 1206)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

1206) CHECK 1205(a-j):

AT LEAST ONE 'YES' (CONTINUE)
NOT A SINGLE 'YES' (GO TO 1209)

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.'

NUMBER OF YEARS ___________
BEFORE MARRIAGE 95

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

a) you have 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

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?

YES 1
NO 2 (GO TO 1211)

1210) 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

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

YES 1
NO 2 (GO TO 1213)

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

OFTEN 1
SOMETIMES 2
NEVER 3

1213) 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 3

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.

a) Did any previous husband ever hit, slap, kick, or do anything else to hurt you physically?
YES 1
NO 2 (GO TO b)
How long ago did this happen?
0-11 MONTHS AGO 1
12+ MONTHS AGO 2
DON'T REMEMBER 3
b) Did any previous husband physically force you to have intercourse or perform any other sexual acts against your will?
YES 1
NO 2 (GO TO 1216)
How long ago did this happen?
0-11 MONTHS AGO 1
12+ MONTHS AGO 2
DON'T REMEMBER 3

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?

YES 1
NO 2 (GO TO 1219)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1219)

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

MOTHER/STEP-MOTHER A
FATHER/STEP-FATHER B
SISTER/BROTHER C
DAUGHTER/SON D
OTHER RELATIVE E
CURRENTY BOYFRIEND F
FORMER BOYFRIEND 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

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

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

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?

YES 1
NO 2 (GO TO 1222A)

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

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

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

HAD ABORTION 1
HAD MISCARRIAGE 2
HAD STILLBIRTH 3
HAD OTHER HEALTH PROBLEM 4
NO PROBLEMS 5

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?

YES 1
NO 2 (GO TO 1224A)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1224A)

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

CURRENT HUSBAND 01
FORMER HUSBAND 02
CURRENT/FORMER BOYFRIEND 03
FATHER/STEP-FATHER 04
BROTHER/STEP-BROTHER 05
OTHER RELATIVE 06
IN-LAW 07
OWN FRIEND/ACQUAINTANCE 08
FAMILY FRIEND 09
TEACHER 10
EMPLOYER/SOMEONE AT WORK 11
POLICE/SOLIDER 12
PRIEST/RELIGIOUS LEADER 13
STRANGERS 14
OTHER (SPECIFY) ________ 96

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?

YES 1 (GO TO 1225)
NO 2 (GO TO 1225)

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?

AGE IN COMPLETED YEARS _______
DON'T KNOW 98

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?

YES 1
NO 2 (GO TO 1229)

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

OWN FAMILY A
HUSBAND'S FAMILY B
CURRENT/FORMER HUSBAND C
CURRENT/FORMER BOYFRIEND D
FRIEND E
NEIGHBOR F
RELIGIOUS LEADER G
DOCTOR/MEDICAL PERSONNEL H
POLICE I
LAWYER J
SOCIAL SERVICE ORGANIZATION K
WOMEN'S CRISIS CENTER L
SHELTER HOMES M
PUBLIC HEALTH FACILITY N
PRIVATE HEALTH FACILITY O
GOVT. SOCIAL WELFARE CENTER P
LOCAL LEADERS (WADERA, KHAN) Q
PUBLIC REPRESENTATIVE R
OTHER (SPECIFY) _________ X
DON'T KNOW/DON'T REMEMBER Y
REFUSED/NO ANSWER Z

1228A) Were you satisfied with the help provided?

YES 1
NO 2

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

ENCOURAGED BY FRIENDS/FAMILY A
PUBLIC CAMPAIGN B
KNOWLEDGE ABOUT HELPLINE C
SERVICE PROVIDER'S ATTITUDE D
COULD NOT ENDURE MORE E
BADLY INJURED F
THREATENED OR TRIED TO KILL HERSELF G
THREATENED TO HIT CHILDREN H
SAW CHILDREN SUFFERING I
THROWN OUT OF HOME J
AFRAID OF MORE VIOLENCE K
OTHER (SPECIFY) __________ X
DON'T KNOW/DON'T REMEMBER Y
REFUSED/NO ANSWER Z

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

GOT THREATS A (GO TO 1229B)
EMBARRASSED/ASHAMED B (GO TO 1229B)
BLAMED C (GO TO 1229B)
MARRIAGE BREAKUP D (GO TO 1229B)
LOST CHILDREN E (GO TO 1229B)
EXPLIOTATION BY THE PERSON WHO APPROACHED TO HELP F (GO TO 1229B)
FACED NO CONSEQUENCES G (GO TO 1229B)
OTHER (SPECIFY) ___________ X (GO TO 1229B)
DON'T KNOW Y (GO TO 1229B)
REFUSED/NO ANSWER Z (GO TO 1229B)

1229) Have you ever told any one about this?

YES 1 (GO TO 1229B)
NO 2

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

FEAR OF THREATS A
FEAR OF CONSEQUENCES B
MORE VIOLENCE C
VIOLENCE WAS NOT SERIOUS D
EMBARRASSED/ASHAMED E
AFRAID WOULD NOT BE BELIEVED OR WOULD BE BLAMED F
NO TRUST ON ANY ONE TO HELP G
UNAWARE IF ANYONE CAN HELP H
UNAWARE IF A FEMALE CAN HELP I
AFRAID OF MARRIAGE BREAKUP J
AFRAID WOULD LOSE CHILDREN K
BRING BAD NAME TO FAMILY L
DID NOT KNOW HER OPTIONS/WAY OUT M
OTHER (SPECIFY) ___________ X
DON'T KNOW Y
REFUSED/NO ANSWER Z

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

ISOLATED SELF A
FIRED FROM JOB B
QUIT JOB C
STOP PARTICIPATING IN DECISION MAKING D
GOT DIVORCED E
NOT FACED ANY CONSEQUENCES F
OTHER (SPECIFY) _______ X
DON'T KNOW Y
REFUSED/NO ANSWER Z

1230) As far as you know, did your 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.

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?

HUSBAND
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3
OTHER MALE ADULT
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3
FEMALE ADULT
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3

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

_________________________________

1233) RECORD THE TIME

HOURS _________
MINUTES ________

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 ______________________