IDENTIFICATION

PREFECTURE (ADMINISTRATIVE CENTER) __________

TOWN OR MUNICIPALITY__________

SECTOR____

SUB-SECTOR___

HOUSEHOLD NUMBER____

URBAN/RURAL

KIGALI, OTHER CITY, OR RURAL?

NAME AND LINE NUMBER OF HUSBAND

LINE NUMBER OF ALL ELIGIBLE WOMEN

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE _____
INTERVIEWER NAME__________
RESULT___

RESULT__________

NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE_____
TIME____

FINAL VISIT
DAY__________
MONTH__________
YEAR_____
NAME__________
RESULT__________

TOTAL NUMBER OF VISITS___

FIELD EDITOR
NAME__________
DATE_____

OFFICE EDITOR
NAME__________
DATE_____

KEYED BY
NAME__________
DATE_____

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD TIME

102) To begin, I'd like to ask you some questions about yourself. During the first 12 years of your life, did you mostly live in the city of Kigali, another city, or a rural village?

103) For how long have you been living continuously in (KIGALI, OTHER CITY, RURAL VILLAGE)?

104A) Just before moving here, did you live in the city of Kigali, another city, or a rural village?

104B) Do you live in a prefecture (administrative center), town or municipality, sector, or sub-sector?
WRITE NAME OF PLACE

105) In what month and year were you born?

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

107) Have you ever attended school?

108) What is the highest level of education that you attended: primary, post-primary, secondary, or higher?

109) What is the highest (CLASS, YEAR) you successfully completed at that level?

109A) Did you finish that level (primary, post-primary, secondary, or higher)?

110) CHECK 108:

111) Do you know how to read and understand a letter or newspaper easily, with difficulty, or not at all?

123) What is your religion?

124) What is your ethnicity?

SECTION 2. REPRODUCTION

201) Now I'd like to ask you some questions about all the children you have given birth to in your life. Have you ever given birth?

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

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

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

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

206) Have you ever given birth to a boy or girl who was born alive but later died?

207A) How many sons have died? And how many daughters have died?
IF NONE, WRITE '00'.

207B) Any child who cried or showed signs of life but survived only a few hours or days who you did not mention in the previous question?

207C) How many sons have died that you have forgotten? And how many daughters have died that you have forgotten?
IF NONE, RECORD '00'.

208) ADD THE RESPONSES FROM 203, 205, 207A, AND 207C, AND RECORD THE TOTAL.
IF NONE, RECORD '00'.

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

210) CHECK 208:

211) Now I would like to talk to you about your births, whether they are still alive or not, beginning with the first child that you had.
(RECORD THE NAMES OF ALL BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.)

212) What name was given to your (first, next) baby?

213) RECORD THE TYPE OF BIRTH: SINGLE OR MULTIPLE

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

215) In what month and year was (NAME) born?
PROBE: What is his/her birthday? OR: In what season was (NAME) born?
WRITE THE SEASON GIVEN BY THE WOMAN IF THE BIRTH MONTH IS UNKNOWN

216) Is (NAME) still alive?

217) IF ALIVE: How old was (NAME) at his/her last birthday?
PROBE: HOW MANY COMPLETED YEARS?

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

219) IF LESS THAN 15 YEARS OLD: With whom does he/she live?
IF 15 YEARS OR OLDER: GO TO NEXT BIRTH

220) IF DEAD: How old was he/she when he/she died?
IF "1 YEAR", PROBE: How many months old was (NAME)?

RECORD DAYS IF LESS THAN ONE MONTH, MONTHS IF LESS THAN TWO YEARS, OR YEARS.

221) COMPARE 208 WITH THE NUMBER OF BIRTHS RECORDED IN THE ABOVE TABLE AND MARK:

222) CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1987.
IF NONE, RECORD '0'.

223) Are you pregnant now?

224) How many months pregnant are you?
(IF THE WOMAN HESITATED BETWEEN TWO MONTHS, TAKE THE SMALLER NUMBER)

225) At the time you became pregnant, did you want to become pregnant then, later, or did you not want to become pregnant at all?

226) When did your last menstrual period start?

227) Between the first day of a woman's period and the first day of her next period, when do you think she has the greatest chance of becoming pregnant?
PROBE: During which days of the menstrual cycle must a woman pay attention in order to not become pregnant?

SECTION 3. CONTRACEPTION

301) Now I would like to talk to you about family planning -- the different ways or methods that a couple can use to delay or avoid a pregnancy. Which ways or methods have you heard about?

CIRCLE CODE 1 IN 302 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN, PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 IF THE METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 302, ASK 303-304 BEFORE PROCEEDING TO THE NEXT METHOD.

302) Have you ever heard of (METHOD)?
READ DESCRIPTION OF EACH METHOD.

303) Have you ever used (METHOD)?

304) Do you know where a person could go to get (METHOD)?

305) CHECK 303:

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

307) What have you done or used?
CORRECT 303, 304, 305 (AND 302 IF NECESSARY)

308) Now I would like to talk about the time you first did something or used a method to avoid getting pregnant. How many children did you have at that time?
IF NONE, RECORD '00'.

309) CHECK 223:

310) CHECK 303:

311) Are you currently doing something or using a method to avoid pregnancy?

312) What method are you using?
312A) CIRCLE '06' FOR FEMALE STERILIZATION

313) When you first started using the pill, did you consult a doctor or a nurse?

314) The last time you obtained the pill, did you consult a doctor or nurse?

315) May I see the package of pills you are currently using?
RECORD NAME OF BRAND.

316) Do you know the brand name of the pills that you are currently using?
RECORD NAME OF BRAND.

317) How much does one packet (cycle) of pills cost you?

318) Where did you get (METHOD) the last time?
318A) Where did the sterilization take place?

319) How long does it take to travel from your home to this place?

320) Is it easy or difficult to get there?

321) CHECK 312:

322) In what month and year (were you/was he) sterilized?

323) For how many months have you been using (CURRENT METHOD) continuously?
IF SINCE THE LAST PREGNANCY OR IF LESS THAN ONE MONTH, RECORD '00'.

324) Do you intend to use a method to avoid getting pregnant in the future?

325) What is the main reason you do not intend to use a method?

326) Do you intend to use a method within the next 12 months?

327) When you will use a method, which method would you prefer to use?

328) Where can you get (METHOD FROM 327)?
(IF MULTIPLE PLACES MENTIONED, INDICATE WHICH THE WOMAN PREFERS)
328A) Where can you obtain information on how to use the periodic abstinence method?

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

330) Where is that?
(IF MULTIPLE PLACES MENTIONED, INDICATE WHICH THE WOMAN PREFERS)

331) How long does it take to travel from your home to this place?

332) Is it easy or difficult to get there?

333) In the last month, have you heard announcements on the radio or read in newspapers about family planning?

334) Do you think it is acceptable or not acceptable that information about family planning is provided on the radio and in newspapers?

335) In the last month, have you heard about family planning anywhere besides the radio or newspapers?

336) From whom did you hear it?

SECTION 4. HEALTH AND BREASTFEEDING

401) CHECK 222:

402) ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS FOR EACH BIRTH SINCE JANUARY 1987 IN THE TABLE. ASK THE QUESTIONS FOR ALL THE BIRTHS, BEGINNING WITH THE LAST BIRTH.

Now I would like to ask you some questions about the health of all of the children you have had in the last 5 years. (We will talk about one child at a time.)

LINE NUMBER FROM Q. 212

FROM Q. 212 AND Q. 216

403) At the time you became pregnant with (NAME), did you want to become pregnant then, later, or did you not want any (more) children?

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

405) When you were pregnant with (NAME), did you see anyone for a consultation about this pregnancy?
IF YES: Whom did you see? Anyone else?
PROBE ABOUT THE KIND OF PERSON AND RECORD ALL PERSONS SEEN.

406) Were you given an antenatal card or booklet for this pregnancy?

407) How many months pregnant were you when you first saw someone for a consultation concerning this pregnancy?

408) How many antenatal visits did you have during this pregnancy?

409) When you were pregnant with (NAME) were you given an antenatal injection to prevent tetanus?

410) How many times did you get this injection?

411) Where did you give birth to (NAME)?

412) Who assisted you with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL MENTIONED.

413) Was (NAME) born on time or prematurely?

414) Was (NAME) delivered by caesarian section?

415) Was (NAME) weighed at birth?

416) How much did he/she weigh?

417) When (NAME) was born, was he/she large, average, or small?

418) Has your period returned since the birth of (NAME)?
[FOR LAST BIRTH ONLY]

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

420) Have you resumed sexual relations since the birth of (NAME)?
[FOR LAST BIRTH ONLY]

420A) How many days after the birth of (NAME) did you have sexual relations for the first time?

421) How long after the birth of (NAME) did you resume sexual relations regularly?

422) Did you breastfeed (NAME)?

423) Why did you not breastfeed (NAME)?

424) How long after delivery did you first put (NAME) to the breast?
RECORD IN DAYS IF MORE THAN 24 HOURS.
[FOR LAST BIRTH ONLY]

425) IF STILL ALIVE: Are you still breastfeeding (NAME)?
IF DEAD, CIRCLE '2'
[FOR LAST BIRTH ONLY]

426) How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.
[FOR LAST BIRTH ONLY]

427) How many times did you breastfeed yesterday, during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.
[FOR LAST BIRTH ONLY]

428) At any time yesterday or last night, did you give (NAME) one of the following things?
[FOR LAST BIRTH ONLY]

429) CHECK 428:
FOOD OR LIQUID GIVEN YESTERDAY?

430) For how many months did you breastfeed (NAME)?

431) Why did you stop breastfeeding (NAME)?

432) CHECK 216:
CHILD ALIVE?

433) Have you ever given (NAME) water or anything else to drink or eat other than breast milk?

434) How many months old was (NAME) when you started giving him/her the following things regularly?

435) CHECK 216:
CHILD ALIVE?

436) Did (NAME) drink anything from a bottle with a nipple yesterday or last night?
[FOR LAST BIRTH ONLY]

437) GO BACK TO 403 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 438.

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

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

440) (1) COPY THE VACCINATION DATES FOR EACH VACCINE FROM THE CARD.
(2) WRITE '44' IN THE DAY COLUMN IF THE CARD SHOWS THAT A VACCINATION WAS GIVEN BUT NO DATE IS RECORDED.

441) Has (NAME) received a vaccination that is not recorded on this card?

442) Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases?

443) Please tell me if (NAME) has received one of the following vaccinations:

444) CHECK 216:
CHILD ALIVE?

445) GO BACK TO 438 FOR THE NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 472.

446) Has (NAME) had a fever at any time during the last two weeks?

447) Has (NAME) been ill with a cough at any time during the last 2 weeks?

448) How long did the cough last? (For how long has the cough lasted?)
IF LESS THAN ONE DAY, RECORD '00'

449 When (NAME) was sick with a cough, did he/she breathe faster than usual (with short, rapid breaths)?

450) CHECK 446 AND 447:
FEVER OR COUGH?

451) Was anything given to (NAME) to treat the fever/cough?

451A) What was given to treat the fever/cough? Anything else?
(CIRCLED ALL MENTIONED)

452) Did you seek advice or treatment for the fever/cough?

453) From whom did you seek advice or treatment for the fever/cough? Anyone else?
CIRCLE ALL MENTIONED

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

455) GO BACK TO 438 FOR THE NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 472

456) Has (NAME) had diarrhea in the past 24 hours?

457) How long did the diarrhea last? (For how long has the diarrhea lasted?)
IF LESS THAN ONE DAY, RECORD '00'

458) Was there any blood in the stool?

459) CHECK 425:
LAST CHILD STILL BREASTFEEDING?

460) When (NAME) had diarrhea, did you change the number of breastfeedings?
[FOR LAST BIRTH ONLY]

461) During the diarrhea, did you increase the number of breastfeedings, reduce them, or did you stop them completely?
[FOR LAST BIRTH ONLY]

462) Aside from breastmilk, did you give him/her the same amount to drink as before the diarrhea, more to drink, or less?

463) During the diarrhea, did (NAME) receive a fluid made from a special packet?

464) Was (NAME) given a home-made fluid recommended by a health worker (with sugar, salt, and water)?

465) CHECK 463 AND 464:
CHILD RECEIVED FLUID FROM A PACKET (463) AND/OR RECOMMENDED HOME-MADE FLUID (464)?

466) For how many days did (NAME) receive this liquid?
IF LESS THAN 1 DAY, ENTER '00'

467) Did he/she receive anything else to treat the diarrhea (aside from this liquid)?

468) What was given or made to treat the diarrhea? Anything else?
CIRCLE ALL MENTIONED

469) Did you seek advice or treatment for the diarrhea?

470) From whom did you seek advice or treatment? Anyone else?
CIRCLE ALL MENTIONED

471) GO BACK TO 438 FOR THE NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 472

472) CHECK 463:

473) Have you ever heard of a special product in a packet?

474) Have you ever seen a packet like this before?
SHOW THE PACKET.

475) Have you ever prepared a solution with one of these packets to treat diarrhea for yourself or someone else?
SHOW THE PACKET.

476) How much water did you use to prepare the liquid from the special packet for diarrhea?

477) Where can you get this packet?
PROBE: Anywhere else?
RECORD ALL PLACES MENTIONED.

478) CHECK 464:

479) Who taught you how to prepare the home-made solution made with sugar, salt, and water, which you gave to (NAME)?

SECTION 5. MARRIAGE

501) Have you ever been married or lived with a man?

502) Are you currently married or living in a union with a man, or are you widowed, divorced, or separated?

503) Does your husband/partner live with you, or is he staying elsewhere?

504) Does your husband/partner have other wives besides you?

505) How many other wives does he have?

506) Are you the first, second, third? spouse?

507) Have you been married only once, or more than once?

508) How old were you when you started living with your (first) husband/partner?

509) In what month and year did you start living with him?
COMPARE AND CORRECT 508 AND/OR 509 IF INCONSISTENT.

510) IF NEVER IN UNION: Have you ever had sexual intercourse?

511) Now we need some information about your sexual activity in order to get a better understanding of contraception and fertility. How many times have you had sexual intercourse in the last four weeks?

512) How many times per week do you usually have sexual intercourse?

513) When was the last time you had sexual intercourse?

514) How old were you when you first had sexual intercourse?

515) PRESENCE OF OTHERS AT THIS POINT

SECTION 6. FERTILITY PREFERENCES

601) CHECK 312:

602) CHECK 501 AND 502:

603) Now I have some questions about the future.
CHECK 223 AND MARK THE APPROPRIATE BOX:

NOT PREGNANT OR UNSURE: Would you like to have a/another child or would you prefer to not have any (more) children?

PREGNANT: After the child you're expecting, would you like to have another child or would you prefer to not have any more children?

604) CHECK 223 AND MARK THE APPROPRIATE BOX:

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

PREGNANT: How long would you like to wait after the birth of the child you are expecting before the birth of another child?

605) CHECK 216:
How old would you like your youngest child to be before having another child?
IF NO LIVING CHILDREN, CIRCLE '96'

606) Do you regret that (you/your husband) had the operation to not have any more children?

607) Why do you regret it?

608) In your current situation, if you had to do it again, do you think to you would make the same decision to get sterilized?

609) Do you think that your husband/partner approves or disapproves of couples using a method to avoid pregnancy?

610) How often have you talked to your husband/partner about this subject in the last 12 months?

611) Have you talked to your husband/partner about the number of children you would like to have?

612) Do you think your husband/partner wants the same number of children that you want, more, or less than you want?

613) After childbirth, how long should couples wait before starting to have sexual relations again?

614) Should a mother wait until she has completely stopped breastfeeding before starting to have sexual relations again, or does it not matter?

615) In general, do you approve or disapprove of couples using a method to avoid getting pregnant?

616) CHECK 216 AND MARK THE APPROPRIATE BOX:

NO LIVING CHILDREN: If you could choose exactly the number of children to have in your whole life, how many would that be?

HAS LIVING CHILDREN: If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?

RECORD SINGLE NUMBER OR OTHER ANSWER

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

701) CHECK 501:

702) Did your husband/partner ever attend school?

703) What is the highest level of school that he attended: primary, post-primary, secondary, or higher?

704) What was the last (CLASS, YEAR) that he completed at that level?

704A) Did he finished that level (primary, post-primary, secondary, or higher)?

705) What kind of work does (did) your (last) husband mainly do?

706) CHECK 705:

707) (Does/did) your husband/partner work mainly on his own land or family land, or someone else's land?

708) Aside from their own housework, many women take jobs for which they are paid in cash or in kind. Others sell things, have a small business, or work on the family farm or in the family business. Are you currently doing any of these things or any other work aside from your own housework?

709) What is your main occupation, that is, what kind of work do you do?

710) In your work, are you an employee, are you self-employed or do you work for your family, or are you an employer?

711) Do you earn money for this work?

711A) Do you receive a regular salary?

712) Do you do this work at home or away from home?

713) CHECK 215/216/218:
CHILD BORN SINCE JANUARY 1987 AND LIVING AT HOME?

714) While you are working, do you usually have (NAME OF YOUNGEST CHILD AT HOME) with you, sometimes with you, or never with you?

715) Who usually takes care of (NAME OF YOUNGEST CHILD AT HOME) while you are working?

716) RECORD THE TIME

SECTION 8. WEIGHT AND HEIGHT

801) CHECK 222:

IN 801-803, RECORD THE LINE NUMBER, THE NAME, AND DATE OF BIRTH OF EACH LIVING CHILD BORN SINCE JANUARY 1, 1987, BEGINNING WITH THE YOUNGEST CHILD. RECORD THE WEIGHT AND HEIGHT IN 805 AND 806.

802) LINE NUMBER FROM Q. 212

803) NAME FROM Q. 212

804) BIRTH DATE FROM Q. 215 AND ASK THE DAY

805) WEIGHT (IN KILOGRAMS)

806) HEIGHT (IN CENTIMETERS)

807) BCG SCAR ON ARM OR SHOULDER

808) DATE WEIGHED AND MEASURED

809) RESULT (WEIGHT AND HEIGHT)

810 NAME OF MEASURER__________

NAME OF ASSISTANT__________

INTERVIEWER'S OBSERVATIONS

(TO BE FILLED IN AFTER COMPLETING INTERVIEW)

COMMENTS ABOUT RESPONDENT_____

COMMENTS ON SPECIFIC QUESTIONS____

ANY OTHER COMMENTS____

NAME OF INTERVIEWER__________
DATE___

SUPERVISOR'S OBSERVATIONS

OBSERVATIONS____

NAME OF SUPERVISOR__________
DATE_____

FIELD EDITOR'S OBSERVATIONS

OBSERVATIONS___

NAME OF FIELD EDITOR__________
DATE_____

CHECKER'S OBSERVATIONS

OBSERVATIONS___

NAME OF CHECKER__________
DATE_____