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RWANDA DEMOGRAPHIC AND HEALTH SURVEY - 2005 WOMAN'S QUESTIONNAIRE

MINECOFIN
DEPARTMENT OF STATISTICS
REPUBLIC OF RWANDA

IDENTIFICATION

NAME OF LOCALITY _____
NAME OF HOUSEHOLD HEAD ______
PROVINCE ______
DISTRICT _____
SECTOR _____
CLUSTER NUMBER _____
STRUCTURE NUMBER _____
HOUSEHOLD NUMBER _____

URBAN/RURAL _______

URBAN 1
RURAL 2

KIGALI CITY/OTHER TOWN/RURAL ____

KIGALI CITY 1
OTHER TOWN 2
RURAL 3

NAME AND LINE NUMBER OF THE WOMAN ______

CHECK COVER PAGE OF THE HOUSEHOLD QUESTIONNAIRE: IS THE HOUSEHOLD SELECTED FOR MAN'S INTERVIEW (RELATIONS IN THE HOUSEHOLD (SECTION 10), HIV AND ANEMIA TESTS, AND ANTHROPOMETRY?) _______

YES 1
NO 2

CHECK TABLE 35A FOR SELECTION OF AN ELIGIBLE WOMAN FOR "RELATIONS IN THE HOUSEHOLD (SECTION 10)". _______

YES 1
NO 2

INTERVIEWER VISITS

FIRST INTERVIEW (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE ____
INTERVIEWER'S NAME ____
RESULT* _____

*RESULT CODES

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

NEXT VISIT: (FOR INTERVIEWERS 1 AND 2)
DATE ____
TIME _____

FINAL VISIT
DAY____
MONTH___
YEAR 200__
CODE ____
RESULT ____

TOTAL NO. OF VISITS ____

LANGUAGE OF INTERVIEW ____

KINYARWANDS 1
OTHER LANGUAGE (SPECIFY) _____ 2

INTERPRETER ___

YES 1
NO 2

SUPERVISOR
NAME ____
DATE____

FIELD EDITOR
NAME ____
DATE ____

OFFICE EDITOR____

KEYED BY____

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

INFORMED CONSENT

Hello. My name is and I am working with MINECOFIN, Department of Statistics.
We are conducting a national survey about the health of women and children in Rwanda.
We would very much appreciate your participation in this survey. I would like to ask you about your health (and the health of your children).
This information will help the government to plan health services. The survey usually takes between 20 and 45 minutes to complete.
Whatever information you provide will be kept strictly confidential and will not be shown to other persons.

Participation in this survey is voluntary and you can choose not to answer any individual question or all of the questions. However, we hope that you will participate in this survey since your views are important.

At this time, do you want to ask me anything about the survey? May I begin the interview now?

Signature of interviewer: _______
Date:_____

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

101. RECORD THE TIME.

HOUR ___
MINUTES ___

102. First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in KIGALI CITY, in other town, or in the rural area?
IF " FOREIGN " STATE AREA OF RESIDENCE

KIGALI CITY 1
OTHER TOWN/FOREIGN TOWN 2
RURAL/FOREIGN 3

103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
IF LESS THAN ONE YEAR, RECORD '00' YEARS.

YEARS ___

ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)

104. Just before you moved here, did you live in KIGALI CITY, in other town, or in the rural area?

KIGALI CITY 1
OTHER CITY 2
RURAL 3

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)

108. What is the highest level of school you attended:
Primary, reformed primary, post-primary, secondary, or higher?

PRIMARY (FORMER OR NEW) 1
PRIMARY REFORMED 2
POST PRIMARY/FAMIL/CERAR/CERAI 2
SECONDARY 4
HIGHER 5

109. What is the highest (class/year) you completed at that level?

CLASS/YEAR _____

110. CHECK 108:

PRIMARY (GO TO 111)
POST-PRIMARY OR HIGHER (GO TO 114)

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 PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) _____ 4
BLIND/VISUALLY IMPAIRED 5

112. Have you ever participated in a literacy program or any other program that involves learning to read or write (not including primary school)?

YES 1
NO 2

113. CHECK 111:

CODE '2', '3' OR '4' CIRCLED (GO TO 114)
CODE '1' OR '5' CIRCLED (GO TO 115)

114. Do you read a newspaper or magazine 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

115. Do you listen to the radio 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

116. Do you watch television 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

117. In the last 12 months, how many times have you traveled outside of your community or your home place?

NUMBER OF TRIPS ___
NONE 00 (GO TO 119)

118. In the last 12 months, have you ever been away from your home place for the period of one month un-interrupted?

YES 1
NO 2

119. What is your religion?

CATHOLIC 1
PROTESTANT 2
7th DAY ADVENTIST 3
MUSLIM 4
TRADITIONALIST 5
OTHER (SPECIFY) ____ 6
NONE 7

119A. In the last four weeks, have you ever

a) have had a consultation of a service provider
YES 1
NO 2
b) been hospitalized for at least one night
YES 1
NO 2

119B. CHECK Q 119A a)

Q. 119A a) YES (GO TO 119C)
Q. 119A a) NO (GO TO 119G)

119C. Where did the last consultation with a service provider take place?

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
AGENT DBC 13
OTHER PUBLIC (SPECIFY) _____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
ARBEF CLINIC 24
OTHER PRIVATE MEDICAL (SPECIFY) ____ 26
OTHER (SPECIFY) _____ 96

119D. How much did you pay on the whole for the last consultation, including the drugs and the tests of laboratory?

PRICE: ____

FREE 00000
DON'T KNOW 99998

119E. Was there (others) expenditure of the drugs related to this consultation and paid on a pharmacy?

YES 1
NO 2 (GO TO 119G)
DON'T KNOW 8 (GO TO 119G)

119F. How much did you pay for these drugs with pharmacy?

PRICE: _____
DON'T KNOW 99998

119G. CHECK Q 119A b)

Q 119A b) YES (GO TO 119H)
Q 119A b) NO (GO TO 119J)

119H. Where were you hospitalized the last time for at least a night?

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
OTHER PUBLIC (SPECIFY) _____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
ARBEF CLINIC 22
OTHER PRIVATE MEDICAL (SPECIFY) ____ 26
OTHER (SPECIFY) _____ 96

119I. How much did you pay on the whole for the hospitalization?

PRICE: _______

FREE 00000
DON'T KNOW 99998

119J. Which type of medical insurance do you currently have?

NONE 1
RAMA MUTUAL 2
OTHER MUTUAL INSURANCE 2
OTHER NON-MUTURAL 6
DON'T KNOW 8

SECTION 2: REPRODUCTION

201. Now I would like to ask about all the births you have had during your life. Have you ever given birth?

YES 1
NO 2 (GO TO 206)

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

YES 1
NO 2 (GO TO 204)

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

SONS AT HOME ____
DAUGHTERS AT HOME ____

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

YES 1
NO 2 (GO TO 206)

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

SONS ELSEWHERE ___
DAUGHTERS ELSEWHERE ___

206. Have you ever given birth to a boy or girl who was born alive but later died?
Any baby who cried or showed signs of life but only survived a few hours or days?

YES 1
NO 2 (GO TO 208)

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

BOYS DEAD ___
GIRLS DEAD ___

207A. Have you had any other children who were born alive and died after a few minutes, a few hours, or a few days?

YES 1
NO 2 (GO TO 208)

207B. CORRECT 207 THEN CONTINUE WITH Q.208

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

TOTAL ____

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

YES (GO TO 210)
NO (PROBE AND CORRECT 201-208 AS NECESSARY.)

210. CHECK 208:

ONE OR MORE BIRTHS (GO TO 211)
NO BIRTHS (GO TO 226)

211. Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had.
RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

212. What name was given to you (first/next) baby? (NAME)

______

213. Were any of these births twins?

SING 1
MULT 2

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

BOY 1
GIRL 2

215. In what month and year was (NAME) born? PROBE: What is his/her birthday?

MONTH ___
YEAR ____

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

217. IF ALIVE: How old was (NAME) at his/her 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)

LINE NUMBER ____ (GO TO NEXT BIRTH)

220. IF DEAD: How old was (NAME) when he/she died?
IF '1 YR', PROBE: How many months old was (NAME)? RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

DAYS 1 ___
MONTHS 2 ___
YEARS 3 ___

221. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?

YES 1
NO 2

222. Have you had any live births since the birth of (NAME OF LAST BIRTH)?

YES 1 (ADD BIRTH AT Q 212)
NO 2

223. COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:

NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)
NUMBERS ARE SAME, CHECK:
FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED __
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED ___
FOR AGE AT DEATH 12 MONTHS OR 1 YR.: PROBE TO DETEREMINE EXACT NUMBER OF MONTHS __

224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 2000 OR LATER. IF NONE, RECORD '0'. ____

225. FOR EACH BIRTH SINCE JANUARY 2000, RECORD 'B' NEXT TO THE MONTH OF BIRTH IN THE CALENDAR FOR EACH BIRTH ASK THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF THE PREGNANCY (NOTE : THE NUMBER OF
'P' MUST BE LESS THAN '1' THAN THE NUMBER OF MONTHS THE PREGNANCY LASTED). RECORD THE NAME OF THE CHILD TO THE LET OF THE CODE 'B'.

226. Are you pregnant now?

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

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. At the time you became pregnant did you want to become pregnant then, did you want to wait until later, or did you not want to have any (more) children at all?

THEN 1
LATER 2
NOT AT ALL 3

229. Have you ever had a pregnancy that miscarried, was aborted, or ended in a stillbirth?

YES 1
NO 2 (GO TO 237)

230. When did the last such pregnancy end?

MONTH ____
YEAR ____

231. CHECK 230:

LAST BIRTH ENDED IN JAN. 2000 OR LATER (GO TO 232)
LAST BIRTH ENDED BEFORE JAN. 2000 (GO TO 237)

232. How many months pregnant were you when the last such pregnancy ended?
RECORD NUMBER OF COMPLETED MONTHS. ENTER 'T' IN COLUMN 1 OF CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

MONTHS ___

233. Since January 1000 (1), have you had any other pregnancies that did not result in a live birth?

YES 1
NO 2 (GO TO 237)

234. ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2000. ENTER 'T' IN COLUMN 1 OF CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

Did you have any pregnancies that terminated before 2000 that did not result in a live birth?

YES 1
NO 2

When did the last such pregnancy that terminated before 2000 end?

MONTH ___
YEAR ____

237. 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 MENSTURATED 996

238. From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant if she has sexual relations?

YES 1
NO 2 (GO TO 240)
DON'T KNOW 8 (GO TO 240)

239. 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

240. Are there children who depend entirely on you?

YES 1
NO 2 (GO TO 301)

241. Are there some children aged below 18 years among those who depend entirely on you?

YES 1
NO 2 (GO TO 301)

242. Now, I would like you to tell about children under 18 who entirely depend on you.
Have you made arrangements of the person who would take care of the children in case you fall sick or in case you become unable to support them.

YES 1
NO 2
UNSURE 8

SECTION 3. CONTRACEPTION

Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.
CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.
CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302.

301. Which ways or methods have you heard about?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK:
Have you ever heard of (METHOD)?

01 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES 1
NO 2 (GO TO NEXT METHOD)
02 MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1
NO 2 (GO TO NEXT METHOD)
03 PILL Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2 (GO TO NEXT METHOD)
04 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2 (GO TO NEXT METHOD)
05 INJECTABLES Women can have an injection by a health provider which stops them from becoming pregnant for one or more months.
YES 1
NO 2 (GO TO NEXT METHOD)
06 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2 (GO TO NEXT METHOD)
07 CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
08 FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
09 DIAPHRAGM Women can place a thin flexible disk in their vagina before intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
10 FOAM OR JELLY Women can place a suppository, jelly, or cream in their vagina before intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
11 LACTATIONAL AMENORRHEA METHOD (LAM) Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.
YES 1
NO 2 (GO TO NEXT METHOD)
12 RHYTHM OR PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2 (GO TO NEXT METHOD)
12A BEADS /STANDARD DAYS METHOD (SDM) The woman know days of the month when she can get pregnant by using beads or calendar
YES 1
NO 2 (GO TO NEXT METHOD)
13 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2 (GO TO NEXT METHOD)
14 EMERGENCY CONTRACEPTION Women can take pills up to three days after sexual intercourse to avoid becoming pregnant.
YES 1
NO 2 (GO TO NEXT METHOD)
15 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
(SPECIFY)______
(SPECIFY) ______
NO 2

302. Have you ever used (METHOD)?

01 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
Have you ever had an operation to avoid having any more children?
YES 1
NO 2
02 MALE STERILIZATION Men can have an operation to avoid having any more children. Have you ever had a partner who had an operation to avoid having any more children?
YES 1
NO 2
03 PILL Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
04 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
05 INJECTABLES Women can have an injection by a health provider which stops them from becoming pregnant for one or more months.
YES 1
NO 2
06 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
07 CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08 FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09 DIAPHRAGM Women can place a thin flexible disk in their vagina before intercourse.
YES 1
NO 2
10 FOAM OR JELLY Women can place a suppository, jelly, or cream in their vagina before intercourse.
YES 1
NO 2
11 LACTATIONAL AMENORRHEA METHOD (LAM) Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.
YES 1
NO 2
12 RHYTHM OR PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
12A BEADS /STANDARD DAYS METHOD (SDM) The woman know days of the month when she can get pregnant by using beads or calendar
YES 1
NO 2
13 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
14 EMERGENCY CONTRACEPTION Women can take pills up to three days after sexual intercourse to avoid becoming pregnant.
YES 1
NO 2
15 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO 2

303. CHECK 302:

NOT A SINGLE "YES" (NEVER USED) (GO TO 304)
AT LEAST ONE "YES" (EVER USED) (GO TO 307)

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

YES 1
NO 2 (GO TO 329)

306. What have you used or done?
CORRECT 302 AND 303 (AND 301 IF NECESSARY).

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

NUMBER OF CHILDREN ____

308. CHECK 302 (01):

WOMAN NOT STERILIZED (GO TO 309)
WOMAN STERILIZED (GO TO 311A)

309. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 310)
PREGNANT (GO TO 329)

310. Are you currently doing something or using any method to delay or to avoid getting pregnant?

YES 1
NO 2 (GO TO 329)

311. Which method are you using?

FEMALE STERILIZATION A
MALE STERILIZATION B
PILL C (GO TO 316A)
IUD D (GO TO 316A)
INJECTABLES E (GO TO 316A)
IMPLANTS F (GO TO 316A)
CONDOM G (GO TO 316A)
FEMALE CONDOM H (GO TO 316A)
DIAPHRAGM I (GO TO 316A)
FOAM/JELLY J (GO TO 316A)
LACTATIONAL AMEN. METHOD K (GO TO 316A)
PERIODIC ABSTINENCE L (GO TO 316A)
WITHDRAWAL M (GO TO 316A)
OTHER (SPECIFY) ____ X (GO TO 316A)

311A. CIRCLE 'A' FOR FEMALE STERILIZATION.
IF MORE THAN ONE METHOD MENTIONED, FOLLOW GO INSTRUCTION FOR HIGHEST METHOD ON LIST.

313. In what facility did the sterilization take place?

IF SOURCE IS GOVERNMENTAL HOSPITAL, GOVERNMENT ASSISTED HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) _______

IF THE CODES 'A' AND 'B' WERE CIRCLED IN 311, ASK 313-317 ABOUT FEMALE STERILISATION ONLY

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT ASSISTED HOSPITAL 12
OTHER PUBLIC (SPECIFY)_____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR 23
OTHER PRIVATE MEDICAL (SPECIFY) ____ 26
OTHER (SPECIFY) _____ 96
DON'T KNOW 98

314. CHECK 311:

CODE 'A' CIRCLED (Before your sterilization operation, were you told that you would not be able to have any (more) children because of the operation?)

CODE 'A' NOT CIRCLED (Before the sterilization operation, was your husband/partner told that he would not be able to have any (more) children because of the operation?

YES 1
NO 2
DON'T KNOW 8

316. In what month and year was the sterilization performed?

316A For how long have you been using (1st METHOD LISTED IN Q.311) without stopping?
PROBE: In what month and year did you start using (1st METHOD of Q.311) continuously?

MONTH ___
YEAR ____

316B. CHECK 316/316A, 215 AND 230:
ANY BIRTH IN 215 OR PREGNANCY IN 230TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 316/316A

YES (GO BACK TO 316/316A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION).

NO (GO TO 317)

317. CHECK 316/316A:

YEAR IS 2000 LATER (GO TO 319)
YEAR IS 1999 OR AFTER (GO TO 327)

319. CHECK 311/311A:
CIRCLE METHOD CODE
IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION 01 (GO TO 322)
MALE STERILIZATION 02 (GO TO 331)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
MAMA 11 (GO TO 320A)
STANDARD DAYS METHOD 13 (GO TO 320A)
WITHDRAWAL 14 (GO TO 331)
ABSTINENCE 15 (GO TO 331)
OTHER METHOD 96 (GO TO 331)

320 Where did you obtain (CURRENT METHOD) when you started using it?

320A. Where did you learn to use the MAMA/SDM method?

IF SOURCE IS GOVERNMENT HOSPITAL, GOVERNMENT ASSISTED HEALTH FACILITY, HEALTH CENTERS OR CLINIC, A NURSE, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) _______
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH HOSPITAL 12
NURSE 13
OTHER PUBLIC (SPECIFY)_____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
ARBEF CLINIC 24
FIELDWORKER 25
OTHER PRIVATE MEDICAL (SPECIFY) ____ 26
OTHER SOURCE
SHOP 31
CHURCH 32
PARENTS/FRIEND 33
OTHER (SPECIFY) ____ 96

321. CHECK 311/311A:
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07 (GO TO 327)
FEMALE CONDOM 08 (GO TO 326)
FOAM/JELLY 10 (GO TO 326)
LACTATIONAL AMEN. (MAMA) 11 (GO TO 326)
STANDARDS DAYS METHOD 12 (GO TO 326)

322. You first obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM 313 OR 320). At that time, were you told about side effects or problems you might have with the method?

YES 1 (GO TO 324)
NO 2

323. 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 325)

324. Were you told what to do if you experienced side effects or problems?

YES 1
NO 2

325. CHECK 322:

CODE '1' CIRCLED (At that time, were you told about other methods of family planning that you could use?)

CODE '1' NOT CIRCLED (When you obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM 313 or 320), were you told about other methods of family planning that you could use?)

YES 1 (GO TO 327)
NO 2

326. 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

327. CHECK 311/311A:
CIRCLE METHOD CODE:

FEMALE STERILIZATION 01 (GO TO 331)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
MAMA 11
BEADS/SDM 12 (GO TO 331)

328. Where did you obtain (CURRENT METHOD) the last time?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) ________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH HOSPITAL 12
NURSE 13
OTHER PUBLIC (SPECIFY)_____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
ARBEF CLINIC 24
FIELDWORKER 25
OTHER PRIVATE MEDICAL (SPECIFY) ____ 26
OTHER SOURCE
SHOP 31
CHURCH 32
PARENTS/FRIEND 33
OTHER (SPECIFY) _____ 96

328A. Did you obtain this method within the last four weeks?

YES 1
NO 2 (GO TO 331)

328B. How much did you spend on this method including fees for the consultation and purchasing the method?

COST: ____

FREE 00000 (GO TO 331)
DON'T KNOW 99998 (GO TO 331)

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

YES 1
NO 2 (GO TO 331)

330. Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) ______

RECORD ALL PLACES MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH HOSPITAL B
AGENT DBC C
OTHER PUBLIC (SPECIFY)_____ D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY F
PRIVATE DOCTOR G
ARBEF CLINIC H
INFIRMARY I
OTHER PRIVATE MEDICAL (SPECIFY) ____ J
OTHER SOURCE
SHOP K
CHURCH L
PARENTS/FRIEND M
OTHER (SPECIFY) _____ X

331. In the last 12 months, were you visited by a fieldworker who talked to you about family planning?

YES 1
NO 2

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

YES 1
NO 2 (GO TO 401)

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

YES 1
NO 2

SECTION 4A. PREGNANCY, POSTNATAL CARE AND BREASTFEEDING

401. CHECK 224:

ONE OR MORE BIRTHS IN 2000 OR LATER (GO TO 402)
NO BIRTHS IN 2000 OR LATER (GO TO 487)

402 ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2000 OR LATER. 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 QUESTIONNAIRES).

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

403. LINE NUMBER FROM 212.

LINE NUMBER FROM Q. 212____

404. FROM 212 AND 216.

NAME ____
LIVING (GO TO 405)
DEAD (GO TO 405)

405. At the time you became pregnant with (NAME), did you want to become pregnant then, did you want to wait until later, or did you not want to have any (more) children at all?

THEN 1 (GO TO 407)
LATER 2
NOT AT ALL 3 (GO TO 407)

406. How much longer would you like to have waited?

MONTHS 1 ___
YEARS 2 ____

DON'T KNOW/DEPENDS 98

407. Did you see anyone for antenatal care for this pregnancy?
[LAST BIRTH ONLY]

IF YES: Whom did you see? Anyone else?

PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MID-WIFE/AUXILIARY MIDWIFE B
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT C
UNTRAINED TRAD. BIRTH ATTENDANT D
OTHER (SPECIFY) ____ X
NO ONE Y (GO TO 415)

408. How many months pregnant were you when you first received antenatal care for this pregnancy? [LAST BIRTH ONLY]

MONTHS ___
DON'T KNOW 98

409. How many times did you receive antenatal care during this pregnancy?
[LAST BIRTH ONLY]

NUMBER OF TIMES ___
DON'T KNOW 98

409A. Where did you go for the last prenatal visit?
[LAST BIRTH ONLY]

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) ________

RECORD ALL THAT ARE MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH HOSPITAL B
OTHER PUBLIC (SPECIFY)_____ C
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC D
PRIVATE DOCTOR E
ARBEF CLINIC F
INFIRMARY G
OTHER PRIVATE MEDICAL (SPECIFY) ____ H
OTHER (SPECIFY) _____ X

409B. Was this consultation done within the last four weeks?
[LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 410)

409C. How much did you spend on that prenatal consultation?
[LAST BIRTH ONLY]

COST: ____

FREE 00000
DON'T KNOW 99998

409D. Are there (other) medical expenses incurred for that prenatal visit, paid in the pharmacy?
[LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 410)
DON'T KNOW 8 (GO TO 410)

409E. How much did you spend to the pharmacy for the medicine?
[LAST BIRTH ONLY]

COST: ____
DON'T KNOW 9998

410. CHECK 409:
NUMBER OF TIMES RECEIVED ANTENATAL CARE
[LAST BIRTH ONLY]

ONCE (GO TO 412)
MORE THAN ONCE OR DK (GO TO 411)

411. How many months pregnant were you the last time you received antenatal care?
[LAST BIRTH ONLY]

MONTHS ___
DON'T KNOW 98

412. During this pregnancy, were any of the following done at least once?
[LAST BIRTH ONLY]

Were you weighed?
Was your height measured?
Was your blood pressure measured?
Did you give a urine sample?
Did you give a blood sample?

WEIGHT
YES 1
NO 2
HEIGHT
YES 1
NO 2
BLOOD PRESSURE
YES 1
NO 2
URINE SAMPLE
YES 1
NO 2
BLOOD SAMPLE
YES 1
NO 2

413. Were you told about the signs of pregnancy complications?
[LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 415)
DON'T KNOW 8 (GO TO 415)

414. Were you told where to go if you had these complications?
[LAST BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8

415. During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?
[LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 417)
DON'T KNOW 8 (GO TO 417)

416. During this pregnancy, how many times did you get this injection?
[LAST BIRTH ONLY]

TIMES ___
DON'T KNOW 8

417. During this pregnancy, were you given or did you buy any iron tablets?
SHOW TABLETS
[LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 419)
DON'T KNOW 8 (GO TO 419)

418. During the whole pregnancy, for how many days did you take the tablets of iron?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.
[LAST BIRTH ONLY]

NUMBER OF DAYS ___
DON'T KNOW 998

419. During this pregnancy, did you have difficulty with your vision during the daylight?
[LAST BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8

420. During this pregnancy, did you suffer from night blindness [USE LOCAL TERM]?
[LAST BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8

421. During this pregnancy, did you take any drugs to prevent you from getting malaria?
[LAST BIRTH ONLY]

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

422. What drugs did you take?
RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.
[LAST BIRTH ONLY]

SP/FANSIDAR A
AMODIAQUINE B
OTHER (SPECIFY) _____ X
DON'T KNOW Z

422A. CHECK 422:
TYPE OF ANTIMALARIAL DRUG USED DURING PREGNANCY
[LAST BIRTH ONLY]

CODE 'A' CIRCLED (GO TO 422B)
CODE 'A' NOT CIRCLED (GO TO 423)

422B. How many times did you use SP/Fansidar during this pregnancy
[LAST BIRTH ONLY]

NUMBER OF TIMES ____

422C. CHECK 407:
TYPE OF PERSON WHO PROVIDED THE PRENATAL CARE DURING THIS PREGNANCY [LAST BIRTH ONLY]

CODE "A" CIRCLED (GO TO 422D)
OTHER CODE CIRCLED (GO TO 423)

422D. Did you get the SP/Fansidar during an antenatal visit, during another visit to a health facility or from some other source?
[LAST BIRTH ONLY]

PRENATAL VISIT 1
OTHER MEDICAL VISIT 2
OTHER SOURCE (SPECIFY) _____ 6

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

VERY LARGE 1
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DON'T KNOW 8

424. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 426)
DON'T KNOW 8 (GO TO 426)

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

GRAMS FROM CARD 1 _____
GRAMS FROM RECALL 2 ____

DON'T KNOW 99998

426. Who assisted with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE/MEDICAL ASSISTANT B
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT C
UNTRAINED TRAD. BIRTH ATTENDANT D
PARENTS/FRIEND E
OTHER (SPECIFY) ____ X
NO ONE Y

427. Where did you give birth to (NAME)?
IF SOURCE IS HOSPITAL, HEALTH CENTER OR CLINIC, WRITE THE NAME OF
THE PLACE, PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE
APPROPRIATE CODE.

(NAME OF PLACE) ________
HOME
YOUR HOME 11 (GO TO 429)
OTHER HOME 12 (GO TO 429)
PUBLIC SECTOR
GOVT. HOSPITAL 21
GOVT. HEALTH CENTER 22
OTHER PUBLIC (SPECIFY) ______ 26
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC 31
OTHER PVT. MEDICAL (SPECIFY) ____ 36
OTHER (SPECIFY) ____ 96 (GO TO 429)

427A. CHECK 427 FOR THE LAST BIRTH:
WAS BORN IN A HEALTH FACILITY?

YES (GO TO 427B)
NO (GO TO 428)

427B. CHECK 427 FOR THE LAST BIRTH:
WAS BORN IN THE LAST FOUR MONTHS?

YES (GO TO 427C)
NO (GO TO 428)

427C. How much did you pay to the facility for the delivery?
[LAST BIRTH ONLY]

COST: ______

FREE 00000
DON'T KNOW 99998

427D. Are there other medical expenses incurred for the delivery which you paid to a pharmacy?
[LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 428)
DON'T KNOW 8 (GO TO 428)

427E. How much did you pay the pharmacy for the medicine(s)?
[LAST BIRTH ONLY]

COST: _____
DON'T KNOW 99998

428. Was (NAME) delivered by caesarian section?

YES 1 (FOR LAST BIRTH, GO TO 433; FOR ALL OTHERS, GO TO 435)
NO 2 (FOR LAST BIRTH, GO TO 433; FOR ALL OTHERS, GO TO 435)

429. After (NAME) was born, did a health professional or a traditional birth attendant check on your health?

YES 1
NO 2 (FOR LAST BIRTH, GO TO 433)

430. How many days or weeks after the delivery did the first post-natal check take place?
RECORD '00' DAYS IF SAME DAY. [LAST BIRTH ONLY]

DAYS AFTER DEL 1 ___
WEEKS AFTER DEL 2 ___

DON'T KNOW 98

431. Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[LAST BIRTH ONLY]

HEALTH PROFESSIONAL
DOCTOR 11
NURSE/MIDWIFE/MEDICAL ASSISTANT 12
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT 21
UNTRAINED TRADITIONAL BIRTH ATTENDANT 22
OTHER (SPECIFY) ____ 96

432. Where did this first visit take place?
[LAST BIRTH ONLY]

IF SOURCE IS HOSPITAL, HEALTH CENTER OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) ______________
HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVT. HOSPITAL 21
GOVT. HEALTH CENTER 22
DISPENSARY 23
OTHER PUBLIC (SPECIFY) ____ 26
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC 31
OTHER PVT. MEDICAL (SPECIFY) ____ 36
OTHER (SPECIFY) ____ 96

432A. Was this post-natal check done in the last four weeks?
[LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 433)

432B. How much did you spend on this post-natal exam?
[LAST BIRTH ONLY]

COST: _____

FREE 00000
DON'T KNOW 99998

432C. Are there other medical expenses incurred on this post-natal visit which you paid the pharmacy. [LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 433)
DON'T KNOW 8 (GO TO 433)

432D. How much did you pay to the pharmacy for the medicine?
[LAST BIRTH ONLY]

COST: _____
DON'T KNOW 99998

433. In the first two months after delivery, did you receive a vitamin A dose like this?
SHOW AMPULE/CAPSULE/SYRUP.
[LAST BIRTH ONLY]

YES 1
NO 2

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

YES 1 (GO TO 436)
NO 2 (GO TO 437)

433A. Have you ever suffered from an obstetrical fistule?
[LAST BIRTH ONLY]

(SICKNESS CHARACTERIZED BY THE INCONTROLLABLE FLOW OF URINE AND/OR FECES FROM THE VAGINA DUE TO A PERFORATION IN THE WALL OF THE VAGINA)

YES 1
NO 2

433B. Did you go to a health establishment to seek medical care?
[LAST BIRTH ONLY]

YES 1
NO 2

435. Did your period return between the birth of (NAME) and your next pregnancy?
[DO NOT ASK FOR LAST BIRTH]

YES 1
NO 2 (GO TO 439)

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

MONTHS ___
DON'T KNOW 98

437. CHECK 226:
IS RESPONDENT PREGNANT?
[LAST BIRTH ONLY]

NOT PREGNANT (GO TO 438)
PREGNANT OR UNSURE (GO TO 439)

438. Have you resumed sexual relations since the birth of (NAME)?

YES 1
NO 2 (GO TO 440)

439. For how many months after the birth of (NAME) did you not have sexual relations?

MONTHS ___
DON'T KNOW 98

440. Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 447)

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

IMMEDIATELY 00

HOURS 1 ___
DAYS 2 ___

442. In the first three days after delivery, before your milk began flowing regularly, was (NAME) given anything to drink other than breast milk?

YES 1
NO 2 (GO TO 444)

443. What was (NAME) given to drink before your milk began flowing regularly?
Anything else?
RECORD ALL LIQUIDS MENTIONED

MILK (OTHER THAN BREAST MILK) A
PLAIN WATER B
SUGAR OR GLUCOSE WATER C
GRIPE WATER FOR COLIC D
SUGAR-SALT-WATER SOLUTION E
FRUIT JUICE F
INFANT FORMULA G
TEA/INFUSIONS H
HONEY I
OTHER (SPECIFY) ____ X

444. CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 445)
DEAD (GO TO 446)

445. Are you still breastfeeding (NAME)?

YES 1 (GO TO 448)
NO 2

446. For how many months did you breastfeed (NAME)?

MONTHS ___
DON'T KNOW 98

447. CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 450)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 454)

448. How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

NUMBER OF NIGHTTIME FEEDINGS ___

449. How many times did you breastfeed yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

NUMBER OF DAYLIGHT FEEDINGS___

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

YES 1
NO 2
DON'T KNOW 8

451. Was sugar added to any of the foods or liquids (NAME) ate yesterday?

YES 1
NO 2
DON'T KNOW 8

452. How many times did (NAME) eat solid, semisolid, or soft foods other than liquids yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.

NUMBER OF TIMES __
DON'T KNOW 8

453. GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 454.

SECTION 4B. IMMUNIZATION, HEALTH AND NUTRITION

454. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 2000 OR AFTER. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES).

455. LINE NUMBER FROM 212.

LINE NUMBER ____

456. FROM 212 AND 216

NAME _____
LIVING (GO TO 457)
DEAD (GO TO 456 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 484)

457. Did (NAME) receive a vitamin A dose like this during the last 6 months?
SHOW AMPULE/CAPSULE/SYRUP.

YES 1
NO 2
DON'T KNOW 8

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

YES, SEEN (GO TO 460) 1
YES, NOT SEEN (GO TO 462) 2
NO CARD 3

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

YES 1 (GO TO 462)
NO 2

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

BCG
DAY ___
MONTH____
YEAR ____
POLIO 0 (GIVEN AT BIRTH)
DAY ___
MONTH ____
YEAR _____
POLIO 1
DAY ___
MONTH ____
YEAR ____
POLIO 2
DAY ___
MONTH ___
YEAR ___
POLIO 3
DAY ___
MONTH ___
YEAR ___
DPT 1
DAY ___
MONTH ___
YEAR ___
DPT 2
DAY ___
MONTH ___
YEAR ___
DPT 3
DAY ___
MONTH ___
YEAR ___
MEASLES
DAY ___
MONTH ___
YEAR ___
VITAMIN A (MOST RECENT)
DAY ___
MONTH ___
YEAR ___

461. Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations received in a national immunization day campaign?

RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, AND/OR MEASLES VACCINE(S).

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 460) (GO TO 466)
NO 2 (GO TO 466)
DON'T KNOW 8 (GO TO 466)

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

YES 1
NO 2 (GO TO 466)
DON'T KNOW 8 (GO TO 466)

463. Please tell me if (NAME) received any of the following vaccinations.

463A. 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

463B. Polio vaccine, that is, drops in the mouth?

YES 1
NO 2 (GO TO 463E)
DON'T KNOW 8 (GO TO 463E)

463C. Was the first polio vaccine received in the first two week after birth or later?

FIRST TWO WEEKS 1
LATER 2
DON'T KNOW 8

463D. How many times was the polio vaccine received?

NUMBER OF TIMES ___

463E. A DPT vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops?

YES 1
NO 2 (GO TO 463G)
DON'T KNOW 8 (GO TO 463G)

463F. How many times?

NUMBER OF TIMES ___

463G. An injection to prevent measles?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 469)
DON'T KNOW 8 (GO TO 469)

468. When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, fast breaths?

YES 1
NO 2
DON'T KNOW 8

469. CHECK 466 AND 467:
FEVER OR COUGH?

"YES" IN 466 OR 467 (GO TO 470)
OTHER (GO TO 475)

470. Did you seek advice or treatment for the fever/cough?

YES 1
NO 2 (GO TO 472)

471. Where did you seek advice or treatment? Anywhere else?
RECORD ALL SOURCES MENTIONED.

PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
AGENT DBC C'
OTHER PUBLIC (SPECIFY) _____ D
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC E
PHARMACY F
PRIVATE DOCTOR G
ARBEF CLINIC H
INFIRMARY I
OTHER PRIVATE MEDICAL (SPECIFY) ____ J
OTHER SOURCE
SHOP K
TRAD. PRACTIONER L
OTHER (SPECIFY) ____ X

472. CHECK 466:
HAD FEVER?

"YES" IN 466 (GO TO 472A)
"NO/"DK" IN 466 (GO TO 475)

472A. Does (NAME) have fever now?

YES 1
NO 2
DON'T NOW 8

472B. Has (NAME) had convulsions at any time in the last 2 weeks?

YES 1
NO 2
DON'T NOW 8

472C. CHECK 466 and 472B:
HAD FEVER OR CONVULSIONS?

"YES" IN 466 OR 472B (GO TO 473)
"NO"/"DK" IN 466 (GO TO 475)

473. Did (NAME) take any drugs for the fever?

YES 1
NO 2 (GO TO 474A)
DON'T NOW 8 (GO TO 474A)

474. What drugs did (NAME) take?

RECORD ALL MENTIONED.

ASK TO SEE DRUG(S) IF TYPE OF DRUG IS NOT KNOWN. IF TYPE OF DRUG IS STILL NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.

ANTI-MALARIALS
SP/FANSIDAR A
AMODIAQUIN B
QUININE C
OTHER DRUGS
ASPIRIN D
PANADOL E
IBUPROFEN/ACETAMINOPHEN F
OTHER (SPECIFY) ____ X
DON'T KNOW Z

474A. Did (NAME) have an injection or a suppository have to treat (the fever/ convulsions)?

INJECTION A
SUPPOSITORY B
NONE Y
DON'T KNOW Z

474B. CHECK 474 :
WHICH MEDICINE?

CODE 'A' CIRCLED (GO TO 474C)
CODE 'A' NOT CIRCLED (GO TO 474F)

474C. For how long after starting (the fever/ convulsions) did (NAME) start taking SP/Fansidar?

SAME DAY 1
THE FOLLOWING DAY 2
TWO DAYS AFTER 3
THREE DAYS OR LONGER AFTER 4
DON'T KNOW 8

474D. How many successive days did (NAME) take SP/Fansidar?
IF 7 DAYS +, RECORD 7

DAYS ___
DON'T KNOW 8

474E. Was the SP/Fansidar available at home or did you get it from somewhere else?
IF MORE THAN ONE SOURCE MENTIONED, ASK: Where did you get the SP/Fansidar first?

AT HOME 1
OTHER SOURCE 2
DON'T KNOW 8

474F. CHECK 474:
WHICH MEDICINE?

CODE 'B' CIRCLED (GO TO 474G)
CODE 'B' NOT CIRCLED (GO TO 474J)

474G. For how long after the start of the (fever/ convulsions) did (NAME) start taking the Amodiaquine?

SAME DAY 1
THE FOLLOWING DAY 2
TWO DAYS AFTER 3
THREE DAYS OR LONGER AFTER 4
DON'T KNOW 8

474H. How many successive days did (NAME) take Amodiaquine?
IF 7 DAYS +, RECORD 7

DAYS ___
DON'T KNOW 8

474I. Was the Amodiaquine available at home or did you get it from somewhere else?
IF MORE THAN ONE SOURCE MENTIONED, ASK Where did you get the Amodiaquine first?

AT HOME 1
OTHER SOURCE 2
DON'T KNOW 8

474J. CHECK 474 :
WHICH MEDICINE?

CODE "C" CIRCLED (GO TO 474K)
CODE "C" NOT CIRCLED (GO TO 474N)

474K. For how long after starting (the fever/ convulsions) did (NAME) start taking the quinine?

SAME DAY 1
THE FOLLOWING DAY 2
TWO DAYS AFTER 3
THREE DAYS OR LONGER AFTER 4
DON'T KNOW 8

474L. How many successive days did (NAME) take quinine?
IF 7 DAYS +, RECORD 7

LAST BIRTH
DAYS ___
DON'T KNOW 8

474M. Was the quinine available at home or did you get it from somewhere else?
IF MORE THAN ONE SOURCES MENTIONED; ASK Where did you get quinine first?

AT HOME 1
OTHER SOURCE 2
DON'T KNOW 8

474N. Did (NAME) use other way (different) to treat (the fever/ convulsions)?

YES 1
NO 2 (GO TO 475)
DON'T KNOW 8 (GO TO 475)

474O What was done about the (fever/ convulsions) of (NAME)?

CONSULTED TRADITIONAL HEALER A
COMPRESS WITH A WET CLOTH B
HERBAL MEDICINES C
OTHER (SPECIFY) _____ X

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

YES 1
NO 2 (GO TO 483)
DON'T KNOW 8 (GO TO 483)

476. Now I would like to know how much was offered to drink during the diarrhea. Was he/she offered less than usual to drink, about the same amount, or more than usual to drink? IF LESS, PROBE: Was he/she offered 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

477. When (NAME) had diarrhea, was he/she offered less than usual to eat, about the same mount, more than usual, or nothing to eat? IF LESS, PROBE: Was he/she offered 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

478. Was he/she given any of the following to drink:

a. A liquid made from a special packet called SERUMU?
b. A government-recommended homemade liquid?

LIQUID FROM ORS PKT
YES 1
NO 2
DK 8
HOMEMADE LIQUID
YES 1
NO 2
DK 8

479. Was anything (else) given to treat the diarrhea?

YES 1
NO 2 (GO TO 481)
DK 8 (GO TO 481)

480. What (else) was given to treat the diarrhea? Anything else?
RECORD ALL TREATMENTS MENTIONED.

PILL OR SYRUP A
INJECTION B
(I.V.) INTRAVENOUS C
HOME REMEDIES/HERBAL MEDICINES D
OTHER (SPECIFY) _____ X

481. Did you seek advice or treatment for the diarrhea?

YES 1
NO 2 (GO TO 483)

482 Where did you seek advice or treatment?

IF SOURCE IS HOSPITAL, HEALTH CENTER OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) ______
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
AGENT DBC C
OTHER PUBLIC (SPECIFY) _____ D
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC E
PHARMACY F
PRIVATE DOCTOR G
ARBEF CLINIC H
INFIRMARY I
OTHER PRIVATE MEDICAL (SPECIFY) ____ J
OTHER SOURCE
SHOP K
TRAD. PRACTIONER L
OTHER (SPECIFY) ____ X

483. GO BACK TO 456 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 486.

486. CHECK 478A, ALL COLUMNS:

NO CHILD RECEIVED LIQUID FROM ORS PACKET (GO TO 487)
A CHILD RECEIVED LIQUID FROM ORS PACKET (GO TO 488)

487. Have you ever heard of a special product called SERUMU you can get for the treatment of diarrhea?

YES 1
NO 2

488. CHECK 218:

HAS ONE OR MORE CHILDREN LIVING WITH HER (GO TO 489)
HAS NO CHILDREN LIVING WITH HER (GO TO 490)

489. When (your child/one of your children) is seriously ill, can you decide by yourself whether or not the child should be taken for medical treatment?

IF SAYS NO CHILD EVER SERIOUSLY ILL, ASK: If (your child/one of your children) became seriously ill, could you decide by yourself whether the child should be taken for medical treatment?

YES 1
NO 2
DEPENDS 3

490. Now I would like to ask you some questions about medical care for you yourself.
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?

Knowing where to go.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Getting permission to go.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Getting money needed for treatment.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
The distance to a health facility.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Having to take transport.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Not wanting to go alone.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Concern that there may not be a female health provider.
BIG PROBLEM 1
NOT A BIG PROBLEM 2

490A. Do you currently smoke cigarettes or tobacco? IF YES: What do you smoke?
RECORD ALL THAT IS MENTIONED.

YES, CIGARETTES A
YES, PIPE B
YES, OTHER TOBACCO C
NO Y

490B. CHECK 490:

CODE 'A' CIRCLED (GO TO 490C)
CODE 'A' NOT CIRCLED (GO TO 490D)

490C. In the last 24 hours, how many cigarettes did you smoke?

CIGARETTES ___

490D. Do you know how people contract malaria in your community?

YES 1
NO 2 (490G)

490E. How can they catch malaria?
RECORD ALL THAT IS MENTIONED.

WHEN IT IS COLD A
WHEN IT IS HOT B
CHANGE OF SEASON C
MOSQUITOS D
HUGGING E
EXPOSURE TO THE SUN F
WITCHCRAFT/SORCERY G
OTHER (SPECIFY)____ X

490F. What can you do to avoid catching malaria?
RECORD ALL THAT IS MENTIONED.

REMAIN INDOORS A
SLEEP UNDER MOSQUITO NET B
AVOID MOSQUITO BITES C
USE INSECTICIDES D
BURN LEAVES/BUSHES E
WEAR WARM CLOTHES F
TAKE ANTI-MALARIALS G
OTHER (SPECIFY)____ X
DON'T KNOW Z

490G. CHECK 226:

CURRENTLY PREGNANT (GO TO 490H)
NOT PREGNANT OR NOT SURE (GO TO 491)

490H. Did you suffer from fever, at one unspecified moment, during the last two weeks?

YES 1
NO 2 (GO TO 491)

490I. Did you take anti fever drugs the last time you suffered?

YES 1
NO 2 (GO TO 491)

490J. Which drugs did you take?
ASK TO SEE THE MEDICINE(S). IF NOT SEEN, SHOW MEDICINES TO THE RESPONDENT. RECORD ALL THAT ARE MENTIONED.

FOR EACH ANTI-MALARIA, ASK: How long after the fever started did you start taking it (NAME OF THE DRUG)?

CODES IN DAY:

SAME DAY 0
1 DAY AFTER FEVER 1
2 DAYS AFTER FEVER 2
3 DAYS OR MORE 3
ANTIMALARIALS
AMODIAQUINE A
FANSIDAR B
QUININE C
UNKNOWN MEDICINES D
OTHER E
OTHER MEDICINES
ASPIRIN F
PARACETAMOL G
OTHER X
DON'T KNOW Z

490K. In total, how much did you spend on drugs the last time you had a fever?

COST: ______

FREE 00000
DON'T KNOW 99998

491. CHECK 215 AND 218:

HAS AT LEAST ONE CHILD BORN IN 2002 OR LATER AND LIVING WITH HER (RECORD NAME OF YOUNGEST CHILD LIING WITH HER (AND CONTINUE TO 492
NAME) ______
DOES NOT HAVE ANY CHILDREN BORN IN 2002 OR LATER AND LIVING WITH HER (GO TO 499B)

492. Now I would like to ask you about liquids (NAME FROM Q. 491) drank over the last seven days, including yesterday. How many days during last seven days did (NAME FROM Q. 491) drink each of the following?

FOR EACH ITEM GIVEN AT LEAST ONCE IN LAST SEVEN DAYS, BEFORE PROCEEDING TO THE NEXT ITEM, ASK: In total, how many times yesterday during the day or at night did (NAME FROM Q. 491) drink (ITEM)?

IF 7 OR MORE TIMES, RECORD '7'.
IF DON'T KNOW, RECORD '8'.

LAST 7 DAYS

a. Plain water?
NUMBER OF DAYS ____
b. Commercially produced infant formula such as Cerelac, soya, sorgho?
NUMBER OF DAYS ____
c. Any other milk such as tinned, powdered, or fresh animal milk?
NUMBER OF DAYS ____
d. Natural fruit juice? ___
NUMBER OF DAYS ____
e. Other liquids such as sugar water, tea, coffee, sodas?
NUMBER OF DAYS ____
f. Broth or soup?
NUMBER OF DAYS ____
g. Any other liquid of any time?
NUMBER OF DAYS ____

YESTERDAY/LAST NIGHT

a. Plain water?
NUMBER OF TIMES ____
b. Commercially produced infant formula such as Cerelac, soya, sorgho?
NUMBER OF TIMES ____
c. Any other milk such as tinned, powdered, or fresh animal milk?
NUMBER OF TIMES ____
d. Natural fruit juice? ___
NUMBER OF TIMES ____
e. Other liquids such as sugar water, tea, coffee, sodas?
NUMBER OF TIMES ____
f. Broth or soup?
NUMBER OF TIMES ____
g. Any other liquid of any time?
NUMBER OF TIMES ____

493. Now I would like to ask you about the types of foods (NAME FROM Q. 491) ate over the last seven days, including yesterday. How many days during last seven days did (NAME FROM Q. 491) eat each of the following foods either separately or combined with other food?

FOR EACH ITEM GIVEN AT LEAST ONCE IN LAST SEVEN DAYS, BEFORE PROCEEDING TO THE NEXT ITEM, ASK: In total, how many times yesterday during the day or at night did (NAME FROM Q. 491) eat (ITEM)?

IF 7 OR MORE TIMES, RECORD '7'.
IF DON'T KNOW, RECORD '8'.

LAST 7 DAYS

a. Cereals and staple foods made from grains [porridge, sorgho, corn, rice, wheat, mush or other local cereals]?
NUMBER OF DAYS ____
b. Pumpkin, red or yellow yams or squash, carrots or red sweet potatoes?
NUMBER OF DAYS ____
c. Any other food made from roots or tubers [e.g. white potatoes, white yams, manioc, cassava, or other local roots/tubers]?
NUMBER OF DAYS ____
d. Any green leafy vegetables?
NUMBER OF DAYS ____
e. Mango, papaya [or other local Vitamin A rich fruits]?
NUMBER OF DAYS ____
f. Any other fruits and vegetables [e.g. bananas, apples, applesauce, green beans, avocados, tomatoes]?
NUMBER OF DAYS ____
g. Meat, poultry, fish, shellfish, or eggs?
NUMBER OF DAYS ____
h. Any food from legumes [e.g. lentils, beans, soybeans, pulses, or peanuts]?
NUMBER OF DAYS ____
i. Cheese or yoghurt?
NUMBER OF DAYS ____
j. Any food made with oil, fat, or butter?
NUMBER OF DAYS ____

YESTERDAY/LAST NIGHT

a. Cereals and staple foods made from grains [porridge, sorgho, corn, rice, wheat, mush or other local cereals]?
NUMBER OF TIMES ____
b. Pumpkin, red or yellow yams or squash, carrots or red sweet potatoes?
NUMBER OF TIMES ____
c. Any other food made from roots or tubers [e.g. white potatoes, white yams, manioc, cassava, or other local roots/tubers]?
NUMBER OF TIMES ____
d. Any green leafy vegetables?
NUMBER OF TIMES ____
e. Mango, papaya [or other local Vitamin A rich fruits]?
NUMBER OF TIMES ____
f. Any other fruits and vegetables [e.g. bananas, apples, applesauce, green beans, avocados, tomatoes]?
NUMBER OF TIMES ____
g. Meat, poultry, fish, shellfish, or eggs?
NUMBER OF TIMES ____
h. Any food from legumes [e.g. lentils, beans, soybeans, pulses, or peanuts]?
NUMBER OF TIMES ____
i. Cheese or yoghurt?
NUMBER OF TIMES ____
j. Any food made with oil, fat, or butter?
NUMBER OF TIMES ____

499B. Now I would like to ask you some questions about your health in the last six months.
During the last six months, did you have an injection for any reason?

IF YES: how many injections did you have?

IF THE NUMBER OF INJECTIONS IS GREATER THAN '94', OR IF THEY WERE RECEIVED DAILY FOR THREE MONTHS OR MORE, RECORD '95'.
IF THE RESPONSE IS NOT NUMERIC, PROBE TO HAVE A NUMERIC RESPONSE.

NUMBER OF INJECTIONS ____
NONE 00 (GO TO 501)

499C. Of these injections, how many were given by a doctor, nurse, pharmacist, dentist or other health personnel?

IF THE NUMBER OF INJECTIONS IS GREATER THAN '94', OR IF THEY WERE RECEIVED DAILY FOR THREE MONTHS OR MORE, RECORD '95'. IF THE RESPONSE IS NOT NUMERIC, PROBE TO HAVE A NUMERIC RESPONSE.

NUMBER OF INJECTIONS ____
NONE 00 (GO TO 501)

499D. THE LAST TIME YOU HAD AN INJECTION, WHERE DID YOU GET IT FROM?
IF IT IS A HOSPITAL, A HEALTH CENTER OR A PRIVATE CLINIC, WRITE NAME OF THE FACILITY. INSIST TO DETERMINE TYPE OF SECTOR AND ENCIRCLE THE SUITABLE CODE.

(NAME OF THE FACILITY) _______
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
AGENT DBC 13
OTHER PUBLIC (SPECIFY) _____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
DENTIST 22
PHARMACY 23
PRIVATE DOCTOR/NURSE 24
ARBEF CLINIC 25
OTHER PRIVATE MEDICAL (SPECIFY) ____ 26
OTHER SOURCE
HOME 31
OTHER (SPECIFY) ____ 96

499E. The last time you had an injection, the person who carried out the injection took the syringe and needle from new packing and which was not open?

YES 1
NO 2
DON'T KNOW 8

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

501. Are you currently married or living with a man?

YES, CURRENTLY MARRIED 1 (GO TO 504)
YES, LIVING WITH A MAN 2 (GO TO 504)
NO, NOT CURRENTLY IN UNION 3

502. Have you ever been married or lived with a man?

YES, CURRENTLY MARRIED 1
YES, LIVING WITH A MAN 2
NO, NOT CURRENTLY IN UNION 3 (GO TO 518)

503. What is your marital status now: are you widowed, divorced, or separated?

WIDOWED 1 (GO TO 510)
DIVORCED 2 (GO TO 510)
SEPARATED 3 (GO TO 510)

504. Is your husband/partner living with you now or is he staying elsewhere?

LIVING WITH HER 1
STAYING ELSEWHERE 2

505. RECORD THE HUSBANDS NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.

NAME ______
LINE NO _____

506. What age was your partner at the last anniversary?

AGE IN COMPLETED YEARS _____

507. Does your husband/partner have any other wives besides yourself?

YES 1
NO 2 (GO TO 510)
DON'T KNOW 8 (GO TO 510)

508. How many other wives does he have?

NUMBER ___
DON'T KNOW 98

509. Are you the first, second ... wife?

RANK ___

510. Have you been married or lived with a man only once, or more than once?

ONCE 1
MORE THAN ONCE 2

511. CHECK 510:

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

MARRIED/LIVED WITH A MAN MORE THAN ONCE Now we will talk about your first husband/partner. In what month and year did you start living with him?

MONTH ___
DON'T KNOW MONTH 98
YEAR ___ (GO TO 513)
DON'T KNOW YEAR 9998

512. How old were you when you started living with him?

AGE ____

513. CHECK 503:
THE RESPONDENT IS A WIDOW?

NOT ASKED OR NOT WIDOW (GO TO 514)
WIDOW (GO TO 516)

514. CHECK 510:

MARRIED MORE THAN ONCE (GO TO 515)
MARRIED ONCE (GO TO 518)

515. How did your last union end?

DEATH/WIDOW 1 (GO TO 518)
DIVORCE 2
SEPARATION 8

516. Who inherited the largest share of the wealth from your previous husband?

RESPONDENT 1 (GO TO 518)
ANOTHER WIFE 2
CHILDREN 3
FAMILY OF THE WIFE 4
OTHER (SPECIFY) ____ 5
NO WEALTH 6

517. Did you receive any valuable possessions from your previous husband?

YES 1
NO 2

518. CHECK FOR PRESENCE OF OTHER PEOPLE
BEFORE CONTINUING, DO EVERYTHING POSSIBLE TO ENSURE THAT YOU ARE IN PRIVACY

519. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues.

How old were you when you first had sexual intercourse (if ever)?

NEVER 00
AGE IN YEARS __ (GO TO 521)
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95 (GO TO 521)

520. Do you intend to wait until you are married to start having sexual intercourse?

YES 1 (GO TO 544)
NO 2 (GO TO 544)
DON'T KNOW/NOT SURE 3 (GO TO 544)

521. CHECK 106:

15-24 YEARS (GO TO 522)
25-49 YEARS (GO TO 526)

522. The first time you had sexual intercourse, was a condom used?

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

522A. What was the main reason for using a condom at this time?

RESPONDENT WANTED TO PREVENT STD/HIV 1
RSEPONDENT WANTED TO PREVENT PREGNANCY 2
RESPONDENT WANTED TO PREVENT BOTH STD/HIV AND PREGNANCY 3
DID NOT TRUST PARTNER/FELT PARTNER HAD OTHER PARTNERS 4
PARTNER REQUESTED/INSISTED 5
OTHER (SPECIFY) ____ 6
DON'T KNOW 8

523. How old was the person with whom you had your first sexual relations?

AGE OF PARTNER ___ (GO TO 526)
DON'T KNOW 98

524. Was this person older than you, younger than you, or was approximately the same age as you?

OLDER 1
YOUNGER 2 (GO TO 526)
SAME AGE 3 (GO TO 526)
DK/DON'T REMEMBER 8 (GO TO 526)

525. Would you say that this person had ten years more than you or more, or less than ten years more than you?

TEN OR MORE YEARS 1
LESS THAN TEN YEARS 2
OLDER, DK HOW MANY YEARS 3

526. When was the last time you had sexual relations?

___ DAYS AGO ___
___ WEEKS AGO ___
___ MONTHS AGO ___
___ YEARS AGO ___

Q. 527- Q. 536 ARE ASKED OF LAST SEXUAL PARTNER, SECOND-TO-LAST SEXUAL PARTNER AND THIRD-TO-LAST SEXUAL PARTNER SEPARATELY

527. The last time you had sexual intercourse with this (second/third) person, was a condom used? (2)

YES 1
NO 2 (GO TO 529)

527A.What is the main reason that you used a condom?

RESPONDENT WANTED TO AVOID STD 1
RESPONDENT WANTED TO AVOID GETTING PREGNANT 2
RESPONDENT WANTED TO AVOID STD AND GETTING PREGNANT 3
RESPONDENT DIDN'T HAVE CONFIDENCE IN PARTNER/SUSPECTED PARTNER OF HAVING SEX WITH OTHERS 4
PARTNER REQUESTED 5
OTHER (SPECIFY) ____ 6
DNK 7

528. Did you use a condom every time you had sexual intercourse with this person in the last 12 months?

YES 1
NO 2

529. The last time you had sexual intercourse with this (second/third) person, did you or this person drink alcohol?

YES 1
NO 2 (GO TO 531)

530. Were you or your partner drunk at that time?
IF YES: Who was drunk?

RESPONDENT ONLY 1
PARTNER ONLY 2
RESPONDENT AND PARTNER BOTH 3
NEITHER 4

531. What was your relationship to this person with whom you had sexual intercourse?
IF BOYFRIEND/GIRLFRIEND: Were you living together as if married?

IF YES, CIRCLE '02'
IF NO, CIRCLE '03'

HUSBAND/WIFE 01 (GO TO 537)
LIVE-IN PARTNER 02 (GO TO 537)
BOYFRIEND/GIRLFRIEND NOT LIVING WITH RESPONDENT 03
CASUAL ACQUAINTANCE 04
COMMERCIAL SEX WORKER 05
OTHER (SPECIFY) ____ 96

532. For how long have you had sexual relations with this person?
IF THE RESPONDENT HAD ONLY HAD SEXUAL RELATIONS ONE TIME, RECORD '01' DAYS.

DAYS 1 ___
WEEKS 2 ___
MONTHS 3 ____
YEARS 4 ____

533. CHECK 103:

15-24 (GO TO 535)
25-49 (GO TO 537)

534. How old is this person?

AGE OF PARTER (GO TO 537)
DON'T KNOW 98

535. Is this person older than you, younger than you, or about the same age?

OLDER 1
YOUNGER 2 (GO TO 537)
SAME AGE 3 (GO TO 537)
DON'T KNOW 8 (GO TO 537)

536. Would you say this person is ten or more years older than you or less than ten years older than you?

TEN OR MORE YERS OLDER 1
LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3

537. Apart from [this person/these two people], have you had sexual intercourse with any other person in the last 12 months?

YES 1 (GO BACK TO 537 IN NEXT COLUMN)
NO 2 (GO TO 539)

INSERT EXCEL SECTION FOR Q 527-537, P. 33-34

539 In all, with how many different people have you had sexual relations with in the past 12 months?

IN CASE OF A NON-NUMERICAL ANSWER, INSIST TO OBTAIN ESTIMATION. IF THE NUMBER IS GREATER THAN ' 95 ', RECORD ' 95 ';

NUMBER OF PARTNERS ____

539. In all, with how many different people have you had sexual relations with in your whole life?

IN CASE OF A NON-NUMERICAL ANSWER, INSIST TO OBTAIN ESTIMATION. IF THE NUMBER IS GREATER THAN ' 95 ', RECORD ' 95 ';

NUMBER OF PARTNERS ____

540 CHECK THE COVER PAGE:

ADDITIONAL QUESTIONS ON SEXUAL ACTIVITY FOR MALES (1) OR FEMALES (2) ______

ADDITIONAL QUESTIONS FOR FEMALE INTERVIEW (COVER PAGE 2) (GO TO 541)

ADDITONAL QUESTIONS FOR MALE INTERVIEW (COVER PAGE 1) (GO TO 544)

541. CHECK PRESENCE OF OTHER PEOPLE

PRIVACY OBTAINED 1
PRIVACY IMPOSSIBLE 2 (GO TO 544)

542. The first time you had sexual intercourse, did you want to have sex or you were forced against your will?

ACCEPTED 1
FORCED 2
REFUSE TO RESPOND/NO RESPOND 3

543. In the last 12 months, did someone force you to have sex against your will?

YES 1
NO 2
REFUSE TO RESPOND/NO RESPOND 3

544. Do you know of a place where a person can get condoms?

YES 1
NO 2 (GO TO 601)

545. Where is that?
Any other place?

RECORD ALL SOURCES MENTIONED.

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) _________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
AGENT DBC C
OTHER PUBLIC (SPECIFY) _____ D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY F
PRIVATE DOCTOR G
ARBEF CLINIC H
NURSE I
OTHER PRIVATE MEDICAL (SPECIFY) ____ J
OTHER SOURCE
SHOP/KIOSK/STREET K
CHURCH L
FRIENDS/RELATIVES M
OTHER (SPECIFY) ____ X

546. If you wanted to, could you yourself get a condom?

YES 1
NO 2
DON'T KNOW/UNSURE 8

546A. Do you know of a place where you can buy condoms by walking?

YES 1
NO 2 (GO TO 601)

546B. Where is that?
Any other place?

RECORD ALL SOURCES MENTIONED.

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) _____________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
AGENT DBC C
OTHER PUBLIC (SPECIFY) _____ D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY F
PRIVATE DOCTOR G
ARBEF CLINIC H
NURSE I
OTHER PRIVATE MEDICAL (SPECIFY) ____ J
OTHER SOURCE
SHOP K
CHURCH L
FRIENDS/RELATIVES M
OTHER (SPECIFY) ____ X

546C. How long does it take you to get to the closest place to buy a condom?

MINUTES ___
ON THE SPOT 998

SECTION 6. FERTILITY PREFERENCES

601. CHECK 311/311A:

NEITHER STERILIZED (GO TO 602)
HE OR SHE STERILIZED (GO TO 614)

602. CHECK 226:

NOT PREGNANT OR UNSURE
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?

PREGNANT
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 (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 604)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 614)
NOT PREGNANT/UNDECIDED/DON'T KNOW 4 (GO TO 610)
PREGNANT/UNDECIDED/DON'TKNOW 5 (GO TO 608)

603. CHECK 226:

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

PREGNANT
After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?

MONTHS 1 ___
YEARS 2 ___
SOON/NOW 993 (GO TO 609)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 614)
AFTER MARRIAGE 995 (GO TO 609)
OTHER (SPECIFY) _____ 996 (GO TO 609)
DON'T KNOW 998 (GO TO 609)

604. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 605)
PREGNANT (GO TO 610)

605. CHECK 310:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 606)
NOT CURRENTLY USING (GO TO 606)
CURRENTLY USING (GO TO 608)

606. CHECK 603:

NOT ASKED (GO TO 607)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 607)
00-23 MONTHS OR 00-01 YEAR (GO TO 610)

607. CHECK 602:

WANTS TO HAVE A/ANOTHER CHILD
You have said that you do not want (a/another) child soon, but you are not using any method to avoid pregnancy. Can you tell me why? Any other reason?

WANTS NO MORE/NONE
You have said that you do not want any (more) children, but you are not using any method to avoid pregnancy. Can you tell me why? Any other reason?

RECORD ALL REASONS MENTIONED.

NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
SUBFECUND/INFECUND E
POSTPARTUM AMENORRHEIC F
BREASTFEEDING G
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
HEALTH CONCERNS O
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COSTS TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY'S NATURAL PROCESSES T
OTHER (SPECIFY) _____ X
DON'T KNOW Z

608. In the next few weeks, if you discovered that you were pregnant, would that be a big problem, a small problem, or no problem for you?

BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
SAYS SHE CAN'T GET PREGNANT/NOT HAVING SEX 4

609. CHECK 310:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 610)
NO, NOT CURRENLTY USING (GO TO 610)
YES, CURRENLTY USING (GO TO 614)

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

YES 1
NO 2 (GO TO 612)
DON'T KNOW 8 (GO TO 612)

611. Which contraceptive method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 614)
MALE STERILIZATION 02 (GO TO 614)
PILL 03 (GO TO 614)
IUD 04 (GO TO 614)
INJECTABLES 05 (GO TO 614)
IMPLANTS 06 (GO TO 614)
CONDOM 07 (GO TO 614)
FEMALE CONDOM 08 (GO TO 614)
DIAPHRAGM 09 (GO TO 614)
FOAM/JELLY 10 (GO TO 614)
LACTATIONAL AMEN. METHOD 11 (GO TO 614)
PERIODIC ABSTINENCE 12 (GO TO 614)
WITHDRAWAL 13 (GO TO 614)
DEADS/SDM 14 (GO TO 614)
OTHER (SPECIFY) _____ 96 (GO TO 614)
UNSURE 98 (GO TO 614)

612. What is the main reason that you think you will not use a contraceptive method at any time in the future?

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX/NO SEX 22 (GO TO 614)
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 614)
SUBFECUND/INFECUND 24 (GO TO 314)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (GO TO 614)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 614)
HUSBAND OPPOSED 32 (GO TO 614)
OTHERS OPPOSED 33 (GO TO 614)
RELIGIOUS PROHIBITION 34 (GO TO 614)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 614)
KNOWS NO SOURCE 42 (GO TO 614)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 614)
FEAR OF SIDE EFFECTS 52 (GO TO 614)
LACK OF ACCESS/TOO FAR 53 (GO TO 614)
COSTS TOO MUCH 54 (GO TO 614)
INCONVENIENT TO USE 55 (GO TO 614)
INTERFERES WITH BODY'S NATURAL PROCESSES 56 (GO TO 614)
OTHER (SPECIFY) _____ 96 (GO TO 614)
DON'T KNOW 98 (GO TO 614)

613. Would you ever use a contraceptive method if you were married?

YES 1
NO 2
DON'T KNOW 8

614. CHECK 216:

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 alive in your whole life, how many would that be?

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

PROBE FOR A NUMERIC RESPONSE.

NUMBER 00 (GO TO 616)
NUMBER ___
OTHER (SPECIFY) _____ 96 (GO TO 616)

615. How many of these children would you like to be boys, how many would you like to be girls and for how many would the sex not matter?

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

616. Would you say that you approve or disapprove of couples using a method to avoid getting pregnant?

APPROVE 1
DISAPPROVE 2
DON'T KNOW/UNSURE 3

617. In the last few months have you heard about family planning:

On the radio?
On the television?
In a newspaper or magazine?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER OR MAGAZINE
YES 1
NO 2

619. In the last few months, have you discussed the practice of family planning with your friends, neighbors, or relatives?

YES 1
NO 2 (GO TO 621)

620. With whom? Anyone else?
RECORD ALL PERSONS MENTIONED.

HUSBAND/PARTNER A
MOTHER B
FATHER C
SISTER (S) D
BROTHER (S) E
DAUGHTER F
SON G
MOTHER-IN-LAW H
FRIENDS/NEIGHBORS I
OTHER (SPECIFY) ____ X

621. CHECK 501:

YES, CURRENTLY MARRIED (GO TO 622)
YES, LIVING WITH A MAN (GO TO 622)
NO, NOT IN UNION (GO TO 628)

622. CHECK 311/311A:

ANY CODE CIRCLED (GO TO 623)
NO CODE CIRCLED (GO TO 624)

623. You have told me that you are currently using contraception. Would you say that using contraception is mainly your decision, mainly your husband's decision or did you both decide together?

MAINLY RESPONDENT 1
MAILY HUSBAND/PARTNER 2
JOINT DECISION 3
OTHER (SPECIFY) ____ 6

624. Now I want to ask you about your husband's/partner's views on family planning.
Do you think that your husband/partner approves or disapproves of couples using a contraceptive method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

625. In the past 12 months, how often have you talked to your husband/partner about family planning?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

626. CHECK 311/311A:

NEITHER STERILIZED (GO TO 627)
HE OR SHE STERILIZED (GO TO 628)

627. Do you think your husband/partner wants 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

628. Husbands and wives do not always agree on everything. Please tell me if you think a wife is justified in refusing to have sex with her husband when

She knows her husband has a sexually transmitted disease?
She knows her husband has sex with other women?
She has recently given birth?
She is tired or not in the mood?

HAS STD
YES 1
NO 2
DK 8
OTHER WOMEN
YES 1
NO 2
DK 8
RECENT BIRTH
YES 1
NO 2
DK 8
TIRED/MOOD
YES 1
NO 2
DK 8

629. When a woman knows that her husband has a sexually transmitted disease, this justified that she asks him to use a condom during sexual intercourse?

YES 1
NO 2
DON'T KNOW 8

630. CHECK 501:

CURRENTLY IN UNION (GO TO 631)
NOT IN UNION (GO TO 701)

631. Can you refuse to have the sexual relations with your husband/partner when you do not wish to have some?

YES 1
NO 2
IT DEPENDS/NOT SURE 8

632. Can you ask your husband/partner to use a condom if you want him to use it?

YES 1
NO 2
IT DEPENDS/NOT SURE 8

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

701. CHECK 501 AND 502:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 703)
FORMERLY MARRIED/LIVED WITH A MAN (GO TO 703)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 707)

703. Did your (last) husband/partner ever attend school?

YES 1
NO 2 (GO TO 706)

704. What was the highest level of school he attended:
Primary, reformed primary, post-primary, secondary, or higher?

PRIMARY (FORMER AND OR NEW) 1
PRIMARY REFORMED 2
POST PRIMARY/FAMIL/CERAR/CARAI 3
SECONDARY 4
HIGHER 5
DON'T KNOW 8 (GO TO 706)

705. What was the highest (class/year) he completed at that level?

CLASS/YEAR ___
DON'T KNOW 8

706. CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN
What is your husband's/partner's occupation? That is, what kind of work does he mainly do?

FORMERLY MARRIED/LIVED WITH A MAN
What was your (last) husband's/partner's occupation? That is, what kind of work did he mainly do?

______________ ___

707. Aside from your own housework, are you currently working?

YES 1 (GO TO 710)
NO 2

708. As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business.
Are you currently doing any of these things or any other work?

YES 1 (GO TO 710)
NO 2

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

YES 1
NO 2 (GO TO 719)

710. What is your occupation, that is, what kind of work do you mainly do?

_____________ ___

711. CHECK 710:

WORKS IN AGRICULTURE (GO TO 712)
DOES NOT WORK IN AGRICULTURE (GO TO 713)

712. Do you work mainly on your own land or on family land, or do you work on land that you rent from someone else, or do you work on someone else's land?

OWN LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
SHARECROPPER 5

713. 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

714. Do you usually work at home or away from home?

HOME 1
AWAY 2

715. 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

716. Are you paid or do you earn 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 (GO TO 719)
NOT PAID 4 (GO TO 719)

717. Who mainly decides how the money you earn will be used?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 6

718. On average, how much of your household's expenditures do your earnings pay for: almost none, less than half, about half, more than half, or all?

ALMOST NONE 1
LESS THAN HALF 2
ABOUT HALF 3
MORE THAN HALF 4
ALL 5
NONE, HER INCOME IS ALL SAVED 6

719. Who in your family usually has the final say on the following decisions:

Your own health care?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
Making large household purchases?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
Making household purchases for daily needs?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
Visits to family or relatives?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
What food should be cooked each day?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6

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

CHILDREN UNDER 10 YRS:
PRES/LISTEN. 1
PRES/NOT LISTEN. 2
NOT PRES 8
HUSBAND:
PRES/LISTEN. 1
PRES/NOT LISTEN. 2
NOT PRES 8
OTHER MALES:
PRES/LISTEN. 1
PRES/NOT LISTEN. 2
NOT PRES 8
OTHER FEMALES:
PRES/LISTEN. 1
PRES/NOT LISTEN. 2
NOT PRES 8

721. Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

If she goes out without telling him?
If she neglects the children?
If she argues with him?
If she refuses to have sex with him?
If she burns the food?

GOES OUT
YES 1
NO 2
DK 8
NEGL. CHILDREN
YES 1
NO 2
DK 8
ARGUES
YES 1
NO 2
DK 8
REFUSES SEX
YES 1
NO 2
DK 8
BURNS FOOD
YES 1
NO 2
DK 8

SECTION 8: AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES

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

YES 1
NO 2 (GO TO 844)

802. Can people reduce their chances of getting the AIDS virus by having just one sex partner who is not infected and who has no other partners?

YES 1
NO 2
DON'T KNOW 8

803. Can a person get the AIDS virus from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

806. Can people reduce their chances of getting the AIDS virus by abstaining from sex?

YES 1
NO 2
DON'T KNOW 8

807. Can people get the AIDS virus by sorcery or supernatural means?

YES 1
NO 2
DON'T KNOW 8

808. Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?

YES 1
NO 2 (GO TO 810)
DON'T KNOW 8 (GO TO 810)

809. What can a person do? Anything else?
RECORD ALL WAYS MENTIONED.

ABSTAIN FROM SEX A
USE CONDOMS B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER C
LIMIT NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PERSONS WH HAVE MANY PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH PERSONS WHO INJECT DRUGS INTRAVENOUSLY H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID SHARING RAZORS/BLADES K
AVOID KISSING L
AVOID MOSQUITO BITES M
SEEK PROTECTION FROM TRADITIONAL PRACTIONER N
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) _____ X
DON'T KNOW Z

810. Is it possible for a healthy-looking person to have the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

811. Can the virus that causes AIDS be transmitted from a mother to a child:

During pregnancy?
During delivery?
By breastfeeding?

DURING PREGNANCY
YES 1
NO 2
DK 8
DURING DELIVERY
YES 1
NO 2
DK 8
BREASTFEEDING
YES 1
NO 2
DK 8

812. CHECK 811:

AT LEAST ONE "YES" (GO TO 813)
OTHER (GO TO 814)

813. Are there special drugs that a doctor or a nurse can give a woman infected by the virus of the AIDS to reduce the risk of transmission to his baby?

YES 1
NO 2
DON'T KNOW 8

814. Are there special drugs that the people infected with the AIDS virus can obtain from a doctor or a nurse?

YES 1
NO 2
DON'T KNOW 8

815. CHECK 215:

LAST BIRTH SINCE JANUARY 2003 (GO TO 816)
NO BIRTHS (GO TO 824)
LAST BIRTH BEFORE JANUARY 2003 (GO TO 824)

816. CHECK 407:

SAW SOMEONE FOR PRENATAL CARE (GO TO 817)
DID NOT SEE ANYONE FOR PRENATAL CARE (GO TO 824)

817. Now I would like to ask some questions about your last birth.
During one of the antenatal visits for this pregnancy, did anyone speak to you about one of the following subjects:

Babies who contract the AIDS virus from their mother?
The things that one can do not to contract AIDS?
Conducting a test for AIDS?

MOTHERS VIRUS
YES 1
NO 2
DK 8
THINGS TO DO
YES 1
NO 2
DK 8
AIDS TEST
YES 1
NO 2
DK 8

818. Within the framework of this prenatal care, did someone propose to you to carry out a test for AIDS?

YES 1
NO 2

819. I do not want to know the results but did you carry out a test for AIDS within the framework of your prenatal care?

YES 1
NO 2 (GO TO 824)

820. I do not want to know the results but did you obtain the results of the test?

YES 1
NO 2

821. Where was the test done?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) __________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
VCT CENTER 13
OTHER PUBLIC (SPECIFY) _____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR 22
VCT CENTER 23
ARBEF CLINIC 24
INFIRMARY 25
YOUTH CENTER 26
OTHER PRIVATE MEDICAL (SPECIFY) ____ 27

822. Did you carry out another test for AIDS since you were tested during your pregnancy?

YES 1 (GO TO 825)
NO 2

823. When was the last time you were tested?

LESS THAN 12 MONTHS 1 (GO TO 831)
12-23 MONTHS 2 (GO TO 831)
2 YEARS OR MORE 3 (GO TO 831)

824. I you do not want to know the results, but have you ever been tested to see if you have the AIDS VIRUS?

YES 1
NO 2 (GO TO 829)

825. When was the last time you were tested?

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

825A. How much did you spend for this test?

PRICE ____
FREE 00000
DON'T KNOW 99998

826. The last time you had the test, did you yourself ask for the test, was it offered to you and you accepted, or was it required?

ASKED FOR THE TEST 1
OFFERED AND ACCEPTED 2
REQUIRED 3

827. I do not want to know the results but did you get the results of the test?

YES 1
NO 2

828. Where did you go for the test?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) ______________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (GO TO 831)
GOVERNMENT HEALTH CENTER 12 (GO TO 831)
VCT CENTER 13 (GO TO 831)
OTHER PUBLIC (SPECIFY) _____ 16 (GO TO 831)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21 (GO TO 831)
PRIVATE DOCTOR 22 (GO TO 831)
VCT CENTER 23 (GO TO 831)
ARBEF CLINIC 24 (GO TO 831)
INFIRMARY 25 (GO TO 831)
YOUTH CENTER 26 (GO TO 831)
OTHER PRIVATE MEDICAL (SPECIFY) ____ 27 (GO TO 831)

829. Do you know a place where you could go to get an AIDS test?

YES 1
NO 2 (GO TO 831)

830 Where can you go for the test?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) ________________

Any other place?
RECORD ALL SOURCES MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
VCT CENTER C
OTHER PUBLIC (SPECIFY) _____ X
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC D
PRIVATE DOCTOR E
VCT CENTER F
ARBEF CLINIC G
INFIRMARY H
YOUTH CENTER I
OTHER PRIVATE MEDICAL (SPECIFY) ____ J

831. Would you buy fresh vegetables from a vendor who has the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

831B .In your opinion, is it acceptable or unacceptable for AIDS to be discussed:

On the radio?
On the TV?
In newspapers?

ON THE RADIO
ACCEPTABLE 1
NOT ACCEPTABLE 2
ON THE TV
ACCEPTABLE 1
NOT ACCEPTABLE 2
IN NEWSPAPERS
ACCEPTABLE 1
NOT ACCEPTABLE 2

831C. During last three months, did you hear or see something on AIDS through the media?

YES 1
NO 2
DON'T KNOW 8

831D. Through which media did you hear or see something on AIDS?

On the radio?
On the Television?
In the newspapers or magazines?
Through the posters, flyers or stickers?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPERS/MAGAZINES
YES 1
NO 2
POSTER/FLYER/STICKER
YES 1
NO 2

831E. Did you change your behavior in an unspecified way following what you heard or saw about AIDS?

YES 1
NO 2 (GO TO 831G)
DON'T KNOW 8 (GO TO 831G)

831F. How did you change behavior? Anything else?
RECORD ALL WAYS MENTIONED.

LIMIT NUMBER OF SEXUAL PARTNERS A
STAY FAITHFUL TO ONE PARTNRE B
AVOID SEX WITH PROSTITUTES C
AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS E
ABSTAIN FROM SEX F
AVOID INJECTIONS G
AVOID BLOOD TRANSFUSIONS H
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) _____ X
DON'T KNOW Z

831G. CHECK 501:

YES, CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 831H)
NO, NOT IN UNION (GO TO 832)

831H. Have you ever talked about ways to prevent getting the virus that causes AIDS with (your husband/the man you are living with)?

YES 1
NO 2

831I. During the last six months, did you advise someone to take unspecified measures to avoid being infected with AIDS virus?

YES 1
NO 2
DON'T KNOW 8

832. If a member of your family got infected with the virus that causes AIDS, would you want it to remain a secret or not?

YES, RMAIN SECRET 1
NO 2
DON'T KNOW/DEPENDS 8

833. If a relative of yours became sick with the virus that causes AIDS, would you be willing to care for her or him in your own household?

YES 1
NO 2
DON'T KNOW 8

834. If a female teacher has the virus that causes aids, should she be allowed to continue teaching in the school?

CAN CONTINUE 1
SHOULD NOT CONTINUE 2
DK/NOT SURE/DEPENDS 8

835. Do you personally know someone who was denied health services during the last 12 months because (s)he was suspected to have AIDS or because s(he) had AIDS?

YES 1
NO 2
KNOWS NOBODY WITH AIDS 8 (GO TO 840)

836. Do you personally know somebody who refused to take part in social demonstrations, religious services or Community events during the last 12 months because (s)he suspect to have AIDS or because (s)he had AIDS?

YES 1
NO 2

837. Do you personally know somebody who was insulted or scoffed during the last 12 months because one (s)he was suspected to have AIDS or because (s)he had AIDS?

YES 1
NO 2

838. CHECK 835,836 AND 837:

NOT ONE 'YES' (GO TO 839)
AT LEAST ONE "YES" (GO TO 840)

839. Do you personally know somebody who is suspected to have AIDS, has AIDS, or who died of AIDS?

YES 1
NO 2

840. Do you agree or not agree with the following assertion:
People who have AIDS should be ashamed of themselves.

AGREE 1
DO NOT AGREE 2
DK/NO OPINION 8

841. Do you agree or do not agree with the following assertion:
People with the AIDS virus should be blamed for bringing the disease in the community.

AGREE 1
DO NOT AGREE 2
DK/NO OPINION 8

842. Should one educate children of 12-14 years on the use of the condom to avoid the AIDS?

AGREE 1
DO NOT AGREE 2
DK/NOT SURE/IT DEPENDS 8

843. Should one teach children of 12-14 years to wait until the marriage to have sexual relations to avoid contracting the AIDS?

AGREE 1
DO NOT AGREE 2
DK/NOT SURE/IT DEPENDS 8

844. Do you think that young men should wait to be married to have sexual relations?

AGREE 1
DO NOT AGREE 2
DK/NOT SURE/IT DEPENDS 8

845. Do you think that the majority of the young men you know wait to be married to have sexual relations?

AGREE 1
DO NOT AGREE 2
DK/NOT SURE/IT DEPENDS 8

846. Do you think that the men who are not married and who have sexual relations should not have sexual relations with only one person?

AGREE 1
DO NOT AGREE 2
DK/NOT SURE/IT DEPENDS 8

847. Do you think that majority of the men you know, who are not married and who have sexual relations should have sexual relations only with one person?

AGREE 1
DO NOT AGREE 2
DK/NOT SURE/IT DEPENDS 8

848. Do you think that the married men should have sexual relations only with their wives?

AGREE 1
DO NOT AGREE 2
DK/NOT SURE/IT DEPENDS 8

849. Do you think that majority of the married men you know have sexual relations only with their wives?

AGREE 1
DO NOT AGREE 2
DK/NOT SURE/IT DEPENDS 8

850. Do you think that young women should wait to be married to have sexual relations?

AGREE 1
DO NOT AGREE 2
DK/NOT SURE/IT DEPENDS 8

851. Do you think that majority of the young women whom you know wait to be married to have sexual relations?

AGREE 1
DO NOT AGREE 2
DK/NOT SURE/IT DEPENDS 8

852. Do you think that the women who are not married and who have sexual relations should not have sexual relations with only one person?

AGREE 1
DO NOT AGREE 2
DK/NOT SURE/IT DEPENDS 8

853. Do you think that majority of women you know, who are not married and who have sexual relations should have sexual relations only with only one person?

AGREE 1
DO NOT AGREE 2
DK/NOT SURE/IT DEPENDS 8

854. Do you think that the married women should have sexual relations only with their husbands?

AGREE 1
DO NOT AGREE 2
DK/NOT SURE/IT DEPENDS 8

855. Do you think that the majority of the married women you know have sexual relations only with their husbands?

AGREE 1
DO NOT AGREE 2
DK/NOT SURE/IT DEPENDS 8

856. CHECK 801:

HEARD OF AIDS:
Apart from AIDS, have you ever heard of other infections that are transmitted by sexual contact?

NOT HEARD OF AIDS
Have you heard of infections that are transmitted by sexual contact?

YES 1
NO 2 (GO TO 859)

857. If a man has a sexually transmitted disease, what symptoms might he have? Any others?
RECORD ALL SYMPTOMS MENTIONED.

AGREE 1
DO NOT AGREE 2
DK/NOT SURE/IT DEPENDS 8

858. If a woman has a sexually transmitted disease, what symptoms might she have? Any others?
RECORD ALL SYMPTOMS MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
LOSS OF WEIGHT K
HARD TO GET PREGNANT/HAVE A CHILD L
OTHER (SPECIFY) _____ W
OTHER (SPEICYF) _____ X
NO SYMPTOMS Y
DON'T KNOW Z

859. CHECK 519:

HAS HAD SEXUAL RELATIONS (GO TO 860)
HAS NOT HAD SEXUAL RELATIONS (GO TO 901A)

860. CHECK 856:

KNOWS STI (GO TO 861)
DOES NOT KNOW STI (GO TO 862)

861. 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 sexually-transmitted disease?

YES 1
NO 2
DON'T KNOW 8
862. 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

863. 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

864. CHECK 861, 862, 863:

HAS HAD AN INFECTION (ONE 'YES') (GO TO 865)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 901A)

865. The last time you had (PROBLEM FROM 861/862//863), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 901A)

866. Where did you go?
Any other place?
RECORD ALL SOURCES MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
AGENT DBC C
VCT CENTER D
YOUTH CENTER E
OTHER PUBLIC (SPECIFY) _____ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PRIVATE DOCTOR H
PHARMACY I
ARBEF CLINIC J
INFIRMARY L
YOUTH CENTER M
OTHER PRIVATE MEDICAL (SPECIFY) ____ Y
OTHER SOURCE
SHOP N
OTHER (SPECIFY) ____ X

867. When you had (PROBLEM FROM 861/862/863), did you inform the person with whom you were having sex?

YES 1
NO 2
SOME/NOT ALL 3
DID NOT HAVE PARTNER 4 (GO TO 901A)

868. When you had (PROBLEM FROM 861/862/863), did you do something to avoid infecting your sexual partner(s)?

YES 1
NO 2 (GO TO 901A)
PARTNER ALREADY INJECTED 3 (GO TO 901A)

869. What did you do to avoid infecting your partner(s)? Did you....

Use medicine?
Stop having sex?
Use a condom when having sex?

USE MEDICINE
YES 1
NO 2
STOP SEX
YES 1
NO 2
USE CONDOM
YES 1
NO 2

SECTION 9. ADULT MORTALITY

901A. Now I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your natural mother.
Did your mother give birth to any children, in addition to you?

YES 1
NO 2 (GO TO 901H)

901B. How many sons did your mother have who are still living?

SONS LIVING ____

901C How many sons did your mother have who have died?

SONS DEAD ____

901D. In addition to you, how many daughters did your mother have who are still living?

DAUGHTERS LIVING ____

901E. How many daughters did your mother have who have died?

DAUGHTERS LIVING ____

901F. Did your mother have any other children which you do not know if they are alive or dead?

YES 1
NO 2 (GO TO 901H)

901G. How many other children did your mother have which you do not know if they are alive or dead?

OTHER CHILDREN ___

901H. SUM ANSWERS TO 901B, C, D, E, AND G, ADD 1 (THE RESPONDENT) AND ENTER TOTAL.

TOTAL ____

901I. CHECK 901H:
Just to make sure that I have this right: including yourself, your mother gave birth to _____ children in total. Is that correct?

YES CORRECT (GO TO 902)
NO (PROBE AND 901-A-H AS NECESSARY)

902. CHECK 901H:

TWO OR MORE BIRTHS (GO TO 903)
ONLY ONE BIRTH (RESPONDENT ONLY) (1004A)

903. How many of these births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS ___

Q. 904 - Q. 913 ARE ASKED OF SIBLING 1-12 SEPARATELY.

904. What was the name given to your oldest (next oldest) brother or sister?

_____________

905. Is (NAME) male or female?

MALE 1
FEMALE 2

906. Is (NAME) still alive?

YES 1
NO 2 (GO TO 908)
DK 8 (GO TO NEXT SIBLING)

907. How old is (NAME)?

_____ (GO TO NEXT SIBLING)

908. How many years ago did (NAME) die?

_____

909. How old was (NAME) when he/she died?
IF DON'T KNOW, PROBE:
Did (NAME) die before age 12?
IF YES, ENTER '95' IF NO, ASK ADDITIONAL QUESTIONS TO GET AN ESTIMATE. FOR EXAMPLE: Did (NAME) die before or after being married?

____ (IF MALE, OR DIED BEFORE AGE 12 YEARS: GO TO NEXT SIBLING)

910. Was (NAME) pregnant when she died?

YES 1 (GO TO 913)
NO 2

911. Did (NAME) die during childbirth?

YES 1 (GO TO 913)
NO 2

912. Did (NAME) die in the two months following the end of a pregnancy or childbirth?

YES 1
NO 2

913. To how many live children did (NAME) give birth to during her life?

_____

IF NO MORE BROTHERS OR SISTERS, GO TO Q.1000A

SECTION 10. RELATIONS IN THE HOUSEHOLD

1000A. CHECK COVER PAGE: THE WOMAN BEING INTERVIEWED IS SELECTED FOR QUESTIONS ON RELATIONS IN THE HOUSEHOLD.

YES (GO TO 1001)
NO (GO TO 1029)

1001. CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED.

PRIVACY OBTAINED 1 (READ LOWER PROMPT)
PRIVACY NOT POSSIBLE 2 (GO TO 1028)

READ TO ALL RESPONDENTS:
Now I would like to ask you questions about some other important aspects of a woman's life. I know that some of these questions are very personal. However, your answers are crucial for helping to understand the condition of women in Rwanda. Let me assure you that your answers are completely confidential and will not be told to anyone. Let me assure you also that you are the only person in this household to whom these questions will be asked. If someone arrives during the discussion then we'll change subjects.

1002. CHECK 501, 502, AND 504:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 1003)
SEPARATED/DIVORCED (GO TO 1003)
WIDOWED/NEVER MARRIED/NEVER LIVIED WITH A MAN (GO TO 1014)

1003. When two people marry or live together, they share both good and bad moments. In your relationship with your (last) husband/partner do (did) the following happen frequently, only sometimes, or never?

a) He usually (spends/spent) his free time with you?
b) He (consults/consulted) you on different household matters?
c) He (is/was) affectionate with you?
d) He (respects/respected) you and your wishes?

FREE TIME
NEVER 1
FREQUENTLY 2
SOMETIMES 3
CONSULTS
NEVER 1
FREQUENTLY 2
SOMETIMES 3
AFFECTIONATE
NEVER 1
FREQUENTLY 2
SOMETIMES 3
RESPECTS
NEVER 1
FREQUENTLY 2
SOMETIMES 3

1004. Now 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/partner?

a) He (is/was) jealous or angry if you (talk/talked) to other men?
b) He frequently (accuses/accused) you of being unfaithful?
c) He (does/did) not permit you to meet your girl friends?
d) He (tries/tried) to limit your contact with your family?
e) He (insists/insisted) on knowing where you (are/were) at all time?
f) He (does/did) not trust you with any money?

JEALOUS
YES 1
NO 2
DK 8
ACCUSES
YES 1
NO 2
DK 8
NOT MEET FRIENDS
YES 1
NO 2
DK 8
NO FAMILY
YES 1
NO 2
DK 8
WHERE YOU ARE
YES 1
NO 2
DK 8
MONEY
YES 1
NO 2
DK 8

1005. Now if you will permit me, I need to ask some more questions about your relationship with your (last) husband/partner.

5A. (Does/did) your (last) husband/partner ever:

Say or do something to humiliate you in front of others?
YES 1 (GO TO 5B)
NO 2 (GO TO NEXT)
Threaten you or someone close to you with harm?
YES 1 (GO TO 5B)
NO 2

5B. How many times did this happen during the last 12 months?

Say or do something to humiliate you in front of others?
TIMES IN LAST 12 MONTHS ____
IF DIV OR SEPARATED 95
Threaten you or someone close to you with harm?
TIMES IN LAST 12 MONTHS ____
IF DIV OR SEPARATED 95

1006. 6A. (Does/did) your (last) husband/partner ever:

Push you, shake you, or throw something at you?
YES 1 (GO TO 6B)
NO 2 (GO TO NEXT)
Slap you or twist your arm?
YES 1 (GO TO 6B)
NO 2 (GO TO NEXT)
Spit on you?
YES 1 (GO TO 6B)
NO 2 (GO TO NEXT)
Punch you with his fist or with something that could hurt you?
YES 1 (GO TO 6B)
NO 2 (GO TO NEXT)
Kick you or drag you?
YES 1 (GO TO 6B)
NO 2 (GO TO NEXT)
Try to strange you or burn you?
YES 1 (GO TO 6B)
NO 2 (GO TO NEXT)
Threaten you with a knife, gun, or other type of weapon?
YES 1 (GO TO 6B)
NO 2 (GO TO NEXT)
Attack you with a knife, gun or other type of weapon?
YES 1 (GO TO 6B)
NO 2 (GO TO NEXT)
Physically force you to have sexual intercourse with him even when you did not want to?
YES 1 (GO TO 6B)
NO 2 (GO TO NEXT)
Force you to perform other sexual acts you did not want to?
YES 1 (GO TO 6B)
NO 2

6B. How many times did this happen during the last 12 months?

Push you, shake you, or throw something at you?
TIMES IN LAST 12 MONTHS ____
IF DIV OR SEPARATED 95
Slap you or twist your arm?
TIMES IN LAST 12 MONTHS ____
IF DIV OR SEPARATED 95
Spit on you?
TIMES IN LAST 12 MONTHS ____
IF DIV OR SEPARATED 95
Punch you with his fist or with something that could hurt you?
TIMES IN LAST 12 MONTHS ____
IF DIV OR SEPARATED 95
Kick you or drag you?
TIMES IN LAST 12 MONTHS ____
IF DIV OR SEPARATED 95
Try to strange you or burn you?
TIMES IN LAST 12 MONTHS ____
IF DIV OR SEPARATED 95
Threaten you with a knife, gun, or other type of weapon?
TIMES IN LAST 12 MONTHS ____
IF DIV OR SEPARATED 95
Attack you with a knife, gun or other type of weapon?
TIMES IN LAST 12 MONTHS ____
IF DIV OR SEPARATED 95
Physically force you to have sexual intercourse with him even when you did not want to?
TIMES IN LAST 12 MONTHS ____
IF DIV OR SEPARATED 95
Force you to perform other sexual acts you did not want to?
TIMES IN LAST 12 MONTHS ____
IF DIV OR SEPARATED 95

1007. CHECK 1006:

AT LEAST ONE 'YES' (GO TO 1008)
NOT A SINGLE 'YES' (GO TO 1009)

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

NUMBER OF YEARS ___
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95
AFTER SEPARATION/DIVORCE 96

1009. Did the following ever happen because of something your (last) husband/partner did to you:

You had bruises and aches?
YES 1 (GO TO 108B)
NO 2 (GO TO NEXT)
You had an injury or a broken bone?
YES 1 (GO TO 108B)
NO 2 (GO TO NEXT)
You went to the doctor or health center as a result of something your husband/partner did to you?
YES 1 (GO TO 108B)
NO 2 (GO TO NEXT)

108B. How many times did this happen during the last 12 months?

You had bruises and aches?
TIMES IN LAST 12 MONTHS___
IF DIV OR SEPARATED 95
You had an injury or a broken bone?
TIMES IN LAST 12 MONTHS___
IF DIV OR SEPARATED 95
You went to the doctor or health center as a result of something your husband/partner did to you?
TIMES IN LAST 12 MONTHS___
DIV OR SEPARATED 95

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

YES 1
NO 2 (GO TO 1012)

1011. In the last 12 months, how many times have you hit, slapped, kicked or done something to physically hurt your (last) husband/partner at a time when he was not already beating or physically hurting you?

TIMES IN LAST 12 MONTHS ___
IF DIV OR SEPARATED 95

1012. Does (did) your (last) husband/partner drink alcohol?

YES 1
NO 2 (GO TO 1014)

1013. How often does (did) he get drunk: very often, only sometimes, or never?

VERY OFTEN 1
SOMETIMES 2
NEVER 3

1014. CHECK 501, 502 AND 504:

MARRIED/LIVING WITH A MAN/SEPARATED/DIVORCED
From the time you were 15 years old has anyone other than your (current/last) husband/partner hit, slapped, kicked, or done anything else to hurt you physically?

WIDOWED/NEVER MARRIED/NEVER LIVED WITH A MAN
From the time you were 15 years old has anyone ever hit, slapped, kicked, or done anything else to hurt you physically?

YES 1
NO 2 (GO TO 1019)
NO ANSWER 6 (GO TO 1019)

1015. Who has physically hurt you in this way? Anyone else?
RECORD ALL MENTIONED.

MOTHER A
FATHER B
STEP-MOTHER C
STEP-FATHER D
SISTER E
BROTHER F
DAUGHTER G
SON H
LATE/EX-HUSBAND/EX-PARTNER I
CURRENT BOYFRIEND K
MOTHER-IN-LAW L
FATHER-IN-LAW M
OTHER FEMALE RELATIVE/IN-LAW N
OTHER MALE RELATIVE/IN-LAW O
FEMALE FRIEND/ACQUAINTANCE Q
TEACHER R
EMPLOYER S
STRANGER T
OTHER (SPECIFY)_____ X

1016. CHECK 1015:

MORE THAN ONE PERSON MENTIONED (GO TO 1017)
ONLY ONE PERSON MENTIONED (GO TO 1018)

1017. Who has hit, slapped, kicked, or done something to physically hurt you most often?

MOTHER A
FATHER B
STEP-MOTHER C
STEP-FATHER D
SISTER E
BROTHER F
DAUGHTER G
SON H
LATE/EX-HUSBAND/EX-PARTNER I
CURRENT BOYFRIEND K
MOTHER-IN-LAW L
FATHER-IN-LAW M
OTHER FEMALE RELATIVE/IN-LAW N
OTHER MALE RELATIVE/IN-LAW O
FEMALE FRIEND/ACQUAINTANCE Q
TEACHER R
EMPLOYER S
STRANGER T
OTHER (SPECIFY)_____ X

1018. In the last 12 months, how many times has this person hit, slapped, kicked, or done anything else to physically hurt you?

NUMBER OF TIMES ___

1019. CHECK 201, 206, AND 226:

HAS ONE OR MORE LIVE OR NON-LIVE BIRTHS OR IS CURRENLTY PREGNANT (GO TO 1020)

NO LIVE BIRTH, NO NON-LIVE BIRTHS, AND IS NOT CURRENTLY PREGNANT (GO TO 1021)

1020. 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 1022)

1021. Who has done any of these things to physically hurt you while you were pregnant? Anyone else?
RECORD ALL MENTIONED.

CURRENT HUSBAND/PARTNER A
MOTHER B
FATHER C
STEP-MOTHER D
STEP-FATHER E
SISTER F
BROTHER G
DAUGHTER H
SON I
LATE/EX-HUSBAND/EX-PARTNER J
CURRENT BOYFRIEND K
MOTHER-IN-LAW M
FATHER-IN-LAW N
OTHER FEMALE RELATIVE/IN-LAW O
OTHER MALE RELATIVE/IN-LAW P
FEMALE FRIEND/ACQUAINTANCE Q
MALE FRIEND/ACQUAINTANCE R
TEACHER S
EMPLOYER T
STRANGER U
OTHER (SPECIFY)_____ X

1022. CHECK 1006, 1009, 1014, AND 1020:

AT LEAST ONE 'YES' (GO TO 1023)
NOT A SINGLE 'YES' (GO TO 1026)

1023. Have you ever tried to get help to prevent or stop (this person/these persons) from physically hurting you?

YES 1
NO 2 (GO TO 1025)

1024. From whom have you sought help? Anyone else?
RECORD ALL MENTIONED

MOTHER A (GO TO 1026)
FATHER B (GO TO 1026)
SISTER C (GO TO 1026)
BROTHER D (GO TO 1026)
CURRENT/LAST/LATE HUSBAND/PARTNER E (GO TO 1026)
CURRENT.FORMER BOYFRIEND F (GO TO 1026)
MOTHER-IN-LAW G (GO TO 1026)
FATHER-IN-LAW H (GO TO 1026)
OTHER FEMALE RELATIVE/IN-LAW I (GO TO 1026)
OTHER MALE RELATIVE/IN-LAW J (GO TO 1026)
FRIEND K (GO TO 1026)
NEIGHBOR L (GO TO 1026)
TEACHER M (GO TO 1026)
EMPLOYER N (GO TO 1026)
RELIGIOUS LEADER O (GO TO 1026)
DOCTOR/MEDICAL PERSONNEL P (GO TO 1026)
POLICE Q (GO TO 1026)
LAWYER R (GO TO 1026)
OTHER (SPECIFY)_____ X (GO TO 1026)

1025. What is the main reason you have never sought help?

DON'T KNOW WHO TO GO TO 01
NO USE 02
PART OF LIFE 03
AFRAID OF DIVORCE/DESERTION 04
AFRAID OF FURTHER BEATINGS 05
AFRAID OF GETTING PERSON BEATING HER INTO TROUBLE 06
EMBARRASSED 07
DON'T WANT TO DISGRACE FAMILY 08
OTHER (SPECIFY) ____ 96

1026. 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 HOUSEHOLD RELATIONS MODULE ONLY.

1027. 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
OTHER FEMALE ADULT
YES ONCE 1
YES, MORE THAN ONCE 2
NO 3

1028. INTERVIEWER'S COMMENTS / EXPLANATION FOR NOT COMPLETING THE HOUSEHOLD RELATIONS MODULE
_______________________

1029. RECORD THE TIME.

HOUR ____
MINUTES ____

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT:
_______________

COMMENTS ON SPECIFIC QUESTIONS:
______________

ANY OTHER COMMENTS:
______________

SUPERVISOR'S OBSERVATIONS
______________

NAME OF THE SUPERVISOR: ___________________
DATE: _______________

EDITOR'S OBSERVATIONS
_______________

NAME OF EDITOR_____________________________
DATE: _______________

INSTRUCTIONS:
ONLY ONE CODE SHOULD APPEAR IN ANY BOX.

BIRTHS AND PREGNANCIES

B BIRTHS
P PREGNANCIES
T TERMINATIONS

2005
12 DEC 01
11 NOV 02
10 OCT 03
09 SEP 04
08 AUG 05
07 JUL 06
06 JUN 07
05 MAY 08
04 APR 09
03 MAR 10
02 FEB 11
01 JAN 12

2004
12 DEC 13
11 NOV 14
10 OCT 15
09 SEP 16
08 AUG 17
07 JUL 18
06 JUN 19
05 MAY 20
04 APR 21
03 MAR 22
02 FEB 23
01 JAN 24

2003
12 DEC 25
11 NOV 26
10 OCT 27
09 SEP 28
08 AUG 29
07 JUL 30
06 JUN 31
05 MAY 32
04 APR 33
03 MAR 34
02 FEB 35
01 JAN 36

2002
12 DEC 37
11 NOV 38
10 OCT 39
09 SEP 40
08 AUG 41
07 JUL 42
06 JUN 43
05 MAY 44
04 APR 45
03 MAR 46
02 FEB 47
01 JAN 48

2001
12 DEC 49
11 NOV 50
10 OCT 51
09 SEP 52
08 AUG 53
07 JUL 54
06 JUN 55
05 MAY 56
04 APR 57
03 MAR 58
02 FEB 59
01 JAN 60

2000
12 DEC 61
11 NOV 62
10 OCT 63
09 SEP 64
08 AUG 65
07 JUL 66
06 JUN 67
05 MAY 68
04 APR 69
03 MAR 70
02 FEB 71
01 JAN 72