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RWANDA DEMOGRAPHIC AND HEALTH SURVEYS 2014-15
WOMAN'S QUESTIONNAIRE

MINECOFIN

MINISTRY OF HEALTH

NATIONAL INSTITUTE OF STATISTICS

IDENTIFICATION

PROVINCE____

DISTRICT____

SECTOR____

NAME OF HOUSEHOLD HEAD____

CLUSTER NUMBER____

HOUSEHOLD STRUCTURE NUMBER____

HOUSEHOLD NUMBER____

NAME AND LINE NUMBER OF WOMAN:
NAME____
LINE NO.____

CHECK COVER PAGE OF THE HOUSEHOLD QUESTIONNAIRE:
HOUSEHOLD SELECTED FOR FEMALE DOMESTIC MODULE

YES 1
NO 2

CHECK Q. 141w IN HOUSEHOLD QUESTIONNAIRE:
IS THIS WOMAN SELECTED FOR FEMALE DOMESTIC VIOLENCE MODULE?

YES 1
NO 2

INTERVIEWER VISITS:

FIRST VISIT
DATE____
INTERVIEWER'S NAME____
RESULT*

NEXT VISIT:
DATE_____
TIME____

SECOND VISIT
DATE____
INTERVIEWER'S NAME____
RESULT*

NEXT VISIT:
DATE____
TIME____

THIRD VISIT
DATE____
INTERVIEWER'S NAME____
RESULT*

FINAL VISIT
DAY____
MONTH____
YEAR____
INT. NUMBER____
RESULT____

TOTAL NUMBER OF VISITS

*RESULT CODES

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

LANGUAGE OF INTERVIEW

KINYARWANDA 1
OTHER (SPECIFY) ____ 6

TRANSLATOR USED?

YES 1
NO 2

SUPERVISOR____
NAME____

FIELD EDITOR____
NAME____

OFFICE EDITOR____

KEYED BY____

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

INFORMED CONSENT

Hello. My name is ____________________. I am working with the National Institute of Statistics of Rwanda. We are conducting a survey about health all over Rwanda. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 30 to 60 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question of you can stop the interview at any time.

In case you need more information about the survey, you may contact the person listed on the card that has already been given to your household.

Do you have any questions? May I begin the interview now?

SIGNATURE OF INTERVIEWER: ____________________ DATE: __________

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

101) RECORD THE TIME.

HOUR
MINUTES

102) In what month and year were you born?

MONTH______
DON'T KNOW MONTH 98
YEAR______
DON'T KNOW YEAR 9998

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

AGE IN COMPLETED YEARS______

104) Have you ever attended school?

YES 1
NO 2 (GO TO 108)

105) What is the highest level of school you attended: primary, post-primary, secondary, or higher?

PRIMARY 1
POST-PRIMARY/VOCATIONAL 2
SECONDARY 3
TERTIARY 4
PRE-PRIMARY 6

106) What is the highest (grade/form/year) you completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

GRADE/FORM/YEAR______

107) CHECK 105:

PRIMARY OR LESS (GO TO 108)
POST-PRIMARY/VOCATIONAL SECONDARY OR TERTIARY (GO TO 110)

108) 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

109) CHECK 108:

CODE '2', '3' OR '4' CIRCLED (GO TO 110)
CODE '1' OR '5' CIRCLED (GO TO 111)

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

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

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

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

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

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

113) What is your religion?

CATHOLIC 1
PROTESTANT 2
ADVENTIST 3
MUSLIM 4
TRADITIONAL 5
OTHER (SPECIFY) ____ 6
NO RELIGION 7

115) In the last 12 months, how many times have you been away from home for one or more nights?

NUMBER OF TIMES______
NONE 00 (GO TO 201)

116) In the last 12 months, have you been away from home for more than one month at a time?

YES 1
NO 2

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______

205C) Where do your sons or daughters who do not live with you live?
CIRCLE ALL MENTIONED.

BOARDING SCHOOL A
RELATIVE B
IN THE STREET C
WORK (SPECIFY) ____ D
MARRIED E
OTHER (SPECIFY) ____ X
DON'T KNOW Z

206) Have you ever given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

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_____

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

TOTAL BIRTHS_____

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 ROWS. (IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW).

212) What name was given to your next baby? RECORD NAME. BIRTH HISTORY NUMBER_____

NAME___________

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

BOY 1
GIRL 2

214) Were any of these births twins?

SINGLE 1
MULTIPLE 2

215) In what month and year was (NAME) born? PROBE: When 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).

HOUSEHOLD LINE NUMBER_____ (GO TO 221)

220) IF DEAD: How old was (NAME) when he/she died?
IF '1 YEAR', 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), including any children who died after birth?

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

222) Have you had any live births since the birth of (NAME OF LAST BIRTH)?
IF YES, RECORD BIRTH(S) IN TABLE.

YES 1
NO 2

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

NUMBERS ARE SAME (GO TO 224)
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

224) CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2009 OR LATER.

NUMBER OF BIRTHS_____
NONE 0 (GO TO 226)

225) FOR EACH BIRTH SINCE JANUARY 2009, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)

226) Are you pregnant now?

YES 1
NO 2 (GO TO 230)
UNSURE 8 (GO TO 230)

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

MONTHS____

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

YES 1 (GO TO 230)
NO 2

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

LATER 1
NO MORE 2

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

YES 1
NO 2 (GO TO 238)

231) When did the last such pregnancy end?

MONTH_____
YEAR_____

232) CHECK 231:

LAST PREGNANCY ENDED IN JAN. 2009 OR LATER (GO TO 233)
LAST PREGNANCY ENDED BEFORE JAN. 2009 (GO TO 238)

233) How many months pregnant were you when the last such pregnancy ended? RECORD NUMBER OF COMPLETED MONTHS.

ENTER 'T' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

MONTHS____

234) Since January 2009, have you had any other pregnancies that did not result in a live birth?

YES 1
NO 2 (GO TO 236)

235) ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2009.

ENTER 'T' IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

236) Did you have any miscarriages, abortions or stillbirths that ended before 2009?

YES 1
NO 2 (GO TO 238)

237) When did the last such pregnancy that terminated before 2009 end?

MONTH____
YEAR____

238) When did your last menstrual period start?

(DATE, IF GIVEN)_____
DAYS AGO 1____
WEEKS AGO 2____
MONTHS AGO 3____
YEARS AGO 4____
IN MENOPAUSE/HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

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

YES 1
NO 2 (GO TO 301)
DON'T KNOW 8 (GO TO 301)

240) 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

SECTION 3. CONTRACEPTION

301) Now I would like to ask about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.

Have you ever heard of (METHOD)?

METHOD 1 Female Sterilization. PROBE: Women can have an operation to avoid having any more children.
YES 1
NO 2
METHOD 2 Male Sterilization. PROBE: Men can have an operation to avoid having any more children.
YES 1
NO 2
METHOD 3 IUD. PROBE: Women can have a loop or coil placed inside them (uterus) by a doctor or nurse.
YES 1
NO 2
METHOD 4 Injectables. PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
METHOD 5 Implants/Jadelle. PROBE: Women can have one or more 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
METHOD 6 Pill. PROBE: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
METHOD 7 Condom. PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
METHOD 8 Female Condom. PROBE: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
METHOD 9 Lactational Amenorrhea Method (LAM)
YES 1
NO 2
METHOD 10 Rhythm Method. PROBE: 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
METHOD 11 Standard Days Methods (SDM). PROBE: The woman knows days of the month when she can get pregnant by using beads or calendar.
YES 1
NO 2
METHOD 12 Withdrawal. PROBE: Men can be careful and pull out before climax.
YES 1
NO 2
METHOD 13 Emergency Contraception. PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
YES 1
NO 2
METHOD 14 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1 (SPECIFY) ____ _____
NO 2

302) CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 303)
PREGNANT (GO TO 311)

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

YES 1
NO 2 (GO TO 311)

304) Which method are you using? CIRCLE ALL MENTIONED.

IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION A (GO TO 307)
MALE STERILIZATION B (GO TO 307)
IUD C (GO TO 308A)
INJECTABLES D (GO TO 308A)
IMPLANTS/JADELLE E (GO TO 308A)
PILL F
CONDOM G (GO TO 306)
FEMALE CONDOM H (GO TO 308A)
DIAPHRAGM I (GO TO 308A)
FOAM/JELLY J (GO TO 308A)
LACTATIONAL AMEN. METHOD K (GO TO 308A)
RHYTHM METHOD L (GO TO 308A)
STANDARD DAYS METHOD M (GO TO 308A)
WITHDRAWAL N (GO TO 308A)
OTHER MODERN METHOD X (GO TO 308A)
OTHER TRADITIONAL METHOD Y (GO TO 308A)

305) What is the brand name of the pills you are using?

IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

MICROGYNON 01 (GO TO 308A)
LOFEMENAL 02 (GO TO 308A)
OVRETTE 03 (GO TO 308A)
OTHER (SPECIFY) ____ 96 (GO TO 308A)
DON'T KNOW 98 (GO TO 308A)

306) What is the brand name of the condoms you are using?

IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

PRUDENCE PLUS 01 (GO TO 308A)
PLEASURE 02 (GO TO 308A)
GENERIC CONDOM 03 (GO TO 308A)
OTHER (SPECIFY) ____ 96 (GO TO 308A)
DON'T KNOW 98 (GO TO 308A)

307) In what facility did the sterilization take place? PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)_____
PUBLIC/AGREE SECTOR
REFERRAL HOSPITAL 11
PROVINCIAL/DISTRICT HOSPITAL 12
HEALTH CENTER 13
HEALTH POST 14
OUTREACH 15
OTHER PUBLIC HEALTH FACILITY (SPECIFY) ____ 16
PRIVATE MEDICAL SECTOR
POLYCLINIC 21
CLINIC 22
DISPENSARY 23
OTHER PRIVATE HEALTH FACILITY (SPECIFY) ____ 26
OTHER (SPECIFY) ____ 96
DON'T KNOW 98

308) In what month and year was the sterilization performed?
308A) Since what month and year have you been using (CURRENT METHOD) without stopping?

PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

MONTH_____
YEAR_____

309) CHECK 308/308A, 215, AND 231:

ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 308/308A

YES (GO BACK TO 308/308A, 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 310)

310) CHECK 308/308A:

YEAR IS 2009 OR LATER
ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING.
YEAR IS 2008 OR EARLIER
ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2009. (GO TO 322)

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

USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2009.

USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

IN COLUMN 1, ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.

ILLUSTRATIVE QUESTIONS:

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

IN COLUMN 2, ENTER CODES FOR DISCONTINUATION NEXT TO THE LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 2 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1.

ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT.

ILLUSTRATIVE QUESTIONS:

Why did you stop using the (METHOD)? Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop for some other reason?
IF DELIBERATELY STOPPED TO GET PREGNANT, ASK: How many months did it take you to get pregnant after you stopped using (METHOD)? AND ENTER '0' IN EACH SUCH MONTH IN COLUMN 1.

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

NO METHOD USED (GO TO 313)
ANY METHOD USED (GO TO 314)

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

YES 1 (GO TO 324)
NO 2 (GO TO 324)

314) CHECK 304:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

NO CODE CIRCLED 00 (GO TO 324)
FEMALE STERILIZATION 01 (GO TO 317A)
MALE STERILIZATION 02 (GO TO 326)
IUD 03
INJECTABLES 04
IMPLANTS/JADELLE 05
PILL 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMEN. METHOD 11 (GO TO 315A)
RHYTHM METHOD 12 (GO TO 315A)
STANDARD DAYS METHOD 13 (GO TO 315A)
WITHDRAWAL 14 (GO TO 326)
OTHER MODERN METHOD 95 (GO TO 326)
OTHER TRADITIONAL METHOD 96 (GO TO 326)

315) You first started using (CURRENT METHOD) in (DATE FROM 308/308A). Where did you get it at that time?
315A) Where did you learn how to use the rhythm/lactational amenorrhea method/standard days method?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)_____
PUBLIC/AGREE SECTOR
REFERRAL HOSPITAL 11
PROVINCIAL/DISTRICT HOSPITAL 12
HEALTH CENTER 13
HEALTH POST 14
OUTREACH 15
COMMUNITY HEALTH WORKER 16
OTHER PUBLIC HEALTH FACILITY (SPECIFY) ____ 17
PRIVATE MEDICAL SECTOR
POLYCLINIC 21
CLINIC 22
DISPENSARY 23
PHARMACY 24
FAMILY PLANNING CLINIC 25
OTHER PRIVATE HEALTH FACILITY (SPECIFY) ____ 26
OTHER SOURCES
KIOSK/SHOP/BAR 31
CHURCH 32
FRIEND/RELATIVE 33
YOUTH CENTER 34
OTHER (SPECIFY) ____ 96
DON'T KNOW 98

316) CHECK 304:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

IUD 03
INJECTABLES 04
IMPLANTS/JADELLE 05
PILL 06
CONDOM 07 (GO TO 323)
FEMALE CONDOM 08 (GO TO 320)
DIAPHRAGM 09 (GO TO 320)
FOAM/JELLY 10 (GO TO 320)
LACTATIONAL AMEN. METHOD 11 (GO TO 326)
RHYTHM METHOD 12 (GO TO 326)
STANDARD DAYS METHOD 13 (GO TO 326)

317) At that time, were you told about side effects or problems you might have with the method?
317A) When you got sterilized, were you told about side effects or problems you might have with the method?

YES 1 (GO TO 319)
NO 2

318) 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 320)

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

YES 1
NO 2

320) CHECK 317:

CODE '1' CIRCLED

At that time, were you told about other methods of family planning that you could use?
YES 1 (GO TO 322)
NO 2
CODE '1' NOT CIRCLED

When you obtained (CURRENT METHOD FROM 314) from (SOURCE OF METHOD FROM 307 OR 315), were you told about other methods of family planning that you could use?
YES 1 (GO TO 322)
NO 2

321) 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

322) CHECK 304:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION 01 (GO TO 326)
MALE STERILIZATION 02 (GO TO 326)
IUD 03 (GO TO 326)
INJECTABLES 04
IMPLANTS/JADELLE 05
PILL 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMEN. METHOD 11 (GO TO 326)
RHYTHM METHOD 12 (GO TO 326)
STANDARD DAYS METHOD 13 (GO TO 326)
WITHDRAWAL 14 (GO TO 326)
OTHER MODERN METHOD 95 (GO TO 326)
OTHER TRADITIONAL METHOD 96 (GO TO 326)

323) Where did you obtain (CURRENT METHOD) the last time? PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)_____
PUBLIC/AGREE SECTOR
REFERRAL HOSPITAL 11 (GO TO 326)
PROVINCIAL/DISTRICT HOSPITAL 12 (GO TO 326)
HEALTH CENTER 13 (GO TO 326)
HEALTH POST 14 (GO TO 326)
OUTREACH 15 (GO TO 326)
COMMUNITY HEALTH WORKER 16 (GO TO 326)
OTHER PUBLIC HEALTH FACILITY (SPECIFY) ____ 17 (GO TO 326)
PRIVATE MEDICAL SECTOR
POLYCLINIC 21 (GO TO 326)
CLINIC 22 (GO TO 326)
DISPENSARY 23 (GO TO 326)
PHARMACY 24 (GO TO 326)
FAMILY PLANNING CLINIC 25 (GO TO 326)
OTHER PRIVATE HEALTH FACILITY (SPECIFY) ____ 26 (GO TO 326)
OTHER SOURCES
KIOSK/SHOP/BAR 31 (GO TO 326)
CHURCH 32 (GO TO 326)
FRIEND/RELATIVE 33 (GO TO 326)
YOUTH CENTER 34 (GO TO 326)
OTHER (SPECIFY) ____ 96 (GO TO 326)
DON'T KNOW 98

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

YES 1
NO 2 (GO TO 326)

325) Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S))_____
PUBLIC/AGREE SECTOR
REFERRAL HOSPITAL A
PROVINCIAL/DISTRICT HOSPITAL B
HEALTH CENTER C
HEALTH POST D
OUTREACH E
COMMUNITY HEALTH WORKER F
OTHER PUBLIC HEALTH FACILITY (SPECIFY) ____ G
PRIVATE MEDICAL SECTOR
POLYCLINIC H
CLINIC I
DISPENSARY J
PHARMACY K
FAMILY PLANNING CLINIC L
OTHER PRIVATE HEALTH FACILITY (SPECIFY) ____ M
OTHER SOURCES
KIOSK/SHOP/BAR N
CHURCH O
FRIEND/RELATIVE P
YOUTH CENTER Q
OTHER (SPECIFY) ____ X

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

YES 1
NO 2

327) 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)

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

YES 1
NO 2

SECTION 4. PREGNANCY AND POSTNATAL CARE

401) CHECK 224:

ONE OR MORE BIRTHS IN 2009 OR LATER (GO TO 402)
NO BIRTHS IN 2009 OR LATER (GO TO 556)

402) CHECK 215: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2005 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

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

403) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

BIRTH HISTORY NUMBER_____

404) FROM 212 AND 216

NAME: ____
LIVING_____
DEAD_____

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

YES 1 (GO TO 408 IF LAST BIRTH, GO TO 430 IF NEXT-TO-LAST OR SECOND-FROM-LAST BIRTH)
NO 2

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

LATER 1
NO MORE 2 (GO TO 408 IF LAST BIRTH, GO TO 430 IF NEXT-TO-LAST OR SECOND-FROM-LAST BIRTH)

407) How much longer did you want to wait?

MONTHS____
YEARS_____
DON'T KNOW 998

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

YES 1
NO 2 (GO TO 415)

409) Whom did you see? Anyone else?

PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

HEALTH PERSONNEL
DOCTOR A
NURSE/MEDICAL ASSISTANT B
MIDWIFE C
OTHER PERSON
TRADITIONAL HEALER D
COMMUNITY HEALTH WORKER E
COMMUNITY HEALTH MOTHER AND CHILD F
OTHER (SPECIFY) ____ X

410) Where did you receive antenatal care for this pregnancy? Anywhere else?

PROBE TO IDENTIFY TYPE(S) OF SOURCE(S).

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S))
HOME
YOUR HOME A
OTHER HOME B
PUBLIC/AGREE SECTOR
REF. HOSPITAL C
PROV/DIST. HOSPITAL D
HEALTH CENTER E
HEALTH POST F
OTHER PUBLIC FACILITY (SPECIFY) ____ G
PRIVATE MEDICAL SECTOR
POLYCLINIC H
CLINIC I
DISPENSARY J
OTHER PRIVATE MEDICAL FACILITY (SPECIFY) ____ K
OTHER (SPECIFY) ____ X

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

MONTHS_____
DON'T KNOW 98

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

NUMBER OF TIMES_____
DON'T KNOW 98 (GO TO 413)

412A) CHECK 412:

2 OR MORE TIMES (GO TO 412B)
LESS THAN 2 TIMES (GO TO 413)

412B) How many months pregnant were you when you received your second antenatal care for this pregnancy?

MONTHS_____
DON'T KNOW 98

412C) CHECK 412:

3 OR MORE TIMES (GO TO 412D)
LESS THAN 3 TIMES (GO TO 413)

412D) How many months pregnant were you when you received your third antenatal care for this pregnancy?

MONTHS_____
DON'T KNOW 98

412E) CHECK 412:

4 OR MORE TIMES (GO TO 412F)
LESS THAN 4 TIMES (GO TO 413)

412F) How many months pregnant were you when you received your fourth antenatal care for this pregnancy?

MONTHS_____
DON'T KNOW 98

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

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

414) During (any of) your antenatal care visit(s), were you told about things to look out for that might suggest problems with the pregnancy?

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?

YES 1
NO 2 (GO TO 418)
DON'T KNOW 8 (GO TO 418)

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

IF 7 OR MORE TIMES, RECORD '7'.

TIMES_____
DON'T KNOW 8

417) CHECK 416:

2 OR MORE TIMES (GO TO 421)
OTHER (GO TO 418)

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

YES 1
NO 2 (GO TO 421)
DON'T KNOW 8 (GO TO 421)

419) Before this pregnancy, how many times did you receive a tetanus injection?

IF 7 OR MORE TIMES, RECORD '7'.

TIMES_____
DON'T KNOW 8

420) How many years ago did you receive the last tetanus injection before this pregnancy?

YEARS AGO_____

421) During this pregnancy, were you given or did you buy any iron tablets?

SHOW TABLETS/SYRUP.

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

422) During the whole pregnancy, for how many days did you take the iron tablets?

IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.

DAYS_____
DON'T KNOW 998

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

YES 1
NO 2
DON'T KNOW 8

424) During this pregnancy, did you take any antimalarial drugs?

YES 1
NO 2 (GO TO 430)
DON'T KNOW 8 (GO TO 430)

425) What drugs did you take?

RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.

COARTEM A
QUININE B
OTHER (SPECIFY) ____ X
DON'T KNOW Z

425A) Where did you get the antimalarial drug?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)
PUBLIC/AGREE SECTOR
REF. HOSPITAL A
PROV/DIST. HOSPITAL B
HEALTH CENTER C
HEALTH POST D
OUTREACH E
COMMUNITY HEALTH WORKER F
OTHER PUBLIC FACILITY (SPECIFY) ____ G
PRIVATE MEDICAL SECTOR
POLYCLINIC H
CLINIC I
DISPENSARY J
PHARMACY K
OTHER PRIVATE MEDICAL FACILITY (SPECIFY) ____ L
OTHER SOURCE
KIOSK M
TRADITIONAL HEALER N
CHURCH O
FRIEND/RELATIVE P
OTHER (SPECIFY) ____ X

430) 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

431) Was (NAME) weighed at birth?

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

432) How much did (NAME) weigh?

RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.

KILOGRAMS FROM CARD_____

KILOGRAMS FROM RECALL_____

DON'T KNOW 99.998

433) Who assisted with the delivery of (NAME)? Anyone else?

PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.

IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

HEALTH PERSONNEL
DOCTOR A
NURSE/MEDICAL ASSISTANT B
MIDWIFE C
OTHER PERSON
TRADITIONAL HEALER D
COMMUNITY HEALTH WORKER E
COMMUNITY HEALTH MOTHER AND CHILD F
OTHER (SPECIFY) ____ X
NO ONE Y

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

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)
HOME
YOUR HOME 11 (GO TO 438)
OTHER HOME 12 (GO TO 438)
PUBLIC/AGREE SECTOR
REF. HOSPITAL 21
PROV./DIST. HOSPITAL 22
HEALTH CENTER 23
HEALTH POST 24
OTHER PUBLIC FACILITY (SPECIFY) ____ 26
PRIVATE MEDICAL SECTOR
POLYCLINIC 31
CLINIC 32
DISPENSARY 33
OTHER PRIVATE MEDICAL FACILITY (SPECIFY) ____ 36
OTHER (SPECIFY) ____ 96 (GO TO 438)

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

YES 1
NO 2 (GO TO 436)

435A) How did you travel to the health facility to deliver (NAME) by caesarean?

AMBULANCE 1
PRIVATE CAR 2
OTHER (SPECIFY) ____ 6

436) After you gave birth to (NAME), did anyone check on your health while you were still in the facility?

YES 1 (GO TO 439)
NO 2

437) Did anyone check on your health after you left the facility?

YES 1 (GO TO 439)
NO 2 (GO TO 446)

438) After you gave birth to (NAME), did anyone check on your health?

YES 1
NO 2 (GO TO 442)

439) Who checked on your health at that time?

PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR 11
NURSE/MEDICAL ASSISTANT 12
MIDWIFE 13
OTHER PERSON
TRADITIONAL HEALER 21
COMMUNITY HEALTH WORKER 22
COMMUNITY HEALTH MOTHER AND CHILD 23
OTHER (SPECIFY) ____ 96

440) How long after delivery did the first check take place?

IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

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

441) CHECK 437:

YES (GO TO 446)
NOT ASKED (GO TO 442)

442) In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on his/her health?

YES 1
NO 2 (GO TO 446)
DON'T KNOW 8 (GO TO 446)

443) How many hours, days or weeks after the birth of (NAME) did the first check take place?

IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

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

444) Who checked on (NAME)'s health at that time?

PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR 11
NURSE/MEDICAL ASSISTANT 12
MIDWIFE 13
OTHER PERSON
TRADITIONAL HEALER 21
COMMUNITY HEALTH WORKER 22
COMMUNITY HEALTH MOTHER AND CHILD 23
OTHER (SPECIFY) ____ 96

445) Where did this first check of (NAME) take place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)
HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC/AGREE SECTOR
REF. HOSPITAL 21
PROV./DIST. HOSPITAL 22
HEALTH CENTER 23
HEALTH POST 24
OTHER PUBLIC FACILITY (SPECIFY) ____ 26
PRIVATE MEDICAL SECTOR
POLYCLINIC 31
CLINIC 32
DISPENSARY 33
OTHER PRIVATE MEDICAL FACILITY (SPECIFY) ____ 36
OTHER (SPECIFY) ____ 96

446) In the first two months after delivery, did you receive a vitamin A dose (like this/any of these?

SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

447) Has your menstrual period returned since the birth of (NAME)?
[Most recent birth since 2009]

YES 1 (GO TO 449)
NO 2 (GO TO 450)

448) Did your period return between the birth of (NAME) and your next pregnancy?
[Repeat question for all births since 2009 except most recent birth]

YES 1
NO 2 (GO TO 452)

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

MONTHS_____
DON'T KNOW 98

450) CHECK 226:

IS RESPONDENT PREGNANT?

NOT PREGNANT (GO TO 451)
PREGNANT OR UNSURE (GO TO 452)

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

YES 1
NO 2 (GO TO 453)

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

DAYS_____
MONTHS_____
DON'T KNOW 98

453) Did you ever breastfeed (NAME)?

YES 1 (GO TO 455)
NO 2

454) CHECK 404:

IS CHILD LIVING?

LIVING (GO TO 460)
DEAD (GO TO 460A)

455) 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 000
HOURS 1_____
DAYS 2_____

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

YES 1
NO 2 (GO TO 458)

457) What was (NAME) given to drink? Anything else?

RECORD ALL LIQUIDS MENTIONED.

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

458) CHECK 404:

IS CHILD LIVING?

LIVING (GO TO 459)
DEAD (GO TO 460A)

459) Are you still breastfeeding (NAME)?

YES 1
NO 2

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

YES 1
NO 2
DON'T KNOW 8

460A) CHECK 434:

WAS CHILD DELIVERED AT HOME?

YES (GO TO 460B)
NO (GO TO 461)

460B) Why did you not deliver (NAME) at a health facility?

FACILITY COST TOO MUCH 01
TOO FAR/NO TRANSPORT 02
DON'T TRUST FACILITY 03
NO FEMALE PROVIDER 04
HUSBAND FAMILY DON'T ALLOW 05
NOT NECESSARY/EASY TO DELIVER/VERY COMFORTABLE POSITION 06
CUSTOMARY TO DELIVER AT HOME 07
OTHER (SPECIFY) ____ 96

461) GO BACK TO 40 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501.

SECTION 5. CHILD IMMUNIZATION, HEALTH AND NUTRITION

501) ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2009 OR LATER.

ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS, BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

502) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

BIRTH HISTORY NUMBER_____

503) FROM 212 AND 216

NAME_____
LIVING (GO TO 504)
DEAD (GO TO 503 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 553)

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

IF YES: May I see it please?

YES, SEEN 1 (GO TO 506)
YES, NOT SEEN 2 (GO TO 509)
NO CARD 3

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

YES 1 (GO TO 509)
NO 2 (GO TO 509)

506) (1) COPY DATES FROM THE CARD. (2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

BCG
DAY: ____
MONTH: ____
YEAR: ____
POLIO 0 (POLIO GIVEN AT BIRTH)
DAY: ____
MONTH: ____
YEAR: ____
POLIO 1
DAY: ____
MONTH: ____
YEAR: ____
POLIO 2
DAY: ____
MONTH: ____
YEAR: ____
POLIO 3
DAY: ____
MONTH: ____
YEAR: ____
PENTAVALENT 1
DAY: ____
MONTH: ____
YEAR: ____
PENTAVALENT 2
DAY: ____
MONTH: ____
YEAR: ____
PENTAVALENT 3
DAY: ____
MONTH: ____
YEAR: ____
PNEUMO. 1
DAY: ____
MONTH: ____
YEAR: ____
PNEUMO. 2
DAY: ____
MONTH: ____
YEAR: ____
PNEUMO. 3
DAY: ____
MONTH: ____
YEAR: ____
ROTAVIRUS 1
DAY: ____
MONTH: ____
YEAR: ____
ROTAVIRUS 2
DAY: ____
MONTH: ____
YEAR: ____
ROTAVIRUS 3
DAY: ____
MONTH: ____
YEAR: ____
MEASLES AND RUBELLA
DAY: ____
MONTH: ____
YEAR: ____
MEASLES
DAY: ____
MONTH: ____
YEAR: ____
VITAMIN A (MOST RECENT)
DAY: ____
MONTH: ____
YEAR: ____

507) CHECK 506:

BCG TO MEASLES ALL RECORDED (GO TO 511)
OTHER (GO TO 508)

508) Has (NAME) had any vaccinations that are not recorded on this card, including vaccinations given in a national immunization day campaign?

RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 506 THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

YES 1 (GO TO 511)
(PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 506)
NO 2 (GO TO 511)
DON'T KNOW 8 (GO TO 511)

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

YES 1
NO 2 (GO TO 511)
DON'T KNOW 8 (GO TO 511)

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

510A) 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

510B) Polio vaccine, that is, drops in the mouth?

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

510C) Was the first polio vaccine given in the first two weeks after birth or later?

FIRST 2 WEEKS 1
LATER 2

510D) How many times was the polio vaccine given?

NUMBER OF TIMES_____

510E) A Pentavalent 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 510G)
DON'T KNOW 8 (GO TO 510G)

510F) How many times was the Pentavalent vaccination given?

NUMBER OF TIMES_____

510G) A Pneumococcal vaccination, that is, an injection given in the thigh, sometimes at the same time as polio or pentavalent vaccines?

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

510H) How many times was the Pneumococcal vaccination given?

NUMBER OF TIMES_____

510I) A Rotavirus vaccine. That is a vaccine given by mouth to protect diarrhea due to Rotavirus. It is given at the same time with pentavalence, polio, and pneumococcal vaccines.

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

510J) How many times was the Rotavirus vaccination given?

NUMBER OF TIMES_____

510K) A measles and rubella vaccine - that is, a shot in the arm at the age of 9 months or older - to prevent him/her from getting measles and rubella?

YES 1
NO 2
DON'T KNOW 8

510L) A measles injection - that is, a shot in the arm at the age of 15 months or older - to prevent him/her from getting measles?

YES 1
NO 2
DON'T KNOW 8

511) Within the last six months, was (NAME) given a vitamin A dose like (this/any of these)?

SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

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

515) Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

516) Now I would like to know how much (NAME) was given to drink during the diarrhea (including breastmilk).

Was he/she given less than usual to drink, about the same amount, or more than usual to drink?

IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8

517) When (NAME) had diarrhea, was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?

IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?

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

517A) CHECK 453:

EVER BREASTFED (GO TO 517B)
NEVER BREASTFED (GO TO 518)

517B) When (NAME) had diarrhea, did you continue to breastfeed him/her?

YES 1
NO 2

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

YES 1
NO 2 (GO TO 522)

519) Where did you seek advice or treatment? Anywhere else?

PROBE TO IDENTIFY EACH TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S))
PUBLIC/AGREE SECTOR
REF. HOSPITAL A
PROV./DIST. HOSPITAL B
HEALTH CENTER C
HEALTH POST D
OUTREACH E
COMMUNITY HEALTH WORKER F
OTHER PUBLIC FACILITY (SPECIFY) ____ G
PRIVATE MEDICAL SECTOR
POLYCLINIC H
CLINIC I
DISPENSARY J
PHARMACY K
OTHER PRIVATE MEDICAL FACILITY (SPECIFY) ____ L
OTHER SOURCE
KIOSK/SHOP M
TRADITIONAL HEALER N
CHURCH O
FRIEND/RELATIVE P
OTHER (SPECIFY) ____ X

520) CHECK 519:

TWO OR MORE CODES CIRCLED (GO TO 521)
ONLY ONE CODE CIRCLED (GO TO 522)

521) Where did you first seek advice or treatment?

USE LETTER CODE FROM 519.

FIRST PLACE_____

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

a) A fluid made from a special packet called ORS PACKET?
YES 1
NO 2
DON'T KNOW 8
b) A government-recommended homemade fluid?
YES 1
NO 2
DON'T KNOW 8

523) Was anything (else) given to treat the diarrhea?

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

524) What (else) was given to treat the diarrhea? Anything else?

RECORD ALL TREATMENTS GIVEN.

PILL OR SYRUP
ANTIBIOTIC A
ANTIMOTILITY B
OTHER (NOT ANTIBIOTIC, ANTIMOTILITY, OR ZINC) C
UNKNOWN PILL OR SYRUP D
INJECTION
ANTIBIOTIC E
NON-ANTIBIOTIC F
UNKNOWN INJECTION G
(IV) INTRAVENOUS H
HOME REMEDY/HERBAL MEDICINE I
OTHER (SPECIFY) ____ X

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

YES 1
NO 2 (GO TO 527)
DON'T KNOW 8 (GO TO 527)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 530)
DON'T KNOW 8 (GO TO 530)

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

YES 1
NO 2 (GO TO 531)
DON'T KNOW 8 (GO TO 531)

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

CHEST ONLY 1 (GO TO 531)
NOSE ONLY 2 (GO TO 531)
BOTH 3 (GO TO 531)
OTHER (SPECIFY) ____ 6 (GO TO 531)
DON'T KNOW 8 (GO TO 531)

530) CHECK 525:

HAD FEVER OR COUGH?

YES (GO TO 531)
NO OR DON'T KNOW (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

531) Now I would like to know how much (NAME) was given to drink (including breastmilk) during the illness with a (fever/cough).

Was he/she given less than usual to drink, about the same amount, or more than usual to drink?

IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8

532) When (NAME) had a (fever/cough), was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?

IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?

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

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

YES 1
NO 2 (GO TO 537)

534) Where did you seek advice or treatment? Anywhere else?

PROBE TO IDENTIFY EACH TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S))
PUBLIC/AGREE SECTOR
REF. HOSPITAL A
PROV./DIST. HOSPITAL B
HEALTH CENTER C
HEALTH POST D
OUTREACH E
COMMUNITY HEALTH WORKER F
OTHER PUBLIC FACILITY (SPECIFY) ____ G
PRIVATE MEDICAL SECTOR
POLYCLINIC H
CLINIC I
DISPENSARY J
PHARMACY K
OTHER PRIVATE MEDICAL FACILITY (SPECIFY) ____ L
OTHER SOURCE
KIOSK/SHOP M
TRADITIONAL HEALER N
CHURCH O
FRIEND/RELATIVE P
OTHER (SPECIFY) ____ X

535) CHECK 534:

TWO OR MORE CODES CIRCLED (GO TO 536)
ONLY ONE CODE CIRCLED (GO TO 537)

536) Where did you first seek advice or treatment?

USE LETTER CODE FROM 534.

FIRST PLACE_____

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

YES 1
NO 2 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)
DON'T KNOW 8 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

538) What drugs did (NAME) take? Any other drugs?

RECORD ALL MENTIONED.

ANTIMALARIAL DRUGS
COARTEM A
PRIMO B
QUININE C
OTHER ANTI-MALARIAL (SPECIFY) ____ D
ANTIBIOTIC DRUGS
PILL/SYRUP E
INJECTION F
OTHER DRUGS
ASPIRIN G
ACETAMINOPHEN H
IBUPROFEN I
OTHER (SPECIFY) ____ X
DON'T KNOW Z

539) CHECK 538:

ANY CODE A-D CIRCLED?

YES (GO TO 540)
NO (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

540) CHECK 538:

COARTEM ('A') GIVEN

CODE 'A' CIRCLED (GO TO 541)
CODE 'A' NOT CIRCLED (GO TO 542)

541) How long after the fever started did (NAME) first take Coartem?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8

542) CHECK 538:

PRIMO ('B') GIVEN

CODE 'B' CIRCLED (GO TO 543)
CODE 'B' NOT CIRCLED (GO TO 544)

543) How long after the fever started did (NAME) first take Primo?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8

544) CHECK 538:

QUININE ('C') GIVEN

CODE 'C' CIRCLED (GO TO 545)
CODE 'C' NOT CIRCLED (GO TO 550)

545) How long after the fever started did (NAME) first take quinine?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8

550) CHECK 538:

OTHER ANTIMALARIAL ('D') GIVEN

CODE 'D' CIRCLED (GO TO 551)
CODE 'D' NOT CIRCLED (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

551) How long after the fever started did (NAME) first take (OTHER ANTIMALARIAL)?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8

552) GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553.

553) CHECK 215 AND 218, ALL ROWS:

NUMBER OF CHILDREN BORN IN 2009 OR LATER LIVING WITH THE RESPONDENT

ONE OR MORE (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE WITH 554)

NAME_____
NONE (GO TO 556)

554) The last time (NAME FROM 553) passed stools, what was done to dispose of the stools?

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

555) CHECK 522(a) AND 522(b), ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET OR HOMEMADE FLUID (GO TO 556)
ANY CHILD RECEIVED FLUID FROM ORS PACKET OR HOMEMADE FLUID (GO TO 557)

556) Have you ever heard of a special product called ORS PACKET you can get for the treatment of diarrhea?

YES 1
NO 2

557) CHECK 215 AND 218, ALL ROWS:

NUMBER OF CHILDREN BORN IN 2012 OR LATER LIVING WITH THE RESPONDENT

ONE OR MORE (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE WITH 558)

NAME_____
NONE (GO TO 563)

558) Now I would like to ask you about liquids or foods that (NAME FROM 557) had yesterday during the day or at night. I am interested in whether your child had the item I mention even if it was combined with other foods.

Did (NAME FROM 557) (drink/eat):

a) Plain water?
YES 1
NO 2
DON'T KNOW 8
b) Juice or juice drinks?
YES 1
NO 2
DON'T KNOW 8
c) Soup?
YES 1
NO 2
DON'T KNOW 8
d) Milk such as tinned, powdered, or fresh animal milk?
YES 1
NO 2
DON'T KNOW 8
IF YES: How many times did (NAME) drink milk? IF 7 OR MORE TIMES, RECORD '7'.
NUMBER OF TIMES DRANK MILK_____
e) Infant formula?
YES 1
NO 2
DON'T KNOW 8
IF YES: How many times did (NAME) drink infant formula? IF 7 OR MORE TIMES, RECORD '7'.
NUMBER OF TIMES DRANK FORMULA_____
f) Any other liquids?
YES 1
NO 2
DON'T KNOW 8
g) Yogurt?
YES 1
NO 2
DON'T KNOW 8
IF YES: How many times did (NAME) eat yogurt? IF 7 OR MORE TIMES, RECORD '7'.
NUMBER OF TIMES ATE YOGURT_____
h) Any [BRAND NAME OF COMMERCIALLY FORTIFIED BABY FOOD, E.G., Cerelac]? (17)
YES 1
NO 2
DON'T KNOW 8
i) Bread, rice, noodles, porridge, or other foods made from grains?
YES 1
NO 2
DON'T KNOW 8
j) Pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside?
YES 1
NO 2
DON'T KNOW 8
k) White potatoes, white yams, manioc, cassava, or any other foods made from roots?
YES 1
NO 2
DON'T KNOW 8
l) Any dark green, leafy vegetables?
YES 1
NO 2
DON'T KNOW 8
m) Ripe mangoes, papayas, or [INSERT ANY OTHER LOCALLY AVAILABLE VITAMIN A-RICH FRUITS]?
YES 1
NO 2
DON'T KNOW 8
n) Any other fruits or vegetables?
YES 1
NO 2
DON'T KNOW 8
o) Liver, kidney, heart, or other organ meats?
YES 1
NO 2
DON'T KNOW 8
p) Any meat such as beef, pork, lamb, goat, chicken, or duck?
YES 1
NO 2
DON'T KNOW 8
q) Eggs?
YES 1
NO 2
DON'T KNOW 8
r) Fresh or dried fish or shellfish?
YES 1
NO 2
DON'T KNOW 8
s) Any foods made from beans, peas, lentils, or nuts?
YES 1
NO 2
DON'T KNOW 8
t) Cheese or other food made from milk?
YES 1
NO 2
DON'T KNOW 8
u) Any other solid, semi-solid, or soft food?
YES 1
NO 2
DON'T KNOW 8

559) CHECK 558 (CATEGORIES "g" THROUGH "u"):

ALL "NO" (GO TO 560)
AT LEAST ONE "YES" OR ALL "DON'T KNOW" (GO TO 561)

560) Did (NAME) eat any solid, semi-solid, or soft foods yesterday during the day or at night?

IF 'YES' PROBE: What kind of solid, semi-solid or soft foods did (NAME) eat?

YES 1 (GO BACK TO 558 TO RECORD FOOD EATEN YESTERDAY)
NO 2 (GO TO 561A)

561) How many times did (NAME FROM 557) eat solid, semisolid, or soft foods yesterday during the day or at night?

IF 7 OR MORE TIMES, RECORD '7'.

NUMBER OF TIMES_____
DON'T KNOW 8

561A) Have you ever heard of any counseling or education on nutrition?

YES 1
NO 2 (GO TO 563)

561B) Where did you hear about counseling or education on nutrition?

A HEALTH FACILITY A
COMMUNITY HEALTH WORKER B
FRIENDS/RELATIVE C
MAGAZINE/PAPER/RADIO/TV D
OTHER (SPECIFY) ____ X

563) CHECK Q.217 AND Q.218, ALL ROWS:

AT LEAST ONE CHILD AGED 0-5 YEARS OLD AND LIVE WITH THE RESPONDENT

YES (GO TO 564)
NO (GO TO 601)

564) CHECK Q. 217

SELECT THE YOUNGEST CHILD AGED 0-5 YEARS OLD, RECORD THE CHILD NAME AND LINE NUMBER

NAME OF THE YOUNGEST CHILD FROM Q.212_____
LINE NUMBER OF THE YOUNGEST CHILD (Q.219)_____

565) Now I would like to ask you about (NAME); your youngest child that is 0-5 years old

566) How many children's books or picture books do you have for (NAME)?

NONE 00
NUMBER OF CHILDREN'S BOOKS_____
TEN OR MORE BOOKS 10

567) I am interested in learning about the things that (NAME) plays with when he/she is at home.

Does he/she play with:

a) Homemade toys (such as dolls, cars, or other toys made at home)?
YES 1
NO 2
DON'T KNOW 8
b) Toys from a shop or manufactured toys?
YES 1
NO 2
DON'T KNOW 8
c) Household objects (such as bowls or pots) or objects found outside (such as sticks, rocks, animal shells or leaves)?
YES 1
NO 2
DON'T KNOW 8

IF THE RESPONDENT SAYS "YES" TO THE CATEGORIES ABOVE, THEN PROBE TO LEARN SPECIFICALLY WHAT THE CHILD PLAYS WITH TO ASCERTAIN THE RESPONSE.

568) Sometimes adults taking care of children have to leave the house to go shopping, wash clothes, or for other reasons and have to leave young children.

On how many days in the past week was (NAME):

a) Left alone for more than an hour?
NUMBER OF DAYS LEFT ALONE MORE THAN AN HOUR_____
b) Left in the care of another child, that is, someone less than 10 years old, for more than an hour?
NUMBER OF DAYS LEFT WITH ANOTHER CHILD FOR MORE THAN AN HOUR_____

IF 'NONE' ENTER '0'. IF 'DON'T KNOW' ENTER '8'.

569) CHECK Q.217 ET 218:

A CHILD AGED 3, 4, OR 5 YEARS OLD; LIVE IN THIS HOUSEHOLD WITH THE MOTHER (Q.217=3, 4, OR 5 AND Q.218=1)?

YES (GO TO 570)
NO (GO TO 601)

570) CHECK Q.217:

SELECT THE YOUNGEST CHILD AGED 3, 4, OR 5 YEARS OLD. RECORD THE CHILD'S NAME AND LINE NUMBER

NAME OF THE YOUNGEST CHILD 3, 4, OR 5 YEARS OLD (Q.212)_____
LINE NUMBER OF THE YOUNGEST CHILD (Q.219)_____

571) Now I would like to ask some questions regarding (NAME), your youngest child aged 3-5 years old.

572) Does (NAME) attend any organized learning or early childhood education programme, such as a private or government facility, including kindergarten or community child care?

YES 1
NO 2 (GO TO 574)
DON'T KNOW 8 (GO TO 574)

573) In the past 3 days, did you or any household member age 15 or over engage in any of the following activities with (NAME):

RECORD ALL MENTIONED.

a) Read books to or looked at picture with (NAME)?
MOM A
DAD B
OTHER X
NO ONE Y
b) Told stories to (NAME)?
MOM A
DAD B
OTHER X
NO ONE Y
c) Sang songs to (NAME) or with (NAME), including lullabies?
MOM A
DAD B
OTHER X
NO ONE Y
d) Took (NAME) outside the home, compound, yard, or enclosure?
MOM A
DAD B
OTHER X
NO ONE Y
e) Played with (NAME)?
MOM A
DAD B
OTHER X
NO ONE Y
f) Named, counted, or drew things to or with (NAME)?
MOM A
DAD B
OTHER X
NO ONE Y

575) I would like to ask you some questions about the health and development of (NAME). Children do not all develop and learn at the same rate. For example, some walk earlier than others. These questions are related to several aspects of (NAME)'s development.

Can (NAME) identify or name at least ten letters of the alphabet?

YES 1
NO 2
DON'T KNOW 8

576) Can (NAME) read at least four simple, popular words?

YES 1
NO 2
DON'T KNOW 8

577) Does (NAME) know the name and recognize the symbol of all numbers from 1 to 10?

YES 1
NO 2
DON'T KNOW 8

578) Can (NAME) pick up a small object with two fingers, like a stick or a rock from the ground?

YES 1
NO 2
DON'T KNOW 8

579) Is (NAME) sometimes too sick to play?

YES 1
NO 2
DON'T KNOW 8

580) Does (NAME) follow simple directions on how to do something correctly?

YES 1
NO 2
DON'T KNOW 8

581) When given something to do, is (NAME) able to do it independently?

YES 1
NO 2
DON'T KNOW 8

582) Does (NAME) get along well with other children?

YES 1
NO 2
DON'T KNOW 8

583) Does (NAME) kick, bite, or hit other children or adults?

YES 1
NO 2
DON'T KNOW 8

584) Does (NAME) get distracted easily?

YES 1
NO 2
DON'T KNOW 8

SECTION 6. MARRIAGE AND SEXUAL ACTIVITY

601) Are you currently married or living together with a man as if married?

YES, CURRENTLY MARRIED 1 (GO TO 604)
YES, LIVING WITH A MAN 2 (GO TO 604)
NO, NOT IN UNION 3

602) Have you ever been married or lived together with a man as if married?

YES, FORMERLY MARRIED 1
YES, LIVED WITH A MAN 2
NO 3 (GO TO 612)

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

WIDOWED 1 (GO TO 609)
DIVORCED 2 (GO TO 609)
SEPARATED 3 (GO TO 609)

604) Is your (husband/partner) living with you now or is he staying elsewhere?

LIVING WITH HER 1
STAYING ELSEWHERE 2

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

NAME_____
LINE NO._____

606) Does your (husband/partner) have other wives or does he live with other women as if married?

YES 1
NO 2 (GO TO 609)
DON'T KNOW 8 (GO TO 609)

607) Including yourself, in total, how many wives or live-in partners does he have?

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNERS_____
DON'T KNOW 98

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

RANK_____

609) Have you been married or lived with a man only once or more than once?

ONLY ONCE 1
MORE THAN ONCE 2

610) CHECK 609:

MARRIED/LIVED WITH A MAN ONLY ONCE

In what month and year did you start living with your (husband/partner)?
MONTH_____
DON'T KNOW MONTH 98
YEAR_____ (GO TO 612)
DON'T KNOW YEAR 9998

MARRIED/LIVED WITH A MAN MORE THAN ONCE

Now I would like to ask 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 612)
DON'T KNOW YEAR 9998

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

AGE_____

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

613) Now I would like to ask some questions about sexual activity in order to gain a better understanding of some important life issues.

How old were you when you had sexual intercourse for the very first time?

NEVER HAD SEXUAL INTERCOURSE 00 (GO TO 628)
AGE IN YEARS_____
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95

614) Now I would like to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question.

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

IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO 1_____ (GO TO 616)
WEEKS AGO 2_____ (GO TO 616)
MONTHS AGO 3_____ (GO TO 616)
YEARS AGO 4____ (GO TO 627)

616) When was the last time you had sexual intercourse with this person?

DAYS AGO 1_____
WEEKS AGO 2______
MONTHS AGO 3______

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

YES 1
NO 2 (GO TO 619)

618) Was a condom used every time you had sexual intercourse with this person in the last 12 months?

YES 1
NO 2

619) What was your relationship to this person with whom you had sexual intercourse?

IF BOYFRIEND: Were you living together as if married?

IF YES, CIRCLE '2'.
IF NO, CIRCLE '3'.

HUSBAND 1
LIVE-IN PARTNER 2
BOYFRIEND NOT LIVING WITH RESPONDENT 3 (GO TO 622)
CASUAL ACQUAINTANCE 4 (GO TO 622)
PROSTITUTE 5 (GO TO 622)
OTHER (SPECIFY) ____ 6 (GO TO 622)

620) CHECK 609:

MARRIED ONLY ONCE (GO TO 621)
MARRIED MORE THAN ONCE (GO TO 622)

621) CHECK 613:

FIRST TIME WHEN STARTED LIVING WITH FIRST HUSBAND (GO TO 623)
OTHER (GO TO 622)

622) How long ago did you first have sexual intercourse with this (second/third) person?

DAYS AGO 1_____
WEEKS AGO 2______
MONTHS AGO 3______
YEARS AGO 4_____

623) How many times during the last 12 months did you have sexual intercourse with this person?

IF NON-NUMERIC ANSWER, PROVE TO GET AN ESTIMATE. IF NUMBER OF TIMES IS 95 OR MORE, WRITE '95'.

NUMBER OF TIMES_____

623A) How many times during the last month did you have sexual intercourse with this person?

NUMBER OF TIMES_____

624) How old is this person?

AGE OF PARTNER_____
DON'T KNOW 98

625) 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 616 IN NEXT COLUMN)
NO 2 (GO TO 627)

626) In total, with how many different people have you had sexual intercourse in the last 12 months?

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR MORE, WRITE '95'.

NUMBER OF PARTNERS LAST 12 MONTHS_____
DON'T KNOW 98

626A) In total, with how many different people have you had sexual intercourse in the last month?

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR MORE, WRITE '95'.

NUMBER OF PARTNERS LAST MONTH_____
DON'T KNOW 98

627) In total, with how many people have you had sexual intercourse in your lifetime?

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR MORE, WRITE '95'.

NUMBER OF PARTNERS IN LIFETIME_____
DON'T KNOW 98

628) PRESENCE OF OTHERS DURING THIS SECTION

CHILDREN YOUNGER THAN 10 YEARS
YES 1
NO 2
MALE ADULTS
YES 1
NO 2
FEMALE ADULTS
YES 1
NO 2

629) Do you know of a place where a person can get condoms?

YES 1
NO 2 (GO TO 632)

630) Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S))
PUBLIC/AGREE SECTOR
REFERRAL HOSPITAL A
PROVINCIAL/DISTRICT HOSPITAL B
HEALTH CENTER C
HEALTH POST D
OUTREACH E
COMMUNITY HEALTH WORKER F
OTHER PUBLIC HEALTH FACILITY (SPECIFY) ____ G
PRIVATE MEDICAL SECTOR
POLYCLINIC H
CLINIC I
DISPENSARY J
PHARMACY K
FAMILY PLANNING CLINIC L
OTHER PRIVATE HEALTH FACILITY (SPECIFY) ____ M
OTHER SOURCES
KIOSK/SHOP/BAR N
TRADITIONAL HEALER O
FRIEND/RELATIVE P
YOUTH CENTER Q
OTHER (SPECIFY) ____ X

631) If you wanted to, could you get yourself a condom?

YES 1
NO 2
DON'T KNOW/UNSURE 8

632) Do you know of a place where a person can get female condoms?

YES 1
NO 2 (GO TO 701)

633) Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S))
PUBLIC/AGREE SECTOR
REFERRAL HOSPITAL A
PROVINCIAL/DISTRICT HOSPITAL B
HEALTH CENTER C
HEALTH POST D
OUTREACH E
COMMUNITY HEALTH WORKER F
OTHER PUBLIC HEALTH FACILITY (SPECIFY) ____ G
PRIVATE MEDICAL SECTOR
POLYCLINIC H
CLINIC I
DISPENSARY J
PHARMACY K
FAMILY PLANNING CLINIC L
OTHER PRIVATE HEALTH FACILITY (SPECIFY) ____ M
OTHER SOURCES
KIOSK/SHOP/BAR N
TRADITIONAL HEALER O
FRIEND/RELATIVE P
YOUTH CENTER Q
OTHER (SPECIFY) ____ X

634) If you wanted to, could you get yourself a female condom?

YES 1
NO 2
DON'T KNOW/UNSURE 8

SECTION 7. FERTILITY PREFERENCES

701) CHECK 304:

NEITHER STERILIZED (GO TO 702)
HE OR SHE STERILIZED (GO TO 712)

702) CHECK 226:

PREGNANT (GO TO 703)
NOT PREGNANT OR UNSURE (GO TO 704)

703) Now I have some questions about the future. After the child you are expecting now, would you like to have another child, or would you prefer not to have any more children?

HAVE ANOTHER CHILD 1 (GO TO 705)
NO MORE/NONE 2 (GO TO 711)
UNDECIDED/DON'T KNOW 8 (GO TO 711)

704) Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?

HAVE (A/ANOTHER CHILD) 1
NO MORE/NONE 2 (GO TO 707)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 712)
UNDECIDED/DON'T KNOW 8 (GO TO 710)

705) CHECK 226:

NOT PREGNANT OR UNSURE

How long would you like to wait from now before the birth of (a/another) child?
MONTHS 1_____
YEARS 2_____
SOON/NOW 993 (GO TO 710)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 712)
AFTER MARRIAGE 995 (GO TO 710)
OTHER (SPECIFY) ____ 996 (GO TO 710)
DON'T KNOW 998 (GO TO 710)

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 710)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 712)
AFTER MARRIAGE 995 (GO TO 710)
OTHER (SPECIFY) ____ 996 (GO TO 710)
DON'T KNOW 998 (GO TO 710)

706) CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 708)
PREGNANT (GO TO 711)

707) CHECK 303: USING A CONTRACEPTIVE METHOD?

NOT CURRENTLY USING (GO TO 708)
CURRENTLY USING (GO TO 712)

708) CHECK 705:

NOT ASKED (GO TO 709)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 709)
00-23 MONTHS OR 00-01 YEAR (GO TO 711)

709) CHECK 703 AND 704:

WANTS TO HAVE A/ANOTHER CHILD

You have said that you do not want (a/another) child soon. Can you tell me why you are not using a method to prevent pregnancy?

Any other reason?

RECORD ALL REASONS MENTIONED.
NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
CAN'T GET PREGNANT E
NOT MENSTRUATED SINCE LAST BIRTH F
BREASTFEEDING G
UP TO GOD/FATALISTIC H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
SIDE EFFECTS/HEALTH CONCERNS O
LACK OF ACCESS/TOO FAR P
COSTS TOO MUCH Q
PREFERRED METHOD NOT AVAILABLE R
NO METHOD AVAILABLE S
INCONVENIENT TO USE T
INTERFERES WITH BODY'S NORMAL PROCESS U
OTHER (SPECIFY) ____ X
DON'T KNOW Z

WANTS NO MORE/NONE

You have said that you do not want any (more) children. Can you tell me why you are not using a method to prevent pregnancy?

Any other reason?

RECORD ALL REASONS MENTIONED.
NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
CAN'T GET PREGNANT E
NOT MENSTRUATED SINCE LAST BIRTH F
BREASTFEEDING G
UP TO GOD/FATALISTIC H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
SIDE EFFECTS/HEALTH CONCERNS O
LACK OF ACCESS/TOO FAR P
COSTS TOO MUCH Q
PREFERRED METHOD NOT AVAILABLE R
NO METHOD AVAILABLE S
INCONVENIENT TO USE T
INTERFERES WITH BODY'S NORMAL PROCESS U
OTHER (SPECIFY) ____ X
DON'T KNOW Z

710) CHECK 303: USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 711)
NO, NOT CURRENTLY USING (GO TO 711)
YES, CURRENTLY USING (GO TO 712)

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

YES 1
NO 2
DON'T KNOW 8

712) 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 have in your whole life, how many would that be?

PROBE FOR A NUMERIC RESPONSE.
NONE 00 (GO TO 714)
NUMBER_____
OTHER (SPECIFY) ____ 96 (GO TO 714)

NO LIVING CHILDREN

If you could choose exactly the number of children to have in your whole life, how many would that be?
NONE 00 (GO TO 714)
NUMBER_____
OTHER (SPECIFY) ____ 96 (GO TO 714)

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

NUMBER

BOYS_____
GIRLS_____
EITHER_____
OTHER (SPECIFY) ____ 96

714) In the last few months have you:

Heard about family planning on the radio?
YES 1
NO 2
Seen anything about family planning on the television?
YES 1
NO 2
Read about family planning in a newspaper or magazine?
YES 1
NO 2
Read about family planning in a brochure/pamphlet?
YES 1
NO 2

716) CHECK 601:

YES, CURRENTLY MARRIED (GO TO 717)
YES, LIVING WITH A MAN (GO TO 717)
NO, NOT IN UNION (GO TO 801)

717) CHECK 303: USING A CONTRACEPTIVE METHOD?

CURRENTLY USING (GO TO 718)
NOT CURRENTLY USING OR NOT ASKED (GO TO 720)

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

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

719) CHECK 304:

NEITHER STERILIZED (GO TO 720)
HE OR SHE STERILIZED (GO TO 801)

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

SAME NUMBER 1
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8

SECTION 8. HUSBAND'S BACKGROUND AND WOMAN'S WORK

801) CHECK 601 AND 602:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 802)
FORMERLY MARRIED/LIVED WITH A MAN (GO TO 803)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 807)

802) How old was your (husband/partner) on his last birthday?

AGE IN COMPLETED YEARS_____

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

YES 1
NO 2 (GO TO 806)

804) What was the highest level of school he attended: primary, secondary, or higher?

PRIMARY 1
POST-PRIMARY/VOCATIONAL 2
SECONDARY 3
TERTIARY 4
PRE-PRIMARY 6
DON'T KNOW 8 (GO TO 806)

805) What was the highest (grade/form/year) he completed at that level?

IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

GRADE_____
DON'T KNOW 98

806) CHECK 801:

CURRENTLY MARRIED/LIVING WITH A MAN

What is your (husband's/partner's) occupation? That is, what kind of work does he mainly do?
OCCUPATION_____

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?
OCCUPATION_____

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

YES 1 (GO TO 811)
NO 2

808) As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business.

In the last seven days, have you done any of these things or any other work?

YES 1 (GO TO 811)
NO 2

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

YES 1 (GO TO 811)
NO 2

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

YES 1
NO 2 (GO TO 815)

811) What is your occupation, that is, what kind of work do you mainly do?

OCCUPATION_____

812) 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

813) 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

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

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

815) CHECK 601:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 816)
NOT IN UNION (GO TO 823)

816) CHECK 814:

CODE 1 OR 2 CIRCLED (GO TO 817)
OTHER (GO TO 819)

817) Who usually decides how the money you earn will be used: mainly you, mainly your (husband/partner), or you and your (husband/partner) jointly?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
OTHER (SPECIFY) ____ 6

818) Would you say that the money you earn is more than what your (husband/partner) earns, less than what he earns, or about the same?

MORE THAN HIM 1
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND/PARTNER DOESN'T BRING IN ANY MONEY 4 (GO TO 820)
DON'T KNOW 8

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

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

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

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

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

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

822) Who usually makes decisions about visits to your family, relatives and friends?

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

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

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4

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

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4

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

CHILDREN YOUNGER THAN 10 YEARS
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
HUSBAND
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
OTHER MALES
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
OTHER FEMALES
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3

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

If she goes out without telling him?
YES 1
NO 2
DON'T KNOW 3
If she neglects the children?
YES 1
NO 2
DON'T KNOW 3
If she argues with him?
YES 1
NO 2
DON'T KNOW 3
If she refuses to have sex with him?
YES 1
NO 2
DON'T KNOW 3
If she has sex with someone else?
YES 1
NO 2
DON'T KNOW 3
If she burns the food?
YES 1
NO 2
DON'T KNOW 3

827) In your opinion, is a parent justified in hitting or beating his children for the following reasons:

If he disobeys?
YES 1
NO 2
DON'T KNOW 3
If he is impolite?
YES 1
NO 2
DON'T KNOW 3
If he has embarrassed the family?
YES 1
NO 2
DON'T KNOW 3

SECTION 9. HIV/AIDS

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

YES 1
NO 2 (GO TO 937)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

907A) Can men reduce their chance of getting the AIDS virus by getting circumcised?

YES 1
NO 2
DON'T KNOW 8

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

During pregnancy?
YES 1
NO 2
DON'T KNOW 8
During delivery?
YES 1
NO 2
DON'T KNOW 8
By breastfeeding?
YES 1
NO 2
DON'T KNOW 8

909) CHECK 908:

AT LEAST ONE 'YES' (GO TO 910)
OTHER (GO TO 911)

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

YES 1
NO 2
DON'T KNOW 8

910A) CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

910B) I don't want to know the results, but have you ever been tested to see if you have the AIDS virus for prenuptial purposes?

YES 1
NO 2

910C) CHECK 601, 602, AND 603:

CURRENTLY MARRIED OR LIVING WITH A MAN (GO TO 910D)
FORMERLY MARRIED OR LIVED WITH A MAN (GO TO 910D)
NEVER MARRIED OR NEVER LIVED WITH A MAN (GO TO 911)

910D) I don't want to know the results, but have you ever been tested as a couple with your husband/partner to see if you and/or him have the AIDS virus?

YES 1
NO 2 (GO TO 911)

910E) I don't want to know the results, but have you and your husband told each other the results of your tests?

YES 1
NO 2

911) CHECK 208 AND 215:

LAST BIRTH SINCE JANUARY 2012 (GO TO 912)
NO BIRTHS (GO TO 926)
LAST BIRTH BEFORE JANUARY 2012 (GO TO 926)

912) CHECK 408 FOR LAST BIRTH:

HAD ANTENATAL CARE (GO TO 913)
NO ANTENATAL CARE (GO TO 920)

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

914) During any of the antenatal visits for your last birth were you given any information about:

Babies getting the AIDS virus from their mother?
YES 1
NO 2
DON'T KNOW 8
Things that you can do to prevent getting the AIDS virus?
YES 1
NO 2
DON'T KNOW 8
Getting tested for the AIDS virus?
YES 1
NO 2
DON'T KNOW 8

915) Were you offered a test for the AIDS virus as part of your antenatal care?

YES 1
NO 2

916) I don't want to know the results, but were you tested for the AIDS virus as part of your antenatal care?

YES 1
NO 2 (GO TO 920)

917) Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)
PUBLIC/AGREE SECTOR
REFERRAL HOSPITAL 11
PROVINCIAL/DISTRICT HOSPITAL 12
HEALTH CENTER 13
HEALTH POST 14
OUTREACH 15
COMMUNITY HEALTH WORKER 16
OTHER PUBLIC HEALTH FACILITY (SPECIFY) ____ 17
PRIVATE MEDICAL SECTOR
POLYCLINIC 21
CLINIC 22
DISPENSARY 23
PHARMACY 24
FAMILY PLANNING CLINIC 25
OTHER PRIVATE HEALTH FACILITY (SPECIFY) ____ 26
OTHER SOURCES
KIOSK/SHOP/BAR 31
TRADITIONAL HEALER 32
FRIEND/RELATIVE 33
YOUTH CENTER 34
OTHER (SPECIFY) ____ 96
DON'T KNOW 98

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

YES 1
NO 2 (GO TO 924)

919) All women are supposed to receive counseling after being tested. After you were tested, did you receive counseling?

YES 1 (GO TO 924)
NO 2 (GO TO 924)
DON'T KNOW 8 (GO TO 924)

920) CHECK 434 FOR LAST BIRTH:

ANY CODE 21-36 CIRCLED (GO TO 921)
OTHER (GO TO 926)

921) Between the time you went for delivery but before the baby was born, were you offered a test for the AIDS virus?

YES 1
NO 2

922) I don't want to know the results, but were you tested for the AIDS virus at that time?

YES 1
NO 2 (GO TO 926)

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

YES 1
NO 2

924) Have you been tested for the AIDS virus since that time you were tested during your pregnancy?

YES 1 (GO TO 927)
NO 2

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

MONTHS AGO_____ (GO TO 932)
TWO OR MORE YEARS 96 (GO TO 932)

926) I don't 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 930)

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

MONTHS AGO_____
TWO OR MORE YEARS 96

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

YES 1
NO 2

929) Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)
PUBLIC/AGREE SECTOR
REFERRAL HOSPITAL 11 (GO TO 932)
PROVINCIAL/DISTRICT HOSPITAL 12 (GO TO 932)
HEALTH CENTER 13 (GO TO 932)
HEALTH POST 14 (GO TO 932)
OUTREACH 15 (GO TO 932)
COMMUNITY HEALTH WORKER 16 (GO TO 932)
OTHER PUBLIC HEALTH FACILITY (SPECIFY) ____ 17 (GO TO 932)
PRIVATE MEDICAL SECTOR
POLYCLINIC 21 (GO TO 932)
CLINIC 22 (GO TO 932)
DISPENSARY 23 (GO TO 932)
PHARMACY 24 (GO TO 932)
FAMILY PLANNING CLINIC 25 (GO TO 932)
OTHER PRIVATE HEALTH FACILITY (SPECIFY) ____ 26 (GO TO 932)
OTHER SOURCES
KIOSK/SHOP/BAR 31 (GO TO 932)
TRADITIONAL HEALER 32 (GO TO 932)
FRIEND/RELATIVE 33 (GO TO 932)
YOUTH CENTER 34 (GO TO 932)
OTHER (SPECIFY) ____ 96 (GO TO 932)
DON'T KNOW 98 (GO TO 932)

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

YES 1
NO 2 (GO TO 932)

931) Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S))
PUBLIC/AGREE SECTOR
REFERRAL HOSPITAL A
PROVINCIAL/DISTRICT HOSPITAL B
HEALTH CENTER C
HEALTH POST D
OUTREACH E
COMMUNITY HEALTH WORKER F
OTHER PUBLIC HEALTH FACILITY (SPECIFY) ____ G
PRIVATE MEDICAL SECTOR
POLYCLINIC H
CLINIC I
DISPENSARY J
PHARMACY K
FAMILY PLANNING CLINIC L
OTHER PRIVATE HEALTH FACILITY (SPECIFY) ____ M
OTHER SOURCES
KIOSK/SHOP/BAR N
TRADITIONAL HEALER O
FRIEND/RELATIVE P
YOUTH CENTER Q
CORRECTIONAL FACILITY R
OTHER (SPECIFY) ____ X

932) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person has the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

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

YES, REMAIN A SECRET 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

934) If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?

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

935) In your opinion, if a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in the school?

SHOULD BE ALLOWED 1
SHOULD NOT BE ALLOWED 2
DON'T KNOW/NOT SURE/DEPENDS 8

936) Should children age 12-14 be taught about using a condom to avoid getting AIDS?

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

937) CHECK 901:

HEARD ABOUT AIDS

Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?
YES 1
NO 2

NOT HEARD ABOUT AIDS

Have you heard about infections that can be transmitted through sexual contact?
YES 1
NO 2

938) CHECK 613:

HAS HAD SEXUAL INTERCOURSE (GO TO 939)
NEVER HAD SEXUAL INTERCOURSE (GO TO 946)

939) CHECK 937: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES (GO TO 940)
NO (GO TO 941)

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

YES 1
NO 2
DON'T KNOW 8

941) 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

942) 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

943) CHECK 940, 941, AND 942:

HAS HAD AN INFECTION (ANY 'YES') (GO TO 944)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 946)

944) The last time you had (PROBLEM FROM 940/941/942), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 946)

945) Where did you go? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S))
PUBLIC/AGREE SECTOR
REFERRAL HOSPITAL A
PROVINCIAL/DISTRICT HOSPITAL B
HEALTH CENTER C
HEALTH POST D
OUTREACH E
COMMUNITY HEALTH WORKER F
OTHER PUBLIC HEALTH FACILITY (SPECIFY) ____ G
PRIVATE MEDICAL SECTOR
POLYCLINIC H
CLINIC I
DISPENSARY J
PHARMACY K
FAMILY PLANNING CLINIC L
OTHER PRIVATE HEALTH FACILITY (SPECIFY) ____ M
OTHER SOURCES
KIOSK/SHOP/BAR N
TRADITIONAL HEALER O
FRIEND/RELATIVE P
YOUTH CENTER Q
OTHER (SPECIFY) ____ X

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

YES 1
NO 2
DON'T KNOW 8

947) Is a wife justified in refusing to have sex with her husband when she knows her husband has sex with other women?

YES 1
NO 2
DON'T KNOW 8

948) CHECK 601:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 949)
NOT IN UNION (GO TO 1001)

949) Can you say no to your (husband/partner) if you do not want to have sexual intercourse?

YES 1
NO 2
DEPENDS/NOT SURE 8

950) Could you ask your (husband/partner) to use a condom if you wanted him to?

YES 1
NO 2
DEPENDS/NOT SURE 8

SECTION 10. OTHER HEALTH ISSUES

1001) Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?

IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS_____
NONE 00 (GO TO 1004)

1002) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?

IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS_____
NONE 00 (GO TO 1004)

1003) The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?

YES 1
NO 2
DON'T KNOW 8

1004) Do you currently smoke cigarettes?

YES 1
NO 2 (GO TO 1006)

1005) In the last 24 hours, how many cigarettes did you smoke?

NUMBER OF CIGARETTES_____

1006) Do you currently smoke or use any (other) type of tobacco?

YES 1
NO 2 (GO TO 1008)

1007) What (other) type of tobacco do you currently smoke or use?

RECORD ALL MENTIONED.

PIPE A
CHEWING TOBACCO B
SNUFF C
OTHER (SPECIFY) ____ X

1008) 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?

Getting permission to go to the doctor?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Getting money needed for advice or treatment?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
The distance to the health facility?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Not wanting to go alone?
BIG PROBLEM 1
NOT A BIG PROBLEM 2

1009) Have you ever heard of an illness called tuberculosis or TB?

YES 1
NO 2 (GO TO 1011)

1010) How does tuberculosis spread from one person to another? PROBE: Any other ways?

RECORD ALL MENTIONED.

THROUGH THE AIR WHEN COUGHING, SNEEZING OR SPEAKING A
THROUGH SHARING UTENSILS B
THROUGH TOUCHING A PERSON WITH TB C
THROUGH SHARING FOOD OR DRINK WITH A PERSON WITH TB D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
OTHER (SPECIFY) ____ X
DON'T KNOW Z

1011) Do you currently have the following symptoms?

a. Cough
YES, TWO WEEKS OR LONGER 1
YES, LESS THAN TWO WEEKS 2
NO 3
b. Fever
YES, ONE MONTH OR LONGER 1
YES, LESS THAN ONE MONTH 2
NO 3
c. Drenching night sweats
YES, ONE MONTH OR LONGER 1
YES, LESS THAN ONE MONTH 2
NO 3
d. Unexpected weight lost
YES, ONE MONTH OR LONGER 1
YES, LESS THAN ONE MONTH 2
NO 3
e. General fatigue or malaise
YES, ONE MONTH OR LONGER 1
YES, LESS THAN ONE MONTH 2
NO 3
f. Chest pain
YES, ONE MONTH OR LONGER 1
YES, LESS THAN ONE MONTH 2
NO 3

1012) CHECK 1011:

IF AT LEAST ONE SYMPTOM "YES" CODE "1" OR "2" CIRCLED (GO TO 1013)
IF "NO" TO ALL SYMPTOMS (GO TO 1015)

1013) Have you ever sought care or help?

YES 1
NO 2 (GO TO 1015)

1014) (IF "YES") Where did you seek care or help?

RECORD ALL MENTIONED.

PUBLIC/AGREE SECTOR
REFERRAL HOSPITAL A
PROVINCIAL/DISTRICT HOSPITAL B
HEALTH CENTER C
HEALTH POST D
OUTREACH E
COMMUNITY HEALTH WORKER F
OTHER PUBLIC HEALTH FACILITY (SPECIFY) ____ G
PRIVATE MEDICAL SECTOR
POLYCLINIC H
CLINIC I
DISPENSARY J
PHARMACY K
FAMILY PLANNING CLINIC L
OTHER PRIVATE HEALTH FACILITY (SPECIFY) ____ M
OTHER SOURCES
KIOSK/SHOP/BAR N
TRADITIONAL HEALER O
FRIEND/RELATIVE P
OTHER (SPECIFY) ____ X

1015) GO TO THE NEXT SECTION (11)

SECTION 11. ADULT MORTALITY

1101) 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, including those who are living with you, those living elsewhere, and those who have died.

How many children did your mother give birth to, including you?

NUMBER OF BIRTHS TO NATURAL MOTHER_____

1102) CHECK 1101:

TWO OR MORE BIRTHS (GO TO 1103)
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO DV01A)

1103) How many of these births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS_____

1104) What was the name given to your oldest (next oldest) brother or sister?

NAME_____

1105) Is (NAME) male or female?

MALE 1
FEMALE 2

1106) Is (NAME) still alive?

YES 1
NO 2 (GO TO 1108)
DON'T KNOW 8 (GO TO THE NEXT COLUMN IN 1104 FOR THE NEXT SIBLING)

1107) How old is (NAME)?

AGE_____ (GO TO THE NEXT COLUMN IN 1104 FOR THE NEXT SIBLING)

1108) How many years ago did (NAME) die?

YEARS_____

1109) How old was (NAME) when he/she died?

AGE_____ (IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO THE NEXT COLUMN IN 1104 FOR THE NEXT SIBLING)

1110) Was (NAME) pregnant when she died?

YES 1 (GO TO 1113)
NO 2

1111) Did (NAME) die during childbirth?

YES 1 (GO TO 1113)
NO 2

1112) Did (NAME) die within two months after the end of a pregnancy or childbirth?

YES 1
NO 2

1113) How many live born children did (NAME) give birth to during her lifetime?

NUMBER OF CHILDREN_____

1114) GO BACK TO 1104 IN NEXT COLUMN, OR, IF NO MORE BROTHERS OR SISTERS, GO TO THE NEXT SECTION.

FEMALE DOMESTIC VIOLENCE MODULE

DV01A) CHECK THE COVER PAGE IF THIS HOUSEHOLD SELECTED FOR FEMALE DV QUESTIONNAIRE

HOUSEHOLD SELECTED (GO TO DV01B)
HOUSEHOLD NOT SELECTED (GO TO DV33)

DV01B) CHECK THE COVER PAGE IF THIS WOMAN SELECTED FOR FEMALE DV QUESTIONNAIRE

WOMAN SELECTED FOR THIS SECTION (GO TO DV01C)
WOMAN NOT SELECTED (GO TO DV33)

DV01C) CHECK FOR PRESENCE OF OTHERS:

DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.

PRIVACY OBTAINED 1
PRIVACY NOT POSSIBLE 2 (GO TO DV32)

[If privacy obtained]:

READ TO THE RESPONDENT

Now I would like to ask you questions about some other important aspects of a woman's life. You may find some of these questions very personal. However, your answers are crucial for helping to understand the condition of women in Rwanda. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else in your household will know that you were asked these questions.

DV02) CHECK 601 AND 602:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO DV03)
FORMERLY MARRIED/LIVED WITH A MAN (READ IN PAST TENSE AND USE 'LAST' WITH HUSBAND/PARTNER) (GO TO DV03)
NEVER MARRIED/NEVER LIVED WITH A MAN (GO TO DV16)

DV03) First, I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your (last) (husband/partner)?

a) He (is/was) jealous or angry if you (talk/talked) to other men?
YES 1
NO 2
DON'T KNOW 8
b) He frequently (accuses/accused) you of being unfaithful?
YES 1
NO 2
DON'T KNOW 8
c) He (does/did) not permit you to meet your female friends?
YES 1
NO 2
DON'T KNOW 8
d) He (tries/tried) to limit your contact with your family?
YES 1
NO 2
DON'T KNOW 8
e) He (insists/insisted) on knowing where you (are/were) at all times?
YES 1
NO 2
DON'T KNOW 8

DV04) Now I need to ask you some more questions about your relationship with your (last) (husband/partner).

DV04-A) Did your (last) (husband/partner) ever:

a) Say or do something to humiliate you in front of others?
YES 1 (GO TO DV04-Ba)
NO 2 (GO TO DV04-Ab)
b) Threaten to hurt or harm you or someone you care about?
YES 1 (GO TO DV04-Bb)
NO 2 (GO TO DV04-Ac)
c) Insult you or make you feel bad about yourself?
YES 1 (GO TO DV04-Bc)
NO 2

DV04-B) How often did this happen during the last 12 months: often, only sometimes, or not at all?

a) Say or do something to humiliate you in front of others?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b) Threaten to hurt or harm you or someone you care about?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c) Insult you or make you feel bad about yourself?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

DV05-A) Did your (last) (husband/partner) ever do any of the following things to you:

a) Push you, shake you, or throw something at you?
YES 1 (GO TO DV05-Ba)
NO 2 (GO TO DV05-Ab)
b) Slap you?
YES 1 (GO TO DV05-Bb)
NO 2 (GO TO DV05-Ac)
c) Twist your arm or pull your hair?
YES 1 (GO TO DV05-Bc)
NO 2 (GO TO DV05-Ad)
d) Punch you with his fist or with something that could hurt you?
YES 1 (GO TO DV05-Bd)
NO 2 (GO TO DV05-Ae)
e) Kick you, drag you, or beat you up?
YES 1 (GO TO DV05-Be)
NO 2 (GO TO DV05-Af)
f) Try to choke you or burn you on purpose?
YES 1 (GO TO DV05-Bf)
NO 2 (GO TO DV05-Ag)
g) Threaten you attack you with a knife, gun, or other weapon?
YES 1 (GO TO DV05-Bg)
NO 2 (GO TO DV05-Ah)
h) Physically force you to have sexual intercourse with him when you did not want to?
YES 1 (GO TO DV05-Bh)
NO 2 (GO TO DV05-Ai)
i) Physically force you to perform any other sexual acts you did not want to?
YES 1 (GO TO DV05-Bi)
NO 2 (GO TO DV05-Aj)
j) Force you with threats or in any other way to perform sexual acts you did not want to?
YES 1 (GO TO DV05-Bj)
NO 2

DV05-B) How often did this happen in the last 12 months: often, only sometimes, or not at all?

a) Push you, shake you, or throw something at you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b) Slap you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c) Twist your arm or pull your hair?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
d) Punch you with his fist or with something that could hurt you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
e) Kick you, drag you, or beat you up?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
f) Try to choke you or burn you on purpose?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
g) Threaten you attack you with a knife, gun, or other weapon?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
h) Physically force you to have sexual intercourse with him when you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
i) Physically force you to perform any other sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
j) Force you with threats or in any other way to perform sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

DV06) CHECK DV05 (a-j):

AT LEAST ONE 'YES' (GO TO DV07)
NOT A SINGLE 'YES' (GO TO DV09)

DV07) How long after you first (got married/started living together) 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

DV08) Did the following ever happen as a result of what your (last) (husband/partner) did to you:

a) You had cuts, bruises, or aches?
YES 1
NO 2
b) You had eye injuries, sprains, dislocations, or burns?
YES 1
NO 2
c) You had deep wounds, broken bones, broken teeth, or any other serious injury?
YES 1
NO 2

DV09) Have you ever hit, slapped, kicked, or done anything 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 DV11)

DV10) In the last 12 months, how often have you done this to your (last) (husband/partner): often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

DV11) Does (did) your (last) (husband/partner) drink alcohol?

YES 1
NO 2 (GO TO DV13)

DV12) How often does (did) he get drunk: often, only sometimes, or never?

OFTEN 1
SOMETIMES 2
NEVER 3

DV13) Are (Were) you afraid of your (last) (husband/partner): most of the time, sometimes, or never?

MOST OF THE TIME AFRAID 1
SOMETIMES AFRAID 2
NEVER AFRAID 3

DV14) CHECK 609:

MARRIED MORE THAN ONCE (GO TO DV15)
MARRIED ONLY ONCE (GO TO DV16)

DV15-A) So far we have been talking about the behavior of your (current/last) (husband/partner). Now I want to ask you about the behavior of any previous (husband/partner).

a) Did any previous (husband/partner) ever hit, slap, kick, or do anything else to hurt you physically?
YES 1 (GO TO DV15-Ba)
NO 2 (GO TO DV15-Ab)
b) Did any previous husband/partner) physically force you to have intercourse or perform any other sexual acts against your will?
YES 1 (GO TO DV15-Bb)
NO 2

DV15-B) How long ago did this last happen?

a) Did any previous (husband/partner) ever hit, slap, kick, or do anything else to hurt you physically?
0-11 MONTHS AGO 1
12 OR MORE MONTHS AGO 2
DON'T REMEMBER 3
b) Did any previous (husband/partner) physically force you to have intercourse or perform any other sexual acts against your will?
0-11 MONTHS AGO 1
12 OR MORE MONTHS AGO 2
DON'T REMEMBER 3

DV16) CHECK 601 AND 602:

EVER MARRIED/EVER LIVED WITH A MAN

From the time you were 15 years old has anyone other than (your/any) (husband/partner) hit you, slapped you, kicked you, or done anything else to hurt you physically?
YES 1
NO 2 (GO TO DV19)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO DV19)

NEVER MARRIED/NEVER LIVED WITH A MAN

From the time you were 15 years old has anyone hit you, slapped you, kicked you, or done anything else to hurt you physically?
YES 1
NO 2 (GO TO DV19)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO DV19)

DV17) Who has hurt you in this way? Anyone else?

RECORD ALL MENTIONED.

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

DV18) Has (this person/have these persons) physically hurt you in the last 12 months?

YES 1
NO 2 (GO TO DV19)

DV18A) How often has (this person/have these persons) physically hurt you in the last 12 months: often or only sometimes?

OFTEN 1
SOMETIMES 2

DV18B) CHECK DV17:

MORE THAN ONE RESPONSE SELECTED (GO TO DV18C)
ONLY ONE RESPONSE SELECTED (GO TO DV19)

DV18C) Who is the main person that has hurt you this way in the last 12 months?

MOTHER/STEP-MOTHER 01
FATHER/STEP-FATHER 02
SISTER/BROTHER 03
DAUGHTER/SON 04
OTHER RELATIVE 05
CURRENT BOYFRIEND 06
FORMER BOYFRIEND 07
MOTHER-IN-LAW 08
FATHER-IN-LAW 09
OTHER IN-LAW 10
TEACHER 11
EMPLOYER/SOMEONE AT WORK 12
POLICE/SOLDIER 13
OTHER (SPECIFY) ____ 96

DV19) CHECK 201, 226, AND 230:

EVER BEEN PREGNANT (YES ON 201 OR 226 OR 230) (GO TO DV20)
NEVER BEEN PREGNANT (GO TO DV22)

DV20) 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 DV22)

DV21) Who has done any of these things to hurt you while you were pregnant? Anyone else?

RECORD ALL MENTIONED.

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

DV22) CHECK 601 AND 602:

EVER MARRIED/EVER LIVED WITH A MAN (GO TO DV22A)
NEVER MARRIED/NEVER LIVED WITH A MAN (GO TO DV22B)

DV22A) Now I want to ask you about things that may have been done to you by someone other than (your/any) (husband/partner).

At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?

YES 1 (GO TO DV23)
NO 2 (GO TO DV24B)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO DV24B)

DV22B) At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?

YES 1
NO 2 (GO TO DV26)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO DV26)

DV23) Who was the person who was forcing you the very first time this happened?

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

DV24) CHECK 601 AND 602:

EVER MARRIED/EVER LIVED WITH A MAN

In the last 12 months, has anyone other than (your/any) (husband/partner) physically forced you to have sexual intercourse when you did not want to?
YES 1
NO 2 (GO TO DV25)

NEVER MARRIED/NEVER LIVED WITH A MAN

In the last 12 months has anyone physically forced you to have sexual intercourse when you did not want to?
YES 1
NO 2 (GO TO DV25)

DV24A) Who was the person who was forcing you the very first time this happened in the last 12 months?

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

DV24B) CHECK DV05A (h-j) and DV15A (b), DV22A, DV22B:

AT LEAST ONE 'YES' (GO TO DV25)
NOT A SINGLE 'YES' (GO TO DV26)

DV25) CHECK 601 AND 602:

EVER MARRIED/EVER LIVED WITH A MAN

How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts by anyone, including (your/any) husband/partner?
AGE IN COMPLETED YEARS_____
DON'T KNOW 98

NEVER MARRIED/NEVER LIVED WITH A MAN

How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts?
AGE IN COMPLETED YEARS_____
DON'T KNOW 98

DV26) CHECK DV05 (a-j), DV15A (a,b), DV16, DV20, DV22A, AND DV22B:

AT LEAST ONE 'YES' (GO TO DV27)
NOT A SINGLE 'YES' (GO TO DV30)

DV27) Thinking about what you yourself will have experienced among the different things we have been talking about, have you ever tried to seek help?

YES 1
NO 2 (GO TO DV29)

DV28) From whom have you sought help? Anyone else?

RECORD ALL MENTIONED.

OWN FAMILY A (GO TO DV30)
HUSBAND'S/PARTNER'S FAMILY B (GO TO DV30)
CURRENT/FORMER HUSBAND/PARTNER C (GO TO DV30)
CURRENT/FORMER BOYFRIEND D (GO TO DV30)
FRIEND E (GO TO DV30)
NEIGHBOR F (GO TO DV30)
RELIGIOUS LEADER G (GO TO DV30)
DOCTOR/MEDICAL PERSONNEL H (GO TO DV30)
POLICE I (GO TO DV30)
LAWYER J (GO TO DV30)
SOCIAL SERVICE ORGANIZATION K (GO TO DV30)
OTHER (SPECIFY) ____ X (GO TO DV30)

DV29) Have you ever told anyone about this?

YES 1
NO 2

DV30) As far as you know, did your father ever beat your mother?

YES 1
NO 2
DON'T KNOW 8

THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER ABOUT THE CONFIDENTIALITY OF HER ANSWERS. FILL OUT THE QUESTIONS BELOW WITH REFERENCE TO THE DOMESTIC VIOLENCE MODULE ONLY.

DV31) DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?

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

DV32) INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE.

DV33) RECORD THE TIME

HOUR_____
MINUTE_____

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 SUPERVISOR:_____
DATE_____

EDITOR'S OBSERVATIONS

NAME OF EDITOR:_____
DATE:_____

CALENDAR

INSTRUCTIONS: ONLY ONE CODE SHOULD APPEAR IN ANY BOX. COLUMN 1 REQUIRES A CODE IN EVERY MONTH.

INFORMATION TO BE CODED FOR EACH COLUMN

COLUMN 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE

BIRTHS B
PREGNANCIES P
TERMINATIONS T
NO METHOD 0
FEMALE STERILIZATION 1
MALE STERILIZATION 2
IUD 3
INJECTABLES 4
IMPLANTS/JADELLE 5
PILL 6
CONDOM 7
FEMALE CONDOM 8
DIAPHRAGM 9
FOAM OR JELLY J
LACTATIONAL AMENORRHEA METHOD K
RHYTHM METHOD L
STANDARD DAYS METHOD M
WITHDRAWAL N
OTHER MODERN METHOD X
OTHER TRADITIONAL METHOD Y

COLUMN 2: DISCONTINUATION OF CONTRACEPTIVE USE

INFREQUENT SEX/HUSBAND AWAY 0
BECAME PREGNANT WHILE USING 1
WANTED TO BECOME PREGNANT 2
HUSBAND/PARTNER DISAPPROVED 3
WANTED MORE EFFECTIVE METHOD 4
SIDE EFFECTS/HEALTH CONCERNS 5
LACK OF ACCESS/TOO FAR 6
COSTS TOO MUCH 7
INCONVENIENT TO USE 8
UP TO GOD/FATALISTIC F
DIFFICULT TO GET PREGNANT/MENOPAUSAL A
MARITAL DISSOLUTION/SEPARATION D
OTHER (SPECIFY) ____ X
DON'T KNOW Z

2015

06 JUN 01_ _
05 MAY 02_ _
04 APR 03_ _
03 MAR 04_ _
02 FEB 05_ _
01 JAN 06_ _

2014

12 DEC 07_ _
11 NOV 08_ _
10 OCT 09_ _
09 SEP 10_ _
08 AUG 11_ _
07 JUL 12_ _
06 JUN 13_ _
05 MAY 14_ _
04 APR 15_ _
03 MAR 16_ _
02 FEB 17_ _
01 JAN 18_ _

2013

12 DEC 19_ _
11 NOV 20_ _
10 OCT 21_ _
09 SEP 22_ _
08 AUG 23_ _
07 JUL 24_ _
06 JUN 25_ _
05 MAY 26_ _
04 APR 27_ _
03 MAR 28_ _
02 FEB 29_ _
01 JAN 30_ _

2012

12 DEC 31_ _
11 NOV 32_ _
10 OCT 33_ _
09 SEP 34_ _
08 AUG 35_ _
07 JUL 36_ _
06 JUN 37_ _
05 MAY 38_ _
04 APR 39_ _
03 MAR 40_ _
02 FEB 41_ _
01 JAN 42_ _

2011

12 DEC 43_ _
11 NOV 44_ _
10 OCT 45_ _
09 SEP 46_ _
08 AUG 47_ _
07 JUL 48_ _
06 JUN 49_ _
05 MAY 50_ _
04 APR 51_ _
03 MAR 52_ _
02 FEB 53_ _
01 JAN 54_ _

2010

12 DEC 55_ _
11 NOV 56_ _
10 OCT 57_ _
09 SEP 58_ _
08 AUG 59_ _
07 JUL 60_ _
06 JUN 61_ _
05 MAY 62_ _
04 APR 63_ _
03 MAR 64_ _
02 FEB 65_ _
01 JAN 66_ _

2009

12 DEC 67_ _
11 NOV 68_ _
10 OCT 69_ _
09 SEP 70_ _
08 AUG 71_ _
07 JUL 72_ _
06 JUN 73_ _
05 MAY 74_ _
04 APR 75_ _
03 MAR 76_ _
02 FEB 77_ _
01 JAN 78_ _