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RWANDA DEMOGRAPHIC AND HEALTH SURVEYS 2014-15 MAN'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 MAN

CHECK COVER PAGE OF THE HOUSEHOLD QUESTIONNAIRE:

HOUSEHOLD SELECTED FOR MALE DOMESTIC VIOLENCE MODULE

YES 1
NO 2

CHECK Q. 141m IN HOUSEHOLD QUESTIONNAIRE:

IS THIS MAN SELECTED FOR MALE 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 20 minutes. All of the answer 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 or you can stop the interview at any time.

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

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

SIGNATURE OF INTERVIEWER:__________ DATE:_____

RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 101)
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, 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 HIGHER (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 any children you have had during your life. I am interested in all of the children that are biologically yours, even if they are not legally yours or do not have your last name.

Have you ever fathered any children with any woman?

YES 1
NO 2 (GO TO 206)
DON'T KNOW 8 (GO TO 206)

202) Do you have any sons or daughters that you have fathered 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 that you have fathered 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?

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 fathered a son or daughter 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)
DON'T KNOW 8 (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 CHILDREN_____

209) CHECK 208:

HAS HAD MORE THAN ONE CHILD (GO TO 210)
HAS HAD ONLY ONE CHILD (GO TO 212)
HAS NOT HAD ANY CHILDREN (GO TO 301)

210) Did all of the children you have fathered have the same biological mother?

YES 1 (GO TO 212)
NO 2

211) In all, how many women have you fathered children with?

NUMBER OF WOMEN_____

212) How old were you when your (first) child was born?

AGE IN YEARS_____

213) CHECK 203 AND 205:

AT LEAST ONE LIVING CHILD (GO TO 214)
NO LIVING CHILDREN (GO TO 301)

214) How old is your (youngest) child?

AGE IN YEARS_____

215) CHECK 214:

(YOUNGEST) CHILD IS AGE 0-2 YEARS (GO TO 216)
OTHER (GO TO 301)

216) What is the name of your (youngest) child?

WRITE NAME OF (YOUNGEST) CHILD

(NAME OF (YOUNGEST) CHILD)

217) When (NAME)'s mother was pregnant with (NAME), did she have any antenatal check-ups?

YES 1
NO 2 (GO TO 219)
DON'T KNOW 8 (GO TO 219)

218) Were you ever present during any of those antenatal check-ups?

PRESENT 1
NOT PRESENT 2

219) Was (NAME) born in a hospital or health facility?

HOSPITAL/HEALTH FACILITY 1
OTHER 2

220) When a child has diarrhea, how much should he or she be given to drink: more than usual, about the same as usual, less than usual, or nothing to drink at all?

MORE THAN USUAL 1
ABOUT THE SAME 2
LESS THAN USUAL 3
NOTHING TO DRINK 4
DON'T KNOW 8

SECTION 3. CONTRACEPTION

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

Have you ever heard of (METHOD)?

01) Female Sterilization. PROBE: Women can have an operation to avoid having any more children?
YES 1
NO 2
02) Male Sterilization. PROBE: Men can have an operation to avoid having any more children.
YES 1
NO 2
03) IUD. PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
04) 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
05) 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
06) Pill. PROBE: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
07) Condom. PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08) Female Condom. PROBE: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09) Lactational Amenorrhea Method (LAM)
YES 1
NO 2
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
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
12) Withdrawal. PROBE: Men can be careful and pull out before climax.
YES 1
NO 2
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
14) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES (SPECIFY) 1
NO 2

302) 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

303) In the last few months, have you discussed family planning with a health worker or health professional?

YES 1
NO 2

304) Now I would like to ask you about a woman's risk of pregnancy.

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

YES 1
NO 2 (GO TO 306)
DON'T KNOW 8 (GO TO 306)

305) 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

306) I will now read you some statements about contraception. Please tell me if you agree or disagree with each one.

a) Contraception is a woman's business and a man should not have to worry about it.

AGREE 1
DISAGREE 2
DON'T KNOW 8

b) Women who use contraception may become promiscuous.

AGREE 1
DISAGREE 2
DON'T KNOW 8

307) CHECK 301 (07) KNOWS MALE CONDOM:

YES (GO TO 308)
NO (GO TO 311)

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

YES 1
NO 2 (GO TO 311)

309) 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

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

YES 1
NO 2

311) CHECK 301 (08) KNOWS FEMALE CONDOM:

YES (GO TO 312)
NO (GO TO 401)

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

YES 1
NO 2 (GO TO 401)

313) 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

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

YES 1
NO 2

SECTION 4. MARRIAGE AND SEXUAL ACTIVITY

401) Are you currently married or living together with a woman as if married?

YES, CURRENTLY MARRIED 1 (GO TO 404)
YES, LIVING WITH A WOMAN 2 (GO TO 404)
NO, NOT IN UNION 3

402) Have you ever been married or lived together with a woman as if married?

YES, FORMERLY MARRIED 1
YES, LIVED WITH A WOMAN 2
NO 3 (GO TO 413)

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

WIDOWED 1 (GO TO 410)
DIVORCED 2 (GO TO 410)
SEPARATED 3 (GO TO 410)

404) Is your (wife/partner) living with you now or is she staying elsewhere?

LIVING WITH HIM 1
STAYING ELSEWHERE 2

405) Do you have other wives or do you live with other women as if married?

YES (MORE THAN ONE) 1
NO (ONLY ONE) 2 (GO TO 407)

406) Altogether, how many wives or live-in partners do you have?

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNERS______

407) CHECK 405:

ONE WIFE/PARTNER:

Please tell me the name of your wife (the woman you are living with as if married).

RECORD THE NAME AND THE LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH WIFE AND LIVE-IN PARTNER.

IF A WOMAN IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.

NAME_____
LINE NUMBER_____
[repeat as needed if more than one wife/partner]

408) ASK 408 FOR EACH PERSON.

How old was (NAME) on her last birthday?

AGE_____
[record age for all wives/live-in partners]

409) CHECK 407:

ONE WIFE/PARTNER (GO TO 410)
MORE THAN ONE PARTNER (GO TO 411A)

410) Have you been married or lived with a woman only once or more than once?

ONLY ONCE 1
MORE THAN ONCE 2 (GO TO 411A)

411) In what month and year did you start living with your (wife/partner)?

MONTH_____
DON'T KNOW MONTH 98
YEAR_____ (GO TO 413)
DON'T KNOW YEAR 9998

411A) Now I would like to ask about your first (wife/partner). In what month and year did you start living with her?

MONTH_____
DON'T KNOW MONTH 98
YEAR (GO TO 413)
DON'T KNOW YEAR 9998

412) How old were you when you first started living with her?

AGE_____

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

414) 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 501)
AGE IN YEARS_____
FIRST TIME WHEN STARTED LIVING WITH (FIRST) WIFE/PARTNER 95

415) 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.

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

IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS.

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

DAYS AGO 1_____
WEEKS AGO 2_____
MONTHS AGO 3_____
YEARS AGO 4______ (GO TO 434)

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

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

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

YES 1
NO 2 (GO TO 420)

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

YES 1
NO 2

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

IF GIRLFRIEND: Were you living together as if married? IF YES, CIRCLE '2'. IF NO, CIRCLE '3'.

WIFE 1
LIVE-IN PARTNER 2
GIRLFRIEND NOT LIVING WITH RESPONDENT 3 (GO TO 423)
CASUAL ACQUAINTANCE 4 (GO TO 423)
PROSTITUTE 5 (GO TO 423)
OTHER (SPECIFY) 6 (GO TO 423)

421) CHECK 410:

MARRIED ONLY ONCE (GO TO 422)
MARRIED MORE THAN ONCE OR 410 NOT FILLED (GO TO 423)

422) CHECK 414:

FIRST TIME WHEN STARTED LIVING WITH FIRST WIFE (GO TO 424)
OTHER (GO TO 423)

423) 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_____

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

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

IF NUMBER OF TIMES IS 95 OR MORE, WRITE '95'.

NUMBER OF TIMES_____

424A) How many times during the last month did you have sexual intercourse with this person?

NUMBER OF TIMES_____

425) How old is this person?

AGE OF PARTNER_____
DON'T KNOW 98

426) 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 417 IN NEXT COLUMN)
NO 2 (GO TO 428)

427) 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 IN LAST 12 MONTHS_____
DON'T KNOW 98

427A) 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 IN LAST MONTH_____
DON'T KNOW 98

428) CHECK 420 (ALL COLUMNS):

AT LEAST ONE PARTNER IS A PROSTITUTE (GO TO 429)
NO PARTNERS ARE PROSTITUTES (GO TO 430)

429) CHECK 420 AND 418 (ALL COLUMNS):

CONDOM USED WITH EVERY PROSTITUTE (GO TO 433)
OTHER (GO TO 434)

430) In the last 12 months, did you pay anyone in exchange for having sexual intercourse?

YES 1 (GO TO 432)
NO 2

431) Have you ever paid anyone in exchange for having sexual intercourse?

YES 1 (GO TO 434)
NO 2 (GO TO 434)

432) The last time you paid someone in exchange for having sexual intercourse, was a condom used?

YES 1
NO 2 (GO TO 434)

433) Was a condom used during sexual intercourse every time you paid someone in exchange for having sexual intercourse in the last 12 months?

YES 1
NO 2
DON'T KNOW 8

434) In total, with how many different 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

435) CHECK 418, MOST RECENT PARTNER (FIRST COLUMN):

CONDOM USED (GO TO 436)
NOT ASKED (GO TO 438)
NO CONDOM USED (GO TO 438)

436) You told me that a condom was used the last time you had sex. What is the brand name of the condom used at that time?

IF BRAND NOT KNOWN, ASK TO SEE THE PACKAGE.

PRUDENCE PLUS 01
PLEASURE 02
GENERIC CONDOM 03
OTHER (SPECIFY) 96
DON'T KNOW 98

437) From where did you obtain the condom the last time?

PROBE TO IDENTIFY 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

438) The last time you had sex did you or your partner use any method (other than a condom) to avoid or prevent a pregnancy?

YES 1
NO 2 (GO TO 501)
DON'T KNOW 8

439) What method did you or your partner use?

PROBE: Did you or your partner use any other method to prevent pregnancy?

RECORD ALL MENTIONED.

FEMALE STERILIZATION A
MALE STERILIZATION B
IUD C
INJECTABLES D
IMPLANTS/JADELLE E
PILL F
FEMALE CONDOM G
DIAPHRAGM H
FOAM/JELLY I
LAM J
RHYTHM METHOD K
STANDARD DAYS METHOD L
WITHDRAWAL M
OTHER MODERN METHOD X
OTHER TRADITIONAL METHOD Y

SECTION 5. FERTILITY PREFERENCES

501) CHECK 401:

CURRENTLY MARRIED OR LIVING WITH A PARTNER (GO TO 502)
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER (GO TO 509)

502) CHECK 439:

MAN NOT STERILIZED (GO TO 503)
MAN STERILIZED (GO TO 509)

503) (Is your (wife/partner)/Are any of your (wives/partners)) currently pregnant?

YES 1
NO 2 (GO TO 505)
DON'T KNOW (GO TO 505)

504) Now I have some questions about the future. After the (child/children) you and your (wife(wives)/partner(s)) 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 506)
NO MORE/NONE 2 (GO TO 509)
UNDECIDED/DON'T KNOW (GO TO 509)

505) 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 509)
SAYS COUPLE CAN'T GET PREGNANT 3 (GO TO 509)
WIFE (WIVES)/PARTNER(S) STERILIZED 4 (GO TO 509)
UNDECIDED/DON'T KNOW 8 (GO TO 509)

506) CHECK 407:

ONE WIFE/PARTNER (GO TO 507)
MORE THAN ONE WIFE/PARTNER (GO TO 508)

507) CHECK 503:

WIFE/PARTNER NOT PREGNANT OR DON'T KNOW:

How long would you like to wait from now before the birth of (a/another) child?

MONTHS 1_____ (GO TO 509)
YEARS 2_____ (GO TO 509)
SOON/NOW 993 (GO TO 509)
COUPLE INFECUND 994 (GO TO 509)
OTHER (SPECIFY) 996 (GO TO 509)
DON'T KNOW 998 (GO TO 509)

WIFE/PARTNER 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_____ (GO TO 509)
YEARS 2_____ (GO TO 509)
SOON/NOW 993 (GO TO 509)
COUPLE INFECUND 994 (GO TO 509)
OTHER (SPECIFY) 996 (GO TO 509)
DON'T KNOW 998 (GO TO 509)

508) How long would you like to wait from now before the birth of (a/another) child?

MONTHS 1_____
YEARS 2_____
SOON/NOW 993
HE/ALL HIS WIVES/PARTNERS ARE INFECUND 994
OTHER (SPECIFY) 996
DON'T KNOW 998

509) CHECK 203 AND 205:

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 601)
NUMBER_____
OTHER (SPECIFY) 96 (GO TO 601)

NO LIVING CHILDREN:

If you could choose exactly the number of children to have in your whole life, how many would that be?

PROBE FOR A NUMERIC RESPONSE.

NONE 00 (GO TO 601)
NUMBER_____
OTHER (SPECIFY) 96 (GO TO 601)

510) 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

SECTION 6. EMPLOYMENT AND GENDER ROLES

601) Have you done any work in the last seven days?

YES 1 (GO TO 604)
NO 2

602) 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, or any other such reason?

YES 1 (GO TO 604)
NO 2

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

YES 1
NO 2 (GO TO 607)

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

OCCUPATION_____

605) 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

606) 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

607) CHECK 401:

CURRENTLY MARRIED OR LIVING WITH A PARTNER (GO TO 608)
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER (GO TO 612)

608) CHECK 606:

CODE 1 OR 2 CIRCLED (GO TO 609)
OTHER (GO TO 610)

609) Who usually decides how the money you earn will be used: mainly you, mainly your (wife (wives)/partner(s)), or you and your (wife (wives)/partner(s)) jointly?

RESPONDENT 1
WIFE (WIVES)/PARTNER(S) 2
RESPONDENT AND WIFE (WIVES)/PARTNER(S) JOINTLY 3
OTHER (SPECIFY) 6

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

RESPONDENT 1
WIFE (WIVES)/PARTNER(S) 2
RESPONDENT AND WIFE (WIVES)/PARTNER(S) JOINTLY 3
SOMEONE ELSE 4
OTHER 6

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

RESPONDENT 1
WIFE (WIVES)/PARTNER(S) 2
RESPONDENT AND WIFE (WIVES)/PARTNER(S) JOINTLY 3
SOMEONE ELSE 4
OTHER 6

612) 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

613) 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

614) 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 8

If she neglects the children?

YES 1
NO 2
DON'T KNOW 8

If she argues with him?

YES 1
NO 2
DON'T KNOW 8

If she refuses to have sex with him?

YES 1
NO 2
DON'T KNOW 8

If she has sex with someone else?

YES 1
NO 2
DON'T KNOW 8

If she burns the food?

YES 1
NO 2
DON'T KNOW 8

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

If he disobeys?

YES 1
NO 2
DON'T KNOW 8

If he is impolite?

YES 1
NO 2
DON'T KNOW 8

If he has embarrassed the family?

YES 1
NO 2
DON'T KNOW 8

SECTION 7. HIV/AIDS

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

YES 1
NO 2 (GO TO 723)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

707A) Can men reduce their chance of getting the AIDS virus by getting circumcised?

YES 1
NO 2
DON'T KNOW 8

708) 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

709) CHECK 708:

AT LEAST ONE 'YES' (GO TO 710)
OTHER (GO TO 711)

710) 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

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

711A) 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

711B) CHECK 401 AND 402:

CURRENTLY MARRIED OR LIVING WITH A WOMAN (GO TO 711C)
FORMERLY MARRIED OR LIVING WITH A WOMAN (GO TO 711C)
NEVER MARRIED OR NEVER LIVED WITH A WOMAN (GO TO 712)

711C) I don't want to know the results, but have you ever been tested as a couple with your wife/partner to see if you and/or her have the AIDS virus?

YES 1
NO 2 (GO TO 712)

711D) I don't want to know the results, but have you and your wife told each other the results of your tests?

YES 1 (GO TO 713)
NO 2 (GO TO 713)

712) 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 716)

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

MONTHS AGO_____
TWO OR MORE YEARS 96

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

YES 1
NO 2

715) 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 718)
PROVINCIAL/DISTRICT HOSPITAL 12 (GO TO 718)
HEALTH CENTER 13 (GO TO 718)
HEALTH POST 14 (GO TO 718)
OUTREACH 15 (GO TO 718)
COMMUNITY HEALTH WORKER 16 (GO TO 718)
OTHER PUBLIC HEALTH FACILITY (SPECIFY) 17 (GO TO 718)
PRIVATE MEDICAL SECTOR
POLYCLINIC 21 (GO TO 718)
CLINIC 22 (GO TO 718)
DISPENSARY 23 (GO TO 718)
PHARMACY 24 (GO TO 718)
FAMILY PLANNING CLINIC 25 (GO TO 718)
OTHER PRIVATE HEALTH FACILITY (SPECIFY) 26 (GO TO 718)
OTHER SOURCES
KIOSK/SHOP/BAR 31 (GO TO 718)
TRADITIONAL HEALER 32 (GO TO 718)
FRIEND/RELATIVE 33 (GO TO 718)
CORRECTIONAL FACILITY 34 (GO TO 718)
YOUTH CENTER 35 (GO TO 718)
OTHER (SPECIFY) 96 (GO TO 718)
DON'T KNOW 98 (GO TO 718)

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

YES 1
NO 2 (GO TO 718)

717) 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)
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
CORRECTIONAL FACILITY Q
YOUTH CENTER R
OTHER (SPECIFY) X

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

YES 1
NO 2
DON'T KNOW 8

719) 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

720) 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

721) 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

722) 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

723) CHECK 701:

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

724) CHECK 414:

HAS HAD SEXUAL INTERCOURSE (GO TO 725)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 732)

725) CHECK 723: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES (GO TO 726)
NO (GO TO 727)

726) 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

727) Sometimes men experience an abnormal discharge from their penis. During the last 12 months, have you had an abnormal discharge from your penis?

YES 1
NO 2
DON'T KNOW 8

728) Sometimes men have a sore or ulcer near their penis. During the last 12 months, have you had a sore or ulcer near your penis?

YES 1
NO 2
DON'T KNOW 8

729) CHECK 726, 727, AND 728:

HAS HAD AN INFECTION (ANY 'YES') (GO TO 730)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 732)

730) The last time you had (PROBLEM FROM 726/727/728), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 732)

731) 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

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

YES 1
NO 2
DON'T KNOW 8

733) 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

SECTION 8. OTHER HEALTH ISSUES

801) Some men are circumcised, that is, the foreskin is completely removed from the penis. Are you circumcised?

YES 1
NO 2 (GO TO 805)
DON'T KNOW 8 (GO TO 805)

802) How old were you when you got circumcised?

AGE IN COMPLETED YEARS_____
DURING CHILDHOOD (YOUNGER THAN 5 YEARS) 95
DON'T KNOW 98

803) Who did the circumcision?

TRADITIONAL PRACTITIONER/FAMILY/FRIEND 1
HEALTH WORKER/PROFESSIONAL 2
OTHER 3
DON'T KNOW 8

804) Where was it done?

HEALTH FACILITY 1
HOME OF A HEALTH WORKER/PROFESSIONAL 2
CIRCUMCISION DONE AT HOME 3
RITUAL SITE 4
OTHER HOME/PLACE 5
DON'T KNOW 8

805) 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 808)

806) 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 808)

807) 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

808) Do you currently smoke cigarettes?

YES 1
NO 2 (GO TO 810)

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

NUMBER OF CIGARETTES_____

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

YES 1
NO 2 (GO TO 812)

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

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

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

YES 1
NO 2 (GO TO 814)

813) 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

814) 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 loss

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

815) CHECK 814:

IF AT LEAST ONE SYMPTOM "YES" CODE "1" OR "2" CIRCLED (GO TO 816)
IF "NO" TO ALL SYMPTOMS (GO TO 818)

816) Have you ever sought care or help?

YES 1
NO 2 (GO TO 818)

817) (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 N
TRADITIONAL HEALER O
FRIEND/RELATIVE P
OTHER (SPECIFY) X

818) GO TO THE NEXT SECTION (DV)

MALE DOMESTIC VIOLENCE MODULE

DV01A) CHECK THE COVER PAGE IF THIS MAN SELECTED FOR MALE DV QUESTIONNAIRE

MAN SELECTED OR THIS SECTION (GO TO DV01B)
MAN NOT SELECTED (GO TO DV33)

DV01B) CHECK FOR PRESENCE OF OTHERS:

DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.

PRIVACY OBTAINED 1 (GO TO DV02)
PRIVACY NOT POSSIBLE 2 (GO TO DV32)

READ TO THE RESPONDENT

Now I would like to ask you questions about some other aspects of a man's life. You may find some of these questions very personal. However, your answers are crucial for helping to understand the condition of men 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 401 AND 402:

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

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

a) She (is/was) jealous or angry if you (talk/talked) to other women?

YES 1
NO 2
DON'T KNOW 8

b) She frequently (accuses/accused) you of being unfaithful?

YES 1
NO 2
DON'T KNOW 8

c) She (does/did) not permit you to meet your friends?

YES 1
NO 2
DON'T KNOW 8

d) She (tries/tried) to limit your contact with your family?

YES 1
NO 2
DON'T KNOW 8

e) She (insists/insisted) on knowing where you (are/were) at all times?

YES 1
NO 2
DON'T KNOW 8

DV04-A) Now I need to ask some more questions about your relationship with your (last) (wife/partner). Did your (last) (wife/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) (wife/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 her 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 or 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 her 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 during 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 her 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 or 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 her 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 DVO5A (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) (wife/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) (wife/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) (wife/partner) at times when she 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) (wife/partner): often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

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

YES 1
NO 2 (GO TO DV13)

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

OFTEN 1
SOMETIMES 2
NEVER 3

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

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

DV14) CHECK 409:

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) (wife/partner). Now I want to ask you about the behavior of any previous (wife/partner).

a) Did any previous (wife/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 (wife/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 (wife/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 (wife/partner) physically force you to have intercourse of 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 401 AND 402:

EVER MARRIED/EVER LIVED WITH A WOMAN

From the time you were 15 years old has anyone other than (your/any) (wife/partner) hit you, slapped you, kicked you, or done anything else to hurt you physically?

YES 1
NO 2 (GO TO DV22)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO DV22)

NEVER MARRIED/NEVER LIVED WITH A WOMAN

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 DV22)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO DV22)

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 GIRLFRIEND F
FORMER GIRLFRIEND 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 DV22)

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 DV22)

DV18C) Who is the main person that has hurt you in 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 GIRLFRIEND 06
FORMER GIRLFRIEND 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

DV22) CHECK 401 AND 402:

EVER MARRIED/EVER LIVED WITH A WOMAN (GO TO DV22A)
NEVER MARRIED/NEVER LIVED WITH A WOMAN (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) (wife/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/NOT 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 WIFE/PARTNER 01
FORMER WIFE/PARTNER 02
CURRENT/FORMER GIRLFRIEND 03
MOTHER/STEP-MOTHER 04
SISTER/STEP-SISTER 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 401 AND 402:

EVER MARRIED/EVER LIVED WITH A WOMAN

In the last 12 months, has anyone other than (your/any) (wife/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 WOMAN

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 GIRLFRIEND 03
MOTHER/STEP-MOTHER 04
SISTER/STEP-SISTER 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), DV15A (b), DV22A, and DV22B:

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

DV25) CHECK 401 AND 402:

EVER MARRIED/EVER LIVED WITH A WOMAN

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) (wife/partner)?

AGE IN COMPLETED YEARS_____
DON'T KNOW 98

NEVER MARRIED/NEVER LIVED WITH A WOMAN

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 DV05A (a-j), DV15A (a,b), DV16, DV22A, AND DV22B:

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

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

YES 1
NO 2 (GO TO DV29)

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

RECORD ALL MENTIONED.

OWN FAMILY A (GO TO DV30)
WIFE'S/PARTNER'S FAMILY B (GO TO DV30)
CURRENT/FORMER WIFE/PARTNER C (GO TO DV30)
CURRENT/FORMER GIRLFRIEND 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 HIS COOPERATION AND REASSURE HIM ABOUT THE CONFIDENTIALITY OF HIS 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?

WIFE

YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3

FEMALE ADULT

YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3

OTHER MALE 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:_____