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DEMOGRAPHIC AND HEALTH SURVEY IN SENEGAL (EDSM IV) - 2005 WOMAN'S QUESTIONNAIRE

IDENTIFICATION

PLACE NAME _____
NAME OF HEAD OF HOUSEHOLD _____
HOUSEHOLD NUMBER _____
COMPOUND NUMBER _____
CLUSTER NUMBER _____
REGION _____

URBAN/RURAL:

URBAN 1
RURAL 2

DAKAR/REGIONAL CAPITAL/OTHER CITY/RURAL:

DAKAR 1
REGIONAL CAPITAL 2
OTHER CITY 3
RURAL 4

NAME AND LINE NUMBER OF WOMAN:

NAME ______
LINE NO. _____

CHECK THE HOUSEHOLD SURVEY: ADDITIONAL QUESTIONS ABOUT SEXUAL ACTIVITY (542, 543) SHOULD BE ASKED OF MEN (1) OF WOMEN (2) IN THE INDIVIDUAL SURVEY.

ADDITIONAL QUESTIONS 2

INTERVIEWER VISITS

INTERVIEW 1 (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE_____
INTERVIEWER NAME_____
RESULT___

RESULTS_____

1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTIALLY FILLED OUT
6 INCAPACITATED
7 OTHER (SPECIFY) ______

NEXT VISIT
DATE_____
TIME_____

FINAL VISIT
DAY_____
MONTH_____
YEAR 2005
INTERVIEWER_____
RESULT_____

TOTAL NUMBER OF VISITS_____

LANGUAGE OF QUESTIONNAIRE: 1

LANGUAGE OF INTERVIEW:

1 FRENCH
2 WOLOF
3 POULAR
4 SERER
5 MANDINGUE
6 DIOLA
8 OTHERS

INTERPRETER:

YES 1
NO 2

SUPERVISOR
NAME_____
DATE_____

FIELD EDITOR
NAME_____
DATE_____

OFFICE EDITOR_____
KEYED BY_____

SECTION 1. SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENT

INTRODUCTION AND CONSENT STATEMENT:

CONSENT STATEMENT AFTER INFORMATION:

Hello. My name is_____ and I work for the Minister of Health. We are conducting a national survey that asks about the health of women and children. We would very much appreciate your participation in this survey. I would like to ask you questions about your health (and that of your children). This information will be useful to the government for planning health services. The interview usually takes 20-45 minutes. The information that you give us will be strictly confidential and will be shared with no one.

Do you have questions about the survey?
Can I begin the interview now?

SIGNATURE OF INTERVIEWER_____
DATE_____

RESPONDENT ACCEPTS TO RESPOND 1(GO TO 101)
RESPONDENT REFUSES TO RESPOND 2 (END INTERVIEW)

101. RECORD THE TIME:

HOUR____
MINUTES____

To begin, I would like to ask you questions about yourself and your household.

102. Until the age of 12 years, did you like the majority of the time in a big city, in a city or in a rural area?

DAKAR 1
REGIONAL CAPITAL 2
OTHER CITIES 3
RURAL AREA 4
FOREIGN COUNTRY 6

103. How long have you been living continuously in (NAME OF CURRENT CITY/VILLAGE OF RESIDENCE)? IF LESS THAN A YEAR, WRITE '00' YEARS.

YEARS_____

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

104. Just before you moved here, did you live in a big city, a city, or village?

DAKAR 1
REGIONAL CAPITAL 2
OTHER CITIES 3
RURAL AREA 4
FOREIGN COUNTRY 6

105. In which month and in which year were you born?

MONTH _____
DOESN'T KNOW MONTH 98
YEAR 19_____
DOESN'T KNOW YEAR 9998

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

AGE IN COMPLETED YEARS_____

107. Did you go to school?

YES 1
NO 2 (GO TO 111)

108. What is the highest level of school you attended: primary, secondary (first cycle), secondary (second cycle), superior or other?

PRIMARY 1
SECONDARY (1ST CYCLE) 2
SECONDARY (2ND CYCLE) 3
SUPERIOR 4
OTHER 7

109. What is the last (year/grade) that you achieved at this level?

YEAR/GRADE _____

110. CHECK 108:

PRIMARY (GO TO 111)
SECONDARY OR HIGHER (GO TO 114)

111. Now I would like you to read this sentence out loud: read as much as you can.

SHOW THE CARD TO THE RESPONDENT.

IF THE RESPONDENT CANNOT READ THE WHOLE PHRASE, PROBE: Can you read certain parts of the phrase to me?

CANNOT READ AT ALL 1
CAN READ SOME PARTS 2
CAN READ THE WHOLE PHRASE 3
NO CARD IN THE RIGHT LANGUAGE (SPECIFY LANGUAGE) _____4
BLIND 5

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

YES 1
NO 2 (GO TO 113)

112B. In which languages were the literacy programs in which you participated?
PROBE: Any other?
RECORD ALL MENTIONED.

ARABIC/MEDERSA A
WOLOF B
POULAR C
SERER D
DIOLA E
MANDINGUE F
SONINKE G
OTHER (SPECIFY) _____X

113. CHECK 111:

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

114. Do you read a newspaper or magazine almost every day, at least once a week, less than once a week or not at all?

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

115. Do you listen to the radio almost every day, at least once a week, less than once a week or not at all?

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

116. Do you watch television almost every day, at least once a week, less than once a week or not at all?

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

117. During the past 12 months, how many times have you traveled outside of your locality and slept somewhere besides your home?

NUMBER OF TRIPS _____
NEVER 00 (GO TO 119)

118. During the past 12 months have you been outside of your locality during more than a month at a time?

YES 1
NO 2

119. What is your religion?

MUSLIM 1
CHRISTIAN 2
ANIMIST 3
NO RELIGION 4
OTHER (SPECIFY) _____ 5

120. Are you Senegalese?

YES 1
NO 2 (GO TO 201)

121. What is your ethnicity?

WOLOF 01
POULAR 02
SERER 03
MANDINGUE 04
DIOLA 05
SONINKE 06
OTHER (SPECIFY) ______96

SECTION 2. REPRODUCTION

Now I would like to ask about all of the births you have had during your life.

201. 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 and who are now living with you?

YES 1
NO 2 (GO TO 204)

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

SONS ELSEWHERE _____
DAUGHTERS ELSEWHERE_____

206. Have you given birth to a son or daughter who was born alive but later died?
IF NO, PROBE: Any who cried and showed signs of life at birth but did not survive?

YES 1
NO 2 (GO TO 208)

207. How many sons have died?
And how many daughters have died?

SONS DEAD_____
DAUGHTERS DEAD_____

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

TOTAL_____

209. CHECK 208:
Just to be 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 BIRTH(S) (GO TO 211)
NONE (GO TO 226)

Now I would like to make a list of all your births, whether still alive or not, starting with the first one you had.

211. RECORD THE NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

[ASK QUESTIONS 212-221 FOR ALL BIRTHS]

212. What name was given to your first/next baby?

NAME______

213. Was (NAME) a single or multiple birth?

SING 1
MULT 2

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

BOY 1
GIRL 2

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

MONTH_____
YEAR_____

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

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

AGE IN YEARS______

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

YES 1
NO 2

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

LINE NO. ____ (GO TO NEXT BIRTH FOR FIRST CHILD; GO TO 221 FOR OTHER BIRTHS)

220. IF DEAD: How old was (NAME) when he/she died?
IF '1 YEAR' PROBE: How old was (NAME) in months?
RECORD IN DAYS IF LESS THAN 1 MONTH; IN MONTHS IF LESS THAN 2 YEARS; OR IN YEARS.

DAYS 1_____
MONTHS 2_____
YEARS 3_____

221. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?
[DO NOT ASK FOR MOST RECENT BIRTH]

YES 1
NO 2

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

YES 1
NO 2

223. COMPARE 208 WITH THE NUMBER OF BIRTH RECORDED IN THE ABOVE TABLE AND MARK:

NUMBERS ARE THE SAME
CHECK: FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED
CHECK: FOR EVERY LIVING CHILD: CURRENT AGE IS RECORDED
CHECK: FOR EACH DECEASED CHILD: AGE AT DEATH IS RECORDED
CHECK: FOR AGE OF DEATH 12 MONTHS OR 1 YEAR: PROBE TO DETERMINE THE EXACT NUMBER OF MONTHS
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

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

NUMBER OF BIRTHS _____

225. FOR EACH BIRTH SINCE JANUARY 2000, WRITE 'N' IN MONTH OF BIRTH IN THE CALENDAR. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED AND WRITE 'G' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF THE PREGNANCY. (NOTE: THE NUMBER OF 'G'S MUST BE 1 LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED). RECORD THE NAME OF THE CHILD LEFT OF THE CODE 'N'. (SEE THE INSTRUCTIONS AT THE END OF THE QUESTIONNAIRE.

226. Are you currently pregnant?

YES 1
NO 2 (GO TO 229)
NOT SURE 8 (GO TO 229)

227. How many months pregnant are you?
RECORD THE NUMBER OF COMPLETED MONTHS. RECORD 'G' IN THE CALENDAR, BEGINNING WITH THE MONTH OF THE SURVEY AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

NUMBER OF MONTHS ____

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

THEN 1
LATER 2
NOT AT ALL 3

229. Have you ever had a pregnancy that ended in a miscarriage, abortion or still birth?

YES 1
NO 2 (GO TO 237)

230. When did the last such pregnancy end?

MONTH _____
YEAR_____

231. CHECK 230:

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

232. How many months pregnant were you when the last such pregnancy ended?
RECORD THE NUMBER OF COMPLETED YEARS. RECORD 'F' IN THE CALENDAR IN THE MONTH THE PREGNANCY ENDED AND 'G' FOR THE REMAINING COMPLETED MONTHS.

NUMBER OF MONTHS_____

233. Have you had other pregnancies that did not end in a live birth?

YES 1
NO 2 (GO TO 237)

234. ASK THE DATE AND DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2000. RECORD 'F' IN THE CALENDAR IN THE MONTH EACH PREGNANCY ENDED AND 'G' FOR THE REMAINING COMPLETED MONTHS,

235. Have you had a pregnancy that ended before January 2000 that did not end in a live birth?

YES 1
NO 2 (GO TO 237)

236. When did the last such birth end before 2000?

MONTH_____
YEAR_____

237. When did your last menstrual period start?
RECORD THE DATE IF GIVEN.

DATE, IF GIVEN _____
DAYS AGO 1_____
WEEKS AGO 2_____
MONTHS AGO 3_____
YEARS AGO 4 _____

IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE THE LAST BIRTH 995
NEVER MENSTRUATED 996

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

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

239. Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?

JUST BEFORE HER PERIOD BEGINS 1
DURING HER PERIOD 2
JUST AFTER THE END OF HER PERIOD 3
HALFWAY BETWEEN 2 PERIODS 4
OTHER (SPECIFY) _____6
DOESN'T KNOW 8

SECTION 3. CONTRACEPTION

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

CIRCLE CODE '1' ON LINE 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN CONTINUE DOWN COLUMN 301 READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE '1' IF THE METHOD IS RECOGNIZED AND CODE '2' IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE '1' CIRCLED IN 301, ASK 302.

301. Which methods have you heard about?
FOR THE METHODS SPONTANEOUSLY MENTIONED, ASK: Have ever heard about (METHOD)?

01. FEMALE STERILIZATION: Women can have an operation to avoid having any more children.
YES 1
NO 2 (GO TO NEXT METHOD)
02. MALE STERILIZATION: Men can have an operation to avoid having any more children.
YES 1
NO 2 (GO TO NEXT METHOD)
03. PILL: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2 (GO TO NEXT METHOD)
04. IUD: Women can have a loop or a coil placed inside them by a doctor or a nurse to avoid becoming pregnant.
YES 1
NO 2 (GO TO NEXT METHOD)
05. INJECTIONS: Women can have an injection by a health provider to avoid becoming pregnant during one or more months.
YES 1
NO 2 (GO TO NEXT METHOD)
06. IMPLANTS: Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2 (GO TO NEXT METHOD)
07. CONDOM: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
08. FEMALE CONDOM: Women can place a sheath in their vagina before intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
09. DIAPHRAGM: Women can place a diaphragm in their vagina before sexual intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
10. FOAM OR JELLY: Women can insert a suppository, put jelly or lotion in their vagina before intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
11. LACTATIONAL AMENORRHEA METHOD (LAM): Up to 6 months after a birth and before her period returns, a woman can use a method consisting of nursing her baby each time that he/she wants, day and night, without ever giving him/her any other food.
YES 1
NO 2 (GO TO NEXT METHOD)
12. RHYTHM METHOD: Every month that a woman is sexually active, she can avoid pregnancy by not having intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2 (GO TO NEXT METHOD)
13. WITHDRAWAL: Men can be careful to pull out before climax.
YES 1
NO 2 (GO TO NEXT METHOD)
14. DAY AFTER PILL: Women can take pills days following intercourse until the third day after to avoid getting pregnant.
YES 1
NO 2 (GO TO NEXT METHOD)
15. Have you heard of other ways or methods that women or men can use to avoid pregnancy? IF YES, LIST UP TO TWO OTHER METHODS.
(SPECIFY)_____
YES 1
NO 2

302. Have you ever used (METHOD)?

01. FEMALE STERILIZATION: Women can have an operation to avoid having any more children: Have you had an operation to avoid having any more children?
YES 1
NO 2
02. MALE STERILIZATION: Men can have an operation to avoid having any more children: Have you ever had a partner who had an operation to avoid having any more children?
YES 1
NO 2
03. PILL: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
04. IUD: Women can have a loop or a coil placed inside them by a doctor or a nurse to avoid becoming pregnant.
YES 1
NO 2
05. INJECTIONS: Women can have an injection by a health provider to avoid becoming pregnant during one or more months.
YES 1
NO 2
06. IMPLANTS: Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
07. CONDOM: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08. FEMALE CONDOM: Women can place a sheath in their vagina before intercourse.
YES 1
NO 2
09. DIAPHRAGM: Women can place a diaphragm in their vagina before sexual intercourse.
YES 1
NO 2
10. FOAM OR JELLY: Women can insert a suppository, put jelly or lotion in their vagina before intercourse.
YES 1
NO 2
11. LACTATIONAL AMENORRHEA METHOD (LAM): Up to 6 months after a birth and before her period returns, a woman can use a method consisting of nursing her baby each time that he/she wants, day and night, without ever giving him/her any other food.
YES 1
NO 2
12. RHYTHM METHOD: Every month that a woman is sexually active, she can avoid pregnancy by not having intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
13. WITHDRAWAL: Men can be careful to pull out before climax.
YES 1
NO 2
14. DAY AFTER PILL: Women can take pills days following intercourse until the third day after to avoid getting pregnant.
YES 1
NO 2
15. OTHER METHOD(S) (SPECIFY) ______
YES 1
NO 2

303. CHECK 302:

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

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

YES 1
NO 2 (GO TO 329)

306. What did you do or use?
CORRECT 302 AND 303 (AND 301 IF NECESSARY).

Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant.

307. How many living children did you have, if any?
IF NONE, RECORD '00'.

NUMBER OF CHILDREN______

308. CHECK 302 (01):

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

309. CHECK 226:

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

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

YES 1
NO 2 (GO TO 329)

311. What method are you using?
311A. CIRCLE "A" FOR FEMALE STERILIZATION.

IF MORE THAN ONE METHOD MENTIONED, FOLLOW THE SKIP INSTRUCTIONS FOR THE HIGHEST METHOD ON THE LIST.

FEMALE STERILIZATION A (GO TO 313)
MALE STERILIZATION B (GO TO 313)
PILL C
IUD D (GO TO 316A)
INJECTIONS E (GO TO 316A)
IMPLANTS F (GO TO 316A)
CONDOM G (GO TO 316A)
FEMALE CONDOM H (GO TO 316A)
DIAPHRAGM I (GO TO 316A)
FOAM/JELLY J (GO TO 316A)
LACTATION AMEN. METHOD K (GO TO 316A)
RHYTHM METHOD L (GO TO 316A)
WITHDRAWAL M (GO TO 316A)
OTHER (SPECIFY) _____X (GO TO 316A)

312. Why do you use the pill rather than another method?

FREE 01
COSTS LESS 02
EASIER TO OBTAIN 03
PRESCRIBED TO RESPONDENT 04
MORE EFFECTIVE 05
NO SIDE EFFECTS 06
RESPONDENT LIKES IT 07
ONLY METHOD KNOWN 08
REVERSIBLE METHOD 09
IT WAS ADVISED FOR HER 10
OTHER (SPECIFY) _____96

312A. Can I see the pill box that you are currently using?
IF THE PACKET IS SHOWN, CIRCLE THE CORRESPONDING CODE.

PLANYL 01 (GO TO 312C)
PLANOR 02 (GO TO 312C)
OVRETTE 03 (GO TO 312C)
LO FEMENAL (GO TO 312C)
MINIDRIL 05 (GO TO 312C)
MINIPHASE 06 (GO TO 312C)
STEDIRIL 07 (GO TO 312C)
MICROVA 08 (GO TO 312C)
ADEPAL 09 (GO TO 312C)
MICROGYNON 10 (GO TO 312C)
NEOGYNON 11 (GO TO 312C)
DIANE THIRTY-FIVE 12 (GO TO 312C)
TRINORDIOL 13 (GO TO 312C)
SECURIL 14 (GO TO 312C)
OTHER (SPECIFY) _____96 (GO TO 312C)
BOX NOT SEEN 98

312B. What is the name of the brand of pill that you currently use?

PLANYL 01
PLANOR 02
OVRETTE 03
LO FEMENAL 04
MINIDRIL 05
MINIPHASE 06
STEDIRIL 07
MICROVA 08
ADEPAL 09
MICROGYNON 10
NEOGYNON 11
DIANE THIRTY-FIVE 12
TRINORDIOL 13
SECURIL 14
OTHER (SPECIFY) _____96
DOESN'T KNOW 98

312C. How much does a box (cycle) of pills cost you?

COST _____ (GO TO 316A)

FREE 9996 (GO TO 316A)
DOESN'T KNOW 9998 (GO TO 316A)

313. Where did the sterilization take place?
IF IT IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF THE ESTABLISHMENT ______
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CENTER 13
STRAT. AVANCÉE/EQU. MOBILE 14
OTHER PUBLIC (SPECIFY) _____16
PRIVATE MEDICAL SECTOR
HOSPITAL/CLINIC/OFFICE 21
PRIVATE DOCTOR 22
OTHER PRIVATE (SPECIFY) _____26
OTHER (SPECIFY) _____96
DOESN'T KNOW 98

314. CHECK 311:

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

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

YES 1
NO 2
DOESN'T KNOW 8

316. In which month and in which year did the sterilization occur?
316A. Since when did you begin to use (METHOD CITED FIRST IN 311) continuously?
PROBE: In which month and in which year did you begin to use (METHOD CITED FIRST IN 311) continuously?

MONTH _____
YEAR_____

316B. CHECK 316/316A, 215 AND 230:
WAS THERE IN 215 A BIRTH OR IN 230 A PREGNANCY THAT ENDED BY A MISCARRIAGE, ABORTION OR STILL BIRTH AFTER THE MONTH AND YEAR OF THE BEGINNING OF USING CONTRACEPTION IN 316/316A?

YES (RETURN TO 316/316A TO CORRECT, PROBE TO RECORD THE MONTH AND YEAR OF THE BEGINNING OF CONTINUOUS USE OF THE CURRENT METHOD (THE DATE MUST BE AFTER THAT OF THE LAST BIRTH OR PREGNANCY))

NO (GO TO 317)

317. CHECK 316/316A:

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

319. CHECK 311/311A:
CIRCLE THE CODE OF THE METHOD:
IF MORE THAN ONE METHOD MENTIONED, CIRCLE THE HIGHEST METHOD CIRCLED ON THE LIST IN 311/311A.

FEMALE STERILIZATION 01 (GO TO 322)
MALE STERILIZATION 02 (GO TO 331)
PILL 03
IUD 04
INJECTIONS 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATION AMEN. METHOD 11 (GO TO 320A)
RHYTHM METHOD 12 (GO TO 331)
WITHDRAWAL 13 (GO TO 331)
OTHER METHOD 96 (GO TO 331)

320. Where did you get (CURRENT METHOD) when you started using it?
320A. Where did you learn how to use the lactational amenorrhea method?

IF THE SOURCE IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF ESTABLISHMENT _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
HEALTH POST 13
GOVERNMENT FAMILY PLANNING CENTER 14
RURAL MATERNITY 15
HEALTH HUT 16
COMMUNITY PHARMACY 17
STRAT. AVANCÉE/EQU. MOBILE 18
OTHER PUBLIC (SPECIFY) _____19
PRIVATE MEDICAL SECTOR
HOSPITAL/CLINIC/OFFICE 21
PRIVATE HOSPITAL/CLINIC/OFFICE 22
PHARMACY 23
PRIVATE DOCTOR 24
RELIGIOUS FREE CLINIC 25
HEALTH CARE WORKER 26
OTHER PRIVATE (SPECIFY) _____27
OTHER SOURCE
SHOP 31
CHURCH 32
RELATIVES/FRIENDS 33
BAR 34
OTHER (SPECIFY) _____96

321. CHECK 311/311A:
CIRCLE THE CODE OF THE METHOD:
IF MORE THAN ONE METHOD MENTIONED, CIRCLE THE HIGHEST METHOD CIRCLED ON THE LIST IN 311/311A.

PILL 03
IUD 04
INJECTIONS 05
IMPLANTS 06
CONDOM 07 (GO TO 327)
FEMALE CONDOM 08 (GO TO 325)
DIAPHRAGM 09 (GO TO 325)
FOAM/JELLY 10 (GO TO 325)
LACTATION AMEN. METHOD 11 (GO TO 325)

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

YES 1 (GO TO 324)
NO 2

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

YES 1
NO 2 (GO TO 325)

324. Did someone tell you what you should do if you experienced secondary effects or if you had problems?

YES 1
NO 2

325. CHECK 322:

CODE '1' CIRCLED: At that time were you told other methods or family planning you could use?

CODE '1' NOT CIRCLED: When you obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM Q. 313 OR 320), did anyone talk to you about other methods of family planning that you could use?

YES 1 (GO TO 327)
NO 2

326. Were you informed by a health or family planning worker about other methods of contraception that you could use?

YES 1
NO 2

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

FEMALE STERILIZATION 01 (GO TO 331)
MALE STERILIZATION 02 (GO TO 331)
PILL 03
IUD 04
INJECTIONS 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATION AMEN. METHOD 11 (GO TO 331)
RHYTHM METHOD 12 (GO TO 331)
WITHDRAWAL 13 (GO TO 331)
OTHER METHOD 96 (GO TO 331)

328. Where did you get (THE CURRENT METHOD) the last time?
IF THE SOURCE IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF ESTABLISHMENT _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (GO TO 331)
GOVERNMENT HEALTH CENTER 12 (GO TO 331)
HEALTH POST 13 (GO TO 331)
GOVERNMENT FAMILY PLANNING CENTER 14 (GO TO 331)
RURAL MATERNITY 15 (GO TO 331)
HEALTH HUT 16 (GO TO 331)
COMMUNITY PHARMACY 17 (GO TO 331)
STRAT. AVANCÉE/EQU. MOBILE 18 (GO TO 331)
OTHER PUBLIC (SPECIFY) _____19 (GO TO 331)
PRIVATE MEDICAL SECTOR
HOSPITAL/CLINIC/OFFICE 21 (GO TO 331)
PRIVATE HOSPITAL/CLINIC/OFFICE 22 (GO TO 331)
PHARMACY 23 (GO TO 331)
PRIVATE DOCTOR 24 (GO TO 331)
RELIGIOUS FREE CLINIC 25 (GO TO 331)
HEALTH CARE WORKER 26 (GO TO 331)
OTHER PRIVATE (SPECIFY) _____27 (GO TO 331)
OTHER SOURCE
SHOP 31 (GO TO 331)
CHURCH 32 (GO TO 331)
RELATIVES/FRIENDS 33 (GO TO 331)
BAR 34 (GO TO 331)
OTHER (SPECIFY) _____96 (GO TO 331)

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

YES 1
NO 2 (GO TO 331)

330. Where is this place?
Anywhere else?
RECORD ALL MENTIONED.

IF THE SOURCE IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF ESTABLISHMENT ______
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
HEALTH POST C
GOVERNMENT FAMILY PLANNING CENTER D
RURALE MATERNITY E
HEALTH HUT F
COMMUNITY PHARMACY G
STRAT. AVANCÉE/EQU. MOBILE H
OTHER PUBLIC (SPECIFY) _____I
PRIVATE MEDICAL SECTOR
HOSPITAL/CLINIC/OFFICE J
PRIVATE HOSPITAL/CLINIC/OFFICE K
PHARMACY L
PRIVATE DOCTOR M
RELIGIOUS FREE CLINIC N
HEALTH CARE WORKER O
OTHER PRIVATE (SPECIFY) _____P
OTHER SOURCE
SHOP Q
CHURCH R
RELATIVES/FRIENDS S
BAR T
OTHER (SPECIFY) _____X

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 401)

333. Did a staff member at the health facility ever talk to you about family planning methods?

YES 1
NO 2

SECTION 4A. PREGNANCY, POSTNATAL CARE AND BREASTFEEDING

401. CHECK 224:

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

402. WRITE THE LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH IN 2000 OR LATER. ASK THE QUESTIONS OF ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE THE LAST TWO COLUMNS OF ADDITIONAL QUESTIONNAIRES).

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

403. LINE NUMBER FROM 212:

LINE NO. _____

404. FROM LINE 212 AND 216:

NAME_____
LIVING ___
DEAD ___

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

THEN 1 (MOST RECENT BIRTH, GO TO 407; OTHERS, GO TO 423)
LATER 2
NOT AT ALL 3 (MOST RECENT BIRTH, GO TO 407; OTHERS, GO TO 423)

406. How much time would you have liked to wait?

MONTHS 1_____
YEARS 2_____

DOESN'T KNOW 998

407. For the last pregnancy, did you receive prenatal care?
IF YES: Whom did you see? Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.
[ASK ONLY FOR MOST RECENT BIRTH]

HEALTH PROFESSIONAL
DOCTOR A
MIDWIFE B
OBSTETRICIAN NURSE C
OTHER PERSON
DOULA D
TRADITIONAL BIRTH ATTENDANT E
RELATIVE/FRIEND F
OTHER (SPECIFY) ____X
NO ONE Y (GO TO 415)

408. How many months pregnant were you when you had your first prenatal consultation?
[ASK ONLY FOR MOST RECENT BIRTH]

NUMBER OF MONTHS_____
DOESN'T KNOW 98

409. How many times did you get consultation during this pregnancy?
[ASK ONLY FOR MOST RECENT BIRTH]

NUMBER OF TIMES_____
DOESN'T KNOW 98

410. CHECK 409:
NUMBER OF PRENATAL CONSULTATIONS RECEIVED
[ASK ONLY FOR MOST RECENT BIRTH]

ONE TIME (GO TO 412)
MORE THAN ONE TIME OR DOESN'T KNOW (GO TO 411)

411. How many months were you pregnant the last time you received prenatal care?
[ASK ONLY FOR MOST RECENT BIRTH]

NUMBER OF MONTHS_____
DOESN'T KNOW 98

412. During your pregnancy did you have the following tests at least once?

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

[ASK ONLY FOR MOST RECENT BIRTH]

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

413. Did they talk to you about signs of complications to the pregnancy?
[ASK ONLY FOR MOST RECENT BIRTH]

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

414. Did they tell you where to go if you had these complications?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2
DOESN'T KNOW 8

415. During the course of this pregnancy, did they give you an injection in the arm to keep the baby from getting tetanus, that is to say, convulsions after birth?
[ASK ONLY FOR MOST RECENT BIRTH]

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

416. How many times during this pregnancy did you have this injection?
[ASK ONLY FOR MOST RECENT BIRTH]

NUMBER OF TIMES____
DOESN'T KNOW 8

417. During this pregnancy, were you given or did you buy iron tablets or small vials of syrup with iron in it? SHOW TABLETS/VIALS.
[ASK ONLY FOR MOST RECENT BIRTH]

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

418. During the whole pregnancy, for how many days did you take the tablets/syrup?
IF THE ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.
[ASK ONLY FOR MOST RECENT BIRTH]

NUMBER OF DAYS____
DOESN'T KNOW 998

419. During this pregnancy, did you have difficulty with your vision during daylight?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2
DOESN'T KNOW 8

420. During this pregnancy did you suffer from night blindness [USE LOCAL NAME]?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2
DOESN'T KNOW 8

421. During this pregnancy did you take any drugs to keep from getting malaria?
[ASK ONLY FOR MOST RECENT BIRTH]

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

422. What medicines did you take?

RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO THE RESPONDENT.
[ASK ONLY FOR MOST RECENT BIRTH]

FANSIDAR A
CHLOROQUINE B
UNKNOWN MEDICINE Z
OTHER (SPECIFY) _____X

422A. CHECK 422:
TYPE OF MEDICINE TAKEN FOR MALARIA PREVENTION.
[ASK ONLY FOR MOST RECENT BIRTH]

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

422B. How many times did you take Fansidar during this pregnancy?
[ASK ONLY FOR MOST RECENT BIRTH]

NO. OF TIMES_____

422C. CHECK 407:
PRENATAL CARE DURING THIS PREGNANCY
[ASK ONLY FOR MOST RECENT BIRTH]

CODE "A," "B," OR "C" CIRCLED (GO TO 422D)
OTHER CODE CIRCLED (GO TO 423)

422D. When you were pregnant with (NAME), did you get the medicine FANSIDAR during a prenatal visit, during another visit in a health facility, or from another source?
[ASK ONLY FOR MOST RECENT BIRTH]

PRENATAL VISIT 1
OTHER MEDICAL VISIT 2
OTHER SOURCE (SPECIFY) _____6

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

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

424. Was (NAME) weighed at birth?

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

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

GRAMS FROM CARD 1_____
GRAMS FROM MEMORY 2_____

DOESN'T KNOW 99998

425A. Was (NAME)'s birth declared?

YES 1
NO 2
DOESN'T KNOW 8

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

PROBE TO DETERMINE 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 PROFESSIONAL
DOCTOR A
MIDWIFE B
OBSTETRICIAN NURSE C
OTHER PERSON
DOULA D
TRADITIONAL BIRTH ATTENDANT E
RELATIVES/FRIENDS F
OTHER (SPECIFY) _____X
NO ONE Y

427. Where did you give birth to (NAME)?

IF IT IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE,

NAME OF THE ESTABLISHMENT _____
HOME
RESPONDENT'S HOME 11 (GO TO 429)
OTHER HOME 12 (GO TO 429)
PUBLIC MEDICAL SECTOR
HOSPITAL 21
HEALTH CENTER/MATERNITY 22
HEALTH POST 23
OTHER PUBLIC (SPECIFY) _____26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL (SPECIFY) _____36
OTHER (SPECIFY) _____96 (GO TO 429)

428. Was (NAME) delivered by caesarean section?

YES 1 (FOR MOST RECENT BIRTH, GO TO 433; FOR OTHERS, GO TO 435)
NO 2 (FOR MOST RECENT BIRTH, GO TO 433; FOR OTHERS, GO TO 435)

429. After (NAME)'s birth, were you examined by a health professional or a village birth attendant?

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

430. How many days after delivery did you have your first health check-up?
RECORD "00" IF THE SAME DAY.
[ASK ONLY FOR MOST RECENT BIRTH]

DAYS AFTER BIRTH 1_____
WEEKS AFTER BIRTH 2_____

DOESN'T KNOW 998

431. Who examined you at this time?
PROBE FOR MOST QUALIFIED PERSON.
[ASK ONLY FOR MOST RECENT BIRTH]

HEALTH PROFESSIONAL
DOCTOR 11
MIDWIFE 12
OBSTETRICIAN NURSE 13
OTHER PERSON
DOULA 21
TRADITIONAL BIRTH ATTENDANT 22
RELATIVE/FRIEND 23
OTHER (SPECIFY) _____96

432. Where did this first health exam take place?
[ASK ONLY FOR MOST RECENT BIRTH]

IF IT IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF THE ESTABLISHMENT _____
HOME
RESPONDENT'S HOME 11
OTHER HOME 12
PUBLIC MEDICAL SECTOR
HOSPITAL 21
HEALTH CENTER/MATERNITY 22
HEALTH POST 23
STR.AV./EQ. MOBILE 24
OTHER PUBLIC (SPECIFY) _____26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL (SPECIFY) _____36
OTHER (SPECIFY) _____96

433. In the two months that followed the birth, did you receive a dose of vitamin A like this one?
SHOW THE PILL/VIAL.
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2

434. Has your period returned since the birth of (NAME)?
[ASK ONLY FOR MOST RECENT BIRTH]

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

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

YES 1
NO 2 (GO TO 439)

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

NUMBER OF MONTHS_____
DOESN'T KNOW 98

437. CHECK 226:
IS RESPONDENT PREGNANT?
[ASK ONLY FOR MOST RECENT BIRTH]

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

438. Have you begun to have sexual intercourse since the birth of (NAME)?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2 (GO TO 440)

439. For how many months after (NAME)'s birth did you not have sexual intercourse?

NUMBER OF MONTHS_____
DOESN'T KNOW 98

440. Did you breastfeed (NAME)?

YES 1
NO 2 (GO TO 447)

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

IMMEDIATELY 000

HOURS 1_____
DAYS 2_____

442. In the 3 days following birth and before your breasts began to produce milk regularly, did (NAME) drink something besides breast milk?

YES 1
NO 2 (GO TO 444)

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

MILK (OTHER THAN BREAST MILK) A
BLESSED WATER B
WATER C
SUGAR OR GLUCOSE WATER D
CALMING HERBAL TEAS FOR COLIC BABIES E
SUGAR-SALT-WATER SOLUTION F
FRUIT JUICE G
INFANT FORMULA H
TEA/HERBAL TEA I
HONEY J
OTHER (SPECIFY) _____X

444. CHECK 404:
CHILD IS LIVING?

ALIVE (GO TO 445)
DECEASED (GO TO 446)

445. Are you still breastfeeding (NAME)?

YES 1 (GO TO 448)
NO 2

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

NUMBER OF MONTHS _____
DOESN'T KNOW 98

447. CHECK 404:
CHILD IS LIVING?

ALIVE (GO TO 450)

DECEASED (RETURN TO 405 IN FOLLOWING COLUMN, OR IF NO MORE BIRTHS, GO TO 454)

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

NUMBER OF NIGHTTIME FEEDINGS_____

449. Yesterday, how many times did you breastfeed during the day?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

NUMBER OF DAYTIME FEEDINGS_____

450. Did (NAME) drink something from a bottle yesterday or last night?

YES 1
NO 2
DOESN'T KNOW 8

451. Was sugar added to any food or liquid given to (NAME) yesterday?

YES 1
NO 2
DOESN'T KNOW 8

452. Yesterday, during the day or night, how many times was (NAME) fed purees or solid food or semi-solid food?
IF 7 TIMES OR MORE, MARK '7'.

NUMBER OF TIMES____
DOESN'T KNOW 8

453. RETURN TO 405 IN THE NEXT COLUMN OR THE NEXT TO LAST COLUMN ON A NEW QUESTIONNAIRE; OR, IF NO MORE BIRTHS, GO TO 454.

SECTION 4B. VACCINATION, HEALTH AND NUTRITION

454. RECORD THE LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH IN 2000 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE THE LAST 2 LINES OF ADDITIONAL QUESTIONNAIRES).

455. LINE NUMBER FROM 212:

LINE NUMBER_____

456. FROM 212 AND 216:

NAME_____
LIVING (GO TO 457)
DEAD (GO TO 456 NEXT BIRTH OR IF NO MORE BIRTH COLUMNS, GO TO 484)

457. Did (NAME) get a dose of vitamin A, like this one, during the past 6 months?
SHOW THE PILL/VIAL.

YES 1
NO 2
DOESN'T KNOW 8

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

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

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

YES 1 (GO TO 462)
NO 2 (GO TO 462)

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

BCG
DAY _____
MONTH _____
YEAR _____
POLIO 0 (AT BIRTH)
DAY _____
MONTH _____
YEAR _____
POLIO 1
DAY _____
MONTH _____
YEAR _____
POLIO 2
DAY _____
MONTH _____
YEAR _____
POLIO 3
DAY _____
MONTH _____
YEAR _____
DPT 1
DAY _____
MONTH _____
YEAR _____
DPT 2
DAY _____
MONTH _____
YEAR _____
DPT 3
DAY _____
MONTH _____
YEAR _____
MEASLES
DAY _____
MONTH _____
YEAR _____
YELLOW FEVER
DAY _____
MONTH _____
YEAR _____
VITAMIN A (MOST RECENT)
DAY _____
MONTH _____
YEAR _____

461. Has (NAME) received any immunizations not recorded on this card, including vaccinations received in a national immunization day campaign?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, MEASLES, AND/OR YELLOW FEVER VACCINES.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 460) (GO TO 464)
NO 2 (GO TO 464)
DOESN'T KNOW 8 (GO TO 464)

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

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

463. Tell me, please, if (NAME) received one of the following vaccinations:

463A A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

YES 1
NO 2
DOESN'T KNOW 8

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

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

463C. Was the first vaccine for polio received right after birth or not?

JUST AFTER BIRTH 1
LATER 2

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

NUMBER OF TIMES____

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

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

463F. How many times?

NUMBER OF TIMES_____

463G. An injection against the measles?

YES 1
NO 2
DOESN'T KNOW 8

463H. An injection against yellow fever?

YES 1
NO 2
DOESN'T KNOW 8

464. Were any of the vaccinations (NAME) received during the past two years given as part of a national immunization campaign?

YES 1
NO 2 (GO TO 466)
NO VACCINATIONS IN THE PAST 2 YEARS 3 (GO TO 466)
DOESN'T KNOW 8 (GO TO 466)

465. At which national immunization day campaigns did (NAME) receive vaccinations?
RECORD ALL MENTIONED CAMPAIGNS.

JNV NOV-DEC/2002 A
OCT-NOV/2004 B

466. Has (NAME) suffered from a fever, at any moment, during the past two weeks?

YES 1
NO 2
DOESN'T KNOW 8

467. Has (NAME) suffered from a cough, at any moment, during the past two weeks?

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

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

YES 1
NO 2
DOESN'T KNOW 8

469. CHECK 466 AND 467:
FEVER OR COUGH?

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

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

YES 1
NO 2 (GO TO 472)

471. Where did you seek advice or treatment?
Where else?
RECORD EVERYTHING MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
RURAL MATERNITY D
HEALTH HUT E
COMMUNITY PHARMACY F
STRAT. AVANCÉE/EQU. MOBILE G
HEALTH CARE WORKER H
OTHER PUBLIC (SPECIFY) _____I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE J
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS FREE CLINIC M
COMMUNITY HEALTH CARE WORKER N
OTHER PRIVATE (SPECIFY) _____O
OTHER SOURCE
SHOP P
TRADITIONAL HEALER Q
RELATIVES/FRIENDS R
OTHER (SPECIFY) _____X

472. CHECK 466:
HAD A FEVER?

"YES" TO 466 (GO TO 472A)
"NO" OR "DOESN'T KNOW" TO 466 (GO TO 475)

472A. Does (NAME) have a fever currently?

YES 1
NO 2
DOESN'T KNOW 8

472B. Did (NAME) have convulsions at any time during the past two weeks?

YES 1
NO 2
DOESN'T KNOW 8

472C. CHECK 466 AND 472B:
FEVER OR CONVULSIONS?

'YES' TO 466 OR 472B (GO TO 473)
OTHER (GO TO 475)

473. Did (NAME) take medicine for the fever?

YES 1
NO 2 (GO TO 474R)
DOESN'T KNOW 8 (GO TO 474R)

474. Which medicine did (NAME) take?
RECORD EVERYTHING THAT IS MENTIONED.

ASK TO SEE THE MEDICINE IF THE TYPE OF MEDICINE IS NOT KNOWN. IF THE TYPE OF MEDICINE CANNOT BE DETERMINED, SHOW SOME COMMON ANTI-MALARIA MEDICINES TO THE RESPONDENT.

ANTI-MALARIA
FANSIDAR A
CHLOROQUINE B
AMODIAQUINE C
QUININE D
OTHER
ASPIRIN E
PANADOL F
IBUPROFEN/ACETAMINOPHEN G
OTHER (SPECIFY) _____X
DOESN'T KNOW Z

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

INJECTION A
SUPPOSITORY B
NEITHER Y
DOESN'T KNOW Z

474B. CHECK 474:
TYPE OF MEDICINE?

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

474C. How long after the beginning of the fever/convulsions did (NAME) begin to take Fansidar?

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

474D. For how many consecutive days did (NAME) take Fansidar?
IF MORE THAN 7 DAYS, RECORD '7'.

ONLY ONCE 0

NUMBER OF DAYS_____

DOESN'T KNOW 8

474E. Did you have the Fansidar at home, or did you get it from another source?
IF MORE THAN ONE SOURCE IS MENTIONED, ASK: Where did you get the Fansidar the first time?

AT HOME 1
OTHER SOURCE 2
DOESN'T KNOW 8

474F. CHECK 474:
TYPE OF MEDICINE?

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

474G. How long after the beginning of the fever/convulsions did (NAME) begin to take Chloroquine?

SAME DAY 1
THE NEXT DAY 2
TWO DAYS AFTER 3
THREE DAYS OR MORE AFTER THE FEVER 4
DOESN'T KNOW 8

474H. For how many consecutive days did (NAME) take Chloroquine?
IF MORE THAN 7 DAYS, RECORD '7'.

NUMBER OF DAYS_____
DOESN'T KNOW 8

474I. Did you have the Chloroquine at home, or did you get it from another source?
IF MORE THAN ONE SOURCE IS MENTIONED, ASK: Where did you get the Chloroquine the first time?

AT HOME 1
OTHER SOURCE 2
DOESN'T KNOW 8

474J. CHECK 474:
TYPE OF MEDICINE?

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

474K. How long after the beginning of (the fever/convulsions) did (NAME) begin to take Amodiaquine?

SAME DAY 1
THE NEXT DAY 2
TWO DAYS AFTER 3
THREE DAYS OR MORE AFTER THE FEVER 4
DOESN'T KNOW 8

474L. For how many consecutive days did (NAME) take Amodiaquine?
IF MORE THAN 7 DAYS, RECORD '7'.

NUMBER OF DAYS_____
DOESN'T KNOW 8

474M. Did you have the Amodiaquine at home, or did you get it from another source?
IF MORE THAN ONE SOURCE IS MENTIONED, ASK: Where did you get the Amodiaquine the first time?

AT HOME 1
OTHER SOURCE 2
DOESN'T KNOW 8

474N. CHECK 474:
TYPE OF MEDICINE?

CODE "D" CIRCLED (GO TO 474O)
CODE "D" NOT CIRCLED (GO TO 474R)

474O. How long after the beginning of (the fever/convulsions) did (NAME) begin to take
Quinine?

SAME DAY 1
THE NEXT DAY 2
TWO DAYS AFTER 3
THREE DAYS OR MORE AFTER THE FEVER 4
DOESN'T KNOW 8

474P. For how many consecutive days did (NAME) take Quinine?
IF MORE THAN 7 DAYS, RECORD '7'.

NUMBER OF DAYS____
DOESN'T KNOW 8

474Q. Did you have the Quinine at home, or did you get it from another source?
IF MORE THAN ONE SOURCE IS MENTIONED, ASK: Where did you get the Quinine the first time?

AT HOME 1
OTHER SOURCE 2
DOESN'T KNOW 8

474R. Was something else done to treat (NAME)'s (fever/convulsions)?

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

474S. What was done to treat (NAME)'s fever/convulsions?

CONSULTED TRADITIONAL HEALER A
SWABBED WITH MOIST COMPRESSES B
GAVE MEDICINAL PLANTS C
OTHER (SPECIFY) _____X

475. Has (NAME) had diarrhea during the past two weeks?

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

476. Now I would like to know how much liquid was given to (NAME) during his/her diarrhea. Did you give him/her less, about the same amount or more to drink than usual?
IF LESS, PROBE: Did you give him a lot or a little less than usual to drink?

A LOT LESS 1
A LITTLE LESS 2
ABOUT THE SAME AMOUNT 3
MORE 4
NOTHING TO DRINK 5
DOESN'T KNOW 8

477. When (NAME) had diarrhea did you give him/her less to eat than usual, about the same amount, more than usual or nothing to eat?
IF LESS: Did you give him/her a lot less to eat or a little less than usual?

A LOT LESS 1
A LITTLE LESS 2
ABOUT THE SAME AMOUNT 3
MORE 4
STOPPED FOOD 5
NEVER FED 6
DOESN'T KNOW 8

478. Did you give him/her any of the following things to drink?

a) A liquid prepared from a (LOCAL NAME FOR ORS PACKET)?
b) A homemade liquid recommended by the government?

LIQUID ORS PACKET
YES 1
NO 2
DOESN'T KNOW 8
HOMEMADE LIQUID
YES 1
NO 2
DOESN'T KNOW 8

479. Was something (else) given to treat diarrhea?

YES 1
NO 2 (GO TO 481)
DOESN'T KNOW 8 (GO TO 481)

480. What else was given to treat diarrhea? Something else?
RECORD EVERYTHING MENTIONED.

PILL OR SYRUP A
INJECTION B
(IV) INTRAVENOUS C
HOMEMADE REMEDIES/PLANTS D
OTHER (SPECIFY) _____X

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

YES 1
NO 2 (GO TO 483)

482. Where did you seek advice or treatment for the diarrhea?
Anywhere else?
RECORD EVERYTHING MENTIONED.

IF IT IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, RECORD THE NAME OF THE PLACE. PROBE TO DETERMINE THE TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE(S).

PLACE NAME_____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
RURAL MATERNITY D
HEALTH HUT E
COMMUNITY PHARMACY F
STRAT. AVANCÉE/EQU. MOBILE G
HEALTH CARE WORKER H
OTHER PUBLIC (SPECIFY) _____I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE J
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS FREE CLINIC M
COMMUNITY HEALTH CARE WORKER N
OTHER PRIVATE (SPECIFY) _____O
OTHER SOURCE
SHOP P
TRADITIONAL HEALER Q
RELATIVES/FRIENDS R
OTHER (SPECIFY) _____X

483. RETURN TO 456 IN THE FOLLOWING COLUMN/SECOND COLUMN IN A NEW QUESTIONNAIRE. IF NO MORE BIRTHS, GO TO 484.

484. CHECK 215 AND 218, ALL LINES:
NUMBER OF CHILDREN BORN IN 2001 OR LATER AND LIVING WITH THE RESPONDENT.

ONE OR MORE BIRTHS SINCE 2001 OR LATER (GO TO 485)
NO BIRTHS SINCE 2001 OR LATER (GO TO 487)

485. What do you usually do with the excrements of your (youngest) child when he/she does not use the toilet facility?

ALWAYS USES THE TOILET/LATRINE 01
THROW IT IN THE TOILET/LATRINE 02
THROW IT OUTSIDE OF THE DWELLING 03
THROW IT OUTSIDE OF THE YARD 04
BURY IT IN THE YARD 05
GET RID OF IT BY WASHING IT AWAY WITH WATER 06
USE DISPOSABLE DIAPERS 07
USE WASHABLE DIAPERS 08
DO NOT GET RID OF IT 09
OTHER (SPECIFY) _____96

486. CHECK 478a, ALL OF THE COLUMNS/BIRTHS:

NO CHILD RECEIVED ORS PACKET/QUESTION WASN'T ASKED (GO TO 487)
A CHILD RECEIVED ORS PACKETS (GO TO 488)

487. Have you ever heard of a special product called (LOCAL NAME OF ORS PACKET), that you can get to treat diarrhea?

YES 1
NO 2

488. CHECK 218:

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

489. When (your child/one of your children) is seriously ill, can you, yourself, decide if he/she should be brought somewhere for medical treatment?

IF THE RESPONDENT RESPONDS THAT NO CHILD HAS EVER BEEN SERIOUSLY ILL, ASK: If (your child/one of your children) becomes seriously ill, can you, yourself, decide if he/she should be brought somewhere for medical treatment?

YES 1
NO 2
IT DEPENDS 3

Now I would like to ask you questions about your own medical care.

490. Different reasons can prevent women from getting advice or medical treatment for themselves. When you are sick and want advice or medical treatment, do the following things pose a problem for you or not?

Knowing where to go.
Getting permission to go.
Getting the necessary money for the treatment.
Not having a medical establishment nearby.
Needing to take a mode of transport.
Not wanting to go alone.
Concern that there are no female personnel.

WHERE TO GO
A BIG PROBLEM 1
NOT A BIG PROBLEM 2
PERMISSION
A BIG PROBLEM 1
NOT A BIG PROBLEM 2
MONEY
A BIG PROBLEM 1
NOT A BIG PROBLEM 2
DISTANCE
A BIG PROBLEM 1
NOT A BIG PROBLEM 2
TRANSPORTATION
A BIG PROBLEM 1
NOT A BIG PROBLEM 2
GOING ALONE
A BIG PROBLEM 1
NOT A BIG PROBLEM 2
FEMALE PERSONNEL
A BIG PROBLEM 1
NOT A BIG PROBLEM 2

491. CHECK 215 AND 218:

AT LEAST ONE CHILD BORN IN 2002 OR LATER AND LIVING WITH HER: RECORD THE NAME OF THE CHILD LIVING WITH HER (GO TO 492)
NAME _____
NO CHILD BORN IN 2002 OR LATER LIVING WITH HER (GO TO 494)

492. Now I would like to ask you what liquid (NAME IN 491) drank during the past 7 days including yesterday. How many days, during the past 7 days, did (NAME IN 491) drink one or more of the following liquids?

FOR EACH LIQUID CONSUMED, AT LEAST ONE TIME, IN THE PAST 7 DAYS, ASK:
Yesterday during the day or night how many times did (NAME IN 491) drink:

a) Water?
b) Baby formula?
c) Any other type of milk, like milk from a box, in powder, or fresh milk from an animal?
d) Fruit juice?
e) Other liquids such as sugar water, tea, coffee, carbonated drinks, or broths?

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

WATER
NUMBER OF DAYS IN PAST 7 DAYS _____
YESTERDAY/LAST NIGHT NUMBER OF TIMES _____
BABY FORMULA
NUMBER OF DAYS IN PAST 7 DAYS _____
YESTERDAY/LAST NIGHT NUMBER OF TIMES _____
OTHER TYPE OF MILK (BOX, POWDERED, FROM ANIMAL)
NUMBER OF DAYS IN PAST 7 DAYS _____
YESTERDAY/LAST NIGHT NUMBER OF TIMES _____
FRUIT JUICE
NUMBER OF DAYS IN PAST 7 DAYS _____
YESTERDAY/LAST NIGHT NUMBER OF TIMES _____
OTHER LIQUIDS
NUMBER OF DAYS IN PAST 7 DAYS _____
YESTERDAY/LAST NIGHT NUMBER OF TIMES _____

493. Now I would like to ask you what food(s) (NAME IN 491) was given during the past 7 days, including yesterday. How many days, during the past 7 days, did (NAME IN 491) get the following foods?

FOR EACH FOOD GIVEN, AT LEAST ONE TIME, IN THE PAST 7 DAYS, ASK: Yesterday during the day and night how many times did (NAME IN 491) get:

a) Rice, corn, millet, sorghum or other grains?
b) Pumpkin, yam or yellow or red squash, carrots, or red sweet potatoes?
c) Other foods from roots (for ex: potatoes, white yam, manioc, white sweet potatoes, other local foods from roots)?
d) Any green leafy vegetables?
e) Mango, papaya?
f) Any other fruit or vegetable? (for ex: banana, apple, apple sauce, green beans, avocado, tomato)?
g) Meat, poultry, fish, shellfish, eggs?
h) Other vegetable foods (for ex: lentils, beans, soy, or nuts)?
i) Cheese or yogurt?
j) Any food prepared with oil, fat or butter?

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

RICE, CORN, OR OTHER GRAINS
NUMBER OF DAYS IN THE PAST 7 DAYS _____
YESTERDAY/LAST NIGHT NUMBER OF TIMES _____
PUMPKIN, YAMS, SQUASH, CARROTS, SWEET POTATOES
NUMBER OF DAYS IN THE PAST 7 DAYS _____
YESTERDAY/LAST NIGHT NUMBER OF TIMES _____
OTHER FOODS FROM ROOTS
NUMBER OF DAYS IN THE PAST 7 DAYS _____
YESTERDAY/LAST NIGHT NUMBER OF TIMES _____
GREEN LEAFY VEGETABLES
NUMBER OF DAYS IN THE PAST 7 DAYS _____
YESTERDAY/LAST NIGHT NUMBER OF TIMES _____
MANGO OR PAPAYA
NUMBER OF DAYS IN THE PAST 7 DAYS _____
YESTERDAY/LAST NIGHT NUMBER OF TIMES _____
OTHER FRUITS OR VEGETABLES
NUMBER OF DAYS IN THE PAST 7 DAYS _____
YESTERDAY/LAST NIGHT NUMBER OF TIMES _____
MEAT, POULTRY, FISH, SHELLFISH, EGGS
NUMBER OF DAYS IN THE PAST 7 DAYS _____
YESTERDAY/LAST NIGHT NUMBER OF TIMES _____
OTHER VEGETABLE FOODS
NUMBER OF DAYS IN THE PAST 7 DAYS _____
YESTERDAY/LAST NIGHT NUMBER OF TIMES _____
CHEESE OR YOGURT
NUMBER OF DAYS IN THE PAST 7 DAYS _____
YESTERDAY/LAST NIGHT NUMBER OF TIMES _____
FOOD PREPARED WITH OIL, FAT, OR BUTTER
NUMBER OF DAYS IN THE PAST 7 DAYS _____
YESTERDAY/LAST NIGHT NUMBER OF TIMES _____

494. Last night did you sleep under a mosquito net?

YES 1
NO 2

495. The last time you prepared a meal for your family did you wash your hands before beginning?

YES 1
NO 2
HAS NEVER PREPARED A MEAL 3

496. Do you currently smoke cigarettes or chew tobacco?
IF YES: What do you usually smoke/chew?
RECORD EVERYTHING MENTIONED.

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

497. CHECK 496:

CODE 'A' CIRCLED (GO TO 498)
CODE 'A' NOT CIRCLED (GO TO 499B)

498. In the past 24 hours, how many cigarettes did you smoke?

NUMBER OF CIGARETTES_____

I would now like to ask you ask you a few questions about your health during the past 6 months.

499B. During the past 6 months, have you had an injection for any reason?
IF YES: How many injections did you have?

IF THE NUMBER OF INJECTIONS IS MORE THAN 94 OR IF THE INJECTIONS WERE DAILY DURING 3 MONTHS OR MORE, RECORD '95'. IF THE RESPONSE IS NOT NUMERIC, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS_____
NONE 00 (GO TO 501)

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

IF THE NUMBER OF INJECTIONS IS MORE THAN 94, OR IF THE INJECTIONS WERE DAILY DURING 3 MONTHS OR MORE, RECORD '95'. IF THE RESPONSE IS NOT NUMERIC, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS_____
NONE 00 (GO TO 501)

499D. The last time you had an injection, where did you go to get it?

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
GOVERNMENT HEALTH POST 13
HEALTH HUT/ RURAL MATERNITY 14
COMMUNITY PHARMACY 15
STRAT. AVANCÉE/EQU. MOBILE 16
HEALTH CARE WORKER 17
OTHER PUBLIC (SPECIFY) _____18
PRIVATE MEDICAL SECTOR
HOSPITAL/CLINIC/OFFICE 21
PHARMACY 22
DENTIST 23
PRIVATE DOCTOR 24
HEALTH CARE WORKER 25
OTHER PRIVATE (SPECIFY) _____26
OTHER PLACE
AT HOME 31
OTHER (SPECIFY) _____96

499E. The last time you had an injection, did the person who administered the shot take the syringe or needle from a new unopened package?

YES 1
NO 2
DOESN'T KNOW 8

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

501. Are you currently married or do you live with a man as if you were married?

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

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

YES HAS BEEN MARRIED 1
YES, HAS LIVED WITH A MAN 2
NO 3 (GO TO 518)

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

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

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

LIVE TOGETHER 1
LIVES ELSEWHERE 2

505. 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._____

507. Besides yourself, does your husband/partner have other wives or does he live with other women as if he were married?

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

508. Counting yourself, how many wives or partners does your husband currently have?

NUMBER OF WIVES OR PARTNERS_____
DOESN'T KNOW 98

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

RANK_____

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

ONLY ONCE 1
MORE THAN ONCE 2

511. CHECK 510:

MARRIED/HAS LIVED WITH 1 MAN ONLY ONCE: In which month and in which year did you begin to live with your husband/partner?

MARRIED/HAS LIVED WITH 1 MAN MORE THAN ONCE: I would like to ask about when you started living with your first husband/partner. In what month and year did you get married or did you begin to live with your husband/partner as if married?

MONTH_____
DOESN'T KNOW MONTH 98
YEAR_____ (GO TO 513)
DOESN'T KNOW YEAR 9998

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

AGE ____

513. CHECK 503:
IS THE RESPONDENT CURRENTLY A WIDOW?

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

514. CHECK 510:

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

515. How did your last union/marriage end?

DEATH/WIDOWHOOD 1
DIVORCE 2 (GO TO 518)
SEPARATION 3 (GO TO 518)

516. Who got the largest part of the belongings your husband possessed?

RESPONDENT 1 (GO TO 518)
RESPONDENT'S CHILDREN 2
OTHER SPOUSE 3
CHILDREN OF THE HUSBAND 4
FAMILY OF THE HUSBAND 5
OTHER (SPECIFY) _____6
NO BELONGINGS 7

517. Did you receive goods or valuables from your last husband?

YES 1
NO 2

518. CHECK THE PRESENCE OF OTHER PEOPLE. BEFORE CONTINUING, DO YOUR BEST TO GO TO A PRIVATE PLACE.

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

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

NEVER 00

AGE IN YEARS____ (GO TO 521)

FIRST TIME AFTER BEGINNING TO LIVE WITH (FIRST) HUSBAND/PARTNER 95 (GO TO 521)

520. Do you intend to wait until marriage to begin sexual intercourse?

YES 1 (GO TO 544)
NO 2 (GO TO 544)
DOESN'T KNOW/NOT SURE 8 (GO TO 544)

521. CHECK 106:

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

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

YES 1
NO 2
DOESN'T KNOW/DOESN'T REMEMBER 8

523. How old was the person with whom you had sexual intercourse for the first time?

AGE OF PARTNER _____ (GO TO 526)
DOESN'T KNOW 98

524. Was this person older than you, younger or about the same age?

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

525. Would you say that this person was 10 more years older than you or less than 10 years older than you?

10 YEARS OR MORE 1
LESS THAN 10 YEARS 2
OLDER, DOESN'T KNOW HOW MUCH 3

526. When did you last have sexual intercourse?
IF IT WAS 12 MONTHS AGO OR MORE, THE ANSWER MUST BE CONVERTED AND RECORDED IN YEARS.

IT WAS...DAYS AGO 1_____
IT WAS...WEEKS AGO 2_____
IT WAS...MONTHS AGO 3_____
IT WAS...YEARS AGO 4_____ (GO TO 538)

[ASK QUESTIONS 527-537 FOR RESPONDENT'S LAST (THREE) SEXUAL PARTNER(S)]

527. Was a condom used the last time you had sexual intercourse with this (second, third) person?

YES 1
NO 2 (GO TO 529)

528. Did you use a condom each time you had sexual intercourse during the past 12 months?

YES 1
NO 2

529. The last time you had sexual intercourse with this (second, third) person, had you consumed alcohol?

YES 1
NO 2 (GO TO 531)

530. Was this person or were you yourself drunk at that time?
IF YES: who was drunk?

ONLY THE RESPONDENT 1
ONLY THE PARTNER 2
THE RESPONDENT AND HER PARTNER 3
NEITHER 4

531. What was your relationship with this person with whom you had sexual intercourse?
IF BOYFRIEND: Did you live together as if you were married?
IF YES, CIRCLE '02'. IF NO, CIRCLE '03'.

HUSBAND 01 (GO TO 537)
PARTNER LIVING WITH RESPONDENT 02 (GO TO 537)
BOYFRIEND NOT LIVING WITH RESPONDENT 03
CAUSAL ACQUAINTANCE 04
PROSTITUTE 05
OTHER (SPECIFY) _____96

532. For how long have you had/did you have sexual intercourse with this person?
IF THE RESPONDENT ONLY HAD SEX ONCE WITH THIS PERSON, RECORD '01' DAY.

DAYS 1_____
MONTHS 2_____
YEARS 3_____

533. CHECK 106:

15-24 YEARS (GO TO 534)
25-49 YEARS (GO TO 537; FOR THIRD-LAST PARTNER, GO TO 538)

534. How old is this person?

PARTNER'S AGE_____ (GO TO 537; FOR THIRD-LAST PARTNER, GO TO 538)
DOESN'T KNOW 98

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

OLDER 1
YOUNGER 2 (GO TO 537; FOR THIRD-LAST PARTNER, GO TO 538)
SAME AGE 3 (GO TO 537; FOR THIRD-LAST PARTNER, GO TO 538)
DOESN'T KNOW 8 (GO TO 537; FOR THIRD-LAST PARTNER, GO TO 538)

536. Would you say that this person was 10 or more years older than you or less than 10 years older than you?

10 YEARS OR MORE 1
LESS THAN 10 YEARS 2
OLDER, DOESN'T KNOW HOW MUCH 3

537. Apart from this/these two person(s) did you have sexual intercourse with anyone else during the past 12 months?
[DO NOT ASK FOR THIRD-LAST PARTNER]

YES 1 (RETURN TO 527 FOR NEXT PARTNER)
NO 2 (GO TO 540)

538. In all, how many different people did you have sexual intercourse with in your life?
IN THE CASE OF A NON-NUMERIC RESPONSE, PROBE TO GET AN ESTIMATE.
IF THE NUMBER IS MORE THAN '95', WRITE '95.'

NUMBER OF PARTNERS _____
DOESN'T KNOW 98

540. CHECK THE COVER PAGE: ADDITIONAL QUESTIONS ABOUT SEXUAL ACTIVITY FOR MEN (1) OR WOMEN (2) 2 (GO TO 541)

541. CHECK THE PRESENCE OF OTHER PEOPLE. DO NOT CONTINUE IF YOU ARE NOT IN PRIVATE WITH THE RESPONDENT.

PRIVACY ACHIEVED 1
PRIVACY IMPOSSIBLE 2 (GO TO 544)

542. The first time that you had sexual intercourse, would you say that you wanted to have sexual intercourse or were you forced against your will?

WANTED 1
WAS FORCED 2
REFUSED TO RESPOND/NO RESPONSE 3

543. During the past 12 months, did someone force you to have sexual intercourse against your will?

YES 1
NO 2
REFUSED TO RESPOND/NO RESPONSE 3

544. Do you know a place where one could procure condoms?

YES 1
NO 2 (GO TO 601)

545. Where is this?
Any other place?
RECORD EVERYTHING MENTIONED.

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

NAME OF PLACE _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CENTER C
HEALTH POST D
HEALTH HUT/ RURAL MATERNITY E
COMMUNITY PHARMACY F
STRAT. AVANCÉE/EQU. MOBILE G
HEALTH CARE WORKER H
OTHER PUBLIC (SPECIFY) _____I
PRIVATE MEDICAL SECTOR
HOSPITAL/CLINIC/OFFICE J
PHARMACY K
PRIVATE DOCTOR L
HEALTH CARE WORKER M
OTHER PRIVATE (SPECIFY) _____N
OTHER SOURCE
SHOP O
BAR P
SCHOOL Q
RELIGIOUS INSTITUTION R
RELATIVES/FRIENDS S
OTHER (SPECIFY) _____X

546. If you wanted to, could you procure a condom?

YES 1
NO 2
DOESN'T KNOW/NOT SURE 8

SECTION 6. FERTILITY PREFERENCES

601. CHECK 311/311A:

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

602. CHECK 226:

NOT PREGNANT OR NOT SURE: Now I have a few questions about the future. Would you like to have (a/another) child, or would you prefer not to have (other) children at all?

PREGNANT: Now I have a few questions about the future. After the child that you are expecting, would you like to have (a/another) child, or would you prefer not to have (other) children at all?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 604)
SAYS SHE CANNOT GET PREGNANT 3 (GO TO 614)
NOT SURE/DOESN'T KNOW AND PREGNANT 4 (GO TO 610)
NOT SURE/DOESN'T KNOW AND NOT PREGNANT/NOT SURE 5 (GO TO 608)

603. CHECK 226:

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

PREGNANT: After the birth of the child you are expecting, 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 609)
SAYS SHE CANNOT GET PREGNANT 994 (GO TO 614)
AFTER MARRIAGE 995 (GO TO 609)
OTHER (SPECIFY) _____996 (GO TO 609)
DOESN'T KNOW 998 (GO TO 609)

604. CHECK 226:

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

605. CHECK 310:
USES A METHOD?

NOT ASKED (GO TO 606)
DOES NOT CURRENTLY USE (GO TO 606)
CURRENTLY USES (GO TO 608)

606. CHECK 603:

NOT ASKED (GO TO 607)
24 MONTHS OR MORE OR 2 YEARS OR MORE (GO TO 607)
00-23 MONTHS OR 00-01 YEAR (GO TO 610)

607. CHECK 602:

WANTS A/ANOTHER CHILD: You said that, right now, you do not want to have a/another child, but you do not use a method of avoiding pregnancy. Could you tell me why? Another reason?

DOES NOT WANT A/ANOTHER CHILD: You said that you do not want to have a/another child, but you do not use a method of avoiding pregnancy. Could you tell me why? Another reason?

RECORD ALL THE REASONS MENTIONED.

NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSE/HYSTERECTOMY D
SUB FECUND/STERILE E
POSTPARTUM AMENORRHEA F
BREASTFEEDING G
FATALISTIC H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND/PARTNER OPPOSED J
OTHER PERSONS OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
HEALTH CONCERNS O
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COSTS TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY'S NORMAL PROCESSES T
OTHER (SPECIFY) _____X
DOESN'T KNOW Z

608. In the coming weeks, if you discover that you are pregnant, would this be a major problem, a minor problem or not a problem at all?

MAJOR PROBLEM 1
MINOR PROBLEM 2
NO PROBLEM 3
SAYS SHE CANNOT GET PREGNANT/IS NOT HAVING SEX 4

609. CHECK 310:
USES A METHOD?

NOT ASKED (GO TO 610)
DOES NOT CURRENTLY USE (GO TO 610)
CURRENTLY USES (GO TO 614)

610. Do you think that, in the near or distant future you will use a method to delay or avoid a pregnancy?

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

611. Which method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 614)
MALE STERILIZATION 02 (GO TO 614)
PILL 03 (GO TO 614)
IUD 04 (GO TO 614)
INJECTIONS 05 (GO TO 614)
IMPLANTS 06 (GO TO 614)
CONDOM 07 (GO TO 614)
FEMALE CONDOM 08 (GO TO 614)
DIAPHRAGM 09 (GO TO 614)
FOAM/JELLY 10 (GO TO 614)
LACTATION AMEN. METHOD 11 (GO TO 614)
RHYTHM METHOD 12 (GO TO 614)
WITHDRAWAL 13 (GO TO 614)
OTHER METHOD (SPECIFY) _____ 96 (GO TO 614)
NOT SURE 98 (GO TO 614)

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

NOT MARRIED 11
FERTILITY-RELATED REASONS
NOT HAVING SEX/INFREQUENT SEX 22 (GO TO 614)
MENOPAUSE/HYSTERECTOMY 23 (GO TO 614)
SUB-FECUND/STERILE 24 (GO TO 614)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (GO TO 614)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 614)
HUSBAND/PARTNER OPPOSED 32 (GO TO 614)
OTHER PERSONS OPPOSED 33 (GO TO 614)
RELIGIOUS PROHIBITION 34 (GO TO 614)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 614)
KNOWS NO SOURCE 42 (GO TO 614)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 614)
FEAR OF SIDE EFFECTS 52 (GO TO 614)
LACK OF ACCESS/TOO FAR 53 (GO TO 614)
COSTS TOO MUCH 54 (GO TO 614)
INCONVENIENT TO USE 55 (GO TO 614)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 614)
OTHER (SPECIFY) _____96 (GO TO 614)
DOESN'T KNOW 98

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

YES 1
NO 2
DOESN'T KNOW 8

614. CHECK 216:

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

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 616)

NUMBER OF CHILDREN _____

OTHER (SPECIFY) _____96 (GO TO 616)

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

NUMBER OF BOYS _____
NUMBER OF GIRLS _____
NUMBER OF EITHER _____
OTHER (SPECIFY) _____96

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

APPROVE 1
DISAPPROVE 2
DOESN'T KNOW/NOT SURE 8

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

On the radio?
On the television?
In newspapers or magazines?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPERS OR MAGAZINES
YES 1
NO 2

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

YES 1
NO 2 (GO TO 621)

620. With whom did you discuss this?
Anyone else?
RECORD EVERYTHING MENTIONED.

HUSBAND/PARTNER A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER(S) F
SON(S) G
STEP MOTHER(S)/MOTHER(S) IN LAW H
FRIEND(S)/NEIGHBOR(S) I
OTHER (SPECIFY) _____X

621. CHECK 501:

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

622. CHECK 311/311A:

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

623. You said that you are currently using a method of contraception. Could you tell me if the use of this method is mainly your own decision, or that of your partner/husband, or a joint decision?

RESPONDENT'S DECISION 1
PARTNER/HUSBAND'S DECISION 2
JOINT DECISION 3
OTHER (SPECIFY) _____6

Now I would like to ask you about your partner/husband's opinions about family planning.

624. Do you think that your partner/husband approves or disapproves of using methods to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DOESN'T KNOW 8

625. How many times during the past year did you speak with your partner/husband about family planning?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

626. CHECK 311/311A:

NEITHER HE NOR SHE STERILIZED (GO TO 627)
HE OR SHE STERILIZED (GO TO 628)

627. Does your husband want the same number of children that you want, or does he want more or fewer than you want?

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

628. Husbands and wives do not always agree on everything. Please, tell me if you think it is legitimate for a wife to refuse to have sexual intercourse with her husband when:

She knows that her husband has a sexually transmitted infection?
She knows that her husband has sexual intercourse with other women besides his wives?
She recently gave birth?
She is tired and not in the mood for it?

HE HAS AN STD
YES 1
NO 2
DOESN'T KNOW 8
OTHER WOMEN
YES 1
NO 2
DOESN'T KNOW 8
RECENT BIRTH
YES 1
NO 2
DOESN'T KNOW 8
TIRED/NOT IN THE MOOD
YES 1
NO 2
DOESN'T KNOW 8

629. When a wife knows that her husband has an infection transmittable by sexual contact, is she justified in asking that they use a condom during intercourse?

YES 1
NO 2
DOESN'T KNOW 8

630. CHECK 501:

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

631. Can you refuse sexual intercourse with your husband when you don't want to have it?

YES 1
NO 2
IT DEPENDS/NOT SURE 8

632. Can you ask that your husband use a condom if you want him to use one?

YES 1
NO 2
IT DEPENDS/NOT SURE 8

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

701. CHECK 501 AND 502:

CURRENTLY MARRIED/LIVES WITH A MAN (GO TO 702)
HAS BEEN MARRIED/HAS LIVED WITH A MAN (GO TO 703)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 707)

702. How old was your husband/partner on his last birthday?

AGE IN COMPLETED YEARS_____

703. Did your (last) husband attend school?

YES 1
NO 2 (GO TO 706)

704. What was the highest level of school that he achieved: primary, secondary (first cycle), secondary (second cycle), superior or other?

PRIMARY 1
SECONDARY (FIRST CYCLE) 2
SECONDARY (SECOND CYCLE) 3
SUPERIOR 4
OTHER 6
DOESN'T KNOW 8 (GO TO 706)

705. What was the last (year/grade) that he achieved at this level?

CLASS/GRADE ____
DOESN'T KNOW 98

706. CHECK 701:

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

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

PARTNER'S OCCUPATION _____

707. Aside from your housework, do you currently work?

YES 1 (GO TO 710)
NO 2

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

YES 1 (GO TO 710)
NO 2

709. Did you do any type of work during the past 12 months?

YES 1
NO (GO TO 719)

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

RESPONDENT'S OCCUPATION _____

711. CHECK 710

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

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

OWN LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
OTHER (SPECIFY) _____6

713. Do you do this work for a member of your family, for someone else, or are you self-employed?

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

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

HOME 1
AWAY 2

715. Do you usually work throughout the year, seasonally or only once in a while?

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

716. Are you paid in cash or in kind for this work or are you not paid at all?

CASH ONLY 1
MONEY AND KIND 2
IN KIND ONLY 3 (GO TO 719)
NOT PAID 4 (GO TO 719)

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

THE RESPONDENT HERSELF 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER TOGETHER 3
FATHER/MOTHER 4
UNCLE 5
SOMEONE ELSE 6
RESPONDENT AND SOMEONE ELSE TOGETHER 7

718. On average, how much of your household 's expenses are paid by what you earn: almost nothing, less than half, about half, more than half or all?

ALMOST NONE 1
LESS THAN HALF 2
ABOUT HALF 3
MORE THAN HALF 4
ALL 5
NONE, ALL EARNINGS ARE KEPT 6

719. In your family, who generally has the last word in the following decisions:

Your own healthcare?
The purchase of major things for the household?
Purchase of things for daily household needs?
Visits to family or parents?
What food will be prepared each day?

OWN HEALTHCARE
THE RESPONDENT HERSELF 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE TOGETHER 5
DECISION NOT MADE/NOT APPLICABLE 6
PURCHASE OF MAJOR HOUSEHOLD THINGS
THE RESPONDENT HERSELF 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE TOGETHER 5
DECISION NOT MADE/NOT APPLICABLE 6
PURCHASE OF DAILY HOUSEHOLD NEEDS
THE RESPONDENT HERSELF 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE TOGETHER 5
DECISION NOT MADE/NOT APPLICABLE 6
VISITS TO PARENTS/FAMILY
THE RESPONDENT HERSELF 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE TOGETHER 5
DECISION NOT MADE/NOT APPLICABLE 6
FOOD PREPARED DAILY
THE RESPONDENT HERSELF 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE TOGETHER 5
DECISION NOT MADE/NOT APPLICABLE 6

720. PRESENCE OF OTHER PEOPLE AT THIS TIME (PERSONS PRESENT AND ARE LISTENING, PRESENT BUT ARE NOT LISTENING, OR NOT PRESENT)

CHILDREN LESS THAN 10 YEARS
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 8
HUSBAND
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 8
OTHER MEN
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 8
OTHER WOMEN
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 8

721. Sometimes, a husband gets upset or angry because a certain things his wife does. In your opinion, is a husband justified in beating or hitting his wife in the following situations:

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

GOES OUT
YES 1
NO 2
DOESN'T KNOW 8
NEGLECTS CHILDREN
YES 1
NO 2
DOESN'T KNOW 8
ARGUES
YES 1
NO 2
DOESN'T KNOW 8
REFUSES SEX
YES 1
NO 2
DOESN'T KNOW 8
BURNS FOOD
YES 1
NO 2
DOESN'T KNOW 8

SECTION 8. HIV/AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES

Now I would like to talk to you about something else.

801. Have you ever heard of a disease called AIDS?

YES 1
NO 2 (GO TO 844)

802. Can people reduce their chance of getting AIDS by having just one uninfected sex partner who has no other sex partners?

YES 1
NO 2
DOESN'T KNOW 8

803. Can people get AIDS from mosquito bites?

YES 1
NO 2
DOESN'T KNOW 8

804. Can people reduce their risk of getting aids by using a condom every time they have sex?

YES 1
NO 2
DOESN'T KNOW 8

805. Can people get AIDS by sharing food with someone who has AIDS?

YES 1
NO 2
DOESN'T KNOW 8

806. Can people reduce their chance of getting AIDS by not having sexual intercourse at all?

YES 1
NO 2
DOESN'T KNOW 8

807. Can people get AIDS by witchcraft or other supernatural means?

YES 1
NO 2
DOESN'T KNOW 8

808. Is there something (else) that a person can do to avoid or reduce their risk of contracting the virus that causes AIDS?

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

809. What can a person do?
Anything else?
RECORD EVERYTHING CITED.

ABSTAIN FROM SEX A
USE CONDOMS B
LIMIT TO ONE PARTNER/STAY LOYAL TO ONE PARTNER C
LIMIT THE NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PERSONS WITH MULTIPLE PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH THOSE WHOM INJECT THEMSELVES WITH DRUGS H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID SHARING THE SAME BLADES/RAZORS K
AVOID KISSING L
AVOID MOSQUITO BITES M
SEEK PROTECTION FROM A TRADITIONAL HEALER N
OTHER (SPECIFY) _____W
OTHER (SPECIFY) _____X
DOESN'T KNOW Z

810. Is it possible that a person who appears to be healthy, in fact, has the AIDS virus?

YES 1
NO 2
DOESN'T KNOW 8

811. Can the virus that causes AIDS be transmitted from mother to her baby?

During the pregnancy?
During birth?
During breastfeeding?

PREGNANCY
YES 1
NO 2
DOESN'T KNOW 8
BIRTH
YES 1
NO 2
DOESN'T KNOW 8
BREASTFEEDING
YES 1
NO 2
DOESN'T KNOW 8

812. CHECK 811:

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

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

815. CHECK 215:

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

Now I would like to ask you some questions about your last birth.

816. Did you see someone for prenatal care during this pregnancy?

YES 1
NO 2 (GO TO 824)

817. During one of these prenatal visits for this pregnancy, did anyone talk to you about the following subjects?

Babies getting the AIDS virus from their mothers?
Things you can do to prevent getting the AIDS virus?
Getting tested for the AIDS virus?

AIDS FROM MOTHER
YES 1
NO 2
DOESN'T KNOW 8
THINGS TO DO
YES 1
NO 2
DOESN'T KNOW 8
TESTED FOR AIDS
YES 1
NO 2
DOESN'T KNOW 8

818. Were you offered a test for the AIDS virus as part of your prenatal care?

YES 1
NO 2

819. I do not want to know the results, but were you tested for the AIDS virus as part of your prenatal care?

YES 1
NO 2 (GO TO 824)

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

YES 1
NO 2

821. Where was the test done?

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

NAME OF PLACE ______
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
PLANNING FAMILY CENTER 13
TESTING CENTER 14
STRAT. AVANCÉE/EQU. MOBILE 15
HEALTH CARE WORKER 16
OTHER PUBLIC (SPECIFY) _____17
PRIVATE MEDICAL SECTOR
HOSPITAL/CLINIC/OFFICE 21
PHARMACY 22
PRIVATE DOCTOR 23
HEALTH CARE WORKER 24
OTHER PRIVATE (SPECIFY) _____26
OTHER (SPECIFY) _____96

822. Have you been tested for the AIDS virus since you were tested during your pregnancy?

YES 1 (GO TO 825)
NO 2

823. When was the last time you were tested for the AIDS virus?

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

824. I don't want to know the results, but have you ever been tested for the AIDS virus?

YES 1
NO 2 (GO TO 829)

825. When did you last get tested for the AIDS virus?

LESS THAN 12 MONTHS AGO 1
BETWEEN 12 AND 23 MONTHS 2
2 OR MORE YEARS AGO 3

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

ASKED FOR TEST 1
TEST OFFERED AND ACCEPTED 2
REQUIRED 3

827. I don't want to know the results, but have you ever been tested for the AIDS virus?

YES 1
NO 2

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

NAME OF PLACE _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (GO TO 831)
GOVERNMENT HEALTH CENTER 12 (GO TO 831)
PLANNING FAMILY CENTER 13 (GO TO 831)
TESTING CENTER 14 (GO TO 831)
STRAT. AVANCÉE/EQU. MOBILE 15 (GO TO 831)
HEALTH CARE WORKER 16 (GO TO 831)
OTHER PUBLIC (SPECIFY) _____17 (GO TO 831)
PRIVATE MEDICAL SECTOR
HOSPITAL/CLINIC/OFFICE 21 (GO TO 831)
PHARMACY 22 (GO TO 831)
PRIVATE DOCTOR 23 (GO TO 831)
HEALTH CARE WORKER 24 (GO TO 831)
OTHER PRIVATE MEDICAL (SPECIFY) _____26 (GO TO 831)
OTHER (SPECIFY) _____96 (GO TO 831)

829. Do you know of a place where people can get tested for the AIDS virus?

YES 1
NO 2 (GO TO 831)

830. Where is this?
Is there another place?
RECORD ALL PLACES MENTIONED.

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

NAME OF PLACE _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
PLANNING FAMILY CENTER C
TESTING CENTER D
STRAT. AVANCÉE/EQU. MOBLI E
HEALTH CARE WORKER F
OTHER PUBLIC (SPECIFY) _____G
PRIVATE MEDICAL SECTOR
HOSPITAL/CLINIC/OFFICE H
PHARMACY I
PRIVATE DOCTOR J
HEALTH CARE WORKER K
OTHER PRIVATE (SPECIFY) _____L
OTHER (SPECIFY) _____X

831. Would you buy fresh vegetables from a shopkeeper or vendor if you knew the person had the AIDS virus?

YES 1
NO 2
DOESN'T KNOW 8

832. If a member of your family had the AIDS virus would you like it to remain a secret or not?

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

833. If a member of your family become sick with the AIDS virus, would you be willing to take care of him/her in your own household?

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

834. In your opinion, if a teacher has the AIDS virus but is not sick, should he/she be able to continue teaching in the school?

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

835. Do you personally know someone who has been denied health service in the last 12 months because he or she is suspected to have the AIDS virus?

YES 1
NO 2
DOESN'T KNOW ANYONE WITH AIDS 3 (GO TO 840)
DOESN'T KNOW 8

836. Do you personally know someone who has been denied involvement in social events, religious services or community events in the last 12 months because he or she is suspected to have the AIDS virus?

YES 1
NO 2
DOESN'T KNOW 8

837. Do you personally know someone who has been verbally abused or teased in the last 12 months because he or she is suspected to have the AIDS virus?

YES 1
NO 2
DOESN'T KNOW 8

838. CHECK 835, 836 AND 837:

OTHER (GO TO 839)
AT LEAST ONE 'YES' (GO TO 840)

839. Do you know someone who is suspected to have or has the AIDS virus?

YES 1
NO 2

840. Do you agree or disagree with the following statement: People with the AIDS virus should be ashamed of themselves.

AGREE 1
DISAGREE 2
DOESN'T KNOW/NO OPINION 8

841. Do you agree or disagree with the following statement: People with the AIDS virus should be blamed for bringing the disease into the community.

AGREE 1
DISAGREE 2
DOESN'T KNOW/NO OPINION 8

842. Should children age 12-14 be taught about using a condom to avoid getting the AIDS virus?

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

843. Should children age 12-14 be taught to wait until they get married to have sex to avoid getting AIDS?

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

844. Do you think that young men should wait until marriage to have sexual intercourse?

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

845. Do you think that young women should wait until marriage to have sexual intercourse?

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

846. Do you think that married men should only have sexual intercourse with their wives?

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

847. Do you think that most of the men you know only have sexual intercourse with their wives?

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

848. Do you think that married women should only have sexual intercourse with their husband?

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

849. Do you think that most of the women that you know only have sexual intercourse with their husband?

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

850. CHECK 801:

HAS HEARD ABOUT AIDS: Apart from AIDS have you heard about other diseases that can be transmitted through sexual contact?

HAS NOT HEARD ABOUT AIDS: Have you heard about infections that can be transmitted through sexual contact?

YES 1
NO 2 (GO TO 853)

851. When a man has a sexually transmitted infection, which symptom(s) could he have?
Are there other symptoms?
RECORD ALL MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE B
FOUL-SMELLING DISCHARGE C
BURNING URINATION D
GENITAL REDNESS/INFLAMMATION E
GENITAL SWELLING F
GENITAL SORE/ULCER G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
WEIGHT LOSS K
IMPOTENCE L
OTHER (SPECIFY) _____W
OTHER (SPECIFY) _____X
NO SYMPTOMS Y
DOESN'T KNOW Z

852. When a woman has a sexually transmitted infection, which symptom (s) could she have?
Are there other symptoms?
RECORD ALL MENTIONED.

ABDOMINAL PAIN A
VAGINAL DISCHARGE B
FOUL-SMELLING DISCHARGE C
BURNING URINATION D
GENITAL REDNESS/INFLAMMATION E
GENITAL SWELLING F
GENITAL SORE/ULCER G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
WEIGHT LOSS K
DIFFICULTY GETTING PREGNANT L
OTHER (SPECIFY) _____W
OTHER (SPECIFY) _____X
NO SYMPTOMS Y
DOESN'T KNOW Z

853. CHECK 519:

HAS HAD SEXUAL INTERCOURSE (GO TO 854)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 901)

854. CHECK 850:

HAS HEARD ABOUT SEXUALLY TRANSMITTED DISEASES (GO TO 855)
HAS NOT HEARD ABOUT SEXUALLY TRANSMITTED DISEASES (GO TO 856)

Now I would like to ask you about your health in the last 12 months.

855. During the last 12 months have you had a disease which you got from sexual contact?

YES 1
NO 2
DOESN'T KNOW 8

856. Sometimes a woman has a bad smelling abnormal genital discharge. During the last 12 months have you had a bad smelling genital discharge?

YES 1
NO 2
DOESN'T KNOW 8

857. Sometimes women have a genital sore or ulcer. During the past 12 months have you had a genital sore or ulcer?

YES 1
NO 2
DOESN'T KNOW 8

858. CHECK 855, 856 AND 857:

HAS HAD AN INFECTION (AT LEAST ONE 'YES') (GO TO 859)
HAS NOT HAD AN INFECTION OR DOESN'T KNOW (GO TO 901)

859. The last time you had (PROBLEM MENTIONED IN 855/856/857), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 901)

860. Where did you go?
Was there another place?
RECORD ALL MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
HEALTH POST C
RURAL MATERNITY D
HEALTH HUT E
COMMUNITY PHARMACY F
STRAT. AVANCÉE/EQU. MOBILE G
HEALTH CARE WORKER H
OTHER PUBLIC (SPECIFY) _____I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE J
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS FREE CLINIC M
COMMUNITY HEALTH CARE WORKER N
OTHER PRIVATE (SPECIFY) _____O
OTHER PLACE
SHOP P
TRADITIONAL HEALER Q
RELATIVE/FRIEND/NEIGHBOR R
OTHER (SPECIFY) ______X

SECTION 9. FEMALE CIRCUMCISION

901. Have you ever heard of female circumcision?

YES 1 (GO TO 903)
NO 2

902. In certain countries, there is a practice that involves cutting a part of the external genitals of girls. Have you heard of this practice?

YES 1
NO 2 (GO TO 1001)

903. Were your external genitals cut?

YES 1
NO 2 (GO TO 909)

I would now like to ask you some questions about what was done at that time.

904. Did someone cut something in the genital area?

YES 1 (GO TO 906)
NO 2
DOESN'T KNOW 8

905. Did they just make a laceration in your genitals without cutting anything off?

YES 1
NO 2
DOESN'T KNOW 8

906. Did they stitch and close the area of your vagina?

YES 1
NO 2
DOESN'T KNOW 8

907. How old were you when you underwent this practice?
IF THE RESPONDENT DOESN'T KNOW THE EXACT AGE, TRY TO GET AN ESTIMATE.

AGE IN YEARS COMPLETED_____

DURING CHILDHOOD 95
DOESN'T KNOW 98

908. Who performed your circumcision?

TRADITIONAL
TRADITIONAL FEMALE CIRCUMCISER 11
TRADITIONAL MIDWIFE 12
OTHER TRADITIONAL (SPECIFY) _____16
HEALTH PROFESSIONAL
DOCTOR 21
NURSE/MIDWIFE 22
OTHER HEALTH PROFESSIONAL (SPECIFY) _____26
DOESN'T KNOW 98

909. CHECK 214 AND 216:

AT LEAST ONE LIVING DAUGHTER (GO TO 910)
NO LIVING DAUGHTER (GO TO 919)

910. Have some of your daughters undergone this kind of practice?
IF YES: How many?

NUMBER OF DAUGHTERS CIRCUMCISED______
NO DAUGHTER CIRCUMCISED 95 (GO TO 918)

911. Which one of your daughters was most recently circumcised?
CHECK 212 AND RECORD THE LINE NUMBER OF THE DAUGHTER

NAME OF DAUGHTER_____
LINE NUMBER OF THE DAUGHTER FROM 212_____

I would now like to ask you some questions about what was done to (NAME OF THE DAUGHTER FROM 911) at that time.

912. Did someone remove part of her genitals?

YES 1 (GO TO 914)
NO 2
DOESN'T KNOW 8

913. Did someone just slash her genitals without removing anything?

YES 1
NO 2
DOESN'T KNOW 8

914. Was her vagina stitched closed?

YES 1
NO 2
DOESN'T KNOW 8

915. How old was (NAME OF THE DAUGHTER FROM 911) at the time of the circumcision?
IF THE RESPONDENT DOESN'T KNOW THE AGE, PROBE TO GET AN ESTIMATE.

AGE IN COMPLETED YEARS_____

DURING CHILDHOOD 95
DOESN'T KNOW 98

916. Who performed the circumcision?

TRADITIONAL
TRADITIONAL FEMALE CIRCUMCISER 11
TRADITIONAL MIDWIFE 12
OTHER TRADITIONAL (SPECIFY) _____16
HEALTH PROFESSIONAL
DOCTOR 21
NURSE/MIDWIFE 22
OTHER HEALTH PROFESSIONAL (SPECIFY) _____26
DOESN'T KNOW 98

917. Did you notice at the time someone cut (NAME OF THE DAUGHTER FROM 911)'s genitals one of the following problems:

Excessive bleeding?
Difficulty urinating or retaining urine?
Swelling in the genital area?
Infection in the genital area/the wound not correctly scarred?

EXCESSIVE BLEEDING
YES 1 (GO TO 919)
NO 2 (GO TO 919)
DOESN'T KNOW 8 (GO TO 919)
DIFFICULTY URINATING/RETAINING URINE
YES 1 (GO TO 919)
NO 2 (GO TO 919)
DOESN'T KNOW 8 (GO TO 919)
SWELLING
YES 1 (GO TO 919)
NO 2 (GO TO 919)
DOESN'T KNOW 8 (GO TO 919)
INFECTION/INCORRECT SCARRING
YES 1 (GO TO 919)
NO 2 (GO TO 919)
DOESN'T KNOW 8 (GO TO 919)

918. In the future, do you intend to have your daughters circumcised?

YES 1
NO 2
DOESN'T KNOW 8

919. What are the advantages to circumcising a girl?
PROBE: Other advantages?
RECORD ALL MENTIONED.

BETTER HYGIENE A
SOCIAL RECOGNITION B
BETTER CHANCE FOR MARRIAGE C
PRESERVATION OF VIRGINITY/PREVENT SEX BEFORE MARRIAGE D
MORE SEXUAL PLEASURE FOR THE MAN E
RELIGIOUS NECESSITY F
OTHER (SPECIFY) _____X
NO ADVANTAGE Y

920. What the advantages of girls not being circumcised?
PROBE: Anything else?
RECORD ALL MENTIONED.

FEWER HEALTH PROBLEMS A
AVOIDING THE SUFFERING B
MORE SEXUAL PLEASURE FOR HER C
MORE PLEASURE FOR THE MAN D
IN ACCORDANCE WITH RELIGION E
OTHER (SPECIFY) _____X
NO ADVANTAGE Y

921. Do you think this practice is a way for preventing girls from having sexual intercourse before marriage or do you think, on the contrary, that this has no effect?

PREVENTS SEX 1
NO EFFECT 2
DOESN'T KNOW 8

922. Do you think that this practice is required by your religion?

YES 1
NO 2
DOESN'T KNOW 8

922A. Do you think this practice is required by your tradition or customs?

YES 1
NO 2
DOESN'T KNOW 8

923. Do you think that this practice should be maintained or that it should disappear?

MAINTAINED 1
DISAPPEAR 2
IT DEPENDS 3
DOESN'T KNOW 8

924. Do you think that men want this practice to be preserved or do you think they favor abandoning it?

PRESERVED 1
ABANDONED 2
IT DEPENDS 3
DOESN'T KNOW 8

SECTION 10. MATERNAL MORTALITY

Now I would like to ask you some questions about your brothers and sisters, that is to say, about all of the children born to your biological mother.

1001. To how many children did your mother give birth, including yourself?

NUMBER OF BIRTHS TO NATURAL MOTHER_____

1002. CHECK 1001:

TWO OR MORE BIRTHS (GO TO 1003)
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 1014)

1003. How many of these births did your mother have before your own birth?

NUMBER OF PREVIOUS BIRTHS_____

1004. What name was given to your oldest brother or sister (or the next)?

NAME ______

1005. Is (NAME) male or female?

MALE 1
FEMALE 2

1006. Is (NAME) still alive?

YES 1
NO 2 (GO TO 1008)
DOESN'T KNOW 8 (GO TO NEXT BIRTH)

1007. How old is (NAME)?

AGE_____ (GO TO NEXT BIRTH)

1008. How many years has (NAME) been deceased?

YEARS______

1009. How old was (NAME) when he/she died?

AGE_____ (IF MAN AT ANY AGE OR WOMAN WHO DIED BEFORE THE AGE OF 12, GO TO NEXT BIRTH)

1010. Was (NAME) pregnant when she died?

YES 1 (GO TO 1013)
NO 2

1011. Did (NAME) die during childbirth?

YES 1 (GO TO 1013)
NO 2

1012. Did (NAME) die in the two months following a pregnancy or birth?

YES 1
NO 2

1013. To how many children did (NAME) give birth during her life?

NUMBER OF CHILDREN _____ (GO TO NEXT BIRTH)

[IF NO MORE BROTHERS OR SISTERS, GO TO 1014]

1014. RECORD THE TIME:

HOURS_____
MINUTES_____

INTERVIEWER'S OBSERVATIONS

FILL OUT AFTER ENDING THE INTERVIEW.

COMMENTS ABOUT THE RESPONDENT _____

COMMENTS ON PARTICULAR QUESTIONS _____

OTHER COMMENTS _____

SUPERVISOR'S OBSERVATIONS _____
NAME _____
DATE _____

FIELD EDITOR'S OBSERVATIONS _____
NAME _____
DATE _____

CALENDAR

INSTRUCTIONS: ONLY ONE CODE PER BOX.

BIRTHS AND PREGNANCIES:

N BIRTH
G PREGNANCY
F END OF PREGNANCY

2005:

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

2004:

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

2003:

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

2002:

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

2001:

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

2000:

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