Data Cart

Your data extract

0 variables
0 samples
View Cart

Continued Demographic and Health Survey (EDS-Continued 2012-2013)
Woman's Questionnaire

Republic of Senegal
Ministry of the Economy and of Finance
Ministry of Health and Social Action

ICF International

IDENTIFICATION

PLACE NAME ________________
NAME OF HEAD OF HOUSEHOLD ______________
PLOT 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

WOMAN'S NAME AND LINE NUMBER ____________

INTERVIEWER VISITS

DATE _____________
INTERVIEWER'S NAME _____________
RESULT____

RESULT

1COMPLETED
2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT
3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME
4 POSTPONED
5 REFUSED
6 DWELLING VACANT OR ADDRESS NOT A DWELLING
7 DWELLING DESTROYED
8 DWELLING NOT FOUND
9 OTHER (SPECIFY) ___________

FINAL VISIT

DAY ______________
MONTH __________
YEAR 201__
INT. NUMBER__________
RESULT ____________

NEXT VISIT

DATE ___________
TIME ___________

TOTAL NO. OF VISITS ______________

LANGUAGE OF QUESTIONNAIRE

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

LANGUAGE OF INTERVIEW

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

Interpreter

YES 1
NO 2

SUPERVISOR

NAME ____________
DATE ____________

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

INFORMED CONSENT

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

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

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

SIGNATURE OF INTERVIEWER ____________ DATE __________

RESPONDENT AGREES TO BE INTERVIEWED 1
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 END

101) RECORD THE TIME

HOUR _________
MINUTES __________

102) In what month and year were you born?

MONTH _____________
DON'T KNOW MONTH 98
YEAR _____________
DON'T KNOW YEAR 9998

103) How old were you at your last birthday?

COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT

AGE IN COMPLETED YEARS ____________

104) Have you ever attended school?

YES 1
NO 2 (GO TO 108)

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

PRIMARY 1
MIDDLE 2
SECONDARY 3
HIGHER 4
OTHER (SPECIFY) __________ 6

106) What is the highest (GRADE/FORM/YEAR) you completed at this level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD 00

GRADE/FORM/YEAR _____________

107) CHECK 105

PRIMARY (GO TO 108)
MIDDLE, SECONDARY OR HIGHER (GO TO 110)

108) Now I would like you to read this sentence to me.

SHOW CARD TO RESPONDENT

IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE:
CAN YOU READ ANY PART OF THE SENTENCE TO ME?

CANNOT READ AT ALL 1
ABLE TO READ ONLY PART OF SENTENCE 2
ABEL TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) __________ 4
BLIND/VISUALLY IMPAIRED 5

108A) Have you ever participated in a literacy program or any other program that included learning how to read and right (not including primary school)?

Yes 1
No 2 (GO TO 109)

108B) In what languages were these literacy programs?
PROBE: ANY OTHER?
RECORD ALL MENTIONED

A ARABIC/MADRASA
B WOLOF
C POULAR
D SERER
E DIOLA
F MANDINGUE
G SONINKE
X OTHER (SPECIFY LANGUAGE) _____________

109) CHECK 108:

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

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

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

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

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

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

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

113) What is your religion?

MUSLIM 1
CHRISTIAN 2
ANIMIST 3
NO RELIGION 4
OTHER (SPECIFY) ___________ 6

114a) Are you Senegalese?

YES 1
NO 2 (GO TO 115)

114) What is your ethnicity?

WOLOF 01
POULAR 02
SERER 03
MANDINGUE 04
DIOLA 05
SONINKE 06
OTHER (SPECIFY) _______ 96

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

NUMBER OF TIMES __________
NONE 00 (GO TO 201)

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

YES 1
NO 2

SECTION 2. REPRODUCTION

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

YES 1
NO 2 (GO TO 206)

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

YES 1
NO 2 (GO TO 204)

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

SONS AT HOME __________
DAUGHTERS AT HOME _____________

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

YES 1
NO 2 (GO TO 206)

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

SONS ELSEWHERE ___________
DAUGHTERS ELSEWHERE _____________

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

YES 1
NO 2 (GO TO 208)

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

BOYS DEAD ____________
GIRLS DEAD _________

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

TOTAL BIRTHS _________

209) CHECK 208:
Just to makes sure that I have this right: you have had in total ____births during your life. Is that correct?

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

210) CHECK 208:

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

211) Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had. RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE ROWS.
(IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW.)

212) What name was given to you (FIRST/NEXT) baby?
RECORD NAME
BIRTH HISTORY NUMBER

NAME__________________

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

BOY 1
GIRL 2

214) Were any of these births twins?

SING 1
MULT 2

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

MONTH ____________

YEAR __________

216) Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

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

AGE IN YEARS ___________

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

YES 1
NO 2

219) IF ALIVE:
RECORD HOUSEHOLD LINE NUMBER OF CHILD (RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD)

HOUSEHOLD LINE NUMBER _____________ (NEXT BIRTH)

220) IF DEAD:
How old was (NAME) when he/she died?

IF '1 YR', PROBE: How many months old was (NAME)? RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS, OR YEARS.

DAYS 1 _______________
MONTHS 2 ______________
YEARS 3 ______________

221) Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME), including any children who died after birth?

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

222) Have you had any live births since the birth of (name of last birth)? IF YES, RECORD BIRTHS IN TABLE.

YES 1
NO 2

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

NUMBERS ARE THE SAME
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

224) CHECK 215:
ENTER THE NUMBER OF BIRTHS IN 2007 OR LATER.

NUMBER OF BIRTHS __________
NONE 0 (GO TO 225)

224A) CHECK 217: CURRENT AGE
CURRENT AGE OF YOUNGEST CHILD-FROM 3 TO 4 COMPLETED YEARS: IDENTIFY THIS CHILD, RECORD HIS/HER NAME (FROM Q 212)

(IF TWINS, USE THE ONE RECORDED LAST) ______________
OTHER (GO TO 225)

224B) Who participates most often in (NAME FROM 224A)'s activities?

FATHER 1
MOTHER 2
OTHER HOUSEHOLD MEMBER 3
NO HOUSEHOLD MEMBER 4 (GO TO 225)
DON'T KNOW 8 (GO TO 225)

224C) What are these activities?

A READING BOOKS OR LOOKING AT PICTURE BOOKS
B TELLING STORIES
C SINGING SONGS, INCLUDING NURSERY RHYMES
D GOING FOR WALKS
E PLAYING WITH HIM/HER
F SPENDING TIME COUNTING/DRAWING/NAME OBJECTS
X OTHER (SPECIFY)

225) C
FOR EACH BIRTH SINCE JANUARY 2007, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE CODE 'N' FOR EACH BIRTH. ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF THE PREGNANCY. (NOTE: THE NUMBER OF 'P'S MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)

226) Are you pregnant now?

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

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

MONTHS

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

YES 1 (GO TO 230)
NO 2

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

LATER 1
NO MORE 2

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

YES 1
NO 2 (GO TO 238)

231) When did the last such pregnancy end?

MONTH ____________
YEAR _____________

232) CHECK 231:

LAST PREGNANCY ENDED IN JAN 2007 OR LATER (GO TO 233)
LAST PREGNANCY ENDED BEFORE JAN. 2007 (GO TO 238)

233) How many months pregnant were you when the last such pregnancy ended?
C
RECORD THE NUMBER OF COMPLETED MONTHS. ENTER T IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND P FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

MONTHS

234) Since January 2007, have you had any other pregnancies that did not result in a live birth?

YES 1
NO 2 (GO TO 236)

235) ASK THE DATE AND DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2007.

C

ENTER T IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND P FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

236) Did you have any miscarriages, abortions or stillbirths that ended before 2007?

YES 1
NO 2 (GO TO 238)

237) When did the last such pregnancy that terminated before 2007 end?

MONTH _______
YEAR _______

238) When did you last menstrual period start?

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

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

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

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

JUST BEFORE HER PERIOD BEGINS 1
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAD ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY) ___________ 6
DON'T KNOW 8

SECTION 3. CONTRACEPTION

301) Now I would like to talk about family planning-the various ways or methods that a couple can use to delay or avoid a pregnancy.
Have you ever heard of (METHOD)?

01) FEMALE STERILIZATION: PROBE: Women can have an operation to avoid having any more children
YES 1
NO 2
02) MALE STERILIZATION: PROBE: Men can have an operation to avoid having any more children
YES 1
NO 2
03) IUD: PROBE: Women can have a loop or coil placed inside them by a doctor, nurse or midwife.
YES 1
NO 2
04) INJECTABLES: PROBE: Women can have an injection by a heath provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
05) IMPLANTS: PROBE: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
06) PILL: PROBE: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
07) CONDOM: PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08) FEMALE CONDOM: PROBE: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09) LACTATIONAL AMENORRHEA METHOD (LAM): Up to six months after giving birth, a woman can use a method which requires her to breastfeed frequently, day and night, and her period does not return.
YES 1
NO 2
10) CYCLE BEADS: PROBE: A woman uses a string of colors beads to know which days she could get pregnant.
YES 1
NO 2
11) RHYTHM METHOD: PROBE: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.
YES 1
NO 2
12) WITHDRAWAL: PROBE: Men can be careful and pull out before climax.
YES 1
NO 2
13) EMERGENCY CONTRACEPTION: PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
YES 1
NO 2
14) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
SPECIFY____ (LIST UP TO TWO METHODS)
YES 1
NO 2

302) CHECK 226:

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

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

YES 1 (GO TO 304)
NO 2

303a) Why are you not using something or a contraceptive method to delay or prevent a pregnancy?

INFREQUENT SEX/HUSBAND ABSENT 01
GOT PREGNANT WHILE USING 02
WANTS TO GET PREGNANT 03
HUSBAND/PARTNER/FAMILY DISAPPROVE 04
SIDE EFFECTS/HEALTH CONCERNS 05
LACK OF ACCESS/TOO FAR 06
COSTS TOO MUCH 07
INCONVENIENT TO USE 08
UP TO GOD/FATALISTIC 09
DIFFICULTY GETTING PREGNANT/MENOPAUSE 10
MARITAL DISSOLUTION/SEPARATION 11
OTHER (SPECIFY) _____________ 96
DON'T KNOW 98

304) Which method are you using?

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

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

305) What is the brand name of the pills you are using?
IF DON'T KNOW BRAND, ASK TO SEE THE PACKAGE.

PLANYL 01
PLANOR 02
OVRETTE 03
LO FEMENAL 04
MINIDRIL 05
MINIPHASE 06
STEDIRIL 07
MICORVAL 08
ADEPAL 09
MICROGYNON 10
NEOGYNON 11
DIANE 35 12
TRINORDIOL 13
SECURIL 14
LUSIAF 15
MICROLUT 16
OTHER (SPECIFY)____________ 96
DK 98

306) What is the brand name of the condoms you are using?
IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

PROTEC 01 (GO TO 308A)
FAGAROU 02 (GO TO 308A)
VISA 03 (GO TO 308A)
MANIX 04 (GO TO 308A)
PRESA 05 (GO TO 308A)
KAMA SUTRA 06 (GO TO 308A)
PROTEX 07 (GO TO 308A)
INNOTEX 08 (GO TO 308A)
CASANOVA 09 (GO TO 308A)
INTIMY 10 (GO TO 308A)
CONTEX 11 (GO TO 308A)
STAR 12 (GO TO 308A)
TROJAM 13 (GO TO 308A)
FEMIDON 14 (GO TO 308A)
DK 98 (GO TO 308A)

307) In what facility did the sterilization take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

(NAME OF PLACE) ___________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
OTHER (SPECIFY) ____________16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE MEDICAL OFFICE 23
MOBILE CLINIC 24
OTHER PRIVATE MEDICAL (SPECIFY) _____________ 26
OTHER (SPECIFY) ______________96
DK 98

308) In what month and year was the sterilization performed?

308a) Since what month and year did you start using (CURRENT METHOD) without stopping?

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

MONTH ______________
YEAR __________

309) CHECK 308/308a, 215, 231:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 308/308A.

IF YES: GO BACK TO 308/308A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION).

YES
NO (GO TO 310)

310) CHECK 308/308A

YEAR IS 2007 OR LATER: ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING. (GO TO 322)

YEAR IS 2006 OR EARLIER: ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2007 (GO TO 322)
311) I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years.

USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2007. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

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

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

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

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

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

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

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

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

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

314) CHECK 304:
CIRCLE METHOD CODE.
IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

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

315) You first started using (CURRENT METHOD) in (DATE FROM 308/308A). Where did you get it at that time?
315a) Where did you learn how to use the cycle beads/rhythm/lactational amenorrhea method?
PROBE TO IDENTITY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ______________
PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
HEALTH POST 13
GOVT. FAMILY PLANNING CENTER 14
RURAL MATERNITY 15
HEALTH HUT 16
COMMUNITY PHARMACY 17
MOBILE CLINIC 18
OTHER PUBLIC SECTOR (SPECIFY)_______________ 19
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE 21/22
PHARMACY 23
PRIVATE DOCTOR 24
RELIGIOUS FREE CLINIC 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ____________ 26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
BAR 34
OTHER (SPECIFY)____________ 96

316) CHECK 304:
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

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

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

YES 1 (SKIP TO 319)
NO 2

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

YES 1
NO 2 (GO TO 320)

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

YES 1
NO 2

320) CHECK 317:

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

CODE '1' NOT CIRCLED: When you obtained (CURRENT METHOD FROM 314) from (SOURCE OF METHOD FROM 307 OR 315), were you told about other methods of family planning that you could use?

YES 1 (GO TO 322)
NO 2

321) Were you ever told by a health or family planning worker about other methods of family planning that you could use?

YES 1
NO 2

322) CHECK 304:
CIRCLE METHOD CODE.
IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

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

323) Where did you obtain (CURRENT METHOD) the last time?
PROBE TO IDENTITY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) _____________
PUBLIC SECTOR
GOVT. HOSPITAL 11 (GO TO 326)
GOVT. HEALTH CENTER 12 (GO TO 326)
HEALTH POST 13 (GO TO 326)
GOVT. FAMILY PLANNING CENTER 14 (GO TO 326)
RURAL MATERNITY 15 (GO TO 326)
HEALTH HUT 16 (GO TO 326)
COMMUNITY PHARMACY 17 (GO TO 326)
MOBILE CLINIC 18 (GO TO 326)
OTHER PUBLIC SECTOR (SPECIFY) ________ 19 (GO TO 326)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE 21/22 (GO TO 326)
PHARMACY 23 (GO TO 326)
PRIVATE DOCTOR 24 (GO TO 326)
RELIGIOUS FREE CLINIC 25 (GO TO 326)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _______ 26 (GO TO 326)
OTHER SOURCE
SHOP 31 (GO TO 326)
CHURCH 32 (GO TO 326)
FRIENDS/RELATIVES 33 (GO TO 326)
BAR 34 (GO TO 326)
OTHER (SPECIFY)________ 96 (GO TO 326)

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

YES 1
NO 2 (GO TO 326)

325) Where is that?
Any other place?
PROBE TO IDENTITY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) ___________________
PUBLIC SECTOR
A GOVT. HOSPITAL
B GOVT. HEALTH CENTER
C HEALTH POST
D GOVT. FAMILY PLANNING CENTER
E RURAL MATERNITY
F HEALTH HUT
G COMMUNITY PHARMACY
H MOBILE CLINIC
I OTHER PUBLIC SECTOR (SPECIFY)
PRIVATE MEDICAL SECTOR
J PRIVATE HOSPITAL/CLINIC/OFFICE
K PHARMACY
L PRIVATE DOCTOR
M RELIGIOUS FREE CLINIC
N OTHER PRIVATE MEDICAL SECTOR (SPECIFY)
OTHER SOURCE
O SHOP
P CHURCH
Q FRIENDS/RELATIVES
R BAR
X OTHER (SPECIFY)

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 401)

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

YES 1
NO 2

SECTION 4. PREGNANCY AND POSTNATAL CARE

401) CHECK 224:

ONE OR MORE BIRTHS IN 2007 OR LATER (GO TO 402)
NO BIRTHS IN 2007 OR LATER (GO TO 556)

402) CHECK 215: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2007 OR LATER. ASK THE QUESTIONS ABOUT ALL THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

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

403) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

LAST BIRTH
BIRTH HISTORY NUMBER ___________

404) FROM 212 AND 216

NAME ___________

LIVING (GO TO 405)
DEAD (GO TO 405)

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

YES 1 (GO TO 408)
NO 2

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

LATER 1
NO MORE 2 (GO TO 408)

407) How much longer did you want to wait?

MONTHS 1 _________
YEARS 2 _________

DON'T KNOW 998

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

YES 1
NO 2 (GO TO 415)

409) Whom did you see?
Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

HEATH PROFESSIONAL
A DOCTOR
B MIDWIFE
C NURSE/NURSE CERTIFIED IN NEWBORN CARE
OTHER PERSON
D MATRON
E TRADITIONAL BIRTH ATTENDANT
X OTHER (SPECIFY) __________

410) Where did you receive this antenatal care for this pregnancy?
Anywhere else?
PROBE TO IDENTITY THE TYPE OF SOURCE.IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) ________________
HOME
A YOUR HOME
B OTHER HOME
PUBLIC SECTOR
C GOVT. HOSPITAL
D GOVT. HEALTH CENTER/MATERNITY
E GOVT. HEALTH POST
F OTHER PUBLIC SECTOR (SPECIFY) _______
PRIVATE MEDICAL SECTOR
G PRIVATE HOSPITAL/CLINIC
H OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ___________
X OTHER (SPECIFY) ___________

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

MONTHS __________
DON'T KNOW 98

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

NUMBER OF TIMES ________
DON'T KNOW 98

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

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

BLOOD PRESSURE
YES 1
NO 2
URINE
YES 1
NO 2
BLOOD
YES 1
NO 2

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

YES 1
NO 2
DON'T KNOW 8

415) During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?

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

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

TIMES __________
DON'T KNOW 8

417) CHECK 416:

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

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

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

419) Before this pregnancy, how many times did you receive a tetanus injection?
IF 7 OR MORE TIMES, RECORD 7

TIMES __________
DON'T KNOW 8

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

YEARS AGO __________

421) During this pregnancy, were you given or did you buy iron tablets or iron syrup?
SHOW TABLES/SYRUP

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

422) During the whole pregnancy, for how many days did you take the tables or syrup?
IF ANSWER NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.

DAYS __________
DON'T KNOW 998

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

YES 1
NO 2
DON'T KNOW 8

424) During this pregnancy, did you take any drugs to keep you from getting malaria?

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

425) What drugs did you take?
RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.

A SP/FANSIDAR
B ACT
X OTHER (SPECIFY) _____________
Z DON'T KNOW

426) CHECK 425:
SP/FANSIDAR TAKEN FOR MALARIA PREVENTION

CODE A CIRCLED (GO TO 427)
CODE A NOT CIRCLED (GO TO 430)

428) CHECK 409:
ANTENATAL CARE FROM HEALTH PERSONNEL DURING THIS PREGNANCY

CODE A, B, OR C CIRCLED (GO TO 429)
OTHER (GO TO 430)

429) Did you get the (SP/Fansidar) during any antenatal care visit, during another visit to a health facility, or from another source?

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6

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

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

431) Was (NAME) weighed at birth?

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

432) How much did (NAME) weigh?
RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE

GRAMS FROM CARD 1 __________
GRAMS FROM RECALL 2 _____________

DON'T KNOW 99998

432a) Was (NAME)'s birth ever declared?

YES 1
NO 2
DON'T KNOW 8

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

PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.
IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

HEATH PROFESSIONAL
DOCTOR A
MIDWIFE B
NURSE/NURSE CERTIFIED IN NEWBORN CARE C
OTHER PERSON
MATRON D
TRADITIONAL BIRTH ATTENDANT E
OTHER (SPECIFY) X
NOBODY Y

434) Where did you give birth to (NAME)?
PROBE TO IDENTITY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S))__________________
HOME
YOUR HOME 11 (GO TO 438)
OTHER HOME 12 (GO TO 438)
PUBLIC SECTOR
GOVT. HOSPITAL 21
GOVT. HEALTH CENTER/MATERNITY 22
GOVT. HEALTH POST 23
OTHER PUBLIC SECTOR (SPECIFY) _____________ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ___________ 36
OTHER (SPECIFY) ____________ 96 (GO TO 438)

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

YES 1
NO 2

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

YES 1 (GO TO 439)
NO 2

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

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

438) Did anyone check on your health after you gave birth to (name)?

YES 1
NO 2 (GO TO 442)

439) Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.

HEATH PROFESSIONAL
DOCTOR 11
MIDWIFE 12
NURSE/NURSE CERTIFIED IN NEWBORN CARE 13
OTHER PERSON
MATRON 21
TRADITIONAL BIRTH ATTENDANT 22
OTHER (SPECIFY) _________ 96

440) How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD IN HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1 _________
DAYS 2 __________
WEEKS 3 ____________

DON'T KNOW 998

441) CHECK 437:

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

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

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

443) How many hours, days, or weeks after the birth of (NAME) did the first check take place?
IF LESS THAN ONE DAY, RECORD IN HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

HRS AFTER BIRTH 1 ___________
DAYS AFTER BIRTH 2 __________
WKS AFTER BIRTH 3 __________

DON'T KNOW 998

444) Who checked on (NAME)'s health at that time?
PROBE FOR THE MOST QUALIFIED PERSON.

HEATH PROFESSIONAL
DOCTOR 11
MIDWIFE 12
NURSE/NURSE CERTIFIED IN NEWBORN CARE 13
OTHER PERSON
MATRON 21
TRADITIONAL BIRTH ATTENDANT 22
OTHER (SPECIFY) __________ 96

445) Where did this first check of (NAME) take place?
PROBE TO IDENTITY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) _________________
HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVT. HOSPITAL 21
GOVT. HEALTH CENTER/MATERNITY 22
GOVT. HEALTH POST 23
OTHER PUBLIC SECTOR (SPECIFY) __________ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)_________ 36
OTHER (SPECIFY) 96

446) In the first two months after delivery, did you receive a vitamin A dose like (this/any of these)?
SHOW COMMON TYPES OF AMPOULES/CAPSULES/SYRUPS

YES 1
NO 2
DON'T KNOW 8

447) Has your menstrual period returned since the birth of (NAME)?

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

448) Did your period return between the birth of (NAME) and your next pregnancy?

YES 1
NO 2 (GO TO 452)

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

MONTHS
DON'T KNOW 98

450) CHECK 226:
IS RESPONDENT PREGNANT?

NOT PREGNANT
PREGNANT OR NOT SURE (GO TO 452)

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

YES 1
NO 2 (GO TO 453)

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

MONTHS _________
DON'T KNOW 98

453) Did you ever breastfeed (NAME)?

YES 1 (GO TO 455)
NO 2

454) CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 460)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 501)

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

IMMEDIATELY 000

HOURS 1 ________
DAYS 2 _________

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

YES 1
NO 2 (GO TO 458)

457) What was (NAME) given to drink?
Anything else?
RECORD ALL LIQUIDS MENTIONED.

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

458) CHECK 404:
IS CHILD LIVING?

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

459) Are you still breastfeeding (NAME)?

YES 1
NO 2

459A) For how many months did you breastfeed (NAME)?

MONTHS
DON'T KNOW 98

459B) CHECK 404:
IS CHILD LIVING?

LIVING
DEAD-(GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501)

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

YES 1
NO 2
DON'T KNOW 8

461) (GO BACK TO 405 IN NEXT COLUMN, OR, IF NO MORE BIRTHS, GO TO 501)

SECTION 5. CHILD IMMUNIZATION, HEALTH AND NUTRITION

501) ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2007 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES.)

502) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY
LAST BIRTH

BIRTH HISTORY NUMBER ______________

503) FROM 212 AND 216

NAME ____________
LIVING
DEAD-(GO TO 503 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 553)

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

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

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

YES 1 (GO TO 509)
NO 2

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

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

507) CHECK 506:

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

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

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

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

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

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

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

510a) A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

YES 1
NO 2
DON'T KNOW 8

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

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

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

FIRST 2 WEEKS 1
LATER 2

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

NUMBER OF TIMES ____________

510e) A DPT vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops?

YES 1
NO 2 (GO TO 510G
DON'T KNOW 3 (GO TO 510G)

510f) How many times was the DPT vaccination given?

NUMBER OF TIMES ____________

510g) A measles injection or an MMR injection- that is, a shot in the arm at the age of 9 months or older, - to prevent him/her from getting measles?

YES 1
NO 2
DON'T KNOW 8

510h) A yellow fever vaccination?

YES 1
NO 2
DON'T KNOW 8

511) Within the last six months, was (Name) given a vitamin A dose like (this/any of these)?
SHOW COMMON TYPES OF AMPOULES/CAPSULES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

512) In the last seven days, was (NAME) given iron pills, sprinkles with iron, or iron syrup like (this/any of these)?
SHOW COMMON TYPES OF PILLS/SPRINKLES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

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

515) Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

516) Now I would like to know how much (NAME) was given to drink during the diarrhea (including breastmilk). Was he/she given less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?

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

517) When (NAME) had diarrhea, was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?

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

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

YES 1
NO 2 (GO TO 522)

519) Where did you seek advice or treatment?
Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) ______________
PUBLIC SECTOR
A GOVT. HOSPITAL
B GOVT. HEALTH CENTER
C GOVT. HEALTH POST
D MOBILE CLINIC
E FIELDWORKER
F OTHER PUBLIC SECTOR (SPECIFY)___________
PRIVATE MEDICAL SECTOR
G PRIVATE HOSPITAL/CLINIC
H PHARMACY
I PRIVATE DOCTOR
J MOBILE CLINIC
K FIELDWORKER
L OTHER PRIVATE MEDICAL SECTOR (SPECIFY)
OTHER SOURCE
SHOP M
TRADITIONAL PRACTITIONER N
MARKET O
OTHER (SPECIFY) ___________ X

520) CHECK 519:

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

521) Where did you first seek advice or treatment?

PUBLIC SECTOR
A GOVT. HOSPITAL
B GOVT. HEALTH CENTER
C GOVT. HEALTH POST
D MOBILE CLINIC
E FIELDWORKER
F OTHER PUBLIC SECTOR (SPECIFY)___________
PRIVATE MEDICAL SECTOR
G PRIVATE HOSPITAL/CLINIC
H PHARMACY
I PRIVATE DOCTOR
J MOBILE CLINIC
K FIELDWORKER
L OTHER PRIVATE MEDICAL SECTOR (SPECIFY)
OTHER SOURCE
SHOP M
TRADITIONAL PRACTITIONER N
MARKET O
OTHER (SPECIFY) ___________ X

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

a) A fluid made from a special packet called (ORS packet/Orasel)?
b) A pre-packaged ORS liquid?
c) A government-recommended homemade fluid?

FLUID FORM ORS PKT
YES 1
NO 2
DK 8
ORS LQD
YES 1
NO 2
DK 8
HOMEMADE FLUID
YES 1
NO 2
DK 8

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

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

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

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

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

YES 1
NO 2
DON'T KNOW 8

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

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

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

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

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

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

530) CHECK 525:
HAD FEVER?

YES (GO TO 531)
NO OR DK (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

531) Now I would like to know how much (NAME) was given to drink (including breastmilk) during the illness with a (fever/cough). Was he/she given less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?

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

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

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

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

YES 1
NO 2 (GO TO 537)

534) Where did you seek advice or treatment?
Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) ___________
PUBLIC SECTOR
A GOVT. HOSPITAL
B GOVT. HEALTH CENTER
C GOVT. HEALTH POST
D HEALTH HUT
E AT HOME CARE
F OTHER PUBLIC SECTOR (SPECIFY)
PRIVATE MEDICAL SECTOR
G PRIVATE HOSPITAL/CLINIC
H PHARMACY
I PRIVATE DOCTOR
J MOBILE CLINIC
K FIELDWORKER
L OTHER PRIVATE MEDICAL SECTOR (SPECIFY)
OTHER SOURCE
M SHOP
N TRADITIONAL PRACTITIONER
O MARKET
X OTHER (SPECIFY)

535) CHECK 534:

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

536) Where did you first seek advice or treatment?
USE LETTER CODE FROM 534

(NAME OF PLACE(S)) ___________
PUBLIC SECTOR
A GOVT. HOSPITAL
B GOVT. HEALTH CENTER
C GOVT. HEALTH POST
D HEALTH HUT
E AT HOME CARE
F OTHER PUBLIC SECTOR (SPECIFY)
PRIVATE MEDICAL SECTOR
G PRIVATE HOSPITAL/CLINIC
H PHARMACY
I PRIVATE DOCTOR
J MOBILE CLINIC
K FIELDWORKER
L OTHER PRIVATE MEDICAL SECTOR (SPECIFY)
OTHER SOURCE
M SHOP
N TRADITIONAL PRACTITIONER
O MARKET
X OTHER (SPECIFY)

536a) At any time during his/her illness, did someone take blood from his/her finger or heal?

YES 1
NO 2 (GO TO 537)

536b) Did someone perform a malaria diagnostic test on (NAME)?

YES 1
NO 2 (GO TO 537)

536c) What was the result?

POSITIVE 1
NEGATIVE 2
DON'T KNOW 8

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

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

538) What drugs did (NAME) take?
Any other drugs?
RECORD ALL MENTIONED

ANTIMALARIAL DRUGS
A ACT
B QUININE
C AMODIAQUINE
D SP/FANSIDAR
E OTHER ANTIMALARIAL (SPECIFY) _______
ANTIBIOTIC
F PILL/SYRUP
G INJECTION
OTHER DRUGS
H ASPIRIN
I ACETAMINOPHEN
J IBUPROFEN
X OTHER (SPECIFY)
Z DON'T KNOW

539) CHECK 538:
ANY CODE A-F CIRCLED?

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

540) CHECK 538:
ACT (A) GIVEN

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

541) How long after the fever started did (Name) first take ACT?

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

542) CHECK 538:
QUININE (B) GIVEN

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

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

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

544) CHECK 538:
AMODIAQUINE (C) GIVEN

CODE C CIRCLED (GO TO 545)
CODE C NOT CIRCLED (GO TO 546)

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

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

546) CHECK 538:
SF/FANSIDAR (D) GIVEN

CODE D CIRCLED (GO TO 547)
CODE D NOT CIRCLED (GO TO 550)

547) How long after the fever started did (NAME) first take SF/Fansidar?

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

550) CHECK 538:
OTHER ANTIMALARIAL (E) GIVEN

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

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

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

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

553) CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2009 OR LATER LIVING WITH THE RESPONDENT

ONE OR MORE (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE TO 554)
NONE (GO TO 556)

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

CHILD USED TOILET OR LATRINE 01
PUT/RINSED INTO TOILET OR LATRINE 02
PUT/RINSED INTO DRAIN OR DITCH 03
THROWN INTO GARBAGE 04
BURIED 05
LEFT IN THE OPEN 06
OTHER (SPECIFY) ________96

555) CHECK 522A AND 522B, ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID (GO TO 556)
ANY CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID (GO TO 557)

556) Have you ever heard of a special product called [LOCAL NAME FOR ORS PACKET OR PRE-PACKAGED ORS LIQUID] you can get for the treatment of diarrhea?

YES 1
NO 2

557) CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2010 OR LATER LIVING WITH RESPONDENT

ONE OR MORE (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE TO 558)
NONE (GO TO 601)

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

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

a) Plain water?
YES 1
NO 2
DK 8
b) Juice or juice drinks?
YES 1
NO 2
DK 8
c) Clear broth?
YES 1
NO 2
DK 8
d) Milk such as tinned, powdered, or fresh animal milk?
YES 1
NO 2
DK 8
IF YES, how many times did (Name) drink milk?
IF 7 OF MORE TIMES, RECORD 7
NUMBER OF TIMES DRANK MILK _______
e) Infant formula?
YES 1
NO 2
DK 8
IF YES: how many times did (NAME) drink infant formula?
IF 7 OR MORE TIMES, RECORD 7
NUMBER OF TIMES DRANK FORMULA __________
f) Any other liquids?
YES 1
NO 2
DK 8
g) Yogurt?
YES 1
NO 2
DK 8
IF YES: How many times did (NAME) eat yogurt?
IF 7 OR MORE TIMES, RECORD 7
NUMBER OF TIMES ATE YOGURT ___________
h) Any [BRAND NAME OF COMMERCIALLY FORTIFIED BABY FOOD, E.G. CERELAC]?
YES 1
NO 2
DK 8
i) Bread, rice, noodles, porridge, or any other foods made from grains?
YES 1
NO 2
DK 8
j) Pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside?
YES 1
NO 2
DK 8
k) White potatoes, white yams, manioc, cassava, or any other foods made from roots?
YES 1
NO 2
DK 8
l) Any dark green, leafy vegetables?
YES 1
NO 2
DK 8
m) Ripe mangoes, papayas or [INSERT ANY OTHER LOCALLY AVAILABLE VITAMIN A-RICH FRUITS]?
YES 1
NO 2
DK 8
n) Any other fruits or vegetables?
YES 1
NO 2
DK 8
o) Liver, kidney, heart or any other organ meats?
YES 1
NO 2
DK 8
p) Any meat, such as beef, pork, lamb, goat, chicken or duck?
YES 1
NO 2
DK 8
q) Eggs?
YES 1
NO 2
DK 8
r) Fresh or dried fish or shellfish?
YES 1
NO 2
DK 8
s) Other foods based in beans, soy, peas, lentils, or nuts?
YES 1
NO 2
DK 8
t) Cheese or other food made from milk?
YES 1
NO 2
DK 8
u) Any other solid, semi-solid, or soft food?
YES 1
NO 2
DK 8

559) CHECK 558 (categories g through u)

NOT A SINGLE YES (GO TO 560)
AT LEAST ONE YES (GO TO 561)

560) Did (NAME) eat any solid, semi-solid or soft foods yesterday during the day or at night?
IF YES, PROBE: What kind of solid, semi-solid, or soft foods did (NAME FROM 557) eat?

YES 1 (GO BACK TO 558 TO RECORD FOOD EATEN YESTERDAY)
NO 2 (GO TO 601)

561) How many times did (NAME FROM 557) eat solid, semi-solid, or soft foods yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD 7

NUMBER OF TIMES _________
DON'T KNOW 8

SECTION 6. MARRIAGE AND SEXUAL ACTIVITY

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

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

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

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

603) What is your current marital status: are you a widow, divorced, or separated?

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

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

LIVES WITH HER 1
STAYING ELSEWHERE 2

605) RECORD THE LINE NUMBER OF HER HUSBAND/PARTNER ACCORDING TO THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT A LISTED IN THE HOUSEHOLD, RECORD '00'.

NAME _____________
LINE NO. _______________

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

YES 1
NO 2 (GO TO 609)
DK 8 (GO TO 609)

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

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNERS ________
DON'T KNOW

608) Are you the first, second…wife?

RANK _____

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

ONCE 1
MORE THAN ONCE 2

610) CHECK 609:

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

MARRIED/LIVED WITH MAN MORE THAN ONCE: Now I would like to talk about your first (husband/partner) in what month and year did you start living with him?

MONTH _____
DON'T KNOW MONTH 98
YEAR ____ (GO TO 612)
DON'T KNOW YEAR 9998

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

AGE _____

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

613) Now I need to ask you some questions about sexual activity in order to gain a better understanding of some important life issues.
How old were you when you had sexual intercourse for the very first time?

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

613a) How old was your partner?

AGE IN YEARS
DON'T KNOW 98

613b) Did you use a condom (male or female)?

YES 1
NO 2
DON'T KNOW 8

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

615) When was the last time you had sexual intercourse.
IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS, OR MONTHS.
IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO 1 ___________
WEEKS AGO 2 ___________
MONTHS AGO 3 ___________
YEARS AGO 4 (GO TO 627) _______________

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

DAYS AGO 1
WEEKS AGO 2
MONTHS AGO 3

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

YES 1
NO 2 (GO TO 619)

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

YES 1
NO 2

619) What was your relationship to this person with whom you had sexual intercourse?
IF BOYFRIEND: Were you living together as if married?
IF YES, CIRCLE 2
IF NO, CIRCLE 3

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

620) CHECK 609:

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

621) CHECK 613

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

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

DAYS AGO 1 ___________
WEEKS AGO 2 ___________
MONTHS AGO 3 __________
YEARS AGO 4 __________

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

NUMBER OF TIMES____________

624) How old is this person?

AGE OF PARTNER ___________
DON'T KNOW 98

625) Apart from (this person/these two people), have you had sexual intercourse with any other persons in the last 12 months?

YES 1 (GO BACK TO 616 IN NEXT COLUMN)
NO 2 (GO TO 627)

626) In total, how many different people have you had sexual intercourse with in the last 12 months?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE 95

NUMBER OF PARTNERS LAST 12 MONTHS _________
DON'T KNOW 98

627) In total, how many different people have you had sexual intercourse with in your lifetime?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE 95

NUMBER OF PARTNERS IN LIFETIME ____________
DON'T KNOW 98

628) PRESENCE OF OTHERS AT THIS POINT

CHILDREN UNDER 10
YES 1
NO 2
MALE ADULTS
YES 1
NO 2
FEMALE ADULTS
YES 1
NO 2

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

YES 1
NO 2 (GO TO 632)

630) Where is that?
Any other place?
PROBE TO IDENTITY THE TYPE OF SOURCE.IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) ____________
PUBLIC SECTOR
A GOVT. HOSPITAL
B GOVT. HEALTH CENTER
C HEALTH POST
D GOVT. FAMILY PLANNING CENTER
E RURAL MATERNITY
F HEALTH HUT
G COMMUNITY PHARMACY
H MOBILE CLINIC
I OTHER PUBLIC SECTOR (SPECIFY)
PRIVATE MEDICAL SECTOR
J PRIVATE HOSPITAL/CLINIC/OFFICE
K PHARMACY
L PRIVATE DOCTOR
M RELIGIOUS FREE CLINIC
N OTHER PRIVATE MEDICAL SECTOR (SPECIFY)
OTHER SOURCE
O SHOP
P CHURCH
Q FRIENDS/RELATIVES
R BAR
X OTHER (SPECIFY)

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

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

YES 1
NO 2 (GO TO 701)

633) Where is that?
Any other place?
PROBE TO IDENTITY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) ____________
PUBLIC SECTOR
A GOVT. HOSPITAL
B GOVT. HEALTH CENTER
C HEALTH POST
D GOVT. FAMILY PLANNING CENTER
E RURAL MATERNITY
F HEALTH HUT
G COMMUNITY PHARMACY
H MOBILE CLINIC
I OTHER PUBLIC SECTOR (SPECIFY)
PRIVATE MEDICAL SECTOR
J PRIVATE HOSPITAL/CLINIC/OFFICE
K PHARMACY
L PRIVATE DOCTOR
M RELIGIOUS FREE CLINIC
N OTHER PRIVATE MEDICAL SECTOR (SPECIFY)
OTHER SOURCE
O SHOP
P CHURCH
Q FRIENDS/RELATIVES
R BAR
X OTHER (SPECIFY)

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

SECTION 7. FERTILITY PREFERENCES

701) CHECK 304:

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

702) CHECK 226:

PREGNANT
NOT PREGNANT OR UNSURE (GO TO 704)

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

HAVE ANOTHER CHILD 1 (GO TO 705)
NO MORE 2 (GO TO 711)
UNDECIDED/DON'T KNOW 8 (GO TO 711)

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

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

705) 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 this child you are expecting now, how long would you like to wait before the birth of another child?

MONTHS 1____
YEARS 2____

SOON/NOW 993 (GO TO 710)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 712)
AFTER MARRIAGE 995 (GO TO 710)
OTHER (SPECIFY) 996 (GO TO 710)
DON'T KNOW 998 (GO TO 710)

706) CHECK 226:

NO PREGNANT OR UNSURE (GO TO 707)
PREGNANT (GO TO 711)

707) CHECK 303:
USING A CONTRACEPTIVE METHOD?

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

708) CHECK 705:

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

709) CHECK 703 AND 704:

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

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

RECORD ALL REASONS MENTIONED.

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

710) CHECK 303:
USING A CONTRACEPTIVE METHOD?

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

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

YES 1
NO 2
DON'T KNOW 8

712) CHECK 216:

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

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 714)
NUMBER ____________
OTHER (SPECIFY) 96 (GO TO 714)

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

NUMBER OF BOYS____
NUMBER OF GIRLS____
NUMBER OF OTHERS____
OTHER (SPECIFY)___________ 96

714) In the last few months have you:

Heard about family planning on the radio?
Seen anything about family planning on the television?
Read about family planning in a newspaper or magazine?

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

715) COUNTRY-SPECIFIC QUESTIONS ON MEDIA MESSAGES ABOUT FAMILY PLANNING

716) CHECK 601:

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

717) CHECK 303:
USING A CONTRACEPTIVE METHOD?

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

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

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

719) CHECK 304:

NEITHER STERILIZED
HE OR SHE STERILIZED (GO TO 801)

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

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

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

801) CHECK 601 AND 602:

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

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

AGE____________

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

YES 1
NO 2 (GO TO 806)

804) What is the highest level of school he attended: Primary, Secondary, or higher?

PRIMARY 1
MIDDLE 2
SECONDARY 3
HIGHER 4
DON'T KNOW 8 (GO TO 806)

805) What is the highest (grade/form/year) he completed at this level?*
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD 00

GRADE _______
DON'T KNOW 98

806) CHECK 801:

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

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

OCCUPATION_____

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

YES 1 (GO TO 811)
NO 2

808) As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business. In the last seven days, have you done any of these things or any other work?

YES 1 (GO TO 811)
NO 2

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

YES 1 (GO TO 811)
NO 2

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

YES (GO TO 815)
NO

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

OCCUPATION_______________

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

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

813) Do you usually work throughout the year, or do you work seasonally, or only once in a while?

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

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

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

815) CHECK 601:

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

816) CHECK 814:

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

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

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

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

MORE THAN HIM 1
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND/PARTNER HAS NO EARNINGS 4- (SKIP TO 820)
DON'T KNOW 8

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

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

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

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

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

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

822) Who usually makes decisions about visits to your family or relatives?

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

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

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

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

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

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

CHILDREN LESS THAN 10
PRESENT/LISTEN 1
PRESENT/NOT LISTEN 2
NOT PRESENT 3
HUSBAND
PRESENT/LISTEN 1
PRESENT/NOT LISTEN 2
NOT PRESENT 3
OTHER MALES
PRESENT/LISTEN 1
PRESENT/NOT LISTEN 2
NOT PRESENT 3
OTHER FEMALES
PRESENT/LISTEN 1
PRESENT/NOT LISTEN 2
NOT PRESENT 3

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

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

GOES OUT WITHOUT TELLING HIM
YES 1
NO 2
DON'T KNOW 8
NEGLECT CHILDREN
YES 1
NO 2
DON'T KNOW 8
ARGUES
YES 1
NO 2
DON'T KNOW 8
REFUSES SEX
YES 1
NO 2
DON'T KNOW 8
BURNS FOOD
YES 1
NO 2
DON'T KNOW 8

SECTION 9: FEMALE GENITAL CUTTING

900) CHECK 213, 215, 216: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER AND NAME OF EACH LIVING DAUGHTER BORN IN 1998 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE DAUGHTERS. BEGIN WITH THE YOUNGEST DAUGHTER. (IF THERE ARE MORE THAN 6 DAUGHTERS, USE ADDITIONAL QUESTIONNAIRES).

HAS ONE OR MORE LIVING DAUGHTERS BORN IN 1998 OR LATER (GO TO 910)
HAS NO LIVING DAUGHTERS BORN IN 1998 OR LATER- (SKIP TO 915)

Now I would like to ask you some questions about your (daughter/daughters) under age 15.

910) BIRTH HISTORY NUMBER AND NAME OF EACH LIVING DAUGHTER BORN IN 1998 OR LATER

BIRTH HISTORY NUMBER_____________
NAME______________

911) Is (NAME OF DAUGHTER) circumcised?

YES 1
NO 2-(GO TO 911 IN NEXT COLUMN OR IF NO MORE DAUGHTERS, GO TO 915)

912) How old was (NAME OF DAUGHTER) when she was circumcised?
IF THE RESPONDENT DOES NOT KNOW THE AGE, PROBE TO GET AN ESTIMATE.

AGE IN COMPLETED YEARS_______
DON'T KNOW 98

913) Was her genital area sewn closed?
PROBE: was the genital area closed?

YES 1
NO 2
DON'T KNOW 8

914) GO BACK TO 911 IN NEXT COLUMN; OR, IF NO MORE DAUGHTERS, GO TO 915

IF NO MORE DAUGHTERS GO TO 915

915) RECORD THE TIME

HOURS__________
MINUTES________

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT:

COMMENTS ON SPECIFIC QUESTIONS:

ANY OTHER COMMENTS:

SUPERVISOR'S OBSERVATIONS

NAME OF SUPERVISOR
DATE

EDITOR'S OBSERVATIONS
NAME OF EDITOR
DATE

CALENDAR

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

INFORMATION TO BE CODED FOR EACH COLUMN.

2013*
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

[##TRANSLATOR NOTE: REPEATED FOR EACH YEAR]
2012
2011
2010
2009
2008
2007

COLUMN 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE**
B BIRTH
P PREGNANCIES
T TERMINATIONS

0 NO METHOD
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 IUD
4 INJECTABLES
5 IMPLANTS
6 PILL
7 CONDOM
8 FEMALE CONDOM
9 DIAPHRAGM
J FOAM OR JELLY
K LACTATIONAL AMENORRHEA METHOD
L RHYTHM METHOD
M WITHDRAWAL
X OTHER MODERN METHOD
Y OTHER TRADITIONAL METHOD

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

* YEAR OF FIELDWORK IS ASSUMED TO BE 2012. FOR FIELDWORK BEGINNING IN 2012 OR 2013, THE YEARS SHOULD BE ADJUSTED.

**RESPONSE CATEGORIES MAY BE ADDED FOR OTHER METHODS, INCLUDING FERTILITY AWARENESS METHODS