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EVER MARRIED WOMAN’S QUESTIONNAIRE

REPUBLIC OF YEMEN
MINISTRY OF PUBLIC HEALTH AND POPULATION
CENTRAL STATISTICAL ORGANIZATION
NATIONAL HEALTH AND DEMOGRAPHIC SURVEY 2013

IDENTIFICATION

GOVERNORATE____

DIRECTORATE NAME____

SUB-DIRECTORATE NAME____

URBAN OR RURAL:

URBAN 1
RURAL 2

SECTOR NUMBER____

SECTION NUMBER____

CLUSTER NUMBER____

HOUSEHOLD NUMBER____

HOUSEHOLD CLUSTER NUMBER____

NAME OF HOUSEHOLD HEAD____

INTERVIEWER VISITS

FIRST VISIT
DATE
INTERVIEWER’S NAME
RESULT*

NEXT VISIT:
DATE
TIME

SECOND VISIT
DATE
INTERVIEWER’S NAME
RESULT*

NEXT VISIT:
DATE
TIME

THIRD VISIT
DATE
INTERVIEWER’S NAME
RESULT*

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT*

TOTAL NUMBER OF VISITS

*RESULT CODES

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

FIELD EDITOR
NAME
SIGNATURE
DATE
CODE

SUPERVISOR
NAME
SIGNATURE
DATE
CODE

OFFICE EDITOR
NAME
SIGNATURE
DATE
CODE

KEYER
NAME
SIGNATURE
DATE
CODE

INTRODUCTION AND CONSENT

INFORMED CONSENT
Hello. My name is (INTERVIEWER’S NAME). I am working on the National Health and Demographic Survey which is implemented (by the Ministry of Public Health and Population and the Central Statistical Organization). We are conducting a survey about health all over Yemen. The information we collect will help the government to plan health services. Your household was selected for the survey. All of the answers you give will be confidential under Article (5) of the Statistics Law No. (28) for the year 1995 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.

Do you have any questions? May I begin the interview now?
SIGNATURE OF INTERVIEWER: ____ DATE: ____


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

SECTION 1. RESPONDENT'S BACKGROUND

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 on 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, fundamental (preparatory, unified), diploma before secondary, secondary, diploma after secondary, or university/higher?

PRIMARY 1
FUNDAMENTAL (PREPARATORY, UNIFIED) 2
DIPLOMA BEFORE SECONDARY 3
SECONDARY 4
DIPLOMA AFTER SECONDARY 5
UNIVERSITY/HIGHER 6

106) What is the highest (grade/year) you completed at that level?

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

GRADE/YEAR____

107) CHECK 105:

PRIMARY FUNDAMENTAL 1-6
OTHER LEVELS (GO TO 110)

108) Now I would like you to read this sentence to me. SHOW CARD TO RESPONDENT. IF RESPONDENT CANNOT READ THE WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

CANNOT READ AT ALL 1
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
BLIND/VISUALLY IMPAIRED 4

109) CHECK 108:

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

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

EVERY DAY 1
AT LEAST ONCE A WEEK 2
NOT AT ALL 3

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

EVERY DAY 1
AT LEAST ONCE A WEEK 2
NOT AT ALL 3

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

EVERY DAY 1
AT LEAST ONCE A WEEK 2
NOT AT ALL 3

112A) Are you currently married?

YES, MARRIED (GO TO 112C)
NO, NOT MARRIED

112B) What is your marital status now: are you widowed or divorced?

WIDOWED 1
DIVORCED 2

112C) Have you been married only once or more than once?

ONLY ONCE 1
MORE THAN ONCE 2

112D) CHECK 112C:

MARRIED ONLY ONCE: In what month and year did you start living with your husband?
MONTH____
DON'T KNOW 98
YEAR____ (GO TO 201)
DON'T KNOW YEAR 9998
MARRIED MORE THAN ONCE: Now I would like to ask about your first husband. In what month and year did you start living with him?
MONTH____
DON'T KNOW 98
YEAR____ (GO TO 201)
DON'T KNOW YEAR 9998

112E) How old were you when you started living with your (first) husband?

AGE____

SECTION 2. REPRODUCTION

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

YES 1
NO 2 (GO TO 206)

202) Do you have any sons or daughters 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 who are alive but do not live with you?

YES 1
NO 2 (GO TO 206)

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

SONS ELSEWHERE____
DAUGHTERS ELSEWHERE____

206) Have you ever given birth to a boy or girl who was born alive but died later? 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 OF 203, 205, AND 207, AND ENTER TOTAL. IF NONE, RECORD '00'.

TOTAL____

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

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

210) CHECK 208:

ONE OR MORE BIRTHS
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 ON SEPARATE ROWS. IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, (STARTING WITH THE SECOND ROW AND CHANGE IT TO 13).

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

NAME____

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

BOY 1
GIRL 2

214) Is (NAME) single or twins?

SING 1
MULT 2

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

MONTH____
YEAR____

216) Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

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

AGE IN YEARS____

218) Is (NAME) living with you?

YES 1
NO 2

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

HOUSEHOLD LINE NUMBER____ (GO TO NEXT BIRTH)

220) 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 2 YEARS, OR RECORD YEARS IF MORE THAN 2 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? (NOT ASKED FOR FIRST BIRTH)

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

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

YES 1
NO 2

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

NUMBERS ARE SAME
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

224) CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2008 OR LATER. IF NONE, CIRCLE COE (0) AND GO TO 226.

NUMBER OF BIRTHS ____
NONE 0 (GO TO 226)

225) FOR EACH BIRTH SINCE JANUARY 2008, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)

226) Are you pregnant now?

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

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

LATER 1
NO MORE 2

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

YES 1
NO 2 (GO TO 237A)

231) When was the last pregnancy that miscarried, was aborted, or ended in stillbirth?

MONTH ____
YEAR ____

232) CHECK 231:

LAST PREGNANCY ENDED IN JAN. 2008 OR LATER
LAST PREGNANCY ENDED BEFORE JAN. 2008 (GO TO 237A)

233) How many months pregnant were you when the last such pregnancy ended? (pregnancy that miscarried, was aborted, or ended in stillbirth)
RECORD NUMBER OF COMPLETED MONTHS. ENTER 'T' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

MONTHS ____

234) Since January 2008, have you had any other pregnancies that did not result in a live birth?

YES 1
NO 2 (GO TO 236)

235) ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2008
ENTER 'T' IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS FOR EACH PREGNANCY THAT MISCARRIED, WAS ABORTED, OR END IN STILLBIRTH.

236) Did you have any miscarriages, abortions, or stillbirths that ended before 2008?

YES 1
NO 2 (GO TO 237A)

237) When did the last pregnancy that terminated before 2008 end?

MONTH ____
YEAR ____

237A) How old were you when you had your first menstrual period?

AGE IN YEARS____

238) When did your last menstrual period start?

(DATE, IF GIVEN) ____
DAYS AGO 1 ____
WEEKS AGO 2 ____
MONTHS 3 ____
YEARS AGO4 ____
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

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)?

METHOD 1 FEMALE STERILIZATION. PROBE: Women can have an operation to avoid having any more children.
YES 1
NO 2
METHOD 2 MALE STERILIZATION. PROBE: Men can have an operation to avoid having any more children.
YES 1
NO 2
METHOD 3 IUD. PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse or midwife.
YES 1
NO 2
METHOD 4 INJECTABLES. PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
METHOD 5 IMPLANTS. 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 two years.
YES 1
NO 2
METHOD 6 PILL. PROBE: Women can take a pill every day to avoid becoming pregnancy.
YES 1
NO 2
METHOD 7 CONDOM. PROBE: Men can put a rubber sheath on their penis before sexual intercourse to avoid pregnancy.
YES 1
NO 2
METHOD 8 FEMALE CONDOM. PROBE: Women can place a sheath in their vagina before sexual intercourse to avoid pregnancy.
YES 1
NO 2
METHOD 9 DIAPHRAGM. PROBE: It is a soft latex with a spring that creates a seal against the walls of the vagina.
YES 1
NO 2
METHOD LACTATIONAL AMENORRHEA METHOD (LAM)
YES 1
NO 2
METHOD 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
METHOD 12 WITHDRAWAL. PROBE: Men can be careful and pull out before climax.
YES 1
NO 2
METHOD 13 EMERGENCY CONTRACEPTION. PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
YES 1
NO 2
Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1 (SPECIFY)____
NO 2

301A) CHECK 112A, 112B:

MARRIED
DIVORCED, WIDOWED (GO TO 311)

302) CHECK 226:

NOT PREGNANT OR UNSURE
PREGNANT (GO TO 311)

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

YES 1
NO 2 (GO TO 311)

304) Which method are you using? CIRCLE ALL MENTIONED. IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION A
MALE STERILIZATION B
IUD C (GO TO 308A)
INJECTABLES D (GO TO 308A)
IMPLANTS E (GO TO 308A)
PILL F (GO TO 308A)
CONDOM G (GO TO 308A)
FEMALE CONDOM (GO TO 308A)
DIAPHRAGM I (GO TO 308A)
LACTATIONAL AMEN. METHOD J (GO TO 308A)
RHYTHM METHOD K (GO TO 308A)
WITHDRAWAL L (GO TO 308A)
OTHER MODERN METHOD X (GO TO 308A)
OTHER TRADITIONAL METHOD Y (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____
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
PRIMARY HEALTH CENTER 13
FAMILY PLANNING CLINIC 14
MOBILE CLINIC 15
PRIVATE SECTOR (HOSPITAL/CLINIC/DOCTOR) 21
NON GOVERNMENT ORGANIZATIONS PR. HOSPITAL/CENTER/CLINIC/MOBILE CLINIC 31
OTHER (SPECIFY)____ 96
DON'T KNOW 98

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

MONTH ____
YEAR ____

308A) Since what month and year have you been using (CURRENT METHOD) without stopping? PROBE: For how long have you been using (CURRENT METHOD) NOW WITHOUT STOPPING?

MONTH ____
YEAR ____

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

YES (PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION).
NO

310) CHECK 308/308A:

YEAR IS 2008 OR LATER: ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING.
YEAR IS 2007 OR EARLIER: ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE THE CALENDAR AND EACH MONTH BACK TO JANUARY 2008 (GO TO 314)

311) I would like to ask you some questions about the times you or your husband 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 2008. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.
IN COLUMN 1, ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.
ILLUSTRATIVE QUESTIONS: When was the last time you used a method? Which method was that? When did you start using that method? How long after the birth of (NAME)? How long did you use the method then?
IN COLUMN 2, ENTER CODES FOR DISCONTINUATION NEXT TO THE LAST MONTH OF USE. NUMBER OF CODES IN COLUMN (2) MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN (1).
ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT.
ILLUSTRATIVE QUESTIONS: Why did you stop using the (METHOD)? Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop for some other reason? IF DELIBERATELY STOPPED TO 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 INTERVIEWER: USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH?)

NO METHOD USED
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 323A)
NO 2 (GO TO 323A)

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 323A)
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
LACTATIONAL AMEN. METHOD 10 (GO TO 315A)
RHYTHM METHOD 11 (GO TO 315A)
WITHDRAWAL 12 (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 3008/308A). Where did you get it at that time?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE. (NAME OF PLACE) ____

GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
PRIMARY HEALTH CENTER 13
FAMILY PLANNING CLINIC 14
MOBILE CLINIC 15
PRIVATE
(HOSPITAL/CLINIC/DOCTOR) 21
PHARMACY 22
NON GOVERNMENT ORGANIZATIONS
PR. HOSPITAL/CENTER/CLINIC/MOBILE CLINIC 31
OTHER (SPECIFY)____ 96

315A) Where did you learn how to use the rhythm/lactational amenorrhea method?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE. (NAME OF PLACE) ____

GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
PRIMARY HEALTH CENTER 13
FAMILY PLANNING CLINIC 14
MOBILE CLINIC 15
PRIVATE
(HOSPITAL/CLINIC/DOCTOR) 21
PHARMACY 22
NON GOVERNMENT ORGANIZATIONS
PR. HOSPITAL/CENTER/CLINIC/MOBILE CLINIC 31
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)
LACTATIONAL AMEN. METHOD 10 (GO TO 326)
RHYTHM METHOD 11 (GO TO 326)

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

YES 1 (GO TO 319)
NO 2

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

YES 1 (GO TO 319)
NO 2

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

YES 1
NO 2 (GO TO 320)

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

YES 1
NO 2

320) CHECK 314:

CODE '1' CIRCLED: At that time, were you told about other mthods of family planning that you could use?
YES 1 (GO 322)
NO 2
CODE '1' NOT CIRCLED: When you obtained (CURRENT METHOD FROM 314) from (SOURCE OF METHOD FROM 307 OR 315), were you told about other methods of family planning that you could use?
YES 1 (GO TO 322)
NO 2

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

YES 1
NO 2

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

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

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

GOVT. HOSPITAL 11 (GO TO 326)
GOVT. HEALTH CENTER 12 (GO TO 326)
PRIMARY HEALTH CENTER 13 (GO TO 326)
FAMILY HEALTH CENTER 14 (GO TO 326)
MOBILE CLINIC (GO TO 15)
PRIVATE SECTOR
(HOSPITAL/CLINIC/DOCTOR) 21 (GO TO 326)
PHARMACY 22 (GO TO 326)
NON GOVERNMENT ORGANIZATIONS (GO TO 326)
PR. HOSPITAL/CENTER/CLINIC/MOBILE CLINIC 31 (GO TO 326)
OTHER (SPECIFY)____ 96 (GO TO 326)

323A) What is the main reason for not using a method of family planning?

FERTILITY-RELATED REASONS
INFREQUENT SEX 21
MENOPAUSAL/HYSTERECTOMY 22
SUBFECUND/INFECUND 23
WANTS (MORE) CHILDREN 24
OPPOSITION TO USE
RESPONDENT OPPOSED 31
HUSBAND OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
LACK OF KNOWLEDGE
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
COSTS TOO MUCH 52
LACK OF ACCESS/TOO FAR 53
OTHER (SPECIFY)____ 96

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

YES 1
NO 2 (GO TO 326)

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

(NAME OF PLACE(S))____
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
PRIMARY HEALTH CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
PRIVATE MEDICAL SECTOR
PR. HOSPITAL/CLINIC/DOCTOR F
PHARMACY G
NON GOVERNMENT ORGANIZATIONS
PR. HOSPITAL/CLINIC/DOCTOR H
OTHER (SPECIFY)____ X

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 401)

328) Did any staff member at this 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 2008 OR LATER
NO BIRTH IN 2008 OR LATER (GO TO 556)

402) CHECK 215: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2008 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).
Now I would like to ask some questions about your children born in the last five years. We will talk about each separately.

403) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

BIRTH HISTORY NUMBER____

404) FROM 212 AND 216

NAME____
LIVING
DEAD

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

YES 1 (GO TO 407A)
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 407A)

407) How much longer did you want to wait?

MONTHS 1 ____
YEARS 2 ____
DON'T KNOW 998)

407A) During your pregnancy with (NAME), did you get any of the following symptoms:

1 Vaginal bleeding?
YES 1
NO 2
DON'T KNOW 8
2 High blood pressure?
YES 1
NO 2
DON'T KNOW 8
3 Swelling of the face and body?
YES 1
NO 2
DON'T KNOW 8
Severe headache?
YES 1
NO 2
DON'T KNOW 8
Convulsion?
YES 1
NO 2
DON'T KNOW 8
Other (SPECIFY)____
YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 415)

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

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT/GRANDMOTHER D
OTHER (SPECIFY)____ X

410) Where did you receive antenatal care for this pregnancy? 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))____
YOUR HOME A
OTHER HOME B
GOVT. HOSPITAL C
GOVT. HEALTH CENTER D
PRIM. HEALTH CENTER E
FP. CLINIC F
MOBILE CLINIC G
PRIVATE SECTOR
HOSP./CLINIC/DISPENSARY/DOCT. OFFICE) H
NG ORGANIZATIONS
(HOSPITAL/CLINIC/DISPENSARY DOCT. OFFICE) I
OTHER (SPECIFY)____ X

411) How many times did you receive antenatal care during 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:

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

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

YES 1
NO 2
DON'T KNOW 8

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

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

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

TIMES____
DON'T KNOW 8

417) CHECK 416:

2 OR MORE TIMES (GO TO 421)
OTHER

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____
DON'T KNOW 98

421) During this pregnancy, were you given or did you buy any iron tablets or iron 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 tablets or syrup?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.

DAYS ____
DON'T KNOW 998

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

YES 1
NO 2
DON'T KNOW 8

424) During this pregnancy, did you take any drugs for (SP/Fansidar)>

YES 1
NO 2
DON'T KNOW 8

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

VERY LARGE 1
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
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.

KG FROM CARD____
KG FROM RECALL ____
DON'T KNOW 99998

433) Who assisted with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED. IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
GRANDMOTHER/TRADITIONAL BIRTH ATTENDANT D
RELATIVE/FRIEND E
OTHER (SPECIFY)____ X
NO ONE ASSISTED Y

433A) During the birth of (NAME), did you get any of the following symptoms:

1 Continuous labor for more than 18 hours?
YES 1
NO 2
DON'T KNOW 8
2 Fever?
YES 1
NO 2
DON'T KNOW 8
3 Convulsion?
YES 1
NO 2
DON'T KNOW 8
4 Vaginal bleeding?
YES 1
NO 2
DON'T KNOW 8
5 Other (SPECIFY)____
YES 1
NO 2
DON'T KNOW 8

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

(NAME OF PLACE)____
YOUR HOME 11 (GO TO 437A)
OTHER HOME 12 (GO TO 437A)
GOVT. HOSPITAL 21
GOVT. H. CENTER 22
PRIM. H. CENTER 23
FP. CLINIC 24
MOBILE CLINIC 25
PRIVATE SECTOR
(HOSP./CLINIC/DISPENSARY/DOCT. OFFICE) 31
NG ORGANIZATIONS
(HOSPITAL/CLINIC/DISPENSARY DOCT. OFFICE) 41
OTHER (SPECIFY)____ 96 (GO TO 437A)

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

YES 1
NO 2

435A) Before you left the health facility, did any health staff speak to you or advise you about family planning methods?

YES 1
NO 2

436) After delivery of (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 442)

437A) Why didn't you deliver in a health facility?

AT HOME BETTER A
THE SERVICE NOT AVAILABLE B
THE SERVICE IS FAR C
COSTS TOO MUCH D
HUSBAND DID NOT ALLOW E
EMERGENCY LABOUR F
THE HEALTH PROVIDERS TREAT BADLY G
NO FEMALE PROVIDER AT FACILITY H
OTHER (SPECIFY) ____ X

438) After delivery of (NAME), did anyone check on your health?

YES 1
NO 2 (GO TO 442)

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

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
AUXILIARY MIDWIFE 13
OTHER (SPECIFY) ____ 96

440) How long after delivery did the first check take place? IF LESS THAN ONE HOUR RECORD '00' IN 'HOURS'. IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

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

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

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

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

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

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

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
AUXILIARY MIDWIFE 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
OTHER (SPECIFY)____ 96

445) Where did this first check of (NAME) take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE THE SECTOR WRITE THE NAME OF PLACE.

(NAME OF PLACE)____
YOUR HOME A
OTHER HOME B
GOVT. HOSPITAL C
GOVT. H. CENTER D
PRIM. H. CENTER E
FP. CLINIC F
MOBILE CLINIC G
PRIVATE SECTOR
(HOSP./CLINIC/DISPENSARY/DOCT. OFFICE) H
NG ORGANIZATIONS
(HOSPITAL/CLINIC/DISPENSARY DOCT. OFFICE) I
OTHER (SPECIFY) ____ X

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 453)

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

YES 1
NO 2 (GO TO 453)

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

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 '000'. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS.

IMMEDIATELY 000
HOURS 1 ____
DAYS 2 ____

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

YES 1
NO 2 (GO TO 458)

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

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

458) CHECK 404: IS CHILD LIVING?

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

459) Are you still breastfeeding (NAME)?

YES 1
NO 2

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

YES 1
NO 2
DON'T KNOW 8

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 2008 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES). NOW, I WOULD LIKE TO ASK YOU SOME QUESTIONS ABOUT YOUR CHILDREN WHO BORN SINCE 2008 OR LATER, WE WILL TALK ABOUT EACH SEPARATELY

502) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

BIRTH HISTORY NUMBER____

503) FROM 212 AND 216: NAME AND SURVIVAL STATUS

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

504) Do you have a vaccination card for (NAME)? IF YES: May I see it please?

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

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

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

506) COPY DATES FROM THE CARD. 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____
PNEUMOCOCCAL 1
DAY____
MONTH____
YEAR____
PNEUMOCOCCAL 2
DAY____
MONTH____
YEAR____
PNEUMOCOCCAL 3
DAY____
MONTH____
YEAR____
MEASLES
DAY____
MONTH____
YEAR____
VITAMIN A (MOST RECENT)
DAY____
MONTH____
YEAR____

507) CHECK 506:

BCG TO MEASLES ALL RECORDED (GO TO 511)
OTHER

508) Has (NAME) had any vaccinations that are not recorded on this card, including vaccinations given in a national immunization day campaign? RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 506 THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

YES 1 (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 have any vaccinations to prevent him/her from getting diseases, including vaccinations received in a national immunization day campaign?

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

510A) Please tell me if (NAME) had any of the following vaccinations: 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) Was (NAME) given a polio vaccine immediately after birth or during the first month?

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

510C) Was the 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) Please tell me if (NAME) had any of the following vaccinations: A PENTA vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops?

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

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

NUMBER OF TIMES____

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

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)?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

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

515) Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

516) Now I would like to know how much (NAME) was given to drink during the diarrhea (including breast milk). 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
NEVER GAVE FOOD 5
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))____
GOVT. HOSPITAL A
GOVT. H. CENTER B
PRIM. H. CENTER C
FP. CLINIC D
MOBILE CLINIC E
PRIVATE SECTOR
(HOSP./CLINIC/DISPENSARY DOCT. OFFICE) H
OTHER SOURCE
SHOP I
TRADITIONAL PRACTITIONER J
OTHER (SPECIFY)____ X

520) CHECK 519:

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

521) Where did you first seek advice or treatment? USE LETTER CODE FROM 519.

FIRST PLACE ____

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

a) A fluid made from a special packet called (LOCAL NAME FOR ORS PACKET)?
YES 1
NO 2
DON'T KNOW 8
b) A pre-packaged ORS liquid?
YES 1
NO 2
DON'T KNOW 8
c) A government-recommended homemade fluid?
YES 1
NO 2
DON'T KNOW 8

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

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

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

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

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

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

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

YES 1
NO 2
DON'T KNOW 8

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

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

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

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

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

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

530) CHECK 525: HAD FEVER?

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

531) Now I would like to know how much (NAME) was given to drink (including breast milk) 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 THE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S))____
GOVT. HOSPITAL A
GOVT. H. CENTER B
PRIM. H. CENTER C
FP. CLINIC D
MOBILE CLINIC E
PRIVATE SECTOR
(HOSP./CLINIC/DISPENSARY/DOCT. OFFICE) F
PHARMACY G
OTHER SOURCE
SHOP I
TRADITIONAL PRACTITIONER J
OTHER (SPECIFY) ____ X

535) CHECK 534:

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

536) Where did you first seek advice or treatment? USE LETTER CODE FROM 524.

FIRST PLACE ____

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

YES 1
NO 2 (GO TO 552)
DON'T KNOW 8 (GO TO 552)

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

ANTIMALARIAL DRUGS A
ANTIBIOTIC DRUGS
PILL/SYRUP B
INJECTION C
OTHER DRUGS
ASPIRIN D
ACETAMINOPHEN E
IBUPROFEN F
OTHER (SPECIFY)____ X
DON'T KNOW Z

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 2008 OR LATER LIVING WITH THE RESPONDENT

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

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

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

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

NO CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID
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 oral rehydration package or oral rehydration solution, 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 THE RESPONDENT

ONE OR MORE: RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE WITH 558 (NAME) ____
NONE (GO TO 561A)

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):

Plain water?
YES 1
NO 2
DON'T KNOW 8
Juice or juice drinks?
YES 1
NO 2
DON'T KNOW 8
Clear broth?
YES 1
NO 2
DON'T KNOW 8
Milk such as tinned, powdered, or fresh animal milk? IF YES: How many times did (NAME) drink milk? IF 7 OR MORE TIMES, RECORD '7'.
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES DRANK MILK ____
Infant formula? IF YES: How many times did (NAME) drink infant formula? IF 7 OR MORE TIMES, RECORD '7'.
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES DRANK FORMULA____
Coffee/tea? IF YES: How many times did (NAME) drink coffee or tea? IF 7 OR MORE TIMES, RECORD '7'.
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES DRANK COFFEE/TEA____
Any other liquids?
YES 1
NO 2
DON'T KNOW 8
Yogurt? IF YES: How many times did (NAME) eat yogurt? IF 7 OR MORE TIMES, RECORD '7'.
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES ATE YOGURT____
Any (BRAND NAME OF COMMERCIALLY FORTIFIED BABY FOOD, E.G., Cerelac)?
YES 1
NO 2
DON'T KNOW 8
Bread, rice, noodles, porridge, or other foods made from grains?
YES 1
NO 2
DON'T KNOW 8
Pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside?
YES 1
NO 2
DON'T KNOW 8
Potatoes, or any other foods made from roots?
YES 1
NO 2
DON'T KNOW 8
Any dark green, leafy vegetables?
YES 1
NO 2
DON'T KNOW 8
Ripe mangoes, papayas, melons or any fruits that are yellow inside?
YES 1
NO 2
DON'T KNOW 8
Any other fruits or vegetables?
YES 1
NO 2
DON'T KNOW 8
Liver, kidney, heart or other organ meats?
YES 1
NO 2
DON'T KNOW 8
Any meat, such as beef, lamb, goat or chicken?
YES 1
NO 2
DON'T KNOW 8
Eggs?
YES 1
NO 2
DON'T KNOW 8
Fresh or dried fish or shellfish?
YES 1
NO 2
DON'T KNOW 8
Any foods made from beans, peas, lentils, or nuts?
YES 1
NO 2
DON'T KNOW 8
Cheese or other food made from milk?
YES 1
NO 2
DON'T KNOW 8
Any sugary foods, such as chocolate, sweets, honey, pastry, or cookies?
YES 1
NO 2
DON'T KNOW 8
Any oil, fats or butter?
YES 1
NO 2
DON'T KNOW 8
Any other solid, semi-solid, or soft food?
YES 1
NO 2
DON'T KNOW 8

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

NOT A SINGLE "YES"
AT LEAST ONE "YES" OR "DON'T KNOW" (GO TO 561)

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

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

561) How many times did (NAME FROM 557) eat solid, 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

561A) Now I would like to ask you about liquids or foods that you had yesterday during the day or at night. I am interested in whether you had the item I mention even if it was combined with other foods. Please don't mention spices such as hot pepper and herbs that are used in small amounts to improve food flavor, I will ask you specifically on this topic. Yesterday during the day or at night, did you drink/eat:

Milk such as tinned, powdered, or fresh animal milk?
YES 1
NO 2
Bread, rice, noodles, porridge, or other foods made from grains?
YES 1
NO 2
Pumpkin, carrots, squash or sweet potatoes?
YES 1
NO 2
Potatoes, or any other foods made from roots?
YES 1
NO 2
Any dark green, leafy vegetables?
YES 1
NO 2
Liver, kidney, heart or other organ meats?
YES 1
NO 2
Any meat, such as beef, lamb, goat or chicken?
YES 1
NO 2
Eggs?
YES 1
NO 2
Fresh, canned or dried fish or shellfish?
YES 1
NO 2
Beans, peas, lentils, or nuts?
YES 1
NO 2
Cheese, yogurt, milk or any food made from milk?
YES 1
NO 2
Oils, fats or butter or any food made from milk?
YES 1
NO 2
Any sugary foods, such as chocolate, sweets, honey, pastry, cookies?
YES 1
NO 2
Spices for flavor, such as pepper and spices and herbs or fish meal?
YES 1
NO 2
Coffee or tea? IF YES: How many times did you drink coffee or tea? IF 7 OR MORE TIMES, RECORD '7'.
YES 1
NO 2
NUMBER OF TIMES DRINK COFFEE OR TEA____
IF YES: When do you drink coffee or tea?
BEFORE MEALS A
DURING MEALS B
AFTER MEALS C

SECTION 7. FERTILITY PREFERENCES

701) CHECK 304:

NEITHER STERILIZED
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)
DON'T KNOW/UNDECIDED 8 (GO TO 711)

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

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

705) CHECK 226:

NOT PREGNANT OR UNSURE: How long would you like to wait from now before the birth of (a/another) child?
MONTHS 1 ____
YEARS 2 ____
SOON/NOW 993 (GO TO 710)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 712)
OTHER (SPECIFY) ____ 996 (GO TO 710)
DON'T KNOW 998 (GO TO 710)
PREGNANT: After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?
MONTHS 1 ____
YEARS 2 ____
SOON/NOW 993 (GO TO 710)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 712)
OTHER (SPECIFY) ____ 996 (GO TO 710)
DON'T KNOW 998 (GO TO 710)

706) CHECK 226:

NOT PREGNANT OR UNSURE
PREGNANT (GO TO 711)

707) CHECK 303: USING A CONTRACEPTIVE METHOD

NOT CURRENTLY USING
CURRENTLY USING (GO TO 712)

708) CHECK 705:

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

709) CHECK 703 AND 704:

WANTS TO HAVE A/ANOTHER CHILD: You have said that you do not want (a/another) child soon. But you don't use any method to avoid pregnancy. Can you tell me why you are not using a method to prevent pregnancy? Any other reason? RECORD ALL REASONS MENTIONED.
NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX WITH HUSBAND B
INFREQUENT SEX WITH HUSBAND C
MENOPAUSAL/HYSTERECTOMY D
CAN'T GET PREGNANT E
NOT MENSTRUATED SINCE LAST BIRTH F
BREASTFEEDING G
UP TO GOD/FATALISTIC H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND OPPOSED J
OTHER OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
SIDE EFFECTS/HEALTH CONCERNS O
LACK OF ACCESS/TOO FAR P
COSTS TOO MUCH Q
PREFERRED METHOD NOT AVAILABLE R
NO METHOD AVAILABLE S
INCONVENIENT TO USE T
INTERFERES WITH BODY'S NORMAL PROCESSES U
OTHER (SPECIFY) ____ X
DON'T KNOW Z

710) CHECK 303: USING A CONTRACEPTIVE METHOD

NOT ASKED
NOT CURRENTLY USING
CURRENTLY USING (712)

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

YES 1
NO 2
DON'T KNOW 8

712) CHECK 216:

HAS LIVING CHILDREN: If you could go back to the time you did not have any children and could choose (exactly) the number of children to have in your whole life, how many would that be? FOR NON-NUMERIC RESPONSE PROBE FOR A NUMERIC RESPONSE.
NONE 00 (GO TO 714)
NUMBER ____
OTHER (SPECIFY) ____ 96 (GO TO 714)
NO LIVING CHILDREN: If you could choose exactly the number of children to have in your whole life, how many would that be? FOR NON-NUMERIC RESPONSE 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 BOYS ____
NUMBER GIRLS ____
NUMBER EITHER ____
OTHER (SPECIFY) ____ 96

714) In the last few months have you:

Heard about family planning on the radio?
YES 1
NO 2
Seen anything about family planning on the radio?
YES 1
NO 2
Read about family planning in a newspaper or magazine?
YES 1
NO 2
Heard about family planning from a health facility?
YES 1
NO 2
Heard about family planning at women's meeting?
YES 1
NO 2

716) CHECK 112A:

CURRENTLY MARRIED
WIDOWED/DIVORCED (GO TO 801)

717) CHECK 303: USING A CONTRACEPTIVE METHOD

CURRENTLY USING
NOT CURRENTLY USING (GO TO 720)

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

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

719) CHECK IN 304:

NEITHER STERILIZED
HE OR SHE STERILIZED (801)

720) 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
DON'T KNOW 8

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

801) CHECK 112A:

CURRENTLY MARRIED
NOT CURRENTLY MARRIED (WINDOWED/DIVORCED) (GO TO 803)

801A) Is your husband living with you now or is he staying elsewhere?

LIVING WITH HER 1
STAYING ELSEWHERE 2

801B) RECORD THE HUSBAND'S NAME LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE, IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.

NAME____
LINE NUMBER____

801C) Does your husband have other wives?

YES 1
NO 2 (GO TO 802)
DON'T KNOW 8 (GO TO 802)

801D) Including yourself, in total, how many wives does he have?

TOTAL NUMBER OF WIVES____
DON'T KNOW 8

801E) Are you the first, second, … wife?

RANK____

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

AGE IN COMPLETED YEARS____

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

YES 1
NO 2 (GO TO 806)

804) What was the highest level of school he attended: primary, fundamental (preparatory, unified), diploma before secondary, secondary, diploma after secondary, or university/higher?

PRIMARY 1
FUNDAMENTAL (PREPARATORY, UNIFIED) 2
DIPLOMA BEFORE SECONDARY 3
SECONDARY 4
DIPLOMA AFTER SECONDARY 5
UNIVERSITY/HIGHER 6
DON'T KNOW 8 (GO TO 806)

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

GRADE/YEAR____
DON'T KNOW 98

806) CHECK 801:

CURRENTLY MARRIED: What is your husband's occupation? That is, what kind of work does he mainly do?
OCCUPATION_____
FORMERLY MARRIED: What was your last husband'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 have a small business or work on the family farm or in the family business. In the last seven days, have you done any of these things or any other work?

YES 1 (GO TO 811)
NO 2

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

YES 1 (GO TO 811)
NO 2

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

YES 1
NO 2 (GO TO 815)

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

OCCUPATION ____

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

FOR FAMILY MEMBER 1
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3
OTHER (SPECIFY) ____ 6

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

THROUGHOUT THE YEAR 1
SEASONALLY 2
ONCE IN A WHILE 3

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

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

815) CHECK 112A:

CURRENTLY MARRIED
NOT CURRENTLY MARRIED (WIDOWED/DIVORCED) (GO TO 901)

816) CHECK 814:

CODE 1 OR 2 CIRCLED
OTHER (GO TO 819)

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

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

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

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

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

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

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

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) ____ 6

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

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ESE 4
OTHER (SPECIFY) ____ 6

SECTION 9. HIV/AIDS

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

YES 1
NO 2 (GO TO 937)

902) From your point of view, how AIDS is transmitted:

Blood transfusion?
YES 1
NO 2
DON'T KNOW 8
Mosquito bites?
YES 1
NO 2
DON'T KNOW 8
Sexual intercourse with an infected husband?
YES 1
NO 2
DON'T KNOW 8
Contaminated sharp instruments?
YES 1
NO 2
DON'T KNOW 8
Swimming with an infected person?
YES 1
NO 2
DON'T KNOW 8
Sharing food with a person who has AIDS?
YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

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

909) CHECK 907:

AT LEAST ONE 'YES'
OTHER (GO TO 930)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 932)

931) Where is that? Any other place? PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF THE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S))____
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
PRIMARY HEALTH CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
PRIVATE SECTOR
(PRIVATE HOSPITAL/CLINIC/DISPENSARY/DOCTOR'S OFFICE) F
NON GOVERNMENT ORGANIZATIONS
(HOSPITAL/CLINIC/DISPENSARY/PRIVATE DOCTOR'S OFFICE, MOBILE CLINIC) G
OTHER (SPECIFY) ____ X

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

YES 1
NO 2
DON'T KNOW 8

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

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

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

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

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

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

937) CHECK 901:

HEARD ABOUT AIDS: Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?
YES 1
NO 2
NOT HEARD ABOUT AIDS: Have you heard about infections that can be transmitted through sexual contact?
YES 1
NO 2

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

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

941) Sometimes women experience a bad-smelling abnormal genital discharge. During the last 12 months, have you had a bad-smelling abnormal genital discharge?

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

942) Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

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

943) CHECK 940, 941, AND 942:

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

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

YES 1
NO 2

945) Where did you go? Any other place? PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF THE SECTOR, WRITE THE NAME OF THE PLACE

(NAME OF PLACE(S))____
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
PRIMARY HEALTH CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
PRIVATE SECTOR
(PRIVATE HOSPITAL/CLINIC/DISPENSARY/DOCTOR'S OFFICE) F
NON GOVERNMENT ORGANIZATIONS
(HOSPITAL/CLINIC/DISPENSARY/PRIVATE DOCTOR'S OFFICE/MOBILE CLINIC) G
OTHER (SPECIFY) ____ X

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

YES 1
NO 2
DON'T KNOW 8

SECTION 10. OTHER HEALTH ISSUES

1001) Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months? IF YES: How many injections have you had? IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ____
NONE 00 (GO TO 1008)

1002) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker? IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ____
NONE 00 (GO TO 1008)

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

YES 1
NO 2
DON'T KNOW 8

1008) Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem or not?

Getting permission to go to the doctor?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Getting money needed for advice or treatment?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
The distance to the health facility?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
No female provider at facility?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Not wanting to go alone?
BIG PROBLEM 1
NOT A BIG PROBLEM 2

1009) Are you covered by any health insurance?

YES 1
NO 2 (GO TO 1011)

1010) What type of health insurance are you covered by? PROBE: Any other health insurance? RECORD ALL MENTIONED.

MUTUAL HEALTH ORGANIZATION/COMMUNITY-BASED HEALTH INSURANCE A
HEALTH INSURANCE THROUGH EMPLOYER B
SOCIAL SECURITY C
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D
OTHER (SPECIFY) ____ X

1011) FISTULA: This series of questions is designed to obtain information on another health problem that affects women. Difficult vaginal delivery can lead to urine and fecal incontinence. This problem usually occurs after a difficult childbirth, but may also be the result of rape or pelvic surgery. Women with this problem are often subject o social discrimination. The following questions relate to women's knowledge of the problem and the reasons for the treatment.
Have you ever heard of this problem of which the woman experiences a constant leakage of urine or stool from the vagina during the day and night?

YES 1
NO 2 (GO TO 1012A)

1012) Do you suffer or did you suffer from this problem?

YES 1
NO 2 (GO TO 1018)
DON'T KNOW 8 (GO TO 1018)

1012A) Sometimes some ladies suffer from the constant leakage of urine or stool from your vagina during the day and night as a result of a difficult birth or surgery and this is called fistula. Do you suffer or did you suffer from this problem?

YES 1
NO 2 (GO O 1018)
DON'T KNOW 8 (GO TO 1018)

1013) Did this problem start after a normal delivery, a caesarean delivery, or after an operation or after anything else?

AFTER NATURAL BIRTH 1
AFTER CAESAREAN BIRTH 2
AFTER AN OPERATION 3
OTHER (SPECIFY) ____ 6

1014) Have you sought treatment for this condition?

YES 1
NO 2

1015) Why have you not sought treatment?

DO NOT KNOW WHERE TO GO 1 (GO TO 1018)
TOO EXPENSIVE 2 (GO TO 1018)
TOO FAR 3 (GO TO 1018)
EMBARRASSMENT 4 (GO TO 1018)
POOR QUALITY OF CARE 5 (GO TO 1018)
OTHER (SPECIFY)____ 6 (GO TO 1018)

1016) From whom did you last seek treatment?

DOCTOR 1
NURSE/MIDWIFE 2
OTHER (SPECIFY) ____ 6

1017) Did your health improve after treatment?

FULLY RECUPERATED 1
PARTIALLY RECUPERATED 2
NO. DIDN'T IMPROVE 3

1018) Did you get any type of tumors?

YES 1
NO 2 (GO TO 1101)

1019) When did you find out that you had a tumor?
RECORD THE YEAR AND THE MONTH IF DON'T KNOW MONTH CIRCLE 98

MONTH____
DON'T KNOW MONTH 98
YEAR____

1020) Who discovered your tumor?

DOCTOR 1
NURSE/MIDWIFE 2
OTHER (SPECIFY)____ 6

1021) In what part of your body did the tumor develop? RECORD IN WHICH PART OF THE BODY THE TUMOR EXIST.

PART OF BODY____

1022) Have you sought treatment for this condition?

YES 1 (GO TO 1024)
NO 2

1023) Why have you not sought treatment?

DO NOT KNOW WHERE TO GO A
TOO EXPENSIVE B
TOO FAR C
OTHER (SPECIFY)____ X

1024) Did you have a biopsy or an ultrasound done to determine the type of tumor?

YES 1
NO 2 (GO TO 1026)

1025) What was the result of the biopsy or the ultrasound?

BENIGN TUMOR 1
MALIGNANT TUMOR 2
OTHER (SPECIFY)____ 6

1026) Do you currently receive or did you receive in the past treatment for the malignant tumor (CANCER)?

YES CURRENTLY 1
YES IN THE PAST 2
NO 3
OTHER (SPECIFY)____ 6

SECTION 11: FEMALE CIRCUMCISION

1101) Have you ever heard of female circumcision?

YES 1 (GO TO 1103)
NO 2

1102) In some countries, there is a practice in which a girl may have part of her genitals cut. Have you ever heard about this practice?

YES 1
NO 2 (GO TO 1201)

1103) Have you yourself ever been circumcised?

YES 1
NO 2 (GO TO 1109)

1104) Was any flesh removed from your genital area?

YES 1
NO 2
DON'T KNOW 8

1107) How old were you when you were circumcised? IF THE RESPONDENT DOES NOT KNOW THE EXACT AGE, PROVE TO GET AN ESTIMATE

AGE IN COMPLETED YEARS____
DURING FIRST WEEK AFTER BIRTH 93
AFTER FIRST WEEK AND BEFORE FIRST YEAR AFTER BIRTH 94
DON'T KNOW 98

1108) Who performed the circumcision?

TRADITIONAL
TRADITIONAL 'CIRCUMCISER' 11
TRADITIONAL BIRTH ATTENDANT 12
HEALTH PROFESSIONAL
DOCTOR 21
NURSE/TRAINED MIDWIFE 22
OTHER (SPECIFY)____ 96
DON'T KNOW 98

1109) CHECK 213 AND 216:

HAS AT LEAST ONE LIVING DAUGHTER
HAS NO LIVING DAUGHTER (GO TO 1120)

1110) Have any of your daughters been circumcised? IF YES: How many?

NUMBER CIRCUMCISED____
NO DAUGHTER CIRCUMCISED 95 (GO TO 1118)

1111) Which of your daughters was circumcised most recently? INTERVIEWER: CHECK 212 AND RECORD THE LINE NUMBER FOR THE DAUGHTER

(DAUGHTER'S NAME)____
DAUGHTER'S LINE NUMBER FROM Q. 212____

1112) Now I would like to ask you what was done to (NAME OF THE DAUGHTER FROM Q. 1111).

1113) Was any flesh removed from the genital area?

YES 1
NO 2
DON'T KNOW 8

1115) How old was (NAME OF THE DAUGHTER FROM Q. 1111) when the circumcision was done? IF THE RESPONDENT DOES NOT KNOW THE AGE, PROBE TO GET AN ESTIMATE.

AGE IN COMPLETED YEARS____
DURING FIRST WEEK AFTER BIRTH 93
AFTER FIRST WEEK AND BEFORE FIRST YEAR AFTER BIRTH 94
DON'T KNOW 98

1116) Who performed the circumcision?

TRADITIONAL
TRADITIONAL 'CIRCUMCISER' 11
TRADITIONAL BIRTH ATTENDANT 12
OTHER TRADITIONAL (SPECIFY)____ 16
HEALTH PROFESSIONAL
DOCTOR 21
NURSE/TRAINED MIDWIFE 22
OTHER HEALTH PROFESSIONAL (SPECIFY)____ 26
DON'T KNOW 98

1117) Do you have any daughter who is not circumcised?

YES 1
NO 2 (GO TO 1120)
DON'T KNOW (GO TO 1120)

1118) Do you intend to have any of your daughters circumcised in the future?

YES 1
NO 2 (GO TO 1120)
DON'T KNOW 8 (GO TO 1120)

1119) Why do you intend to have any of your daughters circumcised? PROBE: Any other reasons? RECORD ALL MENTIONED.

CLEANLINESS/HYGIENE A
SOCIAL ACCEPTANCE B
BETTER MARRIAGE PROSPECTS C
PRESERVE VIRGINITY/PREVENT PREMARITAL SEX D
MORE SEXUAL PLEASURE FOR THE MAN E
RELIGIOUS APPROVAL F
OTHER (SPECIFY)____ X
NO REASON Y

1120) Do you believe that this practice is required by your religion?

YES 1
NO 2
DON'T KNOW 8

1121) Do you think that this practice should be continued, or should it be stopped?

CONTINUED (GO TO 1201)
STOPPED 2
DEPENDS 3 (GO TO 1201)
DON'T KNOW 8 (GO TO 1201)

1122) Why do you think this practice should be stopped? PROBE: Any other reasons? RECORD ALL MENTIONED.

BAD TRADITIONAL PRACTICE A
AGAINST RELIGION B
CAUSES SERIOUS MEDICAL COMPLICATION C
PAINFUL PERSONAL EXPERIENCE D
AGAISNT WOMAN'S DIGNITY E
OTHER (SPECIFY)____ X
DON'T KNOW Z

SECTION 12. OPINIONS ON DOMESTIC VIOLENCE

1201) What is your understanding of domestic violence, does that mean:

1 Physical abuse?
YES 1
NO 2
DON'T KNOW 8
2 No participation in decision-making for household?
YES 1
NO 2
DON'T KNOW 8
3 No participation in decision-making for children
YES 1
NO 2
DON'T KNOW 8
4 Better treatment of males than females?
YES 1
NO 2
DON'T KNOW 8
5 Failing to meet basic living costs?
YES 1
NO 2
DON'T KNOW 8
6 Denial of education?
YES 1
NO 2
DON'T KNOW 8
7 Forced marriage?
YES 1
NO 2
DON'T KNOW 8
8 Rape?
YES 1
NO 2
DON'T KNOW 8
9 Sexual harassment?
YES 1
NO 2
DON'T KNOW 8
10 Other (SPECIFY)
YES (SPECIFY)____ 1
NO 2

1202) Who are the people who commit the most violent acts against women?

FATHER 01
MOTHER 02
HUSBANDS 03
SISTER/BROTHER 04
DAUGHTER/SON 05
EMPLOYER 06
SOMEONE AT WORK 07
OTHER (SPECIFY) ____ 96

1203) What is the place with the most violent acts?

AT HOME 01
WORKPLACE 02
STREET 03
SCHOOL 04
OTHER (SPECIFY)____ 96

1204) Does any form of violence cause damage?

YES 1
NO 2 (GO TO 1206)

1205) What is the most serious damage caused by violence?

HEALTH DAMAGE 1
PSYCHOLOGICAL DAMAGE 2
ECONOMIC DAMAGE 3
EDUCATIONAL DAMAGE 4
SOCIAL DAMAGE 5
OTHER (SPECIFY)____ 6

1206) In your opinion, is a husband justified in hitting or beating his wife in the following situations:

1 If she goes out without telling him?
YES 1
NO 2
DON'T KNOW 8
2 If she neglects the children?
YES 1
NO 2
DON'T KNOW 8
3 If she argues with him?
YES 1
NO 2
DON'T KNOW 8
4 If she refuses to have sex with him?
YES 1
NO 2
DON'T KNOW 8
5 If she burns the food?
YES 1
NO 2
DON'T KNOW 8

1207) RECORD THE TIME.

HOUR____
MINUTES____

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT: ____

COMMENTS ON SPECIFIC QUESTIONS: ____

ANY OTHER COMMENTS: ____

SUPERVISOR'S OBSERVATIONS

NAME OF SUPERVISOR: ____

DATE: ____

EDITOR'S OBSERVATIONS

NAME OF EDITOR: ____

DATE: ____