IDENTIFICATION
PROVINCE
DISTRICT
EA NUMBER
EA TYPE
SADHS CLUSTER NUMBER
HOUSEHOLD NUMBER
NAME AND LINE NUMBER OF WOMAN
NAME OF HOUSEHOLD HEAD

INTERVIEWER VISITS
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT*

SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT*

THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT*

NEXT VISIT
DATE
TIME

FINAL VISIT
DAY
MONTH
YEAR
INTERVIEWER'S NAME
RESULT

*RESULT CODES:

LANGUAGE
LANGUAGE OF QUESTIONNAIRE

LANGUAGE OF INTERVIEW

HOME LANGUAGE OF RESPONDENT

TRANSLATOR USED

LANGUAGE CODES

SUPERVISOR
NAME
DATE

FIELD EDITOR
NAME
DATE

OFFICE EDITOR

KEYED BY

SECTION 1. RESPONDENT'S BACKGROUND

101 RECORD THE TIME.

102 First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in a city, in a large town, on a farm or in rural areas?

103 How long have you been living continuously in (NAME OF CURRENTPLACE OF RESIDENCE)?
IF LESS THAN 1 YEAR, WRITE '00'

104 Just before you moved here, did you live in a city, in a town, or in the rural area /farm?

105 In what month and year were you born?

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

107 Have you ever attended school?

109 What is the highest (standard/year) you completed?

110 CHECK 106:

111 Are you currently attending school?

112 What was the main reason you stopped attending school?

114 Can you read and understand a letter or newspaper in your home language easily, with difficulty, or not at all?

115 Have you read a newspaper or magazine in the last week?

116 Do you usually listen to a radio every day?

117 Do you usually watch television at least once a week?

119 Which race group do you consider yourself?

120 CHECK Q.4 IN THE HOUSEHOLD QUESTIONNAIRE

121 Now I would like to ask about the place in which you usually live.
What is the name of the place in which you usually live?

Is that a large city, town, or rural area /farm?

122 In which PROVINCE is that located?

123 Now I would like to ask about the household in which you usually live.
What is the main source of drinking water for members of your household?

125 What kind of toilet facility does your household have?

126 Does your household have:
Electricity?
A radio?
A television?
A telephone?
A refrigerator?
A personal computer (PC)?
A washing machine?

127 Could you describe the main material of the walls of your home?

SECTION 2. REPRODUCTION

Now I would like to ask you about all the pregnancies that you have had in your lifetime. By this I mean all the children born to you, whether they were born alive or dead, whether still living or not, whether living with you or elsewhere, and all the pregnancies that you have had that did not result in a live birth. I understand that it is not easy to talk about children who have died, or pregnancies that have terminated before full term, but it is extremely important that you tell us about all of them, so that we can develop programs that will help the Government of South Africa improve children's health in the future.

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

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

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

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

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

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 survived only a few hours or days?

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

208 Women sometimes have pregnancies that do not result in a live born child. That is, a pregnancy can end very early, in a miscarriage or an abortion or the child can be born dead. Have you had any such pregnancy that did not result in a live birth?

209 In all, how many such pregnancies have there been?

210 SUM ANSWERS TO 203, 205, 207 AND 209, AND ENTER TOTAL.
IF NONE, RECORD '00'.

211 CHECK 210:

213 Now I would like to ask you about all of your pregnancies, whether born alive, born dead, or lost before full term, starting with the first one you had.
RECORD ALL THE PREGNANCIES. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

214 Think back to the time of your (first/next) pregnancy.

215 Was that a single or multiple pregnancy?

216 Was the baby born alive, born dead, or lost before full term?

217 Did that baby cry, move, or breathe when it was born?

218 What was the name given to that child?

219 Is (NAME) a boy or a girl?

220 In what month and year was (NAME) born?
PROBE: What is his/her birthday? OR: In what season was he/she born?

221 Is (NAME) still alive?

IF BORN ALIVE AND STILL LIVING:

222 How old was (NAME) at his/her last birthday?
RECORD AGE IN COMPLETED YEARS.

223 Is (NAME) living with you?

IF BORN ALIVE BUT NOW DEAD:
224 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.

IF BORN ALIVE BUT NOW DEAD:
224A Did (NAME) die from diarrhea?

IF BORN DEAD OR LOST BEFORE FULL TERM:
225. In what year and month did this pregnancy end?

226 How many months did the pregnancy last?

228 FROM YEAR OF THIS PREGNANCY SUBTRACT YEAR OF PREVIOUS PREGNANCY. IS THE DIFFERENCE 2 OR MORE YEARS?

229 Were there any other pregnancies between the previous pregnancy mentioned and this pregnancy?

230 FROM YEAR OF INTERVIEW SUBTRACT YEAR OF LAST PREGNANCY.
IS THE DIFFERENCE 2 YEARS OR MORE?

231 Have you had any pregnancies since the last pregnancy mentioned?

232 COMPARE 210 WITH NUMBER OF PREGNANCIES IN HISTORY ABOVE AND MARK:

.
233 CHECK 220 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1993. IF NONE, RECORD '0'.

234 Are you pregnant now?

235 How many months pregnant are you?

236 At the time you became pregnant, did you want to become pregnant then, did you want to wait until later, or did you not want to have any more children at all?

237 When did your last menstrual period start?

238 Do you have any of the following problems:
Wet yourself when you cough, sneeze or lift heavy weights?
Are you constantly wet?
Are you constantly soiled?

SECTION 3. CONTRACEPTION

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.
CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY.
THEN PROCEED DOWN COLUMN 302, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED.
THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 301 OR 302, ASK 303.

301 Which ways or methods have you heard about?

302 Have you ever heard (METHOD)?

303 Have you ever used of (METHOD)?

304 CHECK 303:

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

307 What have you used or done?
CORRECT 303 AND 304 (AND 302 IF NECESSARY).

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

309 How many living children did you have at that time, if any?
IF NONE, RECORD '00'.

309A How old were you when you first used something to avoid getting pregnant?

309B From whom did you first get information about methods to avoid pregnancy?

309C CHECK 309A:

309E Did your parent(s) or guardian give advice on contraceptives or explain how to use them?

311 CHECK 303:

312 CHECK 234:

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

314 Which method are you using?
314A CIRCLE '06' FOR FEMALE STERILIZATION.

318 Where did the sterilization take place?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

319 Do you regret that (you/your partner) had the operation not to have any (more) children?

320 Why do you regret the operation?

321 In what month and year was the sterilization performed?

323 How do you determine which days of your monthly cycle not to have sexual relations?

328 Where did you obtain (METHOD) the last time?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFYTHE TYPE OF SOURCE AND CIRCLE THE APPROPRIATECODE.

330 Do you agree with the following statements about the family planning service you use?

330A People select the place where they get family planning services for various reasons.
What were the reasons you went to (NAME OF PLACE IN Q.328) instead of some other place you know about?
RECORD ALL RESPONSES AND CIRCLE CODES.
What is the Main Reason?

330B Over the last 12 months have you had a break in your contraceptive use for any reason?

330C Over the last 12 months, why have you had a break in your contraceptive use?

331 What are the main reasons you are not using a method of contraception to avoid pregnancy?
RECORD ALL MENTIONED
What is the Main Reason?

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

333 Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

335 Have you visited any type of health facility for any reason in the last 12 months?

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

337 During which times of the monthly cycle does a woman have the greatest chance of becoming pregnant?

338 I would like to ask you a question about the law on abortion in South Africa. Does the present law allow a woman in early pregnancy, which is up to 12 weeks, to have an abortion?

SECTION 4A. PREGNANCY AND CHILD HEALTH

401 CHECK 233:

402 ENTER THE NAME, LINE NUMBER, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1993 IN THE TABLE.
ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 2 BIRTHS, USE ADDITIONAL QUESTIONNAIRES).
Now I would like to ask you some questions about your pregnancies and the health of all your children born in the last five years.
(We will talk about one child at a time.)

403 LINE NUMBER FROM Q214

404 FROM Q218 AND Q221

405 At the time you became pregnant with (NAME), did you want to become pregnant then, did you want to wait until later, or did you want no (more) children at all?

406 How much longer would you like to have waited?

407 When you were pregnant with (NAME), did you go for antenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.

407A Where did you go the majority of times?
PROBE FOR THE ONE PLACE VISITED MOST OFTEN

408 How many months pregnant were you when you first received antenatal care?

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

410 When you were pregnant with (NAME) were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?

412 Where did you give birth to (NAME)?

413 Who assisted with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.

415 Was (NAME) delivered by caesarian section?

417 Was (NAME) weighed at birth?

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

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

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

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

422 CHECK 234:
RESPONDENT PREGNANT?

423 Have you resumed sexual relations since the birth of (NAME)?

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

425 Did you ever breastfeed (NAME)?

426 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.

427 CHECK 404: CHILD ALIVE?

428 Are you still breastfeeding (NAME)?

429 For how many months did you breastfeed (NAME)?

430 Why did you stop breastfeeding (NAME)?

431 CHECK 404: CHILD ALIVE?

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

433 How many times did you breastfeed yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC PROBE FOR APPROXIMATE NUMBER.

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

435 At any time yesterday or last night, was (NAME) given any of the following:
Plain water?
Sugar water/Juice
Herbal tea/Rooibos?
Baby formula?
Any kind of milk?
Any other liquid?
Any food made from [MAIZE or RICE or WHEAT], such as PORRIDGE or BREAD
Eggs, fish or poultry?
Meat?
Fruits or vegetables?
Any other solid or semi-solid foods?

436 CHECK 435:
FOOD OR LIQUID GIVEN YESTERDAY?

437 (Aside from breast-feeding,) how many times did (NAME) eat yesterday, including both meals and snacks?
IF 7 OR MORE TIMES, RECORD '7'.

439 GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 440.

SECTION 4B: IMMUNIZATION AND HEALTH

440 ENTER THE NAME, LINE NUMBER, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1993 IN THE TABLE.
ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 2 BIRTHS, USE ADDITIONAL QUESTIONNAIRES).

441 LINE NUMBER FROM Q214

442 FROM Q218 AND Q221

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

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

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

446 Did (NAME) receive any vaccinations that are not recorded on this card?
RECORD 'YES' ONLY IF RESPONDENT MENTIONES BCG, POLIO 0-3, DPT 1-3, AND/OR MEASLES VACCINE(S).

447 Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases?

448 Please tell me if (NAME) received any of the following vaccinations:
448A A BCG vaccination against tuberculosis, that is, an injection in the left arm or shoulder that caused a scar?

448B Polio vaccine, that is, drops in the mouth?

448C How many times?

448D When was the first polio vaccine given, just after birth or later?

448E DPT vaccination, that is, an injection usually given at the same time as polio drops?

448F How many times?

448G An injection to prevent measles?

448H An injection to prevent hepatitis?

448I How many times?

450 Has (NAME) been ill or feverish with a cough at any time in the last 2 weeks?

451 When (NAME) was ill with a cough, did he/she breathe with difficulty or faster than usual with short, fast breaths?

452 Did you seek advice or treatment for the illness?

453 Where did you seek advice or treatment? Anywhere else?
RECORD ALL MENTIONED.

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

455 Was there any blood in the stools?

456 On the worst day of the diarrhea, how many bowel movements did (NAME) have?

457 Was he/she given the same amount to drink as before the diarrhea, or more, or less?

458 Was he/she given the same amount of food to eat as before the diarrhea, or more, or less?

459 When (NAME) had diarrhea, was he/she given any of the following to drink:
A fluid, made from a special rehydration packet?
Thin watery porridge?
Soup?
Home-made sugar-salt-water solution?
Milk or infant formula?
Yoghurt-based drink?
Black Tea?
Water?
Coke?
Any other liquid?

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

461 What was given to treat the diarrhea? Anything else?
RECORD ALL MENTIONED.

462 Did you seek advice or treatment for the diarrhea?

463 Where did you seek advice or treatment? Anywhere else?
RECORD ALL MENTIONED.

464 GO BACK TO 442 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 465.

465 Now I am going to ask you some general questions about caring for children with diarrhea and cough.
When a child has diarrhea, should he/she be given less to drink than usual, about the same amount, or more than usual?

466 When a child has diarrhea, should he/she be given less to eat than usual, about the same amount, or more than usual?

467 When a child is sick with diarrhea, what signs of illness would tell you that he or she should be taken to a health facility or health worker?
RECORD ALL MENTIONED. DO NOT PROBE

468 CHECK 459, ALL COLUMNS:

469 Have you ever heard of a special product called ORSOL OR SOROL that you can get for the treatment of diarrhea?

470 When a child is sick with a cough, what signs of illness would tell you that he or she should be taken to a health facility or health worker?
RECORD ALL MENTIONED.

SECTION 5. MARITAL AND SEXUAL RELATIONS

501 I PRESENCE OF OTHERS AT THIS POINT.

Now I am going to ask you some sensitive questions about your marital and sexual relations. All information you give me is completely confidential.

502 Are you currently married or living with a man?

503 Do you currently have a regular sexual partner, an occasional sexual partner, or no sexual partner at all?

504 Have you ever been married or lived with a man?

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

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

508 Does your husband have any other wives besides yourself?

509 How many other wives does he have?

511 Have you been married or lived with a man only once, or more than once?

512 CHECK 511:
MARRIED/LIVED WITH A MAN ONLY ONCE
In what month and year did you start living with your husband/partner?

MARRIED/LIVED WITH A MAN MORE THAN ONCE
Now we will talk about your first husband/partner. In what month and year did you start living with him?

513 How old were you when you started living with him?

514 How old were you when you had your first period?

515 Now I need to ask you some questions about sexual activity in order to gain a better understanding of some health and family planning issues.
When was the last time you had sexual intercourse (if ever)?

515A Can you describe your relationship with the person you last had sexual intercourse with?

516 CHECK 301 AND 302:
KNOW CONDOM
The last time you had sex, was a condom used?

DOES NOT KNOWS CONDOM
Some men use a condom, which means that they put a rubber sheath on their penis during sexual intercourse. The last time you had sex, was a condom used?

516A If not, what are the reasons why you didn't use one?
RECORD ALL MENTIONED
What is the Main Reason?

516B In the last 12 months, with how many different men have you had sexual intercourse?

517 Do you know of a place where you can get condoms?

518 Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC,
WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY
THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

519 How old were you when you first had sexual intercourse?

SECTION 6. FERTILITY PREFERENCES

601 CHECK 314:

602 CHECK 234:
NOT PREGNANT OR UNSURE
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?

PREGNANT
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?

603 CHECK 234:
NOT PREGNANT OR UNSURE
How long would you like to wait from now before the birth of (a/another) child?

PREGNANT
After the child you are expecting now, how long would you like to wait before the birth of another child?

604 CHECK 234:

605 If you became pregnant in the next few weeks, would you be happy, unhappy, or would it not matter very much?

606 CHECK 313: USING A METHOD?

607 Do you think you will use a method to delay or avoid pregnancy within the next 12 months?

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

609 Which method would you prefer to use?

610 What is the main reason that you think you will never use a method?

612 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.

614 Would you say that you approve or disapprove of couples using a method to avoid getting pregnant?

615 Is it acceptable or not acceptable to you for information on family planning to be provided:
On the radio?
On the television?

616 In the last few months have you heard about family planning and
sterilization:
On the radio?
On the television?
In a newspaper or magazine?
From a poster?
From leaflets or brochures?

618 In the last few months have you discussed the practice of family planning with your friends, neighbours, or relatives?

619 With whom? Anyone else?
RECORD ALL MENTIONED.

620 CHECK 502:

621 Spouses/partners do not always agree on everything. Now I want to ask you about your husband's/partner's views on family planning.
Do you think that your husband/partner approves or disapproves of couples using a method to avoid pregnancy?

622 How often have you talked to your husband/partner about family planning in the past year?

623 Do you think your husband/partner wants the same number of children that you want, or does he want more or fewer than you want?

624 Who makes the decisions about using methods to avoid pregnancy?

SECTION 7: TREATMENT OF WOMEN IN THE HOUSEHOLD

Now I would like to ask you some difficult questions about how you have been treated in your life by other people.

701 CHECK 502:

702 Within the last year, has your partner/husband regularly not provided money you need for food, rent or bills but has money for other things?

703 Over the last year, has anyone ever kicked, bitten, slapped, hit you with a fist, threaten you with a weapon, such as a knife, a stick, or a gun, or thrown something at you?

704 Have any of your boyfriends or husbands ever kicked, bitten, slapped, hit you with a fist, threaten you with a weapon, such as a knife, a stick, or a gun, or thrown something at you?

705 Can you tell me who has done this to you? Anyone else?
RECORD ALL MENTIONED
PROBE IF NOT MENTIONED

706 Who is the person who did or does beat you most often?

707 Is or was this person always, sometimes or never "on something" (drugs or alcohol) when he/she did this to you?

708 In the past one year, approximately how many times did this happen to you?
IF NONE WRITE '00'

709 Have you ever left a husband/partner because you were being beaten?

710 When you were pregnant, has anyone ever kicked, bitten, slapped, hit you with a fist, threaten you with a weapon, such as a knife, a stick, or a gun, or thrown something at you?

711 In the past year, have you ever been so seriously hurt during a beating that you needed medical attention even if you did not see a doctor?

712 Has anyone ever forced you to have sexual intercourse against your will by threatening, holding you down or hurting you in some way?

713 Has anyone ever persuaded you to have sexual intercourse when you did not want to?

715 Did this happen before you were 15 years old?

716 How old were you when this first happened?

717 Who did this to you?

718 Before you were 15 years old, did any man touch you against your will in a sexual way, such as unwanted touching, kissing, grabbing or fondling?

719 How old were you when this first happened?

720 Who did this to you?

721 Before you were 15 years old, did any man force you to touch his private parts against your will?

722 How old were you when this first happened?

723 Who did this to you?

724 Have you tried to get help from services of any kind because of beatings or other bad treatment?

725 What do or did you use?

726 Would you have liked to have had help from a service that was not available?

727 What service would have been helpful to you?

SECTION 8: AIDS

801 Have you ever heard of an illness called AIDS?

802 How much information about HIV/AIDS did you obtain from each of the following sources:
Answer each question with a lot, some or none
a) TV?
b) Radio?
c) Newspaper?
d) Pamphlets?
e) Health Workers?
f) Friends?
g) Partner(s)?
h) Relatives?

803 I am going to read out some statements about protection against HIV/AIDS. For each statement, please tell me whether you think it is true or not.
People can protect themselves from HIV/AIDS by:
a) having a good diet
b) staying with one faithful partner
c) avoiding public toilets
d) using condoms during sexual intercourse
e) avoiding touching a person who has AIDS
f) avoiding sharing food with a person who has AIDS
g) avoiding being bitten by mosquitos or similar insects
h) making sure any injection they have is done with a clean needle
I) avoid sharing razor blades

804 Do you think that a person infected with the AIDS virus always shows symptoms or can such a person look perfectly healthy?

804A I am going to ask you some questions about the need for people to be informed about their HIV/AIDS status:
a) should people with AIDS be told about their status?
b) should people diagnosed HIV positive be told about their status?
c) should HIV/AIDS patients tell their partner(s) about their status?
d) should the reporting of AIDS status to health authorities be made mandatory by law?
e) should the reporting of HIV status to health authorities be made mandatory by law?

805 Do you personally know someone who has been diagnosed with HIV/AIDS or who has died of AIDS?

805A How much assistance and support do you think AIDS patients receive from each of the following:
Answer the questions with a lot, some or none.
a) employers?
b) co-workers?
c) insurance companies?
d) health workers?
e) friends?
f) partner(s)?
g) relatives?

SECTION 9 - MATERNAL MORTALITY

901 Now I would like to ask some questions about your brothers and sisters, that is, all of the children born to your natural mother, including those who are living with you, those living elsewhere and those who have died.
How many children did your mother give birth to, including you?
NUMBER OF BIRTHS TO NATURAL MOTHER

902 CHECK 901:

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

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

905 Is (NAME) male or female?

906 Is (NAME) still alive?

907 How old is (NAME)?

908 In what year did (NAME) die?

909 How many years ago did (NAME) die?

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

911Was (NAME) pregnant when she died?

912 Did (NAME) die during childbirth?

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

914 Was her death due to complications of pregnancy or childbirth?

915 How many children did (NAME) give birth to during her lifetime?

SECTION 10. HUSBAND'S BACKGROUND, WOMAN'S WORK AND RESIDENCE

1001 CHECK 502 AND 504:

1002 How old was your husband/partner on his last birthday?

1003 Did your (last) husband/partner ever attend school?

1004 What was the highest (standard/year) he completed at school?

1005 Does your husband/partner currently work?

1006 What (is/was) your (last) husband/partner's occupation?
That is, what kind of work (does/did) he mainly do?

1009 Aside from your own housework, are you currently working for money?

1010 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.
Are you currently doing any of these things or any other work?

1011 Have you done any work in the last 12 months?

1012 What is your occupation, that is, what kind of work do you mainly do?

1015 Do you do this work for a family business, are you employed by someone outside the family or are you self-employed?

1016 Do you usually work throughout the year, or do you work seasonally, or only once in a while?

1017 During the last 12 months, how many months did you work?

1018 During the last 12 months, how many days a week did you usually work (in the months that you worked)?

1019 During the last 12 months, approximately how many days did you work?

1020 Do you earn cash for your work?
PROBE: Do you make money for working?

1021 How much do you usually earn for this work?
PROBE: Is this by the day, by the week, or by the month?

1022 CHECK 502:
YES, CURRENTLY MARRIED
YES, LIVING WITH A MAN
Who mainly decides how the money you earn will be used: you, your husband/partner, you and your husband/partner jointly, or someone else?

NOT IN UNION
Who mainly decides how the money you earn will be used: you, someone else, or you and someone else jointly?

1023 Do you usually work at home or away from home?

1024 CHECK 222 AND 223: IS A CHILD LIVING AT HOME WHO IS AGE 5 OR LESS?

1025 Who usually takes care of (NAME OF YOUNGEST CHILD AT HOME) while you are working?

1026 RECORD THE TIME

INTERVIEWERS OBSERVATION

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Comments on Specific Questions: ____________________________________________________________________

Any other comments:

SUPERVISOR'S OBSERVATION
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EDITOR'S OBSERVATIONS
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Date: ______________