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DEMOGRAPHIC AND HEALTH SURVEYS - ZAMBIA 1996 - MEN'S QUESTIONNAIRE

IDENTIFICATION

CLUSTER NUMBER ___

PROVINCE _________________ ___

DISTRICT _____________________ ___

HOUSEHOLD NUMBER ___

NAME OF HOUSEHOLD HEAD _______________ ___

URBAN/RURAL

urban = 1
rural = 2

LUSAKA/OTHER CITY/TOWN/VILLAGE

Lusaka = 1
Other city = 2
Town = 3
Village = 4

NAME AND LINE NUMBER OF MAN _______________ ___

NAME AND LINE NUMBER OF FIRST WIFE _______________ ___

NAME AND LINE NUMBER OF SECOND WIFE _______________ ___

NAME AND LINE NUMBER OF THIRD WIFE _______________ ___

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE ______________
INTERVIEWER'S NAME _______________
RESULT___

RESULT* ______________

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

NEXT VISIT:
DATE ______
TIME _____

FINAL VISIT
DAY ____
MONTH ____
YEAR ___
NAME ___
RESULT ____

TOTAL NO. OF VISITS __

LANGUAGE OF QUESTIONNAIRE

ENGLISH 01

LANGUAGE USED IN INTERVIEW

01 ENGLISH
02 BEMBA
03 KAONDE
04 LOZI
05 LUNDA
06 LUVALE
07 NYANJA
08 TONGA
09 OTHER

RESPONDENT'S LOCAL LANGUAGE

01 ENGLISH
02 BEMBA
03 KAONDE
04 LOZI
05 LUNDA
06 LUVALE
07 NYANJA
08 TONGA
09 OTHER

TRANSLATOR USED

1 = NOT AT ALL
2 = SOMETIME
3 = ALL THE TIME

SUPERVISOR
NAME ________ ___
DATE ________

FIELD EDITOR
NAME ________ ___
DATE ________

OFFICE EDITOR

KEYED BY

SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD THE TIME

HOUR _______
MINUTES _______

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 town, or in a village?

LUSAKA 1
OTHER CITY 2
TOWN 3
VILLAGE 4

103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?

YEARS ___

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

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

LUSAKA 1
OTHER CITY 2
TOWN 3
VILLAGE 4

105. In what month and year were you born?

MONTH ___
DON'T KNOW MONTH 98
YEAR __
DON'T KNOW YEAR 98

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

AGE IN COMPLETED YEARS ___

107. Have you ever attended school?

YES 1
NO 2 (GO TO 111)

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

PRIMARY 1
SECONDARY 2
HIGHER 3

109. How many years did you complete at that level?

COMMENT ____________________
YEARS ___

110. CHECK 108

PRIMARY (GO TO 111)
SECONDARY OR HIGHER (GO TO 112)

111. Can you read and understand a letter or newspaper easily, with difficulty, or not at all?

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 113)

112. How often do you usually read a newspaper or magazine? Would you say every day, every other day, at least once a week, at least once a month, a few times a year, or never?
CIRCLE ONLY ONE ANSWER.

EVERYDAY 1
EVERY OTHER DAY 2
AT LEAST ONCE A WEEK 3
AT LEAST ONCE A MONTH 4
FEW TIMES A YEAR 5
NEVER 6

113. How often do you usually listen to a radio? Would you say every day, every other day, at least once a week, at least once a month, a few times a year, or never?
CIRCLE ONLY ONE ANSWER.

EVERYDAY 1
EVERY OTHER DAY 2
AT LEAST ONCE A WEEK 3
AT LEAST ONCE A MONTH 4
FEW TIMES A YEAR 5
NEVER 6

114. How often do you usually watch television? Would you say every day, every other day, at least once a week, at least once a month, a few times a year, or never?
CIRCLE ONLY ONE ANSWER.

EVERYDAY 1
EVERY OTHER DAY 2
AT LEAST ONCE A WEEK 3
AT LEAST ONCE A MONTH 4
FEW TIMES A YEAR 5
NEVER 6

115. Are you currently working?

YES 1 (GO TO 117)
NO 2

116. Have you done any work in the last 12 months?

YES 1
NO 2 (GO TO 124)

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

OCCUPATION________________________ ___

118. CHECK 117:

WORKS IN AGRICULTURE (GO TO 119)
DOES NOT WORK IN AGRICULTURE (GO TO 120)

119. Do you work mainly on your own land or on family land, or do you rent land, or work on someone else's land?

OWN LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4

120. 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

121. Do you usually work at this job throughout the year, or do you work seasonally, or only once in a while?

THROUGHOUT THE YEAR 1 (GO TO 123)
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3

122. During the last 12 months, how many months did you work at this job?

NUMBER OF MONTHS ____

123. How much do you earn for this work?
PROBE: Is this by the hour, by the day, by the week, by the month or by the year?

PER HOUR 1 ___
PER DAY 2 ___
PER WEEK 3 ___
PER MONTH 4 ___
PER YEAR 5 ___

OTHER (SPECIFY) ______________ 99999996

124. What religion are you?

CATHOLIC 1
PROTESTANT 2
MUSLIM 3
OTHER (SPECIFY) ______________ 4

125. What tribe do you belong to?

TRIBE_______________ ___

SECTION 2. REPRODUCTION

201. Now I would like to ask about your children. I am interested only in your own children. Do not include children you may have adopted or care for as a father but whose real father is someone else. Have you ever had children?

YES 1
NO 2 (GO TO 206)

202. Do you have any sons or daughters 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 are alive but do not live with you? And how many daughters are alive but do not live with you?
IF NONE, RECORD '00'.

SONS ELSEWHERE ____
DAUGHTERS ELSEWHERE _____

206. Have you ever had a son or daughter 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?

YES 1
NO 2 (GO TO 208)

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

BOYS DEAD ______
GIRLS DEAD ______

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

TOTAL ________

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

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

210. CHECK 208:

HAS HAD CHILDREN (GO TO 210A)
HAS NEVER HAD CHILDREN (NONE) (GO TO 301)

210A. In what month and year was your last child born?

MONTH ____
YEAR ____

210B. CHECK 210A, LAST CHILD:

BORN SINCE JANUARY 1991 (GO TO 211)
BEFORE JANUARY 1991 (GO TO 301)

211. When you were expecting your last born child, did you want to have the child then, did you want to wait until later, or did you not want to have any (more) children at all?

THEN 1
LATER 2
NOT AT ALL 3

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. Which ways or methods have you heard about?

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 of (METHOD)?

METHOD 01 PILL Women can take a pill every day.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
METHOD 02 IUCD Women can have a loop or coil placed inside them by a doctor or a nurse.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
METHOD 03 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
METHOD 04 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
METHOD 05 FOAMING TABLETS/JELLY Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
METHOD 06 CONDOM Men can put a rubber sheath on their penis during sexual intercourse.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
METHOD 07 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
METHOD 08 MALE STERILIZATION Men can have an operation to avoid having any more children.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
METHOD 09 NATURAL FAMILY PLANNING Couples can avoid having sexual intercourse on the days of the month when the woman is more likely to become pregnant?
SPONTANEOUS YES 1
PROBED YES 2
NO 3
METHOD 10 WITHDRAWAL Men can be careful and pull out before climax.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
METHOD 11 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
SPONTANEOUS YES 1 (SPECIFY) ____
NO 3

303. Have you ever used (METHOD)?

METHOD 01 PILL Women can take a pill every day.
YES 1
NO, DOES NOT KNOW 2
METHOD 02 IUCD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO, DOES NOT KNOW 2
METHOD 03 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO, DOES NOT KNOW 2
METHOD 04 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.
YES 1
NO, DOES NOT KNOW 2
METHOD 05 FOAMING TABLETS/JELLY Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.
YES 1
NO, DOES NOT KNOW 2
METHOD 06 CONDOM Men can put a rubber sheath on their penis during sexual intercourse.
YES 1
NO, DOES NOT KNOW 2
METHOD 07 FEMALE STERILIZATION Women can have an operation to avoid having any more children: Nave you ever had a partner who had an operation to avoid having children?
YES 1
NO, DOES NOT KNOW 2
METHOD 08 MALE STERILIZATION Men can have an operation to avoid having any more children: Have you ever had an operation to avoid having any more children?
YES 1
NO, DOES NOT KNOW 2
METHOD 09 NATURAL FAMILY PLANNING Couples can avoid having sexual intercourse on the days of the month when the woman is more likely to become pregnant?
YES 1
NO, DOES NOT KNOW 2
METHOD 10 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO, DOES NOT KNOW 2
METHOD 11 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO, DOES NOT KNOW 2

304. CHECK 303:

NOT A SINGLE 'YES' (NEVER USED) (GO TO 305)
AT LEAST ONE 'YES' (EVER USED) (GO TO 307)

305. Have you or any of your partners ever used anything or tried in any way to delay or avoid pregnancy?

YES 1
NO 2 (GO TO 309)

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

307. Are you or your partner doing something or using a method to delay or avoid a pregnancy?

YES 1
NO 2 (GO TO 309)

308. Which method are you using?

PILL 01 (GO TO 401)
IUD 02 (GO TO 401)
INJECTIONS 03 (GO TO 401)
IMPLANTS 04 (GO TO 401)
FOAMING TABLETS/JELLY 05 (GO TO 401)
CONDOM 06 (GO TO 401)
FEMALE STERILIZATION 07 (GO TO 401)
MALE STERILIZATION 08 (GO TO 401)
NATURAL FAMILY PLANNING 09 (GO TO 401)
WITHDRAWAL 10 (GO TO 401)
OTHER (SPECIFY) ____________ 96 (GO TO 401)

309. What is the main reason you are not using a method of contraception to avoid pregnancy?

NOT MARRIED 11
FERTILITY-RELATED REASONS
NOT HAVING SEX 21
INFREQUENT SEX 22
MENOPAUSAL/HYSTERECTOMY 23
SUBFECUND/INFECUND 24
POSTPARTUM/BREASTFEEDING 25
WANTS (MORE) CHILDREN 26
WIFE PREGNANT 27
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
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
UP TO THE WOMAN TO USE 61
OTHER (SPECIFY) _______________ 96
DOES NOT KNOW 98

SECTION 4. MARRIAGE

401. Are you currently married or living with a woman?

YES, CURRENTLY MARRIED 1
YES, LIVING WITH A WOMAN 2 (GO TO 402A)
NO, NOT IN UNION 3 (GO TO 404)

402. How many wives do you have?
402A. How many women are you living with as if you are married?

NUMBER OF WIVES ____

403. WRITE THE LINE NUMBERS FROM THE HOUSEHOLD QUESTIONNAIRE FOR HIS WIFE/WIVES. IF A WIFE DOES NOT LIVE IN THE HOUSEHOLD, WRITE '00'.
THE NUMBER OF BOXES FILLED MUST EQUAL THE NUMBER OF WIVES.

LINE NUMBER___ (GO TO 407)

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

REGULAR SEXUAL PARTNER 1
OCCASIONAL SEXUAL PARTNER 2
NO SEXUAL PARTNER 3

405. Have you ever been married or lived with a woman?

YES, FORMERLY MARRIED 1
YES, LIVED WITH A WOMAN 2 (GO TO 407)
NO 3 (GO TO 410F)

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

WIDOWED 1
DIVORCED 2
SEPARATED 3

407. Have you been married or lived with a woman only once, or more than one?

ONCE 1
MORE THAN ONCE 2

408. CHECK 407:

MARRIED/LIVED WITH A WOMAN ONLY ONCE: In what month and year did you start living with your wife/woman?

MARRIED/LIVED WITH A WOMAN MORE THAN ONCE: Now we will talk about your first wife/woman you lived with. In what month and year did you start living with her?

MONTH __
DOES NOT KNOW MONTH 98
YEAR __ (GO TO 409A)
DOES NOT KNOW YEAR 9998

409. How old were you when you started living with her?

AGE _________

409A. CHECK 401:

CURRENTLY MARRIED OR LIVING WITH A WOMAN (GO TO 410)
NOT IN UNION (GO TO 410F)

410. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family planning issues. When was the last time you had sexual intercourse with (your wife/the woman you are living with)?

DAYS AGO 1 __
WEEKS AGO 2 __
MONTHS AGO 3 __
YEARS AGO 4 __

410A. CHECK 301 AND 302:

KNOWS CONDOM: The last time you had sex with (your wife/the woman you are living with), did you use a condom?

DOES NOT KNOW 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 with (your wife/the woman you are living with) did you use a condom?

YES 1
NO 2
DOES NOT KNOW/NOT SURE 8

410B. Have you had sex with anyone other than (your wife/the woman you are living with) in the last 12 months?

YES 1
NO 2 (GO TO 410J)

410C. When was the last time you had sexual intercourse with someone other than (your wife/the woman you are living with)?

DAYS AGO 1 __
WEEKS AGO 2 __
MONTHS AGO 3 __

410D. Did you use a condom that time?

YES 1
NO 2
DOES NOT KNOW/NOT SURE 8

410E. In the last 12 months, how many different persons other than (your wife/the woman you are living with) have you had sex with?

NUMBER OF PERSONS _____ (GO TO 410J)
DOES NOT KNOW 98 (GO TO 410J)

410F. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family planning issues. When was the last time you had sexual intercourse (if ever)?

NEVER 000 (GO TO 509)

DAYS AGO 1 __
WEEKS AGO 2 __
MONTHS AGO 3 __
YEARS AGO 4 __

410G. CHECK 301 AND 302:

KNOWS CONDOM: The last time you had sex, did you use a condom?

DOES NOT KNOW 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, did you use a condom?

YES 1
NO 2
DOES NOT KNOW 8

410H. CHECK 410F:

LESS THAN 12 MONTHS SINCE LAST SEX (GO TO 410I)
12 MONTHS OR LONGER SINCE LAST SEX (GO TO 410J)

410I. In the last 12 months, how many different persons have you had sex with?

NUMBER OF PERSONS ____
DOES NOT KNOW 98

410J. CHECK 401:

CURRENTLY MARRIED OR LIVING WITH A WOMAN: The last time you had sex, was it with your (wife/the woman you live with), a regular partner, an acquaintance, someone you paid for sex, or someone else?

NOT CURRENTLY MARRIED AND NOT LIVING WITH A WOMAN: The last time you had sex, was it with a regular partner, an acquaintance, someone you paid for sex, or someone else?

WIFE/WOMAN LIVES WITH 1
REGULAR PARTNER 2
ACQUAINTANCE 3
SOMEONE HE PAID FOR SEX 4
SOMEONE ELSE 5

413. Do you know of a place where you can get condoms?

YES 1
NO 2 (GO TO 416)

414. 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.

(NAME OF PLACE) ________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FIELDWORKER 13
OTHER PUBLIC (SPECIFY) ___________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
MISSION HOSPITAL/CLINIC 22
PHARMACY 23
PRIVATE DOCTOR 24
MOBILE CLINIC 25
FIELDWORKER 26
OTHER PRIVATE MEDICAL (SPECIFY) ____________ 27
OTHER SOURCE
SHOP 31
FRIENDS/RELATIVES 32
OTHER (SPECIFY) _________________ 36

416. How old were you when you first had sexual intercourse?

AGE ____
FIRST TIME WHEN MARRIED 96

SECTION 5. FERTILITY PREFERENCES

501. CHECK 401:

NOT IN UNION (GO TO 502)
CURRENTLY MARRIED OR LIVING WITH A WOMAN (GO TO 503)

502. CHECK 404:

REGULAR SEXUAL PARTNER (GO TO 503)
OCCASIONAL SEXUAL PARTNER (GO TO 503)
NO SEXUAL PARTNER (GO TO 505A)

503. Is your wife (or one of your wives)/partner pregnant now?

YES 1
NO 2 (GO TO 505A)
UNSURE 8 (GO TO 505A)

504. When she became pregnant, did you want her to become pregnant then, did you want her to wait until later, or did you not want this pregnancy at all?

THEN 1 (GO TO 505B)
LATER 2 (GO TO 505B)
NOT AT ALL 3 (GO TO 505B)

505A) WIFE/PARTNER NOT PREGNANT OR UNSURE OR NO WIFE/PARTNER: 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?

505B) WIFE/PARTNER PREGNANT: Now I have some questions about the future. After the child your wife/partner is expecting, would you like to have another child or would you prefer not to have any more children?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 507)
SAYS WIFE CAN'T GET PREGNANT 3 (GO TO 507)
SAYS HE CAN'T HAVE ONE ANY MORE 4 (GO TO 507)
UNDECIDED/DOES NOT KNOW 8 (GO TO 507)

506. CHECK 503:

WIFE/PARTNER NOT PREGNANT OR UNSURE OR NO WIFE/PARTNER: How long would you like to wait from now before the birth of (a/another) child?

WIFE/PARTNER PREGNANT: After the child your wife/partner is expecting, how long would you like to wait before the birth of another child?

MONTHS 1 __
YEARS 2 __

SOON/NOW 993
SAYS WIFE CAN'T GET PREGNANT 994
AFTER MARRIAGE 995
OTHER (SPECIFY) ___________ 996
DOES NOT KNOW 998

507. CHECK 308:
USING A METHOD?

NOT ASKED (GO TO 508)
NOT CURRENTLY USING (GO TO 508)
CURRENTLY USING (GO TO 512)

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

YES 1 (GO TO 510)
NO 2
DOES NOT KNOW 8

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

YES 1
NO 2 (GO TO 511)
DOES NOT KNOW 8 (GO TO 511)

510. Which method would you prefer to use?

PILL 01 (GO TO 512)
IUD 02 (GO TO 512)
INJECTIONS 03 (GO TO 512)
IMPLANTS 04 (GO TO 512)
FOAMING TABLETS/JELLY 05 (GO TO 512)
CONDOM 06 (GO TO 512)
FEMALE STERILIZATION 07 (GO TO 512)
MALE STERILIZATION 08 (GO TO 512)
NATURAL FAMILY PLANNING 09 (GO TO 512)
WITHDRAWAL 10 (GO TO 512)
OTHER (SPECIFY) _____________ 96 (GO TO 512)
UNSURE 98 (GO TO 512)

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

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX 22
WIFE MENOPAUSAL/HYSTERECTOMY 23
WIFE SUBFECUND/INFECUND 24
WANTS (MORE) CHILDREN 26
OPPOSITION TO USE
RESPONDENT OPPOSED 31
WIFE 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
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
UP TO THE WOMAN TO USE 61
OTHER (SPECIFY) _______________ 96
DOES NOT KNOW 98

512. CHECK 202 AND 204:

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.

NUMBER __________
OTHER (SPECIFY) ____________ 96 (GO TO 514)

513. 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?

NUMBER OF BOYS___
OTHER (SPECIFY) _____________ 96
NUMBER OF GIRLS___
OTHER (SPECIFY) _____________ 96
NUMBER OF EITHER SEX___
OTHER (SPECIFY) _____________ 96

514. Would you say that you approve or disapprove of couples using a method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
NO OPINION 3

515. Is it acceptable or not acceptable to you for information on family planning to be provided:

On the radio?
On the television?

RADIO
ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8
TELEVISION
ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8

516. In the last few months have you heard about family planning:

On the radio?
On the television?
In a newspaper or magazine?
From a billboard?
At a live drama?
From a doctor or nurse?
At a community event?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER OR MAGAZINE
YES 1
NO 2
POSTER
YES 1
NO 2
LEAFLETS OR BROCHURES
YES 1
NO 2
LIVE DRAMA
YES 1
NO 2
DOCTOR OR NURSE
YES 1
NO 2
COMMUNITY HEALTH WORKER
YES 1
NO 2

518. In the last few months have you discussed the practice of family planning with your (wife, partner), friends, neighbors, or relatives?

YES 1
NO 2 (GO TO 520)

519. With whom?
Anyone else?
RECORD ALL MENTIONED.

WIFE/PARTNER A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER F
MOTHER-IN-LAW G
FRIENDS/NEIGHBORS H
COMMUNITY HEALTH WORKER I
LOCAL COMMUNITY LEADER J
RELIGIOUS LEADER K
OTHER (SPECIFY) ___________ X

520. CHECK 401:

CURRENTLY MARRIED (GO TO 521)
LIVING WITH A WOMAN (GO TO 521)
NOT IN UNION (GO TO 601A)

521. Spouses do not always agree on everything. Now I want to ask you about your wife's/the woman you live with's views on family planning. Do you think that your wife/the woman you live with approves or disapproves of couples using a method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DOES NOT KNOW 8

522. How often have you talked to your wife/the woman you live with about family planning in the past year?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

SECTION 6. AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES

601A. Have you heard about diseases that can be transmitted through sexual intercourse?

YES 1
NO 2 (GO TO 601F)

601B. Which diseases do you know?
RECORD ALL RESPONSES.

SYPHILIS A
GONORRHEA B
AIDS C
GENITAL WARTS/CONDYLOMATA D
OTHER (SPECIFY) _______________ W
OTHER (SPECIFY) _______________ X
DON'T KNOW Z

601C. CHECK 410 AND 410F:

HAS HAD SEXUAL INTERCOURSE (GO TO 601D)
HAS NEVER HAD SEXUAL INTERCOURSE (GO TO 601F)

601D. During the last twelve months, did you have any of these diseases?

YES 1
NO 2 (GO TO 601F)
DOES NOT KNOW 8 (GO TO 601F)

601E. Which of the diseases did you have?
RECORD ALL RESPONSES.

SYPHILIS A
GONORRHEA B
AIDS C
GENITAL WARTS/CONDYLOMATA D
OTHER (SPECIFY) _______________ W
OTHER (SPECIFY) _______________ X
DON'T KNOW Z

601F. During the last twelve months, did you have a discharge from your penis?

YES 1
NO 2
DOES NOT KNOW 8

601G. During the last twelve months, did you have a sore or ulcer on your penis?

YES 1
NO 2
DOES NOT KNOW 8

601H. CHECK 601E, 601F AND 601G

HAD ONE OR MORE DISEASES (GO TO 601I)
NONE OF THE DISEASES (GO TO 601N)

601I. The last time you had (DISEASE FROM 601E/DISCHARGE/SORE) did you seek advice or treatment?

YES 1
NO 2 (GO TO 601JA)

601J. Where did you seek advice or treatment?
Any other place or person?
RECORD ALL MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FIELDWORKER 13
OTHER PUBLIC (SPECIFY) ___________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
MISSION HOSPITAL/CLINIC 22
PHARMACY 23
PRIVATE DOCTOR 24
MOBILE CLINIC 25
FIELDWORKER 26
OTHER PRIVATE MEDICAL (SPECIFY) ____________ 27
OTHER SOURCE
SHOP 31
FRIENDS/RELATIVES 33
OTHER (SPECIFY) _________________ 36

601JA. CHECK 410 AND 410F:

HAS HAD SEXUAL INTERCOURSE (GO TO 601K)
HAS NEVER HAD SEXUAL INTERCOURSE (GO TO 601N)

601K. When you had (DISEASE FROM 601E/DISCHARGE/SORE) did you inform your partner(s)?

YES 1
NO 2

601L. When you had (DISEASE FROM 601E/DISCHARGE/SORE) did you do something not to infect your partner(s)?

YES 1
NO 2 (GO TO 601N)
PARNTER ALREADY INFECTED 3 (GO TO 601N)

601M. What did you do?
RECORD ALL MENTIONED.

NO SEXUAL INTERCOURSE A
USED CONDOMS B
TOOK MEDICINES C
OTHER (SPECIFY) ___________ X

601N. CHECK 601B

DID NOT MENTION 'AIDS' (GO TO 601O)
MENTIONED 'AIDS' (GO TO 602)

601O. Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 611C)

602. From which sources of information have you learned most about AIDS?
Any other sources?
RECORD ALL MENTIONED.

RADIO A
TV B
NEWSPAPERS/MAGAZINES C
PAMPLETS/POSTERS D
HEALTH WORKERS E
MOSQUES/CHURCHES F
SCHOOLS/TEACHERS G
COMMUNITY MEETINGS H
FRIENDS/RELATIVES I
WORK PLACE J
OTHER (SPECIFY) ___________X

602B. How can a person get AIDS?
Any other ways?
RECORD ALL MENTIONED.

SEXUAL INTERCOURSE A
SEXUAL INTERCOURSE WITH MULTIPLE PARTNERS B
SEX WITH PROSTITUTES C
NOT USING CONDOM D
HOMOSEXUAL CONTACT E
BLOOD TRANSFUSION F
INJECTIONS G
KISSING H
MOSQUITO BITES I
CONTAMINATED RAZOR BLADES J
OTHER (SPECIFY) ___________ W
OTHER (SPECIFY) ___________ X
DOES NOT KNOW Z

603. Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?

YES 1
NO 2 (GO TO 607)
DOES NOT KNOW 8 (GO TO 607)

604. What can a person do?
Any other ways?
RECORD ALL MENTIONED.

SAFE SEX A
ABSTAIN FROM SEX B
USE CONDOMS C
AVOID MULTIPLE SEX PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH HOMOSEXUALS F
AVOID BLOOD TRANSFUSIONS G
AVOID INJECTIONS H
AVOID KISSING I
AVOID MOSQUITO BITES J
SEEK PROTECTION FROM TRADITIONAL HEALER K
OTHER (SPECIFY) ___________ W
OTHER (SPECIFY) ___________ X
DOES NOT KNOW Z

605. CHECK 604:

MENTIONED 'SAFE SEX' (GO TO 606)
DID NOT MENTION 'SAFE SEX' (GO TO 607)

606. What does 'safe sex' mean to you?
RECORD ALL MENTIONED.

ABSTAIN FROM SEX B
USE CONDOMS C
AVOID MULTIPLE SEX PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH HOMOSEXUALS F
OTHER (SPECIFY) ___________ X
DOES NOT KNOW Z

607. Is it possible for a healthy-looking person to have the AIDS virus?

YES 1
NO 2
DOES NOT KNOW 8

608. Do you think that persons with AIDS almost never die from the disease, sometimes die, or almost always die from the disease?

ALMOST NEVER 1
SOMETIMES 2
ALMOST ALWAYS 3
DOES NOT KNOW 8

608A. Can AIDS be cured?

YES 1
NO 2
DOES NOT KNOW 8

608B. Can AIDS be transmitted from mother to child?

YES 1
NO 2
DOES NOT KNOW 8

608C. Do you personally know someone who has AIDS or has died of AIDS?

YES 1
NO 2 (GO TO 609)
DOES NOT KNOW 8 (GO TO 609)

608D. How many people that you personally know now have AIDS?

NUMBER OF PERSONS ___

608E. How many people that you personally know have died of AIDS?

NUMBER OF PERSONS ___

609. CHECK 601E:
IF RESPONDENT HAS AIDS, CIRCLE 5.
Do you think your chances of getting AIDS are small, moderate, great, or no risk at all?

SMALL 1
MODERATE 2 (GO TO 609B)
GREAT 3 (GO TO 609B)
NO RISK AT ALL 4
HAS AIDS 5 (GO TO 611A)

609A. Why do you think that you have (NO RISK/A SMALL CHANCE) of getting AIDS?
Any other reasons?
RECORD ALL MENTIONED.

ABSTAIN FROM SEX B (GO TO 611A)
USE CONDOMS C (GO TO 611A)
HAVE ONLY ONE SEX PARTNER D (GO TO 611A)
LIMITED NUMBER OF SEX PARTNERS E (GO TO 611A)
AVOID SEX WITH PROSTITUTES F (GO TO 611A)
SPOUSE HAS NO OTHER PARTNER G (GO TO 611A)
NO HOMOSEXUAL CONTACT H (GO TO 611A)
NO BLOOD TRANSFUSIONS I (GO TO 611A)
NO INJECTIONS J (GO TO 611A)
OTHER (SPECIFY) ___________________X (GO TO 611A)

609B. Why do you think that you have a (MODERATE/GREAT) chance of getting AIDS?
Any other reasons?
RECORD ALL MENTIONED.

DO NOT USE CONDOMS C
MORE THAN ONE SEX PARTNER D
MANY SEX PARTNERS E
SEX WITH PROSTITUTES F
SPOUSE HAS OTHER PARTNER(S) G
HOMOSEXUAL CONTACT H
HAD BLOOD TRANSFUSION I
HAD INJECTIONS J
OTHER (SPECIFY) ___________________X

611A. Since you heard of AIDS, have you changed your behavior to prevent getting AIDS?
IF YES, what did you do?
Anything else?
RECORD ALL MENTIONED

DIDN'T START SEX A (GO TO 611C)
STOPPED ALL SEX B (GO TO 611C)
STARTED USING CONDOMS C (GO TO 611F)
RESTRICTED SEX TO ONE PARTNER D (GO TO 611C)
REDUCED NUMBER OF PARTNERS E (GO TO 611C)
AVOID SEX WITH PROSTITUTES F (GO TO 611C)
ASK SPOUSE TO BE FAITHFUL G (GO TO 611C)
NO MORE HOMOSEXUAL CONTACTS H (GO TO 611C)
STOPPED INJECTIONS J
OTHER (SPECIFY) ___________ W
OTHER (SPECIFY) ___________ X
NO BEHAVIOR CHANGE Y

611B. Has your knowledge of AIDS influenced or changed your decisions about having sex or your sexual behavior?
IF YES, In what way?
RECORD ALL MENTIONED

DIDN'T START SEX A
STOPPED ALL SEX B
STARTED USING CONDOMS C
RESTRICTED SEX TO ONE PARTNER D
REDUCED NUMBER OF PARTNERS E
AVOID SEX WITH PROSTITUTES F
NO MORE HOMOSEXUAL CONTACTS G
OTHER (SPECIFY) __________ X
NO CHANGE IN SEXUAL BEHAVIOR Y
DOES NOT KNOW Z

611C. Some people use a condom during sexual intercourse to avoid getting AIDS or other sexually transmitted diseases? Have you ever heard of this?

YES 1
NO 2 (GO TO 611F)

611D. CHECK 410 AND 410F:

HAS HAD SEXUAL INTERCOURSE (GO TO 611E)
HAS NEVER HAD SEXUAL INTERCOURSE (GO TO 613)

611E. We may already have talked about this. Have you ever used a condom during sex to avoid getting or transmitting diseases, such as AIDS?

YES 1 (GO TO 611G)
NO 2 (GO TO 611G)

611F. CHECK 410 AND 410F:

HAS HAD SEXUAL INTERCOURSE (GO TO 611G)
HAS NEVER HAD SEXUAL INTERCOURSE (GO TO 613)

611G. Have you given or received money, gifts or favors in return for sex at any time in the last 12 months?

YES 1
NO 2

613. 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: _____________