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DEMOGRAPHIC AND HEALTH SURVEYS - ZAMBIA 2001 - WOMEN'S QUESTIONNAIRE

IDENTIFICATION

LOCALITY NAME ___________________ ___

NAME OF HOUSEHOLD HEAD ____________________ ___

CLUSTER NUMBER ___

HOUSEHOLD NUMBER ___

PROVINCE _________________ ___

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 WOMAN _______________ ___

WOMAN SELECTED FOR Qs. 720A-720L?

YES = 1
NO = 2

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 NUMBER 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

INTRODUCTION AND CONSENT

INFORMED CONSENT
Hello. My name is ____________ and I am working with CBOH/CSO. We are conducting a national survey about the health of women and children. We would very much appreciate your participation in this survey. I would like to ask you about your health (and the health of your children). This information will help the government to plan health services. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.

We hope that you will participate in this survey since your views are important.
At this time, do you want to ask me anything about the survey?

May I begin the interview now?

Signature of interviewer: ______________ Date: __________

RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 101)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

101. RECORD THE TIME.

HOUR ___
MINUTES ___

103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
IF LESS THAN ONE YEAR, RECORD '00' YEARS.

YEARS ___

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

104. Just before you moved here, did you live in Lusaka, in another 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 9998

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. What is the highest grade you completed at that level?

GRADE __

110. CHECK 108:

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

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

CANNOT READ AT ALL 1
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) _______ 4

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

YES 1
NO 2

113. CHECK 111:

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

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

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
ALMOST NEVER/NOT AT ALL 4

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

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
ALMOST NEVER/NOT AT ALL 4

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

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
ALMOST NEVER/NOT AT ALL 4

117. What is your religion?

CATHOLIC 1
PROTESTANT 2
MUSLIM 3
OTHER (SPECIFY)________ 6

118. What tribe do you belong to?

TRIBE________________ ___

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 to whom you have given birth who are now living with you?

YES 1
NO 2 (GO TO 204)

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

SONS AT HOME ___
DAUGHTERS AT HOME ___

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

YES 1
NO 2 (GO TO 206)

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

SONS ELSEWHERE ____
DAUGHTERS ELSEWHERE ____

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

YES 1
NO 2 (GO TO 208)

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

BOYS DEAD ___
GIRLS DEAD ___

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

TOTAL ___

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

210. CHECK 208:

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

211. Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had.
RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

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

(NAME) ___________

213. Were any of these births twins?

SING 1
MULT 2

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

BOY 1
GIRL 2

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

MONTH ______
YEAR ____

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

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

AGE IN YEARS __

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

YES 1
NO 2

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

LINE NUMBER __ (GO TO NEXT BIRTH OR TO 221)

220. IF DEAD: How old was (NAME) when he/she died?
IF '1 YR', PROBE: How many months old was (NAME)?
RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

DAYS 1 ____
MONTHS 2 ____
YEARS 3 ____

221. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?

YES 1
NO 2

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

YES 1
NO 2

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

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

224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 1996 OR LATER.
IF NONE, RECORD '0'.

NUMBER OF BIRTHS___

226. Are you pregnant now?

YES 1
NO 2 (GO TO 229)
UNSURE 8 (GO TO 229)

227. How many months pregnant are you?

MONTHS ____

228. 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?

THEN 1
LATER 2
NOT AT ALL 3

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

YES 1
NO 2 (GO TO 237)

230. When did the last such pregnancy end?

MONTH _______
YEAR _______

231. How many months pregnant were you when the last such pregnancy ended?

MONTHS ______

232. CHECK 230:

LAST PREGNANCY ENDED IN JAN. 1996 OR LATER (GO TO 233)
LAST PREGNANCY ENDED BEFORE JAN. 1996 (GO TO 237)

233. Have you ever had any other pregnancies that did not result in a live birth?

YES 1
NO 2 (GO TO 237)

234. When did the previous such pregnancy end?

MONTH ____
YEAR ____

235. How many months pregnant were you when that pregnancy ended?

MONTHS ______

237. When did your last menstrual period start?

(DATE, IF GIVEN) ____________
DAYS AGO 1 __
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___

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

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

YES 1
NO 2 (GO TO 301)
DOES NOT KNOW 8 (GO TO 301)

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

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

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

301. Which ways or methods have you heard about?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?

01 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES 1
NO 2
02 MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1
NO 2
03 PILL Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
04 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
05 INJECTABLES Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
06 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
07 CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08 FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09 FOAM TABLETS, DIAPHRAGM OR JELLY Women can place a suppository, a diaphragm, jelly, or cream in their vagina before intercourse.
YES 1
NO 2
10 LACTATIONAL AMENORRHEA METHOD (LAM) Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.
YES 1
NO 2
11 RHYTHM OR NATURAL FAMILY PLANNING Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
12 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
13 EMERGENCY CONTRACEPTION Women can take pills up to three days after sexual intercourse to avoid becoming pregnant.
YES 1
NO 2
14 Have you heard of any other ways or methods that women or men can use to avoid pregnancy? LIST UP TO TWO METHODS
SPECIFY___
YES 1
NO 2

302. Have you ever used (METHOD)?

01 FEMALE STERILIZATION Women can have an operation to avoid having any more children: Have you ever had an operation to avoid having any more children?
YES 1
NO 2
02 MALE STERILIZATION Men can have an operation to avoid having any more children: Have you ever had a partner who had an operation to avoid having any more children?
YES 1
NO 2
03 PILL Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
04 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
05 INJECTABLES Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
06 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
07 MALE CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08 FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09 FOAM TABLETS, DIAPHRAGM OR JELLY Women can place a suppository, a diaphragm, jelly, or cream in their vagina before intercourse.
YES 1
NO 2
10 LACTATIONAL AMENORRHEA METHOD (LAM) Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.
YES 1
NO 2
11 RHYTHM OR NATURAL FAMILY PLANNING Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
12 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
13 EMERGENCY CONTRACEPTION Women can take pills up to three days after sexual intercourse to avoid becoming pregnant.
YES 1
NO 2
14 Have you heard of any other ways or methods that women or men can
use to avoid pregnancy?
YES 1
NO 2

303. CHECK 302:

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

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

YES 1
NO 2 (GO TO 329)

306. What have you used or done?
CORRECT 302 AND 303 (AND 301 IF NECESSARY).

307. Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant. How many living children did you have at that time, if any?

NUMBER OF CHILDREN _______

308. CHECK 302 (01):

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

309. CHECK 226:

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

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

YES 1
NO 2 (GO TO 329)

311. Which method are you using?
IF MORE THAN ONE METHOD MENTIONED, FOLLOW GO INSTRUCTION FOR HIGHEST METHOD ON LIST.
311A. CIRCLE 'A' FOR FEMALE STERILIZATION.

FEMALE STERILIZATION A (GO TO 313)
MALE STERILIZATION B (GO TO 313)
PILL C
IUD D (GO TO 316A)
INJECTABLES E (GO TO 316A)
IMPLANTS F (GO TO 316A)
CONDOM G (GO TO 316A)
FEMALE CONDOM H (GO TO 316A)
DIAPHRAGM/FOAM/JELLY I (GO TO 316A)
LACTATIONAL AMEN. METHOD J (GO TO 316A)
NATURAL FAMILY PLANNING K (GO TO 316A)
WITHDRAWAL L (GO TO 316A)
OTHER (SPECIFY) _____ X (GO TO 316A)

312. What brand of pills are you using?
ASK TO SEE THE PACKAGE IF RESPONDENT DOES NOT REMEMBER NAME OF BRAND.

SAFE PLAN 01 (GO TO 316A)
MICROGYNON 02 (GO TO 316A)
MICROLUT 03 (GO TO 316A)
EUGYNON 04 (GO TO 316A)
LOGYNON 05 (GO TO 316A)
NORDETTE 06 (GO TO 316A)
OTHER (SPECIFY) ___________ 96 (GO TO 316A)
PACKAGE NOT SEEN/DK 98 (GO TO 316A)

313. In what facility 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.

(NAME OF PLACE) __________________
PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
OTHER PUBLIC (SPECIFY) ______ 16

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/SURGERY 21
MISSION HOSPITAL/CLINIC 22
PRIVATE DOCTOR'S OFFICE 23
WORK PLACE 24
OTHER PRIVATE MEDICAL (SPECIFY) ______ 26
OTHER (SPECIFY) _______________ 96
DON'T KNOW 98

314. CHECK 311:

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

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

YES 1
NO 2
DON'T KNOW 8

316. In what month and year was the sterilization performed?
316A. In what month and year did you start using (CURRENT METHOD) without stopping?
PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

MONTH __
YEAR __

317. CHECK 316/316A:

YEAR IS 1996 OR LATER (GO TO 319)
YEAR IS BEFORE 1996 (GO TO 327)

319. CHECK 311/311A:

CIRCLE METHOD CODE.

IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION 01
MALE STERILIZATION 02 (GO TO 331)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07 (GO TO 327)
FEMALE CONDOM 08 (GO TO 327)
DIAPHRAGM/FOAM/JELLY 09 (GO TO 327)
LACTATIONAL AMEN. METHOD 10 (GO TO 327)
NATURAL FAMILY PLANNING 11 (GO TO 331)
WITHDRAWAL 12 (GO TO 331)
OTHER METHOD 96 (GO TO 331)

323. 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 327)

324. Were you told what to do if you experienced side effects or problems?

YES 1
NO 2

327. CHECK 311/311A:

CIRCLE METHOD CODE.

FEMALE STERILIZATION 01 (GO TO 331)
MALE STERILIZATION 02 (GO TO 331)
PILL 03
IUD 04
INJECTIONS 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM/FOAM/JELLY 09
LACTATIONAL AMEN. METHOD 10 (GO TO 328A)
NATURAL FAMILY PLANNING 11 (GO TO 331)
WITHDRAWAL 12 (GO TO 331)
OTHER METHOD 96 (GO TO 331)

328. Where did you obtain (CURRENT METHOD) the last time?
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.
328A. Where did you learn to use Lactational Amenorrhea Method?

(NAME OF PLACE) _____________
PUBLIC SECTOR
GOVT. HOSPITAL 11 (GO TO 331)
GOVT. HEALTH CENTER 12 (GO TO 331)
HEALTH POST 13 (GO TO 331)
OTHER PUBLIC (SPECIFY) ______ 16 (GO TO 331)

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/SURGERY 21 (GO TO 331)
MISSION HOSPITAL/CLINIC 22 (GO TO 331)
PHARMACY 23 (GO TO 331)
PRIVATE DOCTOR 24 (GO TO 331)
WORK PLACE 25 (GO TO 331)
OTHER PRIVATE MEDICAL (SPECIFY) ______ 26 (GO TO 331)
OTHER SOURCE
SHOP 31 (GO TO 331)
COMMUNITY-BASED AGENT 32 (GO TO 331)
FRIEND/RELATIVE 33 (GO TO 331)
OTHER (SPECIFY) _______________ 96 (GO TO 331)

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

YES 1
NO 2 (GO TO 331)

330. Where is that? Any other 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.
RECORD ALL PLACES MENTIONED

(NAME OF PLACE) _____________
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
HEALTH POST C
OTHER PUBLIC (SPECIFY) ______ D

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/SURGERY E
MISSION HOSPITAL/CLINIC F
PHARMACY G
PRIVATE DOCTOR H
WORK PLACE I
OTHER PRIVATE MEDICAL (SPECIFY) ______ K
OTHER SOURCE
SHOP L
COMMUNITY-BASED AGENT M
FRIEND/RELATIVE N
OTHER (SPECIFY) _______________ X

331. In the last 12 months, was anybody in your house visited by a member of the community who is a health worker?

YES 1
NO 2 (GO TO 332)

331A. What services did they provide?
RECORD ALL MENTIONED.

PILLS, CONDOMS, FOAM TABLETS A
ORS PACKETS B
CLORIN C
ANTIMALARIAL MEDICINE D
WEIGHED BABY E
MOSQUITO NET F
VITAMIN A G
INFORMATION, EDUCATION, COUNSELING H
OTHER ______________ X

332. 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)

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

YES 1
NO 2

SECTION 4A. PREGNANCY, POSTNATAL CARE AND BREASTFEEDING

401. CHECK 224:

ONE OR MORE BIRTHS IN 1996 OR LATER (GO TO 402)
NO BIRTHS IN 1996 OR LATER (GO TO 487)

402. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1996 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES).

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

403. LINE NUMBER FROM 212

LINE NUMBER _____

404. FROM 212 AND 216

NAME _______
LIVING __
DEAD __

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

THEN 1 (GO TO 423)
LATER 2
NOT AT ALL 3 (GO TO 423)

406. How much longer would you like to have waited?

MONTHS 1 __
YEARS 2 __

DON'T KNOW 998

407. Did you see anyone 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.
[Last Birth Only]

HEALTH PROFESSIONAL
DOCTOR A
CLINICAL OFFICER B
NURSE/MIDWIFE C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
OTHER (SPECIFY) ________ X
NO ONE Y (GO TO 414B)

407A. Where did the first antenatal visit 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.
[Last Birth Only]

(NAME OF PLACE) _____________
HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVT. HOSPITAL 21
GOVT. HEALTH CENTER 22
GOVT. HEALTH POST 23
OTHER PUBLIC (SPECIFY) ____________ 26
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/SURGERY 31
MISSION HOSPITAL/SURGERY 32
WORK PLACE 33
OTHER PVT. MEDICAL (SPECIFY) _____________ 36
OTHER (SPECIFY) ______________ 96

408. How many months pregnant were you when you first received antenatal care for this pregnancy?
[Last Birth Only]

MONTHS ___
DON'T KNOW 98

409. How many times did you receive antenatal care during this pregnancy?
[Last Birth Only]

NO. OF TIMES ___
DON'T KNOW 98

410. CHECK 409:
NUMBER OF TIMES RECEIVED ANTENATAL CARE
[Last Birth Only]

ONCE (GO TO 412)
MORE THAN ONCE OR DON'T KNOW (GO TO 412)

411. How many months pregnant were you the last time you received antenatal care?
[Last Birth Only]

MONTHS ___
DON'T KNOW 98

412. During this pregnancy, were any of the following done at least once?

Were you weighed?
Was your height measured?
Was your blood pressure measured?
Did you give a urine sample?
Did you give a blood sample?
[Last Birth Only]

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

412A. During this pregnancy, were you offered counseling and testing for the virus that causes AIDS?
[Last Birth Only]

YES 1
NO 2
DON'T KNOW 8

414A. CHECK 407A:
DID RESPONDENT RECEIVE ANTENATAL CARE AT HOME?

CARE AT HOME (GO TO 414B)
CARE AT FACILITY (GO TO 415)

414B. What is the main reason you did not go to a health facility for antenatal care?
[Last Birth Only]

COST TOO MUCH 1
DISTANCE/TRANSPORT 2
SERVICE NOT AVAILABLE AT THAT TIME 3
DID NOT FEEL NEED 4
OTHER (SPECIFY) ______________ 6

414C. Did you ever try to go for antenatal care but the health facility staff told you to go away and come back another day?
[Last Birth Only]

YES 1
NO 2

415. During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, spasms or jerks in the first month after birth?
[Last Birth Only]

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

416. During this pregnancy, how many times did you get this injection?
[Last Birth Only]

TIMES ____
DON'T KNOW 8

417. During this pregnancy, were you given or did you buy any iron tablets or iron syrup or folic acid?
SHOW TABLET/SYRUP.
[Last Birth Only]

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

418. During the whole pregnancy, for how many days did you take the iron tablets or iron syrup?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS
[Last Birth Only]

NUMBER OF DAYS _____
DON'T KNOW 998

421. During this pregnancy, did you take any drugs to prevent you from getting malaria?
[Last Birth Only]

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

422. What drugs did you take?
RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW
TYPICAL ANTI-MALARIAL DRUGS TO RESPONDENT.
[Last Birth Only]

CHLOROQUINE A
FANSIDAR B
OTHER (SPECIFY) _________ X
DON'T KNOW Z

422A. CHECK 407:
DID YOU SEE ANYONE FOR ANTENATAL CARE DURING THIS PREGNANCY?
[Last Birth Only]

'ANY ONE' (A-X) (GO TO 422B)
'NO ONE' (Y) (GO TO 423)

422B. Did you get these drugs during an antenatal visit, another visit to health facility
or from some other source?
[Last Birth Only]

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE (SPECIFY) ___________ 6

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

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

424. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 426)
DON'T KNOW 8 (GO TO 426)

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

GRAMS FROM CARDS 1 ______
GRAMS FROM RECALL 2 ________

DON'T KNOW 99998

426. Who assisted with the delivery of (NAME)?
Anyone else?
IF RELATIVE OR FRIEND, PROBE TO SEE IF BELONGS TO ANOTHER CATEGORY.

HEALTH PROFESSIONAL
DOCTOR A
CLINICAL OFFICER B
NURSE/MIDWIFE C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
RELATIVE/FRIEND E
OTHER (SPECIFY) ________ X
NO ONE Y

427. Where did you give birth to (NAME)?
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)
HOME
YOUR HOME 11 (GO TO 429)
OTHER HOME 12 (GO TO 429)
PUBLIC SECTOR
GOVT. HOSPITAL 21
GOVT. HEALTH CENTER 22
GOVT. HEALTH POST 23
OTHER PUBLIC (SPECIFY) ____________ 26
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC 31
MISSION HOSPITAL/CLINIC 32
OTHER PVT. MEDICAL (SPECIFY) _____________ 36
OTHER (SPECIFY) _____________ 96 (GO TO 429)

428. Was (NAME) delivered by caesarean section?
[Last Birth Only]

YES 1
NO 2

429. After (NAME) was born, did a health professional or a traditional birth attendant check on your health?
[Last Birth Only]

YES 1
NO 2 (GO TO 433)

430. How many days or weeks after delivery did the first check take place?
RECORD '00' DAYS IF SAME DAY.

DAYS AFTER DEL 1 ______
WEEKS AFTER DEL 2 ______

DON'T KNOW 998

431. Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[Last Birth Only]

HEALTH PROFESSIONAL
DOCTOR 11
CLINICAL OFFICER 12
NURSE/MIDWIFE 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
OTHER (SPECIFY) ________ 96

432. Where did this first check 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.
[Last Birth Only]

(NAME OF PLACE) ____________
HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVT. HOSPITAL 21
GOVT. HEALTH CENTER 22
GOVT. HEALTH POST 23
OTHER PUBLIC (SPECIFY) ____________ 26
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC 31
MISSION HOSPITAL/CLINIC 32
OTHER PVT. MEDICAL (SPECIFY) _____________ 36
OTHER (SPECIFY) _____________ 96

433. In the first one month after delivery, did you receive a vitamin A dose like this?
SHOW CAPSULE.
[Last Birth Only]

YES 1
NO 2

434. Has your period returned since the birth of (NAME)?
[Last Birth Only]

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

435. Did your period return between the birth of (NAME) and your next pregnancy?
[Exclude Last Birth]

YES 1
NO 2 (GO TO 439)

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

MONTHS __
DON'T KNOW 98

437. CHECK 226:
IS RESPONDENT PREGNANT?
[Last Birth Only]

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

438. Have you resumed sexual relations since the birth of (NAME)?
[Last Birth Only]

YES 1
NO 2 (GO TO 440)

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

MONTHS ___________
DON'T KNOW 98

440. Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 447)

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

IMMEDIATELY 000

HOURS 1 ______
DAYS 2 ______

442. In the first three days after delivery, before your milk began flowing regularly, was (NAME) given anything to drink other than breast milk?

YES 1
NO 2 (GO TO 444)

443. What was (NAME) given to drink before your milk began flowing regularly?
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
HONEY I
OTHER (SPECIFY) _____ X

444. CHECK 404
CHILD ALIVE?

ALIVE (GO TO 445)
DEAD (GO TO 446)

445. Are you still breastfeeding (NAME)?

YES 1 (GO TO 448)
NO 2

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

MONTHS _____
DON'T KNOW 98

447. CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 450)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 454)

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

NUMBER OF NIGHT TIME FEEDINGS ______

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

NUMBER OF DAYLIGHT FEEDINGS ___

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

YES 1
NO 2
DON'T KNOW 8

451. Was sugar added to any of the foods or liquids (NAME) ate yesterday?

YES 1
NO 2
DON'T KNOW 8

452. How many times did (NAME) eat solid, semisolid, or soft foods other than liquids yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'

NUMBER OF TIMES ________
DON'T KNOW 8

453. GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 454.

SECTION 4B. IMMUNIZATION, HEALTH AND NUTRITION

454. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1996 OR LATER. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES).

455. LINE NUMBER FROM 212

LINE NUMBER _____

456. FROM 212 AND 216

NAME _______
LIVING (GO TO 458)
DEAD (GO TO 456 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 484)

458. Do you have an Under 5 Card where (NAME'S) vaccinations are written down?
IF YES: May l see it please?

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

459. Did you ever have an Under 5 Card for (NAME)?

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

460. (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.

BCG
DAY ___
MONTH _____
YEAR ______
OPV0
DAY ___
MONTH _____
YEAR ______
OPV1
DAY ___
MONTH _____
YEAR ______
OPV2
DAY ___
MONTH _____
YEAR ______
OPV3
DAY ___
MONTH _____
YEAR ______
DPT 1
DAY ___
MONTH _____
YEAR ______
DPT 2
DAY ___
MONTH _____
YEAR ______
DPT 3
DAY ___
MONTH _____
YEAR ______
MEASLES
DAY ___
MONTH _____
YEAR ______
VITAMIN A
DAY ___
MONTH _____
YEAR ______

461. Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations received in a national immunization day, 'Bye Bye Polio' or in a Child Health Week campaign?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, AND/OR MEASLES VACCINE(S).

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

462. Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases, including vaccinations received in a national immunization day, 'Bye Bye Polio' or in a Child Health Week campaign?

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

463. Please tell me if (NAME) received any of the following vaccinations:

463A. A BCG vaccination against tuberculosis, that is, an injection in the forearm that usually causes a scar?

YES 1
NO 2
DON'T KNOW 8

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

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

463C. When was the first polio vaccine received, just after birth or later?

JUST AFTER BIRTH 1
LATER 2

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

NUMBER OF TIMES ___

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

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

463F. How many times?

NUMBER OF TIMES ___

463G. An injection in the upper arm to prevent measles?

YES 1
NO 2
DON'T KNOW 8

464. Do you remember the most recent 'Bye Bye Polio' or Child Health Week campaign in February (August) this year?

YES 1
NO 2 (GO TO 466)

465. Did (NAME) receive a Vitamin A supplement at this event?

YES 1
NO 2 (GO TO 465B)
DON'T KNOW 8 (GO TO 465B)

465A. How was Vitamin A given?
RECORD ALL MENTIONED.
DO NOT READ RESPONSES TO RESPONDENT.A

BLUE/RED CAPSULE TAKEN WHOLE A
CAPSULE CUT WITH SCISSORS B
CAPSULE CUT WITH RAZOR/SURGICAL BLADE C
CAPSULE PRICKED WITH NEEDLE D
OTHER (SPECIFY) ____________ X

465B. Did (NAME) receive any immunizations during this campaign?

YES 1
NO 2 (GO TO 465D)
DON'T KNOW 8 (GO TO 465D)

465C. Did (NAME) receive:

BCG
YES 1
NO 2
DK 8
POLIO
YES 1
NO 2
DK 8
DPT
YES 1
NO 2
DK 8
MEASLES
YES 1
NO 2
DK 8

465D. CHECK 465:

'YES' IN 465: You told me that (NAME) received a Vitamin A capsule. Did this happen in the last six months?

'NO/DON'T KNOW' IN 465 : In the last six months, did (NAME) receive a Vitamin A red or blue capsule?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 467)
DOES NOT KNOW 8 (GO TO 467)

466A. Does (NAME) have a fever now?

YES 1
NO 2
DON'T KNOW 8

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

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

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

YES 1
NO 2
DON'T KNOW 8

469. CHECK 466 AND 467
FEVER OR COUGH?

'YES' IN 466 OR 467 (GO TO 470)
OTHER (GO TO 475)

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

YES 1
NO 2 (GO TO 471A)

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

PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST C
OTHER PUBLIC (SPECIFY) ______ D

PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/SURGERY E
MISSION HOSPITAL/CLINIC F
PHARMACY G
PRIVATE DOCTOR H
COMMUNITY-BASED AGENT I
OTHER PRIVATE MEDICAL (SPECIFY) ______ J
OTHER SOURCE
SHOP K
TRAD. PRACTIONER L
OTHER (SPECIFY) _______________ X

471A. Has (NAME) been ill with convulsions or fits at any time in the last 2 weeks?

YES 1
NO 2
DON'T KNOW 8

472A. CHECK 466 AND 471A:
HAD FEVER OR CONVULSIONS OR FITS?

'YES' IN 466 OR 471A (GO TO 473)
'NO/DK' IN 466 AND 471A (GO TO 475)

473. Did (NAME) take any medicine for the (fever/convulsions/fits)?

YES 1
NO 2 (GO TO 474N)
DON'T KNOW 8 (GO TO 474N)

474. What drugs did (NAME) take?
RECORD ALL MENTIONED.ASK TO SEE DRUG(S) IF TYPE OF DRUG IS NOT KNOWN. IF TYPE OF DRUG IS STILL NOT DETERMINED, SHOW TYPICAL ANTI-MALARIAL DRUGS TO RESPONDENT.

ANTI-MALARIAL
CHLOROQUINE A
FANSIDAR B
QUININE C
OTHER DRUGS
ASPIRIN D
PANADOL E
HERBS/TRADITIONAL MEDICINE F
OTHER (SPECIFY) ______ X
DON'T KNOW Z

474A. Did (NAME) get any injection or suppository for the (fever/convulsions/fits)?

INJECTION A
SUPPOSITORY B
NONE Y
DON'T KNOW Z

474B. CHECK 474:
CHLOROQUINE?

CODE 'A' CIRCLED (CHLOROQUINE) (GO TO 474C)
CODE 'A' NOT CIRCLED (GO TO 474F)

474C. How long after the (fever/convulsions/fits) started did (NAME) first take Chloroquine?

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

474D. For how many days did (NAME) take the Chloroquine?
IF 7 OR MORE DAYS, RECORD '7'.

DAYS ________
DON'T KNOW 8

474E. Did you have the chloroquine at home or you got it from somewhere else?

AT HOME 1
OTHER SOURCE 2
DON'T KNOW 8

474F. CHECK 474:
FANSIDAR?

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

474G. How long after the (fever/convulsions/fits) started did (NAME) first take Fansidar?

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

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

DAYS ________
DON'T KNOW 8

474I. Did you have Fansidar at home or you got it from somewhere else?
IF MORE THAN ONE SOURCE MENTIONED, ASK: Where did you get the Fansidar first?

AT HOME 1
OTHER SOURCE 2
DON'T KNOW 8

474J. CHECK 474:
QUININE?

CODE 'C' CIRCLED (QUININE) (GO TO 474K)
CODE 'C' NOT CIRCLED (GO TO 474N)

474K. How long after the (fever/convulsions/fits) started did (NAME) first take Quinine?

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

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

DAYS ________
DON'T KNOW 8

474M. Did you have the Quinine at home or you got it from somewhere else?

AT HOME 1
OTHER SOURCE 2
DON'T KNOW 8

474N. Was anything else done about (NAME)'s (fever/convulsions/fits)?

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

474O. What was done about (NAME)'s (fever/convulsions/fits)?

CONSULTED TRADITIONAL HEALER A
GAVE TEPID SPONGING B
GAVE HERBS C
OTHER (SPECIFY) ____________ X

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

YES 1
NO 2 (GO TO 482A)
DON'T KNOW 8 (GO TO 482A)

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

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

478. Was he/she given a fluid made from a special packet called Madzi-a-Moyo or ORS?

YES 1
NO 2
DON'T KNOW 8

479. Was anything (else) given to treat the diarrhea?

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

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

PILL OR SYRUP A
INJECTION B
(I.V.) INTRAVENOUS C
HOME REMEDIES/HERBAL MEDICINES D
OTHER (SPECIFY) ____ X

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

YES 1
NO 2 (GO TO 482A)

482. Where did you seek advice or treatment?
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.

PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST C
OTHER PUBLIC (SPECIFY) ______ D

PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/SURGERY E
MISSION HOSPITAL/CLINIC F
PHARMACY G
PRIVATE DOCTOR H
COMMUNITY-BASED AGENT I
OTHER PRIVATE MEDICAL (SPECIFY) ______ J
OTHER SOURCE
SHOP K
TRAD. PRACTIONER L
OTHER (SPECIFY) _______________ X

482A. Has (NAME) received any injection in the past 3 months?

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

482B. Did you bring your own syringe and needle for this injection or was it provided at the facility?

CLIENT PROVIDED 1
HLTH FACILITY PROVIDED 2
DON'T KNOW 8

482C. Had the syringe and needle been used before or was it a new syringe and needle?

USED SYRINGE/NEEDLE 1
NEW SYRINGE/NEEDLE 2
DON'T KNOW 8

482D. Did you keep this needle and syringe after it was used?

YES 1
NO 2

483. GO BACK TO 456 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 484.

484. CHECK 456, ALL COLUMNS:
NUMBER OF LIVING CHILDREN BORN IN 1996 OR LATER

ONE OR MORE (GO TO 486)
NONE (GO TO 487)

486. CHECK 478:

NO CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 487)
ANY CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 488)

487. Have you ever heard of a special product called Madzi-a-Moyo or ORS you can get for the treatment of diarrhea?

YES 1
NO 2

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

FEVER TWO OR MORE DAYS A
SEIZURE/SHAKING B
CHEST INDRAWING C
NOT EATING/NOT DRINKING WELL D
GETTING SICKER/VERY SICK E
NOT GETTING BETTER F
OTHER (SPECIFY) ___________ X
DON'T KNOW Y

490. Now I would like to ask you some questions about medical care for you yourself.
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 for you?

Knowing where to go.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Getting permission to go.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Getting money needed for treatment or transport.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
The distance to the health facility.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Availability of transport.
BIG PROBLEM 1
NOT A BIG PROBLEM 2

491. CHECK 215 AND 218:

HAS AT LEAST ONE CHILD BORN IN 1998 OR LATER AND LIVING WITH HER.
(RECORD NAME OF YOUNGEST CHILD LIVING WITH HER (AND CONTINUE TO 492))
(NAME) __________
DOES NOT HAVE ANY CHILDREN BORN IN 1998 OR LATER AND LIVING WITH HER (GO TO 494)

492. Now I would like to ask you about liquids (NAME FROM Q.491) drank yesterday. In total, how many times yesterday during the day or at night did (NAME FROM Q.491) drink (ITEM)?
IF 7 OR MORE TIMES, RECORD '7'.\ IF DON'T KNOW, RECORD '8'.

a. Plain water?
YESTERDAY/LAST NIGHT __
b. Commercially produced infant formula?
YESTERDAY/LAST NIGHT __
c. Any other milk such as tinned, powdered, or fresh animal milk?
YESTERDAY/LAST NIGHT __
d. Fruit juice?
YESTERDAY/LAST NIGHT __
e. Any other liquids such as sugar water, tea, coffee, carbonated drinks, or soup broth?
YESTERDAY/LAST NIGHT __

493. Now I would like to ask you about the types of foods (NAME FROM Q.491) ate yesterday.
In total, how many times yesterday during the day or at night did (NAME FROM Q.491) eat (ITEM)?
IF 7 OR MORE TIMES, RECORD '7'. IF DON'T KNOW, RECORD '8'.

a. Any food made from grains like maize, millet, sorghum, rice, wheat, or other grains?
YESTERDAY/LAST NIGHT __
b. Pumpkin, red or yellow yams or squash, carrots, or yellow or orange sweet potatoes?
YESTERDAY/LAST NIGHT __
c. Any other food made from roots or tubers like white potatoes, white yams, manioc, cassava, or other local roots/tubers?
YESTERDAY/LAST NIGHT __
d. Any green leafy vegetables like spinach, wild spinach, cassava leaves, sweet potato leaves, pumpkin leaves, black jack leaves, bean leaves?
YESTERDAY/LAST NIGHT __
e. Mango or papaya?
YESTERDAY/LAST NIGHT __
f. Any other fruits and vegetables likes bananas, apple/sauce, green beans, avocados, tomatoes, oranges, mandarines, citrus fruits, lemons, wild fruits and vegetables?
YESTERDAY/LAST NIGHT __
g. Meat, chicken, fish, kapenta, chisense, caterpillars, or eggs?
YESTERDAY/LAST NIGHT __
h. Legumes, lentils, beans, soybeans, pulses, peanuts, or pounded pumpkin seeds?
YESTERDAY/LAST NIGHT __
i. Any food made with oil, fat, or butter?
YESTERDAY/LAST NIGHT __

494. In your whole life, how many tetanus injections have you received?

NO. OF TIMES ___
DON'T KNOW 98

496. Do you currently smoke cigarettes or tobacco?
IF YES: What type of tobacco do you smoke?
RECORD ALL TYPES MENTIONED.

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

497. CHECK 496:

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

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

CIGARETTES ______

499A. Have you ever drunk alcohol?

YES 1
NO 2 (GO TO 501)

499B. In the last month, on how many days did you drink alcohol?
IF EVERY DAY: RECORD '30'.

NUMBER OF DAYS _____
NONE 95

499C. Have you ever gotten 'drunk' from drinking alcohol?

YES 1
NO 2 (GO TO 501)

499D. CHECK 499B:

DRANK ALCOHOL ON AT LEAST ONE DAY (GO TO 499E)
NONE (GO TO 501)

499E. In the last month, on how many occasions did you get 'drunk'?

NUMBER OF TIMES ___
NONE/NEVER 95

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

501. Are you currently married or living with a man?

YES, CURRENTLY MARRIED 1 (GO TO 505)
YES, LIVING WITH A MAN 2 (GO TO 505)
NO, NOT IN UNION 3

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

YES, FORMERLY MARRIED 1
YES, LIVED WITH A MAN 2 (GO TO 510)
NO 3 (GO TO 514)

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

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

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

506. RECORD THE HUSBAND'S/PARTNER'S NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.

NAME _______
LINE NO. ____

507. Does your husband/partner have any other wives besides yourself?

YES 1
NO 2 (GO TO 510)

508. How many other wives does he have?

NUMBER __
DON'T KNOW 8 (GO TO 510)

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

RANK __

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

ONCE 1
MORE THAN ONCE 2

511. CHECK 510:

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?

MONTH ___
DON'T KNOW MONTH 98
YEAR ___ (GO TO 514)
DON'T KNOW YEAR 9998

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

AGE ____

514. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues. How old were you when you first had sexual intercourse (if ever)?

NEVER 00 (GO TO 524)
AGE IN YEARS ________
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95

515. When was the last time you had sexual intercourse?
RECORD 'YEARS AGO' ONLY IF LAST INTERCOURSE WAS ONE OR MORE YEARS AGO. IF 12 MONTHS OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO 1 __
WEEKS AGO 2 __
MONTHS AGO 3 __
YEARS AGO 4 __ (GO TO 524)

516. The last time you had sexual intercourse, was a condom used?
IF YES, PROBE FOR TYPE OF CONDOM USED.

YES, MALE 1
YES, FEMALE 2
NO 3 (GO TO 516B)

516A. What was the main reason you used a condom on that occasion?

RESPONDENT WANTED TO PREVENT STD/HIV 01 (GO TO 517)
RESPONDENT WANTED TO PREVENT PREGNANCY 02 (GO TO 517)
RESPONDENT WANTED TO PREVENT BOTH STD/HIV AND
PREGNANCY 03 (GO TO 517)
DID NOT TRUST PARTNER/FELT PARTNER HAD OTHER
PARTNERS 04 (GO TO 517)
PARTNER REQUESTED/INSISTED 05 (GO TO 517)
OTHER (SPECIFY) ________ 96 (GO TO 517)
DON'T KNOW 98 (GO TO 517)

516B. What is the main reason you did not use a condom that time?

NOT AVAILABLE 01
COST TOO MUCH 02
USED FAMILY PLANNING METHOD 03
TRUSTED PARTNER 04
PARTNER TESTS NEGATIVE/NO RISK 05
RESPONDENT DOESN'T LIKE 06
PARTNER REFUSED/OBJECTED 07
PARTNER DRUNK/ON DRUGS 08
WANTED TO GET PREGNANT 09
OTHER (SPECIFY) ________ 96

517. What is your relationship to the man with whom you last had sex?
IF MAN IS 'BOYFRIEND' OR 'FIANCE', ASK: Was your boyfriend/fiance living with you when you last had sex?
IF YES, CIRCLE '01'. IF NO, CIRCLE '02'.

SPOUSE/COHABITING PARTNER 01 (GO TO 519)
MAN IS BOYFRIEND/FIANCE 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
COMMERCIAL SEX WORKER 06
OTHER (SPECIFY) ________ 96

518. For how long have you had sexual relations with this man?

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

519. Have you had sex with any other man in the last 12 months?

YES 1
NO 2 (GO TO 524)

520. The last time you had sexual intercourse with this other man, was a condom used?

YES 1
NO 2 (GO TO 520B)

520A. What was the main reason you used a condom on that occasion?

RESPONDENT WANTED TO PREVENT STD/HIV 01 (GO TO 521)
RESPONDENT WANTED TO PREVENT PREGNANCY 02 (GO TO 521)
RESPONDENT WANTED TO PREVENT BOTH STD/HIV AND
PREGNANCY 03 (GO TO 521)
DID NOT TRUST PARTNER/FELT PARTNER HAD OTHER
PARTNERS 04 (GO TO 521)
PARTNER REQUESTED/INSISTED 05 (GO TO 521)
OTHER (SPECIFY) ________ 96 (GO TO 521)
DON'T KNOW 98 (GO TO 521)

520B. What is the main reason you did not use a condom that time?

NOT AVAILABLE 01
COST TOO MUCH 02
USED FAMILY PLANNING METHOD 03
TRUSTED PARTNER 04
PARTNER TESTS NEGATIVE/NO RISK 05
RESPONDENT DOESN'T LIKE 06
PARTNER REFUSED/OBJECTED 07
PARTNER DRUNK/ON DRUGS 08
WANTED TO GET PREGNANT 09
OTHER (SPECIFY) ________ 96

521. What is your relationship to this man?
IF MAN IS 'BOYFRIEND' OR 'FIANCE', ASK: Was your boyfriend/fiance living with you when you last had sex with him?
IF YES, CIRCLE '01'. IF NO, CIRCLE '02'.

SPOUSE/COHABITING PARTNER 01 (GO TO 522A)
MAN IS BOYFRIEND/FIANCE 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
COMMERCIAL SEX WORKER 06
OTHER (SPECIFY) ________ 96

522. For how long have you had sexual relations with this man?

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

522A. Other than these two men, have you had sex with any other man in the last 12 months?

YES 1
NO 2 (GO TO 524)

522B. The last time you had sex with this other man, was a condom used?

YES, MALE 1
YES, FEMALE 2
NO 2 (GO TO 522D)

522C. What was the main reason you used a condom on that occasion?

RESPONDENT WANTED TO PREVENT STD/HIV 01 (GO TO 522E)
RESPONDENT WANTED TO PREVENT PREGNANCY 02 (GO TO 522E)
RESPONDENT WANTED TO PREVENT BOTH STD/HIV AND
PREGNANCY 03 (GO TO 522E)
DID NOT TRUST PARTNER/FELT PARTNER HAD OTHER
PARTNERS 04 (GO TO 522E)
PARTNER REQUESTED/INSISTED 05 (GO TO 522E)
OTHER (SPECIFY) ________ 96 (GO TO 522E)
DON'T KNOW 98 (GO TO 522E)

522D. What is the main reason you did not use a condom that time?

NOT AVAILABLE 01
COST TOO MUCH 02
USED FAMILY PLANNING METHOD 03
TRUSTED PARTNER 04
PARTNER TESTS NEGATIVE/NO RISK 05
RESPONDENT DOESN'T LIKE 06
PARTNER REFUSED/OBJECTED 07
PARTNER DRUNK/ON DRUGS 08
WANTED TO GET PREGNANT 09
OTHER (SPECIFY) ________ 96

522E. What is your relationship to this man?
IF MAN IS 'BOYFRIEND' OR 'FIANCE', ASK: Was your boyfriend/fiance living with you when you last had sex with him?
IF YES, CIRCLE '01'. IF NO, CIRCLE '02'.

SPOUSE/COHABITING PARTNER 01 (GO TO 523)
MAN IS BOYFRIEND/FIANCE 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
COMMERCIAL SEX WORKER 06
OTHER (SPECIFY) ________ 96

522F. For how long have you had sexual relations with this man?

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

523. In total, with how many different men have you had sex in the last 12 months?

NUMBER OF PARTNERS ___

524. Do you know of a place where a person can get male condoms?

YES 1
NO 2 (GO TO 526B)

525. Where is that? Any other 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.
RECORD ALL SOURCES MENTIONED.

(NAME OF PLACE) ____________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST C
OTHER PUBLIC (SPECIFY) ______ D

PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/SURGERY E
MISSION HOSPITAL/CLINIC F
PHARMACY G
PRIVATE DOCTOR H
OTHER PRIVATE MEDICAL (SPECIFY) ______ I
OTHER SOURCE
SHOP J
COMMUNITY-BASED AGENT/HEALTH WORKER K
FRIEND/RELATIVE L
SCHOOL M
BAR, HOTEL N
OTHER (SPECIFY) _______________ X

526. If you wanted to, could you yourself get a condom?

YES 1 (GO TO 526B)
NO 2
DONT KNOW/UNSURE 8

526A. Why not?

NO MONEY/TOO EXPENSIVE 1
TOO EMBARASSED 2
NO TRANSPORT 3
OTHER (SPECIFY) __________ 6

526B. Do you think you could ask your partner to use a condom?

YES 1
NO 2
DONT KNOW/NOT SURE 8

527. CHECK 301(08):
EVER HEARD OF FEMALE CONDOM

CODE '1' CIRCLED (GO TO 528)
CODE '2' CIRCLED (GO TO 601)

528. Do you know of a place where a person can get female condoms?

YES 1
NO 2 (GO TO 530)

529. Where is that? Any other 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. RECORD ALL SOURCES MENTIONED.

(NAME OF PLACE) ____________
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST C
OTHER PUBLIC (SPECIFY) ______ D

PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/SURGERY E
MISSION HOSPITAL/CLINIC F
PHARMACY G
PRIVATE DOCTOR H
OTHER PRIVATE MEDICAL (SPECIFY) ______ I
OTHER SOURCE
SHOP J
COMMUNITY-BASED AGENT/HEALTH WORKER K
FRIEND/RELATIVE L
SCHOOL M
BAR, HOTEL N
OTHER (SPECIFY) _______________ X

530. Which brand of female condom have you heard of?
RECORD ALL MENTIONED.
ASK Q.531 IF 'CARE' IS MENTIONED.

CARE A
FEMIDOM B (GO TO 601)
NONE C (GO TO 601)
OTHER (SPECIFY) ____________ X (GO TO 601)

531. Where have you seen or heard messages about CARE female condom?

RADIO A
TV B
SHOP C
LEAFLETS/BOOKLETS D
POSTER E
COMMUNITY-BASED AGENT/HEALTH WORKER F
OTHER (SPECIFY) ______________ X

SECTION 6. FERTILITY PREFERENCES

601. CHECK 311/311A:

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

602. CHECK 226:

NOT PREGNANT OR 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?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 604)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 614)
UNDECIDED/DON'T KNOW AND PREGNANT 4 (GO TO 610)
UNDECIDED/DON'T KNOW AND NOT PREGNANT OR UNSURE 5 (GO TO 608)

603. CHECK 226:

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

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

MONTHS 1 ___
YEARS 2 ___

SOON/NOW 993 (GO TO 609)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 614)
AFTER MARRIAGE 995 (GO TO 609)
OTHER (SPECIFY) _____ 996 (GO TO 609)
DON'T KNOW 998 (GO TO 609)

604. CHECK 226:

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

605. CHECK 310:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 606)
NOT CURRENTLY USING (GO TO 606)
CURRENTLY USING (GO TO 608)

606. CHECK 603:

NOT ASKED (GO TO 607)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 607)
00-23 MONTHS OR 00-01 YEAR (GO TO 610)

607. CHECK 602:

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

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

RECORD ALL REASONS MENTIONED.

NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
INFERTILE E
POSTPARTUM AMENORRHEIC F
BREASTFEEDING G
FATALISTIC H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
HEALTH CONCERNS O
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COSTS TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY'S NORMAL PROCESSES T
OTHER _______ X
DON'T KNOW Z

608. In the next few weeks, if you discovered that you were pregnant, would that be a big problem, a small problem, or no problem for you?

BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
SAYS SHE CAN'T GET PREGNANT/NOT HAVING SEX 4

609. CHECK 310:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 610)
NO, NOT CURRENTLY USING (GO TO 610)
YES, CURRENTLY USING (GO TO 614)

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

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

611. Which contraceptive method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 614)
MALE STERILIZATION 02 (GO TO 614)
PILL 03 (GO TO 614)
IUD 04 (GO TO 614)
INJECTABLES 05 (GO TO 614)
IMPLANTS 06 (GO TO 614)
CONDOM 07 (GO TO 614)
FEMALE CONDOM 08 (GO TO 614)
DIAPHRAGM/FOAM/JELLY 09 (GO TO 614)
LACTATIONAL AMEN. METHOD 10 (GO TO 614)
NATURAL FAMILY PLANNING 11 (GO TO 614)
WITHDRAWAL 12 (GO TO 614)
OTHER (SPECIFY) ______ 96 (GO TO 614)
UNSURE 98 (GO TO 614)

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

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX/NO SEX 22 (GO TO 614)
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 614)
INFERTILE 24 (GO TO 614)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (GO TO 614)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 614)
HUSBAND/PARTNER OPPOSED 32 (GO TO 614)
OTHERS OPPOSED 33 (GO TO 614)
RELIGIOUS PROHIBITION 34 (GO TO 614)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 614)
KNOWS NO SOURCE 42 (GO TO 614)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 614)
FEAR OF SIDE EFFECTS 52 (GO TO 614)
LACK OF ACCESS/TOO FAR 53 (GO TO 614)
COSTS TOO MUCH 54 (GO TO 614)
INCONVENIENT TO USE 55 (GO TO 614)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 614)
OTHER _______ 96 (GO TO 614)
DON'T KNOW 98 (GO TO 614)

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

YES 1
NO 2
DON'T KNOW 8

614. CHECK 216:

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

NO LIVING CHILDREN: If you could choose exactly the number of children to have in your whole life, how many would that be?

PROBE FOR A NUMERIC RESPONSE.

NUMBER ____
OTHER (SPECIFY) ____ 96 (GO TO 616)

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

NUMBER OF BOYS____
OTHER (SPECIFY) ______ 96
NUMBER OF GIRLS____
OTHER (SPECIFY) ______ 96
NUMBER OF EITHER SEX____
OTHER (SPECIFY) ______ 96

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

APPROVE 1
DISAPPROVE 2
DON'T KNOW/UNSURE 8

617. In the last few months, have you discussed the practice of family planning with your friends, neighbors, or relatives?

YES 1
NO 2 (GO TO 619)

618. With whom?
Anyone else?
RECORD ALL PERSONS MENTIONED.

HUSBAND A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER F
SON G
MOTHER-IN-LAW H
FRIENDS/NEIGHBORS I
OTHER (SPECIFY) ____________ X

619. CHECK 501:

YES, CURRENTLY MARRIED (GO TO 620)
YES, LIVING WITH A MAN (GO TO 620)
NO, NOT IN UNION (GO TO 626)

620. CHECK 311/311A:

AT LEAST ONE CODE CIRCLED (GO TO 621)
NO CODE CIRCLED (GO TO 622)

621. You have told me that you are currently using contraception. Would you say that using contraception is mainly your decision, mainly your husband's/partner's decision or did you both decide together?

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

622. 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 contraceptive method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

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

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

625. 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?

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

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

On the radio?
On the television?
In a newspaper or magazine?

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

626A. Have you ever heard of an oral contraception pill called Safeplan?

YES 1
NO 2
NOT SURE 8

627. In the last six months, have you listened to the following programs on the radio?

Your health matters?
Lifeline?
AIDS and the family?
Our neighborhood?

YOUR HEALTH MATTERS
YES 1
NO 2
LIFELINE
YES 1
NO 2
AIDS AND THE FAMILY
YES 1
NO 2
OUR NEIGHBORHOOD
YES 1
NO 2

628. In the last six months, have you seen any of the following programs on television?

Your health matters?
Lifeline?
Soul city?
X-plosion?

YOUR HEALTH MATTERS
YES 1
NO 2
LIFELINE
YES 1
NO 2
SOUL CITY
YES 1
NO 2
X-PLOSION
YES 1
NO 2

629. Have you ever seen a newspaper called 'Trendsetters' aimed at young people?

YES 1
NO 2
DON'T KNOW 8

630. Is there a Neighborhood Health Committee (NHC) in your neighborhood?

YES 1
NO 2 (GO TO 632)
DON'T KNOW 8 (GO TO 632)

631. Have you ever attended a meeting organized by the NHC?

YES 1
NO 2

632. Husbands and wives do not always agree on everything. Please tell me if you think a wife is justified in refusing to have sex with her husband when:

She knows her husband has a sexually transmitted disease?
She knows her husband has sex with other women?
She has recently given birth?
She is tired or not in the mood?

HAS STD
YES 1
NO 2
DK 8
OTHER WOMEN
YES 1
NO 2
DK 8
RECENT BIRTH
YES 1
NO 2
DK 8
TIRED/MOOD
YES 1
NO 2
DK 8

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

701. CHECK 501 AND 502:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 702)
FORMERLY MARRIED/LIVED WITH A MAN (GO TO 703)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 707)

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

AGE IN COMPLETED YEARS _______

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

YES 1
NO 2 (GO TO 706)

704. What was the highest level of school he attended: primary, secondary, or higher?

PRIMARY 1
SECONDARY 2
HIGHER 3
DON'T KNOW 8 (GO TO 706)

705. What was the highest grade he completed at that level?

GRADE ____
DON'T KNOW 98

706. CHECK 701:

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

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

OCCUPATION____

707. Aside from your own housework, are you currently working?

YES 1 (GO TO 710)
NO 2

708. 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?

YES 1 (GO TO 710)
NO 2

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

YES 1
NO 2 (GO TO 719)

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

OCCUPATION_____________ ___

711. CHECK 710:

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

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

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

713. 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

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

HOME 1
AWAY 2

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

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

716. Are you paid or do you earn 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 (GO TO 719)
NOT PAID 4 (GO TO 719)

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5

718. On average, how much of your household's expenditures do your earnings pay for: almost none, less than half, about half, more than half, or all?

ALMOST NONE 1
LESS THAN HALF 2
ABOUT HALF 3
MORE THAN HALF 4
ALL 5
NONE, HER INCOME IS ALL SAVED 6

719. Who in your family usually has the final say on the following decisions:

Your own health care?
RESPONDENT = 1
HUSBAND/PARTNER = 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY = 3
SOMEONE ELSE = 4
RESPONDENT AND SOMEONE ELSE JOINTLY = 5
DECISION NOT MADE/NOT APPLICABLE = 6
Making large household purchases?
RESPONDENT = 1
HUSBAND/PARTNER = 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY = 3
SOMEONE ELSE = 4
RESPONDENT AND SOMEONE ELSE JOINTLY = 5
DECISION NOT MADE/NOT APPLICABLE = 6
Deciding when to visit family, friends or relatives?
RESPONDENT = 1
HUSBAND/PARTNER = 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY = 3
SOMEONE ELSE = 4
RESPONDENT AND SOMEONE ELSE JOINTLY = 5
DECISION NOT MADE/NOT APPLICABLE = 6
Deciding how many children to have and when?
RESPONDENT = 1
HUSBAND/PARTNER = 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY = 3
SOMEONE ELSE = 4
RESPONDENT AND SOMEONE ELSE JOINTLY = 5
DECISION NOT MADE/NOT APPLICABLE = 6

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

CHILDREN UNDER 10 YRS.
PRES/LISTEN. 1
PRES/NOT LISTEN. 2
NOT PRES 8
HUSBAND
PRES/LISTEN. 1
PRES/NOT LISTEN. 2
NOT PRES 8
OTHER MALES
PRES/LISTEN. 1
PRES/NOT LISTEN. 2
NOT PRES 8
OTHER FEMALES
PRES/LISTEN. 1
PRES/NOT LISTEN. 2
NOT PRES 8

720A. CHECK 720 FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL RESPONDENT IS ALONE.

RESPONDENT ALONE AND ELIGIBLE FOR Qs. 720A-720L (GO TO 720B)
READ TO ALL RESPONDENTS:
Now I would like to ask you some personal questions. I know that these questions are very personal. However, your answers are crucial for helping to understand how women are treated in their household. Your answers are completely confidential and will not be told to anyone in this household.
RESPONDENT NOT ALONE OR NOT ELIGIBLE FOR Qs. 720A-720L (GO TO 721)

720B. CHECK 501 AND 502:

CURRENTLY MARRIED/LIVING WITH A MAN/FORMELY MARRIED/LIVED WITH A MAN (GO TO 720C)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 720E)

720C. CHECK 720B:

CURRENTLY MARRIED/LIVING WITH A MAN: Has your husband/partner ever slapped you, hit you, kicked you, thrown things at you, or done anything else to physically hurt you?

FORMERLY MARRIED/LIVED WITH A MAN: Has you last husband/partner ever slapped you, hit you, kicked you, thrown things at your, or done anything else to physically hurt you?

YES 1
NO 2 (GO TO 720E)
NO ANSWER 6 (GO TO 720E)

720D. In the last 12 months, how many times did this happen?

NUMBER OF TIMES ___

720E. CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN/FORMERLY MARRIED/LIVED WITH A MAN: From the time you were 15 years old has anyone other than your (current/last) husband/partner slapped you, hit you, kicked you, thrown things at you, or done anything else to physically hurt you?

NEVER MARRIED/NEVER LIVED WITH A MAN: From the time you were 15 years old has anyone slapped you, hit you, kicked you, thrown things at you, or done anything else to physically hurt you?

YES 1
NO 2 (GO TO 720G)
NO ANSWER 6 (GO TO 720G)

720EX. Who did this to you?
RECORD ALL MENTIONED.

FATHER A
MOTHER B
FATHER-IN-LAW C
MOTHER-IN-LAW D
BROTHER E
SISTER F
SON G
DAUGHTER H
LATE/EX-HUSBAND/EX-PARTNER I
CURRENT BOYFRIEND J
FORMER BOYFRIEND K
OTHER MALE RELATIVE L
OTHER FEMALE RELATIVE M
MALE FRIEND N
FEMALE FRIEND O
TEACHER P
EMPLOYER Q
STRANGER R
OTHER (SPECIFY) _____________ X

720F. In the last 12 months, how many times did this happen?

NUMBER OF TIMES ___

720G. Have you ever been forced by a man to have sexual intercourse with him when you did not want to?

YES 1
NO 2 (GO TO 720J)

720H. Who did this to you?
RECORD ALL MENTIONED.
Anyone else?

HUSBAND/LIVE-IN PARTNER A
BOYFRIEND B
FATHER C
BROTHER D
OTHER MALE RELATIVE E
MALE FRIEND F
TEACHER G
EMPLOYER H
STRANGER I
FATHER-IN-LAW J
FORMER HUSBAND/LIVE-IN PARTNER K
FORMER BOYFRIEND L
OTHER (SPECIFY) _____________ X

720I. In the last 12 months, how many times did this happen?

NUMBER OF TIMES ___

720J. Has anyone ever made you have sexual intercourse with some other person when you did not want to?

YES 1
NO 2 (GO TO 7201)

720K. Who was the person that made you have sexual intercourse with some other person?
RECORD ALL MENTIONED.
Anyone else?

HUSBAND/LIVE-IN PARTNER A
BOYFRIEND B
FATHER C
MOTHER D
BROTHER E
SISTER F
OTHER MALE RELATIVE G
OTHER FEMALE RELATIVE H
MALE FRIEND I
FEMALE FRIEND J
TEACHER K
EMPLOYER L
STRANGER M
MOTHER-IN-LAW N
FATHER-IN-LAW O
FORMER HUSBAND/LIVE-IN PARTNER P
FORMER BOYFRIEND Q
OTHER (SPECIFY) _____________ X

720L. In the last 12 months, how many times did this happen?

NUMBER OF TIMES ___

721. Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

If she goes out with another man?
If she neglects the children?
If she argues with him?
If she refuses to have sex with him?
If she cooks bad food or food is late?

GOES WITH MAN
YES 1
NO 2
DK 8
NEGL.CHILDREN
YES 1
NO 2
DK 8
ARGUES
YES 1
NO 2
DK 8
REFUSES SEX
YES 1
NO 2
DK 8
BAD/LATE FOOD
YES 1
NO 2
DK 8

SECTION 8. AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES

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

YES 1
NO 2 (GO TO 817)

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

YES 1
NO 2 (GO TO 809)
DON'T KNOW 8 (GO TO 809)

803. What can a person do?
Anything else?
RECORD ALL WAYS MENTIONED.

ABSTAIN FROM SEX A
USE CONDOMS B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER C
LIMIT NUMBER OF SEX PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH PERSONS WHO INJECT DRUGS INTRAVENOUSLY H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID SHARING RAZORS/BLADES K
AVOID KISSING L
AVOID MOSQUITO BITES M
SEEK PROTECTION FROM TRADITIONAL PRACTIONER N
OTHER (SPECIFY) _______ W
OTHER (SPECIFY) _______ X
DON'T KNOW Z

804. Can people reduce their chances of getting the AIDS virus by having just one sex partner who has no other partners?

YES 1
NO 2
DON'T KNOW 8

805. Can people get the AIDS virus from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

806. Can people reduce their chances of getting the AIDS virus by using a condom every time they have sex?

YES 1
NO 2
DON'T KNOW 8

807. Can people get the AIDS virus by sharing food with a person who has AIDS?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

810. Do you know someone personally who has the virus that causes AIDS or someone who died of AIDS?

YES 1
NO 2

811. Can the virus that causes AIDS be transmitted from a mother to a child?

YES 1
NO 2 (GO TO 813)
DON'T KNOW 8 (GO TO 813)

812. Can the virus that causes AIDS be transmitted from a mother to a child:

During pregnancy?
During delivery?
By breastfeeding?

DURING PREG.
YES 1
NO 2
DK 8
DURING DELIVERY
YES 1
NO 2
DK 8
BREASTFEEDING
YES 1
NO 2
DK 8

812A. Is there anything that can be done to reduce the chances that a mother would transmit the AIDS virus to her child?

YES 1
NO 2
DON'T KNOW 8

813. CHECK 501:

YES, CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 814)
NO, NOT IN UNION (GO TO 814A)

814. Have you ever talked with (your husband/the man you are living with) about ways to prevent getting the virus that causes AIDS?

YES 1
NO 2

814A. In your opinion, is it acceptable or unacceptable for condoms to be discussed:

on the radio?
on the TV?
in newspapers?

ON THE RADIO
ACCEPTABLE 1
NOT ACCEPTABLE 2
ON THE TV
ACCEPTABLE 1
NOT ACCEPTABLE 2
IN NEWSPAPERS
ACCEPTABLE 1
NOT ACCEPTABLE 2

815. If a member of your family got infected with the virus that causes AIDS, would you want it to remain a secret or not?

YES 1
NO 2
DK/NOT SURE 8

816. If a relative of yours became sick with the virus that causes AIDS, would you be willing to care for her or him in your own household?

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

816A. If a worker is sick with AIDS, should he/she be allowed to work?

ALLOWED 1
NOT ALLOWED 2
DK/NOT SURE/DEPENDS 8

816B. If you knew that a shopkeeper or food seller has the AIDS virus, would you buy food items from them?

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

816C. In the last six months, have you seen any adverts about sexual abstinence, condom use or HIV/AIDS?

YES 1
NO 2 (GO TO 816E)
DON'T KNOW/NOT SURE 8 (GO TO 816E)

816D. Can you describe which ones?
DO NOT READ RESPONSES TO RESPONDENT.
RECORD ALL MENTIONED.

YOU CLEVER GIRL A
BOYS SAYING WHY THEY ABSTAIN FROM SEX B
SAY NO TO SEX/VIRGIN POWER/VIRGIN PRIDE C
ICE IS AT BRAII/ICE GETS STD D
ICE FIXING CAR/FRIEND TELLS HIM TO USE CONDOM EVERY TIME E
CHRISTINE BRAIDING HAIR/FRIENDS SAY USE CONDOM F
BOYS PLAYING BASKETBALL/ONE HIV PLUS/CAN'T TELL WHICH ONE G
GIRLS WALKING/ONE HIV PLUS/CAN'T TELL WHICH ONE H
OTHER (SPECIFY) __________________ X

816E. Should youth age 12-14 be taught about using a condom to avoid AIDS?

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

816F. Do you think your chances of getting AIDS are small, moderate, great, or do you think that you have no chance of getting it at all?

SMALL 1
MODERATE 2 (GO TO 816H)
GREAT 3 (GO TO 816H)
NO RISK AT ALL 4
HAS AIDS 5 (GO TO 816H)

816G. Why do you think your chances of getting AIDS are low?
RECORD ALL MENTIONED.

ABSTAIN FROM SEX A
USE CONDOMS B
HAS ONLY 1 SEX PARTNER C
LIMITED NUMBER OF PARTNERS D
PARTNER HAS NO OTHER PARTNERS E
NO BLOOD TRANSFUSIONS/INJECTIONS F
OTHER (SPECIFY) _______ X
DON'T KNOW Z

816H. Have you ever been tested to see if you have the AIDS virus?

YES 1 (GO TO 816KX)
NO 2

816I. Would you want to be tested for the AIDS virus?

YES 1
NO 2
DON'T KNOW/UNSURE 8

816J. Do you know a place where you could go to get an AIDS test?

YES 1
NO 2 (GO TO 817)

816K. Where can you go for the test?
RECORD ONLY FIRST RESPONSE GIVEN.
816KX. Where did you go for the test?
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
GOVERNMENT HEALTH POST 13
OTHER PUBLIC (SPECIFY) ______ 16

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/SURGERY 21
MISSION HOSPITAL 22
PHARMACY 23
PRIVATE DOCTOR 24
WORK PLACE 25
OTHER PRIVATE MEDICAL (SPECIFY) ______ 26

817. (Apart from AIDS), have you heard about other infections that can be transmitted through sexual contact?

YES 1
NO 2 (GO TO 819C)

818. If a man has a sexually transmitted disease, what symptoms might he have?
Any others?
RECORD ALL SYMPTOMS MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE/DRIPPING B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
LOSS OF WEIGHT K
IMPOTENCE L
OTHER (SPECIFY) ________ W
OTHER (SPECIFY) ________ X
NO SYMPTOMS Y
DON'T KNOW Z

819. If a woman has a sexually transmitted disease, what symptoms might she have?
Any others?
RECORD ALL SYMPTOMS MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
LOSS OF WEIGHT K
HARD TO GET PREGNANT/HAVE A CHILD L
OTHER (SPECIFY) ________ W
OTHER (SPECIFY) ________ X
NO SYMPTOMS Y
DON'T KNOW Z

819A. CHECK 514:

HAS HAD SEXUAL INTERCOURSE (GO TO 819B)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 901)

819B. Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a sexually-transmitted disease?

YES 1
NO 2
DON'T KNOW 8

819C. Sometimes, women experience a heavy or bad smelling genital discharge.
During the last 12 months, have you had a heavy or bad smelling genital discharge?

YES 1
NO 2
DON'T KNOW 8

819D. 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 8

819E. CHECK 819B, 819C, 819D:

HAS HAD AN INFECTION (GO TO 819F)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 901)

819F. The last time you had (PROBLEM FROM 819B/819C/819D), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 819H)

819G. The last time you had (PROBLEM FROM 819B/819C/819D), did you do any of the following? Did you....

Go to a clinic, hospital or private doctor?
Consult a traditional healer?
Seek advice or buy medicines in a shop or pharmacy?
Ask for advice from friends or relatives?

CLINIC/HOSPITAL
YES 1
NO 2
TRADITIONAL HEALER
YES 1
NO 2
SHOP/PHARMACY
YES 1
NO 2
FRIENDS/RELATIVES
YES 1
NO 2

819H. When you had (PROBLEM FROM 819B/819C/819D), did you inform the person with whom you were having sex?

YES 1
NO 2
SOME/NOT ALL 3
DID NOT HAVE A PARTNER 4 (GO TO 901)

819I. When you had (PROBLEM FROM 819B/819C/819D), did you do something to avoid infecting your sexual partner(s)?

YES 1
NO 2 (GO TO 901)
PARTNER ALREADY INFECTED 3 (GO TO 901)

819J. What did you do to avoid infecting your partner(s)? Did you....

Use medicine?
Stop having sex?
Use a condom when having sex?

USE MEDICINE
YES 1
NO 2
STOP SEX
YES 1
NO 2
USE CONDOM
YES 1
NO 2

SECTION 9. MATERNAL MORTALITY

901. Now I would like to ask you 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:

TWO OR MORE BIRTHS (GO TO 903)
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 914)

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

NUMBER OF PRECEDING BIRTHS ____

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

NAME__________

905. Is (NAME) male or female?

MALE 1
FEMALE 2

906. Is (NAME) still alive?

YES 1
NO 2 (GO TO 908)
DK 8 (GO TO NEXT BROTHER OR SISTER)

907. How old is (NAME)?

AGE__________ (GO TO NEXT BROTHER OR SISTER)

908. How many years ago did (NAME) die?

YEARS____

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

AGE__________ (IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO NEXT BROTHER OR SISTER)

910. Was (NAME) pregnant when she died?

YES 1 (GO TO 913)
NO 2

911. Did (NAME) die during childbirth?

YES 1 (GO TO 913)
NO 2

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

YES 1
NO 2

913. How many live born children did (NAME) give birth to during her lifetime (before this pregnancy)?

NUMBER__________

IF NO MORE BROTHERS OR SISTERS, GO TO 914.

914. RECORD THE TIME.

HOURS ____
MINUTES ____

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT:
__________________________________

COMMENTS ON SPECIFIC QUESTIONS:
_______________________________

ANY OTHER COMMENTS:
_______________________________

SUPERVISOR'S OBSERVATIONS
_______________________________

NAME OF THE SUPERVISOR:__________ DATE:____________________

EDITOR'S OBSERVATIONS
_______________________________

NAME OF EDITOR:________________________DATE:_____________________