WARD/VILLAGE __________
NAME OF HOUSEHOLD HEAD __________
CLUSTER NUMBER ___
HOUSEHOLD NUMBER ___
PROVINCE __________
RURAL 2
OTHER URBAN 2
RURAL 3
LINE NUMBER ___
FIRST VISIT:
DATE _____
INTERVIEWER'S NAME __________
RESULT __________
NEXT VISIT:
DATE _____
TIME _____
SECOND VISIT:
DATE _____
INTERVIEWER'S NAME __________
RESULT __________
NEXT VISIT:
DATE _____
TIME _____
THIRD VISIT:
DATE _____
INTERVIEWER'S NAME __________
RESULT __________
FINAL VISIT:
DAY ___
MONTH __________
YEAR _____
NAME __________
RESULT __________
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) __________
LANGUAGE OF QUESTIONNAIRE: ENGLISH
NDEBELE 2
ENGLISH 3
OTHER (SPECIFY) __________ 6
DATE _____
FIELD EDITOR
DATE _____
OFFICE EDITOR ___
KEYED BY ___
SECTION 1. RESPONDENT'S BACKGROUND
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 town or in a rural area? IF TOWN: Which town?
OTHER URBAN 2
RURAL 3
105) In what month and year were you born?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 98
106) How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.
107) Have you ever attended school?
NO 2 (SKIP TO 114)
108) What is the highest level of school you attended: primary, secondary, or higher?
SECONDARY 2
HIGHER 3
109) What is the highest (grade/form/year) you completed at that level?
AGE 25 OR ABOVE ___ (SKIP TO 113)
111) Are you currently attending school?
NO 2
112) What was the main reason you stopped attending school?
GOT MARRIED 02
HAD TO CARE FOR YOUNGER CHILDREN 03
FAMILY NEEDED HELP ON FARM OR IN BUSINESS 04
COULD NOT PAY SCHOOL FEES 05
NEEDED TO EARN MONEY 06
GRADUATED/HAD ENOUGH SCHOOLING 07
BAD GRADES 08
DID NOT LIKE SCHOOL 09
SCHOOL NOT ACCESSIBLE/TOO FAR 10
OTHER (SPECIFY) __________ 96
DON'T KNOW 98
SECONDARY OR HIGHER ___ (SKIP TO 115)
114) Can you read and understand a letter or newspaper easily, with difficulty, or not at all?
WITH DIFFICULTY 2
NOT AT ALL 3 (SKIP TO 116)
115) Do you usually read a newspaper or magazine at least once a week?
NO 2
116) Do you usually listen to a radio every day?
NO 2
117) Do you usually watch television at least once a week?
NO 2
SPIRITUAL 2
CHRISTIAN 3
OTHER (SPECIFY) __________ 6
WHITE 2
COLOURED 3
ASIAN 4
OTHER (SPECIFY) __________ 6
120) CHECK QUESTION 4 IN THE HOUSEHOLD QUESTIONNAIRE
THE WOMAN INTERVIEWED IS A USUAL RESIDENT ___ (SKIP TO 201)
121) Now I would like to ask about the place in which you usually live. Do you usually live in a town or in a rural area? IF TOWN: Which town?
OTHER URBAN 2
RURAL AREA 3
OUTSIDE ZIMBABWE 4 (SKIP TO 123)
122) In which province is that located?
MASHONALAND CENTRAL 02
MASHONALAND EAST 03
MASHONALAND WEST 04
MATABELELAND NORTH 05
MATABELELAND SOUTH 06
MIDLANDS 07
MASVINGO 08
HARARE/CHITUNGWIZA 09
BULAWAYO 10
123) Now I would like to ask about the household in which you usually live. What is the main source of drinking water for members of your household?
COMMUNAL TAP 12
UNPROTECTED WELL 22
BOREHOLE 23
RIVER/STREAM 32
POND/LAKE 33
DAM 34
124) How long does it take to go there, get water, and come back?
ON PREMISES 996
125) What kind of toilet facility does your household have?
SHARED FLUSH TOILET 12
BLAIR TOILET 22
126) Does your household have:
NO 2
NO 2
NO 2
NO 2
127) Could you describe the main material of the floor of your home?
VINYL OR ASPHALT STRIPS 32
CERAMIC TILES 33
CEMENT 34
CARPET 35
128) Does any member of your household own:
NO 2
NO 2
NO 2
NO 2
201) Now I would like to ask about all the births you have had during your life. Have you ever given birth?
NO 2 (SKIP TO 206)
202) Do you have any sons or daughters to whom you have given birth who are now living with you?
NO 2 (SKIP TO 204)
203) How many sons live with you? And how many daughters live with you? IF NONE RECORD '00'.
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?
NO 2 (SKIP 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'.
DAUGHTERS ELSEWHERE ___
206) Have you ever given birth to a boy or a girl who was born alive but later died? IF NO, PROBE: Any baby who cried or showed signs of life but survived only for a few hours or days?
NO 2 (SKIP TO 208)
207) How many boys have died? And how many girls have died? IF NONE RECORD '00'.
GIRLS DEAD ___
208) SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE RECORD '00'.
209) CHECK 208: Just to make sure that I have this right: you have had in TOTAL ___ births during your life. Is that correct?
NO ___ (PROBE AND CORRECT 201-208 AS NECESSARY)
NO BIRTHS ___ (SKIP TO 225)
211) Now I would like to talk to you about all of 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 SEPERATE LINES.
212) What name was given to your (first/next) baby?
213) Were any of these births twins?
MULTIPLE 2
214) Is (NAME) a boy or a girl?
GIRL 2
215) In what month and year was (NAME) born? PROBE: What is his/her birthday? OR: in what season was he/she born?
YEAR _____
NO 2 (SKIP TO 219)
217) IF ALIVE: How old was (NAME) at his/her last birthday? RECORD AGE IN COMPLETED YEARS.
218) IF ALIVE: Is (NAME) living with you?
NO 2 (SKIP TO NEXT BIRTH)
219) IF DEAD: How old was (NAME) when he/she died? IF '1 YEAR' PROBE: How many months old was (NAME)? RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.
MONTHS 2 ___
YEARS 3 ___
220) FROM YEAR OF BIRTH OF (NAME) SUBTRACT YEAR OF PREVIOUS BIRTH; IF 4 YEARS OR MORE, ASK: Were there any other live births between the birth of (NAME) and the birth of (PREVIOUS BIRTH)? (Answer for all children except the first child)
NO 2
221) SUBTRACT YEAR OF LAST BIRTH FROM 1994:
IF 4 YEARS, OR MORE, ASK: Have you had any live births since the birth of (NAME OF LAST BIRTH)?
NO 2
222) COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:
IF NUMBERS ARE SAME, CHECK:
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 ___
223) CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1991. IF NONE, RECORD '0'.
224) FOR EACH BIRTH SINCE JANUARY 1989 ENTER 'B' IN THE MONTH OF BIRTH IN COLUMN 1 OF THE CALENDAR AND 'P' IN EACH OF THE 8 PRECEDING MONTHS. WRITE NAME TO THE LEFT OF THE 'B' CODE.
NO 2 (SKIP TO 228)
UNSURE 8 (SKIP TO 228)
226) How many months pregnant are you?
ENTER 'P' IN COLUMN 1 OF CALENDAR IN MONTH OF INTERVIEW AND IN EACH PRECEDING MONTH PREGNANT.
227) 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 become pregnant at all?
LATER 2 (SKIP TO 229)
NOT AT ALL 3 (SKIP TO 229)
228) When did your last menstrual period start?
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___
IN MENOPAUSE 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996
229) Have you ever had a pregnancy that miscarried, was aborted, or ended in a stillbirth?
NO 2 (SKIP TO 301)
230) When did the last such pregnancy end?
YEAR _____
LAST PREGNANCY ENDED BEFORE JANUARY 1989 ___ (SKIP TO 301)
232) How many months pregnant were you when the last pregnancy ended?
ENTER 'T' IN COLUMN 1 OF THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' IN EACH PRECEDING MONTH OF PREGNANCY.
233) Have you ever had any other pregnancies which did not result in a live birth?
NO 2 (SKIP TO 301)
234) ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER PREGNANCY BACK TO JANUARY 1989.
ENTER 'T' IN COLUMN 1 OF THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' IN EACH PRECEDING MONTH OF PREGNANCY.
301) Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy. Which ways or methods have you heard about?
CIRCLE CODE 1 IN 302 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN THE COLUMN, 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 302, ASK 303 BEFORE PROCEEDING TO THE NEXT METHOD.
302) Have you ever heard of (METHOD)? READ DESCRIPTION OF EACH METHOD.
YES/PROBED 2
NO 3
YES/PROBED 2
NO 3
YES/PROBED 2
NO 3
YES/PROBED 2
NO 3
YES/PROBED 2
NO 3
YES/PROBED 2
NO 3
YES/PROBED 2
NO 3
YES/PROBED 2
NO 3
YES/PROBED 2
NO 3
YES/PROBED 2
NO 3
NO 3
303) Have you ever used (METHOD)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
AT LEAST ONE "YES" (EVER USED) ___ (SKIP TO 308)
305) Have you ever used anything or tried in any way to delay or avoid getting pregnant?
NO 2
306) ENTER "0" IN COLUMN 1 OF CALENDAR IN EACH BLANK MONTH. (SKIP TO 342)
307) What have you used or done? CORRECT 303 AND 304 (AND 302 IF NECESSARY).
308) Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant.
What was the first method you ever used?
IUD 02
INJECTIONS 03
IMPLANTS 04
DIAPHRAGM/FOAMING TABLET/SPONGE 05
CONDOM 06
FEMALE STERILIZATION 07
MALE STERILIZATION 08
SAFE PERIOD/RHYTHM 09
WITHDRAWAL 10
OTHER (SPECIFY) __________ 96
309) How many living children did you have at that time, if any? IF NONE, RECORD '00'.
WOMAN STERILIZED ___ (SKIP TO 313A)
PREGNANT ___ (SKIP TO 337)
312) Are you currently doing something or using any method to delay or avoid getting pregnant?
NO 2 ___ (SKIP TO 337)
313) Which method are you using?
IUD 02 (GO TO 336)
INJECTIONS 03 (GO TO 336)
IMPLANTS 04 (GO TO 336)
DIAPHRAGM/FOAMING TABLET/SPONGE 05 (GO TO 336)
CONDOM 06 (GO TO 336)
FEMALE STERILIZATION 07 (GO TO 328)
MALE STERILIZATION 08 (GO TO 328)
SAFE PERIOD/RHYTHM 09 (GO TO 333)
WITHDRAWAL 10 (GO TO 336)
OTHER (SPECIFY) ________ 96 (GO TO 336)
(NOTE: DO NOT ASK QUESTION 313A IF THE WOMAN IS NOT STERILIZED)
313A) You have said that you had an operation that keeps you from getting pregnant. Is that correct? IF RESPONDENT SAYS "NO", CORRECT 303-304 (AND 302 IF NECESSARY). IF RESPONDENT CONFIRMS WITH A "YES", CIRCLE '07' FOR FEMALE STERILIZATION.
314) At the time you first started using the pill, did you consult a doctor or a nurse?
NO 2
DON'T KNOW 8
315) Now I would like to ask some questions about the brand of pill that you are using. Please show me the package of pills you are now using. RECORD NAME OF BRAND.
NOT ABLE TO SHOW 98 (SKIP TO 318)
316) OBSERVE ORDER IN WHICH PILLS TAKEN FROM PACKET AND CIRCLE CORRECT CODE.
PILL MISSING OUT OF ORDER 2
NO PILL MISSING 3
317) Why is it that you have not taken the pills (in order)?
HEALTH REASONS 02 (SKIP TO 320)
FOLLOWING INSTRUCTIONS ON PACKET/GIVEN BY SOURCE 03 (SKIP TO 320)
NEW PACKET 04 (SKIP TO 320)
MENSTRUATING 05 (SKIP TO 320)
OTHER (SPECIFY) __________ 96 (SKIP TO 320)
318) Why don't you have a package of pills in the house?
COST TOO MUCH 02
HUSBAND AWAY 03
MENSTRUATING 04
OTHER (SPECIFY) __________ 96
319) Do you know the brand name of the pills you are now using? or: SHOW BRAND CHART FOR PILLS: Please tell me which of these is the brand of pills that you are using. RECORD NAME OF BRAND.
DON'T KNOW 98
320) At any time in the past month, have you experienced any of the following (READ EACH PROBLEM):
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
321) At any time in the past month, did you fail to take a pill for even one day because of the problems that you mentioned or for any other reason: IF YES: What was the main reason you stopped taking the pill?
OTHER ILLNESS 02
PERIOD DID NOT COME 03
RAN OUT OF PILLS 04
FORGOT/MISPLACED 05
NOT SEXUALLY ACTIVE 06
OTHER (SPECIFY) __________ 96
NEVER STOPPED TAKING THE PILL 97
322) Sometimes people forget to take the pill. What did you do the last time you forgot to take the pill?
TOOK ONE PILL THE NEXT DAY 02
TOOK TWO PILLS THE NEXT DAY 03
USED ANOTHER METHOD 04
OTHER (SPECIFY) __________ 96
323) When was the last time you took a pill?
MORE THAN ONE MONTH AGO 97
TWO DAYS AGO OR LESS ___ (SKIP TO 326)
325) Why aren't you taking the pill these days?
FORGOT 02
HEALTH REASONS 03
COST TOO MUCH 04
NO NEED TO TAKE DAILY 05
RAN OUT 06
MENSTRUATING 07
OTHER (SPECIFY) __________ 96
326) At the time you last got pills, did you consult a doctor or a nurse?
NO 2
DON'T KNOW 8
327) How much does one (packet/cycle) of pills cost you? RECORD IN CENTS.
FREE 996 (SKIP TO 336)
DON'T KNOW 998 (SKIP TO 336)
328) Where did the sterilization take place?
IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
PROVINCIAL HOSPITAL 12
DISTRICT/RURAL HOSPITAL 13
OTHER PUBLIC (SPECIFY) __________ 16
MISSION FACILITY 19
PRIVATE DOCTOR 23
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26
DON'T KNOW 98
329) Do you regret that (you/your husband) had the operation not to have any (more) children?
NO 2 (SKIP TO 331)
330) Why do you regret the operation?
PARTNER WANTS ANOTHER CHILD 02
SIDE EFFECTS 03
CHILD DIED 04
OTHER (SPECIFY) __________ 96
331) In what month and year was the sterilization performed?
YEAR _____
333) Between the first day of a woman's period and the first day of her next period, are there certain times when she has a greater chance of becoming pregnant than other times?
NO 2 (SKIP TO 335)
DON'T KNOW 8 (SKIP TO 335)
334) During which times of the monthly cycle does a woman have the greatest chance of becoming pregnant?
RIGHT AFTER HER PERIOD HAS ENDED 02
IN THE MIDDLE OF THE CYCLE 03
JUST BEFORE HER PERIOD BEGINS 04
OTHER (SPECIFY) __________ 96
DON'T KNOW 98
335) How do you determine which days of your monthly cycle not to have sexual relations?
BASED ON BODY TEMPERATURE 02
BASED ON CERVICAL MUCUS (BILLINGS METHOD) 03
BASED ON BODY TEMPERATURE AND CERVICAL MUCUS 04
NO SPECIFIC SYSTEM 05
OTHER (SPECIFY) __________ 96
336) ENTER METHOD CODE FROM 313 IN CURRENT MONTH IN COLUMN 1 OF CALENDAR. THEN DETERMINE WHEN SHE STARTED USING METHOD THIS TIME. ENTER METHOD CODE IN EACH MONTH OF USE.
ILLUSTRATIVE QUESTIONS: When did you start using continuously? How long have you been using this method continuously?
337) I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years.
USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 1989.
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.
IN EACH MONTH, ENTER CODE FOR METHOD OR '0' FOR NONUSE IN COLUMN 1. IN COLUMN 2, ENTER CODES FOR DISCONTINUATION NEXT TO LAST MONTH OF USE.
NUMBER OF CODES IN COLUMN 2 MUST BE SAME AS THE NUMBER OF INTERRUPTIONS OF CONTRACEPTIVE USE IN COLUMN 1.
ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT.
ILLUSTRATIVE QUESTIONS: COLUMN 1:
When did you start using that method? How long after the birth of (NAME)?
How long did you use the method then?
COLUMN 2:
Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop for some other reason?
IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK: "How many months did it take you to get pregnant after you stopped using (METHOD)?" AND ENTER '0' IN EACH SUCH MONTH IN COLUMN 1.
PREGNANT ___ (SKIP TO 343)
CIRCLE METHOD CODE:
PILL 01
IUD 02
INJECTIONS 03
IMPLANTS 04
DIAPHRAGM/FOAMING TABLET/CREAM 05
CONDOM 06
FEMALE STERILIZATION 07 (SKIP TO 340A)
MALE STERILIZATION 08 (SKIP TO 340A)
SAFE PERIOD/RHYTHM 09 (SKIP TO 343)
WITHDRAWL 10 (SKIP TO 343)
OTHER 96 (SKIP TO 343)
339) Where did you obtain (METHOD) the last time?
IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
RURAL/MUNICIPAL CLINIC 12
RURAL HEALTH CENTRE 13
ZNFPC MOBILE CLINIC 14
MINISTRY OF HEALTH MOBILE CLINIC 15
ZNFPC CBD 16
MINISTRY OF HEALTH CBD 17
OTHER PUBLIC (SPECIFY) __________ 18
PHARMACY 22
PRIVATE DOCTOR 23
CBD 25
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26
CHURCH 32
FRIENDS/RELATIVES 33
340) Do you know another place where you could have obtained (METHOD) the last time?
NO 2 (SKIP TO 345)
340A) At the time of the sterilization operation, did you know another place where you could have received the operation?
NO 2
341) People select the place where they get family planning services for various reasons. In your case, what was the main reason you went to the place you did rather than some other place?
RECORD RESPONSE BELOW AND CIRCLE CODE.
MAIN REASON
CLOSER TO MARKET/WORK 12
AVAILABILITY OF TRANSPORT 13
CLEANER FACILITY 22
OFFERS MORE PRIVACY 23
SHORTER WAITING TIME 24
LONGER HOURS OF OPERATION 25
USE OTHER SERVICES AT THE FACILITY 26
WANTED ANONYMITY 41
OTHER (SPECIFY) __________ 96
DON'T KNOW 98 (SKIP TO 345)
Any other reason?
RECORD RESPONSE BELOW AND CIRCLE CODE.
CLOSER TO MARKET/WORK 12 (SKIP TO 345)
AVAILABILITY 13 (SKIP TO 345)
CLEANER FACILITY 22 (SKIP TO 345)
OFFERS MORE PRIVACY 23 (SKIP TO 345)
SHORTER WAITING TIME 24 (SKIP TO 345)
LONGER HOURS OF OPERATION 25 (SKIP TO 345)
USE OTHER SERVICES AT THE FACILITY 26 (SKIP TO 345)
WANTED ANONYMITY 41 (SKIP TO 345)
NO OTHER REASON 95 (SKIP TO 345)
OTHER (SPECIFY) _________ 96 (SKIP TO 345)
342) What is the main reason you are not using a method of contraception to avoid pregnancy?
MAIN REASON
INFREQUENT SEX 22
MENOPAUSAL/HYSTERECTOMY 23
SEBFECUND/INFECUND 24
POSTPARTUM/BREASTFEEDING 25
WANTS MORE CHILDREN 26
HUSBAND OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
KNOWS NO SOURCE 42
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
DON'T KNOW 98
Any other reason?
INFREQUENT SEX 22
MENOPAUSAL/HYSTERECTOMY 23
SEBFECUND/INFECUND 24
POSTPARTUM/BREASTFEEDING 25
WANTS MORE CHILDREN 26
HUSBAND OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
KNOWS NO SOURCE 42
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
OTHER (SPECIFY) __________ 96
343) Do you know of a place where you can obtain a method of family planning?
NO 2 (SKIP TO 345)
IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
RURAL/MUNICIPAL CLINIC 12
RURAL HEALTH CENTRE 13
ZNFPC MOBILE CLINIC 14
MINISTRY OF HEALTH MOBILE CLINIC 15
ZNFPC CBD 16
MINISTRY OF HEALTH CBD 17
OTHER PUBLIC (SPECIFY) __________ 18
PHARMACY 22
PRIVATE DOCTOR 23
CBD 25
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26
CHURCH 32
FRIENDS/RELATIVES 33
345) Were you visited by a CBD in the past 12 months?
NO 2
346) Have you visited a health facility in the last 12 months?
NO 2 (SKIP TO 349A)
347) Did anyone at the health facility speak to you about family planning methods?
NO 2
348) Did anyone at the health facility ever refuse to provide you with family planning information or services?
NO 2
349A) Do you think that breastfeeding can affect a woman's chance of becoming pregnant?
NO 2 (SKIP TO 401)
DON'T KNOW 8
349B) Do you think that a woman's chance of becoming pregnant is increased or decreased by breastfeeding?
DECREASED 2
DEPENDS 3
DON'T KNOW 8
NO BIRTHS ___ (SKIP TO 401)
351) Have you ever relied on breastfeeding as a method of avoiding pregnancy?
NO 2 (SKIP TO 401)
PREGNANT ___ (SKIP TO 401)
353) Are you currently relying on breastfeeding to avoid getting pregnant?
NO 2
SECTION 4A. PREGNANCY AND BREASTFEEDING
NO BIRTHS SINCE JANUARY 1991 ___ (SKIP TO 469)
402) ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1991 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE ADDITIONAL FORMS).
Now I would like to ask you some more questions about the health of all your children born in the past three years. (We will talk about one child at a time.)
403) LINE NUMBER FROM QUESTION 212
AND QUESTION 216
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 want no (more) children at all?
LATER 2
NO MORE 3 (SKIP TO 407)
406) How much longer would you like to have waited?
YEARS 2 ___
DON'T KNOW 998
407) When you were pregnant with (NAME), 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.
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
UNTRAINED E
TRAINING UNCERTAIN F
408) How many months pregnant were you when you first received antenatal care?
DON'T KNOW 98
409) How many times did you receive antenatal care during this pregnancy?
DON'T KNOW 98
410) When you were pregnant with (NAME) were you given an injection in the right upper arm to prevent the baby from getting tetanus, that is, convulsions after birth?
NO 2 (SKIP TO 412)
DON'T KNOW 8 (SKIP TO 412)
411) During this pregnancy, how many times did you get this injection?
DON'T KNOW 8
412) Where did you give birth to (NAME)?
OTHER HOME 12
PROVINCIAL HOSPITAL 22
DIST/RURAL HOSPITAL 23
RURAL HEALTH CENTRE 24
RURAL/MUNICIPAL CLINIC 25
OTHER PUBLIC (SPECIFY) __________ 26
OTHER PRIVATE MEDICAL (SPECIFY) __________ 36
413) Who assisted with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.
NURSE/MIDWIFE B
AUXILARY MIDWIFE C
UNTRAINED E
TRAINING UNCERTAIN F
414) At the time of the birth of (NAME), did you have:
NO 2
NO 2
NO 2
NO 2
NO 2
415) Was (NAME) delivered by caesarian section?
NO 2
416) When (NAME) was born, was he/she: very large, larger than average, average, smaller than average, or very small?
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DON'T KNOW 8
417) Was (NAME) weighed at birth?
NO 2 (SKIP TO 419)
418) How much did (NAME) weigh?
DON'T KNOW 9998
419) Has your period returned since the birth of (NAME)? (For most recent birth since January 1991)
NO 2 (SKIP TO 422)
420) Did your period return between the birth of (NAME) and your next pregnancy? (Repeat question for all children born since January 1991, excluding the most recent child)
NO 2 (SKIP TO 424)
421) For how many months after the birth of (NAME) did you not have a period?
DON'T KNOW 98
422) CHECK 225: RESPONDENT PREGNANT? (For most recent birth since January 1991)
PREGNANT OR UNSURE ___ (SKIP TO 424)
423) Have you resumed sexual relations since the birth of (NAME)? (For most recent birth since January 1991)
NO 2 (SKIP TO 425)
424) For how many months after the birth of (NAME) did you not have sexual relations?
DON'T KNOW 98
425) Did you ever breastfeed (NAME)?
NO 2
426) Why did you not breastfeed (NAME)?
CHILD ILL/WEAK 02 (SKIP TO 432)
CHILD DIED 03 (SKIP TO 432)
NIPPLE/BREAST PROBLEM 04 (SKIP TO 432)
INSUFFICIENT MILK 05 (SKIP TO 432)
MOTHER WORKING 06 (SKIP TO 432)
CHILD REFUSED 07 (SKIP TO 432)
OTHER (SPECIFY) __________ 96 (GO TO 432)
427) 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.
HOURS 1 ___
DAYS 2 ___
DEAD ___ (SKIP TO 430)
429) Are you still breastfeeding (NAME)?
NO 2
430) For how many months did you breastfeed (NAME)?
DON'T KNOW 98
431) Why did you stop breastfeeding (NAME)?
CHILD ILL/WEAK 02
CHILD DIED 03
NIPPLE/BREAST PROBLEM 04
INSUFFICIENT MILK 05
MOTHER WORKING 06
CHILD REFUSED 07
WEANING AGE/AGE TO STOP 08
BECAME PREGNANT 09
HUSBAND DISAPPROVED 10
STARTED USING CONTRACEPTION 11
OTHER (SPECIFY) __________ 96
DEAD ___ (SKIP BACK TO 405 IN NEXT COLUMN OR, IF NO MORE BIRTHS, SKIP TO 443)
433) How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPOXIMATE NUMBER.
434) How many times did you breastfeed yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPOXIMATE NUMBER.
435) Did (NAME) drink anything from a bottle with a nipple yesterday or last night?
NO 2
DON'T KNOW 8
436) At any time yesterday or last night, was (NAME) given any of the following:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
437) CHECK 436: FOOD OR LIQUID GIVEN YESTERDAY?
"NO/DON'T KNOW" TO ALL ___
438) CHECK 429: STILL BREASTFED?
"NO" OR NOT ASKED ___ (SKIP TO 440)
439) Did (NAME) get anything at all, other than breastmilk, to eat or drink yesterday during daylight hours or last night?
IF YES: What did (NAME) eat or drink? CORRECT 436.
NO 2 (SKIP TO 441)
440) (Aside from breastfeeding, ) how many times did (NAME) eat yesterday, including both meals and snacks?
DON'T KNOW 8
441) On how many days during the last seven days was (NAME) given any of the following:
IF DON'T KNOW, RECORD '8'
442) GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, SKIP TO 443.
SECTION 4B. IMMUNIZATION AND HEALTH
443) ENTER LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1991 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS USE ADDITIONAL FORMS.)
444) LINE NUMBER FROM QUESTION 212
AND QUESTION 216
DEAD ___ (SKIP TO 445 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, SKIP TO 469.)
446) Do you have a card where (NAME'S) vaccinations are written down? IF YES: May I see it please?
YES, NOT SEEN 2 (SKIP TO 451)
NO CARD 3
447) Did you ever have a vaccination card for (NAME)?
NO 2 (SKIP TO 451)
448) BIRTH WEIGHT RECORDED ON CARD? IF YES: COPY BIRTH WEIGHT.
(1) COPY VACCINATION DATES 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.
MONTH __________
YEAR _____
MONTH __________
YEAR _____
MONTH __________
YEAR _____
MONTH __________
YEAR _____
MONTH __________
YEAR _____
MONTH __________
YEAR _____
MONTH __________
YEAR _____
MONTH __________
YEAR _____
450) Has (NAME) received any vaccinations that are not recorded on this card?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 1-3, DPT 1-3, AND/OR MEASLES VACCINE(S).
DON'T KNOW 8 (SKIP TO 453)
451) Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases?
NO 2 (SKIP TO 453)
DON'T KNOW (SKIP TO 453)
452) Please tell me if (NAME) received any of the following vaccinations:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
453) Has (NAME) been ill with a fever at any time in the last 2 weeks?
NO 2
DON'T KNOW 8
454) Has (NAME) been ill with a cough at any time in the last 2 weeks?
NO 2 (SKIP TO 458)
DON'T KNOW 8 (SKIP TO 458)
455) When (NAME) was ill with a cough, did he/she breathe faster than usual with short, rapid breaths?
NO 2
DON'T KNOW 8
456) Did you seek advice or treatment for the cough?
NO 2 (SKIP TO 458)
457) Where did you seek advice or treatment? Anywhere else? RECORD ALL MENTIONED.
PROVINCIAL HOSPITAL B
DIST/RURAL HOSPITAL C
RURAL HEALTH CENTRE D
RURAL/MUNICIPAL CLINIC E
VILLAGE COMMUNITY WORKER F
OTHER PUBLIC (SPECIFY) __________ G
PRIVATE DOCTOR J
PHARMACY K
VILLAGE COMMUNITY WORKER L
OTHER PRIVATE MEDICAL (SPECIFY) __________ M
TRADITIONAL PRACTICIONER O
458) Has (NAME) had diarrhea in the last two weeks?
NO 2 (SKIP TO 468)
DON'T KNOW 8 (SKIP TO 468)
459) Was there any blood in the stools?
NO 2
DON'T KNOW 8
460) On the worst day of the diarrhea, how many bowel movements did (NAME) have?
DON'T KNOW 98
461) Was he/she given the same amount to drink as before the diarrhea, or more, or less?
MORE 2
LESS 3
DON'T KNOW 8
462) Was he/she given the same amount of food to eat as before the diarrhea, or more, or less?
MORE 2
LESS 3
DON'T KNOW 8
463) Was (NAME) given a salt and sugar solution to drink?
NO 2
DON'T KNOW 8
464) Was anything (else) given to treat the diarrhea?
NO 2 (SKIP TO 466)
DON'T KNOW (SKIP TO 466)
465) What was given to treat the diarrhea? Anything else? RECORD ALL MENTIONED.
PILL OR SYRUP B
INJECTION C
(I.V.) INTRAVENOUS D
HOME REMEDIES/HERBAL MEDICINES E
OTHER (SPECIFY) __________ X
466) Did you seek advice or treatment for the diarrhea?
NO 2 (SKIP TO 468)
467) Where did you seek advice or treatment? Anywhere else? RECORD ALL MENTIONED.
PROVINCIAL HOSPITAL B
DIST/RURAL HOSPITAL C
RURAL HEALTH CENTRE D
RURAL/MUNICIPAL CLINIC E
VILLAGE COMMUNITY WORKER F
OTHER PUBLIC (SPECIFY) __________ G
PRIVATE DOCTOR J
PHARMACY K
VILLAGE COMMUNITY WORKER L
OTHER PRIVATE MEDICAL (SPECIFY) __________ M
TRADITIONAL PRACTITIONER O
468) GO BACK TO 445 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, SKIP TO 469.
469) When a child has diarrhea, should he/she be given less to drink than usual, about the same amount, or more than usual?
ABOUT SAME AMOUNT OF TO DRINK 2
MORE TO DRINK 3
DON'T KNOW 8
470) When a child has diarrhea, should he/she be given less to eat than usual, about the same amount, or more than usual?
ABOUT SAME AMOUNT TO EAT 2
MORE TO EAT 3
DON'T KNOW 8
471) When a child is sick with diarrhea, what signs of illness would tell you that he/she should be taken to a health facility? Any other signs? RECORD ALL MENTIONED.
ANY WATERY STOOLS B
REPEATED VOMITING C
ANY VOMITING D
BLOOD IN STOOLS E
FEVER F
MARKED THIRST G
NOT EATING/NOT DRINKING WELL H
GETTING SICKER/VERY SICK I
NOT GETTING BETTER J
OTHER (SPECIFY) __________ X
DON'T KNOW Z
472) When a child is sick with a cough, what signs of illness would tell you that he/she should be taken to a health facility? Any other signs? RECORD ALL MENTIONED.
DIFFICULT BREATHING B
NOISY BREATHING C
FEVER D
UNABLE TO DRINK E
NOT EATING/NOT DRINKING WELL F
GETTING SICKER/VERY SICK G
NOT GETTING BETTER H
OTHER (SPECIFY) __________ X
DON'T KNOW Z
ANY CHILD RECEIVED SALT-SUGAR SOLUTION ___ (SKIP TO 501)
474) Have you ever heard of a special solution prepared using salt and sugar and water that is used for the treatment of diarrhea?
NO 2 (SKIP TO 501)
475) Have you ever used this solution for treating diarrhea?
NO 2
501) PRESENCE OF OTHERS AT THIS POINT.
NO 2
NO 2
NO 2
NO 2
502) Are you currently married?
NO, NOT CURRENTLY MARRIED 2
503) Have you ever been married or lived with a man?
NO 2
504) ENTER '0' IN COLUMN 3 OF CALENDAR IN THE MONTH OF INTERVIEW, AND IN EACH MONTH BACK TO JANUARY 1989, THEN SKIP TO 514.
505) What is your marital status now: are you widowed or divorced?
DIVORCED 2 (SKIP TO 510)
506) Is your husband living with you now or is he staying elsewhere?
STAYING ELSEWHERE 2
507) Besides yourself, how many other wives does your husband have?
510) Have you been married or lived with a man only once, or more than once?
MORE THAN ONCE 2
511) In what month and year did you start living with your (first) husband?
NOTE: IF RESPONDENT SAYS SHE HAS NEVER LIVED WITH A HUSBAND, PROBE FOR DATE OF FIRST MARRIAGE AND RECORD HER ANSWER.
DON'T KNOW MONTH 98
DON'T KNOW YEAR 98
512) How old were you when you started living with him?
513) DETERMINE MONTHS MARRIED OR IN UNION SINCE JANUARY 1989. ENTER 'X' IN COLUMN 3 OF CALENDAR FOR EACH MONTH MARRIED OR IN UNION, AND ENTER '0' FOR EACH MONTH NOT MARRIED/NOT IN UNION, SINCE JANUARY 1989.
FOR WOMEN NOT CURRENTLY IN UNION OR WITH MORE THAN ONE UNION: PROBE FOR DATE COUPLE STARTED LIVING TOGETHER OR DATE WIDOWED/DIVORCED/SEPERATED, AND FOR STARTING DATE OF ANY SUBSEQUENT UNION.
THEN, SKIP TO 515
NO BIRTHS ___ (SKIP TO 515A)
515) 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?
515A) 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?
DAYS AGO 1 ___
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___
BEFORE LAST BIRTH 996
KNOWS CONDOM ___
NO 2
DON'T KNOW 8
DOES NOT KNOW CONDOM ___
NO 2
DON'T KNOW 8
517) Do you know where you can get condoms?
NO 2 (SKIP TO 519)
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.
RURAL/MUNICIPAL CLINIC 11
ZNFPC CLINIC 12
RURAL HEALTH CENTRE 13
ZNFPC MOBILE CLINIC 14
MOH MOBILE CLINIC 15
ZNFPC CBD 16
MOH CBD 17
OTHER PUBLIC (SPECIFY) __________ 18
PHARMACY 22
PRIVATE DOCTOR 23
CBD 25
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26
CHURCH 32
FRIENDS/RELATIVES 33
NOT CURRENTLY MARRIED ___ (SKIP TO 528)
520) Who did you have sex with the last time you had sexual intercourse? Was it with your husband or was it with someone else?
SOMEONE ELSE 2
521) Have you had sex with your husband in the last four weeks?
NO 2 (SKIP TO 524)
DON'T KNOW 98
523) Was a condom used on any of these occasions? IF YES: Was it each time or sometimes?
YES, SOMETIMES 2
NEVER 3
524) Have you had sex with anyone other than your husband in the last four weeks?
NO 2 (SKIP TO 532)
525) With how many persons other than your husband have you had sex with in the last 4 weeks?
DON'T KNOW 98
526) How many times have you had sex with someone apart from your husband in the last 4 weeks?
DON'T KNOW 98
527) Was a condom used on any of these occasions? IF YES: Was it each time or sometimes?
YES, SOMETIMES 2 (SKIP TO 532)
NEVER 3 (SKIP TO 532)
528) Have you had sex with anyone in the last four weeks?
NO 2 (SKIP TO 532)
529) With how many persons have you had sex in the last 4 weeks?
DON'T KNOW 98
530) How many times have you had sex with someone in the last 4 weeks?
DON'T KNOW 98
531) Was a condom used on any of these occasions? IF YES: Was it each time or sometimes?
YES, SOMETIMES 2
NEVER 3
532) How old were you when you first had sexual intercourse?
WHEN FIRST MARRIED 96
SECTION 6. FERTILITY PREFERENCES
HE OR SHE STERILIZED ___ (SKIP TO 613)
NOT PREGNANT OR UNSURE ___
NO MORE/NONE 2 (SKIP TO 606)
SAYS SHE CAN'T GET PREGNANT 3 (SKIP TO 606)
UNDECIDED/DON'T KNOW 8 (SKIP TO 604)
PREGNANT ___
NO MORE/NONE 2 (SKIP TO 606)
SAYS SHE CAN'T GET PREGNANT 3 (SKIP TO 606)
UNDECIDED/DON'T KNOW 8 (SKIP TO 604)
NOT PREGNANT OR UNSURE ___
YEARS 2 ___
SOON/NOW 993 (SKIP TO 606)
SAYS SHE CAN'T GET PREGNANT 994 (SKIP TO 606)
AFTER MARRIAGE 995
OTHER (SPECIFY) __________ 996
DON'T KNOW 998
PREGNANT ___
YEARS 2 ___
SOON/NOW 993 (SKIP TO 606)
SAYS SHE CAN'T GET PREGNANT 994 (SKIP TO 606)
AFTER MARRIAGE 995
OTHER (SPECIFY) __________ 996
DON'T KNOW 998
PREGNANT ___ (SKIP TO 606)
605) If you became pregnant in the next few weeks, would you be happy, unhappy, or would it not matter very much?
UNHAPPY 2
WOULD NOT MATTER 3
606) CHECK 312: USING A METHOD?
NOT CURRENTLY USING ___
CURRENTLY USING ___ (SKIP TO 613)
607) Do you intend to use a method to delay or avoid pregnancy within the next 12 months?
NO 2
DON'T KNOW 8
608) Do you intend to use a method at any time in the future?
NO 2 (SKIP TO 610)
DON'T KNOW 8 (SKIP TO 610)
609) Which method would you prefer to use?
IUD 02 (SKIP TO 613)
INJECTIONS 03 (SKIP TO 613)
IMPLANTS 04 (SKIP TO 613)
DIAPHRAGM/FOAMING TABLET/JELLY 05 (SKIP TO 613)
CONDOM 06 (SKIP TO 613)
FEMALE STERILIZATION 07 (SKIP TO 613)
MALE STERILIZATION 08 (SKIP TO 613)
SAFE PERIOD 09 (SKIP TO 613)
WITHDRAWAL 10 (SKIP TO 613)
OTHER (SPECIFY) __________ 96 (SKIP TO 613)
UNSURE 98 (SKIP TO 613)
610) What is the main reason you never intend to use a method?
MENOPAUSAL/HYSTERECTOMY 23
SUBFECUND/INFECUND 24
WANTS MORE CHILDREN 26
HUSBAND OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
KNOWS NO SOURCE 42
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
DON'T KNOW 98
CODE 11 NOT CIRCLED ___ (SKIP TO 613)
612) Would you ever use a method if you were married?
NO 2
DON'T KNOW 8
HAS LIVING CHILDREN ___
OTHER (SPECIFY) ________ 96 (GO TO 615)
NO LIVING CHILDREN ___
OTHER (SPECIFY) ________ 96 (GO TO 615)
614) How many of these children would you like to be boys and how many would you like to be girls?
NUMBER GIRLS ___
NUMBER EITHER ___
OTHER (SPECIFY) __________ 999996
615) Do you approve or disapprove of couples using a method of family planning to avoid getting pregnant?
DISAPPROVE 2 (SKIP TO 617)
NO OPINION (SKIP TO 617)
616) Have you ever recommended family planning to a friend, relative, or anyone else?
NO 2
617) Is it acceptable or not acceptable to you for information on family planning to be provided:
NOT ACCEPTABLE 2
DON'T KNOW 8
NOT ACCEPTABLE 2
DON'T KNOW 8
NOT ACCEPTABLE 2
DON'T KNOW 8
618) In the last six months have you heard or learned about family planning:
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
619) In the last six months have you discussed the practice of family planning with your friends or relatives?
NO 2 (SKIP TO 621)
620) With whom? Anyone else? RECORD ALL MENTIONED.
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER F
MOTHER-IN-LAW G
FRIENDS H
OTHER (SPECIFY) __________ X
621) Do you think most, some, or none of the women you know use some kind of family planning?
SOME 2
NONE 3
DON'T KNOW 8
NO, NOT CURRENTLY MARRIED ___ (SKIP TO 626)
623) Now I want to ask you about your husband's view on family planning. Do you think that your husband approves or disapproves of couples using a method to avoid pregnancy?
DISAPPROVES 2
DON'T KNOW 8
624) Have you and your husband ever discussed the number of children you would like to have?
NO 2
625) Do you think your husband wants the same number of children that you want, or does he want more or fewer children than you want?
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8
NEVER HAD SEXUAL INTERCOURSE ___ (SKIP TO 701)
627) Sometimes a woman becomes pregnant when she does not want to be. Have you ever become pregnant when you did not want to be?
NO 2 (SKIP TO 701)
628) How long ago was the last time that you became pregnant when you did not want to be?
629) When that happened to you, what did you do about it?
ATTEMPTED TO STOP THE PREGNANCY BUT FAILED 02
HAD A MISCARRIAGE 03 (SKIP TO 632)
NOTHING/CONTINUED THE PREGNANCY 04 (SKIP TO 636)
OTHER (SPECIFY) __________ 96
DON'T KNOW 98
STRENUOUS WORK 02
SCRUBBING FLOORS 03
BITTER DRINKS (HERBS) 04
TABLETS 05
HARD MASSAGE/SQUEEZING ABDOMEN 06
OBJECT IN WOMB 07
INJECTION 08
SUCTION 09
CURRETAGE 10
OTHER (SPECIFY) __________ 96
DON'T KNOW 98
631) Who provided the methods for you? Anyone else?
TRAINED NURSE/MIDWIFE B (SKIP TO 633)
UNTRAINED BIRTH ATTENDANT C (SKIP TO 633)
PHARMACIST D (SKIP TO 633)
RELATIVE/FRIEND E (SKIP TO 633)
OTHER (SPECIFY) __________ X (SKIP TO 633)
NO ONE Y (SKIP TO 633)
632) What do you think caused you to have a miscarriage?
STRENUOUS WORK 02
SCRUBBING FLOORS 03
BITTER DRINKS (HERBS) 04
TABLETS 05
HARD MASSAGE/SQUEEZING ABDOMEN 06
OBJECT PLACED IN WOMB 07
INJECTION 08
SUCTION 09
CURRETAGE 10
SOMETHING WRONG WITH THE BABY 11
HAD A FIGHT 12
RESPONDENT WAS SICK 13
OTHER (SPECIFY) __________ 96
DON'T KNOW 98
633) Did you have any health problems as a result?
NO 2 (SKIP TO 636)
NO 2 (SKIP TO 636)
635) How many nights did you spend in the hospital? IF NO NIGHTS, RECORD '00'.
636) Did you ever have an earlier unwanted pregnancy that you or someone else stopped?
NO 2
SECTION 7. HUSBAND'S BACKGROUND AND WOMAN'S WORK
YES ___ (ASK QUESTIONS ABOUT MOST RECENT HUSBAND)
NO (SKIP TO 708)
702) Did your (last) husband/partner ever attend school?
NO 2 (SKIP TO 705)
703) What was the highest level of school he attended: primary, secondary, or higher?
SECONDARY 2
HIGHER 3
DON'T KNOW 8 (SKIP TO 705)
704) How many years did he complete at that level?
DON'T KNOW 98
705) What is (was) your (last) husband/partner's occupation? That is, what kind of work does (did) he mainly do?
DOES (DID) NOT WORK IN AGRICULTURE ___ (SKIP TO 708)
707) (Does/did) your husband/partner work mainly on his own land or on family land, on communal land, or (does/did) he rent land, or (does/did) he work on someone else's land?
COMMUNAL/RESETTLEMENT LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
708) Aside from your own housework, are you currently working?
NO 2
709) 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?
NO 2
710) Have you done any work in the last 12 months?
NO 2 (SKIP TO 726)
711) What is your occupation, that is, what kind of work do you mainly do?
DOES NOT WORK IN AGRICULTURE ___ (SKIP TO 714)
713) Do you work mainly on your own land or on family land, do you work on communal land, or do you rent land, or work on someone else's land?
COMMUNAL/RESETTLEMENT LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
714) Do (did) you do this work for a member of your family, for someone else, or are you self-employed?
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3
715) Do you usually work throughout the year, or do you work seasonally, or only once in a while?
SEASONALLY 2
ONCE IN A WHILE 3 (SKIP TO 718)
716) During the last 12 months, how many months did you work?
717) (In the months you worked,) How many days a week did you usually work?
718) During the last 12 months, approximately how many days did you work?
719) On a typical working day, how many hours do you spend working?
DON'T KNOW 98
720) Do you earn cash for your work? PROBE: Do you make money for working?
NO 2 (SKIP TO 723)
721) How much do you usually earn for this work? PROBE: Is this by the day, by the week, or by the month?
RECORD IN ZIMBABWEAN DOLLARS
PER WEEK 2 _____
PER MONTH 3 _____
YES, CURRENTLY MARRIED ___
HUSBAND/PARTNER DECIDES 2
JOINTLY WITH HUSBAND/PARTNER 3
SOMEONE ELSE DECIDES 4
JOINTLY WITH SOMEONE ELSE 5
NO, NOT CURRENTLY MARRIED ___
HUSBAND/PARTNER DECIDES 2
JOINTLY WITH HUSBAND/PARTNER 3
SOMEONE ELSE DECIDES 4
JOINTLY WITH SOMEONE ELSE 5
723) Do you usually work at home or away from home?
AWAY 2
724) CHECK 217 AND 218: IS A CHILD LIVING AT HOME WHO IS AGE 5 OR LESS?
NO ___ (SKIP TO 726)
725) Who usually takes care of (NAME OF YOUNGEST CHILD AT HOME) while you are working?
HUSBAND/PARTNER 02
OLDER FEMALE CHILD 03
OLDER MALE CHILD 04
OTHER RELATIVES 05
NEIGHBORS 06
FRIENDS 07
SERVANTS/HIRED HELP 08
CHILD IS IN SCHOOL 09
INSTITUTIONAL CHILDCARE 10
HAS NOT WORKED SINCE LAST BIRTH 95
OTHER (SPECIFY) __________ 96
726) Who in your household decides whether to purchase a major household item, such as a radio or television? RECORD ALL MENTIONED
THEN ASK: Who has the greatest say in the final decision to make such a purchase?
HUSBAND/PARTNER B
OTHER SENIOR MALE C
OTHER SENIOR FEMALE D
OTHER E
NO ONE F
727) Who in your household decides whether you should work outside the home? RECORD ALL MENTIONED
THEN ASK: Who has the greatest say in the final decision for you to work outside the home?
HUSBAND/PARTNER B
OTHER SENIOR MALE C
OTHER SENIOR FEMALE D
OTHER E
NO ONE F
728) Who decides how many children you will have? RECORD ALL MENTIONED
THEN ASK: Who has the greatest say in deciding how many children to have?
HUSBAND/PARTNER B
OTHER SENIOR MALE C
OTHER SENIOR FEMALE D
OTHER E
NO ONE F
729) Have you lived in only one community or in more than one community since January 1989?
MORE THAN ONE COMMUNITY 2 (SKIP TO 731)
730) ENTER (IN COLUMN 4 OF CALENDAR) THE APPROPRIATE CODE FOR CURRENT COMMUNITY. ('1' MAIN TOWN, '2' OTHER URBAN, '3' RURAL AREA). BEGIN IN THE MONTH OF INTERVIEW AND CONTINUE WITH ALL PRECEDING MONTHS BACK TO JANUARY 1989. THEN SKIP TO 801.
731) In what month and year did you move to (NAME OF COMMUNITY OF INTERVIEW)?
ENTER (IN COLUMN 4 OF CALENDAR) 'X' IN THE MONTH AND YEAR OF THE MOVE, AND IN SUBSEQUENT MONTHS ENTER THE APPROPRIATE CODE FOR TYPE OF COMMUNITY ('1' MAIN TOWN, '2' OTHER URBAN, '3' RURAL AREA). CONTINUE PROBING FOR PREVIOUS COMMUNITIES AND RECORD MOVES AND TYPES OF COMMUNITIES ACCORDINGLY.
ILLUSTRATIVE QUESTIONS
In what month and year did you arrive there?
Is that place in a main town, another urban area, or a rural area?
SECTION 8. AIDS AND SEXUALLY TRANSMITTED DISEASES
801) Have you heard about diseases that can be transmitted through sex?
NO 2 (SKIP TO 814)
802) Which diseases have you heard about? RECORD ALL RESPONSES
GONORRHEA B
AIDS/HIV INFECTION C
GENITAL WARTS / CONDYLONATA D
CHANCROID E
OTHER (SPECIFY) __________ W
OTHER (SPECIFY) __________ X
DON'T KNOW Z
HAS NEVER HAD SEX ___ (SKIP TO 813)
804) During the last 12 months, did you have any of these diseases?
NO 2 (SKIP TO 813)
DON'T KNOW 8 (SKIP TO 813)
805) Which? RECORD ALL RESPONSES
GONORRHEA B
AIDS/HIV INFECTION C
GENITAL WARTS / CONDYLONATA D
CHANCROID E
OTHER (SPECIFY) __________ W
OTHER (SPECIFY) __________ X
DON'T KNOW Z
808) When you had the most recent episode of (DISEASE FROM QUESTION 805) did you seek advice or treatment?
SELF TREATMENT (SKIP TO 810)
DID NOT DO ANYTHING (SKIP TO 810)
809) Where did you seek advice or treatment?
PROVINCIAL HOSPITAL B
DISTRICT/RURAL HOSPITAL C
RURAL HEALTH CENTRE D
RURAL/MUNICIPAL CLINIC E
VILLAGE COMMUNITY WORKER F
OTHER PUBLIC SECTOR (SPECIFY) __________ G
PHARMACY J
PRIVATE DOCTOR K
VILLAGE COMMUNITY WORKER L
OTHER MEDICAL PRIVATE SECTOR (SPECIFY) __________ M
RELATIVES/FRIENDS O
TRADITIONAL HEALER P
810) When you had (DISEASE OF QUESTION 805) did you advise your partner to seek treatment?
NO 2
811) When you had (DISEASE OF QUESTION 805) did you do something not to infect your partner?
NO 2 (SKIP TO 813)
PARTNER ALREADY INFECTED (SKIP TO 813)
812) What did you do? RECORD ALL MENTIONED
USED CONDOMS B
RECEIVED MEDICAL TREATMENT C
OTHER (SPECIFY) __________ X
MENTIONED 'AIDS' ___ (SKIP TO 815)
814) Have you ever heard of an illness called AIDS?
NO 2 (SKIP TO 831)
815) From which sources of information have you learned most about AIDS? Any other sources? RECORD ALL MENTIONED
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
816) How can a person get the AIDS virus? Any other ways? RECORD ALL MENTIONED
SEX WITH PROSTITUTES B
HOMOSEXUAL CONTACT C
SEXUAL INTERCOURSE WITH MULTIPLE PARTNERS D
BLOOD TRANSFUSION E
INJECTIONS F
KISSING G
MOSQUITO BITES H
OTHER (SPECIFY) __________ W
OTHER (SPECIFY) __________ X
DON'T KNOW Z
817) Is there anything a person can do to avoid getting the AIDS virus?
NO 2 (SKIP TO 821)
DON'T KNOW 8 (SKIP TO 821)
818) What can a person do to avoid getting the AIDS virus? Any other ways? RECORD ALL MENTIONED
ABSTAIN FROM SEX B
USE CONDOMS DURING SEX 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
DON'T KNOW Z
DID NOT MENTION SAFE SEX ___ (SKIP TO 821)
820) What does "safe sex" mean to you? RECORD ALL MENTIONED
USE CONDOMS DURING SEX B
AVOID MULTIPLE SEX PARTNERS C
AVOID SEX WITH PROSTITUTES D
AVOID SEX WITH HOMOSEXUALS E
OTHER (SPECIFY) __________ X
DON'T KNOW Z
821) Is it possible for a healthy-looking person to have the AIDS virus?
NO 2
DON'T KNOW 8
822) Can AIDS be cured, or do all persons with AIDS die from the disease?
NO, EVERYONE WITH AIDS DIES 2
DON'T KNOW 8
823) Can the AIDS virus be transmitted from mother to child during pregnancy or childbirth?
NO 2
DON'T KNOW 8
824) Do you personally know someone who has AIDS or has died of AIDS?
NO 2
DON'T KNOW 8
825) Do you think a person who has AIDS should be cared for at home, cared for in a medical facility, or left alone to take care of himself/herself?
MEDICAL FACILITY 2
LEFT ALONE 3
DON'T KNOW 8
826) Do you think your chances of getting the AIDS virus are small, moderate, great, or no risk at all?
SMALL 2
MODERATE 3 (SKIP TO 828)
GREAT 4 (SKIP TO 828)
827) Why do you think that you have (NO RISK/A SMALL CHANCE) of getting the AIDS virus? Any other reasons? RECORD ALL MENTIONED
USE CONDOMS DURING SEX B (SKIP TO 829)
HAVE ONLY ONE SEX PARTNER C (SKIP TO 829)
LIMITED NUMBER OF SEX PARTNERS D (SKIP TO 829)
NO HOMOSEXUAL CONTACT E (SKIP TO 829)
NO BLOOD TRANSFUSIONS F (SKIP TO 829)
NO INJECTIONS G (SKIP TO 829)
OTHER (SPECIFY) __________ X (SKIP TO 829)
DON'T KNOW Z (SKIP TO 829)
828) Why do you think that you have a (MODERATE/GREAT) chance of getting the AIDS virus? Any other reasons? RECORD ALL MENTIONED
MULTIPLE SEX PARTNERS B
SPOUSE HAS MULTIPLE PARTNERS C
HOMOSEXUAL CONTACT D
HAD BLOOD TRANSFUSION E
HAD INJECTIONS F
OTHER (SPECIFY) __________ X
DON'T KNOW Z
829) Since you heard of AIDS, have you changed your behavior to prevent getting the AIDS virus?
NO 2 (SKIP TO 831)
830) What did you do? Anything else? Anything else? RECORD ALL MENTIONED
STARTED USING CONDOMS B
RESTRICTED SEX TO ONE PARTNER C
REDUCED NUMBER OF PARTNERS D
NO MORE HOMOSEXUAL CONTACTS E
STOPPED INJECTIONS F
OTHER (SPECIFY) __________ X
DON'T KNOW Z
831) Some people use a condom during sexual intercourse to avoid getting the AIDS virus or other sexually transmitted diseases. Have you ever heard of this?
NO 2
HAS NEVER HAD SEX (SKIP TO 901)
833) Have you ever used a condom during sex to avoid getting or transmitting diseases, such as the AIDS virus?
NO 2
834) Have you given or received money, gifts or favors in return for sex at any time in the last 4 weeks?
NO 2
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?
ONLY ONE BIRTH ___ (RESPONDENT ONLY) (SKIP TO 915)
903) How many of these births did your mother have before you were born?
904) What was the name given to your oldest (next oldest) brother or sister?
905) Is (NAME) male or female?
FEMALE 2
NO 2 (SKIP TO 908)
DON'T KNOW (SKIP TO NEXT COLUMN)
908) How many years ago did (NAME) die?
909) How old was (NAME) when she/he died?
910) Did (NAME) die during childbirth?
NO 2
911) Was (NAME) pregnant when she died?
NO 2
912) Did (NAME) die within six weeks after the end of a pregnancy or childbirth?
NO 2
913) Did (NAME) die because of complications of pregnancy or childbirth?
NO 2 (SKIP TO NEXT COLUMN)
DON'T KNOW 8
914) How many children had (NAME) given birth to before that pregnancy?
MINUTES ___
NO BIRTHS SINCE JANUARY 1991 ___ (END)
IN 1002 (COLUMNS 2-4) RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY 1991 AND STILL ALIVE. IN 1003 AND 1004 RECORD THE NAME AND BIRTH DATE FOR THE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1991. IN 1006 AND 1008 RECORD HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN. (NOTE: ALL RESPONDENTS WITH ONE OR MORE BIRTHS SINCE JANUARY 1991 SHOULD BE WEIGHED AND MEASURED EVEN IF ALL OF THE CHILDREN HAVE DIED. IF THERE ARE MORE THAN 3 LIVING CHILDREN BORN SINCE JANUARY 1991, USE ADDITIONAL FORMS).
1002) LINE NUMBER FROM QUESTION 212
(Answer for all living children born since January 1991)
1003) NAME (FROM QUESTION 212 FOR CHILDREN)
1004) DATE OF BIRTH FROM QUESTION 215, AND ASK FOR DAY OF BIRTH
(Answer for all living children born since January 1991)
MONTH __________
YEAR _____
1005) BCG SCAR ON TOP OF RIGHT SHOULDER
(Answer for all living children born since January 1991]
NO SCAR 2
1006) HEIGHT (in centimeters) ___
1007) WAS HEIGHT/LENGTH OF CHILD MEASURED LYING DOWN OR STANDING UP?
(Answer for all living children born since January 1991)
STANDING 2
1008) WEIGHT (in kilograms) ___
1009) DATE WEIGHED AND MEASURED
MONTH __________
YEAR _____
NOT PRESENT 3
REFUSED 4
OTHER (SPECIFY) __________ 6
CHILD SICK 2
CHILD NOT PRESENT 3
CHILD REFUSED 4
MOTHER REFUSED 5
OTHER (SPECIFY) __________ 6
To be filled in after completing interview
Comments about respondent:
Comments on specific questions:
Any other comments:
Name of Supervisor __________
Date _____
Name of Editor __________
Date _____
INSTRUCTIONS: ONLY ONE CODE SHOULD APPEAR IN ANY BOX. FOR COLUMNS 1, 3, AND 4 ALL MONTHS SHOULD BE FILLED IN.
INFORMATION TO BE CODED FOR EACH COLUMN
COLUMN 1: Births, Pregnancies, Contraceptive Use
P Pregnancies
T Terminations
1 PILL
2 IUD
3 INJECTIONS
4 IMPLANTS
5 DIAPHRAGM/FOAM/JELLY
6 CONDOM
7 FEMALE STERILIZATION
8 MALE STERILIZATION
9 SAFE PERIOD
A WITHDRAWL
X OTHER (SPECIFY) __________
COLUMN 2: Discontinuation of Contraceptive Use
1 BECAME PREGNANT WHILE USING
2 WANTED TO BECOME PREGNANT
3 HUSBAND DISAPPROVED
4 WANTED MORE EFFECTIVE METHOD
5 HEALTH CONCERNS
6 SIDE EFFECTS
7 LACK OF ACCESS/TOO FAR
8 COST TOO MUCH
9 INCONVENIENT TO USE
F FATALISTIC
A DIFFICULT TO GET PREGNANT/MENOPAUSE
D MARTIAL DISSOLUTION/SEPERATION
X OTHER (SPECIFY) __________
Z DON'T KNOW
O NOT IN UNION
COLUMN 4: Moves and Types of Communities
1 MAIN TOWN
2 OTHER URBAN AREA
3 RURAL AREA
(For each month below, fill out columns as instructed)
1994
02 NOV ___ ___ ___ ___
03 OCT ___ ___ ___ ___
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08 MAY ___ ___ ___ ___
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11 FEB ___ ___ ___ ___
12 JAN ___ ___ ___ ___
1993
14 NOV ___ ___ ___ ___
15 OCT ___ ___ ___ ___
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21 APR ___ ___ ___ ___
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23 FEB ___ ___ ___ ___
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1992
26 NOV ___ ___ ___ ___
27 OCT ___ ___ ___ ___
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29 AUG ___ ___ ___ ___
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33 APR ___ ___ ___ ___
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35 FEB ___ ___ ___ ___
36 JAN ___ ___ ___ ___
1991
38 NOV ___ ___ ___ ___
39 OCT ___ ___ ___ ___
40 SEP ___ ___ ___ ___
41 AUG ___ ___ ___ ___
42 JUL ___ ___ ___ ___
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44 MAY ___ ___ ___ ___
45 APR ___ ___ ___ ___
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47 FEB ___ ___ ___ ___
48 JAN ___ ___ ___ ___
1990
50 NOV ___ ___ ___ ___
51 OCT ___ ___ ___ ___
52 SEP ___ ___ ___ ___
53 AUG ___ ___ ___ ___
54 JUL ___ ___ ___ ___
55 JUN ___ ___ ___ ___
56 MAY ___ ___ ___ ___
57 APR ___ ___ ___ ___
58 MAR ___ ___ ___ ___
59 FEB ___ ___ ___ ___
60 JAN ___ ___ ___ ___
1989
62 NOV ___ ___ ___ ___
63 OCT ___ ___ ___ ___
64 SEP ___ ___ ___ ___
65 AUG ___ ___ ___ ___
66 JUL ___ ___ ___ ___
67 JUN ___ ___ ___ ___
68 MAY ___ ___ ___ ___
69 APR ___ ___ ___ ___
70 MAR ___ ___ ___ ___
71 FEB ___ ___ ___ ___
72 JAN ___ ___ ___ ___