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ZIMBABWE DEMOGRAPHIC AND HEALTH SURVEY 1994

MALE QUESTIONNAIRE

IDENTIFICATION

WARD/VILLAGE __________

NAME OF HOUSEHOLD HEAD __________

CLUSTER NUMBER ___

HOUSEHOLD NUMBER ___

PROVINCE ___

URBAN/ RURAL

Urban 1
Rural 2

MAIN TOWN/OTHER URBAN/RURAL

Main town 1
Other urban 2
Rural 3

NAME AND LINE NUMBER OF MAN

NAME __________
LINE NUMBER ___

INTERVIEWER VISITS

FIRST VISIT:
DATE _____
INTERVIEWER'S NAME __________
RESULT * __________

NEXT VISIT:
DATE _____
TIME _____

SECOND VISIT:
DATE _____
INTERVIEWER'S NAME __________
RESULT * __________

NEXT VISIT:
DATE _____
TIME _____

THIRD VISIT:
DATE _____
INTERVIEWER'S NAME __________
RESULT * __________

FINAL VISIT:
DAY ___
MONTH __________
YEAR _____
NAME __________
RESULT __________

TOTAL NUMBER OF VISITS ___

* RESULT CODES:

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

LANGUAGE OF QUESTIONNAIRE: ENGLISH

LANGUAGE OF INTERVIEW:

SHONA 1
NDEBELE 2
ENGLISH 3
OTHER (SPECIFY) __________ 6

TEAM LEADER

NAME __________
DATE _____

FIELD EDITOR

NAME __________
DATE _____

OFFICE EDITOR __________

KEYED BY __________

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE TIME.

HOUR ___
MINUTES ___

102) First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in a town or in a rural area? IF TOWN: Which town?

MAIN TOWN 1
OTHER URBAN 2
RURAL 3

105) In what month and year were you born?

MONTH __________
DON'T KNOW 98
YEAR _____
DON'T KNOW 98

106) How old were you at your last birthday?

COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

AGE IN COMPLETED YEARS ___

107) Have you ever attended school?

YES 1
NO 2 (SKIP TO 114)

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/form/year) you completed at that level?

YEARS ___

110) CHECK 106:

AGE 24 OR BELOW ___
AGE 25 OR ABOVE ___ (SKIP TO 113)

111) Are you currently attending school?

YES 1 (SKIP TO 113)
NO 2

112) What was the main reason you stopped attending school?

GOT MARRIED 01
HAD TO CARE FOR YOUNGER CHILDREN 02
FAMILY NEEDED HELP ON FARM OR IN BUSINESS 03
COULD NOT PAY SCHOOL FEES 04
NEEDED TO EARN MONEY 05
GRADUATED/HAD ENOUGH SCHOOLING 06
BAD GRADES 07
DID NOT LIKE SCHOOL 08
SCHOOL NOT ACCESSIBLE/TOO FAR 09
OTHER (SPECIFY) __________ 96
DON'T KNOW 98

113) CHECK 108:

PRIMARY ___
SECONDARY OR HIGHER ___ (SKIP TO 115)

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

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3 (SKIP TO 116)

115) Do you usually read a newspaper or magazine at least once a week?

YES 1
NO 2

116) Do you usually listen to a radio every day?

YES 1
NO 2

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

YES 1
NO 2

118) What is your religion?

TRADITIONAL 1
SPIRITUAL 2
CHRISTIAN 3
OTHER (SPECIFY) __________ 6

119) RECORD ETHNICITY.

BLACK 1
WHITE 2
COLOURED 3
ASIAN 4
OTHER (SPECIFY) __________ 6

120) Are you currently working?

YES 1 (SKIP TO 122)
NO 2

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

YES 1
NO 2 (SKIP TO 201)

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

OCCUPATION __________

123) CHECK 122:

WORKS IN AGRICULTURE ___
DOES NOT WORK IN AGRICULTURE ___ (SKIP TO 125)

124) Do you work mainly on your own land or on family land, or do you rent land, or work on communal land or on someone else's land?

OWN LAND 1
RENTED LAND 2
COMMUNAL/RESETTLEMENT LAND 3
SOMEONE ELSE'S LAND 4

125) 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

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

THROUGHOUT THE YEAR 1 (SKIP TO 128)
SEASONALLY 2
ONCE IN A WHILE 3

127) During the last year, how many months did you work at this job?

NUMBER OF MONTHS ___

128) In a typical day, week, or month how much do you earn for this job?

RECORD IN ZIMBABWE DOLLARS

PER DAY 1 _____
PER WEEK 2 _____
PER MONTH 3 _____
NO CASH EARNED 999995

SECTION 2. MARRIAGE AND REPRODUCTION

201) Are you currently married?

YES, CURRENTLY MARRIED 1
NO, NOT CURRENTLY MARRIED 2 (SKIP TO 204)

202) How many wives do you have?

NUMBER OF WIVES ___

203) Does (Do) your wife (wives) live in this household? IF YES, What is (are) her name(s)?

RECORD: LINE NUMBER(S) OF THE WIFE (WIVES) IN HOUSEHOLD QUESTIONNAIRE

(AFTER ALL WIVES' NUMBERS ARE RECORDED SKIP TO 206)

FIRST WIFE ___
SECOND WIFE ___
THIRD WIFE ___
FOURTH WIFE ___

204) Have you ever been married or lived with a woman?

YES 1
NO 2 (SKIP TO 209)

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

WIDOWED 1
DIVORCED 2

206) In what month and year did you start living with your (first) wife?

MONTH __________
DON'T KNOW MONTH 98
YEAR _____ (SKIP TO 208)
DON'T KNOW YEAR 98

207) How old were you when you started living with her?

AGE ___

208) CHECK 201:

NOT CURRENTLY MARRIED ___
CURRENTLY MARRIED ___ (SKIP TO 210)

209) Do you currently have a regular partner, or occasional partner(s) or no partner at all?

REGULAR PARTNER 1
OCCASIONAL PARTNER(S) 2
NO PARTNER AT ALL 3

210) Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family planning issues.

When was the last time you had sexual intercourse with anyone?

NEVER 000 (SKIP TO 301)
DAYS AGO 1 ___
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___

211) How old were you when you first had sexual intercourse?

AGE ___
WHEN FIRST MARRIED 96

212) Now I would like to ask about all the children you have had during your life. Do you have children?

YES 1
NO 2 (SKIP TO 217)

213) Do you have any sons or daughters who are now living with you?

YES 1
NO 2 (SKIP TO 215)

214) How many sons live with you? And how many daughters live with you?

IF NONE RECORD '00'.

SONS AT HOME ___
DAUGHTERS AT HOME ___

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

YES 1
NO 2 (SKIP TO 217)

216) 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 ___

217) Have you ever had a son or a daughter who was born alive but later died? IF NO, PROBE: Any baby who cried or showed signs of life but survived only a few hours or days?

YES 1
NO 2 (SKIP TO 219)

218) How many boys have died? And how many girls have died?

IF NONE RECORD '00'.

BOYS DEAD ___
GIRLS DEAD ___

219) SUM ANSWERS TO 214, 216, AND 218, AND ENTER TOTAL.

IF NONE RECORD '00'.

TOTAL ___

220) CHECK 219:

Just to make sure that I have this right: you have had in TOTAL ___ children during your life. Is that correct?

YES ___
NO ___ (PROBE AND CORRECT 212-219 AS NECESSARY)

221) CHECK 219:

HAS HAD CHILDREN ___
HAS HAD NO CHILDREN ___ (SKIP TO 301)

222) In what month and year was your last child born?

MONTH __________
DON'T KNOW MONTH 98
YEAR _____

223) Is your last child still alive?

YES 1
NO 2

224) When your wife became pregnant with this last child, did you want her to become pregnant then, did you want her to wait until later, or did you not want her to become pregnant at all?

THEN 1
LATER 2
NOT AT ALL 3

SECTION 3. CONTRACEPTION

301) Now I would like to talk to you 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 CHECK IN 303 IF HE HAS EVER HAD SEX. IF NO, SKIP TO 401. IF YES, GO ON WITH 304. THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 302, ASK 304 BEFORE PROCEEDING TO THE NEXT METHOD.

302) Have you ever heard of (METHOD)? READ DESCRIPTION OF EACH METHOD.

01. PILL Women can take a pill every day.
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3
02. IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3
03. INJECTIONS Women can have an injection by a doctor or a nurse which stops them from becoming pregnant for months.
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3
04. IMPLANTS Women can have 5 small rods placed in the arm by a doctor which can prevent pregnancy for several years.
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3
05. DIAPHRAGM, FOAMING TABLETS. Women can place a diaphragm, foaming tablet, sponge, jelly, or cream inside themselves before sexual intercourse.
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3
06. CONDOM Men can use a rubber sheath during sexual intercourse.
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3
07. FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3
08. MALE STERILIZATION Men can have an operation to avoid having any more children.
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3
09. SAFE PERIOD, RHYTHM Every month that a woman is sexually active the couple can avoid having sex on the days of the month she is more likely to get pregnant.
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3
10. WITHDRAWAL Men can be careful and pull out before climax.
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3
11. Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES/SPONTANEOUS 1
NO 3 (SKIP TO 305)
1. (SPECIFY) __________
2. (SPECIFY) __________

303) CHECK 210:

HAS HAD SEX ___
HAS NEVER HAD SEX ___ (SKIP TO 401)

304) Have you ever used (METHOD) with anyone?

01. PILL Women can take a pill every day.
YES 1
NO 2
02. IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
03. INJECTIONS Women can have an injection by a doctor or a nurse which stops them from becoming pregnant for months.
YES 1
NO 2
04. IMPLANTS Women can have 5 small rods placed in the arm by a doctor which can prevent pregnancy for several years.
YES 1
NO 2
05. DIAPHRAGM, FOAMING TABLETS. Women can place a diaphragm, foaming tablet, sponge, jelly, or cream inside themselves before sexual intercourse.
YES 1
NO 2
06. CONDOM Men can use a rubber sheath during sexual intercourse.
YES 1
NO 2
07. FEMALE STERILIZATION Women can have an operation to avoid having any more children: Has your wife ever had this operation?
YES 1
NO 2
08. MALE STERILIZATION Men can have an operation to avoid having any more children: Have you ever had this operation?
YES 1
NO 2
09. SAFE PERIOD, RHYTHM Every month that a woman is sexually active the couple can avoid having sex on the days of the month she is more likely to get pregnant.
YES 1
NO 2
10. WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
11. Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO 2
1. (SPECIFY) __________
2. (SPECIFY) __________

305) CHECK 304:

NOT A SINGLE "YES" (NEVER USED) ___
AT LEAST ONE "YES" (EVER USED) ___ (SKIP TO 308)

306) Have you ever used anything or tried anything in any way to delay or avoid having a child?

YES 1
NO 2 (SKIP TO 316)

307) What have you used or done?

CORRECT 304-305 (AND 302 IF NECESSARY)

308) CHECK 303:

MAN NOT STERILIZED ___
MAN STERILIZED ___ (SKIP TO 310A)

309) Are you currently doing something or using any method to delay or avoid having a child?

YES 1
NO 2 (SKIP TO 316)

310) Which method are you using?

(NOTE: DO NOT ASK QUESTION 310A IF THE MAN IS NOT STERILIZED)

310A) You have said that you had an operation that keeps you from getting a woman pregnant. Is that correct? IF RESPONDENT SAYS "NO", CORRECT 303-304 (AND 302 IF NECESSARY). IF RESPONDENT CONFIRMS WITH A "YES", CIRCLE '08' FOR MALE STERILIZATION.

PILL 01 (SKIP TO 315)
IUD 02 (SKIP TO 315)
INJECTIONS 03 (SKIP TO 315)
IMPLANTS 04 (SKIP TO 315)
DIAPHRAGM/FOAMING TABLET/SPONGE 05 (SKIP TO 315)
CONDOM 06 (SKIP TO 315)
FEMALE STERILIZATION 07
MALE STERILIZATION 08
SAFE PERIOD/RHYTHM 09 (SKIP TO 316)
WITHDRAWAL 10 (SKIP TO 316)
OTHER (SPECIFY) __________ 96 (SKIP TO 316)

311) 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.

NAME OF PLACE __________
PUBLIC SECTOR
CENTRAL HOSPITAL 11
PROVINCIAL HOSPITAL 12
DISTRICT/RURAL HOSPITAL 13
OTHER PUBLIC (SPECIFY) __________ 16
MISSION FACILITY 19
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR 23
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26
OTHER (SPECIFY) __________ 96
DON'T KNOW 98

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

YES 1
NO 2 (SKIP TO 314)

313) Why do you regret the operation?

RESPONDENT WANTS ANOTHER CHILD 01
WIFE WANTS ANOTHER CHILD 02
SIDE EFFECTS 03
CHILD DIED 04
OTHER (SPECIFY) __________ 96

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

MONTH __________ (SKIP TO 316)
YEAR __________ (SKIP TO 316)

315) 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.

NAME OF PLACE __________
PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC 11
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
MISSION FACILITY 19
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
CBD 25
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26
OTHER PRIVATE SECTOR
SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
OTHER (SPECIFY) __________ 96

316) CHECK 201 AND 209:

CURRENTLY MARRIED OR HAVING A REGULAR PARTNER ___
NOT CURRENTLY MARRIED AND NOT HAVING A REGULAR PARTNER ___ (SKIP TO 319)

317) Is your wife (or one of your wives)/ regular partner pregnant now?

YES 1
NO 2 (SKIP TO 319)
UNSURE 8 (SKIP TO 319)

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

THEN 1
LATER 2
NOT AT ALL 3

319) CHECK 210:

HAS HAD SEX ___
NEVER HAD SEX ___ (SKIP TO 401)

320) CHECK 302:

KNOWS CONDOM ___
Now I need to ask you some more questions about sexual activity. The last time you had sex, was a condom used?
YES 1
NO 2
DON'T KNOW 8
DOES NOT KNOW CONDOM ___
Now I need to ask you some more questions about sexual activity. Some men use a condom, which means that they put a rubber sheath on their penis during sexual intercourse. The last time you had sex, was a condom used?
YES 1
NO 2
DON'T KNOW 8

321) Do you know where you can get condoms?

YES 1
NO 2 (SKIP TO 323)

322) Where is that?

IF SOURCE IS A 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/CLINIC 10
RURAL/MUNICIPAL CLINIC 11
ZNFPC 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
MISSION FACILITY 19
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
CBD 25
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26
OTHER PRIVATE SECTOR
SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
OTHER (SPECIFY) __________ 96

323) CHECK 201:

CURRENTLY MARRIED ___
NOT CURRENTLY MARRIED ___ (SKIP TO 332)

324) Who did you have sex with the last time you had sexual intercourse? Was it with your wife or was it with someone else?

WIFE 1
SOMEONE ELSE 2

325) Have you had sex with your wife in the last four weeks

YES 1
NO 2 (SKIP TO 328)

326) How many times?

NUMBER OF TIMES ___
DON'T KNOW 98

327) Was a condom used on any of these occasions? IF YES: Was it each time or sometimes?

YES, EACH TIME 1
YES, SOMETIMES 2
NEVER 3

328) Have you had sex with anyone other than your wife in the last four weeks?

YES 1
NO 2 (SKIP TO 401)

329) With how many persons other than your wife have you had sex with in the last 4 weeks?

NUMBER OF PERSONS ___
DON'T KNOW 98

330) How many times have you had sex with someone apart from your wife in the last 4 weeks?

NUMBER OF TIMES ___
DON'T KNOW 98

331) Was a condom used on any of these occasions? IF YES: Was it each time or sometimes?

YES, EACH TIME 1 (SKIP TO 401)
YES, SOMETIMES 2 (SKIP TO 401)
NEVER 3 (SKIP TO 401)

332) Have you had sex with anyone in the last four weeks?

YES 1
NO 2 (SKIP TO 401)

333) With how many persons have you had sex in the last 4 weeks?

NUMBER OF PERSONS ___
DON'T KNOW 98

334) How many times have you had sex with someone in the last 4 weeks?

NUMBER OF TIMES ___
DON'T KNOW 98

335) Was a condom used on any of these occasions? IF YES: Was it each time or sometimes?

YES, EACH TIME 1
YES, SOMETIMES 2
NEVER 3

SECTION 4. FERTILITY PREFERENCES

401) CHECK 210:

EVER HAD SEX ___
NEVER HAD SEX ___ (SKIP TO 413)

402) CHECK 317 AND 201:

WIFE (WIVES) NOT PREGNANT OR UNSURE OR MAN NOT CURRENTLY MARRIED ___
Now I have some questions about the future. Would you like to have (a/another) child or would you prefer not to have any (more) children?
HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (SKIP TO 406)
SAYS WIFE CAN'T GET PREGNANT 3 (SKIP TO 406)
UNDECIDED/DON'T KNOW 8 (SKIP TO 404)
WIFE PREGNANT ___
Now I have some questions about the future. After the child your wife is expecting, would you like to have another child or would you prefer not to have any more children?
HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (SKIP TO 406)
SAYS WIFE CAN'T GET PREGNANT 3 (SKIP TO 406)
UNDECIDED/DON'T KNOW 8 (SKIP TO 404)

403) CHECK 317 AND 201:

WIFE (WIVES) NOT PREGNANT OR UNSURE OR MAN NOT CURRENTLY MARRIED ___
How long would you like to wait from now before the birth of (a/another) child?
MONTHS 1 ___
YEARS 2 ___
SOON/NOW 993 (SKIP TO 406)
SAYS WIFE CAN'T GET PREGNANT 994 (SKIP TO 406)
AFTER MARRIAGE 995
OTHER (SPECIFY) __________ 996
DON'T KNOW 998
WIFE PREGNANT ___
How long would you like to wait after the birth of the child your wife is expecting before the birth of another child?
MONTHS 1 ___
YEARS 2 ___
SOON/NOW 993 (SKIP TO 406)
SAYS WIFE CAN'T GET PREGNANT 994 (SKIP TO 406)
AFTER MARRIAGE 995
OTHER (SPECIFY) __________ 996
DON'T KNOW 998

404) CHECK 317 AND 201:

WIFE NOT PREGNANT OR UNSURE ___
WIFE PREGNANT OR MAN NOT CURRENTLY MARRIED ___ (SKIP TO 406)

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

HAPPY 1
UNHAPPY 2
WOULD NOT MATTER 3

406) CHECK 309: USING A METHOD?

NOT ASKED ___
NOT CURRENTLY USING ___
CURRENTLY USING ___ (SKIP TO 413)

407) Do you intend to use a method to delay or avoid pregnancy within the next 12 months?

YES 1 (SKIP TO 409)
NO 2
DON'T KNOW 8

408) Do you intend to use a method at any time in the future?

YES 1
NO 2 (SKIP TO 410)
DON'T KNOW 8 (SKIP TO 410)

409) Which method would you prefer to use?

PILL 01 (SKIP TO 413)
IUD 02 (SKIP TO 413)
INJECTIONS 03 (SKIP TO 413)
IMPLANTS 04 (SKIP TO 413)
DIAPHRAGM/FOAM/JELLY 05 (SKIP TO 413)
CONDOM 06 (SKIP TO 413)
FEMALE STERILIZATION 07 (SKIP TO 413)
MALE STERILIZATION 08 (SKIP TO 413)
SAFE PERIOD 09 (SKIP TO 413)
WITHDRAWL 10 (SKIP TO 413)
OTHER (SPECIFY) __________ 96 (SKIP TO 413)
UNSURE 98 (SKIP TO 413)

410) What is the main reason you never intend to use a method?

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

411) CHECK 410:

CODE 11 CIRCLED ___
CODE 11 NOT CIRCLED ___ (SKIP TO 413)

412) Would you ever use a method if you were married?

YES 1
NO 2
DON'T KNOW 8

413) CHECK 214 AND 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? PROBE FOR A NUMERIC RESPONSE.
NUMBER ___
OTHER (SPECIFY) __________ 96 (SKIP TO 415)
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 (SKIP TO 415)

414) How many of these children would you like to be boys and how many would you like to be girls?

NUMBER BOYS ___
NUMBER GIRLS ___
NUMBER EITHER ___
OTHER (SPECIFY) __________ 999996

415) Do you approve or disapprove of couples using a method of family planning to avoid getting pregnant?

APPROVE 1
DISAPPROVE 2 (SKIP TO 417)
NO OPINION (SKIP TO 417)

416) Have you ever recommended family planning to a friend, relative, or anyone else?

YES 1
NO 2

417) Is it acceptable or not acceptable to you for information on family planning to be provided:

On the radio?
ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8
On the television?
ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8
By a CBD?
ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8

418) In the last six months have you heard or learned about family planning:

On the radio?
YES 1
NO 2
On the television?
YES 1
NO 2
In a newspaper or magazine?
YES 1
NO 2
From a poster?
YES 1
NO 2
From leaflets or brochures?
YES 1
NO 2
From a CBD?
YES 1
NO 2

419) In the last six months have you discussed the practice of family planning with your friends or relatives?

YES 1
NO 2 (SKIP TO 421)

420) With whom? Anyone else? RECORD ALL MENTIONED.

WIFE A
MOTHER B
REGULAR PARTNER (NOT WIFE) C
FATHER D
SISTER(S) E
BROTHER(S) F
DAUGHTER G
MOTHER-IN-LAW H
FRIENDS I
OTHER (SPECIFY) __________ X

421) Do you think most, some, or none of the men you know use some kind of family planning?

MOST 1
SOME 2
NONE 3
DON'T KNOW 8

422) CHECK 201:

YES, CURRENTLY MARRIED ___
NO, NOT CURRENTLY MARRIED ___ (SKIP TO 501)

423) Now I want to ask you about your wife's view on family planning. Do you think that your wife approves or disapproves of couples using a method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

424) Have you and your wife ever discussed the number of children you would like to have?

YES 1
NO 2

425) Do you think your wife wants the same number of children that you want, or does she want more or fewer than you want?

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

SECTION 5. AIDS AND SEXUALLY TRANSMITTED DISEASES

501) Have you heard about diseases that can be transmitted through sex?

YES 1
NO 2 (SKIP TO 514)

502) Which diseases have you heard about? RECORD ALL RESPONSES

SYPHILIS A
GONORRHEA B
AIDS/HIV INFECTION C
GENITAL WARTS / CONDYLOMATA D
CHANCROID E
OTHER (SPECIFY) __________ W
OTHER (SPECIFY) __________ X
DON'T KNOW Z

503) CHECK 210:

HAS HAD SEX ___
HAS NEVER HAD SEX ___ (SKIP TO 513)

504) During the last 12 months, did you have any of these diseases?

YES 1
NO 2 (SKIP TO 513)
DON'T KNOW 8 (SKIP TO 513)

505) Which? RECORD ALL RESPONSES

SYPHILIS A
GONORRHEA B
AIDS/HIV INFECTION C
GENITAL WARTS / CONDYLOMATA D
CHANCROID E
OTHER (SPECIFY) __________ W
OTHER (SPECIFY) __________ X
DON'T KNOW Z

506) During the last 12 months, did you have a discharge from your penis?

YES 1
NO 2
DON'T KNOW 8

507) During the last 12 months, did you have a sore or ulcer on your penis?

YES 1
NO 2
DON'T KNOW 8

508) When you had the most recent episode of (DISEASE FROM 505, 506, 507) did you seek advice or treatment?

ADVICE/TREATMENT 1
SELF TREATMENT 2 (SKIP TO 510)
DID NOT DO ANYTHING 3 (SKIP TO 510)

509) Where did you seek advice or treatment? Any other place or person? RECORD ALL MENTIONED

PUBLIC SECTOR
CENTRAL HOSPITAL A
PROVINCIAL HOSPITAL B
DISTRICT/RURAL HOSPITAL C
RURAL HEALTH CENTRE D
RURAL/MUNICIPAL CLINIC E
VILLAGE COMMUNITY WORKER F
OTHER PUBLIC SECTOR (SPECIFY) __________ G
MISSION HOSPITAL/CLINIC H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC I
PHARMACY J
PRIVATE DOCTOR K
VILLAGE COMMUNITY WORKER L
OTHER MEDICAL PRIVATE SECTOR (SPECIFY) __________ M
OTHER PRIVATE SECTOR
SHOP N
RELATIVES/FRIENDS O
TRADITIONAL HEALER P
OTHER (SPECIFY) __________ X

510) When you had (DISEASE of 505, 506, 507) did you advise your partner to seek treatment?

YES 1
NO 2

511) When you had (DISEASE of 505, 506, 507) did you do something not to infect your partner?

YES 1
NO 2 (SKIP TO 513)
PARTNER ALREADY INFECTED 3 (SKIP TO 513)

512) What did you do? RECORD ALL MENTIONED

NO SEXUAL INTERCOURSE A
USED CONDOMS B
RECEIVED MEDICAL TREATMENT C
OTHER (SPECIFY) __________ X

513) SEE QUESTION 502

DID NOT MENTION 'AIDS' ___
MENTIONED 'AIDS' ___ (SKIP TO 515)

514) Have you ever heard of an illness called AIDS?

YES 1
NO 2 ___ (SKIP TO 531)

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

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

516) How can a person get the AIDS virus? Any other ways? RECORD ALL MENTIONED

SEXUAL INTERCOURSE A
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

517) Is there anything a person can do to avoid getting the AIDS virus?

YES 1
NO 2 (SKIP TO 521)
DON'T KNOW 8 (SKIP TO 521)

518) What can a person do to avoid getting the AIDS virus? Any other ways? RECORD ALL MENTIONED

SAFE SEX A
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

519) SEE QUESTION 518:

MENTIONED SAFE SEX ___
DID NOT MENTION SAFE SEX ___ (SKIP TO 521)

520) What does "safe sex" mean to you? RECORD ALL MENTIONED

ABSTAIN FROM SEX A
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

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

YES 1
NO 2
DON'T KNOW 8

522) Can AIDS be cured, or do all persons with AIDS die from the disease?

YES, THERE IS A CURE 1
NO, EVERYONE WITH AIDS DIES 2
DON'T KNOW 8

523) Can the AIDS virus be transmitted from mother to child during pregnancy or childbirth?

YES 1
NO 2
DON'T KNOW 8

524) Do you personally know someone who has AIDS or has died of AIDS?

YES 1
NO 2
DON'T KNOW 8

525) 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?

HOME CARE 1
MEDICAL FACILITY 2
LEFT ALONE 3
DON'T KNOW 8

526) Do you think your chances of getting the AIDS virus are small, moderate, great, or no risk at all?

NO RISK AT ALL 1
SMALL 2
MODERATE 3 (SKIP TO 528)
GREAT 4 (SKIP TO 528)

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

ABSTAIN FROM SEX A (SKIP TO 529)
USE CONDOMS DURING SEX B (SKIP TO 529)
HAVE ONLY ONE SEX PARTNER C (SKIP TO 529)
LIMITED NUMBER OF SEX PARTNERS D (SKIP TO 529)
NO HOMOSEXUAL CONTACT E (SKIP TO 529)
NO BLOOD TRANSFUSIONS F (SKIP TO 529)
NO INJECTIONS G (SKIP TO 529)
OTHER (SPECIFY) __________ X (SKIP TO 529)
DON'T KNOW Z (SKIP TO 529)

528) Why do you think that you have a (MODERATE/GREAT) chance of getting the AIDS virus? Any other reasons? RECORD ALL MENTIONED

DO NOT USE CONDOMS A
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

529) Since you heard of AIDS, have you changed your behavior to prevent getting the AIDS virus?

YES 1
NO 2 (SKIP TO 531)

530) What did you do? Anything else? Anything else? RECORD ALL MENTIONED

STOPPED ALL SEX A
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

531) 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?

YES 1
NO 2

532) CHECK 210:

HAS HAD SEX ___
HAS NEVER HAD SEX ___ (SKIP TO 601)

533) Have you ever used a condom during sex to avoid getting or transmitting diseases, such as the AIDS virus?

YES 1
NO 2

534) Have you given or received money, gifts or favours in return for sex at any time in the last 4 weeks?

YES 1
NO 2

SECTION 6. MATERNAL MORTALITY

601) 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 ___

602) CHECK 601:

TWO OR MORE BIRTHS ___
ONLY ONE BIRTH ___ (RESPONDENT ONLY) (SKIP TO 615)

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

NUMBER OF PRECEDING BIRTHS ___

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

NAME __________

605) Is (NAME) male or female?

MALE 1
FEMALE 2

606) Is (NAME) still alive?

YES 1
NO 2 (SKIP TO 608)
DON'T KNOW (SKIP TO NEXT COLUMN)

607) How old is (NAME)?

AGE ___

608) How many years ago did (NAME) die?

AGE ___

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

AGE ___ (IF MALE OR IF DIED BEFORE 10 YEARS, SKIP TO NEXT COLUMN)

610) Did (NAME) die during childbirth?

YES 1 (SKIP TO 614)
NO 2

611) Was (NAME) pregnant when she died?

YES 1 (SKIP TO 613)
NO 2

612) Did (NAME) die within six weeks after the end of a pregnancy or childbirth?

YES 1
NO 2

613) Did (NAME) die because of complications of pregnancy or childbirth?

YES 1
NO 2 (SKIP TO NEXT COLUMN)
DON'T KNOW 8

614) How many children had (NAME) given birth to before that pregnancy?

NUMBER ___

615) RECORD THE TIME.

HOUR ___
MINUTES ___

INTERVIEWER'S OBSERVATIONS

To be filled in after completing interview

Comments about Respondent:

__________

Comments on Specific Questions:

__________

Any Other Comments:

__________

SUPERVISOR'S OBSERVATIONS

__________

Name of Supervisor __________

Date _________

EDITOR'S OBSERVATIONS

__________

Name of Editor __________

Date _____