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1999 ZIMBABWE DEMOGRAPHIC AND HEALTH SURVEY

WOMEN'S QUESTIONNAIRE

IDENTIFICATION

NAME OF HOUSEHOLD HEAD __________

WARD NAME __________

CLUSTER NUMBER ___

HOUSEHOLD NUMBER ___

PROVINCE ___

URBAN/RURAL

URBAN 1
RURAL 2

LARGE CITY/SMALL CITY/TOWN/RURAL

LARGE CITY 1
SMALL CITY 2
TOWN 3
RURAL 4

NAME OF WOMAN __________

LINE NUMBER OF WOMAN ___

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
* RESULT CODES:

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

LANGUAGE OF QUESTIONNAIRE:

ENGLISH 3

LANGUAGE OF INTERVIEW:

SHONA 1
NDEBELE 2
ENGLISH 3
OTHER 4

SUPERVISOR
NAME __________
DATE _____

FIELD EDITOR
NAME __________
DATE _____

OFFICE EDITOR ___

KEYED BY ___

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

Hello. My name is __________ and I am working with the Central Statistical Office. 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 that of your children. This information may help the country plan health services. Whatever answers you provide will be confidential and will not be shown to other persons.

We hope you will participate in this survey since your views are important. Shall we proceed with the interview?

RESPONDENT AGREES TO BE INTERVIEWED ___ 1 (I HAVE READ THE ABOVE STATEMENT TO THE RESPONDENT AND SHE HAS AGREED TO BE INTERVIEWED.)
RESPONDENT DOES NOT AGREE ___ 2 (END)

SIGNATURE OF INTERVIEWER __________

101) RECORD THE TIME.

HOUR ___
MINUTES ___

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

CITY 1
TOWN 2
COMMERCIAL FARM 3
OTHER RURAL 4

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 (SKIP TO 105)
VISITOR 96 (SKIP TO 105)

104) Just before you moved here, did you live in a city, in a town, on a commercial farm or in another rural area?

CITY 1
TOWN 2
COMMERCIAL FARM 3
OTHER RURAL 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 (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?

GRADE/FORM ___

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 read a newspaper or magazine 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
NOT AT ALL 4

116) 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
NOT AT ALL 4

117) 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
NOT AT ALL 4

118) What is your religion?

TRADITIONAL 1
CHRISTIAN 2
MUSLIM 3
NONE 4
OTHER (SPECIFY) __________ 6

120) Have you ever drank an alcohol-containing beverage?

YES 1
NO 2 (SKIP TO 123)

121) In the last 30 days, on how many days did you drink an alcohol-containing beverage?

NUMBER OF DAYS ___
NONE/NEVER 997 (SKIP TO 123)

122) In the last 30 days, on how many occasions did you get "drunk"?

NUMBER OF TIMES ___
NONE/NEVER 997

123) In the last 3 months, have you had any kind of injection?

YES 1
NO 2 (SKIP TO 201)

124) In the last 3 months, how many times did you have an injection?

NUMBER OF INJECTIONS ___
EVERY DAY 998

124A) What was the injection for?
RECORD ALL RESPONSES.

MEDICAL TREATMENT A
OTHER B

125) The last time you had an injection, who was the person who gave you the injection?

HEALTH PROFESSIONAL 1
PHARMACIST 2
TRADITIONAL HEALER 3
FRIEND/RELATIVE 4
SELF 5
OTHER (SPECIFY) __________ 6

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 (SKIP 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 (SKIP 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 (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'.

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 survived only a few hours or days?

YES 1
NO 2 (SKIP 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 ___
NO ___ (PROBE AND CORRECT 201-208 AS NECESSARY.)

210) CHECK 208:

ONE OR MORE BIRTHS ___
NO BIRTHS ___ (SKIP TO 227)

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?

SINGLE 1
MULTIPLE 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 (SKIP TO 219)

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

218A) IF ALIVE:
RECORD HOUSEHOLD LINE NUMBER OF CHILD (RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD)

LINE NUMBER ___ (SKIP TO NEXT BIRTH)

219) 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 ___

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

YES 1
NO 2

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

YES 1
NO 2

224) 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 YR.: PROBE TO DETERMINE EXACT NUMBER OF MONTHS. ___
NUMBERS ARE DIFFERENT ___ (PROBE AND RECONCILE)

225) CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN JANUARY 1994 OR LATER. IF NONE, RECORD '0'.

NUMBER OF BIRTHS ___

226) FOR EACH BIRTH SINCE JANUARY 1994 ENTER 'B' IN THE MONTH OF BIRTH IN COLUMN 1 OF THE CALENDAR.

FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)

WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE.

227) Are you currently pregnant?

YES 1
NO 2 (SKIP TO 230)
UNSURE 8 (SKIP TO 230)

228) How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS. ENTER 'P's IN COLUMN 1 OF CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR TOTAL NUMBER OF COMPLETED MONTHS.

MONTHS ___

229) 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

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

YES 1
NO 2 (SKIP TO 235)

231) When did the last such pregnancy end?

MONTH __________
YEAR _____

232) CHECK 231:

LAST PREGNANCY ENDED IN JANUARY 1994 OR LATER ___
LAST PREGNANCY ENDED BEFORE JANUARY 1994 ___ (SKIP TO 236)

233) How many months pregnant were you when the last such pregnancy ended?
RECORD NUMBER OF COMPLETED MONTHS. ENTER 'T' IN COLUMN 1 OF CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

MONTHS ___

234) Have you ever had any other pregnancies which did not result in a live birth?

YES 1
NO 2 (SKIP TO 236)

235) ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 1994.
ENTER 'T' IN COLUMN 1 OF CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

235A) IN THE BOXES AT THE BOTTOM OF THE CALENDAR, FILL IN THE MONTH AND YEAR OF TERMINATION OF THE LAST NON-LIVE BIRTH PREGNANCY PRIOR TO JANUARY 1994.

236) When did your last menstrual period start?

DATE, IF GIVEN __________
DAYS AGO 1 ___
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___
IN MENOPAUSE 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

237) From one menstrual period to next, is there a time when a woman is more likely to become pregnant if she has sexual relations?

YES 1
NO 2 (SKIP TO 301)
DON'T KNOW 8 (SKIP TO 301)

238) Is this time during her period, right after her period has ended, just before her period begins or in the middle of her menstrual cycle?

DURING HER PERIOD 1
RIGHT AFTER HER PERIOD HAS ENDED 2
JUST BEFORE HER PERIOD BEGINS 3
IN THE MIDDLE OF THE CYCLE 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 303.

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 (SKIP TO NEXT METHOD)

02 MALE STERILIZATION Men can have an operation to avoid having any more children.

YES 1
NO 2 (SKIP TO NEXT METHOD)

03 PILL Women can take a pill every day.

YES 1
NO 2 (SKIP TO NEXT METHOD)

04 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.

YES 1
NO 2 (SKIP TO NEXT METHOD)

05 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.

YES 1
NO 2 (SKIP TO NEXT METHOD)

06 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.

YES 1
NO 2 (SKIP TO NEXT METHOD)

07 CONDOM Men can put a rubber sheath on their penis before sexual intercourse.

YES 1
NO 2 (SKIP TO NEXT METHOD)

08 FEMALE CONDOM Women can place a rubber sheath in their vagina before sexual intercourse.

YES 1
NO 2 (SKIP TO NEXT METHOD)

09 DIAPHRAGM Women can place a diaphragm in their vagina before intercourse.

YES 1
NO 2 (SKIP TO NEXT METHOD)

10 FOAM OR JELLY Women can place a suppository, jelly, or cream in their vagina before intercourse.

YES 1
NO 2 (SKIP TO NEXT METHOD)

11 LACTATIONAL AMENORRHEA METHOD (LAM) Women can use a specially taught method of pregnancy avoidance to delay the return of the menstrual period by feeding their child nothing but breast milk for up to six months after a birth.

YES 1
NO 2 (SKIP TO NEXT METHOD)

12 RHYTHM OR PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid having sexual intercourse on the days of the month she is most likely to get pregnant.

YES 1
NO 2 (SKIP TO NEXT METHOD)

13 WITHDRAWAL Men can be careful and pull out before climax.

YES 1
NO 2 (SKIP TO NEXT METHOD)

14 EMERGENCY CONTRACEPTION Women can take pills the day after sexual intercourse to avoid becoming pregnant.

YES 1
NO 2 (SKIP TO NEXT METHOD)

15 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?

YES 1
(SPECIFY) __________
(SPECIFY) __________
NO 2 (SKIP TO 304)

303) Have you ever used (METHOD)?

01 FEMALE STERILIZATION Have you ever had an operation to avoid having any (more) children?

YES 1
NO 2

02 MALE STERILIZATION Have you ever had a partner who had an operation to avoid having children?

YES 1
NO 2

03 PILL Women can take a pill every day.

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 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several 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 several 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 rubber sheath in their vagina before sexual intercourse.

YES 1
NO 2

09 DIAPHRAGM Women can place a diaphragm in their vagina before intercourse.

YES 1
NO 2

10 FOAM OR JELLY Women can place a suppository, jelly, or cream in their vagina before intercourse.

YES 1
NO 2

11 LACTATIONAL AMENORRHEA METHOD (LAM) Women can use a specially taught method of pregnancy avoidance to delay the return of the menstrual period by feeding their child nothing but breast milk for up to six months after a birth.

YES 1
NO 2

12 RHYTHM OR PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid having sexual intercourse on the days of the month she is most likely to get pregnant.

YES 1
NO 2

13 WITHDRAWAL Men can be careful and pull out before climax.

YES 1
NO 2

14 EMERGENCY CONTRACEPTION Women can take pills the day after sexual intercourse to avoid becoming pregnant.

YES 1
NO 2

15 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?

YES 1
(SPECIFY) __________
(SPECIFY) __________
NO 2

304) CHECK 303:

NOT A SINGLE "YES" (NEVER USED) ___
AT LEAST ONE "YES" (EVER USED) ___ (SKIP TO 309)

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

YES 1 (SKIP TO 307)
NO 2

306) ENTER '0' IN COLUMN 1 OF CALENDAR IN EACH BLANK MONTH (SKIP TO 332)

307) What have you used or done?

CORRECT 303 AND 304 (AND 301 IF NECESSARY).

309) 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?
IF NONE, RECORD '00'.

NUMBER OF CHILDREN ___

311) CHECK 303 (01):

WOMAN NOT STERILIZED ___
WOMAN STERILIZED ___ (SKIP TO 314A)

312) CHECK 227:

NOT PREGNANT OR UNSURE ___
PREGNANT ___ (SKIP TO 325)

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

YES 1
NO 2 (SKIP TO 325)

314) Which method are you using?

FEMALE STERILIZATION A
MALE STERILIZATION B
PILL C (SKIP TO 324)
IUD D (SKIP TO 324)
INJECTIONS E (SKIP TO 324)
IMPLANTS F (SKIP TO 324)
CONDOM G (SKIP TO 324)
FEMALE CONDOM H (SKIP TO 324)
DIAPHRAGM I (SKIP TO 324)
FOAM/JELLY J (SKIP TO 324)
LACTATIONAL AMENORRHEA METHOD K (SKIP TO 324)
PERIODIC ABSTINENCE L (SKIP TO 324)
WITHDRAWAL M (SKIP TO 324)
OTHER (SPECIFY) __________ X (SKIP TO 324)

314A) CIRCLE 'A' FOR FEMALE STERILIZATION.
IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD.

318) Where did the sterilization take place?

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

NAME OF PLACE __________

PUBLIC SECTOR
CENTRAL HOSPITAL 11
PROVINCIAL HOSPITAL 12
DISTRICT/RURAL HOSPITAL 13
OTHER PUBLIC (SPECIFY) __________ 16
MISSION FACILITY 21
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PRIVATE DOCTOR 32
OTHER PRIVATE MEDICAL (SPECIFY) __________ 36
OTHER (SPECIFY) __________ 96
DON'T KNOW 98

318A) Before the sterilization operation, were (you/your husband/your partner) told that you would not be able to have any (more) children?

YES 1
NO 2
DON'T KNOW 8

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

MONTH __________
YEAR _____

322) CHECK 321:

STERILIZED BEFORE JANUARY 1994 ___

ENTER CODE FOR STERILIZATION IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND EACH MONTH BACK TO JANUARY 1994 (THEN SKIP TO 327)

STERILIZED IN JANUARY 1994 OR LATER ___

ENTER CODE FOR STERILIZATION IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND IN EACH MONTH BACK TO THE DATE OF THE OPERATION.

ENTER METHOD SOURCE CODE IN COLUMN 2 OF CALENDAR IN MONTH OF DATE OF OPERATION. (THEN SKIP TO 325)

324) ENTER METHOD CODE FROM 314 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.

IF CURRENT METHOD STARTED IN JANUARY 1994 OR LATER, ENTER THE METHOD SOURCE CODE IN COLUMN 2 OF CALENDAR IN THE SAME MONTH THAT USE OF CURRENT METHOD BEGAN.

ILLUSTRATIVE QUESTIONS:

When did you start using this method continuously?
How long have you been using this method continuously?
When you started using this method, where did you obtain it?

325) 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 1994.
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

IN COLUMN 1, ENTER METHOD CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.

ILLUSTRATIVE QUESTIONS:
COLUMN 1:
When was the last time you used a method? Which method was that?
When did you start using that method? How long after the birth of (NAME)?
How long did you use the method then?

IN COLUMN 2, ENTER METHOD SOURCE CODE IN FIRST MONTH OF EACH USE.

ILLUSTRATIVE QUESTIONS:
COLUMN 2:
Where did you obtain the method when you started using it?
Where did you get advice on how to use the method [for LAM, rhythm, or withdrawal]?

IN COLUMN 3, ENTER CODES FOR DISCONTINUATION NEXT TO LAST MONTH OF USE.
NUMBER OF CODES IN COLUMN 3 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD 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 3:
Why did you stop using the (METHOD)?
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.

327) CHECK 314/314A:
CIRCLE CODE:
IF MORE THAN ONE METHOD CIRCLED IN 314/314A, CIRCLE CODE FOR HIGHEST METHOD ON LIST

NOT ASKED 00 (SKIP TO 332)
FEMALE STERILIZATION 01
MALE STERILIZATION 02 (SKIP TO 334)
PILL 03
IUD 04
INJECTIONS 05
IMPLANTS 06
CONDOM 07 (SKIP TO 328I)
FEMALE CONDOM 08 (SKIP TO 328I)
DIAPHRAGM 09 (SKIP TO 328I)
FOAM/JELLY 10 (SKIP TO 328I)
LACTATIONAL AMENORRHEA METHOD 11 (SKIP TO 328I)
PERIODIC ABSTINENCE 12 (SKIP TO 334)
WITHDRAWAL 13 (SKIP TO 334)
OTHER METHOD 96 (SKIP TO 334)

328B) CHECK COLUMN 1 OF CALENDAR FOR LENGTH OF USE OF CURRENT METHOD:

STARTED USING AFTER JANUARY 1994 ___
STARTED USING IN JANUARY 1994 OR BEFORE ___ (SKIP TO 328K)

328G) You first obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM CALENDAR) on (DATE).
At that time, were you told about side effects or problems you might have with the method?

YES 1
NO 2 (SKIP TO 328I)

328H) Were you told what to do if you experienced side effects?

YES 1
NO 2

328I) When you were given the (CURRENT METHOD), were you told about other methods of family planning which you could use?

YES 1
NO 2

328K) CHECK 314/314A:
CIRCLE METHOD CODE:

NOT ASKED 00 (SKIP TO 332)
FEMALE STERILIZATION 01 (SKIP TO 334)
MALE STERILIZATION 02 (SKIP TO 334)
PILL 03
IUD 04
INJECTIONS 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMENORRHEA METHOD 11 (SKIP TO 334)
PERIODIC ABSTINENCE 12 (SKIP TO 334)
WITHDRAWAL 13 (SKIP TO 334)
OTHER METHOD 96 (SKIP TO 334)

328L) 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.

NAME OF PLACE __________

PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC 11 (SKIP TO 334)
RURAL/MUNICIPAL CLINIC 12 (SKIP TO 334)
RURAL HEALTH CENTER 13 (SKIP TO 334)
ZNFPC (FIXED) CLINIC 14 (SKIP TO 334)
ZNFPC MOBILE CLINIC 15 (SKIP TO 334)
MOH MOBLIE CLINIC 16 (SKIP TO 334)
ZNFPC CBD 17 (SKIP TO 334)
MOH CBD 18 (SKIP TO 334)
OTHER PUBLIC (SPECIFY) __________ 19 (SKIP TO 334)
MISSION FACILITY 21 (SKIP TO 334)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31 (SKIP TO 334)
PHARMACY 32 (SKIP TO 334)
PRIVATE DOCTOR 33 (SKIP TO 334)
CBD 34 (SKIP TO 334)
OTHER PRIVATE MEDICAL (SPECIFY) __________ 36 (SKIP TO 334)
OTHER SOURCE
SHOP 41 (SKIP TO 334)
CHURCH 42 (SKIP TO 334)
FRIENDS/RELATIVES 43 (SKIP TO 334)
OTHER (SPECIFY) __________ 96

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

YES 1
NO 2 (SKIP TO 334)

333) Where is that?

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

NAME OF PLACE __________

PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC 11
RURAL/MUNICIPAL CLINIC 12
RURAL HEALTH CENTER 13
ZNFPC (FIXED) CLINIC 14
ZNFPC MOBILE CLINIC 15
MOH MOBLIE CLINIC 16
ZNFPC CBD 17
MOH CBD 18
OTHER PUBLIC (SPECIFY) __________ 19
MISSION FACILITY 21
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PHARMACY 32
PRIVATE DOCTOR 33
CBD 34
OTHER PRIVATE MEDICAL (SPECIFY) __________ 36
OTHER SOURCE
SHOP 41
CHURCH 42
FRIENDS/RELATIVES 43
OTHER (SPECIFY) __________ 96

334) In the last 12 months, were you visited by a CBD who talked to you about family planning?

YES 1
NO 2

335) In the last 12 months, have you attended a health facility for care for yourself (or your children)?

YES 1
NO 2 (SKIP TO 401)

336) 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 225:

ONE OR MORE BIRTHS IN JANUARY 1994 OR LATER ___
NO BIRTHS IN JANUARY 1994 OR LATER ___ (SKIP TO 470)

402) ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1994 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 2 BIRTHS, USE ADDITIONAL QUESTIONNAIRES).

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

403) LINE NUMBER FROM QUESTION 212

LINE NUMBER ___

404) FROM QUESTION 212 AND QUESTION 216

NAME __________
ALIVE ___
DEAD ___

404A) Has (NAME) been registered?

YES 1
NO 2 (SKIP TO 405)
DON'T KNOW 8 (SKIP TO 405)

404B) Does (NAME) have a birth certificate?
IF YES: May I see it, please?

YES, SEEN 1
YES, NOT SEEN 2
NO CERTIFICATE 3

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?

THEN 1 (SKIP TO 407)
LATER 2
NO MORE 3 (SKIP TO 407)

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

MONTHS 1 ___
YEARS 2 ___
DON'T KNOW 998

[FOR QUESTIONS 407-411F, COMPLETE COLUMNS FOR LAST BIRTH]

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.

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
TRADITIONAL MIDWIFE
TRAINED C
UNTRAINED D
TRAINING UNCERTAIN E
OTHER (SPECIFY) __________ X
NO ONE Y (SKIP TO 410)

408) How many months pregnant were you when you first received antenatal care for this pregnancy?

MONTHS ___
DON'T KNOW 98

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

NUMBER OF TIMES ___
DON'T KNOW 98

409A) CHECK 409:
NUMBER OF TIMES RECEIVED ANTENATAL CARE

ONCE ___ (SKIP TO 409C)
MORE THAN ONCE OR DK ___

409B) How many months pregnant were you the last time you received antenatal care?

MONTHS ___
DON'T KNOW 98

409C) During this pregnancy, were any of the following done at least once?

Were you weighed?
YES 1
NO 2
Was your height measured?
YES 1
NO 2
Was your blood pressure measured?
YES 1
NO 2
Did you give a urine sample?
YES 1
NO 2
Did you give a blood sample?
YES 1
NO 2

409D) Were you told about the signs of pregnancy complications?

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

409E) Were you told where to go if you had these problems?

YES 1
NO 2
DON'T KNOW 8

410) During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?

YES 1
NO 2 (SKIP TO 411A)
DON'T KNOW 8 (SKIP TO 411A)

410A) During this pregnancy, how many times did you get this injection?

NUMBER OF TIMES ___
DON'T KNOW 8

411A) During this pregnancy, were you given or did you buy any iron tablets?
SHOW TABLET.

YES 1
NO 2 (SKIP TO 411C)
DON'T KNOW (SKIP TO 411C)

411B) During the whole pregnancy, how many tablets did you take?

NUMBER OF TABLETS ___
DON'T KNOW 998

411C) During this pregnancy, did you have difficulty with your vision during the daylight?

YES 1
NO 2
DON'T KNOW 8

411D) During this pregnancy, did you suffer from night blindness?

YES 1
NO 2
DON'T KNOW 8

411E) During this pregnancy, were you given or did you buy any drugs in order to prevent malaria?

YES 1
NO 2 (SKIP TO 412)
DON'T KNOW 8 (SKIP TO 412)

411F) Which drug was that?
RECORD ALL MENTIONED.

ASPIRIN A
FANSIDAR B
CHLOROQUINE C
DELTAPRIM D
NOROLON E
QUININE F
OTHER (SPECIFY) __________ X

412) When (NAME) was born, was he/she:

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

413) Was (NAME) weighed at birth?

YES 1
NO 2 (SKIP TO 415)
DON'T KNOW 8 (SKIP TO 415)

414) How much did (NAME) weigh?
RECORD WEIGHT FROM HEALTH CARD OR MOTHER'S CARD, IF AVAILABLE.

GRAMS FROM CARD 1 ___
GRAMS FROM RECALL 2 ___
DON'T KNOW 99998

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

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
TRADITIONAL MIDWIFE
TRAINED C
UNTRAINED D
TRAINING UNCERTAIN E
OTHER (SPECIFY) __________ X
NO ON Y (SKIP TO 417)

416) Where did you give birth to (NAME)?

HOME
YOUR HOME 11 (SKIP TO 418A)
OTHER HOME 12 (SKIP TO 418A)
PUBLIC SECTOR
CENTRAL HOSPITAL 21
PROVINCIAL HOSPITAL 22
DISTRICT/RURAL HOSPITAL 23
RURAL HEALTH CENTRE 24 (SKIP TO 418A)
RURAL/MUNICIPAL CLC. 25 (SKIP TO 418A)
OTHER PUBLIC (SPECIFY) __________ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL (SPECIFY) __________ 36
MISSION FACILITY 41
OTHER (SPECIFY) __________ 96 (SKIP TO 418A)

417) Was (NAME) delivered by caesarian section?

YES 1
NO 2

418A) After (NAME) was born, did anyone check on your health?

YES 1
NO 2 (SKIP TO 419)

418B) How many days or weeks after the delivery did the first check take place? [ANSWER FOR LAST BIRTH]
RECORD '00' DAYS IF SAME DAY.

DAYS AFTER DELIVERY 1 ___
WEEKS AFTER DELIVERY 2 ___
DON'T KNOW 998

418C) Who checked on your health at that time?
[ANSWER FOR LAST BIRTH]
PROBE FOR MOST QUALIFIED PERSON.

HEALTH PROFESSIONAL
DOCTOR 1
NURSE/MIDWIFE 2
TRADITIONAL MIDWIFE
TRAINED 3
UNTRAINED 4
TRAINING UNCERTAIN 5
OTHER (SPECIFY) __________ 6

418D) Where did this first check take place?
[ANSWER FOR LAST BIRTH]

HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
CENTRAL HOSPITAL 21
PROVINCIAL HOSPITAL 22
DISTRICT/RURAL HOSPITAL 23
RURAL HEALTH CENTRE 24
RURAL/MUNICIPAL CLC. 25
OTHER PUBLIC (SPECIFY) __________ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PRIVATE DOCTOR 32
OTHER PRIVATE MEDICAL (SPECIFY) __________ 36
MISSION FACILITY 41
OTHER (SPECIFY) __________ 96

419) Has your period returned since the birth of (NAME)?
[ANSWER FOR LAST BIRTH]

YES 1 (SKIP TO 421)
NO (SKIP TO 422)

420) Did your period return between the birth of (NAME) and your next pregnancy?
[ANSWER FOR NEXT-TO-LAST BIRTH]

YES 1
NO 2 (SKIP TO 424)

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

MONTHS ___
DON'T KNOW 98

422) CHECK 227:
RESPONDENT PREGNANT?

NOT PREGNANT ___
PREGNANT OR UNSURE ___ (SKIP TO 424)

423) Have you resumed sexual relations since the birth of (NAME)?
[MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS]

YES 1
NO 2 (SKIP TO 425)

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

MONTHS ___
DON'T KNOW 98

425) Did you ever breastfeed (NAME)?

YES 1
NO 2 (SKIP TO 431)

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

IMMEDIATELY 000
HOURS 1 ___
DAYS 2 ___

427) CHECK 404: CHILD ALIVE?

ALIVE ___
DEAD ___ (SKIP TO 429)

428) Are you still breastfeeding (NAME)?

YES 1 (SKIP TO 432)
NO 2

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

MONTHS ___
DON'T KNOW 98

431) CHECK 404:
CHILD ALIVE?

ALIVE ___ (SKIP TO 434)
DEAD ___ (GO BACK TO 404 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 440)

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

NUMBER OF NIGHTTIME FEEDINGS ___

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

NUMBER OF DAYLIGHT FEEDINGS ___

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

YES 1
NO 2
DON'T KNOW 8

437) Now I would like to ask you about the types of foods [NAME] has been fed over the last seven days, including yesterday.

How many days during last seven days was [NAME] given each of the following?

FOR EACH ITEM GIVEN AT LEAST ONCE IN LAST SEVEN DAYS, ASK: How many times yesterday or last night was [NAME] given [ITEM]?
IF 7 OR MORE TIMES, RECORD '7'.
IF DON'T KNOW, RECORD '8'.

A. Plain water?

LAST 7 DAYS ___
NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES ___

B. Commercially prepared baby formula?

LAST 7 DAYS ___
NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES ___

C. Fresh cow or goat milk?

LAST 7 DAYS ___
NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES ___

D. Any other milk such as tinned or powdered milk?

LAST 7 DAYS ___
NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES ___

E. Fruit juice?

LAST 7 DAYS ___
NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES ___

F. Any other liquids such as glucose water, tea, herbal teas/roots, or mahewu?

LAST 7 DAYS ___
NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES ___

G. Any other foods made from grains such as sadza, bread, porridge or thin gruel?

LAST 7 DAYS ___
NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES ___

H. Pumpkin, squash, sweet potatoes, or carrots?

LAST 7 DAYS ___
NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES ___

I. Potatoes or other food made from tubers?

LAST 7 DAYS ___
NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES ___

J. Any green leafy vegetables?

LAST 7 DAYS ___
NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES ___

K. Mango or pawpaw?

LAST 7 DAYS ___
NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES ___

L. Beans, groundnuts, or peanut butter?

LAST 7 DAYS ___
NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES ___

M. Any other fruits and vegetables such as oranges, bananas or tomatoes?

LAST 7 DAYS ___
NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES ___

N. Meat, poultry, fish, or eggs?

LAST 7 DAYS ___
NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES ___

O. Cheese or yogurt?

LAST 7 DAYS ___
NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES ___

438) How many times was (NAME) fed solid or semi-solid (mashed or pureed) food yesterday or last night?
IF 7 OR MORE TIMES, RECORD '7'.

NUMBER OF TIMES ___
DON'T KNOW 8

439) GO BACK TO 404A IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 440.

SECTION 4B. IMMUNIZATION AND HEALTH

440) ENTER THE NAME AND LINE NUMBER OF EACH LIVING CHILD BORN SINCE JANUARY 1994 IN THE TABLE.
ASK THE QUESTIONS ABOUT ALL OF THESE CHILDREN.
BEGIN WITH THE YOUNGEST CHILD. (IF THERE ARE MORE THAN 2 LIVING CHILDREN, USE ADDITIONAL QUESTIONNAIRES).

441) LINE NUMBER FROM QUESTION 212

LINE NUMBER ___

442) FROM QUESTION 212 AND QUESTION 216

NAME __________________
ALIVE ___
DEAD ___ (SKIP TO 442 IN NEXT COLUMN OR, IF NO MORE BIRTHS, SKIP TO 464A)

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

YES, SEEN 1 (SKIP TO 445)
YES, NOT SEEN 2 (SKIP TO 447)
NO CARD 3

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

YES 1 (SKIP TO 447)
NO 2 (SKIP TO 447)

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

BCG
DAY ___
MONTH __________
YEAR _____
POLIO 1
DAY ___
MONTH __________
YEAR _____
POLIO 2
DAY ___
MONTH __________
YEAR _____
POLIO 3
DAY ___
MONTH __________
YEAR _____
DPT 1
DAY ___
MONTH __________
YEAR _____
DPT 2
DAY ___
MONTH __________
YEAR _____
DPT 3
DAY ___
MONTH __________
YEAR _____
MEASLES
DAY ___
MONTH __________
YEAR _____

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

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 445) (SKIP TO 448H)
NO 2 (SKIP TO 448H)
DON'T KNOW 8 (SKIP TO 448H)

447) Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases, including vaccinations received in a national immunization day campaign?

YES 1
NO 2 (SKIP TO 449)
DON'T KNOW 8 (SKIP TO 449)

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

448A. A BCG vaccination against tuberculosis, that is, an injection in the right arm or shoulder that caused a scar?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 448E)
DON'T KNOW 8 (SKIP TO 448E)

448D. How many times was the polio vaccine received?

NUMBER OF TIMES ___

448E. DPT vaccination, that is, an injection given in the thigh, sometimes at the same time as polio drops?

YES 1
NO 2 (SKIP TO 448G)
DON'T KNOW 8 (SKIP TO 448G)

448F. How many times?

NUMBER OF TIMES ___

448G. An injection to prevent measles?

YES 1
NO 2
DON'T KNOW 8

448H. Were any of the vaccinations (NAME) received during the last two years given as a part of a national immunization day campaign?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 451A)
DON'T KNOW 8 (SKIP TO 451A)

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

YES 1
NO 2
DON'T KNOW 8

451A) CHECK 449 AND 450:
FEVER OR COUGH?

"YES" IN 449 OR 450 ___
OTHER ___ (SKIP TO 454)

452) Did you seek advice or treatment for the illness?

YES 1
NO 2 (SKIP TO 454)

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

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

453A) CHECK 449:
HAD FEVER?

"YES" IN 449 ___
"NO"/"DK" IN 449 ___ (SKIP TO 454)

453B) Did (NAME) take any antimalarial drugs for the fever?

YES 1
NO 2 (SKIP TO 454)
DON'T KNOW (SKIP TO 454)

453C) What drug was that?
RECORD ALL MENTIONED.

PARACETAMOL A
ASPIRIN B
FANSIDAR C
CHLOROQUINE D
DELTAPRIM E
NOROLON F
OTHER (SPECIFY) __________ X
DON'T KNOW Z

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

YES 1
NO 2 (SKIP TO 464)
DON'T KNOW 8 (SKIP TO 464)

457) When (NAME) had diarrhea, was he/she given less than usual to drink, about the same amount, or more than usual to drink?

LESS 1
SAME 2
MORE 3
DON'T KNOW 8

458) Was he/she given less than usual to eat, about the same amount, or more than usual to eat?

LESS 1
SAME 2
MORE 3
DON'T KNOW 8

459) Was he/she given any of the following to drink:

A sugar-salt-water solution (SSS)?
YES 1
NO 2
DON'T KNOW 8
Any other liquid?
YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 462)
DON'T KNOW 8 (SKIP TO 462)

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

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

462) Did you seek advice or treatment for the diarrhea?

YES 1
NO 2 (SKIP TO 464)

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

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

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

464A) CHECK 442, ALL COLUMNS:
NUMBER OF LIVING CHILDREN BORN SINCE JANUARY 1994

ONE OR MORE ___
NONE ___ (SKIP TO 470)

464B) The last time you fed your children, did you wash your hands immediately before feeding them?

YES 1
NO 2
NEVER FED CHILDREN 3

464C) The last time you had to clean (your child/one of your children) after (he/she) defecated, did you wash your hands immediately afterwards?

YES 1
NO 2
NEVER CLEANED CHILDREN 3

464D) What usually happens with your child(ren)'s stools when they do not use any toilet facility?

ALWAYS USE TOILET/LATRINE 01
DISPOSED OF IN TOILET/LATRINE 02
DISPOSED OF OUTSIDE DWELLING 03
DISPOSED OF OUTSIDE YARD 04
BURY IN THE YARD 05
WASHED AWAY 06
NOT DISPOSED OF 07
OTHER (SPECIFY) __________ 96

469) CHECK 459, ALL COLUMNS:

NO CHILD RECEIVED SSS ___
ANY CHILD RECEIVED SSS ___ (SKIP TO 470A)

470) Have you ever heard of a special solution prepared using sugar, salt and water that is used for the treatment of diarrhea?

YES 1
NO 2

470A) CHECK 218:

HAS ONE OR MORE CHILDREN LIVING WITH HER ___
HAS NO CHILDREN LIVING WITH HER ___ (SKIP TO 470C)

470B) When (your child/one of your children) is seriously ill, can you decide by yourself whether the child should be taken for medical treatment?

YES 1
NO 2
DEPENDS 3

470C) 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, a small problem, or no problem for you?

Knowing where to go...
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
Getting permission to go...
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
Getting money needed for treatment...
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
Not having a health facility nearby...
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
Having to take transport...
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
Not wanting to go alone...
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
Concern that there may not be a female health provider...
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
Fear of verbal abuse by health provider...
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3

470D) Do you currently smoke cigarettes or tobacco?
IF YES: What type of tobacco do you smoke?

YES, CIGARETTES A
YES, PIPE B
YES, OTHER TOBACCO C
NO E (SKIP TO 470F)

470E) In the last 24 hours, how many times did you smoke?

TIMES ___

470F) The last time you prepared a meal for your family, before starting, did you wash your hands?

YES 1
NO 2
NEVER PREPARED MEALS 3

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

502) Are you currently married or living with a man?

YES, CURRENTLY MARRIED 1 (SKIP TO 507)
YES, LIVING WITH A MAN 2 (SKIP TO 507)
NO, NOT IN UNION 3

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

YES, FORMERLY MARRIED 1 (SKIP TO 506)
YES, LIVED WITH A MAN 2 (SKIP TO 511)
NO 3

505) ENTER '0' IN COLUMN 4 OF CALENDAR IN THE MONTH OF INTERVIEW, AND IN EACH MONTH BACK TO JANUARY 1994 (SKIP TO 515)

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

WIDOWED 1 (SKIP TO 511)
DIVORCED 2 (SKIP TO 511)
SEPARATED 3 (SKIP TO 511)

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

507A) RECORD THE HUSBAND'S LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.

LINE NUMBER ___

508) Besides yourself, how many wives does your husband have?

NUMBER OF CO-WIVES ___

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

ONCE 1
MORE THAN ONCE 2

512) 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 _____ (SKIP TO 514)
DON'T KNOW YEAR 9998

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

AGE ___

514) DETERMINE MONTHS MARRIED OR LIVING WITH A MAN SINCE JANUARY 1994. ENTER 'X' IN COLUMN 4 OF CALENDAR FOR EACH MONTH MARRIED OR LIVING WITH A MAN, AND ENTER '0' FOR EACH MONTH NOT MARRIED/NOT LIVING WITH A MAN, SINCE JANUARY 1994.

FOR WOMEN WITH MORE THAN ONE UNION: PROBE FOR DATE WHEN CURRENT UNION STARTED AND, IF APPROPRIATE, FOR STARTING AND TERMINATION DATES OF ANY PREVIOUS UNIONS.

FOR WOMEN NOT CURRENTLY IN UNION: PROBE FOR DATE WHEN LAST UNION STARTED AND FOR TERMINATION DATE AND, IF APPROPRIATE, FOR THE STARTING AND TERMINATION DATES OF ANY PREVIOUS UNIONS
.

514A) CHECK 502:

CURRENTLY MARRIED OR LIVING WITH A MAN ___
NOT CURRENTLY MARRIED AND NOT CURRENTLY LIVING WITH A MAN ___ (SKIP TO 515)

514B) CHECK 314/314A:

ANY CODE CIRCLED ___
NOT ASKED (NO CODE CIRCLED) ___ (SKIP TO 515)

514C) You have told me that you are 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?

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

515) 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 (SKIP TO 525)
AGE IN YEARS ___
FIRST TIME WHEN MARRIED 96

517) When was the last time you had sexual intercourse?

DAYS AGO 1 ___
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___ (SKIP TO 525)

518) The last time you had sexual intercourse, was a condom used?

YES 1
NO 2 (SKIP TO 519)

518A) What was the main reason you used a condom on that occasion?

OWN CONCERN PREVENT STD/HIV 1
OWN CONCERN TO PREVENT PREGNANCY 2
OWN CONCERN TO PREVENT BOTH STD/HIV AND PREGNANCY 3
DID NOT TRUST PARTNERS/FEELS PARTNER HAS OTHER PARTNERS 4
PARTNER INSISTED 5
OTHER (SPECIFY) __________ 6
DON'T KNOW 8

519) What is your relationship to the man with whom you last had sex?
IF "GIRLFRIEND OR FIANCEE", ASK "the last time you had sex with this partner, were you living with him?"

IF "YES", RECORD '1'
IF "NO", RECORD '2'

SPOUSE/COHABITING PARTNER 1 (SKIP TO 520)
GIRL FRIEND/FIANCEE 2
OTHER FRIEND 3
CASUAL ACQUAINTANCE 4
COMMERCIAL SEX WORKER 5
RELATIVE 6
OTHER (SPECIFY) __________ 7

519A) How long have you had a sexual relationship with this man?

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

520) Have you had sex with anyone else in the last 12 months?

YES 1
NO 2 (SKIP TO 525)

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

YES 1
NO 2 (SKIP TO 523)

522A) What was the main reason you used a condom on that occasion?

OWN CONCERN PREVENT STD/HIV 1
OWN CONCERN TO PREVENT PREGNANCY 2
OWN CONCERN TO PREVENT BOTH STD/HIV AND PREGNANCY 3
DID NOT TRUST PARTNERS/FEELS PARTNER HAS OTHER PARTNERS 4
PARTNER INSISTED 5
OTHER (SPECIFY) __________ 6
DON'T KNOW 8

523) What is your relationship to this man?
IF "GIRLFRIEND OR FIANCEE", ASK "the last time you had sex with this partner, were you living with him?"
IF "YES", RECORD '1'
IF "NO", RECORD '2'

SPOUSE/COHABITING PARTNER 1 (SKIP TO 524)
GIRL FRIEND/FIANCEE 2
OTHER FRIEND 3
CASUAL ACQUAINTANCE 4
COMMERCIAL SEX WORKER 5
RELATIVE 6
OTHER (SPECIFY) __________ 7

523A) How long have you had a sexual relationship with this man?

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

524) Altogether, with how many different men have you had sex in the last 12 months?

NUMBER OF PARTNERS ___

525) Do you know of a place where one can get condoms?

YES 1
NO 2 (SKIP TO 527)

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

NAME OF PLACE __________

PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC 11
RURAL/MUNICIPAL CLINIC 12
RURAL HEALTH CENTRE 13
ZNFPC (FIXED) CLINIC 14
ZNFPC MOBILE CLINIC 15
MOH MOBILE CLINIC 16
ZNFPC CBD 17
MOH CBD 18
OTHER PUBLIC (SPECIFY) __________ 19
MISSION FACILITY 21
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PHARMACY 32
PRIVATE DOCTOR 33
CBD 34
OTHER PRIVATE MEDICAL (SPECIFY) __________ 36
OTHER SOURCE
SHOP 41
CHURCH 42
FRIENDS/RELATIVES 43
OTHER (SPECIFY) __________ 96

526A) If you wanted to, could you easily get a condom?

YES 1
NO 2
DON'T KNOW/UNSURE 8

527) Do you know of a place where one can get female condoms?

YES 1
NO 2 (SKIP TO 601)

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

NAME OF PLACE __________

PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC 11
RURAL/MUNICIPAL CLINIC 12
RURAL HEALTH CENTRE 13
ZNFPC (FIXED) CLINIC 14
ZNFPC MOBILE CLINIC 15
MOH MOBILE CLINIC 16
ZNFPC CBD 17
MOH CBD 18
OTHER PUBLIC (SPECIFY) __________ 19
MISSION FACILITY 21
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PHARMACY 32
PRIVATE DOCTOR 33
CBD 34
OTHER PRIVATE MEDICAL (SPECIFY) __________ 36
OTHER SOURCE
SHOP 41
CHURCH 42
FRIENDS/RELATIVES 43
OTHER (SPECIFY) __________ 96

528A) If you wanted to, could you yourself easily get a female condom?

YES 1
NO 2
DON'T KNOW/UNSURE 8

SECTION 6. FERTILITY PREFERENCES

601) CHECK 314/314A:

NEITHER STERILIZED ___
HE OR SHE STERILIZED ___ (SKIP TO 612)

602) CHECK 227:

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 (SKIP TO 604)
SAYS SHE CAN'T GET PREGNANT 3 (SKIP TO 606)
UNDECIDED/DON'T KNOW AND PREGNANT 8 (SKIP TO 605)
UNDECIDED/DON'T KNOW AND NOT PREGNANT (SKIP TO 606)

603) CHECK 227:

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 (SKIP TO 606)
SAYS SHE CAN'T GET PREGNANT 994 (SKIP TO 606)
AFTER MARRIAGE 995 (SKIP TO 606)
OTHER (SPECIFY) __________ 996 (SKIP TO 606)
DON'T KNOW 998 (SKIP TO 606)

604) CHECK 227:

NOT PREGNANT OR UNSURE ___
PREGNANT ___ (SKIP TO 608)

604A) CHECK 313: USING A METHOD?

NOT ASKED ___
NOT CURRENTLY USING ___
CURRENTLY USING (SKIP TO 605)

604B) CHECK 603:

NOT ASKED ___
24 OR MORE MONTHS OR 02 OR MORE YEARS ___
0-23 MONTHS OR 01 YEAR ___ (SKIP TO 608)

604C) CHECK 602:

WANTS 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?]
WANTS NO (MORE) CHILDREN ___ [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?]

RECORD ALL MENTIONED.

NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
SUBFECUND/INFECUND E
POSTPARTUM AMENORRHEIC F
BREASTFEEDING G
FATALISTIC H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND 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
COST TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY'S NATURAL PROCESSES T
OTHER (SPECIFY) __________ X
DON'T KNOW Z

605) In the next few weeks, if you discovered that you were pregnant, would it 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 4

606) CHECK 313:
USING A METHOD?

NOT ASKED ___
NOT CURRENTLY USING ___
CURRENTLY USING ___ (SKIP TO 612)

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

YES 1
NO 2 (SKIP TO 610)
DON'T KNOW 8 (SKIP TO 610)

609) Which method would you prefer to use?

FEMALE STERILIZATION 01 (SKIP TO 612)
MALE STERILIZATION 02 (SKIP TO 612)
PILL 03 (SKIP TO 612)
IUD 04 (SKIP TO 612)
INJECTIONS 05 (SKIP TO 612)
IMPLANTS 06 (SKIP TO 612)
CONDOM 07 (SKIP TO 612)
FEMALE CONDOM 08 (SKIP TO 612)
DIAPHRAGM 09 (SKIP TO 612)
FOAM/JELLY 10 (SKIP TO 612)
LACTATIONAL AMENORRHEA METHOD 11 (SKIP TO 612)
PERIODIC ABSTINENCE 12 (SKIP TO 612)
WITHDRAWAL 13 (SKIP TO 612)
OTHER (SPECIFY) __________ 96 (SKIP TO 612)
UNSURE 98 (SKIP TO 612)

610) What is the main reason that you think you will not use a method at any time in the future?

NOT CURRENTLY MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX 22 (SKIP TO 612)
MENOPAUSAL/HYSTERECTOMY 23 (SKIP TO 612)
SUBFECUND/INFECUND 24 (SKIP TO 612)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (SKIP TO 612)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (SKIP TO 612)
HUSBAND OPPOSED 32 (SKIP TO 612)
OTHERS OPPOSED 33 (SKIP TO 612)
RELIGIOUS PROHIBITION 34 (SKIP TO 612)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (SKIP TO 612)
KNOWS NO SOURCE 42 (SKIP TO 612)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (SKIP TO 612)
FEAR OF SIDE EFFECTS 52 (SKIP TO 612)
LACK OF ACCESS/TOO FAR 53 (SKIP TO 612)
COST TOO MUCH 54
INCONVENIENT TO USE 55 (SKIP TO 612)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (SKIP TO 612)
OTHER (SPECIFY) __________ 96 (SKIP TO 612)
DON'T KNOW 98 (SKIP TO 612)

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

YES 1
NO 2
DON'T KNOW 8

612) CHECK 216:

HAS LIVING CHILDREN ___ (If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?
NO LIVING CHILDREN ___ (If you could choose exactly the number of children to have in your whole life, how many would that be?

PROBE FOR A NUMERIC RESPONSE.

NUMBER ___
OTHER (SPECIFY) __________ 96 (SKIP TO 614)

613) How many of these children would you like to be boys, how many would you like to be girls and for how many would it not matter?

BOYS
NUMBER ___
OTHER (SPECIFY) __________ 96
GIRLS
NUMBER ___
OTHER (SPECIFY) __________ 96
EITHER
NUMBER ___
OTHER (SPECIFY) __________ 96

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

APPROVE 1
DISAPPROVE 2
DON'T KNOW/UNSURE 3

616) In the last few months have you heard 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

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

YES 1
NO 2 (SKIP TO 620)

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

HUSBAND/PARTNER 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

620) CHECK 502:

YES, CURRENTLY MARRIED ___
YES, LIVING WITH A MAN ___
NO, NOT IN UNION ___ (SKIP TO 623A)

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

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

622) 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

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

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

623A) 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 is tired or not in the mood?
YES 1
NO 2
DON'T KNOW 8
She has recently given birth?
YES 1
NO 2
DON'T KNOW 8
She knows he has had sex with women other than his wife (wives)?
YES 1
NO 2
DON'T KNOW 8
She knows he has the AIDS virus?
YES 1
NO 2
DON'T KNOW 8

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

701) CHECK 502 AND 504:

CURRENTLY MARRIED/LIVING WITH A MAN ___
FORMERLY MARRIED/LIVED WITH A MAN ___ (SKIP TO 703)
NEVER MARRIED AND NEVER LIVED WITH A MAN ___ (SKIP TO 709)

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 (SKIP TO 706)

704) What was the highest level of school he attended?

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

705) What was the highest (grade/form/year) 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 is, what kind of work did he mainly do?
OCCUPATION __________

709) Aside from your own housework, are you currently working?

YES 1 (SKIP TO 712)
NO 2

710) 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 (SKIP TO 712)
NO 2

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

YES 1
NO 2 (SKIP TO 723A)

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

OCCUPATION __________

713) CHECK 712:

WORKS IN AGRICULTURE ___
DOES NOT WORK IN AGRICULTURE ___ (SKIP TO 715)

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

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

715) 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

716) 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

720) Are you paid 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 (SKIP TO 723)
NOT PAID 4 (SKIP TO 723)

720A) 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

722A) 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

723) Do you usually work at home or away from home?

HOME 1
AWAY 2

723A) Who in your family usually has the final say on the following decisions:

Your own health?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
Large household purchases?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
Daily household purchases?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
Visits to family, friends, or relatives?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
What food should be cooked each day?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5

728A) PRESENCE OF OTHERS AT THIS POINT (PRESENT AND LISTENING, PRESENT BUT NOT LISTENING OR NOT PRESENT)

CHILDREN UNDER 10
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 8
HUSBAND
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 8
OTHER MALES
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 8
OTHER FEMALES
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 8

728B) Sometimes a husband is annoyed or angered by things which his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

If she goes out without telling him?
YES 1
NO 2
DON'T KNOW 8
If she neglects the children?
YES 1
NO 2
DON'T KNOW 8
If she argues with him?
YES 1
NO 2
DON'T KNOW 8
If she refuses sex with him?
YES 1
NO 2
DON'T KNOW 8
If she burns the food?
YES 1
NO 2
DON'T KNOW 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 (SKIP TO 816)

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

YES 1
NO 2 (SKIP TO 810)
DON'T KNOW (SKIP TO 810)

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

ABSTAIN FROM SEX A
USE CONDOMS B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER C
LIMIT NUMBER OF SEXUAL 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 INTRAVEN H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID KISSING K
AVOID MOSQUITO BITES L
SEEK PROTECTION FROM TRADITIONAL HEALER M
AVOID SHARING RAZORS/BLADES N
OTHER (SPECIFY) __________ W
OTHER (SPECIFY) __________ X
DON'T KNOW Z

804) CHECK 803:

NEITHER CODE 'C' NOR CODE 'D' CIRCLED ___
CODE 'C' AND/OR CODE 'D' CIRCLED ___ (SKIP TO 807)

805) In your view, is a person's chance of getting AIDS influenced by the number of partners he or she has?

YES 1
NO 2 (SKIP TO 807)
DON'T KONW (SKIP TO 807)

806) If a person has sex with only one partner, does this person have a greater or lesser chance of getting AIDS than a person who has sex with many partners?

GREATER CHANCE OF AIDS 1
LESSER CHANCE OF AIDS 2

807) CHECK 803:

DID NOT MENTION USE OF A CONDOM DURING SEX (CODE 'B' NOT CIRCLED) ___
MENTIONED USE OF A CONDOM DURING SEX (CODE 'B' CIRCLED) ___ (SKIP TO 810)

808) In your view, is a person's chance of getting AIDS affected by using a condom every time he or she has sexual intercourse?

YES 1
NO 2 (SKIP TO 810)
UNSURE/DON'T KNOW 8 (SKIP TO 810)

809) If a person uses a condom every time he or she is engaged in sexual intercourse, does this person have a greater or a lesser chance of getting AIDS than someone who doesn't use a condom?

GREATER CHANCE OF AIDS 1
LESSER CHANCE OF AIDS 2

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

YES 1
NO 2
DON'T KNOW 8

811) Do you know someone personally who has the virus that causes AIDS or someone who died from AIDS?

YES 1
NO 2

812) Can the virus that causes AIDS be transmitted from a mother to a child?

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

812A) When can the virus that causes AIDS be transmitted from a mother to a child?
Any other times?
RECORD ALL RESPONSES.

DURING PREGNANCY A
AT DELIVERY B
DURING BREASTFEEDING C
OTHER TIMES D
DON'T KNOW Z

813) CHECK 502:

CURRENTLY MARRIED/LIVING WITH A MAN ___
NOT CURRENTLY MARRIED/NOT LIVING WITH A MAN ___ (SKIP TO 814A)

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

YES 1
NO 2

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

On the radio?
ACCEPTABLE 1
UNACCEPTABLE 2
On the TV?
ACCEPTABLE 1
UNACCEPTABLE 2
In newspapers?
ACCEPTABLE 1
UNACCEPTABLE 2

815A) If a person learns that he/she is infected with the virus that causes AIDS, should the person be allowed to keep this fact private or should this information be available to the community?

CAN BE KEPT PRIVATE 1
AVAILABLE TO COMMUNITY 2
DON'T KNOW/NOT SURE 8

815B) 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
DON'T KNOW/NOT SURE/DEPENDS 8

815C) Should persons with the AIDS virus who work with other persons such as in a shop, office, or farm be allowed to continue their work or not?

CAN CONTINUE WORK 1
SHOULD NOT CONTINUE WORK 2
DON'T KNOW/NOT SURE/DEPENDS 8

815D) Should children aged 12-14 be taught about using a condom to avoid AIDS?

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

815E) Have you ever been tested to see if you have the AIDS virus?

YES 1
NO 2 (SKIP TO 815HX)

815F) Would you want to be tested for the AIDS virus?

YES 1
NO 2
DON'T KNOW/UNSURE 3

815G) Do you know a place where you could go to get an AIDS test?

YES 1
NO 2 (SKIP TO 816)

815H) Where can you go for the test?

PUBLIC SECTOR
CENTRAL HOSPTIAL A
PROVINCIAL HOSPITAL B
DISTRICT HOSPITAL C
RURAL HEALTH CENTRE D
RURAL/MUNICIPAL CLINIC E
OTHER PUBLIC (SPECIFY) __________ G
MISSION FACILITY H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC I
PRIVATE DOCTOR J
OTHER PRIVATE MEDICAL (SPECIFY) __________ K
TRADITIONAL HEALER L
OTHER (SPECIFY) __________ X

815HX) Where did you go for the test?
Any other places?
RECORD ALL MENTIONED.

PUBLIC SECTOR
CENTRAL HOSPTIAL A
PROVINCIAL HOSPITAL B
DISTRICT HOSPITAL C
RURAL HEALTH CENTRE D
RURAL/MUNICIPAL CLINIC E
OTHER PUBLIC (SPECIFY) __________ G
MISSION FACILITY H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC I
PRIVATE DOCTOR J
OTHER PRIVATE MEDICAL (SPECIFY) __________ K
TRADITIONAL HEALER L
OTHER (SPECIFY) __________ X

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

YES 1
NO 2 (SKIP TO 901)

817) In a man, what signs and symptoms would lead you to think that he has such an infection?
Any others?
RECORD ALL 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
BLOOD IN URINE I
LOSS OF WEIGHT J
IMPOTENCE/STERILITY K
NO SIGNS/SYMPTOMS L
OTHER (SPECIFY) __________ W
OTHER (SPECIFY) __________ X
DON'T KNOW Z

818) In a woman, what signs and symptoms would lead you to think that she has such an infection?
Any others?
RECORD ALL 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
BLOOD IN URINE I
LOSS OF WEIGHT J
INFERTILITY/STERILITY K
NO SIGNS/SYMPTOMS L
OTHER (SPECIFY) __________ W
OTHER (SPECIFY) __________ X
DON'T KNOW Z

819) CHECK 515:

HAS HAD SEXUAL INTERCOURSE ___
HAS NOT HAD SEXUAL INTERCOURSE ___ (SKIP TO 901)

820) Now I would like to ask 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

820A) Sometimes women experience a discharge from their vagina. During the last 12 months have you had a discharge from your vagina?

YES 1
NO 2
DON'T KNOW 8

820B) Sometimes women experience a sore or ulcer in or near their vagina. During the last 12 months have you had a sore or ulcer in or near your vagina?

YES 1
NO 2
DON'T KNOW 8

822) CHECK 820, 820A AND 820B:

HAD STI ___
DID NOT HAVE STI ___ (SKIP TO 901)

825) The last time you had (INFECTION FROM 820/820A/820B), did you seek advice or treatment?

YES 1
NO 2 (SKIP TO 827)

826) Where did you seek advice or treatment?
RECORD ALL MENTIONED.

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

827) When you had (INFECTION FROM 820/820A/820B), did you inform the persons with whom you have been having sex?

YES 1
NO 2
SOME/NOT ALL 3

828) When you had (INFECTION FROM 820/820A/820B) did you do something to avoid infecting your sexual partner(s)?

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

829) What did you do?
Anything else?
RECORD ALL RESPONSES.

STOPPED SEXUAL INTERCOURSE A
USED CONDOMS B
TOOK MEDICINES C
OTHER (SPECIFY) __________ X

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 ___
ONLY ONE BIRTH (RESPONDENT ONLY) ___ (SKIP TO 916)

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 (SKIP TO 908)
DON'T KNOW 8 (SKIP TO NEXT BROTHER/SISTER)

907) How old is (NAME)?

AGE ___ (SKIP TO NEXT BROTHER/SISTER)

908) In what year did (NAME) die?

YEAR _____ (SKIP TO 910)
DON'T KNOW 9998

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

YEARS ___

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

AGE ___ (IF MALE OR DIED BEFORE 12 YEARS OF AGE SKIP TO NEXT BROTHER/SISTER)

911) Was (NAME) pregnant when she died?

YES 1 (SKIP TO 915)
NO 2

912) Did (NAME) die during childbirth?

YES 1 (SKIP TO 915)
NO 2

913) Did (NAME) die within 2 months after the end of a pregnancy or childbirth?

YES 1
NO 2

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

NUMBER ___ (SKIP TO NEXT BROTHER/SISTER)

IF NO MORE BROTHERS OR SISTERS, SKIP TO 916

916) 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: _____

INSTRUCTIONS:
ONLY ONE CODE SHOULD APPEAR IN ANY BOX.
FOR COLUMNS 1 AND 4, ALL MONTHS SHOULD BE FILLED IN.

INFORMATION TO BE CODED FOR EACH COLUMN

COLUMN 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE

B BIRTHS
P PREGNANCIES
T TERMINATIONS
0 NO METHOD
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 PILL
4 IUD
5 INJECTIONS
6 IMPLANTS
7 CONDOM
8 FEMALE CONDOM
9 DIAPHRAGM
F FOAM OR JELLY
L LACTATIONAL AMENORRHEA METHOD
A PERIODIC ABSTINENCE
W WITHDRAWAL
X OTHER (SPECIFY) __________

COLUMN 2: SOURCE OF CONTRACEPTION

1 GOVERNMENT HOSPITAL/CLINIC
2 GOVERNMENT RURAL/MUNICIPAL CLINIC
3 GOVERNMENT RURAL HEALTH CENTRE
4 ZNFPC FIXED CLINIC
5 ZNFPC MOBILE CLINIC
6 MOH MOBILE CLINIC
7 ZNFPC CBD
8 MOH CBD
9 OTHER PUBLIC
A MISSION FACILITY
B PRIVATE HOSPITAL/CLINIC
C PHARMACY
D PRIVATE DOCTOR
E PRIVATE CBD/FIELD WORKER
F OTHER PRIVATE MEDICAL
G SHOP
H CHURCH
I FRIENDS/RELATIVES
X OTHER (SPECIFY) __________

COLUMN 3: DISCONTINUATION OF CONTRACEPTIVE USE

0 INFREQUENT SEX/HUSBAND AWAY
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/MENOPAUSAL
D MARITAL DISSOLUTION/SEPARATION
X OTHER (SPECIFY) __________
Z DON'T KNOW

COLUMN 4: MARRIAGE/UNION

X IN UNION (MARRIED OR LIVING TOGETHER)
0 NOT IN UNION

TERMINATION OF LAST NON-LIVE BIRTH PREGNANCY PRIOR TO JANUARY 1994

IF NO PREVIOUS NON-LIVE BIRTH PREGNANCY, RECORD '00' FOR MONTH AND '0000' FOR YEAR

MONTH __________
YEAR _____

1999 (FILL COLUMNS 1 2 3 and 4 WITH APPROPRIATE CODES)
DEC ___ ___ ___ ___
NOV ___ ___ ___ ___
OCT ___ ___ ___ ___
SEP ___ ___ ___ ___
AUG ___ ___ ___ ___
JUL ___ ___ ___ ___
JUN ___ ___ ___ ___
MAY ___ ___ ___ ___
APR ___ ___ ___ ___
MAR ___ ___ ___ ___
FEB ___ ___ ___ ___
JAN ___ ___ ___ ___

1998 (FILL COLUMNS 1 2 3 and 4)
DEC ___ ___ ___ ___
NOV ___ ___ ___ ___
OCT ___ ___ ___ ___
SEP ___ ___ ___ ___
AUG ___ ___ ___ ___
JUL ___ ___ ___ ___
JUN ___ ___ ___ ___
MAY ___ ___ ___ ___
APR ___ ___ ___ ___
MAR ___ ___ ___ ___
FEB ___ ___ ___ ___
JAN ___ ___ ___ ___

1997 (FILL COLUMNS 1 2 3 and 4)
DEC ___ ___ ___ ___
NOV ___ ___ ___ ___
OCT ___ ___ ___ ___
SEP ___ ___ ___ ___
AUG ___ ___ ___ ___
JUL ___ ___ ___ ___
JUN ___ ___ ___ ___
MAY ___ ___ ___ ___
APR ___ ___ ___ ___
MAR ___ ___ ___ ___
FEB ___ ___ ___ ___
JAN ___ ___ ___ ___

1996 (FILL COLUMNS 1 2 3 and 4)
DEC ___ ___ ___ ___
NOV ___ ___ ___ ___
OCT ___ ___ ___ ___
SEP ___ ___ ___ ___
AUG ___ ___ ___ ___
JUL ___ ___ ___ ___
JUN ___ ___ ___ ___
MAY ___ ___ ___ ___
APR ___ ___ ___ ___
MAR ___ ___ ___ ___
FEB ___ ___ ___ ___
JAN ___ ___ ___ ___

1995 (FILL COLUMNS 1 2 3 and 4)
DEC ___ ___ ___ ___
NOV ___ ___ ___ ___
OCT ___ ___ ___ ___
SEP ___ ___ ___ ___
AUG ___ ___ ___ ___
JUL ___ ___ ___ ___
JUN ___ ___ ___ ___
MAY ___ ___ ___ ___
APR ___ ___ ___ ___
MAR ___ ___ ___ ___
FEB ___ ___ ___ ___
JAN ___ ___ ___ ___

1994 (FILL COLUMNS 1 2 3 and 4)
DEC ___ ___ ___ ___
NOV ___ ___ ___ ___
OCT ___ ___ ___ ___
SEP ___ ___ ___ ___
AUG ___ ___ ___ ___
JUL ___ ___ ___ ___
JUN ___ ___ ___ ___
MAY ___ ___ ___ ___
APR ___ ___ ___ ___
MAR ___ ___ ___ ___
FEB ___ ___ ___ ___
JAN ___ ___ ___ ___