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1999 ZIMBABWE DEMOGRAPHIC AND HEALTH SURVEY

MEN'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 MAN __________

LINE NUMBER OF MAN ___

INTERVIEWER VISITS

VISIT 1
DATE _____
INTERVIEWER'S NAME __________
RESULT * __________

NEXT VISIT
DATE _____
TIME _____

VISIT 2
DATE _____
INTERVIEWER'S NAME __________
RESULT * __________

NEXT VISIT
DATE _____
TIME _____

VISIT 3
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, men, 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
RESPONDENT DOES NOT AGREE 2 (END)

I HAVE READ THE ABOVE STATEMENT TO THE RESPONDENT AND HE HAS AGREED TO BE INTERVIEWED.

SIGNATURE OF INTERVIEWER __________

101) RECORD THE TIME.

HOURS ___
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 97 (SKIP TO 123)

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

NUMBER OF TIMES ___
NONE/NEVER 97

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

YES 1
NO 2 (SKIP TO 126)

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

NUMBER OF INJECTIONS ___
EVERY DAY 98

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

126) Are you currently working?

YES 1
NO 2 (SKIP TO 201)

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

OCCUPATION __________

SECTION 2: REPRODUCTION

201) Now I would like to ask about your children. I am interested only in the children that are biologically yours. Have you ever had children?

YES 1
NO 2 (SKIP TO 206)

202) Do you have any sons or daughters 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 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 had 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 TOAL.
IF NONE, RECORD '00'.

TOTAL ___

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

YES ___
NO ___ (PROBE AND CORRECT 201-208 AS NECESSARY)

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 a partner who had an operation to avoid having any more children?

YES 1
NO 2

02 MALE STERILIZATION Have you ever 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 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 313)

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

YES 1
NO 2 (SKIP TO 334)

307) What have you used or done?

CORRECT 303 AND 304 (AND 301 IF NECESSARY).

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

YES 1
NO 2 (SKIP TO 334)

314) Which method are you using?
IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD.

FEMALE STERILIZATION A
MALE STERILIZATION B
PILL C (SKIP TO 334)
IUD D (SKIP TO 334)
INJECTIONS E (SKIP TO 334)
IMPLANTS F (SKIP TO 334)
CONDOM G (SKIP TO 334)
FEMALE CONDOM H (SKIP TO 334)
DIAPHRAGM I (SKIP TO 334)
FOAM/JELLY J (SKIP TO 334)
LACTATIONAL AMENORRHEA METHOD K (SKIP TO 334)
PERIODIC ABSTINENCE L (SKIP TO 334)
WITHDRAWAL M (SKIP TO 334)
OTHER (SPECIFY) __________ X (SKIP TO 334)

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 wife/your partner) told that you would not be able to have any (more) children?

YES 1
NO 2

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

MONTH __________
YEAR _____

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 4. MARRIAGE AND SEXUAL ACTIVITY

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

YES, CURRENTLY MARRIED 1
YES, LIVING WITH A WOMAN 2 (SKIP TO 403)
NO, NOT IN UNION 3 (SKIP TO 405)

402) How many wives do you have?

NUMBER OF WIVES ___

403) How many (other) women are you living with as if you were married?
RECORD '00' IF THE RESPONSE IS "NONE"

NUMBER OF LIVE-IN PARTNERS ___

404) WRITE THE NAMES AND LINE NUMBERS FROM THE HOUSEHOLD QUESTIONNAIRE FOR HIS WIFE OR WIVES.
IF A WIFE DOES NOT LIVE IN THE HOUSEHOLD, WRITE '00' IN THE LINE NUMBER BOX.
THE NUMBER OF BOXES FILLED MUST BE EQUAL TO THE NUMBER OF WIVES.

IF THE SUM OF 402 AND 403 IS '01'
Please tell me the name of your wife/partner

NAME __________
LINE NUMBER ___ (SKIP TO 408)

IF THE SUM OF 402 AND 403 IS '02' OR MORE
Please tell me the names of all your wives and live-in partners

NAME __________
LINE NUMBER ___ (SKIP TO 408)

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

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

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

YES, FORMERLY MARRIED 1
YES, LIVED WITH A WOMAN 2 (SKIP TO 408)
NO 3 (SKIP TO 411)

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

WIDOWED 1
DIVORCED 2
SEPARATED 3

408) Have you been married or lived with a woman only once, or more than once?

ONCE 1
MORE THAN ONCE 2

409) CHECK 408:

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

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

MONTH __________
DON'T KNOW MONTH 98
YEAR _____ (SKIP TO 411)
DON'T KNOW YEAR 9998

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

AGE ___

411) Now I need to ask you some questions about sexual history 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 437)
AGE ___
FIRST TIME WHEN MARRIED 96

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

DAYS AGO 1 ___
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___ (SKIP TO 434)
DO NOT REMEMBER 998

413) The last time you had sexual intercourse, did you use a condom?

YES 1
NO 2 (SKIP TO 417)

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

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

417) What is your relationship to the woman with whom you last had sex?

IF "BOYFRIEND OR FIANCE", ASK "the last time you had sex with this partner, were you living with her?"
IF "YES", RECORD '1'
IF "NO", RECORD '2'

SPOUSE/COHABITING PARTNER 1 (SKIP TO 419)
BOYFRIEND/FIANCE 2
FRIEND/ACQUAINTANCE 3
RELATIVE 4
CUSTOMER (FOR SEX) 5
OTHER (SPECIFY) __________ 8

418) How long have you had a sexual relationship with the woman you last had sex with?

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

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

YES 1
NO 2 (SKIP TO 434)

420) The last time you had sexual intercourse with another woman, did you use a condom?

YES 1
NO 2 (SKIP TO 424)

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

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

424) What is your relationship to this woman?

IF "BOYFRIEND OR FIANCE", ASK "the last time you had sex with this partner, were you living with her?"
IF "YES", RECORD '1'
IF "NO", RECORD '2'

SPOUSE/COHABITING PARTNER 1 (SKIP TO 426)
BOYFRIEND/FIANCE 2
FRIEND/ACQUAINTANCE 3
RELATIVE 4
CUSTOMER (FOR SEX) 5
OTHER (SPECIFY) __________ 8

425) How long have you maintained a sexual relationship with this woman?

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

426) Other than these two women, have you had sex with anyone else in the last 12 months?

YES 1
NO 2 (SKIP TO 434)

427) The last time you had sexual intercourse with this other woman, did you use a condom?

YES 1
NO 2 (SKIP TO 431)
DOES NOT KNOW CONDOMS 3 (SKIP TO 431)

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

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

431) What is your relationship to this woman?

IF "BOYFRIEND OR FIANCE", ASK "the last time you had sex with this partner, were you living with her?"
IF "YES", RECORD '1'
IF "NO", RECORD '2'

SPOUSE/COHABITING PARTNER 1 (SKIP TO 433)
BOYFRIEND/FIANCE 2
FRIEND/ACQUAINTANCE 3
RELATIVE 4
CUSTOMER (FOR SEX) 5
OTHER (SPECIFY) __________ 8

432) How long have you maintained a sexual relationship with this woman?

DAYS 1 ___
WEEKS 2 ___
MONTHS 3 ___
YEARS 4 ___
DOES NOT REMEMBER 998

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

NUMBER OF PARTNERS ___

434) Have you ever paid for sex?

YES 1
NO 2 (SKIP TO 437)

435) How long ago was the last time you paid for sex?

DAYS AGO 1 ___
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___
DOES NOT REMEMBER 998

436) The last time that you paid for sex, did you use a condom?

YES 1
NO 2

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

YES 1
NO 2 (SKIP TO 440)

438) 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

439) If you wanted to, could you yourself easily get a condom?

YES 1
NO 2
DON'T KNOW/UNSURE 8

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

YES 1
NO 2 (SKIP TO 501)

441) 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

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

SECTION 5. FERTILITY PREFERENCES

501) CHECK 401:

CURRENTLY NOT IN UNION ___
CURRENTLY MARRIED OR LIVING WITH A WOMAN ___ (SKIP TO 503A)

502) CHECK 405:

NOT IN UNION BUT HAS A REGULAR SEX PARTNER ___
HAS ONLY AN OCCASIONAL SEXUAL PARTNER OR NO SEXUAL PARTNER ___ (SKIP TO 505A)

503) CHECK 401 and 405:

A. HAS A WIFE OR LIVING WITH WOMAN ___

Is your wife/the woman you are living with currently pregnant? ___
Are any of your wives/any of the women you are living with currently pregnant? ___

B. HAS A REGULAR SEXUAL PARTNER ___

Is your regular partner currently pregnant? ___
Is one of your regular partners currently pregnant? ___
YES 1
NO 2 (SKIP TO 505A)
DO NOT KNOW/UNSURE 8 (SKIP TO 505A)

504) When she became pregnant, did you want her to become pregnant then, did you want her to have a child but wanted to wait or did you not want her to have a child at all?

THEN 1
WANTED TO WAIT 2 (SKIP TO 505B)
NOT AT ALL 3 (SKIP TO 505B)

505) CHECK 503:

A. WIFE/PARTNER NOT PREGNANT OR UNSURE, OR HAS NO WIFE/PARTNER ___

Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?

B. WIFE/PARTNER PREGNANT ___

Now I have some questions about the future. After the child your wife/partner is 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 505B)
SAYS WIFE CAN'T GET PREGNANT 3 (SKIP TO 505B)
SAYS HE CAN'T HAVE ANY MORE 4 (SKIP TO 505B)
UNDECIDED/DON'T KNOW 8 (SKIP TO 505B)

506) CHECK 503:

WIFE/PARTNER NOT PREGNANT OR UNSURE, OR HAS NO WIFE/PARTNER ___

How long would you like to wait to have a child?
How long would you like to wait to have another child?
MONTHS 1 ___
YEARS 2 ___
SOON/NOW 993
SAYS WIFE CAN'T GET PREGNANT 994
AFTER MARRIAGE 995
OTHER (SPECIFY) __________ 996
DON'T KNOW 998

WIFE/PARTNER PREGNANT ___

After the child your wife/partner is expecting, how long would you like to wait before the birth of another child?
MONTHS 1 __ __
YEARS 2 __ __
SOON/NOW 993
SAYS WIFE CAN'T GET PREGNANT 994
AFTER MARRIAGE 995
OTHER(SPECIFY) ________ 996
DON'T KNOW 998

507) CHECK 314: USING A METHOD

NOT ASKED ___
NOT USING CURRENTLY ___
CURRENTLY USING ___ (SKIP TO 512)

508) Do you think you will use a method to avoid pregnancies within the next 12 months?

YES 1 (SKIP TO 510)
NO 2
DON'T KNOW 8

509) Do you think you will use a method to avoid pregnancies at any time in the future?

YES 1
NO 2 (SKIP TO 511)
DON'T KNOW 8 (SKIP TO 511)

510) Which method would you prefer to use?

FEMALE STERILIZATION 01 (SKIP TO 512)
MALE STERILIZATION 02 (SKIP TO 512)
PILL 03 (SKIP TO 512)
IUD 04 (SKIP TO 512)
INJECTIONS 05 (SKIP TO 512)
IMPLANTS 06 (SKIP TO 512)
CONDOM 07 (SKIP TO 512)
FEMALE CONDOM 08 (SKIP TO 512)
DIAPHRAGM/FOAM/JELLY 09 (SKIP TO 512)
LACTATIONAL AMENORRHEA 10 (SKIP TO 512)
RHYTHM/PERIODIC ABSTINENCE 11 (SKIP TO 512)
WITHDRAWAL 12 (SKIP TO 512)
OTHER (SPECIFY) __________ 96 (SKIP TO 512)
UNDECIDED 98 (SKIP TO 512)

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

NOT CURRENTLY MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX 22
WIFE MENOPAUSAL/HYSTERECTOMY 23
WIFE SUBFECUND/INFECUND 24
DESIRE 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

512) CHECK 203 and 205:

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

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

APPROVE 1
DISAPPROVE 2
NO OPINION 3

514) Is it acceptable or not acceptable to you for information on family planning to be provided on the radio?

ACCEPTABLE 1
NOT ACCEPTABLE 2
NO OPINION 8

515) Is it acceptable or not acceptable to you for information on family planning to be provided on the television?

ACCEPTABLE 1
NOT ACCEPTABLE 2
NO OPINION 8

516) 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

??) 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 520)

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

WIFE/PARTNER A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER F
SON G
MOTHER/FATHER-IN-LAW H
FRIENDS/NEIGHBOURS I
OTHER (SPECIFY) __________ X

ERR) CHECK 401:

CURRENTLY MARRIED ___
LIVING WITH A WOMAN ___
NOT IN UNION ___ (SKIP TO 601)

ERR) Husbands and wives do not always agree on everything. Now I want to ask you about your wife's/partner's views on family planning.

Do you think that your wife/partner approves or disapproves of couples using a method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

ERR) How often have you talked to your wife/partner about family planning in the past year?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

ERR) Do you think your wife/partner 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

524) 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 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 6: AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES

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

YES 1
NO 2 (SKIP TO 616)

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

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

603) 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 DURGS INTRAVEN. H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID KISSING K
AVOID MOSQUITO BITES L
SEEK PROTECTION FROM TRADITIONAL HEALER M
AVOID SHARING RAZOR BLADES N
OTHER (SPECIFY) __________ W
OTHER (SPECIFY) __________ X
DON'T KNOW Z

604) CHECK 603:

NEITHER CODE 'C' NOR CODE 'D' CIRCLED ___
CODE 'C' AND/OR CODE 'D' CIRCLED ___ (SKIP TO 607)

605) 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 607)
DON'T KNOW 8 (SKIP TO 607)

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

GREATER CHANCE OF AIDS 1
LESSER CHANCE OF AIDS 2

607) CHECK 603:

DID NOT MENTION USE OF A CONDOM DURING SEX (CODE 'B' NOT CIRCLED) ___
MENTIONED USE OF A CONDOM DURING SEX (CODE 'B' CIRCLED) ___ (GO TO 610)

608) 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 610)
UNSURE/DON'T KNOW 8 (SKIP TO 610)

609) 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 the AIDS virus than someone who doesn't use a condom?

GREATER CHANCE OF AIDS 1
LESSER CHANCE OF AIDS 2

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2

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

YES 1
NO 2 (SKIP TO 613)
DON'T KNOW 8 (SKIP TO 613)

612A) 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

613) CHECK 401:

CURRENTLY MARRIED/LIVING WITH A WOMAN ___
NOT CURRENTLY MARRIED/NOT LIVING WITH A WOMAN ___ (SKIP TO 614A)

614) Have you ever talked about ways to prevent getting the virus that causes AIDS with (your wife/the woman you are living with)?

YES 1
NO 2

614A) 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

615A) 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

615B) 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

615C) 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

615D) 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

615E) Have you ever been tested to see if you have the AIDS virus?

YES 1 (SKIP TO 615HX)
NO 2

615F) Would you want to be tested for the AIDS virus?

YES 1
NO 2
DON'T KNOW/UNSURE 3

615G) Do you know a place where you could go to get an AIDS test?

YES 1
NO 2 (SKIP TO 616)

615H) Where can you go for the test?

615HX) Where did you go for the test?

Any other places?
RECORD ALL MENTIONED.

PUBLIC SECTOR
CENTRAL HOSPITAL 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

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

YES 1
NO 2 (SKIP TO 630)

617) 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

618) 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

619) CHECK 411:

HAS HAD SEXUAL INTERCOURSE ___
HAS NOT HAD SEXUAL INTERCOURSE ___ (SKIP TO 630)

620) 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 infection?

YES 1
NO 2
DON'T KNOW 8

620A) Sometimes men experience a discharge from their penis.

During the last 12 months, have you had a discharge from your penis?

YES 1
NO 2
DON'T KNOW 8

620B) Sometimes men experience a sore or ulcer on or near their penis.

During the last 12 months, have you had a sore or ulcer on or near your penis?

YES 1
NO 2
DON'T KNOW 8

622) CHECK 620/620A/620B:

HAD STI ___
DID NOT HAVE STI ___ (SKIP TO 630)

625) The last time you had (INFECTION FROM 620/620A/620B), did you seek advice or treatment?

YES 1
NO 2 (SKIP TO 627)

626) Where did you seek advice or treatment?
Any other places?
RECORD ALL RESPONSES.

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

627) When you had (INFECTION FROM 620/620A/620B), did you inform the persons with whom you have been having sex?

YES 1
NO 2
SOME/NOT ALL 3

628) When you had (INFECTION FROM 620/620A/620B) did you do something to avoid infecting your sexual partner(s)?

YES 1
NO 2 (SKIP TO 630)
PARTNER ALREADY INFECTED 3 (SKIP TO 630)

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

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

630) 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 THE SUPERVISOR: __________
DATE: _____

EDITOR'S OBSERVATIONS

__________

NAME OF EDITOR: __________
DATE: _____