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2010 DEMOGRAPHIC AND HEALTH SURVEY WOMAN'S QUESTIONNAIRE (ENGLISH)

ZIMBABWE

ZIMSTAT

IDENTIFICATION

PLACE NAME

NAME OF HOUSEHOLD HEAD

CLUSTER NUMBER

HOUSEHOLD NUMBER

NAME AND LINE NUMBER OF WOMAN

CHECK QUESTION 21 IN HOUSEHOLD QUESTIONNAIRE:
IS THIS WOMAN SELECTED FOR THE HOUSEHOLD RELATIONS MODULE?

YES = 1
NO = 2

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
INT. NUMBER
RESULT

TOTAL NUMBER OF VISITS

*RESULT CODES:

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

LANGUAGE OF QUESTIONNAIRE

SHONA 1
NDEBELE 2
ENGLISH 3

LANGUAGE USED FOR INTERVIEW

SHONA A
NDEBELE B
ENGLISH C
OTHER X

LANGUAGE OF RESPONDENT

SHONA A
NDEBELE B
ENGLISH C
OTHER X

TRANSLATOR USED?

YES 1
NO 2

SUPERVISOR
NAME

FIELD EDITOR
NAME

OFFICE EDITOR

KEYED BY

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

INFORMED CONSENT

Hello. My name is ______________________________. I am working with the Central Statistical Office/ZIMSTAT. We are conducting a survey about health all over Zimbabwe. The information we collect will help the government to plan health services. Your household was selected for the survey. I would like to ask you some questions about your household. The questions usually take about 30 to 60 minutes. All of the answers you give will be confidential and will not be shared with anyone other than the members of our survey team. It's up to if you want to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.

In case you need more information about the survey, you may contact the person listed on this card.
Do you have any questions? May I begin the interview now?

SIGNATURE OF INTERVIEWER:____________________________ DATE:______________

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

101) RECORD THE TIME

HOUR
MINUTES

102) In what month and year were you born?

MONTH___
DON'T KNOW MONTH 98
YEAR___
DON'T KNOW YEAR 9998

103) How old were you at your last birthday? COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT.

AGE IN COMPLETED YEARS___

104) Have you ever attended school?

YES 1
NO 2 (GO TO 108)

105) What is the highest level of school you attended: primary, secondary, or higher?

PRIMARY 1
SECONDARY 2
HIGHER 3

106) What is the highest (grade/form/year) you completed at that level? IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

GRADE/FORM/YEAR

107) CHECK 105:

PRIMARY (GO TO 108)
SECONDARY (GO TO 110)

108) Now I would like you to read this sentence to me. SHOW CARD TO RESPONDENT.

IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

CANNOT READ AT ALL 1
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE)___ 4
BLIND/VISUALLY IMPAIRED 5

109) CHECK 108:

CODE '2', '3', OR '4' CIRCLED (GO TO 110)
CODE '1' OR '5' CIRCLE (GO TO 111)

110) Do you read a newspaper or magazine at least once a week, less than once a week or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

111) Do you listen to the radio at least once a week, less than once a week or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

112) Do you watch television at least once a week, less than once a week or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

113) What is your religion?

TRADITIONAL 1
ROMAN CATHOLIC 2
PROTESTANT 3
PENTECOSTAL 4
APOSTOLIC SECT 5
OTHER CHRISTIAN 6
MUSLIM 7
NONE 8
OTHER (SPECIFY) 96

115) In the last 12 months, how many times have you been away from home for one or more nights?

NUMBER OF TIMES___
NONE 00 (GO TO 201)

116) In the last 12 months, have you been away from home for more than one month at a time?

YES 1
NO 2

SECTION 2. REPRODUCTION

201) Now I would like to ask about all the births you have had during your life. Have you ever given birth?

YES 1
NO 2 (GO TO 206)

202) Do you have any sons or daughters to whom you have given birth who are currently living with you?

YES 1
NO 2 (GO TO 204)

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

SONS AT HOME___
DAUGHTERS AT HOME___

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

YES 1
NO 2 (GO TO 206)

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

SONS ELSEWHERE__
DAUGHTERS ELSEWHERE___

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

YES 1
NO 2 (GO TO 208)

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

BOYS DEAD__
GIRLS DEAD__

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

TOTAL BIRTHS___

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

210) CHECK 208:

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

211) Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had.

RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE ROWS. (IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW).

212) What was the name given to your (first/next) baby? RECORD NAME.
BIRTH HISTORY NUMBER__

NAME___

213) Is (NAME) a boy or a girl?

BOY 1
GIRL 2

214) Were any of these births twins?

SINGULAR 1
MULTIPLE 2

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

MONTH___
YEAR ___


216) Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

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

AGE IN YEARS___

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

YES 1
NO 2

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

LINE NUMBER___

220) IF DEAD: How old was (NAME) when he/she died?

IF '1 YR', PROBE: How many months old was (NAME)?

RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

DAYS 1____
MONTHS 2____
YEARS 3____

221) Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME), including any children who died after birth?

YES 1 (ADD BIRTH)
NO 2 (NEXT BIRTH)

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

IF YES, RECORD BIRTH(S) IN TABLE.

YES 1
NO 2

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

NUMBERS ARE SAME (GO TO 224)
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

224) CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2005 OR LATER.

NUMBER OF BIRTHS____
NONE 0 (GO TO 226)

225) FOR EACH BIRTH SINCE JANUARY 2005, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE.

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.)

226) Are you pregnant now?

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

227) How many months pregnant are you? RECORD NUMBER OF COMPLETED MONTHS

ENTER 'P's IN THE CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

MONTHS___

228) When you got pregnant, did you want to get pregnant at that time?

YES 1 (GO TO 230)
NO 2

229) Did you want to have a baby later on or did you not want any (more) children?

LATER 1
NO MORE 2

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

YES 1
NO 2 (GO TO 238)

231) When did the last such pregnancy end?

MONTH____
YEAR____

232) CHECK 231:

LAST PREGNANCY ENDED IN JAN. 2005 OR LATER (GO TO 232A)
LAST PREGNANCY ENDED BEFORE JAN. 2005 (GO TO 238)

232A) LAST PREGNANCY ENDED IN JAN. 2005 OR LATER NO.

232B) In what month and year did that pregnancy end?

MONTH__
YEAR____

233) How many months pregnant were you when this pregnancy ended?

MONTHS__

234) Since January 2005, have you had any other pregnancies that did not result in a live birth?

YES 1
NO 2 (GO TO 235)

IF THERE ARE MORE THAN FOUR PREGNANCIES SINCE JANUARY 2005 THAT DID NOT RESULT IN A LIVE BIRTH, GO TO 232A ROW 02 IN A NEW QUESTIONNAIRE.

235) FOR EACH PREGNANCY THAT DID NOT RESULT IN A LIVE BIRTH IN JANUARY 2005 OR LATER, ENTER 'T' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS OF PREGNANCY.

236) Did you have any miscarriages, abortions or stillbirths that ended before 2005?

YES 1
NO 2 (GO TO 238)

237) When did the last such pregnancy that terminated before 2005 end?

MONTH
YEAR

238) When did your last menstrual period start?

(DATE, IF GIVEN)____
DAYS AGO 1____
WEEKS AGO 2____
MONTHS AGO 3____
YEARS AGO 4____
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

239) From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant?

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

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

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

SECTION 3. CONTRACEPTION

301) Now I would like to ask about family planning-the various ways or methods that a couple can use to delay or avoid a pregnancy.

Have you ever heard of (METHOD)?

METHOD 1 Female Sterilization. PROBE: Women can have an operation to avoid having any more children.
YES 1
NO 2
METHOD 2 Male Sterilization. PROBE: Men can have an operation to avoid having any more children.
YES 1
NO 2
METHOD 3 IUD (Loop). PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
METHOD 4 Injectables (Depo). PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
METHOD 5 Implants. PROBE: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
METHOD 6 Pill. PROBE: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
METHOD 7 Male Condom. PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
METHOD 8 Female Condom. PROBE: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
METHOD 9 Lactational Amenorrhea Method (LAM)
YES 1
NO 2
METHOD 10 Rhythm Method (Safe days). PROBE: Every month that a women is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
METHOD 11 Withdrawal. PROBE: Men can be careful and pull out before climax.
YES 1
NO 2
METHOD 12 Emergency Contraception (Morning-after pill). PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
YES 1
NO 2
METHOD 13 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1(SPECIFY)______
NO 2

302) CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 303)
PREGNANT (GO TO 311)

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

YES 1
NO 2 (GO TO 311)

304) Which method are you using? CIRCLE ALL MENTIONED

IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION A (GO TO 307)
MALE STERILIZATION B (GO TO 307)
IUD C (GO TO 308A)
INJECTABLES D (GO TO 308A)
IMPLANTS E (GO TO 308A)
PILL F
MALE CONDOM G (GO TO 306)
FEMALE CONDOM H (GO TO 306)
DIAPHRAGM I (GO TO 308A)
FOAM/JELLY J (GO TO 308A)
LACTATIONAL AMENORRHEA METHOD K (GO TO 308A)
RHYTHM METHOD L (GO TO 308A)
WITHDRAWAL M (GO TO 308A)
OTHER MODERN METHOD X (GO TO 308A)
OTHER TRADITIONAL METHOD Y (GO TO 308A)

305) What is the brand of the pills you are using?

IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

OVRETTE SECURE 01 (GO TO 308A)
LO-FEMENAL CONTROL 02 (GO TO 308A)
MICRONOR 03 (GO TO 308A)
MICRONOVUM 04 (GO TO 308A)
MARVELLON 05 (GO TO 308A)
DUOFEM 06 (GO TO 308A)
EXLUTON 07 (GO TO 308A)
TRINODIAL 08 (GO TO 308A)
OTHER (SPECIFY) 96 (GO TO 308A)
DON'T KNOW 98 (GO TO 308A)

306) What is the brand name of the condoms you are using?

IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

MALE CONDOMS
CHOICE ASSORTED 01
DUREX 02
ECSTASY 03
PROTECTOR PLUS 04
PUBLIC SECTOR DIST. (PANTHER OR KAREX) 05
ROUGH RIDER 06
OTHER (SPECIFY) 07
MALE CONDOM, DON'T KNOW 08
FEMALE CONDOMS
CARE 11
FEMIDOM 12
OTHER (SPECIFY) 13
FEMALE CONDOM, DON'T KNOW 18

307) In what facility did the sterilization take place? PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE THE PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)____
PUBLIC SECTOR
CENTRAL HOSPITAL 11
PROVINCIAL HOSPITAL 12
DISTRICT HOSPITAL 13
RURAL HOSPITAL 14
ZNFPC CLINIC 15
OTHER PUBLIC SECTOR (SPECIFY) 16
MISSION HOSPITAL/CLINIC 21
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PRIVATE DOCTOR'S SURGERY 32
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36
OTHER (SPECIFY) 96
DON'T KNOW 98

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

308A) Since what month and year have you been using (CURRENT METHOD) without stopping?

PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

MONTH__
YEAR____

309) CHECK 308/308A, 215 AND 231:

ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 308/308A
YES (GO BACK TO 308/308A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION).
NO (GO TO 310)

310) CHECK 308/308A:

YEAR IS 2005 OR LATER
ENTER CODE FOR METHOD USED IN MONTH OF EACH INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING.
YEAR IS 2004 OR EARLIER
ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2005. (GO TO 322)

311) 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 INTERVALS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2005.

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

ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.

311A) INTERVAL OF USE OR NON-USE

311B) MONTH AND YEAR OF START OF INTERVAL OF USE OR NON-USE.

MONTH
YEAR

311C) Between (EVENT) in (MONTH/YEAR) and (EVENT) in (EVENT) in (MONTH/YEAR), did you or your (husband/partner) use any method of contraception?

YES, USEDA METHOD 1
NO, DID NOT USE A METHOD (GO TO 311B OF NEXT COLUMN)

311D) Which method was that? SEE CALENDAR FOR CODES.

METHOD___

311E) How many months after (EVENT) in (MONTH/YEAR) did you start to use (METHOD)?

RECORD 95 IF RESPONDENT GIVES THE DATE OF STARTING TO USE THE METHOD.

IMMEDIATELY 00 (GO TO 311G)
MONTHS___ (GO TO 311G)
DATE GIVEN 95

311F) RECORD MONTH AND YEAR RESPONDENT STARTED USING METHOD.

MONTH
YEAR

311G) For how many months did you use (METHOD)?

RECORD 95 IF RESPONDENT GIVES THE DATE OF TERMINATION OF USE

MONTHS___ (GO TO 311J)
DATE GIVEN 95

311H) RECORD MONTH AND YEAR RESPONDENT STOPPED USING METHOD.

MONTH
YEAR

311J) Why did you stop using (METHOD)?

SEE CALENDAR FOR CODES.

REASON STOPPED___ (GO TO 311B IN NEXT COLUMN)

312) CHECK THE CALENDAR FOR USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH.

NO METHOD USED (GO TO 313)
ANY METHOD USED (GO TO 314)

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

YES 1 (GO TO 324)
NO 2 (GO TO 324)

314) CHECK 304:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

NO CODE CIRCLED 00 (GO TO 324)
FEMALE STERILIZATION 01 (GO TO 317A)
MALE STERILIZATION 02 (GO TO 326)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
MALE CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 315A)
RHYTHM METHOD 12 (GO TO 315A)
WITHDRAWAL 13 (GO TO 326)
OTHER MODERN METHOD 95 (GO TO 326)
OTHER TRADITIONAL METHOD 96 (GO TO 326)

315) You first started using (CURRENT METHOD) in (DATE FROM 308/308A). Where did you get it at that time?
315A) Where did you learn how use the rhythm lactational amenorrhea method?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

NAME OF PLACE___
PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC 11
RURAL/MUNICIPAL CLINIC 12
RURAL HEALTH CENTRE 13
ZNFPC CLINIC 14
MOH MOBILE CLINIC 15
ZNFPC CBD/DEPOT HOLDER 16
OTHER PUBLIC SECTOR (SPECIFY) 17
MISSION HOSPITAL/CLINIC 21
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PHARMACY 32
PRIVATE DOCTOR 33
CBD 34
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36
RETAIL OUTLET
GENERAL DEALER 41
SUPERMARKET 42
TUCK SHOP 43
SERVIC STATION 44
OTHER RETAIL (SPECIFY) 46
OTHER PRIVATE SOURCE
CHURCH 51
FRIENDS/RELATIVES 52
OTHER (SPECIFY) 96

316) CHECK 304:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLE IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
MALE CONDOM 07 (GO TO 323)
FEMALE CONDOM 08 (GO TO 320)
DIAPHRAGM 09 (GO TO 320)
FOAM/JELLY 10 (GO TO 320)
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 326)
RHYTHM METHOD 12 (GO TO 326)

317) At the time, were you told about side effects or problems you might have with the method?

YES 1 (GO TO 319)
NO 2

317A) When you got sterilized, were you told about side effects or problems you might have with the method?

YES 1 (GO TO 319)
NO 2

318) Were you ever told by a health or family planning worker about side effects or problems you might have with the method?

YES 1
NO 2 (GO TO 320)

319) Were you told what to do if you experienced side effects or problems?

YES 1
NO 2

320) CHECK 317:

CODE '1' CIRCLED

At that time, were you told about other methods of family planning that you could use?
YES 1 (GO TO 322)
NO 2
CODE '1' NOT CIRCLED

When you obtained (CURRENT METHOD FROM 314) from (SOURCE OF METHOD FROM 307 OR 315), were you told about other methods of family planning that you could use?
YES 1 (GO TO 322)
NO 2

321) Were you ever told by a health or family planning worker about other methods of family planning that you could use?

YES 1
NO 2

322) CHECK 304:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION 01 (GO TO 326)
MALE STERILIZATION 02 (GO TO 326)
IUD 03 (GO TO 326)
INJECTABLES 04
IMPLANTS 05 (GO TO 326)
PILL 06
MALE CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 326)
RHYTHM METHOD 12 (GO TO 326)
WITHDRAWAL 13 (GO TO 326)
OTHER MODERN METHOD 95 (GO TO 326)
OTHER TRADITIONAL METHOD 96 (GO TO 326)

323) Where did you obtain (CURRENT METHOD) the last time?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE_____
PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC 11 (GO TO 326)
RURAL/MUNICIPAL CLINIC 12 (GO TO 326)
RURAL HEALTH CENTRE 13 (GO TO 326)
ZNFCP CLINIC 14 (GO TO 326)
MOH MOBILE CLINIC 15 (GO TO 326)
ZNFPC CBD/DEPOT HOLDER 16 (GO TO 326)
OTHER PUBLIC SECTOR (SPECIFY) 17 (GO TO 326)
MISSION HOSPITAL/CLINIC 21 (GO TO 326)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31 (GO TO 326)
PHARMACY 32 (GO TO 326)
PRIVATE DOCTOR 33 (GO TO 326)
CBD 34 (GO TO 326)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36 (GO TO 326)
RETAIL OUTLET
GENERAL DEALER 41 (GO TO 326)
SUPERMARKET 42 (GO TO 326)
TUCK SHOP 43 (GO TO 326)
SERVICE STATION 44 (GO TO 326)
OTHER RETAIL (SPECIFY) 46 (GO TO 326)
OTHER PRIVATE SOURCE
CHURCH 51 (GO TO 326)
FRIENDS/RELATIVE 52 (GO TO 326)
OTHER (SPECIFY) 96 (GO TO 326)

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

YES 1
NO 2 (GO TO 326)

325) Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SCETOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S)

PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
RURAL/MUNICIPAL CLINIC B
RURAL HEALTH CENTRE C
ZNFCP CLINIC D
MOH MOBILE CLINIC E
ZNFPC CBD/DEPOT HOLDER F
OTHER PUBLIC SECTOR (SPECIFY) G
MISSION HOSPITAL/CLINIC H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC I
PHARMACY J
PRIVATE DOCTOR K
CBD L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) M
RETAIL OUTLET
GENERAL DEALER N
SUPERMARKET O
TUCK SHOP P
SERVICE STATION Q
OTHER RETAIL (SPECIFY) R
OTHER PRIVATE SOURCE
CHURCH S
FRIENDS/RELATIVE T
OTHER (SPECIFY) X

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

YES 1
NO 2

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

YES 1
NO 2

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

YES 1
NO 2

SECTION 4. PREGNANCY AND POSTNATAL CARE

401) CHECK 224:

ONE OR MORE BIRTHS IN 2005 OR LATER (GO TO 402)
NO BIRTHS IN 2005 OR LATER (GO TO 556)

402) CHECK 215: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2005 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.

(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

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

403) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

BIRTH HISTORY NUMBER___

404) FROM 212 AND 216

NAME
LIVING___
DEAD___

405) When you got pregnant with (NAME), did you want to get pregnant at that time?

YES 1 (GO TO 408 IF LAST BIRTH, GO TO 430 IF NEXT-TO-LAST OR SECOND-FROM -LAST BIRTH)
NO 2

406) Did you want to have a baby later on, or did you not want any (more) children?

LATER 1
NO MORE 2 (GO TO 408 IF LAST BIRTH, GO TO 430 IF NEXT-TO-LAST BIRTH OR SECOND-FROM-LAST BIRTH)

407) How much longer did you want to wait?

MONTHS___
YEARS___
DON'T KNOW 998

408) Did you see anyone for antenatal care for this pregnancy?

YES 1
NO 2 (GO TO 415)

409) Whom did you see? Anyone else?

PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

HEALTH PERSONNEL
DOCTOR A
NURSE MIDWIFE B
NURSE C
OTHER PERSON
TRADITIONAL BIRTH ATTENDENT D
VILLAGE HEALTH WORKER E
OTHER (SPECIFY) X

410) Where did you receive antenatal care for this pregnancy? Anywhere else?

PROBE TO IDENTIFY TYPE(S) OF SOURCE(S).

IF UNABLE TO DETERMINE IF PUBLIC SECTOR OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

NAME OF PLACE(S)
HOME
YOUR HOME A
OTHER HOME B
PUBLIC SECTOR
CENTRAL HOSPITAL C
PROVINCIAL HOSPITAL D
DISTRICT HOSPITAL E
RURAL HOSPITAL F
URBAN MUNICIPAL CLINIC G
RURAL HEALTH CENTRE H
OTHER PUBLIC SECTOR (SPECIFY) I
MISSION HOSPITAL/CLINIC J
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC K
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) L
OTHER (SPECIFY) X

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

MONTHS___
DON'T KNOW 98

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

NUMBER OF TIMES___
DON'T KNOW 98

413) As part of your antenatal care during this pregnancy, were any of the following done at least once:

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

414) During (any of) your antenatal care visit(s), were you told about things to look out for that might suggest problems with the pregnancy?

YES 1
NO 2
DON'T KNOW 8

415) 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 (GO TO 418)
DON'T KNOW 8 (GO TO 418)

416) During this pregnancy, how many times did you get a tetanus injection?

TIMES___
DON'T KNOW 8

417) CHECK 416:

2 OR MORE TIMES (GO TO 421)
OTHER (GO TO 418)

418) At any time before this pregnancy, did you receive any tetanus injections?

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

419) Before this pregnancy, how many times did you receive a tetanus injection?

IF 7 OR MORE TIMES, RECORD '7'.

TIMES___
DON'T KNOW 8

420) How many years ago did you receive the last tetanus injection before this pregnancy?

YEARS AGO___

421) During this pregnancy, were you given or did you buy any iron tablets or iron syrup?

SHOW TABLETS/SYRUP.

YES 1
NO 2
DON'T KNOW 8

422) During the whole pregnancy, for how many days did you take the tablets or syrup?

IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.

DAYS___
DON'T KNOW 998

423) During this pregnancy, did you take any drug for intestinal worms?

YES 1
NO 2
DON'T KNOW 8

424) During this pregnancy, did you take any drugs to prevent you from getting malaria?

YES 1
NO 2 (GO TO 430)
DON'T KNOW 8 (GO TO 430)

425) What drugs did you take?

RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.

SP/FANSIDAR A
CHLOROQUINE B
COARTEMETHER C
DELTAPRIM D
OTHER (SPECIFY) X
DON'T KNOW Z

426) CHECK 425:

SP/FANSIDAR TAKEN FOR MALARIA PREVENTION.

CODE 'A' CIRCLED (GO TO 427)
CODE 'A' NOT CIRCLED (GO TO 430)

427) How many times did you take (SP/Fansidar) during this pregnancy?

TIMES__

428) CHECK 409:

ANTENATAL CARE FROM HEALTH PERSONNEL DURING THIS PREGNANCY

CODE 'A', 'B', OR 'C' CIRCLED (GO TO 429)
OTHER (GO TO 430)

429) Did you get the (SP/Fansidar) during any antenatal care visit, during another visit to a health facility or from another source?

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6

430) When (NAME) was born, was he/she very big, bigger than average, average, smaller than average, or very small?

VERY BIG 1
BIGGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DON'T KNOW 8

431) Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 433)
DON'T KNOW 8 (GO TO 433)

432) How much did (NAME) weigh?

RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.

KG FROM CARD___
KG FROM RECALL
DON'T KNOW 99998

433) Who assisted with the delivery of (NAME)? Anyone else?

PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.

IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

HEALTH PERSONNEL
DOCTOR A
NURSE MIDWIFE B
NURSE C
OTHER PERSON
TRADITIONAL BIRTH ATTENDENT D
VILLAGE HEALTH WORKER E
RELATIVE/FRIEND F
OTHER (SPECIFY) X
NO ONE ASSISTED Y

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

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE
HOME
YOUR HOME 11 (GO TO 438)
OTHER HOME 12 (GO TO 438)
PUBLIC SECTOR
CENTRAL HOSPITAL 21
PROVINCIAL HOSPITAL 22
DISTRICT HOSPITAL 23
RURAL HOSPITAL 24
URBAN MUNICIPAL CLINIC 25
RURAL HEALTH CENTRE 26
OTHER PUBLIC SECTOR (SPECIFY) 27
MISSION HOSPITAL/CLINIC 31
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 41
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 46
OTHER (SPECIFY) 96 (GO TO 438)

435) Was (NAME) delivered by caesarean, that is, did they cut your belly open to take the baby out?

YES 1
NO 2

436) After you gave birth to (NAME), did anyone check on your health while you were still in the facility?

YES 1 (GO TO 439)
NO 2

437) Did anyone check on your health after you left the facility?

YES 1 (GO TO 439)
NO 2 (GO TO 446)

438) After you gave birth to (NAME), did anyone check your health?

YES 1
NO 2 (GO TO 442)

439) Who checked on your health at that time?

PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR 11
NURSE MIDWIFE 12
NURSE 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
VILLAGE HEALTH WORKER 22
OTHER (SPECIFY) 96

440) How long after delivery did the first check take place?

IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1___
DAYS 2___
WEEKS 3___
DON'T KNOW 998

441) CHECK 437:

YES (GO TO 446)
NOT ASKED (GO TO 442)

442) In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on his/her health?

YES 1
NO 2
DON'T KNOW 8

443) How many hours, days or weeks after the birth of (NAME) did the first check take place?

IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS

HOURS AFTER BIRTH 1___
DAYS AFTER BIRTH 2___
WEEKS AFTER BIRTH 3___
DON'T KNOW 998

444) Who checked on (NAME)'s health at that time?

PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR 11
NURSE MIDWIFE 12
NURSE 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
VILLAGE HEALTH WORKER 22
OTHER (SPECIFY) 96

445) Where did this first check of (NAME) take place?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE___
HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
CENTRAL HOSPITAL 21
PROVINCIAL HOSPITAL 22
DISTRICT HOSPITAL 23
RURAL HOSPITAL 24
URBAN MUNICIPAL CLINIC 25
RURAL HEALTH CENTRE 26
OTHER PUBLIC SECTOR (SPECIFY) 27
MISSION HOSPITAL/CLINIC 31
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 41
OTHER PRIVATE MEDICAL SECTOR 46
OTHER (SPECIFY) 96

446) In the first two months after delivery, did you receive a vitamin A dose like (this/any of these)?

SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

447) Has your menstrual period returned since the birth of (NAME)?
[Most recent birth since 2005]

YES 1 (GO TO 449)
NO 2 (GO TO 450)

448) Did your period return between the birth of (NAME) and your next pregnancy?
[Repeat question for all births since 2005 except most recent birth]

YES 1
NO 2 (GO TO 452)

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

MONTHS___
DON'T KNOW 98

450) CHECK 226:
``IS RESPONDENT PREGNANT?

NOT PREGNANT (GO TO 451)
PREGNANT OR UNSURE (GO TO 452)

451) Have you had sexual intercourse since the birth of (NAME)?

YES 1
NO 2 (GO TO 453)

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

MONTHS___

DON'T KNOW 98

453) Did you ever breastfeed (NAME)?

YES 1 (GO TO 455)
NO 2

454) CHECK 404:

IS CHILD STILL LIVING?

LIVING (GO TO 460)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 501)
455) 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___

456) In the first three days after delivery, was (NAME) given anything to drink other than breast milk?

YES 1
NO 2 (GO TO 458)

457) What was (NAME) given to drink? Anything else?

RECORD ALL LIQUIDS MENTIONED.

MILK (OTHER THAN BREAST MILK) A
PLAIN WATER B
SUGAR OR GLUCOSE WATER C
GRIPE WATER D
SUGAR-SALT-WATER SOLUTION E
FRUIT JUICE F
INFANT FORMULA G
TEA/INFUSIONS H
COFFEE I
HONEY J
OTHER (SPECIFY) X

458) CHECK 404:

IS CHILD STILL LIVING?

LIVING (GO TO 459)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501)

459) Are you still breastfeeding (NAME)?

YES 1
NO 2

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

YES 1
NO 2
DON'T KNOW 8

461) GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501.

SECTION 5. CHILD IMMUNIZATION, HEALTH, AND NUTRUITION

501) ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2005 OR LATER.

ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

502) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

BIRTH HISTORY NUMBER

503) FROM 212 AND 216

NAME___
LIVING (GO TO 504)
DEAD (GO TO 503 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 553)

504) Do you have a card where (NAME)'s vaccinations are written down?

IF YES: May I see it please?

YES, SEEN 1 (GO TO 506)
YES, NOT SEEN 2 (SKIP TO 509)
NO CARD 3

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

YES 1 (GO TO 509)
NO 2 (GO TO 509)

506) (1) COPY DATES FROM THE CARD. (2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE 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
POLIO (BOOSTER)
DAY
MONTH
YEAR
DPT-HEPB-HIB 1 (PENTAVALENT 1)
DAY
MONTH
YEAR
DPT-HEPB-HIB 2 (PENTAVALENT 2)
DAY
MONTH
YEAR
DPT-HEPB-HIB 3 (PENTAVALENT 3)
DAY
MONTH
YEAR
DPT 1
DAY
MONTH
YEAR
DPT 2
DAY
MONTH
YEAR
DPT 3
DAY
MONTH
YEAR
DPT (BOOSTER)
DAY
MONTH
YEAR
MEASLES
DAY
MONTH
YEAR
VITAMIN A (MOST RECENT DOSE)
DAY
MONTH
YEAR

507) CHECK 506:

BCG TO MEASLES ALL RECORDED (GO TO 511)
OTHER (GO TO 508)

508) Has (NAME) had any vaccinations that are not recorded on this card, including vaccinations given in a national immunization day campaign?

RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 506 THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

YES 1 (GO TO 511)
(PROBE VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 506)
NO 2 (GO TO 511)
DON'T KNOW 8 (GO TO 511)

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

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

510) Please tell me if (NAME) had any of the following vaccinations:

510A) A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar and is given at birth?

YES 1
NO 2
DON'T KNOW 8

510B) Polio vaccine, that is, drops in the mouth?

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

510D) How many times was the polio vaccine given?

NUMBER OF TIMES

510E) A pentavalent or DPT vaccination-that is, an injection given in the thigh, sometimes at the same time as polio drops?

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

510F) How many times was the pentavalent or DPT vaccination given?

NUMBER OF TIMES

510G) A measles injection- that is, a shot in the arm at the age of 9 months or older- to prevent him/her from getting measles?

YES 1
NO 2
DON'T KNOW 8

511) Within the last six months, was (NAME) given a vitamin A dose like (this/any of these)?

SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

513A) Has (NAME) ever had worms in his/her stool?

YES 1
NO 2
DON'T KNOW 8

513) Was (NAME) given any drug for intestinal worms in the last six months?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 525)
DON'T KNOW 8 (GO TO 525)

515) Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

516) Now I would like to know how much fluid (including breastmilk) (NAME) was given to drink during the diarrhea.

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

IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8

517) When (NAME) had diarrhea, was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?

IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8

518) Did you seek advice or treatment for the diarrhea from any source?

YES 1
NO 2 (GO TO 522)

519) Where did you seek advice or treatment? Anywhere else?

PROBE TO IDENTIFY EACH TYPE OF SOURCE

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

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

520) CHECK 519:

TWO OR MORE CODES CIRCLED (GO TO 521)
ONLY ONE CODE CIRCLED (GO TO 522)

521) Where did you first seek advice or treatment?

USE LETTER CODE FROM 519.

FIRST PLACE_

522) Was he/she given any of the following to drink at any time since he/she started having the diarrhea:

a) A fluid made from a special packet called an ORS sachet?
YES 1
NO 2
DON'T KNOW 3
b) A homemade sugar-salt-water solution (SSS)?
YES 1
NO 2
DON'T KNOW 3

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

YES 1
NO 2 (GO TO 525)
DON'T KNOW (GO TO 525)

524) What (else) was given to treat the diarrhea? Anything else?

RECORD ALL TREATMENTS GIVEN.

PILL OR SYRUP
ANTIBIOTIC A
ANTIMOTILITY B
ZINC C
OTHER (NOT ANTIBIOTIC, ANTIMOTILITY, OR ZINC) D
UNKNOWN PILL OR SYRUP E
INJECTION
ANTIBIOTIC F
NON-ANTIBIOTIC G
UNKNOWN INJECTION H
(IV) INTRAVENOUS) I
HOME REMEDY/ HERBAL MEDICINE J
OTHER (SPECIFY) X

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

YES 1
NO 2 (GO TO 527)
DON'T KNOW (GO TO 527)

526) At any time during the illness, did (NAME) have blood taken from his/her finger or heel for testing?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 530)
DON'T KNOW 8 (GO TO 530)

528) When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, rapid breaths or have difficulty breathing?

YES 1
NO 2 (GO TO 531)
DON'T KNOW 8 (GO TO 531)

529) Was the fast or difficult breathing due to a problem in the chest or to a blocked or runny nose?

CHEST ONLY 1 (GO TO 531)
NOSE ONLY 2 (GO TO 531)
BOTH 3 (GO TO 531)
OTHER (SPECIFY) 6 (GO TO 531)
DON'T KNOW 8 (GO TO 531)

530) CHECK 525:

HAD FEVER?

YES (GO TO 531)
NO OR DON'T KNOW (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 533)

531) Now I would like to ask you how much fluid (including breastmilk) (NAME) was given to drink during the illness with a (fever/cough).

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

IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 6

532) When (NAME) had a (fever/cough), was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?

IF LESS: PROBE: Was he/she given much less than usual to eat or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8

533) Did you seek advice or treatment for the illness from any source?

YES 1
NO 2 (GO TO 537)

534) Where did you seek advice or treatment? Anywhere else?

PROBE TO IDENTIFY EACH TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

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

535) CHECK 534:

TWO OR MORE CODES CIRCLED (GO TO 536)
ONLY ONE CODE CIRCLED (GO TO 537)

536) Where did you first seek advice or treatment?

USE LETTER CODE FROM 534.

FIRST PLACE___

537) At any time during the illness, did (NAME) take any drugs for the illness?

YES 1
NO 2 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)
DON'T KNOW 8 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

538) What drugs did (NAME) take? Any other drugs?

RECORD ALL MENTIONED.

ANTIMALARIAL DRUGS
SP/FANSIDAR A
CHLOROQUINE B
QUININE C
COARTEMETHER D
OTHER ANTIMALARIAL (SPECIFY) E
ANTIBIOTIC DRUGS
PILL/SYRUP F
INJECTION G
OTHER DRUGS
ASPIRIN H
ACETAMINOPHEN/PARACETAMOL/PANADOL I
IBUPROFEN J
OTHER (SPECIFY) X
DON'T KNOW Z

539) CHECK 538:

ANY CODE A-E CIRCLED?

YES (GO TO 540)
NO (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

540) CHECK 538:

SP/FANSIDAR ('A') GIVEN

CODE 'A' CIRCLED (GO TO 541)
CODE 'A' NOT CIRCLED (GO TO 542)

541) How long after fever started did (NAME) first take (SP/Fansidar)?

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

542) CHECK 538:

CHLOROQUINE ('B') GIVEN

CODE 'B' CIRCLED (GO TO 543)
CODE 'B' NOT CIRCLED (SKIP TO 546)

543) How long after the fever started did (NAME) first take chloroquine?

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

546) CHECK 538:

QUININE ('C') GIVEN

CODE 'C' CIRCLED (GO TO 547)
CODE 'C' NOT CIRCLED (GO TO 548)

547) How long after the fever started did (NAME) first take quinine?

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

548) CHECK 538:

COARTEMETHER ('D') GIVEN

CODE 'D' CIRCLED (GO TO 549)
CODE 'D' NOT CIRCLED (GO TO 550)

549) How long after the fever started did (NAME) first take coartemether?

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

550) CHECK 538:

OTHER ANTIMALARIAL ('E') GIVEN

CODE 'E' CIRCLED (GO TO 551)
CODE 'E' NOT CIRCLED (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

551) How long after the fever started did (NAME) first take (OTHER ANTIMALARIAL)?

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

552) GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553.

553) CHECK 215 AND 218, ALL ROWS:

NUMBER OF CHILDREN BORN IN 2005 OR LATER LIVING WITH THE RESPONDENT

ONE OR MORE (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE WITH 554)
NAME___
NONE (GO TO 556)

554) The last time (NAME FROM 553) passed stools, what was done to dispose of the stools?

CHILD USED TOILET OR LATRINE 01
PUT/RINSED INTO TOILET OR LATRINE 02
PUT/RINSED INTO DRAIN OR DITCH 03
THROWN INTO GARBAGE 04
BURIED 05
LEFT IN THE OPEN 06
OTHER (SPECIFY) 96

555) CHECK 552(a), ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 556)
ANY CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 557)

556) Have you ever heard of a special product called an ORS sachet you can get for the treatment of diarrhea?

YES 1
NO 2

557) CHECK 215 AND 218, ALL ROWS:

NUMBER OF CHILDREN BORN IN 2008 OR LATER LIVING WITH THE RESPONDENT

ONE OR MORE (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE WITH 558)
NAME___
NONE (GO TO 601)

558) Now I would like to ask you about liquids or foods that (NAME FROM 557) had yesterday during the day or at night. I am interested in whether your child had the item I mention even if it was combined with other foods.

Did (NAME FROM 557) (drink/eat):

a) Plain water?
YES 1
NO 2
DON'T KNOW 8
b) Juice or juice drinks?
YES 1
NO 2
DON'T KNOW 8
c) Soup?
YES 1
NO 2
DON'T KNOW 8
d) Milk such as tinned, powdered, or fresh animal milk?
YES 1
NO 2
DON'T KNOW 8
IF YES: How many times did (NAME) drink milk? IF 7 OR MORE TIMES, RECORD '7'.
NUMBER OF TIMES DRANK MILK___
e) Infant formula?
YES 1
NO 2
DON'T KNOW 8
IF YES: How many times did (NAME) drink milk? IF 7 OR MORE TIMES, RECORD '7'.
NUMBER OF TIMES DRANK FORMULA___
f) Any other liquids, freezes, fizzy drinks or maheu?
YES 1
NO 2
DON'T KNOW 8
g) Yogurt or lacto/sourmilk?
YES 1
NO 2
DON'T KNOW 8
IF YES: How many times did (NAME) eat yogurt or lacto/sourmilk?
NUMBER OF TIMES ATE YOGURT/LACTO/SOURMILK___
h) Any Cerelec, Proneutro or other commercially fortified baby food?
YES 1
NO 2
DON'T KNOW 8
i) Sadza, maize or mealie-meal porridge or gruel, bread, rice, noodles, or other foods made from grains?
YES 1
NO 2
DON'T KNOW 8
j) Pumpkin, carrots, squash, sweet potatoes, butternuts, or yams that are yellow or orange inside?
YES 1
NO 2
DON'T KNOW 8
k) White potatoes, white yams, cassava, or any other foods made from roots?
YES 1
NO 2
DON'T KNOW 8
l) Any dark green, leafy vegetables such as spinach, pumpkin, covo, nyevhe, or okra leaves?
YES 1
NO 2
DON'T KNOW 8
m) Ripe mangoes, paw paw, mazhanje, matunduru, or masawu?
YES 1
NO 2
DON'T KNOW 8
n) Any other fruits or vegetables?
YES 1
NO 2
DON'T KNOW 8
o) Liver, kidney, heart or other organ meats?
YES 1
NO 2
DON'T KNOW 8
p) Any meat, such as beef, pork, lamb, goat, chicken, duck, or game?
YES 1
NO 2
DON'T KNOW 8
q) Eggs?
YES 1
NO 2
DON'T KNOW 8
r) Fresh, dried, canned fish or matemba?
YES 1
NO 2
DON'T KNOW 8
s) Any foods made from sugar beans, cowpeas, other peas, lentils, or nuts including bambara nuts?
YES 1
NO 2
DON'T KNOW 8
t) Cheese or other food made from milk?
YES 1
NO 2
DON'T KNOW 8
u) Any insects, such as locust, mopane worms, ishwa harurwa, crickets, or mandere?
YES 1
NO 2
DON'T KNOW 8
v) Any other solid, semi-solid, or soft food?
YES 1
NO 2
DON'T KNOW 8

559) CHECK 558 (CATEGORIES "g" THROUGH "v"):

NOT A SINGLE "YES" (GO TO 560)
AT LEAST ONE "YES" (GO TO 561)

560) Did (NAME) eat any solid, semi-solid, or soft foods yesterday during the day or at night?

IF 'YES' PROBE: What kind of solid, semi-solid, or soft foods did (NAME) eat?

YES 1 (GO BACK TO 558 TO RECORD FOOD EATEN YESTERDAY)
NO 2 (GO TO 601)

561) How many times did (NAME FROM 557) eat solid, semi-solid, or soft foods yesterday during the day or at night?

IF 7 OR MORE TIMES, RECORD '7'.

NUMBER OF TIMES___
DON'T KNOW 8

SECTION 6. MARRIAGE AND SEXUAL ACTIVITY

601) Are you currently married or living together with a man as if married?

YES, CURRENTLY MARRIED 1 (GO TO 604)
YES, LIVING WITH A MAN 2 (GO TO 604)
NO, NOT IN UNION 3

602) Have you ever been married or lived together with a man as if married?

YES, FORMERLY MARRIED 1
YES, LIVED WITH A MAN 2
NO 3 (GO TO 612)

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

WIDOWED 1 (GO TO 609)
DIVORCED 2 (GO TO 609)
SEPARATED 3 (GO TO 609)

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

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

NAME___
LINE NUMBER___

606) Does your (husband/partner) have other wives, does he live with other women as if married, or does he maintain a small house?

YES 1
NO 2 (GO TO 609)
DON'T KNOW 8 (GO TO 609)

607) Including yourself, in total, how many wives or live-in partners does he have?

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNERS___
DON'T KNOW 98

608) Are you the first, second, ... wife?

RANK___

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

ONLY ONCE 1
MORE THAN ONCE 2

610) CHECK 609:

MARRIED/LIVED WITH A MAN ONLY ONCE

In what month and year did you start living with your (husband/partner)?
MONTH__
DON'T KNOW MONTH 98
YEAR___ (GO TO 612)
DON'T KNOW YEAR 9998

MARRIED/LIVED WITH A MAN MORE THAN ONCE

Now I would like to ask you about your first (husband/partner). In what month and year did you start living with him?
MONTH__
DON'T KNOW MONTH 98
YEAR___ (GO TO 612)
DON'T KNOW YEAR 9998

611) How old were you when you first started living with him?

AGE___

612) CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

613) Now I would like to ask some questions about sexual activity in order to gain a better understanding of some important life issues.

How old were you when you had sexual intercourse for the first time?

NEVER HAD SEXUAL INTERCOURSE 00 (GO TO 628)
AGE IN YEARS___
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95

614) Now I would like to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question.

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

IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO 1___
WEEKS AGO 2___
MONTHS AGO 3___
YEARS AGO 4___ (GO TO 627)

616) When was the last time you had sexual intercourse with this person?

DAYS AGO 1___
WEEKS AGO 2___
MONTHS AGO 3___

617) The last time you had sexual intercourse (with this second/third person), was a condom used?

YES 1
NO 2 (GO TO 619)

618) Was a condom used every time you had sexual intercourse with this person in the last 12 months?

YES 1
NO 2

619) What was your relationship to this person with whom you had sexual intercourse?

IF BOYFRIEND: Were you living together as if married?

IF YES, CIRCLE '2'.
IF NO, CIRCLE '3'.

HUSBAND 1
LIVE-IN PARTNER 2
BOYFRIEND NOT LIVING WITH RESPONDENT 3 (GO TO 622)
CASUAL ACQUAINTANCE 4 (GO TO 622)
PROSTITUTE 5 (GO TO 622)
OTHER (SPECIFY) 6 (GO TO 622)

620) CHECK 609:

MARRIED ONLY ONCE (GO TO 621)
MARRIED MORE THAN ONCE (GO TO 622)

621) CHECK 613:

FIRST TIME WHEN STARTED LIVING WITH FIRST HUSBAND (GO TO 623)
OTHER (GO TO 622)

622) How long ago did you first have sexual intercourse with this (second/third) person?

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

623) How many times during the last 12 months did you have sexual intercourse with this person?

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF TIMES IS 95 OR MORE, WRITE '95'.

NUMBER OF TIMES___

624) How old is this person?

AGE OF PARTNER___
DON'T KNOW 98

625) Apart from (this person/these two people), have you had sexual intercourse with any other person in the last 12 months?

YES 1 (GO BACK TO 616 IN NEXT COLUMN)
NO 2 (GO TO 627)

626) In total, with how many people have you had sexual intercourse in the last 12 months?

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR MORE, WRITE '95'.

NUMBER OF PARTNERS IN THE LAST 12 MONTHS___
DON'T KNOW 98

627) In total, with how many people have you had sexual intercourse in your lifetime?

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

IF NUMBER OF PARTNERS IS 95 OR MORE, WRITE '95'.

NUMBER OF PARTNERS IN LIFETIME___
DON'T KNOW 98

628) PRESENCE OF OTHERS DURING THIS SECTION

CHILDREN YOUNGER THAN 10 YEARS
YES 1
NO 2
MALE ADULTS
YES 1
NO 2
FEMALE ADULTS
YES 1
NO 2

629) Do you know a place where a person can get male condoms?

YES 1
NO 2 (GO TO 632)

630) Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

NAME OF PLACE(S)
PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
RURAL/MUNICIPAL CLINIC B
RURAL HEALTH CENTRE C
ZNPFC CLINIC D
MOH MOBILE CLINIC E
ZNFPC CBD/DEPOT HOLDER F
VILLAGE/FARM HEALTH WORKER G
OTHER PUBLIC SECTOR (SPECIFY) H
MISSION HOSPITAL/CLINIC I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC J
PHARMACY K
PRIVATE DOCTOR L
CBD M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) N
RETAIL OUTLET
GENERAL DEALER O
SUPERMARKET P
TUCK SHOP Q
SERVICE STATION R
OTHER RETAIL (SPECIFY) S
OTHER PRIVATE SOURCE
CHURCH T
BAR U
FRIENDS/RELATIVES V
PUBLIC TOILET W
OTHER (SPECIFY) X

631) If you wanted to, could you get yourself a male condom?

YES 1
NO 2
DON'T KNOW/UNSURE 8

632) Do you know of a place where a person can get female condoms?

YES 1
NO 2 (GO TO 701)

633) Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

NAME OF PLACE(S)
PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
RURAL/MUNICIPAL CLINIC B
RURAL HEALTH CENTRE C
ZNPFC CLINIC D
MOH MOBILE CLINIC E
ZNFPC CBD/DEPOT HOLDER F
VILLAGE/FARM HEALTH WORKER G
OTHER PUBLIC SECTOR (SPECIFY) H
MISSION HOSPITAL/CLINIC I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC J
PHARMACY K
PRIVATE DOCTOR L
CBD M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) N
RETAIL OUTLET
GENERAL DEALER O
SUPERMARKET P
TUCK SHOP Q
SERVICE STATION R
OTHER RETAIL (SPECIFY) S
OTHER PRIVATE SOURCE
CHURCH T
BAR U
FRIENDS/RELATIVES V
PUBLIC TOILET W
OTHER (SPECIFY) X

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

SECTION 7. FERTILITY PREFERENCES

701) CHECK 304:

NEITHER STERILIZED (GO TO 702)
HE OR SHE STERILIZED (GO TO 712)

702) CHECK 226:

PREGNANT (GO TO 703)
NOT PREGNANT OR UNSURE (GO TO 704)

703) 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 ANOTHER CHILD 1 (GO TO 705)
NO MORE (GO TO 711)
UNDECIDED/DON'T KNOW (GO TO 711)

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

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 707)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 712)
UNDECIDED/DON'T KNOW 8 (GO TO 710)

705) CHECK 226:

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

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

MONTHS 1_____
YEARS 2_____

SOON/NOW 993 (GO TO 710)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 712)
AFTER MARRIAGE 995 (GO TO 710)
OTHER (SPECIFY) _____ 996 (GO TO 710)
DON'T KNOW 998 (GO TO 998)

706) CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 707)
PREGNANT (GO TO 711)

707) CHECK 303: USING A CONTRACEPTIVE METHOD?

NOT CURRENTLY USING (GO TO 708)
CURRENTLY USING (GO TO 712)

708) CHECK 705:

NOT ASKED (GO TO 709)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 709)
00-23 MONTHS OR 00-01 YEARS (GO TO 711)

709) CHECK 703 AND 704:

WANTS TO HAVE ANOTHER CHILD:

You said that you do not want (a/another) child soon. Can you tell me why you are not using a method to prevent pregnancy?

Any other reason?

RECORD ALL REASONS MENTIONED.

NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
CAN'T GET PREGNANT E
NOT MENSTRUATED SINCE LAST BIRTH F
BREASTFEEDING G
UP TO GOD/FATALISTIC H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
SIDE EFFECTS/HEALTH CONCERNS O
LACK OF ACCESS/TOO FAR P
COSTS TOO MUCH Q
PREFERRED METHOD NOT AVAILABLE R
NO METHOD AVAILABLE S
INCONVENIENT TO USE T
INTERFERES WITH BODY'S NORMAL PROCESSES U
OTHER (SPECIFY) X
DON'T KNOW Z

WANTS NO MORE/NONE:

You have said that you do not want any (more) children. Can you tell me why you are not using a method to prevent pregnancy?

Any other reason?

RECORD ALL REASONS MENTIONED.

NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
CAN'T GET PREGNANT E
NOT MENSTRUATED SINCE LAST BIRTH F
BREASTFEEDING G
UP TO GOD/FATALISTIC H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
SIDE EFFECTS/HEALTH CONCERNS O
LACK OF ACCESS/TOO FAR P
COSTS TOO MUCH Q
PREFERRED METHOD NOT AVAILABLE R
NO METHOD AVAILABLE S
INCONVENIENT TO USE T
INTERFERES WITH BODY'S NORMAL PROCESSES U
OTHER (SPECIFY) X
DON'T KNOW Z

710) CHECK 303: USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 711)
NO, NOT CURRENTLY USING (GO TO 711)
YES, CURRENTLY USING (GO TO 712)

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

YES 1
NO 2
DON'T KNOW 8

712) 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?
NONE 00 (GO TO 714)
NUMBER___
OTHER (SPECIFY) 96 (GO TO 714)

NO LIVING CHILDREN:

If you could choose exactly the number of children to have in your whole life, how many would that be?
NONE 00 (GO TO 714)
NUMBER___
OTHER (SPECIFY) 96 (GO TO 714)

713) How many of these children would you wish to be boys, how many would you wish to be girls and for how many would it not matter if it's not a boy or a girl?

NUMBER
BOYS___
GIRLS___
EITHER___
OTHER (SPECIFY) 96

714) In the last few months have you:

Heard about family planning on the radio?
YES 1
NO 2
Seen anything about family planning on the television?
YES 1
NO 2
Read about family planning in a newspaper or magazine?
YES 1
NO 2
Received pamphlets or posters on family planning?
YES 1
NO 2

715) How would you prefer to get information on family planning?

PROBE: Over the radio, on television, in print, or by speaking to someone?

RADIO 1
TELEVISION 2
PRINT 3
SPEAKING WITH SOMEONE 4
DON'T KNOW 8

716) CHECK 601:

YES, CURRENTLY MARRIED (GO TO 717)
YES, LIVING WITH A MAN (GO TO 717)
NO, NOT IN UNION (GO TO 801)

717) CHECK 303: USING A CONTRACEPTIVE METHOD?

CURRENTLY USING (GO TO 718)
NOT CURRENTLY USING OR NOT ASKED (GO TO 720)

718) Would you say that using a contraception is mainly your decision, mainly your (husband's/partner's) decision, or did you both decide together?

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

719) CHECK 304:

NEITHER STERILIZED (GO TO 720)
HE OR SHE STERILIZED (GO TO 801)

720) Does your (husband/partner) want the same number of children that you want, or does he want more or fewer than you want?

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

SECTION 8. HUSBAND'S BACKGROUND AND WOMAN'S WORK

801) CHECK 601 AND 602:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 802)
FORMERLY MARRIED/LIVED WITH A MAN (GO TO 803)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 807)

802) How old was your (husband/partner) on his last birthday?

AGE IN COMPLETED YEARS___

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

YES 1
NO 2 (GO TO 806)

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

PRIMARY 1
SECONDARY 2
HIGHER 3
DON'T KNOW 8 (GO TO 806)

805) What was the highest (grade/form/year) he completed at that level?

IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

GRADE___
DON'T KNOW 98

806) CHECK 801:

CURRENTLY MARRIED/LIVING WITH A MAN:

What is your (husband's/partner's) occupation? That is, what kind of work does he mainly do?
OCCUPATION ______

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____

807) Aside from your own housework, have you done any work in the last seven days?

YES 1 (GO TO 811)
NO 2

808) 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.

In the last seven days, have you done any of these things or any other work?

YES 1 (GO TO 811)
NO 2

809) Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, maternity leave, or any other such reason?

YES 1 (GO TO 811)
NO 2

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

YES 1
NO 2 (GO TO 815)

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

OCCUPATION___

812) 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

813) 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

814) 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
NOT PAID 4

815) CHECK 601:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 816)
NOT IN UNION (GO TO 823)

816) CHECK 814:

CODE 1 OR 2 CIRCLED (GO TO 817)
OTHER (GO TO 819)

817) Who usually decides how the money you earn will be used: you, your (husband/partner), or you and your (husband/parnter) jointly?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
OTHER (SPECIFY) 6

818) Would you say that the money that you earn is more than what your (husband/partner) earns, less than what he earns, or about the same?

MORE THAN HIM 1
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND/PARTNER HAS NO EARNINGS 4 (GO TO 820)
DON'T KNOW 8

819) Who usually decides how your (husband's/partner's) earnings will be used: you, your (husband/partner), or you and your (husband/partner) jointly?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
HUSBAND/PARTNER HAS NO EARNINGS 4
OTHER (SPECIFY) 6

820) Who usually makes decisions about health care for yourself: you, your (husband/partner), you and your (husband/partner) jointly, or someone else?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE IN THE FAMILY 4
OTHER 6

821) Who usually makes decisions about making major household purchases?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE IN THE FAMILY 4
OTHER 6

822) Who usually makes decisions about visits to your family or relatives?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE IN THE FAMILY 4
OTHER (SPECIFY) 6

823) Do you own this house or any other house either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4

824) Do you own any land either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4

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

CHILDREN YOUNGER THAN 10 YEARS
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
HUSBAND
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
OTHER MALES
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
OTHER FEMALES
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3

826) 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 to have sex with him?
YES 1
NO 2
DON'T KNOW 8
If she burns the food?
YES 1
NO 2
DON'T KNOW 8
If she commits infidelity?
YES 1
NO 2
DON'T KNOW 8

SECTION 9. HIV/AIDS

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

YES 1
NO 2 (GO TO 937)

902) Can people reduce their chance of getting HIV, the virus that causes AIDS, by having just one uninfected sex partner who has no other sex partners?

YES 1
NO 2
DON'T KNOW 8

903) Can people get HIV from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

904) Can people reduce their chance of getting HIV by using a condom every time they have sex?

YES 1
NO 2
DON'T KNOW 8

905) Can people get HIV by sharing food with a person who has AIDS?

YES 1
NO 2
DON'T KNOW 8

906) Can people get HIV because of witchcraft or other supernatural means?

YES 1
NO 2
DON'T KNOW 8

907) Is it possible for a healthy-looking person to have HIV?

YES 1
NO 2
DON'T KNOW 8

908) Can HIV be transmitted from a mother to her baby:

During pregnancy?
YES 1
NO 2
DON'T KNOW 8
During delivery?
YES 1
NO 2
DON'T KNOW 8
By breastfeeding?
YES 1
NO 2
DON'T KNOW 8

909) CHECK 908:

AT LEAST ONE 'YES' (GO TO 910)
OTHER (GO TO 911)

910) Are there any special drugs that a doctor or a nurse can give to a woman infected with HIV to reduce the risk of transmission to the baby?

YES 1
NO 2
DON'T KNOW 8

911) CHECK 208 AND 215:

LAST BIRTH SINCE JANUARY 2008 (GO TO 912)
NO BIRTHS (GO TO 926)
LAST BIRTH BEFORE JANUARY 2008 (GO TO 926)

912) CHECK 408 FOR LAST BIRTH:

HAD ANTENATAL CARE (GO TO 913)
NO ANTENATAL CARE (GO TO 920)

913) CHECK FOR PRESENCE OF OTHER. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

914) During any of the antenatal visits for your last birth were you given any information about:

Babies getting HIV from their mother?
YES 1
NO 2
DON'T KNOW 8
Things that you can do to prevent getting HIV?
YES 1
NO 2
DON'T KNOW 8
Getting tested for HIV?
YES 1
NO 2
DON'T KNOW 8

915) Were you offered a test for HIV as part of your antenatal care?

YES 1
NO 2

916) I don't want to know the results, but were you tested for HIV as part of your antenatal care?

YES 1
NO 2 (GO TO 920)

917) Where was this test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE___
PUBLIC SECTOR
CENTRAL HOSPITAL 11
PROVINCIAL HOSPITAL 12
DISTRICT HOSPITAL 13
RURAL HOSPITAL 14
RURAL HEALTH CENTER/COUNCIL CLINIC 15
URBAN MUNICIPAL CLINIC 16
FAMILY PLANNING CLINIC 17
SCHOOL BASED CLINIC 18
OTHER PUBLIC SECTOR (SPECIFY) 19
MISSION HOSPITAL/CLINIC 21
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 31
NEW START CENTRE 32
SCHOOL BASED CLINIC 33
OTHER PRIVATE VCT CENTRE (SPECIFY) 36
OTHER SOURCE
MOBILE VCT 41
HOME 42
CORRECTIONAL FACILITY 43
OTHER (SPECIFY) 96

918) I don't want to know the results, but did you get the results of the test?

YES 1
NO 2 (GO TO 924)

919) All women are supposed to receive counseling after being tested. After you were tested, did you received counseling?

YES 1 (GO TO 924)
NO 2 (GO TO 924)
DON'T KNOW 8 (GO TO 924)

920) CHECK 434 FOR LAST BIRTH:

ANY CODE 21-46 CIRCLED (GO TO 921)
OTHER (GO TO 926)

921) Between the time you went for delivery but before the baby was born, were you offered a test for HIV?

YES 1
NO 2

922) I don't want to know the results, but were you tested for HIV at that time?

YES 1
NO 2 (GO TO 926)

923) I don't want to know the results, but did you get the results of the test?

YES 1
NO 2

924) Have you been tested for HIV since that time you were tested during your pregnancy?

YES 1 (GO TO 927)
NO 2

925) How many months ago was your most recent HIV test?

MONTHS AGO___ (GO TO 932)
TWO OR MORE YEARS 95 (GO TO 932)

926) I don't want to know the results, but have you ever been tested to see if you have HIV

YES 1
NO 2 (GO TO 930)

927) How many months ago was your most recent HIV test?

MONTHS AGO___
TWO OR MORE YEARS 95

928) I don't want to know the results, but did you get the results of the test?

YES 1
NO 2

929) Where was this test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

NAME OF PLACE___
PUBLIC SECTOR
CENTRAL HOSPITAL 11
PROVINCIAL HOSPITAL 12
DISTRICT HOSPITAL 13
RURAL HOSPITAL 14
RURAL HEALTH CENTER/COUNCIL CLINIC 15
URBAN MUNICIPAL CLINIC 16
FAMILY PLANNING CLINIC 17
SCHOOL BASED CLINIC 18
OTHER PUBLIC SECTOR (SPECIFY) 19
MISSION HOSPITAL/CLINIC 21
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 31
NEW START CENTRE 32
SCHOOL BASED CLINIC 33
OTHER PRIVATE VCT CENTRE (SPECIFY) 36
OTHER SOURCE
MOBILE VCT 41
HOME 42
CORRECTIONAL FACILITY 43
OTHER (SPECIFY) 96

930) Do you know of a place where people can go to get tested for HIV?

YES 1
NO 2 (GO TO 932)

931) Where is that? Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

NAME OF PLACE___
PUBLIC SECTOR
CENTRAL HOSPITAL A
PROVINCIAL HOSPITAL B
DISTRICT HOSPITAL C
RURAL HOSPITAL D
RURAL HEALTH CENTER/COUNCIL CLINIC E
URBAN MUNICIPAL CLINIC F
FAMILY PLANNING CLINIC G
OTHER PUBLIC SECTOR (SPECIFY) H
MISSION HOSPITAL/CLINIC I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR J
NEW START CENTRE K
OTHER PRIVATE VCT CENTRE (SPECIFY) L
OTHER SOURCE
MOBILE VCT M
OTHER (SPECIFY) X

932) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV?

YES 1
NO 2
DON'T KNOW 8

933) If a member of your family got infected with HIV, would you want it to remain a secret or not?

YES, REMAIN A SECRET 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

934) If a member of your family became sick with 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

935) In your opinion, if a female teacher has HIV but is not sick, should she be allowed to continue teaching in the school?

SHOULD BE ALLOWED 1
SHOULD NOT BE ALLOWED 2
DON'T KNOW/NOT SURE/DEPENDS 8

9365A) In your opinion, if a male teacher has HIV but is not sick, should he be allowed to continue teaching in the school?

SHOULD BE ALLOWED 1
SHOULD NOT BE ALLOWED 2
DON'T KNOW/NOT SURE/DEPENDS 8

936) Should children age 12-14 be taught about using a condom to avoid getting AIDS?

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

937) CHECK 901:

HEARD ABOUT AIDS:

Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?
YES 1
NO 2

NOT HEARD ABOUT AIDS:

Have you heard about infections that can be transmitted through sexual contact?
YES 1
NO 2

938) CHECK 613:

HAS HAD SEXUAL INTERCOURSE (GO TO 939)
NEVER HAD SEXUAL INTERCOURSE (GO TO 946)

939) CHECK 937: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES (GO TO 940)
NO (GO TO 941)

940) Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?

YES 1
NO 2
DON'T KNOW 8

941) Sometimes women experience a bad-smelling abnormal genital discharge. During the last 12 months, have you had a bad-smelling abnormal genital discharge?

YES 1
NO 2
DON'T KNOW 8

942) Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

YES 1
NO 2
DON'T KNOW 8

943) CHECK 940, 941, AND 942:

HAS HAD AN INFECTION (ANY 'YES') (GO TO 944)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 946)

944) The last time you had (PROBLEM FROM 940/941/942), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 946)

945) Where did you go? Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

NAME OF PLACE(S)___
PUBLIC SECTOR
CENTRAL HOSPITAL A
PROVINCIAL HOSPITAL B
DISTRICT HOSPITAL C
RURAL HOSPITAL D
RURAL HEALTH CENTER/COUNCIL CLINIC E
URBAN MUNICIPAL CLINIC F
FAMILY PLANNING CLINIC G
OTHER PUBLIC SECTOR (SPECIFY) H
MISSION HOSPITAL/CLINIC I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR J
PHARMACY K
OTHER PRIVATE MEDICAL CENTRE (SPECIFY) L
OTHER SOURCE
MOBILE VCT M
SHOP N
TRADITIONAL HERBALIST O
OTHER (SPECIFY) X

946) If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom when they have sex?

YES 1
NO 2
DON'T KNOW 8

947) Is a wife justified in refusing to have sex with her husband when she knows her husband has sex with women other than his wives?

YES 1
NO 2
DON'T KNOW 8

948) CHECK 601:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 949)
NOT IN UNION (GO TO 1001)

949) Can you say no to your (husband/partner) if you do not want to have sexual intercourse?

YES 1
NO 2
DEPENDS/ NOT SURE 8

950) Could you ask your (husband/partner) to use a condom if you wanted him to?

YES 1
NO 2
DEPENDS/NOT SURE 8

SECTION 10. OTHER HEALTH ISSUES

1001) Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?

IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS___
NONE 00 (GO TO 1004)

1002) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?

IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS___
NONE 00 (GO TO 1004)

1003) The last time you got any injection from a health worker, did he/she take the syringe and needle from a new, unopened package?

YES 1
NO 2
DON'T KNOW 3

1004) Do you currently smoke cigarettes?

YES 1
NO 2 (GO TO 1006)

1005) In the last 24 hours, how many cigarettes did you smoke?

NUMBER OF CIGARETTES___

1006) Do you currently smoke or use any (other) type of tobacco?

YES 1
NO 2 (GO TO 1008)

1007) What (other) type of tobacco do you currently smoke or use?

RECORD ALL MENTIONED.

PIPE A
SNUFF B
OTHER (SPECIFY) X

1008) Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem or not?

Getting permission to go to the doctor?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Getting money needed for advice or treatment?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
The distance to the health facility?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Not wanting to go alone?
BIG PROBLEM 1
NOT A BIG PROBLEM 2

1009) Are you covered by any medical aid?

YES 1
NO 2 (GO TO 1101)

1010) What type of medical aid are you covered by?

RECORD ALL MENTIONED.

MUTUAL HEALTH ORGANIZATION/COMMUNITY-BASED HEALTH INSURANCE A
HEALTH INSURANCE THROUGH EMPLOYER B
SOCIAL SECURITY C
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D
OTHER (SPECIFY) X

SECTION 11. ADULT AND MATERNAL MORTALITY

1101) 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___

1102) CHECK 1101:

TWO OR MORE BIRTHS (GO TO 1103)
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 1201)

1103) How many of these births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS___

1104) What was the name given to your oldest (next oldest) brother or sister?

NAME___

1105) Is (NAME) male or female?

MALE 1
FEMALE 2

1106) Is (NAME) still alive?

YES 1
NO 2 (GO TO 1108)
DON'T KNOW 8 (GO TO THE NEXT COLUMN IN 1104 FOR THE NEXT SIBLING)

1107) How old is (NAME)?

AGE___ (GO TO THE NEXT COLUMN IN 1104 FOR THE NEXT SIBLING)

1108) How many years ago did (NAME) die?

YEARS___

1109) How old was (NAME) when he/she died?

AGE___(IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO THE NEXT COLUMN IN 1104 FOR THE NEXT SIBLING)

1110) Was (NAME) pregnant when she died?

YES 1 (GO TO 1113)
NO 2

1111) Did (NAME) die during childbirth?

YES 1 (GO TO 1113)
NO 2

1112) Did (NAME) die within two months after the end of a pregnancy or childbirth?

YES 1
NO 2

1113) Was (NAME)'s death due to an accident or violence?

YES 1
NO 2

1114) How many live born children did (NAME) give birth to during her lifetime (before this pregnancy)?

NUMBER OF CHILDREN____

IF NO MORE BROTHERS OR SISTERS, GO TO 1201.

SECTION 12. HOUSEHOLD RELATIONS MODULE

1201) CHECK COVER PAGE OF THE QUESTIONNAIRE:

WOMAN SELECTED FOR THIS SELECTION (GO TO 1202)
WOMAN NOT SELECTED (GO TO 1236)

1202) CHECK FOR PRESENCE OF OTHERS:

DO NO CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED

PRIVACY OBTAINED 1
PRIVACY NOT POSSIBLE 2 (GO TO 1235)

[If privacy obtained]:

READ TO THE RESPONDENT

Now I would like to ask you questions about some other important aspects of a woman's life. I know that some of these questions are very personal. However, your answers are crucial for helping to understand the condition of women in Zimbabwe. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else will know that you were asked these questions.

1203) CHECK 601 AND 602:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 1204)
FORMERLY MARRIED/LIVED WITH A MAN (READ IN THE PAST TENSE) (GO TO 1204)
NEVER MARRIED/NEVER LIVED WITH A MAN (GO TO 1215)

1204) First, I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with you (last) (husband/partner)?

a) He (is/was) jealous or angry if you (talk/talked) to other men?
YES 1
NO 2
DON'T KNOW 8
b) He frequently (accuses/accused) you of being unfaithful?
YES 1
NO 2
DON'T KNOW 8
c) He (does/did) not permit you to meet your female friends?
YES 1
NO 2
DON'T KNOW 8
d) He (tries/tried) to limit your contact with your family?
YES 1
NO 2
DON'T KNOW 8
e) He (insists/insisted) on knowing where you (are/were) at all times?
YES 1
NO 2
DON'T KNOW 8
f) He (does/did) not trust you with any money?
YES 1
NO 2
DON'T KNOW 8

1205) Now if you will permit me, I need to ask some more questions about your relationship with your (last) (husband/partner). If we should come to any question that you do not want to answer, just let me know and we will go on to the next question.

(Does/did) your (last) (husband/partner) ever:

a) Say or do something to humiliate you in front of other?
YES 1
NO 2 (GO TO 1205b)
b) Threaten to hurt or harm you or someone close to you?
YES 1
NO 2 (GO TO 1205c)
c) Insult you or make you feel bad about yourself?
YES 1
NO 2 (GO TO 1206)

1205) How often did this happen during the last 12 months: often, only sometimes, or not at all?

a) Say or do something to humiliate you in front of other?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
b) Threaten to hurt or harm you or someone close to you?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
c) Insult you or make you feel bad about yourself?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1206) (Does/did) your (last) (husband/partner) ever do any of the following things to you:

a) Push you, shake you, or throw something at you?
YES 1
NO 2 (go to 1206b)
b) Slap you?
YES 1
NO 2 (GO TO 1206c)
c) Twist your arm or pull your hair?
YES 1
NO 2 (GO TO 1206d)
d) Punch you with his fist or with something that could hurt you?
YES 1
NO 2 (GO TO 1206e)
e) Kick you, drag you or beat you up?
YES 1
NO 2 (GO TO 1206f)
f) Try to choke you or burn you on purpose?
YES 1
NO 2 (GO TO 1206g)
g) Threaten or attack you with a knife, gun, or any other weapon?
YES 1
NO 2 (GO TO 1206h)
h) Physically force you to have sexual intercourse with him even when you did not want to?
YES 1
NO 2 (GO TO 1206h)
i) Force you to perform any sexual acts you did not want to?
YES 1
NO 2 (GO TO 1207)

1206) How often did this happen during the last 12 months: often, only sometimes, or not at all?

a) Push you, shake you, or throw something at you?
OFTEN 1
SOMTETIMES 2
NOT AT ALL 3
b) Slap you?
OFTEN 1
SOMTETIMES 2
NOT AT ALL 3
c) Twist your arm or pull your hair?
OFTEN 1
SOMTETIMES 2
NOT AT ALL 3
d) Punch you with his fist or with something that could hurt you?
OFTEN 1
SOMTETIMES 2
NOT AT ALL 3
e) Kick you, drag you or beat you up?
OFTEN 1
SOMTETIMES 2
NOT AT ALL 3
f) Try to choke you or burn you on purpose?
OFTEN 1
SOMTETIMES 2
NOT AT ALL 3
g) Threaten or attack you with a knife, gun, or any other weapon?
OFTEN 1
SOMTETIMES 2
NOT AT ALL 3
h) Physically force you to have sexual intercourse with him even when you did not want to?
OFTEN 1
SOMTETIMES 2
NOT AT ALL 3
i) Force you to perform any sexual acts you did not want to?
OFTEN 1
SOMTETIMES 2
NOT AT ALL 3

1207) CHECK 1206A (a-i)

AT LEAST ONE 'YES' (GO TO 1208)
NOT A SINGLE 'YES' (GO TO 1210)

1208) How long after you first (got married to/started living with) your (last) (husband/partner) did (this thing/any of these things) first happen?

IF LESS THAN ONE YEAR, RECORD '00'.

NUMBER OF YEARS___
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95

1209) Did the following ever happen as a result of what your (last) (husband/partner) did to you:

a) You had cuts, bruises or aches?
YES 1
NO 2
b) You had eye injuries, sprains, dislocations, or burns?
YES 1
NO 2
c) You had deep wounds, broken bones, broken teeth, or any other serious injury?
YES 1
NO 2

1210) Have you ever hit, slapped, kicked, or done anything else to physically hurt your (last) (husband/partner) at times when he was not already beating or physically hurting you?

YES 1
NO 2 (GO TO 1213)

1212) In the last 12 months, how often have you done this to your (husband/partner): often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1213) (Does/did) your (husband/partner) drink alcohol?

YES 1
NO 2 (GO TO 1215)

1214) How often (does/did) he get drunk: often, only sometimes, or never?

OFTEN 1
SOMETIMES 2
NEVER 3

1215) CHECK 601 AND 602:

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

YES 1
NO 2 (GO TO 1218)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1218)

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

YES 1
NO 2 (GO TO 1218)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1218)

1216) Who hurt you in this way? Anyone else?

RECORD ALL MENTIONED.

MOTHER/STEP-MOTHER A
FATHER/STEP-FATHER B
SISTER/BROTHER C
DAUGHTER/SON D
OTHER RELATIVE E
FORMER HUSBAND/LIVE-IN PARTNER F
CURRENT BOYFRIEND G
FORMER BOYFRIEND H
MOTHER-IN-LAW I
FATHER-IN-LAW J
OTHER-IN-LAW K
TEACHER L
EMPLOYER/SOMEONE AT WORK M
POLICE/SOLDIER N
OTHER (SPECIFY) X

1217) In the last 12 months, how often have you been hit, slapped, kicked, or physically hurt by (this person/these persons): often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1218) CHECK 201, 226, AND 230:

EVER BEEN PREGNANT (YES ON 201 OR 226 OR 230) (GO TO 1219)
NEVER BEEN PREGNANT (GO TO 1221)

1219) Has any one ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?

YES 1
NO 2 (GO TO 1221)

1220) Who has done any of these things to physically hurt you while you were pregnant? Anyone else?

RECORD ALL MENTIONED.

CURRENT HUSBAND/LIVE-IN PARTNER A
MOTHER/STEP-MOTHER B
FATHER/STEP-FATHER C
SISTER/BROTHER D
DAUGHTER/SON E
OTHER RELATIVE F
FORMER HUSBAND/LIVE-IN PARTNER G
CURRENT BOYFRIEND H
FORMER BOYFRIEND I
MOTHER-IN-LAW J
FATHER-IN-LAW K
OTHER-IN-LAW L
TEACHER M
EMPLOYER/SOMEONE AT WORK N
POLICE/SOLDIER O
OTHER (SPECIFY) X

1221) CHECK 613: EVER HAD SEX?

HAS EVER HAD SEX (GO TO 1222)
NEVER HAD SEX (GO TO 1226)

1222) The first time you had sexual intercourse, would you say that you had it because you wanted to, or because you were forced to have it against your will?

WANTED TO 1
FORCED TO 2
REFUSED TO ANSWER/NO RESPONSE 3

1223) CHECK 601 AND 602:

EVER MARRIED/LIVED WITH A MAN:

In the last 12 months, has anyone other than your (current/last) (husband/partner) forced you to have sexual intercourse against your will?
YES 1
NO 2
REFUSED TO ANSWER/NO ANSWER 3

NEVER MARRIED/NEVER LIVED WITH A MAN:

In the last 12 months has anyone forced you to have sexual intercourse against your will?
YES 1
NO 2
REFUSED TO ANSWER/NO ANSWER 3

1224) CHECK 1222 AND 1223:

1222 = '1' OR '3' AND 1223 = '2' OR '3' (GO TO 1225)
OTHER (GO TO 1227)

1225) CHECK 1206A(h) AND 1206A(i):

1206A(h) IS NOT '1' AND 1206A(i) IS NOT '1' (GO TO 1226)
OTHER (GO TO 1229)

1226) At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts?

YES 1
NO 2 (GO TO 1229)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1229)

1227) How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts?

AGE IN COMPLETED YEARS___
DON'T KNOW 98

1228) Who was the person who was forcing you at that time?

CURRENT HUSBAND/LIVE-IN PARTNER 01
FORMER HUSBAND/LIVE-IN PARTNER 02
CURRENT/FORMER BOYFRIEND 03
FATHER 04
STEP-FATHER 05
OTHER RELATIVE 06
IN-LAW 07
OWN FRIEND/ACQUAINTANCE 08
FAMILY FRIEND 09
TEACHER 10
EMPLOYER/SOMEONE AT WORK 11
POLICE/SOLDIER 12
PRIEST/RELIGOUS LEADER 13
STRANGER 14
OTHER (SPECIFY) 96

1229) CHECK 1206A (a-i), 1215, 1219, 1222, 1223, AND 1226:

AT LEAST ONE 'YES' OR 1222=2 (GO TO 1230)
NOT A SINGLE 'YES' AND 1222 IS NOT EQUAL TO 2 (GO TO 1233)

1230) Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help to stop (this/these) person(s) from doing this to you again?

YES 1
NO 2 (GO TO 1232)

1231) From whom have you sought help? Anyone else?

RECORD ALL MENTIONED.

OWN FAMILY A (GO TO 1233)
HUSBAND/LIVE-IN PARTNER'S FAMILY B (GO TO 1233)
CURRENT/LAST/LATE HUSBAND/LIVE-IN PARTNER C (GO TO 1233)
CURRENT/FORMER BOYFRIEND D (GO TO 1233)
FRIEND E (GO TO 1233)
NEIGHBOR F (GO TO 1233)
RELIGIOUS LEADER G (GO TO 1233)
DOCTOR/MEDICAL PERSONNEL H (GO TO 1233)
POLICE I (GO TO 1233)
LAWYER J (GO TO 1233)
SOCIAL SERVICE ORGANIZATION K (GO TO 1233)
OTHER (SPECIFY) X

1232) Have you ever told anyone else about this?

YES 1
NO 2

1233) As far as you know, did your father ever beat your mother?

YES 1
NO 2
DON'T KNOW 8

THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER ABOUT THE CONFIDENTIALITY OF HER ANSWERS. FILL OUT THE QUESTIONS BELOW WITH REFERENCE TO THE DOMESTIC VIOLENCE MODULE ONLY.

1234) DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTEFERED IN ANY OTHER WAY?

HUSBAND
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 2
OTHER MALE ADULT
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 2
FEMALE ADULT
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 2

1235) INTERVIEWER'S COMMENTS ON THE DOMESTIC VIOLENCE MODULE ONLY.

1236) 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 SUPERVISOR:___
DATE: _______
  
EDITOR'S OBSERVATIONS:_________
 
NAME OF EDITOR: __________
DATE: _________
 

CALENDAR

INSTRUCTIONS: ONLY ONE CODE PER BOX. COLUMN 1 REQUIRES A CODE IN EVERY MONTH.

INFORMATION SHOULD BE CODED FOR EACH COLUMN

COLUMN 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE

BIRTHS B
PREGNANCIES P
TERMINATIONS T
NO METHOD 0
FEMALE STERILIZATION 1
MALE STERILIZATION 2
IUD/LOOP 3
INJECTABLES 4
IMPLANTS 5
PILL 6
MALE CONDOM 7
FEMALE CONDOM 8
DIAPHRAGM 9
FOAM OR JELLY J
LACTATIONAL AMENORRHEA METHOD K
RHYTHM METHOD L
WITHDRAWAL M
OTHER MODERN METHOD X
OTHER TRADITIONAL Y

COLUMN 2: DISCONTINUATION OF CONTRACEPTIVE USE

INFREQUENT SEX/HUBAND AWAY 0
BECAME PREGNANT WHILE USING 1
WANTED TO BECOME PREGNANT 2
HUSBAND/PARTNER DISAPPROVED 3
WANTED MORE EFFECTIVE METHOD 4
SIDE EFFECTS/HEALTH CONCERNS 5
LACK OF ACCESS/TOO FAR 6
COSTS TOO MUCH 7
INCONVENIENT TO USE 8
UP TO GOD/FATALISTIC F
DIFFICULT TO GET PREGNANT/MENOPAUSAL A
MARITAL DISSOLUTION/SEPARATION D
OTHER (SPECIFY) X
DON'T KNOW Z

2011

12 DEC 01_ _
11 NOV 02_ _
10 OCT 03_ _
09 SEP 04_ _
08 AUG 05_ _
07 JUL 06_ _
06 JUN 07_ _
05 MAY 08_ _
04 APR 09_ _
03 MAR 10_ _
02 FEB 11_ _
01 JAN 12_ _

2010

12 DEC 13_ _
11 NOV 14_ _
10 OCT 15_ _
09 SEP 16_ _
08 AUG 17_ _
07 JUL 18_ _
06 JUN 19_ _
05 MAY 20_ _
04 APR 21_ _
03 MAR 22_ _
02 FEB 23_ _
01 JAN 24_ _

2009

12 DEC 25_ _
11 NOV 26_ _
10 OCT 27_ _
09 SEP 28_ _
08 AUG 29_ _
07 JUL 30_ _
06 JUN 31_ _
05 MAY 32_ _
04 APR 33_ _
03 MAR 34_ _
02 FEB 35_ _
01 JAN 36_ _

2008

12 DEC 37_ _
11 NOV 38_ _
10 OCT 39_ _
09 SEP 40_ _
08 AUG 41_ _
07 JUL 42_ _
06 JUN 43_ _
05 MAY 44_ _
04 APR 45_ _
03 MAR 46_ _
02 FEB 47_ _
01 JAN 48_ _

2007

12 DEC 49_ _
11 NOV 50_ _
10 OCT 51_ _
09 SEP 52_ _
08 AUG 53_ _
07 JUL 54_ _
06 JUN 55_ _
05 MAY 56_ _
04 APR 57_ _
03 MAR 58_ _
02 FEB 59_ _
01 JAN 60_ _

2006

12 DEC 61_ _
11 NOV 62_ _
10 OCT 63_ _
09 SEP 64_ _
08 AUG 65_ _
07 JUL 66_ _
06 JUN 67_ _
05 MAY 68_ _
04 APR 69_ _
03 MAR 71_ _
02 FEB 71_ _
01 JAN 72_ _

2005

12 DEC 73_ _
11 NOV 74_ _
10 OCT 75_ _
09 SEP 76_ _
08 AUG 77_ _
07 JUL 78_ _
06 JUN 79_ _
05 MAY 80_ _
04 APR 81_ _
03 MAR 82_ _
02 FEB 83_ _
01 JAN 84_ _