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DEMOGRAPHIC AND HEALTH SURVEY - 2015 ZIMBABWE - WOMAN'S QUESTIONNAIRE (ENGLISH)

ZIMBABWE

IDENTIFICATION

PLACE NAME ___

NAME OF HOUSEHOLD HEAD ___

CLUSTER NAME ___

HOUSEHOLD NUMBER ___

NAME AND LINE NUMBER OF WOMAN ___

INTERVIEWER VISITS

FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT*

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

SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT*

NEXT VISIT
DATE
TIME

THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT*

FINAL VISIT
DAY
MONTH
YEAR
INTERVIEWER'S NUMBER
RESULT*

TOTAL NUMBER OF VISITS

LANGUAGE OF QUESTIONNAIRE

01 ENGLISH
02 NDEBELE
03 SHONA

LANGUAGE OF INTERVIEW

01 ENGLISH
02 NDEBELE
03 SHONA

TRANSLATOR USED

YES 1
NO 2

SUPERVISOR
NAME
NUMBER

OFFICE EDITOR
NAME
NUMBER

KEYED BY
NAME
NUMBER

INTRODUCTION AND CONSENT

Hello. My name is ___. I am working with the Central Statistical Office/ZIMSTAT, in collaboration with the Ministry of Health. We are conducting a survey about health and other topics all over Zimbabwe. The information we collect will help the government to plan health services. Your household was randomly selected for the survey. The questions usually take about 30-60 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. Participation in the survey is completely voluntary. It's up to you 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 questions 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 any contact the person listed on the card that has already been given to your household.

Do you have any questions?

SIGNATURE OF INTERVIEWER ___
DATE ___

RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 101)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (GO TO END)

SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD THE TIME.

HOURS ___
MINUTES ___

102. How long have you been living continuously in (NAME OF CURRENT CITY, TOWN OR VILLAGE OF RESIDENCE)?

IF LESS THAN ONE YEAR, RECORD '00'.

YEARS ___
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)

103. Just before you moved here, did you live in an urban or rural area?

URBAN AREA 1
RURAL AREA 2

104. Before you moved here, which province did you live in?

BULAWAYO 00
HARARE 09
MANICALAND 01
MASHONALAND CENTRAL 02
MASHONALAND EAST 03
MASVINGO 08
MASHONALAND WEST 04
MATABELELAND NORTH 05
MATABELELAND SOUTH 06
MIDLANDS 07
OUTSIDE OF ZIMBABWE 96

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

AGE IN COMPLETED YEARS ___

107. Have you ever attended school?

YES 1
NO 2 (GO TO 111)

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?

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

(GRADE/FORM/YEAR) ___

110. CHECK 108:

PRIMARY OR SECONDARY (GO TO 111)
HIGHER (GO TO 113)

111. 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 PART OF THE SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE 4
BLIND/VISUALLY IMPAIRED 5

112. CHECK 111:

CODE '2', '3', OR '4' CIRCLED (GO TO 113)
CODE '1' OR '5' CIRCLED (GO TO 114)

113. 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

114. 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

115. 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

116. Do you own a mobile telephone?

YES 1
NO 2 (GO TO 118)

117. Do you use your mobile phone for any financial transactions?

YES 1
NO 2

118. Do you have an account in a bank or other financial institution that you yourself use?

YES 1
NO 2

119. Have you ever used the internet?

YES 1
NO 2 (GO TO 122)

120. In the last 12 months, have you used the internet?

IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.

YES 1
NO 2 (GO TO 122)

121. During the last one month, how often did you use the internet: 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

122. 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

124. 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)

125. 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?

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, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?

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

210. CHECK 208:

ONE OR MORE BIRTHS (GO 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 10 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW.

212. What name was given to your (first/next) baby?

RECORD NAME AND BIRTH HISTORY NUMBER.

___

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

BOY 1
GIRL 2

214. Were any of these births twins?

SINGLE 1
MULTIPLE 2

215. On what day, month, and year was (NAME) born?

DAY ___
MONTH ___
YEAR ___

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

217. IF ALIVE: How old was (NAME) at (NAME)'s 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.

HOUSEHOLD LINE NUMBER ___ (GO TO NEXT BIRTH)

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

IF '12 MONTHS' OR '1 YEAR', ASK: Did (NAME) have (his/her) first birthday?

THEN ASK: Exactly how many months old was (NAME) when (he/she) died?

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

DAYS 1 ___
MONTH 2 ___
YEARS 3 ___

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

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

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

YES 1 (RECORD BIRTH(S) IN TABLE)
NO 2

223. COMPARE 208 WITH NUMBER OF BIRTHS IN BIRTH HISTORY

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

224. CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2010-2015.

NUMBER OF BIRTH ___
NONE 0 (GO TO 226)

225. C: FOR EACH BIRTH IN 2010-2015, 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 COMPLETED 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.

C: 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. CHECK 208: TOTAL NUMBER OF BIRTHS

ONE OR MORE: Did you want to have a baby later on or did you not want any more children?

NONE: Did you want to have a baby later on or did you not want any children?

LATER 1
NO MORE/NONE 2

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

YES 1
NO 2 (GO TO 239)

231. When did the last such pregnancy end?

MONTH ___
YEAR ___

232. CHECK 231:

LAST PREGNANCY ENDED IN 2010-2015 (GO TO 234)
LAST PREGNANCY ENDED IN 2009 (GO TO 239)

233. In what month and year did that pregnancy end?

MONTH ___
YEAR ___

234. How many months pregnant were you when that pregnancy ended?

NUMBER OF MONTHS ___

235. Since January 2010, have you had any other pregnancies that did not result in a live birth?

YES 1 (GO TO NEXT LINE)
NO 2 (GO TO 236)

236. C: FOR EACH PREGNANCY THAT DID NOT END IN A LIVE BIRTH IN 2010-2015 OR LATER, ENTER 'T' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS OF PREGNANT.

IF THERE ARE MORE THAN FOUR PREGNANCIES THAT DID NOT END IN A LIVE BIRTH, USE AN ADDITIONAL QUESTIONNAIRE STARTING ON THE SECOND LINE.

237. Did you have any miscarriages, abortions or stillbirths that ended before 2010?

YES 1
NO 2 (GO TO 239)

238. When did the last such pregnancy that terminated before 2010 end?

MONTH ___
YEAR ___

239. 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

240. 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 242)
DON'T KNOW 3 (GO TO 242)

241. 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

242. After the birth of a child, can a woman become pregnant before her menstrual period has returned?

YES 1
NO 2
DON'T KNOW 8

SECTION 3. CONTRACEPTION

301. Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy. Have you ever heard of (METHOD)?

01. Female Sterilization: Women can have an operation to avoid having any more children.
YES 1
NO 2
02. Male Sterilization: Men can have an operation to avoid having any more children.
YES 1
NO 2
03. IUCD: Women can have a loop or coil placed inside them by a doctor or a nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
04. Injectables: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
05. Implants: 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
06. Pill: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
07. Male Condom: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08. Female Condom: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09. Emergency Contraception (Morning-after pill): 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
10. Lactational Amenorrhea Method (LAM): Up to six months after childbirth, before the menstrual period has returned, women use a method requiring frequent breastfeeding day and night.
YES 1
NO 2
11. Rhythm Method (Safe days): To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.
YES 1
NO 2
12. Withdrawal: Men can be careful and pull out before climax.
YES 1
NO 2
13. Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES, MODERN METHOD (SPECIFY) 1
YES, TRADITIONAL METHOD (SPECIFY) 2
NO 3

302. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 303)
PREGNANT (GO TO 312)

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

YES 1
NO 2 (GO TO 312)

304. Which method are you suing?

RECORD 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)
IUCD C (GO TO 309)
INJECTABLES D (GO TO 309)
IMPLANTS E (GO TO 309)
PILL F
MALE CONDOM G (GO TO 306)
FEMALE CONDOM H (GO TO 306)
EMERGENCY CONTRACEPTION I (GO TO 309)
LACTATIONAL AMENORRHEA METHOD J (GO TO 309)
RHYTHM METHOD K (GO TO 309)
WITHDRAWAL L (GO TO 309)
OTHER MODERN METHOD X (GO TO 309)
OTHER TRADITIONAL METHOD Y (GO TO 309)

305. What is the brand name of the pills you are using?

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

OVRETTE SECURE 01 (GO TO 309)
LO-FEMENAL CONTROL 02 (GO TO 309)
MICRONOR 03 (GO TO 309)
MICRONOVUM 04 (GO TO 309)
MARVELLON 05 (GO TO 309)
DUOFEM 06 (GO TO 309)
EXLUTON 07 (GO TO 309)
TRINODIAL 08 (GO TO 309)
OTHER (SPECIFY) 96 (GO TO 309)
DON'T KNOW 98 (GO TO 309)

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
PROTECTION PLUS 01 (GO TO 309)
PANTHER (PUBLIC SECTOR) 02 (GO TO 309)
CAREX CHOICE ASSORTED 03 (GO TO 309)
DUREX 04 (GO TO 309)
VIBE 05 (GO TO 309)
ECSTASY 06 (GO TO 309)
CASANOVA 07 (GO TO 309)
MOODS 08 (GO TO 309)
FEMALE CONDOMS
CARE 11 (GO TO 309)
FC 12 (GO TO 309)
FEMINDOM 13 (GO TO 309)
OTHER (SPECIFY) 96 (GO TO 309)
DON'T KNOW 98 (GO TO 309)

307. In what facility did the sterilization take 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 11
PROVINCIAL HOSPITAL 12
DISTRICT HOSPITAL 13
ZNFPC CLINIC 14
OTHER PUBLIC SECTOR (SPECIFY) 15
MISSION HOSPITAL/CLINIC 21
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PRIVATE DOCTOR'S OFFICE 32
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36
OTHER (SPECIFY) 96
DON'T KNOW 98

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

MONTH ___ (GO TO 310)
YEAR ___ (GO TO 310)

309. 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 ___

310. CHECK 308 AND 309, 215 AND 231: ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 308 OR 309.

NO (GO TO 311)
YES (GO BACK TO 308 OR 309, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION).

311. CHECK 308 AND 309:

YEAR IS 2010 C: ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE. THEN CONTINUE (GO TO 312)

YEAR IS 2009 OR EARLIER C: ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK. THEN GO TO 324.

312. I would like to ask you some questions about the time you or your partner may have used a method to avoid getting pregnant during the last few years.

C: USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2010. USE NAMES OF CHILDREN, DATE OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

312A. MONTH AND YEAR OF START OF INTERVAL OF USE OR NON-USE.

MONTH ___
YEAR ___

312B. Between (EVENT) in (MONTH/YEAR) and (EVENT) in (MONTH/YEAR), did you or your partner use any method of contraception?

YES 1
NO 2 (GO TO 312I)

312C. Which method was that?

METHOD CODE ___

312D. 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 312F)
MONTHS ___ (GO TO 312F)
DATE GIVEN 95

312E. RECORD MONTH AND YEAR RESPONDENT STARTED USING METHOD.

MONTH ___
YEAR ___

312F. For how many months did you use (METHOD)?

RECORD '95' IF RESPONDENT GIVES THE DATE OF TERMINATION OF USE.

MONTHS ___ (GO TO 312H)
DATE GIVEN 95

312G. RECORD MONTH AND YEAR RESPONDENT STOPPED USING METHOD.

MONTH ___
YEAR ___

312H. Why did you stop using (METHOD)?

REASON STOPPED ___

312I. GO BACK TO 312A IN NEXT COLUMN; OR, IF NO MORE GAPS, GO TO 313.

313. CHECK CALENDAR FOR USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH.

NO METHOD USED (GO TO 314)
ANY METHOD USED (GO TO 315)

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

YES 1 (GO TO 326)
NO 2 (GO TO 326)

315. CHECK 304:

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

NO CODE CIRCLED 00 (GO TO 326)
FEMALE STERILIZATION 01 (GO TO 319)
MALE STERILIZATION 02 (GO TO 327)
IUCD 03
INJECTBLES 04
IMPLANTS 05
PILL 06
MALE CONDOM 07
FEMALE CONDOM 08
EMERGENCY CONTRACEPTION 09
LACTATIONAL AMENORRHEA METHOD 10 (GO TO 323)
RHYTHM METHOD 11 (GO TO 323)
WITHDRAWAL 12 (GO TO 323)
OTHER MODERN METHOD 95
OTHER TRADITIONAL METHOD 96

316. You first started using (CURRENT METHOD) in (DATE FROM 308 OR 309). Where did you get it at that 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 11
RURAL HEALTH CENTER 12
MUNICIPAL CLINIC 13
ZNFPC CLINIC 14
ZNFPC CBD/DEPOT HOLDER 15
VILLAGE HEALTH WORKER 16
MOHCC MOBILE CLINIC 17
OTHER PUBLIC SECTOR (SPECIFY) 18
MISSION HOSPITAL 21
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PHARMACY 32
PRIVATE DOCTOR 33
CBD 34
PRIVATE OUTREACH CLINIC 35
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36
RETAIL
GENERAL DEALER 41
SUPERMARKET/TUCK SHOP 42
SERVICE STATION 43
BOTTLE STORE/BAR 44
OTHER RETAIL (SPECIFY) 45
OTHER SOURCE
CHURCH 51
FRIEND/RELATIVE 52
PUBLIC TOILE 53
STREET VENDOR 54
WORKPLACE 55
OTHER (SPECIFY) 96

317. CHECK 304:

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

IUCD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
MALE CONDOM 07 (GO TO 323)
FEMALE CONDOM 08 (GO TO 322)
EMERGENCY CONTRACEPTION 09 (GO TO 322)
OTHER MODERN METHOD 95 (GO TO 322)
OTHER TRADITIONAL METHOD 96 (GO TO 323)

318. At that time, were you told about side effects or problems you might have the method?

YES 1 (GO TO 321)
NO 2 (GO TO 320)

319. When you got sterilized, were you told about side effects or problems you might have with the method?

YES 1 (GO TO 321)
NO 2

320. 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 322)

321. Were you told what to do if you experienced side effects or problems?

YES 1
NO 2

322. CHECK 318 AND 319:

ANY YES: At that time, were you told about other methods of family planning that you could use?

OTHER: When you obtained (CURRENT METHOD FROM 315) from (SOURCE OF METHOD FROM 307 OR 316), were you told about other methods of family planning that you could use?

YES 1 (GO TO 324)
NO 2

323. 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

324. 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 327)
MALE STERILIZATION 02 (GO TO 327)
IUCD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
MALE CONDOM 07
FEMALE CONDOM 08
EMERGENCY CONTRACEPTION 09
LACTATIONAL AMENORRHEA METHOD 10 (GO TO 327)
RHYTHM METHOD 11 (GO TO 327)
WITHDRAWAL 12 (GO TO 327)
OTHER MODERN METHOD 95
OTHER TRADITIONAL METHOD 96 (GO TO 327)

325. 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 11 (GO TO 327)
RURAL HEALTH CENTRE 12 (GO TO 327)
MUNICIPAL CLINIC 13 (GO TO 327)
ZNFPC CLINIC 14 (GO TO 327)
ZNFPC CBD/DEPOT HOLDER 15 (GO TO 327)
VILLAGE HEALTH WORKER 16 (GO TO 327)
MOHCC MOBILE CLINIC 17 (GO TO 327)
OTHER PUBLIC SECTOR (SPECIFY) 18 (GO TO 327)
MISSION HOSPITAL 21 (GO TO 327)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31 (GO TO 327)
PHARMACY 32 (GO TO 327)
PRIVATE DOCTOR 33 (GO TO 327)
CBD 34 (GO TO 327)
PRIVATE OUTREACH CLINIC 35 (GO TO 327)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36 (GO TO 327)
RETAIL
GENERAL DEALER 41 (GO TO 327)
SUPERMARKET 42 (GO TO 327)
TUCK SHOP 43 (GO TO 327)
SERVICE STATION 44 (GO TO 327)
BOTTLE STORE/BAR 45 (GO TO 327)
OTHER RETAIL (SPECIFY) 46 (GO TO 327)
OTHER SOURCE
CHURCH 51 (GO TO 327)
FRIEND/RELATIVE 52 (GO TO 327)
PUBLIC TOILET 53 (GO TO 327)
STREET VENDOR 54 (GO TO 327)
WORKPLACE 55 (GO TO 327)
OTHER (SPECIFY) 96 (GO TO 327)

326. Do you know of a place where you can obtain a method of family planning?

YES 1
NO 2

327. In the last 12 months, were you visited by a fieldworker?

YES 1
NO 2 (GO TO 329)

328. Did the fieldworker talk to you about family planning?

YES 1
NO 2

329. CHECK 202: LIVING CHILDREN?

YES: In the last 12 months, have you visited a health facility for care for yourself or your children?

NO: In the last 12 months, have you visited a health facility for care for yourself?

YES 1
NO 2 (GO TO 401)

330. 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 2010-2015 (GO TO 402)
NO BIRTHS IN 2010-2015 (GO TO 648)

402. CHECK 215: RECORD THE BIRTH HISTORY NUMBER IN 403 AND THE NAME AND SURVIVAL STATUS IN 404. FOR EACH BIRTH IN 2010-2015. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE(S).

IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE(S).

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)
NO 2

406. CHECK 208:

ONLY ONE BIRTH: Did you want to have a baby later on, or did you not want any children?

MORE THAN ONE BIRTH: Did you want to have a baby later on, or did you not want any more children?

LATER 1
NO MORE/NONE 2

407. How much longer did you want to wait?

MONTHS 1 ___
YEARS 2 ___
DON'T KNOW 998

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

YES 1
NO 2 (GO TO 414)

409. Whom did you see? Anyone else?

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

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

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

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
HER 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 G
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) H
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:

a. Was your pressure measured?
YES 1
NO 2
b. Did you give a urine sample?
YES 1
NO 2
c. Did you give a blood sample?
YES 1
NO 2

414. 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 417)
DON'T KNOW 8 (GO TO 417)

415. During this pregnancy, how many times did you get a tetanus injection?

TIMES ___
DON'T KNOW 8

416. CHECK 415: TETANUS INJECTIONS

2 OR MORE TIMES (GO TO 420)
OTHER (GO TO 417)

417. At any time before this pregnancy, did you receive any tetanus injections?

YES 1
NO 2 (GO TO 420)
DON'T KNOW 8 (GO TO 420)

418. Before this pregnancy, how many times did you receive a tetanus injection?

IF 7 OR MORE TIMES, RECORD '7'.

TIMES ___
DON'T KNOW 8

419. How many years ago did you receive the last tetanus injection befoer this pregnancy?

YEARS AGO ___

420. During this pregnancy, were you given or did you buy any iron or folic acid (IFA) tablets?

SHOW TABLETS.

YES 1
NO 2 (GO TO 421A)

421. During the whole pregnancy, for how many days did you take the IFA tablets?

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

DAYS ___
DON'T KNOW 998

421A. During this pregnancy, were you given or did you buy any folate tablets?

SHOW TABLETS.

YES 1
NO 2
DON'T KNOW 8

421B. CHECK 420 AND 421A:

AT LEAST ONE 'YES' (GO TO 421C)
NOT A SINGLE 'YES' (GO TO 422)

421C. Where did you get most of the IFA or folate tablets from?

IF HEALTH FACILITY, ASK: During an antenatal care visit or another visit?

HEALTH FACILITY
ANC VISIT 1
ANOTHER VISIT 2
PHARMACY 3
CHW 4
OTHER (SPECIFY) 6

421D. Did you mainly purchase these tablets or receive free of charge?

PURCHASED 1
FREE 2
DON'T KNOW 8

422. During this pregnancy, did you take any medicine for intestinal worms?

YES 1
NO 2
DON'T KNOW 8

426. When (NAME) was born, was (NAME) very large, larger than average, average, smaller than average, or very small?

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

427. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 429)
DON'T KNOW 8 (GO TO 429)

428. How much did (NAME) weigh?

RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.

KILOGRAM FROM CARD ___
KILOGRAM FROM RECALL ___
DON'T KNOW 99998

429. 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 B
NURSE MIDWIFE C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT C
RELATIVE/FRIEND D
VILLAGE HEALTH WORKER E
OTHER (SPECIFY) X
NO ONE ASSISTED Y

430. 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
HER HOME 11 (GO TO 449)
OTHER HOME 12 (GO TO 449)
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 449)

431. How long after (NAME) was delivered did you stay there?

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

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

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

YES 1
NO 2 (GO TO 434)

433. When was the decision made to have the caesarean section? Was it before or after your labor pains started?

BEFORE 1
AFTER 2

434. Immediately after the birth, was (NAME) put directly on the bare skin of your chest?

YES 1
NO 2
DON'T KNOW 8

435. I would like to talk to you about check son your health after delivery, for example, someone asking you question about your health or examining you. Did anyone check on your health while you were still in the facility?

YES 1
NO 2 (GO TO 438)

436. 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

437. Who checked on your health at that time?

PROBE FOR MOST QUALIFIED PERSON.

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

438. Now I would like to talk to you about checks on (NAME)'s health after delivery - for example, someone examining (NAME), checking the cord, or seeing if (NAME) is OK. Did anyone check on (NAME)'s health while you were still in the facility?

YES 1
NO 2 (GO TO 441)
DON'T KNOW 8 (GO TO 441)

439. How long after delivery was (NAME)'s health first checked?

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

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

440. Who check on (NAME)'s health at that time?

PROBE FOR MOST QUALIFIED PERSON.

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

441. Now I want to talk to you about what happened after you left the facility. Did anyone check on your health after you left the facility?

YES 1
NO 2 (GO TO 445)

442. How long after delivery did that 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

443. Who checked on your health at that time?

PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR 1
NURSE 12
NURSE MIDWIFE 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
VILLAGE HEALTH WORKER 22
OTHER (SPECIFY) 96

444. Where did the check take 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 ___
HOME
HER 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 (SPECIFY) 46
OTHER (SPECIFY) 96

445. I would like to talk to you about checks on (NAME)'s health after you left (FACILITY IN 430). Did any health care provider or a traditional birth attendant check on (NAME)'s health in the two months after you left (FACILITY IN 430)?

YES 1
NO 2 (GO TO 457)
DON'T KNOW 8 (GO TO 457)

446. How many hours, days or weeks after the birth of (NAME) did that 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

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

PROBE FOR MOST QUALIFIED PERSON.

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

448. Where did this check of (NAME) take 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 ___
HOME
HER HOME 11 (GO TO 457)
OTHER HOME 12 (GO TO 457)
PUBLIC SECTOR
CENTRAL HOSPITAL 21 (GO TO 457)
PROVINCIAL HOSPITAL 22 (GO TO 457)
DISTRICT HOSPITAL 23 (GO TO 457)
RURAL HOSPITAL 24 (GO TO 457)
URBAN MUNICIPAL CLINIC 25 (GO TO 457)
RURAL HEALTH CENTRE 26 (GO TO 457)
OTHER PUBLIC SECTOR (SPECIFY) 27 (GO TO 457)
MISSION HOSPITAL/CLINIC 31 (GO TO 457)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 41 (GO TO 457)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 46 (GO TO 457)
OTHER (SPECIFY) 96 (GO TO 457)

449. I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health after you gave birth to (NAME)?

YES 1
NO 2 (GO TO 453)

450. 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 ___
WEEK 3 ___
DON'T KNOW 998

451. Who checked on your health at that time?

PROBE FOR MOST QUALIFIED PERSON.

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

452. Where did this first check take 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 ___
HOME
HER HOME 11 (GO TO 449)
OTHER HOME 12 (GO TO 449)
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

453. I would like to talk to you about checks on (NAME)'s health after delivery - for example, someone examining (NAME), check the cord, or seeing if (NAME) is OK. In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on (NAME)'s health?

YES 1
NO 2 (GO TO 457)
DON'T KNOW 8 (GO TO 457)

454. 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

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

PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL

DOCTOR 11
NURSE 12
NURSE MIDWIFE 13

OTHER PERSON

TRADITIONAL BIRTH ATTENDANT 21
VILLAGE HEALTH WORKER 22

OTHER (SPECIFY) 96

456. Where did this first check of (NAME) take 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 ___
HOME
HER HOME 11 (GO TO 449)
OTHER HOME 12 (GO TO 449)
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

457. During the first two days after (NAME)'s birth, did any health care provider do the following:

a. Examine the cord?
YES 1
NO 2
DON'T KNOW 8
b. Measure (NAME)'s temperature?
YES 1
NO 2
DON'T KNOW 8
c. Counsel you on danger signs for newborns?
YES 1
NO 2
DON'T KNOW 8
d. Counsel you on breastfeeding?
YES 1
NO 2
DON'T KNOW 8
e. Observe (NAME) breastfeeding?
YES 1
NO 2
DON'T KNOW 8

458. Has your menstrual period returned since the birth of (NAME)?

YES 1 (GO TO 460)
NO 2 (GO TO 461)

459. Did your period return between the birth of (NAME) and your next pregnancy?

YES 1
NO 2 (GO TO 463)

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

MONTHS ___
DON'T KNOW 98

461. CHECK 226: IS RESPONDENT PREGNANT?

NOT PREGNANT (GO TO 462)
PREGNANT OR UNSURE (GO TO 463)

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

YES 1
NO 2 (GO TO 464)

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

MONTHS ___
DON'T KNOW 98

464. Did you ever breastfeed (NAME)?

YES 1 (GO TO 466)
NO 2

465. CHECK 404: IF CHILD LIVING?

LIVING (GO TO 470)
DEAD (GO TO 471)

466. How long after the 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 ___

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

YES 1
NO 2

468. CHECK 404: IS CHILD LIVING?

LIVING (GO TO 469)
DEAD (GO TO 471)

469. Are you still breastfeeding (NAME)?

YES 1
NO 2

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

YES 1
NO 2
DON'T KNOW 8

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

SECTION 5A. CHILD IMMUNIZATION (LAST BIRTH)

501A. CHECK 215 IN THE BIRTH HISTORY: ANY BIRTHS IN 2012-2015?

ONE OR MORE BIRTHS IN 2012-2015 (GO TO 502A)
NO BIRTHS IN 2012-2015 (GO TO 601)

502A. RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 212 OF THE LAST CHILD BORN IN 2012-2015.

NAME OF LAST BIRTH ___
BIRTH HISTORY NUMBER ___

503A. CHECK 216 FOR CHILD:

LIVING (GO TO 504A)
DEAD (GO TO 501B)

504A. Do you have a child health card or other document where (NAME)'s vaccination are written down?

YES, HAS ONLY A CARD 1 (GO TO 507A)
YES, HAS ONLY AN OTHER DOCUMENT 2
YES, HAS CARD AND OTHER DOCUMENT 3 (GO TO 507A)
NO, NO CARD AND NO OTHER DOCUMENT 4

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

YES 1
NO 2

506A. CHECK 504A:

CODE '2' CIRCLED (GO TO 507A)
CODE '4' CIRCLED (GO TO 511A)

507A. May I see the card or other document where (NAME)'s vaccinations are written down?

YES, ONLY CARD SEEN 1
YES, ONLY OTHER DOCUMENT SEEN 2
YES, CARD AND OTHER DOCUMENT SEEN 3
NO CARD AND NO OTHER DOCUMENT 4 (GO TO 511A)

508A. COPY DATES FROM THE CARD.

WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED

BCG
DAY
MONTH
YEAR
ORAL POLIO VACCINE (OPV) 0 (BIRTH DOSE)
DAY
MONTH
YEAR
ORAL POLIO VACCINE (OPV) 1
DAY
MONTH
YEAR
ORAL POLIO VACCINE (OPV) 2
DAY
MONTH
YEAR
ORAL POLIO VACCINE (OPV) 3
DAY
MONTH
YEAR
DPT-HEPB-HIB (PENTAVALENT) 1
DAY
MONTH
YEAR
DPT-HEPB-HIB (PENTAVALENT) 2
DAY
MONTH
YEAR
DPT-HEPB-HIB (PENTAVALENT) 3
DAY
MONTH
YEAR
PNEUMOCOCCAL 1
DAY
MONTH
YEAR
PNEUMOCOCCAL 2
DAY
MONTH
YEAR
PNEUMOCOCCAL 3
DAY
MONTH
YEAR
ROTAVIRUS 1
DAY
MONTH
YEAR
ROTAVIRUS 2
DAY
MONTH
YEAR
MEASLES
DAY
MONTH
YEAR
VITAMIN 1 (MOST RECENT)
DAY
MONTH
YEAR

509A. CHECK 508A:

'BCG' TO 'MEASLES' ALL RECORDED?

NO (GO TO 510A)
YES (GO TO 526A)

510A. In addition to what is recorded on (this document/these documents), did (NAME) receive any other vaccinations, including vaccinations received in campaigns or immunization days or child health days?

RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 507A THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY THEN GO TO 526A)
NO 2 (GO TO 526A)
DON'T KNOW 8 (GO TO 526A)

511A. Did (NAME) ever receive any vaccinations to prevent (NAME) from getting diseases, including vaccinations received in campaigns or immunization days or child health days?

YES 1
NO 2 (GO TO 526A)
DON'T KNOW 8 (GO TO 526A)

512A. Has (NAME) ever received a BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

YES 1
NO 2
DON'T KNOW 8

514A. Has (NAME) ever received oral polio vaccine, that is, about two drops in the mouth to prevent polio?

YES 1
NO 2 (GO TO 517A)
DON'T KNOW 8 (GO TO 517A)

515A. Did (NAME) receive the first oral polio vaccine in the first two weeks after birth or later?

FIRST TWO WEEKS 1
LATER 2

516A. How many times did (NAME) receive the oral polio vaccine?

NUMBER OF TIMES ___

517A. Has (NAME) ever received a pentavalent vaccination, that is, an injection given in the thigh sometimes at the same time as polio drops?

YES 1
NO 2 (GO TO 519A)
DON'T KNOW 8 (GO TO 519A)

518A. How many times did (NAME) receive the pentavalent vaccine?

NUMBER OF TIMES ___

519A. Has (NAME) ever received a pneumococcal vaccination, that is, an injection in the thigh to prevent pneumonia?

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

520A. How many times did (NAME) receive the pneumococcal vaccine?

NUMBER OF TIMES ___

521A. Has (NAME) ever received a rotavirus vaccination, that is, liquid in the mouth to prevent diarrhea?

YES 1
NO 2 (GO TO 523A)
DON'T KNOW 8 (GO TO 523A)

522A. How many times did (NAME) receive the rotavirus vaccine?

NUMBER ___

523A. Has (NAME) ever received a measles vaccination, that is, an injection in the arm to prevent measles?

YES 1
NO 2 (GO TO 526A)
DON'T KNOW 8 (GO TO 526A)

524A. How many times did (NAME) receive the measles vaccine?

NUMBER OF TIMES ___

526A. CONTINUE WITH 501B.

SECTION 5B. CHILD IMMUNIZATION (NEXT-TO-LAST BIRTH)

501B. CHECK 215 IN THE BIRTH HISTORY: ANY MORE BIRTHS IN 2012-2015?

MORE BIRTHS IN 2012-2015 (GO TO 502B)
NO MORE BIRTHS IN 2012-2015 (GO TO 601)

502B. RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 212 OF THE NEXT-TO-LAST CHILD BORN IN 2012-2015.

NAME OF NEXT-TO-LAST BIRTH ___
BIRTH HISTORY NUMBER ___

503B. CHECK 216 FOR CHILD:

LIVING (GO TO 504B)
DEAD (GO TO 526B)

504B. Do you have a card or other document where (NAME)'s vaccinations are written down?

YES, HAS ONLY A CARD 1 (GO TO 507B)
YES, HAS ONLY AN OTHER DOCUMENT 2
YES, HAS CARD AND OTHER DOCUMENT 3 (GO TO 507B)
NO, NO CARD AND NO OTHER DOCUMENT 4

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

YES 1
NO 2

506B. CHECK 504B:

CODE '2' CIRCLED (GO TO 507B)
CODE '4' CIRCLED (GO TO 511B)

507B. May I see the card or other document where (NAME)'s vaccinations are written down?

YES, ONLY CARD SEEN 1
YES, ONLY OTHER DOCUMENT SEEN 2
YES, CARD AND OTHER DOCUMENT SEEN 3
NO CARD AND NO OTHER DOCUMENT 4 (GO TO 511B)

508B. COPY DATES FROM THE CARD.

WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED

BCG
DAY
MONTH
YEAR
ORAL POLIO VACCINE (OPV) 0 (BIRTH DOSE)
DAY
MONTH
YEAR
ORAL POLIO VACCINE (OPV) 1
DAY
MONTH
YEAR
ORAL POLIO VACCINE (OPV) 2
DAY
MONTH
YEAR
ORAL POLIO VACCINE (OPV) 3
DAY
MONTH
YEAR
DPT-HEPB-HIB (PENTAVALENT) 1
DAY
MONTH
YEAR
DPT-HEPB-HIB (PENTAVALENT) 2
DAY
MONTH
YEAR
DPT-HEPB-HIB (PENTAVALENT) 3
DAY
MONTH
YEAR
PNEUMOCOCCAL 1
DAY
MONTH
YEAR
PNEUMOCOCCAL 2
DAY
MONTH
YEAR
PNEUMOCOCCAL 3
DAY
MONTH
YEAR
ROTAVIRUS 1
DAY
MONTH
YEAR
ROTAVIRUS 2
DAY
MONTH
YEAR
MEASLES
DAY
MONTH
YEAR
VITAMIN 1 (MOST RECENT)
DAY
MONTH
YEAR

509B. CHECK 508B:

'BCG' TO 'MEASLES' ALL RECORDED?

NO (GO TO 510B)
YES (GO TO 526B)

510B. In addition to what is recorded on (this document/these documents), did (NAME) receive any other vaccinations, including vaccinations received in campaigns or immunization days or child health days?

RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 507B THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY THEN GO TO 524B)
NO 2 (GO TO 526B)
DON'T KNOW 8 (GO TO 526B)

511B. Did (NAME) ever receive any vaccinations to prevent (NAME) from getting diseases, including vaccinations received in campaigns or immunization days or child health days?

YES 1
NO 2 (GO TO 526B)
DON'T KNOW 8 (GO TO 526B)

512B. Has (NAME) ever received a BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

YES 1
NO 2
DON'T KNOW 8

514B. Has (NAME) ever received oral polio vaccine, that is, about two drops in the mouth to prevent polio?

YES 1
NO 2 (GO TO 517B)
DON'T KNOW 8 (GO TO 517B)

515B. Did (NAME) receive the first oral polio vaccine in the first two weeks after birth or later?

FIRST TWO WEEKS 1
LATER 2

516B. How many times did (NAME) receive the oral polio vaccine?

NUMBER OF TIMES ___

517B. Has (NAME) ever received a pentavalent vaccination, that is, an injection given in the thigh sometimes at the same time as polio drops?

YES 1
NO 2 (GO TO 519B)
DON'T KNOW 8 (GO TO 519B)

518B. How many times did (NAME) receive the pentavalent vaccine?

NUMBER OF TIMES ___

519B. Has (NAME) ever received a pneumococcal vaccination, that is, an injection in the thigh to prevent pneumonia?

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

520B. How many times did (NAME) receive the pneumococcal vaccine?

NUMBER OF TIMES ___

521B. Has (NAME) ever received a rotavirus vaccination, that is, liquid in the mouth to prevent diarrhea?

YES 1
NO 2 (GO TO 523B)
DON'T KNOW 8 (GO TO 523B)

522B. How many times did (NAME) receive the rotavirus vaccine?

NUMBER ___

523B. Has (NAME) ever received a measles vaccination, that is, an injection in the arm to prevent measles?

YES 1
NO 2 (GO TO 526B)
DON'T KNOW 8 (GO TO 526B)

524B. How many times did (NAME) receive the measles vaccine?

NUMBER OF TIMES ___

526B. CHECK 215 IN BIRTH HISTORY: ANY MORE BIRTHS IN 2012-2015?

MORE BIRTHS IN 2012-2015 (GO TO 502B IN AN ADDITIONAL QUESTIONNAIRE)
NO MORE BIRTHS IN 2012-2015 (GO TO 601)

SECTION 6. CHILD HEALTH AND NUTRITION

601. CHECK 224:

ONE OR MORE BIRTHS IN 2010-2015 (GO TO 602)
NO BIRTHS IN 2010-2015 (GO TO 648)

602. CHECK 215: RECORD THE BIRTH HISTORY NUMBER IN 603 AND THE NAME AND SURVIVAL STATUS IN 604 FOR EACH BIRTH IN 2010-2015. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.

IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE(S).

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

603. BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY.

BIRTH HISTORY NUMBER ___

604. FROM 212 AND 216.

NAME ___
LIVING ___
DEAD ___ (GO TO 646)

605. In 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

607. Was (NAME) given any medicine for intestinal worms in the last six months?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 618)
DON'T KNOW 8 (GO TO 618)

609. CHECK 464: EVER BREASTFED?

YES: Now I would like to know how much (NAME) was given to drink during the diarrhea including breastmilk. Was (NAME) given less than usual to drink, about the same amount, or more than usual to drink?

IF LESS, PROBE: Was (NAME) given much less than usual to drink or somewhat less?

NO: Now I would like to know how much (NAME) was given to drink during the diarrhea. Was (NAME) given less than usual to drink, about the same amount, or more than usual to drink?

IF LESS, PROBE: Was (NAME) 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

610. When (NAME) had diarrhea, was (NAME) given less than usual to eat, about the same amount, more than usual, or nothing to eat?

IF LESS, PROBE: Was (NAME) 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

611. Did you seek advice or treatment for the diarrhea from any source?

YES 1
NO 2 (GO TO 615)

612. Where did you seek advice or treatment? Anywhere else?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

NAME OF PLACE(S) ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
RURAL HEALTH CENTER B
MUNICIPAL CLINIC C
ZNFPC CLINIC D
ZNFPC CBD/DEPOT HOLDER E
VILLAGE HEALTH WORKER F
MOHCC MOBILE CLINIC G
OTHER PUBLIC SECTOR (SPECIFY) H
MISSION HOSPITAL I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC J
PHARMACY K
PRIVATE DOCTOR L
CBD M
PRIVATE OUTREACH CLINIC N
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) O
RETAIL
GENERAL DEALER P
SUPERMARKET Q
TUCK SHOP R
SERVICE STATION S
BOTTLE STORE/BAR T
OTHER RETAIL (SPECIFY) U
OTHER SOURCE
CHURCH V
FRIEND/RELATIVE W
OTHER (SPECIFY) X

613. CHECK 612:

TWO OR MORE CODES CIRCLED (GO TO 614)
ONLY ONE CODE CIRCLED (GO TO 615)

614. Where did you first seek advice or treatment?

USE LETTER CODE FROM 612.

FIRST PLACE ___

615. Was (NAME) given any of the following at any time since (NAME) started having the diarrhea:

a. A fluid made from a special packet called an ORS sachet?
YES 1
NO 2
DON'T KNOW 8
b. A pre-packaged ORS liquid?
YES 1
NO 2
DON'T KNOW 8
c. A homemade sugar-salt-water solution (SSS)?
YES 1
NO 2
DON'T KNOW 8
d. Zinc tablets or syrup?
YES 1
NO 2
DON'T KNOW 8

616. CHECK 615:

ANY 'YES': Was anything else given to treat the diarrhea?

ALL 'NO' OR 'DK': Was anything given to treat the diarrhea?

YES 1
NO 2 (GO TO 618)
DON'T KNOW 8 (GO TO 618)

617. CHECK 615:

ANY 'YES': What else was given to treat the diarrhea? Anything else?

ALL 'NO' OR 'DK': What was given to treat the diarrhea?

RECORD ALL TREATMENTS

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

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

YES 1
NO 2 (GO TO 620)
DON'T KNOW 8 (GO TO 620)

619. At any time during the illness, did (NAME) have blood taken from (NAME)'s finger or heel for testing?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

621. Has (NAME) had fast, short, rapid, breaths or difficulty breathing at any time in the last 2 weeks?

YES 1
NO 2 (GO TO 623)
DON'T KNOW 8 (GO TO 623)

622. 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 624)
NOSE ONLY 2 (GO TO 624)
BOTH 3 (GO TO 624)
OTHER (SPECIFY) 6 (GO TO 624)
DON'T KNOW 8 (GO TO 624)

623. CHECK 618: HAD FEVER?

YES (GO TO 624)
NO OR DK (GO TO 646)

624. Did you seek advice or treatment for the illness from any source?

YES 1
NO 2 (GO TO 629)

625. Where did you seek advice or treatment? Anywhere else?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IN UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME FO THE PLACE(S).

NAME OF PLACE(S) ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
RURAL HEALTH CENTER B
MUNICIPAL CLINIC C
ZNFPC CLINIC D
ZNFPC CBD/DEPOT HOLDER E
VILLAGE HEALTH WORKER F
MOHCC MOBILE CLINIC G
OTHER PUBLIC SECTOR (SPECIFY) H
MISSION HOSPITAL I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC J
PHARMACY K
PRIVATE DOCTOR L
CBD M
PRIVATE OUTREACH CLINIC N
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) O
RETAIL
GENERAL DEALER P
SUPERMARKET Q
TUCK SHOP R
SERVICE STATION S
BOTTLE STORE/BAR T
OTHER RETAIL (SPECIFY) U
OTHER SOURCE
CHURCH V
FRIEND/RELATIVE W
OTHER (SPECIFY) X

626. CHECK 625:

TWO OR MORE CODES CIRCLED (GO TO 627)
ONLY ONE CODE CIRCLED (GO TO 628)

627. Where did you first seek advice or treatment?

USE LETTER CODE FROM 625.

FIRST PLACE ___

628. How many days after the illness began did you first seek advice or treatment for (NAME)?

IF SAME DAY RECORD '00'.

DAYS ___

629. At any time during the illness, did (NAME) take any medicines for the illness?

YES 1
NO 2 (GO TO 646)
DON'T KNOW 8 (GO TO 646)

630. What medicines did (NAME) take? Any other medicines?

RECORD ALL MENTIONED.

ANTIMALARIAL DURGS
ARTESUNATE AND LUMAFANTRINE (AL) A
ARTESUNATE AND AMODIAQUINE (ASAQ) B
QUININE PILLS WITH DOXYCYCLINE C
INJECTION/IV D
ARTESUNATE RECTAL INJECTION/IV F
OTHER ANTIMALARIAL (SPECIFY) G
ANTIBIOTIC DRUGS
PILL/SYRUP H
INJECTION/IV I
OTHER DRUGS
ASPIRIN J
ACETAMINOPHEN K
IBUPROFEN L
OTHER (SPECIFY) X
DON'T KNOW Z

631. CHECK 630:

ANY CODE A-G CIRCLED?

YES (GO TO 632)
NO (GO TO 646)

632. CHECK 630:

ARTESUNATE AND LUMAFANTRINE ('A') GIVEN?

CODE 'A' CIRCLED (GO TO 633)
CODE 'A' NOT CIRCLED (GO TO 634)

633. How long after the fever started did (NAME) first take artesunate and lumafantrine (AL)?

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

634. CHECK 630: ARTESUNATE AND AMODIAQUINE ('B') GIVEN?

CODE 'B' CIRCLED (GO TO 635)
CODE 'B' NOT CIRCLED (GO TO 636)

635. How long after the fever started did (NAME) first take artesunate and amodiaquine (ASAQ)?

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

638. CHECK 630: QUININE INJECTION OR QUININE PILLS WITH DOXYCYCLINE ('C' OR 'D') GIVEN?

CODE 'C' OR 'D' CIRCLED (GO TO 639)
CODE 'C' OR 'D' NOT CIRCLED (GO TO 640)

639. 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

640. CHECK 630: ARTESUNATE ('E' OR 'F') GIVEN?

CODE 'E' OR 'F' CIRCLED (GO TO 641)
CODE 'E' OR 'F' NO CIRCLED (GO TO 642)

641. How long after the fever started did (NAME) first take artesunate?

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

642. CHECK 630: OTHER ANTIMALARIAL ('G') GIVEN?

CODE 'G' CIRCLED (GO TO 643)
CODE 'G' NOT CIRCLED (GO TO 644)

643. 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

646. GO BACK TO 604 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 647.

647. CHECK 615(A) AND 615(B), ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID (GO TO 648)
ANY CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID (GO TO 649)

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

YES 1
NO 2

649. CHECK 215 AND 218, ALL ROWS: NUMBER OF CHILDREN BORN IN 2013-2015 LIVING WITH RESPONDENT

ONE OR MORE:

NAME OF YOUNGEST CHILD LIVING WITH HER ___ (GO TO 650)
NONE (GO TO 701)

650. Now I would like to ask you about liquids or foods that (NAME FROM 649) 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 649) drink or 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. Clear broth?
YES 1
NO 2
DON'T KNOW 8
d. Milk such as tinned, powdered, or fresh animal milk?

IF YES: How many times did (NAME) drink milk?

IF 7 OR MORE TIMES, RECORD '7'.

YES 1
NO 2
DON'T KNOW 8

NUMBER OF TIMES DRANK MILK ___
e. Infant formula?

IF YES: How many times did (NAME) drink infant formula?

IF 7 OR MORE TIMES, RECORD '7'.

YES 1
NO 2
DON'T KNOW 8

NUMBER OF TIMES DRANK ___
f. Any other liquids, freezes, fizzy drinks or maheu?
YES 1
NO 2
DON'T KNOW 8
g. Yogurt or lacto/sourmilk?

IF YES: How many times did (NAME) eat yogurt or lacto/sourmilk?

IF 7 OR MORE TIMES, RECORD '7'.

YES 1
NO 2
DON'T KNOW 8

NUMBER OF TIMES ATE ___
h. Any Cerelac, 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 or canned fish or matemba?
YES 1
NO 2
DON'T KNOW 8
s. Any foods made from beans, 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 haruwa, 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

651. CHECK 650 (CATEGORIES 'G' THROUGH 'V'):

NOT A SINGLE 'YES' (GO TO 652)
AT LEAST ONE 'YES' (GO TO 653)

652. Did (NAME FROM 649) 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 650 TO RECORD FOOD EATEN) (GO TO 653)
NO 2 (GO TO 654)

653. How many times did (NAME FROM 649) 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

654. The last time (NAME FROM 649) 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

SECTION 7. MARRIAGE AND SEXUAL ACTIVITY

701. Are you currently married or living together with a man as if married?

YES, CURRENTLY MARRIED 1 (GO TO 704)
YES, LIVING WITH A MAN 2 (GO TO 704)
NO, NOT IN UNION 3

702. 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 712)

703. What is your marital status now: are you widowed, divorced, or separated?

WIDOWED 1 (GO TO 709)
DIVORCED 2 (GO TO 709)
SEPARATED 3 (GO TO 709)

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

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

NAME ___
LINE NUMBER ___

706. Does your (husband/partner) have other wives or does he live with other women as if married?

YES 1
NO 2 (GO TO 709)
DON'T KNOW 8 (GO TO 709)

707. 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

708. Are you the first, second ... wife?

RANK ___

709. Have you been married or lived with a man only once or more than once?

ONLY ONCE 1
MORE THAN ONCE 2

710. CHECK 709:

MARRIED/LIVED WITH A MAN ONLY ONCE: In what month and year did you start living with your (husband/partner)?

MARRIED/LIVED WITH A MAN MORE THAN ONCE: Now I would like to ask about your first (husband/partner). In what month and year did you start living with him?

MONTH ___
DON'T KNOW 98
YEAR ___ (GO TO 712)
DON'T KNOW YEAR 9998

711. How old were you when you first started living with him?

AGE ___

712. CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

713. Now I would like to ask some questions about sexual activity in order to gain a better understanding of some important life issues. 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. How old were you when you had sexual intercourse for the very first time?

NEVER HAD SEXUAL INTERCOURSE 00 (GO TO 730A)
AGE IN YEARS ___

714. I would like to ask you about your recent sexual activity. 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 ___ (GO TO 716)
WEEKS AGO 2 ___ (GO TO 716)
MONTHS AGO 3 ___ (GO TO 716)
YEARS AGO 4 ___ (GO TO 727)
DON'T KNOW 8 (GO TO 727)

715. When was the last time you had sexual intercourse with this person?

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

716. The last time you sexual intercourse with this person, was a condom used?

YES 1
NO 2 (GO TO 718)

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

YES 1
NO 2

718. What was your relationship to this person with whom you had sexual intercourse?

IF BOYFRIEND: Were you living together as if married?

IF YES, RECORD '2'.

HUSBAND 1
LIVE-IN PARTNER 2
BOYFRIEND NOT LIVING WITH RESPONDENT 3
CASUAL ACQUAINTANCE 4
CLIENT/SEX WORKER 5
OTHER (SPECIFY) 6

719. How long ago did you first have sexual intercourse with this person?

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

720. 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, RECORD '95'.

NUMBER OF TIMES ___

721. How old is this person?

AGE OF PARTNER ___
DON'T KNOW 98

721A. The last time you had sexual intercourse with this person, did you or this person drink alcohol?

YES 1
NO 2 (GO TO 722)
DON'T KNOW 8 (GO TO 722)

721B. Were you or your partner drunk at that time?

IF YES: Who was drunk?

RESPONDENT ONLY 1
PARTNER ONLY 2
BOTH, RESPONDENT AND PARTNER 3
NEITHER 4

722. Apart from this person, have you had sexual intercourse with any other person in the last 12 months?

YES 1 (GO BACK TO 715 IN NEXT COLUMN)
NO 2 (GO TO 725)

723. In total, with how many different 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, RECORD '95'.

NUMBER OF PARTNERS LAST 12 MONTHS ___
DON'T KNOW 98

724. CHECK 106:

AGE 15-24 (GO TO 725)
AGE 25-49 (GO TO 727)

725. CHECK 701:

NOT IN UNION (GO TO 726)
CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 727)

726. In the past 12 months have you had sex or been sexually involved with anyone because he gave you or told you he would give you gifts, cash, or anything else?

YES 1
NO 2

727. In total, with how many different 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, RECORD '95'.

NUMBER OF PARTNERS IN LIFETIME ___
DON'T KNOW 98

728. CHECK 717, MOST RECENT PARTNER (FIRST COLUMN)

YES, CONDOM USED (GO TO 729)
NO, CONDOM NOT USED (GO TO 730A)
NOT ASKED (GO TO 730A)

729. You told me that a condom was used the last time you had sex. What is the brand name of the condom used at that time?

IF BRAND NOT KNOWN, ASK TO SEE THE PACKAGE.

PROTECTOR PLUS 01
PANTHER (PUBLIC SECTOR) 02
CAREX CHOICE ASSORTED 03
DUREX 04
VIBE 05
ECSTASY 06
CASANOVA 07
MOODS 08
OTHER (SPECIFY) 96
DON'T KNOW 98

730. From where did you obtain the condom the last time?

PROBE TO IDENTIFY TYPE OF SOURCE.

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

NAME OF PLACE ___
PUBLIC SECTOR
GOVERNMENT HOPITAL/CLINIC 11 (GO TO 730B)
RURAL HEALTH CENTRE 12 (GO TO 730B)
MUNICIPAL CLNIC 13 (GO TO 730B)
ZNFPC CLINIC 14 (GO TO 730B)
ZNFPC CBD/DEPOT HOLDER 15 (GO TO 730B)
VILAGE HEALTH WORKER 16 (GO TO 730B)
MOHCC MOBILE CLINIC 17 (GO TO 730B)
OTHER PUBLIC SECTOR (SPECIFY) 18 (GO TO 730B)
MISSION HOSPITAL/CLINIC 21 (GO TO 730B)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31 (GO TO 730B)
PHARMACY 32 (GO TO 730B)
PRIVATE DOCTOR 33 (GO TO 730B)
CBD 34 (GO TO 730B)
PRIVATE OUTREACH CLINIC 35 (GO TO 730B)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36 (GO TO 730B)
RETAIL OUTLET
GENERAL DEALER 41 (GO TO 730B)
SUPERMARKET/TUCK SHOP 42 (GO TO 730B)
SERVICE STATION 43 (GO TO 730B)
BOTTLE STORE/BAR 44 (GO TO 730B)
OTHER SOURCE
CHURCH 51 (GO TO 730B)
FRIEND/RELATIVE 52 (GO TO 730B)
PUBLIC TOILET 53 (GO TO 730B)
STREET VENDOR 54 (GO TO 730B)
WORKPLACE 55 (GO TO 730B)
OTHER (SPECIFY) 96 (GO TO 730B)
DON'T KNOW 98

730A. Do you know of a place where a person can get male condoms?

YES 1
NO 2 (GO TO 730D)

730B. CHECK 731A:

NOT ASKED: Do you know of any other places where a person can get a male condom?

ASKED, YES: Where is that? Any other place?

PROBE TO IDENTIFY 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 A
RURAL HEALTH CENTRE B
MUNICIPAL CLINIC C
ZNFPC CLINIC D
ZNFPC CBD/DEPOT HOLDER E
VILLAGE HEALTH WORKER F
MOHCC MOBILE CLINIC G
OTHER PUBLIC SECTOR (SPECIFY) H
MISSION HOSPITAL/CLINIC I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC J
PHARMACY K
PRIVATE DOCTOR L
CBD M
PRIVATE OUTREACH CLINIC N
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) O
RETAIL OUTLET
GENERAL DEALER P
SUPERMARKET/TUCK SHOP Q
SERVICE STATION R
BOTTLE STORE/BAR S
OTHER SOURCE
CHURCH T
FRIEND/RELATIVE U
PUBLIC TOILET V
STREET VENDOR W
WORKPLACE X
OTHER (SPECIFY) Y

730C. If you wanted to, could you yourself get a condom?

YES 1
NO 2
DON'T KNOW 8

730D. Do you know of a place where a person can get female condoms?

YES 1
NO 2 (GO TO 731)

730E. Where is that? Any other place?

PROBE TO IDENTIFY 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 A
RURAL HEALTH CENTRE B
MUNICIPAL CLINIC C
ZNFPC CLINIC D
ZNFPC CBD/DEPOT HOLDER E
VILLAGE HEALTH WORKER F
MOHCC MOBILE CLINIC G
OTHER PUBLIC SECTOR (SPECIFY) H
MISSION HOSPITAL/CLINIC I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC J
PHARMACY K
PRIVATE DOCTOR L
CBD M
PRIVATE OUTREACH CLINIC N
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) O
RETAIL OUTLET
GENERAL DEALER P
SUPERMARKET/TUCK SHOP Q
SERVICE STATION R
BOTTLE STORE/BAR S
OTHER SOURCE
CHURCH T
FRIEND/RELATIVE U
PUBLIC TOILET V
STREET VENDOR W
WORKPLACE X
OTHER (SPECIFY) Y

730F. If you wanted to, could you yourself get a female condom?

YES 1
NO 2
DON'T KNOW 8

731. PRESENCE OF OTHER DURING THIS SECTION.

CHILDREN UNDER 10?
YES 1
NO 2
MALE ADULTS?
YES 1
NO 2
FEMALE ADULTS?
YES 1
NO 2

SECTION 8. FERTILITY PREFERENCES

801. CHECK 304:

NEITHER STERILIZED (GO TO 802)
HE OR SHE STERILIZED (GO TO 813)

802. CHECK 226:

PREGNANT (GO TO 803)
NOT PREGNANT OR UNSURE (GO TO 804)

803. 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 805)
NO MORE 2 (GO TO 812)
UNDECIDED/DON'T KNOW 8 (GO TO 812)

804. 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 807)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 813)
UNDECIDED/DON'T KNOW 8 (GO TO 811)

805. 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 811)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 813)
AFTER MARRIAGE 995 (GO TO 811)
OTHER (SPECIFY) 996 (GO TO 811)
DON'T KNOW 998 (GO TO 811)

806. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 807)
PREGNANT (GO TO 812)

807. CHECK 303: USING A CONTRACEPTIVE

NOT CURRENTLY USING (GO TO 808)
CURRENTLY USING (GO TO 813)

808. CHECK 806:

'24' OR MORE MONTHS OR '02' OR MORE YEARS (GO TO 809)
NOT ASKED (GO TO 809)
'00-23' MONTHS OR '00-01' YEAR (GO TO 812)

809. CHECK 715:

DAYS, WEEKS OR MONTHS AGO (GO TO 810)
YEARS AGO (GO TO 811)
NOT ASKED (GO TO 811)

810. CHECK 804:

WANTS TO HAVE A/ANOTHER CHILD: You have 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?

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 HAVE 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

811. CHECK 303: USING A CONTRACEPTIVE

NOT ASKED (GO TO 812)
NO, NOT CURRENTLY USING (GO TO 812)
YES, CURRENTLY USING (GO TO 813)

812. 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

813. CHECK 216:

HAS LIVING CHILDREN: If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?

NO LIVING CHILDREN: If you could choose exactly the number of children to have in your whole life, how many would that be?

PROBE FOR A NUMERIC RESPONSE.

NONE 00 (GO TO 815)
NUMBER ___
OTHER (SPECIFY) 96 (GO TO 815)

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

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

815. In the last few months have you:

a. Heard about family planning on the radio?
YES 1
NO 2
b. Seen anything about family planning on the television?
YES 1
NO 2
c. Read about family planning in a newspaper or magazine?
YES 1
NO 2
d. Received a voice or text message about family planning on a mobile phone?
YES 1
NO 2
e. Received pamphlets or posters on family planning?
YES 1
NO 2

816. How would you prefer to get information on family planning?

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

RADIO 1
TELEVISION 2
PRINT 3
SPEAKING WITH SOMEONE 4
MOBILE PHONE 5
DON'T KNOW 8

817. CHECK 701:

YES, CURRENTLY MARRIED (GO TO 818)
YES, LIVING WITH A MAN (GO TO 818)
NO, NOT IN A UNION (GO TO 901)

818. CHECK 303: USING CONTRACEPTIVE

CURRENTLY USING (GO TO 819)
NOT CURRENTLY USING (GO TO 820)
NOT ASKED (GO TO 822)

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

MAINLY RESPONDENT 1 (GO TO 821)
MAINLY HUSBAND/PARTNER 2 (GO TO 821)
JOINT DECISION 3 (GO TO 821)
OTHER (SPECIFY) 6 (GO TO 821)

820. Would you say that not using 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

821. CHECK 304:

NEITHER ARE STERILIZED (GO TO 822)
HE OR SHE ARE STERILIZED (GO TO 901)

822. 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 9. HUSBAND'S BACKGROUND AND WOMAN'S WORK

901. CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 902)
NOT IN UNION (GO TO 909)

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

AGE IN COMPLETED YEARS ___

903. Did your (husband/partner) ever attend school?

YES 1
NO 2 (GO TO 906)

904. 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 906)

905. What was the highest (GRADE/FORM/YEAR) he completed at that level?

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

GRADE/FORM/YEAR ___
DON'T KNOW 98

906. Has your (husband/partner) done any work in the last 7 days?

YES 1 (GO TO 908)
NO 2
DON'T KNOW 8

907. Has your (husband/partner done any work in the last 12 months?

YES 1
NO 2 (GO TO 909)
DON'T KNOW 8 (GO TO 909)

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

___

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

YES 1 (GO TO 913)
NO 2

910. 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 913)
NO 2

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

YES 1 (GO TO 913)
NO 2

912. Have you done any work in the last 12 months?

YES 1
NO 2 (GO TO 917)

913. What is your occupation? That is, what kind of work do you mainly do?

___

914. 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

915. 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

916. 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

917. CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 918)
NOT IN UNION (GO TO 925)

918. CHECK 916:

CODE '1' OR '2' CIRCLED (GO TO 919)
OTHER (GO TO 921)

919. Who usually decides how the money you earn 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
OTHER (SPECIFY) 6

920. 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 922)
DON'T KNOW 8

921. Who usually decides how your (husband/partner) 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
OTHER (SPECIFY) 6

922. 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 4
OTHER (SPECIFY) 6

923. Who usually makes decisions about making major household purchases?

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

924. Who usually makes decisions about visits to your family or relatives?

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

925. Do you own this 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 (GO TO 928)

926. Do you have a title deed for any house you own?

YES 1
NO 2 (GO TO 928)
DON'T KNOW 8 (GO TO 928)

927. Is your name on the title deed?

YES 1
NO 2
DON'T KNOW 8

928. Do you own any agricultural or non-agricultural land either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4 (GO TO 931)

929. Do you have a title deed for any land you own?

YES 1
NO 2 (GO TO 931)
DON'T KNOW 8 (GO TO 931)

930. Is your name on the title deed?

YES 1
NO 2
DON'T KNOW 8

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

CHILDREN UNDER 10?
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

932. In your opinion, is a husband justified in hitting or beating his wife in the following:

a. If she goes out without telling him?
YES 1
NO 2
DON'T KNOW 8
b. If she neglects the children?
YES 1
NO 2
DON'T KNOW 8
c. If she argues with him?
YES 1
NO 2
DON'T KNOW 8
d. If she refuses to have sex with him?
YES 1
NO 2
DON'T KNOW 8
e. If she burns the food?
YES 1
NO 2
DON'T KNOW 8
f. If she commits infidelity?
YES 1
NO 2
DON'T KNOW 8

SECTION 10. HIV AND AIDS

1001. Now I would like to talk about something else. Have you ever heard of HIV or AIDS?

YES 1
NO 2 (GO TO 1024)

1002. HIV is the virus that can lead to AIDS. Can people reduce their chance of getting HIV by having just one uninfected sex partner who has no other sex partners?

YES 1
NO 2
DON'T KNOW 8

1003. Can people get HIV from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

1004. 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

1005. Can people get HIV by sharing food with a person who has HIV?

YES 1
NO 2
DON'T KNOW 8

1006. Can people get HIV because of witchcraft or other supernatural means?

YES 1
NO 2
DON'T KNOW 8

1007. Is it possible for a healthy-looking person to have HIV?

YES 1
NO 2
DON'T KNOW 8

1007A. Can men reduce their chance of getting HIV by getting circumcised?

YES 1
NO 2
DON'T KNOW 8

1007B. Can circumcised men who have sex without a condom get HIV during sex?

YES 1
NO 2
DON'T KNOW 8

1007C. Can an HIV-negative woman get HIV if she has sex without a condom with a circumcised HIV-positive man?

YES 1
NO 2
DON'T KNOW 8

1008. Can HIV be transmitted from a mother to her baby:

a. During pregnancy?
YES 1
NO 2
DON'T KNOW 8
b. During delivery?
YES 1
NO 2
DON'T KNOW 8
c. By breastfeeding?
YES 1
NO 2
DON'T KNOW 8

1009. CHECK 1008:

AT LEAST ONE 'YES' (GO TO 1010)
OTHER (GO TO 1011)

1010. Are there any special medicines 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

1011. CHECK 208 AND 215:

LAST BIRTH IN 2013-2015 (GO TO 1012)
LAST BIRTH IN 2012 OR EARLIER (GO TO 1027)
NO BIRTHS (GO TO 1027)

1012. CHECK 408 FOR LAST BIRTH:

HAD ANTENATAL CARE (GO TO 1013)
NO ANTENATAL CARE (GO TO 1020)

1013. CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

1014. During any of the antenatal visits for your last birth were you given any information about:

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

1015. Were you offered a test for HIV as part of your antenatal care?

YES 1
NO 2

1016. 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 1020)

1017. Where was the 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 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 CENTER 32
SCHOOL BASED CLINIC 33
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36
OTHER SOURCE
HOME 41
WORKPLACE 42
MOBILE VCT 43
UNIFORMED FORCES FACILITY 44
OTHER (SPECIFY) 96

1018. I don't want to know the results, but did you get the results of the test?

YES 1
NO 2 (GO TO 1020)

1019. All women are supposed to receive counseling after being tested. After you were tested, did you receive counseling?

YES 1
NO 2
DON'T KNOW 8

1020. CHECK 430 FOR LAST BIRTH:

ANY CODE '21-46' CIRCLED (GO TO 1021)
OTHER (GO TO 1026)

1021. Between the time you went for delivery but before the baby was born, were you offered an HIV test?

YES 1
NO 2

1022. I don't want to know the results, but were you tested for HIV at that time?

YES 1
NO 2 (GO TO 1024)

1023. I don't want to know the results, but did you get the results of the test?

YES 1 (GO TO 1025)
NO 2 (GO TO 1025)

1024. CHECK 1016:

YES (GO TO 1025)
NO OR NOT ASKED (GO TO 1027)

1025. Have you been tested for HIV since that time you were tested during your pregnancy?

YES 1 (GO TO 1028)
NO 2

1026. How many months ago was your most recent HIV test?

MONTHS AGO ___ (GO TO 1033)
TWO OR MORE YEARS 95 (GO O 1033)

1027. I don't want to know the results, but have you ever been tested for HIV?

YES 1
NO 2 (GO TO 1031)

1028. How many months ago was your most recent HIV test?

MONTHS AGO ___
TWO OR MORE YEARS 95

1029. I don't want to know the results, but did you get the results of the test?

YES 1
NO 2

1030. Where was the 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 (GO TO 1033)
PROVINCIAL HOSPITAL 12 (GO TO 1033)
DISTRICT HOSPITAL 13 (GO TO 1033)
RURAL HOSPITAL 14 (GO TO 1033)
RURAL HEALTH CENTER/COUNCIL CLINIC 15 (GO TO 1033)
URBAN MUNICIPAL 16 (GO TO 1033)
FAMILY PLANNING CLINIC 17 (GO TO 1033)
SCHOOL BASED CLINIC 18 (GO TO 1033)
OTHER PUBLIC SECTOR (SPECIFY) 19 (GO TO 1033)
MISSION HOSPITAL/CLINIC 21 (GO TO 1033)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 31 (GO TO 1033)
NEW START CENTER 32 (GO TO 1033)
SCHOOL BASED CLINIC 33 (GO TO 1033)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36 (GO TO 1033)
OTHER SOURCE
HOME 41 (GO TO 1033)
WORKPLACE 42 (GO TO 1033)
MOBILE VCT 43 (GO TO 1033)
UNIFORMED FORCES FACILITY 44 (GO TO 1033)
OTHER (SPECIFY) 96 (GO TO 1033)

1031. Do you know of a place where people can go to get an HIV test?

YES 1
NO 2 (GO TO 1033)

1032. 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 F
FAMILY PLANNING CLINIC G
SCHOOL BASED CLINIC H
OTHER PUBLIC SECTOR (SPECIFY) I
MISSION HOSPITAL/CLINIC J
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR K
NEW START CENTER L
SCHOOL BASED CLINIC M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) N
OTHER SOURCE
HOME O
WORKPLACE P
MOBILE VCT Q
UNIFORMED FORCES FACILITY R
OTHER (SPECIFY) X

1033. Have you heard of test kits people can use to test themselves for HIV?

YES 1
NO 2 (GO TO 1034A)

1034. Have you ever tested yourself for HIV using a self-test kit?

YES 1
NO 2

1034A. If a self-test kit was available, would you be willing to test yourself for HIV?

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

1035. Would you buy fresh vegetables from a shopkeeper or vender if you knew that this person had HIV?

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

1036. Do you think children living with HIV should be allowed to attend school with children who do not have HIV?

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

1037. Do you think people hesitate to take and HIV test because they are afraid of how other people will react if the test result is positive for HIV?

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

1038. Do people talk badly about people living with HIV, or who are thought to be living with HIV?

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

1039. Do people living with HIV, or thought to be living with HIV, lose the respect of other people?

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

1040. Do you agree or disagree with the following statement: I would be ashamed if someone in my family had HIV.

AGREE 1
DISAGREE 2
DON'T KNOW/NOT SURE/DEPENDS 8

1041. Do you fear that you could get HIV if you come into contact with the saliva of a person living with HIV?

YES 1
NO 2
SAYS SHE HAS HIV 3
DON'T KNOW/NOT SURE/DEPENDS 8

1042. CHECK 1001:

HEARD ABOUT HIV OR AIDS: Apart from HIV, have you heard about other infections that can be transmitted through sexual contact?

NOT HEARD ABOUT HIVE OR AIDS: Have you heard about infections that can be transmitted through sexual contact?

YES 1
NO 2

1043. CHECK 713:

HAS HAD SEXUAL INTERCOURSE (GO TO 1044)
NEVER HAD SEXUAL INTERCOURSE (GO TO 1051)

1044. CHECK 142: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES (GO TO 1045)
NO (GO TO 1046)

1045. 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

1046. 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

1047. 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

1048. CHECK 1045, 1046, AND 1047:

HAS HAD AN INFECTION (ANY 'YES') (GO TO 1049)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 1051)

1049. The last time you had (PROBLEM FROM 1045/1046/1047) did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 1051)

1050. 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 ___
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
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR I
PHARMACY J
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) K
OTHER SOURCE
SHOP L
MOBILE VCT M
WORKPLACE N
TRADITIONAL HERBALIST O
OTHER (SPECIFY) X

1051. 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

1052. Is a wife justified in refusing to have sex with her husband when she knows he has sex with other women?

YES 1
NO 2
DON'T KNOW 8

1053. CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 1054)
NOT IN UNION (GO TO 1101)

1054. 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

1055. Could you ask your (husband/partner) to use a condom if you wanted him to?

YES 1
NO 2
DEPENDS/NOT SURE 8

SECTION 11. OTHER HEALTH ISSUES

1101. 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 1104)

1102. 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 1104)

1103. The last time you got an 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 8

1104. Do you currently smoke cigarettes every day, some days, or not at all?

EVERY DAY 1
SOME DAYS 2 (GO TO 1106)
NOT AT ALL 3 (GO TO 1106)

1105. On average, how many cigarettes do you currently smoke each day?

NUMBER OF CIGARETTES ___

1106. Do you currently smoke or use any other type of tobacco every day, some days, or not at all?

EVERY DAY 1
SOME DAYS 2
NOT AT ALL 3 (GO TO 1108)

1107. What other type of tobacco do you currently smoke or use?

RECORD ALL MENTIONED.

PIPE A
SNUFF B
OTHER (SPECIFY) X

1108. 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 a big problem:

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

1108A. Have you ever heard of cervical cancer?

YES 1
NO 2 (GO TO 1109)

1108B. Have you ever been screened for cervical cancer?

YES 1
NO 2 (GO TO 1109)

1108C. When were you last screened for cervical cancer?

DATE, IF GIVEN ___

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

1109. Are you covered by any medical aid?

YES 1
NO 2 (GO TO 1111)

1110. 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

1110A. Have you ever drank alcohol?

YES 1
NO 2 (GO TO 1201)

1110B. In the last 30 days, on how many days did you have at least one drink of alcohol?

IF NONE, RECORD '00'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

DAYS ___
DON'T KNOW 998

1110C. In the last 30 days, how many alcoholic drinks did you have on a typical day when you drank alcohol?

IF NONE, RECORD '00'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

DRINKS ___
DON'T KNOW 998

1110D. In the last 30 days, on how many days did you get drunk?

IF NONE, RECORD '00'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

DAYS ___
DON'T KNOW 998

SECTION 12. MATERNAL MORTALITY

1201. 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.

NUMBER OF BIRTHS TO NATURAL MOTHER ___

1202. CHECK 1201:

TWO OR MORE BIRTHS (GO TO 1203)
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 1300)

1203. How many births did your mother have before you were born?

NUMBER OF PRECEDING BIRTH ___

1204. What was the name given to your (oldest/next oldest) brother or sister?

___

1205. Is (NAME) a male or female?

MALE 1
FEMALE 2

1206. Is (NAME) still alive?

YES 1
NO 2 (GO TO 1208)
DON'T KNOW 8 (GO TO NEXT BIRTH)

1207. How old is (NAME)?

___ (GO TO NEXT BIRTH)

1208. How many years ago did (NAME) die?

___

1209. How old was (NAME) when (he/she) died?

___ (IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO NEXT BIRTH)

1210. Was (NAME) pregnant when she died?

YES 1 (GO TO 1213)
NO 2

1211. Did (NAME) die during childbirth?

YES 1 (GO TO 1213)
NO 2

1212. Did (NAME) die within two months after the end of a pregnancy or childbirth?

YES 1
NO 2

1213. How many live born children did (NAME) give birth to during her lifetime?

___

IF NO MORE BROTHERS OR SISTERS, GO TO NEXT SECTION.

SECTION 13. DOMESTIC VIOLENCE

1300. CHECK HOUSEHOLD QUESTIONNAIRE (LOCATION TO BE CHECKED)

WOMAN SELECTED FOR THIS SECTION (GO TO 1301)
WOMAN NOT SELECTED (GO TO END)

1301. CHECK FOR PRESENCE OF OTHERS: DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.

PRIVACY OBTAINED 1 (GO TO 1301A)
PRIVACY NOT POSSIBLE 2 (GO TO 1332)

1301A. READ TO THE RESPONDENT:

Now I would like to ask you questions about some other important aspects of a woman's life. You may find some of these questions 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 in your household will know that you were asked these questions. 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.

1302. CHECK 701 AND 702:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 1303)
FORMERLY MARRIED/LIVED WITH A MAN (READ IN PAST TENSE AND USE 'LAST' WITH 'HUSBAND/PARTNER') (GO TO 1303)
NEVER MARRIED/NEVER LIVED WITH A MAN (GO TO 1316)

1303. 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 your (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

1304. Now I need to ask some more questions about your relationship with your (last) (husband/partner).

A. Did your (last) (husband/partner) ever:

a. say or do something to humiliate you in front of others?
YES 1 (GO TO 1304B)
NO 2 (GO TO b)
b. threaten to hurt or harm you or someone you care about?
YES 1 (GO TO 1304B)
NO 2 (GO TO c)
c. insult you or make you feel bad about yourself?
YES 1 (GO TO 1304B)
NO 2 (GO TO 1305)

B. 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 others?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b. threaten to hurt or harm you or someone you care about?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c. insult you or make you feel bad about yourself?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

1305A. 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 (GO TO 1305B)
NO 2 (GO TO b)
b. slap you?
YES 1 (GO TO 1305B)
NO 2 (GO TO c)
c. twist your arm or pull your hair?
YES 1 (GO TO 1305B)
NO 2 (GO TO d)
d. punch you with his fist or with something that could hurt you?
YES 1 (GO TO 1305B)
NO 2 (GO TO e)
e. kick you, drag you, or beat you up?
YES 1 (GO TO 1305B)
NO 2 (GO TO f)
f. try to choke you or burn you on purpose?
YES 1 (GO TO 1305B)
NO 2 (GO TO g)
g. threaten or attack you with a knife, gun, or other weapon?
YES 1 (GO TO 1305B)
NO 2 (GO TO h)
h. physically force you to have sexual intercourse with him when you did not want to?
YES 1 (GO TO 1305B)
NO 2 (GO TO i)
i. physically force you to perform any other sexual acts you did not want to?
YES 1 (GO TO 1305B)
NO 2 (GO TO j)
j. force you with threats or in any other way to perform sexual acts you did not want to?
YES 1 (GO TO 1305B)
NO 2 (GO TO 1306)

1305B. 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
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b. slap you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c. twist your arm or pull your hair?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
d. punch you with his fist or with something that could hurt you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
e. kick you, drag you, or beat you up?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
f. try to choke you or burn you on purpose?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
g. threaten or attack you with a knife, gun, or other weapon?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
h. physically force you to have sexual intercourse with him when you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
i. physically force you to perform any other sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
j. force you with threats or in any other way to perform sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

1306. CHECK 1305A (A-J):

AT LEAST ON 'YES' (GO TO 1307)
NOT A SINGLE 'YES' (GO TO 1309)

1307. How long after you first (got married/started living together) with your (last) (husband/partner) did (this/any of these things) first happen?

IF LESS THAN ONE YEAR, RECORD '00'.

NUMBER OF YEARS ___
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95

1308. 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

1309. 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 1311)

1310. In the last 12 months, how often have you done this to your (last) (husband/partner): often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1311. Does (did) your (last) (husband/partner) drink alcohol?

YES 1
NO 2 (GO TO 1313)

1312. How often does (did) he get drunk: often, only sometimes, or never?

OFTEN 1
SOMETIMES 2
NEVER 3

1313. Are (were) you afraid of your (last) (husband/partner): most of the time, sometimes, or never?

MOST OF THE TIME AFRAID 1
SOMETIMES AFRAID 2
NEVER AFRAID 3

1314. CHECK 709:

MARRIED MORE THAN ONCE (GO TO 1315)
MARRIED ONLY ONCE (GO TO 1316)

1315A. So far we have been talking about the behavior of your (current/last) (husband/partner). Now I want to ask you about the behavior of any previous (husband/partner).

A. Did any previous (husband/partner) ever hit, slap, kick, or do anything else to hurt you physically?
YES 1 (GO TO 1315B)
NO 2 (GO TO B)
B. Did any previous (husband/partner) physically force you to have intercourse or perform any other sexual acts against you will?
YES 1 (GO TO 1315B)
NO 2 (GO TO 1316)

1315B. How long ago did this last happen?

a. Did any previous (husband/partner) ever hit, slap, kick, or do anything else to hurt you physically?
0-11 MONTHS AGO 1
12 PLUS MONTHS AGO 2
DON'T REMEMBER 3
b. Did any previous (husband/partner) physically force you to have intercourse or perform any other sexual acts against you will?
0-11 MONTHS AGO 1
12 PLUS MONTHS AGO 2
DON'T REMEMBER 3

1316. CHECK 701 AND 702:

NEVER MARRIED/EVER LIVED WITH A MAN: From the time you were 15 years old has anyone other than (your/any) (husband/partner) hit you, slapped you, kicked you, or done anything else to hurt you physically?

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

YES 1
NO 2 (GO TO 1319)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1319)

1317. Who has 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
CURRENT BOYFRIEND F
FORMER BOYFRIEND G
MOTHER-IN-LAW H
FATHER-IN-LAW I
OTHER IN-LAW J
TEACHER K
EMPLOYER/SOMEONE AT WORK L
POLICE/SOLDIER M
OTHER (SPECIFY) X

1318. In the last 12 months, how often has (this person/have these persons) physically hurt you: often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1319. CHECK 201, 226, AND 230:

EVER BEEN PREGNANT ('YES' ON 201 OR 26 OR 230) (GO TO 1320)
NEVER BEEN PREGNANT (GO TO 1322)

1320. Has anyone ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?

YES 1
NO 2 (GO TO 1322)

1321. Who has done any of these things to physically hurt you while you were pregnant? Anyone else?

RECORD ALL MENTIONED.

CURRENT HUSBAND/PARTNER A
MOTHER/STEP-MOTHER B
FATHER/STEP-FATHER C
SISTER/BROTHER D
DAUGHTER/SON E
OTHER RELATIVE F
FORMER HUSBAND/PARTNER G
CURRENT BOYFRIEND I
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

1322. CHECK 701 AND 702:

EVER MARRIED/EVER LIVED WITH A MAN (GO TO 1322A)
NEVER MARRIED/NEVER LIVED WITH A MAN (GO TO 1322B)

1322A. Now I want to ask you about things that may have been done to you by someone other than (your/any) (husband/partner). 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 when you did not want to?

YES 1 (GO TO 1323)
NO 2 (GO TO 1324A)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1324A)

1322B. 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 when you did not want to?

YES 1
NO 2 (GO TO 1326)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1326)

1323. Who was the person who was forcing you the very first time this happened?

CURRENT HUSBAND/PARTNER 01
FORMER HUSBAND/PARTNER 02
CURRENT/FORMER BOYFRIEND 03
FATHER/STEP-FATHER 04
BROTHER/STEP-BROTHER 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/RELIGIOUS LEADER 13
STRANGER 14
OTHER (SPECIFY) 96

1324. CHECK 701 AND 702:

EVER MARRIED/EVER LIVED WITH A MAN: In the last 12 months, has anyone other than (your/any) (husband/partner) physically forced you to have sexual intercourse when you did not want to?

NEVER MARRIED/NEVER LIVED WITH A MAN: In the last 12 months has anyone physically forced you to have sexual intercourse when you did not want to?

YES 1 (GO TO 1325)
NO 2 (GO TO 1325)

1324A. CHECK 1305A (h-j) AND 1315A (b)

AT LEAST ONE 'YES' (GO TO 1325)
NOT A SINGLE 'YES' (GO TO 1326)

1325. CHECK 701 AND 702:

EVER MARRIED/EVER LIVED WITH A MAN: How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts by anyone, including (your/any) husband/partner?

NEVER MARRIED/NEVER LIVED WITH A MAN: How old were you the first time you were forced to have sexual intercourse or preform any other sexual acts?

AGE IN COMPLETED YEARS ___
DON'T KNOW 98

1326. CHECK 1305A (a-j), 1314A (a, b), 1316, 1320, 1322A, AND 1322B:

AT LEAST ONE 'YES' (GO TO 1327)
NOT A SINGLE 'YES' (GO TO 1330)

1327. Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?

YES 1
NO 2 (GO TO 1329)

1328. From whom have you sought help? Anyone else?

RECORD ALL MENTIONED.

OWN FAMILY A (GO TO 1330)
HUSBAND'S/PARTNER'S FAMILY B (GO TO 1330)
CURRENT/FORMER HUSBAND/PARTNER C (GO TO 1330)
CURRENT/FORMER BOYFRIEND D (GO TO 1330)
FRIEND E (GO TO 1330)
NEIGHBOR F (GO TO 1330)
RELIGIOUS LEADER G (GO TO 1330)
DOCTOR/MEDICAL PERSONNEL H (GO TO 1330)
POLICE I (GO TO 1330)
LAWYER J (GO TO 1330)
SOCIAL SERVICE ORGANIZATION K (GO TO 1330)
OTHER (SPECIFY) X (GO TO 1330)

1329. Have you ever told anyone about this?

YES 1
NO 2

1330. 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.

1331. DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN; OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?

HUSBAND?
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3
OTHER MALE ADULT?
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3
FEMALE ADULT?
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3

1332. INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE.

___

1333. RECORD THE TIME.

HOURS ___
MINUTES ___

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING THE INTERVIEW

COMMENTS ABOUT INTERVIEW:

COMMENTS ON SPECIFIC QUESTIONS:

ANY OTHER COMMENTS:

SUPERVISOR'S OBSERVATIONS

EDITOR'S OBSERVATIONS

CALENDAR

INSTRUCTIONS:

ONLY ONE CODE SHOULD APPEAR IN ANY BOX. COLUMN 1 REQUIRES A CODE IN EVERY MONTH.

CODES FOR EACH COLUMN:

COLUMN 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE

B BIRTHS
P PREGNANCIES
T TERMINATIONS
0 NO METHOD
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 IUCD
4 INJECTABLES
5 IMPLANTS
6 PILL
7 MALE CONDOM
8 FEMALE CONDOM
9 EMERGENCY CONTRACEPTION
K LACTATIONAL AMENORRHEA METHOD
L RHYTHM METHOD (SAFE DAYS)
M WITHDRAWAL
X OTHER MODERN METHOD
Y OTHER TRADITIONAL METHOD

COLUMN 2: DISCONTINUATION OF CONTRACEPTIVE USE

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

2015

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 _ _

2014

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 _ _

2013

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 _ _

2012

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 _ _

2011

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 _ _

2010

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 70 _ _
02 FEB 71 _ _
01 JAN 72 _ _