Survey Text

Bangladesh 2014
Central African Republic 1995
India 2015
Jordan 2007
Jordan 2012
Jordan 2017
Namibia 2000
Namibia 2006
Tanzania 2015
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Bangladesh 2014
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435v. Where did you get the money for (NAME's) delivery?
Any other source?
CIRCLE ALL MENTIONED.

FAMILY FUND A
BORROWED B
SOLD ASSETS/MORTGAGE C
GIFT FROM FAMILY D
GIFT FROM NEIGHBOR/FRIEND E
VOUCHER F
INSURANCE G
OTHER (SPECIFY) _____ X

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Central African Republic 1995
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413B) How much were the medical fees cost for you to give birth to (NAME)?
PROBE TO DETERMINE THE COST

PRICE IN FCFA____
FREE 000000
DON'T KNOW 999998

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India 2015
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449. How much in total did it cost you out of your pocket for this delivery?
IF NO MONEY PAID, RECORD '00000'. [ASK FOR MOST RECENT BIRTH ONLY]

COST Rs. __ __ __ __ __
DON'T KNOW 99998

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Jordan 2007
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429A) How much did you pay the service provider for this delivery?

RECORD TOTAL COST IN DINARS

COST IN JD_________
FREE 9995
DON'T KNOW 9998

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Jordan 2012
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433A. How much did you pay the service provider for this delivery?
RECORD THE TOTAL COST IN DINARS

COST IN JD _____

FREE 9995
DON'T KNOW 9998

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Jordan 2017
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429A) How much did you pay the service provider for the delivery?

IF 9994 JD OR MORE, RECORD 9994

COST IN JD _________
FREE 9995
DON'T KNOW 9998

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Namibia 2000
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420) Altogether how much did you pay for the delivery: including examinations, laboratory tests, medicines, and staff fees?
[Last Birth Only]

COST ____

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Namibia 2006
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436B. Altogether how much did you pay for the delivery, including examinations, laboratory tests, medicines, and staff fees?

COST IN NAM DOLLAR

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Tanzania 2015
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429B) Did you pay for delivery of (NAME)?

YES 1
NO 2 (GO TO 430)