Survey Text

Burkina Faso 2010 Cote d'Ivoire 2011 Malawi 2004 Zimbabwe 2005
Cameroon 2004 Egypt 2005 Mali 2006
Cameroon 2011 Jordan 2007 Mali 2018
Congo (Democratic Republic) 2007 Kenya 2003 Rwanda 2005
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Burkina Faso 2010
Survey form view entire document:  text 
1306. Now if you will permit me, I need to ask some more questions about your relationship with your (last) husband/partner:

1306A. (Does/did) your last husband/partner ever:

a) Push you, shake you, or throw something at you?

YES 1 (GO TO 1306B-a)
NO 2 (GO TO 1306A-b)

b) Slap you or twist your arm?

YES 1 (GO TO 1306B-b)
NO 2 (GO TO 1306A-c)

c) Punch you with his fist or with something that could hurt you?

YES 1 (GO TO 1306B-c)
NO 2 (GO TO 1306A-d)

d) Kick you or drag you?

YES 1 (GO TO 1306B-d)
NO 2 (GO TO 1306A-e)

e) Try to strangle you or burn you?

YES 1 (GO TO 1306B-e)
NO 2 (GO TO 1306A-f)

f) Threaten you with a knife, gun, or other type of weapon?

YES 1 (GO TO 1306B-f)
NO 2 (GO TO 1306A-g)

g) Attack you with a knife, gun, or other type of weapon?

YES 1 (GO TO 1306B-g)
NO 2 (GO TO 1306A-h)

h) Physically force you to have sexual intercourse with him even when you did not want to?

YES 1 (GO TO 1306B-h)
NO 2 (GO TO 1306A-i)

i) Force you to perform other sexual acts you did not want to?

YES 1 (GO TO 1306B-i)
NO 2 (GO TO 1307)

1306B. How many times did this happen during the last 12 months?
IF WIDOW, DIVORCED, OR SEPARATED, RECORD '95'.

a) Push you, shake you, or throw something at you?

NUMBER OF TIMES _____ (RETURN TO 1306A-b)
WIDOWED, DIVORCED, OR SEPARATED 95 (RETURN TO 1306A-b)

b) Slap you or twist your arm?

NUMBER OF TIMES _____ (RETURN TO 1306A-c)
WIDOWED, DIVORCED, OR SEPARATED 95 (RETURN TO 1306A-c)

c) Punch you with his fist or with something that could hurt you?

NUMBER OF TIMES _____ (RETURN TO 1306A-d)
WIDOWED, DIVORCED, OR SEPARATED 95 (RETURN TO 1306A-d)

d) Kick you or drag you?

NUMBER OF TIMES _____ (RETURN TO 1306A-e)
WIDOWED, DIVORCED, OR SEPARATED 95 (RETURN TO 1306A-e)

e) Try to strangle you or burn you?

NUMBER OF TIMES _____ (RETURN TO 1306A-f)
WIDOWED, DIVORCED, OR SEPARATED 95 (RETURN TO 1306A-f)

f) Threaten you with a knife, gun, or other type of weapon?

NUMBER OF TIMES _____ (RETURN TO 1306A-g)
WIDOWED, DIVORCED, OR SEPARATED 95 (RETURN TO 1306A-g)

g) Attack you with a knife, gun, or other type of weapon?

NUMBER OF TIMES _____ (RETURN TO 1306A-h)
WIDOWED, DIVORCED, OR SEPARATED 95 (RETURN TO 1306A-h)

h) Physically force you to have sexual intercourse with him even when you did not want to?

NUMBER OF TIMES _____ (RETURN TO 1306A-i)
WIDOWED, DIVORCED, OR SEPARATED 95 (RETURN TO 1306A-i)

i) Force you to perform other sexual acts you did not want to?

NUMBER OF TIMES _____ (GO TO 1307)
WIDOWED, DIVORCED, OR SEPARATED 95 (GO TO 1307)

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Cameroon 2004
Survey form view entire document:  text 
1106)

6A. (Does/did) your (last) husband/partner ever:

a) Push you, shake you, or throw something at you?
YES 1 (GO TO 6B)
NO 2
b) Slap you or twist your arm?
YES 1 (GO TO 6B)
NO 2
c) Punch you with his fist or with something that could hurt you?
YES 1 (GO TO 6B)
NO 2
d) Kick you or drag you?
YES 1 (GO TO 6B)
NO 2
e) Try to strangle you or burn you?
YES 1 (GO TO 6B)
NO 2
f) Threaten you with a knife, gun, or other type of weapon?
YES 1 (GO TO 6B)
NO 2
g) Attack you with a knife, gun, or other type of weapon?
YES 1 (GO TO 6B)
NO 2
h) Physically force you to have sexual intercourse with him even when you did not want to?
YES 1 (GO TO 6B)
NO 2
i) Force you to perform other sexual acts you did not want to?
YES 1 (GO TO 6B)
NO 2

6B. How often did this occur in the past 12 months?

a) NUMBER OF TIMES: ___
IF WIDOWED, DIVORCED OR SEPARATED 95
b) NUMBER OF TIMES: ___
IF WIDOWED, DIVORCED OR SEPARATED 95
c) NUMBER OF TIMES: ___
IF WIDOWED, DIVORCED OR SEPARATED 95
d) NUMBER OF TIMES: ___
IF WIDOWED, DIVORCED OR SEPARATED 95
e) NUMBER OF TIMES: ___
IF WIDOWED, DIVORCED OR SEPARATED 95
f) NUMBER OF TIMES: ___
IF WIDOWED, DIVORCED OR SEPARATED 95
g) NUMBER OF TIMES: ___
IF WIDOWED, DIVORCED OR SEPARATED 95
h) NUMBER OF TIMES: ___
IF WIDOWED, DIVORCED OR SEPARATED 95
i) NUMBER OF TIMES: ___
IF WIDOWED, DIVORCED OR SEPARATED 95

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Cameroon 2011
Survey form view entire document:  text 
1105)
A. Has your husband/partner ever done any of the following to you?

a) Shoved or shook you or thrown something at you?

YES 1 (GO TO B FOR SAME QUESTION)
NO 2 (GO TO NEXT QUESTION)

b) Slapped you?

YES 1 (GO TO B FOR SAME QUESTION)
NO 2 (GO TO NEXT QUESTION)

c) Twisted your arm or pulled your hair?

YES 1 (GO TO B FOR SAME QUESTION)
NO 2 (GO TO NEXT QUESTION)

d) Hit you with his fist or anything else that might hurt you?

YES 1 (GO TO B FOR SAME QUESTION)
NO 2 (GO TO NEXT QUESTION)

e) Have he ever kicked you, dragged you, or beaten you?

YES 1 (GO TO B FOR SAME QUESTION)
NO 2 (GO TO NEXT QUESTION)

f) Tried to strangle you or burn you?

YES 1 (GO TO B FOR SAME QUESTION)
NO 2 (GO TO NEXT QUESTION)

g) Threatened you with a knife, a pistol, or other type of weapon?

YES 1 (GO TO B FOR SAME QUESTION)
NO 2 (GO TO NEXT QUESTION)

h) Physically forced you to have sexual relations when you did not want to?

YES 1 (GO TO B FOR SAME QUESTION)
NO 2 (GO TO NEXT QUESTION)

i) Forced you to perform sexual acts that you did not want to perform?

YES 1 (GO TO B FOR SAME QUESTION)
NO 2 (GO TO NEXT QUESTION)

CHECK 603: ONLY ASK IF THE RESPONDENT IS NOT A WIDOW.

B: In the last 12 months, has this happened often, sometimes, or never?

a) Shoved or shook you or thrown something at you?

OFTEN 1
SOMETIMES 2
NEVER 3

b) Slapped you?

OFTEN 1
SOMETIMES 2
NEVER 3

c) Twisted your arm or pulled your hair?

OFTEN 1
SOMETIMES 2
NEVER 3

d) Hit you with his fist or anything else that might hurt you?

OFTEN 1
SOMETIMES 2
NEVER 3

e) Has he ever kicked you, dragged you, or beaten you?

OFTEN 1
SOMETIMES 2
NEVER 3

f) Tried to strangle you or burn you?

OFTEN 1
SOMETIMES 2
NEVER 3

g) Threatened you with a knife, a pistol, or other type of weapon?

OFTEN 1
SOMETIMES 2
NEVER 3

h) Physically forced you to have sexual relations when you did not want to?

OFTEN 1
SOMETIMES 2
NEVER 3

i) Forced you to perform sexual acts that you did not want to perform?

OFTEN 1
SOMETIMES 2
NEVER 3

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Congo (Democratic Republic) 2007
Survey form view entire document:  text 
1005) 5A) (Does/did) your (last) husband/partner ever:

a) Push you, shake you, or throw something at you?
YES 1
NO 2 (GO TO B)
b) slap you or twist your arm?
YES 1
NO 2 (GO TO C)
c) punch you with his fist or with something that could hurt you?
YES 1
NO 2 (GO TO D)
d) kick you or drag you?
YES 1
NO 2 (GO TO E)
e) try to strangle you or burn you?
YES 1
NO 2 (GO TO F)
f) threaten you with a knife, gun, or other type of weapon?
YES 1
NO 2 (GO TO G)
g) attack you with a knife, gun, or other type of weapon?
YES 1
NO 2 (GO TO H)
h) physically force you to have sexual intercourse with him even when you did not want to?
YES 1
NO 2 (GO TO I)
i) force you to perform other sexual acts you did not want to?
YES 1
NO 2 (GO TO 1006)

5B) How many times did this happen during the last 12 months?

a) Push you, shake you, or throw something at you?
NUMBER OF TIMES ___
IF WIDOWED, DIVORCED OR SEPARATED 95
b) slap you or twist your arm?
NUMBER OF TIMES ___
IF WIDOWED, DIVORCED OR SEPARATED 95
c) punch you with his fist or with something that could hurt you?
NUMBER OF TIMES ___
IF WIDOWED, DIVORCED OR SEPARATED 95
d) kick you or drag you?
NUMBER OF TIMES ___
IF WIDOWED, DIVORCED OR SEPARATED 95
e) try to strangle you or burn you?
NUMBER OF TIMES ___
IF WIDOWED, DIVORCED OR SEPARATED 95
f) threaten you with a knife, gun, or other type of weapon?
NUMBER OF TIMES ___
IF WIDOWED, DIVORCED OR SEPARATED 95
g) attack you with a knife, gun, or other type of weapon?
NUMBER OF TIMES ___
IF WIDOWED, DIVORCED OR SEPARATED 95
h) physically force you to have sexual intercourse with him even when you did not want to?
NUMBER OF TIMES ___
IF WIDOWED, DIVORCED OR SEPARATED 95
i) force you to perform other sexual acts you did not want to?
NUMBER OF TIMES ___
IF WIDOWED, DIVORCED OR SEPARATED 95

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Cote d'Ivoire 2011
Survey form view entire document:  text 
1206) Now if you will permit me, I need to ask some more questions about your relationship with your (last) husband/partner.

1206a) (Does/did) your last husband/partner ever:
1206b) How many times did this happen during the last 12 months?

a) push you, shake you, or throw something at you?
YES 1
NO 2
A) NUMBER OF TIMES__________
IF WIDOW, DIVORCED, OR SEPARATED 95
b) slap you or twist your arm?
YES 1
NO 2
A) NUMBER OF TIMES_________
IF WIDOW, DIVORCED, OR SEPARATED 95
c) punch you with his fist or with something that could hurt you?
YES 1
NO 2
A) NUMBER OF TIMES______________
IF WIDOW, DIVORCED, OR SEPARATED 95
d) kick you or drag you?
YES 1
NO 2
A) NUMBER OF TIMES______________
IF WIDOW, DIVORCED, OR SEPARATED 95
e) try to strangle you or burn you?
YES 1
NO 2
A) NUMBER OF TIMES_____________
IF WIDOW, DIVORCED, OR SEPARATED 95
f) threaten you with a knife, gun, or other type of weapon?
YES 1
NO 2
A) NUMBER OF TIMES___________
IF WIDOW, DIVORCED, OR SEPARATED 95
g) attack you with a knife, gun, or other type of weapon?
YES 1
NO 2
A) NUMBER OF TIMES____________
IF WIDOW, DIVORCED, OR SEPARATED 95
h) physically force you to have sexual intercourse with him even when you did NOt want to?
YES 1
NO 2
A) NUMBER OF TIMES__________
IF WIDOW, DIVORCED, OR SEPARATED 95
i) force you to perform other sexual acts you did not want to?
YES 1
NO 2
A) NUMBER OF TIMES_____________
IF WIDOW, DIVORCED, OR SEPARATED 95

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Egypt 2005
Survey form view entire document:  text 
905) 905A) (Does/did) your (last) husband ever:

1) push you, shake you, or throw something at you?
YES 1
NO 2
2) slap you or twist your arm?
YES 1
NO 2
3) punch you with his fist or with something that could hurt you?
YES 1
NO 2
4) kick you or drag you?
YES 1
NO 2
5) try to strangle you or burn you?
YES 1
NO 2
6) threaten you with a knife, gun, or other type of weapon?
YES 1
NO 2
7) attack you with a knife, gun, or other type of weapon?
YES 1
NO 2
8) physically force you to have sexual intercourse with him when you did not want to?
YES 1
NO 2

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Jordan 2007
Survey form view entire document:  text 
1105)

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

1) push you, shake you, or throw something at you?
YES 1
NO 2 (GO TO 1105(2))
How often did this happen during the last 12 months: often only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
NOT APPLICABLE 4
2) slap you or twist your arm?
YES 1
NO 2 (GO TO 1105(3))
How often did this happen during the last 12 months: often only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
NOT APPLICABLE 4
3) punch you with his fist or with something that could hurt you?
YES 1
NO 2 (GO TO 1105(4))
How often did this happen during the last 12 months: often only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
NOT APPLICABLE 4
4) kick you, drag you, or beat you up?
YES 1
NO 2 (GO TO 1105(5))
How often did this happen during the last 12 months: often only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
NOT APPLICABLE 4
5) try to choke you or burn you on purpose?
YES 1
NO 2 (GO TO 1105(6))
How often did this happen during the last 12 months: often only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
NOT APPLICABLE 4
6) threaten you with a knife, gun, or any other weapon?
YES 1
NO 2 (GO TO 1105(7))
How often did this happen during the last 12 months: often only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
NOT APPLICABLE 4
7) attack you with a knife, gun, or any other weapon?
YES 1
NO 2 (GO TO 1105(8))
How often did this happen during the last 12 months: often only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
NOT APPLICABLE 4
8) physically force you to have sexual intercourse with him even when you did not want to?
YES 1
NO 2 (GO TO 1106)
How often did this happen during the last 12 months: often only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
NOT APPLICABLE 4

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Kenya 2003
Survey form view entire document:  text 
1006. 6A. (Does/did) your (last) husband/partner ever:

a) Push you, shake you, or throw something at you?
YES 1 (GO TO 6B)
NO 2
b) Slap you or twist your arm?
YES 1 (GO TO 6B)
NO 2
c) Punch you with his fist or with something that could hurt you?
YES 1 (GO TO 6B)
NO 2
d) Kick you or drag you?
YES 1 (GO TO 6B)
NO 2
e) Try to strangle you or burn you?
YES 1 (GO TO 6B)
NO 2
f) Threaten you with a knife, gun, or other type of weapon?
YES 1 (GO TO 6B)
NO 2
g) Attack you with a knife, gun, or other type of weapon?
YES 1 (GO TO 6B)
NO 2
h) Physically force you to have sexual intercourse with him even when you did not want to?
YES 1 (GO TO 6B)
NO 2
i) Force you to perform other sexual acts you did not want to?
YES 1 (GO TO 6B)
NO 2

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Malawi 2004
Survey form view entire document:  text 
DV06. 6A. (Does/did) your (last) husband/partner ever:

a) push you, shake you, or throw something at you?
YES 1
NO 2
b) slap you or twist your arm?
YES 1
NO 2
c) punch you with his fist or with something that could hurt you?
YES 1
NO 2
d) kick you or drag you?
YES 1
NO 2
e) try to strangle you or burn you?
YES 1
NO 2
f) threaten you with a knife, gun, or other type of weapon?
YES 1
NO 2
g) attack you with a knife, gun, or other type of weapon?
YES 1
NO 2
h) physically force you to have sexual intercourse with him even when you did not want to?
YES 1
NO 2
i) force you to perform other sexual acts you did not want to?
YES 1
NO 2

6B. How many times did this happen during the last 12 months?

a) push you, shake you, or throw something at you?
TIMES IN LAST 12 MONTHS ___
b) slap you or twist your arm?
TIMES IN LAST 12 MONTHS ___
c) punch you with his fist or with something that could hurt you?
TIMES IN LAST 12 MONTHS ___
d) kick you or drag you?
TIMES IN LAST 12 MONTHS ___
e) try to strangle you or burn you?
TIMES IN LAST 12 MONTHS ___
f) threaten you with a knife, gun, or other type of weapon?
TIMES IN LAST 12 MONTHS ___
g) attack you with a knife, gun, or other type of weapon?
TIMES IN LAST 12 MONTHS ___
h) physically force you to have sexual intercourse with him even when you did not want to?
TIMES IN LAST 12 MONTHS ___
i) force you to perform other sexual acts you did not want to?
TIMES IN LAST 12 MONTHS ___

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Mali 2006
Survey form view entire document:  text 
1006. Now, if you allow it, I would like to ask you some other questions about your relationship with your (last) husband.

6A. Has your (last) husband or partner ever:

A) pushed you, shaken you or thrown something at you?
YES 1 (GO TO 6B)
NO 2
B) slapped you or twisted your arm?
YES 1 (GO TO 6B)
NO 2
C) punched you or hit you with something that could injure you?
YES 1 (GO TO 6B)
NO 2
D) kicked you or dragged you on the ground?
YES 1 (GO TO 6B)
NO 2
E) tried to strangle or burn you?
YES 1 (GO TO 6B)
NO 2
F) threatened you with a knife, a gun or another type of weapon?
YES 1 (GO TO 6B)
NO 2
G) attacked you with a knife, a gun or another kind of weapon?
YES 1 (GO TO 6B)
NO 2
H) physically forced you to have sexual intercourse even when you didn't want to?
YES 1 (GO TO 6B)
NO 2
I) forced you to do sexual acts that you did not want to do?
YES 1 (GO TO 6B)
NO 2

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Mali 2018
Survey form view entire document:  text 
1505) a) Did your (last) (HUSBAND/PARTNER) ever do any of the following things to you:
b) How often did this happen during the last 12 months: often, only sometimes, or not in the last 12 months?

A) PUSH YOU, SHAKE YOU, OR THROW SOMETHING AT YOU?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
B) SLAP YOU?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
C) TWIST YOUR ARM OR PULL YOUR HAIR?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
D) PUNCH YOU WITH HIS FIST OR WITH SOMETHING THAT COULD HURT YOU?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
E) KICK YOU, DRAG YOU, OR BEAT YOU UP?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
F) INTENTIONALLY TRY TO CHOCK YOU OR BURN YOU?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
G) THREATEN YOU WITH A KNIFE, GUN, OR OTHER TYPE OF WEAPON?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
H) PHYSICALLY FORCE YOU TO HAVE SEXUAL INTERCOURSE WITH HIM EVEN WHEN YOU DID NOT WANT TO?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
I) PHYSICALLY FORCE YOU TO PERFORM OTHER SEXUAL ACTS YOU DID NOT WANT TO?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
J) FORCE YOU WITH THREATS OR IN ANY OTHER WAY TO PERFORM SEXUAL ACTS YOU DID NOT WANT TO?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3

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Rwanda 2005
Survey form view entire document:  text 
1006. 6A. (Does/did) your (last) husband/partner ever:

Push you, shake you, or throw something at you?
YES 1 (GO TO 6B)
NO 2 (GO TO NEXT)
Slap you or twist your arm?
YES 1 (GO TO 6B)
NO 2 (GO TO NEXT)
Spit on you?
YES 1 (GO TO 6B)
NO 2 (GO TO NEXT)
Punch you with his fist or with something that could hurt you?
YES 1 (GO TO 6B)
NO 2 (GO TO NEXT)
Kick you or drag you?
YES 1 (GO TO 6B)
NO 2 (GO TO NEXT)
Try to strange you or burn you?
YES 1 (GO TO 6B)
NO 2 (GO TO NEXT)
Threaten you with a knife, gun, or other type of weapon?
YES 1 (GO TO 6B)
NO 2 (GO TO NEXT)
Attack you with a knife, gun or other type of weapon?
YES 1 (GO TO 6B)
NO 2 (GO TO NEXT)
Physically force you to have sexual intercourse with him even when you did not want to?
YES 1 (GO TO 6B)
NO 2 (GO TO NEXT)
Force you to perform other sexual acts you did not want to?
YES 1 (GO TO 6B)
NO 2

6B. How many times did this happen during the last 12 months?

Push you, shake you, or throw something at you?
TIMES IN LAST 12 MONTHS ____
IF DIV OR SEPARATED 95
Slap you or twist your arm?
TIMES IN LAST 12 MONTHS ____
IF DIV OR SEPARATED 95
Spit on you?
TIMES IN LAST 12 MONTHS ____
IF DIV OR SEPARATED 95
Punch you with his fist or with something that could hurt you?
TIMES IN LAST 12 MONTHS ____
IF DIV OR SEPARATED 95
Kick you or drag you?
TIMES IN LAST 12 MONTHS ____
IF DIV OR SEPARATED 95
Try to strange you or burn you?
TIMES IN LAST 12 MONTHS ____
IF DIV OR SEPARATED 95
Threaten you with a knife, gun, or other type of weapon?
TIMES IN LAST 12 MONTHS ____
IF DIV OR SEPARATED 95
Attack you with a knife, gun or other type of weapon?
TIMES IN LAST 12 MONTHS ____
IF DIV OR SEPARATED 95
Physically force you to have sexual intercourse with him even when you did not want to?
TIMES IN LAST 12 MONTHS ____
IF DIV OR SEPARATED 95
Force you to perform other sexual acts you did not want to?
TIMES IN LAST 12 MONTHS ____
IF DIV OR SEPARATED 95

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Zimbabwe 2005
Survey form view entire document:  text 
1106A) (Does/did) your (last) husband/partner ever do any of the following things to you:

a. Push you, shake you, throw something at you, or twist your arm or pull your hair?
YES 1
NO 2
b. Slap you?
YES 1
NO 2
c. Punch you with his fist or with something that could hurt you, kick you, drag you, or beat you up?
YES 1
NO 2
d. Try to choke you or burn you on purpose?
YES 1
NO 2
e. Threaten you with a knife, gun, or any other weapon?
YES 1
NO 2
f. Attack you with a knife, gun, or any other weapon?
YES 1
NO 2
g. Physically force you to have sexual intercourse with him?
YES 1
NO 2
h. Force you to perform any other sexual acts?
YES 1
NO 2

1106B) CHECK 601: ASK ONLY IF RESPONDENT IS CURRENTLY MARRIED/LIVING WITH A MAN, SEPARATED, OR DIVORCED. EXCLUDE WIDOWED WOMEN.

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

a. Push you, shake you, throw something at you, or twist your arm or pull your hair?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
b. Slap you?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
c. Punch you with his fist or with something that could hurt you, kick you, drag you, or beat you up?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
d. Try to choke you or burn you on purpose?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
e. Threaten you with a knife, gun, or any other weapon?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
f. Attack you with a knife, gun, or any other weapon?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
g. Physically force you to have sexual intercourse with him?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
h. Force you to perform any other sexual acts?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3