Survey Text

Burkina Faso 2010
Congo (Democratic Republic) 2007
Cote d'Ivoire 2011
Egypt 2005
Jordan 2007
Zimbabwe 2005
top
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)

top
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

top
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

top
Egypt 2005
Survey form view entire document:  text 
905B) How often did this happen during the last 12 months: often, only sometimes, or not at all?

1) push you, shake you, or throw something at you?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
NA 5
2) slap you or twist your arm?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
NA 5
3) punch you with his fist or with something that could hurt you?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
NA 5
4) kick you or drag you?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
NA 5
5) try to strangle you or burn you?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
NA 5
6) threaten you with a knife, gun, or other type of weapon?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
NA 5
7) attack you with a knife, gun, or other type of weapon?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
NA 5
8) physically force you to have sexual intercourse with him when you did not want to?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
NA 5

top
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

top
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