1123. Who has done any of these things to physically hurt you while you were pregnant?
Anyone else?
RECORD ALL MENTIONED.
CURRENT HUSBAND/PARTNER A
FORMER HUSBAND/PARTNER B
CURRENT/FORMER BOYFRIEND C
FATHER/STEP-FATHER D
BROTHER/STEP-BROTHER E
OTHER RELATIVE F
IN-LAW G
OWN FRIEND/ACQUAINTANCE H
FAMILY FRIEND I
TEACHER J
EMPLOYER/SOMEONE AT WORK K
POLICE/SOLDIER L
PRIEST/RELIGIOUS LEADER M
STRANGER N
OTHER (SPECIFY)__________X