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Cameroon 2004

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1120) Has anyone ever hit, slapped, kicked or done anything else to hurt you physically while you were pregnant?

YES 1
NO 2 (GO TO 1122)

1121) How has done any of these things to physically hurt you while you were pregnant?

Anyone else?

RECORD ALL MENTIONED.

CURRENT HUSBAND/PARTNER A
MOTHER B
FATHER C
STEP-MOTHER D
STEP-FATHER E
SISTER F
BROTHER G
DAUGHTER H
SON I
LAST/EX-HUSBAND/EX-PARTNER J
CURRENT BOYFRIEND K
FORMER BOYFRIEND L
MOTHER-IN-LAW M
FATHER-IN-LAW N
OTHER FEMALE RELATIVE/IN-LAW O
OTHER MALE RELATIVE/IN-LAW P
FEMALE FRIEND/ACQUAINTANCE Q
MALE FRIEND/ACQUAINTANCE R
TEACHER S
EMPLOYER T
STRANGER U
OTHER (SPECIFY): ___ X

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Congo (Democratic Republic) 2007

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1012) Has anyone ever hit, slapped, kicked or done anything else to hurt you physically while you were pregnant?

YES 1
NO 2 (GO TO 1014)

1013) 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 B
FATHER C
STEP-MOTHER D
STEP-FATHER/MOTHER'S PARTNER E
SISTER F
BROTHER G
DAUGHTER H
SON I
EX-HUSBAND/EX-PARTNER J
FRIEND/CURRENT SEXUAL PARTNER K
EX-FRIEND/EX-SEXUAL PARTNER K
MOTHER-IN-LAW (HUSBAND'S MOTHER) M
FATHER-IN-LAW (HUSBAND'S FATHER) N
OTHER FEMALE IN-LAWS O
OTHER MALE IN-LAWS P
FEMALE FRIEND/ACQUAINTANCE Q
MALE FRIEND/ACQUAINTANCE R
TEACHER S
EMPLOYER T
STRANGER U
POLICE/SOLDIER V
OTHER (SPECIFY) _____ X

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.

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Cote d'Ivoire 2011

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1221) Who has done any of these things to physically hurt you while you were pregnant?
Anyone else?
RECORD ALL MENTIONED

MOTHER A
FATHER B
STEP-MOTHER C
STEP-FATHER/MOTHER'S PARTNER D
SISTER E
BROTHER F
DAUGHTER G
SON H
EX-HUSBAND/EX-PARTNER I
FRIEND/CURRENT SEX PARTNER J
EX-FRIEND/FORMER SEX PARTNER K
MOTHER-IN-LAW L
FATHER-IN-LAW M
OTHER FEMALE IN-LAW N
OTHER MALE IN-LAW O
FEMALE FRIEND/ACQUAINTANCE P
MALE FRIEND/ACQUAINTANCE Q
TEACHER R
EMPLOYER S
STRANGER T
OTHER_______ (SPECIFY) X

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Egypt 2005

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915) Who has done any of these things to physically hurt you while you were pregnant?

Anyone else?
RECORD ALL MENTIONED.

MOTHER A
FATHER B
STEP-MOTHER C
STEP-FATHER D
SISTER E
BROTHER F
DAUGHTER G
SON H
LATE/EX-HUSBAND I
MOTHER-IN-LAW J
FATHER-IN-LAW K
OTHER FEMALE RELATIVE/IN-LAW L
OTHER MALE RELATIVE/ IN-LAW M
FEMALE FRIEND/ACQUAINTANCE N
MALE FRIEND/ACQUAINTANCE O
FEMALE TEACHER P
MALE TEACHER Q
FEMALE EMPLOYER R
MALE EMPLOYER S
STRANGER (FEMALE) T
STRANGER (MALE) U
OTHER (SPECIFY) ___________ X

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Jordan 2007

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1113) Who has done any of these things to physically hurt you while you were pregnant?

Anyone else?

RECORD ALL MENTIONED.

CURRENT HUSBAND A
MOTHER B
FATHER C
STEP-MOTHER D
STEP-FATHER E
BROTHER F
SISTER G
SON H
DAUGHTER I
EX-HUSBAND J
MOTHER-IN-LAW K
FATHER-IN-LAW L
OTHER FEMALE RELATIVE/IN-LAW M
OTHER MALE RELATIVE/ IN-LAW N
FEMALE FRIEND/ACQUAINTANCE O
MALE FRIEND/ACQUAINTANCE P
FEMALE TEACHER Q
MALE TEACHER R
FEMALE EMPLOYER S
MALE EMPLOYER T
FEMALE STRANGER U
MALE STRANGER V
POLICE/SOLDIER W
OTHER (SPECIFY)_______ X

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Jordan 2012

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1221. Who has done any of these things to physically hurt you while you were pregnant?
Anyone else?
RECORD ALL MENTIONED.

CURRENT HUSBAND A
MOTHER B
FATHER C
STEP-MOTHER D
STEP-FATHER E
BROTHER F
SISTER G
SON H
DAUGHTER I
EX-HUSBAND J
MOTHER-IN-LAW K
FATHER-IN-LAW L
OTHER FEMALE RELATIVE/IN-LAW M
OTHER MALE RELATIVE/IN-LAW N
FEMALE FRIEND/ACQUAINTANCE O
MALE FRIEND/ACQUAINTANCE P
FEMALE TEACHER Q
MALE TEACHER R
FEMALE EMPLOYER S
MALE EMPLOYER T
FEMALE STRANGER U
MALE STRANGER V
POLICE/SOLDIER W
OTHER (SPECIFY) _____ X

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Jordan 2017

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

CURRENT HUSBAND A
FORMER HUSBAND B
MOTHER C
FATHER D
STEP-MOTHER E
STEP-FATHER F
BROTHER G
SISTER H
MOTHER IN-LAW I
FATHER IN-LAW J
OTHER FEMALE RELATIVE/IN-LAW K
OTHER MALE RELATIVE/IN-LAW L
FEMALE FRIEND/ACQUAINTANCE M
MALE FRIEND/ACQUAINTANCE N
FEMALE TEACHER O
MALE TEACHER P
FEMALE STRANGER Q
MALE STRANGER R
POLICE/SOLDIER S
OTHER (SPECIFY) ________________ X

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Malawi 2004

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DV21. 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 B
FATHER C
STEP-MOTHER D
STEP-FATHER E
SISTER F
BROTHER G
DAUGHTER H
SON I
LATE/EX-HUSBAND/EX-PARTNER J
CURRENT BOYFRIEND K
FORMER BOYFRIEND L
MOTHER-IN-LAW M
FATHER-IN-LAW N
OTHER FEMALE RELATIVE/IN-LAW O
OTHER MALE RELATIVE/ IN-LAW P
FEMALE FRIEND/ACQUAINTANCE Q
MALE FRIEND/ACQUAINTANCE R
TEACHER S
EMPLOYER T
STRANGER U
OTHER (SPECIFY) ________ X

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Mali 2006

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1021. Who physically attacked you during a pregnancy?
Someone else?
CIRCLE ALL MENTIONED.

MOTHER A
FATHER B
FATHER'S NEW WIFE C
MOTHER'S NEW HUSBAND/PARTNER D
SISTER E
BROTHER F
DAUGHTER G
SON H
EX-HUSBAND/EX -PARTNER I
CURRENT FRIEND/ SEXUAL PARTNER J
FORMER FRIEND/SEXUAL PARTNER K
MOTHER-IN-LAW L
FATHER-IN-LAW M
OTHER FEMALE RELATIVES IN LAW N
OTHER MALE RELATIVES IN LAW O
FEMALE FRIENDS P
MALE FRIENDS Q
INSTRUCTOR R
EMPLOYER S
STRANGER T
OTHERS (SPECIFY) __X

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Rwanda 2005

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1021. 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 B
FATHER C
STEP-MOTHER D
STEP-FATHER E
SISTER F
BROTHER G
DAUGHTER H
SON I
LATE/EX-HUSBAND/EX-PARTNER J
CURRENT BOYFRIEND K
MOTHER-IN-LAW M
FATHER-IN-LAW N
OTHER FEMALE RELATIVE/IN-LAW O
OTHER MALE RELATIVE/IN-LAW P
FEMALE FRIEND/ACQUAINTANCE Q
MALE FRIEND/ACQUAINTANCE R
TEACHER S
EMPLOYER T
STRANGER U
OTHER (SPECIFY)_____ X

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