top

Burkina Faso 2010

Survey form view entire document: text

1321. 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

top

Cameroon 2004

Survey form view entire document: text

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

top

Cameroon 2011

Survey form view entire document: text

1119) Who physically harmed you while you were pregnant?

Anyone else?

RECORD ALL MENTIONED.

CURRENT HUSBAND/PARTNER A
MOTHER B
FATHER C
FATHER'S NEW WIFE D
MOTHER'S NEW HUSBAND E
SISTER/BROTHER F
SON/DAUGHTER G
OTHER RELATIVE H
EX-HUSBAND/EX-PARTNER I
CURRENT BOYFRIEND J
EX-BOYFRIEND K
MOTHER-IN-LAW L
FATHER-IN-LAW M
OTHER RELATIVE BY MARRIAGE N
TEACHER O
HEALTH PROFESSIONAL P
EMPLOYER/SOMEONE AT WORK Q
POLICE/SOLIDER/OFFICER R
PRIEST/RELIGIOUS LEADER S
STRANGER T
NEIGHBOR U
RELATION/ADMIRER V
OTHER (SPECIFY): ___ X

top

Congo (Democratic Republic) 2007

Survey form view entire document: text

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.

top

Cote d'Ivoire 2011

Survey form view entire document: text

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

top

India 2015

Survey form view entire document: text

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

top

Jordan 2007

Survey form view entire document: text

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

top

Jordan 2017

Survey form view entire document: text

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

top

Malawi 2004

Survey form view entire document: text

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

top

Mali 2006

Survey form view entire document: text

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

top

Rwanda 2005

Survey form view entire document: text

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

Burkina Faso 2010	Congo (Democratic Republic) 2007	Jordan 2007	Mali 2006
Cameroon 2004	Cote d'Ivoire 2011	Jordan 2017	Rwanda 2005
Cameroon 2011	India 2015	Malawi 2004

Survey Text