Survey Text

Afghanistan 2015 Ethiopia 2016 Nepal 2016 Togo 2013
Angola 2015 India 2015 Nigeria 2013 Uganda 2011
Benin 2017 Kenya 2014 Nigeria 2018 Uganda 2016
Burundi 2016 Malawi 2016 Pakistan 2017 Zambia 2013
Cameroon 2018 Mali 2012 Rwanda 2014 Zambia 2018
Chad 2014 Mali 2018 Senegal 2017 Zimbabwe 2015
Congo (Democratic Republic) 2013 Myanmar 2015 South Africa 2016
Egypt 2014 Namibia 2013 Tanzania 2015
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Afghanistan 2015
Survey form view entire document:  text 
1305A. Did your (last) husband ever do any of the following things to you:

a) push you, shake you, or throw something at you?
YES 1 (FOLLOW UP WITH 1305B)
NO 2
b) slap you?
YES 1 (FOLLOW UP WITH 1305B)
NO 2
c) twist your arm or pull your hair?
YES 1 (FOLLOW UP WITH 1305B)
NO 2
d) punch you with his fist or with something that could hurt you?
YES 1 (FOLLOW UP WITH 1305B)
NO 2
e) kick you, drag you, or beat you up?
YES 1 (FOLLOW UP WITH 1305B)
NO 2
f) try to choke you or burn you on purpose?
YES 1 (FOLLOW UP WITH 1305B)
NO 2
g) threaten to attack you with a knife, gun, or other weapon?
YES 1 (FOLLOW UP WITH 1305B)
NO 2
h) physically force you to have sexual intercourse with him when you did not want to?
YES 1 (FOLLOW UP WITH 1305B)
NO 2
i) physically force you to perform any other sexual acts you did not want to?
YES 1 (FOLLOW UP WITH 1305B)
NO 2
j) force you with threats or in any other way to perform sexual acts you did not want to?
YES 1 (FOLLOW UP WITH 1305B)
NO 2

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Angola 2015
Survey form view entire document:  text 
1306. A. (Does/did) your (last) husband/partner ever:

A) PUSH YOU, SHAKE YOU, OR THROW SOMETHING AT YOU?
YES 1 (GO TO PART B)
NO 2 (GO TO NEXT QUESTION)
B) SLAP YOU?
YES 1 (GO TO PART B)
NO 2 (GO TO NEXT QUESTION)
C) TWIST YOUR ARM OR PULL YOUR HAIR?
YES 1 (GO TO PART B)
NO 2 (GO TO NEXT QUESTION)
D) PUNCH YOU WITH HIS FIST OR WITH SOMETHING THAT COULD HURT YOU?
YES 1 (GO TO PART B)
NO 2 (GO TO NEXT QUESTION)
E) KICK YOU, DRAG YOU OR BEAT YOU UP?
YES 1 (GO TO PART B)
NO 2 (GO TO NEXT QUESTION)
F) TRY TO CHOKE YOU OR BURN YOU ON PURPOSE?
YES 1 (GO TO PART B)
NO 2 (GO TO NEXT QUESTION)
G) THREATEN OR ATTACK YOU WITH A KNIFE, GUN OR ANY OTHER WEAPON?
YES 1 (GO TO PART B)
NO 2 (GO TO NEXT QUESTION)
H) PHYSICALLY FORCE YOU TO HAVE SEXUAL INTERCOURSE WITH HIM AGAINST YOUR WILL?
YES 1 (GO TO PART B)
NO 2 (GO TO NEXT QUESTION)
I) FORCE YOU TO PERFORM ANY OTHER SEXUAL ACTS AGAINST YOUR WILL?
YES 1 (GO TO PART B)
NO 2 (GO TO NEXT QUESTION)
J) THREATEN YOU IN SOME OTHER WAY TO PERFORM A SEXUAL ACT AGAINST YOUR WILL?
YES 1 (GO TO PART B)
NO 2 (GO TO NEXT QUESTION)

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

A) PUSH YOU, SHAKE YOU, OR THROW SOMETHING AT YOU?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
B) SLAP YOU?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
C) TWIST YOUR ARM OR PULL YOUR HAIR?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
D) PUNCH YOU WITH HIS FIST OR WITH SOMETHING THAT COULD HURT YOU?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
E) KICK YOU, DRAG YOU OR BEAT YOU UP?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
F) TRY TO CHOKE YOU OR BURN YOU ON PURPOSE?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
G) THREATEN OR ATTACK YOU WITH A KNIFE, GUN OR ANY OTHER WEAPON?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
H) PHYSICALLY FORCE YOU TO HAVE SEXUAL INTERCOURSE WITH HIM AGAINST YOUR WILL?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
I) FORCE YOU TO PERFORM ANY OTHER SEXUAL ACTS AGAINST YOUR WILL?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
J) THREATEN YOU IN SOME OTHER WAY TO PERFORM A SEXUAL ACT AGAINST YOUR WILL?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3

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Benin 2017
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) Ever 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) Ever slap you?
Yes 1
No 2
Often 1
Sometimes 2
Not in the last 12 months 3
c) Ever twist your arm or pull your hair?
Yes 1
No 2
Often 1
Sometimes 2
Not in the last 12 months 3
d) Ever 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) Ever kick you, drag you, or beat you up?
Yes 1
No 2
Often 1
Sometimes 2
Not in the last 12 months 3
f) Ever intentionally try to chock you or burn you?
Yes 1
No 2
Often 1
Sometimes 2
Not in the last 12 months 3
g) Ever 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) Ever 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) Ever 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) Ever 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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Burundi 2016
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 at all?

a) push you, shake you, or throw something at you?
A.
YES 1
NO 2
B.
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b) slap you?
A.
YES 1
NO 2
B.
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c) twist your arm or pull your hair?
A.
YES 1
NO 2
B.
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
d) punch you with his fist or with something that could hurt you?
A.
YES 1
NO 2
B.
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
e) kick you, drag you, or beat you up?
A.
YES 1
NO 2
B.
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
f) try to chock you or burn you?
A.
YES 1
NO 2
B.
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
g) threaten you with a knife, gun, or other type of weapon?
A.
YES 1
NO 2
B.
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
h) physically force you to have sexual intercourse with him even when you did not want to?
A.
YES 1
NO 2
B.
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
i) physically force you to perform other sexual acts you did not want to?
A.
YES 1
NO 2
B.
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
j) Force you with threats or in any other way to perform sexual acts you did not want to?
A.
YES 1
NO 2
B.
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

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Cameroon 2018
Survey form view entire document:  text 
1505.

A. Did your (last) (husband / partner) ever do any of the following things to you:
a) push you, shake you, or throw something at you?
YES 1
NO 2
b) slap you?
YES 1
NO 2
c) twist your arm or pull your hair?
YES 1
NO 2
d) punch you with his fist or with something that could hurt you?
YES 1
NO 2
e) kick you, drag you, or beat you up?
YES 1
NO 2
f) try to choke you or burn you on purpose?
YES 1
NO 2
g) threaten or attack you with a knife, gun, or other weapon?
YES 1
NO 2
h) physically force you to have sexual intercourse with him when you did not want to?
YES 1
NO 2
i) physically force you to perform any other sexual acts you did not want to?
YES 1
NO 2
j) force you with threats or in any other way to perform sexual acts you did not want to?
YES 1
NO 2
B. How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

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Chad 2014
Survey form view entire document:  text 
1105) 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 at all?

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

EVER
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

b) slap you?

EVER
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

c) twist your arm or pull your hair?

EVER
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

d) punch you with his fist or with something that could hurt you?

EVER
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

e) kick you, drag you, or beat you up?

EVER
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

f) try to chock you or burn you?

EVER
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

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

EVER
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

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

EVER
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

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

EVER
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

j) Force you with threats or in any other way to perform sexual acts you did not want to?

EVER
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

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Congo (Democratic Republic) 2013
Survey form view entire document:  text 
1305) A) Did your (last) (husband/partner) ever do any of the following things to you:

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

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

a) Push you, shake you, or throw something at you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b) Slap you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c) Twist your arm or pull your hair?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
d) Punch you with his fist or with something that could hurt you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
e) Kick you, drag you, or beat you up?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
f) Try to chock you or burn you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
g) Threaten you with a knife, gun, or other type of weapon?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
h) Physically force you to have sexual intercourse with him even when you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
i) Physically force you to perform other sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
j) Force you with threats or in any other way to perform sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

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Egypt 2014
Survey form view entire document:  text 
1105(A). Did your (last) husband ever do any of the following things to you:

a) push you, shake you, or throw something at you?
YES 1 (GO TO 1105B)
NO 2
b) slap you?
YES 1 (GO TO 1105B)
NO 2
c) twist your arm or pull your hair?
YES 1 (GO TO 1105B)
NO 2
d) punch you with his fist or with something that could hurt you?
YES 1 (GO TO 1105B)
NO 2
e) kick you, drag you, or beat you up?
YES 1 (GO TO 1105B)
NO 2
f) try to choke you or burn you on purpose?
YES 1 (GO TO 1105B)
NO 2
g) threaten to attack you with a knife, gun, or other weapon?
YES 1 (GO TO 1105B)
NO 2
h) physically force you to have sexual intercourse with him when you did not want to?
YES 1 (GO TO 1105B)
NO 2
i) physically force you to perform any other sexual acts did you not want to?
YES 1 (GO TO 1105B)
NO 2
j) force you with threats or in any other way to perform sexual acts you did not want to?
YES 1 (GO TO 1105B)
NO 2

1105B. How often did this happen during the last 12 months: often, only sometimes, or not at all?

a) push you, shake you, or throw something at you?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
b) slap you?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
c) twist your arm or pull your hair?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
d) punch you with his fist or with something that could hurt you?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
e) kick you, drag you, or beat you up?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
f) try to choke you or burn you on purpose?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
g) threaten to attack you with a knife, gun, or other weapon?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
h) physically force you to have sexual intercourse with him when you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
i) physically force you to perform any other sexual acts did you not want to?
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?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3

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Ethiopia 2016
Survey form view entire document:  text 
1405A. Did your (last) (husband/partner) ever do any of the following things to you:

a. Push you, shake you, or throw something at you?
YES 1 (GO TO 1405B)
NO 2 (GO TO b)
b. Slap you?
YES 1 (GO TO 1405B)
NO 2 (GO TO c)
c. Twist your arm or pull your hair?
YES 1 (GO TO 1405B)
NO 2 (GO TO d)
d. Punch you with his fist or with something that could hurt you?
YES 1 (GO TO 1405B)
NO 2 (GO TO e)
e. Kick you, drag you, or beat you up?
YES 1 (GO TO 1405B)
NO 2 (GO TO f)
f. Try to choke you or burn you on purpose?
YES 1 (GO TO 1405B)
NO 2 (GO TO g)
g. Threaten or attack you with a knife, gun, or other weapon?
YES 1 (GO TO 1405B)
NO 2 (GO TO h)
h. Physically force you to have sexual intercourse with him when you did not want to?
YES 1 (GO TO 1405B)
NO 2 (GO TO i)
i. Physically force you to perform any other sexual acts you did not want to?
YES 1 (GO TO 1405B)
NO 2 (GO TO j)
j. Force you with threats or in any other way to perform sexual acts you did not want to?
YES 1 (GO TO 1405B)
NO 2 (GO TO 1406)

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India 2015
Survey form view entire document:  text 
1107A. Now if you will permit me, I need to ask some more questions about your relationship with you (last) husband. (Does/did) your (last) husband ever:

a. Push you, shake you, or throw something at you?
YES 1 (GO TO 1107B-a)
NO 2 (GO TO 1107A-b)
b. Twist your arm or pull your hair?
YES 1 (GO TO 1107B-b)
NO 2 (GO TO 1107A-c)
c. Slap you?
YES 1 (GO TO 1107B-c)
NO 2 (GO TO 1107A-d)
d. Punch you with his fist or with something that could hurt you?
YES 1 (GO TO 1107B-d)
NO 2 (GO TO 1107A-e)
e. Kick you, drag you or beat you up?
YES 1 (GO TO 1107B-e)
NO 2 (GO TO 1107A-f)
f. Try to choke you or burn you on purpose?
YES 1 (GO TO 1107B-f)
NO 2 (GO TO 1107A-g)
g. Threaten to attack you with a knife, gun, or any other weapon?
YES 1 (GO TO 1107B-g)
NO 2 (GO TO 1107A-h)
h. Physically force you to have sexual intercourse with him even when you did not want to?
YES 1 (GO TO 1107B-h)
NO 2 (GO TO 1107A-i)
i. Physically force you to perform any other sexual acts you did not want to?
YES 1 (GO TO 1107B-i)
NO 2 (GO TO 1107A-j)
j. Force you with threats or in any other way to perform sexual acts you did not want to?
YES 1 (GO TO 1107B-j)
NO 2

1107B. How often did this happen during the last 12 months: often, only sometimes, or not at all?

a. Push you, shake you, or throw something at you?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
b. Twist your arm or pull your hair?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
c. Slap you?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
d. Punch you with his fist or with something that could hurt you?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
e. Kick you, drag you or beat you up?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
f. Try to choke you or burn you on purpose?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
g. Threaten to attack you with a knife, gun, or any other weapon?
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?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
i. Physically force you to perform any other sexual acts you did not want to?
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?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3

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Kenya 2014

No questionnaire text is available for this sample.


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Malawi 2016
Survey form view entire document:  text 
1305A. Did your (last) (husband/partner) ever do any of the following things to you:

a. Push you, shake you, or throw something at you?
YES 1 (GO TO 1305B)
NO 2 (GO TO b)
b. Slap you?
YES 1 (GO TO 1305B)
NO 2 (GO TO c)
c. Twist your arm or pull your hair?
YES 1(GO TO 1305B)
NO 2 (GO TO d)
d. Punch you with his fist or with something that could hurt you?
YES 1 (GO TO 1305B)
NO 2 (GO TO e)
e. Kick you, drag you, or beat you up?
YES 1 (GO TO 1305B)
NO 2 (GO TO f)
f. Try to choke you or burn you on purpose?
YES 1 (GO TO 1305B)
NO 2 (GO TO g)
g. Threaten or attack you with a knife, gun, or other weapon?
YES 1 (GO TO 1305B)
NO 2 (GO TO h)
h. Physically force you to have sexual intercourse with him when you did not want to?
YES 1 (GO TO 1305B)
NO 2 (GO TO i)
i. Physically force you to perform any other sexual acts you did not want to?
YES 1 (GO TO 1305B)
NO 2 (GO TO j)
j. Force you with threats or in any other way to perform sexual acts you did not want to?
YES 1 (GO TO 1305B)
NO 2 (GO TO 1306)

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Mali 2012
Survey form view entire document:  text 
1405A) Did your (last) (husband/partner) ever do any of the following things to you:

1405B) IF YES: How often did this happen during the last 12 months: often, only sometimes, or not at all?

a) push you, shake you, or throw something at you?
b) slap you?
c) twist your arm or pull your hair?
d) punch you with his fist or with something that could hurt you?
e) kick you, drag you, or beat you up?
f) try to choke you or burn you on purpose?
g) threaten you or attack you with a knife, gun, or other type of weapon?
h) physically force you to have sexual intercourse with him even when you did not want to?
i) physically force you to perform other sexual acts you did not want to?
j) force you with threats or in any other way to perform sexual acts you did not want to?

a) PUSH YOU, SHAKE YOU, OR THROW SOMETHING AT YOU?
YES 1 (GO TO NEXT RESPONSE SET)
NO 2 (GO TO 1404A-B)
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b) SLAP YOU?
YES 1 (GO TO NEXT RESPONSE SET)
NO 2 (GO TO 1404A-C)
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c) TWIST YOUR ARM OR PULL YOUR HAIR?
YES 1 (GO TO NEXT RESPONSE SET)
NO 2 (GO TO 1404A-D)
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
d) PUNCH YOU WITH HIS FIST OR WITH SOMETHING THAT COULD HURT YOU?
YES 1 (GO TO NEXT RESPONSE SET)
NO 2 (GO TO 1404A-E)
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
e) KICK YOU, DRAG YOU, OR BEAT YOU UP?
YES 1 (GO TO NEXT RESPONSE SET)
NO 2 (GO TO 1404A-F)
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
f) TRY TO CHOKE YOU OR BURN YOU ON PURPOSE?
YES 1 (GO TO NEXT RESPONSE SET)
NO 2 (GO TO 1404A-G)
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
g) THREATEN YOU OR ATTACK YOU WITH A KNIFE, GUN, OR OTHER TYPE OF WEAPON?
YES 1 (GO TO NEXT RESPONSE SET)
NO 2 (GO TO 1404A-H)
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
h) PHYSICALLY FORCE YOU TO HAVE SEXUAL INTERCOURSE WITH HIM EVEN WHEN YOU DID NOT WANT TO?
YES 1 (GO TO NEXT RESPONSE SET)
NO 2 (GO TO 1404A-I)
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
i) PHYSICALLY FORCE YOU TO PERFORM OTHER SEXUAL ACTS YOU DID NOT WANT TO?
YES 1 (GO TO NEXT RESPONSE SET)
NO 2 (GO TO 1404A-J)
OFTEN 1
SOMETIMES 2
NOT IN 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 (GO TO NEXT RESPONSE SET)
NO 2 (GO TO 1406)
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

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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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Myanmar 2015
Survey form view entire document:  text 
1205) A: Did your (last) husband 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 at all?

a) push you, shake you, or throw something at you?
YES 1
NO 2 (GO TO 1205b)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
b) slap you?
YES 1
NO 2 (GO TO 1205c)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
c) twist your arm or pull your hair?
YES 1
NO 2 (GO TO 1205d)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
d) punch you with his fist or something that could hurt you?
YES 1
NO 2 (GO TO 1205e)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
e) kick you, drag you, or beat you up?
YES 1
NO 2 (GO TO 1205f)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
f) try to choke you or burn you on purpose?
YES 1
NO 2 (GO TO 1205g)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
g) threaten or attack you with a knife, gun, or other weapon?
YES 1
NO 2 (GO TO 1205h)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
h) physically force you to have sexual intercourse with him when you did not want to?
YES 1
NO 2 (GO TO 1205i)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
i) physically force you to perform any other sexual acts you did not want to?
YES 1
NO 2 (GO TO 1205j)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
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 (GO TO 1206)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3

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Namibia 2013
Survey form view entire document:  text 
1205) A) Did your (last) (husband/partner) ever do any of the following things to you:

a) Push you, shake you, or throw something at you?
YES 1
NO 2
b) Slap you?
YES 1
NO 2
c) twist your arm or pull your hair?
YES 1
NO 2
d) punch you with his fist or with something that could hurt you?
YES 1
NO 2
e) kick you, drag you, or beat you up?
YES 1
NO 2
f) try to choke you or burn you on purpose?
YES 1
NO 2
g) threaten or attack you with a knife, gun, or other weapon?
YES 1
NO 2
h) physically force you to have sexual intercourse with him when you did not want to?
YES 1
NO 2
i) physically force you to perform any other sexual acts you did not want to?
YES 1
NO 2
j) force you with threats or in any other way to perform sexual acts you did not want to?
YES 1
NO 2

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

a) push you, shake you, or throw something at you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b) slap you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c) twist your arm or pull your hair?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
d) punch you with his first or with something that could hurt you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
e) kick you, drag you, or beat you up?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
f) try to choke you or burn you on purpose?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
g) threaten or attack you with a knife, gun, or other weapon?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
h) physically force you to have sexual intercourse with him when you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
i) physically force you to perform any other sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
j) force you with threats or in any other way to perform sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

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Nepal 2016
Survey form view entire document:  text 
1305A. Did your (last) (husband/partner) ever do any of the following things to you:

a. push you, shake you, or throw something at you?
YES 1 (GO TO 1305B)
NO 2
b. slap you?
YES 1 (GO TO 1305B)
NO 2
c. twist your arm or pull your hair?
YES 1 (GO TO 1305B)
NO 2
d. punch you with his fist or with something that could hurt you?
YES 1 (GO TO 1305B)
NO 2
e. kick you, drag you, or beat you up?
YES 1 (GO TO 1305B)
NO 2
f. try to choke you or burn you on purpose?
YES 1 (GO TO 1305B)
NO 2
g. threaten or attack you with a knife, gun, or other weapon?
YES 1 (GO TO 1305B)
NO 2
h. physically force you to have sexual intercourse with him when you did not want to?
YES 1 (GO TO 1305B)
NO 2
i. physically force you to perform any other sexual acts you did not want to?
YES 1 (GO TO 1305B)
NO 2
j. force you with threats or in any other way to perform sexual acts you did not want to?
YES 1 (GO TO 1305B)
NO 2

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Nigeria 2013
Survey form view entire document:  text 
1305A) Did your (last) (husband/partner) ever do any of the following things to you:

a) push you, shake you, or throw something at you?
YES 1
NO 2
b) slap you?
YES 1
NO 2
c) twist your arm or pull your hair?
YES 1
NO 2
d) punch you with his fist or with something that could hurt you?
YES 1
NO 2
f) try to choke you or burn you on purpose?
YES 1
NO 2
g) threaten or attack you with a knife, gun, or other weapon?
YES 1
NO 2
h) physically force you to have sexual intercourse with him when you did not want to?
YES 1
NO 2
i) physically force you to perform any other sexual acts you did not want to?
YES 1
NO 2
j) force you with threats or in any other way to perform sexual acts you did not want to?
YES 1
NO 2

1305B) How often did this happen during the last 12 months: often, only sometimes, or not at all?

a) push you, shake you, or throw something at you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b) slap you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c) twist your arm or pull your hair?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
d) punch you with his fist or with something that could hurt you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
f) try to choke you or burn you on purpose?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
g) threaten or attack you with a knife, gun, or other weapon?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
h) physically force you to have sexual intercourse with him when you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
i) physically force you to perform any other sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
j) force you with threats or in any other way to perform sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

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Nigeria 2018
Survey form view entire document:  text 
1505A. Did your (last) (husband/partner) ever do any of the following things to you:

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

EVER
YES 1
NO 2
OFTEN
YES 1
NO 2
SOMETIMES
YES 1
NO 2
NOT IN THE LAST 12 MONTHS
YES 1
NO 2

b) slap you?

EVER
YES 1
NO 2
OFTEN
YES 1
NO 2
SOMETIMES
YES 1
NO 2
NOT IN THE LAST 12 MONTHS
YES 1
NO 2

c) twist your arm or pull your hair?

EVER
YES 1
NO 2
OFTEN
YES 1
NO 2
SOMETIMES
YES 1
NO 2
NOT IN THE LAST 12 MONTHS
YES 1
NO 2

d) punch you with his fist or with something that could hurt you?

EVER
YES 1
NO 2
OFTEN
YES 1
NO 2
SOMETIMES
YES 1
NO 2
NOT IN THE LAST 12 MONTHS
YES 1
NO 2

e) kick you, drag you, or beat you up?

EVER
YES 1
NO 2
OFTEN
YES 1
NO 2
SOMETIMES
YES 1
NO 2
NOT IN THE LAST 12 MONTHS
YES 1
NO 2

f) try to choke you or burn you on purpose?

EVER
YES 1
NO 2
OFTEN
YES 1
NO 2
SOMETIMES
YES 1
NO 2
NOT IN THE LAST 12 MONTHS
YES 1
NO 2

g) threaten or attack you with a knife, gun, or other weapon?

EVER
YES 1
NO 2
OFTEN
YES 1
NO 2
SOMETIMES
YES 1
NO 2
NOT IN THE LAST 12 MONTHS
YES 1
NO 2

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

EVER
YES 1
NO 2
OFTEN
YES 1
NO 2
SOMETIMES
YES 1
NO 2
NOT IN THE LAST 12 MONTHS
YES 1
NO 2

i) physically force you to perform any other sexual acts you did not want to do?

EVER
YES 1
NO 2
OFTEN
YES 1
NO 2
SOMETIMES
YES 1
NO 2
NOT IN THE LAST 12 MONTHS
YES 1
NO 2

j) force you with threats or in any other way to preform sexual acts you did not want to?

EVER
YES 1
NO 2
OFTEN
YES 1
NO 2
SOMETIMES
YES 1
NO 2
NOT IN THE LAST 12 MONTHS
YES 1
NO 2

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Pakistan 2017
Survey form view entire document:  text 
1205) Did you (last) husband ever do any of the following things to you:

a) push you, shake you, or throw something at you?
YES 1
NO 2 (GO TO b)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b) slap you?
YES 1
NO 2 (GO TO c)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c) twist your arm or pull your hair?
YES 1
NO 2 (GO TO d)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
d) punch you with his fist or with something that could hurt you?
YES 1
NO 2 (GO TO e)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
e) kick you, drag you, or beat you up?
YES 1
NO 2 (GO TO f)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
f) try to choke you or burn you on purpose?
YES 1
NO 2 (GO TO g)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
g) threaten or attack you with a knife, gun, or other weapon?
YES 1
NO 2 (GO TO h)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
h) physically force you to have sexual intercourse with him when you did not want to?
YES 1
NO 2 (GO TO i)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
i) physically force you to perform any other sexual acts you did not want?
YES 1
NO 2 (GO TO j)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN 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 (GO TO 1206)
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

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Rwanda 2014
Survey form view entire document:  text 
DV05-A) Did your (last) (husband/partner) ever do any of the following things to you:

a) Push you, shake you, or throw something at you?
YES 1 (GO TO DV05-Ba)
NO 2 (GO TO DV05-Ab)
b) Slap you?
YES 1 (GO TO DV05-Bb)
NO 2 (GO TO DV05-Ac)
c) Twist your arm or pull your hair?
YES 1 (GO TO DV05-Bc)
NO 2 (GO TO DV05-Ad)
d) Punch you with his fist or with something that could hurt you?
YES 1 (GO TO DV05-Bd)
NO 2 (GO TO DV05-Ae)
e) Kick you, drag you, or beat you up?
YES 1 (GO TO DV05-Be)
NO 2 (GO TO DV05-Af)
f) Try to choke you or burn you on purpose?
YES 1 (GO TO DV05-Bf)
NO 2 (GO TO DV05-Ag)
g) Threaten you attack you with a knife, gun, or other weapon?
YES 1 (GO TO DV05-Bg)
NO 2 (GO TO DV05-Ah)
h) Physically force you to have sexual intercourse with him when you did not want to?
YES 1 (GO TO DV05-Bh)
NO 2 (GO TO DV05-Ai)
i) Physically force you to perform any other sexual acts you did not want to?
YES 1 (GO TO DV05-Bi)
NO 2 (GO TO DV05-Aj)
j) Force you with threats or in any other way to perform sexual acts you did not want to?
YES 1 (GO TO DV05-Bj)
NO 2

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Senegal 2017
Survey form view entire document:  text 
1506) 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 at all?

a) push you, shake you, or throw something at you?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
b) slap you?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
c) twist your arm or pull your hair?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
d) punch you with his fist or with something that could hurt you?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
e) kick you, drag you, or beat you up?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
f) try to choke you or burn you?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
g) threaten you with a knife, gun, or other type of weapon?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT AT ALL 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 AT ALL 3
i) physically force you to perform other sexual acts you did not want to?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT AT ALL 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 AT ALL 3

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South Africa 2016
Survey form view entire document:  text 
1505) A) Did your (last) partner ever do any of the following things to you:
a) slap you, push you, shake you, or throw something at you?
e) kick you, drag you, or beat you up?
f) try to choke you or burn you on purpose?
g) threaten or attack you with a knife, gun, or other weapon?
h) physically force you to have sexual intercourse with him when you did not want to?
i) physically force you to perform any other sexual acts you did not want to?
j) force you with threats or in any other way to perform sexual acts you did not want to?

A) SLAP, PUSH, ETC.
YES 1 (GO TO PART B)
NO 2
E) KICK, DRAG, BEAT
YES 1 (GO TO PART B)
NO 2
F) CHOKE, BURN
YES 1 (GO TO PART B)
NO 2
G) THREATEN/ATTACK WITH WEAPON
YES 1 (GO TO PART B)
NO 2
H) FORCE INTERCOURSE
YES 1 (GO TO PART B)
NO 2
I) FORCE OTHER SEXUAL ACTS
YES 1 (GO TO PART B)
NO 2
J) FORCE WITH THREATS TO PERFORM SEXUAL ACTS
YES 1 (GO TO PART B)
NO 2

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Tanzania 2015
Survey form view entire document:  text 
1405)

A. Did your (last) (husband/partner) ever do any of the following things to you:

a) push you, shake you, or throw something at you?
YES 1 (GO TO Ba)
NO 2 (GO TO Ab)
b) slap you?
YES 1 (GO TO Bb)
NO 2 (GO TO Ac)
c) twist your arm or pull your hair?
YES 1 (GO TO Bc)
NO 2 (GO TO Ad)
d) punch you with his fist or with something that could hurt you?
YES 1 (GO TO Bd)
NO 2 (GO TO Ae)
e) kick you, drag you, or beat you up?
YES 1 (GO TO Be)
NO 2 (GO TO Af)
f) try to choke you or burn you on purpose?
YES 1 (GO TO Bf)
NO 2 (GO TO Ag)
g) threaten or attack you with a knife, gun, or other weapon?
YES 1 (GO TO Bg)
NO 2 (GO TO Ah)
h) physically force you to have sexual intercourse with him when you did not want to?
YES 1 (GO TO Bh)
NO 2 (GO TO Ai)
i) physically force you to perform any other sexual acts you did not want to?
YES 1 (GO TO Bi)
NO 2 (GO TO Aj)
j) force you with threats or in any other way to perform sexual acts you did not want to?
YES 1 (GO TO Bj)
NO 2 (GO TO 1406)

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

a) push you, shake you, or throw something at you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b) slap you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c) twist your arm or pull your hair?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
d) punch you with his fist or with something that could hurt you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
e) kick you, drag you, or beat you up?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
f) try to choke you or burn you on purpose?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
g) threaten or attack you with a knife, gun, or other weapon?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
h) physically force you to have sexual intercourse with him when you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
i) physically force you to perform any other sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
j) force you with threats or in any other way to perform sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

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Togo 2013
Survey form view entire document:  text 
1405)
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 at all?

a) PUSH YOU, SHAKE YOU, OR THROW SOMETHING AT YOU?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b) SLAP YOU?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c) TWIST YOUR ARM OR PULL YOUR HAIR?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN 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 LAST 12 MONTHS 3
e) KICK YOU, DRAG YOU, OR BEAT YOU UP?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
f) TRY TO CHOCK YOU OR BURN YOU?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN 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 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 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 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 LAST 12 MONTHS 3

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Uganda 2011
Survey form view entire document:  text 
1105) A) Did your (last) husband/partner ever do any of the following things to you:

a) push you, shake you, or throw something at you?
YES 1
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
NO 2
b) slap you?
YES 1
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
NO 2
c) twist your arm or pull your hair?
YES 1
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
NO 2
d) punch you with his fist or with something that could hurt you?
YES 1
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
NO 2
e) kick you, drag you, or beat you up?
YES 1
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
NO 2
f) try to choke you or burn you on purpose?
YES 1
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
NO 2
g) threaten or attack you with a knife, gun, or other weapon?
YES 1
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
NO 2
h) physically force you to have sexual intercourse with him when you did not want to?
YES 1
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
NO 2
i) physically force you to perform any other sexual acts you did not want to?
YES 1
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
NO 2
j) force you with threats or in any other way to perform sexual acts you did not want to?
YES 1
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
NO 2

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Uganda 2016
Survey form view entire document:  text 
DV05) A. Did your (last) (husband/partner) ever do any of the following things to you:

a) push you, shake you, or throw something at you?
YES 1
NO 2
b) slap you?
YES 1
NO 2
c) twist your arm or pull your hair?
YES 1
NO 2
d) punch you with his fist or with something that could hurt you?
YES 1
NO 2
e) kick you, drag you, or beat you up?
YES 1
NO 2
f) try to choke you or burn you on purpose?
YES 1
NO 2
g) threaten or attack you with a knife, gun, or other weapon?
YES 1
NO 2
h) physically force you to have sexual intercourse with him when you did not want to?
YES 1
NO 2
i) physically force you to perform any other sexual acts you did not want to?
YES 1
NO 2
j) force you with threats or in any other way to perform sexual acts you did not want to?
YES 1
NO 2

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Zambia 2013
Survey form view entire document:  text 
1205B) How often did this happen during the last 12 months: often, only sometimes, or not at all?

a) Say or do something to humiliate you in front of others?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b) Threaten to hurt or harm you or someone you care about?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c) Insult you or make you feel bad about yourself?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

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Zambia 2018
Survey form view entire document:  text 
(1405) Did your (last) (husband/partner) ever do any of the following things to you:

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

YES 1 (SKIP TO (B))
NO 2


b) slap you?

YES 1 (SKIP TO (B))
NO 2


c) twist your arm or pull your hair?

YES 1 (SKIP TO (B))
NO 2


d) punch you with his fist or with something that could hurt you?

YES 1 (SKIP TO (B))
NO 2


e) kick you, drag you, or beat you up?

YES 1 (SKIP TO (B))
NO 2


f) try to choke you or burn you on purpose?

YES 1 (SKIP TO (B))
NO 2


g) threaten or attack you with a knife, gun, or other weapon?

YES 1 (SKIP TO (B))
NO 2


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

YES 1 (SKIP TO (B))
NO 2


i) physically force you to perform any other sexual acts you did not want to?

YES 1 (SKIP TO (B))
NO 2


j) force you with threats or in any other way to perform sexual acts you did not want to?

YES 1 (SKIP TO (B))
NO 2

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

OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS

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Zimbabwe 2015
Survey form view entire document:  text 
1305A. Did your (last) (husband/partner) ever do any of the following things to you:

a. push you, shake you, or throw something at you?
YES 1 (GO TO 1305B)
NO 2 (GO TO b)
b. slap you?
YES 1 (GO TO 1305B)
NO 2 (GO TO c)
c. twist your arm or pull your hair?
YES 1 (GO TO 1305B)
NO 2 (GO TO d)
d. punch you with his fist or with something that could hurt you?
YES 1 (GO TO 1305B)
NO 2 (GO TO e)
e. kick you, drag you, or beat you up?
YES 1 (GO TO 1305B)
NO 2 (GO TO f)
f. try to choke you or burn you on purpose?
YES 1 (GO TO 1305B)
NO 2 (GO TO g)
g. threaten or attack you with a knife, gun, or other weapon?
YES 1 (GO TO 1305B)
NO 2 (GO TO h)
h. physically force you to have sexual intercourse with him when you did not want to?
YES 1 (GO TO 1305B)
NO 2 (GO TO i)
i. physically force you to perform any other sexual acts you did not want to?
YES 1 (GO TO 1305B)
NO 2 (GO TO j)
j. force you with threats or in any other way to perform sexual acts you did not want to?
YES 1 (GO TO 1305B)
NO 2 (GO TO 1306)