Survey Text

Afghanistan 2015 Egypt 2008 Malawi 2004 Pakistan 2017
Angola 2015 Egypt 2014 Malawi 2010 Rwanda 2000
Bangladesh 2004 Ethiopia 2000 Malawi 2016 Rwanda 2005
Bangladesh 2007 Ethiopia 2005 Mali 2001 Rwanda 2008
Bangladesh 2011 Ethiopia 2011 Mali 2006 Rwanda 2010
Bangladesh 2014 Ethiopia 2016 Mali 2012 Rwanda 2014
Benin 2001 Ghana 2003 Morocco 2003 Senegal 2017
Benin 2006 Ghana 2008 Mozambique 2003 South Africa 2016
Benin 2011 Ghana 2014 Mozambique 2011 Tanzania 2004
Benin 2017 Guinea 2005 Myanmar 2015 Tanzania 2010
Burkina Faso 2003 Guinea 2012 Namibia 2000 Tanzania 2015
Burkina Faso 2010 Guinea 2018 Namibia 2006 Uganda 2001
Burundi 2010 India 2005 Nepal 2001 Uganda 2006
Burundi 2016 Jordan 2007 Nepal 2006 Uganda 2011
Cameroon 2004 Jordan 2009 Nepal 2011 Uganda 2016
Cameroon 2011 Jordan 2012 Nepal 2016 Yemen 2013
Cameroon 2018 Jordan 2017 Niger 2006 Zambia 2007
Chad 2014 Kenya 2003 Niger 2012 Zambia 2013
Congo (Democratic Republic) 2007 Kenya 2008 Nigeria 2003 Zambia 2018
Congo (Democratic Republic) 2013 Kenya 2014 Nigeria 2008 Zimbabwe 1999
Cote d'Ivoire 2011 Liberia 2013 Nigeria 2013 Zimbabwe 2005
Egypt 2000 Madagascar 2003 Nigeria 2018 Zimbabwe 2010
Egypt 2003 Madagascar 2008 Pakistan 2006 Zimbabwe 2015
Egypt 2005 Malawi 2000 Pakistan 2012
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Afghanistan 2015
Survey form view entire document:  text 
323. Where did you obtain (CURRENT METHOD) the last time?

PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE________________
PUBLIC SECTOR
GOVT. HOSPITAL (NATIONAL, REGIONAL, PROVINCIAL OR DISTRICT) 11
CHC/POLYCLINIC 12
BASIC HEALTH CENTER 13
HEALTH SUB-CENTER 14
HEALTH POST/SUB-HEALTH POST 15
COMMUNITY HEALTH WORKER 16
MOBILE CLINIC 17
OTHER PUBLIC SECTOR__________18
NON-GOVERNMENT SECTOR
MARIE STOPES 21
RED CROSS SOCIETY 22
AFGA 23
OTHER NGO SECTOR_________26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PHARMACY 32
PRIVATE DOCTOR 33
FIELDWORKER 34
OTHER PRIVATE MEDICAL SECTOR_____________36
OTHER SOURCE
CHARITY FOUNDATION 41
REFUGEE CAMP 42
SHOP 43
FRIEND/RELATIVE 44
OTHER__________96

(GO TO 326)


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Angola 2015
Survey form view entire document:  text 
316) You first started using (CURRENT METHOD) in (DATE FROM 307 OR 308). Where did you get it at that time?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)___________
PUBLIC SECTOR
CENTRAL HOSPITAL 11
HOSPITAL IN PROVINCE 12
HOSPITAL IN RURAL AREA 13
HEALTH CENTER 14
MATERNITY WARD 15
MOBILE CLINIC 16
OTHER: (SPECIFY)____ 17
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC 21
PHARMACY 22
HEALTH CENTER 23
OTHER: (SPECIFY)____26
OTHER SOURCE
MARKET/STORE 31
FRIEND/RELATIVE 32
OTHER: (SPECIFY)____96

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Bangladesh 2004
Survey form view entire document:  text 
318. CHECK 311:

IN CURRENT MONTH IN COLUMN 1 OF CALENDAR, ENTER CALENDAR METHOD CODE SHOWN TO THE LEFT OF THE CALENDAR FOR THE HIGHEST METHOD CIRCLED IN 311. THEN DETERMINE WHEN SHE STARTED USING METHOD THIS TIME. ENTER METHOD CODE IN EACH MONTH OF USE. IF CURRENT METHOD STARTED IN JUNE 1998 OR LATER, ENTER METHOD SOURCE CODE IN COLUMN 2 OF CALENDAR IN THE SAME MONTH THAT USE OF CURRENT METHOD BEGAN.

ILLUSTRATIVE QUESTIONS:

When did you start using this method continuously?
How long have you been using this method continuously?
When you started using this method, where did you obtain it?

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Bangladesh 2007
Survey form view entire document:  text 
323) Where is that? Any other place? PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE THE NAME OF THE PLACE.

(NAME OF PLACE(S))____
PUBLIC SECTOR
HOSPITAL/MEDICAL COLLEGE A
FAMILY WELFARE CENTRE B
UPAZILA HEALTH COMPLEX C
SATELLITE CLINIC/EPI OUTREACH D
MATERNAL AND CHILD WELFARE CENTRE (MCWC) E
GOVERNMENT FIELD WORKER (FWA) F
COMMUNITY CLINIC G
OTHER (SPECIFY)____ H
NGO SECTOR
NGO STATIC CLINIC I
NGO SATELLITE CLINIC J
NGO DEPOT HOLDER K
NGO FIELD WORKER (FWA) L
OTHER (SPECIFY)____ M
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC N
QUALIFIED DOCTOR O
TRADITIONAL DOCTOR P
PHARMACY Q
OTHER PRIVATE MEDICAL (SPECIFY)____ R
OTHER SOURCE
SHOP S
FRIEND/RELATIVE T
OTHER (SPECIFY)____ X

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Bangladesh 2011
Survey form view entire document:  text 
311) I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years.

USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2006.
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

C IN COLUMN 1, ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.

ILLUSTRATIVE QUESTIONS:
When was the last time you used a method? Which method was that?
When did you start using that method? How long after the birth of (NAME()?
How long did you use the method then?

IN COLUMN 2, ENTER CODES FOR DISCONTINUATION NEXT TO THE LAST MONTH OF USE. NUMBER OF CODE SIN COLUMN 2 MUST BE SAME AS NUMBER OF INTERRUPTION OF METHOD USE IN COLUMN 1.

ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT.

ILLUSTRATIVE QUESTIONS:
Why did you stop using the (METHOD)? Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop for some other reason?
IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK: How many months did it take you to get pregnant after you stopped using (METHOD)? AND ENTER '0' IN EACH SUCH MONTH IN COLUMN 1.


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Bangladesh 2014

No questionnaire text is available for this sample.


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Benin 2001
Survey form view entire document:  text 
320) Where did you obtain (CURRENT METHOD) when you started using it?
320A) Where did you learn to use the lactational amenorrhea method (LAM)? IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE______
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
FIELDWORKER 14
COMMUNITY CENTER 15
STRAT AV HEALTH WORKER 16
HEALTH WORKER/COMMUNITY LIAISON 17
VENDING MACHINE 18
OTHER PUBLIC (SPECIFY)_____ 19
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
RELIGIOUS HOSPITAL 22
PHARMACY 23
ABPF (BENIN FAMILY ADVOCACY ASSOCIATION) 24
DOCTOR'S OFFICE 25
HEALTH AGENT (NGO) 26
OTHER PRIVATE MEDICAL (SPECIFY) ______ 27
OTHER SOURCE
SHOP/MARKET 31
CHURCH/MOSQUE 32
RELATIVES/FRIENDS 33
OTHER (SPECIFY)______ 96

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Benin 2006
Survey form view entire document:  text 
320) Where did you obtain (CURRENT METHOD) when you first started using it?
320A) Where did you learn to use the lactational amenorrhea method (LAM)?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE ________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
FIELDWORKER 14
COMMUNITY CENTER 15
STRAT AV HEALTH WORKER 16
HEALTH WORKER/ COMMUNITY LIAISON 17
VENDING MACHINE 18
OTHER PUBLIC (SPECIFY) ________ 19
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
RELIGIOUS HOSPITAL 22
PHARMACY 23
ABPF (BENIN FAMILY ADVOCACY ASSOCIATION) 24
DOCTOR'S OFFICE 25
HEALTH AGENT (NGO) 26
OTHER PRIVATE MEDICAL (SPECIFY) ________ 27
OTHER SOURCE
SHOP/MARKET 31
CHURCH/MOSQUE 32
RELATIVES/FRIENDS 33
BAR/SALOON 34
OTHER (SPECIFY) ________ 96
DON'T KNOW 98 (GO TO 328)

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Benin 2011
Survey form view entire document:  text 
315) You first started using (CURRENT METHOD) in (DATE FROM 308/308A). Where did you get it at that time?

315A) Where did you learn how to use the rhythm/lactational amenorrhea method?

PROBE TO IDENTITY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)_______
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
FIELDWORKER 14
SOCIAL CENTER 15
STRAT AV HEALTH WORKER 16
HEALTH WORKER/COMMUNITY LIAISON 17
VENDING MACHINE 18
OTHER PUBLIC SECTOR_______(SPECIFY) 19
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
RELIGIOUS HOSPITAL 22
PRIVATE DOCTOR'S OFFICE 23
PHARMACY 24
BENINESE FAMILY PLANNING ASSOCIATION (ABPF) 25
FIELDWORKER (NOG) 26
OTHER PRIVATE MEDICAL_______ (SPECIFY) 26
OTHER SOURCE
SHOP/MARKET 31
CHURCH/MOSQUE 32
FRIEND/RELATIVES 33
BAR/REFRESHMENT AREA 34
OTHER_______ (SPECIFY) 96

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Benin 2017
Survey form view entire document:  text 
316) You first started using (current method) in (date from 309). Where did you get it at that time?
Probe to identity the type of source.
If unable to determine if public or private sector, write the name of the place.
(Name of place)

Public sector
Govt. Hospital 11
Govt. Health Center 12
Mobile clinic 14
Fieldworker 15

Other public sector (specify) 16
Private medical sector
Private hospital/clinic 21
Pharmacy 22
Private doctor 23
Mobile clinic 24
Religious hospital 25
Other private medical (specify) 26
NGO
Family planning clinic 31
Other source
Shop 41
Church 42
Friend/relative 43

Other (specify) 96

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Burkina Faso 2003
Survey form view entire document:  text 
320. Where did you obtain (METHOD FROM 319) when you first began using it?

IF IT IS A PUBLIC HOSPITAL OR A PRIVATE HOSPITAL OR CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE______
PUBLIC SECTOR
HOSPITAL 11
HEALTH CENTER 12
DISPENSARY 13
MEDICAL POST 14
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE HEALTH CENTER 22
PHARMACY/MEDICINE DEPOT 23
PRIVATE DOCTOR 24
PF/FISA CENTER 25
OTHER SOURCE
DBC AGENT 31
STORE 32
KIOSK 33
CHURCH 34
RELATIVES/FRIENDS 35
OTHER (SPECIFY) _____ 96

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Burkina Faso 2010
Survey form view entire document:  text 
315. You first started using (CURRENT METHOD) in (DATE FROM 308/308A). Where did you get it at that time?
315A. Where did you learn how to use the rhythm/lactational amenorrhea method?

PROBE TO IDENTITY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE_______
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
OTHER (SPECIFY) _____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
OTHER PRIVATE MEDICAL (SPECIFY) _____ 26
OTHER SOURCE
COMMUNITY/VILLAGE FIELDWORKER 31
SHOP 32
CHURCH 33
FRIEND/RELATIVES 34
OTHER (SPECIFY) _____ 96

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Burundi 2010
Survey form view entire document:  text 
315) You first started using (CURRENT METHOD) in (DATE FROM 308/308A). Where did you get it at that time? (5)

Where did you learn how to use the rhythm/lactational amenorrhea method?

PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)___________
PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
FIELDWORKER 15
OTHER PUBLIC SECTOR (SPECIFY)_____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
FIELDWORKER 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)_____ 26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
OTHER (SPECIFY)______ 96

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Burundi 2016
Survey form view entire document:  text 
322) CHECK 318 AND 319:

ANY YES: At that time, were you told about other methods of family planning that you could use?

OTHER: When you obtained (CURRENT METHOD FROM 315) from (SOURCE OF METHOD FROM 307 OR 316), were you told about other methods of family planning that you could use?

YES 1 (GO TO 324)
NO 2

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Cameroon 2004
Survey form view entire document:  text 
320) Where did you obtain (CURRENT METHOD) when you started using it?

320A) Where did you learn to use the lactational amenorrhea method?

(IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.)

NAME OF PLACE: ___
PUBLIC/SEMIPUBLIC SECTOR
HOSPITAL 11
HEALTH CENTER 12
OTHER PUBLIC (SPECIFY): ___ 16
PRIVATE MEDICAL SECTOR
PRIVATE RELIGIOUS HOSPITAL 21
SECULAR HOSPITAL/CLINIC 22
HEALTH CENTER/RELIGIOUS CLINIC/MISSION 23
DOCTOR'S OFFICE (SPECIFY): ___ 24
PHARMACY 25
OTHER PRIVATE MEDICAL (SPECIFY): ___ 26
OTHER PRIVATE SECTOR
SHOP/MARKET 31
BAR/NIGHTCLUB 32
KIOSK 33
INFORMAL COMMERCIAL DISTRIBUTION 34
RELATIVES/FRIENDS 35
OTHER (SPECIFY): ___ 96

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Cameroon 2011
Survey form view entire document:  text 
324) Where did you obtain (CURRENT METHOD) when you started using it?

324A) Where did you learn to use the LAM/Periodic Abstinence/Rhythm Method?

IF UNABLE TO DETERMINE IF THE HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE: ___
PUBLIC/PARA PUBLIC SECTOR
HOSPITAL 11
HEALTH CENTER 12
OTHER PUBLIC (SPECIFY): ___ 16
PRIVATE MEDICAL SECTOR
PRIVATE RELIGIOUS HOSPITAL 21
PRIVATE SECULAR HOSPITAL/CLINIC 22
HEALTH CENTER/RELIGIOUS DISPENSARY/MISSION 23
MEDICAL OFFICE (SPECIFY): ___ 24
PHARMACY 25
OTHER PRIVATE MEDICAL (SPECIFY): ___ 26
OTHER PRIVATE SECTOR
SHOP/MARKET 31
RELIGIOUS INSTITUTION 32
FRIENDS/RELATIVES 33
OTHER SOURCE (SPECIFY): ___ 96

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Cameroon 2018
Survey form view entire document:  text 
316. You first started using (CURRENT METHOD) in (DATE FROM 309). Where did you get it at that time?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

PUBLIC MEDICAL SECTOR
GOVERNMENT HOSPITAL 11
INTEGRATED HEALTH CENTER / DISPENSARY 12
SUB-DIVISIONAL MEDICAL CENTER 13
OTHER PUBLIC SECTOR (SPECIFY)________ 16
PRIVATE MEDICAL SECTOR
CONFESSIONAL HOSPITAL / CLINIC 21
PRIVATE LAY HOSPITAL / CLINIC 22
CONFESSIONAL HEALTH CENTER / DISPENSARY 23
PHARMACY 24
DOCTOR'S OFFICE 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)__________ 26
OTHER SOURCE
SHOP / MARKET 31
CHURCH 32
FRIEND / RELATIVE 33
OTHER (SPECIFY)_________ 96

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Chad 2014
Survey form view entire document:  text 
323) Where did you obtain (CURRENT METHOD) the last time?
PROBE TO IDENTITY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)_________
PUBLIC SECTOR
HOSPITAL/MATERNITY 11
MILITARY HOSPITAL/GARRISON 12
FREE CLINIC 13
POLYCLINIC 14
PHARMACY OF HOSPITAL/HEALTH CENTER 15
OTHER PUBLIC SECTOR (SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL 21
CLINIC/DOCTOR'S OFFICE 22
CHADIAN ASSOCIATION FOR FAMILY WELL-BEING 23
PRIVATE HEALTH CENTER 24
BUSINESS HEALTH CENTER 25
CARE OFFICE/INFIRMARY 26
PHARMACY/PHARMACY DEPOT 27
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 28
PUBLIC/PRIVATE SECTOR
PHARMACY/VILLAGE HEALTH CENTER 31
Other
SHOP/BAR/MARKET 41
FIRST AID WORKER 42
TRAVELING VENDOR 43
FRIENDS/NEIGHBORS/RELATIVES 44
OTHER (SPECIFY) 96
DON'T KNOW 98

ALL SKIP TO 326


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Congo (Democratic Republic) 2007
Survey form view entire document:  text 
320) Where did you obtain (CURRENT METHOD) when you started using it?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) _________
PUBLIC SECTOR
HOSPITAL 11
CLINIC 12
HEALTH OUTPOST/CENTER 13
MATERNITY CENTER 14
OTHER PUBLIC (SPECIFY) _____16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/POLYCLINIC 21
PHARMACY 22
AMO-CONGO 23
HEALTH CENTER 24
MEDICAL OFFICE 25
TRAVELING NURSE 26
FIELDWORKER 27
OTHER PRIVATE MEDICAL (SPECIFY) _____29
OTHER SOURCE
SHOP 31
CHURCH 32
RELATIVES/FRIENDS 33
OTHER (SPECIFY) _____ 96

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Congo (Democratic Republic) 2013
Survey form view entire document:  text 
315) You first started using (CURRENT METHOD) in (DATE FROM 308/308A). Where did you get it at that time?

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Cote d'Ivoire 2011
Survey form view entire document:  text 
315) You first started using (CURRENT METHOD) in (DATE FROM 308/308A). Where did you get it at that time?

315a) Where did you learn how to use the rhythm/lactational amenorrhea method?
Probe to identity the type of source.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE)________

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
HEALTH AGENT 15
OTHER_____ (SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
HEALTH AGENT 25
OTHER PRIVATE MEDICAL__________ (SPECIFY) 26
OTHER SOURCE
SHOP 31
RELIGIOUS INSTITUTION 32
FRIEND/RELATIVES 33
OTHER__________ (SPECIFY) 96

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Egypt 2000
Survey form view entire document:  text 
323)Where did you first obtain/get advice about (METHOD) during your current period of use?

WRITE THE NAME AND ADDRESS OF THE PLACE WHERE THE RESPONDENT HAD OBTAINED THE METHOD/ADVICE. PROBE IF NECESSARY TO IDENTIFY THE TYPE OF SOURCE AND THEN CIRCLE THE APPROPRIATE CODE.

(NAME AND ADDRESS OF PLACE)________
OFFICE: CODE SOURCE____
MINISTRY OF HEALTH FACILITY (MOH)
URBAN HOSPITAL 1
URBAN HEALTH UNIT 2
RURAL HOSPITAL 3
RURAL HEALTH UNIT 4
MCH CENTER 5
MOBILE UNIT 6
OTHER MOH UNITS 7
OTHER GOVERNMENTAL FACILITY
TEACHING HOSPITAL 8
HEALTH INSURANCE ORGANIZATION 9
CURATIVE CARE ORGANIZATION A
OTHER GOVERNMENTAL B
NON-GOVERNMENTAL ORGANIZATIONS (NGO's)
EGYPT FAMILY PLANNING ASSOCIATION C
CSI PROJECT D
OTHER NON-GOVERNMENTAL E
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC F
PRIVATE DOCTOR G
PHARMACY H
OTHER PRIVATE SECTOR
MOSQUE HEALTH UNIT I
CHURCH HEALTH UNIT J
OTHER VENDOR (SHOP, KIOSK, ETC,.) K
FRIENDS/RELATIVES L
OTHER (SPECIFY)_______X
DON'T KNOW Z

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Egypt 2003
Survey form view entire document:  text 
316. CHECK 313:

USING PILL: Where did you obtain the packet of pills you are using now (you used most recently)?

USING INJECTABLES: Where did you go for your last injection?

USING CONDOM, DIAPHRAGM, FOAM, OR JELLY: From where did you obtain your most recent supply of (METHOD)?

USING IUD: Where did you have the IUD inserted?

USING IMPLANT: Where did you have the implant inserted?

SHE/HE STERILIZED: Where did the sterilization take place?

USING PERIODIC ABSTINENCE, WITHDRAWAL, PROLONGED BREASTFEEDING OR OTHER: Did you get advice from anyone about how to use (METHOD) at the time you began this current period of use?

WRITE THE NAME AND ADDRESS OF THE SOURCE FROM WHICH THE RESPONDENT OBTAINED THE METHOD. PROBE IF NECESSARY TO IDENTIFY THE TYPE OF SOURCE AND THEN CIRCLE THE APPROPRIATE CODE.

NAME AND ADDRESS OF PLACE________________
MINISTRY OF HEALTH FACILITY (MOH)
URBAN HOSPITAL 1
URBAN HEALTH UNIT 2
RURAL HOSPITAL 3
RURAL HEALTH UNIT 4
MCH CENTER 5
MOBILE UNIT 6
OTHER MOH UNITS 7
OTHER GOVERNMENTAL FACILITY
TEACHING HOSPITAL 8
HEALTH INSURANCE ORGANIZATION 9
CURATIVE CARE ORGANIZATION A
OTHER GOVERNMENTAL B
NON-GOVERNMENTAL ORGANIZATIONS (NGO's)
EGYPT FAMILY PLANNING ASSOCIATION C
CSI PROJECT D
OTHER NON-GOVERNMENTAL E
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC F
PRIVATE DOCTOR G
PHARMACY H
OTHER PRIVATE SECTOR
MOSQUE HEALTH UNIT I
CHURCH HEALTH UNIT J
OTHER VENDOR (SHOP,KIOSK, ETC.,) K
FRIENDS/RELATIVES L
OTHER___________X
NO ONE Y

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Egypt 2005
Survey form view entire document:  text 
324) Where did you first obtain/get advice about (METHOD) during your current period of use?

IF SOURCE IS HOSPITAL, HEALTH UNIT, OR CLINIC, WRITE THE NAME AND THE ADDRESS OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME AND ADDRESS OF PLACE) ________________________________

FOR OFFICE USE:
SOURCE CODE __ __ __ __ __ __ __ __

MINISTRY OF HEALTH
URBAN HOSP'L (GENERAL/DISTRICT) 1
URBAN HEALTH UNIT 2
HEALTH OFFICE 3
RURAL HOSP'L (COMPLEMENTARY) 4
RURAL HEALTH UNIT 5
MCH CENTER 6
MOBILE UNIT 7
OTHER GOVERNMENTAL
UNIVERSITY HOSPITAL 8
TEACHING HOSPITAL 9
HEALTH INSURANCE ORG A
CURATIVE CARE ORGANIZATION B
OTHER GOVERNMENTAL C
NON-GOVERNMENTAL ORGANIZATION
EGYPT FAMILY PLANNING ASSOC D
CSI PROJECT E
OTHER NON-GOVERNMENTAL F
PRIVATE MEDICAL
PRIVATE HOSPITAL/ CLINIC G
PRIVATE DOCTOR H
PHARMACY I
OTHER PRIVATE
MOSQUE HEALTH UNIT J
CHURCH HEALTH UNIT K
OTHER NON-MEDICAL
OTHER VENDOR (SHOP, KIOSK, ETC.,) L
FRIEND/RELATIVE M
OTHER (SPECIFY) __________ X
DON'T KNOW Z

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Egypt 2008
Survey form view entire document:  text 
324. Where did you first obtain/get advice about (METHOD) during your current period of use? IF SOURCE IS HOSPITAL, HEALTH UNIT, OR CLINIC, WRITE THE NAME AND THE ADDRESS OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME AND ADDRESS OF PLACE ____________

FOR OFFICE USE:
SOURCE CODE___________________

MINISTRY OF HEALTH AND POPULATION
URBAN HOSP'L (GENERAL/DISTRICT) 1
URBAN HEALTH UNIT 2
HEALTH OFFICE 3
RURAL HOSP'L (COMPLEMENTARY 4
RURAL HEALTH UNIT 5
MCH CENTER 6
MOBILE UNIT 7
OTHER GOVERNMENTAL
UNIVERSITY HOSPITAL 8
TEACHING HOSPITAL 9
HEALTH INSURANCE ORG A
CURATIVE CARE ORGANIZATION B
OTHER GOVERNMENTAL C
NON-GOVERNMENTAL ORGANIZATION
EGYPT FAMILY PLANNING ASSOC D
CSI PROJECT E
OTHER NON-GOVERNMENTAL F
PRIVATE MEDICAL
PRIVATE HOSPITAL/ CLINIC G
PRIVATE DOCTOR H
PHARMACY I
OTHER PRIVATE
MOSQUE HEALTH UNIT J
CHURCH HEALTH UNIT K
OTHER NON-MEDICAL
OTHER VENDOR (SHOP, KIOSK, ETC.,) L
FRIEND/RELATIVE M
OTHER (SPECIFY)___________ X
DON'T KNOW Z

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Egypt 2014
Survey form view entire document:  text 
315. You started using (CURRENT METHOD) in (DATE FROM 308A). Where did you get it at that time?

315A. Where did you have the IUD inserted when you started using it in (DATE FROM
308A)?

315B. Where did you have the implant inserted when you started using it in (DATE FROM 308A)?

315C. Did you obtain advice about how to use (CURRENT METHOD) when you started using it in (DATE FROM 308A)?

IF YES: from where did you get the advice?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE_________________________
MINISTRY OF HEALTH AND POPULATION
URBAN HOSP'L (GENERAL/DISTRICT) 11
URBAN HEALTH UNIT 12
HEALTH OFFICE 13
RURAL HOSP'L (CENTRAL) 14
RURAL HEALTH UNIT 15
MCH CENTER 16
MOBILE UNIT 17
OTHER GOVERNMENTAL
UNIVERSITY/TEACHING HOSPITAL 21
HEALTH INSURNACE ORGANIZATION 22
CURATIVE CARE ORGANIZATION 23
OTHER GOVERNMENTAL 26
NON-GOVERNMENTAL ORGANIZATION
EGYPT FAMILY PLANNING ASSOCIATION 31
CSI PROJECT 32
OTHER NON-GOVERNMENTAL 36
PRIVATE MEDICAL
PRIVATE HOSPITAL/CLINIC 41
PRIVATE DOCTOR 42
PHARMACY 43
OTHER PRIVATE MEDICAL
MOSQUE HEALTH UNIT 44
CHURCH HEALTH UNIT 45
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)______________46
OTHER NON-MEDICAL
VENDOR (SHOP, KIOSK, ETC) 61
FRIEND/RELATIVE 62
OTHER (SPECIFY)___________66
NO ONE 94
DON'T KNOW 98

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Ethiopia 2000
Survey form view entire document:  text 
319A. Where did you obtain (CURRENT METHOD) when you started using it the last time?
319B. Where did you learn to use (CURRENT METHOD)?
319C. Where did the sterilization take place?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME AND/LOCATION OF PLACE____

GOVERNMENT
HOSPITAL 11
HEALTH CENTER 12
HEALTH STATION/CLINIC 13
HEALTH POST 14
COMMUNITY-BASED OUTLET 15
OTHER GOVERNMENT (SPECIFY)__________16
NONGOVERNMENTAL (NGO)
HEALTH FACILITY 21
COMMUNITY-BASED OUTLETS 22
OTHER NGO (SPECIFY) ___________________26
PRIVATE MEDICAL
PRIVATE HOSPITAL 31
PRIVATE DOCTOR/CLINIC 32
PHARMACY 33
OTHER PRIVATE MEDICAL (SPECIFY)__________________ 36
OTHER SOURCE
DRUG VENDOR 41
SHOP 42
FRIEND/RELATIVE 43 (GO TO 330)
OTHER (SPECIFY)______________________ 46 (GO TO 330)
DID NOT CONSULT SOURCE 95 (GO TO 330)
DON'T KNOW 98 (GO TO 330)

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Ethiopia 2005
Survey form view entire document:  text 
322. I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years.

USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO MESKEREM 1992.
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

IN COLUMN 1, ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.

ILLUSTRATIVE QUESTIONS:
COLUMN 1:

* When was the last time you used a method? Which method was that?
* When did you start using that method? How long after the birth of (NAME)?
* How long did you use the method then?

IN COLUMN 2, ENTER METHOD SOURCE CODE IN FIRST MONTH OF EACH USE.
ILLUSTRATIVE QUESTIONS:
COLUMN 2:
* Where did you obtain the method when you started using it?
* Where did you get advice on how to use method [for LAM or rhythm]?

IN COLUMN 3, ENTER CODES FOR DISCONTINUATION NEXT TO LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 3 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1.
ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT.

ILLUSTRATIVE QUESTIONS:
COLUMN 3:
* Why did you stop using the (METHOD)?
* Did you become pregnant while using (METHOD), did you stop using to get pregnant, or did you stop for some other reason?

IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK:
* How many months did it take you to get pregnant after you stopped using (METHOD)?
AND ENTER '0' IN EACH SUCH MONTH IN COLUMN 1


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Ethiopia 2011
Survey form view entire document:  text 
315. You first started using (CURRENT METHOD FROM 314) in (DATE FROM 308A). Where did you get it at that time?

PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE _____
PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
GOVT. HEALTH STATION/CLINIC 13
GOVT. HEALTH POST/HEW 14
OTHER PUBLIC (SPECIFY) _____ 15
NGO
NGO HEALTH FACILITY 21
VOLUNTARY COMMUNITY HEALTH WORKERS 22
OTHER NGO (SPECIFY) _____ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL 31
PRIVATE CLINIC 32
PHARMACY 33
OTHER PRIVATE MEDICAL (SPECIFY) _____ 34
OTHER SOURCE
DRUG VENDOR/STORE 41
SHOP 42
FRIEND/RELATIVE 43
OTHER (SPECIFY) _____ 96

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Ethiopia 2016
Survey form view entire document:  text 
316. You first started using (CURRENT METHOD) in (DATE FROM 308 OR 309). Where did you get it at that time?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH STATION/CENTER 12
GOVERNMENT HEALTH POST 13
PUBLIC PHARMACY 14
OTHER PUBLIC SECTOR (SPECIFY) 16
NGO
HEALTH FACILITY 21
OTHER NGO HEALTH FACILITY (SPECIFY) 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL 31
PRIVATE CLINIC 32
PRIVATE PHARMACY 33
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36
OTHER SOURCE
SHOP 41
FRIEND/RELATIVE 42
OTHER (SPECIFY) 96

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Ghana 2003
Survey form view entire document:  text 
320) Where did you obtain (CURRENT METHOD) when you started using it?

320A) Where did you learn to use the lactational amenorrhea method?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE: ______________
PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
FIELDWORKER 15
OTHER PUBLIC (SPECIFY): ________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE HOSPITAL 23
MOBILE CLINIC 24
FIELDWORKER 25
OTHER PRIVATE MEDICAL (SPECIFY): __________ 26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
OTHER (SPECIFY): __________ 96

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Ghana 2008
Survey form view entire document:  text 
324. Where did you obtain (CURRENT METHOD) when you started using it?

324A. Where did you learn how to use the rhythm/lactational amenorrhoea method?

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ___________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC 11
GOVT. HEALTH CENTER 12
GOVT. HEALTH POST/CHIPS 13
FAMILY PLANNING CLINIC 14
MOBILE CLINIC 15
FIELDWORKER/OUTREACH/PEER EDUCATOR ______ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR 22
PHARMACY 23
CHEMICAL/DRUG STORE 24
FP/PPAG CLINIC 25
MATERNITY HOME 26
OTHER PRIVATE MEDICAL (SPECIFY) ____ 27
OTHER SOURCE
SHOP/MARKET 31
CHURCH 32
COMMUNITY VOLUNTEER 33
FRIEND/RELATIVE 34
OTHER (SPECIFY) ____ 96
DON'T KNOW 98

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Ghana 2014
Survey form view entire document:  text 
315) You first started using (CURRENT METHOD) in (DATE FROM 308/308A). Where did you get it at that time?

315A) Where did you learn how to use the rhythm/lactational amenorrhea method?

PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ___________________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC 11
GOVT. HEALTH CENTER/CLINIC 12
GOVT. HEALTH POST/CHPS 13
FAMILY PLANNING CLINIC 14
MOBILE CLINIC 15
FIELDWORKER/OUTREACH/PEER EDUCATOR 16
OTHER PUBLIC (SPECIFY) _____ 17
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR 22
PHARMACY 23
CHEMICAL/DRUG STORE 24
FP/PPAG CLINIC 25
MATERNITY HOME 26
OTHER PRIVATE MEDICAL (SPECIFY) _____ 27
OTHER SOURCE
SHOP/MARKET 31
CHURCH 32
COMMUNITY VOLUNTEER 33
FRIEND/RELATIVE 34
OTHER (SPECIFY) _____ 96

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Guinea 2005
Survey form view entire document:  text 
320. Where did you obtain (CURRENT METHOD) when you started using it?
320A. Where did you learn to use the lactational amenorrhea method?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE _____
PUBLIC SECTOR
HOSPITAL 11
HEALTH CENTER 12
MEDICAL POST 13
FAMILY PLANNING CLINIC 14
COMMUNITY WORKER 15
OTHER PUBLIC (SPECIFY) _____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
FIELDWORKER 25
OTHER PRIVATE MEDICAL (SPECIFY) ____ 26
OTHER SOURCE
SHOP 31
BAR/NIGHTCLUB 32
KIOSK 33
WORKPLACE 34
CHURCH 35
FRIENDS/ACQUAINTANCES/RELATIVES 36
OTHER (SPECIFY) _____ 96

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Guinea 2012
Survey form view entire document:  text 
315) You first started using (CURRENT METHOD) in (date from 308/308a). Where did you get it at that time?

315a) Where did you learn how to use the rhythm/lactational amenorrhea method?
PROBE TO IDENTITY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE)________________

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
FIELDWORKER 14
OTHER (SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
FIELDWORKER 24
OTHER PRIVATE MEDICAL (SPECIFY) 26
OTHER SOURCE
SHOP 31
BAR/NIGHTCLUB/HOTEL 32
FRIEND/RELATIVES 33
OTHER (SPECIFY) 96

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Guinea 2018
Survey form view entire document:  text 
316) You first started using (current method) in (date from 309). Where did you get it at that time?

PROBE TO IDENTITY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE___)

PUBLIC SECTOR
NATIONAL HOSPITAL 11
REGIONAL HOSPITAL 12
PREFECTURAL HOSPITAL/COMMUNAL MEDICAL CENTER 13
HEALTH CENTER 14
HEALTH POST 15
OTHER PUBLIC SECTOR (SPECIFY) 16


PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
PRIVATE HEALTH CLINIC 24
FAMILY PLANNING CLINIC/GUINEAN ASSOCIATION FOR FAMILY WELL-BEING 25


OTHER PRIVATE MEDICAL (SPECIFY) 26

OTHER SOURCE
SHOP 31
RELIGIOUS INSTITUTE 32
FRIENDS/PARENTS 33
COMMUNITY FIELDWORKER 34


OTHER (SPECIFY) 96

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India 2005

No questionnaire text is available for this sample.


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Jordan 2007
Survey form view entire document:  text 
332) Where did you obtain (CURRENT METHOD) the last time?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)__________________
PUBLIC MEDICAL SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HOSPITAL 12
GOVERNMENT MOTHER AND CHILD HEALTH CENTER 13
UNIVERSITY HOSPITAL/CLINIC 14
ROYAL MEDICAL SERVICES 15
OTHER PUBLIC (SPECIFY)____________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL CLINIC/CLINIC 21
PRIVATE DOCTOR 22
PHARMACY 23
JORDANIAN ASSOCIATION. OF FAMILY PLANNING AND PROTECTION (JAFPP) 24
UNITED NATIONS RELIEF AND WORKS AGENCY CLINIC 25
OTHER NON-GOVERNMENT ORGANIZATION 26
OTHER PRIVATE MEDICAL (SPECIFY)_________ 27
OTHER SOURCE
FRIEND/RELATIVE 33
OTHER (SPECIFY)_______ 96
(GO TO 335 FOR ALL)

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Jordan 2009
Survey form view entire document:  text 
322) Where did you obtain (CURRENT METHOD) the last time?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

PUBLIC MEDICAL SECTOR
GOVERNMENT HOSPITAL 11 (SKIP TO 401)
GOVERNMENT HEALTH CENTER 12 (SKIP TO 401)
GOVERNMENT MCH 13 (SKIP TO 401)
UNIVERSITY HOSPITAL /CLINIC 14 (SKIP TO 401)
ROYAL MEDICAL SERVICES 15 (SKIP TO 401)
OTHER PUBLIC (SPECIFY)________ 16 (SKIP TO 401)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21 (SKIP TO 401)
PRIVATE DOCTOR 22 (SKIP TO 401)
PHARMACY 23 (SKIP TO 401)
JORDANIAN AS. OF FP AND PROTECTION (JAFPP) 24 (SKIP TO 401)
UNRWA CLINIC 25 (SKIP TO 401)
OTHER NON-GOVERNMENT ORGANIZATION 26 (SKIP TO 401)
OTHER PRIVATE MEDICAL (SPECIFY) _________ 27 (SKIP TO 401)
OTHER SOURCE
FRIEND/RELATIVE 33 (SKIP TO 401)
OTHER (SPECIFY) ___________ 96 (SKIP TO 401)

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ____________

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Jordan 2012
Survey form view entire document:  text 
315. You first started using (CURRENT METHOD) in (DATE FROM 308/308A). Where did you get it at that time?

315A. Where did you learn to use the rhythm/lactational amenorrhea method?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ___________
PUBLIC MEDICAL SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
GOVT. MCH 13
UNIVERSITY HOSPITAL/CLINIC 14
ROYAL MEDICAL SERVICES 15
OTHER PUBLIC (SPECIFY) ______ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR 22
PHARMACY 23
JORDANIAN AS. OF FP AND PROTECTION (JAFPP) 24
UNRWA CLINIC 25
OTHER NON-GOV ORGANIZATION 26
OTHER PRIVATE MEDICAL (SPECIFY) _____ 27
OTHER SOURCE
FRIEND/RELATIVE 33
OTHER (SPECIFY) _____ 96

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Jordan 2017
Survey form view entire document:  text 
316) You first started using (CURRENT METHOD) in (DATE FROM 309). Where did you get it at that time?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) __________________________________
PUBLIC MEDICAL SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
GOVERNMENT MCH 13
UNIVERSITY HOSPITAL/CLINIC 14
ROYAL MEDICAL SERVICES 15
OTHER PUBLIC (SPECIFY) _______________________________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR 22
PHARMACY 23
JORDNIAN AS OF FP AND PROTECTION (JAFPP) 24
INSTITUTE FOR FAMILY HEALTH (IFH) 25
INTERNATIONAL RESCUE COMMITTEE (IRC) 26
UNRWA CLINIC 27
UNHCR/OTHER NGO 28
OTHER PRIVATE (SPECIFY) _____________________ 29
OTHER SOURCE
FRIEND/RELATIVE 31
OTHER (SPECIFY) __________________________ 96

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Kenya 2003
Survey form view entire document:  text 
328. Where did you obtain (CURRENT METHOD) the last time?

IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) _________

IF NURSING/MATERNITY HOME, ASK IF IT IS RUN BY A CHURCH OR MISSION. IF SO, CIRCLE CODE '21'.

PUBLIC SECTOR

GOVERNMENT HOSPITAL 11 (GO TO 331)
GOVERNMENT HEALTH CENTRE 12 (GO TO 331)
GOVERNMENT DISPENSARY 13 (GO TO 331)
OTHER PUBLIC (SPECIFY) _______ 16 (GO TO 331)
PRIVATE MEDICAL SECTOR
MISSION, CHURCH HOSP./CLINIC 21 (GO TO 331)
FPAK HEALTH CENTRE/CLINIC 22 (GO TO 331)
PRIVATE HOSPITAL OR CLINIC 23 (GO TO 331)
PHARMACY/CHEMIST 24 (GO TO 331)
NURSING/MATERNITY HOME 26 (GO TO 331)
OTHER SOURCE
MOBILE CLINIC 31 (GO TO 331)
COMMUNITY-BASED DISTRIBUTOR 41 (GO TO 331)
SHOP 51 (GO TO 331)
FRIEND/RELATIVE 61 (GO TO 331)
OTHER (SPECIFY) ________ 96 (GO TO 331)

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Kenya 2008
Survey form view entire document:  text 
324. Where did you obtain (CURRENT METHOD) when you started using it?

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ___________

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Kenya 2014
Survey form view entire document:  text 
322) CHECK 304:

CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION 01 (GO TO 326)
MALE STERILIZATION 02 (GO TO 326)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
MALE CONDOM 07
FEMALE CONDOM 08
LACTATIONAL AMEN. METHOD 11 (GO TO 326)
RHYTHM METHOD 12 (GO TO 326)
WITHDRAWAL 13 (GO TO 326)
OTHER MODERN METHOD 95 (GO TO 326)
OTHER TRADITIONAL METHOD 96 (GO TO 326)

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Liberia 2013
Survey form view entire document:  text 
315) You first started using (CURRENT METHOD) in (DATE FROM 308/308A). Where did you get it at that time?

315A) Where did you learn how to use the rhythm method/cyclebeads/ lactational amenorrhea method?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

(NAME OF PLACE)____
PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
GOVT. CLINIC 13
COMMUNITY HEALTH VOL/gCHV 14
OTHER PUBLIC SECTOR (SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
PLANNED PARENTHOOD ASSN. LIB. 24
MOBILE CLINIC 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
OTHER (SPECIFY) 96

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Madagascar 2003
Survey form view entire document:  text 
320. Where did you obtain (METHOD FROM 317A) when you first began using it?

IF IT IS A PUBLIC HOSPITAL OR A PRIVATE HOSPITAL OR CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE ______
PUBLIC SECTOR
DISTRICT HOSPITAL II [FACILITY EQUIPPED FOR SURGERIES] 11
DISTRICT HOSPITAL I [NON-SURGICAL MEDICAL CAPABILITIES] 12
BASIC HEALTH CENTER II [BASIC HEALTH CARE, PHYSICIAN-RUN] 13
BASIC HEALTH CENTER I [BASIC HEALTH CARE, RUN BY PARA-MEDICAL OFFICER] 14
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE HEALTH CENTER 22
PHARMACY/MEDICINE DISPENSARY 23
PRIVATE DOCTOR 24
PF/FISA CENTER 25
OTHER SOURCE
VBC AGENT 31
STORE 32
KIOSK 33
CHURCH 34
RELATIVES/FRIENDS 35
OTHER (SPECIFY) ______ 96

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Madagascar 2008
Survey form view entire document:  text 
324. Where did you obtain (CURRENT METHOD) when you started using it?
324A. Where did you learn how to use the necklace/lactational amenorrhea/rhythm method?

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS A PUBLIC OR PRIVATE INSTITUTION, WRITE THE NAME OF THE PLACE.

NAME OF PLACE _______
PUBLIC SECTOR
DISTRICT HOSPITAL II (facility equipped for surgeries) 11
DISTRICT HOSPITAL I (non-surgical medical capabilities) 12
UNIVERSITY/REGIONAL HOSPITAL 13
BASIC HEALTH CENTER II (basic health care, physician-run) 14
BASIC HEALTH CENTER I (basic health care, run by para-medical officer) 15
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE MOBILE CLINIC 22
PHARMACY 23
PRIVATE DOCTOR 24
FAMILY PLANNING CENTER 25
OTHER SOURCE
FIELDWORKER 31
MEDIA SPOTS 32
STORE 33
KIOSK 34
CHURCH 35
FRIEND/RELATIVE 36
OTHER (SPECIFY) _____ 96

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Malawi 2000
Survey form view entire document:  text 
319. Where did you obtain (CURRENT METHOD) when you started using it?
319A. Where did you learn to use the lactational amenorrhea method?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE______
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
CBDA/FIELD WORKER 15
OTHER PUBLIC (SPECIFY) ____ 16
MISSION
HOSPITAL 21
HEALTH CENTER 22
MOBILE CLINIC 23
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PHARMACY 32
PRIVATE DOCTOR 33
MOBILE CLINIC 34
CBDA/FIELD WORKER 35
OTHER PRIVATE MEDICAL (SPECIFY) _____ 36
BLM 41
OTHER SOURCE
SHOP 51
CHURCH 52
FRIEND/RELATIVE 53
OTHER (SPECIFY) _____ 96

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Malawi 2004
Survey form view entire document:  text 
318) I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years.
USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 1995. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

IN COLUMN 1, ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.

ILLUSTRATIVE QUESTIONS: COLUMN 1:

When was the last time you used a method? Which method was that?
When did you start using that method? How long after the birth of (NAME)?
How long did you use the method then?

IN COLUMN 2, ENTER METHOD SOURCE CODE IN FIRST MONTH OF EACH USE.

ILLUSTRATIVE QUESTIONS: COLUMN 2:

Where did you obtain the method when you started using it?
Where did you get advice on how to use the method [for lactational amenorrhea, rhythm, or withdrawal]?

IN COLUMN 3, ENTER CODES FOR REASON FOR DISCONTINUATION NEXT TO LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 3 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1.

ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT.

ILLUSTRATIVE QUESTIONS: COLUMN 3:

Why did you stop using the (METHOD)?
Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop for some other reason?

IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK:

How many months did it take you to get pregnant after you stopped using (METHOD)?
AND ENTER '0' IN EACH SUCH MONTH IN COLUMN 1.

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Malawi 2010
Survey form view entire document:  text 
324. Where did you obtain (CURRENT METHOD) when you started using it?
324A. Where did you learn how to use periodic abstinence?
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE_________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
GOVERNMENT HEALTH POST/OUTREACH 13
MOBILE CLINIC 14
HSA 15
CBDA/DOOR TO DOOR 16
OTHER PUBLIC 17
CHAM/MISSION
HOSPITAL 21
HEALTH CENTER 22
MOBILE CLINIC 23
DOOR TO DOOR 24
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 31
PHARMACY 32
MOBILE CLINIC 33
CBDA/DOOR TO DOOR 34
OTHER PRIVATE MEDICAL 36
BLM 41
MACRO 51
YOUTH DROP IN CENTRE 61
OTHER SOURCE
SHOP 71
CHURCH 72
FRIEND/RELATIVE 73
OTHER 96

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Malawi 2016
Survey form view entire document:  text 
316. You first started using (CURRENT METHOD) in (DATE FROM 308 OR 309). Where did you get it at that time?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
GOVERNMENT HEALTH POST/OUTREACH 13
MOBILE CLINIC 14
HSA 15
CBDA/DOOR TO DOOR 16
OTHER PUBLIC SECTOR (SPECIFY) 17
CHAM/MISSION
HOSPITAL 21
HEALTH CENTER 22
MOBILE CLINIC 23
CBDA/DOOR TO DOOR 24
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL OR CLINIC 31
PHARMACY 32
PRIVATE DOCTOR 33
MOBILE CLINIC 34
CBDA/DOOR TO DOOR 34
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36
BLM 41
MACRO 51
YOUTH DROP IN CENTRE 61
OTHER SOURCE
SHOP 71
CHURCH 72
FRIEND OR RELATIVE 73
OTHER (SPECIFY) 96

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Mali 2001
Survey form view entire document:  text 
320) Where did you obtain (CURRENT METHOD) when you started using it?

320A) Where did you learn to use the lactational amenorrhea method?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE: ______________
PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
FIELDWORKER 15
OTHER PUBLIC (SPECIFY): ________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE HOSPITAL 23
MOBILE CLINIC 24
FIELDWORKER 25
OTHER PRIVATE MEDICAL (SPECIFY): __________ 26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
OTHER (SPECIFY): __________ 96

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Mali 2006
Survey form view entire document:  text 
320. Where did you get (CURRENT METHOD) when you started using it?

IF THE SOURCE IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF ESTABLISHMENT__
PUBLIC SECTOR
NATIONAL HOSPITAL 11
REGIONAL HOSPITAL 12
CSREF (heath referral center) 13
PMI (protection maternelle et infantile - a program created in France to give free care to expecting/recent mothers) /MATERNITY 14
CSCOM (Centre de Santé Communitaire) Community Health Center 15
OTHER PUBLIC (SPECIFY)__18
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC 21
DOCTOR'S OFFICE 23
HEALTH WARD 24
PHARMACY 25
MOBILE CLINIC 26
OTHER PRIVATE (SPECIFY)__28
OTHER SOURCE
SHOP 31
BAR/NIGHTCLUB 32
KIOSK 33
VENDER 34
ADBC (AGENTS DE DISTRIBUTION À BASE COMMUNAUTAIRE) -MOBILE COMMUNITY HEALTH DISTRIBUTION 35
FRIEND/ACQUAINTANCE/RELATIVE 36
OTHER (SPECIFY)__96

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Mali 2012
Survey form view entire document:  text 
315) You first started using (CURRENT METHOD) in (DATE FROM 308/308A). Where did you get it at that time?

315A) Where did you learn how to use the rhythm/lactational amenorrhea method?
PROBE TO IDENTITY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)______________
PUBLIC SECTOR
NATIONAL HOSPITAL 11
REGIONAL HOSPITAL 12
REFERRAL HEALTH CENTER (CSREF) 13
FREE CLINIC/MATERNITY 14
COMMUNITY HEALTH CENTER (CSCOM) 15
OTHER PUBLIC (SPECIFY) _____________ 16
PRIVATE SECTOR
PRIVATE CLINIC/OFFICE 21
PRIVATE HEALTH CARE OFFICE 22
TREATMENT ROOM 23
PHARMACY 24
COMMUNITY BASED AGENT 25
OTHER PRIVATE (SPECIFY) ________ 26
OTHER SOURCE
SHOP 31
BAR/NIGHTCLUB 32
KIOSK 33
TRAVELING VENDOR 34
FRIEND/ACQUAINTANCE/RELATIVES 35
OTHER (SPECIFY) __________ 96

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Morocco 2003
Survey form view entire document:  text 
320) Where did you first obtain this (CURRENT METHOD) when you start using it?
320A) Where did you learn to use the lactational amenorrhea method; breastfeeding up to 6 months after childbirth, so that your menstrual period does not return (where did you learn the method for counting the days of the cycle, for withdrawal)?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) ____________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
MATERNITY 12
HEALTH CENTER 13
DISPENSARY 14
HOME VISIT 15
MOBILE UNIT 16
OTHER PUBLIC (SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC 21
PHARMACY 22
DOCTOR/MID-WIFE 23
MOROCCAN ASSOCIATION FOR FAMILY PLANNING 24
OTHER PRIVATE MEDICAL (SPECIFY) 26
OTHER SOURCE
RELATIVE/FRIEND 31
MIDWIFE 32
OTHER (SPECIFY) 96 __________

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Mozambique 2003
Survey form view entire document:  text 
320. Where did you obtain (CURRENT METHOD) when you started using it?
320A. Where did you learn to use the lactational amenorrhea method?

IF SOURCE IS HOSPITAL, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE_____
PUBLIC SECTOR
CENTRAL HOSPITAL 11
PROVINCIAL/GENERAL HOSPITAL 12
RURAL HOSPITAL 13
HEALTH CENTER 14
MOBILE CLINIC 15
OTHER (SPECIFY) ____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL 21 (GO TO 321A)
PRIVATE CLINIC 22 (GO TO 321A)
PRIVATE DOCTOR 23 (GO TO 321A)
PRIVATE NURSE 24 (GO TO 321A)
PHARMACY 25 (GO TO 321A)
OTHER PRIVATE MEDICAL (SPECIFY) ____ 26 (GO TO 321A)
OTHER SOURCE
SHOP 31 (GO TO 321A)
CHURCH 32 (GO TO 321A)
FRIEND/RELATIVE 33 (GO TO 321A)
TRADITIONAL HEALER 34 (GO TO 321A)
PARTNER 35 (GO TO 321A)
MEDICAL STAFF IN THE NEIGHBORHOOD 36 (GO TO 321A)
STAND/BOOTH INFORMATION 37 (GO TO 321A)
STORE 38 (GO TO 321A)
BAR/DISCOTHEQUE 39(GO TO 321A)
ADOLESCENTE SPECIAL SERVICES 40 (GO TO 321A)
OTHER (SPECIFY) ____96 (GO TO 321A)

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Mozambique 2011
Survey form view entire document:  text 
315. Where did you get the (CURRENT METHOD) the first time you used it?
315A. Where did you learn how to use the lactational amenorrhea method?

PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)___________
PUBLIC SECTOR
CENTRAL HOSPITAL 11
PROVINCIAL/GENERAL HOSPITAL 12
RURAL HOSPITAL 13
HEALTH CENTER/POST 14
MOBILE CLINIC 15
PHARMACY 16
OTHER (SPECIFY)____ 17
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC 21
PRIVATE DOCTOR 22
PRIVATE NURSE 23
PHARMACY 24
SHOP 25
GAS STATION 26
BAR/DISCOTHEQUE 27
INFORMATION STAND/BOOTH 28
OTHER (SPECIFY)___29
OTHER SOURCE
SCHOOL 31
MARKET/STORE 32
CHURCH 33
FRIEND/RELATIVE 34
TRADITIONAL HEALER 35
ADOLESCENT SPECIAL SERVICES 36
OTHER (SPECIFY)____96

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Myanmar 2015
Survey form view entire document:  text 
323) Where did you obtain (CURRENT METHOD) the last time?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO IDENTIFY IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF PLACE. ____(NAME OF PLACE)
(SKIP TO 326 REGARDLESS OF RESPONSE)

PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER (RHC) 12
GOVT. HEALTH POST (SUB-CENTER) 13
VILLAGE HEALTH WORKER 14
MOBILE CLINIC 15
UHC/MCH CENTER 16
OTHER PUBLIC SECTOR___(SPECIFY) 17
NON-GOVERNMENT SECTOR
MARIE STOPES 21
MYANMAR RED CROSS SOCIETY 22
PSI/M (SUN) 23
MMA 24
OTHER NGO SECTOR___(SPECIFY) 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PHARMACY 32
PRIVATE DOCTOR 33
MOBILE CLINIC 34
FIELDWORKER 35
OTHER PRIVATE MEDICAL SECTOR___(SPECIFY) 36
OTHER SOURCE
SHOP 41
FRIEND/RELATIVE 42
OTHER___(SPECIFY) 96

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Namibia 2000
Survey form view entire document:  text 
316) Where did you obtain (CURRENT METHOD) when you started using it?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) _____
PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTRE/CLINIC 12
PHC CLINIC (MOBILE) 13
COMMUNITY HEALTH WORKER 14
OTHER PUBLIC (SPECIFY)____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
OTHER PRIVATE MEDICAL (SPECIFY)____ 26
OTHER SOURCE
SHOP 31
CHURCH/SCHOOL 32
FRIEND/RELATIVE 33
TRAD. BIRTH ATTENDANT 34
TRADITIONAL HEALER 35
OTHER (SPECIFY) _____ 96

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Namibia 2006
Survey form view entire document:  text 
324. Where did you obtain (CURRENT METHOD) when you started using it?

PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER/CLINIC 12
PHC CLINIC (MOBILE) 13
COMMUNITY HEALTH WORKER 14
OTHER PUBLIC (SPECIFY)____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
OTHER PRIVATE MEDICAL (SPECIFY)____ 26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
TRAD. BIRTH ATTENDANT 34
TRAD. HEALER 35
OTHER (SPECIFY) _____ 96

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Nepal 2001
Survey form view entire document:  text 
319. Where did you obtain (CURRENT METHOD) when you started using it?

IF SOURCE IS HOSPITAL, CLINIC, HEALTH CARE CENTER, OR FAMILY PLANNING CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE _______________
GOVERNMENT SECTOR
GOVT. HOSPITAL/CLINIC 11
PRIMARY HEALTH CARE CENTER/HEALTH CENTER 12
HEALTH POST 13
SUB-HEALTH POST 14
PHC OUTREACH CLINIC 15
FCHV 17
CONDOM BOX 18
OTHER GOVT. (SPECIFY) ____________ 16
NON-GOVT. (NGO) SECTOR
FP ASSN. OF NEPAL 21
MARIE STOPES 22
ADRA 23
NEPAL RED CROSS 24
OTHER NGO (SPECIFY) ___________ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME 31
PHARMACY 32
OTHER PRIVATE (SPECIFY) _______ 36
OTHER SOURCE
SHOP 41
FRIEND/RELATIVE 42

OTHER (SPECIFY) ______________ 96

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Nepal 2006
Survey form view entire document:  text 
336. Where did you obtain (CURRENT METHOD) when you started using it? Where did you learn to use the rhythm method? IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, OR CLINIC, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) ___
PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC 11
PHC CENTER 12
HEALTH POST 13
SUB-HELATH POST 14
PHC OUTREACH 15
MOBILE CLINIC 17
FCHV 18
CONDOM BOX 19
OTHER GOVT. (SPECIFY) ____
NON-GOVT. (NGO) SECTOR
FPAN 21
MARIE STOPES 22
ADRA 23
NEPAL RED CROSS 24
UMN 25
OTHER NGO. (SPECIFY) ___ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME 31
PHARMACY 32
OTHER PRIVATE MEDICAL (SPECIFY) ___ 36
OTHER SOURCE
SHOP 41
FRIEND/RELATIVE 42
OTHER (SPECIFY) ___ 96

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Nepal 2011
Survey form view entire document:  text 
323) Where did you obtain (CURRENT METHOD) the last time?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

________________ (NAME OF PLACE)
PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC 11
PHC CENTER 12
HEALTH POST 13
SUB-HEALTH POST 14
PHC OUTREACH 15
MOBILE CLINIC 17
FCHV 18
CONDOM BOX 19
OTHER GOVT. (SPECIFY) ___________ 16
NON-GOVT. (NGO) SECTOR
FPAN 21
MARIE STOPES 22
ADRA 23
NEPAL RED CROSS 24
UMN 25
OTHER NGO. (SPECIFY) __________ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME 31
PHARMACY 32
SANGINI OUTLET 33
OTHER PRIVATE MEDICAL (SPECIFY) ___________ 36
OTHER SOURCE
SHOP 41
FRIEND/RELATIVE 42
OTHER (SPECIFY) ___________ 96

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Nepal 2016
Survey form view entire document:  text 
316. You first started using (CURRENT METHOD) in (DATE FROM 309). Where did you get it at that time? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OF PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC 11
PRIMARY HEALTH CARE CENTER 12
HEALTH POST/SUB-HEALTH POST 13
PHC OUTREACH CLINIC 14
MOBILE CAMP 15
FCHV 16
SATELLITE CLINIC 17
OTHER PUBLIC FACILITIES (SPECIFY) ___ 18
NON-GOVT. (NGO) SECTOR
FPAN 21
MARIE STOPES 22
OTHER NGO FACILITIES (SPECIFY) ___ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/NURSING HOME 31
PRIVATE CLINIC 32
PHARMACY 33
SANGINI OUTLET 34
OTHER PRIVATE MEDICAL FACILITIES (SPECIFY) ___ 36
OTHER SOURCE
SHOP 41
FRIEND/RELATIVE 42
OTHER (SPECIFY) ___ 96

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Niger 2006
Survey form view entire document:  text 
320. Where did you get (current method) when you started using it?
320A. Where did you learn how to use the Lactational Amenorrhea method?

IF THE SOURCE IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF THE ESTABLISHMENT __________
PUBLIC SECTOR
NATIONAL HOSPITAL 11
INTEGRATED HEALTH CENTER 12
MATERNITY 13
HEALTH HUT 14
COMMUNITY HEALTH CARE WORKER 15
OTHER PUBLIC (SPECIFY) __________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
DOCTOR 23
PHARMACY 24
WALKING SALESMAN 25
OTHER PRIVATE (SPECIFY) __________ 26
OTHER SOURCE
SHOP 31
BAR/NIGHTCLUB 32
KIOSK 33
VENDOR 34
FRIEND/ACQUAINTANCE/RELATIVE 35
HOTEL/MOTEL 36
OTHER (SPECIFY) __________ 96

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Niger 2012
Survey form view entire document:  text 
315) You first started using (CURRENT METHOD) in (DATE FROM 308/308A). Where did you get it at that time?

315a) Where did you learn how to use the rhythm/lactational amenorrhea method?
PROBE TO IDENTITY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE)___________

PUBLIC SECTOR
PHARMACY 11
MATERNITY REFERENCE CENTER 12
MATERNITY IN REGIONAL HOSPITAL 13
MATERNITY IN HD 14 [##TRANSLATOR NOTE: I WAS UNABLE TO FIND WHAT HD STANDS FOR IN THIS CASE]
INTEGRATED HEALTH CENTER 15
HEALTH HUT 16
MOBILE CLINIC 17
OTHER PUBLIC (SPECIFY)__________ 18
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
MOBILE CLINIC 24
NIGERIEN ASSOCIATION FOR FAMILIAL WELL-BEING 25
ROAD KIOSK 26
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 28
OTHER SOURCE
SHOP 31
RELIGIOUS INSTITUTION 32
FRIENDS/RELATIVES 33
TRAVELLING PHARMACY/PEDDLER 34
COMMUNITY LIAISON 35
OTHER (SPECIFY) 96

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Nigeria 2003
Survey form view entire document:  text 
320. Where did you obtain (CURRENT METHOD) when you started using it?
320A. Where did you learn to use the lactational amenorrhea method?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) __________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
COMMUNITY HEALTH WORKER 15
OTHER PUBLIC (SPECIFY) ______ 16

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY/PATENT MEDICINE STORE 22
PRIVATE DOCTOR'S OFFICE 23
MOBILE CLINIC 24
COMMUNITY HEALTH WORKER 25
OTHER PRIVATE MEDICAL (SPECIFY) ______ 26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
NGO 34
OTHER (SPECIFY) _______________ 96

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Nigeria 2008
Survey form view entire document:  text 
324. Where did you obtain (CURRENT METHOD) when you started using it?
324A. Where did you learn how to use the rhythm/lactational amenorrhea method?
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) __________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
FIELDWORKER 15
OTHER PUBLIC (SPECIFY) ______ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
CHEMIST/PMS STORE 23
PRIVATE DOCTOR 24
MOBILE CLINIC 25
FIELDWORKER 26
OTHER PRIVATE MEDICAL (SPECIFY) ______ 27
OTHER SOURCE
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
NGO 34
OTHER (SPECIFY) _______________ 96

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Nigeria 2013
Survey form view entire document:  text 
315) You first started using (CURRENT METHOD) IN (DATE FROM 308/308A). Where did you get it at that time?

315A) Where did you learn how to use the rhythm/lactational amenorrhea method?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE______
PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
FIELD WORKER 15
OTHER PUBLIC SECTOR (SPECIFY)________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
CHEMIST/PMS STORE 23
PRIVATE DOCTOR'S OFFICE 24
MOBILE CLINIC 25
FIELDWORKER 27
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)_______ 26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
NGO 34
OTHER (SPECIFY)__________ 96
DON'T KNOW 98

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Nigeria 2018
Survey form view entire document:  text 
316. You first started using (CURRENT METHOD) in (DATE FROM 309). Where did you get it at that time?

PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
__________

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
FIELDWORKER 15
OTHER PUBLIC SECTOR _____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
CHEMIST/PMS STORE 23
PRIVATE DOCTOR 24
MOBILE CLINIC 25
FIELDWORKER 26
OTHER PRIVATE MEDICAL SECTOR _____ 27
OTHER SOURCE
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
NGO 34

OTHER _____ 96

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Pakistan 2006

No questionnaire text is available for this sample.


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Pakistan 2012
Survey form view entire document:  text 
318) You first started using (CURRENT METHOD) in (DATE FROM 313/313A). Where did you get it at that time?

318A) Where did you learn about LAM being a method of contraception/ how to use the SDM/ rhythm method?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
_____

PUBLIC SECTOR
GOVT. HOSPITAL/RHSA 11
RURAL HEALTH CENTRE 12
FAMILY WELFARE CENTRE/FWW 13
MCH 14
DISPENSORY 15
MOBILE SERVICE CAMP/UNIT 16
LADY HEALTH WORKER 17
LH VISITOR 18
BASIC HEALTH UNIT 19
MALE MOBILIZER 20
FWA 21
OTHER PUBLIC (SPECIFY) ___ 26
PRIVATE/NGO MEDICAL SECTOR
PRIVATE/NGO HOSPITAL/CLINIC 31
PHARMACY, CHEMISTS 32
PRIVATE DOCTOR 33
HOMEOPATH 34
DISPENSER/COMPOUNDER 35
OTHER PRIVATE MEDICAL (SPECIFY) ___ 36
OTHER SOURCE
SHOP (NOT PHARMACY/CHEMIST) 41
FRIEND/RELATIVE 42
HAKIM 43
DAI, TRAD, BIRTH ATTENDANT 44
OTHER (SPECIFY) ___ 96
DON'T KNOW 98

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Pakistan 2017
Survey form view entire document:  text 
316) You first started using (CURRENT METHOD) in (DATE FROM 309). Where did you get it at that time? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE __________

PUBLIC SECTOR
FAMILY HEALTH CLINIC/RHSC 11
FAMILY WELFARE CENTRE/FWW 12
MOBILE SERVICE CAMP/UNIT 13
MALE MOBILIZER 14
GOVERNMENT HOSPITAL 15
RURAL HEALTH CENTER 16
BASIC HEALTH UNIT 17
MCH CENTER 18
DISPENSORY 19
LADY HEALTH WORKER 20
LADY HEALTH VISITOR 21
COMMUNITY MIDWIFE 22
OTHER PUBLIC SECTOR (SPECIFY) __________ 26
PRIVATE/NGO MEDICAL SECTOR
PRIVATE/NGO HOSPITAL/CLINIC 31
PRIVATE DOCTOR 32
PHARMACY/MEDICAL STORE 33
HOMEOPATH 34
DISPENSER/COMPOUNDER 35
OTHER PRIVATE SECTOR (SPECIFY) _________ 36
OTHER SOURCE
SHOP (NOT PHARMACY/CHEMIST) 41
FRIEND/RELATIVE 42
HAKIM 43
DAI, TRADITIONAL BIRTH ATTENDANT 44
OTHER (SPECIFY) ______ 96

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Rwanda 2000
Survey form view entire document:  text 
319. Where did you obtain (CURRENT METHOD) when you first started using it?

IF SOURCE IS GOVERNMENT HOSPITAL, GOVERNMENT-APPROVED HOSPITAL, CLINIC, OR HEALTH CENTER, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE___
PUBLIC SECTOR
GOVERNMENT HOSPITAL/GOVERNMENT-APPROVED HOSPITAL 11 (GO TO 319B)
GOVERNMENT HEALTH CENTER 12 (GO TO319B)
FAMILY PLANNING CLINIC 13 (GO TO 319B)
DBC AGENT 15 (GO TO 319B)
OTHER PUBLIC (SPECIFY)_____ 16 (GO TO 319B)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21 (GO TO 319B)
PHARMACY 22 (GO TO 319B)
PRIVATE DOCTOR 23 (GO TO 319B)
ARBEF (RWANDAN ASSOCIATION FOR FAMILY WELFARE) CLINIC 24 (GO TO 319B)
INFIRMARY 25 (GO TO 319B)
OTHER PRIVATE MEDICAL (SPECIFY)_____ 26 (GO TO 319B)
OTHER SOURCE
SHOP/KIOSK 31 (GO TO 319B)
CHURCH 32 (GO TO 319B)
RELATIVES/FRIEND 33 (GO TO 319B)
OTHER (SPECIFY)____ 96 (GO TO 319B)

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Rwanda 2005
Survey form view entire document:  text 
320 Where did you obtain (CURRENT METHOD) when you started using it?

320A. Where did you learn to use the MAMA/SDM method?

IF SOURCE IS GOVERNMENT HOSPITAL, GOVERNMENT ASSISTED HEALTH FACILITY, HEALTH CENTERS OR CLINIC, A NURSE, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) _______
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH HOSPITAL 12
NURSE 13
OTHER PUBLIC (SPECIFY)_____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
ARBEF CLINIC 24
FIELDWORKER 25
OTHER PRIVATE MEDICAL (SPECIFY) ____ 26
OTHER SOURCE
SHOP 31
CHURCH 32
PARENTS/FRIEND 33
OTHER (SPECIFY) ____ 96

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Rwanda 2008
Survey form view entire document:  text 
312) Where did you obtain (CURRENT METHOD) when you started using it?
312A) Where did you learn how to use the rhythm/lactational amenorrhea method?
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, OR CLINIC IF PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE: ______________________
PUBLIC SECTOR
REFERENCE HOSPITAL 11
DISTRICT HOSPITAL 12
HEALTH CENTER 13
HEALTH WORKER 14
OTHER PUBLIC 16 (SPECIFY) ______________
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC/HOSPITAL 21
PHARMACY 22
PRIVATE DOCTOR 23
ARBEF CLINIC 24
NURSE 25
OTHER PRIVATE MEDICAL 26 (SPECIFY) ________________
OTHER SOURCE
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
OTHER 96 (SPECIFY) __________________

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Rwanda 2010
Survey form view entire document:  text 
315) You first started using (CURRENT METHOD) in (DATE FROM 308/308A). Where did you get it at that time?

NAME OF PLACE
PUBLIC SECTOR
REFERAL HOSPITAL 11
DISTRICT HOSPITAL 12
HEALTH CENTER 13
HEALTH POST 14
OUTREACH 15
COMMUNITY HEALTH WORKER 16
OTHER PUBLIC HEALTH FACILITY (SPECIFY) 17
PRIVATE MEDICAL SECTOR
POLYCLINIC 21
CLINIC 22
DISPENSARY 23
PHARMACY 24
FAMLIY PLANNING CLINIC 25
OTHER PRIVATE HEALTH FACILITY (SPECIFY) 26
OTHER SOURCES
KIOSK 31
CHURCH 32
FRIEND/RELATIVE 33
OTHER (SPECIFY) 96
DON'T KNOW 98

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Rwanda 2014
Survey form view entire document:  text 
315) You first started using (CURRENT METHOD) in (DATE FROM 308/308A). Where did you get it at that time?
315A) Where did you learn how to use the rhythm/lactational amenorrhea method/standard days method?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)_____
PUBLIC/AGREE SECTOR
REFERRAL HOSPITAL 11
PROVINCIAL/DISTRICT HOSPITAL 12
HEALTH CENTER 13
HEALTH POST 14
OUTREACH 15
COMMUNITY HEALTH WORKER 16
OTHER PUBLIC HEALTH FACILITY (SPECIFY) ____ 17
PRIVATE MEDICAL SECTOR
POLYCLINIC 21
CLINIC 22
DISPENSARY 23
PHARMACY 24
FAMILY PLANNING CLINIC 25
OTHER PRIVATE HEALTH FACILITY (SPECIFY) ____ 26
OTHER SOURCES
KIOSK/SHOP/BAR 31
CHURCH 32
FRIEND/RELATIVE 33
YOUTH CENTER 34
OTHER (SPECIFY) ____ 96
DON'T KNOW 98

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Senegal 2017
Survey form view entire document:  text 
316) You first started using (CURRENT METHOD) in (DATE FROM 309). Where did you get it at that time?

PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) _______
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
HEALTH POST 13
GOVERNMENT FAMILY PLANNING CENTER 14
RURAL MATERNITY 15
HEALTH HUT 16
COMMUNITY PHARMACY 17
MOBILE CLINIC 18
OTHER PUBLIC SECTOR (SPECIFY) ____ 19
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE 21/22
PHARMACY 23
PRIVATE DOCTOR 24
RELIGIOUS FREE CLINIC 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ____ 26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
BAR 34
OTHER (SPECIFY) _____ 96

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South Africa 2016

No questionnaire text is available for this sample.


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Tanzania 2004
Survey form view entire document:  text 
318) I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years.
USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 1995. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

IN COLUMN 1, ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.

ILLUSTRATIVE QUESTIONS: COLUMN 1:

When was the last time you used a method? Which method was that?
When did you start using that method? How long after the birth of (NAME)?
How long did you use the method then?

IN COLUMN 2, ENTER METHOD SOURCE CODE IN FIRST MONTH OF EACH USE.

ILLUSTRATIVE QUESTIONS: COLUMN 2:

Where did you obtain the method when you started using it?
Where did you get advice on how to use the method [for lactational amenorrhea, rhythm, or withdrawal]?

IN COLUMN 3, ENTER CODES FOR REASON FOR DISCONTINUATION NEXT TO LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 3 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1.

ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT.

ILLUSTRATIVE QUESTIONS: COLUMN 3:

Why did you stop using the (METHOD)?
Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop for some other reason?

IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK:

How many months did it take you to get pregnant after you stopped using (METHOD)?
AND ENTER '0' IN EACH SUCH MONTH IN COLUMN 1.

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Tanzania 2010
Survey form view entire document:  text 
311. You first started using (CURRENT METHOD) in (DATE FROM 306/306A). Where did you get it at the time?
311A. Where did you learn how to use the rhythm/lactational amenorhea method?
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) _________
GOVERNMENT/PARASTATAL
REFERRAL/SPEC.HOSPITAL 11
REGIONALHOSPITAL 12
DISTRICTHOSPITAL 13
HEALTHCENTRE 14
DISPENSARY 15
VILLAGEHEALTHPOST 16
CBDWORKER 17
RELIGIOUS/VOLUNTARY
REFERAL/SPEC.HOSPITAL 21
DISTRICTHOSPITAL 22
HEALTHCENTRE 23
DISPENSARY 24
PRIVATE
HOSPITAL 31
HEALTHCENTRE 32
DISPENSARY 33
OTHER
PHARMACY 41
NGO 42
VCTCENTRE 43
SHOP/KIOSK 44
BAR 45
GUESTHOUSE/HOTEL 46
FRIEND/RELATIVE/NEIGHBOUR 47
OTHER (SPECIFY) __________ 96

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Tanzania 2015
Survey form view entire document:  text 
316) You first started using (CURRENT METHOD) in (DATE FROM 308 OR 309). Where did you get it at that time?

PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) _____
GOVERNMENT/PARASTATAL
NATIONAL/ZONAL/SPEC. HOSPITAL 11
REGIONAL REFERRAL HOSPITAL 12
REGIONAL HOSPITAL 13
DISTRICT HOSPITAL 14
HEALTH CENTRE 15
DISPENSARY 16
CLINIC 17
CHW 18
RELIGIOUS/VOLUNTARY
REFERRAL SPECIALISED HOSPITAL 21
DISTRICT HOSPITAL 22
HOSPITAL 23
HEALTH CENTRE 24
DISPENSARY 25
CLINIC 26
PRIVATE MEDICAL SECTOR
SPECIALISED HOSPITAL 31
HOSPITAL 32
HEALTH CENTRE 33
DISPENSARY 34
CLINIC 35
OTHER
PHARMACY 41
ACCREDITED DRUG DISPENSING OUTLET (ADDO) 42
NGO 43
VCT CENTRE 44
SHOP/KIOSK 45
BAR 46
GUEST HOUSE/HOTEL 47
FRIEND/RELATIVE/NEIGHBOUR 48
OTHER (SPECIFY) 96

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Uganda 2001
Survey form view entire document:  text 
320 Where did you obtain (current method) when you started using it?

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
OUTREACH 14
GOVERNMENT COMMUNITY BASED DISTRIBUTOR 15
OTHER PUBLIC (SPECIFY) __________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY/DRUG SHOP 22
PRIVATE DOCTOR/NURSE/MIDWIFE 23
OUTREACH 24
NGO COMMUNITY BASED DISTRIBUTOR 25
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26
OTHER SOURCE
SHOP 31
RELIGIOUS INSTITUTION 32
FRIEND/RELATIVE 33
OTHER (SPECIFY) __________ 96

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Uganda 2006
Survey form view entire document:  text 
324) Where did you obtain (CURRENT METHOD) when you started using it?
324A) Where did you learn to use the lactational amenorrhea/rhythm method?

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE____
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
OUTREACH 14
GOVERNMENT COMMUNITY BASED DISTRIBUTOR 15
OTHER PUBLIC (SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY/DRUG SHOP 22
PRIVATE DOCTOR/NURSE/MIDWIFE 23
OUTREACH 24
NGO COMMUNITY BASED DISTRIBUTOR 25
OTHER PRIVATE MEDICAL (SPECIFY) 26
OTHER SOURCE
SHOP 31
RELIGIOUS INSTITUTION 32
FRIEND/RELATIVE 33
OTHER (SPECIFY) 96

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Uganda 2011
Survey form view entire document:  text 
315) You first started using (CURRENT METHOD) in (DATE FROM 308/308A) Where did you get it at that time?

PUBLIC SECTOR
GOVT HOSPITAL 11
GOVT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
OUT REACH 14
FIELDWORKER/VHT 15
OTHER PUBLIC SECTOR (SPECIFY) ____________________16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
OUTREACH 24
FIELDWORKER/VHT 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _________________26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
OTHER (SPECIFY) __________________ 96

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Uganda 2016
Survey form view entire document:  text 
325) Where did you obtain (CURRENT METHOD) the last time?
PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PIBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE ________

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
OTHER PUBLIC SECTOR (SPECIFY) _____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINI 21
PRIVATE DOCTOR'S OFFICE 22
MOBILE CLINIC 23
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____26
OTHERT SOURCE
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
OTHER (SPECIFY) ______ 96

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Yemen 2013
Survey form view entire document:  text 
315) You first started using (CURRENT METHOD) in (DATE FROM 3008/308A). Where did you get it at that time?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE. (NAME OF PLACE) ____

GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
PRIMARY HEALTH CENTER 13
FAMILY PLANNING CLINIC 14
MOBILE CLINIC 15
PRIVATE
(HOSPITAL/CLINIC/DOCTOR) 21
PHARMACY 22
NON GOVERNMENT ORGANIZATIONS
PR. HOSPITAL/CENTER/CLINIC/MOBILE CLINIC 31
OTHER (SPECIFY)____ 96

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Zambia 2007
Survey form view entire document:  text 
324. Where did you obtain (CURRENT METHOD) when you started using it?
324A. Where did you learn to use the lactational amenorrhea/rhythm method?
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) __________________
PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
HEALTH POST 13
OTHER PUBLIC (SPECIFY) ______ 16

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/SURGERY 21
MISSION HOSPITAL/CLINIC 22
PHARMACY 23
PRIVATE DOCTOR 24
WORK PLACE 25
OTHER PRIVATE MEDICAL (SPECIFY) ______ 26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
OTHER (SPECIFY) _______________ 96

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Zambia 2013
Survey form view entire document:  text 
315) You first started using (CURRENT METHOD) in (DATE FROM 308/308A). Where did you get it at that time?
315A) Where did you learn to use the standard days/lactational amenorrhea/ rhythm method?

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVT. HEALTH CENTER/POST 12
MOBILE HOSPITAL/CLINIC 13
FAMILY PLANNING CLINIC 14
COMMUNITY BASED AGENT/FIELDWORKER 15
OTHER PUBLIC SECTOR 16 (SPECIFY) _____________________
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC 21
MISSION HOSPITAL/CLINIC 22
PHARMACY 23
PRIVATE DOCTOR 24
COMMUNITY BASED AGENT/FIELDWORKER
MOBILE HOSPITAL/CLINIC 26
OTHER PRIVATE MEDICAL SECTOR 27 (SPECIFY) __________________
OTHER SOURCE
SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
OTHER 96 (SPECIFY) ___________________

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Zambia 2018
Survey form view entire document:  text 
(316) You first started using (CURRENT METHOD) in (DATE FROM 309). Where did you get it at that time?

PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE: _________________________

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
GOVERNMENT HEALTH POST 13
MOBILE CLINIC/HOSPITAL 14
COMMUNITY BASED AGENT/FIELD WORKER 15
OTHER PUBLIC SECTOR (SPECIFY) __________________________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
MISSION HOSPITAL/CLINIC 22
PHARMACY 23
PRIVATE DOCTOR 24
MOBILE HOSPITAL/CLINIC 25
COMMUNITY BASED AGENT/FIELDWORKER 26
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _________________________ 27
OTHER SOURCES
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
OTHER (SPECIFY) __________________________ 96

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Zimbabwe 1999
Survey form view entire document:  text 
324) ENTER METHOD CODE FROM 314 IN CURRENT MONTH IN COLUMN 1 OF CALENDAR. THEN DETERMINE WHEN SHE STARTED USING METHOD THIS TIME.

ENTER METHOD CODE IN EACH MONTH OF USE.

IF CURRENT METHOD STARTED IN JANUARY 1994 OR LATER, ENTER THE METHOD SOURCE CODE IN COLUMN 2 OF CALENDAR IN THE SAME MONTH THAT USE OF CURRENT METHOD BEGAN.

ILLUSTRATIVE QUESTIONS:

When did you start using this method continuously?
How long have you been using this method continuously?
When you started using this method, where did you obtain it?

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Zimbabwe 2005
Survey form view entire document:  text 
322) I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years.

USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2000.

USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

IN COLUMN 1, ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.

ILLUSTRATIVE QUESTIONS:
COLUMN 1:

When was the last time you used a method? Which method was that?
When did you start using that method? How long after the birth of (NAME)?
How long did you use the method then?

IN COLUMN 2, ENTER METHOD SOURCE CODE IN FIRST MONTH OF EACH USE.

ILLUSTRATIVE QUESTIONS:
COLUMN 2:

Where did you obtain the method when you started using it?
Where did you get advice on how to use the method [for LAM, rhythm, or withdrawal]?

IN COLUMN 3, ENTER CODES FOR DISCONTINUATION NEXT TO LAST MONTH OF USE.
NUMBER OF CODES IN COLUMN 3 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1.

ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT.

ILLUSTRATIVE QUESTIONS:
COLUMN 3:

Why did you stop using the (METHOD)?
Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop for some other reason?

IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK:

How many months did it take you to get pregnant after you stopped using (METHOD)?

AND ENTER '0' IN EACH SUCH MONTH IN COLUMN 1.


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Zimbabwe 2010
Survey form view entire document:  text 
315) You first started using (CURRENT METHOD) in (DATE FROM 308/308A). Where did you get it at that time?
315A) Where did you learn how use the rhythm lactational amenorrhea method?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

NAME OF PLACE___
PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC 11
RURAL/MUNICIPAL CLINIC 12
RURAL HEALTH CENTRE 13
ZNFPC CLINIC 14
MOH MOBILE CLINIC 15
ZNFPC CBD/DEPOT HOLDER 16
OTHER PUBLIC SECTOR (SPECIFY) 17
MISSION HOSPITAL/CLINIC 21
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PHARMACY 32
PRIVATE DOCTOR 33
CBD 34
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36
RETAIL OUTLET
GENERAL DEALER 41
SUPERMARKET 42
TUCK SHOP 43
SERVIC STATION 44
OTHER RETAIL (SPECIFY) 46
OTHER PRIVATE SOURCE
CHURCH 51
FRIENDS/RELATIVES 52
OTHER (SPECIFY) 96

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Zimbabwe 2015
Survey form view entire document:  text 
314. Have you ever used anything or tried in any way to delay or avoid getting pregnant?

YES 1 (GO TO 326)
NO 2 (GO TO 326)