DIVISION:
DISTRICT:
UPAZILA OR THANA:
UNION:
VILLAGE OR MOHALL OR BLOCK:
CLUSTER NUMBER:
HOUSEHOLD NUMBER:
DHAKA/CHITTAGONG OR SMALL CITY OR TOWN OR VILLAGE?
SMALL CITY 2
TOWN 3
VILLAGE 4
NAME AND LINE NUMBER OF MAN:
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT*
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT*
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
NEXT VISIT
DATE
TIME
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT*
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
FINAL VISIT
DAY
MONTH
FEBRUARY 02
MARCH 03
APRIL 04
MAY 05
JUNE 06
JULY 07
AUGUST 08
SEPTEMBER 09
OCTOBER 10
NOVEMBER 11
DECEMBER 12
YEAR 199_
CODE
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
FIELD EDITED BY
DATE
OFFICE EDITED BY
DATE
KEYED BY
DATE
KEYED BY
DATE
SECTION 1. RESPONDENT'S BACKGROUND
101. RECORD THE TIME.
MINUTES ___
103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)
104. Just before you moved here, did you live in a city, in a town, or in the countryside?
TOWN 2
COUNTRYSIDE 3
105. In what month and year were you born?
USE CODES BELOW FOR MONTHS.
IF HE DOES NOT KNOW, WRITE 'D K' IN BOXES.
BENGALI 1
YEAR 13__
02 JAISTHA
03 ASHAR
04 SRABAN
05 BADHRA
06 ASHWIN
07 KARTIK
08 AGRAHAYAN
09 POUSH
10 MAGH
11 FALGUN
12 CHOITRA
ENGLISH 2
YEAR 19__
02 FEBRUARY
03 MARCH
04 APRIL
05 MAY
06 JUNE
07 JULY
08 AUGUST
09 SEPTEMBER
10 OCTOBER
11 NOVEMBER
12 DECEMBER
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.
106A. Are you now married, widowed, or divorced?
MARRIED 2
WIDOWED 3 (GO TO END)
DIVORCED OR DESERTED 4 (GO TO END)
107. Have you ever attended school?
NO 2 (GO TO 114)
108. What is the highest level of school you attended: primary, secondary, or higher?
SECONDARY 2
COLLEGE OR UNIVERSITY 3
109. What is the highest class you completed?
SECONDARY OR COLLEGE (GO TO 115)
114. Can you read and write a letter in any language easily, with difficulty, or not at all?
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 116)
115. Do you usually read a newspaper or magazine at least once a week?
NO 2
116. Do you usually listen to the radio at least once a week?
NO 2
117. Do you usually watch television at least once a week?
NO 2
HINDUISM 2
BUDDHISM 3
CHRISTIANITY 4
OTHER (SPECIFY) 5
119. Are you currently working?
NO 2
120. What is your occupation, that is, what kind of work do you mainly do?
DOES NOT WORK IN AGRICULTURE (GO TO 123)
UNEMPLOYED (GO TO 201)
122. Do you work mainly on your own land or family land, or do you rent land, or work on someone else's land?
RENTED LAND 2
SOMEONE ELSE'S LAND 3
123. Do you do this work for a member of your family, for someone else, or are you self-employed?
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3
124. Do you usually work throughout the year, or do you work seasonally, or only once in a while?
ONLY SOME TIMES (SEASONAL) 2
ONCE IN A WHILE 3
125. Do you earn cash for this work?
PROBE: Do you make money for working?
NO 2
201. Now I would like to ask about your children. I am interested only in the children that are biologically yours. Have you ever had children?
NO 2 (GO TO 206)
202. Do you have any sons or daughters who are now living with you?
NO 2 (GO TO 204)
203. How many sons live with you? And how many daughters live with you?
IF NONE ENTER '00'.
DAUGHTERS AT HOME ___
204. Do you have any sons or daughters who do not live with you?
NO 2 (GO TO 206)
205. How many sons are alive but do not live with you? And how many daughters are alive but do not live with you?
DAUGHTERS ELSEWHERE ___
206. Have you ever had a son or daughter who was born alive but later died?
NO 2 (GO TO 208)
207. In all, how many boys have died? And how many girls have died?
IF NONE ENTER '00'.
GIRLS DEAD ___
208. SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL.
IF NONE ENTER '00'.
209. CHECK 207: Just to make sure that I have this right: you have TOTAL ___ children born alive during your life. Is that correct?
NO (PROBE AND CORRECT 201-208 AS NECESSARY)
HAS NEVER HAD CHILDREN (NONE) (GO TO 301)
210A. In what month and year was your last child born?
BENGALI 1
YEAR 13__
02 JAISTHA
03 ASHAR
04 SRABAN
05 BADHRA
06 ASHWIN
07 KARTIK
08 AGRAHAYAN
09 POUSH
10 MAGH
11 FALGUN
12 CHOITRA
ENGLISH 2
YEAR 19__
02 FEBRUARY
03 MARCH
04 APRIL
05 MAY
06 JUNE
07 JULY
08 AUGUST
09 SEPTEMBER
10 OCTOBER
11 NOVEMBER
12 DECEMBER
BORN BEFORE BAISHAK 1398 (APRIL 1991) (GO TO 301)
211. When you were expecting your lastborn child, did you want to have the child then, did you want to wait until later, or did you not want to have any (more) children at all?
LATER 2
NOT AT ALL 3
212. When one of your children is sick with diarrhea, what signs of illness would tell you that he or she should be taken to a health facility or health worker?
CIRCLE ALL MENTIONED.
ANY WATER STOOLS B
REPEATED VOMITING C
ANY VOMITING D
BLOOD IN STOOLS E
FEVER F
MARKED THIRST G
NOT EATING OR DRINKING WELL H
GETTER SICKER OR VERY SICK I
NOT GETTING BETTER J
OTHER (SPECIFY) X
DOES NOT KNOW Z
213. When one of your children is sick with a cough, what signs of illness would tell you that he or she should be taken to a health facility or health worker?
CIRCLE ALL MENTIONED.
DIFFICULT BREATHING B
NOISY BREATHING C
FEVER D
UNABLE TO DRINK E
NOT EATING OR DRINKING WELL F
GETTING SICKER OR VERY SICK G
NOT GETTING BETTER H
OTHER (SPECIFY X
DOES NOT KNOW Z
214A. Do you have any child born since Baishak 1398 (April 1991) who is still alive?
NO 2 (GO TO 301)
214B. What is the name of your child under age 5?
215A. Has (NAME) ever been sick?
NO 2 (GO TO 301)
215B. Have you or your wife ever taken (NAME) to a health facility or health worker or any other place or person for treatment, when he or she was sick?
NO 2 (GO TO 218)
DOES NOT KNOW 8 (GO TO 218)
216. The last time (NAME) was taken for treatment, what was his or her illness?
FEVER B
COUGH C
SKIN DISEASE D
LOSS OF APPETITE E
OTHER (SPECIFY) X
CANNOT RECALL Z
217. Who took (NAME) for treatment the last time, yourself or your wife or somebody else?
HIS WIFE 2
BOTH 3
OTHER PERSON (SPECIFY) 6
CANNOT RECALL 8
218. Did you ever bring or buy any medicine for (NAME)?
NO 2 (GO TO 301)
219. Who bought or brought the medicine?
HIS WIFE 2
BOTH 3
OTHER PERSON (SPECIFY) 6
CANNOT RECALL 8
220. Who gave the medicine to the child, yourself or your wife?
HIS WIFE 2
BOTH 3
OTHER PERSON (SPECIFY) 6
CANNOT RECALL 8
221. Where did you get the medicine?
FAMILY WELFARE CENTRE 12
THANA HEALTH COMPLEX 13
TRADITIONAL DOCTOR 22
PHARMACY 23
DOES NOT KNOW 98
Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid pregnancy.
CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 302, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 301 OR 302, ASK 303.
301. Which ways or method have you heard about?
302. Have you ever heard or (METHOD)?
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
NO 3
303. Have you ever used (METHOD)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
AT LEAST ONE "YES" (EVER USED) (GO TO 308)
305. Have you or your wife ever used anything or tried in any way to delay or avoid getting pregnant?
NO 2 (GO TO 331)
307. What have you used or done?
CORRECT 303-305 (AND 302 IF NECESSARY).
308. Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant. What was the first method that you ever used?
IUD 02
INJECTIONS 03
IMPLANTS 04
CONDOM 05
FEMALE STERILIZATION 06
MALE STERILIZATION 07
MENSTRUAL REGULATION 08
SAFE PERIOD, COUNTING DAYS 09
WITHDRAWAL 10
OTHER (SPECIFY) 96
309. How many living children did you have at that time, if any?
IF NONE, RECORD '00'.
MAN STERILIZED (GO TO 314A)
313. Are you or your wife currently doing something or using any method to delay or avoid getting pregnant?
NO 2 (GO TO 331)
314. Which method are you using?
314A. CIRCLE '07' FOR MALE STERILIZATION.
IUD 02 (GO TO 328)
INJECTIONS 03 (GO TO 328)
IMPLANTS 04 (GO TO 328)
CONDOM 05
FEMALE STERILIZATION 06 (GO TO 318)
MALE STERILIZATION 07 (GO TO 318)
MENSTRUAL REGULATION 08 (GO TO 328)
SAFE PERIOD, COUNTING DAYS 09 (GO TO 330A)
WITHDRAWAL 10 (GO TO 330A)
OTHER (SPECIFY) 96 (GO TO 330A)
317C. Please show me the package of condoms that you are using.
317D. Why can't you show me the package of condoms that you are using?
RAN OUT 2
OTHER (SPECIFY) 6
317E. SHOW BRAND CHART FOR CONDOMS: Please tell me which of these is the brand or condoms that you are using.
DOES NOT KNOW 98
317F. How much did the condom you last used cost?
PARTNER OBTAINED 95
FREE 96
DOES NOT KNOW 98
317G. Do you use a condom every time that you have sexual intercourse or only sometimes?
ONLY SOMETIMES 2
317H. How many times have you used condoms during the last one month?
318. Where did the sterilization take place?
FAMILY WELFARE CENTRE 12
THANA HEALTH COMPLEX 13
TRADITIONAL DOCTOR 22
DOES NOT KNOW 98
319. Do you regret that (you or your wife) had the operation not to have any more children?
NO 2 (GO TO 321)
PARTNER WANTS ANOTHER CHILD 02
SIDE EFFECTS 03
CHILD DIED 04
OTHER REASON (SPECIFY) 96
321. In what month and year was the sterilization operation performed?
USE CODES BELOW FOR MONTHS.
BENGALI 1
YEAR 13__
02 JAISTHA
03 ASHAR
04 SRABAN
05 BADHRA
06 ASHWIN
07 KARTIK
08 AGRAHAYAN
09 POUSH
10 MAGH
11 FALGUN
12 CHOITRA
ENGLISH 2
YEAR 19__
02 FEBRUARY
03 MARCH
04 APRIL
05 MAY
06 JUNE
07 JULY
08 AUGUST
09 SEPTEMBER
10 OCTOBER
11 NOVEMBER
12 DECEMBER
321A. How much did the operation cost you?
FREE 9996 (GO TO 329A)
DOES NOT KNOW 9998 (GO TO 329A)
328. Where did you obtain (METHOD) the last time?
IF SOURCE IS A HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
FAMILY WELFARE CENTRE 12
THANA HEALTH COMPLEX 13
SATELLITE CLINIC 14
TRADITIONAL DOCTOR 22
PHARMACY 23
FRIENDS OR RELATIVES 32
NGO CLINIC 42
OTHER (SPECIFY) 96
DOES NOT KNOW 98
USING ANOTHER METHOD (GO TO 329)
328B. Who obtained the (pills or condoms) the last time you got them?
WIFE 2 (GO TO 329)
SON OR DAUGHTER 3 (GO TO 329)
OTHER RELATIVE 4 (GO TO 329)
OTHER (SPECIFY) 6 (GO TO 329)
328C. At the place where you got your method the last time, did anyone there ever tell you about side effects or other problems you might have using this method?
NO 2
CANNOT REMEMBER 8
328D. Did anyone there ever tell you about other methods that you might use?
NO 2
CANNOT REMEMBER 8
329. Do you know another place where you could have obtained (CURRENT METHOD) the last time?
329A. At the time of the sterilization operation, did you know another place where you could have received the operation?
NO 2 (GO TO 330A)
330. People select the place where they get family planning services for various reasons. What was the main reason you went to (NAME OF PLACE IN QUESTION 328 OR 318) instead of the other place you know about?
RECORD RESPONSE AND CIRCLE CODE.
CLOSER TO MARKET OR WORK 12
AVAILABILITY OF TRANSPORT 13
CLEANER FACILITY 22
OFFERS MORE PRIVACY 23
SHORTER WAITING TIME 24
LONGER HOURS OF OPERATION 25
USE OTHER SERVICES AT THE FACILITY 26
WANTED ANONYMITY 41
WORKER SUPPLIED AT HOME 51
METHOD NOT AVAILABLE ELSE WHERE 61
OTHER (SPECIFY) 96
DOES NOT KNOW 98
330A. What is the reason you decided to use (CURRENT METHOD) rather than some other method of family planning? Any other reason?
CIRCLE ALL MENTIONED.
FRIEND OR RELATIVE RECOMMENDED B
SIDE EFFECTS OF OTHER METHODS C
METHOD EASY TO USE D
ACCESS OR AVAILABILITY E
COST F
WANTED PERMANENT METHOD G
HUSBAND PREFERRED H
WANTED MORE EFFECTIVE METHOD I
FIELDWORKER CAME TO HOUSE J
OTHER (SPECIFY) X
DOES NOT KNOW Z
330B. When a couple is making a decision, sometimes the husband has more influence, sometime the wife has more influence and sometimes other people have more influence. In your family, who had the most influence in deciding to use family planning the first time you used a method?
WIFE HAD MORE INFLUENCE 2 (GO TO 334)
BOTH, HUSBAND AND WIFE EQUAL 3 (GO TO 334)
OTHER RELATIVE 4 (GO TO 334)
OTHER (SPECIFY) 6 (GO TO 334)
331. What is the main reason you are not using a method of contraception to avoid pregnancy?
INFREQUENT SEX 22
MENOPAUSAL OR HYSTERECTOMY 23
SUB FECUND OR INFECUND 24
POSTPARTUM OR BREASTFEEDING 25
WANTS (MORE) CHILDREN 26
PREGNANT 27
WIFE OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
KNOWS NO SOURCE 42
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS OR TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 5
DOES NOT KNOW 98
332. Do you know where you can obtain a method of family planning?
NO 2 (GO TO 334)
IF HE SAYS MORE THAN ONE PLACE, ASK FOR THE PLACE HE WOULD MOST LIKELY USE.
FAMILY WELFARE CENTRE 12
THANA HEALTH COMPLEX 13
SATELLITE OR EPI CLINIC 14
TRADITIONAL DOCTOR 22
PHARMACY 23
FRIENDS OR RELATIVES 32
NGO CLINIC 42
OTHER (SPECIFY) 96
DOES NOT KNOW 98
SATELLITE OR EPI CLINIC MENTIONED (GO TO 336)
335. In some places, there is a clinic set up for a day or part of a day in someone's house or in a school. During the past 3 months, was there any such clinic in this village or mohalla?
NO 2 (GO TO 338)
DOES NOT KNOW 8 (GO TO 338)
336. Did you ever visit such a temporary health clinic?
NO 2 (GO TO 338)
337. What services did they provide?
CIRCLE ALL MENTIONED.
IMMUNIZATION B
CHILD GROWTH MONITORING C
T.T. FOR PREGNANT WOMEN D
ANTENATAL CARE E
OTHER (SPECIFY) X
DOES NOT KNOW Z
338. Have you ever visited a health facility or centre with your wife or your children?
NO 2 (GO TO 351)
339. For what services did you go there?
CIRCLE ALL MENTIONED.
IMMUNIZATION B
CHILD GROWTH MONITORING C
T.T. FOR PREGNANT WOMEN D
ANTENATAL CARE E
OTHER (SPECIFY) X
DOES NOT KNOW Z
351. Have you ever recommended family planning to a friend, relative, or anyone else?
NO 2
352. Do you think that women should have a medical checkup when they are pregnant, even if they are not sick?
NO 2
DOES NOT KNOW 8
OTHER (GO TO 357)
354A. From where did you hear about male sterilization?
FAMILY WELFARE CENTRE 12
THANA HEALTH COMPLEX 13
SATELLITE OR EPI CLINIC 14
TRADITIONAL DOCTOR 22
PHARMACY 23
FRIENDS OR RELATIVES 32
NGO CLINIC 42
OTHER (SPECIFY) 96
DOES NOT KNOW 98
354B. Do you know of a place where you can obtain male sterilization?
NO 2
355. Has any fieldworker ever discussed with you about male sterilization?
NO 2
356. Some people say that vasectomy makes a man weak, while others say that it has no effect. What do you think?
NO EFFECT 2
DOES NOT KNOW 8
HAS NO LIVING CHILD(REN) (GO TO 401)
358. When a couple is making a decision, sometimes the husband has more influence, sometimes the wife has more influence and sometimes other people have more influence. In your family, who has the most influence in deciding about the health care of children?
WIFE HAD MORE INFLUENCE 2
BOTH, HUSBAND AND WIFE EQUAL 3
OTHER RELATIVE 6
OTHER (SPECIFY) 6
SECTION 4. MARRIAGE
401. WRITE THE LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR HIS WIFE.
IF WIFE DOES NOT LIVE IN HOUSEHOLD, WRITE '00'.
401A. Have you been married only once or more than once?
MORE THAN ONCE 2
402. In what month and year did you start living with your (first) wife?
BENGALI 1
YEAR 13__ (GO TO 501)
02 JAISTHA
03 ASHAR
04 SRABAN
05 BADHRA
06 ASHWIN
07 KARTIK
08 AGRAHAYAN
09 POUSH
10 MAGH
11 FALGUN
12 CHOITRA
ENGLISH 2
YEAR 19__ (GO TO 501)
02 FEBRUARY
03 MARCH
04 APRIL
05 MAY
06 JUNE
07 JULY
08 AUGUST
09 SEPTEMBER
10 OCTOBER
11 NOVEMBER
12 DECEMBER
403. How old were you when you started living with her?
DOES NOT KNOW AGE 98
SECTION 5. FERTILITY PREFERENCES
501. CHECK 314:
SHE OR HE STERILIZED (GO TO 514)
502. Now I have some questions about the future. Would you like to have a (another) child or would you prefer not to have any more children?
NO MORE OR NONE 2 (GO TO 506)
SAYS WIFE CAN'T GET PREGNANT 3 (GO TO 506)
UNDECIDED OR DOES NOT KNOW 8 (GO TO 506)
503. How long would you like to wait from now before the birth of a (another) child?
YEARS 2 ___
SOON OR NOW 995
OTHER (SPECIFY) 996
DOES NOT KNOW 998
506. CHECK 313: USING A METHOD?
NOT CURRENTLY USING (GO TO 507)
CURRENTLY USING (GO TO 514)
507. Do you think you will use a method to delay or avoid pregnancy within the next 12 months?
NO 2
DOES NOT KNOW 8
508. Do you intend to use a method at any time in the future?
NO 2 (GO TO 511)
DOES NOT KNOW 8 (GO TO 511)
509. When you use a method, which method would you prefer to use?
IUD 02
INJECTIONS 03
IMPLANT 04
CONDOM 05
FEMALE STERILIZATION 06
MALE STERILIZATION 07
MENSTRUAL REGULATION 08
CALENDAR, COUNTING DAYS 09 (GO TO 514)
WITHDRAWAL 10 (GO TO 514)
OTHER (SPECIFY) 96 (GO TO 514)
UNSURE (GO TO 514)
509A. Where can you get (METHOD MENTIONED IN 509)?
FAMILY WELFARE CENTRE 12 (GO TO 514)
THANA HEALTH COMPLEX 13 (GO TO 514)
SATELLITE CLINIC 14 (GO TO 514)
TRADITIONAL DOCTOR 22 (GO TO 514)
PHARMACY 23 (GO TO 514)
FRIENDS OR RELATIVES 32 (GO TO 514)
NGO CLINIC 42 (GO TO 514)
OTHER (SPECIFY) 96 (GO TO 514)
DOES NOT KNOW 98 (GO TO 514)
511. What is the main reason you do not intend to use a method?
MENOPAUSAL OR HYSTERECTOMY 23
SUB FECUND OR INFECUND 24
WANTS MORE CHILDREN 26
WIFE OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
KNOWS NO SOURCE 42
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS OR TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
DON'T KNOW 98
514. Would you say that you approve or disapprove of couples using a method to avoid getting pregnant?
DISAPPROVE 2
NO OPINION 3
516. In the last month, have you heard or seen a message about family planning on:
NO 2
NO 2
NO 2
NO 2
518. In the last few months have you discussed family planning with your friends, neighbors, or relatives?
NO 2 (GO TO 521)
519. With whom? Anyone else?
RECORD ALL MENTIONED.
MOTHER B
FATHER C
SISTER(s) OR SISTERS-IN-LAW D
BROTHER(S) OR BROTHERS-IN-LAW E
DAUGHTER F
MOTHER-IN-LAW G
FATHER-IN-LAW H
FRIENDS OR NEIGHBORS I
OTHER (SPECIFY) X
521. Spouses or partners do not always agree on everything. Now I want to ask you about your wife's views on family planning. Do you think that your wife approves or disapproves of couples using a method to avoid pregnancy?
DISAPPROVES 2
DON'T KNOW 8
522. How often have you talked to your wife about family planning in the past year?
ONCE OR TWICE 2
MORE OFTEN 3
SOMETIMES 4
523. Do you think your wife wants the same number of children that you want, or does she want more or fewer than you want?
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8
HAS LIVING CHILDREN: If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?
NO LIVING CHILDREN: If you would choose exactly the number of children to have in your whole life, how many would that be?
RECORD SINGLE NUMBER OR OTHER ANSWER.
OTHER ANSWER (SPECIFY) 96
530. How many of these would you like to be boys and how many would you like to be girls?
GIRLS ___
EITHER ___
UP TO GOD 95
OTHER (SPECIFY) 96
SECTION 6. AIDS
601. Have you ever heard of an illness called AIDS?
NO 2 (GO TO 609)
602. From which sources of information have you learned the most about AIDS? Any other sources?
RECORD ALL MENTIONED.
TV B
NEWSPAPERS OR MAGAZINES C
PAMPHLETS OR POSTERS D
HEALTH WORKERS E
MOSQUES OR CHURCHES F
SCHOOLS OR TEACHERS G
COMMUNITY MEETINGS H
FRIENDS OR RELATIVES I
WORK PLACE J
OTHER (SPECIFY) X
603. Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?
NO 2 (GO TO 607)
DON'T KNOW 8 (GO TO 607)
604. What can a person do? Any other ways?
RECORD ALL MENTIONED.
ABSTAIN FROM SEX B
USE CONDOMS C
HAVE ONLY ONE SEX PARTNER D
AVOID SEX WITH PROSTITUTES E
USE STERILE SYRINGES OR BUY SYRINGES F
AVOID BLOOD TRANSFUSIONS G
AVOID KISSING H
AVOID MOSQUITO BITES I
AVOID TRADITIONAL DOCTORS J
OTHER (SPECIFY) W
OTHER (SPECIFY) X
DON'T KNOW Z
DID NOT MENTION SAFE SEX (GO TO 607)
606. What does "safe sex" mean to you?
USE CONDOMS C
HAVE ONLY ONE SEX PARTNER D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH HOMOSEXUALS F
OTHER (SPECIFY) X
DON'T KNOW Z
607. Is it possible for a healthy-looking person to have the AIDS virus?
NO 2
DON'T KNOW 8
608. Do you think that person with AIDS almost never die from the disease, sometimes die, or almost always dies from the disease?
SOMETIMES 2
ALMOST ALWAYS 3
DON'T KNOW 8
MINUTES ___
(TO BE FILLED IN AFTER COMPLETING THE INTERVIEW)
COMMENTS ABOUT RESPONDENT:
COMMENTS ON SPECIFIC QUESTIONS:
ANY OTHER COMMENTS:
SUPERVISOR'S OBSERVATIONS
NAME OF SUPERVISOR:
DATE:
EDITOR'S OBSERVATIONS