BANGLADESH

IDENTIFICATION

DIVISION:
DISTRICT:
THANA:
UNION OR WARD:
VILLAGE OR MOHALLA OR BLOCK:
CLUSTER NUMBER:
HOUSEHOLD NUMBER:

DHAKA/CHITTAGONG OR SMALL CITY OR TOWN OR VILLAGE?

NAME OF HOUSEHOLD HEAD:
NAME AND LINE NUMBER OF MAN:

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE
INTERVIEWER'S NAME
RESULT*

NEXT VISIT
DATE
TIME

FINAL VISIT
DAY
MONTH

YEAR
CODE
RESULT*

TOTAL NUMBER OF VISITS __________

SUPERVISOR
NAME
DATE

FIELD EDITOR
NAME
DATE

OFFICE EDITOR
KEYED BY

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

INFORMED CONSENT

Hello. My name is ___. We came from the Mitra and Associates, a private research organization, is located at Dhaka. To assist in the implementation of socio-development programs in the country, we conduct different types of surveys. We are now conducting a national survey about man and the health of women and children under the authority of NIPORT of Ministry of Health and Family Welfare. We would very much appreciate your participation in this survey. This information will help the government to plan health services. The survey usually takes between 20 and 45 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.

Participation in this survey is voluntary and you can choose not to answer any individual question or all of the questions. However, we hope that you will participate in this survey since your views are important.

At this time, do you want to ask me anything about the survey? May I begin the interview now?

Signature or interviewer:
Date:

101. RECORD THE TIME STARTED.

102. First, I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in a city, in a town, or in the countryside?

103. In the last 12 months, have you been away from your home community for more than 1 month at a time?

104. In the last 12 months, on how many separate occasions have you traveled away from your home community and slept away?

105. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?

106. Just before you moved here, did you live in a city, a town, or in the countryside?

107. In what month and year were you born?

108. How old are you at your last birthday?

COMPARE AND CORRECT 107 AND/OR 108 IN INCONSISTENT.

108A. Are you now married, widowed, or divorced?

109. Have you ever attended school?

110. What is the highest level of school you attended: primary, secondary, or higher?

111. What is the highest class you completed?

112. CHECK 110:

113. Can you read and write a letter in any language easily, with difficulty, or not at all?

114. Do you usually read a newspaper or magazine?

114A. How often do you read newspaper or magazine: every day, at least once a week, or less than once a week?

115. Do you listen to the radio?

115A. How often do you listen to the radio: every day, at least once a week, less than once a week?

116. Do you watch television?

116A. How often do you watch television: every day, at least once a week, less than once a week?

117. What is your religion?

118. Do you belong to any of the following organizations?

119. Are you currently working?

120. What is your occupation, that is, what kind of work do you mainly do?

121. CHECK 120:

122. Do you work mainly on your own land or on family land, or do you rent land or work on someone else's land?

123. Do you do this work for a member of your family, for someone else, or are you self-employed?

124. Do you usually work throughout the year, or do you work seasonally, or only once in a while?

125. During the last 12 months, how many months did you work?

126. Do you think that what you earn is sufficient to provide for you family's basic needs?

127. On average, how much of your family's expenditures do your earnings pay for: almost none, less than half, about half, more than half, or all?

128. Have you done any work in the last 12 months?

129. What have you been doing over the last 12 months?

SECTION 2. REPRODUCTION

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?

202. Do you have any sons or daughters who are now living with you?

203. How many sons live with you? And how many daughters live with you?

IF NONE, RECORD '00'.

204. Do you have any sons or daughters who are alive but do not live with you?

205. How many sons are alive but do not live with you? And how many daughters are alive but do not live with you?

IF NONE, RECORD '00'.

206. Have you ever had a son or a daughter who was born alive but later died?

IF NO PROBE: Any baby who cried or showed signs of life but survived only a few hours or days?

207. In all, how many boys have died? And how many girls have died?

IF NONE, RECORD '00'.

208. SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL.

IF NONE, RECORD '00'.

209. CHECK 208:

Just to make sure that I have this right: you have had in TOTAL __ children during your life. Is that correct?

IF HE HAS NOT HAVE CHILDREN (208 IS "00"): Just to make sure that I have this right: you have not had any children during your life. Is that correct?

210. CHECK 208:

211. In what months and year your last child born?

211A. Is your last child alive or dead?

211B. How old is your last child (in completed years)?

SECTION 3. CONTRACEPTION

Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.

CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED IN 302. THEN, FOR EACH METHOD WITH CODE 1 OR CIRCLED IN 301 OR 302, ASK 303.

301. Which ways or methods have you heard about?
302. Have you ever heard or (METHOD)?

303. Have you ever used (METHOD)?

303A. CHECK 303:

304. Have you or your wife ever used anything or tried in any way to delay or avoid a pregnancy?

306. What have you used or done?

CORRECT 302 AND 303 (AND 301) IF NECESSARY).

306A. Now I would like to ask you about the first time that you or your wife did something or used a method to avoid getting pregnant. What was the first method that you ever used?

307. How many living children did you have at that time, if any?

IF NONE, RECORD '00'.

308. CHECK 302 NUMBER 02:

310. Are you or your wife currently doing something or using any method to delay or avoid a pregnancy?

311. Which method are you using?
311A. CIRCLE '2' FOR MALE STERILIZATION.

312. May I see the package of condoms that you are using now?

RECORD NAME OF BRAND IF PACKAGE IS SEEN.

312A. SHOW BRAND CHART FOR CONDOMS: Please tell me which of these is the brand of condoms that you are using.

313. Where did the sterilization take place?

314. CHECK 311 AND 311A:

CIRCLE METHOD CODE

315. Where did you obtain (CURRENT METHOD) the last time?

SECTION 4. MARRIAGE

401. WRITE THE LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR HIS WIFE. IF SHE DOES NOT LIVE IN THE HOUSEHOLD, RECORD '00'.

402. Have you been married only once or more than once?

403. In what month and year did you start living with your (first) wife?

404. How old were you when you started living with her?

405. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues. How old were you when you first had sexual intercourse (if ever)?

SECTION 5. FERTILITY PREFERENCES

501. CHECK 311 AND 311A:

502. Is your wife currently pregnant?

503. When she became pregnant, did you want her to become pregnant then, did you want her to have a child but wanted to wit or did you not want her to have a child at all?

504. CHECK 502:

A. WIFE NOT PREGNANT OR UNSURE: Now I have some questions about the future. Would you like to have (a or another) child, or would you prefer not to have any (more) children?

B. WIFE IS PREGNANT: Now I have some questions about the future. After the child your wife is expecting now, would you like to have another child, or would you prefer not to have any more children?

505. CHECK 502:

WIFE IS NOT PREGNANT OR UNSURE: How long would you like to wit from now before the birth of (a or another) child?

WIFE IS PREGNANT: After the birth of child you are expecting now, how long would you like to wait before the birth of another child?

506. CHECK 502:

507. CHECK 310:

USING A METHOD?

508. CHECK 505:

509. CHECK 504:

WANTS A OR ANOTHER CHILD(REN): You have said that you do not want (a or another child soon, but you are not using any method to avoid pregnancy. Can you tell me why?

RECORD ALL MENTIONED.

511. CHECK 310:

USING A METHOD?

512. Do you think you will use a method to delay or avoid a pregnancy at any time in the future?

513. Which method would you prefer to use?

514. What is the main reason that you think you will not use a method at any time in the future?

515. CHECK 203 AND 205:

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 could choose exactly the number of children to have in your whole life, how many would that be?

PROBE FOR A NUMERIC RESPONSE.

516. How many of these children would you like to be boys, how many would you like to be girls and for how many would it not matter?

SECTION 6. PARTICIPATION IN HEALTH CARE

601A. Now we talk about possible problems that women might face when she is going to have a child. Do you know any complications during pregnancy, childbirth and after delivery that need medical attention?

PROBE: Any other complication?

RECORD ALL MENTIONED.

601B. Do you think that women should have a medical checkup when they are pregnant even if they are not sick?

601C. At what months of pregnancy do you think that women should have first checkup for pregnancy?

601D. During the pregnancy do you think women should eat more, same or less?

601E. CHECK 211:

602. What is the name of your last child, that is the one who was born in (DATE AS INDICATED IN 211)?

603. Did you wife go to a health facility to receive antenatal care when she was pregnant with (NAME OF LAST BORN CHILD)?

603A. Did any health professional such as doctor, nurse, FWV or others come for your wife's antenatal care when she was pregnant with (NAME OF LAST BORN CHILD)?

604. Were you present anytime during the antenatal care visit?

605. At any time while she was pregnant with (NAME OF LAST BORN CHILD), did any health professional such as doctor, nurse, or FWV talk to you about this particular pregnancy?

606. During this pregnancy, did you ever talk with your wife about what the health professional such as doctor, nurse, or FWV told her about her own health and the baby's health?

607. Where did your wife give birth to (NAME OF LAST BORN CHILD)?

608. When she gave birth to (NAME OF LAST BORN CHILD), were you present (NAME OF THE PLACE IN 607) at that time?

609. In the first two months after (NAME OF LAST BORN CHILD) was born, did your wife visit a health facility to have her own health or the child's health checked or did someone such as doctor, nurse or FWV from the health facility come to your place to check your wife's or child's health?

610. Were you present at that time?

601. CHECK 211A:

612. Did (NAME OF LAST BORN CHILD) ever receive any vaccinations to prevent him or her from getting diseases?

613. When (NAME OF LAST BORN CHILD) was vaccinated in a health facility, did you take him or her anytime to the health facility?

614. Was (NAME OF LAST BORN CHILD) suffered from any health problem in the last four weeks that a health professional (such as doctor, nurse, FWV) visit was needed?

615. Were you present when (NAME OF LAST BORN CHILD) was seen by the health professional such as doctor, nurse, or FWV for such health problem?

616. Now tell me about your health. Have you ever, at any time in your life, had any of the following health problems?

617. CHECK 616 (ALL HEALTH PROBLEMS):

618. Did you receive any treatment for this (these) disease(s)?

619. At any time during the last 3 months, did (this or these) health problem(s) prevent you from doing your work?

620. For how many days in the last 3 months were you unable to do your work due to this (these) health problem(s)?

SECTION 7. AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES

701. Now I would like to talk about something else. Have you ever heard of an illness called AIDS?

701A. From which sources of information have you learned most about AIDS? Any other sources?

RECORD ALL MENTIONED.

702. Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?

703. What can a person do? Anything else?

RECORD ALL MENTIONED.

704. CHECK 703:

705. In your opinion, is there any chance of getting AIDS from a person with multiple sexual partners?

706. If a person has sex with only one partner, does this person have a greater or a lesser chance of getting AIDS than a person who has sex with many partners?

707. CHECK 703:

709. If a person uses a condom every time he or she has sexual intercourse, does this person have a greater or a lesser chance of getting AIDS than someone who doesn't use a condom?

710. Is it possible for a healthy-looking person to have the AIDS virus?

715. Have you ever talked with your wife about ways to prevent getting the virus that causes AIDS?

718. (Apart from AIDS), have you heard about (other) diseases that can be transmitted through sexual contact?

719. In a man, what signs and symptoms would lead you to think that he has such a disease? Any others?

RECORD ALL MENTIONED.

720. In a woman, what signs and symptoms would lead you to think that she has such a disease? Any others?

RECORD ALL MENTIONED.

721. CHECK 405:

722. During the last 12 months, have you had a sexually-transmitted disease?

723. Now I would like to ask you some questions about your health in the last 12 months. Sometimes, men experience a discharge from their penis. During the last 12 months, have you had a discharge from your penis?

724. Sometimes, men experience a sore or ulcer on or near their penis. During the last 12 months, have you had a sore or ulcer on or near your penis?

724A. During the last 12 months, have you had pain or burning sensation during urination?

725. CHECK 722, 723, 724, 724A:

726. The last you had (INFECTION OR DISEASE FROM 722 OR 723 OR 724 OR 724A), did you seek any kind of advice or treatment?

727. The last time you had (INFECTION OR DISEASE FROM 722 OR 723 OR 724 OR 724A) did you do any of the following? Did you:

728. When you had (INFECTION OR DISEASE FROM 722 OR 723 OR 724 OR 724A), did you inform your wife?

SECTION 8. ATTITUDES TOWARDS WOMEN

Now I would like to ask you a few questions regarding men and women in couples. People have many different opinions on this subject and we would like to know what it is that you think about it.

801. If the husband can provide enough money, do you believe that it is acceptable for married women to work outside the home to earn any income or do you think they should stay home and take care of the household?

802. If for some reason the husband cannot provide enough money for the family, do you believe that it is acceptable for married women to work outside the home to earn an income or do you think they should stay home and take care of the household?

803. In a couple, do you think the woman should have a say about:

804. It is normal for couples to have quarrels and disagreements. During those quarrels some husbands occasionally severely reprimand or even beat their wives. In your opinion, do you think a man would be justified to beat his wife:

805. In a couple, who do you think should have the main responsibility to maintain the discipline among the children, the husband, the wife or both?

806. In a couple, who do you think has the main responsibility to take care of the children, the husband, the wife or both?

807. In a couple, who do you think has the main responsibility to take care of the house, the husband, the wife or both?

808. RECORD THE TIME.