Husband questionnaire
SUBDISTRICT/SEGMENT________
SUBDISTRICT/SEGMENT_________
DWELLING/PLOT_______
HOUSEHOLD NUMBER_________
ORDER NUMBER OF WOMAN___________
FIRST VISIT
DATE__________
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) ____ 6
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) ____ 6
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) ____ 6
NEXT VISIT
DATE
TIME
FINAL VISIT
DAY
MONTH
INT. NUMBER
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) ____ 6
NAME________
DATE_______
FIELD EDITED BY_________
OFFICE EDITED BY_______
KEYED BY________
KEYED BY________
SECTION 1. HUSBAND'S BACKGROUND
101) In what month were you born?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 98
102) How old are you?
INTERVIEWER: COMPARE AND CORRECT 101 AND/OR 102 IF INCONSISTENT
NO 2
104) What is your nationality?
ZAIREAN 2
TANZANIAN 3
OTHER AFRICAN 4
OTHER (SPECIFY) _____ 5
Now I would like to talk about a different topic. There are different traditional or modern ways or methods that a couple can use to delay or avoid pregnancy. Do you know any of these methods or have you heard of them?
INTERVIEWER:
CIRCLE CODE 1 IN 201-202 FOR EACH METHOD MENTIONED SPONTANEOUSLY. FOR EACH METHOD NOT MENTIONED, READ THE DESCRIPTION, ASK 202 AND CIRCLE CODE 2 IF THE METHOD IS RECOGNIZED. ASK 203 TO 205 FOR EACH METHOD CODED 1 OR 2 IN 201-202.
201-202. Have you ever heard of this method?
YES, PROBED 2
NO 3 (GO TO NEXT METHOD)
YES, PROBED 2
NO 3 (GO TO NEXT METHOD)
YES, PROBED 2
NO 3 (GO TO NEXT METHOD)
YES, PROBED 2
NO 3 (GO TO NEXT METHOD)
YES, PROBED 2
NO 3 (GO TO NEXT METHOD)
YES, PROBED 2
NO 3 (GO TO NEXT METHOD)
YES, PROBED 2
NO 3 (GO TO NEXT METHOD)
YES, PROBED 2
NO 3 (GO TO NEXT METHOD)
YES, PROBED 2
NO 3 (GO TO NEXT METHOD)
YES, PROBED 2
NO 3 (GO TO NEXT METHOD)
YES, PROBED 2
NO 3 (GO TO NEXT METHOD)
YES, PROBED 2
NO 3 (GO TO NEXT METHOD)
203) Has your wife 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
NO 2
204) Where would you go to obtain (method)?
02 HEALTH CENTER/MOTHER-INFANT CENTER
03 PUBLIC CLINIC
04 AUTHORIZED CLINIC
05 PRIVATE OFFICE
06 PHARMACY
07 TRADITIONAL HEALER
08 ACQUAINTANCES
09 OTHER (SPECIFY) _____
98 DK
02 HEALTH CENTER/MOTHER-INFANT CENTER
03 PUBLIC CLINIC
04 AUTHORIZED CLINIC
05 PRIVATE OFFICE
06 PHARMACY
07 TRADITIONAL HEALER
08 ACQUAINTANCES
09 OTHER (SPECIFY) _____
98 DK
02 HEALTH CENTER/MOTHER-INFANT CENTER
03 PUBLIC CLINIC
04 AUTHORIZED CLINIC
05 PRIVATE OFFICE
06 PHARMACY
07 TRADITIONAL HEALER
08 ACQUAINTANCES
09 OTHER (SPECIFY) _____
98 DK
205) In your opinion, what is the main problem, if any, with using (method)?
02 NOT EFFECTIVE
03 WIFE/PARTNER DISAPPROVES
04 SIDE EFFECTS
05 ACCESS/AVAILABILITY
06 COST
07 INCONVENIENT TO USE
08 OTHER (SPECIFY) _____
98 DON'T KNOW
02 NOT EFFECTIVE
03 WIFE/PARTNER DISAPPROVES
04 SIDE EFFECTS
05 ACCESS/AVAILABILITY
06 COST
07 INCONVENIENT TO USE
08 OTHER (SPECIFY) _____
98 DON'T KNOW
02 NOT EFFECTIVE
03 WIFE/PARTNER DISAPPROVES
04 SIDE EFFECTS
05 ACCESS/AVAILABILITY
06 COST
07 INCONVENIENT TO USE
08 OTHER (SPECIFY) _____
98 DON'T KNOW
02 NOT EFFECTIVE
03 WIFE/PARTNER DISAPPROVES
04 SIDE EFFECTS
05 ACCESS/AVAILABILITY
06 COST
07 INCONVENIENT TO USE
08 OTHER (SPECIFY) _____
98 DON'T KNOW
02 NOT EFFECTIVE
03 WIFE/PARTNER DISAPPROVES
04 SIDE EFFECTS
05 ACCESS/AVAILABILITY
06 COST
07 INCONVENIENT TO USE
08 OTHER (SPECIFY) _____
98 DON'T KNOW
02 NOT EFFECTIVE
03 WIFE/PARTNER DISAPPROVES
04 SIDE EFFECTS
05 ACCESS/AVAILABILITY
06 COST
07 INCONVENIENT TO USE
08 OTHER (SPECIFY) _____
98 DON'T KNOW
02 NOT EFFECTIVE
03 WIFE/PARTNER DISAPPROVES
04 SIDE EFFECTS
05 ACCESS/AVAILABILITY
06 COST
07 INCONVENIENT TO USE
08 OTHER (SPECIFY) _____
98 DON'T KNOW
02 NOT EFFECTIVE
03 WIFE/PARTNER DISAPPROVES
04 SIDE EFFECTS
05 ACCESS/AVAILABILITY
06 COST
07 INCONVENIENT TO USE
08 OTHER (SPECIFY) _____
98 DON'T KNOW
02 NOT EFFECTIVE
03 WIFE/PARTNER DISAPPROVES
04 SIDE EFFECTS
05 ACCESS/AVAILABILITY
06 COST
07 INCONVENIENT TO USE
08 OTHER (SPECIFY) _____
98 DON'T KNOW
02 NOT EFFECTIVE
03 WIFE/PARTNER DISAPPROVES
04 SIDE EFFECTS
05 ACCESS/AVAILABILITY
06 COST
07 INCONVENIENT TO USE
08 OTHER (SPECIFY) _____
98 DON'T KNOW
02 NOT EFFECTIVE
03 WIFE/PARTNER DISAPPROVES
04 SIDE EFFECTS
05 ACCESS/AVAILABILITY
06 COST
07 INCONVENIENT TO USE
08 OTHER (SPECIFY) _____
98 DON'T KNOW
02 NOT EFFECTIVE
03 WIFE/PARTNER DISAPPROVES
04 SIDE EFFECTS
05 ACCESS/AVAILABILITY
06 COST
07 INCONVENIENT TO USE
08 OTHER (SPECIFY) _____
98 DON'T KNOW
S
AT LEAST ONE 'YES' IN 201-202(KNOWS AT LEAST ONE METHOD) (GO TO 207)
207) From whom or how did you get information contraception for the first time?
OTHER HEALTHCARE PROFESSIONAL 02
SOCIAL ORGANIZER 03
UFB MEETING 04
PARTY MEETINGS 05
WIFE 06
FRIENDS/ACQUAINTANCES 07
RELIGIOUS PERSONNEL 08
RADIO/TELEVISION 09
NEWSPAPER 10
OTHER (SPECIFY) _____ 11
DON'T KNOW 98
208) Do you intend to use a method to prevent your wife from getting pregnant in the future?
NO 2 (SKIP TO 301)
DON'T KNOW 8 (SKIP TO 301)
209) Among the methods we just discussed, which one would you prefer to use with your wife in the future?
WITHDRAWAL 02
ABSTINENCE 03
PERIODIC ABSTINENCE 04
MALE STERILIZATION 05
MEDICAL PLANTS 06
TALISMANS 07
PILL 08
IUD 09
INJECTIONS 10
DIAPHRAGM, FOAM, JELLY 11
FEMALE STERILIZATION 12
SECTION 3. FERTILITY PREFERENCES
301) Now I would like to ask you some questions about yourself and some about your wife. They are about fertility.
Do you have children?
NO 2 (SKIP TO 304)
302) How many children do you have?
NUMBER OF GIRLS _____
303) 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?
UP TO GOD 95 (SKIP TO 305)
OTHER ANSWER (SPECIFY) ____ 96 (SKIP TO 305)
DON'T KNOW 98 (SKIP TO 305)
304) If you could choose exactly the number of children to have in your whole life, how many would that be?
Number
UP TO GOD 95 (SKIP TO 305)
OTHER ANSWER (SPECIFY) ____ 96 (SKIP TO 305)
DON'T KNOW 98 (SKIP TO 305)
305) How many boys? How many girls?
NUMBER OF GIRLS ____
UP TO GOD 95
OTHER (SPECIFY) ____ 96
DON'T KNOW 98
306) In your opinion, what is the best amount of time to wait between two births?
OTHER (SPECIFY) 96 (SKIP TO 308)
DON'T KNOW 98 (SKIP TO 308)
307) Why is this interval the best?
HEALTH OF CHILD 1
CHILDREN'S EDUCATION 1
ECONOMIC DIFFICULTIES 1
CUSTOMS 1
OTHER (SPECIFY) _____ 1
DON'T KNOW 1
308) For how long should a woman wait before starting sexual intercourse after the birth of a baby?
OR NUMBER OF MONTHS 2
OR NUMBER OF YEARS 3
OTHER (SPECIFY) ____ 996
DON'T KNOW 998
309) How often have you talked to your wife about contraception in the past year?
ONCE OR TWICE 2
THREE TIMES OR MORE 3
IN UNION LESS THAN A YEAR 4
310) Do you think that your wife approves or disapproves of couples using a method to avoid pregnancy?
DISAPPROVES 2
DON'T KNOW 8
DISAPPROVE 2
INDIFFERENT 3
312) In your opinion, how many children would you advise to a new couple who just got married? [##translator note: The original text is a bit unclear-it doesn't ask how many children a couple should have specifically, just how many children for a new couple, presumably how many children they should have]