DEMOGRAPHIC AND HEALTH SURVEY
MEN'S QUESTIONNAIRE
IDENTIFICATION
PROVINCE ___
DEPARTMENT LAYER ___
DISTRICT ___
CITY/TOWNSHIP/GROUP CLUSTER ___
VILLAGE STRUCTURE ___
NEIGHBORHOOD/PLACE HOUSEHOLD ___
MAN'S NAME ___
MAN'S LINE NUMBER ___
NUMBER OF COUNTING ZONE ___
LINE NO. OF ELIGIBLE WIFE/WIVES OF INTERVIEWED HUSBAND ___
INTERVIEWER 1
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
DAY__
MONTH__
YEAR__
INTERVIEWER NAME___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY COMPLETED 5
OTHER (SPECIFY)__ 6
NEXT VISIT [FOR INTERVIEWERS 1 AND 2]
DATE__
TIME__
FINAL VISIT
DAY__
MONTH__
YEAR __
INTERVIEWER CODE__
TOTAL NUMBER OF VISITS ______
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY COMPLETED 5
OTHER (SPECIFY)__ 6
ENGLISH 2
FULFULDE 3
EWONDO 4
PIDGIN 5
OTHER 6
NO 2
FIELD EDITOR
NAME ___
DATE ___
OFFICE EDITOR ___
KEYED BY ___
SECTION 1. RESPONDENT'S SOCIO-DEMOGRAPHIC CHARACTERISTICS
101) RECORD THE TIME
MINUTE: ______
102) What is your date of birth?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 98
COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT
104) Have you ever attended school?
NO 2 (GO TO 107)
105) What is the highest level of school you attended: primary, secondary, or higher?
SECONDARY 2
HIGHER 3
106) What is the highest (grade/form/year) you completed at this level?
ALL LEVELS
DON'T KNOW 8
FOR POST-SECONDARY: SEE THE INSTRUCTION MANUAL
PRIMARY
ANGLOPHONE/FRANCOPHONE
STANDARD ONE/CLASS TWO/CP 2
STANDARD TWO/CLASS THREE/CE1 3
STANDARD THREE/CLASS FOUR/CE2 4
STANDARD FOUR/CLASS FIVE/CM1 5
STANDARD FIVE/CLASS SIX/CM2 6
STANDARD SIX/CLASS SEVEN 7
SECONDARY
ANGLOPHONE/FRANCOPHONE
FORM 2/FIFTH/2ND YEAR 2
FORM 3/FOURTH/3RD YEAR 3
FORM 4/THIRD/4TH YEAR 4
FORM 5/SECOND 5
LOWER SIXTH FORM/FIRST 6
UPPER SIXTH FORM/FINAL YEAR 7
107) What is your main occupation?
PROTESTANT 2
MUSLIM 3
OTHER (SPECIFY): ___ 4
NONE 5
109) What is your nationality?
OTHER AFRICAN 2
OTHER 3
110) Now I would like to ask you a few questions about marriage: How many spouses/wives do you currently have?
111) Are you planning to take another (more than one) spouse/wife in the future?
NO 2
112) How old were you when you got married or when you started living for the first time with a woman?
113) In what month and year did you get married or did you start living with a woman for the first time?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 98
201) 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. Which resources or methods have you heard of?
CIRCLE CODE 1 IN 202 FOR EACH METHOD MENTIONED SPONTANEOUSLY.
THEN PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.
CIRCLE CODE 2 IF THE METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED.
THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 202, ASK 203 BEFORE CONTINUING TO THE NEXT METHOD.
202) Have you ever heard of (method)?
YES/DESCRIPTION 2
NO 3
YES/DESCRIPTION 2
NO 3
YES/DESCRIPTION 2
NO 3
YES/DESCRIPTION 2
NO 3
YES/DESCRIPTION 2
NO 3
YES/DESCRIPTION 2
NO 3
YES/DESCRIPTION 2
NO 3
YES/DESCRIPTION 2
NO 3
YES/DESCRIPTION 2
NO 3
YES/DESCRIPTION 2
NO 3
SPECIFY METHOD 1 ________
SPECIFY METHOD 2 ________
SPECIFY METHOD 3 _______
NO 3
203) Have you or your wife/wives ever used (method)?
NO 2
NO 2
NO 2
NO 2
NO 2
Has your wife undergone an operation to avoid having any more children?
NO 2
NO 2
NO 2
NO 2
NO 2
YES 1
NO 2
YES 1
NO 2
YES 1
NO 2
AT LEAST ONE "YES" (USED): ___ (GO TO 207)
205) Have you or any of your partners ever used anything or tried in any way to delay or avoid getting pregnant?
NO 2 (GO TO 209)
206) What have you done or used?
CORRECT 203-204 (AND 202 IF NECESSARY)
207) Are you or your partner currently doing something or using any method to delay or avoid getting pregnant?
NO 2 (GO TO 209)
208) Which method are you using?
IUD 02 (GO TO 212)
INJECTABLES 03 (GO TO 212)
DIAPHRAGM/FOAM/GEL 04 (GO TO 212)
CONDOM 05 (GO TO 212)
FEMALE STERILIZATION 06 (GO TO 212)
MALE STERILIZATION 07 (GO TO 212)
RHYTHM METHOD 08 (GO TO 212)
ABSTINENCE 09 (GO TO 212)
WITHDRAWAL 10 (GO TO 212)
OTHER (SPECIFY): ___ 11 (GO TO 212)
209) Do you think you (yourself, or your wife/wives) will use a contraceptive method to delay or avoid pregnancy at any time in the future?
NO 2 (GO TO 211)
DK 8 (GO TO 212)
210) Which contraceptive method would you prefer to use?
IUD 02 (GO TO 212)
INJECTABLES 03 (GO TO 212)
DIAPHRAGM/FOAM/GEL 04 (GO TO 212)
CONDOM 05 (GO TO 212)
FEMALE STERILIZATION 06 (GO TO 212)
MALE STERILIZATION 07 (GO TO 212)
RHYTHM METHOD 08 (GO TO 212)
ABSTINENCE 09 (GO TO 212)
WITHDRAWAL 10 (GO TO 212)
OTHER (SPECIFY): ___ 11(GO TO 212)
DK 98 (GO TO 212)
211) What is the main reason that you think you would never use a method of contraception to avoid pregnancy?
LACK OF INFORMATION 02
SPOUSE DISAPPROVES 03
COSTS TOO MUCH 04
SIDE EFFECTS 05
HEALTH PROBLEMS 06
DIFFICULT TO OBTAIN 07
RELIGION 08
OPPOSED TO FAMILY PLANNING 09
FATALIST/LEAVE IT UP TO GOD 10
FAMILY DISAPPROVES 11
INFREQUENT SEX 12
WOMAN HAS DIFFICULTY BECOMING PREGNANT 13
WOMAN MENOPAUSE/STERILIZATION 14
INCONVENIENT 15
OTHER (SPECIFY): ___ 16
DK 98
212) Is it acceptable or not acceptable to you for information on family planning to be provided on the radio or on television?
AGAINST/BAD 2
DK 8
SECTION 3. FERTILITY PREFERENCES
301) Do you have children?
NO 2 (GO TO 303)
302) How many boys do you have?
How many girls do you have?
STERILIZED: ___ (GO TO 312)
304) Would you like to have (another) child, or would you prefer not have any (more) children?
NO MORE CHILDREN/NONE 2
SAYS WIFE CAN'T GET PREGNANT 3
SAYS HE CAN'T HAVE ANY (MORE) CHILDREN 4
NOT DECIDED/DON'T KNOW 8
305) Do you think your wife (wives)/partner(s) approves or disapproves of couples using a contraceptive method to avoid pregnancy?
NO /DISAPPROVE 2
DK 8
306) How often have you talked to your wife (wives)/partner(s) about family planning in the last twelve months?
ONCE OR TWICE 2
MORE OFTEN 3
307) Have you discussed with your wife (wives)/partner(s) the number of children you'd like to have?
NO 2
308) Do you think that your wife (wives)/partner(s) 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
DK 8
309) After giving birth, how long should a couple wait before resuming sexual intercourse?
YEARS: ___ 2
OTHER (SPECIFY): ___ 996
310) Should a mother wait until she's completely done breastfeeding before resuming sexual intercourse, or does this not matter?
DOESN'T MATTER 2
311) Are you okay with couples using a method to delay or avoid a pregnancy?
NO, NOT OKAY 2
312) CHECK 301-302 AND CHECK THE BOX:
NO LIVING CHILDREN:
If you could choose exactly the number of children to have in your whole life, how many would that be?
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?
RECORD A SINGLE NUMBER OR OTHER RESPONSE:
OTHER RESPONSE (SPECIFY): ___ 96 (GO TO 314)
313) How many boys and how many girls?
BOYS: IT IS GOD'S WILL 95
NO. OF GIRLS ______
GIRLS: IT IS GOD'S WILL 95
OTHER ANSWER (SPECIFY): ___ 96
DK 98
314) What do you think are the main advantages of having a lot of children?
RECORD THE CODES IN THE ORDER THAT THE RESPONSES ARE GIVEN.
IF THERE IS NO 2ND AND 3RD ADVANTAGE, MARK '00'.
FINANCIAL ASSISTANCE/AID 02
SUPPORT IN OLD AGE 03
AFFECTION/COMPANIONSHIP 04
RELIGIOUS/SOCIAL OBLIGATIONS 05
PRIDE/AFFIRMATION OF SELF 06
SOCIAL STATUS 07
POSTERITY/FAMILY NAME 08
NO ADVANTAGES 09
OTHER (SPECIFY): ___ 10
DK 98
2ND ADVANTAGE: ___
3RD ADVANTAGE: ___
315) What do you think are the main disadvantages of having a lot of children?
RECORD THE CODES IN THE ORDER THAT THE RESPONSES ARE GIVEN.
IF THERE IS NO 2ND AND 3RD ADVANTAGE, MARK '00'.
PROBLEMS WITH SUPERVISION 02
PROBLEM WITH DISCIPLINE 03
INCREASE IN WORK 04
CONSTRAINTS FOR PARENTS 05
WORRY ABOUT THE FUTURE 06
PROBLEMS FOR THE COUPLE'S RELATIONSHIP 07
ILLNESS/DEATH 08
NO DISADVANTAGES 09
OTHER (SPECIFY): ___ 10
2ND DISADVANTAGE: ___
3RD DISADVANTAGE: ___
316) According to you, starting with how many children, would one consider a woman to have a lot of children?
DK 98
MINUTES: ___