GOVERNORATE ___________
PSU/SEGMENT NO. ______________
KISM/MARQAZ _____________
BUILDING NO. ___________
SHIAKHA/VILLAGE __________
HOUSE NO. __________
HOUSEHOLD NO. _________
LARGE CITY 1
SMALL CITY 2
TOWN 3
VILLAGE 4
NAME OF HOUSEHOLD HEAD _____________
ADDRESS IN DETAIL _____________________
NAME OF HUSBAND __________________
LINE NUMBER OF HUSBAND _________________
GOVERNORATE ___
PSU/SEGMENT NO. ___
HOUSEHOLD NO. ___
URBAN/RURAL ___
LOCALITY ___
LINE NUMBER HUSBAND ___
INTERVIEWER VISITS 1
DATE____
TEAM____
INTERVIEWER'S NAME____
SUPERVISOR'S NAME____
RESULT____
NEXT VISIT:
DATE____
TIME____
INTERVIEWER VISITS 2
DATE____
TEAM____
INTERVIEWER'S NAME____
SUPERVISOR'S NAME____
RESULT____
NEXT VISIT:
DATE____
TIME____
INTERVIEWER VISITS 3
DATE____
TEAM____
INTERVIEWER'S NAME____
SUPERVISOR'S NAME____
RESULT____
FINAL VISIT
DAY ____
MONTH____
YEAR____
TEAM____
INTERVIEWER____
SUPERVISOR____
RESULT____
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) ___________
FIELD EDITOR
NAME____
DATE____
SIGNATURE____
OFFICE EDITOR
NAME____
DATE____
SIGNATURE____
CODER
NAME____
DATE____
SIGNATURE____
KEYER
NAME____
DATE____
SIGNATURE____
SECTION 1. RESPONDENT'S BACKGROUND
MINUTES ______
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 Cairo, Giza, Alexandria, another city or town, or in a village?
ALEXANDRIA 2
OTHER LARGE CITY/TOWN 3
VILLAGE 4
OUTSIDE EGYPT 5
103. How long have you been living continuously in (NAME OF VILLAGE OR CITY IN WHICH INTERVIEW OCCURS)? IF LESS THAN ONE YEAR, ENTER '00'.
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)
104. Just before you moved here, did you live in Cairo, Giza, Alexandria, another city or town or in a village?
(NAME OF PLACE) ______
ALEXANDRIA 2
OTHER LARGE CITY/TOWN 3
VILLAGE 4
OUTSIDE EGYPT 5
105. In what month and year were you born?
DON'T KNOW MONTH 98
YEAR ____
DON'T KNOW YEAR 98
106. How old were you at your last birthday? COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.
107. How many times have you been married?
108. In what month and year did you first enter into a marriage contract?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 98
109. How old were you when you first entered into a marriage contract?
110. In what month and year did you first begin to live together (consummate your marriage)?
DON'T KNOW MONTH 98
YEAR ____
DON'T KNOW YEAR 98
111. How old were you when you first began to live together (consummate your marriage)?
112. How many wives do you have now?
113. Have you ever attended school?
NO 2 (GO TO 118)
114. What is the highest level of school you attended?
PREPARATORY 2
SECONDARY 3
UPPER INTERMEDIATE 4
UNIVERSITY 5
MORE THAN UNIVERSITY 6
115. What is the highest grade which you successfully completed at that level?
116. Are you currently attending school?
NO 2
PREPARATORY OR HIGHER (GO TO 119)
118. Can you read and understand a letter or newspaper easily, with difficulty, or not at all?
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 120)
119. Do you usually read a newspaper or magazine at least once a week?
NO 2
120. How many hours on average do you listen to the radio each day? IF LISTENS LESS THAN 1 HOUR, WRITE "00".
ALL OF THE TIME 96
NEVER 97
NOT SURE/DON'T KNOW 98
121. How many hours on average do you watch television each day? IF WATCHES LESS THAN 1 HOUR, WRITE "00".
ALL OF THE TIME 96
NEVER 97
NOT SURE/DON'T KNOW 98
CHRISTIAN 2
OTHER (SPECIFY) ____ 3
123. What kind of work do you mainly do? WRITE THE ANSWER EXACTLY AS GIVEN.
DOES (DID) NOT WORK IN AGRICULTURE (GO TO 126)
125. Do you work mainly on your own land or family land, or do you rent land or do you work on someone else's land?
RENTED LAND 2 (GO TO 201)
SOMEONE ELSE'S LAND 3 (GO TO 201)
126. Do you work for someone else or for yourself?
FOR HIMSELF 2 (GO TO 201)
127. Do you earn a regular wage or salary?
NO 2
201. Now I would like to ask you about all your children. Do you have any children?
NO 2 (GO TO 203)
202. How many sons do you have? And how many daughters do you have? IF NONE ENTER '00'.
DAUGHTERS ____
203. Did you ever have a child who died, even if it was only a small baby?
NO 2 (GO TO 205)
204. How many of your sons have you lost? And how many of your daughters have you lost? IF NONE ENTER '00'.
DAUGHTERS DIED ___
205. Would you like to have a (another) child or would you prefer not to have any more children?
NO MORE/NONE 2 (GO TO 207)
UNDECIDED/DOES NOT KNOW 8 (GO TO 207)
206. Does your wife want to have a (another) child or would she prefer not to have any (more) children?
NO MORE/NONE 2
WIFE IS UNDECIDED 3
DOESN'T KNOW WIFE'S DESIRES 8
207. Have you and your wife ever discussed the number of children you would like to have?
NO 2
208. Do you think your wife wants the same number of children that you want, or does she want more or fewer children than you want?
MORE CHILDREN 2
FEWER CHILDREN 3
DOES NOT KNOW 8
NO, HAS NO LIVING CHILDREN (GO TO 211)
210. 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 you choose?
OTHER ANSWER (SPECIFY) ___ 96 (GO TO 213)
211. If you could choose exactly the number of children to have in your whole life, how many would that be?
OTHER ANSWER (SPECIFY) ____ 96 (GO TO 213)
212. How many boys and how many girls? IF NONE ENTER '00'.
GIRLS ___
OTHER ANSWER (SPECIFY) ____ 96
213. What do you think is the best number of months or years between the birth of one child and the birth of the next child?
IF LESS THAN 2 YEARS, RECORD IN MONTHS. OTHERWISE RECORD IN YEARS.
YEARS 2 ___
OTHER (SPECIFY) ___ 996
214. When a couple is making a decision, sometimes the husband has more influence, in some cases, the wife has more influence, while other decisions are made jointly. In your family, who has the most influence in deciding whether or not to have another child -- you, or your wife or do you have equal say?
BOTH RESPONDENT AND WIFE EQUAL 2
WIFE HAS MORE INFLUENCE 3
OTHER (SPECIFY) ___ 4
215. Do you expect your children to help you financially when you get old?
NO 2
NOT SURE/DOESN'T KNOW 8
216. What is the highest level of school you would like for your daughter(s) to attain?
PREPARATORY 02
SECONDARY 03
UPPER INTERMEDIATE 04
UNIVERSITY 05
MORE THAN UNIVERSITY 06
DEPENDS ON CHILD 95
NO ASPIRATIONS FOR EDUCATION 96
DON'T KNOW 98
217. What is the highest level of school you would like for your son(s) to attain?
PREPARATORY 02
SECONDARY 03
UPPER INTERMEDIATE 04
UNIVERSITY 05
MORE THAN UNIVERSITY 06
DEPENDS ON CHILD 95
NO ASPIRATIONS FOR EDUCATION 96
DON'T KNOW 98
301. 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 ways or methods have you heard about?
CIRCLE CODE 1 IN 302 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 METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 302, ASK 303-304 BEFORE PROCEEDING TO THE NEXT METHOD.
302. Have you ever heard of (METHOD)? READ DESCRIPTION OF EACH METHOD.
YES/PROBED 2
NO 3
YES/PROBED 2
NO 3
YES/PROBED 2
NO 3
YES/PROBED 2
NO 3
YES/PROBED 2
NO 3
YES/PROBED 2
NO 3
YES/PROBED 2
NO 3
YES/PROBED 2
NO 3
YES/PROBED 2
NO 3
YES/PROBED 2
NO 3
YES/PROBED 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
NO 2
304. Do you know where a person could go to get (METHOD)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NOT A SINGLE "YES" (NEVER HEARD) (GO TO 401)
306. Have you ever discussed family planning with your wife?
NO 2 (GO TO 309)
307. Who first started to discuss family planning, you or your wife?
HIS WIFE 2
308. How often have you talked to your wife about family planning in the past year?
TWO OR THREE TIMES 2
FOUR TIMES OR MORE 3
NEVER 4
309. When a couple is making a decision, sometimes the husband has more influence, in some cases, the wife has more influence, while other decisions are made jointly. In your family, who has the most influence in deciding whether or not to use family planning-you, or your wife or do you have equal say?
BOTH RESPONDENT AND WIFE EQUAL 2
WIFE HAS MORE INFLUENCE 3
OTHER (SPECIFY) ___ 4
AT LEAST ONE "YES" (EVER USED) (GO TO 313)
311. Have you ever used anything or tried in any way to delay or avoid getting pregnant?
NO 2 (GO TO 322)
312. What have you or your wife used or done? CORRECT 303-305 (AND 302 IF NECESSARY)
313. Have you ever gone to get family planning supplies?
NO 2
NEVER USED SUPPLY METHODS 3
314. Have you ever accompanied your wife when she went for family planning?
NO 2
SHE NEVER WENT 3
NEVER USED CONDOM (GO TO 320)
316. Do you and your wife usually use the condom in conjunction with some other method? IF YES: Which method?
IUD 02
INJECTIONS 03
NORPLANT 04
DIAPHRAGM/FOAM/JELLY 05
FEMALE STERILIZATION 07
MALE STERILIZATION 08
PERIODIC ABSTINENCE 09
WITHDRAWAL 10
PROLONGED BREASTFEEDING 11
OTHER (SPECIFY) ____ 12
USE CONDOM ONLY 13
317. Did you buy any condoms in the past year?
NO 2 (GO TO 319)
318. Now many packets of condoms have you bought?
OTHER ANSWER (SPECIFY) ___ 96
319. What brand of condoms do you usually obtain?
DON'T KNOW 98
320. Are you and your wife currently doing anything or using anything to avoid or delay getting pregnant?
NO 2 (GO TO 322)
321. Which method are you or your wife using?
IUD 02 (GO TO 326)
INJECTIONS 03 (GO TO 326)
NORPLANT 04 (GO TO 326)
DIAPHRAGM/FOAM/JELLY 05 (GO TO 326)
CONDOM 06 (GO TO 326)
FEMALE STERILIZATION 07 (GO TO 326)
MALE STERILIZATION 08 (GO TO 326)
PERIODIC ABSTINENCE 09 (GO TO 326)
WITHDRAWAL 10 (GO TO 326)
PROLONGED BREASTFEEDING 11 (GO TO 326)
OTHER (SPECIFY) ____ 12 (GO TO 326)
322. Do you intend to use a method to delay or avoid pregnancy at any time in the future?
NO 2
DON'T KNOW 8 (GO TO 326)
323. What is the main reason you do not intend to use a method?
LACK OF KNOWLEDGE 02 (GO TO 326)
PARTNER OPPOSED 03 (GO TO 326)
COST TOO MUCH 04 (GO TO 326)
SIDE EFFECTS 05 (GO TO 326)
HEALTH CONCERNS 06 (GO TO 326)
HARD TO GET METHODS 07 (GO TO 326)
RELIGION 08 (GO TO 326)
OPPOSED TO FAMILY PLANNING 09 (GO TO 326)
FATALISITIC 10 (GO TO 326)
OTHER PEOPLE OPPOSED 11 (GO TO 326)
INFREQUENT SEX 12 (GO TO 326)
WIFE CANNOT GET PREGNANT (GO TO 326)
WIFE MENOPAUSAL/HYSTERECTOMY 14 (GO TO 326)
INCONVENIENT 15 (GO TO 326)
OTHER (SPECIFY) _____ 16 (GO TO 326)
DON'T KNOW 98 (GO TO 326)
324. Do you intend to use a method within the next 12 months?
NO 2
DON'T KNOW 8
325. When you use a method, which method would you prefer to use?
IUD 02
INJECTIONS 03
NORPLANT 04
DIAPHRAGM/FOAM/JELLY 05
CONDOM 06
FEMALE STERILIZATION 07
MALE STERILIZATION 08
PERIODIC ABSTINENCE 09
WITHDRAWAL 10
PROLONGED ABSTINENCE 11
OTHER (SPECIFY) ____ 12
UNSURE 98
326. How did you first hear about family planning?
RADIO 02
PRINT MEDIA 03
WIFE 04
OTHER RELATIVES/FRIENDS 05
GOVERNMENT DOCTOR/CLINIC STAFF 06
PRIVATE DOCTOR/CLINIC STAFF 07
RAIYDA/OTHER FP WORKER 08
COMMUNITY MEETING 09
OTHER (SPECIFY) ____ 10
327. In the last month, have you heard a message about family planning on:
NO 2
NO 2
328. Is it acceptable or not acceptable to you for family planning information to be provided on the radio or television?
NOT ACCEPTABLE 2
DON'T KNOW 8
329. There are many spots or messages regarding family planning on television. Can you tell me about the spots or massages which you have found most informative or helpful to you?
RECORD THE RESPONSE IN DETAIL. IF THE ANSWER IS A TO SERIES (E.G., KAREEMA MUHKTAR OR THE DOCTOR), PROBE TO FIND OUT WHICH SPECIFIC SPOTS IN THE SERIES WERE MOST HELPFUL OR INFORMATIVE. RECORD UP TO THREE SPOTS.
______2
______3
ABLE TO READ__(GO TO 331)
NOT ABLE TO READ__(GO TO 332)
331. In the last month have you read an article about family planning in a newspaper or magazine?
NO 2
332. In the past year, have you ever attended a community meeting or talk in which there was discussion about family planning or Egypt's population problem?
NO 2
333. In general, do you approve or disapprove of couples using a method to avoid pregnancy?
DISAPPROVES 2
DOESN'T KNOW/UNDECIDED 8
334. In general, do you think that your religion allows couples to use family planning or it forbids it?
FORBIDS FP 2
DOESN'T KNOW 8
335. Do you think that your wife approves or disapproves of couples using a method to avoid pregnancy?
DISAPPROVES 2
DOESN'T KNOW/UNDECIDED 8
336. If couples wish to avoid pregnancy, do you approve or disapprove of their using:
DISAPPR 2
DK 3
DISAPPR 2
DK 3
DISAPPR 2
DK 3
DISAPPR 2
DK 3
DISAPPR 2
DK 3
DISAPPR 2
DK 3
337. In your opinion, what is the main problem, if any, with using:
ENTER CODE FOR EACH METHOD FROM LIST BELOW
01 NONE
02 NOT EFFECTIVE
03 WIFE/PARTNER DISAPPROVES
04 COMMUNITY DISAPPROVES
05 RELIGION DISAPPROVES
06 SIDE EFFECTS/HEALTH CONCERN
07 ACCESS/AVAILABILITY
08 COSTS TOO MUCH
09 INCONVENIENT TO USE
10 OTHER (SPECIFY)
98 DON'T KNOW
338. Would you object if your wife went to a male doctor for family planning?
NO 2
DON'T KNOW 8
339. Between the first day of a woman's period (i.e., menstrual cycle) and the first day of her next period, are there certain times when she has a greater chance of becoming pregnant than other times?
NO 2 (GO TO 401)
DON'T KNOW 8 (GO TO 401)
340. During which times of a woman's menstrual cycle does she have the greatest chance of becoming pregnant?
RIGHT AFTER HER PERIOD HAS ENDED 2
IN THE MIDDLE OF THE CYCLE 3
JUST BEFORE HER PERIOD BEGINS 4
OTHER (SPECIFY) ___ 5
DON'T KNOW 8
SECTION 4. WIFE'S CHARACTERISTICS
401. Does your wife go out alone or with your children to buy household items or visit relatives?
YES, WITH CHILDREN 2
NOT ALLOWED TO GO OUT 3
OTHER (SPECIFY) ___ 4
402. In general, if a wife disagree with her husband, do you think she should express her opinion or keep quiet?
KEEP QUIET 2
NOT SURE/DON'T KNOW 8
403. Some say that a woman's place is not only at home but she should be able to work. Do you agree?
DISAGREE 2
NOT SURE/DON'T KNOW 8
404. Who should have the last word on the following--the husband, the wife, both, or someone else?
WIFE 2
BOTH 3
OTHER 4
WIFE 2
BOTH 3
OTHER 4
WIFE 2
BOTH 3
OTHER 4
WIFE 2
BOTH 3
OTHER 4
WIFE 2
BOTH 3
OTHER 4
WIFE 2
BOTH 3
OTHER 4
WIFE 2
BOTH 3
OTHER 4
405. What do you think is the total spent each month by a family in your situation?
NOT SURE/DON'T KNOW 9998
406. Does your wife make any contribution to the household budget?
NO 2
MINUTES ____
THANK THE RESPONDENT FOR PARTICIPATING IN THE SURVEY. COMPLETE QUESTIONS 501-502 AS APPROPRIATE. BE SURE TO REVIEW THE QUESTIONNAIRE FOR COMPLETENESS BEFORE LEAVING THE HOUSEHOLD.
501. DEGREE OF COOPERATION
FAIR 2
GOOD 3
VERY GOOD 4
502 INTERVIEWER'S COMMENTS:
_____________________________________
503 FIELD EDITOR'S COMMENTS:
_____________________________________
504 SUPERVISOR'S COMMENTS:
_____________________________________
505 OFFICE EDITOR'S COMMENTS:
_____________________________________