IDENTIFICATION

STATE___________

DISTRICT__________

TEHSIL/TALUK_________

TYPE OF PSU (URBAN EQUALS 1, RURAL EQUALS 2) ________

PSU NUMBER ________

STRUCTURE NUMBER ________

HOUSEHOLD NUMBER ________

NAME AND LINE NUMBER OF WOMAN________

ADDRESS OF HOUSEHOLD__________

IS HOUSEHOLD SELECTED FOR THE STATE MODULE?

IS WOMAN SELECTED FOR QUESTIONS ON HOUSEHOLD RELATIONS (SECTION 11)?

INTERVIEWER VISITS

FIRST VISIT
DATE______
INTERVIEWER'S NAME_____
RESULT CODE______

SECOND VISIT
DATE______
INTERVIEWER'S NAME_____
RESULT CODE______

THIRD VISIT
DATE______
INTERVIEWER'S NAME_____
RESULT CODE______

NEXT VISIT
DATE_______
TIME_______

FINAL VISIT
DAY ______
MONTH ______
YEAR _____
INT. NO ______
RESULT CODE ______

TOTAL NUMBER OF VISITS _______

SUPERVISOR'S NAME_______

SUPERVISOR NUMBER ________

**LANGUAGE HINDI 04

RESPONDENT'S MOTHER TONGUE _______

LANGUAGE OF INTERVIEW ________________ __ __

TRANSLATOR USED?

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND INFORMED CONSENT

Namaste. My name is _______. I am working with (NAME OF ORGANIZATION). We are conducting a survey about health all over India. The information on family welfare and health that we collect from households and individuals will help the government to plan health services. Your household was selected for the survey. The questions usually take about 40 - 60 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. Your participation in the survey is voluntary. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.

If you have any questions about this survey you may ask me.
GIVE CARD WITH CONTACT INFORMATION.

Do you agree to participate in this survey?

SIGNATURE OF INTERVIEWER:_____________
DATE:______

101. RECORD THE TIME.

102. In what month and year were you born?

103. How old were you at your last birthday?
COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT.

104. How long have you been living continuously in (CURRENT PLACE OF RESIDENCE)?
IF LESS THAN 1 YEAR, RECORD '00'

105. Have you ever attended school?

106. What is the highest standard you completed?

107. CHECK 106:

108. Now I would like you to read this sentence to me.

SHOW A SENTENCE FROM THE LITERACY CARD TO THE RESPONDENT.

IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

109. CHECK 108:

110. Do you read a newspaper or magazine almost every day, at least once a week, less than once a week or not at all?

111. Do you listen to the radio almost every day, at least once a week, less than once a week or not at all?

112. Do you watch television almost every day, at least once a week, less than once a week or not at all?

113. Do you usually go to a cinema hall or theatre to see a movie at least once a month?

114. What is your religion?

115. What is your caste or tribe?

116. Do you belong to a scheduled caste, a scheduled tribe, other backward class, or none of these?

SECTION 2. REPRODUCTION

201. Now I would like to ask about all the births you have had during your life. Have you ever given birth?

202. Do you have any sons or daughters to whom you have given birth who are now living with you?

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

204. Do you have any sons or daughters to whom you have given birth 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 given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

207. 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 ___ births during your life. Is that correct?

210. CHECK 208:

211. Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had.

RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. (IF THERE ARE MORE THAN 12 BIRTHS, USE ADDITIONAL QUESTIONNAIRE STARTING WITH THE SECOND ROW)

212. What name was given to your (first/next) baby?

213. Is (NAME) a boy or a girl?

214. Were any of these births twins?

215. In what month and year was (NAME) born?
PROBE: What is his/her birthday?

216. Is (NAME) still alive?

217. How old was (NAME) at (his/her) last birthday?
RECORD AGE IN COMPLETED YEARS.

218. Is (NAME) living with you?

219. IF ALIVE: RECORD HOUSE-HOLD LINE NUMBER OF CHILD (RECORD '00' IF CHILD NOT LISTED IN HOUSE-HOLD).

220. How old was (NAME) when he/she died?
IF '1 YR', PROBE: How many months old was (NAME)?

RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

221. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME), including any children who died birth?

222. Have you had any live births since the birth of (NAME OF LAST BIRTH)?
IF YES, RECORD BIRTH(S) IN TABLE.

223. Before the birth of (NAME OF FIRST BIRTH), did you have any other live births?
IF YES, RECORD BIRTH(S) IN TABLE.

224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN JANUARY 2010 OR LATER.

225. C:
FOR EACH BIRTH SINCE JANUARY 2010, ENTER 'B' IN THE MONTH OF BIRTH IN COLUMN 1 OF THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)

FOR EACH BIRTH ASK: At any time when you were pregnant with (NAME), did you have an ultrasound test?

RECORD 'Y' IF YES AND 'N' IF NO IN COLUMN 2 IN THE MONTH OF BIRTH.

226. Are you pregnant now?

227. C: How many months are you?

RECORD NUMBER OF COMPLETED MONTHS. ENTER 'P's IN COLUMN 1 OF CALENDAR, BEGINNING WITH MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

228. At any time during this pregnancy, have you had an ultrasound test?

RECORD 'Y' IF YES AND 'N' IF NO IN COLUMN 2 OF THE CALENDAR IN THE CURRENT MONTH.

229. When you got pregnant, did you want to get pregnant at that time?

230. Did you want to have the baby later on or did you not want any (more) children?

231. Have you ever had a pregnancy that miscarried, was aborted, or ended in a stillbirth?

232. When did the last such pregnancy end?

233. CHECK 232:

234. C: Did that pregnancy end in a miscarriage, an abortion, or a stillbirth?

CIRCLE RESPONSE CODE AND ENTER 'M' FOR MISCARRIAGE, 'A' FOR ABORTION, OR 'S' FOR STILLBIRTH IN COLUMN 1 OF THE CALENDAR IN MONTH IN WHICH PREGNANCY WAS TERMINATED.

235. C: How many months pregnant were you when the last such pregnancy ended?

RECORD NUMBER OF COMPLETED MONTHS. ENTER 'P's IN COLUMN 1 OF CALENDAR IN MONTHS BEFORE THE PREGNANCY TERMINATED. TOTAL NUMBER OF 'P's MUST BE ONE LESS THAN NUMBER OF MONTHS PREGNANT AT TIME OF TERMINATION.

236. C: At any time during this pregnancy, did you have an ultrasound test?

RECORD 'Y' IF YES AND 'N' IF NO IN COLUMN 2 OF THE CALENDAR IN MONTH IN WHICH PREGNANCY WAS TERMINATED.

237. CHECK 234:

238. Where was the abortion performed?

239. Who performed the abortion?

240. Did you have any complication from the abortion?

241. Did you seek treatment for the complication?

242. Where did you go for treatment?

243. Why did you not seek treatment?
Any other reason?
RECORD ALL MENTIONED.

244. Since January 2011, have you had any other pregnancies that did not result in a live birth?

245. C:
ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY SINCE JANUARY 2010.

ENTER 'T' IN COLUMN 1 OF CALENDAR IN MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR REMAINING NUMBER OF COMPLETED MONTHS.
FOR EACH TERMINATED PREGNANCY ASK: At any time during this pregnancy, did you have an ultrasound test?

RECORD 'Y' IF YES AND 'N' IF NO IN COLUMN 2 OF THE CALENDAR IN MONTH IN WHICH PREGNANCY WAS TERMINATED.

246. Did you have any pregnancies that terminated before January 2011 that did not result in a live birth?

247. When did the last such pregnancy that terminated before January 2011 end?

248. When did your last menstrual period start?
IF LESS THAN 1 WEEK, RECORD DAYS;
IF LESS THAN 1 MONTH, RECORD WEEKS;
IF LESS THAN 1 YEAR, RECORD MONTHS.

249. CHECK 226:

249A. CHECK 226:

250. Some women undergo an operation to remove the uterus. Have you undergone such an operation?

251. How many years ago was this operation (hysterectomy) performed?
IF LESS THAN 1 YEAR AGO, RECORD '00'.

252. Where was this operation performed?

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE HEALTH SECTOR, WRITE THE NAME OF THE PLACE.

253. Why was this operation performed? Any other reason?

254. CHECK 248:

255. CHECK 103:

256. How old were you when you had your first monthly period?

257. Women use different methods of protection during their menstrual period to prevent bloodstains from becoming evident. What do you use for protection, if anything?
Anything else? RECORD ALL MENTIONED.

258. From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant if she has sexual relations?

259. Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?

SECTION 3A. MARRIAGE AND COHABITATION

301. What is your current marital status?

302. Is your husband living with you now, or is he staying elsewhere?

303. For how long you and your husband not been living together?
IF LESS THAN 1 YEAR, RECORD MONTHS; OTHERWISE RECORD COMPLETED YEARS.

304. RECORD THE HUSBAND'S NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00' IN THE BOXES FOR LINE NUMBER.

305. Besides yourself, does your husband have other wives?

306. Including yourself, in total, how many wives does he have?

307. Have you been married once or more than once?

308. In what month and year did you get married?

308A. Now I would like to ask about when you married your first husband. In what month and year was that?

309. How old were you when you (first) got married?

310. Before you got married, was your (current) husband related to you in any way?

311. What type of relationship was it?

312. CHECK 301: MARITAL STATUS

313. CHECK 307:

MARRIED ONLY ONCE. In what month and year did you start living with your husband?

MARRIED MORE THAN ONCE. Now I would like to ask about when you started living with your first husband. In what month and year was that?

314. How old were you when you first started living with him?

315. CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

Now I need to ask you some questions about sexual life in order to gain a better understanding of some family life issues. Let me assure you again that your answers are completely confidential and will not be told to anyone. If you do not want to answer, just let me know and I will skip to the next question.

Have you ever had sexual intercourse?

316. CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

Now I need to ask you some questions about sexual life in order to gain a better understanding of some family life issues. Let me assure you again that your answers are completely confidential and will not be told to anyone. If you do not want to answer, just let me know and I will skip to the next question.

How old were you when you had sexual intercourse for the very first time?

317. 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.
Have you ever heard of (METHOD)?

318. CHECK 315: EVER HAD SEXUAL INTERCOURSE

319. Have you ever used anything or tried in any way to delay or avoid getting pregnant?

320. ENTER '0' IN COLUMN 1 OF CALENDAR IN EACH BLANK MONTH (GO TO 350A)

321. What have you used or done?
RECORD ALL MENTIONED. CORRECT 317 (IF NECESSARY).

322. CHECK 321: EVER USED EMERGENCY CONTRACEPTION

323. In the last 12 months, how many times have you used emergency contraceptive pills?

324. Where did you get the emergency contraceptive pills? Anywhere else?
RECORD ALL MENTIONED.

325. CHECK 208:

326. Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant. How many living children did you have at that time, if any?
IF NONE, RECORD '00'.

327. CHECK 321: RESPONDENT STERILIZED?

327A. CHECK 248 AND 250:

328. CHECK 226:

329. Are you currently doing something or using any method to delay or avoid getting pregnant?

330. Which method are you using?
330A. RECORD 'A' FOR FEMALE STERILIZATION.

RECORD ALL MENTIONED. IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD ON LIST. CORRECT 317 (IF NECESSARY).

331. In what facility did the sterilization take place?

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE HEALTH SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF FACILITY/PLACE)_____________

332. CHECK 330/330A: RESPONDENT STERILIZED?

333. Before your sterilization operation, were you told by a healthcare provider that you would not be able to have any (more) children because of this operation?

334. How would you rate the care you received during and immediately after the operation: very good, all right, not so good, or bad?

335. How much did you pay in total for the sterilization, including any consultation you may have had?

336. Did you receive compensation for the sterilization?

337. How much compensation did you receive?

338. Do you regret that you had the sterilization?

339. In what month and year was the sterilization performed?
339A. Since what month and year have been using (CURRENT METHOD) without stopping?
PROBE: For how long have you been using (CURRENT METHOD) without stopping?

340. CHECK 339/339A, 215 AND 232:

ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 339/339A?

341. CHECK 339/339A:

342. I would like to ask you some questions about the times you or your husband may have used a method to avoid getting pregnant during the last few years.

USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2010.
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

IN COLUMN 3, ENTER CODES FOR DISCONTINUATION IN THE SAME ROW AS THE LAST MONTH OF USE NUMBER OF CODES IN COLUMN 3 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1.

ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT.

ILLUSTRATIVE QUESTIONS:
COLUMN 3: d. Why did you stop using the (METHOD)?
e. Did you become pregnant while using (METHOD), did you stop using to get pregnant, or did you stop for some other reason?

IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK:
f. How many months did it take you to get pregnant after you stopped using (METHOD)?
AND ENTER '0' IN EACH SUCH MONTH IN COLUMN 1.

343. CHECK 330/330A:

RECORD METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 330/330A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

344. You started using (CURRENT METHOD) in (MONTH/YEAR). At that time, were you told about side effects or problems you might have with the method?

345. Were you ever told by a health worker about side effects or problems you might have with the method?

346. Were you told what to do if you experienced side effects or problems?

347. CHECK 343:

CODE '01' RECORDED (When you got sterilized, were you told about other methods of family planning that you could use?)

CODE '01' NOT RECORDED (When you obtained (CURRENT METHOD) in (MONTH/YEAR), were you told about other methods of family planning that you could use?

348. Were you ever told by a health or family planning worker about other methods of family planning that you could use?

349. CHECK 330/330A:

RECORD METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 330/330A, RECORD CODE FOR HIGHEST METHOD IN LIST.

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

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE HEALTH SECTOR, WRITE THE NAME OF THE PLACE.

350A. CHECK 248 AND 250:

351. Were you ever told by a health worker about any methods of family planning that you can use to avoid pregnancy?

352. Do you know of a place where you can obtain a method of family planning?

353. Where is that? Any other place?

RECORD ALL PLACES MENTIONED.

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE HEALTH SECTOR, WRITE THE NAME OF THE PLACE(S).

354. Now I would like to talk to you about any contacts you have had recently with an ANM or LHV. In the last three months have you met with an ANM or LHV?

355. In the last three months, how many times did you meet with (this person/these persons):
IF NONE, RECORD '00'.

356. In the last three months, have you met with an anganwadi worker, ASHA or other community health worker?

357. Who did you meet?
Anyone else?

RECORD ALL MENTIONED.

358. In the last three months, how many times did you meet with (this person/these persons):
IF NONE, RECORD '00'.

359. CHECK 354 AND 356:

360. During (this contact/all these contacts) with (PERSON MENTIONED IN 354 AND 357) in the last three months, what were the different services provided and matters talked about?
Anything else?

RECORD ALL MENTIONED.

361. Who did you meet during your (most recent) contact?

362. CHECK 355(c) AND 358(c):

363. In the last three months, have you visited a health facility or camp for any reason for yourself (or for your children)?

364. What type of health facility did you visit most recently for yourself (or for your children)?

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE HEALTH SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF FACILITY/PLACE)___________

365. What service did you go for?
Any other service?
RECORD ALL MENTIONED.

SECTION 4. PREGNANCY, DELIVERY, POSTNATAL CARE AND CHILDREN'S NUTRITION

401. CHECK 224:

402. ENTER IN THE TABLE BELOW THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN JANUARY 2010 OR LATER. ASK THE QUESTIONS ABOUT ALL THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).
Now I would like to ask you some questions about the health of all your children born in the last five years. (We will talk about each child separately.)

403. LINE NUMBER FROM 212

404. FROM 212 AND 216

405. When you got pregnant with (NAME), did you want to get pregnant at that time?

406. Did you want to have a baby later on, or did you not want any (more) children?

407. How much longer did you want to wait?

408. How many months pregnant were you when you came to know about the pregnancy?
[ASK FOR MOST RECENT BIRTH ONLY]

408A. Did you use a pregnancy testing kit to confirm this pregnancy?
[ASK FOR MOST RECENT BIRTH ONLY]

409. Was this pregnancy registered?
[ASK FOR MOST RECENT BIRTH ONLY]

410. How many months pregnant were you when you registered?
[ASK FOR MOST RECENT BIRTH ONLY]

411. With whom did you register?
[ASK FOR MOST RECENT BIRTH ONLY]

412. Did you receive a Mother and Child Protection Card after registration?
[ASK FOR MOST RECENT BIRTH ONLY]

413. Did you see anyone for antenatal care for this pregnancy?
[ASK FOR MOST RECENT BIRTH ONLY]

414. Whom did you see? Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON. RECORD ALL MENTIONED.
[ASK FOR MOST RECENT BIRTH ONLY]

415. Where did you receive antenatal care for this pregnancy? Any other place?
[ASK FOR MOST RECENT BIRTH ONLY]

RECORD ALL PLACES MENTIONED. IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE HEALTH SECTOR, WRITE THE NAME OF THE PLACE(S).

416. How many months pregnant were you when you first received antenatal care for this pregnancy? [ASK FOR MOST RECENT BIRTH ONLY]

417. How many times did you receive antenatal care during this pregnancy?
[ASK FOR MOST RECENT BIRTH ONLY]

418. As part of your antenatal care during this pregnancy, were any of the following done at least once? [ASK FOR MOST RECENT BIRTH ONLY]

a. Were you weighed?
b. Was your blood pressure measured?
c. Did you give a urine sample?
d. Was a sample of your blood taken for testing?
e. Was your abdomen examined?

419. During (any of) your antenatal care visit(s), were you told about the following signs of pregnancy complications? [ASK FOR MOST RECENT BIRTH ONLY]

a. Vaginal bleeding?
b. Convulsions?
c. Prolonged labour?
d. Severe abdominal pain?
e. High blood pressure?

420. Were you told where to go if you had any pregnancy complications?
[ASK FOR MOST RECENT BIRTH ONLY]

421. Was (NAME'S) father present during (any of) your antenatal visits?
[ASK FOR MOST RECENT BIRTH ONLY]

422. During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth? [ASK FOR MOST RECENT BIRTH ONLY]

423. During this pregnancy, how many times did you get a tetanus injection?
IF 7 OR MORE TIMES, RECORD '7'. [ASK FOR MOST RECENT BIRTH ONLY]

424. CHECK 423:
[ASK FOR MOST RECENT BIRTH ONLY]

425. At any time before this pregnancy, did you receive any tetanus injections?

426. Before this pregnancy, how many times did you receive a tetanus injection?
IF 7 OR MORE TIMES, RECORD '7'. [ASK FOR MOST RECENT BIRTH ONLY]

427. How many years ago did you receive the last tetanus injection before this pregnancy?
[ASK FOR MOST RECENT BIRTH ONLY]

428. During this pregnancy, were you given or did you buy any iron folic acid tablets or syrup?
SHOW TABLETS/SYRUP. [ASK FOR MOST RECENT BIRTH ONLY]

429. During the whole pregnancy, for how many days did you take the tablets or syrup?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.
[ASK FOR MOST RECENT BIRTH ONLY]

430. During this pregnancy, did you take any drug for intestinal worms?
[ASK FOR MOST RECENT BIRTH ONLY]

431. During this pregnancy, did you use a mosquito net regularly, sometimes or never?
[ASK FOR MOST RECENT BIRTH ONLY]

431A. During this pregnancy, did you have difficulty with your vision during daylight?
[ASK FOR MOST RECENT BIRTH ONLY]

432. During this pregnancy, did you have convulsions not from fever?
[ASK FOR MOST RECENT BIRTH ONLY]

433. During this pregnancy, did you have swelling of the legs, body or face?
[ASK FOR MOST RECENT BIRTH ONLY]

434. Did you receive any supplementary nutrition from the anganwadi centre during this pregnancy? [ASK FOR MOST RECENT BIRTH ONLY]

435. During this pregnancy, were you always able to get the supplementary nutrition from the anganwadi centre? [ASK FOR MOST RECENT BIRTH ONLY]

436. During the last three months of this pregnancy, did you meet with an ANM, Lady Health Visitor, ASHA, anganwadi worker, or other community health worker?
[ASK FOR MOST RECENT BIRTH ONLY]

437. Where did you meet this/these person(s)?
[ASK FOR MOST RECENT BIRTH ONLY]

438. During any of these meetings in the last three months of this pregnancy, did you receive advice on the following at least once? [ASK FOR MOST RECENT BIRTH ONLY]

a. The importance of institutional delivery?
b. Cord care?
e. Breastfeeding?
d. Keeping the baby warm?
e. Family planning or delaying or avoiding another pregnancy?

439. During delivery, did you experience a breech presentation?
[ASK FOR MOST RECENT BIRTH ONLY]

440. During delivery, did you experience prolonged labour?
[ASK FOR MOST RECENT BIRTH ONLY]

441. During delivery, did you experience excessive bleeding?
[ASK FOR MOST RECENT BIRTH ONLY]

442. When (NAME) was born, was (he/she) very large, larger than average, average, smaller than average, or very small?

443. Was (NAME) weighed at birth?

444. How much did (NAME) weigh?
RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.

445. Who assisted with the delivery of (NAME)? Anyone else?

PROBE FOR THE TYPE OF PERSON. RECORD ALL PERSONS ASSISTING. IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT DURING THE DELIVERY.

446. Where did you give birth to (NAME)?

447. What was the main mode of transportation used by you to reach the health facility for delivery? [ASK FOR MOST RECENT BIRTH ONLY]

448. Who arranged the transportation to take you to the health facility for delivery?
RECORD ALL MENTIONED. [ASK FOR MOST RECENT BIRTH ONLY]

448A. How much did it cost you out of your pocket for transportation?
IF NO MONEY PAID, RECORD '00000'.
[ASK FOR MOST RECENT BIRTH ONLY]

448B. How much did it cost you out of your pocket during delivery on: IF NO MONEY PAID, RECORD '00000'. [ASK FOR MOST RECENT BIRTH ONLY]

448C. CHECK 448B a-d:
[ASK FOR MOST RECENT BIRTH ONLY]

449. How much in total did it cost you out of your pocket for this delivery?
IF NO MONEY PAID, RECORD '00000'. [ASK FOR MOST RECENT BIRTH ONLY]

450. CHECK 448A, 448B a-d, AND 449:
[ASK FOR MOST RECENT BIRTH ONLY]

451. How was the out of pocket cost met?
RECORD ALL MENTIONED. [ASK FOR MOST RECENT BIRTH ONLY]

452. Did you receive any financial assistance for delivery care?
[ASK FOR MOST RECENT BIRTH ONLY]

453. From where did you get assistance?
RECORD ALL MENTIONED. [ASK FOR MOST RECENT BIRTH ONLY]

454. How many days after delivery did you receive the financial assistance under JSY?
IF THE SAME DAY, RECORD '00'. [ASK FOR MOST RECENT BIRTH ONLY]

455. What was the total amount that you received?
[ASK FOR MOST RECENT BIRTH ONLY]

456. How long after (NAME) was delivered did you stay in the health facility?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS. [ASK FOR MOST RECENT BIRTH ONLY]

457. Was (NAME) delivered by caesarean section, that is, did they cut your belly open to take the baby out?

458. When was the decision made for you to have a C-section? Was it before the onset of labour on after the onset of labour or after the onset of labour?

459. I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health while you were still in the facility? [ASK FOR MOST RECENT BIRTH ONLY]

460. How long after delivery did the first check take place?
[ASK FOR MOST RECENT BIRTH ONLY]

IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.

461. Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON. [ASK FOR MOST RECENT BIRTH ONLY]

462. In the two months after you were discharged, did any health personnel, anganwadi worker, ASHA, or traditional birth attendant [dai] check on your health?
[ASK FOR MOST RECENT BIRTH ONLY]

463. Why didn't you deliver in a health facility? PROBE: Any other reason?
RECORD ALL MENTIONED. [ASK FOR MOST RECENT BIRTH ONLY]

464. At the time of delivery of (NAME) were the following done?
[ASK FOR MOST RECENT BIRTH ONLY]

a. Was a disposable delivery kit used?
b. Was the baby immediately wiped dry and then wrapped without being bathed?
c. Was a clean blade used to cut the cord?

465. In the two months after (NAME) was born, did any health personnel, anganwadi worker, ASHA, or traditional birth attendant (dai) check on your health?
[ASK FOR MOST RECENT BIRTH ONLY]

466.How many hours, days or weeks after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.

467. How many checkups were done in the first 10 days after delivery?
IF MORE THAN SEVEN, RECORD '7'. IF NONE, RECORD '0'
[ASK FOR MOST RECENT BIRTH ONLY]

468. Who checked on your health (the first time/at that time)?
PROBE FOR MOST QUALIFIED PERSON. [ASK FOR MOST RECENT BIRTH ONLY]

469. Where did this first check take place?
[ASK FOR MOST RECENT BIRTH ONLY]

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE HEALTH SECTOR, WRITE THE NAME OF THE PLACE.

470. In the two months after (NAME) was born, did any health personnel, ASHA or a traditional birth attendant check on his/her health? [ASK FOR MOST RECENT BIRTH ONLY]

471. How many hours, days or weeks after the birth of (NAME) did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS. [ASK FOR MOST RECENT BIRTH ONLY]

472. Who checked on (NAME)'s health at that time?
[ASK FOR MOST RECENT BIRTH ONLY]

473. Where did this first check of (NAME) take place?
[ASK FOR MOST RECENT BIRTH ONLY]

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE HEALTH SECTOR, WRITE THE NAME OF THE PLACE.

474. In the first two months after delivery, did you have:
[ASK FOR MOST RECENT BIRTH ONLY]

a. Massive vaginal bleeding?
b. Very high fever?

475. Has your menstrual period returned since the birth of (NAME)?
[ASK FOR MOST RECENT BIRTH ONLY]

476. Did your period return between the birth of (NAME) and your next pregnancy?
[DO NOT ASK FOR MOST RECENT BIRTH]

477. For how many months after the birth of (NAME) did you not have a period?

478. CHECK 226: IS RESPONDENT PREGNANT?
[ASK FOR MOST RECENT BIRTH ONLY]

479. Have you had sexual relations since the birth of (NAME)?
[ASK FOR MOST RECENT BIRTH ONLY]

480. For how many months after the birth of (NAME) did you not have sexual relations?

481. Did you ever breastfeed (NAME)?

482. How long after birth did you first put (NAME) to the breast?
[ASK FOR MOST RECENT BIRTH ONLY]

IF LESS THAN ONE HOUR, RECORD '00' HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS.

483. In the first three days after delivery, was (NAME) given anything to drink other than breast milk? [ASK FOR MOST RECENT BIRTH ONLY]

484. What was (NAME) given to drink? Anything else?
RECORD ALL LIQUIDS MENTIONED. [ASK FOR MOST RECENT BIRTH ONLY]

485. CHECK 404: IS CHILD LIVING?
[ASK FOR MOST RECENT BIRTH ONLY]

486. Are you still breastfeeding (NAME)?
[ASK FOR MOST RECENT BIRTH ONLY]

487. For how many months did you breastfeed (NAME)?
[ASK FOR MOST RECENT BIRTH ONLY]

488. CHECK 404: IS CHILD LIVING?

489. Did (NAME) drink anything from a bottle with a nipple yesterday or last night?

490. GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 491 OR GO BACK TO 405 IN NEXT-TO-LAST COLUMN OF NEW QUESTIONNAIRE; OR, IF NO MORE BIRTHS, GO TO 491

491. CHECK 215 AND 218:

492. Now, I would like to ask you about liquids or foods that (NAME FROM 491) had yesterday during the day or at night. I am interested in whether your child had the item I mention even if it was combined with other foods. Did (NAME FROM 491) (drink/eat):

493. CHECK 492 CATEGORIES 'g' THROUGH 'v':

494. Did (NAME) eat any solid, semi-solid, or soft foods yesterday during the day or at night?
IF 'YES' PROBE: What kind of solid, semi-solid or soft foods did (NAME) eat?

495. How many times did (NAME) eat solid, semi-solid, or soft foods yesterday during the day or at night? IF 7 OR MORE TIMES, RECORD '7'.

SECTION 5. CHILD IMMUNIZATIONS AND HEALTH

501. ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2011 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

502. BIRTH HISTORY NUMBER FROM 212

503. FROM 212 AND 216:

504. Within the last six months, was (NAME) given a vitamin A dose like (this/any of these)?

505. In the last seven days, was (NAME) given iron pills or iron syrup like (this/any of these)?
SHOW COMMON CAPSULES/SYRUPS.

506. Was (NAME) given any drug for intestinal worms in the last six months?

507. Do you have a card where (NAME's) vaccinations are written down?
IF YES: May I see it please?

508. Did you ever have a vaccination card for (NAME)?

509. (1) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD. (2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED. (3) IF ONLY PART OF DATE IS SHOWN ON CARD, RECORD '98' OR '9998' FOR 'DON'T KNOW' IN THE COLUMN FOR WHICH INFORMATION IS NOT GIVEN.

510. CHECK 509:

511. Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations received in a Pulse Polio campaign?

RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 509 THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

512. Did (NAME) ever receive any vaccinations to prevent him/her form getting diseases, including vaccinations received in a Pulse Polio campaign?

513. Please tell me if (NAME) received any of the following vaccinations:

513A. A BCG vaccination against tuberculosis, that is, an injection in the arm of shoulder that usually causes a scar?

513B. Polio vaccine, that is, drops in the mouth including vaccine received in a Pulse Polio campaign?

513C. Was the first polio vaccine received in the first two weeks after birth or later?

513D. How many times was the polio vaccine given?
IF MORE THAN 7, RECORD '7'.

513E. A DPT vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops?

513F. How many times was a DPT vaccination given?
IF MORE THAN 7, RECORD '7'.

513G. An injection to prevent Hepatitis B?

513H. Was the first Hepatitis B vaccine received in the first two weeks after birth or later?

513I. How many times was a Hepatitis B vaccination given?
IF MORE THAN 7, RECORD '7'.

513J. A measles injection or an MMR injection-that is, a shot in the arm at the age of 9 months or older-to prevent (him/her) from getting measles?

514. CHECK 509 AND 512: ANY VACCINATIONS RECEIVED?

515. Where did (NAME) receive most of (his/her) vaccinations?

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE HEALTH SECTOR, WRITE THE NAME OF THE PLACE.

516. Has (NAME) had diarrhoea in the last two weeks?

517. Was there any blood in the stools?

518. Now I would like to know how much (NAME) was given to drink (including breastmilk) during the diarrhoea. Was (he/she) given less than usual to drink, about the same amount, or more than usual to drink?

IF LESS, PROBE: Was (he/she) given much less than usual to drink or somewhat less?

519. When (NAME) had diarrhoea, was (he/she) given less than usual to eat, about the same amount, more than usual, or nothing to eat?

IF LESS, PROBE: Was (he/she) given much less than usual to eat or somewhat less?

520. Did you seek advice or treatment for the diarrhoea from any source?

521. Where did you seek advice or treatment? Anywhere else?

RECORD ALL SOURCES MENTIONED.

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE HEALTH SECTOR, WRITE THE NAME OF THE PLACE(S).

522. CHECK 521:

523. Where did you first seek advice or treatment?
USE LETTER CODE FORM 521.

524. How many days after the diarrhoea began did you first seek advice or treatment for (NAME)? IF THE SAME DAY, RECORD '00'.

525. Was (he/she) given any of the following to drink at any time since (he/she) started having the diarrhoea:

a. A fluid made from a special packet called (LOCAL NAME FOR ORS PACKET)?
b. Gruel made from nice (OR OTHER LOCAL GRAIN)?

526. Was (he/she) given zinc at any time since (he/she) started having diarrhoea?

527. Was anything (else) given to treat the diarrhoea?

528. What (else) was given to treat the diarrhoea? Anything else?
RECORD ALL TREATMENTS GIVEN.

529. Has (NAME) been ill with a fever at any time in the last 2 weeks?

530. At any time during illness, did (NAME) have blood taken from (his/her) finger or heel for testing?

531. Has (NAME) had an illness with a cough at any time in the last 2 weeks?

532. When (NAME) had an illness with a cough, did (he/she) breathe faster than usual with short, rapid breaths or have difficulty breathing?

533. Was the fast or difficult breathing due to a problem in the chest or to a blocked or runny nose?

534. CHECK 529: HAD FEVER

535. Now I would like to know how much (NAME) was given to drink (including breastmilk) during the illness with a (fever/cough). Was (he/she) given less than usual to drink, about the same amount, or more than usual to drink?

IF LESS, PROBE: Was (he/she) given much less than usual to drink or somewhat less?

536. When (NAME) had a (fever/cough), was (he/she) given less than usual to eat, about the same amount, more than usual, or nothing to eat?

IF LESS, PROBE: Was (he/she) given much less than usual to eat or somewhat less?

537. Did you seek advice or treatment for the illness from any source?

538. Where did you seek advice or treatment? Anywhere else?

RECORD ALL SOURCES MENTIONED.

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE HEALTH SECTOR, WRITE THE NAME OF THE PLACE(S).

539. CHECK 538:

540. Where did you first seek advice or treatment?
USE LETTER CODE FROM 538.

541. How many days after the illness began did you first seek advice or treatment for (NAME)?
IF THE SAME DAY, RECORD '00'.

542. At any time during the illness, did (NAME) take any drugs for the illness?

543. What drugs did (NAME) take? Any other drugs?
RECORD ALL MENTIONED.

544. CHECK 543: ANY CODE 'A-G' RECORDED

545. How long after the fever started did (NAME) first take (DRUG(S) FROM 543 A-G)?

546. GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 547.
FOR THIRD MOST RECENT BIRTH: GO TO 503 IN NEXT-TO-LAST COLUMN OF NEW QUESTIONNAIRE; OR, IF NO MORE BIRTHS. GO TO 547.

547. CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2010 OR LATER LIVING WITH THE RESPONDENT

548. The last time (NAME OF YOUNGEST CHILD) passed stools, what was done to dispose of the stools?

549. CHECK 525 (a), ALL COLUMNS:

550. Have you ever heard of a special product called (LOCAL NAME FOR ORS PACKET) you can get for the treatment of diarrhoea?

IF SHE HAS NEVER HEARD OF ORS, SHOW GOVERNMENT AND COMMERCIAL ORS PACKETS AND ASK: Have you ever seen a packet like one of these before?

551. CHECK 215: ANY LIVE BIRTH IN 2010 OR LATER

SECTION 5A. UTILIZATION OF ICDS SERVICES

552. ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN JANUARY 2010 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.

(IF THERE ARE MORE THAN 5 BIRTHS, USE ADDITIONAL QUESTIONNAIRES).

553. BIRTH HISTORY NUMBER FROM 212

554. FROM 212 AND:

555. During the last 12 months, has (NAME) received any benefits from the anganwadi or ICDS centre?

IF NO, PROBE: Any benefits such as supplementary food, growth monitoring, immunizations, health check-ups or education?

556. In the last 12 months, how often has (NAME) received food from the anganwadi/ICDS centre?

IF CHILD RECEIVES TAKE-HOME RATIONS FOR DAILY CONSUMPTION WEEKLY OR MONTHLY, CODE '1'.

557. In the last 12 months, how often has (NAME) had a health check-up from the anganwadi/ICDS centre?

558. In the last 12 months, has (NAME) received any immunizations through the anganwadi/ICDS centre?

559. In the last 12 months, how often did (NAME) go to the anganwadi/ICDS centre for early childhood care or preschool: regularly, occasionally, or not at all?

560. In the last 12 months, how often has (NAME)'s weight been measured by the anganwadi/ICDS centre?

561. After (NAME) was weighed, did you ever receive counselling from the anganwadi/ICDS worker or ANM?

562. When you were pregnant with (NAME), did you receive any benefits from the anganwadi/ICDS centre?

563. Did you receive any of the following benefits:

564. When you were breastfeeding (NAME) did you receive any benefits from the anganwadi/ICDS centre?

565. Did you receive any of the following benefits:

566. GO TO 554 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 601

SECTION 6. FERTILITY PREFERENCES

601. CHECK 301:

602. CHECK 330/330A:

602A. CHECK 248 AND 250:

603. CHECK 226:

604. Now I have some questions about the future. After the child you are expecting now, would you like to have another child, or would you prefer not to have any more children?

605. 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?

606. CHECK 226:

NOT PREGNANT OR UNSURE (How long would you like to wait from now before the birth of (a/another) child?

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

607. CHECK 226:

608. CHECK 329: USING A CONTRACEPTIVE METHOD?

609. CHECK 606:

610. CHECK 604 AND 605:

WANTS TO HAVE A/ANOTHER CHILD. You have said that you do not want (a/another) child soon, but you are not using any method to avoid pregnancy. Can you tell me why you are not using a method? PROBE: Any other reason?

WANTS NO MORE/NONE. You have said that you do not want any(more) children, but you are not using any method to avoid pregnancy. Can you tell me why you are not using a method? PROBE: Any other reason?

611. CHECK 329: USING A CONTRACEPTIVE METHOD?

612. Do you think you will use a contraceptive method to delay or avoid pregnancy in the next 12 months?

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

614. CHECK 216:

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.

615. 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 if it's a boy or a girl?

616. In the last few months have you:

a. Heard about family planning on the radio?
b. Seen anything about family planning on the television?
c. Read about family planning in a newspaper or magazine?
d. Seen anything about family planning on a wall painting or hoarding?

617. CHECK 301:

618. CHECK 330/330A: USING A CONTRACEPTIVE METHOD?

619. Would you say that using contraception is mainly your decision, mainly your husband's decision, or did you both decide together?

620. CHECK 330/330A:

620A. CHECK 248 AND 250:

621. Does your husband want the same number of children that you want, or does he want more or fewer than you want?

622. Husbands and wives do not always agree on everything. Please tell if you think a wife is justified in refusing to have sex with her husband when:

a. She knows her husband has a sexually transmitted disease.
b. She knows her husband has sex with other women.
c. She is tired or not in the mood.

SECTION 7. OTHER HEALTH ISSUES

701. Now I would like to ask you some questions about medical care for you yourself. Many different factors can prevent women from getting medical advice or treatment for themselves.

When you are sick and want to get medical advice or treatment, is each of the following a big problem, a small problem, or no problem?

a. Getting permission to go?
b. Getting money needed for treatment?
c. The distance to the health facility?
d. Having to take transport?
e. Finding someone to go with you?
f. Concern that there may not be a female healthcare provider?
g. Concern that there may not be any healthcare provider?
h. Concern that there may be no drugs available?

702. Now I would like to ask you some questions about any injections you have had in the last 12 months. Have you had an injection for any reason in the last 12 months?
IF YES: How many injections have you had?

IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

703. The last time you had an injection, was a disposable syringe used?

704. Have you ever had a blood transfusion?

705. Do you currently smoke cigarettes?

706. In the last 24 hours, how many cigarettes did you smoke?

707. Do you currently smoke bidis?

708. In the last 24 hours, how many bidis did you smoke?

709. Do you currently smoke or use tobacco in any other form?

710. In what other form do you currently smoke or use tobacco? Any other form?

711. CHECK 705, 707, AND 709: CURRENTLY SMOKES OR USES TOBACCO

712. During the past 12 months, have you ever tried to stop smoking or using tobacco in any other form?

713. In the last 12 months, have you visited a doctor or other health provider?

714. During any of these visits, were you advised to quit smoking or using tobacco in any other form?

715. In the last 30 days, did someone smoke (other than you) in your home or anywhere else when you were present?

716. Do you drink alcohol?

717. How often do you drink alcohol: almost every day, about once a week or less than once a week?

718. What type of alcohol do you usually drink?

RECORD ALL MENTIONED.

719. Have you ever heard of an illness called tuberculosis or TB?

720. How does tuberculosis spread from one person to another? Any other ways?
RECORD ALL MENTIONED.

721. Can tuberculosis be cured?

722. If a member of your family got tuberculosis, would you want it to remain a secret or not?

723A. Do you currently have:

723B. Have you sought treatment for this problem?

724. Are you covered by any health scheme or any health insurance?

725. What type of health scheme or health insurance? Any other type?
RECORD ALL MENTIONED.

726. How often do you yourself eat the following food items: daily, weekly, occasionally, or never?

727. Have you ever undergone:

728. CHECK COVER PAGE: HOUSEHOLD SELECTED FOR STATE MODULE?

SECTION 8. SEXUAL LIFE

801. CHECK 315 AND 316:

802. CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY. READ TO RESPONDENTS:

Now I need to ask you some more questions about relationships and sexual life. Once again, let me assure you that your answers are completely confidential. If we should come to any question that you don't want to answer, just let me know and I will skip to the next question.

803. CHECK 103:

804. The first time you had sexual intercourse, was a condom used?

805. When was the last time you had sexual intercourse?

IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS, OR MONTHS. IF 12 MONTHS OR MORE, ANSWER MUST BE RECORDED IN YEARS.

FOR QUESTIONS 806 THROUGH 817, ACCOUNT FOR LAST SEXUAL PARTNER AND SECOND-TO-LAST SEXUAL PARTNER.

806. When was the last time you had sexual intercourse with this other person?
[DO NOT ASK FOR MOST RECENT SEXUAL PARTNER]

807. The last time you had sexual intercourse (with this other person), was a condom used?

808. Was a condom used every time you had sexual intercourse with this person in the last 12 months?

809. What was this person's relationship to you?

810. CHECK 307:

811. CHECK 316:

812. How long ago did you first have sexual intercourse with this (second-to-last) person?

813. How many times during the last 12 months did you have sexual intercourse with this person?

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF TIMES IS 95 OR MORE, WRITE '95'.

814. CHECK 103:

815. How old is this person?

816. Apart from this person, have you had sexual intercourse with any other person in the last 12 months? [ASK FOR MOST RECENT SEXUAL PARTNER]

817. In total, with how many different people have you had sexual intercourse in the last 12 months? [DO NOT ASK FOR MOST RECENT SEXUAL PARTNER]

IF NON-NUMERIC, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR MORE, WRITE '95'.

818. In total, with how many different people have you had sexual intercourse in your lifetime?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

819. PRESENCE OF OTHERS DURING THIS SECTION

820. Do you know of a place where a person can get condoms?

821. Where is that? Any other place?
RECORD ALL SOURCES MENTIONED.

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE HEALTH SECTOR, WRITE THE NAME OF THE PLACE(S).

822. If you wanted to, could you yourself get a condom?

SECTION 9. HUSBAND'S BACKGROUND AND WOMAN'S WORK

901. CHECK 301:

902. How old was your husband on his last birthday?

903. Did your (last) husband ever attend school?

904. What was the highest standard he completed?

905. CHECK 901:

CURRENTLY MARRIED. What is your husband's occupation? That is what kind of work does he mainly do?

OTHER. What was your (last) husband's occupation? That is, what kind of work did he mainly do?

906. CHECK 901:

907. In the last 12 months, has your husband been away from home for one month or more at a time?

908. In the last 12 months, has your husband been away from home for six months or more at a time?

909. Aside from your own housework, have you done any work in the last seven days?

910. As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business. In the last seven days, have you done any of these things or any other work?

911. Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, maternity leave or any other such reason?

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

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

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

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

916. Are you paid in cash or kind for this work, or are you not paid at all?

917. In the last 12 months, have you been away from home other than parental/in-laws home for one month or more at a time?

918. In the last 12 months, have you been away from home other than parental/in-laws home for six months or more at a time?

919. CHECK 301: MARITAL STATUS

920. CHECK 916: CASH EARNINGS

921. Who decides how the money you earn will be used: mainly you, mainly your husband, or your and your husband jointly?

922. Would you say that the money that you earn is more than what your husband earns, less than what he earns, or about the same?

923. Who decides how your husband's earnings will be used: mainly you, mainly your husband, or you and your husband jointly?

924. Who usually makes decisions about health care for yourself: mainly you, mainly your husband, you and your husband jointly, or someone else?

925. Who usually makes decisions about making major household purchases: mainly you, mainly your husband, you and your husband jointly, or someone else?

926. Who usually makes decisions about visits to your family or relatives: mainly you, mainly your husband, you and your husband jointly, or someone else?

927. Do you have any money of your own that you alone can decide how to use?

928. Are you usually allowed to go to the following places alone, only with someone else, or not at all?

a. To the market?
b. To the health facility?
c. To places outside this (village/community)?

929. Do you have a bank or savings account that you yourself use?

930. Do you have any mobile phone that you yourself use?

930A. CHECK 106: EDUCATION

930B. CHECK 108: LITERACY

930C. Are you able to read text (SMS) messages?

931. Do you own this or any other house either alone or jointly with someone else?

932. Do you own any land either alone or jointly with someone else?

933. Do you know of any programmes in this area that give loans to women to start or expand a business of their own?

934. Have you yourself ever taken a loan, in cash or in kind, from any of these programmes, to start or expand a business?

935. PRESENCE OF OTHERS AT THIS POINT (PRESENT AND LISTENING, PRESENT BUT NOT LISTENING, OR NOT PRESENT)

936. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

a. If she goes out without telling him?
b. If she neglects the house or the children?
c. If she argues with him?
d. If she refuses to have sex with him?
e. If she doesn't cook food properly?
f. If he suspects her of being unfaithful?
g. If she shows disrespect for in-laws?

SECTION 10. HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

1001. Now I would like to talk about something else. Have you ever heard of an illness called AIDS?

1002. Have you ever heard of HIV?

1003. CHECK 1001 AND 1002: KNOWS ABOUT HIV/AIDS

1004. From which sources of information have you learned about AIDS?
Any other source?

RECORD ALL MENTIONED.

1005. Can people reduce their chances of getting HIV/AIDS by having just one uninfected sex partner who has no other sex partners?

1006. Can people get HIV/AIDS from mosquito bites?

1007. Can people reduce their chances of getting HIV/AIDS by using a condom every time they have sex?

1008. Can people get HIV/AIDS from blood products or blood transfusions?

1009. Can people get HIV/AIDS by injecting drugs?

1010. Can people get HIV/AIDS by sharing food with a person who has AIDS?

1011. Is there anything else a person can do to avoid or reduce the chances of getting HIV/AIDS?

1012. What can a person do? Anything else?
RECORD ALL WAYS MENTIONED.

1013. Is it possible for a healthy-looking person to have HIV/AIDS?

1014. Can HIV/AIDS be transmitted from a mother to her baby:

a. During pregnancy?
b. During delivery?
c. By breastfeeding?

1015. CHECK 1014:

1016. Are there any special medications that a doctor or a nurse can give to a woman infected with HIV/AIDS to reduce the risk of transmitting HIV/AIDS to the baby?

1017. Have you heard about special antiretroviral drugs (USE LOCAL NAME(S)) that people infected with HIV/AIDS can get from a doctor or a nurse to help them live longer?

1018. CHECK 208 AND 215:

1019. CHECK 413 FOR LAST BIRTH:

1020. CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

1021. During any of the antenatal visits for your last birth were you given any information about:

a. Babies getting HIV/AIDS from their mother?
b. Things that you can do to prevent getting HIV/AIDS?
c. Getting tested for HIV/AIDS?

1022. Were you offered a test for HIV/AIDS as part of antenatal care?

1023. I don't want to know the results, but were you tested for HIV/AIDS as part of your antenatal care?

1024. Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

1025. I don't want to know the results, but did you get the results of the test?

1026. All women are supposed to receive counseling after being tested. After you were tested, did you receive counseling?

1027. CHECK 446 FOR LAST BIRTH: PLACE OF BIRTH

1028. Between the time you went for delivery but before the baby was born, were you offered a test for HIV/AIDS?

1029. I don't want to know the results, but were you tested for HIV/AIDS at that time?

1030. I don't want to know the results, but did you get the results of the [test]?

1031. Have you been tested for HIV/AIDS since that time you were tested during your pregnancy?

1032. How many months ago was your most recent HIV test?

1033. I don't want to know the results, but have you ever been tested to see if you have HIV/AIDS?

1034. How many months ago was your most recent HIV test?

1035. I don't want to know the results, but did you get the results of the test?

1036. Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

1037. Do you know of a place where people can go to get tested for HIV/AIDS?

1038. Where is that? Any other place?

RECORD ALL PLACES MENTIONED. IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE HEALTH SECTOR, WRITE THE NAME OF THE PLACE.

1039. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV/AIDS?

1040. Do you think a child with HIV should be allowed to attend school with students who are HIV negative?

1041. If a member of your family got infected with HIV/AIDS, would you want it to remain a secret or not?

1042. If a relative of yours became sick with HIV/AIDS, would you be willing to care for her or him in your own household?

1043. In your opinion, if a female teacher has HIV/AIDS but is not sick, should she be allowed to continue teaching in the school?

1044. In your opinion, if a male teacher has HIV/AIDS but is not sick, should he be allowed to continue teaching in the school?

1045. Do you think that people living with HIV should be treated in the same public hospital with patients who are HIV negative?

1046. Do you think that people living with HIV should be allowed to work in the same office with people who are HIV negative?

1047. CHECK 1001 AND 1002:

HEARD ABOUT HIV/AIDS: Apart from HIV/AIDS, have you heard about other infections that can be transmitted through sexual contact?

NOT HEARD ABOUT HIV/AIDS: Have you heard about infections that can be transmitted through sexual contact?

1048. CHECK 315 AND 316: HAD SEXUAL INTERCOURSE

1049. CHECK 1047: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

1050. Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?

1051. Sometimes women experience a bad smelling abnormal genital discharge. During the last 12 months, have you had a bad smelling abnormal genital discharge?

1052. Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

1053. CHECK 1050, 1051, AND 1052: HAS HAD AN STI

1054. The last time you had (PROBLEM FROM 1050/1051/1052), did you seek any kind of advice or treatment?

1055. Where did you go?
Any other place?

RECORD ALL PLACES MENTIONED. IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE HEALTH SECTOR, WRITE THE NAME OF THE PLACE.

SECTION 11. HOUSEHOLD RELATIONS

1101. CHECK COVER PAGE: WOMAN SELECTED FOR THIS SECTION

1102. CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED.

1103. READ TO RESPONDENT:

Now I would like to ask you questions about some other important aspects of a woman's life. I know that some of these questions are very personal. However, your answers are crucial for helping to understand the condition of women in India. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else will know that you were asked these questions.

1104. CHECK 301:

1105. First, I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your (last) husband.

a. He (is/was) jealous or angry if you (talk/talked) to other men.
b. He frequently (accuses/accused) you of being unfaithful.
c. He (does/did) not permit you to meet your female friends.
d. He (tries/tried) to limit your contact with your family.
e. He (insist/insisted) on knowing where you (are/were) at all times.
f. He (does/did) not trust you with any money.

1106A. Now if you will permit me, I need to ask some more questions about your relationship with you (last) husband. (Does/did) your (last) husband ever:

1106B. How often did this happen during the last 12 months: often, only sometimes, or not at all?

1107A. Now if you will permit me, I need to ask some more questions about your relationship with you (last) husband. (Does/did) your (last) husband ever:

1107B. How often did this happen during the last 12 months: often, only sometimes, or not at all?

1108. CHECK 1107 A (a-j): EXPERIENCED PHYSICAL VIOLENCE

1109. How long after you first got married to your (last) husband did (this/any of these things) first happen? IF LESS THAN ONE YEAR, RECORD '00'.

1110. Did the following ever happen as a result of what your (last) husband did to you?

a. You had cuts, bruises or aches?
b. You had severe burns?
c. You had eye injuries, sprains, dislocations, or minor burns?
d. You had deep wounds, broken bones, broken teeth, or any other serious injury?

1111. Have you ever hit, slapped, kicked, or done anything else to physically hurt your (last) husband at times when he was not already beating or physically hurting you?

1112. In the last 12 months, how often have you done this to your (last) husband: often, only sometimes, or not at all?

1113. (Does/did) your (last) husband drink alcohol?

1114. How often (does/did) he get drunk?

1115. Are (Were) you afraid of your (last) husband: most of the time, sometimes, or never?

1116. CHECK 307:

1117A. So far we have been talking about the behavior of your (current/last) husband. Now I want to ask you about the behavior of any previous husband.

1117B. If so, how long ago did this last happen?

1117B. If so, how long ago did this last happen?

1118. CHECK 301:

EVER MARRIED (a. From the time you were 15 years old has anyone other than (your/any) husband hit you, slapped you, kicked you, or done anything else to hurt you physically?)

NEVER MARRIED OR MARRIED, GAUNA NOT PERFORMED (b. From the time you were 15 years old has anyone ever hit you, slapped you, kicked you, or done anything else to hurt you physically?)

1119. Who has hurt you in this way?
Anyone else?

RECORD ALL MENTIONED.

1120. In the last 12 months, how often has (this person/have these persons) physically hurt you:

1121. CHECK 201, 226, AND 231:

1122. Has anyone ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?

1123. Who has done any of these things to physically hurt you while you were pregnant?
Anyone else?

RECORD ALL MENTIONED.

1124. CHECK 301:

1125. Now I want to ask you about things that may have been done to you by someone other than (your/any) husband. At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?

1126. At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?

1127. Who was the person who was forcing you the very first time this happened?

1128. CHECK 301:

EVER MARRIED. In the last 12 months, has anyone other than (your/any) husband physically forced you to have sexual intercourse when you did not want to?

NEVER MARRIED OR MARRIED, GAUNA NOT PERFORMED . In the last 12 months has anyone physically forced you to have sexual intercourse when you did not want to?

1129. CHECK 1107 A (h-j) and 1117 A (b): EXPERIENCED SEXUAL VIOLENCE

1130. CHECK 301:

EVER MARRIED. How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts by anyone, including (your/any) husband?)

NEVER MARRIED OR MARRIED, GAUNA NOT PERFORMED. How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts?

1131. CHECK 1107 A (a-j), 1117 (a-b), 1118, 1122, 1125, AND 1126: EXPERIENCED ANY VIOLENCE

1132. Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?

1133. From whom have you sought help? Anyone else?
RECORD ALL MENTIONED.

1134. Have you ever told anyone else about this?

1135. CHECK 1133:

1136. Where did you go for medical help? Anywhere else?
RECORD ALL MENTIONED.

1137. As far as you know, did your father ever beat your mother?

THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER ABOUT THE CONFIDENTIALITY OF HER ANSWERS. FILL OUT THE QUESTIONS BELOW WITH REFERENCE TO THE DOMESTIC VIOLENCE MODULE ONLY.

1138. DID YOU HAVE TO INTERRUPT THIS SECTION OF THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?

1139. INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE. _______

1140. RECORD THE TIME

INSTRUCTIONS:

ONLY ONE CODE SHOULD APPEAR IN ANY BOX. FOR COLUMN 1, ALL MONTHS SHOULD BE FILLED IN. INFORMATION TO BE CODED FOR EACH COLUMN

COLUMN 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE

COLUMN 2: ULTRASOUND CONDUCTED DURING PREGNANCY

COLUMN 3: DISCONTINUATION OF CONTRACEPTIVE USE

2015:

12 DEC 01 __ __ __ 01 DEC
11 NOV 02 __ __ __ 02 NOV
10 OCT 03 __ __ __ 03 OCT
09 SEP 04 __ __ __ 04 SEP
08 AUG 05 __ __ __ 05 AUG
07 JUL 06 __ __ __ 06 JUL
06 JUN 07 __ __ __ 07 JUN
05 MAY 08 __ __ __ 08 MAY
04 APR 09 __ __ __ 09 APR
03 MAR 10 __ __ __ 10 MAR
02 FEB 11 __ __ __ 11 FEB
01 JAN 12 __ __ __ 12 JAN

2014:

12 DEC 13 __ __ __ 13 DEC
11 NOV 14 __ __ __ 14 NOV
10 OCT 15__ __ __ 15 OCT
09 SEP 16__ __ __ 16 SEP
08 AUG 17 __ __ __ 17 AUG
07 JUL 18__ __ __ 18 JUL
06 JUN 19 __ __ __ 19 JUN
05 MAY 20 __ __ __ 20 MAY
04 APR 21__ __ __ 21 APR
03 MAR 22 __ __ __ 22 MAR
02 FEB 23 __ __ __ 23 FEB
01 JAN 24 __ __ __ 24 JAN

2013:

12 DEC 25 __ __ __ 25 DEC
11 NOV 26 __ __ __ 26 NOV
10 OCT 27 __ __ __ 27 OCT
09 SEP 28 __ __ __ 28 SEP
08 AUG 29 __ __ __ 29 AUG
07 JUL 30 __ __ __ 30 JUL
06 JUN 31 __ __ __ 31 JUN
05 MAY 32 __ __ __ 32 MAY
04 APR 33 __ __ __ 33 APR
03 MAR 34 __ __ __ 34 MAR
02 FEB 35 __ __ __ 35 FEB
01 JAN 36 __ __ __ 36 JAN

2012:

12 DEC 37 __ __ __ 01 DEC
11 NOV 38 __ __ __ 02 NOV
10 OCT 39 __ __ __ 39 OCT
09 SEP 40 __ __ __ 40 SEP
08 AUG 41 __ __ __ 41 AUG
07 JUL 42 __ __ __ 42 JUL
06 JUN 43 __ __ __ 43 JUN
05 MAY 44 __ __ __ 44 MAY
04 APR 45 __ __ __ 45 APR
03 MAR 46 __ __ __ 46 MAR
02 FEB 47 __ __ __ 47 FEB
01 JAN 48 __ __ __ 48 JAN

2011:

12 DEC 49 __ __ __ 49 DEC
11 NOV 50 __ __ __ 50 NOV
10 OCT 51 __ __ __ 51 OCT
09 SEP 52 __ __ __ 52 SEP
08 AUG 53 __ __ __ 53 AUG
07 JUL 54 __ __ __ 54 JUL
06 JUN 55 __ __ __ 55 JUN
05 MAY 56 __ __ __ 56 MAY
04 APR 57 __ __ __ 57 APR
03 MAR 58 __ __ __ 58 MAR
02 FEB 59 __ __ __ 59 FEB
01 JAN 60 __ __ __ 60 JAN

2010:

12 DEC 61 __ __ __ 61 DEC
11 NOV 62 __ __ __ 62 NOV
10 OCT 63 __ __ __ 63 OCT
09 SEP 64 __ __ __ 64 SEP
08 AUG 65 __ __ __ 65 AUG
07 JUL 66 __ __ __ 66 JUL
06 JUN 67 __ __ __ 67 JUN
05 MAY 68 __ __ __ 68 MAY
04 APR 69 __ __ __ 69 APR
03 MAR 70 __ __ __ 70 MAR
02 FEB 71 __ __ __ 71 FEB
01 JAN 72 __ __ __ 72 JAN

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW.

COMMENTS ABOUT RESPONDENT: ______

COMMENTS ON SPECIFIC QUESTIONS: ______

ANY OTHER COMMENTS: ______

SUPERVISOR'S OBSERVATIONS
NAME OF SUPERVISOR: ________
DATE: ________