NATIONAL FAMILY HEALTH SURVEY
INDIA 2019-20 (NFHS-5)
WOMAN'S QUESTIONNAIRE [STATE NAME]
IDENTIFICATION
STATE __
DISTRICT __
TEHSIL/TALUK __
CITY/TOWN/VILLAGE __
TYPE OF PSU (URBAN = 1, RURAL = 2) __
PSU NUMBER __
STRUCTURE NUMBER __
HOUSEHOLD NUMBER __
NAME AND LINE NUMBER OF WOMAN __
ADDRESS OF HOUSEHOLD __
IS HOUSEHOLD SELECTED FOR THE STATE MODULE? (YES =1, NO =2) __
IS WOMAN SELECTED FOR QUESTIONS ON HOUSEHOLD RELATIONS (SECCTION 11)? (YES =1, NO =2) __
FIRST VISIT
DATE __
INTERVIEWER'S NAME __
RESULT CODE* __
NEXT VISIT:
DATE __
TIME __
SECOND VISIT
DATE __
INTERVIEWER'S NAME __
RESULT CODE* __
NEXT VISIT:
DATE __
TIME __
THIRD VISIT
DATE __
INTERVIEWER'S NAME __
RESULT CODE* __
FINAL VISIT
DAY __
MONTH __
YEAR __
INT. NO. __
RESULT CODE* __
TOTAL NUMBER OF VISITS __
SUPERVISOR'S NAME __
SUPERVISOR'S NUMBER __
COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER 7 (SPECIFY) __
BENGALI 02
GUJARATI 03
HINDI 04
KANNADA 05
KASHMIRI 06
KONKANI 07
MALAYALM 08
MANIPURI 09
MARATHI 10
NEPALI 11
ORIYA 12
PUNJABI 13
SINDHI 14
TAMIL 15
TELUGU 16
URDU 17
ENGLISH 18
GARO 19
KHASI 20
OTHER 96 (SPECIFY) __
**LANGUAGE OF QUESTIONNAIRE HINDI 04
**RESPONDENT'S MOTHER TONGUE __
**LANGUAGE OF INTERVIEW __
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 allover 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 questions 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 or contact the persons listed on the card given to your household.
Do you have any questions?
ANSWER ANY QUESTIONS AND ADDRESS RESPONDENT'S CONCERNS.
Do you agree to participate in this survey?
SIGNATURE OF INTERVIEWER: ______________________ DATE: ___________________
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)
MINUTES __
102. In what month and year were you born?
DON'T KNOW MONTH 98
YEAR __
DON'T KNOW YEAR 9998
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'.
ALWAYS 95
VISITOR 96
105. Have you ever attended school?
NO 2 (SKIP TO 108)
106. What is the highest grade you completed?
GRADE 09 AND ABOVE (SKIP TO 110)
108. Now I would like you to read this sentence to me.
SHOW A SENTENCE FROM THE LITERACY CARD TO RESPONDENT.
IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE 4 (SPECIFY LANGUAGE) __
BLIND/VISUALLY IMPARED 5
CODE '1' OR '5' RECORDED (SKIP TO 111)
110. Do you read a newspaper or magazine at least once a week, less than once a week or not at all?
LESS THAN ONCE A WEEK 2
NOT AT ALL 3
111. Do you listen to the radio at least once a week, less than once a week, or not at all?
LESS THAN ONCE A WEEK 2
NOT AT ALL 3
112. Do you watch television at least once a week, less than once a week, or not at all?
LESS THAN ONCE A WEEK 2
NOT AT ALL 3
113. Do you usually go to a cinema hall or theatre to see a movie at least once a month?
NO 2
MUSLIM 02
CHRISTIAN 03
SIKH 04
BUDDHIST/NEO-BUDDHIST 05
JAIN 06
JEWISH 07
PARSI/ZOROASTRIAN 08
NO RELIGION 09
OTHER 96 (SPECIFY) __
115. What is your caste or tribe?
TRIBE 992 (SPECIFY) ___
NO CASTE/TRIBE 993 (SKIP TO 201)
DON'T KNOW 998
116. Do you belong to a scheduled caste, a scheduled tribe, other backward class, or none of these?
SCHEDULED TRIBE 2
OBC 3
NONE OF THEM 4
201. Now I would like to ask about all the births you have had during our life. Have you ever given birth?
NO 2 (SKIP TO 206)
202. Do you have any sons or daughters to whom you have given birth who are now living with you?
NO 2 (SKIP TO 204)
203. a) How many sons live with you?
b) And how many daughters live with you?
IF NONE, RECORD '00'.
DAUGHTERS AT HOME __
204. Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?
NO 2 (SKIP TO 206)
205. a) How many sons are alive but do not live with you?
b) And how many daughters are alive but do not live with you?
DAUGHTERS ELSEWHERE __
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, who made any movement, sound or effort to breather, or who showed any other signs of live even if for a very short time?
NO 2 (SKIP TO 208)
207. a) How many boys have died?
b) And how many girls have died?
IF NONE, RECORD '00'.
GIRLS DEAD __
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?
NO (PROBE AND CORRECT 201-208 AS NECESSARY)
NO BIRTHS (SKIP TO 226)
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 AN ADDITIONAL QUESTIONNAIRE STARTING WITH THE SECOND ROW.)
212. What name was given to your (first/next) baby?
01 __
213. Is (NAME) a boy or a girl?
GIRL 2
214. Were any of these births twins?
MULTIPLE 2
215. On what day, month and year was (NAME) born?
PROBE: What is his/her birthday?
MONTH __
YEAR __
NO 2 (SKIP TO 220)
217. IF ALIVE: How old was (NAME) at (his/her) last birthday?
RECORD AGE IN COMPLETED YEARS.
218. IF ALIVE: Is (NAME) living with you?
NO 2
219. IF ALIVE: RECORD HOUSEHOLD LINE NUMBER OF CHILD (RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD).
220. IF DEAD: 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.
MONTHS 2 __
YEARS 3 __
221. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME), including any children who died after birth
NO 2 (NEXT BIRTH)
222. Have you had any live births since the birth of (NAME OF LAST BIRTH)?
IF YES, RECORD BIRTH(S) IN TABLE.
NO 2
223. Before the birth of (NAME OF FIRST BIRTH), did you have any other live births?
IF YES, RECORD BIRTH(S) IN TABLE.
NO 2
224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN JANUARY 2014 OR LATER.
NONE 0 (SKIP TO 226)
225. FOR EACH BIRTH SINCE JANUARY 2014, 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 COMPLETED 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.
NO 2 (SKIP TO 231)
UNSURE 8 (SKIP TO 231)
227. How many months pregnant 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?
NO 2
230. CHECK 208: TOTAL NUMBER OF BIRTHS
NO MORE/NONE 2
NO MORE/NONE 2
231. Have you ever had a pregnancy that miscarried, was aborted, or ended in a stillbirth?
NO 2 (SKIP TO 250)
232. When did the last such pregnancy end?
YEAR __
LAST PREGNANCY ENDED IN 2013 OR EARLIER (SKIP TO 250)
234. Did that pregnancy end in a miscarriage, an abortion, or in 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.
ABORTION 2
STILLBIRTH 3
235. 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 RPEGNANT AT TIME OF TERMINATION.
236. 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.
MISCARRIAGE OR STILLBIRTH (SKIP TO 246)
238. Where was the abortion performed?
YOGA AND NATUROPATHY 13
UNANI 14
SIDDHA 15
HOMEOPATHY 16
SOWA RIGPA (TTM) 17
OTHER 18 (SPECIFY) __
UHC/UHP/UFWC 20
CHC/RURAL HOSPITAL/BLOCK PHC 21
PHC/ADDITIONAL PHC 22
SUB-CENTRE 23
GOVT. MOBILE CLINIC 24
OTHER PUBLIC HEALTH SECTOR 25 (SPECIFY) __
DISPENSARY/CLINIC 42
OTHER PRIVATE HEALTH SECTOR 43 (SPECIFY) __
ELSEWHERE 96 (SPECIFY) __
239. Who performed the abortion?
NURSE/ANM/LHV 2
VAIDYA/HAKIM/HOMEOPATH (AYUSH) 3
DAI 4
FAMILY MEMBER/RELATIVE/FRIEND 5
SELF 6
OTHER 7 (SPECIFY) __
240. What method was used for the abortion?
MVA 2
OTHER SURGICAL 3
ANY OTHER 4 (SPECIFY) __
DON'T KNOW 9
241. What was the main reason for the abortion?
CONTRACEPTIVE FAILURE 02
COMPLICATION(S) IN PREGNANCY 03
HEALTH DID NOT PERMIT 04
FEMALE FOETUS 05
MALE FOETUS 06
ECONOMIC REASONS 07
LAST CHILD TOO YOUNG 08
FOETUS HAD CONGENITAL ABNORMALITY 09
HUSBAND/MOTHER IN LAW DID NOT WANT 95
OTHER 96 (SPECIFY) __
242. Did you have any complication from the abortion?
NO 2 (SKIP TO 246)
243. Did you seek treatment for the complication?
NO 2 (SKIP TO 245)
244. Where did you go for treatment?
YOGA AND NATUROPATHY 13 (SKIP TO 246)
UNANI 14 (SKIP TO 246)
SIDDHA 15 (SKIP TO 246)
HOMEOPATHY 16 (SKIP TO 246)
SOWA RIGPA (TTM) 17 (SKIP TO 246)
OTHER 18 (SPECIFY) __ (SKIP TO 246)
UHC/UHP/UFWC 20 (SKIP TO 246)
CHC/RURAL HOSPITAL/BLOCK PHC 21 (SKIP TO 246)
PHC/ADDITIONAL PHC 22 (SKIP TO 246)
SUB-CENTRE 23 (SKIP TO 246)
GOVT. MOBILE CLINIC 24 (SKIP TO 246)
OTHER PUBLIC HEALTH SECTOR 25 (SPECIFY) __ (SKIP TO 246)
DISPENSARY/CLINIC 42 (SKIP TO 246)
OTHER PRIVATE HEALTH SECTOR 43 (SPECIFY) __ (SKIP TO 246)
ELSEWHERE 96 (SPECIFY) __ (SKIP TO 246)
245. Why did you not seek treatment?
Any other reasons?
RECORD ALL MENTIONED.
COULD NOT AFFORD TRANSPORT B
FEAR OF STIGMA BY PROVIDER C
FEAR OF STIGMA BY COMMUNITY D
COMPLICATION WAS MINOR/DID NOT REQUIRE TREATMENT E
PROBLEM RESOLVED ITSELF F
COULD NOT GET AWAY FROM FAMILY RESPONSIBILITIES G
HUSBAND DID NOT GIVE PERMISSION H
OTHER X (SPECIFY) __
246. Since January 2014, have you had any other pregnancies that did not result in a live birth?
NO 2 (SKIP TO 248)
247. ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY SINCE JANUARY 2014.
ENTER 'T' IN COLUMN 1 OF CALENDAR IN MONTHS THAT EACH PREGNANCY TERMINATED 'P' FOR REMAINING NUMBER OF COMPLETED MONTHS
FOR EACH TERMINATE 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.
248. Did you have any pregnancies that terminated in 2013 or earlier that did not result in a live birth?
NO 2 (SKIP TO 250)
249. When did the last such pregnancy that terminated in 2013 or earlier?
YEAR __
250. When did you last menstrual period start?
(DATE, IF GIVEN)
IF LESS THAN 1 MONTH, RECORD WEEKS;
IF LESS THAN 1 YEAR, RECORD MONTHS.
WEEKS AGO 2 __
MONTHS AGO 3 __
YEARS AGO 4 __
IN MENOPAUSE 994 (SKIP TO 253)
BEFORE LAST BIRTH 995 (SKIP TO 253)
NEVER MENSTRUATED 996 (SKIP TO 253)
OTHER (SKIP TO 257)
PREGNANT (SKIP TO 257)
253. Some women undergo an operation to remove the uterus. Have you undergone such an operation?
NO 2 (SKIP TO 257)
DON'T KNOW 8 (SKIP TO 257)
254. How many years ago was this operation (hysterectomy) performed?
IF LESS THAN 1 YEAR AGO, RECORD '00'.
DON'T KNOW 98
255. 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.
(NAME OF FACILITY/PLACE)
GOVT. DISPENSARY 12
UHC/UHP/UFWC 13
CHC/RURAL HOSPITAL/BLOCK PHC 14
PHC/ADDITIONAL PHC 15
SUB-CENTRE 16
GOVT. MOBILE CLINIC 17
CAMP 18
OTHER PUBLIC SECTOR HEALTH FACILITY 19
PVT. DOCTOR/CLINIC 32
PVT. MOBILE CLINIC 33
OTHER PRIVATE HEALTH FACILITY 34
DON'T KNOW 98
256. Why was this operation performed?
Any other reason?
RECORD ALL MENTIONED.
FIBROIDS/CYSTS B
UTERINE RUPTURE C
CANCER D
UTERINE PROLAPSE E
SEVERE POST-PARTUM HEMORRHAGE F
CERVICAL DISCHARGE G
OTHER X (SPECIFY) __
OTHER (CONTINUE)
AGE 25 OR MORE (SKIP TO 261)
259. How old were you when you had your first monthly period?
260. 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.
LOCALLY PREPARED NAPKINS B
SANITARY NAPKINS C
TAMPONS D
MENSTRUAL CUP E
NOTHING F
OTHER X (SPECIFY) __
261. 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?
NO 2 (SKIP TO 263)
DON'T KNOW 8 (SKIP TO 263)
262. Is this time just before her period beings, during her period, right after her period has ended, or halfway between two periods?
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER 6 (SPECIFY) __
DON'T KNOW 8
OTHER (SKIP TO 301)
264. Do you take a bath during your menstrual period?
NO 2 (SKIP TO 301)
265. During your period, do you usually take a bath in the same bathroom as other household members take a bath?
NO 2
DOES NOT HAVE A BATHROOM 3
SECTION 3A. MARRIAGE AND COHABITATION
301. What is your current marital status?
MARRIED, GUANA NOT PERFORMED 2 (SKIP TO 305)
WIDOWED 3 (SKIP TO 307)
DIVORCED 4 (SKIP TO 307)
SEPARATED 5 (SKIP TO 307)
DESERTED 6 (SKIP TO 307)
NEVER MARRIED 7 (SKIP TO 315)
302. Is your husband living with you now, or is he staying elsewhere?
STAYING ELSEWHERE 2
303. For how long have you and your husband not been living together?
IF LESS THAN 1 YEAR, RECORD MONTHS; OTHERWISE RECORD COMPLETED YEARS.
YEARS 2 __
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.
LINE NO __
305. Besides yourself, does your husband have other wives?
NO 2 (SKIP TO 307)
DON'T KNOW 8 (SKIP TO 307)
306. Including yourself, in total, how many wives does he have?
DON'T KNOW 8
307. Have you been married once or more than once?
MORE THAN ONCE 2 (SKIP TO 308A)
308. In what month and year did you get married?
DON'T KNOW MONTH 98
308A. Now, I would like to ask about when you married your first husband. In what month and year was that?
DON'T KNOW YEAR 9998
309. How old were you when you (first) got married?
310. Before you got married, was you (current) husband related to you in any way?
NO 2 (SKIP TO 312)
311. What type of relationship was it?
FIRST COUSIN ON MOTHER'S SIDE 2
SECOND COUSIN 3
UNCLE 4
OTHER BLOOD RELATIVE 5
BROTHER-IN-LAW 6
OTHER NON-BLOOD RELATIVE 7
312. CHECK 301: MARITAL STATUS
CODE '2' NOT CIRCLED (CONTINUE)
DON'T KNOW MONTH 98
YEAR __ (SKIP TO 316)
DON'T KNOW YEAR 9998
DON'T KNOW MONTH 98
YEAR __ (SKIP TO 316)
DON'T KNOW YEAR 9998
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?
NO 2 (SKIP TO 317)
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?
AGE IN YEARS __
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND 95
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)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
318. CHECK 315: EVERY HAD SEXUAL INTERCOURSE
NEVER HAD SEX (SKIP TO 320)
319. Have you ever used anything or tried in any way to delay or avoid getting pregnant?
NO 2
320. ENTER '0' IN COLUMN 1 OF CALENDAR IN EACH BLANK MONTH (SKIP TO 355)
321. What have you used or done?
RECORD ALL MENTIONED.
CORRECT 319 (IF NECESSARY).
MALE STERILIZATION B
IUD/PPIUD C
INJECTABLES D
PILL E
CONDOM/NIRODH F
FEMALE CONDOM G
EMERGENCY CONTRACEPTION H
DIAPHRAGM I
FOAM/JELLY J
STANDARD DAYS METHOD K
LACTATIONAL AMEN. METHOD L
RHYTHM METHOD M
WITHDRAWAL N
OTHER MODERN METHOD X
OTHER TRADITIONAL METHOD Y
322. CHECK 321: EVER USED EMERGENCY CONTRACEPTION
CODE 'H' NOT CIRCLED (SKIP TO 325)
323. In the last 12 months, how many times have you used emergency contraception?
NUMBER OF TIMES __
324. Where did you get the emergency contraception?
Anywhere else?
RECORD ALL MENTIONED.
YOGA AND NATUROPATHY C
UNANI D
SIDDHA E
HOMEOPATHY F
SOWA RIGPA (TTM) G
OTHER H (SPECIFY) __
UHC/UHP/UFWC J
CHC/RURAL HOSPITAL/BLOCK PHC K
PHC/ADDITIONAL PHC L
SUB-CENTRE/ANM M
GOVT. MOBILE CLINIC N
ANGANWADI/ICDS CENTRE O
ASHA P
OTHER COMMUNITY-BASED WORKER Q
OTHER PUBLIC HEALTH SECTOR R
NGO OR TRUST HOSPITAL/CLINIC S
PRIVATE DOCTOR/CLINIC U
PRIVATE MOBILE CLINIC V
YOGA AND NATUROPATHY X
UNANI Y
SIDDHA Z
HOMEOPATHY AA
SOWA RIGPA (TTM) AB
OTHER AC (SPECIFY) __
PHARMACY/DRUGSTORE AE
DAI (TBA) AF
OTHER PRIVATE HEALTH SECTOR AG
FRIEND/REALTIVE BB
NO BIRTHS (SKIP TO 327)
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?
CODE 'A' RECORDED (SKIP TO 330A)
HAS NOT HAD A HYSTERECTOMY (CONTINUE)
PREGNANT (SKIP TO 346)
329. Are you currently doing something or using any method to delay or avoid getting pregnant?
NO 2 (SKIP TO 346)
330. Which method are you using?
RECORD ALL MENTIONED.
IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD ON LIST.
CORRECT 317 (IF NECESSARY).
MALE STERILIZATION B (SKIP TO 331)
IUD/PPIUD C (SKIP TO 339)
INJECTABLES D (SKIP TO 343A)
PILL E (SKIP TO 343A)
CONDOM/NIRODH F (SKIP TO 343A)
FEMALE CONDOM G (SKIP TO 343A)
EMERGENCY CONTRACEPTION H (SKIP TO 343A)
DIAPHRAGM I (SKIP TO 343A)
FOAM/JELLY J (SKIP TO 343A)
STANDARD DAYS METHOD K (SKIP TO 343A)
LACTATIONAL AMEN. METHOD L (SKIP TO 343A)
RHYTHM METHOD M (SKIP TO 343A)
WITHDRAWAL N (SKIP TO 343A)
OTHER MODERN METHOD X (SKIP TO 343A)
OTHER TRADITIONAL METHOD Y (SKIP TO 343A)
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)
GOVT. DISPENSARY 12
UHC/UHP/UFWC 13
CHC/RURAL HOSPITAL/BLOCK PHC 14
PHC/ADDITIONAL PHC 15
SUB-CENTRE 16
GOVT. MOBILE CLINIC 17
CAMP 18
OTHER PUBLIC SECTOR HEALTH FACILITY 19
PRIVATE DOCTOR/CLINIC 32
PRIVATE MOBILE CLINIC 33
OTHER PRIVATE HEALTH FACILITY 34
DON'T KNOW 98
332. CHECK 330/330A: RESPONDENT STERILIZED?
CODE 'A' NOT RECORDED (SKIP TO 339)
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 the operation?
NO 2
334. How would you rate the care you received during and immediately after the operation: very good, all right, not so good, or bad?
ALL RIGHT 2
NOT SO GOOD 3
BAD 4
335. How much did you pay in total for the sterilization, including any consultation you may have had?
FREE 99995
DON'T KNOW 99998
336. Did you receive any compensation for the sterilization?
NO 2 (SKIP TO 338)
337. How much compensation did you receive?
DON'T KNOW 9998
338. Do you regret that you had the sterilization?
NO 2 (SKIP TO 343)
OTHER (SKIP TO 343A)
340. Did you receive compensation for use of the IUD/PPIUD?
NO 2 (SKIP TO 343A)
341. How much compensation did you receive?
DON'T KNOW 9998
342. Was your IUD/PPIUD inserted within 48 hours following childbirth?
NO 2
343. In what month and year was the sterilization performed?
YEAR __
343A. Since what month and year have you been using (CURRENT METHOD) without stopping?
PROBE: For how long have you been using (CURRENT METHOD) now without stopping?
YEAR __
344. CHECK 343/343A, 215 AND 232:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 343/343A?
FOR FEMALE STERILIZATION: CORRECT 343 OR 330 (IF NECESSARY). FOLLOW CORRECT SKIP PATTERN.
ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN COLUMN 1 OF CALENDAR AND IN EACH MONTH BACK TO DATE STARTED USING.
THEN CONTINUE WITH 346.
ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN COLUMN 1 OF CALENDAR AND EACH MONTH BACK TO JANURY 2014.
THEN SKIP TO 353.
346. 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 2014.
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.
IN COLUMN 1, ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLACNK MONTH.
ILLUSTRATIVE QUESTIONS:
a. When was the last time you used a method? Which method was that?
b. When did you start using that method? How long after the birth of (NAME)?
c. How long did you use the method then?
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 THE 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:
d. Why did you stop using the (METHOD)?
e. Did you become pregnant while using (METHOD), or did you stop 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.
RECORD METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 330/330A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.
FEMALE STERILIZATION 01
MALE STERILIATION 02 (SKIP TO 359)
IUD/PPIUD 03
INJECTABLES 04
PILL 05
CONDOM/NIRODH 06 (SKIP TO 351)
FEMALE CONDOM 07 (SKIP TO 351)
EMERGENCY CONTRACEPTION 08 (SKIP TO 351)
DIAPHRAGM 09 (SKIP TO 351)
FOAM/JELLY 10 (SKIP TO 351)
STANDARD DAYS METHOD 11 (SKIP TO 359)
LACTATIONAL AMENORRHOEA METHOD 12 (SKIP TO 359)
RHYTHM METHOD 13 (SKIP TO 359)
WITHDRAWAL 14 (SKIP TO 359)
OTHER MODERN METHOD 15 (SKIP TO 359)
OTHER TRADITIONAL METHOD 16 (SKIP TO 359)
348. 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?
NO 2
349. Were you ever told by a health or family planning worker about side effects or problems you might have with the method?
NO 2 (SKIP TO 351)
350. Were you told what to do if you experienced side effects or problems?
NO 2
CODE '01' RECORDED
NO 2
CODE '01' NOT RECORDED
NO 2
352. Were you ever told by a health or family planning worker about other methods of family planning that you could use?
NO 2
RECORD METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 330/330A, RECORD CODE FOR HIGHEST METHOD IN LIST.
MALE STERILIZATION 02 (SKIP TO 359)
IUD/PPIUD 03
INJECTABLES 04
PILL 05
CONDOM/NIRODH 06
FEMALE CONDOM 07
EMERGENCY CONTRACEPTION 08
DIAPHRAGM 09
FOAM/JELLY 10
STANDARD DAYS METHOD 11 (SKIP TO 359)
LACTATIONAL AMENORRHOEA METHOD 12 (SKIP TO 359)
RHYTHM METHOD 13 (SKIP TO 359)
WITHDRAWAL 14 (SKIP TO 359)
OTHER MODERN METHOD 15 (SKIP TO 359)
OTHER TRADITIONAL METHOD 16 (SKIP TO 359)
354. Where did you obtain (CURRENT METHOD) the last time?
IF UNABLE TO DETERMINE IF A HOSPITLA, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE HEALTH SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF FACILITY/PLACE)
YOGA AND NATUROPATHY 13 (SKIP TO 359)
UNANI 14 (SKIP TO 359)
SIDDHA 15 (SKIP TO 359)
HOMEOPATHY 16 (SKIP TO 359)
SOWA RIGPA (TTM) 17 (SKIP TO 359)
OTHER 18 (SPECIFY) __ (SKIP TO 359)
UHC/UHP/UFWC 20 (SKIP TO 359)
CHC/RURAL HOSPITAL/BLOCK PHC 21 (SKIP TO 359)
PHC/ADDITIONAL PHC 22 (SKIP TO 359)
SUB-CENTRE/ANM 23 (SKIP TO 359)
GOVT. MOBILE CLINIC 24 (SKIP TO 359)
CAMP 25 (SKIP TO 359)
ANGANWADI/ICDS CENTRE 26 (SKIP TO 359)
ASHA 27 (SKIP TO 359)
OTHER COMMUNITY-BASED WORKER 28 (SKIP TO 359)
OTHER PUBLIC HEALTH SECTOR 29 (SKIP TO 359)
PRIVATE DOCTOR/CLINIC 42 (SKIP TO 359)
PRIVATE MOBILE CLINIC 43 (SKIP TO 359)
YOGA AND NATUROPATHY 45 (SKIP TO 359)
UNANI 46 (SKIP TO 359)
SIDDHA 47 (SKIP TO 359)
HOMEOPATHY 48 (SKIP TO 359)
SOWA RIGPA (TTM) 49 (SKIP TO 359)
OTHER 50 (SPECIFY) __ (SKIP TO 359)
PHARMACY/DRUGSTORE 52 (SKIP TO 359)
DAI (TBA) 53 (SKIP TO 359)
OTHER PRIVATE HEALTH SECTOR 54 (SKIP TO 359)
HUSBAND 62 (SKIP TO 359)
FRIEND/RELATIVE 63 (SKIP TO 359)
HAS NOT HAD A HYSTERECTOMY (CONTINUE)
356. Were you ever told by a health worker about any methods of family planning that you can use to avoid pregnancy?
NO 2
357. Do you know of a place where you can obtain a method of family planning?
NO 2 (SKIP TO 359)
358. 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).
(NAME OF FACILITY/PLACE(S))
YOGA AND NATUROPATHY C
UNANI D
SIDDHA E
HOMEOPATHY F
SOWA RIGPA (TTM) G
OTHER H (SPECIFY) __
UHC/UHP/UFWC J
CHC/RURAL HOSPITAL/BLOCK PHC K
PHC/ADDITIONAL PHC L
SUB-CENTRE/ANM M
GOVT. MOBILE CLINIC N
CAMP O
ANGANWAD/ICDS CENTRE P
ASHA Q
OTHER COMMUNITY-BASED WORKER R
OTHER PUBLIC HEALTH SECTOR S
PRIVATE DOCTOR/CLINIC V
PRIVATE MOBILE CLINIC W
YOGA AND NATUROPATHY Y
UNANI Z
SIDDHA AA
HOMEOPATHY AB
SOWA RIGPA (TTM) AC
OTHER AD (SPECIFY) __
PHARMACY/DRUGSTORE AF
DAI (TBA) AG
OTHER PRIVATE HEALTH SECTOR AH
FRIEND/RELATIVE BB
SECTION 3C. CONTACTS WITH COMMUNITY HEALTH WORKERS
359. 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?
NO 2 (SKIP TO 361)
360. In the last three months, how many times did you meet with (this person/these persons):
IF NONE, RECORD '00'.
a. At home?
b. At the anganwadi centre?
c. At a health facility or camp?
d. Anywhere else?
AWC __
HEALTH FACILITY/CAMP __
ELSEWHERE __
361. In the last three months, have you met with an anganwadi worker, ASHA or other community health worker?
NO 2 (SKIP TO 364)
362. Who did you meet?
Anyone else?
RECORD ALL MENTIONED.
ASHA B
MPW C
OTHER X (SPECIFY) __
363. In the last three months, how many times did you meet with (this person/these persons):
IF NONE, RECORD '00'.
a. At home?
b. At the anganwadi centre?
c. At a health facility or camp?
d. Anywhere else?
AWC __
HEALTH FACILITY/CAMP __
ELSEWHERE __
BOTH 'NO' (SKIP TO 368)
365. During (this contact/all these contacts) with (PERSONS MENTIONED IN 359 AND 361) in the last three months, what were the different services provided and matters talked about?
Anything else?
RECORD ALL MENTIONED.
IMMUNIZATION B
ANTENATAL CARE C
DELIVERY CARE D
BIRTH PREPAREDNESS E
COMPLICATION READINESS F
POSTNATAL CARE G
DISEASE PREVENTION H
MEDICAL TREATMENT FOR SELF I
TREATMENT FOR SICK CHLD J
TREATMENT FOR OTHER PERSON K
MALARIA CONTROL L
SUPPLEMENTARY FOOD M
GROWTH MONITORING OF CHILD N
EARLY CHILDHOOD CARE O
PRESCHOOL EDUCATION P
NUTRITION/HEALTH EDUCATION Q
FAMILY LIFE EDUCATION R
MENSTRUAL HYGIENE S
OTHER X (SPECIFY) __
366. Who did you meet during your (most recent) contact?
LHV 2
ANGANWADI WORKER 3
ASHA 4
MPW 5
OTHER 6 (SPECIFY) __
OTHER (SKIP TO 369)
368. In the last three months, have you visited a health facility or camp for any reason for yourself? (or for your children)?
NO 2 (SKIP TO 401)
369. What type of health facility did you visit most recently for yourself (or for your children)?
YOGA AND NATUROPATHY 13
UNANI 14
SIDDHA 15
HOMEOPATHY 16
SOWA RIGPA (TTM) 17
OTHER 18 (SPECIFY) __
UHC/UHP/UFWC 20
CHC/RURAL HOSPITAL/BLOCK PHC 21
PHC/ADDITIONAL PHC 22
SUB-CENTRE 23
GOVT. MOBILE CLINIC 24
CAMP 25
ANGANWADI/ICDS CENTRE 26
OTHER PUBLIC SECTOR HEALTH FACILITY 27
PRIVATE MOBILE CLINIC 42
YOGA AND NATUROPATHY 44
UNAN 45
SIDDHA 46
HOMEOPATHY 47
SOWA RIGPA (TTM) 48
OTHER 49 (SPECIFY) __
PHARMACY/DRUGSTORE 50
OTHER PRIVATE SECTOR HEALTH FACILITY 51
370. What service did you go for?
Any other service?
RECORD ALL MENTIONED.
IMMUNIZATION B
ANTENATAL CARE C
DELIVERY CARE D
POSTNATAL CARE E
DISEASE PREVENTION F
MEDICAL TREATMENT FOR SELF G
TREATMENT FOR CHILD H
TREATMENT FOR OTHER PERSON I
GROWTH MONITORING OF CHILD J
HEALTH CHECK-UP K
MEDICAL TERMINATION OF PREGNANCY (MTP) L
OTHER X (SPECIFY) __
SECTION 4. PREGNANCY, DELIVERY, POSTNATAL CARE AND CHILDREN'S NUTRITION
401. CHECK 224:
NO BIRTHS IN JANUARY 2014 OR LATER (SKIP TO 553)
402. ENTER IN THE TABLE BELOW THE LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH IN JANUARY 2014 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).
Now I would like to ask you some questions about your children born in the last five years. (We will talk about each child separately.)
LINE NUMBER __
LIVING __
DEAD __
405. When you got pregnant with (NAME), did you want to get pregnant at that time?
NO 2
NO MORE 2 (SKIP TO 408)
407. How much longer did you want to wait?
YEARS 2 _
DON'T KNOW 998
408. How many months pregnant were you when you came to know about the pregnancy?
DON'T REMEMBER 98
409. Did you use a pregnancy testing kit to confirm this pregnancy?
NO 2
410. Was this pregnancy registered?
NO 2 (SKIP TO 414)
411. How many months pregnant were you when you registered?
DON'T REMEMBER 98
412. With whom did you register?
ASHA 2
AWW 3
OTHER 6
413. Did you receive a Mother and Child protection card after registration?
NO 2
414. Did you see anyone for antenatal care for this pregnancy?
NO 2 (SKIP TO 423)
415. Whom did you see?
Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON. RECORD ALL MENTIONED.
ANM/NURSE/MID-WIFE/LHV B
COMMUNITY/VILLAGE HEALTH WORKER D
ANGANWADI/ICDS WORKER E
ASHA F
OTHER X (SPECIFY) __
416. Where did you receive antenatal care for this pregnancy?
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).
(NAME OF FACILITY/PLACE(S))
PARENTS' HOME B
OTHER HOME C
GOVERNMENT DISPENSARY E
UHC/UHP/UFWC F
CHC/RURAL HOSPITAL/BLOCK PHC G
PHC/ADDITIONAL PHC H
SUB-CENTRE I
ANGANWADI/ICDS CENTRE J
VILLAGE CLINIC BY ANM K
OTHER PUBLIC SECTOR HEALTH FACLIITY L
OTHER PRIVATE SECTOR HEALTH FACILITY O
417. How many months pregnant were you when you first received antenatal care for this pregnancy?
DON'T KNOW 98
418. How many times did you receive antenatal care during this pregnancy?
DON'T KNOW 98
419. As part of your antenatal care during this pregnancy, were any of the following done at least once?
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?
NO 2
NO 2
NO 2
NO 2
NO 2
420. During (any of) your antenatal care visit(s), were you told about following signs of pregnancy complications?
a. Vaginal bleeding?
b. Convulsions?
c. Prolonged labour?
d. Severe abdominal pain?
e. High blood pressure?
NO 2
NO 2
NO 2
NO 2
NO 2
421. Were you told where to go if you had any pregnancy complications?
NO 2
422. Was (NAME)'s father present during (any of) your antenatal visits?
NO 2
423. During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus injection, that is, convulsions after birth?
NO 2 (SKIP TO 426)
DON'T KNOW 8 (SKIP TO 426)
424. During this pregnancy, how many times did you get a tetanus injection?
IF 7 OR MORE TIMES, RECORD '7'.
DON'T KNOW 8
OTHER (CONTINUE)
426. At any time before this pregnancy, did you receive any tetanus injections?
NO 2 (SKIP TO 429)
DON'T KNOW 8 (SKIP TO 429)
427. Before this pregnancy, how many times did you receive a tetanus injection?
IF 7 OR MORE TIMES, RECORD '7;,
DON'T KNOW 8
428. How many years ago did you receive the last tetanus injection before this pregnancy?
429. During this pregnancy, were you given or did you buy any iron folic acid tablets or syrup?
SHOW TABLETS/SYRUP.
NO 2 (SKIP TO 431)
DON'T KNOW 8 (SKIP TO 431)
430. During the whole pregnancy, for how many days did you take the tablets of syrup?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.
DON'T KNOW 998
431. During this pregnancy, did you take any drug for intestinal worms?
NO 2
DON'T KNOW 8
432. During this pregnancy, did you use a mosquito net regularly, sometimes, or never?
SOMETIMES 2
NEVER 3
433. During this pregnancy, did you have difficulty with your vision during daylight?
NO 2
DON'T KNOW 8
434. During this pregnancy, did you have convulsions not from fever?
NO 2
DON'T KNOW 8
435. During this pregnancy, did you have swelling of the legs, body, or face?
NO 2
DON'T KNOW 8
436. Did you receive any supplementary nutrition from the anganwadi centre during this pregnancy?
NO 2 (SKIP TO 438)
437. During this pregnancy, were you always able to get the supplementary nutrition from the anganwadi centre?
NO 2
438. 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?
NO 2 (SKIP TO 441)
439. Where did you meet this/these person(s)?
ELSEWHERE ONLY 2
BOTH HOME AND ELSEWHERE 3
440. During any of these meetings in the last three months of this pregnancy, did you receive advice on the following at least once?
a. The importance of institutional delivery?
b. Cord care?
c. Breastfeeding?
d. Keeping the baby warm?
e. Family planning or delaying or avoiding another pregnancy?
NO 2
NO 2
NO 2
NO 2
NO 2
441. During delivery, did you experience a breech presentation?
NO 2
DON'T KNOW 8
442. During delivery, did you experience prolonged labour?
NO 2
DON'T KNOW 8
443. During delivery, did you experience excessive bleeding?
NO 2
DON'T KNOW 8
444. When (NAME) was born, was (he/she) very large, larger than average, average, smaller than average, or very small?
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DON'T KNOW 8
445. Was (NAME) weighed at birth?
NO 2 (SKIP TO 447)
DON'T KNOW 8 (SKIP TO 447)
446. How much did (NAME) weigh?
RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.
1 __
KG FROM RECALL
2 __
DON'T KNOW 99998
447. Who assisted with the delivery of (NAME)?
Anyone else?
PROBE FOR THE TYPE OF PERSON.
RECORD AL PERSONS ASSISTING.
IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT DURING THE DELIVERY.
ANM/NURSE/MIDWIFE/LHV B
OTHER HEALTH PERSONNEL C
FRIEND/RELATIVE E
NO ONE Y
448. Where did you give birth to (NAME)?
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)
PARENTS' HOME 12 (SKIP TO 464)
OTHER HOME 13 (SKIP TO 464)
GOVERNMENT DISPENSARY 22
UHC/UHP/UFWC 23
CHC/RURAL HOSPITAL/BLOCK PHC 24
PHC/ADD. PHC 25
SUB-CENTRE 26
OTHER PUBLIC SECTOR HEALTH FACILITY 27
OTHER PRIVATE SECTOR HEALTH FACILITY 42
449. What was the main mode of transportation used by you to reach the health facility for delivery?
OTHER AMBULANCE 02
JEEP/CAR/MOTORCYCLE/SCOOTER 04
BUS/TRAIN 05
TEMPO/AUTO/TRACTOR 06
CART 07
ON FOOT 08 (SKIP TO 452)
OTHER 96 (SPECIFY) __
450. Who arranged the transportation to take you to the health facility for delivery?
RECORD ALL MENTIONED.
ANM B
HEALTH WORKER C
ANGANWADI WORKER D
ASHA E
PRI MEMBER F
NGO G
CBO H
HUSBAND I
MOTHER-IN-LAW J
MOTHER K
RELATIVES/FRIENDS L
SELF M
OTHER X (SPECIFY) __
451. How much did it cost you out of your pocket for transportation?
IF NO MONEY PAID, RECORD '00000'
DON'T KNOW 99998
452. How much did it cost you out o your pocket during delivery on:
IF NO MONEY PAID, RECORD '00000'
b. Tests done?
c. Medicines?
d. Other costs?
DON'T KNOW 99998
b. Rs __
DON'T KNOW 99998
c. Rs __
DON'T KNOW 99998
d. Rs __
DON'T KNOW 99998
OTHER (GO TO 455)
454. How much in total did it cost you out of your pocket for this delivery?
IF NO MONEY PAID, RECORD '00000'
DON'T KNOW 99998
455. CHECK 451, 452 a-d, AND 454:
OTHER (CONTINUE)
456. How was the out of pocket cost met?
RECORD THE OUT OF POCKET COST MET?
RECORD ALL MENTIONED.
BORROWED FROM FRIENDS/RELATIVES B
SELLING PROPERTY C
SELLING JEWLERY D
INSURANCE E
OTHER X (SPECIFY) __
457. Did you receive any financial assistance for delivery care?
NO 2 (SKIP TO 461)
458. From where did you get assistance?
RECORD ALL MENTIONED.
OTHER GOVERNMENT SCHEMES B (SKIP TO 461)
OTHER X (SPECIFY) __ SKIP TO 461)
459. How many days after delivery did you receive the financial assistance under JSY?
IF THE SAME DAY, RECORD '00'.
IF 95 DAYS OR MORE, RECORD '95'.
DON'T NOW 98
460. What was the total amount that you received?
DON'T KNOW 999998
461. 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.
DAYS 2 __
WEEKS 3 __
DON'T KNOW 998
462. Was (NAME) delivered by caesarean section, that is, did they cut your belly open to take the baby out?
NO 2 (SKIP TO 464)
463. When was this decision made for you to have a C-section? Was it before the onset of labour or after the onset of labour?
AFTER ONSET OF LABOUR 2
DON'T KNOW 8
464. Immediately after the birth, was (NAME) put on your chest?
NO 2 (SKIP TO 466)
DON'T KNOW 8 (SKIP TO 466)
465. Was (NAME)'s bare skin touching your bare skin?
NO 2
DON'T KNOW 8
466. CHECK 448: PLACE OF DELIVERY
OTHER (CONTINUE)
467. 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?
NO 2 (SKIP TO 470)
468. How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS 2 __
WEEKS 3 __
DON'T KNOW 998
469. Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
ANM/NURSE/MIDWIFE/LHV 12
OTHER HEALTH PERSONNEL 13
DAI (TBA) 22
470. Now I would like to talk to you about checks on (NAME)'s health after delivery, for example, someone examining (NAME), checking the cord, or seeing if (NAME) is okay.
Did anyone check on (NAME's) health while you were still in the facility?
NO 2 (SKIP TO 473)
DON'T KNOW 8 (SKIP TO 473)
471. How long after delivery was (NAME's) health first checked?
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS 2 __
WEEKS 3 __
DON'T KNOW 998
472. Who checked on (NAME's) health at that time?
PROBE FOR MOST QUALIFIED PERSON.
ANM/NURSE/MIDWIFE/LHV 12
OTHER HEALTH PERSONNEL 13
DAI (TBA) 22
473. Now I would like to talk to you about what happened after you left the facility. Did anyone check on your health after you left the facility?
NO 2 (SKIP TO 477)
474. How long after delivery did that check take place?
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS 2 __
WEEKS 3 __
DON'T KNOW 998
475. Who checked on your health at that time?
ANM/NURSE/MIDWIFE/LHV 12
OTHER HEALTH PERSONNEL 13
DAI (TBA) 22
476. Where did the check take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
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)
PARENTS' HOME12
OTHER HOME 13
GOVERNMENT DISPENSARY 22
UHC/UHP/UFWC 23
CHC/RURAL HOSPITAL/BLOCK PHC 24
PHC/ADD. PHC 25
SUB-CENTRE 26
OTHER PUBLIC SECTOR HEALTH FACILITY 27
OTHER PRIVATE SECTOR HEALTH FACILITY 42
477. I would like to talk to you about checks on (NAME)'s health after you left the facility.
Did any health care provider or a traditional birth attendant check on (NAME)'s health in the two months after you left the facility?
NO 2 (SKIP TO 481)
478. How many hours, days, or weeks after the birth of (NAME) did that check take place?
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS 2 __
WEEKS 3 __
DON'T KNOW 998
479. Who checked on (NAME)'s health at that time?
ANM/NURSE/MIDWIFE/LHV 12
OTHER HEALTH PERSONNEL 13
DAI (TBA) 22
480. Where did this check of (NAME) take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
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)
PARENTS' HOME 12
OTHER HOME 13
GOVERNMENT DISPENSARY 22
UHC/UHP/UFWC 23
CHC/RURAL HOSPITAL/BLOCK PHC 24
PHC/ADD. PHC 25
SUB-CENTRE 26
OTHER PUBLIC SECTOR HEALTH FACILITY 27
OTHER PRIVATE SECTOR HEALTH FACILITY 42
481. In the two months after you were discharged, did any health personnel, anganwadi worker, ASHA, or traditional birth attendant (dai) check on your health?
NO 2 (SKIP TO 489)
482. Why didn't you deliver in a health facility?
PROBE: Any other reason?
RECORD ALL MENTIONED.
FACILITY NOT OPEN B
TOO FAR/NO TRANSPORATION C
DON'T TRUST FACILITY/POOR QUALITY SERVICE D
NO FEMALE PROVIDER AT FACILITY E
HUSBAND/FAMILY DID NOT ALLOW F
NOT NECESSARY G
NOT CUSTOMARY H
OTHER X (SPECIFY) __
483. At the time of delivery of (NAME) were the following done?
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?
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
484. I would like to talk to you about checks on your health after (NAME) was born, for example, someone asking you questions about your health or examining you. Did any health personnel, anganwadi worker, ASHA, or traditional birth attendant (dai) check on your health?
NO 2 (SKIP TO 489)
485. How many hours, days, or weeks after delivery di the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS 2 __
WEEKS 3 __
DON'T KNOW 998
486. How many checkups were done in the first 10 days after delivery?
IF MORE THAN SEVEN, RECORD '7'.
IF NONE, RECORD '0'.
DON'T KNOW 8
487. Who checked on your health (the first time/at that time)?
PROBE FOR MOST QUALIFIED PERSON.
ANM/NURSE/MIDWIFE/LHV 12
OTHER HEALTH PERSONNEL 13
DAI (TBA) 22
488. Where did this first check 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)
PARENTS' HOME 12
OTHER HOME 13
GOVERNMENT DISPENSARY 22
UHC/UHP/UFWC 23
CHC/RURAL HOSPITAL/BLOCK PHC 24
PHC/ADDITIONAL PHC 25
SUB-CENTRE 26
ANGANWADI/ICDS CENTRE 27
OTHER PUBLIC SECTOR HEALTH FACILITY 28
OTHER PRIVATE SECTOR HEALTH FACILITY 42
489. I would like to talk to you about checks on (NAME's) health after delivery, for example, someone examining (NAME), checking the cord, or seeing if (NAME) is ok.
In the two months after (NAME) was born, did any health personnel, ASHA or traditional birth attendant check on his/her health?
NO 2 (SKIP TO 493)
DON'T KNOW 8 (SKIP TO 493)
490. 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.
DAYS AFTER BIRTH 2 __
WEEKS AFTER BIRTH 3 __
DON'T KNOW 998
491.Who checked on (NAME)'s health at that time?
PROBE FOR MOST QUALIFIED PERSON.
ANM/NURSE/MIDWIFE/LHV 12
OTHER HEALTH PERSONNEL 13
DAI (TBA) 22
492. Where did this first check of (NAME) 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)
PARENTS' HOME 12
OTHER HOME 13
GOVERNMENT DISPENSARY 22
UHC/UHPUFWC 23
CHC/RURAL HOSPITAL/BLOCK PHC
PHC/ADDITIONAL PHC 25
SUB-CENTRE 26
ANGANWADI/ICDS CENTRE 27
OTHER PUBLIC SECTOR HEALTH FACILITY 28
OTHER PRIVATE SECTOR HEALTH FACILITY 42
OTHER 96 (SPECIFY) __
493. In the first two months after delivery, did you have:
a. Massive vaginal bleeding?
b. Very high fever?
NO 2
NO 2
494. During the first two days after (NAME)'s birth, did any healthcare provider do the following:
a. Examine the cord?
b. Measure (NAME)'s temperature?
c. Counsel you on danger signs for newborns?
d. Counsel you on breastfeeding?
e. Observe (NAME) breastfeeding?
NO 2
NO 2
NO 2
NO 2
NO 2
495. Has your menstrual period returned since the birth of (NAME)?
NO 2 (SKIP TO 498)
496. Did your period return between the birth of (NAME) and your next pregnancy?
NO 2 (SKIP TO 4001)
497. For how many months after the birth of (NAME) did you not have a period?
DON'T KNOW 98
498. CHECK 226: IS RESPONDENT PREGNANT?
PREGNANT OR UNSURE (SKIP TO 499A)
499. Have you had sexual relations since the birth of (NAME)?
NO 2 (SKIP TO 499I)
499A. For how many months after the birth of (NAME) did you not have sexual relations?
DON'T KNOW 98
499B. Did you ever breastfeed (NAME)?
NO 2 (SKIP TO 499I)
499C. How long after birth did you start breastfeeding (NAME)?
IF LESS THAN ONE HOUR, RECORD '00' HOURS.
IF LESS THAN 24 HOURS, RECORD HOURS.
OTERWISE, RECORD DAYS.
HOURS 1 __
DAYS 2 _
490D. In the first three days after delivery was (NAME) given anything to drink other than breast milk?
NO 2 (SKIP TO 499F)
499E. What was (NAME) given to drink?
Anything else?
RECORD ALL LIQUIDS MENTIONED.
PLAIN WATER B
SUGAR OR GLUCOSE WATER C
GRIPE WATER D
SUGAR-SALT-WATER SOLUTION E
FRUIT JUICE F
INFANT FORMULA G
TEA H
HONEY I
JANAM GHUTTI J
OTHER X (SPECIFY) __
499F. CHECK 404: IS CHILD LIVING?
DEAD (SKIP TO 499H)
499G. Are you still breastfeeding (NAME)?
NO 2
499H. For how many months did you breastfeed (NAME)?
DON'T KNOW 98
499I. CHECK 404: IS CHILD LIVING?
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 499L)
499J. Did (NAME) drink anything from a bottle with a nipple yesterday or last night?
NO 2
DON'T KNOW 8
499K. GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 499L.
RECORD NAME OF YOUNGEST CHILD LIVING WITH HER (AND CONTINUE WITH 499M)
(NAME)
499M. Now I would like to ask you about liquids or foods that (NAME FROM 499L) 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 499L) (drink/eat):
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
IF YES: How many times did (NAME) drink milk?
IF 7 OR MORE TIMES, RECORD '7'.
NO 2
DON'T KNOW 8
IF YES: How many times did (NAME) drink infant formula?
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
IF YES: How many times did (NAME) eat yogurt?
IF 7 OR MORE TIMES, RECORD '7'.
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
499N. CHECK 499M CATEGORIED 'g' THROUGH 'v':
AT LEAST ONE 'YES' (SKIP TO 499P_
499O. 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?
NO 2 (SKIP TO 501)
499P. 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'.
DON'T KNOW 8
SECTION 5. CHILD IMMUNIZATIONS AND HEALTH
501. ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2016 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 QUESTIONNAIRE(S)).
502. BIRTH HISTORY NUMBER FROM 212.
BIRTH HISTORY NUMBER __
LIVING (CONTINUE)
DEAD (GO TO 503 IN NEXT COLUMN OR, IF NO MORE BIRTHS GO TO 550)
504. Within the last six months was (NAME) given a vitamin A dose like (this/any of these)?
SHOW COMMON AMPOULES/CAPSULES/SYRUPS
NO 2
DON'T KNOW 8
505. Within the last seven days, was (NAME) given iron pills or syrup or sprinkles with iron like (this/any of these)?
SHOW COMMON CAPUSLES/SYRUPS/SPRINKLES.
NO 2
DON'T KNOW 8
506. Was (NAME) given any drug for intestinal worms in the last six months?
NO 2
DON'T KNOW 8
507. Do you have a card or other document where (NAME)'s vaccinations are written down?
IF YES: May I see the card or other document where vaccinations are written down?
YES, NOT SEEN 2 (SKIP TO 512)
NO CARD 3
508. Did you ever have a vaccination card for (NAME)?
NO 2 (SKIP TO 512)
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 '96' OR '9996' FOR 'DON'T KNOW' IN THE COLUMNS FOR WHICH INFORMATION IS NOT GIVEN.
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
511. Has (NAME) received any vaccinations that are not recorded on this card or other documents, 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.
NO 2 (SKIP TO 514)
DON'T KNOW 8 (SKIP TO 514)
512. Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases, including vaccinations received in a Pulse Polio campaign?
NO 2 (SKIP TO 517)
DON'T KNOW 8 (SKIP TO 517)
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 or should that usually causes a scar?
NO 2
DON'T KNOW 8
513B. Polio vaccine, that is, drops in the mouth, including vaccine received in a Pulse Polio campaign?
NO 2 (SKIP TO 513E)
DON'T KNOW 8 (SKIP TO 513E)
513C. Was the first polio vaccine received in the first two weeks after birth or later?
LATER 2
513D. How many times was the oral 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?
NO 2 (SKIP TO 513G)
DON'T KNOW 8 (SKIP TO 513G)
513F. How many times was a DPT vaccination given?
IF MORE THAN 7, RECORD '7'.
513G. An flPV injection that is given in the upper arm to protect against polio, often at the same time as oral polio drops?
NO 2 (SKIP TO 513I)
DON'T KNOW 8 (SKIP TO 513I)
513H. How many times was an flPV vaccination given?
IF MORE THAN 7, RECORD '7'.
513I. A pentavalent vaccine/injection that is given in the thigh or buttocks, sometimes given at the same time as polio drops?
NO 2 (SKIP TO 513K)
DON'T KNOW 8 (SKIP TO 513K)
513J. How many times was a pentavalent vaccination given?
513K. Was (NAME) given an injection at birth to prevent Hepatitis B?
NO 2 (SKIP TO 513N)
DON'T KNOW 8 (SKIP TO 513N)
513L. Was the first Hepatitis B vaccine received in the first two weeks after birth or later?
LATER 2
513M. How many times was a Hepatitis B vaccination given?
IF MORE THAN 7, RECORD '7'.
513N. Has (NAME) received a rotavirus vaccine, that is, liquid in the mouth to prevent diarrhea?
NO 2 (SKIP TO 513P)
DON'T KNOW 8 (SKIP TO 513P)
513O. IF YES: How many times was the rotavirus vaccine given?
513P. Did (NAME) ever receive a JE vaccination against Japanese encephalitis?
NO 2 (SKIP TO 513R)
DON'T KNOW 8 (SKIP TO 513R)
513Q. How many times was a JE vaccination given?
IF MORE THAN 3, RECORD '3'.
513R. Was (NAME) ever given a measles or MMR injection -- that is, a shot in the arm at the age of 9 months or older -- to prevent (him/her) from getting measles?
NO 2 (SKIP TO 513T)
DON'T KNOW 8 (SIP TO 513T)
513S. How many times was a measles or MMR vaccination given?
513T. Was (NAME) ever given a DPT1 booster dose?
NO 2
DON'T KNOW 8
514. CHECK 509 AND 512: ANY VACCINATIONS RECEIVED?
NO (SKIP TO 517)
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.
(NAME OF FACILITY/PLACE)
YOGA AND NATUROPATHY 13
UNANI 14
SIDDHA 15
HOMEOPATHY 16
SOWA RIGPA (TTM) 17
OTHER 18 (SPECIFY) __
UHC/UHP/UFWC 20
CHC/RURAL HOSPITAL/BLOCK PHC 21
PHC/ADDITIONAL PHC 22
SUB-CENTRE 23
GOVERNMENT MOBILE CLINIC 24
CAMP 25
ANGANWADI/ICDS CENTRE 26
PULSE POLIO 27
OTHER PUBLIC SECTORE HEALTH FACILITY 28
PRIVATE DOCTOR/CLINIC 42
PRIVATE PARAMEDIC 43
YOGA AND NATUROPATHY 45
UNANI 46
SIDDHA 47
HOMEOPATHY 48
SOWA RIGPA (TTM) 49
OTHER 50 (SPECIFY) __
OTHER PRIVATE HEALTH FACILITY 52
516A. ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2014 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 QUESTIONNAIRE(S)).
516B. BIRTH HISTORY NUMBER FROM 212
BIRTH HISTORY NUMBER __
LIVING (CONTINUE)
DEAD (GO TO 516C IN NEXT COLUMN OR, IF NO MORE BIRTHS GO TO 550)
517. Has (NAME) had diarrhea in the last 2 weeks?
NO 2 (SKIP TO 526)
DON'T KNOW 8 (SKIP TO 526)
517A. Was there any blood in the stools?
NO 2
DON'T KNOW 8
518. Now I would like to know how much (NAME) was given to drink during the diarrhea (including breast milk). Was (NAME) given less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was (NAME) give much less than usual to drink or somewhat less?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8
519. When (NAME) had diarrhea, 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?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8
520. Did you seek advice or treatment for the diarrhea from any source?
NO 2 (SKIP TO 525)
521. Where did you seek advice or treatment?
Anywhere else?
RECORD ALL SOURCES MENTIONED.
IF UNABLE TO DETERMINE IF A HOSPITLA, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE HEALTH SECTOR, WRITE THE NAME OF THE PLACE(S).
(NAME OF FACILITY/PLACE(S))
YOGA AND NATUROPATHY C
UNANI D
SIDDHA E
HOMEOPATHY F
SOWA RIGPA (TTM) G
OTHER H (SPECIFY) __
UHC/UHP/UFWC J
CHC/RURAL HOSPITAL/BLOCK PHC K
PHC/ADDITIONAL PHC L
SUB-CENTRE/ANM M
GOVERNMENT MOBILE CLINIC N
CAMP O
ANGANWADI/ICDS CENTRE P
ASHA Q
OTHER PUBLIC HEALTH SECTOR R
NGO/TRUST HOSPITAL/CLINIC S
PRIVATE DOCTOR/CLINIC U
PRIVATE PARAMEDIC V
YOGA AND NATUROPATY X
UNANI Y
SIDDA Z
HOMEOPATHY AA
SOWA RIGPA (TTM) AB
OTHER AC (SPECIFY) __
OTHER PRIVATE HEALTH SECTOR AE
TRADITIONAL HEALER BB
FRIEND/RELATIVE BC
OTHER BX (SPECIFY) __
ONLY ONE CODE CIRCLED (SKIP TO 524)
523. Where did you first seek advice or treatment?
USE LETTER CODE FROM 521.
524. How many days after the diarrhea 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 diarrhea:
a. A fluid made from a special packet called (LOCAL NAME FOR ORS PACKET)?
b. Gruel made from rice (OR OTHER LOCAL GRAIN)?
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
526. In last seven days, was (NAME) given:
a. ____________________________
(LOCAL NAME FOR MULTIPLE MICRONUTRIENT POWDER)
b. ____________________________
(LOCAL NAME FOR READY TO USE A THERAPEUTIC FOOD SUCH AS PLUMPY NUT)
c. _____________________________
(LOCAL NAME FOR READY TO USE SUPPLEMENTAL FOOD SUCH AS PLUMPY DOZ)
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
526A. CHECK 517: CODE '1' RECORDED
NO (SKIP TO 530)
527. Was (he/she) given zinc at any time since (he/she) started having diarrhea?
NO 2
DON'T KNOW 8
528. Was anything (else) given to treat the diarrhea?
NO 2 (SKIP TO 530)
DON'T KNOW 8 (SKIP TO 530)
529. What (else) was given to treat the diarrhea?
Anything else?
RECORD ALL TREATMENTS GIVEN.
ANTIMOTILITY B
OTHER (NOT ANTIBIOTIC, ANTIMOTILITY, OR ZINC) C
UNKNOWN PILL OR SYRIP D
NON-ANTIBIOTIC F
UNKNOWN INJECTION G
HOME REMEDY/HERBAL MEDICINE I
OTHER X (SPECIFY) __
530. Has (NAME) been ill with a fever at any time in the last 2 weeks?
NO 2 (SKIP TO 532)
DON'T KNOW 8 (SKIP TO 532)
531. At any time during the illness, did (NAME) have blood taken from (his/her) finger or heel for testing?
NO 2
DON'T KNOW 8
532. Has (NAME) had an illness with a cough at any time in the last 2 weeks?
NO 2
DON'T KNOW 8
533. Has (NAME) had fast, short, rapid breaths or difficulty breathing at any time in the last 2 weeks?
NO 2 (SKIP TO 535)
DON'T KNOW 8 (SKIP TO 535)
534. Was the fast or difficult breathing due to a problem in the chest or to a blocked or runny nose?
NOSE ONLY 2 (SKIP TO 536)
BOTH 3 (SKIP TO 536)
OTHER 6 (SPECIFY) __ (SKIP TO 536)
DON'T KNOW 8 (SKIP TO 536)
NO OR DK (SKIP TO 549)
536. Now I would like to know how much (NAME) was given to drink (including breast milk) during the illness with a (fever/cough). Was (he/she) given less than usual to drink, about the same amount, more than usual to drink?
IF LESS, PROBE: Was (he/she) given much less than usual to drink or somewhat less?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8
537. 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?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8
538. Did you seek advice or treatment for the illness from any source?
NO 2 (SKIP TO 543)
539. 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).
(NAME OF FACILITY/PLACE(S))
YOGA AND NATUROPATHY C
UNANI D
SIDDHA E
HOMEOPATHY F
SOWA RIGPA (TTM) G
OTHER H (SPECIFY) __
UHC/UHP/UFWC J
CHC/RURAL HOSPITAL/BLOCK PHC K
PHC/ADDITIONAL PHC L
SUB-CENTRE/ANM M
ANGANWADI/ICDS CENTRE N
GOVT/ MOBILE CLINIC O
CAMP P
OTHER PUBLIC SECTOR HEALTH FACILITY Q
ASHA R
NGO/TRUST HOSPITAL/CLINIC S
PRIVATE DOCTOR/CLINIC U
PRIVATE PARAMEDIC V
YOGA AND NATUROPATHY X
UNANI Y
SIDDHA Z
HOMEOPATHY AA
SOWA RIGPA (TTM) AB
OTHER AC (SPECIFY) __
OTHER PRIVATE HEALTH FACILITY AE
TRADITIONAL HEALER BB
FRIEND/RELATIVE BC
OTHER BX (SPECIFY) __
ONLY ONE CODE CIRCLED (SKIP TO 542)
541. Where did you first seek advice or treatment?
USE LETTER CODE FROM 538.
542. How many days after the illness began did you first seek advice or treatment for (NAME)?
IF THE SAME DAY, RECORD '00'.
543. At any time during the illness, did (NAME) take any drugs for the illness?
NO 2 (SKIP TO 549)
DON'T KNOW 8 (SKIP TO 549)
544. What drugs did (NAME) take?
Any other drugs?
RECORD ALL MENTIONED.
PRIMAQUINE B
SP/FANSIDAR C
QUININE D
ARTEMISININ COMBINATION THERAPY E
OTHER ANTIMALARIAL F
UNKNOWN ANTIMALARIAL G
ACETAMINOPHEN J
IBUPROFEN K
UNKNOWN DRUG Z
545. CHECK 544: ANY CODE 'A-G' RECORDED
NO (SKIP TO 549)
546. How long after the fever started, did (NAME) first take (DRUG(S) FROM 544 A-G)?
NEXT DAY 2
TWO DAYS AFTER FEVER 3
THREE OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8
547. CHECK 544: CODE 'E' RECORDED
NO (SKIP TO 549)
548. How long after the fever started did (NAME) first take an artemisinin combination therapy?
NEXT DAY 2
TWO DAYS AFTER FEVER 3
THREE OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8
549. GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 550.
550. CHECK 215 ND 218, ALL ROWS: NUMBER OF CHILDREN BORN IN 2017 OR LATER LIVING WITH THE RESPONDENT
NONE (SKIP TO 553)
___________________________
(NAME)
551. The last time (NAME OF YOUNGEST CHILD) passed stools, what was done to dispose of the stools?
PUT/RINSED INTO TOILET OR LATRINE 02
PUT/RINSED INTO DRAIN OR DITCH 03
THROWN INTO GARBAGE 04
BURIED 05
LEFT IN THE OPEN 06
OTHER 96 (SPECIFY) __
DON'T KNOW 98
552. CHECK 525(a), ALL COLUMNS:
ANY CHILD RECEIVED FLUID FROM ORS PACKET (SKIP TO 555)
553. Have you ever heard of a special product called (LOCAL NAME FOR ORS PACKET) you can get the treatment of diarrhea?
IF SHE HAS NEVER HEARD OF ORS, SHOW GOVERNMENT AND COMMERICAL ORS PACKETS AND ASK: Have you ever seen a packet like one of these before?
NO 2
554. CHECK 215: ANY LIVE BIRTH IN 2013 OR LATER
NONE (SKIP TO 601)
SECTION 5A. UTILIZATION OF ICDS SERVICES
555. ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2013 OR LATER.
ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 5 BIRTHS, USE ADTIONAL QUESTIONNAIRES).
556. BIRTH HISTORY NUMBER FROM 212
BIRTH HISTORY NUMBER __
LIVING (CONTINUE)
DEAD (GO TO 565)
558. 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?
NO 2 (GO TO 565)
559. 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'.
ALMOST DAILY 1
AT LEAST ONCE A WEEK 2
AT LEAST ONCE A MONTH 3
LESS OFTEN 4
DON'T KNOW 8
560. In the last 12 months, how often has (NAME) had a health check-up from the anganwadi/ICDS centre?
AT LEAST ONCE A MONTH 1
LESS OFTEN 2
DON'T KNOW 8
561. In the last 12 months, has (NAME) received any immunizations through the anganwadi/ICDS centre?
NO 2
DON'T KNOW 8
562. In the last 12 months, how often did (NAME) go to the anganwadi/ICDS centre for early childhood care or for preschool: regularly, occasionally, or not at all?
OCCASIONALLY 2
NOT AT ALL 3
DON'T KNOW 8
563. In the last 12 months, how often was (NAME)'s weight been measured by the anganwadi/ICDS centre?
AT LEAST ONCE A MONTH 1
AT LEAST ONCE IN 3 MONTHS 2
LESS OFTEN 3
DON'T KNOW 8 (GO TO 565)
564. After (NAME) was weighed, did you ever receive counseling from the anganwadi/ICDS worker or ANM?
NO 2
DON'T KNOW 8
565. When you were pregnant with (NAME), did you receive any benefits from the anganwadi/ICDS centre?
NO 2 (GO TO 567)
566. Did you receive any of the following benefits:
NO 2
NO 2
NO 2
567. When you were breastfeeding (NAME) did you receive any benefits from the anganwadi/ICDS centre?
NO 2 (GO TO 569)
DID NOT BREAST FEED (GO TO 569)
568. Did you receive any of the following benefits:
NO 2
NO 2
NO 2
569. GO TO 557 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 601.
SECTION 6. FERTILITY PREFERENCES
OTHER (CONTINUE)
OTHER (CONTINUE)
HAS NOT HAD A HYSTERECTOMY (CONTINUE)
NOT PREGNANT OR UNSURE (SKIP TO 606)
605. 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?
NO MORE 2 (SKIP TO 613)
UNDECIDED/DON'T KNOW 8 (SKIP TO 613)
606. 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?
NO MORE/NONE 2 (SKIP TO 609)
SAYS SHE CAN'T GET PREGNANT 3 (SKIP TO 615)
UNDECIDED/DON'T KNOW 8 (SKIP TO 612)
YEARS 2 __
SOON/NOW 993 (SKIP TO 609)
SAYS SHE CAN'T GET PREGNANT 994 (SKIP TO 615)
OTHER 996 (SPECIFY) __ (SKIP TO 609)
DON'T KNOW 998 (SKIP TO 609)
PREGNANT (SKIP TO 613)
609. CHECK 329: USING A CONTRACEPTIVE METHOD?
NOT CURRENTLY USING (CONTINUE)
CURRENTLY USING (SKIP TO 615)
24 OR MORE MONTHS OR 02 OR MORE YEARS (CONTINUE)
00-23 MONTHS OR 00-01 YEAR (SKIP TO 614)
PROBE: Any other reason?
PROBE: Any other reason?
RECORD ALL REASONS MENTIONED.
INFREQUENT SEX C
MENOPAUSAL D
HYSTERECTOMY E
CAN'T GET PREGNANT F
NOT MENSTRUATED SINCE LAST BIRTH G
BREASTFEEDING H
FATALISTIC/UP TO GOD I
HUSBAND OPPOSED K
OTHERS OPPOSED L
RELIGIOUS PROHIBITION M
KNOWS NO SOURCE O
LACK OF ACCESS/TOO FAR Q
COSTS TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY'S NORMAL PROCESSES T
DON'T LIKE EXISTING METHODS U
DON'T KNOW Z
612. CHECK 329: USING A CONTRACEPTIVE METHOD?
NO, NOT CURRENTLY USING (CONTINUE)
YES, CURRENTLY USING (SKIP TO 615)
613. Do you think you will use a contraceptive method to delay or avoid pregnancy in the next 12 months?
NO 2
DON'T KNOW 8
614. Do you think you will use a contraceptive method to delay or avoid pregnancy at any time in the future?
NO 2
DON'T KNOW 8
NONE 00 (SKIP TO 617)
NUMBER __
OTHER 96 (SPECIFY) __ (SKIP TO 617)
616. How many of these children would you like to be boys, how many would like to be girls and for how many would it not matter if it's a boy or a girl?
GIRLS __
EITHER __
617. 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?
e. Seen anything about family planning on the internet?
NO 2
NO 2
NO 2
NO 2
NO E
OTHER (SKIP TO 624)
619. CHECK 330/330A: USING A CONTRACEPTIVE METHOD?
NO CODE CIRCLED (SKIP TO 623)
620. Would you say that using contraception is mainly your decision, mainly your husband's decision or did you both decide together?
MAINLY HUSBAND 2
JOINT DECISION 3
OTHER 6
OTHER (CONTINUE)
HAS NOT HAD A HYSTERECTOMY (CONTINUE)
623. Does your husband want the same number of children that you want, or does he want more or fewer than you want?
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8
624. Husbands and wives do not always agree on everything. Please tell me 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.
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
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?
SMALL PROBLEM 2
NO PROBLEM 3
SMALL PROBLEM 2
NO PROBLEM 3
SMALL PROBLEM 2
NO PROBLEM 3
SMALL PROBLEM 2
NO PROBLEM 3
SMALL PROBLEM 2
NO PROBLEM 3
SMALL PROBLEM 2
NO PROBLEM 3
SMALL PROBLEM 2
NO PROBLEM 3
SMALL PROBLEM 2
NO PROBLEM 3
702. Now I would like to ask you some other questions relating to health matters. 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 3 MONTHS OR MORE, RECORD '90'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
NONE 00 (SKIP TO 704)
703. The last time you got an injection, were the syringe and needle taken from a new, unopened package?
NO 2
DON'T KNOW 8
704. Have you ever had a blood transfusion?
NO 2
705. Do you currently smoke cigarettes every day, some days, or not at all?
SOME DAYS 2
NOT AT ALL 3 (SKIP TO 708)
706. On average, how many cigarettes do you currently smoke each day?
707. For how long have you been smoking cigarettes regularly?
IF LESS THAN 1 MONTH, RECORD WEEKS;
IF LESS THAN 2 YEARS, RECORD MONTHS.
IF 2 OR MORE YEARS, RECORD YEARS.
MONTHS 2 __
YEARS 3 __
NEVER SMOKED REGULARLY 995
708. Do you currently smoke bidis every day, some days, or not at all?
SOME DAYS 2
NOT AT ALL 3 (SKIP TO 711)
709. On average, how many bidis do you currently smoke each day?
710. For how long have you been smoking bidis regularly?
IF LESS THAN 1 MONTH, RECORD WEEKS;
IF LESS THAN 2 YEARS, RECORD MONTHS.
IF 2 OR MORE YEARS, RECORD YEARS.
MONTHS 2 __
YEARS 3 __
NEVER SMOKED REGULARLY 995
711. Do you currently smoke or use tobacco in any other form?
NO 2 (SKIP TO 715)
712. In what other form do you currently smoke or use tobacco?
Any other form?
RECORD ALL MENTIONED.
PIPE B
HOOKAH C
GUTKA/PAAN MASALA WITH TOBACCO D
KHAINI E
PAAN WITH TOBACCO F
OTHER CHEWING TOBACCO G
SNUFF H
OTHER X (SPECIFY) __
OTHER (SKIP TO 715)
713. How often do you use smokeless tobacco: almost every day, about once a week or less than once a week?
ABOUT ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
714. For how long have you been using smokeless tobacco regularly?
IF LESS THAN 1 MONTH, RECORD WEEKS;
IF LESS THAN 2 YEARS, RECORD MONTHS.
IF 2 OR MORE YEARS, RECORD YEARS.
MONTHS 2 __
YEARS 3 __
NEVER SMOKED REGULARLY 995
715. CHECK 705, 708, 711: CURRENTLY SMOKES OR USES TOBACCO
OTHER (SKIP TO 719_
716. During the last 12 months, have you ever tried to stop smoking or using tobacco in any other form?
NO 2
717. In the last 12 months, have you visited a doctor or other health care provider?
NO 2 (SKIP TO 719)
718. During any of these visits, were you advised to quit smoking or using tobacco in any other form?
NO 2
719. In the last 30 days, did someone (other than you) smoke in your home or anywhere else when you were present?
NO 2
NO 2 (SKIP TO 724)
721. How often do you drink alcohol: almost every day, about once a week, or less than once a week?
ABOUT ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
722. What type of alcohol do you usually drink?
RECORD ALL MENTIONED.
COUNTRI LIQUOR B
BEER C
WINE D
HARD LIQUOR E
OTHER X (SPECIFY) __
723. For how long have you been drinking alcohol regularly?
IF LESS THAN 1 MONTH, RECORD WEEKS;
IF LESS THAN 2 YEARS, RECORD MONTHS.
IF 2 OR MORE YEARS, RECORD YEARS.
MONTHS 2 __
YEARS 3 __
NEVER DRANK ALCOHOL REGULARLY 995
724. Have you ever heard of an illness called tuberculosis or TB?
NO 2 (SKIP TO 728)
725. How does tuberculosis spread from one person to another?
PROBE: Any other ways?
RECORD ALL MENTIONED.
THROUGH SHARING UTENSILS B
THROUGH TOUCHING A PERSON WITH TB C
THROUGH FOOD D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
OTHER X (SPECIFY) __
DON'T KNOW Z
726. Can tuberculosis be cured?
NO 2
DON'T KNOW 8
727. If a member of your family got tuberculosis, would you want it to remain a secret or not?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
728. A. Do you currently have:
NO 2 (CONTINUE)
DON'T KNOW 8 (CONTINUE)
NO 2
NO 2 (CONTINUE)
DON'T KNOW 8 (CONTINUE)
NO 2
NO 2 (CONTINUE)
DON'T KNOW 8 (CONTINUE)
NO 2
NO 2 (CONTINUE)
DON'T KNOW 8 (CONTINUE)
NO 2
NO 2 (CONTINUE)
DON'T KNOW 8 (CONTINUE)
NO 2
NO 2 (CONTINUE)
DON'T KNOW 8 (CONTINUE)
NO 2
NO 2
DON'T KNOW 8
NO 2
729. Are you covered by any health scheme or any health insurance?
YES 1
NO 2 (SKIP TO 731)
730. What type of health scheme or health insurance?
Any other type?
RECORD ALL MENTIONED.
CENTRAL GOVERNMENT HEALTH SCHEME (CGHS) B
RASHTRIYA SWASTHYA BIMA YOJANA (RSBY) D
COMMUNITY HEALTH INSURANCE PROGRAMME E
OTHER HEALTH INSURANCE THROUGH EMPLOYER F
MEDICAL REIMBURSEMENT FROM EMPLOYER G
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE H
OTHER X (SPECIFY) __
731. How often do you yourself eat the following food items: daily, weekly, occasionally, or never?
WEEKLY 2
OCCASIONALLY 3
NEVER 4
WEEKLY 2
OCCASIONALLY 3
NEVER 4
WEEKLY 2
OCCASIONALLY 3
NEVER 4
WEEKLY 2
OCCASIONALLY 3
NEVER 4
WEEKLY 2
OCCASIONALLY 3
NEVER 4
WEEKLY 2
OCCASIONALLY 3
NEVER 4
WEEKLY 2
OCCASIONALLY 3
NEVER 4
WEEKLY 2
OCCASIONALLY 3
NEVER 4
WEEKLY 2
OCCASIONALLY 3
NEVER 4
732. CHECK COVER PAGE: HOUSEHOLD SELECTED FOR STATE MODULE?
YES (SKIP TO 801)
801. CHECK 315 AND 316:
HAS HAD SEXUAL INTERCOURSE (CONTINUE)
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.
25-49 YEARS OLD (SKIP TO 805)
804. The first time you had sexual intercourse, was a condom used?
NO 2
DON'T KNOW/DON'T REMEMBER 8
805. I would like to ask you about your recent sexual activity. 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.
WEEKS AGO 2 __ (SKIP TO 807)
MONTHS AGO 3 __ (SKIP TO 807)
YEARS AGO 4 __ (SKIP TO 818)
806. When was the last time you had sexual intercourse with this person?
WEEKS AGO 2 __
MONTHS AGO 3 __
807. The last time you had sexual intercourse (with this other person), was a condom used?
NO 2 (SKIP TO 809)
808. Was a condom used every time you had sexual intercourse with this person in the last 12 months?
NO 2
809. What was your relationship to this person with whom you had sexual intercourse?
LIVE-IN PARTNER 02
BOYFRIEND NOT LIVING WITH RESPONDENT 03 (SKIP TO 812)
OTHER FRIEND 04 (SKIP TO 812)
RELATIVE 05 (SKIP TO 812)
CASUAL ACQUAINTANCE 06 (SKIP TO 812)
SEX WORKER/CLIENT 07 (SKIP TO 812)
OTHER 96 (SPECIFY) __ (SKIP TO 812)
MARRIED MORE THAN ONCE (SKIP TO 812)
OTHER (CONTINUE)
812. How long ago did you first have sexual intercourse with this (second-to-last) person?
WEEKS AGO 2 __
MONTHS AGO 3 __
YEARS AGO 4 __
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'.
AGE 25-49 (SKIP TO 816)
DON'T KNOW 98
816. Apart from this person, have you had sexual intercourse with any other person in the last 12 months?
NO 2 (SKIP TO 818)
817. In total, with how many different people have you had sexual intercourse in the last 12 months?
IF NON-NUMERIC, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS 95 OR MORE, WRITE '95'.
DON'T KNOW 98
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.
DON'T KNOW 98
819. PRESENCE OF OTHERS DURING THIS SECTION.
NO 2
NO 2
NO 2
820. Do you know of a place where a person can get condoms?
NO 2 (SKIP TO 901)
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).
(NAME OF FACILITY/PLACE(S))
YOGA AND NATUROPATHY C
UNANI D
SIDDHA E
HOMEOPATHY F
SOWA RIGPA (TTM G
OTHER H (SPECIFY) __
UHC/UHP/UFWC J
CHC/RURAL HOSPITAL/BLOCK PHC K
SUB-CENTRE/ANM M
GOVT. MOBILE CLINIC N
CAMP O
ANGANWADI/ICDS CENTRE P
ASHA Q
OTHER COMMUNITY BASED WORKER R
OTHER PUBLIC HEALTH SECTOR S (SPECIFY) __
PRIVATE PARADEMIC V
PRIVATE MOBILE CLINIC W
YOGA AND NATUROPATHY Y
UNANI Z
SIDDHA AA
HOMEOPATHY AB
SOWA RIGA (TTM) AC
OTHER AD (SPECIFY) __
PHARMACY/DRUGSTORE AF
DAI (TBA) AG
OTHER PRIVATE HEALTH SECTOR AH (SPECIFY) __
OTHER SHOP BB
VENDING MACHINE BC
822. If you wanted to, could you yourself get a condom?
NO 2
DON'T KNOW/UNSURE 8
823. CHECK 330 AND 807: 330 = CODE 'F' OR 807 = YES IN EITHER COLUMN (CONTINUE)
OTHER (SKIP TO 901)
824. From where did you obtain the condom last time?
YOGA AND NATUROPATHY 13
UNANI 14
SIDDHA 15
HOMEOPATHY 16
SOWA RIGPA (TTM) 17
OTHER 18 (SPECIFY) __
UHC/UHP/UFWC 20
CHC/RURAL HOSPITAL/BLOCK PHC 21
PHC/ADDITIONAL PHC 22
SUB-CENTRE/ANM 23
GOVT. MOBILE CLINIC 4
CAMP 25
ANGANWADI/ICDS CENTRE 26
ASHA 27
OTHER COMMUNITY BASED WORKER 28
OTHER PUBLIC HEALTH SECTOR 29 (SPECIFY) __
PRIVATE PARADEMIC 42
PRIVATE MOBILE CLINIC 43
YOGA AND NATUROPATHY 45
UNANI 46
SIDDHA 47
HOMEOPATHY 48
SOWA RIGA (TTM) 49
OTHER 50 (SPECIFY) __
PHARMACY/DRUGSTORE 62
DAI (TBA) 63
OTHER PRIVATE HEALTH SECTOR 64 (SPECIFY) __
OTHER SHOP 72
VENDING MACHINE 73
FRIEND/RELATIVE 74
DON'T KNOW 98
SECTION 9. HUSBAND'S BACKGROUND AND WOMAN'S WORK
901. CHECK 301:
NEVER MARRIED OR MARRIED, GAUNA NOT PERFORMED (SKIP TO 911)
OTHER (SKIP TO 903)
902. How old was your husband on his last birthday?
903. Did your (last) husband ever attend school?
NO 2 (SKIP TO 905)
904. What was the highest grade he completed?
DON'T KNOW 98
__
OTHER (SKIP TO 913)
907. Has your husband done any work in the last 7 days?
NO 2
908. Has your husband done any work in the last 12 months?
NO 2
909. In the last 12 months, has your husband been away from home for one month or more at a time?
NO 2 (SKIP TO 911)
910. In the last 12 months, has your husband been away from home for six months or more at a time?
NO 2
911. Aside from our own housework, have you done any work in the last seven days?
NO 2
912. 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?
NO 2
913. Although you did not work in the last seven days, do you have any job or business from which you were absent to leave, illness, vacation, maternity leave or any other such reason?
NO 2
914. Have you done any work in the last 12 months?
NO 2 (SKIP TO 919)
915. What is your occupation, that is, what kind of work do you mainly do?
__
916. Do you do this work for a member of your family, for someone else, or are you self-employed?
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3
917. Do you usually work throughout the year, or do you work seasonally, or only once in a while?
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3
918. Are you paid in cash or kind for this work, or are you not paid at all?
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4
919. 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?
NO 2
921. CHECK 301: MARITAL STATUS
OTHER (SKIP TO 929)
OTHER (SKIP TO 925)
923. Who decides how the money you earn will be used: mainly you, mainly your husband, or you and your husband jointly?
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
OTHER 6
924. 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?
LESS THAN HUSBAND 2
ABOUT THE SAME 3
HUSBAND HAS NO EARNINGS 4 (SKIP TO 926)
DON'T KNOW 8
925. Who decides how your husband's earnings will be used: mainly you, mainly your husband, or you and your husband jointly>
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
HUSBAND HAS NO EARNINGS 4
OTHER 6
926. Who usually makes decisions about health care for yourself: mainly you, mainly your husband, you and your husband jointly, or someone else?
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
OTHER 6
927. Who usually makes decisions about making major household purchases: mainly you, mainly your husband, you and your husband jointly, or someone else?
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
OTHER 6
928. Who usually makes decisions about visits to your family or relatives: mainly you, mainly your husband, you and your husband jointly, or someone else?
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
OTHER 6
929. Do you have any money of your own that you alone can decide how to use?
NO 2
930. 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)?
WITH SOMEONE ELSE ONLY 2
NOT AT ALL 3
WITH SOMEONE ELSE ONLY 2
NOT AT ALL 3
WITH SOMEONE ELSE ONLY 2
NOT AT ALL 3
931. Do you have a bank or savings account that you yourself use?
NO 2
932. Do you have any mobile phone that you yourself use?
NO 2 (SKIP TO 934)
933. Do you your mobile phone for any financial transactions?
NO 2
934. Have you ever used the internet?
NO 2
GRADE 6 AND ABOVE (SKIP TO 937)
CODE '1' OR '5' (SKIP TO 938)
937. Are you able to read text (SMS) messages?
NO 2
938. Do you own this or any other house either alone or jointly with someone else?
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4
939. Do you own any agricultural or non-agricultural land either alone or jointly with someone else?
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4
940. Do you know of any programs in this area that give loans to women to start or expand a business of their own?
NO 2 (SKIP TO 942)
941. Have you yourself ever taken a loan, in cash or in kind, from any of these programs, to start or expand a business?
NO 2
942. PRESENCE OF OTHERS AT THIS POINT (PRESENT AND LISTENING, PRESENT BUT NOT LISTENING, OR NOT PRESENT)
PRESENT/NOT LISTENING 2
NOT PRESENT 3
PRESENT/NOT LISTENING 2
NOT PRESENT 3
PRESENT/NOT LISTENING 2
NOT PRESENT 3
PRESENT/NOT LISTENING 2
NOT PRESENT 3
943. 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 with properly?
f. If he suspects her of being unfaithful?
g. If she shows disrespect for in-laws?
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
944. If a wife knows her husband has a sexually transmitted disease, is she justified in asking that they use a condom when they have sex?
NO 2
DON'T KNOW 8
945. If a wife knows her husband has sex with other women, is she justified in refusing to have sex with him?
NO 2
DON'T KNOW 8
OTHER (SKIP TO 1001)
947. Can you say no to your husband if you do not want to have sexual intercourse with him?
NO 2
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?
NO 2
1002. Have you ever heard of HIV?
NO 2
1003. CHECK 1001 AND 1002: KNOWS ABOUT HIV/AIDS
OTHER (SKIP TO 1048)
1004. From which sources of information have you learned about AIDS?
Any other source?
RECORD ALL MENTIONED.
TELEVISION B
CINEMA C
NEWSPAPERS/MAGAZINES D
POSTERS/HOARDINGS E
EXHIBITON/MELA F
HEALTH WORKERS G
ADULT EDUCATION PROGRAMME H
RELIGIOUS LEADERS I
POLITICAL LEADERS J
SCHOOL/TEACHERS K
COMMUNITY MEETINGS L
HUSBAND M
FRIENDS/RELATIVES N
WORK PLACE O
INTERNET P
OTHER X (SPECIFY) __
1005. HIV is the virus that can lead to AIDS. Can people reduce their change of getting HIV by having just one uninfected sex partner who has no other sex partners?
NO 2
DON'T KNOW 8
1006. Can people get HIV from mosquito bites?
NO 2
DON'T KNOW 8
1007. Can people reduce their chances of getting HIV by using a condom every time they have sex?
NO 2
DON'T KNOW 8
1008. Can people get HIV from blood products or blood transfusions?
NO 2
DON'T KNOW 8
1009. Can people get HIV by injecting drugs?
NO 2
DON'T KNOW 8
1010. Can people get HIV by sharing food with a person who has HIV?
NO 2
DON'T KNOW 8
1011. Is there anything else a person can do to avoid or reduce the chances of getting HIV/AIDS?
NO 2 (SKIP TO 1013)
DON'T KNOW 8 (SKIP TO 1013)
1012. What can a person do?
Anything else?
RECORD ALL WAYS MENTIONED.
USE CONDOMS B
LIMIT SEX TO NOE PARTNER/STAY FAITHFUL TO ONE PARTNER C
LIMIT NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH SEX WORKERS E
AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH PERSONS WHO INJECT DRUGS H
AVOID BLOOD TRANSFUSIONS I
USE BLOOD ONLY FROM RELATIVES J
AVOID INJECTIONS K
USE ONLY NEW/STERILIZED NEEDLES L
AVOID IV DRIP M
AVOID SHARING RAZORS/BLADES N
AVOID KISSING O
AVOID MOSQUITO BITES P
OTHER W (SPECIFY) __
OTHER X (SPECIFY) __
DON'T KNOW Z
1013. Is it possible for a healthy-looking person to have HIV?
NO 2
DON'T KNOW 8
1014. Can HIV be transmitted from a mother to her baby:
a. During pregnancy?
b. During delivery?
c. By breastfeeding?
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
OTHER (SKIP TO 1017)
1016. Are there any special drugs that a doctor or a nurse can give to a woman infected with HIV to reduce the risk of transmission to the baby?
NO 2
DON'T KNOW 8
1017. Have you heard about special antiretroviral drugs (USE LOCAL NAME)'s that people infected with HIV/AIDS can get from a doctor or nurse to help them live longer?
NO 2
NO BIRTHS (SKIP TO 1033)
LAST BIRTH BEFORE 2017 (SKIP TO 1033)
1019. CHECK 414 FOR LAST BIRTH:
NO ANTENATAL CARE (SKIP TO 1027)
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 from their mother?
b. Things that you can do to prevent getting HIV/AIDS?
c. Getting tested for HIV?
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
1022. Were you offered a test for HIV as part of your antenatal care?
NO 2
1023. I don't want to know the results, but were you tested for HIV as part of your antenatal care?
NO 2 (SKIP TO 1027)
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.
(NAME OF FACILITY/PLACE)
GOVERNMENT HEALTH CENTRE 12
STAND-ALONE ICTC 13
FAMILY PLANNING CLINIC 14
MOBILE CLINIC 15
FIELDWORKER 16
SCHOOL BASED CLINIC 17
OTHER PUBLIC SECTOR 18 (SPECIFY) __
STAND-ALONE ICTC 22
PHARMACY 23
MOBILE CLINIC 24
FIELDWORKER 25
SCHOOL BASED CLINIC 26
OTHER PRIVATE HEALTH SECTOR 27 (SPECIFY) __
CORRECTIONAL FACILITY 32
1025. I don't want to know the results, but did you get the results of the test?
NO 2 (SKIP TO 1031)
1026. All women are supposed to receive counseling after being tested. After you were tested, did you receive counseling?
NO 2 (SKIP TO 1031)
DON'T KNOW 8 (SKIP TO 1031)
1027. CHECK 448 FOR LAST BIRTH: PLACE OF BIRTH
OTHER PLACE (SKIP TO 1033)
1028. Between the time you went for delivery but before the baby was born, were you offered a test for HIV/AIDS?
NO 2
1029. I don't want to know the results, but were you tested for HIV/AIDS at that time?
NO 2 (SKIP TO 1033)
1030. I don't want to know the results, but did you get the results of the test?
NO 2
1031. Have you been tested for HIV/AIDS since that time you were tested during your pregnancy?
NO 2
1032. How many months ago was your most recent HIV test?
TWO OR MORE YEARS 95 (SKIP TO 1039)
1033. I don't want to know the results, but have you ever been tested to see if you have HIV/AIDS?
NO 2 (SKIP TO 1037)
1034. How many months ago was your most recent HIV test?
TWO OR MORE YEARS 95
1035. I don't want to know the results, but did you get the results of the test?
NO 2
1036. Where was the test done?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABEL TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF FACILITY/PLACE)
GOVERNMENT HEALTH CENTRE 12 (SKIP TO 1039)
STAND-ALONE ICTC 13 (SKIP TO 1039)
FAMILY PLANNING CLINIC 14 (SKIP TO 1039)
MOBILE CLINIC 15 (SKIP TO 1039)
FIELDWORKER 16 (SKIP TO 1039)
SCHOOL BASED CLINIC 17 (SKIP TO 1039)
OTHER PUBLIC HEALTH SECTOR 18 (SPECIFY) __ (SKIP TO 1039)
STAND-ALONE ICTIC 22 (SKIP TO 1039)
PHARMACY 23 (SKIP TO 1039)
MOBILE CLINIC 24 (SKIP TO 1039)
FIELDWORKER 25 (SKIP TO 1039)
SCHOOL BASED CLINIC 26 (SKIP TO 1039)
OTHER PRIVATE HEALTH SECTOR 27 (SPECIFY) __ (SKIP TO 1039)
CORRECTIONAL FACILITY 32 (SKIP TO 1039)
1037. Do you know of a place where people can go to get tested for HIV/AID?
NO 2 (SKIP TO 1039)
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.
(NAME OF FACILITY/PLACE(S))
GOVERNMENT HEALTH CENTRE B
STAND-ALONE ICTC C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
FIELDWORKER F
SCHOOL BASED CLINIC G
OTHER PUBLIC HEALTH SECTOR H (SPECIFY) __
STAND-ALONE ICTC K
PHARMACY L
MOBILE CLINIC M
FIELDWORKER N
SCHOOL BASED CLINIC O
OTHER PRIVATE HEALTH SECTOR P (SPECIFY) __
CORRECTIONAL FACILITY R
1039. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV/AIDS?
NO 2
DK/NOT SURE/DEPENDS 8
1040. Do you think a child with HIV should be allowed to attend school with students who are HIV negative?
SHOULD NOT BE ALLOWED 2
DK/NOT SURE/DEPENDS 8
1041. If a member of your family got infected with HIV/AIDS, would you want it to remain a secret or not?
NO 2
DK/NOT SURE/DEPENDS 8
1042. Do you fear that you could get HIV if you come into contact with the saliva of a person living with HIV?
NO 2
DON'T KNOW8
1043. If a relative of yours became sick with HIV/AIDS, would you be willing to care for her or him in your own household?
NO 2
DK/NOT SURE/DEPENDS 8
1044. In your opinion, if a female teacher has HIV/AIDS but is not sick, should she be allowed to continue teaching in the school?
SHOULD NOT BE ALLOWED 2
DK/NOT SURE/DEPENDS 8
1045. In your opinion, if a male teacher has HIV/AIDS but is not sick, should he be allowed to continue teaching in the school?
SHOULD NOT BE ALLOWED 2
DK/NOT SURE/DEPENDS 8
1046. Do you think that people living with HIV should be treated in the same public hospital with patients who are HIV negative?
SHOULD NOT BE ALLOWED 2
DK/NOT SURE/DEPENDS 8
1047. Do you think that people living with HIV should be allowed to work in the same office with people who are HIV negative?
SHOULD NOT BE ALLOWED 2
DK/NOT SURE/DEPENDS 8
NO 2
1049. CHECK 315 AND 316: HAD SEXUAL INTERCOURSE
HAS NOT HAD SEXUAL INTERCOURSE (315 = '2' OR 316 = '00') (SKIP TO 1101)
1050. CHECK 1048: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?
NO (SKIP TO 1052)
1051. 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?
NO 2
DON'T KNOW 8
1052. Sometimes women experience a bad smelling abnormal genital discharge. During the last 12 months, have you had a bad smelling abnormal genital discharge?
NO 2
DON'T KNOW 8
1053. Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?
NO 2
DON'T KNOW 8
1054. CHECK 1051, 1052, AND 1053: HAS HAD AN STI
OTHER (SKIP TO 1101)
1055. The last time you had (PROBLEM FROM 1051/1052/1053), did you seek any kind of advice or treatment?
NO 2 (SKIP TO 1101)
1056. Where did you go?
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.
(NAME OF FACILITY/PLACE(S))
YOGA AND NATUROPATHY C
UNANI D
SIDDHA E
HOMEOPATHY F
SOWA RIGPA (TTM) G
OTHER H (SPECIFY) __
STAND-ALONE ICTC J
FAMILY PLANNING CLINIC K
MOBILE CLINIC L
FIELDWORKER M
SCHOOL-BASED CLINIC N
OTHER PUBLIC HEALTH SECTOR O (SPECIFY) __
YOGA AND NATUROPATHY S
UNANI T
SIDDHA U
HOMEOPATHY V
SOWA RIGPA (TTM) W
OTHER X (SPECIFY) __
PHARMACY Z
MOBILE CLINIC AA
FIELDWORKER AB
SCHOOL BASED CLINIC AC
OTHER PRIVATE HEALTH SECTOR AD (SPECIFY) __
CORRECTIONAL FACILITY BB
SECTION 11. HOUSEHOLD RELATIONS
1101. CHECK COVER PAGE: WOMAN SELECTED FOR THIS SECTION
NO (SKIP TO 1140)
1102. CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED.
PRIVACY NOT POSSIBLE 2 (SKIP TO 1139)
Now I would like to ask you questions about some other important aspects of a woman's life. You may find some of these questions 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 now one else in your household will know that you were asked these questions. 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.
FORMERLY MARRIED (1105 TO 1115: READ IN PAST TENSE) (CONTINUE)
NEVER MARRIED OR MARRIED, GAUNA NOT PERFORMED (SKIP TO 1118)
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 (insists/insisted) on knowing where you (are/were) at all times.
f. He (does/did) not trust you with money.
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
1106. Now if you will permit me, I need to ask some more questions about your relationship with your (last) husband. (Does/did) your (last) husband ever:
NO 2 (CONTINUE)
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
NO 2 (CONTINUE)
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
NO 2 (CONTINUE)
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
1107. (Does/did) your (last) husband ever do any of the following things to you:
NO 2 (CONTINUE)
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
NO 2 (CONTINUE)
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
NO 2 (CONTINUE)
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
NO 2 (CONTINUE)
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
NO 2 (CONTINUE)
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
NO 2 (CONTINUE)
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
NO 2 (CONTINUE)
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
NO 2 (CONTINUE)
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
NO 2 (CONTINUE)
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
NO 2 (CONTINUE)
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
1108. CHECK 1107 A (a-j): EXPERIENCED PHYSICAL VIOLENCE
NOT A SINGLE 'YES' (SKIP TO 1111)
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'.
BEFORE MARRIAGE 95
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?
NO 2
NO 2
NO 2
NO 2
1111. Have you ever hit, slapped, or 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?
SOMETIMES 2
NOT AT ALL 3
1113. (Does/did) your (last) husband drink alcohol?
NO 2 (SKIP TO 1115)
1114. How often (does/did) he get drunk: often, only sometimes, or never?
SOMETIMES 2
NEVER 3
1115. Are (Were) you afraid of your (last) husband: most of the time, sometimes, or never?
SOMETIMES AFRAID 2
NEVER AFRAID 3
MARRIED ONLY ONCE (SKIP TO 1118)
1117. 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.
NO 2 (CONTINUE)
12 OR MORE MONTHS AGO 2
DON'T REMEMBER 3
NO 2 (CONTINUE)
12 OR MORE MONTHS AGO 2
DON'T REMEMBER 3
NO 2 (CONTINUE)
12 OR MORE MONTHS AGO 2
DON'T REMEMBER 3
NO 2 (SKIP TO 1121)
REFUSED TO ANSWER/NO ANSWER 3 (SKIP TO 1121)
1119. Who has hurt you in this way?
Anyone else?
RECORD ALL MENTIONED.
FATHER/STEP-FATHER B
SISTER/BROTHER C
DAUGHTER/SON D
OTHER RELATIVE E
CURRENT BOYFRIEND F
FORMER BOYFRIEND G
MOTHER-IN-LAW H
FATHER-IN-LAW I
OTHER IN-LAW J
TEACHER K
EMPLOYER/SOMEONE AT WORK L
POLICE/SOLDIER M
1120. In the last 12 months, how often (has this person/have these persons) physically hurt you: often, only sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3
1121. CHECK 201, 226, AND 231:
NEVER BEEN PREGNANT (SKIP TO 1124)
1122. Has anyone ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?
NO 2 (SKIP TO 1124)
1123. Who has done any of these things to physically hurt you while you were pregnant?
Anyone else?
RECORD ALL MENTIONED.
FORMER HUSBAND/PARTNER B
CURRENT/FORMER BOYFRIEND C
FATHER/STEP-FATHER D
BROTHER/STEP-BROTHER E
OTHER RELATIVE F
IN-LAW G
OWN FRIEND/ACQUAINTANCE H
FAMILY FRIEND I
TEACHER J
EMPLOYER/SOMEONE AT WORK K
POLICE/SOLDIER L
PRIEST/RELIGIOUS LEADER M
STRANGER N
OTHER X (SPECIFY) __
NEVER MARRIED, OR MARRIED, GUANA NOT PERFORMED (SKIP TO 1126)
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?
NO 2 (SKIP TO 1129)
REFUSED TO ANSWER/NO ANSWER 3 (SKIP TO 1129)
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?
NO 2 (SKIP TO 1131)
REFUSED TO ANSWER/NO ANSWER 3 (SKIP TO 1131)
1127. Who was the person who was forcing you the very first time this happened?
FORMER HUSBAND 02
CURRENT/FORMER BOYFRIEND 03
FATHER/STEP-FATHER 04
BROTHER/STEP-BROTHER 05
OTHER RELATIVE 06
IN-LAW 07
OWN FRIEND/ACQUAINTANCE 08
FAMILY FRIEND 09
TEACHER 10
EMPLOYER/SOMEONE AT WORK 11
POLICE/SOLDIER 12
PRIEST/RELIGIOUS LEADER 13
STRANGER 14
OTHER 96 (SPECIFY) __
NO 2 (SKIP TO 1130)
REFUSED TO ANSWER/NO ANSWER 3 (SKIP TO 1130)
1129. CHECK 1107 (h-j) and 1117 A (b): EXPERIENCED SEXUAL VIOLENCE
NOT A SINGLE 'YES' (SKIP TO 1131)
DON'T REMEMBER 98
1131. CHECK 1107 A (a-j), 1117A (a-b), 1118, 1122, 1125, and 1126: EXPERIENCED ANY VIOLENCE
NOT A SINGLE 'YES' (SKIP TO 1137)
1132. Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?
NO 2 (SKIP TO 1134)
1133. From who have you sought help?
Anyone else?
RECORD ALL MENTIONED.
HUSBAND'S FAMILY B (SKIP TO 1135)
CURRENT/FORMER HUSBAND C (SKIP TO 1135)
CURRENT/FORMER BOYFRIEND D (SKIP TO 1135)
FRIEND E (SKIP TO 1135)
NEIGHBOUR F (SKIP TO 1135)
RELIGIOUS LEADER G (SKIP TO 1135)
DOCTOR/MEDICAL PERSONNEL H (SKIP TO 1135)
POLICE I (SKIP TO 1135)
LAWYER J (SKIP TO 1135)
SOCIAL SERVICE ORGANIZATION K (SKIP TO 1135)
OTHER X (SPECIFY) __ (SKIP TO 1135)
1134. Have you ever told anyone else about this?
NO 2
'H' IS NOT CIRCLED (SKIP TO 1137)
1136. Where did you go for medical help?
Anywhere else?
RECORD ALL MENTIONED.
YOGA AND NATEROPATHY C
UNANI D
SIDDHA E
HOMEOPATHY F
SOWA RIGPA (TTM) G
OTHER H (SPECIFY) __
UHC/UHP/UFWC J
CHC/RURAL HOSPITAL/BLOCK PHC K
PHC/ADDITIONAL PHC L
SUB-CENTRE/ANM M
GOVERNMENT MOBILE CLINIC N
CAMP O
ANGANWADI/ICDS CENTRE P
ASHA Q
OTHER COMMUNITY BASED WORKER R
OTHER PUBLIC HEALTH SECTOR S
NGO OR TRUST HOSPITAL/CLINIC T
PRIVATE DOCTOR/CLINIC V
PRIVATE MOBILE CLINIC W
YOGA AND NATEROPATHY Y
UNANI Z
SIDDHA AA
HOMEOPATHY AB
SOWA RIGPA (TTM) AC
OTHER AD (SPECIFY) __
PHARMACY/DRUGSTORE AF
DAI (TBA) AG
OTHER PRIVATE HEALTH SECTOR AH
1137. As far as you know, did your father ever beat your mother?
NO 2
DON'T KNOW 8
THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER ABOUT THE CONFIDENTIALITY OF HER ANSWERS. FILL OUT THE QUESTIONS BELOW WITH REFERENCE TO THE DOMSTIC 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?
YES, MORE THAN ONCE 2
NO 3
YES, MORE THAN ONCE 2
NO 3
YES, MORE THAN ONCE 2
NO 3
1139. INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE
__
MINUTES __
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT RESPONDENT: __
COMENTS ON SPECIFIC QUESTIONS: __
ANY OTHER COMMENTS: __
SUPERVISOR'S OBSERVATIONS
__
NAME OF SUPERVISOR: __
DATE: __