The Hashemite Kingdom of Jordan
JORDAN POPULATION AND FAMILY HEALTH INTERIM SURVEY 2009
Survey Contents Confidential by Statistical Law
QUESTIONNAIRE NO.: _____
GOVERNORATE: __________
DISTRICT: _________
SUB-DISTRICT: ________
LOCALITY: ________
AREA: ________
SUB-AREA: ________
STRATUM: ________
URBAN/RURAL
RURAL 2
BLOCK NO.: ___
BUILDING NO.: ___________
HOUSING UNIT NO.: __________
CLUSTER NO: __________
HOUSEHOLD NO.: ____________
TELEPHONE/MOBILE NO. (if available)
____________________
NAME AND LINE NUMBER OF WOMAN: ______________________ ____
FIRST VISIT
DATE _______
INTERVIEWER NAME _______
RESULT* ________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPCITATED 6
OTHER (SPECIFY) _______ 7
NEXT VISIT:
DATE ________
TIME ________
SECOND VISIT
DATE _______
INTERVIEWER NAME _______
RESULT* _______
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPCITATED 6
OTHER (SPECIFY) _______ 7
NEXT VISIT:
DATE _______
TIME _______
THIRD VISIT
DATE _______
INTERVIEWER NAME _______
RESULT* _______
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPCITATED 6
OTHER (SPECIFY) _______ 7
FINAL VISIT
DAY _______
MONTH _______
YEAR 2009
INT. NUMBER _______
RESULT* _______
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPCITATED 6
OTHER (SPECIFY) _______ 7
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPCITATED 6
OTHER (SPECIFY) _______ 7
FIELD EDITOR
NAME _____________
OFFICE EDITOR
_____________
KEYED BY
_____________
INFORMED CONSENT
Hello. My name is __________________ and I am working with the Department of Statistics. We are conducting a national survey that asks women about the health of women and their children. We would very much appreciate your participation in this survey. This information will help the government to plan health services. The interview usually takes about 40 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shared with anyone other than members of our survey team.
Participation in this survey is voluntary, and if we should come to any question you don't want to answer, just let me know and I will go on to the next question; or you can stop the interview at any time. However, we hope that you will participate in this survey since your views are important.
At this time, do you want to ask me anything about the survey?
May I begin the interview now?
Signature of interviewer: ____________________
Date: _________
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)
MINUTE____
101A) What is your marital status now: are you married, widowed, divorced, or separated?
IF THIS WOMAN IS NOT MARRIED, WIDOWED, DIVORCED, OR SEPARTED, END THE INTERVIEW, AND CORRECT MARITAL STATUS AND ELIGIBILITY IN THE HOUSEHOLD QUESTIONAIRE.
DIVORCED 2
WIDOWED 3
SEPARATED 4
NEVER MARRIED 5 (END)
104) In what month and year were you born?
DK MONTH 98
YEAR ____
DK YEAR 9998
105) How old were you at your last birthday?
COMPARE AND CORRECT 104 AND/OR 105 IF INCONSISTENT.
106) Have you ever attended school?
NO 2 (GO TO 201)
107) What is the highest level of school you attended: Old elementary, old preparatory, old secondary, new basic, new secondary, intermediate diploma, bachelor, or higher?
PREPARATORY 2
SECONDARY 3
SECONDARY 5
BACHELOR 7
HIGHER 8
108) What is the highest grade you completed at that level?
201) Now I would like to ask about all your births you have had during your 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 204)
203) How many sons live with you?
And how many daughters live with you?
IF NONE, RECORD '00'.
DAUGHTERS ELSEWHERE __
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) How many sons are alive but do not live with you?
How many daughters are alive but do not live with you?
IF NONE, RECORD '00'.
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 or showed signs of life but did not survive?
NO 2 (SKIP TO 208)
207) How many boys have died?
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'.
NO (PROBE AND CORRECT 201-208 AS NESSARY)
NO BIRTHS (SKIP 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 BIRTHS IN 212. RECORD TWINS AD 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? RECORD NAME.
(NAME)______________________
213) Were any of these births twins?
MULTIPLE 2
GIRL 2
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?
YEAR ____
NO 2 (GO TO 220)
217) IF ALIVE: How old was (NAME) at his/her last birthday?
RECORD AGE IN COMPLETED YEARS> IF LESS THAN 1 YEAR RECORD '00'
218) IF ALIVE: Is (NAME) living with you?
NO 2
219) IF ALIVE: RECORD HOUSEHOLD LINE NUMBER OF THE CHILD (RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD)
220) IF DEAD: How old was (NAME) when he/she died? IF '1 YEAR', 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 (NMAE OF PREVIOUS BIRTH) and (NAME), including any children who died after birth?
DON'T ASK THIS QUESTION UNTIL SECOND CHILD.
NO 2 (NEXT BIRTH)
222) Have you had any live births since the birth of (NMAE OF LAST BIRTH)? IF YES, RECORD BIRTH(S) IN TABLE.
NO 2
223) COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:
FOR EACH BIRTH SINCE JANUARY 2004: MONTH AND YEAR OF BIRTH ARE RECORDED.
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED.
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED.
FOR AGE AT DEATH 12 MONTHS OR 1 YEAR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS.
224) CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 2004 OR LATER. IF NONE, RECORD '0' AND SKIP TO 226
225) FOR EACH BIRTH SINCE JANUARY 2004 ENTER 'B' IN THE MONTH OF BIRTH IN COLUMN 1 OF THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P'S MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)
NO 2 (SKIP TO 229)
UNSURE 8 (SKIP TO 229)
227) How many months pregnant are you? RECORD NUMBER OF COMPLETED MONTHS. ENTER 'P's IN COLUMN 1 OF THE CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.
228) At the time you became pregnant, did you want to become pregnant then, did you want to wait till later, or did you not want to have any (more) children at all?
LATER 2
NOT AT ALL 3
229) Have you ever had a pregnancy that miscarried, was aborted, or ended in a stillbirth?
NO 2 (SKIP TO 237)
229A) The last time you had such a pregnancy, did the pregnancy end in a miscarriage, an induced abortion or a stillbirth?
INDUCED ABORTION 2
STILL BIRTH 3
230) When did the last such pregnancy end?
YEAR_____
LAST PREGNANCY ENDED BEFORE JANUARY 2004 (SKIP TO 237)
232) How many months pregnant were you when the last such pregnancy ended? RECORD NUMBER OF COMPLETED MONTHS. ENTER 'T' IN COLUMN 1 OF THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.
233) Since January 2004, have you had any other pregnancies that did not result in a live birth?
NO 2 (SKIP TO 235)
233A) Since January 2004, how many other pregnancies that did not result in a live birth have you had?
234) ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2004.
235) Did you have any miscarriages, abortions, or stillbirths that ended before 2004?
NO 2 (SKIP TO 237)
236) When did the last such pregnancy that terminated before 2004 end?
YEAR ____
237) When did your last menstrual period start?
DAYS AGO 1 __
WEEKS AGO 2__
MONTHS AGO 3 __
YEARS AGO 4 __
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996
301) Now I would like to talk about family planning - various ways or methods that a couple can use to delay or avoid a pregnancy.
Which ways or methods have you heard about? FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?
CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302.
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
302) Have you ever used (METHOD)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
AT LEAST ONE "YES" (EVER USED) (SKIP TO 307)
304) Have you ever used anything or tried in any way to delay or avoid getting pregnant?
NO 2
305) ENTER '0' IN COLUMN 1 OF THE CALENDAR IN EACH BLANK MONTH. (SKIP TO 401)
306) What have you used or done? CORRECT 302 AND 303 (AND 301 IF NECESSARY).
307) 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'.
WOMAN STERILIZED (SKIP TO 311A)
PREGNANT (SKIP TO 322)
310) Are you currently doing something or using any method to delay or avoid getting pregnant?
NO 2 (SKIP TO 322)
311) Which method are you using? CIRCLE ALL MENTIONED.
IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.
MALE STERILIZATION B
PILL C (SKIP TO 319A)
IUD D (SKIP TO 319A)
INJECTABLES E (SKIP TO 319A)
IMPLANTS F (SKIP TO 319A)
COMDOM G (SKIP TO 319A)
FEMALE CONDOM H (SKIP TO 319A)
DIAPHRAGM I (SKIP TO 319A)
FOAM/JELLY J (SKIP TO 319A)
LACTATIONAL AMEN. METHOD K (SKIP TO 319A)
PERIODIC ABSTINENCE L (SKIP TO 319A)
WITHDRAWL M (SKIP TO 319A)
OTHER (SPECIFIY) ________ X (SKIP TO 319A)
311A) CIRCLE 'A' FOR FEMALE STERILIZATION
316) In what facility did the sterilization take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
UNIVERSITY HOSPITAL 12
ROYAL MEDICAL SERVICES 13
OTHER PUBLIC (SPECIFY) _________ 16
OTHER PRIVATE MEDICAL(SPECIFY) _________ 26
IF UNABLE TO DETERMINE HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
319) In what month and year was the sterilization performed?
YEAR _______
319A) 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 _______
320) CHECK 319/319A, 215 AND 230:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OR USE OF CONTRACEPTION IN 319/319A
NO
321) CHECK 319/319A: YEAR IS 2004 OR LATER
YEAR IS 2003 OR EARLIER
322) 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 2004.
USE NAMES OF CHILDREN, DATES OR BIRTH, AND PERIODS OR PREGNANCY AS REFERENCE POINTS.
IN COLUMN 1: ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.
When was the last time you used a method? Which method was that?
When did you start using that method? How long after the birth of (NAME)?
How long did you use the method then?
IN COLUMN 2: ENTER CODES FOR DISCONTINUATION NEXT TO LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 2 MUST BE THE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USER 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.
Why did you stop using the (METHOD)?
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:
AND ENTER '0' IN EACH SUCH MONTH IN COLUMN 1
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.
MALE STERILIZATION 02 (SKIP TO 401)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
COMDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMEN. METHOD 11 (SKIP TO 401)
PERIODIC ABSTINENCE 12 (SKIP TO 401)
WITHDRAWL 13 (SKIP TO 401)
OTHER (SPECIFIY) ________ 96 (SKIP TO 401)
322) Where did you obtain (CURRENT METHOD) the last time?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
GOVERNMENT HEALTH CENTER 12 (SKIP TO 401)
GOVERNMENT MCH 13 (SKIP TO 401)
UNIVERSITY HOSPITAL /CLINIC 14 (SKIP TO 401)
ROYAL MEDICAL SERVICES 15 (SKIP TO 401)
OTHER PUBLIC (SPECIFY)________ 16 (SKIP TO 401)
PRIVATE DOCTOR 22 (SKIP TO 401)
PHARMACY 23 (SKIP TO 401)
JORDANIAN AS. OF FP AND PROTECTION (JAFPP) 24 (SKIP TO 401)
UNRWA CLINIC 25 (SKIP TO 401)
OTHER NON-GOVERNMENT ORGANIZATION 26 (SKIP TO 401)
OTHER PRIVATE MEDICAL (SPECIFY) _________ 27 (SKIP TO 401)
OTHER (SPECIFY) ___________ 96 (SKIP TO 401)
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
SECTION 4. PREGNANCY AND POSTNATAL CARE
401) CHECK 224:
NO BIRTHS IN 2004 OR LATER (SKIP TO 601)
402) CHECK 215: ENTER IN THE TABLE THE LINE NUMBER, AND SURVIVAL STATUS OF EACH BIRTH IN 2004 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 the health of all your children born in the last five years. (We will talk about each separately.)
LINE NUMBER ______
LIVING
DEAD
405) At the time you became pregnant with (NAME), did you want to become pregnant then, did you want to wait until later, or did you not want to have any (more) children at all?
LATER 2
NOT AT ALL 3 (SKIP TO 426)
406) How much longer would you have liked to wait?
YEARS 2 _______
DON'T KNOW 998
426) 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
427) Was (NAME) weighed at birth?
NO 2 (SKIP TO 448)
DON'T KNOW 8 (SKIP TO 448)
428) How much did (NAME) weight?
RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.
KG FROM RECALL 2 _.___
DON'T KNOW 99998
448) Has your menstrual period returned since the birth of (NAME)?
NO 2 (SKIP TO 451)
449) Did your period return between the birth of (NAME) and your next pregnancy?
SKIP THIS QUESTION FOR THE LAST BIRTH
NO 2 (SKIP TO 453)
450) For how many months after the birth of (NAME) did you not have a period?
DON'T KNOW 98
451) CHECK 226: IS RESPONDENT PREGNANT?
PREGNANT OR UNSURE (SKIP TO 453)
452) Have you begun to have sexual intercourse again since the birth of (NAME)?
NO 2 (SKIP TO 454)
453) For how many months after the birth of (NAME) did you not have sexual intercourse?
IF LESS THAN 1 MONTH, RECORD '00'.
DON'T KNOW 98
454) Did you ever breastfeed (NAME)?
NO 2 (SKIP TO 465)
455) How long after birth did you first put (NAME) to the breast?
IF LESS THAN 1 HOUR, RECORD '00' HOURS.
IF LESS THAN 24 HOURS, RECORD HOURS.
OTHERWISE, RECORD DAYS.
HOURS 1 ___
DAYS 2 __
456) In the first three days after delivery, was (NAME) given anything to drink other than breast milk?
NO 2 (SKIP TO 458)
457) 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/INFUSIONS H
HONEY I
OTHER(SPECIFY) _______ X
458) CHECK 404: IS THE CHILD LIVING?
DEAD (SKIP TO 460)
459) Are you still breastfeeding (NAME)?
NO 2
460) For how many months did you breastfeed (NAME)?
DON'T KNOW 98
465) GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 601.
SECTION 6. MARRIAGE AND SEXUAL ACTIVITY
601) CHECK 101A:
WIDOWED/SEPARATED/DIVORCED (SKIP TO 606)
602) Is your husband living with you now or is he staying elsewhere?
STAYING ELSEWHERE 2
603) RECORD THE HUSBAND'S NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.
LINE NUMBER __
604) Does your husband have another wife (other wives) besides you?
NO 2 (SKIP TO 606)
605) Including yourself, in total, how many wives does your husband have?
DON'T KNOW 8
606) Have you been married only once or more than once?
MORE THAN ONCE 2
MARRIED ONLY ONCE
MARRIED MORE THAN ONCE
DON'T KNOW MONTH 98
YEAR ____ (SKIP TO 612)
DON'T KNOW YEAR 9998
608) How old were you when you first started living with him?
612) When was the last time you had sexual intercourse?
IN LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS.
IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.
WEEKS AGO 3 ___
MONTHS AGO 2 ___
YEARS AGO 4 ____ (SKIP TO 700)
613) The last time you had sexual intercourse, was a condom used?
NO 2
SECTION 7. FERTILITY PREFERENCES
700) CHECK 101A:
CURRENTLY WIDOWED, DIVORCED, OR SEPARATED (SKIP TO 713)
HE OR SHE STERILIZED (SKIP TO 713)
NOT PREGNANT OR UNSURE
PREGNANT
NO MORE/NONE 2 (SKIP TP 704)
SAYS SHE CAN'T GET PREGNANT 3 (SKIP TP 713)
UNDECIDED/DON'T KNOW AND PREGNANT 4 (SKIP TO 709)
UNDECIDED/ DON'T KNOW AND NOT PREGNANT OR UNSURE 5 (SKIP TO 708)
NOT PREGNANT OR UNSURE
PREGNANT
YEARS 2 __
SOON/NOW 993 (SKIP TO 708)
SAYS SHE CAN'T GET PREGNANT 994 (SKIP TO 713)
OTHER (SPECIFY) ____________ 996 (SKIP TO 708)
DON'T KNOW 998 (SKIP TO 708)
PREGNANT (SKIP TO 709)
705) CHECK 310: USING A CONTRACEPTIVE METHOD?
NOT CURRENTLY USING
CURRENTLY USING (SKIP TO 713)
24 OR MORE MONTHS OR 02 OR MORE YEARS
00-23 MONTHS OR 00-01 YEAR (SKIP TO 709)
WANTS TO HAVE A/ANOTHER CHILD BUT NOT BEFORE 2 YEARS
You have said that you do not want (a/another) child soon, but you are not using any method to avoid pregnancy.
Can you tell me why you are not using a method?
Any other reason?
RECORD ALL REASONS MENTIONED.
WANTS NO MORE/NONE
You have said that you do not want any (more) children, but you are not using any method to avoid pregnancy.
Can you tell me why you are not using a method?
Any other reason?
RECORD ALL REASONS MENTIONED.
INFREQUENT SEX B
MENOPAUSAL/HYSTERECTOMY C
SUBFECUND/INFECUND D
POSTPARTUM AMENORRHEIC E
BREASTFEEDING F
DIFFICULT TO GET PREGNANT G
HUSBAND OPPOSED I
OTHERS OPPOSED J
RELIGIOUS PROHIBITION K
RUMORS L
KNOWS NO SOURCE N
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COSTS TOO MUCH R
INCONVIENT TO USE S
INTERFERES WITH BODY'S NORMAL PROCESSES T
DON'T KNOW Z
708) CHECK 310: USING A CONTRACEPTIVE METHOD?
NO, NOT CURRENTLY USING
YES, CURRENTLY USING (SKIP TO 713)
709) Do you think you will use a contraceptive method to delay or avoid pregnancy at any time in the future?
NO 2 (SKIP TO 711)
DON'T KNOW 8 (SKIP TO 713)
710) Which contraceptive method would you prefer to use?
MALE STERILIZATION 02 (SKIP TO 713)
PILL 03 (SKIP TO 713)
IUD 04 (SKIP TO 713)
INJECTABLES 05 (SKIP TO 713)
IMPLANTS 06 (SKIP TO 713)
COMDOM 07 (SKIP TO 713)
FEMALE CONDOM 08 (SKIP TO 713)
DIAPHRAGM 09 (SKIP TO 713)
FOAM/JELLY 10 (SKIP TO 713)
LACTATIONAL AMEN. METHOD 11 (SKIP TO 713)
PERIODIC ABSTINENCE 12 (SKIP TO 713)
WITHDRAWL 13 (SKIP TO 713)
OTHER (SPECIFIY) ________ 96 (SKIP TO 713)
DK/UNSURE 98 (SKIP TO 713)
711) What is the main reason that you think you will not use a contraceptive method at any time in the future?
MENOPAUSAL/HYSTERECTOMY 12
SUBFECUND/INFECUND 13
WANTS AS MANY CHILDREN AS POSSIBLE 14
HUSBAND OPPOSED 22
OTHERS OPPOSED 23
RELIGIOUS PROHIBITION 24
RUMORS 25
KNOWS NO SOURCE 32
FEAR OF SIDE EFFECTS 42
LACK OF ACCESS/TOO FAR 43
COSTS TOO MUCH 44
INCONVIENT TO USE 45
INTERFERES WITH BODY'S NORMAL PROCESSES 46
DON'T KNOW 98
HAS LIVING CHILDREN
PROBE FOR A NUMERIC RESPONSE.
NO LIVING CHILDREN
PROBE FOR A NUMERIC RESPONSE.
NUMBER _____
OTHER(SPECIFY) ___________ 96 (SKIP TO 811)
714) How many of these children would you like to be boys, how many would you like to be girls and for how many would the sex not matter?
NUMBER OF GIRLS ____
EITHER ___
OTHER(SPECIFY) ______ 96
SECTION 8. HUSBAND'S BACKERGROUND AND WOMAN'S WORK
811) Have you done any work in the last seven days, even for one hour? By "work", I mean any paid work, any work in a business completely or partially owned by yourself, any work in a business owned by the household without payment, or work in other business?
NO 2
812) Do you have any job, but you did not practice it during the last seven days for a reason such as vacation, travel, or illness?
NO 2 (SKIP TP 830)
813) What is your current occupation, that is, what kind of work do you mainly do?
814) What is your employment status: are you an employee, an employer, are you self-employed, are you working for your family without payment, or are you working for someone else without payment?
EMPLOYER 2
SELF-EMPLOYED 3
UNPAID FAMILY WORKER 4
UNPAID WORKER 5
830) Do you smoke: Cigarettes? Nargila?
NO 2
NO 2
MINUTE __
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT RESPONDENT:
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COMMENTS ON SPECIFIC QUESTIONS:
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ANY OTHER COMMENTS:
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NAME OF SUPERVISOR: _____________________
DATE: ____________
_____________________________________________________________________________
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NAME OF EDITOR: ____________________________
DATE:__________
INSTRUCTIONS: ONLY ONE CODE SHOULD APPEAR IN ANY BOX. IN COLUMN 1, ALL MONTHS SHOULD BE FILLED IN.
INFORMATION TO BE CODED FOR EACH COLUMN.
PREGNANCIES P
TERMINATIONS T
NO METHOD 0
FEMALE STERILIZATION 1
MALE STERILIZATION 2
PILL 3
IUD 4
INJECTABLES 5
IMPLANTS 6
CONDOM 7
FAMLE CONDOM 8
DIAPHRAGM 9
FOAM OR JELLY J
LACTATIONAL AMENORRHEA METHOD K
PERIODIC ASTINENCE L
WITHDRAWL M
OTHER(SPECIFY) ________________ X
NOTE: In case of multiple birth which ended with live and non-live birth outcomes record BIRTH to the calendar
BECAME PREGNANT WHILE USING 1
WANTED TO BECOME PREGNANT 2
HUSBAND DISAPPROVED 3
WANTED MORE EFFECTIVE METHOD 4
HEALTH CONCERNS 5
SIDE EFFECTS 6
LACK OF ACCESS/TOO FAR 7
COSTS TOO MUCH 8
INCONVIENT TO USE 9
FATALISTIC F
DIFFICULT TO GET PREGNANT/MENOPAUSAL A
WIDOW/DIVORCE/SEPARATION D
RAMADAN R
OTHER(SPECIFY) _____________ X
DON'T KNOW Z
2009
11 NOV 02 __
10 OCT 03 __
09 SEP 04 __
08 AUG 05 __
07 JUL 06 __
06 JUN 07 __
05 MAY 08 __
04 APR 09 __
03 MAR 10 __
02 FEB 11 __
01 JAN 12 __
2008
11 NOV 14 __
10 OCT 15 __
09 SEP 16 __
08 AUG 17 __
07 JUL 18 __
06 JUN 19 __
05 MAY 20 __
04 APR 21 __
03 MAR 22 __
02 FEB 23 __
01 JAN 24 __
2007
11 NOV 26 __
10 OCT 27 __
09 SEP 28 __
08 AUG 29 __
07 JUL 30 __
06 JUN 31 __
05 MAY 32 __
04 APR 33 __
03 MAR 34 __
02 FEB 35 __
01 JAN 36 __
2006
11 NOV 38 __
10 OCT 39 __
09 SEP 40 __
08 AUG 41 __
07 JUL 42 __
06 JUN 43 __
05 MAY 44 __
04 APR 45 __
03 MAR 46 __
02 FEB 47 __
01 JAN 48 __
2005
11 NOV 50 __
10 OCT 51 __
09 SEP 52 __
08 AUG 53 __
07 JUL 54 __
06 JUN 55 __
05 MAY 56 __
04 APR 57 __
03 MAR 58 __
02 FEB 59 __
01 JAN 60 __
2004
11 NOV 62 __
10 OCT 63 __
09 SEP 64 __
08 AUG 65 __
07 JUL 66 __
06 JUN 67 __
05 MAY 68 __
04 APR 69 __
03 MAR 70 __
02 FEB 71 __
01 JAN 72 __