HUSBAND'S QUESTIONNAIRE
CIRCLE
MUNICIPALITY:
RURAL COMMUNE
CENTER
PRIMARY UNIT NUMBER
SECONDARY UNIT NUMBER
LEVEL:
LARGE CITY 2
CITY 3
COUNTRYSIDE 4
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE
INTERVIEWER NAME
RESULT*
NO HOUSEHOLD MEMBER AT HOME OR COMPETENT RESPONDENT IN HOUSEHOLD AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY)_________ 9
NEXT VISIT: (FOR INTERVIEWERS 1 AND 2)
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT
NO HOUSEHOLD MEMBER AT HOME OR COMPETENT RESPONDENT IN HOUSEHOLD AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY)_________ 9
TOTAL NUMBER OF VISITS
TOTAL PERSONS IN HOUSEHOLD___
TOTAL ELIGIBLE WOMEN___
TOTAL ELIGIBLE MEN___
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE
SUPERVISOR
NAME
FIELD EDITOR
NAME
OFFICE EDITOR
KEYED BY
SECTION 1. RESPONDENT'S SOCIO-DEMOGRAPHIC CHARACTERISTICS
MINUTES____
102) In what month and what year were you born?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 98
103) How old were you at your last birthday?
COMPARE AND CORRECT 102 AND/OR 103 IF INCORRECT
104) Have you ever attended school?
NO 2 (GO TO 107)
105) What is the highest level of school you attended: primary, secondary, or higher
SECONDARY 2
HIGHER 3
106) What is the highest (GRADE/FORM/YEAR) you completed at this level?
107) What type of work do you mainly do?
108) Are you currently a single, married, widowed, or divorced?
MARRIED 2
WIDOWED 3 (GO TO 111)
DIVORCED 4 (GO TO 111)
109) How many spouses do you currently have?
110) Do you intend to take on another (other) wife (wives) in the future?
NO 2
111) In what month and year were you married for the first time?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 98
112) How old were you when you were married for the first time?
DON'T KNOW AGE 98 (GO TO 201)
200A) Now I would like to talk about family planning-the various ways or methods that a couple can use to delay or avoid a pregnancy. Which ways or methods have you heard about?
CIRCLE CODE 1 IN 200B FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED.
THEN, FOR THE CONDOM WITH CODE 1 OR 2 CIRCLED IN 200B, ASK 200C BEFORE GOING TO NEXT METHOD.
200b) Have you ever heard of (METHOD)?
YES, DESCRIPTION 2
NO 3
YES, DESCRIPTION 2
NO 3
YES, DESCRIPTION 2
NO 3
YES, DESCRIPTION 2
NO 3
YES, DESCRIPTION 2
NO 3
NO 2
YES, DESCRIPTION 2
NO 3
YES, DESCRIPTION 2
NO 3
YES, DESCRIPTION 2
NO 3
YES, DESCRIPTION 2
NO 3
YES, DESCRIPTION 2
NO 3
AT LEAST ONE 'YES' (EVER USED) (GO TO 207)
205) Have you or your wife (any of your wives) ever used anything or tried in any way to delay or avoid getting pregnant?
NO 2 (GO TO 210)
206) What have you done or used?
OTHER (GO TO 301)
208) Are you or your wife (any of your wives) currently doing something or using any method to delay or avoid getting pregnant?
NO 2 (GO TO 210)
209) Which method are you using?
IUD 02 (GO TO 301)
INJECTABLES 03 (GO TO 301)
DIAPHRAGM/FOAM/GEL 04 (GO TO 301)
CONDOM 05 (GO TO 301)
FEMALE STERILIZATION 06 (GO TO 301)
MALE STERILIZATION 07 (GO TO 301)
PERIODIC ABSTINENCE 08 (GO TO 301)
WITHDRAWAL 09 (GO TO 301)
OTHER (SPECIFY) 10 (GO TO 301)
210) Do you or your wife (any of your wives) intend to use a contraceptive method to delay or avoid pregnancy at any time in the future?
NO 2
DON'T KNOW 8 (GO TO 301)
211) What is the main reason you do not intend to use a method?
LACK OF KNOWLEDGE 02
HUSBAND OPPOSED 03 [##translator note: the original French does have "husband" here]
COST TOO MUCH 04
SIDE EFFECTS 05
HEALTH CONCERNS 06
HARD TO GET METHODS 07
RELIGION 08
OPPOSED TO FAMILY PLANNING 09
FATALISTIC 10
OTHER PEOPLE OPPOSED 11
INFREQUENT SEX 12
DIFFICULT TO GET PREGNANT 13
MENOPAUSE/STERILIZED 14
INCONVENIENT 15
OTHER (SPECIFY) 16
DON'T KNOW 98
212) Which method would you prefer?
IUD 02
INJECTABLES 03
DIAPHRAGM/FOAM/GEL 04
CONDOM 05
FEMALE STERILIZATION 06
MALE STERILIZATION 07
PERIODIC ABSTINENCE 08
WITHDRAWAL 09
OTHER (SPECIFY) 10
SECTION 3: FERTILITY PREFERENCES
NO 2 (GO TO 303)
302) How many boys do you have? How many girls do you have?
NUMBER OF GIRLS ______
STERILIZED (GO TO 309)
304) Would you like to have (another) child, or would you prefer not have any (more) children?
NO MORE CHILDREN/NONE 2
SAYS WIFE CAN'T GET PREGNANT 3
SAYS HE CANNOT HAVE ANY (MORE) CHILDREN 4
NOT DECIDED/DON'T KNOW 8
305) Do you think your wife/(wives) approves or disapproves of couples using a contraceptive method to avoid pregnancy?
NO 2
DON'T KNOW 8
306) How often have you talked to your wife/(wives) about family planning in the last twelve months?
ONCE OR TWICE 2
MORE OFTEN 3
307) Have you discussed with your wife/(wives) the number of children you'd like to have?
NO 2
308) Do you think that your wife/(wives) wants (want) the same number of children that you want, or does she want more or fewer than you want?
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8
309) Are you for or against family planning information to be provided on the radio or on television?
AGAINST/BAD 2
DON'T KNOW 8
310) In general, do you approve of couples who use a method to avoid pregnancy?
NO 2
311) CHECK 108, 301-302 AND TICK THE BOX:
RECORD SINGLE NUMBER OR OTHER ANSWER
OTHER ANSWER (SPECIFY) 96
OTHER ANSWER (SPECIFY) 96
INTERVIEWER'S OBSERVATIONS (TO BE FILLED IN AFTER COMPLETING INTERVIEW)
DATE: