(E.P.S.F.-2003)
INDIVIDUAL QUESTIONNAIRE FOR WOMEN
REGION ____
PROVINCE OR PREFECTURE ____
CIRCLE ____
MUNICIPALITY/RURAL MUNICIPALITY ___
OTHER CENTER ___
SURVEY DISTRICT ___
RABAT-CASA/LARGE CITY/SMALL CITY/RURAL
LARGE CITY 2
SMALL CITY 3
RURAL 4
CLUSTER NUMBER ___
HOUSEHOLD NUMBER ___
HOUSEHOLD ADDRESS ___
NAME AND LINE NUMBER OF WOMAN ___
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE ____
INTERVIEWER'S NAME AND CODE AND RESULT
_______________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
7 OTHER (SPECIFY)
NEXT VISIT
DATE _____
TIME _____
FINAL VISIT
DAY _____
MONTH ______
YEAR 200_
TOTAL NUMBER OF VISITS _______
SUPERVISOR
NAME _____
DATE _____
FIELD EDITOR
NAME _____
DATE _____
OFFICE EDITOR ______
KEYED BY ________
SECTION 1. RESPONDENT'S BACKGROUND
101. RECORD THE TIME
MINUTES ____
102. First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in a city, a town, or in the countryside?
LARGE CITY 2
SMALL CITY 3
RURAL 4
103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
IF LESS THAN ONE YEAR, RECORD '00' YEARS.
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)
104. Just before you moved here, did you live in a big city, a small city, a town, or in the countryside?
SMALL CITY 2
TOWN 3
RURAL 4
105. In what month and year were you born?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
106. How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT
107. Have you ever attended school?
NO 2 (GO TO 111)
108. What is the highest level of school you attended: primary, middle or junior high school, high school, or higher education?
PREPARATORY, SECONDARY, 1ST CYCLE 2
SECONDARY/2ND CYCLE 3
HIGHER 4
109. What is the highest grade you completed at that level?
PREPARATORY, SECONDARY OR HIGHER (GO TO 114)
111. Now I would like you to read this sentence to me.
SHOW CARD TO RESPONDENT
IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?
ABLE TO READ ONLY PART OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
112. Have you ever participated in a literacy program or any other program that involves learning to read or write (not including primary school)?
NO 2
CODE '1' CIRCLED (GO TO 115)
114. Do you read a newspaper or magazine almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
115. Do you listen to the radio almost every day, at least once a week, less than once a week, or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
116. Do you watch television almost every day, at least once a week, less than once a week, or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
121. What is your marital status now: are you single, married, divorced, separated, or widowed?
SINGLE 2 (GO TO 300)
WIDOW 3 (GO TO 124)
DIVORCED 4 (GO TO 124)
SEPARATED 5 (GO TO 124)
122. Does your husband have any other wives besides yourself?
NO 2 (GO TO 124)
123. How many other wives does he have?
DON'T KNOW 8
124. How many times have you been married?
ONLY ONE MARRIAGE (GO TO 127)
126. How did your first marriage end?
WIDOWED 2
127. In what month and year did you start living with your (first) husband or partner?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
128. How old were you when you got married (the first time)?
129. Are you and your (first) husband related? I mean, are you originally from the same family?
MATERNAL COUSIN 2
OTHER RELATIVE 3
NO RELATION 4
201. Now I would like to ask about all the births you have had during your life. Have you ever given birth?
NO 2 (GO TO 206)
202. Do you have any sons or daughters to whom you have given birth who are not living with you?
NO 2 (GO TO 204)
203. How many sons live with you? 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 (GO TO 206)
205. How many sons are alive but do not live with you?
And how many daughters are alive but do not live with you?
IF NONE, RECORD '00'
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 (GO TO 208)
207. How many boys have died? 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 (GO 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.
212. What name was given to your (first/next) baby?
213. Were any of these births twins?
MULTIPLE BIRTH 2
214. Is (NAME) a boy or a girl?
GIRL 2
214a. Please give me (NAME)'s civil registration booklet or family registration booklet or birth certificate.
CIVIL REGISTRATION 2
BIRTH CERTIFICATE 3
OTHER 4
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 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 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. (For second and later births) Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?
NO 2
222. Have you had any live births since birth of (NAME OF LAST BIRTH)?
NO 2
223. COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:
FOR EACH BIRTH: YEAR OF BIRTH IS 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 SINCE 1998 OR LATER.
IF NONE, RECORD '0'
225. FOR EACH BIRTH SINCE JANUARY 1995, ENTER B IN THE MONTH OF BIRTH IN COLUMN 1 OF THE CALENDAR. 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.) WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE.
NO 2 (GO TO 229)
UNSURE 3 (GO TO 229)
227. How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.
ENTER 'P'S IN COLUMN 1 OF 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 until 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 (GO TO 237)
230. When did the last such pregnancy end?
YEAR _____
LAST PREGNANCY ENDED BEFORE JAN 1998 (GO TO 237)
232. How many months pregnant were you when the last such pregnancy ended?
RECORD THE NUMBER OF COMPLETED MONTHS. ENTER T IN COLUMN 1 OF CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND P FOR THE REMAINING NUMBER OF COMPLETED MONTHS.
233. Have you ever had any other pregnancies that did not result in a live birth?
NO 2 (GO TO 237)
234. ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 1998.
ENTER T IN COLUMN 1 OF CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND P FOR THE REMAINING NUMBER OF COMPLETED MONTHS.
235. Did you have any pregnancies that terminated before January 1998 that did not result in a live birth?
NO 2 (GO TO 237)
236. When did the last such pregnancy that terminated before January 1998 end?
YEAR _____
237. When did your last menstrual period start?
WEEKS AGO 2 _____
MONTHS AGO 3 ______
YEARS AGO 4 ______
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996 (GO TO 238)
237A. How old were you when you had your first period?
DON'T KNOW/DON'T REMEMBER/UNCERTAIN 98
238. 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 (GO TO 301)
DON'T KNOW 8 (GO TO 301)
239. Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods.
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAD ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY) 6
DON'T KNOW 8
FOR NEVER-MARRIED WOMEN:
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. Do you know or have you ever heard of anything like that?
INTERVIEWER: CIRCLE CODE 1 IN 300 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 300, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED.
300) FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK (METHOD) Have you ever heard of (Method)?
Women can have an operation to avoid having any more children.
NO 2
Men can have an operation to avoid having any more children.
NO 2
Women can take a pill every day to avoid becoming pregnant.
NO 2
Women can have a loop or coil placed inside them by a doctor or a nurse.
NO 2
Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
NO 2
Women can have several small rods placed in their left arm by a doctor or nurse, which can prevent pregnancy for one or more years.
NO 2
Men can put a rubber sheath on their penis before sexual intercourse.
NO 2
Women can place a thin flexible disk in their vagina before intercourse.
NO 2
Women can place a suppository, jelly, or cream in their vagina before intercourse.
NO 2
Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, for her menstrual period not to return.
NO 2
There are only few days of the month when a woman can get pregnant if she has intercourse with her husband. Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
NO 2
Men can be careful and pull out before climax.
NO 2
Have you ever heard of any other ways or methods that women or men can use to avoid pregnancy?
NO 2
300B) If you were married would you use something to delay but not stop pregnancy?
NO 2
DON'T KNOW 8
300C) If you had the choice, how many kids would you have your entire life? How many would you have liked to have?
PROBE FOR A NUMERIC RESPONSE.
OTHER (SPECIFY) _____ 96
300D) Out of this number you chose to have in your entire life, how many boys would you want to have and, how many girls (or does gender not making any difference to you)?
NUMBER OF GIRLS ______
NUMBER OF EITHER _____
OTHER (SPECIFY) ______ 96
300E) Do you approve or disapprove of the idea of men or women doing something to prevent or delay pregnancies?
DISAPPROVE 2
DON'T KNOW/UNSURE 3
300F) During this past month, did you hear or see anything related to family planning:
NO 2
NO 2
NO 2
NO 2
300G) During this past month, did you talk to your friends or neighbors or anyone from your family about using family planning methods?
NO 2
FOR NEVER-MARRIED WOMEN, GO TO 601
FOR EVER-MARRIED WOMEN, ASK:
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. Do you know or have you ever heard of anything like that?
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.
301) FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK (METHOD)
Have you ever heard of (METHOD)?
302) Have you ever used (METHOD)
Women can have an operation to avoid having any more children
NO 2
NO 2
Men can have an operation to avoid having any more children.
NO 2
NO 2
Women can take a pill every day to avoid becoming pregnant.
NO 2
NO 2
Women can have a loop or coil placed inside them by a doctor or a nurse.
NO 2
NO 2
Women can have an injection by a nurse/midwife that stops them from becoming pregnant for one or more months.
NO 2
NO 2
Women can have several small rods placed in their left arm by a doctor, which can prevent pregnancy for 5 years.
NO 2
NO 2
Men can put a rubber sheath on their penis before sexual intercourse so that women do not fell pregnant
NO 2
NO 2
Women can place a sheath in their vagina (female condom) or a thin flexible disk in their vagina before intercourse to prevent pregnancy.
NO 2
NO 2
Women can place a suppository, jelly, or cream in their vagina before intercourse to prevent pregnancy.
NO 2
NO 2
Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, so that her menstrual period does not return.
NO 2
NO 2
Only during few days a month can a woman fell pregnant after sexual intercourse. Every month that a woman is sexually active, she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
NO 2
NO 2
Men can be careful and pull out before climax.
NO 2
NO 2
Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
NO 2
NO 2
AT LEAST ONE YES (USED) (GO TO 307)
304) Have you ever used anything or tried any way to delay or avoid getting pregnant?
NO 2 (GO TO 306)
305) IN COLUMN 1 OF THE CALENDAR, RECORD 0 FOR EACH MONTH LEFT BLANK, THEN CONTINUE TO 329.
306) What have you used or done?
CORRECT 302 AND 303 (AND 301 IF NECESSARY)
307) How many children did you have when you did something or used a method for the first time to delay or avoid getting pregnant?
IF NONE, RECORD '00'
WOMAN/HUSBAND STERILIZED (GO TO 311A)
PREGNANT (GO TO 319)
310) Are you currently doing something or using any method to delay or avoid getting pregnant?
NO 2 (GO TO 318)
311) Which method are you using now?
311A) CIRCLE 'A' FOR FEMALE STERILIZATION
IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD ON LIST
MALE STERILIZATION B
PILL C (GO TO 316A)
IUD D (GO TO 316A)
INJECTABLES E (GO TO 316A)
IMPLANTS F (GO TO 316A)
CONDOM G (GO TO 316A)
DIAPHRAGM H (GO TO 316A)
FOAM/JELLY I (GO TO 316A)
LACTATIONAL AMEN. METHOD J (GO TO 316A)
PERIODIC ABSTINENCE K (GO TO 316A)
WITHDRAWAL L (GO TO 316A)
OTHER (SPECIFY) X _______ (GO TO 316A)
DON'T KNOW X (GO TO 316A)
313) In which facility did your sterilization take place? (has your husband done the sterilization operation?)
IF SOURCE IS HOSPITAL, HEATH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
MATERNITY 12
OTHER PUBLIC (SPECIFY) 16
DOCTOR/MID-WIFE 22
MOROCCAN ASSOCIATION FOR FAMILY PLANNING 23
OTHER PRIVATE MEDICAL (SPECIFY) 26
DON'T KNOW 98
314) CHECK 311:
CODE 'A' CIRCLED:
Before your sterilization operation, were you told that you would not be able to have any (more) children because of the operation?
CODE 'B' CIRCLED:
Before the sterilization operation, was your husband/partner told that he would not be able to have any (more) children because of the operation?
NO 2
DON'T KNOW 8
316) In what month and year was your sterilization (your husband's sterilization) performed?
316a) In what month and year did you start using (CURRENT METHOD) continuously?
PROBE:
(FIRST METHOD CIRCLED IN Q311)
YEAR ____
YEAR IS 1998 OR LATER:
RECORD THE CODE OF THE METHOD USED IN THE LINE OF THE MONTH OF THE INTERVIEW IN COLUMN 1 OF THE CALENDAR AND FOR EACH MONTH BEFORE IT TO THE MONTH WHEN THE METHOD WAS FIRST USED.
YEAR IS 1997 OR BEFORE: RECORD THE CODE OF THE METHOD USED IN THE LINE OF THE MONTH OF THE INTERVIEW IN COLUMN 1 OF THE CALENDAR AND FOR EACH MONTH BEFORE IT UP TO JANUARY 1998.
(GO TO 327)
318) I would like to talk about all the times, you and your husband did something to prevent getting pregnant these past years.
USE THE CALENDAR TO DISTINGUISH PERIODS OF USE FROM PERIODS OF NON-USE, STARTING WITH THE MOST RECENT USAGE, THEN GOING UP TO JANUARY 1998.
USE THE NAMES OF THE CHILDREN, THEIR BIRTHDATES, AND THE PREGNANCY PERIODS AS REFERENCE POINTS.
IN COLUMN 1, FOR EACH MOTH, RECORD THE CODE OF THE METHOD USED, OR 0 IF NO METHOD WAS USED.
ILLUSTRATIVE QUESTION FOR COLUMN 1: What was the last time you did something to prevent pregnancy? What did you do? When did you starting doing that?
IN COLUMN 2, IN THE LINE FOLLOWING THE LAST MONTH OF USAGE OF THE METHOD, RECORD THE DISCONTINUATION CODES.
THE NUMBER OF CODES IN COLUMN 2 SHOULD BE EQUAL TO THE NUMBER OF INTERRUPTIONS OF USAGE OF THE METHOD IN COLUMN 1.
ASK THE RESPONDENT WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY OCCURRED, ASK IF SHE INVOLUNTARILY BECAME PREGNANCY WHILE USING THE METHOD, OR IF SHE VOLUNTARILY STOPPED USING THE METHOD TO BECOME PREGNANT.
ILLUSTRATIVE QUESTION FOR COLUMN 2: How long after childbirth was it (NAME) when you started using this method?
Why did you stop using (this method)?
Did you not get pregnant while using (this method) or did you stop using it to get pregnant or do you have another reason (for stopping it)?
IF SHE VOLUNTARILY STOPPED USING THE METHOD TO BECOME PREGNANT, ASK: How long after stopping this (method) did you get pregnant?
THEN RECORD 0 IN COLUMN 1 FOR EACH OF THESE MONTHS.
NOT CURRENTLY USING (GO TO 329)
320) Where did you first obtain this (CURRENT METHOD) when you start using it?
320A) Where did you learn to use the lactational amenorrhea method; breastfeeding up to 6 months after childbirth, so that your menstrual period does not return (where did you learn the method for counting the days of the cycle, for withdrawal)?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
MATERNITY 12
HEALTH CENTER 13
DISPENSARY 14
HOME VISIT 15
MOBILE UNIT 16
OTHER PUBLIC (SPECIFY) 16
PHARMACY 22
DOCTOR/MID-WIFE 23
MOROCCAN ASSOCIATION FOR FAMILY PLANNING 24
OTHER PRIVATE MEDICAL (SPECIFY) 26
MIDWIFE 32
OTHER (SPECIFY) 96 __________
321)
CHECK 311/311A:
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.
MALE STERILIZATION 02 (GO TO 331)
PILL 03
IUD/INTRAUTERINE DEVICE 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07 (GO TO 328)
DIAPHRAGM 08 (GO TO 325)
FOAM/JELLY 09 (GO TO 325)
LACTATIONAL AMEN. METHOD 10 (GO TO 325)
PERIODIC ABSTINENCE 11 (GO TO 331)
WITHDRAWAL 12 (GO TO 331)
OTHER METHOD 96 (GO TO 331)
322) You obtained (CURRENT METHOD FROM 319) from (SOURCE OF METHOD FROM 313 OR 320)
SOURCE OF THE (CURRENT METHOD)
(METHOD FROM Q 313 OR Q 320)
At that time, were you told about side effects or problems you might have with the (Current method)?
NO 2
323) Were you ever told by a doctor, a nurse or a health planning worker about side effects or problems you might have with the method?
(CURRENT METHOD)
NO 2 (GO TO 325)
324) Were you told what to do if you experienced side effects or problems for using (CURRENT METHOD)?
NO 2
325) CHECK 322:
CODE '1' CIRCLED:
At that time, were you told about other methods of family planning that you could use?
CODE '1' NOT CIRCLED:
When you obtained (CURRENT METHOD) from (SOURCE OF THE METHOD FROM Q 313 OR Q 320) at that time, were you told about other methods of family planning that you could use to delay but not stop pregnancy?
NO 2
326) Were you ever told by a doctor, a nurse or a health planning worker about side effects or problems you might have with the method?
NO 2
327)
CHECK 311/311A
CIRCLE METHOD CODE.
MALE STERILIZATION 02 (GO TO 331)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07
DIAPHRAGM 08
FOAM/JELLY 09
LACTATIONAL AMEN. METHOD 10 (GO TO 331)
PERIODIC ABSTINENCE 11 (GO TO 331)
WITHDRAWAL 112 (GO TO 331)
OTHER METHOD 96 (GO TO 331)
328) Where did you obtain (CURRENT METHOD) the last time?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
MATERNITY 12
HEALTH CENTER 13
DISPENSARY 14
HOME VISIT 15
MOBILE UNIT 16
OTHER PUBLIC (SPECIFY) 16
PHARMACY 22
DOCTOR/MID-WIFE 23
MOROCCAN ASSOCIATION FOR FAMILY PLANNING 24
OTHER PRIVATE MEDICAL (SPECIFY) 26
MIDWIFE 32
OTHER (SPECIFY) 96 _________
329) Do you know of a place where you can obtain a method of family planning?
NO 2
330) Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
MATERNITY B
HEALTH CENTER C
DISPENSARY D
HOME VISIT E
MOBILE UNIT F
OTHER PUBLIC (SPECIFY) G
PHARMACY I
DOCTOR/MID-WIFE J
MOROCCAN ASSOCIATION FOR FAMILY PLANNING K
OTHER PRIVATE MEDICAL (SPECIFY) L _______
MIDWIFE N
OTHER (SPECIFY) X _________
331) In the last 12 months, were you visited by a fieldworker who talked to you about family planning?
NO 2
332) In the last 12 months, have you visited a health facility for checking on your health (or on your children's)?
NO 2 (GO TO 333A)
333) Did any staff member at the health facility speak to you about family planning methods?
NO 2
DOESN'T KNOW PILL(GO TO 333G)
333B) What are all the contraceptive Pill brands you have ever heard of?
PROBE: What is the last brand or other brands you have heard of?
RECORD SPONTANEOUS ANSWERS. RECORD ALL MULTIPLE ANSWERS
IF NECESSARY, ASK FOR THE PACKET OF PILLS USED.
ADEPAL B (GO TO 333G)
MICRODIAL C (GO TO 333G)
STEDIRIL D (GO TO 333G)
GYNOVLAR E (GO TO 333G)
LO-FEMENAL F (GO TO 333G)
OVANON G (GO TO 333G)
NEOGYNON H (GO TO 333G)
MINIDRIL I (GO TO 333G)
MICROGYNON J (GO TO 333G)
DIANE 35 K (GO TO 333G)
MICROVAL L (GO TO 333G)
MILLIGYNON M (GO TO 333G)
EXCLUTON N (GO TO 333G)
OVRETTE O (GO TO 333G)
OTHER (SPECIFY) X ______ (GO TO 333G)
DON'T KNOW Y (GO TO 333G)
333C) If you were to compare the quality or price of the "Hilal" pill, do you believe that the Hilal pill is good, average, bad?
IN THE MIDDLE 2
BAD 3
DON'T KNOW 8
333D) Do you know the store (s) where you can get the Hilal pill?
NO 2 (GO TO 333G)
DON'T KNOW 8 (GO TO 333G)
333E) Where can you find the Hilal pill? What are these stores / locations?
RECORD SPONTANEOUS ANSWERS. RECORD ALL MULTIPLE ANSWERS
MATERNITY B
HEALTH CENTER C
DISPENSARY D
HOME VISIT E
MOBILE UNIT F
OTHER PUBLIC (SPECIFY) G __________
PHARMACY I
DOCTOR/MID-WIFE J
MOROCCAN ASSOCIATION FOR FAMILY PLANNING K
OTHER PRIVATE MEDICAL (SPECIFY) L ________
MIDWIFE N
OTHER (SPECIFY) X __________
333F) How long does it take you to go to this location?
IF THE WOMAN KNOWS SEVERAL PRIVATE SOURCES, ASK HER TO REFER TO THE CLOSEST SOURCE.
DON'T KNOW 998
DOESN'T KNOW INJECTION (GO TO 333M)
333H) What are all the injection brands you have already heard of?
RECORD SPONTANEOUS ANSWERS. RECORD ALL MULTIPLE ANSWERS
DEPO PROVERA B
NORISTERAT C
OTHER (SPECIFY) X
DON'T KNOW Y
333I. If you compare the quality or price of the Hilal injection, do you think the Hilal brand is good, average or bad?
IN THE MIDDLE 2
BAD 3
DON'T KNOW 8
333j) Do you know the stores or the locations where you can find the Hilal pill/injection?
NO 2 (GO TO 333M)
DON'T KNOW 8 (GO TO 333M)
333k) In which places can you find the Hilal pill?
Are there other places?
WHAT ARE THOSE PLACES/LOCATIONS?
SPONTANEOUS RESPONSES
POSSIBLE MULTIPLE RESPONSES
MATERNITY B
HEALTH CENTER C
DISPENSARY D
HOME VISIT E
MOBILE UNIT F
OTHER PUBLIC (SPECIFY) G _________
PHARMACY I
DOCTOR/MID-WIFE J
MOROCCAN ASSOCIATION FOR FAMILY PLANNING K
OTHER PRIVATE MEDICAL (SPECIFY) L _________
MIDWIFE N
OTHER (SPECIFY) X __________
333l) How long does it take you to get to this place?
IF THE WOMAN KNOWS SEVERAL PRIVATE SOURCES, ASK HER TO REFER TO THE CLOSEST SOURCE.
DON'T KNOW 998
DOESN'T KNOW IUD (GO TO 341)
333N) What are all the brands of IUD you have already heard of?
RECORD SPONTANEOUS ANSWERS. RECORD ALL MULTIPLE ANSWERS
COPPER T 380A B (GO TO 341)
NOVA T C (GO TO 341)
GYNE T D (GO TO 341)
MULTILOAD 250 E (GO TO 341)
MULTILOAD 375 F (GO TO 341)
OTHER (SPECIFY) X _______ (GO TO 341)
DON'T KNOW Y (GO TO 341)
333O) If you compare the quality or price of the Hilal IUD, do you think the Hilal IUD is good, average, or bad?
IN THE MIDDLE 2
BAD 3
DON'T KNOW 8
333P) Do you know the stores/locations where you can find the Hilal IUD?
NO 2 (GO TO 333M)
DON'T KNOW 8 (GO TO 333M)
333Q) In which place do you find the Hilal IUD?
Are there other places?
What are those stores/places?
SPONTANEOUS RESPONSES
POSSIBLE MULTIPLE RESPONSES
MATERNITY B
HEALTH CENTER C
DISPENSARY D
HOME VISIT E
MOBILE UNIT F
OTHER PUBLIC (SPECIFY) G _________
PHARMACY I
DOCTOR/MID-WIFE J
MOROCCAN ASSOCIATION FOR FAMILY PLANNING K
OTHER PRIVATE MEDICAL (SPECIFY) L __________
MIDWIFE N
OTHER (SPECIFY) X ________
333r) How long does it take you to get to this place?
IF THE WOMAN KNOWS SEVERAL PRIVATE SOURCES, ASK HER TO REFER TO THE CLOSEST SOURCE.
DON'T KNOW 998
SECTION 3B: FERTILITY PREFERENCES
341) CHECK 311/311A:
HE OR SHE STERILIZED (GO TO 352)
342) CHECK 226:
NOT PREGNANT OR UNSURE
Now, I have some questions about your future pregnancies: Would you like to have (a/another) child or would you prefer not to have any (more) children?
PREGNANT:
Now, I have some questions about your future pregnancies: 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/NONE 2 (GO TO 344)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 354)
AND NOT PREGNANT/UNSURE 5 (GO TO 350)
343) CHECK 226:
NOT PREGNANT OR UNSURE:
How long would you like to wait from now before the birth of (a/another) child?
PREGNANT:
After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?
YEARS 2 ____
SOON/NOW 993 (GO TO 349)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 354)
AFTER MARRIAGE 995 (GO TO 354)
OTHER (SPECIFY) 996 _____ (GO TO 354)
DON'T KNOW 998 (GO TO 354)
PREGNANT (GO TO 350)
345) CHECK 310: USING A CONTRACEPTIVE METHOD?
NOT CURRENTLY USING (GO TO 346)
CURRENTLY USING (GO TO 348)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 347)
00-23 MONTHS OR 00-01 YEAR (GO TO 350)
347) CHECK 342:
WANTS TO HAVE A/ANOTHER CHILD:
You have said that you do not want (a/another) child soon, but you are not using any method to avoid pregnancy. Can you tell me why?
Any other reason?
WANTS NO MORE/NONE:
You have said that you do not want any (more) children, but you are not using any method to avoid pregnancy. Can you tell me why?
Any other reason?
RECORD ALL REASONS MENTIONED.
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
SUBFECUND/INFECUND E
POSTPARTUM AMENORRHEIC F
BREASTFEEDING G
FATALISTIC H
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
KNOWS NO SOURCE N
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COSTS TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY'S NORMAL PROCESSES T
DON'T KNOW Z
348) In the next few weeks, if you discovered that your were pregnant, would that be a big problem, a small problem, or no problem for you?
SMALL PROBLEM 2
NO PROBLEM 3
SAYS SHE CAN'T GET PREGNANT/NOT HAVING SEX 4
349) CHECK 310: USING A CONTRACEPTIVE METHOD?
NO, NOT CURRENTLY USING (GO TO 350)
YES, CURRENTLY USING (GO TO 354)
350) Do you think you will use a contraceptive method to delay or avoid pregnancy at any time in the future?
NO 2 (GO TO 352)
DON'T KNOW 8 (GO TO 352)
351) Which contraceptive method you would prefer to use?
MALE STERILIZATION 02 (GO TO 354)
PILL 03 (GO TO 354)
IUD 04 (GO TO 354)
INJECTABLES 05 (GO TO 354)
IMPLANTS 06 (GO TO 354)
CONDOM 07 (GO TO 354)
DIAPHRAGM 08 (GO TO 354)
FOAM/JELLY 09 (GO TO 354)
LACTATIONAL AMEN. METHOD 10 (GO TO 354)
PERIODIC ABSTINENCE 11 (GO TO 354)
WITHDRAWAL 12 (GO TO 354)
OTHER (SPECIFY) 96 (GO TO 354)
UNSURE 98 (GO TO 354)
352) What is the main reason that you think you will not use a contraceptive method to delay or avoid pregnancy at any time in the future?
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 354)
SUBFECUND/INFECUND 24 (GO TO 354)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (GO TO 354)
HUSBAND/PARTNER OPPOSED 32 (GO TO 354)
OTHERS OPPOSED 33 (GO TO 354)
RELIGIOUS PROHIBITION 34 (GO TO 354)
KNOWS NO SOURCE 42 (GO TO 354)
FEAR OF SIDE EFFECTS 52 (GO TO 354)
LACK OF ACCESS/TOO FAR 53 (GO TO 354)
COSTS TOO MUCH 54 (GO TO 354)
INCONVENIENT TO USE 55 (GO TO 354)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 354)
DON'T KNOW 98 (GO TO 354)
353) Would you ever use a contraceptive method If you were married to delay or avoid pregnancy?
NO 2
DON'T KNOW 8
354) CHECK 216:
Has living children:
If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?
NO LIVING CHILDREN:
If you could choose exactly the number of children to have in your whole life, how many would that be?
PROBE FOR A NUMERIC RESPONSE.
OTHER (SPECIFY) 96 (GO TO 356)
355) Out of the (number) you would choose to have in your whole life, how many of these children would you like to be boys, how many would you like to be girls, or would the sex not matter?
NUMBER OF GIRLS ____
NUMBER OF EITHER ____
OTHER (SPECIFY) 96
356) Would you say that you approve or disapprove of couples using a contraceptive method to avoid getting pregnant?
DISAPPROVE 2
NO OPINION/UNSURE 3
357) In the last few months have you heard or seen anything about family planning?
NO 2
NO 2
NO 2
358) In the last few months, have you discussed the practice of family planning with your friends, neighbors or relatives?
NO 2 (GO TO 360)
359) With whom did you talk?
Anyone else?
RECORD ALL PERSONS MENTIONED
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTERS G
SON G
MOTHER-IN-LAW H
FRIEND(S)/NEIGHBOR(S) I
OTHER (SPECIFY) X _____
NO, NOT IN A UNION (GO TO 367)
NO CODE CIRCLED (GO TO 363)
362) You have told me that you are currently using contraception to delay pregnancy. Would you say that using contraception is mainly your decision, mainly your husband's decision or did you both decide together?
MAINLY HUSBAND 2
MUTUAL DECISION 3
OTHER (SPECIFY) 6 __________
363) Now I would like to ask you about your husband's views on family planning. Do you think that your husband approves or disapproves of couples using a contraceptive method to avoid or delay pregnancy?
DISAPPROVES 2
DON'T KNOW 8
364) How often have you talked to your husband about family planning in the past 12 months?
ONCE OR TWICE 2
MORE OFTEN 3
HE OR SHE STERILIZED (GO TO 367)
366) Do you think your husband wants the same number of children that you want? (boys or girls)
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8
367) As you know, husband and wife 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:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
SECTION 4A. PREGNANCY, POSTNATAL CARE, AND BREASTFEEDING
401) CHECK 224:
NO BIRTHS SINCE JANUARY 1999 (GO TO 487)
402) Now, I would like to ask you some questions about your pregnancies ove the past five years.
ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE 1998. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES).
LINE NUMBER _______
LINE NUMBER _________
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 children at all?
LATER 2
NOT AT ALL 3 (GO TO 407)
406) How much longer would you like to have waited?
YEARS 2 ____
DON'T KNOW 998
407) When you were pregnant with (NAME) did you see anyone for antenatal care?
IF YES: Whom did you see?
Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.
MIDWIFE B
NURSE C
OTHER X
408) How many months pregnant were you with (NAME) when you first received antenatal care for this pregnancy?
DON'T KNOW 98
408a) What was the main reason you sought antenatal care for the first time of this pregnancy with (NAME)?
PROBE FOR THE MOST SIGNIFICANT REASON.
RESERVE FOR BIRTH 02
CHECK TO SEE IF SHE'S PREGNANT 03
FAMILY/OTHER INSISTED 04
ROUTINE 05
ENSURE A HEALTHY PREGNANCY 06
HAD COMPLICATIONS 07
OTHER (SPECIFY) 96 ______
409) How many times did you receive antenatal care during this pregnancy with (NAME)?
DON'T KNOW 98
409A) Did you receive antenatal care the last month of this pregnancy?
NO 2
DON'T KNOW 8
409B) Where did you go to the last time you received antenatal care for this pregnancy with (NAME)?
HEALTH CENTER 02
DISPENSARY 03
CLINIC 04
PRIVATE DOCTOR 05
AT HOME 06 (GO TO 410)
OTHER (SPECIFY) 96 _____
409C) How long did it take you to arrive to the health facility the last time you went for antenatal care?
DON'T REMEMBER 998
409D) Did you walk or did you use a ride (which ride)?
BUS/TAXI 2
PERSONAL CAR 3
OTHER (SPECIFY) 6 ____
409E) When you arrived to the place you receive antenatal care in, how long did you wait before receiving the care?
DON'T REMEMBER 998
410)
CHECK 409: NUMBER OF TIMES RECEIVED ANTENATAL CARE
MORE THAN ONCE OR DON'T KNOW (GO TO 411)
411) How many months pregnant were you the last time you received antenatal care?
DON'T KNOW 98
412) During this pregnancy with (NAME), were any of the following done?
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
413) Were you told about the signs of pregnancy complications?
NO 2 (GO TO 414A)
DON'T KNOW 8 (GO TO 414A)
414) Were you told where to go if you had these complications?
NO 2
DON'T KNOW 8
414A) When you receive antenatal care for this pregnancy, did they give you information about:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
414B) Have you ever had an injection against tetanus?
NO 2 (GO TO 417)
DON'T KNOW 8 (GO TO 417)
414C) How many times have you been given this vaccine?
DON'T KNOW 8
415) During this pregnancy, were you given an injection to prevent the baby from getting tetanus?
NO 2 (GO TO 417)
DON'T KNOW 8 (GO TO 417)
416) During this pregnancy, how many times did you get this injection?
NUMBER OF TIMES ____
DON'T KNOW 8
417) During this pregnancy, were you given or did you buy any iron tablets or iron syrup?
NO 2 (GO TO 419)
DON'T KNOW 8 (GO TO 419)
418) During this pregnancy, how many days total did you take these iron tablets or iron syrup
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.
DON'T KNOW 998
419) During this pregnancy, did you have difficulty with your vision during the daylight?
NO 2
DON'T KNOW 8
420) During this pregnancy, did you suffer from night blindness?
NO 2
DON'T KNOW 8
420A) During this pregnancy, did you ever have vaginal bleeding?
NO 2 (GO TO 421A)
DON'T KNOW 8 (GO TO 421A)
420B) How much blood did you lose: a little, a lot, some?
MODERATE 2
MILD 3
420C) When you bled, was it during the first three months, the second three months or the last three months?
SECOND TRIMESTER 2
THIRD TRIMESTER 3
DON'T KNOW 8
420D) Did you get any treatment or seek advice for the bleeding?
NO 2 (GO TO 421A)
420E) Who gave you this advice or treatment?
Anyone else?
NURSE/MIDWIFE B
PHARMACIST C
MIDWIFE D
MOTHER E
HUSBAND F
OTHER RELATIVE G
TRADITIONAL PRACTITIONER H
OTHER (SPECIFY) X ____________
421A) (NAME) when you were pregnant did you get:
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
NOT A SINGLE YES (GO TO 422E)
422A) Did you get any treatment or seek advice for this problem?
NO 2 (GO TO 422C)
422b) Who gave you this advice or treatment?
Anyone else?
NURSE/MIDWIFE B
PHARMACIST C
MIDWIFE D
MOTHER E
HUSBAND F
OTHER RELATIVE G
TRADITIONAL PRACTITIONER H
OTHER (SPECIFY) X ___________
NO CONVULSIONS (GO TO 422E)
422D) Before pregnancy, did you ever have convulsions?
NO 2
422E) During your pregnancy, did you have difficulty breathing when walking?
NO 2
422F) Now, I would like to talk to you about your childbirth. When your birth contractions became continuous and close to each one, did they last more than 12 hours?
NO 2 (GO TO 422K)
DON'T KNOW 8 (GO TO 422K)
422G) When the birth contractions became severe, did they take you somewhere?
NO 2
DON'T KNOW 8
422H) Did you or people caring for you think that there was a problem with your delivery?
NO 2
DON'T KNOW 8
422I) Did they call someone for this problem?
NO 2 (GO TO 422K)
422J) Who?
IF MORE THAN ONE PERSON, CIRCLE THE MOST QUALIFIED ONE.
NURSE/MIDWIFE 2
MIDWIFE 3
OTHER (SPECIFIY) 6
WAS AT HOSPITAL 8 (GO TO 422K)
422K) When you were having birth contractions or were about to give birth, did you have a fever?
NO 2
DON'T KNOW 8
422L) When you were having birth contractions or after you gave birth, did you have convulsions or did you faint?
NO 2 (GO TO 422Q)
DON'T KNOW 8 (GO TO 422Q)
422M) Did you or the people caring for you think that the convulsions were a problem?
NO 2
DON'T KNOW 8
422N) When you had your convulsions or fainted, did they call someone?
NO 2 (GO TO 422P)
422O) Who?
IF MORE THAN ONE PERSON, CIRCLE THE MOST QUALIFIED ONE.
NURSE/MIDWIFE 2
MIDWIFE 3
OTHER (SPECIFY) 6
WAS AT HOSPITAL 8 (GO TO 422Q)
422P) When you fainted or had convulsions, did they take you somewhere to be cared for?
NO 2
DON'T KNOW 8
422Q) Did you lose a lot of blood when you had birth contractions or when you gave birth?
NO 2 (GO TO 423)
DON'T KNOW 8 (GO TO 423)
422R) Did you or the people caring for you think that there was a problem with the bleeding?
NO 2
DON'T KNOW 8
422S) Did they call someone to help you or treat you for the bleeding?
NO 2 (GO TO 422U)
422T) Who did they call?
IF MORE THAN ONE PERSON, CIRCLE THE MOST QUALIFIED ONE.
NURSE/MIDWIFE 2
MIDWIFE 3
OTHER (SPECIFIY) 6
WAS AT HOSPITAL 8 (GO TO 423)
422U) When you bled a lot, did they take you somewhere to get treated?
NO 2
DON'T KNOW 8
422V) Did anyone do anything to lessen the bleeding or stop it?
NO 2
DON'T KNOW 8
423) When (NAME) was born, was he/she very large, small or average?
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DON'T KNOW 8
424) Was (NAME) weighed at birth?
NO 2 (GO TO 426)
DON'T KNOW 8 (GO TO 426)
425) How much did (NAME) weigh?
GRAMS FROM RECALL 2 __________
DON'T KNOW 9998
426) Who assisted you with the delivery of (NAME)?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSON ASSISTING.
IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.
NURSE/MIDWIFE B
RELATIVE(S)/FRIEND(S)
NO ONE Y
427) Where did you give birth to (NAME)?
OTHER HOME 12 (GO TO 428A)
HEALTH CENTER 22
OTHER PUBLIC (SPECIFY) 26 _________
OTHER PRIVATE MEDICAL 36
428) Was (NAME) delivered naturally or by caesarean section?
FORCEPS/VACUUM 2 (GO TO 428D)
CESAREAN 3
428A) Did they tell you why they did the surgery?
NO 2 (GO TO 428D)
DON'T KNOW 8
POSITIONED CROSSWAYS 02 (GO TO 428D)
NARROW PELVIS 03 (GO TO 428D)
UTERINE RUPTURE 04 (GO TO 428D)
UTERINE MUSCLES NOT WORKING/CAN'T PUSH 05 (GO TO 428D)
FETUS SICK/SLOW HEARTBEAT 06 (GO TO 428D)
BABY LATE 07 (GO TO 428D)
PREVIOUS CESAREAN 08 (GO TO 428D)
OTHER (SPECIFY) 96 (GO TO 428D)
428C) Why did you not go to the hospital or the clinic to deliver?
SERVICE NOT AVAILABLE 2
EXPENSIVE 3
BORN PREMATURELY/SUDDEN DELIVERY 4
OTHER (SPECIFY) 6 _________
428D) How did they cut the umbilical cord?
ORDINARY SCISSORS 2
RAZORBLADE 3
KNIFE 4
OTHER (SPECIFY) 6
DON'T KNOW 8
428E) How did you treat (NAME's) umbilical cord?
POWDERED COFFEE 2
FLOUR 3
MUD 4
OTHER (SPECIFY) 6
DON'T KNOW 8
428F) Was there a problem with the placenta?
NO 2
DON'T KNOW 8
428G) When you gave birth to (NAME) had you been pregnant for 9 months, less, or more than 9 months?
BEFORE 9 MONTHS 2
AFTER 9 MONTHS 3
DON'T KNOW 8
429) When (NAME) was born, did a doctor or a nurse check on your health?
NO 2 (GO TO 432B)
430) How many days or weeks after the delivery did the first check take place?
RECORD '00' DAYS IF SAME DAY.
WEEKS AFTER DELIVERY 2 _________
DON'T KNOW 998
431) Who checked on your health at that time?
PROBE FOR THE MOST QUALIFIED PERSON.
NURSE/MIDWIFE 12
OTHER (SPECIFY) 96 __________
432) Where did the check take place?
OTHER HOME 12
HEALTH CENTER 22
OTHER PUBLIC (SPECIFY) 26
OTHER PRIVATE MEDICAL 36
432A) When they checked on your health, did they:
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
432B) What was the main reason you didn't you go for a check on your health after delivery?
WITH EXPERIENCE 02
DOESN'T KNOW IMPORTANCE 03
SERVICE NOT AVAILABLE 04
COSTS TOO MUCH 05
TOO BUSY 06
HUSBAND BUSY 07
OTHER REASONS (SPECIFY) 96 __________
433) In the first two months after delivery, did you receive a vitamin 'A' dose like this?
Show capsule/gel caps/syrup.
NO 2
433A) During the first six weeks after giving birth, did you have an hemorrhage?
NO 2 (GO TO 433D)
433B) How long after the delivery did you get the hemorrhage?
1 TO 7 DAYS 2
OVER 7 DAYS 3
433C) When you had the hemorrhage, did a doctor, a nurse or a midwife give you medication or advice?
NO 2
433D) During the first six weeks after delivery, did your feet swell (edema)?
NO 2 (GO TO 433F)
433E) Did a doctor, a nurse or a midwife give you any medication or advice for this edema and pain?
NO 2
433F) Did you have a fever during the first six month after delivery?
NO 2 (GO TO 433I)
433G) When you had the fever, did you:
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
433H) Did you get any medication or advice from a doctor, a nurse or midwife for this problem?
NO 2
NOT A SINGLE NO (GO TO 434)
433J) Why did not you get medication or advice when (you had the hemorrhage), or when (your feet swelled), or when (you had fever)?
EXPERIENCED 02
DOESN'T KNOW IMPORTANCE 03
SERVICE NOT AVAILABLE 04
COSTS TOO MUCH 05
TOO BUSY 06
HUSBAND BUSY 07
OTHER REASONS (SPECIFY) 96 ___________
434) Has your period returned since the birth of (NAME)?
NO 2 (GO TO 437)
436) For how many months after the birth of (NAME) did you not have a period?
DON'T KNOW 98
437)
CHECK 226:
RESPONDENT PREGNANT?
PREGNANT OR NOT SURE (GO TO 439)
438) Have you resumed sexual relations since the birth of (NAME)?
NO 2 (GO TO 443A)
439) How many months after the birth of (NAME) did you not have sexual relations?
DON'T KNOW 98
440) Did you ever breastfeed (NAME)?
NO 2 (GO TO 443A)
441) 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 __________
442) In the first three days after delivery, before your milk began flowing regularly, was (NAME) given anything to drink other than breast milk?
NO 2 (GO TO 444)
443) What was (NAME) given to drink before your milk began flowing regularly?
Anything else?
PROBE:
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 ___________
443A) Why did you not breastfeed (NAME)?
CHILD SICK 02
CHILD REFUSED 03
MOTHER SICK 04
NO MILK/NOT ENOUGH MILK 05
PROBLEM WITH NIPPLE/BREAST 06
MOTHER WORKS 07
OTHER (SPECIFY) 96 __________
(GO TO 447)
444) CHECK 404:
Is child living?
DEAD (GO TO 446)
445) Are you still breastfeeding (NAME)?
NO 2
446) For how many months did you breastfeed (NAME)?
DON'T KNOW 98
446A) What was the primary reason you stopped breastfeeding him/her?
CIRCLE THE CODE FOR THE PRIMARY REASON
NO MILK/NOT ENOUGH MILK 02
CHILD SICK 03
CHILD REFUSED 04
CHILD DECEASED 05 (GO TO 447)
MOTHER SICK 06
GOT PREGNANT 07
WANTS ANOTHER CHILD 08
WANTS TO USE THE PILL 09
WENT BACK TO WORK 10
PREFERS BOTTLE 11
OTHER (SPECIFY) 96 __________
446B) When you decided to stop breastfeeding (NAME), did you suddenly stop or did you do it gradually?
SLOWLY 2
446C) When you decided to stop breastfeeding (NAME), did you give him/her something hot or sour?
NO 2
447) CHECK 404:
Is child living?
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 454.)
448) How many times did you breastfeed (NAME) last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.
449) How many times did you breastfeed (NAME) yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.
449A) Do you breastfeed (NAME) on demand or do you breastfeed him/her on a schedule?
FIXED TIMES 2
BOTH 3
450) Did (NAME) drink anything from a bottle with a nipple during the day yesterday or last night?
NO 2
DON'T KNOW 8
451) Was sugar added to any of the foods or liquids (NAME) ate yesterday?
NO 2
DON'T KNOW 8
452) How many times did (NAME) eat semisolid or solid foods yesterday during the day or at night?
IF 7 OR MORE, RECORD 7.
DON'T KNOW 8
452A) Who prepares the food of (NAME)?
MAID 2
OTHER (SPECIFY) 6
MAID 2
OTHER (SPECIFY) 6
453) GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 454.
SECTION 4B. IMMUNIZATION AND HEALTH
454) ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE 1998. ASK THE QUESTION FOR ALL BIRTHS. START WITH THE MOST RECENT BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMNS OF ADDITIONAL QUESTIONNAIRES).
LINE NUMBER ______
LINE NUMBER ________
DEAD (GO TO 456 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 484)
457) Did (NAME) receive a vitamin A dose like this during the last 6 months?
NO 2
DON'T KNOW 8
458) Now, I would like to talk to you about (NAME'S) health.
Do you have a card where (NAME'S) vaccinations are written down?
IF YES: May I see it please?
YES, NOT SEEN 2 (GO TO 462)
NO CARD 3
459) Did you ever have a vaccination card for (NAME)?
NO 2 (GO TO 462)
460) 1) COPY VACCINATION DATES 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
MONTH ___
YEAR ___
MONTH ___
YEAR ___
MONTH ___
YEAR ___
MONTH ___
YEAR ___
MONTH ___
YEAR ___
MONTH ___
YEAR ___
MONTH ___
YEAR ___
MONTH ___
YEAR ___
MONTH ___
YEAR ___
MONTH ___
YEAR ___
461) Has (NAME) received any vaccinations that are not recorded on this card?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 1-3, DPT 1-3, MEASLES, AND/OR HEPATITIS B.
NO 2 (GO TO 465A)
DON'T KNOW 8 (GO TO 465A)
462) Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases?
Including vaccinations received in a national immunization day campaign?
NO 2 (GO TO 465A)
DON'T KNOW 8 (GO TO 465A)
463) Please tell me if (NAME) received any of the following vaccinations:
463A) A BCG vaccination against tuberculosis, that is, an injection in the shoulder that usually causes a scar?
NO 2
DON'T KNOW 8
463B) Polio vaccine, that is, drops in the month?
NO 2 (GO TO 463BB)
DON'T KNOW 8 (GO TO 463BB)
463BA) How many times did (NAME) receive a vaccination against Polio?
463BB) The vaccine against diphtheria, whooping cough, tetanus?
NO 2 (GO TO 463C)
DON'T KNOW 8 (GO TO 463C)
463BC) How many times did (NAME) receive a vaccination against diphtheria, whooping cough and tetanus?
463C) Vaccination against Measles?
NO 2
DON'T KNOW 8
463D) Vaccination against Hepatitis?
NO 2
DON'T KNOW 8
465A) Has (NAME) ever suffered from:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
466) Has (NAME) been ill with a fever at any time in the last 2 weeks?
NO 2
DON'T KNOW 8
467) Has (NAME) had an illness with a cough at any time in the last 2 weeks?
NO 2 (GO TO 469)
DON'T KNOW 8 (GO TO 469)
467A) Has (NAME) had an illness with a cough at any time in the last 24 hours?
NO 2
DON'T KNOW 8
467B) The last time he/she had an illness with a cough, how long did it last?
IF LESS THAN A DAY, RECORD 00.
DON'T KNOW 98
468) When (NAME) had an illness with a cough, did he/she breathe faster than usual?
NO 2
DON'T KNOW 8
469)
CHECK 466 AND 467:
FEVER OR COUGH?
OTHER (GO TO 475)
470) When (NAME) had an illness with a cough (or fever), did you seek advice or treatment for the fever/cough?
NO 2 (GO TO 471C)
471) Where did you seek advice or treatment?
Anywhere else?
RECORD ALL MENTIONED
HEALTH CENTER B
DISPENSARY C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) F
PHARMACY H
PRIVATE DOCTOR I
OTHER PRIVATE MEDICAL (SPECIFY) J
MIDWIFE L
COURT/CHURCH M
TRADITIONAL PRACTITIONER N
RELATIVE(S)/FRIEND(S) O
OTHER (SPECIFY) X __________
471A) Did they give you anything to treat him/her from the cough/fever?
NO 2 (GO TO 475)
DON'T KNOW 8 (GO TO 475)
471B) What did they give you to treat him/her for the cough/fever?
PROBE: DID THEY GIVE YOU SOMETHING ELSE?
ANTIBIOTIC (PILLS/SYRUP) B
COUGH SYRUP C
OTHER (PILLS/SYRUP) D
DON'T KNOW PILLS/SYRUP E
HOME REMEDY/ HERBAL REMEDY F
OTHER (SPECIFY) X __________
(GO TO 475)
471C) Why did not you ask for treatment or sought advice to treat him/her for the cough/fever?
HAD A PREVIOUS EXPERIENCE 02
MOTHER BUSY 03
FATHER BUSY 04
DIDN'T HAVE ANYONE TO WATCH THE CHILDREN 05
LOCATION TOO FAR/NOT AVAILABLE 06
OTHER (SPECIFY) 96 _________
475) Has (NAME) had diarrhea in the last 2 weeks?
NO 2 (GO TO 483)
DON'T KNOW 8 (GO TO 483)
475A) Has (NAME) had diarrhea in the last 24 hours?
NO 2
DON'T KNOW 8
475B) How long did (NAME) have diarrhea?
IF LESS THAN ONE DAY, RECORD 00
DON'T KNOW 98
475C) Was the cough accompanied with blood?
NO 2
DON'T KNOW 8
NOT BREASTFEEDING (GO TO 476)
475E) When (NAME) had a cough, did you change the number of times you breastfed him/her?
Did you increase, decrease, or completely stopped breastfeeding him/her?
INCREASE 2
DECREASE 3
STOPPED BREASTFEEDING 4
DON'T KNOW 8
476) Now I would like to know how much (NAME) was offered to drink during during the diarrhea. Was he/she offered less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was he/she offered 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
477) When (NAME) had diarrhea, was he/she offered less than usual solid food, about the same amount, more than usual?
IF LESS, PROBE: Was he/she offered much more 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
478) Was he/she given any of the following to drink:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
479) Was anything (else) given to treat the diarrhea?
NO 2 (GO TO 481)
DON'T KNOW 8 (GO TO 481)
480) What was he/she given to treat the diarrhea?
Anything else?
RECORD ALL TREATMENTS GIVEN.
INJECTION B
(IV) INTRAVENOUS C
PLANTS, BREWS D
OTHER (SPECIFY) X ___________
481) When (NAME) had diarrhea, did you seek advice or treatment for the diarrhea?
NO 2 (GO TO 483)
482) Where did you seek advice or treatment to treat (NAME)?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
(NAME OF PLACE) ____________
Anywhere else?
RECORD ALL PLACES MENTIONED.
HEALTH CENTER B
DISPENSARY C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) F ______
PHARMACY H
PRIVATE DOCTOR I
OTHER PRIVATE MEDICAL (SPECIFY) J _______
TRADITIONAL PRACTITIONER L
RELATIVE(S)/FRIEND(S) M
OTHER (SPECIFY) X ___________
483) GO BACK TO 456 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 484.
484) CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 1998 OR LATER LIVING WITH THE RESPONDENT
NONE (GO TO 487)
485) What is usually done to dispose of (NAME OF YOUNGEST BOY OR GIRL'S) stools when he/she does not use any toilet facility?
THROW IN THE TOILET/LATRINE 02
THROW OUTSIDE THE DWELLING 03
THROW OUTSIDE THE YARD 04
BURY IN THE YARD 05
RINSE AWAY 06
USE DISPOSABLE DIAPERS 07
USE WASHABLE DIAPERS 08
NOT DISPOSED OF 09
OTHER (SPECIFY) 96 __________
486) CHECK 475A, 478A IN ALL COLUMNS:
ANY CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 488)
487) Have you ever heard of salt packets you can get for the treatment of diarrhea?
NO 2
HAS NO CHILDREN LIVING WITH HER (GO TO 490)
489) When (one of your children) is seriously ill, can you decide by yourself whether or not the child should be taken for medical treatment?
IF SAYS NO CHILD EVER SERIOUSLY ILL, ASK: If one of your children is ill, can you decide by yourself whether or not the child should be taken for medical treatment?
NO 2
DEPENDS 3
490) 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 or not?
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
HAS AT LEAST ONE CHILD BORN IN 1998 OR LATER AND LIVING WITH HER: RECORD THE NAME OF YOUNGEST CHILD LIVING WITH HER (AND CONTINUE TO 492)
DOES NOT HAVE ANY CHILDREN BORN IN 1998 OR LATER AND LIVING WITH HER: (GO TO 501)
492) How many times yesterday, during the day or night, did you give (NAME) something to drink of the following?
IF 7 OR MORE TIMES, RECORD 7
IF DON'T KNOW, RECORD 8
493) How many times yesterday during the day or night did you give (NAME) something to eat of the following:
IF 7 OR MORE TIMES, RECORD 7.
IF DON'T KNOW, RECORD 8.
SECTION 5. CHRONIC MORBIDITY AND REPRODUCTIVE HEALTH
501) Now, I would like to talk to you about your health and some health issues women may suffer from.
How would you rate your health: good, average or poor?
GOOD 2
NEUTRAL 3
POOR 4
VERY POOR 5
OTHER (SPECIFY) 6 ______
502) Is your health now better or the same in comparison with last year?
THE SAME 2
WORSE 3
OTHER (SPECIFY) 6 ____
THE FOLLOWING TABLE CONTAINS QUESTIONS REGARDING ILLNESSES. ASK QUESTION 502 STARTING WITH THE FIRST ILLNESS. IF THE RESPONSE IS YES, GO TO QUESTIONS 504-506 BEFORE MOVING TO THE NEXT ILLNESS.
503) Did you ever suffer from:
NO 2 (GO TO NEXT ILLNESS)
NO 2 (GO TO NEXT ILLNESS)
NO 2 (GO TO NEXT ILLNESS)
NO 2 (GO TO NEXT ILLNESS)
NO 2 (GO TO NEXT ILLNESS)
NO 2 (GO TO NEXT ILLNESS)
NO 2 (GO TO NEXT ILLNESS)
NO 2 (GO TO NEXT ILLNESS)
NO 2 (GO TO NEXT ILLNESS)
NO 2 (GO TO NEXT ILLNESS)
NO 2 (GO TO NEXT ILLNESS)
NO 2 (GO TO NEXT ILLNESS)
NO 2
ANSWER FOR EACH ILLNESS WITH A POSITIVE RESPONSE:
504) Was it a doctor or nurse who told you that you had (ILLNESS)?
NO 2
505) How old were you when you heard about (ILLNESS) the first time?
DON'T KNOW 98
506) Are you now being treated for (ILLNESS)?
NO 2
507) Do you have or ever had a cancer?
NO 2 (GO TO 511)
508) Which type of cancer do you have (or used to have)?
DON'T KNOW 98
509) How old were you when they told you the first time that you had cancer?
DON'T KNOW 98
510) Are you now taking any medication against cancer?
NO 2
511) Now, I would like to talk to you about some women's health issues. Because of pregnancy, some women feel as if a weight is coming out of their body or as if the baby is going is coming out. Have you ever experienced this feeling?
NO 2 (GO TO 516)
512) When did you feel that for the first time?
IF LESS THAN ONE YEAR, RECORD 00
DON'T KNOW 98
513) Does this feeling lessen, is about the same, or increase when you laugh, sneeze or lift something heavy?
FEWER 2
MORE 3
514) Have you ever taken any medication or sought advice regarding this problem?
Who gave you the advice or the medication?
Who else?
HEALTH CENTER B
DISPENSARY C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) F _______
PHARMACY H
PRIVATE DOCTOR I
OTHER PRIVATE MEDICAL (SPECIFY) J ____________
MIDWIFE L
COURT OR CHURCH M
TRADITIONAL PRACTITIONER N
RELATIVE(S)/FRIEND(S) O
OTHER (SPECIFY) X __________
515) Why did not you seek advice or take medication for this problem?
PROBE: Was there another reason?
COSTS TOO MUCH B
SERVICE NOT AVAILABLE C
TOO BUSY D
HUSBAND TOO BUSY E
ISN'T VERY SERIOUS F
EMBARRASSED G
WAS AFRAID H
OTHER (SPECIFY) X ___________
516) Some women suffer from urinary incontinence; did you ever suffer from this issue, especially when you laugh, sneeze, or lift something heavy?
NO 2 (GO TO 519A)
517) Did you seek advice or treatment for this problem?
IF YES:
Who did you see?
Someone else?
HEALTH CENTER B (GO TO 519A)
DISPENSARY C (GO TO 519A)
MOBILE CLINIC D (GO TO 519A)
FIELDWORKER E (GO TO 519A)
OTHER PUBLIC (SPECIFY) F ________ (GO TO 519A)
PHARMACY H (GO TO 519A)
PRIVATE DOCTOR I (GO TO 519A)
OTHER PRIVATE MEDICAL (SPECIFY) J ____________ (GO TO 519A)
MIDWIFE L (GO TO 519A)
COURT OR CHURCH M (GO TO 519A)
TRADITIONAL PRACTITIONER N (GO TO 519A)
RELATIVE(S)/FRIEND(S) O (GO TO 519A)
NONE Y (GO TO 519A)
518) Why did not you ask for treatment or advice for this problem?
PROBE:
Was there another reason?
COSTS TOO MUCH B
SERVICE NOT AVAILABLE C
TOO BUSY D
HUSBAND TOO BUSY E
ISN'T VERY SERIOUS F
EMBARRASSED G
WAS AFRAID H
OTHER (SPECIFY) X ____________
519A) Did you suffer from burning urination these last 3 months?
NO 2
519B) Did you have any abnormal genital discharge these past 3 months?
NO 2 (GO TO 521)
520A) Did your genital discharge these past 3 months caused genital itching that only ended with your delivery?
NO 2
520B) Did your genital discharge have a foul smell?
NO 2
520C) Did your genital discharge cause any pain in your lower belly?
NO 2
NOT A SINGLE YES (GO TO 524)
522) Did you seek advice or treatment for this problem?
IF YES: Who did you see?
Someone else?
HEALTH CENTER B (GO TO 524)
DISPENSARY C (GO TO 524)
MOBILE CLINIC D (GO TO 524)
FIELDWORKER E (GO TO 524)
OTHER PUBLIC (SPECIFY) F _________ (GO TO 524)
PHARMACY H (GO TO 524)
PRIVATE DOCTOR I (GO TO 524)
OTHER PRIVATE MEDICAL (SPECIFY) J _________ (GO TO 524)
MIDWIFE L (GO TO 524)
COURT OR CHURCH M (GO TO 524)
TRADITIONAL PRACTITIONER N (GO TO 524)
RELATIVE(S)/FRIEND(S) O (GO TO 524)
NONE Y (GO TO 524)
523) Why did not you seek advice or treatment for this problem?
PROBE: Was there another reason?
COSTS TOO MUCH B
SERVICE NOT AVAILABLE C
TOO BUSY D
HUSBAND TOO BUSY E
ISN'T VERY SERIOUS F
EMBARRASSED G
WAS AFRAID H
OTHER (SPECIFY) X ___________
PREGNANT (GO TO 537)
NO LONGER HAS HER PERIOD (GO TO 537)
NOT CURRENTLY MARRIED (GO TO 533A)
526A) CHECK 310: USES A CONTRACEPTIVE METHOD?
NOT CURRENTLY USED (GO TO 527)
CURRENTLY USED (GO TO 533A)
527) Have you tried getting pregnant and could not?
NO 2 (GO TO 533A)
528) How many months have you tried getting pregnant?
NUMBER OF YEARS 2 ________
529) What would you think is the reason you could not get pregnant?
STERILE 2
ILLNESS 3
HUSBAND ILL 4
OTHER (SPECIFY) 6 __________
DON'T KNOW 8
530) Did you seek advice or treatment for this problem?
IF YES: Whom did you see?
Anyone else?
RECORD ALL MENTIONED
HEALTH CENTER B (GO TO 532)
DISPENSARY C (GO TO 532)
MOBILE CLINIC D (GO TO 532)
FIELDWORKER E (GO TO 532)
OTHER PUBLIC (SPECIFY) F _________ (GO TO 532)
PHARMACY H (GO TO 532)
PRIVATE DOCTOR I (GO TO 532)
OTHER PRIVATE MEDICAL (SPECIFY) J _________ (GO TO 532)
MIDWIFE L (GO TO 532)
COURT OR CHURCH M (GO TO 532)
TRADITIONAL PRACTITIONER N (GO TO 532)
RELATIVE(S)/FRIEND(S) O (GO TO 532)
NONE Y (GO TO 532)
531) Why did not you seek advice or treatment for this problem?
PROBE: Was there another reason?
RECORD ALL MENTIONED
COSTS TOO MUCH B
SERVICE NOT AVAILABLE C
TOO BUSY D
HUSBAND TOO BUSY E
ISN'T VERY SERIOUS F
EMBARRASSED G
WAS AFRAID H
OTHER (SPECIFY) X __________
532) Did your husband seek advice or treatment for this problem?
IF YES: Who did he see?
Anyone else?
RECORD ALL MENTIONED
HEALTH CENTER B
DISPENSARY C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) F _________
PHARMACY H
PRIVATE DOCTOR I
OTHER PRIVATE MEDICAL (SPECIFY) J ________
MIDWIFE L
COURT OR CHURCH M
TRADITIONAL PRACTITIONER N
RELATIVE(S)/FRIEND(S) O
NONE Y
DON'T KNOW Z
533A) Did you have any problem with your menstrual periods these past 3 months: having them last for over 7 days?
NO 2
533B) Did you have any problem with your menstrual periods these past 3 months: having a hemorrhage?
NO 2
533C) Did you have any problem with your menstrual periods these past 3 months: having painful periods?
NO 2
533D) Did you have any problem with your menstrual periods these past 3 months: not having them on schedule?
NO 2
NOT A SINGLE YES (GO TO 537)
535) Did you seek advice or treatment for this problem?
IF YES:
Who did you see?
Anyone else?
RECORD ALL MENTIONED
HEALTH CENTER B (GO TO 537)
DISPENSARY C (GO TO 537)
MOBILE CLINIC D (GO TO 537)
FIELDWORKER E (GO TO 537)
OTHER PUBLIC (SPECIFY) F _________ (GO TO 537)
PHARMACY H (GO TO 537)
PRIVATE DOCTOR I (GO TO 537)
OTHER PRIVATE MEDICAL (SPECIFY) J __________ (GO TO 537)
MIDWIFE L (GO TO 537)
COURT OR CHURCH M (GO TO 537)
TRADITIONAL PRACTITIONER N (GO TO 537)
RELATIVE(S)/FRIEND(S) O (GO TO 537)
NONE Y (GO TO 537)
536) Why did not you seek advice or treatment for this problem?
PROBE: Is there another reason?
RECORD ALL MENTIONED
COSTS TOO MUCH B
SERVICE NOT AVAILABLE C
TOO BUSY D
HUSBAND TOO BUSY E
ISN'T VERY SERIOUS F
EMBARRASSED G
WAS AFRAID H
OTHER (SPECIFY) X ___________
537) Now, I would like to talk to you about your treatment in general? When you have a health issue or need to get a treatment, where do you usually go to get treated?
RECORD ALL MENTIONED
HEALTH CENTER B
DISPENSARY C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) F __________
PHARMACY H
PRIVATE DOCTOR I
OTHER PRIVATE MEDICAL (SPECIFY) J ___________
MIDWIFE L
COURT OR CHURCH M
TRADITIONAL PRACTITIONER N
RELATIVE(S)/FRIEND(S) O
NONE Y
DON'T KNOW/NOT SURE Z
SECTION 6. AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS
601) Now, I would like talk to you about another subject. Have you ever heard of an illness called AIDS?
NO 2 (GO TO 617)
602) Is there anything a person can do to avoid getting AIDS virus?
NO 2 (GO TO 609)
DON'T KNOW 8 (GO TO 609)
603) What can a person do?
Anything else?
RECORD ALL MENTIONED
USE CONDOMS B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER C
LIMIT NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH PERSONS WHO INJECT DRUGS INTRAVENOUSLY H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID SHARING RAZORS/BLADES K
AVOID KISSING L
AVOID MOSQUITO BITES M
SEEK PROTECTION FROM TRADITIONAL PRACTITIONER N
OTHER (SPECIFY) W ______
OTHER (SPECIFY) X __________
DON'T KNOW Z
604) Can people reduce their chances of getting AIDS virus by having just one sex partner who is not ill?
NO 2
DON'T KNOW 8
605) Can people get the AIDS virus from mosquito bites?
NO 2
DON'T KNOW 8
606) Can people reduce their chances of getting AIDS virus by using a condom every time they have sex?
NO 2
DON'T KNOW 8
607) Can people get the AIDS virus by sharing food with a person who has AIDS?
NO 2
DON'T KNOW 8
609) Is it possible for a healthy looking person to have the AIDS virus?
NO 2
DON'T KNOW 8
610) Do you know someone personally who has the virus that causes AIDS or someone who died of AIDS?
NO 2
611) Can the virus that causes AIDS be transmitted from a mother to a child?
NO 2 (GO TO 613)
DON'T KNOW 8 (GO TO 613)
612) Can the virus that causes AIDS be transmitted from a mother to a child:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO, NOT MARRIED (GO TO 615)
614) Have you ever talked with your husband/the man you are living with about ways to prevent getting the virus that causes AIDS?
NO 2
615) If a member of your family got infected with the virus that causes AIDS, would you want it to remain a secret or not?
NO 2
DON'T KNOW/DEPENDS 8
616) If a member of yours became sick with the virus that causes AIDS, would you be willing to care for her or him in your own household?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
617) Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?
NO 2 (GO TO 701)
618) If a man has a sexually transmitted disease, what symptoms might he have?
Any other symptoms?
GENITAL DISCHARGE B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
LOSS OF WEIGHT K
IMPOTENCE L
OTHER (SPECIFY) W ______
OTHER (SPECIFY) X _______
NO SYMPTOMS Y
DON'T KNOW Z
619) If a woman has a sexually transmitted disease, what symptoms might she have?
Other symptoms?
GENITAL DISCHARGE B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
LOSS OF WEIGHT K
INABILITY TO GIVE BIRTH L
OTHER (SPECIFY) W ________
OTHER (SPECIFY) X __________
NO SYMPTOMS Y
DON'T KNOW Z
SECTION 7. HUSBAND'S BACKGROUND AND WOMAN'S WORK
701) CHECK 501 AND 502:
FORMERLY MARRIED (GO TO 703)
NEVER MARRIED (GO TO 707)
702) How old is your (last) husband now?
703) Did your (last) husband /partner ever attend school?
NO 2 (GO TO 706)
704) What was the highest level of school he attended: primary, secondary, or higher?
PREPARATORY, SECONDARY 1ST CYCLE 2
SECONDARY/2ND CYCLE 3
HIGHER 4
DON'T KNOW 8 (GO TO 706)
705) What was the highest (grade/form/year) he completed at that level?
DON'T KNOW 8
706) CHECK 701:
CURRENTLY MARRIED:
What is your husband/partner's occupation?
That is, what kind of work does he mainly do?
FORMERLY MARRIED:
What was your (last) husband/partner's occupation?
That is, what kind of work does he mainly do?
707) Now, I would like to ask you about your work. Aside from your own housework, are you currently working?
NO 2
708) 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.
Are you currently doing any of these things or any other work?
NO 2
709) Have you done any work in the last 12 months?
NO 2 (GO TO 719)
710) What was your occupation these last 12 months, that is, what kind of work did you mainly do?
DOES NOT WORK IN AGRICULTURE (GO TO 713)
712) Do you work mainly on your own land or on family land, or do you work on a land that you rent from someone else, or do you work on someone's else land?
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
713) Do you do this work for a member of you family, for someone else, or are you self-employed?
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3
714) Do you usually work at home or away from home?
AWAY 2
715) Do you usually work throughout the year, or do you work seasonally, or only one in a while?
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3
716) How are you paid for this work?
CASH AND KIND 2
IN KIND ONLY 3 (GO TO 719)
NOT PAID 4 (GO TO 719)
717) Who mainly decides how the money you earn will be used?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
718) On average, how much of your household's expenditures do your earning pay for: almost none, less than half, about half, more than half, or all?
LESS THAN HALF 2
ABOUT HALF 3
MORE THAN HALF 4
ALL 5
NONE, HER INCOME IS ALL SAVED 6
719) Who in your family usually has the final say on the following decisions:
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
720) 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
721) Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations?
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
801) Now, I would like to talk to you about your siblings from your biological mother, the ones living with you, those who live elsewhere, and those who died.
How many living children did your mother have in total, including you?
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 815)
803) How many boys and girls did your mother have before having you?
804) What's the name of your first born and second born brother or sister?
1, 2, 3, THROUGH CHILD 12
FEMALE 2
NO 2 (GO TO 808)
DON'T KNOW 8 (GO TO NEXT)
808) How long has it been since (NAME) died?
809) How old was (NAME) when he/she died?
IF MALE OR FEMALE DIED BEFORE 12 YEARS OF AGE, GO TO NEXT SIBLING.
810) Was she pregnant when (NAME) died?
NO 2
811) Did (NAME) die while delivering?
NO 2
812) Did (NAME) die the first two months of giving birth or after miscarriage?
NO 2
813) How many times total did (NAME) get pregnant before dying of that pregnancy?
813A) From what did (NAME) die?
813B) Where did she die (NAME)?
MATERNITY 2
BIRTHING HOUSE 3
PUBLIC HOSPITAL 4
CLINIC 5
OTHER 6
INSTRUCTIONS:
ONLY ONE CODE SHOULD APPEAR IN EACH BOX
COLUMN 1 AND 2 REQUIRES A CODE IN EVERY MONTH.
CODES TO RECORD IN EACH COLUMN.
COLUMN 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE**
B BIRTH
P PREGNANCIES
T TERMINATIONS
0 NO METHOD
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 PILL
4 IUD
5 INJECTABLES
6 IMPLANTS
7 CONDOM
8 DIAPHRAGM
9 FOAM OR JELLY
J LACTATIONAL AMENORRHEA METHOD
K RHYTHM METHOD
L WITHDRAWAL
X OTHER (SPECIFY)
COLUMN 2: DISCONTINUATION OF CONTRACEPTIVE USE
0 INFREQUENT SEX/HUSBAND AWAY
1 BECAME PREGNANT WHILE USING
2 WANTED TO BECOME PREGNANT
3 HUSBAND DISAPPROVED
4 WANTED MORE EFFECTIVE METHOD
5 HEALTH CONCERNS
6 FEAR OF SIDE EFFECTS
7 LACK OF ACCESS/TOO FAR
8 COSTS TOO MUCH
9 INCONVENIENT TO USE
F UP TO GOD/FATALIST
A DIFFICULT TO GET PREGNANT/MENOPAUSAL
D MARITAL DISSOLUTION/SEPARATION
X OTHER (SPECIFY)
Z DON'T KNOW
04
02 FEB 01
01 JAN 02
02 FEB 0
01 JAN 4
2003
12 DEC 03
11 NOV 04
10 OCT 05
09 SEPT 06
08 AUG 07
07 JUL 08
06 JUN 09
05 MAY 10
04 APR 11
03 MAR 12
02 FEB 13
01 JAN 14
12 DEC
11 NOV
10 OCT
09 SEPT
08 AUG
07 JUL
06 JUN
05 MAY
04 APR
03 MAR
02 FEB
01 JAN
2002
12 DEC 15
11 NOV16
10 OCT 17
09 SEPT 18
08 AUG 19
07 JUL 20
06 JUN 21
05 MAY22
04 APR 23
03 MAR 24
02 FEB 25
01 JAN 26
[DATES CONTINUE IN THIS PATTERN THROUGH 1998]
MINUTES ________
INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT RESPONDENT: ___________
COMMENTS ON SPECIFIC QUESTIONS: ___________
ANY OTHER COMMENTS: ____________
SUPERVISOR'S OBSERVATIONS ___________
NAME OF SUPERVISOR ____________
DATE ____________
EDITOR'S OBSERVATIONS _____________
NAME OF EDITOR ____________
DATE __________