PLACE NAME_____
NAME OF HOUSEHOLD HEAD_____
CLUSTER NUMBER_____
HOUSEHOLD NUMBER_____
PROVINCE_____
RURAL 2
LARGE CITY/SMALL CITY/RURAL AREA:
SMALL CITY 2
VILLAGE 3
RURAL AREA 4
NAME AND LINE NO. OF MAN ______
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE_____
INTERVIEWER'S NAME_____
ABSENCE OF QUALIFIED PERSON / NO COMPETENT RESPONDENT 2
POSTPONED 3
REFUSED 4
INCOMPLETE 5
DISABLED 6
OTHER (SPECIFY) _____ 7
NEXT VISIT
DATE_____
TIME_____
FINAL VISIT
DAY______
MONTH______
YEAR 97
NAME______
RESULT______
LANGUAGE OF SURVEY: PORTUGUESE 01
LANGUAGE OF THE INTERVIEW______
WAS IT NECESSARY TO HAVE AN INTERPRETER?
NO 2
SUPERVISOR
NAME_____
DATE_____
FIELD EDITOR
NAME_____
DATE_____
OFFICE EDITOR_____
KEYED BY_____
SECTION 1 RESPONDENT'S BACKGROUND
MINUTES____
102. For most of the time until you were 12 years old, did you live in a city, village or rural area?
VILLAGE 2
RURAL AREA 3
103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
ALWAYS_____ 95 (GO TO 105)
VISITOR____ 96 (GO TO 105)
104. Before you moved here, did you live in a city, village or rural area?
VILLAGE 2
RURAL AREA 3
105. In what month and year were you born?
DOESN'T KNOW MONTH 98
DOESN'T KNOW YEAR 98
106. How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.
107. Have you attended school?
NO 2
107A. Have you attended a literacy course?
NO 2 (GO TO 114)
108. What is the highest level of school you attended?
SECONDARY 2
HIGH SCHOOL 3
HIGHER/ TEACHER PREP 4
TECHNICAL ELEMENTARY 5
TECHNICAL BASIC 6
TECHNICAL ADVANCED 7
109. What is the highest grade/year you completed at that level?
SECONDARY OR HIGHER (GO TO 112)
111. Can you read and understand a letter or newspaper easily, with difficulty, or not at all?
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 113)
112. Do you usually read a newspaper or magazine at least once a week?
NO 2
113. Do you usually listen to a radio every day?
NO 2
114. Do you usually watch television at least once a week?
NO 2
115. Are you currently working?
NO 2
116. Have you done any work in the last 12 months?
NO 2 (GO TO 124)
117. What is your occupation, that is, what kind of work do you mainly do?
DOES NOT WORK IN AGRICULTURE (GO TO 120)
119. Do you work mainly on your own land, on family land, or do you rent land, or do you work on someone else's land?
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
120. Do you do this work for a member of your family, for someone else, or are you self-employed?
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3
121. Do you usually work throughout the year, or do you work seasonally, or only once in a while?
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3
122. During the last 12 months, approximately how many months did you work?
123. How much do you usually earn for this work?
PROBE: Is this by the day, by the week, or by the month?
REGISTER EM 1.000 METICAIS [MOZAMBICAN CURRENCY]
PER DAY 2____
PER WEEK 3____
PER MONTH 5____
OTHER (SPECIFY) ______ 999996
125. What language did you grow up speaking?
Now I would like to ask about all the children you have had/fathered during your life (and if the children are still alive).
201. Do you have any children?
NO 2 (GO TO 206)
202. Do you have any sons or daughters who are now 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'
204. Do you have any sons or daughters that do not live with you?
NO 2 (GO TO 206)
205. How many sons are living somewhere else?
And how many daughters are living somewhere else?
IF NONE RECORD '00'
206. Have you ever had a boy or a girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but survived only a few hours or days?
NO 2 (GO TO 208)
207. How many boys have died?
And how many girls have died?
IF NONE RECORD '00'
208. SUM ANSWERS TO 203, 205 AND 207, AND ENTER TOTAL.
IF NONE RECORD '00'
209. CHECK 208:
Just to make sure that I have this right: you have had in TOTAL _____ children during your life. Is that correct?
NO (PROBE AND CORRECT 201-208 AS NECESSARY)
NO BIRTHS (GO TO 301)
210A. In which month and year was your last child born?
LAST CHILD WAS BORN BEFORE JANUARY 1993 (GO TO 301)
211. When your wife/partner became pregnant of the last child, did you want the child then, or did you want to wait until later, or did you not want to have any more children at all?
LATER 2
NOT WANT MORE CHILDREN 3
Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid pregnancy.
CIRCLE CODE '1' IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY.
THEN PROCEED DOWN COLUMN 302, 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 EACH METHOD WITH CODE '1' OR '2' CIRCLED IN 301 OR 302, ASK 303.
301. Which ways or methods have you heard about?
302. 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
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 3
303. Have you ever had a wife/partner that used (METHOD)?
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) (GO TO 307)
305. Have you or your wife/partner ever used anything or tried in any way to delay or avoid getting pregnant?
NO 2 (GO TO 309)
306. What have you used or done?
CORRECT 303 AND 304 (AND 302 IF NECESSARY).
307. Currently, are you or your wife/partner using a method to avoid pregnancy?
NO 2 (GO TO 309)
308. Which method are you using?
IUD 02 (GO TO 401)
INJECTABLES 03 (GO TO 401)
IMPLANTS 04 (GO TO 401)
DIAPHRAGM, FOAM, JELLY 05 (GO TO 401)
CONDOM 06 (GO TO 401)
FEMALE STERILIZATION 07 (GO TO 401)
MALE STERILIZATION 08 (GO TO 401)
PERIODIC ABSTINENCE 09 (GO TO 401)
WITHDRAWAL 10 (GO TO 401)
OTHER METHODS (SPECIFY) ____ 96 (GO TO 401)
309. What is the main reason you are not using a method of contraception to avoid pregnancy?
NOT HAVING SEX 21
INFREQUENT SEX 22
WOMEN IS MENOPAUSAL/HYSTERECTOMY 23
WOMEN IS INFECUND/STERILE 24
POSTPARTUM/BREASTFEEDING 25
WANTS MORE CHILDREN 26
WOMEN IS PREGNANT 27
RESPONDENT OPPOSED 31
WIFE OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
HEALTH CONCERNS 51
SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
OTHER (SPECIFY) ______96
DOESN'T KNOW 98
401. Are you currently married or living with a woman?
YES, LIVING WITH A WOMAN 2 (GO TO 402A)
NO, NOT IN UNION 3 (GO TO 404)
402. How many wives do you have?
402A. How many women live with you as if they were your wives?
403. RECORD LINE NUMBER OF WIFE (WIVES) ACCORDING THE HOUSEHOLD QUESTIONNAIRE. IF ONE WIFE DOES NOT LIVE IN THE SAME HOUSEHOLD RECORD '00'. THE NUMBER OF BOXES MUST CONTAIN EQUAL NUMBER OF WIVES.
404. Do you currently have a regular sexual partner, an occasional sexual partner, or no sexual partner at all?
OCCASIONAL SEXUAL PARTNER 2
NO SEXUAL PARTNER 3
405. Have you ever been married or lived with a woman?
YES, LIVED WITH A WOMAN 2 (GO TO 407)
NO 3 (GO TO 410)
406. What is your marital status now: are you widowed, divorced, or separated?
DIVORCED 2
SEPARATED 3
407. Have you been married or lived with a woman only once, or more than once?
MORE THAN ONCE 2
MARRIED/LIVED WITH A WOMAN ONLY ONCE: In what month and year did you start living with your wife/partner?
MARRIED/LIVED WITH A WOMAN MORE THAN ONCE: Now we will talk about your first wife/partner. In what month and year did you start living with her?
DOESN'T KNOW MONTH 98
DOESN'T KNOW YEAR 98
409. How old were you when you started living with her?
Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family planning issues.
410. When was the last time you had sexual intercourse (if ever)?
DAYS AGO 1 ____
WEEKS AGO 2 ____
MONTHS AGO 3____
YEARS AGO 4____
KNOWS ABOUT CONDOMS: The last time you had sex, was a condom used?
DOES NOT KNOW ABOUT CONDOMS: Some men use a condom. That is, men can put a rubber sheath on their penis during sexual intercourse. The last time you had sex, was a condom used?
NO 2
412. Do you know of a place where you can get condoms?
NO 2 (GO TO 414)
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.
PROVINCIAL/GENERAL HOSPITAL B
RURAL HOSPITAL C
HEALTH CENTER D
HEALTH POST E
MOBILE CLINIC F
OTHER (SPECIFY) ____ G
PRIVATE PHARMACY I
PRIVATE DOCTOR J
OTHER PRIVATE MEDICAL (SPECIFY) _____ K
TRADITIONAL HEALER M
MEDICAL STAFF IN THE NEIGHBORHOOD N
CURRENTLY MARRIED OR IN MARITAL UNION: In the last 12 months, with how many women besides your wife/partner did you have sexual intercourse?
NO, NOT MARRIED OR IN MARITAL UNION: In the last 12 months, with how many women did you have sexual intercourse?
415. How old were you when you first had sexual intercourse?
FIRST TIME WHEN MARRIED 96
SECTION 5. FERTILITY PREFERENCES
MARRIED OR IN MARITAL UNION (GO TO 503)
HAS AN OCCASIONAL PARTNER (GO TO 503)
DOES NOT HAVE PARTNER (GO TO 505A)
503. Is your wife/partner (or any of your partners) pregnant at this moment?
NO 2 (GO TO 505A)
DOESN'T KNOW/UNSURE 8 (GO TO 505A)
504. At the time your wife/partner became pregnant, did you want her 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 (GO TO 505B)
DOESN'T WANT MORE CHILDREN 3 (GO TO 505B)
505A. WIFE/PARTNER NOT PREGNANT OR UNSURE: Now I have some questions about the future. Would you like to have (a/another) child or would you prefer not to have any (more) children?
NO MORE/NONE 2 (GO TO 507)
WIFE/PARTNER CAN'T GET PREGNANT 3 (GO TO 507)
HE CANNOT HAVE MORE CHILDREN 4 (GO TO 507)
UNDECIDED/DOESN'T KNOW 8 (GO TO 507)
505B. WIFE/PARTNER PREGNANT: Now I have some questions about the future. After the child you and your wife/partner 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 507)
WIFE/PARTNER CAN'T GET PREGNANT 3(GO TO 507)
HE CANNOT HAVE MORE CHILDREN 4 (GO TO 507)
UNDECIDED/DOESN'T KNOW 8 (GO TO 507)
WIFE/PARTNER NOT PREGNANT OR UNSURE: How long would you like to wait from now before the birth of (a/another) child?
WIFE/PARTNER PREGNANT: After the child you are expecting now, how long would you like to wait from now before the birth of another child?
YEARS 2
NOW 993
SAYS SHE CAN'T GET PREGNANT 994
AFTER MARRIAGE 995
OTHER (SPECIFY) ______ 996
DOESN'T KNOW 998
507. CHECK 308:
IS HE CURRENTLY USING A METHOD?
HE IS NOT CURRENTLY USING A METHOD (GO TO 508)
HE IS CURRENTLY USING A METHOD (GO TO 512)
508. Do you think you will use a method to delay or avoid pregnancy within the next 12 months?
NO 2
DOESN'T KNOW 8
509. Do you think you will use a method to delay or avoid pregnancy any time in the future?
NO 2 (GO TO 511)
DOESN'T KNOW 8 (GO TO 511)
510. Which method would you prefer to use?
IUD 02 (GO TO 512)
INJECTABLES 03 (GO TO 512)
IMPLANTS 04 (GO TO 512)
DIAPHRAGM, FOAM, JELLY 05 (GO TO 512)
CONDOM 06 (GO TO 512)
FEMALE STERILIZATION 07 (GO TO 512)
MALE STERILIZATION 08 (GO TO 512)
PERIODIC ABSTINENCE 09 (GO TO 512)
WITHDRAWAL 10 (GO TO 512)
OTHER METHODS (SPECIFY) ______ 96 (GO TO 512)
UNSURE 98 (GO TO 512)
511. What is the main reason that you think you will not use a method?
MENOPAUSAL/HYSTERECTOMY 23
INFECUND/STERILE 24
WANTS MORE CHILDREN 26
WIFE OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
KNOWS NO SOURCE 42
SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COSTS TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
DOESN'T KNOW 98
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?
RECORD A NUMERICAL ANSWER.
OTHER (SPECIFY) ______96 (GO TO 514)
513. How many of these children would you like to be boys, how many would you like to be girls and for how many would it not matter?
OTHER (SPECIFY) ______96
OTHER (SPECIFY) ______96
OTHER (SPECIFY) ______96
514. Would you say that you approve or disapprove of couples using a method to avoid getting pregnant?
DISAPPROVE 2
NO OPINION 3
515. In your opinion, is it acceptable or not acceptable for information on family planning to be provided:
On the radio?
On the television?
NOT ACCEPTABLE 2
DOESN'T KNOW 8
NOT ACCEPTABLE 2
DOESN'T KNOW 8
516. In the last month, have you heard about family planning:
On the radio?
On the television?
In a newspaper or magazine?
From a poster?
From leaflets or brochures?
NO 2
NO 2
NO 2
NO 2
NO 2
518. In the last few months have you discussed the practice of family planning with your friends, neighbors, or relatives?
NO 2 (GO TO 520)
519. With whom? Anyone else?
RECORD ALL MENTIONED.
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER F
MOTHER-IN-LAW G
FRIENDS/NEIGHBORS H
OTHER (SPECIFY) ______X
YES, LIVING WITH A WOMAN (GO TO 521)
NO, NOT IN UNION/SINGLE (GO TO 601)
Spouses/partners do not always agree on everything. Now I want to ask you about your husband's/partner's views on family planning.
521. Do you think that your wife/partner approves or disapproves of couples using a method to avoid pregnancy?
DISAPPROVES 2
DOESN'T KNOW 8
522. How often have you talked to your wife/partner about family planning in the past year?
ONCE OR TWICE 2
MORE OFTEN 3
523. Do you think your wife/partner wants the same number of children that you want, or does she want more or fewer than you want?
MORE CHILDREN 2
FEWER CHILDREN 3
DOESN'T KNOW 8
601. Have you ever heard of an illness called AIDS?
NO 2 (GO TO 611)
602. From which sources of information have you learned most about AIDS? Any other sources?
RECORD ALL MENTIONED.
TELEVISION B
NEWSPAPER OR MAGAZINE C
PAMPHLETS/POSTER D
HEALTH WORKERS E
MOSQUES/CHURCHES F
SCHOOL/TEACHERS G
COMMUNITY MEETINGS/CONFERENCES H
THEATER I
FRIENDS/RELATIVES/PARTNERS J
WORK PLACE K
OTHER (SPECIFY) ______ X
603. Do you know how a person can avoid getting AIDS or the virus that causes AIDS?
NO 2 (GO TO 607)
DOESN'T KNOW 8 (GO TO 607)
604. What can a person do to avoid the risk of contracting AIDS? Any other ways?
RECORD ALL MENTIONED.
ABSTAIN FROM SEX B
USE CONDOMS C
HAVE ONLY ONE PARTNER D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH HOMOSEXUALS F
AVOID BLOOD TRANSFUSIONS G
AVOID INJECTIONS H
AVOID KISSING I
AVOID MOSQUITO BITES J
SEEK PROTECTION FROM TRADITIONAL HEALER K
OTHER (SPECIFY) ______ M
OTHER (SPECIFY) ______ N
DOESN'T KNOW O
607. Is it possible for a healthy-looking person to have the AIDS virus?
NO 2
DOESN'T KNOW 8
608. Do you think that persons with AIDS almost never die from the disease, sometimes die, or almost always die from the disease?
SOMETIMES 2
ALMOST ALWAYS 3
DOESN'T KNOW 8
609. Do you think your chances of getting AIDS are small, moderate, great, or no risk at all?
MODERATE 2
GREAT 3
NOT RISK AT ALL 4
HAS AIDS 5
610. Has your knowledge of AIDS influenced or changed your decisions about having sex or your sexual behavior?
IF YES, PROBE: In what way?
RECORD ALL MENTIONED.
STOPPED ALL SEX B
STARTED USING CONDOM C
RESTRICTED SEX TO ONE PARTNER D
REDUCED NUMBER OF PARTNER E
OTHER (SPECIFY) ______ F
NO CHANGE IN SEXUAL BEHAVIOR G
DOESN'T KNOW H
MINUTES___
TO BE FILLED OUT AFTER COMPLETING INTERVIEW.
COMMENTS ABOUT RESPONDENT_____
COMMENTS ON SPECIFIC QUESTIONS_____
ANY OTHER COMMENTS_____
SUPERVISOR'S OBSERVATIONS_____
NAME____
DATE____
EDITOR'S OBSERVATIONS_____
NAME ____
DATE____