IDENTIFICATION

PLACE NAME_______________
NAME OF HOUSEHOLD____________
PROVINCE ___
URBAN/RURAL

MAJOR CITY/DIVISION/DISTRICT ____
CLUSTER NUMBER _____
HOUSEHOLD NUMBER ____
MAJOR CITY/SMALL CITY, TOWN/VILLAGE

NAME AND LINE NUMBER OF RESPONDENT ____________
NAME AND LINE NUMBER OF FIRST ELIGIBLE WIFE ___________
NAME AND LINE NUMBER OF SECOND ELIGIBLE WIFE ________

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)

DATE __________
INTERVIEWER'S NAME ______
RESULT*

*RESULT CODES

NEXT VISIT:
DATE _____
TIME ______

FINAL VISIT:
DAY ______
MONTH ______
YEAR _____
NAME ________
RESULT _______

TOTAL NUMBER OF VISITS ________

LANGUAGE OF QUESTIONNAIRE

LANGUAGE OF INTERVIEW

NATIVE LANGUAGE OF RESPONDENT

TRANSLATOR USED

FIELD EDITED BY
NAME ______
DATE _________

OFFICE EDITED BY
NAME _________
DATE __________

KEYED BY
NAME ______
DATE ________

KEYED BY ______

SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD THE CURRENT TIME.

102. First I would like to ask some questions about yourself. For most of the time until you were 12 years old, did you live in a city or in a village?

103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?

104. Just before you moved here, did you live in a city or in a village?

105. In what month and year were you born?

106. How old are you in completed years?

107. Have you ever attended school?

108. What is the highest level of school you attended: primary, middle, secondary, or higher?

109. What is the highest class you completed at that level?

110. CHECK 108:

111. Can you read and understand a letter or newspaper easily, with difficulty, or not at all?

112. Can you write a simple letter?

113. Do you usually read a newspaper or magazine at least once a week?

114. Do you usually listen to a radio at least once a week?

115. Do you usually watch television at least once a week?

116. What kind of work do you mainly do?

117. CHECK 116:

118. Do you work mainly on your own land or family land, or do you rent land, or do you work on someone else's land?

SECTION 2: CONTRACEPTION

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 202 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 EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 202, ASK 203-204 BEFORE PROCEEDING TO THE NEXT METHOD.

202. Have you ever heard of (METHOD)?

READ DESCRIPTION OF EACH METHOD

203. Have you ever used (METHOD)?

204. Do you know where a person could go to get (METHOD)?

205. CHECK 203:

206. Have you ever used anything or tried in any way to delay or avoid getting pregnant?

207. What have you used or done?
CORRECT 203-205 (AND 202 IF NECESSARY)

208. Now I would like to ask you about the time when you first did something or used a method to avoid getting pregnant. What method did you use at that time?

209. How many living children did you have at that time if any?

210. CHECK 203(07):

211. Are you and your wife currently doing something or using any method to delay or avoid a pregnancy?

212. What is the main reason you and your wife are not using a method to delay or avoid a pregnancy?

213. Which method are you using?
213A. CIRCLE '07' FOR MALE STERILIZATION

214. Do you know the brand name of the pills your wife is now using?

215. How much does one packet of pills cost you?

216. May I see the package of condoms you are using now?

217. Do you know the brand name of the condoms you are now using?

218. How much does on condom cost you?

219. CHECK 213:

HE/SHE STERILIZED: (Where did the sterilization take place?)
USING ANOTHER METHOD: (Where did you obtain (METHOD) the last time?)

220. How long does it take to travel from your home to this place?

221. Is it easy or difficult to get there?

222. CHECK 213:

223. In what month and year was the sterilization operation performed?

224. For how many months have you been using (CURRENT METHOD) continuously?

225. Do you intend to use a method to delay or avoid a pregnancy at any time in the future?

226. What is the main reason you do not intend to use a method?

227. If the decision were entirely up to you, would you want to use a method to delay or avoid a pregnancy at any time in the future?

228. Do you intend to use a method within the next 12 months?

229. When you use a method, which method would you prefer to use?

230. Where can you get (METHOD MENTIONED IN 229)?

231. Do you know of a place where you can obtain a method of family planning?

232. Where is that?

233. How long does it take to travel from your home to this place?

234. Is it easy or difficult to get there?

235. In the last month, have you heard a message about family planning on:

236. CHECK 235:

237. Do you think that the message you heard was effective or not effective in persuading couples to use family planning?

238. Is it acceptable or not acceptable to you for family planning information to be provided on the radio or television?

SECTION 3: MARRIAGE

301. Do you have any other wives besides (NAME OF FIRST ELIGIBLE WIFE FROM COVER PAGE)?

302. How many other wives do you have?

303. Have you been married only once or more than once?

304. How old were you when you started living with your (first) wife?

305. In what month and year did you start living with her?

306. PRESENCE OF OTHERS AT THIS POINT.

SECTION 4: FERTILITY PREFERENCES

401. How many own sons do you have? And how many own daughters do you have?

402. CHECK 213:

403. Is your wife pregnant now?

404. CHECK 403:

WIFE 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?)

WIFE PREGNANT (Now I have some questions about the future. After the child your wife is expecting, would you like to have another child or would you prefer not to have any more children?

405. Would you prefer your next child to be a boy or a girl or doesn't it matter?

406. How long would you like to wait from now before the birth of (a/another) child?

407. Do you regret that (you/your wife) had the operation not to have any (more) children?

408. Why do you regret it?

409. Given your present circumstances, if you had to do it over again, do you think you would make the same decision to have a sterilization?

410. Do you think that your wife approves or disapproves of couples using a method to avoid pregnancy?

411. How often have you talked to your wife about family planning in the past year?

412. Have you and your wife ever discussed the number of children you would like to have?

413. Do you think your wife wants the same number of children that you want, or does she want more or fewer than you want?

414. How long should a husband and wife wait before starting sexual intercourse after the birth of a baby?

415. Should a mother wait until she has completely stopped breastfeeding before starting to have sexual relations again, or doesn't it matter?

416. In general, do you approve or disapprove of couples using a method to avoid pregnancy?

417. CHECK 401:

NO LIVING CHILDREN (If you could choose exactly the number of children to have in your whole life, how many would that be?)

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?)

418. How many of these children would you like to be boys and how many would you like to be girls?

419. We would like to know how much schooling you expect your children to have. (IF NOT STERILIZED: Consider the children you already have and also any children that you might have in the future.) First, let's talk about sons. What is the highest level of school that you would expect any of your sons to attend?

420. And how about daughters? What is the highest level of schooling that you would expect any of your daughters to attend?

421. What do you think is the ideal age at marriage for boys?

422. And what is the ideal age at marriage for girls?

423. If your wife needed to go to a health clinic or a hospital, could she go by herself or would she need to be accompanied by someone else?

424. RECORD THE CURRENT TIME