PREFECTURE (ADMINISTRATIVE CENTER)____
TOWN OR MUNICIPALITY_____
SECTOR___
SUB-SECTOR_____
HOUSEHOLD NUMBER___
RURAL 2
OTHER CITY 2
RURAL 3
NAME AND LINE NUMBER OF HUSBAND_____
LINE NUMBER OF ELIGIBLE WOMEN____
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS
DATE __________
INTERVIEWER NAME__________
RESULT___
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTIALLY COMPLETED
6 OTHER (SPECIFY)____
NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE __________
TIME _____
FINAL VISIT
DAY___
MONTH__________
YEAR _____
NAME__________
RESULT__________
FIELD EDITOR
NAME__________
DATE_____
OFFICE EDITOR
NAME__________
DATE_____
KEYED BY
NAME __________
DATE_____
SECTION 1. RESPONDENT'S BACKGROUND
MINUTE___
102) In what month and year were you born?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 98
103) How old were you at your last birthday?
COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT
104) Have you ever attended school?
NO 2 (GO TO 107)
105) What is the highest level of education that you attended: primary, post-primary, secondary, or higher?
POST-PRIMARY 2
SECONDARY 3
HIGHER 4
106) What is the highest (CLASS, YEAR) you successfully completed at that level?
106A) Did you finish this level (primary post-primary, or secondary school, or higher)?
NO 2
107) What is your main occupation? ___________
PROTESTANT 2
SEVENTH DAY ADVENTIST 3
MUSLIM 4
TRADITIONAL 5
NO RELIGION 6
OTHER 7
TUTSI 2
TWA 3
OTHER 4
110) Now I would like to ask you some questions about marriage: How many spouses/wives do you currently have?
111) Do you intend to take another or other spouses/wives in the future?
NO 2
112) In what month and year did you get married or start living with a woman for the first time?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 98
113) How old were you when you got married or started living with a woman for the first time?
DON'T KNOW AGE 98
201) Now I would like to talk to you about family planning -- the different 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. THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 202, ASK 203 BEFORE PROCEEDING TO THE NEXT METHOD.
202) Have you ever heard of (METHOD)?
READ DESCRIPTION OF EACH 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
203) Have you ever used (METHOD)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
AT LEAST ONE 'YES' (EVER USED) (GO TO 207)
205) Have you ever used anything or tried in any way to delay or avoid a pregnancy?
NO 2
206) What have you done or used?
CORRECT 203, 204, 205 (AND 202 IF NECESSARY)
207) Are you or your spouse(s)/wife/wives currently doing something or using a method to avoid pregnancy?
NO 2 (GO TO 209)
208) What method are you using?
IUD 02 (GO TO 212)
INJECTABLES 03 (GO TO 212)
DIAPHRAGM/FOAM/JELLY 04 (GO TO 212)
CONDOM 05 (GO TO 212)
FEMALE STERILIZATION 06 (GO TO 212)
MALE STERILIZATION 07 (GO TO 212)
NORPLANT 08 (GO TO 212)
PERIODIC ABSTINENCE 09 (GO TO 212)
WITHDRAWAL 10 (GO TO 212)
OTHER (SPECIFY)____ 11 (GO TO 212)
209) Do you or your spouse(s)/wife/wives plan to do something or use a method to avoid pregnancy in the future?
NO 2 (GO TO 211)
DON'T KNOW 3 (GO TO 212)
210) What method would you prefer to use?
IUD 02 (GO TO 212)
INJECTABLES 03 (GO TO 212)
DIAPHRAGM/FOAM/JELLY 04 (GO TO 212)
CONDOM 05 (GO TO 212)
FEMALE STERILIZATION 06 (GO TO 212)
MALE STERILIZATION 07 (GO TO 212)
NORPLANT 08 (GO TO 212)
PERIODIC ABSTINENCE 09 (GO TO 212)
WITHDRAWAL 10 (GO TO 212)
OTHER (SPECIFY)____ 11 (GO TO 212)
NOT SURE 98 (GO TO 212)
211) What is the main reason you do not intend to use a method?
LACK OF INFORMATION 02
PARTNER DISAPPROVES 03
COSTS TOO MUCH 04
SIDE EFFECTS 05
HEALTH PROBLEMS 06
DIFFICULT TO OBTAIN 07
RELIGION 08
OPPOSED TO FAMILY PLANNING 09
FATALISTIC 10
OTHER PEOPLE OPPOSED 11
INFREQUENT SEX 12
WIFE HAS DIFFICULTY GETTING PREGNANT 13
WIFE IN MENOPAUSE/STERILIZED 14
INCONVENIENT 15
NOT MARRIED 16
OTHER (SPECIFY)____ 17
DON'T KNOW 98
212) Do you find it acceptable or not acceptable that information about family planning is provided on the radio and in newspapers?
NOT ACCEPTABLE 2
DON'T KNOW 8
SECTION 3. FERTILITY PREFERENCES
NO 2 (GO TO 303)
302) How many boys do you have? How many girls do you have?
STERILIZED (GO TO 312)
304) Would you like to have (a/another) child or would you prefer to not have any (more) children?
NO MORE/NONE 2
SAYS WIFE CANNOT GET PREGNANT 3
SAYS HE CANNOT HAVE ANY (MORE) CHILDREN 4
UNDECIDED OR DON'T KNOW 8
305) Have you ever talked to your spouse(s)/wife/wives about how many children you would like to have?
NO 2
306) How many times have you spoken with your spouse(s)/wife/wives about this subject in the past 12 months?
ONCE OR TWICE 2
MORE OFTEN 3
308) Do you think your spouse(s)/wife/wives wants the same number of children that you want, more, or fewer than you want? [NOTE: QUESTION IS LISTED AS '308' IN ORIGINAL QUESTIONNAIRE, BUT WAS MOST LIKELY INTENDED TO BE '307']
MORE 2
LESS 3
DON'T KNOW 8
305) Do you think that your spouse(s)/wife/wives approve(s) of couples using a method to avoid getting pregnant? [NOTE: QUESTION IS LISTED AS '305' IN ORIGINAL QUESTIONNAIRE, BUT WAS MOST LIKELY INTENDED TO BE '308']
NO 2
DON'T KNOW 8
309) After childbirth, how long should couples wait before starting to have sexual relations again?
YEARS___ 2
OTHER (SPECIFY)_______________ 996
310) Should a mother wait until she has completely stopped breastfeeding before starting to have sexual relations again, or does it not matter?
DOESN'T MATTER 2
311) In general, do you approve of couples using a method to avoid getting pregnant?
NO 2
312) CHECK 301-302 AND CHECK THE BOX:
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 when 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?
RECORD SINGLE NUMBER OR OTHER ANSWER.
OTHER (SPECIFY) __________
(TO BE FILLED IN AFTER COMPLETING INTERVIEW)
COMMENTS ON RESPONDENT___
COMMENTS ON SPECIFIC QUESTIONS____
ANY OTHER COMMENTS____
NAME OF INTERVIEWER__________
DATE____
SUPERVISOR'S OBSERVATIONS
OBSERVATIONS____
NAME OF TEAM LEADER__________
DATE _____
FIELD EDITOR'S OBSERVATIONS
OBSERVATIONS___
NAME OF FIELD EDITOR__________
DATE_____