PLACE NAME (COMMUNE/VILLAGE) _____
NAME OF HEAD OF HOUSEHOLD_____
CLUSTER NUMBER______
HOUSEHOLD NUMBER_____
REGION_____
RURAL 2
LARGE CITY (THIES, KAOLACK, ZIGUINCHOR, SAINT-LOUIS, DIOURB) 2
CITY (OTHER COMMUNES) 3
COUNTRYSIDE (RURAL) 4
NAME/LINE NUMBER OF ELIGIBLE WIVES
FIRST VISIT (REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE_____
INTERVIEWER NAME_____
RESULT___
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTIALLY FILLED OUT
6 ILL/INCAPACITATED
7 OTHER (SPECIFY) _____
NEXT VISIT
DATE_____
TIME_____
FINAL VISIT
DAY_____
MONTH_____
YEAR _____
INTERVIEWER_____
RESULT_____
SUPERVISOR
NAME______
DATE______
FIELD EDITOR
NAME_____
DATE_____
OFFICE EDITOR_____
KEYED BY_____
SECTION 1. SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENT
MINUTES_____
102. In which month and in which year were you born?
DOESN'T KNOW MONTH 98
DOESN'T KNOW YEAR 98
103. How old are you currently?
COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT
NO 2 (GO TO 108)
105. What is the highest level of school you attended: primary, secondary or superior?
SECONDARY 2
SUPERIOR 3
106. What is the last (year/grade) that you achieved at this level?
SECONDARY OR MORE (GO TO 109)
108. Can you read and understand a letter or a newspaper easily, with difficulty or not at all?
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 110)
109. Do you read a newspaper or magazine at least once a week?
NO 2
NO 2 (GO TO 112)
POULAR 2
SERERE 3
MANDINGUE/SOCE/MALINKE 4
DIOLA 5
OTHERS (SPECIFY) _____6
112. What is your occupation, that is to say, what kind of work do you do?
113. Are you currently married?
NO 2
114. Are you celibate, widowed, divorced, separated or do you live in union with someone?
WIDOWED 2 (GO TO 116)
DIVORCED 3 (GO TO 116)
SEPARATED 4 (GO TO 116)
CELIBATE 5 (GO TO 201)
115. How many wives/partners do you have?
FIVE OR MORE 5
116. Do you intend to have (an)other wife/wives in the future?
NO 2
117. How old were you when you were married/began to live with someone for the first time?
118. In which month in and which year were you married/did you begin to live with someone for the first time?
DOESN'T KNOW MONTH 98
DOESN'T KNOW YEAR 98
Now I would like to talk to you 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?
201. CIRCLE CODE '1' ON LINE 202 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN CONTINUE DOWN THE COLUMN READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE '2' IF THE METHOD IS RECOGNIZED AND CODE '3' IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE '1' OR '2' CIRCLED IN 202, ASK 203 BEFORE GOING ON TO THE NEXT QUESTION.
202. Have you ever heard of (METHOD)?
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
NO 3 (GO TO 204)
NO 2
DOESN'T KNOW 8
NO 2
DOESN'T KNOW 8
NO 2
DOESN'T KNOW 8
NO 2
DOESN'T KNOW 8
NO 2
DOESN'T KNOW 8
NO 2
NO 2
NO 2
NO 2
DOESN'T KNOW 8
NO 2
NO 2
DOESN'T KNOW 8
AT LEAST ONE "YES" (EVER USED) (GO TO 207)
205. Have you ever used anything or tried in any way to delay or avoid pregnancy?
NO 2 (GO TO 209)
206. What did you do or use?
CORRECT 203-204 (AND 202 IF NECESSARY), THEN GO TO 207.
207. Are you or your wife/wives/partner(s) currently using a method to avoid getting pregnant?
NO 2 GO TO 209
208. What method(s) are you using?
IUD 02 (GO TO 301)
INJECTIONS 03 (GO TO 301)
IMPLANTS 04 (GO TO 301)
DIAPHRAGM/FOAM/JELLY 05 (GO TO 301)
CONDOM 06 (GO TO 301)
CONDOM/SPERMICIDES 07 (GO TO 301)
FEMALE STERILIZATION 08 (GO TO 301)
MALE STERILIZATION 09 (GO TO 301)
RHYTHM METHOD 10 (GO TO 301)
WITHDRAWAL 11 (GO TO 301)
OTHER (SPECIFY) ____12 (GO TO 301)
DOESN'T KNOW 98
209. Do you and your wife/wives/partner(s) intend to use a method avoid or delay pregnancy in the future?
NO 2
DOESN'T KNOW 8 (GO TO 301)
210. What is the main reason why you do not intend to use a method?
LACK OF INFORMATION 02 (GO TO 301)
PARTNER DISAPPROVES 03 (GO TO 301)
COSTS TOO MUCH 04 (GO TO 301)
SIDE EFFECTS 05 (GO TO 301)
HEALTH CONCERNS 06 (GO TO 301)
DIFFICULT TO OBTAIN 07 (GO TO 301)
RELIGION 08 (GO TO 301)
OPPOSES FAMILY PLANNING/CONTRACEPTION 09 (GO TO 301)
FATALISTIC 10 (GO TO 301)
OTHERS DISAPPROVE 11 (GO TO 301)
INFREQUENT SEX 12 (GO TO 301)
DIFFICULTY BECOMING PREGNANT 13 (GO TO 301)
MENOPAUSAL/HYSTERECTOMY 14 (GO TO 301)
INCONVENIENT 15 (GO TO 301)
NOT MARRIED 16 (GO TO 301)
OTHER (SPECIFY) ____ 17 (GO TO 301)
DOESN'T KNOW 98 (GO TO 301)
211. Do you intend to use a method in the next 12 months?
NO 2
DOESN'T KNOW 8
212. When you use a method, what method would you prefer to use?
IUD 02
INJECTIONS 03
IMPLANTS 04
DIAPHRAGM/FOAM/JELLY 05
CONDOM 06
CONDOM/SPERMICIDES 07
FEMALE STERILIZATION 08
MALE STERILIZATION 09
RHYTHM METHOD 10
WITHDRAWAL 11
OTHER (SPECIFY) _____12
DOESN'T KNOW 98
SECTION 3. FERTILITY PREFERENCES
301. Do you have any living biological children?
NO 2 (GO TO 303)
302. How many boys do you have?
How many girls do you have?
STERILIZED (GO TO 306)
NOT MARRIED/NOT LIVING IN UNION (GO TO 310)
305. Would you like to have (a/another) child, or would you prefer not to have (other) children at all?
NO MORE/NONE 2
SAYS HIS WIFE CANNOT GET PREGNANT 3
SAYS HE CANNOT HAVE CHILDREN 4
NOT SURE/DOESN'T KNOW 8
306. Do you think that your partner(s)/wife/wives approve/s or disapprove/s of using methods to avoid pregnancy?
DISAPPROVES 2
DOESN'T KNOW 8
307. How many times during the past year did you speak with your partner(s)/wife/wives about family planning?
ONCE OR TWICE 2
MORE OFTEN 3
308. Have you discussed the number of children you would like to have with your partner(s)/wife/wives?
NO 2
309. Do you think that your partner(s)/wife/wives want(s) the same number of children that you want, or does/do she/they want more of fewer than you want?
MORE CHILDREN 2
FEWER CHILDREN 3
DOESN'T KNOW 8
310. Do you approve or disapprove of providing information about family planning on the radio or on television?
DISAPPROVES 2
NO OPINION 8
311. Would you say that you approve or disapprove of couples that use a method to avoid getting pregnant?
DISAPPROVES 2
NO OPINION 8
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 RESPONSE (SPECIFY) _____96
401. Do you know that there are sexually transmitted diseases?
NO 2 (GO TO 410)
402. Which sexually transmitted diseases do you know of?
CIRCLE THE CODES CORRESPONDING TO ALL MENTIONED.
GONORRHEA/CANCROID/ HOT URINE B
AIDS C
OTHER (SPECIFY) ____D
DOESN'T KNOW E
403. In your opinion, can sexually transmitted diseases be prevented?
NO 2 (GO TO 406)
DOESN'T KNOW 8 (GO TO 406)
404. Do you know a/any way(s) to prevent sexually transmitted diseases?
NO 2 (GO TO 406)
405. What way(s) of prevention do you know?
CIRCLE THE CORRESPONDING CODES FOR THE RESPONSES GIVEN.
LOYALTY TO PARTNERS B
CONDOM C
ABSTINENCE D
AVOID PROSTITUTES E
OTHER (SPECIFY) _____F
406. In your opinion, can sexually transmitted diseases be treated?
NO 2 (GO TO 409)
DOESN'T KNOW 8 (GO TO 409)
407. Do you know of a place/places where one could find a treatment for these illnesses?
NO 2 (GO TO 409)
408. What place(s) do you know of?
CIRCLE THE CORRESPONDING CODES TO THE RESPONSES GIVEN.
HEALTH CARE PERSONNEL B
HEALER/WITCH DOCTOR C
OTHER (SPECIFY) ____D
SYPHILIS CITED (CODE A) (GO TO 411)
410. Do you know of or have you heard of syphilis?
NO 2
AIDS CITED (CODE C) (GO TO 413)
412. Do you know of or have you heard of AIDS?
NO 2 (GO TO 423)
413. Do you approve or disapprove of sharing information about AIDS on the radio or television?
DISAPPROVES 2
WITHOUT OPINION 8
414. From whom/where did you hear about AIDS during the last three months?
FRIENDS B
RELATIVE/FAMILY C
HEALTH SERVICES D
PHARMACY E
RADIO F (GO TO 416)
TELEVISION G (GO TO 416)
OTHER (SPECIFY) _____H
DOESN'T KNOW I
415. Have you heard talk of AIDS on the radio or television during the last three months?
NO 2
DOESN'T KNOW 8
416. In your opinion, are there significant risks, average risks, weak risks, or are there no risks that you get AIDS?
AVERAGE 2
WEAK 3
NONE AT ALL 4
DOESN'T KNOW 8
417. Do you know AIDS is transmitted?
NO 2 (GO TO 419)
418. What methods of transmission do you know of?
CIRCLE THE CORRESPONDING CODES TO ALL MENTIONED.
SEXUAL INTERCOURSE WITH PROSTITUTE B
SEXUAL INTERCOURSE WITH HOMOSEXUAL C
BLOOD TRANSFUSION D
INJECTION E
BREAST FEEDING F
BLADE/RAZOR G
TATTOO H
OTHER (SPECIFY) _____I
419. In your opinion, can AIDS be prevented?
NO 2 (GO TO 421)
DOESN'T KNOW 8 (GO TO 421)
420. What do you/would you do to prevent AIDS?
CIRCLE THE CORRESPONDING CODES TO ALL MENTIONED.
LOYALTY TO PARTNERS B
CONDOM C
AVOID INJECTION D
AVOID TRANSFUSION E
OTHER (SPECIFY) _____G
421. In your opinion, can AIDS be cured?
NO 2 (GO TO 423)
DOESN'T KNOW 8 (GO TO 423)
422. In your opinion, where can someone get information on treating AIDS?
CIRCLE THE CORRESPONDING CODES TO ALL MENTIONED.
HEALTH CARE PERSONNEL B
HEALER/WITCH DOCTOR C
OTHER (SPECIFY) _____D
MINUTES_____