2000 UGANDA DEMOGRAPHIC AND HEALTH SURVEY MEN QUESTIONNAIRE

IDENTIFICATION
REGION __________
DISTRICT __________
COUNTY __________
SUBCOUNTY/TOWN __________
PARISH/LC2 NAME __________
EA NAME __________
UDHS NUMBER __________

URBAN/RURAL

URBAN 1
RURAL 2

LARGE CITY/SMALL CITY/TOWN/COUNTRYSIDE

LARGE CITY 1
SMALL CITY 2
TOWN 3
COUNTRYSIDE 4

HOUSEHOLD NUMBER ___
NAME AND LINE NUMBER OF MAN __________

INTERVIEWER VISITS (FOR 1, 2, 3 AND FINAL VISITS)

DATE _____
INTERVIEWER'S NAME __________
RESULT __________

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) __________ 7

TIME __________

DAY __________
MONTH __________

YEAR _____
NAME __________
RESULT __________

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) __________ 7

NEXT VISIT:
DATE
TIME
TOTAL NUMBER OF VISITS:

LANGUAGE QUESTIONNAIRE: ENGLISH

LANGUAGE USED IN INTERVIEW

ATESO-KARAMOJONG 1
LUGANDA 2
LUGBARA 3
LUO 4
RUNY ANKOLE-RUKIGA 5
RUNYORO-RUTORO 6
ENGLISH 7
OTHER 8

RESPONDENT'S LOCAL LANGUAGE

ATESO-KARAMOJONG 1
LUGANDA 2
LUGBARA 3
LUO 4
RUNY ANKOLE-RUKIGA 5
RUNYORO-RUTORO 6
ENGLISH 7
OTHER 8

TRANSLATOR USED

NOT AT ALL 1
SOMETIMES 2
ALL THE TIME 3

SUPERVISOR
NAME __________
DATE _____

FIELD EDITOR
NAME __________
DATE _____

OFFICE EDITOR ___
KEYED BY ___

SECTION 1. RESPONDENT'S BACKGROUND

Informed consent

Hello. My name is __________ and I am working with Uganda Bureau of Statistics. We are conducting a national survey about the health of men, women and children. We would very much appreciate your participation in this survey. I would like to ask you some questions about yourself and your family. This information will help the government to plan health services. The survey usually takes about 35 to 45 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.

At this time, do you want to ask me anything about the survey?

May I begin the interview now?

Signature of interviewer: __________
Date: _____

RESPONDENT AGREES TO BE INTERVIEWED 1
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

101. RECORD THE TIME.

HOUR ___
MINUTES ___

102. For most of the time during the last five years, did you live in a city, in a town, or in the countryside?

CITY 1
TOWN 2
COUNTRYSIDE 3

103. How long have you been living continuously in (name of current place of residence)?
IF LESS THAN ONE YEAR, RECORD '00' YEARS.

YEARS ___
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)

104. Just before you moved here, did you live in a city, in a town, or in the countryside?

CITY 1
TOWN 2
COUNTRYSIDE 3

105. In the last 12 months, have you ever traveled away from your home community and slept away?

YES 1
NO 2 (GO TO 108)

106. In the last 12 months, on how many separate occasions have you traveled away from your home community and slept away?

NUMBER OF TRIPS AWAY ___

107. In the last 12 months, have you been away from your home community for more than 1 month at a time?

YES 1
NO 2

108. In what month and year were you born?

MONTH __________
DON'T KNOW MONTH 98

YEAR _____
DON'T KNOW YEAR 9998

109. How old were you at your last birthday?
COMPARE AND CORRECT 108 AND/OR 109 IF INCONSISTENT.

AGE IN COMPLETED YEARS ___

110. Have you ever attended school?

YES 1
NO 2 (GO TO 114)

111. What is the highest level of school you attended: primary, secondary, or post-secondary?

PRIMARY 1
SECONDARY 2
POST-SECONDARY 3

112. What is the highest (grade/form/year) you completed at that level?

GRADE ___

112a. Did you ever receive any vocational training?

NO TRAINING 1
TEACHER TRAINING 2
PARAMEDICAL TRAINING 3
OTHER TRAINING 6

113. CHECK 111:

PRIMARY ___
SECONDARY OR POST-SECONDARY ___ (GO TO 117)

114. 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?

CANNOT READ AT ALL 1
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) __________ 4

115. Have you ever participated in a literacy program or any other program that involves learning to read or write (not including primary school)?

YES 1
NO 2

116. CHECK 114:

CODE '2' '3' OR '4' CIRCLED ___
CODE '1' CIRCLED ___ (GO TO 118)

117. During the last four weeks, did you read a newspaper or magazine almost every day, at least once a week, less than once a week or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

118. During the last four weeks, did you read a newspaper or magazine almost every day, at least once a week, less than once a week or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

119. During the last four weeks, did you watch television almost every day, at least once a week, less than once a week or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

120. Are you currently working?

YES 1 (GO TO 123)
NO 2

121. Have you done any work in the last 12 months?

YES 1 (GO TO 123)
NO 2

122. What have you been doing for most of the time over the last 12 months?

GOING TO SCHOOL/STUDYING 1 (GO TO 129)
LOOKING FOR WORK 2 (GO TO 129)
INACTIVE 3 (GO TO 129)
COULD NOT WORK/HANDICAPPED 4 (GO TO 129)
OTHER (SPECIFY) __________ 6 (GO TO 129)

123. What is your occupation, that is, what kind of work do you mainly do?

__________

124. CHECK 123:

WORKS IN AGRICULTURE ___
DOES NOT WORK IN AGRICULTURE ___ (GO TO 126)

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

OWN LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
PUBLIC LAND 5
COMMUNAL LAND 6

126. During the last 12 months, how many months did you work?

NUMBER OF MONTHS ___

127. Are you paid in cash or kind for this work, or are you not paid at all?

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3 (GO TO 129)
NOT PAID 4 (GO TO 129)

128. On average, how much of your household's expenditures do your earnings pay for: almost none, less than half, about half, more than half, or all?

ALMOST NONE 1
LESS THAN HALF 2
ABOUT HALF 3
MORE THAN HALF 4
ALL 5
NONE, HIS INCOME IS ALL SAVED 6

129. What is your religion?

CATHOLIC 1
PROTESTANT 2
MUSLIM 3
OTHER (SPECIFY) __________ 6

SECTION 2. REPRODUCTION

201. Now I would like to ask about any children you have had. I am interested only in the children that are biologically yours. Have you ever fathered any children with any woman?

YES 1
NO 2 (GO TO 206)
DON'T KNOW 8 (GO TO 206)

202. Do you have any sons or daughters that you have fathered who are now living with you?

YES 1
NO 2 (GO TO 204)

203. How many sons live with you?
And how many daughters are alive but do not live with you?
IF NONE, RECORD '00'.

SONS ELSEWHERE ___
DAUGHTERS ELSEWHERE ___

204. Do you have any sons or daughters you have fathered who are alive but do not live with you?

YES 1
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'.

SONS ELSEWHERE ___
DAUGHTERS ELSEWHERE ___

206. Have you ever fathered a son or a daughter 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?

YES 1
NO 2 (GO TO 208)
DON'T KNOW 8 (GO TO 208)

207. How many boys have died?
And how many girls have died?
IF NONE, RECORD '00'.

BOYS DEAD ___
GIRLS DEAD ___

208. (In addition to the children that you have just told me about), have you ever fathered with any woman
a) Any sons or daughters who are alive?
b) Any sons or daughters who died?

NO TO BOTH ___
OTHER ___ (PROBE AND CORRECT 201-207 AS NECESSARY)

209. SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE, RECORD '00'.

TOTAL CHILDREN ___

210. CHECK 209:

HAS HAD MORE THAN ONE CHILD ___
HAS HAD ONLY ONE CHILD ___ (GO TO 213)
HAS NOT HAD ANY CHILDREN ___ (GO TO 301)

211. Do the children that you have fathered all have the same biological mother?

YES 1 (GO TO 213)
NO 2

212. In all how many women have you fathered children with?

NUMBER OF WOMEN ___

213. How old were you when your (first) child was born?

AGE IN YEARS ___

214. At the time when this child was born, were you married to the child's mother?

YES 1
NO 2

SECTION 3. 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. 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 if applicable.

301. Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (method)?

01 FEMALE STERILIZATION: Women can have an operation to avoid having any more children.

YES 1
NO 2

02 MALE STERILIZATION: Men can have an operation to avoid having any more children.

YES 1
NO 2

03 PILL: Women can take a pill every day to avoid becoming pregnant.

YES 1
NO 2

04 IUD/COIL: Women can have a loop or coil placed inside them by a doctor or a nurse.

YES 1
NO 2

05 INJECTABLES: Women can have an injection by a health provider which stops them from becoming pregnant for one or more months.

YES 1
NO 2

06 IMPLANTS: Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.

YES 1
NO 2

07 CONDOM: Men can put a rubber sheath on their penis before sexual intercourse.

YES 1
NO 2

08 FEMALE CONDOM: Women can place a sheath in their vagina before sexual intercourse.

YES 1
NO 2

09 DIAPHRAGM: Women can place a thin flexible disk in their vagina before intercourse.

YES 1
NO 2

10 FOAM OR JELLY: Women can place a suppository, jelly, or cream in their vagina before intercourse.

YES 1
NO 2

11 LACTATIONAL AMENORRHEA METHOD (LAM): Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.

YES 1
NO 2

12 RHYTHM OR PERIODIC ABSTINENCE: 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.

YES 1
NO 2

13 WITHDRAWAL: Men can be careful and pull out before climax.

YES 1
NO 2

14 EMERGENCY CONTRACEPTION (NORLEVO): Women can take pills up to three days after sexual intercourse to avoid becoming pregnant.

YES 1
NO 2

15 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?

YES (SPECIFY) __________ 1
NO 2

302. Have you ever used (method)?

02 MALE STERILIZATION: Have you ever had an operation to avoid having any more children?

YES 1
NO 2

07 CONDOM

YES 1
NO 2

12 RHYTHM OR PERIODIC ABSTINENCE

YES 1
NO 2
DON'T KNOW 8

13 WITHDRAWAL

YES 1
NO 2

303. CHECK 301(01), 301(03), AND 301(04):

CODE '1' CIRCLED FOR ANY METHOD ___
CODE '1' NOT CIRCLED FOR ANY METHOD ___ (GO TO 308)

304. READ BEFORE ASKING 305 FOR THE FIRST APPLICABLE METHOD: Now I want to talk to you about contraceptive methods that women can use to delay or avoid becoming pregnant.

A) CHECK 301(03):
Knows Pill?

YES ___
NO ___ (GO TO 304 IN NEXT COLUMN)

B) CHECK 301(04):
Knows IUD/coil?

YES ___
NO ___ (GO TO 304 IN NEXT COLUMN)

C) CHECK 301(01):
Knows Female sterilization?

YES ___
NO ___ (GO TO 308)

305. In your opinion, is (method) a good method for a couple to use if they want to plan their family?

A) PILL:

YES 1
NO 2 (GO TO 307)
DEPENDS/UP TO THEM 3 (GO TO 304 IN NEXT COLUMN)
DON'T KNOW 8 (GO TO 304 IN NEXT COLUMN)

B) IUD/COIL:

YES 1
NO 2 (GO TO 307)
DEPENDS/UP TO THEM 3 (GO TO 304 IN NEXT COLUMN)
DON'T KNOW 8 (GO TO 304 IN NEXT COLUMN)

C) In your opinion, is female sterilization a good method for a couple to use if they do not want any more children?

YES 1
NO 2 (GO TO 307)
DEPENDS/UP TO THEM 3 (GO TO 308)
DON'T KNOW 8 (GO TO 308)

306. Why do you think (method) is a good method for a couple to use if they want to plan their family?
RECORD ALL REASONS MENTIONED.

A) PILL:

SIMPLE TO USE A (GO TO 304 IN NEXT COLUMN)
EFFECTIVE B (GO TO 304 IN NEXT COLUMN)
AFFORDABLE C (GO TO 304 IN NEXT COLUMN)
NO/FEW SIDE EFFECTS D (GO TO 304 IN NEXT COLUMN)
CAN STOP WHEN CHILDREN DESIRED E (GO TO 304 IN NEXT COLUMN)
NO NEED FOR MEDICAL PERSONNEL F (GO TO 304 IN NEXT COLUMN)
OTHER (SPECIFY) __________ X (GO TO 304 IN NEXT COLUMN)
DON'T KNOW Y (GO TO 304 IN NEXT COLUMN)

B) IUD/COIL:

c) Why do you think Female sterilization is not a good method for a couple to use if they do not want any more children?

TOO EXPENSIVE A
AGAINST RELIGION B
MAY HARM WOMEN'S HEALTH C
HAS SIDE EFFECTS D
INCREASES PROMISCUITY E
CANNOT HAVE CHILDREN AGAIN F
METHOD CAN FAIL G
INVOLVES DOCTOR/MEDICAL PERSONNEL H
CAN LEAD TO MEDICAL COMPLICATIONS I
OTHER (SPECIFY) __________ X
DON'T KNOW Y

307. Why do you think (method) is not a good method for a couple to use if they want to plan their family?
RECORD ALL REASONS MENTIONED.

A) PILL:

TOO EXPENSIVE A (GO TO 304 IN NEXT COLUMN)
AGAINST RELIGION B
MAY HARM WOMEN'S HEALTH C
HAS SIDE EFFECTS D
INCREASES PROMISCUITY E
CAN CAUSE STERILITY F
METHOD CAN FAIL G
BABY IN DANGER IF PREGNANCY OCCURS H
INVOLVES DOCTOR/MEDICAL PERSONNEL I
OTHER (SPECIFY) __________ X
DON'T KNOW Y

B) IUD/COIL:

c) Why do you think Female sterilization is not a good method for a couple to use if they do not want any more children?

308. Now I would like to ask you about a woman's risk of pregnancy.
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?

YES 1
NO 2 (GO TO 310)
DON'T KNOW 8 (GO TO 310)

309. Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?

JUST BEFORE HER PERIOD BEGINS 1
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY) __________ 6
DON'T KNOW 8

310. Do you think that a woman who is breastfeeding her baby can become pregnant?

YES 1
NO 2
DON'T KNOW 8

311. CHECK 301(07) AND 302(07): Knowledge and use of condoms

HAS HEARD OF AND USED CONDOMS ___
HAS HEARD OF CONDOMS BUT HAS NEVER USED ___ (GO TO 323)
HAS NOT HEARD OF CONDOMS ___ (GO TO 323)

312. Now I want to talk to you about condoms.
How old were you when you used a condom for the first time?

AGE OF FIRST USE ___
DOES NOT REMEMBER 98 98

313. Why did you use a condom that first time?
PROBE: Any other reason?
RECORD ALL REASONS MENTIONED.

TO AVOID PREGNANCY A
TO AVOID GETTING AIDS/HIV B
TO AVOID GETTING AN STD C
TO AVOID INFECTING PARTNER D
TO EXPERIMENT/TRY A CONDOM E
OTHER (SPECIFY) __________ X

314. Now when you have sex, do you use a condom every time, sometimes, or not at all?

EVERY TIME 1 (GO TO 316)
SOMETIMES 2
NOT AT ALL 3 (GO TO 316)
NOT HAVING SEX 4 (GO TO 316)

315. When do you use a condom?
PROBE: Any other times?
RECORD ALL SITUATIONS MENTIONED.

ON PARTNER'S FERTILE DAYS A
DURING WIFE'S/PARTNER'S MENSTRUATION B
WHEN NOT USING SOME OTHER METHOD C
WITH A STRANGER D
WITH A COMMERCIAL, SEX WORKER E
WITH ANYONE OTHER THAN WIFE/REGULAR PARTNER F
WITH WIFE/REGULAR PARTNER G
OTHER (SPECIFY) __________ X

316. Have you ever experienced any problems with using condoms?
IF YES: What problems have you experienced?
PROBE: Any other problems?
RECORD ALL PROBLEMS MENTIONED.

TOO EXPENSIVE A
EMBARRASSING TO BUY/OBTAIN B
DIFFICULT TO DISPOSE OF C
DIFFICULT TO PUT ON/TAKE OFF D
SPOILS THE MOOD E
DIMINISHES PLEASURE F
WIFE PARTNER OBJECTS/DOES NOT LIKE G
WIFE/PARTNER GOT PREGNANT H
INCONVENIENT TO USE/MESSY I
CONDOM BROKE J
OTHER (SPECIFY) __________ X
NO PROBLEM Y

317. CHECK 314: Current use of condoms

EVERY TIME OR SOMETIMES ___
NOT AT ALL/NOT HAVING SEX ___ (GO TO 323)

318. What brand of condom do you usually use?
ASK TO SEE CONDOM PACKET IF BRAND NOT KNOWN.

PROTECTOR 1
ENGABU 2
LIFE GUARD 3
ROUGH RIDER 4
PLEASURE 5
OTHER 6
DON'T KNOW 8

319. From where do you usually obtain the condoms?
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 __________

PUBLIC SECTOR

GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
OUTREACH 14
GOVERNMENT COMMUNITY-BASED DISTRIBUTOR 15
OTHER PUBLIC (SPECIFY) __________ 16

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC 21
PHARMACY/DRUG SHOP 22
PRIVATE DOCTOR/NURSE/MIDWIFE 23
OUTREACH 24
NGO COMMUNITY-BASED DISTRIBUTOR 25
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26

OTHER SOURCE

SHOP 31
RELIGIOUS INSTITUTION 32
FRIEND/RELATIVE 33
STREET VENDOR 34
LODGE 35
OTHER (SPECIFY) __________ 96

320. How much do you usually pay for a packet of condoms?

COST PER PACKET (UGANDA SHILLINGS) _____
FREE 9995 (GO TO 323)
DON'T KNOW 9998 (GO TO 323)

321. How many condoms are in each packet?

NUMBER ___

322. Do you think that at this price condoms are inexpensive, just affordable, or too expensive?

INEXPENSIVE 1
JUST AFFORDABLE 2
TOO EXPENSIVE 3

323. I will now read you some statements about condom use that other men have made. Please tell me if you agree or disagree with each.

a) Condoms diminish a man's sexual pleasure.

AGREE 1
DISAGREE 2
DON'T KNOW 8

b) A condom is very inconvenient to use.

AGREE 1
DISAGREE 2
DON'T KNOW 8

c) A condom can be reused.

AGREE 1
DISAGREE 2
DON'T KNOW 8

d) A condom protects against disease.

AGREE 1
DISAGREE 2
DON'T KNOW 8

e) A woman has no right to tell a man to use a condom.

AGREE 1
DISAGREE 2
DON'T KNOW 8

401. Are you currently married or living with a woman?

YES, CURRENTLY MARRIED 1
YES, LIVING WITH A WOMAN 2 (GO TO 404)
NO, NOT IN UNION 3 (GO TO 405)

402. Do you have one wife or more than one wife?
IF ONLY ONE WIFE, ENTER '01.
IF MORE THAN ONE, ASK: How many wives do you currently have?

NUMBER OF WIVES ___

403. Are there any other women with whom you live as if married?

YES 1
NO 2 (GO TO 409)

404. Are you living with one (other) woman or more than one (other) woman as if married?
IF ONE LIVE-IN PARTNER, ENTER '01'.
IF MORE THAN ONE, ASK: How many women are you living with as if married?

NUMBER OF LIVE-IN PARTNERS ___ (GO TO 409)

405. Do you currently have regular, occasional, or no sexual partners?

REGULAR PARTNER(S) ONLY 1
OCCASIONAL PARTNER(S) ONLY 2 (GO TO 407)
REGULAR AND OCCASIONAL PARTNERS 3
NO SEXUAL PARTNER 4 (GO TO 407)

406. Do you have one or more than one regular partner?

ONE REGULAR PARTNER 1
MORE THAN ONE REGULAR PARTNER 2

407. Have you ever been married or lived with a woman?

YES, FORMERLY MARRIED 1
YES, LIVED WITH A WOMAN 2 (GO TO 411)
NO 3 (GO TO 416)

408. What is your marital status now: are you widowed, divorced, or separated?

WIDOWED 1 (GO TO 411)
DIVORCED 2 (GO TO 411)
SEPARATED 3 (GO TO 411)

409. WRITE THE LINE NUMBERS FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH WIFE/PARTNER. IF A WIFE/PARTNER DOES NOT LIVE IN THE HOUSEHOLD, ENTER '00' IN THE LINE NUMBER BOXES. THE NUMBER OF LINES FILLED IN MUST BE EQUAL TO THE NUMBER OF WIVES AND PARTNERS. IF RESPONDENT HAS MORE THAN FIVE WIVES/PARTNERS USE ADDITIONAL QUESTIONNAIRE(S).

CHECK 402 AND 404:

SUM OF 402 AND 404 = 1 ___
Please tell me the name of your wife/partner.

SUM OF 402 AND 404 > 1 ___
Please tell me the name of each wife/partner that you live with as if married, starting with the one you lived with first.

WIFE/PARTNER
A) NUMBER

1 __________
2 __________
3 __________
4 __________
5 __________

B) LINE NUMBER IN HOUSEHOLD QUESTIONNAIRE

1 ___
2 ___
3 ___
4 ___
5 ___

C) WIFE OR PARTNER?

1

WIFE 1
PARTNER 2

2

WIFE 1
PARTNER 2

3

WIFE 1
PARTNER 2

4

WIFE 1
PARTNER 2

5

WIFE 1
PARTNER 2

410. CHECK 409:

ONLY ONE WIFE/PARTNER ___
MORE THAN ONE WIFE/PARTNER ___ (GO TO 412)

411. Have you been married or lived with a woman only once, or more than once?

ONLY ONCE 1 (GO TO 414)
MORE THAN ONCE 2 (GO TO 413)

412. Have you ever been married to or lived as if married to any woman other than those you have just mentioned?

YES 1
NO 2 (GO TO 414)

413. In total, how many women have you been married to or lived with as if married in your whole life?

NUMBER OF WOMEN ___

414. CHECK 409 AND 411:

ONLY ONE WIFE/PARTNER AND 411 = 1 ___

In what month and year did you start living with your wife/partner?

OTHER ___
Now we will talk about your first wife/partner. In what month and year did you start living with her?

MONTH __________
DON'T KNOW MONTH 98

YEAR _____ (GO TO 416)
DON'T KNOW YEAR 9998

415. How old were you when you started living with her?

AGE ___

416. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues.

How old were you when you first had sexual intercourse with a woman (if ever)?

NEVER 00 (GO TO 448)
AGE IN YEARS ___
FIRST TIME WHEN STARTED LIVING WITH (FIRST) WIFE/PARTNER 95

417. When was the last time you had sexual intercourse with a woman?
RECORD 'YEARS AGO' ONLY IF LAST INTERCOURSE WAS ONE OR MORE YEARS AGO.

DAYS AGO 1 ___
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___

418. The last time you had sexual intercourse, was a condom used?

YES 1
NO 2 (GO TO 420)

419. What was the main reason you used a condom on that occasion?

RESPONDENT WANTED TO PREVENT STD/HIV 01 (GO TO 424)
RESPONDENT WANTED TO PREVENT PREGNANCY 02 (GO TO 424)
RESPONDENT WANTED TO PREVENT BOTH STD/HIV AND PREGNANCY 03 (GO TO 424)
DID NOT TRUST PARTNER/FEELS PARTNER HAS OTHER PARTNERS 04 (GO TO 424)
PARTNER INSISTED 05 (GO TO 424)
OTHER (SPECIFY) __________ 96 (GO TO 424)
DON'T KNOW 98

420. CHECK 302(02):

RESPONDENT NOT STERILIZED ___
RESPONDENT STERILIZED ___ (424)

421. The last time you had sexual intercourse with a woman, did you or she do something or use any method to avoid a pregnancy?

YES 1
NO 2 (GO TO 423)
UNSURE/DON'T KNOW 8 (GO TO 424)

422. What method was used?
IF MORE THAN ONE METHOD USED, RECORD THE HIGHEST METHOD ON THE LIST.

FEMALE STERILIZATION 01 (GO TO 424)
PILL 03 IUD/COIL 04 (GO TO 424)
INJECTABLES 05 (GO TO 424)
IMPLANTS 06 (GO TO 424)
FEMALE CONDOM 08 (GO TO 424)
DIAPHRAGM 09 (GO TO 424)
FOAM/JELLY 10 (GO TO 424)
LACTATIONAL AMENORRHEA 11 (GO TO 424)
PERIODIC ABSTINENCE 12 (GO TO 424)
WITHDRAWAL 13 (GO TO 424)
OTHER (SPECIFY) __________ 96 (GO TO 424)
DON'T KNOW 98 98 (GO TO 424)

423. WHAT IS THE MAIN REASON A METHOD WAS NOT USED?

CASUAL SEX PARTNER 11

FERTILITY-RELATED REASONS

WIFE/PARTNER MENOPAUSAL/HAD HYSTERECTOMY 23
COUPLE SUBFECUND/INFECUND 24
WIFE/PARTNER WAS PREGNANT 25
WIFE/PARTNER WAS POSTPARTUM AMENORRHEIC 26
WIFE/PARTNER WAS BREASTFEEDING 27
WANTED (MORE) CHILDREN 28

OPPOSITION TO USE

RESPONDENT OPPOSED 31
WIFE/PARTNER OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34

LACK OF KNOWLEDGE

KNOWS NO METHOD 41
KNOWS NO SOURCE 42

METHOD-RELATED REASONS

HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56

OTHER (SPECIFY) __________ 96
DON'T KNOW 98

424. What is your relationship to the woman with whom you last had sex?
IF WOMAN IS 'GIRLFRIEND' OR 'FIANCÉE', ASK: Was your girlfriend/fiancée living with you when you last had sex with her?
IF YES, CIRCLE '01'.
IF NO, CIRCLE '02'.

SPOUSE/COHABITING PARTNER 01 (GO TO 426)
WOMAN IS GIRLFRIEND/FIANCÉE 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
COMMERCIAL SEX CUSTOMER 06
OTHER (SPECIFY) __________ 96

425. For how long have you had sexual relations with this woman?

DAYS 1 ___
WEEKS 2 ___
MONTHS 3 ___
YEARS 4 ___

426. Have you had sex with any other woman in the last 12 months?

YES 1
NO 2 (GO TO 445)

427. The last time you had sexual intercourse with another woman, was a condom used?

YES 1
NO 2 (GO TO 445)

428. What was the main reason you used a condom on that occasion?

RESPONDENT WANTED TO PREVENT STD/HIV 01 (GO TO 433)
RESPONDENT WANTED TO PREVENT A PREGNANCY 02 (GO TO 433)
RESPONDENT WANTED TO PREVENT BOTH STD/HIV AND PREGNANCY 03 (GO TO 433)
DID NOT TRUST PARTNER/FEELS PARTNER HAS OTHER PARTNERS 04 (GO TO 433)
PARTNER INSISTED 05 (GO TO 433)
OTHER (SPECIFY) __________ 96 (GO TO 433)
DON'T KNOW 98

429. CHECK 302(02):

RESPONDENT NOT STERILIZED ___
RESPONDENT STERILIZED ___ (GO TO 433)

430. The last time you had sexual intercourse with this woman, did you or she do something or use any method to avoid a pregnancy?

YES 1
NO 2 (GO TO 432)
UNSURE/DON'T KNOW 8 (GO TO 433)

430. The last time you had sexual intercourse with this woman, did you or she do something or use any method to avoid a pregnancy?

YES 1
NO 2 (GO TO 432)
UNSURE/DON'T KNOW 8 (GO TO 433)

431. What method was used?
IF MORE THAN ONE METHOD USED, RECORD THE HIGHEST METHOD ON THE LIST.

FEMALE STERILIZATION 01 (GO TO 433)
PILL 03 (GO TO 433)
IUD/COIL 04 (GO TO 433)
INJECTABLES 05 (GO TO 433)
IMPLANTS 06 (GO TO 433)
FEMALE CONDOM 08 (GO TO 433)
DIAPHRAGM 09 (GO TO 433)
FOAM/JELLY 10 (GO TO 433)
LACTATIONAL AMENORRHEA 11 (GO TO 433)
PERIODIC ABSTINENCE 12 (GO TO 433)
WITHDRAWAL 13 (GO TO 433)
OTHER (SPECIFY) __________ 96 (GO TO 433)
DON'T KNOW 98 (GO TO 433)

432. What is the main reason a method was not used?

CASUAL SEX PARTNER 11

FERTILITY-RELATED REASONS

WIFE/PARTNER MENOPAUSAL/HAD HYSTERECTOMY 23
COUPLE SUBFECUND/INFECUND 24
WIFE/PARTNER WAS PREGNANT 25
WIFE/PARTNER WAS BREASTFEEDING 27
WANTED (MORE) CHILDREN 28

OPPOSITION TO USE

RESPONDENT OPPOSED 31
WIFE/PARTNER OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34

LACK OF KNOWLEDGE

KNOWS NO METHOD 41
KNOWS NO SOURCE 42

METHOD-RELATED REASONS

HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56

OTHER (SPECIFY) __________ 96
DON'T KNOW 98

433. What is your relationship to this woman?
IF WOMAN IS "GIRLFRIEND" OR "FIANCÉE", ASK: Was your girlfriend/fiancée living with you when you last had sex with her?
IF YES, CIRCLE '01'.
IF NO, CIRCLE '02'.

SPOUSE/COHABITING PARTNER 01 (GO TO 435)
WOMAN IS GIRLFRIEND/FIANCÉE 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
COMMERCIAL SEX CUSTOMER 06
OTHER (SPECIFY) __________ 96

434. For how long have you had sexual relations with this woman?

DAYS 1 ___
WEEKS 2 ___
MONTHS 3 ___
YEARS 4 ___

435. Other than these two women, have you had sex with any other woman in the last 12 months?

YES 1
NO 2 (GO TO 445)

436. The last time you had sexual intercourse with this third woman, was a condom used?

YES 1
NO 2 (GO TO 438)

437. What was the main reason you used a condom on that occasion?

RESPONDENT WANTED TO PREVENT STD/HIV 01 (GO TO 442)
RESPONDENT WANTED TO PREVENT A PREGNANCY 02 (GO TO 442)
RESPONDENT WANTED TO PREVENT BOTH STD/HIV AND PREGNANCY 03 (GO TO 442)
DID NOT TRUST PARTNER/FEELS PARTNER HAS OTHER PARTNERS 04 (GO TO 442)
PARTNER INSISTED 05 (GO TO 442)
OTHER (SPECIFY) __________ 96 (GO TO 442)
DON'T KNOW 98

438. CHECK 302(02):

RESPONDENT NOT STERILIZED ___
RESPONDENT STERILIZED ___ (GO TO 442)

439. The last time you had sexual intercourse with this woman, did you or she do something or use any method to avoid a pregnancy?

YES 1
NO 2 (GO TO 441)
UNSURE/DON'T KNOW 8 (GO TO 442)

440. What method was used?
IF MORE THAN ONE METHOD USED, RECORD THE HIGHEST METHOD ON THE LIST.

FEMALE STERILIZATION 01 (GO TO 442)
PILL 03 (GO TO 442)
IUD/COIL 04 (GO TO 442)
INJECTABLES 05 (GO TO 442)
IMPLANTS 06 (GO TO 442)
FEMALE CONDOM 08 (GO TO 442)
DIAPHRAGM 09 (GO TO 442)
FOAM/JELLY 10 (GO TO 442)
LACTATIONAL AMENORRHEA 11 (GO TO 442)
PERIODIC ABSTINENCE 12 (GO TO 442)
WITHDRAWAL 13 (GO TO 442)
OTHER (SPECIFY) __________ 96 (GO TO 442)
DON'T KNOW 98 (GO TO 442)

441. What is the main reason a method was not used?

CASUAL SEX PARTNER 12

OPPOSITION TO USE

RESPONDENT OPPOSED 31
WIFE/PARTNER OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34

LACK OF KNOWLEDGE

KNOWS NO METHOD 41
KNOWS NO SOURCE 42

METHOD-RELATED REASONS

HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH A BODY'S NORMAL PROCESSES 56

OTHER (SPECIFY) __________ 96
DON'T KNOW 98

442. What is your relationship to this woman?
IF WOMAN IS "GIRLFRIEND" OR "FIANCÉE", ASK: Was your girlfriend/fiancée living with you when you last had sex with her?
IF YES, CIRCLE '01'.
IF NO, CIRCLE '02'.

SPOUSE/COHABITING PARTNER 01 (GO TO 444)
WOMAN IS GIRLFRIEND/FIANCÉE 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
COMMERCIAL SEX CUSTOMER 06
OTHER (SPECIFY) ___________ 96

443. For how long have you had sexual relations with this woman?

DAYS 1 ___
WEEKS 2 ___
MONTHS 3 ___
YEARS 4 ___

444. In total, with how many different women have you had sex in the last 12 months?

NUMBER OF PARTNERS ___

445. Have you ever paid for sex?

YES 1
NO 2 (GO TO 448)

446. How long ago was the last time you paid for sex?

DAYS AGO 1 ___
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___

447. The last time that you paid for sex, was a condom used on that occasion?

YES 1
NO 2

448. CHECK 319: Source of condoms:

SOURCE NOT CIRCLED ___
SOURCE CIRCLED ___ (GO TO 451)

449. Do you know of a place where a person can get condoms?

YES 1
NO 2 (GO TO 452)

450. 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.

NAME OF PLACE __________

ANY OTHER PLACE?
RECORD ALL PLACES MENTIONED.

PUBLIC SECTOR

GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
OUTREACH D
GOVERNMENT COMMUNITY BASED DISTRIBUTOR E
OTHER PUBLIC (SPECIFY) __________ F

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC G
PHARMACY/DRUG SHOP H
PRIVATE DOCTOR/NURSE/MIDWIFE I
OUTREACH J
NGO COMMUNITY BASED DISTRIBUTOR K
OTHER PRIVATE MEDICAL (SPECIFY) __________ L

OTHER SOURCE

SHOP M
CHURCH N
FRIENDS/RELATIVES O

OTHER (SPECIFY) __________ X

451. If you wanted to, could you yourself get a condom?

YES 1
NO 2
DON'T KNOW/UNSURE 8

452. CHECK 418:

NOT ASKED ___ (MARK BOX AND GO TO 458)
YES ___ (MARK BOX AND GO TO 459)
NO ___

453. CHECK 421:

NOT ASKED ___ (MARK BOX AND GO TO 458)
YES ___ (MARK BOX AND GO TO 458)
NO ___

454. CHECK 427:

NOT ASKED ___ (MARK BOX AND GO TO 458)
YES ___ (MARK BOX AND GO TO 458)
NO ___

455. CHECK 430:

NOT ASKED ___ (MARK BOX AND GO TO 458)
YES ___ (MARK BOX AND GO TO 458)
NO ___

456. CHECK 436:

NOT ASKED ___ (MARK BOX AND GO TO 458)
YES ___ (MARK BOX AND GO TO 458)
NO ___

457. CHECK 439:

NOT ASKED ___ (MARK BOX AND GO TO 458)
YES ___ (MARK BOX AND GO TO 458)
NO ___

458.

HAS NOT USED A CONTRACEPTIVE METHOD ___
HAS USED A CONTRACEPTIVE METHOD ___

SECTION 5. FERTILITY PREFERENCES

501. CHECK 401:

CURRENTLY MARRIED/LIVING WITH A WOMAN ___
NOT IN UNION ___ (GO TO 516)

502. CHECK 302(02):

RESPONDENT NOT STERILIZED ___
RESPONDENT STERILIZED ___ (GO TO 520)

503. COPY THE NAMES OF WIVES/PARTNERS FROM 409. ASK QUESTIONS FOR ONE WIFE/PARTNER AT A TIME. IF THERE ARE MORE THAN FIVE WIVES/PARTNERS, USE ADDITIONAL QUESTIONNAIRE(S).
Is (name) currently pregnant?

NAME OF WIFE/PARTNER __________

YES 1
NO 2 (GO TO 505)
DON'T KNOW/UNSURE 8 (GO TO 505)

504. When (NAME) became pregnant, did you want her to become pregnant then, did you want to wait until later, or did you not want her to have a child at all?

THEN 1 (GO TO 506)
LATER 2 (GO TO 506)
NOT AT ALL 3 (GO TO 506)

505. In the next few weeks, if you discovered that (NAME) was pregnant, would that be a big problem, a small problem or no problem for you?

BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
STERILIZED/HAD HYSTERECTOMY 4 (GO TO 507)

506. Do you think (NAME) wants the same number of children that you want to have with her, or does she want more or fewer than you want?

SAM NUMBER 1
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8

507. How often have you talked to (name) about family planning in the past year?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

508. Do you think that (NAME) approves or disapproves of couples using a contraceptive method to avoid pregnancy?

APPROVES 1 (GO TO 503 FOR NEXT WIFE/PARTNER. IF NO MORE WIVES/PARTNERS GO TO 509)
DISAPPROVES 2 (GO TO 503 FOR NEXT WIFE/PARTNER. IF NO MORE WIVES/PARTNERS GO TO 509)
DON'T KNOW 8 (GO TO 503 FOR NEXT WIFE/PARTNER. IF NO MORE WIVES/PARTNERS GO TO 509)

509. CHECK 503 FOR ALL WIVES/PARTNERS:

ONE OR MORE WIVES/PARTNERS PREGNANT ___
Now I have some questions about the future. After the child(ren) your wife/wives/partner(s) is/are expecting now, would you like to have another child or would you prefer not to have any more children at all?

NO WIFE/PARTNER PREGNANT ___
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 at all?

HAVE A/ANOTHER CHILD 1
NOT HAVE A/ANOTHER CHILD 2 (GO TO 514)
WIFE/WIVES INFECUND/STERILIZED 3 (GO TO 514)
UNDECIDED/DON'T KNOW 8 (GO TO 511)

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

MONTHS 1 ___
YEARS 2 ___
SOON/NOW 993
AFTER MARRIAGE 995

OTHER (SPECIFY) __________ 996
DON'T KNOW 998

511. CHECK 409:

HAS MORE THAN ONE WIFE/PARTNER ___
HAS ONLY ONE WIFE/PARTNER ___ (GO TO 514)

512. You say you (may) want to have a/another child. Which of your wives would you prefer to have your next child with?

WIFE/PARTNER NUMBER ___
ANY WIFE/PARTNER 0 (GO TO 514)

513. Are you planning to have any more children with any of your other wives?

YES 1
NO 2 (GO TO 516)
UNSURE/DEPENDS 3

514. Do you plan to take another wife at any time in the near future?

YES 1
NO 2 (GO TO 516)
UNSURE/DEPENDS 3

515. What is the main reason you think you will/may take another wife in the near future?

TO HAVE MORE CHILDREN 01
TO HELP IN THE HOME/COMPOUND 02
TO HELP IN THE FAMILY FARM/BUSINESS 03
WANT A YOUNGER WIFE 04
CURRENT WIFE/WIVES TOO SICK/OLD 05
CURRENT WIFE/WIVES NOT FERTILE/BARREN 06
WIFE/WIVES DIED 07

OTHER (SPECIFY) __________ 96

516. CHECK 302: Contraceptive method use:

HAS NOT USED A CONTRACEPTIVE METHOD ___
HAS USED A CONTRACEPTIVE METHOD ___ (GO TO 520)

517. Do you think you will use a contraceptive method to avoid pregnancy at any time in the future?

YES 1
NO 2
DON'T KNOW/UNSURE 8 (GO TO 519)

518. Which contraceptive method would you prefer to use?

FEMALE STERILIZATION 01
MALE STERILIZATION 02
PILL 03
IUD/COIL 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMENORRHEA 11
PERIODIC ABSTINENCE 12
WITHDRAWAL 13
OTHER (SPECIFY) __________ 96
UNSURE 98

519. What is the main reason that you think you will not use a contraceptive method at any time in the future?

FERTILITY-RELATED REASONS

INFREQUENT SEX/NO SEX 22
WIFE(VES)/PARTNER(S) MENOPAUSAL/HAD HYSTERECTOMY 23
COUPLE SUBFECUND/INFECUND 24
WANTS AS MANY CHILDREN AS POSSIBLE 25

OPPOSITION TO USE

RESPONDENT OPPOSED 31
WIFE(WIVES)/PARTNER(S) OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34

LACK OF KNOWLEGE

KNOWS NO METHOD 41
KNOWS NO SOURCE 42

METHOD-RELATED REASONS

HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56

OTHER (SPECIFY) __________ 96
DON'T KNOW 98

520. CHECK 203 AND 205:

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?

NUMBER ___
OTHER (SPECIFY) __________ 96 (GO TO 522)

521. How many of these children would you like to be boys, how many would you like to be girls, and for how many would the sex not matter?

NUMBER OF BOYS ___
NUMBER OF GIRLS ___
EITHER ___
OTHER (SPECIFY) __________ 96

522. Would you say that you approve or disapprove of couples using a contraceptive method to avoid getting pregnant?

APPROVE 1
DISAPPROVE 2
DON'T KNOW/UNSURE 8

523. In the last six months have you heard/read about family planning:

On the radio?

YES 1
NO 2

On the television?

YES 1
NO 2

In a newspaper or magazine?

YES 1
NO 2

Billboards?

YES 1
NO 2

Community meeting/church?

YES 1
NO 2

Mobile van?

YES 1
NO 2

524. In the last few months, have you discussed the practice of family planning with your wife/partner, friends, neighbors, or relatives?

YES 1
NO 2 (GO TO 526)

525. With whom?
Anyone else?
RECORD ALL PERSONS MENTIONED.

WIFE(WIVES)/PARTNER(S) A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER F
SON G
MOTHER-IN-LAW H
FATHER-IN-LAW I
FRIENDS/NEIGHBORS J
OTHER (SPECIFY) __________ X

526. In the last few months, have you discussed the practice of family planning with a health worker or health professional?

YES 1
NO 2

527. How interested would you be in opportunities to learn about the following topics: very interested, somewhat interested or not interested

a) How men can avoid causing an unwanted pregnancy?

VERY INTERESTED 1
SOMEWHAT INTERESTED 2
NOT INTERESTED 3

b) How a man can help their partner have safe and healthy pregnancies?

VERY INTERESTED 1
SOMEWHAT INTERESTED 2
NOT INTERESTED 3

c) How men can help to care for their new born infants?

VERY INTERESTED 1
SOMEWHAT INTERESTED 2
NOT INTERESTED 3

SECTION 6. PARTICIPATION IN HEALTH CARE

601. CHECK 209:

HAS HAD ONE OR MORE CHILDREN ___
HAS NOT HAD ANY CHILDREN ___ (GO TO 628)

602. PLEASE TELL ME THE NAME AND SEX OF YOUR CHILD (WHO WAS BORN MOST RECENTLY).

NAME OF CHILD __________

BOY 1
GIRL 2

603. IN WHAT MONTH AND YEAR WAS (NAME OF CHILD) BORN?

MONTH __________
YEAR _____

604. Is (NAME OF CHILD) still living?

YES 1 (GO TO 606)
NO 2

605. How old was (NAME OF CHILD) when he/she died?
IF '1 YEAR', PROBE: How many months old was (name)?
RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

DAYS 1 ___
MONTHS 2 ___
YEARS 3 ___

606. What is the name of (NAME OF CHILD)'s mother?
WRITE THE CHILD'S MOTHER'S NAME AND HER LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE.
IF THE MOTHER IS DECEASED, RECORD '95'.
IF THE MOTHER IS NOT A HOUSEHOLD MEMBER, RECORD '00'.

NAME OF CHILD'S MOTHER __________

LINE NUMBER IN HOUSEHOLD QUESTIONNAIRE ___

607. CHECK 603:

(LAST) CHILD BORN IN JANUARY 1995 OR LATER ___
(LAST) CHILD BORN BEFORE JANUARY 1995 ___ (GO TO 628)

608. What is your relationship with (NAME OF CHILD'S MOTHER)?

CURRENT SPOUSE 01
FORMER SPOUSE 02
CURRENT LIVE-IN PARTNER 03
FORMER LIVE-IN PARTNER 04
REGULAR SEXUAL PARTNER 05
WOMAN IS GIRLFRIEND/FIANCÉE 06
OCCASIONAL SEXUAL PARTNER 07
FRIEND/ACQUAINTANCE 08
OTHER (SPECIFY) __________ 96

609. What is your relationship with (NAME OF CHILD'S MOTHER)?

610. When (NAME OF CHILD'S MOTHER) became pregnant with (NAME OF CHILD), did you want her to become pregnant then, did you want to wait until later, or did you not want her to have a child at all?

THEN 1 (GO TO 612)
LATER 2
NOT AT ALL 3 (GO TO 612)

611. How much longer would you like to have waited?

MONTHS 1 ___
YEARS 2 ___
UNDECIDED/DON'T KNOW 998

612. ASK QUESTIONS 612-615 FIRST FOR PREGNANCY, THEN FOR DELIVERY, AND THEN FOR THE SIX WEEKS AFTER DELIVERY. ALL QUESTIONS REFER TO THE LAST BIRTH.

Did (NAME OF CHILD'S MOTHER) receive any advice or care from a doctor or any health care provider during the (PREGNANCY/DELIVERY/SIX WEEKS AFTER DELIVERY)?

PREGNANCY

YES 1
NO 2 (GO TO 615)
DON'T KNOW 8 (GO TO 612 IN NEXT COLUMN)

DELIVERY

YES 1
NO 2 (GO TO 615)
DON'T KNOW 8 (GO TO 612 IN NEXT COLUMN)

SIX WEEKS AFTER DELIVERY

YES 1
NO 2 (GO TO 615)
DON'T KNOW 8 (GO TO 616)

613. Was this care provided free, was it completely covered by insurance, or did it have to be paid for in money or goods or services?

PREGNANCY

FREE 1 (GO TO 612 IN NEXT COLUMN)
INSURANCE (GO TO 612 IN NEXT COLUMN)
HAD TO BE PAID FOR 3

DELIVERY

FREE 1 (GO TO 612 IN NEXT COLUMN)
INSURANCE (GO TO 612 IN NEXT COLUMN)
HAD TO BE PAID FOR 3

SIX WEEKS AFTER DELIVERY

FREE 1 (GO TO 616)
INSURANCE 2 (GO TO 616)
HAD TO BE PAID FOR 3

614. Who mainly provided the money/goods/services to pay for this care?

PREGNANCY

RESPONDENT 1 (GO TO 612 IN NEXT COLUMN)
CHILD'S MOTHER 2 (GO TO 612 IN NEXT COLUMN)
RESPONDENT AND CHILD'S MOTHER 3 (GO TO 612 IN NEXT COLUMN)
RESPONDENT'S FAMILY 4 (GO TO 612 IN NEXT COLUMN)
MOTHER'S FAMILY 5 (GO TO 612 IN NEXT COLUMN)

OTHER (SPECIFY) __________ 6 (GO TO 612 IN NEXT COLUMN)

DELIVERY

SIX WEEKS AFTER DELIVERY

RESPONDENT 1 (GO TO 616)
CHILD'S MOTHER 2 (GO TO 616)
RESPONDENT AND CHILD'S MOTHER 3 (GO TO 616)
RESPONDENT'S FAMILY 4 (GO TO 616)
MOTHER'S FAMILY 5 (GO TO 616)
OTHER (SPECIFY) __________ 6 (GO TO 616)

615. What was the main reason (NAME OF CHILD'S MOTHER) did not receive any advice or care from a doctor or other health care provider during (PREGNANCY/DELIVERY/THE SIX WEEKS AFTER DELIVERY)?

PREGNANCY

NOT NECESSARY 01 (GO TO 612 IN NEXT COLUMN)
NOT CUSTOMARY 02 (GO TO 612 IN NEXT COLUMN)
RESPONDENT DIDN'T ALLOW 03 (GO TO 612 IN NEXT COLUMN)
TOO COSTLY 04 (GO TO 612 IN NEXT COLUMN)
TOO FAR/NO TRANSPORT 05 (GO TO 612 IN NEXT COLUMN)
POOR SERVICE 06 (GO TO 612 IN NEXT COLUMN)
LACK OF KNOWLEDGE 07 (GO TO 612 IN NEXT COLUMN)
OTHER (SPECIFY) __________ 96 (GO TO 612 IN NEXT COLUMN)

DELIVERY

NOT NECESSARY 01 (GO TO 612 IN NEXT COLUMN)
NOT CUSTOMARY 02 (GO TO 612 IN NEXT COLUMN)
RESPONDENT DIDN'T ALLOW 03 (GO TO 612 IN NEXT COLUMN)
TOO COSTLY 04 (GO TO 612 IN NEXT COLUMN)
TOO FAR/NO TRANSPORT 05 (GO TO 612 IN NEXT COLUMN)
POOR SERVICE 06 (GO TO 612 IN NEXT COLUMN)
LACK OF KNOWLEDGE 07 (GO TO 612 IN NEXT COLUMN)
OTHER (SPECIFY) __________ 96 (GO TO 612 IN NEXT COLUMN)

SIX WEEKS AFTER DELIVERY

NOT NECESSARY 01
NOT CUSTOMARY 02
RESPONDENT DIDN'T ALLOW 03
TOO COSTLY 04
TOO FAR/NO TRANSPORT 05
POOR SERVICE 06
LACK OF KNOWLEDGE 07
OTHER (SPECIFY) __________ 96

616. Sometimes a pregnancy can have complications that lead to miscarriage or even death. What are some of the signs and symptoms that indicate that a pregnancy may be in danger?
PROBE: Any other signs or symptoms?
RECORD ALL SIGNS AND SYMPTOMS MENTIONED.

VAGINAL BLEEDING A
HIGH FEVER B
ABDOMINAL PAIN C
SWELLING OF HANDS AND FEET D
DIFFICULT LABOR FOR MORE THAN 12 HOURS E
CONVULSIONS F
OTHER (SPECIFY) __________ X
DON'T KNOW ANY SIGNS OR SYMPTOMS Y

617. At any time while (NAME OF CHILD'S MOTHER) was pregnant with (NAME OF CHILD), did you yourself talk with a doctor or any other health care provider about the health of the mother or of the pregnancy?

YES 1
NO 2 (GO TO 619)

618. Did the health provider talk to you about:

a) What foods (NAME OF CHILD'S MOTHER) should eat during pregnancy?

YES 1
NO 2
DON'T RECALL 3

b) How much rest she should have during pregnancy?

YES 1
NO 2
DON'T RECALL 3

c) What you should do to prepare for the delivery?

YES 1
NO 2
DON'T RECALL 3

d) The types of health problems for which she should get mediate medical attention?

YES 1
NO 2
DON'T RECALL 3

619. CHECK 602 AND 604:

NAME OF (LAST) CHILD __________

(LAST) CHILD LIVING ___
(LAST) CHILD NOT LIVING ___ (GO TO 628)

620. Now I want to talk to you about vaccinations given to young children to immunize them against different diseases. CIRCLE CODE 1 IN 620 FOR EACH VACCINE MENTIONED SPONTANEOUSLY. THEN, FOR EACH VACCINE WITH CODE 1 OR CODE 2 CIRCLED IN 620, ASK 621.

What vaccinations have you heard about that are given to young children to protect them against disease?

FOR VACCINATIONS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (name of vaccine)?

620A. BCG: An injection in the arm or shoulder that usually causes a scar.

SPONTANEOUS YES 1
PROBED YES 2
NO 3
DON'T KNOW 8

620B. POLIO VACCINE: Given in the form of drops in the mouth.

SPONTANEOUS YES 1
PROBED YES 2
NO 3
DON'T KNOW 8

620C. DPT VACCINE: An injection in the thigh or buttocks, sometimes given at the same time as polio drops.

SPONTANEOUS YES 1
PROBED YES 2
NO 3
DON'T KNOW 8

620D. MEASLES VACCINE: An injection to prevent measles.

Spontaneous yes 1
Probed yes 2
No 3
Don't know 8

621. Has (NAME OF CHILD) received (NAME OF VACCINE)?

BCG

YES 1
NO 2
DON'T KNOW

Polio vaccine

YES 1
NO 2
DON'T KNOW

DPT vaccine

YES 1
NO 2
DON'T KNOW

Measles vaccine

YES 1
NO 2
DON'T KNOW

622. CHECK 621: All vaccines

NOT ONE YES OR QUESTION NOT ASKED FOR ANY VACCINE ___
AT LEAST ONE YES ___ (GO TO 624)

623. What is the main reason why (NAME OF CHILD) has not received any of these vaccinations?

TOO EXPENSIVE 01
DOES NOT KNOW WHERE TO GET THEM 02
NOT AVAILABLE 03
NOT IMPORTANT/NOT NEEDED 04
NOT GOOD FOR CHILD'S HEALTH 05
CHILD TOO YOUNG 06
TOO FAR/NO TRANSPORT 07
OTHER (SPECIFY) __________ 96
DON'T KNOW ANY VACCINE 99
DON'T KNOW WHY 98

624. Does (NAME OF CHILD) live with you in your household?

YES 1
NO 2 (GO TO 626)

625. In your household who usually decides what to do if the (NAME OF CHILD) is ill?
RECORD ALL PERSONS MENTIONED.

RESPONDENT A
CHILD'S MOTHER B
WIFE/PARTNER WHO IS NOT CHILD'S MOTHER C
FEMALE RELATIVE D
MALE RELATIVE E
OTHER (SPECIFY) __________ X
CHILD HAS NEVER BEEN ILL Y

626. CHECK 606:

MOTHER IS ALIVE (CODED '00' - '94') ___
MOTHER NOT ALIVE (CODED '95') ___ (GO TO 628)

627. Please tell me if you would be angry with (NAME OF CHILD'S MOTHER) if she ever did the following:

a) She took (NAME OF CHILD) to be vaccinated without asking you?

YES, ANGRY 1
NO, NOT ANGRY 2
DON'T KNOW 8

b) Without asking you, she took (NAME OF CHILD) to a doctor or health worker because she thought the child was ill?

YES, ANGRY 1
NO, NOT ANGRY 2
DON'T KNOW 8

628. Now I want to talk to you about some common childhood illnesses.
When a child was diarrhea, should he/she be given less to drink than usual, about the same amount, or more than usual?

LESS 1
ABOUT THE SAME 2
MORE 3
DON'T KNOW 8

629. When a child is sick with diarrhea, what signs of illness would tell you that he or she should be taken to a health facility or health worker?
PROBE: Any other signs?
RECORD ALL SIGNS MENTIONED.

REPEATED WATERY STOOLS A
ANY WATERY STOOLS B
REPEATED VOMITING C
ANY VOMITING D
BLOOD IN STOOLS E
FEVER F
MARKED THIRST G
NOT EATING/NOT DRINKING WELL H
NOT GETTING BETTER I
OTHER (SPECIFY) __________ X
DON'T KNOW ANY SIGNS Y

630. When a child is sick with a cough, what signs of illness would tell you that he or she should be taken to a health facility or health worker?
PROBE: Any other signs?
RECORD ALL SIGNS MENTIONED.

RAPID BREATHING A
DIFFICULT BREATHING B
NOISY BREATHING C
FEVER D
UNABLE TO DRINK/SWALLOW E
NOT EATING/NOT DRINKING WELL F
NOT GETTING BETTER G
OTHER (SPECIFY) __________ X
DON'T KNOW ANY SIGNS Y

631. ASK 631, THEN FOLLOW SKIP PATTERN TO 632 AND 633 FOR EACH ILLNESS.
Now tell me about your own health. Have you ever, at any time in your life, had...

a) Tuberculosis?