Benin 2021

Woman's information panel: WM

WM1. Cluster number: _ _ _

WM2. Household number: _ _

WM3. Woman's name and line number:
WM4. Supervisor's name and number:
WM5. Interviewer's name and number:
WM6. Day/month/year of interview:
Check woman's age in HL6 in list of household members, household questionnaire: If age 15-17, verify in HH33 that adult consent for interview is obtained or not necessary (HL20=90). If consent is needed and not obtained, the interview must not commence and '06' should be recorded in WM17.

WM7. Record the time:
WM8. Check completed questionnaires in this household: Have you or another member of your team interviewed this respondent for another questionnaire?

WM9A. Hello, my name is (your name). We are from the National Institute of Statistics and Economic Analysis. We are conducting a survey about the situation of children, families and households. I would like to talk to you about your health and other topics. This interview usually takes about 45 minutes. We are also interviewing mothers about their children. All the information we obtain will remain strictly confidential and anonymous. If you wish not to answer a question or wish to stop the interview, please let me know. May I start now?

WM9B. Now I would like to talk to you about your health and other topics. This interview usually takes about 45 minutes. All the information we obtain will remain strictly confidential and anonymous. If you wish not to answer a question or wish to stop the interview, please let me know. May I start now?


WM17. Result of woman's interview.
Discuss any result not completed with your Supervisor.

Woman's background: WB

WB1. Check the respondent's line number (WM3) in woman's information panel and the respondent to the household questionnaire (HH47):
WB2. Check ED5 in education module in the household questionnaire for this respondent: Highest level of school attended:
WB3. In what month and year were you born?

WB4. How old are you?
Probe: How old were you at your last birthday? If responses to WB3 and WB4 are inconsistent, probe further and correct. Age must be recorded.
WB5. Have you ever attended school or any early childhood education programme?

WB6. What is the highest level and grade or year of school you have attended?

WB7. Did you complete that (grade/year)?
Probe: Did she successfully complete that (grade/year)?

WB8. Check WB4: Age of respondent:
WB9. At any time during the 2020-2021 school year did you attend school?

WB10. During this 2020-2021 school year, which level and grade or year are you attending?

WB11. At any time during the 2019-2020 school year did you attend school?

WB12. During the 2019-2020 school year, which level and grade or year did you attend?

WB13. Check WB6: Highest level of school attended:
WB14. Now I would like you to read this sentence to me.
Show sentence on the card to the respondent. If respondent cannot read whole sentence, probe: Can you read part of the sentence to me?
WB15. How long have you been continuously living in (name of current town of residence)?
If less than one year, record '00' years.
WB16. Just before you moved here, did you live in a special status city (Cotonou, Porto-Novo or Parakou), in another city, or in a rural area?
Probe to identify the type of place. If unable to determine whether the place is a special status city, other city or a rural area, write the name of the place and then temporarily record '5' until you learn the appropriate category for the response.
(Name of place) ____

WB17. Before you moved here, in which region did you live in?

WB18. Are you covered by any health insurance?

WB19. What type of health insurance are you covered by?
Record all mentioned.
Mass media and ICT: MT

MT1. Do you read a newspaper or magazine at least once a week, less than once a week or not at all?
If 'At least once a week', probe: Would you say this happens almost every day or less often? If 'Yes' record 3, if 'No' record 2.
MT2. Do you listen to the radio at least once a week, less than once a week or not at all?
If 'At least once a week', probe: Would you say this happens almost every day or less often? If 'Yes' record 3, if 'No' record 2
MT3. Do you watch television at least once a week, less than once a week or not at all?
If 'At least once a week', probe: Would you say this happens almost every day or less often? If 'Yes' record 3, if 'No' record 2
MT4. Have you ever used a computer or a tablet from any location?

MT5. During the last 3 months, did you use a computer or a tablet at least once a week, less than once a week or not at all?
If 'At least once a week', probe: Would you say this happened almost every day or less often? If 'Yes' record 3, if 'No' record 2
MT6. During the last 3 months, did you:










MT7. Check MT6[C]: Is 'Yes' recorded?
MT8. Check MT6[F]: Is 'Yes' recorded?
MT9. Have you ever used the internet from any location and any device?

MT10. During the last 3 months, did you use the internet at least once a week, less than once a week or not at all?
If 'At least once a week', probe: Would you say this happens almost every day or less often? If 'Yes' record 3, if 'No' record 2.
MT11. Do you own a mobile phone?

MT12. During the last 3 months, did you use a mobile telephone at least once a week, less than once a week or not at all?
Probe if necessary: I mean have you communicated with someone using a mobile phone. If 'At least once a week', probe: Would you say this happens almost every day or less often? If 'Yes' record 3, if 'No' record 2.
Fertility/Birth history: CM

CM1. Now I would like to ask about all the births you have had during your life. Have you ever given birth?
This module and the birth history should only include children born alive. Any stillbirths should not be included in response to any question.
CM2. Do you have any sons or daughters to whom you have given birth who are now living with you?

CM3. How many sons live with you?
If none, record '00'.
CM4. How many daughters live with you?
If none, record '00'.
CM5. Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?

CM6. How many sons are alive but do not live with you?
If none, record '00'.
CM7. How many daughters are alive but do not live with you?
If none, record '00'.
CM8. Have you ever given birth to a boy or girl who was born alive but later died?
If 'No' probe by asking:
I mean, to any baby who breathed, cried, or showed any other signs of life even if he/she lived for only a very short time?

CM9. How many boys have died?
If none, record '00'.
CM10. How many girls have died?
If none, record '00'.
CM11. Sum answers to CM3, CM4, CM6, CM7, CM9 and CM10.
CM12. Just to make sure that I have this right, you have had in total (total number of live births in CM11) births during your life. Is this correct?

CM13. Check responses to CM1-CM10 and make corrections as necessary until response in CM12 is 'Yes'.

CM14. Check CM11: How many live births?
Fertility/birth history: BH

BH0. Now I would like to list all of your births, whether still alive or not, starting with the first one you had.
Record names of all of the births in BH1. Record twins and triplets on separate lines.

BH. BH line number _ _

BH1. What name was given to your (first/next) baby? ____

BH2. Were any of these births twins?

BH3. Is (name of birth) a boy or a girl?

BH4. In what month and year was (name of birth) born?
Probe: What is (his/her) birthday?
BH5. Is (name of birth) still alive?

BH6. How old was (name of birth) at (his/her) last birthday?
Record age in completed years.
BH7. Is (name of birth) living with you?

BH8. Record household line number of child (from HL1)
Record '00' if child is not listed in household
BH9. If deceased: How old was (name) when (he/she) died?
If '1 year', probe: How many months old was (name)? Record days if less than 1 month; record months if less than 2 years; or years
BH9A. Was (name's) death registered with the civil registry?

BH10. Were there any other live births between (name of previous birth) and (name), including any children who died just after birth?

BH11. Have you had any live births since the birth of (name of last birth listed)?

CM15. Compare number in CM11 with number of births listed in the birth history above and check:
CM16. Probe and reconcile responses in the birth history until response in CM15 is 'Numbers are the same'.

CM17. Check BH4: Last birth occurred within the last 2 years, that is, since (month of interview) in 2019?
If the month of interview and the month of birth are the same, and the year of birth is 2019, consider this as a birth within the last 2 years.
CM18. Copy name of the last child listed in BH1.
If the child has died, take special care when referring to this child by name in the following modules.
Desire for last birth: DB

DB1. Check CM17: Was there a live birth in the last 2 years?
Copy name of last birth listed in the birth history (CM18) to here and use where indicated:
Name ____

DB2. When you got pregnant with (name), did you want to get pregnant at that time?

DB3. Check CM11: Number of live births:
DB4A. Did you want to have a baby later on, or did you not want any children?
DB4B. Did you want to have a baby later on, or did you not want any more children?

Maternal and newborn health: MN

MN1. Check CM17: Was there a birth in the last 2 years?
Copy name of last birth listed in the birth history (CM18) to here and use where indicated:
Name ____

MN2. Did you see anyone for antenatal care during your pregnancy with (name)?

MN3. Whom did you see?
Probe: Anyone else? Probe for the type of person seen and record all answers given.
MN4. How many weeks or months pregnant were you when you first received antenatal care for this pregnancy?
Record the answer as stated by respondent. If "9 months" or later, record 9.
MN5. How many times did you receive antenatal care during this pregnancy?
Probe to identify the number of times antenatal care was received. If a range is given, record the minimum number of times antenatal care received.
MN6. As part of your antenatal care during this pregnancy, were the following things done at least once:





MN6AA. As part of your antenatal care during this pregnancy, how many times were the following things done to you:
Make sure that the number reported is not higher than the total number of antenatal consultations reported in MN5





MN7. Do you have a card or other document with your own immunizations listed?
If yes: May I see it please? If a card is presented, use it to assist with answers to the following questions.
MN8. When you were pregnant with (name), did you receive any injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?

MN9. How many times did you receive this tetanus injection during your pregnancy with (name)?
If number of doses is 7 or more, record '7'.
MN10. Check MN9: How many tetanus injections during last pregnancy were reported?
MN11. At any time before your pregnancy with (name), did you receive any tetanus injection either to protect yourself or another baby?
Include DTP (Tetanus) vaccinations received as a child if mentioned.
MN12. Before your pregnancy with (name), how many times did you receive a tetanus injection?
If 7 or more times, record '7'. Include DTP (Tetanus) vaccinations received as a child if mentioned.
MN13. Check MN12: How many tetanus injections before last pregnancy were reported?
MN14A. How many years ago did you receive that tetanus injection?
MN14B. How many years ago did you receive the last of those tetanus injections?
The reference is to the last injection received prior to this pregnancy, as recorded in MN12. If less than 1 year, record '00'.
MN16. During the pregnancy with (name), did you take SP/Fansidar to keep you from getting malaria?

MN17. How many times did you take SP/Fansidar during your pregnancy with (name)?

MN18. Did you get the SP/Fansidar during an antenatal care visit, during another visit to a health facility, from a community health agent or from another source?

MN18AA. Did you receive a prescription for iron supplements during these antenatal consultations to prevent anemia?

MN18AB. Did you take an iron tablet every day during this pregnancy to prevent anemia?

MN19. Who assisted you with the delivery of (name)?
Probe: Anyone else? Probe for the type of person assisting and record all answers given.
MN20. Where did you give birth to (name)?
Probe to identify the type of place. If unable to determine whether public or private, write the name of the place and then temporarily record '76' until you learn the appropriate category for the response.
(Name of place) ____

MN21. Was (name) delivered by caesarean section? That is, did they cut your belly open to take the baby out?

MN22. When was the decision made to have the caesarean section?
Probe if necessary: Was it before or after your labour pains started?
MN23. Immediately after the birth, was (name) put directly on the bare skin of your chest?
If necessary, show the picture of skin-to-skin position. [Image omitted]
MN24. Before being placed on the bare skin of your chest, was the baby wrapped up?

MN25. Was (name) dried or wiped soon after birth?

MN26. How long after the birth was (name) bathed for the first time?
If "immediately" or less than 1 hour, record '000'. If less than 24 hours, record hours. If "1 day" or "next day", probe: About how many hours after the delivery? If "24 hours", probe to ensure best estimate of less than 24 hours or 1 day. If 24 hours or more, record days. If never washed, record 997. If DK/don't remember, record 998.
MN27. Check MN20: Was the child delivered in a health facility?
MN28. What was used to cut the cord?

MN29. Was the instrument used to cut the cord boiled or sterilized prior to use?

MN30. After the cord was cut and until it fell off, was anything applied to the cord?

MN31. What was applied to the cord?
Probe: Anything else?
MN32. When (name) was born, was (he/she) very large, larger than average, average, smaller than average, or very small?

MN33. Was (name) weighed at birth?

MN34. How much did (name) weigh?
If a card is available, record weight from card.
MN35. Has your menstrual period returned since the birth of (name)?

MN36. Did you ever breastfeed (name)?

MN37. How long after birth did you first put (name) to the breast?
If less than 1 hour, record '00' hours. If less than 24 hours, record hours. Otherwise, record days.
MN38. In the first three days after delivery, was (name) given anything to drink other than breast milk?

MN39A. What was (name) given to drink?
Probe: Anything else? 'Not given anything to drink' is not a valid response and response category Y cannot be recorded.
MN39B. In the first three days after delivery, what was (name) given to drink?
Probe: Anything else? 'Not given anything to drink' (category Y) can only be recorded if no other response category is recorded.
Postnatal health checks: PN

PN1. Check CM17: Was there a live birth in the last 2 years?
Copy name of last birth listed in the birth history (CM18) to here and use where indicated:
Name ____

PN2. Check MN20: Was the child delivered in a health facility?
PN3. Now I would like to ask you some questions about what happened in the hours and days after the birth of (name).
You have said that you gave birth in (name or type of health facility in MN20). How long did you stay there after the delivery?
If less than one day, record hours. If less than one week, record days. Otherwise, record weeks.
PN4. I would like to talk to you about checks on (name)'s health after delivery - for example, someone examining (name), checking the umbilical cord, or seeing if (name) is ok.
Before you left the (name or type of facility in MN20), did anyone check on (name)'s health?

PN5. And what about checks on your health - I mean, someone assessing your health, for example asking questions about your health or examining you?
Did anyone check on your health before you left (name or type or facility in MN20)?

PN6. Now I would like to talk to you about what happened after you left (name or type of health facility in MN20).
Did anyone check on (name)'s health after you left (name or type of health facility in MN20)?

PN7. Check MN19: Did a health professional, traditional birth attendant, or community health worker assist with the delivery?
PN8. You have already said that (person or persons in MN19) assisted with the birth. Now I would like to talk to you about checks on (name)'s health after delivery, for example examining (name), checking the umbilical cord, or seeing if (name) is ok.
After the delivery was over and before (person or persons in MN19) left you, did (person or persons in MN19) check on (name)'s health?

PN9. And did (person or persons in MN19) check on your health before leaving, for example asking questions about your health or examining you?
Here, it is a question of the departure of (person or persons in MN19) who helped with delivery.

PN10. After the (person or persons in MN19) left you, did anyone check on the health of (name)?

PN11. I would like to talk to you about checks on (name)'s health after delivery -- for example, someone examining (name), checking the umbilical cord, or seeing if the baby is ok.
After (name) was delivered, did anyone check on (his/her) health?

PN12. Did such a check happen only once, or more than once?

PN13A. How long after delivery did that check happen?
PN13B. How long after delivery did the first of these checks happen?
If less than one day, record hours. If less than one week, record days. Otherwise, record weeks.
PN14. Who checked on (name)'s health at that time?

PN15. Where did this check take place?
Probe to identify the type of place. If unable to determine whether public or private, write the name of the place and then temporarily record '76' until finding the appropriate category for the response.
(Name of place) ____

PN16. Check MN20: Was the child delivered in a health facility?
PN17. After you left (name or type of health facility in MN20), did anyone check on your health?

PN18. Check MN19: Did a health professional, traditional birth attendant, or community health worker assist with the delivery?
PN19. After the delivery was over and (person or persons in MN19) left, did anyone check on your health?

PN20. After the birth of (name), did anyone check on your health, for example asking questions about your health or examining you?

PN21. Did such a check happen only once, or more than once?

PN22A. How long after delivery did that check happen?
PN22B. How long after delivery did the first of these checks happen?
If less than one day, record hours. If less than one week, record days. Otherwise, record weeks.
PN23. Who checked on your health at that time?

PN24. Where did this check take place?
Probe to identify the type of place.
If unable to determine whether public or private, write the name of the place and then temporarily record '76' until finding the appropriate category for the response.
(Name of place)____

PN25. During the first two days after birth, did any health care provider do any of the following either at home or at a health facility:




PN26. Check MN36: Was child ever breastfed?
PN27. During the first two days after (name)'s birth, did a health agent observe (name)'s breastfeeding?

PN28. Check MN33: Was child weighed at birth?
PN29A. You mentioned that (name) was weighed at birth. After that, was (name) weighed again by a health care provider within two days?
PN29B. You mentioned that (name) was not weighed at birth. Was (name) weighed at all by a health care provider within two days after birth?
PN29C. You mentioned that you do not know if (name) was weighed at birth. Was (name) weighed by a health care provider within two days after birth?

PN30. During the first two days after (name)'s birth, did any health care provider give you information on the symptoms that require you to take your sick child to a health facility for care?

Contraception: CP

CP1. I would like to talk with you about another subject: family planning.
Are you pregnant now?

CP2. Couples use various ways or methods to delay or avoid getting pregnant.
Are you currently doing something or using any method to delay or avoid getting pregnant?

CP3. Have you ever done something or used any method to delay or avoid getting pregnant?

CP4A. What are you doing to delay or avoid a pregnancy?
CP4B. What have you done to delay or avoid a pregnancy?
Do not suggest any answers. If more than one method is mentioned, record each one.
CP5. Check CP4:
CP6. In what facility was the sterilization performed?
(Name of place) ______

CP7. Check CP2=1?
CP8A. Where did you get the method that you are currently using?
CP8B. Where did you get the method that you used?
Probe to identify the type of place.
If unable to determine if place is public or private sector, write the name of the place.
(Name of place) ______

CP9. Do you know of a place where you can get a family planning method?

Unmet need: UN

UN1. Check CP1: Currently pregnant?
UN2. Now I would like to talk to you about your current pregnancy. When you got pregnant, did you want to get pregnant at that time?

UN3. Check CM11: Ever given birth?
UN4A. Did you want to have a baby later on or did you not want any children?
UN4B. Did you want to have a baby later on or did you not want any more children?

UN5. Now I would like to ask some questions about the future. After the child you are now expecting, would you like to have another child, or would you prefer not to have any more children at all?

UN6. Check CP4: Currently using 'Female sterilization'?
UN7. Now I would like to ask you some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?

UN8. How long would you like to wait before the birth of (a/another) child?
Record the answer as stated by respondent.
UN9. Check CP1: Currently pregnant?
UN10. Check CP2: Currently using a method?
UN11. Do you think you are physically able to get pregnant at this time?

UN12. Why do you think you are not physically able to get pregnant?

UN13. Check UN12: 'Never menstruated' mentioned?
UN14. When did your last menstrual period start?
Record the answer using the same unit stated by the respondent. If '1 year', probe: How many months ago?
UN15. Check UN14: Was the last menstrual period within last year?
UN16. Due to your last menstruation, were there any social activities, or work days that you could not attend?

UN17. During your last menstrual period were you able to wash and change in privacy while at home?

UN18. Did you use any materials such as sanitary pads, tampons or cloth?

UN19. Were the materials reusable?

Attitudes toward domestic violence: DV

DV1. Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:








Victimization: VT

VT1. Check for the presence of others. Before continuing, ensure privacy. Now I would like to ask you some questions about crimes in which you personally were the victim.
Let me assure you again that your answers are completely confidential and will not be told to anyone. In the last three years, that is since (month of interview) (year of interview minus 3), has anyone taken or tried taking something from you, by using force or threatening to use force?
Include only incidents in which the respondent was personally the victim and exclude incidents experienced only by other members of the household. If necessary, help the respondent to establish the recall period and make sure that you allow adequate time for the recall. You may reassure: It can be difficult to remember this sort of incidents, so please take your time while you think about your answers.

VT2. Did this last happen during the last 12 months, that is, since (month of interview) (year of interview minus 1)?

VT3. How many times did this happen in the last 12 months?
If 'DK/Don't remember', probe: Did it happen once, twice, or at least three times?
VT4. Check VT3: One or more times?
VT5A. When this happened, was anything stolen from you?
VT5B. The last time this happened, was anything stolen from you?

VT6. Did the person(s) have a weapon?

VT7. Was a knife, a revolver/gun or something else used as a weapon?
Record all that apply.
VT8. Did you or anyone else report the incident to the police?
If 'Yes', probe: Was the incident reported by you or someone else?
VT9A. Apart from the incident(s) just covered, have you in the last three years, that is since (month of interview) (year of interview minus 3), been physically attacked?
VT9B. In the same period, that is since (month of interview) (year of interview minus 3), have you been physically attacked?
If 'No', probe: An attack or a threat can happen at home or any place outside of the home, such as in other homes, in the street, at school, on public transport, public restaurants, or at your workplace.
Include only incidents in which the respondent was personally the victim and exclude incidents experienced only by other members of the household. Exclude incidents where the intention was to take something from the respondent, which should be recorded under VT1.
VT10. Did this last happen during the last 12 months, that is, since (month of interview) (year of interview minus 1)?

VT11. How many times did this happen in the last 12 months?
If 'DK/Don't remember', probe: Did it happen once, twice, or at least three times?
VT12A. Where did this happen?
VT12B. Where did this happen the last time?

VT13. How many people were involved in committing the offence?
If 'DK/Don't remember', probe: Was it one, two, or at least three people?
VT14A. At the time of the incident, did you recognize the person?
VT14B. At the time of the incident, did you recognize at least one person?

VT17. Did the person(s) have a weapon?

VT18. Was a knife, a revolver/gun or something else used as a weapon?
Record all that apply.
VT19. Did you or anyone else report the incident to the police?
If 'Yes', probe: Was the incident reported by you or someone else?
VT20. How safe do you feel walking alone in your neighbourhood after dark?

VT21. How safe do you feel when you are at home alone after dark?

VT22. In the past 12 months, have you personally felt discriminated against or harassed on the basis of the following grounds?








Marriage/union: MA

MA1. Are you currently married or living together with someone as if married?

MA1A. What kind of marriage united you?

MA2. How old is your (husband/partner)?
Probe: How old was your (husband/partner) on his last birthday?
MA3. Besides yourself, does your (husband/partner) have any other wives or partners or does he live with other women as if married?

MA4. How many other wives or partners does he have?

MA5. Have you ever been married or lived together with someone as if married?

MA6. What is your marital status now: are you widowed, divorced or separated?

MA7. Have you been married or lived with someone only once or more than once?

MA8A. In what month and year did you start living with your (husband/partner)?
MA8B. In what month and year did you start living with your first (husband/partner)?

MA9. Check MA8A/B: Is 'DK year' recorded?
MA10. Check MA7: In union only once?
MA11A. How old were you when you started living with your (husband/partner)?
MA11B. How old were you when you started living with your first (husband/partner)?

Informed consent about reproductive health care: ID

ID1. Check MA1: Is woman currently married or does she live with someone as if she were married?
ID2. Can you refuse to have sex with your (husband/partner) when you don't want to?

ID3. Who usually makes decisions about your own health care: you, your (husband/partner), you and your (husband/partner) jointly, or someone else?

ID4. Who usually makes the decision about using family planning/contraception, you, your (husband/partner), you and your (husband/partner) jointly, or someone else?

Adult functioning: AF

AF1. Check WB4: Age of respondent?
AF2. Do you use glasses or contact lenses?
Include the use of glasses for reading.
AF3. Do you use a hearing aid?

AF4. I will now ask you about difficulties you may have doing a number of different activities. For each activity there are four possible answers: Please tell me if you have: 1) no difficulty, 2) some difficulty, 3) a lot of difficulty or 4) that you cannot do the activity at all.
Repeat the categories during the individual questions whenever the respondent does not use an answer category:
Remember, the four possible answers are: 1) no difficulty, 2) some difficulty, 3) a lot of difficulty, or 4) that you cannot do the activity at all.

AF5. Check AF2: Respondent uses glasses or contact lenses?
AF6A. When using your glasses or contact lenses, do you have difficulty seeing?
AF6B. Do you have difficulty seeing?

AF7. Check AF3: Respondent uses a hearing aid?
AF8A. When using your hearing aid(s), do you have difficulty hearing?
AF8B. Do you have difficulty hearing?

AF9. Do you have difficulty walking or climbing steps?

AF10. Do you have difficulty remembering or concentrating?

AF11. Do you have difficulty with self-care, such as washing all over or dressing by yourself?

AF12. Using your usual language, do you have difficulty communicating, for example understanding or being understood?

Domestic Violence: DV

VD1. Check the respondent's line number (WM3) in the woman's information panel and in the household questionnaire (HH30E):
VD2. Check for the presence of other persons: do not continue until you are certain you have privacy.

VD3. Read to respondent:
Now, I would like to ask you some questions concerning certain aspects of a woman's life. You are going to find some of these questions to be very personal. However, your answers are very important to help us understand the condition of women in Benin. I promise you that your answers will remain completely confidential and that they will not be shared with anyone. I also want to assure you that no one else in your household besides you will know that you were asked these questions. If I happen to ask a question that you do not wish to answer, tell me and I will go on to the next question.

DV4. Check MA1 and MA5: Currently in union, formerly in union, or never in union
VD5. First, I am going to ask you some questions on some situations that some women are confronted with. Please tell me if the following situations apply to your relations with your (last) (husband/partner).

VD5A. Has your (last) (husband/partner):




VD5B. How often has this happened over the past 12 months: often, from time to time, or not at all?

VD6A. Has it ever happened that your (last) (husband/partner) did any of the following to you:











VD6B. How many times has this happened in the last 12 months?

VD7. Check DV6A ('a' through 'j')
VD8. How soon (after your marriage/after starting to live) with (last) (husband/partner) did this event or events take place for the first time?
If less than one year, record '00'.
VD9. Did this act or these acts of violence take place in the presence of one or more of your children?

VD10. How frequently did this act or these acts of violence take place in the presence of your children?

VD11. Have you ever hit, slapped, kicked or done something else with the intention of physically hurting your (last) (husband/partner) though he was not beating you or hurting you physically?

VD12. In the last 12 months, how many times did you do that to your (last) (husband/partner): often, sometimes, or not at all?

VD13. Have you ever been (were you ever) afraid of your (last) (husband/partner): often, sometimes, or not at all?

VD13D. Check MA7: was married or lived with someone, one or more times
VD13A. Until now, we have been discussing your (current/last) (husband/partner). Now, I would like to ask you some questions about your past partners/husbands.




VD13B. How long ago did this happen?

DV14. Check MA1 and MA5: already been married or already lived with a man; never married or never lived with a man?
VD14A. Since the age of 15, has anyone other than (your/a) (husband/partner) beat you, slapped you, kicked you or done anything to hurt you physically?
VD14B. Since the age of 15, has anyone beat you, slapped you, kicked you or done anything to hurt you physically?

VD15. Who assaulted you this way? Anyone else?
Record all mentioned.
VD16. In the last 12 months, how many times did (this person/these persons) assault you physically: often, sometimes, or not at all?

VD17: Check MA1 and MA5: already been married or already lived with a man; never married or never lived with a man?
VD18. Now I would like to ask you some questions on things that could have been done to you by someone other than (your/a) (husband/partner). At any time in your life, when you were a child or adult, did someone force you to have sexual intercourse or to perform other sexual acts against your will?

VD19. At any time in your life, when you were a child or adult, did someone force you to have sexual intercourse or to perform other sexual acts against your will?

VD20. Who is the person who forced you the first time that it happened?

VD21. As far as you know, did you father beat your mother?

Thank respondent for her cooperation and reassure her that her answers will remain confidential. Complete the questions below concerning the module on domestic violence only.

VD22. Did you have to stop the interview because an adult tried to listen, came into the room, or tried to intervene in another way?




VD23. Interviewer's comments/if interview on domestic violence could not be conducted, give the reasons.

WM10. Record the time of the end of interview.

WM11. Was the entire interview completed in private or was there anyone else during the entire interview or part of it?
WM12. Language of the Questionnaire.

WM13. Language of the Interview.

WM14. Native language of the Respondent.

WM15. Was a translator used for any part of this questionnaire?

MICS Plus Consent

WM15A. Check respondent's line number (WM3) in woman's information panel and respondents to household questionnaire (HH47), Age 5 to 17 questionnaire (FS4) or under 5 child questionnaire (UF4): has respondent already been interviewed for one of the other questionnaires?

WM15B. Check HC7 [A] and HC12: Does this household have a landline telephone or does a member of the household own a mobile phone?
WM15C. Thank you for your participation.
The National Institute of Statistics and Economic Analysis ("INSAE") will carry out a telephone survey on the situation of children, families and households in the future. We would like to invite you to participate in this survey. If you agree to participate, we will ask you to share a telephone number by which we can reach you at convenient times. The telephone interview will take several minutes, and we may call you several times over the period of several months. Participation in this telephone survey is voluntary, and even if you agree to participate now, you can decide to withdraw from participation in the future. There is no cost for you to participate in the telephone survey. Know that all the information you share at the time of future telephone interviews will remain strictly confidential and that your phone number will not be shared with anyone outside of our team. Do you want to participate?

WM15D. Do you have a personal phone number or does your household have a common number where you can be reached?

WM15E. You may share the common phone number for your household, but please do not share any personal telephone number belonging to individual members of your household. Please tell me what the primary phone number is to use to reach you.

[Repeat WM15F -- WM15J for up to 3 phone numbers]

WM15F. Ask for and record the phone number. _ _ _ _ _ _ _

WM15G. Just to make sure, the number is (number from WM15F)?
If not, go back to WM15F and correct the entry.
WM15H. Is it a landline number or a mobile phone number?

WM15I. What is the best day of the week and time of day to call you at this number?
Probe: A different day or time?
Record all mentioned.
WM15J. Please remember that you can share your household's common phone number, but please do not share any personal telephone number belonging to individual members of your household. Do you have another personal or common phone number where you can be reached?

[] Tick here if additional questionnaire used

WM16. Check columns HL10 and HL20 in list of household members, household questionnaire:
Is the respondent the mother or caretaker of any child age 0-4 living in this household?
[] Yes (Go to WM17 in woman's information panel and record '01'. Then go to the questionnaire for children under five for that child and start the interview with this respondent.)
[] No (Check HH26-HH27 in household questionnaire: Is there a child age 5-17 selected for questionnaire for children age 5-17?)
Interviewer's observations

Supervisor's observations