Belarus

Woman's information panel: WM

This questionnaire is to be administered to all women age 15 through 49 (see Household Listing Form, column HL7). A separate questionnaire should be used for each eligible woman.

WM1. Cluster number: _ _ _

WM2. Household number: _ _

WM3. Woman's name:
WM4. Woman's line number: _ _

WM5. Interviewer number
WM6. Day/month/year of interview _ _ / _ _ / 2012

Repeat greeting if not already read to this woman:
We are from the Statistical Department of (city, region). Now the national household survey is organised in the republic of Belarus to obtain objective information on the situation of children and women. In this respect I would like to ask you several questions. The interview will take about 25 minutes. All the information we obtain will remain strictly confidential and will be used for statistical purposes only.

If greeting at the beginning of the household questionnaire has already been read to this woman, then read the following:
Now I would like to talk to you more about your health and other topics. This interview will take about 25 minutes. Again, all the information we obtain will remain strictly confidential and will be used for statistical purposes only.

May I start now?

WM7. Result of woman's interview

WM8. Field edited by (number):
WM9. Data entry clerk (number):
WM10. Record the time.
Woman's Background: WB

WB1. In what month and year were you born?

WB2. How old are you (in completed years)?
Compare and correct WB1 and/or WB2 if inconsistent.
WB3. Have you ever attended an educational institution, including preschool?

WB4. What is the highest level of education have you received / attending now?

WB5. What is the highest grade you completed at that level?
If less than 1 grade, enter "00"
WB6. Check WB4:
WB7. 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?
Access to mass media and use of information/communication technology: MT

MT1. Check WB7:
MT2. How often do you read a newspaper or magazine: almost every day, at least once a week, less than once a week or not at all?

MT3. Do you listen to the radio almost every day, at least once a week, less than once a week or not at all?

MT4. How often do you watch television: would you say that you watch almost every day, at least once a week, less than once a week or not at all?

MT5. Check WB2: Age of woman is between 15 and 24?

MT6. Have you ever used a computer?

MT7. Have you used a computer from any location in the last 12 months?

MT8. During the last one month, how often did you use a computer: almost every day, at least once a week, less than once a week or not at all?

MT9. Have you ever used the internet?

MT10. In the last 12 months, have you used the internet?
If necessary, probe for use from any location, with any device.
MT11. During the last one month, how often did you use the internet: almost every day, at least once a week, less than once a week or not at all?

Live Birth: CM

CM1. Now I would like to ask about the births you have had during your life. Have you ever given birth?
I mean, to a child who ever breathed or cried or showed other signs of life ? even if he or she lived only a few minutes or hours?

CM1A. To how many children, who was born alive, have you given birth during your life?

CM12. When did you give birth to a child last time (even if the child died)?
If the woman does not know the date of delivery, circle "98". Month and year should be recorded in any case.
CM13. Check CM12: Last birth occurred within the last 2 years, that is, since (day and month of interview) in 2010?
If the woman gave birth to a live child, record this child?s name:
____. Use the name of this child in the next questions.
Desire for last birth: DB

This module is to be administered to all women with a live birth in the 2 years preceding date of interview.

DB1. When you got pregnant with (name), did you want to get pregnant at that time?

DB2. Did you want to have a baby later on, or did you not want any (more) children?

DB3. How much longer did you want to wait?

Maternal and newborn health: MN

This module is to be administered to all women with a live birth in the 2 years preceding date of interview.

MN1. Did you see anyone for antenatal care during your pregnancy with (name)?

MN2. Whom did you see?
Probe: Anyone else? Probe for the type of person seen and circle the codes of all answers given.
MN2AA. To monitor the course of pregnancy, did you use free or paid services?

MN2AB. Decision on the use of paid medical services was taken independently by you alone or together with the husband / partner?

MN3. How many times did you receive antenatal care during this pregnancy?

MN4. As part of your antenatal care during this pregnancy, were any of the following done at least once:

[A] Was your blood pressure measured?

[B] Did you give a urine sample?

[C] Did you give a blood sample?

MN17. Who assisted with the delivery of (name)?
Probe: Anyone else? Probe for the type of person assisting and circle the codes of all answers given.
MN18. Where did you give birth to (name)?
Probe to identify the type of medical institution. If unable to determine whether public or private institution, write the name of the place.
(Name of place) ____
____
____

MN19. Was (name) delivered by caesarean section?

MN20. When (name) was born, was he/she very large, larger than average, average, smaller than average, or very small?

MN21. Was (name) weighed at birth?

MN22. How much did (name) weigh?
Record weight from health card, if available.
MN23. Has your menstrual period returned since the birth of (name)?

MN24. Did you ever breastfeed (name)?

MN25. 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.
MN26. In the first three days after delivery, was (name) given anything to drink other than breast milk?

MN27. What was (name) given to drink?
Probe: Anything else? Continue to probe to identify what the woman was giving to the child to drink, and circle the codes of all answers.
Post-natal health checks: PN

This module is to be administered to all women with a live birth in the 2 years preceding the date of interview.

PN1. Check MN18: Was the child delivered in a health facility?
PN2. 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 facility in MN18). How long did you stay there after the delivery?
If less than one day, record the number of hours. If less than one week, record the number of days. Otherwise, record the number of weeks.
PN3. I would like to talk to you about checks on (name)'s health after delivery during your stay at this medical institution. For example, someone examining (name), checking the cord, or seeing if (name) is ok. Before you left the (name or type of facility in MN18), did anyone check on (name)'s health?

PN4. 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 MN18)?

PN5. Now I would like to talk to you about what happened after you left (name or type of facility in MN18). Did anyone check on (name)'s health after you left (name or type of facility in MN18)?

PN6. Check MN17: Did a health professional, assist with the delivery?

PN7. You have already said that (person or persons in MN17) 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 cord, or seeing if (name) is ok.
After the delivery was over and before (person or persons in MN17) left you, did (person or persons in MN17) check on (name)'s health?

PN8. And did (person or persons in MN17) check on your health before leaving? I mean someone assessing your health, for example asking questions about your health or examining you.

PN9. After the (person or persons in MN17) left you, did anyone check on the health of (name)?

PN10. I would like to talk to you about checks on (name)'s health after delivery - for example, someone examining (name), checking the cord, or seeing if the baby is ok. After (name) was delivered, did anyone check on his/her health?

PN11. Did such a check happen only once, or more than once?

PN12A. How long after delivery did that check happen?
PN12B. How long after delivery did the first of these checks happen?
If less than one day, record the number of hours. If less than one week, record the number of days. Otherwise, record the number of weeks.
PN13. Who checked on (name)'s health?

PN14. Where did this check take place?
Probe to identify the type of medical institution. If unable to determine whether public or private institution, write the name of the place.
(Name of place) ____
____
____

PN15. Check MN18: Was the child delivered in a health facility?
PN16. After you left (name or type of facility in MN18), did anyone check on your health?

PN17. Check MN17: Did a health professional, assist with the delivery?
PN18. After the delivery was over and (person or persons in MN17) left, did anyone check on your health?

PN19. After the birth of (name), did anyone check on your health?
I mean someone assessing your health, for example asking questions about your health or examining you.

PN20. Did such a check happen only once, or more than once?

PN21A. How long after delivery did that check happen?
PN21B. How long after delivery did the first of these checks happen?
If less than one day, record the number of hours. If less than one week, record the number of days. Otherwise, record the number of weeks.
PN22. Who checked on your health?

PN23. Where did the checks take place?
Probe to identify the type of medical institution. If unable to determine whether public or private institution, write the name of the place.
(Name of place) ____
____
____

Illness Symptoms: IS

IS1. Check Household Listing Form, column HL9
Is the respondent the mother or caretaker of any child under age 5?

IS2. Sometimes children have severe illnesses and should be taken immediately to a health facility. What types of symptoms would cause you to take your child to a health facility right away?
Probe: Any other symptoms? Keep asking for more signs or symptoms until the mother/caretaker cannot recall any additional symptoms. Circle all symptoms mentioned, but do not prompt with any suggestions
Contraception: CP

CP0. I would like to talk with you about another subject ? family planning. Some people use various ways or methods to delay or avoid a pregnancy.
Have you heard of:

[A] Female sterilization

[B] Male sterilization

[C] IUD

[D] Injectables

[E] Implants

[F] Pill

[G] Male condom

[H] Female condom

[I] Diaphragm

[J] Foam/jelly

[K] Lactational amenorrhoea method (LAM)

[L] Periodic abstinence/rhythm

[M] Withdrawal

[N] Emergency/postcoital contraception

[X] Other

CP1. Are you pregnant now?

CP2. Are you currently doing something or using any method to delay or avoid getting pregnant?

CP3. What method are you using to delay or avoid a pregnancy?
Do not prompt. If more than one method is mentioned, circle each one.
CP4. Decision on the use of contraception was taken independently by you alone or together with the husband / partner?

Reproductive Health: 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. Did you want to have a baby later on or did you not want any (more) children?

UN4. 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?

UN5. Check CP3. Currently using "female sterilization"
UN6. 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?

UN7. When do you plan to give birth to (a/another) child?

UN8. Check CP1. Currently pregnant?
UN9. Check CP3. Currently using a contraception method?
UN10. Do you think you are physically able to get pregnant at this time?

UN11. Why do you think you are not physically able to get pregnant?

UN12. Check UN11. "Never menstruated" mentioned?
UN13. When did your last menstrual period start?

Marriage/union: MA

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

MA2. How old is your husband/partner?

MA2A. Check MA1. Currently married or living with a man?
MA5. Have you ever been married or lived together with a man as if married?

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

MA7. How many times have you been married or lived with a man?

MA8. In what month and year did you first marry or start living with a man as if married?

MA9. How old were you when you started living with your first husband/partner?

Attitudes toward domestic violence: DV

Check for the presence of others. Before continuing, ensure privacy.

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

[A] If she goes out without telling him?

[B] If she neglects the children?

[C] If she argues with him?

[D] If she refuses to have sex with him?

[E] If she burns the food?

DV2. What would you identify as the most common causes of domestic violence toward women committed by husbands / partners?
Circle all causes mentioned, but do not prompt.
DV3. Check MA1 and MA5. Currently married or in union or ever was married or in union?
DV4. Have you ever experienced any form of domestic violence committed by husbands / partners (physical, psychological, economic or sexual abuse)?

DV5. How often have you experienced some form of domestic violence committed by husbands / partners within 12 months, since (date and month of interview) 2011?

DV6. Have you ever left your house, trying to avoid violence or escape the violence by the husband/partner?

DV7. Have you ever sought for help from anyone because of domestic violence committed by the husband / partner?

DV8. Why have you never seek help?

DV9. What are the most efficient measures to combat domestic violence in your opinion?
Circle all countermeasures mentioned, but do not prompt.
DV10. Have you ever experienced physical violence committed by the parents to you in childhood?

Sexual behaviour: SB

Check for the presence of others. Before continuing, ensure privacy.

SB1. Now I would like to ask you some questions about sexual activity in order to gain a better understanding of some important life issues.
The information you supply will remain strictly confidential.
How old were you when you had sexual intercourse for the very first time?

SB2. The first time you had sexual intercourse, was a condom used?

SB3. When was the last time you had sexual intercourse?
All answers for the last 12 months should be recorded in months, years or days.
If more than 12 months (one year), answer must be recorded in years.
SB4. The last time you had sexual intercourse, was a condom used?

SB5. What was your relationship to this person with whom you last had sexual intercourse?
Probe to ensure that the response refers to the relationship at the time of sexual intercourse.
If 'boyfriend', probe: Were you living together as if married? If 'yes', circle '2'. If 'no', circle'3'.
SB6. Check MA1. Currently married or living with a man?
SB7. How old is this person?
If "DK", probe: About how old is this person?
SB8. Have you had sexual intercourse in the last 12 months with any other person, not yet previously mentioned?

SB9. The last time you had sexual intercourse with this person, was a condom used?

SB10. What was your relationship to this person?
Probe to ensure that the response refers to the relationship at the time of sexual intercourse
If 'boyfriend' probe: Were you living together as if married? If 'yes', circle '2'. If 'no', circle '3'.
SB11. Check MA1 and MA7. Currently married or living with a man and married only once or lived with a man only once?

SB12. How old is this person?
If DK, probe: About how old is this person?
SB13. Other than these two persons, have you had sexual intercourse with any other person in the last 12 months?

SB14. With how many people have you had sexual intercourse in the last 12 months?

SB15. With how many people have you had sexual intercourse in your lifetime?

If a non-numeric answer is given, probe to get an estimate. If number of partners is 95 or more, write '95'.
HIV/AIDS: HA

HA1. Now I would like to talk with you about something else.
Have you ever heard of AIDS or HIV?

HA2. Can people reduce their chance of getting HIV by having just one uninfected sex partner who has no other sex partners?

HA3. Can people get HIV because of witchcraft or other supernatural means?

HA4. Can people reduce their chance of getting HIV by using a condom every time they have sex?

HA5. Can people get HIV from mosquito bites?

HA6. Can people get HIV by sharing food with a person who has the AIDS virus?

HA7. Do you think it is possible for a healthy-looking person to have HIV?

HA8. Can HIV be transmitted from a mother to her baby:

[A] During pregnancy?

[B] During delivery?

[C] By breastfeeding?

HA9. In your opinion, should a person be allowed to continue teaching at school if having HIV?

HA10. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV?

HA11. If a member of your family got infected with HIV, would you want it to remain a secret?

HA12. If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?

HA13. Check CM12: Last birth occurred within the last 2 years, that is, since (day and month of interview) in 2010?
HA14. Check MN1: Received antenatal care?
HA15. During any of the antenatal visits for your pregnancy with (name),

Were you given any information about:

[A] Babies getting HIV from their mother?

[B] Things that you can do to prevent getting HIV?

[C] Getting tested for HIV?

Were you:
[D] Offered a test for HIV?

HA16. I don't want to know the results, but were you tested for HIV as part of your antenatal care?

HA17. I don't want to know the results, but did you get the results of the test?

HA18. Regardless of the result, all women who are tested are supposed to receive counseling after getting the result. After you were tested, did you receive counselling?

HA19. Check MN17: Did a health professional assist with the delivery?
HA20. I don't want to know the results, but were you tested for HIV between the time you went for delivery but before the baby was born?

HA21. I don't want to know the results, but did you get the results of the test?

HA22. Have you been tested for HIV after the delivery?

HA23. When was the most recent time you were tested for the AIDS virus?

HA24. I don't want to know the results, but have you ever been tested to see if you have HIV?

HA25. When was the most recent time you were tested?

HA26. I don't want to know the results, but did you get the results of the test?

HA27. Do you know of a place where people can go to get tested for HIV?

Tobacco and alcohol use: TA

TA1. Have you ever tried cigarette smoking, even one or two puffs?

TA2. How old were you when you smoked a whole cigarette for the first time?

TA3. Do you currently smoke cigarettes?

TA4. In the last 24 hours, how many cigarettes did you smoke?

TA5. During the last one month, on how many days did you smoke cigarettes?
If less than 10 days, record the number of days.
TA6. Have you ever tried any smoked tobacco products other than cigarettes, such as cigars, water pipe, cigarillos or pipe?

TA7. During the last one month, did you use any smoked tobacco products?

TA8. What type of smoked tobacco product did you use or smoke during the last one month?
Circle all mentioned.
TA9. During the last one month, on how many days did you use smoked tobacco products?
If less than 10 days, record the number of days.
TA10. Have you ever tried any form of smokeless tobacco products, such as chewing tobacco or snuff?

TA11. During the last one month, did you use any smokeless tobacco products?

TA12. What type of smokeless tobacco product did you use during the last one month?
Circle all mentioned.
TA13. During the last one month, on how many days did you use smokeless tobacco products?
If less than 10 days, record the number of days.
TA14. Now I would like to ask you some questions about drinking alcohol.
Have you ever drunk alcohol?

TA15. We count one drink of alcohol as one can or bottle of beer, one glass of wine, or one shot of cognac, vodka, whiskey or rum.
How old were you when you had your first drink of alcohol?

TA16. During the last one month, on how many days did you have at least one drink of alcohol?
If less than 10 days, record the number of days.

TA17. In the last one month, on the days that you drank alcohol, how many drinks did you usually have?

Life satisfaction: LS

LS1. Check WB2: Age of woman is between 15 and 24?
LS2. I would like to ask you some simple questions on happiness and satisfaction.
First, taking all things together, would you say you are very happy, somewhat happy, neither happy nor unhappy, somewhat unhappy or very unhappy?
Show side 1 of response card and explain what each symbol represents. [Image omitted.]
You can also look at these pictures to help you with your response.
Now I will ask you questions about your level of satisfaction in different areas.
In each case, we have five possible responses: please tell me, for each question, whether you are very satisfied, somewhat satisfied, neither satisfied, nor unsatisfied, somewhat unsatisfied or very unsatisfied.
Show side 2 of response card and explain what each symbol represents. [Image omitted.]
Again, you can look at these pictures to help you with your response.

Circle the response code shown by the respondent, for questions LS3 to LS13.

LS3. How satisfied are you with your family life?

LS4. How satisfied are you with your friendships?

LS5. During the current school year, did you attend any educational institution?

LS6. How satisfied (are/were) you with this educational institution?

LS7. How satisfied are you with your current job?
If the woman says that she does not have a job, circle "0" and continue with the next question.
LS8. How satisfied are you with your health?

LS9. How satisfied are you with where you live?
If necessary, explain that the question refers to the living environment, including the neighbourhood, district, infrastructure and the quality of dwelling.
LS10. How satisfied are you with how people around you generally treat you?

LS11. How satisfied are you with the way you look?

LS12. How satisfied are you with your life, overall?

LS13. How satisfied are you with your current income?
If the woman says that she does not have any income, circle "0" and continue with the next question.
LS14. Compared to this time last year, would you say that your life has improved, stayed more or less the same, or worsened, overall?

LS15. And in one year from now, do you expect that your life will be better, will be more or less the same, or will be worse, overall?

WM11. Record the time.
WM12. Check Household Listing Form, column HL9.
Is the respondent the mother or caretaker of any child age under-5 living in this household?
Interviewer's observations

Field editor's observations

Supervisor's observations

Response card:

Side 1

Side 2