Women's Information Panel: WM

This module is to be administered to all women age 15 through 49 (see column HL6 of HH listing). Fill in one form for each eligible woman. Fill in the cluster and household number, and the name and line number of the woman in the space below. Fill in your name, number and the date.

WM1. Cluster number _ _ _ _

WM2. Household number _ _ _

WM3. Woman's name ____

WM4. Woman's line number _ _

WM5. Interviewer name and number____ _ _

WM6. Day/month/year of interview _ _ / _ _ / _ _ _ _

WM7. Result of women's interview
Repeat greeting if not already read to this woman:
We are from the Ministry of Economy, Planning and International Cooperation. We are working on a project concerned with family health and education. I would like to talk to you about this. The interview will take about 30 minutes. All the information we obtain will remain strictly confidential and your answers will never be identified. Also, you are not obliged to answer any question you don't want to, and you may withdraw from the interview at any time. May I start now?

If permission is given, begin the interview. If the woman does not agree to continue, thank her, complete wm7, and go to the next interview. Discuss this result with your supervisor for a future revisit.

WM8. In what month and year were you born?

WM9. How old were you at your last birthday?

WM10. Have you ever attended school?

WM11. What is the highest level of school you attended: primary, secondary, or higher?

WM12. What is the last year/class you completed at this level?

WM13. Check WM11:
WM14. Now I would like you to read this sentence to me.
Show sentences to respondent. If respondent cannot read whole sentence, probe: Can you read part of the sentence to me?
WM15A. What is your job?

WM15B. What is your religion?

WM15C. What is your ethnicity?

Child Mortality Module: CM

This module is to be administered to all women age 15-49. All questions refer only to live births.

CM1. Now I would like to ask about all the births you have had during your life. Have you ever given birth?
If "no" probe by asking: 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?
CM2a. What was the date of your first birth?
I mean the very first time you gave birth, even if the child is no longer living, or whose father is not your current partner.
Skip to CM3 only if year of first birth is given. Otherwise, continue with CM2b.
CM2B. How many years ago did you have your first birth?

CM3. Do you have any sons or daughters to whom you have given birth who are now living with you?

CM4 How many sons live with you? How many daughters live with you?

CM5. Do you have any sons or daughters 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? How many daughters are alive but do not live with you?

CM7. Have you ever given birth to a boy or girl who was born alive but later died?

CM8. How many boys have died? How many girls have died?

CM9. Sum answers to CM4, CM6, and CM8
CM10 Just to make sure that I have this right, you have had (total number) births during your life. Is this correct?

CM11. Of these (total number) births you have had, when did you deliver the last one (even if he or she has died)?
If day is not known, enter '98' in space for day.
CM12. Check CM11: Did the woman's last birth occur within the last 2 years, that is, since (day and month of interview in 2004)?
If child has died, take special care when referring to this child by name in the following modules
CM13. At the time you became pregnant with (name), did you want to become pregnant then, did you want to wait until later, or did you want no (more) children at all?

Tetanus Toxoid (TT) module: TT

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

TT1. Do you have a card or other document with your own immunizations listed?
If a card is presented, use it to assist with answers to the following questions.

TT2. When you were pregnant with your last child, did you receive any injection to prevent him or her from getting tetanus, that is convulsions after birth (an anti-tetanus shot, an injection at the top of the arm or shoulder)?

TT3: If yes: how many times did you receive this anti-tetanus injection during your last pregnancy?

TT4. How many TT doses during last pregnancy were reported in TT3?
TT5. Did you receive any tetanus toxoid injection at any time before your last pregnancy?

TT6. How many times did you receive it?

TT7. In what month and year did you receive the last tetanus injection before that last pregnancy?
Proceed to the next module only if the year of injection is known. Otherwise continue with TT8
TT8. How many years ago did you receive the last anti-tetanus injection before that last pregnancy?

Maternal and newborn health module: MN

This module is to be administered to all women with a live birth in the 2 years preceding date of interview.
Check child mortality module CM12 and record name of last-born child here ____
Use this child's name in the following questions, where indicated.

MN1. In the first two months after your last birth [the birth of name], did you receive a vitamin A dose like this?
Show 200,000 IU capsule or dispenser.
MN2. Did you see anyone for antenatal care for this pregnancy?
If yes: Whom did you see? Anyone else? Probe for the type of person seen and circle all answers given.
MN3. As part of your antenatal care, were any of the following done at least once?

MN3A. Were you weighed?

MN3B. Was your blood pressure measured?

MN3C. Did you give a urine sample?

MN3D. Did you give a blood sample?

MN4. During any of the antenatal visits for the pregnancy, were you given any information or counseled about AIDS or the AIDS virus?

MN5. I don't want to know the results, but were you tested for the AIDS virus as part of your antenatal care?

MN6. I don't want to know the results, but did you get the results of the test?

MN6A. During your pregnancy, did you take medicine to avoid getting malaria?

MN6B. What was the medicine?
Circle all that are mentioned. If the type of medicine cannot be determined, show standard types of antimalarials to the respondent.
MN6C. Check MN6B for the type of medicine taken
MN6D. How many times did you take the medicine SP/Fansidar during pregnancy?

MN7. Who assisted with the delivery of your last child (name)? Anyone else?
Probe for the type of person assisting and circle all answers given
MN8. Where did you give birth to (name)?
If source is hospital, health center, or clinic, write the name of the place below. Probe to identify the type of source and circle the appropriate code.
(Name of place) ____

MN9. When you last child (name) was born, was he/she very large, larger than average, average, smaller than average, or very small?

MN10. Was (name) weighed at birth?

MN11. How much did (name) weigh?
Record weight from health card, if available
MN12. Did you ever breastfeed (name)?

MN13. 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.
Marriage/union module: MA

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

MA2. Besides yourself, does your husband/partner have any other wives?

MA2B. How many other wives does he have?

MA3. How old was your husband/partner on his last birthday?

MA3A. What job does your husband/partner have?

MA3B. What religion is your husband/partner?

MA3C. What is your husband/partner's ethnicity?

MA3D What is the highest level of education that your husband/partner achieved?

MA3E. What was the last grade that your husband/partner achieved at this level?

MA4. Have you already been married or lived with a man?

MA5. What is your current marital status: widowed, divorced, separated?

MA6. Have you been married or lived with a man one time or more than one time?

MA7. In what month and year did you first marry or start living with a man as if married?

MA8. Check MA7:
MA9. How old were you when you started to live with your first husband/partner?

Contraception and unmet need: CP

CP1. I would like to talk with you about another subject -- family planning -- and your reproductive health. Are you pregnant now?

CP1A. At the time you became pregnant did you want to become pregnant then, did you want to wait until later, or did you not want to have any more children?

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

CP3. Which method are you using?
Do not prompt.
If more than one method is mentioned, circle each one.
CP4A. Now I would like to ask some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?

CP4B. If currently pregnant: 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?

CP4C. How long would you like to wait before the birth of (a/another) child?

CP4D. Check CP1:
CP4E. Do you think you are physically able to get pregnant at this time?

Female Genital Mutilation Module: FG

FG1. Have you ever heard of female circumcision?

FG2. In a number of countries, there is a practice in which a girl may have part of her genitals cut. Have you ever heard about this practice?

FG3. Have you yourself ever been circumcised?

FG4. Now I would like to ask you what was done to you at this time. Was any flesh removed from the genital area?

FG5. Was the genital area just nicked without removing any flesh?

FG6. Was the genital area sewn closed (or 'sealed')?

FG7. Who circumcised you?

FG8. The following questions apply only to women who have at least one living daughter.
Check CM4 and CM6, Child Mortality Module: Woman has living daughter?
FG9. Have any of your daughters been circumcised? If yes, how many?

FG10. To which of your daughters did this happen most recently?

FG11. Now I would like to ask you what was done to (name) at that time. Was any flesh removed from the genital area?

FG12. Was the genital area just nicked without removing any flesh?

FG13. Was the genital area sewn closed (or 'sealed')?

FG14. How old was (name) when this occurred?
If the respondent does not know the age, probe to get an estimate.

FG15. Who did the circumcision?

FG16. Do you think this practice should be continued or should it be discontinued?

Fistula module: FI

FI1. Have you ever heard of obstetric fistula (urine disease)? If "no", ask : have you ever heard of a case of a woman losing urine and/or passing urine continually following childbirth?

FI2A. What do you think are the causes of this disease?
Anything else?

FI2B. What do you think are the main manifestations of this disease?
Anything else?

FI3. Do you think this disease can be treated and cured?

FI4. Have you ever contracted this disease?

FI5. Is it a continuous loss of urine or defecation or both?

FI6. How long have you had it?

FI7. How do you think you contracted this disease?

FI8. Have you received or are you currently receiving treatment for your fistula?

FI9. What type of treatment do you receive?

FI10. What do you think are the results of these treatments so far?

FI11. Now, I would like to ask you some questions about the reaction of the people around you and other consequences of your illness.
FI11A. What is or was your spouse's reaction

FI11B. What is or was the reaction of your children?

FI11C. What is or was the reaction of other members of your family?

FI11D. What is or has been the reaction of the community?

FI11E. As a result of your fistula, have any of the following occurred?

Check FI8: If the circled answer is 2, then ask the following question:
FI12. Why have you remained uncared for so far?

FI13. In your opinion, can fistulas be prevented by adopting the following behaviours in the event of pregnancy?

FI13A. Conducting prenatal consultations in a health centre

FI13B. Delivering in a hospital or a maternity

FI13C. Provide postnatal consultations

FI13D. Participate in planning sessions family

FI13E. Avoiding housework very hard (water, wood, etc.)

FI13F. Avoid taking potions traditional medicines

FI14. Do you know other women who suffer or have suffered from fistula

FI15. If yes, how many women

Attitudes towards domestic violence module: DV

This module should be administered to all women aged 15-49. See the Instructions to Investigators for further discussion of these issues

Check questions MA1 and MA5 of the union and marriage module (page)
DV1 When two people are married or living together, they share good and bad times. In your relationship with your (last) husband/partner, do the following things (happen/were happening) frequently, sometimes or never?

DV1A. Does he usually (spend) his free time with you?

DV1B. He (consults/consulted) you about various household issues?

DV1C. He (is/was) affectionate with you?

DV1D. He (Respects/respected) and (takes into account/took into account) your desires?

DV2. Now I'm going to ask you some questions about situations that women may encounter. Please tell me if the following facts apply to your relationship with your (last) husband/partner?

DV2A. He (is/was) jealous or angry if you (talk) to other men?

DV2B. He often (accuses) you of being unfaithful?

DV2C. He doesn't/didn't allow you to meet your female friends?

DV2D. He (tries/tried) to limit your contact with your family of origin?

DV2E. He (insists/Insisted) on knowing where you (are/were) at all times?

DV2F. He (does/didn't) trust you with money?

DV2G. Does he say or do anything to humiliate you in front of other people?

DV2H. How many times has this happened in the last 12 months?

DV2I. Does he threaten you or someone close to you?

DV2J. How many times has this happened in the last 12 months?

DV3. Now, if I may, I would like to ask you some more questions about your relationship with your (last) husband/partner. Did your husband/partner ever (last) husband/partner:

DV3A. Shove, shake, or throw something at you?

DV3B. How often has this happened in the last 12 months?

DV3C. Slap or twist your arm?

DV3D. How many times has this happened in the last 12 months?

DV3E. Spit in your face?

DV3F. How many times has this happened in the last 12 months?

DV3G. Hit you with a punch or something that could hurt you?

DV3H. How many times has this happened in the last 12 months?

DV3I. Kicking you or dragging you down?

DV3J. How many times has this happened in the last 12 months?

DV3K. Tried to strangle you or burn you?

DV3L. How many times has this happened in the last 12 months?

DV3M. Threaten Or Attack you with a knife, gun or other type of weapon?

DV3N. How many times has this happened in the last 12 months?

DV3O. Physically forced you to have sex even when you didn't want to?

DV3P. How many times has this happened in the last 12 months?

DV3Q. Forced you to perform other types of sexual acts that you did not want to?

DV3R. How many times has this happened in the last 12 months?

DV4. Check questions KVD3A to KVD3Q
DV5. How long after (your (marriage/union/began to be) with your (last) husband/partner did /(this/these behavior(s)) start for the first time?
If less than 1 year, record '00'
DV6. As a result of any kind of deliberate behaviour towards you by your (last) husband/partner, have you ever had any of the following problems?
DV6A. Have hematoma and bruising?

DV6B. How many times has this happened in the last 12 months?

DV6C. Have an injury, fracture or sprain

DV6D. How many times has this happened in the last 12 months?

DV6E. Going to the doctor or health facility because of something your (last) husband/partner did to you?

DV6F. How many times has this happened in the last 12 months?

DV7. Have you ever beaten, slapped, kicked or done anything to physically assault your (last) Husband/partner/ when he had not beaten you or physically assaulted you?

DV8. In the past 12 months, how many times have you beaten, slapped, kicked, or done something else to physically assault your (last) husband/partner when he did not beat or assault you physically?

DV9A. Does (did) your (last) husband/partner/ drink alcohol?

DV9B. Does (did) he get drunk very often, only sometimes or never?

If married / living with a man / separated / divorced
DV10A. Since the age of 15, has anyone other than your (current/last) husband/partner beat you, slapped you, kicked you or did anything to physically assault you?
Widowed/never married/never been in a union
DV10B. Since the age of 15, has anyone beaten you, slapped you, kicked you in order to physically assault you?

DV11.Who physically assaulted you in this way? Someone else?
Record everything that is mentioned

DV12. Check DV11
DV13A. Who is the person who has most often beaten, slapped, kicked or hit you? Do something to physically assault you?

DV13B. In the past 12 months, how often has this person beaten, slapped, kicked or done anything else to you to physically assault you?

DV14. Check CM1 question in the Child Mortality module (page 2)
DV15A. Has anyone ever beaten, slapped, kicked, or otherwise made you feel uncomfortable?
Something to physically assault you during (a) pregnancy?

DV15B. Who was the person who physically assaulted you during a pregnancy?
Anyone else?
Record everything that is mentioned

DV16. Check the following blocks: DV3A to DV3R, DV6A to DV6E9, DV10A/DV10B and DV15A
DV17A. Have you tried to get help?

DV17B. Who did you seek help from? Anyone else?
Record everything that is mentioned
Switch to DV19 regardless of modality
DV18. What is the main reason why you have never sought help?

DV19. As far as you know, did your father ever beat your mother?

Sexual behaviour module: SB

Check for the presence of others. Before continuing, ensure privacy.
SB0. Check WM9: Age of respondent is between 15 and 24?
SB1. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues. The information you supply will remain strictly confidential. How old were you when you first had sexual intercourse (if ever)?

SB2. When was the last time you had sexual intercourse?
Record 'years ago' only if last intercourse was one or more years ago. If 12 months or more the answer must be recorded in years.
SB3. The last time you had sexual intercourse was a condom used?

SB4. What is your relationship to the man with whom you last had sexual intercourse?
If man is 'boyfriend' or 'fiancee', ask:
Was your boyfriend/fiancee living with you when you last had sex?
If 'yes', circle 1. If 'no', circle 2.
SB5. How old is this person?
If response is DK, probe:
About how old is this person?

SB6. Have you had sex with any other man in the last 12 months?

SB7. The last time you had sexual intercourse with this other man, was a condom used?

SB8. What is your relationship to this man?
If man is 'boyfriend' or 'fiancee', ask: Was your boyfriend/fiancee living with you when you last had sex? If 'yes', circle 1. If 'no', circle 2.
SB9. How old is this person?
If response is DK, probe: About how old is this person?

SB10. Other than these two men, have you had sex with any other man in the last 12 months?

SB11. In total, with how many different men have you had sex in the last 12 months?

HIV/AIDS module: HA

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

HA2. Can people protect themselves from getting infected with the AIDS virus by having one sex partner who is not infected and also has no other partners?

HA3. Can people get infected with the AIDS virus because of witchcraft or other supernatural means?

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

HA5. Can people get the AIDS virus from mosquito bites?

HA6. Can people reduce their chance of getting infected with the AIDS virus by not having sex at all?

HA7. Can people get the AIDS virus by sharing food with a person who has aids?

HA7A. Can people get the aids virus by getting injections with a needle that was already used by someone else?

HA8. Is it possible for a healthy-looking person to have the AIDS virus?

HA9. Can the AIDS virus be transmitted from a mother to a baby?

HA9A. During pregnancy?

HA9B. During delivery?

HA9C. By breastfeeding?

HA10. If a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in school?

HA11. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?

HA12. If a member of your family became infected with the AIDS virus, would you want it to remain a secret?

HA13. If a member of your family became sick with the AIDS virus, would you be willing to care for him or her in your household?

HA14. Check MN5: Tested during antenatal care?
HA15. I do not want to know the results, but have you ever been tested to see if you have HIV, the virus that causes AIDS?

HA15A. When were you last tested?

HA16. I do not want you to tell me the results of the test, but have you been told the results?

HA17. Did you, yourself, ask for the test, was it offered to you and you accepted, or was it required?

HA18. At this time, do you know of a place where you can go to get such a test to see if you have the AIDS virus?
HA18A. If tested for HIV during antenatal care: other than at the antenatal clinic, do you know of a place where you can go to get a test to see if you have the AIDS virus?