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 [country-specific affiliation]. 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 [number] 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 highest grade [Insert country specific term]

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?
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?
CM9. How many live births have you had?

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 [2003]
If child has died, take special care when referring to this child by name in the following modules
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?

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?

MN6A1. During your pregnancy with [name], did you sleep under a mosquito net?

MN6A2. What type of mosquito net was it:

Permanent

Treated

Not treated / ordinary

MN6A. During your pregnancy with [name], did you ever take anti-malarials?

MN6B. What was this medicine?
Circle all that are mentioned. If the type of medicine can't be determined, show examples of typical anti-malarials to the respondent.

Note: The following list of medications was included for MN6B.
Fansidar / Maloxine : Fansimef, etc.
Chloroquine : Nivaquine, Résochine, Flavoquine, Camoquin, Quinimax, Quinoforme, Arsiquinoforme, etc.
Paracétamol : Efferalgan, Doliprane, Aspirine, Aspegic, Sédaspir, etc
Dérivé Artémisinine : Paluter, Arsumax, Coartem, etc.

MN6C Verify MN6B for each type of medicine taken.
MN6D. How many times did you take SP/Fansidar during the 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) ____

MN8A How far away is the place where you delivered?
If delivery was at home, record '00'
MN8B. What method did you use to get to the place where you delivered?

MN8C. Did you deliver via cesarean?

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.
Contraception and unmet need: CP

CP0. Are you currently married or do you currently live with a man?

CP1. 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?

FG8A. Did you have one or more daughters who live in the household or elsewhere?

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?

FB16A. Why do you think this practice should be continued?
Record all the mentioned reasons. After answers, proceed to next module.
FG16B. Why do you think this practice should be discontinued?
Record all the mentioned reasons.
Attitudes toward domestic violence

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:

DV1A. If she goes out with out telling him?

DV1B. If she neglects the children?

DV1C. If she argues with him?

DV1D. If she refuses sex with him?

DV1E. If she burns the food?