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?

WM9A. Beside your house work, are you currently working?
If yes, ask:
Do you work in the government or privately?

WM10. Have you ever attended school?

WM11. What is the highest level of school you reached?

WM12. What is the highest grade you completed at that 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?
Marriage/union module: MA

MA1. Are you currently married?

MA2. How old was your husband on his last birthday?

MA3. Have you ever been married?

MA4. What is your marital status now: are you widowed, divorced, or separated?

MA5. Have you been married only once or more than once?

MA6. In what month and year did you first marry?

MA7. Check MA6:
MA8. How old were you when you started living with your first husband/partner?

MA8A. Before you got married, was your (first) husband related to you in anyway?

MA8B. What type of relationship was it?

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?
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 or write 00 if the answer to question CM1 is No=2

CM10 Just to make sure that I have this right, you have had (total number) births during your life. Is this correct?

CM11. Check CM9

Birth History: BH

Now I would like to record the names of 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 line..

BH Line No. _ _

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

BH2. Were any of these births twins?

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

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

BH6. If alive: How old was (name) at his/her last birthday?

BH7. If alive: Is (name) living with you?

BH8. If alive: Record household line number of child (record "00" if child is not listed in household)

BH9. If dead: 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
BH10. Were there any other live births between (name of previous birth) and (name)

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

BH12. Compare CM9 with number of births in history above and mark:
BH13. Some pregnancies end before full term as a miscarriage or an abortion, while others may result in a stillbirth. have you had a miscarriage or abortion?

BH14. In all how many pregnancies did you have that ended in a miscarriage or an abortion

BH15. Have you had a stillbirth?

BH16. In all how many pregnancies did you have that ended in a stillbirth

CM12. Check BH4 of last birth: Did the woman's last birth occur within the last 2 years, that is, since (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 your last child (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 ever-married 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 anti-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 ever-married women with a live birth in the 2 years preceding date of interview.
Check child birth history and record name of last-born child here____
Use this child's name in the following questions, where indicated.

MN2. Did you see anyone for antenatal care when you were pregnant with (name)?
If yes: Whom did you see? Anyone else? Probe for the type of person seen and circle all answers given.
MN2AA. How many months pregnant were you when you first received antenatal care for this pregnancy?

MN2BB. How many times did you receive antenatal care for this pregnancy?

MN2CC. Did you go mainly to a public or private facility to receive antenatal care?

MN2DD. What is the reason you chose the facility that you mainly go to?

MN2EE. When you last went to this facility, were your medical needs addressed or not?

MN2FF. How many months pregnant were you when you last received antenatal care for this pregnancy?

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?

MN4B. What are the reasons for not seeing anyone?
If more than one reason is mentioned, circle each one.
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. Was (name) delivered by caesarean section?

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
MN11AA. Now I would like to ask you some questions about the 40 days period after the delivery of (name). Did you see anyone for a check-up on your health?
If 'Yes ask: Whom did you see? Anyone else?
MN11B. Did you go to a public or private facility to receive post-natal checkup?

MN11C. Where you prescribed a family planning method in the facility?

MN11D. Were you able to get your prescription medicine at the same facility?

MN11E. What was the main reason for not receiving a post-natal checkup?

MN11F. In the first 40 days after your last birth [the birth of name], did you receive a Vitamin A dose like this?
Show 200,000 IU capsule or dispenser.
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.
Now I would like to talk about some specific health problems related to birth some women have. I will ask you about the time After your last delivary and in the 40 days following it.

MN14A. Did you have fever?

MN14B. Did you have trouble controlling your urine?

MN14C. Did you suffer from urinary tract infection?

MN14D. Did you suffer from mastitis?

MN14E. Did you suffer from offensive discharge?

MN14F. Did you suffer from wound infection?

MN14G. Did you suffer from hemorrhage?

MN14H. Did you suffer from tear/injury?

MN14I. Did you suffer from post delivery depression?

MN14J. Did you suffer from any other problems?
If answer is yes:
What is the main problem that you suffered from?.

Contraception and unmet need: CP
This module is to be administered to married women15-49 years of age only

CP0. Check MA1:
[] Not currently married? (Go to next module)
[] Currently married? (Continue with CP1)

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?

CP2A. What is the reason for not doing something or using any method to delay
or avoid getting pregnant?
If more than one reason is mentioned, circle each one.
CP3. Which method are you using?
Do not prompt.
If more than one method is mentioned, circle each one.
CP3AA. Where did you obtain (Current method) the last time?
If the currently used method is Lactational amenorrhoea method (LAM) or Periodic abstinence or Withdrawal or other, ask: Where/who described the method for you?
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?

Attitudes toward domestic violence

This module is to be administered to all women 15-49 years of age

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?

HIV/AIDS module: HA

This module is to be administered to ALL women 15-49

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?

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?

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?

HA19. In your opinion, What is the best method to be used to increase public knowledge about HIV/AIDS?

HA20. In case of someone was infected with sexualy transmitted diseases, do you think that the other partner (husband) should be tested even if he has no symptoms?