[p. 1]

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 code____ _ _

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

WM7. Result of women's interview
Repeat greeting if not already read to this woman:
We are from [Office of Montenegro/ Research agency strategic marketing]. 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 [15] 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? (Go to WM9)

WM9. How old were you at your last birthday?

[p. 2]
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?
[p. 3]
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.

MN2. Did you see anyone for antenatal care for this pregnancy?
Prompt the respondent to remember 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?

MN3E. Did they perform Papanikolau test?

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?

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
[p. 7]
MN8. Where did you give birth to (name)?
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.
[p. 8]
Marriage/union module: MA

MA.1 Are you currently married or living together with a man as if married?

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

MA3. Have you ever been married or lived together with a man?

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

MA5. Have you been married or lived with a man only once or more than once?

MA6. In what month and year did you first marry or start living with a man as if married

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

[p. 9]
Contraception module: CP

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

CP1A. When you got pregnant did you wish to get pregnant then, or to delay pregnancy, or to avoid pregnancy altogether?
[] 1 Yes, then (Go to CP4B)
[] 2 Yes, later (Go to CP4B)
[] 3 Avoid pregnancy (Go to CP4B)

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 to protect yourself from unwanted pregnancy?
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? Do not read the answers.

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? Do not read the answers.

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

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

[p. 10]
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?

Sexual behaviour module: SB
[Additional module. Not included in all samples.]

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?
If less than 7 days ago circle 1 and write the answer in days. If less than 4 weeks, circle 2 and write the answer in weeks. If less than 12 months, circle 3 and write the answer in months. If more than 12 months, circle 4 and write the answer 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.

(Go to SB5)

SB5. How old is this person?
If response is DK, probe:
About how old is this person?

(Go to SB6)

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.
[p. 15]
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?
[Note: This question is added to the core module, for use in countries where injecting drug use is a common means of HIV transmission]

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?

[p. 11]
HA14. Check Question MN5 on the third page of this questionnaire: Were you Tested for HIV 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?

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?
[] 1 Yes (Go to next questionnaire)
[] 2 No (Go to next questionnaire)

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?

Check: ?If respondent is mother/custodian of child under 5 years of age??
If yes, go to questionnaire for children under 5, and fill special questionnaire for each child under 5 years of age to whom the respondent is mother/custodian.
If no, ask ?If there any other woman aged from 15 to 49 years in your household??
If yes, finish the interview with this woman, extend thanks for cooperation, and start interview with other woman from the household who satisfies the condition.
If no, finish the interview with this woman, extend thanks for cooperation.
Check whether there are any children under 5 in the household. If yes, ask mother/custodian to answer the questions from questionnaire for children under 5.