Woman's information panel: WM

This questionnaire is to be administered to all women age 15 through 49 (see List of Household Members, 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's name and number:

Repeat greeting if not already read to this woman:

We are from National Statistical Office of Mongolia and conducting a survey about the situation of children, women, families and households. I would like to talk to you about your health and well-being nearly 50 minutes. According to the article 5, paragraph 4 of the Mongolian state law on confidentiality of an individual and article 22, paragraph 3 of the Mongolian state law on statistics all the information we obtain will remain strictly confidential.

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 50 minutes. Again, all the information we obtain will remain strictly confidential and anonymous.

May I start now?

Date and result of woman's interview:

13.2
How many times you have visited
WM6. Date (year/month/day)

WM7. Result of the interview* _ _

Codes for the result of the interview*

WM10. Record the time.

Woman's background: WB

WB1. In what month and year were you born?

WB2. How old are you?

Probe: how old were you at your last birthday? Compare and correct WB1 and/or WB2 if inconsistent.

WB3. Have you ever attended school?

WB4. What is the highest level of school you attended?
If completed non-formal equivalent education program (NFRRP), circle '2'.

WB5. What is the highest grade you completed at that level? If less than 1 grade, enter "00". If has attended primary school of NFEEP, record '21', if basic or high school, record '22' and '23' respectively.

WB5A. Have you completed school you have attended?

WB6. Check WB4 and WB5 to see if a woman is completed primary school.

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?

WB7A. Now I would like you to write sentence which I am going to read to you.

Show sentence written on the card to the respondent. If respondent cannot write whole sentence, probe: Can you read part of the sentence to me?

WB8. Aside from your own housework, have you done any work in the last seven days?

WB9. As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business. In the last seven days, have you done any of these things or any other work?

WB10. Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, maternity leave, or any other such reason?

WB11. Have you done any work in the last 12 months?

WB12. What is your occupation, that is, what kind of work do mainly do?

WB13. Do you do this work for a member of your family, for someone else, or are you self-employed?

WB14. Do you usually work throughout the year, or do you work seasonally, or only once in a while?

Access to mass media and use of information/communication technology: MT

MT1. Check WB7 to see if the woman is able to read.

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?

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?

MT12. Do you have a mobile phone?

Marriage/union: MA

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

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

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

MA8A. In what month and year did you marry or start living with a man as if married?

MA8B. 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 first started living with your (first) husband/partner?

Husband/partner's background: HB

HB1. Check MA1 and MA6 for woman's marital status.

HB2. Currently is your husband/partner living with you?

HB3. How long have you been living far away fron each other?

HB4. Has your husband/partner or your ex-husband/partner ever attended school?

HB5. What is the highest level of school he attended?
If completed non-formal equivalent education program (NFEEP), circle '2'.

HB6. What is the highest grade your husband/partner or your ex-husband/partner completed at that level?
If less than 1 grade, enter "0". If less than attended primary school of NFEEP, record '21', if basic or high school, record '22' and '23' respectively.

HB7. Has your husband/partner or your ex-husband/partner completed school he has attended?

Fertility/ birth history: CM

CM1. Now I would like to ask about all the births you have had during your life. Have you ever given birth?

CM4. Do you have any sons or daughters to whom you have given birth who are now living with you? I'm asking about your children to whom you have given birth. Currently, the children may not live with you, died or not children of your current husband/partner.

CM5. How many sons live with you? How many daughters live with you?
If none, record "00".

CM6. Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?

CM7. How many sons are alive but do not live with you? How many daughters are alive but do not live with you?

If none, record "00".

CM8. Have you ever given birth to a boy or girl who was born alive but later died?
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 boys have died? How many girls have died?
If none, record "00".

CM10. Sum answers to CM5, CM7, and CM9.

CM11. Just to make sure that I have this right, you have had in total (total number in CM10) live births/no births during your life. Is this correct?

Birth History: BH

Now I would like to talk to you about your births. Please tell me the names of all your births, starting with the first one you had. Record names of all of the births in BH1. Record twins and triplets in BH2. If there are more than 14 births, use an additional questionnaire.

BH Line No. _ _

BH1. Please tell me the names of your children, starting with the first one? If the child is not named, write "no name" ____

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? If do not know the month, record 98, if do not know the year, record 9998

BH5. Is (name) still alive?

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

BH7. Is (name) living with you?

BH8. Record household line number of child (from HL1)

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 1-24 months; record years if more than 24 months

BH10. Were there any other live births between (name of previous birth) and (name), including any children who died after birth?

BH11. Have you had any live births since the birth of (name of last birth in birth history module)?

CM12A. Compare number in CM10 with number of births in the birth history module above and check:

CM13. Check BH4 in birth history module: Last birth occurred within the last 2 years, that is, since (month of interview) in 2011 (if the month of the interview and the month of the birth are the same, and the year of birth is 2011, consider this as a birth within the last 2 years)

If child has died, take special care when referring to this child by name in the following modules. Continue with next module.

Miscarriage, stillbirth and abortion: AB

CP1. Are you pregnant now?

AB2. How many weeks of pregnancy?

AB3. Women sometimes have pregnancies which do not end in a live born child. Have you ever had a pregnancy that miscarried, was stillbirth, or ended with an aborted?
Cleaning the uterus due to no sign of uterine growth will be considered as a miscarriage.

AB4. When did the last such pregnancy (miscarriages, stillbirths or abortions) end?
Fill in both the month and the year

AB5. Check AB4: Last miscarriage, stillbirth or abortion ended within the last 2 years, that is, since (month of interview) in 2011

AB6. During the last 2 years, that is, since (month of interview) in 2011, how many such pregnancy (miscarriages, stillbirths or abortions) end?

Ask the respondent to tell you, in which year and month each miscarriage, stillbirth or abortion had a place during last 2 years and record year and month for each pregnancy, started from the last miscarriage, stillbirth or abortion. Then, ask to answer each miscarriage, stillbirth and abortion.

AB7. In which year and month the previous pregnancy ended?

AB8. How many weeks you were pregnant, when this pregnancy ended?

AB9. Did that pregnancy end in a spontaneous miscarriage, an induced abortion, or a stillbirth?

Additional questionnaire used

AB10. Check AB9, the column last miscarriage, stillbirth or abortion is that pregnancy end with the induced abortion?

AB11. Why did you have an abortion?
Probe: please tell me the very main reason?

AB12. Did you decide to get an abortion on your own, or was it a joint decision, or someone?

AB13. Where did you have your last abortion?

AB14. Who performed the last abortion?

AB15. What kind of method was used in the last abortion?

AB16. Did a physician provide you with the following counselling when you came to a hospital to have an abortion last time?

[A] Discussed about decision of abortion?

[B] Asked the reason of abortion

[C] Explained the maternity allowances paid by government?

[D] Explained the method of abortion?

[E] Counselled about contraception that can be immediately used after abortion?

[X] Any other counselling?

AB17. Did a physician provide you with the following counselling after the abortion?

[A] Signs and symptoms when the client will need to seek immediate help from a doctor?

[B] Being checked by ultrasound?

[C] Counselled about contraception?

[X] Received brochure that includes above topics?

AB18. After abortion, did you have a rest in the bed?

AB19. Did you have any complications after having the last abortion?

AB20. What kind of complications did you have?

[A] Too much bleeding?

[B] Too much pain?

[C] Had fever?

[D] Had repeated currettage?

[X] Other?

AB21. Did you start using any of the contraceptive methods after your last abortion?

Desire birth: DB

This module is to be administered to all women with a live birth in the 2 years preceding the date of interview.
Record name of last-born child from CM13 here ____
Use this child's name in the following questions, where indicated.

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? Record the answer as stated by respondent.

Maternal and newborn health: MN

This module is to be administered to all women with a live birth in the 2 years preceding the date of interview.
Record name of last-born child from CM13 here ____
Use this child's name in the following questions, where indicated.

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 all answers given.

MN2A. How many weeks or months pregnant were you when you first received antenatal care for this pregnancy?

MN2B. Where did you receive antenatal care?
Probe: where else?

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

MN3A. Did you receive counselling of the following when you received antenatal care during this pregnancy?

[A] Importance of antenatal care?

[B] Meal during pregnancy?

[C] Bad habits (alcohol or tobacco)?

[D] Sexually transmitted infections?

[E] Abnormalities of pregnancy/critical symptoms?

[F] Family planning?

[G] Receiving allowances/grants?

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

[A] Measure blood pressure?

[B] Urine sample?

[C] Blood sample?

[D] Test for STIs/smear?

[E] Weight measurement?

[F] Test for syphilis?

[G] Test for HIV/AIDS viruses?

[H] Ultrasound?

[I] Chest x-ray?

MN5A. Was there problems when received antenatal care during your pregnancy with (name)?

MN5B. Please tell me the main problem you faced when received natenatal care during your pregnancy with (name)?

MN5C. What was the mean important reason that you didn't receive antenatal care?

MN5D. Check MA1 and MA6 for women's marital status.

MN5E. Did your husband/partner come along when you received antenatal care during your pregnancy (name)?

MN5F. How often did your husband/partner come along when you received antenatal care during your pregnancy with (name)?

MN5G. Have you had any of the following pregnancy complications during your pregnancy with (name)?

[A] Vaginal bleeding?

[B] Having any of the following symptoms: dizziness, headache, blurriness, elevated blood pressure?

[C] Having seisures and unconsousness after having high blood pressure?

[D] Presenting early signs of birth?

[X] Other (specify)?

MN5H. Check MN5G to see if woman had pregnancy complications.

MN5I. Did you receive assistance from health professionals or doctors during the complication?

MN5J. Did you have any other illness during your pregnancy with (name)?

[A] Heart?

[B] Kidney, bladder?

[C] Liver, gall?

[D] Lung, respiratory disease?

[E] Indigestion, stomach?

[X] Other (specify)?

MN5K. Did you take iron tablets/syrup during your pregnancy (name)?

MN5L. How many days did you take?

MN5M. Where did you get iron tablets/syrup?

MN5N. Were you given or bought iron tablets/syrup?

MN5O. Did you stay in recreation room before giving birth to (name)?

MN17. Who assisted with the delivery of (name)? Probe: anyone else? Probe for the type of person assisting and circle all answers given.

If respondent says no one assisted, probe to determine whether any adults were present at the delivery.

MN18. Where did you give birth to (name)?

MN19. Was (name) delivered by caesarean section? That is, did they cut your belly open to take the baby out?

MN19A. When was the decision made to have the caesarean section? Was it before or after your labour pains started?

MN19B. Were following symptoms noted or procedures applied when (name) was born?

[A] Used drops to accelerate labour?

[B] Had high temperature during labour?

[C] Bleeding more than usual?

[D] Blood transfusion?

[E] Seisures and unconsousness after having high blood pressure?

[F] Placing forceps or vacuum extractor?

[G] Place the misoprostol under your tongue?

[H] Place misoprostol in the vagina?

MN19C. Were you given vitamin A within 2 months after the birth of (name)?

MN19D. Did you give birth to (name) before, after or on your due date?

MN20. When (name) was born, was he/she larger or smaller than average?
If deemed necessary, probe: very large, larger than averave, smaller than average, or very small?

MN21. Was (name) weighed at birth?

MN22. How much did (name) weigh? If a card is available, record weight from card.

MN22A. Did (name) cry following birth?

MN22B. Has emergency care/treatment/ been provided to (name) immediately after the birth in the delivery room?

MN22C. Has (name) been provided with the following care for warming?

[A] Hat is worn?

[B] Placed on mother's belly and covered with blanket?

[C] Placed on infant warming table?

MN23. Has your menstrual period returned since the birth of (name)?

MN23A. How many months later has your menstrual period returned after the birth of (name)?

MN23B. Check CP1 to see if a woman is currently pregnant or not.

MN23C. Did you have a sexual intercourse after the birth of (name)?

MN23D. How many months later have you had a sexual intercourse after 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?

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.
Record name of last-born child from CM13 here ____.
Use this child's name in the following questions, where indicated.

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 hours. If less than one week, record days. If more than one week, record weeks.

PN3. 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 (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)?

PN4A. Did the health professional record on "mother and child health book" during your release from the hospital after birth of (name)?

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, traditional birth attendant 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? By check on your health, I mean 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 hours. If less than one week, record days. Otherwise, record weeks.

PN13. Who checked on (name)'s health at that time?

PN14. Where did this check take place? Probe to identify the type of source. If unable to determine whether public or private, 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, traditional birth attendant 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 hours. If less than one week, record days. Otherwise, record weeks.

PN22. Who checked on your health at that time?

PN22A. Did health professional provide counselling on the following during examination of you?

[A] Breastfeeding?

[B] Infant nursing?

[C] Family planning?

[D] Sexually transmitted infections?

PN23. Where did this check take place?

Illness symptoms: IS

IS2. Sometimes children have severe illnesses and should be taken immediately to a health facility. What types of symptoms would cause you to take a child under the age of 5 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

CP0A. Have you ever heard of or read about contraceptive methods? Please name them. For contraceptive methods named by the woman, record "1". For the remaining methods, probe using CP0B and record "2" if heard or read.

[A] Female sterilization (women can have an operation to avoid having any more children)

[B] Male sterilization (men can have an operation to avoid having any more children)

[C] IUD (women can have loop or coil placed inside them by a doctor or a nurse.)

[D] Injectables (women can have an injection by a health provider that stops them from becoming pregnant for one or more months)

[E] Implants (women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.)

[F] Pill (women can take a pill every day to avoid becoming pregnant.)

[G] Male condom (men can put a rubber sheath on their penis before sexual intercourse.)

[H] Female condom (women can place a sheath in their vagina before sexual intercourse.)

[I] Diaphragms (a shallow silicone cup inserted into the vagina)

[J] Foam/jelly (placed in the vagina before sex)

[L] Periodic abstinence/rhythm (to avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.)

[M] Withdrawal (men can be careful and pull out before climax.)

[N] Emergency contraception (as an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.)

[X] Have you heard of or read any other contraceptive method?

CP0B. Have you ever heard of or read about .......... methods

[A] Female sterilization (women can have an operation to avoid having any more children)

[B] Male sterilization (men can have an operation to avoid having any more children)

[C] IUD (women can have loop or coil placed inside them by a doctor or a nurse.)

[D] Injectables (women can have an injection by a health provider that stops them from becoming pregnant for one or more months)

[E] Implants (women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.)

[F] Pill (women can take a pill every day to avoid becoming pregnant.)

[G] Male condom (men can put a rubber sheath on their penis before sexual intercourse.)

[H] Female condom (women can place a sheath in their vagina before sexual intercourse.)

[I] Diaphragms (a shallow silicone cup inserted into the vagina)

[J] Foam/jelly (placed in the vagina before sex)

[L] Periodic abstinence/rhythm (to avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.)

[M] Withdrawal (men can be careful and pull out before climax.)

[N] Emergency contraception (as an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.)

[X] Have you heard of or read any other contraceptive method?

CP1A. Check CP1 to see if a woman is currently pregnant?

CP2. Couples 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. Have you ever done something or used any method to delay or avoid getting pregnant?

CP3. What are you doing to avoid a pregnancy? What kind of method are you using? Probe: anything else?

CP4. In what facility did the sterilization take place?

CP5. In what month and year was the sterilization performed?

CP5A. Since what month and year have you been using (current method) without stopping?

Probe: for how long have you been using (current method) now without stopping?

CP6. Is there service fee or purchase cost to obtain the method?

CP6A. Much did you pay for the last time you obtained the method?

CP7. Have you ever used any other methods before using your current methods?

CP8. What kinds of methods did you use the most previously?

CP9. What is the main reason of changing your method?

CP10. Check CP3 for methods currently used by a woman. More than one method code circled in CP3, circle code for highest method in list

CP11. You first started using (current method) in (date from CP5/CP5A). Where did you get it at that time?

CP11A. Where did you learn how to use the periodic abstinence/rhythm?

CP12. Check CP3 for methods currently used by a woman. More than one method code circled in CP3, circle code for highest method in list

CP13. At that time, were you told about side effects or problems you might have with the method?

CP13A. When you got sterilized, were you told about side effects or problems you might have with the method?

CP14. Were you ever told by a health or family planning worker about side effects or problems you might have with the method?

CP15. Were you ever told what to do if you experienced side effects or problems?

CP16. Check CP13/CP13A

CP17. At that time, were you told about other methods of family planning that you could use?

CP18. When you obtained (current method from CP10) from (source of method from CP4 or CP11), were you told about other methods of family planning that you could use?

CP19. Were you ever told by a health or family planning worker about other methods of family planning that you could use?

CP20. Check CP3 for methods currently used by a woman. More than one method code circled in CP3, circle code for highest method in list

CP21. Where did you obtain (current method) the last time?

CP22. Why are you not using a method to prevent pregnancy? Probe: any other reasons?

CP23. Do you intend to use contraceptive method in the future?

CP24. What kind of method would you intend to use the most?

CP25. Do you know that modern contraceptive methods are given for free?

CP26. In the last one month, did you obtain any information on family planning through media?

[A] Radio?

[B] Television?

[C] Internet?

[D] Printed newspapers, magazines or books?

[E] Poster?

CP27. Check MA1 and MA6 for woman's marital status.

CP28. Have you ever talked to your husband/partner about the following topics?

[A] Family planning?

[B] Contraception?

[C] STIs, HIV/AIDS?

[D] Pregnancy and birth?

CP29. How many children does husband/partner want? Same as you, more or less?

CP30. From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant?

CP31. Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?

Unmet need: UN

UN1. Check. 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?

UN6A. What is the main reason which you do not want to get pregnant?

UN6B. How many children would you like to have in addition to that one?

UN6A. Why did you decide to have another child?

UN7. How long would you like to wait before the birth of (a/another) child?

UN8. Check CP1: Currently pregnant?

UN9. Check CP2: Currently using a method?

UN9A. Check CP18: to see if woman not using contraceptive methods for reasons relevant to birth?

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?

UN11A. Check CM4 and CM6 to see if woman has children.

UN11B. If you had a chance to go back and change your life without children, how many children would you like to have in your lifetime?

UN11C. How many children would you like to have in your lifetime?

[] 00 Never wanted/Do not want any children
_ _ Number of wanted children
[] 96 Other (specify) ____

UN12A. When did your first menstrual period start?

Age _ _
[] 96 Never menstruated (Next module)

UN13. When did your last menstrual period start? Record the answer using the same unit stated by the respondent.

Sexual behavior: SB

Check for the presence of others. Make sure you have privacy before you proceed with the interview.

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?Record answers in days, weeks or months if less than 12 months (one year). If 12 months (one year) or more, 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 to see if woman currently married or living together as if married.

SB7. How old is this person?

If response is "DK", probe: About how old is this person?

SB8. Have you had sexual intercourse with any other person in the last 12 months?

SB9. The last time you had sexual intercourse with this other 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:

SB12. How old is this person?

If response is 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. In total, with how many different people have you had sexual intercourse in the last 12 months?

SB15. In total, with how many different 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 AND STI

HA1. Now I would like to talk with you about a different topic. Have you ever heard of an illness called AIDS?

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

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 get the AIDS virus by sharing food with a person who has the AIDS virus?

HA7. Is it possible for a healthy-looking person to have the AIDS virus?

HA7A. Can people get the AIDS virus by using needle or syringe used by other person?

HA8. Can the virus that causes AIDS be transmitted from a mother to her baby:

[A] During pregnancy?

[B] During delivery?

[C] By breastfeeding?

HA9. In your opinion, if a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in school?

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

HA11. If a member of your family got infected with the AIDS virus, 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 CM13: Any live birth in last 2 years?

HA14. Check MN1: Received antenatal care?

HA15. During any of the antenatal visits for your pregnancy with (name), did you receive the following counselling?

[A] AIDS transmitted to babies from mother?

[B] Preventative measures of AIDS virus?

[C] Test for AIDS?

[D] Recommended test for AIDS?

Check MN4G: Tested for the AIDS virus as part of your antenatal care?

HA17. I don't want to know the results, but did you get the results of the AIDS virus test that was tested during antenatal care for the last pregnancy?

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

HA22. Have you been tested for the AIDS virus since that time you were tested for it as part of your antenatal care?

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 the AIDS virus?

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?

HA26A. After you got the results of the test, did you receive counselling?
Regardless of the result, all women tested are supposed to receive counselling after getting the result.

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

HA30. Now I would like to talk to you about different subject. Have you ever heard about any sexually transmitted infections other than AIDS virus?

HA31. What are the main sources of information on sexually transmitted infections and AIDS virus? Any other sources?

HA32. Check SB1B to see if woman had sexual intercourse.

HA33. Check HA30. Heard about other sexually transmitted infections?

HA34. Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?

HA35. Sometimes women experience a bad-smelling abnormal genital discharge. During the last 12 months, have you had a bad-smelling abnormal genital discharge?

HA36. Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

HA37. Check HA34, HA35, HA36.

HA38. Have you ever been tested for the sexually transmitted infections?

HA39. Have you tested for the sexually transmitted infections in the last 12 months?

HA40. Have you ever received treatment for the sexually transmitted infections?

HA41. Have you ever received treatment for the sexually transmitted infections in the last 12 months?

HA42. Where or whom did you seek treatment?
Probe: anywhere else? Probe to identify the type of source. If unable to determine whether public or private, write the name of the place.

HA43. Do you think it is possible to prevent the sexually transmitted infections?

HA44. If possible, how do you prevent getting sexually transmitted infections?
Circle all that apply. Probe: do you know any other method.

Cervical Cancer: CC

CC1. Do you undergo preventative health checkups?

CC2. What about frequency of the checkups?

CC3. Have you ever heard of or read about the cervical cancer?

CC4. How much do you know about the cervical cancer?

CC5. Have you ever received the cervical cancer regular screening?

CC6. Where did you receive the cervical cancer regular screening?
Probe: anywhere else?

CC7. When did you receive the most recent cervical cancer regular screening?

CC8. Why you did not receive the cervical cancer regular screening?

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. If 10 days or more but less than a month, circle "10". If "every day" or "almost every day", circle "30".

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?
Probe: what else? Circle each response.

TA9. During the last one month, on how many days did you use any smoked tobacco products? If less than 10 days, record the number of days. If 10 days or more but less than a month, circle "10". If "every day" or "almost every day", circle "30".

TA10. Have you ever tried any form of smokeless tobacco products, such as chewing tobacco, snuff, or dip?

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

TA12. What type of smokeless tobacco product did you use?
Probe: what else? Circle each response.

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. If 10 days or more but less than a month, circle "10". If "every day" or "almost every day", circle "30".

TA14. Now I would like to ask you some questions about drinking alcohol. Have you ever drunk alcohol?

TA15. How old were you when you had your first drink of alcohol, other than a few sips? Probe: 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.

TA16. During the last one month, on how many days did you have at least one drink of alcohol? If respondent did not drink, circle "00". If less than 10 days, record the number of days.
If 10 days or more but less than a month, circle "10". If "every day" or "almost every day", circle "30".

WM11. Record the time.

WM12. Check List of Household Members, columns HL7B and HL15: Is the respondent the mother or caretaker of any child age 0-4 living in this household?

Interviewer's observations ________

Supervisor's observations ________