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MICS questionnaire for individual women


Mauritania 2015


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:
Name ____

WM4. Woman's line number: _ _

WM5. Interviewer's name and number:
Name ____ _ _

WM6. Day/month/year of interview _ _ / _ _ / 2015

If not already done, introduce yourself to respondent:
We are from the National Statistics Office. We are working on a project about family health and education. I would like to talk to you about these subjects. The interview will take about 30 minutes. All the information we obtain will remain strictly confidential and anonymous.

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

May I start now?

[] Yes, permission is given (Go to WM10 to record the time and then begin the interview.)
[] No, permission is not given (Circle "03" in WM7. Discuss this result with your team leader.)

WM7. Result of woman's interview
[] 01 Completed
[] 02 Not at home
[] 03 Refused
[] 04 Partly completed
[] 05 Incapacitated
[] 96 Other (specify) ____

WM10. Record the time.
Hour and minutes _ _ : _ _

Woman's background: WB

WB1. In what month and year were you born?

Date of birth
_ _ Month
[] 98 DK month
_ _ _ _ Year
[] 9998 DK year

WB2. How old are you?
Probe: how old were you at your last birthday? Compare and correct WB1 and/or WB2 if inconsistent.
Age (in completed years) _ _

WB3. Have you ever attended formal or informal school or preschool?

[] 1 Yes
[] 2 No (Go to WB7)

WB4. What is the highest level of school you attended?

[] 0 Preschool (Go to WB7)
[] 1 Primary
[] 2 Secondary
[] 3 Higher
[] 4 Quranic school (Go to WB6)
[] 5 Mahadra (Go to WB6)

WB5. What is the highest grade you completed at that level?
If the first grade at this level is not completed, enter "00".
Year/Grade _ _

WB6. Check WB4:
[] Secondary, higher, or mahadra (WB4=2 or 3 or 5) (Go to next module)
[] Primary or Quranic (WB4=1 or 4) (Continue with WB7)

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?
[] 1 Cannot read at all
[] 2 Able to read only parts of sentence
[] 3 Able to read whole sentence
[] 4 No sentence in required language (specify language) ____
[] 5 Blind/visually impaired

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

MT1. Check WB7:
[] Question left blank (Respondent has secondary, higher, or mahadra education) (Continue with MT2)
[] Able to read or no sentence in required language (WB7 = 2, 3 or 4) (Continue with MT2)
[] Cannot read at all or blind (WB7 = 1 or 5) (Go to MT3)

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?

[] 1 Almost every day
[] 2 At least once a week
[] 3 Less than once a week
[] 4 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?

[] 1 Almost every day
[] 2 At least once a week
[] 3 Less than once a week
[] 4 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?

[] 1 Almost every day
[] 2 At least once a week
[] 3 Less than once a week
[] 4 Not at all

MT5. Check WB2: Age of respondent?
[] Age 15-24 (Continue with MT6)
[] Age 25-49 (Go to next module)

MT6. Have you ever used a computer?

[] 1 Yes
[] 2 No (Go to MT9)

MT7. Have you used a computer from any location in the last 12 months?

[] 1 Yes
[] 2 No (Go to MT9)

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?

[] 1 Almost every day
[] 2 At least once a week
[] 3 Less than once a week
[] 4 Not at all

MT9. Have you ever used the internet?

[] 1 Yes
[] 2 No (Go to next module)

MT10. In the last 12 months, have you used the internet?
If necessary, probe for use from any location, with any device.
[] 1 Yes
[] 2 No (Go to next module)

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?

[] 1 Almost every day
[] 2 At least once a week
[] 3 Less than once a week
[] 4 Not at all

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?

[] 1 Yes
[] 2 No (Go to CM8)

CM4. Do you have any sons or daughters to whom you have given birth who are now living with you?

[] 1 Yes
[] 2 No (Go to CM6)

CM5. How many sons live with you? How many daughters live with you?
If none, record "00".
_ _ Sons at home
_ _ Daughters at home

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

[] 1 Yes
[] 2 No (Go to CM8)

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".
_ _ Sons elsewhere
_ _ Daughters elsewhere

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?

[] 1 Yes
[] 2 No (Go to CM10)

CM9. How many boys have died? How many girls have died?
If none, record "00".
_ _ Deceased boys
_ _ Deceased girls

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

CM11. Just to make sure that I have this right, you have had in total (total number) births during your life. Is this correct?

[] Yes. Check below:
[] No births (Go to illness symptoms module)
[] One or more live births (Continue with birth history module)
[] No. (Check responses to CM1-CM10 and make corrections as necessary before proceeding to birth history module or illness symptoms module)

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 lines.

BH Line No. _ _

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

BH2. Were any of these births twins?

[] 1 Single
[] 2 Multiple

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

[] 1 Boy
[] 2 Girl

BH4. In what month and year was (name) born?
Probe: what is his/her birthday?
_ _ Month
_ _ _ _ Year

BH5. Is (name) still alive?

[] 1 Yes
[] 2 No (Go to BH9)

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

Record age in completed years. _ _

BH7. Is (name) living with you?

[] 1 Yes
[] 2 No

BH8. Record household line number of child (from HL1)
Record "00" if child is not listed in household _ _ (Go to BH10)

BH9. If deceased: 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
Unit
[] 1 Days
[] 2 Months
[] 3 Years
Number _ _

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

[] 1 Yes (Add birth)
[] 2 No (Go to next birth)

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

[] 1 Yes (Record in birth history)
[] 2 No

CM12A. Compare number in CM10 with number of births in the birth history module above and check:
[] Numbers are same (Continue with CM13)
[] Numbers are different (Probe and reconcile)

CM13. Last birth occurred within the last 2 years, that is, since (month of interview) in 2013 (if the month of the interview and the month of the birth are the same, and the year of birth is 2013, consider this as a birth within the last 2 years)
[] No live birth in last 2 years. (Go to illness symptoms module)
[] One or more live births in last 2 years. (Record the name of the last-born child and continue with the following module.)
Name of last-born child ____
If child has died, take special care when referring to this child by name in the following modules.

Desire for last 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?

[] 1 Yes (Go to next module)
[] 2 No

DB2. Did you want to have a baby later on, or did you not want any (more) children?

[] 1 Later
[] 2 No children (Go to next module)

DB3. How much longer did you want to wait?
Record the answer as stated by respondent.
[] 1 Months _ _
[] 2 Years _ _
[] 998 DK

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.


MN0A. Have you ever heard of an obstetrical health plan?

[] 1 Yes
[] 2 No (Go to MN1)

MN0B. Did you take part in the obstetrical health plan for (name)'s pregnancy?

[] 1 Yes (Go to MN1)
[] 2 No

MN0C. What was the main reason you did not take part in the obstetrical health plan?

[] 01 Obstetrical health plan does not exist in place of residence
[] 02 High cost
[] 03 Distance/transportation
[] 04 Poor quality of health services
[] 05 Husband/family refused
[] 06 Don't see importance of obstetrical health plan
[] 07 Don't know the obstetrical health plan process
[] 96 Other (specify) ______
[] 98 DK

MN1. Did you see anyone for antenatal care during your pregnancy with (name)?

[] 1 Yes
[] 2 No (Go to MN5)

MN2. Whom did you see?
Probe: anyone else? Probe for the type of person seen and circle all answers given.
Health professional:
[] A Doctor
[] B Midwife
[] C Auxiliary midwife
[] D Nurse
Other person
[] F Traditional birth attendant
[] G Community health worker
[] X Other (specify) ____

MN2A. How many weeks or months pregnant were you when you first received antenatal care for this pregnancy?
Record the answer as stated by respondent.
[] 1 Weeks _ _
[] 2 Months 0_
[] 998 DK

MN3. How many times did you receive antenatal care during this pregnancy?
Probe to identify the number of times antenatal care was received. If a range is given, record the minimum number of times antenatal care received.
_ _ Number of times
[] 98 DK

MN3A. Check MN3: Number of antenatal visits
[] 4 or more (Go to MN3C)
[] Fewer than four (Continue with MN3B)

MN3B. What was the main reason that you did not have more antenatal visits?

[] 1 High cost
[] 2 Distance/Transportation
[] 3 Poor quality of health services
[] 4 Husband/family refused
[] 6 Other (specify) ______
[] 8 DK

MN3C. Check MN0B: took part in obstetrical health plan
[] Yes (Continue to MN3D)
[] No (Go to MN4)

MN3D. If you hadn't taken part in the obstetrical health plan, do you think you still would have had at least one antenatal consultation?

[] 1 Yes
[] 2 No

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

[A] Was your blood pressure measured?

[] 1 Yes
[] 2 No

[B] Did you give a urine sample?

[] 1 Yes
[] 2 No

[C] Did you give a blood sample?

[] 1 Yes
[] 2 No

[D] Did you have an ultrasound?

[] 1 Yes
[] 2 No

MN5. Do you have a card or other document with your own immunizations listed?
May I see it please?
If a card is presented, use it to assist with answers to the following questions (MN6 and MN7).
[] 1 Yes (card seen)
[] 2 Yes (card not seen)
[] 3 No
[] 8 DK

MN6. When you were pregnant with (name), did you receive any injection in the arm or shoulder to prevent the baby from getting tetanus, that is convulsions after birth?

[] 1 Yes
[] 2 No (Go to MN9)
[] 8 DK (Go to MN9)

MN7. How many times did you receive this tetanus injection during your pregnancy with (name)?
If 7 or more times, record '7'.
_ Number of times
[] 8 DK (Go to MN9)

MN8. How many tetanus injections during last pregnancy were reported in MN7?
[] At least two tetanus injections during last pregnancy. (Go to MN12)
[] Only one tetanus injection during last pregnancy. (Continue with MN9)

MN9. Did you receive any tetanus injection at any time before your pregnancy with (name), either to protect yourself or another baby?

[] 1 Yes
[] 2 No (Go to MN12)
[] 8 DK (Go to MN12)

MN10. How many times did you receive a tetanus injection before your pregnancy with (name)?
If 7 or more times, record '7'.
_ Number of times
[] 8 DK (Go to MN12)

MN11. How many years ago did you receive the last tetanus injection before your pregnancy with (name)?
If less than 1 year, record '00'.
Years ago _ _

MN12. Check MN1 to see if the woman received antenatal care during this pregnancy:
[] Yes, antenatal care received. (Continue with MN13)
[] No antenatal care (Go to MN17)

MN13. During (any of) your antenatal visit(s) for the pregnancy with (name), did you take any medicine in order to prevent you from getting malaria?

[] 1 Yes
[] 2 No (Go to MN17)
[] 8 DK (Go to MN17)

MN14. Which medicines did you take to prevent malaria?
Circle all medicines taken. If type of medicine is not determined, show typical anti-malarial to respondent.
[] A SP/Fansidar
[] X Other (specify) ____
[] Z DK

MN15. Check MN14 for medicine taken:
[] SP/Fansidar taken. (Continue with MN16)
[] SP/Fansidar not taken. (Go to MN17)

MN16. During your pregnancy with (name), how many times did you take SP/Fansidar in total?
Please include all that you obtained either during an antenatal care visit, during a visit to a health facility or from another source.

_ _ Number of times
[] 98 DK

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.
Health professional:
[] A Doctor
[] B Midwife
[] C Auxiliary midwife
[] D Nurse
Other person
[] F Traditional birth attendant
[] G Community health worker
[] H Relative/friend
[] X Other (specify) ____
[] Y No one

MN18. Where did you give birth to (name)?
Probe to identify the type of source. If unable to determine whether public or private, write the name of the place.
(Name of place) ____

Home
[] 11 Respondent's home (Go to MN19B)
[] 12 Other home (Go to MN19B)
Public sector
[] 21 Hospital
[] 22 Clinic/health centre
[] 23 Health post
[] 26 Other public (specify) ____
Private medical sector
[] 32 Private clinic
[] 36 Other private medical (specify) ____
[] 96 Other (specify) ____ (Go to MN19C)

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

[] 1 Yes
[] 2 No (Go to MN19C)

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

[] 1 Before (Go to MN19C)
[] 2 After (Go to MN19C)

MN19B. What was the main reason that you did not deliver in a health facility?

[] 1 Distance/Transportation
[] 2 Too expensive
[] 3 Poor quality of health services
[] 4 Husband/family refused
[] 5 Tradition of giving birth at home

MN19C. Check MN0B: participated in obstetrical health plan
[] Yes (Continue to MN19D)
[] No (Go to MN20)

MN19D. If you hadn't participated in the obstetrical health plan, do you think that you
still would have delivered in a health facility?

[] 1 Yes
[] 2 No

MN20. When (name) was born, was he/she very large, larger than average, average, smaller than average, or very small?

[] 1 Very large
[] 2 Larger than average
[] 3 Average
[] 4 Smaller than average
[] 5 Very small
[] 8 DK

MN21. Was (name) weighed at birth?

[] 1 Yes
[] 2 No (Go to MN22A)
[] 8 DK (Go to MN22A)

MN22. How much did (name) weigh?
If a card is available, record weight from card.
[] 1 From card (kg) _ _ _ _
[] 2 From recall (kg) _ _ _ _
[] 99998 DK

MN22A. Check MN18: place of delivery MN18 = 21 to 36:
[] Yes (Go to MN23)
[] No (Continue to MN22B)

MN22B. What was used to cut (name)'s umbilical cord?

[] 1 New blade
[] 2 Blade already used for something else
[] 3 Scissors
[] 6 Other (specify) ______
[] 8 DK

MN22C. Was the instrument boiled before being used to cut the cord?

[] 1 Yes
[] 2 No
[] 8 DK

MN22D. Was something applied to the cord after it was cut and tied until it falls off?

[] 1 Yes
[] 2 No (Go to MN23)
[] 8 DK (Go to MN23)

MN22E. What was applied on the cord?
Probe: anything else?
[] A Chlorhexidine (antiseptic)
[] B Other antiseptic (90% alcohol, alcohol, gentian violet)
[] C Mustard or other oil
[] D Animal dung
[] E Coal
[] F Traditional medicine
[] X Other __________
[] Z DK

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

[] 1 Yes
[] 2 No

MN24. Did you ever breastfeed (name)?

[] 1 Yes
[] 2 No (Go to next module)

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.
[] 000 Immediately
[] 1 Hours _ _
[] 2 Days _ _
[] 998 DK/don't remember

MN26. In the first three days after delivery, was (name) given anything to drink other than breast milk?

[] 1 Yes
[] 2 No (Go to next module)

MN27. What was (name) given to drink?
Probe: Anything else?
[] A Milk (other than breast milk)
[] B Plain water
[] C Sugar or glucose water
[] D Gripe water
[] E Sugar-salt-water solution
[] F Fruit juice
[] G Infant formula
[] H Tea/infusions
[] I Honey
[] X Other (specify) ____

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?
[] Yes, the child was delivered in a health facility (MN18=21-26 or 32-36) (Continue with PN2)
[] No, the child was not delivered in a health facility (MN18=11-12 or 96) (Go to PN6)

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. Otherwise, record weeks.
[] 1 Hours _ _
[] 2 Days _ _
[] 3 Weeks _ _
[] 998 DK/don't remember

PN3. I would like to talk to you about checks on (name)'s health after delivery - for example, someone examining (name), checking the umbilical cord, or seeing if (name) is ok.
Before you left the (name or type of health facility in MN18), did anyone check on (name)'s health?

[] 1 Yes
[] 2 No

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 health facility in MN18)?

[] 1 Yes
[] 2 No

PN5. Now I would like to talk to you about what happened after you left (name or type of health facility in MN18).
Did anyone check on (name)'s health after you left (name or type of health facility in MN18)?

[] 1 Yes (Go to PN11)
[] 2 No (Go to PN16)

PN6. Check MN17: Did a health professional, traditional birth attendant, or community health worker assist with the delivery?
[] Yes, delivery assisted by a health professional, traditional birth attendant, or community health worker (MN17=A-G) (Continue with PN7)
[] No, delivery not assisted by a health professional, traditional birth attendant, or community health worker (A-G not circled in MN17) (Go to PN10)

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 umbilical 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?

[] 1 Yes
[] 2 No

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.

[] 1 Yes
[] 2 No

PN9. After the (person or persons in MN17) left you, did anyone check on the health of (name)?

[] 1 Yes (Go to PN11)
[] 2 No (Go to PN18)

PN10. I would like to talk to you about checks on (name)'s health after delivery -- for example, someone examining (name), checking the umbilical cord, or seeing if the baby is ok.
After (name) was delivered, did anyone check on his/her health?

[] 1 Yes
[] 2 No (Go to PN19)

PN11. Did such a check happen only once, or more than once?

[] 1 Once (Go to PN12A)
[] 2 More than once (Go to PN12B)

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.
[] 1 Hours _ _
[] 2 Days _ _
[] 3 Weeks _ _
[] 998 DK/don't remember

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

Health professional:
[] A Doctor
[] B Midwife
[] C Auxiliary midwife
[] D Nurse
Other person:
[] F Traditional birth attendant
[] G Community health worker
[] X Other (specify) ____

PN14. Where did this check take place?
Probe to identify the check place. If unable to determine whether public or private, write the name of the place.
(Name of place) ____

Home
[] 11 Respondent's home
[] 12 Other home
Public sector
[] 21 Hospital
[] 22 Clinic/health centre
[] 23 Health post
[] 26 Other public (specify) ____
Private medical sector
[] 32 Private clinic
[] 36 Other private medical (specify) ____
[] 96 Other (specify) ____

PN15. Check MN18: Was the child delivered in a health facility?
[] Yes, the child was delivered in a health facility (MN18=21-26 or 32-36) (Continue with PN16)
[] No, the child was not delivered in a health facility (MN18=11-12 or 96) (Go to PN17)

PN16. After you left (name or type of facility in MN18), did anyone check on your health?

[] 1 Yes (Go to PN20)
[] 2 No (Go to next module)

PN17. Check MN17: Did a health professional, traditional birth attendant, or community health worker assist with the delivery?
[] Yes, delivery assisted by a health professional or other healthcare worker (MN17=A-G) (Continue with PN18)
[] No, delivery not assisted by a health professional or other healthcare worker (A-G not circled in MN17) (Go to PN19)

PN18. After the delivery was over and (person or persons in MN17) left, did anyone check on your health?

[] 1 Yes (Go to PN20)
[] 2 No (Go to next module)

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.

[] 1 Yes
[] 2 No (Go to next module)

PN20. Did such a check happen only once, or more than once?

[] 1 Once (Go to PN21A)
[] 2 More than once (Go to PN21B)

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.
[] 1 Hours _ _
[] 2 Days _ _
[] 3 Weeks _ _
[] 998 DK/don't remember

PN22. Who checked on your health at that time?

Health professional:
[] A Doctor
[] B Midwife
[] C Auxiliary midwife
[] D Nurse
Other person
[] F Traditional birth attendant
[] G Community health worker
[] X Other (specify) ____

PN23. Where did this check take place?
Probe to identify the type of place. If unable to determine whether public or private, write the name of the place.
(Name of place) ____

Home
[] 11 Respondent's home
[] 12 Other home
Public sector
[] 21 Hospital
[] 22 Clinic/health centre
[] 23 Health post
[] 26 Other public (specify) ____
Private medical sector
[] 32 Private clinic
[] 36 Other private medical (specify) ____
[] 96 Other (specify) ____

Illness symptoms: IS

IS1. Check List of Household Members, columns HL7B and HL15:
Is the respondent the mother or caretaker of any child under age 5?
[] Yes (Continue with IS2)
[] No (Go to next module)

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 suggest any answers.
[] A Child not able to drink or breastfeed
[] B Child becomes sicker
[] C Child develops a fever
[] D Child has fast breathing
[] E Child has difficulty breathing
[] F Child has blood in stool
[] G Child is drinking poorly
[] H Child is having convulsions
[] X Other (specify) ____
[] Y Other (specify) ____
[] Z Other (specify) ____

Contraception: CP

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

[] 1 Yes, currently pregnant (Go to CP2A)
[] 2 No
[] 8 Unsure or DK

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?

[] 1 Yes (Go to CP3)
[] 2 No

CP2A. Have you ever done something or used any method to delay or avoid getting pregnant?

[] 1 Yes (Go to next module)
[] 2 No (Go to CP3A)

CP3. What are you doing now to delay or avoid a pregnancy?
Do not prompt. If more than one method is mentioned, circle each one.
[] A Female sterilization
[] B Male sterilization
[] C IUD
[] D Injectables
[] E Implants
[] F Pill
[] G Male condom
[] H Female condom
[] I Diaphragm
[] J Foam/jelly
[] L Periodic abstinence/rhythm
[] M Withdrawal
[] X Other (specify) ____

CP3A. Do you know of a place where you can obtain contraception?

[] 1 Yes
[] 2 No (Go to next module)

CP3B. What place is it?
Probe to get the place. If unable to determine if place is public or private, write the name of the place.
(Name of place) ______

Public sector
[] 21 Hospital
[] 22 Health centre/clinic
[] 23 Health post
[] 26 Other public
Private medical sector
[] 32 Private clinic
[] 33 Pharmacy
Other sources
[] 41 Market
[] 42 Relatives/friends
[] 43 NGO/Associations
[] 96 Other (specify) ____

Unmet need: UN

UN1. Check CP1: Currently pregnant?
[] Yes, currently pregnant (Continue with UN2)
[] No, unsure or DK (Go to UN5)

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?

[] 1 Yes (Go to UN4)
[] 2 No

UN3. Did you want to have a baby later on or did you not want any (more) children?

[] 1 Later
[] 2 No 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?

[] 1 Have another child (Go to UN7)
[] 2 No more/none (Go to UN13)
[] 8 Undecided/DK (Go to UN13)

UN5. Check CP3: Currently using "female sterilization?"
[] Yes (Go to UN13)
[] No (Continue with UN6)

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?

[] 1 Have (a/another) child
[] 2 No more/none (Go to UN9)
[] 3 Says she cannot get pregnant (Go to UN11)
[] 8 Undecided/DK (Go to UN9)

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

[] 1 Months _ _
[] 2 Years _ _
[] 993 Soon/Now
[] 994 Says she cannot get pregnant (Go to UN11)
[] 995 After marriage
[] 996 Other
[] 998 DK

UN8. Check CP1: Currently pregnant?
[] Yes, currently pregnant (Go to UN13)
[] No, unsure or DK (Continue with UN9)

UN9. Check CP2: Currently using a method?
[] Yes (Go to UN13)
[] No (Continue with UN10)

UN10. Do you think you are physically able to get pregnant at this time?

[] 1 Yes (Go to UN13)
[] 2 No
[] 8 DK (Go to UN13)

UN11. Why do you think you are not physically able to get pregnant?

[] A Infrequent sex/no sex
[] B Menopausal
[] C Never menstruated
[] D Hysterectomy (uterus removed)
[] E Has been trying to get pregnant for 2 years or more without result
[] F Postpartum amenorrheic
[] G Breastfeeding
[] H Too old
[] I Fatalistic
[] X Other (specify) ____
[] Z DK

UN12. Check UN11: "Never menstruated" mentioned?
[] Mentioned (Go to next module)
[] Not mentioned (Continue with UN13)

UN13. When did your last menstrual period start?
Record the answer using the same unit of time stated by the respondent.
[] 1 Days ago _ _
[] 2 Weeks ago _ _
[] 3 Months ago _ _
[] 4 Years ago _ _
[] 994 In menopause/has had hysterectomy
[] 995 Before last birth
[] 996 Never menstruated

Female genital mutilation/cutting: FG

FG1. Have you ever heard of female circumcision?

[] 1 Yes (Go to FG3)
[] 2 No

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

[] 1 Yes
[] 2 No (Go to next module)

FG3. Have you yourself been circumcised?

[] 1 Yes
[] 2 No (Go to FG9)

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

[] 1 Yes (Go to FG6)
[] 2 No
[] 8 DK

FG5. Was the genital area just nicked without removing anything?

[] 1 Yes
[] 2 No
[] 8 DK

FG6. Was the genital area sewn closed?
If necessary, probe: Was it sealed?
[] 1 Yes
[] 2 No
[] 8 DK

FG7. How old were you when you were circumcised?
If the respondent does not know, probe to get an estimate. If less than one year, record 00.
_ _ Age at circumcision
[] 98 DK/Don't remember/not sure

FG8. Who performed the circumcision?

Health professional
[] 11 Doctor
[] 12 Midwife
[] 13 Nurse
Other persons
[] 22 Traditional birth attendant
[] 23 Community healthcare worker
[] 24 Traditional 'circumciser'
[] 96 Other (specify) ____

FG9. Check CM5 for number of daughters at home and CM7 for number of daughters elsewhere, and sum the answers here
Total number of living daughters _ _

FG10. Just to make sure that I have this right, you have (total number in FG9) living daughters. Is this correct?

[] Yes
[] One or more living daughters (Continue with FG11)
[] No living daughters (Go to FG22)
[] No (Check responses to CM1 -- CM10 and make corrections as necessary, until FG10 = Yes)

FG11. Ask the respondent to tell you the name(s) of her daughter(s), beginning with the youngest daughter (if more than one daughter). Write down the name of each daughter in FG12. Then, ask questions FG13 to FG20 for each daughter at a time.
The total number of daughters in FG12 should be equal to the number in FG9. If more than 4 daughters, use additional questionnaires.


FG12. Name of daughter ____

FG13 How old is (name)?

Age _ _

FG14. Is (name) younger than 15 years of age?

[] 1 Yes
[] 2 No (If "No", go to FG13 for the next daughter. If no more daughters, go to FG22)

FG15. Is (name) circumcised?

[] 1 Yes
[] 2 No (If "No", go to FG13 for the next daughter. If no more daughters, go to FG22)

FG16. How old was (name) when this occurred?
If the respondent does not know the age, probe to get an estimate.
_ _ Age
[] 98 DK

FG17. Now I would like to ask you some questions about what was done to (name) at that time.
Was any flesh removed from the genital area?

[] 1 Yes (Go to FG19)
[] 2 No
[] 8 DK

FG18. Was her genital area just nicked without removing anything?

[] 1 Yes
[] 2 No
[] 8 DK

FG19. Was her genital area sewn closed?
If necessary, probe: Was it sealed?
[] 1 Yes
[] 2 No
[] 8 DK

FG20. Who performed the circumcision?

Health professional
[] 11 Doctor
[] 12 Midwife
[] 13 Nurse
Other persons
[] 22 Traditional birth attendant
[] 23 Community healthcare worker
[] 24 Traditional 'circumciser'
[] 96 Other (specify) ____

FG21. Go back to FG13 for next daughter. If no more daughters, continue with FG22.

[] Tick here if additional questionnaire used.

FG22. Do you think this practice should be continued or should it be discontinued?

[] 1 Continued
[] 2 Discontinued
[] 3 Depends
[] 8 DK

Attitudes toward domestic violence: DV

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:

[A] If she goes out without telling him?

[] 1 Yes
[] 2 No
[] 8 DK

[B] If she neglects the children?

[] 1 Yes
[] 2 No
[] 8 DK

[C] If she argues with him?

[] 1 Yes
[] 2 No
[] 8 DK

[D] If she refuses to have sex with him?

[] 1 Yes
[] 2 No
[] 8 DK

[E] If she burns the food?

[] 1 Yes
[] 2 No
[] 8 DK

[F] Lack of respect towards husband's parents

[] 1 Yes
[] 2 No
[] 8 DK

Marriage: MA

MA1. Are you currently married?

[] 1 Yes, currently married
[] 3 No, not married (Go to MA5)

MA1A. Was this marriage declared at the civil registry?

[] 1 Yes
[] 2 No
[] 8 DK

MA2. How old is your husband?
Probe: How old was he on his last birthday?
_ _ Age in years
[] 98 DK

MA3. Besides yourself, does your husband have any other wives?

[] 1 Yes
[] 2 No (Go to MA7)

MA4. How many other wives does he have?

_ _ Number (Go to MA7)
[] 8 DK (Go to MA7)

MA5. Have you ever been married?

[] 1 Yes, have been married
[] 3 No (Go to next module)

MA6. What is your marital status now: are you widowed or divorced?

[] 1 Widowed
[] 2 Divorced

MA7. Have you been married once or more than once?

[] 1 Only once (Go to MA8A)
[] 2 More than once (Go to MA8B)

MA8A. In what month and year did you marry?
MA8B. In what month and year did you first marry?

Date of (first) marriage
_ _ Month
[] 98 DK month
_ _ _ _ Year (Go to next module)
[] 9998 DK year

MA9. How old were you when you first started living with your (first) husband?

Age in years _ _

HIV/AIDS: HA

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

[] 1 Yes
[] 2 No (Go to next module)

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

[] 1 Yes
[] 2 No
[] 8 DK

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

[] 1 Yes
[] 2 No
[] 8 DK

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

[] 1 Yes
[] 2 No
[] 8 DK

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

[] 1 Yes
[] 2 No
[] 8 DK

HA5A. Can people get the AIDS virus by sharing needles?

[] 1 Yes
[] 2 No
[] 8 DK

HA6. Can people get the AIDS virus by sharing food with a person who has the AIDS virus?

[] 1 Yes
[] 2 No
[] 8 DK

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

[] 1 Yes
[] 2 No
[] 8 DK

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

[A] During pregnancy?

[] 1 Yes
[] 2 No
[] 8 DK

[B] During delivery?

[] 1 Yes
[] 2 No
[] 8 DK

[C] By breastfeeding?

[] 1 Yes
[] 2 No
[] 8 DK

HA8A. Check HA8, [A], [B], and [C]
[] All 'No' or 'DK' (Go to HA9)
[] At least one 'Yes' (Continue to HA8B)

HA8B. Are there special medicines that a doctor or nurse can give to a woman who has the AIDS virus to reduce the risk of transmission to her baby?

[] 1 Yes
[] 2 No
[] 8 DK/not sure/depends

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?

[] 1 Yes
[] 2 No
[] 8 DK/not sure/depends

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

[] 1 Yes
[] 2 No
[] 8 DK/not sure/depends

HA11. If a member of your family got infected with the AIDS virus, would you want it to remain a secret?

[] 1 Yes
[] 2 No
[] 8 DK/not sure/depends

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?

[] 1 Yes
[] 2 No
[] 8 DK/not sure/depends

HA12A. Do you think that children living with the AIDS virus should attend the same school as children who don't have the AIDS virus?

[] 1 Yes
[] 2 No
[] 8 DK/not sure/depends

HA13. Check CM13: Any live birth in last 2 years?
[] No live birth in last 2 years (CM13="No" or blank) (Go to HA24)
[] One or more live births in last 2 years (Continue with HA14)

HA14. Check MN1: Received antenatal care?
[] Received antenatal care (Continue with HA15)
[] No, no antenatal care (Go to HA24)

HA15. During any of the antenatal visits for your pregnancy with (name),

Were you given any information about:

[A] Babies getting the AIDS virus from their mother?

[] 1 Yes
[] 2 No
[] 8 DK

[B] Things that you can do to prevent getting the AIDS virus?

[] 1 Yes
[] 2 No
[] 8 DK

[C] The possibility of getting tested for the AIDS virus?

[] 1 Yes
[] 2 No
[] 8 DK

Were you:
[D] Offered a test for the AIDS virus?

[] 1 Yes
[] 2 No
[] 8 DK

HA16. I don't want to know the results, but were you tested for the AIDS virus as part of your antenatal care?

[] 1 Yes
[] 2 No (Go to HA19)
[] 8 DK (Go to HA19)

HA17. I don't want to know the results, but did you get the results of the test?

[] 1 Yes
[] 2 No (Go to HA22)
[] 8 DK (Go to HA22)

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?

[] 1 Yes (Go to HA22)
[] 2 No (Go to HA22)
[] 8 DK (Go to HA22)

HA19. Check MN17: Birth delivered by health professional (A, B or C)?
[] Yes, birth delivered by health professional (Continue with HA20)
[] No, birth not delivered by health professional (Go to HA24)

HA20. I don't want to know the results, but were you tested for the AIDS virus between the time you went for delivery but before the baby was born?

[] 1 Yes
[] 2 No (Go to HA24)

HA21. I don't want to know the results, but did you get the results of the test?

[] 1 Yes
[] 2 No

HA22. Have you been tested for the AIDS virus since that time you were tested during your pregnancy?

[] 1 Yes (Go to HA25)
[] 2 No

HA23. When was the most recent time you were tested for the AIDS virus?

[] 1 Less than 12 months ago (Go to next module)
[] 2 12-23 months ago (Go to next module)
[] 3 2 or more years ago (Go to next module)

HA24. I don't want to know the results, but have you ever been tested to see if you have the AIDS virus?

[] 1 Yes
[] 2 No (Go to HA27)

HA25. When was the most recent time you were tested?

[] 1 Less than 12 months ago
[] 2 12-23 months ago
[] 3 2 or more years ago

HA26. I don't want to know the results, but did you get the results of the test?

[] 1 Yes (Go to next module)
[] 2 No (Go to next module)
[] 8 DK (Go to next module)

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

[] 1 Yes
[] 2 No

Tobacco use: TA

TA1. Have you ever tried cigarette smoking, even one or two puffs?

[] 1 Yes
[] 2 No (Go to TA6)

TA2. How old were you when you smoked a whole cigarette for the first time?

[] 00 Never smoked a whole cigarette (Go to TA6)
_ _ Age

TA3. Do you currently smoke cigarettes?

[] 1 Yes
[] 2 No (Go to TA6)

TA4. In the last 24 hours, how many cigarettes did you smoke?

Number of cigarettes _ _

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".
[] Number of days 0_
[] 10 days or more but less than a month
[] 30 Every day/almost every day

TA6. Have you ever tried any smoked tobacco products other than cigarettes, such as cigars, water pipe, "Moneija", cigarillos, or water pipe?

[] 1 Yes
[] 2 No (Go to TA10)

TA7. During the last one month, did you use any smoked tobacco products?

[] 1 Yes
[] 2 No (Go to TA10)

TA8. What type of smoked tobacco product did you use during the last one month?
Circle all mentioned.
[] A Cigars
[] B Water pipe
[] C Cigarillos
[] E "Moneija"
[] X Other (specify) ____

TA9. During the last one month, on how many days did you use 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".
[] Number of days 0_
[] 10 days or more but less than a month
[] 30 Every day/almost every day

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

[] 1 Yes
[] 2 No (Go to next module)

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

[] 1 Yes
[] 2 No (Go to next module)

TA12. What type of smokeless tobacco product did you use during the last one month?
Circle all mentioned.
[] A Chewing tobacco
[] B Snuff
[] X Other (specify) ____

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".
[] Number of days 0_
[] 10 days or more but less than a month
[] 30 Every day/almost every day

Life satisfaction: LS

LS1. Check WB2: Age of respondent is between 15 and 24?
[] Age 25-49 (Go to WM11)
[] Age 15-24 (Continue with LS2)

LS2. I would like to ask you some simple questions on happiness and satisfaction.
First, taking all things together, would you say you are very happy, somewhat happy, neither happy nor unhappy, somewhat unhappy or very unhappy?
You can also look at these pictures to help you with your response.
Show side 1 of response card and explain what each symbol represents. Circle the response code selected by the respondent. [Image omitted]

[] 1 Very happy
[] 2 Somewhat happy
[] 3 Neither happy nor unhappy
[] 4 Somewhat unhappy
[] 5 Very unhappy

LS3. Now I will ask you questions about your level of satisfaction in different areas.
In each case, we have five possible responses: please tell me, for each question, whether you are very satisfied, somewhat satisfied, neither satisfied nor unsatisfied, somewhat unsatisfied or very unsatisfied.
Again, you can look at these pictures to help you with your response.
Show side 2 of response card and explain what each symbol represents. Circle the response code selected by the respondent, for questions LS3 to LS13. [Image omitted]

How satisfied are you with your family life?

[] 1 Very satisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied

LS4. How satisfied are you with your friendships?

[] 1 Very satisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied

LS5. During the current / 2014-2015 school year, did you attend school at any time?

[] 1 Yes
[] 2 No (Go to LS7)

LS6. How satisfied (are/were) you with your school?

[] 1 Very satisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied

LS7. How satisfied are you with your current job?

[] 0 Does not have a job
[] 1 Very satisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied

LS8. How satisfied are you with your health?

[] 1 Very satisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied

LS9. How satisfied are you with where you live?
If necessary, explain that the question refers to the living environment, including the neighbourhood and the dwelling.
[] 1 Very satisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied

LS10. How satisfied are you with how people around you generally treat you?

[] 1 Very satisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied

LS11. How satisfied are you with the way you look?

[] 1 Very satisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied

LS12. How satisfied are you with your life, overall?

[] 1 Very satisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied

LS13. How satisfied are you with your current income?
If the respondent says that she does not have any income, circle "0" and continue with the next question. Do not probe to find out how she feels about not having any income, unless she tells you herself.
[] 0 Does not have any income
[] 1 Very satisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied

LS14. Compared to this time last year, would you say that your life has improved, stayed more or less the same, or worsened, overall?

[] 1 Improved
[] 2 More or less the same
[] 3 Worsened

LS15. And in one year from now, do you expect that your life will be better, will be more or less the same, or will be worse, overall?

[] 1 Better
[] 2 More or less the same
[] 3 Worse

WM11. Record the time.
Hour and minutes _ _ : _ _

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?
[] Yes (Proceed to complete the result of woman's interview (WM7) on the cover page and then go to questionnaire for children under five for that child and start the interview with this respondent.)
[] No (End the interview with this respondent by thanking her for her cooperation and proceed to complete the result of woman's interview (WM7) on the cover page.)

Interviewer's observations

Team leader's observations

Response card for Life Satisfaction module:

Side 1

Very happy
Somewhat happy
Neither happy, nor unhappy
Somewhat unhappy
Very unhappy

[Images omitted]
Side 2:

Very satisfied
Somewhat satisfied
Neither satisfied, nor unsatisfied
Somewhat unsatisfied
Very unsatisfied

[Images omitted]