Palestinian Multiple Indicator Cluster Survey, 2014

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:
WM6. Day/month/year of interview _ _ / _ _ / 201 4

Repeat greeting if not already read to this woman:
We are from Palestinian Central Bureau of Statistics. We are conducting a survey about the situation of children, families and households. 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?

WM7. Result of woman's interview
WM8. Field editor's name and number:
WM9. Main data entry clerk's name and number
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 or preschool?

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

WB5. What is the highest grade you completed at that level? If the first grade at this level is not completed, enter "00".
WB6. Check WB4:
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?
Marriage/union: MA

MA1. Are you currently married?

MA2. How old is your husband? Probe: How old was your husband on his last birthday?
MA3. Besides yourself, does your husband have any other wives?

MA4. How many other wives or partners does he have?

MA5. Have you ever been 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?
MA8B. In what month and year did you first marry?

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

Fertility/ birth history: CM

[IPUMS note: There are slight variations in the fertility/birth history module depending on whether the country included a full birth history module as a part of the child questionnaire. Divergences are noted below.]

CM0. Now I would like to ask about all the pregnancies and the birth you have had during your life. Have you ever been pregnant?

CM0A. How old were you at your first pregnancy?

CM1. 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?

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 during your life. Is this correct?

[IPUMS Note: If the sample includes a birth history module, respondents should proceed to the birth history module when instructed. If the sample does not include a birth history module, the respondent should proceed to CM12 when instructed.]

Birth History: BH

Now I would like to record the names of all of your births, whether still alive or not, starting with the first one you had. Record names of all of the births in BH1. Record twins and triplets on separate line. If there are more than 14 births, use an additional questionnaire.

BH Line No. _ _

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

BH2. Were any of these births twins?

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

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

BH6. 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 less than 2 years; or years
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)?

CM12B. Some pregnancies may end prematurely, such as miscarriage or abortion, and some other pregnancies end by a stillbirth.
Have you ever had any pregnancy that was miscarried, ended in a stillbirth, or that was terminated prematurely (aborted)?

CM12C. How many miscarriages have you had during your lifetime?
By miscarriage, I mean an early and involuntary end of pregnancy within the first 5 months of pregnancy.

CM12D. In how many cases have your pregnancies ended with a stillbirth?
By stillbirth, I mean a birth that took place after the 5th month of pregnancy, but the child did not show any signs of life.

CM12E. And how many early terminations of pregnancy (abortions) have you had during your lifetime?
By early termination of pregnancy (abortion), I mean a pregnancy that was voluntarily terminated within the first 5 months of pregnancy.

CM12F. When did your (last) abortion take place?
Month and year must be recorded

CM12G. Check CM12F. Last abortion occurred within the last 2 years, that is, since (month of interview) in 2012 (if the month of interview and the month the abortion took place are the same, and the year the abortion took place is 2012, consider this as an abortion within the last 2 years)

CM12I. Did you do any of the following in order to end this pregnancy?

CM12IA
Check 12IA
CM12J. Why did you try to end this pregnancy?

CM12K. Where did this abortion take place?

CM13. Check BH4 in birth history module: Last birth occurred within the last 2 years, that is, since (month of interview) in 20 2 (if the month of the interview and the month of the birth are the same, and the year of birth is 20 2, 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.


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?

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?
Record the answer as stated by respondent.
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.
MN3A.Where did you go mostly to receive the antenatal care for your pregnancy with (name)

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?

[B] Did you give a urine sample?

[C] Did you give a blood sample?

MN4A. Have you had any of the following complications at any time during this pregnancy?

[A] Severe vaginal bleeding?

[B] Hypertension?

[C] Swelling in the face or body?

[D] Severe headache?

[E] Upper abdominal pain?

[F] High fever?

[G]Non-fever convulsions?

[H] Painful micturition?

[I] Severe difficulty breathing?

[J] Anaemia?

[K] Urinary tract infection or genital?

[L] Rheumatic conditions?

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

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?

MN19C. Did you have any of the following symptoms during or immediately after delivery?
[A] than 12 hours?

[B] High fever?

[C] Convulsions without fever?

[D] Severe vaginal bleeding?

[X] Other?

MN19D. Did you suffer from any of the following symptoms at any time during the first six weeks following the delivery?

[A] Severe vaginal bleeding?

[B] Swelling and pain in the legs?

[C] Foul-smelling vaginal discharge with fever?

[D] Lower abdominal pain with fever?

[E] Sever lower back pain with fever?

[F] Painful during urination?

[G]Breast swelling and pain with fever?

[H] Hypertension?

[I] Severe headache?

[X] Other(specify)?

MN20. When (name) was born, was he/she very large, larger than average, average, 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.
MN23. Has your menstrual period returned since 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?
MN27A. Did you hear about mother and child health handbook?

MN27B. Did you use the mother and child health handbook?

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. Otherwise, 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)?

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, or community health worker 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, or community health worker 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?

PN23. 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) ____

PN23A. What is the main reason for not seeking for the postnatal care?

Contraception: CP

CP0.Check MA1. Currently married?

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

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?

CP2AA. What is your main reason for not currently using a family planning method?

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

CP3. What are you doing to delay or avoid a pregnancy?Do not prompt. If more than one method is mentioned, circle each one.
CP4. From where did you get (current method's name) last time?
CP4A: In what facilities did the sterilization take place?

CP5. Did you face any problems with using(current method)?

CP6. What problems did you face? Probe: Any other problems?

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?

UN7. How long would you like to wait before the birth of (a/another) child? Record the answer as stated by respondent.
UN8. Check CP1: Currently pregnant?
UN9. Check CP2: Currently using a method?
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?

UN12. Check UN11: "Never menstruated" mentioned?
UN13. When did your last menstrual period start? Record the answer using the same unit stated by the respondent.
HIV/AIDS: HA

HA1. Now I would like to talk with you about something else.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?

HA3. Can people get 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 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?

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?

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

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 ________

Field Editor's observations ________

Supervisor's observations ________

Response card:

Side 1

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Side 2:

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