MICS questionnaire for women age 15-49 years
[Republic of Serbia]
Woman's information panel: WM
This questionnaire is to be administered to all women age 15 through 49 year (see Household Questionnaire, Module HL - List of household members, column HL7). Fill in one form 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 ____
Interviewer's ID code _ _ _
Interviewer's ID code _ _ _
WM6. Day/month/year of interview _ _ / _ _ / _ _ _ _
Repeat greeting if not already read to this woman:
We are from Statistical Office of the Republic of Serbia. We are working on a survey concerned with health and education of family members. I would like to talk to you about it. The interview will take about 30 minutes. All the information we obtain will remain strictly confidential and your answers will never be identified.
If the greetings were read to this woman when starting with household questionnaire, the following text should be read:
Now I would like to talk to you more about your health and other issues. This interview will take about 30 minutes, and I repeat that all the information we obtain will remain strictly confidential and your answers will never be identified.
May I start now?
[] Yes, permission is given (Go to WM10 and record the time and then begin the interview.)
[] No, permission is not given (Complete WM7. Discuss the result with your supervisor.)
[] No, permission is not given (Complete WM7. Discuss the result with your supervisor.)
WM7. Result of woman's interview
[] 01 Completed
[] 02 Not at home
[] 03 Refused
[] 04 Partly completed
[] 05 Incapacitated
[] 96 Other (specify) ____
[] 02 Not at home
[] 03 Refused
[] 04 Partly completed
[] 05 Incapacitated
[] 96 Other (specify) ____
WM8. Field edited by:
Name ____
ID code _ _ _
ID code _ _ _
WM9. Data entry clerk:
Name ____
ID code _ _ _
ID code _ _ _
WM10. Record the time the interview started.
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
_ _ 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 school or preschool?
[] 1 Yes
[] 2 No (Go to WB7)
[] 2 No (Go to WB7)
WB4. What is the highest level of school you attended or now attend?
[] 0 Preschool (Go to WB7)
[] 1 Primary
[] 2 Secondary
[] 3 Higher
[] 1 Primary
[] 2 Secondary
[] 3 Higher
WB5. What is the highest grade/year you completed at that level?
If less than 1 grade/year, enter "00"
Grade/year _ _
WB6. Check WB4:
[] Secondary school or higher school/university. (Go to next module)
[] Primary school (Continue with WB7)
[] Primary school (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 / mute, visually / speech impaired
[] 2 Able to read only parts of sentence
[] 3 Able to read whole sentence
[] 4 No sentence in required language (specify language) ____
[] 5 Blind / mute, visually / speech impaired
Access to mass media and use of information and communication technologies: MT
MT1. Check EB7:
[] Question left blank (Respondent has secondary or higher education) (Continue with MT2)
[] Able to read or no sentence in required language (codes 2, 3 or 4) (Continue with MT2)
[] Cannot read at all or blind (codes 1 or 5) (Go to MT3)
[] Able to read or no sentence in required language (codes 2, 3 or 4) (Continue with MT2)
[] Cannot read at all or blind (codes 1 or 5) (Go to MT3)
MT2. How often do you read newspapers or magazines: 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
[] 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
[] 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
[] 2 At least once a week
[] 3 Less than once a week
[] 4 Not at all
MT5. Check WB2: Age of respondent 15-24 years?
[] Yes, age 15-24 (Continue with MT6)
[] No, age 25-49 (Go to next module)
[] No, age 25-49 (Go to next module)
MT6. Have you ever used a computer?
[] 1 Yes
[] 2 No (Go to MT9)
[] 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)
[] 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
[] 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)
[] 2 No (Go to next module)
MT10. In the last 12 months, have you used the internet?
If necessary, probe if the woman used internet on any location, on any device.
[] 1 Yes
[] 2 No (Go to next module)
[] 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
[] 2 At least once a week
[] 3 Less than once a week
[] 4 Not at all
Child mortality: CM
All questions refer only to live births.
CM1. Now I would like to ask you about births you have had during your life. Have you ever given birth?
[] 1 Yes
[] 2 No (Go to CM8)
[] 2 No (Go to CM8)
CM2. What was the date of your first birth?
I mean the very first time you gave birth, even if the child is no longer living, or whose father is not your current partner.
Skip to CM4 only if year of first birth is given. Otherwise, continue with CM3.
Date of first birth
_ _ Day
[] 98 DK day
_ _ Month
[] 98 DK month
_ _ _ _ Year (Go to CM4)
[] 9998 DK year
_ _ Day
[] 98 DK day
_ _ Month
[] 98 DK month
_ _ _ _ Year (Go to CM4)
[] 9998 DK year
CM3. How many years ago did you have your first birth?
Completed years since first birth _ _
CM4. Do you have any sons or daughters who are now living with you?
[] 1 Yes
[] 2 No (Go to CM6)
[] 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
_ _ 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)
[] 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
_ _ 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)
[] 2 No (Go to CM10)
CM9. How many boys died? How many girls died?
If none, record '00'.
_ _ Boys dead
_ _ Girls dead
_ _ Girls dead
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 in cm10) live births during your life. Is that correct?
[] Yes. Check below:
[] No live births (Go to illness symptoms module)
[] One or more live births (Continue with CM12)
[] One or more live births (Continue with CM12)
[] No (Check responses to CM1-CM10 and make corrections before proceeding to CM12)
CM12: Of these (total number in CM10) births you have had, when did you deliver the last one (even if the baby died)?
Month and year must be recorded.
Date of last birth
_ _ Day
[] 98 DK day
_ _ Month
_ _ _ _ Year
[] 98 DK day
_ _ Month
_ _ _ _ Year
CM13. Check CM12: Last birth occurred within the last 2 years, that is, since (day and month of interview) in 2008
[] No live birth in last 2 years. (Go to illness symptoms module)
[] One or more live births in last 2 years. (Ask for the child's name)
[] One or more live births in last 2 years. (Ask for the child's name)
Name of child ____
If child has died, take special care when referring to this child by name in the following modules.
Continue with the next module.
Desire for last birth: DB
This module is to be administered to all women with a live birth in the past 2 years.
Check module CM ? child mortality, question CM13 and record name of the last-born child 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 then?
[] 1 Yes (Go to next module)
[] 2 No
[] 2 No
DB2. Did you want to have a baby later on, or did you not want any (more) children?
[] 1 Later
[] 2 No more (Go to next module)
[] 2 No more (Go to next module)
DB3. How much longer did you want to wait?
[] 1 Months _ _
[] 2 Years _ _
[] 998 DK
[] 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 date of interview.
Check module CM ? child mortality, question CM13 and record name of last-born child here ____
Use this child's name in the following questions, where indicated.
MN1. Did you see anyone for antenatal care during your last pregnancy with (name)?
[] 1 Yes
[] 2 No (Go to MN4A)
[] 2 No (Go to MN4A)
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 Nurse/Midwife
[] C Auxiliary midwife
[] B Nurse/Midwife
[] C Auxiliary midwife
Other person
[] F Traditional birth attendant
[] X Other (specify) ____
MN3. How many times did you receive antenatal care during this pregnancy?
_ _ Number of times
[] 98 DK
[] 98 DK
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
[] 2 No
[B] Did you give a urine sample?
[] 1 Yes
[] 2 No
[] 2 No
[C] Did you give a blood sample?
[] 1 Yes
[] 2 No
[] 2 No
MN4A. During this pregnancy, did auxiliary nurse (patronage nurse) visit you at your home?
[] 1 Yes
[] 2 No
[] 2 No
MN4B. During this pregnancy, did you attend any child birth preparation programme (parenting and pregnancy education with health care institution)?
[] 1 Yes
[] 2 No (Go to MN4D)
[] 2 No (Go to MN4D)
MN4C. While you attend preparation programme did you receive information about the following topics:
[A] Health during pregnancy?
[] 1 Yes
[] 2 No (Go to MN17)
[] 2 No (Go to MN17)
[B] Breastfeeding?
[] 1 Yes
[] 2 No (Go to MN17)
[] 2 No (Go to MN17)
[C] newborn' care?
[] 1 Yes
[] 2 No (Go to MN17)
[] 2 No (Go to MN17)
[D] parenting skills?
[] 1 Yes
[] 2 No (Go to MN17)
[] 2 No (Go to MN17)
MN4D. What was the main reason that you didn?t attend childbirth preparation programme (parenting and pregnancy education with health care institution)?
[] 1 Did not know it exists
[] 2 No need
[] 3 No time
[] 4 Not organized in my neighborhood
[] 5 Do not know/do not remember
[] 6 Other (specify) ____
[] 2 No need
[] 3 No time
[] 4 Not organized in my neighborhood
[] 5 Do not know/do not remember
[] 6 Other (specify) ____
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 Nurse/Midwife
[] C Auxiliary midwife
[] B Nurse/Midwife
[] C Auxiliary midwife
Other person
[] F Traditional birth attendant
[] H Relatives/Friends
[] H Relatives/Friends
[] I Husband
[] X Other (specify) ____
[] Y No one
[] 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 Your home (Go to MN20)
[] 12 Other home (Go to MN20)
[] 12 Other home (Go to MN20)
Public sector
[] 21 Govt. hospital
[] 22 Govt. clinic/health centre
[] 23 Govt. health post
[] 26 Other public facility (specify) ____
[] 22 Govt. clinic/health centre
[] 23 Govt. health post
[] 26 Other public facility (specify) ____
Private medical sector
[] 31 Private hospital
[] 32 Private clinic
[] 33 Private maternity home
[] 36 Other private medical facility (specify) ____
[] 32 Private clinic
[] 33 Private maternity home
[] 36 Other private medical facility (specify) ____
[] 96 Other (specify) ____ (Go to MN20)
MN19. Was (name) delivered by caesarean section, i.e. did they cut your belly open to take the baby out?
[] 1 Yes
[] 2 No
[] 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
[] 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 MN23)
[] 8 DK (Go to MN23)
[] 2 No (Go to MN23)
[] 8 DK (Go to MN23)
MN22. How much did (name) weigh?
Record weight from health card, if available.
[] 1 From card (kg) _ _ _ _
[] 2 From recall (kg) _ _ _ _
[] 99998 DK
[] 2 From recall (kg) _ _ _ _
[] 99998 DK
MN23. Has your menstrual period returned since the birth of (name)?
[] 1 Yes
[] 2 No
[] 2 No
MN24. Did you ever breastfed (name)?
[] 1 Yes
[] 2 No (Go to MN27A)
[] 2 No (Go to MN27A)
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 Don't know/remember
[] 1 Hours _ _
[] 2 Days _ _
[] 998 Don't know/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 MN27A)
[] 2 No (Go to MN27A)
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 Anti-colic (cramps) medicine
[] E Sugar-salt-water solution
[] F Fruit juice
[] G Infant formula
[] H Tea/Infusion solution
[] I Honey
[] X Other (specify) ____
[] B Plain water
[] C Sugar or glucose water
[] D Anti-colic (cramps) medicine
[] E Sugar-salt-water solution
[] F Fruit juice
[] G Infant formula
[] H Tea/Infusion solution
[] I Honey
[] X Other (specify) ____
MN27A. Did auxiliary nurse visit you after coming home, within one week of giving birth?
[] 1 Yes
[] 2 No
[] 2 No
Illness Symptoms: IS
IS1. Check Household Questionnaire, Module HL ? List of household members, column HL9
Is the respondent the mother or caretaker of any child under age 5?
[] Yes (Continue with IS2)
[] No (Go to next module)
[] No (Go to next module)
IS2. Sometimes children have severe illnesses and should be taken immediately to a doctor. In case of what symptoms of illness would you take the child to the doctor 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
[] A Cannot drink or breastfeed
[] B Condition getting worse
[] C Fever
[] D Faster breathing
[] E Difficult breathing
[] F Blood in the stool
[] G Difficult drinking
[] X Other (specify) ____
[] Y Other (specify) ____
[] Z Other (specify) ____
[] B Condition getting worse
[] C Fever
[] D Faster breathing
[] E Difficult breathing
[] F Blood in the stool
[] G Difficult drinking
[] 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 next module)
[] 2 No
[] 8 Unsure or DK
[] 2 No
[] 8 Unsure or DK
CP3. Couples use various ways or methods to delay or avoid pregnancy. What are you or your partner doing to delay or avoid pregnancy? Do you use one or more of the following ways/methods:
Prompt the following methods and provide an explanation for a specific method if necessary. If more than one method is mentioned, circle each one.
[] A and B Female/ sterilization: Women and/or man can have an operation to avoid having any more children.
[] C IUD: Women can have a 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 her from becoming pregnant for one or more months.
[] E Implants: Women can have one or more small implants placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
[] F Pill: Women have to take a pill every day to avoid becoming pregnant.
[] G Male condom: Men can put a rubber condom on their penis before or during the sexual intercourse.
[] H Female condom: Women can place a sheath in their vagina before sexual intercourse.
[] I Diaphragm: Women can place a soft rubber cup in their vagina to block sperm from entering uterus or tubes
[] J Foam, jelly: Women may be using spermicides such as foam, jelly, cream that are used to kill supreme or make sperm unable to move to the egg.
[] K Lactational amenorrhoea method (LAM)
[] L Rhythm method: Woman can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
[] M Withdrawal: Men can be careful and pull out before climax.
[] N Emergency Contraception: within three days after they had unprotected sexual intercourse, women can take special pills to prevent pregnancy.
[] X Other (specify) ____
[] Y None
[] C IUD: Women can have a 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 her from becoming pregnant for one or more months.
[] E Implants: Women can have one or more small implants placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
[] F Pill: Women have to take a pill every day to avoid becoming pregnant.
[] G Male condom: Men can put a rubber condom on their penis before or during the sexual intercourse.
[] H Female condom: Women can place a sheath in their vagina before sexual intercourse.
[] I Diaphragm: Women can place a soft rubber cup in their vagina to block sperm from entering uterus or tubes
[] J Foam, jelly: Women may be using spermicides such as foam, jelly, cream that are used to kill supreme or make sperm unable to move to the egg.
[] K Lactational amenorrhoea method (LAM)
[] L Rhythm method: Woman can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
[] M Withdrawal: Men can be careful and pull out before climax.
[] N Emergency Contraception: within three days after they had unprotected sexual intercourse, women can take special pills to prevent pregnancy.
[] X Other (specify) ____
[] Y None
Unmet need: UN
UN1. Check CP1. Currently pregnant?
[] Yes, currently pregnant (Continue with UN2)
[] No, unsure or DK (Go to UN5)
[] 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
[] 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
[] 2 No More
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/don't know (Go to UN13)
[] 2 No more/none (Go to UN13)
[] 8 Undecided/don't know (Go to UN13)
UN5. Check CP3. Currently using "female sterilization"
[] Yes (Go to UN13)
[] No (Continue with UN6)
[] 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/don't know (Go to UN9)
[] 2 No more/none (Go to UN9)
[] 3 Says she cannot get pregnant (Go to UN11)
[] 8 Undecided/don't know (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 Don't know
[] 2 Years _ _
[] 993 Soon/now
[] 994 Says she cannot get pregnant (Go to UN11)
[] 995 After Marriage
[] 996 Other
[] 998 Don't know
UN8. Check CP1. Currently pregnant?
[] Yes, currently pregnant (Go to UN13)
[] No, unsure or DK (Continue with UN9)
[] No, unsure or DK (Continue with UN9)
UN9. Check CP2. Currently using any method of contraception?
[] Yes (Go to UN13)
[] No (Continue with UN10)
[] 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)
[] 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 (surgical removal of uterus)
[] 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 Don't know
[] B Menopausal
[] C Never menstruated
[] D Hysterectomy (surgical removal of uterus)
[] 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 Don't know
UN12. Check UN11. "Never menstruated" mentioned?
[] Mentioned (Go to next module)
[] Not mentioned (Continue with UN13)
[] Not mentioned (Continue with UN13)
UN13. When did your last menstrual period start?
[] 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
[] 2 Weeks ago _ _
[] 3 Months ago _ _
[] 4 Years ago _ _
[] 994 In menopause/has had hysterectomy
[] 995 Before last birth
[] 996 Never menstruated
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
[] 2 No
[] 8 DK
[B] If she neglects the children?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
[C] If she argues with him?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
[D] If she refuses to have sex with him?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
[E] If she burns the food?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
Marriage/union: MA
MA1. Are you currently married or living together with a man as if married?
[] 1 Yes, currently married
[] 2 Yes, living with a man
[] 3 No, not in union (Go to MA5)
[] 2 Yes, living with a man
[] 3 No, not in union (Go to MA5)
MA2. How old is your husband/partner?
Probe: how old was your husband/partner on his last birthday?
_ _ Age in years (Go to MA7)
[] 98 DK (Go to MA7)
[] 98 DK (Go to MA7)
MA5. Have you ever been married or lived together with a man as if married?
[] 1 Yes, formerly married
[] 2 Yes, formerly lived with a man
[] 3 No (Go to next module)
[] 2 Yes, formerly lived with a man
[] 3 No (Go to next module)
MA6. What is your marital status now: are you widowed, divorced or separated?
[] 1 Widowed
[] 2 Divorced
[] 3 Separated
[] 2 Divorced
[] 3 Separated
MA7. Have you been married or lived with a man only once or more than once?
[] 1 Only once
[] 2 More than once
[] 2 More than once
MA8. In what month and year did you first marry or start living with a man as if married?
Date of first marriage
_ _ Month
[] 98 DK month
_ _ _ _ Year (Go to next module)
[] 9998 DK year
[] 98 DK month
_ _ _ _ Year (Go to next module)
[] 9998 DK year
MA9. How old were you when you started living with your first husband/partner?
Age in years _ _
Sexual behaviour: SB
Check for the presence of others. Before continuing, ensure privacy.
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?
[] 00 Never had intercourse (Go to next module)
_ _ Age in years
[] 95 First time when started living with (first) husband/partner
_ _ Age in years
[] 95 First time when started living with (first) husband/partner
SB2. The first time you had sexual intercourse, was a condom used?
[] 1 Yes
[] 2 No
[] 8 DK/don't remember
[] 2 No
[] 8 DK/don't remember
SB3. When was the last time you had sexual intercourse?
Record ?year ago? only if last intercourse was one or more years ago. If 12 months or more the answer must be recorded in years.
[] 1 Days ago _ _
[] 2 Weeks ago _ _
[] 3 Months ago _ _
[] 4 Years ago _ _ (Go to SB15)
[] 2 Weeks ago _ _
[] 3 Months ago _ _
[] 4 Years ago _ _ (Go to SB15)
SB4. The last time you had sexual intercourse, was a condom used?
[] 1 Yes
[] 2 No
[] 2 No
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', then ask: Were you living together as if married? If 'yes', circle '2'. If 'no', circle'3'.
[] 1 Husband
[] 2 Cohabiting partner
[] 3 Boyfriend (Go to SB7)
[] 4 Casual acquaintance (Go to SB7)
[] 6 Other (specify) ____ (Go to SB7)
[] 2 Cohabiting partner
[] 3 Boyfriend (Go to SB7)
[] 4 Casual acquaintance (Go to SB7)
[] 6 Other (specify) ____ (Go to SB7)
SB6. Check MA1:
[] Currently married or living with a man (MA1 = 1 or MA1 = 2) (Go to SB8)
[] Not married / Not in union (MA1 = 3) (Continue with SB7)
[] Not married / Not in union (MA1 = 3) (Continue with SB7)
SB7. How old is this person?
If response is DK, probe: About how old is this person?
_ _ Age of sexual partner
[] 98 DK
[] 98 DK
SB8. Have you had sexual intercourse with any other person in the last 12 months?
[] 1 Yes
[] 2 No (Go to SB15)
[] 2 No (Go to SB15)
SB9. The last time you had sexual intercourse with this other person, was a condom used?
[] 1 Yes
[] 2 No
[] 2 No
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' then ask: Were you living together as if married? If 'yes', circle '2'. If 'no', circle '3'.
[] 1 Husband
[] 2 Cohabiting partner
[] 3 Boyfriend (Go to SB12)
[] 4 Casual acquaintance (Go to SB12)
[] 6 Other (specify) ____ (Go to SB12)
[] 2 Cohabiting partner
[] 3 Boyfriend (Go to SB12)
[] 4 Casual acquaintance (Go to SB12)
[] 6 Other (specify) ____ (Go to SB12)
SB11. Check MA1 and MA7:
[] Currently married or living with a man (MA1 = 1 or MA1 = 2) and Married only once or lived with a man only once (MA7 = 1) (Go to SB13)
[] Else (Continue with SB12)
[] Else (Continue with SB12)
SB12. How old is this person?
If response is DK, probe: About how old is this person?
_ _ Age of sexual partner
[] 98 DK
[] 98 DK
SB13. Other than these two persons, have you had sexual intercourse with any other person in the last 12 months?
[] 1 Yes
[] 2 No (Go to SB15)
[] 2 No (Go to SB15)
SB14. In total, with how many different people have you had sexual intercourse in the last 12 months?
_ _ Number of partners
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'.
_ _ Number of lifetime partners
[] 98 DK
[] 98 DK
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)
[] 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 sex partners?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
HA3. Can people get the AIDS virus because of witchcraft or other supernatural means?
[] 1 Yes
[] 2 No
[] 8 DK
[] 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
[] 2 No
[] 8 DK
HA5. Can people get the AIDS virus from mosquito bites?
[] 1 Yes
[] 2 No
[] 8 DK
[] 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
[] 2 No
[] 8 DK
HA7. Is it possible for a healthy-looking person to have the AIDS virus?
[] 1 Yes
[] 2 No
[] 8 DK
[] 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
[] 2 No
[] 8 DK
[B] During delivery?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
[C] By breastfeeding?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
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
[] 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
[] 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
[] 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
[] 2 No
[] 8 DK/not sure/depends
HA13. Check CM13: Any live birth in last 2 years?
[] No live birth in last 2 years (Go to HA24)
[] One or more live births in last 2 years (Continue with HA14)
[] One or more live births in last 2 years (Continue with HA14)
HA14. Check MN1: Received antenatal care?
[] Received antenatal care (Continue with HA15)
[] Did not receive antenatal care (Go to HA24)
[] Did not receive 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
[] 2 No
[] 8 DK
[B] Things that you can do to prevent getting the AIDS virus?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
[C] Getting tested for the AIDS virus?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
Were you:
[D] Offered a test for the AIDS virus?
[] 1 Yes
[] 2 No
[] 8 DK
[] 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)
[] 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)
[] 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)
[] 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)
[] 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)
[] 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
[] 2 No
HA22. Have you been tested for the AIDS virus after this pregnancy?
[] 1 Yes
[] 2 No (Go to HA25)
[] 2 No (Go to HA25)
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)
[] 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)
[] 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
[] 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)
[] 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
[] 2 No
Life satisfaction: LS
LS1. Check WB2: Age of respondent is between 15 and 24?
[] Age 15-24 (Continue with LS2)
[] Age 25-49 (Go to WM11)
[] Age 25-49 (Go to WM11)
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 pointed by the respondent. [Image omitted.]
[] 1 Very happy
[] 2 Somewhat happy
[] 3 Neither happy nor unhappy
[] 4 Somewhat unhappy
[] 5 Very unhappy
[] 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 shown by the respondent, for questions LS3 to LS13. [Image omitted.]
How satisfied are you with your family life?
[] 0 No family
[] 1 Very satisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied
[] 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?
[] 0 No friends
[] 1 Very satisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied
[] 1 Very satisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied
LS5. During the current school year, did you attend school at any time?
[] 1 Yes
[] 2 No (Go to LS7)
[] 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
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied
LS7. How satisfied are you with your current job?
If the respondent says that he/she does not have a job, circle "0" and continue with the next question. Do not probe to find out how she feels about not having a job, unless she tells you herself.
[] 0 Does not have a job
[] 1 Very satisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied
[] 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
[] 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
[] 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
[] 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
[] 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
[] 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 responds that he/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
[] 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
[] 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
[] 2 More or less the same
[] 3 Worse
WM11. Record the time.
_ _ : _ _ Hour and minutes
WM12. Check Household Listing Form, column HL9.
Is the respondent the mother or caretaker of any child age 0-4 living in this household?
[] Yes (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. Check for the presence of any other eligible woman or child under-5 in the household.)
[] No (End the interview with this respondent by thanking her for her cooperation. Check for the presence of any other eligible woman or child under-5 in the household.)
Interviewer's observations
Field editor's observations
Supervisor's observations