MICS questionnaire for individual women
[Somalia Somaliland]
Woman's information panel: WM
This questionnaire is to be administered to all women age 15 through 49 (see column HL7 of Household Listing Form). 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 name and number
Name ____ _ _ _
WM6. Day/month/year of interview _ _ / _ _ / _ _ _ _
Repeat greeting if not already read to this woman:
We are from MoP and D. We are working on a project concerned with family health and education. I would like to talk to you about these subjects. The interview will take about 20-30 minutes. All the information we obtain will remain strictly confidential and your answers will never be shared with anyone other than our project team.
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 20-30 minutes. Again, all the information we obtain will remain strictly confidential and your answers will never be shared with anyone other than our project team.
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 (Complete WM7. Discuss this result with your supervisor.)
[] No, permission is not given (Complete WM7. Discuss this 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 and number):
Name ____ _ _ _
WM9. Data entry clerk (name and number):
Name ____ _ _
WM10. Record the time.
Hour and minutes _ _ : _ _
Woman's Background: WB
WB1. In what month and year were you born?
If unknown month or year, ask for documents or use the calendar of events
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 formal school or preschool?
[] 1 Yes
[] 2 No (Go to WB7)
[] 2 No (Go to WB7)
WB4. What is the highest level of formal school you attended?
[] 0 Preschool (Go to WB7)
[] 1 Primary
[] 2 Secondary
[] 3 Higher
[] 1 Primary
[] 2 Secondary
[] 3 Higher
WB5. What is the highest grade you completed at that level?
If less than 1 grade, enter "00"
Grade _ _
WB6. Check WB4:
[] Secondary or higher. (Go to next module)
[] Else (Continue with WB7)
[] Else (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/communication technology: 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 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
[] 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 for use from any location, with 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
Marriage: MA
MA1. Are you currently married?
[] 1 Yes, currently married
[] 3 No, not in marriage (Go to MA5)
[] 3 No, not in marriage (Go to MA5)
MA2. How old is your husband?
Probe: how old was your husband on his last birthday?
_ _ Age in years
[] 98 DK
[] 98 DK
MA3. Besides yourself, does your husband have any other wives?
[] 1 Yes
[] 2 No (Go to MA7)
[] 2 No (Go to MA7)
MA4. How many other wives does he have?
_ _ Number (Go to MA7)
[] 98 DK (Go to MA7)
[] 98 DK (Go to MA7)
MA5. Have you ever been married?
[] 1 Yes, formerly married
[] 3 No (Go to illness symptoms module)
[] 3 No (Go to illness symptoms 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 more than once?
[] 1 Only once
[] 2 More than once
[] 2 More than once
MA8. 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
[] 98 DK month
_ _ _ _ Year (Go to next module)
[] 9998 DK year
MA9. How old were you when you started living with your first husband?
Age in years _ _
Child mortality: CM
This module is to be administered to all ever-married women. All questions refer only to live births.
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)
[] 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)
[] 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 have died? How many girls have 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 this correct?
[] Yes. Check below:
[] No live births (Go to illness symptoms module)
[] One or more live births (Continue with birth history 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 the 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 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?
[] 1 Single
[] 2 Multiple
[] 2 Multiple
BH3. Is (name) a boy or a girl?
[] 1 Boy
[] 2 Girl
[] 2 Girl
BH4. In what month and year was (name) born?
Probe: what is his/her birthday?
_ _ Month
_ _ _ _ Year
_ _ _ _ Year
BH5. Is (name) still alive?
[] 1 Yes
[] 2 No (Go to BH9)
[] 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
[] 2 No
BH8. Record household line number of child (from HL1)
Record "00" if child is not listed. _ _ (Go to BH10)
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
Unit
[] 1 Days
[] 2 Months
[] 3 Years
[] 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 after birth?
[] 1 Yes (Add birth)
[] 2 No (Go to next 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)?
[] 1 Yes (Record birth(s) in birth history)
[] 2 No
[] 2 No
CM12. Compare number in CM10 with number of births in the birth history above and check:
[] Numbers are same [Continue with CM13]
[] Numbers are different [Probe and reconcile]
[] Numbers are different [Probe and reconcile]
CM13. Check BH4 birth history: Last birth occurred within the last 2 years, that is, since (day and month of interview) in 2009
[] No live birth in last 2 years. (Go to illness symptoms module)
[] One or more live births in last 2 years. (Record name of last-born child and continue with next module)
[] One or more live births in last 2 years. (Record name of last-born child and continue with next module)
Name of 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 ever-married women with a live birth in the 2 years preceding date of interview.
Check child mortality module CM13 and record name of 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 at that time?
[] 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 ever-married women with a live birth in the 2 years preceding date of interview.
Check child mortality module 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 pregnancy with (name)?
[] 1 Yes
[] 2 No (Go to MN5)
[] 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 Nurse/Midwife
[] C Auxiliary midwife
[] B Nurse/Midwife
[] C Auxiliary midwife
Other person
[] F Traditional birth attendant
[] G Community health worker
[] G Community health worker
[] X Other (specify) ____
MN2A. Where did you mainly receive the antenatal care?
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 Home
[] 12 Other home
[] 12 Other home
Public sector
[] 21 Govt. hospital
[] 22 Govt. clinic/health centre
[] 23 Govt. health post
[] 26 Other public (specify) ____
[] 22 Govt. clinic/health centre
[] 23 Govt. health post
[] 26 Other public (specify) ____
Private medical sector
[] 31 Private hospital
[] 32 Private clinic
[] 33 Private maternity home
[] 36 Other private medical (specify) ____
[] 32 Private clinic
[] 33 Private maternity home
[] 36 Other private medical (specify) ____
[] 96 Other (specify) ____
MN3. How many times did you receive antenatal care during your pregnancy?
_ _ Number of times
[] 98 DK
[] 98 DK
MN4. As part of your antenatal care during your pregnancy with (name)?, 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
MN5. Do you have a card or other document with your own immunizations listed (such as a child health days card)?
May I see it please?
If a card is presented, use it to assist with answers to the following questions.
[] 1 Yes (card seen)
[] 2 Yes (card not seen)
[] 3 No
[] 8 DK
[] 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)
[] 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)
[] 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)
[] 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)
[] 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)
[] 8 DK (Go to MN12)
MN11. How many years ago did you receive the last tetanus injection before your pregnancy with (name)?
_ _ Years ago
MN12. Check MN1 for presence of antenatal care during pregnancy with (name):
[] Yes, antenatal care received (Continue with MN13)
[] No antenatal care received (Go to MN17)
[] No antenatal care received (Go to MN17)
MN13. During any of these antenatal visits for the pregnancy, 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)
[] 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
[] B Chloroquine
[] X Other (specify)____
[] Z DK
[] B Chloroquine
[] X Other (specify)____
[] Z DK
MN15. Check MN14 for medicine taken:
[] SP/Fansidar taken. (Continue with MN16)
[] SP/Fansidar not taken (Go to MN17)
[] SP/Fansidar not taken (Go to MN17)
MN16. During your pregnancy with (name)?, how many times did you take SP/Fansidar?
_ _ Number of times
[] 98 DK
[] 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 Nurse/Midwife
[] C Auxiliary midwife
[] B Nurse/Midwife
[] C Auxiliary midwife
Other person
[] F Traditional birth attendant
[] G Community health worker
[] H Relative/Friend
[] G Community health worker
[] H Relative/Friend
[] X Other (specify) ____
[] Y No one
[] 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 MN19A)
[] 12 Other home (Go to MN19A)
[] 12 Other home (Go to MN19A)
Public sector
[] 21 Govt. hospital
[] 22 Govt. clinic/health centre
[] 23 Govt. health post
[] 26 Other public (specify) ____
[] 22 Govt. clinic/health centre
[] 23 Govt. health post
[] 26 Other public (specify) ____
Private medical sector
[] 31 Private hospital
[] 32 Private clinic
[] 33 Private maternity home
[] 36 Other private medical (specify) ____
[] 32 Private clinic
[] 33 Private maternity home
[] 36 Other private medical (specify) ____
[] 96 Other (specify) ____ (Go to MN19A)
MN19. Was (name) delivered by caesarean section? That is, did they cut your belly open to take the baby out?
[] 1 Yes
[] 2 No
[] 2 No
MN19A. Who advised you on where to give birth to (name)?
[] A Govt. doctor
[] B Govt. health worker
[] C Private doctor
[] D Husband
[] E Other relatives
[] F Friends(s)
[] G NGO health worker
[] X Other (specify) ____
[] Y No one/DK
[] B Govt. health worker
[] C Private doctor
[] D Husband
[] E Other relatives
[] F Friends(s)
[] G NGO health worker
[] X Other (specify) ____
[] Y No one/DK
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 breastfeed (name)?
[] 1 Yes
[] 2 No (Go to next module)
[] 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 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?
If no probe: Not even water, honey, porridge, soup, sugar water, or anything else?
[] 1 Yes
[] 2 No (Go to next module)
[] 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) ____
[] 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) ____
Illness Symptoms: IS
IS1. Check Household Listing, 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 health facility. What types of symptoms would cause you to take your child to a health facility right away?
Probe: Any other symptoms? Keep asking for more signs or symptoms until the mother/caretaker cannot recall any additional symptoms. Circle all symptoms mentioned, but do not prompt with any suggestions
[] 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 difficult breathing
[] F Child has blood in stool
[] G Child is drinking poorly
[] X Other (specify) ____
[] Y Other (specify) ____
[] Z Other (specify) ____
[] B Child becomes sicker
[] C Child develops a fever
[] D Child has fast breathing
[] E Child has difficult breathing
[] F Child has blood in stool
[] G Child is drinking poorly
[] X Other (specify) ____
[] Y Other (specify) ____
[] Z Other (specify) ____
Contraception: CP
CP0. Check MA1. Is respondent currently married?
[] Yes (MA1 = 1) (Continue with CP1)
[] No (MA1 = 3) (Go to FGM/C Module)
[] No (MA1 = 3) (Go to FGM/C Module)
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
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
[] 2 No (Go to CP4)
[] 2 No (Go to CP4)
CP3. What are you doing to delay or avoid a pregnancy?
Do not prompt. If more than one method is mentioned, circle each one.
[] A Female sterilization (Go to next module)
[] B Male sterilization (Go to next module)
[] C IUD (Go to next module)
[] D Injectables (Go to next module)
[] E Implants (Go to next module)
[] F Pill (Go to next module)
[] G Male condom (Go to next module)
[] H Female condom (Go to next module)
[] I Diaphragm (Go to next module)
[] J Foam/jelly (Go to next module)
[] K Lactational amenorrhoea method (LAM) (Go to next module)
[] L Periodic abstinence/rhythm (Go to next module)
[] M Withdrawal (Go to next module)
[] X Other (specify) ____ (Go to next module)
[] B Male sterilization (Go to next module)
[] C IUD (Go to next module)
[] D Injectables (Go to next module)
[] E Implants (Go to next module)
[] F Pill (Go to next module)
[] G Male condom (Go to next module)
[] H Female condom (Go to next module)
[] I Diaphragm (Go to next module)
[] J Foam/jelly (Go to next module)
[] K Lactational amenorrhoea method (LAM) (Go to next module)
[] L Periodic abstinence/rhythm (Go to next module)
[] M Withdrawal (Go to next module)
[] X Other (specify) ____ (Go to next module)
CP4. What is the main reason for not using any method to delay or avoid a pregnancy?
[] 1 Religious
[] 2 Husband against
[] 3 Other family members against
[] 4 Contraceptives not available
[] 5 Desire for child
[] 6 Other (specify) ____
[] 8 DK
[] 2 Husband against
[] 3 Other family members against
[] 4 Contraceptives not available
[] 5 Desire for child
[] 6 Other (specify) ____
[] 8 DK
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)
[] 996 Other
[] 998 Don't know
[] 2 Years _ _
[] 993 Soon/now
[] 994 Says she cannot get pregnant (Go to UN11)
[] 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 a method?
[] 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?
[] Yes (Go to next module)
[] No (Continue with UN13)
[] No (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
Female genital mutilation/cutting: FG
FG1. Have you ever heard of female circumcision?
[] 1 Yes (Go to FG3)
[] 2 No
[] 2 No
FG2. In some countries, there is a practice in which a girl may have part of her genitals cut or nicked slightly (suni). Have you ever heard about this practice?
[] 1 Yes
[] 2 No (Go to next module)
[] 2 No (Go to next module)
FG3. Have you yourself ever been circumcised or undergone suni?
[] 1 Yes
[] 2 No (Go to FG8)
[] 2 No (Go to FG8)
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
[] 2 No
[] 8 DK
FG5. Was the genital area just nicked without removing any flesh?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
FG6. Was the genital area sewn closed?
If necessary, probe: Was it sealed?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
FG7. How old were you when you were circumcised?
If the respondent does not know the exact age, probe to get an estimate using your calendar of events and other information available to you.
_ _ Age at circumcision
[] 98 DK/don't remember/not sure
[] 98 DK/don't remember/not sure
FG8. Who performed the circumcision?
Health professional
[] 11 Doctor
[] 12 Nurse/midwife
[] 16 Other health professional (specify) ____
[] 12 Nurse/midwife
[] 16 Other health professional (specify) ____
Traditional persons
[] 21 Traditional 'circumciser'
[] 22 Traditional birth attendant
[] 26 Other traditional (specify) ____
[] 22 Traditional birth attendant
[] 26 Other traditional (specify) ____
[] 98 DK
FG8A. Check if woman was ever married:
[] MA5=3 (never married) (Skip to FG22)
[] MA5=1 or MA5=No answer (formerly or currently married) (Continue with FG9)
[] MA5=1 or MA5=No answer (formerly or currently married) (Continue with FG9)
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)
[] Does not have any living daughters (Go to FG22)
[] Does not have any living daughters (Go to FG22)
[] No (Check responses to CM1-CM12 and BH1-BH10 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 next daughter. If no more daughters, go to FG22.)
[] 2 No (If "no", go to FG13 for next daughter. If no more daughters, go to FG22.)
FG15. Is (name) circumcised or has undergone suni?
[] 1 Yes
[] 2 No
If "no", go to FG13 for next daughter. If no more daughters, go to FG22
[] 2 No
If "no", go to FG13 for next daughter. If no more daughters, go to FG22
FG16. How old was (name) when this occurred?
If the respondent does not know the exact age, probe to get an estimate using your calendar of events and other information available to you.
_ _ Age
[] 98 DK
[] 98 DK
FG17. Now I would like to ask you 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
[] 2 No
[] 8 DK
FG18. Was her genital area just nicked without removing any flesh?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
FG19. Was her genital area sewn closed?
If necessary, probe: Was it sealed?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
FG20. Who performed the circumcision?
Health professional
[] 11 Doctor
[] 12 Nurse/midwife
[] 16 Other health professional (specify) ____
[] 12 Nurse/midwife
[] 16 Other health professional (specify) ____
Traditional persons
[] 21 Traditional 'circumciser'
[] 22 Traditional birth attendant
[] 26 Other traditional (specify) ____
[] 22 Traditional birth attendant
[] 26 Other traditional (specify) ____
[] 98 DK
FG21.
Go back to FG13 in first column of additional questionnaire for next daughter. If no more daughters, go to FG22
[] Tick here if additional questionnaire used
FG22. Do you think this practice of circumcision should be continued or should it be discontinued?
[] 1 Continued
[] 2 Discontinued
[] 3 Depends
[] 8 DK
[] 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
[] 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
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 WM11)
[] 2 No (Go to WM11)
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)
[] Yes, live birth in last 2 years (Continue with HA14)
[] Yes, live birth in last 2 years (Continue with HA14)
HA14. Check MN1: Received antenatal care?
[] Yes, antenatal care received (Continue with HA15)
[] No antenatal care received (Go to HA24)
[] No antenatal care received (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 since that time you were tested during your pregnancy?
[] 1 Yes (Go to HA25)
[] 2 No
[] 2 No
HA23. When was the most recent time you were tested for the AIDS virus?
[] 1 Less than 12 months ago (Go to WM11)
[] 2 12-23 months ago (Go to WM11)
[] 3 2 or more years ago (Go to WM11)
[] 2 12-23 months ago (Go to WM11)
[] 3 2 or more years ago (Go to WM11)
HA24. I do not 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 WM11)
[] 2 No (Go to WM11)
[] 8 DK (Go to WM11)
[] 2 No (Go to WM11)
[] 8 DK (Go to WM11)
HA27. Do you know of a place where people can go to get tested for the AIDS virus?
[] 1 Yes
[] 2 No
[] 2 No
WM11. Record the time.
_ _ : _ _ Hour and minutes
WM12. Is the respondent the mother or caretaker of any child age 0-4 living in this household? Check Household Listing, column HL9.
[] 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