[p. 1]

South Sudan

Woman's information panel: WM

This questionnaire is to be administered to all women age 15 through 49 (see column HL7 of HH listing). 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 name and number
WM6. Day/month/year of interview _ _ / _ _ / _ _ _ _

Repeat greeting if not already read to this woman:
We are from [Sudan Household Health Survey 2nd]. 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 [40] 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 (number) 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?

WM7. Result of woman's interview

WM8. Field edited by (name and number):
WM9. Data entry clerk (name and number):
[p. 2]
WM10. Record the time.
Woman's Background: WB


WB2. How old are you?
Probe: How old were you at your last birthday?.
WB3. Have you ever attended school?

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

WB5. What is the highest grade you completed at that level?
If less than 1 grade, 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?
Example of sentences for literacy
The child is reading a book.
The rains came late this year.
Parents must care for their children.
Farming is hard work.

[p. 3]
Marriage/union: MA

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

MA3. Besides yourself, does your husband/partner have any other wives or partners or does he live with other women as if married?

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

MA5. Have you ever been married or lived together with a man as if married?

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

MA9. How old were you when you started living with your first husband/partner?

[p. 24]
Reproduction AND CHILD SURVIVAL Child mortality: CM

This Module is to be administered to currently or ever married or in union women in the age group 15-49 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 to a LIVE BABY?
I mean that the child had shown any signs of life; cried, breathed or moved his/her limbs.

CM3. How many years ago did you have 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.

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.
[p. 5]
CM11. Just to make sure that I have this right, so you have had in total live births (sum CM5, CM7, AND CM9)
If YES Continue with CM12
IF No Check CM4, CM6, CM8 and accordingly correct CM10 and CM11

CM12: Of these (total number in CM10) births you have had, when did you deliver the last one (even if he or she has died)?
Month and year must be recorded.
CM13. Check CM12 [or BH4 in the birth history module]: Last birth occurred within the last 2 years, that is, since (day and month of interview) in [2010]
If child has died, take special care when referring to this child by name in the following modules.
Continue with the next module.


[p. 6]
Desire for last birth: DB

This module is to be administered to all 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?

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?

[p. 7]
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 ; if name not given, record 'x'. Record twins and triplets on separate line.

BH Line No. _ _

BH1. ____ Name All children, whether alive or dead:

BH2. Were any of these births twins?

BH3. Is (name) male or female?

BH4. In what month and year was (name) born?
Probe: what is his/her birthday?
If they don't know write "98" for months and "9998" for year

BH5. Is (name) still alive?

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

BH7. If alive Is (name) living with you?

BH8. If alive Record household line number of child (from HL1)
BH9. How old was (name) when he/she died?
Record age at death.
if less than 1 month record days; if less than 2 years record months; If more than 2 years, record years.
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 child mortality module CM13 and record name of last-born child here ____
Use this child's name in the following questions, where indicated.

MN 00. Confirmation question
Have you been pregnant during the last 2 years?

MN 01. How many pregnancies did you have during the past two years?

MN 02. How did these pregnancies end?
Ask for each outcome and record conclusion for each pregnancy reported in MN 01.
Check that total number is equal to the number of pregnancies reported in MN 01. If different, probe for MN 01 and correct of necessary.

If D only and/or C only (Go to CP)

MN1. Before you gave birth to this child, did you see anyone for antenatal care?

MN2. Whom did you see?
Probe: Anyone else? Probe for the type of person seen and circle all answers given.
MN3. How many times did you receive antenatal care during this pregnancy?

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

[MN4A] Was your blood pressure measured?

[MN4B] Did you give a urine sample?

[MN4C] Did you give a blood sample?

[MN4D] As part of your antenatal care, was the mode and/or place of delivery discussed with you?

[MN4E] During this pregnancy, did you receive Iron or Fefol tablets?

MN5. Do you have a card or other document with your own immunizations listed?
May I see it please?
If a card is presented, use it to assist with answers to the following questions.
MN6. During this pregnancy, did you receive any injection in the arm or shoulder to prevent the baby from getting tetanus, that is convulsions after birth?

MN7. How many times did you receive this tetanus injection during your pregnancy with (name)?
If 7 or more times, record '7'.
MN8. How many tetanus injections during last pregnancy were reported in MN7?
[p. 8]
MN9. Did you receive any tetanus injection at any time before your last pregnancy either to protect yourself or another baby?

MN10. How many times did you receive a tetanus injection before your pregnancy?
If 7 or more times, record '7'.
MN11. How many years ago did you receive the last tetanus injection before your last pregnancy?

MN13. During any of these antenatal visits for the pregnancy, did you take any medicine in order to prevent you from getting malaria?

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.
MN15. Check MN14 for medicine taken:
MN16. During this pregnancy, how many times did you take SP/Fansidar?

MN16A What signs and symptoms do you know that tells something is wrong during pregnancy, childbirth/postpartum period that woman should contact her caregiver or seek health care?
Probe: Any other cause? Circle all answers given

MN17. Who assisted with the delivery of your last completed pregnancy?
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.
[p. 9]
MN18. Where did you give birth to your last child (either live or still birth)?
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. Please tell me the mode of delivery of your last child (live or still birth).

MN 19A. What are the signs and symptoms you know, that alerts a mother to seek health care for her newborn?
Probe: Any other cause?

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

MN 23A. In the first 6 weeks after the last delivery, did you see/were you visited by anyone for a checkup on your health?
If yes: Whom did you see/ were you visited by?
Probe for the type of person and circle all answers given.

MN23B. In the first 6 weeks after the last delivery, did you receive a vitamin A does like this?
Show 200,000 IU capsule or dispenser.

MN23C. At any time during pregnancy, labour or within 42 days after delivery of your last completed pregnancy, did you experience any of the following?

[p. 11]
[p. 16]
Contraception: CP

Now I would like to talk about family planning, the various ways or methods that a couple can use to delay or avoid pregnancy. (This question to be asked to all women age 15-49 years)

CP00. Some people use methods to delay or avoid pregnancy. Have you ever heard about these methods of family planning?

CP01. Which methods to avoid or delay pregnancy that you know about?

CP02. Have you ever heard of a male condom?

CP03. Do you know of a place where a person can get condoms?

CP04. If you wanted to, could you yourself get a condom?

CP05: Check marital/ Union status (MA1)

CP06. Have you ever used anything or tried in any way to delay or avoid getting pregnant?

CP1. For currently married/in union women: 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?

CP3. What are you doing to delay or avoid a pregnancy?
Do not prompt. If more than one method is mentioned, circle each one.
[p. 17]
Unmet need: UN

UN1. Check whether the woman is currently pregnant or not (CP1 IF CP moule filled) ?
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. When you got pregnant, 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?

UN8. Check CP1. Currently pregnant?
[p. 18]
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?

[p. 19]
Female genital mutilation/cutting: FG

FG9. Check CM5 and CM7, Child morality module: women has living daughter?
FG00. Do you intend to circumcise your daughters who are not yet been circumcised; if any?

FG17. Do you think this practice should be continued or should it be discontinued?

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?

[B] If she neglects the children?

[C] If she argues with him?

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

[E] If she burns the food?

[p. 23]
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?

[p. 27]
HA13. Check CM13: Any live birth in last 2 years?
HA14. Check MN1: Received antenatal care?
HA15. During any of the antenatal visits for your pregnancy with (name),

Were you given any information about AIDS or the AIDS virus?

[] 1 Yes
[] 2 No
[] 8 DK
HA16. I don't want to know the results, but were you tested for the AIDS virus as part of your antenatal care?

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

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

HA19. Check MN17: Birth delivered by health professional (A, B or C)?
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?

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

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

[p. 28]
HA23. When was the most recent time you were tested for the AIDS virus?

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

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

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

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

[p. 29]
Sexually Transmitted Infections: STI

STI1. CHECK MA1-MA5:

STI2. Sometimes women experience a bad smelling abnormal genital discharge during the last 12 months, have you had an abnormal genital discharge?

STI3. Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

STI4. Check STI2 and STI3:

STI5. The last time you had a genital sore or abnormal genital discharge; did you seek any kind of advice or treatment?

Sexual behavior: 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?

[] 98 DK/Don't remember

SB2. The first time you had sexual intercourse, was a condom used?

SB3. When was the last time you had sexual intercourse?
Record answers in days, weeks or months if less than 12 months (one year). If more than 12 months (one year), answer must be recorded in years.
SB4. The last time you had sexual intercourse, was a condom used?

SB5. What was your relationship to this person with whom you last had sexual intercourse?

If person is 'boyfriend' or 'fiancée' , ask: Were you living together as if married? If 'yes', circle ' 01'. If 'no', circle' 02'.
SB6. How old is this person?
If response is DK, probe: About how old is this person?
SB7. Have you had sexual intercourse with any other person in the last 12 months?

SB8. In total, with how many different people have you had sexual intercourse in the last 12 months?

SB9. For women: think about the male sexual partners you've had in the last 12 months.
How many were: #your spouse(s) or live-in sexual partners ("Regular" partners)
#Sexual partners who you are not married to, have never lived with and did not pay for sex ("non-regular" partners)
#Partners with whom you had sex in exchange for money ("paid" partners)
(Should match with the number of sexual partners in last 12 months)

[p. 25]
SB10. In the last 12 months was condom used every time you had sexual intercourse with all your partner(s) who you are not married to, have never live with?

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'.

WM11. Record the time.

Final Women's Questionnaire Instructions

WM12. Is the respondent he mother or caretaker of any child age 0-4 living in this household?
Check household listing, column HL9.

W12A. Do any other eligible women reside in the household?
Check household listing column. HH7.

Interviewer's Observations
Field Editor's Observations
Supervisor's Observations