Women's Information Panel: WM

1. Region ____ Province ____

2. District ____ Sub-district ____

3. Address No ____ Rd ____ Soi ____

4. Urban Area

Rural Area

5. Primary Sampling Unit No ____

6. Household No ____

HH7. Reg: _
CWT _ _

Area _
PSU_NO _ _ _ _

WM2. HH_NO _ _

WM3. Name of Women (Copy from HL2 in MICS2 Questionnaire) ____

WM4. Woman's line no. (Copy from HL6 in MICS2 Questionnaire) _ _

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

WM7. Interview Results (see Code in no. 7)
7. Result of Interview for Women Age 15-49 (Record Code in _ in WM7)

Enumerator name: ____

Editor editing and coding date: ____
Name ____

Supervisor name ____
Checker (____)

Section 1 General information of women (WM)

No. _ _
Copy from HL6 in MICS2 questionnaire

WM3. Name ____

WM8. In what month and year were you born?

WM9. Record age at the last birthday

WM10. Have you ever attended school?

For code 1 in WM10
WM11. What is the highest level of school attended?

For code 1 in WM10
WM12. What is the highest grade you completed at the level?
Record grade, certificate or academic degree in detail
(Code 1 cont., Code 2-3 skip to Section 2)
For code 2 in WM10 or recorded 1 or 6 in WM11
WM14. Ask the respondent to read the sentence provided.

Section 2 Child Mortality (CM)

For all women age 15-49 years

CM1. All the births you have had during your life, even if the child lived only a few minutes

For those recorded 1 in CM1
CM2A. What was the date of your first birth, even if the child is no longer living?
Record day, month and year of the first birth.
For those recorded 9998 in CM2A Y
CM2B. How many years ago did you have your first birth?

CM3. Do you have any child to whom you have given birth and living with you?

For those recorded 1 in CM3
CM4. How many children live with you?
Record number. If none, record 00.
CM5. Do you have any child to whom you have given birth but do not live with you?

For code 1 in CM5
CM6. How many children are alive but do not live with you?
Record number. If none, record 00.
CM7. Do you have any child to whom you have given birth who was born alive but later died?

For code 1 in CM7
CM8. How many children have died?
Record number. If none, record 00.
CM9. Total number of children ever born. Sum number of son and daughter in CM4A, CM4B, CM6A, CM6B and CM8A, CM8B
(If no child, skip to Section 5)
CM11. When did you deliver the last birth (even if he or she has died)?
Record day, month and year of the last birth. If don't know, record '98'. Month and year of the last birth have to be recorded in order to check for CM12 and to interview Section 3 and 4 (don't know is not allowed).
CM12. Check in CM11 whether the women's last birth occur within the last 2 years
For code Y in CM12
CM13. At the time you became pregnant with (name), did you want to become pregnant then, did you want to wait until later, or did you want no (more) children at all?

Section 3 Tetanus Toxoid (TT)

For all women with a live birth in the 2 years preceding date of interview (CM12= Y)

TT1. Do you have a card or other document with your own immunizations listed?

TT2. When you were pregnant with your last child, did you receive any injection to prevent him or her from getting tetanus?

For those recorded 1 in TT2
TT3. How many times did you receive this anti-tetanus injection during your last pregnancy?
If at least 2 times skip to Section 4. If less than 2 times, continue. If DK, record "98" and continue.
For those recorded 2 or 8 in TT2, or recorded less than 2 or DK in TT3.
TT5. Did you receive any tetanus toxoid injection at any time before your last pregnancy?

For those recorded 1 in TT5
TT6. How many times did you receive it?
Record No. of time
For all women with a live birth in the 2 years preceding date of interview (CM12= Y)
TT7. In what month and year did you receive the last anti-tetanus injection before that last pregnancy?
Record month and year
For all women with a live birth in the 2 years preceding date of interview (CM12= Y)
TT8. How many years ago did you receive the last anti-tetanus injection before that last pregnancy?

Section 4 Maternal and newborn health (MN)

For all women with a live birth in the 2 years preceding date of interview (CM12= Y)

MN2. Did you see anyone for antenatal care for this pregnancy?
Check all that apply.
For code A-X in MN2 [MN3 - MN5]

MN3. As part of your antenatal care, were any of the following done at least once?

MN3A. Were you weighed?

MN3B. Was your blood pressure measured?

MN3C. Did you give a urine sample?

MN3D. Did you give a blood sample?

MN4. During any of the antenatal visits for the pregnancy, were you given any information or counseled about AIDS or the AIDS virus?

MN5. Were you tested for the HIV/AIDS as part of your antenatal care?

For code 1 in MN5
MN6. Did you get the results of the test?

MN7. Who assisted with the delivery of your last child (name)?
(Can circle more than 1 code)
MN8. Where did you give birth to (name)?

MN9. Was he/she very large, larger than average, average, smaller than average, or very small?

MN10. Was (name) weighed at birth?

For code 1 in MN10
MN11. How much did (name) weigh?
Record the birth weight of the newborn from 1. Health card, or 2. Interviewing.
Example of Recording
- If birth weight of the baby is 2,500 gram then record 2.500
- If don't know, ask the respondent to estimate the weight.
MN12. Did you ever breastfeed (name)?

For code 1 in MN12
MN13. How long after birth did you first put (name) to the breastfeed?
Record the unit code, time.
Example of Recording
- If breadtfeed 2 hours after gave birth, then record. Unit code = 1, Time = 02.
Section 5 Marriage/union (MA)

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

For code 1 or 2 in MA 1
MA2. How old was your husband/partner on his last birthday?
Record completed years at the last birth day
For code 3 in MA 1
MA3. Have you ever been married or lived together with a man?

For code 1 or 2 in MA 3
MA4. What is your marital status now?

MA5. Have you been married or lived with a man only once or more than once?

MA6. In what month and year did you first marry or start living with a man as if married?
Record month and year
1. After record month and year skip to Section 6
2. If could not recall month and year, record "98" for month and "9998" for year and continue.

For code 99 and/or 9999 in MA6M, MA6Y
MA8. How old were you when you started living with your first husband/partner?

Section 6 Contraception (CP)

CP1. Are you pregnant now?

For those recorded 2 or 8 in CP1
CP2. Are you currently doing something or using any method to delay or avoid getting pregnant?

For code 1 CP 2
CP3. Which method are you using?
Record code (Circle all that apply).
Section 7 HIV/AIDS (HA)

The knowledge and understanding of HIV/AIDS of the women
The enumerator read each statement from column HA2 to HA13 to the respondent and ask whether the respondent say "yes", "no" or they don't know and then recorded the code
Code

HA1. Have you ever heard of the virus HIV or an illness called AIDS?

HA2. Can people protect themselves from getting infected with the AIDS virus by having one sex partner who is not infected and also has no other partners?

HA3. Can people get infected with 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 reduce their chance of getting infected with the AIDS virus by not having sex at all?

HA7. Can people get the AIDS virus by sharing food with a person who has AIDS?

HA7A. Can people get the AIDS virus by getting injections with a needle that was already used by someone else?

HA8. Is it possible for a healthy-looking person to have the AIDS virus?

HA9. Can the AIDS virus be transmitted from a mother to a baby?

HA9A. During pregnancy?

HA9B. During delivery?

HA9C. By breastfeeding?

HA10. If a female teacher has the AIDS virus but is not sick, should he/she be allowed to continue teaching in school?

HA11. Would you buy fresh food (e.g. vegetable/meat) from a shopkeeper/vendor if you knew that this person had the AIDS virus?

HA12. If a member of your family became infected with the AIDS virus, would you want it to remain a secret?

HA13. If a member of your family became sick with the AIDS virus, would you be willing to care for him or her in your household?