MICS questionnaire for individual women
Thailand
Woman's information panel: WM
This questionnaire is to be administered to all women age 15 through 49 (see Household Listing Form, column HL7). A separate questionnaire should be used for each eligible woman.
WM1. EA number from the MICS sample: _ _ _ _
WM1A. Household cluster (from listing):
[] 1 Households with children under 5 years _
[] 2 Households with no children under 5 years _
[] 2 Households with no children under 5 years _
WM2. Household number: _ _
WM3. Woman's name (copy from HL2 of the Household Listing Form):
First - Last name ____
WM4. Woman's ordinal number (copy from HL1 of the Household Listing Form): _ _
WM5. Interviewer name and number
First - Last name ____ _ _ _ _ _ _ _
WM6. Day/month/year of interview _ _ / _ _ / 2012
Now I would like to ask about your health and other topics. This interview should take 20-25 minutes. The information we collect from you will be kept confidential and your answers will never be shared with anyone.
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.
[] No, permission is not given (Complete WM7.
WM7. Result of the interview with woman age 15-49 years.
[] 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) ____
WM10. Record the time.
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?
[] 0 Preschool (Go to WB7)
[] 1 Primary
[] 2 Lower secondary
[] 3 Upper secondary
[] 4 Associate/commercial college degree
[] 5 Diploma
[] 6 Bachelor degree
[] 7 Higher
[] 8 Doctoral degree
[] 1 Primary
[] 2 Lower secondary
[] 3 Upper secondary
[] 4 Associate/commercial college degree
[] 5 Diploma
[] 6 Bachelor degree
[] 7 Higher
[] 8 Doctoral degree
WB5. What is the highest grade you completed at that level?
If the highest grade completed is lower than the highest grade attained, enter "00"
Grade _ _
[] 98 DK
[] 98 DK
WB6. Check WB4:
[] Lower secondary or higher (WB4 = 02 - 08). (Go to next module)
[] Primary (WB4 = 01) (Continue with WB7)
[] Primary (WB4 = 01) (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
Child mortality: CM
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)
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.
Date of 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 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 living in this household
_ _ Daughters living in this household
_ _ Daughters living in this household
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 contraception module (CP1))
[] 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 as necessary before proceeding to CM12)
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)?
If unknown day, enter "98". Month and year must be recorded.
Date of first birth
_ _ Day
_ _ Month
_ _ Year
_ _ Month
_ _ Year
CM13. Check CM12 Last birth occurred within the last 2 years
[] No live birth in last 2 years. (Go to contraception module (CP1))
[] One or more live births in last 2 years. (Ask for the name of the last born child and continue with the next question)
[] One or more live births in last 2 years. (Ask for the name of the last born child and continue with the next question)
Name of the last born child ____
If the last live birth is dead, try to show compassion when referring to that child, and enter the child's name in the following sections.
CM13A. Is (name of last child) he or she still alive?
[] 1 Yes (Go to next module)
[] 2 No
[] 2 No
CM13B. When did (name of last child) he or she die?
If unknown day, enter "98". The interviewer must ask month and year of the death of last child.
_ _ Day
_ _ Month
_ _ _ _ Year
_ _ Month
_ _ _ _ Year
Desire for last child: 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?
[] 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 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 MN4D)
[] 2 No (Go to MN4D)
MN2. Whom did you see?
Probe: Anyone else? Probe for the type of person seen and circle all answers given.
Health professional
[] A Physician
[] B Nurse/Midwife
[] B Nurse/Midwife
Other health professional
[] E Health centre staff/nurse's aide/midwife's aide
Other personnel
[] F Traditional birth attendant (trained or untrained)
[] G Village health volunteer (VHV)
[] G Village health volunteer (VHV)
[] 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
MN4D. During this pregnancy, did your husband receive counselling and information from a health official about maternal and child care?
[] 1 Yes
[] 2 No
[] 2 No
MN5. Do you have a card or other document with your own immunizations listed?
May I see it please?
If a card or any other document 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)
[] Fewer than two tetanus injections during last pregnancy (Continue with MN9)
[] Fewer than two tetanus injections 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 MN17)
[] 8 DK (Go to MN17)
[] 2 No (Go to MN17)
[] 8 DK (Go to MN17)
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 MN17)
[] 8 DK (Go to MN17)
MN11. How many years ago did you receive the last tetanus injection before your pregnancy with (name)?
_ _ Years ago
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 Physician
[] B Nurse/Midwife
[] B Nurse/Midwife
Other health professional
[] E Health centre staff/nurse's aide/midwife's aide
Other personnel
[] F Traditional birth attendant (trained or untrained)
[] G Village health volunteer (VHV)
[] H Relative/Friend
[] G Village health volunteer (VHV)
[] 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 MN20)
[] 12 Other home (Go to MN20)
[] 12 Other home (Go to MN20)
Govt. health facility
[] 21 Hospital
[] 22 Maternal and child health hospital
[] 23 Health centre/sub-district promotion hospital/Bangkok health centre
[] 26 Other public (specify) ____
[] 22 Maternal and child health hospital
[] 23 Health centre/sub-district promotion hospital/Bangkok health centre
[] 26 Other public (specify) ____
Private health facility
[] 31 Private hospital
[] 32 Private clinic
[] 36 Other private medical (specify) ____
[] 32 Private clinic
[] 36 Other private medical (specify) ____
[] 96 Other (specify) ____ (Go to MN20)
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
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, booklet, if available. Record in kilograms.
[] 1 From card/booklet (kg) _ _ _ _
[] 2 From recall (kg) _ _ _ _
[] 9998 DK
[] 2 From recall (kg) _ _ _ _
[] 9998 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 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.
[] 000 Immediately
[] 1 Within 24 hours _ _
[] 2 More than 24 hours: enter the number of days _ _
[] 998 Don't know/remember
[] 1 Within 24 hours _ _
[] 2 More than 24 hours: enter the number of 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 Water to prevent constipation (gripe water)
[] E Oral rehydration solution
[] F Fruit juice
[] G Infant formula
[] H Tea (other type of brewed beverage)
[] I Honey
[] X Other (specify) ____
[] B Plain water
[] C Sugar or glucose water
[] D Water to prevent constipation (gripe water)
[] E Oral rehydration solution
[] F Fruit juice
[] G Infant formula
[] H Tea (other type of brewed beverage)
[] I Honey
[] X Other (specify) ____
MN27A. In the 2nd week after delivery, did any health personnel visit and check your health at home?
[] 1 Yes
[] 2 No
[] 3 Not yet the appointment date
[] 2 No
[] 3 Not yet the appointment date
MN27B. In the 4th-6th week after delivery, did any health personnel visit and check your health at home?
[] 1 Yes
[] 2 No
[] 3 Not yet the appointment date
[] 2 No
[] 3 Not yet the appointment date
MN27C. In the 2nd week after delivery, did any health personnel visit and check your last child's health at home?
[] 1 Yes
[] 2 No
[] 3 Not yet the appointment date
[] 2 No
[] 3 Not yet the appointment date
MN27D. In the 4th-6th week after delivery, did any health personnel visit and check your last child's health at home?
[] 1 Yes
[] 2 No
[] 3 Not yet the appointment date
[] 2 No
[] 3 Not yet the appointment date
Contraception: CP
CP1. I would like to talk with you about another subject -- family planning.
Are you pregnant now?
[] 1 Yes (Go to next module)
[] 2 No
[] 8 Unsure or DK
[] 2 No
[] 8 Unsure or DK
CP2. Are you currently doing something or using any method to delay or avoid getting pregnant?
[] 1 Yes
[] 2 No (Go to CP3A)
[] 2 No (Go to CP3A)
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 Vasectomy (Go to next module)
[] C IUD (Go to next module)
[] D Injectables (Go to next module)
[] E Implants (Go to next module)
[] F Oral contraceptive 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 Vasectomy (Go to next module)
[] C IUD (Go to next module)
[] D Injectables (Go to next module)
[] E Implants (Go to next module)
[] F Oral contraceptive 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)
CP3A. What is the main reason that you are not doing something or using any method to delay or avoid getting pregnant?
[] 01 Afraid of being harmful to health
[] 02 The cost of contraception is expensive
[] 03 Just deliver/post-abortion
[] 04 Think of being too old/menopausal
[] 05 Difficulty to access the service (far, difficulty traveling, etc.)
[] 06 No desirable contraception at the service outlet
[] 07 Husband/partner forces to have sex
[] 08 Not anticipate to have sex
[] 09 No time to receive the service/busy
[] 96 Other (specify) ____
[] 02 The cost of contraception is expensive
[] 03 Just deliver/post-abortion
[] 04 Think of being too old/menopausal
[] 05 Difficulty to access the service (far, difficulty traveling, etc.)
[] 06 No desirable contraception at the service outlet
[] 07 Husband/partner forces to have sex
[] 08 Not anticipate to have sex
[] 09 No time to receive the service/busy
[] 96 Other (specify) ____
CP3B. In the past, did you ever do something or use any method to delay or avoid getting pregnant?
[] 1 Yes
[] 2 No
[] 2 No
Unmet need: UN
UN1. Check CP1. Currently pregnant?
[] Yes, currently pregnant (CP1=1) (Continue with UN2)
[] No, unsure or DK (CP1 = 2, 8) (Go to UN5)
[] No, unsure or DK (CP1 = 2, 8) (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
UN2A. Before this pregnancy, did you do something or use any method to delay or avoid getting pregnant?
[] 1 Yes
[] 2 No (Go to UN3)
[] 2 No (Go to UN3)
UN2B. What did you do to delay or avoid a pregnancy?
Do not prompt. If more than one method is mentioned, circle each one.
[] A Female sterilization
[] B Vasectomy
[] C IUD
[] D Injectables
[] E Implants
[] F Oral contraceptive pill
[] G Male condom
[] H Female condom
[] I Diaphragm
[] J Foam/jelly
[] K Lactational amenorrhoea method (LAM)
[] L Periodic abstinence/rhythm
[] M Withdrawal
[] X Other (specify) ____
[] B Vasectomy
[] C IUD
[] D Injectables
[] E Implants
[] F Oral contraceptive pill
[] G Male condom
[] H Female condom
[] I Diaphragm
[] J Foam/jelly
[] K Lactational amenorrhoea method (LAM)
[] L Periodic abstinence/rhythm
[] M Withdrawal
[] X Other (specify) ____
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 (CP1 = 1) (Go to UN13)
[] No, unsure or DK (CP1 = 2,8) (Continue with UN9)
[] No, unsure or DK (CP1 = 2,8) (Continue with UN9)
UN9. Check CP2. Currently using a method?
[] Yes (CP2 = 1) (Go to UN13)
[] No (CP2 = 2) (Continue with UN10)
[] No (CP2 = 2) (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 (Number of) days ago _ _
[] 2 (Number of) weeks ago _ _
[] 3 (Number of) months ago _ _
[] 4 (Number of) years ago _ _
[] 994 In menopause/has had hysterectomy
[] 995 Before last birth
[] 996 Never menstruated
[] 2 (Number of) weeks ago _ _
[] 3 (Number of) months ago _ _
[] 4 (Number of) years ago _ _
[] 994 In menopause/has had hysterectomy
[] 995 Before last birth
[] 996 Never menstruated
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
[] 98 DK
[] 98 DK
MA2A. Before marriage, did you ever receive information or counselling about family planning from a health service provider?
[] 1 Yes
[] 2 No
[] 8 DK/unsure
[] 2 No
[] 8 DK/unsure
MA2B. Before marriage, did your husband/partner ever receive information or counselling about family planning from a health service provider?
[] 1 Yes
[] 2 No
[] 8 DK/unsure
[] 2 No
[] 8 DK/unsure
MA2C. Before marriage, did you ever receive a blood test for thalassemia?
If yes, probe: Does she know the results of the test (not necessary to ask what the results were)?
[] 1 Yes, and know the results
[] 2 Yes, but don't know the results
[] 3 No
[] 8 DK/unsure
[] 2 Yes, but don't know the results
[] 3 No
[] 8 DK/unsure
MA2D. Before marriage, did you ever receive a blood test for HIV?
If yes, probe: Does she know the results of the test (not necessary to ask what the results were)?
[] 1 Yes, and know the results
[] 2 Yes, but don't know the results
[] 3 No
[] 8 DK/unsure
[] 2 Yes, but don't know the results
[] 3 No
[] 8 DK/unsure
MA2E. Before marriage, did your husband/partner ever receive a blood test for thalassemia?
If yes, probe: Does she know the results of the test (not necessary to ask what the results were)?
[] 1 Yes, and know the results
[] 2 Yes, but don't know the results
[] 3 No
[] 8 DK/unsure
[] 2 Yes, but don't know the results
[] 3 No
[] 8 DK/unsure
MA2F. Before marriage, did your husband/partner ever receive a blood test for HIV?
If yes, probe: Does she know the results of the test (not necessary to ask what the results were)?
[] 1 Yes, and know the results (Go to MA7)
[] 2 Yes, but don't know the results (Go to MA7)
[] 3 No (Go to MA7)
[] 8 DK/unsure (Go to MA7)
[] 2 Yes, but don't know the results (Go to MA7)
[] 3 No (Go to MA7)
[] 8 DK/unsure (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 _ _
HIV/AIDS: HA
HA1. Now I would like to ask about the knowledge and understanding of HIV/AIDS.
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 (CM13= N or blank) (Go to HA24)
[] One or more live births in last 2 years (CM13 = Y) (Continue with HA14)
[] One or more live births in last 2 years (CM13 = Y) (Continue with HA14)
HA14. Check MN1: Received antenatal care?
[] Received antenatal care (MN1 = 1) (Continue with HA15)
[] Did not receive antenatal care (MN1 = 2) (Go to HA24)
[] Did not receive antenatal care (MN1 = 2) (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 or B)?
[] 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 times 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 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
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
WM11. Record the time.
_ _ : _ _ Hour and minutes
WM12. Check Household Listing Form, column HL8.
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, man 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, man or child under-5 in the household.)
Interviewer's observations
Field editor's observations
Supervisor's observations