Woman's information panel: WM

This questionnaire is to be administered to all women age 15 through 49 (see List of Household Members, column HL7). 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's name and number:

WM6. Day/month/year of interview _ _ / _ _ / 201 _

Repeat greeting if not already read to this woman:

We are from National Statistical Office. We are conducting a survey about the situation of children, families and households. I would like to talk to you about these subjects. The interview will take about 15 minutes. All the information we obtain will remain strictly confidential and anonymous.

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 15 minutes. Again, all the information we obtain will remain strictly confidential and anonymous.

May I start now?

WM7. Result of woman's interview

WM10. Record the time.

Woman's background: WB

WB1. In what month and year were you born?

WB2. How old are you?

Probe: how old were you at your last birthday? Compare and correct WB1 and/or WB2 if inconsistent.

WB3. Have you ever attended school or preschool?

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

WB5. What is the highest grade you completed at that level? If the first grade at this level is not completed, 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?

Fertility/ birth history: CM

CM1. Now I would like to ask about all the births you have had during your life. Have you ever given birth?

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 the father is not your current partner.
Skip to CM4 only if year of first birth is given. Otherwise, continue with CM3.

CM3. How many years ago did you have your first birth?

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.

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?

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: Last birth occurred within the last 2 years, that is, since (month of interview) in 2013 (if the month of interview and the month of birth are the same, and the year of birth is 2013, consider this as a birth within the last 2 years).

If child has died, take special care when referring to this child by name in the following modules. Continue with next module.

Desire for last birth: DB

This module is to be administered to all women with a live birth in the 2 years preceding the date of interview.
Record name of last-born child from CM13 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? Record the answer as stated by respondent.

Maternal and newborn health: MN

This module is to be administered to all women with a live birth in the 2 years preceding the date of interview.
Record name of last-born child from CM13 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)?

MN2. Whom did you see?

Probe: anyone else? Probe for the type of person seen and circle all answers given.

MN2A. How many weeks or months pregnant were you when you first received antenatal care for this pregnancy?

Record the answer as stated by respondent.

MN3. How many times did you receive antenatal care during this pregnancy?

Probe to identify the number of times antenatal care was received. If a range is given, record the minimum number of times antenatal care received.

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?

[B] Did you give a urine sample?

[C] Did you give a blood sample?

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.

MN5A. Check card and record the details for blood test below..

[A] STIs (VDRL) 1st time, test taken

[B] STIs (VDRL) 2nd time, test taken

[C] Screening of Thalassemia (wife)

[D] Screening of Thalassemia (husband)

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?

MN7. How many times did you receive this tetanus injection during your pregnancy with (name)?

MN8. How many tetanus injections during last pregnancy were reported in MN7?

MN9. Did you receive any tetanus injection at any time before your pregnancy with (name), either to protect yourself or another baby?

MN10. How many times did you receive a tetanus injection before your pregnancy with (name)?

If 7 or more times, record '7'.

MN11. How many years ago did you receive the last tetanus injection before your pregnancy with (name)?

If less than 1 year, record '00'.

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.

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) ____

MN19. Was (name) delivered by caesarean section? That is, did they cut your belly open to take the baby out?

MN19A. When was the decision made to have the caesarean section? Was it before or after your labour pains started?

MN20. When (name) was born, was he/she very large, larger than average, average, smaller than average, or very small?

MN21. Was (name) weighed at birth?

MN22. How much did (name) weigh? If a card is available, record weight from card.

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

MN24. Did you ever breastfeed (name)?

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.

MN26. In the first three days after delivery, was (name) given anything to drink other than breast milk?

MN27. What was (name) given to drink? Probe: Anything else?

MN28. In the first 42 days after the delivery of (name), did you receive any post-natal health checks?

MN29. How many times did you receive these checks within 42 days of delivery?
If 7 or more times, record '7'. If unsure or DK, record '8'.

Contraception: CP

CP1. I would like to talk with you about another subject - family planning.
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?

CP2A1. What is the reason that you or your partner currently not doing something or using any method to delay or avoid getting pregnant?

CP2A. Have you ever done something or used 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.

Unmet need: UN

UN1. Check. Check CP1: Currently pregnant?

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. 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? Record the answer as stated by respondent.

UN8. Check CP1: Currently pregnant?

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? Record the answer using the same unit stated by the respondent.

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?

Marriage/union: MA

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

MA2. How old is your husband/partner? Probe: How old was your husband/partner on his last birthday?

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?

MA7. Have you been married or lived with a man only once or more than once?

MA8A. In what month and year did you marry or start living with a man as if married?

MA8B. In what month and year did you first marry or start living with a man as if married?

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

HIV/AIDS: HA

HA1. Now I would like to talk with you about the knowledge and understanding of HIV/AIDS. 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?

HA12A. Do you think children living with HIV should be able to attend school with children who are HIV negative?

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:

[A] Babies getting the AIDS virus from their mother?

[B] Things that you can do to prevent getting the AIDS virus?

[C] Getting tested for the AIDS virus?

Were you:
[D] Offered a test for the AIDS virus?

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 counselling after getting the result. After you were tested, did you receive counselling?

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

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?

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?

HA28. Check age is between 15-24 (WB2=15-24) and ever attended school (WB3=1)

HA29. "Did you study sexuality education in school?" "Sexuality education on topics such as birth control, safe sex, teen pregnancy, reproductive tract infections and good health"

HA30. "What level did you first have sexuality education?"

WM11. Record the time.

WM12. Check List of Household Members, columns HL7B and HL15: Is the respondent the mother or caretaker of any child age 0-4 living in this household?

Interviewer's observations ________

Supervisor's observations ________