[p. 1]

Women's Information Panel: WM

This module is to be administered to all women age 15 through 49 (see column HL6 of HH listing). Fill in one form for each eligible woman. Fill in the cluster and household number, and the name and line number of the woman in the space below. Fill in your name, number and the date.

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 _ _ / _ _ / _ _ _ _

WM7. Result of women's interview

Repeat greeting if not already read to this woman:
We are from NIS. We are working on a project concerned with family health and education. I would like to talk to you about this. The interview will take about [number] minutes. All the information we obtain will remain strictly confidential and your answers will never be identified. Also, you are not obliged to answer any question you don't want to, and you may withdraw from the interview at any time. May I start now?

If permission is given, begin the interview. If the woman does not agree to continue, thank her, complete wm7, and go to the next interview. Discuss this result with your supervisor for a future revisit.

WM8. In what month and year were you born?

WM9. How old were you at your last birthday?

[p. 2]

WM10. Have you ever attended school?

WM11. What is the highest level of school you attended: primary, secondary, or higher?

WM12. What is the highest grade you completed at that level?

WM13. Check WM11:

WM14. Now I would like you to read this sentence to me.

Show sentences to respondent. If respondent cannot read whole sentence, probe: Can you read part of the sentence to me?

[p. 3]

Child Mortality Module: CM

This module is to be administered to all women age 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?

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?

CM2a. What was the date of your first birth?

I mean the very first time you gave birth, even if the child or was fathered by a man you are not living with.

Skip to CM3 only if year of first birth is given. Otherwise, continue with CM2b.

CM2B. How many years ago did you have your first birth?

CM3. Do you have any sons or daughters to whom you have given birth who are now living with you?

CM4 How many sons live with you? How many daughters live with you?

CM5 Do you have any sons or daughters whom you have given birth who are alive but do not live with you?

CM6. How many sons are alive but do not live with you? How many daughters are alive but do not live with you?

CM7. Have you ever given birth to a boy or girl who was born alive but later died?

CM8. How many boys have died? How many girls have died?

CM9. Sum answers to CM4, CM6, and CM8

CM10 Just to make sure that I have this right, you have had (total number) births during your life. Is this correct?

[p. 4]

CM11. Of these (total number) births you have had, when did you deliver the last one (even if he or she has died)?
If day is not known, enter '98' in space for day.

If day is not known, enter '98' in space for day.

CM11A. Women sometimes have pregnancies which do not end in a live born child. That is, a pregnancy can be ended early by ab abortion, a miscarriage, or a stillbirth.
In total, how many abortions have you had?
If none, record '00'.

CM11B. How many miscarriages?
If none, record '00'.

CM11C. How many stillbirths?
If none, record '00'.

CM12. Check CM11: Did the woman's last birth occur within the last 2 years, that is, since (day and month of interview in [2003]

If child has died, take special care when referring to this child by name in the following modules

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?

[p. 5]

Maternal and newborn health module: 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 CM12 and record name of last-born child here ____
Use this child's name in the following questions, where indicated.

MN1. In the first two months after your last birth [the birth of name], did you receive a vitamin A dose like this?

Show 200,000 IU capsule or dispenser.

MN2. Did you see anyone for antenatal care for this pregnancy?

If yes: Whom did you see? Anyone else? Probe for the type of person seen and circle all answers given.

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?

MN3E. Was your blood group determined?

MN3F. Did you have a gynecological exam?

MN3G. Was your pregnancy term calculated?

MN3H. Did you have an ultrasound exam?

MN4A. During this pregnancy, were you given, or did you buy any iron tablets or syrup?

MN4B. During the whole pregnancy, for how many or did you buy any iron tablets?

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

MN5. I don't want to know the results, but were you tested for the HIV/AIDS virus as part of your antenatal care?

MN6. I don't want to know the results, but did you get the results of the test?

MN7. Who assisted with the delivery of your last child (name)? Anyone else?

Probe for the type of person assisting and circle all answers given

[p. 7]

MN8. Where did you give birth to (name)?
If source is hospital, health center, or clinic, write the name of the place below. Probe to identify the type of source and circle the appropriate code.
(Name of place) ____

MN9. When you last child (name) was born, was he/she very large, larger than average, average, smaller than average, or very small?

MN10. Was (name) weighed at birth?

MN11. How much did (name) weigh?
Record weight from health card, if available

MN12. Did you ever breastfeed (name)

MN13. 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.

[p. 8]

Marriage/union module: MA

MA.1 Are you currently married or living together with a man as if married?

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

MA3. Have you ever been married or lived together with a man?

MA3A. Check MA3:

MA4. What is your marital status now: are you widowed, divorced, or separated?

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

MA7. Check MA6:

MA8. How old were you when you started living with your first husband/partner?

[p. 9]

Contraception module: CP

I would like to talk with you about another subject - family planning - and your reproductive health

CP0A. People can use the various ways or methods to delay or avoid a pregnancy.
Which ways or methods have you heard about? Do not prompt. If more than one method is mentioned, circle each one.

CP2. Some people 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. Which method are you using?

Do not prompt. If more than one method is mentioned, circle each one.

CP4A. Now I would like to ask some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?

CP4B. If currently pregnant: 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?

CP4C. How long would you like to wait before the birth of (a/another) child?

CP4D. Check CP1:

CP4E. Do you think you are physically able to get pregnant at this time?

[p. 10]

Attitudes toward domestic violence

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:

DV1A. If she goes out without telling him?

DV1B. If she neglects the children?

DV1C. If she argues with him?

DV1D. If she refuses sex with him?

DV1E. If she burns the food?

DV2 Check in Marriage/Union module question MA1, if women was married/in union.

DV2A. Who usually makes decisions about health care for yourself: mainly you, mainly your husband/partner, you and your husband/partner jointly, or someone else?

DV2B. Who usually makes decisions about major household purchases?

DV2C. Who usually makes decisions about making purchases for daily household needs?

DV2D. Who usually makes decisions about visits to your familiar relatives?

HIV/AIDS module: HA

HA1. Now I would like to talk with you about something else.

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 she be allowed to continue teaching in school?

HA11. Would you buy fresh vegetables from a shopkeeper or 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?

[p. 11]

HA14. Check MN5: Tested during antenatal care?

HA15. I do not want to know the results, but have you ever been tested to see if you have HIV, the virus that causes AIDS?

HA16. I do not want you to tell me the results of the test, but have you been told the results?

HA17. Did you, yourself, ask for the test, was it offered to you and you accepted, or was it required?

HA18. At this time, do you know of a place where you can go to get such a test to see if you have the AIDS virus?

HA18A. If tested for HIV during antenatal care: other than at the antenatal clinic, do you know of a place where you can go to get a test to see if you have the AIDS virus?

Follow instructions in your interviewer's manual.

Tuberculosis module: TB

TB1. Have you heard of illness called Tuberculosis?

TB2. Can Tuberculosis be cured?

TB3. Have you or has anyone in your family ever had Tuberculosis?

TB4. Besides your family, are there persons you contact often (neighbors, colleagues, or close friends) which have been ill with Tuberculosis?

TB5. What signs or symptoms would lead you to think that a person has Tuberculosis?
Probe: Any other ways?
Record all mentioned

TB6. What are symptoms of Tuberculosis require immediate referral for medical assistance?
Other?
Record all mentioned

TB7. When a person first discovers that he/she has Tuberculosis, how should person be treated in hospital, treated at home, or both?

TB8. How Tuberculosis is person-to-person transmitted?
Any other ways?
Record all mentioned

TB9. Where would you go for help if you thought you or your child had Tuberculosis?
Other?
Record all mentioned

TB10. After treatment of a member of your family for Tuberculosis in a hospital, would you be willing to care for him/her in your household?

TB10A. If a member of your family became sick with Tuberculosis, would you want it to remain a secret?

Follow instructions in your Interviewer's Manual