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 the representatives of the State Statistics Committee of Ukraine. The State Statistics Committee and the United Nations Children's Fund (UNICEF) are currently undertaking a survey concerned with family health and education. We would like to pose you several questions. The interview will take about 45 minutes. Your experience in building your family life and bringing up your children will have big importance for the improvement of activities by the healthcare facilities and the social services in Ukraine. All the information we obtain will remain strictly confidential and your answers will never be identified. The information will be used only in the generalised form and only together with the responses of other Ukrainian families. You may abstain from responding to the questions that you do not like and are free to interrupt the interview any time you want. May I start now? 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?

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 and go to next module

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 is no longer living, or whose father is not your current partner.
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 to 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 in total (total number) births during your life. Is this correct?

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.
CM12. Check CM11: Did the woman's last birth occur within the last 2 years?
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?

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.

MN1A. In the first two months after your last birth [the birth of name], did you receive Iodine supplements?

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?
How many times?

MN3B. Was your blood pressure measured?
How many times?

MN3C. Did you give a urine sample?
How many times?

MN3D. Did you give a blood sample?
How many times?

MN3E. Did you take ultra sound tests?
How many times?

MN3F. Did you receive the good parenting training as a part of antenatal care?
How many times?

MN3G. Did you attend this training alone or together with your partner, husband, close relative, or friend?

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

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

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

MN6A. Did you take any iron containing supplements during your last pregnancy?

MN6B. Who recommended the supplementation?

MN6C. What was the reason for supplementation?

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
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) ____

MN8A. Was your husband, partner or close relatives present in the delivery room during the delivery?

MN8B. Did you have any opportunity to choose a position you want during the labour or you had to give birth laying on your back at traditional obstetric bed?

MN8C. Did you share the room with your baby in maternity hospital since the very day of birth?

MN8D. For how many days have you been staying in maternity hospital?

MN8E. Have you been separated from a child in maternity hospital for any reason?

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.
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?

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?

Contraception and unmet need: CP

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

CP0A. Have you ever received information on the use of contraceptives?

CP0B. Where did you first received information on the use of contraception?

CP1. Are you pregnant now?

CP1A. At the time you became pregnant did you want to become pregnant then, did you want to wait until later, or did you not want to have any more children?

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: Apart from 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?

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 with out 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?

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 HIV virus by having one sex partner who is not infected and also has no other partners?

HA3. Can people get infected with the HIV virus because of witchcraft or other supernatural means?

HA4. Can people reduce their chance of getting the HIV virus by using a condom every time they have sex?

HA5. Can people get the HIV virus from mosquito bites?

HA6. Can people reduce their chance of getting infected with the HIV virus by not having sex at all?

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

HA7A. Can people get the HIV 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 HIV virus?

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

HA9A. During pregnancy?

HA9B. During delivery?

HA9C. By breastfeeding?

HA9D. By hygiene manipulations?

HA9E. By playing with a baby?

HA10. If a female teacher has the HIV 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 HIV virus?

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

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

HA14. Check MN5: Tested for HIV 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 HIV 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 HIV virus?

HA19. Where did you get information about HIV/AIDS?

HA20. Do you know where you can get information about HIV/AIDS?

HA21. Where can you get information about HIV/AIDS?