[p. 1]

Ukraine 2012

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. 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 _ _ / _ _ / _ _ _ _

Repeat greeting if not already read to this woman:
We are from the State Statistics Service of Ukraine. We are working on a project concerned with family health and education. I would like to talk to you about these subjects. The interview will take about 40 minutes. All the information we obtain will remain strictly confidential and your answers will never be shared with anyone other than our project team.

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 40 minutes. Again, all the information we obtain will remain strictly confidential and your answers will never be shared with anyone other than our project team.

May I start now?

WM7. Result of woman's interview

WM8. Field edited by (name and number):
WM9. Data entry clerk (name and number):
WM9A. Second data entry clerk (name and number):
[p. 2]
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 other education facility?

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

WB5. What is the highest grade you completed at that level?
If less than 1 grade, 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?
[p. 3]
Access to mass media and use of information/communication technology: MT

MT1. Check WB4:
MT2. How often do you read a newspaper or magazine: almost every day, at least once a week, less than once a week or not at all?

MT3. Do you listen to the radio almost every day, at least once a week, less than once a week or not at all?

MT4. How often do you watch television: would you say that you watch almost every day, at least once a week, less than once a week or not at all?

MT6. Have you ever used a computer?

MT7. Have you used a computer from any location in the last 12 months?

MT8. During the last one month, how often did you use a computer: almost every day, at least once a week, less than once a week or not at all?

MT9. Have you ever used the internet?

MT10. In the last 12 months, have you used the internet?
If necessary, probe for use from any location, with any device.
MT11. During the last one month, how often did you use the internet: almost every day, at least once a week, less than once a week or not at all?

MT12. From what sources do you get information on health related issues for you and your family/children?
Probe: From any other source?
MT13. What sources of information do you consider reliable in issues related to your health and health of your family/relatives?
Probe: Any other source?
[p. 4]
Child mortality: CM

CM1. Now I would like to ask about all the births you have had during your life. Have you ever given 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'.
CM9A. Were there any other children who were born alive, but who died within a few minutes, hours, or days?

CM9B. Correct CM9 and CM9A and then continue with question CM10

CM10. Sum answers to CM5, CM7, and CM9.
[p. 5]
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?

CM11A. Women sometimes have pregnancies which do not result in a live born child. That is, a pregnancy can be ended early by an abortion, a miscarriage or a stillbirth. I will now ask you about each of them separately.
In total, how many abortions have you had?
If "none" probe: I mean a pregnancy that was voluntarily terminated within the first 5 months of pregnancy. If none, record '00'.
CM11B. How many miscarriages have you had?
If "none" probe: I mean an early and involuntary end of pregnancy within the first 5 months of pregnancy. If none, record '00'.
CM11C. How many stillbirths have you had?
If "none" probe: I mean a birth that took place after the 5th month of pregnancy, but the child did not show any signs of life. If none, record '00'.
CM11D. Sum answers to CM11A, CM11B and CM11C. If none, record '00'.
CM11E. Just to make sure that I have this right, you have had in total, not counting the children born alive, (total number in CM11D) abortions, miscarriages and stillbirths. Is this correct?

CM11F. Check CM10 and CM11D. Has the respondent had any pregnancies?

Pregnancy History: PH

Now I want to talk about each of your pregnancies, including those which ended in a live brith, a stillbirth, a miscarriage, and an induced abortion. Starting with your last pregnancy, please tell me the following information:
Record all pregnancies. Record twins and triplets on separate lines. If there are more than 10 pregnancies use an additional questionnaire.

PH1. Line No. _ _

PH2. Did your (last/next to last/etc) pregnancy end in a live birth, a stillbirth, a miscarriage, or an abortion?

PH3. Was this a single or a multiple birth?

PH4. In what month and year (was this child born/did this pregnancy end?)

PH6. Check PH2, write same response
PH7. What name was given to this child?
Write "Baby 1" "Baby 2"etc. If no name was given to a child
PH8. Is/was (name) a boy or a girl?

PH9. Is (name) still alive?

PH10. How old was (name) at his/her last birthday?
Record age in completed years.
PH11. Is (name) living with you?

PH12. Record household line number of child (from HL1)
Record "00" if child is not listed.
PH13. If dead: How old was (name) when he/she died?
If "1 year", probe:: How many months old was (name)?
Record days if less than 1 month; record months if less than 2 years; or years.
PH14. Were there any other pregnancies between previous pregnancy and this one?

CM11G. Have you had any birth, miscarriage or abortion since [birth of (name of last birth in pregnancy history) or last miscarriag /abortion you described]?

CM15. Record and compare number of live births recorded in pregnancy history (code 1 in PH6) with earlier responses:
CM16. Record and compare number of abortions recorded in pregnancy history (code 4 in PH6) with earlier responses:
CM18. Check:
CM19. Check PH2 and PH4: Enter the number of live births in (month of the interview) 2007 or later (in PH2 circled code "1")
CM20. Check PH2 and PH4
CM21. Now let me ask you about your last pregnancy which ended with the abortion. Where was that last abortion performed?
Probe to identify the type of place and circle the appropriate code. If unable to determine if a hospital, health center, or clinic is public pr private medical, write the name of the place.
___________

CM22. In addition to the abortion we just have talked about, in the last five years have you ever been taking any facilitating abortion tablets or medications with an abortive effect?

CM23. In the last five years have you been taking any facilitating abortion tablets or medications with an abortive effect?

CM24. For how many cases of experienced menstruation delays in total have you been taking this medication during the last five years?

CM25. The last time you have used this medication, what was the name of this medication?

CM26. Check PH2 and PH4 in 'pregnancy history': last live birth occurred within the last 2 years, that is, since (day and month of interview) in 2010If child has died, take special care when referring to this child by name in the following modules. Continue with the 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 date of interview.
Check child mortality module CM26 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?

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?

[p. 7]
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 CM26 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)?

MN2. Whom did you see?
Probe: Anyone else? Probe for the type of person seen and circle all answers given.
MN3. How many times did you receive antenatal care during this pregnancy?

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?

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.
[p. 9]
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?

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?
Record weight from health card, if available.
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.
[p. 10]
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?
[p. 11]
Post-natal health checks: PN

This module is to be administered to all women with a live birth in the 2 years preceding the date of interview.
Check child mortality module CM26 and record name of last-born child here ____
Use this child's name in the following questions, where indicated.

PN1. Check MN18: Was the child delivered in a health facility?
PN2. Now I would like to ask you some questions about what happened in the hours and days after the birth of (name).
You have said that you gave birth in (name or type of facility in MN18). How long did you stay there after the delivery?
If less than one day, record hours. If less than one week, record days. Otherwise, record weeks.
PN3. I would like to talk to you about checks on (name)'s health after delivery - for example, someone examining (name), checking the cord, or seeing if (name) is ok. Before you left the (name or type of facility in MN18), did anyone check on (name)'s health?

PN4. And what about checks on your health - I mean, someone assessing your health, for example asking questions about your health or examining you. Did anyone check on your health before you left (name or type or facility in MN18)?

PN5. Now I would like to talk to you about what happened after you left (name or type of facility in MN18). Did anyone check on (name)'s health after you left (name or type of facility in MN18)?

PN6. Check MN17: Did a health professional or a nurse/midwife assist with the delivery?
[p. 12]
PN7. You have already said that (person or persons in MN17) assisted with the birth. Now I would like to talk to you about checks on (name)'s health after delivery, for example examining (name), checking the cord, or seeing if (name) is ok.
After the delivery was over and before (person or persons in MN17) left you, did (person or persons in MN17) check on (name)'s health?

PN8. And did (person or persons in MN17) check on your health before leaving?
By check on your health, I mean assessing your health, for example asking questions about your health or examining you.

PN9. After the (person or persons in MN17) left you, did anyone check on the health of (name)?

PN10. I would like to talk to you about checks on (name)'s health after delivery - for example, someone examining (name), checking the cord, or seeing if the baby is ok. After (name) was delivered, did anyone check on his/her health?

PN11. Did such a check happen only once, or more than once?

PN12A. How long after delivery did that check happen?
PN12B. How long after delivery did the first of these checks happen?
If less than one day, record hours. If less than one week, record days. Otherwise, record weeks.
[p. 13]
PN13. Who checked on (name)'s health at that time?

PN14. Where did this check take place?
Probe to identify the type of source. If unable to determine whether public or private, write the name of the place.
(Name of place) ____

PN15. Check MN18: Was the child delivered in a health facility?
PN16. After you left (name or type of facility in MN18), did anyone check on your health?

PN17. Check MN17: Did a health professional or nurse/midwife assist with the delivery?
PN18. After the delivery was over and (person or persons in MN17) left, did anyone check on your health?

PN19. After the birth of (name), did anyone check on your health?
I mean someone assessing your health, for example asking questions about your health or examining you.

[p. 14]
PN20. Did such a check happen only once, or more than once?

PN21A. How long after delivery did that check happen?
PN21B. How long after delivery did the first of these checks happen?
If less than one day, record hours. If less than one week, record days. Otherwise, record weeks.
PN22. Who checked on your health at that time?

PN23. Where did this check take place?
Probe to identify the type of source. If unable to determine whether public or private, write the name of the place.
(Name of place) ____

[p. 15]
Illness Symptoms: IS

IS1. Check Household Listing, column HL9
Is the respondent the mother or caretaker of any child under age 5?

IS2. Sometimes children have severe illnesses and should be taken immediately to a health facility. What types of symptoms would cause you to take your child to a health facility right away?
Probe: Any other symptoms? Keep asking for more signs or symptoms until the mother/caretaker cannot recall any additional symptoms. Circle all symptoms mentioned, but do not prompt with any suggestions
[p. 16]
Contraception: CP

CP0. I would like to talk with you about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.

CP0A. Have you ever heard of female sterilization?
Probe: Women can have an operation to avoid having any more children.

CP0B. Have you ever heard of male sterilization?
Probe: Men can have an operation to avoid having any more children.

CP0C. Have you ever heard of IUD?
Probe: Women can have a loop or coil placed inside them by a doctor or a nurse?

CP0D. Have you ever heard of injectables?
Probe: Women can have an injection by a health provider that stops them from becoming that stops them from becoming pregnant for one or more months.

CP0E. Have you ever heard of implants?
Probe: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.

CP0F. Have you ever heard of pill?
Probe: Women can take a pill every day to avoid becoming pregnant.

CP0G. Have you ever heard of condom?
Probe: Men can put a rubber sheath on their penis before sexual intercourse.

CP0H. Have you ever heard of female condom?
Probe: Women place a sheath in their vagina before sexual intercourse.

CP0I. Have you ever heard of lactational amenorrhea method?

CP0J. Have you ever heard of rhythm method?
Probe: Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.

CP0K. Have you ever heard of withdrawal?
Probe: Men can be careful and pull out before climax.

CP0L. Have you ever heard of diaphragm?
Probe: A cap can be placed in the vagina to cover the cervix and prevent the sperm from getting into the uterus.

CP0M. Have you ever heard of foam/jelly?
Probe: A special foam/jelly can be put in the vagina to disable spermatozoids or to create a chemical barrier preventing them from getting into the uterus

CP0N. Have you ever heard of patch?
Probe: Women can wear a small adhesive patch on the body all time every week to avoid becoming pregnant.

CP0O. Have you ever heard of ring?
Probe: Women can place a flexible ring in the vagina every 3 weeks to avoid becoming pregnant.

CP0P. Have you ever heard of emergency contraception?
Probe: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.

CP0Q. Have you ever heard of any other ways or methods that women or men can use to avoid pregnancy?

CP0R. Which other methods of contraception have you heard of?

CP1. Are you pregnant now?

CP2. Are you currently doing something or using 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. If more than one method mentioned, follow skip instruction for highest method in list.
CP3AA. Does your husband/partner know that you have been sterilized?

CP6. In what facility did the sterilization take place?
Probe to identify the type of source. If unable to determine whether public or private, write the name of the place.
________ (Name of place)

CP7. In what month and year was the sterilization performed?

CP7A. Since what month and year have you been using (current method) without stopping?
Probe: For how long have you been using (current method) now without stopping?
CP7B. Does your husband/partner know that you are using this method/these methods of contraception?

CP8. Check CP7/CP7A, PH2, PH4: Any birth or pregnancy termination after month and year of start of use of contraception in CP7/CP7A?
CP10. Have you ever used anything or tried in any way to delay or avoid getting pregnant?

CP10A. Beside the method(s) you are currently using, have you ever used anything else or tried any other way to delay or avoid getting pregnant?

CP10B. What have you used or done?

CP11. Check CP3: Circle method code. If more than one method code circled in CP3, circle code for highest method in list?
CP12. You started using (current method) continuously in (date from, CP7/CP7A). Where did you get it at that time?
CP12A. Where did you learn how to use the rhythm/lactational amenorrhea method?
Probe to identify the type of source. If unable to determine whether public or private, write the name of the place.
________ (Name of place)

CP13. Circle method code.
CP14. At that time, were you told about side effects or problems you might have with the method?

CP14A. When you got sterilized, were you told about side effects or problems you might have with the method?

CP15. Were you ever told by a health or family planning worker about side effects or problems you might have with the method?

CP16. Were you told what to do if you experienced side effects or problems?

CP16. Were you told what to do if you experienced side effects or problems?

CP17. Check CP14:
CP18. At that time, were you told about other methods of family planning that you could use?
CP18A. When you obtained (current method from CP11) from (source of method from CP12 or CP12A), were you told about other methods of family planning that you could use?

CP19. Were you ever told by a health or family planning worker about other methods of family planning that you could use?

CP20. Check CP11:
Circle method code.
CP21. Where did you obtain (current method) the last time?
Probe to identify the type of source. If unable to determine whether public or private, write the name of the place.
________ (Name of place)

CP22. Do you know of any (other) place where you can obtain a method of family planning?

CP23. Where is that? Any other place?
Probe to identify the type of source. If unable to determine whether public or private, write the name of the place.
________ (Name of place)

CP24. In the last 12 months, were you visited by a health worker who talked to you about family planning?

CP25. In the last 12 months, have you visited a health facility for care of yourself (or your children)?

CP26. Did any staff member at the health facility speak to you about family planning methods?

CP27. In the last three months, have you heard/seen/read a family planning message?

CP28. Could you recall what the message was?
Probe: Any other message?
CP29. Where did you hear/see/read the message?
Probe: Anywhere else? Record all responses mentioned.
CP30. Did the message motivate you to learn anything new or do anything different?

CP31. What did the message motivate you to learn or do differently?

CP32. What is your general attitude towards hormonal contraceptives, positive, somewhat positive, undecided, somewhat negative, or very negative?
Hormonal contraceptives includes: pill, injectable, implants, patch, ring

CP33. In your view the hormonal contraceptives are absolutely safe, safe, not really safe, not at all safe or are you undecided?

CP35. Now I would like to ask you about the risk of pregnancy. From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant if she has sexual relations?

CP36. In this time just before her period begins, during her period, right after her period ended, or halfway between two periods?

[p. 17]
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?
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?

MA8. 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 started living with your first husband/partner?

Unmet need: UN

UN1. 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?

UN4A. After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?

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?

[p. 18]
UN9. Check CP2. Currently using a method of contraception?

UN9C. You have said that you do not want any (more) children. Can you tell me why you are not using a method to prevent pregnancy? Any other reason?
Record all reasons mentioned.
UN9D. You have said that you do not want (a/another) child soon. Can you tell me why you are not using a method to prevent pregnancy? Any other reason?
Record all reasons mentioned.

UN9E. Check CP2. Currently using a method?
UN9F. Do you think you will use a contraceptive method to delay or avoid pregnancy at any time in the future?

UN9G. Which contraceptive method would you prefer to use?

UN9H. What is the main reason that you think you will not use a contraceptive method at any time in the future?

UN9I. Would you ever use a contraceptive method if you were married?

UN9J. Check CP1. Currently pregnant?
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
UN15. Check CM4 and CM6
UN16. If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?
Probe for a numeric response.
UN16A. If you could choose exactly the number of children to have in your whole life, how many would that be?
Probe for a numeric response.
UN17. How many of these children would you like to be boys, how many would you like to be girls and for how many would it not matter if it's a boy or a girl?
If one answer category is recorded fill '00' for the two remaining ones. If two answer categories are recorded fill '00' for the remaining one.
UN20. Check MA1:
UN21. Check CP2: Currently using a method?
UN22. Would you say that using contraception is mainly your decisions, mainly your (husband's/partner's) decision, or did you both decide together?

UN23. Check CP3.
UN24. Does your (husband/partner) want the same number of children that you want, or does he want more or fewer than you want?

UN25. Are there any circumstances under which a woman should not get pregnant?

UN26. Under which circumstance?
Probe: any other circumstances?
UN27. If a woman got pregnant under the circumstances that you mentioned, what do you think that she should do about her pregnancy?

UN28. If a woman got pregnant under the circumstances that you mentioned and finally gave birth, what do you think she should do about the child?

[p. 19]
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?

[p. 23]
[p. 24]
Sexual behavior: SB

Check for the presence of others. Before continuing, ensure privacy.

SB1. Now I would like to ask you some questions about sexual activity in order to gain a better understanding of some important life issues.
The information you supply will remain strictly confidential.
How old were you when you had sexual intercourse for the very first time?

SB2. The first time you had sexual intercourse, was a condom used?

SB3. When was the last time you had sexual intercourse?
Record answers in days, weeks or months if less than 12 months (one year). If more than 12 months (one year), answer must be recorded in years.
SB4. The last time you had sexual intercourse, was a condom used?

SB5. What was your relationship to this person with whom you last had sexual intercourse?
Probe to ensure that the response refers to the relationship at the time of sexual intercourse.
If 'boyfriend', then ask: Were you living together as if married? If 'yes', circle '2'. If 'no', circle'3'.
SB6. Check MA1:
SB7. How old is this person?
If response is DK, probe: About how old is this person?
SB8. Have you had sexual intercourse with any other person in the last 12 months?

SB9. The last time you had sexual intercourse with this other person, was a condom used?

[p. 25]
SB10. What was your relationship to this person?
Probe to ensure that the response refers to the relationship at the time of sexual intercourse
If 'boyfriend' then ask: Were you living together as if married? If 'yes', circle '2'. If 'no', circle '3'.
SB11. Check MA1 and MA7:
SB12. How old is this person?
If response is DK, probe: About how old is this person?
SB13. Other than these two persons, have you had sexual intercourse with any other person in the last 12 months?

SB14. In total, with how many different people have you had sexual intercourse in the last 12 months?

SB15. In total, with how many different people have you had sexual intercourse in your lifetime?
If a non-numeric answer is given, probe to get an estimate. If number of partners is 95 or more, write '95'.
[p. 26]
HIV/AIDS: HA

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

[p. 27]
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 counseling after getting the result. After you were tested, did you receive counselling?

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

[p. 28]
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?

[p. 29]
Tobacco and alcohol use: TA

TA1. Have you ever tried cigarette smoking, even one or two puffs?

TA2. How old were you when you smoked a whole cigarette for the first time?

TA3. Do you currently smoke cigarettes?

TA4. In the last 24 hours, how many cigarettes did you smoke?

TA5. During the last one month, on how many days did you smoke cigarettes?
If less than 10 days, record the number of days. If 10 days or more but less than a month, circle "10". If "everyday" or "almost every day", circle "30"
TA6. Have you ever tried any smoked tobacco products other than cigarettes, such as cigars, water pipe, cigarillos or pipe?

TA7. During the last one month, did you use any smoked tobacco products?

TA8. What type of smoked tobacco product did you use or smoke during the last one month?
Circle all mentioned.
TA9. During the last one month, on how many days did you use smoked tobacco products?
If less than 10 days, record the number of days. If 10 days or more but less than a month, circle "10". If "everyday" or "almost every day", circle "30"
TA10. Have you ever tried any form of smokeless tobacco products, such as chewing tobacco, snuff, or dip?

TA11. During the last one month, did you use any smokeless tobacco products?

[p. 32]
TA12. What type of smokeless tobacco product did you use during the last one month?
Circle all mentioned.
TA13. During the last one month, on how many days did you use smokeless tobacco products?
If less than 10 days, record the number of days. If 10 days or more but less than a month, circle "10". If "everyday" or "almost every day", circle "30"
TA14. Now I would like to ask you some questions about drinking alcohol.
Have you ever drunk alcohol?

TA15. We count one drink of alcohol as one can or bottle of beer, one glass of wine, or one shot of cognac, vodka, whiskey or rum.
How old were you when you had your first drink of alcohol, other than a few sips?

TA16. During the last one month, on how many days did you have at least one drink of alcohol?
If respondent did not drink, circle "00". If less than 10 days, record the number of days. If 10 days or more but less than a month, circle "10". If "everyday" or "almost every day", circle "30"
TA17. In the last one month, on the days that you drank alcohol, how many drinks did you usually have?

[p. 33]
Life satisfaction: LS

LS1. Check WB2: Age of respondent is between 15 and 24?
LS2. I would like to ask you some simple questions on happiness and satisfaction.
First, taking all things together, would you say you are very happy, somewhat happy, neither happy nor unhappy, somewhat unhappy or very unhappy?
You can also look at these pictures to help you with your response.
Show side 1 of response card and explain what each symbol represents. Circle the response code pointed by the respondent. [Image omitted.]

LS3. Now I will ask you questions about your level of satisfaction in different areas.
In each case, we have five possible responses: please tell me, for each question, whether you are very satisfied, somewhat satisfied, neither satisfied nor unsatisfied, somewhat unsatisfied or very unsatisfied.
Again, you can look at these pictures to help you with your response.
Show side 2 of response card and explain what each symbol represents. Circle the response code shown by the respondent, for questions LS3 to LS13. [Image omitted.]
How satisfied are you with your family life?

LS4. How satisfied are you with your friendships?

LS5. During the current school year, did you attend school at any time?

[p. 34]
LS6. How satisfied (are/were) you with your school?

LS7. How satisfied are you with your current job?
If the respondent says that he/she does not have a job, circle "0" and continue with the next question. Do not probe to find out how she feels about not having a job, unless she tells you herself.
LS8. How satisfied are you with your health?

LS9. How satisfied are you with where you live?
If necessary, explain that the question refers to the living environment, including the neighbourhood and the dwelling.
LS10. How satisfied are you with how people around you generally treat you?

LS11. How satisfied are you with the way you look?

LS12. How satisfied are you with your life, overall?

LS13. How satisfied are you with your current income?
If the respondent responds that he/she does not have any income, circle "0" and continue with the next question. Do not probe to find out how she feels about not having any income, unless she tells you herself.
LS14. Compared to this time last year, would you say that your life has improved, stayed more or less the same, or worsened, overall?

[p. 35]
LS15. And in one year from now, do you expect that your life will be better, will be more or less the same, or will be worse, overall?

[p. 36]
WM11. Record the time.
WM12. Check Household Listing Form, column HL9.
Is the respondent the mother or caretaker of any child age 0-4 living in this household?
[p. 37]
Response card:

Side 1

Side 2