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Mics questionnaire for individual women


Zimbabwe 2019

Woman's information panel: WM

WM1. Cluster number: _ _ _

WM2. Household number: _ _

WM3. Woman's name and line number:
Name ____ _ _

WM4. Supervisor's name and number:
Name ____ _ _ _

WM5. Interviewer's name and number:
Name ____ _ _ _

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

Check woman's age in HL6 in list of household members, household questionnaire: If age 15-17, verify in HH33 that adult consent for interview is obtained or not necessary (HL20=90). If consent is needed and not obtained, the interview must not commence and '06' should be recorded in WM17.

WM7. Record the time:
Hours : minutes _ _ : _ _

WM8. Check completed questionnaires in this household: Have you or another member of your team interviewed this respondent for another questionnaire?

[] 1 Yes, interviewed already (Go to WM9B)
[] 2 No, first interview (Go to WM9A)

WM9A. Hello, my name is (your name). We are from Zimstat. We are conducting a survey about the situation of children, families and households. I would like to talk to you about your health and other topics. This interview usually takes about 45 minutes. We are also interviewing mothers about their children. All the information we obtain will remain strictly confidential and anonymous. If you wish not to answer a question or wish to stop the interview, please let me know. May I start now?

WM9B. Now I would like to talk to you about your health and other topics in more detail. This interview will take about 45 minutes. Again, all the information we obtain will remain strictly confidential and anonymous. If you wish not to answer a question or wish to stop the interview, please let me know. May I start now?

[] 1 Yes (Go to woman's background module)
[] 2 No/not asked (Go to WM17)

WM17. Result of woman's interview.
Discuss any result not completed with Supervisor.

[] 01 Completed
[] 02 Not at home
[] 03 Refused
[] 04 Partly completed
[] 05 Incapacitated (specify) ____
[] 06 No adult consent for respondent age 15-17
[] 96 Other (specify) ____

Woman's background: WB

WB1. Check the respondent's line number (WM3) in woman's information panel and the respondent to the household questionnaire (HH47):
[] 1 WM3=HH47
[] 2 WM3 does not equal HH47 (Go to WB3)

WB2. Check ED5 in education module in the household questionnaire for this respondent: Highest level of school attended:
[] 1 ED5=2, 3, 4, 5, 6, 7, 8, 9 or 10 (Go to WB15)
[] 2 ED5=0, 1, 98 or blank (Go to WB14)

WB3. In what month and year were you born?

Date of birth
_ _ Month
[] 98 DK month
_ _ _ _ Year
[] 9998 DK year

WB4. How old are you?
Probe: How old were you at your last birthday? If responses to WB3 and WB4 are inconsistent, probe further and correct. Age must be recorded.
Age (in completed years) _ _

WB5. Have you ever attended school or any early childhood education programme?

[] 1 Yes
[] 2 No (Go to WB14)

WB6. What is the highest level and grade, form or year of school you have attended?

[] 000 Early childhood education (Go to WB14)
[] 1 Primary _ _
[] 2 Vocational - nat found cert_ _
[] 3 Lower secondary _ _
[] 4 Upper secondary _ _
[] 5 Vocational - certificate _ _
[] 6 Vocational - apprenticeship/teacher's college _ _
[] 7 Tertiary - short cycle _ _
[] 8 Tertiary - higher nat diploma/bachelor/bach's honour _ _
[] 9 Tertiary - master/doctorate medical courses _ _
[] 10 Doctorate _ _



WB7. Did you complete that (grade/form/year)?

[] 1 Yes
[] 2 No

WB8. Check WB4: Age of respondent:
[] 1 Age 15-24
[] 2 Age 25-49 (Go to WB13)

WB9. At any time during the 2018/2019 school year did you attend school?

[] 1 Yes
[] 2 No (Go to WB11)

WB10. During this 2018/2019 school year, which level and grade or year are you attending?

[] 000 Early childhood education
[] 1 Primary _ _
[] 2 Vocational - nat found cert_ _
[] 3 Lower secondary _ _
[] 4 Upper secondary _ _
[] 5 Vocational - certificate _ _
[] 6 Vocational - apprenticeship/teacher's college _ _
[] 7 Tertiary - short cycle _ _
[] 8 Tertiary - higher nat diploma/bachelor/bach's honour _ _
[] 9 Tertiary - master/doctorate medical courses _ _
[] 10 Doctorate _ _

WB11. At any time during the 2017/2018 school year did you attend school?

[] 1 Yes
[] 2 No (Go to WB13)

WB12. During that 2017/2018 school year, which level and grade/form or year did you attend?

[] 000 Early childhood education
[] 1 Primary _ _
[] 2 Vocational - nat found cert_ _
[] 3 Lower secondary _ _
[] 4 Upper secondary _ _
[] 5 Vocational - certificate _ _
[] 6 Vocational - apprenticeship/teacher's college _ _
[] 7 Tertiary - short cycle _ _
[] 8 Tertiary - higher nat diploma/bachelor/bach's honour _ _
[] 9 Tertiary - master/doctorate medical courses _ _
[] 10 Doctorate _ _

WB13. Check WB6: Highest level of school attended:
[] 1 WB6=2, 3, 4. 5, 6, 7, 8, 9 or 10 (Go to WB15)
[] 2 WB6=000 or 1

WB14. 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
[] 6 No sentence in required language/braille (specify) ____

WB15. How long have you been continuously living in (name of current city, town or village of residence)?
If less than one year, record '00' years.
Years _ _
[] 95 Always/since birth (Go to WB18)

WB16. Just before you moved here, did you live in a city, in a town, or in a rural area?
Probe to identify the type of place. If unable to determine whether the place is a city, a town or a rural area, write the name of the place and then temporarily record '9' until you learn the appropriate category for the response.
(Name of place) ____

[] 1 City
[] 2 Town
[] 3 Rural area

WB17. Before you moved here, in which province did you live in?

[] 01 Manicaland
[] 02 Mashonaland central
[] 03 Mashonaland east
[] 04 Mashonaland west
[] 05 Matabeleland north
[] 06 Matabeleland south
[] 07 Midlands
[] 08 Masvingo
[] 09 Harare
[] 10 Bulawayo
[] 96 Outside of Zimbabwe (specify) ____

WB18. Are you covered by any health insurance?

[] 1 Yes
[] 2 No (Go to end of module)

WB19. What type of health insurance are you covered by?
Record all mentioned.
[] A Mutual health organization/community-based health insurance
[] B Health insurance through employer
[] C Social security
[] D Other privately purchased commercial health insurance
[] X Other (specify) ____

Mass media and ICT: MT

MT0. Check WB14. Was the respondent able to read the sentence given.
[] 1 WB14=2, 3, 6 or blank
[] 2 WB14= 1 (Go to MT2)

MT1. Do you read a newspaper or magazine at least once a week, less than once a week or not at all?
If 'At least once a week', probe: Would you say this happens almost every day? If 'Yes' record 3, if 'No' record 2.
[] 0 Not at all
[] 1 Less than once a week
[] 2 At least once a week
[] 3 Almost every day

MT2. Do you listen to the radio at least once a week, less than once a week or not at all?
If 'At least once a week', probe: Would you say this happens almost every day? If 'Yes' record 3, if 'No' record 2
[] 0 Not at all
[] 1 Less than once a week
[] 2 At least once a week
[] 3 Almost every day

MT3. Do you watch television at least once a week, less than once a week or not at all?
If 'At least once a week', probe: Would you say this happens almost every day? If 'Yes' record 3, if 'No' record 2
[] 0 Not at all
[] 1 Less than once a week
[] 2 At least once a week
[] 3 Almost every day

MT4. Have you ever used a computer or a tablet from any location?

[] 1 Yes
[] 2 No (Go to MT9)

MT5. During the last 3 months, did you use a computer or a tablet at least once a week, less than once a week or not at all?
If 'At least once a week', probe: Would you say this happened almost every day? If 'Yes' record 3, if 'No' record 2
[] 0 Not at all (Go to MT9)
[] 1 Less than once a week
[] 2 At least once a week
[] 3 Almost every day

MT6. During the last 3 months, did you:

[A] Copy or move a file or folder?
[] 1 Yes
[] 2 No

[B] Use a copy and paste tool to duplicate or move information within a document?
[] 1 Yes
[] 2 No

[C] Send e-mail with attached file, such as a document, picture or video?
[] 1 Yes
[] 2 No

[D] Use a basic arithmetic formula in a spreadsheet?
[] 1 Yes
[] 2 No

[E] Connect and install a new device, such as a modem, camera or printer?
[] 1 Yes
[] 2 No

[F] Find, download, install and configure software?
[] 1 Yes
[] 2 No

[G] Create an electronic presentation with presentation software, including text, images, sound, video or charts?
[] 1 Yes
[] 2 No

[H] Transfer a file between a computer and other device?
[] 1 Yes
[] 2 No

[I] Write a computer program in anyprogramming language?
[] 1 Yes
[] 2 No

MT7. Check MT6[C]: Is 'Yes' recorded?
[] 1 Yes, MT6[C]=1 (Go to MT10)
[] 2 No, MT6[C]=2

MT8. Check MT6[F]: Is 'Yes' recorded?
[] 1 Yes [MT6[F]=1 (Go to MT10)
[] 2 No, MT6[F]=2

MT9. Have you ever used the internet from any location and any device?

[] 1 Yes
[] 2 No (Go to MT11)

MT10. During the last 3 months, did you use the internet at least once a week, less than once a week or not at all?
If 'At least once a week', probe: Would you say this happens almost every day? If 'Yes' record 3, if 'No' record 2.
[] 0 Not at all
[] 1 Less than once a week
[] 2 At least once a week
[] 3 Almost every day

MT11. Do you own a mobile phone?

[] 1 Yes
[] 2 No

MT12. During the last 3 months, did you use a mobile telephone at least once a week, less than once a week or not at all?
Probe if necessary: I mean have you communicated with someone using a mobile phone. If 'At least once a week', probe: Would you say this happens almost every day? If 'Yes' record 3, if 'No' record 2.
[] 0 Not at all
[] 1 Less than once a week
[] 2 At least once a week
[] 3 Almost every day

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?
This module and the birth history should only include children born alive. Any stillbirths should not be included in response to any question.
[] 1 Yes
[] 2 No (Go to CM8)

CM2. 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 CM5)

CM3. How many sons live with you?
If none, record '00'.
_ _ Sons at home

CM4. How many daughters live with you?
If none, record '00'.
_ _ Daughters at home

CM5. 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)

CM6. How many sons are alive but do not live with you?
If none, record '00'.
_ _ Sons elsewhere

CM7. How many daughters are alive but do not live with you?
If none, record '00'.
_ _ 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 any baby who cried, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?

[] 1 Yes
[] 2 No (Go to CM11)

CM9. How many boys have died?
If none, record '00'.
_ _ Boys dead

CM10. How many girls have died?
If none, record '00'.
_ _ Girls dead

CM11. Sum answers to CM3, CM4, CM6, CM7, CM9 and CM10.
_ _ Sum

CM12. Just to make sure that I have this right, you have had in total (total number in CM11) births during your life. Is this correct?

[] 1 Yes (Go to CM14)
[] 2 No

CM13. Check responses to CM1-CM10 and make corrections as necessary until response in CM12 is 'Yes'.

CM14. Check CM11: How many live births?
[] 0 No live births, CM11=00 (Go to end of module)
[] 1 One or more live birth, CM11=01 or more

Fertility/birth history: BH

BH0. Now I would like to record the names of all of your births, whether still alive or not, starting with the first one you had.
Record names of all of the births in BH1. Record twins and triplets on separate lines.

BH0. BH line number _ _

BH1. What name was given to your (first/next) baby? ____

BH2. Were any of these births twins?

[] 1 Single
[] 2 Multiple

BH3. Is (name of birth) a boy or a girl?

[] 1 Boy
[] 2 Girl

BH4. In what month and year was (name of birth) born?
Probe: What is (his/her) birthday?
Day/month/year _ _ / _ _ / _ _ _ _

BH5. Is (name of birth) still alive?

[] 1 Y
[] 2 N (Go to BH9)

BH6. How old was (name of birth) at (his/her) last birthday?
Record age in completed years.
Age _ _

BH7. Is (name of birth) living with you?

[] 1 Yes
[] 2 No

BH8. Record household line number of child (from HL1)
Record '00' if child is not listed.
Line No _ _ (Go to next birth/Go to BH10)

BH9. How old was (name of birth) when (he/she) died?
If '1 year', probe: How many months old was (name of birth)? Record days if less than 1 month; record months if less than 2 years; or years
Unit
[] 1 Days
[] 2 Months
[] 3 Years
Number _ _

BH10. Were there any other live births between (name of previous birth) and (name of birth), including any children who died after birth?

[] 1 Yes (Add birth)
[] 2 No (Next birth)

BH11. Have you had any live births since the birth of (name of last birth listed)?

[] 1 Yes (Record birth(s) in birth history)
[] 2 No

CM15. Compare number in CM11 with number of births listed in the birth history above and check:
[] 1 Numbers are the same (Go to CM17)
[] 2 Numbers are different

CM16. Probe and reconcile responses in the birth history until response in CM12 is 'Yes'.

CM17. Check BH4: Last birth occurred within the last 2 years, that is, since (month of interview) in (year of interview minus 2)?
If the month of interview and the month of birth are the same, and the year of birth is (year of interview minus 2), consider this as a birth within the last 2 years.
[] 0 No live births in the last 2 years (Go to end of module)
[] 1 One or more live births in the last 2 years

CM18. Copy name of the last child listed in BH1.
If the child has died, take special care when referring to this child by name in the following modules.
Name of last born child ____

Maternal and newborn health: MN

MN1. Check CM17: Was there a live birth in the last 2 years?
Copy name of last birth listed in the birth history (CM18) to here and use where indicated:

Name ____

[] 1 Yes, CM17=1
[] 2 No, CM17=0 or blank (Go to end of module)

MN2. Did you see anyone for antenatal care during your pregnancy with (name)?

[] 1 Yes
[] 2 No (Go to MN7)

MN3. Whom did you see?
Probe: Anyone else? Probe for the type of person seen and record all answers given.
Health professional
[] A Doctor
[] B Nurse/midwife
Other person
[] F Traditional birth attendant
[] G Community health worker
[] H Religious birth attendant
[] X Other (specify) ____

MN4. How many weeks or months pregnant were you when you first received antenatal care for this pregnancy?
Record the answer as stated by respondent. If "9 months" or later, record 9.
[] 1 Weeks _ _
[] 2 Months 0 _
[] 998 DK

MN5. 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.
_ _ Number of times
[] 98 DK

MN6. 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

[B] Did you give a urine sample?
[] 1 Yes
[] 2 No

[C] Did you give a blood sample?
[] 1 Yes
[] 2 No

MN7. Do you have a card or other document with your own immunisations listed?
If yes, ask: May I see it please? If a card is presented, use it to assist with answers to the following questions.
[] 1 Yes (card or other document seen)
[] 2 Yes (card or other document not seen)
[] 3 No
[] 8 DK

MN8. 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 MN11)
[] 8 DK (Go to MN11)

MN9. How many times did you receive this tetanus injection during your pregnancy with (name)?

_ Number of times
[] 8 DK (Go to MN11)

MN10. Check MN9: How many tetanus injections during last pregnancy were reported?
[] 1 Only 1 injection
[] 2 2 or more injections (Go to MN16)

MN11. At any time before your pregnancy with (name), did you receive any tetanus injection either to protect yourself or another baby?
Include DTP (Tetanus) vaccinations received as a child if mentioned.
[] 1 Yes
[] 2 No (Go to MN16)
[] 8 DK (Go to MN16)

MN12. Before your pregnancy with (name), how many times did you receive a tetanus injection?
If 7 or more times, record '7'. Include DTP (Tetanus) vaccinations received as a child if mentioned.
_ Number of times
[] 8 DK

MN13. Check MN12: How many tetanus injections before last pregnancy were reported?
[] 1 Only 1 injection (Go to MN14A)
[] 2 2 or more injections or DK (Go to MN14B)

MN14A. How many years ago did you receive that tetanus injection?
MN14B. How many years ago did you receive the last of those tetanus injections?
The reference is to the last injection received prior to this pregnancy, as recorded in MN12. If less than 1 year, record '00'.
_ _ Years ago
[] 98 DK

MN16. During the pregnancy with (name), did you take SP/Fansidar to keep you from getting malaria?

[] 1 Yes
[] 2 No (Go to MN19)
[] 8 DK (Go to MN19)

MN17. How many times did you take SP/Fansidar during your pregnancy with (name)?

_ _ Number of times
[] 98 DK

MN18. Did you get the SP/Fansidar during an antenatal care visit, during another visit to a health facility or at another source?

[] A Antenatal visit
[] B Another facility visit
[] C Community health worker
[] X Other source (specify) ____

MN19. Who assisted with the delivery of (name)?
Probe: Anyone else? Probe for the type of person assisting and record all answers given.
Health professional
[] A Doctor
[] B Nurse/midwife
Other person
[] F Traditional birth attendant
[] G Community health worker
[] H Relative/friend
[] I Religious birth attendant
[] X Other (specify) ____
[] Y No one

MN20. Where did you give birth to (name)?
Probe to identify the type of place. If unable to determine whether public or private, write the name of the place and then temporarily record '76' until you learn the appropriate category for the response.
(Name of place) ____

Home
[] 11 Respondent's home (Go to MN23)
[] 12 Other home (Go to MN23)
Public medical sector
[] 21 Government hospital
[] 22 Government clinic/health centre
[] 24 Council facility
[] 26 Other public (specify) ____
Private medical sector
[] 31 Private hospital
[] 32 Private clinic
[] 33 Private maternity home
[] 36 Other private medical (specify) ____
Mission facility
[] 41 Mission hospital
[] 42 Mission clinic
[] 46 Other mission (specify) ____
[] 76 DK public, private or mission
[] 96 Other (specify) ____ (Go to MN23)

MN21. Was (name) delivered by caesarean section? That is, did they cut your belly open to take the baby out?

[] 1 Yes
[] 2 No (Go to MN23)

MN22. When was the decision made to have the caesarean section?
Probe if necessary: Was it before or after your labour pains started?
[] 1 Before labour pains
[] 2 After labour pains

MN23. Immediately after the birth, was (name) put directly on the bare skin of your chest?
If necessary, show the picture of skin-to-skin position. [Image omitted]
[] 1 Yes
[] 2 No (Go to MN25)
[] 8 DK/don't remember (Go to MN25)

MN24. Before being placed on the bare skin of your chest, was the baby wrapped up?

[] 1 Yes
[] 2 No
[] 8 DK/don't remember

MN25. Was (name) dried or wiped soon after birth?

[] 1 Yes
[] 2 No
[] 8 DK/don't remember

MN26. How long after the birth was (name) bathed for the first time?
If "immediately" or less than 1 hour, record '000'. If less than 24 hours, record hours. If "1 day" or "next day", probe: About how many hours after the delivery? If "24 hours", probe to ensure best estimate of less than 24 hours or 1 day. If 24 hours or more, record days.
[] 000 Immediately
[] 1 Hours _ _
[] 2 Days _ _
[] 997 Never bathed
[] 998 DK/don't remember

MN32. 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

MN33. Was (name) weighed at birth?

[] 1 Yes
[] 2 No (Go to MN35)
[] 8 DK (Go to MN35)

MN34. How much did (name) weigh?
If a card is available, record weight from card.
[] 1 From card (KG) _ . _ _ _
[] 2 From recall (KG) _ . _ _ _
[] 99998 DK

MN35. Has your menstrual period returned since the birth of (name)?

[] 1 Yes
[] 2 No

MN36. Did you ever breastfeed (name)?

[] 1 Yes
[] 2 No (Go to MN39B)

MN37. 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.
[] 000 Immediately
[] 1 Hours _ _
[] 2 Days _ _
[] 998 DK/don't remember

MN38. In the first three days after delivery, was (name) given anything to drink other than breast milk?

[] 1 Yes (Go to MN39A)
[] 2 No (Go to end of module)

MN39A. What was (name) given to drink?
Probe: Anything else? 'Not given anything to drink' is not a valid response and response category Y cannot be recorded.
MN39B. In the first three days after delivery, what was (name) given to drink?
Probe: Anything else? 'Not given anything to drink' (category Y) can only be recorded if no other response category is recorded.
[] A Milk (other than breast milk)
[] B Plain water
[] C Sugar or glucose water
[] D Gripe water
[] E Sugar-salt-water solution
[] F Fruit juice
[] G Infant formula
[] H Tea/infusions/traditional herbal preparations
[] I Honey
[] J Prescribed medicine
[] X Other (specify) ____
[] Y Not given anything to drink

Post-natal health checks: PN

PN1. Check CM17: Was there a live birth in the last 2 years?
Copy name of last birth listed in the birth history (CM18) to here and use where indicated:

Name ____

[] 1 Yes, CM17=1
[] 2 No, CM17=0 or blank (Go to end of module)

PN2. Check MN20: Was the child delivered in a health facility?
[] 1 Yes, MN20=21 -76
[] 2 No, MN20=11-12 or 96 (Go to PN7)

PN3. 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 MN20). 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.
[] 1 Hours _ _
[] 2 Days _ _
[] 3 Weeks _ _
[] 998 DK/don't remember

PN4. 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 MN20), did anyone check on (name)'s health?

[] 1 Yes
[] 2 No

PN5. 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 MN20)?

[] 1 Yes
[] 2 No

PN6. Now I would like to talk to you about what happened after you left (name or type of facility in MN20).
Did anyone check on (name)'s health after you left (name or type of facility in MN20)?

[] 1 Yes (Go to PN12)
[] 2 No (Go to PN17)

PN7. Check MN19: Did a health professional, traditional birth attendant, religious birth attendant or community health worker assist with the delivery?
[] 1 Yes, at least one of the categories A to G recorded
[] 2 No, none of the categories A to G recorded (Go to PN11)

PN8. You have already said that (person or persons in MN19) 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 MN19) left you, did (person or persons in MN19) check on (name)'s health?

[] 1 Yes
[] 2 No

PN9. And did (person or persons in MN19) check on your health before leaving, for example asking questions about your health or examining you?

[] 1 Yes
[] 2 No

PN10. After the (person or persons in MN19) left you, did anyone check on the health of (name)?

[] 1 Yes (Go to PN12)
[] 2 No (Go to PN19)

PN11. 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?

[] 1 Yes
[] 2 No (Go to PN20)

PN12. Did such a check happen only once, or more than once?

[] 1 Once (Go to PN13A)
[] 2 More than once (Go to PN13B)

PN13A. How long after delivery did that check happen?
PN13B. 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.
[] 1 Hours _ _
[] 2 Days _ _
[] 3 Weeks _ _
[] 998 DK/don't remember

PN14. Who checked on (name)'s health at that time?

Health professional
[] A Doctor
[] B Nurse/midwife
Other person
[] F Traditional birth attendant
[] G Community health worker
[] H Relative/friend
[] I Religious birth attendant
[] X Other (specify) ____

PN15. Where did this check take place?
Probe to identify the type of place. If unable to determine whether public or private, write the name of the place and then temporarily record '76' until you learn the appropriate category for the response.
(Name of place) ____

Home
[] 11 Respondent's home
[] 12 Other home
Public medical sector
[] 21 Government hospital
[] 22 Government clinic/health centre
[] 24 Council facility
[] 26 Other public (specify) ____
Private medical sector
[] 31 Private hospital
[] 32 Private clinic
[] 33 Private maternity home
[] 36 Other private medical (specify) ____
Mission facility
[] 41 Mission hospital
[] 42 Mission clinic
[] 46 Other mission (specify) ____
[] 76 DK public, private or mission
[] 96 Other (specify) ____

PN16. Check MN20: Was the child delivered in a health facility?
[] 1 Yes, MN20=21- 76
[] 2 No, MN20=11-12 or 96 (Go to PN18)

PN17. After you left (name or type of facility in MN20), did anyone check on your health?

[] 1 Yes (Go to PN21)
[] 2 No (Go to PN25)

PN18. Check MN19: Did a health professional, traditional birth attendant, religious health worker or community health worker assist with the delivery?
[] 1 Yes, at least one of the categories A to G recorded
[] 2 No, none of the categories A to G recorded (Go to PN20)

PN19. After the delivery was over and (person or persons in MN19) left, did anyone check on your health?

[] 1 Yes (Go to PN21)
[] 2 No (Go to PN25)

PN20. After the birth of (name), did anyone check on your health, for example asking questions about your health or examining you?

[] 1 Yes
[] 2 No (Go to PN25)

PN21. Did such a check happen only once, or more than once?

[] 1 Once (Go to PN22A)
[] 2 More than once (Go to PN22B)

PN22A. How long after delivery did that check happen?
PN22B. 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.
[] 1 Hours _ _
[] 2 Days _ _
[] 3 Weeks _ _
[] 998 DK/don't remember

PN23. Who checked on your health at that time?

Health professional
[] A Doctor
[] B Nurse/midwife
Other person
[] F Traditional birth attendant
[] G Community health worker
[] H Relative/friend
[] I Religious birth attendant
[] X Other (specify) ____

PN24. Where did this check take place?
Probe to identify the type of place.
If unable to determine whether public or private, write the name of the place and then temporarily record '76' until you learn the appropriate category for the response.

(Name of place)____

Home
[] 11 Respondent's home
[] 12 Other home
Public medical sector
[] 21 Government hospital
[] 22 Government clinic/health centre
[] 24 Council facility
[] 26 Other public (specify) ____
Private medical sector
[] 31 Private hospital
[] 32 Private clinic
[] 33 Private maternity home
[] 36 Other private medical (specify) ____
Mission facility
[] 41 Mission hospital
[] 42 Mission clinic
[] 46 Other mission (specify) ____
[] 76 DK public, private or mission
[] 96 Other (specify) ____

PN25. During the first two days after birth, did any health care provider do any of the following either at home or at a facility:

[A] Examine (name)'s cord?
[] 1 Yes
[] 2 No
[] 8 DK

[B] Take the temperature of (name)?
[] 1 Yes
[] 2 No
[] 8 DK

[C] Counsel you on breastfeeding?
[] 1 Yes
[] 2 No
[] 8 DK

PN26. Check MN36: Was child ever breastfed?
[] 1 Yes, MN36=1
[] 2 No, MN36=2 (Go to PN28)

PN27. Observe (name)'s breastfeeding?

[] 1 Yes
[] 2 No
[] 8 DK

PN28. Check MN33: Was child weighed at birth?
[] 1 Yes, MN33=1 (Go to PN29A)
[] 2 No, MN33=2 (Go to PN29B)
[] 8 DK, MN33=8 (Go to PN29C)

PN29A. You mentioned that (name) was weighed at birth. After that, was (name) weighed again by a health care provider within two days?
PN29B. You mentioned that (name) was not weighed at birth. Was (name) weighed at all by a health care provider within two days after birth?
PN29C. You mentioned that you do not know if (name) was weighed at birth. Was (name) weighed at all by a health care provider within two days after birth?

[] 1 Yes
[] 2 No

PN30. During the first two days after (name)'s birth, did any health care provider give you information on the symptoms that require you to take your sick child to a health facility for care?

[] 1 Yes
[] 2 No

Unmet need: UN

Now I would like to ask you about menstrual hygiene
UN14. When did your last menstrual period start?
Record the answer using the same unit stated by the respondent. If '1 year', probe: How many months ago?
[] 1 Days ago _ _
[] 2 Weeks ago _ _
[] 3 Months ago _ _
[] 4 Years ago _ _
[] 993 In menopause/has had hysterectomy (Go to end of module)
[] 994 Before last birth (Go to end of module)
[] 995 Never menstruated (Go to end of module)

UN15. Check UN14: Was the last menstrual period within last year?
[] 1 Yes, within last year
[] 2 No, one year or more (Go to end of module)

UN16. Due to your last menstruation, were there any social, cultural or religious activities, school or work days that you did not attend?

[] 1 Yes
[] 2 No
[] 8 DK/not sure/no such activity

UN17. During your last menstrual period were you able to wash and change in privacy while at home?

[] 1 Yes
[] 2 No
[] 8 DK

UN18. Did you use any materials such as sanitary pads, tampons, cotton wool, menstrual cups or cloth?

[] 1 Yes
[] 2 No (Go to end of module)
[] 8 DK (Go to end of module)

UN19. Were the materials re-usable?

[] 1 Yes
[] 2 No
[] 8 DK

UN19A. What do you usually use during your menstrual period?

[] 01 Sanitary pads
[] 02 Tampons
[] 03 Cotton wool
[] 04 Cloth
[] 05 Menstrual cup
[] 06 Tissue paper
[] 07 Cow dung
[] 08 Paper
[] 09 Leaves/grass/cobs
[] 96 Other (specify) ____
[] 97 Nothing

Victimisation: VT

VT1. Check for the presence of others. Before continuing, ensure privacy. Now I would like to ask you some questions about crimes in which you personally were the victim.
Let me assure you again that your answers are completely confidential and will not be told to anyone. In the last three years, that is since (month of interview) (year of interview minus 3), has anyone taken or tried taking something from you, by using force or threatening to use force?
Include only incidents in which the respondent was personally the victim and exclude incidents experienced only by other members of the household. If necessary, help the respondent to establish the recall period and make sure that you allow adequate time for the recall. You may reassure: It can be difficult to remember this sort of incidents, so please take your time while you think about your answers.

[] 1 Yes
[] 2 No (Go to VT9B)
[] 8 DK (Go to VT9B)

VT2. Did this last happen during the last 12 months, that is, since (month of interview) (year of interview minus 1)?

[] 1 Yes, during last 12 months
[] 2 No, more than 12 months ago (Go to VT5B)
[] 8 DK/don't remember (Go to VT5B)

VT3. How many times did this happen in the last 12 months?
If 'DK/Don't remember', probe: Did it happen once, twice, or at least three times?
[] 1 One time
[] 2 Two times
[] 3 Three or more times
[] 8 DK/don't remember

VT4. Check VT3: One or more times?
[] 1 One time, VT3=1 (Go to VT5A)
[] 2 More than once or DK, VT3=2, 3 or 8 (Go to VT5B)

VT5A. When this happened, was anything stolen from you?
VT5B. The last time this happened, was anything stolen from you?

[] 1 Yes
[] 2 No
[] 8 DK/not sure

VT6. Did the person(s) have a weapon?

[] 1 Yes
[] 2 No (Go to VT8)
[] 8 DK/not sure (Go to VT8)

VT7. Was a knife, a gun or something else used as a weapon?
Record all that apply.
[] A Yes, a knife
[] B Yes, a gun
[] X Yes, something else

VT8. Did you or anyone else report the incident to the police?
If 'Yes', probe: Was the incident reported by you or someone else?
[] 1 Yes, respondent reported (Go to VT9A)
[] 2 Yes, someone else reported (Go to VT9A)
[] 3 No, not reported (Go to VT9A)
[] 8 DK/not sure (Go to VT9A)

VT9A. Apart from the incident(s) just covered, have you in the last three years, that is since (month of interview) (year of interview minus 3), been physically attacked?
VT9B. In the same period of the last three years, that is since (month of interview) (year of interview minus 3), have you been physically attacked?
If 'No', probe: An attack can happen at home or any place outside of the home, such as in other homes, in the street, at school, on public transport, public restaurants, or at your workplace.
Include only incidents in which the respondent was personally the victim and exclude incidents experienced only by other members of the household. Exclude incidents where the intention was to take something from the respondent, which should be recorded under VT1.
[] 1 Yes
[] 2 No (Go to VT20)
[] 8 DK (Go to VT20)

VT10. Did this last happen during the last 12 months, that is, since (month of interview) (year of interview minus 1)?

[] 1 Yes, during the last 12 months
[] 2 No, more than 12 months ago (Go to VT12B)
[] 8 DK/Don't remember (Go to VT12B)

VT11. How many times did this happen in the last 12 months?
If 'DK/Don't remember', probe: Did it happen once, twice, or at least three times?
[] 1 One time (Go to VT12A)
[] 2 Two times (Go to VT12B)
[] 3 Three or more times (Go to VT12B)
[] 8 DK/don't remember (Go to VT12B)

VT12A. Where did this happen?
VT12B. Where did this happen the last time?

[] 11 At home
[] 12 In another home
[] 21 In the street
[] 22 On public transport
[] 23 Public restaurant/cafe/bar
[] 26 Other public (specify) ____
[] 31 At school
[] 32 At workplace
[] 96 Other place (specify) ____

VT13. How many people were involved in committing the offence?
If 'DK/Don't remember', probe: Was it one, two, or at least three people?
[] 1 One person (Go to VT14A)
[] 2 Two people (Go to VT14B)
[] 3 Three or more people (Go to VT14B)
[] 8 DK/don't remember (Go to VT14B)

VT14A. At the time of the incident, did you recognize the person?
VT14B. At the time of the incident, did you recognize at least one of the persons?

[] 1 Yes
[] 2 No
[] 8 DK/don't remember

VT17. Did the person(s) have a weapon?

[] 1 Yes
[] 2 No (Go to VT19)
[] 8 DK (Go to VT19)

VT18. Was a knife, a gun or something else used as a weapon?
Record all that apply.
[] A Yes, a knife
[] B Yes, a gun
[] X Yes, something else

VT19. Did you or anyone else report the incident to the police?
If 'Yes', probe: Was the incident reported by you or someone else?
[] 1 Yes, respondent reported
[] 2 Yes, someone else reported
[] 3 No, not reported
[] 8 DK/not sure

VT20. How safe do you feel walking alone in your neighbourhood after dark?

[] 1 Very safe
[] 2 Safe
[] 3 Unsafe
[] 4 Very unsafe
[] 7 Never walk alone after dark

VT21. How safe do you feel when you are at home alone after dark?

[] 1 Very safe
[] 2 Safe
[] 3 Unsafe
[] 4 Very unsafe
[] 7 Never alone after dark

VT22. In the past 12 months, have you personally felt discriminated against or harassed on the basis of the following grounds?

[A] Ethnic or immigration origin?
[] 1 Yes
[] 2 No
[] 8 DK

[B] Sex?
[] 1 Yes
[] 2 No
[] 8 DK

[C] Sexual orientation?
[] 1 Yes
[] 2 No
[] 8 DK

[D] Age?
[] 1 Yes
[] 2 No
[] 8 DK

[E] Religion or belief?
[] 1 Yes
[] 2 No
[] 8 DK

[F] Disability?
[] 1 Yes
[] 2 No
[] 8 DK

[G] Marital status?
[] 1 Yes
[] 2 No
[] 8 DK

[H] Pregnancy?
[] 1 Yes
[] 2 No
[] 8 DK

[I] Political affiliation?
[] 1 Yes
[] 2 No
[] 8 DK

[J] Born out of wedlock?
[] 1 Yes
[] 2 No
[] 8 DK

[X] For any other reason?
[] 1 Yes
[] 2 No
[] 8 DK

Marriage/union: MA

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

[] 1 Yes, currently married
[] 2 Yes, living with a partner
[] 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

MA3. Besides yourself, does your (husband/partner) have any other wives or partners or does he live with other women as if married?

[] 1 Yes
[] 2 No (Go to MA7)
[] 8 DK (Go to MA7)

MA4. How many other wives or partners does he have?

_ _ Number (Go to MA7)
[] 98 DK (Go to MA7)

MA5. Have you ever been married or lived together with someone as if married?

[] 1 Yes, formerly married
[] 2 Yes, formerly lived with a partner
[] 3 No (Go to end of module)

MA6. What is your marital status now: are you widowed, divorced or separated?

[] 1 Widowed
[] 2 Divorced
[] 3 Separated

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

[] 1 Only once (Go to MA8A)
[] 2 More than once (Go to MA8B)

MA8A. In what month and year did you start living with your (husband/partner)?
MA8B. In what month and year did you start living with your first (husband/partner)?

Date of (first) union
_ _ Month
[] 98 DK Month
_ _ _ _ Year
[] 9998 DK Year

MA9. Check MA8A/B: Is 'DK year' recorded?
[] 1 Yes, MA8A/B=9998
[] 2 No, MA8A/B does not equal 9998 (Go to end of module)

MA10. Check MA7: In union only once?
[] 1 Yes, MA7=1 (Go to MA11A)
[] 2 No, MA7=2 (Go to MA11B)

MA11A. How old were you when you started living with your (husband/partner)?
MA11B. How old were you when you started living with your first (husband/partner)?

Age in years _ _

Adult functioning: AF

AF1. Check WB4: Age of respondent?
[] 1 Age 15-17 years (Go to end of module)
[] 2 Age 18-49 years

AF2. Do you use glasses or contact lenses?
Include the use of glasses for reading.
[] 1 Yes
[] 2 No

AF3. Do you use a hearing aid?

[] 1 Yes
[] 2 No

AF4. I will now ask you about difficulties you may have doing a number of different activities. For each activity there are four possible answers: Please tell me if you have: 1) no difficulty, 2) some difficulty, 3) a lot of difficulty or 4) that you cannot do the activity at all.
Repeat the categories during the individual questions whenever the respondent does not use an answer category:
Remember, the four possible answers are: 1) no difficulty, 2) some difficulty, 3) a lot of difficulty, or 4) that you cannot do the activity at all.

AF5. Check AF2: Respondent uses glasses or contact lenses?
[] 1 Yes, AF2=1 (Go to AF6A)
[] 2 No, AF2=2 (Go to AF6B)

AF6A. When using your glasses or contact lenses, do you have difficulty seeing?
AF6B. Do you have difficulty seeing?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot see at all

AF7. Check AF3: Respondent uses a hearing aid?
[] 1 Yes, AF3=1 (Go to AF8A)
[] 2 No, AF3=2 (Go to AF8B)

AF8A. When using your hearing aid(s), do you have difficulty hearing?
AF8B. Do you have difficulty hearing?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot hear at all

AF9. Do you have difficulty walking or climbing steps?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot walk/climb steps at all

AF10. Do you have difficulty remembering or concentrating?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot remember/concentrate at all

AF11. Do you have difficulty with self-care, such as washing all over or dressing?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot care for self at all

AF12. Using your usual language, do you have difficulty communicating, for example understanding or being understood?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty

Sexual behavior: SB

SB1. Check for the presence of others. Before continuing, make every effort to ensure privacy. Now I would like to ask you some questions about sexual activity in order to gain a better understanding of some important life issues.
Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question.
How old were you when you had sexual intercourse for the very first time?

[] 00 Never had intercourse (Go to end of module)
_ _ Age in years
[] 95 First time when started living with (first husband/partner)

SB2. I would like to ask you about your recent sexual activity.
When was the last time you had sexual intercourse?
Record answers in days, weeks or months if less than 12 months (one year). If 12 months (one year) or more, answer must be recorded in years.
[] 1 Days ago _ _
[] 2 Weeks ago _ _
[] 3 Months ago _ _
[] 4 Years ago _ _

HIV/AIDS: HA

HA1. Now I would like to talk with you about something else.
Have you ever heard of HIV or AIDS?

[] 1 Yes
[] 2 No (Go to end of module)

HA11. Check CM17: Was there a live birth in the last 2 years?
Copy name of last birth listed in the birth history (CM18) to here and use where indicated:

Name ____

[] 1 Yes, CM17=1
[] 2 No, CM17=0 or blank (Go to HA24)

HA12. Check MN2: Was antenatal care received?
[] 1 Yes, MN2=1
[] 2 No, MN2=2 (Go to HA17)

HA13. During any of the antenatal visits for your pregnancy with (name), were you given any information about:

[A] Babies getting HIV from their mother?
[] 1 Yes
[] 2 No
[] 8 DK

[B] Things that you can do to prevent getting HIV?
[] 1 Yes
[] 2 No
[] 8 DK

[C] Getting tested for HIV?
[] 1 Yes
[] 2 No
[] 8 DK

Were you:
[D] Offered a test for HIV?
[] 1 Yes
[] 2 No
[] 8 DK

HA14. I don't want to know the results, but were you tested for HIV as part of your antenatal care?

[] 1 Yes
[] 2 No (Go to HA17)
[] 8 DK (Go to HA17)

HA15. I don't want to know the results, but did you get the results of the test?

[] 1 Yes
[] 2 No (Go to HA17)
[] 8 DK (Go to HA17)

HA16. After you received the result, were you given any health information or counselling related to HIV?

[] 1 Yes
[] 2 No
[] 8 DK

HA17. Check MN20: Was the child delivered in a health facility?
[] 1 Yes, MN20=21-36 or 76
[] 2 No, MN20=11-12 or 96 (Go to HA21)

HA18. Between the time you went for delivery but before the baby was born were you offered an HIV test?

[] 1 Yes
[] 2 No

HA19. I don't want to know the results, but were you tested for HIV at that time?

[] 1 Yes
[] 2 No (Go to HA21)

HA20. I don't want to know the results, but did you get the results of the test?

[] 1 Yes (Go to HA22)
[] 2 No (Go to HA22)

HA21. Check HA14: Was the respondent tested for HIV as part of antenatal care?
[] 1 Yes, HA14=1
[] 2 No or no answer, HA14 does not equal 1 (Go to HA24)

HA22. Have you been tested for HIV since that time you were tested during your pregnancy?

[] 1 Yes (Go to HA25)
[] 2 No

HA23. How many months ago was your most recent HIV test?

[] 1 Less than 12 months ago (Go to HA28)
[] 2 12-23 months ago (Go to HA28)
[] 3 2 or more years ago (Go to HA28)

HA24. I don't want to know the results, but have you ever been tested for HIV?

[] 1 Yes
[] 2 No (Go to HA27)

HA25. How many months ago was your most recent HIV test?

[] 1 Less than 12 months 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 HA28)
[] 2 No (Go to HA28)
[] 3 DK (Go to HA28)

HA27. Do you know of a place where people can go to get an HIV test?

[] 1 Yes
[] 2 No

HA28. Have you heard of test kits people can use to test themselves for HIV?

[] 1 Yes
[] 2 No (Go to HA30)

HA29. Have you ever tested yourself for HIV using a self-test kit?

[] 1 Yes
[] 2 No

HA30. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV?

[] 1 Yes
[] 2 No
[] 8 DK/Not sure/depends

HA31. Do you think children living with HIV should be allowed to attend school with children who do not have HIV?

[] 1 Yes
[] 2 No
[] 8 DK/Not sure/depends

HA32. Do you think people hesitate to take an HIV test because they are afraid of how other people will react if the test result is positive for HIV?

[] 1 Yes
[] 2 No
[] 8 DK/Not sure/depends

HA33. Do people talk badly about people living with HIV, or who are thought to be living with HIV?

[] 1 Yes
[] 2 No
[] 8 DK/Not sure/depends

HA34. Do people living with HIV, or thought to be living with HIV, lose the respect of other people?

[] 1 Yes
[] 2 No
[] 8 DK/Not sure/depends

HA35. Do you agree or disagree with the following statement?
I would be ashamed if someone in my family had HIV.

[] 1 Agree
[] 2 Disagree
[] 8 DK/Not sure/depends

HA36. Do you fear that you could get HIV if you come into contact with the saliva of a person living with HIV?

[] 1 Yes
[] 2 No
[] 7 Says she has HIV
[] 8 DK/Not sure/depends

Maternal Mortality: MM

MM1. Now I would like to ask you some questions about your brothers and sisters born to your natural mother, including those who are living with you, those living elsewhere and those who have died. From our experience in prior surveys, we know it may sometimes be difficult to establish a complete list of all the children born to your natural mother. We will work together to draw the most complete list and work to recall all your siblings. Could you please now give me the names of all of your brothers and sisters born to your natural mother?
List all names on lines [A] to [H] below. Do not fill in the order number yet. If more than 8 siblings, use additional questionnaires.

[A] ____ _ _
[B] ____ _ _
[C] ____ _ _
[D] ____ _ _
[E] ____ _ _
[F] ____ _ _
[G] ____ _ _
[H] ____ _ _

MM2. Check MM1: How many siblings?
[] 1 No siblings (Go to MM4)
[] 2 One or more siblings

MM3. Read the names of the brothers and sisters to the respondent. After the last one, ask:
Are there any other brothers and sisters from the same mother that you have not mentioned?

[] 1 Yes (Record sibling(s) in MM1)
[] 2 No

MM4. Sometimes people forget to mention children born to their natural mother because they do not live with them or they do not see them very often. Are there any brothers or sisters who do not live with you that you have not mentioned?

[] 1 Yes (Record sibling(s) in MM1)
[] 2 No

MM5. Sometimes people forget to mention children born to their natural mother because they have died. Are there any brothers or sisters who died that you have not mentioned?

[] 1 Yes (Record sibling(s) in MM1)
[] 2 No

MM6. Some people have brothers or sisters from the same mother but a different father. Are there any brothers or sisters born to your natural mother, but who have a different natural father, that you have not mentioned?

[] 1 Yes (Record sibling(s) in MM1)
[] 2 No

MM7. Count the number of siblings listed in MM1.
Sum _ _

MM8. Just to make sure that I have this right: Your natural mother had (total number in MM7) live births, excluding you, during her lifetime. Is that correct?

[] 1 Yes (Go to MM10)
[] 2 No

MM9. Probe and check sum in MM7 and list of siblings in MM1. Make corrections as necessary until response in MM8 is 'Yes'.

MM10. Check MM7: How many siblings?
[] 1 No siblings (Go to end of module)
[] 2 One or more siblings

MM11. Please tell me, which brother or sister was born first? And which was born next?
Record '01' for the order number in MM1 for the first-born brother or sister, '02' for the second, and so on until you have recorded the order number for all brothers and sisters.

MM12. How many of these births did your mother have before you were born?

Number of preceding births _ _

MM13. Write down the names of the brothers and sisters in MM14 according to the order number in MM1. Ask MM15 to MM27 for one brother or sister at a time (vertically). If there are more than 8 brothers and sisters, use an additional questionnaire.

MM14. Copy name of individual siblings to individual columns. ____

MM15. Is (name) male or female?

[] 1 Male
[] 2 Female

MM16. Is (name) still alive?

[] 1 Yes
[] 2 No (Go to MM18)
[] 8 DK (Go to MM28)

MM17. How old is (name)? _ _ (Go to MM28)

MM18. How many years ago did (name) die? _ _

MM19. How old was (name) when (he/she) died? _ _

MM20. Check MM15: Was the sibling male?
[] 1 Yes (Go to MM26)
[] 2 No

MM21. Check MM19: Did the sister die before age 12 years?
[] 1 Yes (Go to MM26)
[] 2 No

MM22. Was (name) pregnant when she died?

[] 1 Yes (Go to MM26)
[] 2 No

MM23. Did (name) die during childbirth?

[] 1 Yes (Go to MM28)
[] 2 No

MM24. Did (name) die within two months after the end of a pregnancy or childbirth?

[] 1 Yes
[] 2 No (Go to MM26)

MM25. How many days after the end of the pregnancy or childbirth did (name) die? _ _

MM26. Was (name)'s death due to an act of violence?

[] 1 Yes (Go to MM28)
[] 2 No

MM27. Was (name)'s death due to an accident?

[] 1 Yes
[] 2 No

MM28. Check MM14: Is there a younger sibling?
[] 1 Yes (Go to [S2])
[] 2 No (Go to end of module)

[] Tick here if additional questionnaire used

Life satisfaction: LS

LS1. 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?
I am now going to show you pictures to help you with your response. [Image omitted].
Show smiley card and explain what each symbol represents. Record the response code selected by the respondent.
[] 1 Very happy
[] 2 Somewhat happy
[] 3 Neither happy nor unhappy
[] 4 Somewhat unhappy
[] 5 Very unhappy

LS2. Show the picture of the ladder.
Now, look at this ladder with steps numbered from 0 at the bottom to 10 at the top. [Image omitted].
Suppose we say that the top of the ladder represents the best possible life for you and the bottom of the ladder represents the worst possible life for you.
On which step of the ladder do you feel you stand at this time?
Probe if necessary: Which step comes closest to the way you feel?
Ladder step _ _

LS3. Compared to this time last year, would you say that your life has improved, stayed more or less the same, or worsened, overall?

[] 1 Improved
[] 2 More or less the same
[] 3 Worsened

LS4. 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?

[] 1 Better
[] 2 More or less the same
[] 3 Worse

[Image omitted]
[Image omitted]
Domestic violence: DV

DV0. Check line number in HH30H?

[] 1 Women selected for DV module
[] 2 Women not selected (Go to end of module)

DV1. Check for the presence of others: Do not continue until privacy is ensured?

[] 1 Privacy obtained
[] 2 Privacy not possible (Go to DV32)

DV1A. Read to the respondent: Now I would like to ask you some questions about some other important aspects of a woman's life. You may find some of these questions very personal. However, your answers are crucial for helping to understand the condition of women in Zimbabwe. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else in your household will know that you were asked these questions. If I ask you any question you don't want to answer, just let me know and I will go on to the next question.

DV2. Check MA1 and MA5: Currently in union, formerly in union or never in union?
[] 1 Currently married/living with a man
[] 2 Formerly married/lived with a man
[] 3 Never married/ never lived with a man (Go to DV16)

DV3. First, I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your (last) (husband/partner)?

[A] He (is/was) jealous or angry if you (talk/talked) to other men?
[] 1 Yes
[] 2 No
[] 8 DK

[B] He frequently (accuses/accused) you of being unfaithful?
[] 1 Yes
[] 2 No
[] 8 DK

[C] He (does/did) not permit you to meet your female friends?
[] 1 Yes
[] 2 No
[] 8 DK

[D] He (tries/tried) to limit your contact with your family?
[] 1 Yes
[] 2 No
[] 8 DK

[E] He (insists/insisted) on knowing where you (are/were) at all times?
[] 1 Yes
[] 2 No
[] 8 DK

[F] He (does/did) not trust you with any money?
[] 1 Yes
[] 2 No
[] 8 DK

DV4A. Now I need to ask some more questions about your relationship with your (last) (husband/partner).
Did your (last) (husband/partner) ever say or do something to humiliate you in front of others?

[] 1 Yes
[] 2 No (Go to DV4B)

DV4A1. How often did this happen during the last 12 months: often, only sometimes, or not at all?

[] 1 Often
[] 2 Sometimes
[] 3 Not in the last 12 months

DV4B. Did your (last) (husband/partner) ever threaten to hurt or harm you or someone you care about?

[] 1 Yes
[] 2 No (Go to DV4C)

DV4B1. How often did this happen during the last 12 months: often, only sometimes, or not at all?

[] 1 Often
[] 2 Sometimes
[] 3 Not in the last 12 months

DV4C. Did your (last) (husband/partner) ever insult you or make you feel bad about yourself?

[] 1 Yes
[] 2 No (Go to DV5)

DV4C1. How often did this happen during the last 12 months: often, only sometimes, or not at all?

[] 1 Often
[] 2 Sometimes
[] 3 Not in the last 12 months

DV5A. Did your (last) (husband/partner) ever push you, shake you, or throw something at you?

[] 1 Yes
[] 2 No (Go to DV5B)

DV5A1. How often did this happen during the last 12 months: often, only sometimes, or not at all?

[] 1 Often
[] 2 Sometimes
[] 3 Not in the last 12 months

DV5B. Did your (last) (husband/partner) ever slap you?

[] 1 Yes
[] 2 No (Go to DV5C)

DV5B1. How often did this happen during the last 12 months: often, only sometimes, or not at all?

[] 1 Often
[] 2 Sometimes
[] 3 Not in the last 12 months

DV5C. Did your (last) (husband/partner) ever twist your arm or pull your hair?

[] 1 Yes
[] 2 No (Go to DV5D)

DV5C1. How often did this happen during the last 12 months: often, only sometimes, or not at all?

[] 1 Often
[] 2 Sometimes
[] 3 Not in the last 12 months

DV5D. Did your (last) (husband/partner) ever punch you with his fist or with something that could hurt you?

[] 1 Yes
[] 2 No (Go to DV5E)

DV5D1. How often did this happen during the last 12 months: often, only sometimes, or not at all?

[] 1 Often
[] 2 Sometimes
[] 3 Not in the last 12 months

DV5E. Did your (last) (husband/partner) ever kick you, drag you, or beat you up?

[] 1 Yes
[] 2 No (Go to DV5F)

DV5E1. How often did this happen during the last 12 months: often, only sometimes, or not at all?

[] 1 Often
[] 2 Sometimes
[] 3 Not in the last 12 months

DV5F. Did your (last) (husband/partner) ever try to choke you or burn you on purpose?

[] 1 Yes
[] 2 No (Go to DV5G)

DV5F1. How often did this happen during the last 12 months: often, only sometimes, or not at all?

[] 1 Often
[] 2 Sometimes
[] 3 Not in the last 12 months

DV5G. Did your (last) (husband/partner) ever threaten or attack you with a knife, something sharp or other weapon?

[] 1 Yes
[] 2 No (Go to DV5H)

DV5G1. How often did this happen during the last 12 months: often, only sometimes, or not at all?

[] 1 Often
[] 2 Sometimes
[] 3 Not in the last 12 months

DV5H. Did your (last) (husband/partner) ever physically force you to have sexual intercourse with him when you did not want to?

[] 1 Yes
[] 2 No (Go to DV5I)

DV5H1. How often did this happen during the last 12 months: often, only sometimes, or not at all?

[] 1 Often
[] 2 Sometimes
[] 3 Not in the last 12 months

DV5I. Did your (last) (husband/partner) ever physically force you to perform any other sexual acts you did not want to?

[] 1 Yes
[] 2 No (Go to DV5J)

DV5I1. How often did this happen during the last 12 months: often, only sometimes, or not at all?

[] 1 Often
[] 2 Sometimes
[] 3 Not in the last 12 months

DV5J. Did your (last) (husband/partner) ever force you with threats or in any other way to perform sexual acts you did not want to?

[] 1 Yes
[] 2 No (Go to DV6)

DV5J1. How often did this happen during the last 12 months: often, only sometimes, or not at all?

[] 1 Often
[] 2 Sometimes
[] 3 Not in the last 12 months

DV6. Check DV5 [A] to [J]: At least one "Yes" recorded?
[] 1 At least one yes
[] 2 Not a single yes (Go to DV9)

DV7. How long after you first (got married/started living together) with your (last) (husband/partner) did (this/any of these things) first happen?
If less than one year, record "00" years.
_ _ Number of years
[] 95 Before marriage/before living together
[] 96 After separation/divorce

DV8. Did the following ever happen as a result of what your (last) (husband/partner) did to you:

[A] You had cuts, bruises or aches?
[] 1 Yes
[] 2 No

[B] You had eye injuries, sprains, dislocations, or burns?
[] 1 Yes
[] 2 No

[C] You had deep wounds, broken bones, broken teeth, or any other serious injury?
[] 1 Yes
[] 2 No

DV9. Have you ever hit, slapped, kicked, or done anything else to physically hurt your (last) (husband/partner) at times when he was not already beating or physically hurting you?

[] 1 Yes
[] 2 No (Go to DV11)

DV10. In the last 12 months, how often have you done this to your (last) (husband/partner): often, only sometimes, or not at all?

[] 1 Often
[] 2 Sometimes
[] 3 Not at all

DV11. Does (did) your (last) (husband/partner) drink alcohol?

[] 1 Yes
[] 2 No (Go to DV13)

DV12. How often does (did) he get drunk: often, only sometimes, or never?

[] 1 Often
[] 2 Sometimes
[] 3 Never

DV13. Are (Were) you afraid of your (last) (husband/partner): most of the time, sometimes, or never?

[] 1 Most of the time afraid
[] 2 Sometimes afraid
[] 3 Never afraid

DV14. Check MA7: Was she married only once or more than once?
[] 1 Married more than once
[] 2 Married only once (Go to DV16)

DV15A. So far we have been talking about the behaviour of your (current/last) (husband/partner). Now I want to ask you about the behaviour of any previous (husband/partner).
Did any of your previous (husband/partner) ever hit, slap, kick, or do anything else to hurt you physically?

[] 1 Yes
[] 2 No (Go to DV15B)

DV15A1. How long ago did this last happen?

[] 1 0-11 months ago
[] 2 12+ months ago
[] 3 Don't remember

DV15B. Did any of your previous (husband/partner) physically force you to have intercourse or perform any other sexual acts against your will?

[] 1 Yes
[] 2 No (Go to DV15C)

DV15B1. How long ago did this last happen?

[] 1 0-11 months ago
[] 2 12+ months ago
[] 3 Don't remember

DV15C. Did any previous (husband/partner) humiliate you in front of others, threaten to hurt you or someone you care about, or insult you or make you feel bad about yourself?

[] 1 Yes
[] 2 No (Go to DV16)

DV15C1. How long ago did this last happen?

[] 1 0-11 months ago
[] 2 12+ months ago
[] 3 Don't remember

DV16. Check MA1 and MA5: Was she ever married/lived with a man?
[] 1 Ever married/ever lived with a man (Go to DV16A)
[] 2 Never married/never lived with a man (Go to DV16B)

DV16A. From the time you were 15 years old has anyone other than (your/any) (husband/partner) hit you, slapped you, kicked you, or done anything else to hurt you physically?
DV16B. From the time you were 15 years old has anyone hit you, slapped you, kicked you, or done anything else to hurt you physically?

[] 1 Yes
[] 2 No (Go to DV19A)
[] 3 Refused to answer/no answer (Go to DV19A)

DV17. Who has hurt you in this way?
Probe: Anyone else? Record all mentioned

[] A Mother/step-mother
[] B Father/step-father
[] C Sister/brother
[] D Daughter/son
[] E Other relative
[] F Current boyfriend
[] G Former boyfriend
[] H Mother-in-law
[] I Father-in-law
[] J Other-in-law
[] K Teacher
[] L Employer/someone at work
[] M Police/soldier
[] X Other (specify) ____

DV18. In the last 12 months, how often has (this person/have these persons) physically hurt you: often, only sometimes, or not at all?

[] 1 Often
[] 2 Sometimes
[] 3 Not at all

DV19A. Check CM1: ever given birth?
[] 1 Yes (Go to DV20)
[] 2 No

DV19B. Have you ever been pregnant?

[] 1 Yes
[] 2 No (Go to DV22)

DV20. Has anyone ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?

[] 1 Yes
[] 2 No (Go to DV22)

DV21. Who has done any of these things to physically hurt you while you were pregnant?
Probe: Anyone else? Record all mentioned

[] A Current husband/partner
[] B Mother/step-mother
[] C Father/step-father
[] D Sister/brother
[] E Daughter/son
[] F Other relative
[] G Former husband/partner
[] H Current boyfriend
[] I Former boyfriend
[] J Mother-in-law
[] K Father-in-law
[] L Other-in-law
[] M Teacher
[] N Employer/someone at work
[] O Police/soldier
[] X Other (specify) ____

DV22. Check MA1 and MA5: Was she ever married/lived with a man?
[] 1 Ever married/ever lived with a man (Go to DV22A)
[] 2 Never married/never lived with a man (Go to DV22B)

DV22A. Now I want to ask you about things that may have been done to you by someone other than (your/any) (husband/partner). At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?

[] 1 Yes (Go to DV23)
[] 2 No (Go to DV24)
[] 3 Refused to answer/no answer (Go to DV24)

DV22B. At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?

[] 1 Yes (Go to DV23)
[] 2 No (Go to DV26)
[] 3 Refused to answer/no answer (Go to DV26)

DV23. Who was the person who was forcing you the very first time this happened?

[] 01 Current husband/partner
[] 02 Former husband/partner
[] 03 Current/former boyfriend
[] 04 Father/step-father
[] 05 Brother/step brother
[] 06 Other relative
[] 07 In-law
[] 08 Own friend/acquaintance
[] 09 Family friend
[] 10 Teacher
[] 11 Employer/someone at work
[] 12 Police/soldier
[] 13 Priest/religious
[] 14 Stranger
[] 96 Other (specify) ____

DV23A. Where were you when this happened to you?

[] 01 Home
[] 02 Perpetrator's home
[] 03 Someone's else home
[] 04 Bush
[] 05 Market shop
[] 06 School
[] 07 Car/bus
[] 08 Church
[] 09 Workplace
[] 96 Other (specify) ____

DV24. Check MA1 and MA5: Was she ever married/lived with a man?
[] 1 Ever married/ever lived with a man (Go to DV24A)
[] 2 Never married/lived with a man (Go to DV24B)

DV24A. In the last 12 months, has anyone other than (your/any) (husband/partner) physically forced you to have sexual intercourse when you did not want to?
DV24B. In the last 12 months has anyone physically forced you to have sexual intercourse when you did not want to?

[] 1 Yes (Go to DV25)
[] 2 No

DV24C. Check DV5(H-J) and DV15B
[] 1 At least one "yes"
[] 2 Not a single "yes" (Go to DV26)

DV25. Check MA1 and MA5: Was she ever married/lived with a man?
[] 1 Ever married/ever lived with a man (Go to DV25A)
[] 2 Never married/lived with a man (Go to DV25B)

DV25A. How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts by anyone, including (your/any) husband/partner?
DV25B. How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts?

_ _ Age in completed years
[] 98 Don't know

DV26. Check DV5A (A-J), DV15A (A,B), DV16, DV20, DV22A, and DV22B:
[] 1 At least one "yes"
[] 2 Not a single "yes" (Go to DV30)

DV27. Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?

[] 1 Yes
[] 2 No (Go to DV29)

DV28. From whom have you sought help?
Probe: Anyone else? Record all mentioned

[] A Own Family (Go to DV30)
[] B Husband's/partner's family (Go to DV30)
[] C Current/former/husband/partner (Go to DV30)
[] D Current/former boyfriend (Go to DV30)
[] E Friend (Go to DV30)
[] F Neighbor (Go to DV30)
[] G Religious leader (Go to DV30)
[] H Doctor/medical personnel (Go to DV30)
[] I Police (Go to DV30)
[] J Lawyer (Go to DV30)
[] K Social service organization (Go to DV30)
[] X Other (specify) ____ (Go to DV30)

DV29. Have you ever told anyone about this?

[] 1 Yes
[] 2 No

DV30. As far as you know, did your father ever beat your mother?

[] 1 Yes
[] 2 No
[] 8 Don't know

Thank the respondent for her cooperation an reassure her about the confidentiality of her answers. Fill out the questions below with reference to the Domestic Violence Module only.

DV31. Did you have to interrupt the interview because some adult was trying to listen, or came into the room, or interfered in any other way?

A. Husband
[] 1 Yes, once
[] 2 Yes, more than once
[] 3 No

B. Other male adult
[] 1 Yes, once
[] 2 Yes, more than once
[] 3 No

C. Female adult
[] 1 Yes, once
[] 2 Yes, more than once
[] 3 No

DV32. Interviewer's comments/explanation for not completing the Domestic Violence Module
____ _
____ _
____ _

WM10. Record the time.

Hours and minutes _ _ : _ _

WM11. Was the entire interview completed in private or was there anyone else during the entire interview or part of it?
[] 1 Yes, the entire interview was completed in private
[] 2 No, Others were present during the entire interview (specify) ____
[] 3 No, Other were present during part of the interview (specify) ____

WM12. Language of the Questionnaire.

[] 1 English
[] 2 Shona
[] 3 Ndebele

WM13. Language of the Interview.

[] 1 English
[] 2 Shona
[] 3 Ndebele
[] 6 Other language (specify) ____

WM14. Native language of the Respondent.

[] 1 English
[] 2 Shona
[] 3 Ndebele
[] 6 Other language (specify) ____

WM15. Was a translator used for any parts of this questionnaire?

[] 1 Yes, the entire questionnaire
[] 2 Yes, parts of the questionnaire
[] 3 No, not used

WM16. Check columns HL10 and HL20 in list of household members, household questionnaire:
Is the respondent the mother or caretaker of any child age 0-4 living in this household?

[] Yes (Go to WM17 in woman's information panel and record '01'. Then go to the questionnaire for children under five for that child and start the interview with this respondent.)
[] No (Check HH26-HH27 in household questionnaire: Is there a child age 5-17 selected for questionnaire for children age 5-17?)
[] Yes [Check column HL20 in list of household members, household questionnaire: Is the respondent the mother or caretaker of the child selected for questionnaire for children age 5-17 in this household?]
[] Yes (Go to WM17 in woman's information panel and record '01'. Then go to the questionnaire for children age 5-17 for that child and start the interview with this respondent.)
[] No (Go to WM17 in woman's information panel and record '01'. Then end the interview with this respondent by thanking her for her cooperation. Check to see if there are other questionnaires to be administered in this household.)
[] No (Go to WM17 in woman's information panel and record '01'. Then end the interview with this respondent by thanking her for her cooperation. Check to see if there are other questionnaires to be administered in this household.)

Interviewer's observations

Supervisor's observations