1 2 1 2
1 2 1 2 3 4
1 2 1 2
1 2 1 2 3 4
1 2 1 2
1 2 1 2 3 4
1 2 1 2
1 2 1 2 3 4
1 2 1 2
1 2 1 2 3 4
1 2 1 2
1 2 1 2 3 4
17.25 17.26
17.27 17.28
SECTION 17: NUMBER OF CHILDREN BORN AND MARRIAGE INFORMATION FOR EVER MARRIED WOMEN UP
1st Women 2nd Women
3rd Women
4rt Women 5th Women
6th Women
Have you given birth since August 2005?
INTERVIEWER: ENSURE THE WOMAN UNDERSTANDS
THE YEARS AND MONTHS SINCE THAT DATE.
IF SHE ANSWERS NO, PROBE TO BE SURE:
“Did you give birth to any child who
cried or showed any sign of life but only
survived for a few minutes or a few
hours or a few days? Do you have a
child under 5 years 60
months old? Is there another ever
married woman 49 years old or less in this household?
ONLY FOR WOMEN WITH A BIRTH SINCE AUGUST 2005: Do you have a TT card?
Women ID Code
17.29
1st Women 2nd Women
3rd Women
4rt Women 5th Women
6th Women
SECTION 17: NUMBER OF CHILDREN BORN AND MARRIAGE INFORMATION FOR EVER MARRIED WOMEN UP
[LOOK AT THE CARD AND RECORD THE DATES FOR EACH TT INJECTION LISTED ON THE CARD. IF MORE THAN 5 INJECTIONS LISTED, RECORD THE 5 MOST RECENT
DAY MONTH
YEAR YEAR
MONTH DAY
YEAR MONTH
DAY YEAR
MONTH DAY
YEAR MONTH
DAY
1st Round 2nd Round
3rd Round 4th Round
5th Round
Women ID Code
1 2 1 2 3 4 5 6 7 8
1 2 3 4 5
1 2 1 2 3 4 5 6 7 8
1 2 3 4 5
1 2 1 2 3 4 5 6 7 8
1 2 3 4 5 1 2
1 2 3 4 5 6 7 8 1 2 3 4 5
1 2 1 2 3 4 5 6 7 8
1 2 3 4 5
1 2 1 2 3 4 5 6 7 8
1 2 3 4 5 16 37
18.1 18.2
18.3 18.4
18.5
1 2
3 4
5 6
7
18.6 18.7
18.16
18.16
18.16
18.16
SECTION 18: RECENT BIRTHS CHILDREN BORN SINCE AUGUST
PLEASE RECORD THE
NAME AND ID CODE OF
THIS WOMAN woman
with a child born
after August
2005 Can you please give me
the month and year for your most recent next
recent delivery? Please answer even if the child
has died. ASK TO SEE THE IMMUNIZATION CARD OF THE
CHILD AND CHECK THE BIRTHDATE.
LAST BIRTH youngest
NEXT TO LAST
THIRD LAST
BIRTH
MONTH YEAR
LAST BIRTH youngest
NEXT TO LAST
THIRD LAST
BIRTH 1ST
WOMAN WITH
BIRTH SINCE
AUGUST 2005
2ND WOMAN
WITH BIRTH
SINCE AUGUST
2005 Is this
child currently
alive? What is the
name of the child?
[RECORD NAME AND ID
CODE] Did you see anyone for prenatal care
during this pregnancy? If yes, who did you see? Anyone else? [RECORD
ALL PERSONS MENTIONED] Who was the
primary person to assist with this
delivery? Where did the
delivery of this baby take place?
DR Midwi
fe Nurse
CHW TBA
Other No
one
Women ID Code
NAME
1 2 1 2 3 4 5 6 7 8
1 2 3 4 5
1 2 1 2 3 4 5 6 7 8
1 2 3 4 5
1 2 1 2 3 4 5 6 7 8
1 2 3 4 5 1 2
1 2 3 4 5 6 7 8 1 2 3 4 5
1 2 1 2 3 4 5 6 7 8
1 2 3 4 5
1 2 1 2 3 4 5 6 7 8
1 2 3 4 5
18.1 18.2
