DEMOGRAPHIC AND HEALTH SURVEY 1994

APPENDIX E

QUESTIONNAIRES

INDONESIA DEMOGRAPHICAND HEALTHSURVEY 1994
HOUSEHOLD SCHEDULE
Confidential
IDENTIFICATION

i.

PROVINCE

2.

EEQENCY/

3.

SUB-DISTRICT

4.

VILLAGE

5.

AREA ............... URBAN

6.

LARGE

7.

ENUMERATION

8.

SUSENAS

9.

IDHS

CODE

.........................................................

ICIPALITY

CITY

-1/SMALL
AREA

1994

1994

L0.

HOUSEHOLD

Ll.

NAME

OF

CITY

1 .......... RURAL
-2/TOWN

2

-3/COUNTRYSIDE

I ............

)
-4*)

NUMBER

SAMPLE

SAMPLE

*I ............................

CODE ...........................

ii

CODE ..............................

NUMBER ...................................
HOUSEHOLD

HEAD

INTERVIEWER

VISITS

FINAL

2

VISIT

MONTH
INTERVIEW

DATE ........
YEAR

INTERVIEWER'S
RESULT

NEXT

N A M E ....

INTERVIEWER

***) . . . . . . . . . . .

VISIT:

FINAL

DATE
TIME

***)

RESULT

OF

I

CODES:
NUMBER OF
HOUSEHOLD
MEMBERS

1 COMPLETED
2 NO HOUSEHOLD
MEMBER AT HOME OR NO COMPETENT
RESPONDENT
AT HOME AT TIME OF VISIT
3 ENTIRE HOUSEHOLD
ABSENT FOR EXTENDED PERIOD
4 POSTPONED
5 REFUSED
6 DWELLING VACANT OR ADDRESS NOT A DWELLING
7 DWELLING
DESTROYED

8 DWELLING
NOT FOUND
9 OTHER
(SPECIFY)

FIELD

EDITOR

SUPERVISOR

OFFICE
EDITOR

NAME
DATE

*)
**)
***)

RESULT

,°,,,°,,,o,,.,,,,,
,of,°°°,,°.,.°°,°,
,.i°°,,i°i..°.....
o,°o,,,,o.o.°,
....
°oo.,,°,o,o,o,o,,,
TOTAL NUMBER
°,o,o,o,,,o,o,o,,,
o.°,°,.,°..,°,°.,,
°i..l,o.°,.°°.°,..
°,°,°,o,o,°°o,°°,, V I S I T S

Cross out category not used
Circle selected category
Choose suitable result

3]]

TOTAL EVERMARRIED
WOMEN 15-49

CODE

KEYED

BY

~

CODE

I

HOUSEHOI .D
N o w I would like some int~)rmation about
EDUCATION
USUAL RESIDENTS

PLease g i v e me the names
of The persons who u s u a l l y
[~ve | n your household,
s t a r t i n g w i t h the head of
t h e household,

RELATIONSHIF
TO HEAD OF
HOUSEHOLD

FOR ALL PERSONSAGED 5 OR OLDER
Is
(NAME)
male
or
female?

~hat i s th(
relations h i p of
(NAME) t o
the head ol
the household? *

(2)

(3)

I

(4)
N

How o l d
is
(NAME)?

I

(5)

F

Has
What i s t h e
(NAME)
h i g h e s t Level
ever
o f school
been
( NAME)
To
: attended?
school?
What i s The
h i g h e s t Grade
(NANE)
completed at
that Level?**
I
(6)
I
(7)

YEARS I YES

,

I

NO

LEVEL

IF AGE
LESS
THAN
25
YEARS
Is
(RANE)
still in
school?
(8)

GRADE YES

.

,

•

•

J

i

i

•

i

i

•

•

i

L

i

•

i

•

•

i

i

•

•

J

i

•

•

i

2

I

F]

i

2

1

F]q

N,,
,

•

Fq

•

|

|

,2

TICK HERE IF CONTINUATION SHEET USED

•

,

i

fq

i

,2

i

N

i

,

i

[]

Just TO make sure That I have a complete L i s t i n g :
I)

Are t h e r e any o t h e r persons such as small c h i l d r e n or
i n f a n t s t h a t we have not l i s t e d ?

2)

Are t h e r e any o t h e r people who may not be members of your f a m i l y ,
l i k e s e r v a n t s , f r i e n d s , lodgers, but who u s u a l l y Live here?

3)

Are t h e r e any o t h e r guests or v i s i t o r s who have been
t e m p o r a r i l y s t a y i n g w i t h you f o r The past 6 months or more?

4)

Are t h e r e any persons who u s u a l l y l i v e here who have been away
f o r tess than 6 months?

5)

Are t h e r e any persons we have l i s t e d who have been away f o r
t h e pest s i x months?

* ) COOES FO~ COLL~4N ( 3 )
RELATIONSHIP TO HEAD OF HOUSEHOLD:
01= HEAD
05 =
0 2 : WIFE OR HUSBAND
06=
0 3 = SON OR DAUGHTER
07=
0 4 = SON OR DAUGHTER'IN'LAW
08=

GRANDCHILD
PARENT
PARENT'IN-LAW
BROTHER OR S%STER

312

2

i

,
|

NO

09: OTHER RELAT%VE
10: ADC~TED/FOSTER CHILD
11: STEPCHILD
1 2 : ROT RELATED
9 8 : DON~T KNOW

i

2

SCHEDULE
the people who usually live in your household.
MARITAL
STATUS

PARENTAL SURVIVORSHIP AND RESIDENCE
FOR PERSONS LESS THAN 15 YEARS OLD
IF ALIVE
Is (NAME)'s
natural
mother a l i v e ?

Does (NAME)'s
n a t u r a l mother
Live in this
household?

I f ALIVE
Is (NAHE)fs
natural
father afire?

Does (NAME)~s
natural father
Live i n t h i s
household?

FOR WOHEN
AGE 10 YEARS
AND ABOVE

HBS
(NAME)
ever
been

IF YES:
What i s her
name?

iF YES:
What is h i s
name?

RECORO MOTHER'S
LINE NU'RBER
(10)

RECORD FATHER'S
LINE NUMBER
(12)

ELIGIBILITY

CIRCLE LINE
NUMBER OF ALL
EVER'MARRIED
WOMEN AGE
15"49 FOR
INDIVIDUAL
INTERVIEW

married?

(9)
YES NO

(11)
YES

OK

1

1 2 B

NO
2

8

(14)

(13)
YES

DK

NO

1

2

01

1

2

8

1

2

8

1

2

02

1

2

8

1

2

8

1

2

03

1

2

8

1

2

8

1

2

04

1

2

8

1

2

8

1

2

05

1

2

8

1

2

8

1

2

06

1

2

8

1

2

8

1

2

07

1

2

8

1

2

8

1

2

08

1

2

8

1

Z

8

1

2

09

1

2

8

1

2

8

1

2

10

1

2

8

1

2

6

1

2

11

1

2

8

1

2

8

1

2

12

1

2

8

1

2

8

1

2

13

1

2

8

1

2

8

1

2

14

1

2

8

1

2

8

1

2

15

[-N

n-1

TOTAL NL~4BEROF ELIGIBLE ~ E N

* * ) CQOES FOR COLLq4g (7)
LEVEL OF EDUCATION:
1= PRIMARY SCHOOL
2= JUNIOR HIGH SCHOOL
S= SENIOR HIGH SCHOOL
4= ACADEMY

YES ~ >

ENTER EACH IN TABLE

NO[]

YES ~ >

ENTER EACH IN TABLE

NO [ ]

YES [ ~ - >

ENTER EACH IN TABLE

NO [ ]

YES [ ~ >

ENTER EACH %N TABLE

NO [ ]

YES [ ~ - >

DELETE NAMES FRed TABLE

NO [ ]

5= UNIVERSITY
8= DON'T KNOW
GRADE:
7=COHPLETED
8=DON'T KNO~

313

NO.
15

16

PERTANYAANDAN SARINGAN

KOOE

~ a t is the main source oF d r i n k i n g water for members
of your household?

I

PIPED INTO RESIDENCE. . . . . . . . . . .
P%PED INTO YARD OR PlOT . . . . . . . .
PUBLIC TAP. . . . . . . . . . . . . . . . . . . . .
PUMP. . . . . . . . . . . . . . . . . . . . . . . . . . .
PROTECTED ~ELL . . . . . . . . . . . . . . . . .
UNPROTECTEDWELL. . . . . . . . . . . . . . .
PROTECTED SPRING. . . . . . . . . . . . . . .
UNPROTECTEDSPRING. . . . . . . . . . . . .
RIVER. . . . . . . . . . . . . . . . . . . . . . . . . .
RAINWATER. . . . . . . . . . . . . . . . . . . . . .
OTHER
(SPECIFY)

How Long does i t take to go there, get mater
and come back?

MINUTES. . . . . . . . . . . . . . . . .

What k i n d of t o i l e t

facility

does your household have?

18

PRIVATE WITH
SEPTIC TANK. . . . . . . . . . . . . . . . . . .
PRIVATE WITH
................
SHARED/PUBLIC. . . . . . . . . . . . . . . . . .
RIVER. . . . . . . . . . . . . . . . . . . . . . . . . .
OTHER
(SPECIFY)

CHECK 15
(CODES 2 1 , 2 ~ : ~ ) ~

OTHER CODES

]1

32
33
41
96

996
11

NOSEPTICTANK

I

11
12/>17
13
21
22
23

J i l l

ON PREMISES. . . . . . . . . . . . . . . . . . .
17

TERUS
KE

12
21
31
96

]

>20

I

V
19

20

How f a r is the distance between the welt and the nearest
cesspool?

DISTANCE. . . . . . . . . . . .

(IN METER)

DONrT KNOW. . . . . . . . . . . . . . . .
YES

NO

ELECTRICITY. . . . . . . . . . . . . .
1
RADIO OR TAPE RECORDER...1
TELEVISION . . . . . . . . . . . . . . .
1
GAS STOVE. . . . . . . . . . . . . . . .
1
KEROSENE STOVE. . . . . . . . . . .
1
ELECTRIC STOVE. . . . . . . . . . .
I
REFRIGERATOR. . . . . . . . . . . . .
1

2
2
2
2
2
2

2

Does any me~nber of your household own:
I

A bicycle/rowboat?
A motorcycte/mo¢orboat?
clr?

YES
BICYCLE/ROWBOAT. . . . . . . . . .
1
MOTORCYCLE/MOTORBOAT
..... 1
CAR. . . . . . . . . . . . . . . . . . . . . .
1

NO I
2
2
2

BAHBO0. . . . . . . . . . . . . . . . . . . . . . . . .

21

I .....................
I

A
22

METERS
98

Does your household have:
Electricity?
A radio or tape recorder?
A television?
A gas stove?
A kerosene stove?
An e l e c t r i c stove?
A refrigerator?

21

I i t

MAiN MATERIAL OF THE FLOOR

...........................

22

CONCRETE/BRICK. . . . . . . . . . . . . . . . .
T%LE. . . . . . . . . . . . . . . . . . . . . . . . . . .
CERAMIC/MARBLE/GRANITE. . . . . . . . .
OTHER
(SPECIFY)

(RECORD OBSERVATION)

What is the FLoor area of your b u i l d i n g ?
AREA. . . . . . . . . . . . . . . .

(IN SQUAREMETERS)

r
I

~
I

DON'T KN(Y,J . . . . . . . . . . . . . . .

I

31
32
33
96

I M2
998

24 ° isthePri Yc°nstruci°n eraL°f he er IBCOTEROBAB
.........................
..........................
.........................
CSPECFY
632
I
25

26

What is the primary c o n s t r u c t i o n material of the roof?

What is the ownership status of your b u i l d i n g ?

I

~/0OO
. . . . . ............................................ .
CONCRETE
TILE . . . . . . . . . . . . . . . . . . . . . . . . . . .
ASBESTOS/ZINC. . . . . . . . . . . . . . . . . .
LEAVES. . . . . . . . . . . . . . . . . . . . . . . . .
OTHER
(SPECIFY)

02i l
O
O]

|

OI4N. . . . . . . . . . . . . . . . . . . . . . . . . . . .
MORTGAGE. . . . . . . . . . . . . . . . . . . . . . .
CONTRACT. . . . . . . . . . . . . . . . . . . . . . .
RENT. . . . . . . . . . . . . . . . . . . . . . . . . . .
OFFICIAL . . . . . . . . . . . . . . . . . . . . . . .
OTHER
(SPECIFY)

01 I
02
O]
D4
05
.96

I

I

3]4
]

INDONESIA

DEMOGRAPHIC

A N D H E A L T H S U R V E Y ]994

iNDIVIDUAL QUESTIONNAIRE

Confidential
IDENTIFICATION
i. PROVINCE

CODE

..........................................................

2. R E G E N C Y / M U N I C I P A L I T Y *) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. S U B - D I S T R I C T
4. V I L L A G E
5. A R E A ............... U R B A N - i .......... RURAL - 2 **)
6. LARGE CITY -1/SMALL CITY -2/TOWN -3/CODI~RYSIDE -4*)
7. EhV3MERATION A R E A NL~BER
8. SUSENAS 1994 SAMPLE CODE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

F

9. IDHS 1994 SAMPLE CODE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
[0, H O U S E H O L D ~ E R

................................................

[i. NAME OF H O U S E H O L D HEA/~
L2.

LINE NI~4BER OF WOM/~N FROM H O U S E H O L D SCHEDULE . . . . . . . . . . . . . . . . . . . . . . .

L3. N~J4E OF W O M A N

INTERVIEWER

1

2

VISITS

3

FINAL V I S I T
MONTH

INTERVIEW DATE..

YEAR
INTERVIEWER' S NAME ....

INTERVIEWER

RESULT ***) ...........
N E X T VISIT:

~

"

'

FINAL R E S U L T

DATE

:::::::::::::::::::
o,.i.J.J...,...,o,°
...................
o,,,.,o,o,.,.,.,...
...................
:::::::::::::::::::
,,,,,..°.°,,.,,,,oo

TIME

TOTAL N U M B E R
OF V I S I T S

11

***) R E S U L T CODES:
1 COMPLETED
2 NOT AT HOME
3 POSTPONED

FIELD EDITOR

4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED

I SUPERVISOR

I OFFICE EDITOR

NAME
DATE

*)
**)

Cross out category not u s e d
Circle selected category
Choose suitable result

315

7 OTHER

~

(SPECIFY)

I

KEYED BY

CODE

"

316

I SECYIOII 1.
NO.

RESPOMDENT'SBACIECRQUND
,
I

QUESTIONSAND FILTERS

SKIP
TO

COOING CATEGORIES

101

RECORDTHE TIME.

HM,~,RuI~IIIIIIIIII~

102

F i r s t I would l i k e to ask some questions about you.
For most of the time u n t i l you were 12 years o l d , d i d
you l i v e in a c i t y , in a town, or in a v i l l a g e ?

CITY. . . . . . . . . . . . . . . . . . . . . . . . . . .
TOWN. . . . . . . . . . . . . . . . . . . . . . . . . . . .
VILLAGE. . . . . . . . . . . . . . . . . . . . . . . . .

MONTH
...................... FT~I

In what month and year were you born?

105

I

I
2
3

WRITE MONTH IF NOT IN WESTERN CALENDAR

DON'T KNOWMONTH. . . . . . . . . . . . . . .

MONTH:

YEAR. . . . . . . . . . . . . . . . . . . . . . .

9B

~

DON'T KNOWYEAR. . . . . . . . . . . . . . . .

98

COMPARE AND CORRECT105 AND/OR 106 IF INCONSISTENT,

IO6AI Are you now married, divorced or widowed?

J D
M
W
D
IV
O
AO
W
RR
E
R
D
C
IEE
D
D.........................

,0,I
ovo

i .............................
,i

primary, j u n i o r high, senior high, academy, or
university?

109

I
I

I
I 110 I

What is the highest (GRADE, YEAR) you completed
at that Level?
COMPLETED = 7
CHECK 106:
AGE LESS
THAN 25 [ ~
v
Are you c u r r e n t l y attending school?

I

I

I

2
3
4
5

GRADE/YEAN
.................... [~[

I

.>113
I

YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

I~I>113

I

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2 I

What was the main reason you stopped attending school?

I

GOT PREGNANT
....................
01
GOT MARRIED. . . . . . . . . . . . . . . . . . . . .
02
TO CARE FOR CHILDREN. . . . . . . . . . . . 03
FAMILY NEEDEDHELPON FARM
OR IN BUSINESS. . . . . . . . . . . . . . . . 04
COULD NOT PAY SCHOOL FEES. . . . . . . 05
NEEDEDTO EARNMONEY. . . . . . . . . . . . 06
GRADUATED/HADENOUGHSCHOOLING..O7
DID HOT PASSEXAMS. . . . . . . . . . . . . . 08
DID NOT LIKE SCHOOL. . . . . . . . . . . . . 09
SCHOOL NOT ACCESSIBLE/TOO FAR...IO
OTHER
_96
(SPECIFY)
DK. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
98

CHECK 108:
PRIMARY ~
V

114

JUNIOR HIGH SCHOOL. . . . . . . . . . . . . .
SENIOR HIGH SCHOOL. . . . . . . . . . . . . .
ACADEMY. . . . . . . . . . . . . . . . . . . . . . . . .
UNIVERSITY. . . . . . . . . . . . . . . . . . . . . .

>114

I- .........................

RECORDALL MENTIONED

113

2

E

I
112

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

AGE 25
OR ABOVE L ~

B

111 I

2
3
lJ

JUNIOR HIGH
OR HIGHER
[~

Can you read and understand a Letter or newspaper
e a s i l y , with d i f f i c u l t y ,
or not at a l l ?

317

i

I

I

EASILY. . . . . . . . . . . . . . . . . . . . . . . . . .
WITH DIFFICULTY. . . . . . . . . . . . . . . . .
NOT AT ALL. . . . . . . . . . . . . . . . . . . . . .

)115

1 I
2 I
3-->116

2

No

I

QUESTIONS AND

SKIP

TO

CODING CATEGORIES

FILTERS

l

115 I

I

Do you usuaLLy read a newspaper or magazine at least
once a week?

116 I 0o you usually

I

117 i

I

Listen to a radio every day?

YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2

YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2

Do you usually watch t e l e v i s i o n at Least

YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 |

once a week?

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2

What religion are you?

MUSLIM. . . . . . . . . . . . . . . . . . . . . . . . . .
PROTESTANT/CHRISTIAN. . . . . . . . . . . .
CATHOLIC. . . . . . . . . . . . . . . . . . . . . . . .
HINDU. . . . . . . . . . . . . . . . . . . . . . . . . . .
BUDDHIST. . . . . . . . . . . . . . . . . . . . . . . .

I
2
3
4
$

OTHER

I

6

(SPECIFY)

119

What i s the Language used at home?

INDONESIAN. . . . . . . . . . . . . . . . . . . . .
JAVANESE . . . . . . . . . . . . . . . . . . . . . . .
SUNDANESE . . . . . . . . . . . . . . . . . . . . . .
BATAR. . . . . . . . . . . . . . . . . . . . . . . . . .
MINANG. . . . . . . . . . . . . . . . . . . . . . . . .
BUGINESE. . . . . . . . . . . . . . . . . . . . . . .

OTHER

120 I Can you speak Bahasa Indonesia?
INTERVIEW IS IN SAHASA INDONESIA, DON'T ASK THIS
QUESTION. CIRCLE CODE 1.
IF

318

(SPECIFY)

I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

I

01-->201
02 |
03
04
05
06

96

I

I I
2

I SECTION2.

RO. I

REPI~DOUCTIOllI
SKIP

QUESTIONSAND fILTERS

COOING CATEGORIES

J TO
m
m

201 ] NOW I would like to ask about all the births you have
had during your l i f e .

Haveyou ever given birth?

YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

I

l
I
2-->206

I

202

:::::::::::::::::::::::::::::::

0o you have any sons or daughters to whomyou have
given birth who are now living with you?

I

203

How many sons live with you?
And how many daughters tire with you?
I f NONE, ENTER '00'.

204

205 I

Do you have any sons or daughters to who~ you have
given birth who are alive but do not Live with you?

207

NO .....................

How many sons are ative but do not live with you?
And how many daughters are alive but do not live with
you?
IF

206

YES .............................

I

I l
!

......... 2 - - > 2 0 6

!

DAUGHTERS ELSEWHERE..

NONEENTER t O 0 ~ .

Have you ever given birth to a boy or a girt who was
burn alive but tater died? IF NO, PROBE: Any baby
who cried or showed any sign of life but survived
only a few hours or days?

I

YES .............................

I l

NO ..............................

2

I

>208

I

GIRLsSOYS
gEAgDEAD.
.... iiiiiiiiiiiiii

In all, how many boys have died?
And how many girls have died?

IF NONE, ENTER '00'.

208

SUM ANSWERSTO 203, 205, AND 207, AND ENTERTOTAL.

TOTAL

. . . . . . . . . . . . . . . . . . . . . .

IF NONE, ENTER '00'.

209

CHECK 208:
Just to make sure that I have this right: you have had in TOTAL
your life. Is that correct?

YES [ ~
/

210

NO F ~

•

PROBEAND
CORRECT201-208 AS NECESSARY

V

CHECK 208:
ONE OR MORE

LIVE BIRTH

live births during

NO LIVE
BIRTHS ~ ]

mV

i

319

>223 1

211

NO~ I WouLd Like to r e c o r d the r ~ s
one you had.

of e l l

RECORD MAMES OF ALL THE BIRTHS IN 212.

your b i r t h s ,

whether s t i L L a l i v e or not, s t a r t i n 9

RECORD TWINS AND TRIPLETS OR SEPARATE LINES

320

w i t h the f i r s t

212

213

!14

I.that name was
given to your
(first,
next)
D~by?

Were
any o f
these
births
twins?

Is
I n what ~ronth
INANE) and y e a r was
I boy (NAME) b o r n ?
Or a
]ir[?
PROBE:
What i s h i s /
her birthday?

08]

(NAME)

215

216

217
IF ALIVE:

I s (NN4E) HOW o l d was
stile
(NAME) a t
alive?
his/her
{ast
birthday?

219
IF DEAD:

I s (MANE)
[ivin g
w i t h you?

SINGLE..1 tOY..1 MONTH..

YES,...1
NO.....2
I

AGE IN
YEARS
[ ~

CALCULATE THE
DIFFERENCE
BETWEEN THE YEAR
IF "1 YEAR", PROBE:
OF BIRTH OF
HOW n~ny nK~lths
(NN4E) AND THE
old WaS (NAME)?
YEAR OF THE PRE
CEDING BIRTH:
RECORD DAYS IF LESS
IF 4 YEARS OR
THAN 1 MONTH; MONTHS MORE. ASK:
IF LESS THAN TWO
YEARS, OR YEARS IF
Were t h e r e any
TWO YEARS OR ABOVE.
other live
IF LESS THAN ONE
birth~ between
DAY, WRITE 'DO ~ IN
the birth of
DAYS BOX.
(NAME) AND
(NAME OF
PRECED%MG BIRTH]

YES

220
INTERVAL CHECK:

How o l d WaS h e / s h e

~en he~she d i e d ?

RECORD AGE
IW COMPLETED YEARS

MULT....2

; ] R L . 2 YEAR...

218
IF ALIVE:

....... 1j

NO. . . . . . . .
2
(TO 220) • .

DAYS

.....

1

219

$[NGLE..1

l a Y . . 1 MONTH.. ~

YES....1|

MOLT....2

~IRL.2 YEAR...

NO.....2

AGEyEARsN
I

YES. . . . . . .

.~2

NO. . . . . . . .
2
(TO 220) •
v

; I R L . E YEAR,..

-

z~---.

NO. . . . . . . . . . .

YEARS
~

|

rll

/

NO. . . . . . . .
2
(TO 220) <

SINGLE..1 l a Y . . 1 MONTH..

YES....1
NO.....2

; ] R L . 2 YEAR...

AGE IN
YEARS
~

---

SINGLE..1 I O Y . . ) MONTH.,

YES....1

MULT....E

NO.....E

3]RL.2 YEAR...

YES . . . . . . .

1

NO. . . . . . . .
2
(TO 220) •

AGE IN
YEARS
~

YES . . . . . . .

1

NO. . . . . . . .
2
(TO 22R) < - -

v
219
.

.

--

--

DAYS. . . . .

--

--

I

MONTHS...E
--

--

--

--

.

DAYS. . . . .

--

--

1

HONTHS,..E
--

--

--

--

YEARS....]
.

.

.

CALCULATE THE DIFFERENCE BETWEEN THE YEAR OF INTERVIEW AND THE YEAR OF THE LAST BIRTH.
IF 4 YEARS OR MORE, ASK: Were t h e r e any o t h e r l i v e b i r t h s a f t e r (NAME OF LAST CHILD)?

(GO TO
NEXT

YES . . . . . . . . . .

1

NO. . . . . . . . . . .

2

(GO TO <
NEXT
BIRTH)
YES . . . . . . . . . .

I

NO. . . . . . . . . . .

2

(GO TO <
NEXT
BIRTH)

YES . . . . . . . . . . . . . . . .

1

NO. . . . . . . . . . . . . . . . .

2

NUMBERS
ARE SANE

~
NUMBERS ARE
~
DIFFERENT
~ >
(PROBE AND RECONCILE)
v
CHECK: FOR EACH LIVE BIRTH ( . 0 2 1 5 ) : YEAR OF BIRTH IS RECORDED
FOR EACH LIVING BIRTH ( 0 . 2 1 7 ) :
FOR EACH DEAD BIRTH ( 0 . 2 1 9 ) :

CURRENT AGE IS RECORDED

AGE AT DEATH IS RECORDED

FOR AGE AT DEATH 12 MONTH OR ONE YEAR ( 0 . 2 1 9 ) :

I

PROSE TO DETERMINE EXACT
NUMBER OF MONTHS

CHECK 215: RECORD NUMBER OF BIRTHS SINCE JANUARY 1989,
IF NONE, RECORD " 0 " .

[]

AT THE BOTTC~4OF THE CALENDARS ENTER THE NAME AND BIRTH DATE OF THE LAST CHILD B(~N PRIOR TO
JANUARY 1989, IF APPLICABLE.

321

2
<

BIRTH)

COt~PARE 208 WITH NUMBER OF BIRTHS ABOVE AND MARK:

223 |

2
•

NO. . . . . . . . . . .

YEARS....3

INANE)

222

---

YEARS....3

v
219

221 !

MONTHS...2

L

MULT....2

.

--

(GO TO
NEXT

.~

BIRTH)

(NAME)

N

4-|

2

(GO TO <
NEXT
BIRTH)
YES . . . . . . . . . .

~

NO..... 2

4

NO. . . . . . . . . . .

DAYS. . . . . 1 t-.~_

YEARS....]

v
219
-

.......... j 1

MONTHS...2

219

MULT....2

YES

----

(NAME)

(NAME)

__

----

MONTHS...2
.
.
.
YEARS...,S

6

NO. I

I

QUESTIONS ANO FILTERS

TAKE CARE WHEN ASKING THIS QUESTION TO DIVORCED
OR WIDOWED WOMERI

I

c ~ , N ° CATEOOR,ES

Re . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2

UNSURE

8

. . . . . . . . . . . . . . . . . . . . . . . . . .

SKIP

re

>229

I
227 I

How many m o n t h s pregnant are you?

II

MONTH . . . . . . . . . . . . . . . . . . . . . .

I
~NTER "H" IN COLO.NI OF CALENgAR ,N MON'HU' ,NTERVIE.ANO ,N EAC"PREDE"NOMON,. PREGNANT I

I

g
I

I

228 I At the tlme you ~came pregnant, did you want to become
pregnant then, did you want to wait unfit tater,
or dLd y o ~ t
want to l:~cOelepregnant at all?

I

I

NOT AT ALL . . . . . . . . . . . . . . . . . . . . . .

3

YES

I

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2 ---)235

I

i

229

I Have you ever had a pregnancy
in

I

was a b o r t e d ,

or

ended

that miscarried,

. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

a stittbirth?

I

!

,,o .h.°°,.,,e,..,,u.,°...°.°cy.o,
231

I

g
I l
2

THEN. . . . . . . . . . . . . . . . . . . . . . . . . . . .
LATER. . . . . . . . . . . . . . . . . . . . . . . . . . .

I

CHECK 230:
I

LAST PREGNANCYENDED
SINCE JANUARY 1989 i ~
I

LAST PREGRANCYENDED
EFORE JANUARY 1989 ~ L

>235

V

[

]

2S2

HOW many months pregnant were you when that pregnancy
ended7

232A

ENTER"K" IN COLUMN I OF CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED, AND "H" FOR THE
REMAINING NUMBEROE COMPLETED MONTHS.

233

Hove you ever had any other
result
in a (ire birth?

pregnancies

which did not

MONTHS

.....................
i

YES. . . . . . . . . . . . . . . . . .

1

NO. . . . . . . . . .

2--

1231

I

234

ASK FOR DATE AND DURAT[ON Of ALL PREGNANC[ES THAT RESULTED IN MISCARRIAGE, WERE ABORTEG OR

I

ENDED IN A STILLBIRTH SINCE JANUARY 1989. ENTER l'N" IN COLUMN I OF CALENDAR IN THE MONTH
THAT THE PREGNANCY TERMINATED, AND "H" IN EACH PRECEDINGMONTH PREGNANT.

I

235

When dld your L a s t m e n s t r u a l

period

~tart?

DAYS AGO . . . . . . . . . . . . . . . . .

1

WEE~S AGO

2

MONTHS AGO. . . . . . . . . . . . . . .

]

YEARS AGO. . . . . . . . . . . . . . . .

4 ~__

IN MENOPAUSE. . . . . . . . . . . . . . . . . .

994

gEFORE LAST PREGNANCY

995

NEVER

996

. . . . . . . . .

MENSTRUATED .............

322

I

I SECTIOM 3 :

KNOJLEDGF AMD PRACTICE OF F A M I L Y PLA/~NING i

301 mNow

[ Would like
to talk about family
planning
- the various
delay,
a v o i d o r er'~d a p r e g n a n c y o r a b i r t h .
Which of these

ways el mt'thods that a COuple
ways or methods have you heard

I

can use
about?

to

CIRCLE COOE I IN 302 FOR EACH METHODMENTIONED SPONTANE{TJSLY.
THEN PROCEED DEYvJNTHE COLUMN, READINGTHE NAME AND DESCRIPTIONOF EACH METHOd)NOT MENTIONEDSPONTANEOUSLy.
CIRCLE COOE 2 IF METHO0 IS RECOGNIZED. AND COOE 3 )F NOT RECOGNIZED.
THEN, FOR EACH METHODVJITH C~E I OR 2 CIRCLED IN 302, ASK 303 304 BEFORE PROCEEDING [ 0 THE NEXT METHO0.

302 Have you ever
of (METHO0)?

303 Have you ever
used (METHO0)?

heard

304 Where would you go i f
you wanted t o u s e (METHO0)?

READ DESCRIPTIONOF
EACH METHOD.

(USE CODES BELOW)*
l

J. Pill

,,o. . . . . .

every

takoo p , .

YES/SPONT
................... T
YES/PROBED. . . . . . . . . . . . . . . . . .

day",

NO . . . . . . . . . . . . . . . . . . . . . . . . . .
__
.
121 ]LJD " w . . . . . . .
h ....
loop or
I COil p l a c e d
i n s i d e them by a
doctor
or a nurse".

,,o. . . . . . .

,.~,.JECTlO.$

-]

h .....

"Wonwen carl place a t i s s u e or a
diaphragm or cream in the
vagina before intercourse".
. . . . . . . . . . .

,~ coNo~

". ...........

sheath during sexual

bber

inter

course".
)6~ NORPLANT/IMPLANT.,women can get
rod~

6

the

under

skin

the

in

upper arm t o prevent pregnancy"
.
.
.
.
.
.
.
.

2

YES . . . . . . . . . . . . . . .

1

v
%

2

NO . . . . . . . . . . . . . . . . . . . . . . . . . .

3~
v

NO . . . . . . . . . . . . . . . .

2

Y,S/SPONT

'

YES ...............

,

2
31

NO . . . . . .

2

...................

an operation
t o avoid having a n y m o r e

v I

.

.

.

.

.

.

.

I
v '

YES/SPONT ................... ,

YES/PROBED .................. 2
NO..........................
31

YESISPONT
...................
YES/PROBED
..................
NO. . . . . . . . . . . . . . . . . . . . . . . . .
.
.
.
.
.
.

I

.

2
.31

.
YES/SPONT

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

"Men can have an operation t o

YES/PROBED
..................

avoid having
chi ldr en",

NO

any more

o91PERIOOICABSTINENCE/CALENDAR
SYSTEM "Couples can ovoid

ct heaervtianiwoman
hbecc~ne
gn ps redaysis
exgunaal nm
ot "foi,nr tetehFecl °i kumer oLs eny t h towhen
on

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

. .........

.

.

.

.

.

.

v

.

.

I] I
OTHER
. .

NO . . . . . . . . . . . . . . . . . . . . . . . . . .

.

.

.

2
OTHER

.E. ............... ,
.

.

.

YES. . . . . . . . . . . . . . .

.

OTHER

L~2]

I

NO. . . . . . . . . . . . . . . .
.
.
.
.

Have y. . . . . .

[IITLI

2

2
.

hada~

v
I
2

to avoid having
chi[dren?
YES . . . . . . . . . . . . . . .
NO . . . . . . . . . . . . . . . .

OTHER
.
.

.

ch { Ldren?
YES. . . . . . . . . . . . . . .
1
NO. . . . . . . . . . . . . . . .
2
.
.
.
.
.
.
.
H"" your husb.~
had an operation t o

Iv
2

.

Eli

ol~ration
to avoid
h a v i n g a n y m307

pregnant?
NO

ENTER "0" IN COLUMN 1 OF CALENDAR IN EACH BLANK MONTH

307

-330B I

What have you used or done? (SPECIFY)
CORRECT 303-305 (AND ASK

308

302 IF NECESSARY)

NOW I w o u l d L i k e t o ask you a b o u t t h e f i r s t
you d l d s ~ e t h i D g or used a
e l avold gett+ng pregnant?

method

to

(SPECIFY)

til~

that

delay a pregnancy

t h i n g yeu ever did o¢ inethod you
e v e r used t o d e l a y or a v o i d g e t t i n g p r e g n a n t ?

What I s the f i r s t

P[LL . . . . . . . . . . . . . . . . . . . . . . . . . . . .

01

CONDOM. . . . . . . . . . . . . . . . . . . . . . . . . .
FEMALE S I f R I t l Z A I I O N . . . . . . . . . . . .
MAkE STERILIZAI]OR . . . . . . . . . . . . . .
PLRIODIC ABSIINENGE. . . . . . . . . . . .
WIIHDRAWAL
......................
OTHER

07
OB
09
910
6

1

I

IUO. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
02
INJECFIONS. . . . . . . . . . . . . . . . . . . . . .
03
IMPLANFS/NORPLANI. . . . . . . . . . . . . . .
04
[NTRAVAG/DIAPHRAGM/FOAM/JELLY...05
06

t >308B

(SPECIFY)

308A

Where dld you go to get thls ow~thc.dthe first time?

C.01/IFRNNENT
HOSPITAL .......................

11

HEALTH CENTER. . . . . . . . . . . . . . . . . .

12
13

FP FIELDWORKER. . . . . . . . . . . . . . . . .
FP MOBILE UNIT . . . . . . . . . . . . . . . . .
OTHER
(SPECIFY)
pRIVATE

14
15

iK)SpIIA~
..................
IP CEINIC ......................
DOEIOR ........................

21
22
23

MIDWIFE ........................

24

pHARMAEY/DRUGSIORE .............

25

OTHER

(SPECIFY)

OTHER

31

VILLAGE DELIVERY POST. . . . . . . . . .
[NIEGRAIED HEALTH POST. . . . . . . . .
FP POST. . . . . . . . . . . . . . . . . . . . . . . .
TRADITIONAL HEALER. . . . . . . . . . . . .
FRIENDS/RELATIVES. . . . . . . . . . . . . .

32
33
34
35

OTHER

96
(SPECIFY)

DON'T KNOW
.

300B

H. . . . .
if

y I,viao c,,Idren

O,d y e a , . . . .

t t,ot " . .

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

98

NUMBER OF CHILDREN. . . . . . . . .

any?

IF NONE, ENTER ' 0 0 ' ,

309

CHECK 303 ITEM 0 7
WOMAN NOT

WOMAN
STERILIZED I ~ [

stERILIzED [i ]

>312A

V

~0

CHECK

22~:

NDT PREGNANT
OR UNSURE

PREGNANT [ ~

[?

.

.

.

.

.

.

>328

V

310A I CHECK I06A:
DIVORCED/
WIDOWED L ~ L

CURRENTLY MARRIED~1--]

- -

-

>33oH

V
i

311 I

Are you c u r r e n t l y d o i n g S o m e t h i n g oc u s i n g any method
t o d e l a y o r a v o i d getting pregnant?

I

]12

Which

312A

CIRCLE ' 0 7 ' FOR FEMALE STERILIZATION,

n~thod

are

you

uslng?

YES .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2

>330B

PILL
01
02
>317
IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . .
INJECTIONS. . . . . . . . . . . . . . . . . . . . .
OS
>316H
[MPLANT/NORPLANT . . . . . . . . . . . . . . .
04
>317
[NTRAVAG/DIAPHRAGM/FOAM/JELLY..O5
>317
Ofi-->316K
CONDOM. . . . . . . . . . . . . . . . . . . . . . . . .
FEMALE STERILIZATION. . . . . . . . . . .
07
MALE STERILIZATION. . . . . . . . . . . . .
OB
>317
PERIODIC ABSTINENCE . . . . . . . . . . . .
09
WITHDRAWAL . . . . . . . . . . . . . . . . . . . . .
OTHER
910 ~
>328
.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

I

(SPECIFY)

9

324

NO.
315A

At the t l r ~ you f i r s t started using the p i t t ,
consult a doctor or a midwife?

315B

Do you have a package of p i l l s

315C

did you

in the house?

Please show me the packa9e of p i l l s

SKIP
TO

COOING CATEGORIES

QUESTIONS AND FILTERS

you

YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2

DK. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

B

YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2- -->316

PACKAGE SEEN. . . . . . . . . . . . . . . . . . . . .

BRAND N

.R
(E
.C
.O
.R.D. . N
. AMEn
iO
' FBRAN°)

A

M

E

:

>316A

PACKAGE NOT SEEH. . . . . . . . . . . . . . . . .
316

Why d o n ' t you have a package of p i ( l s
t h e house?

in

I

I

2

RAN OJf . . . . . . . . . . . . . . . . . . . . . . . . . . .
COST TOO MUCH. . . . . . . . . . . . . . . . . . . . .
ffUSBANO AWAY. . . . . . . . . . . . . . . . . . . . . .
HAS PERIO0. . . . . . . . . . . . . . . . . . . . . . . .

l-2---. 4
3---~>3160
4

OTHER

6

I

(SPECIFY)

316A

CHECKPACKET FOR PILL USE AND MARK

PILLS MISSING IN ORDER............1

A CORRECT COOE*

316B

PILLS "'SS,.G C~JT OF ORDER. . . . . . . .
NO PILLS MISSING. . . . . . . . . . . . . . . . . .

Why i s i t t h a t you have not taken the
pills

DOESN'T KNOWWHAT TO O0 . . . . . . . . . . .
HEALTH REASONS
FOLLOUING FP FIELDWXSRKER'S
INSTRUC][ON. . . . . . . . . . . . . . . . . . . . . .
NEg PACKET. . . . . . . . . . . . . . . . . . . . . . . .
MENSTRUATING. . . . . . . . . . . . . . . . . . . . . .
OTHER

( i n order)?

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

I

1

.

I

I
316E I

I

' ]

.

~ _ >316E
3
4
S---

m

(SPECIFY)
316DI

I >316E

2 m
3

NAME--

SHOWBRANDCHART FOR PILLS:
Please t e l l me which of these is the

brand of p i ( t s t h a t you are using.
DOESN~T KNOW. . . . . . . . . . . . . . . . . . . . .

98

(RECORD NAMEOF BRAND)

When was the Last time you took a p i l l ?

OA,SAGO:

MORE THAN OWE MONTHAGO. . . . . . . . .
|

MORE THAN TWO DAYS
AGO

TWO DAYS AGO OR
LESS
~L

V

316G I Why a r e n ' t you taking the p i l l

these days?

HUSBANDAWAY. . . . . . . . . . . . . . . . . . . . . .
FORGO]. . . . . . . . . . . . . . . . . . . . . . . . . . . .

01

02
O] - -

HEALTH REASONS. . . . . . . . . . . . . . . . . . . .
COST TOO MUCH. . . . . . . . . . . . . . . . . . . . .
NO NEED TO TAKE OAILY
RAN OUT. . . . . . . . . . . . . . . . . . . . . . . . . . .
HAS PERIOD. . . . . . . . . . . . . . . . . . . . . . . .
.

.

.

.

.

.

.

.

.

.

.

.

04 -0506--

.

>317

07
9&

OTHER
(SPECIFY)

I
316H I When did

you l a s t have an injection?

MOUTHSAGO. . . . . . . . . . . . . . . . .

I

! 3161

CHECK316H:

316] I MORETHAN THREE MONTHS

THREE MONTHS AGO OR

AGO
~

V

LESS

>317

|

[

31bJ|

Why h a v e n ' t you had an i n j e c t i o n r e c e n t l y ?

HUSBANDAWAY. . . . . . . . . . . . . . . . . . . . . . .
FORGOT. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HEALTH REASONS. . . . . . . . . . . . . . . . . . . . .
COST TOO MUCH. . . . . . . . . . . . . . . . . . . . . .

I~
2
S4-6

OTHER

10

325

>317

NO,

QUESTIONS AND FILTERS

31~

I SKIP
TO

COOING CATEGORIES

Please show rite the package of condoms
t h a t your husband i s u s i n g .

BRAND NARE:

E ~ I

(RECORD NAHE OF BRAND)

NOT~.L-~ T~ $H0¢4. . . . . . . . . . . . .

.,..98 I

316L

Why canSt you show me the package of
condoms t h a t your husband is using?

HUSBAND KEEPS. . . . . . . . . . . . . . . . . . . . .
RAN OUT. . . . . . . . . . . . . . . . . . . . . . . . . . .
OTHER
(SPECIFY)

316M

SHOW gRAND CHART FOR CONDOMS:
Please t e l l me which of these i s the
brand of condor~ t h a t your husband is u s i n g .

BRAND NAME:

How ~Jch does ( d i d )

S17

>317

1
E
6

[ ~

e KNO~. . . . . . . . . . . . . . . . . . . . .
DOESNT

98

METHOD

i t cost you f o r :

1 c y c l e ( p a c k e t ) of p i l l s
the IUD
an i n j e c t i o n

I
I

the i m p t a n t / N o r p t a n t

FREE METHO0. . . . . . . . . . . . . .

9999995

intravag/diaphra@mJfoam/jetty

PACKAGE. . . . . . . . . . . . . . . . . .

9~4

a package of coP¢lo~ (col~tains 3 pieces)
the s t e r i l i z a t i o n

SERVICE

operation

c°S'(RP" I I j I I I U

How much was the s e r v i c e and r e g i s t r a t i o n

fee, i f any?

FREE SERVICE. . . . . . . . . . . . .

9999996

FREE METHOD AND SERVICE..99999'97 - - DON'T KNOW. . . . . . . . . . . . . . .
317AI

In o b t a i n i n g (METHOD) d i d you pay a t l j

317A21

~:1o p a i d f o r the f a m i l y p l a n n i n g method you are using?

317B I

]ITC|

[

517Cll

part~ or nothing?

>317B

1-->317B
2 I
3 I
8~->317B

COMPANY/INSURANCE. . . . . . . . . . . . . . .
OFFICE . . . . . . . . . . . . . . . . . . . . . . . . . .
FAMILY . . . . . . . . . . . . . . . . . . . . . . . . . .
OTHER
(SPECIFY)
DONST KNO~. . . . . . . . . . . . . . . . . . . . . .

I
2
S
6
8

PILL . . . . . . . . . . . . . . . . . . . . . . . . . . .
01
IUO . . . . . . . . . . . . . . . . . . . . . . . . . . . .
02
INJECTIONS . . . . . . . . . . . . . . . . . . . . .
83
]MPLANT/NORPLANT. . . . . . . . . . . . . . .
04
INIRAVAG/D]APNRAGN/FOAM/JELLY,.05
CONDOI4. . . . . . . . . . . . . . . . . . . . . . . . .
06
FEMALE STERILIZATION . . . . . . . . . . .
07
MALE STERILIZATION . . . . . . . . . . . . .
O~>317E

CHECK 312:
CIRCLE FOR HETHO0:

I n what month and year d i d you o b t a i n (METHC~) the l a s t
tin~?

CHECK 312:

9999998 - -

YES, ALL . . . . . . . . . . . . . . . . . . . . . . . .
YES~ PART. . . . . . . . . . . . . . . . . . . . . . .
NOTHING. . . . . . . . . . . . . . . . . . . . . . . . .
DON'T KNOW. . . . . . . . . . . . . . . . . . . . . .

Y iiiiiiiiiiiiiiiiiiiiiiiii

IMPLANT/NORPLANT
OTHER

I
CHECK 317C:

SINCE JANUARY 1989

BEFORE JANUARY 1989

11

326

NO.

317C3

317D

QUESTIONS AND FILTERS

SKIP
TO

COOING CATEGORIES

k~hy d i d you n o t o b t a i n a n o t h e r i m p t a n t / N o r p t a n t ?

MENOPAUSE. . . . . . . . . . . . . . . . . . . . . .
HUSBAND AWAY. . . . . . . . . . . . . . . . . . .
AFRAID . . . . . . . . . . . . . . . . . . . . . . . . .
FORGOT. . . . . . . . . . . . . . . . . . . . . . . . .
NOT FOUND. . . . . . . . . . . . . . . . . . . . . .
COST TOO MUCB. . . . . . . . . . . . . . . . . .
AVAILABILITY. . . . . . . . . . . . . . . . . . .
OTHER
(SPECIFY)
D ~ ' T KNOtg. . . . . . . . . . . . . . . . . . . . .

Where d i d you o b t a i n (HETBO0) t h e l a s t tirile?

GOVIERIJqEMT
HOSPITAL. . . . . . . . . . . . . . . . . . . . . . .
HEALTH CENTER. . . . . . . . . . . . . . . . . .
FP FIELDIJORKER. . . . . . . . . . . . . . . . .
FP MOBILE UNIT . . . . . . . . . . . . . . . . .
OTHER
(SPECIFY)

11
12
13
141
15

PRIVATE
HOSPITAL. . . . . . . . . . . . . . . . . . . . . . .
FP CLINIC . . . . . . . . . . . . . . . . . . . . . .
DOCTOR. . . . . . . . . . . . . . . . . . . . . . . . .
MIDI,/I FE . . . . . . . . . . . . . . . . . . . . . . . .
PHARMACY/DRUGSTORE. . . . . . . . . . . . .
OTHER
(SPECIFY)

21
22
23
24
35
26

RECORD NAME OF METHOD SOURCE. PROBE TYPE Of METHOO
SOURCE AND CIRCLE CORRECT CODE.

(NAME OF PLACE)

01
02
03
04
05
06
07
96
98

OTHER
VILLAGE DELXVERY POST. . . . . . . . . .
INTEGRATED HEALTH POST. . . . . . . . .
FP POSY. . . . . . . . . . . . . . . . . . . . . . . .
TRAD[TIONAL HEALER. . . . . . . . . . . . .
FR]ENDE/RELATIVES . . . . . . . . . . . . . .
OTHER
(SPEC[FY)
DONfT KN(7~. . . . . . . . . . . . . . . . . . . . .

31
33
33
34
35
96
98

317E

g h a t i s t h e main reason you decided t o use
(CURRENT METHO0 IN 312) r a t h e r t h a n some o t h e r
methods o f f a m i l y p l a n n i n g ?

RECOPA4EMDATION OF
FAMILY PLANNING WORKER. . . . . . . .
01
RECOMMENDATION OF
FRIENDS/RELATIVES . . . . . . . . . . . . .
02
SIDE EFFECTS OF OTHER HETHUDS..O3
CONVENIENCE. . . . . . . . . . . . . . . . . . . .
O4
ACCESS/AVAILABILITY . . . . . . . . . . . .
05
LO~ER COST. . . . . . . . . . . . . . . . . . . . .
O6
WANTED PERMANENT METHOD. . . . . . . .
07
HUSBAND PREFERRED. . . . . . . . . . . . . .
08
WANTED MORE EFFECTIVE METBO0...O9
OTHER
96
(SPECIFY)
DON'T KNOt#. . . . . . . . . . . . . . . . . . . . .
98

31TF

Are yc~ h a v i n g any h e a l t h problems i n u s i n g
(CURRENT METHOD IN 312)?

YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2---->317H

317G

What i s t h e main h e a l t h problem
(CURRENT METHOD IN 312)?

WEIGHT GAIN . . . . . . . . . . . . . . . . . . . .
WEIGHT LOSS. . . . . . . . . . . . . . . . . . . .
BLEEDING. . . . . . . . . . . . . . . . . . . . . . .
HYPERTENSION. . . . . . . . . . . . . . . . . . .
HEADACHE
QUEASY. . . . . . . . . . . . . . . . . . . . . . . . .
AMENORRHEA. . . . . . . . . . . . . . . . . . . . .
MEAK/TIRED . . . . . . . . . . . . . . . . . . . . .
OTHER
(SPECIFY)
OON~T KNOI4. . . . . . . . . . . . . . . . . . . . .

01
02
03
04
05
Q6
Q7
08
96

. . . . . . . . . . . . . . . . . . . . . . .

317H

317[

Are you h a v i n g any o t h e r problems i n u s i n g
(CURRENT METHOD IN 312)?

What i s t h e main p r o b L ~ ?

98

YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2-->317J

HUSBAND D I ~ P P R ~ E S . . . . . . . . . . . .
01
ACCESSIOILITY/AVAILABILITY. . . . . 02
COST T ~ MUCH. . . . . . . . . . . . . . . . . .
03
INE~VENIENT TO USE . . . . . . . . . . . .
04
SIERILIZED~ BUT WANTS CHILDREN*D5
OTHER
(SPECIFY)
O~'T KN~ .....................

RESPONDENT/HUSBAND STERILIZED

NEITHER STERILIZED
~

327

~323

12

NO.
Where d i d

318

the sterilization

SKIP
TO

COOING CATEGORIES

QUESTIONS AND FILTERS
t a k e pLace?

GOVERNMENTHOSPITAL . . . . . . . . . . . . .
HEALTH CENTER. . . . . . . . . . . . . . . . . . .
PRIVATE HOSPITAL . . . . . . . . . . . . . . . .
PRIVATE CLINIC . . . . . . . . . . . . . . . . . .
PRIVATE DOCTOR. . . . . . . . . . . . . . . . . .
O1HER
(SPECIFY)

WRITE THE NAME OF PLACE. PROBE TO IDENTIFY
THE TYPE OF PLACE AND CIRCLE THE APPROPRIATE CODE.

11
12
21

28
23
96

(NAME OF PLACE)
DON'T KNOW. . . . . . . . . . . . . . . . . . . . . .
319

Do y o u r e g r e t t h a t (YC4J/YC4JR HUSBAND) had t h e o p e r a t i o n
n o t t o h a v e any (mere) c h i l d r e n ?

320

Why d o (YOU/YOUR HUSBAND) r e g r e t

321

I n ~dlat ¢ o n t h and year was t h e s t e r i l i z a t i o n

32Z

the operation?

98

YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z

>321

RESPONDENT ~ANTS ANOTHER C H I L D . . . . 1
HUSBAND WANTS ANOTHER CHILD . . . . . . . Z
SiDE EFFECTS . . . . . . . . . . . . . . . . . . . . . .
3
CHILD DiED . . . . . . . . . . . . . . . . . . . . . . . .
4
OTHER
6
(SPECIFY)

performed?

CHECK: 321
STERILIZED BEFORE
JANUARY 1989

STERILIZED SINCE
JANUARY 1989
[~
ENTER COOE FOR STERILIZATION (COOE 7 OR
8)
IN MONTHOF INTERVIEW OF THE CALENDAR
AND IN EACH MONTH BACK TO THE DATE OF
THE OPERATION. GO TO 330B,

ENTER CODE FOR STERILIZATION (COOE 7 OR 81
IN MONTH OF INTERVIEW IN COLUMN 1 OF THE
CALENDAR AND EACH NONTff SACK TO JANUARY 1989

MAIN OTXET
REASOI~ REASO~

P e o p l e s e l e c t t h e pLace where t h e y g e t f a m i l y p ~ a n n i n g
s e r v i c e s for v a r i o u s r e a s o n s , The p l a c e i s s e l e c t e d
may b e more c o n v e n i e n t o r g i v e b e t t e r s e r v i c e s o r i s
cheaper.

323

ACCESS- RELATED REASOIIS
CLOSER TO HONE. . . . . . . . . .
CLOSER TO ~ R K . . . . . . . . . .
AVAILABILITY OF
TRANSPORT. . . . . . . . . . . . . .
LONGER HOURS OF
OF OPERATION . . . . . . . . . . .
USE OTHER SERVICES
AT THE FACILITY . . . . . . . .
SERVICE-RELATED REASONS
STAFF MORE COHPETENT/
FRIENDLY . . . . . . . . . . . . . . .
CLEANER. . . . . . . . . . . . . . . . .

I n y o u r c a s e r what was t h e m a i n r e a s o n you went t o t h e
p l a c e y o u d i d r a t h e r t h a n t o some o t h e r p l a c e s ?
RECORD RESPONSE AND CIRCLE CODE.

Any o t h e r

reasons?

01
OZ

81
02

03

03

04

OR

05

05

06
07

06
07
08
09

OFFERS MORE PRIVACY ..... OB

RECORD RESPONSE AND CIRCLE CODE.

SHORTER WAITING T I M E . . . . 0 9
LO~tER COST............... 10
WANTED ANONYMITY . . . . . . . . .
11
OTHER
96
(SPECIFY)
NO OTHER REASON. . . . . . . . . . . . . . . . .
OTHER
(SPECIFY)
DONST KNOt~. . . . . . . . . . . . . . .
08
328

B e t w e e n t h e f i r s t d a y o f a wocPan's p e r i o d and t h e
first day of her next period, are there certain
t i m e s when s h e has a g r e a t e r chance Of bec~Alting p r e g n a n t
than other times?

BZaA

D u r i n g w h i c h t i c k s o f t h e m o n t h l y c y c l e does a Woman
h a v e t h e g r e a t e s t chance o f becomin B p r e g n a n t ?

Ig

11
12
96

YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
OON'T KNOI~. . . . . . . . . . . . . . . . . . . . . . .

DURING HER PERIO0

.

.

.

.

.

.

.

.

1
2--

BE

.

.

.

.

.

.

.

.

1!

I RIGHT AFTER HER PERIOD
HAS ENDED. . . . . . . . . . . . . . . . . . . . . . . .
Z
IN THE NIBBLE OF THE CYCLE . . . . . . . .
B
JUST BEFORE HER PERIOD B E G I N B . . . . , 4
OTHER
6
DON'T KNOW. . . . . . . . . . . . . . . . . . . . . . . .

ZBA11

.

>330A

8

CHECK 312:
PER]O0]C ABSTINENCE
OR WITHDRAWAL
[~
V

OTHER
HETHOOS[ ~

>3301

B

3zBBI

I

328Cl

Do you a b s t a i n f r o m s e x o n days Hhen you a r e c e r t a i n
t h a t y o u h a v e a g r e a t e r chance o f becoming p r e g n a n t ?
How d o y o u d e t e r m i n e x h i c h d a y s o f y o u r ~ o n t h L y
cyc(e not to have sexual relations?

I

YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2-->330A

BASED ON CALENDAR. . . . . . . . . . . . . .
BASED ON BOOY TEMPERATURE. . . . . .
BASED ON CERVICAL MUCUS
(BiLLiNGS METHO0) . . . . . . . . . . . .
BASED ON BQOY TEMPERATURE
AND CERVICAL MUCUS. . . . . . . . . . .
OTHER
(SPECIFY)
NO SPEC[FIC SYSTEM. . . . . . . . . . . . .

01
OZ
03
04
96
05

328
13

33OR

I

QUESTIONS AND FILTERS

NO.

SKIP
TO

COOING CATEGORIES

ENTER METHOD COOE FROM 312 IN CURRENT MONTH IN COLUMN 1 OF CALENDAR. THEN DETERMINE WHEN
SHE STARTEO USING THIS METRO0 THIS TIME, ENTER NETHO0 COOE IN EACH MONTH OF USE.
ILLUSTRATIVE QUESTIONS:
" When d i d you s t a r t u s i n g t h i s methed c o n t i n u o u s l y ?
" MOW t o n g h a v e y o u been using t h i s method c o n t i n u o u s l y ?

33oe

] w o u l d L i k e t o ask some q u e s t i o n s a b o u t at[ o f t h e nletheds y o u u s e d t o a v o i d G e t t i n g
pregnant in the last five years.
USE CALENDAR TO PROSE FOR EARLIER PERIOOS OF USE AND NONUSE, STARTING WITH MOST RECENT
USE, BACK TO JANUARY 1989.
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIOOS OF PREGNANCY AS REFERENCE POINTS.
]N EACH MONTH, ENTER CGOE FOR METHO0 OR "O" FOR NONUSE IN COLUMN 1.
ENTER COOEE FOR DISCONTINUATION NEXT TO LAST MONTH OF USE.

IN COLUMN 2,

NLIMBER OF COOEG ENTERED IN COLUMN 2 MUST @E THE SAME AS
THE NUMBER OF ]NTERRUPTIORS OF CONTRACEPTIVE USE IN COLUMN 1,
ASK WHY SHE STOPPED USING THE METHO0. IF A PREGNANCY FOLLC~JED, ASK WHETHER SHE
BECN4E PREGNANT UN]NTENTIONALLY WHILE USING THE METHO0 OR DELIBERATELY STOPPED
TO GET PREGNANT.
ILLUSTRATIVE QUESTIONS:
COLUMN I:
-~hen was the Last time you used 8 method? Which l~thed was that?
"When d i d you s t a r t u s i n g t h a t method? How l o n H a f t e r t h e b i r t h o f (NAME)?
-HOW Long d i d you u s e t h e method then?
COLUMN 2:
-Why d i d you s t o p u s i n g t h e (METHO0)?
"Did you become p r e g n a n t w h i l e u s i n g (METHOD), o r d i d you s t o p t o g e t p r e g n a n t ,
or s t o p f o r some o t h e r reason?
IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK:
"How many m o n t h s d i d it t a k e you t o g e t p r e g n a n t a f t e r
ENTER " O " IN EACH SUCH MONTH IN COLUMN 1.
330C

330C1

D i d you b e l o n g t o a g r o u p w h i c h i s r e l a t e d
family planning?

to

What i s t h e name o f g r o u o w h i c h you a t t e n d t h e [ a s t t i c e ?

you s t o p p e d u s i n g (METHOD)?
YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2---->33~

NAME
(SPECIFY)

330C2

ghen did the last

tire

you a t t e n d t h a t g r o u p l s m e e t i n g ?

330C3

Does t h e g r o u p c o l l e c t
planning activities?

33OD

Have you e v e r seen a s i g n o r h e a r d a b o u t B l u e C i r c l e ?

33001

Can y o u teLL me what

money f o r u s e i n t h e f a m i l y

it

is?

YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1
2

YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DON'T KNOW. . . . . . . . . . . . . . . . . . . . . . .

I
28-->330E

PRIVATE FAMILY PLANNING SERVICE..)
2

OTHER

(SPECIFY)
DON'T KNOE~. . . . . . . . . . . . . . . . . . . . . . .
33DE

Have you e v e r seen a s i g n o r h e a r d a b o u t G o l d e n C i r c l e ?

YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DON'T KNO~¢. . . . . . . . . . . . . . . . . . . . . . .
330E1

331

Can you t e l l

tee what

it

is?

CHECK 2 2 6 : P R E G N A N F [ ~

Have