APPENDIX D SURVEY QUESTIONNAIRES

APPENDIX D

SURVEY QUESTIONNAIRES

[Reduced from

orIg|rmt]

1987NATIONAL INOONESIANCONTRACEPTIVEPREVALEMCE SURVEY
14OUSEHOLD SCHEDULE

IDENTIFICATION

1. PROVINCE o . , ° ° ° . ° . . ° . . . . , . ° ° . . . . ° ° , . . , . . ° ° . . * * . ° °

,,,,,..,,,,,.o°

2. REGENCY/MUNICIPALITY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. SUB-DISTRICT
4. VILLAGE

EEl

5. AREA . . . . 1 URBAN. . . . . . 2 RURAL. . . . . . . . . . . . . . . . . . .
6. ENUMERATIONAREA NUMBER
7. CENSUS BLOIC NUNBER
8. SSN 87 SN4PLE COOE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . °. ° ° ° °. o r - ' - T l ~

9. NICPS SAMPLE C~OE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

°°°°o°°.o.°.

I--F-T-1

............ !-F-F-1

I0. HOUSEHOLDNUMBER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I1. NAME OF HOUSEHOLDREAD

INTERVIEWER VISITS
1

2

]

FINAL VISIT

DATE . . . . . . . . . . . . . . .

MONTH

INTERVIEWER'S NAME..

INTERV. F

RESULT ( * ) . . . . . . . . . .

FINAL RESULT ~ ' ~

NEXT VISIT:

DATE I
TIRE

--I

-

-

I

I

~

TOTAL NUMBER D
OF VISITS

*RESULT COOES:
1 COI4PLETED
2 Hg PRESENT BUT NO
COMPETENT RESPONDENT
AT NONE

NAME

3 POSTPONED
4 REFUSED
5 DWELLING VACANT/
ADDRESS ROT A DWELLING
6 DWELLING DESTROYED

7 DWELLING NOT FOUND
8 OTHER

I ELOOEOI o cEEoE Y EYEOYI EYEOY

DATE

107

We t ~ u t d t i k e some information about the people who u s u a t t y Live i n your household.
NN4ES OF USUAL'RESIDENTS
Ptesse g i v e me the names o f
the parsons who usuaLLy Live
i n your household, s t s r t i n Q
w i t h the head of the ho~sehold.

(1)

RELATID~SNIP

SEX

Whet is the
retmtlor,~hlp
of iNANE) to

other parsons
already recorded in the
household'/
(2)

LINE NO.

WONEW10 AND ABOVE
Nas
(MANE)
ever
been
married?

|s
(NAME)
maLe
or
feeeate?

Row
otd
is
he/
she?

(3)

(4)

(5)

YEARS

YES NO

14

I
V

AGE

01

F
I
V

2
i

i

f
V

I
V

1

2

What is
the h i g h est revel
of school
INANE )
compteted?
(6)

i

LEVEL*

(l

O2
03
O4

05
O6
07
O8
09
10
11

~COOES

FOR EDUCATION LEVEL

TICK HERE IF CONTINUATICW~ SHEETUSEDL--~
NONE. . . . . . . .

CIRCLE LINE NO. FOR ALL EVER-MARRIED UOMEN abe 15 - 49.
TOTAL NUMBEROF ELIGIBLE ~314EN IN HOUSEHOLD

]]J

0 JR. HIGH..]
SOMEPRIMRY.1 $R. HIGH..4
ACAD/UNIV.5
COMPLETED
PRIMARY...2 DK. . . . . . . . 6

Just to make sure that I have t h i s r i g h t :
1) Are there any other persons such as small
c h i i d r e n or i n f a n t s that we have not l i s t e d ?

YES[~->ENTERNAMES NO[----]
IN TABLE

2) Are there any other people who may not be
members of your f a m i l y , such as servants,
f r i e n d s or Lodgers, but who ~ u a L t y Live here?

YES[~->

ENTER NAMES
IN TABLE

NO[~

3) Are there any other 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 for
the past s i x months or more?

YES[-'~--> ENTER NAMES
IN TABLE

NO[--]

4) Are there any persons w4~o usuaLLy t i r e here
~,flo have been away for tess than s i x months?

Y E S [ ~ F > ENTER NAMES
IN TABLE

NO[~

5) Are there any persons we have l i s t e d who have
been away for the past s i x months?

YES[~]--> DELETE NAMES NO[~]
FROM TABLE

108

1 ~ 7 NATIONAL INDONESIAN COI~TRACEPTIVE PREVALENCE SURVEY
NCUSEHOLD CONTINUATION SHEET

NAJ4ES OF USUAL RESIOENTS
Pteese g i v e me the names of
t h e persons who u s u a t t y l i v e
i n your household, s t a r t i n g
w i t h t h e head of the household.

(1)

sex i A':E IUO.ENIOANOA"OVE

RELATIONSHIP
~het i s t h e
retetionsh|p
of (NAME) to
o t h e r persons
a l r e a d y recorded i n the
household?

Is
(NAME)
mate
or
femat e?

(3)

(2)

HO~
otd
t$
he/
she?

I
|
l
I
I

(4)

I

m l

LINE
NO.

Has
(HARE)
ever
been
married?.

What i s
the highest |eve[
of school
(NAME)
compteted?

(6)

(5)

YEARS | YES NO

LEVEL*

l

I

V

13
=

14

2

15

2

16

2

17

2

18

2

19

2

20

1

2

21

1

2

22

1

2

23

1

2

24

1

2

TOTAL NUMBER OF EL G 8LE ~I4EN

N HOUSEHOLD

J t l

L I

]09

I

m

2

I -ll, 2
1 1,2

9_

1 1,2

FOR ALL EVER-NARRIED t~C~EN A G E ~ 1 5- 49.
CIRCLE LINE NO,

=

*COOES
LEVEL
NONE
. . . . .FOR
. . . EDUCATION
0 JR. HIGH..3
SOME PRIHRY.1 SR, HIGH..4
CONPLETED
ACAD/UNIV.5
PRIMARY...2 DE . . . . . . . . 6

[Reduced from o r i g ] r m L ]

1967 NATIONAL INDONESIANCCI4TRACEPTIV1EPREVALENCESURVEy
INDIVIDUAL t~qAN'S QUESTIONNAIRE

IOENTIFICATION

1. PROVXNCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.

00pUllOOOQOIOll

REGENCY/MUNZCIPALITY. . . . . . . . . . . . . . . . . . . . . . . . . . . .

0~ . . . . . .

~

110111m ~

3. SUB-DISTRICT
6. VILLAGE
S. AREA . . . .
6.

1 URBAN . . . . . .

r-1

2 RURAL . . . . . . . . . . . . . . . . . . .

ENUMERATIONAREA NUMBER

7. CENSUS BLOK NUNDER
8. SSN 87 SAMPLE CODE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

• ooooo°o°

9, NICPS SAMPLE CODE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

° ....

o , o o ° o o [ ~ " T ~

10, ROUSEHOLDNUlMDER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

,°°.°

.....

• °.

°

°

~

Jl. NAME OF HOUSEHOLDHEAD
12. LINE NUMBEROF I,/OI4Ag FROM HOUSEHOLDSCHEDULE. . . . . . . . . . . . . . . . . . . . .
13. NAME OF WOMAN

INTERVIEWER VISITS
1

2

3

FINAL VISIT

[--[---]

DATE . . . . . . . . . . . . . . .

V~TR

]HTEHVIEWERIS NAME..

INTERV.

RESULT ( * ) . . . . . . . . . .

FINAL RESULT [ ]

NEX, V , S , , :

'."--"

OA,E

TOTAL HUHHER
OF VISITS

TIHE
( * ) RESULT CODES. . . .

1
2

COMPLETED
MOT AT HOME

3
4

POSTPONED
REFUSED

110

5
6

PARTLY COMPLETED
OTHER

NO. |
II IIII
I

CRJESTIONS
AWOFILTERS

J

SKIP

CODINGCATEGORIES

I To

J

101 J RECORDNUMBEROF PEOPLELISTED IN THE
I HOUSEHOLDSCHEDULE.

I NUNBEROF PEOPLE.. ~--]J

103

I HOUR
MINUTES

I

RECORDTHE TIME AT STARTOF INTERVIEW.

. . . . . . . . . . .

104

First I would like to ask some questions
about yourself and your household.
For most of the time until you were 12
years old, did you live in e village,
in a town, or in e city?.
Now tong have you been living
ously in (NAMEOF VILLAGE)?

105

106

I VILLAGE................. 1 I

contirNJ-

I

2

CITY . . . . . . . . . . . . . . . . . . . .

3

95-->107

ALWAYS. . . . . . . . . . . . . . . . .

YEARS. . . . . . . . . . . . . .

In what month

and year

were you born?

IF MONTH HOT IN ~ESTERH CALENDAR, WRITE
NAME:

I MONTH. . . . . . . . . . . . .
DK MONTH. . . . . . . . .

I

COMPARE 107 AND I ~ AND C~RECT IF INCONSISTENT. IF AGE IS 49, STOP.

o

I

I

I
3

F-~
981~

I
I

AGE IN
COMPLETED YEARS...

t

or separated?

110

TO~JN....................

Just before you moved to (NAMEOF VILLAGE) I VILLAGE. . . . . . . . . . . . . . . . .
did you live in the village, in a town, or T O ~ . . . . , . . . . . . . . . . .
....2
in a city?
CITY . . . . . . . . . . . . . . . . . . . .

107 |

109

~ J

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

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

WIDOWED . . . . . . . . . . . . . . . . .
2
| DIVORCED/SEPARATED . . . . . . 3

J*"

Have you ever attended school?

I NO. . . . . . . . . . . . . . . . . . . . . .
.

I

What was the highest level of ~ c h ~ [ you
attended: p r i m a l , junior high, senior
high, academy, or u n i v e r s i % ~

.

.

.

.

.

.

.

.

.

.

.

.

.

2-->113
.

I

.

.

.

.

.

.

;

PRIMARY.SCHOOL .......... I - - > 1 1 1
JUNIOR HIGH SCHOOL ...... 2
S E W I ~ HIGH SCHOOL ...... 3

I ACADEMY. . . . . . . . . . . . . . . . .

4-->111

UNIVERSIIY .............. 5 - - > 1 1 1

llOA I Was that a v~ational or general high
| school?

|

I
2

111

GENERAL . . . . . . . . . . . . . . . . .
VOCATIONAL

I
2

J

I

NO. I

I

QUESTIONSAMO FILTEHS

[

CODING CATEGORIES

~IP

TO

[ °H~E,crass.......... [~I

m

1111whltW.

the highest g r a d e ( c l n s )
compLeted st that Level?
| IF COMPLETED LEVEL, CODE 7.

I you

DONT KNOW. . . . . . . . . . . . . . .

8

1
I

i

CHECK 110:

112

PRINARY L I J

I

JUNION HIGH SCHOOL OR HIGHER 9

->114

/
V

Can you reed • Letter or netmpaper e a s i l y ,
with d i f f i c u l t y ,
or not at aLL?

113

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

I +NO. ......................
....................
2'1

0
o + - - , , mt
y r .(east
+ . _ _once
+ r oar .w~ek?
magazine
115

116

117

116

I

0o you usua(ty watch t e l e v i s i o n
once a week?

I

1 I
I
3---,115

2

at least

I + ..................... 2'I
NO. . . . . . . . . . . . . . . . . . . . . .

Do you usually l i s t e n to a radio every da~m

k'nat i s the major source of d r i n k i n g
water f o r members of your househotcl?

~A~at i s the major source of water f o r
househotd use other than d r i n k i n g (e.g.
washing, cooking) f o r members of your
household?

I ++......................
.....................

~'1

PIPE . . . . . . . . . . . . . . . . . . . .
pLl~p . . . . . . . . . . . . . . . . . . . .
WELL. . . . . . . . . . . . . . . . . . . .
SPRING. . . . . . . . . . . . . . . . . .

1
2
3
4

RIVER . . . . . . . . . . . . . . . . . . .
RAINWATER. . . . . . . . . . . . . . .
OTHER
(SPECIFY)

5
6

PIPE . . . . . . . . . . . . . . . . . . . .
PUMP. . . . . . . . . . . . . . . . . . . .

I
2

WELL . . . . . . . . . . . . . . . . . . . .
SPRING. . . . . . . . . . . . . . . . . .
RIVER . . . . . . . . . . . . . . . . . . .

3
4
5

RAINWATER. . . . . . . . . . . . . . .
OTHER

6

7

7

(SPECIFY)

120

l

~at ki~ of toi[et facility does your
h~sehotd have?

I PRIVATE, WITH SEPTIC T..1
PRIVATE, NO SEPTIC TANK.2
SNARED/PUBL
OTHER

112

I C ...........

3

4

NO. I

QUESTIONSAJ4DEILTERS

YES
122 I Does y o u r h o u s e h o l d h a v e or h a v e access t o : I
ELECTRICITY . . . . . . .
1
Electricity?
RADIO OR CASSETTE. 1
A radio or c a s s e t t e ?
TELEVISION . . . . . . . .
1
A te[evJsion?
A g a s , k e r o s e ~ , or e l e c t r i c
stove?
STOVE . . . . . . . . . . . . .
1

I

123

I

i0I sceoy-o
sh ov Yer--dhv °r
A non-motor vehicle?
A motor v e h i c t e ?

124

NON-NOTOR VEHICLE..
NOTOR VEHICLE . . . . . .

~OD**

1:30

~rnat r e l i g i o n

are you?

113

.......

NO
2
2
2
2

I

YESNOI
1
1

TILE . . . . . . . . . . . . . . . . . . . .
CONCRETE/BRICK . . . . . . . . . .

NAIN NATERIAL OF THE FLO(~.

SKIP
TO

COOING CATEGORIES

I

2
2

1
2

°°°°°°*°°°°3

SANBO0. . . . . . . . . . . . . . . . . .
DIRT/EARTH . . . . . . . . . . . . . .
OTHER
(SPECIFY)

4
S
6

14USLIN . . . . . . . . . . . . . . . . . .
PROTESTANT/CHRISTIAN . . . .
CATHOLIC . . . . . . . . . . . . . . . .
HINDU . . . . . . . . . . . . . . . . . . .
BUDDHIST . . . . . . . . . . . . . . . .
OTHER
(SPECIFY)

1
2
3
4
5
6

SECTION 2:

REPROOUCTION.

G(JESTIONS AWD FILTERS

NO.

201

I

J
SKIP
I TO

COOING CATEGORIES

Now l would l i k e to ask about a l l the
births you have had during your life.
Bave you ever given birth?

202

I

I 'ES

DO you have any son or daughter you have
.....................
given b i r t h to who is now l i v i n g w i t h you? I NO. . . . . . . . . . . . . . . . . . . . . .

'1

2-->204

How many sons l i v e w i t h you?
And how many daughters l i v e w i t h you?

203

IF NONEENTERZEROS.

204

0o you have any son or daughter you have
given b i r t h to who is a l i v e but does not
l i v e w i t h you?

205

How many sons live elsewhere?
Bow many daughters live etsewhere?
IF NONE ENTER ZEROS .

206

Have you ever given b i r t h to a buy or a
g i r l who was burn a l i v e but l a t e r died?
IF NO, PROBE: Any (other) buy or girl who

I SONS ELSEWHERE....

DAUGHTERS
ELSEWHERE........

~ I

I

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

1 I

I

cried or showed any signs of life but
only survived a few hours or days?

NO. . . . . . . . . . . . . . . . . . . . . . 2-->208

I

207 | Now many buys have died?
And how many girts have d~ed?

BOYSDEAD......... ~

IIF NONEENTER

ZEROS .

l

GIRLSDEAD........

I

208 | SUMANSWERSTO203, 205, 207, AND
I ENTERTOTAL. IF NONEENTERZEROS.

J TOTAL.............

~ 1

I

209 | CHECK 208:
Just to make sure that I have this right, you have had in total
tire births d~ring your tile? Is that correct?

F

YES [ ~

210

NO ~

> PROSE AND CORRECT 201-209 AS NECESSARY

I

CHECK 208:
ONE OR MORE
LIVE BIRTHS

NO LIVE BIRTHS

f~
11

>221

I
v

114

211

Mow i would t t k e to t a l k t o you about a l l of your b i r t h s , tdhether s t i l l a l i v e
or n o t , mtmrting w i t h t h e f i r s t b i r t h you had.
RECORD THE NAMES OF ALL LIVE BIRTHS THAT THE IdQMAN HAD STARTING VITN THE FIRST
BIRTH 014 LINE ONE. FILL LN THE NAMES OF ALL CHILDREN, UHETHER OR NOT THEY ARE
STILL ALIVE AND THEN ASK QUESTIONS 213-218 AS APPROPRIATE FOR EACH CHILD,
RECORD TWLNS ON SEPARATE LINES AND MARK WITH A BRACKET.

212
~d~et name
was g i v e n
to yc~Jr
(first,
r~xt)
birth?

214
215
In what
Is
month and
(NAME)
year was
still
(NAME)
alive?
born?
IF MONTH NOT
~ESTERN,
VltiTE NAME.

216
IF DEN): No~
o l d u as (NAME)
when he/she
died? REOORD
DAYS IF UNDER
I MONTH, MONTHS
IF UNDER 2 YEARS
OR YEARS LF MORE
THAN 2 YEARS,

217
IF ALIVE:
Bo~ o l d
was (NAME)
at h i s / h e r
test

YEARS 3
~ TO NEXT BIRTH

AGE

birthday?

218
IF
ALIVE:
is he/
she
Living

with
you
no~?
no~?

m

o, I

YES.....

TO 217317A

DOESN'T KNOW. . . . . . .

..-~.98

IHEH:

MONTH
YEAR . . . . . . . . . . . . .
DOESN'T KNOW...

I
. . . . . . 98

FREE. . . . . . . . . . . . . . .
DK. . . . . . . . . . . . . . . . .

318 I In the last 12 months, have you obtained
a method or advice abo~t how to avoid
pregnancy?

17
2

[-~'~>317A

I BRAND:

315Ml SHOWBRANDCHAR?FOR CONDONS:

317

8-.-

THREE MONTHSAGO OR /-It
I I
LESS

315KII Please

I

7

.......

315J I Why haven't you had an injection
I recentty?

TO

/

m

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

9999~6 J 319
99'999~:~
1-->3198
2-->321
|

NO.

QUESTIONS ANO FILTERS

319

FP CLINIC/NEALTN
CENTER/ KO~PITAL . . . . . .
FAMILY PLANNING
FIELDk~RKER. . . . . . . . . . .
FPPOST/ OOMI4UNITY
ORGANIZATION. . . . . . . . . .
FP MOBILE UNIT . . . . . . . . .
SAFARI/CAMPAIGN . . . . . . . .

~ e r e d i d you obtmin (METHOD) t h e l a s t
timm?

OR

319A tdhere d i d t h e s t e r i l i z a t i o n

3198 Where or from whom d i d you g e t m method
or mdv|ceT

Was t h e r e a n y t h i n g you d i s l i k e d
s e r v i c e y~J received there?
IF YES:

about t h e

~nat?

CHECK 221:
NOT PREGNANT [ ~
ON NOT SURE

I

322

02

l>321

WAIT TOO LONG. . . . . . . . . . .
1
STAFF DISCOURTEOUS. . . . . . 2
EXPENSIVE . . . . . . . . . . . . . . .
3
NOT ABLE TO GET DESIRED
SERVICES/METHOO . . . . . . . . 4
MALE STAFF. . . . . . . . . . . . . .
5
OTHER
.6
(SPECIFY)
NO COMPLAINTS. . . . . . . . . . .
7

IF MORE THAN ONE REASON, CIRCLE MOST
IMPORTANT
321

01

03
04
05
PHARMACY/ SHOP . . . . . . . . .
06
PRIVATE DOCTOR. . . . . . . . .
07
PRIVATE MIDWIFE . . . . . . . . 08
PUBLIC HEALTH POST. . . . . 09
TRADITIONAL HEALER. . . . . 1 ~
11
OTHER. . . . . . . . . . . . . . . . . .
DON+T KNOW. . . . . . . . . . . . .
9~

t a k e piece?

OR

320.

SKIP
TO

O(~ING CATEGORIES

l

>339

PREGNANT ~

V

CHECK 313, 314:
HE/SHE
STERILIZED [ ]
(SKIP TO 324)

CURREHTLY
USING ANOTHER [ ~
METHOO

NOT
CURRENTLY

~

>332A

USING

V

323

325

For how tong have you been u s i n g (CURRENT
NETHO0) c ~ t i n u o ~ [ y ?

MONTHS. . . . . . . . . . . .
YEARS. . . . . . . . . . . . .

u s i r ~ (CURRENT METHOD)?

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

What is the main problem yo~ experienced?
U~ITE BRIEFLY AND CLEARLY.

13

122

2-->326

NETHO0 FAILED . . . . . . . . . .
02
HUSBAND DISAPPROVES....O3
HEALTH CONCERNS. . . . . . . . 04
ACCESS/AVAILABILITY....05
COSTS TOO MUCH. . . . . . . . .
06
INCONVENIENT TO U S E . . . . 0 7
REL|GXOUS/HORAL. . . . . . . . 08
OTHER. . . . . . . . . . . . . . . . . .
11
(SPECIFY)

NO. I

QUESTIONSANO FILTERS

I

326 I I n t h e same month, do you r e g u l a r l y
I YES . . . . . . . . . . . . . . . . . . . . .
| use any o t h e r method t h a n (CURRENT NETH(X))? s NO. . . . . . . . . . . . . . . . . . . . . .
Which method is t h a t ?

327

329

SKIP
TO

1 |
2-->]28

PiLL . . . . . . . . . . . . . . . . . . .
01
IUD . . . . . . . . . . . . . . . . . . . .
02
INJECTIONS . . . . . . . . . . . . .
03
DIAPHRAGM/FOAM/JELLY...O~
CONDOM. . . . . . . . . . . . . . . . .
05
NORPLANT. . . . . . . . . . . . . . .
08
PERICOIC ABSTINENCE . . . . 10
WITHDRAWAL. . . . . . . . . . . . .
11
PROLONGED ABSTINENCE...12
HERBS (JANU) . . . . . . . . . . .
13
ABOOI~L K,kSSAGE ( P I J A T ) 1 4
OTHER
15
(SPECIFY)

CHECK ] 0 2 - 3 0 5 FOR THIS NETHCO ANO CORRECT
IF NECESSARY.

328 I ( S i n c e Y ° u r t e s t b i r t h ) ,
have Y°U used
| any o t h e r method b e f o r e (CURRENT NETHO0)
I to avoid a pregr~ncy or birth?

I

COOINGCATEGORIES

I YEs

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

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

Which method d i d you use b e f o r e (CURRENT
HETHO0)?

PILL . . . . . . . . . . . . . . . . . . .
IUD . . . . . . . . . . . . . . . . . . . .
INJECTIONS . . . . . . . . . . . . .

1 I
2-->341A

01
02
03

DIAPHRAGM/FOAM~JELLY...04
CORDOI4. . . . . . . . . . . . . . . . .
OS
FENALE STERILIZATIOR...06
NALE STERILIZATION . . . . . 07
NORPLANT. . . . . . . . . . . . . . .
08
ABORTION . . . . . . . . . . . . . . .
09
PERIOOIC ABSTINENCE . . . . 10
WITHDRAWAL. . . . . . . . . . . . .
11
PROLONGED ABSTINENCE...12
HERBS (JAMU) . . . . . . . . . . .
13
ABOOM'L MASSAGE (PZJAT)14
15
OTHER

(SPECIFY)
330
(NETHOD BEFORE CURRENT)?
IF NONTH NOT ~STERN, URITE NANE

331

332

I

HONTH
YEAR. . . . . . . . . . . . . .

For how long d i d you use (METHO0 BEFORE
CURRENT) ( t h e tas~ t i m e ) ?

What was t h e main reason you s t o p p e d u s i n g
(METHO0 BEFORE CURRENT) then?
IF ANSUER iS "S~ITCHED TO OTHER NETHO0",
PROBE TO FiND REASON

14

123

I

HON/HS . . . . . . . . . . . .
YEARS. . . . . . . . . . . . .
NETHO0 FAILED . . . . . . . . . .
02-HUSBAND DISAPPROVES....03
HEALTH CONCERNS. . . . . . . .
04
ACCESS/AVAiLABILITY . . . . 05
COSTS TOO HUCH. . . . . . . . .
06
>341A
INCONVENIENT TO USE . . . . 07
RELIGIOU$/NORAL . . . . . . . .
08
[NFREOUEHT SEX . . . . . . . . .
09
FATALISTIC . . . . . . . . . . . . .
10
OTHER
11
(SPECIFY)

NO.

QUESTIORS ANO FILTERS

332A

SKIP
TO

COOING CATEGORIES
DESIRES PREGNANCY. . . . . .
LACK OF KNOWLEDGE
OR LACK OF SOURCE. . . . .

CHECK 221:

O0
01

~,~at i s t h e ~ i n r e a s o n t h a t you a r e n o t
=(r~g a method to avoid pregna~y?

OPPOSED TO FP . . . . . . . . . .
02
HUSBAND DISAPPROVES..o.03

IF PREGNANT, CIRCLE " ~ " .

OTHER PEOPLE DISAPPR.°.04
INFREQU~ENT SEX . . . . . . . . .
05
POSTPARTUM/BF . . . . . . . . . .
06
HENOPAUSAL/SUBFECUND...07
HEALTH CONCERNS. . . . . . . .
08
ACCESS/AVAILABILITY....09
COSTS TOO HUCH. . . . . . . . .
10
FATALISTIC . . . . . . . . . . . . .
11
RELIGION . . . . . . . . . . . . . . .
12
INCOI~YENIENT TO USE . . . . 13

3329

CHECK 3 0 6 :

EVER USED

OTHER

14

(SPECIFY)
CURRENTLY PREGNANT. . . . .
DK . . . . . . . . . . . . . . . . . . . . .

9S
98

NEVER USED

[-7
333

CHECK 2 0 8 :
YES

ANY BIRTHS?
[~

NO ~ ' ~

v
S i n c e yc~Jr East birth have you used any
method to mvoid a pregnancy or m birth?

334

>3s9

>335
I YES . . . . . . . . . . . . . . . . . . . . .
NO. . . . . . . . . . . . . . . . . . . . . .

1 I
2-->339

I

335

ghich

was t h e l a s t m e t h o d y o u used?

PILL ...................
IUO . . . . . . . . . . . . . . . . . . . .

01
02

INJECTIONS . . . . . . . . . . . . .
03
D1APHRAGH/FOAN/JELLY...04
COND(~4. . . . . . . . . . . . . . . . .
05
MALE STERILIZATION . . . . . 07
NORPLANT. . . . . . . . . . . . . . .
08

ABORTION

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

09

PERIOOIC ABSTINENCE .... 10
W%THDRAWAL. . . . . . . . . . . . .
11
PROLONGED ASSTINENCE...12
HERBS (JAMU) . . . . . . . . . . .
13
ABDOH*L MASSAGE ( P I J A T ) 1 4
OTHER
IS
(SPECIFY)
336
IF MONTH NOT WESTERN, WRITE NAME

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

3371F°r'° g' Y e° °gAS I
METHO0) b e f o r e

you stopped using

it?

15

124

MONTHS. . . . . . . . . . . .
YEARS . . . . . . . . . . . . .

NO.

~JESTIONS AJ~ FILTERS
!

338

What was t h e m a i n r e a s o n y ~
(LAST METHCO) t h e n ?

stopped u~ing

339 | Do y o u i n t e n d t o u~e a m e t h o d t o a v o i d
p r e g n a n c y a t any t i m e i n t h e f u t u r e ?

I

340

Which method uc~td you prefer

34' I°°

in

341A

the

TO

COOING CATEGORIES

t o use?

TO GET PREGNANT . . . . . . . .
01
NETHOD FAILED . . . . . . . . . .
02
HUSBAND D I S A P P R O V E S , , . . 0 3
HEALTH CONCERNS . . . . . . . .
04
ACCESS/AVAILABILITY....O5
COSTS TOO NUCH . . . . . . . . .
06
iNCONVENIENT TO U S E . . . . O 7
RELIGIOUS/~L
........
08
INFREQUENT SEX . . . . . . . . .
09
FATALISTIC . . . . . . . . . . . . .
10
I OTHER
11
(SPECIFY)
m YES . . . . . . . . . . . . . . . . . . . . .
I NO. . . . . . . . . . . . . . . . . . . . . .
DK . . . . . . . . . . . . . . . . . . . . . . .

/1
>341A

PILL ...................
01
IOD . . . . . . . . . . . . . . . . . . . .
OZ
INJECTIONS . . . . . . . . . . . . .
03
DIAPHRAGH/FOAH/JELLY..,O~
CONDOM. . . . . . . . . . . . . . . . .
05
FEHALE S T E R I L I Z A T I O N . , . 0 6
MALE STERILIZATION . . . . . 07
NORPLANT . . . . . . . . . . . . . . .
08
ABORTION . . . . . . . . . . . . . . .
09
PERIODIC ABSTINENCE . . . . 10
WITHDRAWAL. . . . . . . . . . . . .
11
PROLONGED A B S T I N E N C E . . . 1 2
HERBS (JAHU) . . . . . . . . . . .
13
ABDON'L MASSAGE ( P I J A T ) 1 4
OTHER
15
(SPECIFY)
DOESN*T KNOU . . . . . . . . . . .
98

PREFEEO'ETO' I YE'..................... '1

n e x t 12 n ~ o t h s ?

I f a wom~n u a n t s t o d e l a y
w h i c h m e t h o d do you t h i n k
f o r h e r t o use?

NO. . . . . . . . . . . . . . . . . . . . . .
DK . . . . . . . . . . . . . . . . . . . . . .

the next birth,
w o u l d be b e s t

PILL . . . . . . . . . . . . . . . . . . .
IUI) . . . . . . . . . . . . . . . . . . . .
INJECTIONS . . . . . . . . . . . . .

2

8
01
02
03

DIAPHRAGH/FOAH/JELLY...O4
CONDO4. . . . . . . . . . . . . . . . .
05
FEMALE S T E R I L I Z A T I O N . . . 0 6
MALE STERILIZATION . . . . . 07
NORPLANT . . . . . . . . . . . . . . .
08
09
ABONTION . . . . . . . . . . . . . . .
PERIODIC ABSTINENCE . . . . 10
WITHDRAWAL. . . . . . . . . . . . .
11
PROLONGED A B S T I N E N C E , . . 1 2
HERBS (JAMU) . . . . . . . . . . .
I]
ABDON'L MASSAGE ( P I J A T ) 1 4
OTHER
15
DOESN'T KNO~/. . . . . . . . . . .
98

16

125

NO.

~JESTIONS AJ~ FILTERS

CODING CATEGORIES

PILL
01
1UD . . . . . . . . . . . . . . . . . . . .
02
INJECTIONS . . . . . . . . . . . . .
03
O i APNI~GN/FOAM/JELLY...04
CO~DON . . . . . . . . . . . . . . . . .
05
FENALE STERI L I Z A T I O W . . . 0 6
HALE STERILIZATION . . . . . 07
NORPLANT . . . . . . . . . . . . . . .
ABORTION . . . . . . . . . . . . . . .
PERIODIC ABSTINENCE . . . . 10
WI T HDRAWAL. . . . . . . . . . . . .
11
PROLORGED ABSTINENCE,.. 12
HERBS (JANU) . . . . . . . . . . .
13
AEIOONSL HASSAGE ( P I J A T ) 1 4
OTHER
15
DOESN=T KNOW. . . . . . . . . . . 98
.

341B

~2

I f a woman has a r t t h e c h i t d r e n she wants,
which method do you t h i n k woutd be best
f o r h e r to use?

I

I n t h e f a s t month, have you heard or seen
a message mbout ramify p t a n n i n g on the
r a d i o or on the t e t e v i s i o n ?

I

TO

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

YES .....................
NO. . . . . . . . . . . . . . . . . . . . . .
NO RADIO OR TV . . . . . . . . . .

1 I
2-->344
3-->344

I

you i n t h e past s i x months?

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

2

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

345 I Have Y°U ever heard ° f OuaLima?

1 I
2-->345B

I

~SA I

]

Can you t e l t

me what i t

is?

CONDOM. . . . . . . . . . . . . . . . . .
I
FAMILY PLANNING METHOd)..2

DO ROT READ RESPOWSES.

OTHER

345B Of

t h e sources 1 8in going to mention,
which do you t h i n k a r e an a p p r o p r i a t e
source f o r f a m i l y p t a n n i n g i n f o r m a t i o n ?

READ

346

RESPONSES.

PRIVATE DOCTOR. . . .
PRIVATE MIDWIFE...
FP FIELD~J(~RKER . . . .

YES
I
I
I

NO
2
2
2

VILLAGE OFFICIAL.. 1

2

REL]GICtJS LEADER..
I~CfIER'S ORG. (PKK)
PHARFJ~CIST . . . . . . . .
TEACHER. . . . . . . . . . .
TELEVISION. . . . . . . .
RADIO . . . . . . . . . . . . .

I

2
2
2

1
1
1

2
2
2

I

1

CHECK 214 AND 22I:

9

HA/) BIRTH SINCE JAR. 1982

NO BIRTH SINCE JAW. 1982

OR PREGNANT

AND NOT PREGNANT OR UNSURE

v

1;'

126

F~
IT

SEC>TION

3/,7

Row I would l i k e t o get s ~
more I n f o r R t t m
years, CHEC1~TflER PREC~CAN~ RECORD N ~ S

CHECK 306:

¢)out (your p r e f w ¢ y I ~ l ) the c h i l d r e n you had i n the l a s t f i v e
OF IlRTHS S l N ~ JAN. 1982. THENENTER EVER USE OF CONTRACEPTION

E~flER~O A)~ET~
~ ( A S K 3~9-356 FO¢ EACH COLUNN)
REVER USED A M ETHCO I ~ ( A S K 355 FOR F-~CHCOUJNB)

BIRTH ORDER
CURRENTLY
PREGNANT?

ASK ~JESTIONSAB~JT
ALL BIRTHS

fES E ~ NO r ~ >
v
349 Before you became pregnant fES . . . . . . . . . . .
1
( w i t h NAME) ( b u t a f t e r your
preceding b i r t h , IF N~Y) had
qO . . . . . . . . . . .
2
-1
you done a n y t h i n g , even f o r
short tir~e, to avoid g e t t i n g
SKIP TO 355 <
pregnant or having e b i r t h ?

/

350 Which was the l a s t
method you used then?

)ILL . . . . . . . . . . 01
ILID. . . . . . . . . . .
02
INJECTIORS....03

)[APH/TM/JLY,,04
USE THESE C~ES IN 351

""°

(RECORD COOE). (IF N O N E ,
ENTER 00).

:ORDON . . . . . . . . 05
~ALE STERIL...O7
~ORPL/~T. . . . . . 08
kBORT]O~. . . . . . 09
>ERIODIC ABST.10
JITHDRAWAL. . . . 11
>ROLWGD ABST..12
tERBS. . . . . . . . . 13
~SSAGE. . . . . . . 14
15
)THER
(SPECIFY)

F

LAST B1RTH

NEXT-TO-LAST
BIRTH

(NAME)

(NNqE)

v.,,.:

1

IO........... 2 q

IO. . . . . . . . . . .

2

-I

dO. . . . . . . . . . .

2

;KIP TO 355 <

;KIP TO 355 <

l

~KIP TO 355 <

IO. . . . . . . . . . .

2

-1
|

RECEDING
METHO0

352 For how tong haw~you used ONTHS,..
(LAST METHGO) t h a t time?
~YEARS. . . .

rES. . . . . . . . . . .

rES. . . . . . . . . . .

FnF

RECEDING
METHOD

1

|

~ILL . . . . . . . . . .
01
[LIO. . . . . . . . . . .
OZ
NJECTIONS....03
IIAPH/FM/JLY..04
;ORDON. . . . . . . . 05
~LE S T E R I L . . . 0 7
NORPLANT . . . . . . 08
ABORTION . . . . . . 09
PERIODIC ABST.IO
WITHDRAWAL. . . . 11
PROLNGD ASST..12
HERBS. . . . . . . . . 13
MASSAGE. . . . . . . 14
OTHER
15
(SPECIFY)

FnF

ONTHS...
EARS. . . .

(NAME)

(N/~E)
1

1

'ILL. . . . . . . . . . 01
ItJO. . . . . . . . . . . 02
INJECTIONS....03
DIAPH/FM/JLY, .04
CORDON. . . . . . . . 05
HALE STERIL...07
NORPLAWT. . . . . . 08
ABORTION. . . . . . 09
PERIOOIC ABST.lO
IJI THDRAUAL. . . . 11
PROLNGO ABST..12
HERBS. . . . . . . . . 1]
MASSAGE. . . . . . . 14
OTHER
15
(SPECIFY)

THIRD FROH
LAST BIRTH

rES. . . . . . . . . . .

rES. . . . . . . . . . .

;KIP TO 355 <

SECO~O FRON
LAST BIRTH

RECEDING
METHO0

~ILL . . . . . . . . . . 01
02
[LID. . . . . . . . . . .
NJECTIORS....03
~IAPH/FM/JLY..04
;ONDOM. . . . . . . . 05
~LE STERIL...07
NONPLANT. . . . . . 08
ABORTION. . . . . . 09
PERIDDIC ABST.10
~ITHDRAUAL. . . . 11
PROLNGO ABST..12
HERBS ......... 13
MASSAGE ....... 14
OTHER
15
(SPECIFY)

FnF

RECEDING
METHGO

ONTHS...
EARS. . . .

>ILL . . . . . . . . . . 01
IUO. . . . . . . . . . .
02
:HJECTIONS....03

)IAPH/FM/JLY..04
~ONDOM. . . . . . . . 05
IALE STERIL...07
INORPLAHT. . . . . . 08

f

BORTION . . . . . .

09

ERIO01C ABST,IO
ITHDRAUAL .... 11
~ROLNGD ABST..12
HERBS ......... 13
tASSAGE ....... 14
)THER
15
(SPECIFY)

FnF

ONTHS...
EARS. . . .

-l
J

m

RECEDING
METHO0

FH

ONTHS...
EARS. . . .

353 Did you beccxne pregnant
white you were s t i i t using
(LAST METHOD)?

rES . . . . . . . . . . . .
1 ~YES. . . . . . . . . . . .
ll~YES . . . . . . . . . . . .
1 IrES . . . . . . . . . . . .
1 ~YES. . . . . . . . . . . .
1]
~u(SKIPTO 356)O,,JORD OR TIN MILK 1
JUICE/TEA/SOUP . . . . . . 1
RICE/BREAD/BISCUIT. 1
, FRUITS/VEGETABLES...1
EGGS/FISH/HEAT . . . . . . 1
i OTHER LIO~ID/SOLIO..1
i PLA1N WATER. . . . . . . . .
1

2O

129

Z
2
2
2
2
2
2

NO.

SKIP
TO

COOING CATEGORIES

QU£STIONS ANO FILTERS

Now I want to ask you some questions about
your marriage.
501

CHECK 108A AND CIRCLE CURRENT
NARITAL STATUS.

NARRIED . . . . . . . . . . . . . . . . .
DIVORCEO/SEPARATED. . . . . .
WIDOWED. . . . . . . . . . . . . . . . .

502

I

Have you M e n married
t h a n once?

only once or more

I

O~CE. . . . . . . . . . . . . . . . . . . .
NORE THAN ONCE. . . . . . . . . .

I~YR

I

504 J I n what month and year d i d you get
| m a r r i e d to your ( f i r s t ) husband?.

DK NONTH. . . . . . . . . . . . . . .

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

;

1-->504
2

FITI
98 I

l--r--1 I

OK YEAR. . . . . . . . . . . . . . . .

,051g .rr,~,
Ho. o,d.er,
o
, y~ ~.o
, y~ ~,,rst,

1
2
3

98 =

I Ao~............... m l

511

R i g h t a f t e r you got m a r r i e d , d i d you
and your ( f i r s t )
husband l i v e w i t h h i s
p a r e n t s or y o u r p a r e n t s f o r at l e a s t s i x
months?

511A

Why not?

I

l

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

1-->512
2

PARENTS NOT ALIVE . . . . . . .

HAD O~N HOUSE. . . . . . . . . . .

I
2

OTHER

3~

>514

I
512

HOW many years d i d you l i v e t o g e t h e r
w i t h a parent at t h a t time?

d i f f e r e n t towns or v i l l a g e s
i n f o r s i x months or more?

have you l i v e d

21

130

I

I

| YEARS. . . . . . . . . . . . . .
LIJ|
I UP TO THE PRESENT. . . . . . 96 I

LOCALITIES

HO.
II III I

QUESTIONSAJ~FILTERS

Ho~ we need some details about your sexual
516 I activity in order to set • better
understanding of births.
Ho~ old were you when you f i r s t hlKI
sexual intercourse?
S16. I CHECK10,8A:
I CURRENTLY~

NARRIED

SKIP
COOINGCATEGORIES i TO

i

WIDOWED,
DIVORCED/

AGE............... ~--~
NEVERHADINTERCOURSE..97I

n

i

SEPARATED

I

517

Havey ~ h~ sex~t interc~rse in the fast YES. . . . . . . . . . . . . . . . . . . . .
one month?
NO. . . . . . . . . . . . . . . . . . . . . .

I

.~oo~,~.~

I ~,,E~..............~ 1

interc~rse?

| ~EK$
m ..THS

A~

........

A~ .......

PRESENCEOFOTHERSAT THISNINT:

I CHILDRENUNDER10..1
I HUSBAND
............ 1
I OTHER~LES. . . . . . . . 1
OTHERFEMALES
...... 1

I

-

22

131

1
2 ~>519

2~--I~ |
]

J BEF~ELASTBIRTH. . . . .
524

>524

I

~6 J

2
2
2
2

I
I SECTION6: FERTILITYPREFERENCES
NO.

QUESTIONS AND FILTERS

601

CHECK 314:
HUSBAND/WOMAN
STERILIZED

[2
(SKIP TO 609)

CURRENTLY
M