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BFR2 Female Questionnaire

IDENTIFICATION
Please record the following information prior to beginning the interview.


A. Are you in the correct household?

[] Yes
[] No

This is the picture of the front of the home taken during the household questionnaire.
If not, go to the right household.
[ODK will display the photo taken during the Household Questionnaire linked to this Female Questionnaire.]

B. Your name: [ODK will display the interviewer's name from the linked Household Questionnaire]

Is this your name?

[] Yes
[] No

B. Enter your name below.
Please record your name
Interviewer's Name________

C. Current date and time.
[ODK will display the device's date and time on the screen]

Is this date and time correct?

[] Yes
[] No

D. Record the correct date and time.

Day___________ Month___________ Year___________
Hours___________ Minutes___________ AM/PM___________

E. The following info is from the household questionnaire. Please review to make sure you are interviewing the correct respondent.
[ODK will display the geographic location information, Structure Number, and Household Number from the linked Household Questionnaire.]

E. The following info is what you provided previously. Please review.

Is the above information correct?
Go to the right household or update the Household Roster if needed.
[] Yes
[] No

CHECK: You should be attempting to interview [Name of the respondent]. Is that correct?
If misspelled, select "yes" and update the name in question "J."
If this is the wrong person, you have two options:
(1) exit and ignore changes to this form. Open the correct form.
(2) find and interview the person whose name appears above.
You must interview the right person.
[] Yes
[] No

F. Is the respondent present and available to be interviewed today?

[] Yes
[] No

G. How well acquainted are you with the respondent?

[] Very well acquainted
[] Well acquainted
[] Not well acquainted
[] Not acquainted

G2. Has the respondent previously participated in PMA 2020 surveys?

[] Yes
[] No
[] Do not know
[] No response

INFORMED CONSENT
Find the woman between the age of 15-49 associated with this Female Respondent Questionnaire. The interview must have auditory privacy. Read the following greeting

Hello. My name is ____________________________________ and I am working for the Institut Supérieur des Sciences de la Population (ISSP). We are conducting a local survey that asks women about various reproductive health issues. We would very much appreciate your participation in this survey. This information will help us inform the government to better plan health services. The survey usually takes between 15 and 20 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to anyone other than members of our survey team.
Participation in this survey is voluntary, and if we should come to any question you don't want to answer, just let me know and I will go on to the next question; or you can stop the interview at any time. However, we hope that you will participate in this survey since your views are important.
At this time, do you want to ask me anything about the survey?

H. Provide a paper copy of the Consent Form to the respondent and explain it. Then, ask: May I begin the interview now?

[] Yes
[] No

Respondent's signature
Please ask the respondent to sign or check the box in agreement of their participation.
GATHER SIGNATURE:
Check box: []

I. Interviewer's name: [Interviewer name from Household Questionnaire]
Mark your name as a witness to the consent process.
Check box: []

I. Interviewer's name
You previously entered [Interviewer name from Household Questionnaire]
Please record your name as a witness to the consent process.

J. Respondent's first name. [ODK will display the Respondent's name from linked Household Roster]
You may correct the spelling here if it is not correct, but you must be interviewing the person whose name appears below.

Section 1 -- Respondent's Background, Marital Status, Household characteristics
Now I would like to ask about your background and socioeconomic conditions.

FQ0. In what month and year were you born?
The age in the household roster is [AGE]

Month____ Year____

FQ1. How old were you at your last birthday?
Must be less than 130. Must agree with FQ0.
Age____

FQ2.What is the highest level of school you attended?

[] Never attended
[] Primary
[] Secondary (first cycle)
[] Secondary (second cycle)
[] Tertiary
[] No response

FQ3. Are you currently married or living together with a man as if married?
Probe: If no, ask whether the respondent is divorced, separated, or widowed.
[] No, never in union
[] Yes, currently married
[] Yes, living with a man
[] Not currently in union: Divorced / separated
[] Not currently in union: Widow
[] No response

FQ4. Have you been married or lived with a man only once or more than once?

[] Only once
[] More than once
[] No response

FQ5a. In what month and year did you start living with your FIRST husband / partner?
Enter Jan 2020 for no response
Cannot be in the future, and cannot be before respondent's birth.

Month____ Year____

CHECK: Based on the response you entered in FQ5a, the respondent was possibly 15 years old or younger at the time of her first marriage.
Did you enter FQ5a correctly?

[] Yes
[] No

FQ5b. Now I would like to ask about when you started living with your CURRENT or MOST RECENT husband / partner. In what month and year was that?
Enter Jan 2020 for no response
Cannot be in the future, and cannot be before respondent's birth.
Month____ Year____

CHECK: Based on the response you entered in FQ5b, the respondent was possibly 15 years old or younger at the time of her current or most recent marriage.
Did you enter FQ5b correctly?

[] Yes
[] No

FQ6. Does your husband / partner have other wives or does he live with other women as if married?

[] Yes
[] No
[] Do not know
[] No response

FQ7. Is your husband / partner living with you now or is he staying elsewhere?

[] Living with respondent
[] Staying elsewhere
[] No response

Section 2 -- Reproduction, Pregnancy and Fertility Preferences
Now I would like to ask about all the births you have had during your life.

FQ8a. How many times have you given birth?
0 is a possible answer.
Must be between 0 and 36.
Number of births:_______________

Were all of those live births ? If no, go back and change FQ8 to record only live birth events.

[] Yes
[] No

FQ8b. How many sons and daughters have you given birth to who were born alive?

Number _______________

FQ8c. Have you ever given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?
[] Yes
[] No
[] No response

FQ8d. How many have died?
Change FQ8c to 'No' if zero deaths.
Check FQ8b and FQ8c.
Number _______________

READ THIS CHECK OUT LOUD:
Just to make sure I have this right: you have had a total of [NUMBER OF BIRTHS] birth(s) during your life, resulting in [NUMBER OF LIVE SONS / DAUGHTERS] son(s) and / or daughter(s) born alive, and [NUMBER OF LIVE CHILDREN] children who are still alive.
Is that correct?
Check FQ8a and FQ8b
[] Yes
[] No

FQ8e. When was your FIRST birth?
Please record the date of the FIRST birth. The date should be found by calculating backwards from memorable events if needed.
Enter Jan 2020 for no response.

Cannot be in the future, respondent must be at least 10 years old at birth.
Month____ Year____

FQ9. When was your MOST RECENT birth?
Please record the date of the MOST RECENT birth. The date should be found by calculating backwards from memorable events if needed.
Enter Jan 2020 for no response.

Cannot be in the future, respondent must be at least 10 years old at birth. Must be at least 6 months after the first birth.
Month____ Year____

FQ10. When did you give birth before the most recent one?
Please record the date of the birth before the last. The date should be found by calculating backwards from memorable events if needed.
Enter Jan 2020 for no response.

Must be at least 6 months before your most recent birth, respondent must be at least 10 years old at birth.
Month____ Year____

FQ11. Is your last baby / child still alive?

[] Yes
[] No
[] Do not know
[] No response

FQ12. When did your last baby / child die?
Please record the date of the child's death. The date should be found by calculating backwards from memorable events if needed.
Enter Jan 2020 for no response.

Cannot be in the future and must be at least the date of birth.
Month____ Year____

FQ13. When did your last menstrual period start?
If you select days, weeks, months, or years, you will enter a number for X on the next screen.
[] X days ago
[] X weeks ago
[] X months ago
[] X years ago
[] Menopausal / Hysterectomy
[] Before last birth
[] Never menstruated
[] No response

FQ14. Are you pregnant now?

[] Yes
[] No
[] Unsure
[] No response

FQ15. How many months pregnant are you?
The most recent birth was: [Date of FQ9]
Please record the number of completed months.
Value must be at least 0 and not more than 10. A current pregnancy must start after the most recent birth.
Number _______________

CHECK 14: Are you pregnant now?

[] Yes
[] No

FQ16a. Now I have some questions about the future. Would you like to have a/another child or would you prefer not to have any / any more children?

[] Have a/another child
[] No more/prefer no children
[] Says she can't get pregnant
[] Undecided / Don't know
[] No response

FQ16b. After the child you are expecting now, would you like to have a/another child or would you prefer not to have any/any more children?

[] Have a/another child
[] No more/prefer no children
[] Says she can't get pregnant
[] Undecided / Don't know
[] No response

FQ17a. How long would you like to wait from now before the birth of a/another child?
If you select months or years, you will enter a number for X on the next screen.
Please check that you correctly entered the value for months/years.
Use years if more than 36 months.
[] X months
[] X years
[] Soon/now
[] Says she can't get pregnant
[] Other
[] Don't know
[] No response

FQ17b. After the birth of the child you are expecting now, how long would you like to wait before the birth of a/another child?
If you select months or years, you will enter a number for X on the next screen.
Please check that you correctly entered the value for months/years.
Use years if more than 36 months.
[] X months
[] X years
[] Soon/now
[] Says she can't get pregnant
[] Other
[] Don't know
[] No response

CHECK 8: How many times have you given birth?

Number of births:_______________

CHECK 14: Are you pregnant now?

[] Yes
[] No

FQ18a. Now I would like to ask a question about your last birth.
At the time you became pregnant, did you want to become pregnant then, did you want to wait until later, or did you not want to have any / any more children at all?

[] Then
[] Later
[] Not at all
[] No response

FQ18b. Now I would like to ask a question about your current pregnancy.
At the time you became pregnant, did you want to become pregnant then, did you want to wait until later, or did you not want to have any / any more children at all?

[] Then
[] Later
[] Not at all
[] No response

Section 3 -- Contraception
Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy
An image will appear on the screen for some methods. If the respondent says that she has not heard of the method or if she hesitates to answer, read the probe aloud and show her the image, if available.


FQ19. Have you ever heard of Female Sterilization?
PROBE: Women can have an operation to avoid having any more children.

[] Yes
[] No
[] No response

FQ19. Have you ever heard of male sterilization?
PROBE: Men can have an operation to avoid having any more children.

[] Yes
[] No
[] No response

FQ19. Have you ever heard of the contraceptive implant?
PROBE: Women can have one or several small rods placed in her upper arm by a doctor or nurse, which can prevent pregnancy for one or more years.
[ODK will display an image of the method on the screen.]

[] Yes
[] No
[] No response

FQ19.Have you ever heard of the IUD?
PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse.
[ODK will display an image of the method on the screen.]

[] Yes
[] No
[] No response

FQ19. Have you ever heard of injectables?
PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
[ODK will display an image of the method on the screen.]

[] Yes
[] No
[] No response

FQ19. Have you ever heard of the (birth control) pill?
PROBE: Women can take a pill every day to avoid becoming pregnant.
[ODK will display an image of the method on the screen.]

[] Yes
[] No
[] No response

FQ19. Have you ever heard of emergency contraception?
PROBE: As an emergency measure after unprotected sexual intercourse women can take special pills at any time within five days to prevent pregnancy.

[] Yes
[] No
[] No response

FQ19. Have you ever heard of condoms?
PROBE: Men can put a rubber sheath on their penis before sexual intercourse.

[] Yes
[] No
[] No response

FQ19. Have you ever heard of female condoms?
PROBE: Women can put a sheath in their vagina before sexual intercourse.

[] Yes
[] No
[] No response

FQ19. Have you ever heard of the diaphragm?
PROBE: Women can place a thin flexible disk in their vagina before sexual intercourse.

[] Yes
[] No
[] No response

FQ19. Have you ever heard of foam or jelly as a contraceptive method?
PROBE: Women can place a suppository, jelly, or cream in their vagina before sexual intercourse to prevent pregnancy.

[] Yes
[] No
[] No response

FQ19. Have you ever heard of the standard days method or Cycle Beads?
PROBE: A Woman can use a string of colored beads to know the days she can get pregnant. On the days she can get pregnant, she and her partner use a condom or do not have sexual intercourse.

[] Yes
[] No
[] No response

FQ19. Have you ever heard of the Lactational Amenorrhea Method or LAM?

[] Yes
[] No
[] No response

FQ19. Have you ever heard of the rhythm method?
PROBE: Women can avoid pregnancy by not having sexual intercourse on the days of the month they think they can get pregnant.

[] Yes
[] No
[] No response

FQ19. Have you ever heard of the withdrawal method?
PROBE: Men can be careful and pull out before climax.

[] Yes
[] No
[] No response

FQ19. Have you ever heard of any other ways or methods that women or men can use to avoid pregnancy?

[] Yes
[] No
[] No response

CHECK 14: Are you pregnant now?

[] Yes
[] No

FQ20. Are you or your partner currently doing something or using any method to delay or avoid getting pregnant?

[] Yes
[] No
[] No response

FQ21. Which method or methods are you using?
PROBE: Anything else?
Select all methods mentioned. SCROLL TO THE BOTTOM to see all choices.
[] Female sterilization
[] Male sterilization
[] Implant
[] IUD
[] Injectables
[] Pill
[] Emergency Contraception
[] Male condom
[] Female condom
[] Diaphragm
[] Foam/Jelly
[] Standard Days/Cycle beads
[] LAM
[] Rhythm method
[] Withdrawal
[] Other traditional method
[] No response

FQ22. Did the provider tell you or your partner that this method was permanent?

[] Yes
[] No
[] No response

FQ23. Do you know of a place where you can obtain a method of family planning?

[] Yes
[] No
[] No response

CHECK 14: Are you pregnant now?

[] Yes
[] No

FQ24a. You said that you are not currently using a contraceptive method. Do you think you will use a contraceptive method to delay or avoid getting pregnant at any time in the future?

[] Yes
[] No
[] No response

FQ24b. Do you think you will use a contraceptive method to delay or avoid getting pregnant at any time in the future?

[] Yes
[] No
[] No response

FQ25. In the last 12 months, have you ever done something or used a method to delay or avoid getting pregnant?

[] Yes
[] No
[] No response

FQ26. Which method did you use most recently?
PROBE: Anything else?
Select most effective method (highest method in list). Scroll to bottom to see all choices.
[] Implant
[] IUD
[] Injectables
[] Pill
[] Emergency Contraception
[] Male condom
[] Female condom
[] Diaphragm
[] Foam/Jelly
[] Standard Days/Cycle beads
[] LAM
[] Rhythm method
[] Withdrawal
[] Other traditional method
[] No response

FQ27. When did you begin using [CURRENT OR MOST RECENT METHOD]?
Calculate backwards from memorable events if needed.
Must be before today. Respondent must be at least 10 years old.
Enter Jan 2020 for no response.
Month____ Year____

CHECK: 20 Are you currently using a contraceptive?

[] Yes
[] No
[] No response

FQ28. When did you stop using [CURRENT OR MOST RECENT METHOD]?
Please record the date. The date should be found by calculating backwards from memorable events if needed. Must be after FQ27.
Enter Jan 2020 for no response.
Month____ Year____

FQ29. Why did you stop using [CURRENT OR MOST RECENT METHOD]?

[] Infrequent sex / husband away
[] Became pregnant while using
[] Wanted to become pregnant
[] Husband / partner disapproved
[] Wanted a more effective method
[] No method available
[] Health concerns
[] Fear of side effects
[] Lack of access / too far
[] Costs too much
[] Inconvenient to use
[] Fatalistic
[] Difficult to get pregnant / menopausal
[] Interferes with body's processes
[] Other
[] Don't know
[] No response

FQ30. You first started using [CURRENT OR MOST RECENT METHOD] on [DATE from QF27]. Where did you get it at that time?
Scroll to bottom to see all choices.
[] National Hospital Center
[] Health and Social Services Center (public)
[] Family planning clinic
[] Mobile clinic (public)
[] Regional Hospital Center
[] Medical Center with Surgery Unit (public)
[] Medical Center (public)
[] Fieldworker and community health volunteers (public)
[] Private hospital or clinic
[] Pharmacy
[] Private practice
[] Mobile clinic (private)
[] Maternity
[] Health Agent
[] Store/market/supermarket/mobile vendors
[] Religious organizations
[] Friend / parent
[] Other
[] Don't know
[] No Response

FQ31. When you obtained your [CURRENT OR MOST RECENT METHOD], were you told by the provider about side effects or problems you might have with a method to delay or avoid getting pregnant?

[] Yes
[] No
[] No response

FQ32. Were you told what to do if you experienced problems or side effects?

[] Yes
[] No
[] No response

FQ33. At that time, were you told by the family planning provider about methods of family planning other than the [CURRENT OR MOST RECENT METHOD] that you could use?

[] Yes
[] No
[] No response

FQ34. During that visit, did you obtain the method you wanted to delay or avoid getting pregnant?

[] Yes
[] No
[] No response

FQ35. Why didn't you obtain the method you wanted?

[] Method out of stock that day
[] Method not available at all
[] Provider not trained to provide
the method
[] Provider recommended a
different method
[] Not eligible for method
[] Decided not to adopt a method
[] Too costly
[] Other
[] No response

FQ36. During that visit, who made the final decision about what method you got?

[] You alone
[] Provider
[] Partner
[] You and provider
[] You and partner
[] Other
[] No response

CONTROL 30: You first started using [CURRENT OR MOST RECENT METHOD] on [DATE from QF27]. Where did you get it at that time?
Scroll to bottom to see all choices.
[] National Hospital Center
[] Health and Social Services Center (public)
[] Family planning clinic
[] Mobile clinic (public)
[] Regional Hospital Center
[] Medical Center with Surgery Unit (public)
[] Medical Center (public)
[] Fieldworker and community health volunteers (public)
[] Private hospital or clinic
[] Pharmacy
[] Private practice
[] Mobile clinic (private)
[] Maternity
[] Health Agent
[] Store/market/supermarket/mobile vendors
[] Religious organizations
[] Friend / parent
[] Other
[] Don't know
[] No Response

FQ37. Would you return to this provider?
[ODK will display the provider selected in QF30.]

[] Yes
[] No
[] No response

FQ38. Would you refer your relative or friend to this provider / facility?

[] Yes
[] No
[] No response

FQ39. In the last 12 months, have you paid any fees for family planning services (including the most current method)?

[] Yes
[] No
[] No response

FQ40. How much did you pay?
Enter all prices in CFA. Must be larger than 0.
Total cost ____________

FQ41. Have you ever done anything or tried in any way to delay or avoid getting pregnant?

[] Yes
[] No
[] No response

FQ41b. How old were you when you first used a method to delay or avoid getting pregnant?
The respondent said she was [AGE from QF1] years old at her last birthday.
Enter the age in years.
Cannot be younger than 9.
Age ____________

FQ41c. How many living children did you have at that time, if any?
Note: the respondent said that she gave birth [NUMBER OF LIVE BIRTHS] times in FQ8.

Number ____________

FQ42. Which method did you first use to delay or avoid getting pregnant?
Do not read the method choices. Scroll to bottom to see all choices.
[] Female sterilization
[] Male sterilization
[] Implant
[] IUD
[] Injectables
[] Pill
[] Emergency Contraception
[] Male condom
[] Female condom
[] Diaphragm
[] Foam/Jelly
[] Standard Days/Cycle beads
[] LAM
[] Rhythm method
[] Withdrawal
[] Other traditional method
[] No response

CHECK 16: Would you like to have a/another child later?

[] Have a/another child 1
[] No more/prefer no children 2
[] Says she can't get pregnant 3
[] Undecided / Don't know -88

CHECK 17: Would you like to wait 2 year or more before the next child?

[] Yes
[] No
[] No response

CHECK: 20 Are you currently using a contraceptive?

[] Yes
[] No
[] No response

CHECK: 40 Have you ever used a contraceptive?

[] Yes
[] No
[] No response

FQ43. You said that you do not want any/any more children and that you are not using a method to avoid pregnancy.
Can you tell me why you are not using a method?
RECORD ALL REASONS MENTIONED.
Cannot select "Do not know" or "No response" with other options.
Cannot select "Not Married" if FQ3 is "Yes, currently married".
Scroll to bottom to see all choices.
[] Not married
[] Infrequent sex / Not having sex
[] Menopausal / Hysterectomy
[] Subfecund / Infecund
[] Not menstruated since last birth
[] Breastfeeding
[] Husband away for multiple days
[] Up to God / fatalistic
[] Respondent opposed
[] Husband / partner opposed
[] Others opposed
[] Religious prohibition
[] Knows no method
[] Knows no source
[] Fear of side effects
[] Health concerns
[] Lack of access / too far
[] Costs too much
[] Preferred method not available
[] No method available
[] Inconvenient to use
[] Interferes with body's processes
[] Other
[] Don't know
[] No response

IFS 1a. If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?
If none, enter '0'.

IFS 1b. If you could choose exactly the number of children to have in your whole life, how many would that be?
If none, enter '0'.

FQ44. In the last 12 months, were you visited by a health worker who talked to you about family planning?

[] Yes
[] No
[] No response

FQ45. In the last 12 months, have you visited a health facility for care for yourself or for your children?
For any health services.
[] Yes
[] No
[] No response

FQ46. Did any staff member at the health facility speak to you about family planning methods?

[] Yes
[] No
[] No response

FQ47. In the last few months have you:

Heard about family planning on the radio?

[] Yes
[] No
[] No response

Seen anything about family planning on the television?

[] Yes
[] No
[] No response

Read about family planning in a newspaper or magazine?

[] Yes
[] No
[] No response

CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

FQ48. How old were you when you first had sexual intercourse?
Enter the age in years. The participant said that she was [AGE from QF1] years old on her last birthday.
[She had X live births.]

Answer must agree with the current age and date of first birth.
Age____________

CHECK: You entered that the respondent was X years old the first time she had sexual intercourse. Is that what the she said?
Go back and change FQ48 if it is not correct.
[] Yes
[] No

FQ49. When was the last time you had sexual intercourse?
If less than 12 months ago, answer must be recorded in months, weeks, or days.
Enter 0 days for today.
You will enter a number for X on the next screen.
[] X days ago
[] X weeks ago
[] X months ago
[] X years ago
[] No response

Section 4 -- Diarrheal Disease Among Children
Now I would like to ask you a few questions about the health of children under 5 years old.

FQ50. How many children under age 5, if any, live in this household for which you are the primary caregiver?
Enter 0 for none.
Number ____________

Starting with the youngest child, I'd like to ask you some questions.
[ODK will repeat FQ51-FQ53 once for each child under age 5.]

FQ51. In what month and year was this child born?
Enter Jan 2020 for no response
Month ____________ Year_____________

FQ52. The last time this child passed stools, what was done to dispose of the stools?
For all feces, normal or diarrhea.
[] Children use a latrine / toilet
[] Yes
[] No
[] Leave waste where it is
[] Yes
[] No
[] Bury waste in field / yard
[] Yes
[] No
[] Dispose of waste in latrine / toilet
[] Yes
[] No
[] Dispose of waste with rubbish / garbage
[] Yes
[] No
[] Dispose of waste with waste water
[] Yes
[] No
[] Use it as manure
[] Yes
[] No
[] Burn it
[] Yes
[] No
[] Do not know
[] Yes
[] No response
[] Yes

FQ53. In the past 7 days, has this child had diarrhea?
Diarrhea is determined as perceived by respondent. If the respondent is not sure what we mean by diarrhea, tell her it means "three or more runny stools per day."
[] Yes
[] No
[] No response

Thank the respondent for her time.
The respondent is finished, but there are still more questions for you to complete outside the home.

K. Location
Take a GPS point near the entrance to the household. Record location when the accuracy is smaller than 6 m.

L. How many times have you visited this household to interview this female respondent?

[] 1st time
[] 2nd time
[] 3rd time

M. Questionnaire result
Record the result of the female respondent survey
[] Completed
[] Not at home
[] Postponed
[] Refused
[] Partly completed
[] Incapacitated