Data Cart

Your data extract

0 variables
0 samples
View Cart


BFR4 Female Questionnaire

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


001a. Are you in the correct household?
This is the picture of the front of the home taken during the Household Questionnaire.

[ODK will display the photo taken during the Household Questionnaire]

[] Yes
[] No

001b. Go interview the correct household.

002. Your name: [Interviewer name from Household Questionnaire]
Is this your name?

[] Yes
[] No
Enter your name below. Please record your name.

003. Current date and time: [ODK will display on screen]
Is this date and time correct?

[] Yes
[] No

Record the correct date and time.

Day____ Month____ Year____
Hours____ Minutes____

004a. The following info is from the household questionnaire. Please review to make sure you are interviewing the correct respondent.
[ODK will open the region, province, commune, Structure number, and Household number entered in the household questionnaire linked to this female questionnaire.]
Is the above information correct?

[] Yes
[] No

004b. Go interview the correct household or correct the household roster if necessary.

005. CHECK: You should be attempting to interview [Respondent’s name]. 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.
Or
(2) find and interview the person whose name appears above.
[] Yes
[] No

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

[] Yes
[] No

007. How well acquainted are you with the respondent?

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

008. 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 be carried out in private. Read the following greeting to the respondent.

Hello. My name is ____________________________________, and I work 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.
Before continuing, do you have any questions about this survey?

009a. Provide a paper copy of the Consent Form to the respondent and explain it. Then, ask: May I begin the interview now?
[] Yes
[] No

009b. Respondent's signature
Please ask the respondent to sign or check the box in agreement of their participation.
GATHER SIGNATURE:

Check box: []

010. Interviewer’s name: [Name entered in the household questionnaire]
Check the box as a witness to the consent process.
Check box: []

011. Respondent's first name.
[ODK will display the first name of the respondent from the household questionnaire]
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.

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

Month:____________ Year: _____________

102. How old were you at your last birthday?

Age:__________

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

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

104. 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

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

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

106a. In what month and year did you start living with your FIRST husband / partner?
Enter Jan 2020 for no response.
Month:____________ Year: _____________

106b. CHECK: Based on the response you entered in 106a, the respondent was possibly 15 years old or younger at the time of her first marriage.
Did you enter 106a correctly?

[] Yes
[] No

106c. Return to 106a to correct before continuing.

107a. 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
Month:____________ Year: _____________

107b. CHECK: Based on the response you entered in 107a, the respondent was possibly 15 years old or younger at the time of her current or most recent marriage.
Did you enter 107a correctly?

[] Yes
[] No

107c. Return to 107a to correct before continuing.

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

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

109. 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.

200. Now I would like to ask about all the births you have had during your life. Have you ever given birth?

[] Yes
[] No
[] No response

201a. Do you have any sons or daughters to whom you have given birth who are now living with you?

[] Yes
[] No
[] No response

201b. How many sons live with you?
Zero is a possible response.
Number:__________

201c. How many daughters live with you?
Zero is a possible response.
Number:__________

202a. Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?

[] Yes
[] No
[] No response

202b. How many sons are alive but do not live with you?
Zero is a possible response.
Number:__________

202c. How many daughters are alive but do not live with you?
Zero is a possible response.
Number:__________

203a. Have you ever given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: Any baby who cried, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?

[] Yes
[] No
[] No response

203b. How many boys have died?
Zero is a possible response.
Number:_________

203c. And how many girls have died?
Zero is a possible response.
Number:_________

CALCULATE: TOTAL NUMBER OF CHILDREN EVER BORN
[ODK will calculate the total number of children born from Q201-203: (201b+201c+202b+202c+203b+203c)]

204. Just to make sure that I have this right, you have had in TOTAL [ODK will display the total number of sons and daughters born from 201-203] births during your life. Is that correct?

[] Yes
[] No

205. 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.
Month:____________ Year: _____________

206. 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.
Month:____________ Year: _____________

207. 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.
Month:___________ Year: _____________

208a. Is your last baby / child still alive?

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

208b. 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.
Month:____________ Year: _____________

209. 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. Enter 0 days for today, not 0 weeks/months/years.
[] _______ days ago
[] _______ weeks ago
[] _______ months ago
[] _______ years ago
[] Menopausal / Hysterectomy
[] Before last birth
[] Never menstruated
[] No response

210a. Are you pregnant now?

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

210b. How many months pregnant are you?
Please record the number of completed months.
Number of months:________

211a. Now I have some questions about the future. Would you like to have a child or would you prefer not to have any children?

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

211b. Now I have some questions about the future. Would you like to have another child or would you prefer not to have any more children?

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

212a. How long would you like to wait from now before the birth of a child?
If you select months or years, you will enter a number on the next screen.
Select “Years” if more than 36 months.
Please check that you correctly entered the value for months/years.
[] ________ months
[] ________ years
[] Soon/now
[] Says she can’t get pregnant
[] Other
[] Don't know
[] No response

212b. After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?
If you select months or years, you will enter a number on the next screen.
Select “Years” if more than 36 months.
Please check that you correctly entered the value for months/years.
[] ________ months
[] ________ years
[] Soon/now
[] Says she can’t get pregnant
[] Other
[] Don't know
[] No response

213a. 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 more children at all?

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

213b. 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 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.


301a. Have you ever heard of female sterilization?
PROBE: Women can have an operation to avoid having any more children.

[] Yes
[] No
[] No response

301b. Have you ever heard of male sterilization?
PROBE: Men can have an operation to avoid having any more children.

[] Yes
[] No
[] No response

301c. 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

301d. 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

301e. 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

301f. 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

301g. 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 three days to prevent pregnancy.

[] Yes
[] No
[] No response

301h. Have you ever heard of (male) condoms?
PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
[ODK will display an image of the method on the screen].

[] Yes
[] No
[] No response

301i. Have you ever heard of female condoms?
PROBE: Women can put a sheath in their vagina before sexual intercourse.
[ODK will display an image of the method on the screen].

[] Yes
[] No
[] No response

301j. Have you ever heard of the intravag/ diaphragm?
PROBE: Women can place a thin flexible latex disk in their cervix before sexual intercourse.
[ODK will display an image of the method on the screen].

[] Yes
[] No
[] No response

301k. 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 kill male sperm. This crème may also be put on a diaphragm.
[ODK will display an image of the method on the screen].

[] Yes
[] No
[] No response

301l. 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.
[ODK will display an image of the method on the screen].

[] Yes
[] No
[] No response



301m. Have you ever heard of the Lactational Amenorrhea Method or LAM?

[] Yes
[] No
[] No response

301n. 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

301o. Have you ever heard of the withdrawal method?
PROBE: Men can be careful and pull out before climax.

[] Yes
[] No
[] No response

301p. Have you ever heard of any other ways or methods that women or men can use to avoid pregnancy?

[] Yes
[] No
[] No response

302a. Are you or your partner currently doing something or using any method to delay or avoid getting pregnant?

[] Yes
[] No
[] No response

302b. Which method or methods are you using?
PROBE: Anything else?
Select all methods mentioned. SCROLL TO THE BOTTOM to see all choices.

[] Female sterilization
[] Yes
[] No
[] Male sterilization
[] Yes
[] No
[] Implant
[] Yes
[] No
[] IUD
[] Yes
[] No
[] Injectables
[] Yes
[] No
[] Pill
[] Yes
[] No
[] Emergency Contraception
[] Yes
[] No
[] Male condom
[] Yes
[] No
[] Female condom
[] Yes
[] No
[] Diaphragm
[] Yes
[] No
[] Foam/Jelly
[] Yes
[] No
[] Standard Days/Cycle beads
[] Yes
[] No
[] LAM
[] Yes
[] No
[] Rhythm method
[] Yes
[] No
[] Withdrawal
[] Yes
[] No
[] Other traditional method
[] Yes
[] No
[] No response
[] Yes

ODK CALCULATION: CURRENT METHOD
THIS TEXT WILL NOT APPEAR ON THE SCREEN.
ODK will identify the most effective method selected by the respondent.

[] 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 31
[] Other traditional method
[] No response

IMP 301. How many rods is your implant?

[] 1
[] 2
[] 3
[] 6
[] Don’t know
[] No response

IMP 302. At the visit when the implant was inserted, were you told for how long the implant would protect you from pregnancy?

[] Yes
[] No
[] No response

IMP 303. How long were you told?
If you select months or years, you will enter a number on the next screen.
Please check that you correctly entered the value for months/years.

[] ________ months
[] ________ years
[] Don't know
[] No response

LCL_301. PROBE: Was the injection administered via syringe or small needle?
Show the image to the respondent.
[ODK will display an image of the method on the screen.]

[] Syringe
[] Small needle (Sayana Press)
[] Both
[] No Response

302c. Are you breastfeeding to delay or avoid getting pregnant?

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

305a. 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

305b. 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

306a. In the last 12 months, have you ever done something or used a method to delay or avoid getting pregnant?

[] Yes
[] No
[] No response

306b. 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

LCL_306c. PROBE: Was the injection administered via syringe or small needle?
Show the image to the respondent.
[ODK will display an image of the method on the screen.]

[] Syringe
[] Small needle (Sayana Press)
[] Both
[] No Response

307. Before you started using [MOST RECENT OR CURRENT METHOD], had you discussed the decision to delay or avoid pregnancy with your husband/partner?

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

308. Would you say that the decision to use contraception was mainly your decision, mainly your husband/partner’s decision or did you both decide together?

[] Mainly respondent
[] Mainly husband/partner
[] Joint decision
[] Other
[] No response

309a. Since what month and year have you been using [CURRENT METHOD] without stopping?
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.
Most Recent Birth: [mm-yyyy]
Current Marriage: [mm-yyyy]

Month________ Year________

309b. When did you stop using [MOST RECENT METHOD]?
Please record the date. The date should be found by calculating backwards from memorable events if needed.
Enter Jan 2020 for no response.

Month________ Year________

309c. In what month and year had you started using [MOST RECENT METHOD] before stopping?
Calculate backwards from memorable events if needed.
Most Recent Birth: [mm-yyyy]
Current Marriage: [mm-yyyy]
Must be before today. Respondent must be at least 10 years old. Enter Jan 2020 for no response.

Month________ Year________

309d. CHECK: Just to make sure I have this correct, you used [MOST RECENT METHOD] continuously between [START DATE] and [STOPPING DATE] without stopping, is that correct?

[] Yes
[] No

GO BACK TO THE PREVIOUS SCREEN AND PROBE TO DETERMINE THE PERIOD OF MOST RECENT CONTINUOUS USE.
Suggested probes:
- When was the last time you used [METHOD]?
- How long had you been using [METHOD] without stopping


310. Why did you stop using [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

311a. You first started using [CURRENT METHOD] on [DATE FROM Q309a or Q309c].
Where did you or your partner get it at that time?
Scroll to bottom to see all choices.
Public sector
[] National Hospital Center
[] Center for Health and Social Promotion (CSPS)
[] Maternity ward
[] Mobile health clinic (public sector)
[] Regional Hospital Center
[] Medical Center with Surgery Wing (CMA)
[] Medical Center
[] Mobile health workers and community volunteers
Private medical sector
[] Private hospital/clinic
[] Pharmacy
[] Physician’s office
[] Mobile health clinic (private sector)
[] Family planning clinic
Other sources
[] Community/village health agent
[] Shop/market/grocery
[] Faith-based organization
[] Friend / relative
[] Other
[] Don’t know
[] No response

311b. Where did you learn how to use [RHYTHM METHOD / LAM]?
Scroll to bottom to see all choices.
Public sector
[] National Hospital Center
[] Center for Health and Social Promotion (CSPS)
[] Maternity ward
[] Mobile health clinic (public sector)
[] Regional Hospital Center
[] Medical Center with Surgery Wing (CMA)
[] Medical Center
[] Mobile health workers and community volunteers
Private medical sector
[] Private hospital/clinic
[] Pharmacy
[] Physician’s office
[] Mobile health clinic (private sector)
[] Family planning clinic
Other sources
[] Community/village health agent
[] Shop/market/grocery
[] Faith-based organization
[] Friend / relative
[] Other
[] Don’t know
[] No response

312a. When you obtained your [CURRENT / 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

312b. Were you told what to do if you experienced side effects or problems?

[] Yes
[] No
[] No response

IMP 304. Were you told where you could go to have the implant removed?

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

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

[] Yes
[] No
[] No response

314a. During that visit, did you obtain the method you wanted to delay or avoid getting pregnant?

[] Yes
[] No
[] No response

314b. When you began using [RHYTHM / LAM], was it the method you wanted to use to delay or avoid getting pregnant?

[] Yes
[] No
[] No response

314c. 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

315a. During that visit, who made the final decision about what method you got?

[] You alone
[] Provider
[] Partner
[] You and provider
[] You and partner
[] Other
[] Do not know
[] No response

315b. Who made the final decision to use [RHYTHM / LAM]?

[] You alone
[] Provider
[] Partner
[] You and provider
[] You and partner
[] Other
[] Do not know
[] No response

316. Would you return to this provider?
Provider: [TYPE OF HEALTH PROVIDER SELECTED IN Q311a OR Q311b]

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

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

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

IMP 305. In the past 12 months, have you tried to have your current implant removed?
If the respondent says "Yes," PROBE to find out who she went to see.
[] Yes, by a health professional
[] Yes, by a non-health professional
[] No
[] No response

IMP 306. Why were you not able to have your implant removed?

[] Facility not open
[] Qualified provider not available
[] Provider attempted but could not remove the implant
[] Provider refused
[] Cost of removal services
[] Travel cost
[] Provider counseled against removal
[] Told to return another day
[] Referred elsewhere
[] Other
[] Don't know
[] No response

318a. In the last 12 months, have you paid any fees for family planning services (including the most recent / current method)?

[] Yes
[] No

318b. How much did you pay?
Enter all prices in CFA.
Total cost amount ____________

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

[] Yes
[] No
[] No response

320. How old were you when you first used a method to delay or avoid getting pregnant?
The respondent said she was [AGE from Q102] years old at her last birthday.
Enter the age in years. Cannot be younger than 9.
Age ____________

321. 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 204.

Number ____________

322. 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

LCL_304. PROBE: Was the injection administered via syringe or small needle?
Show the image to the respondent.
[] Syringe
[] Small needle (Sayana Press)
[] Both
[] No Response

323a. You said that you do not want any children/another child soon and that you are not using a method to avoid pregnancy.
Can you tell me why you are not using a method to prevent pregnancy?
RECORD ALL REASONS MENTIONED
Cannot select "Do not know" or "No response" with other options.
Cannot select "Not Married" if 104 is "Yes, currently married".
Scroll to bottom to see all choices.
[] Not married
[] Yes
[] No
[] Infrequent sex / Not having sex
[] Yes
[] No
[] Menopausal / Hysterectomy
[] Yes
[] No
[] Subfecund / Infecund
[] Yes
[] No
[] Not menstruated since last birth
[] Yes
[] No
[] Breastfeeding
[] Yes
[] No
[] Husband away for multiple days
[] Yes
[] No
[] Up to God / fatalistic
[] Yes
[] No
[] Respondent opposed
[] Yes
[] No
[] Husband / partner opposed
[] Yes
[] No
[] Others opposed
[] Yes
[] No
[] Religious prohibition
[] Yes
[] No
[] Knows no method
[] Yes
[] No
[] Knows no source
[] Yes
[] No
[] Fear of side effects
[] Yes
[] No
[] Health concerns
[] Yes
[] No
[] Lack of access / too far
[] Yes
[] No
[] Costs too much
[] Yes
[] No
[] Preferred method not available
[] Yes
[] No
[] No method available
[] Yes
[] No
[] Inconvenient to use
[] Yes
[] No
[] Interferes with body’s processes
[] Yes
[] No
[] Other
[] Yes
[] No
[] Don’t know
[] Yes
[] No response
[] Yes

323b. Would you say that not using contraception is mainly your decision, mainly your husband/partner’s decision or did you both decide together?

[] Mainly respondent
[] Mainly husband/partner
[] Joint decision
[] Other
[] No response

LCL_305a. 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 you select X children, you will enter a number for X on the following screen. If none, select X children, then enter 0.
_______children
[] It's God's will (not respondent's decision)
[] Other
[] Do not know
[] No response

LCL_305b. If you could choose exactly the number of children to have in your whole life, how many would that be?
If you select X children, you will enter a number for X on the following screen. If none, select X children, then enter 0.
_______children
[] It's God's will (not respondent's decision)
[] Other
[] Do not know
[] No response

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

[] Yes
[] No
[] No response

325a. In the last 12 months, have you visited a health facility or camp for care for yourself or your children?
For any health services.
[] Yes
[] No
[] No response

325b. Did any staff member at the health facility speak to you about family planning methods?

[] Yes
[] No
[] No response

In the last few months have you:

326a. Heard about family planning on the radio?

[] Yes
[] No
[] No response

326b. Seen anything about family planning on the television?

[] Yes
[] No
[] No response

326c. Read about family planning in a newspaper or magazine?

[] Yes
[] No
[] No response

326d. Received a voice or text message about family planning on a mobile phone?

[] Yes
[] No
[] No response

Section 4. Sexual Activity
CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
Verbally prepare the respondent for questions about sexual activity.

401a. How old were you when you first had sexual intercourse?

Age _____________

Enter the age in years.
The respondent said that she was [Age from Q102] years old at her last birthday.
She has had [NUMBER OF LIVE BIRTHS] live births.

You entered that the respondent was [X] years old the first time she had sexual intercourse. Is that what the she said?

[] Yes
[] No

Go back and change 401a if it is not correct.

402. 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 on the next screen.
________ days ago
________ weeks ago
________ months ago
________ years ago

Section 4 – Menstrual Hygiene
Now I'm going to ask you about menstrual hygiene management.
This includes the use of absorbent materials; access to a private, clean, safe space; washing as required; and a place to dispose used materials.


601. The last time you had your period, where were all the places that you changed, washed, dried, or disposed of used sanitary materials?
PROBE: Anywhere else?
Do not read options aloud. Select all that apply.
[] [PRIMARY SANITATION FACILITY FROM HQ]
[] Yes
[] No
[] Other household sanitation facility
[] Yes
[] No
[] Sanitation facilities at school
[] Yes
[] No
[] Sanitation facilities at work
[] Yes
[] No
[] Other sanitation facility
[] Yes
[] No
[] Sleeping area
[] Yes
[] No
[] Backyard
[] Yes
[] No
[] No facility / Bush / Field
[] Yes
[] No
[] Other
[] Yes
[] No
[] No response
[] Yes
[] No

602a. What was the main place that you used for changing your used pads, cloths, or other sanitary materials?

[] [PRIMARY SANITATION FACILITY FROM HQ]
[] Yes
[] No
[] Other household sanitation facility
[] Yes
[] No
[] Sanitation facilities at school
[] Yes
[] No
[] Sanitation facilities at work
[] Yes
[] No
[] Other sanitation facility
[] Yes
[] No
[] Sleeping area
[] Yes
[] No
[] Backyard
[] Yes
[] No
[] No facility / Bush / Field
[] Yes
[] No
[] Other
[] Yes
[] No
[] No response
[] Yes
[] No

602b. While managing your menstrual hygiene, was this place:
MAIN PLACE [ODK will display the selection from Q610 or 602a]
Read each option aloud and select if yes.

[] clean?
[] Yes
[] No
[] private?
[] Yes
[] No
[] safe?
[] Yes
[] No
[] able to be locked?
[] Yes
[] No
[] supplied with clean water?
[] Yes
[] No
[] supplied with soap?
[] Yes
[] No
[] None of the above
[] Yes
[] No response
[] Yes

603. During your last menstrual period, what materials did you use to absorb or collect your menstrual blood?
PROBE: Anything else?
Do not read options aloud. Select all that apply.
Reusable materials
[] Cloths
[] Yes
[] No
[] Cotton wool
[] Yes
[] No
[] Sanitary pads
[] Yes
[] No
[] Foam (from a mattress or other object)
[] Yes
[] No
[] Other
[] Yes
[] No
[] Disposable materials
[] Tampons
[] Yes
[] No
[] Toilet paper
[] Yes
[] No
[] Paper (newspaper, pages from books)
[] Yes
[] No
[] Natural materials (mud, dung, leaves)
[] Yes
[] No
[] No materials used
[] Yes
[] No
[] No Response
[] Yes

604a. Did you wash and reuse pads, cloths, or other sanitary materials during your last menstrual period?

[] Yes
[] No
[] No response

604b. During your last menstrual period, were the sanitary materials that you washed and reused completely dried before each reuse?

[] Yes
[] No
[] No response

605. You mentioned that you used [ODK will display response to 603] during your last menstrual period. Where did you dispose of these materials after use?
PROBE: Anywhere else?
Don’t read options out loud. Select all responses that apply.
[] Flush toilet
[] Yes
[] No
[] Latrine
[] Yes
[] No
[] Waste bin/trash bag
[] Yes
[] No
[] Burning
[] Yes
[] No
[] Bush/field
[] Yes
[] No
[] Other
[] Yes
[] No
[] No response
[] Yes

606. Is there anything else that you need to help you better manage your menstrual period?
PROBE : Anything else ?
Could include financial resources, materials, or changes to your environment. Do not read options aloud.

[] I have all I need
[] Yes
[] No
[] Clean water
[] Yes
[] No
[] Soap
[] Yes
[] No
[] Clean absorbent materials
[] Yes
[] No
[] A private place
[] Yes
[] No
[] A place where I feel safe
[] Yes
[] No
[] More knowledge (training)
[] Yes
[] No
[] A place to buy clean absorbent materials
[] Yes
[] No
[] A place to dry used materials
[] Yes
[] No
[] A place to dispose of used materials
[] Yes
[] No
[] Money
[] Yes
[] No
[] Pain medication
[] Yes
[] No
[] Other
[] Yes
[] No
[] No response
[] Yes

Contraceptive Acceptability Questions

INFORMED CONSENT
CA-0. Next I would like to ask questions about your preferences for contraception and some new methods that are being developed. Your answers to these questions will be used for research purposes. There are no additional risks or benefits to answering these questions. As a reminder, your participation is completely voluntary and no identifying information about you will be shared with the researchers or reported in the study results. May I continue with the questions?

[] Yes
[] No

CA-1. New contraceptive methods are being developed and may become available in the future. If new methods were available to you, would you consider using a new method at some point in the future?

[] Yes
[] No
[] No response

CA-2. In choosing a contraceptive method, what are the things about the method that are important to you?
PROBE: Anything else that is important to you?
Do not read responses out loud.
Select all that apply.
[An error message will appear if No response is selected in addition to another response “You have selected No response as well as another response]
[] Effectiveness
[] Yes
[] No
[] Cost
[] Yes
[] No
[] Access
[] Yes
[] No
[] How long it lasts
[] Yes
[] No
[] Husband/partner approves
[] Yes
[] No
[] Doesn’t affect sex
[] Yes
[] No
[] Available outside clinic
[] Yes
[] No
[] Immediate return to fertility
[] Yes
[] No
[] Recommended by friends/relatives
[] Yes
[] No
[] Recommended by provider
[] Yes
[] No
[] Does not change menstrual bleeding
[] Yes
[] No
[] Causes few other side effect
[] Yes
[] No
[] Not painful to receive
[] Yes
[] No
[] Can be used while breastfeeding
[] Yes
[] No
[] Does not require pelvic exam
[] Yes
[] No
[] Can be used secretly
[] Yes
[] No
[] Other
[] Yes
[] No
[] No Response
[] Yes
Check here to acknowledge you considered all options.
[] NA

CA-3. If you could choose how often to take your contraceptive method, would you choose a method that you would take:
READ RESPONSES ALOUD.
[] Every day
[] Every time you have sex
[] Every month or every few months
[] Every year or every few years
[] Once; it is permanent
[] Other
[] No response

CA-4a. How many months would you want a method to last before you need to get it again?
Must be between 1 and 11 months. If more than 11 months, go back to previous screen and select “Every year or every few years."
Number of months_________

CA-4b. How many years would you want a method to last before you need to get it again?
Must be between 1 and 35 years. If less than 1 year, go back to previous screen and select “Every month or every few months”. If more than 35 years, go back and select “Once; it is permanent."
Number of years_________

You have entered the respondent wants a method that lasts [NUMBER OF YEARS] years before she gets it again. Is that what she said?
Go back and change CA-4b if it is not correct.
[] Yes
[] No

CA-5. Why did you choose this over other options?
Probe: any other reasons?
Do not read responses out loud. Select all that apply.
[An error message will appear if No response is selected in addition to another response “You have selected No response as well as another response]
[] May want to get pregnant soon
[] Yes
[] No
[] Familiar/feel comfortable with short acting methods
[] Yes
[] No
[] Infrequent sex
[] Yes
[] No
[] Fear of side effects of long-acting methods
[] Yes
[] No
[] More convenient to use than long-acting methods
[] Yes
[] No
[] Less expensive than long-acting methods
[] Yes
[] No
[] Easier to access than long-acting methods
[] Yes
[] No
[] Friends/family members use short-acting methods
[] Yes
[] No
[] Fear of medical procedure
[] Yes
[] No
[] Other
[] Yes
[] No
[] No Response
[] Yes
[] No

Check here to acknowledge you considered all options.

[] NA

CA-6. With some contraceptive methods, women do not get their period, but their period and their fertility return when they stop using it. Would you choose a method that stops your period?

[] Yes
[] No
[] No response

Now I would like to talk with you about methods that are not yet widely available in Burkina Faso or that are currently being developed. For each method, I will first describe it and then ask if you would be interested in using it at some point in the future.
All these methods are highly effective at preventing pregnancy.

CA-7. Longer-lasting injectable:
This method is an injection that a woman would get from a health provider. It would prevent pregnancy for six months.
While using this method, a woman may have irregular periods or her period may stop. If a woman has these side-effects, they cannot be stopped until the end of the six months.
This method would contain hormones, substances that change how the body functions, like in existing contraceptive methods such as the pill, the injectable, or the implant.
If this method were available, would you be interested in using it?
Read responses aloud.
[ODK will display an image of the method on the screen.]

[] Definitely would use it
[] Probably would use it
[] Probably would not use it
[] Definitely would not use it
[] No response

CA-8. Longer-lasting single rod implant:
This method is a single rod that would be placed in a woman’s arm by a health provider. It would prevent pregnancy for 5 years but could be removed by a health provider at any time.
While using this method, a woman may have irregular periods.
This method would contain hormones, substances that change how the body functions, like in existing contraceptive methods such as the pill, the injectable, or the implant.
If this method were available, would you be interested in using it?
Read responses aloud.
[ODK will display an image of the method on the screen.]

[] Definitely would use it
[] Probably would use it
[] Probably would not use it
[] Definitely would not use it
[] No response

CA-9. Dissolving implant:
This method is a single rod that would be placed in a woman’s arm by a health provider. It would prevent pregnancy for one and a half years.
This method would dissolve over time so it would not need to be removed, however, it could be removed by a health provider during the first year.
While using this method, a woman may have irregular periods.
This method would contain hormones, substances that change how the body functions, like in existing contraceptive methods such as the pill, the injectable, or the implant.
If this method were available, would you be interested in using it?
Read responses aloud.
[ODK will display an image of the method on the screen.]

[] Definitely would use it
[] Probably would use it
[] Probably would not use it
[] Definitely would not use it
[] No response

CA-10. IUD for 5 years:
This is a method where a loop or coil is placed inside a woman’s womb by a health provider. It would prevent pregnancy for 5 years but could be removed by a health provider at any time.
While using this method, a woman may have a lighter period or her period may stop.
This method can also be used as a treatment for heavy and painful menstruation. A woman using this method may experience some pain and discomfort for a short time after it is placed.
This method would contain hormones, substances that change how the body functions, like in existing contraceptive methods such as the pill, the injectable, or the implant.
If this method were available, would you be interested in using it?
Read responses aloud.
[ODK will display an image of the method on the screen.]

[] Definitely would use it
[] Probably would use it
[] Probably would not use it
[] Definitely would not use it
[] No response

CA-11. IUD for 10 years:
This is a method where a loop or coil is placed inside a woman’s womb by a health provider. It would prevent pregnancy for 10 or more years but could be removed by a health provider at any time.
This method would be different from the current IUD in its shape or size. While using this method, a woman may have heavier periods. A woman using this method may experience some pain and discomfort for a short time after it is placed.
This method would not contain hormones.
If this method were available, would you be interested in using it?
Read responses aloud.
[ODK will display an image of the method on the screen.]

[] Definitely would use it
[] Probably would use it
[] Probably would not use it
[] Definitely would not use it
[] No response

CA-12. Permanent method:
A health provider would perform a procedure on the womb that would permanently prevent pregnancy. It would not be an operation.
Afterward, the woman may need to return to the health provider for an exam to confirm the method is working completely.
This method would not affect a woman’s period.
This method would not contain hormones.
If this method were available, would you be interested in using it?
Read responses aloud.
[ODK will display an image of the method on the screen.]

[] Definitely would use it
[] Probably would use it
[] Probably would not use it
[] Definitely would not use it
[] No response

CA-13. Which one of the following methods would you prefer to use?
Read responses aloud.
[] Longer lasting injectable
[] Longer lasting single rod implant
[] Dissolving implant
[] IUD for 5 years
[] IUD for 10 years
[] Permanent Method
[] [CURRENT OR RECENT METHOD]
[] No response

[ODK will yield a list of methods that were noted as methods that the respondent would (1) definitely or (2) probably use in the future as well as the CURRENT / RECENT METHOD that the respondent indicated using in questions 302b and 306b.]

FLW_701. How many telephone numbers do you have?

[] 0
[] 1
[] 2
[] 3
[] More than three
[] No response

FLW_702. We appreciate your time participating in this survey.
Would you be willing to participate in another survey on this or another topic in the future?

[] Yes
[] No
[] No response

FLW_703a. May I have your principal phone number?

Telephone number__________
[] No response

FLW_703b. To confirm, here is the number you provided: [ODK will display the number entered in FLW_703a]
Is this correct?
If not, return to 703 to correct it.
[] Yes
[] No
[] No response

END OF QUESTIONNAIRE
The respondent is finished, but there are still more questions for you to complete outside the home.

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

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

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

097. In what language was this interview conducted?

[] English
[] French
[] Moore
[] Goumantchema
[] Fulfulde
[] Dioula
[] Other

LCL_001. Presence of others during the interview (people present and listening, people present but not listening, or not present).

a. Children less than 10 years

[] Present, listening
[] Present, not listening
[] Not present

b. Husband

[] Present, listening
[] Present, not listening
[] Not present

c. Other men

[] Present, listening
[] Present, not listening
[] Not present

d. Other women

[] Present, listening
[] Present, not listening
[] Not present

098. Questionnaire result
Record the result of the female respondent survey

[] Completed
[] Not at home
[] Postponed
[] Refused
[] Partly completed
[] Incapacitated