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Burkina Faso 2021 Phase 2 Female Questionnaire

Region:

Province:

Commune:

Village:

Enumeration Area:

Structure number:

Household number:

001a. Are you in the correct household?

EA: {EA}
Structure #: ${structure}
Household #: ${household}

Go to the right household.

[] Yes
[] No

001a. Are you in the correct household?

EA: {EA}
Household head: ${HQ_ODK_display_name}

Go to the right household.

[] Yes
[] No

002. Your ID:

Is this your ID?

[] Yes
[] No

003a. Current date and time.

Is this date and time correct?

[] 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

INFORMED CONSENT

Find the woman between the ages of 15-49 associated with this Female Questionnaire. The interview must have auditory privacy. Administer the consent procedures.

Bonjour. Je m'appelle ________________________________ et je travaille pour l'Institut Supérieur des Sciences de la Population (ISSP) de l'Université Joseph KI-ZERBO. Je vais à présent vous lire une déclaration expliquant l'enquête que nous menons.

Note d'information

L'Institut Supérieur des Sciences de la Population (ISSP) de l'Université Joseph KI-ZERBO en collaboration avec le ministère de la santé du Burkina Faso et l'école de santé publique et de la santé reproductive de l'université Johns Hopkins aux Etats-Unis mène une étude dénommée PMA (Performance Monitoring for Action). Cette étude a pour objectifs de mettre en ?uvre un système de suivi des performances accomplies dans le domaine de la planification familiale, y compris la contraception et l'avortement, et de la santé en général au sein de la population et des structures de santé au Burkina Faso. Les informations que nous recueillerons serviront aussi pour mener des recherches et informer les orientations programmatiques en matière de planification familiale au Burkina Faso.

Consentement

Nous vous demandons de participer à l'étude car vous avez participé à une enquête que nous avons menée l'année dernière et avez indiqué que vous seriez disposé à participer à une enquête de suivi. Bien que vous ayez accepté à l'époque d'être recontactée pour les prochaines enquêtes, vous avez toujours le droit de décider de ne pas participer à tout moment. Néanmoins, nous apprécierons beaucoup que vous fassiez partie de cette enquête, car les informations que nous collecterons aideront à informer le gouvernement afin de mieux planifier les services de santé. Toutes les informations que vous nous donnerez seront strictement confidentielles et ne seront montrées à personne d'autre que les membres de notre équipe.

La participation à cette enquête est volontaire, et s'il y a une question à laquelle vous ne souhaitez pas répondre, faîtes le moi savoir et je passerai à la suivante ; ou vous pouvez également interrompre l'interview à tout moment. La participation à l'étude ne présente aucun avantage direct pour vous. Vous ne serez pas rémunérée pour avoir répondu à ce questionnaire. Cependant, nous espérons que vous accepterez de participer à cette enquête car votre point de vue est important. Notre entretien devrait durer environ 1 heure. A la fin de l'enquête un cadeau symbolique constitué d'un paquet de sucre et de deux boules de savon sera remis à votre ménage comme compensation pour le temps que les membres de votre ménage ont consacré pour répondre à nos différents questionnaires.

Avez-vous des questions sur cette enquête ?

Si vous avez des questions plus tard sur la recherche, contactez
Dr Georges GUIELLA

Vos droits en tant que participante
Cette recherche a été examinée et approuvée par le CERS (Comité d'Ethique pour la Recherche en Santé). Si vous avez des questions concernant la façon dont vous avez été traité ou cours de cette étude ou sur vos droits en tant que participante, vous pouvez contacter :
Pr OUEDRAOGO Dieu-Donné
??????????..

Puis-je commencer ?

008a. Read the verbal consent text.

Then, ask:
May I begin the interview now?

[] Yes
[] No

008b. Respondent's signature

Please ask the respondent to sign or check the box in agreement of their participation.

009. Interviewer's ID: {your_name}

Mark your ID as a witness to the consent process.

[] NA

011. Was this woman interviewed in Phase 1?

[] Yes
[] No

Section 1 -- Respondent's Background, Marital Status, Employment, and Migration

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 {hq_age}.

Month:

[] January
[] February
[] March
[] April
[] May
[] June
[] July
[] August
[] September
[] October
[] November
[] December
[] Do not know

Year:

Cannot be this year or in the future.

102. How old were you at your last birthday?

Age in the Household Roster: {hq_age}

Must be more than 14. Must agree with 101.

Age must be less than 130.

103. Have you attended school in the past 12 months?

[] Yes
[] No
[] No response

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

Only record formal schooling. Do not record bible or koranic school or short courses.

Cannot select "Never attended"

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

105. What is the highest [GRADE/ FORM / STANDARD / YEAR] you completed at that level?

Enter -99 for no response.

XS_101. How old were you when you left school?

Must be between 0 and the respondent's age.

COV_1. Following the emergence of Coronavirus (COVID-19), schools were closed for a time. Were you attending school at that time?

[] Yes
[] No
[] No response

COV_2. Has your school reopened ?

[] Yes
[] No
[] No response

COV_3. Did you resume school when your school opened after Coronavirus (COVID-19) restrictions were lifted?

[] Yes
[] No
[] No response

COV_4. Did you stop school in the past 12 months for any other reason than Coronavirus (COVID-19)?

[] Yes
[] No
[] No response

107. What was the main reason for stopping your education?

[] Finished education
[] Failed exams
[] Did not enjoy school
[] School was too far
[] Wanted to start working
[] Got married
[] Got pregnant
[] Parents did not want you to continue
[] Economic reasons
[] Menstruation / period
[] Illness
[] Other
[] No response

108. Are you currently enrolled in any training program?

[] Yes
[] No
[] No response

109. 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.

[] Yes, currently married
[] Yes, living with a man
[] Not currently in union: Divorced / separated
[] Not currently in union: Widow
[] No, never in union
[] No response

110. What is the highest level of schooling your husband/partner attended, attended, no schooling, primary, secondary, or higher?

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

PL_101. Did you start living with your current husband / partner in past 12 months?

[] Yes
[] No
[] No response

111. How much were you involved in the decision to get married - very much, not very much or not at all?

[] Very much
[] Not very much
[] Not at all
[] No response

112. How much do you think you will be involved in the decision to get married -- very much, not very much or not at all?

[] Very much
[] Not very much
[] Not at all
[] No response

113. Have you ever had a partner / boyfriend?

[] Yes
[] No
[] No response

XS_102. How old were you the first time you had a boyfriend or partner?

Must be between 0 and the respondent's age.

114. Do you currently have a boyfriend or partner?

[] Yes
[] No
[] No response

XS_103. How many times have you been married or lived with a man as if married?

Enter -99 for no response.

Must be at least 1

XS_104. In what month and year did you start living with your FIRST husband / partner?

Select 'Do not know' for month and '2030' for year to indicate 'No Response'.

Month:

[] January
[] February
[] March
[] April
[] May
[] June
[] July
[] August
[] September
[] October
[] November
[] December
[] Do not know

Year: ___

If entering '2030' for No Response, must select 'Do not know' for month. Cannot be in future.

115. Now I would like to ask about when you started living with your CURRENT husband / partner. In what month was that?

Select 'Do not know' for month to indicate 'No Response'.

115. Now I would like to ask about when you started living with your CURRENT/MOST RECENT husband / partner. In what month and year was that?

Select 'Do not know' for month and '2030' for year to indicate 'No Response'.
Month:

[] January
[] February
[] March
[] April
[] May
[] June
[] July
[] August
[] September
[] October
[] November
[] December
[] Do not know

Year: ___

If entering '2030' for No Response, must select 'Do not know' for month.

Cannot be in future.

LCL_101. Does your husband / partner have other wives or does he live with other women as if married?

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

XS_105. How long have you been living continuously in [NAME OF CURRENT PLACE OF RESIDENCE]?

Enter answer in years.

Enter 0 if less than 1 year.
Enter -95 for always.
Enter -96 for visitor.
Enter -99 for no response.

Years entered cannot exceed age.

XS_106. How long have you been living continuously in this particular house / structure?

Enter answer in years.

Enter 0 if less than 1 year.
Enter -95 for always.
Enter -96 for visitor.
Enter -99 for no response.

Years entered cannot exceed age. Must be consistent with previous answer.

116. In the last 12 months, for how many nights have you slept away from your community?

PROBE: Community is the area where you are currently living

Enter -99 for no response.

117. In the last 12 months, for how many nights has your husband/partner slept away from your community?

PROBE: Community is the area where you are currently living

Enter -99 for no response.

COV_5. You previously mentioned that you spent some time away from your current community this year, did you leave your current community to avoid being infected with Coronavirus (COVID-19)?

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

118. As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business. Aside from your own housework, have you done any work in the last seven days?

[] Yes
[] No
[] No response

119. Aside from your own housework, have you done any work in the last 12 months?

[] Yes
[] No
[] No response

120. Are you paid in cash or kind for this work or are you not paid at all?

[] Cash
[] Cash and kind
[] In-kind
[] Not paid
[] No response

121. Who usually makes decisions about making large household purchases: you, your husband/partner, you and your husband/partner jointly, or someone else?

[] Respondent
[] Husband/partner
[] Respondent and husband/partner
[] Someone else
[] No response

122. Who usually makes decisions about making household purchases for daily needs: you, your husband/partner, you and your husband/partner jointly, or someone else?

[] Respondent
[] Husband/partner
[] Respondent and husband/partner
[] Someone else
[] No response

123. Who usually makes decisions about getting medical treatment for yourself: you, your husband/partner, you and your husband/partner jointly, or someone else?

[] Respondent
[] Husband/partner
[] Respondent and husband/partner
[] Someone else
[] No response

EMP_1. Who usually makes decisions about buying clothes for yourself: you, your husband/partner, you and your husband/partner jointly, or someone else?

[] Respondent
[] Husband/partner
[] Respondent and husband/partner
[] Someone else
[] No response

EMP_2. Who usually makes decisions about how your earnings will be used: you, your husband/partner, you and your husband/partner jointly, or someone else?

[] Respondent
[] Husband/partner
[] Respondent and husband/partner
[] Someone else
[] No response

EMP_3. Who usually makes decisions about how your husband/partner's earnings will be used: you, your husband/partner, you and your husband/partner jointly, or someone else?

[] Respondent
[] Husband/partner
[] Respondent and husband/partner
[] Someone else
[] No response

EMP_4. Do you own any land, either jointly or by yourself?

PROBE: This does not include land owned only by your husband.

[] Yes
[] No
[] No response

EMP_5. Would you say that the money that you earn is more than what your husband/partner earns, less than what he earns, or about the same?

[] More
[] Less
[] Same
[] No response

COV_6. Are you currently economically reliant on your husband/partner for basic needs?

[] Yes
[] No
[] No response

EMP_6. Did you take part in any of these activities over the past 30 days?

Read each option aloud and select if yes.

Cannot select 'no response' or 'none of the above' with other options.

[] Agricultural work
[] Raising poultry / livestock
[] Producing ghee / cheese / butter
[] Collecting fuel / wood-cutting
[] Preparing food
[] Sewing / embroidery / crocheting
[] Producing straw products / carpets / textile / ropes
[] Offering services for others in a house, shop, or hotel
[] Independent paid work
[] Buying / selling goods in the market / the street / at home
[] Helping in construction work
[] Learning a skill
[] None of the above
[] No response

FIN_1. Do you currently have any savings for the future, such as a bank account, savings group, or cash?

[] Yes
[] No
[] No response

FIN_2. Do you currently have any mobile money accounts (e.g Orange Money, MobiCash, Coris Money)?

[] Yes
[] No
[] No response

FIN_3. When it comes to managing your money and financial matters, what is your level of knowledge?

[] Not knowledgeable at all
[] Not very knowledgeable
[] Somewhat knowledgeable
[] Very knowledgeable
[] No response

FIN_4. Do you know where to go for financial information or advice?

[] Yes
[] No
[] No response

FIN_5. Do you have financial goals toward which you are working?

PROBE: These are specific financial goals you have setup for yourself.

[] Yes
[] No
[] No response

Section 2 -- Reproduction, Pregnancy and Fertility Preferences

201. 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

202. How many times have you given birth?

Enter -99 for no response.

PL_201. Have you had any births since [Phase 1 survey interview date]?

[] Yes
[] No
[] No response

PL_202. When was that birth?

Select 'Do not know' for month and '2030' for year to indicate 'No Response'.

CALENDAR: Enter the birth and duration of pregnancy in the calendar.

Month:

[] January
[] February
[] March
[] April
[] May
[] June
[] July
[] August
[] September
[] October
[] November
[] December
[] Do not know

Year: ___

If entering '2030' for No Response, must select 'Do not know' for month.

Cannot be in future.

XS_201. When was your FIRST birth?

Please record the date of the first live birth. Date should be found by calculating forward or backward from memorable events if needed.
Select 'Do not know' for month and '2030' for year to indicate 'No Response'.
CALENDAR: If the birth was after {cc_start_date_lab} enter the birth and duration of pregnancy in the calendar.

Month:

[] January
[] February
[] March
[] April
[] May
[] June
[] July
[] August
[] September
[] October
[] November
[] December
[] Do not know

Year: ___

If entering '2030' for No Response, must select 'Do not know' for month.
Cannot be in future.

XS_202. When was your MOST RECENT birth?

Please record the date of the first live birth. Date should be found by calculating forward or backward from memorable events if needed.

Select 'Do not know' for month and '2030' for year to indicate 'No Response'.

CALENDAR: If the birth was after {cc_start_date_lab} enter the birth and duration of pregnancy in the calendar.

Month:

[] January
[] February
[] March
[] April
[] May
[] June
[] July
[] August
[] September
[] October
[] November
[] December
[] Do not know

Year: ___

If entering '2030' for No Response, must select 'Do not know' for month.

Cannot be in future.

XS_203. Have you had any other births since January 2018?

[] Yes
[] No
[] No response

XS_204. When was that birth?

The date should be found by calculating backwards from memorable events if needed.

Select 'Do not know' for month and '2030' for year to indicate 'No Response'.

CALENDAR: Enter the birth and duration of pregnancy in the calendar.

Month:

[] January
[] February
[] March
[] April
[] May
[] June
[] July
[] August
[] September
[] October
[] November
[] December
[] Do not know

Year: ___

If entering '2030' for No Response, must select 'Do not know' for month.

Cannot be in future.

XS_205. Have you ever had a pregnancy that miscarried, was aborted, or ended in a stillbirth since January 2018?

[] Yes
[] No
[] No response

XS_206. When did that pregnancy end?

Select 'Do not know' for month and '2030' for year to indicate 'No Response'.

CALENDAR: Enter the termination and duration of pregnancy in the calendar.

Month:

[] January
[] February
[] March
[] April
[] May
[] June
[] July
[] August
[] September
[] October
[] November
[] December
[] Do not know

Year: ___

If entering '2030' for No Response, must select 'Do not know' for month.

Cannot be in future

PL_203. Have you had a pregnancy that miscarried, was aborted, or ended in a stillbirth since {p1_survey_date_lab}?

[] Yes
[] No
[] No response

PL_204. When did that pregnancy end?

Select 'Do not know' for month and '2030' for year to indicate 'No Response'.

CALENDAR: Enter the termination and duration of pregnancy in the calendar.

Month:

[] January
[] February
[] March
[] April
[] May
[] June
[] July
[] August
[] September
[] October
[] November
[] December
[] Do not know

Year: ___

If entering '2030' for No Response, must select 'Do not know' for month.

Cannot be in future

203. Are you pregnant now?

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

204. How many months pregnant are you?

205. 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.

[] X days ago
[] X weeks ago
[] X months ago
[] X years ago
[] Menopausal / Hysterectomy
[] Before last birth
[] Never menstruated
[] No response

205. Enter {menstrual_period_lab}

Enter 0 days for today, not 0 weeks/months/years.

Must be 0 days or larger. Must be 1 week/month/year or larger.

206a. 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

206b. 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

207a. Before you became pregnant with your last birth, which best describes your situation?

Read response options and select one

[] You and your partner had agreed for you to get pregnant
[] You and your partner had discussed having children together but had not agreed for you to get pregnant
[] You and your partner had never discussed having children together
[] No response

207b. Before you became pregnant with your current pregnancy, which best describes your situation?

Read response options and select one

[] You and your partner had agreed for you to get pregnant
[] You and your partner had discussed having children together but had not agreed for you to get pregnant
[] You and your partner had never discussed having children together
[] No response

Now I have some questions about the future.

208a. 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 / Do not know
[] No response

208a. Would you like to have another child or would you prefer not to have any more children?

[] Have another child
[] No more
[] Says she can't get pregnant
[] Undecided / Do not know
[] No response

208b. After the child you are expecting now, would you like to have another child or would you prefer not to have any more children?

[] Have another child
[] No more
[] Says she can't get pregnant
[] Undecided / Do not know
[] No response

209a. 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 for X on the next screen.

Select "Years" if more than 36 months.

Please check that you correctly entered the value for months/years.

[] X months
[] X years
[] Soon/now
[] Says she can't get pregnant
[] Other
[] Do not know
[] No response

209a. How long would you like to wait from now before the birth of another child?

If you select months or years, you will enter a number for X on the next screen.

Select "Years" if more than 36 months.

Please check that you correctly entered the value for months/years.

[] X months
[] X years
[] Soon/now
[] Says she can't get pregnant
[] Other
[] Do not know
[] No response

209b. 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 for X on the next screen.

Select "Years" if more than 36 months.

Please check that you correctly entered the value for months/years.

[] X months
[] X years
[] Soon/now
[] Says she can't get pregnant
[] Other
[] Do not know
[] No response

209c. Enter the number of {waitchild} you would like to wait:

Use years if more than 36 months.

210a. When you found out you were pregnant, how did you feel?

[] Very happy
[] Sort of happy
[] Mixed happy and unhappy
[] Sort of unhappy
[] Very unhappy
[] No response

210b. If you got pregnant now, how would you feel?

[] Very happy
[] Sort of happy
[] Mixed happy and unhappy
[] Sort of unhappy
[] Very unhappy
[] No response

COV_7. Have you changed your mind about wanting to get pregnant due to concerns about Coronavirus (COVID-19)?

[] Yes
[] No
[] 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.

[] 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.

[] 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.

[] Yes
[] No
[] No response

301f. Have you heard that there is a type of injectable that you can inject yourself?

[] Yes
[] No
[] No response

301g. From whom did you hear about it?

[] Provider
[] Community health worker
[] Pharmacist
[] Friend
[] Husband/partner
[] Other family member
[] Radio/TV
[] Books/Magazine
[] Advertisement/Flyer
[] Other
[] No response

301h. Have you ever heard of the (birth control) pill?

PROBE: Women can take a pill every day to avoid becoming pregnant.

[] Yes
[] No
[] No response

301i. 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

301j. Have you ever heard of male condoms?

PROBE: Men can put a rubber sheath on their penis before sexual intercourse.

[] Yes
[] No
[] No response

301k. Have you ever heard of female condoms?

PROBE: Women can put a sheath in their vagina before sexual intercourse.

[] Yes
[] No
[] No response

301l. 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

301m. 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

301n. 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

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

[] Yes
[] No
[] No response

301p. 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

301q. Have you ever heard of the withdrawal method?

PROBE: Men can be careful and pull out before climax.

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

303. Just to check, are you or your partner doing any of the following to avoid pregnancy: deliberately avoiding sex on certain days, using a condom, using withdrawal or using emergency contraception?

[] Yes
[] No
[] No response

304. Which method or methods are you using?

PROBE: Anything else?

Select all methods mentioned. SCROLL TO THE BOTTOM to see all choices.

You selected no response with another option.

[] 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_301. PROBE: Was the injection administered via syringe or small needle?

Show the image to the respondent.

[] Syringe
[] Small needle (Sayana Press)
[] No response

LCL_302. Who administered the injection?

[] Self
[] Partner/husband
[] Other family/friend
[] Doctor/nurse/midwife
[] Pharmacist/Drug shop employee
[] CHW
[] Another user I know
[] No response

305. Does your husband/partner know that you are using {current_method_label}?

[] Yes
[] No
[] No response

305. Does your husband/partner know that you are using family planning?

[] Yes
[] No
[] No response

LCL_303. Did the provider tell you or your partner that this method was permanent?

[] Yes
[] No
[] No response

ABT_1. Before deciding to use {current_method_label}, did you seek input or information from any of the following sources:

Read all options aloud. Select all that apply.

[] Partner
[] Family members
[] Friends
[] Medical provider at a facility
[] Community health worker
[] Pharmacist/chemist
[] Internet
[] Hotline (phone numbers)
[] Other (Specify)
[] None of the above
[] No response

Specify this other source of advice on how to use {current_method_label}

306. If you needed family planning, where would you go?

[] 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
[] Community event
[] Other
[] Don't know
[] No Response

307. Why would you choose this location?

Cannot select 'no response' or 'do not know' with other options.

[] Close to home
[] Discreet location
[] Know confidentiality will be respected
[] Have the method that I want
[] Providers have a good reputation
[] Recommend by friend/relative
[] Method available for low cost/free
[] Other
[] Do not know
[] No response

308. Please tell me if you agree or disagree with the following statement: I would feel too shy or embarrassed to get family planning at a clinic, health center or physician's office if needed.

PROBE: This question is specifically about your feelings.

[] Agree
[] Disagree
[] No response

309. Please tell me if you agree or disagree with the following statement: I would feel too shy or embarrassed to get family planning at the pharmacy or chemist if needed.

PROBE: This question is specifically about your feelings.

[] Agree
[] Disagree
[] No response

310. 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
[] Do not know
[] No response

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

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

312. When do you think you will start using a method?

[] X months
[] X years
[] Soon/now
[] After the birth of this child
[] Do not know
[] No response

Enter {fp_start_lab}:

Use years if more than 36 months.

313. What method do you think you will use?

[] 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

314. Who would you prefer to have administer the injectable?

Read all options

[] Health professional
[] Self
[] Partner/friend/family
[] Do not know
[] No response

315. Would your husband/partner be supportive of you using family planning?

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

316. Before you started using {current_method_label}, had you discussed the decision to delay or avoid pregnancy with your husband/partner?

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

317. Would you say that 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

Now I'm going to ask you a few sensitive questions about your relationship with your husband/partner. You do not have to answer these questions if you do not want to. We can pause at any time. If you do not feel comfortable answering any of the questions, let me know and I will either move onto the next statement or skip this section entirely.

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

318. In the last 12 months has your husband/partner:

318a. Made you feel bad or treated you badly for wanting to use a FP method to delay or prevent pregnancy?

[] Yes
[] No
[] No response

318. In the last 12 months has your husband/partner:

318b. Tried to force or pressure you to become pregnant?

[] Yes
[] No
[] No response

318. In the last 12 months has your husband/partner:

318c. Said he would leave you if you did not get pregnant?

[] Yes
[] No
[] No response

318. In the last 12 months has your husband/partner:

318d. Told you he would have a baby with someone else if you did not get pregnant?

[] Yes
[] No
[] No response

318. In the last 12 months has your husband/partner:
318e. Taken away your family planning or kept you from going to the clinic to get family planning?

[] Yes
[] No
[] No response

318. In the last 12 months has your husband/partner:

318f. Hurt you physically because you did not get pregnant?

[] Yes
[] No
[] No response

319. Since what month and year have you been using {current_method_label} without stopping?

Calculate backwards from memorable events if needed.

CALENDAR: Enter episode of contraceptive use in the calendar.

Month:

[] January
[] February
[] March
[] April
[] May
[] June
[] July
[] August
[] September
[] October
[] November
[] December
[] Do not know

Year: ___

If entering '2030' for No Response, must select 'Do not know' for month.

Cannot be in future.

320. You first started using {current_method_label} on ${start_date_lab}.

Where did you or your partner 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
[] Community event
[] Other
[] Don't know
[] No Response

320. Where did you or your partner get {current_method_label} when you first started using it?

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
[] Community event
[] Other
[] Don't know
[] No Response

ABT_2. Did any of the following reasons factor into your choice to go to this provider?

Read all options aloud. Select all that apply.

[] Cost
[] Convenience
[] Location (close)
[] Location (far)
[] Privacy / Confidentiality
[] Method offered
[] Recommanded
[] Partner preference
[] Provider had good reputation
[] Knew provider (personally or through friend/family member)
[] Only option knew of nearby
[] Other (Specify)
[] None of these
[] No response

Specify this other reason for seeing this provider

321. When you obtained your {current_method_label}, were you told by the provider about side effects or problems you might have with a method to delay or avoid pregnancy?

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

IMP_301. CHECK. In question 304, the respondent mentioned that she had been using implants. Is that correct?

If she says she is not currently using implants, please verify her answer and go back to 304 and select the correct method.

[] Yes
[] No

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 for X on the next screen.

Please check that you correctly entered the value for months/years.

[] X months
[] X years
[] Do not know
[] No response

IMP_303. Enter the number of {implant_duration_lab} you were told:

If more than 12 months record in years

IMP_304. Were you told where you could go to have the implant removed?

Provider: {provider_label}

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

323. At that time, were you told by the family planning provider about methods of family planning other than the {current_method_label} that you could use?

[] Yes
[] No
[] No response

ABT_3. Which of the following methods did the provider discuss with you?

[] 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

324. At that time, were you told that you could switch to a different method in the future?

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] Did not have a preference
[] No response

326. 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
[] Do not know
[] No response

327a. 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

327b. Who made the final decision to use rhythm?

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

327b. Who made the final decision to use LAM?

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

328. Would you return to this provider?

Provider: {provider_label}

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

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

Provider: {provider_label}

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

330. When you started using {current_method_label}, did you feel pressured by your provider to accept a specific method?

[] Yes
[] No
[] Did not have a preference
[] No response

331. Which method did you feel pressured to use?

[] 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

ABT_4. When you first received your {current_method_label} from ${fp_provider_lab} on ${begin_using_full_lab}, how much did you have to pay out of pocket, including any fees paid for the method, supplies, or services?

Enter all prices in local currency. Zero is a possible answer. Enter -88 if respondent does not know, -99 for no response.

332. Right before you started using {current_method_label} in ${begin_using_full_lab}, were you doing something else or using a different method to delay or avoid getting pregnant?

[] Yes
[] No
[] No response

333. Which method were you using?

[] 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?

[] Syringe
[] Small needle (Sayana Press)
[] No response

IMP_305. In the past 12 months, have you tried to have your current implant removed?

[] Yes
[] No
[] No response

IMP_306. Where did you go or who attempted to remove your implant?

[] 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
[] Community event
[] Friend / parent
[] Self
[] Other
[] Do not know
[] No response

IMP_307. Why were you not able to have your implant removed?

Cannot select 'no response' or 'do not know' with other options.

[] 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 elsewhwere
[] Other
[] Do not know
[] No response

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

[] Yes
[] No
[] No response

XS_301. How old were you when you first used a method to delay or avoid getting pregnant?

The respondent said she was {age} years old at her last birthday.

Enter the age in years.
Enter -88 if the respondent does not know.
Enter -99 if there is no response.
Cannot be younger than 9.

Cannot be older than the current age of the respondent. Cannot be younger than 9. Cannot be after recent/current use.

335. How many living children did you have at that time, if any?

Note: the respondent said that she gave birth {birth_events} times in 202.

Enter -99 for no response.

Must be zero or larger, or -99.

336. Have you used emergency contraception at any time in the last 12 months?

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

337. You said that you do not want a child soon and that you are not using a method to avoid pregnancy.

337. You said that you do not want another child soon and that you are not using a method to avoid pregnancy.

337. You said that you do not want any children and that you are not using a method to avoid pregnancy.

337. You said that you do not want 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 to prevent pregnancy?

PROBE: Any other reason?

RECORD ALL REASONS MENTIONED

Cannot select "Not Married" if 109 is "Yes, currently married".

Scroll to bottom to see all choices.

Cannot select "Do not know" or "No response" with other options.

Cannot select "Not Married" if 109 is "Yes, currently married".

[] 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
[] Do not know
[] No response

COV_8. Can you tell me if any of the following Coronavirus (COVID-19) related reasons contribute to why you are not using a method to prevent pregnancy?

Read each option aloud and select if yes.

Cannot select "Do not know" or "No response" with other options.

Cannot select "Not Married" if 109 is "Yes, currently married".

[] Healthcare facility or doctor's office closed, appointment not possible, services not available
[] Desired product(s) not available
[] Unable to access services because of government restrictions on movement
[] Fear of being infected with COVID-19 at healthcare facilities
[] Other
[] None of the above
[] No response

338. 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

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

[] Yes
[] No
[] No response

340. In the last 12 months, have you visited a health facility or camp for care for yourself?

For any health services.

[] Yes
[] No
[] No response

340. 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

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

[] Yes
[] No
[] No response

342. In the last 12 months have you:
342a. Heard about family planning on the radio?

[] Yes
[] No
[] No response

342. In the last 12 months have you:

342b. Seen anything about family planning on the television?

[] Yes
[] No
[] No response

342. In the last 12 months have you:
342c. Read about family planning in a newspaper or magazine?

[] Yes
[] No
[] No response

342. In the last 12 months have you:
342d. Received a voice or text message about family planning on a mobile phone?

[] Yes
[] No
[] No response

342. In the last 12 months have you:
342e. Seen anything on social media about family planning that is Facebook, Viber, Twitter, WhatsApp or others?

[] Yes
[] No
[] No response

343. People have different opinions about family planning. In your community, would you say most people, some people or few people have the following opinions about family planning:
343a. Adolescents who use family planning are promiscuous.

[] Most
[] Some
[] Few
[] No response

343. People have different opinions about family planning. In your community, would you say most people, some people or few people have the following opinions about family planning:
343b. Using family planning preserves a woman's health

[] Most
[] Some
[] Few
[] No response

343. People have different opinions about family planning. In your community, would you say most people, some people or few people have the following opinions about family planning:
343c. Family planning is only for women who are married.

[] Most
[] Some
[] Few
[] No response

343. People have different opinions about family planning. In your community, would you say most people, some people or few people have the following opinions about family planning:
343d. Women who use family planning can better support their children's schooling

[] Most
[] Some
[] Few
[] No response

343. People have different opinions about family planning. In your community, would you say most people, some people or few people have the following opinions about family planning:
343e. Family planning is only for women who don't want any more children.

[] Most
[] Some
[] Few
[] No response

343. People have different opinions about family planning. In your community, would you say most people, some people or few people have the following opinions about family planning:
343f. People who use family planning have a better quality of life.

[] Most
[] Some
[] Few
[] No response

344. Now, we would now like to know about your personal opinions about these issues. Do you strongly agree, agree, disagree, strongly disagree with the following statements?
344a. Adolescents who use family planning are promiscuous.


[] Strongly agree
[] Agree
[] Disagree
[] Strongly disagree
[] No response

344. Now, we would now like to know about your personal opinions about these issues. Do you strongly agree, agree, disagree, strongly disagree with the following statements?
344b. Using family planning preserves a woman's health


[] Strongly agree
[] Agree
[] Disagree
[] Strongly disagree
[] No response

344. Now, we would now like to know about your personal opinions about these issues. Do you strongly agree, agree, disagree, strongly disagree with the following statements?
344c. Family planning is only for women who are married.


[] Strongly agree
[] Agree
[] Disagree
[] Strongly disagree
[] No response

344. Now, we would now like to know about your personal opinions about these issues. Do you strongly agree, agree, disagree, strongly disagree with the following statements?
344d. Women who use family planning can better support their children's schooling


[] Strongly agree
[] Agree
[] Disagree
[] Strongly disagree
[] No response

344. Now, we would now like to know about your personal opinions about these issues. Do you strongly agree, agree, disagree, strongly disagree with the following statements?
344e. Family planning is only for women who don't want any more children.


[] Strongly agree
[] Agree
[] Disagree
[] Strongly disagree
[] No response

344. Now, we would now like to know about your personal opinions about these issues. Do you strongly agree, agree, disagree, strongly disagree with the following statements?
344f. People who use family planning have a better quality of life.


[] Strongly agree
[] Agree
[] Disagree
[] Strongly disagree
[] No response

345. How important is it for you to achieve the following in the next two years:
345a. Complete secondary school / technical school / vocation school


[] Very important
[] Somewhat important
[] Not important
[] No Response

345. How important is it for you to achieve the following in the next two years:
345b. Attend university / tertiary institution


[] Very important
[] Somewhat important
[] Not important
[] No Response

345. How important is it for you to achieve the following in the next two years:
345c. Have a good job


[] Very important
[] Somewhat important
[] Not important
[] No Response

345. How important is it for you to achieve the following in the next two years:
345d. Start a business


[] Very important
[] Somewhat important
[] Not important
[] No Response

345. How important is it for you to achieve the following in the next two years:
345e. Find a partner


[] Very important
[] Somewhat important
[] Not important
[] No Response

345. How important is it for you to achieve the following in the next two years:
345f. Get married


[] Very important
[] Somewhat important
[] Not important
[] No Response

345. How important is it for you to achieve the following in the next two years:
345g. Have children


[] Very important
[] Somewhat important
[] Not important
[] No Response

346. Do you have any health insurance or are you a member of a mutual health organization?

[] Yes
[] No
[] No response

347. What type of health insurance do you have?

RECORD ALL MENTIONED

Cannot select "No response" with other options.

[] National/District Health Insurance (NHIS)
[] Health insurance through employer
[] Mutual health organization/Community-based health insurance
[] Other privately purchased commercial health insurance
[] Other
[] No response

Section 4 -- Sexual Activity

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

Now I would like to ask some questions about sexual activity in order to gain a better understanding of some important life issues. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question.

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

Enter the age in years.

Enter -77 if she has never had sex.
Enter -99 for no response.
Enter -88 for do not know.

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

402. Looking back to the first time you had sexual intercourse, do you think you would have preferred to: have waited longer before having sex with anyone, not have waited so long, or was it the right time?

[] Waited longer
[] Not have waited so long
[] It was the right time
[] No response

403. The first time you had sexual intercourse, would you say you and your partner were both equally willing to have sexual intercourse was one of you more willing than the other?

[] Equally willing
[] Respondent more willing
[] Partner more willing
[] No response

404. Which of these applied to you at the first time you had sex?

Read each option aloud and select if yes.

Cannot select "None of the above" or "No response" with other options.

[] I was curious
[] I was carried away
[] I was under the influence of a substance
[] I was doing what was expected of me
[] I was forced against my will
[] None of the above
[] No response

405. Did you and your partner want to avoid a pregnancy the first time you had sexual intercourse?

[] Yes
[] No
[] No response

406. Did you or your partner do something or use any method to delay or avoid getting pregnant?

[] Yes
[] No
[] No response

407. When was the last time you had sexual intercourse?
Answer must be in days or weeks up to 4 weeks or 30 days
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.

Must agree with the pregnancy status.

[] X days ago
[] X weeks ago
[] X months ago
[] X years ago
[] No response

407. Enter {last_time_sex_lab}.

If today, enter zero days only, not zero weeks/months/years.
Must agree with the age of first sexual intercourse and the pregnancy status.

Days must be greater or equal to 0. Weeks/months/years must be greater than 0.

408. The last time you had sex did you or your partner use any method to avoid or prevent a pregnancy?

[] Yes
[] No
[] No response

409. What method did you or your partner use?

[] 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

410. Whose choice was it to use that method?

[] Respondent
[] Respondent and partner
[] Partner
[] Someone else
[] No response

WGE_1. At the last time you had sex, did any of the following happen?
WGE_1a. I did not want to have sex at that time

[] Yes
[] No
[] No response

WGE_1. At the last time you had sex, did any of the following happen?
WGE_1b. I felt pressured by my husband / partner to have sex then

[] Yes
[] No
[] No response

WGE_1. At the last time you had sex, did any of the following happen?
WGE_1c. I did not consent (was forced) to have sex then

[] Yes
[] No
[] No response

WGE_1. At the last time you had sex, did any of the following happen?
WGE_1d. I felt at risk of physical violence if I declined to have sex at that time

[] Yes
[] No
[] No response

Section 5 -- Women and Girls Empowerment Section

Now I'm going to ask you a series of statements about family planning and contraception. Please indicate how much you think these statements could apply to you by indicating how strongly you agree or disagree with the statement. Some will seem similar but we would like you to consider each one as different.
We can pause at any time. If you do not feel comfortable answering any of the statements, let me know and I will move onto the next statement.

501. If I use family planning, my husband/partner may seek another sexual partner.

[] Strongly disagree (1)
[] 2
[] 3
[] 4
[] Strongly agree (5)
[] Do not know
[] No response

502. If I use family planning, I may have trouble getting pregnant the next time I want to.

[] Strongly disagree (1)
[] 2
[] 3
[] 4
[] Strongly agree (5)
[] Do not know
[] No response

503a. There could be conflict in my relationship/marriage if I use family planning.

[] Strongly disagree (1)
[] 2
[] 3
[] 4
[] Strongly agree (5)
[] Do not know
[] No response

503b. There will be conflict in my relationship/marriage if I use family planning.

[] Strongly disagree (1)
[] 2
[] 3
[] 4
[] Strongly agree (5)
[] Do not know
[] No response

504. If I use family planning, my children may not be born normal.

[] Strongly disagree (1)
[] 2
[] 3
[] 4
[] Strongly agree (5)
[] Do not know
[] No response

505. If I use family planning, my body may experience side effects that will disrupt my relations with my husband/partner.

[] Strongly disagree (1)
[] 2
[] 3
[] 4
[] Strongly agree (5)
[] Do not know
[] No response

WGE_2. I can decide to switch from one family planning method to another if I want to.

[] Strongly disagree (1)
[] 2
[] 3
[] 4
[] Strongly agree (5)
[] Do not know
[] No response

WGE_3. I feel confident telling my provider what is important for me when selecting a family planning method.

[] Strongly disagree (1)
[] 2
[] 3
[] 4
[] Strongly agree (5)
[] Do not know
[] No response

WGE_4. I feel confident discussing family planning with my husband/partner.

[] Strongly disagree (1)
[] 2
[] 3
[] 4
[] Strongly agree (5)
[] Do not know
[] No response

Now I'm going to ask you a series of statements about pregnancy and childbearing. Please indicate how much you think these statements could apply to you by indicating how strongly you agree or disagree with the statement. Some will seem similar but we would like you to consider each one as different. We can pause at any time. If you do not feel comfortable answering any of the statements, let me know and I will move onto the next statement.

WGE_5a. I want to complete my education before I have a child.

[] Strongly disagree (1)
[] 2
[] 3
[] 4
[] Strongly agree (5)
[] Do not know
[] No response

WGE_5b. I wanted to complete my education before I had a child.

[] Strongly disagree (1)
[] 2
[] 3
[] 4
[] Strongly agree (5)
[] Do not know
[] No response

WGE_6. If I rest between pregnancies, I can take better care of my family.

[] Strongly disagree (1)
[] 2
[] 3
[] 4
[] Strongly agree (5)
[] Do not know
[] No response

WGE_7a. I can decide when I want to start having children.

[] Strongly disagree (1)
[] 2
[] 3
[] 4
[] Strongly agree (5)
[] Do not know
[] No response

WGE_7b. I could decide when I wanted to start having children.

[] Strongly disagree (1)
[] 2
[] 3
[] 4
[] Strongly agree (5)
[] Do not know
[] No response

WGE_8. I feel confident discussing with my husband/partner when to start having children.

[] Strongly disagree (1)
[] 2
[] 3
[] 4
[] Strongly agree (5)
[] Do not know
[] No response

WGE_9. I can decide when to have another child.

[] Strongly disagree (1)
[] 2
[] 3
[] 4
[] Strongly agree (5)
[] Do not know
[] No response

WGE_10a. I will be able to negotiate with my husband/partner when to stop having children.

[] Strongly disagree (1)
[] 2
[] 3
[] 4
[] Strongly agree (5)
[] Do not know
[] No response

WGE_10b. I can negotiate with my husband/partner when to stop having children.

[] Strongly disagree (1)
[] 2
[] 3
[] 4
[] Strongly agree (5)
[] Do not know
[] No response

Section 6 -- COVID-19 (Coronavirus)

We understand that Coronavirus (COVID-19) has impacted many people's lives. We are interested in learning more about how you are being affected.

COV_9. How concerned are you about getting infected with Coronavirus (COVID-19) yourself?

Read all options

[] Very concerned
[] Concerned
[] A little concerned
[] Not concerned
[] I was infected with Coronavirus (COVID-19)
[] No response

COV_10. During the last 12 months, how much of a loss of income did your household experience?

Read all options

[] None
[] Complete
[] Partial
[] No response

COV_11. Was the income loss resulting from Coronavirus (COVID-19) restrictions?

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

COV_12. Has your household income recovered partially or fully in the past 4 weeks?

[] Yes, partially recovered
[] Yes, fully Recovered
[] Not recovered
[] Do not know
[] No response

COV_13. During the past 4 weeks, did you or any household member go a whole day and night without eating anything because there was not enough food?

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

COV_14. During the past 4 weeks, how often did this happen?

[] Rarely (1-2 times)
[] Sometimes (3-10 times)
[] Often (more than 10 times)
[] Do not know
[] No response

COV_15. During the past 4 weeks, did you want to visit a health facility for any of the following services?

Read each option aloud and select if yes.

You selected no response with another option.

[] Family planning services
[] ANC
[] Delivery
[] PNC
[] Child's health
[] Immunization
[] Pick up of regular medications
[] Emergency services
[] General health services
[] Other
[] Did not want to access a health facility
[] No response

COV_16. During the past 4 weeks, did you experience any of the following difficulties in accessing healthcare services?

Read each option aloud and select if yes.

You selected no response with another option.

[] Healthcare facility or doctor's office closed, appointment not possible, services not available
[] Desired product(s) not available
[] Partner does not approve
[] No transportation to access healthcare services
[] Unable to access services because of government restrictions on movement
[] Unable to afford healthcare services
[] Fear of being infected with COVID-19 at healthcare facilities
[] Other
[] Did not experience difficulties accessing care
[] No response

COV_17. Did you successfully access the health services you needed?

[] Yes
[] No
[] No response

COV_18. Did you stop or interrupt your contraceptive use at any time due to Coronavirus (COVID-19) restrictions?

[] Yes
[] No
[] No response

Section 7.1 -- Confidantes

701a. Now I want to ask some questions about your closest female friends (these can be friends, relatives, like sisters, cusins, mother or aunts). These are women whom you share very personal information with and who also share their very personal information with you. How many female friends or relatives like this do you have in Burkina Faso who are between the ages of 15 and 49?

Enter -88 for do not know, -99 for no response.

701b. Now I want to ask some questions about your female friends (these can be friends, relatives, like sisters, cusins, mother or aunts). How many close female friends or relatives do you have in Burkina Faso who are between the ages of 15 and 49?

Enter -88 for do not know, -99 for no response.

702a. Please picture your closest female friend or relative in Burkina Faso who is between the ages of 15 and 49. Again, this woman should be someone with whom you share very personal information and who also shares her very personal information with you. For ease of referencing this woman, please provide a fake name.

702b. Please picture your closest female friend or relative in Burkina Faso who is between the ages of 15 and 49. For ease of referencing this woman, please provide a fake name.

703a. Is this person a friend or a family member?

[] Friend
[] Family member
[] No response

703b. How old was {friend_name} at her last birthday?

Enter -88 for do not know, -99 for no response.

704. What is the highest level of school {friend_name} has ever attended?

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

705. Is {friend_name} currently married or living together with a man?

[] Yes
[] No
[] No response

706a. Does she live in the same place as you?

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

706b. Does she live in a city, a town, or a village?

[] Village
[] Town
[] City
[] Do not know
[] No response

707. How many children does she have, if any?

Enter 0 if no children, -88 for Do not know, -99 for no response.

708. Has she ever used family planning?

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

709. Is she or her partner currently doing something or using any method to delay or avoid getting pregnant?

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

710. What method is she or her partner using?

[] 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
[] Do not know
[] No response

Section 7.2 -- Abortion

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

Sometimes women are worried they are pregnant or get pregnant when they do not want to be and they do something to end the pregnancy. The next series of questions are about things your friend may have done to end a pregnancy. This is a common experience in Burkina Faso and we simply want to better understand what women do in this situation. I want to remind you that this survey is completely confidential and anonymous and we do not know who your friend is. If we should come to any question that you don't want to answer, just let me know and I will skip to the next question.

I have read the above note to the respondent

[] NA

711. Has she ever done something to end a pregnancy when she was pregnant or worried she was pregnant?

[] Yes, I am certain
[] Yes, I think so
[] No
[] Do not know
[] No response

712. In what year did this happen?

If indicates happened more than once, specify most recent time. Enter 2030 for "Do not know" or "No response".

713. At the time, was she very certain, somewhat certain, or not at all certain of being pregnant?

[] Very certain
[] Somewhat certain
[] Not at all certain
[] Did not think was pregnant
[] Do not know
[] No response

714. Was she in a situation where she intentionally ended the pregnancy or did it end naturally?

[] Intentionally ended
[] Ended naturally / miscarriage
[] Do not know
[] No response

715.Did she successfully end the pregnancy?

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

716. How did you learnabout {friend_name}'s experience of ending her pregnancy?

[] She told me
[] Someone else told me
[] I knew she was pregnant and the pregnancy ended
[] She had health issues that made me think she had leaked the pregnancy
[] I heard rumors
[] Other
[] Do not know
[] No response

717. What are all the methods that she used to try to end the pregnancy? Anything else?

[] Surgical procedure (curettage, MVA, etc.)
[] Misoprostol (Cytotec Misoclear Misopro 200 Misodia)
[] Misoprostol + Mifepristone (Medabon Mifepack Mifedia)
[] Emergency contraception (Norlevo)
[] Contraceptive pills
[] Medicines you take when you have a fever like antibiotics or anti-malarial medicine (Palujecte, Novaquine, Cyphaquine
[] Injection with a product
[] Other pills
[] Traditional methods that are not inserted into the vagina (herbs, potions, concoctions)
[] Ingested industrial products (bleach, Coke-Nescafé mix, etc.)
[] Insert materials into the vagina (stem, herb ball, kanigban, etc.)
[] Other
[] Do not know
[] No response

718. What were all the places she went to obtain these methods?

[] National Hospital Center
[] Health and Social Services Center (public)
[] Family planning clinic
[] Mobile clinic (public)
[] Private provider
[] Other private medical sector
[] 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
[] Healer
[] Store/market/supermarket/mobile vendors
[] Religious organizations
[] Community event
[] Friend/Parent
[] House
[] Street vendor
[] Other
[] Don't know
[] No Response

721a. Besides this event, has {friend_name} ever done something to bring back her period when it was late?

[] Yes, I am certain
[] Yes, I think so
[] No
[] Do not know
[] No response

721b. Has {friend_name} ever done something to bring back her period when it was late?

[] Yes, I am certain
[] Yes, I think so
[] No
[] Do not know
[] No response

722. In what year did this happen?

If indicates happened more than once, specify most recent time. Enter 2030 for "Do not know" or "No response".

723. Did she do this because she was worried she was pregnant?

[] Yes, I am certain
[] Yes, I think so
[] No
[] Do not know
[] No response

724. At the time, was she very certain, somewhat certain, or not at all certain she was pregnant?

[] Very certain
[] Somewhat certain
[] Not at all certain
[] Did not think was pregnant
[] Do not know
[] No response

724b. In the end did she successfully bring back her period?

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

725. How do you know about {friend_name}'s experience bringing back her period, when it was late?

[] She told me
[] Someone else told me
[] I knew she was pregnant and the pregnancy ended
[] She had health issues that made me think she had leaked the pregnancy
[] I heard rumors
[] Other
[] Do not know
[] No response

726. What are all the methods that she used to bring back her period? Anything else?

[] Surgical procedure (curettage, MVA, etc.)
[] Misoprostol (Cytotec Misoclear Misopro 200 Misodia)
[] Misoprostol + Mifepristone (Medabon Mifepack Mifedia)
[] Emergency contraception (Norlevo)
[] Contraceptive pills
[] Medicines you take when you have a fever like antibiotics or anti-malarial medicine (Palujecte, Novaquine, Cyphaquine
[] Injection with a product
[] Other pills
[] Traditional methods that are not inserted into the vagina (herbs, potions, concoctions)
[] Ingested industrial products (bleach, Coke-Nescafé mix, etc.)
[] Insert materials into the vagina (stem, herb ball, kanigban, etc.)
[] Other
[] Do not know
[] No response

727. What were all the places she went to obtain these methods?

[] National Hospital Center
[] Health and Social Services Center (public)
[] Family planning clinic
[] Mobile clinic (public)
[] Private provider
[] Other private medical sector
[] 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
[] Healer
[] Store/market/supermarket/mobile vendors
[] Religious organizations
[] Community event
[] Friend/Parent
[] House
[] Street vendor
[] Other
[] Don't know
[] No Response

We know that relationships can sometimes have conflict and difficulty. These next questions ask about conflicts your confidante may have had in her relationships. Remember, you can skip any question you do not want to answer.

728. In the last 12 months, has her husband/partner:
a. Insulted her, yelled at her, screamed or made humiliating remarks?

[] Yes
[] No
[] Don't know
[] No response

728. In the last 12 months, has her husband/partner:
b. Slapped, hit or physically hurt her?

[] Yes
[] No
[] Don't know
[] No response

728. In the last 12 months, has her husband/partner:
c. Threatened with a weapon or attempted to strangle or kill her?

[] Yes
[] No
[] Don't know
[] No response

728. In the last 12 months, has her husband/partner:
d. Pressured or insisted on having sex when her did not want to (without physical force)?

[] Yes
[] No
[] Don't know
[] No response

728. In the last 12 months, has her husband/partner:
e. Physically forced her to have sex when her did not want to?

[] Yes
[] No
[] Don't know
[] No response

Section 7.3 -- Respondent Abortion

730. Now I would like to ask about your own experience. Have you ever done something to try to end a pregnancy when you were pregnant or worried you were pregnant?

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

731. In what year did this last happen?

If indicates happened more than once, specify most recent time. Enter 2030 for "Do not know" or "No response".

732. At the time, were you very certain, somewhat certain, or not at all certain you were pregnant?

[] Very certain
[] Somewhat certain
[] Not at all certain
[] Did not think I was pregnant
[] Do not know
[] No response

733. Did you take a pregnancy test to confirm?

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

734. Were you in a situation where you intentionally ended the pregnancy or did it end naturally?

[] Intentionally ended
[] Ended naturally / miscarriage
[] Do not know
[] No response

735.Did you successfully end the pregnancy?

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

736a. Who have you talked to about this event? Anyone else?

[] Partner
[] Mother
[] Mother-in-law
[] Other female relative
[] Father
[] Other male relative
[] {friend_name}
[] Other friends
[] Health provider
[] Traditional healer
[] Other (Specify)
[] None of the above
[] Do not know
[] No response

736a. Specify this other person told about this event

736b. Were any of the following people involved in the decision to end the pregnancy?

Read options aloud. Select all that apply.

[] Partner
[] Mother
[] Mother-in-law
[] Other female relative
[] Father
[] Other male relative
[] {friend_name}
[] Other friends
[] Health provider
[] Traditional healer
[] Other (Specify)
[] None of the above
[] Do not know
[] No response

736b. Specify this other person involved in the decision to terminate the pregnancy

737. Do you think your friend, {friend_name}, knows about this event?

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

738. How does {friend_name} know about this event?

[] I told her
[] Someone else told her
[] She knew I was pregnant and the pregnancy ended
[] I had health problems that made her think I had leaked the pregnancy
[] She heard rumors
[] Other
[] Do not know
[] No response

740. At the time of this event were you attending school?

[] Yes
[] No
[] No response

742. At the time of this event, did you live in a village, a small town, or a large city?

[] Village
[] Town
[] City
[] Do not know
[] No response

743. How long had you been pregnant when you ended the pregnancy

[] X weeks
[] X months
[] Do not know
[] No response

Enter {pregnant_how_long_lab}

How long had you been pregnant when you ended the pregnancy

744. How many periods had you missed?

Enter -88 for do not know, -99 for no response.

745. Women sometimes do many things to stop a pregnancy from continuing. Did you do more than one thing to try to end the pregnancy, outside of treating complications?

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

746a. What was the first thing you did to try to end the pregnancy?

[] Surgical procedure (curettage, MVA, etc.)
[] Misoprostol (Cytotec Misoclear Misopro 200 Misodia)
[] Misoprostol + Mifepristone (Medabon Mifepack Mifedia)
[] Emergency contraception (Norlevo)
[] Contraceptive pills
[] Medicines you take when you have a fever like antibiotics or anti-malarial medicine (Palujecte, Novaquine, Cyphaquine
[] Injection with a product
[] Other pills
[] Traditional methods that are not inserted into the vagina (herbs, potions, concoctions)
[] Ingested industrial products (bleach, Coke-Nescafé mix, etc.)
[] Insert materials into the vagina (stem, herb ball, kanigban, etc.)
[] Other
[] Do not know
[] No response

746b. What did you do to end the pregnancy?

[] Surgical procedure (curettage, MVA, etc.)
[] Misoprostol (Cytotec Misoclear Misopro 200 Misodia)
[] Misoprostol + Mifepristone (Medabon Mifepack Mifedia)
[] Emergency contraception (Norlevo)
[] Contraceptive pills
[] Medicines you take when you have a fever like antibiotics or anti-malarial medicine (Palujecte, Novaquine, Cyphaquine
[] Injection with a product
[] Other pills
[] Traditional methods that are not inserted into the vagina (herbs, potions, concoctions)
[] Ingested industrial products (bleach, Coke-Nescafé mix, etc.)
[] Insert materials into the vagina (stem, herb ball, kanigban, etc.)
[] Other
[] Do not know
[] No response

747. Where did you get the [first or only pregnancy removal method]?

[] National Hospital Center
[] Health and Social Services Center (public)
[] Family planning clinic
[] Mobile clinic (public)
[] Private provider
[] Other private medical sector
[] 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
[] Healer
[] Store/market/supermarket/mobile vendors
[] Religious organizations
[] Community event
[] Friend/Parent
[] House
[] Street vendor
[] Other
[] Don't know
[] No Response

748. What was the last thing you did that ultimately ended the pregnancy?

[] Surgical procedure (curettage, MVA, etc.)
[] Misoprostol (Cytotec Misoclear Misopro 200 Misodia)
[] Misoprostol + Mifepristone (Medabon Mifepack Mifedia)
[] Emergency contraception (Norlevo)
[] Contraceptive pills
[] Medicines you take when you have a fever like antibiotics or anti-malarial medicine (Palujecte, Novaquine, Cyphaquine
[] Injection with a product
[] Other pills
[] Traditional methods that are not inserted into the vagina (herbs, potions, concoctions)
[] Ingested industrial products (bleach, Coke-Nescafé mix, etc.)
[] Insert materials into the vagina (stem, herb ball, kanigban, etc.)
[] Other
[] Do not know
[] No response

749. Where did you get the {abt_last_method_lab}?

[] National Hospital Center
[] Health and Social Services Center (public)
[] Family planning clinic
[] Mobile clinic (public)
[] Private provider
[] Other private medical sector
[] 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
[] Healer
[] Store/market/supermarket/mobile vendors
[] Religious organizations
[] Community event
[] Friend/Parent
[] House
[] Street vendor
[] Other
[] Don't know
[] No Response

750. Did you experience no pain, mild pain, or severe pain during the process of ending the pregnancy?

[] No pain
[] Mild pain
[] Severe pain
[] Do not know
[] No response

751. Were you given something that made the pain go away?

[] I was not given anything
[] I was given something that didn't stop the pain
[] I was given something that stopped the pain
[] Not applicable
[] Do not know
[] No response

752. Did you experience any of the following problems at any point in the process of ending the pregnancy:

[] Little or no bleeding
[] Heavy bleeding to the point of feeling dizzy
[] Bleeding for more than 3 weeks
[] Fever for more than 1 day
[] Pain in your belly that did not go away after 3 days
[] Severe pain
[] Discharge from vagina that smelled bad
[] Punctured uterus or other internal injury requiring surgery
[] The process was not complete
[] Other (Specify)
[] None of the above
[] No response

752a. Specify this other problem encountered in the process of sinking the pregnancy

Read options aloud. Select all that apply.

753. Did you receive any of the following treatments for these problems?

Read options aloud. Select all that apply.

[] Additional medicines to complete the process
[] Surgery
[] Blood transfusion
[] Antibiotics
[] Pain medication
[] Other (Specify)
[] None of the above
[] Do not know
[] No response

753a. Specify this other treatment received

754. Where did you receive this treatment?

Select all that apply.

[] National Hospital Center
[] Health and Social Services Center (public)
[] Family planning clinic
[] Mobile clinic (public)
[] Private provider
[] Other private medical sector
[] 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
[] Healer
[] Store/market/supermarket/mobile vendors
[] Religious organizations
[] Community event
[] Friend/Parent
[] House
[] Street vendor
[] Other
[] Don't know
[] No Response

755a. Besides this event, have you ever done something to bring back your period when it was late?

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

755b. Have you ever done something to bring back your period when it was late?

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

756. In what year did this happen?

If indicates happened more than once, specify most recent time. Enter 2030 for "Do not know" or "No response".

757. Were worried you were pregnant at the time?

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

758. At the time, how certain were you that you were pregnant? Very certain, somewhat certain, or not at all certain?

[] Very certain
[] Somewhat certain
[] Not at all certain
[] Did not think I was pregnant
[] Do not know
[] No response

758b. In the end did you successfully bring back your period?

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

759a. Who have you talked to about this event? Anyone else?

Read options aloud. Select all that apply.

[] Partner
[] Mother
[] Mother-in-law
[] Other female relative
[] Father
[] Other male relative
[] {friend_name}
[] Other friends
[] Health provider
[] Traditional healer
[] Other (Specify)
[] None of the above
[] Do not know
[] No response

759a. Specify this other person

759b. Were any of the following people involved in the decision to bring back your period?

Read options aloud. Select all that apply.

[] Partner
[] Mother
[] Mother-in-law
[] Other female relative
[] Father
[] Other male relative
[] {friend_name}
[] Other friends
[] Health provider
[] Traditional healer
[] Other (Specify)
[] None of the above
[] Do not know
[] No response

759b. Specify the people involved in the decision to bring back your period?

760. Do you think your friend, {friend_name}, knows about this event?

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

761. How does {friend_name} know about this event?

[] I told her
[] Someone else told her
[] She knew I was pregnant and the pregnancy ended
[] I had health problems that made her think I had leaked the pregnancy
[] She heard rumors
[] Other
[] Do not know
[] No response

763. At the time of this event were you attending school?

[] Yes
[] No
[] No response

764. Were you living in a village, a town, or a large city?

[] Village
[] Town
[] City
[] Do not know
[] No response

765. How many periods had you missed?

Enter -88 for do not know, -99 for no response.

766. Women sometimes do many things to bring back their period. Did you do more than one thing to try to bring back your period?

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

767a. What was the first thing you did to try to bring back your period?

[] Surgical procedure (curettage, MVA, etc.)
[] Misoprostol (Cytotec Misoclear Misopro 200 Misodia)
[] Misoprostol + Mifepristone (Medabon Mifepack Mifedia)
[] Emergency contraception (Norlevo)
[] Contraceptive pills
[] Medicines you take when you have a fever like antibiotics or anti-malarial medicine (Palujecte, Novaquine, Cyphaquine
[] Injection with a product
[] Other pills
[] Traditional methods that are not inserted into the vagina (herbs, potions, concoctions)
[] Ingested industrial products (bleach, Coke-Nescafé mix, etc.)
[] Insert materials into the vagina (stem, herb ball, kanigban, etc.)
[] Other
[] Do not know
[] No response

767b. What did you do to bring back your period?

[] Surgical procedure (curettage, MVA, etc.)
[] Misoprostol (Cytotec Misoclear Misopro 200 Misodia)
[] Misoprostol + Mifepristone (Medabon Mifepack Mifedia)
[] Emergency contraception (Norlevo)
[] Contraceptive pills
[] Medicines you take when you have a fever like antibiotics or anti-malarial medicine (Palujecte, Novaquine, Cyphaquine
[] Injection with a product
[] Other pills
[] Traditional methods that are not inserted into the vagina (herbs, potions, concoctions)
[] Ingested industrial products (bleach, Coke-Nescafé mix, etc.)
[] Insert materials into the vagina (stem, herb ball, kanigban, etc.)
[] Other
[] Do not know
[] No response

768. Where did you get the {reg_first_only_method_lab}?

[] National Hospital Center
[] Health and Social Services Center (public)
[] Family planning clinic
[] Mobile clinic (public)
[] Private provider
[] Other private medical sector
[] 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
[] Healer
[] Store/market/supermarket/mobile vendors
[] Religious organizations
[] Community event
[] Friend/Parent
[] House
[] Street vendor
[] Other
[] Don't know
[] No Response

769. What was the last thing you did that ultimately brought back your period?

[] Surgical procedure (curettage, MVA, etc.)
[] Misoprostol (Cytotec Misoclear Misopro 200 Misodia)
[] Misoprostol + Mifepristone (Medabon Mifepack Mifedia)
[] Emergency contraception (Norlevo)
[] Contraceptive pills
[] Medicines you take when you have a fever like antibiotics or anti-malarial medicine (Palujecte, Novaquine, Cyphaquine
[] Injection with a product
[] Other pills
[] Traditional methods that are not inserted into the vagina (herbs, potions, concoctions)
[] Ingested industrial products (bleach, Coke-Nescafé mix, etc.)
[] Insert materials into the vagina (stem, herb ball, kanigban, etc.)
[] Other
[] Do not know
[] No response

770. Where did you get the {self_reg_last_lab}?

[] National Hospital Center
[] Health and Social Services Center (public)
[] Family planning clinic
[] Mobile clinic (public)
[] Private provider
[] Other private medical sector
[] 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
[] Healer
[] Store/market/supermarket/mobile vendors
[] Religious organizations
[] Community event
[] Friend/Parent
[] House
[] Street vendor
[] Other
[] Don't know
[] No Response

771. Did you experience no pain, mild pain, or severe pain during the process of regulating your period?

[] No pain
[] Mild pain
[] Severe pain
[] Do not know
[] No response

772. Were you given something that made the pain go away?

[] I was not given anything
[] I was given something that didn't stop the pain
[] I was given something that stopped the pain
[] Not applicable
[] Do not know
[] No response

773. Did you experience any of the following problems in the process of regulating your period:

Read all options aloud. Select all that apply.

[] Little or no bleeding
[] Heavy bleeding to the point of feeling dizzy
[] Bleeding for more than 3 weeks
[] Fever for more than 1 day
[] Pain in your belly that did not go away after 3 days
[] Severe pain
[] Discharge from vagina that smelled bad
[] Punctured uterus or other internal injury requiring surgery
[] The process was not complete
[] Other (Specify)
[] None of the above
[] No response

773a. Specify this other problem encountered in the process of regulating your period.

774. Did you receive any of the following treatments for these problems?

Read all options aloud. Select all that apply.

[] Additional medicines to complete the process
[] Surgery
[] Blood transfusion
[] Antibiotics
[] Pain medication
[] Other (Specify)
[] None of the above
[] Do not know
[] No response

774a. Specify this other treatment received

775. Where did you receive this treatment?

Select all that apply.

[] National Hospital Center
[] Health and Social Services Center (public)
[] Family planning clinic
[] Mobile clinic (public)
[] Private provider
[] Other private medical sector
[] 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
[] Healer
[] Store/market/supermarket/mobile vendors
[] Religious organizations
[] Community event
[] Friend/Parent
[] House
[] Street vendor
[] Other
[] Don't know
[] No Response

For the next questions, I want to collect some more information about the time in {abt_year_lab} that you ended a pregnancy.

For the next questions, I want to collect some more information about the time in {abt_reg_year_lab} that you regulated your period.

CCS_701. What were the reason(s) that you decided to {adapt_display_en} at that time?

[] Partner refusal to accept the child
[] No financial means (to take care of the child)
[] Rape
[] Incest
[] I had health problems
[] Possible problems with the health of the fetus
[] Not ready to take on the responsibility of a child
[] Too young to have a child
[] Was still in school
[] Parents wanted me to abort
[] Relationship problems
[] Wanted to avoid single parenthood
[] Had all the children that I wanted or all children were grown up
[] Worried about how having a baby would change my life.
[] Did not want others to know that I had had sex or that I was pregnant
[] Other
[] No response

The next questions are about the {additional_where_lab} you went to to obtain the ${additional_method_lab}.

776a. Did any of the following reasons factor into your decision to go to {additional_where_lab}?

Read all options aloud. Select all that apply.

[] Cost
[] Convenience
[] Location (close)
[] Location (far)
[] Privacy / confidentiality
[] Method offered
[] Recommended
[] Provider had good reputation
[] Knew provider (personally or through friend/family member)
[] Only option knew of nearby
[] Other (Specify)
[] None of the above
[] No response

776a. Specify this other reason for your decision to go to see {additional_where_lab}

776b. What was the most important reason?

[] Cost
[] Convenience
[] Location (close)
[] Location (far)
[] Privacy / confidentiality
[] Method offered
[] Recommended
[] Provider had good reputation
[] Knew provider (personally or through friend/family member)
[] Only option knew of nearby
[] Other (Specify)
[] None of the above
[] No response

777a. Was it very difficult, somewhat difficult, or not difficult to find the necessary funds or did the service not require payment?

[] Very difficult
[] Somewhat difficult
[] Not at all difficult
[] Did not need to pay
[] Do not know
[] No response

777b. Was part of what you were* paid an informal fee for the provider?
This English translation is from the original documentation but the French version translates to "Was part of what you paid an informal fee for the provider?".

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

778. Did the provider and staff treat you with respect during the service?

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

779. Did the provider give you the opportunity to ask questions the way you wanted?

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

780. Did you receive care or consultation in a space where no one other than the provider could hear what you were discussing?

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

781. Were you given a choice of surgery or medication to end the pregnancy?

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

782. Did you trust the provider would keep your information private?

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

783a. Did you know what to expect after TAKING THE MEDICINE ?

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

783b. Did you know what to expect after HAVING THE SURGERY ?

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

784. Did you know where to go if you experienced complications?

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

785. Thinking about this event, which of the following aspects of care could have been improved:

Read all options aloud. Select all that apply.

[] Cost
[] Distance
[] How long it took to receive service
[] Privacy
[] Cleanliness (if facility)
[] How provider treated you
[] Your knowledge of method options before service
[] Explanation of process at time of service
[] Method effectiveness
[] Method safety
[] Level of pain
[] Side effects (other than pain)
[] Other (Specify)
[] Nothing - was fully satisfied with process
[] No response

785a. Specify this other aspect of care that could have been improved

Section 7.4 - Respondent Post-Abortion Contraception

CCS_702. Were you offered a family planning method from the {additional_where_lab} at the time of this event?

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

786. After this event, did you start using contraception?

[] Yes
[] No
[] No response

787. How long after you ENDED THE PREGNANCY did you start using contraception?

[] Less than 1 week
[] 1-4 weeks
[] 1-2 months
[] 3-6 months
[] More than 6 months
[] Do not know
[] No response

787. How long after you BROUGHT BACK YOUR PERIOD did you start using contraception?

[] Less than 1 week
[] 1-4 weeks
[] 1-2 months
[] 3-6 months
[] More than 6 months
[] Do not know
[] No response

788. Which method did you use? Anything else?

Select all that apply.

[] 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

789. How much did you feel involved in the selection of this contraceptive method?

Read all options aloud.

[] Very involved
[] somewhat involved
[] not very involved
[] not at all involved
[] Do not know
[] No response

790. How common is it for women in the community where you currently live to end their pregnancies because they don't want to or can't be pregnant?

Read all options aloud.

[] Very common
[] Somewhat common
[] Not very common
[] Not at all common
[] Do not know
[] No response

791. In your opinion, in which of the following circumstances should it be legal for a woman to end her pregnancy in Burkina Faso:

Read all options aloud. Select all that apply.

[] If continuing the pregnancy puts the woman's life at risk
[] In cases of rape
[] In cases of incest
[] If her physical health is at risk
[] If her mental health is at risk
[] If the pregnancy is not developing properly and would not result in a healthy birth
[] If she is too poor to feed another child
[] If her husband is not supportive of having another child
[] If she is not married
[] If she already has many children
[] Other (Specify)
[] None of the above
[] Do not know
[] No response

791. Specify other circumstance

CCS_703. Does the law in Burkina Faso allow a woman to end a pregnancy under certain circumstances?

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

CCS_704. What are the circumstances under which the law allows abortion in Burkina Faso?

[] If continuing the pregnancy puts the woman's life at risk
[] In cases of rape
[] In cases of incest
[] If her physical health is at risk
[] If her mental health is at risk
[] If the pregnancy is not developing properly and would not result in a healthy birth
[] If she is too poor to feed another child
[] If her husband is not supportive of having another child
[] If she is not married
[] If she already has many children
[] Other (Specify)
[] None of the above
[] Do not know
[] No response

CCS704a. Specify this other circumstance

792. What are all the things that women can do to end a pregnancy? Anything else?

[] Surgical procedure (curettage, MVA, etc.)
[] Misoprostol (Cytotec Misoclear Misopro 200 Misodia)
[] Misoprostol + Mifepristone (Medabon Mifepack Mifedia)
[] Emergency contraception (Norlevo)
[] Contraceptive pills
[] Medicines you take when you have a fever like antibiotics or anti-malarial medicine (Palujecte, Novaquine, Cyphaquine
[] Injection with a product
[] Other pills
[] Traditional methods that are not inserted into the vagina (herbs, potions, concoctions)
[] Ingested industrial products (bleach, Coke-Nescafé mix, etc.)
[] Insert materials into the vagina (stem, herb ball, kanigban, etc.)
[] Other
[] Do not know
[] No response

793. In the area where you live, where can women go to end a pregnancy? Anywhere else?

[] National Hospital Center
[] Health and Social Services Center (public)
[] Family planning clinic
[] Mobile clinic (public)
[] Private provider
[] Other private medical sector
[] 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
[] Healer
[] Store/market/supermarket/mobile vendors
[] Religious organizations
[] Community event
[] Friend/Parent
[] House
[] Street vendor
[] Other
[] Don't know
[] No Response

794. If a friend or relative found herself in a situation where she needed to end a pregnancy, where would you recommend she go to safely end the pregnancy?

[] 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)
[] Community event
[] Private hospital or clinic
[] Pharmacy
[] Private practice
[] Mobile clinic (private)
[] Private provider
[] Other private medical sector
[] Maternity
[] Health Agent
[] Store/market/supermarket/mobile vendors
[] Religious organizations
[] Healer
[] Friend/Parent
[] Street vendor
[] House
[] I'm not going to offer her anything
[] Other
[] Do not know
[] No Response

794a. Specify the other place you would recommend to your friend or family member.

795. What are the reasons you would recommend this provider? Anything else?

[] Cost
[] Convenience
[] Location (close)
[] Location (far)
[] Privacy / confidentiality
[] Method offered
[] Recommended
[] Provider had good reputation
[] Knew provider (personally or through friend/family member)
[] Only option knew of nearby
[] Other (Specify)
[] None of the above
[] No response

795a. Specify this other reason do you have for recommending this provider

Section 8 -- Violence Against Women and Girls

CHECK FOR THE PRESENCE OF OTHERS. DO NOT CONTINUE UNTIL YOU CAN ENSURE COMPLETE PRIVACY.

We know that relationships can sometimes have conflict and difficulty. These next questions ask about conflicts you may have had in relationships. Remember, you can skip any question you do not want to answer.

VIO_1a. Were you able to obtain complete privacy?

[] Yes
[] No

VIO_1. In the last 12 months, has your husband/partner:
a. Insulted you, yelled at you, screamed or made humiliating remarks?

[] Yes
[] No
[] No response

VIO_1. In the last 12 months, has your husband/partner:
b. Slapped, hit or physically hurt you?

[] Yes
[] No
[] No response

VIO_1. In the last 12 months, has your husband/partner:
c. Threatened with a weapon or attempted to strangle or kill you?

[] Yes
[] No
[] No response

VIO_1. In the last 12 months, has your husband/partner:
d. Pressured or insisted on having sex when you did not want to (without physical force)?

[] Yes
[] No
[] No response

VIO_1. In the last 12 months, has your husband/partner:
e. Physically forced you to have sex when you did not want to?

[] Yes
[] No
[] No response

VIO_2a. How many times has this happened?

Insulted you, yelled at you, screamed or made humiliating remarks?

[] One time
[] 1-2 times
[] 3 to 10 times
[] More than 10 times
[] Every day or almost
[] No response

VIO_3a. Since the Coronavirus (COVID-19) restrictions began, is it more frequent, less frequent or the same?

Insulted you, yelled at you, screamed or made humiliating remarks?

[] More frequent
[] Less frequent
[] About the same
[] No response

VIO_2b. How many times has this happened?

Slapped, hit or physically hurt you?

[] One time
[] 1-2 times
[] 3 to 10 times
[] More than 10 times
[] Every day or almost
[] No response

VIO_3b. Since the Coronavirus (COVID-19) restrictions began, is it more frequent, less frequent or the same?

Slapped, hit or physically hurt you?

[] More frequent
[] Less frequent
[] About the same
[] No response

VIO_2c. How many times has this happened?

Threatened with a weapon or attempted to strangle or kill you?

[] One time
[] 1-2 times
[] 3 to 10 times
[] More than 10 times
[] Every day or almost
[] No response

VIO_3c. Since the Coronavirus (COVID-19) restrictions began, is it more frequent, less frequent or the same?

Threatened with a weapon or attempted to strangle or kill you?

[] More frequent
[] Less frequent
[] About the same
[] No response

VIO_2d. How many times has this happened?

Pressured or insisted on having sex when you did not want to (without physical force)?

[] One time
[] 1-2 times
[] 3 to 10 times
[] More than 10 times
[] Every day or almost
[] No response

VIO_3d. Since the Coronavirus (COVID-19) restrictions began, is it more frequent, less frequent or the same?

Pressured or insisted on having sex when you did not want to (without physical force)?

[] More frequent
[] Less frequent
[] About the same
[] No response

VIO_2e. How many times has this happened?

Physically forced you to have sex when you did not want to?

[] One time
[] 1-2 times
[] 3 to 10 times
[] More than 10 times
[] Every day or almost
[] No response

VIO_3e. Since the Coronavirus (COVID-19) restrictions began, is it more frequent, less frequent or the same?

Physically forced you to have sex when you did not want to?

[] More frequent
[] Less frequent
[] About the same
[] No response

VIO_4. In the last 12 months, has a member of your household or family member who is not your spouse/partner (including a family member who does not live in your household):
VIO_4a. Insulted you, yelled at you, screamed or made humiliating remarks?

[] Yes
[] No
[] No response

VIO_4. In the last 12 months, has a member of your household or family member who is not your spouse/partner (including a family member who does not live in your household):
VIO_4b. Slapped, hit or physically hurt you?

[] Yes
[] No
[] No response

VIO_4. In the last 12 months, has a member of your household or family member who is not your spouse/partner (including a family member who does not live in your household):
VIO_4c. Threatened with a weapon or attempted to strangle or kill you?

[] Yes
[] No
[] No response

VIO_4. In the last 12 months, has a member of your household or family member who is not your spouse/partner (including a family member who does not live in your household):
VIO_4d. Pressured or insisted on having sex when you did not want to (without physical force)?

[] Yes
[] No
[] No response

VIO_4. In the last 12 months, has a member of your household or family member who is not your spouse/partner (including a family member who does not live in your household):
VIO_4e. Physically forced you to have sex when you did not want to?

[] Yes
[] No
[] No response

VIO_5a. How many times has this happened?

Insulted you, yelled at you, screamed or made humiliating remarks?

[] One time
[] 1-2 times
[] 3 to 10 times
[] More than 10 times
[] Every day or almost
[] No response

VIO_6a. Since the Coronavirus (COVID-19) restrictions began, is it more frequent, less frequent or the same?

Insulted you, yelled at you, screamed or made humiliating remarks?

[] More frequent
[] Less frequent
[] About the same
[] No response

VIO_5b. How many times has this happened?

Slapped, hit or physically hurt you?

[] One time
[] 1-2 times
[] 3 to 10 times
[] More than 10 times
[] Every day or almost
[] No response

VIO_6b. Since the Coronavirus (COVID-19) restrictions began, is it more frequent, less frequent or the same?

Slapped, hit or physically hurt you?

[] More frequent
[] Less frequent
[] About the same
[] No response

VIO_5c. How many times has this happened?

Threatened with a weapon or attempted to strangle or kill you?

[] One time
[] 1-2 times
[] 3 to 10 times
[] More than 10 times
[] Every day or almost
[] No response

VIO_6c. Since the Coronavirus (COVID-19) restrictions began, is it more frequent, less frequent or the same?

Threatened with a weapon or attempted to strangle or kill you?

[] More frequent
[] Less frequent
[] About the same
[] No response

VIO_5d. How many times has this happened?

Pressured or insisted on having sex when you did not want to (without physical force)?

[] One time
[] 1-2 times
[] 3 to 10 times
[] More than 10 times
[] Every day or almost
[] No response

VIO_6d. Since the Coronavirus (COVID-19) restrictions began, is it more frequent, less frequent or the same?

Pressured or insisted on having sex when you did not want to (without physical force)?

[] More frequent
[] Less frequent
[] About the same
[] No response

VIO_5e. How many times has this happened?

Physically forced you to have sex when you did not want to?

[] One time
[] 1-2 times
[] 3 to 10 times
[] More than 10 times
[] Every day or almost
[] No response

VIO_6e. Since the Coronavirus (COVID-19) restrictions began, is it more frequent, less frequent or the same?

Physically forced you to have sex when you did not want to?

[] More frequent
[] Less frequent
[] About the same
[] No response

VIO_7. Thinking about the experiences of relationship conflict we have just discussed, have you tried to seek help in the last 12 months?

[] Yes
[] No
[] No response

VIO_8. From whom have you sought help?

Probe: Anyone else?

Record all mentioned.

[] Own family
[] Husband's/partner's family
[] Current/former husband/partner
[] Current/former boyfriend
[] Friend
[] Neighbor
[] Religious leader
[] Doctor/medical personnel
[] Police
[] Lawyer
[] Social service organization
[] Violence support program or hotline
[] No response

Thank you for sharing your personal experiences with me. I know it may have been difficult for you to talk about your experiences with me. If you would like to talk further about these experiences, I can refer you to a place that can provide you with help.

VIO_9. Did you have to interrupt the interview during this section because some adult was trying to listen, came into the room, or interfered in any other way?
VIO_9a. Husband / partner?

[] Yes, once
[] Yes, more than once
[] No

VIO_9. Did you have to interrupt the interview during this section because some adult was trying to listen, came into the room, or interfered in any other way?
VIO_9b. Other male adult?

[] Yes, once
[] Yes, more than once
[] No

VIO_9. Did you have to interrupt the interview during this section because some adult was trying to listen, came into the room, or interfered in any other way?
VIO_9c. Female adult?

[] Yes, once
[] Yes, more than once
[] No

Follow-up Consent

801a. Thank you for the time you have kindly granted us.

Would you be willing to participate in another survey one year from now?

[] Yes
[] No
[] No response

801b. We would be very interested in learning more about what you went through to end your pregnancy or bring back your period, including your decision-making about which method to use and where to get services, among other things. Would you be willing to get together with another woman from the project at a later date to talk about your experience?

[] Yes
[] No
[] No response

802. Do you have access to a phone?

[] Yes
[] No
[] No response

803a. Can I have your primary phone number in case we would like to follow up with you in the future?

[] Yes
[] No
[] No response

803b. What is your primary phone number?

Enter an 8-digit number without the country code. Do not include spaces or dashes.

Invalid number of digits.

803c. Can you repeat the number again?

Enter an 8-digit number without the country code. Do not include spaces or dashes.

Number entered must match previously entered number.

803d. Is this your personal phone number?

A personal phone is not shared with other people.

[] Yes
[] No
[] No response

804a. Can I have your secondary phone number in case we would like to follow up with you in the future?

[] Yes
[] No
[] No response

804b. What is your secondary phone number?

Enter an 8-digit number without the country code. Do not include spaces or dashes.

Invalid number of digits.

804c. Can you repeat the number again?

Enter an 8-digit number without the country code. Do not include spaces or dashes.

Number entered must match previously entered number.

804d. Is this your personal phone number?

A personal phone is not shared with other people.

[] Yes
[] No
[] No response

805. Is {firstname_raw} the name you go by in your household?

[] Yes
[] No
[] No response

806. What is the name you go by in your household?

807. Is {firstname_raw} the name you go by in your community?

[] Yes
[] No
[] No response

808. What is the name you go by in your community?

Thank the respondent for her time.

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

Thank you.

There are still more questions for you to complete outside the home.

Location and Questionnaire result

095. Location

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

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
[] Autre

098. Questionnaire Result

Record the result of the questionnaire.

Check answer to 006 and consent.

[] Completed
[] Not at home
[] Postponed
[] Refused
[] Partly completed
[] Incapacitated
[] Deceased
[] Moved out of study area