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CDR1 Female Questionnaire

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


A. Are you in the correct household? Here is the household number in the neighborhood.
[ODK will display the household number in the neighborhood for the Household Questionnaire linked to this Female Questionnaire]
If you are not in the correct household, do not continue the interview. Go to the correct address.

[] Yes
[] No

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

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

C. Interviewer’s name: Is this your name?
[ODK will display the interviewer's name from the linked Household Questionnaire]
Please enter your name:

[] Name _______________

D. DATE AND LOCAL TIME DISPLAYED ON SCREEN
Are the date and time correct?

[] Yes
[] No

E. Enter the correct date and time.

Date____
Day____
Month____
Year____
Time____
Hours____
Minutes____
AM/PM____

F. The following information is from the Household Questionnaire. Please review to make sure you are interviewing the correct respondent.
[ODK will display the province, health zone, neighborhood number, street or avenue number, Structure Number, and Household Number from the linked Household Questionnaire.]

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

[] Yes
[] No

H. 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 age of 15-49 associated with this Female Respondent Questionnaire. The interview must be carried out in private. Read the following greeting to the interviewee:


Hello. My name is _________ and I work for the Public Health School of Kinshasa, as well as the Ministry of Health of the Democratic Republic of the Congo. We are conducting a local survey about women’s health. We would very much appreciate your participation in this survey. This information will help us inform the government to better plan health services. The survey usually takes between 15 and 20 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to anyone other than members of our survey team.
Participation in this survey is voluntary, and if we should come to any question you don't want to answer, just let me know and I will go on to the next question; or you can stop the interview at any time. However, we hope that you will participate in this survey since your views are important.
Before continuing, do you have any questions about the survey?
Provide a paper copy of the consent form to the person being interviewed and explain it to her. Then ask:

May I begin the interview now?

[] Yes
[] No

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

K. Interviewer's name: [Interviewer name from Household Questionnaire]
Mark your name as a witness to the consent process.
L. Respondent's name
You may correct the spelling here if it is not correct, but you must be interviewing the person whose name appears below.
PLEASE ENTER THE RESPONDENT’S NAME.

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

1. How old were you at your last birthday?

Age____
PLEASE ENTER A NUMBER BETWEEN 15 AND 49; DO NOT INTERVIEW ANYONE OLDER OR YOUNGER.

2. What is the highest level of school that you finished?

[] Never Attended
[] Primary
[] University / Higher
[] No response

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

8. How many times have you given birth?
0 is a possible answer.
Number of births:_______________

8b. Were all of those live births? (there were not stillbirths)?
If no, go back and change 8 to record only live birth events
[] Yes
[] No

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

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

11. Is your last baby / child still alive?

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

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

13. When did your last menstrual period start?
If you select days, weeks, months or years, you will enter a number for x on the next screen.
Enter 0 days for today, not 0 weeks/months/years.
Days ago:____
Weeks ago:____
Months ago:____
Years ago:____
[] Menopausal / Hysterectomy 5
[] Before last birth 6
[] Never menstruated 7
[] No response -99

14. Are you pregnant now?

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

15. How many months pregnant are you?
Please record the number of completed months.
Number of months____

CHECK Q: Currently pregnant?

[] Yes
[] No

16a. Now I have some questions about the future. Would you like to have a/another child or would you prefer not to have any / any more children?

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

16b. Now I have some questions about the future. 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 a/another child
[] No more/prefer no children
[] Says she can't get pregnant
[] Undecided / Don't know
[] No response

17a. How long would you like to wait from now before the birth of a/another child?

If you select months or years, you will enter a number for x on the next screen. Check to ensure that you’ve entered a correct number for months or years.

Months____
Years____
[] Soon / now
[] Says she can't get pregnant
[] Other
[] Undecided/Don't know
[] No response

17b. After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?
If you select months or years, you will enter a number on the next screen.

Months____
Years____
[] Soon / now 3
[] Says she can't get pregnant 4
[] Other 5
[] Undecided/Don't know -88
[] No response -99

CHECK 8:

[] Number of births ____

CHECK 14: Currently pregnant?

[] Yes 1
[] No 0

18a. Now I would like to ask a question about your last live birth.
At the time you became pregnant, did you want to become pregnant then, did you want to wait until later, or did you not want to have any / any more children at all?

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

18b. Now I would like to ask a question about your current pregnancy.
At the time you became pregnant, did you want to become pregnant then, did you want to wait until later, or did you not want to have any / any more children at all?

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

Section 3 - Contraception
Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.

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

[] Yes
[] No

20. How old were you when you first used a method to delay or avoid getting pregnant?
Enter the age in years.
Age____

20a. How many living children did you have at that time, if any?

Number_____

21. Which method did you first use to delay or avoid getting pregnant?
Do not read the method choices. Scroll to bottom to see all choices.
[] Female sterilization
[] Male sterilization
[] Implants
[] IUD
[] Injectables
[] Pill
[] Emergency Contraception
[] Male condom
[] Female condom
[] Diaphragm
[] Mousse/gel spermicide
[] Standard Days/Cycle Beads
[] Lactational Amen. Method (LAM)
[] Rhythm method
[] Withdrawal
[] Other traditional methods
[] No response

CHECK 14: Currently pregnant?

[] Yes
[] No

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

[] Yes
[] No

23. What are you currently doing to delay or avoid getting pregnant?
Probe: Anything else?
Select all methods mentioned. Be sure to SCROLL TO THE BOTTOM to see all choices.
[] Female sterilization
[] Male sterilization
[] Implants
[] IUD
[] Injectables
[] Pill
[] Emergency Contraception
[] Male condom
[] Female condom
[] Diaphragm
[] Mousse/gel spermicide
[] Standard Days/Cycle Beads
[] Lactational Amen. Method (LAM)
[] Rhythm method
[] Withdrawal
[] Other traditional methods
[] No response

24. Did the provider tell you / your partner that this method was permanent?

[] Yes
[] No

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

[] Yes
[] No

CHECK 14: Currently pregnant?

[] Yes
[] No

26a. 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 1
[] No 0

26b. Do you think you will use a contraceptive method to delay or avoid getting pregnant at any time in the future?

[] Yes
[] No

CHECK 19: Ever used contraceptives?

[] Yes
[] No

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

[] Yes 1
[] No 0

28. Which method did you use most recently?
Probe: Anything else?
Select most effective method (highest method on list). Scroll to bottom to see all choices.
[] Implants
[] IUD
[] Injectables
[] Pill
[] Emergency Contraception
[] Male condom
[] Female condom
[] Diaphragm
[] Mousse/gel spermicide
[] Standard Days/Cycle Beads
[] Lactational Amen. Method (LAM)
[] Rhythm method
[] Withdrawal
[] Other traditional methods
[] No response

29. When did you begin using your [MOST RECENT / CURRENT METHOD]?
Calculate backwards from memorable events if needed.
Month____
Year____

CHECK 22: Currently using contraceptives?

[] Yes
[] No

30. When did you stop using your [MOST RECENT METHOD]?
Please record the date. The date should be found by calculating backwards from memorable events if needed.
Month____
Year____

31. Why did you stop using your (MOST RECENT METHOD)?

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

32. Where did you obtain your [MOST RECENT / CURRENT METHOD] when you started using it?
Scroll to bottom to see all choices.

Public sector
[] Govt. Hospital
[] Govt. Health Center
[] Govt. Dispensary
[] Family planning clinic (public)
[] Mobile clinic
[] Fieldworker
[] Community Health Center

Private sector
[] Private hospital / clinic
[] Private doctor
[] Pharmacy
[] Drugstore
[] Family planning clinic (private)
[] Maternity
[] Market / supermarket

Other sources
[] Church / religious organizations
[] Community volunteer
[] Friend / parent
[] Other
[] Don't know
[] No Response



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

[] Yes
[] No

34. How much did you pay?
Enter all prices in CEDIS (not PESEWAS).
Total fee amount: _________________________

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

[] Yes
[] No

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

[] Yes
[] No

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

[] Yes
[] No

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

[] Yes
[] No

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

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

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

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

CHECK 32: Where did you obtain your [MOST RECENT / CURRENT METHOD]?

Public sector
[] Govt. Hospital
[] Govt. Health Center
[] Govt. Dispensary
[] Family planning clinic (public)
[] Mobile clinic
[] Fieldworker
[] Community Health Center

Private sector
[] Private hospital / clinic
[] Private doctor
[] Pharmacy
[] Drugstore
[] Family planning clinic (private)
[] Maternity
[] Market / supermarket

Other sources
[] Church / religious organizations
[] Community volunteer
[] Friend / parent
[] Other
[] Don't know
[] No Response



41. Would you return to this health provider?

[] Yes
[] No

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

[] Yes
[] No

CHECK 16: Desire for future child?

[] Have a/another child
[] No more/none
[] Says she can't get pregnant
[] Undecided / Don't know

CHECK 17: 2 or more years before next child?

[] No more/none
[] Less than 2 years
[] 2 or more years

CHECK 22: Currently using contraceptive method?

[] Yes, using contraceptive
[] No, not using contraceptive

CHECK 19: Ever used contraceptives?

[] Yes
[] No

43. You have said that you do not want [(a/another) child soon] / [any (more) children], but you are not using any method to avoid pregnancy. Can you tell me why you are not using a method?

[] Not married
[] Infrequent sex/not having sex
[] Menopausal/Hysterectomy
[] Infecund / subfecund
[] Not menstruated since last birth
[] Breastfeeding
[] Husband away for multiple days
[] Up to God / fatalistic
[] Respondent opposed
[] Husband / partner opposed
[] Others opposed
[] Religious prohibition
[] Knows no method
[] Knows no source
[] Fear of side effects
[] Health concerns
[] Lack of access / too far
[] Costs too much
[] Preferred method not available
[] No method available
[] Inconvenient to use
[] Interferes with body's processes
[] Other
[] Don't know
[] No response



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

[] Yes
[] No

45. In the last 12 months, have you visited a health facility for care for yourself (or your children)?

[] Yes
[] No

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

[] Yes
[] No

47. In the last few months have you:

Heard about family planning on the radio?
[] Yes
[] No
Seen anything about family planning on the television?
[] Yes
[] No
Read about family planning in a newspaper or magazine?
[] Yes
[] No

48. How old were you when you first had sexual intercourse?
Enter the age in years. Enter 0 if she never had sex..
Age____

49. When was the last time you had sexual intercourse?
If less than 12 months ago, answer must be recorded in days, weeks or months.
Enter 0 days for today. You will enter a number for X on the next screen.
DAYS AGO____
WEEKS AGO ____
MONTHS AGO____
YEARS AGO____
No response

Marriage

51a. Are you currently married, or living together with a man, or are you widowed, divorced, or separated?

[] 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

51b. How many times have you been married (counting the current marriage if the woman is married)?

[] Number of marriages _________________

51c. Does your husband / partner have other wives or does he live with other women as if married?

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

51d. Is your husband / partner living with you now or is he staying elsewhere?

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

51e. Partner’s name

[] Name ___________

51f. Start of marriage

[] Month ______
[] Year ______

51g. Age of the respondent at the time of marriage.

[] Age ______
[] Birth year _______

51h. Age of the partner at the time of marriage.

[] Age ______
[] Birth year _______

51i. After you and your husband/wife got married, where did you live?

[] Husband’s residence
[] Wife’s residence
[] Husband’s village
[] Wife’s village
[] Other

51j. Month and year at the end of the marriage.

[] Month ______
[] Year ______

51k. If it ended, what is the current status of the marriage?

[] Separation
[] Divorce
[] Widowhood

51l. What was the main reason why your marriage with [NAME] ended?

[] Lack of love
[] Partner unfaithful
[] Respondent unfaithful
[] Woman suspected to have contracted HIV/AIDS
[] Widow/Widower
[] Other, specify ________

51m. During the years of your marriage, did [NAME] have sexual relations with other people?

[] Yes, I am certain
[] I suspect it
[] Probably not
[] No
[] I don’t know

51n. During the years of your marriage, did you have sexual relations with someone other than [NAME].

[] No
[] Yes
[] I don’t remember anymore

Section 4 - Eau
Now I would like to ask about your water use.

52. On a typical day in the DRY season, how much time do you spend collecting water?
Only record respondent's time; not anyone else's time. If you select minutes or hours you will enter a number for x on the next screen.

[] X hours per day
[] X minutes per day
[] No time, someone else collects water
[] No time, no one collects water
[] Don't know
[] No response

51. On a typical day in the WET season, how much time do you spend collecting water?
Only record respondent's time; not anyone else's time. If you select minutes or hours you will enter a number for x on the next screen.
[] X hours per day
[] X minutes per day
[] No time, someone else collects water
[] No time, no one collects water
[] Don't know
[] No response

Thank the respondent for her time.
The respondent is finished, but there are still 2 more questions for you to complete outside the home.

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

RECORD LOCATION

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