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CDR5 Female Questionnaire

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


A. Are you in the correct household?
Go to the right household.
[] Yes
[] No

This is the picture of the front of the home taken during the household questionnaire.

B. Your name:
[ODK will display the interviewer's name linked with the telephone number]
Is this your name?

[] Yes
[] No

B. Enter your name below.
Please record your name

C. Current date and time.
[ODK will display the current date and time]
Is this date and time correct?

[] Yes
[] No

D. Record the correct date and time.

Date____
Day____
Month____
Year____
Time____
Hours____
Minutes____
AM/PM____

E. The following info is from the household questionnaire. Please review to make sure you are interviewing the correct respondent.
[ODK will display the province, city, commune, and neighborhood for the Enumeration Areas of Kinshasa, or the province, district, health zone, and village in the Enumeration Areas of Kongo Central. In addition, the Enumeration Area, Structure Number, and Household Number from the linked Household Questionnaire will be displayed.]

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

CHECK: You should be attempting to interview [NAME]. Is that correct?
If misspelled, select "yes" and update the name in question "J."
If this is the wrong person, you have two options:
(1) exit and ignore changes to this form. Open the correct form.
Or
(2) find and interview the person whose name appears above.


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

[] Yes
[] No

G. How well acquainted are you with the respondent?

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

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

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

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

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

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

[] Yes
[] No

Respondent's signature

[] Checkbox

I. Interviewer's name: [YOUR NAME]
Mark your name as a witness to the consent process.
[] NA

J. Respondent's first name.
[ODK will display the name of the respondent recorded during the household questionnaire]
You may correct the spelling here if it is not correct, but you must be interviewing the person whose name appears below.

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

FQ0. In what month and year were you born?
The age in the household roster is [AGE].
Cannot be in the future.
Month____ Year____

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

Age in the Household Roster:
[AGE]
This screen must agree with the previous one. Enter the right number.

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

[] Never attended
[] Primary
[] Secondary
[] Tertiary
[] No response

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

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

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

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

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

[] Yes
[] No

FQ5b. Now I would like to ask about when you started living with your CURRENT or MOST RECENT husband / partner. In what month and year was that?

Month____ Year____
Enter Jan 2020 for no response

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

[] Yes
[] No

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

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

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

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

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

FQ8a. How many times have you given birth?
0 is a possible answer

Check: You entered that the respondent has given birth [NUMBER OF BIRTHS] times. Is that what she said?
Go back and change FQ8a if that is not correct.
[] Yes
[] No

Were all of those live births (there were not stillbirths)?
If no, go back and change FQ8 to record only live birth events.
[] Yes
[] No

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

Number:______________

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

FQ8d. How many have died?
Change FQ8c to 'No' if zero deaths.
Number:______________

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

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

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

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

FQ11. Is your last baby / child still alive?

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

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

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

FQ13. Enter [MENSTRUAL PERIOD VALUES]:
Enter 0 days for today, not 0 weeks/months/years. Must be 0 days or larger.

FQ14. Are you pregnant now?

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

FQ15. How many months pregnant are you?

Number of months____

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

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

FQ16b. 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 / Don't know
[] No response

FQ17a. 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. Please check that you correctly entered the value for months/years.
[] X months
[] X years
[] Soon/now
[] Says she can't get pregnant
[] Other
[] Don't know
[] No response

FQ17a. 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. Please check that you correctly entered the value for months/years.
[] X months
[] X years
[] Soon/now
[] Says she can't get pregnant
[] Other
[] Don't know
[] No response

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

FQ17. Enter the number of [TIME] you would like to wait:
Use years if more than 36 months.

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

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

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

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

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


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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

FQ19. Have you ever heard of the contraceptive implant?
PROBE: Women can have one or several small rods placed in her upper arm by a doctor or nurse, which can prevent pregnancy for one or more years.

[] Yes
[] No
[] No response

FQ19.Have you ever heard of the IUD?
PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse.

[] Yes
[] No
[] No response

FQ19. Have you ever heard of injectables?
PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.

[] Yes
[] No
[] No response

FQ19. Have you ever heard of the (birth control) pill?
PROBE: Women can take a pill every day to avoid becoming pregnant.

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

FQ21. Which method or methods are you using?
PROBE: Anything else?
Select all methods mentioned. SCROLL TO THE BOTTOM to see all choices. You selected no response with another option.
OR
You said previously that you used female sterilization.
[] 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

FQ21a. PROBE: Was the injection administered via syringe or small needle?
Show the image to the respondent.
[] Syringe
[] Small needle (Sayana Press)
[] Both
[] No Response

FQ21b. Are you breastfeeding to delay or avoid getting pregnant?

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

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

FQ26a. PROBE: Was the injection administered via syringe or small needle?
Show the image to the respondent.
[] Syringe
[] Small needle (Sayana Press)
[] Both
[] No Response

FQ26b. Before you started using [MOST RECENT / CURRENT METHOD], did you talk with your husband/ partner about using a contraceptive method?

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

FQ27. When did you begin using [MOST RECENT / CURRENT METHOD]?
Calculate backwards from memorable events if needed.

Month____ Year____

Most Recent Birth: [DATE]
Current Marriage: [DATE]
Enter Jan 2020 for no response.

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

Month____ Year____

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

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

FQ30. You first started using [MOST RECENT / CURRENT METHOD] on [DATE]. Where did you get it at that time?
Scroll to bottom to see all choices.
[] National hospital
[] Family planning clinic
[] Health center/ Health post
[] Maternity
[] Community health volunteer
[] Regional hospital
[] Private hospital/clinic
[] pharmacy
[] NGO
[] Private health center
[] Private practice
[] Private doctor
[] Mobile nurse
[] Community health worker (ASC)
[] Community-based medical student
[] Boutique
[] Religious institution
[] Friend / Relative
[] Bar / Night club
[] Kiosk
[] Chayeur
[] Other
[] Don't know
[] No Response

FQ31. 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?
Provider: [PROVIDER]

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

FQ33. 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
[] No response

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

[] Yes
[] No
[] No response

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

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

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

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

FQ37. Would you return to this provider?
Provider: [PROVIDER]

[] Yes
[] No
[] No response

FQ38. Would you refer your relative or friend to this provider / facility?
Provider: [PROVIDER]

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

FQ40. How much did you pay?
Enter all prices in Congolese Francs. Must be larger than 0.
Total fee amount: _________________________

VST1. Where did you obtain [MOST RECENT / CURRENT METHOD] the last time?
Scroll to bottom to see all choices.
[] National hospital
[] Family planning clinic
[] Health center/ Health post
[] Maternity
[] Community health volunteer
[] Regional hospital
[] Private hospital/clinic
[] pharmacy
[] NGO
[] Private health center
[] Private practice
[] Private doctor
[] Mobile nurse
[] Community health worker (ASC)
[] Community-based medical student
[] Boutique
[] Religious institution
[] Friend / Relative
[] Bar / Night club
[] Kiosk
[] Chayeur
[] Other
[] Don't know
[] No Response

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

[] Yes
[] No
[] No response

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

Check: You entered that the respondent first used family planning at the age of [AGE AT FIRST USE]. Is that what she said?
go back and change FQ41b if that is not correct.
[] Yes
[] No

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

Number: _________________________

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

FQ42a. PROBE: Was the injection administered via syringe or small needle?
Show the image to the respondent.
[] Syringe
[] Small needle (Sayana Press)
[] Both
[] No Response

FQ43. You said that you do not want a / another child soon and that you are not using a method to avoid pregnancy.
Can you tell me why you are not using a method?
PROBE: Any other reason?
RECORD ALL REASONS MENTIONED. Scroll to bottom to see all choices.
[] Not married
[] Infrequent sex / Not having sex
[] Menopausal / Hysterectomy
[] Subfecund / Infecund
[] Not menstruated since last birth
[] Breastfeeding
[] Husband away for multiple days
[] Up to God / fatalistic
[] Respondent opposed
[] Husband / partner opposed
[] Others opposed
[] Religious prohibition
[] Knows no method
[] Knows no source
[] Fear of side effects
[] Health concerns
[] Lack of access / too far
[] Costs too much
[] Preferred method not available
[] No method available
[] Inconvenient to use
[] Interferes with body's processes
[] Takes too much time away from regular duties / too busy to go get one
[] intention to use one but did not get a chance to go to the clinic yet
[] Mother-in-law opposed
[] Other
[] Don't know
[] No response

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

[] Yes
[] No
[] No response

FQ44a. In the last 12 months, did you participate in a group talk at the community level about family planning?

[] Yes
[] No
[] No response

FQ45. 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

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

[] Yes
[] No
[] No response

FQ47. In the last few months have you:

[] Heard about family planning on the radio?
[] Seen anything about family planning on the television?
[] Read about family planning in a newspaper or magazine?

FQ47b. Have you seen this image?
Show the logo to the respondent.
[] Yes
[] No
[] Don't know/ don't recall
[] No response

FQ47b1. Where did you see this image?
PROBE: Anywhere else?
Select all that apply.
[] In a health center
[] In the street
[] In a pharmacy
[] On a billboard
[] On the TV
[] On a leaflet
[] On a community heath agent's vest
[] Other
[] Don't know / Don't recall
[] No response

FQ47c. What is this image trying to say?
Select all that apply.
[] Family planning
[] Birth spacing
[] Reproductive health
[] The family unit
[] Other
[] Do not know/ Do not recall
[] No response

FQ47d. Have you seen the billboard that states "How many children do you want?", and shows the FP logo?
Show a photo of the billboard to the respondent.
[] Yes
[] No
[] Don't know/ Do not recall
[] No response

FQ47e. What is this image trying to say?
Select all that apply.
[] Family planning
[] Birth spacing
[] Reproductive health
[] The family unit
[] Other
[] Do not know/ Do not recall
[] No response

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

FQ48. How old were you when you first had sexual intercourse?
Enter the age in years. Answer must agree with the current age and date of first birth.
Age____

Current age: [AGE]
Number of live births: [NUMBER OF BIRTH EVENTS]

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

FQ49. Enter the number of [VALUE].
If today, enter zero days only, not zero weeks/months/years. Must agree with the age of first sexual intercourse and the pregnancy status.

Section 4 -- Exposure to mass media
Now I would like to talk in more detail about your exposure to family planning information through Mass Media.

MM1. Have you watched the television show Libala Ya Bosembo within the past 6 months?

[] Yes
[] No
[] No response

MM2. At the end of each Libala Ya Bosembo show a message is given. The last time you watched the show, what messages had the greatest impression on you?
PROBE: What else?
Select all that apply.
[] Couple communication
[] Harmony in the family
[] Family planning methods
[] Antenatal care
[] Care for mother and child's health in the postpartum period
[] Amenorrheic period after pregnancy
[] Birth spacing
[] Breast feeding
[] Other
[] Don't know
[] No response

MM3. Did they talk about using family planning methods during the show?

[] Yes
[] No
[] Don't know/ don't recall
[] No response

MM4. Did you speak with someone about the family planning messages from the television show Libala Ya Bosembo?

[] Yes
[] No
[] Don't know/ don't recall
[] No response

MM5. With whom did you speak?
PROBE: Anyone else?
Select all that apply.
[] Medical provider
[] Spouse
[] Other relatives
[] Friends/neighbors
[] Pharmacist/pharmacist's aide
[] Outreach worker
[] People at a seminar/community meeting
[] Other
[] Don't know/Don't recall
[] No response

MM6. Have you ever watched the mini-television show called "Elengi"?

[] Yes
[] No
[] No response

MM7. Last time you watched the mini-television show Elengi, what was it about?
PROBE: What else?
Select all that apply.
[] Couple communication
[] Harmony in the family
[] Family planning methods
[] Antenatal care
[] Care for mother and child's health in the postpartum period
[] Amenorrheic period after pregnancy
[] Birth spacing
[] Breast feeding
[] Other
[] Don't know
[] No response

MM8. Have you ever called the telephone hotline '3-2-1'?

[] Yes
[] No
[] No response

MM9. The last time you called the hotline 3-2-1, what did you want information about?
PROBE: Anything else?
Select all that apply.
[] Family planning service locations
[] Information about family planning methods
[] Side-effects of FP methods
[] Post-abortion care
[] Post intimate partner violence care
[] HIV/AIDS
[] Health in general
[] Other
[] Don't know/Don't recall
[] No response

Section 5 -- Perceived self-efficacy in contraceptive use
Now I would like to talk about your level of confidence in your ability to access and use family planning methods. If you are not currently married or have a regular partner, try to imagine how you would respond if you were currently in union.

How confident are you that…
SE1. You can start a conversation with your husband/spouse/partner about family planning/birth spacing?

[] Very confident
[] Confident
[] Somewhat confident
[] Not very confident
[] Not at all confident
[] No response

SE2. You can convince your husband/spouse/partner to use a method of family planning/birth spacing?

[] Very confident
[] Confident
[] Somewhat confident
[] Not very confident
[] Not at all confident
[] No response

SE3. You can go to a site where methods of family planning / birth spacing are available if you decide to use one?

[] Very confident
[] Confident
[] Somewhat confident
[] Not very confident
[] Not at all confident
[] No response

SE4. You can get a method of family planning/ birth spacing if you decide to use one?

[] Very confident
[] Confident
[] Somewhat confident
[] Not very confident
[] Not at all confident
[] No response

SE5. You could use a method of family planning / birth spacing, even if your husband/ partner does not want to?

[] Very confident
[] Confident
[] Somewhat confident
[] Not very confident
[] Not at all confident
[] No response

SE6. You can use a method of family planning / birth spacing, even if none of your friends or neighbors use one?

[] Very confident
[] Confident
[] Somewhat confident
[] Not very confident
[] Not at all confident
[] No response

SE7. You could use a method of family / child spacing planning, even if your religious leader does not think you should use it?

[] Very confident
[] Confident
[] Somewhat confident
[] Not very confident
[] Not at all confident
[] No response

SE8. You will continue to use a method of family planning / birth spacing, even if you experience side effects?

[] Very confident
[] Confident
[] Somewhat confident
[] Not very confident
[] Not at all confident
[] No response

Section 6 -- Diarrheal Disease Among Children
Now I would like to ask you a few questions about the health of children under 5 years old.

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

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

FQ51. In what month and year was this child born?
Enter Jan 2020 for no response
Month ____ Year _____

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

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

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

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

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

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

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