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CDR6 Female Questionnaire

IDENTIFICATION

001a. Are you in the correct household?
This is the picture of the front of the home taken during the Household Questionnaire.
[ODK will display the photo taken during the Household Questionnaire]

[] Yes
[] No

001b. Go to the right household.

002. Your name: [Interviewer name entered in the Household Questionnaire]

Is this your name?

[] Yes
[] No

002. Enter your name below.
Please record your name

003a. Current date and time.
[ODK will display on screen]

Is this date and time correct?

[] Yes
[] No

003b. Record the correct date and time.

Day____ Month____ Year____
Hours____ Minutes____

004a. The following info is from the household questionnaire. Please review to make sure you are interviewing the correct respondent.

004a. The following info is what you provided previously. Please review.
[ODK will open the province, city, commune, and the neighborhoods within Kinshasa or the province, district, health area, and village within Kongo Central. In addition, the Enumeration Area, Structure number, and Household number entered in the household questionnaire linked to this female questionnaire will be displayed.]

004b. Is the above information correct?
Go to the right household or update the Household Roster if needed.
[] Yes
[] No

005. CHECK: You should be attempting to interview [RESPONDENT'S NAME]. Is that correct?
If misspelled, select "yes" and update the name in question 011.
If this is the wrong person, you have two options:
(1) exit and ignore changes to this form. Open the correct form.
Or
(2) find and interview the person whose name appears above.
[] Yes
[] No

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

[] Yes
[] No

007. How well acquainted are you with the respondent?

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

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

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

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

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

009a. Provide a paper copy of the Consent Form to the respondent and explain it. Then, ask: May I begin the interview now?

[] Yes
[] No

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

Checkbox

[] NA

010c. Interviewer's name: [Interviewer name from Household Questionnaire]
Mark your name as a witness to the consent process.
[] ________________________

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

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

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

Month:

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

Year:________________

102. How old were you at your last birthday?

Age:________________

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

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

104. Are you currently married or living together with a man as if married?
Probe: If no, ask whether the respondent is divorced, separated, or widowed.
[] 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

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

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

106a. In what month and year did you start living with your FIRST husband / partner?
Select 'Do not know' for month and '2020' 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 '2020' for No Response, must select 'Do not know' for month.

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

[] Yes
[] No

107a. Now I would like to ask about when you started living with your CURRENT or MOST RECENT husband / partner. In what month and year was that?
Select 'Do not know' for month and '2020' 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 '2020' for No Response, must select 'Do not know' for month.

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

[] Yes
[] No

107c. RETURN TO 107 TO CORRECT THE RESPONSE BEFORE CONTINUING.

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

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

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

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

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

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

[] Yes
[] No
[] No response

LCL201. How many times have you given birth?

Number:________________

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

[] Yes
[] No
[] No response

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

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

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

[] Yes
[] No
[] No response

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

202c. How many daughters are alive but do not live with you?
Zero is a possible response. Enter -99 for No response.
Number:________________

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

LCL202. How many times have you given birth?

Number:________________

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

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

CALC CEB. CALCULATE: TOTAL NUMBER OF CHILDREN BORN. [ODK will automatically calculate the total number of children born from 201-203:
(201b+201c+202b+202c+203b+203c)

Number:________________

204. Just to make sure I have this right: you had a total of [ODK will display the total number of boys and girls born from 201-203] birth(s) during your life, resulting in [CALC CEB] son(s) or daughter(s) born alive.
Is that correct?

[] Yes
[] No

205. When was your FIRST birth?
Please record the date of the FIRST birth. The date should be found by calculating backwards from memorable events if needed.
Select 'Do not know' for month and '2020' 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 '2020' for No Response, must select 'Do not know' for month.
Cannot be in future.


206. When was your MOST RECENT birth?
Select 'Do not know' for month and '2020' 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 '2020' for No Response, must select 'Do not know' for month.
Cannot be in future.


207. When did you give birth before the most recent one?
Select 'Do not know' for month and '2020' 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 '2020' for No Response, must select 'Do not know' for month.
Cannot be in future.


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

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

208b. When did your last baby / child die?
Please record the date of the child's death. The date should be found by calculating backwards from memorable events if needed.
Select 'Do not know' for month and '2020' 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 '2020' for No Response, must select 'Do not know' for month.
Cannot be in future.


209. When did your last menstrual period start?
If you select days, weeks, months, or years, you will enter a number for X on the next screen. Enter 0 days for today, not 0 weeks/months/years.
[] X days ago
[] X weeks ago
[] X months ago
[] X years ago
[] Menopausal / Hysterectomy
[] Before last birth
[] Never menstruated
[] No response

210a. Are you pregnant now?

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

210b. How many months pregnant are you?
The most recent birth was: [DATE OF MOST RECENT BIRTH]
Please record the number of completed months.
Number of months:________________

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

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

211b. Now I have some questions about the future.
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

212a. 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.
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
[] Don't know
[] No response

212b. After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?
If you select months or years, you will enter a number 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
[] Don't know
[] No response

212c. Enter the number of [MONTHS/YEARS] you would like to wait:
Use years if more than 36 months.

213a. Now I would like to ask a question about your last birth.
At the time you became pregnant, did you want to become pregnant then, did you want to wait until later, or did you not want to have any more children at all?

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

213b. Now I would like to ask a question about your current pregnancy.
At the time you became pregnant, did you want to become pregnant then, did you want to wait until later, or did you not want to have any more children at all?

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

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


301a. Have you ever heard of female sterilization?
PROBE: Women can have an operation to avoid having any more children.
[NO IMAGE]

[] Yes
[] No
[] No response

301b. Have you ever heard of male sterilization?
PROBE: Men can have an operation to avoid having any more children.
[NO IMAGE]

[] Yes
[] No
[] No response

301c. Have you ever heard of the contraceptive implant?
PROBE: Women can have one or several small rods placed in her upper arm by a doctor or nurse, which can prevent pregnancy for one or more years.
[ODK WILL DISPLAY AN IMAGE OF THE METHOD ON THE SCREEN.]

[] Yes
[] No
[] No response

301d. Have you ever heard of the IUD?
PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse.
[ODK WILL DISPLAY AN IMAGE OF THE METHOD ON THE SCREEN.]

[] Yes
[] No
[] No response

301e. Have you ever heard of injectables?
PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
[ODK WILL DISPLAY AN IMAGE OF THE METHOD ON THE SCREEN.]

[] Yes
[] No
[] No response

301f. Have you ever heard of the (birth control) pill?
PROBE: Women can take a pill every day to avoid becoming pregnant.
[ODK WILL DISPLAY AN IMAGE OF THE METHOD ON THE SCREEN.]

[] Yes
[] No
[] No response

301g. Have you ever heard of emergency contraception?
PROBE: As an emergency measure after unprotected sexual intercourse women can take special pills at any time within five days to prevent pregnancy.
[NO IMAGE]

[] Yes
[] No
[] No response

301h. Have you ever heard of condoms?
PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
[ODK WILL DISPLAY AN IMAGE OF THE METHOD ON THE SCREEN.]

[] Yes
[] No
[] No response

301i. Have you ever heard of female condoms?
PROBE: Women can put a sheath in their vagina before sexual intercourse.
[ODK WILL DISPLAY AN IMAGE OF THE METHOD ON THE SCREEN.]

[] Yes
[] No
[] No response

301j. Have you ever heard of the diaphragm?
PROBE: Women can place a thin flexible disk in their vagina before sexual intercourse.
[ODK WILL DISPLAY AN IMAGE OF THE METHOD ON THE SCREEN.]

[] Yes
[] No
[] No response

301k. Have you ever heard of foam or jelly as a contraceptive method?
PROBE: Women can place a suppository, jelly, or cream in their vagina before sexual intercourse to prevent pregnancy.
[ODK WILL DISPLAY AN IMAGE OF THE METHOD ON THE SCREEN.]

[] Yes
[] No
[] No response

301l. Have you ever heard of the standard days method or Cycle Beads?
PROBE: A Woman can use a string of colored beads to know the days she can get pregnant. On the days she can get pregnant, she and her partner use a condom or do not have sexual intercourse.
[ODK WILL DISPLAY AN IMAGE OF THE METHOD ON THE SCREEN.]

[] Yes
[] No
[] No response

301m. Have you ever heard of the Lactational Amenorrhea Method or LAM?
[NO DESCRIPTION; NO IMAGE]

[] Yes
[] No
[] No response

301n. Have you ever heard of the rhythm method?
PROBE: Women can avoid pregnancy by not having sexual intercourse on the days of the month they think they can get pregnant.
[NO IMAGE]

[] Yes
[] No
[] No response

301o. Have you ever heard of the withdrawal method?
PROBE: Men can be careful and pull out before climax.
[NO IMAGE]

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

302b. Which method or methods are you using?
PROBE: Anything else?
Select all methods mentioned. SCROLL TO THE BOTTOM to see all choices.
[] Female sterilization
[] Male sterilization
[] Implant
[] IUD
[] Injectables
[] Pill
[] Emergency Contraception
[] Male condom
[] Female condom
[] Diaphragm
[] Foam/Jelly
[] Standard Days/Cycle beads
[] LAM
[] Rhythm method
[] Withdrawal
[] Other traditional method
[] No response



Check here to acknowledge you considered all options.

[] NA

CALC_CM: ODK CALCULATION: CURRENT METHOD
[THIS TEXT WILL NOT APPEAR ON THE ODK SCREEN]
ODK will identify the most effective method that the respondent uses by selecting the method that appears highest in the list.

[] Female sterilization
[] Male sterilization
[] Implant
[] IUD
[] Injectables
[] Pill
[] Emergency Contraception
[] Male condom
[] Female condom
[] Diaphragm
[] Foam/Jelly
[] LAM
[] Other modern method
[] 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

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

305a. You said that you are not currently using a contraceptive method. Do you think you will use a contraceptive method to delay or avoid getting pregnant at any time in the future?

[] Yes
[] No
[] No response

305b. Do you think you will use a contraceptive method to delay or avoid getting pregnant at any time in the future?

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

306b. Which method did you use most recently?
PROBE: Anything else?
Select most effective method (highest method in list). Scroll to bottom to see all choices.
[] Implant
[] IUD
[] Injectables
[] Pill
[] Emergency Contraception
[] Male condom
[] Female condom
[] Diaphragm
[] Foam/Jelly
[] Standard Days/Cycle beads
[] LAM
[] Rhythm method
[] Withdrawal
[] Other traditional method
[] No response

Check here to acknowledge you considered all options.

[] NA

LCL_302. PROBE: Was the injection administered via syringe or small needle?
Show the image to the respondent.
[ODK WILL DISPLAY AN IMAGE OF THE METHOD ON THE SCREEN.]

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

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

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

308. Would you say that 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

309a. Since what month and year have you been using [CURRENT METHOD] without stopping?
Calculate backwards from memorable events if needed. Cannot be in the future. The respondent must be at least 10 years old.
Most Recent Birth: [mm-yyyy]
Current Marriage: [mm-yyyy]

Month:

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

Year:________________
If entering '2020' for No Response, must select 'Do not know' for month.

309b. When did you stop using [CURRENT OR MOST RECENT METHOD]?
Please record the date.
The date should be found by calculating backwards from memorable events if needed.
Select 'Do not know' for month and '2020' 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 '2020' for No Response, must select 'Do not know' for month.
Cannot be in future.


309c. In what month and year had you started using [MOST RECENT METHOD] before stopping?
Calculate backwards from memorable events if needed.
Select 'Do not know' for month and '2020' for year to indicate No Response.

Most Recent Birth: [mm-yyyy]
Current Marriage: [mm-yyyy]

Month:

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

Year:________________
If entering '2020' for No Response, must select 'Do not know' for month.
Cannot be in future.


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

[] Yes
[] No

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


310. Why did you stop using [MOST RECENT OR CURRENT 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

311a. You first started using [MOST RECENT OR CURRENT METHOD] on [DATE OF STARTING METHOD].
Where did you or your partner get it at that time?
Scroll to bottom to see all choices.
[] National hospital
[] Family planning clinic
[] Health center/Poste de sante
[] 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 instituteion
[] Friend / Relative
[] Bar / Night club
[] Ligablo / Kiosk
[] Chayeur
[] Other
[] Don't know
[] No Response

Check here to acknowledge you considered all options.

[] NA

311b. Where did you learn how to use rhythm / LAM method?
Scroll to bottom to see all choices.
[] National hospital
[] Family planning clinic
[] Health center/Poste de sante
[] 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 instituteion
[] Friend / Relative
[] Bar / Night club
[] Ligablo / Kiosk
[] Chayeur
[] Other
[] Don't know
[] No Response

312a. When you obtained your [MOST RECENT OR 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
[] No response

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

314b. When you began using rhythm / LAM was this the method you wanted to use to delay or avoid getting pregnant?

[] Yes
[] No
[] No response

314c. Why didn't you obtain the method you wanted?

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

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

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

315b. Who made the final decision to use rhythm / LAM?

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

316. Would you return to this provider?
Provider: [TYPE OF PROVIDER SELECTED IN 311A OR 311B]

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

317. Would you refer your relative or friend to this provider / facility?
Provider: [TYPE OF PROVIDER SELECTED IN 311A OR 311B]

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

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

[] Yes
[] No
[] No response

318b. How much did you pay?
Enter all prices in Congolese Francs.

LCL_303. Where did you obtain [MORST RECENT OR CURRENT METHOD] the last time?
Scroll to bottom to see all choices.
[] National hospital
[] Family planning clinic
[] Health center/Poste de sante
[] 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 instituteion
[] Friend / Relative
[] Bar / Night club
[] Ligablo / Kiosk
[] Chayeur
[] Other
[] Don't know
[] No Response

LCL_304. You mentioned you obtained or learned about the [MOST RECENT OR CURRENT METHOD] from [PROVIDER FROM 311A OR 311B]. Why did you choose that location as your source for your contraceptive method?
PROBE: Any other reason?
Do not read the response options aloud.
RECORD ALL REASONS MENTIONED.
Cannot select "Do Not Know" or "No response" with other options.
Scroll to the bottom to see all choices.
[] Lower cost at this SDP than others
[] The SDP is close to my house
[] The SDP is close to my work
[] I am familiar with this SDP
[] I believe the provider is more knowledgeable/has better expertise than providers at other facilities
[] I believe the provider is nicer / more respectful than others
[] It's the only SDP that has the method I want
[] I heard about a distribution campaign at this SDP
[] The SDP was just there so I took advantage of it
[] A friend or family member recommended the SDP
[] I saw a sign or an advertisement that the SDP offered family planning
[] I think that nobody will know or recognize me at this SDP (anonymity)
[] This SDP is easy to get to
[] The SDP is an appealing place
[] I know someone that works there
[] Its the place I know of where I can get the method
[] The method is free at this SDP
[] I go to this SDP for all my medical services
[] I work at this SDP
[] Other
[] Don't know / unsure
[] No response

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

[] Yes
[] No
[] No response

320. How old were you when you first used a method to delay or avoid getting pregnant?
The respondent said she was [AGE FROM 102] years old at her last birthday.
Enter the age in years. Cannot be younger than 9.
Age: ________________

321. How many living children did you have at that time, if any?
Note: the respondent said that she gave birth [NUMBER OF LIVE BIRTHS] times in 204.

Number _______________

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

Check here to acknowledge you considered all options.

[] NA

LCL_307. PROBE: Was the injection administered via syringe or small needle?
Show the image to the respondent.
[] Syringe
[] Small needle (Sayana Press)
[] No Response

323a. You said that you do not want a child / another child soon and that you are not using a method to avoid pregnancy.
PROBE: Any other reason?
RECORD ALL REASONS MENTIONED
Cannot select "Not Married" if 104 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 104 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
[] 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


Check here to acknowledge you considered all options.

[] NA

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

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

LCL_308a. If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?
If you select X children, you will enter a number for X on the following screen. If none, select X children, then enter 0.
[] X children
[] It's God's will (not respondent's decision)
[] Other
[] Do not know
[] No response

Number of children:___________

LCL_308b. If you could choose exactly the number of children to have in your whole life, how many would that be?
If you select X children, you will enter a number for X on the following screen. If none, select X children, then enter 0.
[] X children
[] It's God's will (not respondent's decision)
[] Other
[] Do not know
[] No response

Number of children :___________

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

[] Yes
[] No
[] No response

CCP_301. In the last 12 months, did you participate in a group talk at the community level about family planning?

[] Yes
[] No
[] No response

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

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

[] Yes
[] No
[] No response

In the last few months have you:

326a. Heard about family planning on the radio?

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

CCP_302a. Have you seen this image?
Show the logo to the respondent.
[] Yes
[] No
[] Don't know/ don't recall
[] No response

CCP_302b. 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


CCP_302c. 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


CCP_303a. 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/ don't recall
[] No response

CCP_303b. 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

Section 4. Sexual Activity
CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

401a. How old were you when you first had sexual intercourse?
Current age: [AGE from 102]
Number of live births: [NUMBER OF LIVE BIRTHS]

Age_______________

401b. If the age of first sex is less than 10.
CHECK: You entered that the respondent was X years old the first time she had sexual intercourse. Is that what the she said?
Go back and change 401a if it is not correct.
[] Yes
[] No

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

Section 6 -- Menstrual Hygiene
Now I'm going to ask you about menstrual hygiene management.
This includes the use of absorbent materials; access to a private, clean, safe space; washing as required; and a place to dispose used materials.


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


602a. Where do you most often change your used pads, cloths, or other sanitary materials?
[ODK WILL DISPLAY ONLY THOSE PLACES SELECTED IN 601]

[] [MAIN SANITATION FACILITY FROM HQ]
[] Other household sanitation facility
[] Sanitation facilities at school
[] Sanitation facilities at work
[] Other public sanitation facility
[] Sleeping area / bedroom
[] Backyard
[] No facility / bush / field
[] Other
[] No response

Main Place: [ODK WILL DISPLAY THE SELECTION FROM 601 OR 602]
602b. While managing your menstrual hygiene, was this place:
Read each option aloud and select if yes.
[] Clean?
[] Private?
[] Safe?
[] Able to be locked?
[] Supplied with clean water?
[] Supplied with soap?
[] None of the above
[] No response


603. During your last menstrual period, what were all the materials that you used to absorb or collect your menstrual blood?
PROBE: Anything else?
Do not read options aloud. Select all that apply.

[] Reusable materials
[] Cloth / Pieces of fabric
[] Cotton wool
[] Sanitary pads
[] Foam (from mattress or other material)
[] Disposable materials
[] Tampons
[] Toilet paper
[] Paper (newspaper pages from books)
[] Natural materials (mud, dung, leaves)
[] No materials used
[] Other
[] No Response

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

605. You mentioned that you used [ODK WILL DISPLAY RESPONSES TO 603] during your last menstrual period. Where did you dispose of these materials after use?
PROBE: Anywhere else?
Do not read options aloud. Select all that apply.
[] Flush toilet
[] Latrine
[] Waste bin/trash bag
[] Burning
[] Bush/field
[] Other
[] No response


606. Is there anything else that would help you manage your menstrual hygiene/ menstrual period that you do not usually have ?
PROBE : Anything else ?
Could include resources, materials, changes to your environment, etc. Do not read options aloud.

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


Section CCP 1 -- 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 CCP 2 -- 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

END OF QUESTIONNAIRE
Thank the respondent for her time.

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

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

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

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

097. In what language was this interview conducted?

[] French
[] Lingala
[] Kikongo
[] Tshiluba
[] Swahili
[] Kintandu
[] Manianga
[] Kiyombe
[] Kindibu
[] Kilemfu
[] Other

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