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

001a. Are you in the correct household?
This is the picture of the front of the home taken during the Household Questionnaire.
[ODK will display the photo taken during the Household Questionnaire]
Go to the right household.
002. Your ID: [Interviewer number entered in the Household Questionnaire]

Is this your ID?

002. Enter your ID below.
Please record your ID

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

Is this date and time correct?

003b. Record the correct date and time.

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 Region, Department, Sub-prefecture, Enumeration Area, Structure number, and Household number entered in the household questionnaire linked to this female questionnaire.]

004b. Is the above information correct?
Go to the right household or update the Household Roster if needed.

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.

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

007. How well acquainted are you with the respondent?

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 work for the Institut National de la Statistique (INS) 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?

010a. Then, ask:
May I begin the interview now?

010b. Respondent's signature
Please ask the respondent to sign or check the box in agreement of their participation.

GATHER SIGNATURE:
Checkbox:

010c. Interviewer's ID: [Interviewer name from Household Questionnaire]
Mark your ID 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:

102. How old were you at your last birthday?

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

PNSME_101. What is your religion?
Select your currently practiced religion
PNSME_102. What ethnic group do you belong to?

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.

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

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:

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?

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:

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?

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

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

PNSME_103. What is the age of your husband / partner?

PNSME_104. What is the highest level of education achieved by your husband / spouse?

Section 2 -- Reproduction, Pregnancy and Fertility Preferences

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

LCL201. How many times have you given birth?

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

201b. How many sons live with you?
Zero is a possible response.
201c. How many daughters live with you?
Zero is a possible response.
202a. Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?

202b. How many sons are alive but do not live with you?
Zero is a possible response.
202c. How many daughters are alive but do not live with you?
Zero is a possible response.
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?
LCL202. How many times have you given birth?

203b. How many boys have died?

Zero is a possible response.

203c. And how many girls have died?
Zero is a possible response.
204. Just to make sure I have this right: you had a total of [ODK will display the total number of birth events from 201-203] birth(s) during your life, resulting in [Number of children ever born] son(s) or daughter(s) born alive. Is that correct?

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:

206. When was your MOST RECENT birth?
Select 'Do not know' for month and '2020' for year to indicate 'No Response'.

Month:

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:

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

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:

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.

210a. Are you pregnant now?

210b. How many months pregnant are you?
The most recent birth was: [Date of most recent birth]
Please record the number of completed months.
Now I have some questions about the future.

211a. Would you like to have a child or would you prefer not to have any children?

211a. Would you like to have another child or would you prefer not to have any more children?

211b. After the child you are expecting now, would you like to have another child or would you prefer not to have any more children?

212a. How long would you like to wait from now before the birth of a child?
If you select months or years, you will enter a number for X on the next screen.
Select "Years" if more than 36 months.
Please check that you correctly entered the value for months/years.

212a. 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.

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.

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?

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

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.

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

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.

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.

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.

301f. Have you ever heard of the (birth control) pill?
PROBE: Women can take a pill every day to avoid becoming pregnant.

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.

301h. Have you ever heard of condoms?
PROBE: Men can put a rubber sheath on their penis before sexual intercourse.

301i. Have you ever heard of female condoms?
PROBE: Women can put a sheath in their vagina before sexual intercourse.

301j. Have you ever heard of the diaphragm?
PROBE: Women can place a thin flexible disk on their cervix before sexual intercourse.

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.

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

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.

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

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

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

302b. Which method or methods are you using?
PROBE: Anything else?
Select all methods mentioned. SCROLL TO THE BOTTOM to see all choices.
302c. Are you breastfeeding to delay or avoid getting pregnant?

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

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

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?

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

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

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.
307. Before you started using [Most recent or current method], had you discussed the decision to delay or avoid pregnancy with your husband/partner?

308. Would you say that using contraception is mainly your decision, mainly your husband/partner's decision or did you both decide together?

309a. Since what month and year have you been using [Most recent or current method] without stopping?
Calculate backwards from memorable events if needed.

Most Recent Birth: [Date of most recent birth mm-yyyy]
Current Marriage: [Date of current marriage mm-yyyy]

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:

309c. In what month and year had you started using [Most recent or current 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: [Date of most recent birth, mm-yyyy]
Current Marriage: [Date of current marriage, mm-yyyy]

Month:

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?

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]?

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.
311b. Where did you learn how to use rhythm method?
Scroll to bottom to see all choices.
311b. Where did you learn how to use lactational amenorrhea method?
Scroll to bottom to see all choices.
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?

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

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?

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

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

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

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

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

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

316. Would you return to this provider?
Provider: [Provider type selected in Q311a or 311b]

317. Would you refer your relative or friend to this provider / facility?
Provider: [Provider type selected in Q311a or 311b]

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

318b. How much did you pay?
Enter all prices in FCFA.
Must be larger than 0.
319. Have you ever done anything or tried in any way to delay or avoid getting pregnant?

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

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.
You said you are currently pregnant.
323a. You said that you do not want a child/another child 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
Scroll to bottom to see all choices.
Cannot select "Not Married" if 104 is "Yes, currently married".
323b. Would you say that not using contraception is mainly your decision, mainly your husband/partner's decision or did you both decide together?

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

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

In the last few months have you:

326a. Heard about family planning on the radio?

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

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

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

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?
Enter the age in years.
Current age: [Age from Q102]
Number of live births: [X number of live births]
If the age of first sexual intercourse is less than 10:
CHECK: You entered that the respondent was ${age_at_first_sex} 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.
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.
Must agree with the pregnancy status.
Section 5 -- Water
Now I would like to ask about your water use practices.

501. 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
502. 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
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.

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

097. In what language was this interview conducted?

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