Data Cart

Your data extract

0 variables
0 samples
View Cart


Female Questionnaire - First Round Core


A. Are you in the correct household? This is the picture of the front of the home taken during the Household Questionnaire.
IF NOT, RETURN TO INTERVIEW THE CORRECT HOUSEHOLD.
[ODK will display the photo attached to the linked Household Questionnaire]

[] Yes 1
[] No 0

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

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

C. Your name:
[Interviewer name from Household Questionnaire]
Is this your name?

[] Yes 1
[] No 0

Enter your name below.
Please record your name
Interviewer's Name________

D. Current date and time: Is this date and time correct?
[ODK will display on screen]

[] Yes 1
[] No 0

E. Record the correct date and time.
Date
Month____ Day____ Year____
Time
Hours____ Minutes____ AM/PM

F. The following information is from the Household Questionnaire. Please review to make sure you are interviewing the correct respondent.
[ODK will display the Administrative Subdivisions, Enumeration Area, Structure Number, and Household Number entered into the Household Questionnaire linked to this Female Questionnaire.]
Is the above information correct?

[] Yes 1
[] No 0

CHECK: You should be attempting to interview
[Respondent's Name]. Is that correct?
If misspelled, select "yes" here and update the name in question "L."
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 1
[] No 0

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

[] Yes 1
[] No 0

H. How well acquainted are you with the respondent?

[] Very well acquainted 1
[] Well acquainted 2
[] Not well acquainted 3
[] Not acquainted 4

INFORMED CONSENT Find the woman between the ages of 15-49 associated with this Female Questionnaire. The interview must have auditory privacy. Read the following greeting:
Hello. My name is ____________________________________ and I am working for [COUNTRY PARTNER] in collaboration with [OTHER PARTNERS]. 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?
I. Provide a paper copy of the Consent Form to the respondent and explain it. Then, ask:
May I begin the interview now?

[] Yes 1
[] No 0

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

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

L. Respondent's name
[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, HH characteristics
Now I would like to ask about your background and socioeconomic conditions.
0. In what month and year were you born? The age in the household roster is [AGE].

Month____ Year____

1. How old were you at your last birthday?
Must be more than 14. Must agree with FQ0.
Age:____

2. What is the highest level of school you attended?
[ODK will populate country-specific list of the various levels of education that are available in that country]

[] Never Attended 0
[] LEVEL 1 1
[] LEVEL 2 2
[] LEVEL 3 3
[] LEVEL 4 4
[] LEVEL 5 5
[] No response -99

3. 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 0
[] Yes, currently married 1
[] Yes, living with a man 2
[] Not currently in union: Divorced / separated 3
[] Not currently in union: Widow 4
[] No response -99

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

[] Only once 1
[] More than once 2
[] No response -99

5a. In what month and year did you start living with your FIRST husband / partner?
Enter Jan 2020 for no response.
Month____ Year____

[If ≤15 years old at marriage date, ODK will display:]
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 1
[] No 0

5b. 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? Enter Jan 2020 for no response.

Month____ Year____

[If ≤15 years old at marriage date ODK will display:]
CHECK: Based on the response you entered in FQ5b, the respondent was possibly 15 years old or younger at the time of her first marriage. Did you enter FQ5b correctly?

[] Yes 1
[] No 0

CHECK 3: Currently married/cohabitating?

[] Yes 1
[] No 0

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

[] Yes 1
[] No 0
[] Don't know -88
[] No response -99

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

[] Living with respondent 1
[] Staying elsewhere 2
[] No response -99

Section 2 - Reproduction, Pregnancy and Fertility Preferences
Now I would like to ask about all the births you have had during your life.
8. How many times have you given birth?
Enter -99 for no response. 0 is a possible answer.
Number of births:_______________

Were all of those live births? If no, go back and change FQ8 to record only live birth events.

[] Yes 1
[] No 0

8a. When was your FIRST birth? Please record the date of the FIRST live birth. Date should be found by calculating forward or backward from memorable events if needed. Enter Jan 2020 for no response.

Month____ Year____

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

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

11. Is your last baby / child still alive?

[] Yes 1
[] No 0
[] Don't know -88

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

13. When did your last menstrual period start?
If you select days, weeks, months or years, you will enter a number for x on the next screen. Enter 0 days for today, not 0 weeks/months/years.
Days ago:____
Weeks ago: ____
Months ago: ____
Years ago: ____

[] Menopausal / Hysterectomy 1
[] Before last birth 2
[] Never menstruated 3
[] No response -99

14. Are you pregnant now?

[] Yes 1
[] No 0
[] Unsure 2
[] No response -99

15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________

CHECK 14: Currently pregnant?

[] Yes 1
[] No 0

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

[] Have a/another child 1
[] No more/prefer no children 2
[] Says she can't get pregnant 3
[] Undecided / Don't know -88
[] No response -99

16b. Now I have some questions about the future. After the child you are expecting now, would you like to have another child, or would you prefer not to have any more children?

[] Have a/another child 1
[] No more/prefer no children 2
[] Says she can't get pregnant 3
[] Undecided / Don't know -88
[] No response -99

17a. How long would you like to wait from now before the birth of a/another child?
If you select months or years, you will enter a number for x on the next screen. Select "Years" if more than 36 months.
Months: ____
Years: ____

[] Soon / now 1
[] Other 2
[] Says she can't get pregnant 3
[] Don't know -88
[] No response -99

17b. After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?
If you select months or years, you will enter a number for x on the next screen. Select "Years" if more than 36 months.
Months:____
Years:_____

[] Soon / now 1
[] Says she can't get pregnant 2
[] Other 3
[] Don't know -88
[] No response -99

CHECK 8: Number of births
Number of births:_______________

CHECK 14: Currently pregnant?

[] Yes 1
[] No 0

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

[] Then 1
[] Later 2
[] Not at all 3
[] No response -99

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

[] Then 1
[] Later 2
[] Not at all 3
[] No response -99

Section 3 - Contraception

Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.
19. Have you ever used anything or tried in any way to delay or avoid getting pregnant?

[] Yes 1
[] No 0

20. How old were you when you first used a method to delay or avoid getting pregnant? The respondent said she was [age from FQ1] years old at her last birthday.
Enter the age in years. Enter -88 if respondent does not know. Enter -99 if there is no response. Cannot be younger than 9.
Age:____________

20a. 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 FQ8.
Enter -99 for no response
Number of living children:__________

21. Which method did you first use to delay or avoid getting pregnant?
Do not read the method choices. Be sure to scroll to bottom to see all choices.
[] Female Sterilization
[] Male Sterilization
[] Implant
[] IUD
[] Injectables
[] Pill
[] Emergency Contraception
[] Male Condom
[] Female Condom
[] Diaphragm
[] Foam/Jelly
[] Std. Days/Cycle beads
[] LAM
[] Rhythm method
[] Withdrawal
[] Other traditional method
[] No response -99

CHECK 14: Currently pregnant?

[] Yes 1
[] No 0

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

[] Yes 1
[] No 0

23. Which method or methods are you using? Probe: Anything else?
Select all methods mentioned. Be sure to scroll to bottom to see all choices.
[] Female Sterilization
[] Male Sterilization
[] Implant
[] IUD
[] Injectables
[] Pill
[] Emergency Contraception
[] Male Condom
[] Female Condom
[] Diaphragm
[] Foam/Jelly
[] Std. Days/Cycle beads
[] LAM
[] Rhythm method
[] Withdrawal
[] Other traditional method
[] No response -99

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

[] Yes 1
[] No 0
[] No response. -99

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

[] Yes 1
[] No 0
[] No response. -99

CHECK 14: Currently pregnant?

[] Yes 1
[] No 0

26a. You said that you are not currently using a contraceptive method. Do you think you will use a contraceptive method to delay or avoid getting pregnant at any time in the future?

[] Yes 1
[] No 0
[] No response. -99

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

[] Yes 1
[] No 0
[] No response. -99

CHECK 19: ever used contraceptives?

[] Yes 1
[] No 0

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

[] Yes 1
[] No 0
[] No response. -99

28. Which method did you use most recently? Probe: Anything else?
Select most effective method (highest method on list). Scroll to bottom to see all choices.
[] Implant 1
[] IUD 2
[] Injectables 3
[] Pill 4
[] Emergency Contraception 5
[] Male Condom 6
[] Female Condom 7
[] Diaphragm 8
[] Foam/Jelly 9
[] Std. Days/Cycle beads 10
[] LAM 11
[] Rhythm method 12
[] Withdrawal 13
[] Other traditional method 14
[] No response -99

29. When did you begin using your [MOST RECENT /CURRENT METHOD]?
Calculate backwards from memorable events if needed.
Age at first use: [Age from FQ20]
Most Recent Birth: [mm-yyyy]
Current Marriage: [mm-yyyy]
Must be at least the ages she started using a contraceptive method (FQ20). Must be before today. Respondent must be at least 10 years old. Enter Jan 2020 for no response.
Month____ Year____

CHECK 22: Currently using contraceptives?

[] Yes 1
[] No 0

30. When did you stop using your [MOST RECENT METHOD]?
Please record the date. The date should be found by calculating backwards from memorable events if needed. Must be after FQ29. Enter Jan 2020 for no response.
Month____ Year____

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

[] Infrequent sex / husband away 1
[] Became pregnant while using 2
[] Wanted to become pregnant 3
[] Husband / partner disapproved 4
[] Wanted more effective method 5
[] No method available 6
[] Health concerns 7
[] Fear of side effects 8
[] Lack of access / too far 9
[] Costs too much 10
[] Inconvenient to use 11
[] Fatalistic 12
[] Difficult to get pregnant / menopausal 13
[] Interferes with body's processes 14
[] Other 15
[] Don't know -88
[] No response -99

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

[] Govt hospital . 1
[] Gove health center. 2
[] Family planning clinic 3
[] Outreach (public sector) 4
[] Fieldworker/VHT 5

PRIVATE MEDICAL SECTOR:

[] Private hospital/clinic 6
[] Pharmacy 7
[] Private doctor 8
[] Outreach (private sector) 9
[] Fieldworker/VHT 10
[] Maternity home 11

OTHER SOURCE:

[] Shop . 12
[] Church 13
[] Friend/Relative . 14
[] Other 15
[] Don't know -88
[] No response -99

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

[] Yes 1
[] No 0

34. How much did you pay? Enter all prices in [local currency]. Enter -88 if respondent does not know, -99 for no response.
Fee: _______

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

[] Yes 1
[] No 0
[] No response -99

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

[] Yes 1
[] No 0
[] No response -99

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

[] Yes 1
[] No 0
[] No response -99

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

[] Yes 1
[] No 0
[] No response -99

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

[] Method out of stock that day 1
[] Method not available at all 2
[] Provider not trained to provide the method 3
[] Provider recommended a different method 4
[] Not eligible for method 5
[] Decided not to adopt a method 6
[] Too costly 7
[] Other 8
[] No response -99

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

[] You alone 1
[] Provider 2
[] Partner 3
[] You and provider 4
[] You and partner 5
[] Other 6
[] No response -99

CHECK 32: Where did you obtain your [MOST RECENT / CURRENT METHOD]?
[ODK will populate a list of country-specific providers organized by either public, private or other source]
PUBLIC SECTOR:

[] Govt hospital 1
[] Govt health center. 2
[] Family planning clinic 3
[] Outreach (public sector) 4
[] Fieldworker/VHT 5

PRIVATE MEDICAL SECTOR:

[] Private hospital/clinic 6
[] Pharmacy 7
[] Private doctor 8
[] Outreach (private sector) 9
[] Fieldworker/VHT. . 10
[] Maternity home 11

OTHER SOURCE:

[] Shop . 12
[] Church. . 13
[] Friend/Relative . 14
[] Other 15
[] Don't know -88
[] No response -99

41. Would you return to this provider?
Provider: [Type of Provider from FQ32]

[] Yes 1
[] No 0
[] No response -99

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

[] Yes 1
[] No 0
[] No response -99

CHECK 16: Desire for future child?

[] Have a/another child 1
[] No more/none 2
[] Says she can't get pregnant 3
[] Undecided / Don't know -88

CHECK 17: 2 or more years before next child?

[] No more/none 1
[] Less than 2 years 2
[] 2. or more years 3

CHECK 22: Currently using contraceptive method?

[] Yes, using contraceptive 1
[] No, not using contraceptive 0

CHECK 19: Ever use a method?

[] Yes 1
[] No 0

Ask 43 to non-users (current or ever) who do not want a/another child or not before 2 years.
43. You said that you do not want any / anymore children and that you are not using a method to avoid pregnancy. Can you tell me the reason why you are not using a method to prevent pregnancy?
PROBE: Any other reason?
RECORD ALL REASONS MENTIONED. Cannot select "Do Not Know" or "No response" with other options. Cannot select "Not married" if FQ3 is "Yes, currently married". Scroll to the 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
[] Other
[] Don't know
[] No response

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

[] Yes 1
[] No 0
[] No response -99

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

[] Yes 1
[] No 0
[] No response -99

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

[] Yes 1
[] No 0
[] No response -99

47. 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?

CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
48. How old were you when you first had sexual intercourse?
Enter the age in years. The respondent said she was [age from FQ1] years old at her last birthday.
[She has had x live births.] Enter 0 if she never had sex. Enter -88 if respondent does not know. Enter -99 for no response.

Age:___________

[If age at first sex LT 10 years:]
You have entered that the respondent was X years old when she first had sexual intercourse. Is this what she said?
Go back and correct FQ48 if it is not correct.

[] Yes 1
[] No 0

49. 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.
DAYS AGO:____ WEEKS AGO:____ MONTHS AGO:____ YEARS AGO:____

Section 4 - Water
Now I would like to ask about your water practices.
50. 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.
Number of hours/minutes per day (Either 1-24 hours, or 1-180 minutes.) _____

[] X hours per day 11
[] X minutes per day 22
[] No time, someone else collects water 33
[] No time, no one collects water 44
[] Don't know -88
[] No response -99

51. On a typical day in the WET season, how much time do you spend collecting water?
Only record respondent's time; not anyone else's time. If you select minutes or hours you will enter a number for x on the next screen.
Number of hours/minutes per day (Either 1-24 hours, or 1-180 minutes.) ____

[] X hours per day 11
[] X minutes per day 22
[] No time, someone else collects water 33
[] No time, no one collects water 44
[] Don't know -88
[] No response -99

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

M. Location
Take a GPS point near the entrance to the household. Record location when the accuracy is smaller than 6m. GPS coordinates can only be collected when outside.
RECORD LOCATION

QUESTIONNAIRE RESULT

N. Questionnaire result Record the result of the Female Questionnaire

[] Completed 1
[] Not at home 2
[] Postponed 3
[] Refused 4
[] Partly completed 5
[] Incapacitated 6