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mADDS Ethiopia Female Respondent Questionnaire - Round 4

IDENTIFICATION
Please record the following identifying information prior to beginning the interview.
A. 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 attached to the linked Household Questionnaire]

[] Yes 1
[] No 0

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

[] Yes 1
[] No 0

D. Record the correct date and time.

Day____ Month____ Year____
Hours____ Min____ AM/PM____

E. The following information is from the Household Questionnaire. Please review to make sure you are interviewing the correct respondent.
[ODK will display the State, LGA, 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

F. How well acquainted are you with the respondent?

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

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

[] Yes 1
[] No 0

G2. Has this woman participated in a PMA2020 survey before?

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

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 Addis Ababa University, and Federal 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?

H. Explain the consent form. Then, ask: May I begin the interview now?

[] Yes 1
[] No 0

I. Interviewer's name:
[ODK will display the Interviewer's name from linked Household Questionnaire]
Mark your name as a witness to the consent process.
J. 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, 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 agree with FQ0.

Age____

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

[] Never Attended 0
[] Primary 1
[] Secondary 2
[] Technical and vocational 3
[] 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.
[] Yes, currently married 1
[] Yes, living with a man 2
[] Not currently in union: Divorced / separated 3
[] Not currently in union: Widow 4
[] No, never in union 5
[] 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 CURRENT or MOST RECENT 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 FIRST husband / partner. In what month and year was that?
Enter Jan 2020 for no response.
Month____ Year____
CHECK 3: Currently in married/cohabiting?

[] 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 - Migration
Now I would like to ask about your recent migration to and from your current area of residence.
Mig 0. Where were you born? [Region]

[] Tigray 1
[] Afar 2
[] Amhara 3
[] Oromia 4
[] Ethiopia Somali 5
[] Benishangul Gumuz 6
[] SNNPR 7
[] Gambella 8
[] Harari 9
[] Addis Ababa 10
[] Dire Dawa 11

Mig 0a. Was the place where you were born rural or urban?

[] Urban 1
[] Rural 2
[] No response -99

Mig 1. How long have you been living continuously in [NAME of REGION]
If more than a year please enter in number of years on the following screen
[] Always 1
[] Currently visiting 2
[] Less than a year 3
[] More than a year 4
[] No response -99

Mig 2. Just before you moved here, did you live in a city, in a town, or a rural area?

[] City 1
[] Town 2
[] Rural area 3
[] No response -99

Mig 3. Before you moved here, which region or country did you live in most recently?
Select the most recent

[] Tigray 1
[] Afar 2
[] Amhara 3
[] Oromia 4
[] Ethiopia Somali 5
[] Benishangul Gumuz 6
[] SNNPR 7
[] Gambella 8
[] Harari 9
[] Addis Ababa 10
[] Dire Dawa 11
[] Yemen 12
[] Saudi Arabia 13
[] Libya 14
[] Beirut 15
[] United Arab Emirates 16
[] Sudan 17
[] South Sudan 18
[] South Africa 19
[] Kenya 20
[] Lebanon 21
[] Other 22

Mig 4. Can you tell me the reasons why you moved to your current place of residence?
Select all that apply

[] Education 1
[] Search for work 2
[] Marriage 3
[] Divorce/ Marriage dissolution 4
[] Death of spouse 5
[] Death of other household member 6
[] Job transfer/have a job 7
[] Displacement/War/drought 8
[] Moved with family 9
[] Returned back home 10
[] Shortage of land 11
[] Health problems 13
[] Other 12

Section 3 - Reproduction, Pregnancy and Fertility Preferences
Now I would like to ask about all the births you have had during your life.
8a. 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

8b. How many sons and daughters have you given birth to and who were born alive?

Number ____

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

[] Yes 1
[] No 0

8c. 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 1
[] No 0

8d. How many have died?
Enter --88 for do not know and -99 for no response. Change FQ8c to 'No' if zero deaths.

Number ____


READ THIS CHECK OUT LOUD Just to make sure I have this right: you had a total of __ birth(s) during your life, resulting in __ son(s) or daughter(s) born alive. Is that correct?

[] Yes 1
[] No 0

8e. 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 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 5
[] Before last birth 6
[] Never menstruated 7
[] No response -99

14. Are you pregnant now?

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

15. How many months pregnant are you?
Please record the number of completed months.
Enter -88 for do not know, -99 for no response.

The most recent birth was: [Date of FQ9]
Number of months____
CHECK 14: Currently pregnant?

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

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.
Months ____
Years ____
[] Soon / now 3
[] Says she can't get pregnant 4
[] Other 5
[] 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.
Months____
Years____
[] Soon / now 3
[] Says she can't get pregnant 4
[] Other 5
[] 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 4 - 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

OBSERVE: CHECK FOR THE PRESENCE OF OTHERS.
BEFORE CONTINUING MAKE EVER EFFORT TO ENSURE PRIVACY.

19. Have you ever heard of female sterilization?
PROBE: Women can have an operation to avoid having any more children [NO IMAGE]
[] Yes 1
[] No 0
[] No response -99

19. Have you ever heard of male sterilization?
PROBE: Men can have an operation to avoid having any more children [NO IMAGE]
[] Yes 1
[] No 0
[] No response -99

19. Have you ever heard of the contraceptive implant?
PROBE: Women can have one or several small rods placed in their upper arm by a doctor or nurse, which can prevent pregnancy for one or more years IMAGE OF METHOD WILL APPEAR ON SCREEN
[] Yes 1
[] No 0
[] No response -99

19. Have you ever heard of the IUD?
PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse. IMAGE OF METHOD WILL APPEAR ON SCREEN
[] Yes 1
[] No 0
[] No response -99

19. 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. IMAGE OF METHOD WILL APPEAR ON SCREEN
[] Yes 1
[] No 0
[] No response -99

19. Have you ever heard of the (birth control) pill?
PROBE: Women can take a pill every day to avoid becoming pregnant. IMAGE OF METHOD WILL APPEAR ON SCREEN
[] Yes 1
[] No 0
[] No response -99

19. 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 1
[] No 0
[] No response -99

19. Have you ever heard of condoms?
PROBE: Men can put a rubber sheath on their penis before sexual intercourse. IMAGE OF METHOD WILL APPEAR ON SCREEN
[] Yes 1
[] No 0
[] No response -99

19. Have you ever heard of female condoms?
PROBE: Women can put a sheath in their vagina before sexual intercourse. IMAGE OF METHOD WILL APPEAR ON SCREEN

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

19. 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. IMAGE OF METHOD WILL APPEAR ON SCREEN
[] Yes 1
[] No 0
[] No response -99

19. Have you ever heard of the Lactational Amenorrhea Method or LAM?
NO DESCRIPTION; NO IMAGE
[] Yes 1
[] No 0
[] No response -99

19. 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 1
[] No 0
[] No response -99

19. Have you ever heard of the withdrawal method?
PROBE: Men can be careful and pull out before climax. [NO IMAGE]
[] Yes 1
[] No 0
[] No response -99

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

[] Yes 1
[] No 0
[] No response -99
CHECK 14: Currently pregnant?

[] Yes 1
[] No 0

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

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

21. 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 1
[] Male sterilization 2
[] Implants 3
[] IUD 4
[] Injectables 5
[] Pill 7
[] Emergency Contraception 8
[] Male condom 9
[] Female condom 10
[] Standard Days/Cycle Beads 13
[] LAM 14
[] Other modern method 19
[] Rhythm method 30
[] Withdrawal 31
[] Other traditional method 39
[] No response -99

21b. Are you breastfeeding to delay or avoid becoming pregnant?

[] Yes 1
[] No 0
[] No response -99
CHECK FQ21: Using implants?

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

Imp-1. How many rods is your implant?

[] 1 1
[] 2 2
[] 6 6
[] Don't know -88
[] No response -99

Imp-2. At the visit when the implant was inserted, were you told for how long the implant would protect you from pregnancy?

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

Imp-3. [If Yes] How long were you told?
If you select months or years, you will enter a number for x on the next screen.
Months ____
Years ____
[] Soon / now 3
[] Says she can't get pregnant 4
[] Other 5
[] Don't know -88
[] No response -99

CHECK FQ21: Using Female Sterilization and/or Male Sterilization?

[] Female Sterilization 1
[] Male Sterilization 2
[] None of the above -77
22. Did the provider tell you or your partner that this method was permanent?

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

23. 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

24a. 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

24b. 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

25. 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

26. 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.
[] Female Sterilization 1
[] Male Sterilization 2
[] Implants 3
[] IUD 4
[] Injectables 5
[] Pill 7
[] Emergency Contraception 8
[] Male condom 9
[] Female Condom 10
[] Std Days/Cycle Beads 13
[] LAM 14
[] Other modern method 19
[] Rhythm method 30
[] Withdrawal 31
[] Other traditional method 39
[] No response -99

27. 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 age she started using a contraceptive method.
Must be before today. Respondent must have been at least 10 years old.
Enter Jan 2020 for no response
Month____ Year____
CHECK 22: Currently using contraceptives?

[] Yes 1
[] No 0

28. 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____

29. 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
[] Want to use better 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 natural processes 14
[] Other 15
[] Don't know -88
[] No response -99

30. 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 11
[] Govt. Health Center 12
[] Govt. Health Post/HEW 14

NGO
[] NGO 20
[] Community volunteer 22
[] Family planning clinic 25

Private medical sector
[] Private hospital/clinic 31
[] Pharmacy 33

Other source
[] Shop/market 42
[] Friend / relative 43
[] Mobile clinic 44
[] Other 96
[] Don't know -88
[] No response -99

30b. What is the full name of the facility where you obtained your [CURRENT/MOST RECENT METHOD]?
Select from the following facilities if applicable. If the facility where she obtained her method is not shown, select "Other" and enter the full name of the facility on the next screen. [ODK will display the list of facilities interviewed in the previous round that are assigned to the selected EA]

[] Other 96
[] Don't know -88
[] No response -99

31. 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

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

[] Yes 1
[] No 0
[] No response. -99
CHECK 21: Currently using implants?

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

Were you told where you could go to have the implant removed?

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

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

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

34. How much did you pay?
Enter all prices in Ethiopian Birr. Enter -88 if respondent does not know, -99 for no response.

Fee: _________________________

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

39. If not, why not?
(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]?

Public sector
[] Govt. Hospital 11
[] Govt. Health Center 12
[] Govt. Health Post/HEW 14

[] NGO 20
[] Community volunteer 22
[] Family planning clinic 25
Private medical sector
[] Private hospital/clinic 31
[] Pharmacy 33

Other source
[] Shop/market 42
[] Friend / relative 43
[] Mobile clinic 44
[] Other 96
[] 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?
Provider: [Type of Provider from FQ32]

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

Have you ever tried to have your current implant removed?

[] Yes, by a health professional 1
[] Yes, by a non-health professional 1
[] No 0
[] No response. -99

Why were you not able to have your implant removed?

[] Facility not open 1
[] Qualified provider not available 2
[] Provider attempted but could not remove the implant 3
[] Provider refused 4
[] Cost of removal services 5
[] Travel cost 6
[] Provider counseled against removal 7
[] Told to return on another day 8
[] Other 9
[] Don???t know -88
[] No response -99

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

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

41b. 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 have been younger than 9.
Age____

41c. 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____

42. 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.

Modern Methods
[] Female sterilization 1
[] Male sterilization 2
[] Implants 3
[] IUD 4
[] Injectables 5
[] Pill 7
[] Emergency Contraception 8
[] Male condom 9
[] Female condom 10
[] Standard Days/Cycle Beads 13
[] Lactational Amen. Method (LAM) 14
[] Other modern method 19

Non-modern methods
[] Rhythm method 30
[] Withdrawal 31
[] Other traditional method 39

[] 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 year 2
[] 2 or more years 3
CHECK 22: Currently using contraceptive method?

[] Yes, using contraceptive 1
[] No, not using contraceptive 0
43. You have said that you do not want [(a/another) child soon]/[any (more) children], but you are not using any method to avoid pregnancy. Can you tell me why you are not using a method?
Probe: Any other reason?
Hint: 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. Check to acknowledge you considered all options.
[] 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 -88
[] No response -99

44. In the last 12 months, were you visited by a 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?
[] Yes 1
[] No 0

Seen anything about family planning on the television?
[] Yes 1
[] No 0

Read about family planning in a newspaper or magazine?
[] Yes 1
[] No 0

OBSERVE: CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING MAKE EVER EFFORT TO ENSURE PRIVACY.
Verbally prepare the respondent for sexual activity questions.
48. How old were you when you first had sexual intercourse?
The respondent said she was [age from FQ1] years old at her last birthday.
[If pregnant: The respondent is pregnant]
[If FQ8GT 0: She has had X live births]
Enter the age in years.
Enter 0 if she never had sex.
Enter -88 if respondent does not know.
Enter -99 for no response.
Age____

49. When was the last time you had sexual intercourse?
[If pregnant: Respondent is X months pregnant. If FQ, answer must be in days or weeks up to 4 weeks or 30 days]
If 12 months (one year) or more ago, answer must be recorded in years. If less than 12 months ago, answer must be recorded in days, weeks or months.
Enter 0 days for today.
You will enter a number for X on the next screen.
DAYS AGO____
WEEKS AGO____
MONTHS AGO____
YEARS AGO____

How many children under age 5, if any, live in this household for which you are the primary caregiver?

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

In what month and year was this child born?
ENTER JAN 2020 FOR NO RESPONSE.

Month____ Year____

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
[] Don't know -88
[] No response -99

In the past 7 days, has this child had diarrhea?

Diarrhea is determined as perceived by mother/ caretaker. If the respondent is not sure what we mean by diarrhea, tell her it means "three or more runny stools per day."

[] Yes 1
[] No 0

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
L. 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

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

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

QUESTIONNAIRE RESULT
M. RECORD THE RESULT OF THE FEMALE RESPONDENT SURVEY

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