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Ethiopia Female Questionnaire Cross-Section and Panel 2021


IDENTIFICATION


A. Are you in the correct household?

[] Yes
[] No


EA - {EA}


Structure number - {structure}


Household number - {household}


C. Your name

Is this your name ?

[] Yes
[] No


D. Enter your name below.

Please record your name


E. Current date

E. Current time


Is this date and time correct?

[] Yes
[] No


F. Record the correct date and time

The date must be between 2021-10-01 and 2022-09-10..


G. The following information is from the Household Questionnaire. Please review to make sure you are interviewing the correct respondent.

Region

Zone


Is the above information correct?

[] Yes
[] No


I. You should be attempting to interview {firstname}. Is that correct?

If misspelled, select "yes" here 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


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

[] Yes
[] No


K. How well acquainted are you with the respondent?

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


CROSS-SECTION 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 {re_name} 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, including family planning and pregnancy using a smartphone. The survey helps monitor the state of public health and questions will be used for research purposes. 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 30 and 40 minutes to complete. Whatever information you provide will be kept strictly confidential. Your data will not be linked to your identity when conducting analyses, presenting results, or sharing data.

Participation in this survey is entirely voluntary. 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. If you choose to participate in the survey, you will receive 50 birr airtime credit.
If you have any questions about the study and your rights as a research participant, you may ask me now or you may also contact the principal investigators of the study, Solomon Shiferaw or Assefa Seme. For any ethical issues, please call Dr. Adamu Addise, the IRB chairperson at the Addis Ababa University, College of Health Sciences.

At this time, do you want to ask me anything about the survey?


M. May I begin the interview now?

[] Yes
[] No


As a reminder this is a study about maternal and newborn health. We will be visiting you at four time points: now, 6 weeks postpartum, 6 months postpartum and 1 year postpartum. Do you still consent to be enrolled in this study?

[] Yes
[] No


N. May I begin the interview now?

[] Yes
[] No


O. Interviewer?s name: {re_name}

[] NA

Mark your name as a witness to the consent process.


P. Respondent?s first name

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, and Household Characteristics

Now I would like to ask about your background and socioeconomic conditions.


FFQ001. In what month and year were you born? The age in the household roster is {age}.

If respondent knows the year, but not month select the ?Does not know month checkbox Select the ?Do not know? checkbox for month and ?2030? for year to indicate ?No Response?.

Does not know month

[] NA


FFQ002. How old were you at your last birthday?

Age must be more than 14 and less than 50 and must agree with FFQ001.


FFQ003a. Are you currently married or living together with a man as if married?

Probe: If no, ask whether the respondent is divorced, separated, widowed, or never in union/never married.

[] Yes, currently married
[] Yes, living with a man
[] Divorced / separated
[] Not currently in union: Widow
[] No, never in union
[] No response


FFQ003b. Have you been married or lived with a man only once or more than once?

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


FFQ004a. In what month and year did you start living with your FIRST husband / partner?

If respondent knows the year, but not month select the ?Does not know month? checkbox. Select the ?Do not know? checkbox for month and ?2030? for year to indicate ?No Response?.

Date cannot be in the future and before the respondent?s date of birth.

Does not know month

[] NA


FFQ005a. 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 ?2030? for year to indicate ?No Response?

Date cannot be in the future and before the respondent?s date of birth. Date cannot be before FFQ004a.

Does not know month

[] NA


FFQ006. Does your husband / partner have other wives or does he live with other women as if married?

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


FFQ006a. What is the highest level of school your husband/partner attended?

Only record formal schooling. Do not record bible or koranic school or short courses

[] Never attended
[] Primary
[] Secondary
[] Technical and vocational
[] Higher
[] Do not know
[] No response


FFQ006b. How old is your husband/partner?
Age(years)

If respondent is unsure, she can estimate his age. Do not know -88. No response -99.

Age cannot be less than 10 and cannot be more than 120.


FFQ007. What is your religion?

[] Protestant
[] Orthodox
[] Muslim
[] Catholic
[] Traditional
[] Wakefeta
[] Non-believers
[] Other
[] No response


FFQ008. What is the highest level of school YOU attended?

Only record formal schooling. Do not record bible or koranic school or short courses.

[] Never attended
[] Primary
[] Secondary
[] Technical and vocational
[] Higher
[] No response


FFQ009. Can you read or write in any language?

[] Yes
[] No
[] No response


Section 2 ? Reproduction and Fertility Preferences

Now I would like to ask about all the births you have had during your life.


FFQ018. Now I would like to ask about all the pregnancies you have had during your life. Have you ever been pregnant?

[] Yes
[] No
[] No response


FFQ019. How many times have you given birth to a baby that was born alive?

Enter -99 for no response.


FFQ020. 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.
If respondent knows the year, but not month select the ?Does not know month? checkbox. Select the ?Do not know? checkbox for month and ?2030? for year to indicate ?No Response?

Date cannot be in the future.

Do not know month

[] NA


FFQ021. 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. Select ?Do not know? for month and ?2030? for year to indicate ?No Response?.
Note to RE: use visual aid to record dates of most recent birth

Date cannot be in the future and date of recent birth has to be same as or after first birth date.

Do not know month

[] NA


FFQ025. Are you pregnant now?

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


FFQ029a. How many months pregnant are you?
The most recent birth was: {recent_birth_date_lab}

Please record the number of completed months. Do not know -88. No response -99.

Number of months cannot be lesser than 0 and more than 10.


FFQ026. When did your last menstrual period start?

Help the respondent to remember the approximate date by asking her usual menstrual cycle pattern and by using local languages which are equivalent to LMP.
Enter 0 days for today.

[] Days ago
[] Weeks ago
[] Months ago
[] Years ago
[] Before last birth
[] Never menstruated
[] In menopause/has had hysterectomy
[] No response

Enter the number of {last_period_lab}

Enter 0 days for today.

For days value must be greater than or equal to 0 and less than or equal to 6. For weeks value must be greater than 0 and less than 52. For months value must be greater than 0 and less than 12. For years value must be greater than 0 and less than 10.


FFQ029b. 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?

Remind the postpartum respondent that we are asking about her most recent pregnancy; or if currently pregnant respondent about the current pregnancy

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


FFQ172. When you found out you were pregnant, how did you feel?

Read the response options. Remind the postpartum respondent that we are asking about her most recent pregnancy, or if currently pregnant respondent about the current pregnancy.

[] Very happy
[] Sort of happy
[] Mixed happy and unhappy
[] Sort of unhappy
[] Very unhappy
[] No response


FFQ173. When your partner found out you were pregnant, how did he feel?

Read the response options. Remind the postpartum respondent that we are asking about her most recent pregnancy, or if currently pregnant respondent about the current pregnancy.

[] Very happy
[] Sort of happy
[] Mixed happy and unhappy
[] Sort of unhappy
[] Very unhappy
[] Have not told partner
[] No partner
[] Do not know
[] No response


FFQ22A. Is the respondent a usual household member or staying at her parental home temporarily?

[] Yes
[] No
[] No response


FFQ022. Is the respondent enrolled in the panel study?

[] Yes
[] No
[] No response


FFQ022b. If NO: Explain the panel survey to the woman and attempt to enroll her. Even if she is enrolled in the panel study, she may also be eligible for the cross-section Panel consent script:
Based on your answers to the previous questions, you are qualified to participate in our study. The survey is about maternal and neonatal health and is being conducted with the support of the Ministry of Health. The information you give us will help to inform the government to better plan health services. We would very much appreciate your participation in this survey, but whether or not you choose to participate is completely up to you. There is no penalty for not participating.
The survey will take place over three study visits. These visits will take place at 6 weeks, 6 months, and one year after the delivery of your baby. We will return at each of the three visits and ask you questions about your health and the health of your baby. At each visit, we will ask similar questions, because we are trying to learn about how the health of you and your baby changes over time. Some of the questions will have to do with your health during and after pregnancy and what care you received and some of the questions will be about your baby?s health and what care they received. Some of the questions may be sensitive but you do not have to answer any questions that you do not feel comfortable answering.
The first visit will take approximately 45 to 60 minutes to complete. The second and third interview will take approximately 20 to 30 minutes to complete.
There are minimal or no perceived risks or harm for participating in this survey. Keep in mind that you do not have to answer all of the questions and you may stop at any time.
Whatever information you provide will be kept strictly confidential and will not be shown to anyone other than members of our survey team. All research projects carry some risk that information about you may become known to people outside of the study. To protect against this, the phone and any applications with PMA Ethiopia data are password protected.
If you agree to participate today, we will give you an identification card with a bar code scan. This card will only be used to identify you for this study. At the last in-person visit, we will take the card away and destroy it.
There is no direct benefit to you from being in the study. You will receive 50 birr in phone credit at each visit as a thank you for your time.
If you agree to participate today, we will assume that you agree to each of the three study visits but you have the right to stop participation in the study at any time.
If you have any questions related to this study you may contact Drs. Solomon or Assefa Seme. For any ethical issues, please call Dr. Adamu Addise, the IRB chairperson at the Addis Ababa University, College of Health Sciences.


FFQ022c. Did she agree to enroll in the panel survey?

[] Yes
[] No


FFQ030. Have you ever delivered in a health facility before?

[] Yes
[] No
[] No response


FFQ032. Where would you like to deliver your baby?

[] Her Home
[] Other home
[] Government hospital
[] Government health center
[] Government health post
[] Other public sector
[] Private hospital/clinic
[] Other private medical sector
[] NGO/Faith-based health facility
[] Other
[] Have not decided yet
[] No response


FFQ033.Who would you like to deliver your baby?

[] Doctor
[] Health officer
[] Nurse/Midwife
[] Any professional healthcare provider (can?t distinguish)
[] HEW
[] Traditional birth attendant
[] Family member
[] No one
[] Have not decided yet
[] No response


FFQ034a. Thus far in your pregnancy, have you seen a health extension worker for antenatal care?

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


FFQ034b. At any point in your pregnancy, did you see a health extension worker for antenatal care?

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


FFQ035. Where did you see the HEW?

Select multiple

You cannot selected no response with other options.

[] Home
[] Government health post
[] Other health facility
[] Other
[] No response


FFQ036a. How many times have you received antenatal care during this pregnancy from a health extension worker, either at a health post or at home?

Do not know -88. No response -99.


FFQ036b. How many times did you receive antenatal care during this pregnancy from a health extension worker, either at a health post or at home?

Do not know -88. No response -99.


FFQ037. How many months pregnant were you when you first talked to a health extension worker about your pregnancy?

Do not know -88. No response -99.


FFQ038a. Have you seen a professional healthcare provider, other than an HEW, for antenatal care during this pregnancy?

[] Yes
[] No
[] No response


FFQ038b. Did you see a professional healthcare provider, other than an HEW, for antenatal care during this pregnancy?

[] Yes
[] No
[] No response


FFQ039. Whom did you see, not including an HEW? Anyone else?

(Select all that apply) Probe to identify each type of person and record all mentioned.

You cannot selected no response with other options.

[] Doctor
[] Health officer
[] Nurse/midwife
[] Professional health provider, can?t distinguish
[] Other
[] No response


FFQ040a. How many times have you received antenatal care during this pregnancy from a professional healthcare provider, other than an HEW?

Do not know -88. No response -99.


FFQ040b. How many times did you receive antenatal care during this pregnancy from a professional healthcare provider, other than an HEW?

Do not know -88. No response -99.


FFQ041. How many months pregnant were you when you first received antenatal from a professional healthcare provider other than an HEW for this pregnancy?

Do not know -88. No response -99.


FFQ042. Where did you receive antenatal care for this pregnancy, not including from the HEW? Anywhere else?

Select all that apply Probe to identify the type of source and record all mentioned

You cannot selected no response and nowhere, no treatment soughtwith other options.

[] Her home
[] Other home
[] Government hospital
[] Government health center
[] Government health post
[] Other public sector
[] Private hospital/clinic
[] Other private medical sector
[] NGO/Faith-based health facility
[] Traditional healer/medicine
[] Other
[] Nowhere, no treatment sought
[] No response


FFQ043. As part of your antenatal care during this pregnancy were any of the following measured at least once:

This includes any ANC from any provider


Was your blood pressure measured?

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


Was your weight taken?

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


Did you give a urine sample that was not for a pregnancy test?

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


Did you give a blood sample?

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


Did you give a stool sample?

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


FFQ044. I don?t want to know the results, but as part of your antenatal care were you:

This includes any ANC from any provider


Tested for syphilis?

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


Did you receive the results of your test?

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


Did someone discuss the results with you after you were tested?

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


FFQ045. I don?t want to know the results, but as part of your antenatal care were you:

This includes any ANC from any provider

Tested for HIV?

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


Did you receive the results of your test?

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


Did someone discuss the results with you after you were tested?

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


FFQ046a. During your antenatal care visit, did your provider discuss breastfeeding as a method to prevent pregnancy?

This includes any ANC from any provider

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


FFQ046b. During your antenatal care visit, did your provider talk with you about postpartum family planning?

This includes any ANC from any provider

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


FFQ047. Which family planning method or methods did you discuss with the provider?

Select all that apply Note: breastfeeding was included previously and is not part of this list

You cannot selected no response and not sure with other options.

[] Female Sterilization
[] Male Sterilization
[] Implant
[] IUD
[] Injectables
[] Pill
[] Emergency Contraception
[] Male Condom
[] Female Condom
[] Std. Days/Cycle beads
[] Rhythm method
[] Withdrawal
[] Other traditional methods
[] No response


FFQ048. Are you planning to breastfeed?

[] Yes
[] No
[] Not sure yet
[] No response


FFQ049. Are you planning to use breastfeeding to delay or avoid getting pregnant?

[] Yes
[] No
[] Not sure yet
[] No response


FFQ052. Do you plan to use a method of family planning, other than breastfeeding, within a year of giving birth?

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


FFQ053a. When do you plan to start using the method?

[] Immediately (at facility)
[] At first postpartum visit
[] Weeks
[] Months
[] After return of menses
[] Not sure yet
[] No response

FFQ053b. Enter number of {when_start_fpm_lab}

If weeks or months

Number of weeks cannot be more than 52. Number of months cannot be more than 12.


FFQ054. What method do you plan to use?

This does not include LAM/breastfeeding

[] Female Sterilization
[] Male Sterilization
[] Implant
[] IUD
[] Injectables
[] Pill
[] Emergency Contraception
[] Male Condom
[] Female Condom
[] Std. Days/Cycle beads
[] Rhythm method
[] Withdrawal
[] Other traditional methods
[] Not sure
[] No response


FFQ055. During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is convulsions (locked jaw) after birth?

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


FFQ056. During this pregnancy, how many times have you gotten a tetanus injection?

Do not know -88. No response -99.


FFQ057. During this pregnancy have you consumed any multivitamins that contain iron, iron tablets, iron syrup, or folic acid/iron co-packs?

A photo of iron tablets/syrup will appear on the screen

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


FFQ058. During this pregnancy, have you taken any drug for intestinal worms?

A photo of intestinal worms tablets will appear on the screen

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


FFQ059a. Have you experienced any of the following problems during this pregnancy:

Severe headache with blurred vision?
High blood pressure?
Edema (swelling) face/feet/body?
Convulsion/fits?
Vaginal bleeding before delivery?
High fever?
Abnormal vaginal discharge (foul smelling/dark)?
Lower abdominal pain?
Worsening vision, particularly at night?

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


FFQ059b. Did you experience any of the following problems during this pregnancy:

Severe headache with blurred vision?
High blood pressure?
Edema (swelling) face/feet/body?
Convulsion/fits?
Vaginal bleeding before delivery?
High fever?
Abnormal vaginal discharge (foul smelling/dark)?
Lower abdominal pain?
Worsening vision, particularly at night?

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


FFQ060. Did you seek treatment at a health facility for:

Severe headache with blurred vision?
High blood pressure?
Edema (swelling) face/feet/body?
Convulsion/fits?
Vaginal bleeding before delivery?
High fever?
Abnormal vaginal discharge (foul smelling/dark)?
Lower abdominal pain?
Worsening vision, particularly at night?

[] Yes
[] No
[] No response


FFQ060. Did you seek treatment at a health facility for:

Severe headache with blurred vision?
High blood pressure?
Edema (swelling) face/feet/body?
Convulsion/fits?
Vaginal bleeding before delivery?
High fever?
Abnormal vaginal discharge (foul smelling/dark)?
Lower abdominal pain?
Worsening vision, particularly at night?

[] Yes
[] No
[] No response


FFQ061. During your antenatal care visit(s) was there any discussion about the following:

Place of delivery?
Delivery by a skilled attendant?
Arrangement for transport for delivery?
Where to go if experience of pregnancy danger signs?
Severe headaches with blurred vision as a danger sign in pregnancy?
High blood pressure as a danger sign in pregnancy?
Edema/swelling of the face/feet/body as a danger sign in pregnancy?
Convulsions/fits as a danger sign in pregnancy?
Bleeding before delivery as a danger sign in pregnancy?

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


FFQ062. Did you receive any tablets that should be taken to prevent bleeding after delivery?

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


FFQ063. As part of your antenatal care visits, did a healthcare worker or HEW talk with you about your nutrition or diet?

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


FFQ064. What information or messages did you receive during your pregnancy about nutrition or diet?

Probe: From either a health provider at a facility or an HEW?
Select all that apply. Read all responses aloud.

You cannot select no response and none of the above with other options.

[] Eat more (quantity)
[] Eat a variety of foods / foods rich with iron (quality)
[] Take iron-containing tablets (IFAS)
[] Take preventive malaria treatment
[] Take deworming tablet
[] How much weight to gain
[] Regularly exercise
[] How to manage nausea/vomiting
[] Reduce salt intake
[] Do not eat raw meat
[] None of the above
[] No response


FFQ066. Do you know how to contact the HEW if you go into labor?

[] Yes
[] No
[] No HEW
[] No response


FFQ067a. Has your partner encouraged you to go to the clinic for antenatal care?

[] Yes, encouraged
[] No, did not encourage
[] No, actively discouraged
[] No partner
[] Do not know
[] No response


FFQ067b. Did your partner encourage you to go to the clinic for antenatal care?

[] Yes, encouraged
[] No, did not encourage
[] No, actively discouraged
[] No partner
[] Do not know
[] No response


FFQ068. Have you and your partner discussed where you are planning to deliver?

[] Yes
[] No
[] Partner not involved
[] No partner
[] Do not know
[] No response


FFQ069. While you were pregnant, did you and your partner discuss where you planned to deliver?

[] Yes
[] No
[] Partner not involved
[] No partner
[] Do not know
[] No response


FFQ070. Did you go to a maternity waiting home before going into labor?

This is a room or home where women go to live for days before they go into labor. It is not the waiting room in the health center where they stay while laboring before delivery.

[] Yes
[] No
[] No response


FFQ071. How many months pregnant were you when the [pregnancy ended/baby was born]?

Number of months has to be between 0 and 12.


FFQ072. How many children were in this pregnancy? (eg twin or triplet?)

[] Single
[] Twin
[] Triplet +
[] No response


I will now ask you some questions about the baby that was born. If there was more than one child, we will start with the first child born.


FFQ073. What was the outcome of this pregnancy for the {current_baby_pos_lab} born?

[] Live birth
[] Still birth
[] No response


FFQ074. Did the baby cry or show any signs of life?

[] Yes
[] No
[] No response


FFQ075. What was the name given to the baby that was just born?

Write ?Baby? if no name given


FFQ076. Is {baby_name} a boy or a girl?

[] Boy
[] Girl
[] No response


FFQ077. Is {baby_name} still alive?

[] Yes
[] No
[] No response


FFQ078. IF DECEASED: Exactly how many days or weeks old was {baby_name} when (he/she) died?

If less than 1 week, select days

[] Days
[] Weeks
[] Do not know
[] No response

Enter the number of {days_weeks_died_lab}

If less than 1 week, select days


FFQ079. Where did you give birth?

Probe to identify the type of facility.

[] Her Home
[] Other home
[] Government hospital
[] Government health center
[] Government health post
[] Other public sector
[] Private hospital/clinic
[] Other private medical sector
[] NGO/Faith-based health facility
[] Other
[] No response


FFQ080. What are the reasons you did not go to a health facility for delivery?

Any other reason?
Select all that apply

You cannot select no response and do not know with other options.

[] Not necessary
[] Not understand that service is needed
[] Not customary
[] Cost too much
[] Lack of money
[] Too far
[] Transport problem
[] No one to accompany
[] No provider available
[] Baby came too fast
[] Providers mistreat women
[] Provider not competent
[] Sent home previously
[] Concern about privacy
[] Family did not allow
[] Better care at home
[] Not know how to go
[] Not know where to go
[] For fear
[] Other
[] Do not know
[] No response


FFQ081. Who assisted with the delivery?

If Respondent says ?No one assisted,? probe to determine whether any adults were present at the delivery. If Respondent says more than one person, ask who was the primary attendant.

[] No one assisted
[] Doctor
[] Health officer
[] Nurse/Midwife
[] Skilled attendant can?t distinguish
[] Health extension worker
[] Health development army
[] Traditional birth attendant
[] Family member
[] Other
[] No response


FFQ082. Was your delivery by caesarean, that is, did they cut your belly open to take the baby out?

[] Yes
[] No
[] No response


FFQ083. Was the baby weighed at birth?

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


FFQ084. Did you experience any of the following problems during the delivery:

Severe bleeding?
Leaking/rupture of membrane and no labor pain for 24 hours?
Leaking/rupture of membrane before 9 months?
Malpresentation (the feet/hand came out first) or malposition (baby lied transversely during pregnancy)
Prolonged labor (12 hours)?
Convulsion/fits?

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


FFQ085. Where did you seek treatment for the complications you experienced during delivery?

Select all that apply.

You cannot select no response and nowhere with other options.

[] Her home
[] Other home
[] Government hospital
[] Government health center
[] Government health post
[] Other public sector
[] Private hospital/clinic
[] Other private medical sector
[] NGO/Faith-based health facility
[] Traditional healer/medicine
[] Pharmacy
[] Other
[] Nowhere, no treatment sought
[] No response


FFQ086. Did you experience any of the following problems within the first 24 hours after the delivery:

Retained placenta (more than 30 minutes)?
High fever with foul/smelly discharge or lower abdominal pain?
Severe/heavy bleeding?
Convulsions/fits?

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


FFQ087. Where did you seek treatment for:

This question will be repeated for every health problem you said you experienced after delivery

Retained placenta (more than 30 minutes)?
High fever with foul/smelly discharge or lower abdominal pain?
Severe/heavy bleeding?
Convulsions/fits?

You cannot select no response and nowhere with other options.

[] Her home
[] Other home
[] Government hospital
[] Government health center
[] Government health post
[] Other public sector
[] Private hospital/clinic
[] Other private medical sector
[] NGO/Faith-based health facility
[] Traditional healer/medicine
[] Other
[] Nowhere, no treatment sought
[] No response


FFQ088. Did you receive an injection in your thigh immediately after you delivered to prevent excess bleeding?

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


FFQ089. How long were you in labor before you left your home to seek care?

You will enter a number for x on the next screen.

[] Minutes
[] Hours
[] Before labor started
[] Do not know
[] No response

Enter the number of {labor_duration_lab}

Value has to be between 0 and 60 for minutes. Value has to be between 0 and 24 for hours.

The next set of questions asks specifically about your experiences during labor, delivery and immediate postpartum care.

FFQ091. Did the doctors, nurses, or other staff at the facility treat you with respect?

[] No, never
[] Yes, a few times
[] Yes, most of the time
[] Yes, all of the time
[] Do not remember
[] No response

The next set of questions asks specifically about your experiences during labor, delivery and immediate postpartum care.

FFQ092. Did the doctors, nurses, and other staff at the facility treat you in a friendly manner?

[] No, never
[] Yes, a few times
[] Yes, most of the time
[] Yes, all of the time
[] Do not remember
[] No response

The next set of questions asks specifically about your experiences during labor, delivery and immediate postpartum care.

FFQ093. Did the doctors or nurses explain to you why they were doing examinations or procedures on you?

[] No, never
[] Yes, a few times
[] Yes, most of the time
[] Yes, all of the time
[] Do not remember
[] No response

The next set of questions asks specifically about your experiences during labor, delivery and immediate postpartum care.

FFQ094. Did the doctors or nurses ask your permission/consent before doing procedures or examinations on you?

[] No, never
[] Yes, a few times
[] Yes, most of the time
[] Yes, all of the time
[] Do not remember
[] No response

The next set of questions asks specifically about your experiences during labor, delivery and immediate postpartum care.

FFQ095. Did the doctors or nurses explain to you why they were giving you any medicine?

[] No, never
[] Yes, a few times
[] Yes, most of the time
[] Yes, all of the time
[] Did not get any medicine
[] Do not remember
[] No response

The next set of questions asks specifically about your experiences during labor, delivery and immediate postpartum care.

FFQ096. Did you feel you could ask the doctors, nurses or other staff at the facility any questions you had?

[] No, never
[] Yes, a few times
[] Yes, most of the time
[] Yes, all of the time
[] Do not remember
[] No response

The next set of questions asks specifically about your experiences during labor, delivery and immediate postpartum care.

FFQ097. During the delivery, did you feel like you were able to be in the position that you preferred?

[] No, never
[] Yes, a few times
[] Yes, most of the time
[] Yes, all of the time
[] Do not remember
[] No response

The next set of questions asks specifically about your experiences during labor, delivery and immediate postpartum care.

FFQ098. Did you feel like the doctors or nurses at the facility involved you in decisions about your care?

[] No, never
[] Yes, a few times
[] Yes, most of the time
[] Yes, all of the time
[] Did not have to make any decisions
[] Do not remember
[] No response

The next set of questions asks specifically about your experiences during labor, delivery and immediate postpartum care.

FFQ099. When you needed help, did you feel the doctors, nurses or other staff at the facility paid attention?

[] No, never
[] Yes, a few times
[] Yes, most of the time
[] Yes, all of the time
[] Do not remember
[] No response

The next set of questions asks specifically about your experiences during labor, delivery and immediate postpartum care.

FFQ100. Did the doctors or nurses at the facility talk to you about how you were feeling?

[] No, never
[] Yes, a few times
[] Yes, most of the time
[] Yes, all of the time
[] Do not remember
[] No response

The next set of questions asks specifically about your experiences during labor, delivery and immediate postpartum care.

FFQ101. Did you feel the doctors, nurses or other staff at the facility took the best care of you?

[] No, never
[] Yes, a few times
[] Yes, most of the time
[] Yes, all of the time
[] Do not remember
[] No response

The next set of questions asks specifically about your experiences during labor, delivery and immediate postpartum care.

FFQ102. During examinations in the labor room, were you covered up with a cloth or blanket or screened with a curtain so that you did not feel exposed?

[] No, never
[] Yes, a few times
[] Yes, most of the time
[] Yes, all of the time
[] Do not remember
[] No response

The next set of questions asks specifically about your experiences during labor, delivery and immediate postpartum care.

FFQ103. Did the doctors, nurses, or other healthcare providers call you by your preferred name?

[] No, never
[] Yes, a few times
[] Yes, most of the time
[] Yes, all of the time
[] Do not remember
[] No response

The next set of questions asks specifically about your experiences during labor, delivery and immediate postpartum care.

FFQ104. Were you allowed to have someone you wanted (outside of staff at the facility, such as family or friends) stay with you during labor?

[] Yes
[] No
[] Do not remember
[] No response

The next set of questions asks specifically about your experiences during labor, delivery and immediate postpartum care.

FFQ105. Did anyone check on YOUR health after delivery, while you were still in the facility, other than a family member? For example did someone ask you questions about your health or examine you?

[] Yes
[] No
[] Do not remember
[] No response

The next set of questions asks specifically about your experiences during labor, delivery and immediate postpartum care.

FFQ106. Who checked on your health?

[] Doctor
[] Health officer
[] Nurse/Midwife
[] Skilled attendant can?t distinguish
[] Health extension worker
[] Other
[] No response

The next set of questions asks specifically about your experiences during labor, delivery and immediate postpartum care.

FFQ107. How long after delivery did the first check take place?

[] Minutes
[] Hours
[] Days
[] Do not remember
[] No response

Enter the number of {delivery_first_check_lab}

For minutes value must be greater than 0 and less then 60. For hours value must be greater than 0 and less than 24. For days value must be greater than 0 and less than 60.

The next set of questions asks specifically about your experiences during labor, delivery and immediate postpartum care.

FFQ107a. Has your menstrual cycle returned since delivery?

[] Yes
[] No
[] No response

The next set of questions asks specifically about your experiences during labor, delivery and immediate postpartum care.

FFQ107c. Have you resumed sexual activity since the birth of your most recent child?

[] Yes
[] No
[] No response

The next set of questions asks specifically about your experiences during labor, delivery and immediate postpartum care.

FFQ107d. How long after the delivery did you wait before resuming sexual activity?

If less than a month record 0 for number of months. No response -99.

Value has to be between 0 and 62. For 5-8 weeks postpartum number of months cannot be more than 3.

The next set of questions asks specifically about your experiences during labor, delivery and immediate postpartum care.

FFQ108. Before you left the facility after delivery, did a provider talk with you about using a family planning method?

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

The next set of questions asks specifically about your experiences during labor, delivery and immediate postpartum care.

FFQ109. Before you left the facility after delivery, did you receive a method of family planning or a referral for a method?

[] Yes, received method
[] Yes, received referral
[] No
[] Do not know
[] No response

The next set of questions asks specifically about your experiences during labor, delivery and immediate postpartum care.

FFQ110. What method of family planning did you receive immediately after delivery?

[] Female Sterilization
[] Male Sterilization
[] Implant
[] IUD
[] Injectables
[] Pill
[] Emergency Contraception
[] Male Condom
[] Female Condom
[] Std. Days/Cycle beads
[] No response

Now we are going to ask you a few questions specific to the baby that was just born.

FFQ111a. Was {baby_name_bsrg}?s cord tied before it was cut?

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

Now we are going to ask you a few questions specific to the baby that was just born.

FFQ111b. What was used to cut the cord?

[] Surgical blade
[] Razor blade
[] Bamboo strips
[] Scissor
[] Others
[] Do not know
[] No response

Now we are going to ask you a few questions specific to the baby that was just born.

FFQ112. Was the instrument boiled before cutting the cord?

[] Yes
[] No
[] New blade/ no need to boil
[] Do not know
[] No response

Now we are going to ask you a few questions specific to the baby that was just born.

FFQ113. Was anything applied to the cord after cutting it?

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

Now we are going to ask you a few questions specific to the baby that was just born.

FFQ114. What was applied to the cord after cutting the cord?

Select all that apply.

You cannot select no response and do no know with other options.

[] Chlorhexidine
[] Other antiseptic/Savlon
[] Antibiotics (Powder/Ointment )
[] Spirit/Alcohol
[] Gentian violet (GV)
[] Butter
[] Petroleum jelly
[] Body/Hair lotion
[] Cattle dung
[] Other
[] Do not know
[] No response

Now we are going to ask you a few questions specific to the baby that was just born.

FFQ115. Was there any bleeding after the cord was cut and/or tied?

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

Now we are going to ask you a few questions specific to the baby that was just born.

FFQ116. What did they do for the bleeding cord?

[] Pressure
[] Sponge bath (water and soap)
[] Alcohol
[] Chlorhexidine
[] Injection was given
[] Unknown substance applied
[] Nothing was applied
[] No response

Now we are going to ask you a few questions specific to the baby that was just born.

FFQ117. Did {baby_name_bsrg} cry/breathe normally immediately after birth?

[] Yes
[] No
[] No response

Now we are going to ask you a few questions specific to the baby that was just born.

FFQ118. Was anything done to help {baby_name_bsrg} cry or breathe immediately after birth?

Do not suggest any answers. Ask: Anything else? Select all that apply.

You cannot select Nothing done, No response and Do no know with other options.

[] Dried the baby
[] Wrapped the baby
[] Rubbed the back for stimulation
[] Rubbed the feet for stimulation
[] Use of ambu-bag
[] Suction cleaning
[] Heated the cord
[] Slapped the baby
[] Hold the baby upside down
[] Nothing done
[] Other
[] Do not know
[] No response

Now we are going to ask you a few questions specific to the baby that was just born.

FFQ119. Who took initiative to resuscitate or to help the baby cry?

[] Doctor
[] Health officer
[] Nurse/Midwife
[] Skilled attendant, can?t distinguish
[] Health extension worker
[] Health development army
[] Traditional birth attendant
[] Family member
[] Other
[] Do not know
[] No response

Now we are going to ask you a few questions specific to the baby that was just born.

FFQ120. Did the {baby_name_bsrg} receive eye ointment following delivery?

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

Now we are going to ask you a few questions specific to the baby that was just born.

FFQ121. Did someone place {baby_name_bsrg} naked on your chest against your skin, immediately after delivery of the baby?

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

Now we are going to ask you a few questions specific to the baby that was just born.

FFQ122. After delivery, was {baby_name_bsrg} wrapped with a cloth?

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

Now we are going to ask you a few questions specific to the baby that was just born.

FFQ123. How many minutes after delivery of {baby_name_bsrg} was he/she wrapped?

Do not know -88. No response -99.

Now we are going to ask you a few questions specific to the baby that was just born.

FFQ124. When was {baby_name_bsrg} given a bath for the first time?

[] Immediately after birth
[] Within 24 hours
[] Second day
[] Third day
[] Days 4-6
[] Day 7 and later
[] Not given
[] Do not know
[] No response

FFQ125. How long after birth did you first put {baby_name_bsrg} to the breast?

Enter a number for Minutes, Hours, or Days on the next screen.

[] Minutes
[] Hours
[] Days
[] Not yet
[] Do not know
[] No response

FFQ126. Number of {first_breast_lab} baby first put to breast

If less than 1 hour, record minutes. If less than 24 hours, record hours; otherwise, record days. If Immediately, record "0" minutes

For minutes value must be equal to or greater than 0 and less then 60. For hours value must be greater than 0 and less than 24. For days value must be greater than 0 and less than 60.


FFQ127. Did anyone check on {baby_name_bsrg} health after delivery, while you were still in the facility, other than a family member? For example did someone ask you questions about {baby_name_bsrg} health or examine him/her?

[] Yes
[] No
[] Do not remember
[] No response


FFQ128. Who checked on {baby_name_bsrg} health?

[] Doctor
[] Health officer
[] Nurse/Midwife
[] Skilled attendant can?t distinguish
[] Health extension worker
[] Other
[] No response


FFQ129. How long after delivery did the first check take place?

[] Minutes
[] Hours
[] Days
[] Do not remember
[] No response

Enter the number of {when_first_check_lab}

For minutes, enter between 0 and 59. For hours, enter between 1 and 23. For days, enter between 1 and 6.

Please enter the correct value corresponding to FFQ129.


FFQ130. Yesterday during the day or night, did {baby_name_bsrg} receive any of the following?

Breast milk?
Vitamin, mineral supplements or medicine?
Plain water?
Sweetened, flavored water or fruit juice or tea or infusion?
Oral rehydration solution (ORS)?
Infant formula?
Tinned, powered or fresh milk?
Herbal tonic/drinks
Any other liquids?
Anything else?

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


FFQ131. Has {baby_name_bsrg} ever received a BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

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


FFQ132. Has {baby_name_bsrg} ever received oral polio vaccine, that is, about two drops in the mouth to prevent polio?

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


FFQ133. Do you have a formal vaccination card with an official Ministry of Health logo where {baby_name_bsrg} vaccinations are written down?

If yes: May I see it please?

[] Yes, seen
[] Yes, not seen
[] No card
[] Do not know
[] No response


FFQ133a. Did you ever have a formal vaccination card for {baby_name_bsrg}?

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


FFQ133b. What happened to {baby_name_bsrg}?s formal vaccination card?

[] Never given a card
[] Card was lost or destroyed
[] Card at health facility
[] Card is locked away/inaccessible at moment
[] Other
[] Do not know
[] No response


FFQ133c. Do you have any paper or card with vaccination information of {baby_name_bsrg} written down?

This does not have to be an official vaccination card, but please make sure it has a list of vaccines and the dates that they were given.
If yes: May I see it please?

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


FFQ133d. Looking at the vaccine card, does {baby_name_bsrg} have:

BCG
Polio-0
Polio-1

[] Yes, legible
[] No, not given
[] Yes, but month or day illegible
[] No Response


FFQ134.BCG

Vaccine Card (1) Copy date from the card for each vaccine (2) If either the day or month are illegible select the respective checkbox to indicate which date is not legible

Date
Day illegible

[] NA

Month illegible

[] NA


FFQ134. Polio-0

Vaccine Card (1) Copy date from the card for each vaccine (2) If either the day or month are illegible select the respective checkbox to indicate which date is not legible

Date

Day illegible

[] NA

Month illegible

[] NA


FFQ134. Polio-1

Vaccine Card (1) Copy date from the card for each vaccine (2) If either the day or month are illegible select the respective checkbox to indicate which date is not legible

Date

Day illegible

[] NA

Month illegible

[] NA


FFQ135. What illness, if any, has {baby_name_bsrg} suffered from since birth?

Select all that apply.
Do not read aloud.

Cannot select ?no response? or ?No illness? with other options.

[] Poor feeding or unable to suck
[] Diarrhea
[] Pus in the umbilicus
[] Redness of the umbilicus
[] Red eye/passage of pus from eyes
[] Hypothermia
[] Jaundice
[] Convulsion
[] Skin rash/skin lesion
[] Baby doesn?t cry/breathe
[] Fever
[] Unconscious
[] Fast breathing
[] Sore throat/Tonsillitis
[] Difficulty in breathing
[] Chest in drawing
[] Doesn?t pass urine
[] Doesn?t pass stool
[] Cold/cough
[] Vomiting
[] Reduced alertness (lethargy)
[] No illness
[] Other
[] No response


FFQ136. This question will be repeated for every illness you said that {baby_name_bsrg} experienced since birth. Where did you seek treatment for:

Poor feeding or unable to suck?
Diarrhea
Pus in the umbilicus
Redness of the umbilicus
Red eye/passage of pus from eyes
Hypothermia
Jaundice
Convulsion
Skin rash/skin lesion
Baby doesn?t cry/breathe
Fever
Unconscious
Fast breathing
Sore throat/Tonsillitis
Difficulty in breathing
Chest in drawing
Doesn?t pass urine
Doesn?t pass stool
Cold/cough
Vomiting
Reduced alertness (lethargy)

Select all that apply

Cannot select ?no response? or ?No illness? with other options.

[] Her home
[] Other home
[] Government hospital
[] Government health center
[] Government health post
[] Other public sector
[] Private hospital/clinic
[] Other private medical sector
[] NGO/Faith-based health facility
[] Traditional healer/medicine
[] Pharmacy
[] Other
[] Nowhere, no treatment sought
[] No response


FFQ137. Has any health extension worker visited you since delivery?

[] Yes
[] No
[] No response


FFQ138. How many days after birth did the health extension worker visit you?

If less than 24 hours, write 0 days
No response: -99; Do not know: -88

Value has to be more than 0 or lesser than 60.


FFQ139. Did you go visit a health extension worker since delivery, either for yourself or for the baby?

[] Yes
[] No
[] No response


FFQ140. How many days after birth did you go visit the health extension worker?

If less than 24 hours, write 0 days No response: -99; Do not know: -88

Value has to be more than 0 or lesser than 60.


FFQ141. Did you go visit another professional healthcare provider other than an HEW since delivery, either for yourself or for the baby?

[] Yes
[] No
[] No response


FFQ142. How many days after birth did you go visit the other professional healthcare provider?

If less than 24 hours, write 0 days No response: -99; Do not know: -88

Value has to be more than 0 or lesser than 60.


FFQ143. Whom did you see, not including an HEW? Anyone else?

Select all that apply
Probe to identify each type of person and record all mentioned.

You cannot select no response with other options.

[] Doctor
[] Health officer
[] Nurse/Midwife
[] Professional healthcare provider, can?t distinguish
[] Traditional healer
[] Other
[] No response


FFQ144. At your visit after delivery (either by a HEW or other professional healthcare provider) did the provider discuss:

Family planning?
Exclusive breastfeeding?
Immunization?
Infant feeding?
Infant growth?
Other infant development issues?

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


FFQ145. Are you currently breastfeeding?

[] Yes
[] No
[] No response


FFQ146. Are you using breastfeeding as a family planning method to delay or avoid getting pregnant?

[] Yes
[] No
[] No response


Now I have some questions about the future


FFQ175a. Would you like to have a/another child or would you prefer not to have any / any more children?

[] Have a/another child
[] No more/prefer no children
[] Says she can?t get pregnant
[] Undecided / Don?t know
[] No response


FFQ175b. 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
[] No more/prefer no children
[] Undecided / Don?t know
[] No response


FFQ176a. 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.

[] Months
[] Years
[] Soon / now
[] Says she can?t get pregnant
[] Other
[] Don?t know
[] No response

Enter the number of {how_long_wait_lab} you would like to wait


FFQ176b. 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.

[] Months
[] Years
[] Soon / now
[] Says she can?t get pregnant
[] Other
[] Don?t know
[] No response

Enter the number of {how_long_wait_preg_lab} you would like to wait


FFQ177. If you got pregnant now, how would you feel?

[] Very happy
[] Sort of happy
[] Mixed happy and unhappy
[] Sort of unhappy
[] Very unhappy
[] Do not know
[] No response


SECTION 3 - COVID Related Questions

The next series of questions are about COVID-19, also called Coronavirus


COV4.How concerned are you about the spread of Coronavirus (COVID-19) in your community?

Read all options

[] Very concerned
[] Concerned
[] A little concerned
[] Not concerned
[] Do not know
[] No response


COV5.How concerned are you about getting infected yourself?

Read all options

[] Very concerned
[] Concerned
[] A little concerned
[] Not concerned
[] I was infected with COVID-19
[] Do not know
[] No response


COV5a.Will you take vaccination against Coronavirus (COVID-19) if it is offered to you?

[] Yes, I will take
[] No, I won?t
[] Already vaccinated
[] Not decided
[] Do not know
[] No response


COV8.Since the Coronavirus (COVID-19) restrictions began, how much of a loss of income has your household experienced?

Read all options

[] No change
[] Partial
[] Complete
[] Do not know
[] No response


COV9.Since the Coronavirus (COVID-19) restrictions began, how much of a loss of income have you personally experienced?

Read all options

[] Large
[] Moderate
[] Small
[] No change
[] Has no income
[] Do not know
[] No response


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


FFQ178a. 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


FFQ178b. 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


FFQ178c. 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
[] No
[] No response


FFQ178d. 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
[] No
[] No response


FFQ178e. 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
[] No
[] No response


FFQ178f. 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
[] No
[] No response


FFQ178g. 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


FFQ178h. 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
[] No
[] No response


FFQ178i. 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
[] No
[] No response


FFQ178j. 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
[] No
[] No response


FFQ178k. Have you ever heard of the Lactational Amenorrhea Method or LAM?

PROBE: Up to six months after childbirth, before the menstrual period has returned, women use a method requiring frequent breastfeeding day and night.

[] Yes
[] No
[] No response


FFQ178l. 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


FFQ178m. Have you ever heard of the withdrawal method?

PROBE: Men can be careful and pull out before climax. [NO IMAGE]

[] Yes
[] No
[] No response


FFQ178n. Have you ever heard of any other ways or methods that women or men can use to avoid pregnancy?

[] Yes
[] No
[] No response


FFQ179a. Are you or your partner currently doing something or using any method to delay or avoid getting pregnant?

[] Yes
[] No
[] No response


FFQ179aa. Just to check, are you or your partner doing any of the following to avoid pregnancy: deliberately avoiding sex on certain days, using a condom, using withdrawal or using emergency contraception?

[] Yes
[] No
[] No response


FFQ179b. Which method or methods are you using?

Probe: Anything else? Select all methods mentioned. Be sure to scroll to bottom to see all choices.

You cannot select no response with other options

[] Female sterilization
[] Male sterilization
[] Implant
[] IUD
[] Injectables
[] Pill
[] Emergency Contraception
[] Male Condom
[] Female Condom
[] Std Days/Cycle beads
[] LAM
[] Rhythm method
[] Withdrawal
[] Other traditional methods
[] No response


FFQ180. Since what month and year have you been using {curr_mthd_calc_lab} without stopping? Most Recent Birth: {recent_birth_date_lab} Current Marriage: {living_start_cmy_lab}

Calculate backwards from memorable events if needed. Must be before today. Respondent must be at least 10 years old. Select ?Do not know? for month and ?2030? for year to indicate ?No Response?.
For RE: Mark start date and all months until now as current use on the visual aid

Date cannot be in the future and respondent must be at least 10 years old.

Do not know month

[] NA


FFQ181. Did you or your partner use any other methods between November 2019 and when you started using {curr_mthd_calc_lab} which was {curr_mthd_my_lab}?

Interviewer notes: [Since November 2019]. Probe to see if she has used the same method at a previous time.

[] Yes
[] No
[] No response


FFQ182. Have you or your partner done anything or used a method to delay or avoid getting pregnant in the last 2 years (since November 2019)?

[] Yes
[] No
[] No response


CS2. Which method did you use just before {curr_mthd_calc_lab}?"

Do not include the current method of use. Only select the current method if the woman used it continuously, stopped and restarted during the two year period.

[] Male sterilization
[] Implant
[] IUD
[] Injectables
[] Pill
[] Emergency Contraception
[] Male Condom
[] Female Condom
[] Std. Days/Cycle beads
[] LAM
[] Rhythm method
[] Withdrawal
[] Other traditional
[] No response


CS2. Which method did you use?

Do not include the current method of use. Only select the current method if the woman used it continuously, stopped and restarted during the two year period.

[] Male sterilization
[] Implant
[] IUD
[] Injectables
[] Pill
[] Emergency Contraception
[] Male Condom
[] Female Condom
[] Std. Days/Cycle beads
[] LAM
[] Rhythm method
[] Withdrawal
[] Other traditional
[] No response


Cal001. Have you completed the paper Calendar Visual aid form?

[] Yes
[] No
[] No response


FFQ 182a. What Method Were You using in (MMYY)?

[] No Method
[] Female Sterilization
[] Male Sterilization
[] Implant
[] IUD
[] Injectables
[] Pill
[] Emergency Contraception
[] Male Condom
[] Female Condom
[] Std Days/Cycle beads
[] LAM
[] Rhythm method
[] Withdrawal
[] Other traditional methods
[] Birth
[] Pregnancy
[] Termination
[] No response


CURRENT/RECENT USERS

I will ask you a few more questions on the method that you are currently using or the method you used most recently


FFQ186. Did the provider tell you or your partner that this method was permanent?

[] Yes
[] No
[] No response


FFQ187. You first started using {rec_cur_method_lab} in {rec_cur_method_my_lab}. Where did you or your partner get it at that time?

Scroll to bottom to see all choices.

You cannot select no response with do not know.

[] GOVT HOSPITAL
[] GOVT HEALTH CENTER
[] GOVT HEALTH POST/HEW
[] HEALTH DEVELOPMENT ARMY
[] PUBLIC PHARMACY
[] OTHER PUBLIC
[] NGO HEALTH FACILITY
[] OTHER NGO
[] PRIVATE HOSPITAL
[] PRIVATE CLINIC
[] PRIVATE PHARMACY
[] OTHER PRIVATE MEDICAL
[] DRUG VENDORS/STORE
[] SHOP
[] FRIEND/RELATIVE
[] SELF
[] OTHER
[] DO NOT KNOW
[] NO RESPONSE


FFQ188. When you obtained your {rec_cur_method_lab} , did the provider ask you about your prior experience with contraception?

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


Now I am going to ask you some questions about the family planning consultation you had WHEN YOU RECEIVED YOUR MOST RECENT/CURRENT METHOD. Please tell me how much you agree with each statement based on your experiences WHEN YOU RECEIVED YOUR MOST RECENT/CURRENT METHOD.


QCC001. During the family planning visit, I felt encouraged to ask questions and express my concerns

Read all options

[] Completely agree
[] Agree
[] Disagree
[] Completely disagree
[] Do not know
[] No response


QCC002. During the family planning visit, the provider made efforts to ensure there were no interruptions during our session

Read all options

[] Completely agree
[] Agree
[] Disagree
[] Completely disagree
[] Do not know
[] No response


QCC003. During the family planning visit, the provider asked me questions in order to provide counseling that fit me personally

Read all options

[] Completely agree
[] Agree
[] Disagree
[] Completely disagree
[] Do not know
[] No response


QCC004. During the family planning visit, I received all of the information I wanted to know about my options for contraceptive methods

Read all options

[] Completely agree
[] Agree
[] Disagree
[] Completely disagree
[] Do not know
[] No response


QCC005. During the family planning visit, the provider gave me the time I needed to consider the contraceptive options we discussed

Read all options

[] Completely agree
[] Agree
[] Disagree
[] Completely disagree
[] Do not know
[] No response


QCC006. After the family planning visit, I could understand how my body might react to using contraception

Read all options

[] Completely agree
[] Agree
[] Disagree
[] Completely disagree
[] Do not know
[] No response


QCC007. After the family planning visit, I understood how to use the method(s) we talked about during the consultation

Read all options

[] Completely agree
[] Agree
[] Disagree
[] Completely disagree
[] Do not know
[] No response


QCC008. During the family planning visit, I was able to give my opinion about what I needed

Read all options

[] Completely agree
[] Agree
[] Disagree
[] Completely disagree
[] Do not know
[] No response


QCC009. During the family planning visit, I felt pressured by the healthcare provider to use the method they wanted me to use

Read all options

[] Completely agree
[] Agree
[] Disagree
[] Completely disagree
[] Do not know
[] No response


QCC010. During the family planning visit, I felt scolded because of my marital status.

Read all options

[] Completely agree
[] Agree
[] Disagree
[] Completely disagree
[] Do not know
[] No response


FFQ189. When you obtained your {rec_cur_method_lab}, did you obtain the method you wanted to delay or avoid getting pregnant?

[] Yes
[] No
[] No response


PNL 012. How satisfied are you with the method you are currently using?

[] Very satisfied
[] Satisfied
[] Neither satisfied nor dissatisfied
[] Dissatisfied
[] Very dissatisfied
[] No response


PNL012a. Would you prefer to be using a different method?

[] Yes
[] No
[] No response


PBL012b. What method would you prefer to use?

[] Female Sterilization
[] Male Sterilization
[] Implant
[] IUD
[] Injectables
[] Pill
[] Emergency Contraception
[] Male Condom
[] Female Condom
[] Std. Days/Cycle beads
[] LAM
[] Rhythm method
[] Withdrawal
[] Other traditional methods
[] No response


FFQ190. Why did you choose the implant?

Select multiple

Cannot select ?no response? with other options.

[] Long duration of protection
[] Less need for follow-up
[] Unavailability of other methods
[] Provider recommended
[] Other
[] No response


FFQ191. At the visit when the implant was inserted, were you told for how long the implant would protect you from pregnancy?

[] Yes
[] No
[] No response


FFQ192. Were you told where you could go to have the implant removed?

[] Yes
[] No
[] No response


FFQ193. Were you told how much it would cost to get your implant removed?

[] Yes
[] No
[] No response


FFQ194. When you obtained your {rec_cur_method_lab} , were you told by the provider about side effects or problems you might have with a method to delay or avoid pregnancy?

[] Yes
[] No
[] No response


FFQ196. Were you told what to do if you experienced these side effects or problems?

[] Yes
[] No
[] No response


FFQ197. At that time, were you told by a family planning provider about methods of family planning other than {rec_cur_method_lab} that you could use?

[] Yes
[] No
[] No response


FFQ199. At that time, were you told that you could switch to a different method in the future?

[] Yes
[] No
[] No response


FFQ200. 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


FFQ201. Would you return to this provider? Provider: {curr_mthd_src_lab}

[] Yes
[] No
[] Do not know


FFQ202. Would you refer your relative or friend to this provider / facility? Provider: {curr_mthd_src_lab}

[] Yes
[] No
[] Do not know


FFQ205. Have you experienced any side effects while using this method?

[] Yes
[] No
[] No response


FFQ205. Did you experience any side effects while using this method?

[] Yes
[] No
[] No response


FFQ206. What side effects have you experienced?

Do not read option choices aloud Multiple select

You cannot select no response and do not know with other options.

[] Less bleeding
[] No bleeding
[] Heavier bleeding
[] Irregular bleeding/spotting
[] Uterine cramping/lower abdominal pain
[] Gained weight
[] Lost weight
[] Facial spotting
[] Headaches
[] Got infection
[] Nausea/vomiting
[] Increased menstrual cramping
[] Lowered sex drive
[] Decreased sexual pleasure
[] Vaginal dryness
[] General weakness/pain
[] Diarrhea
[] Partner feels during sex
[] Pain at insertion site
[] Mood swings
[] Backache
[] OTHER
[] DO NOT KNOW
[] NO RESPONSE


FFQ206. What were the side effects that you EXPERIENCED while using the method?

Do not read option choices aloud Multiple select

You cannot select no response and do not know with other options.

[] Less bleeding
[] No bleeding
[] Heavier bleeding
[] Irregular bleeding/spotting
[] Uterine cramping/lower abdominal pain
[] Gained weight
[] Lost weight
[] Facial spotting
[] Headaches
[] Got infection
[] Nausea/vomiting
[] Increased menstrual cramping
[] Lowered sex drive
[] Decreased sexual pleasure
[] Vaginal dryness
[] General weakness/pain
[] Diarrhea
[] Partner feels during sex
[] Pain at insertion site
[] Mood swings
[] Backache
[] OTHER
[] DO NOT KNOW
[] NO RESPONSE


PNL017. Did you talk with anyone about any of the side effects you experienced?

[] Yes
[] No
[] No response


PNL017b. Who have you talked to about any of the side effects you experienced?

Anyone else?
SELECT ALL THAT APPLY

You cannot select do not know and no response with other options.

[] Friend
[] Family
[] Spouse
[] Daughter
[] Health extension worker
[] Other professional health care worker
[] Traditional healer
[] OTHER
[] DO NOT KNOW
[] NO RESPONSE


FFQ209. The last time you received your {rec_cur_method_lab}, did you have to pay out of pocket for:

Medical card
Supplies (like gloves or syringes)
The method itself
Transportation

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


FFQ210. Do you want to have your implant removed?

[] Yes
[] No
[] No response


FFQ211a. In the past 12 months, did you try to have your current implant removed?

[] Yes
[] No
[] No response


FFQ211b. Where did you go to try to have your implant removed?

[] GOVT HOSPITAL
[] GOVT HEALTH CENTER
[] GOVT HEALTH POST/HEW
[] HEALTH DEVELOPMENT ARMY
[] PUBLIC PHARMACY
[] OTHER PUBLIC
[] NGO HEALTH FACILITY
[] OTHER NGO
[] PRIVATE HOSPITAL
[] PRIVATE CLINIC
[] PRIVATE PHARMACY
[] OTHER PRIVATE MEDICAL
[] DRUG VENDORS/STORE
[] HOME (including friend/relative home)
[] OTHER
[] DO NOT KNOW
[] NO RESPONSE


FFQ211c. Who tried to remove the implant?

[] Self
[] Friend/Relative
[] Partner
[] HEW
[] Other professional healthcare provider, can?t distinguish
[] No one tried
[] No response


FFQ212. Why were you not able to have your implant removed?

Select all that apply

Cannot select ?no response? with other options.

[] Facility not open
[] Qualified provider not available
[] Provider attempted but could not remove the implant
[] Provider refused
[] Cost of removal services
[] Travel cost
[] Provider counseled against removal
[] Told to return on another day
[] Referred elsewhere
[] Other
[] Do not know
[] No response


FFQ213. When you stopped using the implant, where did you go to have your implant removed?

Scroll to bottom to see all choices.

Cannot select ?no response? with other options.

[] GOVT HOSPITAL
[] GOVT HEALTH CENTER
[] GOVT HEALTH POST/HEW
[] HEALTH DEVELOPMENT ARMY
[] PUBLIC PHARMACY
[] OTHER PUBLIC
[] NGO HEALTH FACILITY
[] OTHER NGO
[] PRIVATE HOSPITAL
[] PRIVATE CLINIC
[] PRIVATE PHARMACY
[] OTHER PRIVATE MEDICAL
[] DRUG VENDORS/STORE
[] SHOP
[] FRIEND/RELATIVE
[] SELF
[] OTHER
[] DO NOT KNOW
[] NO RESPONSE


FFQ214. Who removed the implant?

[] Self
[] Friend/Relative
[] Partner
[] HEW
[] Other professional healthcare provider, can?t distinguish
[] No one tried
[] No response


CURRENT NON-USERS


FFQ217. Have you ever done anything or tried in any way to delay or avoid getting pregnant?

[] Yes
[] No
[] No response


FFQ218. 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 "Not married" if 104 is "Yes, currently married". Scroll to the bottom to see all choices.

Cannot select ?no response? with other options.

[] Not married
[] Infrequent sex / not having sex
[] Menopausal/Hysterectomy
[] Subfecund / infecund
[] Not menstruated since last birth
[] Breastfeeding
[] Husband/partner away
[] Up to God / fatalistic
[] Respondent opposed
[] Husband / partner opposed
[] Others opposed
[] Religious reasons
[] Does not know of a method
[] Does not know where to get method
[] Fear of side effects
[] Health concerns
[] Too far to get method
[] Costs too much
[] Preferred method not available
[] No method available
[] Inconvenient to use
[] Interferes with body?s processes
[] Other
[] Do not know
[] No response


FFQ219. Would you say that NOT using contraception is mainly your decision, mainly your husband/partner?s decision or do you both decide together?

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


FFQ220. Do you think you will use a contraceptive method to delay or avoid getting pregnant in the future?

[] Yes
[] No
[] No response


FFQ221. When do you think you will start using a method?

[] Months
[] Years
[] Soon/now
[] After the birth of this child
[] Do not know
[] No response

Please enter the number of {when_future_use_lab}

For months value has to be more than 0 and less than 12. For years value has to be more than 0 and less than 10.


All women in the cross-section

FFQ222. How old were you when you first used a method to delay or avoid getting pregnant? The respondent said she was {last_dob_age} 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.

First use age has to be lesser than or equal to the respondent?s age.

FFQ223. How many living children did you have at that time, if any?
Note: the respondent said that she gave birth {no_live_birth} times in FFQ019.

Enter -99 for no response

Value has to be lesser than or equal to the number of live births the repspondent had.

FFQ224. Have you used emergency contraception at any time in the last 12 months?

PROBE: As an emergency measure after unprotected sexual intercourse women can take special pills at any time within three to five days to prevent pregnancy.

[] Yes
[] No
[] No response


FFQ225. In the last 12 months, were you visited by a health extension worker who talked to you about family planning?

[] Yes
[] No
[] No response


FFQ226. In the last 12 months, have you attended a group family planning counseling session with a provider?

[] Yes
[] No
[] No response


FFQ227. In the last 12 months, have you visited a health facility for care for yourself or your children?

For any health services

[] Yes
[] No
[] No response


FFQ228. Did any staff member at the health facility speak to you about family planning methods?

[] Yes
[] No
[] No response


FFQ229. 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?

Received text message about family planning on a mobile phone?

Seen anything on social media about family planning (Facebook, Viber, Twitter, WhatsApp etc.)

[] Yes
[] No
[] No response


FFQ246. During your postpartum care, did you feel pressured by providers to use a method?

[] Yes
[] No
[] No response


FFQ248. During your postpartum care, did any of the health service providers pressure you to accept a SPECIFIC method?

[] Yes
[] No
[] No response


FFQ249. Which method did you feel pressured to use?

[] Female sterilization
[] Male sterilization
[] Implant
[] IUD
[] Injectables
[] Pill
[] Emergency Contraception
[] Male Condom
[] Female Condom
[] Std Days/Cycle beads
[] LAM
[] Rhythm method
[] Withdrawal
[] Other traditional methods
[] No response


Section 5-Partner

Now I would like to ask you some questions about your husband/partner


FFQ250. Before you started using {rec_cur_method_lab}, had you discussed the decision to delay or avoid pregnancy with your husband/partner?

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


FFQ252. Does/did your husband/partner know that you are/were using {rec_cur_method_lab}?

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


FFQ253. Did you talk with your partner about using your {rec_cur_method_lab} before you started using, after you started using, or you have not talked about it?

[] Before
[] After
[] No discussion
[] No response


FFQ254. Why have you not discussed your family planning use with your husband/partner?

Select all that apply?do not read options aloud

You cannot select no response with other options.

[] It does not concern him
[] There might be negative consequences in telling him
[] He doesn?t know about FP
[] Other
[] No response


FFQ255. In the past 12 months, has your husband/partner:

Made you feel bad or treated you badly for wanting to use a FP method to delay or prevent pregnancy?

[] Yes
[] No
[] No response

FFQ255. In the past 12 months, has your husband/partner:

Tried to force or pressure you to become pregnant?

[] Yes
[] No
[] No response

FFQ255. In the past 12 months, has your husband/partner:

Said he would leave you if you did not get pregnant?

[] Yes
[] No
[] No response

FFQ255. In the past 12 months, has your husband/partner:

Told you he would have a baby with someone else if you did not get pregnant?

[] Yes
[] No
[] No response

FFQ255. In the past 12 months, has your husband/partner:

Taken away your family planning or kept you from going to the clinic to get family planning?

[] Yes
[] No
[] No response


Section-6 Empowerment/Norms Now I?m going to ask you a series of statements about family planning. For each, please tell me how strongly you agree or disagree with the statement. Some will seem similar but we would like you to consider each one as different.
We can pause at any time. If you do not feel comfortable answering any of the statements, let me know and I will move onto the next statement.


FFQ256. If I use family planning, my husband/partner may seek another sexual partner.

[] Strongly agree
[] Somewhat agree
[] Neither agree nor disagree
[] Somewhat disagree
[] Strongly disagree
[] No response


FFQ257. If I use family planning, I may have trouble getting pregnant the next time I want to.

[] Strongly agree
[] Somewhat agree
[] Neither agree nor disagree
[] Somewhat disagree
[] Strongly disagree
[] No response


FFQ258. There could be/will be conflict in my relationship/marriage if I use family planning.

[] Strongly agree
[] Somewhat agree
[] Neither agree nor disagree
[] Somewhat disagree
[] Strongly disagree
[] No response


FFQ259. If I use family planning, my children may not be born normal.

[] Strongly agree
[] Somewhat agree
[] Neither agree nor disagree
[] Somewhat disagree
[] Strongly disagree
[] No response


FFQ260. If I use family planning, my body may experience side effects that will disrupt my relations with my husband/partner.

[] Strongly agree
[] Somewhat agree
[] Neither agree nor disagree
[] Somewhat disagree
[] Strongly disagree
[] No response


FFQ261. It is acceptable for a woman to use family planning before she has children

[] Strongly agree
[] Somewhat agree
[] Neither agree nor disagree
[] Somewhat disagree
[] Strongly disagree
[] No response


FFQ262. Women who use family planning are considered promiscuous

[] Strongly agree
[] Somewhat agree
[] Neither agree nor disagree
[] Somewhat disagree
[] Strongly disagree
[] No response


FFQ263. Couples who use family planning are financially responsible

[] Strongly agree
[] Somewhat agree
[] Neither agree nor disagree
[] Somewhat disagree
[] Strongly disagree
[] No response


FFQ264. Women should be the ones to decide about family planning

[] Strongly agree
[] Somewhat agree
[] Neither agree nor disagree
[] Somewhat disagree
[] Strongly disagree
[] No response


Section 7. Sexual Activity Now I?m going to ask you a few sensitive questions about sexual activity. You do not have to answer these questions if you do not want to. We can pause at any time. If you do not feel comfortable answering any of the questions, let me know and I will either move onto the next statement or skip this section entirely.

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


FFQ277. You stated that you were not currently married, but are you currently in a relationship?

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


FFQ278. How long have you been in a relationship with your current partner?

[] Months
[] Years
[] No response

Please enter the number of {how_long_in_rshp_lab}


FFQ279a. How old were you when you first had sexual intercourse? The respondent said she was {last_dob_age} years old at her last birthday. She has had {no_live_birth} live births.

Enter the age in years. Enter -77 if she never had sex. Enter -88 if respondent does not know. Enter -99 for no response.


FFQ281. 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. Enter -99 for no response

[] Days ago
[] Weeks ago
[] Months ago
[] Years ago

Please enter the number of {when_last_intercourse_lab}

For days value must be greater than or equa to 0 and less than or equal to 365. For weeks value must be greater than 0 and less than 52. For months value must be greater than 0 and less than 12. For years value must be greater more than when the respondent was 9 years old.

FFQ282. Sometimes conflict can occur in relationships. At any time during your pregnancy, did your husband/partner do any of the following things to you:

A. Push you, shake you, or throw something at you?

[] Yes
[] No
[] No response

FFQ282. Sometimes conflict can occur in relationships. At any time during your pregnancy, did your husband/partner do any of the following things to you:

B. Slap you?

[] Yes
[] No
[] No response

FFQ282. Sometimes conflict can occur in relationships. At any time during your pregnancy, did your husband/partner do any of the following things to you:

C. Twist your arm or pull your hair?

[] Yes
[] No
[] No response

FFQ282. Sometimes conflict can occur in relationships. At any time during your pregnancy, did your husband/partner do any of the following things to you:

D. Punch you with his fist or with something that could hurt you?

[] Yes
[] No
[] No response

FFQ282. Sometimes conflict can occur in relationships. At any time during your pregnancy, did your husband/partner do any of the following things to you:

E. Kick you, drag you, or beat you up?

[] Yes
[] No
[] No response

FFQ282. Sometimes conflict can occur in relationships. At any time during your pregnancy, did your husband/partner do any of the following things to you:

F. Try to choke you or burn you on purpose?

[] Yes
[] No
[] No response

FFQ282. Sometimes conflict can occur in relationships. At any time during your pregnancy, did your husband/partner do any of the following things to you:

G. Threaten or attack you with a knife, gun, or other weapon?

[] Yes
[] No
[] No response

FFQ282. Sometimes conflict can occur in relationships. At any time during your pregnancy, did your husband/partner do any of the following things to you:

H. Physically force you to have sexual intercourse with him when you did not want to?

[] Yes
[] No
[] No response

FFQ282. Sometimes conflict can occur in relationships. At any time during your pregnancy, did your husband/partner do any of the following things to you:

I. Physically force you to perform any other sexual acts you did not want to?

[] Yes
[] No
[] No response

FFQ282. Sometimes conflict can occur in relationships. At any time during your pregnancy, did your husband/partner do any of the following things to you:

J. Used threats or pressure to make you have sex when you didn?t want to, but did not use physical force?

[] Yes
[] No
[] No response


We understand that this interview may have raised some difficult issues. How are you feeling after we?ve asked these questions? Would you like to speak with a trained care provider further? We can connect you to the local health center for follow-up care.


END OF SURVEY Thank the respondent for her time

The respondent is finished, but there are still 3 more questions for you to complete outside the home


Future Follow-up Consent (Cross-section only)


Thank you for the time you have kindly granted us. Would you be willing to participate in another survey in the future?

[] Yes
[] No
[] No response


802a. Do you own a phone?

To select yes, the phone should be equipped with a mobile or fixed voice subscription.

[] Yes, Mobile
[] Yes, Fixed
[] No
[] No response


802b. Do you have access to a phone owned by members of your household or other people that you can be easily reached over the phone?

[] Yes, Mobile
[] Yes, Fixed
[] No
[] No response


802c. Would you please tell me your relationship to the owner of the phone?

We are asking here only about the primary phone number.

[] Husband/partner
[] Son/Daughter/in-law
[] Brother/Sister/in-law
[] Parent/in-law
[] Other relative
[] Neighbor
[] HEW/HDA
[] PMA Field Guide/Translator
[] other
[] No response


Can I have your primary phone number in case we would like to follow up with you in the future?

Enter an 10-digit number without the country code. Do not include spaces or dashes. Enter 0 for no response.


Can you repeat the number again?

Enter an 10-digit number without the country code. Do not include spaces or dashes. Enter 0 for no response.

Number entered must match previously entered number.


Can I have your secondary phone number in case we would like to follow up with you in the future?

Enter an 10-digit number without the country code. Do not include spaces or dashes. Enter 0 for no response.


Can you repeat the number again?

Enter an 10-digit number without the country code. Do not include spaces or dashes.

Number entered must match previously entered number.


P1. Have you participated in a previous survey with PMA Ethiopia in 2019 to 2021, where we asked you questions about your health and the health of your baby at three different times before?

[] Yes, in the same EA
[] Yes, but different EA
[] No
[] Do not know
[] No response


END OF SURVEY Thank the respondent for her time and update the ID card

Before you leave, update the ID card with the respondent?s name, baby?s name (if given), the outcome of the birth (live birth, still birth, miscarriage), whether there were multiple births, and whether the baby is still alive.


FOLLOW UP INTERVIEW DATES

Check dates within ODK and update the woman


FU6W. Date of six-week interview. Enter Jan 1, 2030 if no date scheduled for upcoming interview


FU6Wi. Did the respondent refuse follow-up for the six-week survey?

[] Yes
[] No


FU6Wj. Did the respondent refuse future follow-up?

[] Yes
[] No


FU6Ma. Date of six-month interview

The six-month follow-up should occur 3 weeks after {birth_plus_6m_lab} Enter Jan 1, 2030 if no date scheduled for upcoming interview


FU6Mb. Did the respondent refuse future follow-up?

[] Yes
[] No


FU1Y. Date of one-year interview

The 1-Year follow-up should occur 2 weeks before or 2 weeks after {birth_plus_1y_lab}


Location


Q. Did the interview take place at the respondent?s home or her family home?

[] Respondent?s home
[] Her family home


R. Do you intend to move to your parent?s or relative?s home right before or after delivery of this pregnancy?

[] Yes
[] No
[] Do not know


S. Do you intend to remain in your family?s house for one year post-partum?

[] Yes
[] No
[] Do not know


T. Do they live in the same kebele to your home?

[] Yes
[] No
[] Do not know


U. 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.


V. Did you have to step away from the respondent?s home to take the GPS reading?

[] Yes
[] No


Va. Take a photo of the QR code. Make sure you have taken a picture of the full page and not just the QR code image and number


QUESTIONNAIRE RESULT


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

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


X. What language was this interview conducted in?

If you have used a translator while interviewing, please select the language that the respondent speaks.

[] English
[] Amharic
[] Afaan Oromo
[] Tigrigna
[] Sidamigna
[] Wolayitigna
[] Afar
[] Somali
[] Kefigna
[] Other


Y. Was a translator used for this interview?

[] Yes
[] No


Z. Questionnaire result

Result must agree with J ( availability ) and M or N ( consent ).

[] Completed
[] Not at home
[] Postponed
[] Refused
[] Partly completed
[] Incapacitated
[] Respondent death
[] Respondent temporarily moved
[] Respondent permanently moved
[] Household moved
[] Interview date after eligibility window
[] Enrolled by mistake / unknown pregnancy outcome
[] Abortion/miscarriage happened before the baseline survey