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mADDS Ghana Female Respondent Questionnaire- Round 1

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 roster.
ODK will display the photo taken as part of the Household Roster linked to this Female Respondent Questionnaire.

[] Yes 1
[] No 0

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

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

C. Interviewer's name: Is this your name? If not, please record your name:

ODK will display the name associated with the phone's serial number

[] Yes 1
[] No 0

D. CURRENT DATE AND TIME DISPLAYED ON SCREEN.
Is this date and time correct?

[] Yes 1
[] No 0

E. Record the correct date and time.

Date____ Day____ Month____ Year____
Time____ Hours____ Minutes____ AM/PM____

F. The following information is from the Household Roster. Please review to make sure you are interviewing the correct respondent.
ODK will display the Region, District, Locality, Enumeration Area, Structure Number, and Household Number entered into the Household Roster linked to this Female Respondent Questionnaire.

G. How well acquainted are you with the respondent?

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

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

[] Yes 1
[] No 0

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

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

[] Yes 1
[] No 0

J. Respondent's signature
PLEASE ASK THE RESPONDENT TO SIGN OR CHECK THE BOX IN AGREEMENT OF THEIR PARTICIPATION.
GATHER SIGNATURE:
Check box: ☐

K. Interviewer's name
PLEASE RECORD YOUR NAME AS A WITNESS TO THE CONSENT PROCESS.

L. Respondent's name
PLEASE RECORD THE FIRST NAME OF THE RESPONDENT.

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?

Month____
Year____

1. How old were you at your last birthday?
PLEASE RECORD A NUMBER BETWEEN 15-49. DO NOT INTERVIEW ANYONE OUTSIDE THIS RANGE.
Year____

2. What is the highest level of school you attended: primary, middle/JSS, secondary/SSS, or higher?

[] Never Attended 0
[] Primary 1
[] Middle / JSS 2
[] Secondary / SSS 3
[] Higher 4

3. Are you currently married or living together with a man as if married?
IF NO, ASK WHETHER THE RESPONDENT IS DIVORCED, SEPARATED, OR WIDOWED
[] No, never in union 5
[] Yes, currently married 1
[] Yes, living with a man 2
[] Not currently in union: Divorced / separated 3
[] Not currently in union: Widow 4

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

[] Only once 1
[] More than once 2

5a. In what month and year
did you start living with your current husband / partner?
We need an alert to the RE on the ODK form if this age at first marriage is less than 15 years. The RE should confirm.
Month____
Year____

5b. Now I would like to ask about when you started living with your first husband / partner. In what month and year was that?
We need an alert to the RE on the ODK form if this age at marriage is less than 15 years. The RE should confirm.
Month____
Year____

CHECK 3: Currently married?

[] 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

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

[] Living with respondent 1
[] Staying elsewhere 2

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

8. How many times have you given birth?
0 IS A POSSIBLE ANSWER.

Number of births____

Were all of those live births?
IF NO, GO BACK AND CHANGE FQ8 TO RECORD ONLY LIVE BIRTH EVENTS

[] Yes 1
[] No 0

8a. When was your first birth?
PLEASE RECORD THE DATE OF THE FIRST LIVE BIRTH. DATE SHOULD BE FOUND BY CALCULATING FORWARD OR BACKWARD FROM MEMORABLE EVENTS IF NEEDED.
Month____
Year____

9. When was your most recent birth?
PLEASE RECORD THE DATE OF THE LAST BIRTH. THE DATE SHOULD BE FOUND BY CALCULATING BACKWARDS FROM MEMORABLE EVENTS IF NEEDED.
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.
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.
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.

Days ago____
Weeks ago____
Months ago____
Years ago____
[] Menopausal / Hysterectomy 5
[] Before last birth 6
[] Never menstruated 7

14. Are you pregnant now?

[] Yes 1
[] No 0
[] Unsure 2

15. How many months pregnant are you?
PLEASE RECORD THE NUMBER OF COMPLETED MONTHS. ENTER -88 FOR DO NOT KNOW.
Number of months____

CHECK 14: Currently pregnant?

[] Yes 1
[] No 0

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

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

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

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 PLEASE CHECK THAT YOU CORRECTLY ENTERED THE VALUE FOR MONTHS/YEARS.

Months____
Years____
[] Soon / now 3
[] Other 4
[] Says she can't get pregnant 5
[] Don't know -88

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 PLEASE CHECK THAT YOU CORRECTLY ENTERED THE VALUE FOR MONTHS/YEARS.
Months____
Years____
[] Soon / now 1
[] Other 2
[] Says she can't get pregnant 3
[] Don't know -88

CHECK 8

Number of births____

CHECK 14
Currently pregnant?

[] Yes 1
[] No 0

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

[] Then 1
[] Later 2
[] Not at all 3

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

Section 3 - Contraception
Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.

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

[] Yes 1
[] No 0

20. How old were you when you first used a method to delay or avoid getting pregnant?
ENTER THE AGE IN YEARS. ENTER 0 IF SHE NEVER USED A METHOD. ENTER -88 IF RESPONDENT DOES NOT KNOW.

Age____

20a. How many living children did you have at that time, if any?

Number____

21. Which method did you use to delay or avoid getting pregnant?
DO NOT READ THE METHOD CHOICES. BE SURE TO SCROLL TO BOTTOM TO SEE ALL CHOICES.
[] Female sterilization
[] Male sterilization
[] Implants
[] IUD
[] Injectables - 3 mo
[] Injectables - 1 mo
[] Pill
[] Emergency Contraception
[] Male Condoms
[] Female Condoms
[] Diaphragm
[] Foam/Jelly
[] Standard Days/Cycle Beads
[] LAM
[] N-tablet
[] Other modern method
[] Rhythm
[] Withdrawal
[] Washing
[] Other traditional method

CHECK 14 Currently pregnant?

[] Yes 1
[] No 0

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

[] Yes 1
[] No 0

23. What are you doing to delay or avoid a pregnancy?
PROBE: ANYTHING ELSE?
DO NOT PROMPT. SELECT ALL METHODS MENTIONED. BE SURE TO SCROLL TO BOTTOM TO SEE ALL CHOICES.
[] Female sterilization
[] Male sterilization
[] Implants
[] IUD
[] Injectables - 3 mo
[] Injectables - 1 mo
[] Pill
[] Emergency Contraception
[] Male Condoms
[] Female Condoms
[] Diaphragm
[] Foam/Jelly
[] Standard Days/Cycle Beads
[] LAM
[] N-tablet
[] Other modern method
[] Rhythm
[] Withdrawal
[] Washing
[] Other traditional method

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

[] Yes 1
[] No 0

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

[] Yes 1
[] No 0

CHECK 14: Currently pregnant?

[] Yes 1
[] No 0

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

[] Yes 1
[] No 0

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

[] Yes 1
[] No 0

CHECK 19: ever used contraceptives?

[] Yes 1
[] No 0

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

[] Yes 1
[] No 0

28. Which method did you use most recently?
PROBE: ANYTHING ELSE?
BE SURE TO SCROLL TO BOTTOM TO SEE ALL CHOICES
[] Implants
[] IUD
[] Injectables - 3 mo
[] Injectables - 1 mo
[] Pill
[] Emergency Contraception
[] Male Condoms
[] Female Condoms
[] Diaphragm
[] Foam/Jelly
[] Standard Days/Cycle Beads
[] LAM
[] N-tablet
[] Other modern method
[] Rhythm
[] Withdrawal
[] Washing
[] Other traditional method

29. When did you begin using your (MOST RECENT / CURRENT METHOD)?
PLEASE RECORD THE DATE. THE DATE SHOULD BE FOUND BY CALCULATING BACKWARDS FROM MEMORABLE EVENTS IF NEEDED.
Month____
Year____

CHECK 22: Currently using contraceptives?

[] Yes 1
[] No 0

30. When did you stop using your (MOST RECENT METHOD)?
PLEASE RECORD THE DATE. THE DATE SHOULD BE FOUND BY CALCULATING BACKWARDS FROM MEMORABLE EVENTS IF NEEDED.
Month____
Year____

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

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

32. Where did you obtain your (MOST RECENT / CURRENT METHOD) when you started using it?
SCROLL TO BOTTOM TO SEE ALL CHOICES
Public Sector
[] Govt. Hospital/polyclinic 11
[] Govt. Health center 12
[] Govt. Health post 13
[] Family planning clinic 14
[] Mobile clinic 15
[] Fieldworker/outreach/peer educator 16
[] CHPS 10
Private medical sector
[] Private hospital/clinic 21
[] Private doctor 22
[] Pharmacy 23
[] Chemical/drug store 24
[] FP/PPAG clinic 25
[] Maternity home 26
Other source
[] Shop/market 31
[] Church 32
[] Community volunteer 33
[] Friend / relative 34
[] NGO 35
[] Other 96
[] Don't know -88

33. In the last 6 months, have you paid any fees for family planning services (including the most recent/current method)?

[] Yes 1
[] No 0

34. How much did you pay?
ENTER THE AMOUNT USING THE LOCAL CURRENCY UNIT. ENTER ALL PRICES IN NEW CURRENCY AND CEDIS (NO PESEWAS). ENTER-88 IF RESPONDENT DOES NOT KNOW.
Fee:________

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

[] Yes 1
[] No 0

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

[] Yes 1
[] No 0

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

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

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

CHECK 32: Where did you obtain your (MOST RECENT / CURRENT METHOD)?

Public sector
[] Govt. Hospital/polyclinic 11
[] Govt. Health center 12
[] Govt. Health post 13
[] Family planning clinic 14
[] Mobile clinic 15
[] Fieldworker/outreach/peer educator 16
[] CHPS 10
Private medical sector
[] Private hospital/clinic 21
[] Private doctor 22
[] Pharmacy 23
[] Chemical/drug store 24
[] FP/PPAG clinic 25
[] Maternity home 26
Other source
[] Shop/market 31
[] Church 32
[] Community volunteer 33
[] Friend / relative 34
[] NGO 35
[] Other 96
[] Don't know -88

41. Would you return to this provider?

[] Yes 1
[] No 0

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

[] Yes 1
[] No 0

CHECK 16: Desire for future child?

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

CHECK 17: 2 or more years before next child?

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

CHECK 22: Currently using contraceptive method?

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

CHECK 19: Ever use a method?

[] Yes 1
[] No 0

43. You said that you do not want any / anymore children and that you are not using a method to avoid pregnancy.
Can you tell me the main reason why you are not using a method to prevent pregnancy?

[] Not married
[] Infrequent sex / husband away
[] Menopausal/Hysterectomy
[] Subfecund / infecund
[] Not menstruated since last birth
[] Breastfeeding
[] Up to God / fatalistic
[] Respondent opposed
[] Husband / partner opposed
[] Others opposed
[] Religious prohibition
[] Knows no method
[] Knows no source
[] Fear of side effects
[] Health concerns
[] Lack of access / too far
[] Costs too much
[] Preferred method not available
[] No method available
[] Inconvenient to use
[] Interferes with body's processes
[] Other
[] Don't know
[] No response

44. In the last 6 months, were you visited by a health worker who talked to you about family planning?

[] Yes 1
[] No 0

45. In the last 6 months, have you visited a health facility for care for yourself (or your children)?

[] Yes 1
[] No 0

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

[] Yes 1
[] No 0

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



Do you have any health insurance or are you a member of a mutual health organization?

[] Yes 1
[] No 0

What type of health insurance do you have?
RECORD ALL MENTIONED

[] National/District Health Insurance (NHIS) 1
[] Health insurance through employer 2
[] Mutual health organization/Community-based health insurance 3
[] Other privately purchased commercial health insurance 4
[] Other 5

Do you hold a valid National Health Insurance Scheme (NHIS) card?
IF ANSWER IS 'YES', REQUEST TO SEE THE CARD

[] Yes, card seen 1
[] Yes, card not seen/lost 2
[] No 3

48. How old were you when you first had sexual intercourse?
ENTER THE AGE IN YEARS. ENTER 0 IF SHE NEVER HAD SEX. ENTER -88 IF RESPONDENT DOES NOT KNOW.
Age____

If age at first sex less than 10 years:
CHECK:
You have entered that the respondent was X years old when she first had sexual intercourse. Is this what she said?
IF NO, GO BACK AND CORRECT FQ48
[] Yes 1
[] No 0

49. When was the last time you had sexual intercourse?
IF 12 MONTHS (ONE YEAR) OR MORE AGO, ANSWER MUST BE RECORDED IN MONTHS, WEEKS, OR DAYS.
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____

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

LOCATION
M. TAKE A GPS POINT NEAR THE ENTRANCE TO THE HOUSEHOLD.
RECORD LOCATION WHEN THE ACCURACY IS SMALLER THAN 6 M.

Instructions are given directly by the ODK software
RECORD LOCATION

QUESTIONNAIRE RESULT
N. RECORD THE RESULT OF THE FEMALE RESPONDENT SURVEY
[] Completed 1
[] Not at home 2
[] Postponed 3
[] Refused 4
[] Partly completed 5
[] Incapacitated 6