PMA2020 Ghana Female Questionnaire - Round 5
IDENTIFICATION
001a. Are you in the correct household?
This is the picture of the front of the home taken during the Household Questionnaire.
[ODK will display the photo attached to the linked Household Questionnaire]
[] No
001b. RETURN TO INTERVIEW THE CORRECT HOUSEHOLD.
002. Your name:
[Interviewer name from Household Questionnaire]
Is this your name?
[] No
Please record your name
003. Current date and time.
[ODK will display on screen]
Is this date and time correct?
[] No
Record the correct date and time.
Month____
Year____
Hours____
Min____
AM/PM____
004a. The following information is from the Household Questionnaire. 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 Questionnaire linked to this Female Questionnaire.]
Is the above information correct?
[] No
GO TO THE RIGHT HOUSEHOLD OR UPDATE THE HOUSEHOLD ROSTER IF NEEDED.
005. CHECK: You should be attempting to interview [Respondent's Name]. Is that correct?
If misspelled, select "yes" 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.
[] No
006. Is the respondent present and available to be interviewed today?
[] No
007. How well acquainted are you with the respondent?
[] Well acquainted
[] Not well acquainted
[] Not acquainted
008. Has the respondent previously participated in PMA2020 surveys?
[] No
[] Don?t know
[] No response
INFORMED CONSENT
Find the woman between the ages of 15-49 associated with this Female Questionnaire. The interview must have auditory privacy. Read the following greeting:
Hello. My name is ____________________________________ and I am working for 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 shall also ask you questions about your experiences seeking healthcare for yourself or your children. This information will help us understand how people use the health services available, for what purpose, and whether they are of high or low quality. 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 20 and 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?
009a. Provide a paper copy of the Consent Form to the respondent and explain it. Then, ask:
May I begin the interview now?
[] No
009b. Respondent's signature
Please ask the respondent to sign or check the box in agreement of their participation.
Checkbox: ?
010. Interviewer's name: [Interviewer name from Household Questionnaire]
Mark your name as a witness to the consent process.
011. Respondent's first name
[ODK will display the Respondent's name from linked Household Roster]
You may correct the spelling here if it is not correct, but you must be interviewing the person whose name appears below.
Section 1 -- Respondent's Background, Marital Status, and household characteristics
Now I would like to ask about your background and socioeconomic conditions.
101. In what month and year were you born? The age in the household roster is [AGE].
Year____
102. How old were you at your last birthday?
Must be more than 14. Must agree with FQ101.
103. What is the highest level of school you attended?
[] Primary
[] Middle / JSS
[] Secondary / SSS
[] Higher
[] No response
LCL101. Do you have any health insurance or are you a member of a mutual health organization?
[] No
[] No response
LCL102. What type of health insurance do you have?
Record all that are mentioned
[] Health insurance through employer
[] Mutual health organization/Community-based health insurance
[] Other privately purchased commercial health insurance
[] Other
[] No response
LCL103. Do you hold a valid National Health Insurance Scheme (NHIS) card?
If answer is "Yes", request to see the card.
[] Yes, card seen
[] Yes, card not seen/lost
[] No response
LCL104. Are you currently married or living together with a man as if married?
Probe: If no, ask whether the respondent is divorced, separated, or widowed.
[] Yes, living with a man
[] Not currently in union: Divorced / separated
[] Not currently in union: Widow
[] No, never in union
[] No response
105. Have you been married or lived with a man only once or more than once?
[] More than once
[] No response
106a. In what month and year did you start living with your FIRST husband / partner?
Enter Jan 2020 for no response.
Year____
106b. CHECK: Based on the response you entered in 106a, the respondent was possibly 15 years old or younger at the time of her first marriage. Did you enter 106a correctly?
[] No
106c. RETURN TO 106A TO CORRECT BEFORE CONTINUING
107a. Now I would like to ask about when you started living with your CURRENT or MOST RECENT husband / partner. In what month and year was that?
Enter Jan 2020 for no response.
Year____
107b. [If less than or equal to 15 years old at marriage date ODK will display:]
CHECK: Based on the response you entered in107a, the respondent was possibly 15 years old or younger at the time of her first marriage. Did you enter 107a correctly?
[] No
107c. RETURN TO 107A TO CORRECT BEFORE CONTINUING
108. Does your husband / partner have other wives or does he live with other women as if married?
[] No
[] Don?t know
[] No response
109. Is your husband / partner living with you now or is he staying elsewhere?
[] Staying elsewhere
[] No response
Section 2 -- Reproduction, Pregnancy and Fertility Preferences
200. Now I would like to ask about all the births you have had during your life. Have you ever given birth?
[] No
[] No response
201a. Do you have any sons or daughters to whom you have given birth who are now living with you?
[] No
[] No response
201b. How many sons live with you?
Zero is a possible response. Enter -99 for No response.
201c. How many daughters live with you?
Zero is a possible response. Enter -99 for No response.
202a. Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?
[] No
[] No response
202b. How many sons are alive but do not live with you?
Zero is a possible response. Enter -99 for No response.
202c. How many daughters are alive but do not live with you?
Zero is a possible response. Enter -99 for No response.
203a. Have you ever given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: Any baby who cried, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?
[] No
[] No response
203b. How many boys have died?
Zero is a possible response. Enter -99 for No response.
203c. And how many girls have died?
Zero is a possible response. Enter -99 for No response.
CALC_CEB. CALCULATE: NUMBER OF CHILDREN EVER BORN
ODK will automatically calculate the total number of children ever born from FQ201-203:
(201b+201c+202b+202c+203b+203c)
204. Just to make sure that I have this right, you have had in TOTAL [NUMBER OF CHILDREN EVER BORN] births during your life. Is that correct?
[] No
205. When was your FIRST birth?
Please record the date of the first live birth. Date should be found by calculating forward or backward from memorable events if needed. Enter Jan 2020 for no response.
Year____
206. When was your MOST RECENT birth?
Please record the date of the MOST RECENT live birth. The date should be found by calculating backwards from memorable events if needed.
Enter Jan 2020 for no response.
Year____
207. When did you give birth before the most recent one?
Please record the date of the birth before the last. The date should be found by calculating backwards from memorable events if needed.
Enter Jan 2020 for no response.
Year____
208a. Is your last baby / child still alive?
[] No
[] Don?t know
[] No response
208b. When did your last baby / child die?
Please record the date of the child's death.
The date should be found by calculating backwards from memorable events if needed.
Enter Jan 2020 for no response.
Year____
209. When did your last menstrual period start?
If you select days, weeks, months or years, you will enter a number for x on the next screen.
Enter 0 days for today, not 0 weeks/months/years.
____weeks ago
____months ago
____years ago
[] Menopausal / Hysterectomy
[] Before last birth
[] Ghana - Round 5 Never menstruated
[] No response
210a. Are you pregnant now?
[] No
[] Don?t know
[] No response
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
211a. 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?
[] No more/prefer no children
[] Says she can't get pregnant
[] Undecided / Don?t know
[] No response
211b. 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?
[] No more/prefer no children
[] Says she can't get pregnant
[] Undecided / Don?t know
[] No response
212a. 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.
Years____
[] Soon / now
[] Says she can't get pregnant
[] Other
[] Don?t know
[] No response
212b. After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?
If you select months or years, you will enter a number for x on the next screen.
Select "Years" if more than 36 months.
Please check that you correctly entered the value for months/years.
Years____
[] Soon / now
[] Says she can't get pregnant
[] Other
[] Don?t know
[] No response
213a. Now I would like to ask a question about your last birth.
At the time you became pregnant, did you want to become pregnant then, did you want to wait until later, or did you not want to have any / any more children at all?
[] Later
[] Not at all
[] No response
213b. Now I would like to ask a question about your current pregnancy.
At the time you became pregnant, did you want to become pregnant then, did you want to wait until later, or did you not want to have any / any more children at all?
[] Later
[] Not at all
[] No response
Section 3 -- Contraception
Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.
An image will appear on the screen for some methods. If the respondent says that she has not heard of the method or if she hesitates to answer, read the probe aloud and show her the image, if available.
301a. Have you ever heard of female sterilization?
PROBE: Women can have an operation to avoid having any more children.
[NO IMAGE]
[] No
[] No response
301b. Have you ever heard of male sterilization?
PROBE: Men can have an operation to avoid having any more children.
[NO IMAGE]
[] No
[] No response
301c. 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]
[] No
[] No response
301d. Have you ever heard of the IUD?
PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse.
[IMAGE OF METHOD WILL APPEAR ON SCREEN]
[] No
[] No response
301e. Have you ever heard of injectables?
PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
[IMAGE OF METHOD WILL APPEAR ON SCREEN]
[] No
[] No response
301f. 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]
[] No
[] No response
301g. Have you ever heard of emergency contraception?
PROBE: As an emergency measure after unprotected sexual intercourse women can take special pills at any time within five days to prevent pregnancy.
[NO IMAGE]
[] No
[] No response
301h. 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]
[] No
[] No response
301i. 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]
[] No
[] No response
301j. Have you ever heard of the diaphragm?
PROBE: Women can place a thin flexible disk in their vagina before sexual intercourse.
[IMAGE OF METHOD WILL APPEAR ON SCREEN]
[] No
[] No response
301k. Have you ever heard of foam or jelly as a contraceptive method?
PROBE: Women can place a suppository, jelly, or cream in their vagina before sexual intercourse to prevent pregnancy.
[IMAGE OF METHOD WILL APPEAR ON SCREEN]
[] No
[] No response
301l. 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]
[] No
[] No response
301m. Have you ever heard of the Lactational Amenorrhea Method or LAM?
[NO DESCRIPTION; NO IMAGE]
[] No
[] No response
301n. Have you ever heard of the rhythm method?
PROBE: Women can avoid pregnancy by not having sexual intercourse on the days of the month they think they can get pregnant.
[NO IMAGE]
[] No
[] No response
301o. Have you ever heard of the withdrawal method? PROBE: Men can be careful and pull out before climax.
[NO IMAGE]
[] No
[] No response
301p. Have you ever heard of any other ways or methods that women or men can use to avoid pregnancy?
[] No
[] No response
302a. Are you or your partner currently doing something or using any method to delay or avoid getting pregnant?
[] No
[] No response
302b. Which method or methods are you using?
Probe: Anything else?
Select all methods mentioned. SCROLL TO THE BOTTOM to see all choices.
[] Male sterilization
[] Implant
[] IUD
[] Injectables-3 month
[] Injectables-1 month
[] Pill
[] Emergency Contraception
[] Male Condom
[] Female Condom
[] Diaphragm
[] Foam/Jelly
[] Std. Days/Cycle beads
[] LAM
[] N_tablet
[] Rhythm method
[] Withdrawal
[] Washing
[] Other traditional methods
[] No response
CALC_CM. ODK CALCULATE: CURRENT METHOD THIS WILL NOT APPEAR ON THE SCREEN. ODK will identify the most effective method currently being used by the respondent by selecting the highest method in the choice list.
[] Male Sterilization
[] Implant
[] IUD
[] Injectables-3 month
[] Injectables-1 month
[] Pill
[] Emergency Contraception
[] Male Condom
[] Female Condom
[] Diaphragm
[] Foam/Jelly
[] Std. Days/Cycle beads
[] LAM
[] N-tablet
[] Rhythm method
[] Withdrawal
[] Washing
[] Other traditional methods
[] No response
302c. Are you breastfeeding to delay or avoid becoming pregnant?
[] No
[] No response
303. Did the provider tell you or your partner that this method was permanent?
[] No
[] No response
304. Do you know of a place where you can obtain a method of family planning?
[] No
[] No response
305a. You said that you are not currently using a contraceptive method. Do you think you will use a contraceptive method to delay or avoid getting pregnant at any time in the future?
[] No
[] No response
305b. Do you think you will use a contraceptive method to delay or avoid getting pregnant at any time in the future?
[] No
[] No response
306a. In the last 12 months, have you ever done something or used a method to delay or avoid getting pregnant?
[] No
[] No response
306b. Which method did you use most recently? Probe: Anything else?
Select most effective method (highest method on list).
Scroll to bottom to see all choices.
[] IUD
[] Injectables -- 3 month
[] Injectables -- 1 month
[] Pill
[] Emergency Contraception
[] Male Condom
[] Female Condom
[] Diaphragm
[] Foam/Jelly
[] Std. Days/Cycle beads
[] LAM
[] N_tablet
[] Rhythm method
[] Withdrawal
[] Washing
[] Other traditional methods
[] No response
307. Before you started using [MOST RECENT / CURRENT METHOD], had you discussed the decision to delay or avoid pregnancy with your husband/partner?
[] No
[] Don?t know
[] No response
308. Would you say that using contraception is mainly your decision, mainly your husband/partner's decision or did you both decide together?
[] Mainly husband/partner
[] Joint Decision
[] Other
[] No response
309a. Since what month and year have you been using [CURRENT METHOD] without stopping?
Calculate backwards from memorable events if needed.
Most Recent Birth: [mm-yyyy]
Current Marriage: [mm-yyyy]
Must be before today. Respondent must be at least 10 years old.
Enter Jan 2020 for no response.
Year____
309b. 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.
Enter Jan 2020 for no response.
Year____
309c. In what month and year had you started using [MOST RECENT METHOD] before stopping? Calculate backwards from memorable events if needed.
Most Recent Birth: [mm-yyyy]
Current Marriage: [mm-yyyy]
Must be before today. Respondent must be at least 10 years old.
Enter Jan 2020 for no response.
Year____
309d. CHECK: Just to make sure I have this correct, you used [RECENT METHOD] continuously between [START DATE] and [END DATE] without stopping, is that correct?
[] No
GO BACK TO THE PREVIOUS SCREEN AND PROBE TO DETERMINE THE PERIOD OF MOST RECENT CONTINUOUS USE.
Suggested probes:
- When was the last time you used [METHOD]?
- How long had you been using [METHOD] without stopping
310. Why did you stop using your [MOST RECENT METHOD]?
[] Became pregnant while using
[] Wanted to become pregnant
[] Husband / partner disapproved
[] Wanted more effective method
[] No method available
[] Health concerns
[] Fear of side effects
[] Lack of access / too far
[] Costs too much
[] Inconvenient to use
[] Fatalistic
[] Difficult to get pregnant / menopausal
[] Interferes with body's processes
[] Other
[] Don?t know
[] No response
311a. You first started using [CURRENT/MOST RECENT METHOD] in [DATE FROM 310a or 310c]. Where did you or your partner get it at that time?
Scroll to bottom to see all choices.
[] Govt. Hospital/polyclinic
[] Govt. Health center
[] Govt. Health post
[] Public Family planning clinic
[] Mobile clinic
[] Fieldworker/outreach/peer educator
[] Private doctor
[] Pharmacy
[] Chemical/drug store
[] Private FP/PPAG clinic
[] Maternity home
[] Church
[] Community volunteer
[] Friend / relative
[] NGO
[] Herbal Clinic
[] Don?t know
[] No response
311b. Where did you learn how to use [RHYTHM/LACTATIONAL AMENORRHEA METHOD]?
Scroll to bottom to see all choices.
[] Govt. Hospital/polyclinic
[] Govt. Health center
[] Govt. Health post
[] Public Family planning clinic
[] Mobile clinic
[] Fieldworker/outreach/peer educator
[] Private doctor
[] Pharmacy
[] Chemical/drug store
[] Private FP/PPAG clinic
[] Maternity home
[] Church
[] Community volunteer
[] Friend / relative
[] NGO
[] Herbal Clinic
[] Don't know
[] No Response
312a. 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?
[] No
[] No response
312b. Were you told what to do if you experienced side effects or problems?
[] No
[] No response
313. At that time, were you told by a family planning provider about methods of family planning other than the [MOST RECENT/CURRENT METHOD] that you could use?
[] No
[] No response
314a. During that visit, did you obtain the method you wanted to delay or avoid getting pregnant?
[] No
[] No response
314b. When you began using [LAM/Rhythm] was this the method you wanted to use to delay or avoid getting pregnant?
[] No
[] No response
314c. Why didn't you obtain the method you wanted?
[] Method not available at all
[] Provider not trained to provide the method
[] Provider recommended a different method
[] Not eligible for method
[] Decided not to adopt a method
[] Too costly
[] Other
[] No response
315a. During that visit, who made the final decision about what method you got?
[] Provider
[] Partner
[] You and provider
[] You and partner
[] Other
[] No response
315b. Who made the final decision to use [LAM/Rhythm]?
[] Provider
[] Partner
[] You and provider
[] You and partner
[] Other
[] No response
316. Would you return to this provider?
Provider: [Type of Provider from FQ30]
[] No
[] No response
317. Would you refer your relative or friend to this provider / facility?
[] No
[] No response
318a. In the last 12 months, have you paid any fees for family planning services (including the most current method)?
[] No
318b. How much did you pay?
Enter all prices in Ghana Cedis. Enter -88 if respondent does not know, -99 for no response.
319. Have you ever done anything or tried in any way to delay or avoid getting pregnant?
[] No
[] No response
320. How old were you when you first used a method to delay or avoid getting pregnant?
The respondent said she was [age from 102] 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.
321. How many living children did you have at that time, if any?
Note: the respondent said that she gave birth [number of live births] times in 204.
Enter -99 for no response
322. Which method did you first use to delay or avoid getting pregnant?
Do not read the method choices. Be sure to scroll to bottom to see all choices.
[] Male sterilization
[] Implant
[] IUD
[] Injectables - 3 months
[] Injectables -- 1 month
[] Pill
[] Emergency Contraception
[] Male Condom
[] Female Condom
[] Diaphragm
[] Foam/Jelly
[] Std. Days/Cycle beads
[] LAM
[] N_tablet
[] Rhythm method
[] Withdrawal
[] Washing
[] Other traditional methods
[] No response
323a. You said that you do not want any / anymore children and that you are not using a method to avoid pregnancy.
Can you tell me the reason why you are not using a method to prevent pregnancy?
PROBE: Any other reason?
RECORD ALL REASONS MENTIONED.
Cannot select "Do Not Know" or "No response" with other options.
Cannot select "Not married" if 104 is "Yes, currently married".
Scroll to the bottom to see all choices.
[] Infrequent sex / not having sex
[] Husband away for multiple days
[] 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
323b. Would you say that not using contraception is mainly your decision, mainly your husband/partner's decision or did you both decide together?
[] Mainly husband/partner
[] Joint Decision
[] Other
[] No response
324. In the last 12 months, were you visited by a community health worker who talked to you about family planning?
[] No
[] No response
325a. In the last 12 months, have you visited a health facility or camp for care for yourself or your children?
For any health services
[] No
[] No response
325b. Did any staff member at the health facility speak to you about family planning methods?
[] No
[] No response
326. In the last few months have you:
[] No
[] No response
[] No
[] No response
[] No
[] No response
[] No
[] No response
Section 4. Sexual Activity
CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
401a. How old were you when you first had sexual intercourse?
The respondent said she was [age from 102] years old at her last birthday.
[She has had x 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.
401b. You have entered that the respondent was X years old when she first had sexual intercourse. Is this what she said?
Go back and correct FQ40a1 if it is not correct.
[] No
402. When was the last time you had sexual intercourse?
If less than 12 months ago, answer must be recorded in months, weeks, or days.
Enter 0 days for today.
You will enter a number for X on the next screen.
____weeks ago
____months ago
____years ago
Section 6- Menstrual Hygiene
Now I'm going to ask you about menstrual hygiene management. This includes the use of absorbent materials; access to a private, clean, safe space; washing as required; and a place to dispose used materials.
601. The last time you had your period, where are all the places where you changed, washed, dried, or disposed of used sanitary materials?
PROBE: Anywhere else?
Do not read options aloud. Select all that apply.
[] Other household sanitation facility
[] Sanitation facilities at school
[] Sanitation facilities at work
[] Other public sanitation facility
[] Sleeping area/bedroom
[] Backyard
[] No facility/Bush/Field
[] Other
[] No response
602. Where do you most often change your used pads, cloths, or other sanitary materials?
[ODK will only display the options selected in FQ503]
[] Other household sanitation facility
[] Sanitation facilities at school
[] Sanitation facilities at work
[] Other public sanitation facility
[] Backyard
[] Sleeping area/bedroom
[] No facility/Bush/Field
[] Other
[] No response
602b. While managing your menstrual hygiene, was this place:
Main place: [Selection from 503 or 504]
Read each option aloud and select if yes.
[] Private?
[] Safe?
[] Able to be locked?
[] Supplied with clean water?
[] Supplied with soap?
[] None of the above
[] No response
603. During your last menstrual period, what did you use to collect or absorb your menstrual blood?
PROBE: Anything else?
Do not read options aloud. Select all that apply.
[] Cotton wool
[] Sanitary pads
[] Foam (from a mattress or other material)
[] Other
[] Toilet paper
[] Paper (newspaper, pages from books)
[] Natural materials (mud, dung, leaves)
[] No response
604. Did you wash and reuse pads, cloths, or other sanitary materials during your last menstrual period?
[] No
[] No response
604a. During your last menstrual period, were the sanitary materials that you washed and reused completely dried before each reuse?
[] No
[] No response
605. You mentioned that you used [RESPONSES FROM FQ505] during your last menstrual period. Where did you dispose of these materials after use?
PROBE: Anywhere else?
Do not read options aloud. Select all that apply.
[] Latrine
[] Waste bin/Trash bag
[] Burning
[] Bush/Field
[] Other
[] No response
606. Is there anything else that would help you manage your menstrual period that you do not usually have?
PROBE: Anything else?
Could include resources, materials, changes to your environment, etc. Do not read options aloud.
[] Clean water
[] Soap
[] Clean absorbent materials
[] A private place
[] A place where I feel safe
[] More knowledge
[] A place to buy clean absorbent materials
[] A place to dry used materials
[] A place to dispose used materials
[] Money
[] Pain medication
[] Other
[] No response
Primary Health Care Module: Section 1
PHC101a. Have you visited a health facility for yourself or your child in the last six months?
[] No
[] No response
PHC101b. Why not?
Do not read options aloud. Select all that are mentioned.
[] Facility is too far away
[] Too expensive
[] Too difficult to get to
[] Distrust of provider/facility
[] Negative prior experience
[] Lack of privacy or confidentiality
[] Did not know where to go
[] CHW provided needed services in house/community
[] Other
[] Don?t know
[] No response
PHC101c. You selected "other" on the previous screen. Please note down the response that was given here.
PHC102a. During your most recent visit to the health facility, for whom were you seeking care?
Do not read out loud.
[] Your child
[] Another family member
[] Other
[] No response
PHC102b. You selected "other" on the previous screen. Please note down the response that was given here.
PHC103a. For what reasons were you seeking care?
Do not read out loud. Select all that apply
[] Maternity services
[] Vaccination
[] Malaria/fever
[] Feel sick (undifferentiated symptoms)
[] CHW told me to go
[] Snake bite
[] Injury
[] Blood pressure
[] Diabetes
[] HIV testing/treatment
[] Worried about a new symptom or feeling
[] Other
[] No response
PHC103b. You selected "other" on the previous screen. Please note down the response that was given here.
PHC104. What type of health facility did you visit?
This also refers to the most recent visit the respondent made. Do not read out loud. Select the one that best applies.
[] Govt. Hospital/polyclinic
[] Govt. Health center
[] Govt. Health post
[] Family planning clinic
[] Mobile clinic
[] Private doctor
[] Pharmacy
[] Chemical/drug store
[] FP/PPAG clinic
[] Maternity home
[] Herbal Clinic
[] Don?t know
[] No response
PHC104b. What was the name of the facility you visited?
[ODK will display a list of facilities based on the location selected.]
[] Don?t know
[] No response
PHC105a. Please tell me the most important things that influence your decision about where to seek health services.
PROBE: Anything else?
Do not read out loud. Select all answers that apply.
[] Distance to facility
[] Cleanliness of facility
[] Being treated with respect
[] Competence/ knowledge of provider
[] Confidentiality/privacy
[] Availability/supply of medicines
[] Cost of treatment
[] Being able to choose health care provider
[] Personally know health care provider
[] Prefer traditional healers
[] Other, specify
[] No response
You selected "other" on a previous screen. Please note down the response that was given here.
PHC105b You mentioned that: [ANSWERS SELECTED IN 105a] are important to you in deciding where to seek health care services. Can you tell me which of these things is the most important to you?
[] Cleanliness of facility
[] Competence/ knowledge of provider
[] Cost of treatment
[] Distance to facility
[] Personally know health care provider
[] Confidentiality/privacy
[] Being treated with respect
[] Availability/supply of medicines
[] Prefer traditional healers
[] Waiting time to see doctor
[] Other, specify
[] No response
106. If you or your child were to get sick tomorrow, how easy or difficult would it be for you to get the care you need?
Read the question and answer choices out loud and ask the respondent to pick the best answer.
[] Difficult
[] Easy
[] Very easy
[] No response
PHC107. When you go to your primary care site, are you taken care of by the same provider each time?
Read the question and answer choices out loud and ask the respondent to pick the best answer.
[] Frequently
[] Rarely
[] Never
[] Don?t know
[] No response
Thinking about the last time you visited your local health facility for yourself or your child for any reason, please answer the following questions.
PHC108a. How long did you wait before being seen by your provider?
Record in unit respondent provides.
[] X hours
[] Gave up without seeing provider
[] Don?t know
[] No response
PHC108b. How would you rate this waiting time?
Read the question and answer choices out loud and ask the respondent to pick the best answer.
[] Very long
[] Long
[] A little long
[] Fine
[] No response
PHC109. How would you rate the cleanliness of the rooms inside the facility, including toilets? Read the question and answer choices out loud and ask the respondent to pick the best answer.
[] Very good
[] Good
[] Fair
[] Poor
[] No response
PHC110. Please tell me if you agree or disagree with the following statement: You trust the skills and abilities of the health workers at this facility.
Read the question and answer choices out loud and ask the respondent to pick the best answer.
[] Agree
[] Disagree
[] Strongly disagree
[] No response
PHC111. How easy or difficult was it to understand the information your provider gave to you?
Read the question and answer choices out loud and ask the respondent to pick the best answer.
[] Difficult
[] Easy
[] Very easy
[] No response
PHC112. How easy or difficult was it for you to follow the provider's advice?
Read the question and answer choices out loud and ask the respondent to pick the best answer.
[] Difficult
[] Easy
[] Very easy
[] No response
PHC113. How would you rate the level of respect shown to you by the providers and staff at this facility during this visit?
Read the question and answer choices out loud and ask the respondent to pick the best answer.
[] Very Good
[] Good
[] Fair
[] Poor
[] No response
PHC114. Overall, taking everything into account, how would you rate the quality of care you received at this facility?
Read the question and answer choices out loud and ask the respondent to pick the best answer.
[] Very Good
[] Good
[] Fair
[] Poor
[] No response
PHC115. How likely are you to return or bring your children to this facility for health care in the future?
Read the question and answer choices out loud and ask the respondent to pick the best answer.
[] Likely
[] Unlikely
[] Extremely unlikely
[] Don?t know
[] No response
PHC116. Were your services covered by insurance?
[] No
[] No response
PHC117. Which insurance program covered these services?
Do not read out loud. Record all that are mentioned.
[] Health insurance through employer
[] Mutual health organization/ community based insurance
[] Other privately purchased commercial health insurance
PHC118a. Was the cost to you lower because you had insurance?
[] No
[] Don?t know
[] No response
PHC118b. How much did you have to pay out of pocket?
Record amount in GHC
Enter -99 for no response
PHC119. How easy or difficult was it for you to pay for this visit?
Read the question and answer choices out loud and ask the respondent to pick the best answer.
[] Difficult
[] Easy
[] Very easy
[] No response
PHC120. Did you have to borrow money or sell something to afford the costs of this visit, including all costs such as transportation and lost wages?
[] No
[] No response
END OF SURVEY
Thank the respondent for her time
The respondent is finished, but there are still 4 more questions for you to complete outside the home.
096. 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.
097. How many times have you visited this household to interview this female respondent?
[] 2nd time
[] 3rd time
098. In what language was this interview conducted?
[] Akan
[] Ga
[] Ewe
[] Nzema
[] Dagbani
[] Other
099. Questionnaire result
Record the result of the Female Questionnaire
[] Not at home
[] Postponed
[] Refused
[] Partly completed
[] Incapacitated