A. Are you in the correct household?
This is the picture of the front of the home taken during the Household Questionnaire.
[ODK will display the photo taken during the Household Questionnaire linked to this Female Questionnaire]

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

Enter your name below.
Please record your name

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

D. Record the correct date and time.

E. The following information is from the Household Questionnaire. Please review to make sure you are interviewing the correct respondent.
[ODK will display the Province, District, Subdistrict, Village, Blok Sensus, Structure Number, and Household Number entered into the Household Questionnaire linked to this Female Questionnaire.]
Is the above information correct?

CHECK: You should be attempting to interview [Respondent?s Name]. Is that correct?
If misspelled, select ?yes? here and update the name in question ?L.?
If this is the wrong person, you have two options:
(1) exit and ignore changes to this form. Open the correct form.
Or
(2) find and interview the person whose name appears above.
F. Is the respondent present and available to be interviewed today?

G. How well acquainted are you with the respondent?

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

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

Respondent?s signature
Please ask the respondent to sign or check the box in agreement of their participation.

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

J. Respondent?s 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, HH characteristics
Now I would like to ask about your background and socioeconomic conditions.

0. In what month and year were you born? The age in the household roster is [AGE].

1. How old were you at your last birthday?

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

3. Are you currently married or living together with a man as if married?
Probe: If no, ask whether the respondent is divorced, separated, or widowed.
4. Have you been married or lived with a man only once or more than once?

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

[If ?15 years old at marriage date ODK will display:]
CHECK: Based on the response you entered in FQ5a, the respondent was possibly 15 years old or younger at the time of her first marriage. Did you enter FQ5a correctly?

5b. Now I would like to ask about when you started living with your CURRENT or MOST RECENT husband / partner. In what month and year was that?
Enter Jan 2020 for no response.
[If ?15 years old at marriage date ODK will display:]
CHECK: Based on the response you entered in FQ5b, the respondent was possibly 15 years old or younger at the time of her first marriage. Did you enter FQ5b correctly?

CHECK 3: Currently married/cohabitating?

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

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

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

8. How many times have you given birth?
Enter - -99 for no response. 0 is a possible answer.

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

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

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

11. Is your last baby / child still alive?

12. When did your last baby / child die?
Please record the date of the child?s death. The date should be found by calculating backwards from memorable events if needed. Enter Jan 2020 for no response.
13. When did your last menstrual period start?
If you select days, weeks, months or years, you will enter a number for x on the next screen.
Enter 0 days for today, not 0 weeks/months/years.
14. Are you pregnant now?

15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. CHECK 14: Currently pregnant?

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?

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?

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.
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.CHECK 8: Number of births

CHECK 14: Currently pregnant?

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

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?

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. Show the image to the respondent after the probe, but not before she tells you whether she has heard of the method.

19. Have you ever heard of Female Sterilization?
PROBE: Women can have an operation to avoid having any more children.

19. Have you ever heard of male sterilization?
PROBE: Men can have an operation to avoid having any more children.

19. Have you ever heard of the contraceptive implant?
PROBE: Women can have one or several small rods placed in her upper arm by a doctor or nurse, which can prevent pregnancy for one or more years.
[IMAGE OF METHOD WILL APPEAR ON SCREEN]
19. Have you ever heard of the IUD?
PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse.
[IMAGE OF METHOD WILL APPEAR ON SCREEN]
19. Have you ever heard of injectables?
PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
[IMAGE OF METHOD WILL APPEAR ON SCREEN]

19. Have you ever heard of the (birth control) pill?
PROBE: Women can take a pill every day to avoid becoming pregnant.
[IMAGE OF METHOD WILL APPEAR ON SCREEN]
19. Have you ever heard of emergency contraception?
PROBE: As an emergency measure after unprotected sexual intercourse women can take special pills at any time within five days to prevent pregnancy.
[IMAGE OF METHOD WILL APPEAR ON SCREEN]
19. Have you ever heard of condoms?
PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
[IMAGE OF METHOD WILL APPEAR ON SCREEN]

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

19. Have you ever heard of the intravag/diaphragm?
PROBE: Women can place a thin flexible disk in their vagina before sexual intercourse.
[IMAGE OF METHOD WILL APPEAR ON SCREEN]

19. Have you ever heard of the standard days method or Cycle Beads?
PROBE: A Woman can use a string of colored beads to know the days she can get pregnant. On the days she can get pregnant, she and her partner use a condom or do not have sexual intercourse
[IMAGE OF METHOD WILL APPEAR ON SCREEN]
19. Have you ever heard of the Lactational Amenorrhea Method or LAM?
[IMAGE OF METHOD WILL APPEAR ON SCREEN]
19. Have you ever heard of the rhythm method?
PROBE: Women can avoid pregnancy by not having sexual intercourse on the days of the month they think they can get pregnant.
[IMAGE OF METHOD WILL APPEAR ON SCREEN]
19. Have you ever heard of the withdrawal method?
PROBE: Men can be careful and pull out before climax.

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

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

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

20b. How many living children did you have at that time, if any?
Note: the respondent said that she gave birth [number of live births] times in FQ8.
Enter -99 for no response

21. Which method did you first use to delay or avoid getting pregnant?
Do not read the method choices. Be sure to scroll to bottom to see all choices.
CHECK 14: Currently pregnant?

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

23. Which method or methods are you using?
Probe: Anything else?
Select all methods mentioned. Be sure to scroll to bottom to see all choices.
24. Did the provider tell you or your partner that this method was permanent?

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

CHECK 14: Currently pregnant?

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?

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

CHECK 19: ever used contraceptives?

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

28. Which method did you use most recently?
Probe: Anything else?
Select most effective method (highest method on list). Scroll to bottom to see all choices.
29. When did you begin using your [MOST RECENT / CURRENT METHOD]?
Calculate backwards from memorable events if needed.
Must be at least the ages she started using a contraceptive method (FQ20).
Must be before today. Respondent must be at least 10 years old.
Enter Jan 2020 for no response.
CHECK 22: Currently using contraceptives?

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

32. You first started using (CURRENT/MOST RECENT METHOD) in (DATE FROM FQ29). Where did you get it at that time?
Scroll to bottom to see all choices.
33. 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?

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

35. 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?

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

37. Why didn?t you obtain the method you wanted?

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

CHECK 32: Where did you obtain your [MOST RECENT / CURRENT METHOD]?

39. Would you return to this provider?

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

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

42. How much did you pay?
Enter all prices in Indonesian rupiah.
Enter -88 if respondent does not know
Enter -99 for no response.
FQIns1. When did you last obtain the [CURRENT/MOST RECENT METHOD]?
Provider: [ODK will display response to FQ_I-1]

FQIns2. Where did you last obtain your [CURRENT/MOST RECENT METHOD]?

FQIns3. At that visit, did you pay for any of the family planning services that you received?

FQIns4. How much did you pay?

FQIns5. Were your services covered by insurance?

FQIns6. Which insurance program covered those services?

CHECK 16: Desire for future child?

CHECK 17: 2 or more years before next child?

CHECK 22: Currently using contraceptive method?

43. You said that you do not want any / any more children and that you are not using a method to avoid pregnancy.
Can you tell me the reason why you are not using a method to prevent pregnancy?
PROBE: Any other reason?
RECORD ALL REASONS MENTIONED.
Cannot select ?Do Not Know? or ?No response? with other options.
Cannot select ?Not married? if FQ3 is ?Yes, currently married?.
Scroll to the bottom to see all choices.
44. In the last 12 months, were you visited by a village health volunteer who talked to you about family planning?

45. In the last 12 months, have you visited a health facility for care for yourself or your children?
For any health services
46. Did any staff member at the health facility speak to you about family planning methods?

47. In the last few months have you:

CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
48. How old were you when you first had sexual intercourse?
Enter the age in years.
The respondent said she was [age from FQ1] years old at her last birthday.
[She has had x live births.] Enter -77 if she never had sex. Enter -88 if respondent does not know. Enter -99 for no response.

[If age at first sex LT 10 years:]
You have entered that the respondent was X years old when she first had sexual intercourse. Is this what she said?
Go back and correct FQ48 if it is not correct.
49. When was the last time you had sexual intercourse?
If less than 12 months ago, answer must be recorded in months, weeks, or days. Enter 0 days for today. You will enter a number for X on the next screen.
Section 4 - Water
Now I would like to ask about your water practices.

50. On a typical day in the DRY season, how much time do you spending water?
Only record respondent?s time; not anyone else?s time.
If you select minutes or hours you will enter a number for x on the next screen.
51. On a typical day in the WET season, how much time do you spend collecting water?
Only record respondent?s time; not anyone else?s time.
If you select minutes or hours you will enter a number for x on the next screen.Thank the respondent for her time
The respondent is finished, but there are still 2 more questions for you to complete outside the home.

[pg. 14]
LOCATION
K. 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.
QUESTIONNAIRE RESULT
L. How many times have you visited this household to interview this female respondent?

M. Questionnaire result
Record the result of the Female Questionnaire