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Female Questionnaire

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 taken during the Household Questionnaire linked to this Female Questionnaire]

[] Yes 1
[] No 0

001b. RETURN TO INTERVIEW THE CORRECT HOUSEHOLD.
002. Your name:
[Interviewer name from Household Questionnaire]
Is this your name?

[] Yes 1
[] No 0

Enter your name below.
Please record your name

Interviewer's Name________

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

[] Yes 1
[] No 0

Record the correct date and time.

Day____ 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 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?

[] Yes 1
[] No 0

004b. 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 ???L.???
If this is the wrong person, you have two options:
(1) exit and ignore changes to this form. Open the correct form. Or
(2) find and interview the person whose name appears above.
[] Yes 1
[] No 0

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

[] Yes 1
[] No 0

007. How well acquainted are you with the respondent?

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

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

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

INFORMED CONSENT
Find the woman between the 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?
009a. 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

009b. Respondent's signature
Please ask the respondent to sign or check the box in agreement of their participation.
GATHER SIGNATURE:
Check box: []

010. Interviewer's name: [Interviewer name from Household Questionnaire]
Mark your name as a witness to the consent process.
________

011. 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.

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

Month____ Year____

102. How old were you at your last birthday?

Age____

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

[] Never Attended 0
[] Primary 1
[] Junior High School 2
[] Senior High School 3
[] Academy 4
[] University 5
[] No response -99

104. Are you currently married or living together with a man as if married?
Probe: If no, ask whether the respondent is divorced, separated, or widowed.
[] Yes, currently married 1
[] Yes, living with a man 2
Not currently in union:
[] Divorced / separated 3
[] Not currently in union: Widow 4
[] No, never in union 5
[] No response -99

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

[] Only once 1
[] More than once 2
[] No response -99

106a. In what month and year did you start living with your FIRST husband / partner?
Enter Jan 2020 for no response.
Month____ Year____

106b. CHECK: Based on the response you entered in FQ106a, the respondent was possibly 15 years old or younger at the time of her first marriage. Did you enter FQ106a correctly?

[] Yes 1
[] No 0

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.
Month____ Year____

107b. 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 FQ107a correctly?

[] Yes 1
[] No 0

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?

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

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

[] Living with respondent 1
[] Staying elsewhere 2
[] No response -99

Section 2 - Reproduction, Pregnancy and Fertility Preferences
Now I would like to ask about all the births you have had during your life.
ID_ RPJM_201. From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant if she were to have sexual intercourse?

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

ID_ RPJM_202. Is this the time just before her period begins, during her period, right after her period has ended, or halfway between two periods?

[] Just before her period begins 1
[] During her period 2
[] Right after her period has ended 3
[] Halfway between 4
[] Other 96
[] Don't know -88
[] No response -99

200. Now I would like to ask about all the births you have had during your life. Have you ever given birth?

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

201a. Do you have any sons or daughters to whom you have given birth who are now living with you?

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

201b. How many sons live with you?
Zero is a possible response. Enter -99 for No response.
Number____

201c. How many daughters live with you?
Zero is a possible response. Enter -99 for No response.
Number____

202a. Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?

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

202b. How many sons are alive but do not live with you?
Zero is a possible response. Enter -99 for No response.
Number____

202c. How many daughters are alive but do not live with you?
Zero is a possible response. Enter -99 for No response.
Number____

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?

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

203b. How many boys have died?
Zero is a possible response. Enter -99 for No response.
Number____

203c. And how many girls have died?
Zero is a possible response. Enter -99 for No response.
Number____

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)

Number____

204. Just to make sure that I have this right, you have had in TOTAL [ODK will display the total number of sons and daughters birthed from FQ201-203] births during your life. Is that correct?

[] Yes 1
[] No 0

205. When was your FIRST live birth?
Please record the date of the FIRST live birth. Date should be found by calculating forward or backward from memorable events if needed.
Enter Jan 2020 for no response.
Month____ Year____

206. When was your MOST RECENT live birth?
Please record the date of the MOST RECENT live birth. The date should be found by calculating backwards from memorable events if needed.
Enter Jan 2020 for no response.
Month____ Year____

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.
Month____ Year____

208a. Is your last baby / child still alive?

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

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.

Month____ Year____

ID_ RPJM_203. Did you ever breastfeed your last baby/child?

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

ID_ RPJM_204. How long after birth did you first put them to the breast?
If less than 1 hour, select hours and enter 0. If less than 24 hours, select hours and record in hours. Otherwise record in days.

[] Immediately 1
[] X hours 2
[] X days 3
[] No response -99
Number____

ID_ RPJM_205. Are you still breastfeeding your last baby/child?

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

ID_ RPJM__206. How long after birth did your last baby/child stop breastfeeding?

[] X hours 1
[] X days 2
[] X weeks 3
[] X months 4
[] X years 5
[] When the baby/child died 6
[] No Response -99
Number____

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.

Days ago:____ 1
Weeks ago:____ 2
Months ago:____ 3
Years ago:____ 4
[] Menopausal / Hysterectomy 5
[] Before last birth 6
[] Never menstruated 7
[] No response -99

210a. Are you pregnant now?

[] Yes 1
[] No 0
[] Unsure -88
[] No response -99

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.

Number of months____

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?

[] Have a/another child 1
[] No more/prefer no children 2
[] Says she can't get pregnant 3
[] Undecided / Don't know -88
[] No response -99

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?

[] Have a/another child 1
[] No more/prefer no children 2
[] Says she can't get pregnant 3
[] Undecided / Don't know -88
[] No response -99

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.
Months: ____
Years: ____
[] Soon / now 3
[] Says she can't get pregnant 4
[] Other 5
[] Don't know -88
[] No response -99

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.
Months: ____
Years: ____
[] Soon / now 3
[] Says she can't get pregnant 4
[] Other 5
[] Don't know -88
[] No response -99

213a. Now I would like to ask a question about your last live birth. At the time you became pregnant, did you want to become pregnant then, did you want to wait until later, or did you not want to have any / any more children at all?

[] Then 1
[] Later 2
[] Not at all 3
[] No response -99

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?

[] Then 1
[] Later 2
[] Not at all 3
[] No response -99

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.

301a. Have you ever heard of Female Sterilization?
PROBE: Women can have an operation to avoid having any more children.

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

301b. Have you ever heard of male sterilization?
PROBE: Men can have an operation to avoid having any more children.

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

301c. 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]

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

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]

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

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]

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

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]

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

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. [IMAGE OF METHOD WILL APPEAR ON SCREEN]

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

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]

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

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]

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

301j. 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]

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

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]

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

301m. Have you ever heard of the Lactational Amenorrhea Method or LAM?
[IMAGE OF METHOD WILL APPEAR ON SCREEN]

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

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. [IMAGE OF METHOD WILL APPEAR ON SCREEN]

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

301o. Have you ever heard of the withdrawal method?
PROBE: Men can be careful and pull out before climax.

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

301p. Have you ever heard of any other ways or methods that women or men can use to avoid pregnancy?

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

302a. Are you or your partner currently doing something or using any method to delay or avoid getting pregnant?

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

302b. Which method or methods are you using?
Probe: Anything else?
Select all methods mentioned. Be sure to scroll to bottom to see all choices.

[] Female Sterilization
[] Male Sterilization
[] Implant
[] IUD
[] Injectables - 1 month
[] Injectables - 3 months
[] Pill
[] Emergency Contraception
[] Male Condom
[] Female Condom
[] Intravag/Diaphragm
[] Std Days/Cycle Beads
[] LAM
[] Rhythm method
[] Withdrawal
[] Other traditional method
[] No response -99

CALC_ CM. CALCULATE: CURRENT METHOD
ODK will identify the most effective method currently being used by the respondent by selecting the highest method in the choice list

[] Female Sterilization
[] Male Sterilization
[] Implant 3
[] IUD 4
[] Injectables 5
[] Injectables_1mo 6
[] Pill 7
[] Emergency Contraception 8
[] Male Condom 9
[] Female Condom 10
[] Diaphragm 11
[] Std. Days/Cycle beads 13
[] LAM 14
[] Rhythm method 30
[] Withdrawal 31
[] Other traditional methods 39
[] No response. -99

302c. Are you breastfeeding to delay or avoid becoming pregnant?

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

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

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

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

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

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?

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

305b. Do you think you will use a contraceptive method to delay or avoid getting pregnant at any time in the future?

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

306a. In the last 12 months, have you ever done something or used a method to delay or avoid getting pregnant?

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

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.

[] Implant 3
[] IUD 4
[] Injectables - 1 month 5
[] Injectables - 3 months 6
[] Pill 7
[] Emergency Contraception 8
[] Male Condom 9
[] Female Condom 10
[] Intravag/Diaphragm 11
[] Std Days/Cycle Beads 13
[] LAM 14
[] Rhythm method 30
[] Withdrawal 31
[] Other traditional method 39
[] No response -99

307. Before you started using [MOST RECENT / CURRENT METHOD], had you discussed the decision to delay or avoid pregnancy with your husband/partner?

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

308. Would you say that using contraception is mainly your decision, mainly your husband/partner's decision or did you both decide together?

[] Mainly respondent 1
[] Mainly husband/partner 2
[] Joint Decision 3
[] Other 96
[] No response -99

309a. Since what month and year have you been using [MOST RECENT / 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.

Month____ 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.

Month____ 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.

Month____ 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?

[] Yes 1
[] No 0

310. 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
[] Fear of side effects 8
[] Lack of access / too far 9
[] Costs too much 10
[] Inconvenient to use 11
[] Fatalistic 12
[] Difficult to get pregnant / Menopausal 13
[] Interferes with body's processes 14
[] Other 15
[] Don't know -88
[] No response -99

311a. You first started using (CURRENT/MOST RECENT METHOD) in (DATE FROM FQ309a or 309c).
Where did you or your partner get it at that time?
Scroll to bottom to see all choices.

Public Sector:
[] Government Hospital 11
[] Government Health Center 12
[] Government Sub Health Center 13
[] FP Fieldworker 14
[] FP Mobile Unit 15
[] Village Health Post 16
[] Delivery Post 17
[] FP Cadre 18
[] Integrated Health Post 19

Private Medical Sector:
[] Private Hospital 21
[] Maternity Hospital 22
[] Maternity Home 23
[] Private Clinic 24
[] General Practitioner 25
[] Obstetrician 26
[] Midwife 27
[] Nurse 28
[] Village Midwife 29
[] Pharmacy/Drug Store 30

Other Source:
[] Friends/Relative 41
[] Shop 42
[] Other 96
[] Don't Know -88
[] No Response -99

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?

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

312b. Were you told what to do if you experienced side effects or problems?

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

313. At that time, were you told by the family planning provider about methods of family planning other than the [MOST RECENT/CURRENT METHOD] that you could use?

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

314a. During that visit, did you obtain the method you wanted to delay or avoid getting pregnant?

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

314b. When you began using [LAM/Rhythm] was this the method you wanted to use to delay or avoid getting pregnant?

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

314c. Why didn't you obtain the method you wanted?

[] Method out of stock that day 1
[] Method not available at all 2
[] Provider not trained to provide the method 3
[] Provider recommended a different method 4
[] Not eligible for method 5
[] Decided not to adopt a method 6
[] Too costly 7
[] Other 8
[] No response -99

315a. During that visit, who made the final decision about what method you got?

[] You alone 1
[] Provider 2
[] Partner 3
[] You and provider 4
[] You and partner 5
[] Other 6
[] No Response -99

315b. Who made the final decision to use [LAM/Rhythm]?

[] You alone 1
[] Provider 2
[] Partner 3
[] You and provider 4
[] You and partner 5
[] Other 6
[] Don't know -88
[] No response -99

316. Would you return to this provider?
Provider: [Type of Provider from Q 311a or 311b]

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

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

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

318a. In the last 12 months, have you paid any fees for family planning services (including the most current method)?

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

318b. How much did you pay?
Enter all prices in Indonesian rupiah.
Enter -88 if respondent does not know,
Enter -99 for no response.

Fee____

ID_ INS1. When did you last obtain the [CURRENT/MOST RECENT METHOD]?
Provider: [ODK will display response to FQ301]

Month____ Year____

ID_ INS2. Where did you last obtain your [CURRENT/MOST RECENT METHOD]?

Public Sector:
[] Government Hospital 11
[] Government Health Center 12
[] Government Sub Health Center 13
[] FP Fieldworker 14
[] FP Mobile Unit 15
[] Village Health Post 16
[] Delivery Post 17
[] FP Cadre 18
[] Integrated Health Post 19

Private Medical Sector:
[] Private Hospital 21
[] Maternity Hospital 22
[] Maternity Home 23
[] Private Clinic 24
[] General Practitioner 25
[] Obstetrician 26
[] Midwife 27
[] Nurse 28
[] Village Midwife 29
[] Pharmacy/Drug Store 30

Other Source:
[] Friends/Relative 41
[] Shop 42
[] Other 96
[] Don't Know -88
[] No Response -99

ID_ INS3. At that visit, did you pay for any of the family planning services that you received?

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

ID_ INS4 How much did you pay?

Enter Amount: ____

ID_INS ID_ INS5. Were your services covered by insurance?

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

ID_ INS6. Which insurance program covered those services?

[] BPJS: BPI 1
[] BPJS: non-BPI 2
[] Jamskesda 3
[] Private Insurance 4
[] Other 5
[] None of the above -77
[] No Response -99

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

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

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.

Age____

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

Number____

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.
[] Female sterilization 1
[] Male sterilization 2
[] Implant 3
[] IUD 4
[] Injectables- 3 months 5
[] Injectables_1month 6
[] Pill 7
[] Emergency Contraception 8
[] Male Condom 9
[] Female Condom 10
[] Diaphragm 11
[] Std. Days/Cycle beads 13
[] LAM 14
[] Rhythm method 30
[] Withdrawal 31
[] Other traditional methods 39
[] No response. -99

323a. 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.

[] Not married
[] Infrequent sex / Not having sex
[] Menopausal/Hysterectomy
[] Subfecund / infecund
[] Not menstruated since last birth
[] Breastfeeding
[] Husband away for multiple days
[] Up to God / fatalistic
[] Respondent opposed
[] Husband / partner opposed
[] Others opposed
[] Religious prohibition
[] Knows no method
[] Knows no source
[] Fear of side effects
[] Health concerns
[] Lack of access / too far
[] Costs too much
[] Preferred method not available
[] No method available
[] Inconvenient to use
[] Interferes with body's processes
[] Other
[] Don't know -88
[] No response -99

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 respondent 1
[] Mainly husband/partner 2
[] Joint Decision 3
[] Other 96
[] No response -99

ID_ RPJM_301. At what age would you like to be married?

Age in years ____
[] Never -77
[] Don't know -88
[] No response -99

ID_ RPJM_302. In your opinion, what is the best age for a woman to get married?

Age in years____

ID_ RPJM_303. In your opinion, what is the best age for a woman to have the first baby?

Age in years____

ID_ RPJM_304. How long do you think a woman should wait after one birth before she has another birth?

[] X Months 1
[] X Years 2
[] No response -99
Age in years____

LCL_308a. If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?
If you select X children, you will enter a number for X on the following screen. If none, select X children, then enter '0.'

Number of Children____
[] It's God's will (not respondent's decision) 2
[] Other 3
[] Don't know -88
[] No response -99

LCL_308b. If you could choose exactly the number of children to have in your whole life, how many would that be?
If you select X children, you will enter a number for X on the following screen. If none, select X children, then enter '0.'

Number of Children____
[] It's God's will (not respondent's decision) 2
[] Other 3
[] Don't know -88
[] No response -99

ID_ RPJM_305. Does your (husband/partner) want the same number of children that you want, or does he want more or fewer than you want?

[] Same number 1
[] More children 2
[] Fewer children 3
[] Do not know -88
[] No Response -99

324. In the last 12 months, were you visited by a village health volunteer who talked to you about family planning?

[] Yes 1
[] No 0

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

[] Yes 1
[] No 0

325b. Did any staff member at the health facility speak to you about family planning methods?

[] Yes 1
[] No 0

ID_ RPJM_306. In the last few months, did you obtain family planning information from any of the following sources?

[] FP officer?
[] Teacher?
[] Religious leader?
[] Doctor?
[] Nurse or midwife?
[] Village leader?
[] Women's group (PKK)?
[] Pharmacist?
[] Mobile information unit?
[] Traditional art?
[] None of the above -77
[] No response -99

ID_ RPJM_307. In the last few months, have you heard, seen, or read anything about family planning from any of the following sources?
Examples of family planning information:
Family planning methods, family planning service points, slogans ???Ayo Ikut KB???, KB Andalan advertisement, etc.
Read all options aloud and select all that apply.
Be sure to scroll to bottom to see all choices.
[] Radio
[] Television
[] Newspaper/Tabloid
[] Magazine
[] Pamphlet/leaflet/brochure
[] Flip chart
[] Poster
[] Banner
[] Billboard
[] Exhibition
[] Internet
[] FP information car unit (Mupen KB)
[] Mural
[] Traditional art?
[] Puppet show
[] Others
[] None of the above -77
[] Don't know-88
[] No response -99

ID _ RPJM_308a. Do you have any children between the ages of 10-19 who live with you?

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

IDE_ RPJM_308b. Have you or your husband/ partner discussed the following topics with your teenage children:

[] Reproductive age?
[] Sexually transmitted infection?
[] Drugs?
[] Delay in age at marriage?
[] Issues in family planning and reproductive health?
[] Puberty?
[] None of the above -77
[] No response -99

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?
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.
Age:____

401b. [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.

[] Yes 1
[] No 0

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.
DAYS AGO ____
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.
[] [Main sanitation facility from HQ
[] 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 -99

602a. Where do you most often change your used pads, cloths, or other sanitary materials? Only record respondent's time; not anyone else's time.
[ODK will only display the options selected in 601]

[] [Main sanitation facility from HQ
[] Other household sanitation facility
[] More than 1 option
[] Sanitation facilities at school
[] Sanitation facilities at work
[] Other public sanitation facility
[] Sleeping area/bedroom
[] Backyard
[] No facility/Bush/Field
[] Other
[] No response -99

602b. While managing your menstrual hygiene, was this place:
Main place: [Selection from 601 or 602a]
Read each option aloud and select if yes.
[] Clean?
[] Private?
[] Safe?
[] Able to be locked?
[] Supplied with clean water?
[] Supplied with soap?
[] None of the above -77
[] No response -99

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.
Reusable materials
[] Cloth/Pieces of fabric
[] Cotton wool
[] Sanitary pads
[] Foam (from a mattress or other material)
[] Other

Disposable materials
[] Tampons
[] Toilet paper
[] Paper (newspaper, pages from books)
[] Natural materials (mud, dung, leaves)

[] No materials used -77
[] No response -99

604a. Did you wash and reuse pads, cloths, or other sanitary materials during your last menstrual period?

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

604b. During your last menstrual period, were the sanitary materials that you washed and reused completely dried before each reuse?

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

605. You mentioned that you used [RESPONSES FROM 603] 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.
[] Flush toilet
[] Latrine
[] Waste bin/Trash bag
[] Burning
[] Bush/Field
[] Other
[] No response -99

606. Is there anything else that would help you manage your menstrual period that you do not usually have?
PROBE: Anything else?
Hints: Could include resources, materials, changes to your environment, etc. Do not read options aloud.
[] I have all I need
[] 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 -99

END OF SURVEY
Thank the respondent for her time
The respondent is finished, but there are still 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.
RECORD LOCATION

QUESTIONNAIRE RESULT
097. How many times have you visited this household to interview this female respondent?

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

098. In what language was this interview conducted?

[] English 1
[] Indonesian language 2
[] Traditional language 3
[] Other 96

099. Questionnaire result
Record the result of the Female Questionnaire
[] Completed 1
[] Not at home 2
[] Postponed 3
[] Refused 4
[] Partly completed 5
[] Incapacitated 6