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India/Rajasthan Female Questionnaire - Round 1

IDENTIFICATION

A. Are you in the correct household?
This is the picture of the front of the home taken during the Household Questionnaire.
IF NOT, RETURN TO INTERVIEW THE CORRECT HOUSEHOLD.
[ODK will display the photo attached to the linked Household Questionnaire]

[] Yes
[] No

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

[] Yes
[] No

Enter your ID below.

Interviewers ID____

C. Current date and time [ODK will display on screen]

Is this date and time correct?

[] Yes
[] No

D. Record the correct date and time.

Day____
Month____
Year____
Hours____
Min____
AM/PM____

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

[ODK will display the District, Tehsil/Taluk, City/Town/Village, Enumeration Area, Structure Number, and Household Number entered into the Household Questionnaire linked to this Female Questionnaire.]
Is the above information correct?

[] Yes
[] No

CHECK: You should be attempting to interview [Respondents Name]. Is that correct?

[] Yes
[] No

If misspelled, select "yes" here and update the name in question "J"

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?

[] Yes
[] No

G. How well acquainted are you with the respondent?

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

G2. Has this woman participated in a PMA2020 survey before?

[] Yes
[] 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

Namaskar! My name is ________ and I am working for the IIHMR University Jaipur in collaboration with local Partners. I belong to this/nearby village. We are conducting a local survey that asks women about various reproductive health issues. This survey is conducted across Rajasthan. From every enumeration area 35 households have been selected and in this extension your house is randomly selected. Though we would very much appreciate your participation in the survey, your refusal to take part in this survey will have no repercussions on you. Information provided by you would help us inform the government to better plan health services. As such there is no risk however there may be a distress among participants to share information on personal topics. If you agree to take part in this study, it will not benefit you directly. However, we believe that information gathered in this study will help us and other groups like us to develop programs that will improve the lives of men and women in communities in Rajasthan and around India so we hope that you would take part in this survey. Whatever information you provide will be kept confidential and only our research team will have access to it. We will never use your name while analyzing the data. The tracking sheet and the database with your responses will be kept on password-protected computers and on a secure server. Participation in this study is entirely voluntary, if you do not wish to answer any question feel free to inform me and I would skip to the next question. You can choose not to participate at all or to end the interview at any point. The survey usually takes between 20 to 30 minutes to complete. If you have any questions about the study and your right as a research participant, you may ask me now or you may also contact Dr. Dhirendra Kumar at IIHMR University, in Jaipur, Rajasthan at 91-141-3924738.

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

[] Yes
[] No
Please ask the respondent to sign the paper copy of the consent form or give a thumb print on the paper copy of the consent form and do likewise in the ODK form in agreement of their participation.
Respondent's signature________
[] Check box

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

NAME________

J. Respondent's first name
[ODK will display the Respondents 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.

NAME____

Section 1 Respondents 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].

Month____
Year____


1. How old were you at your last birthday?
Must be more than 14. Must agree with FQ0.

Age____

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

[] Never Attended
[] Primary
[] Secondary
[] Higher secondary
[] Graduate and above
[] No response

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.

[] Yes, currently married
[] Yes, living with a man
[] Married but gauna not performed
[] Divorced / separated
[] Widow
[] No, never in union
[] No response

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

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

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

Month____
Year____

[If less than or equal to 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?

[] Yes
[] No

5b. Now I would like to ask about when you started living with your CURRENT or MOST RECENT husband. In what month and year was that?
Enter Jan 2020 for no response.

Month____
Year____

[If less than or equal to 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 FQ5b correctly?

[] Yes
[] No

CHECK 3 Currently married/cohabitating?

[] Yes
[] No

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

[] Living with respondent
[] Staying elsewhere
[] No response

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

[] Yes
[] No
[] Don?t know
[] No response

Section 2 Reproduction, Pregnancy 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.

Number____

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

[] Yes
[] No


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. Enter Jan 2020 for no response.

Month____
Year____


9. 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.

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. Enter Jan 2020 for no response.

Month____
Year____

11. Is your last baby / child still alive?

[] Yes
[] No
[] Don?t know
[] No response

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.

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. Enter 0 days for today, not 0 weeks/months/years.

____days ago
____weeks ago
____months ago
____years ago
[] Menopausal/Hysterectomy
[] Before last birth
[] Never menstruated
[] No response

14. Are you pregnant now?

[] Yes
[] No
[] Don?t know
[] No response

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.

Number of months____

CHECK 14: Currently pregnant?

[] Yes
[] No

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
[] No more/prefer no children
[] Says she can't get pregnant
[] Undecided / Don?t know
[] No response

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
[] No more/prefer no children
[] Says she can't get pregnant
[] Undecided / Don?t know
[] No response

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. Select Years if more than 36 months.

Months____
Years____
[] Soon / now
[] Says she can't get pregnant
[] Other
[] Undecided / Don?t know
[] No response


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. Select Years if more than 36 months.

Months____
Years____
[] Soon / now
[] Says she can't get pregnant
[] Other
[] Undecided / Don?t know
[] No response

CHECK 8: Number of births

Number of births____

CHECK 14: Currently pregnant?

[] Yes
[] No

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

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
[] 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.

19. Have you ever heard of female sterilization?
PROBE: Women can have an operation to avoid having any more children.
[NO IMAGE]

[] Yes
[] No
[] No response

19. Have you ever heard of male sterilization?
PROBE: Men can have an operation to avoid having any more children.
[NO IMAGE]

[] Yes
[] No
[] No response

19. Have you ever heard of the contraceptive implant?
PROBE: Women can have one or several small rods placed in their upper arm by a doctor or nurse, which can prevent pregnancy for one or more years.
[IMAGE OF METHOD WILL APPEAR ON SCREEN]

[] Yes
[] No
[] No response

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]

[] Yes
[] No
[] No response

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]

[] Yes
[] No
[] No response

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]

[] Yes
[] No
[] No response


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.
[NO IMAGE]

[] Yes
[] No
[] No response


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]

[] Yes
[] No
[] No response

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]

[] Yes
[] No
[] No response

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]

[] Yes
[] No
[] No response

19. Have you ever heard of the Lactational Amenorrhea Method or LAM?
[NO DESCRIPTION NO IMAGE]

[] Yes
[] No
[] No response

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.
[NO IMAGE]

[] Yes
[] No
[] No response


19. Have you ever heard of the withdrawal method?
PROBE: Men can be careful and pull out before climax.
[NO IMAGE]

[] Yes
[] No
[] No response


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

[] Yes
[] No
[] No response

CHECK 14: Currently pregnant?

[] Yes
[] No

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

[] Yes
[] No

21. 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
[] (PPIUD)/IUD/PPIUD
[] Injectibles
[] Pill
[] Emergency Contraception
[] Male Condom/Nirodh
[] Female Condom
[] Std. Days/Cycle beads
[] LAM
[] Rhythm method
[] Withdrawal
[] Other/traditional methods
[] No response

21b. Are you breastfeeding to delay or avoid becoming pregnant?

[] Yes
[] No
[] No response

CHECK FQ21: Using Female Sterilization and/or Male Sterilization?

Female Sterilization
[] Yes
[] No
Male Sterilization
[] Yes
[] No
[] None of the above

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

CHECK 14: Currently pregnant?

[] Yes
[] No

24a. 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
[] No
[] No response

24b. Do you think you will use a contraceptive method to delay or avoid getting pregnant at any time in the future?

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

26.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.

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

27. When did you begin using your [MOST RECENT / CURRENT METHOD]?
Calculate backwards from memorable events if needed.
Age at first use [Age from FQ20]
Most Recent Birth [mm-yyyy]
Current Marriage [mm-yyyy]
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.

Months____
Years____

CHECK 20: Currently using contraceptives?

[] Yes
[] No

28. 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 FQ27.
Enter Jan 2020 for no response.

Month____
Year____

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

[] Infrequent sex/husband away
[] 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

30. You first started using [CURRENT/MOST RECENT METHOD] in [DATE FROM FQ27]. Where did you get it at that time?
Scroll to bottom to see all choices.

Public Health Sector
[] Govt./Municipal Hospital
[] Govt. Dispensary
[] UFWC/UHC/UHP
[] CHC/Rural Hospital/Block PHC
[] Sub-Centre/ANM
[] Govt. Mobile Clinic
[] Camp
[] Anganwadi/ICDS Centre
[] ASHA
[] Other Community-Based Worker
[] NGO or Trust Hospital/Clinic
Private Health Sector
[] Pvt. Hospital
[] Pvt. Doctor/Clinic
[] Pvt. Mobile Clinic
[] Vaidya/Hakim/Homeopath (Ayush)
[] Traditional Healer
[] Pharmacy/Drugstore
[] Dai (TBA)
Other Source
[] Shop
[] Friend/Parent/Relative
[] Other
[] Don?t know
[] No response


31. 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
[] No
[] No response

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

[] Yes
[] No
[] No response

33. 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
[] No
[] No response

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

[] Yes
[] No
[] No response

35. Why didn't you obtain the method you wanted?

[] Method out of stock that day
[] 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

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

[] You alone
[] Provider
[] Partner
[] You and provider
[] You and partner
[] Other
[] No response

CHECK 30: You first started using [CURRENT/MOST RECENT METHOD] in
[DATE FROM FQ27]. Where did you get it at that time?

Public Health Sector
[] Govt./Municipal Hospital
[] Govt. Dispensary
[] UFWC/UHC/UHP
[] CHC/Rural Hospital/Block PHC
[] Sub-Centre/ANM
[] Govt. Mobile Clinic
[] Camp
[] Anganwadi/ICDS Centre
[] ASHA
[] Other Community-Based Worker
[] NGO or Trust Hospital/Clinic
Private Health Sector
[] Pvt. Hospital
[] Pvt. Doctor/Clinic
[] Pvt. Mobile Clinic
[] Vaidya/Hakim/Homeopath (Ayush)
[] Traditional Healer
[] Pharmacy/Drugstore
[] Dai (TBA)
Other Source
[] Shop
[] Friend/Parent/Relative
[] Other
[] Don?t know
[] No response

37. Would you return to this provider?
Provider: [Type of Provider from FQ30]

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

40. How much did you pay?
Enter all prices in Rupees. Enter -88 if respondent does not know, -99 for no response.

Fee____

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

[] Yes
[] No
[] No response

41b. 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.

Age

41c. 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

Number

42. 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
[] Male Sterilization
[] Implant
[] (PPIUD)/IUD/PPIUD
[] Injectibles
[] Pill
[] Emergency Contraception
[] Male Condom/Nirodh
[] Female Condom
[] Std. Days/Cycle beads
[] LAM
[] Rhythm method
[] Withdrawal
[] Other / traditional methods
[] No response

CHECK 16: Desire for future child?

[] Have a/another child
[] No more/prefer no children
[] Says she can't get pregnant
[] Undecided / Don?t know

CHECK 17: 2 or more years before next child?

[] No more/ none
[] Less than 2 years
[] 2 or more years

CHECK 20: Currently using contraceptive method?

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

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 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 / 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 12 months, were you visited by an anganwadi worker, ASHA, or other community health worker who talked to you about family planning?

[] Yes
[] No
[] No response

45. 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
[] No
[] No response

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

[] Yes
[] No
[] No response

47. In the last few months have you:

Heard about family planning on the radio?
[] Yes
[] No
[] No response
Seen anything about family planning on the television?
[] Yes
[] No
[] No response
Read about family planning in a newspaper or magazine?
[] Yes
[] No
[] No response

CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
Verbally prepare the respondent for sexual activity questions.

48. How old were you when you first had sexual intercourse?
The respondent said she was [age from FQ1] 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.

Age____

[If age at first sex 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
[] No

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.

____days ago
____weeks ago
____months ago
____years ago

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 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.

[] X minutes per day
[] X hours per day
[] No time, someone else collects water
[] No time, no one collects water
[] Don?t know
[] No response
Number of hours/minutes per day____
(Either 1-24 hours, or 1-180 minutes.)

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.

[] X minutes per day
[] X hours per day
[] No time, someone else collects water
[] No time, no one collects water
[] Don?t know
[] No response
Number of hours/minutes per day____
(Either 1-24 hours, or 1-180 minutes.)

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

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.

Record Location________

QUESTIONNAIRE RESULT

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

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

M. Questionnaire result
Record the result of the Female Questionnaire

[] Completed
[] Not at home
[] Postponed
[] Refused
[] Partly completed
[] Incapacitated