IDENTIFICATION
Please record the following information prior to beginning the interview.
A. Are you in the correct household?
This is the picture of the front of the home taken during the Household Questionnaire.
[ODK will display the photo taken during the Household Questionnaire linked to this Female Questionnaire.]
If not, go interview the correct household.
[] No
B. Your name: [Interviewer name from Household Questionnaire]
Is this your name?
[] No
B. Enter your name below.
Please record your name
C. Current date and time: [ODK will display on screen]
Is this date and time correct?
[] No
D. Record the correct date and time.
Hours____ Min____ AM/PM____
E. The following info is from the household questionnaire. Please review to make sure you are interviewing the correct respondent.
[ODK will open the region, commune, locality, Enumeration Area, Structure number, and Household number entered in the Household Questionnaire linked to this female questionnaire.]
Is the above information correct?
[] No
CHECK: You should be attempting to interview [Respondent's name]. Is that correct?
If misspelled, select "yes" 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.
[] No
F. Is the respondent present and available to be interviewed today?
[] No
G. How well acquainted are you with the respondent?
[] Well acquainted
[] Not well acquainted
[] Not acquainted
G2. Has the respondent previously participated in PMA 2020 surveys?
[] No
[] Do not know
[] No response
INFORMED CONSENT
Find the woman between the age of 15-49 associated with this Female Respondent Questionnaire. The interview must have auditory privacy. Read the following greeting
Hello. My name is ____________________________________ and I work for l'Institut National de la Statistique (INS). 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. Ask: May I begin the interview now?
[] No
Respondent's signature
Please ask the respondent to sign or check the box in agreement of their participation.
GATHER SIGNATURE:
Check box: []
I. Interviewer's name: [Interviewer name from Household Questionnaire]
Mark your name as a witness to the consent process.
J. 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 above.
Section 1 - Respondent's Background, Marital Status, Household Characteristics
Now I would like to ask about your background and socioeconomic conditions.
FQ0. In what month and year were you born?
The age in the household roster is [AGE].
FQ1. How old were you at your last birthday?
FQ2.What is the highest level of school you attended?
[] Primary
[] Secondary
[] Tertiary
[] No response
FQ3. 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
[] Not currently in union: Divorced / separated
[] Not currently in union: Widow
[] No response
FQ4. Have you been married or lived with a man only once or more than once?
[] More than once
[] No response
FQ5a. In what month and year did you start living with your FIRST husband / partner?
Enter Jan 2020 for no response
If the respondent was less than 15 years old at the time of her first marriage, 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?
[] No
FQ5b. 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 the respondent was less than 15 years old at the time of her marriage, 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 current or most recent marriage.
Did you enter FQ5b correctly?
[] No
CHECK 3. Are you currently married or living together with a man as if married?
[] No
FQ6. Does your husband / partner have other wives or does he live with other women as if married?
[] No
[] Do not know
[] No response
FQ7. Is your husband / partner living with you now or is he staying elsewhere?
[] Staying elsewhere
[] No response
Section 2 -- Reproduction, Pregnancy and Fertility Preferences
Now I would like to ask about all the births you have had during your life.
FQ8. How many times have you given birth?
0 is a possible answer
Were all of those live births?
If no, go back and change FQ8a to record only live birth events.
[] No
FQ8b. When was your FIRST birth?
Please record the date of the FIRST birth. The date should be found by calculating backwards from memorable events if needed.
Enter Jan 2020 for no response.
FQ9. When was your MOST RECENT 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.
FQ10. 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.
FQ11. Is your last baby / child still alive?
[] No
[] Do not know
[] No response
FQ12. 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.
FQ13. 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.
[] X weeks ago
[] X months ago
[] X years ago
[] Menopausal / Hysterectomy
[] Before last birth
[] Never menstruated
[] No response
FQ14. Are you pregnant now?
The respondent said she was menopaused / hysterectomized
[] No
[] Unsure
[] No response
FQ15. How many months pregnant are you?
The most recent pregnancy was [Date of the most recent pregnancy]
Now I have some questions about the future.
FQ16a. Would you like to have a child/another child or would you prefer not to have any/more children?
[] Don't have any children
[] Says she can't get pregnant
[] Undecided / Don't know
[] No response
FQ16b. After the child you are expecting now, would you like to have another child or would you prefer not to have any more children?
[] Don't have any more children
[] Says she can't get pregnant
[] Undecided / Don't know
[] No response
FQ17a. How long would you like to wait from now before the birth of a child?
If you select months or years, you will enter a number for X on the next screen.
Please check that you correctly entered the value for months/years. Select years if more than 36 months.
[] X years
[] Soon/now
[] Says she can't get pregnant
[] Other
[] Don't know
[] No response
FQ17b. After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?
If you select months or years, you will enter a number for X on the next screen. Please check that you correctly entered the value for months/years. Select years if more than 36 months.
[] X years
[] Soon/now
[] Says she can't get pregnant
[] Other
[] Don't know
[] No response
FQ17. Enter the number of months/years you would like to wait:
CHECK 8: Number of births?
CHECK 14: Currently pregnant?
FQ18a. 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
FQ18b. 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.
FQ19. Have you ever heard of Female Sterilization?
PROBE: Women can have an operation to avoid having any more children.
[] No
[] No response
FQ19. Have you ever heard of male sterilization?
PROBE: Men can have an operation to avoid having any more children.
[] No
[] No response
FQ19. 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.
[ODK will display an image of the method on the screen.]
[] No
[] No response
FQ19.Have you ever heard of the IUD?
PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse.
[ODK will display an image of the method on the screen.]
[] No
[] No response
FQ19. 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.
[ODK will display an image of the method on the screen.]
[] No
[] No response
FQ19. Have you ever heard of the (birth control) pill?
PROBE: Women can take a pill every day to avoid becoming pregnant.
[ODK will display an image of the method on the screen.]
[] No
[] No response
FQ19. 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
FQ19. Have you ever heard of condoms?
PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
[ODK will display an image of the method on the screen.]
[] No
[] No response
FQ19. Have you ever heard of female condoms?
PROBE: Women can put a sheath in their vagina before sexual intercourse.
[ODK will display an image of the method on the screen.]
[] No
[] No response
FQ19. 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.
[ODK will display an image of the method on the screen.]
[] No
[] No response
FQ19. Have you ever heard of the Lactational Amenorrhea Method or LAM?
[No description, no image]
[] No
[] No response
FQ19. 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
FQ19. Have you ever heard of the withdrawal method?
PROBE: Men can be careful and pull out before climax.
[No image]
[] No
[] No response
FQ19. Have you ever heard of any other ways or methods that women or men can use to avoid pregnancy?
[] No
[] No response
CHECK 14: Currently pregnant?
[] No
FQ20. Are you or your partner currently doing something or using any method to delay or avoid getting pregnant?
[] No
[] No response
FQ21. Which method or methods are you using?
PROBE: Anything else?
Select all methods mentioned. SCROLL TO THE BOTTOM to see all choices.
You selected no response with another option.
OR
You said previously that you used female sterilization.
[] Male sterilization
[] Implant
[] IUD
[] Injectables
[] Pill
[] Emergency Contraception
[] Male condom
[] Female condom
[] Standard Days/Cycle beads
[] LAM
[] Rhythm method
[] Withdrawal
[] Other traditional method
[] No response
FQ21b. Are you breastfeeding to delay or avoid getting pregnant?
[] No
[] No response
CHECK: do you use female or male sterilization?
[] No
[] No
FQ22. Did the provider tell you or your partner that this method was permanent?
[] No
[] No response
FQ23. Do you know of a place where you can obtain a method of family planning?
[] No
[] No response
FQ24a. 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
FQ24b. Do you think you will use a contraceptive method to delay or avoid getting pregnant at any time in the future?
[] No
[] No response
FQ25. In the last 12 months, have you ever done something or used a method to delay or avoid getting pregnant?
[] No
[] No response
FQ26. Which method did you use most recently?
PROBE: Anything else?
Select most effective method (highest method in list). Scroll to bottom to see all choices.
[] IUD
[] Injectables
[] Pill
[] Emergency Contraception
[] Male condom
[] Female condom
[] Standard Days/Cycle beads
[] LAM
[] Rhythm method
[] Withdrawal
[] Other traditional method
[] No response
Check here to acknowledge you considered all options.
FQ27. When did you begin using [Most recent or current method]?
Calculate backwards from memorable events if needed.
Age of first use: [Age recorded for FQ20.]
Most recent birth [MM-YYYY]
Current marriage [MM-YYYY]
Must be at least the age at which she starting using a contraceptive method (FQ20). Must be before today. Respondent must be at least 10 years old.
Enter Jan 2020 for no response.
FQ28. When did you stop using [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.
FQ29. Why did you stop using [MOST RECENT METHOD]?
[] Became pregnant while using
[] Wanted to become pregnant
[] Husband / partner disapproved
[] Wanted a 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 processe
[] Other
[] Don't know
[] No response
FQ30. You first started using [CURRENT METHOD / MOST RECENT METHOD] on [DATE FROM Q27]. Where did you get it at that time?
Scroll to bottom to see all choices. Check here to acknowledge you considered all options.
[] Maternity Central
[] Center of Madonna and Child
[] Maternity CHR
[] Maternity HD
[] Health Center
[] Community-based distribution site
[] Health hut
[] Mobile clinic
[] Pharmacy - private
[] Mobile clinic (private)
[] Center ANBEF
[] Roadside kiosk
[] Polyclinic or Private clinic
[] Religious organizations
[] Friend / parent
[] Walking pharmacy
[] Other
[] Don't know
[] No Response
FQ31. When you obtained your [CURRENT OR MOST RECENT 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
FQ32. Were you told what to do if you experienced side effects or problems?
[] No
[] No response
FQ33. At that time, were you told by the family planning provider about methods of family planning other than the [CURRENT OR MOST RECENT METHOD] that you could use?
[] No
[] No response
FQ34. During that visit, did you obtain the method you wanted to delay or avoid getting pregnant?
[] No
[] No response
FQ35. 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
FQ36. During that visit, who made the final decision about what method you got?
[] Provider
[] Partner
[] You and provider
[] You and partner
[] Other
[] No response
CHECK 30. You first started using [CURRENT OR MOST RECENT METHOD] on [DATE from QF27].
Where did you get it at that time?
Scroll to bottom to see all choices.
[] Maternity Central
[] Center of Madonna and Child
[] Maternity CHR
[] Maternity HD
[] Health Center
[] Community-based distribution site
[] Health hut
[] Mobile clinic
[] Pharmacy - private
[] Mobile clinic (private)
[] Center ANBEF
[] Roadside kiosk
[] Polyclinic or Private clinic
[] Religious organizations
[] Friend / parent
[] Walking pharmacy
[] Other
[] Don't know
[] No Response
FQ37. Would you return to this provider?
[] No
[] No response
FQ38. Would you refer your relative or friend to this provider / facility?
[] No
[] No response
FQ39. In the last 12 months, have you paid any fees for family planning services (including the most current method)?
[] No
[] No response
FQ40. How much did you pay?
Enter all prices in FCFA.
FQ41. Have you ever done anything or tried in any way to delay or avoid getting pregnant?
[] No
[] No response
FQ41b. 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. Cannot be younger than 9.
FQ41c. 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.
FQ42. Which method did you first use to delay or avoid getting pregnant?
Do not read the method choices. Scroll to bottom to see all choices.
[] Male sterilization
[] Implant
[] IUD
[] Injectables
[] Pill
[] Emergency Contraception
[] Male condom
[] Female condom
[] Standard Days/Cycle beads
[] LAM
[] Rhythm method
[] Withdrawal
[] Other traditional method
[] No response
CHECK 16: Would you like to have a/another child later?
[] No more/prefer no children
[] Says she can't get pregnant
[] Undecided / Don't know
CHECK 17: Would you like to wait 2 years or more before the next child?
[] No
[] No response
CHECK: 20 Are you currently using a contraceptive?
[] No
[] No response
CHECK: 41 Have you ever used a contraceptive?
[] No
[] No response
FQ43. 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 why you are not using a method?
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 bottom to see all choices.
[] 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
[] No response
FQ44. In the last 12 months, were you visited by a health worker who talked to you about family planning?
[] No
[] No response
FQ45. In the last 12 months, have you visited a health facility for care for yourself or for your children?
For any health services.
[] No
[] No response
FQ46. Did any staff member at the health facility speak to you about family planning methods?
[] No
[] No response
FQ47. In the last few months have you:
Heard about family planning on the radio?
[] No
[] No response
Seen anything about family planning on the television?
[] No
[] No response
Read about family planning in a newspaper or magazine?
[] No
[] No response
CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
FQ48. How old were you when you first had sexual intercourse?
Enter the age in years. The participant said that she was [AGE from QF1] years old on her last birthday.
[She had X live births.]
Answer must agree with the current age and date of first birth.
The timing of the number of births should agree with FQ48.
You must reconcile FQ48 with the respondent's pregnancy history.
[] No
If the age of first sexual intercourse is less than 10:
CHECK: You entered that the respondent was X years old the first time she had sexual intercourse. Is that what the she said?
Go back and change FQ48 if it is not correct.
[] No
FQ49. 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.
[] X weeks ago
[] X months ago
[] X years ago
[] No response
FQ49. When did your menstrual period first start?
You will enter a number for X on the next screen.
[] X weeks ago
[] X months ago
[] X years ago
[] Menopausal / Hysterectomy
[] Before last birth
[] Never menstruated
[] No response
CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
Section 4 -- 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.
FQ50. The last time you had your period, where were all the places that 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
[] Backyard
[] No facility / Bush / Field
[] Other
[] No response
FQ51a. What was the main place that you used for changing your used pads, cloths, or other sanitary materials?
You did not select that choice in FQ50.
[] Other household sanitation facility
[] Sanitation facilities at school
[] Sanitation facilities at work
[] Other public sanitation facility
[] Sleeping area
[] Backyard
[] No facility / Bush / Field
[] Other
[] No response
Main Place: [ODK will display the selection from FQ50 or FQ51a]
FQ51b. While managing your menstrual hygiene, was this place:
Read each option aloud and select if yes.
Cannot select 'no response' or 'none of the above' with other options.
[] Private?
[] Safe?
[] Able to be locked?
[] Supplied with clean water?
[] Supplied with soap?
[] None of the above
[] No response
FQ52. During your last menstrual period, what were all the materials that you used to absorb or collect your menstrual blood?
PROBE: Anything else?
Do not read options aloud. Select all that apply.
Cannot select 'no response' or 'no materials used' with other options.
[] Cotton wool
[] Sanitary pads
[] Foam (from mattress or other material)
[] Toilet paper
[] Paper (newspaper pages from books)
[] Natural materials (mud, dung, leaves)
[] Other
[] No Response
FQ53. Did you wash and reuse pads, cloths, or other sanitary materials during your last menstrual period?
[] No
[] No response
FQ54. During your last menstrual period, were the sanitary materials that you washed and reused completely dried before each reuse?
[] No
[] No response
CHECK 52. During your last menstrual period, what were all the materials that you used to absorb or collect your menstrual blood?
[] Cotton wool
[] Sanitary pads
[] Foam (from mattress or other material)
[] Toilet paper
[] Paper (newspaper pages from books)
[] Natural materials (mud, dung, leaves)
[] Other
[] No Response
CHECK 53. Did you wash and reuse pads, cloths, or other sanitary materials during your last menstrual period?
[] No
[] No response
FQ55. You mentioned that you used [ODK will display responses from FQ52] during your last menstrual period. Where did you dispose of these materials after use?
PROBE: Anywhere else?
[] Latrine
[] Waste bin/trash bag
[] Burning
[] Bush/field
[] Other
[] No response
FQ56. Is there anything else that would help you manage your menstrual hygiene 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
Thank the respondent for her time.
The respondent is finished, but there are still more questions for you to complete outside the home.
K. Location
Take a GPS point near the entrance to the household. Record location when the accuracy is smaller than 6 m.
[ENTER GPS COORDINATES]
L. How many times have you visited this household to interview this female respondent?
[] 2nd time
[] 3rd time
M. Questionnaire result
Record the result of the female respondent survey
[] Not at home
[] Postponed
[] Refused
[] Partly completed
[] Incapacitated