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NER4 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.
Go to the right household.
[] Yes
[] No

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

[] Yes
[] No

002. Enter your name below.
Please record your name

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

[] Yes
[] No

003b. Record the correct date and time.

Day____ Month____ Year____
Hours____ Min____

004a. The following info is from the household questionnaire. Please review to make sure you are interviewing the correct respondent.
[ODK will open the region, department, commune, locality, Enumeration Area, Structure number, and Household number entered in the Household Questionnaire linked to this female questionnaire.]

004b. Is the above information correct?
Go to the right household or update the Household Roster if needed.
[] Yes
[] No

005. 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.

You must interview the right person.

[] Yes
[] No

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

[] Yes
[] No

007. How well acquainted are you with the respondent?

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

008. Has the respondent previously participated in PMA 2020 surveys?

[] Yes
[] 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 am working for l'Institut National de la Statisttique (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?

009a. Ask: May I begin the interview now?

[] Yes
[] No

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]
Please record your name as a witness to the consent process.
Check box: []

011. Respondent's first name.
[ODK will display the Respondent's name from linked Household Roster]
You may correct the spelling here if it is not correct, but you must be interviewing the person whose name appears below.

Section 1 - Respondent's Background, Marital Status, Household Characteristics
Now I would like to ask about your background and socioeconomic conditions.

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

Month____ Year____

102. How old were you at your last birthday?

Age ____

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

[] Never attended
[] Primary
[] Secondary
[] Tertiary
[] No response

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.
[] No, never in union
[] Yes, currently married
[] Yes, living with a man
[] Not currently in union: Divorced / separated
[] Not currently in union: Widow
[] No response

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

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

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

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

[] Yes
[] No

106C. RETURN TO CORRECT 106A 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 107a, the respondent was possibly 15 years old or younger at the time of her current or most recent marriage.
Did you enter 107a correctly?

[] Yes
[] No

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

[] Yes
[] No
[] Do not know
[] No response

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

[] Living with respondent
[] 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.

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

201b. How many sons live with you?
Zero is a possible response.
Number ____

201c. How many daughters live with you?
Zero is a possible 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
[] No
[] No response

202b. How many sons are alive but do not live with you?
Zero is a possible response.

202c. How many daughters are alive but do not live with you?
Zero is a possible response.

203a. Have you ever given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: Any baby who cried, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?
[] Yes
[] No
[] No response

203b. How many boys have died?
Zero is a possible response.

203c. And how many girls have died?
Zero is a possible response.

CALCULATE: TOTAL NUMBER OF CHILDREN EVER BORN
[ODK will calculate the total number of children born from Q201-203: (201b+201c+202b+202c+203b+203c)]

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 born from 201-203] births during your life. Is that correct?
Go back and change your numbers
[] Yes
[] No

205. 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.
Month:____________ Year: _____________

206. 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.

Cannot be in the future, respondent must be at least 10 years old at birth. Must be at least 6 months after the first birth.
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
[] No
[] Do not know
[] No response

208b. When did your last baby / child die?
Please record the date of the child's death. The date should be found by calculating backwards from memorable events if needed. Enter Jan 2020 for no response.
Month:____________ Year: _____________

209. When did your last menstrual period start?
If you select days, weeks, months, or years, you will enter a number for X on the next screen.
[] X days ago
[] X weeks ago
[] X months ago
[] X years ago
[] Menopausal / Hysterectomy
[] Before last birth
[] Never menstruated
[] No response

210a. Are you pregnant now?
The respondent said she was menopaused / hysterectomized
[] Yes
[] No
[] Unsure
[] No response

210b. How many months pregnant are you?
The most recent birth was: [DATE OF MOST RECENT BIRTH]
Please record the number of completed months.
Number of months:________

211a. Now I have some questions about the future. Would you like to have a child / another child or would you prefer not to have any children?

[] Have a child
[] Prefer no children
[] Says she can't get pregnant
[] Undecided / Don't know
[] No response

211b. 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 another child
[] No more
[] Says she can't get pregnant
[] Undecided / Don't know
[] No response

212a. How long would you like to wait from now before the birth of a / another child?
If you select months or years, you will enter a number for X on the next screen.
Select "Years" if more than 36 months.
Please check that you correctly entered the value for months/years.
[] X months
[] X years
[] Soon/now
[] Says she can't get pregnant
[] Other
[] Don't know
[] No response

212b. After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?
If you select months or years, you will enter a number for X on the next screen.
Select "Years" if more than 36 months.
Please check that you correctly entered the value for months/years.
[] X months
[] X years
[] Soon/now
[] Says she can't get pregnant
[] Other
[] Don't know
[] No response

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

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

213b. Now I would like to ask a question about your current pregnancy.
At the time you became pregnant, did you want to become pregnant then, did you want to wait until later, or did you not want to have any 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.


301a. 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

301b. 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

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.
[ODK WILL DISPLAY AN IMAGE OF THE METHOD ON THE SCREEN].

[] Yes
[] No
[] No response

301d. Have you ever heard of the IUD?
PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse.
[ODK WILL DISPLAY AN IMAGE OF THE METHOD ON THE SCREEN].

[] Yes
[] No
[] No response

301e. Have you ever heard of injectables?
PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
[ODK WILL DISPLAY AN IMAGE OF THE METHOD ON THE SCREEN].

[] Yes
[] No
[] No response

301f. Have you ever heard of the (birth control) pill?
PROBE: Women can take a pill every day to avoid becoming pregnant.
[ODK WILL DISPLAY AN IMAGE OF THE METHOD ON THE SCREEN].

[] Yes
[] No
[] No response

301g. Have you ever heard of emergency contraception?
PROBE: As an emergency measure after unprotected sexual intercourse women can take special pills at any time within five days to prevent pregnancy.
[NO IMAGE].

[] Yes
[] No
[] No response

301h. 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].

[] Yes
[] No
[] No response

301i. 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].

[] Yes
[] No
[] No response

301j. 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].

[] Yes
[] No
[] No response

301k. Have you ever heard of the Lactational Amenorrhea Method or LAM?
[NO DESCRIPTION; NO IMAGE]

[] Yes
[] No
[] No response

301l. 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

301m. Have you ever heard of the withdrawal method?
PROBE: Men can be careful and pull out before climax.
[NO IMAGE]

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

302b. Which method or methods are you using?
PROBE: Anything else?
Select all methods mentioned. SCROLL TO THE BOTTOM to see all choices.
[] 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

Check here to acknowledge you considered all options.

[] NA

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

305a. You said that you are not currently using a contraceptive method. Do you think you will use a contraceptive method to delay or avoid getting pregnant at any time in the future?

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

306b. 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.
Cannot select "no response" with other options.

[] Implant
[] 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.

[] NA

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

[] Yes
[] No
[] Do not know
[] No response

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

[] Mainly respondent
[] Mainly husband/partner
[] Joint decision
[] Other
[] No response

309a. Since what month and year have you been using [CURRENT METHOD] without stopping?
Calculate backwards from memorable events if needed. Must be before today. Respondent must be at least 10 years old. Enter Jan 2020 for no response.
Most Recent Birth: [mm-yyyy]
Current Marriage: [mm-yyyy]

Month________ Year________

309b. 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. Enter Jan 2020 for no response.
Must be within the last 12 months. Otherwise, the answer to 306a should be no.

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 [MOST RECENT METHOD] continuously between [START DATE] and [STOPPING DATE] without stopping, is that correct?

[] Yes
[] No

GO BACK TO THE PREVIOUS SCREEN AND PROBE TO DETERMINE THE PERIOD OF MOST RECENT CONTINUOUS USE.
Suggested probes:
- When was the last time you used [METHOD]?
- How long had you been using [METHOD] without stopping


310. Why did you stop using [MOST RECENT METHOD]?

[] Infrequent sex / husband away
[] 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

311a. You first started using [CURRENT METHOD] on [DATE FROM QF309a or Q309c].
Where did you or your partner get it at that time?
Scroll to bottom to see all choices.
Public sector

[] Pharmacy - public
[] Maternity Central (Issaka Gazobi Maternity)
[] Center of Madonna and Child
[] Maternity CHR
[] Maternity HD
[] Health Center
[] Community-based distribution site
[] Health hut
[] Mobile clinic

Private sector

[] Private hospital or clinic
[] Pharmacy - private
[] Mobile clinic (private)
[] Center ANBEF
[] Roadside kiosk
[] Polyclinic or Private clinic

Other

[] Boutique
[] Religious organizations
[] Friend / parent
[] Walking pharmacy
[] Other
[] Don't know
[] No Response

Check here to acknowledge you considered all options.

[] NA

311b. Where did you learn how to use rhythm / LAM method?
Scroll to bottom to see all choices.
Public sector

[] Pharmacy - public
[] Maternity Central (Issaka Gazobi Maternity)
[] Center of Madonna and Child
[] Maternity CHR
[] Maternity HD
[] Health Center
[] Community-based distribution site
[] Health hut
[] Mobile clinic

Private sector

[] Private hospital or clinic
[] Pharmacy - private
[] Mobile clinic (private)
[] Center ANBEF
[] Roadside kiosk
[] Polyclinic or Private clinic

Other

[] Boutique
[] Religious organizations
[] Friend / parent
[] Walking pharmacy
[] Other
[] Don't know
[] No Response

312a. 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?

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

313. 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?

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

314c. 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

315a. 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

315b. Who made the final decision to use rhythm / LAM?

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

316. Would you return to this provider?
Provider: [Type of provider selected in Q311a or 311b]

[] Yes
[] No
[] No response

317. Would you refer your relative or friend to this provider / facility?
Provider: [Type of provider selected in Q311a or 311b]

[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

318b. How much did you pay?
Enter all prices in FCFA.
Total cost ____________

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

[] Yes
[] No
[] No response

320. How old were you when you first used a method to delay or avoid getting pregnant?
The respondent said she was [AGE from FQ102] years old at her last birthday.
Enter the age in years. Cannot be younger than 9.
[] Age ________

Check: You entered that the respondent first used family planning at the age of [AGE AT FIRST USE]. Is that what she said?
Go back and change 320 if that is not correct.
[] Yes
[] No

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.

[] Number ________

322. 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.
[] 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

Check here to acknowledge you considered all options.

[] NA

LCL_301. PROBE: Was the injection administered via syringe or small needle?
Show the image to the respondent.
[ODK will display an image of the method on the screen.]

[] Syringe
[] Small needle
[] Both
[] No Response

323a. You said that you do not want any / another child [soon] and that you are not using a method to avoid pregnancy.
Can you tell me why you are not using a method to prevent pregnancy?
PROBE: Any other reason?
RECORD ALL REASONS MENTIONED
Cannot select "Do not know" or "No response" with other options. Cannot select "Not Married" if 104 is "Yes, currently married". Scroll to bottom to see all choices.
Cannot select "Do not know" or "No response" with other options.
Cannot select "Not Married" if 104 is "Yes, currently married".

[] 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
[] No response

Check here to acknowledge you considered all options.

[] NA

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
[] Mainly husband/partner
[] Joint decision
[] Other
[] No response

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

[] Yes
[] No
[] No response

325a. In the last 12 months, have you visited a health facility or camp for care for yourself or your children?
For any health services.
[] Yes
[] No
[] No response

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

[] Yes
[] No
[] No response

In the last few months have you:

326a. Heard about family planning on the radio?

[] Yes
[] No
[] No response

326b. Seen anything about family planning on the television?

[] Yes
[] No
[] No response

326c. Read about family planning in a newspaper or magazine?

[] Yes
[] No
[] No response

326d. Received a voice or text message about family planning on a mobile phone?

[] Yes
[] No
[] No response

Section 4. Sexual Activity
CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

401a. How old were you when you first had sexual intercourse?

Enter the age in years. The participant said that she was [AGE from Q102] years old on her last birthday.
[She had X live births.]
Answer must agree with the current age and date of first birth.
Age____________
The timing of the number of births should agree with 401a. You must reconcile 401a with the respondent's pregnancy history.
[] Yes
[] No