001a. Are you in the correct household?

EA: [EA entered in the Household Questionnaire]

Structure #: [Structure entered in the Household Questionnaire]

Household #: [Household entered in the Household Questionnaire]

002. Enter your name below.

Please record your name

003b. Record the correct date and time.
Day: Month: Year:

The following information is from the Household Questionnaire. Please review to make sure you are interviewing the correct respondent. [ODK will display the LIST OF GEOGRAPHIES ENTERED, Enumeration Area, Structure Number, and Household Number entered into the Household Questionnaire linked to this Female Questionnaire.]

Is the above information correct?

Region: {level1_unlinked}

Commune / Department: {level2_unlinked}

Locality / Commune: {level3_unlinked}

Enumeration Area: [EA]

Structure number: [#]

Household number: [#]

004b. Is the above information correct?

005. CHECK: You should be attempting to interview [Name of the interviewee]. Is that correct? If misspelled, select "yes" and update the name in question "011." 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.

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

007. How well acquainted are you with the respondent?

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

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

Bonjour. Je m'appelle ________________________________ et je travaille pour l'Institut National de la Statistique (INS) du en partenariat avec la Direction de Santé de la Mère et de l'Enfant du Ministère de la Santé. Nous menons actuellement une enquête nationale sur plusieurs thèmes lié à la santé reproductive des femmes. Nous apprécions beaucoup que vous fassiez partie de cette enquête. Les informations que nous collecterons aideront à informer le gouvernement à mieux planifier les services de santé. Le questionnaire prend généralement entre 15 et 20 minutes. Toutes les informations que vous nous donnerez seront strictement confidentielles et ne seront partagées avec personne d'autre que les membres de notre équipe. La participation à cette enquête est volontaire, et s'il y a une question à laquelle vous ne souhaitez pas répondre, faîtes le moi savoir et je passerai à la suivante; ou vous pouvez également interrompre l'entretien à tout moment. Cependant, nous espérons que vous accepterez de participer à cette enquête car votre point de vue est important. Avant de continuer, avez-vous des questions sur cette enquête?

009a. Provide a paper copy of the Consent Form to the respondent and explain it. Then, ask: May I begin the interview now?

009b. Respondent's signature

Please ask the respondent to sign or check the box in agreement of their participation.

010. Interviewer's name

Please record your name as a witness to the consent process. You previously entered "[Interviewer's name]."

Section 1 - Respondent's Background, Marital Status, Household characteristics

101. In what month and year were you born?

The age in the household roster is [AGE]

101. In what month and year were you born?

Month:

Year:

102. How old were you at your last birthday?

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

Only record formal schooling. Do not record bible or koranic school or short courses.

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.

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

106a. In what month and year did you start living with your FIRST husband / partner?

Select 'Do not know' for month and '2020' for year to indicate '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?

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?

Select 'Do not know' for month and '2020' for year to indicate '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?

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

Section 2 - Reproduction, Pregnancy, and Fertility Preferences

200. Have you ever given birth?

201. How many times have you given birth?

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. Select 'Do not know' for month and '2020' for year to indicate 'No Response'.

Month:

Year:

206. When was your MOST RECENT birth?

Select 'Do not know' for month and '2020' for year to indicate 'No Response'.

Month:

Year:

210a. Are you pregnant now?

210b. How many months pregnant are you?

The most recent birth was: [Date of most recent birth]

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.

209a. Enter [days / weeks / months / years]

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

213a. Now I would like to ask a question about your last birth.

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 more children at all?

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?

Now I have some questions about the future.

211a. Would you like to have a child or would you prefer not to have any children?

211a. Would you like to have another child or would you prefer not to have any more children?

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?

212a. 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. Select "Years" if more than 36 months. Please check that you correctly entered the value for months/years.

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.

212c. Enter the number of [Months OR Years] you would like to wait:

Section 3 - Contraception

301a. Have you ever heard of female sterilization?

PROBE: Women can have an operation to avoid having any more children.

301b. Have you ever heard of male sterilization?

PROBE: Men can have an operation to avoid having any more children.

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. [implant_150x300.png]

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. [IUD_150x300.png]

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. [sayana_depo_150x300.jpg]

301f. Have you ever heard of the (birth control) pill?

PROBE: Women can take a pill every day to avoid becoming pregnant. [pill_150x300.png]

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 three to five days to prevent pregnancy.

301h. Have you ever heard of condoms?

PROBE: Men can put a rubber sheath on their penis before sexual intercourse. [male_condom_150x300.png]

301i. Have you ever heard of female condoms?

PROBE: Women can put a sheath in their vagina before sexual intercourse. [female_condom_150x300.png]

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. [SDM-beads_only.png]

301m. Have you ever heard of the Lactational Amenorrhea Method or LAM?

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.

301o. Have you ever heard of the withdrawal method?

PROBE: Men can be careful and pull out before climax.

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

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

302b. Which method or methods are you using?

PROBE: Anything else? Select all methods mentioned. SCROLL TO THE BOTTOM to see all choices.

CALC_CM. CALCULATE: CURRENT METHOD THIS WILL NOT APPEAR ON THE SCREEN ODK will identify the most effective method currently being used by the respondent by selecting the highest method in the choice list.

LCL_301. PROBE: Was the injection administered via syringe or small needle?

Show the image to the respondent. [sayana_depo_150x300.jpg]

302c. Does your husband/partner know that you are using [CURRENT METHOD]?

302c. Does your husband/partner know that you are using family planning?

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?

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

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

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.

LCL_302. PROBE: Was the injection administered via syringe or small needle? Show the image to the respondent. [sayana_depo_150x300.jpg]

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

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

308a. The last time you received your [CURREN METHOD /MOST RECENT METHOD], how much did you have to pay out of pocket, including any fees paid for the method, supplies or services, and transportation?

Enter all prices in FCFA.

309a. Since what month and year have you been using [CURRENT METHOD / MOST RECENT METHOD] without stopping?

Calculate backwards from memorable events if needed.

Most Recent Birth: [mm-yyyy]

Current Marriage: [mm-yyyy]

Month:

Year:

309b. When did you stop using [CURRENT METHOD / MOST RECENT METHOD]?

Please record the date. The date should be found by calculating backwards from memorable events if needed. Select 'Do not know' for month and '2020' for year to indicate No Response.

Month:

Year:

309c. In what month and year had you started using [CURRENT METHOD / MOST RECENT METHOD] before stopping?

Calculate backwards from memorable events if needed. Select 'Do not know' for month and '2020' for year to indicate No Response.

Most Recent Birth: [mm-yyyy]

Current Marriage: [mm-yyyy]

Month:

Year:

309d. CHECK: Just to make sure I have this correct, you used [CURRENT METHOD / MOST RECENT METHOD] continuously between [START DATE] and [END DATE] without stopping, is that correct?

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 [CURRENT METHOD / MOST RECENT METHOD?

311a. You first started using [CURRENT METHOD / MOST RECENT METHOD] on [DATE FROM FQ309a OR 309c] Where did you or your partner get it at that time?

Scroll to bottom to see all choices.

311a. Where did you or your partner get {current_recent_label} when you first started using it?

Scroll to bottom to see all choices.

312a. When you obtained your [CURRENT METHOD / 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?

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

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

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

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

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

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

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

316. Would you return to this provider?

Provider: [Type of provider selected in 311a or 311b]

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

Provider: [Type of provider selected in 311a or 311b]

SW_1a. Right before you started using [CURRENT METHOD / MOST RECENT METHOD] in [MONTH/YEAR], were you doing something or using any method to delay or avoid getting pregnant?

SW_1b. Which method were you using?

PP_1. Since the birth of your child in [DATE OF MOST RECENT BIRTH], have you ever done something or used any method to delay or avoid getting pregnant?

PP_2. How long after the birth in [DATE OF MOST RECENT BIRTH] did you start doing something or start using a method?

Enter 0 days for today. You will enter a number for X on the next screen.

PP_2. Enter [METHOD]. If today, enter zero days only, not zero weeks/months/years.

PP_3. What was the method?

LCL_PP_302. PROBE: Was the injection administered via syringe or small needle?

Show the image to the respondent. [sayana_depo_150x300.jpg]

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

320. How old were you when you first used a method to delay or avoid getting pregnant?

The respondent said she was [AGE] years old at her last birthday. Enter the age in years. Cannot be younger than 9.

321. How many living children did you have at that time, if any?

Note: the respondent said that she gave birth [NUMBER OF LIFE BIRTHS] times in 201.

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.

LCL_322a. PROBE: Was the injection administered via syringe or small needle? Show the image to the respondent. [sayana_depo_150x300.jpg]

322a. Have you used emergency contraception at any time in the last 12 months?

PROBE: As an emergency measure after unprotected sexual intercourse women can take special pills at any time within three to five days to prevent pregnancy.

323a. You said that you do not want a child soon and that you are not using a method to avoid pregnancy.

323a. You said that you do not want another child soon and that you are not using a method to avoid pregnancy.

323a. You said that you do not want any children and that you are not using a method to avoid pregnancy.

323a. You said that you do not want 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 to prevent pregnancy? PROBE: Any other reason?

RECORD ALL REASONS MENTIONED Cannot select "Not Married" if 104 is "Yes, currently married". Scroll to bottom to see all choices.

323b. Would you say that not using contraception is mainly your decision, mainly your husband/partner's decision or did you both decide together?

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

325a. In the last 12 months, have you visited a health facility or camp for care for yourself? For any health services.

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.

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

326. In the last few months have you:

326a. Heard about family planning on the radio?

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

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

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

Section 4 - Sexual Activity

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

Enter the age in years

402. When was the last time you had sexual intercourse?

Enter [# days / weeks / months / years]. If today, enter zero days only, not zero weeks/months/years. Must agree with the age of first sexual intercourse and the pregnancy status.

Section 6 - Menstrual Hygiene

602a. Where do you most often change your used pads, cloths, or other sanitary materials?

Place: [MAIN PLACE FROM 602a] 602b. While managing your menstrual hygiene, was this place: Read each option aloud and select if yes.

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.

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

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

605. You mentioned that you used [ODK will display the 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.

606a. Aside from your own housework, have you done any work in the last month?

606b. Due to your last menstrual period, were there any work days in the last month that you did not attend?

607a. Did you attend school at any time in the past 12 months?

607b. Due to your menstrual period, were there any school days in the past 12 months that you did not attend?

LCL_608. How old were you at the time you experienced your first menstruation?

Enter the age in years.

FLW_801. Thank you for the time you have kindly granted us. Would you be willing to participate in another survey on this or any other topic either by phone or in person at some point in the future?

FLW_802. Do you own a phone?

FLW_803. Can I have your primary phone number in case we would like to follow up with you in the future?

Enter an 8-digit number without the country code. Do not include spaces or dashes. Enter -99 for no response.

FLW_804. To confirm, here is the number you gave me: [FLW_803]. Is that correct?

If not, return to 803 and correct it.

Thank the respondent for her time.

The respondent is finished, but there are still more questions for you to complete outside the home.

Location and Questionnaire result

095. Location Take a GPS point near the entrance to the household.

Record location when the accuracy is smaller than 6 m.

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

097. In what language was this interview conducted?

099. Questionnaire Result

Record the result of the questionnaire.