ACCESS Nigeria Safe Motherhood Questionnaire - 0

ACCESS Nigeria Safe Motherhood Community Survey
CONFIDENTIAL. INFORMATION TO BE
USED FOR RESEARCH PURPOSES ONLY.
ACCESS NIGERIA SAFE MOTHERHOOD QUESTIONNAIRE—HOUSEHOLD
Questionnaire No.
Household ID No.
Time Interview Started: Hour: _____ Minute: _____

Time Interview Ended: Hour: _____ Minute: _____
Location Information
Urban/Rural
Name of Head of
Household
INTERVIEWER VISITS
1 2 3
DATE
INTERVIEWER'S NAME
RESULT*
NEXT VISIT: DATE
TIME
* RESULT CODES:
1 = COMPLETED 4 = DWELLING NOT FOUND 7 = REFUSED
2 = HOUSEHOLD ABSENT 5 = NO COMPETENT 8 = OTHER: (SPECIFY):
RESPONDENT AT HOME ________________
3 = TIME AND DATE SET FOR
________________
LATER 6 = INCOMPLETE INTERVIEW
NAME DATE SIGNATURE

Field-edited by:
Office-edited by:
Keyed by:
October 30,2006 1
Verbal Consent Form for Household Survey
Good morning/afternoon/evening. My name is _________________________________.

(Interviewer)
I represent the ACCESS Program and the Ministry of Health (Kano/Zamfara). We are speaking with
women and their families about the experience of being pregnant and of having children. The results of
this survey will be used to help improve health programs for women.
You have been selected for the interview by means of a random or chance selection process, much
like picking a mango out of a basket without looking. I would like to ask you some questions if I may,
but you can refuse to answer any question I ask. You may end the interview at any time. You can also
refuse to participate in the study entirely. The first interview will last approximately 30 minutes. The
information we collect from you will not be shown to anyone outside of this project.
If you have any question about this study, you can contact our office in [Kano/Zamfara] at the address
listed on the card given to you.
May I proceed with the questions? Yes/No
____________________________
Name of interviewer
Date ___________________
NOT VALID WITHOUT THE COMMITTEE OR

IRB STAMP OF CERTIFICATION
Void One Year From Above Date

CHR No.
October 30,2006 2
HOUSEHOLD CENSUS
RELATIONSHIP
LINE USUAL RESIDENTS CHILD LESS
TO HEAD OF AGE SEX ELIGIBLE?
NO. AND VISITORS THAN 2 YRS
HOUSEHOLD
Please give me the What is the How old Is ASK ONLY IF BETWEEN
names of the persons relationship of is (NAME) FEMALE: Does 15 AND 49,
who usually live in your (NAME) to the (NAME)? male or (NAME) have a AND
household, starting with head of female? child less than FEMALE
the head of household. household? 2 years old?
(1) (2) (3) (4) (5) (6) (7)
1 YEARS M F Y N Y N
1 2 1 2
2 YEARS M F Y N Y N
1 2 1 2
3 YEARS M F Y N Y N
1 2 1 2
4 YEARS M F Y N Y N
1 2 1 2
5 YEARS M F Y N Y N
1 2 1 2
6 YEARS M F Y N Y N
1 2 1 2
7 YEARS M F Y N Y N
1 2 1 2
8 YEARS M F Y N Y N
1 2 1 2
9 YEARS M F Y N Y N
1 2 1 2
10 YEARS M F Y N Y N
1 2 1 2
1 2 1 2
1 2 1 2
1 2 1 2
October 30,2006 3
RELATIONSHIP
LINE USUAL RESIDENTS CHILD LESS
TO HEAD OF AGE SEX ELIGIBLE?
NO. AND VISITORS THAN 2 YRS
HOUSEHOLD
Please give me the What is the How old Is ASK ONLY IF BETWEEN
names of the persons relationship of is (NAME) FEMALE: Does 15 AND 49,
who usually live in your (NAME) to the (NAME)? male or (NAME) have a AND
household, starting with head of female? child less than FEMALE
the head of household. household? 2 years old?
1 2 1 2
1 2 1 2
1 2 1 2
1 2 1 2
1 2 1 2
1 2 1 2
1 2 1 2
Codes for “Relationship to Head of Household” (column 3):

01 = Head 05 = Grandchild 09 = Other Relative
02 = Wife or Husband 06 = Father or Mother 10 = Adopted/Foster/Stepchild
03 = Son or Daughter 07 = Parent-in-Law 11 = Not Related
04 = Son-in-Law or Daughter- 08 = Brother or Sister 98 = Don’t Know
in-Law
October 30,2006 4
Now I would like to ask you some questions about your household.
Q. # QUESTION CODES GO TO Q.
1. What is the main material of the floor? NATURAL FLOOR
EARTH/SAND ................................. 11
Record observation. DUNG .............................................. 12
RUDIMENTARY FLOOR
WOOD PLANKS.............................. 21
PALM/BAMBOO ............................. 22
FINISHED FLOOR
PARQUET OR
POLISHED WOOD..................... 31
VINYL OR
ASPHALT STRIPS..................... 32
CERAMIC TILES ............................. 33
CEMENT.......................................... 34
CARPET .......................................... 35
OTHER.................................................. 97
(SPECIFY)
2. How many rooms in total are in your NUMBER OF ROOMS (TOTAL):
household, including rooms for sleeping and
all other rooms?
3. What is the main source of drinking water for PIPED WATER
members of your household? PIPED INTO DWELLING ................ 11
PIPED INTO YARD/PLOT............... 12
PUBLIC TAP ................................... 13
WATER FROM OPEN WELL

OPEN WELL IN DWELLING ........... 21
OPEN WELL IN YARD/PLOT.......... 22
OPEN PUBLIC WELL ..................... 23
WATER FROM COVERED WELL OR

BOREHOLE
PROTECTED WELL/BOREHOLE IN
DWELLING.................................. 31
PROTECTED WELL/BOREHOLE IN
YARD/PLOT ................................ 32
PROTECTED PUBLIC
WELL/BOREHOLE ......................... 33
SURFACE WATER
SPRING ........................................... 41
RIVER/STREAM.............................. 42
POND/LAKE.................................... 43
DAM................................................. 44
RAINWATER ........................................ 51
TANKER TRUCK.................................. 61
BOTTLED/”PURE” WATER................ 71
OTHER.................................................. 97
(SPECIFY)
October 30,2006 5
4. What kind of toilet facilities does your FLUSH TOILET..................................... 11
household use?
PIT TOILET/LATRINE
TRADITIONAL PIT TOILET ............ 21
VENTILATED IMPROVED PIT (VIP)
LATRINE .................................... 22
NO FACILITY
BUSH/FIELD ................................... 31
RIVER.............................................. 32
OTHER _________________________ 97
(SPECIFY)
5. What type of fuel do you mainly use for ELECTRICITY....................................... 01 Æ7
cooking in your household? LPG/NATURAL GAS............................ 02
BIOGAS ................................................ 03
KEROSENE .......................................... 04
COAL/LIGNITE ..................................... 05
CHARCOAL.......................................... 06
FIREWOOD, STRAW ........................... 07
DUNG.................................................... 08
OTHER _________________________ 97
(SPECIFY)
6. Does your household have electricity? YES ......................................................... 1
NO ........................................................... 2
7. Does your household own: YES NO
A landline telephone? TELEPHONE—LANDLINE.........1.......... 2
A refrigerator? REFRIGERATOR........................1.......... 2
A radio that is in working order? RADIO.........................................1.......... 2
A television that is in working order? TELEVISION...............................1.......... 2

8. Does any member of your household own:
YES NO
A cell phone?
CELL PHONE .............................1.......... 2
A bicycle?
BICYCLE ....................................1.......... 2
A motorcycle or motor scooter?
MOTORCYCLE/SCOOTER ........1.......... 2
A car or truck?
CAR/TRUCK ...............................1.......... 2
A tractor?
TRACTOR...................................1.......... 2
A donkey or horse or camel?
DONKEY/HORSE/CAMEL .........1.......... 2
THANK THE RESPONDENT
October 30,2006 6
CONFIDENTIAL. INFORMATION TO BE
USED FOR RESEARCH PURPOSES ONLY.
FMOH AND ACCESS NIGERIA SAFE MOTHERHOOD QUESTIONNAIRE—

WOMAN WHO GAVE BIRTH IN THE LAST 12 MONTHS
Questionnaire No.
Household ID No.
Time Interview Started: Hour: _____ Minute: _____

Time Interview Ended: Hour: _____ Minute: _____
Location Information
Urban/Rural
Name of Head of
Household
INTERVIEWER VISITS
1 2 3
DATE
INTERVIEWER'S NAME
RESULT*
NEXT VISIT: DATE
TIME
* RESULT CODES:
1 = COMPLETED 4 = DWELLING NOT FOUND 7 = REFUSED
2 = HOUSEHOLD ABSENT 5 = NO COMPETENT 8 = OTHER: (SPECIFY):
RESPONDENT AT HOME ________________
3 = TIME AND DATE SET FOR
________________
LATER 6 = INCOMPLETE INTERVIEW
NAME DATE SIGNATURE

Field-edited by:
Office-edited by:
Keyed by:
October 30,2006 7
Verbal Consent Form for Household Survey
Good morning/afternoon/evening. My name is _________________________________.

(Interviewer)
I represent the ACCESS Program and the Ministry of Health (Kano/Zamfara). We are speaking with
women and their families about the experience of being pregnant and of having children. The results of
this survey will be used to help improve health programs for women.
You have been selected for the interview by means of a random or chance selection process, much
like picking a mango out of a basket without looking. I would like to ask you some questions if I may,
but you can refuse to answer any question I ask. You may end the interview at any time. You can also
refuse to participate in the study entirely. This second interview will last approximately one and a half
hours. The information we collect from you will not be shown to anyone outside of this project.
If you have any question about this study, you can contact our office in [Kano/Zamfara] at the address
listed on the card given to you.
May I proceed with the questions? Yes/No
____________________________
Name of interviewer
Date ___________________
NOT VALID WITHOUT THE COMMITTEE OR

IRB STAMP OF CERTIFICATION
Void One Year From Above Date

CHR No.
October 30,2006 8
SECTION 1. SOCIODEMOGRAPHIC INFORMATION

First, I would like to ask you some questions about yourself and the pregnancies you’ve had.
101 In what month and year were you
born? MONTH ............................................
DON’T KNOW MONTH.............................98
YEAR ....................................
DON’T KNOW YEAR ............................9998
102 How old are you now? If under age 15
COMPARE AND CORRECT 101 AGE IN COMPLETED YEARS ....... or over age 49,
AND/OR 102 IF INCONSISTENT. STOP. Conclude
interview using
language from
the interviewer ‘s
guide.
103 CHECK THIS WOMAN’S LINE IN THE
HOUSEHOLD QUESTIONNAIRE AGE REPORTED IN HQ .................
(HQ.). DOES AGE REPORTED
THERE AND AGE REPORTED HERE
MATCH? IF NOT, CORRECT ON HQ.
104 Have you given birth in the last 12 YES ............................................................ 1
months, either to a baby that was born NO .............................................................. 2 If NO, STOP.
alive or a baby that was born dead Conclude
(that is, a baby who never cried or interview using
showed any signs of life)? language from
the interviewer ‘s
guide.
105 Are you pregnant now? YES ............................................................ 1
NO .............................................................. 2
DON’T KNOW/NOT SURE....................... 98
106. What is your ethnicity (tribe)?
ETHNICITY: ...................................
___________________________________
(SPECIFY)
107. What is your religion?
RELIGION: ......................................
CATHOLIC……………………………………1
PROTESTANT………………………...……..2
OTHER CHRISTIAN……………….………..3
ISLAM……………...…………………...…….4
TRADITIONALIST……………...……………5
OTHER __________________________ 97
(SPECIFY)
NO RELIGION………………………………6
108. What is your marital status now? Are SINGLE ...................................................... 1
you single, married, widowed, MARRIED/IN UNION.................................. 2 Æ110
divorced, or separated? WIDOWED ................................................. 3
DIVORCED................................................. 4
SEPARATED ............................................. 5
October 30,2006 9
109. Are you currently living with a partner? YES ............................................................ 1
NO .............................................................. 2
110. Have you ever attended school? YES ............................................................ 1
NO ............................................................. 2 Æ113
111. What is the highest level of school you FORMAL EDUCATION
attended: primary, secondary, or PRIMARY…………………………………….1
higher? SECONDARY………………………………..2
HIGHER ……………………………………...3
RELIGIOUS/NON-FORMAL EDUCATION
ISLAMIC/KORANIC SCHOOL……………4 Æ113
112. What is the highest (CLASS/YEAR)
you completed at that level? CLASS/YEAR .................................
DO NOT KNOW ...................................... 98
113. Can you read a letter or newspaper EASILY ...................................................... 1
easily, with difficulty, or not at all? WITH DIFFICULTY .................................... 2
NOT AT ALL .............................................. 3 Æ115
114. In addition to your housework, do you YES ............................................................ 1
do any other work for which you are NO ............................................................. 2
paid in cash or in kind?
SECTION 2. BIRTHS AND STILLBIRTHS

Now I would like to ask you some more questions about the pregnancies you have had
during your life, focusing on pregnancies that resulted in babies born alive and babies born
dead. At this time, we will not be discussing miscarriages.
201.
CHECK 105: IS PREGNANT NOW?
YES NO
↓
NO TO 105 ---------------------------- Æ205
202. How many months pregnant are you?
MONTHS .........................................
RECORD NUMBER OF COMPLETED
MONTHS.
203. How many months pregnant were you MONTHS .....................................................
when you first told someone about your
pregnancy?
October 30,2006 10
204. Who did you tell first about your current HUSBAND…………………………………..01
pregnancy? MOTHER IN LAW………………………….02
MOTHER…………………………………….03
SISTER IN LAW……………………………04
FATHER IN LAW………………..…………05
OTHER FAMILY MEMBER………………06
FRIEND………….…………………………..07
HEALTH WORKER………………………..08
OTHER __________________________ 97
(SPECIFY)
205. Have any of your pregnancies resulted in YES............................................................ 1

a baby that was born dead (a stillbirth, NO ............................................................. 2 Æ207
that is, a baby who never cried or showed
any signs of life)?
206. How many of these pregnancies resulted
in a baby that was born dead? BABIES BORN DEAD.....................
207. Have any of your pregnancies resulted in a YES............................................................ 1
baby that was born alive? NO ............................................................. 2 Æ209
208. How many of these pregnancies resulted
in a baby that was born alive? BABIES BORN ALIVE ....................
PROBE: Any baby who cried or showed

signs of life but may have later died?
209. SUM ANSWERS TO 206 AND 208 AND
ENTER TOTAL. IF NONE, ENTER ‘00’ LIVE + STILL BIRTHS.......................
210. Did your most recent birth result in a baby LIVE BIRTH ............................................. 01
that was born alive or dead (that is, a
baby who never cried or showed any MONTH.......................................
signs of life)?
YEAR..........................................
IF LIVE BIRTH: In what month and year
did your most recent birth occur? STILLBIRTH ............................................ 02
IF STILLBIRTH: In what month and year MONTH.......................................

did your last such birth occur?
YEAR..........................................
211. Did your birth prior to this most recent LIVE BIRTH ............................................. 01
birth result in a baby that was born alive
or dead (that is, a baby who never cried or MONTH.......................................
showed any signs of life)?
YEAR..........................................
IF LIVE BIRTH: In what month and year
did your most recent birth occur? STILLBIRTH ............................................ 02
IF STILLBIRTH: In what month and year MONTH.......................................

did your last such birth occur?
YEAR..........................................
IF ONLY ONE PRIOR BIRTH, CIRCLE
03. ONLY ONE PRIOR BIRTH ...................... 03
October 30,2006 11
SECTION 3. KNOWLEDGE
Now I would like to ask you some questions about pregnancy and childbirth. Specifically, I
am going to be asking you questions about three different phases that women go through
when having a child. These phases are the period of being pregnant, the period of labor and
birth, and the period immediately after the birth of the child.
301 In your opinion, can unexpected problems YES.........................................................01
related to pregnancy occur during any NO...........................................................02
pregnancy or childbirth that could DON’T KNOW.........................................98
endanger the life of a woman?
302 In your opinion, what are some serious BLEEDING ...............................................01
health problems that can occur during SEVERE HEADACHE ..............................02
pregnancy that could endanger the life of BLURRED VISION ...................................03
a pregnant woman? CONVULSIONS........................................04
SWOLLEN HANDS/FACE........................05
PROBE: Any others? HIGH FEVER ............................................06
LOSS OF CONSCIOUSNESS ..................07
[CIRCLE ALL MENTIONED] DIFFICULTY BREATHING .......................08
SEVERE WEAKNESS..............................09
SEVERE ABDOMINAL PAIN ...................10
ACCELERATED/ REDUCED
FETAL MOVEMENT............................11
WATER BREAKS
WITHOUT LABOR ..............................12
OTHER __________________________ 97
(SPECIFY)
NONE........................................................00 Æ304
DON’T KNOW...........................................98 Æ304
303 In your opinion, could a woman die from YES...........................................................01
[this problem] any of these problems? NO.............................................................02
DON’T KNOW...........................................98
304 In your opinion, what are some serious SEVERE BLEEDING ................................01
health problems that can occur during SEVERE HEADACHE ..............................02
labor and childbirth that could endanger CONVULSIONS........................................03
the life of a pregnant woman? HIGH FEVER ............................................04
PROBE: Any others? LABOR LASTING >12 HOURS................06
PLACENTA NOT DELIVERED
30 MINUTES AFTER BABY................07
OTHER __________________________ 97
(SPECIFY)
NONE........................................................00 Æ306
DON’T KNOW...........................................98 Æ306
DON’T KNOW...........................................98
October 30,2006 12
306 In your opinion, what are some serious SEVERE BLEEDING ................................01
health problems that can occur during the SEVERE HEADACHE ..............................02
first 2 days after birth that could endanger BLURRED VISION ...................................03
the life of the woman? CONVULSIONS........................................04
SWOLLEN HANDS/FACE........................05
PROBE: Any others? HIGH FEVER ............................................06
MALODOROUS VAGINAL DISCHARGE 07
DIFFICULTY BREATHING .......................09
SEVERE WEAKNESS..............................10
OTHER __________________________ 97
(SPECIFY)
NONE........................................................00 Æ308
DON’T KNOW...........................................98 Æ308
DON’T KNOW...........................................98
308 Now, I would like to ask you a few DIFFICULT OR FAST BREATHING.........01
questions about the health of newborn YELLOW SKIN/EYE COLOR (JAUNDICE)02
babies. In your opinion, what are some POOR SUCKING OR FEEDING...............03
serious health problems that can occur PUS, BLEEDING, OR DISCHARGE FROM
during the first 7 days after birth that could AROUND THE
endanger the life of a newborn baby? UMBILICAL CORD..............................04
BABY VERY SMALL................................05
PROBE: Any others? SKIN LESIONS OR BLISTERS................06
CONVULSIONS/SPASMS/
RIGIDITY .............................................07
LETHARGY/
UNCONSCIOUSNESS ........................08
RED OR SWOLLEN EYES
WITH PUS ...........................................09
OTHER __________________________ 97 Æ310

(SPECIFY)
NONE........................................................98 Æ310
309 In your opinion, could a newborn baby die YES...........................................................01
from [this problem] any of these NO.............................................................02
problems? DON’T KNOW...........................................98
310 Could you name some types of basic care EXCLUSIVE BREASTFEEDING ..............01
that can be provided to a newborn baby DRY AND WRAP......................................02
immediately after birth? EYE CARE................................................03
CORD CARE ............................................04
Probe: Are there any others? SKIN TO SKIN ..........................................05
OTHER1 _________________________ 95
(SPECIFY)
OTHER2 _________________________ 96
(SPECIFY)
OTHER3 _________________________ 97
(SPECIFY)
DON’T KNOW...........................................98
311 Have you ever heard the term “birth YES.............................................................1
preparedness”? NO...............................................................2
October 30,2006 13
312 In your opinion, what are some things a IDENTIFY MODE OF TRANSPORT FOR
woman can do to prepare for birth? BIRTH AT A FACILITY OR AN
EMERGENCY......................................01
Probe: Are there any others? SAVE MONEY FOR BIRTH AT A
FACILITY OR AN EMERGENCY ........02
[CIRCLE ALL MENTIONED] IDENTIFY BLOOD DONOR .....................03
IDENTIFY SKILLED PROVIDER..............04
PURCHASE CLEAN DELIVERY
KIT/ITEMS (CLEAN BLADE. ETC.)…05
PURCHASE CLOTHING FOR THE
BABY…………………………………….06
OTHER __________________________ 97
(SPECIFY)
313 Does your community provide support to YES NO DK
assist women in preparing for birth?
TRANSPORT..................1 ........... 2 ......... 8
For instance, are there: _________________________________
(SPECIFY TYPE OF TRANSPORT)
Transportation services for pregnant
women? FINANCIAL.....................1 ........... 2 ......... 8
Ways to get money to help families pay BLOOD ...........................1 ........... 2 ......... 8
for birth or pregnancy-related emergency?
OTHER _____________ 1 ........... 2 ......... 8
Ways to get blood donated during (SPECIFY)
pregnancy or complications?
OTHER _____________ 1 ........... 2 ......... 8
Any other support?
(SPECIFY)
October 30,2006 14
SECTION 4. PERCEPTIONS OF LOCAL FACILITIES

Now I am going to ask you some questions about the local health facilities in which a
woman can give birth to a baby.
401. Do you know of a place where a woman HOME
can go to give birth to a baby with RESPONDENT’S HOME ...................11 ÆSec. 5
assistance from a doctor, nurse, or TBA’S HOME ....................................12 ÆSec. 5
midwife? OTHER HOME...................................13 ÆSec. 5
IF YES: Where is that? PUBLIC SECTOR

GVT. HOSPITAL................................21
RECORD ALL PLACES MENTIONED. GVT. PRIMARY HEALTH CARE
CENTER (PHC) ................................22
IF MORE THAN ONE FACILITY GVT. DISPENSARY ..........................23
MENTIONED: Which of these health
facilities is the closest to here? OTHER PUBLIC _______________ 26
(SPECIFY)
_______________________________
PRIVATE SECTOR
(NAME OF HEALTH FACILITY)
PVT. HOSPITAL ................................31
MATERNITY/NURSING HOME .........32
OTHER PRIVATE ______________ 36

(SPECIFY)
OTHER _________________________ 97
(SPECIFY)
ÆSec. 5
DOES NOT KNOW PLACE ....................98
402. In your community, how would a woman go AMBULANCE .........................................01
to this health facility? PRIVATE CAR ........................................02
TAXI/BUS ...............................................03
PROBE: What type of transportation would CART ......................................................04
she mainly use to get to the health facility? MOTORBIKE ..........................................05
BOAT ......................................................06
ON FOOT................................................07
BICYCLE ................................................08
DONKEY/HORSE/CAMEL……………....09
OTHER _________________________ 97
(SPECIFY)
DON’T KNOW.........................................98
403. In general, how long would it take to reach
this health facility using the mode of HOURS .......................................1
transport you just mentioned?
MINUTES ....................................2
IF LESS THAN 2 HOURS, RECORD IN DON’T KNOW.........................................98
MINUTES. OTHERWISE, RECORD IN
HOURS.
404. Is this transport available at night? YES .......................................................... 01
NO............................................................ 02
DON’T KNOW ............................................. 98
October 30,2006 15
405. In your opinion, how are the services in this EXCELLENT ...........................................01
facility? Would you say they are excellent, GOOD .....................................................02
good, average, or poor? AVERAGE ..............................................03
POOR......................................................04
DON’T KNOW.........................................98
406. Can you tell me why you have ranked the DOCTOR ALWAYS THERE ...................01
services as [CHECK 405] __________? FACILITY ALWAYS OPEN ....................02
STAFF RESPOND TO
MY QUESTIONS................................03
PROBE: What else? FACILITY ALWAYS HAS
NECESSARY MEDICINES................04
RECORD ALL RESPONSES. NOT A LONG WAIT................................05
STAFF TREAT WOMEN
WITH RESPECT ................................06
OFTEN DOCTOR NOT THERE ..............07

OFTEN FACILITY IS CLOSED...............08
STAFF DO NOT ANSWER MY
QUESTIONS......................................09
FACILITY DOES NOT HAVE
NECESSARY MEDICINES................10
LONG WAIT TO BE SEEN .....................11
STAFF TREAT WOMEN POORLY.........12
OTHER _________________________ 97
(SPECIFY)
DON’T KNOW.........................................98
October 30,2006 16
SECTION 5. PERSONAL EXPERIENCE RELATED TO LAST PREGNANCY

In the next three sets of questions, I am going to be asking about your experiences related to
the three phases women go through when having a child that we discussed earlier:
pregnancy, birth, and the period after birth. I’d like to begin by speaking with you about your
last pregnancy that resulted in a baby (born alive or born dead).
501. Did you see anyone for antenatal care YES ................................................................1
during your last pregnancy? NO ..................................................................2 Æ 515
502. How many times in total did you receive
antenatal care during your pregnancy? NO. OF TIMES .....................................
DON’T KNOW/DON’T REMEMBER ............98
503. How many months pregnant were you
when you first received antenatal care MONTHS ..............................................
for this pregnancy? DON’T KNOW/DON’T REMEMBER ............98
504. Whom did you first see for a checkup on HEALTH PROFESSIONAL
this pregnancy? DOCTOR.................................................01
NURSE/MIDWIFE ...................................02
Anyone else? COMMUNITY HEALTH EXTENSION
WORKER (CHEW)..................................03
PROBE FOR THE TYPE OF PERSON
AND RECORD ALL PERSONS SEEN. OTHER PERSON
TBA .........................................................04
COMMUNITY HEALTH WORKER .........05
RELATIVE/FRIEND ................................06
OTHER ____________________________ 97
(SPECIFY)
DON’T KNOW/DON’T REMEMBER ............98

505. Where did you receive antenatal care HOME
for this pregnancy? RESPONDENT’S HOME .................. 11
TBA’S HOME.................................... 12
Anywhere else? OTHER HOME .................................. 13
PUBLIC SECTOR
GVT. HOSPITAL ............................... 21
GVT. PRIMARY HEALTH CARE CENTER
(PHC). ............................................... 22
GVT. DISPENSARY.......................... 23
OTHER PUBLIC _______________ 26

(SPECIFY)
PRIVATE SECTOR
PVT. HOSPITAL ............................... 31
MATERNITY/NURSING HOME ........ 32
OTHER PRIVATE ______________ 36

(SPECIFY)
OTHER _________________________ 97
(SPECIFY)
October 30,2006 17
506. How many months pregnant were you
when you last received antenatal care MONTHS ..............................................
for this pregnancy? DON’T KNOW/CAN’T REMEMBER ............98
507. During this pregnancy, were you given YES .......................................................... 01
or did you buy any iron tablets or iron NO ............................................................ 02
syrups? DON’T KNOW ................. 98
(Show samples)
508. During this pregnancy, did you take any YES .......................................................... 01
drugs to prevent you from getting NO ............................................................ 02 Æ 511
malaria? DON’T KNOW .......................................... 98 Æ 511
509. What drugs did you take? FANSIDAR/SP………………………………..01
CHLOROQUINE………………………………02 Æ 511
N.B: SP=Sulphadoxine/Pyrimethamine OTHER _________________________ 97 Æ 511
(Fansidar is one brand of SP) (SPECIFY)
510. How many times did you take SP TIMES _____________
(Fansidar) during this pregnancy. DON’T KNOW/DON’T REMEMBER…….98
511. During this pregnancy, were you given YES .......................................................... 01
an injection in the arm to prevent the NO ............................................................ 02 Æ 513
baby from getting tetanus, that is, DON’T KNOW………………………………98 Æ 513
convulsions after birth?
512. During this pregnancy, how many times TIMES _____________

did you get this injection? DON’T KNOW/DON’T REMEMBER…….98
513. During this pregnancy, did you receive
information and counseling about:
YES NO DK
Benefits of family planning/birth spacing
(healthy timing and spacing of
pregnancies)? FP/BIRTH SPACING...... 01............02........98
Immediate breastfeeding? IMMED. BRSTFDG. ....... 01............02........98
Exclusive breastfeedin? EXCL. BRSTFDG............ 01............02........98
October 30,2006 18
514. During this pregnancy, did a health
worker advise you about any of the
following at least once?
Danger signs of serious health problems YES NO DK

during pregnancy, childbirth, or soon
after? DANGER SIGNS ............ 01............02........98
Where to go if you had danger signs of

serious health problems? WHERE TO GO.............. 01............02........98
Where you should give birth to your WHERE TO
baby? GIVE BIRTH .................... 01............02........98
Arrangements for transportation?
TRANSPORT .................. 01............02........98
Arrangements for funds/finances?
MONEY ........................... 01............02........98
Arrangements for a blood donor?
BLOOD DONOR ............. 01............02........98
Arrangements for a healthcare
professional to deliver your child? HEALTH
PROFESSIONAL ............ 01............02........98
515. Did you speak with anyone outside of a YES NO DK

health facility about danger signs of
serious health problems during DANGER SIGNS ............. 01............02........98
pregnancy, childbirth, or soon after? HUSBAND ..............................................01
MOTHER-IN-LAW...................................02
IF YES: Whom did you speak with? OTHER FAMILY MEMBER.....................03
FRIEND/NEIGHBOR...............................04
RECORD ALL RESPONSES. COMMUNITY HEALTH WORKER..........05
health facility about where to go if you
had danger signs of serious health WHERE TO GO............... 01............02........98
problems? HUSBAND ..............................................01
MOTHER-IN-LAW...................................02
FRIEND/NEIGHBOR...............................04
RECORD ALL RESPONSES. COMMUNITY HEALTH WORKER .........05
health facility about where you should
give birth to your baby? WHERE TO
GIVE BIRTH ............... 01............02........98
IF YES: Whom did you speak with? HUSBAND ..............................................01
MOTHER-IN-LAW...................................02
RECORD ALL RESPONSES. OTHER FAMILY MEMBER.....................03
FRIEND/NEIGHBOR...............................04
health facility about arrangements for
transport? TRANSPORT .................. 01............02........98
HUSBAND ..............................................01
IF YES: Whom did you speak with? MOTHER-IN-LAW...................................02
OTHER FAMILY MEMBER.....................03
RECORD ALL RESPONSES. FRIEND/NEIGHBOR...............................04
October 30,2006 19
health facility about arrangements for
funds/finances? MONEY ........................... 01............02........98
HUSBAND ..............................................01
health facility about arrangements for a
blood donor? BLOOD DONOR ............. 01............02........98
HUSBAND ..............................................01
health facility about arrangements for a
healthcare professional to deliver SKILLED PROVIDER...... 01............02........98
your child? HUSBAND ..............................................01
MOTHER-IN-LAW...................................02
FRIEND/NEIGHBOR...............................04
RECORD ALL RESPONSES. COMMUNITY HEALTH WORKER .........05
522. CHECK 501: RECEIVED ANTENATAL
CARE? YES ------------------------------------------- Æ524
NO
↓
523. What is the MAIN reason you did not DID NOT KNOW WHERE TO GO................01
see anyone for antenatal care? HEALTH FACILITY TOO FAR .....................02
(CIRCLE ONLY ONE RESPONSE.) TOO EXPENSIVE.........................................03
NO ONE WAS THERE TO ACCOMPANY...04
NO GOOD SERVICE....................................05
OTHER ____________________________ 97
(SPECIFY)
524. During this pregnancy, did you YES ..............................................................01
experience any serious health problems NO ................................................................02 ÆSec. 6
related to the pregnancy? DON’T KNOW ..............................................98 ÆSec. 6
October 30,2006 20
525. What problems did you experience? UNPROMPTED PROMPTED
(CIRCLE ALL RESPONSES GIVEN.)
BLEEDING ....................... 01 .......................01
THEN PROBE: Did you experience SEVERE
[ANY REMAINING COMPLICATIONS]? HEADACHE ................ 02 .......................02
BLURRED VISION ........... 03 .......................03
CONVULSIONS ............... 04 .......................04
SWOLLEN
HANDS/FACE ............. 05 .......................05
HIGH FEVER.................... 06 .......................06
LOSS OF
CONSCIOUSNESS ..... 07 .......................07
DIFFICULTY
BREATHING ............... 08 .......................08
SEVERE WEAKNESS ..... 09 .......................09
SEVERE
ABDOMINAL PAIN ..... 10 .......................10
ACCELERATED/REDUCED
FETAL MOVEMENT ... 11 .......................11
WATER BREAKS
WITHOUT LABOR ...... 12 .......................12
OTHER ____________________________ 97
(SPECIFY)
DON’T KNOW ..............................................98
526. Which one of these problems was the BLEEDING ...................................................01
most severe? SEVERE HEADACHE..................................02
BLURRED VISION .......................................03
CONVULSIONS ...........................................04
SWOLLEN HANDS/FACE ...........................05
HIGH FEVER................................................06
LOSS OF CONSCIOUSNESS .....................07
DIFFICULTY BREATHING ..........................08
SEVERE WEAKNESS .................................09
SEVERE ABDOMINAL PAIN.......................10
ACCELERATED/ REDUCED FETAL
MOVEMENT............................................11
WATER BREAKS WITHOUT LABOR .........12
OTHER ____________________________ 97
(SPECIFY)
527. Did you seek assistance for this YES ..............................................................01 Æ 529
problem? NO ................................................................02
DON’T KNOW ..............................................98 ÆSec. 6
October 30,2006 21
528. Why did you not seek assistance for this RESP. DIDN’T THINK NECESSARY...........01
problem? HUSBAND/FAMILY DIDN’T
THINK NECESSARY ..............................02
Anything else? FACILITY TOO FAR ....................................03
NO TRANSPORT .........................................04
PROBE FOR OTHER REASONS AND NO CHILDCARE ..........................................05
RECORD ALL REASONS TOO EXPENSIVE.........................................06
MENTIONED. SERVICES ARE POOR ...............................07
USED HOME REMEDY................................08
DID NOT KNOW WHERE TO GO................09
NO TIME TO GO ..........................................10
OTHER ____________________________ 97
(SPECIFY)
DON’T KNOW ..............................................98
529. Who made the final decision about NO ONE .......................................................01
whether or not to seek assistance for RESPONDENT.............................................02
this problem? RESPONDENT & HUSBAND ......................03
HUSBAND....................................................04
RESP.’S MOTHER .......................................05
RESP.’S FATHER ........................................06
MOTHER-IN-LAW ........................................07
FATHER-IN-LAW .........................................08
SISTER/SISTER-IN-LAW.............................09
OTHER MEMBER OF RESP.’S FAM ..........10
OTHER MEMBER OF HUSB.’S FAM ..........11
FRIEND/NEIGHBOR ....................................12
HEALTH PROFESSIONAL..........................13
TBA ..............................................................14
OTHER ____________________________ 97
(SPECIFY)
DON’T KNOW ______________________ 98
530. CHECK 527: SOUGHT ASSISTANCE?
NO ----------------------------------------------- ÆSec. 6
YES
↓ DON’T KNOW ---------------------------------- ÆSec. 6
531. Did you go to a health facility for NO, DID NOT GO .........................................11
assistance?
PUBLIC SECTOR
IF YES: Which facility did you go to GVT. HOSPITAL .....................................21
first? GVT. PRIMARY HEALTH CARE
CENTER (PHC).......................................22
GVT. DISPENSARY................................23
OTHER PUBLIC __________________ 26

________________________________ (SPECIFY)
(NAME OF PLACE) PRIVATE SECTOR
PVT. HOSPITAL .....................................31
MATERNITY/NURSING HOME ..............32
OTHER PRIVATE _________________ 36

(SPECIFY)
OTHER ____________________________ 97
(SPECIFY)
October 30,2006 22
532. Whom did you see for assistance for HEALTH PROFESSIONAL
this problem? DOCTOR.................................................01
NURSE/MIDWIFE ...................................02
Anyone else? COMMIUNITY HEALTH EXTENSION
WORKER ................................................03
AND RECORD ALL PERSONS SEEN. OTHER PERSON
TBA .........................................................04
RELATIVE/FRIEND ................................06
OTHER ____________________________ 97
(SPECIFY)
533. How much money did you pay in total
for the assistance of the people you NAIRA: _________________________
mentioned?
534. CHECK 531: WENT TO A HEALTH

FACILITY? NO ------------------------------------------- ÆSec. 6
YES
↓
535. Did you undergo any diagnostic tests? YES.............................................................. 01
NO ............................................................... 02 Æ 537
DON’T KNOW ............................................. 98 Æ 537
536. How much money did you spend on

diagnostic tests? NAIRA: _________________________
537. Did you and your support person spend YES.............................................................. 01

money on transportation or NO ............................................................... 02 Æ 540
food/lodging? DON’T KNOW ............................................. 98 Æ 540
538. How much did you and your support NAIRA: _________________________
person spend on food/lodging?
person spend on transport?
540. Were you prescribed any medicines? YES.............................................................. 01
NO ............................................................... 02 Æ 542
DON’T KNOW ............................................. 98 Æ 542
541. How much did you spend on NAIRA: _________________________
medicines?
542. Did you incur any other costs at the YES.............................................................. 01

facility? NO ............................................................... 02 Æ 544
DON’T KNOW ............................................. 98 Æ 544
543. How much?
NAIRA: _________________________
544. In all, how many days did you abstain

from all work (housework and other DAYS:
work)?
October 30,2006 23
SECTION 6. PERSONAL EXPERIENCE RELATED TO LAST BIRTH

Now I’d like to speak with you about the birth that resulted from the pregnancy we were just
discussing.
601. Where did you give birth to your last HOME
child? RESPONDENT’S HOME........................ 11
TBA’S HOME ......................................... 12
OTHER HOME ....................................... 13
PUBLIC SECTOR
GOVT. HOSPITAL ................................. 21
________________________________ GOVT. PRIMARY HEALTH CARE
(NAME OF PLACE) CENTER (PHC)...................................... 22
GOVT. DISPENSARY ............................ 23
OTHER PUBLIC __________________ 26

(SPECIFY)
PRIVATE SECTOR
PVT. HOSPITAL .................................... 31
MATERNITY/NURSING HOME ............. 32
OTHER PRIVATE _________________ 36

(SPECIFY)
OTHER ____________________________ 97
(SPECIFY)
602. Did you plan to give birth at this place? YES.............................................................. 01
NO ............................................................... 02
DON’T KNOW ............................................. 98
603. Did you pay for the assistance at the YES.............................................................. 01
time of delivery of your last child? NO ............................................................... 02 Æ606
DON’T KNOW ............................................. 98 Æ606
604. Who did you pay? DOCTOR ..................................................01
NURSE/ MIDWIFE....................................02
NURSE .....................................................03
COMMUNITY HEALTH EXTENSION
WORKER (CHEW) ..............................04
TBA ..........................................................05
RELATIVE/FRIEND..................................06
HOSPITAL ACCOUNTS DEPT./CASHIER..07
OTHER __________________________ 97
605. How much money did you pay in total NAIRA: ________________________
for the assistance of the people you
mentioned?
606. Prior to this birth, did you or your family YES.............................................................. 01
make any arrangements for the birth of NO ............................................................... 02 Æ614
this child? DON’T KNOW ............................................. 98 Æ614
October 30,2006 24
607. Which arrangements did you or your UNPROMPTED PROMPTED
family make for the birth of this child?
(CIRCLE ALL RESPONSES GIVEN.) IDENTIFY
TRANSPORT ..............…01................... 01
THEN PROBE: Did you [ANY SAVE MONEY..................…02................... 02
REMAINING ARRANGEMENTS]? IDENTIFY BLOOD DONOR. 03 .................. 03
IDENTIFY SKILLED
PROVIDER ..................…04................... 04
OTHER ____________________________ 97
(SPECIFY)
608. CHECK 607: IDENTIFIED A MODE OF
TRANSPORT? NO ------------------------------------------------- Æ610
YES
↓
609. Did you use the mode of transport that YES.............................................................. 01
you identified? NO ............................................................... 02
DON’T KNOW ............................................. 98
610. CHECK 607: SAVED MONEY?
NO --------------------------------------------- Æ709
YES
↓
611. Did you use the money that you saved? YES.............................................................. 01
NO ............................................................... 02
DON’T KNOW ............................................. 98
612. CHECK 607: IDENTIFIED A BLOOD
DONOR? NO --------------------------------------------- Æ711
YES
↓
613. Did you use the blood donor you YES.............................................................. 01
identified? NO ............................................................... 02
DON’T KNOW ............................................. 98
614. Who made the final decision about NO ONE....................................................... 01
where you would give birth? RESPONDENT............................................ 02
RESPONDENT & HUSBAND ..................... 03
HUSBAND................................................... 04
RESP.’S MOTHER ...................................... 05
RESP.’S FATHER ....................................... 06
MOTHER-IN-LAW ....................................... 07
FATHER-IN-LAW ........................................ 08
SISTER/SISTER-IN-LAW............................ 09
OTHER MEMBER OF RESP.’S FAM.......... 10
OTHER MEMBER OF HUSB.’S FAM ......... 11
FRIEND/NEIGHBOR ................................... 12
HEALTH PROFESSIONAL ......................... 13
TBA ............................................................. 14
OTHER ____________________________ 97
(SPECIFY)
DON’T KNOW ............................................. 98
October 30,2006 25
615. CHECK 601: GAVE BIRTH IN
FACILITY? NO --------------------------------------------- Æ634
YES
↓
616. Can you tell me the three major reasons 1 ___________________________________
why you gave birth in a health facility
rather than elsewhere? 2 ___________________________________
PROBE: What else? 3 ___________________________________

617. How did you go to the health facility? AMBULANCE.............................................. 01
PRIVATE CAR ............................................ 02
PROBE: What type of transportation TAXI/BUS .................................................... 03
did you mainly use to get to the health CART........................................................... 04
facility? MOTORBIKE............................................... 05
BOAT........................................................... 06
ON FOOT .................................................... 07
BICYCLE ..................................................... 08
DONKEY/HORESE/CAMEL………………...09
OTHER ____________________________ 97
(SPECIFY)
DON’T KNOW ............................................. 98
618. Who accompanied you to the place NO ONE....................................................... 01
where you gave birth? HUSBAND................................................... 02
RESP.’S MOTHER ...................................... 03
PROBE FOR THE PERSON(S) RESP.’S FATHER ....................................... 04
ACCOMPANYING AND RECORD ALL MOTHER-IN-LAW ....................................... 05
PERSONS. FATHER-IN-LAW ........................................ 06
FRIEND/NEIGHBOR ................................... 10
TBA ............................................................. 12
OTHER ____________________________ 97
(SPECIFY)
DON’T KNOW ............................................. 98
619. How long did it take to reach the health
facility? HOURS………………………….1
IF LESS THAN 2 HOURS, RECORD IN MINUTES………………………..2

HOURS. DON’T KNOW ............................................. 98
620. How long after reaching the health
facility did it take for you to get services HOURS…………………………..1
from the health personnel?
MINUTES………………………..2
IF LESS THAN 2 HOURS, RECORD IN IMMEDIATELY .............................................. 3
MINUTES. OTHERWISE, RECORD IN DON’T KNOW ............................................. 98
HOURS.
October 30,2006 26
621. In your opinion, how were the services EXCELLENT ............................................... 01
in this facility? Would you say they were GOOD.......................................................... 02
excellent, good, average or poor? AVERAGE ................................................... 03
POOR .......................................................... 04
DON’T KNOW ............................................. 98
QUESTION CODES GO TO Q.
Q. #
622. Can you tell me why you have ranked DOCTOR ALWAYS THERE........................ 01
the services as __________? [CHECK FACILITY ALWAYS OPEN ......................... 02
621] STAFFRESPOND TO MY QUESTIONS ..... 03
FACILITY ALWAYS HAS NECESSARY
MEDICINES............................................ 04
PROBE: What else? NOT A LONG WAIT .................................... 05
STAFF TREAT WOMEN WITH RESPECT . 06
OFTEN DOCTOR NOT THERE .................. 07

OFTEN FACILITY IS CLOSED ................... 08
STAFF DO NOT ANSWER
MY QUESTIONS .................................... 09
FACILITY DOES NOT HAVE NECESSARY
MEDICINES............................................ 10
LONG WAIT TO BE SEEN......................... 11
STAFF TREAT WOMEN POORLY ............. 12
OTHER ____________________________ 97
DON’T KNOW ............................................. 98

623. Now I’d like to ask you about the costs YES.............................................................. 01
you incurred delivering at the facility. NO ............................................................... 02 Æ 625
Did you undergo any diagnostic tests? DON’T KNOW ............................................. 98 Æ 625


money on transportation or NO ............................................................... 02 Æ 628
food/lodging? DON’T KNOW ............................................. 98 Æ 628
NO ............................................................... 02 Æ 630
DON’T KNOW ............................................. 98 Æ 630
medicines?

facility? NO ............................................................... 02 Æ 632
DON’T KNOW ............................................. 98 Æ 632
October 30,2006 27
Q. #
631. How much?
NAIRA: _________________________

work)?
633. CHECK 601: GAVE BIRTH IN
FACILITY? YES ------------------------------------------- Æ635
NO
↓
634. Can you tell me the three major reasons RESP. DIDN’T THINK NECESSARY .......... 01
why you did not give birth in a health HUSBAND/FAMILY DIDN’T
facility? THINK NECESSARY ............................. 02
FACILITY TOO FAR.................................... 03
NO TRANSPORT ........................................ 04
PROBE: What else? NO CHILDCARE ......................................... 05
TOO EXPENSIVE........................................ 06
SERVICES ARE POOR............................... 07
DID NOT KNOW WHERE TO GO............... 08
NO TIME TO GO ......................................... 09
OTHER ____________________________ 97
(SPECIFY)
DON’T KNOW ............................................. 98
635. Who assisted with the birth? HEALTH PROFESSIONAL
DOCTOR ................................................ 01
Anyone else? NURSE/ MIDWIFE ................................. 02
CLINICAL OFFICER .............................. 03
AND RECORD ALL PERSONS OTHER PERSON
ASSISTING. TBA ........................................................ 04
COMMUNITY HEALTH WORKER......... 05
RELATIVE/FRIEND ............................... 06
NO ONE/SELF……………………………….07
OTHER ____________________________ 97
(SPECIFY)
636. Would you have preferred that someone YES................................................................ 1
else assist with the birth instead of NO ................................................................. 2 Æ638
__________? [CHECK 635] DON’T KNOW ............................................... 8 Æ638
637. Who would you have preferred to assist HEALTH PROFESSIONAL
with the birth? DOCTOR ................................................ 01
NURSE/ MIDWIFE ................................. 02
CLINICAL OFFICER ............................ 03
OTHER PERSON
TBA ........................................................ 04
RELATIVE/FRIEND ............................... 06
OTHER ____________________________ 97
(SPECIFY)
October 30,2006 28
Q. #
638. Was the child born by cesarean section YES................................................................ 1
(operation)? NO ................................................................. 2
639. Was the child born by forceps or YES.............................................................. 01
vacuum extraction? NO ............................................................... 02
DON’T KNOW ............................................. 98
640. During labor and birth, did you YES.............................................................. 01
experience any serious health problems NO ............................................................... 02 ÆSec. 7
related to birth? DON’T KNOW ............................................. 98 ÆSec. 7
SEVERE BLEEDING........01 ...................... 01
THEN PROBE: Did you experience SEVERE HEADACHE ......02 ...................... 02
[ANY REMAINING COMPLICATIONS]? CONVULSIONS ...............03 ...................... 03
HIGH FEVER....................04 ...................... 04
LOSS OF
CONSCIOUSNESS .....05 ...................... 05
LABOR LASTING
>12 HOURS................06 ...................... 06
PLACENTA NOT
DELIVERED 30 MINUTES
AFTER BABY..............07 ...................... 07
BABY IN WRONG POSITION (BREECH,
HAND FIRST, ETC.) ...08 ...................... 08
OTHER ____________________________ 97
(SPECIFY)
DON’T KNOW ............................................. 98
642. Which one of these problems was the SEVERE BLEEDING................................... 01
most severe? SEVERE HEADACHE ................................. 02
CONVULSIONS .......................................... 03
HIGH FEVER............................................... 04
LOSS OF CONSCIOUSNESS..................... 05
LABOR LASTING >12 HOURS .................. 06
PLACENTA NOT DELIVERED
30 MINUTES AFTER BABY .................. 07
OTHER ____________________________ 97
(SPECIFY)
October 30,2006 29
Q. #
643. Where were you when you developed HOME
this problem? RESPONDENT’S HOME........................ 11
TBA’S HOME ......................................... 12
OTHER HOME ....................................... 13
PUBLIC SECTOR
GOVT. HOSPITAL ................................. 21 Æ655
GOVT. PRIMARY HEALTH CARE
CENTER (PHC)...................................... 22
GOVT.DISPENSARY ............................. 23
OTHER PUBLIC __________________ 26

(SPECIFY)
PRIVATE SECTOR
PVT. HOSPITAL .................................... 31 Æ655
MATERNITY/NURSING HOME ............. 32 Æ655
OTHER PRIVATE _________________ 36 Æ655

(SPECIFY)
OTHER ____________________________ 97
(SPECIFY)
644. Did you seek assistance for this YES.............................................................. 01 Æ646
problem? NO ............................................................... 02
DON’T KNOW ............................................. 98 ÆSec. 7
645. Why did you not seek assistance for this RESP. DIDN’T THINK NECESSARY .......... 01
THINK NECESSARY ............................. 02
Anything else? FACILITY TOO FAR.................................... 03
NO TRANSPORT ........................................ 04
PROBE FOR THE REASONS AND NO CHILDCARE ......................................... 05
RECORD ALL REASONS TOO EXPENSIVE........................................ 06
MENTIONED. SERVICES ARE POOR............................... 07
USED HOME REMEDY............................... 08
DID NOT KNOW WHERE TO GO............... 09
NO TIME TO GO ......................................... 10
OTHER ____________________________ 97
(SPECIFY)
DON’T KNOW ............................................. 98
October 30,2006 30
Q. #
646. Who made the final decision about NO ONE....................................................... 01
whether or not you would go RESPONDENT............................................ 02
somewhere for assistance? RESPONDENT & HUSBAND ..................... 03
HUSBAND................................................... 04
RESP.’S MOTHER ...................................... 05
RESP.’S FATHER ....................................... 06
MOTHER-IN-LAW ....................................... 07
FATHER-IN-LAW ........................................ 08
FRIEND/NEIGHBOR ................................... 12
TBA ............................................................. 14
OTHER ____________________________ 97
(SPECIFY)
DON’T KNOW ............................................. 98
647. How long did it take to make the
decision about whether or not to go HOURS.............................................1
somewhere for assistance?
MINUTES…………………………2
IF LESS THAN 2 HOURS, RECORD IN DON’T KNOW ............................................. 98
HOURS.
NO --------------------------------------------- ÆSec. 7
YES
↓ DON’T KNOW -------------------------------- ÆSec. 7
649. Did you go to a health facility for NO, DID NOT GO. ....................................... 11 ÆSec. 7
assistance?
PUBLIC SECTOR
IF YES: Which facility did you go to GOVT. HOSPITAL. ................................ 21
first? GOVT. PRIMARY HEALTH CARE
CENTER (PHC)...................................... 22
GOVT. DISPENSARY. ........................... 23
OTHER PUBLIC __________________ 26

________________________________ (SPECIFY)
(NAME OF PLACE)
PRIVATE SECTOR
PVT. HOSPITAL .................................... 31
MATERNITY/NURSING HOME ............. 32
OTHER PRIVATE _________________ 36

(SPECIFY)
OTHER ____________________________ 97
(SPECIFY)
October 30,2006 31
Q. #
650. Who accompanied you to seek care? NO ONE....................................................... 01
HUSBAND................................................... 02
PROBE FOR THE PERSON(S) RESP.’S MOTHER ...................................... 03
ACCOMPANYING AND RECORD ALL RESP.’S FATHER ....................................... 04
PERSONS. MOTHER-IN-LAW ....................................... 05
FATHER-IN-LAW ........................................ 06
FRIEND/NEIGHBOR ................................... 10
TBA ............................................................. 12
OTHER ____________________________ 97
(SPECIFY)
651. How long did it take to find transport
once a decision was made to seek HOURS……………………………1
care?
MINUTES…………………………2
HOURS.
652. How long did it take to get there?
HOURS……………………………1
IF LESS THAN 2 HOURS, RECORD IN
MINUTES. OTHERWISE, RECORD IN MINUTES………………………….2
HOURS. DON’T KNOW ............................................. 98
653. How long was the time between when
you arrived at the facility and the time HOURS……………………………1
you were first examined by a healthcare
provider? MINUTES…………………………2
IMMEDIATELY .............................................. 3
HOURS.
654. Were you treated at this facility or were TREATED THERE……………………………01
you referred to another facility? REFERRED TO ANOTHER FACILITY
(SPECIFY WHICH FACILITY): ……………..02
____________________________
October 30,2006 32
Q. #
655. Whom did you see for assistance for HEALTH PROFESSIONAL
this health problem? DOCTOR ................................................ 01
NURSE/ MIDWIFE ................................. 02
Anyone else? NURSE ................................................... 03
PROBE FOR THE TYPE OF PERSON WORKER (CHEW) ................................. 03
AND RECORD ALL PERSONS SEEN.
OTHER PERSON
TBA ........................................................ 04
RELATIVE/FRIEND ............................... 06
OTHER ____________________________ 97
(SPECIFY)
DON’T KNOW 98
656. Have you paid any money for the YES.............................................................. 01
services provided? NO ............................................................... 02 Æ658
DON’T KNOW ........................................ 98 Æ658
657. How much money did you pay for the NAIRA: _________________________
services provided
658. Did you undergo any diagnostic tests? YES.............................................................. 01
NO ............................................................... 02 Æ660
DON’T KNOW ............................................. 98 Æ660
money on transportation or NO ............................................................... 02 Æ663
food/lodging? DON’T KNOW ............................................. 98 Æ663
NO ............................................................... 02 Æ665
DON’T KNOW ............................................. 98 Æ665
medicines?
facility? NO ............................................................... 02 Æ667
DON’T KNOW ............................................. 98 Æ667
666. How much?
NAIRA: _________________________
work)?
October 30,2006 33
SECTION 7. PERSONAL EXPERIENCE RELATED TO LAST BIRTH:

POSTPARTUM CARE FOR MOTHER
Now I’d like to speak with you about the period after the birth we were just discussing.
701. After you gave birth, did someone check on YES ..........................................................01
your health? NO ............................................................02 Æ715
DON’T KNOW ..........................................98 Æ716
702. When did someone first check on your MINUTES……………………………1
health after you gave birth?
HOURS.......................................... 2
DAYS............................................. 3
WEEKS ......................................... 4
DON’T KNOW ..........................................98
703. Where did this first checkup take place? HOME
RESPONDENT’S HOME ....................11
TBA’S HOME......................................12
OTHER HOME ....................................13
PUBLIC SECTOR
___________________________________ GOVT. HOSPITAL ..............................21
(NAME OF PLACE) GOVT. HEALTH CENTER ..................22
GOVT.DISPENSARY ..........................23
OTHER PUBLIC ________________ 26

(SPECIFY)
PRIVATE SECTOR
PVT. HOSPITAL .................................31
MATERNITY/NURSING HOME ..........32
OTHER PRIVATE _______________ 36

(SPECIFY)
OTHER __________________________ 97
(SPECIFY)
704. Who checked on your health at that time? DOCTOR ..................................................01
NURSE/ MIDWIFE....................................02
Anyone else? CLINICAL OFFICER ................................03
COMMUNITY HEALTH WORKER...........04
PROBE FOR THE TYPE OF PERSON AND TBA ..........................................................05
RECORD ALL PERSONS CHECKING. RELATIVE/FRIEND..................................06
OTHER __________________________ 97
(SPECIFY)
DON’T KNOW ..........................................98
705. During this visit, did you receive a Vitamin A YES ..........................................................01
dose like this? NO ............................................................02
DON’T KNOW ..........................................98
(SHOW AMPULE/CAPSULES/SYRUP)
October 30,2006 34
706. During this visit, were you given any iron YES ..........................................................01
tablets or iron syrups? NO ............................................................02
(Show samples) DON’T KNOW ..........................................98
707. During this visit, were you given a physical YES ..........................................................01
exam, including your abdomen and breasts? NO ............................................................02
DON’T KNOW ..........................................98
708. During this visit, did you receive information YES ..........................................................01
about the lactational amennorhea method NO ............................................................02
(LAM) of family planning/birth spacing? DON’T KNOW ..........................................98
[Up to 6 months after childbirth, a woman

can use a method that requires that she
breastfeeds frequently, day and night, and
that her menstrual period has not returned.]
and counseling about birth spacing, that is., NO ............................................................02
the healthy interval of time to wait before DON’T KNOW ..........................................98
trying to become pregnant again?
and counseling about family planning/birth NO ............................................................02 Æ712
spacing methods -- the various ways or DON’T KNOW ..........................................98 Æ712
methods that a couple can use to delay or
avoid a pregnancy?
711. Which family planning/birth spacing FEMALE STERILIZATION………………..01
methods did you receive information about? MALE STERILIZATION…………………...02
PILL………………………………………….03
Probe: Any others? IUD …………………………………………..04
INJECTABLES …………………………….05
IMPLANTS …………………………………06
CONDOM …………………………………..07
FEMALE CONDOM ………………………08
DIAPHRAGM ………………………………09
FOAM/JELLY ……………………………...11
LACTATIONAL AMEN. METHOD ………12
PERIODIC ABSTINENCE ………………..13
WITHDRAWAL ……………………………14
OTHER __________________________ 97
(SPECIFY)
712. During this visit, did you select and receive YES ..........................................................01 Æ714
a family planning/birth spacing method? NO ............................................................02
DON’T KNOW/DON’T REMEMBER ........98 Æ715
October 30,2006 35
713. Why did you NOT receive a family WANT TO HAVE ANOTHER BABY
planning/spacing method? SOON……...........................................01
PREFERRED METHOD OUT OF
STOCK………………………………..…02
HUSBAND NOT PRESENT AT VISIT TO
APPROVE ……………………………...03
DID NOT HAVE WRITTEN APPROVAL OF
HUSBAND…….. .................................04
NOT SEXUALLY ACTIVE........................05
HUSBAND DOES NOT LIKE FAMILY
PLANNING AND WOULD NOT ALLOW
IT…….. ................................................06
DON’T KNOW ..........................................98

OTHER __________________________ 97
(SPECIFY)
714. Which family planning/birth spacing method FEMALE STERILIZATION………………..01
did you receive? MALE STERILIZATION…………………...02
PILL………………………………………….03
IUD …………………………………………..04
INJECTABLES …………………………….05
IMPLANTS …………………………………06
CONDOM …………………………………..07
FEMALE CONDOM ………………………08
Probe: Any others? DIAPHRAGM ………………………………09
FOAM/JELLY ……………………………...11
LACTATIONAL AMEN. METHOD ………12
PERIODIC ABSTINENCE ………………..13
WITHDRAWAL ……………………………14
OTHER __________________________ 97
(SPECIFY)
715. CHECK 701: RECEIVED POSTPARTUM
CARE? YES ---------------------------------------- Æ717
NO DON’T KNOW ---------------------------- Æ717

↓
716. Why did no one check on your health after
the birth of your child? 1. ________________________________
2. ________________________________
3. ________________________________
717. During the 2 days after the birth of your YES ..........................................................01
child, did you experience any serious health NO ............................................................02 Æ801
problems related to the birth? DON’T KNOW ..........................................98 Æ801
October 30,2006 36
SEVERE BLEEDING....... 01....................01
THEN PROBE: Did you experience [ANY SEVERE HEADACHE..... 02....................02
REMAINING COMPLICATIONS]? BLURRED VISION .......... 03....................03
CONVULSIONS .............. 04....................04
SWOLLEN
HANDS/FACE ............ 05....................05
HIGH FEVER................... 06....................06
MALODOROUS
VAGINAL
DISCHARGE .............. 07....................07
LOSS OF
CONSCIOUSNESS ... 08....................08
DIFFICULTY
BREATHING .............. 09....................09
SEVERE WEAKNESS .... 10....................10
OTHER __________________________ 97
(SPECIFY)
DON’T KNOW ..........................................98
719. Which one of these problems was the most SEVERE BLEEDING................................01
severe? SEVERE HEADACHE..............................02
BLURRED VISION ...................................03
CONVULSIONS .......................................04
SWOLLEN HANDS/FACE .......................05
HIGH FEVER............................................06
MALODOROUS
VAGINAL DISCHARGE......................07
LOSS OF CONSCIOUSNESS .................08
DIFFICULTY BREATHING ......................09
SEVERE WEAKNESS .............................10
OTHER __________________________ 97
(SPECIFY)
DON’T KNOW ..........................................98
October 30,2006 37
720. Where were you when you developed this HOME
problem? RESPONDENT’S HOME ....................11
TBA’S HOME......................................12
OTHER HOME ....................................13
PUBLIC SECTOR
GVT. HOSPITAL .................................21 Æ731
GVT. HEALTH CENTER.....................22
GVT.DISPENSARY.............................23
OTHER PUBLIC ________________ 26

(SPECIFY)
PRIVATE SECTOR
PVT. HOSPITAL .................................31 Æ731
MATERNITY/NURSING HOME ..........32 Æ731
OTHER PRIVATE _______________ 36 Æ731

(SPECIFY)
OTHER __________________________ 97
(SPECIFY)
721. Did you seek assistance for this problem? YES ..........................................................01 Æ723
NO ............................................................02
DON’T KNOW ..........................................98 Æ801
722. Why did you not seek assistance for this RESP. DIDN’T THINK NECESSARY.......01
THINK NECESSARY ..........................02
Anything else? FACILITY TOO FAR ................................03
NO TRANSPORT .....................................04
PROBE FOR THE REASONS AND NO CHILDCARE ...................................... 05
RECORD ALL REASONS MENTIONED. TOO EXPENSIVE.....................................06
SERVICES ARE POOR ...........................07
USED HOME REMEDY............................08
DID NOT KNOW WHERE TO GO............09
NO TIME TO GO ......................................10
OTHER __________________________ 97
(SPECIFY)
DON’T KNOW ..........................................98
October 30,2006 38
723. Who made the final decision about whether NO ONE ...................................................01
or not you would go somewhere for RESPONDENT.........................................02
assistance? RESPONDENT & HUSBAND ..................03
HUSBAND................................................04
RESP.’S MOTHER ...................................05
RESP.’S FATHER ....................................06
MOTHER-IN-LAW ....................................07
FATHER-IN-LAW .....................................08
SISTER/SISTER-IN-LAW.........................09
OTHER MEMBER OF RESP.’S FAM ......10
OTHER MEMBER OF HUSB.’S FAM ......11
FRIEND/NEIGHBOR ................................12
HEALTH PROFESSIONAL......................13
TBA ..........................................................14
OTHER __________________________ 97
(SPECIFY)
DON’T KNOW ..........................................98
724. How long did it take to make the decision
about whether or not to go somewhere for HOURS.......................................... 1
assistance?
MINUTES ...................................... 2
IF LESS THAN 2 HOURS, RECORD IN DON’T KNOW ..........................................98
HOURS.
NO ---------------------------------------- Æ744
YES
↓ DON’T KNOW ---------------------------- Æ744
726. Did you go to a health facility for NO, DID NOT GO. ....................................11
assistance?
PUBLIC SECTOR
IF YES: Which facility did you go first? GOVT. HOSPITAL. .............................21
GOVT. PRIMARY HEALTH CARE
CENTER (PHC)...................................22
GOVT. DISPENSARY. ........................23
OTHER PUBLIC ________________ 26

___________________________________ (SPECIFY)
(NAME OF PLACE)
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL .................................31
MATERNITY/NURSING HOME ..........32
OTHER PRIVATE _______________ 36

(SPECIFY)
OTHER __________________________ 97
(SPECIFY)
October 30,2006 39
727. Who accompanied you to seek care? NO ONE ...................................................01
HUSBAND................................................02
PROBE FOR THE PERSON(S) RESP.’S MOTHER ...................................03
ACCOMPANYING AND RECORD ALL RESP.’S FATHER ....................................04
PERSONS. MOTHER-IN-LAW ....................................05
FATHER-IN-LAW .....................................06
SISTER/SISTER-IN-LAW.........................07
OTHER MEMBER OF RESP.’S FAM ......08
OTHER MEMBER OF HUSB.’S FAM ......09
FRIEND/NEIGHBOR ................................10
HEALTH PROFESSIONAL......................11
TBA ..........................................................12
OTHER __________________________ 98
(SPECIFY)
728. How long did it take to find transport once a
decision was made to seek care? HOURS…………………………1
IF LESS THAN 2 HOURS, RECORD IN MINUTES………………………2

MINUTES. OTHERWISE, RECORD IN DON’T KNOW ..........................................98
HOURS.
HOURS…………………………1
MINUTES. OTHERWISE, RECORD IN MINUTES………………………2
HOURS. DON’T KNOW ..........................................98
730. How long was the time between when you
arrived at the facility and the time you were HOURS…………………………1
first examined by a healthcare provider?
MINUTES………………………2
MINUTES. OTHERWISE, RECORD IN IMMEDIATELY .............................. 3
HOURS. DON’T KNOW ..........................................98
731. Whom did you see for assistance for this HEALTH PROFESSIONAL
health problem? DOCTOR.............................................01
NURSE/ MIDWIFE ..............................02
Anyone else? CLINICAL OFFICER ...........................03
PROBE FOR THE TYPE OF PERSON AND OTHER PERSON

RECORD ALL PERSONS SEEN. TBA .....................................................04
COMMUNITY HEALTH WORKER......05
RELATIVE/FRIEND ............................06
OTHER __________________________ 97
(SPECIFY)
732. Have you paid any money for the services YES ..........................................................01
provided? NO ............................................................02 Æ734
DON’T KNOW ........................................ 98 Æ734
733. How much money did you pay for the NAIRA: _________________________
services provided
734. Did you undergo any diagnostic tests? YES ..............................................................01
NO ................................................................02 Æ736
DON’T KNOW ..............................................98 Æ736
October 30,2006 40
736. Did you and your support person spend YES ..........................................................01
money on transportation or food/lodging? NO ............................................................02 Æ739
DON’T KNOW ..............................................98 Æ739
737. How much did you and your support person NAIRA: _________________________
spend on food/lodging?
738. How much did you and your support person NAIRA: _________________________
spend on transport?
739. Were you prescribed any medicines? YES ..........................................................01
NO ............................................................02 Æ741
DON’T KNOW ..............................................98 Æ741
740. How much did you spend on medicines? NAIRA: _________________________
741. Did you incur any other costs at the facility? YES ..........................................................01
NO ............................................................02 Æ743
DON’T KNOW ..............................................98 Æ743
742. How much?
NAIRA: _________________________
743. In all, how many days did you abstain from
any work (housework or other work)? DAYS:
744. Now I would like to ask you about the first 7 YES, URINE .............................................01
days after the birth of your last child. During YES, FAECES ..........................................02
the 7 days after the birth of your last child, YES, URINE AND FAECES .....................03
did you experience continuous, uncontrolled NO ............................................................04 Æ748
leakage of urine or feces from the vagina?
(“Continuous” is defined as lasting during
both day and night; “uncontrolled” is defined
as uncontrolled leakage of urine from the
vagina (does NOT include stress or urge
incontinence), or uncontrolled leakage of
feces from the vagina, during the first seven
days following delivery.)
745. What do you think caused the leakage? DIFFICULT LABOR………………………..01
LABOR MISMANAGED BY HEALTH
CARE PROVIDER………..……………02
CURSE………………………………………03
WITCHCRAFT………………...……………04
OTHER __________________________ 97
(SPECIFY)
746. Did you seek assistance from a hospital or YES ..........................................................01 Æ748
other health facility for this leakage? NO ............................................................02
October 30,2006 41
747. Why did you not seek assistance? RESP. DIDN’T THINK NECESSARY.......01
HUSBAND/FAMILY DIDN’T
DO NOT PROMPT. CIRCLE ALL THINK NECESSARY ..........................02
MENTIONED. FACILITY TOO FAR ................................03
NO TRANSPORT .....................................04
DID NOT KNOW THERE WAS A
TREATMENT/CURE ...........................05
TOO EXPENSIVE.....................................06
SERVICES ARE POOR ...........................07
USED HOME OR TRADITIONAL
REMEDY ............................................08
DID NOT KNOW WHERE TO GO............09
NO TIME TO GO ......................................10
OTHER __________________________ 97
(SPECIFY)
748. How many women in your family developed NONE .......................................................00 Æ801
continuous, uncontrolled leakage of urine or ONE..........................................................01
feces from the vagina soon after delivery TWO .........................................................02
(e.g., about 7 days)? (“Continuous” is THREE OR MORE ...................................03
defined as lasting during both day and night;
“uncontrolled” is defined as uncontrolled
leakage of urine from the vagina (does NOT
include stress or urge incontinence), or
uncontrolled leakage of feces from the
vagina, during the first seven days following
delivery.)
749. What do you think caused the leakage? DIFFICULT LABOR………………………..01
LABOR MISMANAGED BY HEALTH
CARE PROVIDER………..……………02
CURSE………………………………………03
WITCHCRAFT………………...……………04
OTHER __________________________ 97
(SPECIFY)
October 30,2006 42
SECTION 8: PERSONAL EXPERIENCE RELATED TO LAST BIRTH:

POSTPARTUM CARE FOR NEWBORN
801. CHECK 210: MOST RECENT BIRTH WAS
A LIVE BIRTH? NO ---------------------------------------- ÆSec. 9
YES
↓
802. After you gave birth, did someone check on YES .......................................................... 01
the health of your baby within the first 6 NO............................................................ 02 Æ809
weeks after his/her birth? DON’T KNOW.......................................... 98 Æ810
NOTE: IF THE BIRTH WAS A MULTIPLE
BIRTH, ASK THE FOLLOWING SET OF
QUESTIONS ABOUT THE LAST BABY
BORN.
803. When did someone first check on the health
of your baby after you gave birth? HOURS ..........................................1
DAYS .............................................2
WEEKS ..........................................3
DON’T KNOW.......................................... 98
804. Where did this first checkup take place? HOME
RESPONDENT’S HOME .................... 11
TBA’S HOME ..................................... 12
OTHER HOME.................................... 13
___________________________________ PUBLIC SECTOR

(NAME OF PLACE) GVT. HOSPITAL................................. 21
GVT. HEALTH CENTER .................... 22
GVT.DISPENSARY ............................ 23
OTHER PUBLIC_________________ 26
(SPECIFY)
PRIVATE SECTOR
PVT. HOSPITAL ................................. 31
MATERNITY/NURSING HOME .......... 32
OTHER PRIVATE _______________ 36

(SPECIFY)
OTHER __________________________ 97
(SPECIFY)
805. Who checked on the health of your baby at DOCTOR.................................................. 01
that time? NURSE/ MIDWIFE ................................... 02
CLINICAL OFFICER................................ 03
Anyone else? COMMUNITY HEALTH WORKER .......... 04
TBA.......................................................... 05
PROBE FOR THE TYPE OF PERSON RELATIVE/FRIEND ................................. 06
AND RECORD ALL PERSONS
CHECKING. OTHER __________________________ 97
(SPECIFY)
DON’T KNOW..........................................98
October 30,2006 43
806. At this visit, did you receive information and

counseling about care of your baby, YES NO DK
including:
Exclusive breastfeeding? BRSTFDG ........... 01……02............98
Cord care? CORD CARE ....... 01……02............98
Keeping the baby warm/skin to skin? WARM ................. 01……02............98
Danger signs in the newborn? DANGER SIGNS . 01……02............98

Where to seek care for the newborn in case SEEK CARE........ 01……02............98
of emergency?
[DK= Don’t know]
807. CHECK 802: RECEIVED NEWBORN

CARE? YES ---------------------------------------- Æ809
NO DON’T KNOW ---------------------------- Æ809

↓
808. Why did no one check on the health of your 1. _________________________________
baby within the first 6 weeks after his/her 2. _________________________________
birth?
3. _________________________________
809. During the 7 days after the birth of your YES .......................................................... 01
child, did he/she experience any serious NO............................................................ 02 ÆSec. 9
health problems? DON’T KNOW.......................................... 98 ÆSec. 9
810. What problems did he/she experience? DIFFICULTY OR FAST BREATHING ..... 01
(CIRCLE ALL RESPONSES GIVEN.) YELLOW SKIN/EYE COLOR
(JAUNDICE) ....................................... 02
PROBE FOR THE TYPES OF PROBLEMS POOR SUCKING OR FEEDING .............. 03
AND RECORD ALL PROBLEMS. PUS, BLEEDING, OR DISCHARGE FROM
AROUND THE UMBILICAL CORD .... 04
BABY VERY SMALL ............................... 05
SKIN LESIONS OR BLISTERS ............... 06
CONVULSIONS/SPASMS/RIGIDITY ...... 07
LETHARGY/UNCONSCIOUSNESS ........ 08
RED OR SWOLLEN EYES WITH PUS ... 09
OTHER __________________________ 97
(SPECIFY)
DON’T KNOW.......................................... 98
October 30,2006 44
811. Which one of these problems was the most DIFFICULTY OR FAST BREATHING ..... 01
severe? YELLOW SKIN/EYE
COLOR (JAUNDICE) ......................... 02
POOR SUCKING OR FEEDING .............. 03
PUS, BLEEDING, OR DISCHARGE FROM
AROUND THE UMBILICAL CORD .... 04
BABY VERY SMALL ............................... 05
SKIN LESIONS OR BLISTERS ............... 06
CONVULSIONS/SPASMS/RIGIDITY ...... 07
LETHARGY/UNCONSCIOUSNESS ........ 08
RED OR SWOLLEN EYES WITH PUS ... 09
OTHER __________________________ 97
(SPECIFY)
DON’T KNOW.......................................... 98
812. Where were you and the baby when he/she HOME
developed this problem? RESPONDENT’S HOME .................... 11
TBA’S HOME ..................................... 12
OTHER HOME.................................... 13
PUBLIC SECTOR
GOVT. HOSPITAL.............................. 21 Æ845
GOVT. HEALTH CENTER.................. 22
GOVT.DISPENSARY.......................... 23
OTHER PUBLIC_________________ 26
(SPECIFY)
PRIVATE SECTOR
PVT. HOSPITAL ................................. 31 Æ845
MATERNITY/NURSING HOME .......... 32 Æ845
OTHER PRIVATE _______________ 36 Æ845

(SPECIFY)
OTHER __________________________ 97
(SPECIFY)
813. Did you seek assistance for this problem? YES .......................................................... 01 Æ815
NO............................................................ 02
DON’T KNOW.......................................... 98 ÆSec. 9
814. Why did you not seek assistance for this RESP. DIDN’T THINK NECESSARY ...... 01
THINK NECESSARY .......................... 02
Anything else? FACILITY TOO FAR ................................ 03
NO TRANSPORT..................................... 04
PROBE FOR THE REASONS AND NO CHILDCARE...................................... 05
RECORD ALL REASONS MENTIONED. TOO EXPENSIVE .................................... 06
SERVICES ARE POOR ........................... 07
USED HOME REMEDY ........................... 08
DID NOT KNOW WHERE TO GO ........... 09
NO TIME TO GO...................................... 10
OTHER __________________________ 97
(SPECIFY)
DON’T KNOW.......................................... 98
October 30,2006 45
815. Who made the final decision about whether NO ONE ................................................... 01
or not to take the baby somewhere for RESPONDENT ........................................ 02
assistance? RESPONDENT & HUSBAND .................. 03
HUSBAND ............................................... 04
RESP.’S MOTHER................................... 05
RESP.’S FATHER.................................... 06
MOTHER-IN-LAW.................................... 07
FATHER-IN-LAW..................................... 08
SISTER/SISTER-IN-LAW ........................ 09
OTHER MEMBER OF RESP.’S FAM ...... 10
OTHER MEMBER OF HUSB.’S FAM...... 11
FRIEND/NEIGHBOR................................ 12
HEALTH PROFESSIONAL ..................... 13
TBA.......................................................... 14
OTHER __________________________ 97
(SPECIFY)
DON’T KNOW ...........................
816. How long did it take to make the decision
about whether or not to go somewhere for HOURS………………………….1
assistance?
MINUTES……………………….2
IF LESS THAN 2 HOURS, RECORD IN DON’T KNOW.......................................... 98
HOURS.
NO ---------------------------------------- ÆSec. 9
YES
↓ DON’T KNOW ---------------------------- ÆSec. 9
818. Was the baby taken to a health facility for NO, DID NOT GO..................................... 11
this assistance?
PUBLIC SECTOR
IF YES: Which facility was the baby taken GOVT. HOSPITAL.............................. 21
first? GOVT. PRIMARY HEALTH CARE
CENTER (PHC). ................................. 22
GOVT. DISPENSARY......................... 23
OTHER PUBLIC_________________ 26
(SPECIFY)
___________________________________
(NAME OF PLACE) PRIVATE MEDICAL SECTOR
PVT. HOSPITAL ................................. 31
MATERNITY/NURSING HOME .......... 32
OTHER PRIVATE _______________ 36

(SPECIFY)
OTHER __________________________ 97
(SPECIFY)
October 30,2006 46
819. Who took the baby to seek care? RESPONDENT ........................................ 01

HUSBAND ............................................... 02
PROBE FOR THE PERSON(S) RESP.’S MOTHER................................... 03
ACCOMPANYING AND RECORD ALL RESP.’S FATHER.................................... 04
PERSONS. MOTHER-IN-LAW.................................... 05
FATHER-IN-LAW..................................... 06
SISTER/SISTER-IN-LAW ........................ 07
OTHER MEMBER OF RESP.’S FAM ...... 08
OTHER MEMBER OF HUSB.’S FAM...... 09
FRIEND/NEIGHBOR................................ 10
HEALTH PROFESSIONAL ..................... 11
TBA.......................................................... 12
OTHER __________________________ 97
(SPECIFY)
820. How long did it take to find transport once a
decision was made to seek care? HOURS………………………….1
IF LESS THAN 2 HOURS, RECORD IN MINUTES……………………….2

MINUTES. OTHERWISE, RECORD IN DON’T KNOW..........................................98
HOURS.
HOURS………………………….1
MINUTES. OTHERWISE, RECORD IN MINUTES……………………….2
HOURS. DON’T KNOW..........................................98
822. How long was the time between when your
baby arrived at the facility and the time your HOURS………………………….1
baby was first examined by a healthcare
provider? MINUTES……………………….2
IF LESS THAN 2 HOURS, RECORD IN IMMEDIATELY............................... 3

MINUTES. OTHERWISE, RECORD IN DON’T KNOW..........................................98
HOURS.
823. Whom did your baby see for assistance for HEALTH PROFESSIONAL
this health problem? DOCTOR ............................................ 01
NURSE/ MIDWIFE .............................. 02
Anyone else? CLINICAL OFFICER........................... 03
PROBE FOR THE TYPE OF PERSON OTHER PERSON

AND RECORD ALL PERSONS SEEN. TBA..................................................... 04
COMMUNITY HEALTH WORKER ..... 05
RELATIVE/FRIEND ............................ 06
OTHER __________________________ 97
(SPECIFY)
824. Have you paid any money for the services YES .............................................................. 01
provided to your baby? NO................................................................ 02 Æ826
DON’T KNOW.........................................98 Æ826
825. How much money did you pay for the NAIRA……………….
services provided
DON’T KNOW.........................................98
826. Did your baby undergo any diagnostic YES .............................................................. 01
tests? NO................................................................ 02 Æ828
DON’T KNOW.............................................. 98 Æ828
October 30,2006 47

828. Did you spend money on transportation or YES .............................................................. 01 Æ831
food/lodging? NO................................................................ 02 Æ831
DON’T KNOW.............................................. 98
829. How much did you spend on food/lodging? NAIRA: _________________________
830. How much did you spend on transport? NAIRA: _________________________
831. Was your baby prescribed any medicines? YES .............................................................. 01

NO................................................................ 02 Æ833
DON’T KNOW.............................................. 98 Æ833
832. How much did you spend on medicines? NAIRA: _________________________
833. Did you incur any other costs at the facility YES .............................................................. 01
for the treatment of your baby? NO................................................................ 02 Æ835
DON’T KNOW.............................................. 98 Æ835
834. How much?
NAIRA: _________________________
835. In all, how many days did you abstain from
work (housework and other work)? DAYS:
October 30,2006 48
SECTION 9. PERSONAL EXPERIENCE WITH BREASTFEEDING AND

POSTPARTUM FAMILY PLANNING, INCLUDING LAM
Now I’d like to ask you some questions about your experience with family planning – the various ways or
methods that a couple can use to delay or avoid a pregnancy.
901. Has your period returned since the birth of YES ............................................................ 01 ”
your most recent baby? NO .............................................................. 02
902. For how many months after the birth of
your most recent baby did you NOT have MONTHS
period?
DON”T KNOW ........................................... 98
903. CHECK 105: CURRENTLY PREGNANT?
YES ---------------------------------------- Æ904
NO
↓
904. CHECK 210: WAS BABY BORN ALIVE?

NO ---------------------------------------- Æ914
YES
↓
905. Did you ever breastfeed your baby? YES .......................................................... 01
NO ............................................................ 02 Æ914
906. How long after birth did you first put the DURING THE FIRST HOUR AFTER
baby to the breast? BIRTH ...................................................... 01
MORE THAN ONE HOUR ....................... 02
DON’T KNOW.......................................... 98
907. Did you give the baby the first liquid (local YES ............................................................ 1
term) that came from your breasts? NO .............................................................. 2
908. Are you still breastfeeding your baby? YES .............................................................. 1

NO .............................................................. 2 Æ914
909. For how many months did you breastfeed
your baby? MONTHS
DON’T KNOW............................................ 98
October 30,2006 49
910. Now I would like to ask you about the types
of liquids your most recent baby drank
yesterday during the day and at night.
Did your most recent baby drink any of the

following liquids yesterday during the day or
at night?
READ THE LIST OF LIQUIDS (A

THROUGH G, STARTING WITH
“BREASTMILK”). PLACE A CHECK MARK
IN THE BOX IF CHILD DRANK LIQUID IN
QUESTION.
A ..................................................... |___|
Breastmilk?
Plain water? B ..................................................... |___|
Fruit juice C ..................................................... |___|
Any other liquids (Commercially produced D ..................................................... |___|

infant formula, animal milk, powdered milk,
etc.)?
911. How many times did you breastfeed NUMBER OF DAYLIGHT FEEDINGS:
yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE

FOR APPROXIMATE NUMBER
912. How many times did you breastfeed last NUMBER OF NIGHT TIME FEEDINGS:
night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE

FOR APPROXIMATE NUMBER
913. How many times did your baby eat solid, NUMBER OF TIMES:
semi-solid or soft foods other than liquids
yesterday during the day or at night? DON’T KNOW ................................... 98
If seven or more times, record ‘7’

Now I’d like to ask you some questions about your experience with family planning – the various ways or
methods that a couple can use to delay or avoid a pregnancy.
Which ways or methods have you heard about? FOR METHODS NOT MENTIONED SPONTANEOUSLY,
ASK: Have you ever heard of (METHOD)?
914. FEMALE STERILIZATION [Women can Unprompted Prompted

have an operation to avoid having any YES………………1 YES………………1
more children] NO………………..2 NO………………..2
915. MALE STERILIZATION [Men can have an Unprompted Prompted

operation to avoid having any more YES………………1 YES………………1
children] NO………………..2 NO………………..2
October 30,2006 50
916. PILL [Women can take a pill every day to Unprompted Prompted
avoid becoming pregnant] YES………………1 YES………………1
NO………………..2 NO………………..2
917. IUD [Women can have a loop or coil Unprompted Prompted
placed inside them by a doctor or nurse.] YES………………1 YES………………1
NO………………..2 NO………………..2
918. INJECTABLES [Women can have an Unprompted Prompted
injection by a health provider which stops YES………………1 YES………………1
them from becoming pregnant for one or NO………………..2 NO………………..2
more months.]
919. IMPLANTS [Women can have several Unprompted Prompted
small rods placed in their upper arm by a YES………………1 YES………………1
doctor or nurse, which can prevent NO………………..2 NO………………..2
pregnancy for one or more years.]
920. CONDOM [Men can put a rubber sheath Unprompted Prompted
on their penis before sexual intercourse] YES………………1 YES………………1
NO………………..2 NO………………..2
921. FEMALE CONDOM [Women can place a Unprompted Prompted
sheath in their vagina before sexual YES………………1 YES………………1
intercourse] NO………………..2 NO………………..2
922. DIAPHRAGM [Women can place a thin Unprompted Prompted
flexible disk in their vagina before sexual YES………………1 YES………………1
intercourse] NO………………..2 NO………………..2
923. FOAM OR JELLY [Women can place a Unprompted Prompted
suppository, jelly or cream in their vagina YES………………1 YES………………1
before intercourse] NO………………..2 NO………………..2
924. LACTATIONAL AMENORRHEA Unprompted Prompted
METHOD (LAM) [Up to 6 months after YES………………1 YES………………1
childbirth, a woman can use a method that NO………………..2 NO………………..2
requires that she breastfeeds frequently,
day and night, and that her menstrual
period has not returned.]
925. RHYTHM OR PERIODIC ABSTINENCE Unprompted Prompted
[Every month that a woman is sexually YES………………1 YES………………1
active she can avoid pregnancy by not NO………………..2 NO………………..2
having sexual intercourse on the days of
the month when she is most likely to get
pregnant.]
926. WITHDRAWAL [Men can be careful and Unprompted Propmpted
pull out before climax.] YES………………1 YES………………1
NO………………..2 NO………………..2
927. EMERGENCY CONTRACEPTION Unprompted Prompted
[Women can take pills up to three days YES………………1 YES………………1
after sexual intercourse to avoid becoming NO………………..2 NO………………..2
pregnant.]
928. Have you heard of any other ways or YES……………………………………………1
methods that women or men can use to ______ _____________________________
avoid pregnancies? (SPECIFY)
____ _______________________________
If so, mention them.
(SPECIFY)
NO………………………………………………2
October 30,2006 51
929. In your opinion, what is the healthy 3 TO 5 YEARS……………………………….01
interval of time for spacing pregnancies? OTHER………………………………………..97
DON’TKNOW…………………………………98
930. CHECK 105: CURRENTLY PREGNANT?
YES ---------------------------------------- ÆSec. 10
NO
↓
931. Are you currently doing something or YES............................................................... 1
using any method to delay or avoid NO………………………………………………2 ÆSec. 10
getting pregnant?
932. What is the MAIN method of FEMALE STERILIZATION……..……………01
contraception, family planning or [child MALE STERILIZATION………..…………….02
spacing] you are using now? PILL…………………………..….……………..03
IUD…………………………….………………..04
IF MORE THAN ONE METHOD INJECTABLES………………………………..05
MENTIONED, FOLLOW SKIP IMPLANTS………….…………………………06
INSTRUCTION FOR HIGHEST CONDOM…………………..………………….07
METHOD ON LIST. FEMALE CONDOM……….……….…………08
DIAPHRAGM………………………….………09
FOAM/JELLY………………………………….10
LACTATIONAL AMEN. METHOD………….11
PERIODIC ABSTINENCE……………………12
WITHDRAWAL………………………………..13
OTHER __________________________ 97
(SPECIFY)
933. In what month and year was the MONTH………………………….
sterilization performed?
YEAR……………..
OR
For how long have you been using

(CURRENT METHOD) now without
stopping?
PROBE: In what month and year did you

start using (CURENT METHOD)
continuously?
934. CHECK 932: CURRENTLY USING LAM?
NO ---------------------------------------- Æ937
YES
↓
935. If using LAM: Can you tell me what are CHILD LESS THAN 6 MONTHS OLD……..01
the 3 conditions that must be met to be EXCLUSIVELY OR PREDOMINANTLY
able to use LAM? BREASTFEEDING……………………….02
NO MENSES……………………………….…03
(CIRCEL ALL MENTIONED) OTHER………………………………………...97
October 30,2006 52
936. If using LAM: What method do you plan FEMALE STERILIZATION……..……………01
to use once you have finished using MALE STERILIZATION………..…………….02
LAM? PILL…………………………..….……………..03
IUD…………………………….………………..04
INJECTABLES………………………………..05
IMPLANTS………….…………………………06
CONDOM…………………..………………….07
FEMALE CONDOM……….……….…………08
DIAPHRAGM………………………….………09
FOAM/JELLY………………………………….10
WITHDRAWAL………………………………..13
OTHER __________________________ 97
(SPECIFY)
937. Where did you obtain (CURENT PUBLIC SECTOR
METHOD) when you started using it? GOVT. HOSPITAL ..............................21
GOVT. HEALTH CENTER ..................22
Or for LAM users: GOVT.DISPENSARY.. .................... …23
MOBILE CLINIC………………………….24
Where did you learn to use the lactational COMMUNITY HEALTH EXTENSION
amenorrhea method? WORKER (CHEW)………………………25
IF THE SOURCE IS HOSPITAL,

HEALTH CENTER, OR CLINIC, WRITE OTHER PUBLIC ________________ 26
THE NAME OF THE PLACE, PROBE TO (SPECIFY)
IDENTIFY THE TYPE OF SOURCE AND
CIRCLE THE APPROPRIATE CODE. PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC.....................31
____________________________
PHARMACY/PATENT MEDICINE
(NAME OF PLACE)
STORE ................................................32
PRIVATE DOCTOR………………………33
MOBILE CLINIC…………………………..34
COMMUNITY HEALTH WORKER……35
OTHER PRIVATE _______________ 36

(SPECIFY)
OTHER SOURCE
SHOP………………………………………..37
CHURCH……………………………………38
FRIEND/RELATIVE………………………..39
NGO………………………………………….40
OTHER __________________________ 97
(SPECIFY)
938. You first obtained (CURRENT METHOD) YES............................................................. 01
from (SOURCE OF METHOD). At that NO .............................................................. 02
time, were you told about the benefits DON’T KNOW ............................................ 98
you might have with the method?
939. Were you ever told by a health worker YES............................................................. 01
about side effects or problems you might NO .............................................................. 02
have with the method? DON’T KNOW ............................................ 98
940. Were you told by a health worker what to YES............................................................. 01

do if you experienced side effects or NO .............................................................. 02
problems? DON’T KNOW ............................................ 98
October 30,2006 53
941. Were you ever told by a health worker YES............................................................. 01
about other methods of family planning NO .............................................................. 02
that you could use? DON’T KNOW ............................................. 98
942. What methods did the health worker tell FEMALE STERILIZATION……..……………01
you about? MALE STERILIZATION………..…………….02
PILL…………………………..….……………..03
Probe: Any others? IUD…………………………….………………..04
INJECTABLES………………………………..05
IMPLANTS………….…………………………06
CONDOM…………………..………………….07
FEMALE CONDOM……….……….…………08
DIAPHRAGM………………………….………09
FOAM/JELLY………………………………….10
WITHDRAWAL………………………………..13
OTHER __________________________ 97
(SPECIFY)
943. Do you know of a place where you can YES............................................................. 01
obtain a method of family planning? NO .............................................................. 02 Æ Sec. 10
944. Where is that? PUBLIC SECTOR
GOVT. HOSPITAL ..............................21
IF THE SOURCE IS HOSPITAL, GOVT. HEALTH CENTER ..................22
HEALTH CENTER, OR CLINIC, WRITE GOVT.DISPENSARY ..........................23
THE NAME OF THE PLACE, PROBE TO MOBILE CLINIC………………………….24
IDENTIFY THE TYPE OF SOURCE AND COMMUNITY HEALTH EXTENSION
CIRCLE THE APPROPRIATE CODE. WORKER (CHEW)………………………25
____________________________
(NAME OF PLACE) OTHER PUBLIC ________________ 26
(SPECIFY)
PRIVATE MEDICAL SECTOR

PVT. HOSPITAL/CLINIC.....................31
PHARMACY/PATENT MEDICINE
STORE ................................................32
PRIVATE DOCTOR………………………33
MOBILE CLINIC…………………………..34
COMMUNITY HEALTH WORKER……35
OTHER PRIVATE _______________ 36

(SPECIFY)
OTHER SOURCE
SHOP………………………………………..41
CHURCH……………………………………42
FRIEND/RELATIVE………………………..43
NGO………………………………………….44
OTHER __________________________ 97
(SPECIFY)
October 30,2006 54
SECTION 10. FERTILITY PREFERENCES

1001. CHECK QUESTION 934: IS EITHER THE RESPONDENT OR HUSBAND STERILIZED?
IF NOT, PROCEED. IF YES, GO TO QUESTION 1101.
1002. NOT PREGNANT OR UNSURE: HAVE (A/ANOTHER) CHILD……………01
Now I have some questions about the NO MORE/NONE…………………………02 Æ1004
future. Would you like to have (a/another) SAYS SHE CAN’T GET PREGNANT…..03 ÆSec.11
child, or would you prefer not to have any UNDECIDED/DON’T KNOW:
(more) children? AND PREGANT………………………….04 Æ1006
AND NOT PREGNANT OR UNSURE..05 Æ1006
PREGNANT: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?
1003. NOT PREGNANT OR UNSURE:
How long would like to wait from now MONTHS…………………….01
before the birth of (a/another) child?
YEARS……………….02
PREGNANT: After the birth of the child
you are expecting now, how long would SOON/NOW………………………………993
you like to wait before the birth of another SAYS SHE CAN’T GET PREGNANT…994
child? AFTER MARRIAGE……………………..995
OTHER _________________________ 997

(SPECIFY)
DON’T KNOW.......................................998
• CHECK QUESTION 105. TO SEE IF SHE IS PREGNANT. IF PREGNANT, GO TO QUESTION
1005.
• IF NOT PREGNANT, CHECK QUESTION 934 TO SEE IF SHE IS USING A CONTRACEPTIVE

METHOD. IF YES, GO TO QUESTION 1101.
• IF NOT USING A METHOD OF CONTRACEPTION, AND ANSWER TO QUESTION 1003 IS

EQUAL TO 24 OR MORE MONTHS OR 2 OR MORE YEARS, PROCEED TO QUESTION
1004 . IF ANSWER TO QUESTION 1003 IS LESS THAN 24 MONTHS, GO TO QUESTION
1005.
October 30,2006 55
1004. ---- WANTS TO HAVE A/ANOTHER NOT MARRIED……………………………01
CHILD:
You have said that you do not want FERTILITY-REALTED REASONS
(a/another) child soon, but you are not NOT HAVING SEX…………………….02
using any method to avoid pregnancy. INFREQUENT SEX……………………03
Can you tell me why? MENOPAUSAL/HYSTERECTOMY….04
SUBFECUND/INFECUND……………05
Any other reason? POSTPARTUM AMENORRHEIC……..06
BREASTFEEDING……………………..07
RECORD ALL REASONS MENTIONED. GOD WILL DECIDE/FATE……………08
--- WANTS NO MORE/NONE OPPOSITION TO USE
You have said that you do not want any RESOPNDENT OPPOSED……………..09
(more) children, but you are not using any HUSBAND/PARTNER OPPOSED…….10
method to avoid pregnancy. Can you tell
OTHERS OPPOSED……………………11
me why?
RELIGIOUS PROHIBITION…………….12
Any other reason?
LACK OF KNOWLEDGE
KNOWS NO METHOD…………………13
KNOWS NO SOURCE………………….14
METHOD-RELATED REASONS
HEALTH CONCERNS…………………..15
FEAR OF SIDE EFFECTS……………..16
LACK OF ACCESS/TOO FAR…………17
COSTS TOO MUCH……………………..18
INCONVENIENT TO USE………………19
INTERFERES WITH BODY’S NATURAL
PROCESSES…………………………..20
OTHER __________________________ 97
(SPECIFY)
DON’T KNOW...........................................98
1005. Do you think you will use a contraceptive YES.............................................................01
method to delay or avoid pregnancy at NO...............................................................02
any time in the future? DON’T KNOW...........................................98
October 30,2006 56
SECTION 11. DECISIONMAKING/CARE SEEKING BEHAVIOR

1101. Now I would like to ask you some
questions about medical care for you
yourself.
Many different factors can prevent women
from getting medical advice or treatment
for themselves. When you are sick and
want to get medical advice or treatment, is
each of the following a big problem, a BIG SMALL NO
small problem or no problem? PROBLEM PROBLEM PROBLEM
A. Knowing where to go. 1 2 3

B. Getting permission to go. 1 2 3
C. Getting money needed for treatment.
1 2 3
D. The distance to a health facility.
1 2 3
E. Having to take transport.
1 2 3
F. Not wanting to go alone.
1 2 3
G. Concern that there may not be a
female health provider. 1 2 3
1102. Who do you think should take the WIFE…………………………………………01

decisions to use Family Planning/Child HUSBAND………………………………….02
Spacing? BOTH……………….……………………….03
EITHER OF THEM…………………………04
NEITHER OF THEM………….……………05
OTHER __________________________ 97
(SPECIFY)
DON’T KNOW.........................................98
October 30,2006 57
1103. How important to you personally are the
opinions of ______________ in the use of
Family Planning/Child Spacing?
[READ OUT OPTIONS] IMPORTANT NOT N/A

IMPORTANT
Spouse 1 2 9
Parent 1 2 9
Other relatives 1 2 9
Son 1 2 9
Daughter
1 2 9
Religious leaders
1 2 9
Health care workers
1 2 9
Community leaders
1 2 9
School teachers
1 2 9
Friends
1 2 9
October 30,2006 58
SECTION 12. MEDIA AND OTHER INFORMATION SOURCES

Thank you for the information you’ve provided thus far about pregnancy and birth. In the
last two sections of the questionnaire, I am going to ask you about the types of media you
use—for instance, reading the newspaper, listening to the radio, and watching TV.
Additionally, we will talk about information you may have received through media or
through other venues about pregnancy and preparing for birth.
1201.
1202.
1203.
1201. Which sources of information would be RADIO ......................................................... 01

appropriate for delivering messages on TV ............................................................... 02
preparing for birth to you? (CIRCLE ALL CINEMA....................................................... 03
RESPONSES GIVEN.) NEWSPAPER/MAGAZINE.......................... 04
POSTERS/PAMPHLETS............................. 05
PROBE: Any other sources? FRIENDS/NEIGHBORS .............................. 06
HEALTH WORKER ..................................... 07
WORKER
COMMUNITY VOLUNTEER
TBA ............................................................. 08
TRADITIONAL HEALERS .......................... 09
FLIPCHART ................................................ 10
CALENDARS .............................................. 11
PICTORIAL CARDS W/DRAWINGS........... 12
PICTORIAL CARDS W/PHOTOGRAPHS .. 13
BOOKLETS................................................. 14
BROCHURES.............................................. 15
STREET DRAMA ........................................ 16
OTHER ____________________________ 97
(SPECIFY)
October 30,2006 59
1202. Of the above mentioned sources, which RADIO ......................................................... 01

THREE do you prefer the most? TV ................................................................ 02
(CIRCLE THE THREE PREFERRED CINEMA....................................................... 03
SOURCES.) NEWSPAPER/MAGAZINE.......................... 04
POSTERS/PAMPHLETS............................. 05
FRIENDS/NEIGHBORS .............................. 06
HEALTH WORKER ..................................... 07
WORKER…………………………………08
COMMUNITY VOLUNTEER………………09
TBA ............................................................. 10
TRADITIONAL HEALERS .......................... 11
FLIPCHART ................................................ 12
CALENDARS .............................................. 13
PICTORIAL CARDS W/DRAWINGS........... 14
PICTORIAL CARDS W/PHOTOGRAPHS .. 15
BOOKLETS................................................. 16
BROCHURES.............................................. 17
STREET DRAMA ........................................ 18
OTHER ____________________________ 97
(SPECIFY)
October 30,2006 60
SECTION 13. EXPOSURE TO EDUCATION/COMMUNICATION

INTERVENTIONS
Now I would like to ask you a few questions about messages related to pregnancy that you
may have heard through the media.
1301. Have you seen, heard or read any YES .................................................................01
information related to birth NO...................................................................02 Æ Sec. 14
preparedness in the past six months? DON’T REMEMBER .......................................98 Æ Sec. 14
1302. From which source(s) did you see, RADIO.............................................................01
hear, or read about birth TV....................................................................02
preparedness? (CIRCLE ALL WRITTEN SOURCES .....................................03
RESPONSES GIVEN.) INTERPERSONAL SOURCES (TALKING
WITH PEOPLE) .........................................04
PROBE: Any other sources?
OTHER _____________________________ 97
(SPECIFY)
DON’T REMEMBER .......................................98
1303. Can you give me some examples of Source Healt Comm Writ Oth
Frien
messages related to birth h CHE unity ten er
Message Radio d/Rel
preparedness that you heard, saw, or Woke W Volunte
ative
read? r er/TBA
Y N Y N Y N Y N Y N Y N Y N
PROBE: Where did you hear about Transport
that? 1 2 1 2 1 2 1 2 1 2 1 2 1 2
PROBE: Any other messages? Y N Y N Y N Y N Y N Y N Y N

Money
1 2 1 2 1 2 1 2 1 2 1 2 1 2
Blood
1 2 1 2 1 2 1 2 1 2 1 2 1 2
Skilled
Provider
1 2 1 2 1 2 1 2 1 2 1 2 1 2
Other Y N Y N Y N Y N Y N Y N Y N
________
________ 1 2 1 2 1 2 1 2 1 2 1 2 1 2
1304. Did you discuss these messages with YES .................................................................01
anyone? NO...................................................................02 Æ 1306
DON’T REMEMBER .......................................98 Æ 1306
1305. With whom did you discuss these HUSBAND ......................................................01
messages? (CIRCLE ALL MOTHER.........................................................02
RESPONSES GIVEN.) MOTHER-IN-LAW...........................................03
SISTER ...........................................................04
PROBE: Anyone else? SISTER-IN-LAW .............................................05
FRIENDS.........................................................06
NEIGHBORS................................................... 07
COMMUNITY HEALTH WORKER .................08
TBA.................................................................09
TRADITIONAL HEALER ................................10
OTHER _____________________________ 97
(SPECIFY)
DON’T REMEMBER .......................................98
October 30,2006 61
1306. Did you do anything or take any action YES .................................................................01
related to birth preparedness after NO...................................................................02 ÆSec. 14
hearing the information? DON’T REMEMBER .......................................98 ÆSec. 14
1307. What action(s) did you take? (CIRCLE ARRANGE TRANSPORTATION....................01
ALL RESPONSES GIVEN.) ARRANGE MONEY ........................................02
ARRANGE BLOOD DONOR ..........................03
PROBE: Anything else? ARRANGE SKILLED PROVIDER ..................04
OTHER _____________________________ 97
(SPECIFY)
DON’T REMEMBER .......................................98
SECTION 14. PARTICIPATION IN COMMUNITY INTERVENTIONS

Now I would like to ask you a few questions about messages related to pregnancy that you
may have heard through community events or community members.
GO TO
Q. # QUESTION CODES
Q.
1401. Have you participated in any community YES.................................................................... 01
activities related to birth preparedness NO ..................................................................... 02 ÆEnd
in the past six months? interview
DON’T REMEMBER.......................................... 98 ÆEnd
interview
1402. Through which activities did you hear STREET DRAMA .............................................. 01
about birth preparedness? (CIRCLE COMMUNITY MEETINGS ................................. 02
ALL RESPONSES GIVEN.) MOTHER’S GROUPS ....................................... 03
LITERACY GROUPS ........................................ 04
PROBE: Any other sources? GROUP HEALTH EDUCATION SESSIONS BY
WORKERS…………………………………………05
OTHER _______________________________ 97
(SPECIFY)
DON’T REMEMBER.......................................... 98
October 30,2006 62
GO TO
Q. # QUESTION CODES
Q.
1403. Can you give me some examples of Source Mother’s
messages related to birth preparedness Drama Meeting Literacy Other
Message Group
that you learned about through these
activities? Y N Y N Y N Y N Y N
Transport
1 2 1 2 1 2 1 2 1 2
PROBE: Where did you learn about
that? Y N Y N Y N Y N Y N
Money
1 2 1 2 1 2 1 2 1 2
PROBE: Any other messages?
Y N Y N Y N Y N Y N
Blood
1 2 1 2 1 2 1 2 1 2
Skilled Y N Y N Y N Y N Y N
Provider
1 2 1 2 1 2 1 2 1 2
Other Y N Y N Y N Y N Y N
________
________ 1 2 1 2 1 2 1 2 1 2
1404. Did you later discuss what you learned YES.................................................................... 01
with anyone? NO ..................................................................... 02 Æ 1406
DON’T REMEMBER.......................................... 98 Æ 1406
1405. With whom did you discuss these HUSBAND ......................................................... 01
topics? (CIRCLE ALL RESPONSES MOTHER ........................................................... 02
GIVEN.) MOTHER-IN-LAW ............................................. 03
SISTER .............................................................. 04
SISTER-IN-LAW................................................ 05
FRIENDS ........................................................... 06
NEIGHBORS ..................................................... 07
COMMUNITY HEALTH WORKER .................... 08
TBA ................................................................... 09
TRADITIONAL HEALER ................................... 10
OTHER _______________________________ 97
(SPECIFY)
DON’T REMEMBER.......................................... 98
1406. Did you do anything or take any action YES.................................................................... 01
related to birth preparedness after NO ..................................................................... 02
learning about these topics? DON’T REMEMBER.......................................... 98
1407. What action(s) did you take? (CIRCLE ARRANGE TRANSPORTATION ...................... 01
ALL RESPONSES GIVEN.) ARRANGE MONEY........................................... 02
ARRANGE BLOOD DONOR............................. 03
PROBE: Anything else? ARRANGE SKILLED PROVIDER..................... 04
OTHER _______________________________ 97
(SPECIFY)
DON’T REMEMBER.......................................... 98
THANK THE RESPONDENT
October 30,2006 63

ACCESS Nigeria Safe Motherhood Questionnaire - 0

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ACCESS Nigeria Safe Motherhood Community Survey

ACCESS NIGERIA SAFE MOTHERHOOD QUESTIONNAIRE—HOUSEHOLD

Time Interview Started: Hour: _____ Minute: _____

NAME DATE SIGNATURE

Verbal Consent Form for Household Survey

Good morning/afternoon/evening. My name is _________________________________.

May I proceed with the questions? Yes/No

NOT VALID WITHOUT THE COMMITTEE OR

Void One Year From Above Date

Codes for “Relationship to Head of Household” (column 3):

WATER FROM OPEN WELL

WATER FROM COVERED WELL OR

A landline telephone? TELEPHONE—LANDLINE.........1.......... 2

A radio that is in working order? RADIO.........................................1.......... 2

A television that is in working order? TELEVISION...............................1.......... 2

THANK THE RESPONDENT

FMOH AND ACCESS NIGERIA SAFE MOTHERHOOD QUESTIONNAIRE—

Time Interview Started: Hour: _____ Minute: _____

NAME DATE SIGNATURE

Verbal Consent Form for Household Survey

Good morning/afternoon/evening. My name is _________________________________.

May I proceed with the questions? Yes/No

NOT VALID WITHOUT THE COMMITTEE OR

Void One Year From Above Date

SECTION 1. SOCIODEMOGRAPHIC INFORMATION

SECTION 2. BIRTHS AND STILLBIRTHS

205. Have any of your pregnancies resulted in YES............................................................ 1

PROBE: Any baby who cried or showed

IF STILLBIRTH: In what month and year MONTH.......................................

IF STILLBIRTH: In what month and year MONTH.......................................

OTHER __________________________ 97 Æ310

SECTION 4. PERCEPTIONS OF LOCAL FACILITIES

IF YES: Where is that? PUBLIC SECTOR

OTHER PRIVATE ______________ 36

OFTEN DOCTOR NOT THERE ..............07

SECTION 5. PERSONAL EXPERIENCE RELATED TO LAST PREGNANCY

DON’T KNOW/DON’T REMEMBER ............98

OTHER PUBLIC _______________ 26

OTHER PRIVATE ______________ 36

512. During this pregnancy, how many times TIMES _____________

Immediate breastfeeding? IMMED. BRSTFDG. ....... 01............02........98

Exclusive breastfeedin? EXCL. BRSTFDG............ 01............02........98

Danger signs of serious health problems YES NO DK

Where to go if you had danger signs of

515. Did you speak with anyone outside of a YES NO DK

OTHER PUBLIC __________________ 26

OTHER PRIVATE _________________ 36

534. CHECK 531: WENT TO A HEALTH

536. How much money did you spend on

537. Did you and your support person spend YES.............................................................. 01

542. Did you incur any other costs at the YES.............................................................. 01

544. In all, how many days did you abstain

SECTION 6. PERSONAL EXPERIENCE RELATED TO LAST BIRTH

OTHER PUBLIC __________________ 26

OTHER PRIVATE _________________ 36

PROBE: What else? 3 ___________________________________

IF LESS THAN 2 HOURS, RECORD IN MINUTES………………………..2

OFTEN DOCTOR NOT THERE .................. 07

DON’T KNOW ............................................. 98

624. How much money did you spend on

625. Did you and your support person spend YES.............................................................. 01

630. Did you incur any other costs at the YES.............................................................. 01

Time Interview Started: Hour: _ Minute: _

Time Interview Started: Hour: _ Minute: _

If seven or more times, record ‘7’