Questionnaire - Measurement, Learning & Evaluation Project

OFFICE USE ONLY: QUESTIONNAIRE NO: [__|__|__|__|__|__|__|__|__||__|__](Baseline cluster code 4 digits + HH number 3 digits + household division number 2 digits + Respondent line number 2 digits)MLE URBAN NIGERIAN SURVEY 2012WOMAN QUESTIONNAIRE: ENGLISH/HAUSABASELINE STATE NAME & CODE _______________________________________________BASELINE CITY NAME & CODE________________________________________________(Abuja=1, Ibadan=3, Ilorin=4, Kaduna=5)BASELINE LGA NAME & CODE _________________________________________________(IF RELOCATED) MID-TERM CITY NAME & CODE ________________________________(Abuja=1, Ibadan=3, Ilorin=4, Kaduna=5)(IF RELOCATED) MID-TERM LGA NAME & CODE _________________________________BASELINE CLUSTER NAME & CODE ____________________________________________BASELINE HOUSEHOLD NUMBER …………………………………………………………………HOUSEHOLD DIVISION NUMBER……………………………………………………………………..(Same HH=0, Household divided/1 st new household =1, Household divided/2 nd new household =2, etc.)BASELINE LINE NUMBER OF WOMAN……………………………………………………………[__|__|__][__][__|__|__][__][__|__|__][__|__|__|__][__|__|__][__|__][__|__]NAME OF RESPONDENT _____________________________________________________[surname, given name]ADDRESS OF HOUSEHOLD ____________________________________________________INTERVIEWER VISITSVISIT No. 1 2 3 FINAL VISITDATEDAY/ MONTH/ YEARDAY/ MONTH/ YEARDAY/ MONTH/ YEARDAY[____|____][____/_____/_12_][____/_____/__12_][____/_____/__12_]MONTH[____|____]YEAR[_2_|_0_|_1_|_2_]INTERVIEWER’S NAME______________________________________________________________________INTERVIEWER CODERESULT*NEXT VISIT:DATE[____/_____/12_][____/_____/12_]TIMEH H M M H H M M*RESULT CODES:1. COMPLETED 4. REFUSED2. NOT AT HOME 5. PARTLY COMPLETED3. POSTPONED 6. INCAPACITATED7. OTHER __________________________________(Specify)LANGUAGETOTAL NO. OF VISITSMAIN LANGUAGE OF INTERVIEW TRANSLATOR USED? YES = 1 NO = 2LANGUAGE CODES: HAUSA =1 YORUBA =2 ENGLISH = 3 PIDGIN =4 OTHERS = 6 ( Specify_______________________ )SUPERVISOR FIELD EDITOR OFFICE EDITOR KEYED BYNAME…………………….……….…NAME………………………….NAME…………….……………………NAME…………………………………………..…CODE:CODE:CODE:CODE:DATE [__ / ___/ 12_]DD MM YYDATE [__ / __/ 12_]DD MM YYDATE [__ / ___/ 12_]DD MM YYDATE [__/ __/ 12_]DD MM YY1

Individual Consent: Woman’s Survey on Family Planning IntroductionHello! My name is _________________________________; I am part of a research team working for the National Population Comissionunderthe Monitoring, Learning and Evaluation Project for the Nigerian Urban Reproductive Health Initiative (NURHI). We are carrying out research onchild birth spacing in urban areas of Nigeria. Your participation in this study will help to improve child birth spacing services in this city. We willbe asking women aged 15-49 questions from this household for this study.Barka da war haka! Sunana ----------------------------------------Ina daya daga cikin mutane masu yiwa Hukumar Kidaya taKasa bincike.Muna gudanar da bincike kan hanyar tsarin iyali a biranen Najeriya. Kasancewarka cikin wannan bincikezai taimaka a inganta harkojin tsarin iyali a wannan garin.Za muyi wa dukkan mata ‘yan shekara 15-49 a wannan gidan.Explanation of ProcedureThe interview will take place in or around your home, somewhere private. The interview will take about 60 minutes. I will ask you questionsabout your home, child birth spacing, health-care seeking, and family size decisions. You may choose not to give the interview, or not to answera question for any reason. You can stop the interview at any time by telling me that you want to stop it. If you decide not to give the interview ornot to answer a question, no harm will come to you, and there will be no effect on your access to health services in the future.Tambayoyin zasu kasance a gidanki ko kusa da gidanki ko wani wuri kebabbe.Tambayoyin zasu dauki kusan minti 60.Zanyi miki tambayoyi game da gidanki,hanyar tsarin iyali, neman kiwon lafiya da kuma yanke hukunci kan yawan iyali.Ki na dammar kin amsa tambayoyi, ko ki ki amsa wata tambaya saboda wani dalili. Za ki iya tsaida tambayoyi a kowannelokaci ki ka fada mini ba ki son ki cigaba.Idan ba ki son shiga ko ba ki son amsa wata tambaya, babu wani abu da zaisame ki, kuma ba zai shafi damar gidanki na samun harkokin kiwon lafiya nan gaba ba.ConfidentialityYour answers will not be shared with anyone outside this research project. Your name will not appear on the survey. We will not share answerswith community members, health providers, family or anyone else. At the end of the study, we will put all the answers together and make areport.In addition to the interview today, we would like to meet with you once more to ask you some more questions. We will need to contact you in 2years to interview you a third time. We would like to interview you three times to see how the circumstances in your life change. So we can findyou again in two years, we need to ask questions on how, where and when to best contact you. We will make every effort to plan the nextinterview without anyone knowing. Your contact information will be kept in a locked cabinet, and kept apart from your answers to the questions.Once the study is finished, the list of names with your contact information, and the completed surveys will be destroyed.Ba za’a fadawa wani Wadda bay a cikin wannan binciken amsoshinki ba.Duk tambayoyi za’a yisu a sirri. Kuma sunankiba zai fito a binciken ba.Amsoshinki ba za mu fadawa jama’ar al’ummarki ba, ko masu bada kiwon lafiya , ko iyalanki kokuma wani daban. A karshen wannan binciken, za mu sa duk amsoshinku awuri daya kuma mu rubuta rahoto.Kuma bayan wannan tambayoyin na yau, munason mu hadu da ke da sauran matan gidanku sau biyu ko fiye da hakadomin karin wasu tambayoyin.Muna fatan mu sadu da ke shekara biyu mai zuwa in Allah ya kaimu domin yi mikitambaya; kashi na biyu , bayan wata shekara biyu kuma mu dawo mu yi miki tambaya kashi na ukku in Allah yakaimu.Muna fatar mu yi miki tambayoyi kashi uku domin nazartar yadda abubuwa suka canja a gidanki.Idan muna son mu sami gidanki nan gaba, yana da kyau mu tambayeki kan ya ya, a ina da kuma wanne lokaci ya fi kyaudon saduwa da ke.Za muyi kokarin shirya wata ziyara domin yi miki tambaya ba tare da wani ya sani ba.Bayanai kanyadda za’a sameki za a boyesu, kuma a ajiye amsoshinki dabam da tambayoyi.Matukar an gama wannan binciken, za’alalata sunayenku da bayanan yadda za’a sameku da kuma amsoshinku da aka ciccike .How many People will take part in this study?If you decide to be interviewed, you will be one of about 18,000 women from urban areas of Nigeria who will be interviewed throughout the lifeof the study.Idan kin yadda ki shiga wannan binciken, za ki kasance daya daga cikin mata kusan 12,000 na biranen Najeriya wadandaza a yiwa tambayoyi.BenefitsResearch helps society by providing new knowledge. You may not benefit directly from this survey. However, your answers will be importantfor planning better programs to make sure women can access the health care they need.Bincike, na taimakawa al’umma da sanin sababbin abubuwa, Ba lalle ne ki amfana kai tsaye da wannan binciken ba.Kodayake amsoshinki za su kasance masu muhimmanci wajen zana kyawawan shirye-shiryen da za su baiwa mata damarsamun inganta kiwon lafiyarsu.Risks and DiscomfortThere is the possibility you may feel uncomfortable about a question I ask. If you feel uncomfortable about any of the questions, you do nothave to answer them. I can skip those questions and go on to the next section. You can end the interview at any time. There is also thepossibility that someone may approach us during the interview to find out what we are discussing. We intend to do this interview in private, ifsomeone approaches us, we will stop the interview until we can continue in private.Some questions may not apply to you, but the interviewer must ask the same questions of everyone.Babu mamaki ki ji babu dadi game da tambayoyin da na ke yi.Idan ba ki ji dadin ko wacce tambaya ba, ba sai lalle sai kinamsa ba. Zan iya tsallakewa zuwa tambayoyi na gaba.Kina da dammar ki tsaida ni daga yin tambayoyi duk lokacin da ki keso.2

Kuma babu mamaki wani yazo wurinmu lokacin amsa tambayoyi don ya san abinda muke tattaunawa.Munyi niyyar muyiwadannan tambayoyin a sirrance saboda haka idan wani yazo zami iya tsaida tambayoyin har sai mun kebe mu biyu. Wasutambayoyin ba su shafe ki ba,amma kuma mai tambaya dole ya tambayi kowa tambaya iri daya.Costs and Payment Individual Consent:There are no costs for being in this study. You will not receive any compensation for taking part in this study.Babu wani biyan kudi don an shiga wannan binciken.Ba za ki karbi wani kudi ba domin kin shiga wannan binciken.Questions /Your rights as ParticipantsThis study has been approved by the Nigerian Ministry of Health Ethics Review Board and the University of North Carolina (USA). If you haveany questions about this study or the results, you can contact the following: The study coordinator, Mr. Bolaji Akinsulieat the National PopulationCommission(0802-330-7806) or the Institutional Review Board at the University of North Carolina at +1 919-966-3113. You have the right toask, and have answers, to any questions you may have about this research. If you have questions or concerns, you should contact theresearchers listed above, or ask me before or after the interview. Do you have any questions now?An sami amincewar wannan binciken daga Ma’aikatar kiwon lafiya da kula da binciken ladubba ta Najerya da jami’arArewacin Carolina (Amurka). Idan ki na da tambaya game da wannan binciken ko sakamakonsa za ki iya tuntubarwadannaKodinetan binciken , Mr Bolaji Babatunde Akinsulie a Hukumar Kidaya ta Kasa (0803-497-0932) ko Hukumarmakarantar Nazari ta Jami’ar Arewacin Carolina a +1919-966-3113.Ki na da ‘yancin yin tambaya kuma ki samu amsar tambayarki, duk tambayar da ki ke so a wannan binciken.Idan ki nada tambayoyi ko damuwa kina iya tumtubar masu binciken da a ka lissafa a sama, ko ki tambaye ni kafin ko bayan nagama miki tambayoyi.Yanzu ki na da wasu tambayoyi da za kiyi mini?ConsentNow, can you tell me if you agree to participate in this research? If you say yes, it means that you have agreed to be part of the study.May I begin the interview now?Zan iya fara tambaya Yanzo?Yes ………………………1No …………………………2CONTINUETHANK RESPONENT AND END INTERVIEWWould you like a copy of this document?Ka na bukatar kwafin wannan takardar?Interviewer’s signature............................................................................. DATE [____/_____/2012]3

SECTION 1: BACKGROUND CHARACTERISTICSQno Questions and filters Coding categoriesSkiptoHOUR……………………………….[__|__]RECORD START TIME:MINUTES…………………………..[__|__]Thank you for agreeing to participate in this survey. As I mentioned in asking for your consent, we are looking to assess your health andinformation needs. To begin, we are going to ask you some background questions about yourself.Nagode da amincewar ki a wannan binciken. Kamar yadda na fada miki wajen neman izininki, muna neman bayanai akan lafiyar ki Da farko,zamu tambayeki wasu mahimman abubuwa game da ke kanki.Q101In what month and year were you born?A wane wata da shekara aka haife ki?How old were you on your last birthday?MONTH . . . . . . . . . . . . . . . . . ………[__|__]DON'T KNOW MONTH . . . . . . . . . . . . . . 98YEAR . . . . . . . . . . . . . . …..…[__|__][__|__]DON'T KNOW YEAR . . . . . . . . . . . . . . 9998Q102Q103Q104Shekarunki nawa cikakku?COMPARE AND CORRECT Q101 AND/OR Q102 IFINCONSISTENTHave you ever attended school formal or Qur’anic?Kin taba shiga makaranta?What is the highest level of school you attended: Quraniconly, primary, junior secondary, senior secondary, or higher?Mene ne zurfin ilmin ki: Makarantar Alo (Al qur’ani) kadai,firamare, Karamar Sakandare, Babbar Sakandare ko gaba daSakandare?What is the highest (class/year) you completed at that level?AGE IN COMPLETED YEARS…..…[__|__]YES…………………………………....1NO …………………………………….2QURANIC ONLY……………………...0PRIMARY………………………….…..1JUNIOR SECONDARY (JSS)……... 2SENIOR SECONDARY (SSS)……...3HIGHER…………………………...…...4Q106Q106Q106Q105Aji nawa ne mafi zurfi ki ka kammala a wannan matsayin?CLASS/YEAR……………………[__|__]Q106Q107Q108Q109IF NO YEAR COMPLETED, WRITE “00”What is your religion?Menene addinin ki?How religious do you consider yourself? Do you consideryourself …READ OUT RESPONSESYaya ki ka dauki kanki a addinance? Kin dauki kan ki mai yinaddini sosai , mai yin addini dai dai gwargwado ko ba mai yinaddini ba…..To what degree does your religion influence the decisions youmake about family planning? Would you say that your beliefs:never, somewhat, often, or always influence the decisions youmake about family planningA wanne matsayi ne addiniki yake shafar kudurin da kike yigame da tsarin iyali? Zakiiya cewa addininki baya shafarkudurin da ki ke yi game da tsarin iyali,yana shafar kudurin kiko da yaushe/ ko sa’ i sa’ i .What language do you usually speak at home?Wane harsheki ka fi amfani dashi a gida?CATHOLIC…………………………..1PROTESTANT/OTHERCHRISTIAN……………………….…2MUSLIM…………………………...…3NO RELIGION ……………….…..…5OTHER______________________6(SPECIFY)STRONGLY RELIGIOUS ……….…1SOMEWHAT RELIGIOUS …….…..2NOT AT ALLRELIGIOUS…….………………...….3NEVER…………………………….…1SOMEWHAT……..……………….…2OFTEN/FREQUENTLY………….…3ALWAYS…………………………..…4DON’T KNOW (ABOUTFP)………………………………....…8HAUSA………………………….……1YORUBA………………………..……2IGBO…………………………….……3ENGLISH……………………………..4PIDGIN ENGLISH………………..….5OTHER______________________6(SPECIFY)Q1094

Q110As you know, some women take up jobs for which they arepaid in cash or kind. Others sell things, have a small businessor work on the family farm or in the family business. In the lastseven days, have you done any of these things or any otherwork?YES ……………………….…………………NO …………………..……………….………12Q112Kamar yadda kika sani, wasu mata na aikin da ake biyan suda kudi, ko da kyaututuka.Wasu suna saida abubuwa,sunada karamin sana’a , ko suna noma a gonar gidansu, ko kumakasuwancin gidansu.A cikin kwanaki bakwai da sukashige,kinyi daya daga cikin su ko kuma ko wane irin aiki ?Q111Q112Q113Have you done any work in the last 12 months?Kin yi ko wanne irin sana’a, a cikin watanni gomashabiyu dasuka shige?Do you do this work for a member of your family, for someoneelse, or are you self-employed?Shin kina yin wannan aikin ne ma wani daga cikin iyalanki, kowani dabam ko kina aikin kan ki ne?Do you usually work throughout the year, or do you workseasonally, or only once in a while?Shin ki na yin aiki cikin shekara gaba daya ne, ko lokacilokaci, ko sau daya a wani lokaci ?YES ………………………………..…………NO …………………………………………….FOR FAMILY MEMBER…………….………FOR SOMEONE ELSE ………………..…..SELF-EMPLOYED…………………….....THROUGHOUT THE YEAR .. . . . …………SEASONALLY/PART OF THE YEAR……...ONCE IN A WHILE…………………………12 Q2011231235

SECTION 2: REPRODUCTIONQNo. Questions and filters Coding categories Skip toNow I would like to ask you about all the births you have had during your life. Please be as honest as possible and know that your answers willnot be shared with anyone else.Yanzu ina so nayi miki tambayoyi game da haife- haife da ki ka yi a rayuwarki. Ki yi iyakar kokari ki gaya mini gaskiya,kuma ki sani cewa dukamsoshin ki za’a barsu a sirance ba za a gayawa kowa ba.Q201Have you ever had any live birth?Kin taba haihuwar dan da yazo da rai?YES……………………………………1NO……………………………………..2Q204Q202Q203How many live births have you had in your lifetime?Sau nawa ki ka taba haihuwa a rayuwarki?What was the age of your youngest child at their lastbirthday?Menene cikakkun shekarar dan ki na karshe?IF YOUNGEST CHILD IS NOT YET 1 YEAR OF AGE,ENTER AGE AS ‘00’NUMBER OF. LIVEBIRTH………………..…[__[__|AGE IN COMPLETEDYEARS…………………………[__|__]Q204Q205Have you had any live births since January 2010?Kin ta ba haihuwa daga watan January 2010?Do you have any sons or daughters to whom you have givenbirth since January 2010 who are now living with you?A yanzu haka kina da ‘ya’ya maza ko mata da ki ka haifawadanda kuke tare?Of those births since January 2010,Da ga cikin wadanda ki ka haifa tun daga January 2010.YES……………………………..…….1NO…………………………………….2YES……………………………..…….1NO…………………………….……….2Q209Q207Q206How many of these sons live with you?And how many daughters live with you?SONS AT HOME……………………..…… [__|__]DAUGHTERS AT HOME…………………. [__|__]Ya’yanki maza nawa ne kuke tare?Q207Da kuma ‘ya’ya mata nawa ne kuke tare?Do you have any sons or daughters to whom you have givenbirth since January 2010 who are alive but do not live withyou?Kina da ‘ya’ya maza ko mata wadanda ki ka haifa, suna rayeamma ba kwa tare dasu?Of those births since January 2010,Da ga cikin wadanda ki ka haifa tun daga January 2010.YES……………………………………..1NO………………………….……………2Q209Q208How many sons are alive but not living with you?SONS ELSEWHERE………………….…. [__|__]And how many daughters are alive but not living with you?DAUGHTERS ELSEWHERE……….…… [__|__]‘Ya’yan ki maza nawa ne ke raye amma ba kwa tare?Da kuma ‘ya’ya mata nawa ne ke raye amma ba kwa tare?Sometimes it happens that children die. It may be painful totalk about and I am sorry to ask you about painful memories,but it is important to get correct information. Since January2010, have you given birth to a boy or a girl who was bornalive but later died?Q209IF NO, PROBE: Any baby who cried or showed signs of lifebut did not survive?Wani lokaci yana faruwa cewa yara na mutuwa. Kiyihakuriinna tuna miki da abun da yariga ya wuce, amma yakamata mu samu ainihin bayanai.Kin taba haihuwan ‘danamiji ko‘ya mace wanda ya/ta zo da rai amma daga bayaya/ta rasu?YES……………………………………..1NO………………………….……………2Q211IF NO, PROBE: Akwai dan da yayi kuka, ko ya nuna alamarrai amma daga baya ya rasu?6

Since January 2010,Tun da ga January 2010.Q210How many boys have died?And how many girls have died?‘Ya’ya maza nawa ne suka rasu?Da kuma ya’ya mata nawa ne suka rasu?BOYS DEAD…………….………………. [__|__]GIRLS DEAD…………………….……… [__|__]Q211SUM ANSWERS TO 206, 208, AND 210, AND ENTERTOTAL.If none, record 00.CHECK 211:TOTAL……………………………..………[__|__]Just to make sure that I have this right: you have had in TOTAL _______ births since January 2010. Is that correct?Q212Dan tabbatar da ganin banyi kuskure ba,jimilar (dukka) ‘ya’yan da ki ka Haifa tun dag a watan Jeneru 2010TOTAL _______ haka ne?YES NO PROBE AND CORRECT 201-209 as necessary.Q213CHECK Q211:ONE OR MORE BIRTHS SINCE JANUARY 2010 (go to nextquestion)NO BIRTHS SINCE JANUARY 2010Q2317

BIRTH HISTORYNow I would like to record the names of all your births since JANUARY 2010, whether still alive or not, starting with the first one you had.Yanzu ina so in rubuta sunayen ‘ya’yan da ki ka Haifa, wadanda suke raye da wanda suka rasu, zan fara da haihuwar ki ta farko.RECORD NAMES OF ALL THE LIVEBIRTHS SINCE JANUARY 2010 in Q215. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. IF THERE ARE MORE THAN 5 BIRTHS,USE AN ADDITIONAL QUESTIONNAIRE. STARTING WITH THE SECOND ROW.(Q214)Line no.(Q215)What name was given to yourbaby?Wanne suna a ka ba wa da ko yar kita (tun daga Jeneru 2010)?(Q216)Were anyof thesebirthstwins/triplets?Wannanhaihuwartagwaye neko ‘yanuku?CIRCLE(Q217)Is(NAME)a boy ora girl?Shin(Suna)namijine komace?CIRCLE(Q218)In what month andyear was (NAME)born? PROBE: Whatis her/his birthday?(other probes: whatseason was it)A wanne wata ne dashekara ki ka haifi(SUNA)?PROBE:Yaushe neranar haihuwar sa/ta?(Other probes: Awane lokaci (daminako rani) ?(Q219)Is (NAME)still alive?Shin(SUNA)ya/ta naraye?(Q220)IF ALIVE:How old is(NAME)currently?Shekarun(SUNA) nawane cikakku?RECORD AGEINCOMPLETEDMONTHS; IFLESS THANONE MONTH,RECORD “00”.(Q221)IF ALIVE:Is (Name) livingwith you?(SUNA) ya/tana zama tareda ke?(Q222)IF DEAD:How old was (NAME) whenshe/he died?IF LESS THAN 2 YEARS,PROBE:How many months old was(NAME)?Shekarun (SUNA) nawa nekafin rasuwar sa/ta?IF 1 YR, PROBE:Watan (SUNA) nawa nekafin rasuwar sa/ta?IF LESS THAN 1 MONTHOLD, RECORD DAYS.(Q223)Were there any otherlive births between(NAME OF PREVIOUSBIRTH) and (NAME),including any childrenwho died after birth?Akwai wata haihuwa mairai a tsakanin (NAMEOF PREVIOUS BIRTH)and (NAME), Harda‘ya’yan da suka rasubayan haihuwa?01NAME:_____________________________SING……1MULT…..2BOY…1GIRL...2MONTH [__|__]DK……….....98YEAR [__|__][__|__]DK…………….9998YES….1NO……2Q222AGE INMONTHS[__|__]YES…..1NO……2All skip toNEXTQ214DAYS….….1 [__|__]MONTHS…2 [__|__]DK………...…….99802 NAME:__________________________SING……1MULT…..2BOY…1GIRL...2MONTH [__|__]DK……….....98YEAR [__|__][__|__]DK…………….9998YES….1NO……2Q222AGE INMONTHS[__|__]YES…..1NO……2All skip to Q223DAYS….….1 [__|__]MONTHS…2 [__|__]DK…………...….998YES…1NO....2ADD BIRTHNEXT BIRTH03NAME:_____________________________SING……1MULT…..2BOY…1GIRL...2MONTH [__|__]DK……….....98YEAR [__|__][__|__]DK…………….9998YES….1NO……2Q222AGE INMONTHS[__|__]YES…..1NO……2All skip to Q223DAYS….….1 [__|__]MONTHS…2 [__|__]DK…………...….998YES…1NO....2ADD BIRTHNEXT BIRTH04NAME:_____________________________SING……1MULT…..2BOY…1GIRL...2MONTH [__|__]DK……….....98YEAR [__|__][__|__]DK…………….9998YES….1NO……2Q222AGE INMONTHS[__|__]YES…..1NO……2All skip to Q223DAYS……..1 [__|__]MONTHS…2 [__|__]DK…………...….998YES…1NO....2ADD BIRTHNEXT BIRTH05 NAME:_____________________________SING……1MULT…..2BOY…1GIRL...2MONTH [__|__]DK………….98YEAR [__|__][__|__]DK…………….9998YES….1NO……2Q222AGE INMONTHS[__|__]YES…..1NO……2All skip to Q223DAYS……..1 [__|__]MONTHS…2 [__|__]DK…………...….998YES…1NO....2ADD BIRTHNEXT BIRTH8

From which type of facility did you obtain (A CHECK UP)last time?Daga wacce cibiyar kiwo lafia ki ka yi awon karshe?PUBLIC SECTORGOVT HOSPITAL……………………….…11WOMEN AND CHILDREN’SHOSPITAL……………………………….....12CHILD WELFARE CLINIC………………..13GOVT. HEALTH CENTER……………......14GOVERNMENT POST/DISPENSARY.....15MATERNITY HOME……………..........…..16MOBILE CLINIC……….……………...…...17OTHER PUBLIC___________________18(SPECIFY)Q234PRIVATESECTORPRIVATE HOSPITAL/CLINIC..................21PRIVATE DOCTOR’S OFFICE……..…..22NURSING/MATERNITY HOME……...…23PHARMACY…………………..………...…24PMS/CHEMIST…………………….…..….25MOBILE CLINIC………….…………...…...26CHW/TBA……………………………...…..27TRADITIONAL HEALER……………...….28OTHER PRIVATE__________________29(SPECIFY)FAITH-BASED SECTORMISSION HOSPITAL…………….............31FAITH-BASED, CHURCH CLINIC…..…32Q235At the time you became pregnant, did you want to becomepregnant then, did you want to wait until later, or did younot want to have any more children at all?A lokacin da ki ka sami ciki, kin so dauka ne, ko kin so kijinkirta sai zuwa gaba, ko kuma ba kida sha’awar sakehaihuwar ko kadan?OTHER SOURCEOTHER NGO HOSPITAL/CLINIC……….41WORKSITE CLINIC…………….…………42OTHER________________________________96(SPECIFY)DON'T KNOW . . . . . . . . . . . . . . …..………... .98THEN……………………………...….……1LATER……………………….………....… 2NOT AT ALL………………………….…3Q237Q237Q236How much longer would you have liked to wait?Har tsawon wane lokaci ki ka so ki jira?IF RESPONSE IS A DECIMAL FOR MONTHS & YEARS(2.5YRS), THEN CONVERT IN MONTH AND FILL INONLY MONTHS.MONTHS………..1 [__|__]ORYEARS..………...2 [__|__]OROTHER (SPECIFY)__________________996ORDON’T KNOW…………………………….…998Q237When did your last menstrual period start?Yaushe ki ka fara ganin hailar ki ta karshe?______________________________________(DATE, IF GIVEN)IF LESS THAN ONE DAY, CIRCLE “1” AND WRITE “00”DAYS AGO.DAYS AGO…………………………..……1 [__|__]WEEKS AGO………………………...……2 [__|__]MONTHS AGO……………………...…… 3 [__|__]YEARS AGO………………………...…….4 [__|__]IN MENOPAUSE/HAS HADHYSTERECTOMY……………………….….994BEFORE LAST BIRTH……………………......995NEVER MENSTRUATED…………………..…996CANT REMEMBER………………………..…..998Q238From one menstrual period to the next, are there certaindays when a woman is more likely to get pregnant if shehas sex?Shin dagahailar zuwa wata hailar da akwairana kun damace zata iya daukan ciki idan ta yi jima’i?YES…………………………….……………1NO…………………………….……………..2DON’T KNOW……………….……………..8Q240Q24010

Which days are these? Would you say that this time is JUST BEFORE HER PERIODjust before her period begins, during her period, right BEGINS………………………….....1after her period has ended, or halfway between two DURING HER PERIOD.………….….2periods??RIGHT AFTER IT ENDS..…….......…3Q239HALFWAY BETWEEN TWOShin wannan lokacin yana iya faruwa dab da ta fara PERIODS……………………………...4haila ne, lokacin da take haila ne, dab da ta gama haila OTHER_______________________6ne ko kuma tsakanin haila da haila?(SPECIFY)SINGLE MENTIONDON’T KNOW……………….………...8CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.Have you ever had a pregnancy that ended in amiscarriage, abortion or stillbirth?By miscarriageI mean a pregnancy that ended just byitself.Q240Q241Q242By abortion, I mean a pregnancy that ended, becauseyou did something or used something.By still birth, I mean a baby that was born at full termand did not show any sign of life.Kin yi cikin da ki kayi barin cikin?Abun nufi da bari ko zubar da ciki, ina nufin cikin da yazube da wuri, ko don kin yi wani abu ki chire ko dan yazuba da kansaHow many miscarriages have you ever had?Sau nawa ki ka ta ba yin bari?How many abortions have you ever had?Sau nawa ki ka ta ba zubda ciki tareda amfani da waniabu ko hakanan kawai?YES………………………………1NO………………………………..2.NUMBEROFMISCARRAIGES………….[__]__]NUMBER OFABORTIONS…………..….[__]__]Q301C(01)(02)(03)PREGNANCYOUTCOMESINCE JANUARY2010Stillbirth (pregnancywas full term but thebaby showed nosigns of life)Haihuwar da danbaizo da rai baMiscarriage(pregnancy endedjust by itself)Cikin day a zube dakanshiAbortion (pregnancyended by somethingyou did or used, e.g.manual vacuumaspiration)Cikin da ya zubedomin kin yi wani abuko amfani da waniabu,misali aka ciremaki.243. Since January2010, have youhad a pregnancythat ended in a(PREGNANCYOUTCOME)?Tun Janaury2010, Kin ta badaukar cikin da kika haihu?YES…..………..1NO………..……2(02)YES…..………..1NO………..……2(03)YES…………....1NO…..…………2Q301244. How manytimes has thisoccurred sinceJanuary 2010?Sau nawa hakanya faru tun dagaJanaury 2010?NUMBER OFTIMES……..[__|__]NUMBER OFTIMES……..[__|__]NUMBER OFTIMES……..[__|__]245. When did the lastsuch pregnancy end?Yaushe kika yi haihuwarkarshe?MONTH…….[__|__]YEAR…..[__|__|__|__].MONTH…………….[__|__]YEAR………..[__|__|__|__]MONTH…………….[__|__]YEAR………..[__|__|__|__]246. How many months pregnantwere you when the last suchpregnancy ended?Cikin wan shi nawa lokacinhaihuwarki ta karshe?RECORD THE NUMBER OFCOMPLETED MONTHS. INCOLUMN 1 OF THE CALENDAR,ENTER ‘T’ IN THE MONTH THATTHE PREGNANCY TERMINATEDAND ‘P’ FOR THE NUMBER OFCOMPLETED MONTHS. FOLLOWTHIS PROCEDURE FOR THENUMBER OF TIMES THE EVENTHAPPENED ACCORDING TOQ244.MONTHS….…[__|__]MONTHS….…[__|__]MONTHS….…[__|__]11

SECTION 3: CONTRACEPTIONCHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.Now I would like to talk about family planning/child spacing/ child birth spacing, the various ways or methods that a couple/ partners can use todelay or avoid a pregnancy.Yanzu ina so in yi magana akan dabarun tsarin iyali, tazara tsakanin haihuwa/ tazara tsakanin yara daban daban da ma’aurata kebi don jinkirtadaukar ciki ko guje wa daukan ciki.INSTRUCTIONS: CIRCLE ‘1’ FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN READING THE NAMEAND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE ‘2’ FOR EACH METHOD RECOGNIZED UPONLISTENING TO DESCRIPTION. CIRCLE ‘3’ FOR EACH METHOD NOT MENTIONED NOR RECOGNIZED.Q301. Which ways or methods have you heard of?Wadanne dabarun tsarin iyali daban-daban ki ka ta ba ji?PROBE: HAVE YOU HEARD OF ANY OTHER WAYS OR METHODS THAT WOMEN OR MEN CAN USE TO AVOID PREGNANCY?FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?Kin taba jin? (METHOD)?Yes, MENTIONEDSPONTANEOUSLYYes, WHENPROBEDNo01FEMALE STERILIZATION/ TUBAL LIGATION Women can have a simple operation toavoid having any more children.Ana iya yi wa mata aiki a mahaifa don kar su sake samun haihuwa.1 2 302MALE STERILIZATION/VASECTOMY Men can have a simple operation to avoid havingany more children.Ana iya yi wa maza dandaka don hana haihuwa1 2 3030405DAILY PILL Women can take a pill every day to avoid becoming pregnant.Mata na iya shan kwayar magani a ko wacce rana don hana daukan ciki 1 2 3IUCD Women can have a loop or coil placed inside them by a health provider.Likitoci ko jami’an kula da kiwon lafiya kan sawa mata wata irin roba/ karfe a farjinsu donhana daukan cikiINJECTABLES OR INJECTIONS Women can have an injection by a health provider thatstops them from becoming pregnant for one or more months.Jami’in kiwon lafiya na yi wa mata allura wadda za ta hana su samun ciki na wata dayako fiye da haka.1 2 31 2 306IMPLANTS/IMPLANON/JADELLE Women can have a small rod placed in their upperarm by a health provider, which can prevent pregnancy for one to three years.likita ko jami’in kiwon lafiya kan sawa mata wasu kananan karafa a dantsen su don suhana daukan ciki na tsawon shekara daya zuwa shekera uku?1 2 30708MALE CONDOM Men can put a rubber sheath on their penis before sexualintercourse.Maza na iya sa kororon roba a azzakarin su kafin suyi jima’iFEMALE CONDOM: Women can place a sheath in their vagina before sexualintercourse.Mata na iya sanya irin na su kororon roba a farjin su kafin su yi jima’i1 2 31 2 309RHYTHM METHOD/STANDARD DAYS METHOD/ SAFE DAYS/ CYCLE BEADS:Every month that a woman is sexually active she can avoid pregnancy by not havingsexual intercourse on the days of the month she is most likely to get pregnant.Mace na iya gujewa yin jima’I daidai lokacin da take ganin tana iya daukan ciki.1 2 310WITHDRAWAL Men can be careful and pull out before climax.Namiji na iya zare azzakarin sa a yayin jima’I daidai lokacin da ya ji zai yi zuwan kai. 1 2 311EMERGENCY CONTRACEPTION/MORNING AFTER PILL/ POSTINOR 2 Women cantake pills up to five days after sexual intercourse to avoid becoming pregnant.Don gujewa daukan ciki mace na iya shan kwayoyin maganin hana daukan ciki har natsawon kwanaki biyar bayan jima’i1 2 312

12LACTATIONAL AMENORRHEA (LAM) Up to six (6) months after childbirth, a womancan use a method that requires that she feeds the baby with only breastmilk (no otherformula, water or other food) and that her menstrual period has not returned.Mata kan yi amfani da hanyar shayar da nono (banda wani abinci /madara) akai-akaidare da rana har na tsawon wata shida wanda yin haka yakansa rashin ganin jinin hailarsu.1 2 313Have you heard of any other ways or methods that women or men can use to avoidpregnancy?YES___________________1(SPECIFY)NO………………………...…3Q30214Kin ta ba jin wata dabara ko ta gargajiya da mata da maza ke amfani dasu don gujewadaukan ciki?NOTE: IF RESPONDENT MENTIONS ABSTINENCE AS A METHOD OF FP, DO NOTRECORD AS A METHOD. PROBE FOR ANY OTHER METHOD KNOWN.YES___________________1(SPECIFY)NO………………………...…3Now I would like to talk about family planning/child birth spacing/child spacing, the various ways or methods that a couple can use to delay or avoida pregnancy.Yanzu ina so in yi magana akan dabarun tsarin iyali, tazara tsakanin haihuwa/ tazara tsakanin yara daban daban da ma-aurata kan bi don jinkirtadaukar ciki ko guje wa daukan cikiCHECK Q231 CURRENTLY PREGNANTQ302NOT CURRENTLYPREGNANT (Q231=2 OR =8)CURRENTLY PREGNANT (Q231=1)Q308Q303Q304Are you (or your partner) currently doing something orusing any method to delay or avoid getting pregnant?Shin ke ko (abokin zaman ki) na yin wani abu ko amafanida wani dabara yanzu don jinkirta ko gujewa daukanciki?Which method(s) are you (or your partner) currentlyusing?Wacce irin dabara ki (abokin zaman ki) ke amfani da shiyanzu?MULTIPLE METHODS – CIRCLE ALL MENTIONEDIF RESPONDENT SAYS “PILL”, PROBE FURTHER TOESTABLISH IF THEY MEAN THE “DAILY PILL” OR THE“EMERGENCY PILL”IF MORE THAN ONE METHOD CODE CIRCLED INQ304, REFER TO HIGHEST METHOD IN LISTYES………………………………..……..………1NO……………………………………….……….2SAYS SHE CAN’T GETPREGNANT…………………………………….3FEMALE STERILIZATION………………AMALE STERILIZATION……………….....BIMPLANT……………………………….....CIUCD………………………………………..DINJECTABLE... . . . . . . . . . ………...……EDAILY PILL……….………………………..FEMERGENCY PILL (Postnor2, etc.)……GMALE CONDOM . . . . . . . .…………......HFEMALE CONIDOM . .. . .…. . . …………IBREASTFEEDING/LAM . . . . . …..…….JSTANDARD DAYS METHOD/ SAFE DAYS/CYCLE BEADS…..………………KRHYTHM METHOD …….………………..LWITHDRAWAL ………...………………...MOTHER _________________________X(SPECIFY)Q308Q308Q305Since what month and year have you been using[CURRENT METHOD] without stopping?MONTH……………………….[__|__]YEAR………….……….[__|__][__|__]Tun wanne wata da shekara ki ke amfani da wannanhanyar ba tare da kin tsaya ba?13

CHECK Q305, Q218, Q245(01)-Q245(03)ANY BIRTH OR PREGNANCY TERMINATION AFTERMONTH AND YEAR OF START OF USE OFCONTRACEPTION IN 305?YESNOQ306FOR METHODS OTHER THAN MALESTERILIZATION: GO BACK TO 305, PROBE AND RECORDMONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTERLAST BIRTH OR PREGNANCY TERMINATION)FOR MALE STERILIZATION: GO BACK TO 305, PROBE AND RECORD MONTH AND YEAR OFSTERILIZATIONQ307CCHECK 305:YEAR IS JANUARY 2010 ORLATERENTER CODE FOR METHOD USED IN MONTH OFINTERVIEW IN COLUMN 1 OF THE CALENDAR AND INEACH MONTH BACK TO THE DATE STARTED USINGYEAR IS 2009 OR EARLIERENTER CODE FOR METHOD USED IN MONTH OFINTERVIEW IN COLUMN 1 OF THE CALENDAR ANDEACH MONTH BACK TO JANUARY 2010THEN CONTINUE WITH 308THEN SKIP TOQ30914

Q308CI would like to ask you some questions about the times you or your partner may have used a method to avoid gettingpregnant since January 2010.Yanzu ina so in tambayeki gameda da lokutan da ke da abokin zamanki ku ka ta ba amfani da wata hanya domin hanadaukar ciki tun daga Janaury r 2010?USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENTUSE, BACK TO JANUARY 2010.USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.IN COLUMN 1, ENTER METHOD USE CODE OR ‘0’ FOR NONUSE IN EACH BLANK MONTHILLUSTRATIVE QUESTIONS: When was the last time you used a method? Which method was that? Wannene lokacin karshen da ki ka yi amfani da wani tsari? Wanne irin tsari ne?When did you start using that method? How long after the birth of (NAME)?Yaushe ki ka fara amfani da wannan tsarin? Yaushe bayan haihuwar (NAME)?How long did you use the method then?Menene tsawon lokacin da ki ka yi amfanin da wannan tsarin?IN COLUMN 2, ENTER CODES FOR DISCONTINUATION NEXT TO THE LAST MONTH OF USE. NUMBEROF CODES IN COLUMN 2 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE INCOLUMN 1.ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHEBECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPEDTO GET PREGNANT.ILLUSTRATIVE QUESTIONS: Why did you stop using the (METHOD)? Don me ki ka daina amfani da wannan (METHOD)?Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop forsome other reason?Kin dauki ciki da kina amfani da (METHOD), ko ba ki dauki ciki ba, ko baki dauki ciki ba domin wasudalilai?IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK: How many months did it take you to get pregnant after you stopped using (METHOD)?Wata nawa ya dauke ki samun ciki bayan kin daina amfani da wannan(METHOD)AND ENTER ‘0’ IN EACH SUCH MONTH IN COLUMN 1.Q309CHECK Q304:CIRCLE METHOD CODE:IF MORE THAN ONE METHOD CODE CIRCLED IN304, CIRCLE CODE FOR HIGHEST METHOD INLIST.NO CODE CIRCLED………………………00FEMALE STERILIZATION………………..01MALE STERILIZATION…………………...02IMPLANT…………………………………...03IUCD…………………………………….…..04INJECTABLE... . . . . . . . . . …..……….…05DAILY PILL……….……………………......06EMERGENCY PILL (Postnor2, etc.)….…07MALE CONDOM . . . . . . . . ………….......08FEMALE CONDOM . .. …. . . …………....09BREASTFEEDING/LAM . . . . . …..……..10STANDARD DAYS METHOD/ SAFE DAYS/CYCLE BEADS……………………….……11RHYTHM METHOD………………………..12WITHDRAWAL …………………………...13OTHER __________________________96(SPECIFY)Q31815

Q310Q311Q312Who decided which type of family planning/ child birthspacing/child spacing method to use? Is it mainlyyour decision, mainly your partner's decision, or didyou both decide together?Shin wa ya ke yanke shawara wajen wane irindabarar tsarin iyali/tazara tsakanin haihuwa/tazaratsakanin yara za ku yi amfani da shi? Shin ra’ ayin kine ke kadai, ko na mijin ki /abokin zaman ki,ko ra’ayinku ne tare ?Were you ever told by a health or family planningworker about side effects or problems you might haveusing this family planning method [CIRCLED INQ309]?Shin ko jami’an kiwon lafiya ko na tsarin iyali sungaya miki illoli ko matsalolin da zasu iya faruwa idankin yi amfani da wannan hanyar tsarin iyali?Were you told by a health or family planning workerwhat to do if you experienced side effects orproblems with this method [CIRCLED IN Q309]?Shin ko jami’an kiwon lafiya ko ta tsarin iyali sun gayamiki abin da za ki yi idan illolin ko matsalolin sukafaru?MAINLY YOU..………..……………….……1MAINLY PARTNER………..…………….…2JOINTLY…………………….……………….3OTHER__________________________6(SPECIFY)YES . . . . . . . . . . . . . . ………… . . . . . . .NO . . . . . . . . . . . . . . . . . . . . . . ………….DON’T KNOW . . . . . . . . . . . . . ………….YES . . . . . . . . . . . . . . . . . . …………….. . . .1NO . . . . . . . . . . . . . . . . . . . . . ……………. . 2DON’T KNOW/CAN’T REMEMBER . .. .…. .8128Q313Q313Q313Have you experienced any problems with yourcurrent method?Kin ta ba samun wata matsala wajen amfani dawannan tsarin.YES . . . . . . . . . . . . . . . . . . . . …….…1NO . . . . . . . . .. . . . . . . . . ……….……2Were you ever told by a health or family planningworker about other methods of family planning(beside the one you are currently using)?Q314Shin ko jami’an kiwon lafiya ko ta tsarin iyali suntaba gaya miki wasu dabaraun tsarin iyali/tazaratsakanin haihuwa/tazara tsakanin yara, da za ki iyaamfani da su?(banda wanda ki ke amfani dashiyanzu)YES . . . . . . . . . . . . . . . ……………. . . . . . .1NO . . . . . . . . . . . . . . ……………. . . . . . . . .2DON’T KNOW . . . . . . . . ……………. . . . . .8CHECK Q309:Q315IF CIRCLED FEMALE STERILIZATION “01” MALESTERILIZATION “02”, IMPLANT “03”, IUCD “04”,INJECTABLE “05”, DAILY PILL “06”, EMERGENCYPILL “07”, MALE CONDOM “08”,FEMALE CONDOM “09”,OR OTHER PRODUCT “96”IF CIRCLED BREASTFEEDING/LAM “10”STANDARD DAYS/SAFE DAYS/CYCLE BEADS “11”RHYTHM METHOD “12” WITHDRAWAL“13” OR OTHER NATURAL METHOD “96”Q321Q316From where or whom did you obtain [CURRENTMETHOD] last time?A ina ko a gun wa ki ka samu wannan dabarar awancan lokacin?PROBE: What is the name of this place/person? Andwhere is it located?PROBE: Ya ya sunan wajen/mutumin? Kuma inaya/ta ke?NAME OF FACILITY /PERSON__________________________________________________________________STREET NAME/ADDRESS___________________________________________LAND MARK DESCRIPTION_______________________16

PUBLIC SECTORGOVT HOSPITAL………………………………11WOMEN AND CHILDREN’SHOSPITAL……………………………….….…..12CHILD WELFARE CLINIC………………...…..13GOVT. HEALTH CENTER…………………….14GOVERNMENTPOST/DISPENSARY……………..………..…..15MATERNITY HOME………………………..….16MOBILE CLINIC…………….…………….……17OTHER PUBLIC______________________18(SPECIFY)Q317What type of place/person is this?Wanne irin waje ko mutun ne?SINGLE MENTION.PRIVATESECTORPRIVATE HOSPITAL/CLINIC.........................21PRIVATE DOCTOR’S OFFICE.…………..….22NURSING/MATERNITY HOME………...……23PHARMACY………………………………....…24PMS/CHEMIST………………………….….....25MOBILE CLINIC…………….…………………26CHW/TBA………………………………….…..27TRADITIONAL HEALER…………………….28OTHER PRIVATE____________________29(SPECIFY)Q321FAITH-BASED SECTORMISSION HOSPITAL……………....................31FAITH-BASED, CHURCH CLINIC…………..32OTHER SOURCEOTHER NGO HOSPITAL/CLINIC………...…41WORKSITE CLINIC……………………..….…42YOUTH CENTER………………………….…..43VENDING MACHINE/DISPENSER…………44VCT…….………………….………………........45BAR……………………………………….….…46KIOSK/SHOP/MARKET………………………47OTHER ____________________________96(SPECIFY)DON'T KNOW . . . . . . . . . . . . . . ………………… .9817

FERTILITY RELATED REASONS:A. NO SEXB. INFREQUENTSEXC. NOT MARRIED YET/ NO PARTNERD. AWAY FROM SPOUSEE. ALREADY PREGNANTF. BREASTFEEDINGG. RECENTLY HAD BABYH. WANTS MORE CHILDREN/TRYING TO GETPREGNANTI. MENOPAUSAL/HYSTERECTOMY Q321J. CAN’T HAVE (MORE) CHILDREN Q321Q318What are the main reasons why you are notcurrently using a method of family planning/ childbirth spacing to delay or avoid pregnancy?Shin wanne dalili ne yasa ba kya amfani da watadabarar tsarin iyali/taraza tsakanin haihuha/tazaratsakanin yara don jinkirta wa ko hana daukan cikiyanzu?CIRCLE ALL MENTIONED.PROBE: Any other?PROBE: Akwai wani?OPPOSITION TO USE:K. RESPONDENT OPPOSESL. PARTNER OPPOSESM. OTHERS OPPOSEN. RELIGIOUS PROHIBITIONLACK OF KNOWLEDGE:O. DOESN’T KNOW WHICH METHOD TO USEP. DON’T KNOW HOW TO USE METHODQ. KNOWS NO SOURCEMETHOD-RELATED REASONS:R. HEALTH CONCERNSS. FEAR OF SIDE EFFECTST. LACK OF ACCESS/TOO FARU. COSTS TOO MUCHV. INCONVENIENT TO USEW. DON’T LIKE EXISTING METHODSX. BAD EXPERIENCE WITH EXISTINGMETHODSFATALISTIC:Y. UP TO GODOTHER:WW. OTHER ____________________________XX. OTHER ____________________________YY. OTHER ____________________________Q319Q320Do you or your partner intend to use/continue to usea method to delay or avoid pregnancy within the nexttwelve (12) months?Ke ko mijin ki/abokin zaman ki, na da niyar yinamfani da wata dabarar don jinkirta ko gujewadaukanciki nan da watanni goma sha biyu?What method would you prefer MOST to use, if youdo use a method in the future?Wacce irin dabara za ki fi son yin amfani dashi, in harza ki yi amfani da wata dabara nan gaba?SINGLE MENTIONZZ.DON'T KNOWYES . . . . . . . . . . . . . . . . . . . . . . ………..1NO . . . . . . . . . . . . . . . . . . . . . . . ………..2DON’T KNOW . . . . . . . . . . . . . . ………..8FEMALE STERILIZATION……………..…..01MALE STERILIZATION…………….….…...02IMPLANT…………………………….….…...03IUCD………………………………………....04INJECTABLE... . . . . . . . . . ………..………05DAILY PILL ……….…………………..….…06EMERGENCY PILL (Postnor2, etc.)…...…07MALE CONDOM . . . . . . . . …………........08FEMALE CONDOM . .. . . …. . . …………..09BREASTFEEDING/LAM . . . . . …..…...….10STANDARD DAYS METHOD/SAFE DAYS/CYCLE BEADS………………11RHYTHM METHOD………………………….12WITHDRAWAL………………………………13Q321Q321Q321Do you approve of using family planning?Kin amince da amfani da tazarar tsarin iyali?OTHER ___________________________96(SPECIFY)YES……………………………………………….1NO…………………………………………………2DON’T KNOW……………………………………818

CHECK Q301: IF KNOWLEDGE OF ANYINJECTABLE:IF NO KNOWLEDGE OF INJECTABLE:Q322IF CIRCLED RESPONSES ‘1’ OR ‘2’ FORINJECTABLE “05”IF CIRCLED RESPONSE ‘3’ FOR INJECTABLE “05”Q324Q323Some women choose not to use injectables. Why is itso?Menene akasarin illar yin allurar tsarin iyali?PROBE: Any other?PROBE: Da akwai wasu kuma?MULTIPLE RESPONSES.CIRCLE ALLMENTIONED.INEFFECTIVE AGAINST PREGNANCYPREVENTION………………………………………ABLEEDING OR MENSTRUAL PROBLEMS…….BWEIGHT GAIN…………………….………………..CWEIGHT LOSS……..……………………………...DHEADACHES……………………………………….EDIZZINESS…………………………………….……FBACKACHES……………………………………….GNAUSEA/VOMITING………………………………HBLOATING…………………………………………..IBREAST TENDERNESS…………………….……JSLEEPLESSNESS…………………………………KMOOD CHANGES………………………………….LWEAKNESS……………………………………..….MLACK OF SEXUAL URGE………….……………..NOTHER HEALTH PROBLEMS…………………...OINFERTILITY………………………………………..PCANCER………………………………………….….QDEFORMED CHILDREN……………………….….RHARD TO GET…………………………................SCOSTS TOO MUCH………………………………..THUSBAND DOES NOT APPROVE………………UCONTAINS HORMONES THAT ARE BAD FOR THEBODY…………………................................VDIFFICULT TO REMEMBER TO GET MORE ONTIME…………………………………………………WOTHER_________________________________X(SPECIFY)OTHER_________________________________Y(SPECIFY)Q324Q325Since January 2010, have you recommended anyfamily planning methods to your friends and/orrelatives?Ko kin taba bada shawara wa kawayenki ko ‘yanuwanki akan dabarar tsarin iyali / tazara tsakaninhaihuwa/tazara tsakanin yara?Which methods did you recommend?Wadanne irin dabaru ki ka bada shawara akai?CIRCLE ALL MENTIONED.IF RESPONDENT SAYS “PILL”, PROBE FURTHERTO ESTABLISH IF THEY MEAN THE “DAILY PILL”OR THE “EMERGENCY PILL”DON’T KNOW………………….…………………....ZYES…………………………..…………………...1NO………………………………………..……….2FEMALE STERILIZATION……………….…..AMALE STERILIZATION………………….......BIMPLANT………………………………...…....CIUCD……………………………………………DINJECTABLE... . . . . . . . . . ………….….…..EDAILY PILL……….……………………....…...FEMERGENCY PILL (Postnor2, etc.)…...….GMALE CONDOM . . . . . . . . ………….........HFEMALE CONDOM . .. . . …. . . ……….…..IBREASTFEEDING/LAM . . . . . …..…….…JSTANDARD DAYS METHOD/SAFE DAYS/ CYCLE BEADS………….…..KRHYTHM METHOD…………………..….…..LWITHDRAWAL ………………………….......MOTHER ____________________________X(SPECIFY)Q32619

Quality of Care – Services and TreatmentPlease tell me how you would agree or disagree with the following statements.If you say you disagree, I will ask you to tell me if you strongly disagree or justdisagree. If you say you agree, I will ask you to tell me if you strongly agree orjust agreeIna son ki gaya mani ko zaki yarda, ko ba zaki yarda ba, da wadannanmaganganu. Idan ba ki yarda ba, zan tambayeki, ko baki yarda ba kwarai, kokuma baki yarda ba ne kawai. Idan kin yarda, zan tambayeki, ko kin yardakwarai ne ko kuma kin yarda kawai.StronglyAgreeAgree Disagree StronglyDisagreeQ326Q327Q328Family planning providers around here treat clients very badly.Jami’an/ masu kula da dabarun tsarin iyali a kewayen nan sunamusgunawa wadanda suke zuwaWomen don't like the way they are treated in family planning clinicsaround here.Mata basu son yadda ake lura da su a asibitin tsarin iyali akewayen nanFamily planning sellers/providers make women like you feel badwhen obtaining contraceptives.Jami’an/ masu sayar /kula da dabarun tsarin iyali suna sanyamata suji rashin dadi lokacin da suke karban dabarar tsarin iyali4 3 2 14 3 2 14 3 2 1BeliefsPlease tell me how you would agree or disagree with the following statements. If you say youdisagree, I will ask you to tell me if you strongly disagree or just disagree. If you say you agree,I will ask you to tell me if you strongly agree or just agree.Ina so ki gaya mani ko zaki yarda, ko ba zaki yarda ba, da wadannan maganganu. Idan ba kiyarda ba, zan tambayeki, ko baki yarda ba kwarai, ko kuma baki yarda ba ne kawai. Idan kinyarda, zan tambayeki, ko kin yarda kwarai ne ko kuma kin yarda ne kawai.StronglyAgreeAgreeDisagreeStronglyDisagreeQ329Q330Q331Q332Q333Q334Q335Q336Use of a contraceptive injection can make a woman permanently infertile.Amfani da allura tsarin iyali na iya hana mace haihuwa har abadaPeople who use family planning end up with health problems.Mutane masu amfani da dabarun tsarin iyali suna karewa da matsalolin rashin lafiyaContraceptives can harm your womb.Dabarun tsarin iyali na iya bata mahaifar maceContraceptives reduce women’s sexual urge.Dabarun tsarin iyali na rage shaáwar jima’i wa mata.Contraceptives can cause cancer.Dabarun tsarin iyali na iya sa ciwun sankara/DajiContraceptives can give you deformed babies.Dabarun tsarin iyali na sa a haifi yara ma su nakasa.Contraceptive are dangerous to your health.Dabarun tsarin iyali su nada illa ga lafiyar ki.Women who use family planning /child birth spacing may become promiscuousMatan da ke amfani da dabaruntsarin iyali/ tazara tsakanin haihuwa da haihuwa naiya zama haliga?4 3 2 14 3 2 14 3 2 14 3 2 14 3 2 14 3 2 14 3 2 14 3 2 120

Q401Section 4: MATERNAL AND CHILD HEALTHCHECKQ211:ONE OR MORE BIRTHSNO BIRTHSSINCE JANUARY 2010 SINCE JANUARY 2010 Q409ENTER NAME AND LINE NUMBER OF YOUNGEST CHILD BORN SINCE JANUARY 2010FROM Q214 AND Q215:Q402___________________________NAME[__|__]LINE NUMBERQ403Q404Q405Q406Now I would like to ask you about the delivery of [NAME OF YOUNGEST CHILD].Yanzu ina so na tambayeki game da haihuwar ki ta karshe.Within 12 months of delivery of [NAME ABOVE], did youstart using a family planning method?A cikin watanni goma sha biyu da ki ka haifi [NAMEABOVE], kina amfani da hanyar tsarin iyali?Which method(s)?Wacce irin hanya ki ke amfani da ita?PROBE: Any others?Akwai wata kuma?When did you start using the method (how long afterdelivery of ________[NAME ABOVE]Yaushe ki ka fara amfani da wannan hanyar( Tun yaushebayan haihuwar________[NAME ABOVE]RECORD COMPLETED DAYS IF LESS THAN 1 WEEK;COMPLETED WEEKS IF MORE THAN 7 DAYS ANDLESS THAN 1 MONTH; COMPLETED MONTHS IF 1MONTH OR MOREWhere did you give birth to [NAME]?A ina ki ka haifi ______________________?(NAME OF CHILD)YES………………………………1NO………………………………..2FEMALE STERILIZATION……………………AMALE STERILIZATION……………….............BIMPLANT……………………………….............CIUCD…………………………………………….DINJECTABLE... . . . . . . . . . ………...…………EDAILY PILL……….……………………………..FEMERGENCY PILL (Postnor2, etc.)………....GMALE CONDOM . . . . . . . .…………..............HFEMALE CONIDOM . .. . .…. . . …………........IBREASTFEEDING/LAM . . . . . …..…………..JSTANDARD DAYS METHOD/ SAFE DAYS/CYCLE BEADS…..……………….....................KRHYTHM METHOD …….……………………..LWITHDRAWAL ………...………………............MOTHER __________________________X(SPECIFY)DAYS POST PARTUM……………..1. [__|__]WEEKS POST PARTUM……….…..2 [__|__]MONTHS POST PARTUM…………3 [__|__]IMMEDIATELY POST PARTUM/TIME OFDELIVERY………….……………….. 993PUBLIC SECTORGOVT HOSPITAL…………………….…11WOMEN AND CHILDREN’SHOSPITAL…………………………….....12CHILD WELFARE CLINIC……….….....13GOVT. HEALTH CENTER…………..….14GOVERNMENTPOST/DISPENSARY…………………...15MATERNITY HOME…………………….16MOBILE CLINIC……..…………….…....17OTHER PUBLIC__________________18(SPECIFY)PRIVATESECTORPRIVATE HOSPITAL/CLINIC..............21PRIVATE DOCTOR’S OFFICE……….22NURSING/MATERNITY HOME………23MOBILE CLINIC…………….……….…..26CHW/TBA…………………………….…..27TRADITIONAL HEALER……………….28OTHER PRIVATE_________________29(SPECIFY)FAITH-BASED SECTORMISSION HOSPITAL……………...........31FAITH-BASED, CHURCH CLINIC..……32OTHER SOURCEOTHER NGO HOSPITAL/CLINIC……….41WORKSITE CLINIC…………….…………42YOUTH CENTER………………………….43OTHER FACILITY _________________48(SPECIFY)AT HOME…………………………………..51OTHER(specify) ___________________96Q406Q409Q40921

When you came to the facility for delivery, did anyonegive you information or counsel you on family planningbefore you delivered?Q407Shin kafin ki haihu ko bayan kin haihu ko,akwai wanima’aikacin /jami’an kiwon lafiya ko ta tsarin iyali da sukayi maki bayani akan tsarin iyali/tazara tsakaninhaihuwa/tazara tsakanin yara?After you had delivered, did anyone talk to you aboutusing a family planning method postpartum before youleft the health facility?YES……………………………………………1NO……………………………………………..2Q408Q409Shin kafin ki haihu ko bayan kin haihu ko, akwai wanima’aikacin /jami’an kiwon lafiya ko ta tsarin iyali da sukayi maki bayani akan tsarin iyali/tazara tsakaninhaihuwa/tazara tsakanin yara?CHECK Q205 & Q207 FOR ANY BIRTHS SINCEJANUARY 2010NO YES CIRCLE YESYES……………………………………………1NO……………………………………………..2YES, AT LEAST ONE CHILD…………….…1NO LIVING CHILDREN……….…………..…2Q415Do you have any children who are alive?Kin a da yaran da suke raye?Now I am going to ask you questions about your experience seeking and receiving health services.Yanzu ina son in tambayeki game da yadda kikeneman da karbar shaánin/kiwon lafiya.Q410.In the last six months, have you gone to a healthfacility for any child health services?Cikin watanni shida da suka shige kunje asibiti donkiwon lafiya yaro/yarinyaYES . . . . . . . . . . . . . . . . . . . . . . ………………..….1NO . . . . . . . . . . . . . . . . . . . . . . . …………...………2Q415Where did you go for child services at your last visit?NAME OF FACILITY__________________________________Q411.Ina ki ka je kwanan nan don nema lafyanyaro/yarinya?PROBE: What is the name of this place? And whereis it located?__________________________________________________STREET NAME/ADDRESS_____________________________Menene sunan wurin? Kuma a ina wurin yake?___________________________________________________LAND MARKDESCRIPTION____________________________22

PUBLIC SECTORGOVERNMENTHOSPITAL……..……................11WOMEN AND CHILDREN’S HOSPITAL……….12CHILD WELFARE CLINIC………………….……13GOVT. HEALTH CENTER………………….……14GOVERNMENT POST/DISPENSARY………….15MATERNITY HOME……………………….…..….16MOBILE CLINIC……………………………..……17OTHER PUBLIC________________________18(SPECIFY)Q412What type of facility is this?Wanne irin asibiti ne?PRIVATE SECTORPRIVATEHOSPITAL/CLINIC……………………….………21PRIVATE DOCTOR’S OFFICE…………………22NURSING/MATERNITY HOME………………...23PHARMACY…………………………………….…24PMS/CHEMIST…………………..…………….…25MOBILE CLINIC………………………………….26CHW/TBA…………………………………….……27TRADITIONAL HEALER………………………....28OTHER PRIVATE_______________________29(SPECIFY)FAITH-BASED SECTORMISSION HOSPITAL…………….……................31FAITH-BASED, CHURCH CLINIC……………...32OTHER SOURCEOTHER NGOHOSPITAL/CLINIC…………………..…………..41WORKSITE CLINIC…………….…………….….42YOUTH CENTER………………………………...43OTHER ______________________________96(SPECIFY)DON'T KNOW . . . . . . . . . . . . . . …………………... . .98Q413Q414Did you receive any information or counseling onfamily planning/child birth spacing/child spacingduring this visit?Kin samu wani bayani ko shawara akan tsariniyali/tazara tsakanin haihuwa /tazara tsakanin yara awannan lokacin ziyarar?Did you receive a method or a referral for familyplanning/child birth spacing/child spacing method atthat time?Kin samu dabara ko an tura ki wajen tsariniyali/tazara tsakanin haihuwa/tazara tsakanin yara awancan lokacin?YES . . . . . . . . . . . . . . . . . . . . . …………………..1NO . . . . . . . . . . . . . . . . . . . . . ………………….. .2YES, RECEIVED A METHOD. . . . . . . . . . …………….1YES, RECEIVED A PRESCRIPTION……………...…..2YES, RECEIVED A REFERRAL . . . . . . . ……………. 3NO, DID NOT RECEIVE ANY OF THESE…………..…4Q415In the last year, have you gone to a health facility formaternal health services, such as prenatal andpostpartum care?Cikin shekararda ta shige, kin je asibiti domin awoncikiko kuma kula bayan haihuwa/lokacin jego?YES . . . . . . . . . . . . . . . . . . . . . . ………….1NO . . . . . . . . . . . . . . . . . . . . . . . ………….2Q41923

PUBLIC SECTORGOVERNMENT HOSPITAL……..…….............11WOMEN AND CHILDREN’S HOSPITAL……..12CHILD WELFARE CLINIC…………………...…13GOVT. HEALTH CENTER…………………...…14GOVERNMENT POST/DISPENSARY………..15MATERNITY HOME…………………………….16MOBILE CLINIC…………………………………17OTHER PUBLIC_______________________18(SPECIFY)Q416What type of health facility did you go to for maternalhealth services at your last visit?Wanne wurin kiwon lafiya kika je kwanan nan, dominawon ciki ko kula bayan haihuwa ko jego?PRIVATE SECTORPRIVATEHOSPITAL/CLINIC…………………………...…21PRIVATE DOCTOR’S OFFICE………………..22NURSING/MATERNITY HOME…………….….23PHARMACY………………………………...……24PMS/CHEMIST…………………..………..….…25MOBILE CLINIC…………………………………26CHW/TBA……………………………………...…27TRADITIONAL HEALER…………………….….28OTHER PRIVATE______________________29(SPECIFY)FAITH-BASED SECTORMISSION HOSPITAL…………….…………......31FAITH-BASED, CHURCH CLINIC…………….32OTHER SOURCEOTHER NGOHOSPITAL/CLINIC……………………..………41WORKSITE CLINIC…………….……………...42YOUTH CENTER……………………………....43OTHER _____________________________96(SPECIFY)DON'T KNOW . . . . . . . . . . . . . . ………………… . .98Q417Q418At your last visit, did you receive any information orcounseling on family planning/ child birth spacing?Zuwan ki asibiti na karshe nan, kin samu wannibayani ko shawara akan dabarun tsarin iyali /tazaratsakanin haihuwa?Did you receive a method or a referral for familyplanning/ contraceptive method at that time?Kin samu dabara ko an tura ki wajen dabarar tsariniyali/tazara tsakanin haihuwa/tazara tsakanin yara awancan lokacin?I don’t want to know the results, but In the last year,have you gone to a health facility for an HIV test?YES . . . . . . . . . . . . . . . . . . . . . . ………...…….1NO . . . . . . . . . . . . . . . . . . . . . . . ………………2YES, RECEIVED A METHOD. . . . . . . …………. . . 1YES, RECEIVED A PRESCRIPTION……………....2YES, RECEIVED A REFERRAL . . . . . . . . ……..….3NO, DID NOT RECEIVE ANY OF THESE………….4YES . . . . . . . . . . . . . . . . . . . . . . ……………….….1Q419Ba na son in san sakamakon,A cikin shekarar da tashige, kinje asibiti domin gwajin cuutar kanjamau(HIV)?NO . . . . . . . . . . . . . . . . . . . . . . . ……………….….2Q42324

Q420Q421Q422What type of facility did you go to for your last HIVtest?Wacce irin cibiyar kiwon lafiya ki ka je domin gwajincutar kanjamau?At the time of your last test, did you receive anyinformation or counseling on family planning/ childbirth spacing?A lokacin gwajin ki na karshe, kin samu wani bayaniko shawara akan dabarar tsarin iyalin/ tazaratsakanin haihuwa?Did you receive a method or a referral for familyplanning/contraceptive method at that time?Shin kin karbi wata dabara ko an tura ki wajendabaran tsarin iyali/tazara tsakanin haihuwa/tazaratsakanin yara a wancan lokacin?PUBLIC SECTORGOVERNMENT HOSPITAL……..……..........11WOMEN AND CHILDREN’S HOSPITAL…...12CHILD WELFARE CLINIC……………………13GOVT. HEALTH CENTER……………………14GOVERNMENT POST/DISPENSARY……...15MATERNITYHOME……………………………16MOBILE CLINIC………………………………..17OTHER PUBLIC______________________18(SPECIFY)PRIVATE SECTORPRIVATEHOSPITAL/CLINIC………………………….…21PRIVATE DOCTOR’SOFFICE……................22NURSING/MATERNITY HOME………….…..23PHARMACY……………………………....……24PMS/CHEMIST…………………..……….……25MOBILE CLINIC……………………………….26CHW/TBA………………………………….……27TRADITIONAL HEALER……………….....…..28OTHER PRIVATE_____________________29(SPECIFY)FAITH-BASED SECTORMISSION HOSPITAL…………….……….......31FAITH-BASED, CHURCH CLINIC…………..32OTHER SOURCEOTHER NGOHOSPITAL/CLINIC…………………………….41WORKSITE CLINIC…………….…….……….42YOUTH CENTER……………………………...43VCT……………………………………………...45OTHER _____________________________96(SPECIFY)DON'T KNOW . . . . . . . . . . . . . . ……………….. . .98YES . . . . . . . . . . . . . . . . . . . . . . …………………..1NO . . . . . . . . . . . . . . . . . . . . . . . …………………..2YES, RECEIVED A CONDOM…………………..…1YES, RECEIVED A METHOD OTHER THANA CONDOM………………... . . . . . . . . ……... . .2YES, RECEIVED A PRESCRIPTION. . . . ……. . . 3YES, RECEIVED A REFERRAL . . . . . . . ……... . .4NO, DID NOT RECEIVE ANY OF THESE……..….5Q423In the last year, how often did you visit a pharmacy?A cikin shekarar da ta shige sau nawa ki ka ziyartakantin magani?TIMES PER YEAR………….…..1TIMES PER MONTH………………2TIMES PER WEEK..………………3……..Never visit a pharmacy………………………….. 997 Q42525

Q424In the past year, did you receive a method,information or counseling or a referral for familyplanning/ child birth spacing methods at thepharmamcy?Shin cikin shekarar da ta wuce, kin karbi wata dabarako an tura ki wajen dabaran tsarin iyali/tazaratsakanin haihuwa/tazara tsakanin yara a kemis kokantin magani?YES, RECEIVED A METHOD…………………..….….AYES, RECEIVED INFORMATION ORCOUNSELING…………………………..… . . . . . . ... . .BYES, RECEIVED A REFERRAL . . . …………... ... .. .CNO, DID NOT RECEIVE ANY OF THESE………...….YIn the last year, how often did you visit a PMS/chemist?TIMES PER YEAR………….……...1Q425A shekarar da ta shige, kamar yaya kike ziyartarkantin magani/kemis?TIMES PER MONTH………………2TIMES PER WEEK..……….………3……..Q426In the past year, did you receive a method,information or counseling or a referral for familyplanning/ child birth spacing methods at thePMS/chemist?A cikin shekarar da ta shige,kin ta ba karbar shawaragameda da dabarar tsarin iyali ko atura ki wajen daake tsarin iyali / tazara tsakanin haihuwa a kantinmagani ko kemis?Never visit a PMS/ chemist…………………….. 997YES, RECEIVED A METHOD………………………AYES, RECEIVED INFORMATION ORCOUNSELING……………… . . . . . . . . …............ . .BYES, RECEIVED A REFERRAL . . . . . . …. . ……. .CNO, DID NOT RECEIVE ANY OF THESE…..…........YQ50126

SECTION 5: SEXUAL ACTIVITY AND MARRIAGEQuestions and filters Coding categories SkipsNow I would like to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completelyconfidential and will not be told to anyone. If we should come to a question that you don’t want to answer, just let me know and we will goto the next questionMAKE SURE YOU ARE SITTING IN A PRIVATE PLACE TO DISCUSS THE FOLLOWING QUESTIONS.Q501Yanzu ina son in yi mi ki tambayoyi akan jima’in da ki ka yi kwanannan.Ina son in sake tabbatar ma ki duk amsoshin da ki ka bada sirrine,domin ba za ‘a fadawa wani ba,idan muka zo wurin tambayar da ba kya son amsawa,ki fada mun don muje tambaya ta gaba.Now I need to ask you some questions about sexual activityin order to gain a better understanding of some family life AGE…..…………………..…issues.How old were you when you had sexual intercourse for thevery first time?Yanzu ina son na yi maki wasu tambayoyi a kan jima’i dominsamun kyaykyawar fahimta akan harkar iyali.NEVER HAD SEXUALINTERCOURSE…………….…00Q503Q502Shekarun ki nawa cikakku lokacin da ki ka fara yin jima’i?When was the last time you had sexual intercourse?Yaushe ne ki ka yi jima’i na karshe?WHEN LESS THAN A DAY, RECORD “00” DAYS.IF LESS THAN ONE WEEK AGO, RECORD DAYSIF LESS THAN ONE MONTH AGO, RECORD WEEKS AGOIF LESS THAN 12 MONTHS AGO, RECORD MONTHSIF 12 MONTHS OR MORE, RECORD IN YEARSDAYS AGO……………1 [__|__]ORWEEKS AGO…………2 [__|__]ORMONTHS AGO……… 3 [__|__]ORYEARS AGO………….4 [__|__]Now I would like to ask you some questions about marriage. Remember that your responses will be kept confidential.Yanzu ina so nayi maki wasu tambayoyi akan auren ki.Duk amsoshin ki za su kasance a sirranceQ503Q504What is your marital status now: are you currently marriedor living with man as if married, widowed, divorced, orseparated?Yanzu menene matsayin ki na aure: Kina da aure ko ki nazaune da namijikamar zaman aure a yanzu, ko mijin ki yarasu, ko aurenki ya mutu ko kuma kin yi yaji ne?Is your husband/partner living with you now, or is he stayingelsewhere?Shin yanzu kina tare da mijin ki/abokin zaman, ko shi yanawani waje dabam ne?CHECK Q503:CURRENTLY MARRIED………LIVING WITH A MAN………………....REMARRIED……………………………WIDOWED………………..……………DIVORCED…………………………….SEPARATED…………………………..NEVER MARRIED…………………….LIVING WITH YOU……..………….STAYING ELSEWHERE …………..123456712Q505Q505CQ506DETERMINE MONTHS MARRIED, REMARRIED OR LIVING WITH A MANSINCE JANUARY 2010. ENTER ‘X’ IN COLUMN 3OF CALENDAR FOR EACH MONTH MARRIED, REMARRIED OR LIVING WITH A MAN. ENTER ‘O’ IN COLUMN X OFCALENDAR FOR EACH MONTH SHE WAS NOT IN UNION.FOR WOMEN WHO ARE WIDOWED/DIVORCED/SEPARATED/NEVER MARRIED(Q503=4 OR Q503=5 OR Q503=6 ORQ503=7):PROBE FOR DATE WHEN LAST MARRIAGE STARTED AND TERMINATION DATE. ENTER ‘X’ IN COLUMN 3 OFCALENDAR FOR EACH MONTH MARRIED ENTER ‘O’ IN COLUMN 3 OF CALENDAR FOR EACH MONTHWIDOWED/DIVORCED/SEPARATEDCHECK MARITAL STATUS Q503CURRENTLY MARRIED:NOT CURRENTLY MARRIED:IF CIRCLED RESPONSES ‘1’ FOR CURRENTLY MARRIED OR IF CIRCLED RESPONSES ‘4’ FOR WIDOWED OR‘2’ FOR LIVING WITH A MAN OR ‘3’ FOR REMARRIED ‘5’ FOR DIVORCED OR ‘6’ FOR SEPERATED OR‘ ‘7’ FOR NEVER MARRIED.Q601Q507Besides yourself, does your husband/partner have otherwives?Ban da ke, ko mijinki/abokin zamanki yana da wasu matanko yana zaune da wasu matan kamar zaman aure?YES . . . . . . . . . . . . . . . . . . …………….. . . .1NO . . . . . . . . . . . . . . . . . . . …………….. . . .2DON’T KNOW . . . . . . . . . . . . …………….. .8Q510Q51027

Q508Q509Q510Including yourself, in total, how many wives does yourhusband/partner have?Har da ke gabaki daya mata nawa mijin ki/abokin zaman kiyake dasu?Are you the first, second, third, fourth…… wife?Shin ke ce ta fari, ta biyu, a cikin matan mijin ki /abokanzaman ki?Do you think your spouse/partner has any other sexualpartners who are not wives? If so, how many do youthink?Ki na tunanin mijinki/abokin zamanki yana da wadandayake yin jima’Iidasu wadanda ba matansa bane? Idanhaka ne, su nawa?TOTAL NUMBER OF WIVES………….. [__|__]DON'T KNOW . . . . . . . . . . . . ..………..… . . 98RANK……………NUMBER OF PARTNERS……………..IF NONE, FILL IN ‘00’Q511Q512How old was your partner on his last birthday?Shekarun mijin /abokin zamanki nawa cikakku?Did your husband/partner ever attend school?Shin mijin ki/abokin zamanki ya taba zuwa makaranta?AGE IN COMPLETED YEARS………….........…[__|__]YES . . . . . . . . . . . . . . . …………...............….1NO . . . . . . . . . . . . . . .....................................2Q515What was the highest level of school he attended: quranic,primary, secondary, or higher?QURANIC ONLY…………………………..…….0Q515Q513Menene zurfin ilmin sa: makaranta Alo (Al Qur’an) kadai,firamari, karamar makarantar sakandare, babbar makarantar sakandare ko gaba da sakandare?PRIMARY……………………………………..….1JUNIOR SECONDARY (JSS)…...................... 2SENIOR SECONDARY (SSS)……………...….3Q514Q515What is the highest (class/year) he completed at thatlevel?Aji nawa mafi zurfi ya kammala a wannan matsayin?RECORD “00“ IF NO COMPLETED YEARSWhat is your partner’s occupation, that is, what kind ofwork does he mainly do when he is/was working?Shin menene ainihin irin aikin da mijin/ abokin zamankiyake /ya ta ba yi?HIGHER………………………………………..…4DON’T KNOW.……………………………..…….8CLASS/YEAR……………………….…[__|__]DON’T KNOW………………………………98BANKER ……………………………………………………CIVIL SERVANT……………………………...…………….DEVELOPMENT WORKER……………………..………..MEDICAL…………………………………….……………..LEGAL…………………………………………..…………...BUSINESS/TRADER……………………………………….COMMUNICATION/MEDIA………………………………...LABORER…………………………………………………….FARMER (include fishing, livestock)…………..………….ARTISAN (carpenter, metal worker, hadiworker, trades)OTHER (specify)________________0102030405060708091096Q515Q516Is your husband/partner currently working?Shin mijin ki/abokin zamanki yana aiki yanzu?YES . . . . . . . . . . . . . . . . . . . . . . ……………….....1NO . . . . . . . . . . . . . . . . . . . . . . . ………………….2DON’T KNOW……...………………………….…….8Q518Q517What has he been doing for most of the time over the last12 months?Menene ya fi yi a watanni goma sha biyu da suka shige?NOTHING/IDLE…………………………………………..01LOOKING FOR WORK………………………………….02GOING TO SCHOOL/STUDYING……………………..03UNABLE TO WORK DUE TOILLNESS/DISABILITY…………………………………....04RETIRED………………………………………………….05HOUSEHOLD/FARM WORK……………………….…..06OTHER(SPECIFY)_________________________________96Q601Q518Does he usually work throughout the year, seasonally, oronly once in a while?Shin ya kan yi aiki cikin shekara gaba daya , ko lokacilokaciko sau daya a wani lokaci?THROUGHOUT THE YEAR . . . . . . . . . . . ……………1SEASONALLY/PART OF THE YEAR . . …………..…..2ONCE IN A WHILE . . . . . . . . . . . . . . . . . . ……………328

CHECK Q309: METHOD CURRENTLY USINGSECTION 6: FERTILITY PREFERENCESQuestions and filters Coding categories Skip toQ601DOES NOT USEFEMALE STERILIZATIONFEMALE STERILIZATION (Q309=1)Q606Now, I would like to ask you a few questions about you and your opinion about births.Yanzu, ina son in yi maki wadansu tamboyoyi akan ki da ra’ayin ki game da haife-haifeCHECK Q231:NOT PREGNANTPREGNANTOR UNSUREQ602Now I have some questions aboutthe future. Would you like to have(a/another) child, or would youprefer not to have any (more)children?Yanzu ina da wasu tambayoyigame da nan gaba.Kina fatansamun wani da ko kumaba kya son samun karin ‘ya’ya?Now I have some questions aboutthe future. After the birth of thechild you are expecting now,would you like to have anotherchild, or would you prefer not tohave any more children?Yanzu ina da wasutambayoyi game da nan Gababayan kin haihu lafiya .Yanzu kina fatansamun wani ‘da ko bakya fatan samun karinya’ya?HAVE (A/ANOTHER) CHILD…1NO MORE/NONE………….…..2SAYS SHE CAN’T GETPREGNANT……………….…...3UNDECIDED/DON’T KNOW…8Q604Q606Q604CHECK Q602:NOT PREGNANTOR UNSUREPREGNANTMONTHS . . . . . . . . . . . . . . . . 1YEARS . . . . . . . . . . . . . . . . . . 2Q603How long would you like to waitfrom now before having(a/another) child?Har tsawon wane lokaci ki ke soki dakatakafin ki sake haifar wani‘dan?After the birth of the child you areexpecting now, how long wouldyou like to wait before havinganother child?Bayan wannan haihuwar da ki kesa rai yanzu,har tsawon wanelokaci ki ke so ki dakatakafin ki sake wata haihuwar?SOON/NOW . . . . . . . . . ……… .. . .. .993AFTER MARRIAGE…………………..995OTHER ______________________ 996(SPECIFY)DON’T KNOW . . . . . . . . . . . . . . .. ... . 998IF RESPONSE IS IN MONTHSAND YEARS (E.G. 2 ½ YEARS),CONVERT TO MONTHS (e.g. 30months)IF RESPONSE IS IN MONTHSAND YEARS (E.G. 2 ½ YEARS),CONVERT TO MONTHS (e.g. 30months)29

CHECK Q602:Q604NOT PREGNANT ORUNSUREPREGNANTQ606Q605In the next few weeks, if you discovered that you were pregnant, wouldthat be a big problem, a small problem or no problem at all?Nan da ‘yan sati kadan, In ki ka ga cewa kina da ciki,wannan zai iyazama babban matsala,karamar matsala ko ba matsala ko kadan?CHECK Q503: CURRENTLY MARRIEDBIG PROBLEM . . . . . . . . . . . . . . …...1SMALL PROBLEM . . . . . . . . . . . …...2NO PROBLEM . . . . . . . . . . . . . . …....3SAYS SHE CAN'T GETPREGNANT/OR NOTHAVING SEX…………………….........4Q606CURRENTLY MARRIED OR LIVING TOGETHERNOT IN A UNIONOR REMARRIED(Q503=1, 2 or 3) Q503=(4, 5, 6 OR 7)Now let’s talk about your partner and his preferences for the future.Q611Yanzu zamuyi magana akan mijin /abokin zamanki da abin da ya fi sonan gaba.HAVE (A/ANOTHER) CHILD . . . . …1Q607CHECK Q604:NOT PREGNANTOR UNSUREWould he like to have(a/another) child, orwould he prefer notto have any (more)children?Zai so ya samu wani dako kuma baya sonsamun Karin ‘ya ‘yaPREGNANTAfter the child you are expectingnow, would your partner like tohave another child, or would heprefer not to have any morechildren?Bayan kin haihu lafiya,abokinzaman ki zai so samun wani da kobaya son samun Karin‘ya’ya?NO MORE/NONE . . . . . . . . . . … . . 2SAYS SHE CAN’TGETPREGNANT………………..….….….3DON’T KNOW partner’sdesire………………………………….8Q609Again, this question relates to your partner’s preferences for the future.Har yanzu, wannan tambayar ta shafi abinda mijin’ ki/abokin zaman kizai so nan gabaCHECK Q604:MONTHS . . . . . . . . . . .1NOT PREGNANTOR UNSUREPREGNANTYEARS . . . . . . . . . . . . . 2Q608How long would yourpartner/husband like to waitbefore the birth of(a/another) child?Har tsawon wane lokacimijin ki /abokin zaman ki zai so ya jirakafin ki sake haifan wani ‘da?IF RESPONSE IS IN MONTHSAND YEARS (E.G. 2 ½ YEARS),CONVERT TO MONTHS (e.g. 30months)After the birth of the child that youand your partner are nowexpecting, how long would yourpartner like to wait before youhave another child?Bayan wannan haihuwarda ku ke jira ke da mijin/ abokinzaman ki,har tsawon wanelokaciku ke son ku jirakafin haifan wani ‘da?IF RESPONSE IS IN MONTHSAND YEARS (E.G. 2 ½ YEARS),CONVERT TO MONTHS (e.g. 30months)SOON/NOW . . . . . . . . .. . .. . . 993OTHER _________________ 996(SPECIFY)SAYS SHE CAN’T GETPREGNANT…………………………994DON’T KNOW PARTNERS DESIRE. . .99830

Q609Q610Does your husband/partner want the same number of children that youwant, or does he want more or fewer than you want?Shin mijin ki/abokin zaman ki yana bukatar yawan ‘ya ‘ya kamar yaddaki ke so, ko yana son fiye da ki ke so, ko kasa da yadda ki ke so?Who (will) decides how many children that you are going to haveWould you say that it is mainly your decision, mainly yourhusband's/partner's decision, or do you decide together?Shin wa yake shawarar yara nawa za ki samu – Za ki iya cewara’ayinki ne ke kadai, ko na mijin ki/abokin zaman ki ne, ko dukkan kubiyu ku ke shawara?SAME NUMBER……………………..1MORE CHILDREN……………….….2FEWER CHILDREN………………...3DON’T KNOW…………………..……8MAINLY YOU………………….…….1MAINLY PARTNER…………………2JOINTLY……………………………..3OTHER______________________6(SPECIFY)CHECK IF WOMAN HAS ANY LIVE CHILDREN (Q409=1)Now let’s talk about you again and your childbearing preferences.Yanzu za muyi magana akan ki kuma da zabin haife haifen kiPROBE FOR A NUMERIC RESPONSE.HAS LIVINGCHILDRENNO LIVINGCHILDRENQ611If you could go back to the timeyou did not have any children andcould have exactly the number ofchildren you wanted to have inyour whole life, howmany would that be?Idan zaki koma lokacinda baki fara samun yara bakuma aka baki zabinyawan yaran da za ki ke soa rayuwar ki, yara nawaza ki yi fatan samu?If you could have exactly thenumber of children you wanted tohave in your whole life, how manywould that be?Idan za ki iya samun yawan yaranda ki ke so a rayuwarki,kamarnawa zaki so?NONE . . . . . . . . . . . . . . . . . . . . . . . . 00NUMBER . . . . . . . . . . . . . . . .OTHER ______________________ 96(SPECIFY)Now, I would like to ask you a few questions about how other women like you think about children and births.Yanzu, ina so nayi maki tambayoyi game da wasu mata kamar ki, ke yin tunanigame yara da haife haife .Q612Q613In your opinion, how long should a couple wait to have their first child?A ra’ayin ki har tsawon wanne lokaci ya kamata ma’aurata su jira kafinsu samu haihuwar su ta farko?In your opinion, what should be the ideal age in years for a woman toget her first child/ pregnancy?A ra’ayin ki kamar shekaru nawa ne ya kamata mace ta kai kafin tasamu ciki, ko, dan ta/yar ta na/ farko?IMMEDIATELY…………………….1LESS THAN ONE YEAR………….2MORE THAN 1 YR BUT LESSTHAN 2 YRS……………………....32 OR MORE YEARS…………..…4OTHER ____________________6(SPECIFY)DON’T KNOW……………….….…8AGE IN YEARS………………….[__|__]DON’T KNOW……………………….9831

SECTION 7: SPOUSAL AND INTERPERSONAL COMMUNICATIONQuestions and filters Coding categories SkipNow, I would like to ask you a few questions on discussions that you might have had with other people on health issues.Q701Yanzu zanyi miki wasu yan tamboyoyi akan tattaunawa da maiyiwa kika taba yi game da kiwon lafiyaCHECK Q503:CURRENTLY MARRIED OR LIVING NOT IN A UNION (Q503= 4, 5,6, OR 7)TOGETHER (Q503=1, 2 OR 3)Q707How often have you talked to your spouse/partnerabout the number of children you would like to haveinthe last six (6) months?NUMBER OF TIMES TOPIC DISCUSSEDQ702Sau nawa ki ka yi magana da mijin ki/abokin zamanki akan wannan zancen a cikin watanni shida dasuka shige?NOT DISCUSSED AT ALL IN LAST SIX (6)MONTHS…………………………………………………..97How often have you talked to your spouse/partnerabout the use of a family planning method in the lastsix (6) months?NUMBER OF TIMES TOPIC DISCUSSEDQ703Sau nawa ki ka yi magana da mijin ki/ abokin zamanki akan wannan zancen a cikin watanni shida dasuka shige?NOT DISCUSSED AT ALL IN LAST SIX (6)MONTHS…………………………………………………..97Q704Q705Q706Q707Who usually starts adiscussion about familyplanning, you or your spouse/partner?Shin wa ya ke fara maganar tsarin iyali,ke ce ko mijinki/abokin zamanki?How difficult is it to start a conversation about familyplanning with your partner –is it very difficult,somewhat difficult, or easy?Yaya wahalar fara maganar tsarin iyali/ tazaratsakanin haihuwa/tazara tsakanin yara da mijin/abokin zaman ki – da wahala sosai, da dan wahala,da sauki?Do you intend to talk to your spouse about familyplanning in the next three months?Shin kina da niyyar magana da mijin ki akan tsariniyali/tazara tsakanin haihuwa/tazara tsakanin yara acikin watanni uku nan gaba?Do you need anyone’s permission to use a familyplanning/ child birth spacing/child spacing method?Shin idan kina son ki yi amfani da dabarar tsariniyali/tazara tsakanin haihuwa/tazara tsakanin yara,Kina bukatar izinin wani?YOU......................................................................1SPOUSE/PARTNER.............................................2EITHER…………………………………………..…..3NEITHER / NEVER TALK ABOUT FP……………4VERY DIFFICULT ……………………………..…..1SOMEWHAT DIFFICULT ……………………..….2EASY………………………………………….……..3YES ……………………………………………..…1NO………………………………………………….2DON’T KNOW…………………………………….8YES . . . . . . . . . . . . . . . . . . . . . . ………………….1NO . . . . . . . . . . . . . . . . . . . . . . . ………………....2DON’T KNOW………….…………………………...8Q709Q709Q708From whom would you need permission?A wurin wa zaki nemi izini?CIRCLE ALL MENTIONED.HUSBAND/PARTNER……………………..…AFATHER....................................................... BMOTHER………….. .....................................CFATHER-IN-LAW..........................................DMOTHER-IN-LAW …………......…………….ESISTER(S)…………………………………..…FSISTER(S)-IN-LAW…………………………..GOTHER RELATIVE……………………….….HQ709Do you think that government officials should speakpublicly about family planning/child birth spacing?A ganin ki, ya kamata ma áikatan gwamnati su yimagana a wajen taro akan dabarun tsarin iyali/tazara tsakanin haihuwa da haihuwa?OTHER ____________________________X(SPECIFY)YES…………………………………………….…1NO……………………………………………...…2DON’T KNOW ……………………………..……832

Q710Q711Q712Q713Q714Q715Q716Q717In the past year, have you heard or seen a LocalGovernment Official speaking publicly against familyplanning/ child birth spacing/child spacing?A cikin shekara da ta shige kin taba jin ko ganin wanima’aikacin gwamnatin karamar hukuma na maganaa wajen taro a kan rashin mahimmancin tsariniyali/tazara tsakanin haihuwa/tazara tsakanin yara?In the past year, have you heard or seen a LocalGovernment Official speaking publicly in favor offamily planning/ child birth spacing/child spacing?A cikin shekara da ta shige kin taba ji ko ganin wanima’aikacin gwamnatin karamar hukuma na maganaa taro a kan mahimmancin tsarin iyali/tazara tsakaninhaihuwa/tazara tsakanin yara?Do you think that religious leaders should speakpublicly about family planning/child birth spacing?A ganinkishu’agabannin addini na iya magana awajen taron jama’ a kan mahimmancin tsariniyali/tazara tsakanin haihuwa/tazara tsakanin yara?In the past year, have you heard or seen a religiousleader speaking publicly against family planning/childbirth spacing?A cikin shekarar da ta shige kin taba ji ko ganinshu’agabannin addini na magana a wajen taronjama’ a kan rashin mahimmancin tsarin iyali/tazaratsakanin haihuwa/tazara tsakanin yara?In the past year, have you heard or seen a religiousleader speaking publicly in favor of familyplanning/child birth spacing?A cikin shekarar da ta shige kin taba jin ko ganinJami’in gwamnati na magana a wajen taron jama’ akan mahimmancin tsarin iyali/tazara tsakaninhaihuwa/tazara tsakanin yara?How many of your close friends and relatives do youthink use family planning: none, some, most, or all?Shin zaki iya cewa nawa daga cikin kawayanki nakussancin ki ko yanuwan ki, su ke amfani da dabarartsarin iyali/tazara tsakanin haihuw/tazara tsakaninyara: ba ko daya, kadan daga cikin su, mafiya yawadaga cikin su, ko gaba ki dayansu?Do you think there are some people within this communitywho will call you bad names or avoid your company if theyknew that you were using a family planning/contraceptivemethod?Shin kina ganin cewa da akwai wasu mutane a cikin wannanal’uma da za su kira ki da sunaye mara sa kyau ko kumabaza su so su yi ma’amala dake ba in sun san kina amfani dadabarar tsarin iyali/tazara tsakanin haihuwa/tazara tsakaninyara?Do you think there are some people within this communitywho will praise, encourage, or talk favorably about you if theyknew that you were using a family planning/contraceptivemethod?Shin kina ganin cewa da akwai wasu mutane a cikin wannanal’uma wanda zasu yabeki ko su baki goyon baya ko suyimagana mai kyau akan ki , in sun san kina amfani da dabarartsarin iyali/tazara tsakanin haihuwa/tazara tsakanin yara?YES………………………………………………1NO…………………………………………….….2DON’T REMEMBER …………………………..8YES………………………………………..……1NO……………………………………………….2DON’T REMEMBER ………………………….8YES . . . . . . . . . . . . . . . . . . . . . . …………….1NO . . . . . . . . . . . . . . . . . . . . . . . …………….2DON’T KNOW………….………………………8YES…………………………………………..…1NO…………………………………………...….2DON’T REMEMBER ………………………….8YES………………………………………….…1NO…………………………………………..….2DON’T REMEMBER ………………………...8NONE………………………………………….1SOME…………………………………….……2MOST…………………………………….……3ALL………………………………………..……4DON’T KNOW…………………………….…..8YES . . . . . . . . . . . . . . . . . . . . . . ………….…..1NO . . . . . . . . . . . . . . . . . . . . . . . …………..….2DON’T KNOW……...……………………...…….8YES . . . . . . . . . . . . . . . . . . . . . . ……………..1NO . . . . . . . . . . . . . . . . . . . . . . . ……………..2DON’T KNOW……...……………………….….833

Please tell me how you would agree or disagree with the followingstatements.Don AllahIna son ki gaya mini ko zaki yarda ko ba zaki yarda dawadannan maganganun ba.Strongly Agree Agree Disagree StronglyDisagreeQ718Q719Q720Q721Q722Q723Q724You could start a conversation with your partner aboutfamily planning.Zaki iya fara magana da mijin/abokin zamanki akan tsariniyaliYou could convince your partner that you should use amethod of family planning.Zaki iya shawo kan mijin/abokin zaman ki don ki faraamfani da dabarar tsarin iyaliYou could obtain a family planning/child birthspacing/child spacing method if you decided to use one.Zaki iya samun dabarar tsarin iyali /tazara tsakaninhaihuwa/tazara tsakani yara idan kina son ki yi amfani dashi.You could use a method of family planning/ child birthspacing/child spacing even if your partner doesn’t wantyou to.Zaki iya yin amfani da dabarar tsarin iyali /tazara tsakaninhaihuwa/tazara tsakani yara ko mijin/abokin zaman kibaya son kiyi.You could use a method of family planning/child birthspacing/child spacing even if none of your friends orneighbors uses one.Zaki iya yin amfani da dabarar tsarin iyali /tazara tsakaninhaihuwa/tazara tsakani yara ko da kawayen ki komakobtan ki basu amfani da shi.You could use a method of family planning/child birthspacing/child spacing even if your religious leader did notthink you should use one.Zaki iya yin amfani da dabarar tsarin iyali /tazara tsakaninhaihuwa/tazara tsakani yara ko da wani shugaban addininkana ganin cewa ba za ka yi amfani da shi ba.You could continue to use a family planning/child birthspacing/child spacing method even if you experiencesome side effects.Zaka iya cigaba da amfani dadabarar tsarin iyali/tazaratsakanin haihuwa/tazara tsakanin yara ko da ka samuwasu matsaloli.4 3 2 14 3 2 14 3 2 14 3 2 14 3 2 14 3 2 14 3 2 134

Q801.Q802.Q803.Do you read newspaper(s) or magazines?SECTION 8: MEDIA EXPOSUREQuestions and filters Coding categories SkipKina karanta jarida ko mujalla?Have you read any articles on family planning/child birth spacingin newspapers/magazines in the past three months?Kin karanta wa ta kasida akan tsarin iyali/ tazarar haihuwa acikin watanni ukku da suka shige?Do youlisten to the radio?Ki na sauraren rediyo?YES .............................................................. 1NO .................................................................. 2YES .................................................................... 1NO ...................................................................... 2DON’T KNOW ................................................. ….8YES .............................................................. 1NO…………………………………………………2Q803Q807Q804.How many days in a week do you listen to radio?Kwanakinawa a sati ki ke sauraren rediyo?NUMBER OF DAYS IN A WEEKLESS THAN WEEKLY/NOT REGULARLY .......... 8Q805.Q806.On average how long in total do you listen to radio on a normalday?A taikace tsawon lokaci nawa a yini ki ke jin rediyo?Have you heard any family planning/ child birth spacinginformation on the radio in the past three months?Kin taba jin bayani a rediyo game da dabarun tsarin iyali/tazara tsakanin haihuwa a cikin watanni ukku da suka shige?HOURS PER DAY…………………1 [__|__]ORMINUTES PER DAY………………2 [__|__]YES................................………….………….…...1NO....................................………….....................2DON’T KNOW………………………….…………..8ASK THE FOLLOWING QUESTION BASED ON CITY:FCT ABUJA:Have you ever heard about a radio program called “SecondChance”?A cikin shekara daya da ta shige, kin ta ba ji ko ganin wannankalmar “Mu hade tare”Q807.IBADAN OR ILORIN:Have you ever heard about a radio program called “IretiEda”?Kin tab a sauraro wani shirin rediyo da ake kira “Ireti Eda”?YES………………………………………………..……1NO…………………………………………………..…..2DON’T KNOW ................................................. ……8Q811Q811KADUNA:Have you ever heard about a radio program called “KomaiNisan Jifa”?Kin ta ba sauraron wani shiri a gidan rediyo “ komai nisan jifa”Q808.Q809.PROBE: “You may have heard this program played on the radioor on a CD”Maiyuwa kin ji wannan shirin a rediyo ko “CD”.Have you ever listened to this radio program?Kin ta ba sauraron wannan shirin?How often do you listen to this program – every week, once ortwice a month, or less than once a month?Kamar sau nawa ki ke sauraron wannan shirin- ko wane sati,sau daya ko biyu a wata ko kasa da s au daya a wata?YES……………………………………………………..1NO………………………………………………………2DON’T KNOW………………………………………....8DON’T LISTEN TO THE RADIO…………………….9EVERY WEEK…………………………………………1ALMOST EVERY WEEK……………………………..2ONCE OR TWICE A MONTH………………………..3LESS THAN ONCE A MONTH………………………4USED TO LISTEN BUT DON’T ANYMORE……….5ONLY LISTENED ONCE……………………………..6Q810Q810Q810Q810.Have you ever attended a meeting where this program wasplayed or discussed?Kin ta ba halartar wani taron da a ka sa wannan shirin ko aketattaunawa akai?YES……………………………………………………..1NO………………………………………………………2DON’T KNOW ................................................. …...835

Q831Q832Q833Q834Q835Q836Where did you see or hear this phrase?A ina ki ka ga ko ji wannan kalmar?CIRCLE ALL MENTIONED“Ki la siri ewa re” – “ifeto somo bibi lasiri ewa mi”(meaning what is the secret of your beauty? Familyplanning is the secret of my beauty)( Ma’ana-Menene sirrin kyawon ki? Tsarin iyali shinesirrin kyau na)What does this phrase mean to you?Menene wannan kalmar ta ke nufi?[IF RESPONDENT ONLY GIVES THE COMMONDEFINITION OF THE PHRASE, PROBE TO SEE IFTHERE IS ANY OTHER MEANING.CIRCLE ALL MENTIONEDWhere did you see or hear this phrase?A ina ki ka ga ko ji wannan kalmar?CIRCLE ALL MENTIONEDDo you understand Hausa language?Kin a jin Hausa?In the past year, have you heard the phrase “Ko kugane, tazaran haihuwa” (meaning Go for familyplanning)?RADIO……………………………………………………...ATELEVISION……………………………………………….BPOSTER ………………………………………………….CUMBRELLA……………………………………………….DSHOPPING BAG…………………………………………ET-SHIRT…………………………………………………...FLEAFLET………………………………………………….GBADGE……………………………………………………HCAPS………………………………………………….…...IWRISTBAND…………………………………………..….JON A SIGN AT A HEALTH FACILITY…………………KON A SIGN AT A PHARMACY / CHEMIST…………...LAT A ROADSHOW / RALLY……………………………MAT A PARADE……………………………………………NOTHER (Specify)_____________________________XDON’T KNOW……………………………………………ZYES…………………………………………………….1NO……………………………………………………...2DON’T KNOW…………………………………………8AGE AT MARRIAGE………………..……….……....ADELAYING FIRST BIRTH…………………………...BUSE FAMILY PLANNING…………………………...CDELAYING AGE AT FIRST SEX…………………...DABSTINENCE………………………………………..ESPACING BETWEEN BIRTHS……………………..FLIMITING FAMILY SIZE……………………………..GTALK TO HEALTH PROVIDER ABOUT FP………HTALK TO SPOUSE/PARTNER ABOUT FP…….…IOTHERS (Specify)_________________________XDON’T KNOW……………………………………...…ZRADIO……………………………………………..……...ATELEVISION……………………………………….…….BPOSTER …………………………………………..…….CUMBRELLA………………………………………...…….DSHOPPING BAG…………………………………………ET-SHIRT…………………………………………………...FLEAFLET………………………………………………….GBADGE……………………………………………………HCAPS………………………………………………….…...IWRISTBAND………………………………………….….JON A SIGN AT A HEALTH FACILITY…………………KON A SIGN AT A PHARMACY / CHEMIST……….…..LAT A ROADSHOW / RALLY……………………………MAT A PARADE……………………………………………NOTHER (Specify)_____________________________XDON’T KNOW………………………………………….…ZYES……………………………………………………1NO……………………………………………………..2YES……………………………………………………1NO……………………………………………………..2Q835Q835Q839Q839Q837A cikin shekara daya da ta shige,kin tab a jin wa takalma “Ko kun gane, tazaran haihuwa”.What does this phrase mean to you?Me wannan kalmar ta ke nufi?[IF RESPONDENT ONLY GIVES THE COMMONDEFINITION OF THE PHRASE, PROBE TO SEE IFTHERE IS ANY OTHER MEANING.CIRCLE ALL MENTIONEDDON’T KNOW……………………………………......8AGE AT MARRIAGE………………..……….……....ADELAYING FIRST BIRTH…………………………...BUSE FAMILY PLANNING…………………………...CDELAYING AGE AT FIRST SEX…………………...DABSTINENCE………………………………………..ESPACING BETWEEN BIRTHS……………………..FLIMITING FAMILY SIZE……………………………..GTALK TO HEALTH PROVIDER ABOUT FP………HTALK TO SPOUSE/PARTNER ABOUT FP…….…IOTHERS (Specify)_________________________XDON’T KNOW……………………………………...…ZQ83939

Q838Q839Where did you see or hear this phrase?A ina ki ka gani ko ji wannnan kalmar?CIRCLE ALL MENTIONEDIn the past year, have you seen or heard the word“NURHI”A cikin shekara daya da ta shige, kin ta ba gani ko jinwannan kalmar “NURHI”RADIO……………………………………………..……...ATELEVISION……………………………………….…….BPOSTER …………………………………………..…….CUMBRELLA……………………………………………….DSHOPPING BAG…………………………………………ET-SHIRT…………………………………………………...FLEAFLET………………………………………………….GBADGE……………………………………………………HCAPS……………………………………………….……...IWRISTBAND………………………………………….….JON A SIGN AT A HEALTH FACILITY…………………KON A SIGN AT A PHARMACY / CHEMIST…….……..LAT A ROADSHOW / RALLY……………………………MAT A PARADE……………………………………………NOTHER (Specify)_____________________________XDON’T KNOW……………………………………….……ZYES……………………………………………………1NO……………………………………………………..2DON’T KNOW……………………………………......8Q840Which of the following logos have you seen in thepast year?Wacce alama ki ka gani a cikin shekara daya da tawuce?LOGO A/PUZZLE…………………………...ALOGO B………………………………...…….BLOGO C………………………………………CNONE…………………………………………YQ843SHOW A CARD WITH THREE LOGOS.Q841Q842Q843Q844Where did you see this logo?A ina ki ka ga wannan alamar?CIRCLE ALL MENTIONEDWhat does this logo(s) mean to you?Menene wannan alamar ta ke nufi?In the past year, have you seen any health providerwearing a button that said “Ask me about FP?”A cikin shekarar da ta wuce,kin tab a ganin wanijami’in bada lafiya da yake saye da wata alama maicewa “Tambaye ni gameda Tsarin Iyali”Do you own a cell phone that is mainly for your ownuse?RADIO……………………………………………..….…...ATELEVISION………………………………………..…….BPOSTER ………………………………………………….CUMBRELLA……………………………………………….DSHOPPING BAG…………………………………………ET-SHIRT…………………………………………………...FLEAFLET………………………………………………….GBADGE……………………………………………………HCAPS………………………………………………….…...IWRISTBAND………………………………………….….JON A SIGN AT A HEALTH FACILITY…………………KON A SIGN AT A PHARMACY / CHEMIST……….…..LAT A ROADSHOW / RALLY……………………………MAT A PARADE……………………………………………NOTHER (Specify)_____________________________XDON’T KNOW………………………………………….…ZAGE AT MARRIAGE………………..……….……....ADELAYING FIRST BIRTH…………………………...BUSE FAMILY PLANNING…………………………...CDELAYING AGE AT FIRST SEX…………………...DABSTINENCE………………………………………..ESPACING BETWEEN BIRTHS……………………..FLIMITING FAMILY SIZE……………………………..GTALK TO HEALTH PROVIDER ABOUT FP………HTALK TO SPOUSE/PARTNER ABOUT FP…….…IOTHERS (Specify)_________________________XDON’T KNOW……………………………………...…ZYES……………………………………………………….1NO………………………………………………………...2DON’T KNOW……………………………………………8YES……………………………………………………….1NO………………………………………………………...2Q845Ki na da wayar hannu da ki ke amfani da ita?Have you received any family planning/child birthspacing messages via SMS in the past sixmonths?Kin ta ba samun sako kan wani shirin tsariniyali/tazarar haihuwa a watanni shida da suka shige?YES……………………………………………………….1NO………………………………………………………...2DON’T KNOW……………………………………………840

Q846Q847Q848Q849Q850In the past three months, have you accessed theinternet, web, facebook or email at least once?A cikin watanni ukku da suka shige, kin ta ba budeyanar gizon internet, facebook ko wasikar yanar gizoko das au daya?Have you seen any family planning/child birth spacingmessages on the internet, web, facebook or email inthe past three months?Kin ta ba ganin wani sako kan tsarin iyali/ tazararhaihuwa a yanar gizon internet ko facebook ko emaila cikin watanni ukku da su ka shige?Do you belong to any groups, clubs, or organizations?Ki na cikin wata kungiya, kulof –kulof ko kungiyoyi?Have you heard or seen any family planning/childbirth spacing information at these meetings?Kin ta ba ji ko ganin wani abu akan tsarin iyali/ tazararhaihuwa a wajen wadannan taron?In the past year, have you heard any informationabout family planning/child birth spacing at any of thefollowing events [READ LIST]Naming CeremoniesFreedom ceremonies from an apprenticeshipSchool graduation ceremoniesChristmas/Eid celebrationWeddingA cikin shekarar da ta shige, kin ta ba jin watamagana akan tsarin iyali/ tazarar haihuwa a dayadaga cikin wadannan taron.,Bikin kamala koyonsasana’a,kamala karatu,bukukuwan kirismeti ko salla.Bukukuwan kirismeti/Sallar idiBikin kamala makarantaBikin aureYES…………………………………………………….1NO……………………………………………………...2DON’T KNOW………………………………………...8YES……………………………………………………….1NO………………………………………………………...2DON’T KNOW……………………………………………8YES………………………………………………………1NO………………………………………………………..2YES………………………………………………………1NO………………………………………………………..2DON’T KNOW…………………………………………..8NAMING CEREMONY…………………………………AFREEDOM CEREMONY………………………………BGRADUATION………………………………………….CCHRISTMAS/EID……………………………………….DWEDDING……………………………………………….ENONE…………………………………………………….YQ848Q848Q850SECTION 9: MIGRATION HISTORYQuestions and filters Coding categories SkipNow I would like to ask you about how often you visit other areas. Specifically, if you have visited an urban area or city/town and if you have visited arural area or a village.Yanzu ina so na san tun wanne tsawon lokaci kike zaune a nan, kuma daga ina kika zo nan da kuma sau nawa ki kan ziyarci wasu wurare.Q901Where were you born? In this city,another city, a town or a ruralarea/village?A ina aka haife ki? A wannan birnin, wanibirnin, gari ko karkara/kauye?THIS CITY……………………………………………………………...1ANOTHER CITY………………………………………………………2A TOWN………………………………………………………………..3A RURAL AREA OR VILLAGE………………………………………4ABROAD………………………………………………………………..5Q902Q903Q904How long have you been livingcontinuously in this city?Tun yaushe ki ke zaune a wannan birnin?Just before you moved to this city, didyou live in a city, a town or a village?Kafin ki dawo wannan birnin, kin ta bazama a wani birnin, gari kokauye?Since JANUARY 2010, have you movedresidences/houses?Tun daga January 2010,kin taba canjawurin zama ko gida?NUMBER OF MONTHS……………………1NUMBER OF YEARS………………………2HAVE ALWAYS LIVED IN THIS CITY………………………......995A CITY…………………………………………………………….……1A TOWN……………………………………………………………….2A VILLAGE…………………………………………………………….3YES . . . . . . . . . . . . . . . . . . . . . . ……………………………..……..1NO . . . . . . . . . . . . . . . . . . . . . . ……………………………..………2Q90441

Which city or town in Nigeria did youvisit most often in the past 12 months?SHE HAS TRAVELED IN THE PAST YEAR………………………1NAME OF TOWN/CITY _______________________Q905Wanne birni ko gari ki ka fi yawan kaiziyara a watani goma sha biyu da sukashige?LGA NAME:___________________________________CODE BOXES: OFFICE ONLY [__|__|__]WRITE NAME OF THE CITY, LGA ANDSTATESTATE NAME:____________________________CODE BOXES: OFFICE ONLY[__|__|__]Q906Q907Q908Q909How often did you visit this city/town[NAME OF CITY/TOWN Q905] in the last12 months?Kamar yaya kike ziyartar wannanbirni/gari [NAME OF CITY/TOWN Q901]a cikin watanni goma sha biyu da sukashige?How long do you usually stay when youvisit [NAME OF CITY/TOWN]?Tsawon wane lokaci ki kan zauna idan kika kai ziyarar [NAME OF CITY/TOWN]?During your visit(s), do you ever discussfamily planning/child birth spacing/childspacing with anybody?A lokacin ziyarar shin kokin taba yinmagana game da tsarin iyali/tazaratsakanin haihuwa/tazara tsakanin yara dawata/wanni?During your visit(s), do you ever seekfamily planning spacing services?A lokacin ziyarar,shin ko kin taba nemandabarar tsarin iyali/tazara tsakaninhaihuwa/tazara tsakanin yara?SHE HAS NOT TRAVELED IN THE PAST YEAR……………….2PER WEEK……………………..….…1[__|__]PER MONTH…………………………2PER YEAR……………………………3[__|__][__|__]DAYS …………………………………..1[__|__]WEEKS ………………………………. .2[__|__]MONTHS …………………..………....3[__|__]YES………………………………………………………1NO………………………………………………………..2YES……………………………………………….……1NO………………………………………………….…..2Q910Q910Do friends or family from ANOTHERCITY OR TOWN IN Nigeria ever come tovisit you?Shin kawayen ki ko iyalan ki daga wananwurin sun taba ziyartan ki?YES…………………………………………….………1NO……………………………………………….……..2Q913Q911Q912Do you ever talk about family planningwith your friends and family who arevisiting you here?Shin ko kin taba magana akan tsarin iyalida kawaye da iyalin ki idan sun ziyarce kianan?Do your friends and family who visit everseek family planning services when theyare visiting?Shin ko kawayen ki ko iyalan ki sun tabaneman dabarar tsaran iyali yayin da sukaziyarce ki?YES……………………………………………………1NO……………………………………………………..2YES…………………………………………………………1NO…………………………………………………………..2DON’T KNOW…………………………………..…………8In the past 12 months, have you visited arural area in Nigeria in order to visit familyor friends?YES . . . . . . . . . . . . . . . . . . . . . . ………………………1Q913A wata goma sha biyu da suka shige, kintaba ziyartan wani karkara (kauye) aNijeriya da niyar ziyartan ‘yan’uwa kokawaye?NO . . . . . . . . . . . . . . . . . . . . . . …………………..……2Q100542

Which rural area did you visit most oftenin the past 12 months?NAME OF VILLAGE_______________________Q914Wacce karkarar (kauye) ki ke yawan kaiziyara a watani goma sha biyu da sukashige?LOCAL GOVERNMENTAREA:__________________________________CODE BOXES: OFFICE ONLY [__|__|__]Q915Q916GIVE THE NAME OF THE VILLAGE,LGA AND STATEHow often did you visit this rural area[NAME OF PLACE IN Q914 in the last 12months?Kamar yaya ki ke ziyartar wannan kauyena watanni goma sha biyu da sukashige?[NAME OF PLACE IN Q911]How long do you usually stay when youvisit [NAME OF PLACE)?Tsawon wane lokaci ki ke zama idan kinkai ziyarar?During your visit(s), do you ever discussfamily planning/child birth spacing/childspacing with anybody?STATE___________________________CODE BOXES: OFFICE ONLY [__|__|__]PER WEEK……………………..….…1[__|__]PER MONTH…………………………2PER YEAR……………………………3[__|__][__|__]DAYS…………………………………..1 [__|__]WEEKS ………………………………. 2 [__|__]MONTHS …………………..………....3 [__|__]YES……………………………………………….……1Q917Q918Q919Q920Q921A lokacin ziyarar, shin ko kin tabatattaunawa akan tsarin iyali/tazaratsakanin haihuwa/tazara tsakanin yara dawata/wanni?During your visit(s), do you ever seekfamily planning spacing services?A lokacin ziyarar, shin ko kin taba nemihanyoyin tsarin iyali/tazara tsakaninhaihuwa/tazara tsakanin yara?Do friends or family from this rural area[MENTIONED IN Q914] ever come tovisit you?Shin kawaye ko iyali daga wanan wurin[MENTIONED IN Q914] sun taba ziyartanki?Do you ever talk about family planningwith your friends and family who arevisiting you here?Shin ko kin taba magana akan tsarin iyalida kawaye da iyalin ki idan su ka ziyarceki anan?Do your friends and family who visit everseek family planning services when theyare visiting?Shin ko kawayen ki ko iyalan ki sun tabaneman hanyoyin tsran iyali yayin da sukaziyarce ki?NO………………………………………………….…..2YES………………………………………………….…1NO……………………………………………………...2YES……………………………………………………1NO……………………………………………………..2YES……………………………………………………1NO……………………………………………………..2YES……………………………………………………1NO……………………………………………………..2DON’T KNOW………………………………...………8Q100543

INSTRUCTIONS:ONLY ONE CODE SHOULD APPEAR IN ANY BOXALL MONTHS SHOULD BE FILLED IN COL 1 AND COL 2INFORMATION TO BE CODED FOR EACH COLUMNCOL 1 BIRTHS, PREGNANCIES, CONTRACEPTIVE USEB BIRTHSP PREGNANCIEST TERMINATIONSCOL1 COL2 COL312 DEC 01 01 DEC11 NOV 02 02 NOV10 OCT 03 03 OCT09 SEP 04 04 SEP2 08 AUG 05 05 AUG 2COL 2COL 30 NO METHOD1 FEMALE STERILIZATION2 MALE STERILIZATION3 IMPLANT4 IUCD5 INJECTABLES6 DAILY PILL7 EMERGENCY PILL8 MALE CONDOM9 FEMALE CONDOMJ LAMK STANDARD DAYS METHODL RHYTHM METHODMXWITHDRAWALOTHER _______________________(SPECIFY)DISCONTINUATION OF CONTRACEPTIVE USE0 INFREQUENT SEX/HUSBAND AWAY1 BECAME PREGNANT WHILE USING2 WANTED TO BECOME PREGNANT3 HUSBAND/PARTNER DISAPPROVED4 WANTED MORE EFFECTIVE METHOD5 HEALTH CONCERNS6 SIDE EFFECTS7 LACK OF ACCESS/TOO FAR8 COSTS TOO MUCH9 INCONVENIENT TO USEF FATALISTICA DIFFICULT TO GET PREGNANT/MENOPAUSALDXMARITAL DISSOLUTION/SEPARATIONOTHER ____________________________(SPECIFY)MARRIAGEX MARRIED, REMARRIED OR LIVING WITH A MANO NOT MARRIED/WIDOWED/SEPARATED/DIVORCED0 07 JUL 06 06 JUL 01 06 JUN 07 07 JUN 12 05 MAY 08 08 MAY 204 APR 09 09 APR03 MAR 10 10 MAR02 FEB 11 11 FEB01 JAN 12 12 JAN12 DEC 13 13 DEC11 NOV 14 14 NOV10 OCT 15 15 OCT09 SEP 16 16 SEP2 08 AUG 17 17 AUG 20 07 JUL 18 18 JUL 01 06 JUN 19 19 JUN 11 05 MAY 20 20 MAY 104 APR 21 21 APR03 MAR 22 22 MAR02 FEB 23 23 FEB01 JAN 24 24 JAN12 DEC 25 25 DEC11 NOV 26 26 NOV10 OCT 27 27 OCT09 SEP 28 28 SEP2 08 AUG 29 29 AUG 20 07 JUL 30 30 JUL 01 06 JUN 31 31 JUN 10 05 MAY 32 32 MAY 004 APR 33 33 APR03 MAR 34 34 MAR02 FEB 35 35 FEB01 JAN 36 36 JAN44

OFFICE USE ONLY: QUESTIONNAIRE NO: [__|__|__|__|__|__|__|__||__|__](cluster code 4 digits + HH number 3 digits + household division number + Respondent line number 2 digits)Questions and filtersFOLLOW-UP CONTACTSCoding categoriesCLUSTER NUMBER……………………………………………………………………………………..(City code + Cluster number)BASELINE HOUSEHOLD NUMBER……………………………………………………………………..HOUSEHOLD DIVISION NUMBER………………………………………………………………………………..(Same HH=0, Household divided/1 st new household =1, Household divided/2 nd new household =2, etc.)BASELINE LINE NUMBER OF WOMAN ………………………………………………………………..NAME OF ELIGIBLE WOMAN/ RESPONDENT ___________________________________________________NAME OF HOUSEHOLD HEAD ________________________________________________________________ADDRESS OF THE HOUSEHOLD________________________________________________________________________________________________________________________________________________________As I mentioned earlier, you have been selected to participate in this exercise based on your participation in the urban health study about one and ahalf years ago. We will also be back in about two years to update your contact information again. For this reason, I will be asking for the contactinformation of people that maybe able to tell us where you and your household are in case you move. Remember you are free to skip any questionsthat you are uncomfortable providing answers to. This information will be kept separate from your responses in a locked cabinet in a secured roomwhere only the primary researcher can access.Kamar yadda nace daga farko, zamu dawo muga yaya kike ciki nan da shekara biyu, kuma mu kara dawo wa bayan wasu shekara biyu kuma ,domin muga ko wani abu ya canza game da bayanai akan kiwon lafiya . A wannan dalili, zan yi tambaya akan mutanen da za mu nema ko da kinbar nan da zama, wadanda zasu iya fadan inda kike a shekara biyu da kuma shekara hudu nan gaba. Wannan bayanan za a boye a wani kabod akulle, dabam da sauran amsoshin da kika bada inda sai masu Bincike ne zasu samu shiga. . Ki tuna kina da ‘yancin ki tsallake tambayar da batakwanta miki ba.Q1005What other names are you commonlyknown by?_______________________________________________________Q1006Q1007Q1008Wadanne sunayen aka fi sanin kidasu?Do you have access to a cell phone?Kina da wayar hannu ko tarhon gida?If yes, could you please share with mea cell phone number?In kina da ita, ko zaki iya bani lamba?Could you also please share with me asecond cell phone number forcontacting you?YES…………………..1NO…………………….2 skip to 1009PRIMARY CELL NUMBER [ __|__|___|___|___|___|___|___|___|___|___|SECONDARY CELL NUMBER: [__|___|___|___|___|___|___|___|___|___|___|Q1009Zaki iya bani wata lamba?Does your family/household have anyplans to move in the next two years?YES, _______________________________________Q1010Shin ko iyalin ki na da niyar barin nanwajen, nan da shekaru biyu?IF YES, where do you plan to move to?IF YES, ina kuke da niyar komawa?IF RESPONDENT IS NOT HH HEAD:What is the name and cell phonenumber (if possible) of the head of thishousehold?Menene sunan maigidan wannangidan da kuma lambar wayar hannunsa/ta (in da akwai)____________________________________________...1(SPECIFY)NO PLANS TO MOVE………………………………….…….2NAME: _________________________CELL NUMBER: [ ___|___|___|___|___|___|___|___|___|___|___|45

Q1011Q1012Q1013Q1014Q1015What is the name and cell phonenumber (if possible) of someone elsewithin your household?Menene sunan wani/wata a cikinwannan gidan da kuma lambar wayarhannun sa/ta (in da akwai)?What is the name, location (addressand description), and cell phonenumber (if possible) of someoneoutside of your household?Menene suna, da wurin (adireshi dakwatancen) da lambar wayar hannu (inda akwai) na wani/wata wandabaya/bata gidan ku?What is the name, location (addressand description), and cell phonenumber (if possible) of another personoutside of your household?Menene suna, da wurin (adireshi dakwatancen) da lambar wayar hannu (inda akwai) na wani/wata kuma wandabaya/bata gidan ku?Other than this place of residence(house), where else does thehousehold head frequently stay? Isthere a phone number and contactperson there?Banda wannan wajen zaman (gidan)ina ne inda maigidan nan ya/ta fiyawan zama?Akwai lambar waya da wanda za asamu a wajen?Do you have an email address forcontacting you?Kina da adireshin lambar yanar gizo daza a iya samun ki?NAME: _________________________CELL NUMBER: [ __|__|___|___|___|___|___|___|___|___|___|RELATIONSHIP TO RESPONDENT_____________________________NAME: _________________________LOCATION:_____________________________________________________CELL NUMBER: [ __|___|___|___|___|___|___|___|___|___]___]RELATIONSHIP TO RESPONDENT_____________________________NAME: _________________________LOCATION:_____________________________________________________CELL NUMBER: [ __|___|___|___|___|___|___|___|___|___]___]RELATIONSHIP TO RESPONDENT_____________________________OTHER RESIDENCE ___________________________________PHONE NUMBER _____________________________________CONTACT PERSON THERE __________________________________YES…………………………………………………………………………………….1EMAIL ADDRESS ________________________________________________NO………………………………………………………………………………………2RECORD END TIME.HOUR……………………………….[__|__]MINUTES…………………………..[__|__]COMMENTS:END THE INTERVIEW AND THANK THE RESPONDENT FOR HER TIME AND PARTICIPATION.46