Questionnaire - Measurement, Learning & Evaluation Project

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