2022 NATIONAL DEMOGRAPHIC AND HEALTH SURVEY

WOMAN'S QUESTIONNAIRE (FORM 2) PSA APPROVAL NO: PSA-2207-02

EXPIRES ON: 28 February 2023
CONFIDENTIALITY:

Article 55 of RA 10625, states that "The information collected shall not be used for purposes of taxation, investigation or
regulation."

Section 26 of RA 10625, stipulates that individual data furnished by a respondent to statistical inquiries, surveys, and
censuses of the PSA shall be considered privileged information and such shall be inadmissible as evidence in any
proceeding.

Section 27 of RA No. 10625 states that a person, including parties within the PSA Board and the PSA, who breach the
confidentiality of information, whether by carelessness, improper behavior, behavior with malicious intent, and use of
confidential information for profit shall be liable to a fine of five thousand pesos (PhP 5,000.00) to not more than ten
thousand pesos (PhP 10,000.00) and or imprisonment of three months but not to exceed one year, subject to the degree of
breach of information.

IDENTIFICATION BOOKLET ___ OF ____ BOOKLETS

REGION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PROVINCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CITY/MUNICIPALITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BARANGAY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

EA ...................................................................

HOUSING UNIT SERIAL NUMBER (HUSN) .............................................

HOUSEHOLD SERIAL NUMBER (HSN) .............................................

NDHS HOUSEHOLD NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NUMBER OF HOUSEHOLDS IN THE HOUSING UNIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NAME OF HOUSEHOLD HEAD

NAME AND LINE NUMBER OF WOMAN

RESPONDENT SELECTED FOR THE WOMEN'S SAFETY MODULE (YES = 1; NO = 2)

ADDRESS

INTERVIEWER VISITS

1 2 3 FINAL VISIT

DATE MONTH

DAY

YEAR
2 0 2 2
INTERVIEWER'S
NAME INT. NO.

RESULT* RESULT*

NEXT VISIT:DATE
TOTAL NUMBER
TIME OF VISITS

*RESULT CODES: 1 COMPLETED 4 REFUSED 8 OCW/OFW

2 NOT AT HOME 5 PARTLY COMPLETED 7 OTHER
3 POSTPONED 6 INCAPACITATED SPECIFY

TRANSLATOR USED
LANGUAGE OF
QUESTIONNAIRE** 0 1 LANGUAGE OF
INTERVIEW**
NATIVE LANGUAGE
OF RESPONDENT** (YES = 1, NO = 2)

LANGUAGE OF
QUESTIONNAIRE** ENGLISH **LANGUAGE CODES:
01 ENGLISH 04 BIKOLANO 07 CEBUANO
02 TAGALOG 05 WARAY 96 OTHER
03 ILOKANO 06 HILIGAYNON

TEAM TEAM SUPERVISOR

NUMBER NAME NUMBER

Appendix E • 497
 INTRODUCTION AND CONSENT
(1)

Hello. My name is _______________________________________. I am working with the Philippine Statistics Authority. We are
conducting a survey about health and other topics all over the Philippines. The information we collect will help the government to plan health services. Your
household was randomly selected for the survey. The questions usually take about 30 to 60 minutes. All personnel involved in this survey are required to
keep in strict confidence any information obtained during the interview that pertains to any particular household or individual. Likewise, the data gathered will
be released only in the form of statistical summaries in which no reference to any person shall appear. You don't have to be in the survey, but we hope you
will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the
next question or you can stop the interview at any time.

In case you need more information about the survey, you may contact the Philippine Statistics Authority Provincial Statistical Officer in your province.

Do you have any questions?

May I begin the interview now?

SIGNATURE OF INTERVIEWER DATE

RESPONDENT AGREES RESPONDENT DOES NOT AGREE

TO BE INTERVIEWED . . 1 TO BE INTERVIEWED . . 2 END

SECTION 1. RESPONDENT'S BACKGROUND

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

101 RECORD THE TIME.

HOURS ..........................

MINUTES . . . . . . . . . . . . . . . . . . . . . . . . . .

102 What province were you born in?

103A
PROVINCE .......................

OUTSIDE OF THE PHILIPPINES . . . . . . . . . . . . . . 96

CODES FOR Q. 102 AND 107 (PROVINCE)

01 ILOCOS 06 WESTERN VISAYAS 11 DAVAO 16 CARAGA

28 ILOCOS NORTE 04 AKLAN 23 DAVAO DEL NORTE 02 AGUSAN DEL NORTE
29 ILOCOS SUR 06 ANTIQUE 82 DAVAO DE ORO 03 AGUSAN DEL SUR
33 LA UNION 19 CAPIZ 86 DAVAO OCCIDENTAL 67 SURIGAO DEL NORTE
55 PANGASINAN 30 ILOILO 24 DAVAO DEL SUR 68 SURIGAO DEL SUR
79 GUIMARAS 25 DAVAO ORIENTAL 85 DINAGAT ISLANDS
02 CAGAYAN VALLEY 45 NEGROS OCCIDENTAL
09 BATANES 12 SOCCSKSARGEN 17 MIMAROPA
15 CAGAYAN 07 CENTRAL VISAYAS 47 COTABATO 40 MARINDUQUE
31 ISABELA 12 BOHOL 65 SULTAN KUDARAT 51 OCCID. MINDORO
50 NUEVA VIZCAYA 22 CEBU 63 SOUTH COTABATO 52 ORIENT. MINDORO
57 QUIRINO 46 NEGROS ORIENTAL 80 SARANGANI 53 PALAWAN
61 SIQUIJOR 98 COTABATO CITY 59 ROMBLON
03 CENTRAL LUZON
08 BATAAN 08 EASTERN VISAYAS 13 NATIONAL CAPITAL
14 BULACAN 26 EASTERN SAMAR 91 NCR - CITY OF MANILA, FIRST DISTRICT
49 NUEVA ECIJA 48 NORTHERN SAMAR 92 NCR, SECOND DISTRICT
54 PAMPANGA 60 SAMAR (WESTERN SAMAR) 93 NCR, THIRD DISTRICT
69 TARLAC 64 SOUTHERN LEYTE 94 NCR, FOURTH DISTRICT
71 ZAMBALES 78 BILIRAN 95 NCR, FIFTH DISTRICT
77 AURORA 37 LEYTE
14 CORDILLERA
04 CALABARZON 09 ZAMBOANGA PENINSULA 01 ABRA
10 BATANGAS 72 ZAMBOANGA DEL NORTE 11 BENGUET
21 CAVITE 73 ZAMBOANGA DEL SUR 27 IFUGAO
34 LAGUNA 83 ZAMBOANGA SIBUGAY 44 MOUNTAIN PROVINCE
56 QUEZON 97 ISABELA CITY 32 KALINGA
58 RIZAL 81 APAYAO
10 NORTHERN MINDANAO
05 BICOL 13 BUKIDNON 15 ABANGSAMORO AUTONOMOUS REGION
05 ALBAY 18 CAMIGUIN IN MUSLIM MINDANAO
16 CAMARINES NORTE 35 LANAO DEL NORTE 38 MAGUINDANAO
17 CAMARINES SUR 42 MISAMIS OCCIDENTAL 07 BASILAN
20 CATANDUANES 43 MISAMIS ORIENTAL 36 LANAO DEL SUR
41 MASBATE 66 SULU
62 SORSOGON 70 TAWI-TAWI

498 • Appendix E
 SECTION 1. RESPONDENT'S BACKGROUND

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

103 What country were you born in?

COUNTRY

103A At the time of your birth, did your mother usually live in a CITY ................................... 1
city, in a town proper/ poblacion, in the barrio or rural area, TOWN PROPER/POBLACION .............. 2
or abroad? BARRIO/RURAL AREA .................... 3
ABROAD ................................ 4
DON'T KNOW ............................. 8

104 How long have you been living continuously in (NAME OF

CURRENT CITY, TOWN OR VILLAGE OF RESIDENCE)? YEARS ..........................

ALWAYS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
110
IF LESS THAN ONE YEAR, RECORD ‘00’ YEARS. VISITOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96

105 CHECK 104:

00 - 04 YEARS 05 YEARS
107
OR MORE

106 In what month and year did you move here?

MONTH ..........................

DON'T KNOW MONTH . . . . . . . . . . . . . . . . . . . . . . . 98

YEAR . . . . . . . . . . . . . . . . .

DON'T KNOW YEAR . . . . . . . . . . . . . . . . . . . . . . .9998

107 Just before you moved here, which province did you live in?
PROVINCE .......................

OUTSIDE OF THE PHILIPPINES . . . . . . . . . . . . . . . . . 96

108 Just before you moved here, did you live in a city, in a town CITY ................................... 1
proper/poblacion, or in a barrio or rural area or abroad? TOWN PROPER/ POBLACION . . . . . . . . . . . . . . . . . 2
BARRIO/RURAL AREA . . . . . . . . . . . . . . . . . . . . . . . 3
ABROAD ................................ 4

109 Why did you move to this place? EMPLOYMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 01

(2) EDUCATION/TRAINING . . . . . . . . . . . . . . . . . . . . . . . 02
MARRIAGE FORMATION .................... 03
FAMILY REUNIFICATION/OTHER
FAMILY-RELATED REASON .............. 04
FORCED DISPLACEMENT . . . . . . . . . . . . . . . . . . . . 05
OTHER 96
(SPECIFY)

110 In what month and year were you born?

MONTH ..........................

DON'T KNOW MONTH . . . . . . . . . . . . . . . . . . . . . . . 98

YEAR . . . . . . . . . . . . . . . . .

DON'T KNOW YEAR . . . . . . . . . . . . . . . . . . . . . . .9998

111 How old were you at your last birthday?

AGE IN COMPLETED YEARS ........
COMPARE AND CORRECT 110 AND/OR 111
IF INCONSISTENT.

112 In general, would you say your health is very good, good, VERY GOOD ............................. 1
moderate, bad, or very bad? GOOD ................................... 2
MODERATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
BAD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
VERY BAD ................................ 5

Appendix E • 499
 SECTION 1. RESPONDENT'S BACKGROUND

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

113 Have you ever attended school? YES ...................................... 1

NO ...................................... 2 117

115 What is the highest grade or year you completed?

GRADE/YEAR ..............
IF COMPLETED LESS THAN ONE YEAR AT THAT
LEVEL, RECORD '00'. IF CODE 404, 504, 607, 702, OR 802
SPECIFY COURSE:

CODES FOR Qs. 115: EDUCATION

LEVEL 0 - EARLY CHILDHOOD EDUCATION LEVEL 4 - POST SECONDARY EDUCATION

000 = NO GRADE COMPLETED 401 = 1ST YEAR
001 = NURSERY 402 = 2ND YEAR
002 = KINDERGARTEN 403 = 3RD YEAR OR MORE
404 = GRADUATE (SPECIFY COURSE)
LEVEL 1 - PRIMARY EDUCATION
(ELEMENTARY) LEVEL 5 - SHORT- CYCLE
101 = GRADE 1 TERTIARY EDUCATION
102 = GRADE 2 501 = 1ST YEAR
103 = GRADE 3 502 = 2ND YEAR
104 = GRADE 4 503 = 3RD YEAR OR MORE
105 = GRADE 5 504 = GRADUATE (SPECIFY COURSE)
106 = GRADE 6
LEVEL 6 - BACHELOR LEVEL EDUCATION
108 = IPED OR EQUIVALENT
109 = MADRASAH 601 = 1ST YEAR
110 = SPED 602 = 2ND YEAR
603 = 3RD YEAR
LEVEL 2 - LOWER SECONDARY EDUCATION 604 = 4TH YEAR
(JUNIOR HIGH SCHOOL/ OLD CURRICULUM) 605 = 5TH YEAR
201 = GRADE 7/ 1ST YEAR 606 = 6TH YEAR OR MORE
202 = GRADE 8/ 2ND YEAR 607 = GRADUATE (SPECIFY COURSE)
203 = GRADE 9/ 3RD YEAR
204 = GRADE 10/ FOURTH YEAR LEVEL 7 - MASTER LEVEL EDUCATION
205 = OLD CURRICULUM GRADE 10 GRADUATE OR EQUIVALENT
701 = UNDERGRADUATE
208 = IPED (ANY YEAR OTHER THAN GRADUATE)
209 = MADRASAH 702 = GRADUATE (SPECIFY COURSE)
210 = SPED
LEVEL 8 - DOCTORAL LEVEL
LEVEL 3 - UPPER SECONDARY EDUCATION EDUCATION OR EQUIVALENT
(SENIOR HIGH SCHOOL) 801 = UNDERGRADUATE
(ANY YEAR OTHER THAN GRADUATE)
ACADEMIC TRACK (GAS, HUMSS, STEM, ABM) 802 = GRADUATE (SPECIFY COURSE)
301 = GRADE 11
302 = GRADE 12 998 = DON'T KNOW

ARTS AND DESIGN TRACK

303= GRADE 11
304 = GRADE 12

SPORTS TRACK
305 = GRADE 11
306 = GRADE 12

TECHNOLOGY & LIVELIHOOD EDUCATION & TECH-VOC

(AGRI-FISHERIES, HOME EC., INDUST. ARTS, ICT)
307 = GRADE 11
308 = GRADE 12

116 CHECK 115:

LESS THAN CODE 301 OR

119
CODE 301 HIGHER

117 Now I would like you to read this sentence to me. CANNOT READ AT ALL .................... 1
(4) ABLE TO READ ONLY PART OF
SHOW CARD TO RESPONDENT. THE SENTENCE ....................... 2
ABLE TO READ WHOLE SENTENCE ........... 3
NO CARD WITH REQUIRED . . . . . . . . . . . . . . . . . . . .
IF RESPONDENT CANNOT READ WHOLE SENTENCE,
LANGUAGE 4
PROBE: Can you read any part of the sentence to me? (SPECIFY LANGUAGE)
BLIND/VISUALLY IMPAIRED ................. 5

118 CHECK 117:

CODE '2', '3' CODE '1' OR '5'
OR '4' CIRCLED
CIRCLED 120

119 Do you read a newspaper or magazine at least once a AT LEAST ONCE A WEEK . . . . . . . . . . . . . . . . . . . . 1
week, less than once a week or not at all? LESS THAN ONCE A WEEK ................. 2
NOT AT ALL ............................. 3

500 • Appendix E
 SECTION 1. RESPONDENT'S BACKGROUND

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

120 Do you listen to the radio at least once a week, less than AT LEAST ONCE A WEEK . . . . . . . . . . . . . . . . . . . . 1
once a week or not at all? LESS THAN ONCE A WEEK ................. 2
NOT AT ALL ............................. 3

121 Do you watch television at least once a week, less than AT LEAST ONCE A WEEK . . . . . . . . . . . . . . . . . . . . 1
once a week or not at all? LESS THAN ONCE A WEEK ................. 2
NOT AT ALL ............................. 3

122 Do you own a mobile phone? YES ...................................... 1

NO ...................................... 2 124

123 Is your mobile phone a smart phone? YES ...................................... 1

NO ...................................... 2

124 In the last 12 months, have you used a mobile phone to

make financial transactions such as sending or receiving YES ...................................... 1
money, paying bills, purchasing goods or services, or NO ...................................... 2
receiving wages?

125 Do you have an account in a bank or other financial YES ...................................... 1

institution that you yourself use? NO ...................................... 2 127

126 Did you yourself put money in or take money out of this YES ...................................... 1
account in the last 12 months? NO ...................................... 2

127 Have you ever used the Internet from any location on any YES ...................................... 1
device?
NO ...................................... 2 130

128 In the last 12 months, have you used the Internet?

YES ...................................... 1
IF NECESSARY, PROBE FOR USE FROM ANY NO ...................................... 2 130
LOCATION, WITH ANY DEVICE.

129 During the last one month, how often did you use the ALMOST EVERY DAY ....................... 1
Internet: almost every day, at least once a week, less than AT LEAST ONCE A WEEK . . . . . . . . . . . . . . . . . . . . 2
once a week, or not at all? LESS THAN ONCE A WEEK ................. 3
NOT AT ALL ............................. 4

130 What is your religion? ROMAN CATHOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . 01

PROTESTANT ............................. 02
IGLESIA NI CRISTO . . . . . . . . . . . . . . . . . . . . . . . . . . 03
AGLIPAY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 04
ISLAM ................................... 05

NO RELIGION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95

OTHER 96
(SPECIFY)

131 What is your ethnicity by descent/blood/relation/consanguinity? TAGALOG ................................ 01

CEBUANO ................................ 02
ILOKANO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 03
HILIGAYNON/ILONGGO . . . . . . . . . . . . . . . . . . . . . . . 04
BIKOLANO ................................ 05
KAPAMPANGAN .......................... 06
MARANAO ................................ 07
TAUSOG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 08
WARAY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 09
IF RESPONDENT DOES NOT UNDERSTAND QUESTION AETA ................................... 10
USE PROBING GUIDE DOUND IN YOUR DISPLAY BOOK BADJAO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
AND PROBE ACCORDING TO PROVINCE
OTHER 96
(SPECIFY)

Appendix E • 501
 SECTION 2. REPRODUCTION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

201A Now I would like to ask about all the pregnancies you have
had during your life. By this I mean all the children born to
you, whether they were born alive or dead, whether they are
still living or not, whether they live with you or somewhere
else, and pregnancies which you have had that did not
result in a live birth. I understand that it is not easy to talk
about all the children who have died or pregnancies that
ended before full term, but it is important that you tell us
about all of them, so that we can develop programs to
improve children's health.

201 First I would like to ask about all the births you have had YES ....................................... 1
during your life. Have you ever given birth? NO ....................................... 2 206

202 Do you have any sons or daughters to whom you have YES ....................................... 1
given birth who are now living with you? NO ....................................... 2 204

203 a) How many sons live with you?

a) SONS AT HOME . . . . . . . . . . . . . . . . . .
b) And how many daughters live with you?
b) DAUGHTERS AT HOME ........
IF NONE, RECORD '00'.

204 Do you have any sons or daughters to whom you have YES ....................................... 1
given birth who are alive but do not live with you? NO ....................................... 2 206

205 a) How many sons are alive but do not live with you?
a) SONS ELSEWHERE ...........
b) And how many daughters are alive but do not live with
you? b) DAUGHTERS ELSEWHERE .....
IF NONE, RECORD '00'.

206 Have you ever given birth to a boy or girl who was born alive
but later died?
YES ....................................... 1
IF NO, PROBE: Any baby who cried, who made any NO ....................................... 2 208
movement, sound, or effort to breathe, or who showed any
other signs of life even if for a very short time?

207 a) How many boys have died?

a) BOYS DEAD ..................
b) And how many girls have died?
b) GIRLS DEAD ..................
IF NONE, RECORD '00'.

208 SUM ANSWERS TO 203, 205, AND 207, AND ENTER

TOTAL. IF NONE, RECORD '00'. TOTAL LIVE BIRTHS ..............

209 CHECK 208:

Just to make sure that I have this right: you have had in TOTAL _____ births during your life. Is that correct?

YES NO

PROBE AND CORRECT

201-208 AS
NECESSARY.

210 Women sometimes have a pregnancy that does not result in

a live birth. For example, a pregnancy can end early in a
miscarriage, someone can do something to end the YES ....................................... 1
pregnancy, or the child can be born dead. Have you ever NO ....................................... 2 212
had a pregnancy that did not end in a live birth?

211 In all, how many pregnancies have you had that did not end
in live births? PREGNANCY LOSSES ...........

212 SUM ANSWERS TO 208 AND 211 AND ENTER TOTAL.

IF NONE, RECORD '00'. TOTAL PREGNANCY OUTCOMES ..

213 CHECK 212:

ONE OR MORE PAST NO PAST 232

PREGNANCIES PREGNANCIES

502 • Appendix E
 SECTION 2. REPRODUCTION

214 Now I would like to record all your pregnancies including live births, stillbirths, and those lost before full term, starting with your first pregnancy.

RECORD ALL PREGNANCIES IN 215-228. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. IF THERE ARE MORE THAN 3 PREGNANCIES, USE AN ADDITIONAL
QUESTIONNAIRE.

215 216 217 218 219 220 221 222

Think back to IF 215=1, ASK: Did the What name Is (NAME) a CHECK 216 AND 217: How long did this FOR ROW 01, ASK:
your Was the baby born baby cry, was given to boy or a TYPE OF pregnancy last in weeks Were there any other
(first/next) alive, born dead, or move, or the baby? girl? PREGNANCY or months? pregnancies before this
pregnancy. lost before full breathe? OUTCOME. pregnancy?
Was that a term?
single NOTE: IF 217=1, AFTER ROW 01:
pregnancy, THEN PREGNANCY
twins, or OUTCOME= BORN IF 215=1 OR THIS IS
IF 215 > 1, ASK:
triplets? ALIVE. THE FIRST BIRTH OF A
Was the (first/next)
MULTIPLE
baby in this RECORD RECORD IN PREGNANCY, ASK:
pregnancy born NAME. COMPLETED WEEKS Were there any other
IF MULTIPLE alive or born dead OR MONTHS.
IF BORN ALIVE, ASK: pregnancies between the
PREG- or lost before full
On what month, day, previous pregnancy and
NANCY: term?
and year was (NAME) this pregnancy?
COPY VALUE
born?
FOR 215 IN
IF 215 > 1 AND THIS IS
NEXT
IF BORN DEAD, OR NOT THE FIRST BIRTH
ROW(S).
LOST BEFORE FULL OF THE PREGNANCY,
TERM, ASK: On what SKIP TO 216 IN NEXT
PREG- month, day, and year ROW.
NANCY did this pregnancy
HISTORY end?
LINE
NUMBER

01 BORN ALIVE 1 YES 1

MONTH WEEKS 1
SING 1 (SKIP TO 218) YES 1 BOY 1
(ADD
PREGNANCY)
TWINS 2
DAY MONTHS 2
BORN DEAD 2 NO 2 GIRL 2

TRIP 3 LOST BEFORE 3 NAME NO 2

FULL TERM (SKIP TO (NEXT
NO. OF
(SKIP TO 220) 220) YEAR PREGNANCY)
OUT-
COMES

02 BORN ALIVE 1 YES 1 YES 1

MONTH WEEKS 1
SING 1 (SKIP TO 218) BOY 1
(ADD
PREGNANCY)
TWINS 2 NO 2
DAY MONTHS 2
BORN DEAD 2 GIRL 2

TRIP 3 LOST BEFORE 3 (SKIP TO NAME NO 2

FULL TERM 220) (NEXT
NO. OF YEAR PREGNANCY)
(SKIP TO 220)
OUT-
COMES

03 BORN ALIVE 1 YES 1 YES 1

MONTH WEEKS 1
SING 1 (SKIP TO 218) BOY 1
(ADD
PREGNANCY)
TWINS 2 NO 2
DAY MONTHS 2
BORN DEAD 2 GIRL 2

TRIP 3 LOST BEFORE 3 (SKIP TO NAME NO 2

FULL TERM 220) (NEXT
NO. OF YEAR PREGNANCY)
(SKIP TO 220)
OUT-
COMES

222A Have you had any pregnancies that

YES ADD TO TABLE
ended since the last pregnancy
mentioned?
NO GO TO 223, ROW 1

Appendix E • 503
 SECTION 2. REPRODUCTION

223 224 225 226 227 228 228A

IF BORN ALIVE AND STILL LIVING: IF BORN ALIVE AND IF LOST BEFORE
NOW DEAD: FULL TERM

CHECK 216, 217 AND Is How old was Is RECORD How old was (NAME) Did you or someone
221: (NAME) (NAME) at (NAME) HOUSEHOLD LINE when (he/she) died? else do something to
still (his/her) last living NUMBER OF end this pregnancy?
IF 216=1 OR 217=1, alive? birthday? with you? CHILD. RECORD IF '12 MONTHS' OR '1
THEN PREGNANCY '00' IF CHILD NOT YR', ASK: Did (NAME)
OUTCOME = BORN LISTED IN have (his/her) first
ALIVE. HOUSEHOLD. birthday?

IF 216=2 OR 3, THEN THEN ASK: Exactly how

CHECK 221. many months old was
IF 221 ш 7 MONTHS OR (NAME) when (he/she)
28 WEEKS, THEN died?
PREGNANCY
OUTCOME = BORN RECORD
DEAD. AGE IN
IF 221 < 7 MONTHS OR COMP-LETED RECORD DAYS IF
28 WEEKS, FINAL YEARS. LESS THAN 1 MONTH;
PREGNANCY MONTHS IF LESS
OUTCOME = LOST THAN TWO YEARS; OR
BEFORE FULL TERM YEARS.

01 BORN ALIVE 1 YES 1 AGE IN YES 1 HOUSEHOLD YES 1

DAYS 1
YEARS LINE NUMBER
BORN DEAD 2
(SKIP TO 223 IN NO 2 NO 2 NO 2
MONTHS 2
THE NEXT ROW)

LOST BEFORE (SKIP TO

YEARS 3
FULL TERM 3 228)
(SKIP TO 223 IN
(SKIP TO 223 IN NEXT
(SKIP TO 228A) NEXT ROW)
ROW)

02 BORN ALIVE 1 YES 1 AGE IN YES 1 HOUSEHOLD YES 1

DAYS 1
YEARS LINE NUMBER
BORN DEAD 2
(SKIP TO 223 IN NO 2 NO 2 NO 2
MONTHS 2
THE NEXT ROW)

LOST BEFORE (SKIP TO

YEARS 3
FULL TERM 3 228)
(SKIP TO 223 IN
(SKIP TO 223 IN NEXT
(SKIP TO 228A) NEXT ROW)
ROW)

03 BORN ALIVE 1 YES 1 AGE IN YES 1 HOUSEHOLD YES 1

DAYS 1
YEARS LINE NUMBER
BORN DEAD 2
(SKIP TO 223 IN NO 2 NO 2 NO 2
MONTHS 2
THE NEXT ROW)

LOST BEFORE (SKIP TO

YEARS 3
FULL TERM 3 228)
(SKIP TO 223 IN
(SKIP TO 223 IN NEXT
(SKIP TO 228A) NEXT ROW)
ROW)

504 • Appendix E
 SECTION 2. REPRODUCTION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

230 COMPARE 212 WITH NUMBER OF PREGNANCY OUTCOMES IN PREGNANCY HISTORY

NUMBER IN
NUMBER IN PREGNANCY PREGNANCY HISTORY IS
HISTORY IS GREATER THAN LESS THAN 212
OR EQUAL TO 212
(PROBE AND RECONCILE)

231 FOR EACH LIVE BIRTH IN 2017-2022, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE
NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH LIVE BIRTH, RECORD 'P' IN EACH OF

C THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF
'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)

FOR EACH PREGNANCY THAT DID NOT END IN A LIVE BIRTH IN 2017-2022, ENTER 'T' IN THE CALENDAR
IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF
COMPLETED MONTHS OF PREGNANCY.

IF DURATION OF PREGNANCY WAS REPORTED IN WEEKS, MULTIPLY THE NUMBER OF WEEKS BY 0.23
TO CONVERT TO THE NUMBER OF MONTHS. ROUND DOWN TO THE NEAREST WHOLE NUMBER TO GET
THE NUMBER OF COMPLETED MONTHS.

232 Are you pregnant now? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO ...................................... 2
236
UNSURE ................................ 8

233 How many weeks or months pregnant are you?

WEEKS ....................... 1
RECORD NUMBER OF COMPLETED WEEKS OR
MONTHS.
MONTHS . . . . . . . . . . . . . . . . . . . . . . . 2

C
ENTER 'P's IN THE CALENDAR, BEGINNING
WITH THE MONTH OF INTERVIEW AND FOR
THE TOTAL NUMBER OF COMPLETED
MONTHS.
IF DURATION OF PREGNANCY WAS
REPORTED IN WEEKS, MULTIPLY THE
NUMBER OF WEEKS BY 0.23 TO CONVERT
TO THE NUMBER OF MONTHS. ROUND
DOWN TO THE NEAREST WHOLE NUMBER
TO GET THE NUMBER OF COMPLETED
MONTHS.

234 When you got pregnant, did you want to get pregnant at YES ...................................... 1 236
that time? NO ...................................... 2

235 CHECK 208: TOTAL NUMBER OF LIVE BIRTHS

ONE OR MORE NONE

a) Did you want to have a b) Did you want to have a

baby later on or did you baby later on or did you LATER ................................... 1
not want any more not want any children? NO MORE/NONE .......................... 2
children?

236 When did your last menstrual period start?

DAYS AGO .............. 1

WEEKS AGO .............. 2

MONTHS AGO .............. 3

(DATE, IF GIVEN) YEARS AGO .............. 4

IN MENOPAUSE/
HAS HAD HYSTERECTOMY ........... 94
240
BEFORE LAST PREGNANCY ........... 95

NEVER MENSTRUATED ................. 96 241

Appendix E • 505
 SECTION 2. REPRODUCTION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

237 CHECK 236: WAS THE LAST MENSTRUAL PERIOD WITHIN THE LAST YEAR?

YES, NO,
WITHIN ONE YEAR 240
LAST YEAR OR MORE

238 During your last menstrual period, what did you use to REUSABLE SANITARY PADS . . . . . . . . . . . . . . . . . A
(1) collect or absorb your menstrual blood? DISPOSABLE SANITARY PADS .............. B
TAMPONS ................................ C
Anything else? MENSTRUAL CUP . . . . . . . . . . . . . . . . . . . . . . . . . . D
CLOTH ................................... E
TOILET PAPER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F
COTTON WOOL .......................... G
UNDERWEAR ONLY ....................... H

OTHER X
(SPECIFY)
NOTHING .. ............................. Y

239 During your last menstrual period, were you able to wash YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
and change in privacy while at home? NO ...................................... 2
AWAY FROM HOME DURING LAST MENSTRUAL
PERIOD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

240 How old were you when you had your first menstrual
period? AGE .............................

DON'T KNOW ............................. 98

241 From one menstrual period to the next, are there certain YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
days when a woman is more likely to become pregnant? NO ...................................... 2
243
DON'T KNOW ............................. 8

242 Is this time just before her period begins, during her JUST BEFORE HER PERIOD BEGINS ........ 1
period, right after her period has ended, or halfway DURING HER PERIOD . . . . . . . . . . . . . . . . . . . . . . . 2
between two periods? RIGHT AFTER HER PERIOD HAS ENDED ..... 3
HALFWAY BETWEEN TWO PERIODS ........ 4

OTHER 6
(SPECIFY)
DON'T KNOW ............................. 8

243 After the birth of a child, can a woman become pregnant YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
before her menstrual period has returned? NO ...................................... 2
DON'T KNOW ............................. 8

506 • Appendix E
 SECTION 3. CONTRACEPTION

301 Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy. Have
you ever heard of (METHOD)?

01 Female Sterilization/ Ligation. YES ................................... 1

PROBE: Women can have an operation to avoid having any more NO ................................... 2
children.

02 Male SterilizationVasectomy. YES ................................... 1

PROBE: Men can have an operation to avoid having any more children. NO ................................... 2

03 Intrauterine Device (IUD). YES ................................... 1

PROBE: Women can have a loop or coil placed inside them by a doctor NO ................................... 2
or a nurse which can prevent pregnancy for one or more years.

04 Injectables. YES ................................... 1

PROBE: Women can have an injection by a health provider that stops NO ................................... 2
them from becoming pregnant for one or more months.

05 Implants. YES ................................... 1

PROBE: Women can have one or more small rods placed in their upper NO ................................... 2
arm by a doctor or nurse which can prevent pregnancy for one or more
years.

06 Patch. YES ................................... 1

PROBE: Women can put a hormonal patch on their upper outer arm, NO ................................... 2
buttocks, abdomen, or thigh to avoid getting pregnant

07 Pill. YES ................................... 1

PROBE: Women can take a pill every day to avoid becoming pregnant. NO ................................... 2

08 Condom. YES ................................... 1

PROBE: Men can put a rubber sheath on their penis before sexual NO ................................... 2
intercourse.

09 Female Condom. YES ................................... 1

PROBE: Women can place a sheath in their vagina before sexual NO ................................... 2
intercourse.

10 Emergency Contraception. YES ................................... 1

(1) PROBE: As an emergency measure, within 5 days after they have NO ................................... 2
unprotected sexual intercourse, women can take special pills to prevent
pregnancy.

11 Standard Days Method. YES ................................... 1

(2) PROBE: A woman uses a string of colored beads to know the days she NO ................................... 2
can get pregnant. On the days she can get pregnant, she uses a condom
or does not have sexual intercourse.

12 Mucus/Billings/Ovulation Method. YES ................................... 1

PROBE: Women can monitor their cervical mucus to determine the days NO ................................... 2
of the month they are most likely to get pregnant.

13 Basal Body Temperature. YES ................................... 1

PROBE: Women can monitor their body temperature to determine the NO ................................... 2
days of the month they are most likely to get pregnant.

14 Symptothermal. YES ................................... 1

PROBE: Women can monitor their cervical mucus and their body NO ................................... 2
temperature to determine the days of the month they are most likely to
get pregnant.

15 Lactational Amenorrhea Method (LAM). YES ................................... 1

(3) PROBE: Up to 6 months after childbirth, before the menstrual period has NO ................................... 2
returned, women use a method requiring frequent breastfeeding day and
night.

Appendix E • 507
 SECTION 3. CONTRACEPTION

16 Calendar or Rhythm Method or Periodic Abstinence. YES ................................... 1

PROBE: To avoid pregnancy, women do not have sexual intercourse on NO ................................... 2
the days of the month they think they can get pregnant.

17 Withdrawal. YES ................................... 1

PROBE: Men can be careful and pull out before climax. NO ................................... 2

18 Have you heard of any other ways or methods that women or men can YES, MODERN METHOD
use to avoid pregnancy?
A
(SPECIFY)
YES, TRADITIONAL METHOD

B
(SPECIFY)
NO ................................... Y

508 • Appendix E
 SECTION 3. CONTRACEPTION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

302 CHECK 232:

NOT PREGNANT PREGNANT

317
OR UNSURE

303 Are you or your partner currently doing something or using YES ...................................... 1 307
any method to delay or avoid getting pregnant? NO ...................................... 2

304 Are you or your partner sterilized? YES, RESPONDENT STERILIZED ONLY ..... 1
(4) YES, PARTNER STERILIZED ONLY ........... 2
IF YES: Who is sterilized, you or your partner? YES, BOTH STERILIZED .................... 3
NO, NEITHER STERILIZED ................. 4 306

305 CHECK 304:

(4) RESPONDENT PARTNER BOTH

STERILIZED ONLY STERILIZED ONLY STERILIZED

PROCEED TO 307. CIRCLE PROCEED TO 307. CIRCLE CODE PROCEED TO 307. CIRCLE CODE
CODE 'A' AND FOLLOW THE 'B' AND FOLLOW THE SKIP 'A' AND CODE 'B' AND FOLLOW
SKIP INSTRUCTION. INSTRUCTION. THE SKIP INSTRUCTION.

306 Just to check, are you or your partner doing any of the YES ...................................... 1
following to avoid pregnancy: deliberately avoiding sex on NO ...................................... 2 317
certain days, using a condom, using withdrawal or using
emergency contraception?

307 Which method are you using? FEMALE STERILIZATION . . . . . . . . . . . . . . . . . . . . A

312
(5) MALE STERILIZATION . . . . . . . . . . . . . . . . . . . . . . . B
IUD ...................................... C
RECORD ALL MENTIONED. INJECTABLES ............................. D
313C
IMPLANTS ................................ E
IF MORE THAN ONE METHOD MENTIONED, FOLLOW PATCH F
SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST. PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G
CONDOM ................................ H 311
FEMALE CONDOM . . . . . . . . . . . . . . . . . . . . . . . . . . I
313C
EMERGENCY CONTRACEPTION . . . . . . . . . . . . . . J
STANDARD DAYS METHOD ................. K
MUCUS/BILLINGS/OVULATION .............. L
BASAL BODY TEMPERATURE . . . . . . . . . . . . . . . . . M
SYMPTOTHERMAL . . . . . . . . . . . . . . . . . . . . . . . . . . N
LACTATIONAL AMENORRHEA METHOD ..... O 314
CALENDAR/RHYTHM METHOD .............. Q
WITHDRAWAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . R
OTHER MODERN METHOD
X
(SPECIFY)
OTHER TRADITIONAL METHOD
Y
(SPECIFY)

310 What is the brand name of the pills you are using? EXLUTON ................................ 01
DIANE 35 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 02
TRUST ................................... 03
IF DON'T KNOW THE BRAND, ASK TO SEE THE
PACKAGE. OTHER 96
(SPECIFY)
DON'T KNOW ............................. 98

310A How many pill cycles did you get last time?
NUMBER OF PILL
CYCLES .......................
313C
DON'T KNOW ............................. 98

311 What is the brand name of the condoms you are using? TRUST ................................... 01
DUREX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 02
PREMIERE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 03
IF DON'T KNOW THE BRAND, ASK TO SEE THE
PACKAGE. OTHER 96
(SPECIFY)
DON'T KNOW ............................. 98

Appendix E • 509
 SECTION 3. CONTRACEPTION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

311A How many condoms did you (your husband/partner) get

the last time? NUMBER OF
CONDOMS . . . . . . . . . . . . . . . . . . . . . . .
313C
DON'T KNOW ............................. 98

312 In what facility did the sterilization take place? PUBLIC SECTOR
(7) GOVERNMENT HOSPITAL . . . . . . . . . . . . . . . . . 11
RURAL HEALTH CENTER (RHC)/
PROBE TO IDENTIFY THE TYPE OF SOURCE. URBAN HEALTH CENTER (UHC)/
LYING IN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
IF UNABLE TO DETERMINE IF PUBLIC, PRIVATE, OR BARANGAY HEALTH STATION ........... 13
NGO SECTOR, RECORD '96' AND WRITE THE NAME
BARANGAY SUPPLY/SERVICE
OF THE PLACE.
POINT OFFICER/BHW . . . . . . . . . . . . . . . . . 14
OTHER PUBLIC SECTOR
16
(SPECIFY)

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC/
LYING IN CLINIC . . . . . . . . . . . . . . . . . . . . . . . 21
PHARMACY .......................... 22
PRIVATE DOCTOR . . . . . . . . . . . . . . . . . . . . . . . 23
PRIVATE NURSE/MIDWIFE .............. 24
INDUSTRY BASED CLINIC . . . . . . . . . . . . . . . . . 25
OTHER PRIVATE MEDICAL SECTOR
26
(SPECIFY)

OTHER 96
(SPECIFY)
DON'T KNOW ............................. 98

313 In what month and year was the sterilization performed?

MONTH ..........................

YEAR ..............

313A How much did you (your husband/partner) pay in total for
the sterilization, including any consultation you (he) may
COST (PHP) . . . . .
have had?
FREE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00000
DONE WITH CAESAREAN
SECTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99995
DON'T KNOW .......................... 99998

313B CHECK 307:

CODE 'A' CODE 'B'

CIRCLED CIRCLED

a) Before your b) Before the sterilization

sterilization operation, was your
operation, were you husband/partner told that
told that you would he would not be able to
not be able to have have any (more) children
YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
any (more) children because of the
NO ...................................... 2 315
because of the operation?
operation? DON'T KNOW ............................. 8

510 • Appendix E
 SECTION 3. CONTRACEPTION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

313C The last time you obtained (HIGHEST METHOD IN 304),

how much did you pay in total, including the cost of the
method and any consultation you may have had? COST (PHP) . . . . . . . . . . . . . . . . .

FREE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 000
DON'T KNOW .......................... 998

314 Since what month and year have you been using
(CURRENT METHOD) without stopping? MONTH ..........................

PROBE: For how long have you been using (CURRENT YEAR ..............
METHOD) now without stopping?

315 CHECK 313 AND 314, AND 220: ANY LIVE BIRTH, STILLBIRTH, OR PREGNANCY LOST BEFORE FULL TERM AFTER
MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 313 OR 314?

NO YES

GO BACK TO 313 OR 314, PROBE AND RECORD MONTH AND YEAR AT

START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER
LAST BIRTH OR PREGNANCY TERMINATION).

Appendix E • 511
 SECTION 3. CONTRACEPTION (CAPI OPTION) (8)

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

316 CHECK 313 AND 314:

(9) YEAR IS 2017-2022 YEAR IS 2016 OR EARLIER

C C
ENTER CODE FOR METHOD USED IN MONTH OF ENTER CODE FOR METHOD USED IN MONTH
INTERVIEW IN THE CALENDAR AND IN EACH OF INTERVIEW IN THE CALENDAR AND EACH
MONTH BACK TO THE DATE STARTED USING. MONTH BACK TO JANUARY 2017 .

THEN CONTINUE THEN

(SKIP TO 329)

317 I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the
(9) last few years.

C
USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE,
BACK TO JANUARY 2017. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS
REFERENCE POINTS.

317A MONTH AND YEAR OF START OF INTERVAL OF USE

OR NON-USE. MONTH ..........................

YEAR ..............

317B Between (EVENT) in (MONTH/YEAR) and (EVENT) in

(MONTH/YEAR), did you or your partner use any method YES ...................................... 1
of contraception? NO ...................................... 2 317I

317C Which method was that?

METHOD CODE .......................

317D How many months after (EVENT) in (MONTH/YEAR) did IMMEDIATELY .......................... 00
you start to use (METHOD)?
317F
CIRCLE '95' IF RESPONDENT GIVES THE DATE OF MONTHS .......................
STARTING TO USE THE METHOD.
DATE GIVEN ............................. 95

317E RECORD MONTH AND YEAR RESPONDENT STARTED

USING METHOD. MONTH ..........................

YEAR ..............

317F For how many months did you use (METHOD)?

317H
MONTHS .......................
CIRCLE '95' IF RESPONDENT GIVES THE DATE OF
TERMINATION OF USE. DATE GIVEN ............................. 95

317G RECORD MONTH AND YEAR RESPONDENT STOPPED

USING METHOD. MONTH ..........................

YEAR ..............

317H Why did you stop using (METHOD)?

REASON STOPPED ....................

317I GO BACK TO 317A FOR NEXT GAP; OR, IF NO MORE GAPS, GO TO 318.

512 • Appendix E
 SECTION 3. CONTRACEPTION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

318 Have you used emergency contraception in the last 12 YES ...................................... 1
(1) months? That is, have you taken special pills within 5 days NO ...................................... 2
after having unprotected sexual intercourse to prevent
pregnancy?

319 CHECK THE CALENDAR FOR USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH

NO METHOD USED ANY METHOD USED

321

320 Have you ever used anything or tried in any way to delay YES ...................................... 1
331
or avoid getting pregnant? NO ...................................... 2

321 CHECK 307: NO CODE CIRCLED ....................... 00 331

FEMALE STERILIZATION ................. 01 324
CIRCLE METHOD CODE: MALE STERILIZATION . . . . . . . . . . . . . . . . . . . . . . . 02 332
IUD ...................................... 03
IF MORE THAN ONE METHOD CODE CIRCLED IN 307, INJECTABLES ............................. 04
CIRCLE CODE FOR HIGHEST METHOD IN LIST. IMPLANTS ................................ 05
PATCH ................................ 06
PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 07
CONDOM ................................ 08
FEMALE CONDOM ....................... 09
EMERGENCY CONTRACEPTION ........... 10
STANDARD DAYS METHOD .............. 11
MUCUS/BILLINGS/OVULATION .............. 12
BASAL BODY TEMPERATURE .............. 13
SYMPTOTHERMAL .. .. .. .............. 14
332
LACTATIONAL AMENORRHEA METHOD .. 15
CALENDAR/RHYTHM METHOD ........... 16
WITHDRAWAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
OTHER MODERN METHOD ................. 95
OTHER TRADITIONAL METHOD ........... 96 332

322 You first started using (CURRENT METHOD) in (DATE PUBLIC SECTOR
(7) FROM 314). Where did you get it at that time? GOVERNMENT HOSPITAL . . . . . . . . . . . . . . . . . 11
RURAL HEALTH CENTER (RHC)/
URBAN HEALTH CENTER (UHC)/
LYING IN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
BARANGAY HEALTH STATION ........... 13
BARANGAY SUPPLY/SERVICE
POINT OFFICER/BHW .............. 14
PROBE TO IDENTIFY THE TYPE OF SOURCE. OTHER PUBLIC SECTOR
16
IF UNABLE TO DETERMINE IF PUBLIC, PRIVATE, OR (SPECIFY)
NGO SECTOR, RECORD '96' AND WRITE THE NAME
OF THE PLACE.
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/
LYING IN CLINIC . . . . . . . . . . . . . . . . . . . . . . . 21
PHARMACY .......................... 22
PRIVATE DOCTOR . . . . . . . . . . . . . . . . . . . . . . . 23
PRIVATE NURSE/MIDWIFE .............. 24
INDUSTRY BASED CLINIC .............. 25
OTHER PRIVATE MEDICAL SECTOR
26
(SPECIFY)

OTHER SOURCE
PUERICULTURE CENTER .............. 41
SHOP/STORE .......................... 42
CHURCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
FRIEND/RELATIVE . . . . . . . . . . . . . . . . . . . . . . . 44

OTHER 96
(SPECIFY)

323 At that time, were you told about side effects or problems YES ...................................... 1
325
you might have with the method? NO ...................................... 2

324 When you got sterilized, were you told about side effects YES ...................................... 1
or problems you might have with the method? NO ...................................... 2

325 Were you told what to do if you experienced side effects or YES ...................................... 1
problems? NO ...................................... 2

Appendix E • 513
 SECTION 3. CONTRACEPTION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

326 At that time, were you told about other methods of family YES ...................................... 1
planning that you could use? NO ...................................... 2

327 CHECK 307: FEMALE STERILIZATION ................. 01 332

(2) IUD ...................................... 03
CIRCLE METHOD CODE: INJECTABLES ............................. 04
IMPLANTS ................................ 05
IF MORE THAN ONE METHOD CODE CIRCLED IN 307, PATCH ................................ 06
CIRCLE CODE FOR HIGHEST METHOD IN LIST. PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 07
CONDOM ................................ 08
FEMALE CONDOM ....................... 09
EMERGENCY CONTRACEPTION ........... 10
STANDARD DAYS METHOD .............. 11
OTHER MODERN METHOD ................. 95

328 At that time, were you told that you could switch to another YES ...................................... 1
330
method if you wanted to or needed to? NO ...................................... 2

329 CHECK 307: FEMALE STERILIZATION ................. 01

332
MALE STERILIZATION .................... 02
CIRCLE METHOD CODE: IUD ...................................... 03
INJECTABLES ............................. 04
IF MORE THAN ONE METHOD CODE CIRCLED IN 307, IMPLANTS ................................ 05
CIRCLE CODE FOR HIGHEST METHOD IN LIST. PATCH ................................... 06
PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 07
CONDOM ................................ 08
FEMALE CONDOM ....................... 09
EMERGENCY CONTRACEPTION ........... 10
STANDARD DAYS METHOD .............. 11
MUCUS/BILLINGS/OVULATION .............. 12
BASAL BODY TEMPERATURE ........... 13
SYMPTOTHERMAL .. .. .. .............. 14
332
LACTATIONAL AMENORRHEA METHOD .. 15
CALENDAR/RHYTHM METHOD ........... 16
WITHDRAWAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
OTHER MODERN METHOD ................. 95
OTHER TRADITIONAL METHOD ........... 96 332

330 Where did you obtain (CURRENT METHOD) the last PUBLIC SECTOR
(7) time? GOVERNMENT HOSPITAL . . . . . . . . . . . . . . . . . 11
RURAL HEALTH CENTER (RHC)/
URBAN HEALTH CENTER (UHC)/
LYING IN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
BARANGAY HEALTH STATION ........ 13
PROBE TO IDENTIFY THE TYPE OF SOURCE. BARANGAY SUPPLY/SERVICE ........
POINT OFFICER/BHW . . . . . . . . . . . . . . . . . 14
IF UNABLE TO DETERMINE IF PUBLIC, PRIVATE, OR OTHER PUBLIC
NGO SECTOR, RECORD '96' AND WRITE THE NAME SECTOR 16
OF THE PLACE. (SPECIFY)

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC/
LYING IN CLINIC . . . . . . . . . . . . . . . . . . . . . . . 21
PHARMACY .......................... 22
PRIVATE DOCTOR .................... 23
PRIVATE NURSE/MIDWIFE .............. 24
INDUSTRY BASED CLINIC .............. 25
OTHER PRIVATE MEDICAL
SECTOR 26
(SPECIFY)

OTHER SOURCE
PUERICULTURE CENTER . . . . . . . . . . . . . . 41
SHOP/STORE . . . . . . . . . . . . . . . . . . . . . . . . . . 42
CHURCH ....................... 43
FRIEND/RELATIVE .................... 44

OTHER ..... 96
(SPECIFY)

330A In the last 12 months, was it easier or harder for you to get EASIER/NO CHANGE ....................... 1 332
a resupply, follow-up visit, or check up with regards the HARDER ................................ 2
family planning method you are using? Or was there no DON'T KNOW ............................. 8 332
change?

514 • Appendix E
 SECTION 3. CONTRACEPTION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

330B What is your primary reason why it has been harder for FACILITIES CLOSED ....................... 1
you to get a resupply, follow-up visit, or check up with PROVIDER NOT AROUND ................. 2
regards the family planning method you are using? NO TRANSPORTATION ................. 3
CROWDED HEALTH FACILITY .............. 4
FEAR TO GO OUTSIDE DUE TO
332
COVID-19 PANDEMIC .............. 5
FACILITY RAN OUT OF STOCK/
SUPPLY .......................... 6
FINANCIAL CONCERN .................... 7
OTHER . . . . . 96
(SPECIFY)

331 Do you know of a place where you can obtain a method of YES ...................................... 1
family planning? NO ...................................... 2 332

331A Where is that? PUBLIC SECTOR

(7) GOVERNMENT HOSPITAL . . . . . . . . . . . . . . . . . A
Any other place? RURAL HEALTH CENTER (RHC)/
URBAN HEALTH CENTER (UHC)/
LYING IN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B
BARANGAY HEALTH STATION ........ C
PROBE TO IDENTIFY THE TYPE OF SOURCE. BARANGAY SUPPLY/SERVICE ........
POINT OFFICER/BHW . . . . . . . . . . . . . . . . . D
IF UNABLE TO DETERMINE IF PUBLIC, PRIVATE, OR OTHER PUBLIC
NGO SECTOR, RECORD '96' AND WRITE THE NAME SECTOR E
OF THE PLACE. (SPECIFY)

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC/
LYING IN CLINIC . . . . . . . . . . . . . . . . . . . . . . . F
PHARMACY .......................... G
PRIVATE DOCTOR .................... H
PRIVATE NURSE/MIDWIFE .............. I
INDUSTRY BASED CLINIC .............. J
OTHER PRIVATE MEDICAL
SECTOR K
(SPECIFY)

OTHER SOURCE
PUERICULTURE CENTER .............. O
SHOP/STORE .......................... P
CHURCH ....................... Q
FRIEND/RELATIVE .................... R

OTHER ..... S
(SPECIFY)

332 In the last 12 months, were you visited by a health care YES ...................................... 1
(10) provider/worker? NO ...................................... 2 334

333 Did the health care provider/worker talk to you about family YES ...................................... 1
(10) planning? NO ...................................... 2

334 CHECK 202: CHILDREN LIVING WITH RESPONDENT

YES NO

a) In the last 12 months, b) In the last 12 months, YES ...................................... 1

have you visited a health have you visited a health NO ...................................... 2 401
facility for care for facility for care for
yourself or your children? yourself?

335 Did any staff member at the health facility speak to you YES ...................................... 1
about family planning methods? NO ...................................... 2

Appendix E • 515
 SECTION 4. PREGNANCY AND POSTNATAL CARE

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

401 CHECK 220 AND 225:

ONE OR MORE PREGNANCY NO PREGNANCY OUTCOMES

OUTCOMES 0-35 MONTHS 0-35 MONTHS BEFORE 601
BEFORE THE SURVEY THE SURVEY

402 CHECK 220. LIST THE PREGNANCY HISTORY NUMBER IN 215 FOR EACH PREGNANCY OUTCOME 0-35 MONTHS
BEFORE THE SURVEY, STARTING FROM THE LAST ONE. CLASSIFY EACH PREGNANCY OUTCOME BY TYPE USING
223 AND THE ORDER OF OUTCOMES IN THE PREGNANCY HISTORY.

PREGNANCY OUTCOME TYPE

MOST RECENT LIVE BIRTH 1
PRIOR LIVE BIRTH 2
MOST RECENT STILLBIRTH 3
PRIOR STILLBIRTH 4
PREGNANCY LOST BEFORE FULL TERM 5

PREGNANCY HISTORY NUMBER .. PREGNANCY OUTCOME TYPE ............

PREGNANCY HISTORY NUMBER .. PREGNANCY OUTCOME TYPE ............

PREGNANCY HISTORY NUMBER .. PREGNANCY OUTCOME TYPE ............

PREGNANCY HISTORY NUMBER .. PREGNANCY OUTCOME TYPE ............

PREGNANCY HISTORY NUMBER .. PREGNANCY OUTCOME TYPE ............

PREGNANCY HISTORY NUMBER .. PREGNANCY OUTCOME TYPE ............

403 Now I would like to ask some questions about your pregnancies in the last 3 years. (We will talk about each separately, starting
with the last one you had.)

404 PREGNANCY HISTORY NUMBER FROM 402. PREGNANCY HISTORY

NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . .

405 PREGNANCY OUTCOME TYPE FROM 402. MOST RECENT LIVE BIRTH .................. 1
407
PRIOR LIVE BIRTH . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
MOST RECENT STILLBIRTH .................. 3
PRIOR STILLBIRTH . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
PREGNANCY LOST BEFORE FULL TERM ...... 5

406 RECORD DATE PREGNANCY ENDED FROM 220.

DAY .............................

408
MONTH ..........................

YEAR . . . . . . . . . . . . . . . .

407 RECORD NAME FROM 218.

NAME

408 CHECK 405:

PREGNANCY TYPE PREGNANCY TYPE

1 OR 2 3, 4, OR 5

a) When you got pregnant b) When you got pregnant YES ....................................... 1 411
with (NAME), did you with the pregnancy that NO ....................................... 2
want to get pregnant at ended in (DATE FROM
that time? 406), did you want to get
pregnant at that time?

516 • Appendix E
 SECTION 4. PREGNANCY AND POSTNATAL CARE

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

NO. NAME OR DATE PREGNANCY HISTORY NUMBER ..

409 Did you want to have a baby later on, or not at all? LATER .................................... 1
NOT AT ALL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 411

410 How much longer did you want to wait?

MONTHS . . . . . . . . . . . . . . . . . . . . . . . 1

YEARS ....................... 2

DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 998

411 CHECK 405: PREGNANCY OUTCOME TYPE MOST RECENT LIVE BIRTH .................. 1
PRIOR LIVE BIRTH . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 434
MOST RECENT STILLBIRTH .................. 3
PRIOR STILLBIRTH . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 434
PREGNANCY LOST BEFORE FULL TERM ...... 5 475

412 Did you see anyone for prenatal care for this pregnancy? YES ....................................... 1 414
NO ....................................... 2

413 CHECK 405: PREGNANCY OUTCOME TYPE

MOST RECENT
LIVE BIRTH MOST RECENT
426
(SKIP TO 420) STILLBIRTH

414 Whom did you see? HEALTH PERSONNEL

(1) DOCTOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A
Anyone else? NURSE .............................. B
MIDWIFE .............................. C
PROBE TO IDENTIFY EACH TYPE OF PERSON AND OTHER PERSON
RECORD ALL MENTIONED. TRADITIONAL BIRTH
ATTENDANT/HILOT . . . . . . . . . . . . . . . . . . . . . D
BARANGAY HEALTH
WORKER ........................... E
RELATIVE/FRIEND . . . . . . . . . . . . . . . . . . . . . . . . F

OTHER X
(SPECIFY)

415 Where did you receive prenatal care for this pregnancy? HOME
(1) HER HOME . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A
Anywhere else? OTHER HOME ........................... B

PUBLIC SECTOR
GOVERNMENT HOSPITAL . . . . . . . . . . . . . . . . . . C
PROBE TO IDENTIFY THE TYPE OF SOURCE. RURAL HEALTH CENTER (RHC)/
RECORD ALL MENTIONED. URBAN HEALTH CENTER (UHC)/
LYING IN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D
BARANGAY SUPPLY SERVICE POINT
OFFICER/BHW . . . . . . . . . . . . . . . . . . . . . . . . F
OTHER PUBLIC
IF UNABLE TO DETERMINE IF PUBLIC, PRIVATE, OR SECTOR G
NGO SECTOR, RECORD 'X' AND WRITE THE NAME OF (SPECIFY)
THE PLACE(S).
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/
LYING IN CLINIC . . . . . . . . . . . . . . . . . . . . . . . . H
INDUSTRY-BASED CLINIC . . . . . . . . . . . . . . . . . . I
OTHER PRIVATE MEDICAL
SECTOR J
(SPECIFY)

OTHER X
(SPECIFY)

416 How many weeks or months pregnant were you when you
first received prenatal care for this pregnancy? WEEKS .................... 1

MONTHS . . . . . . . . . . . . . . . . . . . . 2

DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 998

Appendix E • 517
 SECTION 4. PREGNANCY AND POSTNATAL CARE

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

NO. NAME OR DATE PREGNANCY HISTORY NUMBER ..

417 How many times did you receive prenatal care during this
pregnancy? NUMBER OF TIMES ..............

DON'T KNOW .............................. 98

418 As part of your prenatal care during this pregnancy, did a

healthcare provider do any of the following: YES NO DK

a) Measure your blood pressure? a) BP ....................... 1 2 8

b) Take a urine sample? b) URINE .................... 1 2 8
c) Take a blood sample? c) BLOOD . . . . . . . . . . . . . . . . . . . . 1 2 8
d) Listen to the baby's heartbeat? d) HEARTBEAT . . . . . . . . . . . . . . . . . 1 2 8
e) Talk with you about which foods you should eat? e) FOODS . . . . . . . . . . . . . . . . . . . . 1 2 8
f) Talk with you about breastfeeding? f) BREASTFEED ........... 1 2 8
g) Ask you if you had vaginal bleeding? g) BLEEDING ................. 1 2 8
h) Measure your weight? h) WEIGHT ................. 1 2 8
i) Measure your height? i) HEIGHT ................. 1 2 8
j) Give you Calcium Carbonate? j) CALCIUM CARBONATE . . . . . . . . 1 2 8
k) Give you iodine supplementation? k) IODINE SUPP . . . . . . . . . . . . . . . . . 1 2 8
l) Screen you for HIV? l) HIV SCREENING . . . . . . . . . . . . . . 1 2 8

418A During (any of) your prenatal visit(s), were you told about YES . . . . . . . . . . . . . . . . . . . . . . . 1
things to look out for that might suggest problems with the NO ....................... 2
418C
pregnancy? DON'T KNOW .............. 8

418B Were you told where to go if you had any of these YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
complications? NO ....................................... 2
DON'T KNOW .............................. 8

418C What symptoms or conditions did you experience during VAGINAL BLEEDING ........................ A
your pregnancy with (NAME), if any? HEADACHE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B
DIZZINESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C
Anything else? BLURRED VISION ........................... D
SWOLLEN FACE ........................... E
SWOLLEN HANDS/FEET ..................... F
PALE OR ANEMIC . . . . . . . . . . . . . . . . . . G

OTHER ............... X
(SPECIFY)
NONE .................................... Y

418D During your pregnancy, did you set aside any money in YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
case of an emergency? NO ....................................... 2
DON'T KNOW .............................. 8

419 CHECK 405: PREGNANCY OUTCOME TYPE

MOST RECENT MOST RECENT

426
LIVE BIRTH STILLBIRTH

420 During this pregnancy, were you given an injection in the YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
(2) arm to prevent the baby from getting tetanus, that is, NO ....................................... 2
423
convulsions after birth? DON'T KNOW .............................. 8

421 During this pregnancy, how many times did you get a
tetanus injection? TIMES .................................

DON'T KNOW .............................. 8

422 CHECK 421:

ONE TIME TWO OR MORE TIMES 426

OR DK

423 At any time before this pregnancy, did you receive any YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
tetanus injections? NO ....................................... 2
426
DON'T KNOW .............................. 8

518 • Appendix E
 SECTION 4. PREGNANCY AND POSTNATAL CARE

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

NO. NAME OR DATE PREGNANCY HISTORY NUMBER ..

424 Before this pregnancy, how many times did you receive a
tetanus injection? TIMES .................................

IF 7 OR MORE TIMES, RECORD '7'. DON'T KNOW .............................. 8

425 CHECK 424:

ONLY MORE THAN

ONE ONE TIME
a) How many years ago did b) How many years ago did
you receive that tetanus you receive the last YEARS AGO . . . . . . . . . . . . . . . . . . . . . . .
injection? tetanus injection prior to
this pregnancy?

426 During this pregnancy, were you given or did you buy any YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
(3) iron tablets or multivitamins that contain iron? NO ....................................... 2
429
DON'T KNOW .............................. 8
SHOW TABLETS/SYRUP/MULTIVITAMIN WITH IRON

426A Did the iron tablets or multivitamins that contain iron also <(6 1
include folic acid? ? 12 2

DON'T KNOW .............................. 8

427 Where did you get the iron tablets or multivitamins that PUBLIC SECTOR
(1) contain iron? GOVERNMENT HOSPITAL . . . . . . . . . . . . . . . . . . A
(3) RURAL HEALTH CENTER (RHC)/
Anywhere else? URBAN HEALTH CENTER (UHC)/
LYING IN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B
BARANGAY HEALTH STATION ............ C
PROBE TO IDENTIFY THE TYPE OF SOURCE. BARANGAY SUPPLY/SERVICE
POINT OFFICER/BHW . . . . . . . . . . . . . . . . . . D
OTHER PUBLIC
SECTOR E
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE (SPECIFY)
SECTOR, RECORD 'X' AND WRITE THE NAME OF THE
PLACE(S). PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/
LYING IN CLINIC . . . . . . . . . . . . . . . . . . . . . . . . F
PHARMACY ........................... G
PRIVATE DOCTOR . . . . . . . . . . . . . . . . . . . . . . . . H
PRIVATE NURSE/MIDWIFE ............... I
INDUSTRY BASED CLINIC . . . . . . . . . . . . . . . . . . J
OTHER PRIVATE MEDICAL
SECTOR . K
(SPECIFY)

OTHER SOURCE
PUERICULTER CENTER .................. O
SHOP/STORE ........................... P
CHURCH ........................ Q
FRIEND/RELATIVE . . . . . . . . . . . . . . . . . . . . . . . . R

OTHER ..... X
(SPECIFY)

428 During the whole pregnancy, for how many days did you
(3) take the iron tablets or multivitamins that contain iron? DAYS . . . . . . . . . . . . . . . . . . . . . . .
(4)
IF ANSWER IS NOT NUMERIC, PROBE FOR DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 998
APPROXIMATE NUMBER OF DAYS.

429 During this pregnancy, did you take any medicine for YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
(5) intestinal worms? NO ....................................... 2
DON'T KNOW .............................. 8

Appendix E • 519
 SECTION 4. PREGNANCY AND POSTNATAL CARE

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

NO. NAME OR DATE PREGNANCY HISTORY NUMBER ..

429A Around the time of the birth of (NAME), did you have
any of the following problems?
YES NO
a) Long labor, that is, your regular contractions a) LONG LABOR .................... 1 2
lasted more than 12 hours?

b) Excessive bleeding, so much that you thought b) BLEEDING ....................... 1 2

you might die?

c) A high fever with a bad-smelling vaginal c) SEPSIS .......................... 1 2

discharge (sepsis)?

d) Loss of consciousness? d) LOSS OF CONSCIOUSNESS ........ 1 2

434 CHECK 405:

(1) PREGNANCY TYPE PREGNANCY TYPE HEALTH PERSONNEL

1 OR 2 3 OR 4 DOCTOR .............................. A
NURSE .............................. B
a) Who assisted with the b) Who assisted with the MIDWIFE .............................. C
delivery of (NAME)? delivery of the stillbirth OTHER PERSON
you had in (DATE FROM TRADITIONAL BIRTH
Anyone else? 406)? ATTENDANT/HILOT . . . . . . . . . . . . . . . . . . . . . D
BARANGAY HEALTH
WORKER ........................... E
PROBE FOR THE TYPE(S) OF PERSON(S) AND RELATIVE/FRIEND . . . . . . . . . . . . . . . . . . . . . . . . F
RECORD ALL MENTIONED.
OTHER X
IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO (SPECIFY)
DETERMINE WHETHER ANY ADULTS WERE PRESENT NO ONE ASSISTED ........ Y
AT THE DELIVERY.

435 CHECK 405: HOME

(1) HER HOME . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
437
PREGNANCY TYPE PREGNANCY TYPE OTHER HOME ........................... 12
1 OR 2 3 OR 4

a) Where did you give birth b) Where did you deliver PUBLIC SECTOR
to (NAME)? this stillbirth? GOVERNMENT HOSPITAL . . . . . . . . . . . . . . . . . . 21
RURAL HEALTH CENTER (RHC)/
URBAN HEALTH CENTER (UHC)/
LYING IN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
PROBE TO IDENTIFY THE TYPE OF SOURCE. BARANGAY HEALTH STATION . . . . . . . . . . . . . . . 23
BARANGAY SUPPLY SERVICE POINT
IF UNABLE TO DETERMINE IF PUBLIC, PRIVATE, OR OFFICER/BHW . . . . . . . . . . . . . . . . . . . . . . . . 24
NGO SECTOR, RECORD '96' AND WRITE THE NAME OTHER PUBLIC
OF THE PLACE. SECTOR 26
(SPECIFY)

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC/
LYING IN CLINIC .................. 31
INDUSTRY-BASED CLINIC . . . . . . . . . . . . . . . . . . 32
OTHER PRIVATE MEDICAL
SECTOR 36
(SPECIFY)

OTHER 96 437
(SPECIFY)

435A How much did you pay in total for the delivery of
(NAME)?
COST IN PHP . . . . . . . . . . . . . . . .

INCLUDE COST OF DOCTORS, NURSES,

HOSPITAL, ETC DONATIONS IN PHP . . . . . . . . . . .

FREE/NO COST . . . . . . . . . . . . . . . . . . . . . . 000000

IN KIND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 999996
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 999998

520 • Appendix E
 SECTION 4. PREGNANCY AND POSTNATAL CARE

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

NO. NAME OR DATE PREGNANCY HISTORY NUMBER ..

436 CHECK 405:

PREGNANCY TYPE PREGNANCY TYPE

1 OR 2 3 OR 4

a) Was (NAME) delivered b) Was this stillbirth YES ....................................... 1

by caesarean, that is, did delivered by caesarean, NO ....................................... 2
they cut your belly open that is, did they cut your
to take the baby out? belly open to take the
baby out?

437 CHECK 405: PREGNANCY OUTCOME TYPE MOST RECENT LIVE BIRTH .................. 1
PRIOR LIVE BIRTH . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 441
MOST RECENT STILLBIRTH .................. 3 445
PRIOR STILLBIRTH . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 486A

438 After the birth, was (NAME) put on your chest? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
NO ....................................... 2
441
DON'T KNOW .............................. 8

439 Was (NAME)'s bare skin touching your bare skin? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
NO ....................................... 2
441
DON'T KNOW .............................. 8

440 How long after birth was (NAME) put on the bare skin of IMMEDIATELY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 000
your chest?

IF LESS THAN 1 HOUR, RECORD ‘00' HOURS; HOURS ....................... 1

IF LESS THAN 24 HOURS, RECORD HOURS;
OTHERWISE, RECORD DAYS. DAYS . . . . . . . . . . . . . . . . . . . . . . . . . . 2

441 When (NAME) was born, was (NAME) very large, larger VERY LARGE .............................. 1
than average, average, smaller than average, or very LARGER THAN AVERAGE . . . . . . . . . . . . . . . . . . . . . 2
small? AVERAGE ................................. 3
SMALLER THAN AVERAGE .................. 4
VERY SMALL .............................. 5
DON'T KNOW .............................. 8

442 Was (NAME) weighed at birth? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO ....................................... 2
444
DON'T KNOW .............................. 8

443 How much did (NAME) weigh?

KG FROM CARD 1 .

RECORD WEIGHT IN KILOGRAMS FROM HEALTH

CARD, IF AVAILABLE. KG FROM RECALL 2 .

DON'T KNOW ........................... 9.998

444 CHECK 405: PREGNANCY OUTCOME TYPE

MOST RECENT PRIOR LIVE BIRTH

480
LIVE BIRTH

445 CHECK 435: PLACE OF DELIVERY

CODE
FACILITY BIRTH: ANY CODE 11, 12, OR 96
463B
21 THROUGH 46 CIRCLED CIRCLED

446 Did the doctors, nurses, or other staff at the facility treat ALL OF THE TIME ........................... 1
you with respect all of the time, some of the time, or not at SOME OF THE TIME ........................ 2
all? NOT AT ALL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Appendix E • 521
 SECTION 4. PREGNANCY AND POSTNATAL CARE

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

NO. NAME OR DATE PREGNANCY HISTORY NUMBER ..

447 CHECK 405:

PREGNANCY TYPE PREGNANCY TYPE

1 3

a) How long after (NAME) b) For the stillbirth you had HOURS ....................... 1
was delivered did you in (DATE FROM 406),
stay in (FACILITY IN how long after the baby DAYS . . . . . . . . . . . . . . . . . . . . . . . . . . 2
435)? was born did you stay in
(FACILITY IN 435)? WEEKS ....................... 3

DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 998

IF LESS THAN ONE DAY, RECORD HOURS;
IF LESS THAN ONE WEEK, RECORD DAYS.

448 I would like to talk to you about checks on your health after
delivery, for example, someone asking you questions about
your health or examining you. YES ....................................... 1
NO ....................................... 2 451
Before you left the facility, did anyone check on your
health?

449 How long after delivery did the first check take place?
HOURS ....................... 1

DAYS . . . . . . . . . . . . . . . . . . . . . . . . . . 2
IF LESS THAN ONE DAY, RECORD HOURS;
IF LESS THAN ONE WEEK, RECORD DAYS. WEEKS ....................... 3

DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 998

450 Who checked on your health at that time? HEALTH PERSONNEL

(1) DOCTOR .............................. 11
NURSE .............................. 12
MIDWIFE .............................. 13
PROBE FOR MOST QUALIFIED PERSON. OTHER PERSON
TRADITIONAL BIRTH ATTENDANT/ HILOT . . . . . . 21
BARANGAY HEALTH WORKER . . . . . . . . . . . . . . . 22
RELATIVE/FRIEND . . . . . . . . . . . . . . . . . . . . . . . . 23

OTHER 96
(SPECIFY)

451 CHECK 405: PREGNANCY OUTCOME TYPE

MOST RECENT MOST RECENT

455
LIVE BIRTH STILLBIRTH

452 Now I would like to talk to you about checks on (NAME'S)

health -- for example, someone examining (NAME),
checking the cord, or talking to you about how to care for YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
(NAME). NO ....................................... 2
455
DON'T KNOW .............................. 8
Before (NAME) left the facility, did anyone check on
(NAME'S) health?

453 How long after delivery was (NAME)’s health first checked?
HOURS ....................... 1

IF LESS THAN ONE DAY, RECORD HOURS; DAYS . . . . . . . . . . . . . . . . . . . . . . . . . . 2

IF LESS THAN ONE WEEK, RECORD DAYS.
WEEKS ....................... 3

DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 998

522 • Appendix E
 SECTION 4. PREGNANCY AND POSTNATAL CARE

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

NO. NAME OR DATE PREGNANCY HISTORY NUMBER ..

454 Who checked on (NAME)’s health at that time? HEALTH PERSONNEL

(1) DOCTOR .............................. 11
NURSE .............................. 12
MIDWIFE .............................. 13
PROBE FOR MOST QUALIFIED PERSON. OTHER PERSON
TRADITIONAL BIRTH ATTENDANT/ HILOT . . . . . . 21
BARANGAY HEALTH WORKER . . . . . . . . . . . . . . . 22
RELATIVE/FRIEND . . . . . . . . . . . . . . . . . . . . . . . . 23

OTHER 96
(SPECIFY)

455 Now I would like to talk to you about what happened after YES ....................................... 1
you left the facility. Did anyone check on your health after NO ....................................... 2 459
you left the facility?

456 How long after delivery did that check take place?
HOURS ....................... 1

IF LESS THAN ONE DAY, RECORD HOURS; DAYS . . . . . . . . . . . . . . . . . . . . . . . . . . 2

IF LESS THAN ONE WEEK, RECORD DAYS.
WEEKS ....................... 3

DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 998

457 Who checked on your health at that time? HEALTH PERSONNEL

(1) DOCTOR .............................. 11
NURSE .............................. 12
MIDWIFE .............................. 13
PROBE FOR MOST QUALIFIED PERSON. OTHER PERSON
TRADITIONAL BIRTH ATTENDANT/ HILOT . . . . . . 21
BARANGAY HEALTH WORKER . . . . . . . . . . . . . . . 22
RELATIVE/FRIEND . . . . . . . . . . . . . . . . . . . . . . . . 23

OTHER 96
(SPECIFY)

458 Where did the check take place? HOME

(1) HER HOME . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
OTHER HOME ........................... 12

PROBE TO IDENTIFY THE TYPE OF SOURCE.

PUBLIC SECTOR
GOVERNMENT HOSPITAL . . . . . . . . . . . . . . . . . . 21
IF UNABLE TO DETERMINE IF PUBLIC, PRIVATE, OR RURAL HEALTH CENTER (RHC)/
NGO SECTOR, RECORD '96' AND WRITE THE NAME URBAN HEALTH CENTER (UHC)/
OF THE PLACE. LYING IN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
BARANGAY HEALTH STATION . . . . . . . . . . . . . . . 23
BARANGAY SUPPLY SERVICE POINT
OFFICER/BHW . . . . . . . . . . . . . . . . . . . . . . . . 24
OTHER PUBLIC
SECTOR 26
(SPECIFY)

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC
LYING IN CLINIC .................. 31
INDUSTRY-BASED CLINIC . . . . . . . . . . . . . . . . . . 32
OTHER PRIVATE MEDICAL
SECTOR 36
(SPECIFY)

OTHER 96
(SPECIFY)

459 CHECK 405: PREGNANCY OUTCOME TYPE

MOST RECENT MOST RECENT

474
LIVE BIRTH STILLBIRTH

Appendix E • 523
 SECTION 4. PREGNANCY AND POSTNATAL CARE

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

NO. NAME OR DATE PREGNANCY HISTORY NUMBER ..

460 After (NAME) left (FACILITY IN 435) did any health care YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
provider or a traditional birth attendant check on (NAME)’s NO ....................................... 2
473
health? DON'T KNOW .............................. 8

461 How long after the birth of (NAME) did that check take
place? HOURS ....................... 1

IF LESS THAN ONE DAY, RECORD HOURS; DAYS . . . . . . . . . . . . . . . . . . . . . . . . . . 2

IF LESS THAN ONE WEEK, RECORD DAYS.
WEEKS ....................... 3

DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 998

462 Who checked on (NAME)’s health at that time? HEALTH PERSONNEL

(1) DOCTOR .............................. 11
NURSE .............................. 12
MIDWIFE .............................. 13
PROBE FOR MOST QUALIFIED PERSON. OTHER PERSON
TRADITIONAL BIRTH ATTENDANT/ HILOT . . . . . . 21
BARANGAY HEALTH WORKER . . . . . . . . . . . . . . . 22
RELATIVE/FRIEND . . . . . . . . . . . . . . . . . . . . . . . . 23

OTHER 96
(SPECIFY)

463 Where did this check of (NAME) take place? HOME

(1) HER HOME . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
OTHER HOME ........................... 12

PROBE TO IDENTIFY THE TYPE OF SOURCE.

PUBLIC SECTOR
GOVERNMENT HOSPITAL . . . . . . . . . . . . . . . . . . 21
IF UNABLE TO DETERMINE IF PUBLIC, PRIVATE, OR RURAL HEALTH CENTER (RHC)/
NGO SECTOR, RECORD '96' AND WRITE THE NAME URBAN HEALTH CENTER (UHC)/
OF THE PLACE. LYING IN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
BARANGAY HEALTH STATION . . . . . . . . . . . . . . . 23
BARANGAY SUPPLY SERVICE POINT
OFFICER/BHW . . . . . . . . . . . . . . . . . . . . . . . . 24
OTHER PUBLIC
SECTOR 26
(SPECIFY)

PRIVATE MEDICAL SECTOR

473
PRIVATE HOSPITAL/CLINIC
LYING IN CLINIC .................. 31
INDUSTRY-BASED CLINIC . . . . . . . . . . . . . . . . . . 32
OTHER PRIVATE MEDICAL
SECTOR 36
(SPECIFY)

OTHER 96
(SPECIFY)

463B Why didn't you deliver in a health facility? COST TOO MUCH . . . . . . . . . . . . . . . . . . . . . . . . . . . A
FACILITY NOT OPEN . . . . . . . . . . . . . . . . . . . . . . . . . . . B
Any other reason? TOO FAR/NO TRANSPORT . . . . . . . . . . . . . . . . . . . . . C
DON'T TRUST FACILITY/
POOR QUALITY SERVICE . . . . . . . . . . . . . . . . . . D
RECORD ALL MENTIONED NO FEMALE PROVIDER
AT FACILITY . . . . . . . . . . . . . . . . . . E
HUSBAND/FAMILY DID NOT
ALLOW ................. ............... F
NOT NECESSARY . . . . . . . . . . . . . . . . . . . . . . . . . . . G
NOT CUSTOMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . H
CROWDED HEALTH FACILITY . . . . . . . . . . . . . . . . . . I
FEAR OF GOING OUTSIDE DUE TO
COVID-19 PANDEMIC . . . . . . . . . . . . . . . . . . . . . J

OTHER X
(SPECIFY)

524 • Appendix E
 SECTION 4. PREGNANCY AND POSTNATAL CARE

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

NO. NAME OR DATE PREGNANCY HISTORY NUMBER ..

464 CHECK 405:

PREGNANCY TYPE PREGNANCY TYPE

1 3

a) I would like to talk to you b) I would like to talk to you YES ....................................... 1
about checks on your about checks on your NO ....................................... 2 468
health after delivery, for health after delivery, for
example, someone example, someone
asking you questions asking you questions
about your health or about your health or
examining you. Did examining you. Did
anyone check on your anyone check on your
health after you gave health after you delivered
birth to (NAME)? the stillbirth you had in
(DATE FROM 406)?

465 How long after delivery did the first check take place?
HOURS ....................... 1

IF LESS THAN ONE DAY, RECORD HOURS; DAYS . . . . . . . . . . . . . . . . . . . . . . . . . . 2

IF LESS THAN ONE WEEK, RECORD DAYS.
WEEKS ....................... 3

DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 998

466 Who checked on your health at that time? HEALTH PERSONNEL

(1) DOCTOR .............................. 11
NURSE .............................. 12
MIDWIFE .............................. 13
PROBE FOR MOST QUALIFIED PERSON. OTHER PERSON
TRADITIONAL BIRTH ATTENDANT/ HILOT . . . . . . 21
BARANGAY HEALTH WORKER . . . . . . . . . . . . . . . 22
RELATIVE/FRIEND . . . . . . . . . . . . . . . . . . . . . . . . 23

OTHER 96
(SPECIFY)

467 Where did this first check take place? HOME

(1) HER HOME . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
OTHER HOME ........................... 12

PROBE TO IDENTIFY THE TYPE OF SOURCE.

PUBLIC SECTOR
GOVERNMENT HOSPITAL . . . . . . . . . . . . . . . . . . 21
IF UNABLE TO DETERMINE IF PUBLIC, PRIVATE, OR RURAL HEALTH CENTER (RHC)/
NGO SECTOR, RECORD '96' AND WRITE THE NAME URBAN HEALTH CENTER (UHC)/
OF THE PLACE. LYING IN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
BARANGAY HEALTH STATION . . . . . . . . . . . . . . . 23
BARANGAY SUPPLY SERVICE POINT
OFFICER/BHW . . . . . . . . . . . . . . . . . . . . . . . . 24
OTHER PUBLIC
SECTOR 26
(SPECIFY)

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC
LYING IN CLINIC .................. 31
INDUSTRY-BASED CLINIC . . . . . . . . . . . . . . . . . . 32
OTHER PRIVATE MEDICAL
SECTOR 36
(SPECIFY)

OTHER 96
(SPECIFY)

468 CHECK 405: PREGNANCY OUTCOME TYPE

MOST RECENT MOST RECENT

474
LIVE BIRTH STILLBIRTH

Appendix E • 525
 SECTION 4. PREGNANCY AND POSTNATAL CARE

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

NO. NAME OR DATE PREGNANCY HISTORY NUMBER ..

469 I would like to talk to you about checks on (NAME's) health -

- for example, someone examining (NAME), checking the
cord, or talking to you about how to care for (NAME). YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
NO ....................................... 2
473
After (NAME) was born, did any health care provider or a DON'T KNOW .............................. 8
traditional birth attendant check on (NAME's) health?

470 How long after the birth of (NAME) did that check take
place? HOURS ....................... 1

IF LESS THAN ONE DAY, RECORD HOURS; DAYS . . . . . . . . . . . . . . . . . . . . . . . . . . 2

IF LESS THAN ONE WEEK, RECORD DAYS.
WEEKS ....................... 3

DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 998

471 Who checked on (NAME)'s health at that time? HEALTH PERSONNEL

(1) DOCTOR .............................. 11
NURSE .............................. 12
MIDWIFE .............................. 13
PROBE FOR MOST QUALIFIED PERSON. OTHER PERSON
TRADITIONAL BIRTH ATTENDANT/ HILOT . . . . . . 21
BARANGAY HEALTH WORKER . . . . . . . . . . . . . . . 22
RELATIVE/FRIEND . . . . . . . . . . . . . . . . . . . . . . . . 23

OTHER 96
(SPECIFY)

472 Where did this first check of (NAME) take place? HOME
(1) HER HOME . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
OTHER HOME ........................... 12
PROBE TO IDENTIFY THE TYPE OF SOURCE.
PUBLIC SECTOR
GOVERNMENT HOSPITAL . . . . . . . . . . . . . . . . . . 21
IF UNABLE TO DETERMINE IF PUBLIC, PRIVATE, OR RURAL HEALTH CENTER (RHC)/
NGO SECTOR, RECORD '96' AND WRITE THE NAME URBAN HEALTH CENTER (UHC)/
OF THE PLACE. LYING IN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
BARANGAY HEALTH STATION . . . . . . . . . . . . . . . 23
BARANGAY SUPPLY SERVICE POINT
OFFICER/BHW . . . . . . . . . . . . . . . . . . . . . . . . 24
OTHER PUBLIC
SECTOR 26
(SPECIFY)

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC
LYING IN CLINIC .................. 31
INDUSTRY-BASED CLINIC . . . . . . . . . . . . . . . . . . 32
OTHER PRIVATE MEDICAL
SECTOR 36
(SPECIFY)

OTHER 96
(SPECIFY)

473 During the first 2 days after (NAME)’s birth, did any health
care provider do the following: YES NO DK

a) Examine the cord? a) CORD .................... 1 2 8

b) Measure (NAME)’s temperature? b) TEMPERATURE . . . . . . . . . . . . . . 1 2 8
c) Tell you how to recognize if your baby needs
immediate medical attention? c) MEDICAL ATTENTION . . . . . . . . 1 2 8
d) Perform a breast examination d) BREAST EXAM . . . . . . . . . . . . . . 1 2 8
e) Talk with you/ give advice about breastfeeding? e) TALK ABOUT BREASTFEEDING 1 2 8
f) Observe (NAME) breastfeeding? f) OBSERVE BREASTFEEDING . . 1 2 8
g) Counsel you on kangaroo care/ provide baby care g) KANGAROO CARE . . . . . . . . . . . 1 2 8
advice?

526 • Appendix E
 SECTION 4. PREGNANCY AND POSTNATAL CARE

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

NO. NAME OR DATE PREGNANCY HISTORY NUMBER ..

474 During the first 2 days after the birth, did any healthcare
provider do the following to you: YES NO DK

a) Perform a full physical examination? a) FULL PHYSICAL ........... 1 2 8

b) Measure your blood pressure? b) BLOOD PRESSURE . . . . . . . . . . . 1 2 8
c) Perform an abdominal examination? c) ABDOMINAL EXAM . . . . . . . . . . . 1 2 8
d) Perform an internal examination? d) INTERNAL EXAM ........... 1 2 8
e) Discuss your vaginal bleeding with you? e) DISCUSS BLEEDING . . . . . . . . . . . 1 2 8
f) Discuss family planning with you? f) FAMILY PLANNING . . . . . . . . . . . 1 2 8
g) Provide an iron supplement? g) IRON SUPPLEMENT . . . . . . . . . . . 1 2 8
h) Provide a Vitamin A capsule? h) VITAMIN A ........... 1 2 8
i) Provide nutrition counseling? i) NUTRITION COUNSELING . . . . . 1 2 8

475 CHECK 215: IS THIS PREGNANCY THE WOMAN'S LAST PREGNANCY?

YES NO
479

476 CHECK 405:

PREGNANCY PREGNANCY
TYPE 1 TYPE 3 OR 5

a) Has your menstrual b) Has your menstrual YES ....................................... 1

period returned since the period returned since the NO ....................................... 2
birth of (NAME)? pregnancy that ended in
(DATE FROM 406)?

477 CHECK 232: IS RESPONDENT PREGNANT?

NOT PREGNANT PREGNANT

479
OR UNSURE

478 CHECK 405:

PREGNANCY PREGNANCY
TYPE 1 TYPE 3 OR 5

a) Have you had sexual b) Have you had sexual YES ....................................... 1
intercourse since the intercourse since the NO ....................................... 2
birth of (NAME)? pregnancy that ended in
(DATE FROM 406)?

479 CHECK 405: PREGNANCY OUTCOME TYPE MOST RECENT LIVE BIRTH .................. 1
MOST RECENT STILLBIRTH .................. 3
486A
PREGNANCY LOST BEFORE FULL TERM . . . . . . . . . 5

480 Did you ever breastfeed (NAME)? YES ....................................... 1 482

NO ....................................... 2

481 CHECK 224 FOR CHILD: LIVING 486

DEAD 486A

482 How long after birth did you first put (NAME) to the breast? IMMEDIATELY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 000

IF LESS THAN 1 HOUR, RECORD ‘00' HOURS; HOURS ....................... 1

IF LESS THAN 24 HOURS, RECORD HOURS;
OTHERWISE, RECORD DAYS. DAYS . . . . . . . . . . . . . . . . . . . . . . . . . . 2

483 In the first 2 days after delivery, was [NAME] given YES ....................................... 1
anything other than breastmilk to eat or drink – anything at NO ....................................... 2 484
all like lowfat milk, nonfat milk, condensed milk, evaporated
milk, or am?

Appendix E • 527
 SECTION 4. PREGNANCY AND POSTNATAL CARE

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

NO. NAME OR DATE PREGNANCY HISTORY NUMBER ..

483A What was (NAME) given to drink? Anything else?

LOW FAT MILK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A
NONFAT MILK .............................. B
CONDENSED MILK . . . . . . . . . . . . . . . . . . . . . . . . . . . C
EVAPORATED MILK . . . . . . . . . . . . . . . . . . . . . . . . . . . D
AM ....................................... E
PLAIN WATER ........................... F
SUGAR OR GLUCOSE WATER . . . . . . . . . . . . . . . . . . G
GRIPE WATER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . H
RECORD ALL MENTIONED SUGAR-SALT-WATER SOLUTION . . . . . . . . . . . . . . . I
FRUIT JUICE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J
INFANT FORMULA . . . . . . . . . . . . . . . . . . . . . . . . . . . K
TEA/INFUSIONS ........................... L
HONEY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . M

OTHER ............... X
(SPECIFY)

484 CHECK 224 FOR CHILD:

LIVING DEAD
486A

485 Are you still breastfeeding (NAME)? YES ....................................... 1

NO ....................................... 2

486 Did (NAME) drink anything from a bottle with a nipple YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
yesterday during the day or at night? NO ....................................... 2
DON'T KNOW .............................. 8

486A
CHECK 232 OR CHECK 220 OR 228:

RESPONDENT IS
RESPONDENT' RESPONDENT NOT
PREGNANT
PREGNANT AT ANY PREGNANT AT ANY
TIME IN THE LAST 12 TIME IN THE LAST 12
MONTHS MONTHS

(SKIP TO 487)

486B In the last 12 months, was it easier or harder than expected EASIER OR NO CHANGE ..................... 1 487
for you to get pregnancy related care (for example going for HARDER ................................. 2
prenatal check up, delivering in a health facility, or going DON'T KNOW .............................. 8 487
for postnatal check up?). Or was there no difference from
what you expected?

486C What is your primary reason why its harder for you to go for FACILITY CLOSED . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
prenatal check up, deliver in a health facility, go for PROVIDER NOT AROUND .................. 2
postpartum check up? NO TRANSPORTATION . . . . . . . . . . . . . . . . . . . . . . . . 3
CROWDED HEALTH FACILITY ............... 4
FEAR TO GO OUTSIDE DUE TO
COVID-19 PANDEMIC ..................... 5
TESTING REQUIREMENTS .................. 6

OTHER ............... 7
(SPECIFY)

487
CHECK 402: ANY MORE PREGNANCY OUTCOMES 0-35 MONTHS BEFORE THE SURVEY?

MORE PREGNANCY NO MORE PREGNANCY

OUTCOMES 0-35 MONTHS OUTCOMES 0-35 MONTHS
BEFORE THE SURVEY BEFORE THE SURVEY

(GO TO 404 FOR THE NEXT

PREGNANCY OUTCOME)

528 • Appendix E
 SECTION 5. CHILD IMMUNIZATION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

501 CHECK 220, 224 AND 225 IN THE PREGNANCY HISTORY: ANY SURVIVING CHILDREN BORN 0-35 MONTHS BEFORE
THE SURVEY?

ONE OR MORE NO SURVIVING CHILDREN

SURVIVING CHILDREN BORN
BORN 0-35 MONTHS 0-35 MONTHS 601
BEFORE THE SURVEY BEFORE THE SURVEY

502 Now I would like to ask some questions about vaccinations received by your children born in the last 3 years. (We will talk
about each separately, starting with the youngest.)

503 RECORD THE NAME AND PREGNANCY HISTORY NUMBER FROM 215 AND 218 OF THE SURVIVING CHILDREN
BORN 0-35 MONTHS BEFORE THE SURVEY, STARTING WITH THE LAST ONE.

NAME OF CHILD PREGNANCY HISTORY NUMBER ..

504 Do you have a card or booklet for mother and child or YES, HAS ONLY A CARD/BOOKLET ........... 1 507
(1) other document where (NAME)'s vaccinations are written YES, HAS ONLY ANOTHER DOCUMENT ..... 2
down? YES, HAS CARD/BOOKLET AND OTHER DOC. . . 3 507
NO, NO CARD AND NO OTHER DOCUMENT .. 4

505 Did you ever have a vaccination card or booklet for mother YES ...................................... 1
(1) and child for (NAME)? NO ...................................... 2

506 CHECK 504:

CODE '2' CIRCLED CODE '4' CIRCLED

513

507 May I see the card or other document where (NAME)'s YES, ONLY CARD/BOOKLET SEEN ........... 1
(1) vaccinations are written down? YES, ONLY OTHER DOCUMENT SEEN ........ 2
YES, CARD/BOOKLET AND OTHER DOC. SEEN . . 3
NO CARD/BOOKLET AND NO OTHER DOC. SEEN. . 4 513

507A CHECK CARD/MOTHER AND CHILD BOOKLET OR CARD/BOOKLET FROM DOH/PUBLIC SOURC. . . . . 1
OTHER DOCUMENT CARD/BOOKLET FROM PRIVATE SOURC . . . . . . . . 2
CARD/BOOKLETS FROM PUBLIC AND
PRIVATE SOURCES . . . . . . . . . . . . . . . . . . . . 3

508 RECORD (NAME'S) DATE OF BIRTH FROM THE

VACCINATION CARD OR OTHER DOCUMENT. MONTH ..........................

DAY ..........................

YEAR . . . . . . . . . . . . . . . . .

DATE OF BIRTH NOT ON CARD . . . . . . . . . . . . . . 95

508A CHECK CARD/MOTHER AND CHILD BOOKLET OR YES, PENTAVALENT OR DPT-HEPB-HIB

OTHER DOCUMENT: IS PENTAVALENT OR DPT-HEB- PRINTED OR WRITTEN ON CARD . . . . . . . . . . . 1
HIB PRINTED OR WRITTEN ON CARD? NO, NEITHER PENTAVALENT NOR DPT-HEPB-HIB
PRINTED OR WRITTEN ON CARD . . . . . . . . . . . 2 509B

Appendix E • 529
 SECTION 5A. CHILD IMMUNIZATION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

NAME OF LIVE BIRTH PREGNANCY HISTORY NUMBER . . . . .

509A COPY VACCINATION DATES FROM THE CARD/MOTHER AND CHILD BOOKLET FOR (NAME).
(1) RECORD ‘44' IN ‘MONTH' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.
RECORD '00' IN 'MONTH' COLUMN IF CARD IS BLANK FOR THE DOSE.

MONTH DAY YEAR

BCG

HEPATITIS B AT BIRTH

PENTAVALENT 1/ DPT - HEPB - HIB 1

PENTAVALENT 2/DPT - HEPB - HIB 2

PENTAVALENT 3/ DPT - HEPB- HIB 3

ORAL POLIO VACCINE (OPV) 1

ORAL POLIO VACCINE (OPV) 2

ORAL POLIO VACCINE (OPV) 3

INACTIVATED POLIO VACCINE (IPV) 1

PNEUMOCOCCAL CONJUGATE VACCINE (PCV) 1

PNEUMOCOCCAL CONJUGATE VACCINE (PCV) 2

PNEUMOCOCCAL CONJUGATE VACCINE (PCV) 3

MEASLES, MUMPS, RUBELLA (MMR)1

MEASLES, MUMPS, RUBELLA (MMR) 2

(8)

VITAMIN A (MOST RECENT)

510A ASK THE RESPONDENT FOR PERMISSION TO PHOTOGRAPH TAKEN . . . . . . . . . . . . . . . . . . . . . . . 1

PHOTOGRAPH VACCINATION CARD OR OTHER PHOTOGRAPH NOT TAKEN,
DOCUMENT WHERE VACCINATIONS ARE WRITTEN. PERMISSION NOT RECEIVED ........... 2
IF PERMISSION IS GRANTED, PHOTOGRAPH CARD. PHOTOGRAPH NOT TAKEN,
OTHER REASON 6
(SPECIFY)

511A CHECK 509: 'BCG' TO 'MEASLES, MUMPS, RUBELLA 2' ALL HAVE A DATE RECORDED OR '44' RECORDED IN THE
'MONTH' COLUMN?
NO YES
529

530 • Appendix E
 SECTION 5A. CHILD IMMUNIZATION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

NAME OF LIVE BIRTH PREGNANCY HISTORY NUMBER . . . . .

512A In addition to what is recorded on (this document/these YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

documents), did (NAME) receive any other vaccinations, (USE THE LIST SHOWN IN CAPI TO SELECT THE
including vaccinations received in campaigns or OTHER VACCINATIONS GIVEN.
immunization days or child health days like: The National NOTE THAT CAPI WILL CHANGE THE ANSWER IN
Campaign Against Measles, the "Bakuna Para Sa 509A IN THE 'MONTH' COLUMN FROM '00' TO '66'
Kabataan Proteksyon Sa Kinabukasan", NGO, Charity, FOR THE SELECTED VACCINATIONS.)
Medical Mission?

(THEN SKIP TO 529)

RECORD 'YES' ONLY IF THE RESPONDENT
MENTIONS AT LEAST ONE OF THE VACCINATIONS IN NO ...................................... 2
509 THAT ARE NOT RECORDED AS HAVING BEEN DON'T KNOW ............................. 8
GIVEN.

512AA CHECK 509: ANY VACCINATIONS RECORDED ON THE CARD?

YES NO
530
SKIP TO 529

Appendix E • 531
 SECTION 5A. CHILD IMMUNIZATION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

NAME OF LIVE BIRTH PREGNANCY HISTORY NUMBER . . . . .

5B. CHILD IMMUNIZATION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

NAME OF LIVE BIRTH PREGNANCY HISTORY NUMBER . . . . .

509B COPY VACCINATION DATES FROM THE CARD FOR (NAME).

RECORD ‘44' IN ‘MONTH' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.
RECORD '00' IN 'MONTH' COLUMN IF CARD IS BLANK FOR THE DOSE.

MONTH DAY YEAR

BCG

HEPATITIS B AT BIRTH

DPT 1

DPT 2

DPT 3

HEPATITIS B (HEPB) 1

HEPATITIS B (HEPB) 2

HEPATITIS B (HEPB) 3

HAEMOPHILUS INFLUENZAE B (HIB) 1

HAEMOPHILUS INFLUENZAE B (HIB) 2

HAEMOPHILUS INFLUENZAE B (HIB) 3

INACTIVATED POLIO VACCINE (IPV) 1

INACTIVATED POLIO VACCINE (IPV) 2

INACTIVATED POLIO VACCINE (IPV) 3

ORAL POLIO VACCINE (OPV) 1

ORAL POLIO VACCINE (OPV) 2

ORAL POLIO VACCINE (OPV) 3

PNEUMOCOCCAL CONJUGATE VACCINE (PCV) 1

PNEUMOCOCCAL CONJUGATE VACCINE (PCV) 2

PNEUMOCOCCAL CONJUGATE VACCINE (PCV) 3

MEASLES, MUMPS, RUBELLA (MMR) 1

MEASLES, MUMPS, RUBELLA (MMR) 2

VITAMIN A (MOST RECENT)

510B ASK THE RESPONDENT FOR PERMISSION TO PHOTOGRAPH TAKEN . . . . . . . . . . . . . . . . . . . . . . . 1

PHOTOGRAPH VACCINATION CARD OR OTHER PHOTOGRAPH NOT TAKEN,
DOCUMENT WHERE VACCINATIONS ARE WRITTEN. PERMISSION NOT RECEIVED ........... 2
IF PERMISSION IS GRANTED, PHOTOGRAPH CARD. PHOTOGRAPH NOT TAKEN,
OTHER REASON 6
(SPECIFY)

532 • Appendix E
 SECTION 5A. CHILD IMMUNIZATION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

NAME OF LIVE BIRTH PREGNANCY HISTORY NUMBER . . . . .

511B CHECK 509: 'BCG' TO 'MEASLES, MUMPS, RUBELLA 2' ALL HAVE A DATE RECORDED OR '44' RECORDED IN THE
'DAY' COLUMN?
NO YES
529

512B In addition to what is recorded on (this document/these YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

documents), did (NAME) receive any other vaccinations, (USE THE LIST SHOWN IN CAPI TO SELECT THE
including vaccinations received in campaigns or OTHER VACCINATIONS GIVEN.
immunization days or child health days like: The National NOTE THAT CAPI WILL CHANGE THE ANSWER IN
Campaign Against Measles, the "Bakuna Para Sa 509 IN THE 'DAY' COLUMN FROM '00' TO '66' FOR
Kabataan Proteksyon Sa Kinabukasan", NGO, Charity, THE SELECTED VACCINATIONS.)
Medical Mission?

(THEN SKIP TO 529)

RECORD 'YES' ONLY IF THE RESPONDENT
MENTIONS AT LEAST ONE OF THE VACCINATIONS IN NO ...................................... 2
509B THAT ARE NOT RECORDED AS HAVING BEEN DON'T KNOW ............................. 8
GIVEN.

512BA CHECK 509: ANY VACCINATIONS RECORDED ON THE CARD/ BOOKLET?

YES NO
530
SKIP TO 529

Appendix E • 533
 SECTION 5A. CHILD IMMUNIZATION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

NAME OF LIVE BIRTH PREGNANCY HISTORY NUMBER . . . . .

513 Did (NAME) ever receive any vaccinations to prevent YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

(NAME) from getting diseases, including vaccinations NO ...................................... 2
received in campaigns or immunization days or child 530
DON'T KNOW ............................. 8
health days like: Todo Ligtas, NGO, Charity, Medical
Mi i ?
514 Has (NAME) ever received a BCG vaccination against YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
tuberculosis, that is, an injection in the arm or shoulder NO ...................................... 2
that usually causes a scar? DON'T KNOW ............................. 8

515 At or soon after birth, did (NAME) receive a Hepatitis B YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

vaccination, that is, an injection in the thigh to prevent NO ...................................... 2
Hepatitis B? 517
DON'T KNOW ............................. 8

516 Did (NAME) receive it within 24 hours of birth? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO ...................................... 2
DON'T KNOW ............................. 8

517 Has (NAME) ever received oral polio vaccine, that is, YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
about two drops in the mouth to prevent polio? NO ...................................... 2
521
DON'T KNOW ............................. 8

519 How many times did (NAME) receive the oral polio
vaccine? NUMBER OF TIMES ....................

520 Did (NAME) receive the inactivated polio vaccine, an YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

(4) injection given to prevent polio? NO ...................................... 2
DON'T KNOW ............................. 8

520A How many times did (NAME) receive the inactivated polio
vaccine?
NUMBER OF TIMES ....................

521 Has (NAME) ever received a Pentavalent vaccination,

that is, an injection in the thigh that includes DPT and Hib YES ................................ 1
and sometimes HepB or IPV or a DPT vaccination alone? NO ...................................... 2
522B
DON'T KNOW ............................. 8

522 How many times did (NAME) receive the pentavalent/DPT

vaccine? NUMBER OF TIMES ....................

522A Did (NAME) receive the last dose of Pentavalent/DPT PUBLIC FACILITY .......................... 1
vaccine from a public or private facility? PRIVATE FACILITY . . . . . . . . . . . . . . . . . . . . . . . . . . 2
DON'T KNOW ............................. 8

522B Excluding any vaccinations given to (NAME) at birth, has YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

(NAME) ever received a HEP B vaccination, that is, an NO ...................................... 2
injection given in the arm or thigh sometimes at the same 523
DON'T KNOW ............................. 8
time as polio drops?

522C Excluding any vaccinations given to (NAME) at birth, how

many times did (NAME) receive the HEP B vaccine? NUMBER OF TIMES ....................

534 • Appendix E
 SECTION 5A. CHILD IMMUNIZATION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

NAME OF LIVE BIRTH PREGNANCY HISTORY NUMBER . . . . .

523 Has (NAME) ever received a pneumococcal vaccination, YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

that is, an injection in the thigh to prevent pneumonia? NO ...................................... 2
527
DON'T KNOW ............................. 8

524 How many times did (NAME) receive the pneumococcal

vaccine? NUMBER OF TIMES ....................

527 Has (NAME) ever received an MMR vaccination, that is, YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
an injection in the arm to prevent measles, or measles, NO ...................................... 2
mumps, and rubella? 529
DON'T KNOW ............................. 8

528 How many times did (NAME) receive the measles or MMR
vaccine? NUMBER OF TIMES ....................

529 Where did (NAME) receive most of his/her vaccinations? PUBLIC SECTOR
GOVERNMENT HOSPITAL . . . . . . . . . . . . . . . . . 11
RURAL HEALTH CENTER (RHC)/
URBAN HEALTH CENTER (UHC)/
LYING IN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
PROBE TO IDENTIFY THE TYPE OF SOURCE. BARANGAY HEALTH STATION ........... 13
BARANGAY SUPPLY/SERVICE
IF UNABLE TO DETERMINE IF PUBLIC, PRIVATE, OR POINT OFFICER/BHW . . . . . . . . . . . . . . . . . 14
NGO SECTOR, RECORD '96' AND WRITE THE NAME
OTHER PUBLIC
OF THE PLACE.
SECTOR 16
(SPECIFY)

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC
LYING IN CLINIC ................. 21
PHARMACY .......................... 22
PRIVATE DOCTOR . . . . . . . . . . . . . . . . . . . . . . . 23
PRIVATE NURSE/MIDWIFE .............. 24
INDUSTRY BASED CLINIC . . . . . . . . . . . . . . . . . 25
OTHER PRIVATE MEDICAL
SECTOR 26
(SPECIFY)

OTHER SOURCE
VACCINATION CAMPAIGN . . . . . . . . . . . . . . 41
OTHER . . . . . 96
(SPECIFY)

530 CHECK 220 AND 224 IN PREGNANCY HISTORY: ANY MORE SURVIVING CHILDREN BORN 0-35 MONTHS BEFORE
THE SURVEY?

MORE SURVIVING CHILDREN BORN NO MORE SURVIVING

0-35 MONTHS CHILDREN BORN 0-35 601
BEFORE THE SURVEY MONTHS BEFORE THE
SURVEY
(GO TO 503 FOR THE NEXT
SURVIVING CHILD)

Appendix E • 535
 SECTION 6. CHILD HEALTH AND NUTRITION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

601 CHECK 220, 224, AND 225 IN THE PREGNANCY HISTORY: ANY SURVIVING CHILDREN BORN 0-59 MONTHS BEFORE THE
SURVEY?

ONE OR MORE SURVIVING NO SURVIVING CHILDREN

CHILDREN BORN 0-59 MONTHS BORN 0-59 MONTHS BEFORE
BEFORE THE SURVEY THE SURVEY 643

602 Now I would like to ask some questions about the health of your children born in the last 5 years. (We will talk about each
separately, starting with the youngest.)

603 RECORD THE NAME FROM 218 AND PREGNANCY HISTORY NUMBER FROM 215 OF THE SURVIVING CHILDREN BORN 0-
59 MONTHS BEFORE THE SURVEY, STARTING WITH THE LAST ONE.

NAME OF CHILD PREGNANCY HISTORY NUMBER ...

604 In the last 12 months, was (NAME) given any of the

(1) following: YES NO DK

a) Iron tablets or syrup? a) TABLETS/SYRUP ........... 1 2 8

b) Nutri Foods or Vita Meena or other b) NUTRI FOODS OR VITA MEENA

Micronutrient Powder? OR OTHERS . . . . . . . . . . . . . . 1 2 8

SHOW COMMON TYPES OF TABLETS/SYRUPS/

MULTIPLE MICRONUTRIENT POWDERS.

605 In the last 6 months, was (NAME) given a vitamin A dose

like [this/any of these]? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
NO ....................................... 2
SHOW COMMON TYPES OF DON'T KNOW .............................. 8
AMPULES/CAPSULES/SYRUPS.

606 In the last 6 months, was (NAME) given any medicine for YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
(2) intestinal worms? NO ....................................... 2
DON'T KNOW .............................. 8

607 In the last 3 months, has any healthcare provider or

(3) community health worker measured: YES NO DK

a) (NAME)'s weight? a) WEIGHT .............. 1 2 8

b) (NAME)'s length or height? b) LENGTH/HEIGHT ........... 1 2 8

c) Around (NAME)'s upper arm? c) UPPER ARM .............. 1 2 8

608 Has (NAME) had diarrhea in the last 2 weeks? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

(4) NO ....................................... 2
618
DON'T KNOW .............................. 8

608A Was there any blood in the stools? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO ....................................... 2
DON'T KNOW .............................. 8

536 • Appendix E
 SECTION 6. CHILD HEALTH AND NUTRITION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

NO. NAME OF LIVE BIRTH PREGNANCY HISTORY NUMBER ......

609 CHECK 485: CURRENTLY BREASTFEEDING?

YES NO/ NOT

ASKED

a) Now I would like to know b) Now I would like to know how MUCH LESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
how much (NAME) was much (NAME) was given to SOMEWHAT LESS . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
given to drink during the drink during the diarrhea. ABOUT THE SAME . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
diarrhea, including breast Was (NAME) given less than
MORE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
milk. Was (NAME) given usual to drink, about the
NOTHING TO DRINK ........................ 5
less than usual to drink, same amount, or more than
about the same amount, usual to drink? DON'T KNOW .............................. 8
or more than usual to
drink? IF LESS, PROBE: Was
(NAME) given much less
IF LESS, PROBE: Was than usual to drink or
(NAME) given much less somewhat less?
than usual to drink or
somewhat less?

610 When (NAME) had diarrhea, was (NAME) given less than MUCH LESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
usual to eat, about the same amount, more than usual, or SOMEWHAT LESS . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
nothing to eat? ABOUT THE SAME . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
MORE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
IF LESS, PROBE: Was (NAME) given much less than usual STOPPED FOOD ........................... 5
to eat or somewhat less? NEVER GAVE FOOD ........................ 6
DON'T KNOW .............................. 8

611 Did you seek advice or treatment for the diarrhea from any YES ....................................... 1
source? NO ....................................... 2 615

612 Where did you seek advice or treatment? PUBLIC SECTOR

(5) GOVERNMENT HOSPITAL . . . . . . . . . . . . . . . . . . A
Anywhere else? RURAL HEALTH CENTER (RHC)/
URBAN HEALTH CENTER (UHC)/
LYING IN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B
BARANGAY HEALTH STATION . . . . . . . . . . . . . . . C
BARANGAY SUPPLY SERVICE POINT
PROBE TO IDENTIFY THE TYPE OF SOURCE. OFFICER/BHW . . . . . . . . . . . . . . . . . . . . . . . . D
OTHER PUBLIC
SECTOR E
IF UNABLE TO DETERMINE IF PUBLIC, PRIVATE, OR (SPECIFY)
NGO SECTOR, RECORD 'X' AND WRITE THE NAME OF
THE PLACE(S). PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC
LYING IN CLINIC .................. F
PHARMACY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G
PRIVATE DOCTOR . . . . . . . . . . . . . . . . . . . . . . . . H
PRIVATE NURSE/ MIDWIFE ............... I
INDUSTRY BASED CLINIC . . . . . . . . . . . . . . . . . . J
OTHER PRIVATE MEDICAL
SECTOR K
(SPECIFY)

OTHER SOURCE
PUERICULTURE CENTER . . . . . . . . . . . . . . . . . . O
SHOP/STORE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P
TRADITIONAL PRACTITIONER . . . . . . . . . . . . . . Q
CHURCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . R
FRIEND/RELATIVE . . . . . . . . . . . . . . . . . . . . . . . S

OTHER X
(SPECIFY)

613 CHECK 612: TWO OR

MORE
CODES ONLY ONE
CIRCLED CODE CIRCLED 614A

Appendix E • 537
 SECTION 6. CHILD HEALTH AND NUTRITION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

NO. NAME OF LIVE BIRTH PREGNANCY HISTORY NUMBER ......

614 Where did you first seek advice or treatment?

FIRST PLACE ...........................
USE LETTER CODE FROM 612.

614A How many days after the diarrhea began did you
first seek advice or treatment for (NAME)? DAYS .....................

615 Was (NAME) given any of the following at any time since
(NAME) started having the diarrhea: YES NO DK

a) A fluid made from a special packet called Oresol or from

a Hydrite tablet or a solution called Pedialyte? a) FLUID FROM ORS PACKET .. 1 2 8
(6) b) A government-recommended homemade fluid?
b) HOMEMADE FLUID . . . . . . . . . . . 1 2 8
c) Zinc syrup/drops or tablets ? c) ZINC . . . . . . . . . . . . . . . . . . . . . . . 1 2 8
(7) d) Probiotic Sachets? d) PROBIOTIC . . . . . . . . . . . . . . . . 1 2 8

616 CHECK 615:

ANY 'YES' ALL 'NO'

OR 'DK'
a) Was anything else given b) Was anything given to YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
to treat the diarrhea? treat the diarrhea? NO ....................................... 2
618
DON'T KNOW .............................. 8

617 CHECK 615: PILL OR SYRUP

ANTIBIOTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A
ANY 'YES' ALL 'NO' ANTIMOTILITY ........................... B
OR 'DK' OTHER (NOT ANTIBIOTIC
a) What else was given to b) What was given to treat OR ANTIMOTILITY) . . . . . . . . . . . . . . . . . . . . . C
treat the diarrhea? the diarrhea? UNKNOWN PILL OR SYRUP ............... D

INJECTION
ANTIBIOTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E
RECORD ALL TREATMENTS GIVEN. NON-ANTIBIOTIC ........................ F
UNKNOWN INJECTION .................. G

(IV) INTRAVENOUS . . . . . . . . . . . . . . . . . . . . . . . . . . . H

HOME REMEDY/HERBAL MEDICINE ............ I

OTHER X
(SPECIFY)

617A CHECK 615c : ZINC GIVEN ZINC NOT GIVEN

(615c = 1) (615c = 2 OR 3
CIRCLED)

(SKIP TO 618)

617B How many days was (NAME) given zinc

drops/syrup or tablets? DAYS .....................

618 Has (NAME) been ill with a fever at any time in the last 2 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
weeks? NO ....................................... 2
DON'T KNOW .............................. 8

621 Has (NAME) had an illness with a cough at any time in the YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
last 2 weeks? NO ....................................... 2
DON'T KNOW .............................. 8

622 Has (NAME) had fast, short, rapid breaths or difficulty YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
breathing at any time in the last 2 weeks? NO ....................................... 2
624
DON'T KNOW .............................. 8

623 Was the fast or difficult breathing due to a problem in the CHEST ONLY .............................. 1
chest or to a blocked or runny nose? NOSE ONLY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
BOTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
624A
OTHER 6
(SPECIFY)
DON'T KNOW ............... 8

538 • Appendix E
 SECTION 6. CHILD HEALTH AND NUTRITION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

NO. NAME OF LIVE BIRTH PREGNANCY HISTORY NUMBER ......

624 CHECK 618: HAD FEVER? NO OR

YES DON'T KNOW
634

624A CHECK 485: CURRENTLY BREASTFEEDING?

YES NO/ NOT

ASKED

a) Now I would like to know b) Now I would like to know how MUCH LESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
how much (NAME) was much (NAME) was given to SOMEWHAT LESS . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
given to drink during a drink during the ABOUT THE SAME . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
(fever/cough), including (fever/cough). Was (NAME)
MORE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
breast milk. Was (NAME) given less than usual to drink,
NOTHING TO DRINK ........................ 5
given less than usual to about the same amount, or
drink, about the same more than usual to drink? DON'T KNOW .............................. 8
amount, or more than
usual to drink? IF LESS, PROBE: Was
(NAME) given much less
IF LESS, PROBE: Was than usual to drink or
(NAME) given much less somewhat less?
than usual to drink or
somewhat less?

624B When (NAME) had a (fever/cough), was (NAME) given less MUCH LESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
than usual to eat, about the same amount, more than usual, SOMEWHAT LESS . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
or nothing to eat? ABOUT THE SAME . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
MORE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
IF LESS, PROBE: Was (NAME) given much less than usual STOPPED FOOD ........................... 5
to eat or somewhat less? NEVER GAVE FOOD ........................ 6
DON'T KNOW .............................. 8

625 Did you seek advice or treatment for the illness from any YES ....................................... 1
source? NO ....................................... 2 630

626 Where did you seek advice or treatment? PUBLIC SECTOR

(5) GOVERNMENT HOSPITAL . . . . . . . . . . . . . . . . . . A
Anywhere else? RURAL HEALTH CENTER (RHC)/
URBAN HEALTH CENTER (UHC)/
LYING IN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B
PROBE TO IDENTIFY THE TYPE OF SOURCE. BARANGAY HEALTH STATION ............ C
BARANGAY SUPPLY/SERVICE
POINT OFFICER/BHW . . . . . . . . . . . . . . . . . . D
OTHER PUBLIC
IF UNABLE TO DETERMINE IF PUBLIC, PRIVATE, OR SECTOR E
NGO SECTOR, RECORD 'X' AND WRITE THE NAME OF (SPECIFY)
THE PLACE(S).
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC
LYING IN CLINIC .................. F
PHARMACY ........................... G
PRIVATE DOCTOR . . . . . . . . . . . . . . . . . . . . . . . . H
PRIVATE NURSE/MIDWIFE ............... I
INDUSTRY BASED CLINIC . . . . . . . . . . . . . . . . . . J
OTHER PRIVATE MEDICAL
SECTOR K
(SPECIFY)

OTHER SOURCE
PUERICULTURE CENTE . . . . . . . . . . . . . . . . . . . . . O
SHOP/STORE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P
CHURCH ........................ Q
FRIEND/RELATIVE . . . . . . . . . . . . . . . . . . . . . . . . R

OTHER ..... X
(SPECIFY)

Appendix E • 539
 SECTION 6. CHILD HEALTH AND NUTRITION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

NO. NAME OF LIVE BIRTH PREGNANCY HISTORY NUMBER ......

627 CHECK 626: TWO OR

MORE
CODES ONLY ONE
CIRCLED CODE CIRCLED 629

628 Where did you first seek advice or treatment?

FIRST PLACE ...........................
USE LETTER CODE FROM 626.

629 How many days after the illness began did you first seek
advice or treatment for (NAME)?
DAYS ...........................
IF THE SAME DAY RECORD ‘00’.

630 At any time during the illness, did (NAME) take any medicine YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
for the illness? NO ....................................... 2
634
DON'T KNOW .............................. 8

631 What medicine did (NAME) take? ANTIMALARIAL MEDICINE

(9) ARTEMISININ COMBINATION
Any other medicine? THERAPY (ACT) ..................... A
SP/FANSIDAR ........................... B
CHLOROQUINE . . . . . . . . . . . . . . . . . . . . . . . . . . . C
RECORD ALL MENTIONED. AMODIAQUINE . . . . . . . . . . . . . . . . . . . . . . . . . . . D
QUININE
IF MEDICINE NOT KNOWN, ASK TO SEE THE PACKAGE PILLS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E
OR PRESCRIPTION. INJECTION/IV ........................ F
ARTESUNATE
RECTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G
INJECTION/IV ........................ H

OTHER
ANTIMALARIAL I
(SPECIFY)

ANTIBIOTIC MEDICINE
AMOXICILLIN ........................... J
COTRIMOXAZOLE . . . . . . . . . . . . . . . . . . . . . . . . K
OTHER PILL/SYRUP ..................... L
OTHER INJECTION/IV . . . . . . . . . . . . . . . . . . . . . M

OTHER MEDICINE
ASPIRIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N
PARACETAMOL/PANADOL/
ACETAMINOPHEN . . . . . . . . . . . . . . . . . . . . . O
IBUPROFEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P
DECONGESTANT ........................ Q
EXPECTORANT . . . . . . . . . . . . . . . . . . . . . . . . . . . R
NEBULES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S

OTHER X
(SPECIFY)

DON'T KNOW ............... Z

634 CHECK 220, 224, AND 225 IN PREGNANCY HISTORY: ANY MORE SURVIVING CHILDREN BORN 0-59 MONTHS BEFORE
THE SURVEY?

MORE SURVIVING CHILDREN NO MORE SURVIVING

BORN 0-59 MONTHS BEFORE THE CHILDREN BORN 635
SURVEY 0-59 MONTHS BEFORE
THE SURVEY
(GO TO 603 FOR THE NEXT
SURVIVING CHILD)

540 • Appendix E
 SECTION 6. CHILD HEALTH AND NUTRITION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

635 CHECK 220, 225 AND 226, ALL ROWS: NUMBER OF CHILDREN BORN 0-23 MONTHS BEFORE THE SURVEY LIVING
WITH THE RESPONDENT

ONE OR MORE NONE

643

(NAME OF YOUNGEST CHILD LIVING WITH HER)

636 Now I would like to ask you about liquids that (NAME
(10) FROM 635) had yesterday during the day or at night.
Please tell me about all drinks, whether (NAME) had them
at home, or somewhere else.

Yesterday during the day or at night, did (NAME) drink: YES NO DK

a) Plain water? a) . . . . . . . . . . . . . . 1 2 8

b) Infant formula such as S26, Nan, Promil? b) . . . . . . . . . . . . . . 1 2 8

IF YES: How many times did (NAME) drink infant NUMBER OF TIMES
8
formula? DRANK FORMULA
IF 7 OR MORE TIMES, RECORD '7'.

c) Milk from animals like fresh milk, milk powders like c) . . . . . . . . . . . . . . 1 2 8

Nido or Bear brand, or evaporated milk?

IF YES: How many times did (NAME) drink milk? NUMBER OF TIMES
8
IF 7 OR MORE TIMES, RECORD '7'. DRANK MILK

IF YES: Was the milk a sweet or flavored type of milk? SWEET/

FLAVORED . . . . 1 2 8

d) Yogurt drinks or probiotic drinks? d) . . . . . . . . . . . . . . 1 2 8

IF YES: How many times did (NAME) drink yogurt NUMBER OF TIMES
drinks or probiotic drinks? DRANK YOGURT 8
IF 7 OR MORE TIMES, RECORD '7'.

IF YES: Was the yogurt drink or probiotic drink a sweet SWEET/

or flavored type of yogurt drink or probiotic drink? FLAVORED . . . . 1 2 8

f) Sweetened condensed milk, bubble tea, chocolate f) .............. 1 2 8

flavored drinks, or sago at gulaman?

g) Fresh fruit juice, or fruit-flavored drinks such as Zesto g) . . . . . . . . . . . . . . 1 2 8

or C2?

h) Soft drinks such as Coke, Sprite, or Royal Tru, energy h) . . . . . . . . . . . . . . 1 2 8

drinks such as Red Bull or Gatorade?

i) Tea, coffee, or herbal drinks? i) .............. 1 2 8

IF YES: Was the drink sweetened? SWEETENED . . . 1 2 8

j) Clear broth or clear soup? j) .............. 1 2 8

k) Any other liquids? k) . . . . . . . . . . . . . . 1 2 8

IF YES: What was the drink? OTHER DRINK(S)

(SPECIFY)

IF YES: Was the drink sweetened? SWEETENED . . . 1 2 8

Appendix E • 541
 SECTION 6. CHILD HEALTH AND NUTRITION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

637 Now I would like to ask you about foods that (NAME) had
(10) yesterday during the day or at night. I am interested in
foods your child ate whether at home or somewhere else.
Please think about snacks and small meals as well as
main meals.

I will ask you about different foods, and I would like to

know whether your child ate the food even if it was
combined with other foods.

Please do not answer ‘yes’ for any food or ingredient only

used in a small amount to add flavor to a dish.

Yesterday during the day or at night, did (NAME) eat:

YES NO DK

a) Yogurt, other than probiotic drinks? a) . . . . . . . . . . . . . . 1 2 8

IF YES: How many times did (NAME) eat yogurt? NUMBER OF TIMES
8
IF 7 OR MORE TIMES, RECORD '7'. ATE YOGURT

b) Am, rice, bread, pancit, macaroni, spaghetti, misua, or b) . . . . . . . . . . . . . . 1 2 8

corn grits?

c) Carrots, squash, or orange camote? c) . . . . . . . . . . . . . . 1 2 8

d) Potato, cassava, ube, yam, taro root, white camote, or d) . . . . . . . . . . . . . . 1 2 8

plantain?

e) Moringa leaves, Chinese cabbage, camote leaves, e) . . . . . . . . . . . . . . 1 2 8

water spinach, sayote leaves, yam leaves, or bitter
gourd leaves?

f) Any other vegetables, such as tomatoes, bitter gourd, f) .............. 1 2 8

string beans, cabbage, eggplant or other vegetables?

g) Ripe mango, ripe papaya, orange colored melon, or g) . . . . . . . . . . . . . . 1 2 8

chiesa?

h) Any other fruits, such as banana, watermelon, guava, h) . . . . . . . . . . . . . . 1 2 8

aratiles, dalandan or other fruits?

i) Dinuguan, liver, heart, kidney, or gizzard? i) .............. 1 2 8

j) Hot dogs, sausages, longganisa, chorizo, canned j) .............. 1 2 8

meats, tocino or tapa?

k) Any other meat, such as beef, goat, pork, chicken, or k) . . . . . . . . . . . . . . 1 2 8

duck?

l) Chicken eggs, quail eggs, duck eggs, or salted duck l) .............. 1 2 8

eggs?

m) Fish, sardines, daing or tuyo, dilis, smoked fish, or m) . . . . . . . . . . . . . . 1 2 8

seafood?

n) Tofu, taho, beans, mung beans, or cowpeas? n) . . . . . . . . . . . . . . 1 2 8

542 • Appendix E
 SECTION 6. CHILD HEALTH AND NUTRITION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

YES NO DK

o) Peanuts, peanut butter, cashews, watermelon seeds, o) . . . . . . . . . . . . . . 1 2 8

squash seeds, or jackfruit seeds?

p) Keso or kesong puti? p) . . . . . . . . . . . . . . 1 2 8

r) Any sweet foods such as cookies, sweet breads, r) . . . . . . . . . . . . . . 1 2 8

ensaymada, kakanin or biko, candy, ice cream or
sorbetes, or halo-halo?

s) Potato chips, corn chips, cornick, chichacorn, French s) . . . . . . . . . . . . . . 1 2 8

fries, fishball, kropek, or instant noodles?

u) Any other solid, semi-solid, or soft food? u) . . . . . . . . . . . . . . 1 2 8

IF YES: What was the food? OTHER FOOD(S)

(SPECIFY)
MARK THE APPROPRIATE FOOD GROUP FOR
EACH ADDITIONAL FOOD, IF THE GROUP IS NOT
YET CODED ‘YES’.

IF UNABLE TO DETERMINE WHICH GROUP THE

ADDITIONAL FOOD BELONGS TO, RECORD THE
NAME OF THE FOOD.

638 CHECK 637 (CATEGORIES 'a' THROUGH 'u'):

NOT A SINGLE 'YES' AT LEAST ONE 'YES' 640

639 Did (NAME) eat any solid, semi-solid, or soft foods YES ...................................... 1
yesterday during the day or at night? (GO BACK TO 637 TO RECORD
FOOD EATEN YESTERDAY)
IF ‘YES’ PROBE: What kind of solid, semi-solid or soft
foods did (NAME) eat? (THEN CONTINUE TO 640)

NO ...................................... 2 641

640 How many times did (NAME) eat solid, semi-solid, or soft
foods yesterday during the day or at night? NUMBER OF TIMES ....................

IF 7 OR MORE TIMES, RECORD ‘7'. DON'T KNOW ............................. 8

641 In the last 6 months, did any healthcare provider or YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

community health worker talk with you about how or what NO ...................................... 2
to feed (NAME)? DON'T KNOW ............................. 8

642 The last time (NAME) passed stools, what was done to CHILD USED TOILET OR LATRINE ........... 01
dispose of the stools? PUT/RINSED
INTO TOILET OR LATRINE . . . . . . . . . . . . . . . . . 02
PUT/RINSED
INTO DRAIN OR DITCH ................. 03
THROWN INTO GARBAGE . . . . . . . . . . . . . . . . . . . . 04
BURIED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05
LEFT IN THE OPEN . . . . . . . . . . . . . . . . . . . . . . . . . . 06
THROWN INTO RIVER/SEA 07

OTHER 96
(SPECIFY)

Appendix E • 543
 SECTION 6. CHILD HEALTH AND NUTRITION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

643 Now I’d like to ask you about foods and drinks that you
(10) consumed yesterday during the day or night, whether you
ate or drank it at home or somewhere else. Please think
about snacks and small meals as well as main meals.

I will ask you about different foods and drinks, and I would
like to know whether you ate the food even if it was
combined with other foods.

Please do not answer ‘yes’ for any food or ingredient only

used in a small amount to add flavor to a dish.

Yesterday during the day or at night, did you eat or drink:

YES NO DK

a) Rice, bread, pancit, macaroni, spaghetti, misua, corn a) . . . . . . . . . . . . . . 1 2 8

grits, or corn on the cob?

b) Carrots, squash, or orange camote? b) . . . . . . . . . . . . . . 1 2 8

c) Potato, cassava, ube, yam, taro root, white camote, or c) . . . . . . . . . . . . . . 1 2 8

plantain?

d) Moringa leaves, Chinese cabbage, camote leaves, d) . . . . . . . . . . . . . . 1 2 8

water spinach, sayote leaves, yam leaves, or bitter
gourd leaves?

e) Any other vegetables, such as tomatoes, bitter gourd, e) . . . . . . . . . . . . . . 1 2 8

string beans, cabbage, eggplant or other vegetables?

f) Ripe mango, ripe papaya, orange colored melon, or f) .............. 1 2 8

chiesa?

g) Any other fruits, such as banana, watermelon, guava, g) . . . . . . . . . . . . . . 1 2 8

aratiles, dalandan or other fruits?

h) Dinuguan, liver, heart, kidney, or gizzard? h) . . . . . . . . . . . . . . 1 2 8

i) Hot dogs, sausages, longganisa, chorizo, canned i) .............. 1 2 8

meats, tocino or tapa?

j) Any other meat, such as beef, goat, pork, chicken, or j) .............. 1 2 8

duck?

k) Chicken eggs, quail eggs, duck eggs, or salted duck k) . . . . . . . . . . . . . . 1 2 8

eggs?

544 • Appendix E
 SECTION 6. CHILD HEALTH AND NUTRITION

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

YES NO DK

l) Fish, sardines, daing or tuyo, dilis, smoked fish, or l) .............. 1 2 8

seafood?

m) Tofu, taho, beans, mung beans, or cowpeas? m) . . . . . . . . . . . . . . 1 2 8

n) Peanuts, peanut butter, cashews, watermelon seeds, n) . . . . . . . . . . . . . . 1 2 8

squash seeds, or jackfruit seeds?

o) Milk from animals such as milk, milk powder such as o) . . . . . . . . . . . . . . 1 2 8

Nido or Bear brand, yogurt, keso or kesong puti?

q) Any sweet foods such as cookies, sweet breads, q) . . . . . . . . . . . . . . 1 2 8

ensaymada, kakanin or biko, candy, ice cream or
sorbetes, or halo-halo?

r) Potato chips, corn chips, cornick, chichacorn, French r) . . . . . . . . . . . . . . 1 2 8

fries, fishball, kropek, or instant noodles?

s) Fresh fruit juice, or fruit-flavored drinks such as Zesto s) . . . . . . . . . . . . . . 1 2 8

or C2?

t) Soft drinks such as Coke, Sprite, or Royal Tru, energy t) .............. 1 2 8

drinks such as Red Bull, or Gatorade?

u) Sweetened tea, bubble tea, sweetened coffee, 3-in-1, u) . . . . . . . . . . . . . . 1 2 8

chocolate flavored drinks, or sago at gulaman?

w) Any other liquids? w) . . . . . . . . . . . . . . 1 2 8

IF YES: What was the drink? OTHER DRINK(S)

(SPECIFY)

IF YES: Was the drink sweetened? SWEETENED . . . 1 2 8

x) Any other food? x) . . . . . . . . . . . . . . 1 2 8

IF YES: What was the food? OTHER FOOD(S)

(SPECIFY)
MARK THE APPROPRIATE FOOD GROUP FOR
EACH ADDITIONAL FOOD, IF THE GROUP IS NOT
YET CODED ‘YES’.

IF UNABLE TO DETERMINE WHICH GROUP THE

ADDITIONALFOOD BELONGS TO, RECORD THE
NAME OF THE FOOD.

Appendix E • 545
 EARLY CHILDHOOD DEVELOPMENT INDEX MODULE

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

ECD1 CHECK 225 AND 226: ANY CHILD 2-4 YEARS OLD LIVING WITH HIS/HER MOTHER?

YES NO
701

ECD2 CHECK CAPI TO IDENTIFY ONE RANDOMLY SELECTED CHILD AGE 2-4 LIVING WITH HIS/HER MOTHER

NAME OF THE SELECTED LINE NUMBER OF THE

CHILD FROM CAPI SELECTED CHILD FROM CAPI

ECD3 I would like to ask you about certain things (NAME OF CHILD SELECTED IN ECD2) is currently able to do. Please keep in
mind that children can develop and learn at a different pace. For example, some start talking earlier than others, or they might
already say some words but not yet form sentences. So, it is fine if your child is not able to do all the things I am going to ask
you about. You can let me know if you have any doubts about what answer to give.

ECD4 Can (NAME) walk on an uneven surface, for example, a YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

bumpy or steep road, without falling? NO ...................................... 2
DON'T KNOW ............................. 8

ECD5 Can (NAME) jump up with both feet leaving the ground? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
NO ...................................... 2
DON'T KNOW ............................. 8

ECD6 Can (NAME) dress (him/herself), that is, put on pants and YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
(1) a shirt, without help? NO ...................................... 2
DON'T KNOW ............................. 8

ECD7 Can (NAME) fasten and unfasten buttons without help? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
NO ...................................... 2
DON'T KNOW .......................... 8

ECD8 Can (NAME) say 10 or more words, like 'mama' or 'ball'? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
NO ...................................... 2
DON'T KNOW ............................. 8

ECD9 Can (NAME) speak using sentences of 3 or more words YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

that go together, for example, "I want water" or "The house NO ...................................... 2 ECD
is big"? DON'T KNOW ............................. 8 11

ECD10 Can (NAME) speak using sentences of 5 or more words YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

that go together, for example, "The house is very big"? NO ...................................... 2
DON'T KNOW ............................. 8

ECD11 Can (NAME) correctly use any of the words 'I', 'you', 'she', YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
or 'he', for example, "I want water" or "He eats rice"? NO ...................................... 2
DON'T KNOW ............................. 8

ECD12 If you show (NAME) an object (he/she) knows well, such YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
as a cup or animal, can (he/she) consistently name it? NO ...................................... 2
DON'T KNOW ............................. 8
By consistently, we mean that (he/she) uses the same
word to refer to the same object, even if the word used is
not fully correct.

ECD13 Can (NAME) recognize at least 5 letters of the alphabet? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

(1) NO ...................................... 2
DON'T KNOW ............................. 8

ECD14 Can (NAME) write (his/her) name? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO ...................................... 2
DON'T KNOW ............................. 8

ECD15 Can (NAME) recognize all numbers from 1 to 5? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO ...................................... 2
DON'T KNOW ............................. 8

546 • Appendix E
 EARLY CHILDHOOD DEVELOPMENT INDEX MODULE

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

ECD16 If you ask (NAME) to give you 3 objects, such as 3 stones YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
(1) or 3 beans, does (he/she) give you the correct amount? NO ...................................... 2
DON'T KNOW ............................. 8

ECD17 Can (NAME) count 10 objects, for example, 10 fingers or YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

10 blocks, without mistakes? NO ...................................... 2
DON'T KNOW ............................. 8

ECD18 Can (NAME) do an activity, such as coloring or playing YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

(1) with building blocks, without repeatedly asking for help or NO ...................................... 2
giving up too quickly? DON'T KNOW ............................. 8

ECD19 Does (NAME) ask about familiar people other than parents YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
(1) when they are not there, for example, "Where is NO ...................................... 2
Grandma?"? DON'T KNOW ............................. 8

ECD20 Does (NAME) offer to help someone who seems to need YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
help? NO ...................................... 2
DON'T KNOW ............................. 8

ECD21 Does (NAME) get along well with other children? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
NO ...................................... 2
DON'T KNOW ............................. 8

ECD22 How often does (NAME) seem to be very sad or DAILY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

depressed? Would you say: daily, weekly, monthly, a few WEEKLY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
times a year, or never? MONTHLY ................................ 3
A FEW TIMES A YEAR . . . . . . . . . . . . . . . . . . . . . . . 4
NEVER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
DON'T KNOW ............................. 8

ECD23 Compared with other children of the same age, how much NOT AT ALL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
does (NAME) kick, bite, or hit other children or adults? THE SAME OR LESS ....................... 2
Would you say: not at all, the same or less, more, or a lot MORE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
more?
A LOT MORE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
DON'T KNOW ............................. 8

Appendix E • 547
 SECTION 7. MARRIAGE AND SEXUAL ACTIVITY

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

701 Are you currently married or living together with a man as if YES, CURRENTLY MARRIED . . . . . . . . . . . . . . . . . 1 706
married? YES, LIVING WITH A MAN . . . . . . . . . . . . . . . . . . . . 2 709
NO, NOT IN UNION . . . . . . . . . . . . . . . . . . . . . . . . . . 3

702 Have you ever been married or lived together with a man YES, FORMERLY MARRIED ................. 1
as if married? YES, LIVED WITH A MAN .................... 2
NO ...................................... 3 721

703 What is your marital status now: are you widowed, WIDOWED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
divorced, or separated? DIVORCED/ ANNULLED . . . . . . . . . . . . . . . . . . . . . . . 2
SEPARATED ............................. 3

704 CHECK 702:

YES, YES,
FORMERLY MARRIED LIVED WITH A MAN 714

705 Did you have a marriage certificate for your last marriage? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 714
NO ...................................... 2
707
DON'T KNOW ............................. 8

706 Do you have a marriage certificate for this marriage? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 709
NO ...................................... 2
DON'T KNOW ............................. 8

707 Was this marriage ever registered with the civil registry YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
office? NO ...................................... 2
DON'T KNOW ............................. 8

708 CHECK 701:

YES, NO,
714
CURRENTLY NOT IN A UNION
MARRIED

709 Is your (husband/partner) living with you now or is he LIVING WITH HER . . . . . . . . . . . . . . . . . . . . . . . . . . 1
staying elsewhere? STAYING ELSEWHERE .................... 2 710C

710 RECORD THE HUSBAND'S/PARTNER'S NAME AND NAME

LINE NUMBER FROM THE HOUSEHOLD
QUESTIONNAIRE. IF HE IS NOT LISTED IN THE
HOUSEHOLD, RECORD '00'.
LINE NO. . . . . . . . . . . . . . . . . . . . . . . . . . .

710A CHECK 709:

HUSBAND/PARTNER HUSBAND/PARTNER
710C
LIVING WITH HER STAYING ELSEWHERE

710B During your (marriage/partnership) with your YES ................. ........ ........... 1
(husband/partner), did you ever live separately? NO ...................................... 2 714

710C In the last 24 months, how many months in total did you LESS THAN ONE MONTH .................... 00 714
and your (husband/partner) live separately?

NUMBER OF MONTHS . . . . . . . . . . . . . .

IF SEPARATION OCCURRED MORE THAN 2 YEARS

NO SEPARATION IN THE LAST
AGO, RECORD 95.
IF SEPARATED FOR FULL 24 MONTHS, RECORD 24 2 YEARS (24 MONTHS) . . . . . . . . . . . . . . . . . . . . 95 714

710D In the last 24 months, were you and your husband/partner YES ................. ........ ........... 1
ever living separately because one of you lived overseas? NO ...................................... 2

714 Have you been married or lived with a man only once or ONLY ONCE ............................. 1
more than once? MORE THAN ONCE ....................... 2

548 • Appendix E
 SECTION 7. MARRIAGE AND SEXUAL ACTIVITY

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

715 CHECK 714:

MARRIED/
MARRIED/ LIVED WITH A
LIVED WITH A MAN MAN MORE MONTH ..........................
ONLY ONCE THAN ONCE

a) In what month and year b) Now I would like to ask DON'T KNOW MONTH .................... 98
did you start living with about your first
your (husband/partner)? (husband/partner). In
what month and year did 717
YEAR ..............
you start living with him?

DON'T KNOW YEAR .................... 9998

716 How old were you when you first started living with him?
AGE .............................

717 CHECK 714:

MARRIED/LIVED WITH MARRIED/LIVED WITH

A MAN MORE THAN ONCE A MAN ONLY ONCE 721

718 CHECK 701:

YES, YES, NO,

721
CURRENTLY LIVING NOT IN A UNION
MARRIED WITH A MAN

719 Now I’d like to ask you about your current

(husband/partner). In what month and year did you MONTH ..........................
start living with him?

DON'T KNOW MONTH .................... 98

721
YEAR ..............

DON'T KNOW YEAR .................... 9998

720 How old were you when you first started living with your
current (husband/partner)? AGE .............................

721 CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

722 Now I would like to ask some questions about sexual

activity in order to gain a better understanding of some
important life issues. Let me assure you again that your NEVER HAD SEXUAL
answers are completely confidential and will not be told to INTERCOURSE . . . . . . . . . . . . . . . . . . . . . . . . . . 00 738
anyone. If we should come to any question that you don't
want to answer, just let me know and we will go to the next
question. How old were you when you had sexual
AGE IN YEARS ....................
intercourse for the very first time?

723 I would like to ask you about your recent sexual activity.
When was the last time you had sexual intercourse? DAYS AGO .............. 1

WEEKS AGO .............. 2

IF LESS THAN 12 MONTHS, ANSWER MUST BE MONTHS AGO .............. 3

RECORDED IN DAYS, WEEKS OR MONTHS. IF 12
MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE 737
YEARS AGO .............. 4
RECORDED IN YEARS.

724 CHECK 232:

NOT PREGNANT PREGNANT

727
OR UNSURE

Appendix E • 549
 SECTION 7. MARRIAGE AND SEXUAL ACTIVITY

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

725 The last time you had sexual intercourse, did you or your YES ...................................... 1
partner do something or use any method to delay or avoid NO ...................................... 2 727
getting pregnant?

726 Which method did you use? FEMALE STERILIZATION . . . . . . . . . . . . . . . . . . . . A

MALE STERILIZATION . . . . . . . . . . . . . . . . . . . . . . . B
RECORD ALL MENTIONED. IUD ...................................... C
INJECTABLES ............................. D
IF CODES 'G' OR 'H' ARE CIRCLED, SKIP TO 728 EVEN IMPLANTS ................................ E
IF ANOTHER METHOD WAS ALSO USED.
PATCH F
PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G
CONDOM ................................ H
728
FEMALE CONDOM . . . . . . . . . . . . . . . . . . . . . . . . . . I
EMERGENCY CONTRACEPTION . . . . . . . . . . . . . . J
STANDARD DAYS METHOD ................. K
MUCUS/BILLINGS/OVULATION .............. L
BASAL BODY TEMPERATURE . . . . . . . . . . . . . . . . . M
SYMPTOTHERMAL . . . . . . . . . . . . . . . . . ..... N
LACTATIONAL AMENORRHEA METHOD O
CALENDAR/RHYTHM METHOD .............. Q
WITHDRAWAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . R
OTHER MODERN METHOD X
OTHER TRADITIONAL METHOD Y

727 The last time you had sexual intercourse, was a condom YES ...................................... 1
(2) used? NO ...................................... 2 730

728 What is the brand name of the condom used? TRUST ................................ 01
(2) DUREX ................................ 02
PREMIERE ................................ 03

OTHER 96
IF BRAND NOT KNOWN, ASK TO SEE THE PACKAGE. (SPECIFY)
DON'T KNOW ............................. 98

729 From where did you obtain the condom the last time? PUBLIC SECTOR
(2) GOVERNMENT HOSPITAL . . . . . . . . . . . . . . . . . 11
(3) RURAL HEALTH CENTER (RHC)/
URBAN HEALTH CENTER (UHC)/
LYING IN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
PROBE TO IDENTIFY TYPE OF SOURCE. BARANGAY HEALTH STATION ........... 13
BARANGAY SUPPLY/SERVICE
IF UNABLE TO DETERMINE IF PUBLIC, PRIVATE, OR POINT OFFICER/BHW . . . . . . . . . . . . . . . . . 14
NGO SECTOR, RECORD '96' AND WRITE THE NAME
OTHER PUBLIC
OF THE PLACE.
SECTOR 16
(SPECIFY)

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC
LYING IN CLINIC ................. 21
PHARMACY .......................... 22
PRIVATE DOCTOR . . . . . . . . . . . . . . . . . . . . . . . 23
PRIVATE NURSE/MIDWIFE .............. 24
INDUSTRY BASED CLINIC . . . . . . . . . . . . . . . . . 25
OTHER PRIVATE MEDICAL
SECTOR 26
(SPECIFY)

OTHER SOURCE
PUERICULTURE CENTER . . . . . . . . . . . . . . . . . 41
SHOP/STORE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
CHURCH ....................... 43
FRIEND/RELATIVE . . . . . . . . . . . . . . . . . . . . . . . 44

OTHER ..... 96
(SPECIFY)
DON'T KNOW ............................. 98

550 • Appendix E
 SECTION 7. MARRIAGE AND SEXUAL ACTIVITY

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

730 What was your relationship to this person with whom you HUSBAND ................................ 1
had sexual intercourse? LIVE-IN PARTNER . . . . . . . . . . . . . . . . . . . . . . . . . . 2
BOYFRIEND NOT LIVING WITH
IF BOYFRIEND: Were you living together as if married? RESPONDENT . . . . . . . . . . . . . . . . . . . . . . . . . . 3
CASUAL ACQUAINTANCE ................. 4
IF YES, RECORD '2'. CLIENT/SEX WORKER .................... 5
IF NO, RECORD '3'.
OTHER 6
(SPECIFY)

731 Apart from this person, have you had sexual intercourse YES ...................................... 1
with any other person in the last 12 months? NO ...................................... 2 737

732 The last time you had sexual intercourse with this second YES ...................................... 1
(2) person, was a condom used? NO ...................................... 2

733 What was your relationship to this second person with HUSBAND ................................ 1
whom you had sexual intercourse? LIVE-IN PARTNER . . . . . . . . . . . . . . . . . . . . . . . . . . 2
BOYFRIEND NOT LIVING WITH
IF BOYFRIEND: Were you living together as if married? RESPONDENT . . . . . . . . . . . . . . . . . . . . . . . . . . 3
CASUAL ACQUAINTANCE ................. 4
IF YES, RECORD '2'. CLIENT/SEX WORKER .................... 5
IF NO, RECORD '3'.
OTHER 6
(SPECIFY)

734 Apart from these two people, have you had sexual YES ...................................... 1
intercourse with any other person in the last 12 months? NO ...................................... 2 737

735 The last time you had sexual intercourse with this third YES ...................................... 1
(2) person, was a condom used? NO ...................................... 2

736 What was your relationship to this third person with whom HUSBAND ................................ 1
you had sexual intercourse? LIVE-IN PARTNER . . . . . . . . . . . . . . . . . . . . . . . . . . 2
BOYFRIEND NOT LIVING WITH
IF BOYFRIEND: Were you living together as if married? RESPONDENT . . . . . . . . . . . . . . . . . . . . . . . . . . 3
CASUAL ACQUAINTANCE ................. 4
IF YES, RECORD '2'. CLIENT/SEX WORKER .................... 5
IF NO, RECORD '3'.
OTHER 6
(SPECIFY)

737 In total, with how many different people have you had
sexual intercourse in your lifetime? NUMBER OF PARTNERS
IN LIFETIME . . . . . . . . . . . . . . . . . . . .
IF NON-NUMERIC ANSWER, PROBE TO GET AN
ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR DON'T KNOW ............................. 98
MORE, RECORD '95'.

738 PRESENCE OF OTHERS DURING THIS SECTION. YES NO

CHILDREN <10 . . . . . . . . . . . . . . . . . . . . 1 2
MALE ADULTS . . . . . . . . . . . . . . . . . . . . 1 2
FEMALE ADULTS ................. 1 2

Appendix E • 551
 SECTION 8. FERTILITY PREFERENCES

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

801 CHECK 307:

NOT ASKED NEITHER ARE HE OR SHE

813
STERILIZED STERILIZED

802 CHECK 232:

PREGNANT NOT PREGNANT

804
OR UNSURE

803 Now I have some questions about the future. After the HAVE ANOTHER CHILD ...................... 1 805
child you are expecting now, would you like to have NO MORE .................................. 2 810B
another child, or would you prefer not to have any more UNDECIDED/DON'T KNOW ................... 8 812
children?

804 Now I have some questions about the future. Would you HAVE (A/ANOTHER) CHILD ................... 1
like to have (a/another) child, or would you prefer not to NO MORE/NONE ............................ 2 807
have any (more) children? SAYS SHE CAN'T GET PREGNANT ............ 3 813
UNDECIDED/DON'T KNOW ................... 8 811

805 CHECK 232:

MONTHS ................. 1
NOT PREGNANT PREGNANT
OR UNSURE YEARS .................... 2

a) How long would you like b) After the birth of the child SOON/NOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 993 811
to wait from now before you are expecting now, SAYS SHE CAN'T GET PREGNANT . . . . . . . . . . . . 994 813
the birth of (a/another) how long would you like AFTER MARRIAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . 995
child? to wait before the birth of
another child? OTHER 996 811
(SPECIFY)
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 998

806 CHECK 232:

NOT PREGNANT PREGNANT

812
OR UNSURE

807 CHECK 307: USING A CONTRACEPTIVE METHOD?

NOT CURRENTLY
ASKED USING 813

808 CHECK 805:

'24' OR MORE MONTHS NOT '00-23' MONTHS

OR '02' OR MORE YEARS ASKED OR '00-01' YEAR 812

809 CHECK 723:

YEARS
811
DAYS, WEEKS OR AGO
MONTHS AGO NOT
ASKED 811

552 • Appendix E
 SECTION 8. FERTILITY PREFERENCES

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

810 CHECK 804: NOT MARRIED ............................... A

WANTS TO HAVE WANTS NO MORE/ FERTILITY-RELATED REASONS

A/ANOTHER CHILD NONE NOT HAVING SEX . . . . . . . . . . . . . . . . . . . . . . . . . B
INFREQUENT SEX . . . . . . . . . . . . . . . . . . . . . . . . . C
a) You have said that you b) You have said that you MENOPAUSAL/HYSTERECTOMY . . . . . . . . . . . . D
do not want (a/another) do not want any (more) CAN'T GET PREGNANT ................... E
child soon. Can you tell children. Can you tell me NOT MENSTRUATED SINCE
me why you are not why you are not using a LAST BIRTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . F
using a method to method to prevent BREASTFEEDING . . . . . . . . . . . . . . . . . . . . . . . . . G
prevent pregnancy? pregnancy? UP TO GOD/FATALISTIC ................... H

Any other reason? Any other reason? OPPOSITION TO USE

RESPONDENT OPPOSED . . . . . . . . . . . . . . . . . . . I
HUSBAND/PARTNER OPPOSED . . . . . . . . . . . . J
RECORD ALL REASONS MENTIONED. OTHERS OPPOSED ...................... K
RELIGIOUS PROHIBITION . . . . . . . . . . . . . . . . . . . L

LACK OF KNOWLEDGE
KNOWS NO METHOD ...................... M
KNOWS NO SOURCE ...................... N

METHOD-RELATED REASONS
INCONVENIENT TO USE ................... O
CHANGES IN MENSTRUAL BLEEDING ...... P
METHODS COULD CAUSE INFERTILITY .. Q
INTERFERES WITH BODY'S NORMAL
PROCESSES ......................... R
OTHER SIDE EFFECTS/
HEALTH CONCERNS ................... S

COST/ACCESS/AVAILABILITY
LACK OF ACCESS/TOO FAR . . . . . . . . . . . . . . . T
COSTS TOO MUCH ...................... U
PREFERRED METHOD
NOT AVAILABLE ...................... V
NO METHOD AVAILABLE . . . . . . . . . . . . . . . . . . . W

OTHER X
(SPECIFY)
DON'T KNOW ............................... Z

810A CHECK 804:

WANTS WANTS TO HAVE A/

813
NO MORE/ NONE ANOTHER CHILD

810B You have said that you do not want any (more) children. ECONOMIC/ FINANCIAL CONCERNS . . . . . . . . . . . . A
Can you tell me the reason/s why you do not want to have PROFESSIONAL GROWTH/ CAREER . . . . . . . . . . . . B
any (more) children? EDUCATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C
HEALTH CONCERNS ......................... D
Any other reason? ENVIRONMENTAL CONCERNS . . . . . . . . . . . . . . . . . . . E
COVID-19 RELATED CONCERNS . . . . . . . . . . . . . . . F
OTHER X
(SPECIFY)

811 CHECK 307: USING A CONTRACEPTIVE METHOD?

NOT YES,
813
ASKED CURRENTLY USING

812 Do you think you will use a contraceptive method to delay YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
or avoid pregnancy at any time in the future? NO ........................................ 2 812B
DON'T KNOW ............................... 8

Appendix E • 553
 SECTION 8. FERTILITY PREFERENCES

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

812A Which contraceptive method would you prefer to use? FEMALE STERILIZATION . . . . . . . . . . . . . . . . . . . . . . 01
MALE STERILIZATION . . . . . . . . . . . . . . . . . . . . . . . . . 02
IUD ........................................ 03
INJECTABLES ............................... 04
IMPLANTS .................................. 05
PATCH 06
PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 07
CONDOM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 08
FEMALE CONDOM . . . . . . . . . . . . . . . . . . . . . . . . . . . . 09
EMERGENCY CONTRACEPTION . . . . . . . . . . . . . . . 10 813
STANDARD DAYS METHOD ................... 11
MUCUS/BILLINGS/OVULATION . . . . . . . . . . . . . . . . . . . 12
BASAL BODY TEMPERATURE . . . . . . . . . . . . . . . . . . . 13
SYMPTOTHERMAL . . . . . . . . . . . . . . . . . . . . . . . 14
LACTATIONAL AMENORRHEA METHOD . . . . . . . . . 15
CALENDAR/RHYTHM METHOD . . . . . . . . . . . . . . . . . . . 16
WITHDRAWAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
OTHER MODERN METHOD ................... 95
OTHER TRADITIONAL METHOD ............... 96

812B What is the main reason you think you will not use a NOT MARRIED ............................... A
contraceptive method at any time in the future?
FERTILITY-RELATED REASONS
NOT HAVING SEX . . . . . . . . . . . . . . . . . . . . . . . . . B
Any other reason? INFREQUENT SEX . . . . . . . . . . . . . . . . . . . . . . . . . C
MENOPAUSAL/HYSTERECTOMY . . . . . . . . . . . . D
CAN'T GET PREGNANT ................... E
NOT MENSTRUATED SINCE
LAST BIRTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . F
BREASTFEEDING . . . . . . . . . . . . . . . . . . . . . . . . . G
UP TO GOD/FATALISTIC ................... H

OPPOSITION TO USE
RESPONDENT OPPOSED . . . . . . . . . . . . . . . . . . . I
HUSBAND/PARTNER OPPOSED . . . . . . . . . . . . J
OTHERS OPPOSED ...................... K
RELIGIOUS PROHIBITION . . . . . . . . . . . . . . . . . . . L

LACK OF KNOWLEDGE
KNOWS NO METHOD ...................... M
KNOWS NO SOURCE ...................... N

METHOD-RELATED REASONS
INCONVENIENT TO USE ................... O
CHANGES IN MENSTRUAL BLEEDING ...... P
METHODS COULD CAUSE INFERTILITY .. Q
INTERFERES WITH BODY'S NORMAL
PROCESSES ......................... R
OTHER SIDE EFFECTS/
HEALTH CONCERNS ................... S

COST/ACCESS/AVAILABILITY
LACK OF ACCESS/TOO FAR . . . . . . . . . . . . . . . T
COSTS TOO MUCH ...................... U
PREFERRED METHOD
NOT AVAILABLE ...................... V
NO METHOD AVAILABLE . . . . . . . . . . . . . . . . . . . W

OTHER X
(SPECIFY)
DON'T KNOW ............................... Z

812BA CHECK 812B: CODE A "NOT MARRIED" CIRCLED?

CODE A CIRCLED CODE A NOT CIRCLED

813

812C Would you ever use a contraceptive method if you were YES ..................................... 1
married? NO ..................................... 2
DON'T KNOW ............................... 8

554 • Appendix E
 SECTION 8. FERTILITY PREFERENCES

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

813 CHECK 224:

HAS LIVING NO LIVING

CHILDREN CHILDREN NONE ..................................... 00 815

a) If you could go back to b) If you could choose

the time you did not have exactly the number of
any children and could children to have in your NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . .
choose exactly the whole life, how many
number of children to would that be?
have in your whole life, OTHER 96 815
how many would that (SPECIFY)
be?
PROBE FOR A NUMERIC RESPONSE.

814 How many of these children would you like to be boys, BOYS GIRLS EITHER
how many would you like to be girls and for how many
would it not matter if it’s a boy or a girl? NUMBER . .

OTHER 96
(SPECIFY)

815 In the last 12 months have you: YES NO

a) Heard about family planning on the radio? a) RADIO .......................... 1 2

b) Seen anything about family planning on the television? b) TELEVISION .................... 1 2

c) Read about family planning in a newspaper or c) NEWSPAPER OR MAGAZINE ........ 1 2

magazine?
d) Received a voice or text message about family d) MOBILE PHONE . . . . . . . . . . . . . . . . . . . . 1 2
planning on a mobile phone?
e) Seen anything about family planning on social media e) FACEBOOK/TWITTER/
such as Facebook, Twitter, or Instagram? INSTAGRAM . . . . . . . . . . . . . . . . . . . . 1 2
f) Seen anything about family planning on a poster, f) POSTER/LEAFLET/BROCHURE ..... 1 2
leaflet or brochure?
g) Seen anything about family planning on an outdoor g) OUTDOOR SIGN/BILLBOARD ........ 1 2
sign or billboard?
h) Heard anything about family planning at community h) COMMUNITY MEETINGS/EVENTS .. 1 2
meetings or events?

817 CHECK 701:

YES, YES, NO,

901
CURRENTLY LIVING NOT IN A UNION
MARRIED WITH A MAN

818 Who usually makes the decision on whether or not you RESPONDENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
820
should use contraception, you, your (husband/partner), HUSBAND/PARTNER ......................... 2
you and your (husband/partner) jointly, or someone else? RESPONDENT AND HUSBAND/PARTNER
JOINTLY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
SOMEONE ELSE ............................ 4
820
OTHER 6
(SPECIFY)

819 When making this decision with your (husband/partner), MORE IMPORTANT . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
would you say that your opinion is more important, equally EQUALLY IMPORTANT . . . . . . . . . . . . . . . . . . . . . . . . . 2
important, or less important than your LESS IMPORTANT . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
(husband’s/partner’s) opinion?

820 Has your (husband/partner) or any other family member YES ........................................ 1
ever tried to pressure you to become pregnant when you NO ........................................ 2
did not want to become pregnant?

821 CHECK 307:

NOT ASKED NEITHER ARE HE OR SHE ARE

901
STERILIZED STERILIZED

822 Does your (husband/partner) want the same number of SAME NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
children that you want, or does he want more or fewer than MORE CHILDREN ............................ 2
you want? FEWER CHILDREN . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
DON'T KNOW ............................... 8

Appendix E • 555
 SECTION 9. HUSBAND'S BACKGROUND AND WOMAN'S WORK

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

901 CHECK 701:

CURRENTLY MARRIED/ NOT IN

909
LIVING WITH A MAN UNION

902 How old was your (husband/partner) on his last birthday?

AGE IN COMPLETED YEARS ........

903 Did your (husband/partner) ever attend school? YES ...................................... 1

NO ...................................... 2 906

905 What was the highest grade or year he completed?

(1) GRADE/YEAR
IF COMPLETED LESS THAN ONE YEAR AT THAT
LEVEL, RECORD '00'. DON'T KNOW ............................. 998

IF CODE 404, 504, 607, 702, OR 802

SPECIFY COURSE:

CODES FOR Q. 905: EDUCATION

LEVEL 0 - EARLY CHILDHOOD EDUCATION LEVEL 4 - POST SECONDARY EDUCATION

000 = NO GRADE COMPLETED 401 = 1ST YEAR
001 = NURSERY 402 = 2ND YEAR
002 = KINDERGARTEN 403 = 3RD YEAR OR MORE
404 = GRADUATE (SPECIFY COURSE)
LEVEL 1 - PRIMARY EDUCATION
(ELEMENTARY) LEVEL 5 - SHORT- CYCLE
101 = GRADE 1 TERTIARY EDUCATION
102 = GRADE 2 501 = 1ST YEAR
103 = GRADE 3 502 = 2ND YEAR
104 = GRADE 4 503 = 3RD YEAR OR MORE
105 = GRADE 5 504 = GRADUATE (SPECIFY COURSE)
106 = GRADE 6
LEVEL 6 - BACHELOR LEVEL EDUCATION
108 = IPED OR EQUIVALENT
109 = MADRASAH 601 = 1ST YEAR
110 = SPED 602 = 2ND YEAR
603 = 3RD YEAR
LEVEL 2 - LOWER SECONDARY EDUCATION 604 = 4TH YEAR
(JUNIOR HIGH SCHOOL/ OLD CURRICULUM) 605 = 5TH YEAR
201 = GRADE 7/ 1ST YEAR 606 = 6TH YEAR OR MORE
202 = GRADE 8/ 2ND YEAR 607 = GRADUATE (SPECIFY COURSE)
203 = GRADE 9/ 3RD YEAR
204 = GRADE 10/ FOURTH YEAR LEVEL 7 - MASTER LEVEL EDUCATION
205 = OLD CURRICULUM GRADE 10 GRADUATE OR EQUIVALENT
701 = UNDERGRADUATE
208 = IPED (ANY YEAR OTHER THAN GRADUATE)
209 = MADRASAH 702 = GRADUATE (SPECIFY COURSE)
210 = SPED
LEVEL 8 - DOCTORAL LEVEL
LEVEL 3 - UPPER SECONDARY EDUCATION EDUCATION OR EQUIVALENT
(SENIOR HIGH SCHOOL) 801 = UNDERGRADUATE
(ANY YEAR OTHER THAN GRADUATE)
ACADEMIC TRACK (GAS, HUMSS, STEM, ABM) 802 = GRADUATE (SPECIFY COURSE)
301 = GRADE 11
302 = GRADE 12 998 = DON'T KNOW

ARTS AND DESIGN TRACK

303= GRADE 11
304 = GRADE 12

SPORTS TRACK
305 = GRADE 11
306 = GRADE 12

TECHNOLOGY & LIVELIHOOD EDUCATION & TECH-VOC

(AGRI-FISHERIES, HOME EC., INDUST. ARTS, ICT)
307 = GRADE 11
308 = GRADE 12
(AGRI-FISHERIES, HOME EC., INDUST. ARTS, ICT)
307 = GRADE 11
308 = GRADE 12

906 Has your (husband/partner) done any work in the last 7 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 908
days? NO ...................................... 2
DON'T KNOW ............................. 8

907 Has your (husband/partner) done any work in the last 12 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
months? NO ...................................... 2
909
DON'T KNOW ............................. 8

556 • Appendix E
 SECTION 9. HUSBAND'S BACKGROUND AND WOMAN'S WORK

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

908 What is your (husband's/partner's) occupation? That is,

what kind of work does he mainly do?

909 Aside from your own housework, have you done any work YES ...................................... 1 913
in the last 7 days? NO ...................................... 2

910 As you know, some women take up jobs for which they
are paid in cash or kind. Others sell things, have a small YES ...................................... 1 913
business or work on the family farm or in the family NO ...................................... 2
business. In the last 7 days, have you done any of these
things or any other work?

911 Although you did not work in the last 7 days, do you have
any job or business from which you were absent for leave, YES ...................................... 1 913
illness, vacation, maternity leave, or any other such NO ...................................... 2
reason?

912 Have you done any work in the last 12 months? YES ...................................... 1
NO ...................................... 2 917

913 What is your occupation? That is, what kind of work do you
mainly do?

914 Do you do this work for a member of your family, for FOR FAMILY MEMBER . . . . . . . . . . . . . . . . . . . . . . . 1
someone else, or are you self-employed? FOR SOMEONE ELSE . . . . . . . . . . . . . . . . . . . . . . . 2
SELF-EMPLOYED .......................... 3

915 Do you usually work throughout the year, or do you work THROUGHOUT THE YEAR ................. 1
seasonally, or only once in a while? SEASONALLY/PART OF THE YEAR ........... 2
ONCE IN A WHILE . . . . . . . . . . . . . . . . . . . . . . . . . . 3

916 Are you paid in cash or kind for this work or are you not CASH ONLY ............................. 1
paid at all? CASH AND KIND .......................... 2
IN KIND ONLY ............................. 3
NOT PAID ................................ 4

917 CHECK 701:

CURRENTLY
MARRIED/LIVING NOT IN UNION 925
WITH A MAN

918 CHECK 916:

CODE '1' OR '2' OTHER

921
CIRCLED

919 Who usually decides how the money you earn will be RESPONDENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
used: you, your (husband/partner), or you and your HUSBAND/PARTNER ....................... 2
(husband/partner) jointly? RESPONDENT AND
HUSBAND/PARTNER JOINTLY ........... 3

OTHER 6
(SPECIFY)

920 Would you say that the money that you earn is more than MORE THAN HIM .......................... 1
what your (husband/partner) earns, less than what he LESS THAN HIM .......................... 2
earns, or about the same? ABOUT THE SAME . . . . . . . . . . . . . . . . . . . . . . . . . . 3
HUSBAND/PARTNER HAS
NO EARNINGS . . . . . . . . . . . . . . . . . . . . . . . . . . 4 922
DON'T KNOW ............................. 8

Appendix E • 557
 SECTION 9. HUSBAND'S BACKGROUND AND WOMAN'S WORK

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

921 Who usually decides how your (husband's/partner's) RESPONDENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

earnings will be used: you, your (husband/partner), or you HUSBAND/PARTNER ....................... 2
and your (husband/partner) jointly? RESPONDENT AND
HUSBAND/PARTNER JOINTLY ........... 3
HUSBAND/PARTNER HAS
NO EARNINGS . . . . . . . . . . . . . . . . . . . . . . . . . . 4

OTHER 6
(SPECIFY)

922 Who usually makes decisions about health care for RESPONDENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
yourself: you, your (husband/partner), you and your HUSBAND/PARTNER ....................... 2
(husband/partner) jointly, or someone else? RESPONDENT AND
HUSBAND/PARTNER JOINTLY ........... 3
SOMEONE ELSE .......................... 4

OTHER 6
(SPECIFY)

923 Who usually makes decisions about making major RESPONDENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

household purchases? HUSBAND/PARTNER ....................... 2
RESPONDENT AND
HUSBAND/PARTNER JOINTLY ........... 3
SOMEONE ELSE .......................... 4

OTHER 6
(SPECIFY)

924 Who usually makes decisions about visits to your family or RESPONDENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
relatives? HUSBAND/PARTNER ....................... 2
RESPONDENT AND
HUSBAND/PARTNER JOINTLY ........... 3
SOMEONE ELSE .......................... 4

OTHER 6
(SPECIFY)

925 Do you own this or any other house either alone or jointly ALONE ONLY ............................. 01
with someone else? JOINTLY WITH HUSBAND/PARTNER ONLY . . . . . 02
JOINTLY WITH SOMEONE ELSE ONLY . . . . . 03
JOINTLY WITH HUSBAND/PARTNER
AND SOMEONE ELSE ................. 04
BOTH ALONE AND JOINTLY ................. 05
DOES NOT OWN . . . . . . . . . . . . . . . . . . . . . . . . . . 06 928

926 Do you have a title deed or other government recognized YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

document for any house you own? NO ...................................... 2
928
DON'T KNOW ............................. 8

927 Is your name on this document? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO ...................................... 2
DON'T KNOW ............................. 8

928 Do you own any agricultural or non-agricultural land either ALONE ONLY ............................. 01
alone or jointly with someone else? JOINTLY WITH HUSBAND/PARTNER ONLY . . . . . 02
JOINTLY WITH SOMEONE ELSE ONLY . . . . . 03
JOINTLY WITH HUSBAND/PARTNER
AND SOMEONE ELSE ................. 04
BOTH ALONE AND JOINTLY ................. 05
DOES NOT OWN . . . . . . . . . . . . . . . . . . . . . . . . . . 06 931

558 • Appendix E
 SECTION 9. HUSBAND'S BACKGROUND AND WOMAN'S WORK

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

929 Do you have a title deed or other government recognized YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

document for any land you own? NO ...................................... 2
931
DON'T KNOW ............................. 8

930 Is your name on this document? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO ...................................... 2
DON'T KNOW ............................. 8

931 PRESENCE OF OTHERS AT THIS POINT (PRESENT PRES./

AND LISTENING, PRESENT BUT NOT LISTENING, OR PRES./ NOT NOT
NOT PRESENT) LISTEN. LISTEN. PRES.

CHILDREN < 10 . . . . . . . . . . . 1 2 3
HUSBAND .............. 1 2 3
OTHER MALES . . . . . . . . . . . 1 2 3
OTHER FEMALES . . . . . . . . 1 2 3

932 In your opinion, is a husband justified in hitting or beating

his wife in the following situations: YES NO DK

a) If she goes out without telling him? a) GOES OUT . . . . . . . . . . . 1 2 8

b) If she neglects the children? b) NEGLECTS CHILDREN . . 1 2 8
c) If she argues with him? c) ARGUES . . . . . . . . . . . . . . 1 2 8
d) If she refuses to have sex with him? d) REFUSES SEX . . . . . . . . 1 2 8
e) If she burns the food? e) BURNS FOOD ........ 1 2 8

Appendix E • 559
 SECTION 10. HIV/AIDS

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

1001 Now I would like to talk to you about something else. Have YES ...................................... 1
(1) you ever heard of HIV or AIDS? NO ...................................... 2 1040

1002 CHECK 111: AGE

15-24 YEARS 25 YEARS
OR OLDER 1008

1003 HIV is the virus that can lead to AIDS. Can people reduce YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
their chance of getting HIV by having just one uninfected NO ...................................... 2
sex partner who has no other sex partners? DON'T KNOW ............................. 8

1004 Can people get HIV from mosquito bites? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO ...................................... 2
DON'T KNOW ............................. 8

1005 Can people reduce their chance of getting HIV by using a YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
condom every time they have sex? NO ...................................... 2
DON'T KNOW ............................. 8

1006 Can people get HIV by sharing food with a person who YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
has HIV? NO ...................................... 2
DON'T KNOW ............................. 8

1007 Is it possible for a healthy-looking person to have HIV? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO ...................................... 2
DON'T KNOW ............................. 8

1008 Have you heard of ARVs, that is, antiretroviral medicines YES ...................................... 1
that treat HIV? NO ...................................... 2

1009 Are there any special medicines that a doctor or a nurse YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
can give to a woman infected with HIV to reduce the risk of NO ...................................... 2
transmission to the baby? DON'T KNOW ............................. 8

1024 Have you ever been tested for HIV? YES ...................................... 1
NO ...................................... 2 1032

1025 In what month and year was your most recent HIV test?
MONTH ..........................

DON'T KNOW MONTH .................... 98

YEAR ..............

DON'T KNOW YEAR .................... 9998

560 • Appendix E
 SECTION 10. HIV/AIDS

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

1026 Where was the test done? PUBLIC SECTOR

(5) GOVERNMENT HOSPITAL .............. 11
RURAL HEALTH CENTER (RHC)/
URBAN HEALTH CENTER (UHC)/
LYING IN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
PROBE TO IDENTIFY THE TYPE OF SOURCE. STANDALONE HIV TESTING (HTS) FACILITY . . 13
SOCIAL HYGIENE CLINIC .............. 14
IF UNABLE TO DETERMINE IF PUBLIC, PRIVATE, OR PRIMARY HIV CARE CLINIC 15
NGO SECTOR, RECORD '96' AND WRITE THE NAME
MOBILE HTS SERVICES ................. 16
OF THE PLACE.
OTHER PUBLIC SECTOR

17
(SPECIFY)

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC
LYING IN CLINIC ................. 21
INDUSTRY-BASED CLINIC . . . . . . . . . . . . . . . . . 22
PRIVATE DOCTOR . . . . . . . . . . . . . . . . . . . . . . . 23
STANDALONE HIV TESTING (HTS) FACILITY . . 24
PRIMARY HIV CARE CLINIC 25
MOBILE HTS SERVICES ................. 26
OTHER PRIVATE MEDICAL SECTOR

27
(SPECIFY)

OTHER SOURCE
HOME ................................ 41
WORKPLACE .......................... 42
CORRECTIONAL FACILITY .............. 43
COMMUNITY- BASED HIV SCREENING (CBS) . . 44

OTHER 96
(SPECIFY)

1027 Did you get the results of the test? YES ...................................... 1
NO ...................................... 2 1031

1028 What was the result of the test? POSITIVE ................................ 1

NEGATIVE ................................ 2
INDETERMINATE .......................... 3
1031
DECLINED TO ANSWER .................... 4

1029 In what month and year did you receive your first HIV-
positive test result? MONTH ..........................

DON'T KNOW MONTH .................... 98

YEAR ..............

DON'T KNOW YEAR .................... 9998

SAME DATE AS LAST HIV TEST . . . . . . . . . . . . . . 95

1030 Are you currently taking ARVs, that is antiretroviral YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

medicines? NO ...................................... 2
By currently, I mean that you may have missed some DON'T KNOW ............................. 8
doses but you are still taking ARVs.

1031 How many times have you been tested for HIV in your
lifetime?

IF NON-NUMERIC ANSWER, PROBE TO GET AN

ESTIMATE, IF NUMBER OF TESTS IS 95 OR MORE, NUMBER OF HIV TESTS ...........
RECORD '95'.

1032 Have you heard of test kits people can use to test YES ...................................... 1
themselves for HIV? NO ...................................... 2 1034

Appendix E • 561
 SECTION 10. HIV/AIDS

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

1033 Have you ever tested yourself for HIV using a self-test kit? YES ...................................... 1
NO ...................................... 2

1034 Would you buy fresh vegetables from a shopkeeper or YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

vendor if you knew that this person had HIV? NO ...................................... 2
DON'T KNOW/NOT SURE/DEPENDS . . . . . . . . . . . 8

1035 Do you think children living with HIV should be allowed to YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
attend school with children who do not have HIV? NO ...................................... 2
DON'T KNOW/NOT SURE/DEPENDS . . . . . . . . . . . 8

1036 CHECK 1028:

(6) CODE '1' OTHER

1040
CIRCLED

1037 Now I would like to ask you a few questions about your YES ...................................... 1
(6) experiences living with HIV. NO ...................................... 2

Have you disclosed your HIV status to anyone other than

me?

1038 Do you agree or disagree with the following statement: I AGREE ................................ 1
have felt ashamed because of my HIV status.
(6) DISAGREE ............................. 2

1039 Please tell me if the following things have happened to

(6) you, or if you think they have happened to you, because of
your HIV status in the last 12 months: YES NO

a) People have talked badly about me because of my

HIV status. a) PEOPLE TALK BADLY ........... 1 2

b) Someone else disclosed my HIV status without my

permission. b) DISCLOSED STATUS ........... 1 2

c) I have been verbally insulted, harassed, or threatened

because of my HIV status. c) VERBALLY INSULTED ........... 1 2

d) Healthcare workers talked badly about me because of d) HEALTHCARE WORKERS

my HIV status. TALKED BADLY . . . . . . . . . . . . . . 1 2

e) Healthcare workers yelled at me, scolded me, called e) HEALTHCARE WORKERS

me names, or verbally abused me in another way VERBALLY ABUSED ........ 1 2
because of my HIV status.

562 • Appendix E
 SECTION 10. HIV/AIDS

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

1040 CHECK 1001:

(1) HEARD ABOUT NOT HEARD ABOUT

HIV OR AIDS HIV OR AIDS

a) Apart from HIV, have b) Have you heard about

you heard about other infections that can be YES ...................................... 1
infections that can be transmitted through NO ...................................... 2
transmitted through sexual contact?
sexual contact?

1041 CHECK 722:

HAS HAD SEXUAL NEVER HAD SEXUAL

1046
INTERCOURSE INTERCOURSE

1042 CHECK 1040: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES NO
1044

1043 Now I would like to ask you some questions about your YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
health in the last 12 months. During the last 12 months, NO ...................................... 2
have you had a disease which you got through sexual DON'T KNOW ............................. 8
contact?

1044 Sometimes women experience a bad-smelling abnormal YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

genital discharge. During the last 12 months, have you NO ...................................... 2
had a bad-smelling abnormal genital discharge? DON'T KNOW ............................. 8

1045 Sometimes women have a genital sore or ulcer. During the YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
last 12 months, have you had a genital sore or ulcer? NO ...................................... 2
DON'T KNOW ............................. 8

1046 If a wife knows her husband has a disease that she can YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
get during sexual intercourse, is she justified in asking that NO ...................................... 2
they use a condom when they have sex? DON'T KNOW ............................. 8

1047 Is a wife justified in refusing to have sex with her husband YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
when she knows he has sex with other women? NO ...................................... 2
DON'T KNOW ............................. 8

1048 CHECK 701:

CURRENTLY MARRIED/ NOT IN UNION

1101
LIVING WITH A MAN

1049 Can you say no to your (husband/partner) if you do not YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

want to have sexual intercourse? NO ...................................... 2
DEPENDS/NOT SURE . . . . . . . . . . . . . . . . . . . . . . . 8

1050 Could you ask your (husband/partner) to use a condom if YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

you wanted him to? NO ...................................... 2
DEPENDS/NOT SURE . . . . . . . . . . . . . . . . . . . . . . . 8

Appendix E • 563
 SECTION 11. OTHER HEALTH ISSUES

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

1101 How long does it take in minutes to go from your home to

(1) the nearest healthcare facility, which could be a hospital, a
health clinic, a medical doctor, or a health post? MINUTES . . . . . . . . . . . . . . . . . . . .

1102 How do you travel to this healthcare facility from your MOTORIZED
home? CAR/TRUCK/JEEP/VAN . . . . . . . . . . . . . . . . . . . . 01
PUBLIC BUS/ JEEP/ JEEPNEY . . . . . . . . . . . . . . 02
IF MORE THAN ONE WAY OF TRAVEL IS MENTIONED, MOTORCYCLE/TRICYCLE . . . . . . . . . . . . . . . . . 03
CIRCLE THE ONE HIGHEST ON THE LIST. E TRIKE ............................. 04
BOAT WITH MOTOR/ BANCA . . . . . . . . . . . . . . 05

NOT MOTORIZED
ANIMAL-DRAWN CART . . . . . . . . . . . . . . . . . 06
BICYCLE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 07
BOAT WITHOUT MOTOR . . . . . . . . . . . . . . . . . 08
WALKING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 09

OTHER 96
(SPECIFY)

1103 Has a doctor or other healthcare provider examined your YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

breasts to check for breast cancer? NO ...................................... 2
DON’T KNOW ............................. 8

1104 Now I’m going to ask you about tests a healthcare worker can do to check for cervical cancer, which is cancer in the cervix.
The cervix connects the womb to the vagina. To be checked for cervical cancer, a woman is asked to lie on her back with her
legs apart. Then the healthcare worker will use a brush or swab to collect a sample from inside her. The sample is sent to a
laboratory for testing. This test is called a Pap smear or HPV test. Another method is called a VIA or Visual Inspection with
Acetic Acid. In this test, the healthcare worker puts vinegar on the cervix to see if there is a reaction.

1105 Has a doctor or other healthcare worker ever tested you YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
for cervical cancer? NO ...................................... 2
DON’T KNOW ............................. 8

1106 Now I would like to ask you some questions on smoking EVERY DAY ............................. 1
and tobacco use. Do you currently smoke cigarettes every SOME DAYS ............................. 2
day, some days, or not at all? 1108
NOT AT ALL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

1107 On average, how many cigarettes do you currently smoke

each day? NUMBER OF CIGARETTES ........

1108 Do you currently smoke or use any other type of tobacco EVERY DAY ............................. 1
every day, some days, or not at all? SOME DAYS ............................. 2
NOT AT ALL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1110

1109 What other type of tobacco do you currently smoke or KRETEKS ................................ A
(2) use? PIPES FULL OF TOBACCO ................. B
CIGARS, CHEROOTS, OR CIGARILLOS . . . . . . . . C
RECORD ALL MENTIONED. WATER PIPE/SHISHA/HOOKAH. . . . . . . . . . . . . . . . . D
SNUFF BY MOUTH . . . . . . . . . . . . . . . . . . . . . . . . . . E
SNUFF BY NOSE .......................... F
CHEWING TOBACCO . . . . . . . . . . . . . . . . . . . . . . . G
BETEL QUID WITH TOBACCO .............. H

OTHER X
(SPECIFY)

1110 Now I would like to ask you some questions about drinking YES ...................................... 1
alcohol. Have you ever consumed any alcohol, such as NO ...................................... 2 1113
beer, wine, spirits, rhum, gin, tuba, lambanog, or basi?

564 • Appendix E
 SECTION 11. OTHER HEALTH ISSUES

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

1111 We count one drink of alcohol as one can or bottle of beer,

one glass of wine, one shot of spirits, or one cup of gin, DID NOT HAVE EVEN ONE DRINK . . . . . . . . . . . 00 1113
tuba, lambanog, or basi. During the last one month, on
how many days did you have at least one drink of alcohol?
NUMBER OF DAYS . . . . . . . . . . . . . . . . .

IF NON-NUMERIC ANSWER, PROBE TO GET AN

ESTIMATE. IF RESPONDENT ANSWERS 'EVERY DAY' EVERY DAY/ALMOST EVERY DAY . . . . . . . . . . . 95
OR 'ALMOST EVERY DAY,' CODE'95'.

1112 In the last one month, on the days that you drank alcohol,
how many drinks did you usually have per day? NUMBER OF DRINKS ..............

1113 Many different factors can prevent women from getting

medical advice or treatment for themselves. When you are
sick and want to get medical advice or treatment, is each
of the following a big problem or not a big problem: BIG NOT A BIG
PROBLEM PROBLEM

a) Getting permission to go to the doctor? a) PERMISSION TO GO ..... 1 2

b) Getting money needed for advice or treatment? b) GETTING MONEY ........ 1 2

c) The distance to the health facility? c) DISTANCE .............. 1 2

d) Not wanting to go alone? d) GO ALONE .............. 1 2

Appendix E • 565
 WOMEN'S SAFETY MODULE

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

1200 CHECK COVER PAGE: WOMAN SELECTED FOR 12 MODULE?

WOMAN SELECTED WOMAN 1237A

FOR THIS SECTION NOT SELECTED

1201 CHECK FOR PRESENCE OF OTHERS:

DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.

PRIVACY PRIVACY
OBTAINED . . . . . . . . . . . 1 NOT POSSIBLE . . . . . . . . . . . 2 1237

1202 READ TO THE RESPONDENT:

Now I would like to ask you questions about some other important aspects of a woman's life. You may find some of these
questions very personal. However, your answers are crucial for helping to understand the condition of women in the
Philippines. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else in
your household will know that you were asked these questions. If I ask you any question you don't want to answer, just let me
know and I will go on to the next question.

1203 CHECK 701 AND 702:

CURRENTLY
MARRIED/ 1206
NEVER MARRIED/ LIVING FORMERLY
NEVER LIVED WITH WITH A MAN MARRIED/
1206
A MAN LIVED WITH A MAN
(READ IN PAST TENSE
AND USE 'LAST' WITH
'HUSBAND/ MALE PARTNER')

1204 You have said that you are not married and are not living with a man YES ............................. 1 1206
as if married. Are you currently in an intimate relationship with a man NO ............................. 2
even though you are not living with him?

1205 Have you ever been in an intimate relationship with a man even YES ............................. 1
though you did not ever live with him? NO ............................. 2 1219

1206 Now, I am going to ask you about some situations that can happen
between some women and their (husband/male partner).

A. Please tell me if these descriptions apply to your relationship with B. How often did this happen during the last
your (last) (husband/male partner). 12 months: often, only sometimes, or not at
all?

SOME- NOT IN LAST

EVER OFTEN TIMES 12 MONTHS

a) He (is/was) jealous or angry if you YES 1 1 2 3

(talk/talked) to other men? NO 2

b) He wrongly (accuses/accused) you of being YES 1 1 2 3

unfaithful? NO 2

c) He (does/did) not permit you to meet your YES 1 1 2 3

female friends? NO 2

d) He (tries/tried) to limit your contact with your YES 1 1 2 3

family? NO 2

e) He (insists/insisted) on knowing where you YES 1 1 2 3

(are/were) at all times? NO 2

566 • Appendix E
 WOMEN'S SAFETY MODULE

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

1207 Now I need to ask some more questions about your relationship with
your (last) (husband/male partner).

A. Did your (last) (husband/male partner) ever: B. How often did this happen during the last
12 months: often, only sometimes, or not at
all?

SOME- NOT IN LAST

EVER OFTEN TIMES 12 MONTHS

a) say or do something to humiliate you in YES 1 1 2 3

front of others? NO 2

b) threaten to hurt or harm you or someone YES 1 1 2 3

you care about? NO 2

c) insult you or make you feel bad about YES 1 1 2 3

yourself? NO 2

d) not allow you to engage in any legitimate YES 1 1 2 3

work or practice your profession? NO 2

e) control your own money or properties or YES 1 1 2 3

force you to work? NO 2

f) destroy your personal properties, pets, or YES 1 1 2 3

belongings, or threaten or actually harm NO 2
your pets?

g) have other intimate relationships? YES 1 1 2 3

NO 2

1208 A. Did your (last) (husband/male partner) ever do any of the following B. How often did this happen during the last
things to you: 12 months: often, only sometimes, or not at
all?

SOME- NOT IN LAST

EVER OFTEN TIMES 12 MONTHS

a) push you, shake you, or throw something at YES 1 1 2 3

you? NO 2

b) slap you? YES 1 1 2 3

NO 2

c) twist your arm or pull your hair? YES 1 1 2 3

NO 2

d) punch you with his fist or with something YES 1 1 2 3

that could hurt you? NO 2

e) kick you, drag you, or beat you up? YES 1 1 2 3

NO 2

f) try to choke you or burn you on purpose? YES 1 1 2 3

NO 2

g) attack you with a knife, gun, or other YES 1 1 2 3

weapon? NO 2

h) physically force you to have sexual YES 1 1 2 3

intercourse with him when you did not want NO 2
to?

i) physically force you to perform any other YES 1 1 2 3

sexual acts you did not want to? NO 2

j) force you with threats or in any other way to YES 1 1 2 3

perform sexual acts you did not want to? NO 2

Appendix E • 567
 WOMEN'S SAFETY MODULE

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

1209 CHECK 1208A (a-j):

AT LEAST ONE NOT A SINGLE

1211
'YES' 'YES'

1209A How long after you first (got married/started living together/began this
relationship) with your (last) (husband/partner) did (this/any of these NUMBER OF YEARS . . . . . . . .
things) first happen?
IF LESS THAN ONE YEAR, RECORD '00' BEFORE MARRIAGE/BEFORE
LIVING TOGETHER . . . . . . . . . . . . . . 95

1210 Did the following ever happen as a result of what your (last)
(husband/male partner) did to you:

a) You had cuts, bruises, or aches? YES ............................. 1

NO ............................. 2

b) You had eye injuries, sprains, dislocations, or burns? YES ............................. 1

NO ............................. 2

c) You had deep wounds, broken bones, broken teeth, or any other YES ............................. 1
serious injury? NO ............................. 2

1211 Have you ever hit, slapped, kicked, or done anything else to YES ............................. 1
physically hurt your (last) (husband/male partner) at times when he NO ............................. 2 1213
was not already beating or physically hurting you?

1212 In the last 12 months, how often have you done this to your (last) OFTEN .......................... 1
(husband/male partner): often, only sometimes, or not at all? SOMETIMES . . . . . . . . . . . . . . . . . . . . . . . 2
NOT AT ALL .................... 3

1213 Does (did) your (last) (husband/male partner) drink alcohol? YES ............................. 1
NO ............................. 2 1215

1214 How often does (did) he get drunk: often, only sometimes, or never? OFTEN .......................... 1
SOMETIMES . . . . . . . . . . . . . . . . . . . . . . . 2
NEVER . . . . . . . . . . . . . . . . . . . . . . . . . . 3

1215 Are (Were) you afraid of your (last) (husband/male partner): most of MOST OF THE TIME AFRAID . . . . . . . . 1
the time, sometimes, or never? SOMETIMES AFRAID .............. 2
NEVER AFRAID ................. 3

1216 A. So far we have been talking about the behavior of your B. How long ago did this last happen?
(current/last) (husband/male partner). Now I want to ask you
about the behavior of any previous husband or any other current
or previous male partner that you may have ever had.

0 - 11 12+
EVER MONTHS MONTHS DON'T
AGO AGO REMEMBER

HAS NEVER HAD ANOTHER HUSBAND/

a) Did any previous husband or any other MALE PARTNER ........... 6 1217
current or previous male partner ever hit,
slap, kick, or do anything else to hurt you YES 1 1 2 3
physically? NO 2

b) Did any previous husband or any other

current or previous male partner physically
force you to have intercourse or perform YES 1 1 2 3
any other sexual acts that you did not want NO 2
to?

c) Did any previous husband or any other

current or previous male partner humiliate YES 1 1 2 3
you in front of others, threaten to hurt you NO 2
or someone you care about, or insult you or
make you feel bad about yourself?

568 • Appendix E
 WOMEN'S SAFETY MODULE

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

1217 CHECK 1208A (h-j) AND 1216A (b):

AT LEAST ONE NOT A SINGLE

1219
'YES' YES

1218 How old were you the first time you were forced to have sexual AGE IN COMPLETED
intercourse or perform any other sexual acts that you did not want to YEARS ..............
by any current or previous husband or male partner?
DON'T KNOW .................... 98

1219 CHECK 212 AND 232:

CURRENTLY PREGNANT NOT PREGNANT

232=1 OR 232=2 AND
HAD ONE OR MORE PAST NO PAST 1222
PREGNANCIES PREGNANCIES
212>0 212=0

1220 Has any one ever hit, slapped, kicked, or done anything else to hurt YES ............................. 1
you physically while you were pregnant? NO ............................. 2 1222

1221 Who has done any of these things to physically hurt you while you CURRENT HUSBAND/PARTNER . . . . . A
were pregnant? MOTHER/STEP-MOTHER . . . . . . . . . . . B
FATHER/STEP-FATHER ........... C
Anyone else? SISTER/BROTHER . . . . . . . . . . . . . . . . . D
DAUGHTER/SON ................. E
RECORD ALL MENTIONED. OTHER RELATIVE . . . . . . . . . . . . . . . . . F
FORMER HUSBAND/PARTNER ..... G
CURRENT BOYFRIEND ........... H
FORMER BOYFRIEND . . . . . . . . . . . . . . I
MOTHER-IN-LAW ................. J
FATHER-IN-LAW ................. K
OTHER IN-LAW . . . . . . . . . . . . . . . . . . . . L
TEACHER ....................... M
SCHOOLMATE/CLASSMATE ........ N
EMPLOYER/SOMEONE AT WORK .. O
POLICE/SOLDIER ................. P

OTHER X
(SPECIFY)

1222 CHECK 701 AND 702 AND 1204 AND 1205:

EVER MARRIED/EVER NEVER MARRIED/

LIVED WITH A MAN/ NEVER HAD
EVER HAD A A MALE PARTNER
MALE PARTNER

a) From the time you were 15 b) From the time you were 15 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
years old, has anyone other years old has anyone hit you, NO ............................. 2
than a husband or male slapped you, kicked you, or REFUSED TO ANSWER/ 1225
partner, hit you, slapped done anything else to hurt you NO ANSWER ................. 3
you, kicked you, or done physically?
anything else to hurt you
physically? Remember, I do
not want you to include any
husband or any other male
partner.

Appendix E • 569
 WOMEN'S SAFETY MODULE

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

1223 Who has hurt you in this way? MOTHER/STEP-MOTHER . . . . . . . . . . . A

FATHER/STEP-FATHER ........... B
Anyone else? SISTER/BROTHER . . . . . . . . . . . . . . . . . C
DAUGHTER/SON ................. D
RECORD ALL MENTIONED. OTHER RELATIVE . . . . . . . . . . . . . . . . . E
CURRENT BOYFRIEND ........... F
FORMER BOYFRIEND . . . . . . . . . . . . . . G
MOTHER-IN-LAW ................. H
FATHER-IN-LAW ................. I
OTHER IN-LAW ................. J
TEACHER ....................... K
SCHOOLMATE/CLASSMATE ........ L
EMPLOYER/SOMEONE AT WORK .. M
POLICE/SOLDIER ................. N

OTHER X
(SPECIFY)

1224 In the last 12 months, how often (has this person/have these persons) OFTEN .......................... 1
physically hurt you: often, only sometimes, or not at all? SOMETIMES . . . . . . . . . . . . . . . . . . . . . . . 2
NOT AT ALL .................... 3

1225 CHECK 701 AND 702 AND 1204 AND 1205:

EVER MARRIED/ NEVER MARRIED/

EVER LIVED WITH A MAN/ NEVER HAD
1227
EVER HAD A A MALE PARTNER
MALE PARTNER

1226 At any time in your life, as a child or as an adult, has anyone other YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1228
than any previous husband or any other current or previous male NO ............................. 2
partner ever forced you in any way to have sexual intercourse or REFUSED TO ANSWER/ 1231
perform any other sexual acts when you did not want to? Remember I NO ANSWER ................. 3
do not want you to include any husband or male partner.

1227 At any time in your life, as a child or as an adult, has anyone ever YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
forced you in any way to have sexual intercourse or perform any other NO ............................. 2
sexual acts when you did not want to? REFUSED TO ANSWER/ 1231
NO ANSWER ................. 3

1228 CHECK 701 AND 702 AND 1204 AND 1205:

EVER MARRIED/EVER NEVER MARRIED/

LIVED WITH A MAN/ NEVER HAD A
EVER HAD A MALE PARTNER
MALE PARTNER

a) How old were you the first time b) How old were you the first
you were forced to have sexual time you were forced to AGE IN COMPLETED
intercourse or perform any other have sexual intercourse or YEARS ..............
sexual acts that you did not want perform any other sexual
to by anyone, not including any acts that you did not want
DON'T KNOW .................... 98
husband or any other male to?
partner?
`

570 • Appendix E
 WOMEN'S SAFETY MODULE

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

1229 Who has forced you to have sexual intercourse or perform any other FATHER/STEP-FATHER ........... A
sexual acts that you did not want to? BROTHER/STEP-BROTHER ........ B
OTHER RELATIVE . . . . . . . . . . . . . . . . . C
Anyone else? CURRENT BOYFRIEND ........... D
FORMER BOYFRIEND . . . . . . . . . . . . . . E
IN-LAW . . . . . . . . . . . . . . . . . . . . . . . . . . F
OWN FRIEND/ACQUAINTANCE ..... G
FAMILY FRIEND . . . . . . . . . . . . . . . . . . . . H
TEACHER ....................... I
RECORD ALL MENTIONED. SCHOOLMATE/CLASSMATE ........ J
EMPLOYER/SOMEONE AT WORK .. K
POLICE/SOLDIER ................. L
PRIEST/RELIGIOUS LEADER . . . . . . . . M
STRANGER . . . . . . . . . . . . . . . . . . . . . . . N

OTHER X
(SPECIFY)

1230 CHECK 701 AND 702 AND 1204 AND 1205:

EVER MARRIED/EVER NEVER MARRIED/

LIVED WITH A MAN/ NEVER HAD A MALE
EVER HAD A MALE PARTNER
PARTNER

a) In the last 12 months, has b) In the last 12 months, has

anyone other than any anyone forced you to have
previous husband or any sexual intercourse or YES ............................. 1
other current or previous perform any other sexual NO ............................. 2
male partner forced you to acts that you did not want
have sexual intercourse or to?
perform any other sexual
acts that you did not want
to?

1231 CHECK 1208A (a-j), 1216A (a,b), 1220, 1222, 1226, AND 1227:

AT LEAST ONE NOT A SINGLE

1234A
'YES' 'YES'

1232 Thinking about what you yourself have experienced among the YES ............................. 1
different things we have been talking about, have you ever tried to NO ............................. 2 1234
seek help?

1233 From whom have you sought help? OWN FAMILY .................... A
HUSBAND'S/PARTNER'S FAMILY .. B
Anyone else? CURRENT/FORMER
HUSBAND/PARTNER ........... C
RECORD ALL MENTIONED. CURRENT/FORMER BOYFRIEND .. D
FRIEND ....................... E
NEIGHBOR . . . . . . . . . . . . . . . . . . . . . . . F
1234A
RELIGIOUS LEADER .............. G
DOCTOR/MEDICAL PERSONNEL . . . . . H
POLICE ....................... I
LAWYER ....................... J
SOCIAL SERVICE ORGANIZATION .. K

OTHER X
(SPECIFY)

1234 Have you ever told any one about this? YES ............................. 1
NO ............................. 2

Appendix E • 571
 WOMEN'S SAFETY MODULE

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

1234A Are you aware of the following protection orders issued under
RA,9262 Anti Violence Against Women and their Children Act of
2004?

a) Barangay Protection Order? BPO refers to the protection order YES ............................. 1
issued by the Punong Barangay, or in his absence the Barangay NO ............................. 2
Kagawad, ordering the perpetrator to desist from committing acts
of violence against the family or household members particularly
women and their children under Sections 5a and 5b of R.A. No.
9262.

b) Temporary Protection Order? TPO refers to the protection order

issued by the court on the filing of the application and after ex YES ............................. 1
parte determination of its need. It may also be issued in the NO ............................. 2
course of a hearing, motu proprio or upon motion.

c) Permanent Protection Order? PPO refers to the protection order YES ............................. 1
issued by the court after notice and hearing. NO ............................. 2

1234B Are you aware of the following places where you could seek help in
case you need it?

a) Barangay Violence Against Women (VAW) Desk? YES ............................. 1

NO ............................. 2

b) PNP Women and Children's Protection Desk? YES ............................. 1

NO ............................. 2

c) DSWD Regional Center for Women/Girls (e.g. Crisis YES ............................. 1

Intervention Unit)? NO ............................. 2

d) Women and Children's Protection Unit in DOH-retained YES ............................. 1

hospitals or other government health facilities? NO ............................. 2

e) Public Attorney's Office of the Department of Justice or any public YES ............................. 1
legal assistance office? NO ............................. 2

f) Civil Society Organizations, non-government organizations YES ............................. 1

(NGOs), people's organization that provides help/services to NO ............................. 2
i i f i l i ?
g) Temporary Protection Desk or Permanent Protection Desk under YES ............................. 1
RA 9262? NO ............................. 2

1235 As far as you know, did your father ever beat your mother? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
NO ............................. 2
DON'T KNOW .................... 8

THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER ABOUT THE CONFIDENTIALITY OF HER
ANSWERS. FILL OUT THE QUESTIONS BELOW WITH REFERENCE TO THE DOMESTIC VIOLENCE MODULE ONLY.

1236 DID YOU HAVE TO INTERRUPT THE YES, YES, MORE

INTERVIEW BECAUSE SOME ADULT WAS ONCE THAN ONCE NO
TRYING TO LISTEN, OR CAME INTO THE HUSBAND .............. 1 2 3
ROOM, OR INTERFERED IN ANY OTHER OTHER MALE ADULT .. 1 2 3
WAY?
FEMALE ADULT ........ 1 2 3

1237 INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE.

1237A RECORD THE TIME.

HOURS ..........................

MINUTES . . . . . . . . . . . . . . . . . . . . . . . . . .

572 • Appendix E
INSTRUCTIONS: COL. 1 COL. 2
ONLY ONE CODE SHOULD APPEAR IN ANY BOX. 12 DEC 01
COLUMN 1 REQUIRES A CODE IN EVERY MONTH. 11 NOV 02
10 OCT 03
CODES FOR EACH COLUMN: 09 SEP 04
2 08 AUG 05 2
COLUMN 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE (2) 0 07 JUL 06 0
2 06 JUN 07 2
B BIRTHS 05 MAY 08
2 2
P PREGNANCIES 04 APR 09
T TERMINATIONS (1) 03 MAR 10
02 FEB 11
0 NO METHOD 01 JAN 12

1 FEMALE STERILIZATION 12 DEC 13

2 MALE STERILIZATION 11 NOV 14
3 IUD 10 OCT 15
4 INJECTABLES 09 SEP 16
5 IMPLANTS 2 08 AUG 17 2
6 PATCH 0 07 JUL 18 0
7 PILL 2 06 JUN 19 2
8 CONDOM 05 MAY 20
1 1
9 FEMALE CONDOM 04 APR 21
J EMERGENCY CONTRACEPTION 03 MAR 22
K STANDARD DAYS METHOD 02 FEB 23
L MUCUS/BILLINGS/OVULATION 01 JAN 24

M BASAL BODY TEMPERATURE 12 DEC 25

N SYMPTOTHERMAL 11 NOV 26
O LACTATIONAL AMENORRHEA METHOD 10 OCT 27
Q RHYTHM METHOD 09 SEP 28
R WITHDRAWAL 2 08 AUG 29 2
X OTHER MODERN METHOD 0 07 JUL 30 0
Y OTHER TRADITIONAL METHOD 2 06 JUN 31 2
05 MAY 32
0 0
COLUMN 2: DISCONTINUATION OF CONTRACEPTIVE USE 04 APR 33
03 MAR 34
0 INFREQUENT SEX/HUSBAND AWAY/ OLD AGE 02 FEB 35
1 BECAME PREGNANT WHILE USING 01 JAN 36

2 WANTED TO BECOME PREGNANT 12 DEC 37

3 HUSBAND/PARTNER DISAPPROVED 11 NOV 38
4 WANTED MORE EFFECTIVE METHOD 10 OCT 39
5 CHANGES IN MENSTRUAL BLEEDING 09 SEP 40
6 OTHER SIDE EFFECTS/HEALTH CONCERNS 2 08 AUG 41 2
7 LACK OF ACCESS/TOO FAR/ TRAVEL RESTRICTIONS 0 07 JUL 42 0
8 COSTS TOO MUCH 1 06 JUN 43 1
05 MAY 44
9 9
N INCONVENIENT TO USE 04 APR 45
F UP TO GOD/FATALISTIC 03 MAR 46
A DIFFICULT TO GET PREGNANT/MENOPAUSAL 02 FEB 47
D MARITAL DISSOLUTION/SEPARATION 01 JAN 48

X OTHER 12 DEC 49
11 NOV 50
(SPECIFY) 10 OCT 51
Z DON'T KNOW 09 SEP 52
2 08 AUG 53 2
0 07 JUL 54 0
1 06 JUN 55 1
05 MAY 56
8 8
04 APR 57
03 MAR 58
02 FEB 59
01 JAN 60

12 DEC 61
11 NOV 62
10 OCT 63
09 SEP 64
2 08 AUG 65 2
0 07 JUL 66 0
1 06 JUN 67 1
05 MAY 68
7 7
04 APR 69
03 MAR 70
02 FEB 71

Appendix E • 573
 INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT INTERVIEW:

COMMENTS ON SPECIFIC QUESTIONS:

ANY OTHER COMMENTS:

SUPERVISOR'S OBSERVATIONS

574 • Appendix E