1993 Contraceptive Prevalence Survey Jamaica Volume I Administrative Report

Publication date: 1994

1993 Contraceptive Prevalence Survey JAMAICA CONTRACEPTIVE PREVALENCE SURVEY JAMAICA 1993 VOLUME I ADMINISTRATIVE REPORT Carmen P. McFarlane, M.Sc. (Econ.) Jay S. Friedman, M.A. Leo Morris, Ph.D., M.P.H. NATIONAL FAMILY PLANNING BOARD. February, 1994 PREFACE The 1993 Jamaica Contraceptive Prevalence Survey (CPS) is the fifth in a series of periodic enquiries conducted by the National Family Planning Board (NFPB). The Survey seeks to update measures of fertility and contraceptive use among women aged 15 - 44 years and will for the first time include a special module for young adults (male and female) aged 15-24 years as well as males aged 15-54 years. The scope of the survey, as in earlier studies, is designed to gather information on a broad range of areas including knowledge, attitudes and practices in contraception; perceptions on the role of men and women, including views on sexuality, child bearing, child rearing and health care. This CPS, coming as it does in the last decade of the century, is of significance to the NFPB in particular and the wider com- munity in general, as it heralds the beginning of the twenty first century and the realization of the goals of Jamaica's National Population Policy. It also comes against the gradual phased withdrawal of contraceptive procure- ment by the major funding agency, the United States Agency for International Development (USAID), by a twenty percent (20 percent) annual decline over the period 1993-1998 under the Family Planning Initiatives Project (FPIP), as well as the phased diminution of funding from other donor agencies such as the United Nations Fund for Population Activities (UNFPA). This CPS is in fact one of two surveys to be conducted during the life of the FPIP. Against this background, the NFPB has many challenges ahead which are, inter alia, not only to maintain but also to increase contraceptive prevalence and to achieve further milestones by the inception of the twenty-first century, such as a population of not more than 2.7 million and replacement level fertility of two children per woman. For contraceptive methods and family life services to impact on fertility and contribute to the processes of national development, it is vital that programme effectiveness be evaluated. The reliable and current data collected from the CPS will be of invaluable use in policy analysis and programme imple- mentation for administrators and planners, not only in health but in those areas which impact on population issues at the broader national level. The Final Report of the 1993 CPS is present- ed in the following five volumes: I Administrative Report II Knowledge Of and Attitudes Towards Family, Contraception and AIDS III Sexual Experience, Contraceptive Practice and Reproduction IV Sexual Behaviour and Contraceptive Use Among Young Adults V Profiles of Health Regions In addition, an Executive Summary, contain- ing a summary of the main findings of the Survey will be presented. Volume I - the Administrative Report, contains background information on historical, geographical, demographic and social features relating to Jamaica and its population as well as the relationship of the Survey data to the population policies and programmes being implemented by the Government. In addi- tion, the survey design and organization including the sample design as well as the outcome of the data collection are presented. Background variables used in the exposition - ii - of the data are also displayed. Finally, a summary report on the National Dissemina- tion Seminar together with recommendations made by participants are included. Volume II presents data on knowledge of and attitudes towards family, contraception and AIDS of women aged 15-44 years and men aged 15-54 years while Volume III contains information on their sexual experience, contraceptive practice and reproductive history. Volume IV is dedicated to young adults, female and male, aged 15-24 years and in particular to their sexual behaviour and contraceptive use. The last volume, Volume V, presents selected information at the health region level so as to be able to determine the success or otherwise of the programmes being provided in each of the four health regions. The 1993 CPS was funded by USAID and directed by Mrs. Carmen McFarlane, Survey Director, a former Director General of the Statistical Institute of Jamaica (STATIN), in collaboration with NFPB and the Ministry of Health, while field work and data entry were carried out by STATIN. Technical assistance was provided by the Division of Reproduct- ive Health, National Centre for Chronic Disease Prevention and Health Promotion, Centres for Disease Control and Prevention (CDC) in the areas of survey design and sampling, questionnaire development and training, data processing and report prepara- tion. STATIN and CDC were jointly res- ponsible for printing. The National Family Planning Board wishes to place on record its sincere thanks to all those organizations which participated in the planning of the Survey, the development of the questionnaire and the review of the various modules. Main participants were the Ministry of Health, the Statistical Institute of Jamaica, the Planning Institute of Jamaica and the Fertility Management Unit of the University of the West Indies. Special acknowledgements are due to Mr. Vernon James, Director General, STATIN, for his leadership and support of STATIN's participation; Miss Isbeth Bernard, Director of Surveys, for supervision of the field work and data entry, Mrs. Valerie Nam, Director of Censuses & Related Studies and Mrs. Morville Anderson, Senior Statistician, for their assistance in training on the question- naires, all of STATIN; and to Ms. Margaret Watson and Mr. Daniel Wallace, computer specialists of CDC, for installation of the data entry/edit software and training of STATIN personnel in its use. The NFPB also wishes to thank the following persons for their input in the development, implementation and finalization of the survey: Mrs. Carmen McFarlane, Survey Director; Dr. Leo Morris and Mr. Jay Friedman of CDC; Mrs. Betsy Brown, Director, Office of Health, Nutrition and Population and Mrs. Grace Ann Grey, Project Officer, both of USAID; Dr. Sheila Campbell-Forrester, SMO, Cornwall Regional Hospital, Dr. Beryl Irons, SMO/MCH, Drs. Peter Weller and Peter Figueroa of the Epidemiology Unit and Ms. Kristin Fox, Director, Health and Information Unit, of MOH; Dr. Olivia McDonald, Medical Direc- tor, Mrs. Eugenia McFarquhar, Family Planning Co-ordinator, Mrs. Ellen Radlein, Director, Projects & Research, Mrs. Janet Davis, Director, Information, Education & Communication, and Mrs. Marian Kenneally, Programme Co-ordinator, of the NFPB. Finally, to the more than 7,000 women and men who gave us their time to answer so many questions, we owe a debt of gratitude for this information, which we are sure will be useful in enhancing their lives. Beryl Chevannes, Executive Director. July, 1994. - iii - CONTENTS Page No. PREFACE . i TABLE OF CONTENTS. iii LIST OF TABLES . iv CHAPTER I - BACKGROUND I.1 Historical, Geographical, Demographic and Social Background . 1 I.2 Population Policies and Programmes . 5 I.3 Objectives and Coverage of the Surveys. 6 CHAPTER II - ORGANIZATION OF THE SURVEY II.1 General . 9 II.2 Sample Design . 9 II.3 Questionnaire Design and Development . 10 II.4 Recruitment and Training . 11 II.5 Field Work . 12 II.6 Response Rates. 13 CHAPTER III - CHARACTERISTICS OF THE SURVEY POPULATION III. 1 Age Distribution . 15 III.2 Educational Attainment . 16 III.3 Religion . 17 III.4 Economic Activity . 18 III.5 Residence . 20 III.6 Children Ever Born . 20 III.7 Socio-Economic Index . 21 CHAPTER IV - NUPTIALITY AND RELATIONSHIP STATUS IV.1 Marital and Union Status. 22 IV.2 Union History. 24 REFERENCES . 25 TABLES . 27 - iv - Page No. APPENDICES I SAMPLING ERRORS AND DESIGN . 41 II SOCIO-ECONOMIC INDEX - METHODOLOGY . 43 III QUESTIONNAIRES: A. Household Questionnaire - Female (Form CPS 1A) . 51 B. Individual Questionnaire - Female (Form CPS 2) . 55 C. Household Questionnaire - Male (Form CPS 1B) . 105 D. Individual Questionnaire - Male (Form CPS 3) . 109 IV REPORT ON THE NATIONAL DISSEMINATION SEMINAR . 149 LIST OF TABLES 2.6.1 Household and individual interview status - number and percent . 27 distribution - female and male surveys, 1993 JAMAICA CPS 2.6.2 Household and individual interview status by health region:. 28 Females 15-44 years of age; Percent distribution - 1993 JAMAICA CPS 2.6.3 Household and individual interview status by health region: . 29 Males 15-54 years of age; Percent distribution - 1993 JAMAICA CPS 3.1.1 Age distribution comparisons of women aged 15-44 by five year . 30 age group - 1982, 1983, 1987, 1989, 1993 - percentage distribution 3.1.2 Age distribution comparisons of men aged 15-54 by five year age . 30 group - 1982, 1987, 1993 - percentage distribution 3.2.1 Educational attainment of women aged 15-44 by highest level of . 31 education - 1982, 1983, 1989, 1993 - percentage distribution 3.2.2 Educational attainment of men aged 15-54 by highest level of . 31 education - 1982, 1993 - percentage distribution - v - Page No. 3.3.1 Percentage distribution of women aged 15-44 by religious . 32 affiliation - 1982, 1989, 1993 3.4.2 Percentage distribution of men aged 15-54 by religious . 32 affiliation - 1982, 1993 3.3.3 Percentage distribution by regularity of attendance at church . 33 services by religious affiliation - 1993 3.4.1 Percent distribution of women aged 15-44 by five year age group. 34 and employment status - 1993 3.4.2 Percent distribution of men aged 15-44 by five year age group . 34 and employment status - 1993 3.4.2 Percent distribution of respondents by occupation group by place of . 35 work - 1993 4.1.1 Percent distribution of women aged 15-44 by current union status . 36 by five year age group - 1989, 1993 4.1.2 Percent distribution of men aged 15-54 by current union status . 36 by five year age group - 1993 4.1.3 Percent distribution of women aged 15-44 by current union status. 37 by selected characteristics - 1993 4.1.4 Percent distribution of men aged 15-54 by current union status . 38 by selected characteristics - 1993 4.2.1 Percent distribution of women aged 15-44 currently in a union . 39 by change from initial status to current status by selected characteristics - 1993 4.2.2 Percent distribution of men aged 15-54 currently in a union . 40 in a union by change from initial status to current status by selected characteristics - 1993 - vi - CHAPTER I BACKGROUND I.1 HISTORICAL, GEOGRAPHICAL, DEMOGRAPHIC AND SOCIAL BACKGROUND Jamaica, located in the north western section of the Caribbean archipelago, is one of the group of four islands which comprise the Greater Antilles. It is situated at latitude 18° north and 77° west and is approximately 90 miles south of Cuba and 100 miles west of Haiti. The inhabitants are English-speaking, Jamaica having been a member of the British Empire from its capture by Britain in 1655 until it attained independence in 1962. The country shares common cultural links with the other English-speaking territories of the regions - the islands of the Lesser Antilles, the Bahamas, Bermuda, the British Virgin Islands, the Cayman and Turks and Caicos Islands as well as Belize and Guyana on the American mainland. At the regional level, it is a member of CARICOM. the Caribbean Community, and at the international level, it is one of the group of countries which forms the Latin American and Caribbean Region (ECLAC), as designated by the United Nations. The island has a maximum length of 146 miles and the width varies from 22 to 51 miles, with a total area of 4,411 square miles or 11,244 square kilometers. Jamaica is divided into three counties: Cornwall in the west, Middlesex in the middle and Surrey in the east. There are fourteen parishes - Kingston, St. Andrew, St. Thomas and Port- land in the county of Surrey, St. Mary, St. Ann, Manchester, Clarendon and St. Cath- erine in the county of Middlesex, and Trelawny, St. James, Hanover, Westmore- land and St. Elizabeth in the country of Cornwall. In addition to these divisions, a number of administrative areas has been defined and used for many purposes; the most important of these is the breakdown into constituencies which are the political divisions of the country. Constituency numbers vary by parish, ranging from two to eleven. A division of significance to this study is the breakdown into health regions. The health regions now being administered are comprised as follows: Region 1 Kingston, St. Andrew, St. Thomas and St. Catherine; Region 2 Portland, St. Mary and St. Ann; Region 3 Trelawny, St. James, Hanover and Westmoreland; Region 4 St. Elizabeth, Manchester and Clarendon. The population of Jamaica at the end of 1992 was 2,460,500, with an annual growth rate of 1.0 percent. Annual growth rates have been varying over the period since populations were measured in the population census of 1844 at which time the population was 377,400. Table 1.i shows population sizes by gender in censuses conducted since then up until the last census in 1991. Annual average growth rates are also shown. Variations in average annual growth rates have occurred, based on movements in the intercensal birth and death rates as well as -2- the migration balance, as shown in Table l.ii below. Declines in intercensal birth rates since 1844 have taken place but these have not been as significant as the corresponding death rates. Thus, with the intercensal birth rate of 39.6 per 1,000 births between 1844 and 1861, the rate was at 37.9 per 1,000 in 1921. There -3- was a fall to 33.2 per 1,000 in 1943 but by the next census in 1960 the movement was reversed, rising to 35.4 per 1.000 in 1960 and climbing further to 39.1 per 1,000 in 1970. The most significant fall was in the decade of the 1970s and continuing into the 1980s so that the rate was 24.7 per 1,000 in the intercensal period ending in 1991. At the same time, the death rate fell consistently, from 32.2 per 1,000 in the intercensal period between 1844 and 1861 to 5.7 per 1,000 in 1991. These movements resulted in rates of natural increase rising from 7.4 per 1,000 in 1861 to 19.0 per 1,000 in 1991. The migration balances, as shown in Table l.ii, complete the impact on the intercensal growth rates. Growth rates in the last intercensal period have also shown some variation as may be observed from Table l.iii below. Variations range from a high of 2.0 in 1983 to 0.1 in 1988. Another consideration of consequence to this study is the distinction between urban and rural areas of residence. It is generally recognized that residential location has a significant impact on the quality of life of the inhabitants and accordingly can exert a strong influence on their attitudes to life. On this account, the design of the sample for the 1993 CPS allows for a differentiation of the results by urban and rural residence. In Jamaica, as in many other countries, the breakdown into "urban" and "rural" is not based on predetermined characteristics inherent in the derived data, but instead, areas are defined as urban if they satisfy pre- determined basic criteria of urban living. In the population censuses, two types of urban areas are identified - major urban and other urban. For purposes of the 1993 CPS, only major urban areas are considered as "urban". All other areas are categorized as "rural". Population size of the conglomerations re- -4- presented in the major urban areas as defined for this study are presented in Table l.iv below for census years 1960 to 1991. Five major urban centres are covered, including the township of Portmore. This town, which was developed during the 1970s as a dormitory for the Kingston Metropolitan Area, was rural in character before then. Accordingly, it has only been included as urban since the 1982 census. In general, growth in major urban areas has been increasing over the period. Thus, whereas approximately 25 percent of the population lived in major urban areas in 1960, there was over one-third living in these areas by 1991. The decline in percentage terms in the Kingston Metropolitan Area which was seen in the decade of the 1970s was reversed in the 1980s although in 1991 the percentage was still below that in 1970. Age distribution in the population is import- ant to any study of fertility and population control. Of particular significance is the proportion and size of the child bearing and child rearing ages. This is of consequence not only to females in the population but to males also. Accordingly, demographic enqui- ries in general and contraceptive prevalence surveys in particular have focused on break- downs of the population into broad age groupings. Three main age groups are con- sidered significant - the infant and child population, the adult population and the elderly. In general, the population under 15 years has been identified as the infant and child population; the population between the ages of 15 to 44 years (and in the case of males, an extension up to age 54 years has been applied in some instances) as the repro- ductive age population, while the rest of the population is classified as elderly. The size of these three groups provide the determin- ants of dependency ratios and, in the case of females in the reproductive age, of fertility. The age structure of Jamaica's population has been determined largely by the patterns of migration and to a lesser extent by the rela- tively high fertility rates. The age break- down by sex of the population is shown in Table l.v below. -5- Marked increases have been observed among males and females in the proportions of the population under 15 years between 1943 and 1970, representing the combined effects of both the high levels of migration, particularly among adults, and the high fertility rates, between 1970 and 1992, the proportion has fallen, reflecting mainly the lowering of the fertility rates. The reverse movements have been occurring in the middle age groups and particularly between the ages of 15 and 44 years. For both sexes, their percentage shares fell up to 1970 then rose between 1970 and 1982. I.2 POPULATION POLICIES AND PROGRAMMES It is generally recognized that the adoption and promotion of positive population policies by a country can have significant social and economic impact on its people which can contribute to improvement in their wellbeing and to their quality of life. The United Nations definition of a population policy is stated as "Measures and programmes desig- ned to contribute to the achievement of social, economic and other collective goals through affecting critical demographic variables - mainly size and growth in the population, its geographical distribution (local and abroad), and its demographic characteristics". In Jamaica, the country's current population policy has been articulated in a document entitled "A Statement of National Population Policy", published in 1983. The definition of a population policy as set out in the document is "A coherent set of national priorities in terms of optimal size and growth of population, consistent with sustained social and economic growth and development". Six basic goals have been identified: i) To achieve favourable conditions for economic and social development of the country in the next two decades. ii) To promote a continued improvement in the health status of the nation. iii) To ensure high quality family plan- ning services for Jamaicans of repro- ductive age who wish to use them. -6- iv) To create new and additional employ- ment opportunities in sufficient number to correspond to the natural growth of the population of labour force age, through the vigorous devel- opment of agriculture, industry and services. v) To promote balanced rural, urban and regional development, thereby achiev- ing optimal spatial distribution of the population. vi) To improve the satisfaction of basic human needs and the quality of life in such areas as housing, nutrition, education, and environmental condi- tions. The primary aim of Jamaica's population policy, which is an integral component of the Government's overall social and economic policy, may accordingly be stated as effect- ing greater improvement in the social and economic conditions of the people. The attainment of the goals is implicit in the specific target articulated in the Policy whereby it is expected to contain the popu- lation to 2.7 million or under by the year 2000; this compression being achieved through reduction of the average family size of almost 6 children per family which existed in the late 1960s to 2 per family by the late 1990s, thereby realizing the goal of replace- ment levels of fertility thereafter. In order to achieve this desired level, the strategy adopted by the Government, which has the support of a wide cross-section of interests at national and local levels, is directed at achieving shifts in attitudes to family size away from a preference for larger families to more limited numbers, stimulated by changing attitudes to life in general brought about by improvements in social and economic conditions. Limitations of family size is considered, however, to be complementary to the basic health objectives set out in the Policy. In achieving the health objectives, a minimum goal which has been set is to increase average life expectancy at birth from levels of approximately 70 years, which has been attained in the 1970s to around 73 years by the year 2000. This should be achieved by continuing reductions in fertility rates and the maintenance of improvement in acceptably low levels of mortality. Promotion of health will be in line with the objective of the World Health Organization of "health for all by the year 2000", with the responsible ministry working for "improvement in its network of health facilities while creating the optimum conditions for the private sector and for voluntary organizations to complement the activities of the public system". The responsible ministry would also continue to devote attention to maternal and child care and to the delivery of health care to the neediest strata of the population and to persons living in remote areas. Supplementary to the implementation pro- gram would be the promotion of health edu- cation in relation to curative strategies and perhaps more importantly, in association with prevention. This is particularly significant in the context of the threats being faced as a result of the growing incidence of sexually transmitted diseases, especially AIDS. I.3 OBJECTIVES AND COVERAGE OF THE SURVEYS The 1993 Jamaica Contraceptive Prevalence Survey programme is the most recent in the continuing series of enquiries undertaken by the National Family Planning Board aimed at obtaining information on levels of fertility in Jamaica and on related factors which impact on the size of the population and on the rate -7- of growth. Earlier enquiries were conducted among females in 1974, 1979, 1983 and 1989 and among males between November 1983 to April 1985, with a more restricted enquiry carried out in 1987 among males and females in the age group 14-24 years. Other studies in this field have been undertaken by other institutions, chief of which is the government's statistical agency. Estimates of fertility rates are generally available from the decennial censuses of population carried out between 1861 until 1980 by the former Department of Statistics and more recently by the Statistical Institute of Jamaica, with intercensal estimates also being provided by these institutions. In addition, a more comprehensive study, the 1975/76 Jamaica Fertility Survey was carried out within the programme of the World Fertility Survey by the former Department of Statistics. The 1993 Survey is the most comprehensive of the enquiries to be undertaken, focusing on women and men in their most active reproductive ages, with specific emphasis on young adults in the group. The main aim of the survey programme is to obtain a wide range of information on the knowledge and practices of Jamaican men and women in general and their partners in particular in all matters relating to the determination of the levels of fertility of women in the population, the number of births and efforts made (if any) to regulate the number and spacing of their children. It also aims at assessing other related health conditions covering maternal-child health and behavioural risk factors. These insights will prove invaluable for projecting trends as well as for formulating population policy and more generally, ensuring that the necessary data exist. The extension of the coverage to in-clude men will enlarge the information which can be used among other things to develop meaningful male responsibility programmes for controlling the birth rate in Jamaica. Major users of the data will be the National Family Planning Board, the Ministry of Health, the Jamaica Family Planning Association, the Planning Institute of Jamaica and the Population Policy Committee. The Survey should provide these main users as well as other decision- makers with data which will assist in the development of policies which would lead to effective control of the population of Jamaica by way of overall reductions in the birth rate and through a more efficient spacing of children. In addition to the development of policies directly concerned with population growth, a further objective of the Survey is to provide information which could contribute to an effective family life education programme within and outside the formal education sys- tem which aim at improving knowledge prac- tices relating to the conception and care of children. Finally, information on selected behavioural risk factors which include smoking and alcohol use during pregnancy and AIDS, are provided with a view to con- tributing to the effort of minimizing the impact which such diseases might have on the population as a whole and women in particular and in this context, providing information for the development of appropri- ate educational programmes. The 1993 CPS covers a wide cross-section of topics which include fertility, infant and child mortality and reproductive history, contra- ceptive usage, attitudes towards reproduction, maternal and child health, and behavioural risks. Background characteristics relating to the demographic and socio-economic status of the population surveyed are also included. These comprise age structure, educational attainment, socio-economic and employment status, religious affiliation and union status. Within this coverage, knowledge of contra- ception and the level of contraceptive usage -8- will be estimated. Differentials across health regions, in urban and rural areas of residence as well as by demographic and socio-econo- mic characteristics will be identified in order to assess the impact of current programmes as well as to provide guidelines as to areas which might benefit from special or intensi- fied program efforts. Data on current ferti- lity, levels of unintended fertility and esti- mates of current infant and child mortality will be provided as well as information on general attitudes of women and men towards desired family size, birth spacing, breast- feeding and contraceptive use. The repro- ductive history of men will also be provided, thus giving a more complete picture of child bearing in Jamaica. The 1993 Contraceptive Prevalence Survey, in addition, provides information on current sexual activity of both men and women, part- icularly in relation to the use of contra- ceptives as well as commonly held beliefs on sexuality and on contraceptive practices by Health region Current parishes 1 Kingston, St. Andrew, St. Thomas, St. Catherine 2 Portland, St. Mary, St. Ann 3 Trelawny, St. James, Hanover, Westmoreland 4 St. Elizabeth, Manchester, Clarendon It will be noted that both the current and previous health regions vary in size of popu- lation, with current Health Region 1 being respondents in the Survey. A further feature is the examination of the extent of family life education offered inside and outside of the formal education system. Details should be useful to planners of programmes in this area. Geographic coverage in general is national with disaggregations at two levels - urban and rural, and health region. With respect to urban and rural distinctions, major urban areas throughout the country are identified and grouped. All other areas are classified as rural. Health regions, on the other hand, are grouped into parishes. The health re- gions used in this Report represent those which are currently in use in the adminis- tration and delivery of health care in Jamaica and differ somewhat from those which were current when the 1989 CPS was conducted. Set out below are the grouping of parishes now being used by the health administration together with those in use prior to this change are shown below: Previous parishes Kingston, St. Andrew, St. Thomas Portland, St. Mary, St. Ann Trelawny, St. James, Hanover, Westmoreland, St. Elizabeth Manchester, Clarendon, St. Catherine significantly larger, population-wise than the other three regions. This is so both in the current and previous administrations. -9- CHAPTER II ORGANIZATION OF THE SURVEY II.1 GENERAL The 1993 Jamaica Contraceptive Survey con- tinues the series of surveys sponsored by the National Family Planning Board and by the United States Agency for International Development (USAID). McFarlane Consult- ants provided the services of Survey Director while the sample design and selection, field work, coding and editing and data entry were carried out by STATIN and the tabulations by the Behavioural Epidemiology and Demo- graphic Research Branch, Division of Repro- ductive Health, Centers for Disease Control and Prevention who also, through profession- als from the Branch, provided technical consultation in all aspects of the Survey. II.2 SAMPLE DESIGN The 1993 Jamaica Contraceptive Prevalence Survey utilized the design adopted for the Continuous Social and Demographic Surveys conducted by the Statistical Institute of Jamaica. This design is based on a two-stage stratified sample with the first stage being a selection of geographic areas and the second stage, of dwellings. For the selection of the first stage units, the country has been divided into enumeration districts (EDs) which are grouped into sampling regions consisting of a predetermined number of strata, approxi- mately equal in size (where size is measured by the number of dwellings in each sampling region). Two EDs within each sampling region, selected with probability proportion- ate to size (determined by the number of dwellings), make up the sample at the first stage. At the second stage, a second pre- determined number of dwellings are selected systematically from lists of dwellings arran- ged on a circular basis in each of the EDs designated in the first stage of selection. The selection process for the 1993 Contra- ceptive Prevalence Survey involved a refine- ment of the general sample design of the household surveys conducted by STATIN. First stage sample selection is generally made by parishes, thus providing independent parish samples which allow for the calcula- tion of major characteristics in the sample. In the 1993 CPS, the decision was taken that, based on the need to obtain an affordable sample size, the lowest level of disaggrega- tion would be at the health region and not the parish level. Accordingly, the design provi- ded for independent samples to be selected, with the lowest geographical level being the health region. Secondly, in the general sample design used by STATIN, the first stage sample is selected using identical sampling fractions in each parish; in the 1993 CPS, sampling fractions were varied to take account of the significant disparity in the population in the four health regions. This design was applied to ensure appropriate minimum levels of representation in the smaller health regions population-wise, while reducing oversampling in the more populated health regions. The modified sample design was adopted in an identical way for both the survey of males and that of females. In the effort to achieve cost-effectiveness, it was decided to use the EDs selected for the first stage sample of the Labour Force Survey carried out by STATIN as the basis for the first stage selection of the 1993 surveys, modified in accordance with the description -10- stated above. This ensured that the creation of lists of dwellings prepared for the labour force surveys would be available at no extra cost for use in the 1993 CPS. The modifica- tion applied at this stage was to reduce scien- tifically by twenty five percent the number of EDs in the parishes comprising Health Re- gion 1, which were selected for the labour force surveys. The numbers of EDs selected in the remaining three health regions were maintained in the 1993 CPS. The determination of the numbers of dwell- ings to be chosen at the second stage of selection also took into account the size of the health regions to be surveyed. Thus, the numbers of dwellings chosen in each ED in the four regions were 15, 23, 19 and 15 in Health Regions 1, 2, 3 and 4, respectively. Based on these selections, and taking into consideration expected non-response rates, it was anticipated that a total number of 3,500 responses would be obtained in each of the two surveys. It should be noted that, as described above, this is not a self-weighting sample design and smaller health regions have been oversamp- led. In addition, one respondent per house- hold was selected with probability inverse to the number of eligible respondents in the household. Thus, results are based on weighted data even though the unweighted number of.cases are shown in each table. II.3 QUESTIONNAIRE DESIGN AND DEVELOPMENT Four separate survey instruments were developed for use in the 1993 Contraceptive Prevalence Survey programme; one house- hold questionnaire and one individual questionnaire for both male and female surveys. The household questionnaires (Form CPS 1A for females and Form CPS 1B for males) were designed to record in- formation on all members of the household and included the number of persons living in the household, name, sex, age and educational standard of all household members, iden- tification of the head of household and relationship of all other members to the household head. Information on age provi- ded the basis for identifying eligible residents, allowing for selection of respon- dents based on the predetermined age cri- teria, that is, females between the ages of 15 to 44 years in the female survey and males between the ages of 15 to 54 years in the male survey. Data on occupation of the head and number of rooms occupied by household members were also included. The individual questionnaires, on the other hand, (Form CPS 2 for females and Form CPS 3 for males) were developed to capture the data on the selected respondents in each of the surveys. Each of the individual ques- tionnaires were divided into eight sections with seven of the eight being identical except for the fact that each has been genderized. The eight sections in both of the surveys are: A. Respondent's background B. Union status and partnership history C. Fertility (female survey) or repro ductive history (male survey) D. Family planning E. Attitudes toward contraception and sexuality F. Young adult module G. Current sexuality H. Knowledge of AIDS and its trans- mission and prevention. -11- The individual questionnaires were developed to provide comparisons with earlier studies including the 1975/76 Jamaica Fertility Sur- vey, the 1983 and 1989 Contraceptive Preva- lence Surveys and the 1987 Young Adult Re- productive Health Survey. In addition, the evaluation of the 1989 Survey by staff mem- bers of the National Family Planning Board and the Ministry of Health contributed to the introduction of the new areas of coverage. Consultations on the content of the survey were held between the Division of Repro- ductive Health, Centers for Disease Control and Prevention (whose core questionnaires for family planning, maternal-child health and young adult reproductive health surveys provided guidelines), the National Family Planning Board, the Ministry of Health, United States Agency for International Development and the Survey Director, and on the more technical aspects of the survey design, with the Statistical Institute of Jamaica. II.4 RECRUITMENT AND TRAINING The Statistical Institute of Jamaica had responsibility for the conduct of the field work and for the coding and editing of the questionnaires and also for data entry. Accordingly, they were in charge of recruit- ment of field staff, editor/coders and data entry staff. Due to the sensitive nature of the questions included in the survey, a deci- sion was taken to use only female interview- ers in the female survey; in the male survey, both male and female interviewers would be used. Thus, females selected for interview would be questioned by females only; males would be interviewed by males or females. In the case of the interviews of males in the male survey, experience has shown that fe- male interviewers are just as or even more effective than male interviewers. Coders, editors and data entry clerks are not gender- specific although the office clerks working with the supervisors who were included in the training were all female. Training on field work in both the pretest and the main surveys was the responsibility of STATIN while that on the technical as- pects including the pretest was undertaken by a team of three local trainers headed by the Survey Director, supported by a team from CDC. All trainers were professionals who have had extensive training and experience in the field of demography, epidemiology and survey taking. Officers from the National Family Planning Board including the Medical Director assisted in the training on contra- ceptive methods. In the areas of coding and editing, the training was provided by the Sur- vey Director while CDC had direct responsi- bility for training in data entry, using updated SURVEY software developed by them for data entry and editing on micro- computers. Training for the field work was undertaken in two phases. The first related to the pretest of the questionnaires and to procedures to be implemented during the survey programme and was carried out during the period January 12-22, 1993. The second training for the main surveys was carried out over the period February 15 to March 1, 1993. Three training classes were held in Kingston, Black River and May Pen during the first week of the training (February 15-19, 1993) while another was held in Kingston the following week. Due the postponement of field work in some parts of the country as a result of the holding of an election at the end of March, retraining of some twenty interviewers was undertaken by the Survey Director. In all cases, the training consisted of class- room lecturers, discussions, mock interviews and written tests. Field interviews were also -12- carried out as part of the training with the completed questionnaires reviewed in the classroom. A total of 142 field personnel were trained. Of these, there were 23 super- visors (15 males and 8 females) and 107 interviewers (29 males and 78 females). Twelve office clerks, all females, were included in the training. II.5 FIELD WORK The organization of the field staff for administering the CPS surveys was similar to that used for all other household surveys conducted by STATIN. The country is divi- ded into four contiguous, non-overlapping areas, each of which is managed by a senior supervisor. Within each area, there are four zones, each covering approximately 28 Primary Sampling Units. One supervisor and five interviewers are assigned to each zone. Field work for the pretest was scheduled to be conducted in a few pre-selected areas and was scheduled to last three days. This was executed according to schedule. In the case of the main surveys, the original schedule identified three months for both surveys. There were, however, a number of inter- ruptions to the schedule, starting with the calling of a general election for the end of March, 1993 which resulted in a postpone- ment of the start date in some volatile areas and a suspension in others where enumera- tion had commenced. Full work resumed in all areas in April but within a few days, heavy rains began in some parishes, causing a further cessation. Parishes affected were St. Thomas, Portland, St. Mary, St. Ann, Trelawny, St. James, Clarendon and St. Catherine. The highly volatile political climate, diffi- culties experienced in carrying out the field visits, reluctance of a relatively high proportion of persons to cooperate, not entirely unexpected in the context of the disruption to their normal routine caused by the floods, resulted in a longer than expected period of time needed to establish contact, both with householders and selected respond- ents as well as higher than expected refusal rates. Accordingly, in order to achieve the target for completed number questionnaires set, field work had to be extended beyond the scheduled time. Field work officially ended on August 31, 1993. II.6 RESPONSE RATES The household and individual status of inter- views for both female and male samples are shown in Table I-2.6.1. The profile of house- hold selection categories is similar for both males and females. In both samples, slightly more than 50 percent of households (females - 53.9 percent; males - 54.6 percent) had an eligible respondent while residents were hot at home in three percent of households. In households with eligible female res- pondents, the percentage with complete interviews was disappointingly lower than in previous surveys. The completion rate of 81.9 percent compares with a completion rate of 94.6 percent achieved in the 1989 CPS. The refusal rate was higher than in past surveys - 7.0 percent compared with 2.2 percent in 1989. In male households, a similar proportion, 80.0 percent of eligible respondents, were interviewed, compared with 95.7 percent of males successfully interviewed in the 1987 Young Adult Reproductive Health Survey (YARHS). The refusal rate was comparable to the female sample - 6.7 percent. At the national level, in spite of the lower -13- completion rates for males (80.0 percent) and females (81.9 percent), the age distribution of respondents with complete interviews appears to be representative of the population. As seen in the following chapter, the age distribution of men and women with complete interviews closely approximates the end of year population estimates for 1992 produced by the Stat- istical Institute of Jamaica (Table I-3.1.1). For females, the only age group with more than a one percentage point difference between the CPS and the population esti- mates is the 35-39 year age group (11.7 percent versus 12.9 percent). However, since the 95 percent confidence interval for the 12.9 percent figure is 1.4 percent, the difference is not statistically significant. For males, the only age group statistically different from the end of year estimates for 1992 is the 15-19 year old age group. After taking into account sampling error, the percentage of teenage males in the sample is about 1.5 percentage points higher than expected. This was unexpected as sample surveys usually under-represent teenage males due to their mobility within the population. Household completion rates and individual refusal rates appear to have been affected by two events that occurred during the survey. First, as mentioned in the previous section of this chapter, soon after the survey field work began, a general election was called. As is customary in Jamaica, interviewing was sus- pended during the 30 day election period. Refusal rates were higher in the Kingston Metropolitan Area (part of Health Region 1) where the election campaign was more in- tense. Secondly, unseasonal early heavy rains in some parishes were devastating, resulting in landslides and flooding, es- pecially in Health Regions 2 and 4. The rains led to an increase in demolished buildings and/or eligible respondents temporarily moving to other dwellings while their houses were being repaired. The household and individual status of interviews are shown by health region in Tables I-2.6.2 (for females) and I-2.6.3 (for males). As seen in these two tables, the percentage of households with eligible respondents in the female sample ranges from 48 percent in Health Region 3 to 59 percent in Health Region 1 and in the male sample, the corresponding percentages range from 49 percent in Health Region 3 to 58 percent in Health Region 1. The pattern in each health region is similar for both samples. In both samples, there is an elevated proportion of households in Health Region 3 in the "other" category, which includes demolished households. Further analysis (not shown here) indicates the problem area to be in the parish of St. James. In this parish, 15 percent of female households and 21 percent of male house- holds were in the "other" category compared with no more than 1 to 6 percent in the other three parishes in this health region. A sigifi- cant factor in this finding is that there were a number of households not contacted during the visits, probably because of the nature of the employment is this parish, one of the main tourist areas in the country. Accord- ingly, it was not possible to identify if the households not located fell in the sample since the information to determine eligibility could not be obtained. The individual status of interviews is shown in the bottom panel of these two tables. The higher refusal rates in Health Region 1 and eligible respondents not at home in Health Region 2 are noteworthy. In Health Region 1, the refusal rate in St. Andrew was 16 percent for both females and males. This parish, which forms part of the Kingston Metropolitan Area, includes a high propor- tion of both lower and upper socio-economic -14- areas. In the lower socio-economic areas, the political climate is especially volatile. At the same time, in the upper socio-economic areas, there is a growing resistance to providing information to government inter- viewers in all of the social surveys being conducted. Respondents not at home (after several re- visits) in Health Region 2 was a particular problem in Portland, due to the heavy rains and in St. Ann, another tourist area with characteristics similar to those described for St. James. The problem was more severe for males in both parishes than for females; 28 percent versus 22 percent and 36 percent versus 21 percent, respectively. The third parish in this region, St. Mary, did not have a serious revisit problem despite the heavy rains which fell in that parish but had higher refusal rates than the other two parishes (about 12 percent for both females and males). All national results in this final report have been weighted to compensate for these diff- erentials in non-response as well as the over- sampling of smaller health regions and select- ion of one respondent per household already mentioned in Section II.2 - Sampling Design. -27- -28- -29- -15- CHAPTER III BACKGROUND CHARACTERISTICS OF THE SURVEY POPULATION III.1 AGE DISTRIBUTION OF THE SURVEY POPULATION One of the most important variables to be studied in enquiries relating to fertility and on associated factors which impact on population size and growth is that of age and particularly the distribution among the age ranges of the population surveyed. This distribution is meaningful, however, only if the results of the surveys are representative of the population as a whole and the age groups covered are shown to be consistent with observed structures and trends. The age distribution of the population as a whole for all population census years between 1943 and 1992 has been shown, by gender, in Table 1.v. There it was shown that the impact of lowering rates of fertility, high levels of migration and increasing life expectancy had resulted in varying trends among . the different age groups; in particular, the percentage of the under 15 population for both sexes was falling, rising in the middle age groups (up to age 35); falling again thereafter to age 54 and rising again in the oldest age groups. The age distribution of the surveyed population (15-44 for females and 15-54 for males) is given in Tables I-3.1.1 and I-3.1.2, respectively. Here, comparisons are given for the female population for the years 1982, 1983, 1987, 1989, 1992 and 1993. Estimates for 1982, 1987 and 1992 are end- year estimates derived from intercensal estimates (with 1982 adjusted from the population census data for underestimation in some age groups) and the remaining estimates from contraceptive prevalence surveys in 1983, 1987 and 1993. With respect to males, the 1982, 1987 and 1992 end-year estimates are given along with the results of the 1993 Contraceptive Prevalence Survey. The trend for females in the 15-19 age group appears to confirm the continuing decline in the under 15 age group. This is not the case for young men in this age group, however. With the percentages for both males and females falling fairly sharply in 1992, it will be important to follow up the comparative movements when the results of the 1992 Population Census become available so as to ascertain the degree of accuracy of the 1992 estimates and to determine the extent of possible overestimation in the 1993 survey. The three five-year age groups (25-39 years) show increasing percentages, failing thereafter in the other groups represented. The increases in the more fertile age groups, particularly among women is important to observe. Age is one of the background variables which will be compared with the main results of the survey. Five year age groups will be the indicator used in Volumes I, II, III and V. The age groups in Volume IV which presents data on young adults will, in general, represent two or three year age groups and where relevant, single years. The five year age classifications in Volume I will comprise the principal background variable along with other characteristics including education, religion, attendance at church services, employment and occupation. -16- Also included will be classifications relating to union status, both current and changes from initial status. In Volume II, the main variables will cover knowledge and attitudes towards family, contraception and AIDS; in Volume III they will relate to sexual exper- ience, contraceptive practice and reproduct- ive history; those in Volume V will cover all of the subjects included in the above volumes but will be presented at the health region level. The weighted percentage distri- bution of female and male respondents by five year age groups and the unweighted number of cases are given below: III.2 EDUCATIONAL ATTAINMENT Educational attainment is another variable considered to be an important factor associa- ted with fertility and the rates of growth in a population since the educational levels attain- ed are known to have influence on people's attitudes and their perceptions toward family including the size. Thus, it will be instruct- ive to examine attitudes and behavioural re- sults obtained from the survey in the context of the educational attainment of the popula- tion surveyed. Before doing this, however, it is important, as in the case of the age distribution, to examine the results derived from the classification by educational attain- ment with comparative data from other en- quiries. Tables I-3.2.1 and I-3.2.2 give the percentage distribution of educational attain- ment for the population surveyed (15-44 years for females and 15-54 years for males). Comparative figures are given for females from the 1982 Population Census and the CPSs of 1983, 1989 and 1993. For males, comparison is made with the 1982 Population Census. The 1993 survey figures support the trend, consistent for both females and males, of increasing percentages of secondary school attainers and the consequent lowered percent- ages of persons who completed their school- ing at the primary or lower levels. Trends for post-secondary appear mixed which could be contributed to by imprecise classifications in some of the enquiries. Four levels of educational attainment will be employed in the representation of the educa- tion variable. These are primary & lower, secondary not completed, secondary comple- ted, and post secondary. Primary and lower includes "no education", "primary" and "other". With respect to "other", the cate- gories included represent primary or lower levels such as schools for the disabled, other special schools and the JAMAL (Jamaican Movement for the Advancement of Literacy) classes; in addition, institutions such as creches, child care centres and play groups were included. With respect to secondary, -17- secondary - completed represents all persons who have completed five or more years of secondary education; all others who have attended secondary school and have comple- ted less than five years of schooling at that level is classified at secondary - not com- pleted. The weighted percentage distribution and the unweighted number of cases repre- sented in each of the four groups are set out below: III.3 RELIGION Religious beliefs and affiliations may also play a part in the development of fertility behaviour, although the influence of religion appears to be lessening with the rise of other competing interests. Available data demon- strate the shifts in membership away from the more traditional denominations towards those non-traditional churches which are more revivalist in nature, a development which will contribute further to the lessening influence of church membership on attitudes and behaviour and here, attendance at church may be a more significant influence than membership. The consistency of the inform- ation on religious affiliation obtained from the surveys is examined in Tables I-3.3.1 and 3.3.2. Data from the 1982 population census is used in the comparison for both females and males and additionally in the case of females, the 1989 CPS data have been pre- sented also. In some cases, comparisons are difficult, due to varying differences in classi- fication. On the overall, however, the di- rectional movement in relation to both sexes appear consistent, although levels of affili- ation differ by gender. Of note is the higher level of males than females (more than double) reporting no religion in the com- parable year. The percentages affiliated with Church of God, the religion reported most often, is significantly higher for women than for men. Also of interest is the pattern of attendance at church services, shown in Table I-3.3.3. Here, attendance at church services applies to the reporting of respondents on actual attendance at church although the services attended are not necessarily those of their religious affiliation. In the case of women, some 42 percent attend church services at least once per month, a further 46 percent attend but rarely while nearly 12 percent never attends; the corresponding percentages for males are 25 percent attending at least once per month, a further 40 percent attends rarely while nearly one third percent (32.2) never attends. In the case of females, some 40 percent (36.7 percent) with no religious affiliation attend although rarely in most cases; 52.2 percent of women and 76.4 never attends. The only other significant group is that of whose who rarely attends (7.0 percent of women and 5.1 percent of men). In earlier surveys, religious affiliation did not appear to influence the fertility behaviour -18- patterns of the respondents. From a cursory examination of the data, it appears that attendance at church services is more sensi- tive. Accordingly, for purposes of classifi- cation, this will be used as the indicator on religion. The percent contribution as well as the unweighted number of cases represented are given below. III.4 ECONOMIC ACTIVITY Economic activity is another of the factors which impact on attitudes as well as practices which affect levels of fertility, particularly among women. It is important, therefore, to include the related variables as part of the background characteristics of women and men in the sample. In the 1993 survey, in- formation on employment status, place of work and occupation have been collected for both female and male respondents. The first of these classifications relate to employment status. Here, the information identifies those respondents who were employed at the time of the survey, separating those who were working at the time from those with jobs but were not working. Categories used were: • "working"; • "with job, not working"; • "looking for work"; • "keeping house"; • at school"; • "incapable of working"; and • "other". Persons in the "keeping house" or "other" categories who "want work and are available" are not separately identified.1 The table below gives the percentage distribution of respondents in each category and number of cases represented for both females and males. -19- The percent distribution of the total popu- lation is shown in Tables I-3.4.1 and I-3.4.2, for those working and those not working, by age group. The total labour force cannot be derived from these tables since the un- employed non-seekers were not identified and are included in the categories "keeping house" and "other". What has been shown, therefore, are those in the labour force who are employed and the rest of females and males who are unemployed. As is expected, a higher percentage of men than women were employed (76.0 percent for men compared with 43.8 percent for women). There was little gender difference in percentage terms among those seeking work (10.1 of women and 9.9 percent of men); the difference between those keeping house was, however, marked (1.0 percent of men and 33.0 percent of women). Looking at the employed population by age groups, only ten percent of women in the age group 15-19 were employed with percentages increasing up the final age group of 40-44. In the age group 20-24, the percentage of those employed was almost four times that of the younger five year age group (39.2 per- cent), increasing to 54.8 percent in the age group 25-29 and gradually thereafter to 65 percent in the final age group 40-44. In the case of the men, 30 percent of the very young (age group 15-19) were employed, moving up to 78.9 percent in the next five year age group; thereafter, all other age groups had over 90 percent employed. The movement in the other categories were as expected. Another aspect of economic activity is occupational classification of respondents. The categories used are: a) - professional, technical and related; b) - administrative, executive and managerial occupations; c) - clerical and sales; d) - self-employed in- dependent producers; e) - service, sport and recreation occupations; f) - craftsmen, pro- duction and operating occupations; and g) - unskilled manual and general workers. Pro- fessional, technical and managerial workers for both females and males represent a small proportion of the employed work force, with a higher proportion of females than males (11.5 percent of females compared with 5.6 percent of males). Clerical and sales workers, on the other hand, constitute a higher proportion of the female employed work force (23.5 percent compared with 6.1 percent for males). The self employed independent producers comprise a significant proportion, some 30 percent of females and 44 percent of males. Service workers are particularly notable in the case of females, constituting the next highest group for this sex (22.0 percent compared with 8.8 percent for males). Craftsmen, production and oper- ating occupations, on the hand, demonstrate the opposite pattern (26.6 percent for males, the next highest group for this sex, with 8.4 percent for females) while a lower percent- age (3.8 percent for females and 8.4 percent for males) comprise the group - unskilled manual and general workers. Occupation groups classified by place of work (outside the home, inside the home, or both) are shown below: Women aged Men aged Place of work 15-44 15-54 Outside the home 82.2 88.9 Inside & outside the home 3.0 5.2 Inside the home only 14.8 5.9 Total 100.0 100.0 No. of cases (1,295) (2,312) As is expected, the majority of respondents work outside the home (82.2 percent of women and 88.9 percent of men). A smaller proportion (3.0 percent and 5.2 percent for -20- women and men respectively work both out- side and outside of the home while the re- mainder (14.8 percent and 5.9 percent for women and men respectively) perform econ- omic activities inside the home only. III.5 RESIDENCE Place of residence has, in many studies, been demonstrated to have some influence on fac- tors which impact on the fertility of the population. In keeping with these findings, geographic dispersion of respondents has been used as another major background char- acteristic. The composition of the geo- graphic areas designated as urban and rural has been shown in Table l.v. The consistent increase in the areas classified as major urban is evident in the table, with a per- centage contribution of 38.0 percent in 1991 compared with 26.6 percent in 1960. The population in the surveys in both urban and rural areas represents subsets of the total population which might move in different, directions from the total, based on the age distribution patterns of migration, internal and/or external, from each area. The move- ment in the 1993 CPS may be compared with that of the 1989 CPS for females. Here, the increase in urban areas was from 30.7 per- cent in 1989 to 34.9 percent in 1993. The percentage of males in urban areas in the 1993 CPS is slightly lower than for females (31.5 percent compared with 34.9 percent for females). The breakdown into urban and rural areas will be employed in the creation of the residence indicator, the composition of which is represented in the percent contribution of the respondents in the 1993 survey and the unweighted number of cases covered, as indi- cated below: III.6 CHILDREN EVER BORN Parity is another of those factors which impact on attitudes towards fertility and the planning of families. Accordingly it is a very important variable to be used in the analysis of some of the variables being examined. In the case of the reporting on children ever born by women, these is some possibility of error due to the recall factor. Also, children who die at birth or in infancy can often be overlooked. In the case of men, not only are the above factors relevant but, in addition, there is some possibility that men can be unaware of some children born to women, either because the women them- selves are not sure of the paternity of the children but in some cases they, for a number of reasons, do not communicate the information to the fathers. Accordingly, the information on children ever born relates to those reported rather than to all children ever born and the extent of under-reporting is probably higher for men than for women. Taking these factors into account, the percent distribution of children ever born together with the unweighted number of cases reported are shown below: -21- III.7 SOCIO-ECONOMIC INDEX A further classification which will be employed in the analysis of the impact of social, economic and cultural factors on the respondent population is a socio-economic index, developed mainly on the education and occupation of the head of the household but also considered on the basis of elements pertaining to the household density and access to media by household members. The items used in this latter comparison are: number of rooms occupied by household members, possession by members of the household of radio and television, and readership of newspapers by household members. The trends observed were analy- zed on the basis of expected trends, taking into account the anticipated movement of each variable. Within educational attainment and occupation categories, the physical density and access to media variables were very consistent for each gender for both the male and female surveys. With the consistency found, the principal ex- planatory variables were educational attain- ment and occupation status. Thus, it was concluded that a validated index based on education and occupation, with adaptation, could be utilized for the socio-economic index. (See Appendix II for a more detailed description of the methodology).2 Four ranks have been employed in setting up the index. These are: high, medium, low and very low. In addition, there was in- sufficient information for some 2.5 percent of female respondents and 2.2 percent of male respondents to allow for their classifi- cation. Based on these factors and on the methodology employed in constructing the index, the percent distribution and the un- weighted number of cases represented were computed, the result of which is given, by rank, below: The Socio-Economic Index will be used in all of the volumes to represent the impact of socio-economic factors on fertility behaviour and other related characteristics. -30- -31- -32- -33- -34- -35- -22- CHAPTER IV NUPTIALITY AND RELATIONSHIP STATUS IV.1 MARITAL AND UNION STATUS Marital or union status, regarded as one of the primary direct determinants of fertility in any population, may be used for the purpose of identifying the degree to which women in the reproductive age are sexually active. In a population in which the majority of child- bearing activities take place within unions, this can be approximated by nuptiality or the proportion of time women spend in formal or informal unions. In Jamaica, as in most Caribbean and Latin American countries, sexual unions occur not only in the context of legal marriage, but also in common-law and visiting unions, and particularly for young adults, within relationships which are not necessarily steady - often regarded as having a boyfriend or a girlfriend with whom there is some sexual activity. Accordingly, a study of sexual activity must take account not only persons who are legally married but also those who, though not legally married, are living in some sexual union or are being generally sexually active. In this report, the concern is not on the legality of marriage but rather the status of the union. Thus, four sexual relationships are identified for study. These are: a) Legally married - a union in which a woman or a man is legally married and lives with her or his spouse. b) Common-law - a union in which a woman or a man lives together with a partner to whom she or he is not legally married. c) Visiting - a union in which a woman or a man reports that they have regular sexual relations with a partner but does not live together with him or her and they describes it as a visiting relationship. d) Boyfriend/girlfriend - a relationship which does not fall in either of the three unions specified above, in which the woman or man reports that they are having a relationship with some one of the opposite sex, described as a boyfriend or a girlfriend. There may or may not be sexual intercourse bet- ween the two partners. If there is, it is classified as boyfriend/ girlfriend with sexual relations; if not, then the classification is boyfriend/girlfriend without sexual relations. Unless otherwise specified, "in union" includes categories (a), (b) and (c) and excludes category (d). The relationship status of both females and males has been studied in the 1993 CPS while in 1989 and in earlier CPSs, the study was confined to females only. Table I-4.1.1 presents data on the percent distribution of women aged 15-44 years by current union status by five year groups for 1993 and 1989; Table I-4.1.2 presents comparable data for men aged 15-54, also by five year age groups, for 1993 only. In these tables, "current union status" represents not only those "in union" but includes those with boyfriend/girlfriend, with or without sex and those with no steady partner. On the whole, the patterns of association of female respond- -23- ents has remained fairly steady although some variations may be observed over the four year period. Whereas there has been practically no change among women in union (69 percent compared with 68 percent) bet- ween 1989 and 1993, the proportion of legal unions appear to have fallen (15.1 percent in 1989 to 13.4 percent in 1993); and both common-law and visiting unions have pro- portionately increased, none of these dif- ferences are statistically significant. There was a slight increase in the proportion of women with boyfriends with whom they had sex but a corresponding decrease, again slight, in those with boyfriend with whom they were not having sex. In the case of those with no steady partner, there was a slight decline. Again, none of these dif- ferences are statistically significant. Patterns among women and men are not very dissimilar, the main difference being those in common-law relationships (23.5 percent of women and 20.9 percent of men) and those with boyfriends/girlfriends with whom they are having sex (5.3 percent of women with boyfriends with whom they are having sex compared with 9.8 percent of men with girlfriends with whom they are having sex). There is a consistent rise in the proportion of respondents, women and men, who are legally married and living with spouse, as age increases. In the case of common-law unions, a similar increase is observed up to age 34 years, generally falling off thereafter. Visiting unions tend to be more intense bet- ween ages 20-24 again for both women and men, falling off thereafter, although the decrease in the case of men is more gradual for the age group 25-29. Tables I-4.1.3 and I-4.1.4 present classifi- cations of current union status by residence, educational attainment, religion and parity for 1993 and 1989 for women while Table I- 4.1.5 shows the classifications for men in 1993. As in 1989, the proportion of women in legally married unions is higher in rural than in urban areas; this is true also of the men. Proportionately, the reverse is true for the women and men in the other unions; that is, there are higher proportions of women and men living in common-law unions and with visiting partners in the urban than in the rural areas. With respect to education, female secondary school graduates continue to appear atypical in respect to union status, with a higher percentage reporting "no steady partner" (24.2 percent compared with 19.1 and 19.9 percent for primary and lower and post secondary in 1993; in 1989 the corresponding percentages were 26.9 percent compared with 20.3 and 24.3 percent respectively). The differentials in the case of those legally married is perhaps the most significant. The comparisons by parity presents no surprises, being generally consistent between 1993 and 1989 in the case of women and for 1993 between women and men. It should be noted that parity in the case of men represents those children reported by them and does not necessarily represent all the children they have ever had since it is very probable that a number of children fathered by them was not even known by them. In all cases, the highest proportion of women, for both 1993 and 1989, with no children ever born were to those with no steady partner followed by those in visiting unions. In the case of men, the highest percentage was in the case of those with visiting partner, followed by those with no steady partner. Next were those with girlfriends with whom they were having sex. In all cases, the movement in the percentages was upward for those who were legally married as parity increased. There was a similar pattern for those in common- law unions for both women (in 1993 and 1989) and men (in 1993), whereby the per- -24- centage was highest for those in visiting unions for one child, reducing thereafter. Whereas in the case of women, however, the increase for those with one child was signi- ficantly higher that for those without any children, for men, there was not much dif- ference between the two. IV.2 UNION HISTORY Information on the change in status of women currently in union, from that of ini- tial status to that of the present status is given in Tables I-4.2.1 and 4.2.2 for women and men for 1993. Patterns are fairly similar for both women and men in 1993. For women, 5.1 percent remained in a marriage relationship from the start of the initial union; the corresponding percentage for men is 4.6 percent. Again for women, 5.5 per- cent of those now legally married started out the relationship in a common law union, 49.3 percent with a visiting partner and 30.1 percent with a boyfriend. In the case of men, 11.8 percent started out with a common law partner, 43.8 percent as visiting and 39.8 percent with a girlfriend. In the case of those now in common law unions, 2.4 percent of women and 8.7 percent of men have maintained the same status while only a minimum number of women and men (0.1 percent in both cases) started off as married; of the rest, 57.1 percent of women and 52.0 percent of men changed from a visiting relationship to common law, while 40.5 percent of women and 39.2 percent of men started out as boyfriend and girlfriend respectively. The movement within those now in visiting relationships showed a similar pattern; 45.5 percent of women and a slight- ly higher percentage (50.0 percent) of men did not change status while 0.9 and 1.1 per- cent of women and 1.3 and 1.4 percent of men changed from the more stable (legally married and common law) to the less stable status; 52.5 percent of women moved from boyfriend to visiting while the corresponding percent moving from girlfriend was 47.3 percent. Changes by residence, age and education also show the similarity of movement between women and men demonstrated above in the case of those in a legal marital relationship; differences between them may, however, be observed in those currently in common law unions and in visiting relationships. A generally lower percentage of women than of men have maintained their initial relationship over all the characteristics, with little variation by residence but more marked changes by educational attainment, with less stability among those with primary and lower education than in the other two groups. Looking at upward changes toward greater stability among unions, the patterns were similar. -36- -37- -38- -39- -40- -25- NOTES 1. The definition of the labour force recommended by the United Nations comprise the following: i). Working; ii). With job, not working; iii). Looking for work; iv). Wanting work and available for work. It should be noted that a measurement of the total labour force is not available from the 1993 CPS since category (iv) has not been separately identified. The only measurement that is available, therefore, is based on the restricted (categories i - iii) rather the extended definition (all categories). 2. The Socio-Economic Index used in this Report is similar to the Hollingshead Index, with adaptations to take account of Jamaican conditions. The methodology used in the development of the Index is given in Appendix II. 3. "Professional, technical & related" is grouped with "administrative, executive & managerial" to form the first group; all other groups excluding "unskilled manual and general workers" are in the second group. REFERENCES Contraceptive Prevalence Survey, Jamaica - 1983 by Dorien Powell. National Family Planning Board; August 1984. Contraceptive Prevalence Survey, Jamaica - 1989 by Carmen McFarlane and Charles Warren. National Family Planning Board; December 1989. Demographic Statistics - 1988. Statistical Institute of Jamaica; 1993. Hollingshead, August B. Two Factor Index of Social Position; 1957. Privately mimeo-graphed. 1965 Yale Station, New Haven, Connecticut. Jamaica Fertility Survey 1975-76, Country Report, Vol. II. Dept. of Statistics, Kingston, Jamaica; 1979. Population Census of Jamaica - 1982. Department of Statistics, Jamaica; 1986, 1987. Population Census of Jamaica - 1991: Pre-liminary Report. Statistical Institute of Jamaica; 1992. A Statement of National Population Policy. Prepared by the Population Policy Task Force, Ministry of Health, August 1981; revised by Population Policy Coordinating Committee, National Planning Agency, December 1982. Young Adult Reproductive Health Survey, Jamaica - 1987, National Family Planning Board in collaboration with Dorien Powell and Jean Jackson with technical assistance from Statistical Institute of Jamaica and Centres for Disease Control; March 1988. Yinger, N., Ochoa, L. H., Morris L., and Hirsch, J. Adolescent Sexual Activity and Childbearing in Latin America and the Caribbean: Risks and Consequences. Population Reference Bureau, Washington D.C 1992. -41- APPENDIX I SAMPLING ERRORS The estimates for a sample survey are affect- ed by two types of errors: (1) sampling error, and (2) non-sampling error. Non-sampling error is the result of mistakes made in carrying out data collection and data processing, including the failure to interview the correct household, errors in the way questions are asked or understood, and data entry errors. Although quality control efforts were implemented during the design of the survey in order to minimize this type of error, non-sampling errors are impossible to avoid completely and are difficult to evaluate statistically. Sampling error is defined as the difference between the expected value for any variable measured in a survey and the value estimated by the survey. Sampling error is a measure of the variability between all possible samples that could have been selected from the same population using the same sample design and size. For the entire population and for large subgroups, the sample size in the Jamaica survey is large enough that sampling error for most estimates is small. However, for small subgroups, sampling errors are larger and may affect the reliability of the estimates. Because the statistics presented in this report are based on a sample, they may differ by chance variations from the statistics that would result if all women 15-44 years of age or all men 15-54 years of age in Jamaica had been interviewed. The standard error of an estimate (or sampling error) is a measure of such differences. The standard error can be used to calculate confidence intervals for estimated statistics. The estimated sampling errors for selected percents and sample sizes are shown in Table A-l. The chances are about 68 out of 100 (about two out of three) that sample estimate would fall within one standard error of a statistic based on a complete count of the population. The chances are about 95 in 100 that a sample estimate would fall within two standard errors of the same measure obtained if all people in the population were inter- viewed. To obtain the sampling error for percents or sample sizes not shown in the table, one may interpolate. For example, for a sample size of 200 and an estimate of 25 percent, the sampling error would be 3.55 percent, halfway between the values of 3.3 and 3.8 for 20 and 30 percent, respectively; for an estimate of 40 percent and a sample size of 350, the sampling error would be 3.05 percent, halfway between the values for 300 and 400. Statistical differences between percents discussed in this report were found to be statistically significant at the 5 percent level using a 2-tailed normal deviate test. This means that in repeated samples of the same type and size, a difference as large as the one observed would occur in only 5 percent of samples if there were, in fact, no difference between the percents in the population. In the text, terms such as "greater," "less," "increase," or "decrease" indicate that the observed differences were statistically signi- ficant at the 0.05 level using a 2-tailed nor- mal deviate test. Statements using the phrase "the data suggest" indicate that the difference -42- was significant at the 0.10 (10 percent) level but not the 0.05 (5 percent) level. Lack of comment in the text about any two statistics does not mean that the difference was tested and found not to be significant. The relative standard error (or coefficient of variation) of a statistic is the ratio of the standard error to the statistic and usually is expressed as a percent of the estimate. In this report statistics with a relative standard error of 30 percent or more are generally in- dicated with an asterisk (*). These estimates may be viewed as unreliable by themselves, but may be combined with other estimates to make comparisons of greater precision. * Based on an overall average design effect of 1.4. -43- APPENDIX II SOCIO-ECONOMIC INDEX - METHODOLOGY The socio-economic index is designed to pro- vide a measure of the effect of socio- economic factors on the behaviour of the persons being surveyed. The index deve- loped is similar to the Hollingshead Socio- economic Index, with a minor variation which will be described later. The Hollings- head Index assumes the characteristics of the head of the household as the main determi- nant of status and uses as elements of such definition a combination of educational attainment and occupation of the head. The socio-economic index used in the analyses of the subsequent volumes adopts the principle of the Hollingshead Index as outlined, adapting it to the Jamaican situation. The first investigation which was carried out was an examination of the characteristics of the household based on gender, involving an identification of the numbers of female and male heads in the two surveys. With respect to the categorization of head, in both sur- veys, a head of household was identified in accordance with instructions given to inter- viewers which were to record as the house- hold head any person identified as such by the person giving the information, the only criterion being that the head should be adult and acknowledged as such by the household. The results obtained indicate some bias to- wards male household heads, particularly in the male survey. There was an almost fifty/ fifty breakdown (49.7 percent of female- headed households to 50.3 percent of male- headed households) in the female survey. In contrast, in the male survey, the breakdown is much more heavily weighted in favour of the males (28.4 percent of female-headed households compared with 71.6 percent of male-headed households). This arose mainly from the design of the sample and the fact that it appears that more of the smaller households and particularly one-person households are headed by males (for example, the 18.6 percent of one-person households in the male survey [headed of course by males] compared with 3.1 percent being one-person households [headed by women] in the female survey). -44- How do the patterns relating to gender of the head of the household therefore compare be- tween the two surveys. The categorization on educational attainment demonstrates pat- terns relating to earlier years, indicating the older age ranges of the heads. This is con- sistent in both surveys. The percentages move in the same direction in the two sur- veys although there are slight differences in the percent distribution in the two surveys. In the case of the breakdown by occupation, on the other hand, the patterns are consistent in both surveys and are fairly close to those of the respondent population.3 In respect of the household heads, however, the lower rates of employment among women is more pronounced than among the respondents. It would appear, therefore, that while some difference has been observed in relation to educational attainment, the significance of the gender of the household head with respect to occupation is not meaningfully different bet- ween the two surveys. It appears, therefore that, despite the observed bias in gender of household head in the two surveys, the cate- gorization based on educational attainment and occupation appear to reflect the break- down expected for household heads and is consistent with the overall population. The representation of the categories by educational attainment and by occupation groups showing percentage distribution and unweighted number of cases in each of the two surveys by gender of household head are set out below: How do the differences appear in relation to factors which are not expected to be influen- ced by gender. Occupancy of households by number of rooms was next examined. Here, the variable used was number of rooms occupied by the household. From the -45- results, it would appear that gender does have some effect on room occupancy al- though on the overall, the movement is generally consistent. The next stage in the examination of the data was to classify the heads of households based on the breakdown of their educational attain- ment and occupation with the possession of radios and television by household members and their readership of the main national newspapers. The information relating to these characteristics are set out below: -46- From the above, it may be seen that the pat- tern of ownership appears to reflect the status of the heads, with the movement in both sur- veys being in the expected direction when classified by both educational attainment and occupation. The more significant movement is in respect to television ownership since the possession of one or more radios is more universal than that of television sets. This expected movement is also apparent in relation to readership of national newspapers as shown below, taking into account the gen- eral readership in terms of class: -47- As indicated earlier, the Index of Social Well-being is comparable to the Hollingshead Index, but has been adapted to Jamaican con- ditions. The significant difference is that all -48- persons falling in the "Professional/Manager- ial" group has been ranked as "high" regard- less of educational attainment. The treatment in the Hollingshead Index is to distinguish persons in that category in terms of their educational attainment; thus persons who had gone no further than "primary" would be classified as "medium" rather than as "high" regardless of their occupational status. However, an adaptation for Jamaica is to allocate those persons with primary and lower levels of education who are in the "professional/managerial" group to "high", which takes into account the educational system of earlier years. Many older persons with only primary education have advanced in their jobs despite this low level of education and accordingly enjoy a high status in the society. Thus, in terms of their likely status, they have been ranked as "high" in the Index. The Algorithm employed in the Socio- Economic Index is accordingly as follows: -51- APPENDIX IIIA HOUSEHOLD QUESTIONNAIRE - FEMALE 1993 CONTRACEPTIVE PREVALENCE SURVEY - JAMAICA FORM CPS 1A HOUSEHOLD QUESTIONNAIRE - FEMALE CONFIDENTIAL CAP. 368 Identification No. Questionnaire No. 1 _______________ Parish Constituency E.D. No. Dwelling No. H/hold No. Eligible Respondents Sex 1 Interview calls 1 2 3 Final Visit Day (Date) Month Interview Status * Eligible Respondent ** Interviewer's Name Supervisor's Name Next Visit: Date Time * Interview Status Codes: ** Eligible Respondent Codes 1. Completed household interview 3. Vacant dwelling 2. Not at home - deferred 4. Refusal 1 Yes 8. Other (specify): 5. Partly completed 2 No FOR OFFICE USE ONLY: Reviewed by: Position: Date: Edited by: Date: -52- - 2 - 10. How many persons live in this household? number PLEASE RECORD THE NAMES OF ALL PERSONS WHO USUALLY LIVE AT THIS LOCATION. THIS SHOULD INCLUDE ALL WHO USUALLY EAT AND SLEEP HERE. YOU SHOULD START WITH THE HEAD OF THE HOUSEHOLD. HOUSEHOLD SCHEDULE EDUCATIONAL SEQUENCE NAME SEX AGE STANDARD NO. Please give me the names What is the Is [NAME] How old Highest [Eligible of the persons who usually relationship male(l) or is he/she? Level Years Women] live in your household to the head * female (2) (years) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 -53- - 3 - * Relationship codes: ** Educational standard codes: Level Years N/S 1 Head 0 None 2 Spouse of head 1 Primary 1 2 3 4 5 6 7 8 + 9 3 Child of head 2 Secondary 1 2 3 4 5 6 7 8 + 9 4 Other relative of head 3 Post secondary 1 2 3 4 5 6 7 8 + 9 8 Other 8 Other 9 Not stated 9 Not stated 11. Number of women aged 15-44 years living in household (Total number of eligible women recorded in the Schedule) number 12. Now, 1 would like you to tell me the occupation of the head of the household. Occupation For office use only 13. How many rooms does your household occupy (exclude bathrooms and kitchen) ? number 99 No response 14. Who gave this information? [BY OBSERVATION] 1 One of the eligible female respondents 2 Other household member 3 Neighbour 8 Other (specify): ___________________________________________________ IF THERE IS ONE OR MORE ELIGIBLE RESPONDENTS, SELECT THE ONE TO BE INTERVIEWED, BASED ON THE INSTRUCTIONS GIVEN AND USING THE RANDOM TABLE SHOWN OVERLEAF. THEN COMPLETE THE INDIVIDUAL QUESTIONNAIRE FOR THE SELECTED RESPONDENT. IF THERE ARE NO ELIGIBLE RESPONDENTS, COMPLETE TITLE PAGE AND MOVE ON TO THE NEXT HOUSEHOLD. -54- -4- RANDOM SELECTION OF RESPONDENT Questionnaire No. 1 No. of Eligible Respondents Last digit on questionnaire number Last digit of number of eligible women 1 2 3 4 5 6 7 8 9 0 1 2 3 1 2 5 2 8 7 1 1 1 1 2 3 6 3 1 8 2 1 2 2 3 4 1 4 2 9 3 1 1 3 4 5 2 5 3 1 4 1 2 1 1 1 3 6 4 2 5 1 1 2 2 2 4 7 5 3 6 1 2 3 3 3 5 1 6 4 7 1 1 1 4 4 6 2 7 5 8 1 2 2 1 5 1 3 8 6 9 1 1 3 2 1 2 4 1 7 SEQUENCE NUMBER OF WOMAN SELECTED FOR INTERVIEW: AFTER COMPLETING THE HOUSEHOLD QUESTIONNAIRE, RETURN TO TITLE PAGE AND COMPLETE INFORMATION ON INTERVIEW CALLS COMMENTS -55- APPENDIX IIIB INDIVIDUAL QUESTIONNAIRE - FEMALE 1993 CONTRACEPTIVE PREVALENCE SURVEY - JAMAICA FORM CPS 2 INDIVIDUAL QUESTIONNAIRE – FEMALE CONFIDENTIAL (For Eligible Female Respondents aged 15-44 Years) CAP. 368 Identification No. Parish Constituency E.D. No. Dwelling No. H/hold No. Sequence Number Sex 1 Interview calls 1 2 3 Final Visit Day Month Interview Status * Interviewer's Name Supervisor's Name Next Visit: Date Time * Interview Status Codes: 1. Completed household interview 4. Refusal 2. Not at home - deferred 5. Partly completed 8. Other (specify): FOR OFFICE USE ONLY: Reviewed by: Position: Date: Edited by: Date: -56- - 2 - SECTION I - RESPONDENT'S BACKGROUND TIME INTERVIEW STARTED . 101. In what month and year were you born? month 1 9 year 99 Don't know 102. How old were you on your last birthday? years 103. In what parish was your mother living at the time of your birth, or in what country other than Jamaica ? 1 Kingston 8 St. James 2 St. Andrew 9 Hanover 3 St. Thomas 10 Westmoreland 4 Portland 11 St. Elizabeth 5 St. Mary 12 Manchester 6 St. Ann 13 Clarendon 7 Trelawny 14 St. Catherine 88 Other country (specify):____________________________________ 104. Have you ever attended school? 1 Yes 2 No (SKIP TO Q. 106) 105. How many years of primary, secondary and/or post secondary schooling did you complete? NOT LEVEL ____________YEARS ___________ SPECIFIED 1 Primary 0 1 2 3 4 5 6 7 8+ 9 2 Secondary 0 1 2 3 4 5 6 7 8+ 9 3 Post secondary 0 1 2 3 4 5 6 7 8+ 9 4 Other (specify): ______________________________________________ 9 Refused/not stated 106. What is your religion? 1 Anglican 8 Roman Catholic 2 Baptist 9 Seventh Day Adventist 3 Church of God 10 United Church 4 Methodist 88 Other (specify: 5 Pentecostal __________________________ 6 Rastafarian 98 No religion 7 Revivalist 99 No response -57- - 3 - 107. With what frequency do you attend religious services? 1 At least once a week 2 At least once a month 3 Rarely 6 Do not attend 9 No response 108. What is your employment status? 1 Working 2 With a job but not working 3 Looking for work 4 Keeping house 5 At school SKIP TO Q. I l l 6 Incapable of working 8 Other (specify):_________________________________________________ 109. Do you work outside or inside the house? 1 Inside only 2 Outside 3 Both 110. What is your occupation? Occupation For office use only 9999 No response 111. Do you have radio and/or television in the household and if so, how many? Yes No Number 1 Radio 1 2 2 Television 1 2 112. Do members of the household read any newspapers and with what regularity? [STATE THE GREATEST REGULARITY APPLICABLE WITHIN THE HOUSEHOLD] Daily Weekly Rarely Never 1 Gleaner 1 2 3 4 2 Jamaica Herald 1 2 3 4 3 Star 1 2 3 4 8 Other (specify)______________________1 2 3 4 -58- - 4 - SECTION II - RELATIONSHIP STATUS AND PARTNERSHIP HISTORY Now, I would like to ask you .some questions about your steady relationships. 201. Are you legally married now? 1 Yes (SKIP TO Q. 203) 2 No 202. Are you and your husband living together as man and wife now? 1 Yes (SKIP TO Q. 206) 2 No 203. Are you living with a common-law partner now? [IF RESPONDENT DOES NOT APPEAR TO UNDERSTAND THE TERM "COMMON-LAW", ASK]: Are you living as man and wife now with a partner to whom you are not legally married? 1 Yes (SKIP TO Q. 206) 2 No 204. Do you have a visiting partner, that is, a more or less steady partner with whom you have sexual relations? 1 Yes (SKIP TO Q. 206) 2 No 205. Do you have a boyfriend? 1 Yes (SKIP TO Q. 207) 2 No (SKIP TO Q. 209) 206. When you and your husband/partner first started together, what type of relationship did you have? [READ OPTIONS]. 1 Married 2 Common-law 3 Visiting partner 4 Steady boyfriend SKIP TO Q.208 207. Have you ever had sexual intercourse with your present boyfriend? 1 Yes 2 No (SKIP TO Q. 209) -59- - 5 - 208. In what month and year did your present relationship start? month 1 9 year 98 Doesn't remember 209. What is the total number of partners, including your present partner if any, you have had in the past five years? number 90 Many partners, more than 10 98 Doesn't remember IF "00", SKIP TO Q.212. IF "01" AND Q. 208 IS BLANK, SKIP TO Q. 211. IF "01" AND THERE IS A RESPONSE AT Q.208, SKIP TO Q. 213. IF "02" OR MORE, CONTINUE. 210. When you and your first partner started together, what type of relationship did you have ? [READ OPTIONS] 1 Married 2 Common-law 3 Visiting partner 4 Steady boyfriend 211. In what month and year did your first relationship start? month 1 9 year 98 Doesn't remember (month/year) 212. Have you ever had sexual intercourse? 1 Yes 2 No (SKIP TO Q. 301) 213. At what age did you first have sexual intercourse? years SKIP TO Q.213 98 Doesn't remember -60- - 6 - SECTION III - FERTILITY Now. we arc fining to talk about your history of menstruation and your childbearing history. Sonic of the questions niav not apply to you. In these eases, just say so. 301. How old were you when your first period started (first started menstruation)? age 77 Never had a period (SKIP TO Q. 303) 302. How long has it been since your last period (your last menstruation)? months 00 Currently having a period 01 Up to one month 96 Does not have a period (menstruate) any more 97 Before last pregnancy 98 Don't remember IF RESPONDENT HAS NEVER HAD SEX [Q. 212 = "NO"], SKIP TO Q. 401. ALL OTHERS, CONTINUE. 303. Have you ever been pregnant? 1 Yes 2 No 304. Are you currently pregnant? 1 Yes 3 Not sure 2 No IF RESPONDENT ANSWERED "YES" TO Q. 303 AND "YES" TO Q. 304, CONTINUE. IF RESPONDENT ANSWERED "YES" TO Q. 303 AND EITHER "NO" OR "NOT SURE" TO Q. 304, SKIP TO Q. 306. IF RESPONDENT ANSWERED "NO" TO Q. 303 AND "NO" OR "NOT SURE" TO Q. 304, SKIP TO Q.401. -61- - 7 - 305. When do you expect to give birth'} month 1 9 year 306. Just before you became pregnant with this child (your last child) did you . [READ] Yes No A Smoke any kind of tobacco products 1 2 B Drink any alcoholic beverages 1 2 307. During the past month, have you . [READ] Yes No A Smoked any kind of tobacco products 1 2 B Drunk any alcoholic beverages 1 2 308. During the 12 months before your last (this) pregnancy, did you use any contraceptive method, even for a short time, to avoid getting pregnant? 1 Yes 2 No (SKIP TO Q. 312) 309. What was the last method you used during that time? 1 Female sterilization, tubal ligation 8 Foaming tablets 2 Male sterilization, vasectomy 9 Creams/jellies 3 Implant (Norplant) 10 Diaphragms 4 Injection 11 Withdrawal 5 Pill 12 Rhythm (calendar method) 6 Intra-uterine device/coil 13 Billings method 7 Condom 88 Other (specify): 310. Did you become pregnant while you were using [LAST METHOD]? 1 Yes (SKIP TO Q. 312) 2 No 311. What was the main reason you stopped using [LAST METHOD]? 1 Wanted to get pregnant 5 Cost too much (SKIP TO Q. 314) 6 Inconvenient to use 2 Husband/partner disapproved 7 Infrequent sex 3 Health concerns 8 Other (specify): _____________ 4 Accessibility/availability 9 Don't know -62- - 8 - 312. When you became pregnant with your last (current) pregnancy, did you want to become pregnant? 1 Yes (SKIP TO Q. 314) 2 No 3 God's will, fate, didn't think about it (SKIP TO Q. 314) 4 Don't know, not sure (SKIP TO Q. 314) 313. Was it that you wanted no more children, or that you just wanted to wait longer before another pregnancy? 1 Wanted no more children 8 Don't know, not sure, don't remember 2 Wanted to wait longer Now we want to collect information on the number of times you have been pregnant. 314. How many pregnancies resulted in live births? 315. How many in still births? 316. How many in miscarriages? 317. How many in abortions? 318. Currently pregnant? [ENTER "1" if "YES" at Q. 304] 319. Therefore, the total number of your pregnancies is: 320. How many live births have you had? IF SHE HAS HAD ONE OR MORE MISCARRIAGES OR ABORTION (THAT IS, TERMINATION OF PREGNANCY), CONTINUE ALL OTHERS, SKIP TO BOX ABOVE Q. 329. 321. Vie last time that you lost a baby before seven months of pregnancy, what month and year was it? month 1 9 year 98 Don't remember (month/year) 322. Was it a miscarriage or an induced abortion (that is, a termination of pregnancy) ? 1 Miscarriage (SKIP TO BOX ABOVE Q. 329) 2 Abortion 9 Refusal (SKIP TO BOX ABOVE Q. 329) -63- - 9 - 323. Who performed the abortion? 1 Doctor 5 Herself 2 Nurse 6 Friend, family member 3 Midwife 8 Other (specify): 4 Nana _________________________________ 324. After the abortion did you have complications which required treatment? 1 Yes 2 No (SKIP TO BOX ABOVE Q. 329) 325. Where were you treated? 1 Government hospital 5 At home 2 Private hospital 6 At home of relative or friend 3 Private clinic/doctor- 8 Other (specify): 4 Pharmacy ______________________________ 326. How many nights did you spend in the hospital? nights IF SHE ANSWERED "GOVERNMENT OR PRIVATE HOSPITAL",[CODE 1 OR 2], CONTINUE ALL OTHERS, SKIP TO QUESTION 327. 98 Don't know 327. Do you still have a health problem as a result of the abortion? 1 Yes 2 No (SKIP TO BOX ABOVE Q. 329) 328. What is the problem ? Mentioned Not Mentioned A Pain 1 2 B Sterility 1 2 C Infection 1 2 -64- - 10- IF SHE IS CURRENTLY PREGNANT WITH HER FIRST PREGNANCY (Q. 304 = "YES" AND TOTAL PREGNANCIES IN Q. 319 = "1"), OR IF SHE HAS HAD NO LIVE BIRTHS ("00" IN Q. 320) SKIP TO QUESTION 401. OTHERWISE, CONTINUE. Now, 1 would like to talk to you about all the live births you have had. 329. Beginning with your last live birth, please give me the names and dates of birth of each. [WHEN YOU HAVE COMPLETED THE RECORDING, CHECK Q.320 TO ENSURE THAT THE ANSWER IS CONSISTENT. IF NOT, QUERY AND CORRECT AS APPROPRIATE] Birth Date Birth Order Name Month Year Last birth 1 9 Next to last 1 9 Second from last 1 9 Third from last 1 9 Fourth from last 1 9 Fifth from last 1 9 Sixth from last 1 9 Seventh from last 1 9 Eighth from last 1 9 Ninth from last 1 9 Tenth from last 1 9 Eleventh from last 1 9 Twelfth from last 1 9 98 Don't remember (month/year) 330. How many of your live births occurred from January 1, 1988? number IF LAST LIVE BIRTH WAS BEFORE JANUARY 1, 1988 ["00 " IN Q. 330], SKIP TO QUESTION 342. FOR ALL BIRTHS ON OR AFTER JANUARY 1, 1988, RECORD THE NAMES AND DATES OF BIRTH IN THE BIRTH HISTORY CHART ON NEXT PAGE BIRTH HISTORY CHART (Only for live births occurring from January 1, 1988) Last birth Next to last birth Second from last birth Third from last birth Fourth from last birth NAME 331. Is [NAME] a boy or a girl? 1 Boy 2 Girl 1 Boy 2 Girl 1 Boy 2 Girl 1 Boy 2 Girl 1 Boy 2 Girl 332. When you were pregnant with [NAME] were you given any injection to prevent the baby from getting tetanus, that is lockjaw? 1 Yes 2 No (SKP TO Q.334) 8 Don't know (SKIP TO Q.334) 1 Yes 2 No (SKP TO Q.334) 8 Don't know (SKIP TO Q.334) 1 Yes 2 No (SKP TO Q.334) 8 Don't know (SKIP TO Q.334) 1 Yes 2 No (SKP TO Q.334) 8 Don't know (SKIP TO Q.334) 1 Yes 2 No (SKP TO Q.334) 8 Don't know (SKIP TO Q.334) 333. How many? ___ Number ___ Number ___ Number ___ Number ___ Number 334. When you were pregnant with [NAME] did you see anyone for a check on this pregnancy? 1 Yes 2 No (SKIP TO Q. 337) 1 Yes 2 No (SKIP TO Q. 337) 1 Yes 2 No (SKIP TO Q. 337) 1 Yes 2 No (SKIP TO Q. 337) 1 Yes 2 No (SKIP TO Q. 337) 335. Where did you go for most of this care? 1 Gov't health centre/clinic 2 Gov't hospital 3 Pvte hosp. 4 Rur. mat. centre 5 Pvt doctor/ clinic 6 Midwife 7 Other 1 Gov't health centre/clinic 2 Gov't hospital 3 Pvte hosp. 4 Rur. mat. centre 5 Pvt doctor/ clinic 6 Midwife 7 Other 1 Gov't health centre/clinic 2 Gov't hospital 3 Pvte hosp. 4 Rur. mat. centre 5 Pvt doctor/ clinic 6 Midwife 7 Other 1 Gov't health centre/clinic 2 Gov't hospital 3 Pvte hosp. 4 Rur. mat. centre 5 Pvt doctor/ clinic 6 Midwife 7 Other 1 Gov't health centre/clinic 2 Gov't hospital 3 Pvte hosp. 4 Rur. mat. centre 5 Pvt doctor/ clinic 6 Midwife 7 Other -65- 336. How many rimes did you go ? times times times times times 337. Where did you give birth to [NAME]? 1 Victoria Jubilee 2 Other Gov't hosp. 3 Pvte hospital 4 Pvte nursing home 5 Rur. mat. centre 6 Own home 7 Home of relative or friend 8 Other 1 Victoria Jubilee 2 Other Gov't hosp. 3 Pvte hospital 4 Pvte nursing home 5 Rur. mat. centre 6 Own home 7 Home of relative or friend 8 Other 1 Victoria Jubilee 2 Other Gov't hosp. 3 Pvte hospital 4 Pvte nursing home 5 Rur. mat. centre 6 Own home 7 Home of relative or friend 8 Other 1 Victoria Jubilee 2 Other Gov't hosp. 3 Pvte hospital 4 Pvte nursing home 5 Rur. mat. centre 6 Own home 7 Home of relative or friend 8 Other 1 Victoria Jubilee 2 Other Gov't hosp. 3 Pvte hospital 4 Pvte nursing home 5 Rur. mat. centre 6 Own home 7 Home of relative or friend 8 Other 338. Who assisted with the delivery of [NAME]?" 1 Doctor 2 Trained nurse 3 Trained midwife 4 Nana 5 Other 6 No one 1 Doctor 2 Trained nurse 3 Trained midwife 4 Nana 5 Other 6 No one 1 Doctor 2 Trained nurse 3 Trained midwife 4 Nana 5 Other 6 No one 1 Doctor 2 Trained nurse 3 Trained midwife 4 Nana 5 Other 6 No one 1 Doctor 2 Trained nurse 3 Trained midwife 4 Nana 5 Other 6 No one 339. How was [NAME] delivered? 1 Normal delivery 2 Forceps delivery 3 Caesarean section 1 Normal delivery 2 Forceps delivery 3 Caesarean section 1 Normal delivery 2 Forceps delivery 3 Caesarean section 1 Normal delivery 2 Forceps delivery 3 Caesarean section 1 Normal delivery 2 Forceps delivery 3 Caesarean section 340. Is [NAME] still alive? 1 Yes (SKIP TO BOX) 2 No 1 Yes (SKIP TO BOX) 2 No 1 Yes (SKIP TO BOX) 2 No 1 Yes (SKIP TO BOX) 2 No 1 Yes (SKIP TO BOX) 2 No 341. IF DEAD: How old was [NAME] when he/she died? [RECORD DAYS IF UNDER 30 DAYS, MONTHS IF UNDER 12 MONTHS, YEARS IF 12 MONTHS AND OVER|. 1 days 2 _ _ mths 3 yrs 1 days 2 _ _ mths 3 yrs 1 days 2 _ _ mths 3 yrs 1 days 2 _ _ mths 3 yrs 1 days 2 _ _ mths 3 yrs IF NO OTHER LIVE BIRTHS CONTINUE WITH Q.342 ON NEXT PAGE. OTHERWISE CONTINUE WITH NEXT BIRTH, THAT IS, RETURN TO Q.331. -66- -67- - 13 - 342. Has your period (menstruation) returned since your last birth? 1 Yes 2 No, but have become pregnant since last birth (SKIP TO Q. 344) 3 No (SKIP TO Q. 344) 343. How many months after birth did your period (menstruation) return? months 00 Less than 1 month 98 Don't remember 344. How many weeks after you had your last birth did you resume sexual relations? weeks 00 Less than one week 77 Not yet resumed 345. Did you breastfeed your last child? 1 Yes 2 No (SKIP TO Q. 401) 346. How soon (in minutes, hours or days) after the birth did you first breastfeed that last child, that is, first put him/her to the breast? 1 minutes 2 hours 3 days 347. Are you still breastfeeding that child? 1 Yes (SKIP TO Q. 349) 2 No 348. How many months did you breastfeed that child? months 00 Less than one month 98 Don't remember -68- - 1 4 - 349. How old was the child, in months, when you started giving him/her milk other than breast milk and/or solid food? months 00 Less than one month 44 Not yet 55 Child died first 98 Don't remember IF CURRENTLY BREASTFEEDING, CONTINUE. ALL OTHERS, SKIP TO QUESTION 401 350. During the last 24 hours, how many times did the infant suckle? times 351. During the last 24 hours, how many times did the child get other food such as: [READ] No. of times Fresh milk ___________ Tinned or powdered milk ___________ Plain water ___________ Sugar water/tea ___________ Juices ___________ Solid food (rice, potatoes, bananas, etc.) -69- - 15 – SECTION IV - FAMILY PLANNING Now, I would like to talk about methods that people use to space or limit the number of their children. 401. a. FIRST Please tell me all the methods you have heard of to space or limit the ASK: number of children a person can have. [CIRCLE " 1" IN THE COLUMN "SPONTANEOUS", NEXT TO EACH METHOD MENTIONED]. b. THEN: READ EACH METHOD NOT MENTIONED. [CIRCLE "2" OR "0", AS APPROPRIATE]. c. THEN: ASK QUESTIONS ABOUT USE FOR EVERY METHOD KNOWN BY THE RESPONDENT. [CIRCLE "3" OR "4" AS APPROPRIATE]. Have you Have you/your Sponta- ever heard partner ever Method neous of [METHOD]? used it? Yes No Yes No 1 Female sterilization, 1 2 0 3 4 tubal ligation 2 Male ster., vasectomy 1 2 0 3 4 3 Implant (Norplant) 1 2 0 3 4 4 Injection 1 2 0 3 4 5 Pill 1 2 0 3 4 6 IUD/coil 1 2 0 3 4 7 Condom 1 2 0 3 4 8 Foaming tablets 1 2 0 3 4 9 Creams/jellies 1 2 0 3 4 10 Diaphragm 1 2 0 3 4 11 Withdrawal 1 2 0 3 4 12 Rhythm (calendar 1 2 0 3 4 method) 13 Billings method 1 2 0 3 4 88 Other (specify): 1 2 0 3 4 402. HAS RESPONDENT EVER USED AT LEAST ONE METHOD OF CONTRA CEPTION? [AT LEAST ONE "3" CIRCLED IN Q. 401] 1 Yes 2 No (SKIP TO Q. 414) -70- - 16- 403. Are you/your partner currently using a method of contraception? 1 Yes 2 No (SKIP TO Q. 405) 404. Which method? Please tell me if you and your partner are using two methods? FIRST METHOD SECOND METHOD 1 Female sterilization, 1 Female sterilization, tubal ligation tubal ligation 2 Male sterilization, vasectomy 2 Male sterilization, vasectomy 3 Implant (Norplant) 3 Implant (Norplant) 4 Injection 4 Injection 5 Pill 5 Pill 6 Intra-uterine device/coil 6 Intra-uterine device/coil 7 Condom 7 Condom 8 Foaming tablets 8 Foaming tablets 9 Creams/jellies 9 Creams/jellies 10 Diaphragm 10 Diaphragm 11 Withdrawal 11 Withdrawal 12 Rhythm (calendar method) 12 Rhythm (calendar method) 13 Billings method 13 Billings method 88 Other (specify): 88 Other (specify): 00 No second method 405. How old were you when you first used contraception? age 98 Don't remember (month/year) 406. How many living children did you have when you first used contraception? number 98 Don't remember IF RESPONDENT HAS USED CONTRACEPTION IN THE PAST BUT IS NOT CURRENTLY USING [Q. 402 = YES AND Q. 403 = NO], CONTINUE. IF RESPONDENT IS CURRENTLY USING METHODS 3-10 [THAT IS, A MODERN REVERSIBLE CONTRACEPTIVE], SKIP TO Q. 423. IF RESPONDENT IS NOW USING METHODS 11-13 ONLY Q. 404 = METHODS "11-13"), SKIP TO Q. 434. IF RESPONDENT OR HUSBAND/PARTNER IS STERILIZED, (Q. 404 = METHODS 1 OR 2), SKIP TO Q. 452. -71- - 17 - 407. What was the last family planning method you or your partner used? 1 Female sterilization, tubal ligation 8 Foaming tablets 2 Male sterilization, vasectomy 9 Creams/jellies 3 Implant (Norplant) 10 Diaphragm 4 Injection 11 Withdrawal SKIP TO 5 Pill 12 Rhythm (calendar method) Q. 414 6 Intra-uterine device/coil 13 Billings method 7 Condom 88 Other (specify): 408. Where did you or your partner get your family planning supplies? 1 Government hospital 7 Outreach worker 2 Government health clinic/centre 8 Factory/workplace 3 Private hospital 9 Supermarket/shop/bar 4 Private clinic 88 Other (specify): 5 Private doctor _____________________________ 6 Pharmacy 98 Doesn't know/doesn't remember IF METHOD USED WAS "INJECTION" ["4" IN Q. 407], AND SUPPLY SOURCE WAS "PHARMACY" ["6" IN 0- 408], CONTINUE WITH Q. 409. ALL OTHERS, SKIP TO Q. 410. 409. Who administered the injection ? 1 A doctor 4 Other health professional 2 A nurse 8 Other (specify): ______________ 3 The pharmacist 9 Doesn't remember 410. How far did you have to travel to obtain the supplies? 1 At home 5 5 to under 10 miles 2 Under one mile 6 10 miles and over 3 1 to under 2 miles 9 No response 4 2 to under 5 miles 411. INJECTION OR PILL USER? 1 Yes (CODES 4 OR 5 IN Q. 407, CONTINUE WITH Q. 412) 2 No (SKIP TO Q. 414) -72- - 18- 412. Did you ever use the injection or pill while you were breastfeeding? 1 Yes 8 Don't remember (SKIP TO Q. 414) 2 No (SKIP TO Q. 414) 413. Did you have any problems or side effects? [CIRCLE ALL THAT APPLY] Yes No 1 None, no problems 1 2 2 Gained weight 1 2 3 Headaches 1 2 4 Breastmilk dried up 1 2 5 Irregular bleeding 1 2 8 Other (specify): _____________________________________ IF SHE IS PREGNANT NOW [SEE Q. 304], CODE "3" IN Q. 414. 414. Do you think you are able to get pregnant at the present time? 1 Yes (SKIP TO Q. 416) 3 Currently pregnant (SKIP TO Q. 418) 2 No 4 Not sure, don't know 415. Why not? 1 Menopause 2 Has had an operation for medical reasons which makes pregnancy (SKIP TO impossible (or husband/partner has had an operation) Q. 458) 3 Has tried to get pregnant for at least two years without success (or has not gotten pregnant despite at least two years of non- contraception 4 Not sexually active (SKIP TO Q. 418) 5 Postpartum/breastfeeding 6 Other (specify) __________________________________________________ 416. Would you like to become pregnant now? 1 Yes (SKIP TO Q. 418) 3 God's will, fate 2 No 9 Don't know, not sure -73- - 19 - 417. Why are you not using a method to prevent pregnancy now? 1 Health/medical 8 Partner opposes 2 Doesn't like 9 Lack of knowledge 3 Had side effects from last (other) 10 Considers contraception not effective methods 11 Considers method last used not effective 4 Fear of side effects 12 Method difficult to use 5 Method unavailable 13 Money problems 6 Partner's responsibility 14 Religion against 7 Source far away 88 Other (specify):___________________ 418. In the future (after this pregnancy), do you think you will want to use a method to prevent pregnancy? 1 Yes 2 No (SKIP TO Q. 439) 3 Not sure (SKIP TO Q. 439) 419. What method would you most like to use? 1 Female sterilization, tubal ligation 9 Creams/jellies 2 Male sterilization, vasectomy 10 Diaphragm 3 Implant (Norplant) 10 Withdrawal (SKIP TO Q. 439) 4 Injection 11 Rhythm (calendar method) 5 Pill 12 Billings method 6 Intra-uterine device/coil 88 Other (specify): 7 Condom ________________________ 8 Foaming tablets 98 Don't know (SKIP TO Q. 439) 420. Do you know where to obtain that method, (or information on the method if it is either the Rhythm or Billings methods (METHODS 12 AND 13)? 1 Yes 2 No (SKIP TO Q. 439) 421. Where? [IF MORE THAN ONE PLACEMENTIONED, CIRCLE THE ONE SHE WOULD MOST LIKELY USE] 1 Government hospital 7 Outreach worker 2 Government health clinic/centre 8 Factory/workplace 3 Private hospital 9 Supermarket/shop/bar 4 Private clinic 88 Other (specify): 5 Private doctor _____________________________ 6 Pharmacy 98 Doesn't know/doesn't remember -74- -20- 422. How far would you have to travel to obtain the supplies or information relating to the method? 1 At home 5 5 to under 10 miles 2 Under one mile 6 10 miles and over 3 1 to under 2 miles 9 No response 3 2 to under 5 miles SKIP TO QUESTION 439 423. Where do you/your partner get your family planning supplies? 1 Government hospital 7 Outreach worker 2 Government health clinic/centre 8 Factory/workplace 3 Private hospital 9 Supermarket/shop/bar 4 Private clinic 10 Other (specify): 5 Private doctor _______________________ 6 Pharmacy 98 Doesn't know/doesn't remember IF METHOD USED IS "INJECTION" (THAT IS, "4" IN Q. 407), AND SUPPLY SOURCE IS "PHARMACY", CONTINUE WITH Q. 424. ALL OTHERS, SKIP TO Q. 425. 424. Who administered the injection? 1 A doctor 2 A nurse 3 The pharmacist 4 Other health professional 8 Other (specify): ______________________________________________ 9 Doesn't remember 425. How far did you have to travel to obtain the supplies? 1 At home 5 5 to under 10 miles 2 Under 1 mile 6 10 miles and over 3 1 to under 2 miles 9 No response 4 2 to under 5 miles 426. INJECTION OR PILL USER? 1 Yes [CODES 4 OR 5 IN Q. 404: CONTINUE WITH Q. 427] 2 No (SKIP TO Q. 439) -75- - 21 - 427. Did you ever use the injection or pill while you were breastfeeding? 1 Yes 8 Don't know 2 No (SKIP TO BOX FOLLOWING Q. 428) 428. Did you have any problems or side effects? [CIRCLE ALL THAT APPLY] Yes No 1 None, no problems 1 2 2 Gained weight 1 2 3 Headaches 1 2 4 Breast milk dried up 1 2 5 Irregular bleeding 1 2 8 Other (specify): ____________________________________________ INJECTION USERS [CODE "4" IN Q. 404] SKIP TO Q. 439. PILL USERS [CODE "5" IN Q. 404] CONTINUE. 429. What is the brand name of the pill you are currently using? 1 Anteovin 12 Ortho 2 Diane 13 Ortho Novum 3 Eugynon 14 Ovral 4 Gynera 15 Ovulen 5 Lo Femenal 16 Perle 6 Logynon 17 Trinordiol 7 Microgynon 18 Trinovum 8 Microval 19 Tri-Regal 9 Minulet 88 Other (specify): 10 Neogynon _____________________ 11 Nordette 98 Doesn't know 430. How long (in months) have you been using this (brand) continuously? months 431. Who first fold you to use if? 1 A doctor 5 A friend 2 A nurse 8 Other (specify): 3 A pharmacist ______________________ 4 A family member -76- -22- 432. Do you currently have a supply of [BRAND] which you are currently using? 1 Yes 2 No 9 No answer 433. What brand were you using before? 1 Anteovin 12 Ortho 2 Diane 13 Ortho Novum 3 Eugynon 14 Ovral 4 Gynera 15 Ovulen 5 Lo Femenal 16 Perle 6 Logynon 17 Trinordiol 7 Microgynon 18 Trinovum 8 Microval 19 Tri-Regal 9 Minulet 88 Other (specify): 10 Neogynon __________________________ 11 Nordette 00 None ALL SKIP TO QUESTION 439 434. In the future, do you think you will want to use a different method to prevent pregnancy? 1 Yes 2 No (SKIP TO Q. 439) 9 Don't know, not sure (SKIP TO Q. 439) 435. What method would you most like to use? 1 Female sterilization, tubal ligation 8 Foaming tablets 2 Male sterilization, vasectomy 9 Creams/jellies 3 Implant (Norplant) 10 Diaphragm 4 Injection 11 Withdrawal (SKIP TO Q. 439) 5 Pill 12 Rhythm (calendar method) 6 Intra-uterine device/coil 13 Billings method 7 Condom 88 Other (specify): 436. Do you know where to obtain this method, or information about this method if it is either the Rhythm method or the Billings method [METHODS 12 AND 13]? 1 Yes 2 No (SKIP TO Q. 439) -77- -23 - 437. Where? [IF MORE THAN ONE PLACE MENTIONED, CIRCLE THE ONE SHE WOULD MOST LIKELY USE] 1 Government hospital 7 Outreach worker 2 Government health clinic/centre 8 Factory/workplace 3 Private hospital 9 Supermarket/shop/bar 4 Private clinic 88 Other (specify): 5 Private doctor ___________________________ 6 Pharmacy 98 Doesn't know/doesn't remember 438. How far would you have to travel to obtain the supplies or information about the method? 1 At home 5 5 to under 10 miles 2 Under one mile 6 10 miles and over 3 1 to under 2 miles 9 No response 4 2 to under 5 miles 439. Do you want to have any (more), children (after this pregnancy)? 1 Yes (SKIP TO Q. 445) 2 No 3 God's will, fate (SKIP TO Q. 447) 9 Not sure (SKIP TO Q. 447) RESPONDENTS WHO HAVE INDICATED THAT THEY WOULD LIKE TO HAVE A TUBAL LIGATION IN THE FUTURE OR THEIR PARTNER TO HAVE A VASECTOMY ["1" OR "2" IN Q. 419], SKIP TO Q. 458. ALL OTHERS, CONTINUE. QUESTIONS 440-444 ARE ONLY FOR WOMEN WHO DO NOT WANT MORE CHILDREN. 440. Would you be interested in an operation that would prevent you from having any (more) children ? 1 Yes 2 No (SKIP TO Q. 451) 9 Not sure 441. Do you know where to go for this operation? 1 Yes (SKIP TO Q. 443) 2 No -78- - 2 4 - 442. Do you know where to get information about this operation"? 1 Yes 2 No (SKIP TO Q. 458) 443. Where? [IF MORE THAN ONE PLACE MENTIONED, CIRCLE THE ONE SHE WOULD MOST LIKELY USE] 1 Clinic/health centre 4 Private doctor/clinic 2 Public hospital 8 Other (specify): 3 Private hospital _______________________________ 444. Since you have (or will have) all the children you want and you know where to get this operation/ information about this operation, why have you not had it? [IF CURRENTLY PREGNANT (" 1" IN Q. 304), CIRCLE "16"] 1 Fear of method/side effects 10 Current partner opposes 2 Fear of operation (cut) 11 Advanced age, approaching menopause 3 Fear of anaesthesia 12 Not sexually active 4 Service facility too far 13 Religion 5 Too young 14 women should have all the children 6 Future partner might want they want more children 15 Family opposes 7 May want more children if 16 Currently pregnant situation changes 88 Other (specify): 8 Lack of information _______________________________ 9 Lack of money 99 No answer SKIP TO QUESTION 458. QUESTIONS 445-451 ARE ONLY FOR WOMEN WHO WANT OR MIGHT WANT MORE CHILDREN. 445. How many (more) children would you like to have (after this pregnancy)? children 77 As many as God sends, up to fate 98 Don't know 66 As many as possible 446. When would you like to have the next one? [ANSWER IN MONTHS IF LESS THAN TWELVE MONTHS OR IN YEARS IF MORE THAN ONE YEAR] months years 00 Now, as soon as possible 98 Don't know (month/year) -79- - 25 - 447. When you have had all the children you want, would you be interested in an operation that would prevent you from having any (more) children? 1 Yes 2 No (SKIP TO Q. (451) 3 Not sure 448. Do you know where to go for this operation? 1 Yes 2 No 449. Do you know where to get information about this operation? 1 Yes 2 No (SKIP TO Q. 458) 450. Where? [IF MORE THAN ONE PLACE MENTIONED, CIRCLE THE ONE SHE WOULD MOST LIKELY USE] 1 Clinic/health centre 2 Public hospital 3 Private hospital 4 Private doctor/clinic 8 Other (specify): ______________________________ SKIP TO QUESTION 458 451. Win- would you not be interested in this operation? [IF CURRENTLY PREGNANT ("1" IN Q. 304), CIRCLE "16"] 1 Fear of method/side effects 10 Current partner opposes 2 Fear of operation (cut) 11 Advancing age, approaching menopause 3 Fear of anaesthesia 12 Not sexually active 4 Service facility too far 13 Religion 5 Too young 14 Women should have all the children 6 Future partner may want they want more children 15 Family opposes 7 May want more children if 16 Currently pregnant situation changes 88 Other (specify): 8 Lack of information _______________________________ 9 Lack of money 99 No answer SKIP TO QUESTION 458 -80- -26- 452. Where was your tubal ligation/your husband's (partner's) vasectomy done? 1 Public hospital 3 Private doctor/clinic 2 Private hospital 8 Other (specify): ___________________ 453. How old were you when you/he had the operation? age QUESTIONS 452 - 457 ARE FOR WOMEN WHO HAVE BEEN STERILIZED OR WHOSE HUSBANDS/PARTNERS HAVE HAD A VASECTOMY. 454. Did you receive any counselling about family planning methods at that location? 1 Yes 2 No (SKIP TO Q. 456) 455. Did the counsellor or person you talked with give the following information? [FOR EACH POSSIBLE RESPONSE ASK: "Did she tell you about . " Yes No DK/DR A How the operation is performed 1 2 9 B The fact that sterilization does not affect sex life 1 2 9 C Postoperative consequences like pain, discomfort 1 2 9 D The anesthesia which would be used 1 2 9 E Tire possible medical risks of surgery and anesthesia 1 2 9 F The possibility of failure 1 2 9 G Tire fact that if the operation is successful, you 1 2 9 would not be able to 'have more children H The possibility of regret 1 2 9 I What to do in the event of postoperative complications 1 2 9 J Other available contraceptive methods 1 2 9 K Benefit of other methods 1 2 9 L Side effects of other methods 1 2 9 -81- - 2 7 - 456. Are you satisfied with having had the operation? 1 Yes (SKIP TO Q. 458) 2 No 457. Why are you not satisfied with the operation? 1 In a new union 2 The operation has caused complications 3 Had bad side effects 4 It has decreased sexual enjoyment 5 Desires more children because child(ren) died 6 Would like another child because my other children have grown up 7 Sterilization is morally wrong 8 Husband/partner treats me differently 9 She feels less important 88 Other (specify): ________________________________________ 98 Don't know 99 Refused IF RESPONDENT HAS NEVER HAD SEX [Q. 212 = "NO"], SKIP TO Q. 504. IF RESPONDENT HAS NEVER BEEN PREGNANT [Q. 314 = "00"] AND HAS NEVER USED CONTRACEPTION [Q. 402 = "2"], SKIP TO Q. 504. ALL OTHERS, CONTINUE. 458. Now we would like to obtain a monthly record of your family planning history over a 5 year period (since January 1988). Therefore, I would like to go back over some of the information we have discussed and try to get the exact dates of certain events. First, I need to go over and record in this chart the dates of all of your live births, your stillbirths, your miscarriages and your abortions which occurred since then. You told me that you had ____ pregnancy(ies) which resulted in (a) live birth(s) [Q. 314]; pregnancies which ended in (a) stillbirth(s) [Q. 315]; ___ which ended in (a) miscarriage(s) [Q. 316]; and __ which ended in (an) abortion(s) [Q.317]. You have also told me that the live birth(s) occurred in ___ , 19 __ [INTERVIEWER, CHECK Q. 329 AND RECOUNT THE DATES OF BIRTH OF THE LIVE BIRTH(S) OCCURRING AS OF JANUARY 1, 1988. ENTER THE CORRECT CODE FOR EACH OCCURRENCE IN THE MONTH AND YEAR WHICH APPLY]. -82- - 2 8 - Now, please tell me the month and year each of the pregnancies started and how many months you were pregnant. [ENTER CODE " 1 "FOR EACH MONTH DURING WHICH SHE WAS PREGNANT. REMEMBER, YOU SHOULD NOT ENTER "1" IN THE MONTH IN WHICH THE OCCURRENCE TOOK PLACE. YOU SHOULD NOT MAKE ANY FURTHER ENTRIES IN THE FIRST LINE OF EACH YEAR1. Next, I have to record all of your contraceptive usage during that period and how long you have used each method. [SKIP TO THE SECOND LINE AND BEGIN WITH THE LAST METHOD USED AND WORK BACKWARDS. FINALLY, FILL IN ALL THE BLANKS WITH "0" ("NO METHOD") EXCEPT FOR THOSE MONTHS SHE WAS NOT ON A METHOD BECAUSE SHE WAS PREGNANT. REMEMBER, IF SHE WAS ON A METHOD AND BECAME PREGNANT ON THE METHOD, YOU SHOULD FIND OUT WHEN SHE DISCOVERED THAT SHE WAS PREGNANT AND MAKE THE APPROPRIATE ENTRIES UP TO THAT MONTH]. Lastly, I would like you to tell me why did you stop using ________ in _____. [IDENTIFY THOSE TIMES WHEN THE RESPONDENT EITHER SWITCHED FROM ONE METHOD TO ANOTHER, OR STOPPED USING ALTOGETHER. FIND OUT THE REASON FOR STOPPING THE METHOD WHICH WAS CURRENTLY BEING USED AND ENTER THE APPROPRIATE CODE IN THE THIRD LINE FOR THE RELEVANT YEAR]. CODES TO BE USED IN THE CALENDAR Pregnancy/Outcomes Method used Reason stopped use 1 Pregnant 1 Female sterilization, 1 Became pregnant on method tubal ligation 2 Live birth 2 Male sterilization, 2 Stopped to become pregnant vasectomy 3 Stillbirth 3 Implant (Norplant) 3 Husband/partner objected 4 Induced abortion 4 Injection 4 Side effects 5 Miscarriage 5 Pill 5 Health concerns 6 Intra-uterine device/ 6 Stopped to "rest body" coil 7 Condom 7 Physician's decision 8 Foaming tablets 8 Supply/Access problems 9 Creams/jellies 9 Inconvenient to use 10 Diaphragm 10 Infrequent sex/Partner away 11 Withdrawal 11 Felt couldn't get pregnant 12 Rhythm (calendar 12 Marriage/relationship ended method) 13 Billings method 13 Cost 88 Other (specify): 88 Other (specify): 0 No Method 98 Don't remember -83- - 29 - METHODS CALENDAR ______________________________________M O N T H ________________________________ 1 2 3 4 5 6 7 8 9 10 11 12 1988 Pregnancy/Outcome Method used Reason stopped use 1989 Pregnancy/Outcome Method used Reason stopped use 1990 Pregnancy/Outcome Method used Reason stopped use 1991 Pregnancy/Outcome Method used Reason stopped use 1992 Pregnancy/Outcome Method used Reason stopped use 1993 Pregnancy/Outcome Method used Reason stopped use 459. You said you were using ___________in January of J988. When did you start using that method? month 19 year IF USING A METHOD IN JANUARY 1988, CONTINUE WITH Q. 459. ALL OTHERS SKIP TO INSTRUCTIONS FOLLOWING Q. 459. IF CURRENTLY USING A MODERN METHOD [LAST "METHOD USED" SHOWN IN 1993 IS CODE 1-10], SKIP TO Q. 501. ALL OTHERS, SKIP TO Q. 504. -84- - 30 - SECTION V - ATTITUDES TOWARD CONTRACEPTION AND SEXUALITY 501. If you or your partner do not currently pay for the contraceptive(s) you use, would you he prepared to pay for it ahem? 1 Yes 3 Already pays for it/them 2 No (SKIP TO Q. 503) 502. How much would you/your partner he prepared to pay [ I f " 1 " in Q. 501]? Or, what is the highest amount you/your partner would he prepared to pay [If "3" in Q. 501]? Please tell me if more than one method is being used. [ IF $997 AND MORE. CODE "997"]. ______ FIRST METHOD SECOND METHOD J$ J$ per cycle of pill per cycle of pi l l per piece of condom per piece of condom per tube of foam/jelly per tube of foam/jelly per dose of injection per dose of injection per IUD (device only) per IUD (device only) per unit of diaphragm per unit of diaphragm per procedure (tubal ligation) per procedure (tubal ligation) per procedure (vasectomy) per procedure (vasectomy) 998 Don't know 998 Don't know 999 Regardless of cost 999 Regardless of cost 000 No second method SKIP TO Q. 504 503. What would you then do to obtain contraceptives if you could nor get them free of charge ? 1 Stop using, do without, etc. 4 Use herbal medicines 2 Abstain from sex 8 Other (specify): 3 Use Natural Family Planning _______________________________ methods or withdrawal 504. If a woman takes the pill correctly, how sure can she he that she will not become pregnant? [READ OPTIONS 1-3] 1 Completely sure 3 Some risk of pregnancy 2 Slight risk of pregnancy 9 Don't know -85- - 3 1 – 505. How safe for a woman's health is the pill? [READ OPTIONS 1 -3] 1 Completely safe 3 Unsafe 2 Slight risk 9 Don't know IF RESPONDENT HAS NEVER HEARD OF TUBAL LIGATION, INJECTION, PILL OR IUD, SKIP TO Q. 507. ALL OTHERS, CONTINUE. I am now going to ask you how you feel about different kinds of contraceptives. For each contraceptive mentioned, that is, the injection, the pill, the IUD and tubal ligation, please give me your response after I read the possible answers. [READ ALL ANSWERS EXCEPT "DON'T KNOW"] the Inj- the the TL ection Pill IUD 506a. How would you rate 1 Very effective [METHOD] as to its 2 Sometimes effective effectiveness in 3 Not effective preventing pregnancy? 9 Don't know 506b. How would you rate 1 Very easy [METHOD| as to its 2 Somewhat easy ease of use? 3 Not easy 9 Don't know 506c. Do you think 1 Yes [METHOD] can cause 2 No vaginal discharge? 9 Don't know 506d. Do you think 1 Yes [METHOD] can 2 No cause abnormal 9 Don't know bleeding ? 506e. Do you think women 1 Yes who use [METHOD| 2 No have a higher risk 9 Don't know of cancer? 506f Do you think 1 Yes [ M ET H O D | can cause 2 No XXX infertility if you 9 Don't know use it for a long time, say five years? 506g. Do you think 1 Yes [METHOD] is bad for 2 No blood circulation? 3 Don't know -86- - 32 - Now, I'd like to read some statements to you. Please indicate if you agree, disagree or are uncertain about them. Dis- Un- No Re- Agree agree certain sponse 507. God should decide how many children one 1 2 8 9 should have. 508. Work in the kitchen is women's work. 1 2 8 9 509. Care of children is women's work. 1 2 8 9 510. Sex with a virgin can cure gonorrhoea. 1 2 8 9 511. The man is the one to decide how many 1 2 8 9 children his wife/partner should have. 512. A woman should he a virgin when she marries. 1 2 8 9 513. Men should always have financial respons- 1 2 8 9 ihility towards their children. 514. Parents who provide their children with sex 1 2 8 9 education encourage them to have sexual intercourse. 515. Sex education should he taught in schools. 1 2 8 9 516. A woman should have a baby before she is 1 2 8 9 twenty to prove she is not a mule. 517. A woman can become pregnant during her 1 2 8 9 first sexual intercourse. 518. If a man uses a condom, it doesn't take away 1 2 8 9 any pleasure from the woman. 519. You can use the same condom more than once. 1 2 8 9 520. Using the pill will protect you against sexually 1 2 8 9 transmitted diseases including AIDS. 521. Who ought to make the decision to use something to avoid becoming pregnant, the man only, the woman only, or both together? 1 The man 4 Each one is on his or her own 2 The woman 8 Other (specify): 3 Both -87- -33- Now I would like to ask you about your attitude towards childbearing. 522. If you could choose exactly the number of children to have in your whole life, how many would that be? number 77 Fate, up to God 88 Don't know 523. In your opinion, at what age is a woman responsible enough to have her first child? years 66 Soon after she enters her first union 77 When she matures, is in a stable union 55 Depends on circumstances 98 Doesn’t have an opinion 88 Other (specify): ______________________________________________ 524. What is the main reason a woman might wish to limit the number of children that she has? 1 Health of the mother 2 Health of the child 3 Economic reasons 4 Wellbeing of the family 5 Don't think a woman should limit the number of children she has 8 Other (specify): _________________________________________________ 525. How old do you think a child should be before the mother stops breastfeeding him/her? months 77 As long as possible 526. How old do you think it is best for a child to be before another child is born? months 527. Who should decide the number of children a couple wants to have? 1 Husband/partner 4 Mother-in-law 2 Wife/woman 5 Fate, up to God 3 Both 6 Other (specify): ____________________ 528. What are the days during the month when a woman has to be careful to avoid becoming pregnant? [READ OPTIONS 1-5] 1 During her period 5 At any time 2 Right after her period has ended 8 Other (specify): 3 In the middle of the cycle ________________________________ 4 Just before her period begins 9 Don't know -88- - 3 4 - 529. Which do you think is better, vasectomy for men or tubal ligation for women? 1 Vasectomy 3 Neither, both equally (SKP TO Q.531) 2 Tubal ligation 9 No opinion (SKIP TO Q. 531) 530. Why do you think vasectomy/tubal ligation [USE ANSWER TO Q. 529] is better? 1 Cheaper 2 Safer 3 Vasectomy diminishes a man's potency 4 Tubal ligation eliminates the future possibility of childbearing 5 Vasectomy eliminates the future possibility of childbearing 8 Other (specify): __________________________________________ 9 Don't know 531. EVER USED CONDOMS. 1 Yes [Q. 401-7 = "3"] 2 No (SKIP TO Q. 533) 532. Why do (did) you and your partner use condoms? [READ OPTIONS 1-3] 1 Prevent pregnancy 2 Prevent sexually transmitted diseases 3 Prevent pregnancy and disease 4 Don't know/Don't remember SKIP TO QUESTION 534 533. Why haven't you and your partner(s) ever used condoms? 1 Partner(s) didn't like them 2 Have only one partner 3 Preventing pregnancy is woman's responsibility 4 They diminish pleasure/spontaneity 5 Not effective at preventing pregnancy 6 They are too expensive 7 Condoms are to be used only outside of marriage 8 Condoms are to be used only with prostitutes 9 Never sexually active 88 Other (specify): ______________________________________________ 98 Don't know 534. CURRENT CONDOM USER. 1 Yes [CODE "7" IN Q. 404] 2 No (SKIP TO Q. 601) -89- -35 - 535. How often do you use condoms during sexual intercourse? [READ OPTIONS 1-5] 1 Every time 2 Every time with certain partners 3 Most of the time 4 Some of the times 5 Occasionally 9 Refused 536. The last time you had sexual intercourse, did you use. a condom ? 1 Yes 2 No 537. What is the brand name of the condom you/your partner normally use? 1 Arouser 15 Maximum 2 Bare Back 16 Pamitex 3 Black Jack 17 Panther 4 Fantasy 18 Power Play 5 Featherlite 19 Rough Rider 6 Fiesta 20 Sensuals 7 Gold 21 Siltex 8 Gossemar 22 Sultan 9 Jellia 23 trojan 10 Jiffi 24 Wet'N'Wild 11 Kiss of Mint 88 Other (specify): 12 Licks 13 Life Force 00 No brand 14 Life Styles 98 Don't know 538. Do you currently have a supply of them? 1 Yes 9 No answer/don't know 2 No 539. Did you buy them (the last time you had them) ? 1 Yes 2 No (SKIP TO Q. 541) 540. Where did you buy the condoms that you normally use? 1 Pharmacy 4 Bar 2 Supermarket 8 Other (specify): 3 Grocery shop ALL SKIP TO Q. 601 -90- - 36- 541. Where did you get the condoms if you did not buy it? 1 Hospital 2 Clinic 3 Doctor's office 4 Partner 5 Friend 6 Outreach worker 8 Other (specify): _________________________________________________ -91- - 3 7 - SECTION VI - YOUNG ADULT MODULE (For Eligible Female Respondents aged 15-24 years) 601. AGE OF RESPONDENT: [SEE Q. 102] 1 15-24 [CONTINUE WITH Q. 602] 2 25-44 (SKIP TO Q. 701) 602. What ways are used by men to get a young woman into a sexual relationship? [IF MORE THAN ONE WAY MENTIONED, ASK THE MOST IMPORTANT WAY]. 1 Persistence 2 Good looks 3 Coaxing 4 Bragging about property 5 Money 6 Material things 7 Seclusion/seduction 8 Saying she doesn't love him if she won't have sex 9 Promise employment 10 Promise marriage 11 Promise "Uptown, Downtown, and Parade”/promise "the world" 12 Brute force 88 Other (specify): ____________________________________________________ 98 Don't know 99 No answer 603. How can a woman put off 'having sex if she is not ready for it? [IF SHE GIVES MORE THAN ONE REASON, ASK FOR THE MOST IMPORTANT]. 1 Take his mind off it 7 Don't listen 2 Avoid him 8 Pretend illness 3 Don't take anything 9 Say no 4 Stay away from secluded areas 88 Other (specify): ___________ 5 Pretend menstruation 98 Don't know 6 Don't move in with him 99 No answer 604. For young people your age who have had sexual intercourse, what do you think is the most appropriate contraceptive method to use to avoid pregnancy? 1 Female sterilization, tubal ligation 10 Diaphragm 2 Male sterilization, vasectomy 11 Withdrawal 3 Implant (Norplant) 12 Rhythm 4 Injection 13 Billings method 5 Pill 14 Abstinence SKIP TO 6 Intra-uterine device/coil 00 None Q.606 7 Condom 98 Doesn't know 8 Foaming tablets 99 Doesn't answer 9 Creams/jellies 88 Other (specify):_____________ -92- - 38 - 605. Could you afford to use this method? 1 Yes 2 No 9 Doesn't know 606. Have you ever had a class or course about family life or sex education in school? 1 Yes 2 No (SKIP TO Q. 612) 9 Doesn't know 607. How old were you when you had the first class or course? age 98 Doesn't remember 608. What grade of schooling (level and years) had you reached when you had this first class or course ? NOT LEVEL ______________YEARS _______________SPECIFIED 1 Primary 0 1 2 3 4 5 6 7 8+ 9 2 Secondary 0 1 2 3 4 5 6 7 8+ 9 3 Post secondary 0 1 2 3 4 5 6 7 8+ 9 9 Doesn't remember 609. Who was the main person who taught this first class or course? 1 School teacher 2 Physician 3 Counsellor or psychologist 4 Social worker 5 Nurse 8 Other (specify): ___________________________________ 9 Doesn't remember 610. Was it a man or a woman? 1 Man 2 Woman 9 Doesn't remember -93- - 3 9 - 611. Did this first class or course or any later class or course in school include information about.? [READ] Doesn't Yes No Remember 1 The human reproductive system 1 2 8 2 The woman's menstrual cycle or period 1 2 8 3 Pregnancy and how it occurs 1 2 8 4 Modern birth control methods such as the pill, 1 2 8 IUD, condom, spermicidals, or injectables 5 Sexually transmitted diseases that can 1 2 8 result from sexual contact 6 AIDS 1 2 8 7 Services available for adolescents 1 2 8 612. At what age do you think sex education should begin in schools? age 77 It should not be taught 98 Doesn't know 613. Have you ever had a formal course or lecture about family life or sex education anywhere outside of the school? 1 Yes 2 No (SKIP TO Q. 619) 614. Where was the first place you had it? 1 Community centre 7 Work place 2 Clinic 8 HEART 3 Club 9 Home 4 Church 88 Other (specify): 5 Youth centre ______________________ 6 Bar 98 Doesn't remember 615. How old were you when you had this first course or lecture on sex education? age 98 Doesn't remember -94- - 4 0 - 616. Who was the main person who taught this course? 1 School teacher 6 Other social worker 2 Physician 7 Peers 3 Nurse 8 Parent/guardian 4 Counsellor or psychologist 88 Other (specify): _____________ 5 Family planning outreach worker 99 Doesn't remember 617. Was it a man or a woman? 1 Man 2 Woman 9 Doesn't remember 618. Did this first class or course or any later class or course in school include information about .? [READ] Doesn't Yes No Remember 1 The human reproductive system 1 2 8 2 The woman's menstrual cycle or period 1 2 8 3 Pregnancy and how it occurs 1 2 8 4 Modern birth control methods such as the pill, 1 2 8 IUD, condom, spermicidals or injectables 5 Sexually transmitted diseases that can 1 2 8 result from sexual contact 6 AIDS 1 2 8 7 Services available for adolescents 1 2 8 Now, I'd like to ask you some very personal questions which are very important to the study. 619. In what month and year did you first have sexual intercourse? [CHECK WITH ANSWERS GIVEN AT QUESTIONS 212 AND 213. IF NOT CONSISTENT, CLARIFY AND CORRECT WHERE RELEVANT] month 1 9 year 98 Doesn't remember 99 No response 2222 Has never had sexual intercourse (SKIP TO Q. 801) -95- -41 - 620. How old was the person with whom you had sexual intercourse for the first time? age 621. What was the relationship of this person to you at that time? 1 Husband/partner 5 Casual acquaintance 2 Visiting partner 6 Mother's partner 3 Boyfriend 8 Other (specify): 4 Friend __________________________ 622. Where did this first experience take place? 1 At her own home 2 At her partner's home 7 At a dance hall/party 3 At a friend's home 8 At the beach 4 In a hotel or motel 9 In the bushes 5 In a car 88 Another place (specify): ________ 6 School 98 Doesn't remember 623. Did you or your partner use a contraceptive method during this first sexual intercourse? 1 Yes 2 No (SKIP TO Q. 627) 9 Doesn't remember/doesn't know (SKIP TO Q. 628) 624. What was the method? 1 Female sterilization, tubal ligation 8 Foaming tablets 2 Male sterilization, vasectomy 9 Cream/jellies 3 Implant (Norplant) 10 Diaphragm 4 Injection 11 Withdrawal 5 Pill 12 Rhythm (calendar method) 6 Intra-uterine device/coil 13 Billings method 7 Condom 88 Other (specify): 625. Where did you or your partner get this method used during your first sexual intercourse? IN CASE OF BILLINGS OR RHYTHM (CALENDAR METHOD),. Where did you or your partner receive orientation?) 1 Government hospital 7 Outreach worker 2 Government health clinic/centre 8 Factory/work place 4 Private clinic 9 Supermarket/shop/bar 5 Private doctor 88 Other (specify):______________ 6 Pharmacy 99 Doesn't know/doesn't remember -96- - 4 2 - 626. Whose decision was it to use this method? You alone, your partner alone, or was it made together? 1 Her decision 3 Decision made together 2 Partner's decision 4 Doesn't remember ALL SKIP TO QUESTION 628. 627. Why didn't you or your partner use a contraceptive method during this first sexual intercourse? 1 Didn't expect to have sexual relations at that time 2 Partner was against using something 3 Contraceptive methods are bad for one's health 4 Religion doesn't permit use 5 Didn't know of any methods 6 Knew of methods but didn't know where to get them 7 Intercourse is not satisfying when methods are used 8 Wanted to use something but couldn't get it at that moment 9 Too embarrassed to get method 10 Wanted to become pregnant 11 Other (specify): _______________________________________ 88 Doesn't know 98 Didn't respond 628. EVER PREGNANT: [SEE ANSWER TO Q. 303] 1 Yes [Q. 303 = "1" - CONTINUE] 2 No [Q. 303 = "2" - SKIP TO Q. 701] 629. When pregnant with your first child, were you in school? 1 Yes 2 No (SKIP TO Q. 635) 630. What grade of schooling (level and years) had you reached? NOT LEVEL ___________YEARS _________ SPECIFIED 1 Primary 1 2 3 4 5 6 7 8+ 9 2 Secondary 1 2 3 4 5 6 7 8+ 9 3 Post Secondary 1 2 3 4 5 6 7 8+ 00 No schooling 88 Other (specify): __________________________________________________ 99 Doesn't remember -97- - 4 3 - 631. During your pregnancy, did you receive help with your schooling from any organization ? 1 Yes 2 No (SKIP TO Q. 633) 632. Winch organization offered help? 1 Women's Centre 2 Church 3 Y.W.C.A. 4 Service Clubs 8 Other (specify): ______________________________________________ 633. After the first child was horn, did you return to school? 1 Yes 2 No (SKIP TO Q. 635) 634. What type of school did you return to? 1 Primary 2 Secondary 3 Post secondary 8 Other (specify): ____________________________________ 635. Does anyone help you with the care of your child/children? 1 Yes 2 No (SKIP TO Q. 701) 636. What kind of help do you get? Yes No A Child care 1 2 B Financial help 1 2 C Gifts 1 2 D Other (specify): ________________________________________________ 637. Who is the main source of help? 1 Husband/partner 2 Mother 3 Grandmother 4 Other relative 5 Partner's parents/relative 8 Other (specify):_____________________________________________ -98- - 4 4 - SECTION VII - CURRENT SEXUAL ACTIVITY (For all eligible respondents) 701. EVER HAD SEXUAL INTERCOURSE? [SEE Q. 207 OR Q. 212] 1 Yes 2 No (SKIP TO Q. 801) 702. Have you had sexual intercourse in the last 30 days? 1 Yes 2 No (SKIP TO Q. 705) 703. How many times have you had sexual intercourse in the last 30 days? times 90 Many times - more than 10 98 Don't remember 704. With how many men? number 98 Don't remember 705. What was the relationship of the last person with whom you had sexual intercourse to you? 1 Husband/partner 2 Visiting partner 3 Boyfriend 4 Friend 5 Casual acquaintance 6 Mother's partner 7 Other relative's partner 8 Other (specify):________________________________________ 706. Did you or the man involved use a contraceptive method during the last time you had sexual intercourse? 1 Yes 2 No (SKIP TO Q. 708) -99- -45 - 707. What was this method? 1 Female sterilization, tubal ligation 8 Foaming tablets 2 Male sterilization, vasectomy 9 Cream/jellies 3 Implant (Norplant) 10 Diaphragm 4 Injection 11 Withdrawal 5 Pill 12 Rhythm (calendar method) 6 Intra-uterine device/coil 13 Billings method 7 Condom 88 Other (specify): 708. NUMBER OF MEN WITH WHOM YOU HAD SEXUAL RELATIONS IN PAST 30 DAYS. [CHECK Q. 704] 1 One man (SKIP TO Q. 801) 2 Two men 3 Three or more men 709. What was the relationship of the next-to-last person with whom you had sexual intercourse in the past 30 days to you? 1 Husband/partner 5 Casual acquaintance 2 Visiting partner 6 Mother's partner 3 Boyfriend 7 Other relative's partner 4 Friend 8 Other (specify): _____________ 710. Did you or this person use a contraceptive method? 1 Yes 2 No (SKIP TO BOX FOLLOWING Q. 711) 711. What was this method? 1 Female sterilization, tubal ligation 8 Foaming tablets 2 Male sterilization, vasectomy 9 Cream/jellies 3 Implant (Norplant) 10 Diaphragm 4 Injection 11 Withdrawal 5 Pill 12 Rhythm (calendar method) 6 Intra-uterine device/coil 13 Billings method 7 Condom 88 Other (specify): RESPONDENTS WHO HAVE HAD SEXUAL RELATIONS WITH TWO MEN IN PAST 30 DAYS, SKIP TO Q. 801. WITH THREE OR MORE MEN, CONTINUE. -100- - 4 6 - 712. What was the relationship of the second-from-last person with whom you had sexual intercourse in the past 30 days to you? 1 Husband/partner 2 Visiting partner 3 Boyfriend 4 Friend 5 Casual acquaintance 6 Mother's partner 7 Other relative's partner 8 Other (specify): ____________________________________ 713. Did you or this person use a contraceptive method? 1 Yes 2 No (SKIP TO Q. 801) 714. What was this method? 1 Female sterilization, tubal ligation 8 Foaming tablets 2 Male sterilization, vasectomy 9 Cream/jellies 3 Implant (Norplant) 10 Diaphragm 4 Injection 11 Withdrawal 5 Pill 12 Rhythm (calendar method) 6 Intra-uterine device/coil 13 Billings method 7 Condom 88 Other (specify): -101- - 4 7 - SECTION VIII - KNOWLEDGE AND TRANSMISSION OF AIDS AND PREVENTION 801. Have you ever heard of HIV or HIV infection? 1 Yes 2 No 802. Have you ever heard of the disease called AIDS? 1 Yes 2 No 803. Do you think a person can be infected with the virus which causes AIDS and not have any signs or symptoms of the AIDS disease? 1 Yes 2 No 8 Don't know 804. Can you tell me two different ways in which a person can become infected with the virus which causes AIDS? First Second Sexual transmission 1 1 Intravenous drugs 2 2 Blood transfusion 3 3 Mother to child 4 4 Mosquito bites 5 5 Casual contact 6 6 Other (specify):_____________________________ 8 8 Don't know 805. Can a person get AIDS from someone who has the AIDS virus but does not have the disease? 1 Yes 2 No 8 Don't know 806. What risk do you think there is of your getting AIDS? [READ] 1 A great risk 2 Some risk 3 Not much risk 4 No risk at all -102- -48 - 807. What can a person do to reduce the risk of getting AIDS? [IF NON-SPONTANEOUS RESPONSE, PROBE: Can a person . to reduce the risk of AIDS? Sponta- Probed neous Yes No DK A Use condoms 1 2 3 9 B Avoid relations with prostitutes 1 2 3 9 C Have only one sexual partner 1 2 3 9 D Ask partner to have blood tested for 1 2 3 9 AIDS E Not have sexual relations 1 2 3 9 F Sterilize needles 1 2 3 9 G Avoid relations with bisexuals/homosexuals 1 2 3 9 H Any thing else? ___________________________ 1 2 3 9 808. In which of the following ways do you think a person can get the virus which causes AIDS? [READ1 Don't Yes No know A Shaking hands or hugging 1 2 8 B Being in the same room as a person who has the 1 2 8 AIDS virus C Sharing personal items like dishes, toilets, etc. 1 2 8 D Sharing needles used for drugs 1 2 8 E Sexual intercourse between men 1 2 8 F Sexual intercourse between a man and a woman 1 2 8 G Giving a blood donation 1 2 8 H Receiving a blood transfusion 1 2 8 I Being bitten by an insect that has bitten someone 1 2 8 with the AIDS virus -103- - 4 9 - END OF INTERVIEW…… THANK YOU!!! Date Hr. Min. TIME INTERVIEW STARTED: [See Title Page and page 2] TIME INTERVIEW ENDED: INTERRUPTION TIME (IF ANY): DURATION OF INTERVIEW: NOW RETURN TO TITLE PAGE AND COMPLETE INFORMATION ON INTERVIEW CALLS. -104- -50- COMMENTS -105- APPENDIX IIIA HOUSEHOLD QUESTIONNAIRE - MALE 1993 CONTRACEPTIVE PREVALENCE SURVEY - JAMAICA FORM CPS 1B HOUSEHOLD QUESTIONNAIRE - MALE CONFIDENTIAL CAP. 368 Identification No. Questionnaire No. 2 _______________ Parish Constituency E.D. No. Dwelling No. H/hold No. Eligible Respondents Sex 2 Interview calls 1 2 3 Final Visit Day (Date) Month Interview Status * Eligible Respondent ** Interviewer's Name Supervisor's Name Next Visit: Date Time * Interview Status Codes: ** Eligible Respondent Codes 1. Completed household interview 3. Vacant dwelling 2. Not at home - deferred 4. Refusal 1 Yes 8. Other (specify): 5. Partly completed 2 No FOR OFFICE USE ONLY: Reviewed by: Position: Date: Edited by: Date: -106- - 2 - 10. How many persons live in this household? number PLEASE RECORD THE NAMES OF ALL PERSONS WHO USUALLY LIVE AT THIS LOCATION. THIS SHOULD INCLUDE ALL WHO USUALLY EAT AND SLEEP HERE. YOU SHOULD START WITH THE HEAD OF THE HOUSEHOLD. HOUSEHOLD SCHEDULE EDUCATIONAL SEQUENCE NAME SEX AGE STANDARD NO. Please give me the names What is the Is [NAME] How old Highest [Eligible of the persons who usually relationship male(l) or is he/she? Level Years Women] live in your household to the head * female (2) (years) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 -107- - 3 - * Relationship codes: ** Educational standard codes: Level Years N/S 1 Head 0 None 2 Spouse of head 1 Primary 1 2 3 4 5 6 7 8 + 9 3 Child of head 2 Secondary 1 2 3 4 5 6 7 8 + 9 4 Other relative of head 3 Post secondary 1 2 3 4 5 6 7 8 + 9 8 Other 8 Other 9 Not stated 9 Not stated 11. Number of women aged 15-44 years living in household (Total number of eligible women recorded in the Schedule) number 12. Now, 1 would like you to tell me the occupation of the head of the household. Occupation For office use only 13. How many rooms does your household occupy (exclude bathrooms and kitchen)? number 99 No response 14. Who gave this information? [BY OBSERVATION] 1 One of the eligible female respondents 2 Other household member 3 Neighbour 8 Other (specify): ___________________________________________________ IF THERE IS ONE OR MORE ELIGIBLE RESPONDENTS, SELECT THE ONE TO BE INTERVIEWED, BASED ON THE INSTRUCTIONS GIVEN AND USING THE RANDOM TABLE SHOWN OVERLEAF. THEN COMPLETE THE INDIVIDUAL QUESTIONNAIRE FOR THE SELECTED RESPONDENT. IF THERE ARE NO ELIGIBLE RESPONDENTS, COMPLETE TITLE PAGE AND MOVE ON TO THE NEXT HOUSEHOLD. -108- -4- RANDOM SELECTION OF RESPONDENT Questionnaire No. 2 No. of Eligible Respondents Last digit on questionnaire number Last digit of number of eligible women 1 2 3 4 5 6 7 8 9 0 1 2 3 1 2 5 2 8 7 1 1 1 1 2 3 6 3 1 8 2 1 2 2 3 4 1 4 2 9 3 1 1 3 4 5 2 5 3 1 4 1 2 1 1 1 3 6 4 2 5 1 1 2 2 2 4 7 5 3 6 1 2 3 3 3 5 1 6 4 7 1 1 1 4 4 6 2 7 5 8 1 2 2 1 5 1 3 8 6 9 1 1 3 2 1 2 4 1 7 SEQUENCE NUMBER OF MAN SELECTED FOR INTERVIEW: AFTER COMPLETING THE HOUSEHOLD QUESTIONNAIRE, RETURN TO TITLE PAGE AND COMPLETE INFORMATION ON INTERVIEW CALLS COMMENTS -109- APPENDIX IIID INDIVIDUAL QUESTIONNAIRE - MALE 1993 CONTRACEPTIVE PREVALENCE SURVEY - JAMAICA FORM CPS 3 INDIVIDUAL QUESTIONNAIRE – MALE CONFIDENTIAL (For Eligible Male Respondents aged 15-44 Years) CAP. 368 Identification No. Parish Constituency E.D. No. Dwelling No. H/hold No. Sequence Number Sex 2 Interview calls 1 2 3 Final Visit Day Month Interview Status * Interviewer's Name Supervisor's Name Next Visit: Date Time * Interview Status Codes: 1. Completed household interview 4. Refusal 2. Not at home - deferred 5. Partly completed 8. Other (specify): FOR OFFICE USE ONLY: Reviewed by: Position: Date: Edited by: -110- - 2 - SECTION I - RESPONDENT'S BACKGROUND TIME INTERVIEW STARTED . 101. In what month and year were you born? month 1 9 year 99 Don't know 102. How old were you on your last birthday? years 103. In what parish was your mother living at the time of your birth, or in what country other than Jamaica ? 1 Kingston 8 St. James 2 St. Andrew 9 Hanover 3 St. Thomas 10 Westmoreland 4 Portland 11 St. Elizabeth 5 St. Mary 12 Manchester 6 St. Ann 13 Clarendon 7 Trelawny 14 St. Catherine 88 Other country (specify):____________________________________ 104. Have you ever attended school? 1 Yes 2 No (SKIP TO Q. 106) 105. How many years of primary, secondary and/or post secondary schooling did you complete? NOT LEVEL ____________YEARS ___________ SPECIFIED 1 Primary 0 1 2 3 4 5 6 7 8+ 9 2 Secondary 0 1 2 3 4 5 6 7 8+ 9 3 Post secondary 0 1 2 3 4 5 6 7 8+ 9 4 Other (specify): ______________________________________________ 9 Refused/not stated 106. What is your religion? 1 Anglican 8 Roman Catholic 2 Baptist 9 Seventh Day Adventist 3 Church of God 10 United Church 4 Methodist 88 Other (specify: 5 Pentecostal __________________________ 6 Rastafarian 98 No religion 7 Revivalist 99 No response -111- - 3 - 107. With what frequency do you attend religious services? 1 At least once a week 2 At least once a month 3 Rarely 6 Do not attend 9 No response 108. What is your employment status? 1 Working 2 With a job but not working 3 Looking for work 4 Keeping house 5 At school SKIP TO Q. I l l 6 Incapable of working 8 Other (specify):_________________________________________________ 109. Do you work outside or inside the house? 1 Inside only 2 Outside 3 Both 110. What is your occupation? Occupation For office use only 9999 No response 111. Do you have radio and/or television in the household and if so, how many? Yes No Number 1 Radio 1 2 2 Television 1 2 112. Do members of the household read any newspapers and with what regularity? [STATE THE GREATEST REGULARITY APPLICABLE WITHIN THE HOUSEHOLD] Daily Weekly Rarely Never 1 Gleaner 1 2 3 4 2 Jamaica Herald 1 2 3 4 3 Star 1 2 3 4 8 Other (specify)______________________1 2 3 4 -112- - 4 - SECTION II - RELATIONSHIP STATUS AND PARTNERSHIP HISTORY Now, I would like to ask you .some questions about your steady relationships. 201. Are you legally married now? 1 Yes (SKIP TO Q. 203) 2 No 202. Are you and your wife living together as man and wife now? 1 Yes (SKIP TO Q. 206) 2 No 203. Are you living with a common-law partner now? [IF RESPONDENT DOES NOT APPEAR TO UNDERSTAND THE TERM "COMMON-LAW", ASK]: Are you living as man and wife now with a partner to whom you are not legally married? 1 Yes (SKIP TO Q. 206) 2 No 204. Do you have a visiting partner, that is, a more or less steady partner with whom you have sexual relations? 1 Yes (SKIP TO Q. 206) 2 No 205. Do you have a girlfriend? 1 Yes (SKIP TO Q. 207) 2 No (SKIP TO Q. 209) 206. When you and your husband/partner first started together, what type of relationship did you have? [READ OPTIONS]. 1 Married 2 Common-law 3 Visiting partner 4 Steady girlfriend SKIP TO Q.208 207. Have you ever had sexual intercourse with your present girlfriend? 1 Yes 2 No (SKIP TO Q. 209) -113- - 5 - 208. In what month and year did your present relationship start? month 1 9 year 98 Doesn't remember 209. Besides your main partner, do you have another with whom you have sexual relations? 1 Yes 2 No 210. What is the total number of partners, including your present partner if any, you have had in the past five years? number 90 Many partners, more than 10 98 Doesn't remember 211. When you and your first partner started together, what type of relationship did you have ? [READ OPTIONS] 1 Married 3 Visiting partner 2 Common-law 4 Steady girlfriend 212. In what month and year did your first relationship start? month 1 9 year 98 Doesn't remember (month/year) 213. Have you ever had sexual intercourse? 1 Yes 2 No (SKIP TO Q. 401) 214. At what age did you first have sexual intercourse? years 98 Doesn't remember IF "00", SKIP TO Q.213. IF "01" AND THERE IS A RESPONSE AT Q.208, SKIP TO Q. 214. IF "01" AND Q. 208 IS BLANK, SKIP TO Q. 212. IF "02" OR MORE, CONTINUE. SKIP TO Q.214 -114- -6- SECTION III - REPRODUCTIVE HISTORY Now, we are going to talk about your history as a parent. Some of the questions may not apply to you, but just say so when this is the case. 301. Have you ever fathered any children? 1 Yes 2 No (SKIP TO Q. 315) 302. How many children have you fathered who currently live with you? 303. How many children have you fathered who live somewhere else? 304. How many children have you fathered who have died? [INCLUDE CHILDREN BORN ALIVE BUT WHO DIED SHORTLY AFTER BIRTH] 305. Therefore, the total number of children you have had is: 306. Now, I would like to ask you for some details about all your children. Please answer in the order of their birth, starting from the last child and going backwards to the first. [INCLUDE IN THIS LIST ALL CHILDREN WHO WERE BORN ALIVE, INCLUDING THOSE WHO DIED AFTER THEY WERE BORN]. Birth Date Is Birth Order Name Month Year Sex [NAME] Last birth 1 9 Next to last 1 9 Second from last 1 9 Third from last 1 9 Fourth from last 1 9 Fifth from last 1 9 Sixth from last 1 9 Seventh from last 1 9 Eighth from last 1 9 Ninth from last 1 9 Tenth from last 1 9 Eleventh from last 1 9 Twelfth from last 1 9 98 Don't remember 1 Male 1 Yes (month/year) 2 Female 2 No still alive? -115- -7- 307. Did you plan to have your first child? 1 Yes 2 No 9 Not sure 308. Did you plan to have your last (only) child? 1 Yes 2 No 9 Not sure 309. How many "baby mothers" (including wives) do you have? [IF RESPONDENT HAS ONE CHILD ONLY, ENTER "01"] number IF RESPONDENT HAS HAD ONE CHILD ONLY [Q. 305 = "01"], SKIP TO Q. 308. ALL OTHERS, CONTINUE WITH Q. 307. 88 Doesn't know 310. Do you help with the care of your children'} 1 Yes 2 No (SKIP TO BOX ABOVE Q. 313) 311. What kind of help do you give? Yes No 1 Child care 1 2 2 Financial Help 1 2 3 Gifts 1 2 8 Other (specify): ______________________________________________ 312. Do you think the help you give is important or not important in taking care of your children? 1 Important 2 Not important -116- - 8- IF RESPONDENT HAS HAD ONE CHILD ONLY BORN ALIVE, [Q. 305 = "01"], SKIP TO Q. 315. ALL OTHERS, CONTINUE. 313. Have you ever had more than one child born in the same year with different mothers? 1 Yes 2 No (SKIP TO Q. 315) 314. What was the highest number you have had in that year? number 88 Don't know/not sure 315. Is anyone (including your wife) pregnant for you now? 1 Yes 2 No (SKIP TO Q. 401) 8 Doesn't know (SKIP TO Q. 401) 316. Is this person your current partner? 1 Yes 2 No (SKIP TO Q. 318) 317. Did you plan this pregnancy? 1 Yes 2 No SKIP TO Q. 401 3 God's will, fate, didn't think about it 4 Don't know, not sure 318. Did you plan this pregnancy (any of these pregnancies) ? 1 Yes 2 No 3 God's will, fate, didn't think about it 4 Don't know, not sure -117- -9- SECTION IV - FAMILY PLANNING Now, I would like to talk about methods that people use to space or limit the number of their children. 401. a. FIRST Please tell me all the methods you have heard of to space or limit the ASK: number of children a person can have. [CIRCLE " 1" IN THE COLUMN "SPONTANEOUS", NEXT TO EACH METHOD MENTIONED]. b. THEN: READ EACH METHOD NOT MENTIONED. [CIRCLE "2" OR "0", AS APPROPRIATE]. c. THEN: ASK QUESTIONS ABOUT USE FOR EVERY METHOD KNOWN BY THE RESPONDENT. [CIRCLE "3" OR "4" AS APPROPRIATE]. Have you Have you/your Sponta- ever heard partner ever Method neous of [METHOD] ? used it? Yes No Yes No 1 Female sterilization, 1 2 0 3 4 tubal ligation 2 Male ster., vasectomy 1 2 0 3 4 3 Implants (Norplant) 1 2 0 3 4 4 Injections 1 2 0 3 4 5 Pill 1 2 0 3 4 6 WD/coil 1 2 0 3 4 7 Condom 1 2 0 3 4 8 Foaming tablets 1 2 0 3 4 9 Creams/jellies 1 2 0 3 4 10 Diaphragm 1 2 0 3 4 11 Withdrawal 1 2 0 3 4 12 Rhythm (calendar 1 2 0 3 4 method) 13 Billings method 1 2 0 3 4 88 Other (specify): 1 2 0 3 4 402. HAS RESPONDENT EVER USED AT LEAST ONE METHOD OF CONTRA CEPTION. [AT LEAST ONE "3" CIRCLED IN Q. 401] 1 Yes 2 No (SKIP TO BOX BELOW Q. 413) -118- - 10- 403. Are you/your (main) partner currently using a method of contraception? 1 Yes 2 No (SKIP TO Q. 405) 404. Which method? Please tell me if you and your (main) partner are using two methods? FIRST METHOD SECOND METHOD 1 Female sterilization, 1 Female sterilization, tubal ligation tubal ligation 2 Male sterilization, vasectomy 2 Male sterilization, Vasectomy 3 Implants (Norplant) 3 Implants (Norplant) 4 Injection 4 Injection 5 Pill 5 Pill 6 Intra-uterine device/coil 6 Intra-uterine device/Coil 7 Condom 7 Condom 8 Foaming tablets 8 Foaming tablets 9 Creams/jellies 9 Creams/jellies 10 Diaphragm 10 Diaphragm 11 Withdrawal 11 Withdrawal 12 Rhythm (calendar method) 12 Rhythm (calendar method) 13 Billings method 13 Billings method 88 Other (specify): 88 Other (specify): 00 No second method 405. How old were you when you/your partner first used contraception: age 98 Don't remember 406. How many living children did you have when you/your partner first used contraception? number 98 Don't remember 407. MORE THAN ONE SEXUAL PARTNER? [SEE Q. 209]. 1 Yes 2 No (SKIP TO INSTRUCTION FOLLOWING Q. 409) -119- - 11 - 408. Are you/your other partner currently using a method of contraception? 1 Yes 2 No (SKIP TO BOX BELOW Q. 409) 409. Which method? Please tell me if you and your other partner are using two methods? FIRST METHOD SECOND METHOD 1 Female sterilization, 1 Female sterilization, tubal ligation tubal ligation 2 Male sterilization, vasectomy 2 Male sterilization, vasectomy 3 Implants (Norplant) 3 Implants (Norplant) 4 Injection 4 Injection 5 Pill 5 Pill 6 Intra-uterine device/coil 6 Intra-uterine device/coil 7 Condom 7 Condom 8 Foaming tablets 8 Foaming tablets 9 Creams/jellies 9 Creams/jellies 10 Diaphragm 10 Diaphragm 11 Withdrawal 11 Withdrawal 12 Rhythm (calendar method) 12 Rhythm (calendar method) 13 Billings method 13 Billings method 88 Other (specify): _________________ 88 Other (specify): _________________ 00 No second method THE REST OF THIS SECTION INCLUDING THE FOLLOWING INSTRUCTIONS REFER TO "MAIN PARTNER" ONLY IF RESPONDENT HAS USED CONTRACEPTION IN THE PAST BUT IS NOT CURRENTLY USING [Q. 402 = "YES" AND Q. 403 = "NO"], CONTINUE. IF RESPONDENT IS USING ONE OF METHODS 3-10 [THAT IS, A MODERN REVERSIBLE CONTRACEPTIVE METHOD NOW (Q. 402 = "YES" AND Q. 404 = METHODS 3-10)], SKIP TO Q. 423. IF RESPONDENT IS USING ONE OF METHODS 11-13 ONLY [Q. 404 = ""11", "12" OR "13" ] SKIP TO Q. 425. IF RESPONDENT OR WIFE/PARTNER IS STERILIZED [Q. 404 = METHODS 1 OR 2], SKIP TO Q. 450. -120- - 12 - 410. What was the last family planning method you or your partner used? 1 Female sterilization, tubal ligation 8 Foaming tablets 2 Male sterilization, vasectomy 9 Creams/jellies 3 Implants (Norplant) 10 Diaphragm 4 Injection 11 Withdrawal (SKIP TO BOX 5 Pill 12 Rhythm FOLLOWING 6 Intra-uterine device/coil 13 Billings method Q. 413) 7 Condom 88 Other (specify): 411. Where did you or your partner get your family planning supplies! 1 Government hospital 7 Outreach worker 2 Government health clinic/centre 8 Factory/workplace 3 Private hospital 9 Supermarket/shop/bar 4 Private clinic 88 Other (specify): 5 Private doctor _____________________________ 6 Pharmacy 98 Doesn't know/doesn't remember IF METHOD USED WAS "INJECTION" ["4" IN Q. 410], AND SUPPLY SOURCE WAS "PHARMACY" ["6" IN Q. 411], CONTINUE WITH Q. 412. ALL OTHERS, SKIP TO Q. 413. 412. Who administered the injection? 1 A doctor 4 Other health professional 2 A nurse 5 Other (specify): ____________ 3 The pharmacist 9 Doesn't remember 413. How far did you or your partner have to travel to obtain the supplies? 1 At home 5 5 to under 10 miles 2 Under 1 mile 6 10 miles and over 3 1 to under 2 miles 9 No response 4 2 to under 5 miles IF MARRIED OR LIVING WITH COMMON-LAW PARTNER, CONTINUE. ALL OTHERS, SKIP TO Q. 418. - 13- 414. Do you think your partner is able to get pregnant at the present time? 1 Yes (SKIP TO Q. 416) 3 Currently pregnant (SKIP TO Q. 418) 2 No 4 Not sure, don't know 415. Why not? 1 Menopause 2 Has had an operation for medical reasons which makes pregnancy (SKIP TO BOX impossible (or husband/partner has had an operation) FOLLOWING Q. 455) 3 Has tried to get pregnant for at least two years without success (or has not gotten pregnant despite at least two years of non-contraception) -121- 4 Not sexually active (SKIP TO Q. 418) 5 Postpartum/breastfeeding 6 Other (specify) __________________________________________________ 416. Would you like her to become pregnant now? 1 Yes (SKIP TO Q. 418) 3 God's will, fate 2 No 4 Don't know, not sure 417. Why are you/your partner not using a method to prevent pregnancy now? 1 Health/medical 8 Partner opposes 2 Doesn't like 9 Lack of knowledge 3 Had side effects from last (other) 10 Considers contraception not effective methods 11 Considers method last used not effective 4 Fear of side effects 12 Method difficult to use 5 Method unavailable 13 Money problems 6 Partner's responsibility 14 Religion against 7 Source far away 88 Other (specify): _____________________ 418. In the future (after this pregnancy), do you think you will want to use a method to prevent pregnancy? 1 Yes 2 No (SKIP TO Q. 437) 3 Not sure (SKIP TO Q. 437) -122- - 14 - 419. What method would you most like to use? 1 Female sterilization, tubal ligation 9 Creams/jellies 2 Male sterilization, vasectomy 10 Diaphragm 3 Implants (Norplant) 11 Withdrawal (SKIP TO Q. 437) 4 Injection 12 Rhythm (calendar method) 5 Pill 13 Billings method 6 Intra-uterine device/coil 88 Other (specify): 7 Condom 8 Foaming tablets 98 Don't know (SKIP TO Q. 437) 420. Do you know where to obtain that method, (or information on the method if it is either the Rhythm or Billings methods (METHODS 12 AND 13)? 1 Yes 2 No (SKIP TO Q. 437) 421. Where? [IF MORE THAN ONE PLACE MENTIONED, CIRCLE THE ONE HE WOULD MOST LIKELY USE] 1 Government hospital 7 Outreach worker 2 Government health clinic/centre 8 Factory/workplace 3 Private hospital 9 Supermarket/shop/bar 4 Private clinic 88 Other (specify): 5 Private doctor 6 Pharmacy 98 Doesn't know/doesn't remember 422. How far would you/your partner have to travel to obtain the supplies or information relating to the method? 1 At home 5 5 to under 10 miles 2 Under 1 mile 6 10 miles and over 3 1 to under 2 miles 9 No response 4 2 to under 5 miles ALL SKIP TO QUESTION 437 423. Where do you/your partner get your family planning supplies? 1 Government hospital 7 Outreach worker 2 Government health clinic/centre 8 Factory/workplace 3 Private hospital 9 Supermarket/shop/bar 4 Private clinic 88 Other (specify): 5 Private doctor _____________ 6 Pharmacy 98 Doesn't know/doesn't remember -123- - 15- IF METHOD USED IS "INJECTION" (THAT IS, "4" IN Q. 407), AND SUPPLY SOURCE IS "PHARMACY" (THAT IS, "6" IN Q. 423), CONTINUE. ALL OTHERS, SKIP TO Q. 425. 424. Who administered the injection? 1 A doctor 2 A nurse 3 The pharmacist 4 Other health professional 8 Other (specify): _______________________________________________ 9 Doesn't remember 425. How far did you/your partner have to travel to obtain the supplies or information on the methods? 1 At home 5 5 to under 10 miles 2 Under 1 mile 6 10 miles and over 3 1 to under 2 miles 9 No response 4 2 to under 5 miles 426. PILL USER? [CODE "5" IN Q. 404] 1 Yes (CONTINUE WITH Q. 427) 2 No (SKIP TO Q. 437) 427. What is the brand name of the pill your (main) partner is currently using? 1 Anteovin 12 Ortho 2 Diane 13 Ortho Novum 3 Eugynon 14 Ovral 4 Gynera 15 Ovulen 5 Lo Femenal 16 Perle 6 Logynon 17 Trinordiol 7 Microgynon 18 Trinovum 8 Microval 19 Tri-Regal 9 Minulet 88 Other (specify): 10 Neogynon __________________________ 11 Nordette 98 Doesn't know 428. How long (in months) has she been using this (brand) continuously? months -124- - 16- 429. Who first told her to use it? 1 A doctor 5 A friend 2 A nurse 8 Other (specify): 3 A pharmacist _______________________ 4 A family member 9 Doesn't know 430. Does she currently have a supply of [BRAND] which she is currently using? 1 Yes 9 Doesn't know 2 No 431. What brand was she using before? 1 Anteovin 12 Ortho 2 Diane 13 Ortho Novum 3 Eugynon 14 Ovral 4 Gynera 15 Ovulen 5 Lo Femenal 16 Perle 6 Logynon 17 Trinordiol 7 Microgynon 18 Trinovum 8 Microval 19 Tri-Regal 9 Minulet 88 Other (specify): ______________ 10 Neogynon 00 No change 11 Nordette 98 Doesn't know ALL SKIP TO QUESTION 437 432. In the future, do you think you or your partner will want to use a Afferent method to prevent pregnancy? 1 Yes 9 Doesn't know, not sure (SKIP 2 No (SKIP TO Q. 437) TO Q. 437) 433. What method would you/your partner most like to use? 1 Female sterilization, tubal ligation 8 Foaming tablets 2 Male sterilization, vasectomy 9 Creams/jellies 3 Implants (Norplant) 10 Diaphragm 4 Injection 11 Withdrawal (SKIP TO Q. 443) 5 Pill 12 Rhythm (calendar method) 6 Intra-uterine device/coil 13 Billings method 7 Condom 88 Other (specify): -125- - 17- 434. Do you/your partner know where to obtain this method, or information about this method if it is either the Rhythm method or the Billings method [METHODS 12 AND 13]? 1 Yes 2 No (SKIP TO Q. 437) 435. Where? [IF MORE THAN ONE PLACE MENTIONED, CIRCLE THE ONE HE WOULD MOST LIKELY USE] 1 Government hospital 7 Outreach 2 Government health clinic/centre 8 Factory/workplace 3 Private hospital 9 Supermarket/shop/bar 4 Private clinic 88 Other (specify): 5 Private doctor _________________________ 6 Pharmacy 98 Doesn't know/doesn't remember 436. How far would you/your partner have to travel to obtain the supplies or information about the method? 1 At home 5 5 to under 10 miles 2 Under 1 mile 6 10 miles and over 3 1 to under 2 miles 9 No response 4 2 to under 5 miles 437. Do you want to have any (more) children (after this pregnancy)? 1 Yes (SKIP TO Q. 443) 3 God's will, fate (SKIP TO Q.445) 2 No 9 Not sure (SKIP TO Q. 445) RESPONDENTS WHO HAVE INDICATED THAT THEY WOULD LIKE TO HAVE A VASECTOMY IN THE FUTURE OR THEIR PARTNER TO HAVE A TUBAL LIGATION ["2" OR "1" IN Q. 419], SKIP TO BOX FOLLOWING Q. 455. ALL OTHERS, CONTINUE. QUESTIONS 438-442 ARE ONLY FOR MEN WHO DO NOT WANT MORE CHILDREN. 438. Would you be interested in an operation that would prevent you or your partner from having any (more) children? 1 Yes 2 No (SKIP TO Q. 449) 3 Not sure -126- - 18- 439. Do you/does your partner know where to go for this operation? 1 Yes (SKIP TO Q. 441) 2 No 440. Do you/does your partner know where to get information about this operation'} 1 Yes 2 No (SKIP TO BOX FOLLOWING Q. 455) 441. Where? [IF MORE THAN ONE PLACE MENTIONED, CIRCLE THE ONE SHE WOULD MOST LIKELY USE] 1 Clinic/health centre 4 Private doctor/clinic 2 Public hospital 8 Other (specify): 3 Private hospital ___________________________ 442. Since you have (or will have) all the children you want and you know where to get this operation/information about this operation, why have you not had it? 1 Fear of method/side effects 10 Current partner opposes 2 Fear of operation (cut) 11 Advanced age, approaching menopause 3 Fear of anaesthesia 12 Not sexually active 4 Service facility too far 13 Religion 5 Too young 14 Man should have all the children they 6 Future partner might want children want 7 May want more children if those 15 Family opposes living should die 88 Other (specify): 8 Lack of information ________________________________ 9 Lack of money 99 No answer SKIP TO BOX FOLLOWING Q. 455. 443. How many (more) children would you like to have (after this pregnancy)? children 77 As many as God sends, up to fate 98 Don't know 66 As many as possible QUESTIONS 443-449 ARE ONLY FOR MEN WHO WANT OR MIGHT WANT MORE CHILDREN. -127- - 19- 444. When would you like to have the next one? [ANSWER IN MONTHS IF LESS THAN TWELVE MONTHS OR IN YEARS IF MORE THAN ONE YEAR] months years 00 As soon as possible 98 Don't know 445. When you have had all the children you want, would you be interested in an operation that would prevent you from having any (more) children? 1 Yes 3 Not sure 2 No (SKIP TO Q. (449) 446. Do you know where to go for this operation? 1 Yes 2 No 447. Do you know where to get information about this operation! 1 Yes 2 No (SKIP BOX FOLLOWING Q. 455) 448. Where? [IF MORE THAN ONE PLACE MENTIONED, CIRCLE THE ONE HE WOULD MOST LIKELY USE] 1 Clinic/health centre 4 Private doctor/clinic 2 Public hospital 8 Other (specify): 3 Private hospital ____________________________ ALL SKIP TO BOX FOLLOWING Q. 455. 449. Why would you not be interested in this operation ? 1 Fear of method/side effects 10 Current partner opposes 2 Fear of operation (cut) 11 Advanced age, approaching menopause 3 Fear of anaesthesia 12 Not sexually active 4 Service facility too far 13 Religion 5 Too young 14 Men should have all the children 6 Future partner might want children they want 7 May want more children if 15 Family opposes situation changes 88 Other (specify): 8 Lack of information ________________________________ 9 Lack of money 99 No answer SKIP TO BOX FOLLOWING Q. 455. -128- -20- 450. Where was your vasectomy/your wife's (partner's) tubal ligation done? 1 Public hospital 3 Private doctor/clinic 2 Private hospital 8 Other (specify): ________________________ 451. How old were you when you/she had the operation? age QUESTIONS 450 - 455 ARE FOR MEN WHO HAVE HAD A VASECTOMY OR WHOSE WIVES/PARTNERS HAVE HAD TUBAL LIGATION. 452. Did you/your partner receive any counselling about family planning methods at that location? 1 Yes 2 No (SKIP TO Q. 454) 453. Did the counsellor or person you talked with give the following information? [FOR EACH POSSIBLE RESPONSE ASK: "Did she tell you about . " Yes No DK/DR A How the operation is performed 1 2 9 B The fact that sterilization does not affect sex life 1 2 9 C Postoperative consequences like pain, discomfort 1 2 9 D The anesthesia which would be used 1 2 9 E The possible medical risks of surgery and anesthesia 1 2 9 F The possibility of failure 1 2 9 G The fact that if the operation is successful, you 1 2 9 would not be able to have more children H The possibility of regret 1 2 9 I What to do in the event of postoperative 1 2 9 complications J Other available contraceptive methods 1 2 9 K Benefit of other methods 1 2 9 L Side effects of other methods 1 2 9 -129- -21 - 454. Are you satisfied with you/your partner having had the operation? 1 Yes (SKIP TO BOX FOLLOWING Q. 455) 2 No 455. Why are you not satisfied with the operation? 1 In a new union 2 The operation has caused complications 3 Had bad side effects 4 It has decreased sexual enjoyment 5 Desires more children because child(ren) died 6 Would like another child because my other children have grown up 7 Sterilization is morally wrong 8 Husband/partner treats me differently 9 She feels less important 88 Other (specify): __________________________________________ 98 Don't know 99 Refused IF CURRENTLY USING A MODERN METHOD [Q. 404 AND/OR Q. 409 = "1-10"], CONTINUE WITH Q. 501. ALL OTHERS, SKIP TO Q. 504. -130- -22 - SECTION V - ATTITUDES TOWARD CONTRACEPTION AND SEXUALITY 501. If you or your partner do nor currently pay for the contraceptive (s) you use, would you be prepared to pay for it/them ? 1 Yes 3 Already pays for it/them 2 No (SKIP TO Q. 503) 502. How much would you/your partner he prepared to pay [If " I" in Q. 501]? Or, what is the highest amount you/your partner would he prepared to pay [If "3" in Q. 501]? Please tell me if more than one method is being used. [IF $997 AND MORE, CODE "997"]. FIRST METHOD SECOND METHOD J$ J$ per cycle of pill per cycle of pill per piece of condom per piece of condom per tube of foam/jelly per tube of foam/jelly per dose of injection per dose of injection per IUD (device only) per IUD (device only) per unit of diaphragm per unit of diaphragm per procedure (tubal ligation) per procedure (tubal ligation) per procedure (vasectomy) per procedure (vasectomy) 998 Don't know 998 Don't know 999 Regardless of cost 999 Regardless of cost 000 No second method SKIP TO Q. 504 503. What would you then do to obtain contraceptives if you could not get them free of charge? 1 Stop using, do without, etc. 4 Use herbal medicines 2 Abstain from sex 8 Other (specify): 3 Use Natural Family Planning _______________________________ methods or withdrawal 504. If a woman takes the pill correctly, how sure can she be that she will not become pregnant? [READ OPTIONS 1-3] 1 Completely sure 3 Some risk of pregnancy 2 Slight risk of pregnancy 9 Don't know -131- - 23 - 505. How safe for a woman's health is the pill? [READ OPTIONS 1 -3] 1 Completely safe 3 Unsafe 2 Slight risk 9 Don't know IF RESPONDENT HAS NEVER HEARD OF TUBAL LIGATION, INJECTION, PILL OR IUD, SKIP TO Q. 507. ALL OTHERS, CONTINUE. I am now going to ask you how you feel about different kinds of contraceptives. For each contraceptive mentioned, that is, the injection, the pill, the IUD and tubal ligation, please give me your response after I read the possible answers. [READ ALL ANSWERS EXCEPT "DON'T KNOW"] the Inj- the the TL ection Pill IUD 506a. How would you rate 1 Very effective [METHOD] as to its 2 Sometimes effective effectiveness in 3 Not effective preventing pregnancy? 9 Don't know 506b. How would you rate 1 Very easy [METHOD| as to its 2 Somewhat easy ease of use? 3 Not easy 9 Don't know 506c. Do you think 1 Yes [METHOD] can cause 2 No vaginal discharge? 9 Don't know 506d. Do you think 1 Yes [METHOD] can 2 No cause abnormal 9 Don't know bleeding ? 506e. Do you think women 1 Yes who use [METHOD| 2 No have a higher risk 9 Don't know of cancer? 506f Do you think 1 Yes [ M ET H O D | can cause 2 No XXX infertility if you 9 Don't know use it for a long time, say five years? 506g. Do you think 1 Yes [METHOD] is bad for 2 No blood circulation? 3 Don't know -132- -24- Now, I'd like to read some statements to you. Please indicate if you agree, disagree or are uncertain about them. Dis- Un- No Re- Agree agree certain sponse 507. God should decide how many children one 1 2 8 9 should have. 508. Work in the kitchen is women's work. 1 2 8 9 509. Care of children is women's work. 1 2 8 9 510. Sex with a virgin can cure gonorrhoea. 1 2 8 9 511. The man is the one to decide how many 1 2 8 9 children his wife/partner should have. 512. A woman should be a virgin when she marries. 1 2 8 9 513. Men should always have financial respons- 1 2 8 9 ibility towards their children. 514. Parents who provide their children with sex 1 2 8 9 education encourage them to have sexual intercourse. 515. Sex education should be taught in schools. 1 2 8 9 516. A woman should have a baby before she is 1 2 8 9 twenty to prove she is not a mule. 517. A woman can become pregnant during her 1 2 8 9 first sexual intercourse. 518. If a man uses a condom, it doesn't take away 1 2 8 9 any pleasure from the woman. 519. You can use the same condom more than once. 1 2 8 9 520. Using the pill will protect you against sexually 1 2 8 9 transmitted diseases including AIDS. 521. Who ought to make the decision to use something to avoid becoming pregnant, the man only, the woman only, or both together? 1 The man 4 Each one is on his or her own 2 The woman 8 Other (specify): 3 Both _________________________ -133- -25- Now I would like to ask you about your attitude towards childbearing. 522. If you could choose exactly the number of children to have in your whole life, how many would that be? number 77 Fate, up to God 99 Don't know 523. In your opinion, at what age is a woman responsible enough to have her first child? years 66 Soon after she enters her first union 77 When she matures, is in a stable union 55 Depends on circumstances 98 Doesn't have an opinion 88 Other (specify): _______________________________________________ 524. What is the main reason a woman might wish to limit the number of children that she has? 1 Health of the mother 2 Health of the child 3 Economic reasons 4 Wellbeing of the family 5 Don't think a woman should limit the number of children she has 8 Other (specify): _________________________________________________ 525. How old do you think a child should be before the mother stops breastfeeding him/her? months 77 As long as possible 98 Don't know 526. How old do you think it is best for a child to be before another child is born? months 98 Fate, up to God 99 Don't know IF RESPONDENT HAS NO LIVING CHILDREN [SEE Q. 302 AND 303], SKIP TO Q. 523 ALL OTHERS, CONTINUE. 527. Who should decide the number of children a couple wants to have? 1 Husband/partner 4 Mother-in-law 2 Wife/woman 5 Fate, up to God 3 Both 6 Other (specify): ____________________ -134- -26- 528. What are the days during the month when a woman has to be careful to avoid becoming pregnant? [READ OPTIONS 1-5] 1 During her period 5 At any time 2 Right after her period has ended 8 Other (specify): 3 In the middle of the cycle __________________________ 4 Just before her period begins 9 Don't know 529. Which do you think is better, vasectomy for men or tubal ligation for women? 1 Vasectomy 3 Neither, both equally (SKIP TO Q. 531) 2 Tubal ligation 9 No opinion (SKIP TO Q. 531) 530. Why do you think vasectomy/tubal ligation [USE ANSWER TO Q. 529] is better? 1 Cheaper 2 Safer 3 Vasectomy diminishes a man's potency 4 Tubal ligation eliminates the future possibility of childbearing 5 Vasectomy eliminates the future possibility of childbearing 8 Other (specify): ___________________________________________ 9 Don't know 531. EVER USED CONDOMS. 1 Yes [Q. 401-7 = "3"] 2 No (SKIP TO Q. 533) 532. Wliy do (did) you and your partner use condoms? [READ OPTIONS 1-3] 1 Prevent pregnancy 3 Prevent pregnancy and disease 2 Prevent sexually transmitted diseases 4 Don't know/Don't remember SKIP TO QUESTION 534 533. Why haven't you and your partner(s) ever used condoms? 1 Partner(s) didn't like them 2 Have only one partner 3 Preventing pregnancy is woman's responsibility 4 They diminish pleasure/spontaneity 5 Not effective at preventing pregnancy 6 They are too expensive 7 Condoms are to be used only outside of marriage 8 Condoms are to be used only with prostitutes 9 Never sexually active 88 Other (specify):_______________________________________________ 98 Don't know -135- -27- 534. CURRENT CONDOM USER. 1 Yes [CODE "7" IN Q. 404 OR Q. 409] 2 No (SKIP TO Q. 601) 535. How often do you use condoms during sexual intercourse? [READ OPTIONS 1-5] 1 Every time 2 Every time with certain partners 3 Most of the time 4 Some of the times 5 Occasionally 9 Refused 536. The last time you had sexual intercourse, did you use a condom? 1 Yes 2 No 537. What is the brand name of the condom you/your partner normally use! 1 Arouser 15 Maximum 2 Bare Back 16 Pamitex 3 Black Jack 17 Panther 4 Fantasy 18 Power Play 5 Featherlite 19 Rough Rider 6 Fiesta 20 Sensuals 7 Gold 21 Siltex 8 Gossemar 22 Sultan 9 Jellia 23 Trojan 10 Jiffi 24 Wet'N'Wild 11 Kiss of Mint 88 Other (specify): 12 Licks _____________________________ 13 Life Force 00 No brand 14 Life Styles 98 Don't know 538. Do you currently have a supply of them! 1 Yes 2 No 9 No answer/don't know 539. Did you buy them (the last time you had them)? 1 Yes 2 No (SKIP TO Q. 541) -136- -28- 540. Where did you buy the condoms that you normally use? 1 Pharmacy 2 Supermarket 3 Grocery shop 4 Bar 8 Other (specify): ___________________________________________ ALL SKIP TO Q. 601 541. Where did you get the condoms if you did not buy it? 1 Hospital 2 Clinic 3 Doctor's office 4 Partner 5 Friend 6 Outreach worker 8 Other (specify):_________________________________________________ -137- -29- SECTION VI - YOUNG ADULT MODULE (For all eligible respondents aged 15-24 years) 601. AGE OF RESPONDENT: [SEE Q. 102] 1 15-24 [CONTINUE WITH Q. 602] 2 25-54 (SKIP TO Q. 701) 602. What ways are used by men to get a young woman into a sexual relationship? [IF MORE THAN ONE WAY MENTIONED, ASK THE MOST IMPORTANT WAY]. 1 Persistence 2 Good looks 3 Coaxing 4 Bragging about property 5 Money 6 Material things 7 Seclusion/seduction 8 Saying she doesn't love him if she won't have sex 9 Promise employment 10 Promise marriage 11 Promise "Uptown, Downtown, and Parade”/promise "the world" 12 Brute force 88 Other (specify): _____________________________________________________ 98 Don't know 99 No answer 603. How can a woman put off having sex if she is not ready for it? [IF HE GIVES MORE THAN ONE REASON," ASK FOR THE MOST IMPORTANT]. 1 Take his mind off it 7 Don't listen 2 Avoid him 8 Pretend illness 3 Don't take anything 9 Say no 4 Stay away from secluded areas 88 Other (specify): ___________ 5 Pretend menstruation 98 Don't know 6 Don't move in with him 99 No answer 604. For young people your age who have had sexual intercourse, what do you think is the most appropriate contraceptive method to use to avoid pregnancy? 1 Female sterilization, tubal ligation 10 Diaphragm 2 Male sterilization, vasectomy 11 Withdrawal 3 Implant (Norplant) 12 Rhythm 4 Injection 13 Billings method 5 Pill 14 Abstinence (SKIP TO 6 Intra-uterine device/coil 00 None Q.606) 7 Condom 98 Doesn't know 8 Foaming tablets 99 Doesn't answer 9 Creams/jellies 88 Other (specify): _____________ -138- -30- 605. Could you afford to use this method? 1 Yes 2 No 9 Doesn't know 606. Have you ever had a class or course about family life or sex education in school? 1 Yes 2 No (SKIP TO Q. 612) 607. How old were you when you had the first class or course? age 98 Doesn't remember 608. What grade of schooling (level and years) had you reached when you had this first class or course? NOT LEVEL ______________ YEARS________________ SPECIFIED 1 Primary 0 1 2 3 4 5 6 7 8+ 9 2 Secondary 0 1 2 3 4 5 6 7 8+ 9 3 Post secondary 0 1 2 3 4 5 6 7 8+ 9 9 Doesn't remember 609. Who was the main person who taught this first class or course? 1 School teacher 2 Physician 3 Counsellor or psychologist 4 Social worker 5 Nurse 8 Other (specify): ____________________________________ 9 Doesn't remember 610. Was it a man or a woman? 1 Man 2 Woman 9 Doesn't remember -31 - 611. Did this first class or course or any hirer class or course in school include information about. ? [READ] Doesn't Yes No Remember 1 The human reproductive system 1 2 8 2 The woman's menstrual cycle or period 1 2 8 3 Pregnancy and how it occurs 1 2 8 4 Modern birth control methods such as the pill, 1 2 8 IUD, condom, spermicidals, or injectables 5 Sexually transmitted diseases that can 1 2 8 result from sexual contact 6 AIDS 1 2 8 7 Services available for adolescents 1 2 8 672. At what age do you think sex education should begin in schools? age 77 It should not be taught 98 Doesn't know 613. Have you ever had a formal course or lecture about family life or sex education anywhere outside of the school? 1 Yes 2 No (SKIP TO Q. 619) 614. Where was the first place you had it? 1 Community centre 7 Work place 2 Clinic 8 HEART 3 Club 9 Home 4 Church 88 Other (specify): 5 Youth centre ______________________ 6 Bar 98 Doesn't remember 615. How old were you when you had this first course or lecture on sex education? age -139- 98 Doesn't remember -140- -32- 616. Who was the main person who taught this course? 1 School teacher 6 Other social worker 2 Physician 7 Peers 3 Nurse 8 Parent/guardian 4 Counsellor or psychologist 88 Other (specify): _____________ 5 Family planning outreach worker 99 Doesn't remember 617. Was it a man or a woman? 1 Man 2 Woman 9 Doesn't remember 618. Did this first class or course or any later class or course in school include information about . ? [READ] Doesn't Yes No Remember 1 The human reproductive system 1 2 8 2 The woman's menstrual cycle or period 1 2 8 3 Pregnancy and how it occurs 1 2 8 4 Modern birth control methods such as the pill, 1 2 8 IUD, condom, spermicidals or injectables 5 Sexually transmitted diseases that can 1 2 8 result from sexual contact 6 AIDS 1 2 8 7 Services available for adolescents 1 2 8 Now, I'd like to ask you some very personal questions which are very important to the study. 619. In what month and year did you first have sexual intercourse? [CHECK WITH ANSWERS GIVEN AT QUESTIONS 213 AND 214. IF NOT CONSISTENT, CLARIFY AND CORRECT WHERE RELEVANT] month 1 9 year 98 Doesn't remember 99 No response 2222 Has never had sexual intercourse (SKIP TO Q. 801) -141- -33- 620. How old was the person with whom you had sexual intercourse for the first time? age 621. What was the relationship of this person to you at that time? 1 Wife/partner 5 Casual acquaintance 2 Visiting partner 6 Father's partner 3 Girlfriend 8 Other (specify): 4 Friend ______________________________________________________________ 622. Where did this first experience take place? 1 At his own home 2 At his partner's home 7 At a dance hall/party 3 At a friend's home 8 At the beach 4 In a hotel or motel 9 In the bushes 5 In a car 88 Another place (specify): _______ 6 School 98 Doesn't remember 623. Did you or your partner use a contraceptive method during this first sexual intercourse? 1 Yes 2 No (SKIP TO Q. 627) 9 Doesn't remember/doesn't know (SKIP TO Q. 628) 624. What was the method? 1 Female sterilization, tubal ligation 8 Foaming tablets 2 Male sterilization, vasectomy 9 Cream/jellies 3 Implant (Norplant) 10 Diaphragm 4 Injection 11 Withdrawal 5 Pill 12 Rhythm (calendar method) 6 Intra-uterine device/coil 13 Billings method 7 Condom 88 Other (specify): 625. Where did you or your partner get this method used during your first sexual intercourse? IN CASE OF BILLINGS OR RHYTHM (CALENDAR METHOD),. Where did you or your partner receive orientation?) 1 Government hospital 7 Outreach worker 2 Government health clinic/centre 8 Factory/work place 4 Private clinic 9 Supermarket/shop/bar 5 Private doctor 88 Other (specify): ____________ 6 Pharmacy 99 Doesn't know/doesn't remember -142- -34- 626. Whose decision was it to use this method? You alone, your partner alone, or was it made together1? 1 His decision 3 Decision made together 2 Partner's decision 4 Doesn't remember SKIP TO Q. 701. 627. Why didn't you or your partner use a contraceptive method during this first sexual intercourse? 1 Didn't expect to have sexual relations at that time 2 Partner was against using something 3 Contraceptive methods are bad for one's health 4 Religion doesn't permit use 5 Didn't know of any methods 6 Knew of methods but didn't know where to get them 7 Intercourse is not satisfying when methods are used 8 Wanted to use something but couldn't get it at that moment 9 Too embarrassed to get method 10 Wanted to become pregnant 11 Other (specify): ________________________________________________ 88 Doesn't know 98 Didn't respond -143- -35 - SECTION VII - CURRENT SEXUAL ACTIVITY (For all eligible respondents) 701. EVER HAD SEXUAL INTERCOURSE? [SEE Q. 207 OR Q. 213] 1 Yes 2 No (SKIP TO Q. 801) 702. Have you had sexual intercourse in the last 30 days? 1 Yes 2 No (SKIP TO Q. 705) 703. How many times have you had sexual intercourse in the last 30 days? times 90 Many times - more than 10 98 Don't remember 704. With how many women ? number 98 Don't remember 705. What was the relationship of the last person with whom you had sexual intercourse to you? 1 Wife/partner 2 Visiting partner 3 Girlfriend 4 Friend 5 Casual acquaintance 6 Father's partner 7 Other relative's partner 8 Other (specify): ________________________________________ 706. Did you or the woman involved use a contraceptive method during the last time you had sexual intercourse? 1 Yes 2 No (SKIP TO Q. 708) -144- -36- 707. What was this method? 1 Female sterilization, tubal ligation 8 Foaming tablets 2 Male sterilization, vasectomy 9 Cream/jellies 3 Implant (Norplant) 10 Diaphragm 4 Injection 11 Withdrawal 5 Pill 12 Rhythm (calendar method) 6 Intra-uterine device/coil 13 Billings method 7 Condom 88 Other (specify): 708. NUMBER OF WOMEN WITH WHOM YOU HAD SEXUAL RELATIONS IN PAST 30 DAYS. [CHECK Q. 704] 1 One woman (SKIP TO Q. 801) 2 Two women 3 Three or more women 709. What was the relationship of the next-to-last person with whom you had sexual intercourse in the past 30 days to you? 1 Wife/partner 5 Casual acquaintance 2 Visiting partner 6 Father's partner 3 Girlfriend 7 Other relative's partner 4 Friend 8 Other (specify): _____________ 710. Did you or this person use a contraceptive method? 1 Yes 2 No (SKIP TO BOX FOLLOWING Q. 711) 711. What was this method? 1 Female sterilization, tubal ligation 8 Foaming tablets 2 Male sterilization, vasectomy 9 Cream/jellies 3 Implant (Norplant) 10 Diaphragm 4 Injection 11 Withdrawal 5 Pill 12 Rhythm (calendar method) 6 Intra-uterine device/coil 13 Billings method 7 Condom 88 Other (specify): RESPONDENTS WHO HAVE HAD SEXUAL RELATIONS WITH TWO WOMEN IN PAST 30 DAYS, SKIP TO Q. 801. WITH THREE OR MORE WOMEN, CONTINUE. -145- -37- 712. What was the relationship of the second-from-last person with whom you had sexual intercourse in the past 30 days to you? 1 Wife/partner 2 Visiting partner 3 Girlfriend 4 Friend 5 Casual acquaintance 6 Father's partner 7 Other relative's partner 8 Other (specify): _____________________________________ 713. Did you or this person use a contraceptive method] 1 Yes 2 No (SKIP TO Q. 801) 714. What was this method? 1 Female sterilization, tubal ligation 8 Foaming tablets 2 Male sterilization, vasectomy 9 Cream/jellies 3 Implant (Norplant) 10 Diaphragm 4 Injection 11 Withdrawal 5 Pill 12 Rhythm (calendar method) 6 Intra-uterine device/coil 13 Billings method 7 Condom 88 Other (specify): -146- -38- SECTION VIII - KNOWLEDGE AND TRANSMISSION OF AIDS AND PREVENTION 801. Have you ever heard of HIV or HIV infection? 1 Yes 2 No 802. Have you ever heard of the disease called AIDS? 1 Yes 2 No 803. Do you think a person can be infected with the virus which causes AIDS and not have any signs or symptoms of the AIDS disease? 1 Yes 2 No 8 Don't know 804. Can you tell me two different ways in which a person can become infected with the virus which causes AIDS? First Second Sexual transmission 1 1 Intravenous drugs 2 2 Blood transfusion 3 3 Mother to child 4 4 Mosquito bites 5 5 Casual contact 6 6 Other (specify):_____________________________ 8 8 Don't know 805. Can a person get AIDS from someone who has the AIDS virus but does not have the AIDS disease? 1 Yes 2 No 8 Don't know 806. What risk do you think there is of your getting AIDS? [READ] 1 A great risk 2 Some risk 3 Not much risk 4 No risk at all -147- -39- 807. What can a person do to reduce the risk of getting AIDS? [IF NON-SPONTANEOUS RESPONSE, PROBE: Can a person . to reduce the risk of AIDS? Sponta- Probed neous Yes No DK A Use condoms 1 2 3 9 B Avoid relations with prostitutes 1 2 3 9 C Have only one sexual partner 1 2 3 9 D Ask partner to have blood tested for 1 2 3 9 AIDS E Not have sexual relations 1 2 3 9 F Sterilize needles 1 2 3 9 G Avoid relations with bisexuals/homosexuals 1 2 3 9 H Any thing else? ____________________________ 1 2 3 9 808. In which of the following ways do you think a person can get the virus which causes AIDS? [READ] Don't Yes No know A Shaking hands or hugging 1 2 8 B Being in the same room as a person who has the 1 2 8 AIDS virus C Sharing personal items like dishes, toilets, etc. 1 2 8 D Sharing needles used for drugs 1 2 8 E Sexual intercourse between men 1 2 8 F Sexual intercourse between a man and a woman 1 2 8 G Giving a blood donation 1 2 8 H Receiving a blood transfusion 1 2 8 I Being bitten by an insect that has bitten someone 1 2 8 with the AIDS virus -148- -40- END OF INTERVIEW ……. THANK YOU!!! Date Hr. Min. TIME INTERVIEW STARTED: [See Title Page and page 2] TIME INTERVIEW ENDED: INTERRUPTION TIME (IF ANY): DURATION OF INTERVIEW: NOW RETURN TO TITLE PAGE AND COMPLETE INFORMATION ON INTERVIEW CALLS. COMMENTS -149- APPENDIX IV REPORT ON THE NATIONAL DISSEMINATION SEMINAR The main results of the surveys were present- ed in a two-day seminar held in February 1994 to disseminate and evaluate the findings of the surveys. The purpose of the Seminar was to discuss the findings of the 1993 Contraceptive Prevalence Survey so as to develop a better understanding among policy makers and family planning, health and population workers of their implications in order to improve the delivery of family planning services. The major objectives of the Seminar were: 1. To present and compare the findings of the 1993 CPS with data from other rele- vant sources. 2. To examine the findings within the con- text of areas of national population policy which relate to family planning. 3. To make recommendations on the impli- cations of the data for family planning. The four main areas presented at the Seminar were: a) Fertility and planning status of last pregnancy. b) Contraception: Knowledge, use and attitudes, including women in need of family planning services. c) Young adults. d) AIDS. The following are the highlights of the eval- uation of the findings and the recommenda- tions made by the participants. Measurement of Fertility A significant finding of the survey was that the total fertility rate had remained virtually unchanged since 1989 (3.0 births per woman compared with 2.9 in 1989, a change which was not statistically significant). This was an unexpected result since the target or 1993, based on earlier trends, had been set at 2.7 births per woman. The apparent failure of fertility to decline, on cursory examination, appears surprising, given the substantial increase in reported contraceptive use by women in union (from 55 percent to 62 per- cent) in the interval between the two surveys. However, when fertility is plotted against contraceptive prevalence, the 1993 TFR falls exactly where it is expected (that is, a popu- lation with the contraceptive use level report- ed for Jamaica would be expected to have a TFR of about 2.9). Since the TFR according to the 1989 survey was lower than expected, it is possible that the apparent failure of fertility to decline in recent years is in reality a result of an under- estimate of the 1989 TFR and/or due to an increase in prevalence principally accounted for by an increase in condom use. Other factors which could account for the higher than expected TFR could have been that the changes in prevalence rate could have occur- red in the recent past thus it would have ben too early to be reflected in the fertility rate or that changes which occurred in the method mix would not have contributed directly to a lowering of the fertility rate. Mean number of children ever born is another measure of fertility which can be applied. There was a reduction in all but the younger age groups (15-19 and 20-24 years) where no change occurred. This supports the findings of the total fertility rate. With respect to level of education, there was an inverse relationship, the higher the level of education, the lower is the number of child- ren ever born. With respect to desired number of children, there was a substantial increase in every age group. This was seen when cross-classified against most of the major characteristics. Until secondary analysis is performed, there is no obvious explanation for this increase in desired number of children. In the case of educational levels, as in the case of the number of children ever born, there was a consistent inverse relationship whereby the higher the level of education, the lower was the desired number of children. The planning status of the last pregnancy within the last five years was examined. Planned pregnancies were slightly under 21 percent, that is, 4/5ths of last pregnancies were unplanned. Another feature was that some 50 percent were mistimed, mostly among younger women. This showed no progress since the 1989 survey when the proportion of planned pregnancies was 29 percent and the percentage of mistimed pregnancies was similar to the 1993 level. With respect to non-contraceptive determi- nants of fertility, breast-feeding of babies continued to be high (94 percent in 1993, a slight fall from the 98 percent in 1989). Duration of breast-feeding remained virtually unchanged, with no urban/rural differences. With respect to the period of exclusive breast-feeding, the mean was 1.7 months with slight urban/rural differences. More significant were the differences between women who were employed and those who were not employed. No distinction was made in the survey between "exclusive breastfeeding" and "complete breastfeeding", concepts which was gaining recognition at the international level and particularly in the World Health Organization as important to meaningful analysis of breastfeeding habits, particularly in the context of the contra- ceptive impact, that is, the period during which ovulation is inhibited. Other factors considered were postpartum amenorrhoea and postpartum abstinence; two factors which can contribute to delaying susceptibility to pregnancy after a birth. Postpartum amenorrhoea is that period after birth before the resumption of menstruation, during which, as in the case of breastfeeding, ovulation is inhibited; while postpartum abstinence is that period after birth when the new mother voluntarily abstains from sexual intercourse. It was found that within 3-4 months after the birth of the child, 60 percent of women were no longer amenorr- hoeaic and by 12 months the proportion had fallen to only 3.3 percent. The mean period of postpartum abstinence was 5.5 months, with average postpa

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