Age as at birth of the youngest child (in years)
What is your marital status?
Level of Education
Post-secondary (specify)
What is your religious affiliation?
What ethnic group do you belong to?
Other ethnic group respondent belong to
Was your partner/husband living with you during your last prgnancy/after deliver
Occupation
Kindly specify other type(s) of occupation
Average income per month (#)
Type of family
How many children/child do you have?
What is the birth order of your last child?
Was the birth of the last child planned?
Age of the husband as at birth of the youngest child
What is your husbdand's religion?
Kindly specify other religion of your husband
What ethnic group does your husband belong to?
Kindly specify other ethnicity of your husband
Husband's occupation:
Kindly specify other occupation of your husband
Husband's education:
Husband's post-secondary (specify)
Husband's average income per month
Who was the first person you informed of your recent/last pregnancy when you dis
Someone else you told
Tell us reason(s) for informing such a person first
Did you discuss pregnancy and delivery issues (such as ANC, during your last pre
Why didn't you discuss pregnancy and delivery ?
Which of the folowing is applicable when discusing wit yr hus
He listens to you
He asks question
Responses appropriately
He shows concern/interest
He gives advices/suggestions
He expresses his feelings
He shows no interest
How often do you discuss pregnancy related issues with your husband during the l
For how long does discussion with your husband on pregnany issues usually last d
Which of the following is applicable when discussing with your husband about pre
Did you perceive any change in your husband’s attitude toward you during your la
Was there any time you tried discussing pregnancy and delivery issues with your
Has there been any time that the two of you tried to avoid having a discussion o
Did your husband give instruction(s) on pregnancy safety (what to do and not to
Did he ask about your health during your last pregnancy and/health of the baby a
Did he seek your opinion when making decisions related to your last pregnancy/ch
Communication on money matter for maternal/child healthcare
Communication on number of children to have
Communication on the use of family planning after delivery
Communication on your health/pregnancy status
Communication on good nutrition during pregnancy and after delivery or breasfeed
Communication on reducing work load during pregnancy and/after delivery
Reminder of check-up/clinic date
At the time of your last pregnancy, were you ready for it?
If No, Did you want the pregnancy later or you don’t want any more child?
Are you currently using any contraceptive method?
Is there any reason for not using contraceptive method?
What is/are the reasons for not using contraceptive method?
Is your husband aware that you are using contraceptive method?
Is it a joint decision for you to use contraceptive method with your husband?
Do you agree there is a need for antenatal care during pregnancy?
Did you receive antenatal care for your last pregnancy?
Who initiated when to start antenatal care during your last pregnancy?
Kindly specify someone else who initiated when to start antenatal
Who decided on where to attend antenal care services during your last pregnancy?
Kindly specify someone else who decided where to attend antenatal
Where did you receive antenatal care for your last pregnancy?
Kindly specify other place you received antenata care
How many time(s) did you attend antenatal clinic duing your last pregnancy
Who usually make decision about your health and delivery issues during your last
Who else usually make decision abot your heaelth and delivery issues during your
Did your husband encourage you to go for regualar check-ups during your last pre
How often did your husband ask for feedback/Doctor's report from your antenatal
Where did you give borth to your youngest child?
Kindly specify other place you delievered your youngest child
Who made the decision on where to have the birth of your last child?
Who else usually make decision about other place of delivery?
In the last 12 months, have you visited a health facility for care of yourself/c
Have you ever taken your child to hospital for immunization?
If you have obtained immunization for your child, at what age of the child did y
Who made the decision on postnatal care?
Specify some else who made decision
Which of these did you discuss or prepare with your husband during your last pre
Arrangement of money for normal and special circumstances
Preparation for people who can donate blood during emergency
Transportation
Birth attendant
Pospartum cultural expenses
Mother's health care
Delivery
Baby/mother's clothes
Naming ceremony
Others (specify)
Specify other activities your husband planned for.
Husband should accompany wife during ANC?
Husband should accomapany wife to hospital during delivery?
Husband should be present in the labour room?
Husband should accomapny wife for postnatal care?
Did he give permission only?
Did he render financial support? (transport/drugs)
Did he accompany you to antenatal care services?
Did he occasionally attend antenatal care with you?
Did he take part in health talk at maternity with you?
Did he decide a place of delivery of the last pregnancy/child?
Did render financial support (for transport/hospital charges)?
Did he arrange skilled birth assistance?
Did he donate blood?
Did he attend any of your delivery (either waiting outside/inside delivery room)
Did he give money for transportation/drugs
Has he ever accompanied you for postnatal chech_up
Has he ever donated blood when needed?
Did he help in feeding the baby?
Did he help in carrying baby when crying?
Did he help in domestic work?
Did he engage the services of a house-help?
Kindly specify other area of support received from the husband
Do you think your husband advice during pregnancy has effect on pregnancy outcom
Do you think your husband presence during delivery serve as a form of help for y
Do you think your husband prayer has effect on the delivery?
Do you think your husband financial support has effect on pregnancy outcome?
Which of the following factors hinder discusion/communication with your husband
Men being preoccupied with work
Men believe ANC is a concern of the wife only
Do not know pregnancy could result in complication
Men do not feel responsible
Men do feel shame
Women do not allow their partner to accompany
They do not know the reason
Other factors