Questionnaire Text

Questionnaire form view entire document:  text  image

Residents 12 years of age and older
[Questions 16-20 were asked for residents age 12 and older.]


Women only
[Questions 17-20 were asked for females age 12 and older.]


Births in the last 12 months

19. Male _ _
20. Female _ _

Questionnaire instructions view entire document:  text  image
Columns 17 to 20 only concern women age 12 or older.


Columns nineteen and twenty - births during the last 12 months:

This concerns live births in the household during the 12-month period preceding your visit (December 1984 to December 1985).

Write the number of children in columns 19 and 20 according to the sex of the child. If there are twins, note this at the bottom of the page.