Questionnaire Text

Questionnaire form view entire document:  text  image

The following questions are only for women 15 years and older
[Applies to questions 50 - 57]


52./53. Children had born dead

[6] male _ _ female _ _

Questionnaire instructions view entire document:  text  image

The following questions will be filled out only for women age 15 or over, that is, those born before September 1, 1965.
[Applies to questions 50 - 57]


Questions 52/53 - Stillborn children

Record, according to sex, the number of stillborn children. Do not consider fetuses of less than 7 months as stillborn.
When entering the information, observe the instructions provided in the preceding questions.