Questionnaire Text

Questionnaire form view entire document: text image

For all women 15 years of age and older

17. In the last twelve months have you given birth to a live born?

1. Yes

How many?

1 ____
2 or more ____

2. No (continue on to question 18)

Questionnaire instructions view entire document: text image

17. In the last 12 months, have you given birth to children born alive?

If the response is affirmative, you should ask how many and fill in the corresponding oval according to the number of children reported to you.

It is important that these questions be asked of all women 15 and older, regardless of their marital status, since for the purposes of this study it is necessary to have complete responses.

[The above directions refer to a picture of question 17 in this section of the enumeration form.]