Questionnaire Text

Questionnaire form view entire document:  text  image

For all women 15 years of age and older


16. Of these, how many are still living?

1 ____
2 ____
3 ____
4 ____
5 ____
6 ____
7 ____
8 ____
9 ____
10 ____
11 ____
12 ____
13 ____
14 or more ____

Questionnaire instructions view entire document:  text  image

16. Of these, how many are currently alive?

Fill in the oval corresponding to the number of children currently alive reported to you.

[The above directions refer to a picture of question 16 in this section of the enumeration form.]