Questionnaire Text

Questionnaire form view entire document:  text  image

For all women 14 years of age and older [applies to questions 17 to 19]


19. What is the date of birth of your last child born alive?

____ Month
____ Year

Month
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9
[] 10
[] 11
[] 12

Year
[] 87
[] 88
[] 89
[] 90
[] 91
[] 92

Questionnaire instructions view entire document:  text  image

19. When was your last child born alive born?

Inquire as to the month and year of birth of the last child born alive had by the woman whose data you are requesting. Don't forget that this refers to the last child born alive, even if after the birth the child died, after having shown signs of life.

Record only the month and year of Birth and don't fill in the circles that are found at the end of the question.