Questionnaire Text

Questionnaire form view entire document:  text  image

Females 12 and above
[Questions 34-36 were asked of females age 12 and older.]

34. How many live births has she ever had?

_ _ Male
_ _ Female

Questionnaire instructions view entire document:  text  image

34. Woman's name and number of live born children

Live births
Live births means all products of conception which, after expulsion or extraction from the mother's body, shows any sign of life, like crying, tears, breathing, heartbeat, motility, even if it only lived a few minutes after birth.
-Write down the name of the each woman age 12 or older respecting the order number of the registration rank of the first page of the questionnaire.

[Example omitted]

Q: Did ______ deliver a live baby?
If the answer is no:
-Mark in the reserved space 00 for the male sex and 00 for the female sex in Q. 34 and Q35

If the answer is yes:
-Ask the number of male births and the number of female births;
-Mark the number of children of male sex and the number of children of female sex declared in the reserved space.