Questionnaire Text

Questionnaire form view entire document: text image

E. For women fifteen years old or older.
[Applies to questions 46 - 50]

50. When was your last child born (live-birth)?

Month _ _
Year 19 _ _
[] 98 Does not know

Questionnaire instructions view entire document: text image

E. Only for women 15 years old or older

(Questions 46 to 50)

Take into account that this part of the form is directed only to women and that it should only be filled out for women who are 15 years old or older, even if they are single.

Question No. 50 Date in which the last child born alive was born

[Below the text is a form.]

[p. 52]

Write in the open boxes the number of the month in which the last child born alive was born, taking into account the following table that you find on the first page of the form.

[Below the text is a form with numbers corresponding to months of the year. January 01, February 02, etc.]

Write in the open boxes the last two numbers of the year in which the last child born alive was born, since the first two numbers are already written.