Questionnaire Text

Questionnaire form view entire document:  text  image
For persons of 15 years old and more
[Questions 60-63 were asked for persons age 15+.]

62. Of these of sisters, how many have died? If any, indicate the number; if none fill the oval box.

_ _ Sisters
[] None

63. Of sisters who have died, how many died during pregnancy, childbirth, or risk period? If any, indicate the number, if not fill the oval box.

_ _ Sisters
[] None
Questionnaire instructions view entire document:  text  image
For people age 15 or older:

Question 63: Of the sisters that died, how many died during pregnancy, childbirth, or at-risk pregnancy?
Of the total number of sisters who died and were noted in the previous question (62), write the number of sisters who died during pregnancy, childbirth, or at-risk pregnancy.
If the person responds "none", fill in the corresponding bubble.