Questionnaire Text

Questionnaire form view entire document:  text  image
For women of 15 years old and more
[Questions 64-67 were asked for women age 15+.]

66. What is the date of birth of [the respondent]'s last live-born son or daughter?

Month _ _
Year _ _ _ _
Questionnaire instructions view entire document:  text  image
Questions 64-67 should only be asked to women who are 15 years old or older.

Question 66: In what month and year was the last child born alive of (NAME)?

Record the month and year of the birth date of the last child.

Use two digits to record the month. For example, 01 for January 02 for February 03 for March and so on.
Use four digits to record the year. For example: 1999.