Questionnaire Text

Questionnaire form view entire document: text image

For women 12 years of age and older
[Questions 26-30 were asked of female aged 12 years or older]

28. Is your last child alive?

[] Yes
[] No
[] Doesn't know

Questionnaire instructions view entire document: text image

28. Is your last child still alive?
An "X" is marked according to the answer given.