Questionnaire Text

Questionnaire form view entire document: text image

For women age 14 or older
[Questions 19-25 were asked of women age 14 or older]

19. Has the woman had any live-born children?

[] 1 Yes
[] 2 No (Continue to the next person.)

Questionnaire instructions view entire document: text image

Questions only for women who are age 14 or older
This series of questions will only be asked of women age 14 or older. For the case of all of the females younger than 14 and all males of any age, you will annul the questions from 19 to 25 by making a diagonal line through each of the boxes.

Question 19: Has the woman had any live-born children?
We understand as live-born the boy or girl who at the moment of birth shows signs of life: breathing, crying, muscle movement or palpitations, even if the child died immediately.

This question should be asked of all women age fourteen years and more. If the answer is "No", continue with the next person and make a diagonal line through each of the questions from 20 to 25.