Questionnaire Text

Questionnaire form view entire document:  text  image
12. How many live born children have you born? ____

If the answer is 0, go to question 14

Live born child is an infant, that after separation from its mother breathes or shows and evidence signs of life, e.g. beating of the heart, definite movement of voluntary muscles, crying.
13. Please give the information of all live born children
(Repeat the question for each child)

1. Number of children in order of bearing
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9
[] 10
2. Given name: ____

3. Sex
[] 1 Male
[] 2 Female
4. Date of birth
_ _ Month
_ _ _ _ Year
Questionnaire instructions view entire document:  text  image
Question 12. How many live born children have you born? [p. 64]

The number of all the live born children should be listed, regardless if the children are now living or died, if they live with the woman or separately or if they are single or have their own families. If a woman has never given birth to a live born child -- the answer should be 0 and the next question asked should be 14.

Question 13. Please give the information of all live born children [p. 64]

1. In a table the information of every live born child should be given. The number of children listed in the table should be equal to the number of live born children given in question 12. The children should be listed chronologically -- starting form the first one born.

2. In the first column the number of the child should be given.

3. Asking a woman to give the name of the child may make it easier for her to recall the exact information regarding that child. If a live born child died before being given a name -- symbol NN should be listed instead of a name in column 2.