Questionnaire Text

Questionnaire form view entire document: text image

H. Answer question 18 only if this person is female and between 15 and 50 years old. Otherwise, skip to question 19a.
18. Has this person given birth to any children in the past 12 months?

[] Yes
[] No

Questionnaire instructions view entire document: text image

[Housing Question 17-42 should be asked only of individuals 15 and older.]

18. Answer this question if the person is a female who is at least 15 years old and younger than 51 years old. Mark the "Yes" box if the person has given birth to at least one child born alive in the past 12 months, even if the child died or no longer lives with the mother. Do not consider miscarriages, or stillborn children, or any adopted, foster, or step children.