Questionnaire Text

Questionnaire form view entire document:  text  image
Section IV. Population information

[Questions 19 through 21 were asked to females 14 years and above who ever had any live birth]


20. How many sons and daughters born alive have died?

____ Number of deceased children
[] 00 None

Questionnaire instructions view entire document:  text  image

Only for women 14 years old and older.

The questions 18 and on refer to fertility. They will be asked only of women who are fourteen years old and older.

Question 18: Have you had a son (or daughter) born alive?

If she responds yes, continue asking questions 19 and on.

If she answers no, end the interview and continue with the next person.

Question 20: How many sons (and daughters) born alive have died?


Write, with legible numbers, the number of children that were born alive and then died. You should not register those that were born dead. If none died, mark the circle that corresponds to "none".