1. Womens Questionnaire MATERNAL AND NEWBORN HEALTH MODULE

2. Purpose Obtain information on health and care received by the mother during pregnancy, labour and delivery, as well as the weight of the child at birth and breastfeeding at time of birth Womens Questionnaire MATERNAL AND NEWBORN HEALTH MODULE

3. Eligibility Questions are asked of women of reproductive age (15-49 years) who have had a live birth in the two years preceding the date of interview Womens Questionnaire MATERNAL AND NEWBORN HEALTH MODULE

4. Goals WFFC: Access through primary health-care system to reproductive health for all individuals of appropriate ages as soon as possible and no later than 2015. WFFC: Reduction in the rate of low birth weight by at least one third of the current rate. WFFC: Special emphasis must be placed on prenatal and post-natal care, essential obstetric care and care for newborns, particularly for those living in areas without access to services. Womens Questionnaire MATERNAL AND NEWBORN HEALTH MODULE

5. Indicators Antenatal care Skilled attendant at delivery Institutional deliveries Proportion of low-birth-weight infants Proportion of infants weighed at birth Timely initiation of breastfeeding Vitamin A supplementation (post-partum mothers) HIV testing Womens Questionnaire MATERNAL AND NEWBORN HEALTH MODULE

6. Content Questions are asked about the following: –Providers of antenatal care during last pregnancy –Procedures that were done during antenatal care (including counseling and testing for HIV) –Providers of delivery care –Place of delivery –Size and weight at birth –Timely initiation of breastfeeding –Supplementation with vitamin A post-partum Womens Questionnaire MATERNAL AND NEWBORN HEALTH MODULE

7. Preparation Coding categories must be locally adapted based on the pretest for questions on: Type of provider for antenatal care Type of provider for delivery care – Maintain the broad categories shown in the model Q. – Doctors, nurses midwives and auxiliary midwives are skilled health personnel who have midwifery skills to manage normal deliveries and diagnose or refer obstetric complications Place of delivery Womens Questionnaire MATERNAL AND NEWBORN HEALTH MODULE

8. MATERNAL AND NEWBORN HEALTH MODULEMN THIS MODULE IS TO BE ADMINISTERED TO ALL WOMEN WITH A LIVE BIRTH IN THE 2 YEARS PRECEDING DATE OF INTERVIEW. CHECK CHILD MORTALITY MODULE CM12 AND RECORD NAME OF LAST-BORN CHILD HERE _____________________. USE THIS CHILDS NAME IN THE FOLLOWING QUESTIONS, WHERE INDICATED. MN1. In the first two months after your last birth [the birth of name ], did you receive a Vitamin A dose like this? SHOW 200,000 IU CAPSULE OR DISPENSER. Yes1 No2 DK8 MN2. Did you see anyone for antenatal care for this pregnancy? If yes : Whom did you see? Anyone else? PROBE FOR THE TYPE OF PERSON SEEN AND CIRCLE ALL ANSWERS GIVEN. Health professional: DoctorA Nurse/midwifeB Auxiliary midwifeC Other person Traditional birth attendantD Community health workerE Relative/friendF Other ( specify )X No oneY Y MN7 MN3. As part of your antenatal care, were any of the following done at least once? A. Were you weighed? B. Was your blood pressure measured? C. Did you give a urine sample? D. Did you give a blood sample? No Yes Weight12 Blood pressure12 Urine sample12 Blood sample12

9. MN4. During any of the antenatal visits for the pregnancy, were you given any information or counseled about AIDS or the AIDS virus? Yes1 No2 DK8 MN5. I dont want to know the results, but were you tested for HIV/AIDS as part of your antenatal care? Yes1 No2 DK8 2 MN7 8 MN7 MN6. I dont want to know the results, but did you get the results of the test? Yes1 No2 DK8 MN7. Who assisted with the delivery of your last child ( or name )? Anyone else? PROBE FOR THE TYPE OF PERSON ASSISTING AND CIRCLE ALL ANSWERS GIVEN. Health professional: DoctorA Nurse/midwifeB Auxiliary midwifeC Other person Traditional birth attendantD Community health workerE Relative/friendF Other ( specify )X No oneY

10. Maternal and Newborn Health Module MN8. Where did you give birth to (name) ? Home Your home11 Other home12 Public sector Govt hospital21 Govt clinic/health center22 Other public ( specify )26 Private Medical Sector Private hospital31 Private clinic32 Private maternity home33 Other private medical (specify) 36 Other (specify) 96 MN9. When your last child ( name ) was born, was he/she very large, larger than average, average, smaller than average, or very small? Very large1 Larger than average2 Average3 Smaller than average4 Very small5 DK8

11. MN10. Was ( name ) weighed at birth? Yes…………………………………………….1 No……………………………………………..2 DK……………………………………………..8 2 MN12 8 MN12 MN11. How much did ( name ) weigh? RECORD WEIGHT FROM HEALTH CARD, IF AVAILABLE. From card1 (kilograms) __. __ __ __ From recall2 (kilograms) __. __ __ __ DK99998 MN12. did you ever breastfeed (name) ? Yes…………………………………………….1 No……………………………………………..2 2 next mod ule MN13. How long after birth did you first put (name) to the breast? IF LESS THAN 1 HOUR, RECORD 00 HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS. Immediately000 Hours………………………………………1 __ __ OR Days………………………………………..2 __ __ Dont know/remember998