preg

[p. 72]

PREGNANCY

1a. During the past 12 months, has anyone in the family been pregnant or had a miscarriage?

b. Who is this? ____
Mark "Was pregnant" box in person's column.

c. During the past 12 months, has anyone else in the family been pregnant or had a miscarriage?

If "Was pregnant," ask:

2a. Is -- now pregnant?

(Not counting --'s current pregnancy)

b. During the past 12 months, how many times has -- been pregnant, including miscarriages?

(Not counting --'s current pregnancy)

c. How many times has -- EVER been pregnant, including miscarriages?

d. How many of these -- pregnancies resulted in live births?

TABLE P:
Complete a line of Table P for each terminated pregnancy reported in Q. 2b. If no terminated pregnancies reported, go to next page.

[Columns for 3 additional people are identical and, thus, omitted here.]

a. Person Number ____

b. Did --'s (last pregnancy/pregnancy before that) end in a full-term live birth, a premature live birth, a miscarriage, or what?

c. Did she see a doctor at any time during that pregnancy?

d. How many months pregnant was -- when she first saw a doctor?

e. About how many visits did -- make to a doctor BEFORE that pregnancy ended? (e)

f. Did a doctor ever tell -- to remain in bed for two weeks or more during that pregnancy?

Table P - Continued

g. How many months pregnant was -- when that pregnancy ended?

h. Did -- have a check-up a month or two after that pregnancy ended?

i. How long has it been since that pregnancy ended?

j. Does -- intend to have a check-up for that pregnancy?

[p. 73]

[Note: The following section appears to be a response sheet for questions asked on page 72]

1b.

2a.

b.

c.

d.

Note: End response sheet.]