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preg

[p. 72]

PREGNANCY

Interviewer Check Item
[] No Females 17 - 44 yrs. old (Next page)
[] 1+ Females 17 - 44 yrs. old (1)
1a. During the past 12 months, has anyone in the family been pregnant or had a miscarriage?

[] Y
[] N (Next page)

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

[] Was pregnant

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

[] Y (Reask 1b and c)
[] N

If "Was pregnant," ask:

2a. Is -- now pregnant?

[] Y
[] N

(Not counting --'s current pregnancy)

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

[] None (NP)
Pregnancies ____

(Not counting --'s current pregnancy)

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

01 [] Once (NP)
Pregnancies ____

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

00 [] None (NP)
Live births ____ (NP)

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?

1 [] Full term
2 [] Premature
3 [] Miscarriage
4 [] Stillbirth
5 [] Abortion
6 [] Other -- Specify ____

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

1 [] Y
2 [] N (g)

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

Months ____

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

Visits ____

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

1 [] Y
2 [] N
Table P - Continued

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

Months ____

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

1 [] Y (NP)
2 [] N

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

1 [] Less than two months
2 [] 2+ months (NP)

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

1 [] Y
2 [] N

[p. 73]


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

1b.

[] Was pregnant

2a.

[] Y
[] N

b.

[] None (NP)
Pregnancies ____

c.

01 [] Once (NP)
Pregnancies ____

d.

00 [] None (NP)
Live births ____ (NP)


Note: End response sheet.]