MICS Survey Design Workshop Multiple Indicator Cluster Surveys Survey Design Workshop Questionnaires for Individual Women and Men

Overall session overview Objective is to understand, for each module, the flow, eligibility, indicators, and preparatory work for customizing the module Women = Men

First session Woman’s Information Panel [M] Woman’s Background [M] Access To Mass Media And Use of Information and Communication Technology [M] Fertility/Birth History [M*] Desire For Last Birth Unmet Need

Second session Maternal And Newborn Health Post-Natal Health Checks Illness Symptoms Contraception Unmet Need Female Genital Mutilation/Cutting Attitudes Toward Domestic Violence [M]

Third session Marriage/Union [M] Sexual Behaviour [M] HIV/AIDS [M] Circumcision [M only] Maternal Mortality Tobacco And Alcohol Use [M] Life Satisfaction [M]

Woman’s Information Panel Upper panel filled during Household Questionnaire (after completing List of Household Members) Lower Panel filled after interview ends

Woman’s Information Panel

Interviewer Question

Woman’s Information Panel Pre-coded Instruction

Woman’s Information Panel Customise

Woman’s Information Panel Response categories Pre-coded

Woman’s Information Panel Response rate of women

Woman’s Background First question “belongs” to Information Panel Questions are few but critical: Age: Background characteristic Education: Background characteristic Literacy: MDG

Woman’s Background

On age/DOB: Critical for most indicators Age estimate is necessary Use calendar of events

Woman’s Background

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Woman’s Background MICS Indicator 7.1 (MDG 2.3): Literacy rate among young women [M] = Number of women age years who are able to read a short simple statement about everyday life or who attended secondary or higher education Total number of women age years

Woman’s Background MICS Indicator 7.1 (MDG 2.3): Literacy rate among young women [M] = WB4 = 2 or WB4 = 3 or WB7 = 3 WB2 <= 24

Woman’s Background

Access To Mass Media And Use of ICT MICS Indicator 10.1: Exposure to mass media [M] Percentage of women age years who, at least once a week, read a newspaper or magazine, listen to the radio, and watch television MICS Indicator 10.2: Use of computers [M] Percentage of young women age years who used a computer during the last 12 months MICS Indicator 10.3: Use of internet [M] Percentage of young women age who used the internet during the last 12 months

Access To Mass Media And Use of ICT

Fertility/Birth History Two versions of module: Fertility (Summary Birth History) Fertility/Birth History Both are included in questionnaires: You must take out one

Fertility (Summary Birth History) Purpose: To measure infant and under-5 mortality rates To estimate the adolescent birth rate and early childbearing To determine if any live births within the last 2 years – whether the woman is eligible for the maternal and newborn health module

Fertility (Summary Birth History) Information collected: Summary information on all live births, living and deceased children Timing of first live birth Timing of last live birth

Fertility (Summary Birth History) Mortality Estimation: Indirect estimation method used (Brass) Calculates average numbers of children ever born and children deceased, and calculate proportion deceased Using proportion deceased and mortality models, estimate infant and under-5 mortality rates

Fertility (Summary Birth History) Mortality Estimation: Results not as detailed as those from birth histories (neonatal rates etc.) Estimated rates will refer to 3-6 years before the survey on the average, depending on the variant of the method used The method provides estimates of mortality trends as retrospective estimates are obtained for a period of 3-15 years

Fertility (Summary Birth History) Adolescent birth rate: Normally, the indicator would be calculated by collecting information on all births during a given period preceding the survey, including dates of birth of each The Summary Birth History only collects information on the date of birth of the first and last live birth However, the rate can be estimated

Fertility (Summary Birth History) Early childbearing: Proportion of women age who had one or more live births before age 18

Fertility (Summary Birth History)

Fertility/Birth History Direct Mortality Estimation: “Complete birth history” for every woman of reproductive age (15-49 years) Women are asked to report for each live birth the date of birth and, if the child has died, the age at death Can directly estimate child mortality rate for defined time periods before the survey

Fertility/Birth History Direct Mortality Estimation: Relies heavily on the quality of information collected Work best in populations where dates and durations are well-known

Fertility/Birth History Sources of errors: Omission of births and deaths Recall bias: –Misreporting of age at death (age heaping at 12 months is common) –Birth misplacement Length of instrument –Longer fieldworker training needed –Careful monitoring of data collection needed

Fertility/Birth History

Indirect/ Summary Direct/ Full

Desire For Last Birth (and Unmet Need) Women with an unmet need for family planning are women who –are married or in union –are fecund –not using any method of contraception –report not wanting any more children or wanting to delay the birth of their next child for at least two years

Desire For Last Birth (and Unmet Need) And among those married or in union: –Those who are pregnant, but whose current pregnancy was unwanted or mistimed –Those who are Postpartum amenorrheic women (not using contraception) whose last birth was unwanted or mistimed

Desire For Last Birth (and Unmet Need) Therefore, the indicator is based on information from multiple modules: –Marital status [Marriage/Union] –Current and ever use of contraception (any method) [Contraception] –Fecundity [Unmet Need] –Pregnant or amenorrheic [Contraception][UN][MN] –Desire for last birth [Desire for last birth] –Desire for future births [Unmet Need]

Desire For Last Birth (and Unmet Need)

Maternal And Newborn Health Eligibility is: Live birth in the two years preceding interview Questions refer to the last live birth Module covers: –Maternal health Antenatal care, Delivery characteristics –Newborn health Birthweight, Initiation of breastfeeding, Tetanus protection

Maternal And Newborn Health Response categories to be customised in country: Type of provider for antenatal care Type of provider for delivery care Place of delivery Prelacteal feed For a comparable indicator, some question series may not be adapted: Birthweight Tetanus Toxoid Provider: Maintain broad categories

Maternal And Newborn Health

Post-Natal Health Checks Eligibility is: Live birth in the two years preceding interview Questions refer to the last live birth Measures contact with a provider not content of care. Focus of data collection on PNC visit: –In the case of facility deliveries contact occurring after discharge. –In the case of home deliveries, the focus will be on any contact with a care provider after the TBA/birth attendant leaves the home. –Note that structure of module allows for addition of questions on content, if desired.

Post-Natal Health Checks MICS Indicator 5.10: Post-partum stay in health facility MICS Indicator 5.11: Post-natal health check for the newborn MICS Indicator 5.12: Post-natal health check for the mother

Institutional deliveries Post partum stay in facility Health check in facility 1)Baby 2)Mother Health check after discharge (with info on timing, location, and provider) 1)Baby 2)Mother Post-Natal Health Checks Period after birth PNC visit

Institutional deliveries Post partum stay in facility Health check in facility 1)Baby 2)Mother Health check after discharge (with info on timing, location, and provider) 1)Baby 2)Mother Post-Natal Health Checks Period after birth PNC visit Counts as a post-natal health check if yes to either one (or both)

Institutional deliveriesNon-institutional deliveries with attendant Post partum stay in facility Health check in facility 1)Baby 2)Mother Health check from birth attendant 1)Baby 2)Mother Health check after discharge (with info on timing, location, and provider) 1)Baby 2)Mother Health check after attendant leaves home (with info on timing, location, and provider) 1)Baby 2)Mother Post-Natal Health Checks Period after birth PNC visit Counts as a post-natal health check if yes to either one (or both)

Institutional deliveriesNon-institutional deliveries with attendant Non-institutional deliveries without attendant Post partum stay in facility Health check in facility 1)Baby 2)Mother Health check from birth attendant 1)Baby 2)Mother Health check after discharge (with info on timing, location, and provider) 1)Baby 2)Mother Health check after attendant leaves home (with info on timing, location, and provider) 1)Baby 2)Mother Health check (with info on timing, location, and provider) 1)Baby 2)Mother Post-Natal Health Checks Period after birth PNC visit Counts as a post-natal health check if yes to PNC visit

Institutional deliveriesNon-institutional deliveries with attendant Non-institutional deliveries without attendant Post partum stay in facility Health check in facility 1)Baby 2)Mother Health check from birth attendant 1)Baby 2)Mother Health check after discharge (with info on timing, location, and provider) 1)Baby 2)Mother Health check after attendant leaves home (with info on timing, location, and provider) 1)Baby 2)Mother Health check (with info on timing, location, and provider) 1)Baby 2)Mother Post-Natal Health Checks Period after birth PNC visit Counts as health checks for mother and newborn

Post-Natal Health Checks

Illness Symptoms No specific indicator; programmatically useful information; table relates to recognising the two danger sign of pneumonia All mothers and caretakers (of children <5) asked this question Answers must be spontaneous Refine response codes after pretest (keep pneumonia signs)

Illness Symptoms

Contraception MICS Indicator 5.3 (MDG 5.3): Contraceptive prevalence rate = Number of women age years currently married or in union who are using (or whose partner is using) a (modern or traditional) contraceptive method Total number of women age years who are currently married or in union

Contraception

Attitudes Toward Domestic Violence Attitudinal questions used to assess the acceptance of certain social norms on gender roles Positive attitudes do not necessarily signify approval by women of wife-beating, but they signify women’s acceptance of such norms Option to add country specific prevalent or emerging circumstances. Please keep standard

Attitudes Toward Domestic Violence

Female Genital Mutilation/Cutting # Prevalence of FGM/C among women Proportion of women age years who report to have undergone any form of FGM/C # Prevalence of FGM/C among girls Number of daughters age 0-14 years who have undergone any form of FGM/C, as reported by mothers age years

Female Genital Mutilation/Cutting # Approval for FGM/C Proportion of women age years who state that FGM/C should be continued

FGM/C Questions Three sets of questions: 1)Questions for women years of age If FGM/C has happened to her The type of procedure: if flesh was removed, nicked without removing flesh, sewn closed Age at circumcision Performer: traditional person, health professional

FGM/C Questions 2) Questions for women years of age with at least one living daughter age below 15 years of age Circumcision status of all daughters The type of procedure: if flesh was removed, nicked without removing flesh, sewn closed Age at circumcision Performer: traditional person, health professional 3) Attitudes regarding the continuation of the practice

Marriage/Union MICS Indicator 8.4: Marriage before age 15 [M] MICS Indicator 8.5: Marriage before age 18 [M] MICS Indicator 8.6: Young women age years currently married or in union [M] MICS Indicator 8.7: Polygyny [M] MICS Indicator 8.8a/b: Spousal age difference

Marriage/Union Used for background characteristics in many tables In countries where dates are not culturally important and/or little documentation, precise information is difficult to obtain

Marriage/Union

Sexual Behaviour Methodological Issues: Position of this module is important Sexual behavior module should be asked after marriage/union module so rapport is built but before HIV module to avoid biasing responses Interviews must be conducted in private Must assure respondent that answers are completely confidential

Sexual Behaviour Methodological Issues: Most of the indicators derived from this module are dependent on each other; care should be taken not to delete questions that contribute to the calculation of related indicators Data Quality: Very sensitive information. Even with perfect rapport, complete privacy, and every other best circumstances, some respondents will not provide truthful answers

Sexual Behaviour Summary of questions/indicators: Age at sexual debut Higher-risk sexual partnerships Condom use during higher-risk sex Age of sexual partners Number of recent sexual partners Number of lifetime sexual partners

Sexual Behaviour Ensure privacy!

Sexual Behaviour

HIV/AIDS Summary of questions/indicators: Knowledge of HIV or AIDS Knowledge of HIV prevention Misconceptions about HIV and AIDS Attitudes towards people living with HIV Knowledge of mother-to-child transmission of HIV Knowledge of HIV testing services HIV testing for the general population HIV testing for pregnant women at antenatal clinics

HIV/AIDS A large number of indicators and tables Questions are rather straight-forward No customisation necessary, except the option of doing so in one subset of questions Some questions/indicators require the CM and MN modules (for women)

HIV/AIDS Comprehensive knowledge is constructed from the following set of questions: HA2. Can people reduce their chance of getting the AIDS virus by having just one uninfected sex partner who has no other sex partners? HA4. Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex? HA7. Is it possible for a healthy-looking person to have the AIDS virus? HA5. Can people get the AIDS virus from mosquito bites? HA6. Can people get the AIDS virus by sharing food with a person who has AIDS? HA3. Can a person get HIV through supernatural means?

HIV/AIDS The first three questions [HA2 - HA4 - HA7] should not be altered; the correct answers are “Yes” The next three questions [HA5 - HA6 – HA3] ask about local misconceptions; the correct answers are “No” and additional questions about local common misconceptions can be added in your country Example: “Can a person get HIV by hugging or shaking hands with a person who is infected?” Indicator is constructed using the two most prevalent misconceptions

HIV/AIDS Ensure privacy!

HIV/AIDS

Circumcision The only module specifically for men Use is in relation to HIV/AIDS, as circumcision is known to significantly reduce the risk of men contracting STDs, incl. HIV Translation is very important as terms may not be precisely described in various languages General understanding of concept may be necessary to expand on in question, as some population groups may be completely unfamiliar

Circumcision

Maternal Mortality The module is based on the direct sisterhood method –Maternal mortality –Adult mortality (male and female) Sisterhood method is *not* appropriate for countries…. –Likely to have low maternal mortality ratio –With low levels of fertility –Where other source of maternal mortality data available

Maternal Mortality

Tobacco And Alcohol Use MICS Indicator 12.1: Tobacco use [M] MICS Indicator 12.2: Smoking before age 15 [M] MICS Indicator 12.3: Use of alcohol [M] MICS Indicator 12.4: Use of alcohol before age 15 [M]

Tobacco And Alcohol Use

Life Satisfaction Subjective perceptions of well-being play an important role, autonomously from objective conditions, such as income, health Can help create a fuller picture of well-being Life satisfaction: summation of evaluation regarding a person’s life as a whole Happiness – a fleeting, transient condition that can be affected by numerous current factors (weather, recent incident) Perceptions of a better life is also an important correlate of both life satisfaction and happiness

Life Satisfaction Questions used to assess feelings of satisfaction, happiness and sense of belonging Individual items reported Responses on a scale out of 5, ranging from 'very satisfied‘ to 'very dissatisfied‘

Life Satisfaction

Vulnerable to the: –Item order –Current mood –Other contextual factors Careful interpretation of cultural comparisons: –Different scale use across cultural groups –Different item functioning –Cultural differences in self presentation, reference group and standard of comparison; or memory or positivity bias when making life satisfaction judgments Life satisfaction Indicator –Highly associated with the economic well-being –However, economic growth alone is necessary but insufficient factor for growing life satisfaction

Closing the questionnaire Record time, return to cover page and mark result of interview Remember to use the last page for comments

Thank you