CDC Reproductive Health Assessment Toolkit for Conflict-Afflicted Women

Publication date: 2007

Suggested Citation: Reproductive Health Assessment Toolkit for Conflict-Affected Women. Atlanta, GA: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Coordinating Center for Health Promotion, Centers for Disease Control and Prevention, Department of Health and Human Services, 2007. Updates to the Toolkit will be posted on the CDC Web site at the following address: www.cdc.gov/reproductivehealth/Refugee/ For additional information, send an email to Rconflicttoolkit@cdc.gov or write to CDC, ATTN: Reproductive Health for Refugees 4770 Buford Highway, NE Mail Stop K-22 Atlanta, GA 30341-3717 USA Voice: +1 770-488-5200 Fax: +1 770-488-6291 � Reproductive Health Assessment Toolkit for Conflict-Affected Women Reproductive Health Assessment Toolkit for Conflict-Affected Women �� This publication is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of the Participating Agency Services Agreement # HRN P 00-97-00014-00. The contents are the responsibility of the authors and do not necessarily reflect the views of USAID, the Centers for Disease Control and Prevention or the United States Government. Division of Reproductive Health National Center for Chronic Disease Prevention and Health Promotion Coordinating Center for Health Promotion Centers for Disease Control and Prevention Atlanta, Georgia www.cdc.gov/reproductivehealth January 2007 Reproductive Health Assessment Toolkit for Conflict-Affected Women ��� Acknowledgements The Reproductive Health Assessment Toolkit for Conflict-Affected Women was developed by the Division of Reproductive Health (DRH) at the Centers for Disease Control and Prevention (CDC), US Department of Health and Human Services (DHHS). DRH gratefully acknowledges the following for their collaboration and commit­ ment leading to the development of this Toolkit: The collaboration and financial support of the United States Agency for International De­ velopment (USAID) and the Andrew Mellon Foundation, through the CDC Foundation, for the production and development of the Toolkit. Ms. Mary Kay Larson, former Reproductive Health for Refugees Coordinator and leader of CDC’s Services Management, Research and Translation Team (SMART), who initiated the development of this Toolkit in 2003. Dr. Martha Rogers of the Task Force for Child Survival and Development, developer of the Child Needs Assessment Tool Kit, which was used as a model for this Toolkit. In addition, Dr. Rogers worked with the CDC in the initial stages of Toolkit development. Dr. Basia Tomczyk, formerly of the CDC’s SMART Team, for her work on the reproduc­ tive health surveys that preceded the Toolkit. These surveys contributed to the development of the survey that is contained in this Toolkit. Ms. Wyndy Amerson and Mr. Gary Weeks of the CDC, for programming the data entry software and data analysis and for their pa­ tience throughout the many changes resulting from pilot tests during development; Mr. Brian Morrow, also of the CDC, for his statistical support; and Dr. Lubna Bhatti, formerly of the CDC, for her assistance in designing the survey and training manual. Ms. Michelle Hynes, Ms. Stacy Laswell, Dr. Marianne E. Zotti, and Ms. Van Tong, the primary authors. DRH would also like to thank the following organizations for their partnership and participa­ tion in the pilot testing of the Toolkit in Ethiopia, Democratic Republic of Congo, and Colombia: Ethiopia: African Medical Research Founda­ tion (AMREF); Administration for Refugee and Returnee Affairs (ARRA), which is part of the Ethiopian government; and the United Nations High Commissioner for Refugees (UNHCR) Democratic Republic of Congo (DRC): Care International—DRC; CDC Global AIDS Pro­ gram—DRC; CDC Global AIDS Program Atlan­ ta, Georgia; CDC International Emergency and Refugee Health Branch; DRC Ministry of Health; and the Kinshasa School of Public Health Colombia: PROSER Finally, appreciation and gratitude must be extended to all of the women affected by conflict who participated in our pilot tests in Ethiopia, Democratic Republic of Congo, and Colombia. Reproductive Health Assessment Toolkit for Conflict-Affected Women �v Reproductive Health Assessment Toolkit for Conflict-Affected Women TABLE OF CONTENTS v ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii CHAPTER 1: Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 CHAPTER 2: Planning Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 CHAPTER 3: Sampling Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 CHAPTER 4: Training Manual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Training Agenda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Module 1: Administrative arrangements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Module 2: Introduction to the survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Module 3: Defining the roles and responsibilties of survey team . . . . . . . . . . . . . . . . . . . . . . . . . 27 Module 4: Understanding the survey and survey questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Module 5: Interviewing techniques and initiating the interview. . . . . . . . . . . . . . . . . . . . . . . . . . 29 Module 6: Practice interviews with role playing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Module 7: Locator training—overview of process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Module 8: Locator training—use of forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Module 9: Locator training—role playing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Module 10: Supervisor training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Module 11: Practice interviews in the community . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Module 12: Review of survey schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Module 13: Data entry—administrative arrangements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Module 14: Data entry instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Module 15: Data entry and cleaning (supervisors only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 CHAPTER 5: Analysis Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Key Indicator List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Analysis Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Background. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Safe motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71 Sexual history/sexually transmitted infections (STIs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Gender-based violence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Reproductive Health Assessment Toolkit for Conflict-Affected Women v� Female genital cutting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110 Emotional health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115 CHAPTER 6: Suggestions for Data Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .117 CHAPTER 7: Evaluating Survey Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121 ADDITIONAL RESOURCES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 APPENDIX A: Budget Template. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 APPENDIX B: Random Number Table and Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 APPENDIX C: Training Handouts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Handout 1: Sample training schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Handout 2: Sample logistics administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .141 Handout 3: Overview of survey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Handout 4: Reproductive health terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Handout 5: Roles and responsibilities of team members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 Handout 6: Research participant’s rights and confidentiality . . . . . . . . . . . . . . . . . . . . . . . . . . . .147 Handout 7: Safety and emergency procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Handout 8: Incident report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 Handout 9: Filling out the questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Handout 10: Guiding principles for interviewers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 Handout 11: Keys to successful interviewing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160 Handout 12: Data entry staff guidelines. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Handout 13: Data entry instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 Handout 14: Concatenating data (for supervisors only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .178 Handout 15: Data cleaning (for supervisors only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .179 APPENDIX D: Questionnaire Guide: Question by Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .191 APPENDIX E: Practice Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 APPENDIX F: Locator and Consent Form. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .213 APPENDIX G: Toolkit Questionnaire. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .219 APPENDIX H: Final Report Template . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263 APPENDIX I: Group Discussion Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265 APPENDIX J: Exit Survey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267 Reproductive Health Assessment Toolkit for Conflict-Affected Women Reproductive Health Assessment Toolkit for Conflict-Affected Women � CHAPTER 1 Introduction � The Division of Reproductive Health (DRH) at the Centers for Disease Control and Preven­ tion (CDC), US Department of Health and Hu­ man Services (DHHS), officially began a refugee program in 1998 and has since increased the program’s focus on refugee reproductive health. DRH defines refugees and internally displaced persons (IDPs) as all populations affected by conflict, including those in the emergency phase, those in post-emergency camps, those returning to their countries of origin, and those who have integrated into the local host community. This broad definition allows public health officers to follow health issues throughout the refugee experi­ ence—from the emergency setting to that of viable communities. An important goal for DRH is to design and im­ plement epidemiologic investigations to evaluate the reproductive health status of women affected by conflict and to provide information about reproductive health services. The Reproductive Health Assessment Toolkit for Conflict- Affected Women was developed to meet this goal. The Toolkit provides a quantitative survey instru­ ment, sampling instructions, a training manual, a data entry program, a list of key indicators, data analysis tables, suggestions for data use, and additional resources that will enable field agencies to assess the reproductive health needs of conflict- affected women. Survey results can guide field agencies in selecting, promoting, and enhancing programs and services to improve the reproduc­ tive health of their target populations. This Toolkit has been deemed public health practice by the CDC because it can identify reproductive health problems, needs, or gaps among conflict-affected women and then be used to inform programs and services. Purpose The Reproductive Health Assessment Toolkit for Conflict-Affected Women can be used to quanti­ tatively assess reproductive health risks, services, and outcomes in conflict-affected women between 15 and 49 years of age. Survey data can be used to compare a population across points in time or to make comparisons across populations. The Toolkit offers many specific benefits: It provides data to inform program planning, monitoring, evaluation, and advocacy. It is designed for mid-level field staff with limited survey skills. The methodology has been tested among conflict-affected women in multiple sites. It provides public-domain software (CSPro) that is pre-programmed for data entry. It provides pre-programmed key indicators and data analysis tables as well as guidance on how to use the data. Users can obtain preliminary results (through tabulation of frequencies in CSPro) as soon as data entry is complete. Data collection and analysis costs are reduced because external assistance is not required. It builds capacity of staff in conducting a survey and using the data for program planning. The data can be compared across countries and other conflict-affected populations. It covers a broad range of reproductive health issues and emphasizes the reproductive health needs of conflict-affected women. Toolkit users can obtain technical assistance from CDC via telephone, email, or fax. By providing necessary tools to collect repro­ ductive health data, the Toolkit can play a very important role in the overall process of improving the reproductive health of women affected by conflict. However, Toolkit users are responsible for using the collected information to identify and prioritize reproductive health needs, translate priorities into programmatic responses, evaluate programs, systems, and policies, and disseminate results. In addition, users bear the responsibility of addressing sociopolitical factors as well as individ­ ual factors that influence their target populations. Reproductive Health Assessment Toolkit for Conflict-Affected Women � Topics included in the questionnaire Survey questions have been adapted from the World Health Organization (WHO) Multi-Coun­ try Study on Women’s Health and Domestic Violence Against Women,1 the CDC Reproduc­ tive Health Survey (RHS),2 the Demographic and Health Survey (DHS),3 the Reproductive Health Response in Conflict (RHRC) Consortium Gender-based Violence Tools Manual,4 and the Behavioral Surveillance Survey for the Great Lakes Initiative Against AIDS (GLIA).5 The questionnaire covers the following topics: Section 1: Background characteristics Section 2: Safe motherhood Section 3: Family planning Section 4: Marriage and live-in partnerships Section 5: Sexual history: numbers and types of partners and condom use Section 6: Sexually transmitted infections (STIs) Section 7: Knowledge, opinions, and attitudes regarding HIV/AIDS Section 8: Gender-based violence (GBV)* Section 9: Female genital cutting (FGC)† Section 10: Emotional health‡ *Because of the sensitive nature of the gender- based violence questions and the potential trauma involved in recounting violent events, this module should not be undertaken unless there are at least minimal referral services available to participants. †This module may be deleted if FGC is not prac­ ticed among the population being interviewed. ‡Users with crucial questions that are not already covered in the questionnaire may add them in Section 10. However, technical assistance from DRH is required in doing so. Target users The Toolkit is intended for organizations such as government, non-governmental, and United Nations agencies that provide or are interested in providing reproductive health services to conflict- affected women. Independent research consul­ tants and field staff who use this Toolkit will need some survey skills, but the Toolkit is designed to be used by those with limited survey expertise. Required resources Survey staff Pentium processor-equipped computer for data entry, cleaning, and write-up of findings. The computer should have a minimum of 256 MB of memory and Windows 98SE, ME, NT 4.0, 2000 or XP Internet access (for downloading CSPro and accessing technical assistance via email) SPSS or Excel software for data cleaning Locked storage cabinet for the completed ques­ tionnaires Access to photocopy machine Thank-you gifts for participants (optional) Vehicle (if needed) Technical assistance The Division of Reproductive Health (DRH) at CDC is available for remote technical assistance via telephone, email, or fax. Topic areas where DRH can provide technical assistance include: Inclusion or exclusion of a module (e.g., GBV, FGC) Inclusion of crucial questions that are not provided in the Toolkit questionnaire Survey logistics Interviewer training Budget issues Sampling issues and questions (e.g., oversample pregnant women) Data entry and analysis Report writing Reproductive Health Assessment Toolkit for Conflict-Affected Women � To contact DRH for technical assistance, please call, email, or fax: Reproductive Health for Refugees Division of Reproductive Health Centers for Disease Control and Prevention 4770 Buford Highway, NE Mailstop K-22 Atlanta, Georgia 30341 USA Voice: +1 770 488 6260 Fax: +1 770 488 6291 Email: Rconflicttoolkit@cdc.gov Reproductive Health Assessment Toolkit for Conflict-Affected Women � CHAPTER 2 Planning Checklist Reproductive Health Assessment Toolkit for Conflict-Affected Women � Awell-devised plan is needed to ensure suc­cessful implementation of the Toolkit. The planning process should be initiated prior to securing funding. The amount of time required for the planning process will vary based on your organization’s existing infrastructure and resources. Consider this checklist a model that can be adapted as necessary to meet your specific needs and situation. You can also change the sequence of activities as needed. For example, you could conduct field-level planning before initiating national-level planning. Part I. National-level planning A. Select a site to conduct survey. Criteria for selection include: Availability of a reasonable estimate of popu­ lation size A stable, post-emergency population with no major influx or outflow of people Availability of basic reproductive health services B. Engage national-level stakeholders. Engage potential stakeholders, such as: National government agencies responsible for refugees Ministries of Health United Nations High Commissioner for Refugees Other non-governmental organizations working with the population of interest Establish how involved each of these organi­ zations will be. Inform them of the purpose and scope of the assessment. C. Develop budget and timeline. Develop budget using the template in Appen­ dix A. This will determine the financial scope of the survey. Develop project timeline, which should include activities such as preparation of ques­ tionnaire, hiring and training survey team, data collection, data cleaning, analysis, report writing, and dissemination of findings. Secure funding. D. Prepare locator form and questionnaire. Modify country-specific responses on ques­ tionnaire. This may require technical assis­ tance from DRH. Modify country-specific fields on the locator form. Translate locator form and questionnaire into the local language, using translators who are able to read and write both English and the local language. Back-translate forms into English to ensure they were translated correctly. Revise translated forms as needed. (This normally occurs during training and the pilot test, with input from the survey team.) Finalize standard local-language version of the locator form and questionnaire. Part II. Field-level planning A. Meet with camp coordinators or local officials. Inform them of the purpose and scope of the survey and obtain buy-in. Obtain information regarding the camp or community, such as population size, organi­ zation, and other contextual issues that may affect survey implementation. Request to meet with community leadership to identify potential survey team members. Identify potential training and interview sites and necessary materials, such as tables and chairs. Meet with key community stakeholders to learn about needs and services of the popula­ tion. Examples of key stakeholders include community leadership, health center direc­ tors, food distribution coordinators, reproduc­ tive health and HIV/AIDS project coordina­ tors, and other NGO representatives. Reproductive Health Assessment Toolkit for Conflict-Affected Women ______________________________________ � Establish a resource list of referral services (e.g., social workers, health care services) that will be available to participants. If applicable, establish roles and responsibili­ ties of stakeholders. You may also be able to recruit trainers and supervisors from among the key stakeholders you have identified. Determine availability of household lists from stakeholders that could be used in sampling. B. Determine which sampling method you will use. (See Chapter 3, Sampling Instructions, for more information on sampling.) Define geographic bounds of area to be surveyed. Obtain or create a map of area to be surveyed. Determine what sampling method you will use (random vs. cluster). Use the selected sampling method to develop a list of households that will be surveyed. C. Determine staffing needs. Identify trainer(s). Having two trainers is ideal, as the locators will be trained separately from supervisors and interviewers. Trainers can also serve as supervisors during data col­ lection. Determine the number of interviewers need­ ed using the following method: What is your sample size (the number of people that will be interviewed)? Refer to the sampling strategy to determine this number. ________ (sample size) Divide the sample size by the number of days you have allotted for data collection. This will give you the number of interviews that need to be conducted in one day. _____ (number of interviews collected per day) Divide the number of interviews collected per day by the number of interviews that can be completed by one interviewer in one day. In previous surveys, interviews averaged about 1 hour per interview, and 5 interviews were conducted per interviewer per day. Consider the advantages of fewer versus more interviewers to meet your desired project timeline (Table 2.1). _____ (number of interviewers needed) Table 2.1: Advantages of having fewer or more interviewers. Fewer interviewers: More interviewers: It will be easier to find a sufficient number of competent interviewers. More people will be trained in survey methods. Fewer people will need to be trained. More people will obtain field experience. Better coordination between interviewers can be achieved. It will foster broad participa­ tion and involvement of more organizations. Fewer vehicles and less equip­ ment will be needed. Data collection will be com­ pleted in less time. Determine number of locators needed. Previ­ ous surveys used a ratio of 1 locator per 2 to 3 interviewers. For example, if there are 10 interviewers, then 3 to 5 locators would be needed. ______ (number of locators needed) Determine number of supervisors needed, based on number of survey teams. Previous surveys used a ratio of 1 supervisor per 5 to 8 interviewers. ______ (number of supervisors needed) Determine number of data entry staff needed. Previous surveys required 1 to 2 data entry staff. ______ (number of data entry staff needed) Determine how data analysis will be conduct­ ed. Options include pre-programmed analy­ ses, site-specific programming, or submission of cleaned data to CDC for analysis. If you are going to perform your own data analysis, then you will need staff with appropriate skills. ______ (number of data analysis staff needed, optional) Determine additional staffing needs, such as support staff listed in Table 2.2. ___________ Reproductive Health Assessment Toolkit for Conflict-Affected Women � D. Plan and conduct interviews with potential survey team members. Obtain supplies for meeting, such as pens, pencils, and paper. Develop standard interview questions to test ability of survey team applicants. Questions could focus on the qualifications and responsibilities described in Table 2.2. Explain roles and responsibilities of team members (from Table 2.2) to applicants. Conduct interviews with survey team applicants. Select and hire team members. You may need to re-assign or release individuals during training. We recommend that you train a few more people than what you estimate you will need. Table 2.2: Titles, qualifications, and responsibilities of survey team members. Title Qualifications Responsibilities Trainers • Female or male (female preferred) • Health knowledge or experience • Able to conduct interviewer and locator training • Training experience (preferred) • Modifying training manual as needed • Preparing location for training • Obtaining training supplies and make photocopies of handouts and materials • May assist with report writing • May also serve as a supervisor during data collection Supervisors • Female or male (female preferred) • Able to read and write in local language • Able to gain strong familiarity with survey • Previous survey experience (preferred) • Health knowledge or experience (preferred) • Reviewing completed questionnaires to ensure completeness, accuracy, and logic of survey responses • Responding to difficult situations, filing Incident Reports, etc. • May assist with report writing • Could also serve as a trainer during training Interviewers • Female • Able to read and write in local language • Age is within respondents’ age range • Representative of ethnic groups of respondents • Administering surveys and recording responses • Providing information on referral services, if needed • Protecting privacy and confidentiality of respondents Locators • Male or female • Able to read and write in local language • Familiar with local area • Respected community member • Locating respondent households • Explaining general purpose of survey • Selecting one respondent from all eligible women in selected household • Obtaining verbal consent from respondents • Sending selected respondents to interview location Translators • Male or female • Able to read and write in local language and language of survey team supervisor • Translating interviewer and locator training materials • Translating English language questionnaire to local language version • Back-translating from local language version to English language to check accuracy (A different translator should perform the back-translation.) Interpreters • Male or female • Able to speak both local language and language of supervisor • Assisting in communication between supervisor and team members during training and data collection • Could also serve as a translator Data entry staff • Male or female • Experience in the specific job responsibilities (preferred) • Entering the completed questionnaires into the pre-programmed CSPro data entry program Support staff • Male or female • Experience in the specific job responsibilities (preferred) • Data analysts (optional): analyzing the data based on the tables and guidelines provided in the Toolkit, using software such as CSPro, Epi Info, SAS, STATA, or SPSS • Driver(s) (optional): transporting survey team(s) to the central interview location, bringing selected participants to the interview location, and providing logistical support as needed • Financial officer (optional): tracking expenses and overseeing the budget Reproductive Health Assessment Toolkit for Conflict-Affected Women � Part III: Training Modify training manual to fit needs. Secure a location for training. Ensure tables and chairs are available. Obtain supplies for training, including: name tags or tents refreshments or meals pens, pencils, and paper Make copies of training handouts, including locator form and questionnaire, for partici­ pants. Part IV: Data collection Make a sufficient number of copies (based on your sample size) of the locator form and questionnaire. Provide a list of selected households and a map of the area to locators, drivers, and/or interviewers. Make copies of resource list, to be distributed to all participants. Equip interview room with adequate seating and provide seating for women waiting to be interviewed. If possible, arrange room to provide privacy for each interview. Provide a space with a chair for supervisor to check completed questionnaires. Determine number of cars and drivers needed to transport survey team members or respondents to interview site. Estimate amount of water and other refresh­ ments needed for team members and partici­ pants. Provide extra paper, pencils, or erasers. Obtain thank-you gifts for participants (if providing). Provide a secure location to store completed questionnaires. Part V: Data entry and analysis Determine number of computers needed to conduct data entry and analysis. Install CSPro computer program for data entry. Develop a schedule to ensure that data is backed up on a routine basis. Provide a locked cabinet on-site to secure completed questionnaires when not in use. Part VI: Report preparation, dissemination, and translation of data to action Determine number of copies of reports needed and how they will be printed. Develop a dissemination plan for findings. The plan should identify the target audience and dissemination methods. Potential audi­ ences include stakeholders at the national and local level, media, and your survey team. Determine how you will present findings back to the community that was surveyed. Community meetings are one possible venue. Refugee or local leadership may be able to assist you in presenting findings. Engage stakeholders to determine next steps and discuss priority needs, based on findings. Review Chapter 6, Suggestions for Data Use, to create a data to action plan. Reproductive Health Assessment Toolkit for Conflict-Affected Women �0 Reproductive Health Assessment Toolkit for Conflict-Affected Women Reproductive Health Assessment Toolkit for Conflict-Affected Women �� CHAPTER 3 Sampling Instructions �� The two sampling methods described in this chapter are appropriate for a service orga­ nization that wants to collect information from women of reproductive age living in a defined geographic area. Thus, the geographic bounds of the survey area will need to be clearly identified. Normally, the area of interest is the area served by the organization and where programs and services for women and their families will be developed or improved. This is also sometimes called the “catchment” area. Some examples of catchment areas include a camp of refugees, internally dis­ placed persons, or returnees; a group of camps; or villages or towns where displaced populations are living among local populations. In preparation for sampling, obtain or create a map that represents the geographic area to be surveyed. An example of a map of a hypothetical survey area is below (Figure 3.1). Sampling is needed when it is not feasible to interview every household with a woman of reproductive age in the catchment area in a timely fashion. Sampling means that only some of the households in the catchment area are selected for the survey. Selected households are meant to be representative of all eligible households in the area. The concept of “representativeness” means that the selected sample of households reason­ ably represents the entire group. In addition, each household must have an equal chance of being selected to participate in the survey. To accomplish this, households can be sampled using one of two suggested sampling methods: random sampling or cluster sampling. Both meth­ ods have specific requirements and each have their own advantages and disadvantages, which are discussed. The user must weigh these factors when deciding which sampling strategy to use. These sampling instructions may be adapted to your setting and needs. Sampling plans must be developed by the study coordinator prior to car­ rying out the field work. Because sound sampling methods are essential to obtaining representative data from your population, DRH will review your sampling plan, if requested, before you begin data collection. DRH can also assist you in adapting the instructions, if necessary. Refer to Chapter 2, Planning Checklist, for the logistical steps of the sampling process. Figure 3.1: Map of Hypothetical Survey Area = Household Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Random Sampl�ng Random sampling requires household lists that contain the minimum elements described in Step 1. Though random sampling may provide more precise estimates than other sampling methodolo­ gies, it may be more difficult to implement in some situations. For example, if the area of inter­ est covers a large geographic area, then survey teams will be required to travel greater distances to reach the selected households. This would re­ quire additional resources for staffing or fuel and may prolong the data collection period. For random sampling, households are randomly selected, and then one woman of reproductive age is randomly selected from each household. This is called “two-stage random sampling.” In general for random sampling, you will need to have completed interviews for at least 400 women of reproductive age. By following these sampling instructions, you will meet DRH’s standards of point estimates within +/- 5% of the true popula­ tion prevalence, with 95% confidence. We made the following assumptions when estimating needed sample size: We estimate a prevalence rate of 50%, the most conservative estimate, for all reproductive health outcomes. We want a 95% confidence interval ± 5.0 percentage points (based on exact binomial confidence intervals). We estimate a response rate of 80%, in which case 500 households must be contacted to ob­ tain 400 completed interviews. Please note that this estimate is based on household lists where only households with women of reproductive age are identified. If women of reproductive age can not be identified before the sampling, the response rate would need to be adjusted to account for sampled households without women of reproductive age. To conduct random sampling, you must work through the steps in Box 3.1. Box 3.1: Random sampling steps Step �:Obta�n household l�sts. Step �:Select the households to be sampled. Step �:Select one woman of reproduct�ve age w�th�n each selected household to be surveyed. Step 1: Obtain household lists. Household lists may be available from registra­ tion files, census lists, ration card lists, community leaders, and other sources. The term “household” should be clearly defined and understood by all members of the survey team and should match how household is defined in the lists used for the survey. Household lists should have the following minimum elements: Total population Total number of households Breakdown of households by categories (camp, neighborhood blocks, etc.), if needed for strati­ fication Household lists may need to be updated (e.g., recording who has moved in and out of the community since the lists were created) to ensure reasonable accuracy and to eliminate ineligible households. Community leaders, community health workers, and traditional birth attendants are all examples of people in the community who may be able to help you update household lists. In some instances, lists will have detailed information that will allow you to eliminate some households before selection of your sample. For example, if the age and sex of all residents of the household is provided, you should eliminate all households with no women of reproductive age or male-only households. Step 2: Select the households to be sampled. Once the household lists are obtained and updat­ ed (if necessary), you are ready to randomly select the households to be surveyed. You will need to assign a number in consecutive order to each household on the lists for the selection process. Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Step 2a: Stratifying the sample To ensure the sample of households is more repre­ sentative, you can stratify your sample by dividing the sample into groups, such as ethnic groups or zones (camps or villages). Stratification reduces the risk of drawing an extreme sample that is unrepre­ sentative of the population. For example, if there are two major ethnic populations in your camp, you may want to stratify by ethnicity, provided that your household lists include information on ethnicity. This will ensure that you have enough participants from each ethnic group in your sample to make valid comparisons. If you do not plan to stratify your sample, you can skip the rest of Step 2a and go to Step 2b. After stratifying your sample, you can either continue to number households consecutively or restart the numbering for each group. Next, you will need to determine how many households to sample from each group. To do so, you will need to create a table similar to Table 3.1. The first column of the sample size table is filled in accord­ ing to your stratification groups. For example, if you are surveying a series of camps, column 1 will list each camp. If you are sampling from one large community, column 1 will list the different neighborhoods or zones in the community. If you are stratifying by ethnic groups, column 1 would list those groups. For the following example, we will be looking at a geographic area consisting of refugees in different zones (Zone 1, Zone 2, etc.). The second column lists the number of house­ holds within each stratification group (in this example, the number of households within each zone are listed). This number is obtained from the household list. The third column, “household pro­ portion,” is calculated by dividing the number of households in each zone by the total sample size. The fourth column, “sample size,” is calculated by multiplying the third column by the total survey sample size to get the sample size for each zone. Box 3.2 provides an example of how to calculate the numbers in each column. Table 3.1: Sample size selection of eligible households by zone for random sampling. Zone (Camp, neighborhood, village, etc. . .) Households Household proportion Sample size Zone 1 228 15.06% 75 Zone 2 344 22.72% 114 Zone 3 223 14.73% 74 Zone 4 314 20.74% 104 Zone 5 405 26.75% 134 Total 1514 100.00% 501* * Total may be higher due to rounding Box 3.2: Example for calculating sample size for Zone 1. Refer to Table 3.1 to work through this exercise. In this example, there are 228 eligible households in Zone 1. Calculat�on �: ��� el�g�ble households �n Zone � d�v�ded by ���� total households = ��.0�% of all households. Calculat�on �: ��.0�% household propor­ t�on mult�pl�ed by �00 total sample = sample s�ze of ��.� rounded to �� women to be �nterv�ewed for Zone �. Therefore, we will randomly select 75 of the possible 228 households in Zone 1. Step 2b: Randomly select households Once you have determined how many house­ holds you need from each area, use a computer program or a random numbers table to select which households will be sampled for the survey. Several computer applications, such as Excel, Access, SAS, and CSPro, can generate random numbers. If you are familiar with these programs, you can generate numbers electronically rather than using the random numbers table. The ran­ dom numbers table and instructions on how to use it can be found in Appendix B. Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Step 3: Select one woman of reproductive age within each selected household to be surveyed. Once the households have been randomly se­ lected, locators will be responsible for going to each selected household and randomly selecting one respondent from all women of reproductive age that live in that household. The selection of women at the household level is described in detail in the training manual in Module 8: Locator Training—Use of Forms. Cluster Sampl�ng The cluster sampling method has been used widely in developing countries to assess health measures. Cluster sampling is usually selected over (the more statistically precise) random sampling when the geographic area is large, and it will be too difficult, costly, and/or lengthy to cover the entire area with random sampling. This method is also appropriate in cases where household lists are not available or do not meet the criteria needed for random sampling. Cluster sampling can help save time and resources as you need only to create a list of households in the selected clusters rather than for all households in the entire population. However, one disadvantage of cluster sampling is that households in clusters (e.g., neighborhoods, blocks) may share similar characteristics (e.g., income, education, ethnicity). For this reason, the information collected from clusters can be more homogenous than informa­ tion collected from a random sampling through­ out the catchment area, and the sample may not be as representative of the entire population as a sample selected using random sampling. Because cluster sampling is less precise than ran­ dom sampling, we must obtain a larger sample size. For cluster sampling, we estimate you will need to have completed interviews from at least 500 wom­ en of reproductive age. We anticipate a response rate of 80%, in which case 625 households must be contacted to obtain 500 completed interviews. For cluster sampling, we can not guarantee any preci­ sion of the data collected. The sample size is only an estimate, and the true sample size depends upon how different the clusters are from each other, which usually cannot be determined until after data collection is completed. The cluster survey method in this Toolkit has been designed based on a scientific paper by Steve Ben­ nett and colleagues6. Cluster sampling involves a multi-step process. First, you must select which clusters to survey. Second, within each of the selected clusters, you must select which households to survey. Then one woman of reproductive age is randomly selected from each household. To conduct cluster sampling, you must work through the steps listed in Box 3.3. Box 3.3: Cluster sampling steps Step �: Define clusters w�th�n the geograph�c boundar�es. Step �: Determ�ne the number of households w�th�n each cluster. Step �: Select the clusters to be sampled. Step �: Select the households w�th�n each cluster to be sampled. Step �: Select one woman of reproduct�ve age w�th�n each selected household to be surveyed. Step 1: Define clusters within the geographic boundaries. This step involves identifying natural groupings of populations, such as camps, villages, neighbor­ hoods, districts, city blocks, or other communities, within the geographic area selected for the survey. When defining groupings, ensure that they do not overlap. These natural groupings will serve as the basis to form clusters. Clusters may vary in size, but each must contain enough households so that the number of eligible households within each cluster can be interviewed. If clusters are too small (i.e., fewer than 25 households), then you must combine them with other neighboring clusters. There is no upper limit on how many households each cluster can contain. We have determined that at least 25 clusters with at least 25 households each are needed for our survey. If you have fewer than 25 clusters, seek technical assistance from DRH to determine the best way to gather infor­ mation for your population. Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Using the map that you created for defining the geographic bounds of your survey area, identify each grouping of households that will serve as a cluster. For example, if refugee tents are orga­ nized by blocks, then these blocks may be used to define the clusters. Step 2: Determine the number of households within each cluster. For each of the clusters, you must know the total number of households. If you have a listing of households, total up the number of households per cluster. If you do not have a listing of all the households, then the total number can be estimat­ ed from the total population and the average size of each household. Divide the total population by the average size of households to estimate the number of households, as follows: Total population ÷ average size of households = total number of households For example, if a camp has an approximate popu­ lation of 5000 people, and the average size of each household is about 5 people, then there are about 1000 households in this camp. Step 3: Select the clusters to be sampled. Before you select the clusters, you must determine what your sample size will be, since you will only be surveying a randomly selected sample of the clusters. It is important to determine the right number of clusters and households within those clusters so that the information you collect will accurately represent the entire population and provide the level of accuracy you wish to obtain. As previously mentioned, we have concluded that in most cases, 25 clusters of 25 households each is an appropriate sample size for this survey. To select the clusters to be surveyed, you will be using a method for sampling called probability proportional to size. This means that a cluster with more households will have a greater chance of be­ ing picked for the sample than a cluster with fewer households. This will help assure that the sample is representative. To choose the 25 clusters, refer to the map of your geographic area and clusters within that area. You will be randomly selecting 25 clusters out of all possible clusters within the survey area. First, create a table of possible clusters in your area. List the clusters in the first column and their estimated number of households in the second column. The list should include communities that are not on official lists (new settlements, refugee camps, etc.). In the third column, which lists the cumulative number of households, add each number of households per community as you go down the list. Table 3.2 is an example of a cluster list created to facilitate the sampling. This list represents a geographic area with 30 clusters from which you would pick 25. The clusters vary in number of households: Table 3.2: Number of households per cluster. Cluster # Number of households in cluster Cumulative number of households 1 28 28 2 32 60 (28+32) 3 65 125 (60+65) 4 48 173 (and so forth…) 5 25 198 6 29 227 7 37 264 8 34 298 9 29 327 10 27 354 11 25 379 12 30 409 13 29 438 14 32 470 15 40 510 16 33 543 17 28 571 18 31 602 19 25 627 20 27 654 21 25 679 22 31 710 23 27 737 24 31 768 25 44 812 26 28 840 27 39 879 28 26 905 29 34 939 30 31 970 Reproductive Health Assessment Toolkit for Conflict-Affected Women �� To select 25 clusters, divide the total number of households in all clusters by 25. This will be the sampling interval: Cumulative number of households ÷ 25 (the number of clusters to be selected) = sampling interval From the random number table provided in Ap­ pendix B, choose a random number between 1 and your sampling interval, following the direc­ tions in Appendix B. To select the first cluster, refer to the table you cre­ ated of the number of households per cluster and look to see where this number falls within your cumulative number column. The cluster selected is where the number falls. To select the second cluster, add the sampling interval to your original random number, and determine where this number falls within your cumulative number column. The second cluster selected is where the number falls. Continue adding the sampling interval to the num­ ber that identified the previous cluster, and choose clusters until you have identified all 25 needed. Be­ cause we are using probability proportional to size, it is possible that the same cluster will be selected more than once. Each time a cluster is chosen, it counts as 1 cluster. If a cluster is chosen twice, then 50 (2 x 25) households will be selected. Box 3.4 provides an example of how to select clusters. Box 3.4: Example of calculating sampling interval and selecting clusters. Use Table 3.2 to work through this exercise. Calculate sampling interval: 970 cumulative number of households ÷ 25 clusters = 38.8, rounded to 39. Thus, 39 is our sampling interval. Select first cluster: Using the random numbers table, let’s say you randomly selected 29. Look to see where this number falls within your cumulative number column. 29 falls between 28 and 60, so you would choose cluster #2 as your first sampled cluster. Select second cluster: To choose the second cluster, add the sampling interval (39) to your original random number (29), and the sum of 39 + 29 equals 68. Again, find where this number lies in the cumulative number column (in this case, 68 falls between 61 and 125, so you would choose cluster #3 as your second sampled cluster. Select third cluster: To choose the third cluster, add the sampling interval (39) to the number that identified your previous cluster (68), and the sum of 39 + 68 equals 107. Again, find where this number lies in the cumulative number column (in this case, 107 falls between 61 and 125, so you would choose cluster #3 as your third sampled cluster. Because cluster #3 has now been selected twice, you will select a total of 50 households (2 x 25 households) out of cluster #3’s 65 households. You would then continue this process until you have selected all 25 clusters. Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Step 4: Select the households within each cluster to be sampled. Once you have selected the clusters, randomly select households within the selected clusters. You will need some way of identifying the individual households in the selected clusters. If household lists are not available, you can easily and quickly develop a basic list of all the households in the cluster. Often, people familiar with the area, such as community leaders or health workers, can help you develop a list of households. Once this is done, assign each household a num­ ber and then choose your 25 households per cluster using a computer program or the random numbers table (Appendix B). Step 5: Select one woman of reproductive age within each selected household to be surveyed. Once the clusters and their households have been randomly selected, the locators will be responsible for going to every selected household in that cluster and randomly selecting one respondent from all women of reproductive age who live in that household. The selection of women at the household level is described in detail in the train­ ing manual in Module 8: Locator Training—Use of Forms. Reproductive Health Assessment Toolkit for Conflict-Affected Women �� CHAPTER 4 Training Manual Reproductive Health Assessment Toolkit for Conflict-Affected Women �0 This training manual is used to train the entire survey team. As the trainer, you should fa­ miliarize yourself with all contents of the training manual. The training agenda provides estimated times to complete the 15 modules in the train­ ing manual. Each module specifies participants, estimated time needed to complete the module, goals of the module, a list of training handouts (Appendix C), and in-class activities. The training manual provides guidance and suggestions for training, but as the trainer, you may need to make modifications based on your specific situation. Space is provided in the manual for taking notes, such as plans for customizing the module or a list of items that are missing. Some training modules cover the use of forms; the ac­ tual forms needed in order to conduct the survey are included in the appendices. The suggested time needed to accomplish each module, listed in the training agenda, is only an estimate. The actual number of training hours required will vary depending on factors such as the number of people in training and how quickly they master the skills. The number of days re­ quired to accomplish the training will depend on factors such as how many hours per day people can concentrate on learning new things, the amount of time taken for breaks and meals, and the time of day when the pilot test will be most efficient, according to when it is likely that eli­ gible women will be available for interviews The estimated overall time needed for training will be approximately 10 days for the supervisors and interview team(s), 3 days for the locator team(s), and 1/2 day for the data entry staff. IMPORTANT: Because of the sensitive nature of the questions and the difficulty in obtaining privacy at a participant’s home, it is strongly recommended that your teams conduct interviews at a central location (outside the participant’s home), where the questionnaire can be admin­ istered in a private area. If it is not possible to conduct the interviews in a central location, interviewers will need to try to find a private area in the house to conduct the interview and ask the other household or family members to respect the participant’s privacy. It may be necessary to pause several times throughout the interview to ensure the privacy of the participant’s responses. Training the Survey Team The goal of this training is to provide informa­ tion, examples, and practice opportunities to the survey team so that they can do their jobs well. The team will need sufficient time to practice to ensure that they collect quality information. Adjustments should be made during training if needed to ensure that every member of the team can perfectly understand the questionnaire and survey procedures. The survey requires a field team of interview­ ers, locators who are responsible for selecting women at the household and sending them to the interview location, and team supervisors. Although interviewers, locators, and supervisors have different tasks during the survey process, all are responsible for protecting the rights and privacy of the participants. All field team trainees should be together during the training sessions covering Modules 1-3 so that everyone has a clear understanding of the overall purpose of the survey and their respective roles and responsibilities. Interviewers and supervisors will then continue on with the training together, while locators can split into a separate training group to learn their specific tasks. The data entry staff will be responsible for timely and accurate entry of the questionnaires as they are completed and returned from the field. The training for data entry staff should take place after the field team training is completed. The ques­ tionnaires collected from the practice interviews and pilot testing can then be used for data entry training. Re-assigning trainees You may find in the course of the training that some trainees are not able to develop the skills needed to adequately conduct the survey. In this case, it is important that you re-assign or release them and not risk compromising the quality of data collection. To allow for this possibility, we recommend that you train a few more people Reproductive Health Assessment Toolkit for Conflict-Affected Women �� than you will ultimately need. It should be made clear from the first day of training that trainees are required to demonstrate a certain level of com­ petency in order to be hired. If possible, offer a different task or project when trainees fail to meet competency requirements. Preparation for training Chapter 2, Planning Checklist, has been provided to help you organize the administrative details needed before training and data collection begins. You may need to modify the list according to your specific situation. There is also a table outlining the criteria and responsibilities of each member of the survey team which may be helpful to you as you hire your survey team. In addition, Chapter 3, Sampling Instructions, will help determine which sampling method is best for your situation. Finally, you will need to develop and distribute to team members a resource list containing contact information for local referral services available to survey participants. Reproductive Health Assessment Toolkit for Conflict-Affected Women �� TRAINING AGENDA Below are estimated times to complete each training module. These estimates are based on pilot-testing of the Toolkit and assume an 8-hour work day. As the trainer, you may need to adjust the estimates to fit your specific situation. SURVEY TEAM: Estimated Time to Accomplish Module 1: Administrative Arrangements . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 hours Introductions Administrative details Identify questions to be answered during the training Module 2: Introduction to the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 hours Introduction to the survey and its purpose Issues of reproductive health covered in survey Reproductive health terminology Module 3: Defining the Roles and Responsibilities of Survey Team . . . . . . . . . . . . . 3 hours Responsibilities of each team member Rights of participants and confidentiality Safety and emergency procedures Module 4: Understanding the Survey and Survey Questions . . . . . . . . . . . . . . . . . 24 hours Questionnaire administration process description Question-by-question explanation and discussion Module 5: Interviewing Techniques and Initiating the Interview . . . . . . . . . . . . . . . 4 hours Guiding principles for interviewers Tips for good interviewing Practice through role-playing Module 6: Practice Interviews with Role Playing . . . . . . . . . . . . . . . . . . . . . . . 36 hours Practice interviewing Practice recording responses Module 7: Locator Training—Overview of Process . . . . . . . . . . . . . . . . . . . . . . 2 hours Administrative details Review of Locator Form Identify questions to be answered during training Module 8: Locator Training—Use of Forms. . . . . . . . . . . . . . . . . . . . . . . . . . 5 hours Review of Locator Form in detail Practice in filling out each section of the form Reproductive Health Assessment Toolkit for Conflict-Affected Women SURVEY TEAM: Estimated Time to Accomplish �� Module 9: Locator Training— Role Playing. . . . . . . . . . . . . . . . . . . . . . . . . . 8 hours Practice in introductions at households Practice in random selection of woman Practice in obtaining consent Practice in filling out visit record box Module 10: Supervisor Training— Household Selection Process . . . . . . . . . . . . . . 8 hours Familiarization with sampling method to be used (random or cluster) Training on how to identify households for survey Training on how to review questionnaires for logic and completeness Module 11: Practice Interviews in the Community . . . . . . . . . . . . . . . . . . . . . . 8 hours Provides interviewers, supervisors, and locators real-life experience in administering the survey Module 12: Review of Survey Schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 hours Review logistics of how the interview teams will conduct the survey DATA ENTRY: Estimated Time to Accomplish Module 13: Data Entry—Administrative Arrangements . . . . . . . . . . . . . . . . . . .0.5 hours Review administrative and logistical details Explanation of roles and responsibilities of each team member Review confidentiality procedures Module 14: Data Entry Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 hours Overview of survey CSPro data entry program and instructions Reinforce importance of data quality issues Practice in entering questionnaires Module 15: Data Entry and Cleaning (supervisors only) . . . . . . . . . . . . . . . . . . . 1 hour Resolving questionnaire errors or data entry errors Checking the quality of data being entered Combining datasets Producing a clean dataset Total training hours for supervisors: . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109.5 hours (Note: It will be necessary to have some supervisors participate in the locator training and data entry training as they will be the locators and data entry staff supervisors.) Total training hours for interviewers: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 hours Total training hours for locators: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 hours Total training hours for data entry staff: . . . . . . . . . . . . . . . . . . . . . . . . . . .3.5 hours Reproductive Health Assessment Toolkit for Conflict-Affected Women �� MODULE �: Adm�n�strat�ve Arrangements Participants: Interviewers, locators, and supervisors Estimate of time needed: At least 2 hours are needed to complete this module. Goals of this module: Help trainers and trainees get to know each other Address immediate questions trainees may have Identify questions to be answered during the training Handouts for this module: Handout 1: Sample Training Schedule (to be modified by trainer) Handout 2: Sample Logistics Administration (to be modified by trainer) In class: As the trainer, begin by introducing yourself and ask the trainees to state their names and briefly de­ scribe themselves. Request that the trainees create nametags or write their name on a folded sheet of paper placed in front of them. Discuss working arrangements for the survey, including: Salary and per diem Working hours Training schedule, including time for breaks Survey schedule Transportation and other logistical issues Training schedules (Handout 1) and logistical details (Handout 2) should be developed in advance and given to the trainees on the first day. In addition, rules regarding absenteeism should be established and discussed with the trainees. Both the training and survey data collection are labor intensive. It is impor­ tant that an appropriate schedule is established to ensure that work can be done in the most efficient manner possible. You may choose to have a 5-day or 5 ½ - day work week in accordance with what is typical in your location. We recommend that team members do not exceed this amount due to the intensive nature of the work. Team members will also need some time off to relax each week. As for the training sessions, it is important to include several breaks, normally lunch and a morning and afternoon break, in order to give everyone a rest and a chance to socialize and get to know each other. Other logistical considerations may also influence the schedule. For example, team members may need time to take transportation to reach the training or interview location. Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Trainees will likely ask you questions about the survey that you intend to answer during upcoming training sessions. Acknowledge the relevancy of the questions but do not try to answer them at this time. Instead, write down all of these questions and explain that they will be addressed during another train­ ing session. At the end of the training, revisit the questions to make sure that all have been answered. We recommend delaying the announcement of personnel assignments to survey teams (as interviewers, locators, and supervisors) until the end of training, when you will know better each person’s strengths and weaknesses and how different people work together. Trainer notes: Reproductive Health Assessment Toolkit for Conflict-Affected Women �� MODULE �: Introduct�on to the Survey Participants: Interviewers, locators, and supervisors Estimate of time needed: At least 2 hours are needed to complete this module. Goals of this module: Introduce the survey and discuss its purpose Familiarize survey team with reproductive health issues covered in survey Review reproductive health terms Handouts for this module: Handout 3: Overview of the Survey Handout 4: Reproductive Health Terms In class: Using Handout 3, go over the main goals of the survey, what your organization hopes to accomplish with the information obtained through the survey, and the main topic areas covered in the question­ naire. Make sure that trainees understand the reproductive health terms covered in Handout 4. Trainer notes: Reproductive Health Assessment Toolkit for Conflict-Affected Women �� MODULE �: Defin�ng the Roles and Respons�b�lt�es of the Survey Team Participants: Interviewers, locators, and supervisors Estimate of time needed: At least 3 hours are needed to complete this module. Goals of this module: Explain responsibilities of each team member Explain rights of participants and confidentiality Explain possible emergency situations Understand how to complete the Incident Report Handouts for this module: Handout 5: Roles and Responsibilities of Team Members Handout 6: Research Participant’s Rights and Confidentiality Handout 7: Safety and Emergency Procedures Handout 8: Incident Report In class: Using Handout 5, discuss and review the roles and responsibilities of each team member. Using Hand­ out 6, review the rights of research participants and confidentiality issues. Review the guidelines all team members must follow. You must make sure that confidentiality issues are well explained, given the sensi­ tive nature of the topics covered in the survey. Using Handout 7, make sure survey staff are aware of possible emergency situations and review safety and emergency procedures. Review the Incident Report (Handout 8) and make sure everyone understands the procedures to follow should a problem arise. Trainer notes: Reproductive Health Assessment Toolkit for Conflict-Affected Women �� MODULE �: Understand�ng the Survey and Survey Quest�ons Participants: Interviewers and supervisors Estimate of time needed: Approximately 3 days are needed to complete this module. Goals of this module: Describe the questionnaire administration process Explain and discuss the questionnaire, question-by-question Handouts for this module: Handout 9: Filling Out the Questionnaire Appendix G: Copies of the questionnaire For the trainer: Appendix D: Questionnaire Guide—Question by Question In class: Using Handout 9, go over all questions in the questionnaire, making sure that everyone understands the terminology, language, and concepts. You may want to take advantage of the local expertise of the team to make any needed adjustments to the local language translations of the questionnaire. In addition, review the questionnaire using the Questionnaire Guide (Appendix D). Trainer notes: Reproductive Health Assessment Toolkit for Conflict-Affected Women �� MODULE �: Interv�ew�ng Techn�ques and In�t�at�ng the Interv�ew Participants: Interviewers and supervisors Estimate of time needed: At least 4 hours are needed to complete this module. Goals of this module: Review the guiding principles that interviewers should follow Review keys for good interviewing Practice interviewing through role playing Handouts for this module: Handout 10: Guiding Principles for Interviewers Handout 11: Keys to Successful Interviewing For the trainer: Appendix E: Practice Exercises In class: Use Handout 10 to review the guiding principles for interviewers. Use Handout 11 to review the keys to successful interviewing. Then practice Exercises 1 and 2 (Appendix E). Trainer notes: Reproductive Health Assessment Toolkit for Conflict-Affected Women �0 MODULE �: Pract�ce Interv�ews w�th Role Play�ng Participants: Interviewers and supervisors Estimate of time needed: At least 4½ days are needed to complete this module. Goals of this module: Practice interviewing Practice recording responses Handouts for this module: Appendix G: Copies of the questionnaire For the trainer: Appendix E: Practice Exercises In class: Do practice exercises 3-5 (Appendix E). Have the interviewers role-play in pairs before the class and have the others comment on what went well and what can be improved upon. Make sure the class discusses various scenarios and issues that may arise and discusses approaches that may help facilitate the process. Trainer notes: Reproductive Health Assessment Toolkit for Conflict-Affected Women �� MODULE �: Locator Tra�n�ng—Overv�ew of Process Participants: Locators and supervisors Estimate of time needed: At least 2 hours are needed to complete this module. Goals of this module: Discuss administrative details Review Locator Form Identify questions to be answered during training Handouts for this module: Appendix F: Locator and Consent Form In class: Explain to the locators that they will be responsible for going to houses selected for the study and re­ cruiting study participants. They will also be responsible for obtaining consent from the participants who agree to take part in the study. Discuss the logistical arrangements for their role and write down any outstanding questions participants have that need be addressed during training. Hand out copies of the Locator and Consent Form. Perform a general review of the form, making sure that everyone understands the terminology and concepts covered, especially in the consent section. Trainer notes: Reproductive Health Assessment Toolkit for Conflict-Affected Women �� MODULE �: Locator Tra�n�ng—Use of Forms Participants: Locators and supervisors Estimate of time needed: At least 5 hours are needed to complete this module. Goals of this module: Review the Locator Form in detail Practice filling out each section of the form Handouts for this module: Appendix F: Locator and Consent Form In class: The locators will be given locator forms which include consent information and the visit record. Explain to the locators how to fill out the information according to the guidelines below. Overview: Locator Name Locator enters his/her name. Camp Number These can be pre-entered by the locator supervisor Locator Form Number (range 0-9) This number will be used for randomly selecting a participant within each household. The Supervisor will fill this in before data collection begins. S/he will enter 0,1,2,3, etc over and over until all the forms have a number. See instructions on how to use this number for random selection of participants within households. Questionnaire Number The supervisor will enter the corresponding questionnaire number at the time of the interview. This will allow the locator form to be linked to the questionnaire. Supervisor Supervisor will fill in his/her name. For the locators: When the locator approaches a home, s/he reads word for word the introduction and purpose of the study to the adult male or female who comes to the door. The locator should be well practiced giving general information about the survey and should be able to answer questions confidently. Next, the locator asks how many women between the ages of 15 and 49 (referred to in this manual as women of reproductive age or “WRA”) live in the household and writes down the number on the form. If there are no women who are between the ages of 15 and 49 years, then the locator should thank the person and SKIP to the “Visit Record” and complete that section. If at least one eligible woman lives in the house, then the locator asks for the age of each woman liv­ ing in the house who is between 15 and 49 years of age (starting with the oldest woman and ending with the youngest). The locator should read this out loud as s/he is filling the WRA table to verify that the information is correct (see Box 1). Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Box 1: Table of eligible women in household In this example, there are three women between the ages of 15-49 in the households, recorded from oldest to youngest. WRA Line AGE (Complete years) 1 45 2 30 3 21 4 5 6 7 8 After entering the ages of all eligible women (i.e., all women between the ages of 15-49 years), the locator should randomly select one woman in the household for the interview using these steps and the selection table (see Box 2). a) Reading down the column titled “The Locator Form Number” find the number that corresponds to the number recorded on top of the Locator Form and circle it. In this example, the locator form number is 2. b) Then find the number of eligible women recorded in the WRA table from the row where the numbers run from 1-8 under the heading “Number of WRA in the House.” In this example, there are 3 eligible women from the example in Box 1, so you circle “3”. c) Follow the locator number line across and the WRA number down until you reach the number where the two rows intersect. In this example, they intersect at “1” so the woman listed in Line 1 of the WRA table you have filled out, who is 45 years old, will be selected as the respondent from the household. d) Fill out the appropriate numbers in the box below the table. In this example, the WRA on line 1 of your WRA table was chosen, and the total number of WRA in the household is 3. Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Box 2: Example of randome selection of WRA to be interviewed Number of WRA in the House The Locator Form Number 1 2 3 4 5 6 7 8 0 1 2 2 4 3 6 5 4 1 1 1 3 1 4 1 6 5 2 1 2 1 2 5 2 7 6 3 1 1 2 3 1 3 1 7 4 1 2 3 4 2 4 2 8 5 1 1 1 1 3 5 3 1 6 1 2 2 2 4 6 4 2 7 1 1 3 3 5 1 5 3 8 1 2 1 4 1 2 6 4 9 1 1 2 1 2 3 7 5 1. Line Number of the Chosen WRA 2. Total Number of WRA in the Household 1 3 If the chosen woman is at home: The locator will read the consent form to her word for word. If the woman agrees to the interview, then the locator should sign that section. For reasons of confi­ dentiality, the woman should not sign the consent form nor should her name appear anywhere on the locator form. The locator should complete the visit record and use the result code of “1” that the woman agrees to the interview. The locator should then either direct the woman to the interview location or make an appointment time for the woman to participate. The locator should return the locator form to the supervisor at the time of the interview, either in person or sent with the participant, to ensure that the supervisor can keep the consent form with the questionnaire. If the selected woman refuses to participate in the survey, the locator will read the question asking why the woman does not want to participate (see Box 3), circle the corresponding response given by the woman, thank her for her time, complete the visit record, and give the completed locator form back to her supervisor. Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Box 3: Refusal If respondent refuses, read the following, circle the appropriate response and then continue: I’m sorry you will not be able to participate in this survey. May I ask you why you do not want to participate in the survey? 1. No time/busy 2. Not interested 3. Information too sensitive 4. Other (specify) ___________________ 5. No reason given/don’t know Thank you very much for your time. -------------------------END If the chosen woman is not at home: The locator will ask when she will be back, complete the visit record and make arrangements to return to speak with her later. A total of 7 attempts to speak with the selected woman should be made. How to complete the visit record The locator should complete the visit record appropriately and use the result codes listed below the visit record box to indicate the result. Box 4 provides an example of how to complete the visit record. Conduct up to 7 attempts to locate the selected woman. If after 7 attempts, the locator is unable to speak to the selected woman, the locator will complete the visit record and give it back to her supervisor. Box 4: Example of completing the visit record In this example , the locator has selected a woman, but she is not home. The locator returns the next day, and the selected woman is home and agrees to be interviewed. The following is how the Visit Record should be completed. Visit number 1 2 3 4 5 6 7 Locator # ______ ______ Date of visit Day Month 05 Day Month 06 Day Month Day Month Day Month Day Month Day Month11 11 Result* 4 1 *Result codes 1. Agree to interview 2. No eligible woman (age 15-49) 3. Nobody home 4. Selected respondent not home 5. Selected respondent refusal 6. Unoccupied house 7. Other (specify)___________ Trainer notes: Reproductive Health Assessment Toolkit for Conflict-Affected Women �� MODULE �: Locator Tra�n�ng—Role Play�ng Participants: Locators and supervisors Estimate of time needed: At least 1 day is needed to complete this module. Goals of this module: Practice introduction at household Practice random selection of woman from household Practice obtaining consent Practice filling out visit record box Handouts for this module: Appendix F: Locator and Consent Form In class: As with the interviewer trainees, have the locators role-play in pairs before the class and have the oth­ ers comment on what went well and what can be improved upon. Make sure the class discusses various scenarios and issues that may arise and discusses approaches that may help facilitate the process. Trainer notes: Reproductive Health Assessment Toolkit for Conflict-Affected Women �� MODULE �0: Superv�sor Tra�n�ng Participants: Supervisors Estimate of time needed: At least 1 day is needed to complete this module. Goals of this module: Familiarize supervisors with sampling method to be used (random or cluster) Train supervisors on how to identify households for survey Train supervisors on how to review questionnaires for logic and completeness Handouts for this module: Chapter 3, Sampling Instructions In class: Supervisors may be selected from the interviewer and locator groups or may be the trainers themselves. A qualified supervisor is a good interviewer who is very familiar with the survey and is knowledgeable about the survey area and its culture and politics. Supervisors should have gone through the entire train­ ing. If they will be supervising the interview team(s), they should have experience correcting question­ naires. They must be able to review the completed questionnaire quickly so that they do not delay the respondents unnecessarily and to keep up a good pace for the interviews. Both locator and interviewer supervisors will be expected to be with their teams every day of data collection to ensure data quality and help problem-solve any logistical issues that come up. Review the relevant sampling instructions (random or cluster) and ensure supervisors understand the selection process, as they will be guiding their teams in household selection. Supervisor responsibilities: Ensure the correct selection of households to be sampled. Coordinate the locators so that the flow of participants allows for the greatest number of interviews. Collect the completed locator forms at the time of the interview and staple it to the corresponding questionnaire. Review the questionnaire before the participant leaves the interview location to ensure for correct logic (e.g., skip patterns) and complete information. Deal with any logistical issues that arise. Trainer notes: Reproductive Health Assessment Toolkit for Conflict-Affected Women �� MODULE ��: Pract�ce Interv�ews �n the Commun�ty Participants: Interviewers, locators, and supervisors Estimate of time needed: Approximately 1 day to complete this module. Goals of this module: Provide interviewers, supervisors, and locators real-life experience in administering the survey Practice survey/data collection logistics Handouts for this module: Appendix F: Locator and Consent Form Appendix G: Copies of the questionnaire In class: This is the most crucial part of the training. It should serve as the final determination to see who is fully capable of conducting an interview or acting as a locator. It will also help to identify any issues or trans­ lation problems that might not have arisen during the training. The practice interviews should take place in a community where you will not be conducting the real sur­ vey. If necessary, obtain permission from authorities to conduct interviews in the area. These interviews will not be included in the analysis. However, these interviews will be used for data entry training. Divide the supervisors and interviewers into teams that will practice interviews. Direct each team to a different area so that they will not disturb one another or cause unnecessary confusion in the commu­ nity. Coordinate the locator supervisor and locators so they know which houses they must visit in order to recruit participants for the practice interviews. Each interviewer should conduct 2-3 interviews. Supervisors should review the questionnaires when the interview is complete. The supervisors should closely observe several of the interviewers as they conduct an interview and provide feedback once the interview is over. Make sure these discussions do not take place in front of the participant. The locator supervisor should observe the locators to make sure they complete the locator form correctly, select the WRA appropriately according to the WRA and selection tables, and obtain consent for the interview. Time should be allotted during the following work day to discuss the experience as a group and to ad­ dress issues that came up, including any changes to the questionnaire that might be needed. Trainer notes: Reproductive Health Assessment Toolkit for Conflict-Affected Women �� MODULE ��: Rev�ew of Survey Schedule Participants: Interviewers, locators, and supervisors Estimate of time needed: At least 3 hours are needed to complete this module. Goal of this module: Review logistics of how the interview teams will conduct the survey. Handouts for this module: Survey schedule and assignments In class: Announce assignments to the survey teams. Give each interviewer, locator, and supervisor a schedule of where the teams will be throughout the survey. Let them know when and where to report for duty. Remember that interviewers will need time to discuss any problems they anticipate, such as transporta­ tion, security, or overnight stays. Check to see that all questions have been answered. Before you dismiss the teams, stress the importance of the work to be done and your confidence in their ability to do a good job. Trainer notes: Reproductive Health Assessment Toolkit for Conflict-Affected Women �0 MODULE ��: Data Entry—Adm�n�strat�ve Arrangements Participants: Data entry staff and supervisors Estimate of time needed: At least 30 minutes are needed to complete this module. Goals of this module: Review administrative and logistical details Explain roles and responsibilities of each member of the team Review confidentiality procedures Handouts for this module: Handout 12: Data Entry Staff Guidelines In class: Introduce yourself and ask trainees to state their names and briefly describe themselves. Request that the trainees create name tags or write their name on a folded sheet of paper placed in front of them. Review the guidelines for team members. Though the questionnaires will not have any identifying information (only a unique questionnaire identification number), it is important to review issues of confidentiality, given the sensitive nature of many of the topics covered in the survey. Address working arrangements for the survey. We suggest you discuss: Salary Working hours Transportation and other logistical issues, if necessary Schedules and logistical details should be developed and given to the data entry staff on the first day. In addition, rules regarding absenteeism should be established and discussed with the trainees. Before training begins, determine whether data entry staff will be paid per day or per questionnaire. Paying by questionnaire is generally preferred as it encourages work to be completed in a timely manner; however, it is important to ensure that the data entry is not done too quickly, such that accuracy is sacrificed. Double entry of all records is recommended, to check for accuracy, but a subset of questionnaires (10%) is acceptable. Establish a data entry schedule to ensure that work can be done in the most efficient manner possible. Staff should be made aware of how many questionnaires they are expected to enter each day and how long the process should take. The length of the questionnaire, the accuracy of the editing, and the skills of the data entry staff will influence how many questionnaires can be entered each day. The schedule may be adjusted as the data entry staff become more experienced with the job or as problems arise; however, it is often useful to develop a structure at the outset (with some flexibility built in) so that Reproductive Health Assessment Toolkit for Conflict-Affected Women �� people know what is expected of them and in what timeframe. Other logistical considerations may also influence the schedule. For example, team members may need to take transportation to reach the train­ ing or data entry location. Trainer notes: Reproductive Health Assessment Toolkit for Conflict-Affected Women �� MODULE ��: Data Entry Instruct�ons Participants: Data entry staff and supervisors Estimate of time needed: At least 3 hours are needed to complete this module. Goals of this module: Provide overview of survey Review data entry program and instructions Reinforce data quality issues Practice entering questionnaires Handouts for this module: Handout 3: Overview of Survey Handout 13: Data Entry Instructions In class: Using Handout 3, provide an overview of the main goals of the survey, what the organization hopes to accomplish with the information obtained through the survey, and the main topic areas covered in the questionnaire. Using Handout 13, review the data entry instructions. Instruct the data entry staff on where to save their data files, how to enter questionnaires into CSPro, and important considerations to keep in mind when entering data. For practice, use questionnaires collected during the practice interviews. It is important to walk data entry staff through the entry process on the computer. Show the trainees how to enter one questionnaire and then allow them to practice with a few questionnaires. Answer questions as they arise. Remind the data entry staff that it is not their responsibility to guess what a response might be or to make decisions as to how to enter incorrectly filled out questionnaires. There should always be a super­ visor available to answer questions. Each staff member will be assigned a unique two digit code. This code is entered in Q009 on the front page of the questionnaire, and it will help identify who entered the questionnaire, in case consistent errors are being noticed. After practicing, check to see if trainees have additional questions. Give them information on when and where to report for duty. Before dismissing the trainees, stress the importance of the work to be done and your confidence in their ability to do a good job. Trainer notes: Reproductive Health Assessment Toolkit for Conflict-Affected Women �� MODULE ��: Data Entry and Clean�ng (Superv�sors Only) Participants: Supervisors Estimate of time needed: At least 1 hour is needed to complete this module. Goals of this module: Understand how to resolve questionnaire errors or data entry errors Know how to check the quality of data being entered Learn how to combine datasets Learn how to produce a clean dataset Handouts for this module: Handout 14: Concatenating Data Handout 15: Data Cleaning In class: Have participants read the following to themselves and be prepared to answer any questions: Supervisors will already have been selected during survey collection. The supervisor for data entry may be selected from that group. The selected data entry supervisor should undergo the data entry train­ ing and should also be very familiar with the survey and knowledgeable about computers. Supervisors should be able to resolve any questionnaire errors or data entry errors. Supervisors must also check the quality of data being entered. At the beginning of the data entry pro­ cess, the supervisor will need to review each data entry staff member’s work to make sure he or she understands the data entry instructions. Once data entry staff become more experienced, the supervisor should check data quality on a periodic basis. Data quality may be checked using CSPro VERIFY mode. You will need to decide whether data entry staff or supervisors will verify the questionnaires. The verification process will help to minimize data entry errors but will require additional staff time. It is recommended to verify all files, but verifying only a randomly selected sample (for example, 10%), based on questionnaire numbers is acceptable. During the data collection period, supervisors should carefully check completed questionnaires for er­ rors. In the case that an error is found during data entry, data entry supervisors should correct or clarify data and document the correction on the questionnaire. In the case that there is an unclear response on the questionnaire or other problem, the data entry supervisor should be the only one to make a judg­ ment call on how to correct or clarify the data. Data entry staff should never make the call in such cases. Data entry supervisors should seek to apply decisions consistently. Reproductive Health Assessment Toolkit for Conflict-Affected Women �� If there are multiple data files, supervisors are responsible for concatenating (combining) them into a single data file (Handout 14). Supervisors are also responsible for cleaning the dataset (Handout 15). The supervisor will also be responsible for ensuring that completed questionnaires are stored in a secure location. Trainer notes: Reproductive Health Assessment Toolkit for Conflict-Affected Women �� CHAPTER 5 Analysis Guide Reproductive Health Assessment Toolkit for Conflict-Affected Women �� The Division of Reproductive Health (DRH) at CDC created the Analysis Guide which is composed of the Key Indicator List and Analysis Tables. These will guide Toolkit users in looking across all topic areas to identify and prioritize the most critical needs among their population of interest. DRH can provide technical assistance by generat­ ing the following key indicator list and analysis tables using your clean dataset. (See contact infor­ mation for technical assistance in the Chapter 1, Introduction.) However, if you have the capability of conducting the analysis yourself in SAS, DRH can send you the appropriate SAS programs to generate the analysis. Please note that the data will need to be weighted to account for the num­ ber of eligible women per selected household so that it represents all women of reproductive age in the population. Use the number of eligible women in the household (variable: TOT_WRA), as recorded on the Locator Form, as the analysis weight. Standard statistical packages such as SAS, SPSS, SUDAAN, and STATA all incorporate the use of weights in the analysis of data. With the provided programming and sampling instructions described in Chapter 3, you will only be able to calculate point estimates and not confidence intervals. This means that the data are descriptive, and they identify what proportion of women within the target population represent a specific outcome. For example, the data analysis will determine what proportion of women are cur­ rently pregnant or are currently using a modern contraceptive method to prevent pregnancy. Al­ though confidence intervals will not be calculated, a random sample of 400 respondents typically will provide point estimates within +/- 5% of the true population prevalence, with 95% confidence. The data gathered through the Toolkit question­ naire do not allow determination of whether differences between groups, such as ethnic group or age groups, are statistically significant. The data will describe women with an outcome by specific characteristics. For example, Table SM­ 13 provides the proportion of women who had a live or still birth in the last two years and received antenatal care from a trained provider by age, relationship status, ability to read, and displace­ ment status. Software packages with complex sample survey capabilities (e.g., SUDAAN) can test for differences between groups, but this level of analysis is outside the scope of the Toolkit. Toolkit data can be used to describe the popula­ tion of interest, identify reproductive health needs, identify gaps in services, and provide percentages of the population who have experienced specific health outcomes. The data can then be used to advocate and solicit funding to improve programs and services and evaluate current programs and services. Key Ind�cator L�st The Key Indicator List provides a general over­ view/summary of the most important data from each section of the questionnaire. Reading across the columns, the list provides the name of the indicator, definition, how the indicator is calcu­ lated from the questionnaire, value (which will be transcribed after the analysis), and rationale/sug­ gestions for data use. Related tables found in the Analysis Tables section are also identified. The information from this list can be used to develop reports for administrators and policy-makers. Refer to Chapter 6, Suggestions for Data Use, for more detail on how to use the key indicator list. Reproductive Health Assessment Toolkit for Conflict-Affected Women Key Indicator List �� NOTE: FOR EACH INDICATOR, EXCLUDE NO RESPONSE FROM THE ANALYSIS Indicator Definition Construction using questionnaire Value Rationale/ Data use Related tables SAFE MOTHERHOOD SM-a) Pregnancies in last two years Proportion of women who had one or more pregnancies in the last two years among all women of reproduc­ tive age Numerator: Pregnancies = Q217>1 Women who had a pregnancy in the last two years Denominator: Total surveyed This provides an estimate of how many women are recently pregnant in your population. Reviewing table SM-1 will detail the types of pregnancy outcomes. SM-1 SM-b) Knowledge of danger signs of pregnancy complications Proportion of women who know at least two danger signs of pregnancy complica­ tions among all women of reproductive age Numerator: Q201= 1 (mentioned) for at least two danger signs Danger signs of pregnancy Denominator: Total surveyed Knowledge of danger signs of pregnancy complica­ tions can help facilitate access to appropriate care. Actions could focus on increasing knowledge to prevent maternal and infant deaths. SM-2,3 SM-c) Currently pregnant Proportion of women who are currently pregnant among all women of reproduc­ tive age Numerator: Q203= 1 (yes) Currently pregnant Denominator: Total surveyed This measures the proportion of women who are in need of antenatal care services, enabling administrators to assess whether current services are sufficient. SM-4,5 SM-d) Antenatal care for currently pregnant women Proportion of currently pregnant women re­ ceiving antenatal care by a trained provider Numerator: Q205= 1 (Yes) Seen anyone for antenatal care AND Q206= Doctor or Nurse/midwife =1) Trained antenatal care provider Denominator: Q203 = 1 (yes) Currently pregnant women This identifies currently pregnant women who are receiving antenatal care. Not receiving adequate ANC may put women and infants at risk. Actions could focus on promot­ ing antenatal care by a trained provider for all pregnant women. SM-6, 7, 8, 9, 10 SM-e) Receipt of minimum antenatal care visits during most recent pregnancy in last 2 years Proportion of women who received mini­ mum antenatal care visits (at least 3) by a trained provider among women whose most recent pregnancy ended in a live birth or stillbirth in the last two years Numerator: Q218= 1 (Yes) Seen anyone for antenatal care AND Q219 = 1 (mentioned) for Doctor or nurse/midwife Trained antenatal care provider AND Q220= 3 OR 4 (3 or more times) Minimum antenatal care visits Denominator: Q217A= 1 or 2 or 3 or 4 Women whose most recent pregnancy ended in a live birth or stillbirth in the last two years This measures whether women who gave birth in the last two years received minimum antenatal visits by a trained provider. At least three visits are rec­ ommended. This indicates local antenatal care prac­ tices that can put women and infants at risk. SM-11, 12, 13, 14, 15 Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Indicator Definition Construction using questionnaire Value Rationale/ Data use Related tables SAFE MOTHERHOOD (continued) SM-f) Help-seeking behavior for pregnancy complications Proportion of women who sought help at a health facility among those who reported pregnancy complica­ tions before labor or delivery with their most recent pregnancy that ended in a live birth or stillbirth in the last two years Numerator: Q224= 1 (yes) Sought help AND Q225=2 or 3 (Health center or hospital) Health facility Denominator: Q222= (yes) Had complications during pregnancy This identifies what pro­ portion of women did not seek help for pregnancy complications. Cultural norms of not seeking care, lack of access, or women’s perception of clinical services may exist. Reviewing knowledge of danger signs of pregnancy complications may provide information on whether lack of knowledge is a barrier. Actions could focus on promoting help- seeking behaviors when complications arise. SM-16, 17, 18 SM-g) Delivery care Proportion of women whose delivery was attended by a trained health care provider at a health facility among women whose most recent pregnancy ended in a live birth or stillbirth in the last two years Numerator: Q227= 1 (Yes) Someone helped with the delivery AND Q226=2 or 3 (Health center/clinic/ hospital) Health facility AND Q228 = 3 (Midwife, nurse, or doctor) Trained health care provider Denominator: Q217A= 1 or 2 or 3 or 4 Women whose most recent pregnancy ended in a live birth or stillbirth in the last two years This indicates high­ est degree of safety for women and infants during delivery. Actions could focus on promoting quality delivery care of all women of reproductive age. SM-19, 20, 21, 22 SM-h) Postpartum care Proportion of women who received at least one postpartum care visit within six weeks after delivery among women whose most recent pregnancy ended in a live birth or stillbirth in the last two years Numerator: Q231= 1 or 2 or 3 Received postpartum visit Denominator: Q217A= 1 or 2 or 3 or 4 Women whose most recent pregnancy ended in a live birth or stillbirth in the last two years This identifies whether women are likely to re­ ceive or go for postpartum visits. Actions could focus on connecting currently pregnant women to post­ partum care and promote care of infants. SM-23, 24, 25 SM-i) Help-seeking behavior for postpartum complications Proportion of women who sought help at a health facility among women who had post­ partum complications after their most recent pregnancy ending in a live birth or stillbirth in the last two years Numerator: Q235=1 (yes) Sought help AND Q236=2 or 3 (Health center or hospital) Health facility Denominator: Q233= 1 (yes) Had complications This indicates women not seeking help for postpar­ tum complications. Cul­ tural norms of not seeking care, lack of access, or women’s perception of clinical services may exist. Actions could focus on strategies to promote help-seeking behaviors when complications arise. SM-26, 27, 28 Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Indicator Definition Construction using questionnaire Value Rationale/ Data use Related tables FAMILY PLANNING FP-a) Ever heard of Proportion of women who have ever heard Numerator: Q300=1 for method A or B or C or D or Knowledge of modern family planning methods FP-1, 2, 3, 4 modern family of at least one modern E or F or G or H can help facilitate use planning methods family planning method among all Ever heard of any modern methods of methods. Actions could focus on education women of reproductive Denominator: strategies to promote age Total surveyed modern methods. FP-b) Proportion of women Numerator: This measures the FP-2, 4 Ever used modern who have ever used Q302 = 1 for method A or B or C or D acceptance of modern family planning at least one modern or E or F or G or H family planning methods methods family planning method Ever used any modern methods in the population. among all women of reproductive age Denominator: Total surveyed FP-c) Modern contraceptive prevalence rate Proportion of women using any modern family planning method among all women of reproductive age Numerator: Q309= 1 (yes) Currently using any method AND Q312 = 1 (mentioned) for Pill, IUD, condom, implants, injectables, emergency hormonal contraception, tubal ligation, OR vasectomy Any modern method This measures the percentage of women who are using modern family planning methods, and it can inform logistics for family planning services. FP-5, 6, 7 Denominator: Total surveyed FP-d) Barriers to family planning Proportion of women reporting at least one barrier to family planning (except for fertility-related reasons) among women not currently using a method Numerator: Q310=1 (mentioned) for any; exclude fertility-related reasons (wants more children now, not having sex/infrequent sex, unable/difficult get pregnant, postpartum, breastfeeding) Barrier to family planning except fertility-related reasons Denominator: Q309=2 (no) Women not currently using family planning method This indicates women who are not currently using a family planning method. The related tables group barriers by fertility-related, opposition to use, lack of knowledge, method-related, and lack of access. Actions could target the predominant type of barrier to promote family planning. FP-8, 9 Reproductive Health Assessment Toolkit for Conflict-Affected Women �0 Indicator Definition Construction using questionnaire Value Rationale/ Data use Related tables FAMILY PLANNING (continued) FP-e) Unmet need for family planning Proportion of women currently not using a method and not wanting to have a baby who are at risk for pregnancy (not using a method, not currently pregnant or postpartum, fecund, sexually active in the last 30 days, and do not want a baby in the immediate future) among all women of reproductive age Numerator: Q309= 2 (no) Currently not using a method AND Q203=2 (Not pregnant) OR Q310= postpartum=2 (postpartum recent 30 days) Not currently pregnant or postpartum AND Q307 = 1 (yes) Fecund (able to get pregnant) AND Q502 = 1 (yes) Sexually active in last 30 days AND Q306= 2, 3, or 4 OR Q305 =2 Want pregnancy later or want no more Denominator: Total surveyed This indicator provides information on the current need for family planning among women at risk for pregnancy who desire to limit or space future births but who are not using a method (refer to Diagram 5 in Analysis Tables). These women have an “unmet need” for family planning and can be targeted for programming efforts. Reviewing modern contraceptive prevalence rate and unmet need can provide information about the overall need for family planning. Actions could enhance strategies to promote family planning. FP-10 FP-f) Future intent to use a method in the next 12 months Proportion of women who intend to use a family planning method in the next 12 months among women who are currently not using a method Numerator: Q314= 1 (yes) Intend to use a method to delay or avoid pregnancy Denominator: Q309=2 (no) Women not using family planning method This indicates women who intend to use family planning in the next 12 months and who are currently not using family planning. This could help inform need for family planning supplies and services. FP-11, 12, 13, 14 SEXUAL HISTORY/SEXUALLY TRANSMITTED INFECTIONS (STIs) STI-a) Condom use at last higher risk sex Proportion of women who did not use a con­ dom at last intercourse with a casual partner among women who had sex with a casual partner in the last 12 months Numerator: Q505 = 2 (no) Did not use condom at last sex with casual partner Denominator: Q504>1 Sex with casual partner in last 12 months This indicates women who are at high risk of STIs. Actions could focus on strategies to reduce high-risk sex by abstaining from sex, being mutually faithful, and consistently using condoms (ABCs). STI-1, 2, 3 STI-b) Knowledge of selected STI- associated symptoms Proportion of women who know at least one of three selected STI- associated symptoms that can be found in women among all women of reproduc­ tive age Numerator: Q602= 1 (mentioned) for “green or curd-like vaginal discharge” or “foul smelling discharge” or “genital ulcers/sores” STI-associated symptoms in women Denominator: Total surveyed (Note: For those women who never heard of STIs (Q601=2 or 9), then Q602 for those respondents should be coded as “no” or “2” for numerator in the analysis.) Unusual genital discharge and genital ulcers or sores are indicative of STIs based on WHO’s syndromic management of STIs.7 Knowledge of selected STI-associated symptoms can facilitate treatment for proper care. Actions could focus on education strategies to improve knowledge of STI symptoms. STI-4, 5 Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Indicator Definition Construction using questionnaire Value Rationale/ Data use Related tables SEXUAL HISTORY/SEXUALLY TRANSMITTED INFECTIONS (STIs) (continued) STI-c) Selected STI- associated symptoms in the last 12 months Proportion of women who have had unusual genital discharge and/or genital ulcers or sores in the last 12 months among all women of reproductive age Numerator: Q603= 1 (yes) Had unusual discharge OR Q604=1 (yes) Had genital ulcers/sores Denominator: Total surveyed This measures the prevalence of STI- associated symptoms of women in the last 12 months. Indicates a need for STI programs/services. STI-6, 7 STI-d) Help-seeking behaviors for treating selected STI -associated symptoms Proportion of women who reported selected STI-associated symptoms in the last 12 months and went to a health facility for treatment Numerator: Q605= 1 (yes) Sought treatment AND Q606= 1,2, OR 3 (health center, hospital) Where sought treatment Denominator: Q603=1 Had unusual genital discharge OR Q604=1 Had genital ulcers/sores This indicates women not seeking treatment for selected STI-associated symptoms. Cultural norms of not seeking care, lack of access, or women’s perception of clinical services may exist. Reviewing knowledge of selected STI-associated symptoms and barriers to treatment can provide more information on this indicator. Actions could focus on promoting help-seeking behaviors when experiencing STI- associated symptoms. STI-8, 9, 10 HIV/AIDS HIV-a) Comprehensive correct knowledge of HIV/AIDS Proportion of women who identify two major ways of preventing HIV sexual transmission: • Using condoms • Limiting sex to one faithful, uninfected partner AND who reject the two most common misconceptions: • Mosquitoes transmit HIV • Sharing food with an infected person transmits HIV AND who know that: • A healthy looking person can have HIV among all women of reproductive age Numerator: Q703=1 (yes) Know condoms prevent HIV AND Q702=1 (yes) Know sex with only 1 faithful, uninfected partner prevents HIV AND Q705=2 (no) Do not think mosquitoes transmit HIV AND Q709=2 (no) Do not think sharing food transmits HIV AND Q710=1 (yes) Knows healthy looking person can have HIV Denominator: Total surveyed (Note: For those women who never heard of HIV/AIDS (Q701=2 or 9), then the indicator should be coded as “no” or “2” for numerator in the analysis.) This measures the comprehensive correct knowledge about HIV/ AIDS. This is a composite indicator constructed from 5 prompted knowledge and misconceptions questions. The person must respond correctly to all 5 questions. Actions could target strategies to educate the population on correct knowledge of HIV/ AIDS transmission and inform/guide voluntary counseling and testing (VCT) programs. HIV-1, 2, 3 Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Indicator Definition Construction using questionnaire Value Rationale/ Data use Related tables HIV/AIDS (continued) HIV-b) Comprehensive correct knowledge of mother-to-child transmission (MTCT) of HIV/AIDS Proportion of women who know that HIV/AIDS can be transmitted from mother to child during pregnancy or delivery, and through breastfeeding among all women of reproductive age Numerator: Q711=1 (yes) Transmit during pregnancy and delivery AND Q712=1 (yes) Transmit through breastfeeding Denominator: Total surveyed (Note: For those people who never heard of HIV/AIDS (Q701=2 or 9), then the indicator should be coded as “no” or “2” for numerator in the analysis.) This measures the knowledge of modes of MTCT. Knowledge of how HIV can be transmitted from mother to child is likely to affect help- seeking and breastfeeding behaviors. Actions could focus on strategies to educate the population on correct knowledge of HIV/AIDS transmission. This indicator could also inform/guide MTCT programs. HIV-4, 5 HIV-c) Accepting attitudes of people living with HIV/AIDS (PLWH/A) Proportion of women who have accepting attitudes of PLWH/A among women who have ever heard of HIV/AIDS Numerator: Q713=2 (no) Do not believe HIV positive status of family member should be kept secret AND Q714=1 (yes) Willing to care for HIV positive family member in home AND Q715=1 (yes) Believes HIV positive teacher should be allowed to continue teaching AND Q716=1 (yes) Would buy fresh vegetables from HIV positive person This measures women’s attitudes towards PLWH/A and attempts to capture different dimensions of the social phenomenon of HIV positive status. Stigma­ tization surrounding HIV/ AIDS is a major obstacle to many of the programs aiming to prevent further spread of HIV and mitigate AIDS impact. Actions could focus on promoting positive attitudes towards PLWH/A. HIV-6, 7 Denominator: Q701=1 (yes) Have heard of HIV HIV-d) Perceived risk of getting HIV/AIDS Proportion of women who believe they are at moderate to high risk of getting HIV/AIDS among women who have ever heard of HIV/AIDS Numerator: Q718= 1 or 2 Moderate to high risk for HIV Denominator: Q701=1 (yes) All women who have heard of HIV This identifies women who perceive they are at moderate to high risk for getting HIV. Actions could target this group for HIV/AIDS prevention and VCT and MTCT services. HIV-8 HIV-e) Received HIV test results in the last 12 months Proportion of women who received their HIV test results among women who were tested for HIV in the last 12 months Numerator: Q730=1 (yes) Received results Denominator: Q726=1 (yes) Had HIV test less than 1 year ago This measures the prevalence of women who have recently had an HIV test and found out the results. Knowledge of status often leads to safer sex practices and greater sensitivity to persons liv­ ing with HIV/AIDS. Actions could focus on promoting VCT and MTCT services. HIV-9, 10, 11 Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Indicator Definition Construction using questionnaire Value Rationale/ Data use Related tables HIV/AIDS (continued) HIV-f) Would have an HIV test in the future Proportion of women who would go for an HIV test in the future among women who have ever heard of HIV/AIDS Numerator: Q731=1 (yes) Go for test in the future Denominator: Q701=1 (yes) Have heard of HIV This measures a desire for future HIV testing and can inform planning for programs and supplies. HIV-12, 13, 14, 15 GENDER-BASED VIOLENCE (GBV) GBV-a) Outsider physical violence during conflict Proportion of women who have experienced physical violence by someone outside of their family during the conflict among all women of reproductive age Numerator: Q801 A-D=1 (yes) Women experiencing physical violence during conflict Denominator: Total surveyed This measures the extent of physical violence by people outside of the family during the conflict and indicates need for response to GBV that may include services to meet physical and psychological needs. GBV-1, 2, 4, 6, 10, 12, 31 GBV-b) Outsider physical violence post- conflict Proportion of women who have experienced physical violence by someone outside of their family post-con­ flict among all women of reproductive age Numerator: Q805 A-D=1 (yes) Women experiencing physical violence post-conflict Denominator: Total surveyed This measures the extent of physical violence by people outside of the family post-conflict and in­ dicates need for response to GBV that may include services to meet physical and psychological needs. GBV-1, 2, 4, 7, 10, 12, 31 GBV-c) Outsider sexual violence during conflict Proportion of women who have experienced sexual violence by someone outside of their family during the conflict among all women of reproductive age Numerator: Q801 E-H=1 (yes) Women experiencing sexual violence during conflict Denominator: Total surveyed This measures the extent of sexual violence by people outside of the family during the conflict and indicates need for response to GBV that may include services to meet physical and psychological needs. GBV-1, 3, 5, 8, 11, 12, 31 GBV-d) Outsider sexual violence post- conflict Proportion of women who have experienced sexual violence by someone outside of their family post-con­ flict among all women of reproductive age Numerator: Q805 E-H=1 (yes) Women experiencing sexual violence post-conflict Denominator: Total surveyed This measures the extent of sexual violence by people outside of the family post-conflict and in­ dicates need for response to GBV that may include services to meet physical and psychological needs. GBV-1, 3, 5, 9, 11, 12, 31 GBV-e) Reporting outsider violence Proportion of women who told an author­ ity about any incident of outsider violence among women who experienced outsider violence. Author­ ity persons include doctor/provider, police, military, and NGO worker. Numerator: Q812 C, D, E any=1 (yes) Women who told an authority about any incidence of outsider violence Denominator: Q801 any = 1 or Q805 any = 1 Women who experienced outsider violence during and post-conflict This indicates whether women are reporting violence to an author­ ity. Actions could focus on encouraging women to report violence to an authority when experienc­ ing outsider violence. GBV-13, 14, 15, 16, 17 Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Indicator Definition Construction using questionnaire Value Rationale/ Data use Related tables GENDER-BASED VIOLENCE (continued) GBV-f) Intimate partner violence (IPV) ever Proportion of women who have ever experi­ enced IPV by a current or previous partner among ever-partnered women Numerator: Q815 A-D any=1 (yes) Women experiencing IPV Denominator: Q401=1 (yes) Ever-partnered women This measures the preva­ lence of intimate partner violence and indicates need for response to IPV that may include services to meet physical and psy­ chological needs. GBV-18, 21, 30, 31 GBV-g) IPV in past year Proportion of women who have experienced IPV in the past year among currently partnered women Numerator: Q816 A-D =2, 3 or 4 Women experiencing IPV in past year Denominator: Q815 A-D any =1 (yes) Ever-partnered women who ever experienced IPV AND Q407=1 (yes) Partnered in last 12 months This measures the preva­ lence of intimate partner violence in the past year. It indicates the current need for immediate response to IPV that may include services to meet physical and psychological needs and legal and protective services. GBV-19, 20, 27, 31 GBV-h) Reporting IPV Proportion of women who told an authority about any incident of IPV among women who ever experienced IPV. Authority persons include doctor/pro­ vider, police, military, and NGO worker. Numerator: Q820 C, D, E any=1 (yes) Women who told an authority about any incidence of intimate partner violence Denominator: Q815 A-E any=1 Women who experienced IPV ever This indicates whether women are reporting violence to an authority. Actions could focus on en­ couraging women to report violence to an authority when experiencing IPV. GBV-22, 23, 24, 25, 26 GBV-i) Physical violence by family members in past year Proportion of women who have experienced physical violence by family members in the past year among all women of reproductive age Numerator: Q823=1 (yes) Women experiencing physical violence by family members in past year Denominator: Total surveyed This measures the preva­ lence of physical violence by family members in the past year and indicates need for response to family violence that may include services to meet physical and psychologi­ cal needs and legal and protective services. GBV-28, 29 FEMALE GENITAL CUTTING (FGC) FGC-a) Prevalence of FGC Proportion of women who have ever had their genitals cut among all women of reproductive age Numerator: Q902 = 1 (yes) Women who ever had their genitals cut Denominator: Total surveyed (Note: For those women who never heard of FGC (Q901=2 or 9), then the indicator should be coded as “no” or “2” for numerator in the analysis) This indicates the prevalence of FGC among respondents. FGC-1, 2 Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Indicator Definition Construction using questionnaire Value Rationale/ Data use Related tables FEMALE GENITAL CUTTING (FGC) (continued) FGC-b) Prevalence of FGC among youngest daughter that occurred in current setting Proportion of youngest daughters who have ever had their genitals cut and cutting was done in their current location among women who have at least one daughter and have heard of FGC Numerator: Q907 = 1 (yes) Youngest daughter who ever had their genitals cut AND Q912 = 1 (current location) Cutting took place in current location Denominator: Q905 =>1 Women who have >1 daughter(s) This indicates the prevalence of current FGC practice. Differences in proportion in FGC among respondents and youngest daughters may indicate changes in practice. FGC-3, 4 FGC-c) Future intent of FGC Proportion of women who intend to have youngest daughter’s genitals cut in the future among women who have at least one daughter and have heard of FGC Numerator: Q908 = 1 (yes) Women who intend to circumcise their youngest daughter in the future Denominator: Q905 =>1 Women who have >1 daughter(s) This measures the future intent of FGC among youngest daughters. Actions could include education on the complications of FGC and awareness-building among those who provide female circumcision services. FGC-5, 6, 7, 8, 9 FGC-d) Favorable to the continuation of FGC Proportion of women who think the practice should continue among women who have ever heard of FGC Numerator: Q917=1 (continued) Women who think the practice should be continued Denominator: Q901=1 (yes) Women who have ever heard of FGC This indicates the accep­ tance of the FGC practice. Actions could promote education strategies on the complications of FGC. FGC-9 EMOTIONAL HEALTH EH-a) Emotional distress as measured by the Self Report Questionnaire-20 (SRQ-20) score. Mean SRQ-20 score of all women of reproduc­ tive age Numerator: Q1001A-T = 1 (yes) Denominator: Total surveyed SRQ-20 was developed by WHO as a screening tool for emotional distress.8 The score ranges from 0-20, with 0 being low and 20 being high for emotional distress. Mean scores can be compared with country of origin or residence if they have also completed the SRQ-20. Actions could focus on promoting mental health services. EH-1, 3 EH-b) Suicidal thoughts in the past 4 weeks Proportion of women who have had thoughts of ending their life in the past 4 weeks among all women of reproductive age Numerator: Q1001Q = 1 (yes) Had suicidal thoughts Denominator: Total surveyed This measures suicidal thoughts in the past 4 weeks. Immediate actions could focus on active screening and on promoting mental health services. EH-2 Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Analys�s Tables The Analysis Tables provide more detail than the Key Indicator List and organize the data by various subgroups (e.g., age groups, relationship status, ability to read). By looking at the data in this way, you may be able to see what groups are in greater need for services and how to tailor interventions to better reach those groups. The tables provide a percentage (%) and number (n) of respondents. The percentage is weighted by the number of women of reproductive age in the household and reflects the population of women of reproductive age. The number is the actual number of respondents in the survey. Refer to Chapter 6, Suggestions for Data Use, for more detailed information on how to use the Analysis Tables. Background Character�st�cs This section describes background characteristics of the women of reproductive age in your popula­ tion. These data are descriptive and can be useful in describing your population when reporting findings and identifying particular groups at high risk of having poor reproductive health. Characteristics Table B-1: Demographic characteristics of women of reproductive age [country and year]. {N = total surveyed} Characteristic % women Age (n= ) Q105 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Don’t Know Religion (n= ) Q106 Religion 1 Religion 2 Religion 3 Religion 4 Other Ethnicity (n= ) Q107 Ethnic group 1 Ethnic group 2 Ethnic group 3 Ethnic group 4 Ethnic group 5 Other Mixed Ethnicity Highest grade completed (n= ) Q110 None 1-4 5-8 9-12 >12 Technical Vocational University or higher Reproductive Health Assessment Toolkit for Conflict-Affected Women Table B-1 (continued) Marriage and live-in partnerships �� Characteristic % women Ability to read (n= ) Q111 Read easily With difficulty Not at all Ability to write (n= ) Q112 Write easily With difficulty Not at all Respondent is head of household (n= ) Q102 Yes No Household size (n= ) Q101 1-2 people 3-4 people >5 people Displaced status (n= ) Q113 Not displaced (=1) Displaced (=2, 3, or 4) Length of displacement (n= ) (Calcu­ late as follows: [Year of survey] – Q115) <1 year 1-5 years > 5 years Don’t Know Total lifetime pregnancies (n= ) (Sum of Q209, Q211, Q213, 216) 0 1-2 3-4 4-5 >6 Table B-2: Age at first marriage or live-in with partner and current relationship status among ever-partnered women [country and year]. {N= Q401=1} Characteristic % women Age at first marriage or live-in with partner (n= ) Q402 <14 years 15-19 years 20-24 years >25 years Don’t Know Mean age at first marriage or live-in with partner (n= ) Q402 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Table B-3: Demographic characteristics of current or most recent partner among ever-partnered women [country and year]. {N= Q401=1} Characteristic % women Highest grade completed (n= ) Q404 None 1-4 5-8 9-12 >12 Technical vocational University or higher Type of work of partner (n= ) Q405 Professional Semi-skilled Unskilled/manual Military/police Unemployed Other Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Table B-4: Husband has multiple wives and order among the wives among currently married women [country and year]. {N= Q406=1 OR 2} Characteristic % women Husband has other wives (n= ) Q408 Yes No Respondent order among wives (n= ) Q409 First wife Second wife Third wife Fourth wife Sexual history: numbers and types of partners Table B-5: Average age of sexual debut, sexual activity in the last 30 days, sexual activity with casual partners, and condom use among women of reproductive age [country and year]. {N= total surveyed} Characteristic % women Average age of sexual debut, in years Q501 Age at sexual debut (n= ) Q501 <15 years 15-19 years >19 years Sexually active in last 30 days (n= ) Q502 Yes No Casual partners in past year (n= ) Q504 0 partners 1-2 partners > 2 partners Average number of casual partners in past year Q504 Safe Motherhood This section assesses knowledge of danger signs during pregnancy, access to antenatal services, incidence of pregnancy-related complications, help-seeking behaviors during pregnancy, labor/ delivery, and postpartum care, and pregnancy outcomes in the last two years. The data from this section will help determine the need to promote antenatal care, in order to reduce maternal com­ plications and poor birth outcomes. Pregnancy outcomes Table SM-1: Pregnancy outcomes in the last 2 years [country and year]. {N= Total pregnancies, Q217>0} Characteristic % Pregnancies Singleton Pregnancies (n= ) Live birth Stillbirth Multiple Pregnancies (n= ) Spontaneous abortion Induced abortion Ectopic pregnancy Knowledge of danger signs during pregnancy Table SM-2: Knowledge of danger signs during preg­ nancy among women of reproductive age [country and year] (Q201).* {N= total surveyed} Characteristic % women Feeling very weak or tired (anemia) Severe abdominal pain (pain in the belly) Bleeding from the vagina Fever Swelling of hands and face Headache Blurred vision Other Don’t know * Percentages may add up to greater than 100% as respondent may give more than 1 response. Reproductive Health Assessment Toolkit for Conflict-Affected Women Table SM-3: Demographic characteristics of women Table SM-4: Demographic characteristics of currently who have knowledge of danger signs during pregnancy pregnant women [country and year]. {N= Q203=1} �� [country and year] (Q201). {N= total surveyed} Characteristic % women Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) Q115 <1 year 1-5 years > 5 years Table SM-5: Trimester of currently pregnant women [country and year] (Q204). {N= Q203=1} Characteristic 0-1 sign known % >2 signs known % Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) Q115 <1 year 1-5 years > 5 years Ever pregnant (n= ) Q202 Yes No Currently pregnant (n= ) Q203 Yes No Characteristic % women First trimester (0-3 months) Second trimester (4-6 months) Third trimester (>6 months) Don’t know Reproductive Health Assessment Toolkit for Conflict-Affected Women �0 Antenatal care for currently pregnant women Table SM-7: Demographic characteristics of currently Table SM-6: Antenatal care (ANC) provider among cur- pregnant women by receipt of antenatal care (ANC) rently pregnant women who sought ANC [country and [country and year]. {N= Q203 = 1) year] (Q206).* {N= Q203 = 1 AND Q205=1} Characteristic % women Doctor Nurse/midwife Traditional birth attendant/community health worker Other * Percentages may add up to greater than 100% as respondents may give more than 1 response. Characteristic ANC by a trained provider % (Q206=doctor OR nurse/midwife) ANC by an untrained provider or no ANC % (Q206=TBA/CHW OR Q205=2) Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not liv­ ing with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) Q115 <1 year 1-5 years > 5 years Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Table SM-8: Trimester of currently pregnant women Table SM-9: Barriers to antenatal care among currently who have NOT seen anyone for antenatal care [country pregnant women who are NOT seeing someone for and year] (Q204). {N = Q203=1 AND Q205=2} antenatal care [country and year] (Q207).* {N = Q203=1 AND Q205=2}Characteristic % women First trimester (0-3 months) Second trimester (4-6 months) Third trimester (>6 months) Don’t know Characteristic % women No healthcare provider available Could not afford Distance too far Lack of transportation Poor road conditions Husband/partner would not permit Afraid of doctor, nurse, etc. Have never used doctor, nurse before Not treated well previously Embarrassed or ashamed Other * Percentages may add up to greater than 100% as respondent may give more than 1 response. Diagram 1: Barriers to antenatal care for currently pregnant women This diagram is used to categorize barriers to antenatal care: lack of access, opposition to care, and perception of care. Barriers are asked of all women who are not seeing anyone for ANC. ��������������� ������ ������������������ ���������� ������� ������������� ����������� ���������� ��������������� ������������������� ������������������� 1 = Lack of access includes no healthcare provider available, could not afford, distance too far, lack of transportation, or poor road conditions. 2 = Opposition to care includes husband/partner would not permit. 3 = Perception of care includes afraid of doctor, nurse, etc.; have never used doctor, nurse before; not treated well previously; or embar­ rassed or ashamed. Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Table SM-10: Demographic characteristics of currently pregnant women who have not seen anyone for antenatal care by barriers reported [country and year] (Q207).* {N = Q203=1 AND Q205=2} Characteristic Any barrier % Type of Barrier Lack of access % Opposition to care % Perception of care % Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) Q115 <1 year 1-5 years > 5 years * Percentages may add up to greater than 100% as respondent may give more than 1 response. Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Antenatal care for women whose most recent pregnancy ended in a live birth or stillbirth in the last two years Table SM-11: Type of provider of antenatal care (ANC) for women during their most recent pregnancy that ended in a live birth or stillbirth in the last two years [country and year] (Q219).* {N= Q218 = 1} Characteristic % women Doctor Nurse/midwife Traditional birth attendant/community health worker Other * Percentages may add up to greater than 100% as respondent may give more than 1 response. Table SM-12: Women who received antenatal care (ANC) during their most recent pregnancy that ended in a live birth or stillbirth in the last two years by number of visits [country and year] (Q220). {N= (Q218 = 1 AND (Q219= doctor OR nurse/ midwife OR TBA/CHW))} Characteristic % women One time Two times Three times More than 3 times Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Table SM-13: Antenatal care (ANC) practices among women who sought ANC during their most recent pregnancy that ended in a live birth or stillbirth in the last two years by maternal characteristics (219). {N=218=1} Characteristic ANC by a trained provider and >3 visits % ((Q219 =doctor OR nurse/midwife) AND (Q220=3 or 4)) ANC by a trained provider and <3 visits OR ANC with untrained provider OR no ANC % ((Q219 =doctor OR nurse/midwife) AND (Q220=1 or 2)) OR (Q219=TBA/CHW) OR (Q218=2) Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) Q115 <1 year 1-5 years > 5 years Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Diagram 2: Barriers to antenatal care for women whose most recent pregnancy ended in a live birth or stillbirth This diagram is used to categorize barriers to antenatal care: lack of access, opposition to care, and per­ ception to care. Barriers are asked of all women who did not see anyone for ANC in their most recent pregnancy that ended in a live birth or stillbirth. 1 = Lack of access includes no healthcare provider available, could not afford, distance too far, lack of transportation, or poor road conditions. 2 = Opposition to care includes husband/partner would not permit. 3 = Perception of care includes afraid of doctor, nurse, etc.; have never used doctor, nurse before; not treated well previously; or embarrassed or ashamed. ��������������� ������ ��������������������������������� ������������������������������������������� ������� ������������� ����������� ���������� ��������������� ������������������� ������������������� Table SM-14: Barriers to antenatal care (ANC) among women who did not see anyone for care during their most recent pregnancy that ended in a live birth or stillbirth in the last two years [country and year] (Q221).* {N= Q218=2} Characteristic % women No healthcare provider available Could not afford Distance too far Lack of transportation Poor road conditions Husband/partner would not permit Afraid of doctor, nurse, etc. Have never used doctor, nurse before Not treated well previously Embarrassed or ashamed Other * Percentages may add up to greater than 100% as respondent may give more than 1 response. Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Table SM-15: Demographic characteristics of women who did not see someone for antenatal care among women whose most recent pregnancy ended in a live birth or stillbirth in the last two years by barriers reported [country and year] (Q221).* {N= Q218=2} Characteristic Any barrier % Type of Barrier Lack of access % Opposition to care % Perception of care % Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) Q115 <1 year 1-5 years > 5 years * Percentages may add up to greater than 100% as respondent may give more than 1 response. Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Incidence of pregnancy complications Table SM-16: Type of complications during pregnancy among women whose most recent pregnancy ended in a live birth or stillbirth in the last two years [country and year] (Q223).* {N= (Q217=1 or 2 or 3 or 4) AND Q222=1} Characteristic % women Feeling very weak or tired (anemia) Severe abdominal pain (pain in the belly) Bleeding from the vagina Fever Swelling of hands and face Blurred vision Other * Percentages may add up to greater than 100% as respondent may give more than 1 response. Help-seeking behavior for pregnancy complications Table SM-17: Help-seeking behavior among women who had >1 pregnancy complications during their most recent pregnancy ended in a live birth or stillbirth in the last two years [country and year] (Q225). {N= Q222=1 AND Q223=>1 complication except other} Characteristic % women No help (Q224=2) Help at home (Q225=1) Help at health center (Q225=2) Help at hospital (Q225=3) Other (Q225=4) Table SM-18: Demographic characteristics of women who had >1 pregnancy complications by type of help- seeking behavior during their most recent pregnancy ended in a live birth or stillbirth in the last two years [country and year] (Q225). {N= (Q222=1 AND Q223=>1 complication except other)} Characteristic Help at a health facility % (Q225=2 OR 3) Help at home or no help% (Q225 =1 OR Q224=2) Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) Q115 <1 year 1-5 years > 5 years Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Delivery Care Table SM-19: Delivery care among women whose most recent pregnancy ended in a live birth or stillbirth in the last two years by maternal demographic characteristics [country and year] (Q226, Q228). {N=Q217=1 or 2 or 3 or 4}. Characteristic Delivery with a trained health care worker and at a health facility % (Q228=3 AND Q226=2) Delivery with a trained health care worker but not at a health facility % (Q228=3 AND Q226 2) Delivery with no trained health worker and not at a health facility % (Q228 3 AND Q226 2) Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) Q115 <1 year 1-5 years > 5 years Table SM-20: Location of delivery among women Table SM-21: Person who helped with delivery among whose most recent pregnancy ended in a live birth women whose most recent pregnancy ended in a live or stillbirth in the last two years [country and year] birth or stillbirth in the last two years [country and (Q226). {N= Q217=1 or 2 or 3 or 4} year] (Q228). {N= Q217=1 or 2 or 3 or 4} Characteristic % women At home Health clinic/hospital On the way to the hospital/clinic Other Characteristic % women Relative/friend Traditional birth attendant Midwife, nurse, or doctor Other Reproductive Health Assessment Toolkit for Conflict-Affected Women - �� Table SM-22: Type of complications among women who had >1 complications during labor and delivery in their most recent pregnancy ending in a live birth or stillbirth in the last two years [country and year] (Q230).* {N= Q229=1} Characteristic % women Heavy bleeding Prolonged (>12 hours)/obstructed labor Vaginal tearing Convulsions Fever Green or brown water coming from the vagina Other * Percentages may add up to greater than 100% as respondent may give more than 1 response. Postpartum care Table SM-23: Type of postpartum care among women whose most recent pregnancy ended in a live birth or stillbirth in the last two years [country and year] (Q231). {N= (Q217=1 or 2 or 3 or 4)} Characteristic % women No postpartum care (Q231=4) Health worker visited (Q231=1) Went to health center (Q231=2) Both (Q231=3) Table SM-24: Postpartum care among women who received postpartum care during their most recent pregnancy ending in a live birth or stillbirth in the last two years by maternal demographic characteristics [country and year] (Q231). {N= (Q217=1 or 2 or 3 or 4)} Characteristic Received postpar tum care % (Q231=1 OR 2 OR 3) Did NOT receive postpartum care % (Q231=4) Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) Q115 <1 year 1-5 years > 5 years Reproductive Health Assessment Toolkit for Conflict-Affected Women �0 Table SM-25: Received information or counseling about family planning during a postpartum visit among women whose most recent pregnancy ended in a live birth or stillbirth in the last two years [country and year] (Q232). {N= Q231=1 OR 2 OR 3} Characteristic % women Received information or counseling Did NOT receive information or counseling Help-seeking behavior for postpartum complications Table SM-26: Type of postpartum complications among women who had >1 complications during postpartum in their most recent pregnancy ending in a live birth or stillbirth in the last two years [country and year] (Q234).* {N= Q233=1} Characteristic % women Heavy bleeding Bad smelling vaginal discharge High fever Painful urination Hot, swollen painful breasts Other * Percentages may add up to greater than 100% as respondent may give more than 1 response. Table SM-27: Help-seeking behavior among women who had >1 complications during postpartum in their most recent pregnancy ending in a live birth or stillbirth in the last two years [country and year] (Q236). {N= (Q233=1 AND Q234=>1 complications except other)} Characteristic % women No help (Q235=2) Help at home (Q236=1) Help at health center (Q236=2) Help at hospital (Q236=3) Table SM-28: Postpartum care practices among women who had >1 complications of postpartum by type of help-seeking behavior during their most recent pregnancy ending in a live birth or stillbirth in the last two years by maternal demographic characteristics [country and year]. {N= (Q233=1 AND Q234=>1 complications except other)} Characteristic Help at a health facility % (Q236=2 OR 3) Help at home or no help % (Q236=1 OR Q235=2) Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) Q115 <1 year 1-5 years > 5 years Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Fam�ly Plann�ng This section assesses knowledge of family planning methods, current contraceptive use, unmet need for family planning, and barriers to family planning. The data from this section will help determine the need to promote family planning (limiting number of children or spacing births) and identify barriers to fam­ ily planning efforts. Knowledge of and ever used modern family planning methods Table FP-1: Knowledge of and ever used family planning methods among women of reproductive age [country and year] (Q300, 301, 302). {N= total surveyed} Method Ever heard of method % (Q300) Instructed how to use method % (Q301) Ever used % (Q302) Any modern method† Any traditional method‡ Pill IUD Condom Implants Injectables Emergency contraception Tubal ligation Vasectomy Rhythm/calendar Withdrawal Other † Modern methods include: the Pill, IUD, condom, implants, injectables, emergency hormonal contraception, tubal ligation, and vasectomy. ‡ Traditional methods include: rhythm/calendar method, and withdrawal . Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Table FP-2: Demographic characteristics of women who have ever heard of methods among women of reproductive age [county and year] (Q300). {N= total surveyed} Characteristic Any modern method† % Only traditional method‡ % No method % Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) Q115 <1 year 1-5 years > 5 years Total lifetime pregnancies (n= ) Q209, Q211, Q213, Q216 0 1-2 3-4 >4 Sexually active in last 30 days (n= ) Q502 Yes No Causal partners in past year (n= ) Q504 0 partner 1-2 partners >2 partners † Modern methods include: the Pill, IUD, condom, implants, injectables, emergency hormonal contraception, tubal ligation, and vasectomy. ‡ Traditional methods include: rhythm/calendar method, and withdrawal . Reproductive Health Assessment Toolkit for Conflict-Affected Women Table FP-3: Knowledge of where to get methods among those who have ever heard of a method [county and year] (Q303). {N= Q300=1} �� Method Health center % Private clinic % Market % Friends/ relatives % Pharmacy % Don’t know % Pill IUD Condom Implants Injectables Emergency contraception Tubal ligation Vasectomy Rhythm/calendar NA NA NA NA NA NA Withdrawal NA NA NA NA NA NA Other Diagram 3: Main problems with family planning method This diagram is used to categorize main problems of using a family planning method: lack of access, opposition to method, and method-related use. Problems are asked of all women who have ever heard of a method. 1 = Lack of access includes cannot obtain method or cannot afford. 2 = Opposition to method includes husband/partner will not permit, religious reasons. 3 = Method-related use includes stops my period, increase/irregular period, or does not work. ����������������������������������� �������������������� ������������������ ��������������� ��������������������� ������������������� Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Table FP-4: Main reported problem of using a family planning method among women who ever heard of method [country and year] (Q304).* {N= Q300=1} Method Lack of access % Opposition to method % Method-related % Pill IUD Condom Implants Injectables Emergency contraception Tubal ligation Vasectomy Rhythm/calendar Withdrawal Other * Percentages may add up to greater than 100% as respondent may give more than 1 response. Reproductive Health Assessment Toolkit for Conflict-Affected Women Contraceptive use Table FP-5: Family planning method currently being used [county and year] (Q312).* {N= Q309=1} �� Method % women Any modern method† Any traditional method‡ Pill IUD Condom Implants Injectables Emergency contraception Tubal ligation Vasectomy Rhythm/calendar Withdrawal Other * Percentages may add up to greater than 100% as respondent may give more than 1 response. † Modern methods include: the Pill, IUD, condom, implants, injectables, emergency hormonal contraception, tubal ligation, and vasectomy. ‡ Traditional methods include: rhythm/calendar method, and withdrawal . Table FP-6: Where the method is obtained among current users of family planning [county and year] (Q313). {N= Q309=1} Method Health center % Hospital % Supermarket/ Market % Pharmacy % Pill IUD Condom Implants Injectables Emergency contraception Tubal ligation Vasectomy Rhythm/calendar NA NA NA NA Withdrawal NA NA NA NA Other Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Table FP-7: Demographic characteristics of women currently using a family planning method by type of method [county and year] (Q310). {N= Q309=1} Characteristic Any modern method† % Only traditional method‡ % No method % Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) Q115 <1 year 1-5 years > 5 years Total lifetime pregnancies (n= ) Q209, Q211, Q213, Q216 0 1-2 3-4 >4 Sexually active in last 30 days(n= ) Q502 Yes No Causal partners in past year (n= ) Q504 0 partner 1-2 partners >2 partners † Modern methods include: the Pill, IUD, condom, implants, injectables, emergency hormonal contraception, tubal ligation, and vasectomy. ‡ Traditional methods include: rhythm/calendar method, and withdrawal . Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Diagram 4: Barriers to family planning This diagram is used to categorize barriers to family planning: fertility-related reasons, opposition to use, lack of knowledge, method-related reasons, or lack or access. Barriers are asked of women who are cur­ rently not using a method, not pregnant and physically able to get pregnant. 1 = Fertility-related reasons include wants more children now, not having sex/infrequent sex, unable/difficulty get pregnant, postpartum, or breastfeeding. 2 = Opposition to use includes respondent opposed, husband opposed, others opposed, or religious prohibition. 3 = Lack of knowledge includes knows no method or knows no source. 4 = Method-related reasons include fears side effects or inconvenient to use. 5 = Lack of access includes lack of access/too far, method unavailable, or expensive. ���������������������������������� �������������������������������������� ����������� ����������������� �������� ���������� ������� ������� ���������� �������������� �������� �������������� � Table FP-8: Barriers to family planning among women who are currently not using a method, not pregnant and physically able to get pregnant [country and year] (Q310).* {N= Q309=2} Characteristic % women Wants more children now Not having sex/infrequent sex Unable/difficulty get pregnant Postpartum Breastfeeding Respondent opposed Husband opposed Others opposed Religious prohibition Knows no method Knows no source Fears side effects Inconvenient to use Too far/method not available Expensive Other * Percentages may add up to greater than 100% as respondent may give more than 1 response. Reproductive Health Assessment Toolkit for Conflict-Affected Women - �� Table FP-9: Demographic characteristics of women reporting barriers to family planning and are currently not using a method, not pregnant and physically able to get pregnant [county and year] (Q310). {N= Q309=2} Characteristic Fertility-related % Opposition to use % Lack of knowl edge % Method-related % Lack of access % Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) Q115 <1 year 1-5 years > 5 years Total lifetime pregnancies (n= ) Q209, Q211, Q213, Q216 0 1-2 3-4 >4 Sexually active in last 30 days(n= ) Q502 Yes No Causal partners in past year (n= ) Q504 0 partner 1-2 partners >2 partners Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Diagram 5: Total Current Unmet Need for Family Planning The definition of unmet need for family planning applies to women currently not using contraceptives, not pregnant, fertile (able to get pregnant) and sexually active. The figure below indicates how to calcu­ late the current unmet need of family planning. The groups in the light shaded boxes are included in the calculation, and the groups in the dark shaded boxes are excluded from the calculation. It is important to follow the sequence of inclusion for the calculation. ��������� ������������ ������������� �������������������������� ��������������������� �������������� ������������ ����������������� �������������� ������������������ ������� �������� �������� ����������� ������ �������������� ����� �������� ������������� ���������� ������������ ������������ ������ �������� ��������������������������������� Reproductive Health Assessment Toolkit for Conflict-Affected Women �0 Table FP-10: Demographic characteristics of women who have unmet need for family planning among women of reproductive age [country and year] {N= total surveyed} Characteristic % women reporting Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) Q115 <1 year 1-5 years > 5 years Total lifetime pregnancies (n= ) Q209, Q211, Q213, Q216 0 1-2 3-4 >4 Sexually active in last 30 days(n= ) Q502 Yes No Causal partners in past year (n= ) Q504 0 partner 1-2 partners >2 partners Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Intent to use a method in the next 12 months Table FP-11: Intend to use a method in the next 12 months among current non-users of family planning by demographic characteristics [country and year] (Q314). {N= Q309=2} Characteristic Intends to use a method % Does NOT intend to use a method % Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) Q115 <1 year 1-5 years > 5 years Total lifetime pregnancies (n= ) Q209, Q211, Q213, Q216 0 1-2 3-4 >4 Sexually active in last 30 days(n= ) Q502 Yes No Causal partners in past year (n= ) Q504 0 partner 1-2 partners >2 partners † Modern methods include: the Pill, IUD, condom, implants, injectables, emergency hormonal contraception, tubal ligation, and vasectomy. ‡ Traditional methods include: rhythm/calendar method, and withdrawal . Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Table FP-12: Preferred method for women who intend to Table FP-13: Barriers to family planning among women use a method in the next 12 months among current non- who do not intend to use a method in the next 12 users of family planning [country and year] (Q316).* months among current non-users of family planning {N= Q314=1} [country and year] (Q315).* {N= Q314=2} Characteristic % women Pill IUD Condom Implants Injectables Emergency contraception Tubal ligation Vasectomy Rhythm/calendar Withdrawal Other * Percentages may add up to greater than 100% as respondent may give more than 1 response. * Percentages may add up to greater than 100% as respondent may give more than 1 response. Characteristic % women Wants more children now Not having sex/infrequent sex Unable/difficulty get pregnant Postpartum Breastfeeding Respondent opposed Husband opposed Others opposed Religious prohibition Knows no method Knows no source Fears side effects Inconvenient to use Too far/method not available Expensive Other Reproductive Health Assessment Toolkit for Conflict-Affected Women - Table FP-14: Demographic characteristics of women who do not plan to use a method in the next 12 months by type of family planning barrier [country and year] (Q315).* {N= Q314=2} �� Characteristic Fertility-related reasons % Opposition to use % Lack of knowl edge % Method-related reasons % Lack of access % Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) <1 year 1-5 years > 5 years Total lifetime pregnancies (n= ) Q209, Q211, Q213, Q216 0 1-2 3-4 >4 Sexually active in last 30 days(n= ) Q502 Yes No Causal partners in past year (n= ) Q504 0 partner 1-2 partners >2 partners * Percentages may add up to greater than 100% as respondent may give more than 1 response. Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Sexual H�story/Sexually Transm�tted Infect�ons (STIs) This section assesses knowledge of STIs, prevalence of self-reported STI-associated symptoms, help-seek­ ing behaviors, and barriers to treatment. The data from this section will help determine the need to prevent STIs and provide access to treatment. Sex with a casual partner Table STI-1: Demographic characteristics of women who had sex with one or more casual partners in the last 12 months [country and year] (Q504). {N= Q504>1} Characteristic % women Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Age at sexual debut (n= ) Q501 < 15 years 15-19 years 20-24 years >24 years Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) Q115 <1 year 1-5 years > 5 years Table STI-2: Condom use at last sex with casual partner in the last 12 months [country and year]. {N= Q504 >1} Characteristic % women Used a condom at last sex with casual partner (Q505) Yes No Suggested use of condom at last sex with casual partner (Q507) {N= Q505=1} Partner Myself Joint decision Table STI-3: Reason for not using a condom at last sex with casual partner in the last 12 months [country and year] (Q506).* {N= (Q504>1 AND Q505=2)} Characteristic % women Not available Too expensive Partner objected Do not like them Used other contraceptive Didn’t think it was necessary Didn’t think of it Other * Percentages may add up to greater than 100% as respondent may give more than 1 response. Knowledge of STI-associated symptoms in women Table STI-4: Knowledge of STI-associated symptoms among women of reproductive age [country and year] (Q602).* {N= total surveyed} Characteristic % women Abdominal pain Green or curd-like vaginal discharge Foul-smelling discharge Burning during urination Redness/inflammation of genital area Genital ulcers/sores Genital itching Blood in urine Loss of weight Yellow eyes/yellow skin Hard to get pregnant or have a child Other Don’t know * Percentages may add up to greater than 100% as respondent may give more than 1 response. Reproductive Health Assessment Toolkit for Conflict-Affected Women Table STI-5: Knowledge of systemic, vaginal, urinary, and fertility symptoms of STIs among women of reproductive age by demographic characteristics [county and year] (Q602).* {N= total surveyed} �� Characteristic Systemic† % Vaginal‡ % Urinary§ % Fertility Effects# % Don’t Know % Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Age at sexual debut (n= ) Q501 < 15 years 15-19 years 20-24 years >24 years Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Sexually active in last 30 days(n= ) Q502 Yes No Casual partners in past year (n= ) Q504 0 partners 1-2 partners > 2 partners * Percentages may add up to greater than 100% as respondent may give more than 1 response. † Systemic symptoms are abdominal pain, loss of weight, or yellow eyes and/or skin. ‡ Vaginal symptoms are green or curd-like discharge, foul smelling discharge, redness/inflammation of the genitals, genital ulcers/sores, or genital itching. § Urinary symptoms are burning pain during urination or blood in the urine. # Fertility effects are hard to get pregnant or have a child. Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Selected STI-associated symptoms in the last 12 months Table STI-6: Demographic characteristics of women who reported selected STI-associated symptoms in the last 12 months among women of reproductive age [country and year] (Q603, Q604). {N= total surveyed} Characteristic Genital discharge only % (Q603=1 AND Q604 1) Genital ulcers/ sores only % (Q603 1 AND Q604=1) Discharge and ulcers % (Q603 =1 AND 604 =1) Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Age at sexual debut (n= ) Q501 < 15 years 15-19 years 20-24 years >24 years Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Living with husband/partner in past 12 months (n= ) Q407 Yes No Casual partners in past year (n= ) Q504 0 partners 1-2 partners > 2 partners Used a condom at last sex with casual partner (n= ) Q505 Yes No Intimate partner violence in past 12 months (n= ) Q816A-D Controlling behavior (A) Physical violence (B,C) Sexual violence (D) Reproductive Health Assessment Toolkit for Conflict-Affected Women Table STI-7: Selected STI-associated symptoms in the last 12 months by age among women of reproductive age [country and year] (Q603). {N= total surveyed} �� Characteristic Genital discharge or genital ulcers or sores % (Q603=1 OR Q604=1) No discharge or ulcers/sores % (Q603=2 AND Q604=2) 15-24 (Q105) >25 (Q105) Help-seeking behavior for STI-associated symptoms Table STI-8: Source of treatment by type of selected STI-associated symptoms in the last 12 months [country and year] (Q606). {N=(Q603=1 or Q604=1) and Q605=2} Characteristic Genital discharge only % (Q603=1 AND Q604 1) Genital ulcers/ sores only % (Q603 1 AND Q604=1) Discharge and ulcers % (Q603 =1 AND Q604 =1) Health center in camp/community Health center outside of camp/comunity Hospital Local healer Pharmacy Supermarket/market Other Diagram 6: Barriers to seeking help for selected STI-associated symptoms This diagram is used to categorize barriers to seeking treatment for STI-associated symptoms: lack of ac­ cess, opposition to care, or perception of care. Barriers are asked of women who did not seek treatment the last time they had any unusual genital discharge, genital ulcers, or sores. 1 = Lack of access includes no healthcare provider available, could not afford, distance too far, lack of transportation, or poor road conditions. 2 = Opposition to care includes husband/partner would not permit. 3 = Perception to care includes afraid of doctor, nurse, etc.; have never used doctor, nurse before; not treated well previously, or embarrassed or ashamed. ��������������������������������� ����������������������� ����������������������������������������� ���������������������������������� �������� �������� ��� ����������� ��������������� ������������������� ������������������� Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Table STI-9: Barriers to seeking treatment for STI-associated symptoms [country and year] (Q607).* {N= Q605=2} Characteristic % women No healthcare provider available Could not afford Distance too far Lack of transportation Poor road conditions Husband/partner would not permit Afraid of doctor, nurse, etc. Have never used doctor, nurse before Not treated well previously Embarrassed or ashamed Other * Percentages may add up to greater than 100% as respondent may give more than 1 response. Table STI-10: Demographic characteristics of women who did not seek treatment for STI-associated symptoms by type of barrier [country and year] (Q607)*. {N= (Q603=1 OR Q604=1) AND Q605=2} Characteristic Any barrier % Lack of access % Opposition to care % Perception to care % Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Age at sexual debut (n= ) Q501 < 15 years 15-19 years 20-24 years >24 years Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all * Percentages may add up to greater than 100% as respondent may give more than 1 response. Reproductive Health Assessment Toolkit for Conflict-Affected Women �� HIV/AIDS This section provides information on knowledge of HIV/AIDS, social views of HIV/AIDS, HIV testing, and future intent to get tested. The data from this section will help determine the need for HIV/AIDS prevention services and will assess demand for testing. Comprehensive correct knowledge of HIV/AIDS Table HIV-1: Correct knowledge of HIV/AIDS among women of reproductive age [country and year]. {N= total surveyed} Knowledge % women Using condoms to prevent HIV/AIDS (Q703) Having one uninfected, faithful partner to prevent HIV/AIDS (Q702) Can not get HIV/AIDS from mosquitoes (Q705) Can not get HIV/AIDS from sharing food with infected person (Q709) A healthy-looking person can have HIV/AIDS (Q710) Table HIV-2: Comprehensive correct knowledge of HIV/AIDS among women of reproductive age by demographic characteristics [country and year]. {N= total surveyed} Characteristic Does have comprehensive correct knowledge % (Q703=1 AND Q702=1 AND Q705=2 AND Q709=2 AND Q710=1) Does NOT have comprehensive correct knowledge % Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Sexually active in last 30 days(n= ) Q502 Yes No Casual partners in past year (n= ) Q504 0 partners 1-2 partners > 2 partners Reproductive Health Assessment Toolkit for Conflict-Affected Women �0 Table HIV-3: Demographic characteristics of women who have knowledge of ABC’s to avoid HIV/AIDS among women of reproductive age [country and year]. {N= total surveyed} Characteristic Abstinence % (Q704=1) Limit number of sexual partners % (Q702=1) Use condoms % (Q703=1) Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Sexually active in last 30 days (n= ) Q502 Yes No Casual partners in past year (n= ) Q504 0 partners 1-2 partners > 2 partners Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Comprehensive correct knowledge of mother-to-child transmission of HIV/AIDS Table HIV-4: Correct knowledge of how HIV/AIDS can be transmitted from mother-to-child among women of reproductive age [country and year]. {N= total surveyed} Knowledge % women Can transmit HIV/AIDS during pregnancy and delivery (Q711=1) Can transmit HIV/AIDS through breastfeeding (Q712=1) Table HIV-5: Comprehensive correct knowledge of how HIV/AIDS can be transmitted from mother-to-child among women of reproductive age by demographic characteristics [country and year]. {N= total surveyed} Characteristic Does have comprehensive correct knowledge % (Q711=1 AND Q712=1) Does NOT have comprehensive correct knowledge % Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Ever pregnant (n= ) Q202 Yes No Currently pregnant (n= ) Q203 Yes No Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Accepting attitudes toward people living with HIV/AIDS (PLWH/A) Table HIV 6: Accepting attitudes toward PLWH/A among women who have ever heard of HIV/AIDS [country and year]. {N= Q701=1} Attitude % women Does not believe HIV positive status of family member should be kept secret (Q713=2) Willing to care for relative with AIDS at home (Q714=1) Believes HIV positive teacher should be allowed to keep teaching (Q715=1) Willing to buy fresh vegetables from shopkeeper infected with HIV/AIDS (Q716=1) Table HIV-7: Accepting attitudes towards PLWH/A among women who have ever heard of HIV/AIDS by demographic characteristics [country and year]. {N= Q701=1} Characteristic Does have accepting attitudes % (Q713=2 AND Q714=1 AND Q715=1 AND Q716=1) Does NOT have accepting attitudes % Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) Q115 <1 year 1-5 years > 5 years Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Perceived risk of getting HIV/AIDS Table HIV-8: Perceived risk of getting HIV/AIDS among moderate and high risk women [country and year] (Q719). {N= Q718=(1 or 2)} Characteristic >1 partner % Husband/partner >1 partner % Partner works far away % Intravenous drug user % Family/friends HIV+ % Other % Total (N=) Moderate Risk High Risk Table HIV-9: Women who ever had an HIV test [county Table HIV-10: Demographic characteristics of women and year]. {N= Q725=1} who ever had an HIV test among those who ever heard of HIV [county and year] (Q725). {N= Q701=1}Characteristic % women Timing (n= ) Q726 Less than 1 year 1-2 years 3 or more years Testing voluntary (n= ) Q727 Received counseling (n= ) Q728 Source of testing (n= ) Q729 Public Hospital Government health facility Clinic/family planning Mobile clinic (government, public) Private Private hospital Pharmacy Private medical doctor Mobile clinic (private) Traditional healer Other Characteristic Ever had an HIV test % NEVER had an HIV test % Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) Q115 <1 year 1-5 years > 5 years Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Table HIV-11: Demographic characteristics of women who did not receive the results of an HIV test by when they last took an HIV/AIDS test [country and year]. {N= Q730=2} Characteristic <1 year % (Q726=1) 1-2 years % (Q726=2) 3 or more % (Q726=3) Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) <1 year 1-5 years > 5 years Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Intent to be tested in the future Table HIV-12: Intent to be tested among women who have ever heard of HIV by demographic characteristics [county and year] (Q731). {N= Q701=1} Characteristic Would go for HIV test in future % (Q731=1) Would not go for a HIV test in future % (Q731=2) Don’t know % (Q731=3) Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) <1 year 1-5 years > 5 years Know a source for testing (n= ) Q723 Yes No Table HIV-13: Knowledge of where to get an HIV test Table HIV-14: Primary reason for not wanting to get an among those who ever heard of HIV [country and year] HIV test in the future among women who ever heard of (Q724). {N= Q723=1} HIV [country and year] (Q732). {N= Q701} Characteristic % women In refugee camp In local community In both refugee camp and local community Other Don’t know Characteristic % women Sure of being infected Afraid of the result Afraid of the blood taking Afraid of catching infection Fear of stigmatization Too expensive Other Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Table HIV-15: Demographic characteristics of women who received information about HIV/AIDS in the last 12 months and preferred type of source among women who ever heard of HIV/AIDS [county and year] (Q721, 722).* {N= Q701=1} Received (Q721) Preferred (Q722) Characteristic Mass media % Health services % People % Other places % Mass media % Health services % People % Other places % Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) Q115 <1 year 1-5 years > 5 years Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Gender-Based V�olence This section provides information on prevalence of physical and sexual violence during and post- conflict, intimate partner violence, GBV-related injuries, and help-seeking behaviors. The data from this section will help to assess the magnitude of the problem. Outsider Violence Table GBV-1: Demographic characteristics of women experiencing outsider physical and sexual violence during and post-conflict among women of reproductive age [country and year] (Q801, 805). {N = total surveyed} During conflict physical Post-conflict physical During conflict sexual Post-conflict sexual Characteristic violence % violence % violence % violence % (Q801 A-D any = 1) (Q805 A-D any = 1) (Q801 E-H any=1) (Q805 E-H any =1) Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Table GBV-2: Type of outsider physical violence during and post-conflict [country and year]* {Q801 A-D any=1; Q805 A-D any=1}. Type of violence During conflict % women Post-conflict % women Physically hurt, such as slapped, hit, choked, beaten, or kicked Threatened with a weapon of any kind Shot or stabbed Detained against will * Percentages may add up to greater than 100% as respondent may give more than 1 response Reproductive Health Assessment Toolkit for Conflict-Affected Women �� Table GBV-3: Type of outsider sexual violence during and post-conflict [country and year]* {N=Q801 E-H any=1, Q805 E-H any=1}. Type of violence During conflict % women Post-conflict % women Subjected to improper sexual comments Forced to remove or stripped of clothing Subjected to unwanted kissing or touching on sexual parts of body Forced or threatened with harm to make give or receive oral sex or have vaginal or anal sex * Percentages may add up to greater than 100% as respondent may give more than 1 response Perpetrators, frequency, and location of outsider violence incidents during and after conflict Table GBV-4: Perpetrators of outsider physical violence during and post-conflict [country and year]* {N=Q803 A-D, Q807 A-D}. Perpetrator During conflict % women (Q801A-D any =1) Post-conflict % women (Q805A-D any=1) Military Paramilitary Police Jail or prison guard Doctor/medical person Religious worker Humanitarian relief worker Neighbor/community member Fellow refugee/IDP Other * Percentages may add up to greater than 100% as respondent may give more than 1 response. Reproductive Health Assessment Toolkit for Conflict-Affected Women Table GBV-5: Perpetrators of outsider sexual violence during and post-conflict [country and year]* {N=Q803E-H; Q807E-H}. �� Perpetrator During conflict % women (Q801E-H any =1) Post-conflict % women (Q805E-H any=1) Military Paramilitary Police Jail or prison guard Doctor/medical person Religious worker Humanitarian relief worker Neighbor/community member Fellow refugee/IDP Other * Percentages may add up to greater than 100% as respondent may give more than 1 response. Table GBV-6: Frequency of outsider physical violence by type of violence, during the conflict [country and year] (Q802 A-D). {N= Q801A-D=1} Type of violence Once or twice % Several times % Many times % Physically hurt, such as slapped, hit, choked, beaten, or kicked Threatened with a weapon of any kind Shot or stabbed Detained against will Table GBV-7: Frequency of outsider physical violence by type of violence, post-conflict [country and year] (Q806 A-D). {N = Q805A-D=1} Type of violence Once or twice % Several times % Many times % Physically hurt, such as slapped, hit, choked, beaten, or kicked Threatened with a weapon of any kind Shot or stabbed Detained against will Reproductive Health Assessment Toolkit for Conflict-Affected Women �00 Table GBV-8: Frequency of outsider sexual violence by type of violence, during the conflict [country and year] (Q802 E-H). {N =Q801E-H=1} Type of violence Once or twice % Several times % Many times % Subjected to improper sexual comments Forced to remove or stripped of clothing Subjected to unwanted kissing or touching on sexual parts of body Forced or threatened with harm to make give or receive oral sex or have vaginal or anal sex Table GBV-9: Frequency of outsider sexual violence by type of violence, post-conflict [country and year] (Q806 E-H). {N =Q805E-H=1} Type of violence Once or twice % Several times % Many times % Subjected to improper sexual comments Forced to remove or stripped of clothing Subjected to unwanted kissing or touching on sexual parts of body Forced or threatened with harm to make give or receive oral sex or have vaginal or anal sex Table GBV-10: Location of outsider physical violence during and post-conflict [country and year]* {N=Q804 A-D; Q808 A-D}. Characteristic During conflict % women (Q801A-D any =1) Post-conflict % women (Q805A-D any=1) Current location Any previous camp Home village/town Traveling by road/boat * Percentages may add up to greater than 100% as respondent may give more than 1 response. Table GBV-11: Location of outsider sexual violence during and post-conflict [country and year]* {N=Q804 E-H; Q808 E-H}. Characteristic During conflict % women (Q801E-H any =1) Post-conflict % women (Q805 E-H any=1) Current location Any previous camp Home village/town Traveling by road/boat * Percentages may add up to greater than 100% as respondent may give more than 1 response. Reproductive Health Assessment Toolkit for Conflict-Affected Women �0� Injuries and help-seeking behavior related to the conflict violence Table GBV-12: Self-reported injuries and help-seeking behavior among women who had experienced outsider violence during or post-conflict [country and year]. {N=Q801A-I any = 1 OR Q805A-1 any=1} Characteristic % women Total injury (N= ) Q809 Type of injury reported* (n= ) Q810 Cuts, punctures, bites Scratch, abrasion, bruises Sprains, dislocations Burns Penetrating injury, deep cuts, gashes Broken eardrum, eye injuries Fractures, broken bones Broken teeth Other Sought medical treatment for injuries (n= ) Q811 * Percentages may add up to greater than 100% as respondent may give more than 1 response. Table GBV-13: Reporting behavior of women experiencing outsider violence during and post-conflict [country and year] (Q812=C, D or E). {N= Q801A-I ANY=1 OR Q805A-I ANY =1} Characteristic % women Total violence (N= ) Q812A-F Person reported to* (n= ) Q812A-F Family member Friend Doctor/other provider Police/military NGO worker Other Reporting to someone in authority (Q812C-E) * Percentages may add up to greater than 100% as respondent may give more than 1 response. Reproductive Health Assessment Toolkit for Conflict-Affected Women �0� Table GBV-14: Reporting violence to authority among women experiencing outsider violence during or post-conflict by demographic characteristics [country and year]. {N= Q801A-I any = 1 OR Q805A-1 any=1} Characteristic Reported outsider violence to authority % (Q812=C-E any=1) Did NOT report outsider violence to authority % (Q812C-E all 1) Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) <1 year 1-5 years > 5 years Table GBV-15: Reporting behavior for women experiencing outsider violence during and post-conflict by injury status [country and year]. {N= Q801A-I ANY=1 OR Q805A-I any =1} Characteristic Reported outsider violence to authority % (Q812=C-E any=1) Did NOT report outsider violence to authority % (Q812C-E all 1) Injured (Q809=1) Not injured (Q809 = 2) Reproductive Health Assessment Toolkit for Conflict-Affected Women Table GBV-16: Main reasons given for not reporting incidence(s) of outsider violence [country and year] (Q813).* {N= Q812A-F ALL 1} �0� Characteristic % women Did not know where to go No use/ would not do any good Embarrassed Afraid of more violence Afraid of causing problems in relationship Would not be believed/taken seriously Violence normal/no need to complain Thought she would be blamed Bring bad name to family Other * Percentages may add up to greater than 100% as respondent may give more than 1 response. Table GBV-17: Strategies that would be helpful in coping with outsider violence experiences [country and year] (Q814).* {N= Q801A-I ANY=1 OR Q805A-I any =1} Characteristic % women Support group for women Talking it over with friends Talking it over with family Assistance from NGO workers Legal advice/traditional justice Religious counseling Mental health counseling Medical assistance Trying to forget about it Other * Percentages may add up to greater than 100% as respondent may give more than 1 response. Reproductive Health Assessment Toolkit for Conflict-Affected Women �0� Intimate Partner Violence (IPV) and Family Violence Prevalence and frequency of IPV Table GBV-18: Types of violence toward women who have ever experienced intimate partner violence (IPV) among ever partnered women [country and year] (Q815).* {N= Q401=1} Type of violence % women Forbid from participating in community activities Threatened with a weapon or himself Slapped, twisted arm, hit with fist, pushed, kicked, choked Threatened or forced to have sex Other * Percentages may add up to greater than 100% as respondent may give more than 1 response. Table GBV-19: Frequency of occurrence of intimate partner violence in past 12 months by type among currently partnered women [country and year] (Q816). {N= Q407 = 1 or 2 or 3) Type of violence Never % Once or twice % Several times % Most of the time % Forbid from participating in community activities Threatened with a weapon or himself Slapped, twisted arm, hit with fist, pushed, kicked, choked Threatened or forced to have sex Other Reproductive Health Assessment Toolkit for Conflict-Affected Women Table GBV-20: Experiences of IPV in the last year among currently partnered women by demographic characteristics [country and year]. {N= Q407 = 1 or 2 or 3} �0� Characteristic IPV in last year % (Q816 A-D any 1) No IPV in last year % (Q816 A-D all = 1) Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Currently pregnant (n= ) Q203 Yes No Type of work of partner (n=) Q405 Professional Semi-skilled Unskilled/manual Military/police Unemployed Other Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) Q115 <1 year 1-5 years > 5 years Reproductive Health Assessment Toolkit for Conflict-Affected Women - = - �0� Injuries and help-seeking behavior related to IPV Table GBV-21: Self-reported injuries and help- seeking behavior of ever-partnered women who ever experienced IPV [country and year]. {N= Q815A-D any=1} Characteristic % women Total injury (N= ) Q819 Types of injuries (n= ) (Q820)* Cuts, punctures, bites Scratch, abrasion, bruises Sprains, dislocations Burns Penetrating injury, deep cuts, gashes Broken eardrum, eye injuries Fractures, broken bones Broken teeth Other Sought medical treatment for injuries (n=) Q821 * Percentages may add up to greater than 100% as respondent may give more than 1 response. Table GBV-22: Reporting behavior of ever-partnered women who ever experienced IPV [country and year] (Q820A-F). {N= Q815A-D any=1} Characteristic % women Told anyone about the violence (Q820A-F) Total (n= ) Person reported to* (n= ) Q820A-F Family member Friend Doctor/other provider Police/military NGO worker Other Reporting to someone in authority (Q820C-E) Table GBV-23: Demographic characteristics of ever­ partnered women experiencing IPV by whether they report IPV to an authority [country and year]. {N Q815A-D any=1} Characteristic Reported IPV to an authority % (Q820C E any 1) Did NOT report IPV to an authority % (Q820C E all 1) Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) Q115 <1 year 1-5 years > 5 years * Percentages may add up to greater than 100% as respondent may give more than 1 response. Reproductive Health Assessment Toolkit for Conflict-Affected Women �0� Table GBV-24: Reporting behavior by injury status Table GBV-26: Strategies that would be helpful in among ever-partnered women who experienced IPV coping with IPV among ever-partnered women [country and year]. {N Q815A-D any=1} [country and year] (Q822).* {N = Q815A-D any=1} Reported IPV to an Did not report IPV to Characteristic authority % authority % (Q820C-E any =1) (Q820C-E all 1) Injured Q817 Not injured Q817 Table GBV-25: Main reasons given for not reporting incidence(s) of IPV among ever-partnered women [country and year] (Q821).* {N= Q820A-F ALL 1} Characteristic % women Did not know where to go No use/ would not do any good Embarrassed Afraid of more violence Afraid of causing problems in relationship Would not be believed/taken seriously Violence normal/no need to complain Thought she would be blamed Bring bad name to family Other * Percentages may add up to greater than 100% as respondent may give more than 1 response. Characteristic % women Support group for women Talking it over with friends Talking it over with family Assistance from NGO workers Legal advice/traditional justice Religious counseling Mental health counseling Medical assistance Trying to forget about it Other * Percentages may add up to greater than 100% as respondent may give more than 1 response. Table GBV-27: IPV in the past year by current decision making control [country and year]. {N = Total surveyed} Characteristic IPV in past year % No IPV in past year % (Q816 A-D any= 1) (Q816 A-E all 1) Makes family decisions solely or jointly (Q103 A, D and E = 1 or 3 or 5) Does not make fam­ ily decisions solely or jointly (Q103 A, D and E = 2 or 4) Prevalence of family violence Table GBV-28: Perpetrators of family violence in the past year (Q824).* {N = Q823=1} Characteristic % women Mother Father Mother-in-law Father-in-law Other female relative Other male relative Other * Percentages may add up to greater than 100% as respondent may give more than 1 response. Reproductive Health Assessment Toolkit for Conflict-Affected Women �0� Table GBV-29: Experiences of physical violence by other family members in the past year by demographic characteristics [country and year] (Q823). {N = total surveyed} Characteristic Physical violence by family members % (Q823 = 1) No physical violence by family members % (Q823 1) Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Relationship status (n= ) Q406 Married, living together Married, not living together Not married, living with partner Not married, not living with partner Able to read (n= ) Q111 Read easily Read with difficulty or not at all Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) <1 year 1-5 years > 5 years Currently pregnant (n= ) Q203 Yes No Reproductive Health Assessment Toolkit for Conflict-Affected Women Table GBV-30: Thoughts of ending life in past 4 weeks among women who ever experienced IPV [country and year]. {N = total surveyed} �0� Characteristic IPV % (n) (Q815 any =1) No IPV % (n) (Q815 any 1) Thoughts of ending life in past 4 weeks (n=) Q1001q No thoughts of ending life in past 4 weeks (n=) Q1001q Table GBV-31: Ever attempted to take life among women who ever experienced GBV [country and year]. {N = total surveyed} Characteristic GBV % (Q801 any =1 OR Q805 any =1 OR Q815 any =1 OR Q823=1) No GBV % (Q801 any AND Q815 any 1 AND Q805 any 1 1 AND Q823 1) Ever attempted to take life (n=) Q1003 Never attempted to take life (n=) Q1003 Reproductive Health Assessment Toolkit for Conflict-Affected Women ��0 Female Gen�tal Cutt�ng This section provides information on prevalence of female genital cutting (FGC) in your current location and perceptions and attitudes regarding FGC. Prevalence of FGC Table FGC-1: Demographic characteristics of Table FGC-2: Details of genital cutting of the respondents who ever had their genitals cut [country respondent [year and country]. {N= Q902=1} and year] (Q902). {N= Q902=1} Characteristic % women Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Ethnic Group (n= ) Q107 Group A Group B Group C Group D Group E Religion (n= ) Q106 Religion A Religion B Religion C Religion D Religion E Characteristic % women Total (N= ) Age when genitals cut (n= ) Q904 <1 1-4 5-10 >10 Mean age when genitals cut (n= ) Q904 Had genital area sewn closed (n= ) Q903 Yes No Reproductive Health Assessment Toolkit for Conflict-Affected Women ��� Prevalence of FGC among youngest daughter Table FGC-4: Details of genital cutting of the youngest daughter that occurred in the current setting Table FGC-3: Demographic characteristics of the [county and year]. {N= 907=1 AND Q912=1} mother whose youngest daughter had her genitals cut in the current setting [country and year]. {N= 907=1 AND Q912=1} Characteristic % women Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Ethnic Group (n= ) Q107 Group A Group B Group C Group D Group E Religion (n= ) Q106 Religion A Religion B Religion C Religion D Religion E Highest grade completed (n= ) Q110 1-4 5-8 9-12 Technical/vocational University Able to read (n= ) Q111 Read easily Read with difficulty or not at all Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) Q115 <1 year 1-5 years > 5 years Characteristic % daughter Total (N= ) Age when genitals cut (n= ) Q910 <1 1-5 5-10 >10 Mean age when genitals cut (n= ) Q910 Had genital area sewn closed (n= ) Q909 Yes No Person who performed FGC (n= ) Q911 Traditional circumciser Traditional birth attendant Doctor Trained nurse/midwife Other Reproductive Health Assessment Toolkit for Conflict-Affected Women ��� Future intent of FGC and attitudes towards FGC Table FGC-5: Demographic characteristics of mothers whose youngest daughter’s genitals are not cut, by intention to cut in the future [country and year] (Q908). {N= Q907=2} Characteristic Intend to cut % (Q908=1) Do not intend to cut % (Q908=2) Don’t know % (Q908=3) Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Ethnic Group (n= ) Q107 Group A Group B Group C Group D Group E Religion (n= ) Q106 Religion A Religion B Religion C Religion D Religion E Highest grade completed (n= ) Q110 1-4 5-8 9-12 Technical/vocational University Able to read (n= ) Q111 Read easily Read with difficulty or not at all Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) Q115 <1 year 1-5 years > 5 years Reproductive Health Assessment Toolkit for Conflict-Affected Women ��� Table FGC-6: Perceived benefits of having genitals cut Table FGC-8: Attitudes and beliefs about FGC among among women who ever heard of FGC [country and women who have ever heard of FGC [country and year] (Q913).* {N= Q901 = 1} year]. {N= Q901 = 1} Characteristic % of women No benefits Cleanliness/hygiene Social acceptance Better marriage prospects Preserve virginity/prevent premarital sex More sexual pleasure for the man Religious approval Other Attitudes and beliefs % of women Prevents a girls from having sex before marriage (Q915=1) FGC is required by religion (Q916=1) Practice should be continued (Q917=1) Men want practice of FGC to continue (Q918=1) * Percentages may add up to greater than 100% as respondent may give more than 1 response. Table FGC-7: Perceived benefits of NOT having genitals cut among women who ever heard of FGC [country and year] (Q914).* {N= 901=1} Characteristic % of women No benefits Fewer medical problems Avoiding pain More sexual pleasure for woman More sexual pleasure for man Follows religion Other * Percentages may add up to greater than 100% as respondent may give more than 1 response. Reproductive Health Assessment Toolkit for Conflict-Affected Women ��� Table FGC-9: Demographic characteristics by respondent’s attitudes regarding whether FGC should be continued or discontinued among women who have ever heard of FGC [country and year] (Q917). {N= 901=1} Characteristics Should be continued % (Q917=1) Should be discontinued % (Q917=2) Don’t know % (Q917=3) Total (N= ) Age (n= ) Q105 15-24 25-34 35-49 Ethnic Group (n= ) Q107 Group A Group B Group C Group D Group E Religion (n= ) Q106 Religion A Religion B Religion C Religion D Religion E Highest grade completed (n= ) Q110 1-4 5-8 9-12 Technical/vocational University Able to read (n= ) Q111 Read easily Read with difficulty or not at all Displaced status (n= ) Q113 Not displaced Displaced Length of displacement (n= ) <1 year 1-5 years > 5 years Reproductive Health Assessment Toolkit for Conflict-Affected Women ��� EMOTIONAL HEALTH This section provides information on emotional distress issues and general health status. This section will assess the need for mental and other health-related services. Table EH-1: Emotional distress among all women [country and year] (Q1001).* {N= total surveyed) Problems % of women Headaches Appetite poor Sleep badly Easily frightened Hands shake Nervous, tense, or worried Digestion poor Trouble thinking clearly Unhappy Cry more than usual Difficult to enjoy daily activities Difficult to make decisions Daily work suffering Unable to play a useful part in life Lost interest in things Feel that you are a worthless person Thoughts of ending life Tired all the time Uncomfortable feelings in your stomach Easily tired * Percentages may add up to greater than 100% as responde

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