DHS OCCASIONAL PAPER NO. 11

SEPTEMBER 2018

This publication was produced for review by the United States Agency for International Development (USAID).

The report was prepared by Sarah Staveteig and Christina Juan.

Potential Implications of the Ghana and 

Nepal Follow-Up Studies for DHS

Questionnaires and Fieldwork Procedures

DHS Occasional Paper No. 11 

Potential Implications of the Ghana and Nepal Follow-Up 

Studies for DHS Questionnaires and Fieldwork Procedures 

Sarah Staveteig1,2 

Christina Juan2,3 

ICF 

Rockville, Maryland, USA 

September 2018 

1

 Avenir Health 

2

 The DHS Program 

3

 ICF 

Corresponding author: Sarah Staveteig, The DHS Program, 530 Gaither Road, Suite 500, Rockville, MD 

20850, USA; phone: +1 301-572-0577; fax: +1 301-572-0999; email: Sarah.Staveteig@icf.com 
Cover photos from DHS fieldwork in Bangladesh, Namibia, and Liberia © 2011-2013 The DHS Program. 

Editor: Cathy Johnson 

Document Production: Natalie Shattuck and Joan Wardell 

Cover Design: Chris Gramer 

This study was carried out with support provided by the United States Agency for International 

Development (USAID) through The DHS Program (#AID-OAA-C-13-00095). The views expressed are 

those of the authors and do not necessarily reflect the views of USAID or the United States Government. 

The DHS Program assists countries worldwide in the collection and use of data to monitor and evaluate 

population, health, and nutrition programs. Additional information about The DHS Program can be obtained 

from ICF, 530 Gaither Road, Suite 500, Rockville, MD 20850 USA; telephone: +1 301-572-0200, fax: 

+1 301-572-0999, email: info@DHSprogram.com, internet: www.DHSprogram.com. 

Recommended citation: 

Staveteig, Sarah, and Christina Juan. 2018. Potential Implications of the Ghana and Nepal Follow-Up 

Studies for DHS Questionnaires and Fieldwork Procedures. DHS Occasional Paper No. 11. Rockville, 

Maryland, USA: ICF. 
iii 

CONTENTS 

TABLES ........................................................................................................................................................ V 

FIGURES .................................................................................................................................................... VII 

ACKNOWLEDGMENTS .............................................................................................................................. IX 

ABSTRACT.................................................................................................................................................. XI 

1 INTRODUCTION .............................................................................................................................. 1 

1.1 Objectives ........................................................................................................................... 1 

1.2 Background ......................................................................................................................... 1 

1.2.1 Design of follow-up studies in Ghana and Nepal ................................................... 1 

1.2.2 Key findings from the Ghana follow-up study ........................................................ 3 

1.2.3 Key findings from the Nepal follow-up study .......................................................... 3 

1.3 Project Procedure ............................................................................................................... 4 

1.4 Notes and Report Structure ................................................................................................ 5 

2 POSSIBLE ADDITIONS TO THE DHS CORE WOMAN’S QUESTIONNAIRE .............................. 7 

2.1 Questions to Improve the Accuracy of Family Planning Method Reporting ....................... 7 

2.1.1 Motivation ............................................................................................................... 7 

2.1.2 Initial proposals ...................................................................................................... 7 

2.1.3 Advantages and disadvantages ........................................................................... 10 

2.1.4 Panel discussion and revised strategy ................................................................ 11 

2.1.5 Next steps ............................................................................................................ 16 

2.2 Questions about Family Planning Counseling around the Time 

of the Most Recent Birth ................................................................................................... 16 

2.2.1 Motivation ............................................................................................................. 16 

2.2.2 Proposal ............................................................................................................... 17 

2.2.3 Advantages and disadvantages ........................................................................... 19 

2.2.4 Panel discussion .................................................................................................. 20 

2.2.5 Next steps ............................................................................................................ 20 

2.3 Questions to Gauge Proximal Fertility Intention Concordance with Partner ..................... 21 

2.3.1 Motivation ............................................................................................................. 21 

2.3.2 Proposal ............................................................................................................... 22 

2.3.3 Advantages and disadvantages ........................................................................... 23 

2.3.4 Panel discussion .................................................................................................. 24 

2.3.5 Next steps ............................................................................................................ 24 

2.4 Flags to Indicate Field Estimation of Ages and Dates ...................................................... 24 

2.4.1 Motivation ............................................................................................................. 24 

2.4.2 Proposal ............................................................................................................... 25 

2.4.3 Advantages and disadvantages ........................................................................... 26 

2.4.4 Panel discussion .................................................................................................. 26 

2.4.5 Next steps ............................................................................................................ 27 

3 POSSIBLE SUPPLEMENTAL QUESTIONS ................................................................................ 29 

3.1 Follow-up Questions on Fear of Side Effects/Health Concerns ....................................... 29 

3.1.1 Motivation ............................................................................................................. 29 

3.1.2 Proposals ............................................................................................................. 29 

3.1.3 Advantages and disadvantages ........................................................................... 30 
iv 

3.1.4 Panel discussion .................................................................................................. 30 

3.1.5 Next steps ............................................................................................................ 30 

3.2 Questions on Postabortion Family Planning Counseling and Use ................................... 31 

3.2.1 Motivation ............................................................................................................. 31 

3.2.2 Proposal ............................................................................................................... 31 

3.2.3 Advantages and disadvantages ........................................................................... 32 

3.2.4 Panel review ......................................................................................................... 32 

3.2.5 Next steps ............................................................................................................ 32 

3.3 Questions to Capture Prolonged and Postpartum Abstinence as a Method 

to Regulate Fertility Risk ................................................................................................... 32 

3.3.1 Motivation ............................................................................................................. 32 

3.3.2 Proposal ............................................................................................................... 33 

3.3.3 Advantages and disadvantages ........................................................................... 34 

3.3.4 Panel discussion .................................................................................................. 34 

3.3.5 Next steps ............................................................................................................ 36 

3.4 Questions about Contraceptive Preparedness During Extended Periods 

of Marital Abstinence......................................................................................................... 36 

3.4.1 Motivation ............................................................................................................. 36 

3.4.2 Proposals ............................................................................................................. 36 

3.4.3 Advantages and disadvantages ........................................................................... 37 

3.4.4 Panel discussion .................................................................................................. 38 

3.4.5 Next steps ............................................................................................................ 38 

4 SUMMARY AND PROPOSED NEXT STEPS ............................................................................... 39 

REFERENCES ............................................................................................................................................ 45 

APPENDIX A: SECTIONS OF THE DHS-7 TABULATION PLAN FINAL REPORTS REFERRED 

TO IN PROPOSALS ......................................................................................................... 51 
v 

TABLES 

Table 4.1 Summary of issues, proposals, and recommendations in this report ...................... 40 

Appendix Table A.1 DHS-7 standard tabulation plan table 7.3: Current use of contraception 

according to age ...................................................................................................... 51 

Appendix Table A.2 DHS-7 standard tabulation plan table 7.4.1: Current use of contraception 

according to background characteristics ................................................................. 52 

Appendix Table A.3 Example of final report table about ever use of contraception by method .............. 53 

Appendix Table A.4 DHS-7 standard tabulation plan table 9.3: Components of antenatal care ............. 54 

Appendix Table A.5 DHS-7 standard tabulation plan table 9.10: Type of provider for the first 

postnatal checkup .................................................................................................... 55 

Appendix Table A.6 DHS-7 standard tabulation plan table 6.1: Fertility preferences according 

to number of living children ...................................................................................... 56 

Appendix Table A.7 DHS-7 standard tabulation plan appendix table C.3: Completeness of 

reporting ................................................................................................................... 57 

Appendix Table A.8 DHS-7 standard tabulation plan table 7.15: Future use of contraception ................ 58 

vii 

FIGURES 

Figure 1 Standard DHS-7 questions about current family planning use .................................... 7 

Figure 2 Family planning use questions and probes from the Nepal follow-up study ................ 9 

Figure 3a Contraceptive knowledge inventory preceding DHS questions on family planning 

use in DHS-7 .............................................................................................................. 13

Figure 3b Contraceptive knowledge inventory and additional questions preceding family 

planning use in DHS-I ................................................................................................. 14 

Figure 3c Contraceptive knowledge inventory and additional questions preceding family 

planning use in DHS-V ............................................................................................... 15 

Figure 4a Postnatal family planning counseling question asked of women who gave birth 

in a health facility in the 2016 NDHS .......................................................................... 18 

Figure 4b Postnatal family planning counseling question asked of women who did not give 

birth in a health facility, 2016 NDHS ........................................................................... 19 

Figure 5 DHS-7 question on components of antenatal care .................................................... 19 

Figure 6 DHS-7 question on women’s perception of their partner’s desired number 

of children relative to their own ................................................................................... 22 

Figure 7 DHS-7 questions on women’s proximal fertility preferences ...................................... 23 

Figure 8 2016 NDHS questions on postabortion family planning counseling and use ............. 31 

Figure 9 Standard DHS-7 question about future contraceptive method use ............................ 37 

ix 

ACKNOWLEDGMENTS 

We are grateful to Fred Arnold, Yodit Bekele, Julia Fleuret, Sunita Kishor, Joanna Lowell, Anjushree 

Pradhan, and Ann Way, who were part of a technical review panel that provided valuable feedback on our 

initial proposals; individually, several members also provided helpful additional reviews of the manuscript. 

We also wish to thank our panel discussion facilitator Erica Nybro for guiding our internal conversations 

and providing advice on report structure, as well as Sunita Kishor for general project oversight. Kathryn T. 

Kampa provided valuable assistance with referencing, and Chris Gramer provided helpful support with 

questionnaire graphics. The opinions expressed herein are those of the authors and do not necessarily 

represent the views of above-named staff nor of USAID. 

xi 

ABSTRACT 

Recent follow-up mixed-methods studies undertaken by The Demographic and Health Surveys (DHS) 

Program in Ghana and Nepal sought to better understand the reasons behind unmet need and barriers to 

contraceptive use. Both studies, the first of their kind at The DHS Program, re-interviewed a selected 

number of respondents from a parent DHS survey: the 2014 Ghana DHS and the 2016 Nepal DHS, 

respectively. As such, in addition to their substantive findings, these follow-up studies also provide unique 

insights into measurement issues, themes not well captured by existing questionnaires, and reflections on 

the DHS survey process that could potentially benefit future DHS questionnaires and fieldwork procedures. 

The purpose of the project on which this report is based was threefold: first, to share the Ghana and Nepal 

studies with a technical review panel of DHS survey management and questionnaire experts, who may find 

ways to translate the studies into revisions of DHS questionnaires or fieldwork procedures; second, for the 

report authors to propose specific changes to DHS questionnaires and fieldwork procedures for the panel 

to review after reading both reports; and third, after meeting with the panel, to revise proposals, circulate a 

draft report to panel members for additional feedback, revise again, and then make our recommendations 

public. 

This report contains eight proposals, four that earned support for possible inclusion in the DHS Woman’s 

Questionnaire, and four that garnered varying levels of support for testing or inclusion in specific country 

contexts where the issue is relevant. The four potential additions to the core questionnaire are: ways to 

improve the accuracy of current family planning method reporting; questions about receipt of family 

planning counseling around the time of the most recent birth; questions to gauge proximal fertility intention 

concordance with partner—which sets the stage for potential fertility empowerment questions; and flags to 

indicate field estimation of ages and dates. The four proposals for inclusion in specific country contexts 

where the issue is relevant are: follow-up questions on fear of side effects and health concerns, questions 

about postabortion family planning counseling and use, questions to capture prolonged and postpartum 

abstinence as a method to regulate fertility risk, and questions about contraceptive preparedness during 

extended periods of marital abstinence. For each proposal, we provide a brief description of the issue it 

addresses, the proposal itself, panel discussion and feedback, advantages and disadvantages, and 

recommended next steps with policy and programmatic implications. 

1 

1 INTRODUCTION 

1.1 Objectives 

The Demographic and Health Surveys (DHS) Program recently conducted two mixed-methods follow-up 

studies, one in Ghana on reasons for unmet need (Staveteig 2016, 2017) and one in Nepal on barriers to 

family planning use (Staveteig et al. 2018). In addition to producing substantive findings for policymakers 

about the topics they investigated, both studies, which reinterviewed a subsample of DHS respondents, 

offer unique insights into The DHS Program’s survey process, data quality, and important themes that are 

not well captured by existing DHS survey instruments. The purpose of the project that this paper 

summarizes is to explore the ways in which the follow-up studies in Ghana and Nepal could be used to 

improve The DHS Program’s core questionnaires and fieldwork procedures. 

1.2 Background 

1.2.1 Design of follow-up studies in Ghana and Nepal 

Both follow-up studies used a sequential embedded design (Schatz 2012) to sample from within a nationally 

representative survey: in Ghana, the 2014 Ghana DHS (herein the GDHS), and in Nepal, the 2016 Nepal 

DHS (herein the NDHS). While embedded follow-up studies have been conducted in other types of 

household surveys, the mixed-methods design and sampling procedures used in the Ghana follow-up study 

were sufficiently unique to merit standalone publication (Staveteig et al. 2017). The Nepal follow-up study 

followed a similar methodology with a few key differences outlined below and detailed by Staveteig et al. 

(2018). 

In brief, both studies were funded, planned, and fielded independently, but depended on sampling, data 

entry, and consent to follow-up gathered by the parent DHS survey. The follow-up study region (Nepal) or 

regions (Ghana) were preselected for reasons described in Staveteig (2016) and Staveteig et al. (2017; 

2018). Within the preselected study region(s) we sampled clusters based in part on the timing of the main 

DHS fieldwork; our fieldwork schedule was shorter than the main survey, so a completely random selection 

would not have been possible. To keep a short fieldwork schedule and to relocate respondents in a timely 

manner, it was necessary to select from among the clusters that had just been completed. The other part of 

cluster selection was achieving geographic diversity in both countries and linguistic diversity in Ghana. The 

local survey firm worked with ICF and with DHS supervisors to select clusters, which ICF reviewed. 

Additional details on cluster selection for each follow-up study are described in their respective reports. 

Ethical consent for both studies was obtained by the ICF Institutional Review Board, which requires 

compliance with the U.S. Department of Health and Human Services regulations for the protection of 

human subjects (45 CFR 46), as well as from local review boards and managers at the local DHS fieldwork 

agency. HIV testing was administered during the GDHS; given additional ethical considerations regarding 

the risk of respondent reidentification, identifying information and record linkages were scrambled after 

fieldwork and the only linkage remains at ICF headquarters. 

In the selected DHS clusters (13 in Ghana, 17 in Nepal) a computer program was used to select a subsample 

of eligible respondents who had consented to be approached for a follow-up interview based on 
2 

predetermined criteria. In Ghana our target respondents were fecund and pregnant women with unmet need1

as well as a random subsample of modern family planning users, excluding sterilization users,2

 who 

functioned as a quasi-experimental control group. In Nepal our target respondents were nonpregnant 

married women not using sterilization who either: had a period in the last 3 months, terminated a pregnancy 

in the last 3 months, were using a hormonal method of contraception, and/or gave birth in the past year. 

In Ghana over 99% of GDHS respondents agreed to be re-contacted for a follow-up study nationwide, and 

in Nepal 98% of NDHS respondents in Province 1 agreed to be approached for a follow-up study. This 

initial consent did not necessarily translate into ease of respondent relocation—particularly in Ghana where 

the paper format of the GDHS necessitated a longer wait time between the main study and follow-up—nor 

did it mean that requesting a new interview was straightforward. Both study reports (Staveteig 2017; 

Staveteig et al. 2018) describe in depth some of the challenges involved in respondent relocation and 

consent, including that ethical restrictions prohibit DHS surveys from collecting phone numbers to recontact respondents or GPS coordinates of the household. Beyond the address, name of respondent (Nepal), 

or name of and relation to the head of household (Ghana), both studies made use of exported information 

from the main DHS, such as month and year of birth, marital status, number of resident children, and 

whether ever given birth, to help verify identity. In total, 92% of respondents in Ghana and 90% of 

respondents in Nepal who were selected for follow-up were successfully relocated and reinterviewed, 

resulting in a sample size of 96 GHDS respondents in the Ghana study and 194 NDHS respondents in the 

Nepal study. Selected respondents who did not participate in the study included those who did not provide 

a sufficient amount of matching identifying information, those who were visiting at the time of the main 

survey and had left by the day of the follow-up interview, those who refused or whose husbands did not 

grant permission, and those who could not be reached at home after three follow-ups. 

The GHDS used paper questionnaires but employed computer-assisted field editing (CAFE), which sped 

the process of data entry, but still required verification of data entry with the paper questionnaire at the 

home office, necessitating at a minimum of several days between fieldwork and follow-up. As a result, the 

average time between the GDHS and the follow-up study interviews was three weeks. The NDHS, on the 

other hand, was conducted digitally using computer-assisted personal interviewing (CAPI); while 

supervisors still reviewed data, no separate data entry was required. Follow-up interviewers were required 

to wait until the NDHS team departed the cluster, but could otherwise begin on the same day that NDHS 

fieldwork ended. The average time between interviews in Nepal was seven days. 

Both follow-up studies were conducted on tablets, which enabled them to more easily make use of imported 

data from the original study to improve respondent reidentification (as mentioned above, matching on key 

characteristics) as well as to check responses to a few repeated questions from the parent DHS survey. 

These repeated questions were used both to determine new skip patterns and, to some extent, to assess data 

quality. In Ghana, the display of repeated information required interviewers to check for a match, but in 

 

1

 Fecund married and sexually active women who are not using contraception but who wish to postpone the next birth 

for two or more years or who wish to stop childbearing altogether, postpartum amenorrheic women whose most recent 

birth was unwanted or mistimed, and women who are pregnant with an unwanted or mistimed pregnancy are 

considered to have unmet need. See Bradley et al. (2012) for the complete definition. Postpartum amenorrheic women 

were excluded from the Ghana study. 

2

 Sterilization users were excluded from both studies as there are no more remaining contraceptive decisions to make. 
3 

Nepal an improved CAPI design for follow-up only showed original responses if they contradicted new 

responses. 

As mixed-methods studies, both the Ghana and Nepal follow-up study questionnaires (Staveteig 2017, 

2018) asked respondents a combination of closed- and open-ended questions. At the start of each interview, 

respondents were asked for permission to record the audio of the exchange. All respondents in both studies 

consented to audio recording; these recordings were transcribed, translated into English, and passages were 

systematically coded both by question number and by theme into ATLAS.ti qualitative software. Analysis 

for both studies thus made use of these qualitative data as well as quantitative tablet data entry; in the Nepal 

study, advance permission was obtained to release tablet data. After obtaining standard NDHS dataset 

permissions, users may now download the Nepal tablet data (ICF and New ERA [Nepal] 2018) at no charge 

from The DHS Program’s website. 

1.2.2 Key findings from the Ghana follow-up study 

The Ghana follow-up study, which aimed to describe local meanings and lived experiences behind survey 

responses that produce the category of unmet need, investigated the reasons why Ghana, a country with 

regionally modest levels of fertility, recorded one of the highest levels of unmet need for family planning 

in sub-Saharan Africa in its 2008 DHS survey. Additionally, the study served to provide insight on DHS 

data quality and possible strategies to improve surveys. The follow-up study found substantial 

underreporting of traditional method use, and the intentional use of prolonged and postpartum abstinence 

as a method of family planning (Staveteig 2016, 2017), which are not explicitly counted as means to delay 

or avoid pregnancy in most standard surveys covering contraceptive use, including DHS surveys. 

Additionally, fertility preferences expressed by respondents were unstable even within a short time period; 

in several cases, respondents expressed a fertility preference upon follow-up that would have rendered them 

as having no need for family planning according to the standard definition of unmet need. Often this fertility 

ambivalence appeared to be driven by differing proximal fertility intentions between husband and wife. 

Finally, opposition to modern contraception among respondents was more substantial than appeared in the 

DHS. Beyond a simple fear of side effects based on rumors, many respondents had themselves experienced 

side effects from hormonal methods, particularly menstrual disruption, which they perceived as a marker 

of or even a source of disease in the body. Religion had both a positive and negative influence on family 

planning use. Some respondents expressed a desire for greater accessibility of long-acting methods, 

including the intrauterine device (IUD) and sterilization. Partners’ attitudes toward modern contraception 

had an important influence on contraceptive uptake, with a number of respondents perceiving their partner 

as a kind of gatekeeper for family planning use. Taken together, these responses suggest the central 

importance of women’s empowerment to family planning uptake, to providing contraceptive messaging 

geared toward men, and to improving access to long-term methods nationwide. 

1.2.3 Key findings from the Nepal follow-up study 

While the government of Nepal and outside donors have recently ramped up efforts to meet the demand for 

contraception in Nepal, unmet need for family planning increased from 2006 to 2011 (Ministry of Health 

and Population [Nepal], New ERA, and ICF International 2012). Temporary male migration appears to play 

a pivotal role in this phenomenon: the increase in unmet need occurred only among married women with 

nonresident husbands (Khanal et al. 2013). The Nepal follow-up study, which was designed after the 
4 

completion of the Ghana follow-up study, aimed to understand barriers to family planning uptake in Eastern 

Nepal, a region with high male migration. Additionally, the study sought to assess DHS data quality and to 

build on lessons learned for DHS surveys from the earlier Ghana follow-up study. 

The follow-up study found that, in addition to the importance of spousal absence in contraceptive nonuse 

(and thus, unmet need), women tended to be poorly prepared for their husband’s return, either not wanting 

a child soon but not having a contraceptive plan in place for his return, or planning to start a hormonal 

method only after he returned home (Staveteig et al. 2018). Cultural norms that dictate contraceptive use 

during a husband’s absence signifies unfaithfulness appeared to play an important role in couples’ lack of 

contraceptive preparedness. Despite almost universal knowledge of when their husband would be returning, 

among respondents with migrant husbands who did not want a/another child soon, 15% intended to wait 

until his arrival to discuss contraceptive plans, and another 30% planned to use a method but were either 

undecided about which method, undecided about when to start, or intended to start a hormonal method 

within 3 days or fewer of his arrival. 

As in the Ghana study, fear of side effects and health concerns was frequently expressed in follow-up 

interviews, at a rate higher than in the parent survey. While personal experiences with modern methods and 

rumors from friends and relatives contributed to these fears, the primary source of concern about side effects 

appeared to be from women’s husbands. 

Using closed-ended probes, 20% of follow-up respondents agreed that it is difficult to obtain contraception 

and 17% perceived it to be expensive. Yet in discussions, it was clear that subtle access barriers such as 

limited operating hours and inconsistent staffing made it challenging for a much larger share of respondents 

to obtain their preferred method at the lowest cost. Government health posts, which provide free or very 

low-cost contraceptives, were difficult to access—sometimes requiring a day or more of walking each 

way—and when respondents did reach the clinic, they were frequently constrained by limited opening 

hours, unannounced closures, and, in some cases, method stockouts. Female Community Health Volunteers 

(FCHVs) improved coverage in remote areas by providing condoms, resupplying pills, and offering method 

and source advising, but at times women had to choose a less-preferred method because of availability. 

Respondents who were motivated to obtain contraception typically did anyway, by selecting a less-desired 

method or paying a higher price at a pharmacy to avoid these access challenges, but received virtually no 

counseling on method selection or side effects. Another somewhat subtle theme of many interviews was 

that pills, condoms, and injectables were perceived as the entire universe of short-term modern methods, 

suggesting lack of method diversity in many communities. 

1.3 Project Procedure 

This project was about ways to improve DHS questionnaires and fieldwork procedures, but was designed 

to receive direct feedback from DHS experts, to solicit other ideas, and to build support for proposals within 

The DHS Program. As such, it was designed to be entirely internal to The DHS Program’s staff. Under the 

guidance of management, we selected a panel of questionnaire and survey experts that includes both a 

current and a former DHS director, both of whom have expertise in survey management, experience with 

questionnaire revisions, and a large-scale perspective on DHS operations; a deputy manager who is both a 

survey expert and the primary questionnaire design manager, a survey manager who led the parent survey 

of one of the follow-up studies, a survey manager with expertise in survey innovation, and two survey 
5 

managers with a breadth of experience in different countries and an interest in improving DHS 

questionnaires. 

Upon formation of the expert panel we circulated the two original reports, two additional journal articles, 

and the Nepal questionnaire for panelists to read 6 weeks before our main meeting. Then, based on the 

Nepal and Ghana studies, and on existing literature, we developed a set of proposals about how to improve 

DHS questionnaires and fieldwork procedures. These underwent initial feedback from a panelist and 

manager, after revisions we circulated these proposals to panelists a week before the panel meeting. The 

meeting was moderated by the DHS Senior Communications Advisor, with six panelists and both of us in 

attendance. A seventh panelist provided feedback remotely. Discussion was quite extensive, and we took 

detailed notes on panelists’ feedback. 

Following the panel discussion, most proposals were revised, a few were cut, comments from panelists 

were synthesized, and a synthesized report was drafted. The draft was circulated to three panelists for indepth comments and to three panelists for summary comments on the concluding table; in some panel 

discussion sections we describe subsequent feedback received. 

As mentioned in the acknowledgments, the opinions herein are those of the authors and not necessarily 

those of panelists or of other staff from The DHS Program who were involved in the project. Therefore, 

this report is written in the first person, using “us” and “we” to represent the opinions of the two report 

authors. 

1.4 Notes and Report Structure 

One recurring issue in DHS is the relationship between questionnaire length and data quality. The current 

DHS-7 Woman’s Questionnaire contains over 500 questions. While not all questions are administered to 

every woman, any proposal to add survey questions faces a major disadvantage of burdening an already 

overfull questionnaire. Our task was not to cut questions. However, in keeping with findings about the 

inverse relationship between questionnaire length and data quality discussed in Staveteig (2016), and the 

obvious respondent fatigue we encountered when trying to solicit an additional interview from respondents 

in both countries (Staveteig 2016; Staveteig et al. 2018), we aimed to be judicious about what additions to 

the core could have widespread utility and what other proposals might be better saved as possible 

supplements in appropriate contexts. 

We have therefore divided our proposals into two groups: possible additions to the core questionnaire 

(Chapter 2), possible supplementary questions that the panel deemed may be useful in certain contexts but 

not universally applicable enough to be included in the DHS core Woman’s Questionnaire (Chapter 3). For 

each proposal in Chapters 2 and 3, we describe the motivation, detail the proposal(s), discuss the advantages 

and disadvantages, summarize the feedback received internally from our panel, and discuss potential next 

steps. A thumbnail sketch of the issue, the proposal, discussion, next steps, and policy significance of all 

eight proposals is contained in our concluding chapter (Chapter 4). 

7 

2 POSSIBLE ADDITIONS TO THE DHS CORE WOMAN’S 

QUESTIONNAIRE 

2.1 Questions to Improve the Accuracy of Family Planning Method

Reporting 

2.1.1 Motivation 

Both follow-up studies employed the standard DHS questions (Figure 1) about family planning use, but 

added simple prompts afterward about traditional method use. After prompting, 20% of GDHS nonusers in 

the Ghana study and 9% of NDHS nonusers in the Nepal study reported traditional method use, primarily 

the rhythm method in Ghana and withdrawal in Nepal (Staveteig 2017; Staveteig et al. 2018). Additionally, 

in Nepal, a prompt about lactational amenorrhea (LAM) found one additional user. When asked to explain 

the discrepancy between follow-up and their DHS response on method use, most respondents reported that 

they had understood the DHS question to be about modern or commodity-based method use only. Obtaining 

more accurate information about current method use is not only important in and of itself, it would also 

help donors and governments to spend their funds more wisely and would allow policymakers and program 

managers to focus their efforts more efficiently. 

Figure 1 Standard DHS-7 questions about current family planning use 

2.1.2 Initial proposals 

Based on the Ghana and Nepal follow-up studies, we developed two proposals to correct underreporting of 

method use for the expert review panel to consider. 

Proposal 2.1a 

After the standard DHS question sequence about family planning use (Figure 1), we proposed adding 

additional prompts for traditional and natural methods, using similar wording and logic as the prompts used 

303 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 312

304 FEMALE STERILIZATION . . . . . . . . . . . . . . . . . . . A

(4) MALE STERILIZATION . . . . . . . . . . . . . . . . . . . . . . B

IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C

INJECTABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . D 309

IMPLANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E

PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F

CONDOM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G 306

FEMALE CONDOM . . . . . . . . . . . . . . . . . . . . . . . . . H

EMERGENCY CONTRACEPTION . . . . . . . . . . . . . I

STANDARD DAYS METHOD . . . . . . . . . . . . . . . . J

LACTATIONAL AMENORRHEA METHOD . . . . . . . . K

RHYTHM METHOD . . . . . . . . . . . . . . . . . . . . . . . . . L

WITHDRAWAL . . . . . . . . . . . . . . . . . . . . . . . . . . . M

OTHER MODERN METHOD . . . . . . . . . . . . . . . . X

OTHER TRADITIONAL METHOD . . . . . . . . . . . . . Y

Are you or your partner currently doing something or 

using any method to delay or avoid getting pregnant?

Which method are you using?

RECORD ALL MENTIONED.

IF MORE THAN ONE METHOD MENTIONED, FOLLOW 

SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.

309

307
8 

by the Nepal and Ghana3

 studies as shown in Figure 2 below. However, in most DHS surveys unmarried 

women are included, so the phrasing of question 203D would need to be changed. 

We recommended that the resulting variable on family planning, inclusive of prompts, be included in the 

dataset, perhaps as variable v312a. This new composite variable would also be the primary basis for the 

main contraceptive prevalence (CPR) tables in DHS Reports (see Appendix Tables A.1 and A.2). We also 

proposed that a new standard table prior to contraceptive prevalence tables could be added to show current 

use by method type among all women, currently married women, and sexually active unmarried women 

before prompts (currently variable v312) and after prompts (new variable v312a). We recommended a 

column for either the percentage point difference between estimates (i.e., responses generated by the new 

probes) or for the percentage of women who reported a method upon probing, among those who initially 

declared themselves to be nonusers, by method type. By adding this separate table, DHS final reports would 

make it clear that contraceptive prevalence estimates and family planning method disaggregations are not 

fully backwards-compatible. Estimates of initial nonusers who reported method use upon follow-up could 

be added as an indicator to the DHS Application Programming Interface (API) and, by extension, to 

STATcompiler. These additional reports of method use could be valuable for researchers or policymakers 

analyzing surveys with contraceptive use questions similar to DHS who wanted to do model-based 

adjustments of method reporting. Such adjustments would be the decision of end users and not necessarily 

endorsed by The DHS Program. Depending on the demand for and interest in these metrics of additional 

contraceptive use reporting could be phased out at a later date. 

 

3

 The Ghana study did not include question 203C or 203D. Question 203C is about LAM, but postpartum amenorrheic 

women were excluded from the Ghana study. Question 203D, which is about sterilization, was not included as 

underreporting of sterilization was not hypothesized to be an issue in Ghana. 
9 

Figure 2 Family planning use questions and probes from the Nepal follow-up study 

NO.

201 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 203

202 FEMALE STERILIZATION . . . . . . . . . . . . . . A

MALE STERILIZATION . . . . . . . . . . . . . . B

IUCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C

INJECTABLES . . . . . . . . . . . . . . . . . . . . . . . D

IMPLANTS . . . . . . . . . . . . . . . . . . . . . . . . . E

PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F

CONDOM . . . . . . . . . . . . . . . . . . . . . . . . . G

EMERGENCY CONTRACEPTION . . . . . I

LACTATIONAL AMENORRHEA METHOD .... K

RHYTHM METHOD . . . . . . . . . . . . . . . . . . . . L

WITHDRAWAL . . . . . . . . . . . . . . . . . . . . . . . M

OTHER MODERN METHOD X

Y

YES, USING BOTH . . . . . . . . . . . . . . . . . . . . 1 203C

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

203

203A YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

203B YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

203C YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

YES, USING A METHOD . . . . . . . . . . . . . . 1 203F

NO, NO METHOD . . . . . . . . . . . . . . . . . . . . 2

203D YES, STERILIZED . . . . . . . . . . . . . . . . . . . . 1

NO, NOT STERILIZED . . . . . . . . . . . . . . . . . 2 204

OTHER TRADITIONAL

METHOD (SPECIFY)

CAPI PROGRAM: CHECK IF USING BOTH RHYTHM AND

WITHDRAWAL

SECTION 2. FAMILY PLANNING USE

SRETLIFDNASNOITSEUQ SEIROGETACGNIDOC PIKS

Thank you. Now, I would like to have a conversation with you.

First I would like to talk to you about family planning--ways or

methods that a couple can use to delay or avoid a pregnancy.

I would like to confirm some information I have received. Are

you or your (husband/partner) currently doing something or

using any method to delay or avoid getting pregnant?

203E Which method(s) are you using? (NAME ALL)

RECORD ALL MENTIONED.

I would like you to know that I am also interested in learning

about your use of natural or traditional methods.

IF NO TO 201 OR RHYTHM NOT MENTIONED: Are you

currently using the calendar or rhythm method? By that, I mean

to avoid pregnancy, women do not have sexual intercourse on

the days of the month they might get pregnant.

IF NO TO 201 OR WITHDRAWAL NOT MENTIONED: Are you

and your (husband/partner) currently using withdrawal? By

that, I mean that men can be careful and pull out before climax.

IF NO TO 201 OR LAM NOT MENTIONED BUT LAST BIRTH

WITHIN 6 MONTHS: Are you currently using the Lactational

Amenorrhea Method? By that, I mean that up to six months

after childbirth, before the menstrual period has returned,

women use a method requiring frequent breastfeeding day and

night.

I also just want to confirm that you and your husband have

never been sterilized? That is, neither of you have ever had an

operation to prevent pregnancy?

(SPECIFY)

CAPI PROGRAM: CHECK IF USING A METHOD
10 

Proposal 2.1b 

We proposed that, in lieu of specific prompts for traditional and natural methods, a second, more inclusive 

prompt could be added after the standard DHS question sequence (Figure 1), for women who have not 

reported any method use. This could be something along the lines of, “Just to clarify, I am interested in all 

possible methods you and your partner may be currently using. That includes female or male sterilization, 

IUD, injectables, implants, pill, condom, female condom, emergency contraception, standard days method, 

lactational amenorrhea, the rhythm method, and withdrawal. Is it correct that you are not currently using 

any of these methods?” The effects on dataset and tabulation plan would be similar as for proposal 2.1a, 

above. 

2.1.3 Advantages and disadvantages 

Improving reporting of traditional methods, LAM, and sterilization increases the accuracy of surveys, 

which is important in and of itself. In addition, researchers and policymakers interested in using DHS data 

to increase usage of family planning benefit from this additional information about the market of potential 

users. Approaching a traditional method user about modern family planning use is much different than 

approaching a nonuser. Increased accuracy is valuable for efforts to improve modern contraceptive uptake 

as well as better understanding method use—both traditional and modern—among women and girls. 

Both types of additional probes maintain the existing DHS family planning use question sequence (Figure 

1), thereby maintaining backwards compatibility. In other words, researchers could still use v312 in 

isolation, however analysts could also see the result of these probes to the question and make use of the 

new composite family planning variable, v312a. 

An obvious downside of Proposal 2.1a was that there were no other specific prompts for any of the other 

family planning methods, and so this could potentially distort reporting of traditional/natural family 

planning relative to other methods. However, outside of one case of underreporting the pill in Nepal,4

 there 

was no real evidence in either follow-up study that modern, commodity-based methods were underreported. 

Hence, we believed that such additional probes would be unlikely to significantly distort method reporting. 

Proposal 2.1b may elicit more information about family planning generally rather than just about traditional 

methods specifically. However, by not explaining the meaning of traditional methods (as in 2.1a) we may 

still miss respondents who are actually using these methods. In Nepal, since there was no local term for 

‘withdrawal’, we found that by explaining each traditional method, women were better able to recognize 

the method as something that they used. 

Also, with a general follow-up along the lines of proposal 2.1b, unlike the traditional method use prompts, 

we would not necessarily capture dual use because women reporting any method would be skipped out of 

the follow-up question. 

Overall, there is a risk that any of these additional probes could be perceived by respondents, particularly 

those who have never had sex, as somewhat badgering, as perhaps they imply that the respondent really 

 

4

 The follow-up respondent stated that she had not reported the pill as a method of family planning in NDHS because 

she was on the iron pills the day of the interview (Staveteig et al. 2018). 
11 

should be reporting a method. We worked extensively with interviewers on tone for these types of 

discrepancy probes, namely that these questions should be posed as friendly, polite inquiries, and did not 

find any evidence that respondents made up method use just to satisfy the interviewer. Training on or 

discussion of tone for these questions would also be recommended for DHS interviewers. 

Regardless of how additional prompting is done, we recommend that the new composite family planning 

variable (inclusive of prompts) be the basis for subsequent questionnaire skip patterns, for example, 

contraceptive calendar, reasons for nonuse, and so forth. 

2.1.4 Panel discussion and revised strategy 

The proposals to improve accuracy of family planning method reporting generated a lot of interest among 

the internal DHS panel of survey experts. Discussion initially centered around concerns that, in addition to 

traditional and natural methods of family planning, female sterilization may be underreported and deserves 

explicit prompting. Older women could have been sterilized years or decades ago and may not think about 

sterilization as a ‘current’ method to prevent or avoid pregnancy. We noted that while this may occur, the 

Nepal follow-up study, which excluded respondents who had reported female or male sterilization to the 

NDHS, included an explicit prompt about sterilization and did not find any additional respondents who 

reported that they or their partners were sterilized. However, the lack of evidence from 198 cases out of 

thousands should not be interpreted as meaning that it never occurs. The additional probe on sterilization 

from the Nepal study could be maintained, particularly in contexts where sterilization is common, but risks 

alienating unmarried women (marital status is not known until later in the survey). Panelists who have 

worked in countries where sterilization was common were nonetheless concerned that it is underreported. 

Panelists also noted the concern that, in addition to rhythm and withdrawal, coitus-dependent methods can 

be easily underreported by respondents who are not using them on the day of the interview, including those 

who have intercourse infrequently or those whose husbands are away. Generally, ‘current use’ of a coitusdependent method suggests use at last sex and intention to use at next sex, but it is unclear how respondents 

interpret these questions. Staveteig et al. (2018) discussed the particular difficulty in measuring ‘current 

use’ of a coitus-dependent method among women who are separated from their husbands for months or 

years at a time. Assuming she has no other sexual partners, is it sufficient that she and her husband used a 

method at last sex and intend to use it at next sex? If not, how should current use of a coitus-dependent 

method be defined? 

As there was concern about underreporting of other methods besides natural and traditional methods, 

discussion quickly gravitated toward proposal 2.1b, to probe respondents on the entire list of methods rather 

than just traditional methods. However, panelists expressed concern that the entire list of methods would 

not truly be read, so then the order of the list would be important. Currently, in the contraceptive knowledge 

inventory in DHS, traditional methods are asked about last. The order could be reversed, but would there 

be a strong justification if sterilization (currently first) is also underreported? Furthermore, we pointed out 

that based on reports from interviewers and from our transcripts, simply mentioning the name of a 

traditional method was insufficient, as there were not necessarily local language terms for rhythm and 

withdrawal. Instead, it was only by explaining the meaning of the method that respondents could recognize 

it as what they are using. 
12 

Panelists knowledgeable about the history of DHS said that in the method knowledge table that precedes 

the standard sequence of questions on current use (Figure 3a), there were originally more columns. As 

Figure 3b illustrates, during DHS-I, for example, respondents were asked if they had ever used every 

method in the inventory, where they would obtain the method if desired, and what the main problem, if any, 

was with using the method (Demographic and Health Surveys 1987). Additionally, the interviewer recorded 

whether a “yes” response was spontaneous or after probing. 
13 

Figure 3a Contraceptive knowledge inventory preceding DHS questions on family planning use in DHS-7 

301

01 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

02 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

03 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

04 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

05 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

06 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

07 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

08 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

09 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

(1) NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

10 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

(2) NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

11

(3) YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

12 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

13 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

14 YES, MODERN METHOD

A

YES, TRADITIONAL METHOD

B

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Y

(SPECIFY)

Now I w ould like to talk about family planning - the various w ays or methods that a couple can use to delay or avoid a 

pregnancy. Have you ever heard of (METHOD)?

Female Sterilization.

PROBE: Women can have an operation to avoid having any more 

children.

Injectables.

PROBE: Women can have an injection by a health provider that stops 

them from becoming pregnant for one or more months.

IUD.

PROBE: Women can have a loop or coil placed inside them by a doctor 

or a nurse w hich can prevent pregnancy for one or more years.

Male Sterilization.

PROBE: Men can have an operation to avoid having any more children.

Have you heard of any other w ays or methods that w omen or men 

can use to avoid pregnancy?

Emergency Contraception.

PROBE: As an emergency measure, w ithin three days after they have 

unprotected sexual intercourse, w omen can take special pills to 

prevent pregnancy.

Withdraw al.

PROBE: Men can be careful and pull out before climax.

Rhythm Method.

PROBE: To avoid pregnancy, w omen do not have sexual intercourse

on the days of the month they think they can get pregnant.

Female Condom.

PROBE: Women can place a sheath in their vagina before sexual 

intercourse.

Condom.

PROBE: Men can put a rubber sheath on their penis before sexual

intercourse.

Pill.

PROBE: Women can take a pill every day to avoid becoming pregnant. 

Implants.

PROBE: Women can have one or more small rods placed in their upper 

arm by a doctor or nurse w hich can prevent pregnancy for one or

more years.

Lactational Amenorrhea Method (LAM).

PROBE: Up to six months after childbirth, before the menstrual period 

has returned, w omen use a method requiring frequent breastfeeding 

day and night.

SECTION 3. CONTRACEPTION

Standard Days Method.

PROBE: A w oman uses a string of colored beads to know the days 

she can get pregnant. On the days she can get pregnant, she uses a 

condom or does not have sexual intercourse.

(SPECIFY)
14 

Figure 3b Contraceptive knowledge inventory and additional questions preceding family planning use in 

DHS-I 

Moving into DHS-III, as survey writers sought to reduce the size of the questionnaire, only the question on 

ever use was retained for each method, the spontaneous versus probed ‘yes’ remained, but all other 

additional information was dropped (Macro International 1995a, 1995b). By DHS-IV, differentiation 

between a spontaneous or probed ‘yes’ answer was dropped (ORC Macro 2001a, 2001b). The question on 

ever use in the knowledge inventory persisted through DHS-5 (Figure 3c). By DHS-6, according to 

panelists, it was felt that these data were not being used widely and the ‘ever use’ questions were dropped. 

Panelists proposed that adding ‘ever use’ questions back into the contraceptive knowledge inventory, as in 

Figure 3c, would be a good way to address the multiple possible types of method use underreporting. 

Women, once having identified themselves as ‘ever users’ of sterilization, would surely then be current 

users, and women who identified themselves as ever using a traditional, natural, or coitus-dependent method 

would likely be more inclined to realize these are methods being asked about by DHS and include their use 

in reporting of a current method. Other panelists liked this idea, as it would prompt respondents to think 

more critically about the contraceptive knowledge questions rather than just go through them quickly. In a 

short time, panelists seemed to reach consensus that adding an ‘ever use’ column into the knowledge 

inventory as in DHS-5 would help address the underreporting of traditional methods, natural methods, and 

possibly of coitus-dependent methods and sterilization. 
15 

Figure 3c Contraceptive knowledge inventory and additional questions preceding family planning use in 

DHS-V 

SECTION 3. CONTRACEPTION

301 Now I w ould like to talk about family planning - the various w ays or methods that 302 Have you ever used

a couple can use to delay or avoid a pregnancy. (METHOD)?

Which w ays or methods have you heard about? (1) 

FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK:

Have you ever heard of (METHOD)?

CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY.

THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF

EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD

IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD

WITH CODE 1 CIRCLED IN 301, ASK 302.

01 FEM ALE STERILIZATION Women can have an operation to avoid YES . . . . . . . . . . . . . . . . . 1 Have you ever had an operation to

having any more children. NO . . . . . . . . . . . . . . . . . 2 avoid having any more children?

YES . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . 2

02 M ALE STERILIZATION M en can have an operation to avoid having YES . . . . . . . . . . . . . . . . . 1 Have you ever had a partner who had

any more children. NO . . . . . . . . . . . . . . . . . 2 an operation to avoid having any 

more children?

YES . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . 2

03 PILL Women can take a pill every day to avoid becoming pregnant. YES . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . 2

NO . . . . . . . . . . . . . . . . . . . . . . . 2

04 IUD Women can have a loop or coil placed inside them by a doctor or YES . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . 1

a nurse. NO . . . . . . . . . . . . . . . . . 2

NO . . . . . . . . . . . . . . . . . . . . . . . 2

05 INJECTABLES Women can have an injection by a health provider YES . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . 1

that stops them from becoming pregnant for one or more months. NO . . . . . . . . . . . . . . . . . 2

NO . . . . . . . . . . . . . . . . . . . . . . . 2

06 IM PLANTS Women can have several small rods placed in their upper YES . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . 1

arm by a doctor or nurse which can prevent pregnancy for one or more NO . . . . . . . . . . . . . . . . . 2

years. NO . . . . . . . . . . . . . . . . . . . . . . . 2

07 CONDOM M en can put a rubber sheath on their penis before sexual YES . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . 1

intercourse. NO . . . . . . . . . . . . . . . . . 2

NO . . . . . . . . . . . . . . . . . . . . . . . 2

08 FEM ALE CONDOM Women can place a sheath in their vagina before YES . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . 1

sexual intercourse. NO . . . . . . . . . . . . . . . . . 2

NO . . . . . . . . . . . . . . . . . . . . . . . 2

09 LACTATIONAL AM ENORRHEA M ETHOD (LAM ) (2) YES . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . 2

NO . . . . . . . . . . . . . . . . . . . . . . . 2

10 RHYTHM M ETHOD Every month that a woman is sexually active YES . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . 1

she can avoid pregnancy by not having sexual intercourse NO . . . . . . . . . . . . . . . . . 2

on the days of the month she is most likely to get pregnant. NO . . . . . . . . . . . . . . . . . . . . . . . 2

11 WITHDRAWAL M en can be careful and pull out before climax. YES . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . 2

NO . . . . . . . . . . . . . . . . . . . . . . . 2

12 EM ERGENCY CONTRACEPTION As an emergency measure after YES . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . 1

 unprotected sexual intercourse, women can take special pills at any NO . . . . . . . . . . . . . . . . . 2

time within five days to prevent pregnancy. NO . . . . . . . . . . . . . . . . . . . . . . . 2

13 Have you heard of any other ways or methods that women or men can YES . . . . . . . . . . . . . . . . . 1

use to avoid pregnancy?

YES . . . . . . . . . . . . . . . . . . . . . . . 1

(SPECIFY) NO . . . . . . . . . . . . . . . . . . . . . . . 2

YES . . . . . . . . . . . . . . . . . . . . . . . 1

(SPECIFY) NO . . . . . . . . . . . . . . . . . . . . . . . 2

NO . . . . . . . . . . . . . . . . . 2
16 

2.1.5 Next steps 

After discussions with the expert panel, we believe reintroducing an ‘ever use’ column to the contraceptive 

knowledge inventory could be valuable, but we note that there is no evidence as of yet to show that this 

reduces underreporting of, for example, traditional methods. We propose that the DHS-5 style ever use 

questions (Figure 3c) be pilot tested during the knowledge inventory with additional prompts afterward, as 

in the Ghana and Nepal surveys (Figure 2), to ensure that the knowledge inventory is correcting the apparent 

underreporting of traditional methods. An ideal pilot location would be Central and West Africa, where 

evidence from other studies also indicates that traditional family planning methods are underreported 

(Rossier, Senderowicz, and Soura 2014). A pilot of the ever-use inventory compared with probes on 

sterilization questions could also be piloted in a country with high levels of sterilization, such as those in 

South Asia (United Nations, Department of Economic and Social Affairs, and Population Division 2015). 

If the pilot shows that the knowledge inventory questions provide successful correction of method 

underreporting, then adding an inventory of ‘ever use’ back into the contraceptive knowledge section of the 

questionnaire would have beneficial spillover effects of potentially improving the completeness of the DHS 

contraceptive calendar, and of providing additional data about women’s method preference outside of the 

window covered by the contraceptive calendar. In particular, the ever-use inventory could help gauge the 

extent to which some women and couples have an apparent preference for traditional methods despite their 

lower efficacy (Gebreselassie et al. 2017; Johnson-Hanks 2002; Staveteig 2017; Staveteig et al. 2018) by 

examining how many traditional method users have ever used a modern method, and which type(s). 

Naturally, skip patterns into the current DHS questions would need to be adjusted so that women who state 

never having used a method would not be asked about current use. 

While our original proposals faced the challenge of backwards compatibility, as they obtained additional 

responses to current use with probes, an ‘ever use’ inventory eliminates measurement of backwards 

compatibility. Instead, it would be desirable to add a table in final DHS reports on ever use by background 

characteristics as was present in earlier DHS surveys (Appendix Table A.3). 

2.2 Questions about Family Planning Counseling around the Time of the 

Most Recent Birth 

2.2.1 Motivation 

Optimal birth spacing has been proven to be extremely important for the health of the mother, baby, and 

family (Ahmed et al. 2012; Conde-Agudelo, Rosas-Bermudez, and Kafury-Goeta 2006; Rutstein 2005; 

World Health Organization 2013). In particular, it reduces the risk of maternal and child mortality (Ahmed 

et al. 2012; Rutstein 2005; Stover and Ross 2010), helps protect the health of other young children in the 

family, and has a number of other benefits (Conde-Agudelo et al. 2012). The period surrounding childbirth 

is a critical time to reach women with counseling about the importance of birth spacing and the means of 

doing so (Cleland, Shah, and Daniele 2015; World Health Organization 2013). In tandem with the NDHS, 

the follow-up study in Nepal found that, despite very clear government policies on counseling women after 

a birth, less than half of women who had given birth in the past five years said that they had received any 

information about the importance of birth spacing from any source, and even fewer had received 

information about the means to do so (Staveteig et al. 2018). Nationwide, when asked about family planning 

method counseling by the most qualified provider of postnatal care, only 13% of women who had recently 

given birth said that they received such counseling (Ministry of Health [Nepal], New ERA, and ICF 2017). 
17 

The core DHS-7 Woman’s Questionnaire asks, for the most recent live birth in the past five years, about 

the content of antenatal (ANC) counseling, postnatal counseling, and post-birth checkups (ICF International 

2015). With the exception of a few surveys where specific probes on family planning during maternal care 

were added, DHS surveys do not ask about counseling on birth spacing or on family planning method use. 

2.2.2 Proposal 

We proposed to add specific questions on birth spacing counseling and on family planning method 

counseling to the existing questions about the content of antenatal and postnatal care. The 2016 NDHS 

provides a good example of how these questions can be added to the standard DHS sequence on postnatal 

care. As Figure 4a shows, in NDHS question 437a, women who gave birth in a health facility and received 

a postnatal check on their care were asked, after the standard question about provider type, whether the 

provider discussed family planning with them. Women who did not give birth in a health facility but did 

receive a postnatal checkup were also asked if they were counseled on birth spacing or ways to avoid 

pregnancy (Figure 4b). 
18 

Figure 4a Postnatal family planning counseling question asked of women who gave birth in a health 

facility in the 2016 NDHS 
19 

Figure 4b Postnatal family planning counseling question asked of women who did not give birth in a 

health facility, 2016 NDHS 

Given the importance of family planning counseling during antenatal care (Hodgins et al. 2016; USAID 

2018; World Health Organization 2016), which helps women and couples to have a specific post-birth 

contraceptive strategy, we recommended that women also be asked about family planning counseling 

during antenatal care. Specifically, we recommended that, during the standard DHS-7 question about the 

components of antenatal care received (Figure 5), women be asked whether a provider discussed the 

importance of birth spacing and specific methods to avoid pregnancy after the birth. Such a question would 

aid assessments of the level of integration between antenatal care and family planning counseling, as well 

as the effect of antenatal counseling about birth spacing and contraceptive methods on postpartum family 

planning use. 

Figure 5 DHS-7 question on components of antenatal care 

2.2.3 Advantages and disadvantages 

As stated, birth spacing is crucial for the health of the mother, baby, and other siblings in the household. 

Antenatal and postnatal counseling on family planning methods tend to increase postpartum family 

planning use, which helps ensure safe birth spacing (Cleland, Shah, and Daniele 2015). There is some 

complexity to measuring family planning method counseling around the time of birth. In a few cases in 

Nepal, at least one follow-up respondent reported that when she was advised about the importance of birth 

spacing, she informed the provider that she knew all about this and was not counseled further; in other 

NO. NAME

LAST BIRTH

QUESTIONS AND FILTERS

SECTION 4. PREGNANCY AND POSTNATAL CARE

451 HEALTH PERSONNEL

DOCTOR . . . . . . . . . . . . . . . . 11

NURSE/MIDWIFE . . . . . . . 12

HEALTH ASST./

AHW . . . . . . . . . . . . . 13

MCH WORKER . . . . . . . . . . 14

VHW . . . . . . . . . . . . . . . . . . 15

OTHER PERSON

TRADITIONAL BIRTH

ATTENDANT . . . . . . . . . . 21

FCHV . . . . . . . . . . . . . . . . . . 22

OTHER 96

451A YES . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . 2

DON'T KNOW . . . . . . . . . . . . . 8

Did this person talk to you about using a

family planning method?

(SPECIFY)

Who checked on your health at that

time?

PROBE FOR MOST QUALIFIED

PERSON.

413

YES NO

a) a) BP . . . . . . . . . . 1 2

b) b) URINE . . . . . . . . 1 2

c) c) BLOOD . . . . . . . . 1 2

As part of your antenatal care during this 

pregnancy, w ere any of the follow ing 

done at least once:

Was your blood pressure measured?

Did you give a urine sample?

Did you give a blood sample?
20 

words, the provider likely intended to counsel on specific methods but was stopped from doing so. However, 

this scenario is expected to be uncommon. 

Despite an already full questionnaire, adding measures of family planning counseling during antenatal and 

postnatal health care is important because the data can be linked to the contraceptive calendar and to 

information on postpartum abstinence to test whether counseling is associated with practices of postpartum 

abstinence or postpartum family planning. In other words, these data can be used to test whether stated 

guidelines are used in practice, and to answer the questions, “Did having the most qualified healthcare 

provider (and if so, which type of provider) suggest a specific family planning method before or 

immediately after the time of birth relate to uptake of postpartum family planning, net of other factors? If 

so, did provider type or timing matter?” Additionally, in countries with postnatal IUD insertion programs 

or specific postnatal counseling guidelines, monitoring how effectively these guidelines are followed will 

be of particular importance to policymakers. 

While the antenatal family planning counseling questions ask about content of care during any postnatal 

visit and thus encompass a range of providers, a disadvantage of the postnatal family planning questions is 

that they only apply to the most qualified provider who provided postnatal care (see instructions to 

interviewer in Figures 4a and 4b). During the Nepal follow-up studies, where we asked general questions 

on whether anyone provided postnatal counseling on family planning methods, we found that women who 

were counseled on family planning use were typically counseled by a nurse, midwife, FCHV, or family 

member, either because they were not seen by someone more qualified or, as a handful of respondents 

explained, doctors are too busy to spend any time with them. It is possible that an additional general question 

about whether the respondent was counseled on family planning during the first few days or weeks after 

birth from any provider would be helpful, but it would also add complexity and length to the questionnaire 

and provide little information on the context in which this information was received. 

2.2.4 Panel discussion 

Panelists thought postnatal questions were important to policymakers and have the advantage of already 

being used successfully used in certain country questionnaires, including Nepal and the Philippines. Some 

panelists noted that a new maternal health module intends to include questions on postnatal family planning 

counseling, but that these questions could also be considered for the core questionnaire. Panelists 

recommend some consideration to adapting these questions to country-specific circumstances, for example 

in situations where there are no guidelines on family planning counseling before or after birth. A probe on 

which methods were discussed would add specificity, but would pose some recall challenges and likely 

overburden the questionnaire. Family planning counseling during antenatal care was not explicitly 

discussed, but subsequent manuscript reviews by panelists indicated support for this idea. 

2.2.5 Next steps 

We recommend questions about antenatal and postnatal counseling on family planning method use be added 

to the next revision of the DHS-8 core questionnaire. If desired, counseling on family planning during 

antenatal care could be pretested alongside a separate item about counseling on birth spacing—i.e., the 

motivation for using family planning. Alternately, a question on family planning method counseling during 

antenatal care could be added and would likely not need pretesting, as its counterpart questions on 

counseling during postnatal care have already been fielded successfully. Some countries with specific 

antenatal and postnatal counseling programs may want to include a follow-up question about which specific 
21 

method(s) were suggested, but this would likely overburden the core questionnaire. As discussed, to 

determine whether any postnatal care provider besides the most qualified one provided family planning, 

counseling could be added in specific circumstances, but will likely require additional follow-ups on 

provider type and context. Hence, we only recommend the two or three specific questions discussed above. 

Note that we anticipate some ambiguity about providers recommending postpartum abstinence, a specific 

means to avoid pregnancy and common recommendation in the Nepal follow-up study, but a method that 

is not currently recognized by DHS as a means of family planning. We recommend instructions to 

interviewers about whether, if the woman was told to not have sex for a certain period after giving birth, it 

would be counted as method counseling. 

The added question on antenatal counseling could be included in DHS survey final reports under the 

components of antenatal care (see Appendix Table A.4) and for postnatal counseling could be included as 

a separate table after the table about provider type for postnatal checkup (Appendix Table A.5). We suggest 

the table include the percentage counseled on a family planning method by each type of provider. 

2.3 Questions to Gauge Proximal Fertility Intention Concordance with 

Partner 

2.3.1 Motivation 

The DHS-7 Woman’s Questionnaire includes new questions to measure women’s role in decisionmaking 

about family planning. While this is an important measure, fertility preferences typically precede the 

decision of whether to use family planning and thus are essential to understanding reproductive 

empowerment. In the Ghana study, we found that ambivalent fertility preferences underlying some cases of 

unmet need were frequently tied to the fact that the woman believed that she and her husband had different 

desires for another child and for timing of the next birth. In other words, women’s nonuse of family planning 

despite declaring an intention to have no more children anytime soon (i.e., unmet need) was frequently 

linked to conflicting proximal fertility preferences and to her deference to her husband’s fertility 

preferences. In many cultures, men are more pronatalist than women (Doepke and Tertilt 2018; 

Gebreselassie 2008), so reproductive empowerment can be an important precursor to family planning use. 

In the Nepal follow-up study, while there was greater perceived concordance in fertility intentions, it was 

clear that women’s perception of their husband’s proximal fertility preferences was frequently an important 

aspect of their decisionmaking around family planning. 

If a woman is subject to her husband’s desire for more children while she, herself, does not want more 

children, this dynamic increases the pressure to not use family planning. A husband who wants more 

children soon may discourage or even actively try to prevent his wife from using family planning (Miller 

et al. 2014; John and Edmeades 2018; Mosha, Ruben, and Kakoko 2013). In these cases, women’s 

empowerment is an important aspect of their decision whether to use family planning. Understanding 

women’s perception of whether and when their partner wants a/another birth is an important element of 

understanding their contraceptive empowerment. Currently, we only know from the DHS Woman’s 

Questionnaire whether a woman thinks that her husband/partner wants more or fewer children than she 

does, not whether he wants one sooner or later than her. In combination with new questions on family 

planning decisionmaking, data on women’s perceptions of their partner’s proximal fertility intentions would 

be valuable. 
22 

2.3.2 Proposal 

Assessing women’s participation in reproductive decisionmaking is complex, as both partners may have 

similar proximal fertility preferences (in which case presumably few to no decisions need to be made), or 

may have widely divergent views. We considered different ways of asking women about how involved they 

are in the decision about whether and when to have more children, but potentially similar or differing 

answers at the most basic level (whether to have a/another) combined with potentially differing timeframes 

make participation in reproductive decisionmaking difficult to measure; moreover, such a measure assumes 

both partners plan in concrete timeframes and communicate with each other about their preferences. 

We ultimately decided to propose a set of questions that would measure proximal fertility concordance, to 

which a question on reproductive decisionmaking could later be added if desired. Currently, the DHS 

Woman’s Questionnaire includes a question to women in union about whether her husband or partner wants 

the same number of children as she wants, more, or fewer (Figure 6). This gauge of his ideal number of 

children relative to hers is not commonly used and not useful for programmatic purposes. A woman’s 

husband may want more or fewer children than she does, and yet still want her to delay, start, or resume 

childbearing. 

Figure 6 DHS-7 question on women’s perception of their partner’s desired number of children relative to 

their own 

We proposed replacing the question about women’s perceptions of their husband’s relative desired family 

size with a question about women’s perceptions of their husband’s proximal fertility preference. The 

question could be asked at the same point in the questionnaire as above, or during the section on fertility 

preferences where women are asked whether their husband wants more, the same, or fewer children than 

they do. The question would be phrased separately for pregnant and nonpregnant women following the 

structure used by DHS Woman’s Questionnaire questions about a respondent’s proximal fertility 

preferences (Figure 7). 

We proposed that for pregnant women, the question about their husband’s proximal fertility preferences be 

asked as “After the child you are expecting now, do you think your husband/partner wants another child or 

does he prefer not to have any more children?” If he wants another, the question on timing would say “After 

the birth of the child you are expecting now, how long do you think your husband/partner would like to wait 

before the birth of another child?” For nonpregnant women the question sequence could be phrased as “Do 

you think your husband would like to have (a/another) child or would he prefer not to have any more 

children?” and, if she thinks he wants a/another child, then “How long do you think he would like to wait 

from now before the birth of (a/another) child?”

822 SAME NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

MORE CHILDREN . . . . . . . . . . . . . . . . . . . . . . . . . 2

FEWER CHILDREN . . . . . . . . . . . . . . . . . . . . . . . . . 3

DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Does your (husband/partner) w ant the same number 

of children that you w ant, or does he w ant more or 

few er than you w ant?
23 

Figure 7 DHS-7 questions on women’s proximal fertility preferences 

2.3.3 Advantages and disadvantages 

As discussed, women’s empowerment with regards to fertility preferences is, in many ways, central to their 

empowerment with regard to family planning use or nonuse. Substituting a question on women’s 

perceptions of their husband or partner’s proximal fertility intentions would enable a better understanding 

of the relationship between empowerment around fertility intentions and family planning, for example, an 

analysis of the relationship between proximal fertility intention concordance, reproductive empowerment, 

and family planning use. A better understanding of this relationship can help policymakers gauge how to 

design health programs and interventions with reproductive empowerment in mind. Health providers, for 

instance, can adapt their prevention and treatment services with better screening efforts and referral services 

to help women retain increased reproductive autonomy. 

Of note, as many respondents in both follow-up studies were uncertain about the timing of their own fertility 

preferences, or explained these as contingent, it is substantially more likely that there will be uncertainty 

around the degree and timing of their husband’s fertility preferences. Yet perfect accuracy is not the goal; 

to the extent that women consider their husband’s preferences, they consider what they know of his 

preferences. 

As with other proposals, these questions have the downside of adding to an already full questionnaire. 

Additionally, they may prove more challenging to answer than most questions, adding to the cognitive 

burden of the questionnaire. 

801

NEITHER HE OR SHE

STERILIZED STERILIZED

802

PREGNANT NOT PREGNANT

OR UNSURE

803 HAVE ANOTHER CHILD . . . . . . . . . . . . . . . . . . . 1 805

NO MORE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

UNDECIDED/DON'T KNOW . . . . . . . . . . . . . . . . 8

804 HAVE (A/ANOTHER) CHILD . . . . . . . . . . . . . . . . 1

NO MORE/NONE . . . . . . . . . . . . . . . . . . . . . . . . . 2 807

SAYS SHE CAN'T GET PREGNANT . . . . . . . . . . 3 813

UNDECIDED/DON'T KNOW . . . . . . . . . . . . . . . . 8 811

805

MONTHS . . . . . . . . . . . . . . . . 1

NOT PREGNANT PREGNANT

OR UNSURE YEARS . . . . . . . . . . . . . . . . . . . 2

a) b) SOON/NOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 993 811

SAYS SHE CAN'T GET PREGNANT . . . . . . . . . . 994 813

AFTER MARRIAGE . . . . . . . . . . . . . . . . . . . . . . . . .995

OTHER 996 811

DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . 998

(SPECIFY)

CHECK 304:

CHECK 226:

813

CHECK 226:

Now I have some questions about the future. Would 

you like to have (a/another) child, or w ould you prefer 

not to have any (more) children?

After the birth of the 

child you are expecting 

now , how long w ould 

you like to w ait before 

the birth of another 

child?

How long w ould you 

like to w ait from now 

before the birth of 

(a/another) child?

804

812

Now I have some questions about the future. After the 

child you are expecting now , w ould you like to have 

another child, or w ould you prefer not to have any 

more children?
24 

2.3.4 Panel discussion 

One panelist dislikes all fertility intention questions, including the above. Other panelists were skeptical 

about the idea of asking women their impressions of their husband’s proximal fertility preferences. They 

stated that the question to women on their partner’s desired number of children (Figure 6) is a holdover 

from when the DHS interviewed only women, and questions on women’s perceptions of their husband’s 

fertility preferences were redundant with what is already asked in the men’s questionnaire. However, we 

noted (and others discussed) that not all men are administered the questionnaire: if men’s interviews are 

conducted, they are typically a subsample; not all partners are live-in partners; men have lower response 

rates than women; in countries with extensive male labor migration, male partners of respondents cannot 

be reached; and so forth. Moreover, the woman’s perception of her partner’s preference arguably has a 

greater effect on her decisionmaking than the preference he would state to an interviewer, if he is 

interviewed. 

2.3.5 Next steps 

We propose that that questions on women’s impressions of their husbands’ or partners’ proximal fertility 

intentions be tested, either during an upcoming DHS survey or as a pilot followed by cognitive interviews, 

to discern how well respondents understand and feel comfortable answering these questions. The degree of 

concordance with what men themselves (when applicable) respond would be interesting to note. Moreover, 

these questions on a woman’s impression of her husband’s proximal fertility preferences set the stage for a 

set of more case-appropriate questions about women’s involvement in reproductive decisionmaking. For 

example, a different question could be asked if she perceives that they disagree at the most basic level of 

preference (whether to have a/another child), if they disagree only in terms of timing, if they are fairly 

concordant or agree completely, and so forth. 

If these questions are substituted for the existing question on husband’s fertility preferences in the DHS-8 

core questionnaire, we recommend that in Final Reports following the existing table on women’s and men’s 

fertility preferences by number of children (Appendix Table A.6), a new table comparing women’s fertility 

intentions against their perceptions of their husband’s/partner’s intentions could be added. 

2.4 Flags to Indicate Field Estimation of Ages and Dates 

2.4.1 Motivation 

Accurate ages and dates of birth are foundational to the computation of nearly every major indicator based 

on DHS data. Incomplete and inaccurate data on ages and dates of birth of respondents and children result 

in incorrect measurement of key demographic and health indicators such as infant and child mortality, the 

total fertility rate, teenage pregnancy and motherhood, demand satisfied among young women, child 

nutrition, anthropometric measurements such as height-for-age and weight-for-age, and so forth. The DHS 

Program has worked diligently to obtain accurate information on age and date of birth from respondents, 

including the establishment of several field estimation procedures for unknown ages and dates of birth. 

When respondents do not know both their age and date of birth outright, interviewers may use one piece of 

information to estimate the other, but they may also check identity cards, estimate based on ages at key life 

events and time since that event, use a historical events calendar to narrow down dates, determine their age 

relative to someone else in the household with a known date of birth, or—as a last resort—estimate the 

respondent’s age themselves. Such procedures are of particular importance in countries and areas where 
25 

innumeracy is prevalent and vital recordkeeping is deficient. More details are provided about these 

procedures by Pullum and Staveteig (2017), who find that while the quality of DHS data on ages and dates 

has improved over time, inconsistencies remain. 

Currently, if respondents do not know their age and date of birth, or provide inconsistent pieces of 

information, interviewers are instructed to attempt to establish an estimate through other means. For 

example, they may ask the respondent for an identity card (and in doing so, they are advised to check with 

the respondent about the veracity of the date printed on the card). When both age and date of birth are 

unknown, interviewers are instructed to reference respondent’s age at certain life events (for example, birth 

of first child) and number of years ago the event took place, to relate their age to someone in the household 

whose age is more reliably known, or to use the local and/or national historical events calendar they received 

during training. At times, respondents will ask a nearby relative who knows their date of birth reliably. 

Interviewers may also use multiple methods to help narrow down a likely age. 

The DHS Program provides flags in the dataset to indicate whether data processors had to impute age, year 

of birth, and/or month of birth based on incomplete information. However, one key finding from the Ghana 

follow-up study is that the majority of age and date estimation took place in the field, in ways that some 

follow-up respondents could not even recall, and thus analysts lack valuable information about the extent 

to which ages and dates were stated outright or estimated using other information (Staveteig 2016). 

2.4.2 Proposal 

For respondent’s age, year of birth, month of birth, and children’s dates of birth, we proposed that 

interviewers indicate whether the age or date provided was stated outright or estimated in the field, and the 

means used to do so. Note the importance of separating flags for year of birth and month of birth, as 

respondents may state outright one piece of information such as year but may not have any idea about the 

other. Our recommended options to indicate field estimation were: 

(a) the respondent stated the item outright 

(b) for adult respondents: age was computed based on date of birth/year of birth was estimated using 

age 

(c) the respondent obtained this information from an identity card or document (that the interviewer 

verified) or, as sometimes happens, from a relative 

(d) the interviewer obtained the item from the household questionnaire 

(e) the respondent did not know this information, so the interviewer helped them estimate (based on an 

historical calendar, season, or date of or age at key life events plus time since then, or relative to 

someone else in the household) 

(f) age was estimated without any concrete information5

 

5

 According to the DHS interviewer’s manual (ICF 2017), this strategy should only be used after all other options are 

exhausted. 
26 

If desired, similar flags could be added for dates of key life events, such as date of first marriage/ 

cohabitation. 

2.4.3 Advantages and disadvantages 

While these field estimation flags might add a few seconds to overall interview length, we believe they 

could help improve data quality simply by making interviewers cognizant of the type of field estimation 

they are doing. Anecdotes from survey managers indicate that, despite the best possible training, some 

interviewers take shortcuts in the field and compute age based on date of birth immediately, for example. 

Assuming these flags are filled out accurately—an assumption, to be sure, although some independent 

auditing could be done on tablets based on number of seconds spent answering the question—these flags 

could also be used by DHS fieldwork supervisors to help monitor data quality and interviewer performance. 

In Ghana, 7% of mixed-methods study respondents could not provide a year of birth upon follow-up, but 

all were shown in the GDHS dataset as having provided complete age and date of birth information. Most 

of these respondents did not have an identity card available and were uncertain how their year of birth could 

have been obtained by the interviewer. Additionally, research by Pullum and Staveteig (2017) found 

evidence of overcorrection of ages and dates in countries where prior survey rounds had shown substantial 

evidence of age heaping; having to indicate how they obtained the respondent’s age and date of birth may 

remind them to guard against overcorrection. 

When a date of birth or an age is recorded in the dataset as complete, analysts have little choice except to 

use it literally. Researchers would benefit from knowledge of which ages and dates of birth had been 

estimated in the field, and how this was done to improve the accuracy of their confidence bounds on key 

indicators such as infant and child mortality or demand for modern methods satisfied among adolescents. 

For example, researchers could simulate likely margins of error around stated dates of birth and around 

different types of field-estimated dates of birth, and use alternate scenarios to test the sensitivity of their 

estimate to these margins of error. Applications to other ages and dates recorded in the questionnaire, 

particularly to the birth history, would be valuable to analysts for the same reasons. Importantly, field 

supervisors would also benefit from field check tables of these age and date flags, which could be used to 

monitor which interviewers appear to be doing an unusually low or high amount of field estimation. 

2.4.4 Panel discussion 

While there was initial reluctance to place any additional burdens on interviewers and concerns about the 

utility of such information, after discussion and explanation most panelists seemed to think that some kind 

of flag could be valuable. They remarked that the reality is that despite clear instructions that DHS 

interviewers ask respondents for their age directly (ICF 2017), some interviewers will compute based on 

date of birth and in other contexts may default to a complicated formula to sum of ages at a key demographic 

event or events (for example, age at menarche, how many years later she married, how many years after 

that she gave birth, and how old the child is). It would be useful to keep track of how widespread this 

practice is. However, several panelists were concerned that the number of categories proposed would be 

overly burdensome for interviewers. We discussed a simplified three-category flag to indicate whether the 

respondent’s date of birth was stated outright, estimated from the accompanying piece of information, such 

as an ID card or a reliable source, or derived in some other way. There was near consensus that simplified 

flags could be valuable and not overly burdensome. 
27 

At least one panelist was opposed to adding these flags to children’s ages because it would be too 

burdensome for interviewers. Another suggested that for children these flags be used only for births in the 

past five years, as these dates are the only ones relevant for most key indicators, including infant and child 

mortality. Otherwise, most panelists suggested piloting at least a simplified flag for respondents in an 

upcoming DHS survey, and including the flag in internal DHS field check tables. 

2.4.5 Next steps 

We recommend piloting a flag for interviewers to indicate field estimation of ages and dates in an upcoming 

DHS survey. Potentially during the fieldwork pilot stage some interviewers could be asked the simplified 

flag for respondents and for children born in the past five years, others a more detailed flag, and survey 

managers could receive feedback about the burden of each type of flag and then determine whether to 

proceed with a detailed or simplified flag of respondent’s age, year of birth, month of birth, and possibly 

children’s dates of birth during fieldwork. 

As this flag for age and date estimation would not affect the questionnaire and could improve the quality of 

data collection and monitoring of interviewers, we anticipate that it should not be too difficult to find a 

country that would allow this pilot. If implemented, flags may benefit survey managers who track data 

quality throughout the course of fieldwork. 

The flags for age and date estimation would naturally be included in the datasets accompanying release of 

the final report. In terms of presenting results in final DHS reports, we recommend that immediately before 

or after the standard DHS Appendix Table on Completeness of Reporting (Appendix Table A.7), a table 

could be added to indicate what percentage of ages and dates of birth were stated outright or computed in 

some other way, as well as what percentage were imputed during data processing (a variable that already 

exists in the dataset but is not tabulated in final reports). Such a table, and the inclusion of these flags in the 

DHS API/StatCompiler, would be valuable summary information for readers as well as valuable data for 

analysts. 

29 

3 POSSIBLE SUPPLEMENTAL QUESTIONS 

3.1 Follow-up Questions on Fear of Side Effects/Health Concerns

3.1.1 Motivation 

Fear of side effects is the most commonly cited reason for contraceptive nonuse in DHS surveys in Africa, 

Latin America, and the Caribbean, and the second most common reason in Asia (Sedgh and Hussain 2014) 

While DHS data on reasons for nonuse are valuable to researchers and policymakers, the ‘fear of side 

effects’ category is so frequently cited and so broad as to be difficult to interpret. Policymakers and program 

implementers could benefit from knowing whether fear of side effects is based on rumors, secondhand 

information, information shared by a health provider during a consultation, and/or personal experience as 

they develop messaging and design programs (Castle and Askew 2015; Hindin, McGough, and Adanu 2014; 

Sedgh and Hussain 2014). 

3.1.2 Proposals 

We proposed that if the woman replies to Q810 that she is not using a method due to side effects or health 

concerns, then additional probes be added. First, a general probe along the lines of “What is the main reason 

you came to believe that you cannot use contraception due to side effects or health concerns?” In other 

words, are these side effects that she herself has experienced, things that she has heard about in the form of 

secondhand information, something her partner believes, advice from her mother or mother-in-law (Char, 

Saavala, and Kulmala 2010), generalized rumors (along the lines of “all hormonal methods prevent women 

from giving birth afterward”), or has she been warned away from modern methods by health providers or 

community health workers? 

Based on the response to this probe about the main reason why she believes that there are side effects or 

health concerns with contraceptives, we recommended three additional follow-ups: 

• If she herself has experienced these side effects, we suggested that a question be included about which 

of the methods she has mentioned using in her lifetime had she experienced these side effects. Note 

that if proposal 2.1 on ‘ever use’ is accepted, then in a CAPI survey the interviewer could select from 

a list of the methods she reported ever using, but in a paper survey, cross-referencing methods ever 

used could be somewhat difficult for the interviewer. 

• If the information is secondhand, something her partner believes, or based on general rumors, it would 

be valuable to know from whom this information is coming: partner/husband, mother or mother-inlaw, other family member, friend, health care provider. The source of the information is particularly 

valuable when cross-referenced against new DHS-7 questions on the decisionmaker for family 

planning. 

• If—as occasionally was the case in Ghana and Nepal—she cites a medical provider or community 

health volunteer as having warned her away from contraception due to side effects, a probe on provider 

type would likely be valuable. 
30 

3.1.3 Advantages and disadvantages 

In addition to the common downside of adding a new set of questions to an already very long questionnaire, 

the complexity of responses is a possible downside to this proposal. For example, women may have 

different side effect concerns about different methods, and it may not be possible to summarize the nuances 

cleanly in a quantitative survey such as the DHS. 

However, we believe that these additional questions could yield valuable additional information. In Nepal, 

and to some extent in Ghana, when we probed about side effects as a reason for not using a method, we 

learned that this reason was frequently due to the husband’s strongly held views and her deference to those 

views; hence, women’s lack of reproductive empowerment was an important factor in unmet need. These 

additional probes would enable analysis of the source of these concerns in tandem with new data about 

contraceptive decisionmaking. In Ghana, the perception in the literature was that women were basing their 

fear of side effects on rumors, but we found that often women themselves had used a single method with 

side effects and that experience, combined with rumors, led them to extrapolate that all modern methods, 

or all hormonal modern methods, were unusable. And, in both countries, we found instances where doctors 

and community health volunteers had recommended the respondent use a traditional method to avoid side 

effects of modern methods or reduced fecundability from injectables. Hence, information provided by these 

probes can be used to identify issues with different types of provider training and to improve contraceptive 

messaging and counter myths, both for women and men. 

3.1.4 Panel discussion 

The panel had a diversity of viewpoints about this proposal. Some panelists thought that it would be difficult 

for interviewers to categorize the likely wide range of spontaneous responses to the general probe, which 

might go into very specific or complex circumstances. Another panelist thought that if respondents reported 

having personally experienced side effects, we would want to know from which methods and which types 

of side effects they experienced, which could dramatically increase length and complexity. We noted that if 

the experience with side effects happened in the last five years, it might be better to capture it through a 

follow-up during the contraceptive calendar on reasons for discontinuation, as that lends specificity to 

method type and length of use. 

Overall, three panelists recommended that these probes are better suited to a qualitative study. On the other 

hand, one panelist who frequently works in Central and Western Africa thought that this was an excellent 

proposal as it helps shed light on a common and poorly understood response to the question about reasons 

for nonuse. 

3.1.5 Next steps 

Based on the panel discussion, we conclude that these questions may be best thought of as optional additions 

in settings where there is particular interest in disaggregating the reasons behind perceived side effects and 

health concerns. The insertion of these questions into the DHS Woman’s Questionnaire could be overly 

burdensome in contexts where demand satisfied is high, or where other factors (such as infrequent sex or 

spousal absence) are majority responses. Additional details are not very valuable if there is insufficient 

sample size to gauge their prevalence. These dynamics are well-suited to a qualitative study, however not 

to the typical type of convenience sampling at health facilities done in qualitative studies. 
31 

In terms of the effect that these questions would have on a survey final report, we note that reasons for 

nonuse are not tabulated in the DHS tab plan, but the dataset variables on these reasons are routinely 

employed in studies of unmet need (Bongaarts and Bruce 1995; Machiyama and Cleland 2014; Sedgh and 

Hussain 2014). Given that demand for modern methods satisfied, which is based on unmet need, is a 

Sustainable Development Goal, if these follow-up probes are included in a country questionnaire, regardless 

of the adoption of the proposal above it may be desirable to add a table to the tabulation plan about reasons 

for nonuse to final reports. Additional aspects of side effects could be tabulated as subcategories or included 

in a separate table. Additionally, questionnaire designers should keep in mind the possibility of adding 

probes to side effects as a reason for discontinuation in the contraceptive calendar. 

3.2 Questions on Postabortion Family Planning Counseling and Use 

3.2.1 Motivation 

In several DHS countries, there is interest in postabortion counseling, including on family planning. Nepal 

is one such country. The follow-up mixed-methods study in Nepal found that, among women who had ever 

had an abortion, only 25% received postabortion counseling, in part because there was no postabortion 

visit, for example the woman obtained the abortion through pharmaceutical means or from a nonmedical 

provider (Staveteig et al. 2018). Note, however that the sample size was very small (n=28). The parent 

study in Nepal, the NDHS, found that just over half (52%) of all women who had an abortion in the 5 years 

preceding the survey received family planning method counseling (Ministry of Health [Nepal], New ERA, 

and ICF 2017). Postabortion family planning counseling and the availability of long-acting methods at the 

abortion site have been shown to increase contraceptive acceptance and use (Ceylan et al. 2009; Curtis, 

Huber, and Moss-Knight 2010; Huber et al. 2016), which helps prevent future unwanted pregnancies and 

repeat abortions. 

3.2.2 Proposal 

We proposed, for countries that are interested in postabortion counseling, that a woman who has had a 

postabortion visit for her most recent abortion be asked whether she received counseling on a family 

planning method during that visit. Also, we recommended asking if she used a contraceptive method within 

two weeks after the abortion. Typically, to help ensure recall, DHS questions about health care are only 

asked about if the visits occurred in the past five or six years. The 2016 NDHS provides a good example of 

how these questions can be phrased (Figure 8). 

Figure 8 2016 NDHS questions on postabortion family planning counseling and use 

However, we recommended an option in the first question of Figure 8 to indicate that there was no 

postabortion visit, as was the case for 43% of women who had an abortion in the Nepal follow-up study. 

These women indicated that there was no postabortion visit because they obtained the abortion through 
32 

pharmaceutical means, outside of a medical provider, or because they found it unnecessary or too difficult 

to return for the recommended visit (Staveteig et al. 2018). 

3.2.3 Advantages and disadvantages 

Postabortion family planning questions face the common downside of adding to the length of an already 

very long questionnaire. However, we believe that their advantages outweigh this disadvantage as they can 

help policymakers and program managers in several ways. They help provide information on the number 

of women who are not receiving postabortion care, and the number who receive such care but are not 

counseled about family planning. And, when combined with data on the type of facility in which the 

abortion took place and the type of provider, these data can assist policymakers in assessing the need for 

postabortion education packages, for provider re-education and training, and for investigating and 

potentially improving contraceptive availability at the abortion provision site. If contraceptive counseling 

seems ineffective at improving postabortion family planning uptake, additional in-depth research on the 

content and efficacy of counseling may be warranted. 

3.2.4 Panel review 

As the panel discussion focused on postnatal family planning counseling, we did not explicitly discuss 

postabortion family planning counseling. However, all three panel members who provided in-depth review 

and all three who provided a summary review either actively supported or did not object to this idea in 

contexts where there is interest in postabortion counseling. 

3.2.5 Next steps 

We recommend that upcoming surveys in countries with expressed interest in postabortion counseling 

consider these additional questions on counseling about family planning and on method use within two 

weeks of a reported abortion. 

3.3 Questions to Capture Prolonged and Postpartum Abstinence as a 

Method to Regulate Fertility Risk 

3.3.1 Motivation 

Some follow-up respondents in Ghana who had been classified as having an unmet need for contraception 

by the GDHS (18%) reported being intentionally abstinent for long periods of time as a method of 

preventing or avoiding pregnancy. Postpartum women were not included in the study, so postpartum 

abstinence was not captured. However, it is widely known that prolonged and/or postpartum abstinence is 

traditionally used among married couples, particularly in some parts of Central and West Africa, to space 

and limit births (Bongaarts and Potter 2013; Oni and McCarthy 1986; Page and Lesthaeghe 1981). 

Contemporary evidence indicates that prolonged and postpartum abstinence, along with abortion, continue 

to be used as methods of fertility regulation in Africa (Lauro 2011; Rossier and Hellen 2014; Van de Walle 

and Foster 1990) and that postpartum abstinence is regularly practiced in other contexts as well (Cleland, 

Shah, and Benova 2015). 

Some early definitions of unmet need excluded women practicing prolonged abstinence (DeGraff and 

Siddhisena 2015). The current definition of unmet need—and, by extension, of demand for modern methods 
33 

satisfied—implicitly considers all married women to be sexually active. One argument for including 

abstinent women in unmet need calculations is that they have a prospective need for family planning once 

abstinence ends (Ross and Winfrey 2001). We argue that such information could be better obtained through 

questions about contraceptive preparedness. While abstinence is not a contraceptive method as such, it is a 

method of regulating fertility risk that is 100% effective (CDC 2018). Moreover, it meets the definition of 

current use asked about by DHS and shown in Figure 1 (“doing anything or using a method to delay or 

avoid getting pregnant”). We believe it is problematic that prolonged and postpartum abstinence, two 

effective means of fertility regulation, are not explicitly recorded as responses to the standard question on 

doing something to delay or avoid getting pregnant in DHS surveys. 

3.3.2 Proposal 

Currently, the DHS Woman’s Questionnaire does not provide space for prolonged or postpartum abstinence 

to be recorded separately as a means to delay or avoid pregnancy (Figure 1), nor are these techniques of 

fertility regulation included in the knowledge inventory. Recently, interviewer instructions were modified 

to state that prolonged abstinence can be reported as an ‘other traditional method’ in Q304 (Figure 1). We 

are uncertain to what extent this new guidance is being implemented in countries; typically, only a very 

small number of women report using an ‘other traditional method’ and we have no additional means of 

disaggregating that category. We believe that prolonged abstinence should not simply be recorded as an 

“other” method as it is not an actual contraceptive practice, but a fertility regulation practice, and due to its 

obvious efficacy, it is important to capture. Particularly in countries where prolonged and/or postpartum 

abstinence is prevalent among married couples, we recommended that it be recorded and tabulated distinctly 

but not, of course, included in contraceptive prevalence calculations. While reports of other traditional 

methods are extremely low, we believe that adding it to the inventory of knowledge and ever use (see first 

proposal) would increase its reporting in surveys. 

In a recent Guttmacher survey in Ghana (Juarez et al. 2015; Tapales, Juarez, and Philbin 2016) prolonged 

and postpartum abstinence were added to the knowledge and ever use inventory preceding the question 

about method use. The phrasing of the definition of postpartum abstinence was “women can abstain from 

sexual intercourse after birth to prevent a pregnancy.” The definition of [prolonged] abstinence6

 was 

“women can abstain from sexual intercourse to avoid getting pregnant.” Out of 328 users of modern and 

traditional methods captured by the Guttmacher survey, 13 (4%) reported current use of postpartum 

abstinence, while 24 (7%) reported currently using prolonged abstinence.7

We recommended, in a country with a high prevalence of abstinence, piloting separate knowledge inventory 

questions on postpartum and prolonged abstinence, following the Guttmacher model above, and separate 

response categories for these two methods. In this way, we could observe whether there is any confusion 

between responses and how many women who report abstinence elsewhere state it as a means of fertility 

regulation. We suggested keeping reports of prolonged and postpartum abstinence in a variable on fertility 

regulation that is separate from the question on method use so as to avoid including it in method mix. 

 

6

 In the Guttmacher questionnaire, called simply ‘abstinence’. 7

 Authors’ personal correspondence with Jesse Philbin, August 31, 2018. 
34 

Alternately, a second composite variable including all responses to the question on current use could be 

created. 

Note that there are complications. First, is the abstinence intentional on the part of both members of a 

couple? A woman’s ability to use abstinence depends on her level of sexual empowerment within the 

relationship. However, the same is true of withdrawal and periodic abstinence. Second, with prolonged 

abstinence there is a complication of whether the category can apply to unmarried women, many of whom 

avoid sex for a number of reasons, including to prevent pregnancy. While the sequencing of DHS Woman’s 

Questionnaires prevents filtering out married women during contraceptive method questions,8

 we could 

tabulate prolonged abstinence among married women only. Alternately, the reports among unmarried 

women could be left as is, but they would automatically drop out of the sexually active category and thus 

typically not be counted. 

Our proposal noted that the intentionality behind abstinence could be considered in deciding whether the 

response of postpartum or prolonged abstinence is sufficient to be counted separately from other responses 

to this question, such as through a follow-up question confirming the intention behind abstinence. However, 

no other responses to the question on method type are subject to this requirement, and we believe that by 

stating it as a means to delay or avoid pregnancy, intentionality is implied. 

3.3.3 Advantages and disadvantages 

As with proposals to correct the underreporting of traditional methods, a tabulation of postpartum and 

prolonged abstinence would enable our survey results to more accurately reflect the intentional means that 

married women are using to space or limit births. Moreover, we could measure the extent to which periods 

of prolonged and postpartum abstinence (captured elsewhere in the questionnaire) are explicitly being 

thought of as a means to prevent or delay pregnancy. While these two additions to the ‘ever use’ inventory 

would add more length to the questionnaire, and some complications of measurement, the results would be 

a valuable way to measure abstinence as a means of fertility regulation. 

3.3.4 Panel discussion 

This was a controversial proposal. While two additions to the knowledge inventory were not seen as difficult 

or burdensome for interviewers and respondents, there were several other objections. First, whether these 

methods would count in contraceptive prevalence. DHS, which is funded by USAID, follows the USAID 

definitions of contraceptive method types and categories. As stated above, abstinence is technically a means 

of fertility regulation and not a contraceptive method, hence it could be used to restrict the denominator for 

calculations of unmet need and thus of demand satisfied—as infecundity already is (Bradley et al. 2012)—

but should not be included in CPR. However, tabulating prolonged and postpartum abstinence alongside 

method use could be a valuable reflection of the means women use to delay or avoid pregnancy. 

Second, several panelists felt strongly that the definition and intentionality behind prolonged abstinence is 

unclear. For example, a panelist asked whether labor migration would count as prolonged abstinence if it is 

involuntary. We believe prolonged abstinence would count even if it is circumstantial rather than truly 

 

8

 We were told that in DHS surveys women are intentionally asked about their contraceptive use before being asked 

about their marital status in order to help reduce underreporting of contraceptive use among unmarried women. 
35 

intentional, as long as it is a response to the standard DHS question (Figure 1) about using a method or 

means to delay or avoid pregnancy. Abstinence itself is already captured through questions on sexual 

frequency and on resumption of intercourse after a recent birth; what separate entries on the knowledge and 

ever use inventory and separate responses to the standard question on delaying or avoiding pregnancy add 

to this is a sense of intentionality or consciousness. Postpartum abstinence, and, to some extent, prolonged 

abstinence may also have the primary purpose of helping to protect a woman’s health. Yet we again posit 

that if women are responding to the question about delaying or avoiding pregnancy with the response of 

abstinence, then its intentionality is implied and the other reasons for abstinence are irrelevant. 

Third, panelists also noted the difficulty with having unmarried women possibly state that they are using 

abstinence as a method. Abstinence among married women, compared to, for example, young women who 

have never had sex, is a qualitatively different phenomenon. Our response about women who have never 

had sex reporting that they use abstinence as a method—which we agree is qualitatively different from 

reports among married women—would not be part of the contraceptive method tabulation in variable v312, 

but as a separate variable, and in any case would drop out of standard DHS tabulations of method use among 

unmarried women, which restrict the denominator to sexually active women. 

On a related note, a panelist noted that FP2020 and other groups are moving toward measurement of 

contraceptive use among all women regardless of their marital status or sexual activity, so abstinence could 

indeed confuse counting. However, because FP2020 focuses on modern methods only, women using 

prolonged or periodic abstinence to avoid pregnancy would continue to be counted as nonusers. However, 

tabulations of the proportions of women and couples engaging in abstinence could help improve 

contraceptive messaging or support for contraceptive planning. The only concern about confusion in 

method use reporting would be if prolonged or postpartum abstinence would be counted as a method in the 

family planning method type variable (v312) and could thus distort computations of contraceptive method 

mix. As abstinence is not a contraceptive method, we believe that it would be wise to tabulate it separately 

under a separate variable next to v312. Users would then have the option to combine both variables, but it 

would not otherwise distort method mix calculations or CPR estimates. 

Fourth, panelists raised the potential confusion between reporting on periodic versus prolonged abstinence. 

Respondents could potentially hear the word abstinence three times in the inventory (periodic, prolonged, 

and postpartum) and be confused about which to report. Our correspondence with Guttmacher about their 

Ghana study, which included all three types of abstinence in the knowledge and ever use inventory, 

indicated that no women reported using more than one type of abstinence and that interviewers did not 

report any confusion between these three types of abstinence. 

Fifth, a concern was raised on the minimum duration of prolonged abstinence. We replied that we would 

not measure prolonged abstinence by length (as women may have just begun a day ago) or add specific 

probes on intentions, but simply count whether women stated it as a spontaneous response to the question 

on current means to delay or avoid pregnancy. Stating any other method or means in response to the question 

on delaying or avoiding pregnancy is considered sufficient evidence for it being used as a method, so we 

are not certain why abstinence would be treated differently. 

Finally, and on a related note, panelists asked that since abstinence typically ends, how would the DHS 

survey capture whether the couple will be protected afterwards? This can be particularly difficult in 
36 

relationships where women are physically unable or are not empowered enough to refuse sex. We argue 

that abstinence should not be treated any differently than other methods. We do not ask about what will 

happen after pill and condom use end, or what the woman would do if she was coerced into having sex 

during the time of her periodic abstinence, and feel that our contraceptive preparedness proposal (next 

section) covers the issue of planning for resumption of sex. 

3.3.5 Next steps 

We recommend testing the inclusion of postpartum and prolonged abstinence in the knowledge-ever use 

inventory as valid options in response to the question on current family planning use. Those responses 

would be included as a variable separate from v312 on method type as a type of fertility regulation. While 

prolonged and postpartum abstinence should not be counted as contraceptive methods for the purposes of 

CPR, postpartum and prolonged abstinence could be included in a variable separate from v312 and shown 

as columns in tables about current method use (Appendix Table A.2), with a footnote to indicate that they 

are not included in contraceptive prevalence. However, we recognize that there is very little support for this 

proposal within DHS and that it is unlikely to be piloted. 

3.4 Questions about Contraceptive Preparedness During Extended 

Periods of Marital Abstinence 

3.4.1 Motivation 

As described in proposal 3.3, prolonged and postpartum abstinence are used to delay or avoid pregnancy 

by married couples worldwide (Borda, Winfrey, and McKaig 2010; Rossier and Hellen 2014; Rossier et al. 

2015). Similarly, a husband’s extended absence due to labor or educational migration is extremely common 

in Nepal, and to varying degrees in many other Asian and African countries (Adams and Ahsan 2014; Chua 

and Wellman 2015; Coffey, Papp, and Spears 2015; Curtin 1997; Hoang and Yeoh 2015; Garcia et al. 2015; 

Mahtab 2015; Malhotra, Misra, and Leal 2016; Rain 2018; Segatti 2016). While abstinence is the only 

100% effective method of pregnancy avoidance (CDC 2018), women and couples practicing postpartum 

abstinence tend to be poorly prepared for the resumption of sexual intercourse (Alum et al. 2015; Borda, 

Winfrey, and McKaig 2010). As described in the introductory section, the Nepal follow-up study asked 

specifically about contraceptive preparedness upon resumption of sex after a husband’s return and found 

that, despite nearly universal knowledge of his return date, nearly half of all respondents with migrant 

husbands who did not want a/another child soon were unprepared or inadequately prepared for 

contraceptive use upon his return (Staveteig et al. 2018). The DHS questionnaire provides no real 

information on contraceptive preparedness in such situations. 

3.4.2 Proposals 

The DHS Woman’s Questionnaire asks, of nonpregnant women who have been sexually active in the past 

year and who do not desire having children in the next 23 months but are not using family planning, why 

they are not using a method to prevent pregnancy (ICF International 2015). We proposed that if a married 

or in-union respondent reports that she is not using family planning because she is not having sex,9

 ask 

 

9

 Reasons for nonuse are only asked of women who do not want a/another child soon, so contraceptive preparedness 

would only be assessed among this group. 
37 

about her plans for contraceptive use upon the resumption of intercourse. This may require two questions, 

one on anticipated time sexual intercourse will resume—for example, based on the date (if she knows it) 

when her husband returns, after six months postpartum—and at least one question on advance preparation 

for contraceptive use. The question on the resumption of sexual intercourse is not so much to pin down a 

specific timeframe, but to understand how well she can anticipate resumption of intercourse in the future. 

A question on contraceptive preparedness could be phrased something like “Do you expect to use a family 

planning method upon the resumption of sexual intercourse?” and if yes, ask “Have you made a plan 

personally or discussed together the method that you will use and how it will be obtained?” Both parts, the 

contraceptive method and the source, would need to be known, or potentially at least perceived as 

commonly understood by the respondent, to count as a ‘yes’ answer. Some rephrasing may be necessary as 

traditional methods and LAM are not commodity- or service-based methods that require acquisition. 

Additionally, an implicit understanding with their partners, as some women with routinely migrant 

husbands in Nepal stated they had, is difficult to capture. 

In any case, we are not necessarily interested in the specific method, rather in whether an actual plan is in 

place. In some countries and contexts, it may be useful to know more about the specific method type the 

respondent and her partner intend to use, and, if not coitus-dependent, the anticipated start time prior to the 

resumption of sex. 

Note that the current DHS question on whether the respondent intends to use contraception at any point in 

the future (Figure 9), which we believe is generally too vague to be programmatically useful, could be 

removed from the core questionnaire to free up space for these specific questions about contraceptive 

preparedness among women who report no sex as the reason for contraceptive nonuse. 

Figure 9 Standard DHS-7 question about future contraceptive method use 

3.4.3 Advantages and disadvantages 

These additional questions would provide valuable information on contraceptive preparedness in contexts 

where postpartum abstinence, prolonged abstinence, and extended spousal absence frequently puts women 

and couples at risk of an unwanted birth upon return. Analysis of these questions could be conducted in 

tandem with women’s sexual and reproductive empowerment (for example, her perceived ability to refuse 

sex, to decide on family planning, or to ask her husband to use a condom) to better evaluate possible 

programmatic approaches to encourage adequate preparation for a spouse’s return. However, contraceptive 

preparedness is a complex topic. Couples can sometimes be prepared without explicit communication, for 

example the woman follows her common habit of starting the pill a month in advance of her husband’s 

return. These questions may depend on the specific country context and the type of abstinence that is of 

primary concern. 

811

NOT NO, NOT YES,

ASKED CURRENTLY USING CURRENTLY USING

812 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

813

CHECK 303: USING A CONTRACEPTIVE METHOD?

Do you think you w ill use a contraceptive method to 

delay or avoid pregnancy at any time in the future?
38 

3.4.4 Panel discussion 

One panelist noted that this proposal becomes complicated because some women may engage in 

extramarital sex when their partner is absent, so we cannot assume that respondents are only preparing for 

their husband’s return. We agree that it would be challenging to include a specific question on contraceptive 

preparedness for extramarital sexual partners. At the same time, very few women in union in DHS surveys 

state that they have now or have recently had an extramarital partner, so it seems unlikely to be a line of 

questioning that would produce reliable data. Another panelist noted that correctly capturing contraceptive 

preparedness may require several questions, for example whether there is a plan, whether the plan has been 

discussed with her husband/partner, whether there is a specific method in mind, and—if the method involves 

a commodity or service—how it will be obtained. Then, some of the specifics on inadequate start time for 

a hormonal method would need to be captured separately, thus this could become a questionnaire module 

and not a simple addition. Other discussions related to this proposal were largely country- and contextspecific. For example, a panelist noted that women in the Philippines are often the ones who go away for 

work and return, thus unlikely to be interviewed, so a measure of contraceptive preparedness would be 

better among men. Overall, it was suggested that this proposal be revisited based on demand, given that the 

proposal seems more geared toward specific countries or regions with large groups of labor migrants or in 

countries where contraceptive use following postpartum abstinence is a major concern. 

3.4.5 Next steps 

While contraceptive preparedness is likely too specific an issue to be added to the core questionnaire, we 

recommend that countries with substantial levels of stated contraceptive nonuse due to no sex and where 

there may be interest in measuring contraceptive preparedness, such as Nepal, Bangladesh, or the 

Philippines, consider in their next survey piloting a series of questions–or potentially a short module–on 

plans for the resumption of sex, as detailed above. These questions could be used in place of the generic 

DHS question on whether the respondent intends to use contraception at any point in the future, which tends 

to be too vague for programmatic use. The data from these questions could be tabulated before, after, or 

instead of the current DHS tabulation plan table on future use of contraception (Appendix Table A.9) to 

indicate contraceptive preparedness among those who are not using because they don’t have sex. 
39 

4 SUMMARY AND PROPOSED NEXT STEPS 

In addition to their substantive findings, recent DHS follow-up studies in Ghana and Nepal provide insights 

on ways to improve DHS questionnaires and fieldwork procedures. In this report, we detailed our eight 

proposals for improvement: four proposals that received some support to be added to the core questionnaire 

and fieldwork, and four potential supplemental questions or modules that could be used in certain contexts. 

The aim of this report was not to achieve complete consensus among the expert panel—due to the current 

length of the questionnaire, two panelists said that they typically oppose any additions to the DHS Woman’s 

Questionnaire—but rather to engage survey experts who can assess viability and value of our proposals and 

who may have ideas of their own. The assignment given to The DHS Program was to find ways to improve 

the questionnaire and fieldwork procedures; finding ways to cut the questionnaire would have been an 

entirely different undertaking altogether. However, when possible, we suggested times when new questions 

could substitute for extant questions that we do not perceive as particularly valuable. 

Ultimately, we hope that our recommendations will contribute to the large-scale process of DHS core 

questionnaire revisions that will occur at the beginning of DHS-8. Below is a summary table of key issues, 

ultimate decisions after our panel discussion, recommended next steps, and benefits of these suggestions. 

The main downside of each proposal is its addition to the length of the core questionnaire; for reasons of 

space and redundancy we did not make this its own column. 
40 

Table 4.1 Summary of issues, proposals, and recommendations in this report 

Section Title Issue Ultimate decision Recommended next 

steps 

Policy and programmatic 

benefits 

Recommended changes to the core DHS Woman’s Questionnaire 

2.1 Questions to 

improve the 

accuracy of 

family planning 

method 

reporting 

Both follow-up studies 

found, upon prompting, 

that traditional 

contraceptive methods had 

been substantially 

underreported by 

respondents who 

understood DHS to be 

asking about modern 

methods only. There was 

also one case of 

underreporting a natural 

modern method (LAM). 

Panelists expressed 

additional concerns about 

possible underreporting of 

sterilization and coitusdependent methods. 

Consider reintroducing an 

‘ever use’ column to the 

contraceptive knowledge 

inventory that precedes the 

question on current use, as 

was included in DHS-1 

through DHS-5. By having 

to think about their prior 

use of every method, 

women may be less likely 

to underreport traditional 

methods, natural modern 

methods, sterilization, and 

coitus-dependent methods. 

In upcoming DHS surveys, 

test whether an ever-use 

inventory actually 

addresses underreporting 

by probing on methods that 

are likely underreported 

after current use (i.e., a 

modified version of Figure 

2). If ever-use inventory 

reduces or eliminates 

underreporting, then 

strongly consider whether 

to reintroduce the ever-use 

column to the 

contraceptive knowledge 

inventory in the DHS-8 

core questionnaire. 

By obtaining more accurate 

reports of current family 

planning use, including 

traditional methods, 

sterilization, and coitusdependent methods, 

policymakers and program 

implementers can make 

better use of time and 

funding to increase uptake 

among the potential 

‘market’ of family planning 

users. In particular, correct 

estimates of traditional 

method users would 

enable an examination of 

whether and how they 

should be reached 

separately from nonusers. 

2.2 Questions 

about family 

planning 

counseling 

around the time 

of the most 

recent birth 

Using family planning 

during the postpartum 

period helps protect the 

health of mother and baby 

and contributes to optimal 

birth spacing. Optimal 

spacing reduces maternal 

and child mortality, reduces 

health risks to siblings, and 

has other beneficial effects. 

The period surrounding 

childbirth is a critical time to 

reach women and couples 

with counseling and 

messaging about birth 

spacing and family 

planning method 

awareness. 

Given the importance of 

postpartum family 

planning, we recommend 

adding questions about 

antenatal and postnatal 

family planning method 

counseling to existing 

questions about antenatal 

and postnatal care. 

Questions about postnatal 

family planning counseling 

have been successfully 

fielded by DHS; it would 

not be overly burdensome 

to test antenatal counseling 

questions. 

As postnatal counseling 

questions have already 

been tested, they could be 

added straightaway to the 

DHS-8 Woman’s 

Questionnaire. Antenatal 

counseling on birth spacing 

and on counseling about 

postpartum family planning 

methods could be 

pretested to understand 

whether the distinction 

between the two is useful 

before adding these to the 

questionnaire as well. 

Antenatal and postnatal 

family planning counseling 

have been shown to 

increase uptake of 

postnatal contraception. 

Measuring counseling 

during antenatal and 

postnatal care—in 

conjunction with existing 

measures of the type of 

provider, timing, and 

facility—helps 

policymakers gauge the 

extent to which national 

guidelines are being 

followed, and allows 

program directors to 

determine the 

effectiveness of counseling 

on postpartum family 

planning. These data, in 

turn, will help in reviewing 

what types of retraining 

and what social and 

behavior change 

communication 

interventions could be 

improved. 

(Continued...) 

 
41 

Table 4.1—Continued

Section Title Issue Ultimate decision Recommended next 

steps 

Policy and programmatic 

benefits 

Recommended changes to the core DHS Woman’s Questionnaire (cont.) 

2.3 Questions to 

gauge proximal 

fertility intention 

concordance 

with partner 

While empowerment 

around family planning is 

important, fertility 

preferences typically 

precede the question of 

whether to use family 

planning. In Ghana, and to 

some extent in Nepal, we 

found that differing 

proximal fertility 

preferences between 

partners was a critical 

dimension of unmet need. 

To better understand 

women’s reproductive 

empowerment, it would 

help to gauge concordance 

between her own stated 

preferences and her 

impression of his proximal 

fertility preferences, which 

presumably has a greater 

effect on her 

decisionmaking than what 

he states to an interviewer. 

Consider replacing the 

DHS question on partner’s 

desired number of children 

(Figure 6) with questions 

about partner’s proximal 

fertility preference similar to 

those already asked to 

women (Figure 7). In this 

way, concordance of 

fertility intentions can be 

studied among all couples 

in relation to family 

planning empowerment 

and use. 

Test these questions, likely 

during a pilot followed by 

cognitive interviewing or 

during a pretest to an 

upcoming DHS survey to 

discern how well 

respondents understand 

and feel comfortable 

answering these questions, 

along with how much 

additional information they 

provide (above and beyond 

his own statement, when 

available). 

If desired, consider adding 

a follow-up question on 

fertility empowerment 

based on the perceived 

concordance of the 

couple’s proximal fertility 

intentions. 

Given the growing demand 

to measure women’s 

reproductive empowerment 

and assess how it is 

connected to their 

reproductive outcomes, 

data on women’s 

impression of their 

husband’s/partner’s 

proximal fertility 

preferences would be 

valuable. Some women 

experience reproductive 

coercion, which results in 

the women using 

contraception covertly, or 

in undesirable outcomes. 

Through analysis of 

proximal fertility preference 

concordance, 

empowerment, and family 

planning use, stakeholders 

will be better equipped to 

understand how to design 

programs and interventions 

with reproductive 

empowerment in mind. 

2.4 Flags to 

indicate field 

estimation of 

ages and dates 

Accurate age and date 

reporting is foundational to 

the computation of nearly 

every demographic and 

health indicator that uses 

DHS data. The follow-up 

study in Ghana showed 

that a number of 

respondents did not know 

their age or date of birth 

and did not recall any type 

of field estimation, but were 

labeled as having provided 

complete age and date 

information. It is unknown 

how widespread field 

estimation is, and what 

means are being used. 

Panelists expressed 

concern about the added 

burden placed on 

interviewers by having to 

indicate in detail how the 

age or date of birth was 

derived, particularly if flags 

applied to dates of birth of 

children, but there was a 

near-consensus that a 

simple flag to indicate 

whether the respondent’s 

age and date of birth had 

been stated outright, 

derived through some 

other method, or estimated 

without other data would 

be valuable and not overly 

burdensome. Panelists 

recommended piloting the 

flag in an upcoming survey. 

We recommend piloting 

both a simplified flag and a 

more detailed flag for field 

estimation of the 

respondent’s year of birth, 

month of birth, age, and 

dates of birth of children 

born in the past 5 or 6 

years. The two types of 

flags could potentially each 

be tried during a fieldwork 

pilot, and the survey 

manager could request 

feedback on their ease of 

use and decide how to 

implement flags in the full 

survey. Results would be 

added to the dataset and 

final report. 

Given the importance of 

accurate age and date 

information to indicators 

such as infant and child 

mortality, the Total Fertility 

Rate, teenage pregnancy 

and motherhood, demand 

satisfied among young 

women, and 

anthropometric 

measurements, we expect 

that the inclusion of these 

flags could be an important 

means to improve the 

quality of data and 

estimates in three ways. 

First, by making 

interviewers cognizant of 

the type of estimation they 

are doing; second, by 

allowing DHS fieldwork 

monitoring to track these 

flags; and third, because 

analysts could use these 

flags to improve the 

accuracy of confidence 

intervals around key 

demographic and health 

indicators monitored by 

policymakers. 

(Continued...) 

 
42 

Table 4.1—Continued

Section Title Issue Ultimate decision Recommended next 

steps 

Policy and programmatic 

benefits 

Optional/supplemental questions 

3.1 Follow-up 

questions on 

fear of side 

effects/health 

concerns 

Fear of side effects and 

health concerns is the most 

commonly cited reason for 

nonuse of contraception in 

DHS surveys in Latin 

America and the Caribbean 

as well as in Africa, but 

encompasses such a wide 

range of experiences and 

concerns as to be fairly 

uninformative for 

programmatic purposes. 

We propose that if 

respondents report fear of 

side effects/health 

concerns as a reason for 

nonuse, follow-up 

questions be posed to 

ascertain the nature and 

source of these fears. 

There are concerns that 

additional inquiries about 

side effects and health 

concerns are complex, 

difficult for interviewers to 

code, and best left to 

qualitative studies that can 

provide an in-depth 

exploration. On the other 

hand, there was agreement 

that knowing whether side 

effects were experienced 

directly, based on rumors, 

or partner’s preferences 

could be very valuable in 

contexts such as Central 

and West Africa where fear 

of side effects is common. 

Keeping in mind the 

caveats about complexity 

and length, in countries 

where fear of side effects is 

a frequently cited and 

poorly understood 

category, consider 

including the suggested 

follow-up questions to 

better understand this 

response. More in-depth 

qualitative studies may 

also be warranted. 

Program implementers, 

policymakers, and health 

providers will be better able 

to implement more contextspecific guidance, 

messaging, and training 

related to different 

contraceptive methods, 

and potential side effects. 

By learning, for instance, 

how women are getting 

their information on side 

effects, stakeholders will 

be able to target their 

messaging and counseling 

with these social networks 

in mind. 

3.2 Questions on 

postabortion 

family planning 

counseling and 

use 

In countries where there is 

an interest in postabortion 

counseling, questions 

about method counseling 

and use after the most 

recent abortion would help 

gauge the efficacy of the 

healthcare system in 

helping to prevent future 

unwanted and mistimed 

pregnancies. 

We recommend that in 

countries where abortion 

questions are included in a 

DHS survey, women be 

asked whether they 

received postabortion care 

and, if so, whether it 

included counseling on 

family planning method 

use. And, regardless of 

whether they received 

counseling, ask 

respondents whether they 

used a method of family 

planning in the first two 

weeks after the abortion. 

Develop and offer standard 

phrasing on counseling 

about postabortion family 

planning counseling and on 

method use within two 

weeks of a reported 

abortion for future surveys 

in countries interested in 

postabortion counseling. 

Questions about method 

counseling and use after 

the most recent abortion 

would help gauge the 

efficacy of the health-care 

system in preventing future 

unwanted and mistimed 

pregnancies. By 

incorporating counseling 

questions related to family 

planning and method use 

after an abortion visit, 

these data could help 

ensure implementation of 

health-care guidelines and 

gauge whether provider 

retraining is necessary. 

(Continued...) 

 
43 

Table 4.1—Continued

Section Title Issue Ultimate decision Recommended next 

steps 

Policy and programmatic 

benefits 

Optional/supplemental questions (cont.)

3.3 Questions to 

capture 

prolonged or 

postpartum 

abstinence as a 

method to 

regulate fertility 

risk 

Prolonged and postpartum 

abstinence are fertility risk 

management strategies 

frequently used to avoid 

and delay pregnancy in 

many countries, particularly 

Central and West Africa, 

but—despite their 

efficacy—postpartum and 

prolonged abstinence are 

not explicitly captured by 

DHS surveys in the 

question about doing 

something to delay or 

avoid pregnancy (Figure 

1). Including postpartum 

and prolonged abstinence 

in the knowledge inventory, 

and counting these 

responses separately from 

other traditional methods, 

would more accurately 

reflect means women and 

couples use to delay 

pregnancy. 

There are concerns about 

the intentionality behind 

abstinence, the difficulty 

of fielding reports about 

abstinence among 

unmarried women (as 

marital status is not yet 

known at the time of the 

family planning 

questions), the risk 

women face when 

abstinence ceases, and 

whether to include 

abstinence in CPR (see 

text). Prolonged and 

postpartum methods are 

fertility risk mitigation 

strategies, so they should 

not be included as 

contraceptive methods 

unless USAID declares 

them as a such. There 

was also a concern about 

possible confusion 

between prolonged and 

periodic abstinence. 

Testing of these questions 

in a recent Guttmacher 

survey in Ghana supports 

their utility; there was no 

evidence of confusion. 

We recommend testing the 

inclusion of questions 

about prolonged and 

postpartum abstinence 

during the knowledge 

inventory, and allowing 

them as separate 

responses during the 

question on what method 

or strategy women and 

couples are using to delay 

or avoid pregnancy, 

particularly in areas where 

their usage is common. As 

prolonged and postpartum 

abstinence are not 

contraceptive methods, we 

believe they should be 

counted separately from 

method types so as not to 

distort method mix and 

CPR reporting. In terms of 

intentionality, we believe 

that responding to a 

question about methods to 

delay or avoid pregnancy is 

sufficient evidence of 

intentional or at least 

conscious use. 

It is important for surveys 

to fully reflect the strategies 

women and couples are 

using to prevent 

pregnancy, not only for the 

sake of accuracy, but also 

because they might 

change messaging around 

family planning. For 

example, data on 

abstinence, when reported 

as a means to delay or 

avoid pregnancy, could 

prompt more messaging 

around preparation for 

contraception after the 

resumption of sex. By 

testing the inclusion of 

these questions, we can 

better understand the 

intentionality of these 

fertility risk management 

strategies and whether 

their inclusion in a core 

DHS questionnaire is 

useful or whether they 

should be saved for 

countries where 

postpartum and prolonged 

abstinence is particularly 

high. 

3.4 Questions 

about 

contraceptive 

preparedness 

during 

extended 

periods of 

marital 

abstinence 

Contraceptive 

preparedness during 

periods of postpartum 

abstinence, during a 

husband’s absence, or 

other periods of prolonged 

abstinence, is important to 

help avoid unintended 

pregnancies. Postpartum 

abstinence is routinely 

used by couples 

worldwide, and temporary 

labor migration is common 

varying degrees in many 

other African and Asian 

countries. Contraceptive 

preparedness questions 

would provide valuable 

information on how wellprepared couples are and 

on how important it is for 

policymakers to consider 

messaging around 

contraceptive 

preparedness. 

While questions on 

contraceptive 

preparedness have value, 

there are concerns about 

the number of questions 

required, the standard for 

planning (for example, 

must it require 

discussion), and hence 

the possible utility of the 

information collected. 

Discerning a 

contraceptive plan is quite 

complex, for example 

does it have to involve a 

clear source where the 

method will be obtained (if 

it is a commodity- or 

service-based method)? 

Is it necessary for both 

partners to communicate 

directly about the plan? In 

some countries, there 

would not be sufficient 

numbers of respondents 

using abstinence to justify 

inclusion of a new series 

of questions. 

We recommend that in 

countries with substantial 

levels of abstinence within 

marriage, such as 

postpartum abstinence or 

temporary spousal 

migration, questions about 

contraceptive 

preparedness for the 

resumption of sex be 

included, perhaps as a 

module since several 

questions are involved. 

See text for detail on 

proposed question 

phrasing. 

By gaining an 

understanding of 

whether—and to what 

extent—women and their 

partners prepare for the 

resumption of intercourse 

will help program 

implementers shape 

programs in a way that will 

proactively engage couples 

in these types of important 

discussions. Adequate 

contraceptive 

preparedness enables 

women and couples to 

prevent unintended births. 

45 

REFERENCES 

Adams, R. H., and A. Ahsan. 2014. Managing International Migration for Development in East Asia. 

Washington, DC, USA: World Bank Group. 

Ahmed, S., Q. Li, L. Liu, and A. O. Tsui. 2012. “Maternal Deaths Averted by Contraceptive Use: An 

Analysis of 172 Countries.” Lancet 380 (9837): 111-25. https://doi.org/10.1016/S0140-6736(12)60478-4. 

Alum, A. C., I. B. Kizza, C. P. Osingada, G. Katende, and D. K. Kaye. 2015. “Factors Associated with 

Early Resumption of Sexual Intercourse among Postnatal Women in Uganda.” Reproductive Health 12: 

107. https://doi.org/10.1186/s12978-015-0089-5. 

Bongaarts, J., and J. Bruce. 1995. “The Causes of Unmet Need for Contraception and the Social Content 

of Services.” Studies in Family Planning 26 (2): 57-75. https://www.jstor.org/stable/2137932 

Bongaarts, J., and R. E. Potter. 2013. Fertility, Biology, and Behavior: An Analysis of the Proximate 

Determinants. Cambridge, Massachusetts, USA: Academic Press. 

Borda, M. R., W. Winfrey, and C. McKaig. 2010. “Return to Sexual Activity and Modern Family 

Planning Use in the Extended Postpartum Period: An Analysis of Findings from Seventeen Countries.” 

African Journal of Reproductive Health 14 (4) 75-82. https://www.jstor.org/stable/41329756. 

Bradley, S. E. K., T. N. Croft, J. D. Fishel, and C. F. Westoff. 2012. Revising Unmet Need for Family 

Planning. DHS Analytical Studies No. 25. Calverton, Maryland, USA. 

https://dhsprogram.com/pubs/pdf/AS25/AS25%5B12June2012%5D.pdf. 

Castle, S., and I. Askew. 2015. Contraceptive Discontinuation: Reasons, Challenges, and Solutions. 

Family Planning 2020 and Population Council. http://ec2-54-210-230-186.compute1.amazonaws.com/wp-content/uploads/2015/12/FP2020_ContraceptiveDiscontinuation_ 

SinglePage_Final_12.08.15.pdf. 

CDC. 2018. Abstinence: HIV Risk Reduction Tool. 

https://www.cdc.gov/hivrisk/decreased_risk/abstinence.html. 

Ceylan, A., M. Ertem, G. Saka, and N. Akdeniz. 2009. “Post Abortion Family Planning Counseling as a 

Tool to Increase Contraception Use.” BMC Public Health 9: 20. https://doi.org/10.1186/1471-2458-9-20. 

Char, A., M. Saavala, and T. Kulmala. 2010. “Influence of Mothers-in-Law on Young Couples’ Family 

Planning Decisions in Rural India.” Reproductive Health Matters 18 (35): 154-162. 

https://doi.org/10.1016/S0968-8080(10)35497-8. 

Cleland, J., I. H. Shah, and L. Benova. 2015. “A Fresh Look at the Level of Unmet Need for Family 

Planning in the Postpartum Period, Its Causes and Program Implications.” International Perspectives on 

Sexual and Reproductive Health 41 (3): 155-162. https://doi.org/10.1363/4115515 
46 

Cleland, J., I. H. Shah, and M. Daniele. 2015. “Interventions to Improve Postpartum Family Planning in 

Low- and Middle-Income Countries: Program Implications and Research Priorities.” Studies in Family 

Planning 46 (4): 423-441. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1728-4465.2015.00041.x. 

Coffey, D., J. Papp, and D. Spears. 2015. “Short-Term Labor Migration from Rural North India: Evidence 

from New Survey Data.” Population Research and Policy Review 34 (3): 361-380. 

https://link.springer.com/article/10.1007/s11113-014-9349-2 

Conde-Agudelo, A., A. Rosas-Bermudez, and A. C. Kafury-Goeta. 2006. “Birth Spacing and Risk of 

Adverse Perinatal Outcomes: A Meta-Analysis.” JAMA 295 (15): 1809-23. 

https://doi.org/10.1001/jama.295.15.1809. 

Conde-Agudelo, A., A. Rosas-Bermudez, F. Castaño, and M. H. Norton. 2012. “Effects of Birth Spacing 

on Maternal, Perinatal, Infant, and Child Health: A Systematic Review of Causal Mechanisms.” Studies 

in Family Planning 43 (2): 93-114. 

Curtin, P. 1997. “Africa and Global Patterns of Migration.” Global History and Migration, 63-94. 

Boulder: Westview Press. 

Curtis, C., D. Huber, and T. Moss-Knight. 2010. “Postabortion Family Planning: Addressing the Cycle of 

Repeat Unintended Pregnancy and Abortion.” International Perspectives on Sexual and Reproductive 

Health 36 (1): 44-48. https://doi.org/10.1363/ipsrh.36.044.10 

DeGraff, D. S., and K. Siddhisena. 2015. “Unmet Need for Family Planning in Sri Lanka: Low Enough or 

Still an Issue?” International Perspectives on Sexual and Reproductive Health 41 (4): 200-209. 

https://doi.org/10.1363/4120015. 

Demographic and Health Surveys. 1987. Demographic and Health Surveys Model “A” Questionnaire 

with Additional Health Questions and Commentary for High Contraceptive Prevalence Countries. 

Columbia, Maryland, USA: Institute for Resource Development. 

Doepke, M., and M. Tertilt. 2018. “Women’s Empowerment, the Gender Gap in Desired Fertility, and 

Fertility Outcomes in Developing Countries.” AEA Papers and Proceedings 108: 358-62. DOI: 

10.1257/pandp.20181085 

Garcia, A. J., D. K. Pindolia, K. K. Lopiano, and A. J. Tatem. 2015. “Modeling Internal Migration Flows 

in Sub-Saharan Africa Using Census Microdata.” Migration Studies 3 (1): 89-110. 

http://dx.doi.org/10.1093/migration/mnu036. 

Gebreselassie, T. 2008. Spousal Agreement on Reproductive Preferences in Sub-Saharan Africa. DHS 

Analytical Studies No. 10. Calverton, Maryland, USA: Macro International. 

https://dhsprogram.com/pubs/pdf/AS10/AS10.pdf. 

Gebreselassie, T., K. Bietsch, S. Staveteig, and T. Pullum. 2017. Trends, Determinants, and Dynamics of 

Traditional Contraceptive Method Use. DHS Analysis Studies No. 63. Rockville, Maryland, USA: ICF. 

http://dhsprogram.com/pubs/pdf/AS63/AS63.pdf. 
47 

Hindin, M. J., L. J. McGough, and R. M. Adanu. 2014. “Misperceptions, Misinformation and Myths 

About Modern Contraceptive Use in Ghana.” Journal of Family Planning and Reproductive Health Care

40 (1): 30-5. https://doi.org/10.1136/jfprhc-2012-100464. 

Hoang, L. A., and B. S. Yeoh. 2015. Transnational Labor Migration, Remittances, and the Changing 

Family in Asia, Anthropology, Change and Development. Basingstoke, UK: Palgrave MacMillan. 

Hodgins, S., J. Tielsch, K. Rankin, A. Robinson, A. Kearns, and J. Caglia. 2016. “A New Look at Care in 

Pregnancy: Simple, Effective Interventions for Neglected Populations.” PLoS One 11 (8): e0160562. 

https://doi.org/10.1371/journal.pone.0160562. 

Huber, D., C. Curtis, L. Irani, S. Pappa, and L. Arrington. 2016. “Postabortion Care: 20 Years of Strong 

Evidence on Emergency Treatment, Family Planning, and Other Programming Components.” Global 

Health: Science and Practice 4 (3): 481-94. https://doi.org/10.9745/GHSP-D-16-00052. 

ICF. 2017. Demographic and Health Survey Interviewer’s Manual. Rockville, Maryland, USA: ICF. 

http://www.dhsprogram.com/pubs/pdf/DHSM1/DHS7-Interviewer’s-Manual-EN-12Jun2017-

DHSM1.pdf. 

ICF, and New ERA [Nepal]. 2018. Nepal DHS 2016 Mixed Methods Dataset. Rockville, Maryland, USA: 

ICF and New ERA [Producers]. ICF [Distributor]. 

ICF International. 2015. DHS-7 Woman’s Questionnaire. DHS Model Questionnaires – Phase 7 (2013-

2018). Rockville, Maryland, USA: ICF International. http://dhsprogram.com/pubs/pdf/DHSQ7/DHS7-

Womans-QRE-EN-07Jun2017-DHSQ7.pdf. 

John, N. A., and J. Edmeades. 2018. “Reproductive Coercion and Contraceptive Use in Ethiopia.” Etude 

de la Population Africaine 32 (1). http://dx.doi.org/10.11564/32-1-1150. 

Johnson-Hanks, J. 2002. “On the Modernity of Traditional Contraception: Time and the Social Context of 

Fertility.” Population and Development Review 28 (2): 229-249. 

Juarez, F., J. Philbin, A. Tapales, and H. Whitehead. 2015. Ghana Barriers to Contraceptive Use Survey 

Questionnaire. Mimeograph. New York, NY, USA: Guttmacher Institute. 

Khanal, M. N., D. R. Shrestha, P. D. Panta, and S. Mehata. 2013. Impact of Male Migration on 

Contraceptive Use, Unmet Need and Fertility in Nepal. Further Analysis of the 2011 Demographic and 

Health Survey. Calverton, Maryland, USA: Nepal Ministry of Health and Population, New ERA, and ICF 

International. http://dhsprogram.com/pubs/pdf/FA74/FA74.pdf. 

Lauro, D. 2011. “Abortion and Contraceptive Use in Sub-Saharan Africa: How Women Plan Their 

Families.” African Journal of Reproductive Health 15 (1): 13-23. 

Machiyama, K., and J. Cleland. 2014. “Unmet Need for Family Planning in Ghana: The Shifting 

Contributions of Lack of Access and Attitudinal Resistance.” Studies in Family Planning 45 (2): 203-226. 

https://doi.org/10.1111/j.1728-4465.2014.00385.x. 
48 

Macro International. 1995a. DHS Model “A” Questionnaire with Commentary for High Contraceptive 

Prevalence Countries. Calverton, Maryland, USA: Macro International. 

https://dhsprogram.com/pubs/pdf/DHSQ3/DHS-III-Model-A.pdf.pdf. 

Macro International. 1995b. DHS Model “B” Questionnaire with Commentary for Low Contraceptive 

Prevalence Countries. Calverton, Maryland, USA: Macro International. 

https://dhsprogram.com/pubs/pdf/DHSQ3/DHS-III-Model-B.pdf.pdf. 

Mahtab, N. 2015. “The Effect of Macroeconomic Variables on the Inflow of Remittance in Bangladesh.” 

Economy, Asian Online Journal Publishing Group 2 (1): 21-31. 

Malhotra, R. S., J. Misra, and D. F. Leal. 2016. “Gender and Reproductive Labor Migration in Asia, 

1960–2000.” International Journal of Sociology 46 (2): 114-140. 

Miller, E., H. L. McCauley, D. J. Tancredi, M. R. Decker, H. Anderson, and J. G. Silverman. 2014. 

“Recent Reproductive Coercion and Unintended Pregnancy among Female Family Planning Clients.” 

Contraception 89 (2): 122-128. 

Ministry of Health [Nepal], New ERA, and ICF. 2017. Nepal Demographic and Health Survey 2016. 

Kathmandu, Nepal: Ministry of Health [Nepal], New ERA, and ICF.

http://dhsprogram.com/pubs/pdf/FR336/FR336.pdf. 

Ministry of Health and Population [Nepal], New ERA, and ICF International. 2012. Nepal Demographic 

and Health Survey 2011. Kathmandu, Nepal: Ministry of Health and Population [Nepal], New ERA, and 

ICF International. http://dhsprogram.com/pubs/pdf/FR257/FR257.pdf. 

Mosha, I., R. Ruben, and D. Kakoko. 2013. “Family Planning Decisions, Perceptions and Gender 

Dynamics among Couples in Mwanza, Tanzania: A Qualitative Study.” BMC Public Health 13: 523-523. 

https://doi.org/10.1186/1471-2458-13-523. 

Oni, G. A., and J. McCarthy. 1986. “Use of Contraceptives for Birth Spacing in a Nigerian City.” Studies 

in Family Planning 17 (4): 165-171. 

ORC Macro. 2001a. DHS-IV Model “A” Questionnaire with Commentary for High Contraceptive 

Prevalence Countries. ORC Macro. http://dhsprogram.com/pubs/pdf/DHSQ4/DHS-IV-Model-A.pdf.pdf. 

ORC Macro. 2001b. DHS-IV Model “B” Questionnaire with Commentary for Low Contraceptive 

Prevalence Countries. ORC Macro. http://dhsprogram.com/pubs/pdf/DHSQ4/DHS-IV-Model-B.pdf.pdf. 

Page, H. J., and R. Lesthaeghe. 1981. “Child-Spacing in Tropical Africa: Traditions and Change.” New 

York, NY, USA: Academic Press. 

Pullum, T., and S. Staveteig. 2017. An Assessment of the Quality and Consistency of Age and Date 

Reporting in DHS Surveys, 2000-2015. DHS Methodological Report No. 19. Rockville, Maryland, USA: 

ICF. http://dhsprogram.com/pubs/pdf/MR19/MR19.pdf. 
49 

Rain, D. 2018. Eaters of the Dry Season: Circular Labor Migration in the West African Sahel. London, 

England: Routledge. 

Ram, F., C. Shekhar, and B. Chowdhury. 2014. “Use of Traditional Contraceptive Methods in India & Its 

Socio-Demographic Determinants.” The Indian Journal of Medical Research 140 (Suppl 1): S17. 

Ross, J. A., and W. L. Winfrey. 2001. “Contraceptive Use, Intention to Use and Unmet Need During the 

Extended Postpartum Period.” International Family Planning Perspectives: 20-27. 

Rossier, C., S. E. Bradley, J. Ross, and W. Winfrey. 2015. “Reassessing Unmet Need for Family Planning 

in the Postpartum Period.” Studies in Family Planning 46 (4): 355-367. https://doi.org/10.1111/j.1728-

4465.2015.00037.x. 

Rossier, C., and J. Hellen. 2014. “Traditional Birthspacing Practices and Uptake of Family Planning 

During the Postpartum Period in Ouagadougou: Qualitative Results.” International Perspectives on 

Sexual and Reproductive Health 40 (2): 87-94. 

Rossier, C., L. Senderowicz, and A. Soura. 2014. “Do Natural Methods Count? Underreporting of Natural 

Contraception in Urban Burkina Faso.” Studies in Family Planning 45 (2): 171-182. 

http://doi.org/10.1111/j.1728-4465.2014.00383.x. 

Rutstein, S. O. 2005. “Effects of Preceding Birth Intervals on Neonatal, Infant and Under-Five Years 

Mortality and Nutritional Status in Developing Countries: Evidence from the Demographic and Health 

Surveys.” International Journal of Gynecology & Obstetrics 89 (S1): S7-24. 

https://doi.org/10.1016/j.ijgo.2004.11.012 

Schatz, E. 2012. “Rationale and Procedures for Nesting Semi-Structured Interviews in Surveys or 

Censuses.” Population Studies 66 (2): 183-195. https://dx.doi.org/10.1080%2F00324728.2012.658851. 

Sedgh, G., and R. Hussain. 2014. “Reasons for Contraceptive Nonuse among Women Having Unmet 

Need for Contraception in Developing Countries.” Studies in Family Planning 45 (2): 151-169. 

http://dx.doi.org/10.1111/j.1728-4465.2014.00382.x. 

Segatti, A. 2016. “Explaining the Impasse of Circular Migration in Southern Africa.” In Impact of 

Circular Migration on Human, Political and Civil Rights, 85-108. New York, NY: Springer Publishing. 

http://link.springer.com/chapter/10.1007/978-3-319-28896-3_5. 

Staveteig, S. 2016. Understanding Unmet Need in Ghana: Results from a Follow-up Study to the 2014 

Ghana Demographic and Health Survey. DHS Qualitative Research Studies No. 20. Rockville, Maryland,

USA: ICF International. http://dhsprogram.com/pubs/pdf/QRS20/QRS20.pdf. 

Staveteig, S. 2017. “Fear, Opposition, Ambivalence, and Omission: Results from a Follow-up Study on 

Unmet Need for Family Planning in Ghana.” PLOS ONE 12 (7): e0182076. 

https://doi.org/10.1371/journal.pone.0182076. 

Staveteig, S. 2018. Barriers to Family Planning Use in Eastern Nepal – English Questionnaire. 

Rockville, Maryland, USA: ICF. http://dhsprogram.com/pubs/pdf/OD70/OD70.pdf. 
50 

Staveteig, S., R. Aryeetey, M. Anie-Ansah, C. Ahiadeke, and L. Ortiz. 2017. “Design and Methodology 

of a Mixed Methods Follow-up Study to the 2014 Ghana Demographic and Health Survey.” Global 

Health Action 10 (1): 1274072. https://dx.doi.org/10.1080%2F16549716.2017.1274072. 

Staveteig, S., N. Shrestha, S. Gurung, and K. T. Kampa. 2018. Barriers to Family Planning Use in 

Eastern Nepal: Results from a Mixed Methods Study. DHS Qualitative Research Studies No. 21. 

Rockville, Maryland, USA: ICF. http://dhsprogram.com/pubs/pdf/QRS21/QRS21.pdf. 

Stover, J., and J. Ross. 2010. “How Increased Contraceptive Use Has Reduced Maternal Mortality.” 

Maternal and Child Health Journal 14 (5): 687-695. https://doi.org/10.1007/s10995-009-0505-y. 

Tapales, A., F. Juarez, and J. Philbin. 2016. Preliminary Findings and Lessons Learned from a Pilot 

Study: Ghana Barriers to Contraceptive Use Survey, 2015. Guttmacher White Paper [Mimeograph]. New 

York, NY, USA: Guttmacher Institute. 

United Nations, Department of Economic and Social Affairs, and Population Division. 2015. Trends in 

Contraceptive Use Worldwide. New York, New York, USA. 

http://www.un.org/en/development/desa/population/publications/pdf/family/trendsContraceptiveUse2015

Report.pdf. 

USAID. 2018. Leveraging Antenatal Care to Increase Uptake of Postpartum Family Planning: A Key 

Time for Counseling. https://www.mcsprogram.org/resource/leveraging-antenatal-care-increase-uptakepostpartum-family-planning-key-time-counseling/. 

Van de Walle, E., and A.D. Foster. 1990. Fertility Decline in Africa. Assessment and Prospects. World 

Bank Technical Paper; no. WTP 125. Africa Technical Department series. Washington, D.C. , USA: The 

World Bank. 

World Health Organization. 2013. Programming Strategies for Postpartum Family Planning. Geneva, 

Switzerland: World Health Organization. 

http://apps.who.int/iris/bitstream/handle/10665/93680/9789241506496_eng.pdf?sequence=1. 

World Health Organization. 2016. WHO Recommendations on Antenatal Care for a Positive Pregnancy 

Experience. Luxembourg: World Health Organization. 

http://apps.who.int/iris/bitstream/handle/10665/250796/9789241549912-eng.pdf?sequence=1. 
51 

APPENDIX A: SECTIONS OF THE DHS-7 TABULATION PLAN 

FINAL REPORTS REFERRED TO IN PROPOSALS 

Appendix Table A.1 DHS-7 standard tabulation plan table 7.3: Current use of contraception according to age 

15-19 100.0

20-24 100.0

25-29 100.0

30-34 100.0

35-39 100.0

40-44 100.0

45-49 100.0

Total 100.0

15-19 100.0

20-24 100.0

25-29 100.0

30-34 100.0

35-39 100.0

40-44 100.0

45-49 100.0

Total 100.0

15-19 100.0

20-24 100.0

25+ 100.0

Total 100.0

Table 7.3 Current use of contraception according to age

Percent distribution of all w omen, currently married w omen, and sexually active unmarried w omen age 15-49 by contraceptive method currently used, according to age, [Country Survey Year]

Modern method Traditional method

SEXUALLY ACTIVE UNMARRIED WOMEN1

CURRENTLY MARRIED WOMEN

Total

Number 

of 

w omen

ALL WOMEN

Implants Rhythm Withdraw al Other

Male 

condom

Female 

Age condom LAM Other

Any 

method

Any 

traditional 

method

Male 

sterilization

Not 

currently 

using

1 Women w ho have had sexual intercourse w ithin 30 days preceding the survey 

Note: If more than one method is used, only the most effective method is considered in this tabulation.

LAM = Lactational amenorrhoea method

IUD Injectables

Any 

modern 

method

Female 

sterilization Pill

Emergency 

contraception SDM

SDM= Standard days method
52

Appendix Table A.2 DHS-7 standard tabulation plan table 7.4.1: Current use of contraception according to background characteristics 

Background characteristic

Number of living children

0 100.0

1-2 100.03-4 100.05+ 100.0

Residence

Urban 100.0

Rural 100.0

Region

Region 1 100.0

Region 2 100.0Region 3 100.0Region 4 100.0

Education

No education 100.0

Primary 100.0Secondary 100.0More than secondary 100.0

Wealth quintile

Low est 100.0Second 100.0Middle 100.0Fourth 100.0Highest 100.0

Total 100.0Residence

Urban 100.0

Rural 100.0

Total 100.0

Emergency 

contraception

Table 7.4.1 Current use of contraception according to background characteristics

Percent distribution of currently married w omen and sexually active unmarried w omen age 15-49 by contraceptive method currently used, according to background characteristics, [Country Survey Year]

Modern method Traditional method

Any 

method

Any 

modern 

method

Female 

sterilization

Male 

sterilization Pill IUD Injectables Implants

Male 

condom

Female 

condom

Note: If more than one method is used, only the most effective method is considered in this tabulation.SDM = Standard days methodLAM = Lactational amenorrhea method 

1 Women w ho have had sexual intercourse w ithin 30 days preceding the survey.

Other

Not 

currently 

using Total

Number 

of 

w omen

CURRENTLY MARRIED WOMEN

SEXUALLY ACTIVE UNMARRIED WOMEN1

SDM LAM Other

Any 

traditional 

method Rhythm Withdraw al
53 

Appendix Table A.3 Example of final report table about ever use of contraception by method

 
54 

Appendix Table A.4 DHS-7 standard tabulation plan table 9.3: Components of antenatal care 

 

Age at birth

<20

20-34

35-49

Birth order

1

2-3

4-5

6+

Residence

Urban 

Rural 

Region

Region 1

Region 2

Region 3

Region 4

Education

No education

Primary

Secondary

More than secondary

Wealth quintile

Low est

Second

Middle

Fourth

Highest

Total

Table 9.3 Components of antenatal care

 Among w omen age 15-49 w ith a live birth in the 5 years preceding the survey, percentages w ho took iron tablets or syrup and 

drugs for intestinal parasites during the pregnancy of the most recent live birth; and among w omen receiving antenatal care 

(ANC) for the most recent live birth in the 5 years preceding the survey, percentage receiving specific antenatal services, 

according to background characteristics, [Country Survey Year]

Background 

characteristic

Took iron 

tablets or 

syrup

Took 

intestinal 

parasite 

drugs

Urine sample 

taken

Blood 

pressure 

measured

Among w omen w ith a live 

birth in the past 5 years, 

percentage w ho during the 

pregnancy for the their most 

recent live birth:

Among w omen w ho received antenatal 

care for their most recent live birth in the 

past 5 years, percentage w ith the selected 

services

Blood sample 

taken

Number of 

w omen w ith 

a live birth in 

the past 5 

years

Number of 

w omen w ith 

ANC for their 

most recent 

birth
55 

Appendix Table A.5 DHS-7 standard tabulation plan table 9.10: Type of provider for the first postnatal 

checkup 

Age at birth

<20 100.0

20-34 100.0

35-49 100.0

Birth order

1 100.0

2-3 100.0

4-5 100.0

6+ 100.0

Place of delivery

Health facility 100.0

Elsew here 100.0

Residence

Urban 100.0

Rural 100.0

Region

Region 1 100.0

Region 2 100.0

Region 3 100.0

Region 4 100.0

Education

No education 100.0

Primary 100.0

Secondary 100.0

More than secondary 100.0

Wealth quintile

Low est 100.0

Second 100.0

Middle 100.0

Fourth 100.0

Highest 100.0

Total 100.0

No postnatal 

check during 

the first 2 

days after the 

birth Total

Number of 

w omen

Table 9.10 Type of provider for the first postnatal check for the mother

Among w omen age 15-49 giving birth in the 2 years preceding the survey, percent distribution by type of provider for the 

mother’s first postnatal health check during the 2 days after the last live birth, according to background characteristics 

[Country Survey Year]

Background 

characteristic

Doctor/ 

nurse/ 

midw ife

Auxiliary 

nurse/ 

midw ife

Community 

health 

w orker

Traditional 

birth 

attendant

Type of health provider for mother's first postnatal 

check
56 

Appendix Table A.6 DHS-7 standard tabulation plan table 6.1: Fertility preferences according to number of 

living children 

 

0 1 2 3 4 5 6+

Have another soon2 na

Have another later3 na

Have another, undecided w hen na

Undecided na

Want no more na

Sterilized4 na

Declared infecund na

 

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 na

Number of w omen na

Have another soon2

Have another later3

Have another, undecided w hen

Undecided

Want no more

Sterilized4

Declared infecund

 

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Number of men

Table 6.1 Fertility preferences according to number of living children

Number of living children

WOMEN1

MEN5

Total 15-49

Total 15-

54[59]

Percent distribution of currently married w omen and currently married men age 15-49 by desire for children, 

according to number of living children, [Country Survey Year]

Desire for children

5 The number of living children includes one additional child if respondent’s w ife is pregnant (or if any w ife is pregnant

for men w ith more than one current w ife).

na = Not applicable

1 The number of living children includes the current pregnancy.

2 Wants next birth w ithin 2 years

3 Wants to delay next birth for 2 or more years

4 Includes both female and male sterilization
57 

Appendix Table A.7 DHS-7 standard tabulation plan appendix table C.3: Completeness of reporting 

 

Birth date Births in the 15 years preceding the survey 

Day only

Day and month

Day, month, and year 

Age at death Deceased children born in the 15 years preceding the survey

Age/date at first union1 Ever-married w omen age 15-49

Ever-married men age 15-54[59]

Respondent's education Women age 15-49

Men age 15-54[59]

Diarrhea in past 2 weeks Living children age 0-59 months

Anthropometry of Living children age 0-59 months (from the Biomarker 

Height 

Weight 

Height or w eight 

Anthropometry of women Women age 15-49 (from the Biomarker Questionnaire)

Height 

Weight 

Height or w eight 

Anthropometry of men Men age 15-49 (from the Biomarker Questionnaire)

Height 

Weight 

Height or w eight 

Anemia

Children Living children age 6-59 months (from the Biomarker 

Women All w omen (from the Biomarker Questionnaire)

Men All men (from the Biomarker Questionnaire)

1 Both year and age missing

Table C.3 Completeness of reporting

Subject Reference group

Number of 

cases

Percentage 

w ith 

information 

Percentage of observations missing information for selected demographic and health questions (w eighted), [Country Survey

Year]
58 

Appendix Table A.8 DHS-7 standard tabulation plan table 7.15: Future use of contraception