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Household Template 42 -Form Fill
HOUSEHOLD COMPOSITION
Q01
Line Number
Q02
Please tell me the names of all the persons who usually live in your household, starting with the head of the household.
Q03
What is the relationship of [NAME] to the head of household?
HEAD OF THE HOUSEHOLD
SPOUSE
SON/DAUGHTER
SON/DAUGHTER IN LAW
GRANDCHILD
FATHER/MOTHER
FATHER/MOTHER IN LAW
BROTHER/SISTER
BROTHER/SISTER IN LAW
NIECE/NEPHEW
GRAND PARENT/GRAND PARENT-IN-LAW
OTHER RELATIVE
ADOPTED/FOSTER/STEPCHILD
DOMESTIC SERVANT
OTHER (SPECIFY)
NOT STATED
Q04
What is the sex of [NAME]?
MALE
FEMALE
TRANSGENDER
Q05
How old is [NAME]?
Q06
Does [NAME] suffer from any disability?
Yes
No
Q07
Type of disability?
In Seeing
In Hearing
In Speech
In Movement
Mental Retardation
Mental Illness
Other disability
Multiple disability
Not disabled
Q08
What is [NAME’s] marital status?
CURRENTLY MARRIED
MARRIED, GAUNA NOT PERFORMED
WIDOWED
DIVORCED
SEPARATED
DESERTED
NEVER MARRIED
NOT MARRIED, BUT LIVE TOGETHER
Q09
Has (Name) had diarrhea in the last two weeks?
Yes
No
Q10
Was there any blood in the stools?
Yes
No
Q11
What was your age when you got married?
Q12
What was your age when you gave birth to your first child?
Q13
How old was your husband when you got married?
Q14
Do you know how to read and write?
YES, READ AND WRITE
YES, READ ONLY
CAN SIGN ONLY
CANT READ AND WRITE
Q15
Have you ever attended school?
Yes
No
Q16
What is the highest standard or class you completed?
Q17
Apart from housework, have you worked in any job for which you were paid in cash or kind in the last 12 months?
Yes
No
Q18
What kinds of work did/do you do?
FARMER (CROPS)
AGRICULTURAL DAY LABOR
HERDING ANIMALS
NON AGRICULTURAL DAY LABOR
MAID SERVANT
COOK
CHILD CARE PROVIDER
SERVICE/SALARIED WORKER
SMALL/COTTAGE INDUSTRY
PETTY BUSINESS/SHOP
BUSINESS/TRADER
OTHER SELF-EMPLOYMENT
SKILLED WORKER
OTHER (SPECIFY)
Q19
What is the highest standard or class your husband completed?
Q20
In the past 12 months, has your husband been employed?
Yes
No
Q21
What is your husband’s occupation?
FARMER
AGRICULTURAL DAY LABOR
NON AGRICULTURAL DAY LABOR
SERVICE/SALARIED WORKER
SMALL/COTTAGE INDUSTRY
BUSINESS/TRADERS
RICKSHAW/VAN PULLING
SERVANT
COOK
OTHER SELF-EMPLOYMENT
PETTY BUSINESS/SHOP
JOBLESS
SKILLED WORKER
TOO OLD TO WORK
PENSION
OTHER (SPECIFY)
DO NOT KNOW
HOUSEHOLD CHARACTERISTICS
A01
Name of the respondent
A02
Line Number of respondent
A03
What is your religion?
HINDU
MUSLIM
CHRISTIAN
SIKH
BUDDHIST/NEO-BUDDHIST
JAIN
JEWISH
PARSI/ZOROASTRIAN
NO RELIGION
SARNA
OTHER (SPECIFY)
A04
Which caste do you belong to?
SCHEDULED CASTE
SCHEDULED TRIBE
OTHER BACKWARD CASTE
GENERAL
OTHER (SPECIFY)
A05
What is the type of your household?
Nuclear
Joint
Extended
Others
A06
Does your household own this house or any other house?
Yes
No
A07
LOOK AT THE FLOOR AND CODE THE MAIN MATERIAL OF THE FLOOR
MUD/CLAY/EARTH
SAND
DUNG
RAW WOOD PLANKS
PALM/BAMBOO
BRICK
STONE
PARQUET OR POLISHED WOOD
VINYL OR ASPHALT
CERAMIC TILES
CEMENT
CARPET
POLISHED TONE/MARBLE/GRANITE
OTHER (SPECIFY)
A08
LOOK AT THE ROOF AND CODE THE MAIN MATERIAL OF THE ROOF
NO ROOF
THATCH/PALM LEAF/REED/GRASS
MUD
SOIL/MUD AND GRASS MIXTURE
PLASTIC/POLYTHENE SHEETING
RUSTIC MAT
PALM/BAMBOO
RAW WOOD PLANKS/TIMBER
UNBURNT BRICK
LOOSELY PACKED STONE
METAL/GI
WOOD
CALAMINE/CEMENT FIBER
ASBESTOS SHEETS
RCC/RBC/CEMENT/CONCRETE
ROOFING SHINGLES
TILES
SLATE
BURNT BRICK
OTHER (SPECIFY)
A09
LOOK AT THE EXTERIOR WALLS AND CODE THE MAIN MATERIAL OF THE WALLS
NO WALLS
CANE/PALM/TRUNKS/BAMBOO
MUD
GRASS/REEDS/THATCH
BAMBOO WITH MUD
STONE WITH MUD
PLYWOOD
CARDBOARD
UNBURNT BRICK
RAW WOOD/REUSED WOOD
CEMENT/CONCRETE
STONE WITH LIME/CEMENT
BURNT BRICKS
CEMENT BLOCKS
WOOD PLANKS/SHINGLES
GI/METAL/ASBESTOS SHEETS
OTHER (SPECIFY)
A10
TYPE OF WINDOWS
A10_1
ANY WINDOWS
Yes
No
A10_2
WINDOWS WITH GLASS
Yes
No
A10_3
WINDOWS WITH SCREENS
Yes
No
A10_4
WINDOWS WITH CURTAINS OR SHUTTERS
Yes
No
A11
How many rooms in total is there in this house?
A12
How many rooms in this house are used for sleeping?
A13
Do you have a separate room which is used as a kitchen?
Yes
No
A14
What type of fuel does your household mainly use for cooking?
ELECTRICITY
LPG/NATURAL GAS
BIOGAS
KEROSENE
COAL/LIGNITE
CHARCOAL
WOOD
STRAW/SHRUBS/GRASS
AGRICULTURAL CROP WASTE
DUNG CAKES
OTHER (SPECIFY)
A15
What is the main source of lighting in this household?
LANTERN
KEROSENE LAMP
CANDLE
ELECTRIC
LPG/BATTERY
SOLAR ENERGY
NONE
OTHERS (SPECIFY)
A16
What is the main source of drinking water for members of your household?
PIPED INTO DWELLING
PIPED TO YARD/PLOT
PUBLIC TAP/STANDPIPE
TUBE WELL/BOREHOLE
PROTECTED WELL
UNPROTECTED WELL
PROTECTED SPRING
UNPROTECTED SPRING
RAINWATER
TANKER TRUCK
CART WITH SMALL TANK
SURFACE WATER (RIVER/DAM/LAKE/POND/STREAM/CANAL/IRRIGATION CHANNEL)
BOTTLED WATER
GOVERNMENT HAND PUMP
HAND PUMP AT HOME
NEIGHBOUR’S HAND PUMP
OTHER (SPECIFY)
A17
Is the main source of drinking water within the premises of the household?
Yes
No
A18
How far is the main source of drinking water located?
A19
How long does it take to go to the water source, get water, and come back during the rainy season?
A20
How long does it take to go to the water source, get water, and come back during the dry season?
A21
Do you treat / do something special with the water that you fetch to make it safer to drink?
Yes
No
A22
What do you usually do to the water to make it safer to drink?
BOIL
USE ALUM
ADD BLEACH/CHLORINE TABLETS
STRAIN THROUGH A CLOTH/ANY OTHER STRAINER
USE WATER FILTER (CERAMIC/SAND/COMPOSITE/ETC.)
USE ELECTRONIC PURIFIER
LET IT STAND AND SETTLE
OTHER (SPECIFY)
DO NOT KNOW
A23
Does your household have a functional toilet?
Yes
No
A24
What kind of toilet facilities does your household have?
FLUSH TO PIPED SEWER SYSTEM
FLUSH TO SEPTIC TANK
FLUSH TO PIT LATRINE
FLUSH TO SOMEWHERE ELSE
FLUSH, DON'T KNOW WHERE
VENTILATED IMPROVED PIT (VIP)/BIOGAS LATRINE
PIT LATRINE WITH SLAB
PIT LATRINE WITHOUT SLAB/ OPEN PIT
TWIN PIT/COMPOSTING TOILET
DRY TOILET
OTHER (SPECIFY)
A25
What kind of toilet facility do members of your household usually use?
FLUSH TO PIPED SEWER SYSTEM
FLUSH TO SEPTIC TANK
FLUSH TO PIT LATRINE
FLUSH TO SOMEWHERE ELSE
FLUSH, DON'T KNOW WHERE
VENTILATED IMPROVED PIT (VIP)/BIOGAS LATRINE
PIT LATRINE WITH SLAB
PIT LATRINE WITHOUT SLAB/ OPEN PIT
TWIN PIT/COMPOSTING TOILET
DRY TOILET
NO FACILITY/USES OPEN SPACE OR FIELD
OTHER (SPECIFY)
A26
In the past week has anyone in your household including children defecated in the open for example in the field or in the river?
Yes
No
A27
The last time a child passed stools, what was done to dispose of the stools?
CHILD USED TOILET/ LATRINE
PUT/RINSED INTO TOILET OR LATRINE
PUT/RINSED INTO DRAIN OR DITCH
THROWN INTO GARBAGE
BURIED
LEFT/WASHED IN THE OPEN
NO CHILD IN HOUSEHOLD
OTHER (SPECIFY)
DO NOT KNOW
A28
Does the household have soap and water immediately near the toilet facility?
Yes
No
A29
On what occasions did you wash your hands with soap since this time yesterday?
NO SOAP AVAILABLE IN THE HOUSEHOLD
SOAP AVAILABLE IN THE HOUSEHOLD BUT DID NOT USE IT TO WASH HANDS
BEFORE COOKING
AFTER HANDLING FOOD
BEFORE EATING
BEFORE FEEDING THE INFANT
AFTER CLEANING INFANT FECES
WHEN I WASH CLOTHES
WHEN I BATHE
WHEN I WASH DISHES
AFTER USING TOILET
AFTER COMING BACK FROM OUTSIDE
OTHER SPECIFY
A30
Does your household have
A30_1
Electricity
Yes
No
A30_2
A mattress
Yes
No
A30_3
A pressure cooker
Yes
No
A30_4
A chair
Yes
No
A30_5
A cot or bed
Yes
No
A30_6
A table
Yes
No
A30_7
An electric fan
Yes
No
A30_8
A radio or transistor
Yes
No
A30_9
A black and white television
Yes
No
A30_10
A color television
Yes
No
A30_11
A sewing machine
Yes
No
A30_12
A mobile telephone
Yes
No
A30_13
Any other type of telephone
Yes
No
A30_14
A computer/laptop
Yes
No
A30_15
A refrigerator
Yes
No
A30_16
A watch or clock
Yes
No
A30_17
A bicycle
Yes
No
A30_18
A motorcycle or scooter
Yes
No
A30_19
An animal-drawn cart
Yes
No
A30_20
A car
Yes
No
A30_21
A water pump
Yes
No
A30_22
A thresher
Yes
No
A30_23
A tractor
Yes
No
A30_24
Internet
Yes
No
A30_25
Air Conditioner or Cooler
Yes
No
A30_26
Washing Machine
Yes
No
ACESS TO AND KNOWLEDGE OF GOVERNMENT SCHEMES
B01
Have you ever heard about _?
B01_1
Indira Awas Yojna (IAY)/Pradhan Mantri Gramin Awaas Yojana
Yes
No
B01_2
Swachh Bharat Abhiyan (SBA)
Yes
No
B01_3
Janani Shishu Suraksh Karykaram
Yes
No
B01_4
Pradhanmantri Surakha Beema Yojana (accidental death insurance)
Yes
No
B01_5
Atal Pension Yojana
Yes
No
B01_6
Pension for the disabled
Yes
No
B01_7
Ladli Laxmi Yojana
Yes
No
B01_8
Ujjwala Yojana
Yes
No
B01_9
Prime Minister Crop Insurance Scheme
Yes
No
B02
Is your household / anyone in your household eligible for this scheme?
B02_1
Indira Awas Yojna (IAY)/Pradhan Mantri Gramin Awaas Yojana
Yes
No
B02_2
Swachh Bharat Abhiyan (SBA)
Yes
No
B02_3
Janani Shishu Suraksh Karykaram
Yes
No
B02_4
Pradhanmantri Surakha Beema Yojana (accidental death insurance)
Yes
No
B02_5
Atal Pension Yojana
Yes
No
B02_6
Pension for the disabled
Yes
No
B02_7
Ladli Laxmi Yojana
Yes
No
B02_8
Ujjwala Yojana
Yes
No
B02_9
Prime Minister Crop Insurance Scheme
Yes
No
B03
Has anyone in your household ever availed this scheme?
B03_1
Indira Awas Yojna (IAY)/Pradhan Mantri Gramin Awaas Yojana
Yes
No
B03_2
Swachh Bharat Abhiyan (SBA)
Yes
No
B03_3
Janani Shishu Suraksh Karykaram
Yes
No
B03_4
Pradhanmantri Surakha Beema Yojana (accidental death insurance)
Yes
No
B03_5
Atal Pension Yojana
Yes
No
B03_6
Pension for the disabled
Yes
No
B03_7
Ladli Laxmi Yojana
Yes
No
B03_8
Ujjwala Yojana
Yes
No
B03_9
Prime Minister Crop Insurance Scheme
Yes
No
B04
When was the last time someone in your household used this scheme?
B04_1
Indira Awas Yojna (IAY)/Pradhan Mantri Gramin Awaas Yojana
B04_2
Swachh Bharat Abhiyan (SBA)
B04_3
Janani Shishu Suraksh Karykaram
B04_4
Pradhanmantri Surakha Beema Yojana (accidental death insurance)
B04_5
Atal Pension Yojana
B04_6
Pension for the disabled
B04_7
Ladli Laxmi Yojana
B04_8
Ujjwala Yojana
B04_9
Prime Minister Crop Insurance Scheme
B05
Have you ever heard about Mahatma Gandhi National Rural Employment Guarantee Act?
Yes
No
B06
Does anyone in your household have a MGNREGA job card? If yes, please show me.
YES, SEEN
YES, REPORTED BUT NOT SEEN
NO
B07
In the past year, how many days did members of your household work for MGNREGA?
B08
For this total number of days worked by household members, how many days were worked by men and how many days were worked by women?
B09
When was the last time someone in your household worked for MGNREGA in last 1 year?
B10
Have you ever heard of Public Distribution System?
Yes
No
B11
Have you ever heard of Antyodaya Anna Yojana?
Yes
No
B12
Does your household have a ration card?
Yes
No
B13
Is your name included in the ration card?
Yes
No
B14
Which card do you have?
ANTODAYA ANNA YOJANA
ANNAPURNA
BPL
APL
OTHER
DO NOT KNOW
B15
In the past 30 days, did you buy anything from a ration shop?
Yes
No
B16
Which items did you buy from the ration shop in the last 30 days and in what quantity?
B17
Whether Purchased
B17_1
Rice
Yes
No
B17_2
Wheat
Yes
No
B17_3
Sugar
Yes
No
B17_4
Salt
Yes
No
B17_5
Kerosene
Yes
No
B17_6
Clothes
Yes
No
B18
Quantity Purchased
B18_1
Rice
B18_2
Wheat
B18_3
Sugar
B18_4
Salt
B18_5
Kerosene
B18_6
Clothes
B19
Have you ever heard of the ICDS scheme / Anganwadi centre?
Yes
No
B20
At present is there any ____ in your household?
B20_1
Pregnant Woman
Yes
No
B20_2
Lactating Woman
Yes
No
B20_3
Child aged 6-35 months
Yes
No
B20_4
Child aged 3-6 years
Yes
No
B21
Did the member receive supplementary nutrition / hot cooked food from the AWC in the last 12 months?
B21_1
Pregnant Woman
Yes
No
B21_2
Lactating Woman
Yes
No
B21_3
Child aged 6-35 months
Yes
No
B21_4
Child aged 3-6 years
Yes
No
B22
How many times did the member receive food from the AWC in the last month?
B22_1
Pregnant Woman
B22_2
Lactating Woman
B22_3
Child aged 6-35 months
B22_4
Child aged 3-6 years
B23
Have you ever heard about the Janani suraksha Yojana Scheme?
Yes
No
B24
Do you know how much money the beneficiary is supposed to get under the JSY scheme?
B25
Does the household avail the following?
B25_1
SAVINGS
Yes
No
B25_2
CREDIT
Yes
No
B25_3
INSURANCE
Yes
No
B25_4
REMITTANCE
Yes
No
B25_5
PENSION
Yes
No
B26
Where does the household save?
SHG
GOVERNMENT BANK
COOPERATIVE BANK
PRIVATE BANK
POST OFFICE
FRIENDS / RELATIVES
AT HOME
OTHERS (Specify)
B27
From what sources does the household avail credit?
SHG
GOVERNMENT BANK
COOPERATIVE BANK
PRIVATE BANK
FRIENDS / RELATIVES
KISAN CREDIT CARD
MONEY LENDERS
OTHERS (Specify)
B28
What type of insurance does the household have?
LIFE INSURANCE
ASSET INSURANCE
LIVESTOCK INSURANCE
CROP INSURANCE
HEALTH INSURANCE
ACCIDENT INSURANCE
OTHER (SPECIFY)
B29
Does anyone in your household have a bank account opened under the Pradhan Mantri Jan Dhan Yojana?
Yes
No
B30
Has the account been operated in the last 3 months?
Yes
No
B31
What activity was performed on the account?
WITHDRAWL
DEPOSIT
OTHER (SPECIFY)
DO NOT KNOW
B32
Have you availed the overdraft facility from your account under the Jan Dhan Yojana in the last 1 year?
Yes
No
B33
If yes, what was the overdraft amount?
B34
Does any member of your household avail retirement pension?
Yes
No
B35
What are the pensions that the household members receive?
CENTRAL GOVERNMENT PENSION
STATE GOVERNEMENT PENSION
PRIVATE COMPANY PENSION
CONTRIBUTARY PENSION FROM BANK (NATIONALIZED OR PRIVATE)
OTHER
B36
Have you ever heard of the old Age Pension Scheme?
Yes
No
B37
How many members in your household were eligible for the Old Age Pension Scheme in the last 1 year?
B38
How many members availed the Old Age Pension Scheme in the last 1 year?
B39
Have you ever heard of the widow pension scheme?
Yes
No
B40
How many members in your household were eligible for the Widow Pension Scheme in the last 1 year?
B41
How many members have availed the Widow Pension Scheme in the last 1 year?
B42
Have you ever heard about Rashtriya Swasth Bima Yojana (RSBY)?
Yes
No
B43
Does your Household have a RSBY smart card?
Yes
No
B44
Was the smart card updated in the last one year?
Yes
No
B45
Did anyone in your household use the smart card in last one year?
Yes
No
Awareness to acts and entitlements
C01
Are you aware of NREGA scheme? EXPLAIN: In which you get a job card and can avail employment?
Yes
No
C02
Can you highlight some of the key provisions of NREGA?
C02_1
Every adult member of the HH whose name appears on the job card can apply for unskilled work under NREGA
Spontaneous
Prompt
Do Not Know
C02_2
Registration for job card has to be made at Gram Panchayat
Spontaneous
Prompt
Do Not Know
C02_3
A registered HH can get employment for maximum 100 days in a year
Spontaneous
Prompt
Do Not Know
C02_4
Wages paid within a fortnight of the end of the work
Spontaneous
Prompt
Do Not Know
C02_5
Work under NREGA has to be provided within a period of 15 days of application by HH
Spontaneous
Prompt
Do Not Know
C02_6
Work site facilities like toilet, drinking water, crèche for children, first aid etc.
Spontaneous
Prompt
Do Not Know
C02_7
Social audit in NREGA
Spontaneous
Prompt
Do Not Know
C03
Are you aware of the Right to Education Act, which provides free and compulsory education to all children aged 6 to 14 years
Yes
No
C04
What are the provisions that come under the RTE Act?
C04_1
Every child of the age of 6 to14 be provided 8 years of free and compulsory elementary education
Spontaneous
Prompt
Do Not Know
C04_2
Primary schools are established within walking distance of 1 Km of neighborhood
Spontaneous
Prompt
Do Not Know
C04_3
Secondary schools are established within walking distance of 3 Km of neighborhood
Spontaneous
Prompt
Do Not Know
C04_4
No child shall be liable to pay any kind of fee or charges or expenses which may stop the child from getting education
Spontaneous
Prompt
Do Not Know
C05
Are you aware of the entitlements under Public distribution system?
Yes
No
C06
What are the major commodities distributed through PDS?
C06_1
Wheat
Spontaneous
Prompt
Do Not Know
C06_2
Rice
Spontaneous
Prompt
Do Not Know
C06_3
Sugar
Spontaneous
Prompt
Do Not Know
C06_4
Kerosene
Spontaneous
Prompt
Do Not Know
C06_5
Clothes
Spontaneous
Prompt
Do Not Know
C07
Are you aware of the entitlements under Old Age Pension Scheme?
Yes
No
C08
What are the features of OAP scheme?
C08_1
Covers all Indians above 60 years of age and living below the poverty line
Spontaneous
Prompt
Do Not Know
C08_2
The beneficiaries aged 60-79 receive a monthly pension of Rs. 200 60 से 79
Spontaneous
Prompt
Do Not Know
C08_3
Those 80 years and above receive a monthly pension amount of Rs. 500
Spontaneous
Prompt
Do Not Know
C09
Are you aware of the entitlements from Angan Wadi Center?
Yes
No
C10
What are the entitlements available under this?
C10_1
Pregnant women in the village are provided supplementary nutrition / Take Home Ration
Spontaneous
Prompt
Do Not Know
C10_2
Lactating women in the village are provided supplementary nutrition / Take Home Ration
Spontaneous
Prompt
Do Not Know
C10_3
Children aged 6-35 years receive supplementary nutrition / Take Home Ration
Spontaneous
Prompt
Do Not Know
C10_4
Children aged 3-6 years receive hot cooked food at the AWC
Spontaneous
Prompt
Do Not Know
C10_5
Children aged 3-6 years receive pre-school education
Spontaneous
Prompt
Do Not Know
C11
Are you aware of the entitlements available under the Janani Suraksha Yojana?
Yes
No
C12
What are the entitlements available under this?
C12_1
Women giving birth to a child at a Government health facility are entitled to benefit from this
Spontaneous
Prompt
Do Not Know
C12_2
Such women are entitled to a sum of Rs. 1400 for institutional delivery
Spontaneous
Prompt
Do Not Know
C13
Are you aware of the entitlements available under the Mid-Day Meal scheme?
Yes
No
C14
What are the entitlements available under this?
C14_1
Every child in every Government and Government assisted Primary Schools will be provided a prepared mid-day meal each school day for a minimum of 200 days
Spontaneous
Prompt
Do Not Know
C14_2
The cost for preparation of food shall not be borne by children or their parents
Spontaneous
Prompt
Do Not Know
C14_3
In drought affected areas, midday meals shall be supplied even during summer vacations
Spontaneous
Prompt
Do Not Know
C15
Are you aware of the entitlements under the Sarva Shiksha Abhiyan?
Yes
No
C16
What are the entitlements available under this?
C16_1
Provision of free text books and stationary
Spontaneous
Prompt
Do Not Know
C16_2
Provision of school uniforms
Spontaneous
Prompt
Do Not Know
C16_3
Provision of bicylces to girls enrolled in upper primary sections outside the village
Spontaneous
Prompt
Do Not Know
LAND OWNERSHIP AND USE OF LAND FOR FARMING
D01
Does any your household own, lease in any agricultural land?
Yes
No
D02
Does your household engage in agricultural activities?
Yes
No
D03
How much agricultural land does your household presently have access to:
D04
Out of this land how much is irrigated or rainfed?
Risk taking Behaviour and adoption of new crop varieties
E01
What is the main crop that your produce?
WHEAT
RICE
MAIZE
FINGER MILLET
Cotton
soyabean
daal
Groundnut
OTHERS (SPECIFY)
E02
Now I would like to ask you whether you are completely dependent on your main crop or you also grow other crops or engage in livestock rearing or other non-farm activites.
OPT FOR DIFFERENT VARIETY OF SAME CROPS
GROW OTHER CROPS
ENGAGE IN LIVESTOCK REARING
ENGAGE IN OTHER NON-FARM ACTIVITIES
NO MEASURES TAKEN
OTHERs (SPECIFY)
E03
What type of crops do you choose to grow?
GROW OTHER VEGETABLE CROPS
GROW FRUIT CROPS
ENGAGE IN FLORICULTURE
OTHER CERIAL
OTHER PULSE
OTHERS (SPECIFY)
E04
What type of animals do you rear
COWS
BUFFALO
PIGS
POULTRY
FISHERY
GOAT
OTHERS (SPECIFY)
E05
What type of non-farm activities do you undertake?
SMALL SCALE ENTERPRISE
LARGE SCALE ENTERPRISE
LOCAL AGRI LABOUR
LOCAL NON-AGRI LABOUR
MIGRANT LABOUR
OTHERS (SPECIFY)
PRODUCTION TECHNOLOGY
F01
Main crop of household
WHEAT
RICE
MAIZE
FINGER MILLET
Cotton
soyabean
daal
Groundnut
OTHERS (SPECIFY)
F02
What type of seed was primarily used for production of ____?
Improved
Local
Don’t know
F03
When was the last time you purchased new seeds for this crop?
F04
Do you treat the seeds in some way before planting?
Yes
No
F05
How long before transplantation/sowingdo you practice weeding?
F06
Do you use a germination test to check the seeds?
Yes
No
F07
Was any fertilizer used on the land during production of _______?
Organic
K (Potash)
P(Phosphate)
N (Nitrogen/ Urea)
Composite (DAP, N`PK, Gromor etc.)
Organic and chemical both
None
Other
Don’t know
F08
Do you apply anything else to improve the quality of the soil?
Apply Lime
Apply Dolomite
Apply anything else
Nothing
F09
For this crop, are you mostly using line planting/transplanting or do you broadcast the crop in the main field or both?
Line planting/ transplanting
Broadcast crop
Both
First broadcast then line planting/transplanting
Don’t know
F10
At what stage of the cropping practices do you usually apply urea?
Never
At the time of sowing
After irrigation/rain
Before irrigation/rain
After weeding
Before weeding
During Eartning
Flowering stage
Don’t know
F11
How many days after planting do you irrigate the crop?
F12
After planting, when do you practice earthing-up?
Immediately
Within 7 days
Within 30 days
After 1month
Any time
Never
Do not need earthing
Don’t know
F13
Do you practice hoeing in fields where you grow _____?
Yes
No
F14
What inputs does your HH normally purchase for a cropping season
F14_1
SEEDS
Yes
No
F14_2
CHEMICAL FERTILIZERS
Yes
No
F14_3
ORGANIC FERTILIZERS
Yes
No
F14_4
CHEMICAL PESTICIDES
Yes
No
F14_5
ORGANIC PESTICIDES
Yes
No
F14_6
FARMING TOOLS (such as spades, sickles etc.)
Yes
No
F14_7
FARMING IMPLEMENTS (such as tillers, threshers, Pesticide sprayers etc.)
Yes
No
F14A
Do you ever go to purchase _____ for the crop?
F14A_1
SEEDS
Yes
No
F14A_2
CHEMICAL FERTILIZERS
Yes
No
F14A_3
ORGANIC FERTILIZERS
Yes
No
F14A_4
CHEMICAL PESTICIDES
Yes
No
F14A_5
ORGANIC PESTICIDES
Yes
No
F14A_6
FARMING TOOLS (such as spades, sickles etc.)
Yes
No
F14A_7
FARMING IMPLEMENTS (such as tillers, threshers, Pesticide sprayers etc.)
Yes
No
F15
Who decides on the purchase of inputs required for farming?
F15_1
SEEDS
self
husband
any other male member
other female members
both male and female members
other (specify)
F15_2
CHEMICAL FERTILIZERS
self
husband
any other male member
other female members
both male and female members
other (specify)
F15_3
ORGANIC FERTILIZERS
self
husband
any other male member
other female members
both male and female members
other (specify)
F15_4
CHEMICAL PESTICIDES
self
husband
any other male member
other female members
both male and female members
other (specify)
F15_5
ORGANIC PESTICIDES
self
husband
any other male member
other female members
both male and female members
other (specify)
F15_6
FARMING TOOLS (such as spades, sickles etc.)
self
husband
any other male member
other female members
both male and female members
other (specify)
F15_7
FARMING IMPLEMENTS (such as tillers, threshers, Pesticide sprayers etc.)
self
husband
any other male member
other female members
both male and female members
other (specify)
F16
Where does your HH purchase the inputs from?
F16_1
SEEDS
local weekly markets (haat)
local dealers
market in nearest town
market in block headquarters
market in district headquarters
Farmers cooperative/group
others (specify)
F16_2
CHEMICAL FERTILIZERS
local weekly markets (haat)
local dealers
market in nearest town
market in block headquarters
market in district headquarters
Farmers cooperative/group
others (specify)
F16_3
ORGANIC FERTILIZERS
local weekly markets (haat)
local dealers
market in nearest town
market in block headquarters
market in district headquarters
Farmers cooperative/group
others (specify)
F16_4
CHEMICAL PESTICIDES
local weekly markets (haat)
local dealers
market in nearest town
market in block headquarters
market in district headquarters
Farmers cooperative/group
others (specify)
F16_5
ORGANIC PESTICIDES
local weekly markets (haat)
local dealers
market in nearest town
market in block headquarters
market in district headquarters
Farmers cooperative/group
others (specify)
F16_6
FARMING TOOLS (such as spades, sickles etc.)
local weekly markets (haat)
local dealers
market in nearest town
market in block headquarters
market in district headquarters
Farmers cooperative/group
others (specify)
F16_7
FARMING IMPLEMENTS (such as tillers, threshers, Pesticide sprayers etc.)
local weekly markets (haat)
local dealers
market in nearest town
market in block headquarters
market in district headquarters
Farmers cooperative/group
others (specify)
F17
What according to you is the best place to buy the agricultural inputs from?
F17_1
SEEDS
local weekly markets (haat)
local dealers
market in nearest town
market in block headquarters
market in district headquarters
Farmers cooperative/group
others (specify)
do not know
F17_2
CHEMICAL FERTILIZERS
local weekly markets (haat)
local dealers
market in nearest town
market in block headquarters
market in district headquarters
Farmers cooperative/group
others (specify)
do not know
F17_3
ORGANIC FERTILIZERS
local weekly markets (haat)
local dealers
market in nearest town
market in block headquarters
market in district headquarters
Farmers cooperative/group
others (specify)
do not know
F17_4
CHEMICAL PESTICIDES
local weekly markets (haat)
local dealers
market in nearest town
market in block headquarters
market in district headquarters
Farmers cooperative/group
others (specify)
do not know
F17_5
ORGANIC PESTICIDES
local weekly markets (haat)
local dealers
market in nearest town
market in block headquarters
market in district headquarters
Farmers cooperative/group
others (specify)
do not know
F17_6
FARMING TOOLS (such as spades, sickles etc.)
local weekly markets (haat)
local dealers
market in nearest town
market in block headquarters
market in district headquarters
Farmers cooperative/group
others (specify)
do not know
F17_7
FARMING IMPLEMENTS (such as tillers, threshers, Pesticide sprayers etc.)
local weekly markets (haat)
local dealers
market in nearest town
market in block headquarters
market in district headquarters
Farmers cooperative/group
others (specify)
do not know
F18
Why do you think ____ is the best place to buy the agricultural inputs?
F18_1
SEEDS
easily accessible
cheaper inputs are available
better quality inputs are available
more stock availability
Get on credit
Because hh members/all villagers purchase from there
others (specify)
F18_2
CHEMICAL FERTILIZERS
easily accessible
cheaper inputs are available
better quality inputs are available
more stock availability
Get on credit
Because hh members/all villagers purchase from there
others (specify)
F18_3
ORGANIC FERTILIZERS
easily accessible
cheaper inputs are available
better quality inputs are available
more stock availability
Get on credit
Because hh members/all villagers purchase from there
others (specify)
F18_4
CHEMICAL PESTICIDES
easily accessible
cheaper inputs are available
better quality inputs are available
more stock availability
Get on credit
Because hh members/all villagers purchase from there
others (specify)
F18_5
ORGANIC PESTICIDES
easily accessible
cheaper inputs are available
better quality inputs are available
more stock availability
Get on credit
Because hh members/all villagers purchase from there
others (specify)
F18_6
FARMING TOOLS (such as spades, sickles etc.)
easily accessible
cheaper inputs are available
better quality inputs are available
more stock availability
Get on credit
Because hh members/all villagers purchase from there
others (specify)
F18_7
FARMING IMPLEMENTS (such as tillers, threshers, Pesticide sprayers etc.)
easily accessible
cheaper inputs are available
better quality inputs are available
more stock availability
Get on credit
Because hh members/all villagers purchase from there
others (specify)
F19
Does your hh sell any of the agricultural produce in the market?
F19_1
Cereal
Yes
No
F19_2
Pulses
Yes
No
F19_3
Vegetable
Yes
No
F19_4
Fruits
Yes
No
F19_5
Other crop
Yes
No
F19A
Do you ever go to sell _____?
F19A_1
Cereal
Yes
No
F19A_2
Pulses
Yes
No
F19A_3
Vegetable
Yes
No
F19A_4
Fruits
Yes
No
F19A_5
Other crop
Yes
No
F20
Who decides on the sale of the produce in the market?
F20_1
Cereal
self
husband
any other male member
other female members
both male and female members
other (specify)
F20_2
Pulses
self
husband
any other male member
other female members
both male and female members
other (specify)
F20_3
Vegetable
self
husband
any other male member
other female members
both male and female members
other (specify)
F20_4
Fruits
self
husband
any other male member
other female members
both male and female members
other (specify)
F20_5
Other crop
self
husband
any other male member
other female members
both male and female members
other (specify)
F21
Where does your hh sell the produce?
F21_1
Cereal
local weekly markets (haat)
local dealers
market in nearest town
market in block headquarters
market in district headquarters
other villagers
Government Centres where produce is sold at MSP
others
do not know
F21_2
Pulses
local weekly markets (haat)
local dealers
market in nearest town
market in block headquarters
market in district headquarters
other villagers
Government Centres where produce is sold at MSP
others
do not know
F21_3
Vegetable
local weekly markets (haat)
local dealers
market in nearest town
market in block headquarters
market in district headquarters
other villagers
Government Centres where produce is sold at MSP
others
do not know
F21_4
Fruits
local weekly markets (haat)
local dealers
market in nearest town
market in block headquarters
market in district headquarters
other villagers
Government Centres where produce is sold at MSP
others
do not know
F21_5
Other crop
local weekly markets (haat)
local dealers
market in nearest town
market in block headquarters
market in district headquarters
other villagers
Government Centres where produce is sold at MSP
others
do not know
F22
What according to you is the best place to sell the agricultural produce?
F22_1
Cereal
local weekly markets (haat)
local dealers
market in nearest town
market in block headquarters
market in district headquarters
other villagers
Government Centres where produce is sold at MSP
do not know
F22_2
Pulses
local weekly markets (haat)
local dealers
market in nearest town
market in block headquarters
market in district headquarters
other villagers
Government Centres where produce is sold at MSP
do not know
F22_3
Vegetable
local weekly markets (haat)
local dealers
market in nearest town
market in block headquarters
market in district headquarters
other villagers
Government Centres where produce is sold at MSP
do not know
F22_4
Fruits
local weekly markets (haat)
local dealers
market in nearest town
market in block headquarters
market in district headquarters
other villagers
Government Centres where produce is sold at MSP
do not know
F22_5
Other crop
local weekly markets (haat)
local dealers
market in nearest town
market in block headquarters
market in district headquarters
other villagers
Government Centres where produce is sold at MSP
do not know
F23
Why do you think ____ is the best place to sell the agricultural produce?
F23_1
Cereal
Easily accessible/convenient
Better market price
Do not produce sufficient quantity to sell in larger markets
Because household members/all villagers sell there
others (specify)
F23_2
Pulses
Easily accessible/convenient
Better market price
Do not produce sufficient quantity to sell in larger markets
Because household members/all villagers sell there
others (specify)
F23_3
Vegetable
Easily accessible/convenient
Better market price
Do not produce sufficient quantity to sell in larger markets
Because household members/all villagers sell there
others (specify)
F23_4
Fruits
Easily accessible/convenient
Better market price
Do not produce sufficient quantity to sell in larger markets
Because household members/all villagers sell there
others (specify)
F23_5
Other crop
Easily accessible/convenient
Better market price
Do not produce sufficient quantity to sell in larger markets
Because household members/all villagers sell there
others (specify)
Women’s space in agricultural decision making and gendered division of labor
G01
Did you participate in _____ in the past 12 months?
G01_1
Food crop farming: crops that are grown primarily for household food consumption
Yes
No
G01_2
Cash crop farming: crops that are grown primarily for sale in the market
Yes
No
G01_3
Livestock raising
Yes
No
G01_4
Poultry (e.g. chicken, duck, pigeon)
Yes
No
G01_5
piscicultue or fishpond culture
Yes
No
G02
How much input did you have in making decisions about_____?
G02_1
Food crop farming: crops that are grown primarily for household food consumption
NO INPUT
INPUT INTO VERY FEW DECISIONS
INPUT INTO SOME DECISIONS
INPUT INTO MOST DECISIONS
INPUTS INTO ALL DECISIONS
G02_2
Cash crop farming: crops that are grown primarily for sale in the market
NO INPUT
INPUT INTO VERY FEW DECISIONS
INPUT INTO SOME DECISIONS
INPUT INTO MOST DECISIONS
INPUTS INTO ALL DECISIONS
G02_3
Livestock raising
NO INPUT
INPUT INTO VERY FEW DECISIONS
INPUT INTO SOME DECISIONS
INPUT INTO MOST DECISIONS
INPUTS INTO ALL DECISIONS
G02_4
Poultry (e.g. chicken, duck, pigeon)
NO INPUT
INPUT INTO VERY FEW DECISIONS
INPUT INTO SOME DECISIONS
INPUT INTO MOST DECISIONS
INPUTS INTO ALL DECISIONS
G02_5
piscicultue or fishpond culture
NO INPUT
INPUT INTO VERY FEW DECISIONS
INPUT INTO SOME DECISIONS
INPUT INTO MOST DECISIONS
INPUTS INTO ALL DECISIONS
G03
Are you engaged in any of the agricultural activities?
Yes
No
G04
Are you engaged in ________?
G04_1
Tilling/ Ground preparation
Yes
No
G04_2
Sowing/Transplanting
Yes
No
G04_3
Intercultural operations (weeding, hoeing)
Yes
No
G04_4
Fertiliser application
Yes
No
G04_5
Irrigation application
Yes
No
G04_6
Harvesting
Yes
No
G04_7
Sale/marketing of produce in local haat
Yes
No
G04_8
Sale/marketing of produce in mandi
Yes
No
G05
Why do you think you should be involved in this activity?
G05_1
Tilling/ Ground preparation
IT’S MY RESPONSIBILITY
IT REQUIRES LESS LABOUR
THIS WORK IS BETTER SUITED FOR WOMEN
IT SAVES TIME OF OTHER MEMBERS
G05_2
Sowing/Transplanting
IT’S MY RESPONSIBILITY
IT REQUIRES LESS LABOUR
THIS WORK IS BETTER SUITED FOR WOMEN
IT SAVES TIME OF OTHER MEMBERS
G05_3
Intercultural operations (weeding, hoeing)
IT’S MY RESPONSIBILITY
IT REQUIRES LESS LABOUR
THIS WORK IS BETTER SUITED FOR WOMEN
IT SAVES TIME OF OTHER MEMBERS
G05_4
Fertiliser application
IT’S MY RESPONSIBILITY
IT REQUIRES LESS LABOUR
THIS WORK IS BETTER SUITED FOR WOMEN
IT SAVES TIME OF OTHER MEMBERS
G05_5
Irrigation application
IT’S MY RESPONSIBILITY
IT REQUIRES LESS LABOUR
THIS WORK IS BETTER SUITED FOR WOMEN
IT SAVES TIME OF OTHER MEMBERS
G05_6
Harvesting
IT’S MY RESPONSIBILITY
IT REQUIRES LESS LABOUR
THIS WORK IS BETTER SUITED FOR WOMEN
IT SAVES TIME OF OTHER MEMBERS
G05_7
Sale/marketing of produce in local haat
IT’S MY RESPONSIBILITY
IT REQUIRES LESS LABOUR
THIS WORK IS BETTER SUITED FOR WOMEN
IT SAVES TIME OF OTHER MEMBERS
G05_8
Sale/marketing of produce in mandi
IT’S MY RESPONSIBILITY
IT REQUIRES LESS LABOUR
THIS WORK IS BETTER SUITED FOR WOMEN
IT SAVES TIME OF OTHER MEMBERS
INCOME
H01
Did anyone in the household earn income from any of the following sources in the last 12 months?
H01_1
In last 12 months has anyone in your household engaged in agriculture labour
Yes
No
H01_2
In last 12 months has anyone in your household engaged in non-agricultural labour like construction of roads, carrying bricks, digging wells etc.
Yes
No
H01_3
In last 12 months has anyone in your household engaged in skilled labour
Yes
No
H01_4
In last 12 months has anyone in your household engaged in Small business activities (street vending, shop keeping, handicrafts, sells liquor)
Yes
No
H01_5
In last 12 months has anyone in your household engaged in NTFP selling
Yes
No
H01_6
In last 12 months has anyone in your household earned from salaried job?
Yes
No
H01_7
In last 12 months has anyone in your household engaged in Other activity(specify)- – excluding Agriculture and livestock as we will talk about agriculture and livestock later
Yes
No
H02
Whether earned from this activity?
H02_1
In last 12 months has anyone in your household engaged in agriculture labour
Yes
No
H02_2
In last 12 months has anyone in your household engaged in non-agricultural labour like construction of roads, carrying bricks, digging wells etc.
Yes
No
H02_3
In last 12 months has anyone in your household engaged in skilled labour
Yes
No
H02_4
In last 12 months has anyone in your household engaged in Small business activities (street vending, shop keeping, handicrafts, sells liquor)
Yes
No
H02_5
In last 12 months has anyone in your household engaged in NTFP selling
Yes
No
H02_6
In last 12 months has anyone in your household earned from salaried job?
Yes
No
H02_7
In last 12 months has anyone in your household engaged in Other activity(specify)- – excluding Agriculture and livestock as we will talk about agriculture and livestock later
Yes
No
H03
Who in the household earned income over last 12 months?
H03_1
In last 12 months has anyone in your household engaged in agriculture labour
MEN
WOMEN
BOTH MEN & WOMEN
CHILDREN
ALL HH MEMBERS
H03_2
In last 12 months has anyone in your household engaged in non-agricultural labour like construction of roads, carrying bricks, digging wells etc.
MEN
WOMEN
BOTH MEN & WOMEN
CHILDREN
ALL HH MEMBERS
H03_3
In last 12 months has anyone in your household engaged in skilled labour
MEN
WOMEN
BOTH MEN & WOMEN
CHILDREN
ALL HH MEMBERS
H03_4
In last 12 months has anyone in your household engaged in Small business activities (street vending, shop keeping, handicrafts, sells liquor)
MEN
WOMEN
BOTH MEN & WOMEN
CHILDREN
ALL HH MEMBERS
H03_5
In last 12 months has anyone in your household engaged in NTFP selling
MEN
WOMEN
BOTH MEN & WOMEN
CHILDREN
ALL HH MEMBERS
H03_6
In last 12 months has anyone in your household earned from salaried job?
MEN
WOMEN
BOTH MEN & WOMEN
CHILDREN
ALL HH MEMBERS
H03_7
In last 12 months has anyone in your household engaged in Other activity(specify)- – excluding Agriculture and livestock as we will talk about agriculture and livestock later
MEN
WOMEN
BOTH MEN & WOMEN
CHILDREN
ALL HH MEMBERS
H04
How much did the household earn from [activity] ______ over the past 12 months?
H04_1
In last 12 months has anyone in your household engaged in agriculture labour
H04_2
In last 12 months has anyone in your household engaged in non-agricultural labour like construction of roads, carrying bricks, digging wells etc.
H04_3
In last 12 months has anyone in your household engaged in skilled labour
H04_4
In last 12 months has anyone in your household engaged in Small business activities (street vending, shop keeping, handicrafts, sells liquor)
H04_5
In last 12 months has anyone in your household engaged in NTFP selling
H04_6
In last 12 months has anyone in your household earned from salaried job?
H04_7
In last 12 months has anyone in your household engaged in Other activity(specify)- – excluding Agriculture and livestock as we will talk about agriculture and livestock later
H05
In the last 12 months, has any member of the household or other relatives have sent you any money from outside?
Yes
No
H06
How often has your household received remittances in the last 12 months?
EACH MONTH
MANY TIMES / YEAR
TWICE A YEAR
ONCE A YEAR
LESS THAN ONCE A YEAR
DO NOT KNOW
H07
How much money did your household receive as remittances in the last 12 months?
H08
During the last 12 months, did anyone in the household own any animals including livestock, poultry, fish, etc.?
Yes
No
H09
How many _______ did you sell in the last 12 months?
H09_1
Buffalo
H09_2
Oxen
H09_3
Cow
H09_4
Goat
H09_5
Sheep
H09_6
Duck
H09_7
Poultry
H09_8
Pig
H09_9
Fish
H10
How much did your household receive for the sale of these _________ in the last 12 months?
H10_1
Buffalo
H10_2
Oxen
H10_3
Cow
H10_4
Goat
H10_5
Sheep
H10_6
Duck
H10_7
Poultry
H10_8
Pig
H10_9
Fish
H11
Did you produce any ___ during the last 12 months?
H11_1
Animal/Fish meat/offal
Yes
No
H11_2
Poultry meat/offal
Yes
No
H11_3
Milk (including that produced for milk products)
Yes
No
H11_4
Eggs
Yes
No
H12
Did your household sell any of the ___ produced?
H12_1
Animal/Fish meat/offal
Yes
No
H12_2
Poultry meat/offal
Yes
No
H12_3
Milk (including that produced for milk products)
Yes
No
H12_4
Eggs
Yes
No
H13
How much in total did your household receive for the sale of ________?
H13_1
Animal/Fish meat/offal
H13_2
Poultry meat/offal
H13_3
Milk (including that produced for milk products)
H13_4
Eggs
H14
Did your household engage in agricultural activities in the past 12 months?
Yes
No
H16
What is the total quantity produced?
H17
How much of the harvested____was sold?(Quantity in kg)
H18
What was the income from the sale of ___?
H19
Does your household receive any farm produce from the land that you lease out?
Yes
No
H21
What is the total quantity received?
H22
How much of the received ____was sold?
H23
What was the income from the sale of ___?
FOOD SECURITY
I01
how many times were the following food groups consumed by:
I02
YOU
I02_1
Rice, Wheat, Maize, maize porridge, Other cereal (sorghum, millet, etc),
I02_2
Beans and peas, pulses groundnuts and cashew nuts
I02_3
VITAMIN A RICH VEGETABLES AND TUBERS
I02_4
WHITE TUBERS AND ROOTSWHITE TUBERS AND ROOTS
I02_5
DARK GREEN LEAFY VEGETABLES
I02_6
OTHER VEGETABLES
I02_7
VITAMIN A RICH FRUITS
I02_8
ORGAN MEAT
I02_9
FLESH MEATS
I02_10
EGGS
I02_11
FISH
I02_12
Milk/yogurt/other dairy product
I02_13
Sugar or sugar products, honey
I02_14
Oils/fats/butter
I02_15
RED PALM PRODUCTS
I02_16
SPICES, CONDIMENTS,BEVERAGES
I03
CHILDREN AGE 3-5 YRS
I03_1
Rice, Wheat, Maize, maize porridge, Other cereal (sorghum, millet, etc),
I03_2
Beans and peas, pulses groundnuts and cashew nuts
I03_3
VITAMIN A RICH VEGETABLES AND TUBERS
I03_4
WHITE TUBERS AND ROOTSWHITE TUBERS AND ROOTS
I03_5
DARK GREEN LEAFY VEGETABLES
I03_6
OTHER VEGETABLES
I03_7
VITAMIN A RICH FRUITS
I03_8
ORGAN MEAT
I03_9
FLESH MEATS
I03_10
EGGS
I03_11
FISH
I03_12
Milk/yogurt/other dairy product
I03_13
Sugar or sugar products, honey
I03_14
Oils/fats/butter
I03_15
RED PALM PRODUCTS
I03_16
SPICES, CONDIMENTS,BEVERAGES
I04
OTHER MEMBERS
I04_1
Rice, Wheat, Maize, maize porridge, Other cereal (sorghum, millet, etc),
I04_2
Beans and peas, pulses groundnuts and cashew nuts
I04_3
VITAMIN A RICH VEGETABLES AND TUBERS
I04_4
WHITE TUBERS AND ROOTSWHITE TUBERS AND ROOTS
I04_5
DARK GREEN LEAFY VEGETABLES
I04_6
OTHER VEGETABLES
I04_7
VITAMIN A RICH FRUITS
I04_8
ORGAN MEAT
I04_9
FLESH MEATS
I04_10
EGGS
I04_11
FISH
I04_12
Milk/yogurt/other dairy product
I04_13
Sugar or sugar products, honey
I04_14
Oils/fats/butter
I04_15
RED PALM PRODUCTS
I04_16
SPICES, CONDIMENTS,BEVERAGES
COPING STRATEGY
J01
Usually, does your household has sufficient food available for the whole year?
Yes
No
J02
If no, in a year how many months / days, the household has insufficient food?
J03
In a year, how frequently do you have to do ________ because of insufficient food in the household
J03_1
Skip entire days without eating?
NEVER
SELDOM
SOMETIMES
OFTEN
DAILY
J03_2
Limit portion size at mealtimes?
NEVER
SELDOM
SOMETIMES
OFTEN
DAILY
J03_3
Reduce number of meals eaten per day?
NEVER
SELDOM
SOMETIMES
OFTEN
DAILY
J03_4
Borrow food or rely on help from friends or relatives?
NEVER
SELDOM
SOMETIMES
OFTEN
DAILY
J03_5
Rely on less expensive or less preferred foods?
NEVER
SELDOM
SOMETIMES
OFTEN
DAILY
J03_6
Purchase/borrow food on credit?
NEVER
SELDOM
SOMETIMES
OFTEN
DAILY
J03_7
Gather unusual types or amounts of wild food / hunt?
NEVER
SELDOM
SOMETIMES
OFTEN
DAILY
J03_8
Send household members to eat elsewhere?
NEVER
SELDOM
SOMETIMES
OFTEN
DAILY
J03_9
Send household members to beg?
NEVER
SELDOM
SOMETIMES
OFTEN
DAILY
J03_10
You or other female members eat less?
NEVER
SELDOM
SOMETIMES
OFTEN
DAILY
J04
Have you sold any household assets to buy food?
Yes
No
MATERNAL HEALTH
K01
During your pregnancy with [CHILD NAME], did you register the pregnancy?
Yes
No
K02
In which month of pregnancy was your pregnancy registered?
K03
During your pregnancy with [CHILD NAME], did you go to see anyone for antenatal checkup?
Yes
No
K04
During your pregnancy with [CHILD NAME], did anyone come to you for antenatal checkup?
Yes
No
K05
Who all did your antenatal checkups during your pregnancy with [CHILD NAME]?
GOVERNMENT DOCTOR
PRIVATE DOCTOR
STAFF NURSE
LHV
MALE HEALTH WORKER
ANM
OTHER HEALTH PERSONNEL
AWW
OTHER (SPECIFY)
K05A
When you were pregnant with [CHILD NAME], in which month did you receive first antenatal checkup?
K06
When you were pregnant with [CHILD NAME], how many times did you receive antenatal checkups ?
K07
During your pregnancy, as part of your antenatal check-ups were you weighed?
Yes
No
K08
During your pregnancy, as part of your antenatal check-ups was your blood pressure measured?
Yes
No
K09
During your pregnancy, as part of your antenatal check-ups did you give a urine sample?
Yes
No
K10
During your pregnancy, as part of your antenatal check-ups was your blood checked for hemoglobin level?
Yes
No
K11
During your pregnancy, as part of your antenatal check-ups was your abdomen checked?
Yes
No
K12
During your pregnancy, as part of your antenatal check-ups was your ultrasound done?
Yes
No
K13
During your pregnancy with [CHILD NAME], were you given a TT injection?
Yes
No
K14
During your pregnancy with [CHILD NAME], how many times did you receive a tetanus injection?
K15
During your pregnancy with [CHILD NAME], did you receive any Iron Folic Acid (IFA) tablets or bottles?
Yes
No
K16
How many tablets did you receive in total during your whole pregnancy with [CHILD NAME]?
K17
During the whole pregnancy with [CHILD NAME], how many tablets did you consume?
K18
During your pregnancy with [CHILD NAME], did you ever receive any Take Home Ration from the Anganwadi Center?
Yes
No
K19
For how long did you receive THR during your pregnancy?
K20
During your pregnancy with [CHILD NAME], did you take rest more frequently than when you were not pregnant?
Yes
No
K21
During your pregnancy with [CHILD NAME] did you consume more food as compared to when you were not pregnant?
Yes
No
K22
Which of the following foods did you consume almost daily during pregnancy?
Dark green leafy vegetables
Yellow or orange fruits or vegetables (e.g. Pumpkin, carrots, ripe mango, ripe papaya)
Lentils, dal
Roti, bread or rice
Eggs
Meat, chicken or fish
Milk, paneer or yogurt
Others
K23
During your pregnancy with [CHILD NAME], did you avoid picking up heavy objects?
Yes
No
K24
Prior to the delivery, did you plan or intend to deliver [CHILD NAME] at home or in a health facility?
Yes
No
K25
Did you discuss plans for your delivery with [CHILD NAME’s] father?
Yes
No
K26
Did you discuss your plans for your delivery with your mother-in-law?
Yes
No
K27
Now I would like to ask you about anything specific that you did to prepare for a delivery. Did you do anything specific to prepare for delivery?
K27_1
Identify and arrange for a skilled birth attendant, such as an ANM, DAI to be present during childbirth
YES, SPONTANEOUS
YES, AFTER READING
DID NOT RECEIVE ANY ADVICE
K27_2
Obtain a new blade to cut the cord
YES, SPONTANEOUS
YES, AFTER READING
DID NOT RECEIVE ANY ADVICE
K27_3
Obtain a new/clean thread to tie the cord
YES, SPONTANEOUS
YES, AFTER READING
DID NOT RECEIVE ANY ADVICE
K27_4
Obtain clean cloth for drying the baby
YES, SPONTANEOUS
YES, AFTER READING
DID NOT RECEIVE ANY ADVICE
K27_5
Obtain clean cloth for wrapping the baby
YES, SPONTANEOUS
YES, AFTER READING
DID NOT RECEIVE ANY ADVICE
K27_6
Save money for the delivery
YES, SPONTANEOUS
YES, AFTER READING
DID NOT RECEIVE ANY ADVICE
K27_7
Identify a health facility to go, in case of an emergency
YES, SPONTANEOUS
YES, AFTER READING
DID NOT RECEIVE ANY ADVICE
K27_8
Identify in advance a vehicle you would use to reach health facility for delivery or in case of emergency
YES, SPONTANEOUS
YES, AFTER READING
DID NOT RECEIVE ANY ADVICE
K27_9
Kept important phone numbers handy, like the phone numbers of the ASHA, hospital, and ambulance
YES, SPONTANEOUS
YES, AFTER READING
DID NOT RECEIVE ANY ADVICE
K27_10
Identify a person to accompany you to the healthcare facility
YES, SPONTANEOUS
YES, AFTER READING
DID NOT RECEIVE ANY ADVICE
K27_11
Identifying a person with the similar blood group as the woman
YES, SPONTANEOUS
YES, AFTER READING
DID NOT RECEIVE ANY ADVICE
K27_12
Ensure soap is available for the person conducting the delivery
YES, SPONTANEOUS
YES, AFTER READING
DID NOT RECEIVE ANY ADVICE
K28
Did the ASHA come to meet you at your home during your pregnancy with [CHILD NAME]?
Yes
No
K29
How many times did the ASHA come to meet you at your home during your pregnancy with [CHILD NAME]?
K30
Did the ASHA come to meet you at your home during the last three months of your pregnancy with [CHILD NAME]?
Yes
No
K31
How many times did the ASHA come to meet you at your home during the last three months of your pregnancy with [CHILD NAME]?
K32
Did the AWW come to meet you at your home during your pregnancy with [CHILD NAME]?
Yes
No
K33
How many times did the AWW come to meet you at your home during the pregnancy with [CHILD NAME]?
K34
Did the AWW come to meet you at your home during the last three months of your pregnancy with [CHILD NAME]?
Yes
No
K35
How many times did the AWW come to meet you at your home during the last three months of your pregnancy with [CHILD NAME]?
K36
Did the ANM come to meet you at your home during your pregnancy with [CHILD NAME]?
Yes
No
K37
How many times did the ANM come to meet you at your home during the pregnancy with [CHILD NAME]?
K38
Did the ANM come to meet you at your home during the last three months of your pregnancy with [CHILD NAME]?
Yes
No
K39
How many times did the ANM come to meet you at your home during the last three months of your pregnancy with [CHILD NAME]?
K40
Did the LHV/Government Doctor come to meet you at your home during your pregnancy with [CHILD NAME]?
Yes
No
K41
How many times did the LHV/Government Doctor come to meet you at your home during the pregnancy with [CHILD NAME]?
K42
Did the LHV/Government Doctor come to meet you at your home during the last three months of your pregnancy with [CHILD NAME]?
Yes
No
K43
How many times did the LHV/Government Doctor come to meet you at your home during the last three months of your pregnancy with [CHILD NAME]?
K44
During your pregnancy with [CHILD NAME], did anyone tell you about your expected delivery date?
Yes
No
K45
Was the delivery caesarean?
Yes
No
K46
Where did you deliver [CHILD NAME]?
HOME
GOVERNMENT HEALTH FACILITY
PRIVATE HEALTH FACILITY
OTHERS (SPECIFY)
K47
What type of a government health facility was it?
SUB-CENTER
PRIMARY HEALTH CENTER
COMMUNITY HEALTH CENTER
FIRST REFERAL UNIT
DISTRICT WOMEN HOSPITAL/DISTRICT HOSPITAL
OTHERS (SPECIFY)
K48
Did you receive a benefit for delivery care from the Government (Janani Suraksha Yojana)?
Yes
No
K49
How much was the payment received?
K50
How long after the delivery did you receive the financial payment/ assistance?
K51
Did the ASHA come to your home to check on you or [CHILD NAME] within 24 hours after your delivery?
Yes
No
CHILD HEALTH & NUTRITION
L01
Did you ever breastfeed [CHILD NAME]?
Yes
No
L02
How long after birth did you first put [CHILD NAME] to the breast?
L03
Did you feed [CHILD NAME] your first yellow thick milk (local term)?
Yes
No
L04
Are you still breastfeeding [CHILD NAME]?
Yes
No
L05
For how many months did you breastfeed [CHILD NAME]?
L06
How long did you exclusively breastfeed [CHILD NAME]?
L07
Have you breastfed [CHILD NAME] in the past 24 hours – either day time or night time?
Yes
No
L08
How many times did you breastfeed [CHILD NAME] in the past 24 hours – either day time or night time?
L09
Next I would like to ask you about some liquids that your child may have had yesterday during the day or at night.
L09_1
PLAIN WATER
Yes
No
L09_2
HONEY
Yes
No
L09_3
SUGAR WATER
Yes
No
L09_4
GHUTTI
Yes
No
L09_5
OIL TO CLEAN TONGUE
Yes
No
L09_6
TINNED / POWDERED MILK
Yes
No
L09_7
ANIMAL MILK
Yes
No
L09_8
RICE WATER
Yes
No
L09_9
DAL WATER
Yes
No
L09_10
ROTI MIXED IN MILK
Yes
No
L09_11
SATTU IN WATER/MILK
Yes
No
L09_12
THIN SUJI HALWA
Yes
No
L09_13
THIN KHICHDI
Yes
No
L09_14
JUICE
Yes
No
L09_15
Clear broth
Yes
No
L09_16
Yogurt
Yes
No
L09_17
Thin porridge
Yes
No
L09_18
OTHER LIQUIDS
Yes
No
L09_19
OTHER FOOD
Yes
No
L10
Do you have a mother and child protection card (immunization card)?
Yes
No
L11
COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD. CODE ‘77’ IF CARD IS BLANK AND THEN SKIP TO N12. WRITE ‘44’ IN ‘DAY’ COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED. CODE 0 IF DATE IS NOT MENTIONED & THE CARD DOES NOT SHOW THAT A VACCINE WAS GIVEN OR NOT. IF ONLY PART OF DATE IS SHOWN ON CARD, RECORD ‘99’ OR ‘9999’ FOR ‘DO NOT KNOW’ IN THE COLUMN FOR WHICH INFORMATION IS NOT GIVEN.
L11_1
BCG
L11_2
POLIO 0
L11_3
HEPATITIS B 0
L11_4
POLIO 1
L11_5
DPT 1
L11_6
HEPATITIS B 1
L11_7
PENTAVALENT 1
L11_8
POLIO 2
L11_9
DPT 2
L11_10
HEPATITIS B 2
L11_11
PENTAVALENT 2
L11_12
POLIO3
L11_13
DPT 3
L11_14
HEPATITIS B 3
L11_15
PENTAVALENT 3
L11_16
MEASLES
L11_17
DPT (16-24 MONTHS)
L11_18
POLIO (16-24 MONTHS)
L11_19
VITAMIN A (FIRST DOSE)
L11_20
VITAMIN A (SECOND DOSE)
L11_21
VITAMIN A (THIRD DOSE)
L11_22
RotaVirus Dose-1
L11_23
RotaVirus Dose-2
L11_24
RotaVirus Dose-3
L12
Please tell me if [CHILD NAME] received any of the following vaccinations:
L12_1
A BCG vaccination against tuberculosis that is, an injection in the arm or shoulder that usually causes a scar?
Yes
No
L12_2
A Polio vaccine that is drop given in the mouth?
Yes
No
L12_3
How many times?
L12_4
Was the first polio vaccine received in the first two weeks after birth?
Yes
No
L12_5
Drops in the mouth as part of the Pulse Polio campaign?
Yes
No
L12_6
A DPT vaccination, that is, an injection given in the thigh, sometimes at the same time as polio drops?
Yes
No
L12_7
How many times?
L12_8
A Hepatitis B vaccination, that is, an injection given sometimes at the same time as DPT?
Yes
No
L12_9
How many times?
L12_10
A pentavalent vaccine given in place of DPT, HEP B and Hib in child’s thigh to protect from 5 diseases.
Yes
No
L12_11
How many times?
L12_12
An injection against measles at right arm/shoulder?
Yes
No
L12_13
Vitamin A that is given by a spoon?
Yes
No
L12_14
How many times?
L13
Do you give [CHILD NAME] any solid, semi-solid, mashed or soft foods to eat?
Yes
No
L14
Now I would like to ask you about the food [CHILD NAME] ate during the last 24 hours, either separately or combined with other foods.
L14_1
Porridge or gruel (Rice/Khichdi)
Yes
No
L14_2
Biscuit
Yes
No
L14_3
Commercially fortified baby food such as Cerelac or Farex
Yes
No
L14_4
Bread, roti, chapatti
Yes
No
L14_5
Daal (Foods made with lentils or beans)
Yes
No
L14_6
Pumpkin, carrots, or sweet potatoes that are yellow or orange inside
Yes
No
L14_7
Green leafy vegetables
Yes
No
L14_8
Ripe mangoes or ripe papayas
Yes
No
L14_9
Other fruits or vegetables (potatoes)
Yes
No
L14_10
Meat/chicken/fish
Yes
No
L14_11
Egg
Yes
No
L14_12
Nuts
Yes
No
L14_13
Salty purchased snacks foods (chips, kurkure, namkeen,)
Yes
No
L14_14
Sweet purchased snacks ( chocolate, candies)
Yes
No
L15
From what age did you start feeding [CHILD NAME] solid, semi-solid, mashed or soft foods?
L16
Excluding oil for cooking, did you add oil/ghee/butter to the food you gave [CHILD NAME] in the last 24 hours?
Yes
No
L17
How many times did [CHILD NAME] eat solid, semi-solid, mashed or soft foods other than liquids yesterday during the last 24 hours?
SHG membership and leadership
M01
What is the name of the self-help group to which you belong?
M02
When you expressed desire to become SHG member, did you have to face any challenges?
Yes
No
M03
What challenges did you have to overcome to become SHG member?
Opposition from mother-in-law
Scolding from husband
Violence or beating
Others (specify)
M04
For how long have you belonged to the self-help group to which you belong?
M05
Have you participated in meetings conducted in last 3 months?
Yes
No
M06
Have you participated in meetings conducted in last 1 months?
Yes
No
M07
Has a representative from this NGO/organisation visited you and talked about agricultural practices?
Yes
No
M08
Has the NGO/organisation conducted any training on livelihood practices?
Yes
No
M09
Does your self-help group have savings and credit activities?
Yes
No
M10
Do you personally participate in these savings and credit activities?
Savings
Credit
Both
None
M11
How much money do you save in each meeting? (average amount – in Rs.)
M12
How often do you save?
Weekly
Bi-monthly
Monthly
Occasionally
Never saved so far
M13
Are you currently a portfolio-holder?
Yes
No
M14
Which position do you hold?
President
Treasurer
Secretary
Other (specify)
M15
What issues do you discuss in the self-help group meeting ?
Livelihoods/socio-economic problems in the community
Agriculture problems
Education problems
Health and nutrition problems
Gender dynamics in society
Violence against women
Rights and entitlements
Savings and loans
Sanitation
Never attended any meeting till now
Other
M16
How often does your group meet for discussions or activities in a month?
Weekly
Bi-monthly
Monthly
Occasionally
Never met so far
M17
Have you participated in the maintenance of books of accounts of the SHG?
Yes
No
M18
How responsible do you feel for achieving the objectives of your group?
Not at all
Somewhat
Very much
Completely
M19
How much do you agree or disagree with the following statements
M19_1
I can count on fellow SHG members if I need to borrow money
Agree
Neither agree nor disagree
Disagree
M19_2
I can count on fellow SHG members to talk about my problems
Agree
Neither agree nor disagree
Disagree
M19_3
SHG members worry about themselves only
Agree
Neither agree nor disagree
Disagree
M19_4
I can count on fellow SHG members to help me address the problems I am unable to solve on my own. (E.g. Violence)
Agree
Neither agree nor disagree
Disagree
M20
Are you a panchayat member?
Yes
No
M21
What position do you hold as a panchayat member?
SARPANCH
SECRETARY
WARD MEMBER
OTHERS (SPECIFY)
M22
Are you a member of any committee associated with Gram Panchayat?
Yes
No
M23
Which committees are you associated with?
VHSNC
MGNREGA
FRC
LAND RIGHTS COMMITTEE
ICDS
SCHOOL MANAGEMENT COMMITTEE
OTHERS (SPECIFY)
GENDER
N01
Did you engage in any income generating activities in last 12 months?
Yes
No
N02
Was it usually at home or away from home?
HOME
AWAY
N03
Was it usually throughout the year, seasonal or once in a while?
THROUGHOUT THE YEAR
SEASONALLY / PART OF THE YEAR
ONCE IN A WHILE
N04
Were you usually paid in cash or kind for this work?
CASH ONLY
CASH AND KIND
KIND ONLY
NOT PAID
N05
According to you, what share of household income do you contribute to?
LESS THAN HALF
HALF
MORE THAN HALF
N06
Who decided how to use the money you earn?
Self
Husband
Jointly
OTHERS (SPECIFY)
N07
Do you save any of the income that you earn?
Yes
No
N08
Where do you save?
SHG
GOVERNMENT BANK
COOPERATIVE BANK
PRIVATE BANK
POST OFFICE
FRIENDS / RELATIVES
AT HOME
OTHERS (Specify)
N09
Do you have any money of your own that you can decide how to spend?
Yes
No
N10
Does your household have any bank account?
Yes
No
N11
Who does the account belong to?
IN THE NAME OF MALE MEMBER
IN THE NAME OF BOTH MALE AND FEMALE MEMBER
IN THE NAME OF FEMALE MEMBER ONLY
N12
Is there an account in your name?
Yes
No
N13
If yes, have you operated it in the last 3 months?
Yes
No
N14
What is your role in buying or selling of land or other similar assets?
INFORMED OF THE PURCHASE/SALE TO BE MADE
INFORMED OF THE PURCHASE/SALE ALREADY MADE
CONSULTED ON THE PURCHASE/SALE
DECIDE THE PURCHASE/SALE
NO ROLE
N15
What is your role in buying, selling OR mortgaging of gold or other jewelry?
INFORMED OF THE PURCHASE/SALE TO BE MADE
INFORMED OF THE PURCHASE/SALE ALREADY MADE
CONSULTED ON THE PURCHASE/SALE
DECIDE THE PURCHASE/SALE
NO ROLE
N16
What is your role in buying or selling of livestock?
INFORMED OF THE PURCHASE/SALE TO BE MADE
INFORMED OF THE PURCHASE/SALE ALREADY MADE
CONSULTED ON THE PURCHASE/SALE
DECIDE THE PURCHASE/SALE
NO ROLE
N17
What is your role in buying or selling of farm produce?
INFORMED OF THE PURCHASE/SALE TO BE MADE
INFORMED OF THE PURCHASE/SALE ALREADY MADE
CONSULTED ON THE PURCHASE/SALE
DECIDE THE PURCHASE/SALE
NO ROLE
N18
How easy it is for you to go to the following places?
N18_1
To go out and work
NOT ALLOWED TO GO ALONE
ALLOWED TO GO WITH OTHER FAMILY MEMBERS / FRIENDS
ALLOWED TO GO ONLY WITH SPOUSE
ALLOWED TO GO ALONE AFTER SEEKING PERMISSION
DO NOT NEED ANY PERMISSION
OTHERS (SPECIFY)
N18_2
Ration Shop
NOT ALLOWED TO GO ALONE
ALLOWED TO GO WITH OTHER FAMILY MEMBERS / FRIENDS
ALLOWED TO GO ONLY WITH SPOUSE
ALLOWED TO GO ALONE AFTER SEEKING PERMISSION
DO NOT NEED ANY PERMISSION
OTHERS (SPECIFY)
N18_3
Paternal Home
NOT ALLOWED TO GO ALONE
ALLOWED TO GO WITH OTHER FAMILY MEMBERS / FRIENDS
ALLOWED TO GO ONLY WITH SPOUSE
ALLOWED TO GO ALONE AFTER SEEKING PERMISSION
DO NOT NEED ANY PERMISSION
OTHERS (SPECIFY)
N18_4
Weekly Market
NOT ALLOWED TO GO ALONE
ALLOWED TO GO WITH OTHER FAMILY MEMBERS / FRIENDS
ALLOWED TO GO ONLY WITH SPOUSE
ALLOWED TO GO ALONE AFTER SEEKING PERMISSION
DO NOT NEED ANY PERMISSION
OTHERS (SPECIFY)
N18_5
Government Offices
NOT ALLOWED TO GO ALONE
ALLOWED TO GO WITH OTHER FAMILY MEMBERS / FRIENDS
ALLOWED TO GO ONLY WITH SPOUSE
ALLOWED TO GO ALONE AFTER SEEKING PERMISSION
DO NOT NEED ANY PERMISSION
OTHERS (SPECIFY)
N18_6
Banks
NOT ALLOWED TO GO ALONE
ALLOWED TO GO WITH OTHER FAMILY MEMBERS / FRIENDS
ALLOWED TO GO ONLY WITH SPOUSE
ALLOWED TO GO ALONE AFTER SEEKING PERMISSION
DO NOT NEED ANY PERMISSION
OTHERS (SPECIFY)
N18_7
Gram Sabha
NOT ALLOWED TO GO ALONE
ALLOWED TO GO WITH OTHER FAMILY MEMBERS / FRIENDS
ALLOWED TO GO ONLY WITH SPOUSE
ALLOWED TO GO ALONE AFTER SEEKING PERMISSION
DO NOT NEED ANY PERMISSION
OTHERS (SPECIFY)
N18_8
Police Station
NOT ALLOWED TO GO ALONE
ALLOWED TO GO WITH OTHER FAMILY MEMBERS / FRIENDS
ALLOWED TO GO ONLY WITH SPOUSE
ALLOWED TO GO ALONE AFTER SEEKING PERMISSION
DO NOT NEED ANY PERMISSION
OTHERS (SPECIFY)
N18_9
Meeting/training in the village
NOT ALLOWED TO GO ALONE
ALLOWED TO GO WITH OTHER FAMILY MEMBERS / FRIENDS
ALLOWED TO GO ONLY WITH SPOUSE
ALLOWED TO GO ALONE AFTER SEEKING PERMISSION
DO NOT NEED ANY PERMISSION
OTHERS (SPECIFY)
N18_10
Meeting / training outside village
NOT ALLOWED TO GO ALONE
ALLOWED TO GO WITH OTHER FAMILY MEMBERS / FRIENDS
ALLOWED TO GO ONLY WITH SPOUSE
ALLOWED TO GO ALONE AFTER SEEKING PERMISSION
DO NOT NEED ANY PERMISSION
OTHERS (SPECIFY)
N19
Do you usually go to the local market place?
Yes
No
N20
Was any Jati Panchayat meeting held during the last one year?
Yes
No
N21
Did you attend any of the Jati Panchayat meetings that were held in the last one year?
Yes
No
N22
How many meetings did you attend in the last one year?
N23
Did you vote in any of the elections in last 5 years?
Yes
No
N24
Who decides who will you cast your vote to?
SELF
HUSBAND
ELDER FAMILY MEMBER
INFLUENTIAL PEOPLE IN THE VILLAGE
REPRESENTATIVES OF POLITICAL PARTIES
OTHERS (SPECIFY)
N25
Have you ever wathched TV in the last one year?
Yes
No
N26
How often do you watch TV?
DAILY
2 TO 6 DAYS IN A WEEK
ONCE A WEEK
ONCE EVERY FORTNIGHT
ONCE A MONTH
RARELY
N27
Have you ever listened to the radio in the last one year?
Yes
No
N28
How often do you listen to the radio?
DAILY
2 TO 6 DAYS IN A WEEK
ONCE A WEEK
ONCE EVERY FORTNIGHT
ONCE A MONTH
RARELY
N29
Do you think that girls should be given equal opportunities for employment outside the house or may be to work in another village as boys?
NOT AGREE
PARTIALLY AGREE
AGREE
N30
What do you think should be ideal age for girls to get married?
Awareness, responsiveness, and participation in Gram Sabha
O01
Are you aware about the Gram Sabha?
Yes
No
O02
Who are the members that constitute a Gram Sabha?
All male voters in the village
All Female voters in the village
All Male and Female voters in the village
Only the members of the Gram Panchayat
None of the above
Others (Specify)
Do Not Know
O03
How frequently are the Gram Sabha Meetings conducted?
Once Every Month
Once every 2 months
Once every 3 months
Once every 6 months
Once a year
In lesser frequency
Do not know
Other (Specify)
O04
Was any Gram Sabha meeting held during the last one year?
Yes
No
O05
How many Gram Sabha meetings were held in the last one year?
O06
Have you participated in any of the Gram Sabha meetings in the last one year?
Yes
No
O07
How many meetings did you attend in the last one year?
O08
Did you participate in the last GS meeting?
Yes
No
O09
When was the last GS meeting held?
O10
What was discussed in the last Gram Sabha meeting that you attended?
Information / news about new programs / schemes
Updation about previous programs / schemes
Income and expenditure on programs / schemes
Allotment / allocation to beneficiaries
None of the above
Other (Specify)
O11
What according to you are the key functions of the GS?
Institute solving of disputes of villagers
Promotion of education, health, agriculture and communication facilities in the village
Represent the voice & opinion of the village at the GP, block & district level
Conduct regular meetings
Keep records of various departments
Other (Specify)
Do Not Know
O12
Do you consider GS meetings to be a platform for raising your issues and concerns?
Yes
No
O13
Do you give your opinion in the discussions/raise issues at the Gram Sabha meetings?
Yes
No
O14
Is your opinion deliberated and considered while arriving at decisions?
Yes
No
O15
Are you or any member of your household, member of any village level committee?
Village Education Committee
Forest Rights Committee
Mother’s committee
Village Health Sanitation & Nutrition Committee VHND
None
Others (Specify)
ANTHROPOMETRY
P01
Name of index child
P02
Sex
MALE
FEMALE
TRANSGENDER
P03
RECORD DATE OF BIRTH
P04
RECORD AGE OF [CHILD NAME]
P05
Name of mother
P06
Age of mother
P07
RECORD WHETHER MOTHER’S WEIGHT WAS TAKEN OR NOT AND REASON WHY NOT.
MEASURED
MOTHER ABSENT
MOTHER REFUSED
MOTHER DEFORMED
MOTHER ILL
OTHER (SPECIFY)
P08
RECORD WEIGHT (G) OF THE MOTHER
P08_1
FIRST MEASUREMENT
P08_2
SECOND MEASUREMENT
P09
RECORD WHETHER MOTHER AND CHILD WEIGHT WAS TAKEN OR NOT AND REASON WHY NOT.
MEASURED
CHILD ABSENT
CHILD REFUSED
MOTHER REFUSED
CHILD DEFORMED
CHILD ILL
OTHER (SPECIFY)
P10
RECORD WEIGHT (G) OF THE MOTHER AND CHILD
P10_1
FIRST MEASUREMENT
P10_2
SECOND MEASUREMENT
P11
RECORD WHETHER CHILD’S HEIGHT WAS TAKEN OR NOT AND REASON WHY NOT.
MEASURED
CHILD ABSENT
CHILD REFUSED
MOTHER REFUSED
CHILD DEFORMED
CHILD ILL
OTHER (SPECIFY)
P12
RECORD HEIGHT
P12_1
FIRST MEASUREMENT
P12_2
SECOND MEASUREMENT
P13
RECORD WHETHER MOTHER’S HEIGHT WAS TAKEN OR NOT AND REASON WHY NOT.
MEASURED
CHILD ABSENT
CHILD REFUSED
MOTHER REFUSED
CHILD DEFORMED
CHILD ILL
OTHER (SPECIFY)
P14
RECORD HEIGHT
P14_1
FIRST MEASUREMENT
P13_2
SECOND MEASUREMENT
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