Items:

 1. Did you see anyone for antenatal care for this pregnancy?

Response Options:
Yes
No

 2. Whom did you see? Anyone else? (Probe to identify each type of person and record all mentioned.)

Response Options:
Health Personnel:
Doctor
NurseMidwife
Auxiliary Midwife
Other Person:
Traditional Birth Attendant
Community Health WorkerField worker
Other (Additionally, specify in text)

 3. Where did you receive antenatal care for this pregnancy? Anywhere else? (Probe to identify the type of source)

Response Options:
Home:
Her home
Other home
Public sector:
Government hospital
Government health center
Government health post
Other public sector (specify)
Private Medical Sector:
Private hospital
Private clinic
Other private medical sector (specify)
NGO Medical Sector:
NGO hospital
NGO clinic
Other NGO medical sector (specify)
Other (specify)
If unable to determine if public, private, or NGO sector, record ‘X’ and write the name of the place(s).

 4. How many weeks or months pregnant were you when you first received antenatal care for this pregnancy?

Response Options:
2-digit numeric value (_Weeks)
2-digit numeric value (_Months)
Don’t know

 5. How many times did you receive antenatal care during this pregnancy?

Response Options:
2-digit numeric value (_Number of Times)
Don’t know