Serial number
D3 Social Status :
D4 Other wives other than you:
D6 Are you and your husband related?
D7 How many years have you been married?
D8 How old were you when you got married?
You Financial responsible
Husband Financial responsible
Your family (father, mother, brother,….) Financial responsible
responsibility between me and my husband Financial responsible
You health responsibility
Husband health responsibility
Mutual decision health responsibility
Family income
D13 Do you work currently?
No of Male childs
No of female child
Total No of children
Males relatives
Females relatives
D17 Place of residence in Jordan?
D18 Place of residence in Syria?
D19 The number of years you’ve been living in Jordan (immigrant) ?
D20 Did you get married in Jordan ?
D21 The husband’s nationality?
D22 Husband’s Education level?
education husband 4 groups ordered
D23 Husband’s Work?
D24 Husband’s age?
F1 Number of previous births?
F2 Number of previous abortions?
F3 Number of multiple pregnancies (twins or more than one baby)?
F4 Are you medically insured ?
F5 specify the insurance company?
F6 Have you been through baby loss (born after 7 months of pregnancy or later?
F9 current baby’s age ?
F10 baby’s gender ?
F11 The nature of this pregnancy?
F12 was this pregnancy wanted or planned for?
F13 Did you get antenatal care during pregnancy?
The unavailability of medical care providers
can’t afford financial expenses for antenatal visit (No health insurance)
Its far away from the health care center and no transportation
The husband doesn’t allow me to leave the house
Embarrassed (specify) ………….
Scared (specify)
I wasn’t treated well during previous pregnancies
Other ( Specify) __________
I didn't feel that I needed health care or follow up/ she didn’t feel any symptom that requires her to go to the doctor.
Maternal and child care centers
Governmental Hospitals
Private Hospitals
Local Community Organizations
Private Clinics
Others (Specific)……………..
doctors without boundries
Swiss Peace Organization
Fedral primary Hospital
UNRWA
Cartis Organization
F16 Number of follow ups during pregnancy?
F17 pregnancy in months once the follow ups started?
F18 Have you suffered from any health problems during pregnancy or birth or after birth ?
Maternal and Child care center .
Traditional home treatment
Other (Specify)……………..
private clinic/ private doctor
doctors with no boundries
Commission
no one/ nothing/ didn’t go
Pharmacy
husband/family
special private center
Cartis organization
Fedral primary hospital
Swiss Organization
F20 Birth method ?
F21 Place of birth?
Male Doctor
Female Doctor
Midwife
Other
The mother
F23 was the baby born with any medical problem?
F24 Does the current baby face any health problems?
F25 During the first 6 months after birth, did any health care provider visit you or did you follow up with any of them?
F26 Are you pregnant now ?
R1 are you breastfeeding your child now?
R5 Which of the following describes the way in which you breastfeed your child ?
R6 age at birth?
R7 Current baby’s weight at birth?
R8 is the current baby your first child?
R9 did you breastfeed your previous children?
In general, how do you find your health condition?
Comparing to the past year, how do you evaluate your health condition right now?
'Doing hard activities like running, carrying heavy things or doing heavy exercises' :
'Doing medium-effort activities, such as moving the table, cleaning with a vacuum cleaner, or cleaning and caring of the home garden' :
carrying purchases from the grocery store or the central market (supermarket) :
Going upstairs for several floors :
'bowing, kneeling or prostration' :
walking for more than a kilometer and a half :
walking half a kilometer :
walking a hundred meters :
bathing or wearing your own clothes :
Minimizing the time you spend doing the work or any other activity : CATEGORICAL Question
Minimizing the amount of work or any other activity you want to achieve : CATEGORICAL Question
Restricting you from doing a specific kind of work or any other activity : CATEGORICAL Question
Find it difficult to do your work or any other activity ( like you needed an extra effort to achieve them) : CATEGORICAL Question
Minimizing the time you spend doing the work or any other activity :
Minimizing the amount of work or any other activity you want to achieve :
not achieving the work or any other activity in the usual way :
Over the past four weeks, how often your physical or mental health has conflicted with your usual social activities with your family, friends, neighbors, or other social events?
What is the severity of the physical pain you have suffered in the past four weeks?
Over the past four weeks, to what extent physical pain has conflicted with your usual works or activities (inside or outside the home)?
you felt you were full of energy and vitality : CATEGORICAL Question
you were a nervous person : CATEGORICAL Question
You felt you were in a state of depression to a point where you could not bring joy to yourself : CATEGORICAL Question
You felt calm and peaceful : CATEGORICAL Question
You were full of energy : CATEGORICAL Question
You were depressed and desperate : CATEGORICAL Question
You felt exhausted (your energy was consumed) : CATEGORICAL Question
You felt you are a happy person : CATEGORICAL Question
You felt tired : CATEGORICAL Question
Over the past four weeks, how much time did your physical health or mental problems conflicted with your social activities (such as visiting friends, relatives, etc.)?
I seem to get sick more easily than others : CATEGORICAL Question
My health condition is equal to anyone I know : CATEGORICAL Question
I expect my health condition to become worse : CATEGORICAL Question
My health condition is excellent : CATEGORICAL Question
F1
F2
f3
f4
f5
F6
F8
f9
f10
f11
f12
f13
f14
f15
f16
f17
f18
f19
f20
f21
f22
f23
f24
f25
f26
f27
f28
f29
f30
f31
f32
f33
f34
f35
f36
mother's age
mothers_education
Husband_education
Total Score for general health
U2 Are you using any family planning?
U5 specify the family planning method you use currently ( what do you do to avoid pregnancy or to postpone it)?
Sexual physical ( example: Rape)
E5 Have you experienced any kind of domestic violence?
Sexual (e.g. forced sexual intercourse or anal or cohabitation in menstrual or after birth periods)
E7 Have you experienced any type of domestic violence during pregnancy?
E10 Have you experienced sexual violence (sexual harassment or sexual violence / rape) during the period of immigration in Jordan?
Did you suffer of STIs before?
Did you get medical treatment for STIs?
Do you follow a regular health check-up of STIs?