SP2000-M

REPUBLIC OF INDONESIA

SP 2000 POPULATION CENSUS BPS 2000 POPULATION MODULE

Confidential

I. IDENTIFICATION 101 Province 102 Regency/Municipality *) 103 Subregency 104 Village/Kelurahan *) 105 Village/Kelurahan classification 1. Urban 2. Rural

106 Enumeration area number 107 Segments group number

108 Sample code number 109 Serial number of Sample household

II. HOUSEHOLD CHARACTERISTICS 201 The name of household head 204 Number of household member aged 10 yaers old

and above 202 Number of household members 205 Number of women who ever been married aged

10 years old and above

203 Number of household member aged 5 years old and above

206 Number of household member wre passed away since January 1997

III. ENUMERATING CHARACTERISTICS

301 Name and employment identity number of enumerator

305 Name and employment identity number of supervisor

302 Enumerator’s occupation: 1. BPS provincial staff 3. Subregency staff 2. BPS regency staff 4. Hired worker

306 Supervisor’s occupation 1. BPS provincial staff 3. Subregency staff 2. BPS regency staff 4. Hired worker

303 Date of enumeration 307 Date of supervision 304 Signature of enumerator

308 Signature of supervisor

*) Cross out inapplicable category

IV. A. HOUSEHOLD MEMBERS CHARACTERISTICS IF HOUSEHOLD MEMBER AGED < 15

YEARS OLD WOMEN

≤ 10 Years old

Serial number

401. Name of Househol

d Members

(write down who

usually stay and eating in

this household

; adult, children, or baby)

402. Relation to the

head of

household (Cod

e)

403. Sex:

Male 1 Female2

404. Age

(Year) 405.

Is biologic

al mother

still alive?

Yes 1 No 2 Do not know 3

406. IF STILL ALIVE

Is biological mother lives in the same household

If yes, serial no. of

biological mother*)

407. Is

biological father

still alive?

Yes 1 No 2 Do not know 3

408. IF STILL ALIVE

Is biological

father lives in the same household

If yes, serial no. of biological father*)

409. Have ever

been married?

Yes 1 No 2

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) 01 02 03 04 05 06 07 08 09 10

IV.B. DEATH INCIDENT SINCE JANUARY 1997 415.

For women who passed away at the age of ≥10, were the death

happened during

Serial number

410. Name of

household members

were passed away

411. Relationship with

other household members when he/ she/ they was/ were

alive (code)

412. Year of

the incident

since January

1997

413. Sex

Male 1 Female 2

414. Passed away at

the age… (If less than 2 year old, fill in

month) Pregna

ncy period

Yes 1 No 2

Child birth /

miscarriage

period Yes 1 No 2

Parturition period**)

Yes 1 No 2

(1) (2) (3) (4) (5) (6) (7) (8) (9) 01

Year old Month

02 03 04 GIVE CHECK MARK” “ IN THE APPROPRIATE BOX To make sere there is no question missed: 1) Is there any body like baby or child not listed? Yes →Write down on the list No 2) Is there any body, may be has no relationship with father/ mother like house maid, guest/ friend, but very Yes →Write down on the list No often live here? 3) Is there guest/ any body stay temporary here for six Yes →Write down on the list No months/ more but not listed? 4) Is there any body who is usually live here but in traveling Yes →Write down on the list No less than 6 months? 5) Is there any body listed ‘in traveling’ for six months/ more; or less Yes →Write down on the list No than six months but has an itinerary to stay permanently in new place? Code column (3) Block IV.A.& Block IV.B: 1= Head of household 4= Child in law 7= Other relatives 2= Wives/husband 5= Grandchild 8= House maid 3= Son/ daughter 6= Parents in law 9= Other *) This question refers to relationship between parents and biological child. Code”00” if parents not household member **) 42 days after childbirth/ miscarriage

V. HOUSEHOLD MEMBER GENERAL CHARACTERISTICS 501. Name:…………… No. Household member: …………. 502. Date, month and year of birth

Date : Month: Year:

512. The main reason to move from your previous address (regency/ municipality) 5 year ago

1. Job 2. Finding job 3. Education 4. Marital status changes 5. Follow husband/ parents/ son (daughter) 6. Follow brother (sister)/ other relatives 7. Housing 8. Security 9. Other (………………………………) Write it down

503. Age …………………… year old

504. Current marital status 1. Single 3. Divorced 2. Married 4. Widowed

513. School participation

1. No/ never schooling→ Q.519 2. Still schooling→ Q.516.a 3. Out of schooling/ drop out

514. When you stop your schooling? (Filling in 00, if stop schooling before the year 1990) → [Q.516.a] Month:…… Year: ……… Month Year

505. Religion 1. Islam 4. Hindu 2. Catholic 5. Buddha 3. Protestant 6. Other

506. Place of birth Province: …………………………………... Regency/ Municipality*): ………………….

515. Reason of stop schooling:

1. No money 2. Do not like/ ashamed 3. Help to support family/ working 4. Help to take care family 5. Do not be accepted/ be dropped out 6. The school is too far 7. Other (………………………………….)

Write it down

507. Had you ever lived in other regency/ municipality? Yes 1 No 2→ Q.509A

508. Previous address before you live in this address? Province: ………………………………….. Regency/ Municipality: …………………...

509. How long have you lived in this address (regency/ municipality)?

…………………………. Years

516. a. The highest level and type of education ever or being attended: 01. Primary school 08.“Aliyah” (islamic)

02. “Ibtidaiyah” 09. Vocational High (Islamic) School 03. Be equal with 10. Diploma I/II Package “A” 11. Diploma III/ 04.Junior High School/ Bachelor Vocational 12. Diploma IV/ 05. “Tsanawiyah” Graduate (Islamic) 13. Master 06. Senior High School 14. Ph.D. b. Education organizer 1. Government 3. Abroad 2. Private

509A. LOOK AT Q. 503, IF RESPONDENT AGED <<<< 5 YEAR OLD →→→→ Q. 501 NEXT HOUSEHOLD MEMBER

ONLY FOR 5 YEAR OLD AND ABOVE 517.The highest level/ class that have been/ are attended 0 1 2 3 4 5 6 7 8 (Finished)

510. LOOK AT Q. 509 (GIVE CHECK MARK) 4 YEAR OLD OR LESS

5 YEAR OLD OR ABOVE/ NO ANSWER→ Q.513

518. The highest certificate that be owned: 1. None 2. Primary School 3. Junior High School/ Vocational 4. Senior High School 5. Vocational High School 6. Diploma I/II 7. Diploma III/ Bachelor 8. Diploma IV/ Graduate 9. Master Degree 10. Ph.D.

511. Your address 5 years ago Province: …………………………………. Regency/ Municipality: …………………..

519. Can read and write 1. Roman Script 2. Other Script 3. Cannot

*) Cross out inapplicable category

VI. ACTIVITY OF HOUSEHOLD MEMBER AGED 10 YEAR AND ABOVE VI.A. ACTIVITY A WEEK AGO EXTRA JOB

611. Had you had an extra job or other which was furloughed during a previous week? Yes 1 No 2→Q.IV.C

612. Business/ working field of extra job (Write down completely) …………………………………………………..

Filled By Editor

VI.C. LOOKING FOR JOB ACTIVITY (LOOKED Q.604, IF “1” →→→→ Q.613 IF “2” →→→→ Q.617)

601. a. Did you do some activity during previous week? Yes No

1.Working 1 2 2.Attending school 1 2 3.House keeping 1 2 4.Others 1

b. From activity 1 to 4 that are answered “Yes”, which activity used most of the time during previous week?

1 →→→→ Q.604 2 3 4

602. Did you worked at least 1 hour during a previous week? [If Q.601.a.1 =1, circled code 1] Yes 1→→→→ Q.604 No 2

603. Do you have permanent job, but were temporary not working during previous week? Yes 1 No 2

613. Main reason to look for job 1. Finish the school/ not schooling anymore 2. Helping household/ family economically 3. Have responsibility to finance household 4. Extra income 5. Do not satisfied with previous job 6. Being fired/ business stopped 7. Other (…………………………………)

Write it down

604. Had you been finding job during a previous week Yes 1 No 2

VI.B. WORKING ACTIVITY Q. 605 TO Q. 612 ONLY FOR WORKING

HOUSEHOLD MEMBER (Q. 601.b=1, OR Q. 603=1)

614. What efforts that you have done in looking for job?

01. Registering in job market 02. Contacting some companies/ offices 03. Applying thorough job advertisement 04. Contacting family/ relatives 05. Other (……………………………….)

Write it down

615. How long you have been looking for job? ………………… months

605. a. Total days of work: …………. Days b. Number of hours of total daily worked in the previous week Mon Tue Wen Thu Fri Sat Sun Total Hour

616. The Job which is looked for 1. Full time job 2. Part time job Q. 619

MAIN JOB 605. Business field/ main job field from work

place during a previous week (write down completely)

……………………………………………..

Filled By Editor

617. Reason for not looking for job 1. Desperate 2. Still schooling 3. Taking care household 4. Feel satisfied/ do not need the job 5. Do not able to do a job 6. Other (…………………………………) Write it down

607. Type/occupation of main job during a previous week: (write down completely) …………………….………………………

Filled By Editor

618. If there is job offering, do you still want to accept it? Yes 1 No 2

608. Total working hour of your main job during a previous week …………………………………….. hours

619. Have you ever worked before? Yes 1 No 2→B.VII or next household member 620. Have you worked since July 1998? Yes 1 No 2→B.VII or next household member 621. Have you stopped working/ changed the job since July 1998? Yes 1 No 2→B.VII or next household member

609. Status/ position of main job during a Previous week

1. Self-employed 2. Self-employed, assisted by workers/

temporary workers/ unpaid workers 3. Self-employed, assisted by workers/ permanent workers 4. Workers/employees/paid workers 5. Unpaid workers

Code 1, 2, 3 or 5 →→→→Q. 611

622. The main reason to stop/ change the last job 1. Get fired 5. The income not satisfied 2. Business stopped 6. Do not fit with working 3. Taking care household circumstance 4. The job was not 7. Other (……………….) appropriate Write it down 610. How much the wage/net salary received in a

month from main job? a. In cash: Rp………………….. b. In-goods/ services: Rp …….……………

IF RESPONDEN IS A MARRIED WOMAN AGED 10 YEAR OLD OR ABOVE→→→→BLOCK VII

VII. MARRIED WOMEN AGED 10 YEAR OLD AND ABOVE

VII.A. FERTILITY 701. Name: ____________ No. Household member: ……. 707. Your age at the first child birth

…………………. Year old

702. In what month and year your first marriage? Month: …………… Year: ……………

708. How many biological son and how many biological daughter who are still alive live with you? Son Daughter

703. Your age at your first marriage …………………… year old

709. How many biological son and how many biological daughter who are still alive but not live with you? Son Daughter

704. Number of year of you marriage ……………………. years

710. How many biological son and how many biological daughter who were died? Son Daughter 705. How many time have you ever married?

…………………… times

706. Had you ever given birth? Yes 1 No 2→→→→B. VII

711. Number of biological child born alive …………………………..

VII.B. CHILD BIRTH CHRONOLOGIES

712. Please write

down the name of

your child who was born

alive (first,

second, ..)

713. Are there twins

among your

children?

714. Sex

M 1 F 2

715. Month

and year of birth

716. Child birth

helper

Doctor 1

Midwives 2

Traditional healer

3 Other

4

717.

Is he/ she still

alive? (Name)

718. IF

STILL ALIVE

How old?

(Name)

WRITE DOWN

IN YEAR

719. IF

STILL ALIVE

Does he/ she lives

with you?

(Name)

720. IF

HAVE BEEN DIED:

How old was he/she when he/ she was

died? (NAME) IF”LESS” THAN 2

YEAR OLD: How old was he/she when he/ she was

died?(in moth)

721. CHECK BIRTH

INTERVAL: Count year difference

between one child (Name) to previous child:

If 4 year or more, please ask

this question: Is there another child who was

born alive between (Name)

and (Name of previous child)?

01. Month. Year.

Yes –1 No –2 →Q.720

Yes –1 No –2 →Q.721

Month -1 Year -2

02. Month. Year.

Yes –1 No –2 →Q.720

Yes –1 No –2 →Q.721

Month -1 Year -2

Yes -1 No -2 (To the next child)

03. Month. Year.

Yes –1 No –2 →Q.720

Yes –1 No –2 →Q.721

Month -1 Year -2

Yes -1 No -2 (To the next child)

04. Month. Year.

Yes –1 No –2 →Q.720

Yes –1 No –2 →Q.721

Month -1 Year -2

Yes -1 No -2 (To the next child)

05. Month. Year.

Yes –1 No –2 →Q.720

Yes –1 No –2 →Q.721

Month -1 Year -2

Yes -1 No -2 (To the next child)

06. Month. Year.

Yes –1 No –2 →Q.720

Yes –1 No –2 →Q.721

Month -1 Year -2

Yes -1 No -2 (To the next child)

07. Month. Year.

Yes –1 No –2 →Q.720

Yes –1 No –2 →Q.721

Month -1 Year -2

Yes -1 No -2 (To the next child)

712.

Please write

down the name of

your child who was born

alive (first,

second, ..)

713. Are there twins

among your

children?

714. Sex

M 1 F 2

715. Month

and year of birth

716. Child birth

helper

Doctor 1

Midwives 2

Traditional healer

3 Other

4

717.

Is he/ she still

alive? (Name)

718. IF

STILL ALIVE

How old?

(Name)

WRITE DOWN

IN YEAR

719. IF

STILL ALIVE

Does he/ she lives

with you?

(Name)

720. IF

HAVE BEEN DIED:

How old was he/she when he/ she was

died? (NAME) IF”LESS” THAN 2

YEAR OLD: How old was he/she when he/ she was

died?(in moth)

721. CHECK BIRTH

INTERVAL: Count year difference

between one child (Name) to previous child:

If 4 year or more, please ask

this question: Is there another child who was

born alive between (Name)

and (Name of previous child)?

08. Month. Year.

Yes –1 No –2 →Q.720

Yes –1 No –2 →Q.721

Month -1 Year -2

Yes -1 No -2 (To the next child)

09. Month. Year.

Yes –1 No –2 →Q.720

Yes –1 No –2 →Q.721

Month -1 Year -2

Yes -1 No -2 (To the next child)

10. Month. Year.

Yes –1 No –2 →Q.720

Yes –1 No –2 →Q.721

Month -1 Year -2

Yes -1 No -2 (To the next child)

11. Month. Year.

Yes –1 No –2 →Q.720

Yes –1 No –2 →Q.721

Month -1 Year -2

Yes -1 No -2 (To the next child)

12. Month. Year.

Yes –1 No –2 →Q.720

Yes –1 No –2 →Q.721

Month -1 Year -2

Yes -1 No -2 (To the next child)

722. Substracted enumeration year with year of birth of the last child, If 4 year or more, asked : Is there another alive child birth after (NAME OF THE LAST CHILD)?

Yes -1 No -2

VII.C. FAMILY PLANNING

723. Have you used/wore contraceptive tools/ method? Yes 1 No 2→Q.730

727. The latest sources of Family Planning services 01. State hospital 07. “Polindes”/ BDD/ 02. Private hospital “Posyandu” 03. Practice doctor 08. “PLKB” 04. “Puskesmas”/ 09. “PPKBD”/Family Supporting Post “Puskesmas” 10. Pharmacy/ drug store 05. Polyclinic 11. Others 06. Practice midviwes Planning

724. The last contraceptive method/ tools that ever been used/ wore

1. MOW/ tubectomy 2. MOP/ vasectomyI 3. UD/ spiral 4. Injection 5. Norplant/ Implant/ alwalit 6. FP pills 7. Condom 8. Intravag/ tissue/ women 9. Traditional method

728. Expenditures to get the latest Family Planning services Rp. ……………………… →→→→ Next Household member

Only For Marital Status Women 725. Are you currently using a contraceptive? 1. Yes 2. No →→→→ Q.729

729. If Q.725 coded 2, when did you used the latest contraceptive tools/ method? Month: Year: Month Year

726. Type of contraceptive currently using 1. MOW/ tubectomy 2. MOP/ vasectomy 3. UD/ spiral 4. Injection 5. Norplant/ Implant/ alwalit 6. FP pills 7. Condom

730. The main reason to not use contraceptive tools/ method

01. Do not have enough knowledge about contaceptive tools/ method or service sources

02. Seldom to be “together” 03. Menopause/ hysterectomy 04. Unfertile period/ parturition/ wet nurse

8. Intravag/ tissue/ women 9. Traditional method→→→→ Next Household

member

perion 05. Want to have a child 06. Respondent/ husband doesn’t agree 07. Health problem/ side-effect 08. The contraceptive tools/ method is very

difficult to reach 09. Expensive 10. Other (………………………………….) Write it down

NOTES