4 2018 MCH Survey Juris Module_FSM_English_Formatted

Federated States of Micronesia

[ONLY ASK THIS QUESTION IF CHILD IS 0-5 or 6-11 YEARS OLD]

I am going to start by asking a few questions about your child’s health.

1. Does this child currently have developmental delay?

   1. ☐ Yes

   2. ☐ No [Go to MC2]

77. ☐ Don’t Know [Go to MC2]

99. ☐ Prefer not to answer [Go to MC2]

[If yes] Would you describe [his/her] developmental delay as mild, moderate, or severe?

1. ☐ Mild

2. ☐ Moderate

3. ☐ Severe

77. ☐ Don’t Know

99. ☐ Prefer not to answer

[ONLY ASK THIS QUESTION IF CHILD IS 0-1 YEAR OLD AND IF BIOLOGICAL MOTHER]

Now I am going to ask a few questions about your health.

2. During your most recent pregnancy, did you have any of the following health conditions?

   	Yes	No	Don’t Know	Prefer not to answer
   MC2a. Gestational diabetes (diabetes that started during this pregnancy)	1 ☐	2 ☐	77 ☐	99 ☐
   MC2b. High blood pressure (that started during this pregnancy), pre-eclampsia or eclampsia	1 ☐	2 ☐	77 ☐	99 ☐
   MC2c. Depression	1 ☐	2 ☐	77 ☐	99 ☐

3. [ONLY ASK THIS QUESTION IF CHILD IS 0-5 YEARS OLD AND IF BIOLOGICAL MOTHER]

Before your new baby was born, did any of the following things happen?

	YES	NO	Don’t Know	Prefer Not to Answer
MC3a. Someone answered my questions about breastfeeding	1 ☐	2 ☐	77 ☐	99 ☐
MC3b. I was offered a class on breastfeeding	1 ☐	2 ☐	77 ☐	99 ☐
MC3c. I attended a class on breastfeeding	1 ☐	2 ☐	77 ☐	99 ☐
MC3d. I decided or planned to feed only breast milk to my baby	1 ☐	2 ☐	77 ☐	99 ☐
MC3e. I discussed feeding only breast milk to my baby with my family	1 ☐	2 ☐	77 ☐	99 ☐
MC3f. I discussed feeding only breast milk to my baby with my health care worker	1 ☐	2 ☐	77 ☐	99 ☐
MC3g. I chose not to breastfeed my baby	1 ☐	2 ☐	77 ☐	99 ☐

4. In the past 12 months, was there any time when you wanted healthcare for yourself, for any reason (such as getting a regular check-up or seeing a doctor when you were sick), but didn’t get it?

   1. ☐ Yes

   2. ☐ No [GO TO END]

77. ☐ Don’t Know [GO TO END]

99. ☐ Prefer not to answer [GO TO END]

5. Why were you unable to get health care for yourself? Check all that apply.

	YES	NO	Don’t Know	Prefer Not to Answer
MC5a. I couldn’t afford it.	1 ☐	2 ☐	77 ☐	99 ☐
MC5b. I did not know where to go.	1 ☐	2 ☐	77 ☐	99 ☐
MC5c. It was too far away.	1 ☐	2 ☐	77 ☐	99 ☐
MC5d. I could not get there when it was open.	1 ☐	2 ☐	77 ☐	99 ☐
MC5e. I could not get an appointment soon enough.	1 ☐	2 ☐	77 ☐	99 ☐
MC5f. I did not have transportation.	1 ☐	2 ☐	77 ☐	99 ☐
MG5g. I didn’t have time to go.	1 ☐	2 ☐	77 ☐	99 ☐
MC5h. I was worried that it wasn’t covered under my insurance.	1 ☐	2 ☐	77 ☐	99 ☐
MC5i. Some other reason, please specify	1 ☐	2 ☐	77 ☐	99 ☐