1 - ESDS

DwQi 1 Hava yOUever had a blby?
NO=. EVW if YOUhave had a babywho ontylivedfar a tioff time, m
plemw ring 1. A 8UIIbornbaby sham matbe indudad. Pleala dng 2
if no Itiabom ba(rf,
Yes, have had a baby .... .... ... .... .... . . .................. [11] GOfa Dkw212N0
No, have never had a baby ................................................. [31 tnslnlmormon
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DWQ12N0 TO AU WOMEN WHO HAVE SVER HAD A OABY
(A)
(B)
(c)
Child
first mm
?+ecmdborn
Third born
Foutth km
Fhth born
Sixthmm
Seventh bom
EighfhImm
Ninthbarn
,Tenth mm
overall
How many dlildmn have you@vanbidhto aiiogethor?
Enfm total nun’Awr,including any WIIOnow liva
mmcwhem elm ●nd ●ny who may hava dlad, bui
excluding ●ny stillborn twby .. . . .. . ... . . .. . . .._ 26 — Go to 0kw213M
P!zmsamconl lha followingdetati foraam of the ch#dmnPU hava
Total nmnbar of
ghmnt4rthto in ths gtid bdow, (atarnngwdhma old- child)
1
childraa
mO dsfo of birth. enwr Monm and Yew
The sax - rtng1 forMale, 2 far Female
Is that childlMrtqwithyou or not?
DWO13M DWQ13YR
(A)
Data of bfrth
Month Year
19...........
. . .... 19...........
.... ..... . 19...........
19...........
... .... 19...........
19,..........
. . ... 19...........
19...........
19...........
19...........
DW012S
(B)
sex
M F
[Sl [a
(41 [4]
{1] [3]
[a
[1!
[1] [0]
[0] [1]
[0] [1]
[14] [1q
4
M-an
DW013L
(c)
IS your child Ilvlng with you or not.
rfng qpropnati nunbw?
I
m
Yes No - alsawhem INOdorossad
[a [a [1]
M [$4 [0]
[31 [1] [q
[1] [a [0]
[0] [1[ [0]
[0] [1] [0]
[1] [01 [0]
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