SDG16
Survey Initiative
Questionnaire
Technical Document
United Nations Development Programme is the leading United Nations
organization fighting to end the injustice of poverty, inequality, and climate change.
Working with our broad network of experts and partners in 170 countries, we help
nations to build integrated, lasting solutions for people and planet.
Learn more at undp.org or follow at @UNDP
United Nations Office on Drugs and Crime’s mission is to contribute to global peace
and security, human rights and development by making the world safer from drugs,
crime, corruption and terrorism.
Learn more at www.unodc.org or follow @UNODC
Office of the United Nations High Commissioner for Human Rights OHCHR-UNOG,
CH-1211 Geneva 10, Switzerland
The Office of the United Nations High Commissioner for Human Rights (OHCHR)
is a key branch of the UN human rights structure. The High Commissioner is
responsible to the UN Secretary-General for encouraging the international
community and States to uphold universal human rights standards. OHCHR seeks to
work with a wide range of actors, including the private sector, to promote respect
for and commitment to human rights as widely as possible. OHCHR serves as
Secretariat to the Human Rights Council, a UN intergovernmental body.
SDG16
Survey Initiative
Questionnaire
Questions marked with * are mandatory
Questions without an asterisk are optional (non-essential to compute the indicator)
For socio-demographic questions, instructions are given as to which modules they are mandatory with
2 | Contents
CONTENTS
INTRODUCTION (INT) ........................................................................................................................ 4
SOCIO-DEMOGRAPHIC VARIABLES .................................................................................................. 5
GENERAL SCREENERS (SCR) ........................................................................................................... 12
SAFETY (SA) ..................................................................................................................................... 13
16.1.4 Proportion of population that feel safe walking alone around the area they live after dark ...... 13
16.7.2 Proportion of population who believe decision-making is inclusive and responsive – External
political efficacy (EPE) ..................................................................................................................................14
16.6.2 Proportion of the population satisfied with their last experience of public services (SPS) .........16
CORRUPTION (CR) ........................................................................................................................... 25
16.5.1 Proportion of persons who had at least one contact with a public official and who paid
a bribe to a public official, or were asked to pay a bribe by those public officials, during the
previous 12 months ......................................................................................................................................25
ACCESS TO JUSTICE (AJ) ................................................................................................................ 37
16.3.3 Proportion of the population who have experienced a dispute in the past two years and
who accessed a formal or informal dispute resolution mechanism to resolve it ....................................37
DISCRIMINATION (DS) ..................................................................................................................... 42
16.b.1/10.3.1 Proportion of population reporting having personally felt discriminated against
or harassed in the previous 12 months on the basis of a ground of discrimination prohibited under
international human rights law ...................................................................................................................42
PHYSICAL VIOLENCE (PHV) ............................................................................................................. 48
16.1.3(a) Proportion of population subjected to (a) physical violence in the previous 12 months........48
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 3
SEXUAL VIOLENCE (SEV) AND SEXUAL HARASSMENT (SHAR) ...................................................... 62
11.7.2(b): Proportion of persons victim of sexual harassment in the previous 12 months ..................... 62
16.1.3(c) Proportion of population subjected to (c) sexual violence in the previous 12 months ...........62
PSYCHOLOGICAL VIOLENCE (PSV) AND NON-SEXUAL HARASSMENT (PHAR) ............................. 78
11.7.2(a): Proportion of persons victim of physical harassment in the previous 12 months ..................78
16.1.3(b) Proportion of population subjected to (b) psychological violence in the previous
12 months .....................................................................................................................................................78
VIOLENCE REPORTING (VR) ............................................................................................................ 93
16.3.1 Proportion of victims of violence in the previous 12 months who reported their victimization
to competent authorities or other officially recognized conflict resolution mechanisms ...................... 93
TRAFFICKING IN PERSONS FOR FORCED LABOUR (TIP) ................................................................ 94
16.2.2 Estimated number of victims of trafficking for forced labour per 100,000 population over
the past five years ........................................................................................................................................94
INTERVIEW EVALUATION ................................................................................................................ 99
4 | IntRoDUCtIon (Int)
INTRODUCTION (INT)
<< Record from sample, do not ask >>
* REG. Geographical region
01 – << code list of national regions >>
02 –
03 –
<< Record from sample, do not ask >>
* URB. Level of urbanisation
01 – urban
02 – rural
1
INT1. Good morning/afternoon/evening, my name is <<name of interviewer>>. I am with <<NSO/
organisation>>, and I am here because we conduct an important survey. The survey collects information on
certain aspects of governance and safety as experienced by the residents in <<COUNTRY >>.
This questionnaire contains no information that could make possible identifying you, thus you will remain
anonymous.
<<insert consent and confidentiality text as appropriate and according with the national legislation>>
Please answer every question based on your knowledge and experience. There are neither correct nor
incorrect answers.
This interview will take about <<XX>> minutes. Participation in the survey is voluntary, you can also
decide not to answer specific questions during the interview. Please answer every question based on your
knowledge and experience. There are neither correct nor incorrect answers.
Do you consent to start the interview?
01 – Yes
02 – No
1 NSO/instituteencouragedtouseanationalvariableforurbanizationlevelthatcanbematchedwithpopulationstatistics,forpost-straticationorpost-hoc
vericationofsamplecomposition.
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 5
SOCIO-DEMOGRAPHIC VARIABLES
<< Ask all >>
D1. May I ask, in which year were you born?
MANDATORY WITH: PHV, SEV, PSV, PHAR, SHAR, VR, SA, CR, EPE, SPS, DS, TIP
<< control for age range 18
2
-105 >>
Write in year of birth: ____________
9998 – Don’t know
9999 – Prefer not to say
<< Ask if D1 = 9998 or 9999 >>
D1_CAT. Can you then give me the category that corresponds to your age? Are you between ...
MANDATORY WITH: PHV, SEV, PSV, PHAR, SHAR, VR, SA, CR, EPE, SPS, DS, TIP
2 Assuming that the survey population consists of adults
3 NSOs to map these categories according to nationally relevant types of education levels and may replace the categories with those that are well unders-
toodbythegeneralpopulation,butstillallowthemappingwiththesecategories.
01 – 18-19
02 – 20-24
03 – 25-29
04 – 30-34
05 – 35-39
06 – 40-44
07 – 45-49
08 – 50-54
09 – 55-59
10 – 60-64
11 – 65-69
12 – 70-74
13 – 75-79
14 – 80-89
15 – 90 or above
98 – Don’t know
99 – Prefer not to say
<< Ask all >>
D2. What is your highest level of education?
3
MANDATORY WITH: PHV, SEV, PSV, PHAR, SHAR, CR, DS
<< Do not read, code from response >>
00 – No formal education
01 – Informal schooling only
02 – Less than primary education
03 – Primary school completed
04 – Lower secondary school completed
05 – Upper secondary school completed
06 – Post-secondary non-tertiary education
07 – Bachelor/equivalent degree completed
08 – Masters/equivalent degree or above
98 – Don’t know
99 – Prefer not to say
6 | soCIo-DemoGRAphIC VARIAbles
<< Ask all >>
D3. What is your sex?
MANDATORY WITH: PHV, SEV, PSV, PHAR, SHAR, VR, SA, CR, EPE, SPS, AJ, DS, TIP
<< Do not read, one response only >>
4 NotetoNSOs:“intersex”tobeaddedonlyifcountryallowedintersexasathirdgenderonbirthcerticates,sincetherstlegitimateyearofbirth
consideringtheloweragelimitofthetargetpopulationandtheyearofadministration,useofcialterms
01 – Male
02 – Female
03 – Intersex
77 – Other, please specify ___________
98 – Don’t know
99 – Prefer not to say
<< Ask IF D3 < 98 >>
D3A. Is it the same as your sex at birth?
MANDATORY WITH: DS
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<< Ask if D3A = 02 >>
D3B. What was your sex at birth?
MANDATORY WITH: DS
<< Do not read, code reply>>
01 – Male
02 – Female
03 – Intersex
4
98 – Don’t know
99 – Prefer not to say
<< Ask all >>
D3C. Do you currently identify as a … ?
MANDATORY WITH: DS
<< Read out>>
01 – Man
02 – Woman
77 – Other, please specify ___________
98 – Don’t know
99 – Prefer not to say
<< Ask all >>
D4A. Are you a citizen of <<country of enumeration>>?
MANDATORY WITH: PHV, SEV, PSV, PHAR, SHAR, VR, AJ, DS
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 7
<< Ask if D4A = 02, 98. Auto-code to country of enumeration if D4A = 01. Auto-code to 99 if D4A = 99>>
D4B. What is your citizenship?
MANDATORY WITH: PHV, SEV, PSV, PHAR, SHAR, VR, AJ, DS
<< Do not read out. Code according to country name>>
Code with list of Standard Country or Area Codes for Statistical Use – Country names
Include in code list:
77 – Stateless / No nationality
98 – Don’t know
99 – Prefer not to say
<< Ask if D4B not 77, 98, 99 >>
D4C. Do you have a second citizenship?
MANDATORY WITH: PHV, SEV, PSV, PHAR, SHAR, VR, AJ, DS
<< Do not read out >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<< Ask if D4C = 01>>
D4D. What is your second citizenship?
MANDATORY WITH: PHV, SEV, PSV, PHAR, SHAR, VR, AJ, DS
<< Do not read out. Code according to country name>>
Code with list of Standard Country or Area Codes for Statistical Use – Country names
98 – Don’t know
99 – Prefer not to say
<< Ask all >>
D5A. Were you born in (the current territory of) <<country of enumeration>>?
MANDATORY WITH: VR, AJ, DS, TIP
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<< Ask if D5A = 02, 98. Auto-code to country of enumeration if D5A = 01. Auto-code to 99 if D4A = 99>>
D5B. In which country were you born?
MANDATORY WITH: VR, AJ, DS, TIP
<< Do not read out, code according to country name. If in doubt, consider current territories of countries >>
Code with list of Standard Country or Area Codes for Statistical Use – Country names, put country of enumeration
in first position for easy retrieval.
997 – Not <<country of enumeration>>, but do not
know which country
998 – Don’t know
999 – Prefer not to say
<< Ask all >>
8 | soCIo-DemoGRAphIC VARIAbles
D5C. In which country was your father born?
MANDATORY WITH: VR, AJ, DS, TIP
<< Do not read out, code according to country name. If in doubt, consider current territories of countries >>
Code with list of Standard Country or Area Codes for Statistical Use – Country names, position country of
enumeration on top of the list for easy selection
97 – Not <<country of enumeration>>, but do not
know which country
98 – Don’t know
99 – Prefer not to say
<< Ask all >>
D5D. In which country was your mother born?
MANDATORY WITH: VR, AJ, DS, TIP
<< Do not read out, code according to country name. If in doubt, consider current territories of countries >>
Code with list of Standard Country or Area Codes for Statistical Use – Country names, position country of
enumeration on top of the list for easy selection
97 – Not <<country of enumeration>>, but do not
know which country
98 – Don’t know
99 – Prefer not to say
<< Ask if D5A not country of enumeration, 98 or 99>>
D5E. When did you first come to reside in <<country of enumeration>>?
MANDATORY WITH: VR, AJ, DS, TIP
<< Date fields for month and year.
Code month (MM) as 98 if month unknown and enter year. Code month as 98 and year (YYYY) as 9998 if don’t
know at all. Code month as 99 and year as 9999 if prefer not to say.
Definition of „come to reside in”: person came to the country and stayed there for at least one year regardless
of reason and legal status; or is planning to stay there for at least one year if they first arrived less than a year
ago.>>
Record date: MM-YYYY
<< Ask if D5A = 02>>
D5F. What was the main reason you most recently came to reside in <<country of enumeration>>?
MANDATORY WITH: VR, AJ, DS, TIP
<< Do not read out. One response only. >>
01 – Employment (including military service), job found before migrating
02 – Employment (including military service), no job found before migrating
03 – Education, study or training
04 – Marriage, partnership formation, family reunification or family formation
05 – <<country of enumeration>> is one or both parent’s country of origin
06 – Armed conflict
07 – Generalized violence
08 – Persecution and/or violations of human rights
09 – Experience and/or fear of crime
10 – Natural or human-made disasters
11 – Trafficking / coercion
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 9
96 – Other forced displacements or evictions
97 – Other voluntary movements
98 – Don’t know
99 – Prefer not to say
<< Ask all >>
D6. To what ethnic group do you belong?
5
MANDATORY WITH: PHV, SEV, PSV, VR, DS
<< Read out, mark all that apply >>
01 – <<Nationally relevant ethnic/racial group 1>>
02 – <<Nationally relevant ethnic/racial group 2>>
03 – <<Nationally relevant ethnic/racial group 3>>
04 – <<Nationally relevant ethnic/racial group 4>>
05 – <<Nationally relevant ethnic/racial group 5>>
06 – <<Mixed/Multiple ethnic/racial groups 6>>
77 – Other, specify: __________________
98 – Don’t know
99 – Prefer not to say
<< Ask all >>
D7. The next questions ask about difficulties you may have doing certain activities because of a HEALTH
PROBLEM.
MANDATORY WITH: SPS, EPE, AJ, DS
<< Read out items and response categories, one answer per item >>
No – no
difficulty
Some
difficulty
A lot of
difficulty
Cannot
do at all
Don’t
know
Prefer
not to
say
A. Do you have difficulty seeing, even if
wearing glasses?
01 02 03 04 98 99
B. Do you have difficulty hearing, even
if using a hearing aid?
01 02 03 04 98 99
C. Do you have difficulty walking or
climbing steps?
01 02 03 04 98 99
D. Do you have difficulty remembering
or concentrating?
01 02 03 04 98 99
E. Do you have difficulty (with self-care
such as) washing all over or dressing?
01 02 03 04 98 99
F. Using your usual (customary)
language, do you have difficulty
communicating, for example
understanding or being understood?
01 02 03 04 98 99
5 NSOtoadjust/addnationallyrelevantquestionthatisusuallyusedtoclarifyethnic/racialbackground.Thequestionmustbebasedsolelyonrespondent
self-identication,multipleselectionshouldbeallowed,andmustofferanopenpossibilityof“other”,enteredverbatim,besidesthenationallymost
frequent categories See: https://www.ohchr.org/EN/Issues/Indicators/Pages/documents.aspx
10 | soCIo-DemoGRAphIC VARIAbles
<< Ask all >>
D8. What is your religion?
MANDATORY WITH: DS
<< One response only >>
6 IncomedecilerangestobedeterminedbyNSO/institution,basedonnationalhouseholdlevelincomestatistics
00 – No religion
01 – Atheist / agnostic
11 – <<nationally relevant denomination 1>>
12 – <<nationally relevant denomination 2>>
13 – <<nationally relevant denomination 3>>
14 – <<nationally relevant denomination 4>>
15 – <<nationally relevant denomination 5>>
16 – <<nationally relevant denomination 6>>
77 – Other, specify:__________________
98 – Don’t know
99 – Prefer not to say
<< Ask all >>
D9. Which of the followings best describe your current marital status?
MANDATORY WITH: DS
<< Read out, one response only >>
01 – Single / Never married
02 – Married
03 – Cohabiting with intimate partner
04 – Separated
05 – Divorced
06 – Widowed
77 – Other, specify: __________________
98 – Don’t know
99 – Prefer not to say
<< Ask all >>
D10. A household may have different sources of income and more than one household member may
contribute to it. Thinking of your household’s total monthly income: is your household able to cover basic
expenses…?
01 – Very easily
02 – Easily
03 – Fairly easily
04 – With some difficulty
05 – With difficulty
06 – With great difficulty
98 – Don’t know
99 – Prefer not to say
<< Ask all >>
D11 What range best matches your household’s total monthly net income?
6
.
MANDATORY WITH: PHV, SEV, PSV, PHAR, SHAR, CR, SPS, DS
01 – <<1st decile>>
02 – <<2nd decile>>
03 – <<3rd decile>>
04 – <<4th decile>>
05 – <<5th decile>>
06 – <<6th decile>>
07 – <<7th decile>>
08 – <<8th decile>>
09 – <<9th decile>>
10 – <<10th decile>>
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 11
<< Ask all >>
D12. Do you consider yourself as … ?
MANDATORY WITH: DS
<< Read out, one response only >>
01 – Heterosexual or straight
02 – Homosexual or gay / lesbian
03 – Bisexual
77 – Other, specify: ______________________
98 – Don’t know
99 – Prefer not to say
D13. Is the person (him/herself) answering to the questions?
MANDATORY IF PROXY REPORTING IS A POSSIBITILY
01 – Yes
02 – No
12 | GeneRAl sCReeneRs (sCR)
GENERAL SCREENERS (SCR)
* SCR1. Please let me know if you have permanently lived in <<country>> for the past 12 months
(since MONTH YEAR)?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
* SCR2. Family status screener
Yes No Don’t
know
Prefer
not to
say
A Are you currently living together with a spouse or partner? 1 2 8 9
IF SCR2_A=2 (NOT HAVING A COHABITING INTIMATE PARTNER) ASK:
B Are you in a relationship
7
without living together? 1 2 8 9
ASK ALL
C Have you been previously in a relationship, with or without
living with your partner or a spouse (not counting your current
relationship)?
1 2 8 9
D Do you have children under the age of 18 that you currently live
with? Please include your own children, as well as step or foster
children, or any children you are the primary caregiver of.
1 2 8 9
<< Compute/record family intimate partner status filter IPS = 1 if any SCR2 A-C = 1 >>
* SCR3. Do you currently work or have you worked in the last 3 years (since MONTH YEAR)?
MANDATORY WITH: TIP
01 – Yes, currently working
02 – Not currently working, but had been working over the past three years
03 – No
98 – Don’t know
99 – Prefer not to say
7 Instructiontotheinterviewer:Recordas‘yes’hereifrespondenthasaboyfriendorgirlfriend.
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 13
SAFETY (SA)
16.1.4 Proportion of population that feel safe
walking alone around the area they live after dark
<<Ask all>>
* SA1. How safe do you feel walking alone in your neighbourhood after dark?
IF RESPONDENT NEVER GOES OUT ALONE AFTER DARK, PROBE: How safe WOULD you feel?
<<Read out, one response only>>
01 – Very safe
02 – Safe
03 – Unsafe
04 – Very unsafe
98 – Don’t know
99 – Prefer not to say
<<Ask all>>
SA2. How safe do you feel at home after dark?
<<Read out, one response only>>
01 – Very safe
02 – Safe
03 – Unsafe
04 – Very unsafe
98 – Don’t know
99 – Prefer not to say
<<Ask all>>
SA3. Some of us WORRY at some time or other about falling victim to crime. Could you tell me how
worried you are about the following:
A. (How worried are you about) … being physically attacked by strangers, including being mugged or
robbed?
<<Read out, one response only>>
01 – Very worried
02 – Fairly worried
03 – Not very worried
04 – Not at all worried
98 – Don’t know
99 – Prefer not to say
B. (How worried are you about) … having your home broken into and something stolen?
<<Read out, one response only>>
01 – Very worried
02 – Fairly worried
03 – Not very worried
04 – Not at all worried
98 – Don’t know
99 – Prefer not to say
C. (How worried are you about) … having your other valuables stolen or vandalized?
<<Read out, one response only>>
01 – Very worried
02 – Fairly worried
03 – Not very worried
04 – Not at all worried
98 – Don’t know
99 – Prefer not to say
14 | sAFetY (sA)
16.7.2 Proportion of population who believe
decision-making is inclusive and responsive –
External political ecacy (EPE)
<<Ask all>>
* EPE1. How much would you say the political system in [country] allows people like you to have a say in
what the government does?
<<Read out, one response only>>
01 – Not at all
02 – Very little
03 – Some
04 – A lot
05 – A great deal
98 – Don’t know
99 – Prefer not to say
<<Ask all>>
* EPE2. And how much would you say that the political system in [country] allows people like you to have
an influence on politics?
<<Read out, one response only>>
01 – Not at all
02 – Very little
03 – Some
04 – A lot
05 – A great deal
98 – Don’t know
99 – Prefer not to say
<< Ask all >>
CV3a. Are you currently legally allowed to vote at the national* elections in [country]?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<<Ask if CV3a = 01>>
CV4a. When was the last time you voted at the national* elections in [country]?
<< Do not read out>>
01 – Within the past four years / the last elections
02 – Earlier than that
03 – Never voted
97 – I was not allowed, or not of voting age
98 – Don’t know
99 – Prefer not to say
<<Ask all>>
CV3b. Are you currently legally allowed to vote at the municipal / local council elections** here in this town
or village?
01 – Yes
02 – No
97 – There are no municipal elections
98 – Don’t know
99 – Prefer not to say
* NSO to amend to “legislative and presidential national elections” where this is ambiguous
** NSO to adapt to the nationally used term for municipal elections in the local translation
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 15
<<Ask if CV3b = 01>>
CV4b. When was the last time you voted at the municipal / local council elections** here in this town or
village?
<< Do not read out>>
01 – Within the past four years / the last elections
02 – Earlier than that
03 – Never voted
97 – I was not allowed, or not of voting age
98 – Don’t know
99 – Prefer not to say
16 | sAFetY (sA)
16.6.2 Proportion of the population satised with
their last experience of public services (SPS)
<<Ask all>>
I would like to ask you a few questions about your experience with primary healthcare services. Please
exclude your experiences with surgery, dental care and teeth exams, and focus only on primary health
services, such as those with a public health clinic
8
or a government-employed doctor or nurse. These
experiences may be personal or related to a child below 18 years of age in your care.
<<Ask all>>
VERSION IF SCR2_D <> 2
SPS_H1A. Was there any time during the past 12 months (since MONTH YEAR) when you, or a child in your
care, really needed a medical examination or treatment?
<<Read out, one response only>>
8 Usethespecicnameofpublichealthfacilitiesprovidingprimaryhealthcareservicesinthecountry
01 – Yes, yourself
02 – Yes, both yourself and a child
03 – Yes, a child, but not yourself
04 – No, neither yourself nor a child in your care needed
medical examination or treatment —> SKIP TO SPS_H4.
98 – Don’t know —> SKIP TO SPS_H4.
99 – Prefer not to say —> SKIP TO SPS_H4.
VERSION IF SCR2_D = 2
SPS_H1B. Was there any time during the past 12 months (since MONTH YEAR) when you really needed a
medical examination or treatment?
<<Read out, one response only>>
01 – Yes
04 – No —> SKIP TO SPS_H4.
98 – Don’t know —> SKIP TO SPS_H4.
99 – Prefer not to say —> SKIP TO SPS_H4.
<<Ask if SPS_H1A or SPS_H1B < 4>>
SPS_H2A. Did you have a medical examination or treatment performed by public health services each time
you really needed it (such as from public clinics or from doctors, nurses in primary care)?
<< Readout, one response only >>
01 – Yes, each time
02 – No, not each time, but at least one time
03 – No, never
98 – Don’t know
99 – Prefer not to say
<<Ask if SPS_H1 = 3>>
SPS_H2B. Did the child/children in your care have a medical examination or treatment performed by public
health services (such as from public clinics or from doctors, nurses in primary care) each time (s)he/they
really needed it?
<< Readout, one response only >>
01 – Yes, each time
02 – No, not each time, but at least one time
03 – No, never
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 17
<<Ask if SPS_H2A = 2,3 OR SPS_H2B = 2,3>>
SPS_H3. What was the main reason for not having the medical examination or treatment from public health
services the last time it happened?
<<Read out, one response only>>
01 – Could not afford (too expensive)
02 – Too long waiting list or waiting time
03 – Too far to travel or no means of transportation to get there
04 – Didn’t know any good medical doctor or health professional
05 – Could not take time because of work, care for children or for other reasons
06 – Wanted to wait and see if the problem got better on its own
07 – Fear of medical doctors, hospitals, examination or treatment
08 – Healthcare facilities are not clean
09 – Healthcare facilities are not adequately equipped or lack medicine
77 – Other reasons: _______________
88 – Not using public health services for primary care (uses private healthcare, alternative medicine, etc.)
98 – Don’t know
99 – Prefer not to say
<< Ask all >>
VERSION IF SCR2_D <> 2
* SPS_H4. (If optional section H1-H3 was asked, add: Let me confirm:) Did you or a child in your care receive
medical examination or treatment from primary public health services (such as from public clinics or from
doctors, nurses in primary care) in <country> at least once over the past 12 months, that is since <<MONTH
YEAR>>?
<<Read out, one response only>>
01 – Yes, yourself
02 – Yes, both yourself and a child
03 – Yes, a child, but not yourself
04 – No, neither yourself nor a child in your care received medical examination or treatment from these places
over the past 12 months —> SKIP TO SPS_E1
98 – Don’t know —> SKIP TO SPS_E1
99 – Prefer not to say —> SKIP TO SPS_E1
VERSION IF SCR2_D = 2
* SPS_H4. (If optional section H1-H3 was asked, add: Let me confirm: ) Did you receive medical examination
or treatment from primary public health services (such as from public clinics or from doctors, nurses in
primary care) in <country> at least once over the past 12 months, that is since <<MONTH YEAR>>?
<<Read out, one response only>>
01 – Yes
04 – No —> SKIP TO SPS_E1
98 – Don’t know —> SKIP TO SPS_E1
99 – Prefer not to say —> SKIP TO SPS_E1
18 | sAFetY (sA)
* SPS_H5.
<< Ask if SPS_H4<3 >>
I now want to ask you some questions about the last time you had a medical examination or treatment
provided by public health services, in the past 12 months.
<< Ask if SPS_H4=3 >>
I now want to ask you some questions about the last time your child had a medical examination or
treatment provided by public health services, in the past 12 months.
<< Ask if SPS_H4<4 >>
Thinking about this last experience, how much do you agree with the following statements:
<<Read out items and answer categories, one response per line>>
Strongly
agree
Agree Disagree Strongly
disagree
DK REF
A It was easy to get to the place
where you received healthcare
services.
3 2 1 0 98 99
B Expenses for healthcare services
were affordable to you/your
household.
3 2 1 0 98 99
C The healthcare facilities were clean
and in good condition.
3 2 1 0 98 99
D All people are treated equally in
receiving healthcare services in your
area.
3 2 1 0 98 99
E The doctor or other healthcare
staff you saw spent enough time
with you [or your child] during the
consultation.
3 2 1 0 98 99
* SPS_H6.
<< Ask if SPS_H4<3 >>
A. Overall, how satisfied or dissatisfied were you with the quality of primary healthcare services you
received on that last consultation?
<< Ask if SPS_H 4=3 >>
B. Overall, how satisfied or dissatisfied were you with the quality of primary healthcare services the child in
your care received on that last consultation?
03 – Very satisfied
02 – Satisfied
01 – Dissatisfied
00 – Very dissatisfied
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 19
<< Ask if SCR2_D = 1, else skip to SPS_G1>>
* SPS_E1. The next few questions focus on your experience with the primary and secondary public school
system. By this, I mean schools that are funded by the government. Are there children in your care whose
age falls between 5 and 18 years old
9
?
9 Reviseagerange(5-18yearsold)withtheappropriateagerangespanningprimaryandsecondaryeducationinthecountry.
10 PrimaryschoolshouldbeprovingacurriculumequivalenttoISCED1
11 SecondarySchoolatminimumshouldbeprovidingacurriculumequivalenttoISCED2and3
01 – Yes, more than one
02 – Yes, just one
03 – No —> SKIP TO SPS_G1.
98 – Don’t know —> SKIP TO SPS_G1
99 – Prefer not to say —> SKIP TO SPS_G1
<< Ask if SPS_E1 = 2>>
SPS_E2A. Does this child attend a public primary or secondary school regularly?
01 – Yes, a primary school
10
02 – Yes, a secondary school
11
04 – No —> SKIP TO NEXT SEGMENT
98 – Don’t know —> SKIP TO NEXT SEGMENT
99 – Prefer not to say —> SKIP TO NEXT SEGMENT
<< Ask if SPS_E1 = 01>>
SPS_E2B. Do all of these children attend a public primary or secondary school regularly?
01 – Yes, a primary school
02 – Yes, a secondary school
03 – Yes, some attend primary, some secondary school
04 – No
98 – Don’t know —> SKIP TO NEXT SEGMENT
99 – Prefer not to say —> SKIP TO NEXT SEGMENT
<< Ask if SPS_E2A = 04 OR SPS_E2B = 04 >>
SPS_E3A. What is the main reason for this child/some children in your care not to attend a public school
regularly?
<<Read out, one response only>>
01 – Cannot afford school-related expenses (administrative fees, books, uniforms, transportation, etc.)
02 – The nearest school is too far away and/or transportation is not available
03 – School facilities are in poor conditions
04 – The school and its compound are not safe
05 – Teachers and other school staff do not treat children with respect
06 – Teachers are ineffective/not adequately trained
07 – Teachers are often absent
08 – Child/children need to stay home to help with housework/farm/other work
09 – No culturally or religiously appropriate educational programs available
10 – School not equipped for children with special learning needs
77 – Other reasons: _______________
98 – Don’t know
99 – Prefer not to say
20 | sAFetY (sA)
<< Ask if SPS_E2A = 04 OR SPS_E2B = 04 >>
SPS_E3B. What kind of education does the child / children in your care who do not regularly attend public
schools receive?
<<Read out, multiple responses permitted>>
01 – They attend a private school
02 – They are home-schooled
03 – They receive education but not in formal structure (they attend youth literacy and education for out-of-school
children or other programmes).
04 – They receive no formal education (they work at home or elsewhere, they have their own children, etc.)
98 – Don’t know
99 – Prefer not to say
<< Ask if SPS_E2B = 04 >>
* SPS_E4. You said not all children attend public schools. Are there any children in your care who attend
public primary or secondary schools regularly?
<<Read out, one response only>>
01 – Yes, primary school
02 – Yes, secondary school
03 – Yes, both
04 – No —> SKIP TO NEXT SEGMENT
98 – Don’t know —> SKIP TO NEXT SEGMENT
99 – Prefer not to say —> SKIP TO NEXT SEGMENT
<< Ask if any children in public primary school, based on SPS_E2A-B, SPS_E4 >>
* SPS_E5_1. Considering the public primary school of children you care for (eldest child, if children attend
different public primary schools), how much do you agree with the following statements?
<<Read out items and answer categories, one response per line>>
Strongly
agree
Agree Disagree Strongly
disagree
DK REF
A The school can be reached by public
or private transportation, or by walk,
in less than 30 minutes and without
difficulties.
3 2 1 0 98 99
B School-related expenses (including
administrative fees, books, uniforms
and transportation) are affordable to
you/your household.
3 2 1 0 98 99
C School facilities are in good condition. 3 2 1 0 98 99
D All children are treated equally in the
school attended by the child/children
in your household, including admission
to these schools.
3 2 1 0 98 99
E The quality of teaching is good. 3 2 1 0 98 99
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 21
<< Ask if any children in public secondary school, based on SPS_E2A-B, SPS_E4 >>
* SPS_E5_2. (And) Considering the public secondary school of the children you care for (eldest child, if
children attend different public secondary schools), how much do you agree with the following statements?
<<Read out items and answer categories, one response per line>>
Strongly
agree
Agree Disagree Strongly
disagree
DK REF
A The school can be reached by public
or private transportation, or by walk,
in less than 30 minutes and without
difficulties.
3 2 1 0 98 99
B School-related expenses (including
administrative fees, books, uniforms
and transportation) are affordable to
you/your household.
3 2 1 0 98 99
C School facilities are in good condition. 3 2 1 0 98 99
D All children are treated equally in the
school attended by the child/children
in your household, including admission
to these schools.
3 2 1 0 98 99
E The quality of teaching is good. 3 2 1 0 98 99
<< Ask if any children in public primary school, based on SPS_E2A-B, SPS_E4 >>
* SPS_E6_1. Overall, how satisfied or dissatisfied are you with the quality of education services provided
by the primary public school attended by the child/children in your care (eldest child, if children attend
different public primary schools)?
03 – Very satisfied
02 – Satisfied
01 – Dissatisfied
00 – Very dissatisfied
98 – Don’t know
99 – Prefer not to say
<< Ask if any children in public secondary school, based on SPS_E2A-B, SPS_E4 >>
* SPS_E6_2. Overall, how satisfied or dissatisfied are you with the quality of education services provided
by the secondary public school attended by the child/children in your care (eldest child, if children attend
different public primary schools)?
03 – Very satisfied
02 – Satisfied
01 – Dissatisfied
00 – Very dissatisfied
98 – Don’t know
99 – Prefer not to say
22 | sAFetY (sA)
<< Ask all >>
* SPS_G1. I am now going to ask you a few questions about government services in [country name]. In the
past 12 months, did you need to obtain or renew a government-issued identification, such as a national
identity card, a passport, a driver’s license, a voter’s card, or a certificate of birth, death, marriage or
divorce
12
?
12 NSOtotailorthelistofgovernment-issuedidenticationdocumentsinthisquestiontotheirnationalcontextandincludeonlythoseinuseinthecountry,
andforwhichcitizensactuallyneedtoleanapplication.Forinstance,nationalidentitycardsmaynotexist,orvoters’cardsmaysimplybemailedtoa
personbeforevoting,etc.Dependingonthenationalcontext,otherrelevantIDdocumentsthatcouldbeaddedincludepermanentresidentcardsand
citizenshipcards.Wherethereisarelevantmigrantsubpopulation,thelistingofdocumentsshouldincludethosethatarespecicforthisgroup(i.e.
residencepermit,etc.)
13 NSOtoreplace‘civilregistrationservicesorotherrelevantagencies’withthenameoftheparticularagency(ies)responsibleforissuingsuchidentication
documentsinthecountry.
01 – Yes
02 – No —> SKIP TO NEXT MODULE.
98 – Don’t know —> SKIP TO NEXT MODULE
99 – Prefer not to say —> SKIP TO NEXT MODULE
<< Ask if SPS_G1 = 01>>
SPS_G2. Did you try to obtain all document(s) you needed from the civil registration services or other
relevant agencies
13
?
01 – Yes, all
02 – No, not all
98 – Don’t know
99 – Prefer not to say
<< Ask if SPS_G2 = 02>>
SPS_G3. Please specify the document(s) you needed but did not try to obtain
<< Read list, prompt for “other”, if respondent refuses enter “not mentioned” >>
mentioned not mentioned
A. National identity card 1 0
B. Passport 1 0
C. Driver’s license 1 0
D. Voter’s card 1 0
E. Certificate of birth, death, marriage or divorce 1 0
X. Other, write in: ____________________________ 1 0
<< Ask if SPS_G2 = 02>>
SPS_G4. What is the main reason you did not try to obtain such a document(s) from the civil registration
services or other relevant agencies?
<<Read out, one response only>>
01 – Cannot afford to (administrative fees are too expensive)
02 – Too difficult to access the ‘point-of-service’ (office, phone number, website)
03 – The staff do not treat people with respect
04 – The process for applying and obtaining such documents is too complicated
05 – It takes too long to get what you need
77 – Other reasons: _______________
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 23
<< Ask if SPS_G1 = 01>>
* SPS_G5. Let me confirm; did you attempt to obtain or renew a government-issued identification, such
as a national identity card, a passport, a driver’s license, a voter’s card, or a certificate of birth, death,
marriage or divorce
14
in the past 12 months, that is since <<MONTH YEAR>>?
<< One response only>>
14 NSOsshouldtailorthelistofgovernment-issuedidenticationdocumentsinthisquestiontotheirnationalcontextandincludeonlythoseinuseinthe
country,andforwhichcitizensactuallyneedtoleanapplication.Forinstance,nationalidentitycardsmaynotexist,orvoters’cardsmaysimplybemailed
toapersonbeforevoting,etc.Dependingonthenationalcontext,otherrelevantIDdocumentsthatcouldbeaddedincludepermanentresidentcards
andcitizenshipcards.Wherethereisarelevantmigrantsubpopulation,thelistingofdocumentsshouldincludethosethatarespecicforthisgroup(i.e.
residencepermit,etc.)
15 NSOscanskipthisquestionifobtainingsuchdocumentscannotbedoneonlineintheircountry.
01 – Yes
02 – No —> SKIP TO NEXT MODULE.
98 – Don’t know —> SKIP TO NEXT MODULE
99 – Prefer not to say —> SKIP TO NEXT MODULE
<< Ask if SPS_G5 = 1 >>
* SPS_G6. I now want to ask you some questions about the last time you tried to obtain such a document
in the past 12 months. Please tell me what the last document you tried to obtain was:
<< Read-out, one response only>>
01 – national identity card
02 – passport
03 – driver’s license
04 – a voter’s card
05 – certificate of birth, death, marriage or divorce
77 – other document
98 – Don’t know —> SKIP TO NEXT MODULE
99 – Prefer not to say —> SKIP TO NEXT MODULE
<< Ask if SPS_G6 < 98 >>
SPS_G7. Did you apply for this document online?
15
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
24 | sAFetY (sA)
<< Ask if SPS_G6 < 98 >>
* SPS_G8. Thinking about this last time you tried to obtain << name of the document identified by the
respondent in SPS_G6 >>, how much do you agree with the following statements?
<<Read out items and answer categories, one response per line>>
Strongly
agree
Agree Disagree Strongly
disagree
DK REF
A The office, website or telephone
number was easily accessible.
3 2 1 0 98 99
B The fees you needed to pay for the
document or the certificate were
affordable to you/your household.
<<code 3 if free of charge>>
3 2 1 0 98 99
C The process for applying and
obtaining the document or the
certificate was simple and easy to
understand.
3 2 1 0 98 99
D All people are treated equally in
receiving government services in your
area.
3 2 1 0 98 99
E The amount of time it took to obtain
the document or the certificate was
reasonable.
3 2 1 0 98 99
<< Ask if SPS_G5 = 1 >>
* SPS_G8. Overall, how satisfied or dissatisfied were you with the quality of government services you
received on that occasion, that is when you tried to obtain << name of the document identified by the
respondent in SPS_G6 >> in the past 12 months?
03 – Very satisfied
02 – Satisfied
01 – Dissatisfied
00 – Very dissatisfied
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 25
CORRUPTION (CR)
16.5.1 Proportion of persons who had at least one
contact with a public ocial and who paid a bribe to
a public ocial, or were asked to pay a bribe by those
public ocials, during the previous 12 months
A
* CR1. In the last 12 months (since MONTH YEAR), have you had contact, either by yourself or through
someone else, with any of the following types of officials? By contact I mean official rather than private
communication with these officials.
Yes No Don’t
know
Prefer not
to say
A Municipal or provincial officials 01 02 98 99
B Elected local government representatives at the provincial,
municipal, canton, etc. level
01 02 98 99
C Elected national or federal government representatives 01 02 98 99
D Social security or welfare officials 01 02 98 99
E Teachers, lecturers or professors at public schools or
universities
01 02 98 99
F Doctors, nurses or other healthcare officials at a public
clinic or hospital
01 02 98 99
G Police officers, including local police 01 02 98 99
H Prosecutors, judges or magistrates 01 02 98 99
I Tax or revenue officers 01 02 98 99
J Customs officers 01 02 98 99
K Public utility officials or inspectors (electricity, water,
sanitation, etc.)
01 02 98 99
L Passport agency officials 01 02 98 99
M Car registration or driving licence agency officials 01 02 98 99
N Members of the armed forces 01 02 98 99
O Land registry (cadastre) officials 01 02 98 99
P-X Additional types of public official that could be included in
survey questionnaires, subject to the national context
16
01 02 98 99
16 Forexample:Members of parliament/legislature at national and local level ; Trafc management authority ofcials (when different from police) ; Public
transport ofcials (e.g., ticket inspectors on buses, trains, etc.); Immigration service ofcers ; Inspection ofcials (health, safety, re, labour, etc.) ;
Embassy/consulate ofcers of foreign countries ; Public banks and nancial institutions ; Prison administration ; Other public ofcial/civil servant — See
https://www.unodc.org/documents/data-and-analysis/Crime-statistics/CorruptionManual_2018_web.pdf,pp84.
26 | CoRRUptIon (CR)
<<If any of CR1A-X = 01 >>
CR2_INTRO. You seem to have had a contact with public officials in the past year. I will ask some brief
questions if you had to give any of these officials a gift or money in addition to any official fee, or done
them a favour in return for a service, including through someone else. (IF RESPONDENT UNCLEAR,
EXPLAIN) By official fee we mean the normal payment, if any, for the administrative procedure processed,
as set by the institution. When talking about gifts, please consider only those gifts that had to be given in
return for a service.
<<Read and continue >>
<< Ask if CR1_A = 1 >>
* CR2_A. In the last 12 months (since MONTH YEAR), have you had to give municipal/provincial officials a
gift or money in addition to any official fee, or done them a favour in return for a service, including through
someone else.
101 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<< Ask if CR2_A = 101>>
CR3_A. Still thinking about the last 12 months (since MONTH YEAR), how many times have you had to give
municipal/provincial officials a gift or extra money, or done them a favour in return for a service?
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
B
<< Ask if CR1_B = 1 >>
* CR2_B. In the last 12 months (since MONTH YEAR), have you had to give elected local government
representatives (provinces, municipalities, cantons, etc.) a gift or money in addition to any official fee, or
done them a favour in return for a service, including through someone else.
102 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<< Ask if CR2_B = 102>>
CR3_B. Still thinking about the last 12 months (since MONTH YEAR), how many times have you had to give
elected local government representatives (provinces, municipalities, cantons, etc.) a gift or extra money, or
done them a favour in return for a service?
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
C
<< Ask if CR1_C = 1 >>
* CR2_C. In the last 12 months (since MONTH YEAR), have you had to give elected national/federal
government representatives a gift or money in addition to any official fee, or done them a favour in return
for a service, including through someone else?
103 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 27
<< Ask if CR2_C = 103>>
CR3_C. Still thinking about the last 12 months (since MONTH YEAR), how many times have you had to give
elected national/federal government representatives a gift or extra money, or done them a favour in return
for a service?
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
D
<< Ask if any CR1_D = 1 >>
* CR2_D. In the last 12 months (since MONTH YEAR), have you had to give social security or welfare
officials a gift or money in addition to any official fee, or done them a favour in return for a service,
including through someone else?
104 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<< Ask if CR2_D = 104>>
CR3_D. Still thinking about the last 12 months (since MONTH YEAR), how many times have you had to give
social security or welfare officials a gift or extra money, or done them a favour in return for a service?
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
E
<< Ask if CR1_E = 1 >>
* CR2_E. In the last 12 months (since MONTH YEAR), have you had to give teachers, lecturers or professors
(public schools/universities) a gift or money in addition to any official fee, or done them a favour in return
for a service, including through someone else?
105 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<< Ask if CR2_E = 105>>
CR3_E. Still thinking about the last 12 months (since MONTH YEAR), how many times have you had to give
teachers,lecturers or professors (public schools/universities) a gift or extra money, or done them a favour in
return for a service?
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
28 | CoRRUptIon (CR)
F
<< Ask if CR1_F = 1 >>
* CR2_F. In the last 12 months (since MONTH YEAR), have you had to give doctors/nurses/healthcare
officials at a public clinic or hospital a gift or money in addition to any official fee, or done them a favour in
return for a service, including through someone else?
106 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<< Ask if CR2_F = 106>>
CR3_F. Still thinking about the last 12 months (since MONTH YEAR), how many times have you had to give
doctors/nurses/healthcare officials at a public clinic or hospital a gift or extra money, or done them a favour
in return for a service?
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
G
<< Ask if any CR1_G = 1 >>
* CR2_G. In the last 12 months (since MONTH YEAR), have you had to give police officers including local
police a gift or money in addition to any official fee, or done them a favour in return for a service, including
through someone else?
107 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<< Ask if CR2_G = 107>>
CR3_G. Still thinking about the last 12 months (since MONTH YEAR), how many times have you had to give
police officers including local police a gift or extra money, or done them a favour in return for a service?
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
H
<< Ask if CR1_H = 1 >>
* CR2_H. In the last 12 months (since MONTH YEAR), have you had to give prosecutors, judges or
magistrates a gift or money in addition to any official fee, or done them a favour in return for a service,
including through someone else?
108 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 29
<< Ask if CR2_H = 108>>
CR3_H. Still thinking about the last 12 months (since MONTH YEAR), how many times have you had to give
prosecutors, judges or magistrates a gift or extra money, or done them a favour in return for a service?
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
I
<< Ask if CR1_I = 1 >>
* CR2_I. In the last 12 months (since MONTH YEAR), have you had to give tax or revenue officers a gift
or money in addition to any official fee, or done them a favour in return for a service, including through
someone else?
109 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<< Ask if CR2_I = 109>>
CR3_I. Still thinking about the last 12 months (since MONTH YEAR), how many times have you had to give
tax or revenue officers a gift or extra money, or done them a favour in return for a service ?
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
J
<< Ask if CR1_J = 1 >>
* CR2_J. In the last 12 months (since MONTH YEAR): have you had to give customs officers a gift or money
in addition to any official fee, or done them a favour in return for a service, including through someone
else?
110 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<< Ask if CR2_J = 110>>
CR3_J. Still thinking about the last 12 months (since MONTH YEAR), how many times have you had to give
customs officers a gift or extra money, or done them a favour in return for a service?
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
K
<< Ask if CR1_K = 1 >>
* CR2_K. In the last 12 months (since MONTH YEAR), have you had to give public utility officials or
inspectors (electricity, water, sanitation, etc.) a gift or money in addition to any official fee, or done them a
favour in return for a service, including through someone else?
111 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
30 | CoRRUptIon (CR)
<< Ask if CR2_K = 111>>
CR3_K. Still thinking about the last 12 months (since MONTH YEAR), how many times have you had to give
public utility officials or inspectors a gift or extra money, or done them a favour in return for a service?
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
L
<< Ask if CR1_L = 1 >>
* CR2_L. In the last 12 months (since MONTH YEAR), have you had to give passport agency officials a gift
or money in addition to any official fee, or done them a favour in return for a service, including through
someone else?
112 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<< Ask if CR2_L = 112>>
CR3_L. Still thinking about the last 12 months (since MONTH YEAR), how many times have you had to give
passport agency officials a gift or extra money, or done them a favour in return for a service?
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
M
<< Ask if CR1_M = 1 >>
* CR2_M. In the last 12 months (since MONTH YEAR), have you had to give car registration or driving
licence agency officials a gift or money in addition to any official fee, or done them a favour in return for a
service, including through someone else?
113 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<< Ask if CR2_M = 113>>
CR3_M. Still thinking about the last 12 months (since MONTH YEAR), how many times have you had to give
car registration or driving licence agency officials a gift or extra money, or done them a favour in return for
a service?
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 31
N
<< Ask if CR1_N = 1 >>
* CR2_N. In the last 12 months (since MONTH YEAR), have you had to give members of the armed forces a
gift or money in addition to any official fee, or done them a favour in return for a service, including through
someone else?
114 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<< Ask if CR2_N = 114>>
CR3_N. Still thinking about the last 12 months (since MONTH YEAR), how many times have you had to give
members of the armed forces a gift or extra money, or done them a favour in return for a service ?
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
O
<< Ask if CR1_O = 1 >>
* CR2_O. In the last 12 months (since MONTH YEAR), have you had to give give land registry (cadastre)
officials a gift or money in addition to any official fee, or done them a favour in return for a service,
including through someone else?
115 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<< Ask if CR2_O = 115>>
CR3_O. Still thinking about the last 12 months (since MONTH YEAR), how many times have you had to give
give land registry (cadastre) officials a gift or extra money, or done them a favour in return for a service?
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
32 | CoRRUptIon (CR)
<<Do not ask, only record>>
CR2_FLAG Technical variable: flag corruption incidents that have taken place in the past 12 months, either
manually or via a script, based on CR2_A-X
Flag (0/1)
A Municipal or provincial officials
B Elected local government representatives at the provincial, municipal, canton, etc.
level
C Elected national or federal government representatives
D Social security or welfare officials
E Teachers, lecturers or professors at public schools or universities
F Doctors, nurses or other healthcare officials at a public clinic or hospital
G Police officers, including local police
H Prosecutors, judges or magistrates
I Tax or revenue officers
J Customs officers
K Public utility officials or inspectors (electricity, water, sanitation, etc.)
L Passport agency officials
M Car registration or driving licence agency officials
N Members of the armed forces
O Land registry (cadastre) officials
P-X Additional types of public official that could be included in survey questionnaires,
subject to the national context
<< PROGRAMMER Compute sum of CR2_FLAG_A-X into variable CR2_SUM >>
CR2_SUM Domains where bribery has occurred in the past 12 months
If CR2_SUM = 0 SKIP TO CR10
If CR2_SUM = 1 SKIP TO CR5
If CR2_SUM >= 2 CONTINUE WITH CR2_SEL
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 33
CR2_SEL. CAPI to pick among all types of bribery marked as “yes” in CR2_FLAG.
Selected
randomly for
follow-up
A Municipal or provincial officials
B Elected local government representatives at the provincial, municipal, canton,
etc. level
C Elected national, state or federal government representatives
D Social security or welfare officials
E Teachers, lecturers or professors at public schools or universities
F Doctors, nurses or other healthcare officials at a public clinic or hospital
G Police officers, including local police
H Prosecutors, judges or magistrates
I Tax or revenue officers
J Customs officers
K Public utility officials or inspectors (electricity, water, sanitation, etc.)
L Passport agency officials
M Car registration or driving licence agency officials
N Members of the armed forces
O Land registry (cadastre) officials
P-X Additional types of public official that could be included in survey
questionnaires, subject to the national context
<< Ask if CR2_SUM = > 0 >>
* CR_TYPE.
<< Read if CR2_SUM > 1 >>
I would like to ask you some additional question about your experience when you had to offer a gift, a
favour or extra payment in return for a service. You mentioned several type of officials with whom this has
happened. the computer has randomly chosen [type of official identified in CR2_SEL].
<< Read if CR2_SUM = 1 >>
* CR_TYPE2. You said had to offer a gift, a favour or payment for [type of official identified in CR2_SEL]
over the past 12 months.
<< Read if CR2_SUM > 0 >>
I am now going to ask you some questions about how you went about this particular incident.
34 | CoRRUptIon (CR)
<< Ask if CR2_SUM > 0 >>
CR4. The last time you had to give something in addition to an official fee to this type of official (the most
recent event), what did you give?
<< Read out, please mark all that apply, the selected official is [type of official identified in CR2_SEL] >>
Yes No Don’t
know
Prefer not
to say
A Food or drink
17
1 2 98 99
B Valuables (gold, jewellery, phones, etc.) or other goods 1 2 98 99
C Money 1 2 98 99
D Exchange with another service or favour 1 2 98 99
<< Ask if CR4_C = 1 (‘Money’ is selected)>>
CR5. Would you be able to tell me approximately how much it was? Was it ...
<< Read out, one response only >>
17 NSOtoassessifthereareanyothertypicalformsofbribesinthenationalcontext(forexample,cigarettes,animals,etc.)andifadditionalcategoriesare
necessary.Ifyes,thosemaybeaddedtothislist.
18 Tobereviewedandpossiblyadjustedbynationalimplementationteams.Tobeconvertedtonationalcurrency,with“natural”bandsofsimilarworthto
theseUSDvalues
01 – Up to USD10
18
02 – Between USD 11 and USD 20
03 – Between USD 21 and USD 50
04 – Between USD 51 and USD 100
05 – Between USD 101 and USD 500
06 – Between USD 501 and USD 1,000
07 – Between USD 1,001 and USD 5,000
08 – Over USD 5,000
98 – Don’t know
99 – Prefer not to say
<< Ask if CR2_SUM > 0 >>
CR6. The last time that you had to give a gift or money in addition to an official fee to the selected type of
official, how did you know that an additional payment or gift was expected from you?
<< Read out, one response only, the selected official is [type of official identified in CR2_SEL]>>
01 – Direct request from the official
02 – The official indirectly requested a payment
03 – A third person requested the extra payment
04 – Nobody asked for it, I did it to facilitate/accelerate the procedure
05 – Nobody asked for it, it was a sign of appreciation for a service provided
98 – Don’t know
99 – Prefer not to say
<< Ask if CR2_SUM > 0 >>
CR7. The last time you had to give additonal money or a gift to the selected type of official, did you report
it to an official authority (for example the police, prosecutor, anti-corruption agency, etc.) or to any non-
official institution including the press and social media forums?
<<One response only, the selected official is [type of official identified in CR2_SEL]>>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 35
<< Ask if CR7 = 1 >>
CR8A. Did you report it to any of these official institutions?
<<Read out, please mark all that apply>>
01 – Police
02 – << nationally relevant Anti-Corruption Agency >>
19
03 – << nationally relevant Public Complaints Commission >>
08 – Same agency/institution of the officer requesting the bribe
09 – Other official institution
88 – No, did not report to any official institution
98 – Don’t know
99 – Prefer not to say
<< Ask if CR7 = 1 >>
CR8B. Did you report it to any of these non-official institutions?
<<Read out, please mark all that apply>>
01 – Press, media
02 – International Organization
03 – Non-governmental organization (NGO)
04 – Other non-official institution
05 – Posted about it on social media
88 – No, did not report to any non-official institution
98 – Don’t know
99 – Prefer not to say
<< Ask if CR7 = 2 >>
CR9. Why didn’t you report the incident?
<<Read out the full list, mark only one answer – if in doubt probe for the main reason why it was not
reported>>
01 – It is a common practice to pay or give gifts, no reason to report
02 – It is pointless, nobody would care
03 – Did not know to whom to report it
04 – You know where to report, but it is too far away or difficult
05 – Fear of negative consequences for yourself
06 – You did not report it because you received a benefit from the payment/gift
07 – You did not report it because you made the payment/gift as a sign of gratitude
08 – You did not report it because you did not want to incur additional expenses
88 – Other reason
98 – Don’t know
99 – Prefer not to say
19 NSOtoprecisetheseitemswithaddingnamesofrespectivenationalinstitutions.Additionalinstitutionsmaybeaddedforcodes04-07,whereapplicable.
36 | CoRRUptIon (CR)
<< Ask if any CR1_A-X = 1 >>
* CR10. In the last 12 months, was there an occasion when a public official asked you, either directly or
through someone else, for money or a gift related to his/her function, but you did not give anything?
<<Do not read out, one response only>>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<< Ask if CR10 = 1 >>
CR11. The last time you refused to pay additional money or give a gift to a public official, which type of
public official was involved?
<< One answer only, do not read out >>
01 – Municipal or provincial officials
02 – Elected local government representatives at the provincial, municipal, cantons, etc. level
03 – Elected state or federal government representatives
04 – Officers of social security and welfare authorities
05 – Teachers lecturers or professors at state schools or universities
06 – Doctors, nurses or other healthcare officials at a public clinic or hospital
07 – Police officers, including local police
08 – Prosecutors, judges or magistrates at court
09 – Tax or revenue officers
10 – Customs officers
11 – Public utility officials or inspectors (electricity, water, sanitation, etc.)
12 – Passport agency officials
13 – Car registration or driving licence agency officials
14 – Members of the armed forces
15 – Land registry (cadastre) officials
77 – Other, specify: _____________________
98 – Don’t know
99 – Prefer not to say
<< Ask if CR10 = 01 >>
CR12. The last time you refused to pay additional money or give a gift to a public official, did you report
it to an official authority (for example the police, prosecutor, anti-corruption agency, etc.) or to any non-
official institution including the press and social media forums?
<<One response only>>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 37
ACCESS TO JUSTICE (AJ)
16.3.3 Proportion of the population who have
experienced a dispute in the past two years and who
accessed a formal or informal dispute resolution
mechanism to resolve it
INTRODUCTION TO THE MODULE: READ TO THE RESPONDENT (Literate)
I am going to ask you a few questions on disputes that you have experienced in the past two years, meaning
since (insert date of two years before initiating fieldwork
20
) until now.
INTRODUCTION TO THE MODULE: READ TO THE RESPONDENT (Illiterate)
I am going to ask you a few questions on disputes that you have experienced in the past two years, meaning
since (insert an event of national relevance that is common knowledge for most of the population
21
) until now.
<Ask all>
* AJ1. I am going to read you a list of problems and disputes that people commonly experience in
everyday life. Please only include problems that you have had yourself – not problems experienced by
a business you run or in the course of self-employment or as an employer, and not situations where you
represented or helped somebody else with their problem. Please only mention problems once.
In each case, can you tell me whether you have personally experienced such a problem in the past two
years, by which I mean a problem that started since <<MONTH YEAR>> or started before then, but
continued afterwards?
AJ1.
yes no DK REF
A. Problems with LAND, OR BUYING AND SELLING PROPERTY (for
example, dispute over a property title, the right to pass through
property, or illegally occupying land)
101 02 98 99
B. Issues with HOUSING (for example, problems with a landlord or
tenant over rent; damage or repairs; or eviction)
102 02 98 99
C. Trying to resolve FAMILY ISSUES (for example, divorce, child
support, child custody, or a will)
103 02 98 99
D. Seeking compensation for INJURIES OR ILLNESS caused by an
accident, poor workplace conditions, or wrong medical treatment.
104 02 98 99
E. Problems with EMPLOYMENT OR LABOR (for example, being
dismissed unfairly, problems obtaining wages or benefits, or
harassment)
105 02 98 99
F. Problems with GOVERNMENT PAYMENTS (including cash
transfers, pensions, education grants, or disability benefits)
106 02 98 99
G. GOVERNMENT AND PUBLIC SERVICES OTHER THAN PAYMENTS
(including problems accessing healthcare and education, problems
obtaining ID or other personal government documents, lack of
access to water or electricity
22
)
107 02 98 99
20 Tobeinsertedintheinstrumentrevision,priortoFieldwork.
21 Tobeinsertedintheinstrumentrevision,priortoFieldwork.
22 Lackofaccesstowaterandelectricitytobeaddedonlyifstatemanaged.
38 | ACCess to jUstICe (Aj)
AJ1.
yes no DK REF
H. Problems with other GOODS AND SERVICES (for example,
problems related to poor professional services, faulty goods)
108 02 98 99
I. Issues with MONEY, DEBT OR FINANCIAL SERVICES (such as being
unable to pay bills or debts, or problems collecting money owed
to you)
109 02 98 99
J. ENVIRONMENTAL issues affecting you, your property or your
community (for example land or water pollution, waste dumping)
110 02 98 99
K. NEIGHBORHOOD disputes, including problems with neighbours
over noise, vandalism, or consumption of alcohol or drugs on the
streets
111 02 98 99
AJ_SUM Total number of justiciable problems over the past two years
If AJ_SUM = 0 SKIP TO NEXT MODULE
If SEV_SUM = 0 SKIP TO PHAR_LEAD
If AJ_SUM = 1 SKIP TO AJ2
If AJ_SUM >= 2 CONTINUE WITH AJ1_SEL
AJ1_SEL. CAPI to pick among all disputes that were marked as “yes” in AJ1.
Selected
randomly for
follow-up
A Problems with LAND, OR BUYING AND SELLING PROPERTY
B Issues with HOUSING
C FAMILY issues
D Seeking compensation for INJURIES OR ILLNESS
E Problems with EMPLOYMENT OR LABOR
F Problems with GOVERNMENT PAYMENTS
G Problems with GOVERNMENT AND PUBLIC SERVICES OTHER THAN PAYMENTS
H Problems with GOODS AND SERVICES
I Issues with MONEY, DEBT, OR FINANCIAL SERVICES
J ENVIRONMENT issues
K NEIGHBORHOOD disputes
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 39
IF PAPI
*AJ1_SEL. Technical variable: Select one dispute identified in AJ1_A-K at random to ask the respondent
additional questions about it, make a selection rolling two dice (physical, or using a dice app on the
phone).
If administered on paper: please take two dice and throw them at the same time. Read the values add them up,
and find the dispute that corresponds to the value on the dice. Pick that dispute or if the respondent did not
have that dispute, the next on the list that (s)he had. If you reach the end of the list, start from the top.
Dice Respondent had
the dispute (mark)
Result of random
selection (mark)
A 12 Problem with LAND, OR BUYING AND SELLING
PROPERTY
B 2 Issue with HOUSING
C 3 FAMILY issue
D 4 Seeking compensation for INJURIES OR ILLNESS
E 5 Problem with EMPLOYMENT OR LABOR
F 6 Problem with GOVERNMENT PAYMENTS
G 7 Problem with GOVERNMENT AND PUBLIC
SERVICES OTHER THAN PAYMENTS
H 8 Problem with GOODS AND SERVICES
I 9 Issue with MONEY, DEBT, OR FINANCIAL
SERVICES
J 10 ENVIRONMENTAL issue
K 11 NEIGHBORHOOD dispute
* AJ2.You said you had [dispute descriptor identified in AJ1_SEL]. I am now going to ask you some
questions about how you went about dealing with this particular dispute.
<< Ask if any AJ1_A-X = 01 >>
AJ3. Is the problem ongoing or done with? By ‘done with’ I mean that the problem is either completely
resolved or that it persists, but you and everybody else have given up all actions to resolve it further.
<< Read out, mark only one >>
01 – Ongoing
02 – Done with, but problem persists
03 – Done with, problem resolved
98 – Don’t know
99 – Prefer not to say
40 | ACCess to jUstICe (Aj)
<< Ask if any AJ1_A-X = 01 >>
* AJ4. Considering this particular dispute; did you, somebody acting on your behalf, the other party or
anybody else go to a court or turn to any other third-party individual or institution to intervene to resolve
the problem?
<< Read out, mark all that applies, the selected dispute is [dispute descriptor identified in AJ1_SEL] >>
AJ4.
yes no DK REF
A. Court or tribunal 01 02 98 99
B. Police (or other law enforcement) 01 02 98 99
C. A government or municipal office or other formal designated
authority or agency
01 02 98 99
D. Religious leader or authority 01 02 98 99
E. Community leader or authority (such as village elder, or local
leader)
01 02 98 99
F. Lawyer, solicitor, paralegal 01 02 98 99
G. Other formal complaints or appeal process 01 02 98 99
H. Other external help, such as mediation, conciliation, arbitration 01 02 98 99
X. Other person or organisation 01 02 98 99
<< Ask if all AJ4_A-X = 02 >>
* AJ5. Why did you not go to anybody to resolve the dispute?
<< Read out, mark all that applies >>
11 – I think/thought the problem is/was not important enough
12 – I was/am confident that I could/can easily resolve it by myself
13 – I caused the problem / Up to the other party
21 – I did not know where to go to
22 – I could not obtain legal assistance
23 – It was too far away or hard to get to
24 – It was too expensive or inconvenient
25 – I did not trust the authorities
26 – I did not think they could help
27 – I was afraid of the consequences for me or my family
28 – I did not know it was possible to turn to somewhere to resolve the issue
77 – Other reason
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 41
<< Ask if AJ3 = 02 OR 03>>
AJ6. Which of these institutions took the final decision in this dispute? Note that the institution/entity that
took the final decision might not be the first instution/entity you reached out initially.
<< One response only. Read only if the respondent asks >>
01 – No decision was taken: the dispute was dropped, or was resolved otherwise
02 – No decision was taken, because the case still ongoing
11 – Court or tribunal
12 – Police (or other law enforcement)
13 – A government or municipal office or other formal designated authority or agency
14 – Religious leader or authority
15 – Community leader or authority (such as village elder, or local leader)
16 – Lawyer, solicitor, paralegal
17 – Other formal complaints or appeal process
18 – Other external help, such as mediation, conciliation, arbitration
19 – Other person or organisation
98 – Don’t know
99 – Prefer not to say
<< Ask if AJ6 = 11 TO 19>>
AJ7. Considering the selected dispute, please indicate if the followings applied or not?
<< Read out >>
yes no DK Ref
A. Both parties had the same opportunity to explain their position 01 02 98 99
B. There was a written record of the process 01 02 98 99
C. You received the final decision on the process in writing 01 02 98 99
D. The justification for the decision was clearly explained to you 01 02 98 99
E. It was, or would have been possible to appeal the decision, at
least once
01 02 98 99
F. You were helped by somebody, a lawyer, paralegal, other expert,
in this dispute
01 02 98 99
G. The process was fast/efficient 01 02 98 99
H. The process was affordable 01 02 98 99
42 | ACCess to jUstICe (Aj)
DISCRIMINATION (DS)
16.b.1/10.3.1 Proportion of population reporting
having personally felt discriminated against or
harassed in the previous 12 months on the basis
of a ground of discrimination prohibited under
international human rights law
<<Read for all>>
* DS0. I will now ask you about discrimination: Discrimination happens when you
are treated less favourably compared to others or harassed because of the way you
look, where you come from, what you believe or for other reasons.
<< Pause briefly>>
You may be refused equal access to work, housing, healthcare, education, marriage or family life, the police
or justice system, shops, restaurants, or any other services or opportunities.
<< Pause briefly>>
You may also encounter comments, gestures or other behaviours that make you feel offended, threatened
or insulted, or have to stay away from places or activities to avoid such behaviours.
<<Go to next screen>>
* DS1_INTRO. In <<COUNTRY>>, do you feel that you personally experienced any form of discrimination
or harassment during the last 3 years, namely since <<YEAR OF INTERVIEW MINUS 3>> (or since you have
been in the country), and if yes, during the past 12 months, since <<MONTH OF INTERVIEW>> <<YEAR OF
INTERVIEW MINUS 1>>, on any of the following grounds?
<<READ SLOWLY>>
<<Ask all>>
* DS1_A. Since <<YEAR OF INTERVIEW MINUS 3>> do you feel that you personally experienced any form
of discrimination or harassment based on your ... Sex: such as you are a woman or a man?
<<If necessary, clarify again that the questions asks about experiences in <<COUNTRY>> only>>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<<Ask if DS1_A = 1>>
* DS2_A. How about since <<MONTH OF INTERVIEW>> <<YEAR OF INTERVIEW MINUS 1>>?
(If needed, clarify the ground again: Sex)
<<If necessary, clarify again that the questions asks about experiences in <<COUNTRY>> only>>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<<Ask all>>
* DS1_B. Since <<YEAR OF INTERVIEW MINUS 3>> do you feel that you personally experienced any form
of discrimination or harassment based on your ... Age: such as you are perceived to be too young or too
old?
<<If necessary, clarify again that the questions asks about experiences in <<COUNTRY>> only>>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 43
<<Ask if DS1_B = 1>>
* DS2_B. How about since <<MONTH OF INTERVIEW>> <<YEAR OF INTERVIEW MINUS 1>>?
(If needed, clarify the ground again: Age)
<<If necessary, clarify again that the questions asks about experiences in <<COUNTRY>> only>>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<<Ask all>>
* DS1_C. Since <<YEAR OF INTERVIEW MINUS 3>> do you feel that you personally experienced any form
of discrimination or harassment based on your ... Disability or health status: such as having difficulty in
seeing, hearing, walking or moving, concentrating or communicating, having a disease or other health
conditions and no reasonable accommodation provided for it?
<<If necessary, clarify again that the questions asks about experiences in <<COUNTRY>> only>>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<<Ask if DS1_C = 1>>
* DS2_C. How about since <<MONTH OF INTERVIEW>> <<YEAR OF INTERVIEW MINUS 1>>?
(If needed, clarify the ground again: Disability or health status)
<<If necessary, clarify again that the questions asks about experiences in <<COUNTRY>> only>>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<<Ask all>>
* DS1_D. Since <<YEAR OF INTERVIEW MINUS 3>> do you feel that you personally experienced any form
of discrimination or harassment based on your ... Ethnicity, colour, language: such as skin colour or physical
appearance, ethnic origin or way of dressing, culture, traditions, native language or accent, indigenous
status, or being of African descent?
<<If necessary, clarify again that the questions asks about experiences in <<COUNTRY>> only>>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<<Ask if DS1_D = 1>>
* DS2_D. How about since <<MONTH OF INTERVIEW>> <<YEAR OF INTERVIEW MINUS 1>>?
(If needed, clarify the ground again: Ethnicity, colour, language)
<<If necessary, clarify again that the questions asks about experiences in <<COUNTRY>> only>>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<<Ask all>>
* DS1_E. Since <<YEAR OF INTERVIEW MINUS 3>> do you feel that you personally experienced any form
of discrimination or harassment based on your ... Migration status: such as nationality or national origin,
country of birth, refugees, asylum seekers, migrant status, undocumented migrants or stateless persons:
not considered a citizen of any country?
<<If necessary, clarify again that the questions asks about experiences in <<COUNTRY>> only>>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
44 | ACCess to jUstICe (Aj)
<<Ask if DS1_E = 1>>
* DS2_E. How about since <<MONTH OF INTERVIEW>> <<YEAR OF INTERVIEW MINUS 1>>?
(If needed, clarify the ground again: Migration status)
<<If necessary, clarify again that the questions asks about experiences in <<COUNTRY>> only>>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<<Ask all>>
* DS1_F. Since <<YEAR OF INTERVIEW MINUS 3>> do you feel that you personally experienced any form
of discrimination or harassment based on your ... Socio-economic status: such as wealth or education level,
being perceived to be from a lower or different social or economic group or class, land or home ownership
or not?
<<If necessary, clarify again that the questions asks about experiences in <<COUNTRY>> only>>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<<Ask if DS1_F = 1>>
* DS2_F. How about since <<MONTH OF INTERVIEW>> <<YEAR OF INTERVIEW MINUS 1>>?
(If needed, clarify the ground again: Socio-economic status)
<<If necessary, clarify again that the questions asks about experiences in <<COUNTRY>> only>>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<<Ask all>>
* DS1_G. Since <<YEAR OF INTERVIEW MINUS 3>> do you feel that you personally experienced any form
of discrimination or harassment based on your ... Geographic location or place of residence: such as living
in urban or rural areas, formal or informal settlements?
<<If necessary, clarify again that the questions asks about experiences in <<COUNTRY>> only>>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<<Ask if DS1_G = 1>>
* DS2_G. How about since <<MONTH OF INTERVIEW>> <<YEAR OF INTERVIEW MINUS 1>>?
(If needed, clarify the ground again: Geographic location or place of residence)
<<If necessary, clarify again that the questions asks about experiences in <<COUNTRY>> only>>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<<Ask all>>
* DS1_H. Since <<YEAR OF INTERVIEW MINUS 3>> do you feel that you personally experienced any form
of discrimination or harassment based on your ... Religion: such as having or not a religion or religious
beliefs?
<<If necessary, clarify again that the questions asks about experiences in <<COUNTRY>> only>>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 45
<<Ask if DS1_H = 1>>
* DS2_H. How about since <<MONTH OF INTERVIEW>> <<YEAR OF INTERVIEW MINUS 1>>?
(If needed, clarify the ground again: Religion)
<<If necessary, clarify again that the questions asks about experiences in <<COUNTRY>> only>>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<<Ask all>>
* DS1_I. Since <<YEAR OF INTERVIEW MINUS 3>> do you feel that you personally experienced any form
of discrimination or harassment based on your ... Marital and family status: such as being single, married,
divorced, widowed, pregnant, with or without children, orphan or born from unmarried parents, or having
children outside a wedlock?
<<If necessary, clarify again that the questions asks about experiences in <<COUNTRY>> only>>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<<Ask if DS1_I = 1>>
* DS2_I. How about since <<MONTH OF INTERVIEW>> <<YEAR OF INTERVIEW MINUS 1>>?
(If needed, clarify the ground again: Marital and family status)
<<If necessary, clarify again that the questions asks about experiences in <<COUNTRY>> only>>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<<Ask all>>
* DS1_J. Since <<YEAR OF INTERVIEW MINUS 3>> do you feel that you personally experienced any form
of discrimination or harassment based on your ... Sexual orientation or gender identity such as being
attracted to person of the same sex, self-identifying differently from sex assigned at birth or as being
either sexually, bodily and/or gender diverse?
<<If necessary, clarify again that the questions asks about experiences in <<COUNTRY>> only>>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<<Ask if DS1_J = 1>>
* DS2_J. How about since <<MONTH OF INTERVIEW>> <<YEAR OF INTERVIEW MINUS 1>>?
(If needed, clarify the ground again: Sexual orientation or gender identity)
<<If necessary, clarify again that the questions asks about experiences in <<COUNTRY>> only>>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<<Ask all>>
* DS1_K. Since <<YEAR OF INTERVIEW MINUS 3>> do you feel that you personally experienced any form
of discrimination or harassment based on your ... Political opinion: such as expressing political views,
defending the rights of others, being a member or not of a political party or trade union?
<<If necessary, clarify again that the questions asks about experiences in <<COUNTRY>> only>>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
46 | ACCess to jUstICe (Aj)
<<Ask if DS1_K = 1>>
* DS2_K. How about since <<MONTH OF INTERVIEW>> <<YEAR OF INTERVIEW MINUS 1>>?
(If needed, clarify the ground again: Political opinion)
<<If necessary, clarify again that the questions asks about experiences in <<COUNTRY>> only>>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<<Ask all>>
* DS1_X. Since <<YEAR OF INTERVIEW MINUS 3>> do you feel that you personally experienced any
OTHER form of discrimination or harassment in <<COUNTRY>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<<Ask if DS1_X = 01>>
* DS1_X_OTHER. On what ground?
INSERT RESPONSE: __________________________
98 – Don’t know
99 – Prefer not to say
<<Ask if DS1_X = 1>>
* DS2_X. How about since <<MONTH OF INTERVIEW>> <<YEAR OF INTERVIEW MINUS 1>> have you
personally experienced any form of discrimination or harassment, based on this ground you just specified?
<<If necessary, clarify again that the questions asks about experiences in <<COUNTRY>> only>>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<<Ask if any of DS2_A-X. = 01>>
DS3. In what types of situations have you experienced these incidents?
<<READ OUT, MARK ALL THAT APPLY >>
01 – At work
02 – When applying for a job
03 – In a shop, bank, restaurant, bar, night club or hotel
04 – On public transportation, on the street or in other public places
05 – In my household
06 – When seeking or using health care services
07 – When attending school or classes
08 – When looking for housing
09 – When dealing with the police or courts
10 – When voting, running for public office or participating in public consultation
11 – On social media
77 – Other (specify):
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 47
<<Ask if any of DS2_A-X. = 01>>
DS4. Who did you report the incident or make the complaint to?
<<MARK ALL THAT APPLY, READ OUT THE FIRST TWO ITEMS ONLY>>
00 – Did not report
01 – Police and other law enforcement agencies
02 – Union, staff committee, professional association
03 – Employer
04 – Non-governmental organisation (NGO)/charity/community organisation
05 – Country’s equality body/ national human rights institution (NAME)
06 – Private lawyer/Independent legal service
77 – Other (specify):
98 – Don’t know
99 – Prefer not to say
<<Ask if DS4. = 00>>
DS5. Why did you not report the incident or make a complaint?
<<MARK ALL THAT APPLY, DO NOT READ>>
01 – I was afraid of not being treated properly/of retaliation/of negative consequences
02 – I didn’t know how to make a complaint/where to report it/don’t know the laws
03 – Nothing would happen by reporting discrimination
04 – Not serious enough, not worth reporting it
05 – It is a long process/it takes time/money
06 – Because of legal issues/I don’t have papers/residence permit
07 – Because of language difficulties
08 – I had no evidence/it would have been difficult to produce evidence
77 – Other (specify):
98 – Don’t know
99 – Prefer not to say
48 | phYsICAl VIolenCe (phV)
PHYSICAL VIOLENCE (PHV)
16.1.3(a) Proportion of population subjected to
(a) physical violence in the previous 12 months
PHV_LEAD. The following questions explore the types of violence suffered by people in <<country>>.
I understand that some of them are sensitive and may even come across as too personal, but it is very
important to ask them in order to understand the problems faced by people in the country. Let me assure
you once again that your responses will be treated in strictest confidence and no one else will find out that
you were asked these questions, nor the answers you have given.
<Ask all>
PHV0. Please only focus on events that happened in << country >>. In the past three years (since YEAR),
have you been physically attacked, in a way that hurt or frightened you, either at home or elsewhere?
<<READ SLOWLY>> This may include hitting, slapping, pushing, tripping, knocking down; being shot,
stabbed or cut; hit by an object; hit by a thrown object; poisoning or other applications of force with the
potential to cause bodily injury.
<< ONE ANSWER ONLY >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask all>
* PHV_INTRO. <<Add if PHV0 = 2>> Please bear with me while we look at specific types of incidents.
<<Ask all>> In the past three years (since YEAR), has anyone done any of the following to you personally?
They could be either a stranger or someone you know, including a member of your family, such as your
current or former partner. <<IF NEEDED, ADD:>> By partner we mean a boyfriend, girlfriend, husband,
wife or civil partner.
A
* PHV1_A. Has anyone threatened to hurt you physically with a weapon (stick, knife, firearm, etc.)?
<< ONE ANSWER ONLY >>
01 – Yes
02 – No —————————— SKIP TO PHV1_B
98 – Don’t know ————— SKIP TO PHV1_B
99 – Prefer not to say —— SKIP TO PHV1_B
<Ask if PHV1_A = 1>
* PHV2_A. How about in the past 12 months? << IF NEEDED, READ OUT:>> Has anyone threatened to hurt
you physically with a weapon since <<MONTH YEAR>>?
<< ONE ANSWER ONLY >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 49
<Ask if PHV2_A = 1>
PHV3_A. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, someone has
threatened to hurt you physically with a weapon?
<<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a high frequency
without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and 99 for ’Prefer
not to say’>>
WRITE IN (1-9): ________ 77 – more than 10 times
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and PHV2_A = 1>
PHV4_A. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
<< EXPLAIN AS NECESSARY >> By partner we mean a boyfriend, girlfriend, husband, wife or civil partner.
<< CODE YES IF AT LEAST ONCE IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS
DONE IT TO THE RESPONDENT >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
B
* PHV1_B. And in the past three years (since YEAR), has anyone threatened to hurt you physically without a
weapon, but in a way that really frightened you?
<< ONE ANSWER ONLY >>
01 – Yes
02 – No —————————— SKIP TO PHV1_C
98 – Don’t know ————— SKIP TO PHV1_C
99 – Prefer not to say —— SKIP TO PHV1_C
<Ask if PHV1_B = 1>
* PHV2_B. How about in the past 12 months? << IF NEEDED, READ OUT:>> Has anyone threatened to hurt
you physically without a weapon since <<MONTH YEAR>>?
<< ONE ANSWER ONLY >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if PHV2_B = 1>
PHV3_B. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, someone has
threatened to hurt you physically without a weapon?
<<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a high frequency
without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and 99 for ’Prefer
not to say’>>
WRITE IN (1-9): ________ 77 – more than 10 times
98 – Don’t know
99 – Prefer not to say
50 | phYsICAl VIolenCe (phV)
<Ask if IPS = 1 and PHV2_B = 1>
PHV4_B. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you
<< EXPLAIN AS NECESSARY >> By a partner we mean a boyfriend, girlfriend, husband, wife or civil partner.
<< CODE YES IF AT LEAST ONCE IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS
DONE IT TO THE RESPONDENT >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
C
* PHV1_C. And in the past three years (since YEAR), has anyone pushed, shoved or shaken you?
<< ONE ANSWER ONLY >>
01 – Yes
02 – No —————————— SKIP TO PHV1_D
98 – Don’t know ————— SKIP TO PHV1_D
99 – Prefer not to say —— SKIP TO PHV1_D
<Ask if PHV1_C = 1>
* PHV2_C. How about in the past 12 months? << IF NEEDED, READ OUT:>> Has anyone pushed, shoved or
shaken you, since <<MONTH YEAR>>?
<< ONE ANSWER ONLY >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if PHV2_C = 1>
PHV3_C. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, someone has
pushed, shoved or shaken you?
<<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a high frequency
without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and 99 for ’Prefer
not to say’>>
WRITE IN (1-9): ________ 77 – more than 10 times
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and PHV2_C = 1>
PHV4_C. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
<< EXPLAIN AS NECESSARY >> By partner we mean a boyfriend, girlfriend, husband, wife or civil partner.
<< CODE YES IF AT LEAST ONCE IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS
DONE IT TO THE RESPONDENT >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 51
D
* PHV1_D. And in the past three years (since YEAR), has anyone slapped or punched you?
<< ONE ANSWER ONLY >>
01 – Yes
02 – No —————————— SKIP TO PHV1_E
98 – Don’t know ————— SKIP TO PHV1_E
99 – Prefer not to say —— SKIP TO PHV1_E
<Ask if PHV1_D = 1>
* PHV2_D. How about in the past 12 months? << IF NEEDED, READ OUT:>> Has anyone slapped or
punched you, since <<MONTH YEAR>>?
<< ONE ANSWER ONLY >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if PHV2_D = 1>
PHV3_D. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, someone has
slapped or punched you?
<<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a high frequency
without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and 99 for ’Prefer
not to say’>>
WRITE IN (1-9): ________ 77 – more than 10 times
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and PHV2_D = 1>
PHV4_D. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
<< EXPLAIN AS NECESSARY >> By partner we mean a boyfriend, girlfriend, husband, wife or civil partner.
<< CODE YES IF AT LEAST ONCE IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS
DONE IT TO THE RESPONDENT >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
E
* PHV1_E. And in the past three years (since YEAR), has anyone thrown a hard object at you?
<< ONE ANSWER ONLY >>
01 – Yes
02 – No —————————— SKIP TO PHV1_F
98 – Don’t know ————— SKIP TO PHV1_F
99 – Prefer not to say —— SKIP TO PHV1_F
<Ask if PHV1_E = 1>
* PHV2_E. How about in the past 12 months? << IF NEEDED, READ OUT:>> Has anyone thrown a hard
object at you, since <<MONTH YEAR>>?
<< ONE ANSWER ONLY >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
52 | phYsICAl VIolenCe (phV)
<Ask if PHV2_E = 1>
PHV3_E. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, someone has
thrown a hard object at you?
<<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a high frequency
without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and 99 for ’Prefer
not to say’>>
WRITE IN (1-9): ________ 77 – more than 10 times
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and PHV2_E = 1>
PHV4_E. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
<< EXPLAIN AS NECESSARY >> By partner we mean a boyfriend, girlfriend, husband, wife or civil partner.
<< CODE YES IF AT LEAST ONCE IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS
DONE IT TO THE RESPONDENT >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
F
* PHV1_F. And in the past three years (since YEAR), has anyone grabbed you, pulled your hair or dragged
you?
<< ONE ANSWER ONLY >>
01 – Yes
02 – No —————————— SKIP TO PHV1_G
98 – Don’t know ————— SKIP TO PHV1_G
99 – Prefer not to say —— SKIP TO PHV1_G
<Ask if PHV1_F = 1>
* PHV2_F. How about in the past 12 months? << IF NEEDED, READ OUT:>> Has anyone grabbed you,
pulled your hair or dragged you, since <<MONTH YEAR>>?
<< ONE ANSWER ONLY >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if PHV2_F = 1>
PHV3_F. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, someone has
grabbed you, pulled your hair or dragged you?
<<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a high frequency
without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and 99 for ’Prefer
not to say’>>
WRITE IN (1-9): ________ 77 – more than 10 times
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 53
<Ask if IPS = 1 and PHV2_F = 1>
PHV4_F. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
<< EXPLAIN AS NECESSARY >> By partner we mean a boyfriend, girlfriend, husband, wife or civil partner.
<< CODE YES IF AT LEAST ONCE IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS
DONE IT TO THE RESPONDENT >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
G
* PHV1_G. And in the past three years (since YEAR), has anyone beaten you with their fist or a hard object,
or kicked you?
<< ONE ANSWER ONLY >>
01 – Yes
02 – No —————————— SKIP TO PHV1_H
98 – Don’t know ————— SKIP TO PHV1_H
99 – Prefer not to say —— SKIP TO PHV1_H
<Ask if PHV1_G = 1>
* PHV2_G. How about in the past 12 months? << IF NEEDED, READ OUT:>> Has anyone beaten you with
their fist or a hard object, or kicked you since <<MONTH YEAR>>?
<< ONE ANSWER ONLY >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if PHV2_G = 1>
PHV3_G. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, someone has
beaten you with their fist or a hard object, or kicked you?
<<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a high frequency
without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and 99 for ’Prefer
not to say’>>
WRITE IN (1-9): ________ 77 – more than 10 times
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and PHV2_G = 1>
PHV4_G. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
<< EXPLAIN AS NECESSARY >> By partner we mean a boyfriend, girlfriend, husband, wife or civil partner.
<< CODE YES IF AT LEAST ONCE IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS
DONE IT TO THE RESPONDENT >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
54 | phYsICAl VIolenCe (phV)
H
* PHV1_H. And in the past three years (since YEAR), has anyone burned you?
<< ONE ANSWER ONLY >>
01 – Yes
02 – No —————————— SKIP TO PHV1_I
98 – Don’t know ————— SKIP TO PHV1_I
99 – Prefer not to say —— SKIP TO PHV1_I
<Ask if PHV1_H = 1>
* PHV2_H. How about in the past 12 months? << IF NEEDED, READ OUT:>> Has anyone burned you, since
<<MONTH YEAR>>?
<< ONE ANSWER ONLY >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if PHV2_H = 1>
PHV3_H. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, someone has
burned you?
<<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a high frequency
without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and 99 for ’Prefer
not to say’>>
WRITE IN (1-9): ________ 77 – more than 10 times
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and PHV2_H = 1>
PHV4_H. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
<< EXPLAIN AS NECESSARY >> By partner we mean a boyfriend, girlfriend, husband, wife or civil partner.
<< CODE YES IF AT LEAST ONCE IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS
DONE IT TO THE RESPONDENT >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
I
* PHV1_I. And in the past three years (since YEAR), has anyone tried to suffocate you or strangle you?
<< ONE ANSWER ONLY >>
01 – Yes
02 – No —————————— SKIP TO PHV1_J
98 – Don’t know ————— SKIP TO PHV1_J
99 – Prefer not to say —— SKIP TO PHV1_J
<Ask if PHV1_I = 1>
* PHV2_I. How about in the past 12 months? << IF NEEDED, READ OUT:>> Has anyone tried to suffocate
you or strangle you, since <<MONTH YEAR>>?
<< ONE ANSWER ONLY >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 55
<Ask if PHV2_I = 1>
PHV3_I. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, someone has
tried to suffocate you or strangle you?
<<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a high frequency
without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and 99 for ’Prefer
not to say’>>
WRITE IN (1-9): ________ 77 – more than 10 times
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and PHV2_I = 1>
PHV4_I. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
<< EXPLAIN AS NECESSARY >> By partner we mean a boyfriend, girlfriend, husband, wife or civil partner.
<< CODE YES IF AT LEAST ONCE IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS
DONE IT TO THE RESPONDENT >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
J
* PHV1_J. And in the past three years (since YEAR), has anyone cut or stabbed you?
<< ONE ANSWER ONLY >>
01 – Yes
02 – No —————————— SKIP TO PHV1_K
98 – Don’t know ————— SKIP TO PHV1_K
99 – Prefer not to say —— SKIP TO PHV1_K
<Ask if PHV1_J = 1>
* PHV2_J. How about in the past 12 months? << IF NEEDED, READ OUT:>> Has anyone cut or stabbed
you, since <<MONTH YEAR>>?
<< ONE ANSWER ONLY >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if PHV2_J = 1>
PHV3_J. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, someone has
cut or stabbed you?
<<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a high frequency
without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and 99 for ’Prefer
not to say’>>
WRITE IN (1-9): ________ 77 – more than 10 times
98 – Don’t know
99 – Prefer not to say
56 | phYsICAl VIolenCe (phV)
<Ask if IPS = 1 and PHV2_J = 1>
PHV4_J. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
<< EXPLAIN AS NECESSARY >> By partner we mean a boyfriend, girlfriend, husband, wife or civil partner.
<< CODE YES IF AT LEAST ONCE IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS
DONE IT TO THE RESPONDENT >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
K
* PHV1_K. And in the past three years (since YEAR), has anyone shot at you?
<< ONE ANSWER ONLY >>
01 – Yes
02 – No —————————— SKIP TO PHV1_L
98 – Don’t know ————— SKIP TO PHV1_L
99 – Prefer not to say —— SKIP TO PHV1_L
<Ask if PHV1_K = 1>
* PHV2_K. How about in the past 12 months? << IF NEEDED, READ OUT:>> Has anyone shot at you, since
<<MONTH YEAR>>?
<< ONE ANSWER ONLY >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if PHV2_K = 1>
PHV3_K. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, someone has
shot at you?
<<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a high frequency
without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and 99 for ’Prefer
not to say’>>
WRITE IN (1-9): ________ 77 – more than 10 times
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and PHV2_K = 1>
PHV4_K. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
<< EXPLAIN AS NECESSARY >> By partner we mean a boyfriend, girlfriend, husband, wife or civil partner.
<< CODE YES IF AT LEAST ONCE IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS
DONE IT TO THE RESPONDENT >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 57
L
* PHV1_L. And in the past three years (since YEAR), has anyone beaten your head against something?
<< ONE ANSWER ONLY >>
01 – Yes
02 – No —————————— SKIP TO PHV1_M
98 – Don’t know ————— SKIP TO PHV1_M
99 – Prefer not to say —— SKIP TO PHV1_M
<Ask if PHV1_L = 1>
* PHV2_L. How about in the past 12 months? << IF NEEDED, READ OUT:>> Has anyone beaten your head
against something, since <<MONTH YEAR>>?
<< ONE ANSWER ONLY >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if PHV2_L = 1>
PHV3_L. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, someone has
beaten your head against something?
<<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a high frequency
without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and 99 for ’Prefer
not to say’>>
WRITE IN (1-9): ________ 77 – more than 10 times
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and PHV2_L = 1>
PHV4_L. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
<< EXPLAIN AS NECESSARY >> By partner we mean a boyfriend, girlfriend, husband, wife or civil partner.
<< CODE YES IF AT LEAST ONCE IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS
DONE IT TO THE RESPONDENT >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
X
* PHV1_X. And in the past three years (since YEAR), has anyone done anything else to physically hurt you,
not counting a sexual attack?
<< ONE ANSWER ONLY >>
01 – Yes
02 – No —————————— SKIP TO PHV_FLAG
98 – Don’t know ————— SKIP TO PHV_FLAG
99 – Prefer not to say —— SKIP TO PHV_FLAG
58 | phYsICAl VIolenCe (phV)
<Ask if PHV1_X = 1>
* PHV1_STRING. Please tell me what they did:
<< INTERVIEWER: RECORD REPLY >>
RECORD VERBATIM REPLY: ___________________________________________________________________________
99 – Prefer not to say
<Ask if PHV1_X = 1>
* PHV2_X. How about in the past 12 months? Have you been a victim of the violence you just described
since <<MONTH YEAR>>?
<< ONE ANSWER ONLY >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if PHV2_X = 1>
PHV3_X. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, you have
been a victim of the violence you just described?
<<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a high frequency
without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and 99 for ’Prefer
not to say’>>
WRITE IN (1-9): ________ 77 – more than 10 times
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and PHV2_X = 1>
PHV4_X. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
<< EXPLAIN AS NECESSARY >> By partner we mean a boyfriend, girlfriend, husband, wife or civil partner.
<< CODE YES IF AT LEAST ONCE IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS
DONE IT TO THE RESPONDENT >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<<Do not ask, only record>>
PHV_FLAG Technical variable: flag incidents that have taken place in the past 12 months, either manually or
via script
Flag (1/0)
A. Someone THREATENED TO HURT YOU PHYSICALLY WITH A WEAPON (stick, knife,
firearm, etc.)
B. Someone THREATENED TO HURT YOU PHYSICALLY WITHOUT A WEAPON, but in a
way that really frightened you
C. Someone PUSHED YOU, SHOVED you or SHOOK you
D. Someone SLAPPED you or PUNCHED you
E. Someone THREW A HARD OBJECT at you
F. Someone GRABBED YOU, PULLED YOUR HAIR or DRAGGED you
G. Someone BEAT YOU WITH THEIR FIST OR A HARD OBJECT, OR KICKED you
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 59
Flag (1/0)
H. Someone BURNED you
I. Someone tried to SUFFOCATE you or STRANGLE you
J. Someone CUT OR STABBED you
K. Someone SHOT at you
L. Someone BEAT YOUR HEAD AGAINST SOMETHING
X. Someone did SOMETHING ELSE TO PHYSICALLY HURT YOU, NOT COUNTING A
SEXUAL ATTACK
<< PROGRAMMER Compute sum of PHV_FLAG_A-X into variable PHV_SUM >>
PHV_SUM Types of physical violence experienced in the past 12 months
If PHV_SUM = 0 SKIP TO NEXT SECTION
If PHV_SUM = 1 SKIP TO PHV6
If PHV_SUM >= 2 CONTINUE WITH PHV5
<< Ask if PHV_SUM >= 2 >>
PHV5. Thinking of the most recent incident of all the physical violence you have experienced, could you tell
me what it was?
<< One answer only, do not read out >>
01 – Threatened to hurt you physically with a weapon (stick, knife, firearm, etc.)
02 – Threatened to hurt you physically without a weapon, but in a way that really frightened you
03 – Pushed you, shoved you or shook you
04 – Slapped you or punched you
05 – Threw a hard object at you
06 – Grabbed you, pulled your hair or dragged you.
07 – Beat you with their fist or a hard object, or kicked you
08 – Burned you
09 – Tried to suffocate you or strangle you
10 – Cut or stabbed you
11 – Shot at you
12 – Beat your head against something
13 – Did something else to physically hurt you, not counting sexual attacks
98 – Don’t know
99 – Prefer not to say
60 | phYsICAl VIolenCe (phV)
<< Ask if PHV5 = 01 to 13 >>
PHV6. Still thinking of this most recent incident, did the perpetrator(s) have a weapon or something he/
she/they used as a weapon? If yes, what did they have? <<PROBE:>> Any other weapon you can recall?
<< Consider all weapons that respondent was aware that the perpetrator(s) had on their person, at the time of
the incident, regardless if these were used or just displayed, or only referred to verbally >>
<< DO NOT READ, MARK ALL THAT APPLY >>
01 – No weapon
02 – A bladed weapon, such as a knife or an axe
03 – A firearm, such as a pistol or a rifle
04 – A blunt weapon, such as a stick or a rock
05 – An explosive device, such as a grenade or a bomb
77 – Some other weapon. Specify: ______________________
98 – Don’t know
99 – Prefer not to say
<< Ask if PHV5 = 01 to 13 >>
PHV7. Still thinking of this most recent incident, where did the incident happen?
<< DO NOT READ, ONE ANSWER ONLY >>
01 – Private home/dwelling
02 – Commercial indoor premises such as restaurants, bars, shopping malls, shops, etc.
03 – Business premises not open to the public such as office buildings, factories, warehouses, etc.
04 – Educational establishments such as schools, universities, etc.
05 – Care establishments such as hospitals, retirement homes, etc.
06 – Public places such as streets, markets, parks, public transportation, etc.
77 – Elsewhere. Specify:_______________
98 – Don’t know
99 – Prefer not to say
<< Ask if PHV_SUM <> 0 >>
* VR1. Did you report this last incident to the police or to any other competent authority where you could
seek assistance or justice?
<<MARK ALL THAT APPLY, PROBE FOR SPECIFIC AUTHORITIES BEFORE ACCEPTING RESPONSE 88>>
23 Listtobecompletedbynationalimplementingpartner.Policeandmedicalservicesmustremaininrsttwopositionsandmustbeincludedbydefault.
11 – Yes, to the police
12 – Yes, to medical services
13 – Yes, to <<formal competent authority3>>
23
14 – Yes, to <<formal competent authority4>>
21 – Yes, to <<informal competent authority1>>
22 – Yes, to <<informal competent authority2>>
23 – Yes, to <<informal competent authority3>>
24 – Yes, to <<informal competent authority4>>
77 – Reported elsewhere, specify:____________________
88 – Not reported to any authority
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 61
<< Ask if VR1 = 88 >>
* VR1A. Why didn’t you report this last incident?
<<DO NOT READ, MARK ALL THAT APPLY>>
11 – It came to the attention of the authorities in another way
21 – Not serious enough, I did not consider it a crime
22 – I solved it myself
23 – I knew the offender and did not want to report them
24 – I believed the police/competent authority could or would do nothing
25 – I did not want to deal with the police/authorities // Dislike or fear of police/authorities
26 – The entire process, both during and after reporting, is very long, complicated and/or expensive
27 – Fear of reprisal by the offender or by others
28 – I did not know where to report the incident, and/or the correct procedure for doing so.
29 – I did not report it because I was ashamed
77 – Other reason
98 – Don’t know
99 – Prefer not to say
62 | sexUAl VIolenCe (seV) AnD sexUAl hARAssment (shAR)
SEXUAL VIOLENCE (SEV)
AND SEXUAL HARASSMENT (SHAR)
11.7.2(b): Proportion of persons victim of sexual
harassment in the previous 12 months
16.1.3(c) Proportion of population subjected to
(c) sexual violence in the previous 12 months
* SEV_LEAD. The following questions further explore the types of violence suffered by people in
<<country>>. I understand that some of them are sensitive and may come across as too intimate, but
it is very important to ask them in order to understand the problems faced by some people – men and
women alike – in the country. I know some of these questions will be uncomfortable. Please be assured
that by asking these questions we do not mean to offend anybody, we do it to explore the extent of
these problems in our country. There are only a few questions in this section, please help by sharing your
experience. Let me assure assure you once again that your responses will be treated in strictest confidence
and no one else will find out that you were asked these questions, nor the answers you have given.
* SEV0. Please only focus only on events that happened in << country >>. In the past three years
(since YEAR), have you been harassed or sexually assaulted, either at home or elsewhere? This may include
unwanted behaviour with a sexual connotation that made you feel offended, humiliated or intimidated, or
forced or coerced you into certain sexual activities.
<< “ELSEWHERE” INCLUDES FOR EXAMPLE: IN A BAR, IN THE STREET, AT SCHOOL, IN THE PUBLIC
TRANSPORT, OR AT WORK>>
<< ONE RESPONSE ONLY >>
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
* SHAR_INTRO. << add if SEV0 = 2 >> Please bear with me and let us look quickly at various types of
incidents specifically.
<< read out to all >> People may sometimes be approached or treated in a way that puts them in an
uncomfortable situation, either by someone they know or by a stranger. In the past three years (since
YEAR), have any of the following behaviours been directed against you, either by a stranger or someone
you know? This could be someone from your workplace, a member of your family, or even your current or
former partner. IF NEEDED ADD: By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner.
A
* SHAR1_A. In the past three years (since YEAR), have you experienced an unwanted sexual proposition or
pressure for a date?
01 – Yes
02 – No —————————— SKIP TO SHAR1_B
98 – Don’t know ————— SKIP TO SHAR1_B
99 – Prefer not to say —— SKIP TO SHAR1_B
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 63
<Ask if SHAR1_A = 1 >
* SHAR2_A. How about in the past 12 months? Have you experienced an unwanted sexual proposition or
pressure for a date since <<MONTH YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if SHAR2_A = 1 >
SHAR3_A. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened to you? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a
high frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and
99 for ’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and SHAR2_A = 1>
SHAR4_A. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF AT LEAST ONCE
IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
B
* SHAR1_B. In the past three years (since YEAR), have you received any unwanted messages, e-mails or
calls of a sexual nature that offended you?
01 – Yes
02 – No —————————— SKIP TO SHAR1_C
98 – Don’t know ————— SKIP TO SHAR1_C
99 – Prefer not to say —— SKIP TO SHAR1_C
<Ask if SHAR1_B = 1 >
* SHAR2_B. How about in the past 12 months? Have you received any unwanted messages, e-mails or calls
of a sexual nature that offended you since <<MONTH YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if SHAR2_B = 1 >
SHAR3_B. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened to you? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a
high frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and
99 for ’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
64 | sexUAl VIolenCe (seV) AnD sexUAl hARAssment (shAR)
<Ask if IPS = 1 and SHAR2_B = 1>
SHAR4_B. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF AT LEAST ONCE
IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
C
* SHAR1_C. In the past three years (since YEAR), have embarrassing and sexually explicit messages about
you and/or embarrassing and sexually explic photos or videos of you been posted online or sent to anyone
without your consent?
01 – Yes
02 – No —————————— SKIP TO SHAR1_D
98 – Don’t know ————— SKIP TO SHAR1_D
99 – Prefer not to say —— SKIP TO SHAR1_D
<Ask if SHAR1_C = 1 >
* SHAR2_C. How about in the past 12 months?? Have embarrassing and sexually explicit messages about
youand/or embarrassing and sexually explicit photos or videos of you been posted online or sent to
anyone without your consent since <<MONTH YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if SHAR2_C = 1 >
SHAR3_C. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened to you? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a
high frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and
99 for ’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and SHAR2_C = 1>
SHAR4_C. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF AT LEAST ONCE
IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
D
* SHAR1_D. In the past three years (since YEAR), have you received any unwanted sexual comments about
your physical appearance or body?
01 – Yes
02 – No —————————— SKIP TO SHAR1_E
98 – Don’t know ————— SKIP TO SHAR1_E
99 – Prefer not to say —— SKIP TO SHAR1_E
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 65
<Ask if SHAR1_D = 1 >
* SHAR2_D. How about in the past 12 months? Have you received any unwanted sexual comments about
your physical appearance or body since <<MONTH YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if SHAR2_D = 1 >
SHAR3_D. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened to you? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a
high frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and
99 for ’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and SHAR2_D = 1>
SHAR4_D. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF AT LEAST ONCE
IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
E
* SHAR1_E. In the past three years (since YEAR), have you experienced unwanted non-physical contact,
such as sexual hand gestures, whistling and leering, or has anyone got inappropriately close to you?
01 – Yes
02 – No —————————— SKIP TO SHAR1_F
98 – Don’t know ————— SKIP TO SHAR1_F
99 – Prefer not to say —— SKIP TO SHAR1_F
<Ask if SHAR1_E = 1 >
* SHAR2_E. How about in the past 12 months? Have you experienced unwanted non-physical contact,
such as sexual hand gestures, whistling and leering, or has anyone got inappropriately close to you since
<<MONTH YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if SHAR2_E = 1 >
SHAR3_E. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened to you? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a
high frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and
99 for ’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
66 | sexUAl VIolenCe (seV) AnD sexUAl hARAssment (shAR)
<Ask if IPS = 1 and SHAR2_E = 1>
SHAR4_E. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF AT LEAST ONCE
IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
F
* SHAR1_F. In the past three years (since YEAR), has anybody indecently exposed themselves to you?
01 – Yes
02 – No —————————— SKIP TO SHAR1_G
98 – Don’t know ————— SKIP TO SHAR1_G
99 – Prefer not to say —— SKIP TO SHAR1_G
<Ask if SHAR1_F = 1 >
* SHAR2_F. How about in the past 12 months? Has anybody indecently exposed themselves to you since
<<MONTH YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if SHAR2_F = 1 >
SHAR3_F. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened to you? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a
high frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and
99 for ’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and SHAR2_F = 1>
SHAR4_F. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF AT LEAST ONCE
IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
G
* SHAR1_G. In the past three years (since YEAR), have you received unwanted gifts of a sexual nature, such
as toys, accessories or underwear?
01 – Yes
02 – No —————————— SKIP TO SHAR_FLAG
98 – Don’t know ————— SKIP TO SHAR_FLAG
99 – Prefer not to say —— SKIP TO SHAR_FLAG
<Ask if SHAR1_G = 1 >
* SHAR2_G. How about in the past 12 months? Have you received unwanted gifts of a sexual nature since
<<MONTH YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 67
<Ask if SHAR2_G = 1 >
SHAR3_G. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened to you? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a
high frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and
99 for ’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and SHAR2_G = 1>
SHAR4_G. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF AT LEAST ONCE
IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<<Do not ask, only record>>
SHAR_FLAG Technical variable: flag incidents that have taken place in the past 12 months, either manually
or via script
Flag (1/0)
A. UNWANTED SEXUAL PROPOSITION or pressure for a date
B. Unwanted MESSAGES, E-MAILS, CALLS OF A SEXUAL NATURE that offended you
C. Embarrassing and SEXUALLY EXPLICIT MESSAGES about you and/or PHOTOS
OR VIDEOS OF YOU POSTED ONLINE OR SENT TO ANYONE WITHOUT YOUR
CONSENT
D. UNWANTED SEXUAL COMMENTS ABOUT YOUR PHYSICAL APPEARANCE OR BODY
E. UNWANTED SEXUAL GESTURES, WHISTLING AND LEERING OR ANYONE GOT
INAPPROPRIATELY CLOSE TO YOU
G. Somebody INDECENTLY EXPOSED THEMSELVES TO YOU
H. Receiving UNWANTED GIFTS of a sexual nature such as toys, accessories or
underwear
<< PROGRAMMER Compute sum of SHAR_FLAG_A-X into variable SHAR_SUM >>
SHAR_SUM Types of sexual harassment experienced in the past 12 months
If SHAR_SUM = 0 SKIP TO SEV1_A
If SHAR_SUM = 1 SKIP TO SHAR6
If SHAR_SUM >= 2 CONTINUE WITH SHAR5
68 | sexUAl VIolenCe (seV) AnD sexUAl hARAssment (shAR)
<< Ask if SHAR_SUM >= 2 >>
SHAR5. Thinking of the most recent incident of the sexual harassment that you have mentioned, could you
tell me what it was?
<< One answer only, do not read out >>
01 – UNWANTED SEXUAL PROPOSITION or pressure for a date
02 – Unwanted MESSAGES, E-MAILS, CALLS OF A SEXUAL NATURE that offended you
03 – Embarrassing and SEXUALLY EXPLICIT MESSAGES and/or PHOTOS OR VIDEOS OF YOU POSTED ONLINE
OR SENT TO ANYONE WITHOUT YOUR CONSENT
04 – Unwanted SEXUAL COMMENTS ABOUT YOUR PHYSICAL APPEARANCE OR BODY
05 – UNWANTED SEXUAL GESTURES, WHISTLING AND LEERING OR ANYONE STOOD INAPPROPRIATELY
CLOSE TO YOU
06 – Somebody INDECENTLY EXPOSED THEMSELVES TO YOU
07 – Receiving UNWANTED GIFTS of a sexual nature such as toys, accessories or underwear.
98 – Don’t know
99 – Prefer not to say
SHAR6*. Still thinking of this most recent incident, where did the incident happen?
01 – Private home/dwelling
02 – Commercial indoor premises such as restaurants, bars, shopping malls, shops, etc.
03 – Business premises not open to the public such as office buildings, factories, warehouses, etc.
04 – Educational establishments such as schools, universities, etc.
05 – Care establishments such as hospitals, retirement homes, etc.
06 – Public places such as streets, markets, parks, public transportation, etc.
07 – Online / Mobile device
77 – Elsewhere. Specify:_______________
98 – Don’t know
99 – Prefer not to say
<< Ask if SHAR_SUM <> 0 >>
* VR2. Did you report this last incident to the police or to any other competent authority where you could
seek assistance or justice?
<<MARK ALL THAT APPLY, PROBE FOR SPECIFIC AUTHORITIES BEFORE ACCEPTING RESPONSE 88>>
11 – Yes, to the police
12 – Yes, to medical services
13 – Yes, to <<formal competent authority3>>
24
14 – Yes, to <<formal competent authority4>>
21 – Yes, to <<informal competent authority1>>
22 – Yes, to <<informal competent authority2>>
23 – Yes, to <<informal competent authority3>>
24 – Yes, to <<informal competent authority4>>
24 Listtobecompletedbynationalimplementingpartner.Policeandmedicalservicesmustremaininrsttwopositionsandmustbeincludedbydefault.
Amonginformalcompetentauthorities,pleaseconsidermechanismsinpublicandprivateinstitutionsforaddressingthesesituations(e.g.,ofcesof
internalaffairsorinternaldisciplinarycontrol).
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 69
77 – Reported elsewhere, specify: ___________________
88 – Not reported to any authority
98 – Don’t know
99 – Prefer not to say
<< Ask if VR2 = 88 >>
* VR2A. Why didn’t you report this last incident?
<<DO NOT READ, MARK ALL THAT APPLY>>
11 – It came to the attention of the authorities in another way
21 – Not serious enough, I did not consider it a crime
22 – I solved it myself
23 – I knew the offender and did not want to report them
24 – I believed the police/competent authority could or would do nothing
25 – I did not want to deal with the police/authorities // Dislike or fear of police/authorities
26 – The entire process, both during and after reporting, is very long, complicated and/or expensive
27 – Fear of reprisal by the offender or by others
28 – I did not know where to report the incident, and/or the correct procedure for doing so.
29 – I did not report it because I was ashamed
77 – Other reason
98 – Don’t know
99 – Prefer not to say
A
<Ask all>
* SEV1_A. In the past three years (since YEAR), has anyone forced you to have sexual intercourse
by threatening you, holding you down or hurting you in any way? << If needed, clarify >> By sexual
intercourse, I mean vaginal or anal penetration including with objects, or oral sex.
01 – Yes
02 – No —————————— SKIP TO SEV1_B
98 – Don’t know ————— SKIP TO SEV1_B
99 – Prefer not to say —— SKIP TO SEV1_B
<Ask if SEV1_A = 1 >
* SEV2_A. How about in the past 12 months?
<<If absolutely necessary read>> Has anyone forced you to have sexual intercourse by threatening you,
holding you down or hurting you in some way since <<MONTH YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
70 | sexUAl VIolenCe (seV) AnD sexUAl hARAssment (shAR)
<Ask if SEV2_A = 1 >
SEV3_A. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened to you? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a
high frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and
99 for ’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and SEV2_A = 1>
SEV4_A. Could you tell me if, in the past 12 months, your partner or an ex-partner has done this to you? By
partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF AT LEAST ONCE IN
THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
B
<Ask all>
* SEV1_B. In the past three years (since YEAR), has anyone attempted to force you to have sexual
intercourse by threatening you, holding you down or hurting you in any way, but intercourse did not occur?
01 – Yes
02 – No —————————— SKIP TO SEV1_C
98 – Don’t know ————— SKIP TO SEV1_C
99 – Prefer not to say —— SKIP TO SEV1_C
<Ask if SEV1_B = 1 >
* SEV2_B. How about in the past 12 months?
<<If necessary read>>Has anyone attempted to force you to have sexual intercourse by threatening you,
holding you down or hurting you in any way, but intercourse did not occur since <<MONTH YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if SEV2_B = 1 >
SEV3_B. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened to you? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a
high frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and
99 for ’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and SEV2_B = 1>
SEV4_B. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF AT LEAST ONCE
IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 71
C
<Ask all>
* SEV1_C. In the past three years (since YEAR), apart from the episodes already mentioned, has anyone
made you have sexual intercourse when you could not refuse owing to the influence of alcohol or drugs?
01 – Yes
02 – No —————————— SKIP TO SEV1_D
98 – Don’t know ————— SKIP TO SEV1_D
99 – Prefer not to say —— SKIP TO SEV1_D
<Ask if SEV1_C = 1 >
* SEV2_C. How about in the past 12 months ?
<<If necessary read>> Has anyone made you have sexual intercourse when you could not refuse owing to
the influence of alcohol or drugs since <<MONTH YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if SEV2_C = 1 >
SEV3_C. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened to you? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a
high frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and
99 for ’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and SEV2_C = 1>
SEV4_C. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF AT LEAST ONCE
IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
D
<Ask all>
* SEV1_D. In the past three years (since YEAR), has anyone forced you, attempted to force you or
threatened you or blackmailed you to have sexual intercourse with someone else? Please include being
forced to have sex in exchange for money, goods or favours.
01 – Yes
02 – No —————————— SKIP TO SEV1_E
98 – Don’t know ————— SKIP TO SEV1_E
99 – Prefer not to say —— SKIP TO SEV1_E
72 | sexUAl VIolenCe (seV) AnD sexUAl hARAssment (shAR)
<Ask if SEV1_D = 1 >
* SEV2_D. How about in the past 12 months?
<<If necessary read>> Has anyone forced you, attempted to force you or threatened you or blackmailed
you to have sexual intercourse with someone else since <<MONTH YEAR>>? Please include being forced
to have sex in exchange for money, goods or favours.
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if SEV2_D = 1 >
SEV3_D. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened to you? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a
high frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and
99 for ’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and SEV2_D = 1>
SEV4_D. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF AT LEAST ONCE
IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
E
<Ask all>
* SEV1_E. In the past three years (since YEAR), apart from the cases discussed, have you had sexual
intercourse that you did not want to have because you were afraid of what might happen if you refused?
01 – Yes
02 – No —————————— SKIP TO SEV1_F
98 – Don’t know ————— SKIP TO SEV1_F
99 – Prefer not to say —— SKIP TO SEV1_F
<Ask if SEV1_E = 1 >
* SEV2_E. How about in the past 12 months?
<<If necessary read>> Have you had sexual intercourse that you did not want to have because you were
afraid of what might happen if you refused since <<MONTH YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if SEV2_E = 1 >
SEV3_E. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened to you? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a
high frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and
99 for ’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 73
<Ask if IPS = 1 and SEV2_E = 1>
SEV4_E. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF AT LEAST ONCE
IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
F
<Ask all>
* SEV1_F. In the past three years (since YEAR), has anyone stripped you, touched your intimate parts –
genitals <<for women add: or breasts >> – or kissed you when you did not want them to?
01 – Yes
02 – No —————————— SKIP TO SEV1_G
98 – Don’t know ————— SKIP TO SEV1_G
99 – Prefer not to say —— SKIP TO SEV1_G
<Ask if SEV1_F = 1 >
* SEV2_F. How about in the past 12 months?
<<If necessary read>> Has anyone stripped you, touched your intimate parts – genitals <<for women add:
or breasts >> – or kissed you when you did not want them to since <<MONTH YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if SEV2_F = 1 >
SEV3_F. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened to you? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a
high frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and
99 for ’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and SEV2_F = 1>
SEV4_F. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
By a partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF AT LEAST ONCE
IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
G
<Ask all>
* SEV1_G. In the past three years (since YEAR), has anyone done, or forced you to do, anything else of a
sexual nature that was degrading or humiliating?
01 – Yes
02 – No —————————— SKIP TO SEV1_H
98 – Don’t know ————— SKIP TO SEV1_H
99 – Prefer not to say —— SKIP TO SEV1_H
74 | sexUAl VIolenCe (seV) AnD sexUAl hARAssment (shAR)
<Ask if SEV1_G = 1 >
* SEV2_G. How about in the past 12 months?
<<If necessary read>> Has anyone done, or forced you to do, anything else of a sexual nature that was
degrading or humiliating since <<MONTH YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if SEV2_G = 1 >
SEV3_G. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened to you? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a
high frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and
99 for ’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and SEV2_G = 1>
SEV4_G. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF AT LEAST ONCE
IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
H
<Ask all>
* SEV1_H. In the past three years (since YEAR), apart from the incidents discussed earlier, has anyone
threatened you with violent sexual acts, such as rape <<for women add: or forced pregnancy>>, in a way
that really frightened you?
01 – Yes
02 – No —————————— SKIP TO SEV_FLAG
98 – Don’t know ————— SKIP TO SEV_FLAG
99 – Prefer not to say —— SKIP TO SEV_FLAG
<Ask if SEV1_H = 1 >
* SEV2_H. How about in the past 12 months?
<<If necessary read>> Has anyone threatened you with violent sexual acts, such as rape <<for women add:
or forced pregnancy>>, in a way that really frightened you since <<MONTH YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if SEV2_H = 1 >
SEV3_H. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, this
happened to you? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a
high frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and
99 for ’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 75
<Ask if IPS = 1 and SEV2_H = 1>
SEV4_H. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF AT LEAST ONCE
IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<<Do not ask, only record>>
SEV_FLAG Technical variable: flag incidents that have taken place in the past 12 months, either manually or
via script
Flag (0/1)
A. Someone FORCED YOU TO HAVE SEXUAL INTERCOURSE by threatening you,
holding you down or hurting you in some way. << If needed, clarify >> By sexual
intercourse, I mean vaginal or anal penetration, including with objects, or oral sex.
B. Someone ATTEMPTED to FORCE YOU TO HAVE SEXUAL INTERCOURSE by
threatening you, holding you down or hurting you in some way, but intercourse DID
NOT OCCUR.
C. Apart from the episodes we have already mentioned, did anyone MAKE YOU HAVE
SEXUAL INTERCOURSE when YOU COULD NOT REFUSE owing to the influence of
alcohol or drugs?
D. Someone forced or attempted to FORCE YOU or THREATENED YOU or
BLACKMAILED YOU TO HAVE SEXUAL INTERCOURSE WITH SOMEONE ELSE. Please
include here being forced to have sex in exchange for money, goods or favours.
E. Apart from the episodes we have already mentioned, did you have sexual intercourse
that you did not want to have BECAUSE YOU WERE AFRAID OF WHAT MIGHT
HAPPEN IF YOU REFUSED?
F. Someone STRIPPED YOU, TOUCHED YOUR INTIMATE PARTS – GENITALS OR
BREASTS –OR KISSED YOU when you did not want them to.
G. Someone did something or forced you to do something else of sexual nature that
YOU FOUND DEGRADING OR HUMILIATING.
H. Apart from these incidents, did someone THREATEN YOU WITH VIOLENT SEXUAL
ACTS, SUCH AS RAPE <<for women add: OR FORCED PREGNANCY>>, in a way that
really frightened you?
<< PROGRAMMER Compute sum of SEV_FLAG_A-X into variable SEV_SUM >>
SEV_SUM Types of sexual violence experienced in the past 12 months
If SEV_SUM = 0 SKIP TO PHAR_LEAD
If SEV_SUM = 1 SKIP TO SEV6
If SEV_SUM >= 2 CONTINUE WITH SEV5
76 | sexUAl VIolenCe (seV) AnD sexUAl hARAssment (shAR)
<< Ask if SEV_SUM >= 2 >>
SEV5. Thinking of the most recent incident of sexual violence you mentioned, could you tell me what it
was?
<< One answer only, do not read out >>
01 – Someone FORCED YOU TO HAVE SEXUAL INTERCOURSE by threatening
you, holding you down or hurting you in some way
02 – Someone ATTEMPTED to FORCE YOU TO HAVE SEXUAL INTERCOURSE by threatening you, holding you
down or hurting you in some way, but intercourse DID NOT OCCUR
03 – Someone MADE YOU HAVE SEXUAL INTERCOURSE when YOU COULD NOT REFUSE owing to the
influence of alcohol or drugs
04 – Someone forced or attempted to FORCE YOU or THREATENED YOU or BLACKMAILED YOU TO HAVE
SEXUAL INTERCOURSE WITH SOMEONE ELSE, including being forced to have sex in exchange for money,
goods or favours
05 – You had sexual intercourse you did not want to have BECAUSE YOU WERE AFRAID OF WHAT MIGHT
HAPPEN IF YOU REFUSED. Apart from the episodes we have already mentioned
06 – Someone STRIPPED YOU, TOUCHED YOUR INTIMATE PARTS – GENITALS OR BREASTS – OR KISSED YOU
when you did not want them to
07 – Someone did, or forced you to do, something else of sexual nature YOU FOUND DEGRADING OR
HUMILIATING
08 – Apart from these incidents, did someone THREATEN YOU WITH VIOLENT SEXUAL ACTS, SUCH AS RAPE
(OR FORCED PREGNANCY) in a way that really frightened you.
98 – Don’t know
99 – Prefer not to say
<< Ask if SEV_SUM <> 0 >>
SEV6. Still thinking of this most recent incident, where did the incident happen?
01 – Private home/dwelling
02 – Commercial indoor premises such as restaurants, bars, shopping malls, shops, etc.
03 – Business premises not open to the public such as office buildings, factories, warehouses, etc.
04 – Educational establishments such as schools, universities, etc.
05 – Care establishments such as hospitals, retirement homes, etc.
06 – Public places such as streets, markets, parks, public transportation, etc.
77 – Elsewhere, specify:_______________
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 77
<< Ask if SEV_SUM <> 0 >>
* VR3. Did you report this last incident to the police or to any other competent authority where you could
seek assistance or justice? In countries where applicable
25
, please add:, << include national examples,
corresponding to the list of informal authorities >>).
<<MARK ALL THAT APPLY, PROBE FOR SPECIFIC AUTHORITIES BEFORE ACCEPTING RESPONSE 88>>>
25 Suchinformalmechanismsaretobeaddediftheirroleis(usually)ofciallyrecognizedbyauthorities.Amendwordingandexamplestotnational
characteristics.Tobedecidedbythenationalimplementingpartner.
26 Listtobecompletedbynationalimplementingpartner.Policeandmedicalservicesmustremaininrsttwopositionsandmustbeincludedbydefault.
Amonginformalcompetentauthorities,pleaseconsidermechanismsinpublicandprivateinstitutionsforaddressingthesesituations(e.g.,ofcesof
internalaffairsorinternaldisciplinarycontrol).
11 – Yes, to the police
12 – Yes, to medical services
13 – Yes, to <<formal competent authority3>>
26
14 – Yes, to <<formal competent authority4>>
21 – Yes, to <<informal competent authority1>>
22 – Yes, to <<informal competent authority2>>
23 – Yes, to <<informal competent authority3>>
24 – Yes, to <<informal competent authority4>>
77 – Reported elsewhere, specify: ___________________
88 – Not reported to any authority
98 – Don’t know
99 – Prefer not to say
<< Ask if VR3 = 88 >>
* VR3A. Why didn’t you report this last incident?
<<DO NOT READ, MARK ALL THAT APPLY>>
11 – It came to the attention of the authorities in another way
21 – Not serious enough, I did not consider it a crime
22 – I solved it myself
23 – I knew the offender and did not want to report them
24 – I believed the police/competent authority could or would do nothing
25 – I did not want to deal with the police/authorities // Dislike or fear of police/authorities
26 – The entire process, both during and after reporting, is very long, complicated or expensive
27 – Fear of reprisal by the offender or by others
28 – I did not know where to report the incident, and/or the correct procedure for doing so.
29 – I did not report it because I was ashamed
77 – Other reason
98 – Don’t know
99 – Prefer not to say
78 | psYCholoGICAl VIolenCe (psV) AnD non-sexUAl hARAssment (phAR)
PSYCHOLOGICAL VIOLENCE (PSV)
AND NON-SEXUAL HARASSMENT
(PHAR)
11.7.2(a): Proportion of persons victim of physical
harassment in the previous 12 months
16.1.3(b) Proportion of population subjected
to (b) psychological violence in the previous
12 months
<Ask all>
* PHAR_LEAD. Apart from the behaviour relating to sexual harassment already mentioned, people
may sometimes be harassed, physically or otherwise. The following few questions are aimed at such
experiences. As stated previously, this type of behaviour could come from either a stranger or someone
you know, for example, someone from your workplace or a member of your family, including your current
or former partner. <<IF NEEDED ADD: By partner we mean a boyfriend, girlfriend, husband, wife or civil
partner. >> Please exclude any incidents already covered.
A
<Ask all>
* PHAR1_A. In the past three years (since YEAR), have you received non-sexual threatening or offensive
messages, e-mails or calls ?
01 – Yes
02 – No —————————— SKIP TO PHAR1_B
98 – Don’t know ————— SKIP TO PHAR1_B
99 – Prefer not to say —— SKIP TO PHAR1_B
<Ask if PHAR1_A = 1 >
* PHAR2_A. How about in the past 12 months? <<IF NEEDED READ>> Have you recieved non-sexual
threatening or offensive messages, e-mails or calls since <<MONTH YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if PHAR2_A = 1 >
PHAR3_A. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened to you? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a
high frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and
99 for ’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 79
<Ask if IPS = 1 and PHAR2_A >
PHAR4_A. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF AT LEAST ONCE
IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
B
<Ask all>
* PHAR1_B. In the past three years (since YEAR), has anyone made offensive, threatening or humiliating
comments to you in person, such as insulting you or calling you names?
01 – Yes
02 – No —————————— SKIP TO PHAR1_C
98 – Don’t know ————— SKIP TO PHAR1_C
99 – Prefer not to say —— SKIP TO PHAR1_C
<Ask if PHAR1_B = 1 >
* PHAR2_B. How about In the past 12 months? <<IF NEEDED READ>> Has anyone made offensive,
threatening or humiliating comments to you in person, such as insulting you or calling you names since
<<MONTH YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if PHAR2_B = 1 >
PHAR3_B. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened to you? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a
high frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and
99 for ’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and PHAR2_B >
PHAR4_B. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF AT LEAST ONCE
IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
C
<Ask all>
* PHAR1_C. In the past three years (since YEAR), has anyone made offensive or threatening gestures to
demean, insult or humiliate you?
01 – Yes
02 – No —————————— SKIP TO PHAR1_D
98 – Don’t know ————— SKIP TO PHAR1_D
99 – Prefer not to say —— SKIP TO PHAR1_D
80 | psYCholoGICAl VIolenCe (psV) AnD non-sexUAl hARAssment (phAR)
<Ask if PHAR1_C = 1 >
* PHAR2_C. How about in the past 12 months? <<IF NEEDED READ>> Has anyone made offensive or
threatening gestures to demean, insult or humiliate you since <<MONTH YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if PHAR2_C = 1 >
PHAR3_C. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened to you? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a
high frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and
99 for ’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and PHAR2_C >
PHAR4_C. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF AT LEAST ONCE
IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
D
<Ask all>
* PHAR1_D. In the past three years (since YEAR), has anyone posted offensive, demeaning or embarrassing
content, including for example comments, chat messages, photos or videos of you online?
01 – Yes
02 – No —————————— SKIP TO PHAR1_E
98 – Don’t know ————— SKIP TO PHAR1_E
99 – Prefer not to say —— SKIP TO PHAR1_E
<Ask if PHAR1_D = 1 >
* PHAR2_D. How about in the past 12 months? <<IF NEEDED READ>> Has anyone posted offensive
demeaning, or embarrassing content since <<MONTH YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if PHAR2_D = 1 >
PHAR3_D. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened to you? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a
high frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and
99 for ’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 81
<Ask if IPS = 1 and PHAR2_D >
PHAR4_D. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF AT LEAST ONCE
IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
E
<Ask all>
* PHAR1_E. In the past three years (since YEAR), has anyone followed you against your will, either
physically – for example, on the street – or online in a way that made you feel uncomfortable?
01 – Yes, physically
02 – Yes, online
03 – Yes, both
04 – No —————————— SKIP TO PHAR_FLAG
98 – Don’t know ————— SKIP TO PHAR_FLAG
99 – Prefer not to say —— SKIP TO PHAR_FLAG
<Ask if PHAR1_E = 1 >
* PHAR2_E. How about in the past 12 months? <<IF NEEDED READ>> Has anyone followed you against
your will, either physically or online, in a way that made you feel uncomfortable since <<MONTH YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if PHAR2_E = 1 >
PHAR3_E. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened to you? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a
high frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and
99 for ’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and PHAR2_E >
PHAR4_E. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF AT LEAST ONCE
IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
82 | psYCholoGICAl VIolenCe (psV) AnD non-sexUAl hARAssment (phAR)
PHAR_FLAG Technical variable: flag incidents that have taken place in the past 12 months, either manually
or via script
Flag (0/1)
A. Received non-sexual threatening or offensive MESSAGES, E-MAILS OR CALLS
B. Somebody personally made OFFENSIVE, THREATENING OR HUMILIATING
COMMENTS to you, such as insulting you or calling you names
C. Somebody made OFFENSIVE OR THREATENING GESTURES to demean, insult or
humiliate you
D. Somebody posted OFFENSIVE, demeaning OR EMBARASSING COMMENTS,
PHOTOS OR VIDEOS OF YOU ONLINE
E. Somebody FOLLOWED YOU AGAINST YOUR WILL, EITHER PHYSICALLY OR ONLINE
in a way that made you feel uncomfortable
<< PROGRAMMER Compute sum of PHAR_FLAG_A-X into variable PHAR_SUM >>
PHAR_SUM Types of physical harassment experienced in the past 12 months
If PHAR_SUM = 0 SKIP TO PSV_LEAD
If PHAR_SUM = 1 SKIP TO PHAR6
If PHAR_SUM >= 2 CONTINUE WITH PHAR5
<< Ask if PHAR_SUM >= 2 >>
PHAR5. Thinking of the most recent incident of harassment that you have mentioned, could you tell me
what it was?
<< One answer only, do not read out >>
01 – You have received non-sexual threatening or offensive MESSAGES, E-MAILS OR CALLS
02 – Somebody personally made OFFENSIVE, THREATENING OR HUMILIATING COMMENTS to you, such as
insulting you or calling you names
03 – Somebody made OFFENSIVE OR THREATENING GESTURES to demean, insult or humiliate you
04 – Somebody posted OFFENSIVE, demeaning OR EMBARASSING COMMENTS, PHOTOS OR VIDEOS OF
YOU ONLINE
05 – Somebody FOLLOWED YOU AGAINST YOUR WILL, EITHER PHYSICALLY OR ONLINE in a way that made
you feel uncomfortable
98 – Don’t know
99 – Prefer not to say
*PHAR6. Still thinking of this most recent incident, where did the incident happen?
01 – Private home/dwelling
02 – Commercial indoor premises such as restaurants, bars, shopping malls, shops, etc.
03 – Business premises not open to the public such as office buildings, factories, warehouses, etc.
04 – Educational establishments such as schools, universities, etc.
05 – Care establishments such as hospitals, retirement homes, etc.
06 – Public places such as streets, markets, parks, public transportation, etc.
07 – Online
77 – Elsewhere. Specify:_______________
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 83
98 – Don’t know
99 – Prefer not to say
<< Ask if PHAR5 = 01 to 12 >>
* VR4. Did you report this last incident to the police or to any other competent authority where you could
seek assistance or justice? << include national examples, corresponding to the list of informal authorities >>).
<<MARK ALL THAT APPLY, PROBE FOR SPECIFIC AUTHORITIES BEFORE ACCEPTING RESPONSE 88>>>
27 Listtobecompletedbynationalimplementingpartner.Policeandmedicalservicesmustremaininrsttwopositionsandmustbeincludedbydefault.
Amonginformalcompetentauthorities,pleaseconsidermechanismsinpublicandprivateinstitutionsforaddressingthesesituations(e.g.,ofcesof
internalaffairsorinternaldisciplinarycontrol).
11 – Yes, to the police
12 – Yes, to medical services
13 – Yes, to <<formal competent authority3>>
27
14 – Yes, to <<formal competent authority4>>
21 – Yes, to <<informal competent authority1>>
22 – Yes, to <<informal competent authority2>>
23 – Yes, to <<informal competent authority3>>
24 – Yes, to <<informal competent authority4>>
77 – Reported elsewhere, specify:____________________
88 – Not reported to any authority
98 – Don’t know
99 – Prefer not to say
<< Ask if VR4 = 88 >>
* VR4A. Why didn’t you report this last incident?
<<DO NOT READ, MARK ALL THAT APPLY>>
11 – It came to the attention of the authorities in another way
21 – Not serious enough, I did not consider it a crime
22 – I solved it myself
23 – I knew the offender and did not want to report them
24 – I believed the police/competent authority could or would do nothing
25 – I did not want to deal with the police/authorities // Dislike or fear of police/authorities
26 – The entire process, both during and after reporting, is very long, complicated and/or expensive
27 – Fear of reprisal by the offender or by others
28 – I did not know where to report the incident, and/or the correct procedure for doing so
29 – I did not report it because I was ashamed
77 – Other reason
98 – Don’t know
99 – Prefer not to say
<Ask all>
* PSV_LEAD. People are sometimes exposed to emotional abuse in their own family or relationship, or
elsewhere, for example, at work or at school, or even by random strangers. The following few questions
are aimed at such experiences.
84 | psYCholoGICAl VIolenCe (psV) AnD non-sexUAl hARAssment (phAR)
A
<< Ask if SCR2_D = 1, ELSE SKIP TO PSV2_A >>
* PSV1_A. In the past three years (since YEAR), has an adult member of your family or a current or former
partner hurt or threathened to hurt your children, or threatened to take them away?
01 – Yes
02 – No —————————— SKIP TO PSV1_B
98 – Don’t know ————— SKIP TO PSV1_B
99 – Prefer not to say —— SKIP TO PSV1_B
< Ask if PSV1_A = 1 >
* PSV2_A. How about in the past 12 months? <<IF NEEDED READ>> Has an adult member of your family
or a current or former partner hurt or threatened to hurt your children, or threatened to take them away
since <<MONTH YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
< Ask if PSV2_A = 1 >
PSV3_A. Could you tell how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a high
frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and 99 for
’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
< Ask if IPS = 1 and PSV2_A = 1 >
PSV4_A. Could you tell me if, in the past 12 months, your partner or an ex-partner have done any of these
things to you? By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF
AT LEAST ONCE IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE
RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
B
<< Ask all >>
*PSV1_B. In the past three years (since YEAR), has an adult member of your family or a current or former
partner limited your choices about family planning, for example, by forbidding you to use contraception or
misleading you about their own use of contraception?
01 – Yes
02 – No —————————— SKIP TO PSV1_C
98 – Don’t know ————— SKIP TO PSV1_C
99 – Prefer not to say —— SKIP TO PSV1_C
< Ask if PSV1_B = 1 >
* PSV2_B. How about in the past 12 months? <<IF NEEDED READ>> Has an adult member of your family
or a current or former partner limited your choices about family planning since <<MONTH YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 85
< Ask if PSV2_B = 1 >
PSV3_B. Could you tell how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a high
frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and 99 for
’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
< Ask if IPS = 1 and PSV2_B = 1 >
PSV4_B. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF AT LEAST ONCE
IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
C
<< Ask all >>
*PSV1_C. In the past three years (since YEAR), has an adult member of your family or a current or former
partner expected you to ask for their permission to see a doctor?
01 – Yes
02 – No —————————— SKIP TO PSV1_D
98 – Don’t know ————— SKIP TO PSV1_D
99 – Prefer not to say —— SKIP TO PSV1_D
< Ask if PSV1_C = 1 >
* PSV2_C. How about in the past 12 months? <<IF NEEDED READ>> Has an adult member of your family
or a current or former partner expected you to ask for their permission to see a doctor since <<MONTH
YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
< Ask if PSV2_C = 1 >
PSV3_C. Could you tell how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a high
frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and 99 for
’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
< Ask if IPS = 1 and PSV2_C = 1 >
PSV4_C. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF AT LEAST ONCE
IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
86 | psYCholoGICAl VIolenCe (psV) AnD non-sexUAl hARAssment (phAR)
D
<< Ask all >>
*PSV1_D. In the past three years (since YEAR), has an adult member of your family or a current or former
partner tried to prevent you from talking to other men/women out of jealousy, or insisted on knowing your
whereabouts at all times?
01 – Yes
02 – No —————————— SKIP TO PSV1_E
98 – Don’t know ————— SKIP TO PSV1_E
99 – Prefer not to say —— SKIP TO PSV1_E
< Ask if PSV1_D = 1 >
* PSV2_D. How about in the past 12 months? <<IF NEEDED READ>> Has an adult member of your family
or a current or former partner tried to restrict you from talking to other men/women out of jealousy, or
insisted on knowing your whereabouts at all times since <<MONTH YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
< Ask if PSV2_D = 1 >
PSV3_D. Could you tell how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a high
frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and 99 for
’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
< Ask if IPS = 1 and PSV2_D = 1 >
PSV4_D. Could you tell me if, in the past 12 months, your partner or an ex-partner have done any of these
things to you? By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF
AT LEAST ONCE IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE
RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
E
<< Ask all >>
*PSV1_E. In the past three years (since YEAR), has an adult member of your family or a current or former
partner controlled what clothes you are allowed to wear and told you how to dress against your will?
01 – Yes
02 – No —————————— SKIP TO PSV1_F
98 – Don’t know ————— SKIP TO PSV1_F
99 – Prefer not to say —— SKIP TO PSV1_F
< Ask if PSV1_E = 1 >
* PSV2_E. How about In the past 12 months? <<IF NEEDED READ>> Has an adult member of your family
or a current or former partner controlled what clothes you are allowed to wear and told you how to dress
against your will since <<MONTH YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 87
< Ask if PSV2_E = 1 >
PSV3_E. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened to you? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a
high frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and
99 for ’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
< Ask if IPS = 1 and PSV2_E = 1 >
PSV4_E. Could you tell me if, in the past 12 months, your partner or an ex-partner have done any of these
things to you? By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF
AT LEAST ONCE IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE
RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
F
<Ask all>
* PSV1_F. In the past three years (since YEAR), has anyone done anything to scare or intimidate you on
purpose, for example, by yelling and smashing things?
01 – Yes
02 – No —————————— SKIP TO PSV1_G
98 – Don’t know ————— SKIP TO PSV1_G
99 – Prefer not to say —— SKIP TO PSV1_G
<Ask if PSV1_F = 1 >
* PSV2_F. How about in the past 12 months? <<IF NEEDED READ>> Has anyone done anything to scare or
intimidate you on purpose, for example, by yelling and smashing things since <<MONTH YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if PSV2_F = 1 >
PSV3_F. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened to you? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a
high frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and
99 for ’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and PSV2_F = 1 >
PSV4_F. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF AT LEAST ONCE
IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
88 | psYCholoGICAl VIolenCe (psV) AnD non-sexUAl hARAssment (phAR)
G
<Ask all>
* PSV1_G. In the past three years (since YEAR), has anyone damaged or destroyed your possessions or
property, including pets, to scare or hurt you?
01 – Yes
02 – No —————————— SKIP TO PSV1_H
98 – Don’t know ————— SKIP TO PSV1_H
99 – Prefer not to say —— SKIP TO PSV1_H
<Ask if PSV1_G = 1 >
* PSV2_G. How about in the past 12 months? <<IF NEEDED READ>> Has anyone damaged or destroyed
your possessions or property, including pets, to scare or hurt you since <<MONTH YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if PSV2_G = 1 >
PSV3_G. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened to you? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a
high frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and
99 for ’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and PSV2_G = 1 >
PSV4_G. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF AT LEAST ONCE
IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
H
<Ask all>
* PSV1_H. In the past three years (since YEAR), has anyone harmed, or threatened to harm, someone close
to you (apart from the cases already discussed)?
01 – Yes
02 – No —————————— SKIP TO PSV1_I
98 – Don’t know ————— SKIP TO PSV1_I
99 – Prefer not to say —— SKIP TO PSV1_I
<Ask if PSV1_H = 1 >
* PSV2_H. How about in the past 12 months? <<IF NEEDED READ>> Has anyone harmed, or threatened to
harm, someone close to you (apart from the cases already discussed) since <<MONTH YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 89
<Ask if PSV2_H = 1 >
PSV3_H. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened to you? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a
high frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and
99 for ’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and PSV2_H = 1 >
PSV4_H. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF AT LEAST ONCE
IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
I
<Ask all>
* PSV1_I. In the past three years (since YEAR), has anyone restricted your freedom of movement, for
example, by locking you up somewhere or taking away your I.D. or passport?
01 – Yes
02 – No —————————— SKIP TO PSV1_J
98 – Don’t know ————— SKIP TO PSV1_J
99 – Prefer not to say —— SKIP TO PSV1_J
<Ask if PSV1_I = 1 >
* PSV2_I. How about in the past 12 months? <<IF NEEDED READ>> Has anyone restricted your freedom
of movement, for example, by locking you up somewhere or taking away your I.D. or passport since
<<MONTH YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if PSV2_I = 1 >
PSV3_I. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened to you? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a
high frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and
99 for ’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and PSV2_I = 1 >
PSV4_I. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF AT LEAST ONCE
IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
90 | psYCholoGICAl VIolenCe (psV) AnD non-sexUAl hARAssment (phAR)
J
<Ask all>
* PSV1_J. In the past three years (since YEAR), has anyone tried to limit your contact with family or friends
or restrict your use of social media sites such as Facebook, Instagram or Twitter?
01 – Yes
02 – No —————————— SKIP TO PSV_FLAG
98 – Don’t know ————— SKIP TO PSV_FLAG
99 – Prefer not to say —— SKIP TO PSV_FLAG
<Ask if PSV1_J = 1 >
* PSV2_J. How about in the past 12 months? <<IF NEEDED READ>> Has anyone tried to limit your contact
with family or friends or restrict your use of social media sites such as Facebook, Instagram or Twitter, since
<<MONTH YEAR>>?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<Ask if PSV2_J = 1 >
PSV3_J. Could you tell me how many times in the past 12 months, since <<MONTH YEAR>>, this has
happened to you? <<INT: Enter number of occasions 1-9. If the reply is over 10, or something that refers to a
high frequency without specifying a number (’constantly’, ’many times’, code 77. Code 98 for ’Don’t know’and
99 for ’Prefer not to say’>>
WRITE IN (1-9): ________
10 – 10 times or more
98 – Don’t know
99 – Prefer not to say
<Ask if IPS = 1 and PSV2_J = 1 >
PSV4_J. Could you tell me if, in the past 12 months, your partner or an ex-partner have done this to you?
By partner, we mean a boyfriend, girlfriend, husband, wife or civil partner. (CODE YES IF AT LEAST ONCE
IN THE PAST 12 MONTHS THE FORMER OR CURRENT PARTNER HAS DONE IT TO THE RESPONDENT)
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
PSV_FLAG Technical variable: flag incidents that have taken place in the past 12 months, either manually or
via script
Flag (0/1)
A. Family member or intimate partner HURT, THREATENED TO HURT, OR THREATENED
TO TAKE AWAY YOUR CHILDREN
B. Family member or intimate partner LIMITED YOUR CHOICES ABOUT FAMILY
PLANNING, for example, by forbidding you to use contraception or misleading you
about their own use of contraception
C. Family member or intimate partner EXPECTED YOU TO ASK PERMISSION TO SEE A
DOCTOR
D. Family member or intimate partner TRIED TO PREVENT YOU FROM TALKING
TO OTHER MEN/WOMEN out of jealousy, OR INSISTED ON KNOWING YOUR
WHEREABOUTS at all times
E. Family member or intimate partner CONTROLLED WHAT CLOTHES YOU ARE
ALLOWED TO WEAR AND TOLD YOU HOW TO DRESS AGAINST YOUR WILL
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 91
Flag (0/1)
F. Somebody DID things to SCARE OR INTIMIDATE YOU ON PURPOSE, for example, by
yelling and smashing things
G. Somebody DAMAGED OR DESTROYED YOUR POSSESSIONS OR PROPERTY,
including pets, to scare or hurt you
H. Somebody HARMED, OR THREATENED TO HARM, SOMEONE CLOSE TO YOU (apart
from the cases already discussed)
I. Somebody RESTRICED YOUR FREEDOM OF MOVEMENT, for example, by locking
you up somewhere or taking away your I.D. or passport
J. Somebody tried to LIMIT YOUR CONTACT WITH FAMILY OR FRIENDS or restrict your
use of social media sites such as Facebook, Instagram or Twitter
PSV_SUM Types of psychological violence experienced in the past 12 months
If PSV_SUM = 0 SKIP TO NEXT MODULE
If PSV _SUM = 1 SKIP TO PSV6
If PSV _SUM >= 2 CONTINUE WITH PSV5
<< Ask if PSV_SUM >= 2 >>
PSV5. Thinking of the most recent case of emotional abuse among those you have mentioned, could you
tell me what it was?
<< One answer only, do not read out >>
01 – Family member or intimate partner HURT, THREATENED TO HURT OR THREATENED TO TAKE AWAY YOUR
CHILDREN
02 – Family member or intimate partner FORBADE YOU TO USE CONTRACEPTION OR OTHERWISE LIMITED
YOUR CHOICES ABOUT FAMILY PLANNING
03 – Family member or intimate partner EXPECTED YOU TO ASK PERMISSION TO SEE A DOCTOR
04 – Family member or intimate partner was jealous or otherwise TRIED TO PREVENT YOU FROM TALKING TO
OTHER MEN/WOMEN, OR INSISTED ON KNOWING YOUR WHEREABOUTS at all times
05 – Family member or intimate partner wanted to DECIDE WHAT CLOTHES YOU WORE AND HOW YOU DRESSED
06 – Somebody did something to SCARE OR INTIMIDATE YOU ON PURPOSE, for example, by yelling and
smashing things
07 – Somebody DAMAGED OR DESTROYED YOUR POSSESSIONS OR PROPERTY, including pets
08 – Somebody HARMED, OR THREATENED TO HARM, SOMEONE CLOSE TO YOU
09 – Somebody RESTRICTED YOUR FREEDOM OF MOVEMENT, for example, by locking you up somewhere or
taking away your I.D. or passport
10 – Somebody tried to LIMIT YOUR CONTACT WITH FAMILY OR FRIENDS or RESTRICT YOUR USE OF SOCIAL
MEDIA sites such as Facebook, Instagram or Twitter
98 – Don’t know
99 – Prefer not to say
92 | psYCholoGICAl VIolenCe (psV) AnD non-sexUAl hARAssment (phAR)
<< Ask if PSV_SUM <> 0 >>
* VR5. Did you report this last incident to the police or to any other competent authority where you
could seek assistance or justice? In countries where applicable
28
, please add: These may include persons or
institutions in the informal justice system or within organizations where such harassments may occur, as
long as they are officially recognized conflict resolution mechanisms (e.g., << include national examples,
corresponding to the list of informal authorities >>).
<<MARK ALL THAT APPLY, PROBE FOR SPECIFIC AUTHORITIES BEFORE ACCEPTING RESPONSE 88>>>
28 Suchinformalmechanismsaretobeaddediftheirroleis(usually)ofciallyrecognizedbyauthorities.Amendwordingandexamplestotnational
characteristics.Tobedecidedbythenationalimplementingpartner.
29 Listtobecompletedbynationalimplementingpartner.Policeandmedicalservicesmustremaininrsttwopositionsandmustbeincludedbydefault.
Amonginformalcompetentauthorities,pleaseconsidermechanismsinpublicandprivateinstitutionsforaddressingthesesituations(e.g.,ofcesof
internalaffairsorinternaldisciplinarycontrol).
11 – Yes, to the police
12 – Yes, to medical services
13 – Yes, to <<formal competent authority3>>
29
14 – Yes, to <<formal competent authority4>>
21 – Yes, to <<informal competent authority1>>
22 – Yes, to <<informal competent authority2>>
23 – Yes, to <<informal competent authority3>>
24 – Yes, to <<informal competent authority4>>
77 – Reported elsewhere, specify: ___________________
88 – Not reported to any authority
98 – Don’t know
99 – Prefer not to say
<< Ask if VR5 = 88 >>
* VR5A. Why didn’t you report this last incident?
<<DO NOT READ, MARK ALL THAT APPLY>>
11 – It came to the attention of the authorities in another way
20 – It is a family matter
21 – Not serious enough, I did not consider it a crime
22 – I solved it myself
23 – I knew the offender and did not want to report them
24 – I believed the police/competent authority could or would do nothing
25 – I did not want to deal with the police/authorities // Dislike or fear of police/authorities
26 – The entire process, both during and after reporting, is very long, complicated and/or expensive
27 – Fear of reprisal by the offender or by others
28 – I did not know where to report the incident, and/or the correct procedure for doing so
29 – I did not report it because I was ashamed
77 – Other reason
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 93
VIOLENCE REPORTING (VR)
16.3.1 Proportion of victims of violence in the previous
12 months who reported their victimization to
competent authorities or other ocially recognized
conict resolution mechanisms
<<Mandatory items included above as VR1-1A, VR2-2A, VR3-3A, VR4-4A, VR5-5A>>
National revision of items for nonreporting is encouraged (between response items 20 and 76), maybe to add
further typical reasons, if applicable.
Additional optional items for contextualization may include, for the last incident of violence of all types:
• the clarification if the victims talked about the incident with anybody else other than competent
authorities (such as family, social networks, specialised services – for example specialised NGOs, etc.
• satisfaction with the authorities’ response, including if the victim would recommend other victims to
report a similar offence to a competent authority
94 | tRAFFICkInG In peRsons FoR FoRCeD lAboUR (tIp)
TRAFFICKING IN PERSONS
FOR FORCED LABOUR (TIP)
16.2.2 Estimated number of victims of tracking
for forced labour per 100,000 population over
the past ve years
<< Ask if SCR3 = 1 OR 2 >>
* TIP1. I will now list a number of practices that sometimes workers are exposed to. Could you tell me, in
the last 3 years, have any of the following incidents ever happened to you at work?
<< Ask if TIP1_A-X = 01 >>
TIP2. How about in the past 12 months? Has it happened since << Month, Year>>?
TIP1. TIP2.
Yes No Prefers
not to
say
Yes No Prefers
not to
say
A Pay was significantly less than you were promised 01 02 99 01 02 99
B The type of work was very different from what
you were promised
01 02 99 01 02 99
C The working hours were excessively longer than
you were promised
01 02 99 01 02 99
D Housing conditions offered at work were poor
and worse than you were promised
01 02 99 01 02 99
E You were instructed to lie about your identity/the
identity of your employer
01 02 99 01 02 99
F You were instructed to lie to any official about
your work
01 02 99 01 02 99
G Part of your wage or any number of days’ wage
was withheld on payday, without a good reason
01 02 99 01 02 99
<< Ask if SCR3 = 1 OR 2 >>
* TIP3. In the last 3 years, have any of the following incidents ever happened to you at work?
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 95
<< Ask if TIP3_A-X = 01 >>
TIP4. How about in the past 12 months? Has it happened since << Month, Year>>?
TIP1. TIP2.
Yes No Prefers
not to
say
Yes No Prefers
not to
say
A Your identification papers (such as passport, visa,
or birth certification) were taken away
01 02 99 01 02 99
B You were prevented or restricted from
communicating freely with your family, including
making or receiving phone calls, even outside
working hours
01 02 99 01 02 99
C You were prevented or restricted from
communicating freely with others outside the
workplace, even outside working hours
01 02 99 01 02 99
D You were restricted where you could go during
non-working hours
01 02 99 01 02 99
E You felt physically or psychologically threatened
when working
01 02 99 01 02 99
F You could not voluntarily resign from the job 01 02 99 01 02 99
<< Ask if any of TIP1_A-X = 01 or any of TIP3_A-X = 01 >>
* TIP5. Is this your current job?
01 – Yes
02 – No
99 – Prefers not to say
<< Ask if TIP5_ = 02 >>
*TIP6. You mentioned you are no longer in that job. Have you left that job in the past 12 months, since
<<Month, Year>>?
01 – Yes, I left the job in the past 12 months
02 – No, I left the job before <<Month, Year>>
98 – Don’t know
99 – Prefers not to say
<< Ask if TIP5_ = 02 >>
* TIP7. Did you stay longer than you wanted at that job?
01 – Yes
02 – No
98 – Don’t know
99 – Prefers not to say
96 | tRAFFICkInG In peRsons FoR FoRCeD lAboUR (tIp)
<< Ask if of TIP5 = 01 >>
* TIP8. Would any of the following incidents happen if you decided to leave?
TIP8.
Yes No Don’t
know
Prefers
not to say
A Physical violence, including being punched, kicked, dragged,
beaten up, threatened with a gun, knife or other weapons
01 02 98 99
B Physically restrained, including being tied up or locked in a
room
01 02 98 99
C Deprived of food, water and/or sleep 01 02 98 99
D Sexual abuse or violence 01 02 98 99
E Emotional violence, including belittling or ostracising a
person in front of their peers
01 02 98 99
F Harm to family or someone you care about 01 02 98 99
G Legal action, including being arrested 01 02 98 99
H Withholding of passport or other documents 01 02 98 99
I Financial loss, including loss of wages, confiscation of savings
or other valuables
01 02 98 99
J Being expelled from country 01 02 98 99
<< Ask if TIP7 = 01>>
* TIP9. Why did you stay longer than you wanted? Were any of the following incidents to happen if you
decided to leave?
TIP9.
Yes No Don’t
know
Prefers
not to say
A Physical violence, including being punched, kicked, dragged,
beaten up, threatened with a gun, knife or other weapons
01 02 98 99
B Physically restrained, including being tied up or locked in a
room
01 02 98 99
C Deprived of food, water and/or sleep 01 02 98 99
D Sexual abuse or violence 01 02 98 99
E Emotional violence, including belittling or ostracising a
person in front of their peers
01 02 98 99
F Harm to family or someone you care about 01 02 98 99
G Legal action, including being arrested 01 02 98 99
H Withholding of passport or other documents 01 02 98 99
I Financial loss, including loss of wages, confiscation of savings
or other valuables
01 02 98 99
J Being expelled from country 01 02 98 99
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 97
<< DO NOT ASK, COMPUTE VARIABLE WITH SCRIPT >>
TIP_VOT_12M. Current Victim of Trafficking for forced labour
<< code 01 if:
- Any of TIP2A-X = 01 AND
- Any of TIP4A-X = 01 AND
- (TIP5 = 01 OR TIP6 = 01) AND
- Any of TIP8A-X = 01 OR Any of TIP9A-X = 01
code 00: all else>>
<< DO NOT ASK, COMPUTE VARIABLE WITH SCRIPT >>
TIP_VOT_3Y. Victim of Trafficking for forced labour in the past 3 years
<< code 01 if:
- Any of TIP1A-X = 01 AND
- Any of TIP3A-X = 01 AND
- Any of TIP8A-X = 01 OR Any of TIP9A-X = 01
code 00: all else>>
<< Read if TIP_VOT_12M = 01 OR TIP_VOT_3Y = 01>>
I understand that you have had a job where you experienced some very bad working conditions. I would
like to ask a few questions about this job, or the last one of these you had in the past three years.
<< Ask if TIP_VOT_12M = 01 OR TIP_VOT_3Y = 01 AND TIP5 = 02>>
TIP10. Did you have this job in this country?
01 – Yes
02 – No
98 – Don’t know
99 – Prefer not to say
<< Ask if TIP10 = 02>>
TIP11. In which country did you have this job?
<< Do not read out, code according to country name. If in doubt, consider current territories of countries >>
Code with list of Standard Country or Area Codes for Statistical Use – Country names
97 – Not <<country of enumeration>>,
but no specific other country (i.e. on a vessel)
98 – Don’t know
99 – Prefer not to say
<< Ask if TIP_VOT_12M = 01 OR TIP_VOT_3Y = 01>>
TIP12. Who contacted and offered you the job?
<< Do not read the answers, select up to three options >>
01 – A friend or family member
02 – An acquaintance
03 – An official job recruitment agency
04 – A private individual with connections of job
placement
77 – Other (specify): _____
98 – Don’t know
99 – Prefers not to say
98 | tRAFFICkInG In peRsons FoR FoRCeD lAboUR (tIp)
<< Ask if TIP_VOT_12M = 01 OR TIP_VOT_3Y = 01>>
TIP13. What type of job is/was it?
<< Do not read the answers, select up to three options >>
01 – Administrative work (receptionist, assistant, etc.)
02 – Agriculture/Fishery
03 – Begging
04 – Construction/Landscaping/Plumbing/Welder/
Electrician
05 – Delivery/Packing/Moving/Driving
06 – Education and Childcare
07 – Food Services/Restauration
08 – Professional (Healthcare/Official)
09 – Janitorial/Housekeeping
10 – Religious or spiritual organisation
11 – Sales/Retail/Street vendor
12 – Sex worker
77 – Other (specify):_____
98 – Don’t know
99 – Prefer not to say
sDG16 sURVeY InItIAtIVe – QUESTIONNAIRE | 99
INTERVIEW EVALUATION
30
<<Do not ask, record after the interview>>
X1. Number of persons, aged 6 or above, (typically) present during the interview, including interviewer.
<< One response only >>
01 – Two (Interviewer and respondent)
02 – Three
03 – Four or more
<<Do not ask, record after the interview>>
X2. Respondent cooperation
<< One response only >>
30 Maybeexpandedbynationalimplementingpartner
31 Uptonationalimplementingpartner,forCAPIimplementationthesemayberecordedbythesamplingmanagementandinterviewingsoftware(i.e.number
ofvisits,lengthofinterviewandsections,interviewcompleteness,reasonsforincompleteinterview,etc.).
01 – Very good
02 – Good
03 – Fair
04 – Poor
05 – Very poor
X3. Technical information about the interview
31