PILL: Women can take a pill every day to delay or avoid pregnancy.

YES 1
NO 2

IUD: Women can have a plastic or metal coil or device placed inside their uterus by a doctor.

YES 1
NO 2

INJECTIONS: Women can have an injection by a doctor or a nurse which stops them from becoming pregnant for several months.

YES 1
NO 2

DIAPHRAGM/FOAM/JELLY: Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse to avoid pregnancy.

YES 1
NO 2

CONDOM: Men use a condom to avoid getting the woman pregnant.

YES 1
NO 2

FEMALE STERILIZATION: Women can have an operation to avoid having any more children

YES 1
NO 2

MALE STERILIZATION: Men can have an operation to avoid having any more children

YES 1
NO 2

WITHDRAWAL: Men can be careful and pull out before climax.

YES 1
NO 2

ABSTINENCE: Some couples, not including the post-natal period of abstinence, avoid sexual intercourse for months so that the woman doesn't get pregnant.

YES 1
NO 2

PERIODIC ABSTINENCE: Some couples can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.

YES 1
NO 2

MEDICAL PLANTS (bark, roots, leaves) are used by some women to delay or space out pregnancies.

YES 1
NO 2

TALISMANS: (charm, cord with knot, etc) are used by some women to delay or space out pregnancies.

YES 1
NO 2

OTHER METHODS: Have you heard of any other ways or methods, including traditional methods, that women or men can use to avoid pregnancy?

YES 1
NO 2

01. PILL: Women can take a pill every day.

YES 1
NO 2

02. IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.

YES 1
NO 2

03.INJECTABLES: Women can have an injection by a heath provider which stops them from becoming pregnant for several months.

YES 1
NO 2

04. IMPLANTS: Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.

YES 1
NO 2

05. DIAPHRAGM/FOAM/JELLY: Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.

YES 1
NO 2

06. CONDOM (RUBBER): Men can put a rubber sheath on their penis during sexual intercourse.

YES 1
NO 2

07. FEMALE STERILIZATION: Women can have an operation to avoid having any more children. Have you ever had an operation to avoid having any (more) children?

YES 1
NO 2

08. MALE STERILIZATION: Men can have an operation to avoid having any more children. Has your spouse/partner ever had an operation to avoid having any (more) children?

YES 1
NO 2

09. RHYTHM METHOD/PERIODIC ABSTINENCE: Every month that a woman is sexually active, she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.

YES 1
NO 2

10. WITHDRAWAL: Men can be careful and pull out before climax.

YES 1
NO 2

11. Have you heard of any other ways or methods that women or men can use to avoid pregnancy? IF YES, LIST UP TO TWO OTHER METHODS.

YES 1
NO 2

(SPECIFY) _____

1) Have you ever had an operation to avoid having any more children?

YES 1
NO 2

2) Have you ever had a husband who had an operation to avoid having any more children?

YES 1
NO 2

3) Have you ever used the pill?

YES 1
NO 2

4) Have you ever used an IUD?

YES 1
NO 2

5) Have you ever used an injectable?

YES 1
NO 2

6) Have you ever used an implant?

YES 1
NO 2

7) Have you ever used a condom?

YES 1
NO 2

8) Have you ever used a female condom?

YES 1
NO 2

9) Have you ever used a lactational amenorrhea method (lam)?

YES 1
NO 2

10) Have you ever used periodic abstinence?

YES 1
NO 2

11) Have you ever used withdrawal?

YES 1
NO 2

12) Have you ever used emergency contraception?

YES 1
NO 2

13) Have you tried any of these methods you have heard of, but it was not listed?

YES 1
NO 2

METHOD 01) FEMALE STERILISATION Women can have an operation to avoid having any more children: Have you ever had an operation to avoid having any more children?

YES 1
NO 2

METHOD 02) MALE STERILISATION Men can have an operation to avoid having any more children: Have you ever had a partner who had an operation to avoid having any more children?

YES 1
NO 2

METHOD 03) PILL Women can take a pill every day to stop them from becoming pregnant.

YES 1
NO 2

METHOD 04) IUD Women can have a loop or coil placed inside them by a doctor or a nurse.

YES 1
NO 2

METHOD 05) INJECTIONS Women can have an injection by a health provider which stops them from becoming pregnant for one or more months.

YES 1
NO 2

METHOD 06) IMPLANTS, NORPLANT Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.

YES 1
NO 2

METHOD 07) CONDOM Men can put a rubber sheath on their penis before sexual intercourse.

YES 1
NO 2

METHOD 08) FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.

YES 1
NO 2

METHOD 09) RHYTHM OR NATURAL METHODS Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.

YES 1
NO 2

METHOD 10) WITHDRAWAL Men can be careful and pull out before climax.

YES 1
NO 2

METHOD 11) EMERGENCY CONTRACEPTION Women can take pills up to three days after sexual intercourse to avoid becoming pregnant.

YES 1
NO 2

METHOD 12) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?

METHOD ONE
YES 1
NO 2

METHOD TWO
YES 1
NO 2

01. PILL Women can take a pill every day to avoid becoming pregnant.

YES 1
NO 2

02. IUD Women can have a loop or coil placed inside them by a doctor or a nurse.

YES 1
NO 2

03. INJECTABLES Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.

YES 1
NO 2

04. IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.

YES 1
NO 2

05. DIAPHRAGM, FOAM OR GEL Women can place a diaphragm, gel or foam inside their vagina before sexual intercourse.

YES 1
NO 2

06. CONDOM Men can put a rubber or latex sheath on their penis before sexual intercourse.

YES 1
NO 2

07. FEMALE STERILIZATION Women can have an operation to avoid having any more children. Have you ever had an operation to avoid having any more children?

YES 1
NO 2

08. MALE STERILIZATION Men can have an operation to avoid having any more children. Have you ever had a partner who has an operation to avoid having any more children?

YES 1
NO 2

09. RHYTHM METHOD Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.

YES 1
NO 2

10. WITHDRAWAL Men can be careful and pull out before climax.

YES 1
NO 2

11. OTHER METHOD (SPECIFY) ____

YES 1
NO 2

01) PILL: Women can take a pill every day.

YES 1
NO 2

02) IUCD: Women can have a loop or coil placed inside them by a doctor or a nurse.

YES 1
NO 2

03) INJECTIONS: Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.

YES 1
NO 2

04) DIAPHRAGM, FOAM, JELLY: Women can place a sponge, suppository, diaphragm, jelly or cream inside them before intercourse.

YES 1
NO 2

05) CONDOM: Men can use a rubber sheath during sexual intercourse.

YES 1
NO 2

06) FEMALE STERILIZATION: Women can have an operation to avoid having any more children: Have you ever had an operation to avoid having any more children?

YES 1
NO 2

07) MALE STERILIZATION: Men can have an operation to avoid having any more children.

YES 1
NO 2

08) NATURAL METHOD: Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant.

YES 1
NO 2

09) WITHDRAWAL: Men can be careful and pull out before climax.

YES 1
NO 2

10) Have you heard of any other ways or methods that women or men can use to delay or avoid pregnancy?

YES 1
NO 2

01) FEMALE STERILIZATION: Women can have an operation to avoid having any more children: Have you ever had an operation to avoid having any more children?

YES 1
NO 2

02) MALE STERILIZATION: Men can have an operation to avoid having any more children: Have you ever had a partner who had an operation to avoid having any more children?

YES 1
NO 2

03) PILL: Women can take a pill every day to avoid becoming pregnant.

YES 1
NO 2

04) IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.

YES 1
NO 2

05) INJECTIONS: Women can have an injection by a health provider which stops them from becoming pregnant for three months.

YES 1
NO 2

06) IMPLANTS: Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.

YES 1
NO 2

07) CONDOM: Men can put a rubber sheath on their penis before sexual intercourse.

YES 1
NO 2

08) FEMALE CONDOM: Women can place a sheath in their vagina before sexual intercourse.

YES 1
NO 2

09) DIAPHRAGM: Women can place a thin flexible disk in their vagina before intercourse.

YES 1
NO 2

10) FOAM OR JELLY: Women can place a suppository, jelly, or cream in their vagina before intercourse.

YES 1
NO 2

11) LACTATIONAL AMENORRHEA METHOD (LAM): Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.

YES 1
NO 2

12) RHYTHM, BILLINGS OR OTHER NATURAL METHODS: Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.

YES 1
NO 2

13) WITHDRAWAL: Men can be careful and pull out before climax.

YES 1
NO 2

14) EMERGENCY CONTRACEPTION: Women can take pills up to three days after sexual intercourse to avoid becoming pregnant.

YES 1
NO 2

15) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?

YES 1
NO 2

PILL Women can take a pill every day to avoid becoming pregnant.

YES 1
NO 2

IUD Women can have a loop or a coil in plastic or metal placed inside their uterus by a doctor or a nurse to avoid becoming pregnant.

YES 1
NO 2

INJECTIONS Women can have an injection by a health provider to avoid becoming pregnant during one or more months.

YES 1
NO 2

CREAM, JELLY, SPONGE Some women put a diaphragm, a sponge, effervescent pills, jelly or cream before having sexual intercourse to avoid getting pregnant.

YES 1
NO 2

CONDOM Men can put a rubber sheath on their penis before sexual intercourse.

YES 1
NO 2

FEMALE STERILIZATION Women can have an operation to avoid having any more children. Are you sterilized?

YES 1
NO 2

MALE STERILIZATION Men can have an operation to avoid having any more children.
Have you ever had a partner who had an operation to avoid having any more children?

YES 1
NO 2

PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid pregnancy by not having intercourse on the days of the month she is most likely to get pregnant.

YES 1
NO 2

WITHDRAWAL Men can be careful to pull out before climax.

YES 1
NO 2

ABSTINENCE Some couples, in addition to post natal abstinence, avoid having sexual intercourse so that the woman does not get pregnant.

YES 1
NO 2

MEDICINAL PLANTS (stem, root, leaves) are products that can be used to delay pregnancy.

YES 1
NO 2

AMULET (cord with a knot) are things couples can use to delay pregnancy.

YES 1
NO 2

OTHER METHOD (SPECIFY) ____

YES 1
NO 2

01. FEMALE STERILIZATION Have you ever had an operation to avoid having any more children?

YES 1
NO 2

02. MALE STERILIZATION Have you ever had a partner who had an operation to avoid having any more children?

YES 1
NO 2

03. PILL Women can take a pill every day to avoid becoming pregnant.

YES 1
NO 2

04. IUD Women can have a loop or coil placed inside them by a doctor or a nurse.

YES 1
NO 2

05. INJECTABLES Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.

YES 1
NO 2

06. IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.

YES 1
NO 2

07. CONDOM Men can put a rubber sheath on their penis before sexual intercourse.

YES 1
NO 2

08. FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.

YES 1
NO 2

09. DIAPHRAGM Women can place a thin flexible disk in their vagina before intercourse.

YES 1
NO 2

10. FOAM OR JELLY Women can place a suppository, jelly or cream in their vagina before intercourse.

YES 1
NO 2

11. LACTATIONAL AMENORRHEA METHOD (LAM) Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.

YES 1
NO 2

12. RHYTHM OR PERIODIC ABSTINENCE Every month that a woman is sexual active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.

YES 1
NO 2

13. WITHDRAWAL Men can be careful and pull out before climax.

YES 1
NO 2

14. EMERGENCY CONTRACEPTION Women can take pills up to three days after sexual intercourse to avoid becoming pregnant.

YES 1
NO 2

15. Have you heard of any other ways or methods that women or men can use to avoid pregnancy?

YES1
NO 2

01 PILL Women can take a pill every day.

YES 1
NO 2

02 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.

YES 1
NO 2

03 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.

YES 1
NO 2

04 DIAPAGM, FOAM, JELLY Women can place a sponge, suppository, jelly, or cream in their vagina before sexual intercourse.

YES 1
NO 2

05 CONDOM Men can put a rubber sheath on their penis before sexual intercourse.

YES 1
NO 2

06 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
Have you ever had an operation to avoid having any more children?

YES 1
NO 2

07 MALE STERILIZATION Men can have an operation to avoid having any more children.
Have you ever had a partner who had an operation to avoid having any more children?

YES 1
NO 2

08 RHYTHM, CALENDAR METHOD Every month that a woman is sexually active she can avoid having sexual intercourse on the days of the month she is most likely to get pregnant.

YES 1
NO 2

09 WITHDRAWAL Men can be careful and pull out before climax.

YES 1
NO 2

10 HERBS. Women use natural herbs or Dutch remedies to avoid pregnancy

YES 1
NO 2

11 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?

YES 1
NO 2

YES 1
NO 2

METHOD 01 PILL Women can take a pill every day.

YES 1
NO 2

METHOD 02 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.

YES 1
NO 2

METHOD 03 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.

YES 1
NO 2

METHOD 04 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.

YES 1
NO 2

METHOD 05 DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.

YES 1
NO 2

METHOD 06 CONDOM, RUBBER, RAINCOAT, DUREX A man can wear a rubber bag in his penis during sex to prevent pregnancy. The rubber bag is also used to prevent passing diseases such as AIDS and for cleanliness.

YES 1
NO 2

METHOD 07 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
Have you ever had an operation to avoid having any more children?

YES 1
NO 2

METHOD 08 MALE STERILIZATION Men can have an operation to avoid having any more children.
Have you ever had a partner who had an operation to avoid having children?

YES 1
NO 2

METHOD 09 CALENDAR/SAFE PERIOD Couples can have sexual intercourse only during the safe period of the monthly cycle that is the times during monthly cycle when women is least likely to get pregnant.

YES 1
NO 2

METHOD 10 MUCUS METHOD A woman can observe daily the state of the mucus and avoid sexual intercourse at the time when the mucus is colorless and extremely elastic.

YES 1
NO 2

METHOD 11 WITHDRAWAL Men can be careful and pull out before climax.

YES 1
NO 2

METHOD 12 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?

YES 1
NO 2

METHOD 01 PILL Women can take a pill every day.

YES 1
NO 2

METHOD 02 IUCD Women can have a loop or coil placed inside them by a doctor or a nurse.

YES 1
NO 2

METHOD 03 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.

YES 1
NO 2

METHOD 04 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.

YES 1
NO 2

METHOD 05 FOAMING TABLETS/JELLY Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.

YES 1
NO 2

METHOD 06 CONDOM Men can put a rubber sheath on their penis during sexual intercourse.

YES 1
NO 2

METHOD 07 FEMALE STERILIZATION Women can have an operation to avoid having any more children: Have you ever had an operation to avoid having any more children?

YES 1
NO 2

METHOD 08 MALE STERILIZATION Men can have an operation to avoid having any more children: Have you ever had a partner who had an operation to avoid having children?

YES 1
NO 2

METHOD 09 NATURAL FAMILY PLANNING Couples can avoid having sexual intercourse on the days of the month when the woman is more likely to become pregnant.

YES 1
NO 2

METHOD 10 WITHDRAWAL Men can be careful and pull out before climax.

YES 1
NO 2

METHOD 11 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?

YES 1
NO 2