02 NOT EFFECTIVE
03 HUSBAND DISAPPROVES
04 HEALTH CONCERNS
05 ACCESS/AVAILABILITY
06 COSTS TOO MUCH
07 INCONVENIENT TO USE
09 METHOD PERMANENT
11 OTHER (SPECIFY) __________
12 NONE
98 DON'T KNOW

01. PILL Women can take a pill by mouth every day.

PROBLEM FROM LIST ___
OTHER __________

02. LOOP Women can have a loop or IUD inserted in their wombs by a doctor or a nurse.

PROBLEM FROM LIST ___
OTHER __________

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

PROBLEM FROM LIST ___
OTHER __________

04. DIAPHRAGM Women can place a diaphragm or pessary inside them before intercourse.

PROBLEM FROM LIST ___
OTHER __________

05. CONDOM OR DUREX Men can use a rubber during sexual intercourse.

PROBLEM FROM LIST ___
OTHER __________

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

PROBLEM FROM LIST ___
OTHER __________

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

PROBLEM FROM LIST ___
OTHER __________

08. SAFE PERIOD Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant.

PROBLEM FROM LIST ___
OTHER __________

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

PROBLEM FROM LIST ___
OTHER __________

10. FOAM/JELLY/FOAMING TABLETS Women can insert foam or jelly or foaming tablets inside them before intercourse.

PROBLEM FROM LIST ___
OTHER __________

11. ANY OTHER METHODS? Have you heard of any other ways or methods that women or men can use to avoid pregnancy? (SPECIFY) __________

PROBLEM FROM LIST ___
OTHER __________