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

01 NONE
02 NOT EFFECTIVE
03 HUSBAND/PARTNER DISAPPROVES
04 SIDE EFFECTS
05 ACCESS/AVAILABILITY
06 COST
07 INCONVENIENT TO USE
08 OTHER (SPECIFY) ______
98 DK

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

01 NONE
02 NOT EFFECTIVE
03 HUSBAND/PARTNER DISAPPROVES
04 SIDE EFFECTS
05 ACCESS/AVAILABILITY
06 COST
07 INCONVENIENT TO USE
08 OTHER (SPECIFY) ______
98 DK

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

01 NONE
02 NOT EFFECTIVE
03 HUSBAND/PARTNER DISAPPROVES
04 SIDE EFFECTS
05 ACCESS/AVAILABILITY
06 COST
07 INCONVENIENT TO USE
08 OTHER (SPECIFY) ______
98 DK

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

01 NONE
02 NOT EFFECTIVE
03 HUSBAND/PARTNER DISAPPROVES
04 SIDE EFFECTS
05 ACCESS/AVAILABILITY
06 COST
07 INCONVENIENT TO USE
08 OTHER (SPECIFY) ______
98 DK

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

01 NONE
02 NOT EFFECTIVE
03 HUSBAND/PARTNER DISAPPROVES
04 SIDE EFFECTS
05 ACCESS/AVAILABILITY
06 COST
07 INCONVENIENT TO USE
08 OTHER (SPECIFY) ______
98 DK

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

01 NONE
02 NOT EFFECTIVE
03 HUSBAND/PARTNER DISAPPROVES
04 SIDE EFFECTS
05 ACCESS/AVAILABILITY
06 COST
07 INCONVENIENT TO USE
08 OTHER (SPECIFY) ______
98 DK

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

01 NONE
02 NOT EFFECTIVE
03 HUSBAND/PARTNER DISAPPROVES
04 SIDE EFFECTS
05 ACCESS/AVAILABILITY
06 COST
07 INCONVENIENT TO USE
08 OTHER (SPECIFY) ______
98 DK

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

01 NONE
02 NOT EFFECTIVE
03 HUSBAND/PARTNER DISAPPROVES
04 SIDE EFFECTS
05 ACCESS/AVAILABILITY
06 COST
07 INCONVENIENT TO USE
08 OTHER (SPECIFY) ______
98 DK

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

01 NONE
02 NOT EFFECTIVE
03 HUSBAND/PARTNER DISAPPROVES
04 SIDE EFFECTS
05 ACCESS/AVAILABILITY
06 COST
07 INCONVENIENT TO USE
08 OTHER (SPECIFY) ______
98 DK

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.

01 NONE
02 NOT EFFECTIVE
03 HUSBAND/PARTNER DISAPPROVES
04 SIDE EFFECTS
05 ACCESS/AVAILABILITY
06 COST
07 INCONVENIENT TO USE
08 OTHER (SPECIFY) ______
98 DK

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

01 NONE
02 NOT EFFECTIVE
03 HUSBAND/PARTNER DISAPPROVES
04 SIDE EFFECTS
05 ACCESS/AVAILABILITY
06 COST
07 INCONVENIENT TO USE
08 OTHER (SPECIFY) ______
98 DK

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

01 NONE
02 NOT EFFECTIVE
03 HUSBAND/PARTNER DISAPPROVES
04 SIDE EFFECTS
05 ACCESS/AVAILABILITY
06 COST
07 INCONVENIENT TO USE
08 OTHER (SPECIFY) ______
98 DK

01 PILL Women can take a pill every day.

RESPONSE ____________

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

RESPONSE ____________

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

RESPONSE ____________

05 FOAM/JELLY Women can place a sponge, suppository, jelly or cream inside the before intercourse.

RESPONSE ____________

06 CONDOM Men can use a rubber sheath during sexual intercourse.

RESPONSE ____________

07 FEMALE STERILIZATION Women can deliberately choose to have an operation to avoid having any more children.

RESPONSE ____________

08 MALE STERILIZATION Men can deliberately choose to have an operation to avoid having any more children.

RESPONSE ____________

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

RESPONSE ____________

10 SAFE PERIOD Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant.
Where would you go to obtain advice on safe peried?

RESPONSE ____________

11 PROLONGED BREASTFEEDING Women can prolong the time that they breastfeed their babies to delay the next pregnancy.

RESPONSE ____________

02 NOT EFFECTIVE
04 HUSBAND DISAPPROVES
05 OTH RELAT DISAPPROVE
06 RELIGIOUS PROHIBITIONS
07 SIDE EFFECTS FOR WOMAN
08 SIDE EFFECTS FOR CHILD
09 METHOD PERMANENT
11 DIFFICULT TO OBTAIN
12 COSTS TOO MUCH
13 INCONVENIENT TO USE
18 OTHER (SPECIFY)
96 NO PROBLEM
98 NOT SURE/DON'T KNOW

02 NOT EFFECTIVE
03 PARTNER DISAPPROVES
04 HEALTH CONCERNS
05 DIFFICULT TO GET
06 COSTS TOO MUCH
07 INCONVENIENT TO USE
11 OTHER (SPECIFY)
12 NONE
98 DK

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

PROBLEM
OTHER ______

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

PROBLEM
OTHER ______

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

PROBLEM
OTHER ______

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

PROBLEM
OTHER ______

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

PROBLEM
OTHER ______

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

PROBLEM
OTHER ______

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

PROBLEM
OTHER ______

08) PERIODIC ABSTINENCE 'Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant.'

PROBLEM
OTHER ______

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

PROBLEM
OTHER ______

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

____
OTHER__________

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

____
OTHER__________

METHOD 03) INJECTIONS Women can have an injection by a health provider which stops them from becoming pregnant for one or more months.

____
OTHER__________

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

____
OTHER__________

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

____
OTHER__________

METHOD 06) FEMALE STERILISATION Women can have an operation to avoid having any more children.

____
OTHER__________

METHOD 07) MALE STERILISATION Men can have an operation to avoid having any more children.

____
OTHER__________

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

____
OTHER__________

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

____
OTHER__________

01 NONE
02 NOT EFFECTIVE
03 PARTNER DISAPPROVES
04 COMMUNITY DISAPPROVES
05 RELIGION DISAPPROVES
06 HEALTH CONCERN
07 ACCESS/AVAILABILITY
08 COSTS TOO MUCH
09 INCONVENIENT TO USE
10 OTHER (SPECIFY) _____
98 DOESN'T KNOW

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

NONE 1
ACCESS/AVAILABILITY 2
COST 3
SECONDARY EFFECTS 4
METHOD DOESN'T WORK 5
HUSBAND OPPOSED 6
OTHER (SPECIFY) _____ 7
DOESN'T KNOW 8

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

NONE 1
ACCESS/AVAILABILITY 2
COST 3
SECONDARY EFFECTS 4
METHOD DOESN'T WORK 5
HUSBAND OPPOSED 6
OTHER (SPECIFY) _____ 7
DOESN'T KNOW 8

03. INJECTIONS: Women can have an injection by a doctor, mid-wife or nurse to avoid becoming pregnant during many months.

NONE 1
ACCESS/AVAILABILITY 2
COST 3
SECONDARY EFFECTS 4
METHOD DOESN'T WORK 5
HUSBAND OPPOSED 6
OTHER (SPECIFY) _____ 7
DOESN'T KNOW 8

04. OTHER SCIENTIFIC METHODS FOR THE WOMAN: Some women insert a diaphragm, a sponge, effervescent pills, jelly or cream before having sexual intercourse.

NONE 1
ACCESS/AVAILABILITY 2
COST 3
SECONDARY EFFECTS 4
METHOD DOESN'T WORK 5
HUSBAND OPPOSED 6
OTHER (SPECIFY) _____ 7
DOESN'T KNOW 8

05. CONDOM: Men can put a rubber sheath on their penis before sexual intercourse so that their wife does not get pregnant.

NONE 1
ACCESS/AVAILABILITY 2
COST 3
SECONDARY EFFECTS 4
METHOD DOESN'T WORK 5
HUSBAND OPPOSED 6
OTHER (SPECIFY) _____ 7
DOESN'T KNOW 8

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

NONE 1
ACCESS/AVAILABILITY 2
COST 3
SECONDARY EFFECTS 4
METHOD DOESN'T WORK 5
HUSBAND OPPOSED 6
OTHER (SPECIFY) _____ 7
DOESN'T KNOW 8

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

NONE 1
ACCESS/AVAILABILITY 2
COST 3
SECONDARY EFFECTS 4
METHOD DOESN'T WORK 5
HUSBAND OPPOSED 6
OTHER (SPECIFY) _____ 7
DOESN'T KNOW 8

08. RHYTHM METHOD: 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.

NONE 1
ACCESS/AVAILABILITY 2
COST 3
SECONDARY EFFECTS 4
METHOD DOESN'T WORK 5
HUSBAND OPPOSED 6
OTHER (SPECIFY) _____ 7
DOESN'T KNOW 8

11. MEDICINAL PLANTS (bark, roots, leaves)

NONE 1
ACCESS/AVAILABILITY 2
COST 3
SECONDARY EFFECTS 4
METHOD DOESN'T WORK 5
HUSBAND OPPOSED 6
OTHER (SPECIFY) _____ 7
DOESN'T KNOW 8

12. GRIS-GRIS (amulet cord, node, fass, galane)

NONE 1
ACCESS/AVAILABILITY 2
COST 3
SECONDARY EFFECTS 4
METHOD DOESN'T WORK 5
HUSBAND OPPOSED 6
OTHER (SPECIFY) _____ 7
DOESN'T KNOW 8

13. OTHER METHOD (SPECIFY) _____

NONE 1
ACCESS/AVAILABILITY 2
COST 3
SECONDARY EFFECTS 4
METHOD DOESN'T WORK 5
HUSBAND OPPOSED 6
OTHER (SPECIFY) _____ 7
DOESN'T KNOW 8

NOT EFFECTIVE 2
HUSBAND DISAPPROVES 3
HEALTH CONCERNS 4
ACCESS/AVAILABILITY 5
COSTS TOO MUCH 6
INCONVENIENT TO USE 7
OTHER (SPECIFY ABOVE) ____ 10
NONE 11
DOES NOT KNOW 98

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

_______
OTHER _____

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

_______
OTHER _____

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

_______
OTHER _____

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

_______
OTHER _____

08 PERIODIC ABSTINENCE Couples can avoid having sexual intercourse on certain days of the month when the woman is most likely to become pregnant.

_______
OTHER _____

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

_______
OTHER _____

02 HOT EFFECTIVE
03 HUSBAND DISAPPROVES
04 OTHERS DISAPPROVE
05 HEALTH CONCERNS
06 ACCESS/AVAILABILITY
07 COSTS TOO MUCH
08 INCONVENIENT TO USE
09 PERMANENT METHOD
11 RELIGION
12 OTHER (SPECIFY)
13 NONE
98 DONT KNOW

01 HOSPITAL/MATERNITY
02 CLINIC
03 DISPENSARY
04 MOBILE UNIT
05 FAMILY PLANNING CLINIC
06 MEDICAL-SOCIAL CENTER
07 PRIVATE DOCTOR'S OFFICE/CLINIC
08 PHARMACY
09 FRIENDS/NEIGHBORS/KABLA ARBI [##TRANSLATOR NOTE: TRANSLATION UNAVAILABLE]
10 OTHER
98 DON'T KNOW

01 PILL Women can take a pill every day.

OTHER ____________

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

OTHER ____________

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

OTHER ____________

04 DIAPHRAGM/FOAM/JELLY Women can place jelly, cream, tablets, or a diaphragm around the neck of the womb before intercourse.

OTHER ____________

05 CONDOM Men can wear a rubber sheath during sexual intercourse.

OTHER ____________

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

OTHER ____________

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

OTHER ____________

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

OTHER ____________

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

OTHER ____________

10 ANY OTHER METHODS? Have you ever heard of any other ways or methods that women or men can use to avoid pregnancy?

OTHER ____________

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

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 __________