Items:

Knowledge of Health Rights
1. The government ensures that family planning services are free of cost.
2. I have the right to privacy during my family planning visit.
3. The healthcare provider should not share my information with other people.
4. Healthcare providers must answer all my health related questions.
5. Healthcare providers should inform me about the different family planning options.

Mistreatment by health workers
6. One of the providers or staff refused to offer me the service I wanted to receive.*
7. The provider ignored my request or my preferences today.
8. I felt like the provider did not listen to what I was saying.*
9. A provider encouraged me to use one family planning that was different to the one I wanted.*.

Perception of quality services
10. The staff at this health facility have high quality family planning services.
11. The staff at this health facility ensures privacy and confidentiality when providing services.
12. The health facility is clean.

Response Options:
Likert scale 1-5

Women's participation in household decision-making
13. Which member of your household makes decisions about making household purchases for daily needs?
14. Which member of your household usually makes decisions about how to use the money that you bring into the household?
15. Which member of your household usually makes decisions about whether you and your husband/partner use family planning?
16. Which member of your household usually makes decisions about where you will receive family planning?
17. Which member of your household usually makes decisions about if you will be tested for the AIDS virus?
18. Which member of your household usually makes decisions about how many children you will have?

Response Options:
Likert scale 1-6

Ability to attend community meetings
19. How sure are you that you could attend a community meeting if your family did not support you to participate?
20. How sure are you that you could attend a community meeting if your family said you could not go?
21. How sure re you that you could attend a community meeting if your family would not help with your household duties so that you could attend?

Ability to participate in community meetings
22. How sure are you that you could express your opinion at a community meeting?
23. How sure are you that you could express your opinion at a community meeting if a few people did not agree with what you were saying?
24. How sure are you that you could express your opinion at a community meeting if many people did not agree with what you were saying?

Awareness of accountability mechanisms
25. Health providers and district government officials can directly influence the quality of your local family planning services?
26. Challenging people of influence is the best way to change family planning services in the clinic.
27. Collaboration with people of influence is the best way to change family planning services in the clinic.

Mutual responsibility for and support of services
28. Who could have the most impact on making sure that women are treated with respect by health workers?
29. Who could have the most impact on making sure that women have transportation to the hospital for permanent methods of contraception?
30. Who could have the most impact on increasing the number of days a health worker visits your community?
31. Who could have the most impact on making sure the poorest and most vulnerable women in the community receive care?
32. Who could have the most impact on getting funding to improve health services in this community?

Collective efficacy
33. How sure are you that the people in your community could work together to improve family planning services in this community?
34. How sure are you that the people in your community could work together to improve how women are treated at the health facility?
35. How sure are you that the people in your community could work together to obtain government services and entitlements?
36. How sure are you that the people in your community could work together to improve the health and well-being of women in this community?

Community support in the time of crisis
37. How sure are you that there is someone in your community, apart from your immediate family, who could take you to the clinic?
38. How sure are you that there is someone in your community, apart from your immediate family, who would help care for your children or household while you are away?
39. How sure are you that there is someone in your community, apart from your immediate family, who would loan you money for transport?

Response Options:
Likert scale 1-5

*Items are reverse scored