Items:

1. Do you know how to use [method name]?
2. Can you name a benefit/advantage of not using family planning?
3. Can you name a risk/disadvantage of not using family planning?
4. Can you name a benefit/advantage of [name of method they currently use]?
5. Can you name a risk/disadvantage of [name of method they currently use]?
6. When you procured [name of method they currently use], were you told what to do if you experienced side effects or problems?
7. When you procure [name of method they currently use], were you informed about how to stop using the method?
8. Did the provider tell you that your method was permanent when you procured it?
9. Do you think that [method name] would be available to you if you wanted it?
10. Do you think that [method name] would be affordable to you if you wanted it?
11. Do you think you could get your method removed without difficulty if you wanted?
12. Do you think that the cost of getting your method removed would be a barrier if you wanted to stop using the method?
13. Did you make the choice not to use family planning voluntarily?
14. Did you make the choice to use [name of method they currently use] voluntarily?
15. Were you offered any type of benefit or incentive not to use family planning?
16. Were you offered any type of benefit or incentive to use [name of method they currently use]?
17. Did you feel you could say no to using [name of method they currently use]?
18. Are you currently using [name of method they currently use] against your will?
19. Have you ever attempted to get the [name of method they currently use] removed by a provider?
20. If so, did the provider remove your method on request?

Response Options:
Yes - 1
No - 0

Method Names
Oral contraceptive pills
Injectable contraceptives
Subdermal implants
Intrauterine devices
External condoms
Internal condoms
Rhythm/calendar method
Emergency contraception
Lactational amenorrhea
Standard Days Method
Spermicide
Withdrawal
Diaphragm
Female sterilization