Items:

 1. The last time you had sexual intercourse with this person, was a condom used?

Response Options:
Yes
No

 2. From where did you obtain the condom last time?

(Probe to identify type of source. If unable to determine if public, private, or NGO sector, write the name of the place.)

Response Options:
Under Public Sector:
Government hospital
Government health center
Family planning clinic
Mobile clinic
Community Health WorkerFieldworker
Other public sector (Additionally, specify in text)
Under Private Medical Sector: Private hospital Private clinic Pharmacy Private Doctor Mobile clinic Community health workerFieldworker Other private medical sector (Additionally, specify in text)
Under NGO Medical Sector
NGO Hospital
NGO Clinic
Other NGO Medical Sector (Additionally, specify in text)
Other Source:
Shop
Church
Friendrelative
Other (Additionally, specify in text)
Don’t know

 3. You have said that you do not want (aanother) child soon. Can you tell me why you are not using a method to prevent pregnancy? Any other reason? OR
You have said that you do not want any (more) children. Can you tell me why you are not using a method to prevent pregnancy? Any other reason?
Record all reasons mentioned.

Response Options:
Not married
Under Fertility-related Reasons: Not having sex
Infrequent sex
Menopausalhysterectomy
Can’t get pregnant
Not menstruated since last birth
Breastfeeding
Up to godfatalistic
Under Opposition to Use:
Respondent opposed
Husbandpartner opposed
Others opposed
Religious prohibition
Under Lack of Knowledge:
Knows no method
Knows no source
Under Method-related Reasons:
Inconvenient to use
Changes in menstrual bleeding
Methods could cause infertility
Interferes with body’s normal processes
Other side effects
Under CostAccessAvailability
Lack of accesstoo far
Costs too much
Preferred method not available
No method available
Other (Additionally, specify in text)
Don’t know

 4. Do you think you will use contraceptive method to delay or avoid pregnancy at any time in the future?

Response Options:
Yes
No
Don’t know

 5. When making this decision with your (husbandpartner), would you say that your opinion is more important, equally important, or less important than your (husband’spartner’s) opinion?

Response Options:
More important
Equally important Less important

 6. Who usually makes the decision on whether or not you should use contraception, you, your (husbandpartner), you and your (husbandpartner) jointly, or someone else?

Response Options:
Respondent
Husbandpartner
Respondent and Husbandpartner jointly
Someone else
Other (Additionally, specify in text)

 7. Could you ask your (husbandpartner) to use a condom if you wanted him to?

Response Options:
Yes
No
DependsNot sure