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03 Questionnaire

This document surveys family planning acceptors on the effectiveness of family planning methods from 2011-2015. It asks for demographic information and then rates the effectiveness of family planning on various factors like reproductive health, relationships, health of mothers and children, and quality of life.

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Euljun Salarda
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12 views

03 Questionnaire

This document surveys family planning acceptors on the effectiveness of family planning methods from 2011-2015. It asks for demographic information and then rates the effectiveness of family planning on various factors like reproductive health, relationships, health of mothers and children, and quality of life.

Uploaded by

Euljun Salarda
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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EFFECTIVENESS OF FAMILY PLANNING ON ACCEPTORS

CY 2011 – 2015

Respondent No. ____

PART I: GENERAL INFORMATION (Please check appropriate space corresponding your answer.
All answers will be kept confidential).

Educational Qualification: ____ No formal education


____ Elementary education
____ High school
____ College
____ Others

Number of children: ____

Age at marriage: ____

Monthly check-up practice: ____ Regular


____ Not regular

Family planning method used: ____ IUD ____ Condom


____ Pills ____ Injectable contraceptives

Length of time using family


planning method: ____

Family monthly income: ____ Below 1,000.00


____ 1,000.00 – 1,999.00
____ 2,000.00 – 2,999.00
____ 3,000.00 – 3,999.00
____ 4,000.00 – 4,999.00
____ 5,000.00 – 5,999.00
____ 6,000.00 – 6,999.00
____ 7,000.00 – 7,999.00
____ 8,000.00 – 8,999.00
____ 9,000.00 – 9,999.00
____ 10,000.00 and above

Part II. Ratings on effects of Family Planning to the acceptors (Please check the box that
represents your observations and views.).

A. Reproductive Health

1. How do you rate Family Planning program as an essential element of reproductive health?
□ Very Effective □ Effective □ Less Effective □ Not Effective
2. Family planning will improve the health status of the mother and child when the birth interval
is three years than one year.
□ At all times □ Most of the time □ Sometimes □ Never
3. Family planning is like having a small family that would result to both child’s and mother’s
health become better.
□ At all times □ Most of the time □ Sometimes □ Never
4. Family planning prevents high – risk pregnancy and death.
□ At all times □ Most of the time □ Sometimes □ Never
B. Husband and Wife Relationship

1. Family planning helps my husband and I on birth spacing.


□ At all times □ Most of the time □ Sometimes □ Never
2. The family planning method helps my husband and I in rearing our children to a better life.
□ At all times □ Most of the time □ Sometimes □ Never
3. We have few problems on husband – wife relationship especially on sexual needs and
satisfaction due to family planning.
□ At all times □ Most of the time □ Sometimes □ Never
4. The family planning method creates problems between my husband and I.
□ At all times □ Most of the time □ Sometimes □ Never
C. Protection of Client’s Health
1. How do you assess the effectiveness of family planning method used to protect women
against high risk pregnancy?
□ Very Effective □ Effective □ Less Effective □ Not Effective
2. Family planning methods safeguard serious complications like septic abortion.
□ At all times □ Most of the time □ Sometimes □ Never
3. Women who are acceptors of family planning can follow-up and maintain their physical
needs.
□ At all times □ Most of the time □ Sometimes □ Never
4. Family planning method can cause physical sickness on the acceptor.
□ At all times □ Most of the time □ Sometimes □ Never
D. Household Chores

1. As an acceptor of family planning method, does it help in coping with household chores?
□ At all times □ Most of the time □ Sometimes □ Never
2. As an acceptor of family planning method, mothers have leisure time with the children.
□ At all times □ Most of the time □ Sometimes □ Never
3. As an acceptor of family planning, mothers have time for personal needs.
□ At all times □ Most of the time □ Sometimes □ Never
E. Health of Children

1. Family planning can improve child rearing practices and can effectively reduce infant
mortality rate by decreasing the number of high risk pregnancies.
□ At all times □ Most of the time □ Sometimes □ Never
2. Family planning program can effectively influence on the ability to feed and care of newly
born child.
□ At all times □ Most of the time □ Sometimes □ Never

F. Quality of Life
1. Family planning can help families have a decent and better life.
□ At all times □ Most of the time □ Sometimes □ Never
2. Family planning provides opportunity for the children to acquire better education.
□ At all times □ Most of the time □ Sometimes □ Never
G. Perception on Family Planning Issues
1. Family planning is the sole responsibility of the woman.
□ At all times □ Most of the time □ Sometimes □ Never
2. The choice of family planning method should be mutually agreed upon by both husband
and wife.
□ At all times □ Most of the time □ Sometimes □ Never
3. Family planning should be discussed by both husband and wife.
□ At all times □ Most of the time □ Sometimes □ Never

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