Identifaction number
Demographic varible
woreda name
kebele code
Cluster code
HH code
Gotte type
personel
Data collector name
Supervisor Name
Date of visit
Name of Mother
Age
living time
Read and write skill
Formal School
Highest grade completed
Religion
Ethinicity
Occupation
Husband age
Husband Formal School
Highest garde
Single wife
wife number
Wife order
Community Responsibility
Religious Ledaer
Clan Leader
Health Committe
1 to 5 network
Faema Leader
Children education
Number of Children educated
Male
Female
Total
Child Highest garde
Child grade in Number
Child Employement
Number Child employed
Occupation Type
Other Occupation
Avalaiblity Facility
Electricity
Transport
Health Facility
Veternary Scince
School
time to nearest Health facility
Source of income
Live stock number
camel
sheep
Goat
Cow
Source of water
Source of improved water
Pipped into dwelling
Pipped into neigbored
Public Standpipe
Tube well
protedcted dug well
protected spring water
Time to obatin drink water
who collectes water
Other water collector
Finacial support
Amount of money you get
Saving Opportunity
Where do you save money
Part 3 Head
marraige age
pregnancy number
age at fisrt pregnancy
Number of delivery
first delivery age
if last year of live birth
is last year live birth
if dead last year live birth
Total number of birth
Sex prefrences
Age diffrences
Face abortion
Number of Abortion
Abortion month
Family size
Youngest Child Breast fed
Breast feed after Child Birth
Minutes
Hours
Days
colostrum
Given other than Milk in three days
What additives
Other additives
When you breastfed
Other condition of Breast fed
Months of only breastfed
Given for month BF
Still Bresat feeding
Fed other than breast milk in the past 24 hours
Face unwanted pregnancy while BF
Month of Unwanted Px
visit in Recnet Px
Purpose of visit
Other Purpose
Start month of 1st ANC
Number of ANC visit
Last delivery Place
Visit within 42 days
Reason for visit
Other reason
1st PNC
2nd PNC
Did you diagnosed for infertility
Result of dignose infertility
Heard of FP
Type of FP
Pill
IUD
Injection
Implanon
Jaddle
Condom
Feamle sterlization
Male sterlization
Periodic Abstince
LAM
Other speicfy
In the last 3 month Have u heard off
Radio
TV
HEW
Health Worker
BMW
Clan leader
Religious leader
Husband
Social gathering
YES
Pregnant mother Confrence
APDA health/Women extension
TBA
Family
Neigbored
RIF
Faema
info from clan or religious leader
01 month
02 month
03 month
06 month
12 month
Husband info
Reason for using of FP
Limiting birth
Spacing Birth
Preventing of STI/HIV/AIDS
As therapy
I donot know
Other
Place where u obtain FP
Where can u obtain FP
Hospital
HC
Health Post
NGO health Facility
Private Health Facility
Pharamcy
Drug vendor
Family planning did not have any side effect
Family planning use could cause ministration disturbance
Family planning use could cause heavy bleeding
Family planning could lead to excessive weight gain
Family planning use could prevent daily activity
Family planning use can prevent HIV/AIDS
Family planning has no interference with sexual intercourse or desire
Following family planning use, pregnancy can return immediately
Family planning use can cause a cancer
Depo- Prova can prevent pregnancies for 3 months
There is a family planning can prevent pregnancy for more than 10 years
Pill should be taken on daily basis so as to prevent pregnancy
Family planning improves the health of the mother
Family planning improves the health of the child
Once a female undergo female sterilization fertility is impossible
Family planning use can improves the economy status of the household
There is a family planning option for men
Exclusive breast feeding can prevent pregnancy
Family planning should be used by single or currently non-married individuals
Women in polygamous marriage should not use family planning
For me, using family planning to space or limit birth is
bad good
unpleasnat
Inconvenient
Worthless
Unsatisfactory
Harmful
shameful
wastage of resource
Source of sickness
weak
discouraging
sinful
Q502
a)Deteriorate qulaity of life
weakned
sad
sick
503
Laed to criticim
Discouraging
Refused
unwanted
504
Educated women
Urban resident
Being non married
Not all......wives/relatives of Clan leader
Not all......wives/relatives of religious leader
Not all......wives/relatives of kebele leader
Not all......wives/relatives of volunters
Not all......among TBA
have small number of children
being older age
Being monogamous wife
Rarely
??_
505
distant
religiously prohibted
psycholigically inconvinent
depend on my husband decision
not affordable
Diffcult
Impossible
Infulnced by others
Hard to remind the schedule
How pleasant if you use family planning for limiting the number of children
Does limiting the number of children has anything worthy for you?
How pleasant you will be if you use family planning?
How important the pleasure you would get if you use family planning
How would you feel if family planning methods administered through injection?
Does the pain following use of injectable methods bother you?
How comfortable is it, if you use family planning
How the comfort of family planning methods matter for you?
Do you believe that family planning could cause infertility?
How do you worry about being infertile as a result of family planning?
How do you feel if you use family planning?
How you are concerned with psychological factors following family planning use?
Do you believe that using modern contraceptive could space child birth?
How do evaluate the benefit/s associated to spacing childbirth
Did you believe that frequent birth has an effect on health of the mother?
How giving many children is worthy for you?
Do you believe that modern contraceptive could improve the health of the child?
How frequent you bother about of the health of your children?
Do you believe that family planning could limit the number of children?
How limiting number of children is worthy for you
Do you believe that modern contraceptive could improve the health of the mother?
How you are wondering about your health associated with giving birth?
Did you believe that frequent birth has an effect on health of the child?
How do evaluate having many children for you?
Do you think modern contraceptive methods are effective to delay pregnancy?
How do you evaluate the benefit of family planning for delaying pregnancy for you?
Does use of family planning makes the women healthy?
How you are concerned with the health of women related to childbirth?
Do you think that most of your close relatives use family planning?
Does your close relatives’ status of FP use affect your willingness to use family planning?
If you want to use FP, do you believe that your religious leader in your community would annoy of it?
Regarding with FP use, do you believe that you should always do what your religious leaders thinks
Do you think your husband’s close relatives use family planning?
Does your husband’s close relatives status to use family planning your use to family planning?
If you want to use FP, do you believe that your clan leader in your community would approve it?
Regarding with FP use, do you believe that you should always do what your clan leaders think?
If you want to use FP, do you believe that your grandparents in would be happy with it?
Regarding with FP use, do you believe that you should always do what your parents think
Do you think that wives of your religious leaders in your community use family planning?
Does the use of FP among wives of your religious leaders inhibit or affect your use to FP?
If you want to use FP, do you believe that your husband’s ‘relatives would approve it?
Regarding with FP use, do you believe that you should always do what your husband’s relatives think?
If you want to use FP, do you believe that your neighbors would blame you?
Regarding with FP use, do you believe that you should always do what your neighbors think?
Do you think that wife/wives of your clan leaders in your community use family planning?
Do you believe that use of FP among wives of your clan leaders affect your use to FP?
If you want to use FP, do you believe that your husband would allow you to practice it?
Regarding with FP use, do you believe that you should always do what your husband thinks?
Do you think that most of the women in your neighbors use family planning?
Do your neighbors of Practice affect your use to family planning?
Do you think that husbands in your community disallow their wives to use family planning?
How the disallowance of husbands in your community matter you to use family planning?
Do you believe that opposition from others is likely to happen consequent to family planning use?
Do you think that possible oppositions from others could influence your decision to use family planning?
Do you believe that side effect is likely to happen for you following family planning use?
How possible side effect could matter your to use family planning?
Do you think is there is a risk of discrimination by community members if they know that you are using family planning?
How possible discrimination could matter your practice to use family planning?
Do you think that the cost of family planning may be expensive if you decided to use it?
Do you believe that the cost for family planning would worry you if you want to use it?
If want to use family planning, I am certain that I would afford the cost for it.
If want to use family planning, I am confident that I always would keep the appointment regarding it.
Though I need to space childbirth, I am not sure that I always can get methods of my choice in health facility.
If want to use family planning, I am confident to convince your husband that I should use it.
If I want to use family planning, I am confident that I can ask and discuss with health providers o how to use it.
If want to use family planning, I am certain that I would overcome an oppositions from others elsewhere.
It is up to me, If I want to use family planning, I can do it.
Do you think that the sedentary life could affect the appointment for family planning?
If you decided to use FP, do you think that your method of choice may not always available at health facility?
Do you think there are no skilled health professionals for family planning?
Do you think there would no secrete /safe place to put pills in home?
Do you think the attitude of health professionals may not be pleasant?
Do you believe that you can remind every day to take your pills for family planning?
Do you think that you and your partner able to use condom to prevent pregnancy?
I am not clear with the benefits of using family planning
At this moment, I can list some of the benefits of family planning use I would gain if I use it?
I am happy if I could use family planning to space the number of children I would have in the future
I am happy if I could use family planning to limit the number of children I would have in the future
I am willing to use family planning to space/limit number of children
I have already decided that Ishould use family planning in the near future.
I have ever used family planning in the previous 6 months and I found it relevant me.
I have ever used FP in the past 6 months and I am quite sure I will continue using it in the future.
It is expected that women in our community should use family planning and so do I
Who decided to take or not to take the contraceptive?
Is that the decision making of stopping contraceptive use is due to :
Is that the decision making of not contraceptive use is due to:
Who decides the number of children you will have for the future?’
Have you ever discussed about family planning with your husband
In the past 1 month have your ever discussed about family planning with your husband
Are you pregnant now?
At the time you became pregnant did you want to become pregnant then, did you want to wait until later, OR did you NOT WANT to have any more children?
Now I have some questions about the future. After the child you are expecting now, would you like to have another child, or Would you prefer not to have any more children?
Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?
After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?
month
years
Have you or your partner ever used any method to delay or avoid getting pregnant?
Check Question 607, If The Women Is Not Pregnant Or Unsure: Ask The Following Question: Are you or your partner currently doing something or using any method to delay or prevent getting pregnant?
Age at fisrt use for FP
which method
Where did u obatin
HP
NGO
Private
Pharmacy
Drug Vendor
Did you disclose to anyone that you are using family planning?
For whom did you disclose
Who encouraged you to use the family planning
Others
Does your husband know you are using family planning
Does your husband support you in using family planning
Accompany me to health facility
Remind me the schedule
Participate in making the choice of type of FP
Help in me domestic activity
Sharing me in use of family planning
Provide me financial support
Aware and discuss of the side effect of the family planning
Have you ever discontinued any contraceptive methods?
Reason for not use
Male Involvement
My husband would discuss with me about the need to space childbirth.
My husband has ever discussed with me about the need to limit birth childbirth
My husband would allow me to discuss with others or attend awareness creation activities on Family planning
My husband would share me importance information about family planning
For me convincing my husband to allow me to use family planning may be easy for me
If I am going to use family planning, I think my husband will allow me to use it
My husband have ever involved in the decision to use family planning
My husband has ever participated in making the choice of type of family planning
My husband would handle the domestic activities to let me visit health facility for family planning
My husband would provide me financial support to visit health facility for family planning
My husband would accompany me to health facility if I want to use family planning.
My husband would remind me the schedule for family planning not to forget it.
Does your household have Electricity?
Does your household have Mobile Phone?
Does your household has Television?
Does your household have Radio?
How often do you listen to the radio??
Often when do you listen radio messages on working days
Often when do you listen radio messages on week end days
Did you listen to a radio alone or together?
For radio/TV, who selects the media channel?
In the last few months have you heard about
In the last few months have you heard the following family planning messages Radio?
Using family planning is wise
Your family’s happiness is on your hand
Spacing children for healthy and happy family
Children by choice not by chance
Have you ever heard information about FP from newspaper?
The total number of children a couple should have is two.
The total number of children a couple should have is three
The total number of children a couple should have is four.
The total number of children a couple should have is Five.
The total number of children a couple should have is ten and above.
Arm descrption
Percived male involvement with 12 as low and36 high
Kge cat with 80 and 60%
NEW 582
INTENTION_SUM
Intention cata with 50 and 75
kge of FP by number
new intention catagory
cluster with arm
identification number
NN_581
NN_588
Mean of Mean Intention
Direct expressional attitde
Direct instrumental attitude
Direct injective attitude
Direct descrptive
Direct controlability
Direct self efficacy
Sum indirect expressional 507_18
Sum indirect expressional
sum controllability
Sum descrptive
Sum injective
sum selfefficacy
mother education
Are you single wife to your husband
Religious
clan
Health committe
Faema leader
electricity availbilty
transport availbility
health facility availibity
veternary Facility availibilty
school availability
finacial support for poor women
saving opportunity
sex prefrences
abortion
heard off fp
ever use of FP
ever discuss about FP
NA
cat desire on number of children
catagory on decission making of FP
infrastructure catagory
community responsibility catagory
catagory of Media asset y
place of delivery
number of children
facility
co munity desire
c decission making
community responsibility
c single wife
birth interval new
kge on type of modern FP
Kge catagory based on mean/median
all are under the catagory of low
distance to the nearst health facility
ANC visit
child number