Hospital Name
Participants' age
Participants' occupation
Participants' occupation(other:specify)
Religion
Level of Education
Place of residence
Mode of delivery
Was your partner present at any stage of labour during your recent childbirth?
To what extent can you rate your partner's participation during childbirth
Where was your partner during your labour and delivery period?
Have you chosen any family planning (FP) method to use before leaving the hospital?
Which among the following FP methods did you choose?
Which among the following FP methods did you choose? (Other-Please specify)
Who took the initiative to decide which contraceptive to use?
Did you receive any information from the providers regarding the mode of action of available family planning methods at the facility?
Did you receive any information from the providers regarding the contraindication of available family planning methods at the facility?
Did you receive any information from the providers regarding the side effects of available family planning methods at the facility?
Did the health provider do any assessment such as history taking and clinical examination before offering you the contraceptive method of your choice?
If the answer is no, did the health provider explain to you why he/she did not assess you?
Which of the following reasons prevented you from using any FP method?
Which of the following reasons prevented you from using any FP method? (Other_specify)
Do you plan to use any contraceptive method in the future?
When do you plan to choose any contraceptive method?
Q201 = 2 (FILTER)
Age corrected