PART I: Demographic Characteristics

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Questions

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101

How old are you?

_____________ (age in full years)

102

Where is your current residence?

(write the name of residence in the blank space)

1. urban ______________________

2. Rural ______________________

103

What is the highest educational level you completed?

_____________ grade completed

1. No formal education(Unable to read and write)

2. No formal education (Able to read and write)

3. Technical/Vocational certificate

4. University/college diploma

5. University/college degree or higher

104

What ethnic group do you belong to?

1. Amhara

2. Tigre

3. Oromo

Other (specify) _________________

105

What is your religion?

1. Orthodox

2. Muslim

3. Protestant

4. Catholic

Other (specify) _________________

106

What is your current occupation status?

1. Un employed/House wife/

2. Daily laborer

3. Merchant

4. Government employee

5. Private organization/sector employee

6. Student

7. House servant

8. Sex worker

9. Farmer

10. No response

Other (specify) _________________.

107

What is your current marital status?

1. Married

2. cohabited partner

3. Non-cohabited partner

4. Divorced/separated

5. Single

6. Widowed/

7. No response

Other (specify) _________________

108

What is the total monthly family income?

Your own income (_________) ETB

Husband income (_________) ETB

Other source of income (_______) ETB

1. no income

2. Don’t know

3. no response

109

What is the highest educational level your spouse/partner completed ?

____________ grade completed

1. No formal education(Unable to read and write)

2. No formal education (Able to read and write)

3. Technical/Vocational certificate

4. University/college diploma

5. University/college degree or higher

PART II. Information on Family planning counseling, use, demand and choice

201

Have you ever heard of any contraceptive methods that couple can use to avoid or delay pregnancy?

1. Yes

2. No

204

202

If yes to Q. 201, which methods have you heard about?

(Do not read the list. Check all that apply Probe: anything else)

1. Female sterilization/Tubal ligation

2. Male sterilization/Vasectomy

3. condom

4. Pills (OCP)

5. injectable

6. IUD

7. Implants

8. Calendar/

9. LAM

10. Absistence

Other (specify) ______________________

203

Where did you get the information about contraceptive?

1. Mass media

2. Health professionals

3. friends

4. families

Other (specify) ______________________

204

Have you (your partner) ever used any contraceptive methods before your HIV diagnosis?

1. Yes 3. I don’t remember

2. No 4. No response

205

If yes for Q 204, specify the method you / your partner used?

( more than one answer is possible)

1. Female sterilization/Tubal ligation

2. Male sterilization/Vasectomy

3. condom

4. Pills (OCP)

5. injectable

6. IUD

7. Implants

8. Calendar/rhythm method

9. LAM

10. Absistence

Other(specify) ______________________

206

Have you (your partner) ever used any contraceptive methods after your HIV diagnosis?

1. Yes

2. No

3. I don’t remember

4. No response

207

If yes for Q 206, specify the method you or your partner used?

( more than one answer is possible)

1. Female sterilization/Tubal ligation

2. Male sterilization/Vasectomy

3. condom

4. Pills (OCP)

5. injectable

6. IUD

7. Implants

8. Calendar/rhythm method

9. LAM

10. Absistence

Other(specify) ______________________

208

Have you ever been counseled by your ART provider/counselor about any contraceptive methods?

1. Yes

2. No

3. I don’t remember

4. No response

Other(specify) ______________________

209

About which method does the ART provider/counselor/counseled you?

/more than one answer is possible/

1. Female sterilization/Tubal ligation

2. Male sterilization/Vasectomy

3. condom

4. Pills (OCP)

5. injectable

6. IUD

7. Implants

8. Calendar/rhythm method

9. LAM

10. Absistence

11. Dual contraceptive method

Other (specify) ______________________

210

Have you ever been provided any family planning method from the ART clinic?

1. Yes

2. No

Other (specify) ______________________

211

If yes to Q no 210, what methods have you been provided?

1. condom

2. Pills (OCP)

3. injectable

4. IUD

5. Implants

6. Emergency contraceptive

Other (specify) ______________________

212

Are you (your partner) using any contraceptive methods currently?

1. Yes

2. No

218

213

Would you specify the method you (your partner) are using now?

(more than one answer is possible)

1. Female sterilization/Tubal ligation

2. Male sterilization/Vasectomy

3. condom

4. Pills (OCP)

5. injectable

6. IUD

7. Implants

8. Calendar/rhythm method

9. LAM

Other (specify) ______________________

214

For what purpose are you (your partner) using contraceptive now?

1. For spacing birth

2. For limiting birth

Other (specify) ______________________

215

Why do you choose the current FP method?

1. Health professional advice

2. Because it is suitable to my health

3. From my friends experience and advice

4. Partner preference

Other (specify) ______________________

216

Where do you get the (current contraceptive method in Q 212) last time?

1. ART clinic in this facility

2. FP clinic with in this facility

3. other governmental Hospital

4. other governmental health center

5. other governmental health post

6. Private clinic/hospital

7. Pharmacy /drug vendors

8. Community Health/Health extension workers

9. NGO clinics/ FGA

10. Shop

Other (specify) ______________________

217

The last time you obtained (CURRENT METHOD IN Q 212), how much did you pay in total?

______________________birr

1. I didn’t pay/free

2. Don’t know

218

Why don’t you/ your partner want to use FP?

(more than one answer is possible)

1. Want to have child/children

2. Don’t know it is indicated to HIV positive women

3. Fear of FP method interference with my ART drug

4. Religious prohibition

5. Partner/spouse not willing to use contraceptive

6. Fear of side effects

7. Cost too much

Other reason (specify) _____________________

219

If no to Q212, Would you (your partner) like to use contraceptive method in the future?

1. Yes

2. No

3. I am not sure

Other (specify) ______________________

220

If yes to Q219, which contraceptive method is you (your partner) intend to use?

(more than one answer is possible)

1. Female sterilization/Tubal ligation

2. Male sterilization/Vasectomy

3. condom

4. Pills (OCP)

5. injectable

6. IUD

7. Implants

8. Calendar/rhythm method

9. LAM

10. Absistence

Other (specify) ______________________

221

Have you ever been referred for FP service by your counselor/ART provider?

1. Yes

2. No

Other (specify) ______________________

224

222

where have u been referred to get FP service by your counselor/ART provider?

1. FP clinic with in this facility

2. Other governmental health facilities

3. Private clinic/hospital

4. Pharmacy /Drug vendor

5. NGO clinics/FGA

Other (specify) ______________________

223

what was the reason you referred for ?

1. method unavailable at the facility/method stock out

2. Health professional was busy

3. I prefer to be referred to other site

4. I don’t know the reason

5. I don’t remember

Other (specify) ______________________

224

Where do you prefer to get FP method in the future?

1. ART clinic in this facility

2. FP clinic with in this facility

3. other governmental Hospital

4. other governmental health center

5. other governmental health post

6. Private clinic/hospital

7. Pharmacy /drug vendors

8. NGO clinics/ FGA

9. Shop

Other (specify) ______________________

225

Is there any cultural practice in your community that prevents you from using contraceptive?

1. Yes

2. No

3. I don’t know

Other (specify) ______________________

226

If yes, please mention some of the most common cultural practices that prevent you from using contraceptive

_______________________________________

_______________________________________

227

Have you ever discussed with your partner about using any contraceptive method to delay or avoid pregnancy use?

1. Yes

2. No

3. I don’t have a partner

Other (specify) ______________________

229

228

Would you say that using contraception is mainly yours, your partner or joint decision?

1. My decision

2. My partner decision

3. Joint decision

Others (specify) ______________________

229

Most Contraceptive methods are safe for use by women who are HIV-positive? Would you say that you………..

(read each option 1-5)

1. Strongly agree

2. Somewhat agree

3. No opinion

4. Somewhat disagree

5. Strongly disagree

No response

Part III፡ Information about HIV diagnosis, ART treatment condition and knowledge about MTCT and PMTCT

301

How long it has become since you know your HIV status?

______ year/s and ______ month/s

1. Don’t remember

2. No response

302

Have you started to take ART treatment?

1. Yes

2. No

406

404

If yes, How many children do you want to have in the future?

1. ________ (total number of children)

2.a) ______Son b) ______Daughter

405

How soon do you want to have a child?

________________month or ________ year

1. I don’t know/I am not sure

No response

406

Does your spouse/partner desire to have a child in the future?

1. Yes

2. No

3. I don’t know/I am not sure

4. I don’t have spouse/partner

No response

407

Have you ever become pregnant after you know your HIV test result?

1. Yes

3. Don’t have spouse/partner currently

Other (specify) ______________________

511

509

Do you know the HIV status of your current sexual partner/spouse?

1. yes

2. No

3. No response

510

If yes, what was his test result?

1. HIV positive

2. HIV negative

3. No response

511

What is your opinion regarding the provision of FP service in ART clinic?

(Read option 1-5)

1. Strongly support

2. Support

3. No opinion

4. Oppose

5. Strongly oppose