PART I: Demographic Characteristics | ||||||||||||
No | Questions | Categories | Skip | |||||||||
101 | How old are you? | _____________ (age in full years) |
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102 | Where is your current residence? (write the name of residence in the blank space) | 1. urban ______________________ 2. Rural ______________________ |
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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 |
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104 | What ethnic group do you belong to? | 1. Amhara 2. Tigre 3. Oromo Other (specify) _________________ |
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105 | What is your religion? | 1. Orthodox 2. Muslim 3. Protestant 4. Catholic Other (specify) _________________ |
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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) _________________. |
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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) _________________ |
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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 |
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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 |
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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) ______________________ |
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203 | Where did you get the information about contraceptive? | 1. Mass media 2. Health professionals 3. friends 4. families Other (specify) ______________________ |
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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 |
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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) ______________________ |
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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 |
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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) ______________________ |
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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) ______________________ |
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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) ______________________ |
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210 | Have you ever been provided any family planning method from the ART clinic? | 1. Yes 2. No Other (specify) ______________________ |
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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) ______________________ |
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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) ______________________ |
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214 | For what purpose are you (your partner) using contraceptive now? | 1. For spacing birth 2. For limiting birth Other (specify) ______________________ |
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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) ______________________ |
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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) ______________________ |
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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 |
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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) _____________________ |
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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) ______________________ |
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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) ______________________ |
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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) ______________________ |
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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) ______________________ |
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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) ______________________ |
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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) ______________________ |
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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) ______________________ |
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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 |
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Part III፡ Information about HIV diagnosis, ART treatment condition and knowledge about MTCT and PMTCT |
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301 | How long it has become since you know your HIV status? | ______ year/s and ______ month/s 1. Don’t remember 2. No response |
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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 |
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405 | How soon do you want to have a child? | ________________month or ________ year 1. I don’t know/I am not sure No response |
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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 |
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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 |
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510 | If yes, what was his test result? | 1. HIV positive 2. HIV negative 3. No response |
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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 |
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