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APPENDIX E SAMPLE QUESTIONNAIRE PERSONAL INFORMATION A. Name (optional): __________________________ Instruction: Please put check mark (√) on the space provided that coincides with your personal data. B. Age: ____ Below 25 years old ____ 25 - 40 years old ____ Above 40 years old C. Religion: ____ Catholic ____ Non – Catholic D. Occupation: ____ Employed ____ Self – employed ____ Unemployed E. Highest Educational Attainment ____ Elementary Level ____ High school level ____ College Level

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Listed below are cultural beliefs involved in maternal and newborn health care. The following cultural beliefs are grouped into three: a) During pregnancy and b) During child delivery and c) After child delivery CULTURAL BELIEFS Instruction: Left column of the table: Please put a check mark (√) in the appropriate boxes of the cultural beliefs on maternal and newborn health care you are still practicing at present. • Right Column of the table: Please put a check mark (√) in the appropriate boxes of the beliefs on maternal and newborn health care that best represents your extent of practice. Legend ○ 1 = Never ○ 2 = Often ○ 3 = Always During Pregnancy ( Beliefs: )
1. Conceiving mother should not go around looking up Extent of Practice

1

2

3

to fruit bearing trees and /or desiring the fruits.
2. Pregnant woman should not open the “lutsen”

(gourd used in storing salted pork) while her husband is away. 3. Avoid eating twin fruits.
4. During pregnancy, both husband and wife should

not travel to other places outside their barrio / barangay.
5. Husband and wife should avoid going to hot spring

or cold springs.

43 6. Husband and wife should never criticize, mock, or

laugh at a person with physical defect. 7. The pregnant woman is given only anything she desires in the house as long as her husband is around.
8. Pregnant woman is not allowed to butcher animals

in absence of their husband. 9. When the expectant mother feels her labor pains while out of the house, she should try to make it back home. During Child Delivery (√) Beliefs: 1. When labor pains starts, she must walk around and keep herself busy to keep off her mind from the pain.
2. When the labor is too much prolonged and difficult, Extent of Practice

1

2

3

a traditional healer (insup - ok) will be called.
3. Traditional midwife will be called to help the

mother deliver the baby. The traditional midwife and the giving birth mother are the only ones allowed to stay in a room where the mother feels she is comfortable to give birth.
4. The farey (placenta) should be wrapped with cloth

or be placed in a container and will be buried on the left hand side of the doorway facing outside if the child is a girl. If it is a boy, the placenta will be buried on the right hand side of the doorway.
5. The position of the child when it came out should

be noted.

43 6. When the mother is alone when she delivers the

baby, she will bath the baby, suck the mucus and other foreign matters from the baby’s nose and mouth, then wrap the baby with lampin afterwards. After Child Delivery

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( ) Beliefs:
1. Itab (Black – eyed beans) are cooked with lots of

Extent of Practice

1

2

3

water and with inasin (salted meat) to make broth for the mother.
2. Itab (Black – eyed beans) is the only viand

allowed for the whole family for 1 week after the baby’s birth.
3. Butchering of chicken on the second day of ngilin

(No working on the fields for 1 week)
4. Mangmang ( 5 days of eating fresh foods) is

observed. 5. The mother should never eat mushrooms until the child’s teeth are complete.
6. Dog meat and utong (meat that came from

burials) are prohibited for the mother. 7. Breastfeeding lasts up to 4 years.
8. Feeding the baby with rice ahm when breast milk

is unavailable. 9. The baby may breastfed from other’s breast milk. 10. Lactating mother should drink a lot of meat soup.
11. Fresh fish, fruits and vegetables are not allowed

for 1 week starting from the day the child was born.
12. Knife or any blades are prohibited in cutting the

umbilical cord.
13. The mother should wash herself and tie around

her waist a waist binder (bagkhet).
14. Bathing will only be washing only of the face,

arms and legs.

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