Annex I: Questionnaire Form

Part I: Socio-demographic Information

Code Variable Answer

101 Marital status 1. Married

2. Divorced
3. Separated
4. Single
5. Widowed
102 Mother’s age in years Year completed /__________/

102 Educational Status 1. No formal education

2. Primary Education
3. Secondary Education
4. Tertiary Education

103 Occupation 1. Housewife

2. Government and private
employed Laborer
3. Self-employed
4. Others
104 Religion 1. Muslim
2. Christian
3. Others

105 Partners educational status 1. No formal education

2. Primary Education
3. Secondary Education
4. Tertiary Education

106 Partners occupation 1. Government and private

employed
2. Laborer
3. Self-employed
4. Others
Part II: Reproductive Health Service-related
Cod Variable Answer Remark
e
201 Parity In number(……)
202 Mode of Delivery 1. SVD
2. Others
203 Intension of having another child 1. Yes
2. No
204 Do you have an abortion 1. Yes
2. No
205 Type of abortion 1. Spontaneous
2. Induced
206 No of abortion 1. Once
2. Two times
3. More than 2
times
207 Delivery place 1. Institutional
delivery
2. Home delivery

208 Period of postpartum 1. ≤three months

2. 4-6 Months
3. 7-9 Months
4. 10-12 Months
209 Birth interval between recent and previous 1. <2 years
birth 2. 2years
3. >3years
4. First birth
210 Breast feeding 1. Yes
2. No
211 Started Complementary Feeding 1. Yes
2. No

212 Months complementary feeding started 1. Less than 6

months
2. At 6 months
3. Greater than 6
 months
213 Menses resumed after your recent child 1. Yes
2. No
214 Months resumed 1. Less 3 months
2. 4-6 months
3. 7-9 months
215 Started sexual intercourse after recent birth 1. Yes
2. No
216 Weeks of sexual intercourse started 1. 6 weeks – 3
months
2. 4-6 months
3. 7-9 months
217 Contraceptive started 1. Yes
2. No
218 Months contraceptive started 1. 6 weeks – 3
months
2. 4-6 months
3. 7months and
above

Part III: Assessment on knowledge of postpartum women

Code Variable Answer Remark

301 Know contraceptive used to prevent unwanted 1. Yes

pregnancy 2. No

302 Know contraceptive used to space pregnancy 1. Yes

2. No
303 Know contraceptive used to limit pregnancy 1. Yes
2. No
304 Know condoms used to prevent pregnancy 1. Yes
2. No

305 Know side effects of contraceptives 1. Yes

2. No

306 Know exclusive breastfeeding used as family 1. Yes

planning 2. No

307 Know that fertility resumed after stopping 1. Yes

contraceptive 2. No

308 Have Knowledge about PPFP 1. Yes

2. No

Part IV: Assessment on Attitude of postpartum women

Code Variable Answer Remark

401 Adopt contraceptive in the future 1. Strongly disagree

2. Disagree
3. Neutral
4. Agree
5. Strongly Agree

402 Encourage your friend to adopt PPFP 1. Strongly disagree

2. Disagree
3. Neutral
4. Agree
 5. Strongly Agree

403 Discussing PPFP use with partner is good 1. Strongly disagree

2. Disagree
3. Neutral
4. Agree
5. Strongly Agree

404 Using postpartum contraceptive is shame 1. Strongly disagree

2. Disagree
3. Neutral
4. Agree
5. Strongly Agree

405 PPFP is good for mother and child health 1. Strongly disagree
2. Disagree
3. Neutral
4. Agree
5. Strongly Agree

406 small family size makes family happy 1. Strongly disagree

2. Disagree
3. Neutral
4. Agree
5. Strongly Agree

407 PPFP use good for standard of living 1. Strongly disagree

2. Disagree
3. Neutral
4. Agree
5. Strongly Agree
408 Exclusive BF used to prevent pregnancy 1. Strongly disagree
2. Disagree
3. Neutral
4. Agree
5. Strongly Agree

409 Unmarried women can use contraceptive 1. Strongly disagree

2. Disagree
3. Neutral
4. Agree
5. Strongly Agree

410 using Contraceptive can cause infertility 1. Strongly disagree

2. Disagree
3. Neutral
4. Agree
5. Strongly Agree

411 Using contraceptive could affect cultures 1. Strongly disagree

2. Disagree
3. Neutral
4. Agree
5. Strongly Agree

412 Religion forbids contraceptive 1. Strongly disagree

2. Disagree
3. Neutral
4. Agree
5. Strongly Agree
Part V: Health service characteristics
Code Variable Answer Remark

501 Health facility in your town 1. Yes

2. No
502 ANC visit 1. Yes
2. No
503 ANC visit 1. One visit
2. Two visit
3. Three visit
4. Four and above visit
504 Counselled for FP during Antenatal care 1. Yes
2. No
505 Place of Delivery for the recent child 1. Health Centre
 2. At home
3. Hospital

506 Counselled for FP during delivery 1. Yes

2. No
507 Any visit of health facility after giving 1. Yes
birth
2. No
508 Period of PNC started 1. <=1 day
2. 2-7 days
3. 8-44 days
4. ≥45 day
509 Reason for visiting after giving birth 1. Immunization
2. Postnatal care
3. Family planning
4. To get treatment

510 Counselled for family planning during 1. Yes

Postnatal care 2. No