This survey questionnaire is designed to determine the experiences that leads

to early pregnancy and its perceived effect on the academic performance .

This research is for educational purpose only and whatever data gathered will
be treated wit utmost confidentiality.

Name (Optional):___________________________________ Age:_________

Course:____________________ Year :_________________ GPA :

________

GENERAL INSTRUCTION: Please read each questions carefully and put a

check (/) to indicate your response by selecting the most appropriate choice.

Scale:

5 Strongly Agree

4 Agree

3 Neutral

2 Disagree

1 Strongly disagree

Questions 5 4 3 2 1

Peer Influence

1. I got my early pregnancy because I

was being pressurized by my peers to
take in sexual activity.

2. I engaged in early pregnancy

because I just tried to blend and fit in
the group.
3. I engaged in early pregnancy
because I allowed my friends to
manipulate my decision to have sex.

4. I engaged in early pregnancy

because I am afraid of criticism and
rejection from my friends.

5. I engaged in early pregnancy

because I was being forced to have
sex.

Lack of Sex Education

1. I engaged in early pregnancy

because I haven’t received accurate
information on sex education.

2. I engaged in early pregnancy

because I experienced doubt and
misunderstanding when it comes to
sexual issues.

3. I engaged in sexual activities

because I was not educated about
sex.

4. I engaged in early pregnancy

because I have no appropriate
knowledge about safe sex.

5. I engaged in early pregnancy

because of my curiosity and not
aware of its possible effects.
Family

1. I engaged in early pregnancy

because I was being pressured by my
parents.

2. I got early pregnancy because I

was being forced to indulge in sexual
activities due to family financial
condition.

3. I engaged in early pregnancy

because I was not guided by my
parents and family members.

4. I was being forced to engaged in

early pregnancy by my parents
because of my family custom and
tradition of practicing early marriage.

5. I engaged early pregnancy due to

intra-family communication.

Perceived Effect of Early

Pregnancy on Academic
Performance

1. I perform poorly in my study due to

other responsibility.

2. I can’t manage my time well for

being a mother and a student at the
same time.

3. My laziness during pregnancy have

resulted to negligence to study.
4. I am out of focus because of my
pregnant condition that leads to poor
academic performance.

5. I lack effort and motivation to do

my weekly activities and quizzes
during pregnancy.