Full Name Age

Reproductive Health
Survey
Religion Gender Male Female

How many people currently live in your household? Males Females

Have you ever heard about sexual intercourse? Yes No

How old were you when you had sexual intercourse for the first time?
18 years 19 years 20 years
21 years Other (Please specify)

What's your take on increasing population in India?

Severe Normal Don't know

Have you ever used any contraceptive devices?

Yes No No response

What method did you or your partner used to prevent pregnancy?

Control Pills Condoms Withdrawal Implants UIDs

Do you want to have baby in future?

Yes No Don't know No response

Have you ever heard of Sexually Transmitted Diseases?

Yes No

Source of information on Sexually Transmitted Diseases?

Friends School Media Parents Others

Have you ever suffered from any STDs?

Yes No Don't know No response

Which STD have you suffered from?

Gonorrhea AIDS Herpes Hepatitis B

Do you think sex education must be included in school curriculum?

Yes No Don't know No response

Feedback for the survey taken

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