SCHOOL OF NURSING, AHMADU BELLO UNIVERSITY TEACHING

HOSPITAL TUDUN-WADA, ZARIA.

A Questionnaire on the Factors influencing the choice of contraceptive

methods among women attending reproductive health centre, general hospital
Kofa-Gayan, Zaria.

Dear respondents,

I am a final year student of the above mentioned school carrying out a research work on
Assessment of Factors Influencing the Choice of Contraceptive methods of family planning
among women attending family planning units.

The respondent’s name is not required, information given will be confidential and be
used for academic purpose.

Please tick (√) the appropriate option applicable to you.

SECTION A: SOCIO-DEMOGRAPHIC DATA

1.1 AGE: 15 – 19 [ ], 20 – 24 [ ], 25 – 29 [ ], 30 – 34 [ ], 35 and Above [ ]

1.2 TRIBE: Hausa [ ], Yoruba [ ], Igbo [ ], Others [ ] ______________
1.3 RELIGION: Christianity [ ], Islam [ ], Others [ ] ____________________
1.4 MARITAL STATUS: Single [ ], Married [ ], Divorced [ ], Widowed [ ]
1.5 PARITY: 1 [ ], 2 [ ], 3 [ ], 4 [ ], 5 [ ], 6 [ ], Greater than 6 [ ]
1.6 EDUCATION BACKGROUND: Informal Education [ ], Primary [ ],
Secondary [ ], Tertiary [ ]
1.7 OCCUPATION: Student [ ], Housewife [ ]. Trader [ ],
Professionals [ ], Civil Servant [ ], Others [ ] ________________________
SECTION B: FACTORS INFLUENCING THE CHOICE OF
CONTRACEPTIVE METHODS OF FAMILY
PLANNING.
2.1 Have you ever heard of contraceptive method of family planning (a) yes [ ],
(b) no [ ]
If yes, where? (a) Radio [ ], (b) Television [ ], (c) Friends [ ],
(d) Newspaper/Magazine [ ]
2.2 Have you been practicing family planning (a) yes [ ], (b) no [ ]
If yes, what method? (a) Pills [ ], (b) Injectables [ ], (c) Nor – Plant [ ]
(d) Intrauterine Device (ICUD) [ ] (e) None of the above [ ]
2.3 If injectables, what are the factors that influence you on the choice? (a) Is it save [ ]
(b) No side effect [ ], (c) Is there any side effect [ ]
2.4 Did the family accept family planning? (a) yes [ ] (b) no [ ]

SECTION C: FACTORS THAT MAY HINDER THE CHOICE OF

CONTRACEPTIVE METHOD OF FAMILY PLANNING

3.1 Fear of side effect? (a) yes [ ], (b) no [ ], (c) None of the above [ ]
3.2 Is it against your religion? (a) yes [ ], (b) no [ ], (c) None of the above [ ]
3.3 Opposition from husband? (a) yes [ ], (b) no [ ], (c) None of the above [ ]
3.4 Discouragement from friends? (a) yes [ ], (b) no [ ], (c) None of the above [ ]
3.5 Fear of previous complications? (a) yes [ ], (b) no [ ], (c) None of the above [ ]

SECTION D: IMPACT OF WOMEN ON THE CHOICE ON

CONTRACEPTIVE METHODS OF FAMILY PLANNING

4.1 Any negative impacts? (a) yes [ ], (b) no [ ], if yes state ___________________
4.2 Any positive impacts? (a) yes [ ], (b) no [ ], if yes state ___________________
4.3 None of the above? (a) yes [ ], (b) no [ ]
4.4 All of the above? (a) yes [ ], (b) no [ ]