A case study on reproductive health of local people

Respondent Name:

Gender:

Age:

Caste/Ethnicity:

Education status:

A) illiterate

B) Literate (Primary, Secondary, +2, Bachelor level, Master level)

Questions

1. How often do you go to health post or hospital?

i) Monthly ii) Quarterly iii) Yearly iv) Whenever sick

2. How is the facilities provided by health post?

3. What do women wear during menstrual period?

4. Is sanitary pad available in this locality? a) Yes b) No

5. Do people still believe in witch doctor? a) Yes b) No
6. Is family planning done in your home? a) Yes b) No
7. Type of family structure? a) Nuclear b)Joint
8. Do people here use reproductive birth control measures?
 a) yes (why)
b) No (why)

9. How is your reproductive health? Do you take any measures for maintaining
good reproductive health?

10. What do you do during menstrual period?

11.Do you enter the house during menstrual period?