Performance Task 1

Directions: Your task is to administer a survey questionnaire about the use of contraceptive methods by a
married couple. Select respondents who are willing to participate in this survey. Ask the respondents their
permission for you to take pictures for documentation purposes, do not force them if they do not want to.
Tell them that their participation is on a voluntary basis and confidentiality of whatever data they provide
will be respected. You may only give the survey questionnaire to one of the couples.
Note: You do not need to administer the survey questionnaire as a group. Each member of your group
must be looking for willing respondents within their respective neighborhood and you do not need to go
far places to look for respondents for your safety.

Demographic Information
a. Name: (optional)
b. Age: -18-24y/o -25- 34 y/o -44-54 y/o -55 y/o and above
c. Educational -Elementary -Secondary -College -Masters -Doctorate
Attainment:
d. Marital Status: -Single -Married -Widowed -Separated
e. No. of Children: -1 -2 -3 -4 -5 -6 - others (specify): _________
Current Contraceptive Use
1. Are you currently using any form of contraception? -Yes -No
2. If YES, please select the method you are using.
-Condom -Birth Control Pills -Birth Control Injection -Tubal Ligation
-Calendar Method -Intra-Uterine Device -Withdrawal Method -Abstinence
-Others (please specify): ________________________________
3. What is/are your primary reasons for using contraception? Check all that apply.
-to prevent pregnancy
-to avoid sexually transmitted infections
-for hormonal regulation
-others (please specify)

Previous Contraceptive Use

4. Have you used any contraceptive method in the past? -Yes -No
5. If YES, please select the method you used before.
-Condom -Birth Control Pills -Birth Control Injection -Tubal Ligation
-Calendar Method -Intra-Uterine Device -Withdrawal Method -Abstinence
-Others (please specify): ________________________________
6. What is/are your primary reasons for using contraception before? Check all that apply.
-to prevent pregnancy
-to avoid sexually transmitted infections
-for hormonal regulation
-others (please specify)

Performance Task 1
Leader: ________________________
Members: ________________________, ________________________, ________________________,
________________________, ________________________, ________________________ ,
________________________, ________________________, ________________________
Table 1. Demographic Profile of the Respondents
Frequency Percentage
a. Age:
18-24 y/o
25-34 y/o
35-44 y/o
45-55 y/o
55 /o and above
Total
b. Educational Attainment
Elementary
Secondary
College
Masters
Doctorate
Total
c. Marital Status
Single
Married
Widowed
Separated
Total
d. Number of Children
1
2
3
4
5
6
7 and above
Total

Table 2. Current Contraceptive Use

1. Current Contraceptive Use Frequency Percentage

Yes
No
Total
2. Contraceptive Method Used
Condom
Birth Control Pills
Birth Control Injection
Tubal Ligation
Intra-uterine Device
 Calendar Method
Withdrawal Method
Abstinence
Total
3. Reason for Contraception
Prevent pregnancy
Avoid sexually transmitted disease
Hormonal Regulation
Others
Total

Table 3. Previous Contraceptive Use

4. Current Contraceptive Use Frequency Percentage

Yes
No
Total
5. Contraceptive Method Used
Condom
Birth Control Pills
Birth Control Injection
Tubal Ligation
Intra-uterine Device
Calendar Method
Withdrawal Method
Abstinence
Total
6. Reason for Contraception
Prevent pregnancy
Avoid sexually transmitted disease
Hormonal Regulation
Others
Total

Questions:
1. How many respondents does your group have? How many of them presently use contraceptive
methods? How many of them do not?
2. What contraceptive method is used mostly by your respondents?
3. How many of them previously used contraceptive methods? How many of them did not?
4. What contraceptive method was used mostly by your respondents before?