Survey of knowledge of couple on family planning

Instruction: answer the following question with necessary response according to what is being ask. Put a
mark (X) on the spaces provide below on your chosen response.

NOTE : answer correctly and honestly.

1. Age:

2. Sex:

( ) male ( ) female

3. Marital Status:

( ) married ( ) unmarried

4. Educational attainment:

( ) secondary level ( ) college level ( ) undergraduate

5. Monthly income:

( ) <10,000 ( ) 10,000-15,000 ( ) 15,000-20,000

( ) 20, 000-30,000 ( ) over 30,000 ( ) other

6. Total monthly expenses( electricity, water, food, rents, tuition)

( ) <10,000 ( ) 10,000-15,000 ( )15,000-20,000

( ) 20,000-30,000 ( ) over 30,000 ( ) other

7. House hold environment:

( ) squatter ( ) village subdivision ( ) apartment

( ) house and lot
 Survey of knowledge of couple on family planning

Instruction: answer the following question with necessary response according to what is being ask. Put a
mark (X) on the spaces provide below on your chosen response.

NOTE : answer correctly and honestly.

1.1 spacing or gap of the children:

( ) 2 years ( ) 4 years ( ) 6 years others:

1.2 able to handle and care of the children?

( ) yes ( ) no others:

1.3 able to handle family expenses?

( ) yes ( ) no others:

1.4 are you happy with your partner?

( ) yes ( ) no

1.5 are you happy with your family?

( ) yes ( ) no

1.6 do you have some knowledge about family planning?

( ) yes ( ) no

1.7 who facilitated the family planning education?

( ) parents ( ) social workers ( ) none others:

1.8 how significant is your knowledge about family planning?

( ) significant ( ) very significant ( ) not significant ( ) not very significant

1.9 what are the methods that you are using in family planning?

( ) condoms ( ) IUD ( ) calendar method ( ) vasectomy

1.10 do you think family planning is good?

( ) yes ( ) no not sure: ……

If yes give a
reason………………………………………………………………………………………………………………………………………………………
……………………………………………………..