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Evaluation Template -Form Fill

Identification of facility (To be pre-filled before consent)
Q01

Code of Interviewer
Q02

Code of Supervisor
Q03

Date of interview
Q04

State Code
Respondent Information
A01

Respondent ID/ Unique ID
A02

Age
A03

Sex

A04

Marital status

A05

Do you or your partner have any children?
A06

What is the highest standard of education you have completed?
Increased awareness, motivation, and confidence to access health information.
B01

In the past six months, have you been exposed to any information or messages related to contraceptive methods, family planning, sexual health, or maintaining healthy partner relationships?
B02

Were you exposed to this information or messages through online platforms associated with MTV Nishedh?

B03

From which MTV Nishedh online platforms did you have exposure to such information or messages?

B04

Can you specify the information or messages that you were exposed to via MTV Nishedh online platforms?
B05

Please specify the other sources or individuals through which you have been exposed to such information.
B06

Have you discussed the information you encountered on MTV Nishedh online platforms with anyone? If yes, please specify with whom?
B07

Can you specify which topics you discussed with them?
B08

Do you intend to share information from MTV Nishedh online platforms with others in the future? If yes, please specify with whom.

B09

In the future, if you wanted to access reliable information on contraceptive methods, family planning, sexual health, or maintaining healthy partner relationships, which information sources would you use?

B10

What method would you use to protect yourself from Sexually Transmitted Infections (STIs)?

B11

Have you heard of contraceptive methods that help men or women to prevent pregnancy? If yes, which methods have you heard about?
B12

On a scale of 1 to 5, where 1-Not at all motivated and 5 – Extremely motivated. How motivated are you to access information about contraceptive methods for your sexual health and family planning needs in the future?
Understanding contraception use and partner discussion on contraception.
C01

Are you and your partner/spouse currently expecting or trying to have a child?
C02

In the past six months, have you or your partner/spouse been using any contraceptive method if you wanted to avoid unplanned pregnancy? If yes, which one?
C03

What are the reasons for not using any modern contraceptive method in the last 6 months?
C04

Before planning for the child, which contraception method were you and your partner/spouse using in case you wanted to avoid unplanned pregnancy?
C04A

In the past when you had a partner, which contraception method were you and your partner using in case you wanted to avoid unwanted pregnancy?
C05

What were the reasons for you and your partner/spouse to not use any modern contraceptive method when you were not planning to have a child? (Multiple choice)
C07_1

Before deciding whether to use or not use a contraceptive method to avoid pregnancy, do you and your partner/spouse specifically talk with each other about this?

C07_2

Are decisions taken mutually by you and your partner/spouse while deciding whether to use or not use any contraceptive method?
C08_1

On a scale of 1 to 5, where 1-Not at all motivated and 5 – Extremely motivated, how motivated are you to actively voice your contraceptive preferences to your partner/spouse in the future?
C08_2

On a scale of 1 to 5, where 1-Not at all motivated and 5 – Extremely motivated., how motivated are you to take decisions mutually with your partner/spouse regarding contraceptive usage in the future?
C09_1

Do you intend to use any contraceptive method to avoid unwanted pregnancy in the future? If yes, which one?
C09_2

Do you intend to continue using contraceptives to avoid unwanted pregnancy in the future? If yes, which one?
C10

What is the main reason for not intending to use modern contraceptive methods in the future?
Perceptions, beliefs and confidence in accessing information, services and asserting preferences.
D01

It is okay for a woman to have sexual intercourse before marriage.
D02

A woman has the right to say “no” to sexual intercourse if she does not want it.
D03

Parents should actively participate in sex education discussions with their children at home.
D04

It is okay to have an open conversation about your sexual preferences and sexual needs with one’s partner/spouse.
D05

It is okay if women use a contraceptive method to avoid or delay pregnancy.
D06

Family should have a role in deciding when a couple should have a child.
D07

A married couple should have their second child within a year of their first child.
D08

A married couple should have a child if they become pregnant, even if they are not ready.
D09

How confident are you in finding accurate and helpful information about contraception when needed?
D10

How confident are you in reaching out to other individuals if you had questions or concerns about a specific contraceptive method?
D11

How confident are you in expressing your contraceptive preferences during discussions with your partner/spouse.
D12

How confident are you in accessing contraceptive method of your choice?
D13

Who do you think should make a final decision on using contraceptives?
D14

Who do you think should make the final decision on whether to have a child or not?