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Do you currently have a boyfriend/girfliend?
 

By whom?
 
 

Over the last year have you had to visit a doctor/ clinic/other health centre for a sexually transmitted disease such as syphillis or ghonorrhea?
 
 

Have you ever had sexual intercourse with your current boyfriend/girlfriend?
 
 

At what age did you first have sexual intercourse?
 
 
For female respondents only
Are you pregnant now?
 
 
For female respondents only
Have you ever been pregnant?
 
 
 
How old were you when you first used contraception?
   
 
 

Are you and your partner currently using a method of contraception or doing anything to prevent pregnancy?
 
 

Which method?
 
Injection
 
Pill
 
Intra-uterine device
 
Condom
 
Diaphragm
 
Withdrawal
 
Billings Method
 
Other
 

 
 

Hve you had sexual intercourse in the last 3 months?
 
 
 
With how many men/ women have you had sexual intercourse in the last 3 months?
   
 
 

What was your relationship to the last person with whom you had sexual intercourse?
 
 

Did you or your partner use a contraceptive method the last time that you had sexual intercourse?
 
 

Where did you or your partner get your contraceptive supplies?
 

Have you ever been forced or tricked into having sexual intercourse?
 
 

By whom?
 

Over the last year have you had to visit a doctor/ clinic other health s=centre for a sexually transmitted ilness?
 
 

Have yo uever heard a family planning message or on the radio or televison or read on in the newspaper?
 
 
 
What do you remember from these messages?
   
 
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