1 - ESDS

Q39 (1ST WETHOD)
Q39
(2wD-4TH NETHODS )
Q40 Q40
I
Q39 (1]
Q39 (2)
Q39 (3)
Q39 (4)
Q41 Q41 MSTH
Q42
I
Q42 LONG
I
2
2
2
2
2
Codang Instructions/Remarks
Values -3-13
Withdrawal ...............Ol
Sheath/Condom ....... ....02
Safe pariod/rhythm
mathod .............. ...03
Cap/diaphragm ...... ......04
Contracaptivm mponge ....05
PL1l: min~ pill
(progesterone only) .....06
Pill: combind P1ll
(including multi-pham LC
pill) ...................07
PL1l: not sure Lf mini or
combined ................O8
I~\cOLlf Lntra-utarlne
davLca . . . . . . . . . . . . . . . . ..O9
FOmm/gO1faprays fps*arim9
( a~nn>cldes ) . . . . . . . . ...10
Injectumm.... . . . . . . . . . . .12
Othar method .............13
v
--
I ‘“a 3 ‘a
(d Co ● u for l-t mmthod.
1~
I
va~ -3- 3
Umad only on- m.thod. .....01
us-d more than on- method
at a tLm9 ...............02
Som.tumam US.C3 on- mathod,
saaatuncs another. .......03
Value* -3-13
Enter number of method.
v
--
How long had ❑wchod been
tha one you umually used?
Less than 3 months ........Ol
At least 3 months, lesfJ
than 6monthm ........ .. 02
At leaat 6 months, leas
than 1 year .............03
At leant 1 year, less than
2 vears .............. .. 04
Atlmaat 2 years .........05
192