1 - ESDS

1 - ESDS 1 - ESDS

24.08.2013 Views

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Mwau Wflcll of thd followingmethod(s)of pmv.ntlng pregnancy,if any, did YKJUuumlty uw irmmdiataly botim tfmtY MwQ4bsA0 kwQ44MEN MWQ44fNF hfWQ4UJNS Mwa44REL Mwa440TN If you hadno SUuai mfaUnrIshiB ring __.——.._ . . . . if no nWhOd Uud ●t d, ffng ----------ff pu W@fapregnant, rfng ._.—-.—--- If using am of mom ma4h0ds, ring ●ll the n~ that ●pply Wffhdmwal................ ........................ .. ... ....................... Sh8alhlcmdom ................................................................. Sati @mt@thm method. ....... ...... ....... ........ ......... . capldia@nxgnl.................................................................. Contmcapftveaponga ...... ........................ ............ ........ Pit rrdnlpill(pmgtin oniy) .. .. ..................... ... . ..... Pllt cambhad PIN(includingmum.phasicpall) . .......... .... PIN notsum Kndnlor combirnd . ........... ....... .... ... Plaass writ- U19bmnd m blow ..... --------- Iummwntm.ufwlm ** ............................................... Foa~eldspmywpo,ndas (spwmicidas) .......... . ........ G@19Wi+tWUf sexualIntemoumato avoid pmgnmcy .,,.,... l~ns ............................................................................ Anothermdhod Plcaw writs its nanw balow ...--— -------- TO TNOSI?WNO WERE NOT USING A MSTNOO OF PREVENllNG PREGNANOY AT TNl?lfME OF EECOMINQ PREGNANT Hem m8 IM of maaorn whypeoF4edo notusa a methcdforpmvwklng pmgnwmy. kWIidI of the m190n9 W@iad to you and yourhuabmWpWtnar at tfw tinmynu teams pregnant? [0] ml [0] [0] [0] [0] P] [0] [0] [0] [0] [0] [0] [0] [0] Whnf,d to haw ●baby ............ ........ ................................... [1] Utmkatyto canaiua b0au9a of menopausa.. ....... ............ [0] UnlikNyto cancdw bscausa pwd~ infadils. ..... .............. [0] Do notmmconimcamon mM/or findmethodunsatisfactw. ... [0] ~airmf taachi~s of cnum+wmliiiausbolid .. ....... ......... ........ [0] Anotherma9an ............... ......... ................... ...... . ................. [0] Pleau wtfto your mason below ... . . . . . . . . . . . MwQ4s In the bst 2 years have you (oryour husbmdlpwtner) usualany of tlw methcdsof pfevertingpmgfmw listedbelowat MW2407 Yes ............................`............................................................ No .......................................................................................... 10 [0] [0] [1] — Returnfonmto Intexvlevmr —Goto MW24S ‘Goto MkW4d — Returnformto lntmviaww

Mwau Wflcll of thd followingmethod(s)of pmv.ntlng pregnancy,if any,<br />

did YKJUuumlty uw irmmdiataly botim tfmtY<br />

MwQ4bsA0<br />

kwQ44MEN<br />

MWQ44fNF<br />

hfWQ4UJNS<br />

Mwa44REL<br />

Mwa440TN<br />

If you hadno SUuai mfaUnrIshiB ring __.——.._ . . . .<br />

if no nWhOd Uud ●t d, ffng ----------ff<br />

pu W@fapregnant, rfng ._.—-.—---<br />

If using am of mom ma4h0ds, ring ●ll the<br />

n~ that ●pply<br />

Wffhdmwal................ ........................ .. ... .......................<br />

Sh8alhlcmdom .................................................................<br />

Sati @mt@thm method. ....... ...... ....... ........ ......... .<br />

capldia@nxgnl..................................................................<br />

Contmcapftveaponga ...... ........................ ............ ........<br />

Pit rrdnlpill(pmgtin oniy) .. .. ..................... ... . .....<br />

Pllt cambhad PIN(includingmum.phasicpall) . .......... ....<br />

PIN notsum Kndnlor combirnd . ........... ....... .... ...<br />

Plaass writ- U19bmnd m blow ..... ---------<br />

Iummwntm.ufwlm ** ...............................................<br />

Foa~eldspmywpo,ndas (spwmicidas) .......... . ........<br />

G@19Wi+tWUf sexualIntemoumato avoid pmgnmcy .,,.,...<br />

l~ns ............................................................................<br />

Anothermdhod<br />

Plcaw writs its nanw balow ...--— --------<br />

TO TNOSI?WNO WERE NOT USING A MSTNOO OF PREVENllNG<br />

PREGNANOY AT TNl?lfME OF EECOMINQ PREGNANT<br />

Hem m8 IM of maaorn whypeoF4edo notusa a methcdforpmvwklng<br />

pmgnwmy. kWIidI of the m190n9 W@iad to you and yourhuabmWpWtnar<br />

at tfw tinmynu teams pregnant?<br />

[0]<br />

ml<br />

[0]<br />

[0]<br />

[0]<br />

[0]<br />

P]<br />

[0]<br />

[0]<br />

[0]<br />

[0]<br />

[0]<br />

[0]<br />

[0]<br />

[0]<br />

Whnf,d to haw ●baby ............ ........ ................................... [1]<br />

Utmkatyto canaiua b0au9a of menopausa.. ....... ............ [0]<br />

UnlikNyto cancdw bscausa pwd~ infadils. ..... .............. [0]<br />

Do notmmconimcamon mM/or findmethodunsatisfactw. ... [0]<br />

~airmf taachi~s of cnum+wmliiiausbolid .. ....... ......... ........ [0]<br />

Anotherma9an ............... ......... ................... ...... . ................. [0]<br />

Pleau wtfto your mason below ... . . . . . . . . . . .<br />

MwQ4s In the bst 2 years have you (oryour husbmdlpwtner) usualany of<br />

tlw methcdsof pfevertingpmgfmw listedbelowat MW2407<br />

Yes ............................`............................................................<br />

No ..........................................................................................<br />

10<br />

[0]<br />

[0]<br />

[1]<br />

— Returnfonmto<br />

Intexvlevmr<br />

—Goto MW24S<br />

‘Goto MkW4d<br />

— Returnformto<br />

lntmviaww

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