1 - ESDS

Mwa4s If you (or yourhusbm!dlparm.,) mad mm .X mom methodsIn U19Ibst
2 yams. nng all ttu numbm ttmtopp~
WtMt’awml [0]
Sh- Wmndom [0]
Sa18pamw~hm mdlmd [0]
Capldhphmgm [0]
contnmptNa spHtg* [0]
Pill mm PN(pmgastamnonlf) [0]
PIN combuwi F41(Irtckdlngmuffl.pttmc PIU) [0]
Pill notsum f mlmor combuwd
Plea- titm the brand nmm bdc=w .—.-—__—---- [0]
NJO/mUiWa-ddm devua [0]
FoarmJgoWwwm-noa (spanwdes) [0]
GOlriEWhoti SSUI lntwcoum [0 avoid p~IUflCY [0]
Ilqedmns [0]
Anotlmrmethod
Plrnu wnta h nmna bdow -------- . ..—.-. [0]
-7 TO THOSE WHO ARE NOT PREGNANT ANO HAVE NOT SEEN
sTERIusED TO PREVENT PREQNANCY
Have you ar yourhutimllpbtar had ●y Otir 0p8raU0nwhich
pmvmntaPU gettingWgnant (sgmn)?
Y*S [3]
No [s3]
MW04S Was fl YOUor your hukmdlmdnar who had ●n apamtbn whti
prwonti you gatthg pregnant(lgam)?
Yournlf PI
HusbanrUptmr [0]
soul [0]
In what moti and ymarma UM opwaimn?
MWMSIMH w94sPMH ~lYR ~PYR own Husbsnd’s/
Opmuon parttwrs
Opamt&l
Entm month
Enteryew
Mwa60 MS ●aw you or yourhusbmtidpsfiots opmtion la=
than 2 yammam?
Y*S [1]
No [2]
11
— Rdum formto
Intafwavml
— Ga to MW24S
— Go to MWX2
I n=3 I
‘Go to MWW91MH
— Go b MW250
— Go bMWQ5i
— R*tum farmto
Inhrvmww
312