A family planning questionnaire helps to do family planning for a healthy and better lifestyle. It helps to keep population in control. This questionnaire gives an idea about total number of members in an individual’s family and the total number of children in the family.

Sample Family Planning Questionnaire:

First name: ______ Middle name: _____________ last name: ____________

Street address: _____________ City name: _______________ State name: _______

Postal code: _____________

Gender: ____________

Date of birth: _______________

Contact number: ______________

1. What is your marital status?

a) Single

b) Married

c) Divorced

2. If the answer to the above question is married, how long have you been married?

a) Less than a year

b) Between 2 to 5 years

c) More than 5 years

3. Do you have children or planning to have one?

a) Yes

b) No

4. If the answer to the above children is no, when do you plan to have a child?


5. If you have children, then how many?

a) One

b) Two

c) Three

d) Four

e) Five

f) More than five

7. Do you have a steady source of income?

a) Yes

b) Sometimes

c) No

6. Do you feel that your income is enough to feed all the members of the family?

a) Yes

b) Somewhat

c) Not completely

d) No

7. How often do you have sex with your spouse?


8. Do you use protection while having sex with your spouse?

a) Yes

b) Sometimes

c) No

9. If you already have children do you wish to plan for more?

a) Yes

b) No

10. If the answer to the above question is yes, mention the reason?

a) Family pressure

b) My spouse want

c) It’s our combined decision

d) If any other reason, please mention?