Family Planning Survey is done to check the awareness of the people regarding the family planning methods. Family Planning Survey Questionnaire is given to the married couples who should have knowledge about family planning procedures. Solving this questionnaire does not just check their knowledge but also helps them learn a number of things on the subject.

 Sample Family Planning Survey Questionnaire

Name of the Participant: _____________________

Date of Birth: ____/____/____

Gender __________

Address: ____________ City: ___________ State: ___________ PIN: _____________

Phone Number: ______________

Email Address: _____________________

What is your gender?

a)      Male

b)      Female

Are you married?

a)      Yes

b)      No

Since how long have you been married?

a) Less than a year

b) 1 to 2 years

c) 2-5 years

d) More than 5 years

Are you planning a family?

a)      Yes

b)      No

Have you consulted a doctor for having a discussion about family planning?

a)      Yes

b)      No

Are you and your partner taking any preventive measures for refraining from getting pregnant?

a)      Yes

b)      No

What preventive measures are you and your partner taking for avoiding unplanned pregnancy? (Select from the below mentioned options)

a)      Condoms

b)      Vasectomy

c)      Pill

d)     Foam

e)      Withdrawal

f)       Tubes tied

g)      Others

In case you are not taking any measures for avoiding pregnancy then please select an appropriate reason for the same out of the ones mentioned below?

a)      Too Old

b)      Breast feeding

c)      Post-partum

d)     Can’t afford

e)      Others

When are you planning to have a child?

a)      Within 1 year

b)      After 1 year

c)      After 2-3 years

d)     After 5 years

Have you heard about the free family planning services?

a)      Yes

b)      No

If the answer to the above mentioned question is ‘Yes’ then please specify as to where you have heard it from.