40 Injection Among the drugs 1. Yes drug use you have used in the 2. No Go to 42 past 3 months, are 97. Refused Go to 42 there some that you injected? 41 Needle/ In the past 3 months, a. New needle/syringe If yes to drug syringe type which types of b. Used needle/syringe use and needles/syringes did (only by yourself) injection; you use to inject c. Used needle/syringe drugs? (previously used by Note: can someone else) choose, 97. Refused multiple 98. Don’t know/can’t responses remember Contraceptive use/fertility intentions 42 Are you currently 1. Yes use using contraception 2. No Go to 44 3. No (Trying to conceive) Go to 44 97. Refused Go to 44 43 What contraceptive a. None, If yes to method methods are you b. Oral contraceptives currently using? (pill), use; c. Injectable, d. IUD, Note: can e. Condom, choose f. Implants , multiple g. Sterilization, methods 96. Other (specify) ____________________ 97. Refused 44 Living How many living Number_____ children children do you have? 97. Refused 45 Fertility Are you planning to 1. Yes intentions become pregnant in 2. No the near future? 97. Refused Violence INTERVIEWER: Now I am going to ask you some questions about your personal experience with violence. These questions can be sensitive and you can refuse to answer any question that makes you feel uncomfortable. 46 Physical In the last 3 months, 1. Once violence how many times 2. 2-5 times would you say 3. 6-10 someone has beaten 4. 11 or more times (hurt, hit, slapped, 5. Never pushed, kicked, 96. Other (specify): punched, choked, __________________ burned but not used 97. Refused weapon) you? 98 Don't know
40 Injection drug use Among the drugs you have used in the past 3 months, are there some that you injected? 1. Yes 2. No 97. Refused Go to 42 Go to 42 41 Needle/ syringe type In the past 3 months, which types of needles/syringes did you use to inject drugs? a. New needle/syringe b. Used needle/syringe (only by yourself) c. Used needle/syringe (previously used by someone else) 97. Refused 98. Don’t know/can’t remember If yes to drug use and injection; Note: can choose, multiple responses Contraceptive use/fertility intentions 42 use Are you currently using contraception 1. Yes 2. No 3. No (Trying to conceive) 97. Refused Go to 44 Go to 44 Go to 44 43 method What contraceptive methods are you currently using? a. None, b. Oral contraceptives (pill), c. Injectable, d. IUD, e. Condom, f. Implants , g. Sterilization, 96. Other (specify) ____________________ 97. Refused If yes to use; Note: can choose multiple methods 44 Living children How many living children do you have? Number_____ 97. Refused 45 Fertility intentions Are you planning to become pregnant in the near future? 1. Yes 2. No 97. Refused Violence INTERVIEWER: Now I am going to ask you some questions about your personal experience with violence. These questions can be sensitive and you can refuse to answer any question that makes you feel uncomfortable. 46 Physical violence In the last 3 months, how many times would you say someone has beaten (hurt, hit, slapped, pushed, kicked, punched, choked, burned but not used weapon) you? 1. Once 2. 2-5 times 3. 6-10 4. 11 or more times 5. Never 96. Other (specify): __________________ 97. Refused 98 Don't know
Ashodaya_baseline_questionnaire.docx