37 Are you currently 1. Yes use using 2. No Go to 40 contraception 3. No (Trying to conceive) Go to 40 97. Refused Go to 40 38 What a. None, If yes to method contraceptive b. Oral contraceptives (pill), methods are you c. Injectable, use; currently using? d. IUD, e. Condom, Note: can f. Implants choose g. Sterilization, multiple 96. (specify) methods ____________________ 97. Refused 39 Fertility Are you planning 1. Yes intentions to become 2. No pregnant in the 97. Refused near future? 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. 40 Physical In the last 3 1. Once violence months, how 2. 2-5 times many times would 3. 6-10 times you say someone 4. 11 or more times has beaten (hurt, 5. Never hit, slapped, 96. Other (specify): pushed, kicked, __________________ punched, choked, 97. Refused burned but not 98 Don't know used weapon) you? 41 Sexual In the last 3 1. Yes violence months, did 2. No anyone ever force 97. Refused you to have sex with them by sexually assaulting or raping you? 42 Violence In the last 3 1. Yes services months, have you 2. No used the 97. Refused DMSC/Ashodaya violence intervention program services? PrEP experience
37 use Are you currently using contraception 1. Yes 2. No 3. No (Trying to conceive) 97. Refused Go to 40 Go to 40 Go to 40 38 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. (specify) ____________________ 97. Refused If yes to use; Note: can choose multiple methods 39 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. 40 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 times 4. 11 or more times 5. Never 96. Other (specify): __________________ 97. Refused 98 Don't know 41 Sexual violence In the last 3 months, did anyone ever force you to have sex with them by sexually assaulting or raping you? 1. Yes 2. No 97. Refused 42 Violence services In the last 3 months, have you used the DMSC/Ashodaya violence intervention program services? 1. Yes 2. No 97. Refused PrEP experience
Ashodaya_follow-up-_questionnaire.docx