Methodology Documentation

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Methodology Documentation
Proof of Concept Assessment: My Choice/Revitalizing Family
Planning in Indonesia Initiative
Background
The Indonesian national family planning (FP) program, a global success story in the 1980s and 1990s, has
been stagnant since the early 2000s, with only nominal growth in contraceptive prevalence. At the
same time, there is excessive reliance on short-term contraceptive methods, leading to delivery
inefficiencies and high discontinuation rates (27% 12-month discontinuation per the 2012 DHS). The
National Population and Family Planning Board (BKKBN) has been slow to move beyond the highly
centralized program that featured large numbers of community family planning workers (PLKB) that was
successful in earlier years in response to a highly decentralized mode of government in which districts
pay a pivotal role in both the funding and implementation of FP activities. Due to insufficient
prioritization of FP by the MOH and many local governments, leading to limited local government
funding for community FP workers, the BKKBN has had to rely on the private sector, private midwives in
particular, as the primary purveyors of FP information and contraceptive supplies. The 2012 DHS
indicated that around 70% of married women using modern contraceptives obtained their contraceptive
method from private sector sources, 50% of suhc women from private or village midwifes alone.
Furthermore, of the 57 percent of couples using modern contraceptives, 79 percent are using just two
short-acting methods: injectables and oral contraceptive (OC) pills. These methods are popular and
effective in the short term, but more difficult to use consistently and therefore less reliable for longer
spacing of births or for preventing future pregnancies after a couple has achieved their desired family
size. The impact of stagnation of national FP program efforts, which falls largely on women, is evident in
(1) the fact that the “total wanted fertility rate” of 2.0 births per woman is 23% lower than the actual
total fertility rate (2.6 births per woman per the 2012 DHS), (2) anecdotal evidence of relatively high
rates of illegal and often unsafe abortion, and (3) a stagnating maternal mortality ratio (MMR),
estimated at 359 per 100,000 live births in the five years prior to the 2012 DHS, not significantly
different from the estimate from the 2007 DHS and much higher than the Indonesian MDG target for
MMR.
The My Choice/Revitalizing Family Planning in Indonesia program aspires to assist the GOI in moving on
to the next generation of FP programming in Indonesia. The program will implement supply side and
demand generation communication programs designed to promote underutilized LARCs for women
whose life stage calls for greater control over long-term spacing and limiting of births. In addition, the
program will communicate to healthcare workers the benefits of LARCs and the realignment of incentive
structures under the new UHC to support more widespread availability of LARCs. My Choice is a proof of
concept project.
The vision of the My Choice/Revitalizing FP in Indonesia initiative is to contribute to the Government of
Indonesia’s family planning goal of increasing the nation’s mCPR from 57.9% in 2012 to 60.5% by 2015
and 62.2% by 2020. This will be accomplished by helping BkkbN and MOH move from a provider- to a

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consumer-driven approach that creates a more positive climate where every woman can choose and
access the right method at the right time. Mechanisms for accomplishing this will include:
 Increase the modern contraceptive prevalence rate by 5 percentage points in each district
through a consumer-driven demand approach resulting in an estimated increase of 150,709
MWRAs using modern FP.
 Double the percentage of women who adopt postpartum family planning before leaving a
high-volume birthing facility to approximately 25% by improving facility readiness to provide
contraceptive methods, especially postpartum IUDs.
 Increase the CYP attributable to LARCs by 5 percentage points by aligning method mix with
women’s life-stage needs (current national trend is 1.47% annual increase in CYP from 2007-
2012).
 Reduce contraceptive supply stockouts from 47% to 15% by strengthening supply chain
management.
 Strengthen and scale up BkkbN’s leadership and technical capacity at the central, provincial and
district levels.
This initiative will provide proof of concept in 11 districts in four provinces, where the goal is to increase
mCPR by 5 percentage points within three years. The primary use of the evaluation results will be to
inform the GOI as to the efficacy of selected new strategies and approaches as it seeks to reinvigorate its
long-stagnant FP program.
Organization
The proof of concept assessment will a joint undertaking of consortium partners associated with BMGF
funding for the Revitalizing Family Planning in Indonesia initiative (a.k.a. Right Time – Right Method –
My Choice). Avenir Health and Indonesian implementing partner the University of Gadjah Mada (UGM)
will take the lead role in coordinating inputs from consortium partners and will be responsible for data
base management, initial and final analyses, and reporting to BKKBN, other Indonesian stakeholders and
the BMGF. All analyses and conclusions presented will reflect consortium consensus and approval.
Methodology
Research Design
Ideally, proof of concept assessments would include a counterfactual and be undertaken as a
randomized controlled trial (RCT). An RCT was not possible in the present case both because of
insufficient resources and because the 11 districts chosen for the My Choice/Revitalizing Family Planning
in Indonesia program were not chosen randomly.

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Instead, three (3) types of “controls” or “counterfactuals” will be used. The first will entail the use of
historical controls. The trend in selected output and outcome indicators for targeted districts in the
post-intervention period will be compared with trends during the five years prior to the intervention,
with the expectation of a statistically significant change in trend/slope in the post-intervention period in
the event that the intervention package being pilot tested was successful in changing FP behaviors and
practices. Second, post-intervention trends in key outcome indicators for target districts will be
compared with those for matched non-targeted districts (a) in the same provinces and (b) in other
provinces targeted by the BKKBN KB Kencana program. Further details are provided in the Analysis
section of this document. Third, multivariate analyses will be undertaken using propensity score
matching (PSM) to estimate the impact of exposure to My Choice interventions controlling for
differences in the probability of intervention exposure. Further details on this approach are also
provided below in the Analysis section.
The districts 11 districts in four (4) provinces targeted by the My Choice/Revitalizing Family Planning in
Indonesia program were chosen taking into account the likelihood of cooperation/vigorous
implementation, as well as achievement to date with regard to mCPR and unmet need – both high and
low performing districts were included. Matched “control” districts were chosen for each of the 11
priority districts for the My Choice Initiative as follows.
For Group 2 control districts, that is 11 districts in the four My Choice priority provinces that are to be
provided limited (vs. full-scale) district-level informatics support, but no other My Choice/Revitalizing
Family Planning in Indonesia program interventions, during the BMGF grant period, districts were
chosen by identifying districts that most closely matched the My Choice districts with regard to Total
Fertility Rate (TFR) and mCPR. The procedure is illustrated for the three My Choice districts in Central
Java – Brebas, Cilacap and Klaten (indicated by red dots). A similar process was carried out in the other
three My Choice priority provinces.

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For Group 3 controls, that is districts in BKKBN KB Kencana Provinces that will not receive any
informatics assistance associated with the BMGF grants, 11 districts were chosen from four (4) KB
Kencana provinces in a similar fashion; note: control districts were not chosen from NTT and Papua
Provinces due to their very different socio-cultural settings and levels of both TFR and mCPR from the
My Choice districts. The provinces from which group 3 controls were chosen are indicated in the table
below.
Targeted My Choice Province Control KB Kencana Province
Central Java East Java
Jakarta West Java
North Sumatra West Sumatra
South Sulawesi West Kalimantan
The same matching procedure as described above was used to select Group 3 control districts. The final
set of matched control district selections made is documented in the table below:
No.
Cluster I (District
My Choice)
Cluster II (within My Choice
Provinces)
Cluster III (outside My Choice
Provinces, KB Kencana)
1. North Sumatera
Province
West Sumatera Province

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Medan
Deli Serdang
Asahan
Binjai
Tebing Tinggi
Serdang Bedagai
Kota Padang
Bukittinggi
Payakumbuh
2. South Sulawesi
Province
Makassar
Bulukumba
Gowa
Palopo
Pare-Pare
Sidenreng Rappang
South East Sulawesi
Kendari
Bau Bau
Kolaka
3. Central Java Province
Brebes
Cilacap
Klaten
Pemalang
Kebumen
Magelang
East Java Province
Kediri
Sampang
Malang
4. DKI Jakarta
(pending permission)
Jakarta Timur
Jakarta Utara
(pending permission)
Jakarta Selatan
Jakarta Pusat
West Java Province
Depok
Kota Cirebon
Spill-over effects
Measurement
A set of process, output, outcome and impact indicators has been chosen for the assessment in
consultation with BKKBN and My Choice consortium partners. The agreed-to set of indicators is
presented in a summary table that may be found in Annex 1. As indicated in the Annex table, the data
to be used to measure the indicators derive from a variety of data sources with varying measurement
frequencies. These are summarized below.
Routine GOI data systems
 BKKBN Forms 1, 2 and 5: These forms provide data on numbers of contraceptive commodities
distributed to clients and/or disbursed to other service outlets, and will the primary source of data
for calculating and tracking trends in the indicator Couple-Years of Protection (CYP). We will also
assess whether Form 2 reports of current contraceptive users and new users are sufficiently reliable
to be added to the list of indicators to be tracked. In principle, all family planning-related activities
undertaken at MOH facilities (i.e., contraceptive commodities distributed to clients, number of IUDs

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inserted and surgical contraceptive procedures performed) are reported to BKKBN and included in
the data reported by districts on BKKBN Form 2. Form 2 data are reported monthly.
 National Socioeconomic Survey (SUSENAS): The SUSENAS is undertaken annually by the
Indonesian Central Statistics Board (BPS) and is designed to produce reliable estimates of key
indicators at the district level. Unfortunately, SUSENAS only measures two (2) family planning-
related indicators: (1) number (and percent) of married women using a contraceptive method and
(2) method mix among contraceptive users. Nevertheless, SUSENAS is useful for the for the
purposes of the My Choice Assessment as it provides measures of two key indicators for My Choice
districts as well as for control or comparison districts.
Data collected by consortium partners in connection with program activities
 Johns Hopkins Center for Communication Programs (CCP): A number of activities falling under the
heading of “demand generation” are the responsibility (sole or shared) of CCP, the most prominent
being outreach and mass media (DKT will also provide inputs in this domain). CCP will provide data
relevant to the measurement of input, process and output indicators in these domains. Outcomes
will be measured via annual district surveys (see below for further details).
 Jhpiego: Jhpiego has been working with the MOH in selected facilities in all nine districts where My
Choice is currently working. Jhpiego-supported field staff will facilitate the reporting of data
relevant to the PPFP-related indicators in My Choice districts. Starting in October, when the
consortium has the right to work in East and North Jakarta, Jhpiego is ready to work with the DHO
and BKKBN to determine the high volume facilities, assess these sites, and mentor providers on
postpartum family planning services. Using the same modified Kohort forms from MOH that
includes relevant postpartum data, Jhpiego staff will collect this data.
 DKT: DKT will provide data national informational campaigns undertaken and on the number of CYP
generated by sales of contraceptive commodities by DKT-supported midwives in My Choice districts.
 JSI: JSI will provide data on a number of supply chain system indicators including contraceptive
availability, access and use of logistics data, inventory management and storage conditions. In
addition to using the routine sources as mentioned above (F2 and F5 data), baseline and endline
surveys will be conducted at province and district warehouses and a sample of service delivery
points in the 11 My Choice districts (see below for further details).
New data collection for the assessment
 Annual District Surveys: There are significant gaps in existing data sources for district-level
measurement of outcome and impact indicators, which have to be measured at the population
level. In order to fill data gaps for results tracking and evaluation purposes, annual surveys will be
undertaken in the 11 My Choice districts at intervention at three (3) points in time: Baseline (Year 1),

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Midline (Year 2) and Endline (Year 3).1
The surveys will be designed to, among other things measure
changes in the modern contraceptive rate (mCPR) and key behavioral determinants targeted by the
intervention to measure and explain change over the duration of the program.2
The sample size per survey round was determined in each district by the need to detect a five
percentage point increase in the modern contraceptive prevalence rate using a significance level of
5% (one-tailed test), at 80% power and a design effect of 1.5. The following table summarizes the
required levels of change and sample size by district needed to detect those changes.
Sample size calculations for annual district surveys
District
Actual
Baseline
mCPR
Proposed
Endline
mCPR
Percentage point
increase in mCPR
required by donor*
Percentage increase
in mCPR by district
to be detected
Sample
needed
North Sumatra
Asahan 55.3 60.3 5.0 9.0 1,990
Deli Serdang 56.4 61.4 5.0 8.9 1,975
Kota Medan 44.5 49.5 5.0 11.2 2,033
DKI Jakarta
Jakarta Timur 58.4 63.4 5.0 8.6 1,942
Jakarta Utara 57.2 62.2 5.0 8.7 1,962
Central Java
CIlacap 63.5 68.5 5.0 7.9 1,830
Klaten 55.8 60.8 5.0 9.0 1,983
Brebes 65.9 70.9 5.0 7.6 1,764
South Sulawesi
Bulukumba 50.8 55.8 5.0 9.8 2,031
Gowa 58.1 63.1 5.0 8.6 1,947
Kota Makassar 45.1 50.1 5.0 11.1 2,034
TOTAL 21,491
* Donor set a target of a 5 percentage point change in mCPR for each intervention district.
Survey respondents will consist of women of reproductive age (15-49 years old) and will be selected
using a multi-stage cluster sampling procedure. Within districts, census blocks will be randomly
selected and mapped, then households within selected census units will be randomly selected.
Within selected households, all household members will be enumerated by gender and age. If more
than one eligible woman aged 15-49 is present in a household, one will be randomly selected and
invited to participate.
A copy of the Baseline Survey Questionnaire may be found in Annex 2 of this document.
 Informatics assessment survey: As part of a BMGF grant entitled “Testing Decentralized FP M&E in
Indonesia,” Avenir Health and the University of Gadjah Mada (UGM) will be working with BKKBN to
strengthen informatics support to FP program planning, monitoring and improvement. Attention
will be focused on three dimensions: (1) data accessibility, (2) data quality and (3) data use. One of
the primary targets of this work will be the 11 My Choice priority districts.
1
Due to cost constraints, the midline survey will only be implemented in four (4) My Choice districts.
2
The surveys are to be co-financed from BMGF grant funds provided to consortium partners JHU/CCP, DKT and
Avenir Health.

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Accordingly, improvements in informatics support to district-level program monitoring, which
conceptually should be associated with improved FP program performance, will be assessed via an
“Informatics Index” that tries to capture improvements across the three dimensions outlined above.
In addition to the index, a series of questions will be asked of key informants to objectively verify the
ratings of different aspects of and changes over time in the local informatics environment as much
as is feasible.
The key informants for the assessment consist of the following provincial-level personnel:
• BKKBN Office (3)
• PHO (2)
• Governor’s Office (2)
• Provincial parliament (2)
• BAPPEDA (2)
• PKBI Office (1)
Targeted district-level personnel include the following:
• FP Office (3)
• DHO (3)
• District parliament (2)
• BAPPEDA (2)
Respondents will be purposively chosen in each province and district with an eye toward selecting the
most senior and/or well-informed respondents possible within each respondent category. Data will be
collected at two points in time – Baseline in Year 1 and Endline in Year 3.
A copy of the Baseline Informatics Assessment Tool to be used may be found in Annex 3 of this
document.
 PMA 2020 surveys: In connection with the FP2020 initiative, the JHU Gates Institute for Population
and Reproductive Health is implementing Programme Monitoring and Accountability (PM&A) 2020
Surveys in 10 countries globally, including Indonesia. The surveys are in essence a truncated version
of the DHS, but also include data collection on FP/RH service availability and quality at health
facilities located in the census blocks chosen for the survey. The surveys, which are undertaken
biannually, also feature the use of hand-phone technology to improve data quality and accelerate
data processing and dissemination times.
In Indonesia, the PMA2020 survey will be used to produce national and provincial estimates of key
parameters/indicators. Because the PMA2020 surveys lack the statistical power to produce reliable
district-level estimates, the primary utility of the PMA2020 surveys for the My Choice Assessment is
that they provide national- and provincial-level estimates of a number of key indicators that can be
used as “generic controls” to be compared against estimates for My Choice districts obtained via the
other data sources described above. The indicators for which PMA2020 surveys are intended to

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provide generic controls are documented in the table in Annex 1. Methodological details on the
PMA2020 rapid survey, including the standard questionnaires being used, may be found on the
PMA2020 website.
Supply Chain Management Survey: JSI will be working with BKKBN to strengthen supply chain
systems and improve contraceptive availability at resupply and service delivery points in the My
Choice project areas. A comprehensive supply chain systems assessment will be conducted using
qualitative and quantitative methodologies. Focus areas include procurement and quantification,
logistics management information systems, inventory management, storage and distribution.
The qualitative component will include group discussions with key informants involved in supply
chain fuctions at each level of the supply chain. The key informants include representatives from
BKKBN central and province, district and sub district family planning offices, and service providers
both public and private.
The quantitative survey sample will include visting provincial and district warehouses and a sample
of service delivery points. The assessment will include interviews with staff at their worksites,
physical count of contraceptive stock on hand, review of logistics records and reports and
observation of storage conditions. The sample of SDPs are restricted to public health centers, pubic
hospitals and private providers that have received contraceptives from BKKBN in the last 12 months.
The sample was constructed to allow for detecting a 10 percentage point change in any indicator
over time at each of the facility types, respectively, with a power of 0.8 and a two-sided alpha of
0.05. This would allow the results to be representative for the project districts as a whole (not to be
representative at the district level). The sampling strategy employs a finite population correction
factor. Facilities to be sampled were chosen randomly based on probability-proportionate-to-size
sampling, after stratifying by district. Thus, districts with a greater number of a facility type
contributed more to the sample for that facility type than did districts with fewer facilities of that
facility type. Sampling was conducted separately for each facility type.
Analysis
The data collected as described above will be used in several ways. At the most basic level, the data will
be used to track implementation performance and changes in process, output and outcome indicators
over time. Program results will be analyzed quarterly to assess progress over time against end-of-
program targets. The results will be disseminated via My Choice dashboards and other mechanisms (see
the section on Dissemination below for further details).
As was noted in the Research Design section above, three (3) types of “controls” or “counterfactuals”
will be used in the assessment. The first will entail the use of historical controls. The trend in selected
output and outcome indicators for targeted districts in the post-intervention period will be compared
with trends during the five years prior to the intervention, with the expectation of a statistically
significant change in trend/slope in the post-intervention period in the event that the intervention

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package being pilot tested was successful in changing FP behaviors and practices. Such an interrupted
time-series/regression discontinuity design is made possible by the availability of program data as well
as an annual survey (i.e., the National Socioeconomic Survey) that provide district-level estimates of pre-
and post-intervention trends on several key outcome indicators (e.g., contraceptive commodities
distributed to clients, CYP, method mix, mCPR).
Second, post-intervention trends in key outcome indicators for target districts will be compared with
those for matched non-targeted districts (a) in the same provinces and (b) in other provinces targeted
by the BKKBN KB Kencana program. The procedures used to select targeted districts for the My
Choice/Revitalizing Family Planning in Indonesia program and control districts were described earlier. In
univariable analyses, changes in key output and outcome indicators for My Choice districts will be
compared. Both matched and unmatched analyses will be undertaken. In a second phase of analyses,
multivariable analyses will be undertaken in order to control for effects of factors that might be
confounding bivariable comparisons – for example, district population size, population socioeconomic
status, district development status and others as data permit. We will experiment with the use of
instrumental variables methods and fixed effects models in these analyses in order to minimize the
impact of unobserved heterogeneity among comparison groups.
We will also use propensity score matching (PSM) methods methods to produce more refined estimates
of intervention impact within the 11 districts targeted for the My Choice initiative. One of the
limitations of studies other than RCTs is that they fail to fully account for factors that determine
exposure to interventions. Of major concern is selection bias – that is, some individuals in any given
population are predisposed toward the outcomes or behaviors being promoted in a given intervention
(e.g., contraceptive use or adoption of LARCs) and thus are more receptive toward the promotional
messages being disseminated or services being offered by the intervention and may actually seek out
the infoirmation and services being provided. Others may be more difficult to reach by interventions
and thus have a lower probability of exposure to intevrentions being evaluated. Thus, observed
differences in outcomes between individuals or groups may reflect who was exposed to an intervention
more so than the effect or impact of the intervention per se.
Propensity score matching attempts to reduce this potential bias by estimating the probability of
intervention exposure based on observed predictors via logistic regression to create a counterfactual
based upon probability of exposure vs. a simple “exposed” vs. “not exposed” dichotomy. The impact of
intervention exposure is then estimated in logistic regressions controlling for propensity toward a given
intervention.
Dissemination
As part of a broader effort to assist the BKKBN in developing a platform for producing high quality
dashboards for FP data, My Choice dashboards will be established displaying program results at the
program, provincial and district levels. These will be updated quarterly so that the most recent data
available on key indicators will be readily available to all stakeholders, including provincial and district

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government, health and family planning, and civil society. Other components of the decentralized M&E
model, to be developed and pilot tested in My Choice provinces and districts, include:
 Standard computer-generated quarterly provincial and district feedback reports based upon
routinely reported data from the BKKBN and MOH systems;
 Annual progress review & feedback reports for targeted provinces and districts; and
 A “Special Analysis” series focusing on key program issues (at least two inquiries/reports per
year).
The above information products will be widely disseminated in order to promote and support more
frequent consultation and use of data for FP program planning, monitoring and improvement.
Assessment Limitations
A number of limitations of the assessment methodology for the My Choice program need to be
acknowledged. These include:
1. The lack of randomization in the selection of intervention and control districts noted earlier,
leading to the possibility of unobserved heterogeneity among intervention and control districts
distorting comparative trends in the output and outcome indicators being tracked;
2. Due to resource constraints, it was not possible to measure all of the key indicators chosen for
My Choice districts in control districts. The major resulting implication is that we will have
limited ability to isolate the specific program components that were responsible for successful
program outcomes over the proof of concept period (or conversely the factors that were
responsible for lack of success in the event that the desired programmatic results are not
achieved);
3. The measurement of a number of key indicators relies on data from routine BKKBN and MOH
reporting systems, which are prone to incomplete and other reporting errors by health facilities
and other service providers to varying degrees; and
4. The number of districts being compared is modest in size, resulting in limited statistical power
in some analyses;
5. There is a possibility of “spill-over” effects of program interventions implemented in targeted
districts to other districts in priority My Choice provinces. However, the availability of data from
control districts in four other provinces mitigates this risk to some extent.

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Annex 1: Indicators and Data Sources for “My Choice” Proof of Concept Assessment
Category and Indicator
Data Source(s)
My Choice Districts
Control/Counterfactual
Type of Control Data Source
Mass Media Campaign
1. Number of campaign messages aired on mass media MC program records
(JHU & DKT) None
NA
2. Percentage of WRA in targeted districts able to recall program-
related messages, by message source (including outreach)
MC Annual District
Survey
None NA
Community Outreach
1. Percentage of WRA in targeted districts who report contact
community outreach workers and events
MC Annual District
Survey
None NA
2. Number of downloads of the family planning consumer app/joins
of the mobile website (visits to website)
MC program/website
records (JHU)
None NA
Postpartum FP
1. Number and percent of high volume facilities in targeted districts
that provide PP FP counseling and services
MOH records at MC-
supported facilities
MC-targeted provinces
PMA2020 Survey
Generic national control
2. Number of and percent of post-partum follow-up women in high
volume facilities who are counseled on PPFP
MOH records at MC-
None NA
3. Percentage of postpartum follow-up women in targeted high
volume facilities who received a FP method, by method selected
MOH records at MC-
None NA
Supply chain and distribution (Final indicators TBD)
1. Percentage of provincial and district warehouses, SDPs and other
distribution points reporting stock-outs of authorized methods
during given reference period, by method and type of unit
BKKBN Forms 2 & 5
MC-targeted provinces PMA2020 Survey
[SDPs only]Generic national control
2. Mean length of stock outs (in days) for SDPs/distribution points
experiencing stock outs in prior month, by method and reporting
unit type
BKKBN Forms 2 & 5 LMIS NA
3. % of SDPs/distribution points with stock levels within assigned
Min-Max limits, by method and reporting unit type
BKKBN Forms 2 & 5 LMIS NA
4. CYP provided by FP services and commodity distribution (includes
sterilization)
BKKBN Form 2 + MOH
program data +
BKKBN & MOH
program data

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DKT sales data;
or SUSENAS;
or MC Annual District
Survey
PMA2020 Survey
Contraceptive Choice
1. Method information index ( DHS/PMA2020 indicator) MC Annual District
Survey
PMA2020 Survey
2. % of public sector SDPs offering 3+ modern methods; at least one
short-term and one long-term
MOH program records
or Annual district
facility mapping (TBD)
PMA2020 Survey
3. % of women who make FP decisions alone or jointly with
husbands/partners
MC Annual District
Survey
PMA2020 Survey
4. Percentage of WRA in targeted districts who can correctly identify
IUD, implants and sterilization as limiting methods
MC Annual District
Survey
None NA
5. Percentage of WRA in targeted districts who report that a provider
recommended LARCs
MC Annual District
Survey
None NA
6. Percentage of WRA in targeted districts who know that an implant
can last 3-5 years
MC Annual District
Survey
None NA
Informatics
1. Informatics Index Score (with separate component scores for data
accessibility, quality and use)
Informatics Assessment
Survey
Matched comparison
districts (n=11) in MC-
targeted provinces
Informatics
Assessment Survey
Matched comparison
districts (n=11) non MC-
targeted KB Kencana
provinces
Contraceptive Outcomes
1. mCPR (all modern method and method specific)
SUSENAS;
MC Annual District
Survey
Non MC-supported
districts in targeted
provinces SUSENAS
PMA2020 Survey

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2. Number of additional users of modern contraceptive methods
SUSENAS and district
population size
estimates (WRA)
Non MC-supported
districts in targeted
provinces SUSENAS
PMA2020 Survey
3. Unmet need for modern contraception (spacing, limiting)
MC Annual District
Survey
PMA2020 Survey
4. Met demand for modern contraception
MC Annual District
Survey
PMA2020 Survey
Impact (Tentative pending assessment of adequacy of measurement precision at district level – mCPR and method mix)
1. # unintended pregnancies averted MC Annual District
Survey / modeling
PMA2020 Survey
2. # maternal deaths averted MC Annual District
Survey / modeling
PMA2020 Survey
3. # abortions averted MC Annual District
Survey / modeling
PMA2020 Survey

15
Annex 2: Annual District Survey - Baseline Survey Questionnaire (Bilingual)
INFORMED CONSENT – Kepala Rumah Tangga
Selamat pagi/siang/sore, nama saya ….. dan sedang bekerja dengan Pusat Penelitian Kesehatan Universitas Indonesia. Apa bisa kami bicara
dengan kepala keluarga atau ibu yang bertanggungjawab saat ini? Kami sedang melakukan survei rumah tangga mengenai Keluarga
Berencana.Rumah tangga Bapak/Ibu terpilih secara acak dari seluruh rumah tangga yang berada di wilayah ini. Kami hendak mewawancarai
perempuan yang telah menikah usia 15-49 tahun yang berada dalam rumah tangga ini. Untuk itu, kami akan menanyakan seluruh anggota rumah
tangga ini, untuk mengetahui siapa saja yang dapat kami wawancarai. Tidak ada imbalan uang untuk Bapak/Ibu ataupun untuk ibu yang akan kami
wawancarai jika memang bersedia berpartisipasi dalam penelitian ini. Walaupun demikian, informasi yang Bapak/Ibu berikan dapat membantu
pemerintah dalam memperbaiki kualitas program KB dan pelayanan KB di daerah ini. Kontribusi Bapak/Ibu pada penelitian ini bersifat sukarela.
Bapak/Ibu dan rumah tangga Bapak/Ibu tidak harus berpartisipasi jika Bapak/Ibu merasa tidak nyaman. Kami berharap Bapak/Ibu dapat
berpartisipasi karena pendapat anggota rumah tanggap Bapak/Ibu sangat penting.
Apakah ada pertanyaan? Apakah Ibu bersedia berpartisipasi dalam survei ini?
Ya bersedia Nama Tanda tangan:
TIDAK bersedia
BILA RESPONDEN SETUJU UNTUK DIWAWANCARAI, PEWAWANCARA DAPAT MULAI MENGISI DAFTAR ANGGOTA RUMAH TANGGA.
BILA RESPONDEN TIDAK SETUJU DIWAWANCARAI → AKHIRI WAWANCARA DAN CARI RUMAH TANGGA LAIN SESUAI RENCANA
SAMPLING.
Jika ada pertanyaan atau komentar tentang penelitian ini, ibu dapat menghubungi peneliti utama: RITA DAMAYANTI, Pusat Penelitian Kesehatan
Universitas Indonesia, Kampus Baru UI Depok, telp. 021-7270154 atau Prof. Dr. Sudiianto Kamso MD, Sekretaris Komisi Etik Universitas Indonesia,
Fakultas Kesehatan Masyarakat, Kampus Baru UI Depok, Telp. 021-7864975.
RECRUITMENT SCRIPT – Head of Household
Good morning/afternoon, I am _______________ from Center for Health Research, University of Indonesia. May we speak to the head of this household or to the
adult woman who is responsible here? We are conducting a household survey about family planning. Your household was selected randomly for this study from
all the households in this community. We would like to interview married women in this household about their use of family planning methods, but first we need
to make a list of the people who live in this household in order to know who is eligible to participate in this survey. We will not pay you or the person we
interview to participate in this study, but the information you provide may help to improve the quality of family planning programs and of the family planning
services that you use. Your participation in this survey is voluntarily. You and your household do not have to participate in the study if it is inconvenient to you.
We hope you can participate in this survey since the opinions of your household are very important.
Do you have any questions? Do you agree to participate in this survey?
Yes I agree to participate Name: Signature:
NO, I do not agree to participate
IF RESPONDENT AGREES TO BE INTERVIEWED, HOUSEHOLD LISTING CAN BE STARTED.
IF RESPONDENT REFUSES TO BE INTERVIEWED, END THE INTERVIEW AND FIND OTHER HOUSEHOLD ACCORDING THE SAMPLING PLAN
If you have questions or comments about this study, you may contact the principal investigator, RITA DAMAYANTI, Pusat Penelitian Kesehatan Universitas
Indonesia, Kampus Baru UI Depok, telp. 021-7270154, or Prof. Dr. Budi Utomo MD, Head of Research Ethics Committee, University of Indonesia, Faculty of
Public Health, Kampus Baru UI Depok, Telp. 021-7864975.

16
BASELINE DATA OF MY CHOICE SURVEY
IN 11 DISTRICTS, INDONESIA - 2015
Confidential
I. IDENTIFICATION/LOCATION CODE
1. PROVINCE: ______________________________________________________________________________________
2. DISTRICT/CITY: __________________________________________________________________________________
3. SUB-DISTRICT: __________________________________________________________________________________
4. VILLAGE: ________________________________________________________________________________________
5. CLUSTER ID: ____________________________________________________________________________________
6. HAMLET (RT/DUSUN/DUKUH): ______________________________________________________________________
7. HOUSEHOLD ID: _________________________________________________________________________________
8. HOUSE ID: ______________________________________________________________________________________
9. LINE NUMBER OF RESPONDENTS (REFER TO LIST OF HH MEMBER) : ___________________________________
II. STAFF VISIT AND SUMMARY
1 2 3 KUNJUNGAN TERAKHIR
DATE OF INTERVIEW:
TIME OF INTERVIEW START
FINISH
NAME OF INTERVIEWER:
______________
______________
______________
______________
______________
______________
______________
______________
______________
______________
______________
______________
DAY:
MONTH:
YEAR:
NUMBER OF VISIT:
RESULT OF VISIT:
RESULT OF VISIT: VISIT. 1: ________ VISIT. 2: ________ VISIT. 3: _________
CODE OF RESULT OF VISIT: (1) FINISHED (2) INCOMPLETED (3) POSTPONED (4) REFUSED (5) RESPONDENT NOT AVAILABLE
NAME/SIGN
DATE
INTERVVIEWER II FIELD COORDINATOR DATA ENTRY I DATA ENTRY II

17
A. DAFTAR ANGGOTA RUMAH TANGGA
(A. LIST OF HOUSEHOLD MEMBER)
Sekarang saya ingin memperoleh beberapa keterangan mengenai orang-orang yang tinggal di rumah tangga (satu dapur).
First, we would like to know who a few things about the people who live in this household.
NO NAME
HUBUNGAN
RELATIONSHIP
UMUR
AGE
JENIS KELAMIN
SEX
STATUS
KAWIN
MARITAL
STATUS
JENIS
PEKERJAAN
OCCUPATION
TINGKAT
PENDIDIKAN
LEVEL OF
EDUCATION
STATUS
SEKOLAH
STATUS OF
EDUCATION
STATUS
MEROKOK
SMOKING
STATUS
Sebutkan nama orang-orang
yang tinggal di rumah tangga
ini, mulai dengan kepala
rumah tangga.
Please give me the names of
the
persons who usually live in
your household, starting with
the head of the household
Apa hubungan
(NAMA) dengan
kepala rumah
tangga?1
What is the
relationship of
(NAME) to the
head of the
household?
Berapa umur
NAMA pada
ulang tahun
terakhirnya?
DI BAWAH 1
TAHUN TULIS
‘0’
How old was
NAME at last
birthday
WRITE ‘0’ IF
LESS THAN 1
YEAR
Apakah (NAMA)
laki-laki atau
perempuan?
Is (NAME) male
or female?
Apa status
perkawinan
NAMA?2
What is
(NAME)'s
marital
status?2
Apakah
pekerjaan utama
(NAMA)?3
What is (NAME)
main
occupation?3
Apa tingkat
pendidikan
tertinggi yang
ditamatkan
NAMA?4
What is the
highest
education level
completed by
(NAME)?4
Apakah
NAMA saat ini
masih
bersekolah?
Is (NAME)
still in
school?
Apakah
NAMA
Pernah atau
saat ini
masih
merokok? 5
What is
(NAME)
smoking
status? 5
(A1) (A2) (A3) (A4) (A5) (A6) (A7) (A8) (A9) (A10)
YEAR
L P YES NO
01 1 2 1 2
02 1 2 1 2
03 1 2 1 2
04 1 2 1 2
05 1 2 1 2
06 1 2 1 2
07 1 2 1 2
08 1 2 1 2
09 1 2 1 2
10 1 2 1 2
11 1 2 1 2
12 1 2 1 2
13 1 2 1 2

18
1) KODE UNTUK KOLOM (A3): HUBUNGAN
DENGAN KEPALA RUMAH TANGGA
11 = KEPALA RUMAH TANGGA
12 = ISTRI/SUAMI KEPALA RUMAH TANGGA
13 = ANAK KANDUNG
14 = MENANTU
15 = CUCU
16 = ORANG TUA
17 = MERTUA
18 = SAUDARA KANDUNG
19 = SAUDARA LAIN
20 = ANAK ADOPSI
21 = ANAK TIRI
22 = TIDAK ADA HUBUNGAN KELUARGA
98 = TIDAK TAHU
2) KODE UNTUK STATUS PERKAWINAN (A6):
1 = LAJANG/BELUM MENIKAH
2 = MENIKAH
3 = CERAI HIDUP
4 = CERAI MATI
5 = BERPISAH
3) KODE UNTUK PEKERJAAN (A7):
11 = IBU RUMAH TANGGA
12 = PEGAWAI NEGERI SIPIL
13 = PROFESIONAL
14 = KARYAWAN SWASTA
15 = PETANI/BERKEBUN MILIK SENDIRI
16 = NELAYAN/PEMILIKI PERAHU
17 = MENYEWAKAN PERAHU/MOBIL/MOTOR/ RUMAH
18 = WIRASWASTA/PEMILIK SALON/BENGKEL
09 = BERDAGANG/PEMILIK WARUNG
10 = BURUH/BURUH TANI/BURUH NELAYAN/SUPIR/TUKANG/TUKANG
OJEK
11 = HONORER
12 = PELAJAR
13 = TIDAK BEKERJA
96= LAIN-LAIN
4) KODE UNTUK TINGKAT PENDIDIKAN (A8):
11 = TIDAK SEKOLAH/BELUM SEKOLAH
12 = TIDAK/BELUM TAMAT SD
13 = TAMAT SD
14 = TAMAT SMP
15 = TAMAT SMA
16 = AKADEMI/ D1/D2/ D3
17 = UNIVERSITAS (S1/S2/S3)
98 = TIDAK TAHU
5) KODE UNTUK STATUS MEROKOK (A10):
1 = TIDAK PERNAH
2 = PERNAH (<1 BUNGKUS/HARI) NAMUN SUDAH TIDAK
MEROKOK LAGI DALAM 6 BULAN TERAKHIR
3 = PERNAH (≥1 BUNGKUS/HARI) NAMUN SUDAH TIDAK
MEROKOK LAGI DALAM 6 BULAN TERAKHIR
4 = SAAT INI MASIH (< 1 BUNGKUS/HARI)
5 = SAAT INI MASIH (≥1 BUNGKUS/HARI)

19
1) CODES FOR RELATIONSHIP TO HEAD OF
HOUSEHOLD
11 = HEAD OF HOUSEHOLD
12 = WIFE/HUSBAND OF HEAD OF HOUSEHOLD
13 = CHILD
14 = SON OR DAUGHTER IN LAW
15 = GRANDCHILD
16 = PARENT
17 = PARENT IN LAW
18 = SIBLING
19 = RELATIVES
20 = ADOPTED CHILD
21 = STEP CHILD
22 = NOT RELATED
98 = DON’T KNOW
2) CODE FOR MARITAL STATUS (A6):
1 = SINGLE
2 = MARRIED
3 = DIVORCED
4 = WIDOWED
5= SEPARATED
3) CODE FOR EDUCATION (A7):
11 = HOUSEWIFE
12 = CIVIL EMPLOYEE
13 = PROFESIONAL
14 = PRIVATE EMPLOYEE
15 = FARMER (OWNER OF FAM)
16 = FISHERMAN/OWNER OF BOAT
17 = RENTING OUT BOAT/CAR/MOTOR CYCLE/HOUSEH
18 = ENTERPRENEUR/OWNER OF A SALON/CAR SERVICE
09 = TRADER/OWNER OF SMALL SHOP
10 = LABOUR/AGRICULTURAL LABOUR/ FISHING
LABOUR/DRIVER/CONSTRUCTION LABOUR/MOTORCYCLE-TAXI
DRIVER
11 = HONORARIUM BASED WORKER
12 = STUDENT
13= NOT WORKING
96= OTHERS
4) CODE FOR EDUCATION LEVEL (A8):
11 = NEVER ATTENDED ANY SCHOOL/HAVE NOT
ATTENDED ANY SCHOOL YET
12 = INCOMPLETE PRIMARY SCHOOL
13 = COMPLETE PRIMARY SCHOOOL
14 = COMPLETE JUNIOR HIGH SCHOOL
15 = COMPLETE SENIOR HIGH SCHOOL
16 = ACADEMY/ D1/D2/ D3
17= UNIVERSITY
98 = DON’T KNOW
5) CODE FOR SMOKING STATUS (A9):
1 = NEVER
2 = EVER SMOKED (<1 PACK PER DAY) BUT NOT LONGER
SMOKED OVER THE LAST 6 MONTHS
3 = EVER SMOKED (≥1 PACK PER DAY) BUT NOT LONGER
SMOKED OVER THE LAST 6 MONTHS
4 = CURRENT SMOKER (<1 PACK PER DAY)
5= CURRENT SMOKER (≥1 PACK PER DAY)
B. KARAKTERISTIK REPRODUKSI
(B. REPRODUCTIVE CHARACTERISTICS)
Pertanyaan berikut berkaitan dengan karakter reproduksi responden. Pewawancara tidak membacakan pilihan jawaban, kecuali bila ada
petunjuk.
The following questions are related to reproductive characteristics of respondents. Interviewer does not read the option, unless indicated.
NO PERTANYAAN JAWABAN DAN KODE
SKIP
B01
Kapankah ibu dilahirkan?
/ /
(Tanggal) (Bulan) (Tahun)

20
SKIP
Date of birth
/ /
(Day) (Month) (Year)
B02
Berapa jumlah anak laki-laki dan anak perempuan ibu,
yang lahir hidup dan masih hidup hingga saat ini?
ANAK LAKI-LAKI ...................................................................
ANAK PEREMPUAN .............................................................
How many sons and daughters do you have who are
still alive at this moment?
SON ..............................................................................
DAUGHTER ................................................................
B03
Berapa jumlah anak laki-laki dan anak perempuan ibu,
yang lahir hidup tapi saat ini sudah tiada/meninggal?
ANAK LAKI-LAKI ...................................................................
ANAK PEREMPUAN .............................................................
How many sons and daughters do you have, who
were alive at birth but later died?
SON ..............................................................................
DAUGHTER ................................................................
C02A JUMLAHKAN SELURUH KELAHIRAN HIDUP = B01 + B02
C02A ALL LIVE BIRTHS = C01 + C02
B04 Apakah saat ini ibu sedang hamil? YA.......................................................................................................... 1
TIDAK.................................................................................................... 2
Are you currently pregnant?
YES ....................................................................................................... 1
NO......................................................................................................... 2
B05 Berapa jumlah seluruh kehamilan yang berakhir
dengan keguguran atau digugurkan?
JUMLAH KEGUGURAN/DIGUGURKAN ........................................
How many pregnancies have you had that ended with
miscarriage or abortion?
MISCARRIAGE OR ABORTION....................................
B06 Berapa jumlah seluruh kehamilan yang berakhir
dengan lahir mati? JUMLAH LAHIR MATI..............................................................
How many pregnancies have you had that ended as
stillbirth? STILLBIRTH ...................................................................
C04A JUMLAHKAN SELURUH KEHAMILAN = B01 + B02 + B03 + B04

21
SKIP
C04A ALL PREGNANCIES = C01 + C02 + C03 + C04
B07 Berapa usia ibu ketika pertama kali menikah?
USIA DALAM TAHUN ...................................................................
At what age were you when you got married for the
first time?
AGE IN YEAR ...............................................................
B08 B
0
8
Kapan hari pertama dari haid ibu yang terakhir?
1. HARI YANG LALU
2. MINGGU YANG LALU
3. BULAN YANG LALU
4. TAHUN YANG LALU
When did your last menstrual period start?
1. DAYS AGO
2. WEEK AGO
3. MONTHS AGO
4. YEARS AGO
B09 Pada usia berapa ibu pertama kali hamil?
USIA DALAM TAHUN ...................................................................
At what age did you have your first pregnancy AGE IN YEAR ...............................................................
B10 Pada usia berapa ibu pertama kali melahirkan anak
hidup?
USIA DALAM TAHUN ...................................................................
At what age did you have the first live birth? AGE IN YEAR ...............................................................
B11 Kapan ibu melahirkan anak terakhir?
/ /
(Tanggal) (Bulan) (Tahun)
When did you deliver your last child?
/ /
(Day) (Month) (Year)

22
SKIP
B12 Apakah ibu ingin hamil ketika hamil anak terakhir?
YA............................................................................................................ 1
TIDAK........................................................................................................ 2
TIDAK PUNYA PENDAPAT..................................................................... 3
When you got pregnant your last child, did you want to
get pregnant at that time?
YES ...................................................................................................................... 1
NO ....................................................................................................................... 2
INDIFFERENT ...................................................................................................... 3
B13 Apakah ibu telah mendapat haid kembali setelah
melahirkan anak terakhir?
YA............................................................................................................. 1
TIDAK........................................................................................................ 2
Has your menstrual period returned since of the birth
of your last child?
YES........................................................................................................... 1
NO............................................................................................................. 2
B14 Kapan terakhir ibu berhubungan suami istri?
1. HARI YANG LALU
2. MINGGU YANG LALU
3. BULAN YANG LALU
4. TAHUN YANG LALU
When was the last time you had sexual intercourse?
1. DAYS AGO
2. WEEKS AGO
3. MONTHS AGO
4. YEARS AGO
B15 Apakah perkawinan ini merupakan perkawinan
pertama?
YA............................................................................................................. 1
TIDAK........................................................................................................ 2
 Bag C
Is this your first marriage?
YES........................................................................................................... 1
NO............................................................................................................. 2
 Part C
B16 Jika TIDAK, perkawinan ini merupakan perkawinan
yang keberapa?
__________ kalinya
If NOT, how many times have you been married?
__________ times

23
C. PENGETAHUAN TENTANG KELUARGA BERENCANA
(C. KNOWLEDGE OF FAMILY PLANNING)
Pertanyaan berikut berkaitan dengan pengetahuan ibu tentang keluarga berencana.
The following questions related to the mother's knowledge about family planning.
NO PERTANYAAN JAWABAN DAN KODE SKIP
C01 Apa saja jenis alat/cara KB yang ibu ketahui, baik
untuk laki-laki atau perempuan?
Ada lagi? [PROBING satu kali saja]
Spontan Probe
MOW / STERILISASI / KB MANTAP..............................................
MOP / STERILISASI / KB MANTAP...............................................
IMPLAN / SUSUK KB ....................................................................
SPIRAL / IUD / AKDR....................................................................
SUNTIK KB ...................................................................................
PIL KB ...........................................................................................
KONDOM PEREMPUAN ...............................................................
KONDOM LAKI-LAKI.....................................................................
KONTRASEPSI DARURAT ...........................................................
SENGGAMA TERPUTUS..............................................................
ALAMIAH (ASI, PUASA, KALENDER) ...........................................
LAINNYA SPONTAN (SEBUTKAN):
___________________________________________ ..................
LAINNYA PROBE (SEBUTKAN):
____________________________________________ ................
TIDAK TAHU .................................................................................
A
B
C
D
E
F
G
H
I
J
K
X
--
Z
A
B
C
D
E
F
G
H
I
J
K
--
X
Z  Bag D
C01 What are the family planning methods you are
aware of?
What else? (PROBE only once)
Spontan
eous
Probe
TUBECTOMY/FEMALE STERILIZATION .......................................
VASECTOMY/MALE STERILIZATION ...........................................
IMPLANT........................................................................................
IUD.................................................................................................
INJECTION ....................................................................................
PILL................................................................................................
FEMALE CONDOM........................................................................
MALE CONDOM.............................................................................
EMERGENCY CONTRACEPTION .................................................
COITUS INTERRUPTUS................................................................
TRADITIONAL METHOD (BREASTFEEDING, ABSTINENT,
CALENDER)...................................................................................
OTHER - SPONTANEOUS (SPECIFY):
___________________________________________ ...................
OTHER – PROBE (SPECIFY):
___________________________________________ ...................
DON'T KNOW.................................................................................
A
B
C
D
E
F
G
H
I
J
K
X
--
Z
A
B
C
D
E
F
G
H
I
J
K
--
X
Z  Part D

24
C02 Di mana saja ibu dapat memperoleh alat/cara KB
tersebut?
Di mana lagi? [PROBING satu kali saja]
PEMERINTAH
RUMAH SAKIT...................................................................................................
PUSKESMAS/PUSTU........................................................................................
LAINNYA (SEBUTKAN):
_________________________________ ..........................................................
SWASTA
RUMAH SAKIT...................................................................................................
RUMAH SAKIT BERSALIN ................................................................................
KLINIK ./ BALAI KESEHATAN IBU DAN ANAK..................................................
PRAKTEK DOKTER UMUM...............................................................................
PRAKTEK DOKTER KANDUNGAN ..................................................................
PRAKTEK BIDAN...............................................................................................
APOTEK/TOKO OBAT.......................................................................................
LAINNYA (SEBUTKAN):
_____________________________ ..................................................................
LAINNYA
POLINDES/POSKESDES ..................................................................................
POSYANDU.......................................................................................................
POS KB..............................................................................................................
PLKB..................................................................................................................
TOKO/WARUNG................................................................................................
LAINNYA (SEBUTKAN):
_____________________________ ..................................................................
TIDAK INGAT.................................................................................
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
X
Z
Where can you get that method?
Where else? (PROBE only once)
PUBLIC SECTOR
HOSPITAL ..................................................................................................
HEALTH CENTER / SUB HEALTH CENTER ..............................................
OTHER (SPECIFY): ______________________ ........................................
PRIVATE MEDICAL SECTOR
HOSPITAL .............................................................................................
MATERNITY HOSPITAL ............................................................................
CLINIC / MCH HEALTH FACILITY .............................................................
GP ..............................................................................................................
OBGYN PRACTICE ....................................................................................
MIDWIFE PRACTICE ................................................................................
PHARMACY / DRUG STORES ..................................................................
OTHER (SPECIFY):____________________________..............................
OTHER
MATERNITY VILLAGE HUT (POLINDES / POSKESDES) ..........................
INTEGRATED HEALTH POST (POSYANDU) ..........................................
FAMILY PLANNING POST (POS KB) ....................................................
FP FIELD OFFICER (PLKB) ......................................................................
OTHER STORE ..........................................................................................
OTHER: (SPECIFY): ______________________________ ......................
DO NOT REMEMBER ...........................................................................................
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
X
Z

25
C03 Dapatkah ibu sebutkan alat/cara KB apa saja yang
paling sesuai bagi pasangan yang ingin menunda
kehamilan?
MOW / STERILISASI / KB MANTAP..........................................................................
MOP / STERILISASI / KB MANTAP...........................................................................
IMPLAN / SUSUK KB ................................................................................................
SPIRAL / IUD / AKDR................................................................................................
SUNTIK KB ...............................................................................................................
PIL KB .......................................................................................................................
KONDOM PEREMPUAN ...........................................................................................
KONDOM LAKI-LAKI.................................................................................................
KONTRASEPSI DARURAT .......................................................................................
SENGGAMA TERPUTUS..........................................................................................
ALAMIAH (ASI, PUASA, KALENDER) .......................................................................
LAINNYA, (SEBUTKAN):
________________________________________________________________ .....
TIDAK TAHU ..........................................................................................................
11
12
13
14
15
16
17
18
19
20
21
96
98
To your knowledge, what is the best family
planning method suited those who want to spacing
their children?
What else? (PROBE)
TUBECTOMY/FEMALE STERILIZATION ...............................................................
VASECTOMY/MALE STERILIZATION ...................................................................
IMPLANT................................................................................................................
IUD.........................................................................................................................
INJECTION ............................................................................................................
PILL........................................................................................................................
FEMALE CONDOM................................................................................................
MALE CONDOM.....................................................................................................
EMERGENCY CONTRACEPTION .........................................................................
COITUS INTERRUPTUS........................................................................................
NATURAL METHOD (BREASTFEEDING, ABSTINENT, CALENDER) ...................
OTHER (SPECIFY):
___________________________________________ ...........................................
DON'T KNOW............................................................................................................
11
12
13
14
15
16
17
18
19
20
21
96
98

26
C04 Dapatkah ibu sebutkan alat/cara KB apa saja yang
paling sesuai bagi pasangan yang tidak ingin
punya anak lagi?
MOW / STERILISASI / KB MANTAP..........................................................................
MOP / STERILISASI / KB MANTAP...........................................................................
IMPLAN / SUSUK KB ................................................................................................
SPIRAL / IUD / AKDR................................................................................................
SUNTIK KB ...............................................................................................................
PIL KB .......................................................................................................................
KONDOM PEREMPUAN ...........................................................................................
KONDOM LAKI-LAKI.................................................................................................
KONTRASEPSI DARURAT .......................................................................................
SENGGAMA TERPUTUS..........................................................................................
ALAMIAH (ASI, PUASA, KALENDER) .......................................................................
LAINNYA, (SEBUTKAN):
_________________________________________________...................................
TIDAK TAHU .............................................................................................................
11
12
13
14
15
16
17
18
19
20
21
96
98
To your knowledge, what is the best family
planning method suited those who want to limit or
stop having children?
TUBECTOMY/FEMALE STERILIZATION ...............................................................
VASECTOMY/MALE STERILIZATION ...................................................................
IMPLANT................................................................................................................
IUD.........................................................................................................................
INJECTION ............................................................................................................
PILL........................................................................................................................
FEMALE CONDOM................................................................................................
MALE CONDOM.....................................................................................................
EMERGENCY CONTRACEPTION .........................................................................
COITUS INTERRUPTUS........................................................................................
NATURAL METHOD (BREASTFEEDING, ABSTINENT, CALENDER) ...................
OTHER (SPECIFY):
___________________________________________ ...........................................
DON'T KNOW.........................................................................................................
11
12
13
14
15
16
17
18
19
20
21
96
98
C05 Menurut ibu berapa lama jangka waktu pemakaian
[…]:

27
C05a Spiral / IUD
C05b Susuk KB / Implan / AKBW
C05c Sterilisasi/MOW atau MOP/KB Mantap
C05d Suntik
C05e Pill
1. Setiap hari 2. BULAN 3. TAHUN 4. Selamanya 5. Tidak tahu
C05 To your knowledge, how long will the following
family planning […] methods last?
C05a IUD
C05b Implant
C05c strelization for women and men
C05d Injection
C05e Pills
1. Every day 2. MONTH 3. YEAR 4. Selamanya 5.DON’T KNOW
1. Every day 2. MONTH 3. YEAR 4. Selamanya 5.DON’TKNOW
C06 Pada kondisi apa, alat/cara KB […] tidak boleh
digunakan:
C06a Spiral / IUD
C06b Susuk KB / Implan / AKBK
C07a C07b C07c C07d
C07d
A
B
C
D
E
F
G
H
I
SEDANG MENYUSUI...........................................
TEKANAN DARAH TINGGI ..................................
BARU MELAHIRKAN ANTARA 2-28
HARI YANG LALU ...............................................
BARU KEGUGURAN............................................
SEDANG HAMIL...................................................
PERDARAHAN ....................................................
PENYAKIT-PENYAKIT LAINNYA,
SEPERTI INFEKSI HATI, GINJAL,
JANTUNG ............................................................
A
B
C
D
E
F
G
H
I
A
B
C
D
E
F
G
H
I
A
B
C
D
E
F
G
H
I
A
B
C
D
E
F
G
H
I

28
C06c Sterilisasi / MOW atau MOP/ KB Mantap
C06d Suntik
C06e Pill
PENYAKIT KELAMIN ...........................................
LAINNYA SPIRAL/IUD (SEBUTKAN):
___________________________ .......................
LAINNYA SUSUK KB / IMPLAN / AKBW
(SEBUTKAN):
___________________________ .......................
LAINNYA MOW/MOP/STERILISASI
(SEBUTKAN):
___________________________ .......................
LAINNYA SUNTIK (SEBUTKAN):
___________________________ .......................
LAINNYA PIL (SEBUTKAN):
___________________________ .......................
TIDAK TAHU ........................................................
X
--
--
--
--
Z
--
X
--
--
--
Z
--
--
X
--
--
Z
--
--
--
X
--
Z
--
--
--
--
X
Z
In what conditions can the following family
planning methods […] NOT be used?
C06a IUD
C06b Implant
C06c strelization for women and men
C06d Injection
C06e Pills
C07a C07b C07c C07d C07e
A
B
C
D
E
F
G
H
-
--
--
--
X
Z
BREASTFEEDING ...............................................
HIGH BLOOD PRESSURE....................................
RECENTLY DELIVER A BABY (2-28 DAYS).........
JUST HAD MISCARRIAGE ..................................
IS PREGNANT ......................................................
VAGINAL BLEEDING ............................................
OTHER DISEASES, SUCH AS LIVER, KIDNEY
INFECTION OR HEART PROBLEM......................
STIs.......................................................................
OTHER (SPECIFY):
______________________ ...................................
OTHER (SPECIFY):
______________________ ...................................
OTHER (SPECIFY):
______________________ ...................................
OTHER (SPECIFY):
______________________ ...................................
OTHER (SPECIFY):
______________________ ...................................
DON’T KNOW .......................................................
A
B
C
D
E
F
G
H
X
--
--
--
--
Z
A
B
C
D
E
F
G
H
--
X
--
--
--
Z
A
B
C
D
E
F
G
H
--
--
X
--
--
Z
A
B
C
D
E
F
G
H
-
--
--
X
--
Z

29
C07 Menurut ibu, efek samping/komplikasi apa saja
yang dapat terjadi pada mereka yang
menggunakan alat KB […]:
C07a Spiral / IUD
C07b Susuk KB / Implan / AKBW
C07c sterilisasi / MOW atau MOP/ KB Mantap
C07d Suntik
C07e Pill
C07a C07b C07c C07d
A
B
C
D
E
F
G
H
--
--
--
X
--
Z
C07e
A
B
C
D
E
F
G
H
--
--
--
--
X
Z
BERAT BADAN BERTAMBAH ............................................
BERAT BADAN BERKURANG ............................................
PERDARAHAN....................................................................
TEKANAN DARAH NAIK .....................................................
SAKIT KEPALA ...................................................................
MUAL ..................................................................................
HAID TERHENTI .................................................................
MUDAH LELAH ...................................................................
LAINNYA SPIRAL/IUD (SEBUTKAN):
_______________________________ ...............................
LAINNYA SUSUK KB/IMPLAN/AKBW
(SEBUTKAN):
______________________________ .................................
LAINNYA MOW/MOP/STERILISASI (SEBUTKAN):
_______________________________ ...............................
LAINNYA SUNTIK (SEBUTKAN):
_______________________________ ...............................
LAINNYA PIL (SEBUTKAN):
_______________________________ ...............................
TIDAK TAHU..........................................................................
A
B
C
D
E
F
G
H
X
--
--
--
--
Z
A
B
C
D
E
F
G
H
--
X
--
--
--
Z
A
B
C
D
E
F
G
H
--
--
X
--
--
Z
To you knowledge what are the side effects of
using the following family planning methods?
C07a IUD
C07b Implant
C07c Sterilization
C07d Injection
C07e Pills
C08a C08b C08c C08d C08e
WEIGHT GAIN .....................................................................
WEIGHT LOSS.....................................................................
BLEEDING ...........................................................................
HYPERTENSION .................................................................
HEADACHE..........................................................................
NAUSEA...............................................................................
NO MENSTRUATION...........................................................
EASLY FEELING TIRED ......................................................
OTHER (SPECIFY):
_________________________ ...........................................
OTHER (SPECIFY):
_________________________ ............................................
OTHER (SPECIFY):
_________________________ ............................................
OTHER (SPECIFY):
_________________________ ............................................
OTHER (SPECIFY):
_________________________ ............................................
DON’T KNOW……………… .................................................
A
B
C
D
E
F
G
H
X
--
--
--
--
Z
A
B
C
D
E
F
G
H
--
X
--
--
--
Z
A
B
C
D
E
F
G
H
--
--
X
--
--
Z
A
B
C
D
E
F
G
H
--
--
--
X
--
Z
A
B
C
D
E
F
G
H
--
--
--
--
X
Z

31
D. RIWAYAT PENGGUNAAN ALAT KONTRASEPSI OLEH IBU
(D. HISTORY OF CONTRACEPTION USED BY WOMEN)
Pertanyaan berikut berkaitan dengan riwayat penggunaan kontrasepsi. Pewawancara tidak membacakan pilihan
jawaban, kecuali bila ada petunjuk.
The following questions related to the history contraception used by respondent and her husband. The interviewer
does not read the option, unless indicated.
D01 Menurut ibu berapa jumlah anak yang ideal?
[BILA IBU TIDAK TAHU, TULISKAN 98 PADA
SELURUH KOTAK YANG TERSEDIA]
ANAK LAKI-LAKI
ANAK PEREMPUAN
LAKI/PEREMPUAN SAMA SAJA
In your opinion, what is the ideal number of
children?
[IF THE MOTHER DON'T KNOW, WRITE 98 IN THE
AVAILABLE BOX]
Sons
Daughters
Sons/ Daughters indiffrent
D02 Menurut suami ibu berapa jumlah anak yang
ideal?
[BILA IBU TIDAK TAHU, TULISKAN 98 PADA
SELURUH KOTAK YANG TERSEDIA]
ANAK LAKI-LAKI
ANAK PEREMPUAN
LAKI/PEREMPUAN SAMA SAJA
According to your husband, what is the ideal
number of children?
[IF THE MOTHER DON'T KNOW, WRITE 98 IN THE
AVAILABLE BOX]
Sons
Daughters
Sons/ Daughters indiffrent
D03 Apakah ibu sedang hamil saat ini? YA..................................................................................................................................
TIDAK ..............................................................................................................................
1
2
 D05

32
Are you currently pregnant? YES ...............................................................................................................................
NO ................................................................................................................................
1
2
 D05
D04 Jika ibu tidak dalam kondisi hamil, apakah
menjadi masalah jika beberapa minggu ke
depan ibu ternyata hamil? YA, MASALAH BESAR ..................................................................................................
YA, AGAK MASALAH ....................................................................................................
TIDAK MASALAH ..........................................................................................................
TIDAK MUNGKIN HAMIL/TIDAK BERHUBUNGAN INTIM .............................................
1
2
3
4
D06
In the next few weeks, if you find out that you
are pregnant, is that a problem for you?
YES, MAJOR PROBLEM...................................................................................1
YES, MINOR PROBLEM ...................................................................................2
NO PROBLEM ...................................................................................................3
NOT BE PREGNANT/NO HAVING SEX...........................................................4
1
2
3
4
D06
D05 Jika ibu dalam kondisi hamil, apakah ibu
menginginkan kehamilannya?
YA..................................................................................................................................
TIDAK ...........................................................................................................................
TIDAK PUNYA PENDAPAT (TERSERAH).....................................................................
1
2
3
If mother is pregnant, ask the mother if that is
an intended pregnancy ?
YES....................................................................................................................1
NO .....................................................................................................................2
NEUTRAL ..........................................................................................................3
1
2
3
D06 Apakah ibu ingin hamil (lagi)?
YA INGIN, SEKARANG..................................................................................................
YA, NANTI (TIDAK SEKARANG) ..................................................................................
TIDAK BISA HAMIL........................................................................................................
TIDAK INGIN HAMIL LAGI.............................................................................................
TIDAK TAHU/TIDAK YAKIN...........................................................................................
1
2
3
4
6
 D08
 D08
 D08
 D08
Do you still want to become pregnant?
YES, NOW .........................................................................................................1
YES, LATER ......................................................................................................2
CANNOT GET PREGNANT ................................................................................
DO NOT WANT TO GET PREGNANT ...............................................................
DON’T KNOW/NOT SURE ................................................................................3
1
2
3
4
6
 D08
 D08
 D08
 D08
D07 Jika ibu ingin hamil nanti (tidak sekarang):
berapa lama ibu ingin menunggu sebelum ibu
ingin punya anak lagi?
1. BULAN
2. TAHUN
96. TIDAK TAHU
(LINGKARI PILIHAN YANG SESUAI DAN TULISKAN WAKTU PADA KOTAK YANG
TERSEDIA)
If you want to become pregnant later, how
long do you want to wait?
1. MONTH
2. YEAR
96. DON’T KNOW

33
(CIRCLE THE MOST APPROPRIATE AND WRITE THE TIME IN THE AVAILABLE BOX)
D08 Apakah ibu pernah menggunakan alat/cara KB?
YA..................................................................................................................................
TIDAK ............................................................................................................................
1
2
 D12
Have you ever used any family planning
method?
YES...................................................................................................................
NO.....................................................................................................................
1
2
 D12
D09 Apa alasan ibu tidak pernah menggunakan
alat/cara KB?
ALASAN FERTILITAS:
JARANG/PUASA KUMPUL/SUAMI TIDAK DI RUMAH..............................................
MENOPAUSE/HISTEREKTOMI.................................................................................
TIDAK SUBUR/MANDUL...........................................................................................
INGIN PUNYA ANAK.................................................................................................
TIDAK DIIZINKAN UNTUK MEMAKAI:
SUAMI TIDAK MENGIZINKAN...................................................................................
ORANG LAIN TIDAK MENGIZINKAN ........................................................................
LARANGAN ADAT/AGAMA.......................................................................................
KURANG PENGETAHUAN:
TIDAK TAHU ALAT/CARA KB ...................................................................................
TIDAK TAHU DI MANA MENDAPATKANNYA...........................................................
ALASAN ALAT/CARA KB:
KESEHATAN.............................................................................................................
TAKUT EFEK SAMPING ...........................................................................................
TAKUT GAGAL..........................................................................................................
BIAYA TERLALU MAHAL ..........................................................................................
TIDAK NYAMAN........................................................................................................
MENJADI GEMUK/KURUS........................................................................................
ALAT YANG DIINGINKAN TIDAK TERSEDIA ...........................................................
LAINNYA:
SUAMI SUDAH MEMAKAI ALAT KB .........................................................................
BARU MELAHIRKAN/MASIH DALAM MASA NIFAS..................................................
TIDAK MAU ...............................................................................................................
REPOT ......................................................................................................................
KURANGNYA AKSES/TERLALU JAUH....................................................................
TIDAK ADA PETUGAS KESEHATAN / KB YANG MELAYANI...................................
LAINNYA (SEBUTKAN): ______________________________________.................
TIDAK TAHU..................................................................................................................
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
X
Z
What is the reason you never used any family
planning method?
FERTILITY-RELATED REASON:
INFREQUENT/NOT HAVING SEX/HUSBAND NOT AT HOME .................................
MENOPAUSE/HISTERECTOMY ...............................................................................
SUBFECUND/INFECUND .........................................................................................
WANT TO HAVE CHILDREN.....................................................................................
PERMISSION TO USE:
HUSBAND OPPOSED...............................................................................................
OTHER OPPOSED....................................................................................................
RELIGIOUS OR CUSTOM FORBIDS ........................................................................
LACK OF KNOWLEDGE:
DONT KNOW THE METHOD ....................................................................................
DONT KNOW THE SOURCE ....................................................................................
A
B
C
D
E
F
G
H
I

34
METHOD-RELATED REASON:
HEALTH CONCERNS ...............................................................................................
FEAR OF SIDE EFFECT ...........................................................................................
FEAR OF FAILURE ...................................................................................................
EXPENSIVE ..............................................................................................................
INCONVENIENCE.....................................................................................................
WEIGHT GAIN /LOSS ...............................................................................................
FAMILY PLANNING METHOD NOT AVAILABLE ......................................................
OTHERS:
HUSBAND USES CONTRACEPTIVE........................................................................
STILL IN POSTPARTUM PERIOD..............................................................................
DON'T WANT TO USE ANY ......................................................................................
TROUBLESOME .......................................................................................................
LACK OF ACCESS/TOO FAR...................................................................................
NO HEALTH / FAMILY PLANNING PERSONNEL.....................................................
OTHER (SPECIFY): _________________________________________..................
DONT KNOW ............................................................................................................
J
K
L
M
N
O
P
Q
R
S
T
U
X
Z
D10 Apakah ibu merencanakan menggunakan
alat/cara KB di masa mendatang?
YA.....................................................................................................................................
TIDAK .........................................................................................................................
1
2
Do you consider using any family planning
method in the future?
YES ..................................................................................................................................
NO ..............................................................................................................................
1
2
D11 Apakah suami ibu pernah menggunakan
alat/cara KB? YA...............................................................................................................................
TIDAK .........................................................................................................................
TIDAK TAHU.....................................................................................................................
1
2
7
 ke E
 ke E
 ke E
Has your husband ever used any family planning
method?
YES...................................................................................................................
NO.....................................................................................................................
DON'T REMEMBER ............................................................................................
1
2
7
 ke E
 ke E
 ke E
Setelah menyelesaikan D11, lanjutkan ke Bagian E.
After completing D11, continue to Part E.
D12 Apa alat/cara KB yang ibu gunakan pertama
kali?
MOW / STERILISASI ..................................................................................................
IMPLAN /SUSUK KB 5 TAHUN...................................................................................
SPIRAL / IUD / AKDR .................................................................................................
SUNTIK 3 BULAN .......................................................................................................
SUNTIK 1 BULAN .......................................................................................................
PIL ..............................................................................................................................
KONDOM PEREMPUAN.............................................................................................
KONTRASEPSI DARURAT.........................................................................................
ALAMIAH (ASI, PUASA, KALENDER).........................................................................
LAINNYA (SEBUTKAN): _______________________________________ ................
11
12
13
14
15
16
17
18
19
20
21
96
What was the first family planning method you
used?
TUBECTOMY/FEMALE STERILIZATION ...................................................................
IMPLANT 5 YEARS.....................................................................................................
IMPLANT 3 YEARS.....................................................................................................
IMPLANT 2 YEARS.....................................................................................................
11
12
13
14

35
IUD .............................................................................................................................
INJECTION 3 MONTHS..............................................................................................
INJECTION 1 MONTH ................................................................................................
PILL ............................................................................................................................
FEMALE CONDOM.....................................................................................................
EMERGENCY CONTRACEPTION..............................................................................
NATURAL METHOD (BREASTFEEDING, ABSTINENT, CALENDER)........................
OTHER (SPECIFY):
___________________________________________................................................
DON’T KNOW.............................................................................................................
15
16
17
18
19
20
21
96
98
D13 Pada usia berapa ibu pakai KB pertama kali?
USIA DALAM TAHUN……………………………………………………
[TULISKAN “97” BILA IBU MENJAWAB “TIDAK INGAT”, DI KOTAK YANG TERSEDIA]
At what age did you use family planning
contraceptive for the first time? AGE IN YEARS…………………………………………………………
[WRITE “97” IF MOTHER DOES NOT REMEMBER]
D14 Apakah ibu pernah berganti alat/cara KB sejak
pertama kali menggunakannya?
YA..................................................................................................................................
TIDAK ...........................................................................................................................
1
2  D16
Have you ever changed family planning
contraceptive since you used it for the first time?
YES ...............................................................................................................................
NO ................................................................................................................................
1
2  D16
D15 Sudah berapa kali ibu berganti alat/cara KB
sejak pertama kali menggunakan alat/cara KB?
[TULISKAN 97 BILA IBU TIDAK INGAT DI KOTAK
YANG TERSEDIA]
KALI
How many times have you changed your
contraceptive method since you used it for the
time? TIMES
D16 Apakah saat ini atau sebulan ini
ibu menggunakan alat/cara KB?
YA.....................................................................................................................................
TIDAK ...............................................................................................................................
1
2
 D19
Do you use any family planning method at this
time or this month?
YES ..................................................................................................................................
NO ....................................................................................................................................
1
2
 D19
D17 Apakah ini adalah alat/cara KB yang ibu
inginkan?
YA.....................................................................................................................................
SAMA SAJA......................................................................................................................
TIDAK ...............................................................................................................................
1
2
3
Is this the contraceptive method you desired to
use?
YES ..................................................................................................................................
INDIFFERENT ..................................................................................................................
NO ....................................................................................................................................
1
2
3

36
D18 Apakah suami ibu menyetujui pemakaian alat
KB ini?
YA.....................................................................................................................................
BIASA SAJA .....................................................................................................................
TIDAK ...............................................................................................................................
1
2
3
Do your husband agree with the contraception
you used?
YES ..................................................................................................................................
INDIFFERENT ..................................................................................................................
NO ....................................................................................................................................
1
2
3
D19 Metode KB apa saja yang tersedia pada petugas
atau fasilitas kesehatan di daerah ini?
MOW / STERILISASI ..................................................................................................
SPIRAL / IUD / AKDR .................................................................................................
SUNTIK 3 BULAN .......................................................................................................
SUNTIK 1 BULAN .......................................................................................................
PIL ..............................................................................................................................
LAINNYA (SEBUTKAN): _______________________________________ ......................
11
12
13
14
15
16
17
18
19
20
21
96
What are the family planning methods available
in health facility/from health personnel in this
area?
IMPLANT 5 YEARS.....................................................................................................
IMPLANT 3 YEARS.....................................................................................................
IMPLANT 2 YEARS.....................................................................................................
IUD .............................................................................................................................
INJECTION 1 MONTH ................................................................................................
PILL ............................................................................................................................
FEMALE CONDOM.....................................................................................................
OTHER (SPECIFY):
___________________________________________................................................
DON’T KNOW...................................................................................................................
11
12
13
14
15
16
17
18
19
20
21
96
98
D20 Metoda KB apa yang paling dianjurkan oleh
petugas kesehatan di daerah ini?
MOW / STERILISASI ..................................................................................................
SPIRAL / IUD / AKDR .................................................................................................
SUNTIK 3 BULAN .......................................................................................................
SUNTIK 1 BULAN .......................................................................................................
PIL ..............................................................................................................................
LAINNYA (SEBUTKAN): _______________________________________ ......................
11
12
13
14
15
16
17
18
19
20
21
96
What are the family planning methods
encourage by health facility/from health
personnel in this area?
IMPLANT 5 YEARS.....................................................................................................
IMPLANT 3 YEARS.....................................................................................................
IMPLANT 2 YEARS.....................................................................................................
IUD .............................................................................................................................
11
12
13
14
15

37
INJECTION 1 MONTH ................................................................................................
PILL ............................................................................................................................
FEMALE CONDOM.....................................................................................................
OTHER (SPECIFY):
___________________________________________................................................
DON’T KNOW...................................................................................................................
16
17
18
19
20
21
96
98
D21 Apakah ibu puas dengan pelayan yang diberikan
oleh petugas kesehatan saat itu?
PUAS................................................................................................................................
BIASA SAJA .....................................................................................................................
TIDAK PUAS.....................................................................................................................
1
2
3
Are you satisfied with the service provided?
D22 Apakah petugas memberikan kesempatan
bertanya?
YA.....................................................................................................................................
TIDAK ...............................................................................................................................
1
2
Did the health provider give you a chance to ask
questions?
YES ..................................................................................................................................
NO ....................................................................................................................................
1
2
D23 Apakah petugas kesehatan menjawab
pertanyaan yang ibu dengan baik?
YA.....................................................................................................................................
BIASA SAJA .....................................................................................................................
TIDAKSAMA ....................................................................................................................
1
2
3
Did the heatlh provider answer your questions
well?
YES ..................................................................................................................................
INDIFFERENT ..................................................................................................................
NO ...................................................................................................................................
D24 Berapa lama ibu harus menunggu di tempat
pelayanan tersebut?
SEBENTAR.......................................................................................................................
CUKUP LAMA...................................................................................................................
LAMA SEKALI...................................................................................................................
1
2
3
How long did you wait before receiving the FP
services?
NOT LONG .......................................................................................................................
LONG ENOUGH ...............................................................................................................
VERY LONG .....................................................................................................................
1
2
3
D25 Bagaimana dengan biaya yang harus ibu
keluarkan untuk pelayanan KB tersebut?
TIDAK MAHAL ..................................................................................................................
CUKUP MAHAL ................................................................................................................
MAHAL SEKALI………………………………………………………………………………
GRATIS ............................................................................................................................
1
2
3
4
How do you feel about the amount you have to
pay for the FP services?
NOT EXPENSIVE .............................................................................................................
WEXPENSIVE ENOUGH..................................................................................................
VERY EXPENSIVE ...........................................................................................................
1
2
3
D26 Berapa jarak dari rumah Ibu ke tempat
pelayanan KB?
TIDAK JAUH .....................................................................................................................
CUKUP JAUH ...................................................................................................................
JAUH SEKALI ...................................................................................................................
1
2
3
How far is your home from the FP service point? NOT FAR ..........................................................................................................................
FAR ENOUGH ..................................................................................................................
VERY FAR........................................................................................................................
1
2
3

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