These questions will help assess whether your current method of contraception or one you may consider using in the future will be effective for you.

These questions will help assess whether your current method of contraception or one you may consider using in the future will be effective for you. Answering yes to any of these questions predicts potential problems. If you have more than a few yes responses, consider talking to a health care provider, counselor, partner, or friend to decide whether to use this method or how to use it so that it will really be effective.

Method of contraception you use now or are considering: 

Question 1: Have I or my partner ever become pregnant while using this method?

You answered and please explain why

Question 2: Am I afraid of using this method?

You answered and please explain why 

Question 3: Would I really rather not use this method?

You answered and please explain why 

Question 4: Will I have trouble remembering to use this method?

You answered and please explain why 

Question 5: Will I have trouble using this method correctly?

You answered and please explain why 

Question 6: Does this method make menstrual periods longer or more painful for me or my partner?

You answeredand please explain why 

Question 7: Does this method cost more than I can afford?

You answeredand please explain why 

Question 8: Could this method cause serious complications?

You answered and please explain why 

Question 9: Am I, or is my partner, opposed to this method because of any religious or moral beliefs?

You answered and please explain why 

Question 10: Will using this method embarrass me or my partner?

You answered and please explain why 

Question 11: Will I enjoy intercourse less because of this method?

You answered and please explain why 

Question 12: Am I at risk of being exposed to HIV or other sexually transmitted infections if I use this method?

You answered and please explain why