West Bengal State University

Department of Rural Studies

Questionnaire: A Case Study on the Health Condition of Women in Vulnerable Areas of South 24
Parganas

Demographic Information

Personal Details: 1. Type of House:

10. Name (Optional): _________ No House(0), Hut (1), Kancha (2), Mixed (3), Pucca(4),
11. Age Group: Mansion(5)

Below 18 (1), 18–25(2), 26–35(3), 36–45(4), 46–60(5), 2. Ownership of House:

Above 60(6)
Own house(1), Rented(2), Temporary settlement/slum(3)
12. Marital Status:
Economic Status & Employment:
Single(1), Married(2), Widowed(3), Separated/Divorced(4)
3. Primary Occupation (Family):
13. Are you Pregnant: Yes (1), No (0) __________________________________________
14. Number of Children: 4. Monthly household income: ___________________
5. Are you employed? Yes(1), No(0)
None (0), 1–2(1), 3 or more(4) 6. If yes, what is your occupation?

15. Highest Level of Education Completed: Homemaker(1), Daily wage laborer(2), Agricultural worker(3),
Fisherwoman(4), Self-employed(5), Government/private job(6),
No formal education(0), Primary(1), Secondary (2), Higher Unemployed(0)
Secondary (3), Graduate/Postgraduate(4)
7. Your monthly income?: ___________________
16. Caste: 8. Access to Government Welfare Schemes (Yes/No)
9. If yes, tick (multiple):
General(1), OBC(2), SC(3), ST(4)
Ration card (PDS)(1), MGNREGA job card(2), Widow pension(3),
Old age pension(4), Ayushman Bharat/Health insurance(5)
17. Religion:
Geographical & Environmental Factors:
Hindu(1), Muslim(2), Christian(3), Others(4)
14. Region of Residence:
Household Composition & Living Conditions:
Coastal area(1), Riverine/flood-prone area(2), Rural village(3)
18. Number of Family Members Living Together:
15. Major Environmental Challenges Faced (Multiple choices
1–3(1), 4–6(2), More than 6 (3) allowed):

19. Head of Household: Frequent floods/cyclones(1), Water scarcity(2), Poor sanitation

facilities(3), Poor road connectivity(4), Limited access to
Self(1), Husband(2), Father(3), Other(4) (Specify) healthcare(5)
_________________________________________
 General Health and Nutrition

General Health Status

16. Do you suffer from any chronic illness? (e.g., diabetes, hypertension, tuberculosis, etc.)

Yes(1), No(0)

17. If yes, Specify _________________________________________________________

18. How often do you visit a doctor or healthcare centre?

Only in emergencies (1), Occasionally(2), Regularly (3)

19. Do you have access to nutritious food regularly?

No(0), Yes(1), Sometimes(2)

20. What is your primary source of drinking water?

Tube well (1), Well(2), Piped Water(3), River/Pond(4), Others(5) (Specify) _________________________________

21. Do you or your family members suffer from waterborne diseases frequently? No(0), Yes(1)
22. Are you aware of government healthcare schemes available for women in your area? No(0), Yes(1)
23. Are healthcare facilities easily accessible in your area? No(0), Yes(1)

Nutrition and Lifestyle

24. Do you face challenges in accessing nutritious food due to financial constraints? No(0), Yes(1)

25. Are you aware of government nutrition programs (e.g., Mid-Day Meal Scheme, ICDS, Poshan Abhiyan)? No(0), Yes(1)

26. Do you receive rations from the Public Distribution System (PDS)? No(0), Yes(1)

Nutritional Deficiencies and Health Issues:

27. Do you or any female family members suffer from anemia (low hemoglobin levels)? Yes(1), No(0), Don’t know(2)

28. Have you ever experienced symptoms like weakness, dizziness, or hair fall due to poor nutrition? No(0), Yes(1) Don’t

know(2)

29. Do pregnant and lactating women in your household receive special nutritional care? No(0), Yes(1)

30. Have you or anyone in your family received iron and folic acid supplements from a government program? No(0), Yes(1)

Hygiene and Sanitation Practices

31. What is your primary source of drinking water?

Piped water(1), Tube well(2), Open well(3), River/Pond/Lake(4)

32. Do you treat water before drinking?

Yes (Boiling/Filtering)(1), No(0)

33. What kind of toilet facility do you use?

Personal household toilet(1), Shared toilet(2), Community toilet(3), Open defecation(4)

34. How often do you wash your hands with soap?

Never(0), Rarely (1), Occasionally (3), Often(4), Most Often (5)

35. How often is waste collected from your area?

Rarely/Never(0), Regularly(1), Occasionally(2)

36. Do you have proper drainage facilities in your locality?

Yes(1), No(0)

37. What menstrual hygiene products do you use?

Sanitary napkins(1), Cloth(2), Other(3) (specify)_____________________________________________________________

38. How do you dispose of used menstrual hygiene products?

Proper disposal (dustbin, burning, pit)(1), Open dumping(2), Other(3) (specify)____________________________________________

39. Do you receive any education on menstrual and reproductive health?

Yes(1), No(0)

40. Where did you give birth? (If applicable)

Government Hospital(1), Private Hospital(2), Home(3)

41. Do you use or have access to contraceptives?

Yes(1), No(0)

42. Are menstrual hygiene products (e.g., sanitary napkins) easily available to you?

Yes(1), No(0)

43. Do you face any difficulties in accessing sanitary products?

Yes(1), No(0)

44. If yes, what are the main reasons?

High cost(1), Limited availability in local shops(2), Social stigma and embarrassment(3), Other(4) (please specify) _______________

45. Do you experience restrictions or taboos during menstruation (e.g., avoiding religious places, cooking, or social interactions)?

Yes(1), No(0)

46. Have you faced any health problems related to poor menstrual hygiene?

Urinary tract infections(1), Skin rashes or irritation(2), Reproductive health issues(3)

(please specify) ____________________________

Antenatal (Pregnancy) Health Care

47. Did you receive antenatal care (ANC) during pregnancy?

Yes, Regularly(1), Yes, but Occasionally(2), No(0)

48. How many antenatal check-ups did you attend?

None(0), 1-2 times(1), 3-4 times(2), More than 4 times(3)

49. Where did you receive antenatal care?

No care received(0), Government hospital/clinic(1), Private clinic/hospital(2), Traditional birth attendant(3)

50. Were you given Iron and Folic Acid (IFA) supplements during pregnancy?

Yes(1), No(0)

51. Did you experience complications during pregnancy?

Severe vomiting(1), High blood pressure(2), Anaemia(3), Diabetes(4), Other(5) (Specify)____________________________________

52. Were you advised on nutrition and diet during pregnancy?

Yes(1), No(0)

53. What type of food did you mostly consume during pregnancy?

Nutritious balanced diet (fruits, vegetables, milk, proteins, etc.)(1), Mostly rice and vegetables(2), Poor diet due to financial issues(3)

54. Did you get vaccinated during pregnancy (e.g., tetanus shots)?

Yes(1), No(0)

55. What are the major challenges you face in accessing healthcare for pregnancy and post-pregnancy?

Psychological and Emotional Well-being

56. Do you often feel stressed or anxious?

Yes, frequently(1), Sometimes(2), Rarely(3), Never(0)

57. What are the main sources of stress in your life? (Select all that apply)

Financial difficulties(1), Family responsibilities(2), Health issues(3), Domestic violence(4), Lack of employment opportunities(5),
Other(6) (Specify)_______________________________________

58. Have you ever felt symptoms of depression (e.g., persistent sadness, lack of interest, hopelessness)?

Yes(1), No(0)

59. Do you have someone to talk to when you feel emotionally distressed?

Yes, a family member(1), Yes, a friend(2), Yes, a counselor/social worker(3), No, I have no one to talk to(4)

60. How often do you feel lonely or socially isolated?

Often(1), Sometimes(2), Rarely(3), Never(4)

61. How do you usually cope with stress or emotional distress? (Select all that apply)

Talking to someone(1), Engaging in religious/spiritual activities(2), Engaging in work or household chores(3), Crying alone(4),
Ignoring it and hoping it goes away(5), Others(6), (Specify)_______________________________

62. Have you or any women in your community sought professional help for mental health issues?

Yes(1), No(0)

63. Are there any support groups or NGOs in your area that offer mental health counseling or emotional support?

Yes(1), No(0), Don’t know(2)

64. What kind of support do you think is most needed for improving mental health in your community?

Counseling and mental health awareness programs(1), Financial aid for women in distress(2), Community support groups(3),

Better hygiene and living conditions(4), Others(5) (Specify)__________________________________________

Impact of Environmental
Vulnerabilities
65. Have floods or cyclones affected your access to clean water and sanitation?

Yes(1), No(0)
 66. How do environmental disasters impact your daily hygiene practices?

Limited access to clean water(1), Increased waterborne diseases(3), Difficulty in maintaining menstrual hygiene(2),

Other (4) (please specify) ________

67. Do you receive any support (government or NGO) for improving sanitation and hygiene in your area?

Yes(1), No(0)

68. What challenges do you face in maintaining hygiene during extreme weather conditions?

Lack of clean water(1), Damaged sanitation facilities(2), Limited access to healthcare(3),

Other(4) (please specify) ________

Healthcare Infrastructure Access

69. What is the nearest healthcare facility available?

Primary Health Center (PHC)(1), Community Health Center (CHC)(2), Government hospital(3), Private hospital/clinic(4),

Traditional/alternative healer(5), No healthcare facility nearby(0)

70. How far is the nearest healthcare facility from your home?

Less than 1 km(1), 1–5 km(2), 5–10 km(3), More than 10 km(4)

71. How do you usually travel to the healthcare facility?

Walking(1), Bicycle(2), Public transport(3), Private vehicle(4), Other(5) (Specify)

72. How much time does it take to reach the nearest healthcare facility?

Less than 30 minutes(1), 30 minutes – 1 hour(2), More than 1 hour(3)

73. Have you or your family Less faced challenges in accessing emergency healthcare due to poor infrastructure?

Yes(1), No(0)

74. What are the main difficulties you face while accessing healthcare? (Multiple choices allowed)

Distance from healthcare facility(1), Poor road connectivity(2), Lack of transportation(3), High treatment cost(4), Lack of female
healthcare providers(5), Long waiting time(6)

75. Are maternity and childcare services available in your area?

Yes, fully available(1), Partially available(2), Not available(0)

76. What are the major challenges you face in accessing healthcare?

Government Schemes and Awareness

77. Are you aware of government health schemes for women (e.g., Janani Suraksha Yojana, Rashtriya Kishor Swasthya
Karyakram)? Yes(1), No(0)
78. Have you received any benefits from these schemes? Yes(1), No(0)
 79. Do you or your community receive hygiene awareness programs from any NGOs or government bodies? Yes(1), No(0)
80. How often do you interact with local health workers (e.g., ASHA, Anganwadi workers)?

Never(0), Rarely(1), Occasionally (a few times a year)(2), Regularly (once a month or more)(3)

81. What additional support would you like from the government?

More awareness campaigns(1), Free distribution of hygiene products(2), Improved healthcare facilities nearby(3), Regular health
camps and screenings(4), Others (5) (please specify) ______________________________________________________________

82. In your opinion, what is the best way to increase awareness about women’s health schemes in your area?

Door-to-door campaigns(1), Community meetings(2), Radio/TV programs(3), School and college programs(4), Other (5) (please
specify) _________________________________________________________________________________________________

83. Are you willing to participate in awareness campaigns if organized in your village? Yes(1), No(0)