Protección del cliente de correo electrónico

My name is _____________________ and I have come from the Population Council, an international non-profit organization working for improving the maternal and reproductive health of the marginalized populations. We are conducting a survey to assess gaps in service delivery and clients’ choices when seeking family planning (FP) services in Pakistan.

You are invited to take part in this research study. Before you decide whether to participate, you need to understand why the research is being done and what it would involve. Please take the time to read, or to listen as I read, the following information. You may talk to others about the study if you wish. Please ask me if there is anything that is not clear or if you would like more information. When all of your questions have been answered and you feel that you understand this study, you will be asked if you wish to participate in the study. If your answer is yes, you will be asked to sign this Informed Consent Form. You may be given a signed copy to keep, if you require.

PURPOSE OF THIS RESEARCH STUDY

The purpose of this study is to assess gaps in services delivery and to see what drives clients’ choices when seeking FP services with regard to choice of provider, location and contraceptive method in Pakistan.

The study is being conducted by the Population Council and is funded by the Department for International Development (DFID).

1. PROCEDURES

You are invited to participate in an interview because you are knowledgeable and understand about FP services being provided in your community. The interview will take 30 minutes. The duration of the entire study is 12 months. We may need to contact you again to clarify a point made earlier, and you may agree or disagree to participate.

2. POSSIBLE RISKS OR DISCOMFORT

If this is not a convenient time for you, we can come back later to your home for the interview. Since the interview will be conducted in privacy, the risks of other people learning about what you have said are very minimal. Another possible

inconvenience may be the time and effort you take to be an informant. You are free to not respond to any question that makes you uncomfortable or that you do not want to answer. You may end your participation at any time without any penalty.

3. POSSIBLE BENEFITS

There are no direct benefits to you for participating in the study. You may find an indirect benefit in knowing that you have participated in an important study that would help achieve the goal of universal access to FP services for Punjab in Pakistan.

4. VOLUNTARINESS

Your participation in this study is completely voluntary and you will not be paid any compensation for your time. There is no penalty for refusing to take part. If you agree to participate in this study, you may end your participation at any time without penalty and leave. If you decide to take part, you are free to not respond to any questions. You are free to withdraw at any time without affecting your relationship with the study team and community. There is no penalty for refusing to take part.

5. CONFIDENTIALITY

Your responses to this interview will be completely confidential and will be used for research purposes only. No personal reference will be made to your participation in this study. We will combine your responses with those of other participants to describe the general picture in Pakistan. Data will be stored in a locked cabinet dedicated to this study. This information will only be accessible to the authorized study team. All records and related documents will be destroyed after 3 years. National and international regulatory agencies and sponsoring agencies may request access to confidential records of participating subjects, but the identity of subjects will remain confidential.

As part of the sponsor’s monitoring program, you may be asked for an interview by a representative of the sponsor of the study to determine whether informed consent was given. If an interview is requested, you will have the option of accepting/declining the interview.

6. ADDITIONAL SOURCES OF INFORMATION

The results of the study will be published in a report and discussed at national meetings and conferences. This study has been reviewed by the Population Council’s Internal Review Board in New York.

Any complaint about the way you have been treated during the study or any possible harm you might suffer will be addressed. You may call Ms. Zeba Tasneem at 0092-51-8445566 (Ext. 127) for any complaints.

For information about your rights or in case of violation of rights you may contact Ms. Iram Kamran at 0092-51-8445566 (Ext. 129).

7. AUTHORIZATION

I have read/heard the Informed Consent for this study. I have received an explanation of the planned interview and its procedure, risks and benefits, and privacy of my personal information. I agree to take part in this study. I understand that my participation in this study is voluntary. I understand that information obtained in this study will be transmitted only in a form that cannot be identified with me.

Your name: _______________________________________________________________ Your signature: ____________________________________________Date:___________

Investigator or person who conducted Informed Consent discussion: I confirm that I have personally explained, in the language he/she understands, the nature and extent of the study, potential risks and benefits, and confidentiality of personal

information.

Name of person obtaining consent: ______________________________________ Signature of person obtaining consent: ____________________Date:__________

Consent Form for Focus Group Discussions with Currently Married Men and Women of