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APPENDIX E

SAMPLE QUESTIONNAIRE

PERSONAL INFORMATION

A. Name (optional): __________________________

Instruction: Please put check mark (√) on the space provided that coincides with

your personal data.

B. Age:

____ Below 25 years old

____ 25 - 40 years old

____ Above 40 years old

C. Religion:

____ Catholic

____ Non – Catholic

D. Occupation:

____ Employed

____ Self – employed

____ Unemployed

E. Highest Educational Attainment

____ Elementary Level

____ High school level

____ College Level

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Listed below are cultural beliefs involved in maternal and newborn health
care. The following cultural beliefs are grouped into three: a) During pregnancy
and b) During child delivery and c) After child delivery

CULTURAL BELIEFS

Instruction:

• Left column of the table:

Please put a check mark (√) in the appropriate boxes of the
cultural beliefs on maternal and newborn health care you are still
practicing at present.
• Right Column of the table:
Please put a check mark (√) in the appropriate boxes of the beliefs
on maternal and newborn health care that best represents your extent of
practice.
Legend
○ 1 = Never
○ 2 = Often
○ 3 = Always
During Pregnancy
Extent of Practice
(
) Beliefs:
1 2 3
1. Conceiving mother should not go around looking up
to fruit bearing trees and /or desiring the fruits.
2. Pregnant woman should not open the “lutsen”
(gourd used in storing salted pork) while her
husband is away.
3. Avoid eating twin fruits.
4. During pregnancy, both husband and wife should
not travel to other places outside their barrio /
barangay.
5. Husband and wife should avoid going to hot spring
or cold springs.
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6. Husband and wife should never criticize, mock, or

laugh at a person with physical defect.
7. The pregnant woman is given only anything she
desires in the house as long as her husband is
around.
8. Pregnant woman is not allowed to butcher animals
in absence of their husband.
9. When the expectant mother feels her labor pains
while out of the house, she should try to make it
back home.

During Child Delivery

Extent of Practice
(√) Beliefs:
1 2 3
1. When labor pains starts, she must walk around and
keep herself busy to keep off her mind from the
pain.
2. When the labor is too much prolonged and difficult,
a traditional healer (insup - ok) will be called.
3. Traditional midwife will be called to help the
mother deliver the baby. The traditional midwife
and the giving birth mother are the only ones
allowed to stay in a room where the mother feels
she is comfortable to give birth.
4. The farey (placenta) should be wrapped with cloth
or be placed in a container and will be buried on the
left hand side of the doorway facing outside if the
child is a girl. If it is a boy, the placenta will be
buried on the right hand side of the doorway.
5. The position of the child when it came out should
be noted.
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6. When the mother is alone when she delivers the

baby, she will bath the baby, suck the mucus and
other foreign matters from the baby’s nose and
mouth, then wrap the baby with lampin afterwards.

After Child Delivery

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( Extent of Practice
) Beliefs:
1 2 3

1. Itab (Black – eyed beans) are cooked with lots of

water and with inasin (salted meat) to make broth
for the mother.
2. Itab (Black – eyed beans) is the only viand
allowed for the whole family for 1 week after the
baby’s birth.
3. Butchering of chicken on the second day of ngilin
(No working on the fields for 1 week)
4. Mangmang ( 5 days of eating fresh foods) is
observed.
5. The mother should never eat mushrooms until the
child’s teeth are complete.
6. Dog meat and utong (meat that came from
burials) are prohibited for the mother.
7. Breastfeeding lasts up to 4 years.
8. Feeding the baby with rice ahm when breast milk
is unavailable.
9. The baby may breastfed from other’s breast milk.
10. Lactating mother should drink a lot of meat soup.
11. Fresh fish, fruits and vegetables are not allowed
for 1 week starting from the day the child was
born.
12. Knife or any blades are prohibited in cutting the
umbilical cord.
13. The mother should wash herself and tie around
her waist a waist binder (bagkhet).
14. Bathing will only be washing only of the face,
arms and legs.