QUESTIONNAIRE FOR RANDOM RESPONDENT
1. PERSONAL INFORMATION
i.
Age: ___26_____
ii.
Educational Qualification: b. Graduate
a. School level
b. Graduate
c. Post-Graduate
d. M.Phil./PhD
e. No formal education
f.
iii.
Other _______________
What is your marital status? a. Married
a. Married
b. Widowed
c. Divorced
d. Separated
iv.
Age at Marriage: c) 22 – 27 years
a) 10-15 years
b) 16-21 years
c) 22-27 years
d) 28-33 years
e) 34-39 years
f) 40 years & above
v.
Age of the husband at marriage: e) 34-39 years
a) 10-15 years
b) 16-21 years
c) 22-27 years
d) 28-33 years
e) 34-39 years
f) 40 years & above
vi.
Type of family structure: a) Nuclear
a) Nuclear
b) Joint
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2. DOMESTIC VIOLENCE EXPERIENCE AND HISTORY
1. Did you face any form of violence prior to getting married? b. No
a. Yes
b. No
c. Not sure
2. Do you ever face any kind of violence after marriage? No What form did this Domestic
Violence take?
a.) Physical: _____________________________________________________
b.) Emotional: ____________________________________________________
c.) Sexual: _______________________________________________________
d.) Economic: ____________________________________________________
e.) Other: ________________________________________________________
If yes what have you done please describe. If no why you did not took any action?
3. Is he supported/ encouraged to do the violence by anyone? If so, who? Why? Etc. (During
and after the violence) No
4. How much say did you have in your household decision making aspects? 50/50 (Equal)
5. Were you accused of infidelity or did your husband get jealous/aggressive when you talked
to other men? No
6. Did your husband keep track of your mobility at all times? No
7. Did you suffer from any stigma/ criticism from other family or community members? Yes
If yes, what did you did about it? Nothing. If nothing, why? Ignored criticism. Didn’t
care enough.
3. EXPERIENCES AT FAMILY OF BIRTH
1.
Do you live nearby your family of birth? Yes Do you get support from them? Yes
2.
Was there violence in your family of birth? No. Were you a direct victim of it? No.
3.
Did your husband ever make you ask for money from your maternal family? No. If
yes, how was their reaction to it?
4.
Were you ever restricted from talking/meeting your friends or family members? No.
4. REPORTING AND AWARENESS OF THE DOMESTIC VIOLENCE ACT, 2005 AND
SUBSEQUENT SERVICES
1. Did the Domestic Violence Act, 2005 help you in anyway? Didn’t know about it.
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5. VIEWS TOWARDS DOMESTIC VIOLENCE
1. What is your understanding of domestic violence? Physical or verbal abuse.
2. Is Domestic Violence ever justified? If so, under what circumstances? Never justified.
3. What are your views about marital rape? It is wrong.
4. Are there circumstances when it is justified? If so, what are those circumstances? Why? When?
What about within marriage? Never justified.
5. In your community, if a man rapes a girl or woman, what tends to happen? What do you think
about this reaction? Sometimes people blame the victim for the choice of their attire and
slut shame. Such reaction is totally unwarranted and they are no better than the rapist.
6. How do you think this issue can be tackled? Tackling is hard because it’s difficult to explain
to each and everyone.
7. Did you ever extend any form of help to the victim/s of domestic violence? if yes, than what
form of? I have tried explaining to them but they are not ready to take action against the
perpetrator.
8. Do you provide any help to the victim or survivor? If yes then what kind of? If no then why? I
haven’t met anyone.
9. Is there anything else you would like us to know?
Name & Sign of the Investigator
Date:
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