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Motherhood Questionnaire
Our goal is to interrogate the state of black motherhood and uncover common threads and experiences that are impacting black mothers across the nation. Completing this survey will help our research team collect data that will lead to making recommendations for change for black moms. 
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Demographic Information
This section is regarding your background information. Please note when we say mom adjacent woman, we are referring to women who do not have biological children but are raising or helping raise children in some capacity.
I identify as...
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I am a...
How many living children do you have?
What city and state do you live in?
Please select your age range
Please select your marital status
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Please select you highest level of education
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Who lives in your home
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Where do you live?
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Which best describes where you live
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Employment status
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Please select your annual income level
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Your Experience

This section is about your general experience as a black mother or woman raising children. Please note when we say mom adjacent woman, we are referring to women who do not have biological children but are raising or helping raise children in some capacity.
Have you ever lost a child?

Can you describe your experiences as a Black mother or mom adjacent woman?

What challenges have you faced in balancing motherhood with other responsibilities?

How have historical and current societal factors impacted your life as a Black mother/mom adjacent woman?

How do you feel about the intersection of your identities as a Black woman and a mother?

Social and Cultural Factors



How do societal views and expectations influence your parenting style?

Who are your main sources of support as a Black mother/mom adjacent woman?

Are there specific cultural practices or traditions you incorporate into your parenting?

What challenges or opportunities have you encountered raising Black children in today's society?

Systemic Barriers



This section is regarding those systems that may or may not exist for you that impact how your parent
I feel I have access to resources I need in my community
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What resources do you feel are missing?

Do you feel systemic racism affected your access to healthcare, education, or housing?

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Have you experienced any difficulties in accessing maternal and child health services?
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Have you encountered biases or discrimination when interacting with healthcare providers or other professionals?

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What economic challenges have you faced as a Black mother/mom adjacent woman, if at all?
What economic advantages have you faced as a black mother/mom adjacent woman, if at all?
What are some of the best resources you have access to?

Mental Health and Well-being


This section is regarding mental health and well being of you as a woman

Have you ever experienced post-partum depression?

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If yes, did your healthcare provider provide resources?
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Have you experienced the loss of a child (e.g., through stillbirth, miscarriage, illness, or tragedy)
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If yes, did your healthcare provider provide resources?
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Do you know a black mother who has ever lost a child?
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Do you feel the stress of motherhood, combined with the challenges of racism, impacted your mental health?

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If yes, please describe how or why

Have you experienced any specific mental health issues, such as postpartum depression or anxiety?

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If yes what do you use to combat the negative impact
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Have you encountered barriersin accessing mental health services?

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If yes, please describe
If you could describe the state of black motherhood in one word what it be
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