Reproductive Healthcare Practitioner Assessment
In a time of escalated healthcare concerns, we want to assist in making sure that BIPOC folk in our state are receiving the most comprehensive and culturally sensitive care possible. Your participation in this survey is invaluable to that effort. The information gathered from this survey will be used to help drive efforts to improve gynecological healthcare in Georgia. Thank you for participating

**For this survey practitioner refers to anyone in the facility you frequent that provides care. This includes physicians, physicians assistants, nurses, nurse practitioners, and all other medical service providers in the space.
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Age *
Occupation/Professional Title *
Gender Identity *
Racial Identity (Check all that apply)
County In Which You Provide Care *
In your practice do you show patients how to check for breast cancer? *
In your practice are patients informed about the full spectrum of birth control methods? *
Do you provide education on ways to prevent the transmission of STIs and HIV/AIDS? *
Have you ever witnessed a patient whose questions or concerns were ignored or minimized in the process of seeking gynecological care? Please describe the situation. *
What was the race and gender identity of the practitioner from the above answer? What was the  race and gender identity of the patient?
Were there any repercussions for the practitioner?
Clear selection
Have you ever witnessed someone being given care or treatment that they did not consent to? What was the procedure? Was it in a hospital setting? If so which one? *
What was the race and gender identity of the practitioner from the above answer? What was the  race and gender identity of the patient?
Were there any repercussions for the practitioner?
Clear selection
Have you ever witnessed someone being pressured by a healthcare practitioner to seek medication or treatment they didn't need? *
If you chose yes for the above question, what was the race and gender identity of the practitioner? What was the  race and gender identity of the patient?
Were there any repercussions for the practitioner?
Clear selection
Is there a medical care facility that you will not work in due to the interactions you witnessed between a practitioner and patient there? Name the Facility and Practitioner if you are comfortable. *
Have you ever witnessed someone being intimidated by a practitioner in the process or accessing gynecological care? Please describe the interaction. *
What was the race and gender identity of the practitioner from the above answer? What was the  race and gender identity of the patient?
Were there any repercussions for the practitioner?
Clear selection
Have you ever felt pressured by a superior to provide a treatment or administer a drug to a patient without their full knowledge or consent? *
If you chose yes for the above question, what was the race and gender identity of the practitioner? What was the  race and gender identity of the patient?
Have you ever participated in a racial bias training? Was it required by your institution? *
Do you believe that healthcare providers should be required participate in racial bias trainings? *
If you are willing to further our research into racism in gynecology by sharing your full story, please provide your name and contact information.
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