Infant Feeding Survey for the MS Coast
This survey is open to ANY family (no matter how or what you fed your baby) that has given birth or lived in Hancock, Harrison or Jackson County of MS. Please complete one survey per household. We know that every baby has a unique feeding story and they don't always fit into multiple choice - feel free to use the "other" option to better explain or the the open question at the end of the survey to tell us more.
Please help us better understand why families in our area may not breastfeed or breastfeed as long as they would like to. The survey will close on October 16. All participants will be entered to win a $20 Amazon Gift Card (1 winner will be announced after the survey closes).
Any questions or feedback can be directed to the South MS Breastfeeding Coalition at
If you have multiple children, please answer the questions thinking about the child born most recently. What was your child's year of birth? *
At the time of your baby's birth, where did you live? (City only) *
Where was your baby born? (Name of hospital or indicate home birth) *
During your pregnancy, did your care provider (OB or midwife) talk to you about breastfeeding? *
Before your baby arrived, what was your feeding plan? *
If you planned on using baby formula, why?
If you started breastfeeding, were you able to provide breastmilk for as long as you wish you could?
Clear selection
Why did you stop breastfeeding or begin feeding with formula/donor milk in addition to breastfeeding?
Please tell us more about why you had to stop breastfeeding or had to start supplementing (adding in donor milk or formula).
Did/Do you feel supported in your feeding (whether it was breast or formula) by the following people? (Mark all that apply) *
Are you aware (have you heard of) of any of these breastfeeding resources in our area? *
Did/Do YOU USE any of these breastfeeding resources in our area? *
What prevented/prevents your from getting help with breastfeeding? *
If you needed/need a pump, did you have access to one? *
What would have/could made a positive difference for you in feeding your baby?
Please share any other thoughts you have (more about your personal story, your other children, or ideas for what could be done to encourage more families to breastfeed or help them breastfeed longer)
If you would like to be entered for a chance to win a $20 Amazon gift card, please provide your phone number or email address.
If you would like to be added to our email list, please provide your email address here. We would love your help in implementing some of the ideas we gather.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy