Mommy Monitor: Maternal Health Survey for Young Parents
With this survey, we would like to learn about the needs of young parents during and after pregnancy, and their experiences accessing maternal healthcare services. Based on the results of this survey, which are kept anonymous, we will be hosting a community roundtable discussion on the experiences of young mothers. To learn more about Mommy Monitor's Youth Subcommittee, please visit:
https://www.mommymonitor.ca/youth-subcommittee
, or email:
youth@mommymonitor.ca
.
* Required
Email address
Your answer
Current City Location
*
Your answer
Age
*
Less than 15 years old
15-20 years old
21-25 years old
26-30 years old
31+ years old
Gender Identity
*
Male
Female
Non-binary
Transgender
Two spirit
Prefer not to say
Other:
Sexual Orientation
*
Bisexual
Gay/lesbian
Heterosexual (Straight)
Prefer not to say
Other:
Number of children
*
None (currently pregnant)
1
2
3
4
Other:
Your ethnicity (check all that apply)
*
Arab/West Asian
Black (African, Caribbean, African American, African Canadian, etc.)
East Asian (Chinese, Korean, Japenese, etc.)
First Nations/Indigenous/ Metis
Hawaiian/Pacific Islander
Latin American
South Asian (Indian, Pakistani, Bangladeshi, etc.)
South East Asian (Vietnamese, Thai, Philipino, Indonesian, etc.)
White/Caucasian
Other:
Required
The ethnicity of your child/children (check all that apply)
*
Arab/West Asian
Black (African, Caribbean, African American, African Canadian, etc.)
East Asian (Chinese, Korean, Japenese, etc.)
First Nations/Indigenous/ Metis
Hawaiian/Pacific Islander
Latin American
South Asian (Indian, Pakistani, Bangladeshi, etc.)
South East Asian (Vietnamese, Thai, Philipino, Indonesian, etc.)
White/Caucasian
Other:
Required
What is your annual household income?
*
Less than $25,000
$25,000 to $49,999
$50,000 to $74,999
$75,000 to $99,999
$100,000 to $124,999
$125,000 or more
What is your primary mode of transportation?
*
Personal car
Public transit
Taxi
Uber or similar ride-sharing service
Biking
Walking
Other:
What type of dwelling do you live in?
*
Social housing (subsidized housing)
Transitional housing
Apartment
Co-operative home
Condominium
House (e.g. townhouse, detached, etc.)
None (no fixed address)
Shelter
Other:
What is the highest level of education that you have completed?
*
Elementary school
High school/secondary school
College diploma
Postsecondary apprenticeship or training certificate
University undergraduate degree
Postgraduate diploma
Graduate degree
Other:
Are you the primary caregiver of your child/children?
*
Yes
No
Is your partner or co-parent actively involved in the upkeep and care of your child/children?
*
Yes
No
What forms of support do you receive at home (e.g. emotional support, financial support, etc.)?
*
Your answer
Please list all of the health concerns you have had (if any) that may impact, or have impacted, your pregnancy, childbirth, and/or parenting.
*
Your answer
Have you ever accessed maternal health and/or parenting progams/organizations?
*
Yes
No
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