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:, or email:
Email address
Current City Location *
Age *
Gender Identity *
Sexual Orientation *
Number of children *
Your ethnicity (check all that apply) *
The ethnicity of your child/children (check all that apply) *
What is your annual household income? *
What is your primary mode of transportation? *
What type of dwelling do you live in? *
What is the highest level of education that you have completed? *
Are you the primary caregiver of your child/children? *
Is your partner or co-parent actively involved in the upkeep and care of your child/children? *
What forms of support do you receive at home (e.g. emotional support, financial support, etc.)? *
Please list all of the health concerns you have had (if any) that may impact, or have impacted, your pregnancy, childbirth, and/or parenting. *
Have you ever accessed maternal health and/or parenting progams/organizations? *
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