Birth Control Information Survey
Please complete this survey to help us understand knowledge, attitudes, and experiences regarding birth control methods.
What is your age?
*
What is your gender?
*
Female
Male
Non-binary/Other
Prefer not to say
What is your current relationship status?
*
Single
In a relationship
Married/Partnered
Divorced/Separated
Other
Which of the following birth control methods are you currently using? (Select all that apply)
*
Birth control pills
Condoms
Intrauterine device (IUD)
Implant
Injections
Patch or ring
Natural methods
None
Other
How would you rate your knowledge about birth control methods?
*
1
2
3
4
5
Please indicate your level of agreement with the following statements about birth control methods:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Birth control methods are safe to use.
1
2
3
4
5
Birth control is easily accessible.
6
7
8
9
10
Using birth control is important for family planning.
11
12
13
14
15
I feel comfortable discussing birth control with my partner.
16
17
18
19
20
Where did you first learn about birth control methods?
*
Healthcare provider
School/education
Internet/social media
Family/friends
Other
What are the main reasons you use (or do not use) birth control? (Select all that apply)
*
To prevent pregnancy
Health reasons
Religious or cultural beliefs
Lack of access
Side effects concerns
Partner preference
Cost
Other
How satisfied are you with your current birth control method?
*
Not satisfied
1
2
3
4
Very satisfied
5
1 is Not satisfied, 5 is Very satisfied
What challenges or barriers have you experienced in accessing or using birth control methods? (Select all that apply)
*
Cost
Lack of information
Side effects
Cultural or religious reasons
Partner or family opposition
Limited access to healthcare
Other
Please share any additional comments or suggestions about birth control information or access:
Submit Survey
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