Contraceptive Access Survey
Help us understand your experiences and challenges in accessing contraceptive options. Your responses are confidential and will be used to improve services.
Please indicate your age group.
*
Under 18
18-24
25-34
35-44
45 or older
What is your gender?
*
Female
Male
Non-binary/Other
Prefer not to say
Which type(s) of contraceptives are you currently using? (Select all that apply)
*
Birth control pills
Condoms
IUD (Intrauterine Device)
Implant
Injection
Emergency contraception
Natural methods
Not currently using any
Other
How easy is it for you to access contraceptives when needed?
*
Very easy
Somewhat easy
Neutral
Somewhat difficult
Very difficult
What barriers have you experienced when trying to access contraceptives? (Select all that apply)
*
Cost
Lack of information
Limited availability
Transportation issues
Privacy concerns
Cultural or religious reasons
None
Other
Where do you usually obtain information about contraceptives?
*
Healthcare provider
Pharmacy
Internet or social media
Family or friends
School/education programs
Other
How satisfied are you with the contraceptive options available to you?
*
1
2
3
4
5
Have you ever felt judged or uncomfortable when seeking contraceptives from a healthcare provider?
*
Yes
No
Not applicable
Please rate your overall experience with accessing contraceptives.
*
Very poor
1
2
3
4
Excellent
5
1 is Very poor, 5 is Excellent
What improvements would you suggest to make contraceptives more accessible in your area?
If you would like to be contacted for follow-up or to participate in further research, please provide your email address (optional).
example@example.com
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