Menstrual Health Baseline-Endline Survey Form
Menstrual Health Baseline-Endline Survey Form
What is your age group?
*
Please Select
10-14
15-19
20-24
25-29
30-34
35+
What is your current education level?
*
Please Select
No formal education
Primary
Secondary
Tertiary/College/University
Other
How would you describe your menstrual cycle?
*
Regular (predictable)
Irregular (unpredictable)
Not sure
Prefer not to say
Which products do you typically use during menstruation? (Select all that apply)
*
Disposable pads
Reusable pads
Tampons
Menstrual cup
Cloth
Other
How easy is it for you to access menstrual products when you need them?
*
Very easy
Somewhat easy
Somewhat difficult
Very difficult
In the past 3 months, how often did you miss school or work because of your period?
*
Never
Once
2-3 times
4 or more times
How comfortable do you feel discussing menstruation with the following people?
*
Rows
Very comfortable
Somewhat comfortable
Somewhat uncomfortable
Very uncomfortable
Mother or female guardian
1
2
3
4
Father or male guardian
5
6
7
8
Friends
9
10
11
12
Teachers
13
14
15
16
Healthcare providers
17
18
19
20
How confident do you feel in your knowledge about menstrual health?
*
1
2
3
4
5
How would you rate your ability to manage your period comfortably and hygienically?
*
1
2
3
4
5
Please share any comments or experiences related to your period that you feel are important for this survey.
Submit Survey
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