Breastfeeding Contraception Survey Form
Please complete this brief survey about breastfeeding and contraception. Your responses are anonymous and will help us understand current experiences and perspectives.
What is your age group?
*
Please Select
Under 20
20–24
25–29
30–34
35–39
40 and above
Are you currently breastfeeding?
*
Yes
No
How familiar are you with contraception options suitable during breastfeeding?
*
1
2
3
4
5
Which contraception methods do you believe are safe to use while breastfeeding? (Select all that apply)
*
Condoms
Progestin-only pill (mini-pill)
Intrauterine device (IUD)
Implant
Natural family planning
Not sure
Other
Which contraception method(s) are you currently using, if any? (Select all that apply)
*
None
Condoms
Progestin-only pill (mini-pill)
Intrauterine device (IUD)
Implant
Natural family planning
Other
How easy is it for you to access contraception while breastfeeding?
*
1
2
3
4
5
Please indicate your agreement with the following statements about contraception and breastfeeding.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I feel confident choosing contraception while breastfeeding.
1
2
3
4
5
I have received enough information about safe contraception during breastfeeding.
6
7
8
9
10
I believe contraception can affect breastfeeding.
11
12
13
14
15
Healthcare providers have discussed contraception options with me.
16
17
18
19
20
What are the main factors influencing your choice of contraception while breastfeeding? (Select up to 3)
*
Effectiveness
Safety for breastfeeding
Ease of use
Cost
Availability
Partner’s preference
Other
Have you experienced any barriers to using contraception while breastfeeding?
*
Yes
No
If you would like to share any additional comments about breastfeeding and contraception, please do so below.
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