Survey Form

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Multicultural Maternal Health

The objective of the survey is to gain insight on people’s awareness of Maternal Mortality Rate, and openness to conversation and education on maternal care.

"*" indicates required fields

What is your age range?
How many pregnancies have you had?*
What racial group is more likely to suffer from maternal mortality?*
What age group has the highest mortality rate:*
Have you, or know anyone that has, experienced any complications during pregnancy?*
I’m comfortable asking questions about my pregnancy at every doctor's visit.*
My doctor encourages and addresses every question I have about my pregnancy.*
I am familiar with the CDC guidelines that could help for a healthy pregnancy.*
Is maternal mortality (pregnancy related death) something that we should be concerned about?*
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Unfortunately, your child/baby is over 3 months old and doesn't meet the eligibility criteria for this program. However, we recommend exploring other programs that may be better suited for their current age.