If you have never been pregnant and never wanted to be pregnant, please circle 0 and skip to the next section, Section

0

1. Please indicate if you have ever been pregnant and fill in any other blanks that apply:

    a. I have been pregnant________ times.

    b. _______________of my pregnancies were planned.

    c. _______________of my pregnancies were unplanned

    d. _______________of my pregnancies resulted in live births.

    e. _______________of my pregnancies ended in spontaneous abortion or miscarriage.

    f. _______________of my pregnancies ended in an arranged abortion.

    g. _______________of my babies were given up for adoption.

 

2. At some time in my life, trying to become pregnant enhanced my sexual pleasure and/or satisfaction.

 

Strongly Disagree                              Strongly Agree                                  N/A
1	2	3	4	5	6	7	0

 

 

 

3. At some time in my life, I had difficulty becoming pregnant when I wanted to.

Strongly Disagree                               Strongly Agree                                 N/A
1	2	3	4	5	6	7	0

 

 

 

4. At some time in my life, trying to become pregnant diminished my sexual pleasure and/or satisfaction.

 

Strongly Disagree                                Strongly Agree                                N/A
1	2	3	4	5	6	7	0

 

 

 

5. At some time in my life, I have undergone medical testing and/or interventions for fertility.

____Yes

____No

 

 

If you have never been pregnant, please skip to Question 8.

6. In my life, becoming pregnant has resulted in the following (check all that apply):

    ___I married someone I had not previously planned to marry.

    ___I married someone I never would have chosen to marry otherwise.

    ___I married someone at the time who was not the biological father.

    ___I had a baby in marriage before I felt ready.

    ___The biological father knew about the pregnancy but did not remain with me through it.

    ___The biological father never knew about the pregnancy.

    Other _____________________________

    None of the above_____________

7a. I am pregnant now._____Yes ______ No____Not sure

7b. I have a baby I currently breastfeed. ____Yes ______ No

7c. I have sometime had a baby delivered by Cesarean section. _____Yes ____ No

8. During, or as a result of, partner sex during the last 3 months I have felt (check all that apply):

    Desirous of becoming pregnant._____Yes ______No

    Concerned or fearful that I might not become pregnant.______Yes ________No

    Concerned or fearful that I was pregnant._____Yes _____ No

    Concerned or fearful that I might become pregnant._____Yes ______No

    None of the above._______________

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