Sample of a questionaire on teenage pregnancy?


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Michelle Fernandes Profile

first name:

Date of birth:



1. At what age did you become sexually active?

2. What is your current situation with pregnancy?

3. How did you come to be pregnant? Was the pregnancy planned?

4. Tell me, in your own words, about your sex education. Include here how important you think the following are in terms of this: Teachers, school nurses, school ‘sex talks’ from visiting advisors, friends, parents and relatives, the media, or anything else you feel relevant.

5. Do you feel that the sex education you received at school was sufficient?

6. How much do you feel you know about the following, 1 being none at all, 5 being substantial knowledge:
the pill
the morning-after pill
other contraceptive methods
stis and stds

7. Do you know the whereabouts of your local family planning clinic. Did you know this before you fell pregnant?

8. A do you know of anywhere in your local area where free condoms are available to young people? List these.

B have you ever used this service? If not, state why, or why you think others might not.

9. As a teenage mother, how would you plan to finance your baby?

10. Are you or a partner currently working? If yes, where do you see yourself in terms of occupation?

skilled non-manual
skilled manual
partly skilled
armed forces
don’t know

11. Similarly, where do you see your direct family in terms of these?

12. Tell me about your educational qualifications.

Are there any other comments you would like to add?

Thank you for taking part.

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