Mothers of Avalon Survey
Please fill out this anonymous survey for research to support Newfoundland and Labrador’s Mothers and Caregivers.
Age
0 - 17
18 - 24
25 - 34
35 - 44
45 - 54
55+
What is your gender?
Female
Male
Non Binary
Which role describes you best?
Mother
Father and Primary Caregiver
Primary Caregiver / Guardian
Other
Which ethnicity do you belong to?
Indigenous / Aborignal
Innu
Mi’kmaq
Black
Inuit
Arab
Chinese
South Asian
Filipino
Other visible minority
Caucasian
Other
Are you from Newfoundland
Yes
No
Current Location
St. John’s
Logy Bay / Middle Cove / Outer Cove / Torbay
CBS
Mount Pearl
St. Phillips/Portugal Cove
Elsewhere on the Avalon Peninsula
Elsewhere in Newfoundland
Labrador
Other
How many children (18 and under) do you have?
1
2
3
4
5
6+
My children are over 18
Education
Less than HS diploma
High school
Some college
Bachelors degree
College Diploma
Higher education
Type of Employment
Student
Unemployed (looking for a job)
Unemployed (not looking for a job)
Self-employed
Full-time employment
Part-time employment
Household Income
$0 - $24,999
$25,000 - $49,999
$50,000 - $74,999
$75,000 - $99,999
$100,000 - $149,999
$150,000 or more
Marital Status
Single
Married
Divorced
Widowed
Do you have a partner that lives with you?
Yes
No
On a scale of 1 - 10 how supported do you feel by your partner? (1 being not at all supported, 10 being very supported)
1
2
3
4
5
6
7
8
9
10
Do you have any mental health issues or diagnoses?
Yes
No
Prefer not to say
Do you have any substance abuse or addiction issues?
Yes
No
Prefer not to say
Do you have any majorly debilitating health issues?
Yes
No
Prefer not to say
Do you have a disability?
Yes
No
Prefer not to say
Do any of your children have a disability?
Yes
No
Prefer not to say
Do any of your children have any mental health issues or diagnoses?
Yes
No
Prefer not to say
Do any of your children have any majorly debilitating health issues?
Yes
No
Prefer not to say
What are your biggest struggles in motherhood? Please tick all that apply.
Postpartum Depression
Breastfeeding
Sleep
Lack of self care
Financial Stress
Personal health issues
Child’s health issues
Lack of family support
Lack of support from other mothers
Unsupportive partner or no partner
Substance Abuse
Other
What are you in need of the most? Please tick all that apply.
Counselling / Therapy Services
Diapers
Tampons, pads, or sanitary products
Breastfeeding support
Formula
Food
Clothing
Toys
Financial advice
Transportation
Friendship / supportive relationships
Access to more Health Care Services
Other
What are your interests?Please tick all that apply.
Art and craft
Music
Health / Wellness
Fitness / Sport
Cooking / Baking
Nature / outdoor activities
Mindfulness
Gardening
Foraging
Beauty
Self Care
Other
Which of these activities would you be interested in doing?Please tick all that apply.
Mommy and Me Art Class
Relaxation Art Class
Self Care Sessions ( haircuts, manicures, massages etc.)
Cooking Class / Meal Prep
Excursions out of Town
Foraging / Berry Picking
Female Empowerment Talks
Fitness classes
Socializing event (bbqs, picnics, potlucks, holiday parties)
Youth enrichment classes
Other
If you wish, please give us any additional details on how you struggle in motherhood, or anything mentioned above, Let us know HOW we can HELP you.
Feel free to leave your contact information for us to chat with you further.
Submit Survey
Should be Empty: