Survey – Youth
Teenage Pregnancy – Abortion
1. When you discovered you were pregnant, how old were you? ___________
2. Were your parent(s) told about your pregnancy? [Please Tick]
o Yes
o No
3. Did you tell your partner? [Please Tick]
o Yes
o No
[If no for Number 3 then skip to number 5]
4. Did the father of the baby stay with you after he was told about the pregnancy? [Please Tick]
o Yes
o No
5. Did you have a friend or your partner to support you physically and emotionally during this time? [Please Tick]
o Yes
o No
6. What made you decide about abortion? [Please Tick as many that apply to you]
o Couldn’t financially afford a baby
o It wasn’t the right time
o Family wouldn’t accept the baby
o Would have gotten kicked out of home
o Other ______________________________________
7. Did you do background research about abortion procedure before your decision? [Please Tick]
o Yes
o No
8. How did you find out about the clinic? [Please Tick]
o Internet
o Yellow pages
o School or around the neighbourhood
o Friends
o Other________________
9. Do you think it was the right decision for you? [Please Tick]
o Yes
o No
10. Do you have any advice for teenagers with the same circumstances as you were?
Teenage Pregnancy – Abortion
1. When you discovered you were pregnant, how old were you? ___________
2. Were your parent(s) told about your pregnancy? [Please Tick]
o Yes
o No
3. Did you tell your partner? [Please Tick]
o Yes
o No
[If no for Number 3 then skip to number 5]
4. Did the father of the baby stay with you after he was told about the pregnancy? [Please Tick]
o Yes
o No
5. Did you have a friend or your partner to support you physically and emotionally during this time? [Please Tick]
o Yes
o No
6. What made you decide about abortion? [Please Tick as many that apply to you]
o Couldn’t financially afford a baby
o It wasn’t the right time
o Family wouldn’t accept the baby
o Would have gotten kicked out of home
o Other ______________________________________
7. Did you do background research about abortion procedure before your decision? [Please Tick]
o Yes
o No
8. How did you find out about the clinic? [Please Tick]
o Internet
o Yellow pages
o School or around the neighbourhood
o Friends
o Other________________
9. Do you think it was the right decision for you? [Please Tick]
o Yes
o No
10. Do you have any advice for teenagers with the same circumstances as you were?