Name:
Country:
State:
Age:
Describe your relationship with your parents (before you became pregnant):
Did your parents or school discuss sex or birth control with you before you became sexually active?
If yes, how old were you?
Hobbies/Special Talents:(Outside of being a Mother)
Were you working when you became pregnant? What type of work? (business, retail, etc...)
Do you work outside of the home now that you are a Mother?
Were you still in school when you became pregnant? If yes, what grade? If no, please explain why.
Are you in school now? (Please indicate year Middle, High, College)
If you've graduated, what is your degree? (High School Diploma, GED, Cert, AA, BA, BS, Masters)
How old were you during your first pregnancy?
Did you keep the child? Abort? Give up for adoption?:
Do you raise the child alone? If no, who helps?
Was it the first time you had sex?
Were you and the father a couple?
Are you still together?
Did you marry the father as a result of the pregnancy?
If you're not together, is the father involved? How is he involved? (Visitation, Child Support)
Were you using protection against pregnancy and STDs? If yes, what kind?
Were you using the protection PROPERLY? (condoms, bc pill)
Did you know there is a WRONG way to put a condom on and that doing so can cause it to break!?
If you were not using protection, please explain why?
Did you think, "It won't happen to me" or "I can't get pregnant"?
If yes to last question, looking back, why do you think you believed that?
Did you have any more children before your 21st birthday?
How many children do you have?
Was your first pregnancy emotionally difficult?
Were there any medical problems during your first pregnancy or delivery?
What was/is the most difficult experience as a young mother?
How did your family react to your pregnancy?
Where did/do you live? (On your own, with your parents, with child's Father's parents)
Did your family help support you? The baby? Emotionally, financially, or both?
Did the Father's family help support you? The baby? Emotionally, financially, or both?
Did/do you need Public Assistance? (Financial Aid, Food Stamps, Medical)
How did/does that make you feel?
How long did you need Public Assistance?
Were you able to keep a social life/relationships with your friends?
Do you feel accepted by people your age?
Do you find it difficult to have things in common with people your own age?
Do you feel accepted by Mothers that are older than you?
Do you feel like you have it harder than people your own age without children?
Do you regret having your child so young? If yes, why?
What is the hardest thing to deal with being a young mother.
What are your personal goals? (goals for yourself as an individual NOT as a mother)
Have your goals changed since you became a Mother?
Do you feel that reaching your goals will be more difficult now that your a teen parent? Why?
What would you tell a school age girl that wanted to get pregnant at such a young age?
How do you think being a Young Mother has changed you?
How do you think society looks upon teen pregnancy?
Why do you think there are so many teen parents?
List 3 Pro's to being a teen Mother?
List 3 Con's to being a teen Mother?:
What are the most important qualities a good Mother should have?
Any Other Comments You Wish To Make?
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