1. Survey for Providers on Proper Pregnancy Care for Muslim Patients

This survey is intended for Muslim women in New York State.

Responses to this survey will be analyzed, and a report prepared for medical professionals working with pregnant women and their families.

Please share your personal stories, so that providers can learn from them. If you do not have a personal story to share, please provide input or pieces of information you feel important for providers to understand.

* 1. Contact Information (For follow-up if necessary):

Country of Origin Questions will be used to help determine major cultural groups within our service area.

* 2. What do you want to tell providers about:
Modesty when dealing with Muslim patients

* 3. What do you want to tell providers about:
Communication when dealing with Muslim patients

(Please cover how providers can figure out who the decision maker is within the family unit).

* 4. What do you want to tell providers about:
About Miscarriage; About Abortion

* 5. What do you want to tell providers about:
Home/Herbal Remedies in Pregnancy


(Did you use any herbal remedies when pregnant? If so, what?)

* 6. What do you want to tell providers about:
Testing for HIV/AIDS, and Sexually Transmitted Diseases's (for instance herpes or gonorrhea)

* 7. What do you want to tell providers about:
How you feel about birth control and birth control methods

* 8. What would be important to you during a prenatal care visit?

* 9. What do you want to tell providers about:
How my religious beliefs should be honored during prenatal care and childbirth.

* 10. Comments/Questions/Concerns

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