Exit Community Survey Question Title Question Title Question Title Question Title Question Title Question Title * 1. What is your age range? 15-19 20-23 24-29 30-35 36-40 40+ Question Title * 2. Do you identify as a Black/African American mother? Yes No Question Title * 3. Are you currently pregnant? Yes No Question Title * 4. If you're pregnant, how far along are you in your pregnancy? First trimester Second trimester Third trimester N/A Question Title * 5. Have you given birth within the last 12 months? Yes No Question Title * 6. Do you reside in LA County? Yes No Question Title * 7. Have you or are you currently experiencing any of the following mental health concerns? Postpartum depression Depression Anxiety Stress Grief Other (please specify) Question Title * 8. Do you know someone who has experienced any of the following mental health concerns? Postpartum depression Depression Anxiety Stress Grief Other (please specify) Question Title * 9. Have you or are you currently experiencing any of the following physical health concerns? Preeclampsia High blood pressure Gestational diabetes Brest cancer Diabetes High cholesterol Other (please specify) Question Title * 10. Have you or are you currently experiencing any financial challenges? Credit issues No savings Job loss Struggling to pay bills Other (please specify) Question Title * 11. Do you have health insurance? Yes No Question Title * 12. If insured, are you underinsured? Yes No N/a Question Title * 13. Do you know your maternity leave rights i.e. FMLA? Yes No Question Title * 14. Do you (or did you) feel cared for or valued during childbirth and pre-natal visits? Yes No Question Title * 15. If so, please explain why. Question Title * 16. During your prenatal care visits, how long did your provider spend with you? Less than five minutes Up to 10 minutes 10 to 20 minutes 20 minutes and more N/a Question Title * 17. Did you (do you) feel rushed during your prenatal care visits? Yes No N/a Question Title * 18. Based on your prenatal visits, how prepared and comfortable did/do you feel about giving birth? Not comfortable Slightly comfortable Neutral Mostly comfortable Very comfortable N/a Question Title * 19. Do you have a mental health provider? Yes No Question Title * 20. Is your mental health provider Black/African American? Yes No N/a Question Title * 21. Do you have a birthing provider? Yes No N/a Question Title * 22. What type of birthing provider do you have? Doctor Obgyn Doula Midwife N/a Other (please specify) Question Title * 23. Is your birthing provider Black/African American? Yes No N/a Question Title * 24. If you have a doula or midwife, please explain why you chose this type of provider? Question Title * 25. Do you prefer being helped by a Black/African American provider? Yes No Question Title * 26. Are you comfortable with being helped by a non-Black provider that is empathetic, genuine and aware of your challenges as a Black mother? Yes No Question Title * 27. If not, please explain why. Question Title * 28. What are some characteristics you would like to see in a healthcare provider? Question Title * 29. Do you prefer a homeopathic (non-traditional/Eastern modalities/natural), pharmaceutical (traditional/Western medicine), or holistic (homeopathic, pharmaceutical and mental wellness) approach to your healthcare needs? Homeopathic Pharmaceutical Holistic N/a Other (please specify) Question Title * 30. Please explain why. Question Title * 31. Do you know what resources are available to you during and after pregnancy? Yes No N/a Question Title * 32. Are the any other comments or concerns you’d like to share regarding 1) mental health, 2) gaps in services/service delivery, and/or 3) ways to serve our community that are culturally appropriate and holistic. Done