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* 1. Are you a woman or a man?

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* 2. What country do you practise in?

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* 3. What type of setting do you practise in?

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* 4. How many years have you practised as a midwife

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* 5. Are you a midwife or do you know a midwife who has positively impacted women’s rights? If yes, please tell us the story below.

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* 6. Are you a midwife or do you know a midwife who has positively impacted midwives’ rights? If yes, please tell us the story below.

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* 7. ICM recognises that many midwives work in places where their rights are violated as women and as midwives. We want to hear about your experiences. Please tick all of the below that apply to you.

  Yes No
I feel safe traveling to work
I am not concerned about my physical safety when I am at work (e.g. no violence)
I feel respected by my medical colleagues
My salary reflects my qualifications and experience
I consistently receive my salary on time
I receive the same salary as my male colleagues who have the same role as me
I have the same opportunity for promotion as my male colleagues
In my workplace women are represented in leadership roles
I have been sexually harassed at work (if you ticked yes please answer question 8)
I have been bullied (undermined, shamed, insulted) at work (if you ticked yes please answer question 8)

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* 8. If you feel comfortable to do so, please describe what happened to you.

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* 9. Did you report what happened to you? If yes, please describe what actions were taken or not taken to address your concerns.

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* 10. Is there anything else you would like to share with us at this time?

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* 11. If you feel comfortable please leave your contact details below or the details of the midwife who you have identified above. We will contact you if we want further information or to showcase your/their wonderful work. 

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