Perinatal & Early Years Survey Question Title * 1. Please provide your postal code. Question Title * 2. Are you currently a YMCA Member? Yes No Question Title * 3. What is your primary language? English French Other (please specify) Question Title * 4. Do you self-Identify as Indigenous? Yes No Question Title * 5. Are you a newcomer to Canada? Yes No Question Title * 6. What is your marital status? Married Single Common Law Divorced Widow Separated Question Title * 7. What is your annual household income? Less than 25,000 26,000 - 50,000 51,000 - 75,000 76,000 - 100,000 More than 100,000 Prefer not to answer Question Title * 8. Which of the following categories best describes your employment status? Employed, working full-time Employed, working part-time Maternity Leave Paternity leave Casual Unemployed Retired Question Title * 9. How many immediate family members do you have? Question Title * 10. How many children are you parent or guardian for and live in your household (aged 5 or younger only)? None 1 2 3 4 More than 4 Question Title * 11. How old are your your children? (Check all that apply) Under 1 years old 1 years old 2 years old 3 years old 4 years old 5 years old I don't have any children Question Title * 12. Are you currently pregnant or expecting? Yes No Question Title * 13. Do you currently engage in any early year's programs or services? No Yes Question Title * 14. There are opportunities and services that meet the needs of my family for: Free and/or inexpensive access to prenatal care and support Free and/or inexpensive access to postnatal care and support Free and/or inexpensive access to play-based programs and activities for children under 5 years Opportunities to engage with other families in a safe and supportive environment Free and/or inexpensive access to mental health services (inc. post-partum depression, anxiety, etc) Strongly agree Strongly agree Free and/or inexpensive access to prenatal care and support Strongly agree Free and/or inexpensive access to postnatal care and support Strongly agree Free and/or inexpensive access to play-based programs and activities for children under 5 years Strongly agree Opportunities to engage with other families in a safe and supportive environment Strongly agree Free and/or inexpensive access to mental health services (inc. post-partum depression, anxiety, etc) Agree Agree Free and/or inexpensive access to prenatal care and support Agree Free and/or inexpensive access to postnatal care and support Agree Free and/or inexpensive access to play-based programs and activities for children under 5 years Agree Opportunities to engage with other families in a safe and supportive environment Agree Free and/or inexpensive access to mental health services (inc. post-partum depression, anxiety, etc) Neither agree nor disagree Neither agree nor disagree Free and/or inexpensive access to prenatal care and support Neither agree nor disagree Free and/or inexpensive access to postnatal care and support Neither agree nor disagree Free and/or inexpensive access to play-based programs and activities for children under 5 years Neither agree nor disagree Opportunities to engage with other families in a safe and supportive environment Neither agree nor disagree Free and/or inexpensive access to mental health services (inc. post-partum depression, anxiety, etc) Disagree Disagree Free and/or inexpensive access to prenatal care and support Disagree Free and/or inexpensive access to postnatal care and support Disagree Free and/or inexpensive access to play-based programs and activities for children under 5 years Disagree Opportunities to engage with other families in a safe and supportive environment Disagree Free and/or inexpensive access to mental health services (inc. post-partum depression, anxiety, etc) Strongly disagree Strongly disagree Free and/or inexpensive access to prenatal care and support Strongly disagree Free and/or inexpensive access to postnatal care and support Strongly disagree Free and/or inexpensive access to play-based programs and activities for children under 5 years Strongly disagree Opportunities to engage with other families in a safe and supportive environment Strongly disagree Free and/or inexpensive access to mental health services (inc. post-partum depression, anxiety, etc) Question Title * 15. In my community: I have a support network of friends and family I have access to reliable transportation I have access to medical care I have access to reliable food services I have access to safe and stable housing I have access to prenatal and postnatal support Strongly agree Strongly agree I have a support network of friends and family Strongly agree I have access to reliable transportation Strongly agree I have access to medical care Strongly agree I have access to reliable food services Strongly agree I have access to safe and stable housing Strongly agree I have access to prenatal and postnatal support Agree Agree I have a support network of friends and family Agree I have access to reliable transportation Agree I have access to medical care Agree I have access to reliable food services Agree I have access to safe and stable housing Agree I have access to prenatal and postnatal support Neither agree nor disagree Neither agree nor disagree I have a support network of friends and family Neither agree nor disagree I have access to reliable transportation Neither agree nor disagree I have access to medical care Neither agree nor disagree I have access to reliable food services Neither agree nor disagree I have access to safe and stable housing Neither agree nor disagree I have access to prenatal and postnatal support Disagree Disagree I have a support network of friends and family Disagree I have access to reliable transportation Disagree I have access to medical care Disagree I have access to reliable food services Disagree I have access to safe and stable housing Disagree I have access to prenatal and postnatal support Strongly disagree Strongly disagree I have a support network of friends and family Strongly disagree I have access to reliable transportation Strongly disagree I have access to medical care Strongly disagree I have access to reliable food services Strongly disagree I have access to safe and stable housing Strongly disagree I have access to prenatal and postnatal support Question Title * 16. Please describe any perinatal and early years programs or services that you believe would benefit you and your family. Done
