Form 1 Fertility Knowledge Survey

ATTACHMENT B
Fertility Knowledge Survey: Female and Male Versions

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 16 [2/20/19] | PAGE 1
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

INTRODUCTION

INTRODUCTION

We are conducting a survey to learn what people your age (15–29 years) know
and believe about pregnancy and having children.

We are conducting a survey to learn what people your age (15–29 years) know
and believe about pregnancy and having children.

Some of the survey questions are about sensitive issues like sex, pregnancy, and
birth control, and may make you uncomfortable. This survey is confidential, and your
answers will be kept private. Your answers to these questions are important to the
study. You may skip any questions you do not wish to answer.

Some of the survey questions are about sensitive issues like sex, pregnancy, and
birth control, and may make you uncomfortable. This survey is confidential, and your
answers will be kept private. Your answers to these questions are important to the
study. You may skip any questions you do not wish to answer. The survey should take
about 20 minutes to complete. We ask you to complete the survey in one sitting,
without taking any breaks, if at all possible. Your input is extremely valuable.

The survey should take about 20 minutes to complete. We ask you to complete
the survey in one sitting, without taking any breaks, if at all possible. Your input is
extremely valuable.
SCREENER QUESTIONS
S1.

What is your sex? By sex we mean the sex you were assigned at birth on your
original birth certificate?
1.
2.

S2.

Female
Male

Have you ever had a medical operation or medical procedure that
makes it impossible for you to get pregnant and have a baby in the
future?
Examples of these include having both tubes tied or blocked (tubal
sterilization or ligation), removal of uterus or womb (hysterectomy),
or removal of both ovaries.
1.
2.

SCREENER QUESTIONS
S1.

What is your sex? By sex we mean the sex you were assigned at birth on your
original birth certificate?
1.
2.

Female
Male

SCREENING QUESTIONS
S2. Have you ever had a medical operation that makes it impossible for you to get a
woman pregnant, such as a vasectomy (cut tubes that carry sperm out of the
testicles) ?
1.
2.

Yes → TERMINATE
No

Yes → TERMINATE
No

SECTION A.
First, we’d like to ask some questions about you.

SECTION A.
First, we’d like to ask some questions about you.

A1. What is your age?

A1. What is your age?

ENTER ___ years

ENTER ___ years

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 16 [2/20/19] | PAGE 2
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

A2. What is the highest grade or year of school you have completed? For example, if
you are currently in 11th grade, the highest grade that you have completed is
10th grade.
1. Grade 8 or less
2. Grade 9
3. Grade 10
4. Grade 11
5. Grade 12 or GED (High school graduate)
6. Technical school
7. Some college but no degree
8. 2-year college degree (Associate degree)
9. 4-year college degree (Bachelor’s degree)
10. Graduate or professional school

A2. What is the highest grade or year of school you have completed? For example, if
you are currently in 11th grade, the highest grade that you have completed is
10th grade.
1. Grade 8 or less
2. Grade 9
3. Grade 10
4. Grade 11
5. Grade 12 or GED (High school graduate)
6. Technical school
7. Some college but no degree
8. 2-year college degree (Associate degree)
9. 4-year college degree (Bachelor’s degree)
10. Graduate or professional school

SECTION B.
This section is about fertility. By fertility, we mean the ability of a woman to get
pregnant and give birth to a child and the ability of a man to get a woman pregnant.

SECTION B.
This section is about fertility. By fertility, we mean the ability of a woman to get
pregnant and give birth to a child and the ability of a man to get a woman pregnant.

For women, infertility means NOT being able to get pregnant after at least 1 year of
trying. Infertility also means the inability to carry a pregnancy to a live birth.

For women, infertility means NOT being able to get pregnant after at least 1 year of
trying. Infertility also means the inability to carry a pregnancy to a live birth.

For men, infertility means NOT being able to get a woman pregnant after at least 1
year of trying.

For men, infertility means NOT being able to get a woman pregnant after at least 1
year of trying.

B1.a. Before starting this survey, how much did you know about female fertility?

B1.a. Before starting this survey, how much did you know about female fertility?

1.
2.
3.
4.

Nothing
A little
A moderate amount
A lot

B1.b. Before starting this survey, how much did you know about male fertility?
1.
2.
3.
4.

Nothing
A little
A moderate amount
A lot

1.
2.
3.
4.

Nothing
A little
A moderate amount
A lot

B1.b. Before starting this survey, how much did you know about male fertility?
1.
2.
3.
4.

Nothing
A little
A moderate amount
A lot

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 16 [2/20/19] | PAGE 3
B2. Below are some statements about fertility. For each statement, please select
True or False. If you do not know the answer, please select Don’t know.
True

False

B2. Below are some statements about fertility. For each statement, please select
True or False. If you do not know the answer, please select Don’t know.

Don’t
Know

True

a. After giving birth, a woman can get pregnant again
before her menstrual period returns.

a. After giving birth, a woman can get pregnant again
before her menstrual period returns.

b. A woman who is breastfeeding cannot get pregnant.

b. A woman who is breastfeeding cannot get pregnant.

c. After her mid-30s, a woman’s chances of getting
pregnant decrease sharply.

c. After her mid-30s, a woman’s chances of getting
pregnant decrease sharply.

d. A woman’s ovaries keep making new eggs from the
time she starts having periods until she stops having
periods (menopause).

d. A woman’s ovaries keep making new eggs from the
time she starts having periods until she stops having
periods (menopause).

e. Smoking or exposure to cigarette smoke has no effect
on women’s fertility.

e. Smoking or exposure to cigarette smoke has no effect
on women’s fertility.

f.

f.

A woman’s weight has no effect on her chances of
getting pregnant.

A woman’s weight has no effect on her chances of
getting pregnant.

g. Use of water-based lubricants or “lube” (K-Y Jelly™ or
Astroglide®) during vaginal sex increases a woman’s
chances of getting pregnant. (A lubricant reduces
friction and irritation during sex.)

g. Use of water-based lubricants or “lube” (K-Y Jelly™ or
Astroglide®) during vaginal sex increases a woman’s
chances of getting pregnant. (A lubricant reduces
friction and irritation during sex.)

h. Taking birth control pills for any length of time has no
effect on a woman’s chances of getting pregnant
once she stops taking them.

h. Taking birth control pills for any length of time has no
effect on a woman’s chances of getting pregnant
once she stops taking them.

i.

Difficulty getting pregnant can be caused by problems
in the man, the woman, or both the man and the
woman.

i.

Difficulty getting pregnant can be caused by problems
in the man, the woman, or both the man and the
woman.

j.

A doctor would consider a 15 to 29-year-old woman
infertile if she had tried to get pregnant but could not
after 1 year of regular, unprotected sex.
(Unprotected sex is when people do NOT use any
birth control method to prevent pregnancy.)

j.

A doctor would consider a 15 to 29-year-old woman
infertile if she had tried to get pregnant but could not
after 1 year of regular, unprotected sex.
(Unprotected sex is when people do NOT use any
birth control method to prevent pregnancy.)

k. Having a healthy lifestyle (regular exercise and a
healthy diet) increases fertility in women and men.

k. Having a healthy lifestyle (regular exercise and a
healthy diet) increases fertility in women and men.

l.

l.

Some sexually transmitted diseases (STDs) can cause
infertility in women and men.

m. A man’s age has no effect on his ability to get a
woman pregnant.

Some sexually transmitted diseases (STDs) can cause
infertility in women and men.

m. A man’s age has no effect on his ability to get a
woman pregnant.

False

Don’t
Know

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 16 [2/20/19] | PAGE 4
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

n. Long-term use of steroids can decrease a man’s
ability to get a woman pregnant.

n. Long-term use of steroids can decrease a man’s
ability to get a woman pregnant.

o. By frequently wearing tight pants or underwear, a
man can reduce his ability to get a woman pregnant.

o. By frequently wearing tight pants or underwear, a
man can reduce his ability to get a woman pregnant.

p. Frequent hot tub use can increase a man’s ability to
get a woman pregnant.

p. Frequent hot tub use can increase a man’s ability to
get a woman pregnant.

B3. If a woman has sex with a man without using any birth control method, at what
point in her menstrual cycle is she most likely to get pregnant?
1.
2.
3.
4.
5.
6.

Right before her period (bleeding) starts
During her period
Right after her period ends
About halfway between two periods
It’s all the same
Don’t know

B3. If a woman has sex with a man without using any birth control method, at what
point in her menstrual cycle is she most likely to get pregnant?
1.
2.
3.
4.
5.
6.

Right before her period (bleeding) starts
During her period
Right after her period ends
About halfway between two periods
It’s all the same
Don’t know

Section C.
The next questions are about your views on having children. It doesn’t matter
whether you have had any children.

Section C.
The next questions are about your views on having children. It doesn’t matter
whether you have had any children.

C1. How important is it to you to have one or more children you give birth to?

C1. How important is it to you to have one or more children that you biologically
father? To biologically father a child means that a man has a child by getting a
woman pregnant. It does not include adopted or stepchildren.

1.
2.
3.
4.
5.
6.

Not at all important
Slightly important
Moderately important
Very important
Extremely important
I have not thought about having children that I give birth to

1.
2.
3.
4.
5.
6.

Not at all important
Slightly important
Moderately important
Very important
Extremely important
I have not thought about biologically fathering children

The next four questions ask your opinion on the ideal ages for women and men to
give birth to or father their first and last child.

The next four questions ask your opinion on the ideal ages for women and men to
give birth to or father their first and last child.

We are not asking about the medically ideal ages. Instead, we want your opinion on
the socially ideal ages for having children in today’s society. There are no right or
wrong answers to these questions.

We are not asking about the medically ideal ages. Instead, we want your opinion on
the socially ideal ages for having children in today’s society. There are no right or
wrong answers to these questions.

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 16 [2/20/19] | PAGE 5
FEMALE QUESTIONNAIRE
C2. What do you think is the ideal age at which a woman should give birth to her
first child?
1.
2.
3.
4.
5.
6.
7.
8.

Under 20
20-24
25-29
30-34
35-39
40-44
45 or over
There is no ideal age

C3. What do you think is the ideal age at which a woman should give birth to her
last child?
1.
2.
3.
4.
5.
6.
7.
8.

Under 20
20-24
25-29
30-34
35-39
40-44
45 or over
There is no ideal age

C4. What do you think is the ideal age at which a man should biologically father his
first child? To biologically father a child means that a man has a child by getting
a woman pregnant. It does not include adopted or stepchildren.
1.
2.
3.
4.
5.
6.
7.
8.

Under 20
20-24
25-29
30-34
35-39
40-44
45 or over
There is no ideal age

MALE QUESTIONNAIRE
C2. What do you think is the ideal age at which a woman should give birth to her
first child?
1.
2.
3.
4.
5.
6.
7.
8.

Under 20
20-24
25-29
30-34
35-39
40-44
45 or over
There is no ideal age

C3. What do you think is the ideal age at which a woman should give birth to her
last child?
1.
2.
3.
4.
5.
6.
7.
8.

Under 20
20-24
25-29
30-34
35-39
40-44
45 or over
There is no ideal age

C4. What do you think is the ideal age at which a man should biologically father his
first child? (To biologically father a child means that a man has a child by getting
a woman pregnant. It does not include adopted or stepchildren.)
1.
2.
3.
4.
5.
6.
7.
8.

Under 20
20-24
25-29
30-34
35-39
40-44
45 or over
There is no ideal age

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 16 [2/20/19] | PAGE 6
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

C5. What do you think is the ideal age at which a man should biologically father his
last child?

C5. What do you think is the ideal age at which a man should biologically father his
last child?

1.
2.
3.
4.
5.
6.
7.
8.

Under 20
20-24
25-29
30-34
35-39
40-44
45 or over
There is no ideal age

1.
2.
3.
4.
5.
6.
7.
8.

Under 20
20-24
25-29
30-34
35-39
40-44
45 or over
There is no ideal age

SECTION D.
The next questions are about your experiences with menstruation, pregnancy, and
childbearing. The information you provide is confidential.

SECTION D.
The next questions are about your experiences with menstruation, pregnancy, and
childbearing. The information you provide is confidential.

D1. How old were you when you had your first menstrual period? If you are not
sure, a best guess is fine.

D1. FEMALE ONLY

1.
2.

ENTER ____ years old
I haven’t had my first period yet [SKIP TO D3]

D2. The length of the menstrual cycle is the number of days starting from the first
day of your period (when bleeding begins) to the first day of your next period.
What is the typical length of your menstrual cycle?
1.
2.
3.
4.
5.
6.

Less than 21 days
21 to 35 days
Longer than 35 days
The length varies from month to month
I currently do not have a period
Don’t know

D3. Are you pregnant now? If you are not sure, a best guess if fine.
1.
2.

D2. FEMALE ONLY

Yes
No

D3. Do you have a spouse or partner who is pregnant with your baby now? If you
don’t know or are not sure, a best guess is fine.
1.
2.

Yes
No

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 16 [2/20/19] | PAGE 7
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

D4. [IF D3 = 1]: Not including this pregnancy, how many times have you been
pregnant in your life? Please count all of your pregnancies, even if they did not
result in the birth of a baby.
D4. [IF D3 = 2]: How many times have you been pregnant in your life? Please count
all of your pregnancies, even if they did not result in the birth of a baby.

D4. [IF D3 = 1]: Not including this pregnancy, how many times have you have you
gotten a woman pregnant in your life? Please count all of your pregnancies,
even if they did not result in the birth of a baby. A best guess is fine.
D4. [IF D3 = 2]: How many times have you gotten a woman pregnant in your life?
Please count all of your pregnancies, even if they did not result in the birth of a
baby. A best guess is fine.

ENTER ___ number

ENTER ___ number

[IF D4 = 0, SKIP TO Section E]

[IF D4 = 0, SKIP TO Section E]

D5. How many children have you ever given birth to?

D5. How many children have you ever biologically fathered? (To biologically father
a child means that a man has a child by getting a woman pregnant. It does not
include adopted or stepchildren)

ENTER ___ number

ENTER ___ number
D6. Have you ever gotten pregnant when you did not intend or mean to get
pregnant? Please count all of your pregnancies, even if they did not result in
the birth of a baby.
1.
2.

D6. Have you ever gotten a woman pregnant when you did not intend or mean to?
Please count all of these pregnancies, even if they did not result in the birth of a
baby.

Yes
No

1.
2.

Yes
No

SECTION E.
In this section, we ask about your relationships.

SECTION E.
In this section, we ask about your relationships.

E1.

E1.

What is your current marital or cohabiting status?
1.
2.
3.
4.
5.

Married
Cohabiting – Not married but living with a partner
Separated from my spouse
Divorced, annulled, or widowed
Never been married---SKIP TO E4

What is your current marital or cohabiting status?
1.
2.
3.
4.
5.

Married
Cohabiting – Not married but living with a partner
Separated from my spouse
Divorced, annulled, or widowed
Never been married---SKIP TO E4

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 16 [2/20/19] | PAGE 8
FEMALE QUESTIONNAIRE
E2.
E2.
E2.

[IF E1 = 1 OR 3]: What sex is your spouse?
[IF E1 = 2]: What sex is your partner?
[IF E1 = 4]: What sex was your (most recent) spouse?
1.
2.
3.

E3.
E3.
E3.

MALE QUESTIONNAIRE
E2.
E2.
E2.

Male
Female
Other

[IF E1 = 1 OR 3]: How old were you when you married your spouse?
[IF E1 = 4]: How old were you when you married your (most recent) spouse?
[IF E1 = 2]: How old were you when you started living with your partner?

[IF E1 = 1 OR 3]: What sex is your spouse?
[IF E1 = 2]: What sex is your partner?
[IF E1 = 4]: What sex was your (most recent) spouse?
1.
2.
3.

E3.
E3.
E3.

Male
Female
Other

[IF E1 = 1 OR 3]: How old were you when you married your spouse?
[IF E1 = 4]: How old were you when you married your (most recent) spouse?
[IF E1 = 2]: How old were you when you started living with your partner?

ENTER ___ years old

ENTER ___ years old

[IF E1 = 1 OR 2, SKIP TO E7]
[IF E1 = 3 OR 4 OR 5, ASK E4]

[IF E1 = 1 OR 2, SKIP TO E7]
[IF E1 = 3 OR 4 OR 5, ASK E4]

E4.

E4.

In this survey, a serious committed relationship means that you and your
partner have agreed to see only each other and no other romantic partners.
This type of relationship may or may not include sexual activity.
Are you currently in a serious committed relationship?
1.
2.

E5.

1.
2.
3.
E6.

Are you currently in a serious committed relationship?

Yes
No—SKIP TO SECTION F

What sex is your romantic partner?

1.
2.
E5.

Male
Female
Other

How old were you when your current romantic relationship began?

In this survey, a serious committed relationship means that you and your
partner have agreed to see only each other and no other romantic partners.
This type of relationship may or may not include sexual activity.

What sex is your romantic partner?
1.
2.
3.

E6.

Yes
No—SKIP TO SECTION F

Male
Female
Other

How old were you when your current romantic relationship began?

ENTER__ years old

ENTER__ years old

E7.

E7.

[If E1 = 1-2]: How old is your current spouse or partner?
[If E4 = 1]: How old is your romantic partner?

ENTER__ years old

[If E1 = 1-2]: How old is your current spouse or partner?
[If E4 = 1]: How old is your romantic partner?

ENTER__ years old

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 16 [2/20/19] | PAGE 9
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

SECTION F.
The next questions are about your feelings and intentions, if any, about having
children that you give birth to in the future. Sometimes what people want and what
they intend are different because they are not able to do what they want. Intentions
refer to what you are realistically going to try to do, and not what you want.

SECTION F.
The next questions are about your feelings and intentions, if any, about having
children that you biologically father in the future. Sometimes what people want and
what they intend are different because they are not able to do what they want.
Intentions refer to what you are realistically going to try to do, and not what you
want.

F1.

F1.

How much thought have you given to whether you want to have [IF D5 > 0
“more”] children that you give birth to in the future, (IF D3=1 SHOW “after this
pregnancy is over)?
1.
2.
3.
4.

F2.

A lot
Some/moderate
A little
Not at all

[IF D3=1] In the future, after this pregnancy is over, do you want to have [IF D5
> 0 “more”] children that you give birth to?
[IF D3=2] In the future, do you want to have [IF D5 > 0 “more”] children that
you give birth to?
1.
2.
3.
4.
5.

Definitely yes
Probably yes
Probably no— SKIP TO CHECKPOINT AT F7
Definitely no— SKIP TO CHECKPOINT AT F7
Don’t know— SKIP TO CHECKPOINT AT F7

How much thought have you given to whether you want to have [IF D5 > 0
“more”] children that you biologically father in the future (IF D3=1 SHOW
“after this pregnancy is over)? (To biologically father means to have a child by
getting a woman pregnant. Do not include intended adoptions or stepchildren.)
1.
2.
3.
4.

F2.

A lot
Some/moderate
A little
Not at all

[IF D3=1] In the future, after this pregnancy is over, do you want to have [IF D5
> 0 “more”] children that you biologically father? (To biologically father means
to have a child by getting a woman pregnant. Do not include intended
adoptions or stepchildren.)
[D3=2] In the future, do you want to have [IF D5 > 0 “more”] children that you
biologically father? (To biologically father means to have a child by getting a
woman pregnant. Do not include intended adoptions or stepchildren.)
1.
2.
3.
4.
5.

Definitely yes
Probably yes
Probably no—SKIP TO CHECKPOINT AT F7
Definitely no—SKIP TO CHECKPOINT AT F7
Don’t know—SKIP TO CHECKPOINT AT F7

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 16 [2/20/19] | PAGE 10
FEMALE QUESTIONNAIRE
F3.

[IF F2=1 OR 2 AND D3=1] After this pregnancy is over, do you realistically
intend to give birth to any [IF D5 > 0 “more”] children in the future?

MALE QUESTIONNAIRE
F3.

[IF F2=1 OR 2 AND D3=1] After your spouse’s or partner’s current pregnancy is
over, do you realistically intend to biologically father any [IF D5 > 0 “more”]
children in the future? (To biologically father means to have a child by getting a
woman pregnant. Do not include intended adoptions or stepchildren.)
[IF F2=1 OR 2 AND D3=2] Do you realistically intend to biologically father any
[IF D5>0 “more”] children in the future? (To biologically father means to have a
child by getting a woman pregnant. Do not include intended adoptions or
stepchildren.)

[IF F2=1 OR 2 AND D3=2] Do you realistically intend to give birth to any [IF
D5>0 “more”] children in the future?
1.
2.
3.
4.
5.

F4.

Definitely yes
Probably yes
Probably no— SKIP TO CHECKPOINT AT F7
Definitely no— SKIP TO CHECKPOINT AT F7
Don’t know— SKIP TO CHECKPOINT AT F7

[IF D3=1] Not counting your current pregnancy, how many [IF D5 > 0, “more”]
children do you realistically intend to give birth to in the future?

1.
2.
3.
4.
5.
F4.

[IF D3 = 1]: Not counting your spouse’s or partner’s current pregnancy, how
many [IF D5 > 0, “more”] children do you realistically intend to biologically
father in the future? (To biologically father means to have a child by getting a
woman pregnant. Do not include intended adoptions or stepchildren.)
[IF D3 = 2]: How many [IF D5 > 0, “more”] children do you realistically intend to
biologically father in the future? (To biologically father means to have a child
by getting a woman pregnant. Do not include intended adoptions or
stepchildren.)

[IF D3 = 2]: How many [IF D5 > 0, “more”] children do you realistically intend to
give birth to in the future?
1.
2.
3.
4.
5.

1
2
3
4 or more
Don’t know— SKIP TO CHECKPOINT AT F7

Definitely yes
Probably yes
Probably no— SKIP TO CHECKPOINT AT F7
Definitely no— SKIP TO CHECKPOINT AT F7
Don’t know— SKIP TO CHECKPOINT AT F7

1.
2.
3.
4.
5.

1
2
3
4 or more
Don’t know— SKIP TO CHECKPOINT AT F7

F5.

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 16 [2/20/19] | PAGE 11
F5. [IF F4=1-4 AND D3=1] Not counting your spouse’s or partner’s current
[IF F4=1-4 AND D3=1] Not counting your current pregnancy,
pregnancy, considering everything in your life, at what age do you expect the
considering everything in your life, at what age do you expect to give
next child that you biologically father to be born? (To biologically father
birth to your next child?]
[IF F4=1-4 AND D3=2 AND D5=0] Considering everything in your life, at what
age do you expect to give birth to your first child?]
[IF F4=1-4 AND D3=2 AND D5>0] Considering everything in your life, at what
age do you expect to give birth to your next child?]

Display response categories based on A1 (age)
If A1<20, show:
1. Under 20
2. 20-24
3. 25-29
4. 30-34
5. 35-39
6. 40-44
7. 45 or over
8. Don’t know
If A1>19, show:
1. Under 20
2. 20-24
3. 25-29
4. 30-34
5. 35-39
6. 40-44
7. 45 or over
8. Don’t know
If A1>24, show:
1. Under 20
2. 20-24
3. 25-29
4. 30-34
5. 35-39
6. 40-44
7. 45 or over
8. Don’t know
[IF F4 = 1, SKIP TO CHECKPOINT AT F7. OTHERWISE ASK F6]

means to have a child by getting a woman pregnant. Do not include intended
adoptions or stepchildren.)
[IF F4=1-4 AND D3=2 AND D5=0] Considering everything in your life, at what
age do you expect the first child that you biologically father to be born? (To
biologically father means to have a child by getting a woman pregnant. Do
not include intended adoptions or stepchildren.)
[IF F4=1-4 AND D3=2 AND D5>0] Considering everything in your life, at what
age do you expect the next child that you biologically father to be born? (To
biologically father means to have a child by getting a woman pregnant. Do
not include intended adoptions or stepchildren.)
Display response categories based on A1 (age)
If A1<20, show:
1. Under 20
2. 20-24
3. 25-29
4. 30-34
5. 35-39
6. 40-44
7. 45 or over
8. Don’t know
If A1>19, show:
1. Under 20
2. 20-24
3. 25-29
4. 30-34
5. 35-39
6. 40-44
7. 45 or over
8. Don’t know
If A1>24, show:
1. Under 20
2. 20-24
3. 25-29
4. 30-34

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 16 [2/20/19] | PAGE 12
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE
5. 35-39
6. 40-44
7. 45 or over
8. Don’t know
[IF F4 = 1, SKIP TO CHECKPOINT AT F7. OTHERWISE ASK F6]

F6. [IF D3=1] Not counting your current pregnancy, considering everything in

your life, at what age do you expect to give birth to your last child?]
[IF D3=2] Considering everything in your life, at what age do you expect
to give birth to your last child?]
Display response categories based on A1 (age)
If A1<20, show:
1. Under 20
2. 20-24
3. 25-29
4. 30-34
5. 35-39
6. 40-44
7. 45 or over
8. Don’t know
If A1>19, show:
1. Under 20
2. 20-24
3. 25-29
4. 30-34
5. 35-39
6. 40-44
7. 45 or over
8. Don’t know
If A1>24, show:
1. Under 20
2. 20-24
3. 25-29
4. 30-34
5. 35-39
6. 40-44
7. 45 or over
8. Don’t know

F6.

[IF D3=1] Not counting your spouse’s or partner’s current pregnancy,
considering everything in your life, at what age do you expect the last
child that you biologically father to be born?]
[IF D3=2] Considering everything in your life, at what age do you expect
the last child that you biologically father to be born?]

Display response categories based on A1 (age)
If A1<20, show:
1. Under 20
2. 20-24
3. 25-29
4. 30-34
5. 35-39
6. 40-44
7. 45 or over
8. Don’t know
If A1>19, show:
1. Under 20
2. 20-24
3. 25-29
4. 30-34
5. 35-39
6. 40-44
7. 45 or over
8. Don’t know
If A1>24, show:
1. Under 20
2. 20-24
3. 25-29
4. 30-34
5. 35-39
6. 40-44
7. 45 or over
8. Don’t know

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 16 [2/20/19] | PAGE 13
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

CHECKPOINT F7: IF (E1=1-2 AND E2=1 or 2) OR (E1=3-5 AND E4=1 AND E5=1 OR
2), ASK F7. OTHERWISE, SKIP TO SECTION G

CHECKPOINT F7: IF (E1=1-2 AND E2=1 OR 2) OR (E1=3-5 AND E4=1 AND E5=1 OR
2), ASK F7. OTHERWISE, SKIP TO SECTION G

F7.

F7.

[IF E1=1-2] Have you ever talked with your spouse or partner about whether
they want to have any (IF D5>0 “more”) children together with you in the
future? Do not include intended adoptions or stepchildren.

[IF E1=1-2] Have you ever talked with your spouse or partner about whether
they want to have any (IF D5>0 “more”) children together with you in the
future? Do not include intended adoptions or stepchildren.

[IF E1=3-5] Have you ever talked with your romantic partner about whether
they want to have any (IF D5>0 “more”) children together with you in the
future? Do not include intended adoptions or stepchildren.
1.
2.
F8.

[IF E1=3-5] Have you ever talked with your romantic partner about whether
they want to have any (IF D5>0 “more”) children together with you in the
future? Do not include intended adoptions or stepchildren.

Yes
No—SKIP TO SECTION G
[IF D3=1 AND (E1=1-2 AND E2=1) OR (E1=3-5 AND E4=1 AND E5=1)] After this
pregnancy is over, does your spouse or partner want to biologically father any
more children with you in the future? (To biologically father means to have a
child by getting a woman pregnant. Do not include intended adoptions or
stepchildren.)
[IF D3=2 AND (E1=1-2 AND E2=1) OR (E1=3-5 AND E4=1 AND E5=1)]:
Does your spouse or partner want to biologically father any [IF D5 > 0 “more”]
children with you in the future? (To biologically father means to have a child by
getting a woman pregnant. Do not include intended adoptions or stepchildren.)
[IF (E1=1-2 AND E2=2) OR (E1=3-5 AND E4=1 AND E5=2)]:
Does your spouse or partner want to give birth to any (more) children in the
future?
1.
2.
3.
4.
5.

Definitely yes
Probably yes
Probably no
Definitely no
Don’t know

1.
2.
F8.

Yes
No—SKIP TO SECTION G
[IF D3=1 AND (E1=1-2 AND E2=2) OR (E1=3-5 AND E4=1 AND E5=2)]: After this
pregnancy is over, does your spouse or partner want to give birth to any more
children that you biologically father in the future? (Do not include intended
adoptions or stepchildren.)
[IF D3=2 AND (E1=1-2 AND E2=2) OR (E1=3-5 AND E4=1 AND E5=2]:
Does your spouse or partner want to give birth to any [IF D5 > 0 “more”]
children that you biologically father in the future? (Do not include intended
adoptions or stepchildren.)
[IF (E1=1-2 AND E2=1) OR (E1=3-5 AND E4=1 AND E5=1)]: Does your spouse or
partner want to biologically father any (more) children in the future? (To
biologically father means to have a child by getting a woman pregnant. Do not
include intended adoptions or stepchildren.)
1.
2.
3.
4.
5.

Definitely yes
Probably yes
Probably no
Definitely no
Don’t know

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 16 [2/20/19] | PAGE 14
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

SECTION G.
Now we’d like to ask you questions about your own fertility status.

SECTION G.
Now we’d like to ask you questions about your own fertility status.

G1.

G1.

Some people have difficulty or are unable to get pregnant. If you tried to get
pregnant, how likely is it that you would have difficulty or be unable to get
pregnant?
1.
2.
3.
4.
5.
6.

G2.

Not at all likely—SKIP TO G3
Somewhat likely
Moderately likely
Very likely
Extremely likely
Don’t know—SKIP TO G3

Some people have difficulty or are unable to father a child. If you tried to get
a woman pregnant, how likely is it that you would have difficulty or be
unable to get her pregnant?
1.
2.
3.
4.
5.
6.

Which of the following are reasons why you think you might have difficulty
or be unable to get pregnant? For each reason, please select Yes if it applies
to you or No if it does not.
Yes

G2.

Not at all likely—SKIP TO G3
Somewhat likely
Moderately likely
Very likely
Extremely likely
Don’t know—SKIP TO G3
Which of the following are reasons why you think you might have difficulty
or be unable to get pregnant? For each reason, please select Yes if it applies
to you or No if it does not.

No

Yes

a.

A doctor has told you that you are infertile or that you might
have difficulty getting pregnant.

a.

A doctor has told you that you are infertile or that you might
have difficulty getting a woman pregnant.

b.

Other women in your family are infertile or have had difficulty
getting pregnant.

b.

Other men in your family are infertile or have had difficulty
getting a woman pregnant.

c.

You have had vaginal intercourse many times with a man
without using a birth control method and you have not gotten
pregnant.

c.

You have had vaginal intercourse many times with a woman
without using a birth control method and you have not gotten
her pregnant.

d.

You do not have menstrual periods or the length of your
menstrual cycle varies from month to month.

d.

Blank

e.

e.

You have had an operation or procedure that makes it
impossible for you to have a baby.

You have had an operation or procedure that makes it
impossible for you to get a woman pregnant.

f.

f.

[IF E1 = 1 OR 2 AND E2 = 1; OR IF E1 = 3, 4, OR 5 AND E4 = 1
AND E5 = 1], ASK G2f. OTHERWISE SKIP TO G3 : Your male
spouse or partner has had an operation that makes it
impossible for him to get you pregnant.

[IF E1 = 1 OR 2 AND E2 = 2; OR IF E1 = 3, 4, OR 5 AND E4 = 1
AND E5 = 2], ASK G2f. OTHERWISE SKIP TO G3. Your female
spouse or partner has had an operation that makes it
impossible for her to get pregnant.

G3.

Have you ever spoken to a doctor, nurse, or other medical care provider
about ways to help you get pregnant?
1.
2.

Yes
No

G3.

No

Have you ever spoken to a doctor, nurse, or other medical care provider
about ways to help you get a woman pregnant?
1.
2.

Yes
No

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 16 [2/20/19] | PAGE 15
FEMALE QUESTIONNAIRE
G4.

MALE QUESTIONNAIRE

Have you, a spouse, or a partner (current or former) ever received from a
doctor, nurse, or other medical care provider any of the following services to
help you get pregnant? Please select Yes or No for each service.
Yes

G4.

Have you, a spouse, or a partner (current or former) ever received from a
doctor, nurse, or other medical care provider any of the following services to
help you get a woman pregnant? Please select Yes or No for each service.

No

Yes

a.

Advice or counseling on fertility

a.

Advice or counseling on fertility

b.

Infertility testing

b.

Infertility testing

c.

Drugs to help ovulation (develop eggs and release them from
ovaries)

c.

Surgery to repair damaged or blocked tubes (female or male)

d.

d.

Surgery to repair damaged or blocked tubes (female or male)

Injecting your sperm into a woman’s uterus (Intrauterine
insemination)

e.

Injecting sperm into your uterus (Intrauterine insemination)

e.

Treatment for low testosterone, low sperm count, or no sperm

f.

Treatment for conditions of the ovaries or uterus (like
polycystic ovary syndrome, endometriosis, or uterine fibroids)

f.

Treatment for varicocele (swollen veins inside the bag of skin
that holds the testicles [scrotum])

g.

Other medical help for female infertility (like other female
pelvic surgery)

g.

Other medical help for male infertility (like problems with
sexual intercourse)

h.

Other medical help for male infertility (like treatment for
low/abnormal sperm count or varicocele)

h.

Other medical help for female infertility (like drugs to induce
ovulation or treatment for polycystic ovary syndrome,
endometriosis, or uterine fibroids)

G5.

How concerned are you about your ability to get pregnant in the future?
1.
2.
3.
4.
5.

Not at all concerned
A little concerned
Somewhat concerned
Very concerned
Extremely concerned

G5.

No

How concerned are you about your ability to biologically father a child in the
future? (To biologically father a child means that a man has a child by getting
a woman pregnant.)
1.
2.
3.
4.
5.

Not at all concerned
A little concerned
Somewhat concerned
Very concerned
Extremely concerned

[(IF E1 = 3, 4, OR 5 AND E4=2) OR E2=3 OR E5=3, SKIP TO G7]
[(IF E1 = 3, 4, OR 5 AND E4=2) OR E2=3 OR E5=3, SKIP TO G7]

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 16 [2/20/19] | PAGE 16
FEMALE QUESTIONNAIRE
G6.

[IF E1=1-2 AND E2=1]: How concerned are you about your spouse’s or
partner’s ability to biologically father a child? (To biologically father a child
means that a man has a child by getting a woman pregnant.)

MALE QUESTIONNAIRE
G6.

[IF E1=1-2 AND E2=1]: How concerned are you about your spouse’s or partner’s
ability to biologically father a child? (To biologically father a child means that a
man has a child by getting a woman pregnant.)

[If E1=1-2 AND E2=2]: How concerned are you about your spouse’s or
partner’s ability to get pregnant?
[If E1=3-5 AND E4=1 AND E5=1]: How concerned are you about your
romantic partner’s ability to biologically father a child? (To biologically father
a child means that a man has a child by getting a woman pregnant.)

[IF E1=3-5 AND E4=1 AND E5=2]: How concerned are you about your romantic
partner’s ability to get pregnant?]
[IF E1=3-5 AND E4=1 AND E5 = 1]: How concerned are you about your romantic
partner’s ability to biologically father a child? (To biologically father a child
means that a man has a child by getting a woman pregnant.)

[IF E1=3-5 AND E4=1 AND E5 = 2]: How concerned are you about your
romantic partner’s ability to get pregnant?]
1.
2.
3.
4.
5.
G7.

[If E1=1-2 AND E2=2]: How concerned are you about your spouse’s or partner’s
ability to get pregnant?]

Not at all concerned
A little concerned
Somewhat concerned
Very concerned
Extremely concerned

Egg freezing is a medical technique that gives a woman the chance to freeze
her eggs when they are most likely to be healthy. She can use her eggs Later,
when she is ready to try to get pregnant, her eggs can then be thawed,
combined with sperm (fertilized), and placed into her uterus.
Before reading this description, had you heard of egg freezing?

1.
2.
3.
4.
5.
G7.

Not at all concerned
A little concerned
Somewhat concerned
Very concerned
Extremely concerned

Egg freezing is a medical technique that gives a woman the chance to freeze
her eggs when they are most likely to be healthy. She can use her eggs Later,
when she is ready to try to get pregnant, her eggs can then be thawed,
combined with sperm (fertilized), and placed into her uterus.
Before reading this description, had you heard of egg freezing?

1. Yes
2. No
3. Not sure
[IF F4 = 1-4, ASK G8. OTHERWISE, SKIP TO SECTION H.

1. Yes
2. No
3. Not sure
[IF F4 = 1-4, ASK G8. OTHERWISE, SKIP TO SECTION H.

G8.

G8.

You answered earlier that you intend to give birth to one or more children in
the future. Please imagine that you had to delay getting pregnant until an
age when you might be worried about being able to get pregnant. How likely
is it that you would consider freezing your eggs for use later?
1.
2.
3.
4.
5.

Not at all likely
Somewhat likely
Moderately likely
Very likely
Extremely likely

You answered earlier that you intend to biologically father one or more
children in the future. Please imagine that you had to delay getting your
spouse or partner pregnant until an age when you might be worried about
her ability get pregnant. How likely is it that you would consider asking her to
freeze her eggs for use later?
1.
2.
3.
4.
5.

Not at all likely
Somewhat likely
Moderately likely
Very likely
Extremely likely

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 16 [2/20/19] | PAGE 17
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

SECTION H.
The next questions ask about your experience with voluntary vaginal intercourse and
birth control. Vaginal intercourse is when a man puts his penis into a woman’s vagina.
Voluntary means that you were not forced to have vaginal intercourse against your
will.

SECTION H.
The next questions ask about your experience with voluntary vaginal intercourse and
birth control. Vaginal intercourse is when a man puts his penis into a woman’s vagina.
Voluntary means that you were not forced to have vaginal intercourse against your
will.

H1.

H1.

At any time in your life, have you ever had vaginal intercourse with a man?
1.
2.

H2.

Yes
No—SKIP TO H7
The very first time you had vaginal intercourse with a man, how old were
you? A best guess is fine.

1.
2.
H2.

ENTER ___years old
H3.

In the last 12 months, how many men, if any, have you had vaginal
intercourse with? Please count every male sexual partner, even those you
had vaginal intercourse with only once.

At any time in your life, have you ever had vaginal intercourse with a
woman?
Yes
No—SKIP TO H7
The very first time you had vaginal intercourse with a woman, how old were
you? A best guess is fine.
ENTER ___years old

H3.

In the last 12 months, how many women, if any, have you had vaginal
intercourse with? Please count every female sexual partner, even those you
had vaginal intercourse with only once.

ENTER ___ number

ENTER ___ number

[IF H3 = 0, SKIP TO H7]

[IF H3 = 0, SKIP TO H7]

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 16 [2/20/19] | PAGE 18
FEMALE QUESTIONNAIRE
H4.

MALE QUESTIONNAIRE

In the last 12 months, have you or any male sexual partner used any of the
birth control methods listed below to prevent pregnancy? For each method,
select Yes or No. Please select Yes even if you used the method only once.
Select Not Sure if you are not sure whether a method was used and Don’t
Know Method if you don’t know a method.

Yes

No

Not
Sure

H4.

In the last 12 months, have you or any male [MALE: female] sexual partner
used any of the birth control methods listed below to prevent pregnancy? For
each method, select Yes or No. Please select Yes even if you used the method
only once. Select Not Sure if you are not sure whether a method was used and
Don’t Know Method if you don’t know a method.

Don’t
Know
Method

Yes

a. Birth control pills

a. Birth control pills

b. Condoms

b. Condoms

c. Shots or injections (Depo-Provera),

c. Shots or injections (Depo-Provera),

d. Patch (Xulane) or vaginal ring (NuvaRing)

d. Patch (Xulane) or vaginal ring (NuvaRing)

e. IUD (Paragard, Mirena, or Skyla)

e. IUD (Paragard, Mirena, or Skyla)

f. Implant (Nexplanon)

f. Implant (Nexplanon)

g. Withdrawal or pulling out

g. Withdrawal or pulling out

h. Fertility awareness method (like
calendar/rhythm, temperature, or
cervical mucus or rhythm method)

h. Fertility awareness method (like
calendar/rhythm, temperature, or cervical
mucus or rhythm method)

i. Male partner’s vasectomy (male
sterilizing operation)

i. Female partner’s sterilizing operation (tubal
ligation) or occlusion (Essure®)

j. Other method

j. Other method

No

Not
Sure

Don’t
Know
Method

[IF IN H4, ITEMS A-J WERE ALL “NO,” “NOT SURE,” OR “DON’T KNOW,” SKIP TO H6.
OTHERWISE, ASK H5.]

[IF IN H4, ITEMS A-J WERE ALL “NO” OR “DON’T KNOW,” SKIP TO H6. OTHERWISE,
ASK H5.]

H5.

H5.

Please think about all the times you had vaginal intercourse in the last 12
months. [IF D3=1 “Before you became pregnant,”] How much of the time did
you or any male sexual partner use a birth control method to prevent
pregnancy? Your best guess is fine.
1.
2.
3.
4.
5.

Never or almost never
Some of the times
About half of the times
Most of the times
Every or almost every time

[IF H5 = 1 OR 2, SKIP TO H7. OTHERWISE, ASK H6.]

Please think about all the times you had vaginal intercourse in the last 12
months. [IF D3=1 “Before your spouse or partner became pregnant,”] How
much of the time did you or any female sexual partner use a birth control
method to prevent pregnancy? Your best guess is fine.
6.
7.
8.
9.
10.

Never or almost never
Some of the times
About half of the times
Most of the times
Every or almost every time

[IF H5 = 4 OR 5, SKIP TO H7. OTHERWISE, ASK H6.]

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 16 [2/20/19] | PAGE 19
H6.

[IF H4_a-j all=2 or 4]: You answered that in the last 12 months, you had
voluntary vaginal intercourse and did not use any birth control methods to
prevent pregnancy. What are the reasons you did not use any method? For
each reason below, please select Yes if it applies to you or No if it does not.

H6.

[IF H4_a-j all=2 or 4]: You answered that in the last 12 months, you had
voluntary vaginal intercourse and did not use any birth control methods to
prevent pregnancy. What are the reasons you did not use any method? For
each reason below, please select Yes if it applies to you or No if it does not.

[IF H4_a-j any combination of=(2,3,4) OR (2 and 3) OR (3 and 4): You
answered that in the last 12 months, you had voluntary vaginal intercourse
and did not or were not sure that you used any birth control methods to
prevent pregnancy. What are the reasons you may not have used any
method? Please select Yes or No for each reason.

[IF H4_a-j any combination of=(2,3,4) OR (2 and 3) OR (3 and 4): You
answered that in the last 12 months, you had voluntary vaginal intercourse
and did not or were not sure that you used any birth control methods to
prevent pregnancy. What are the reasons you may not have used any
method? Please select Yes or No for each reason.

[IF H5=1] You answered that in the last 12 months, you had voluntary vaginal
intercourse but never or almost never used any birth control methods to
prevent pregnancy. What are the reasons you did not use a method more
often? For each reason below, please select Yes if it applies to you or No if it
does not.

[IF H5=1] You answered that in the last 12 months, you had voluntary vaginal
intercourse but never or almost never used any birth control methods to
prevent pregnancy. What are the reasons you did not use a method more
often? For each reason below, please select Yes if it applies to you or No if it
does not.

[IF H5=2] You answered that in the last 12 months, you had voluntary vaginal
intercourse but used birth control methods to prevent pregnancy some of
the times. What are the reasons you did not use a method more often? For
each reason below, please select Yes if it applies to you or No if it does not.

[IF H5=2] You answered that in the last 12 months, you had voluntary vaginal
intercourse but used birth control methods to prevent pregnancy some of
the times. What are the reasons you did not use a method more often? For
each reason below, please select Yes if it applies to you or No if it does not.

[IF H5=3] You answered that in the last 12 months, you had voluntary vaginal
intercourse but used birth control methods to prevent pregnancy about half
of the times. What are the reasons you did not use a method more often?
For each reason below, please select Yes if it applies to you or No if it does
not.

[IF H5=3] You answered that in the last 12 months, you had voluntary vaginal
intercourse but used birth control methods to prevent pregnancy about half
of the times. What are the reasons you did not use a method more often?
For each reason below, please select Yes if it applies to you or No if it does
not.

[IF H5=4] You answered that in the last 12 months, you had voluntary vaginal
intercourse and used birth control methods to prevent pregnancy most of
the times. What are the reasons you did not use a method every time? For
each reason below, please select Yes if it applies to you or No if it does not.

[IF H5=4] You answered that in the last 12 months, you had voluntary vaginal
intercourse and used birth control methods to prevent pregnancy most of
the times. What are the reasons you did not use a method every time? For
each reason below, please select Yes if it applies to you or No if it does not.

Yes

No

Yes

a.

I didn’t think I could get pregnant

a.

I didn’t think I could get my partner pregnant

b.

II didn’t think my partner could get me pregnant

b.

I didn’t think my partner could get pregnant

c.

I didn’t expect to have sex

c.

I didn’t expect to have sex

d.

I didn’t really care or mind if I got pregnant

d.

I didn’t really care or mind if I got my partner pregnant

e.

I was trying to get pregnant

e.

I was trying to get my partner pregnant

f.

My male partner did not want me to use a birth control
method

f.

My female partner did not want me to use a birth control
method (like condoms, withdrawal, or vasectomy)

g.

I was worried about the side effects of birth control
methods

g.

I was worried about the side effects of birth control
methods

No

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 16 [2/20/19] | PAGE 20
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

h.

I was concerned that using a birth control method would
affect my ability to get pregnant in the future

h.

I was concerned that using a birth control method would
affect my partner’s ability to get pregnant in the future

i.

I didn’t like any of the birth control methods available

i.

I didn’t like any of the birth control methods available

j.

I couldn’t afford the birth control method I wanted

j.

I couldn’t afford the birth control method I wanted

H7.

In the last 12 months, have you or any sexual partner used condoms (male or
female) to prevent sexually transmitted diseases (STDs)?
1.
2.
3.

H8.

H7.

Yes
No
Don’t know or not sure

In the last 12 months, have you or any sexual partner used condoms (male or
female) to prevent sexually transmitted diseases (STDs)?
1.
2.
3.

Following are three statements about birth control methods and women’s
fertility. For each statement, please select True, False, or Don’t Know. Select
Don’t Know Method if you don’t know the birth control method.

True

False

H8.

Yes
No
Don’t know or not sure
Following are three statements about birth control methods and women’s
fertility. For each statement, please select True, False, or Don’t Know. Select
Don’t Know Method if you don’t know the birth control method.

Don’t
Don’t know
know method

Don’t
Don’t know
True False know method

a. A woman can use an IUD even if she has
never had a child. An IUD (intrauterine
device) is a tiny device placed into a
woman’s uterus to prevent pregnancy.

a. A woman can use an IUD even if she has never
had a child. An IUD (intrauterine device) is a
tiny device placed into a woman’s uterus to
prevent pregnancy.

b. Women who stop using an IUD take longer
to get pregnant than women who have
not used an IUD.

b. Women who stop using an IUD take longer to
get pregnant than women who have not used
an IUD.

c. Taking birth control pills is riskier to a
woman’s health than having a baby
(including pregnancy, labor, and delivery).

c. Taking birth control pills is riskier to a woman’s
health than having a baby (including
pregnancy, labor, and delivery).

Section J.
The next questions ask about health care and your health.

Section J.
The next questions ask about health care and your health.

J1.

J1.

Is there a place that you usually go to for general health care such as when you
are sick, need advice about your health, or need routine medical care?
1.
2.

Yes
No

Is there a place that you usually go to for general health care such as when you
are sick, need advice about your health, or need routine medical care?
1.
2.

Yes
No

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 16 [2/20/19] | PAGE 21
FEMALE QUESTIONNAIRE
J2.

Is there a place that you usually go when you need sexual or reproductive
health care such as family planning, gynecological or breast exams, pregnancy
testing, sexually transmitted disease (STD) testing, or related counseling or
information?
1.
2.

J3.

MALE QUESTIONNAIRE
J2.

Is there a place that you usually go when you need sexual or reproductive
health care such as sexually transmitted disease (STD) testing, birth control, or
related counseling or information?
1.
2.

Yes
No

In the past 12 months, did you receive any of the following services from a
doctor, nurse, or other medical care provider? Please select Yes or No for each
service.
Yes

J3.

Yes
No

In the past 12 months, did you receive any of the following services from a
doctor, nurse, or other medical care provider? Please select Yes or No for each
service.

No

Yes

a.

General or routine physical exam

a.

General or routine physical exam

b.

Visit for an illness or injury

b.

Visit for an illness or injury

c.

STDs or HIV: Testing, treatment, information, or advice

c.

STDs or HIV: Testing, treatment, information, or advice

d.

Birth control: Method/prescription, checkup/test,
information, or advice

d.

Birth control: Method, information, or advice

e.

Other sexual/reproductive care (like Pap smear or pelvic
exam, pregnancy test, or prenatal or postnatal care)

e.

Other sexual/reproductive health care (like testicular or penis
exam)

J4.

In the past 12 months, was there a time that you did not have any health
insurance or coverage?

J4.

In the past 12 months, was there a time that you did not have any health
insurance or coverage?

1. Yes
2. No -- SKIP TO J6
3. Unsure or Don’t know-- SKIP TO J6
J5. In how many of the past 12 months were you without coverage?

1. Yes
2. No -- SKIP TO J6
3. Unsure or Don’t know-- SKIP TO J6
J5. In how many of the past 12 months were you without coverage?

ENTER _____Number of months

ENTER _____Number of months

J6.

J6.

In general, how is your health?
1.
2.
3.
4.
5.

Excellent
Very good
Good
Fair
Poor

In general, how is your health?
1.
2.
3.
4.
5.

Excellent
Very good
Good
Fair
Poor

No

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 16 [2/20/19] | PAGE 22
FEMALE QUESTIONNAIRE
J7.

How tall are you? A best guess is fine.

MALE QUESTIONNAIRE
J7.

How tall are you? A best guess is fine.

ENTER _____FEET [RANGE 3-7]
ENTER _____INCHES [RANGE 0-11]

ENTER _____FEET [RANGE 3-7]
ENTER _____INCHES [RANGE 0-11]

J8.

J8.

How much do you weigh? A best guess is fine.

How much do you weigh? A best guess is fine.

ENTER ____Pounds

ENTER ____Pounds

The next questions ask about alcohol and tobacco use.

The next questions ask about alcohol and tobacco use.

J9.

J9.

During the past 30 days, on how many days (if any) did you have at least one
drink of any alcoholic beverage such as beer, wine, a malt beverage, or liquor?
If you do not drink alcohol or did not drink alcohol in the past 30 days, enter 0.

During the past 30 days, on how many days (if any) did you have at least one
drink of any alcoholic beverage such as beer, wine, a malt beverage, or liquor?
If you do not drink alcohol or did not drink alcohol in the past 30 days, enter 0.

ENTER ____Number of DAYS [ALLOW ONLY 0-30]
[IF J9 = 0, SKIP TO J11].

ENTER ____Number of DAYS [ALLOW ONLY 0-30]
[IF J9 = 0, SKIP TO J11].

J10. During the past 30 days, on the days when you drank, about how many drinks
did you drink per day on average? One drink is equal to a 12-ounce beer, a 5ounce glass of wine, or a drink with one shot (1.5 ounces) of liquor.

J10. During the past 30 days, on the days when you drank, about how many drinks
did you drink per day on average? One drink is equal to a 12-ounce beer, a 5ounce glass of wine, or a drink with one shot (1.5 ounces) of liquor.

ENTER_____ (Average number of drinks per day)

ENTER_____ (Average number of drinks per day)

J11.

During the past 30 days, on how many days (if any) did you smoke cigarettes? If
you do not smoke cigarettes or did not smoke a cigarette in the past 30 days,
enter 0.
ENTER ____Number of DAYS [ALLOW ONLY 0-30]
[IF J11 = 0, SKIP TO J13]

J11. During the past 30 days, on how many days (if any) did you smoke cigarettes? If
you do not smoke cigarettes or did not smoke a cigarette in the past 30 days,
enter 0.
ENTER ____Number of DAYS [ALLOW ONLY 0-30]
[IF J11 = 0, SKIP TO J13]

J12. During the past 30 days, on the days you smoked, about how many cigarettes
did you smoke per day on average?

J12. During the past 30 days, on the days you smoked, about how many cigarettes
did you smoke per day on average?

1.
2.
3.
4.

Less than 1 cigarette per day
1 to 9 cigarettes per day
10 to 20 cigarettes per day (1/2 to 1 pack)
More than 20 cigarettes per day

1.
2.
3.
4.

Less than 1 cigarette per day
1 to 9 cigarettes per day
10 to 20 cigarettes per day (1/2 to 1 pack)
More than 20 cigarettes per day

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 16 [2/20/19] | PAGE 23
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

J13. In the last 12 months, have you been told by a doctor or other medical care
provider that you had chlamydia or gonorrhea?
1.
2.
3.

Yes
No
Don’t know or not sure

J13. In the last 12 months, have you been told by a doctor or other medical care
provider that you had chlamydia or gonorrhea?
1.
2.
3.

Yes
No
Don’t know or not sure

SECTION K.
Now we’d like to ask about information you have received about your fertility or your
plans and goals for having or not having children.

SECTION K.
Now we’d like to ask about information you have received about your fertility or your
plans and goals for having or not having children.

K1. Has a doctor, nurse, or other medical care provider ever talked with you about
the following topics? Please select Yes or No for each topic.

K1. Has a doctor, nurse, or other medical care provider ever talked with you about
the following topics? Please select Yes or No for each topic.

Yes

No

Yes

a. Your ability to get pregnant and give birth to a child.

a. Your ability to get a woman pregnant

b. Your plans or goals for having or not having children

b. Your plans or goals for having or not having children

c. How you could improve your health before a pregnancy

c. How you could improve your health before trying to get a
woman pregnant

d. The impact of diet or lifestyle factors (like smoking, alcohol, or
drug use) on your ability to get pregnant
e. The impact of sexually transmitted diseases on your ability to
get pregnant
f. How your age could affect your ability to get pregnant
g. Factors affecting the ability of your spouse or partner to get
you pregnant

d. The impact of diet or lifestyle factors (like smoking, alcohol, or
drug use) on your ability to get a woman pregnant
e. The impact of sexually transmitted diseases on your ability to
get a woman pregnant
f. How your age could affect your ability to get a woman
pregnant
g. Factors affecting the ability of your spouse or partner to get
pregnant and have a child

No

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 16 [2/20/19] | PAGE 24
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

K2. Have you ever gotten information about your fertility or your plans and goals
for having or not having children from any of the following sources? For each
source, please select Yes or No.
SOURCES

Yes

No

K2. Have you ever gotten information about your fertility or your plans and goals
for having or not having children from any of the following sources? For each
source, please select Yes or No.
SOURCES

Yes

No

a. A friend or acquaintance

a. A friend or acquaintance

b. Your spouse or partner (current or past)

b. Your spouse or partner (current or past)

c. Your mother or father

c. Your mother or father

d. A brother, sister, or other relative

d. A brother, sister, or other relative

e. A doctor, nurse, or other medical care provider

e. A doctor, nurse, or other medical care provider

f. A teacher or counselor

f. A teacher or counselor

g. A religious leader

g. A religious leader

h. A U.S. government website

h. A U.S. government website

i. Other internet or social media

i. Other internet or social media

j. A fertility tracking app on your phone

j. A fertility tracking app on your phone

k. Books, magazines, or pamphlets

k. Books, magazines, or pamphlets

l. Television or radio

l. Television or radio

K3. From the list of information sources below, please identify the three
sources you would trust the most to give you the most accurate information
about your fertility or your plans and goals for having or not having children.
Enter the item letter for the first, second, and third most trusted sources.
Enter item letter
SOURCES

K3. From the list of information sources below, please identify the three sources
you would trust the most to give you the most accurate information about
your fertility or your plans and goals for having or not having children. Enter
the item letter for the first, second, and third most trusted sources.
Enter item letter
SOURCES

a. A friend or acquaintance
b. Your spouse or partner (current or past)
c.

Your mother or father

d. A brother, sister, or other relative

_____ First most trusted source
_____ Second most trusted source

e. A doctor, nurse, or other medical care provider
f.

A teacher or counselor

a. A friend or acquaintance
b. Your spouse or partner (current or past)
c.

Your mother or father

d. A brother, sister, or other relative
e. A doctor, nurse, or other medical care provider

_____ Third most trusted source

f.

A teacher or counselor

g. A religious leader

g. A religious leader

h. A U.S. government website

h. A U.S. government website

i.

Other internet or social media (like Facebook
or Twitter)

i.

Other internet or social media (like Facebook or
Twitter)

j.

A fertility tracking app on your phone

j.

A fertility tracking app on your phone

k. Books, magazines, or pamphlets

k. Books, magazines, or pamphlets

l.

l.

Television or radio

Television or radio

_____ First most trusted source
_____ Second most trusted source
_____ Third most trusted source

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 16 [2/20/19] | PAGE 25
FEMALE QUESTIONNAIRE

MALE QUESTIONNAIRE

SECTION L.
Here are some final questions about you.

SECTION L.
Here are some final questions about you.

L1.

L1.

Currently, how important is religion in your daily life?
1.
2.
3.

L2.

Are you Hispanic or Latino, or of Spanish origin?
1.
2.

L3.

L5.

L2.

L3.

Straight (heterosexual)
Lesbian or gay (homosexual)
Bisexual
Don’t know or not sure

Which of the following best describes your current employment status?
1. Working full time for pay (35 hours or more per week)
2. Working part time for pay (less than 35 hours per week)
3. Working in an unpaid job such as an internship or volunteer
4. Not working—on temporary layoff from a job or looking for work
5. Not working—student
6. Not working—stay-at-home spouse, partner, or caregiver
7. Not working—other

L6. How much is the combined income of all members of YOUR HOUSEHOLD for the
PAST 12 MONTHS?
Please include your income PLUS the income of all members living in your household
(including cohabiting partners and armed forces members living at home). Please

White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
Other, specify: __________

Which of the following best describes you?
1.
2.
3.
4.

L5.

Yes
No

What is your race? Select all that apply.
1.
2.
3.
4.
5.
6.

L4.

Very important
Moderately important
Not important

Are you Hispanic or Latino, or of Spanish origin?
1.
2.

White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
Other, specify: __________

Which of the following best describes you?
1.
2.
3.
4.

1.
2.
3.

Yes
No

What is your race? Select all that apply.
1.
2.
3.
4.
5.
1.

L4.

Very important
Moderately important
Not important

Currently, how important is religion in your daily life?

Straight (heterosexual)
Lesbian or gay (homosexual)
Bisexual
Don’t know or not sure

Which of the following best describes your current employment status?
1. Working full time for pay (35 hours or more per week)
2. Working part time for pay (less than 35 hours per week)
3. Working in an unpaid job such as an internship or volunteer
4. Not working—on temporary layoff from a job or looking for work
5. Not working—student
6. Not working—stay-at-home spouse, partner, or caregiver
7. Not working—other

L6. How much is the combined income of all members of YOUR HOUSEHOLD for the
PAST 12 MONTHS?
Please include your income PLUS the income of all members living in your household
(including cohabiting partners and armed forces members living at home). Please

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 16 [2/20/19] | PAGE 26
FEMALE QUESTIONNAIRE
count income BEFORE TAXES and from all sources (such as wages, salaries, tips, net
income from a business, interest, dividends, child support, alimony, and Social
Security, public assistance, pensions, or retirement benefits).

MALE QUESTIONNAIRE
count income BEFORE TAXES and from all sources (such as wages, salaries, tips, net
income from a business, interest, dividends, child support, alimony, and Social
Security, public assistance, pensions, or retirement benefits).

1. 1 = Less than $5,000
2. $5,000 to $7,499
3. $7,500 to $9,999
4. $10,000 to $12,499
5. $12,500 to $14,999
6. $15,000 to $19,999
7. $20,000 to $24,999
8. $25,000 to $29,999
9. $30,000 to $34,999
10. $35,000 to $39,999
11. $40,000 to $49,999
12. $50,000 to $59,999
13. $60,000 to $74,999
14. $75,000 to $84,999
15. $85,000 to $99,999
16. $100,000 to $124,999
17. $125,000 to $149,999
18. $150,000 to $174,999
19. $175,000 to $199,999
20. $200,000 to $249,999
21. $250,000 or more
L7.

[IF A1>17] Including yourself, how many people are 18 years of age or older
and currently live in your household at least 50% of the time? Please include
unrelated individuals (such as roommates), and also include those now away
traveling, away at school, or in a hospital.
[IF A1<18] How many people are 18 years of age or older and currently live in
your household at least 50% of the time? Please include unrelated individuals
(such as roommates), and also include those now away traveling, away at
school, or in a hospital.

ENTER _____Number of people 18 years of age or older who currently live in your
household at least 50% of the time

1. Less than $5,000
2. $5,000 to $7,499
3. $7,500 to $9,999
4. $10,000 to $12,499
5. $12,500 to $14,999
6. $15,000 to $19,999
7. $20,000 to $24,999
8. $25,000 to $29,999
9. $30,000 to $34,999
10. $35,000 to $39,999
11. $40,000 to $49,999
12. $50,000 to $59,999
13. $60,000 to $74,999
14. $75,000 to $84,999
15. $85,000 to $99,999
16. $100,000 to $124,999
17. $125,000 to $149,999
18. $150,000 to $174,999
19. $175,000 to $199,999
20. $200,000 to $249,999
21. $250,000 or more
L7.

[IF A1>17] Including yourself, how many people are 18 years of age or older
and currently live in your household at least 50% of the time?
Please include unrelated individuals (such as roommates), and also include
those now away traveling, away at school, or in a hospital.
[IF A1<18] How many people are 18 years of age or older and currently live in
your household at least 50% of the time?
Please include unrelated individuals (such as roommates), and also include
those now away traveling, away at school, or in a hospital.

ENTER _____Number of people 18 years of age or older who currently live in your
household at least 50% of the time

FEMALE & MALE VERSIONS OF THE FERTILITY KNOWLEDGE SURVEY | IRB/PRA VERSION 16 [2/20/19] | PAGE 27
FEMALE QUESTIONNAIRE
L8.

[IF A1>17] How many people are 17 years of age or younger and currently live
in your household at least 50% of the time? Include babies and small children.
If none, enter “0”.
[IF A1<18] Including yourself, how many people are 17 years of age or younger
and currently live in your household at least 50% of the time? Include babies
and small children. If none, enter “0”.

MALE QUESTIONNAIRE
L8.

[IF A1>17] How many people are 17 years of age or younger and currently live
in your household at least 50% of the time? Include babies and small children.
If none, enter “0”.
[IF A1<18] Including yourself, how many people are 17 years of age or younger
and currently live in your household at least 50% of the time? Include babies
and small children. If none, enter “0”.

ENTER _____Number of people 17 years of age or younger who currently live in your
household at least 50% of the time

ENTER _____Number of people 17 years of age or younger who currently live in your
household at least 50% of the time

Thank you very much for taking part in this survey!

Thank you very much for taking part in this survey!

Please click here to see the correct answers to the fertility knowledge questions:
[PLACEHOLDER FOR CLIENT PROVIDED LINK WITH CORRECT ANSWERS]

Please click here to see the correct answers to the fertility knowledge questions:
[PLACEHOLDER FOR CLIENT PROVIDED LINK WITH CORRECT ANSWERS]

For more information about reproductive health, pregnancy, infertility, or
contraception, please go to the following websites of the U.S. Department of Health
and Human Services Centers for Disease Control and Prevention (CDC):

For more information about reproductive health, pregnancy, infertility, or
contraception, please go to the following websites of the U.S. Department of Health
and Human Services Centers for Disease Control and Prevention (CDC):

Reproductive Health: https://www.cdc.gov/reproductivehealth/index.html

Reproductive Health: https://www.cdc.gov/reproductivehealth/index.html

Pregnancy: https://www.cdc.gov/pregnancy/index.html

Pregnancy: https://www.cdc.gov/pregnancy/index.html

Infertility: https://www.cdc.gov/reproductivehealth/infertility/index.htm

Infertility: https://www.cdc.gov/reproductivehealth/infertility/index.htm

Contraception: https://www.cdc.gov/reproductivehealth/contraception/index.htm

Contraception: https://www.cdc.gov/reproductivehealth/contraception/index.htm