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 FEMALE QUESTIONNAIRE - PAGE 6(b) 

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PREGNANCY: PAST PREGNANCIES
626.  Have you had any miscarriages?
None / don't know
Probably, or too early to be sure
Yes, early in pregnancy
Yes, one later than second month of pregnancy
Two or more after second month
627.  Have you had any ectopic pregnancies?
No / Don't know
It has been suggested but not confirmed
One for sure
Two for sure
More than two
628.  How many intentional abortions have you had?
None / don't know
One
Two
Three
Four or more
629.  How many successful pregnancies have you had?
None / don't know
One
Two
Three
Four or more
630.  If you have had children, how old were you at the birth of your first child?
I don't have children / don't know
Under 17
17-20
21-35
Over 35
631.  Are you currently nursing (breastfeeding) a child?
Don't know
No
Yes, but unable to produce enough milk for 1 child
Yes, successfully nursing 1 child
Yes, successfully nursing 2 or more children
632.  How much of the last 5 years have you spent nursing a child?
Don't know
None
Less than 1 year
1 to 3 years
More than 3 years

Add any additional information here for the questions above:

Please mention the question number(s) if possible.

 


 


GLOSSARY

Ectopic Pregnancy (Ectopic Pregnancies, Tubal Pregnancies, Tubal Pregnancy)
A pregnancy in which the egg becomes fertilized but cannot pass into the uterus to grow. Instead, the egg usually attaches in the fallopian tube, which connects the ovary to the uterus. The fertilized egg cannot grow normally in the fallopian tube. This type of pregnancy is life-threatening to the mother, and almost always fatal to her fetus. It is the leading cause of pregnancy-related death in African-American women.

Miscarriage (Miscarriages, Spontaneous Abortion)
The expulsion of a fetus before it is able to survive outside of the womb.





























 
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