Help Us Build Better Kits! Take Our Birth Control Survey

First Name *

Last Name *

Age

Race

Gender

Email

Phone 1

Address Line 1

Address Line 2

City

State/Province

Zip/Postal Code

Country

1. Contraceptive Awareness & Access

Is this your 1st, 2nd, or 3rd+ time getting (ordering or receiving) a kit? *

First time

Second time

Third time or more

How did you receive it? *

In person

Online-Mailed/Shipped

If you received your kit in person, where did you get it? *

Health Fair/Community Event

School or Campus

Community Clinic/Health Center

Other

How was your overall experience getting your kit (whether by mail or in person)? *

Private, safe, and respectful

Neutral

Uncomfortable

What would make receiving sexual health supplies even better in the future? (Select all that apply)

More discreet packaging

More local pick-up locations

Plain-language instructions/guides

Other

Have any of these made it hard for you to get contraceptives in your community? (Select all that apply) *

Lack of privacy/worried family or neighbors will see me

Items locked up in stores

Didn't know where to go

Uncomfortable talking to clinic staff

Cost

Lack of transportation

None of these

Which of these methods are you familiar with, and which could you explain how to use to a friend? (Check all that apply)

Condoms (External/Internal): *

Heard of it

Could explain how to use to a friend

Have not heard of it

Birth Control Pill: *

Heard of it

Could explain how to use to a friend

Have not heard of it

Emergency Contraception (Plan B) *

Heard of it

Could explain how to use to a friend

Have not heard of it

The Shot (Depo-Provera) *

Heard of it

Could explain how to use it to a friend

Have not heard of it

IUD or Implant: *

Heard of it

Could explain how to use it to a friend

Never heard of it

Patch or Vaginal Ring: *

Heard of it

Could explain how to use it to a friend

Never heard of it

Fertility Awareness/Cycle Tracking: *

Heard of it

Could explain how to use it to a friend

Never heard of it

Kit Items and Feedback

We want to know how helpful the items in your kit were! For each item listed below, please pick the single option that best describes what you learned or how you plan to use it.

External Condoms *

Already know how to use and plan to use

Learned something new and plan to use

Learned something new but won't use

Won't use/dont need

Lubricant *

Already know how to use and plan to use

Learned something new and plan to use

Learned something new but won't use

Won't use/don't need

Dental Dams *

Already know how to use and plan to use

Learned something new and plan to use

Learned something new but won't use

Won't use/dont need

Finger Cots *

Already know how to use and plan to use

Learned something new and plan to use

Learned something new, but won't use

Won't use/ don't need

Educational Guides: *

Found helpful

Learned something new

Didn't read

Did this kit help build your confidence in practicing safe sex or finding resources? *

Yes, much more confident

Somewhat more confident

No change

3. Next Steps & Q&A

How have you connected—or how would you like to connect—with Teen Health Mississippi? (Select all that apply) *

I follow THMS on social media (or plan to)

Sign me up for the Teen Health Mississippi email list for updates and resources!

I checked out birth control & contraceptive resources on the Choose Your Method site.

I shared kit materials or resources with a friend.

Sign me up for the Youth Action Network (YAN) to receive updates to get involved.

I attended (or plan to attend) a Teen Health Mississippi workshop.

None / Not at this time

What’s ONE question you still have about sexual health or contraceptives? (May be answered anonymously on our social media or live show!)