Report on ACT Survey of Women’s Health
By Women’s Health Matters

Appendix 1: Survey instrument

Appendix to the report on the ACT Survey of Women’s Health by Women’s Health Matters (2023).1 Reproduced here as circulated in Word and RTF formats on the Women’s Health Matters website, representing survey as delivered online via SurveyMonkey.

Survey of Women’s Health in the ACT
November 2022

About this survey
Who is this survey for?
This survey is for people who are:
women / femme-identifying or people who align themselves with this group, AND
aged 18 years or over, AND
living in the ACT or surrounding regions
Only people in that group are eligible to complete the survey and enter the prize draw.
How long will it take?
The survey takes around 15 minutes. It might be a bit shorter or longer for you depending on your answers.
Is the survey online?
Yes. If you would like to complete this survey online, please do. The survey link is: https://www.surveymonkey.com/r/SM5P5SG

An FAQ about the survey is online here: https://www.womenshealthmatters.org.au/faq-survey-of- womens-health-in-the-act/
Can I do the survey another way?
Yes. If the online survey is not accessible for you or is difficult to use, please contact us by emailing healthpromotion@womenshealthmatters.org.au or phone (02) 6290 2166.

Or, if you like, you can download and complete the survey on this document by printing it out and writing on it, or by typing into the electronic document. If you do this, please make sure you follow all the instructions. You can email it back to us at healthpromotion@womenshealthmatters.org.au

1 See https://www.womenshealthmatters.org.au/resources/reports/

Do I have to complete the survey?
No, it is voluntary. You can stop at any time. When doing the survey online, you can withdraw at any time by closing the browser window, or choosing not to submit the survey. After you press "submit" at the end it will not be possible to withdraw your response.
Will I have to answer all the questions?
If a question is marked with an asterisk (*), you need to complete that question. For some questions you have an option to skip the question or select "Prefer not to answer". You can also choose to exit or stop the survey at any time.
Is there any payment or reward for doing the survey?
There is no payment or reward, but everyone who is eligible for the survey and completes it can enter a prize draw to win one of two $100 gift cards. The prizes will be drawn in January 2023. We will check people are eligible before awarding the prizes.
If you want to enter the prize draw you will need to tell us your email address and postcode. There is more information about this at the end of the survey. Your email address and postcode will be separated from the survey data, only used for the prize draw and then deleted after prizes are awarded.
How will my information be used?
Women's Health Matters will make sure that personal information is kept safe in line with our privacy policy, which is online here: https://www.womenshealthmatters.org.au/privacy-policy/. Information will be used to create reports and submissions to help improve the health and wellbeing of women in the ACT. Survey answers will only be used anonymously.
Are there any sensitive topics in the survey?
Yes. The survey covers topics including sexual and reproductive health, experiences of violence, pregnancy loss and infertility.
We suggest you do the survey in a private space and at a time when you will feel comfortable and safe.
Thinking about these topics might bring up difficult feelings for you.
Feel free to take a break if you need to, and consider using some of the support options listed online at https://www.womenshealthmatters.org.au/support-options-survey-of-womens-health-in-the- act/ and at the end of this document.
Completing the survey
Instructions for moving through the survey are given below the questions and answer options. Some answers will mean that you need to skip to a new question number. If there are no instructions, that means you should move on to the next question.
If you need help with completing the survey or have any questions about it, please email healthpromotion@womenshealthmatters.org.au or phone (02) 6290 2166.

The survey questions

Eligibility
1. Are you a woman/femme-identifying person or someone who aligns themselves with this group, who is aged 18 years or over and lives in the ACT or surrounding regions?
Yes
No
If ‘Yes’ Continue to question 2
If ‘No’, you are not eligible to complete the survey.

Health and healthcare
2. Overall, how would you rate your health during the past 4 weeks2
Excellent
Very good
Good
Fair
Poor
Don't know
Prefer not to answer

3. Have you consulted with the following services for your own health in the last twelve months?3 (select all that apply)
A GP (general practitioner)
A specialist (such as a cardiologist, a gynaecologist or a neurologist)
The emergency department in a hospital
A psychologist, counsellor or other mental health worker
A dentist
Another allied health professional (optometrist, physiotherapist, dietitian, chiropractor, osteopath, pharmacist, podiatrist, speech pathologist)
An alternative health practitioner (naturopath, acupuncturist, herbalist)
A midwife
A community nurse, practice nurse or nurse practitioner (e.g. walk-in clinic)
Health information on the internet
Healthdirect phone service
Apps to support your health (e.g. on your phone, watch or tablet)
Telehealth (consultation with a health service by phone/computer)
None of the above

2 Adapted from the 36-Item Short Form Survey (SF-36)
3 Adapted from the Australian Longitudinal Study on Women’s Health (ALSWH)- www.alswh.org.au

4. Thinking about your own health care, how would you rate your access to a GP?4
Access means being able to get healthcare when and where you need it. This question is about access to a GP in general. Later questions will ask about different aspects such as bulk billing and waiting times.
Excellent
Very good
Good
Fair
Poor
If ‘Excellent’, ‘Very good’, or ‘Good’, skip to Question 6. If ‘Fair’ or ‘Poor’ continue to Question 5.

5. You rated your access to a GP as fair or poor. What is the main factor which makes it difficult for you to access a GP?
Too expensive
Difficulty getting an appointment
Not enough time personally to see a GP
Difficult to travel to see a GP
Other (please explain – write your answer)

6. Thinking about consulting a GP for your own health care, how would you rate the following now:5
Access to a GP who bulk bills
Excellent
Very good
Good
Fair
Poor
Don't know / not applicable

Access to a female GP
Excellent
Very good
Good
Fair
Poor

4 Adapted from the Australian Longitudinal Study on Women’s Health
5 Adapted from the Australian Longitudinal Study on Women’s Health

Don't know / not applicable

Access to my preferred GP every time
Excellent
Very good
Good
Fair
Poor
Don't know / not applicable

7. Here are some questions about your most recent consultation with a general practitioner. In terms of satisfaction, how would you rate the following6
The cost of the appointment
Excellent
Very good
Good
Fair
Poor
Don't know / not applicable
How accessible the facilities were for you
Excellent
Very good
Good
Fair
Poor
Don't know / not applicable
How long you waited to get an appointment
Excellent
Very good
Good
Fair
Poor
Don't know / not applicable

6 Adapted from the ALSWH and the GP Preventive Health Services Utilisation Questionnaire (GP-PHSUQ) - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797786/

The length of time you waited in the waiting room
Excellent
Very good
Good
Fair
Poor
Don't know / not applicable
The amount of time you spent with the doctor
Excellent
Very good
Good
Fair
Poor
Don't know / not applicable
The doctor’s explanation of your problem and treatment
Excellent
Very good
Good
Fair
Poor
Don't know / not applicable
Your opportunity to ask all the questions you wanted
Excellent
Very good
Good
Fair
Poor
Don't know / not applicable
How well the doctor listened to you explain your problem or concerns
Excellent
Very good
Good
Fair
Poor
Don't know / not applicable

How well the doctor treated you with dignity and respect
Excellent
Very good
Good
Fair
Poor
Don't know / not applicable
How well the doctor respected your culture, identity, beliefs and choices
Excellent
Very good
Good
Fair
Poor
Don't know / not applicable
The technical skills of the doctor (thoroughness, carefulness, competence)
Excellent
Very good
Good
Fair
Poor
Don't know / not applicable

8. Thinking about your own health care, how would you rate the following now:7
Access to medical specialists if you need them
Excellent
Very good
Good
Fair
Poor
Don't know / not applicable
Access to medical care in an emergency
Excellent
Very good
Good

7 Adapted from the Australian Longitudinal Study on Women’s Health and the GP Preventive Health Services Utilisation Questionnaire (GP-PHSUQ)s

Fair
Poor
Don't know / not applicable
Access to medical care on short notice
Excellent
Very good
Good
Fair
Poor
Don't know / not applicable
Access to after-hours medical care
Excellent
Very good
Good
Fair
Poor
Don't know / not applicable
Access to mental health services (counselling, psychology) if you need it
Excellent
Very good
Good
Fair
Poor
Don't know / not applicable
Access to family planning or sexual health services
Excellent
Very good
Good
Fair
Poor
Don't know / not applicable
Access to telehealth (consultations with health service by phone/computer)
Excellent
Very good
Good
Fair
Poor
Don't know / not applicable

[Optional] Please tell us more about your access to different health services if you wish

(write your answer)
10. Please rate the extent to which you agree with the following statements8
The care I have received from doctors in the last few years has been good
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
If you wait long enough, you can get over almost any disease without seeing a doctor
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
I avoid seeing a doctor whenever possible
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
I only go to a doctor if there is no other option
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree

11. Thinking about the last few years, please rate the extent to which you feel you have been taken seriously by doctors when explaining symptoms or health concerns?
Not at all seriously
Somewhat seriously
Mostly seriously
Completely seriously

12. [optional] Is there anything else you would like to tell us about your experiences of seeing a doctor?

8 Adapted from the GP Preventive Health Services Utilisation Questionnaire (GP-PHSUQ)s

(write your answer)

Health information
13. Do you use the internet and/or social media to get information about your health? (select all that apply)
Internet
Social media
Neither
If ‘Neither’, skip to Question 17
If ‘Internet’ and/or ‘Social media’ go on to Question 14

14. Which of the following sources have you used to try to get health information?9 (select all that apply)
Tik Tok
Instagram
Twitter
Facebook
Other social media or messaging apps
Other health-related apps
Healthdirect
Government websites
Websites with Health On the Net (HON) certification
Other websites or online sources (please specify – write your answer)

15. Which of the following describes your reasons for using these online sources (above)? (select all that apply)
To decide whether or not to see a health practitioner about my symptoms / health condition
To prepare myself to see a health practitioner about my symptoms / health condition
To improve my understanding of symptoms / health condition after seeing a health practitioner or receiving a diagnosis
To get information about my symptoms/ health conditions instead of seeing a health practitioner
To better understand public health information or directions
Other (please tell us more – write your answer)

16. Apart from online sources, where do you get information about your health?10 (select all that apply)
Friends
Family
School/university/TAFE/work
Journal articles/textbooks/books
Nurse
Doctor
Family planning or sexual health clinic
Community organisation
Other health professionals
TV/ radio/ podcasts/ magazines/
Posters/ leaflets
Other (please specify – write your answer) All answers, skip to Question 18

17. Where do you get information about your health?11 (select all that apply)
Friends
Family
School/university/TAFE/work
Journal articles/textbooks/books
Nurse
Doctor
Family planning or sexual health clinic
Community organisation
Other health professionals
TV/ radio/ podcasts/ magazines
Posters/ leaflets
Other (please specify – write your answer)

10 Adapted from ALSWH

Mental Health
The following questions are about your mental health. If you would like support, please consider contacting one of these services:
Lifeline – for crisis support - ph: 13 11 14 - More information and online chat at https://www.lifeline.org.au/
Beyond Blue – for help with anxiety and depression – ph: 1300 22 4636 – More information and online chat at https://www.beyondblue.org.au/
ACT Access Mental Health – 24/7 mental health service offering access to assessment, treatment, advice and information - Ph: 1800 629 354 or 6205 1065

18. In the past 4 weeks, about how often did you feel nervous?12
All the time
Most of the time
Some of the time
A little of the time
None of the time
Don't know
Prefer not to answer

19. In the past 4 weeks, about how often did you feel hopeless?13
All the time
Most of the time
Some of the time
A little of the time
None of the time
Don't know
Prefer not to answer

20. In the past 4 weeks, about how often did you feel restless or fidgety?14
All the time
Most of the time
Some of the time
A little of the time
None of the time
Don't know
Prefer not to answer

12 Kessler Psychological Distress scale (K6), Kessler et al (2002)
13 K6
14 K6

21. In the past 4 weeks, about how often did you feel that everything was an effort?15
All the time
Most of the time
Some of the time
A little of the time
None of the time
Don't know
Prefer not to answer

22. In the past 4 weeks, about how often did you feel so sad that nothing could cheer you up?16
All the time
Most of the time
Some of the time
A little of the time
None of the time
Don't know
Prefer not to answer

23. In the past 4 weeks, about how often did you feel worthless?17
All the time
Most of the time
Some of the time
A little of the time
None of the time
Don't know
Prefer not to answer

24. Have you ever been diagnosed with or treated for (select all that apply)18
Depression
Anxiety disorder
Post-traumatic stress disorder (PTSD)
Anorexia
Bulimia
Other eating disorder
Bipolar disorder
Borderline personality disorder
Complex post-traumatic stress disorder (C-PTSD)

15 K6
16 K6
17 K6
18 Adapted from ALSWH

Prefer not to answer
Other mental illness or mental disorder (please describe – write your answer)
None of the above

25. Have you been diagnosed with or treated for any of the following in the last two years?19
(select all that apply)
Depression
Anxiety disorder
Post-traumatic stress disorder (PTSD)
Anorexia
Bulimia
Other eating disorder
Bipolar disorder
Borderline personality disorder
Complex post-traumatic stress disorder (C-PTSD)
Prefer not to answer
Other mental illness or mental disorder (please describe – write your answer)
None of the above

Discrimination
26. In the past 12 months, do you feel that you have experienced discrimination or have been treated unfairly by others?
Yes
No
Don't know
If ‘No’ or ‘Don’t know’, skip to Question 29 If ‘Yes’, go on to Question 27

27. Thinking about the last time you experienced discrimination or were treated unfairly, which of the following factors do you believe it was related to? (Select all that apply)
Being Aboriginal and/or Torres Strait Islander
Disability
Race
Gender
Language
Age
Sexuality
Religion
Appearance

19 Adapted from ALSWH

Other (please specify – write your answer)
[Optional] Is there anything that you would like to tell us about your experience(s) of discrimination or unfair treatment?
(write your answer)

Sexual and reproductive health
29. In the last 6 months, have you engaged in any physical sexual activity with another person?
Yes
No
Prefer not to answer
If ‘No’ or ‘Prefer not to answer’, skip to Question 34 If ‘Yes’, go on to Question 30

30. Thinking about the last 6 months, what forms of contraception have you used, if any? (Select all that apply)
Contraception means methods for preventing pregnancy. For this question, select all forms of contraception you've used in or with your own body.
I didn’t have penis in vagina sexual activity
I used a combined oral contraceptive pill (The Pill)
I used a progestogen only oral contraceptive pill (The Mini Pill)
I used oral contraceptive pill but I don't know what type
I used condoms (yourself or a partner)
I used emergency contraception (e.g. morning after pill)
I used an implant (e.g. Implanon, 'the Rod')
I used the withdrawal method
I used a copper intrauterine device (non-hormonal IUD)
I used a progestogen intrauterine device (IUD) (e.g. Mirena, Kyleena)
I used an injection (e.g. Depo-provera)
I used a fertility awareness method (e.g. natural family planning, rhythm method, Billings method, body temperature method, periodic abstinence)
I used a vaginal ring (e.g. Nuvaring)
I used breastfeeding method
I have had tubal ligation / I have had a vasectomy
I used another method of contraception (please specify – write your answer)
I didn't use contraception
If ‘I didn’t use contraception’, skip to Question 33 For all other answers, go on to Question 31

31. How would you rate your satisfaction with your current form of contraception?
Extremely satisfied
Very satisfied
Quite satisfied
Dissatisfied
Very dissatisfied
If ‘Extremely satisfied’, ‘Very satisfied or ‘Quite satisfied’, skip to Question 34 If ‘Dissatisfied’ or ‘Very dissatisfied’, go on to Question 32

32. What is preventing you from changing your current form of contraception? (select all that apply)
Cost
Not sure what options there are
Don't have time
My doctor has advised other options are not suitable for me
Preferences or dynamics in my relationship
Other (please explain – write your answer) All answers, skip to Question 34

[Optional] If you wish, please tell us more about why you do not use contraception (e.g. no need due to menopause or hysterectomy, trying to get pregnant, or other reasons) (write your answer)

34. Have you ever been diagnosed with or treated for endometriosis?20
If you select 'No' you will still get a chance to comment, for example about trying to get a diagnosis, or managing possible endometriosis.
Yes
No
Prefer not to answer
If ‘No’ or ‘Prefer not to answer’, skip to Question 37 If ‘Yes’, go on to Question 35

35. In what year was your endometriosis first diagnosed or treated?
(write the year)

36. How satisfied have you been with your endometriosis health care?
Extremely satisfied
Very satisfied
Quite satisfied
Dissatisfied
Very dissatisfied

[Optional] Is there anything else you would like to tell us about your experience in relation to endometriosis?

38. Have you ever been diagnosed with or treated for polycystic ovary syndrome (PCOS)?21
If you select 'No' you will still get a chance to comment, for example about trying to get a diagnosis, or managing possible PCOS.
Yes
No
Prefer not to answer
If ‘No’ or ‘Prefer not to answer’, skip to Question 41 If ‘Yes’, go on to Question 39

39. In what year was your polycystic ovary syndrome first diagnosed or treated?
(write the year)

40. How satisfied have you been with your polycystic ovary syndrome health care?
Extremely satisfied
Very satisfied
Quite satisfied
Dissatisfied
Very dissatisfied

[Optional] Is there anything else you would like to tell us about your experience in relation to polycystic ovary syndrome?
(write your answer)

42. In the last 12 months, have you experienced persistent pelvic pain?
Persistent pelvic pain is pain below your belly button and above your legs that is present on most days (or more than 2 days of your period, for people who have periods) for six months or more.
Yes
No
Prefer not to answer
If ‘No’ or ‘Prefer not to answer’, skip to Question 48 If ‘Yes’, go on to Question 43

43. In what year did your persistent pelvic pain first start?
(write the year)

44. Have you sought treatment from a health care professional for persistent pelvic pain?
Yes
No
If ‘No’, skip to Question 46
If ‘Yes’, go on to Question 45

45. How satisfied have you been with your treatment for persistent pelvic pain?
Extremely satisfied
Very satisfied
Quite satisfied
Dissatisfied
Very dissatisfied

46. In the last 12 months, have you ever missed work or study commitments due to persistent pelvic pain?
Yes
No
Prefer not to answer

47. [Optional] Is there anything else you would like to tell us about your experience in relation to persistent pelvic pain?
(write your answer)

Parenting intentions
The following questions are about situations you may have experienced relating to pregnancy and becoming a parent. These include questions about infertility, stillbirths, miscarriages, abortions/terminations and ectopic pregnancies (tubal pregnancies).
Many of these experiences are difficult, and you may prefer not to answer questions of this nature. If you don’t wish to answer a particular question, please go on to the next question.
If these questions raise issues or difficult feelings for you, please consider contacting one of the support services listed at the end of this document.

48. Which of the following applies to you?
I have a biological child/children (including adult children)
I have a person/people under 18 years old in my care/guardianship, who is/are not my biological child
I have a biological child/children AND a person/people under 18 years old in my care/guardianship, who is/are not my biological child
I don't have children
Prefer not to answer

49. Which of the following best describes your current parenting intentions?
This question is for everyone (including those who have children and those who do not).
I am currently pregnant / having a baby
I am trying to get pregnant / have a baby
I am not currently trying to get pregnant / have a baby, but intend to in future
I am not currently trying to get pregnant / have a baby, and am not sure about whether I will in future
I am not currently trying to get pregnant / have a baby, and I don’t plan to be pregnant / have a baby in the future
Prefer not to answer

50. Which of the following factors influence your current parenting intentions? (select all that apply)
Personal choice – want/ don’t want children
Finances
Concern about climate change
Concern about the future (other than climate change)
My current relationship/ status
Happy with my current family size
My age
My fertility
My access to fertility treatment

Other (please explain)
Prefer not to answer

51. If you have ever intended or tried to become pregnant/ have a baby, which of the following descriptions of fertility apply to you?
Select all that apply. Please include all experiences even if you later became pregnant or had a baby
I had/have difficulty conceiving for medical reasons (now or in the past)
My partner had/has difficulty having children for medical reasons (now or in the past)
Partner and I cannot/were not able to conceive together because we are same sex/gender diverse
I cannot/could not conceive without assistance because I am/was single
Prefer not to answer
Other fertility challenges (please specify – write your answer)
None of the above (no difficulty conceiving, or have not intended or tried to conceive)

Pregnancy and parenting
52. To the best of your knowledge, how many times have you been pregnant?
Please include if you are currently pregnant, as well as any previous abortions, miscarriages and stillbirths.
Select a number from zero (0) to 10+, or
Prefer not to answer
If zero (0) or ‘Prefer not to answer’, skip to Question 73 All other answers, continue to Question 53

This question is about stillbirth. If this question raises any difficult or distressing emotions for you, you may wish to call Sands (Miscarriage, Stillbirth and Newborn Death Support) on 1300 308 307 for 24/7 support; online info: https://www.sands.org.au/
Have you ever had a stillbirth?22
Yes
No
Prefer not to answer
If ‘No’ or ‘Prefer not to answer’, skip to Question 57 If ‘Yes’, go on to Question 54

22 Adapted from ALSWH

[Optional] How many times have you had a stillbirth?23
(write the number)

In relation to your stillbirth(s), how satisfied were you with your access to support services?
Extremely satisfied
Very satisfied
Quite satisfied
Dissatisfied
Very Dissatisfied
Prefer not to answer

If this question has raised any difficult or distressing emotions for you, you may wish to call Sands (Miscarriage, Stillbirth and Newborn Death Support) on 1300 308 307 for 24/7 support; online info at https://www.sands.org.au/

[Optional] Is there anything else you would like to tell us about your experience?
(write your answer)

57. To the best of your knowledge, how many times have you had a miscarriage?24
0
1
2
3
4+
Prefer not to answer

58. How many times have you had an ectopic pregnancy (tubal pregnancy)?25
0
1
2
3
4+
Prefer not to answer

23 Adapted from ALSWH
24 Adapted from ALSWH
25 Adapted from ALSWH

If this question has raised any difficult or distressing emotions for you, you may wish to call Sands (Miscarriage, Stillbirth and Newborn Death Support) on 1300 308 307 for 24/7 support; online info at https://www.sands.org.au/

[Optional] Is there anything else you would like to tell us about your experience?
(write your answer)

60. How many times have you ever had an abortion or termination of pregnancy?26
0
1
2
3
4+
Prefer not to answer

If ‘0’ or ‘Prefer not to answer’, skip to Question 65 All other answers, go on to Question 61

61. How many times have you had an abortion or termination in the ACT/region?
0
1
2
3
4+
Prefer not to answer
If ‘0’ or ‘Prefer not to answer’, skip to Question 64 All other answers, go on to Question 62

62. Have you had an abortion/termination in the ACT/region in the last 12 months?
Yes
No
Prefer not to answer

26 Adapted from ALSWH

63. Thinking about your most recent (or only) experience of having an abortion or termination in the ACT/region, how satisfied were you with your ability to access the procedure?
Extremely satisfied
Very satisfied
Quite satisfied
Dissatisfied
Very dissatisfied

[optional] What would make it easier to access an abortion or termination? (e.g. cost, promotion of services)
(write your answer)

65. How many times have you given birth to a living baby?
0
1
2
3
4+
Prefer not to answer
If ‘0’ or ‘Prefer not to answer’, skip to Question 73 All other answers, go on to Question 66

66. Thinking about the most recent time in the ACT when you gave birth to a living baby, which of the following types of care did you have?27
GP shared care
Continuity of midwifery care
Maternity care team
Private obstetrician
Private midwifery-led care
Not sure
My most recent birth was not in the ACT

67. Did you have a homebirth?28
Yes
No

27 Adapted from ALSWH
28 Adapted from ALSWH

68. Did you have a caesarean section?29
Yes
No

69. Have you experienced any of the following?30 (select all that apply)
Caesarean section after labour started
Labour lasting more than 36 hours
Emotional distress during delivery
None of the above

70. How satisfied were you with your maternity care?
Extremely satisfied
Very satisfied
Quite satisfied
Dissatisfied
Very dissatisfied

71. In relation to your most recent pregnancy, were you diagnosed with or treated for:31
(answer Yes or No for each)
Antenatal depression
Postnatal depression
Antenatal anxiety
Postnatal anxiety
Postpartum psychosis
Gestational diabetes
Hypertension (high blood pressure) during pregnancy
Pre-eclampsia during pregnancy

72. [Optional] Is there anything else you would like to tell us about your experience(s) of pregnancy and giving birth?
(write your answer)

29 Adapted from ALSWH
30 Adapted from ALSWH
31 Adapted from ALSWHme

Menopause
73. Have you reached menopause?
For people with a uterus, menopause is when you stop menstruating, i.e. when you no longer have periods.
Yes
No
Unsure
Not applicable
Prefer not to answer
If ‘No’, or ‘Prefer not to answer’, skip to section ‘Safety, violence and coercion’ (Question 77) If ‘Unsure’ or ‘Not applicable’, skip to Question 76
If ‘Yes’, go on to Question 74

74. At what age did your periods completely stop?
before 40 years of age
between 40 and 45 years
between 45 and 55 years
over 55

75. In relation to your experience of menopause, how satisfied were/are you with your access to support services?
Extremely satisfied
Very satisfied
Quite satisfied
Dissatisfied
Very dissatisfied

[Optional] Is there anything else you would like to tell us about experiencing (or not experiencing) menopause?
(write your answer)

Safety, violence and coercion
The following questions are about experiences of violence and coercion.
You might find the questions confronting or find that they prompt difficult feelings. The questions ask about whether you have experienced:
reproductive coercion
feelings of safety / lack of safety in public spaces
sexual violence
workplace sexual harassment
domestic violence
family violence, and/or
institutional violence
and give you the option to tell us more about your experiences.
If you feel distressed or need support about these issues, please get in touch with 1800RESPECT (ph: 1800 737 732; https://www.1800respect.org.au/), DVCS (ph: 02 6280 0900; https://dvcs.org.au/) , or Canberra Rape Crisis Centre (ph: 02 6247 2525; https://crcc.org.au/) for counselling and support.

77. Would you like to proceed with the questions about experiences of violence and coercion? If you select No, you will skip to the next section. If you select Yes, you will still be able to choose 'Prefer not to answer' for individual questions.
Yes
No
If ‘No’, skip to ‘Demographics’ section, Question 106 If ‘Yes’, go on to Question 78

Reproductive coercion
78. The following questions are about situations where a partner or another person tried to control whether you became pregnant or had a baby.
If you are pregnant now and trying to make a decision about whether to continue a pregnancy, you can call SHFPACT for free all-options pregnancy counselling on 02 6247 3077.
The questions cover times in the past as well as more recent or current experiences. If you believe the questions don't apply to you (e.g. because you have never been in a situation where you could get pregnant) please select 'skip'.
Skip reproductive coercion questions
Go ahead with questions (you can still choose 'Prefer not to answer' for individual questions)
If ‘Skip reproductive coercion questions’, skip to Question 86 If ‘Go ahead with questions’, go ahead to Question 79

79. If you have a partner, do you feel OK talking to them about if or when you might want to get pregnant?32
Yes
No
Prefer not to answer
I do not have a partner

80. Has your partner or anyone ever hurt you, or threatened you or made you feel bad because you didn’t agree to get pregnant?33
Yes
No
Prefer not to answer

81. Has a sexual partner ever tried to interfere with your birth control?34 (E.g. thrown away or hidden your contraceptive pills or damaged condoms)
Yes
No
Prefer not to answer

82. Have you ever felt you needed to hide contraception from a sexual partner so they wouldn’t get you pregnant?35
Yes
No
Prefer not to answer

83. Has anyone ever made you feel afraid or threatened you to try to make you end a pregnancy against your will?36
Yes
No
Prefer not to answer

32 Adapted from Children by Choice screening tool
33 Adapted from Children by Choice screening tool
34 Adapted from Children by Choice screening tool
35 Adapted from Children by Choice screening tool
36 Adapted from Children by Choice screening tool

84. Has anyone ever made you feel afraid or threatened you to try to make you continue a pregnancy against your will?37
Yes
No
Prefer not to answer

If you have answered yes to any of the last five questions, feel worried or distressed, or would like help with your situation, you may wish to contact 1800RESPECT (ph: 1800 737 732; https://www.1800respect.org.au/) or DVCS (ph: 02 6280 0900; https://dvcs.org.au/) for counselling and support.
[Optional] Is there anything else you'd like to add about becoming pregnant / having a baby and experiences of violence or coercion?
(write your answer)

86. In the last 12 months have you used public transport alone after dark in the ACT?38
Public transport includes buses, light rail, taxis and ride share (such as Uber).
Yes
No
Prefer not to answer
If ‘No’ or ‘Prefer not to answer’, skip to Question 89. If ‘Yes’, go on to Question 87

87. In general, do you feel safe while waiting for public transport alone after dark in the ACT?39
Yes
No
Prefer not to answer

88. In general, do you feel safe while using public transport alone after dark in the ACT?40
Yes
No
Prefer not to answer
All answers, skip to Question 90

37 Adapted from Children by Choice screening tool
38 Adapted from the ABS Personal Safety Survey
39 Adapted from the ABS Personal Safety Survey
40 Adapted from the ABS Personal Safety Survey

89. What is your reason for not using public transport alone after dark?41 (select the answer that best applies)
No need
Did not feel safe
Other (please specify)
Prefer not to answer

90. In the last 12 months, have you walked alone in your local area after dark?42
Yes
No
Prefer not to answer
If ‘No’ or ‘Prefer not to answer’, skip to Question 92. If ‘Yes’, go on to Question 91

91. In general, do you feel safe when walking alone in your local area after dark?43
Yes
No
Prefer not to answer
All answers, skip to Question 93

92. What is your reason for not walking alone in your local area after dark?44 (select the answer that best applies)
No need
Did not feel safe
Other (please specify – write your answer)
Prefer not to answer

93. [Optional] Is there anything you would like to tell us about your feelings of safety (or lack of safety) in public spaces or on public transport in the ACT?
(write your answer)

41 Adapted from the ABS Personal Safety Survey
42 Adapted from the ABS Personal Safety Survey
43 Adapted from the ABS Personal Safety Survey
44 Adapted from the ABS Personal Safety Survey

94. This question is about sexual violence. Sexual violence is when someone forces, pressures or tricks another person into doing sexual things, or having sexual things done to them. Sexual violence can include sexual harassment, unwanted sexual touch, stalking, having images taken or distributed without consent, indecent assault and rape.

Have you ever been forced to take part in unwanted sexual activity?45
Yes
No
Prefer not to answer
If ‘No’ or ‘Prefer not to answer’, skip to Question 96 If ‘Yes’, go on to Question 95

95. Have you been forced to take part in unwanted sexual activity in the last 12 months?46
Yes
No, more than 12 months ago
Prefer not to answer

96. This question is about workplace sexual harassment. Sexual harassment is any unwelcome sexual behaviour that would reasonably be expected to cause the targeted person to be offended, humiliated or intimidated. Workplace sexual harassment is sexual harassment that occurs at work, at a work-related event or while looking for work, including any place where a worker goes, or is likely to be, while working, such as remote working at home or in online environments.
Have you ever experienced sexual harassment at work, at a work-related event or while looking for work?47
Yes
No
Prefer not to answer
If ‘No’ or ‘Prefer not to answer’, skip to Question 99 If ‘Yes’, go on to Question 97

97. Have you experienced sexual harassment at work, at a work-related event or while looking for work in the last 12 months?48
Yes
No, more than 12 months ago
Prefer not to answer

45 Adapted from ALSWH
46 Adapted from ALSWH
47 Adapted from AHRC
48 Adapted from AHRC

If ‘Yes’ or ‘Prefer not to answer’, skip to Question 99
If ‘No, more than 12 months ago’, go on to Question 98

98. Have you experienced sexual harassment at work, at a work-related event or while looking for work in the last 5 years?49
Yes
No, more than 5 years ago
Prefer not to answer

99. This question is about domestic violence. Domestic violence is when someone uses force or manipulation to maintain power and control over their partner or spouse. It can involve controlling behaviour, physical violence, sexual violence, stalking, using technology to control or threaten, financial abuse, intimidation, and emotional and verbal abuse such as insults.
For the purposes of this question, we are talking about situations where you have been subjected to this kind of behaviour.
Have you ever been in a violent relationship with a partner/spouse?50
Yes
No
Prefer not to answer
If ‘No’ or ‘Prefer not to answer’, skip to Question 101 If ‘Yes’, go on to Question 100
100. Have you experienced domestic violence within the last 12 months?
Yes
No, more than 12 months ago
Prefer not to answer

101. This question is about family violence. Family violence is when someone uses force or manipulation to maintain power and control over another person in their family (other than their partner or spouse). It can involve controlling behaviour, physical violence, sexual violence, stalking, using technology to control or threaten, financial abuse, intimidation, and emotional and verbal abuse such as insults. Family violence includes violence by an adult against a child or young person, by a young person against an adult, and by one adult against another (for example, between in- laws).
Have you ever experienced violence from another family member (not a partner or spouse)?
Yes
No

49 Adapted from AHRC
50 Adapted from ALSWH

Prefer not to answer
If ‘No’ or ‘Prefer not to answer’, skip to Question 103 If ‘Yes’, go on to Question 102

102. Have you experienced family violence in the last 12 months?
Yes
No, more than 12 months ago
Prefer not to answer

103. This question is about institutional violence. Institutional violence is when a facility or organisation inflicts harm on a person, or controls them in harmful ways. This can happen in different settings such as hospitals, prisons, schools, group homes, or nursing homes.
Examples include being forcibly restrained, forced to take medicine, or denied the ability to make your own choices. It can also include sexual violence, physical violence or emotional abuse by workers, or by others in those settings.
We know that often it is not safe for people experiencing this kind of violence to communicate with others about it. If you would like to talk to someone at Women’s Health Matters about this, please email healthpromotion@womenshealthmatters.org.au or phone (02) 6290 2166.
Have you ever experienced institutional violence?
Yes
No
Prefer not to answer

104.
If answering these questions has raised difficult feelings or if you need support about these issues, please get in touch with 1800RESPECT (ph: 1800 737 732; https://www.1800respect.org.au/), DVCS (ph: 02 6280 0900; https://dvcs.org.au/) , or Canberra Rape Crisis Centre (ph: 02 6247 2525; https://crcc.org.au/) for counselling and support.

[Optional] Is there anything else you would like to tell us about experiences of sexual violence, workplace sexual harassment, domestic or family violence, or institutional violence?
(write your answer)

Household finances
* 105. This question is about being short of money. If you would like some help with your financial situation, please consider contacting Care Financial Counselling- ph: 1800 007 007 or online at https://www.carefcs.org
In the past 12 months, did any of these happen to you because you were short of money?51
(Please answer ‘Yes’, ‘No’, ‘Not sure’ or ‘Prefer not to answer’ for each of the following)
Had to delay or cancel non-essential purchases e.g. holiday, going to a restaurant or movie, buying clothes
Could not pay electricity, gas or telephone bills on time
Could not pay mortgage or rent payments on time
Could not pay for car registration or insurance on time
Could not make minimum payment on your credit card
Pawned or sold something because you needed cash
Went without meals
Were unable to heat or cool your home
Sought financial assistance from friends or family
Sought assistance from welfare or community organisations

Demographics
You are almost at the end of the survey! We just have a few more short questions about you.
We ask these questions so we can learn more about the health needs of different groups of people. Your answers will only be used anonymously.

106. Are you an Aboriginal and/or Torres Strait Islander person?
Aboriginal
Torres Strait Islander
Aboriginal and Torres Strait Islander
Neither
Prefer not to answer

107. How do you describe your sexual orientation?52
Straight (heterosexual)
Gay or lesbian
Bisexual

51 Adapted from Household, Income and Labour Dynamics in Australia (HILDA) survey
52 Adapted from ACON

Don’t know
Prefer not to answer
I use a different term (please specify – write your answer)

108. How do you describe your gender?53
Woman or female
I use a different term (please specify – write your answer)
Prefer not to answer

109. Were you born with a variation of sex characteristics (sometimes called 'intersex')?54
Yes
No
Prefer not to answer

110. At birth, you were recorded as:55
Female
Male
Prefer not to answer
Another term (please specify – write your answer)

111. Are you a person with disability / disabilities?
For this question, disability means any impairment, activity limitation or participation restriction that prevents a person's full and equal participation in society. This includes mental illness and/or mental disorders as well as physical or intellectual disabilities.
Yes
No
Unsure (please describe – write your answer)

112. In which country were you born?56
Australia

53 Adapted from ACON
54 Adapted from ACON
55 Adapted from ACON
56 Adapted from National Health Survey

England
India
China
Nepal
Philippines
New Zealand
Vietnam
United States of America
Sri Lanka
Pakistan
Malaysia
South Africa
Germany
Other (please specify – write your answer) If ‘Australia’, skip to Question 114
All other answers, go on to Question 113

113. How long have you been living in Australia?
Less than 5 years
Between 5 and 10 years
Between 10 and 20 years
More than 20 years

114. Which language do you mainly speak at home?57
English
Mandarin
Nepali
Vietnamese
Punjabi
An Aboriginal language
A Torres Strait Island language
Other (please specify – write your answer)

If ‘An Aboriginal language’ or ‘A Torres Strait Island language’, go on to Question 115

All other answers, skip to Question 116

115. What Aboriginal or Torres Strait Island language do you mainly speak at home?
(write your answer)

116. What is your preferred language?58
English
Mandarin
Nepali
Vietnamese
Punjabi
An Aboriginal language
A Torres Strait Island language
Other (please specify – write your answer)
If ‘An Aboriginal language’ or ‘A Torres Strait Island language’, go on to Question 117 All other answers, skip to Question 118

117. What Aboriginal or Torres Strait Islander language do you prefer to speak?
(write your answer)

118. Do you identify as being from one or more of these backgrounds? (select all that apply)
Migrant background
Refugee/asylum seeker background
Temporary visa holder
Prefer not to answer
None of the above

119. What is your age?
18-24
25-34
35-44

45-54
55-64
65-74
75-84
85 years or older
Prefer not to answer

120. Which area of the ACT and region do you live in?
Belconnen
Gungahlin
Molonglo Valley
North Canberra
South Canberra
Tuggeranong
Weston Creek
Woden Valley
Rural or regional area outside of the above areas

121. Have you ever spent time in a jail, prison, juvenile detention centre, or other correctional facility?
Note: We are asking this question so we can better understand the health risks and needs of women in the ACT who are in this group. Your answers will only be used anonymously.
Yes
No
Unsure (please specify – write your answer)
Prefer not to answer

122. What is the highest level of schooling or qualification you have obtained?59 (If you hold multiple qualifications, only answer for the highest qualification)
Doctorate
Masters Degree
Graduate Diploma
Graduate Certificate
Bachelor Degree with Honours
Bachelor Degree
Associate Degree
Advanced Diploma
Diploma
Associate Diploma

Advanced Certificate
Certificate IV (or Post-trade)
Certificate III (or Trade)
Certificate II
Certificate I
Year 12 or equivalent
Year 11 or equivalent
Year 10 or equivalent
Year 9 or equivalent
Year 8 or below
Did not go to school or obtain any qualification
Prefer not to answer

123. What is your current housing arrangement?60
Owned outright
Owned with a mortgage
Rented – through a real estate agent
Rented – through ACT Housing
Rented – through community housing provider
Rented – other landlord type
Another housing arrangement (please specify – write your answer)

124. Do you receive a government pension or allowance?61
Examples: Jobseeker, Carers Allowance, Disability Support Pension, study allowances for students, other pensions and allowances received by people who are aged, disabled, unemployed or sick, carers, families and children, veterans or their families
Yes
No
Unsure

125. Are you currently employed? (Mark one only)62

60 Adapted from ABS Census
61 Adapted from ABS Census

Yes
No, unemployed for less than 6 months
No, unemployed for 6 months or more

126. Would you like to work more (for pay) than you currently are?63
No
Yes - What is making it difficult to work more? (write your answer)

127. In a usual week, how many hours do you spend doing paid work?64
(write the number of hours)

128. In a usual week, how many hours do you spend studying?65
(write the number of hours)

129. This question is about being a carer. Carers provide unpaid assistance with the tasks of daily living to another person who:
has a disability
has a mental disorder or mental illness
has an ongoing medical condition (terminal or chronic illness)
is aged and frail, and/or
is a child or young person for whom the carer is a kinship carer or a foster carer
A kinship carer is a relative or a person from a child's community who provides care for the child when they cannot live with their parents.
Being a carer does not include being a parent except where your child has one of the other conditions or disabilities listed above.
Are you a carer?66
Yes
No

Option to go into prize draw
That is the end of the survey!

63 Adapted from ALSWH
64 Adapted from ALSWH
65 Adapted from ALSWH
66 Definition from ACT Carers Recognition Act 2021

We appreciate your time and effort in completing it. If the survey has raised issues or difficult feelings for you, please consider contacting one of the support services listed at the end of this document.
Would you like to go into a prize draw to win one of two $100 gift cards?
If you would like a chance to win, you will need to share your contact details with us so we can get in touch if you win.
If you complete the survey online, there are spaces to write your details in a form. If you are completing the survey a different way (e.g. by typing into an electronic document), please email healthpromotion@womenshealthmatters.org.au or phone us on (02) 6290 2166.

Contact information will be deleted after prizes are awarded.
Prizes will be awarded in January 2023. We will check people are eligible before awarding the prizes.
If you have questions about the prize draw, please email healthpromotion@womenshealthmatters.org.au or phone us on (02) 6290 2166.

Thank you for completing our survey!
If you would like support with any issues that the survey has raised for you, please consider contacting one or more of the services listed below.
If you would like to talk to someone at Women's Health Matters about the survey, please email healthpromotion@womenshealthmatters.org.au or phone (02) 6290 2166

Support options for survey participants

Lifeline – for crisis support 24 hours a day, 7 days a week - ph: 13 11 14 - More information and online chat at https://www.lifeline.org.au/

Beyond Blue – for help with anxiety and depression 24 hours a day, 7 days a week – ph: 1300 22 4636 - More information and online chat at https://www.beyondblue.org.au/

Sands - Miscarriage, Stillbirth and Newborn Death Support – 24/7 helpline ph: 1300 308 307 – More information and online chat https://www.sands.org.au

QLife – LGBTI peer support and referral for LGBTI people and issues relating to sexuality and gender - ph: 1800 184 527 - More information and online chat at https://qlife.org.au/

Domestic Violence Crisis Service – local service for people impacted by domestic and family violence: 24/7 Crisis Line: ph 02 6280 0900 - More information and online chat at https://dvcs.org.au/

Canberra Rape Crisis Centre – assistance, counselling and advocacy for issues relating to sexual violence: CRCC Crisis Line 7am-11pm 7 days per week – ph: 02 6247 2525 – More information here: https://www.crcc.org.au

1800RESPECT – national service for issues relating to domestic and family violence, sexual assault and other forms of gender-based violence - ph: 1800 737 732 - More information and online chat at https://www.1800respect.org.au/

ACT Women’s Health Service – ph: 02 5124 1787 – more information here: https://www.health.act.gov.au/services-and-programs/women-youth-and-children/womens- health/womens-health-service

Sexual Health and Family Planning ACT – All Options Pregnancy Counselling - if you are pregnant now and trying to make a decision about whether to continue a pregnancy, you can call SHFPACT for free all options counselling on 02 6247 3077 – more information online at https://www.shfpact.org.au/index.php/counselling

Perinatal Wellbeing Centre – for mental health issues related to becoming a parent – Non- crisis phone support, support groups and support for partners as well as information and referral – ph 02 6288 1936; more information online at https://www.perinatalwellbeingcentre.org.au/
Care Financial Counselling – Canberra-based service helping with financial distress and debt – Phone support (Mon to Fri 9am to 5pm) - ph: 1800 007 007; more information online at https://www.carefcs.org
National Debt Hotline – financial counselling by phone: 1800 007 007 (Mon-Fri 9:30am to 4:30pm) or Live Chat (Mon-Fri 9am to 8pm) via website https://ndh.org.au/