QUESTIONNAIRE I

Dear Sir / Madam,

1. What are the driving factors to become surrogate mother as per your view?
1a) Helping the women Xx 1b) Generate a source of income x

1c) To maintain the family Xx 1d) For completing the cycle of womanhood Xx

2. Kindly tell us the sources through you came to know about surrogacy?
2a) Friends Xx 2b) Relatives Xx

2c) Media Xx 2d) Internet Xx

3. How many members are present in your home?

3a) 3 to 4 Xx 3b) 4 to 6 Xx

3c) 6 to 8 Xx 3d) 8 and above Xx

4. Are you married?

4a) Yes Xx 4b) No Xx

5. When did you go for surrogacy

5a) After the First issue Xx 5b) After the Second issue x

5c) Before the First issue Xx

6. Do you have further desire to become a surrogate mother in the future?
6a) Yes Xx 6b) No Xx

7. At any point of the time in surrogacy did you feel that the amount given to surrogate
mother various from woman to woman on the basis of beauty colour and structure?
7a) Yes Xx 7b) No Xx

8. Whether you received co-operation from your husband, parents and in law
8a) Yes Xx 8b) No Xx

9 Are you facing any social stigma for your role of surrogate mother?
9a) Yes Xx 9b) No Xx

10. Kindly tell us the number of times you adapted for surrogacy.
10a) 1-2 Xx 10b) 2-3 Xx

10c) 3-4 Xx 10d) 4 and above Xx

11 Do you find the facilities given during the time of surrogacy is

11a) Outstanding Xx 11b) Very good Xx

11c) Good Xx 11d) Poor Xx

11e) Very poor Xx

12 Are satisfied with the surrogate money you received as adequate

12a) Yes Xx 12b) No Xx

13 Have you faced any difficulties from?

13a) Clinic Xx 13b) Doctors Xx

13c) Intermediaries Xx 13d) Friends and relatives Xx

14 Have you received any sort of training such as computer training, knitting, spoken
English, you making etc.
14a) Yes Xx 14b) No x

If “yes” pl. specify............... ……………..

15 Did you face any health problem after the surrogacy?
15a) Yes Xx 15b) No Xx

If ‘Yes’, please state the problem................................

16 Whether a woman to become surrogate mother has to face legal problem before and
after the surrogacy?
16a) Yes Xx 16b) No Xx