Name ____________________________ Age ______ Sex ____ Occupation

_______________________ No. of offspring _____

1. How many hours do you send with your child/children?

• _______________
2. With whom does your child/children stay with when you are at work?
• Family member ● School/crèche
• Friends/Relatives
3. Have you ever felt that your absence is negatively impacting your child?
• Yes ● No
• Sometimes
4. Who is responsible for preparing the daily meals?
• You ● Other family members
• Domestic helper
5. Do you feel like your child’s eating habits are unhealthy?
• Yes ● No
6. Do your work often interfere with your family life?
• Yes ● No
• Sometimes
7. Are you overwhelmed while balancing your family and work?
• Yes ● No
• Sometimes
8. Have any of your family members suggested you to leave work after becoming a mother?
• Yes ● No
9. Do your family members support you with your work?
• Yes ● No
10. Do you regularly attend your child’s PTM at school?
• Yes ● No