Chapter 1 10 data has been published on this topic. One study from 2012 showed that one in five Dutch women experienced a UP during her lifetime, including both ongoing pregnancies, abortions and miscarriages9. Although not all UPs are unwanted pregnancies, the Dutch government put the issue of UPs on the national agenda since 2017, with the goal to ‘aid in preventing unintended and unwanted pregnancies’. This acknowledgment of UPs as a national problem has fueled research on the topic of family planning, especially in groups of persons with one or more vulnerabilities in their life, such as intellectual disabilities, poverty, young age and psychiatric vulnerability. As UP rates in Dutch women with psychiatric vulnerability are currently lacking, the development of tailored preventative programs to the needs of women who face UPs, is also challenged. This thesis aims to fill the knowledge gap on the prevalence of UPs amongst persons with psychiatric vulnerability. Unintended pregnancies and psychiatric disorders Past research indicates that UPs are associated with reduced sexual independence, compromised coping skills (specifically related to intimacy, asserting boundaries, or requesting contraception), engagement in abusive relationships, insufficient awareness about pregnancy planning, or challenges in accessing or using contraceptives11,12. Additionally, factors like diminished autonomy, lack of information, perceived stigma, and concerns about contraceptive safety complicate the process of pregnancy planning12. The convergence between psychiatric vulnerability and social as well as psychological predictors of ineffective contraceptive use may clarify the risk for UPs amongst women with psychiatric vulnerability13. Factors such as intimate partner violence, lack of social support and low self-esteem are interconnected with both reproductive decision-making and psychiatric vulnerability14 - 16. Women seeking termination of pregnancies often reported to have experienced traumatic events like sexual violence, alongside symptoms of depression and anxiety17. Psychiatric symptoms or symptoms related to psychiatric vulnerability might affect psychological processes crucial for the utilization of contraceptive methods. Loss of planning capacity, reduced oversight and difficulties with impulse control challenge reproductive decision-making18. Compliance with contraceptive methods might be diminished in situations where severe psychiatric vulnerability such as (a history of) mood disorders, schizophrenia, or related psychotic disorders impact cognitive or emotional functioning19-22. (Hypo)manic symptoms in women with bipolar disorder could lead to impulsive and hypersexual behavior, resulting in risky sexual conduct23. In women with eating disorders, oligomenorrhea might be misconstrued as reduced pregnancy risk and fuel beliefs about infertility, potentially leading to UPs. Moreover, oral contraceptives might not effectively prevent UPs in situations involving frequent purging24,25. Some studies conducted separate analyses on women exhibiting
RkJQdWJsaXNoZXIy MTk4NDMw