General introduction and outline of this thesis 13 outcomes. This is important, as mood disorders are the most prevalent psychiatric disorders during pregnancy and the postpartum55,56. A subgroup of patients at risk for perinatal depressive disorder, are women with bipolar vulnerability. Without treatment, there is a relapse risk of 60-80% for postpartum psychosis in women with bipolar disorder45,48. Treatment with preferably lithium, a mood stabilizer, protects from perinatal relapse. Aside from the psychiatric risk during pregnancy, birth outcomes in women with bipolar vulnerability appear to be adverse compared to outcomes of neonates born to women without bipolar vulnerability57,58. What is less clear, is the role of lithium and/or other psychopharmacological medication on birth outcomes, indicating another research gap. Family planning, desire for children and childlessness in relation to psychiatric vulnerability The working definition of family planning is ‘the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births’, used by the WHO Department of Reproductive Health and Research [2008]. Because family planning aims to fulfil reproductive goals (not just prevent unwanted pregnancies), involuntary childlessness among individuals with psychiatric vulnerability should be included in family planning research as well. Various factors linked to psychiatric vulnerability could hinder achieving desired pregnancies. Problems with sexual functioning, worries about passing on inheritable psychiatric disorders, and concerns about parental adequacy could cause hardship for persons with psychiatric vulnerability in regard to achieving their desired family size59-61. Past studies have demonstrated that persons with psychiatric vulnerability like schizophrenia, autism, eating disorders, substance abuse, and/or depression tend to have lower fertility rates compared to their unaffected siblings62,63. These large-scale studies strongly indicate that individuals dealing with psychiatric vulnerability may encounter challenges in fulfilling their reproductive intentions. Qualitative research on perspectives on family planning, desire for children and childlessness in relation to mental health amongst persons with lived experience with psychiatric vulnerability are needed. Reproductive health in psychiatric healthcare Information regarding reproductive health holds relevance for individuals with psychiatric disorders, given the intricate connection between mental and reproductive health. There is a scarcity of studies addressing family planning needs within mental healthcare. In 2009, Becker and Krumm already identified several gaps in this area, with studies often lacking the patient's perspective and insights into the attitudes of
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