Family planning decision-making in relation to psychiatric disorders in women 135 doubting the possibility of breaking the transmission cycle, while others remained hopeful. Prospect of motherhood Insecurities about motherhood were deliberated. Participants felt incapable of raising a child for varying reasons, such as difficulty combining motherhood and having psychiatric symptoms. Other participants could rationalize this by referring to ‘other mothers’ without psychiatric disorder(s) who make parenting mistakes. Another participant stated that although her illness was heritable, it also aided her in supporting her child. Discussion Key findings This study has provided insights into family planning decision-making among women with psychiatric disorders by extending the Narrative Framework29 with two themes. First, we dedicated a theme to reflections on decision-making, which encompasses emotions of grief, relief and regret. Second, we introduced the shadow of the present, which emphasized the impact of psychiatric disorders on decision-making by considering awareness of psychiatric disorders and psychiatric stability. Furthermore, the shadows of the past and future were broadened by integrating categories tailored to women with psychiatric disorders, including trauma, adverse life events, and social influences. Interpretation in relation to literature The retrospective nature of the focus group discussions allowed us to reflect on the participants’ family planning decisions, where the emotions of regret, grief and relief emerged. Regret over the delay in childbearing decisions has been described before in couples seeking fertility treatments32. Like our participants, voluntary childless women reported relief, feeling financially unburdened compared to their parenting peers, and enjoying various forms of freedom. However, they also faced stigmatization, and some expressed that their decision was influenced by their concern about potentially transmitting diseases to their children33. We hypothesize that cognitive dissonance, influenced by the type of psychiatric disorder, may contribute to regret in individuals as they grapple with conflicting thoughts and emotions34.
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