Chapter 6 136 Our study enhanced the shadow of the past with insights from 17 women with psychiatric disorder(s), shedding light on the impact of (childhood) trauma and adverse experiences on family planning decision-making. Previous research has shown an increased risk of unintended pregnancy in mothers with adverse childhood experiences35. Furthermore, women with unintended pregnancies reported more psychosocial problems36. Together with our findings, these findings imply that past experiences (related to psychiatric disorders) play a significant role in shaping family planning decisions and outcomes. In the shadow of the present, we expanded upon the existing themes of (socioeconomic) status and perceptions29. Various enablers and constraints in the decision-making process surfaced, aligning with descriptions in other frameworks22,23,25,26, and are therefore not unique to our population. The personal perceptions of our participants were portrayed as a complex array of emotions and thoughts, contributing to a fluctuating experience of family planning marked by ambivalence and uncertainty. Ambivalence toward motherhood in women with severe mental illness has been previously documented37. However, our study focused primarily on ambivalence in decision-making. Surprisingly, participants did not bring up the issue of psychoactive medication usage in relation to family planning. Although most psychotropic medication can be continued during pregnancy, some psychoactive medications can be teratogenic and should be used with caution38,39. Also, previous studies showed that (pregnant) women with psychiatric disorders contemplate their medication usage40. Overall, our findings suggest that family planning decision-making is more complex in women with psychiatric disorders than in those without psychiatric disorders, consistent with prior research41. A potential explanation lies in additional factors influencing the decision, such as awareness of the psychiatric disorder and psychiatric stability at the time of the decision. The notion that social influences, including stigma, shape the shadow of the future through uncertainty is not limited to women with psychiatric disorders. A study on disabled women’s childbirth experiences revealed diverse reactions from their surroundings, leading to heightened fears and a sense of diminished control over their childbirth experiences42. Despite the difference in study populations, similar findings indicate a convergence in the experiences of women. While uncertainty about the future during the COVID-19 pandemic has been noted among the general population28,29, we specifically examined uncertainty regarding stigma surrounding psychiatric disorders and their potential transmission. Participants' narratives may be influenced by maladaptive prospection seen in persons with psychiatric disorders such as depression and anxiety, which distorts future expectations43. Additionally, the
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