Family planning decision-making in relation to psychiatric disorders in women 137 potential of transmitting psychiatric disorders to their children might have intensified feelings of uncertainty about the future and thus made the decision-making process more challenging. This phenomenon is not novel and has been documented in various other hereditary diseases44,45. The actual extent of inheritance in psychiatric disorders significantly influences this dynamic. For instance, the estimated heritability for psychotic and neurodevelopmental disorders ranges from 74–85%, whereas for mood and anxiety disorders, it ranges between 37–58%46. The high heritability rate of these disorders aligns with the uncertainty as described in the narratives. Strengths and limitations This study provides a nuanced exploration of family planning decision-making in 17 women with psychiatric disorders. The transdiagnostic approach sheds light on overarching issues that were experienced. The use of focus group discussions captured societal dynamics and fostered an interactive environment for reflective perspectives47,48. Thematic framework analysis offered a structured examination of identified themes29. However, limitations include the small group of women with unintended pregnancies ( n=3) and the retrospective nature of reflections, potentially introducing recall bias49,50. Moreover, it is important to acknowledge the wide age range of participants, as this may affect the consistency of the data. We addressed the potential recall bias by incorporating the reflective nature of our framework and acknowledging its influence on the findings. The iterative process did not include respondent validation of the findings. To mitigate potential misinterpretations, we involved a researcher with lived experience with perinatal mental health problems. Furthermore, the utilization of focus groups may restrict the depth of individual analyses. Although all our participants had been known with a psychiatric disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), we hypothesize that within the diverse array of disorders represented, each psychiatric disorder may have impacted family planning decisions in distinct ways. Additionally, the focus groups did not allow for an in-depth examination of the individual socioeconomic status of the women and how this influenced their reproductive desires. Given the established importance of socioeconomic status in the context of unintended pregnancies14, it is crucial to consider this factor in individual sessions. Opting for individual interviews could provide a more comprehensive exploration. Suggestions for future research Future research could benefit from longitudinal and prospective study designs, allowing examination of family planning decision-making in women with psychiatric
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