Exploring UP journeys among women with psychiatric vulnerability using interpretative phenomenological analysis 153 Background Unintended pregnancies (UPs) (pregnancies that are mistimed and/or unwanted) account for up to 50% of all pregnancies worldwide1. UPs have a tremendous impact on pregnant womena, their newborns and society, as they influence the risk of mental health disorders such as perinatal depression, impair parent‒child interactions, and increase parenting stress2-5. This impact is especially relevant to patients with psychiatric vulnerability (present or past psychiatric disorders), as they have an increased risk for UPs and an increased risk for adverse pregnancy and birth outcomes irrespective of pregnancy planning status6-11. Hypotheses on how psychiatric vulnerability contributes to challenges with family planning include difficulties adhering to contraceptives, oversight, planning and reproductive autonomy12-16. These hypotheses are mainly based on quantitative studies, which do not explore the individual experiences of pregnant women and expectant parents. To date, some qualitative studies have explored the experiences of UPs of women without psychiatric vulnerability. These studies describe pregnancy intentions as complex processes influenced by extrinsic factors, such as social, financial and relationship status, and intrinsic factors, such as the emotional and mental health status of the pregnant woman17,18. The impact of UPs on the lives of the interviewed women varied greatly and included experiences of guilt, self-blame, stress, worry, interpersonal conflict and societal stigma19,20. It has not yet been explored whether similar processes apply to women with psychiatric vulnerability. Previous research on family planning perceptions of nonpregnant women with psychiatric vulnerability revealed specific concerns such as the transmission of psychiatric vulnerability, parenting skills and bonding capacities with children21-26. Based on these qualitative findings, we hypothesize that in pregnant women with psychiatric vulnerability, factors related to mental health may specifically impact the experience of UPs. This study aims to explore how women with psychiatric vulnerability experience unintended and ongoing (i.e., nonaborted) pregnancy journeys. We also include the partner’s perspective on women’s pregnancy journeys, as the partner’s perspective is often overlooked in studies on UPs, and little is known about their experiences27. To support women with psychiatric vulnerability and UPs emotionally and practically, it is crucial to understand the challenges these women encounter and the needs that are derived from those challenges. Understanding women’s self-expressed needs is key in developing family planning programs tailored to the needs of women with psychiatric vulnerability. a In this article, the word ‘women’ represents persons who are assigned female sex at birth and identify as women.
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