The conversation about family planning and desire for children in mental healthcare 193 Introduction The unmet need of family planning (defined by the World Health Organization as the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births) is a global issue with major public health impact1,2. In the current study, the term ‘family planning’ includes both prevention of unwanted pregnancies and achievement of wanted pregnancies and can therefore include contraception but does not necessarily. The World Health Organization has recently called on countries to implement family planning strategies nationally. The Sustainable Development Goals demand countries by 2030 to ‘ensure universal access to sexual and reproductive healthcare services, including family planning, information and education, and the integration of reproductive health into national strategies and programmes’3. Access to information about reproductive health might be specifically interesting to persons with mental health issues. Literature shows a high rate of co-occurrence between depression, anxiety and reproductive system disorders such as polycystic ovary syndrome and chronic pelvic pain4. Mental health issues interfere with reproductive health by posing risk for sexual violence5, sexually transmitted diseases6,7, and unintended pregnancies8,9. Unintended pregnancies in particular, comprising half of all pregnancies worldwide2, have tremendous societal impact through adverse maternal and offspring outcomes10-12. Recent data shows that only a minority of patients with mental health problems had a conversation about the desire to have children. This is worrisome, as mental health does not only co-occur with reproductive problems but is also subject to change in various reproductive phases, such as the menstrual period13, pregnancy and postpartum14,15 and the perimenopause16,17. However, studies that investigate family planning needs in mental healthcare are scarce. In 2009, Becker and Krumm already noticed several shortcomings in this field. Studies lacked a patients’ perspective and data regarding attitudes of mental health professionals (MHPs). Currently, there are still limited papers that have addressed these issues, specifically in countries other than the United States. Qualitative studies on women with borderline personality and bipolar disorders showed that family planning and desire for children were important topics of conversation in treatment, particularly the offspring’s health in relation to psychotropic medication usage and heritability of bipolar disorder18,19. As these topics are generally the expertise of MHPs, we hypothesize that MHPs should have a significant role in discussing family planning and desire for children. Several papers discussed that MHPs encounter obstacles, such as moral concerns regarding autonomy20 and
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