General discussion and future directions 235 We employed a mixed methods approach by integrating quantitative (parts I and II) and qualitative (part III) research designs. In Part I, we estimated the prevalence of UPs amongst women with and without psychiatric vulnerability in a systematic review and meta-analysis. Data from a nationwide survey exemplified the impact of psychiatric vulnerability on various domains of family planning. In Part II, we collected quantitative data on the prevalence of UPs amongst women with psychiatric vulnerability, in addition to obstetric and neonatal outcomes after UPs. Next, we specifically focused on obstetric and neonatal outcomes in infants born to women with bipolar disorders. In Part III, we explored perceptions on family planning decisionmaking amongst individuals with lived experience with psychiatric vulnerability. Moreover, we captured experiences from women with UPs and psychiatric vulnerability and their partners on pregnancy journeys. Last, experiences with discussing family planning in psychiatric healthcare were gathered from MHPs and from individuals with lived experiences with psychiatric vulnerability. This final chapter provides summaries and an integrative discussion of all key findings in addition to directions for future research and clinical implications. Summary of key findings Part I Psychiatric vulnerability, unintended pregnancies and desire for children Chapter 2 presents the results of a systematic review and meta-analysis on the prevalence of UPs in women with (n=2.650) versus without (n=16.031) psychiatric vulnerability. Results suggest that UPs are more prevalent amongst women with psychiatric vulnerability versus women without psychiatric vulnerability ((OR 1.34, CI 1.08–1.67). The overall weighed prevalence of UPs among women with psychiatric vulnerability is 65% (CI 0.43–0.82, n=3881). Chapter 3 provides results of a semi-quantitative survey that captured experiences with family planning amongst individuals with (prior) mental health issues. The study gives valuable insights in the broad impact of psychiatric vulnerability on four domains. Reproductive history is impacted as UPs are common in this sample (21.7% ever had a UP and of the persons who were ever pregnant, 45.4% ever had a UP). Decisions about family planning are impacted by psychiatric vulnerability, as half of the sample relates their childlessness to (prior) mental health issues. Third, more than half of the sample experiences taboo around sexuality, indicating impact on sexual
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