Chapter 9 246 making in this heterogenous sample of women with psychiatric vulnerability. On the other hand, recall bias may play a role and memories about childhood trauma, reproductive history and past decisions may be difficult to recollect. Figure 9.4 - Framework on the ‘Shadows of Impact’ of psychiatric vulnerability on family planning decisionmaking. Adjusted from Chapter 6 There is a noteworthy ambiguity in the influence of ACE on pregnancy decisionmaking. ACE (indirectly) attribute to the risk of UPs, as shown in quantitative work. On the other side, ACE are also related to not having children, as shown in our qualitative studies (Chapter 6, Chapter 7). Fear of motherhood or transmitting trauma and psychiatric vulnerability motivated women to remain childless. In Chapter 3, we found that childlessness was related to having mental health symptoms in crosssectional data. Although the direction of this association is unsure, which marks an important limitation of this study, it is remarkable that childlessness is poorly studied in relation to psychiatric vulnerability, given the possible negative impact on women’s mental health for those who experience childlessness with regret52. In conclusion, it is most likely that the occurrence of UPs among women with psychiatric vulnerability is an interplay of all three hypotheses: a causal effect of
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