General discussion and future directions 249 Future directions Research recommendations Although this thesis has provided some valuable insights in the prevalence of UPs amongst women with psychiatric vulnerability, there are several gaps in current literature. We suggest incorporating the presence of adverse childhood experiences and/or past trauma in addition to social variables in studies on the prevalence of UPs amongst women with psychiatric vulnerability, to distinguish between the many possible predictors (Chapter 3, Chapter 4). Identifying predictors has purpose in developing targeted interventions for women at risk for UPs. Given the discrepancy between previous studies on birth outcomes after UPs and our findings (Chapter 4), future studies on outcomes in women with psychiatric vulnerability (with and without UPs) may adhere to a prospective setting with assessment of pregnancy intentions with a validated tool, such as the London Measure of Unplanned Pregnancy7. A growing body of evidence assesses long-term outcomes after UPs, and it would be interesting to consider (a history of) psychiatric vulnerability in future studies64,65. Additional qualitative work could be employed that investigates why women with psychiatric vulnerability have difficulties achieving their desired family size. Also, additional research is needed amongst women with severe mental illnesses, women who are unemployed, women from migrant backgrounds, women who do not have a partner relationship and women with psychiatric vulnerability who chose to terminate their pregnancies. Childlessness in women with psychiatric vulnerability is an important issue for future research, as this thesis shows that childlessness was related to mental health problems. Another fascinating avenue would be assessing the implementation of family planning conversations in psychiatric healthcare to better understand how such conversations can be personalized and optimized. It is of specific relevance to understand why persons with psychiatric vulnerability are reluctant to discuss contraceptive care with their MHP. As our qualitative findings are limited to selective samples of mostly native Dutch or English-speaking patients, higher educated and/or employed, we advise future researchers to make an additional effort in including patients from other backgrounds. It would be a shame to base current reproductive health practices in psychiatry on a subgroup of patients only. Finally, there is abundant room for studying positive outcomes or positive influencers on outcomes after UPs, regarding parent relationships, infant attachment and transition to motherhood46,66. Besides doing justice to the variation in lived experiences with UPs, positive scientific attention for this topic may aid in decreasing societal stigma.
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