Chapter 9 250 Clinical implications In understanding the clinical implications of our work, we must first come to terms with one key question: should UPs be perceived as a problem for women with psychiatric vulnerability? We argue that the evidence provided in this thesis, supported by previous literature on UP rates amongst various populations, supports the hypothesis that the impact of UPs should not be overlooked. Certainly, the impact of UPs in the Netherlands might be limited to a certain extent, as abortion care is safe and widely accessible and obstetric healthcare free and available to all. Birth and neonatal outcomes were not disadvantaged in children born after UPs compared to intended pregnancies (Chapter 4). However, our studies have also shown the personal narratives of women with UPs, which ranged from positive experiences with UPs to stories of women with unwanted pregnancies who were forced to continue their pregnancies (Chapter 6,7). These narratives demonstrate how UPs profoundly impact lives of expectant parents, also in the Netherlands. Moreover, women with psychiatric vulnerability encountered challenges with family planning, pregnancy journeys and parenting in case they had UPs, but also if pregnancies were intended of if they remained (involuntarily) childless. As such, family planning may be perceived as a challenge for many women with psychiatric vulnerability and should be better addressed in clinical practice. In this chapter, we will outline several clinical implications that are derived from our findings. Discussions about family planning and desire for children should take place in psychiatric healthcare We make several practical suggestions to facilitate conversations about family planning in psychiatric healthcare (Chapter 3,6,7,8): Customized family planning for individuals dealing with psychiatric vulnerability ought to specifically tackle concerns related to involuntary childlessness, uncertainties surrounding the prospect of (potential) parenthood (Chapter 6,7,8), and the impact of mental health on sexuality (Chapter 3). We recommend MHPs to proactively address family planning with all patients during their reproductive life stage and encourage patients to initiate these discussions within a trusting therapeutic relationship (Chapter 8). Information about (in)fertility in relation to psychiatric vulnerability should be provided to patients in these conversations, as this fear emerged in focus group conversations (Chapter 6), surveys (Chapter 3) and interviews (Chapter 7).
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