Experiences with family planning amongst persons with mental health problems 53 Introduction Family planning is an important aspect for most people at some point in their lives1. The working definition of family planning (‘the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births’, used by the WHO Department of Reproductive Health and Research [2008]), includes prevention of unwanted pregnancies as well as obtaining desired pregnancies. Researchers have become increasingly interested in studying the risk factors for impaired family planning, as unwanted pregnancies have adverse impacts on maternal and child health2. One of these risk factors is impaired mental health, as mental health problems can coincide with several aspects of family planning. Unintended pregnancies are often associated with misuse or non-use of contraceptive methods3,4. For women with severe mental illnesses such as schizophrenia and bipolar disorders, efficient use of contraceptive methods might, at times, be challenging. This arises from impaired decision-making and advanced planning skills during disease episodes3-6. Aside from proper contraceptive use, eating disorders or use of antipsychotic medication disrupted menstruation and could lead to an incorrect belief with respect to fertility7,8. Although impaired mental health is an established risk factor for unintended pregnancies9, the perspective and preferences of persons with mental health problems on their own family planning are currently lacking. Moreover, most studies have a profound focus on preventing unwanted pregnancies and only a minor interest in studying how desired pregnancies can be achieved. As the goal of family planning is to have reproductive intentions met, involuntary childlessness amongst persons with mental health problems should be included in the study of family planning. Several factors related to mental health problems could interfere with achieving desired pregnancies, such as problems with sexual functioning10, concerns about passing on heritable psychiatric conditions11, and fears of ‘not being a good parent’12. Previous literature has shown that persons with mental illnesses (schizophrenia, autism, eating disorders, substance abuse, and/or depression) have lower fecundity when compared to their unaffected siblings13,14. These population-based studies clearly suggest that persons with mental health problems might struggle to have their reproductive intentions met. Despite these additional challenges facing mental health patients in relation to family planning, their perspectives on childlessness have received little scientific attention. A few qualitative interview studies have discussed family planning in small samples of women with severe mental illness11,15. These studies demonstrate a lack of findings
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