Experiences with family planning amongst persons with mental health problems 59 chose to postpone a possible pregnancy until the point they felt mentally stable themselves or had a stable relationship with a partner. The fear of becoming mentally unwell during the postpartum period and fear for the health of the baby caused respondents to postpone their wish for pregnancy. Decreasing the dosage of medication or quitting medication was often reported as a prerequisite to becoming pregnant. Medication use was also reported to coincide with having a safe pregnancy. Many close ones also recognized the relationship between mental health problems and various reproductive decisions, except for the question on experiencing taboo (Figure 3.2, question 7). While a taboo on discussing mental health problems was experienced by most (former) patients (62.4%), this was less mentioned by close ones (25.0%). (Former) patients explained that there was no space to discuss their problems amidst the other problems in traumatized families and that talking about mental health problems was not deemed to be ‘appropriate’. (Former) patients described feeling perceived as ‘crazy’, weak, and felt they should not complain. Moreover, (former) patients reported feeling ashamed, experiencing denial, and feeling misunderstood by family, co-workers, or community. Of the (former) patients and close ones who desired to discuss family planning, only one in five had discussed it with a mental health professional. A subgroup analysis showed that respondents <40 years of age more often spoke about family planning than respondents >40 years of age (Figure 3.2b, question 7). Of the childless respondents (n=207), 48.3% attributed childlessness to their mental health state (see Supplementary Table S3.2). After stratification for childlessness, (former) patients without children confirmed the influence of their mental health problems on the desire to have children (75.4% versus 27.2%, p<0.001) and the ability to become pregnant (36.7% versus 17.0%, p<0.001) more often than (former) patients without children. Almost half of all childless (former) patients never had a conversation about family planning (45.9%). In free-form text boxes, respondents further elaborated that childlessness was related to the fear of transmitting one’s mental health disorder or (childhood) trauma to their children, which led them to refrain from having children. Additionally, respondents described a feeling of responsibility in preventing a child from any harm (as they had often endured themselves). It was a conscious decision to be childless for some (couples), while others that had experienced mental health problems (or the treatment thereof with psychoactive medication) attributed this to be the source of fertility problems that resulted in childlessness. Lastly, respondents experienced discouragement from others to have children. Respondents reported that they received no tailored help. Relief and grief about childlessness were both mentioned.
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