Chapter 3 64 Discussion Key results Our results, derived from survey data from a panel of (former) patients with mental health problems and close ones, reflect the severe and adverse impact of mental health problems on four domains of reproductive health and family planning: reproductive history (including unintended pregnancies), reproductive decision making, parenting, and sexuality. High proportions of unintended pregnancies (45.4%), childlessness related to mental health problems (48.3%), experiencing taboo around sexuality (58.2%), and feeling impaired as a parent due to mental health problems (59.9%) illustrate common challenges that (former) patients with mental health problems face. Given these findings, it is striking that only one in five (former) patients who desired to have a conversation about family planning with a mental health professional were able to have that discussion. Interpretation of findings Amidst the (former) patients, the proportion of unintended pregnancies (21.7%) was comparable to the lifetime prevalence of unintended pregnancy in the general Dutch population (20.0%)19. However, the proportion of unintended pregnancies amongst women who were ever pregnant in our sample was comparable to other samples of women with anxiety and depression (45.4%)20. This confirms the high risk of unintended pregnancies in persons with mental health problems, as previously shown in a review and meta-analysis9. Moreover, as a proportion of women in our sample is in the reproductive phase of life, the lifetime prevalence of unintended pregnancies could increase in our sample. Contraceptive use through self-reporting was high in our study (75.3% according to (former) patients and 83.3% according to close ones). The discrepancy between contraceptive use and unintended pregnancies is generally explained by the suboptimal use of contraceptive methods. This is a common pitfall and appears to exist irrespective of educational level21. However, based on the results from our survey, additional reasons have been uncovered, such as intolerance to contraceptive methods and the perception of being infertile (due to mental health problems). Previous studies reported that unintended pregnancies were related to decreased sexual autonomy, impaired coping mechanisms (intimacy-related, ability to say no, or to ask for contraception), involvement in violent relationships, lack of knowledge about unintended pregnancies, or difficult access to, or interaction with, contraceptives15,22. In line with these findings, respondents of our study illustrated the inability to protect
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