Experiences with family planning amongst persons with mental health problems 65 against unintended pregnancy with examples of involuntary intercourse, forced nonuse of contraceptive methods, and interaction of contraceptive methods and other medication. Interestingly, 48.3% of the (former) patients in this panel attributed their childlessness to their mental health. For 8.2% of childless (former) patients, mental health was not related to their childlessness. This is in concordance with a Scandinavian population register study that found associations between several major diseases, including mental disorders and being childless14. We found that insecurities about being a good parent could be attributed to (involuntary) childlessness, as explained by respondents. Close ones in this sample less frequently reported that mental health problems impaired the mental health patient as a parent or that mental health problems were related to pregnancies or early parenthood. This illustrates how the uncertainties that people with mental health problems encounter are not always visible or understood by others. Our data confirm prior research: fear of transmission of disease increases the fear of becoming a parent23. In addition, an unmet need to discuss family planning with mental health professionals could feed beliefs about harmful medication, infertility, and the inability to be a good parent, as described by the respondents. We did not specifically inquire about unwanted childlessness in this study, and thus have no knowledge about the proportions of respondents feeling regret, grief, or satisfaction with having no children and the relationship with mental health problems. Future (qualitative) studies could pay attention to childlessness in relation to mental health. (Former) patients in this sample experienced a taboo in talking about family planning and sexuality in the context of their mental health problems. These experiences were hardly recognized by close ones. Furthermore, (former) patients felt supported in their mental health problems to a lesser extent than close ones indicated. Feeling an absence of support can negatively impact mental health, as unsupportive responses to mental health problems make it less likely that patients would seek help, as illustrated in another sample of patients with mental health problems and their close ones24. In addition, fear of being stigmatized added to the reluctance of patients to express their worries and needs to close ones and mental health professionals24,25. This might explain the reported unmet need for discussing family planning in our study. Previous research has shown that mental health professionals considered taboo and stigma barriers to providing care for their patients26. For patients with a mental health disorder, complex care needs, care avoidance, and lack of trust in mental health professionals hindered patients from seeking help. This can be further compounded by the practical aspects of healthcare, such as lack of time and waiting lists. However,
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