Chapter 3 66 family planning could be initiated by both patients and professionals. As previous studies show that professionals are aware of the challenges for patients in discussing their family planning, professionals could initiate a conversation. Possibly, this feeling of reluctance to talk about family planning is less prevalent amongst younger generations, as shown by our respondents <40 years of age, who more often discussed family planning than respondents >40 years of age. Strengths and Limitations Our study provides self-reported data from a large sample of (former) patients with mental health problems and a smaller sample of close ones. Although the sample of close ones is limited, the sample is valuable as close ones are often not included in experience surveys in mental health care. We invited all members of the panel, irrespective of self-reported mental health disorder and/or problems and status of recovery. This increases the generalizability of findings, as mental health problems are known to be difficult to classify, subject to cultural differences, and subject to the classifier’s interpretation27. Our sample was diverse in self-reported mental health problems. Key limitations are the homogeneity of the sample regarding female gender, educational level, and respondents being middle-aged. There may be a sample bias as panel members might have a more intrinsic motivation to participate in research than the general population of people with mental health problems. Furthermore, non-response bias is a common problem in voluntary recruitment in public health studies and could lead to an underestimation of the severity of the problem, as more healthy persons tend to participate in surveys28,29. It is possible that (former) patients and close ones who find it difficult to discuss these topics did not fill out the questionnaires, pointing towards an underestimation of perceived taboo in the general population of people with mental health problems. The response rate of 9% among a panel of persons who regularly respond to questionnaires about mental health was lower compared to another survey amongst the panel (21.5% response rate)30. This might indicate that wishes for children and family planning are sensitive topics to address. Additionally, questions regarding motherhood and pregnancy might be less relatable to people of non-female gender, people without a life partner, people with no history of pregnancies, or people who have never experienced challenges with reproductive health. With the broad age range of the respondents, recall bias might influence our results as we inquire about experiences that, in some cases, occurred years ago. Moreover, experiences from decades ago may not represent the current situation in mental health care or reproductive care. As younger respondents had a conversation about family planning more often than older ones, a shift towards discussing family planning in mental health care might already be underway.
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