Experiences with family planning amongst persons with mental health problems 67 Recommendations for future research The results of this exploratory study point to a compelling need to validate the findings in other samples of persons with mental health problems, for example, samples from other geographical regions or inpatients with mental health problems. This would clarify whether our findings are context-specific or universally applicable to persons with mental health problems. Another promising line of research would be to explore the perspective of adolescents and young adults with mental health problems on family planning, as young persons might encounter struggles with family planning in the future. Their experiences might better reflect current practices in mental health care. Although unintended pregnancies are a global public health problem and evidence of the magnitude of this problem is much needed31, we also emphasize the need to investigate (involuntary) childlessness and fear of impaired motherhood on an individual level, as we found that individuals with mental health problems struggle with family planning. Future (qualitative) studies should focus on how, when, and by whom family planning and parenting should be addressed in people with mental health problems and their close ones and what information a conversation about family planning should entail addressing the unmet need. Conclusions This study has uncovered 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. Apart from focusing on the prevention of unintended pregnancies, family planning tailored to the needs of those with mental health problems should specifically address (involuntary) childlessness, insecurities about (possible) motherhood, and the influence of mental health on sexuality. It should also be considered that patients experience taboos on discussing sexuality and mental health in general. Ultimately, only one-fifth of the respondents had a conversation about family planning when it was desired, indicating that patients have an unmet need for talking about their challenges (with mental health professionals). Aside from scientific merits, we believe our findings eventually are also important for policymakers. Family planning should be a topic of discussion in psychiatric healthcare. Acknowledgments We thank Bianca Weel for her contribution to the data cleaning, Gerda van Ittersum and Nic Vos de Wael for their technical help with the questionnaire, and the (former)
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