Barriers to family planning among women with severe mental illness Open Access
Lawley, Megan (Summer 2018)
Published
Abstract
Background: Limited attention has been paid to family planning among women diagnosed with severe mental illness (SMI) since the deinstitutionalization of this population more than 50 years ago. Overall, the few existing studies on the reproductive health of women with SMI suggest a potential unmet need for family planning education, counseling, and contraceptive services.
Objective: We explored the family planning perspectives, experiences and needs of women diagnosed with serious mental illness (SMI).
Methods: We interviewed 17 English-speaking women aged 18-55 with previously diagnosed serious mental illness who were currently receiving treatment at an outpatient community mental health clinic associated with a large safety net hospital in Atlanta, Georgia. We conducted in-depth, in person interviews, lasting 30-90 minutes, with semi-structured guides. We defined SMI as: major depressive disorder (MDD) with or without psychotic features, bipolar disorder with or without psychotic features, post-traumatic stress disorder (PTSD), schizophrenia or schizoaffective disorder[1]. Two investigators analyzed key codes and themes which emerged from the qualitative data using MAXQDA software.
Results: The most common diagnoses were major depressive disorder and post-traumatic stress disorder among the 17 women who participated in the qualitative interviews. Of the participants interviewed, 8 had more than one diagnosis. The most common type of contraception ever used was condoms with (94%), followed by oral contraceptives (88%); only 23% had ever used LARC (long acting reversible contraception). Several themes have emerged from our analysis: 1) pregnancy intention 2) pregnancy decision-making, 3) pregnancy coercion, 4) access to reproductive care and 5) barriers to reproductive care. The first three themes were influenced by both the women and partner’s attitude toward the pregnancy and often by the woman’s feelings toward her partner. The remaining themes established an unmet need for reproductive care among women with SMI seeking regular follow up with their mental health provider in addition to a general gap in psychiatric providers addressing reproductive care.
Conclusions: The findings raise important questions regarding unintended pregnancy, pregnancy decision making and partner dynamics. There is also a clear reproductive healthcare gap among these women who desire more access to reproductive healthcare but don’t always know where or how to receive it in addition to it not being addressed by their mental health providers. These themes suggest an unmet need for reproductive care in this population and an opportunity for family planning providers to partner with colleagues in psychiatry to help address these needs. Furthermore, there is a need to recognize and address partner coercion as well as a need to empower women with SMI to make their own decisions.
Table of Contents
Chapter 1: Introduction……………………………………………………………..……….1-6
Background………………………………………………………………………….1-4
Proposed Research………………………………………………………..................4
Theoretical Framework…………………………………………...............................4-5
Purpose……………………………………………………………………………....5-6
Chapter 2: Literature Review……………………………………………………. ………... 7-13
The Prevalence and Significance of Serious Mental Illness………………………...7-8
Changing Models of Health Care Has Implications for Reproductive Health……...8
Family Planning Outcomes Among Women with SMI …………………………….8-9
Implications of SMI for Reproductive Health……………………………………....9-11
Unique Issues Regarding Reproductive Aged Women with SMI………………….11-12
Research is Needed to Understand and Address Unmet Family Planning
Needs for Women with SMI………………………………………….…………….12-13
Chapter 3: Methods………………………………………………………………………....14-19
Study Design and Sample…………………………………………………………...14-16
Measures…………………………………………………………………….............16-17
Procedure…………………………………………………………………………....17-18
Analysis………………………………………………………………..…………....18-19
Chapter 4. Results…………………………………………………………………...............20- 31
Table 1: Demographics……………………………………………………………...21-22
Table 2: Themes…………………………………………………………..………...22
Unintended Pregnancy……………………………………………………...............23-24
Pregnancy Decision Making………………………………………………………..24-26
Coercion…………………………………………………………………….............26- 28
A. Influence of Partners…………………………………………………..............26-27
B. Influence of Family……………………………………………………............27-28
Accessing Reproductive Healthcare………………………………………………..28-29
A. Inability to Access Care…………………………………………….................29
Barriers to Reproductive Healthcare………………………………………………..29-30
A. Role of Mental Health Providers ……………………………………………...29-30
B. Barriers to Addressing Reproductive Care with Mental Health Providers …...30-31
Chapter 5. Discussion………………………………………………………………………32-35
Findings………………………………………………………………………….....32-34
Public Health Implications…………………………………………………………34-36
Strengths and Limitations…………………………………………………….…….36
Conclusions…………………………………………………………………………36-37
Bibliography………………………………………………………………………………...38-40
Appendix A………………………………………………………………………………….41-46
Appendix B………………………………………………………………………………….47- 52
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