Family planning for women with severe mental illness in rural Ethiopia: a qualitative study

Abstract

Background Family planning is a crucial issue for all women of reproductive age, but in women with severe mental illness (SMI), there may be particular challenges and concerns. As primary care-based mental health services are expanding in low- and middle-income countries (LMICs), there is an opportunity to improve family planning services for women with SMI. However, research exploring unmet family planning needs of women with SMI in such settings is scarce. Therefore, the present study explored the family planning experiences and preferences of women with SMI who reside in a predominantly rural area of Ethiopia. Methods A qualitative study was conducted. Women with SMI who were participating in the ongoing population-based cohort study in Butajira were selected purposively based on their responses to a quantitative survey of current family planning utilisation. In-depth interviews were conducted with 16 women with SMI who were of reproductive age. Audio files were transcribed in Amharic, translated into English and analysed thematically. Results Participants reported pervasive effects of SMI upon the intimate relationships and sexual lives of women. Although women with SMI felt that family planning was important, they had limited knowledge of family planning generally, and a lack of understanding of the specific family planning needs relevant to having SMI. None of the women with SMI in the present study had received any recommendations to use family planning services while accessing mental health care services. The participants identified ways in which primary care-based mental health services could better meet their family planning needs. Conclusions This study provided in-depth perspectives from women with SMI about the broader context of their family planning experience, needs, barriers and how integrated primary care services could better meet their needs. Empowerment of women with SMI to access information and services needs to be an important focus of future efforts to improve the reproductive experiences of this vulnerable group.

Contraceptive use in women with mental illness in Soweto, South Africa

“… 23 This links back to the association between MI and poor socioeconomic circumstances and disempowerment of women with MI. 2 , 3 , 4 , 5 , 6 This highlights a need for interventions that are targeted at empowering women with MI in order to allow them improved reproductive autonomy.…”

“…Having one or more children has been previously associated with increased usage of contraception. 5 A history of postpartum onset of MI was not investigated. This study did not establish chronology of presentation of depressive symptoms and contraceptive use and it is therefore beyond this study to establish causality with regards to depression and contraceptive use.…”

“…Despite this added risk, women with MI often receive inadequate family planning education (FPE) and reproductive health support. 5 Although motherhood is often a positive experience and may provide persons living with MI with an increased purpose in life and motivation to be well, women with MI have, on average, higher rates of unemployment, poverty, and weak social support 6 increasing the burden of childcare.…”

Sexual and Reproductive Health Needs of Women with Severe Mental Illness in Low- and Middle-Income Countries: A Scoping Review

“…Nineteen of the 100 included studies did not report whether ethical approval had been obtained [23][25][36][35][34][37][43][44][51][55][65][66][71][81][102][90] [104][19]. Seventy-six studies explicitly stated that informed consent had been sought from participants but of those, only 16 studies [31][32][37][36][42][52][57][60][67][70][5][2][99][110][111][113] included a statement that capacity to consent had been assessed prior to participants being included in studies. This means that almost a quarter of studies did not provide information in their published papers as to whether consent had been obtained and most studies in the review (n=79) did not include information as to whether capacity to consent had been assessed.…”

“…Seven studies focused on family planning advice from professionals [41][33][87][93][82][110][104]. The focus of included studies was varied.…”