Family planning is a crucial issue for all women of reproductive age, but in women with severe mental illness, there may be particular challenges and concerns. As primary care-based mental health services are expanding in low- and middle-income countries, there is an opportunity to improve family planning services for women with severe mental illness.
Women with severe mental illness also have increased risks of pregnancy, birth and neonatal complications. Mental illness is a risk factor for poor obstetric outcome, including perinatal mortality and congenital malformations. Some of these complications may be directly related to mental illness.
Family planning is particularly important for these women due to the perinatal effects of psychotropic medication. The risk of teratogenicity from some psychotropic medications is highest during the first trimester of pregnancy, with the critical period of exposure often occurring before pregnancy is detected or disclosed. Moreover, discontinuation of the medication during pregnancy increases the risk of relapse. Psychotropic medications may also cross into breast milk, which adds an important consideration in settings with high levels of exclusive breastfeeding and no realistic option to bottle feed
Taking the challenges and complexities faced by women with mental illness in relation to pregnancy and childbearing, family planning and education about future pregnancy is of critical importance in a woman living with mental illness during childbearing years. It is recommended that information about family planning should be incorporated into regular health care services.
At present, no studies have explored reasons for low access to family planning in women with mental illness in Ethiopia. There is also no published evidence on how these women prefer family planning services to be rendered. The plans to scale up mental health care by integrating into primary care services in Ethiopia provide a potential opportunity to deliver more holistic care to women with mental illness and improve their access to family planning advice.