Friday, Oct. 20
14:30 – 15:30 (N/A)
Meeting Room: Finback (3rd floor – B Tower)
Rebecca Zivanovic*, BSc MD FRCPC; Ella Hardie, BSc; Marianne Vidler, PhD

CanMEDS Roles:

1. Health Advocate
2. Medical Expert
3. Collaborator

At the end of this session, participants will be able to: 1) Identify unmet need regarding contraception for women with serious mental illness; 2) Identify systemic, individual, and psychosocial factors that constitute potential barriers; and 3) Be encouraged to consider potential next steps in research, quality improvement, education, and clinical care to address this gap.

Despite compelling evidence that women with schizophrenia and bipolar disorder experience high rates of unintended pregnancy, induced abortion, obstetrical complications, poor neonatal outcomes, and child apprehension, little has been done to address this unmet need for contraception. This systematic literature review and narrative summary explored attitudes and preferences of women and their care providers to identify barriers to overcoming this unmet need.
Methods: We searched databases (PubMed, Embase, MEDLINE, Scopus, PsycINFO, and Cochrane Database of Systematic Reviews), reference lists, and conference proceedings between 1990 and 2022. Search terms included bipolar or schizophrenia coupled with contraception, birth control, family planning, contraception behaviour, unintended pregnancy, unplanned pregnancy, unwanted pregnancy, induced abortion, sexual health, and reproductive health. Two authors did a full-text review of 136 papers.
Results: Nineteen qualitative and quantitative studies were included. Client perspectives highlight challenges in the use of contraception and reinforce the significant burden of unintended pregnancies and unsupported parenthood. Studies consistently found client interest in having mental health care providers engage with them around issues of reproductive health, including contraception. Studies of care providers found issues of stigma, perceived lack of adequate training or education to address this in clinical practice, concern about working outside of their scope, and uncertainty about client preferences.
Discussion: Barriers to overcoming this gap include client and provider knowledge, stigma, concerns around coercion and boundaries, and systemic and socioeconomic issues. This research indicates potential points of intervention within clinical practice and the broader social context.

References:

1. Nikolajski CE. Contraceptive and family planning experiences, priorities, and preferences of women with serious mental illness. Dissertation presented to the University of Pittsburgh; 2018.
2. Hughes E, Edmondson AJ, Onyekwe I, et al. Identifying and addressing sexual health in serious mental illness: views of mental health staff working in two NHS organisations in England. Int J Ment Health Nurs 2018;27(3):966–974.