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Contraceptive and family planning experiences, priorities, and preferences of women with serious mental illness

Nikolajski, Cara (2018) Contraceptive and family planning experiences, priorities, and preferences of women with serious mental illness. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Over three million women of reproductive age residing in the United States are living with a serious mental illness (SMI). Compared to the general population, women with SMI have lower rates of contraceptive use, receive suboptimal reproductive care, and are at increased risk for unintended pregnancy. Few studies examine the factors associated with contraceptive nonuse/misuse and unintended pregnancy among this population or what women with SMI identify as important contraceptive and family planning counseling topics.

A systematic literature review was conducted in Study 1 to understand the current state of research regarding the contraceptive experiences, knowledge, and attitudes of women with SMI. Research quality, outcomes assessed, and findings varied, but many studies confirmed that women with SMI have disproportionately poorer contraceptive experiences. In Study 2, qualitative interviews were facilitated with women with SMI to understand factors influencing their contraceptive use/nonuse. Findings revealed that pregnancy intentions did not always align with contraceptive behaviors. Contributing factors to contraceptive nonuse/misuse included the influence of SMI symptoms, knowledge of and attitudes toward contraception, reproductive coercion, and sexual violence. Study 3 examined women’s reproductive counseling preferences and priorities, which included consideration of SMI symptoms when making contraceptive decisions, SMI medication contraindications and teratogenicity, SMI symptom changes during pregnancy/post-partum, and provider sensitivity. Additionally, these studies uncovered a more robust understanding of the differential reproductive experiences of women with bipolar, major depressive, and schizophrenia/schizoaffective disorders. Primary differences included variations in SMI symptoms and their influence on contraceptive use, with bipolar mania contributing to nonuse and fear of exacerbations in depressive symptoms impacting contraceptive method choice. Further, a higher proportion of women with schizophrenia/schizoaffective disorder experienced reproductive coercion, increasing their risk for unintended pregnancy.

This dissertation provides important information that can enhance the way reproductive services are delivered to women with SMI. All women deserve the opportunity to express their sexuality and realize their family planning goals, however they may be defined. To promote the reproductive health and rights of this population, it is of significant public health importance to ensure that women with SMI can safely and effectively prevent or experience pregnancy and achieve optimal fertility-related outcomes.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Nikolajski, Caracen4@pitt.educen4
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairBurke,
Committee MemberFelter,
Committee MemberHawk,
Committee MemberReynolds,
Committee MemberZickmund,
Date: 28 June 2018
Date Type: Publication
Defense Date: 12 February 2018
Approval Date: 28 June 2018
Submission Date: 4 April 2018
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 149
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Behavioral and Community Health Sciences
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Serious mental illness Family planning Contraceptive Use Experiences Qualitative
Date Deposited: 28 Jun 2018 20:40
Last Modified: 01 May 2020 05:15


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