Family planning for the mentally disordered and retarded

Increasing perception of healthy reproductive functioning and conception prevention has been accompanied by greater recognition of the needs for emotional and sexual fulfillment of individuals with mental disorder or retardation. Although family planning services have burgeoned in the United States and many other countries and the special concerns of mentally disordered and retarded persons have been well documented, organized efforts to include counseling on fertility regulation in mental health and in training programs have, with few exceptions, been sparse. Recent trends are discussed in terms of reported experience from the United States and Denmark. It is recommended that women of childbearing age in psychiatric facilities be given an opportunity to participate in programs offering screening for and treatment of gynecological conditions, as well as family planning counseling, before going on home leave or discharge. Such counseling should be adapted to a woman's emotional functioning, consider possible contraindications of specific contraceptive methods, and, to the extent possible, involve the partner. Ethical aspects need to be considered to avoid even the appearance of coercion. Similar opportunities should be provided for retarded persons seeking to achieve a satisfying sexual life. Surgical contraception and abortion are discussed within the context of patient rights, competence, and the desirability of avoiding unintended conceptions and reducing unwanted births that may engender further stress and psychosocial difficulties for the woman, the child, and society. The experience of former patients might well be useful in restructuring current service programs and priorities.