Factors Influencing Contraceptive Use Among Women With Serious Mental Illness Residing in Pennsylvania

Women living with a serious mental illness (SMI) can experience a myriad of challenges throughout their reproductive years including suboptimal contraceptive use and unintended pregnancy. Little is known about the contextual factors that influence the contraceptive use of women with SMI. To address this gap, we conducted qualitative interviews with women with SMI residing in Pennsylvania, to understand their pregnancy intentions, current contraceptive use, and factors that influence their contraceptive use behaviors and experiences.

We conducted twenty-eight semi-structured in-depth interviews with a convenience sample of women who were sexually active and between the ages of 18-45 with a diagnosis of bipolar disorder (n = 10), MDD (n = 12), and schizophrenia/schizoaffective disorder (n = 6). Two coders analyzed transcripts using Crabtree and Miller's editing approach to identify qualitative themes and subthemes.

Most women (89%) reported wanting to avoid pregnancy; however, their contraceptive use did not always align with these intentions. SMI symptoms, contraceptive knowledge and attitudes, substance use, reproductive coercion, intimate partner violence, and sexual assault/abuse influenced participants' contraceptive use. Among this sample, a larger proportion of women with schizophrenia/schizoaffective disorder experienced reproductive coercion compared to women with MDD or bipolar disorder.

Study findings underscore the critical need for contraceptive counseling that considers the complex and potentially unique challenges faced by women with SMI. Future research should focus on developing and evaluating integrated care models that effectively support their family planning and contraceptive needs.