Abstract
Although much research has focused on socio-demographic determinants of uptake of contraception, few have studied the impact of poor mental health on women's reproductive behaviours. The aim of this study was to examine the impact of poor mental health on women's unmet need for contraception and fertility rate in a low-income country setting. A population-based cohort of 1026 women recruited in their third trimester of pregnancy in the Butajira district in rural Ethiopia was assessed for symptoms of antenatal common mental disorders (CMDs; depression and anxiety) using Self-Reporting Questionnaire-20. Women were followed up regularly until 6.5 years postnatal (between 2005 and 2012). We calculated unmet need for contraception at 1 year (n = 999), 2.5 (n = 971) and 3.5 years (n = 951) post-delivery of index child and number of pregnancies during study period. We tested the association between CMD symptoms, unmet need for contraception and fertility rate. Less than one-third of women reported current use of contraception at each time point. Unmet need for birth spacing was higher at 1 year postnatal, with over half of women (53.8%) not using contraception wanting to wait 2 or more years before becoming pregnant. Higher CMD symptoms 1 year post-index pregnancy were associated with unmet need for contraception at 2.5 years postnatal in the unadjusted [odds ratio (OR) 1.09; 95% confidence interval (CI) 1.04-1.15] and fully adjusted model [OR 1.06; 95% CI 1.01-1.12]. During the 6.5 year cohort follow-up period, the mean number of pregnancies per woman was 2.4 (s.d. 0.98). There was no prospective association between maternal CMD and number of pregnancies in the follow-up period. CMD symptoms are associated with increased unmet need for family planning in this cohort of women with high fertility and low contraceptive use in rural Ethiopia. There is a lack of models of care promoting integration of mental and physical health in the family planning setting and further research is necessary to study the burden of preconception mental health conditions and how these can be best addressed.
Highlights
Planning has been shown to improve women’s and children’s lives in a multitude of ways (Ahmed et al, 2012; Cleland et al, 2012)
Despite the high prevalence of common mental disorders (CMDs) in women of reproductive age in low- and middle-income countries (LMICs) (Fisher et al, 2012) and mounting evidence of the impact of CMDs on infant illness rates (Rahman et al, 2004; Ross et al, 2011), and reduced help-seeking of the mother on behalf of her child (Rahman et al, 2004), less focus has been given to how maternal CMDs may impact a woman’s behaviours pertaining to her own health
Mental health symptoms and would benefit from these interventions but may not access other parts of the health system. To our knowledge this was the first study to investigate the impact of poor mental health on unmet need for contraception and fertility rate in a rural sample of women from a lower income country
Summary
Planning has been shown to improve women’s and children’s lives in a multitude of ways (Ahmed et al, 2012; Cleland et al, 2012). Much research to date has focused on socio-economic determinants of the uptake of family planning (Tadele et al, 2019), few investigators have studied the impact of poor mental health on women’s reproductive behaviours in low- and middle-income countries (LMICs). There is evidence from high-income countries that depression is associated with increased rates of unintended pregnancy in young adulthood and shorter pregnancy spacing (Patchen et al, 2009; Hall et al, 2014; Corcoran, 2016). Despite the high prevalence of common mental disorders (CMDs) in women of reproductive age in LMICs (Fisher et al, 2012) and mounting evidence of the impact of CMDs on infant illness rates (Rahman et al, 2004; Ross et al, 2011), and reduced help-seeking of the mother on behalf of her child (Rahman et al, 2004), less focus has been given to how maternal CMDs may impact a woman’s behaviours pertaining to her own health
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