Green Oak Initiative, Bengaluru, India.
Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India.
Int J Soc Psychiatry. 2020 Dec;66(8):792-798. doi: 10.1177/0020764020925104. Epub 2020 Jun 24.
Decision-making around pregnancy is challenging for women with severe mental illness (SMI), and several clinical and socio-cultural factors might influence this process.
The main objective of this study was to determine factors that influence decision-making regarding pregnancy for women with SMI.
Using a qualitative design, 42 women with SMI who were pregnant or planning pregnancy were assessed using a semi-structured interview by an independent researcher not involved in their clinical care. Areas of inquiry included knowledge about their illness, treatment; family and societal beliefs on mental illness and motherhood; illness management; and attitude towards medical advice.
Among the 42 women, majority of the women (88%) reported reduced autonomy in decision-making related to pregnancy. Stigma was one of the major contributory factors in decision-making. Over 80% reported not using contraception despite medical advice due to lack of control over the decisions related to the use of contraception. Over 50% of the women in the study believed that taking psychotropic medications during pregnancy would definitely harm the baby. A similar number believed that their illness would not recur if medications were to be stopped during pregnancy.
Women with SMI who plan to become pregnant, especially from low-income settings in India, are disadvantaged by stigma and societal expectations, affecting their ability to make optimum decisions during this crucial period. Decision-making around pregnancy in women with SMI is complex and appears to be influenced by several socio-cultural factors and needs to be dealt with sensitively.
对于患有严重精神疾病（SMI）的女性来说，妊娠决策极具挑战性，有几个临床和社会文化因素可能会影响这一过程。
本研究的主要目的是确定影响 SMI 女性妊娠决策的因素。
采用定性设计，通过独立研究人员（不参与其临床护理）对 42 名患有 SMI 的孕妇或计划怀孕的女性进行半结构式访谈。调查内容包括对自身疾病的了解、治疗情况；家庭和社会对精神疾病和母性的观念；疾病管理；以及对医疗建议的态度。
在这 42 名女性中，大多数女性（88%）报告说，与妊娠相关的决策自主权减少。污名化是决策中的一个主要促成因素。尽管有医学建议，但超过 80%的女性因无法控制与避孕措施相关的决定而未使用避孕药具。超过 50%的研究女性认为在怀孕期间服用精神类药物肯定会伤害婴儿。同样数量的女性认为，如果在怀孕期间停止服药，她们的病情就不会复发。
计划怀孕的 SMI 女性，尤其是来自印度低收入地区的女性，由于受到污名化和社会期望的影响而处于不利地位，这影响了她们在这一关键时期做出最佳决策的能力。SMI 女性的妊娠决策复杂，似乎受到多种社会文化因素的影响，需要谨慎处理。
