Academic Clinical Fellow in Psychiatry, South London and Maudsley NHS Foundation Trust and King's College London, London, UK.
Aklilu-Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
Epidemiol Psychiatr Sci. 2020 Aug 18;29:e160. doi: 10.1017/S2045796020000736.
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.
尽管大量研究集中在社会人口决定因素对避孕措施的影响上，但很少有研究关注心理健康不良对女性生殖行为的影响。本研究旨在探讨在低收入国家环境下，心理健康不良对女性避孕需求未满足和生育率的影响。
本研究为基于人群的队列研究，在埃塞俄比亚农村的布塔吉拉区，招募了 1026 名处于妊娠晚期的妇女，使用自我报告问卷-20 评估产前常见精神障碍（抑郁和焦虑）的症状。对这些妇女进行了定期随访，随访时间为产后 6.5 年（2005 年至 2012 年）。我们计算了 1 年（n=999）、2.5 年（n=971）和 3.5 年（n=951）时生育指数儿童后的避孕需求未满足率和生育次数。我们检验了 CMD 症状与避孕需求未满足率和生育率之间的关系。
不到三分之一的妇女在每个时间点报告当前使用避孕措施。产后 1 年时，生育间隔的避孕需求未满足率更高，超过一半的妇女（53.8%）不想在怀孕前等待 2 年或更长时间。产后 1 年时，CMD 症状较高与产后 2.5 年时避孕需求未满足相关，未经调整的模型[比值比（OR）1.09；95%置信区间（CI）1.04-1.15]和完全调整的模型[OR 1.06；95%CI 1.01-1.12]。在 6.5 年的队列随访期间，每位妇女的平均生育次数为 2.4（标准差 0.98）。在随访期间，产妇 CMD 与妊娠次数之间没有前瞻性关联。
在埃塞俄比亚农村地区，该队列中生育力高、避孕使用率低的妇女中，CMD 症状与计划生育需求未满足率增加有关。目前缺乏在计划生育环境中促进精神和身体健康整合的护理模式，需要进一步研究孕前心理健康状况的负担以及如何最好地解决这些问题。
