Reproductive Health Among Women With Mental Illness in Kenya: a Study on Knowledge, Attitude and Behaviour

Abstract

Introduction and background: Women with mental illness in Kenya are a unique population and frequently their care focuses on the management of their psychiatric conditions with little focus on

their reproductive health, despite the fact that reproductive ill health contributes to close to one third of the disease burden in women. There are few Kenyan studies regarding their knowledge, attitude and behaviour towards reproductive health in the setting of concurrent treatment of mental illness Objective: The main objective was to establish the knowledge, attitude and behavior with regard to reproductive health among women with mental illness in Kenya. The specific objectives were to establish knowledge, attitude and reproductive health practices related to pregnancy and contraception, safe sex and cervical cancer screening among women with mental illness. Methods: The study was conducted at the Mathari National Teaching and Referral Hospital in Nairobi County, Kenya. It utilized a purposive sample of the population of female outpatients with mental illness aged between 18 and 49 years attending the consultant follow-up clinics for mental illness. The research design was cross sectional descriptive study. A structured questionnaire drawn from the relevant portions of the short version of the Female Questionnaire of the Kenya Demographic Health Survey 2014 was be used for data collection. Data analysis and presentation: Data was analyzed using SPSS version 23 and presented using tables. Out of the 249 respondents, a large proportion were aged between 20 to 39 years (74.3%), and those aged 40 years and above were 24.9%.73% of the respondents had secondary level of education and above, with 26.9% having primary level education. 63.5% of the respondents sampled were single, separated or divorced while 34.1% were married. 45.4% of the respondents had a working diagnosis of psychosis, followed by bipolar and related disorders at 38.2% , depressive disorders at 6.4%, anxiety disorders at 4.8%, convulsive disorders and temporal lobe epilepsy at 2.8 %. 46.2% were able to correctly state when exactly safe days are in the menstrual cycle, 79.2% had knowledge of the need for condom use to prevent transmission of sexually transmitted infections. Of the 83.1% of respondents who had heard of cancer of the cervix, 30% had been screened. 64.3% were not using any contraceptive method at the time of interview with 46.9% of these intending to use a contraceptive in the future. 65.9 % of the 85 respondents who were married or living in a relationship as if married, were able to ask their husbands or partners to use condoms if need arose and 75.3% of these were able in certain circumstances to decline their husband or partners requests for sex.76.3% of the respondents who had been pregnant in the five years preceding the interview, had four or more antenatal clinics during their pregnancies. The mean age at sexual debut was 19.4 years. Out of the 85 respondents who were married or in a relationship as if married, 36 respondents had had other sexual partners besides their husbands or regular partners in the year preceding data collection. The mean number of lifetime sexual partners was 3.4 (SD 6.4).21.7% of respondents had a history of sexual trauma. Conclusion: There was good knowledge on the prevention of STI, sexual debut later than the general population and good utilization of antenatal clinic services in pregnancy, good level of awareness of cervical cancer and cervical cancer screening rates higher than the general population in Kenya. We also found among our respondents higher rates of sexual trauma and risky sexual behavior than the general population of women in Kenya .