Unmet Needs for Family Planning and Attitudes Towards Pregnancy Among Women With Mental Illness in Mathari National Teaching and Referral Hospital in Nairobi, Kenya

Abstract

Introduction: In spite of widespread gain in contraceptive coverage, unmet need for family planning in Kenya still remains high. Mental and behavioral health disorders are increasing globally contributing to 7.4% of the global burden of disease. Women with mental health disorders are at an increased risk of unplanned pregnancy which carries risks such as foetal exposure to psychotropics in first trimester, unsafe abortions and contracting sexually transmitted infections. Pregnancy and the postpartum period can also exacerbate an already preexisting mental illness. Mental illness herein referring to mental disorder. Despite above challenges, there are few studies in Kenya regarding unmet needs for family planning and attitudes towards pregnancy among women with concurrent mental illness. Significance of the study: Unplanned pregnancy in mentally ill not only poses a risk to maternal health but also places an extra burden on public funding of governments hence the drive to increase contraceptive prevalence in view of long-term economic efficiency. This study provides information about contraceptive behavior and attitude towards pregnancy that can guide health care workers in providing more specific or suitable family planning services to women with mental illness. Objective: The study objective was to determine the prevalence of unmet need for family planning and attitudes towards pregnancy among women with mental illness as well as explore associated socio-demographic variables. Methodology: This was a cross sectional descriptive study conducted among female outpatients with mental disorders aged between 18 and 49 years on follow up at the weekly psychiatric outpatient clinics in Mathari National Teaching and Referral Hospital and who met the inclusion criteria. Systematic random sampling was done to achieve a sample size of 250 patients. The Mini Mental State examination was done to assess for suitability into the study. Data was collected using a MINI international neuropsychiatric interview version 7.0.0, a researcher designed socio demographic questionnaire, a semi structured questionnaire drawn from the short version of the Kenya Demographic Health Survey Female Questionnaire 2014 and an Attitude to Pregnancy questionnaire. COVID-19 guidelines on prevention were adhered to throughout the process. Data analysis and Presentation: Data collected was cleaned, entered and stored in MS Excel then transferred to SPSS version 26 for analysis. Univariate analysis was done to describe the prevalence of unmet need for family planning, attitude and socio demographic characteristics. Bivariate analysis was used to describe the association between the mental illness and dependent variables. Multivariate regression was used to determine the effect of the dependent variables on unmet need for family planning. Pierson Chi 12 squared was used to test for association with p value set at less than 0.05 and confidence interval of ninety five percent. Unmet need for family planning was expressed as a percentage calculated from adding up the total number of women in the study who were not using contraceptives despite having a need for spacing or limiting births. Attitude was measured on a five-point Likert scale. Positive statements yielded a high score while negative statements a low score. Results were expressed as percentages, mean and median and diagrammatically displayed via graphs and tables. Results: The mean age of the 250 participants was 32.4 years. The total unmet need for family planning was 31.2% with unmet need for spacing births being 20.4% and unmet need for limiting births being 10.8%. The overall attitude towards pregnancy was positive at 97.2% with 7 people reporting a negative attitude (2.8%). There was no significant association between mental illness and both unmet need for family planning which was p=0.452 and attitude towards pregnancy as shown by chi square test of p=0.949. There was also no association between unmet need for family planning and attitude towards pregnancy which had a p value of 0.500. The participant’s marital status, level of education, main source of income and religion were found to be significantly associated with unmet needs for family planning. There was no significant association between sociodemographic factors and attitudes towards pregnancy. Majority of the patients (73.2%) had never received any information regarding family planning from staff at Mathari Hospital during their clinic reviews. Conclusion: There was a high prevalence of unmet need for family planning among women with mental illness which was higher than the general population at 31.2% irrespective of their high level of education, knowledge of contraceptives and easier access to family planning methods. Socioeconomic factors have a significant role in unmet need for family planning. This reflects the importance of empowering and enhancing stability of female psychiatric patients. Regardless of the unmet need, attitude towards pregnancy was positive and not confounded by the mental illness or sociodemographic status of the patients. Attitude remains a complex thing to explore and its implication towards contraceptive use, behaviour and intention may have other underlying factors involved.