Women's Reproductive Health Groups: Empowering a High-Risk Population

Abstract:

Introduction:
Women with mental illness are five times more likely to experience an unplanned pregnancy due to lower rates of effective contraception use, higher rates of comorbid substance use, and the nature of psychiatric illness itself. They also experience higher rates of adverse pregnancy outcomes, perinatal and postpartum psychiatric disorders, and changes in child placement. Despite this, education on women’s reproductive health and family planning is not routinely a part of adult psychiatric care.

Purpose:
To gain insight into the impact that reproductive health counseling via a psychiatrist can have on women with severe mental illness.

Methods:
Psychiatry residents were trained, provided a script, and led weekly groups on an inpatient psychiatry unit. Groups focused on structured contraception education followed by an open-discussion format. Data collected included the percentage of women with a history of contraception use, child protective service involvement, unplanned pregnancy, abortion, and the percentage of women who found the group helpful. Special care was taken to discuss all available options, including long-acting reversible contraception, to empower women to make their own decisions about their contraceptive needs.

Results:
From March 2022 to March 2024, 22 sessions were conducted with 78 participants who identified as women with severe mental illness. 32% self-identified as having used contraception, 50% have had an unplanned pregnancy, 23.3% have had an abortion, and 27.7% have had child protective services involvement. Among the 78 participants, 89% responded they would share information they learned with women outside the group. Following the group, several participants requested a consultation with the hospitalist to initiate long-acting reversible contraception. Group facilitators and free responses indicated the women who participated gained a better understanding of the medical, emotional, spiritual, and financial implications that unplanned pregnancies can have for those with mental illness.

Conclusions/Implications:
The prevailing model of general adult psychiatric care does not adequately address the impact that reproductive health factors have on mental health outcomes. The groups conducted on the psychiatric unit provide valuable insight into the utility, efficacy, overall attitudes, and receptiveness that women with severe mental illness have towards receiving reproductive health counseling from their psychiatrist. As stewards of collaborative care, consult liaison psychiatrists are uniquely positioned to address this vital aspect; they may employ a holistic approach to psychiatric practice, facilitate informed decision-making, and address health literacy barriers faced by high-risk patient populations, thereby promoting the overall wellness of their patients. The future implications are profound: educators are encouraged to recognize the need to incorporate reproductive health counseling as part of the general psychiatric residency training curriculum.