Contraceptive use and counselling in women with mental illness: KwaZulu-Natal, South Africa

Abstract

Background: While women with mental illness are prone to unplanned pregnancies, sexual violence and exposure to teratogenic medications, there is limited knowledge of contraceptive use and counselling in this vulnerable group.

Aim: This study aims to determine the prevalence of contraceptive use and counselling in women of childbearing age attending a psychiatric facility in KwaZulu-Natal Province, South Africa.

Setting: This study was conducted on in- and outpatients attending Townhill Hospital, a tertiary psychiatric facility in Pietermaritzburg that provides specialised services for the uMgungundlovu District and surrounds.

Methods: An interviewer-designed and administered questionnaire was used to obtain data from 186 participants in this quantitative, cross-sectional study. Clinical information was obtained from the participants’ medical records.

Results: Among the 186 participants, the prevalence of consistent contraceptive use was 50%, 65.9% of prior pregnancies were unplanned, 35.5% reported a history of forced sex, 25.8% reported having unmet contraceptive needs and 59.7% requested integrated health care services. Only a quarter (25.3%) reported having received contraceptive counselling from their mental health care practitioner, while 31.2% (n = 58) received counselling on medication teratogenicity. Both contraceptive counselling (p = 0.018) and teratogenicity counselling (p = 0.007) were significantly associated with contraceptive use (n = 111).

Conclusion: There is inconsistent contraceptive use and low levels of counselling among women with mental illness. Integrated health care and contraceptive counselling by mental health care practitioners could improve the consistency of contraceptive use in this vulnerable group.

Contribution: Contraceptive counselling should be incorporated into psychiatric services to increase contraceptive uptake and reduce the impact of unplanned pregnancy and teratogenicity in this vulnerable population.