Severe Mental Illness and Reproductive Health

Severe mental illness (SMI) during pregnancy and the postpartum has the potential to impact negatively on the well-being of the mother, the mother-infant dyad, and her family. Untreated SMI can lead to poor attendance to antenatal care, impair mother-infant attachment, and, in rare cases, lead to suicide and infanticide. The wider usage of newer antipsychotics, deinstitutionalization, lessened stigma, and greater opportunities for social interaction have allowed many women with preexisting severe mental illness to embrace the possibility of, and plan for parenthood. However, mothers with SMI in general, continue to experience multifaceted risks such as unplanned pregnancies, obstetric complications, comorbid substance abuse, poor social support, and interpersonal violence which impact on outcomes and stretch available health resources. Mental health services and clinicians need to be aware that their female patients with SMI of reproductive age can and often do become pregnant and that preventative strategies (preconception counseling) for those who plan to become pregnant and contingent strategies (timely referral pathways and specialist consultations) for those who have unplanned pregnancies should become part of their core business. Obstetric and child health services need to work in conjunction with mental health services in identifying the needs of high-risk women, who may develop index episodes of severe mental illness during their perinatal period, particularly in the postpartum. As psychotropic medication is the mainstay of treatment for women with SMI, a necessary impetus is on the need for robust safety data in pregnancy and breastfeeding, so the woman and her family can make informed choices. Equally important though are the relational and sociocultural forces that pervade the lives of pregnant women with SMI, which need to be explored and addressed. Despite advocacy from caregivers, women’s groups, and health professionals, services for mothers with mental illness are unevenly distributed worldwide with majority of the services only available in developed or high-income countries. In low- and middle-income countries (LAMICs), where high rates of maternal morbidity have been reported, the focus is predominantly on physical health with a less emphasis on mental health services. Strategies to overcome this challenge will be needed. In this chapter, we focus on the spectrum of perinatal healthcare for women with SMI.