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Margaret Jackson Prize Essay 2013
Contraceptive and sexual health care issues in women with schizophrenia
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  1. Rowan Oliver
  1. Fourth Year Medical Student, University of Manchester, Manchester,UK
  1. Correspondence to Ms Rowan Oliver, University of Manchester, Medical School, Stopford Building, Oxford Road, Manchester M13 9PT, UK; rowan.oliver{at}student.manchester.ac.uk

https://doi.org/10.1136/jfprhc-2013-100704

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    Introduction

    Schizophrenia is a debilitating mental health disease that currently affects about 1% of the world's population with over 250 000 diagnosed cases in Great Britain. The typical age of onset of the disease in females is 25–30 years old,1 meaning that many women with this disease are of childbearing years. However, women with schizophrenia are often assumed to be sub-fertile, with their fertility rate estimated at 30–80% of that of the general population.2 The primary characteristics of the disease such as impairment of abstract thinking, lack of focus, impaired coping strategies, and abnormalities in perception of reality – sometimes resulting in social withdrawal and reduced functional capacity – can cause behaviours that complicate family planning and deem resultant pregnancies as ‘high-risk’.

    Historical context

    During the last few decades, changes in societal context, health care delivery, and pharmacotherapy have effected profound changes in the sexual and reproductive lives of women with schizophrenia. It was long believed that women suffering with a chronic mental health disorder, such as schizophrenia, engaged in sexual activities less than the general population. The reasoning was thought to be due to biological aspects of the disorder itself, neuroleptic medication and also living in separate gender wards in hospitals. With the introduction of community care, atypical antipsychotics and changing attitudes within society more light is being shed on the sexual landscapes of these patients, calling for a better understanding in the management of family planning and sexual health care in this context. There is increased concern related to sexually transmitted infections (STIs) (mainly HIV) triggered by the discovery of high-risk sexual behaviours of women with schizophrenia.

    In the 1950s, the sexuality of women with schizophrenia was restricted; this was mainly due to the lack of access to marriage and chronic institutionalisation.3 Sexual activity was discouraged in the psychiatric institutions, …

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