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Schizophr Bull. 1997;23(4):623-35.

Sexuality, reproduction, and family planning in women with schizophrenia.

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Dept. of Psychiatry, University of Illinois at Chicago 60612, USA.


This article reviews data about how schizophrenia affects sexuality, pregnancy, the puerperium, parenting, and family planning. Women with schizophrenia have high rates of coerced sex, sexual risk behavior, and unwanted pregnancies. High rates of obstetric complications and custody loss increase morbidity for women and their offspring. Since untreated psychosis increases these problems, the risks of withholding pharmacotherapy must be weighed against the risks of prescribing medications during pregnancy. The puerperium is a time when women are especially vulnerable to exacerbations of schizophrenia. Mothers with schizophrenia may have a reduced ability to read children's cues, and they often have weak social support networks. Their children may be more difficult to raise than other children. Parenting rehabilitation can address some of these problems. Often, women with schizophrenia who are sexually active and do not wish to become pregnant do not use contraception. Incorporating family planning measures into mental health care delivery systems may reduce unwanted pregnancies.


A review of the literature indicates that women with schizophrenia may have limited knowledge about sexuality, high rates of coerced sex, low contraceptive usage, many unwanted pregnancies, and severe parenting difficulties. Given problems with contraceptive compliance, long-acting hormonal methods are optimal. Since schizophrenic women are especially vulnerable to exacerbations of mental illness during pregnancy, the risks to the mother of withholding pharmacotherapy must be weighed against the slight increase in risks of congenital anomalies associated with such treatment. Postpartum psychotic episodes are also common, with serious consequences for the mother-infant relationship. The quality of child care provided by mothers with schizophrenia may be compromised by a reduced ability to read children's cues and weak social support networks. Mental health services and child welfare agencies need to collaborate to weigh the risks to a child of remaining with a psychotic parent versus those of being removed from the home. Recommended for mental heath practice are the following: incorporation of sex education and assertiveness training into psychosocial rehabilitation programs, HIV education and screening, systems for the early detection of pregnancy in chronically mentally ill women, steps to reduce the likelihood of relapse during the vulnerable postpartum period, improved methods for assessing parenting capability, parenting education, and the incorporation of family planning programs into mental health care delivery systems.

[Indexed for MEDLINE]

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