Assessment of reproductive health needs of women with mental illness on follow-up at outpatient psychiatry clinic at MTRH – Eldoret, Kenya

Abstract

Background: World over, women with mental illness (WMI) face more reproductive health (RH) challenges than those without. They have lower rates of contraception uptake, more unintended pregnancies, more likely to suffer gender based violence and unsafe abortions. They however often interact with the health system in pursuance of mental but seldom RH services. At Moi Teaching and Referral Hospital (MTRH), WMI rely heavily on mental health service providers (MHSP) for screening, diagnosis and treatment and/or referral for RH services - with numerous missed opportunities. Objective: To assess the reproductive health needs of women with mental illness on follow up at outpatient psychiatry clinic at MTRH. Methods: This was a cross sectional study using a concurrent mixed method approach. It was conducted at the Outpatient Psychiatry Clinic at Chandaria Cancer and Chronic Disease Centre at MTRH-Eldoret. The study populations were WMI and MHSP. Systematic sampling was used to identify 218 WMI. An interviewer administered semi structured questionnaire was used to collect socio-demographic characteristics and data on RH service need for: contraception, abortal care, cervical cancer screening and gender based violence. The uptake of services was determined from among those with need. Continuous variables were summarized using mean and the corresponding standard deviation (SD) while categorical variables were summarized using frequencies and the corresponding percentages. Qualitative data was collected from 10 MHSP who were purposively sampled after stratification by cadre. An interview schedule was administered for information on the challenges MHSP faced in offering RH alongside mental health services. The major themes on the challenges faced were reported and illustrative quotes provided. Results: Of the 218 WMI, the mean age was 39.1±12.1 years, with 169 (77.5%) aged 18-49 years. The unmet need for contraception was 75% (n=100). Of the WMI ever pregnant (n=187), the need for abortal care services was 61(32.6%) with abortal care service uptake by 18 (29.5%). The need for cervical cancer screening was 95.9% (N=218) with a service uptake by 40/209 (19.1%). Prevalence of gender based violence (GBV) was 85 (39.0%) (N=218) with service uptake by 3 (3.5%) of the 85 with GBV experience. The major challenges faced by MHSP in provision of RH alongside mental health services to WMI included heavy patient workload and an uncoordinated multidisciplinary approach in RH service provision. Conclusion: The RH status of WMI in MTRH is characterized by a high unmet need and a low RH service uptake. This is occurring in a setting where patient factors and system related challenges hamper provision of reproductive alongside mental health services by MHSP. Recommendations: Strategies to integrate reproductive health and mental health services should be developed and implemented to improve the reproductive health status of WMI.