Choosing not to have children with schizophrenia

This is a composite story, drawn from common experiences shared in the schizophrenia community. It does not depict a real individual.

I am 35, I live in Brooklyn, and I have decided not to have biological children. I was diagnosed with schizophrenia at 22. The decision came in stages, over years, and it has not always felt the same to me from one season to the next. I am writing this not to recommend the choice but to describe what it has been like to make it.

What went into the decision

There were several threads, and they did not all feel equally important on the same days.

The first was the genetic question. I had read enough to know that having a parent with schizophrenia raises a child's risk, though most children of people with schizophrenia do not develop the condition. The NIMH overview describes the increase as roughly tenfold over the baseline 1% — meaningful but not deterministic. This piece on genetic risk walks through the numbers carefully. I did not want to make a decision based on fear, but I also did not want to dismiss the data.

The second was the question of medication during pregnancy. Several of the medications I had been on were considered relatively safe in pregnancy; others would have required switching. I had spent years getting my regimen stable. The thought of going through another period of titration during pregnancy, and then again postpartum, was daunting. The risk of postpartum psychosis in women with a history of schizophrenia is real and elevated.

The third — and this one took me longest to admit — was about my own capacity. Parenting is not optional once you start. I had spent my twenties working out a sustainable life with my illness. My energy budget was real. My sleep was non-negotiable. I had built a life that fit me carefully. I was not sure I had the resilience to add the constant unpredictability of a small child to that life.

The years of being unsure

I did not arrive at certainty quickly. From about 27 to 32 I was actively unsure. My partner at the time wanted children, and we talked about it often. I went to a perinatal psychiatrist for a consultation. I went to genetic counselling. I read everything I could find. None of those resources told me what to do — they gave me better information to think with.

That relationship eventually ended, in part because of this question and in part for many other reasons. The ending was painful and it forced me to think about what I wanted independent of someone else's expectations. I did not want to default into either having children or not having them because of what someone I loved wanted.

How the decision settled

The decision settled, in the end, around 33. I was on a hike with a close friend who has two young children. She was telling me about a hard week — not in a complaining way, just describing the actual texture of having two small children with her own job and her partner's job and the constant low-grade exhaustion. I listened carefully. I felt, in a way I had not before, that I knew this was not the life I could sustain.

That knowledge did not feel like deprivation. It felt like clarity. I had been afraid that I would never have the kind of certainty that everyone seemed to talk about — the way other people described "knowing" they wanted children. What I got instead was a quieter knowing in the other direction. It was sufficient.

The grief that came afterwards

I want to be honest about this. The clarity did not eliminate the grief. There were months after the decision when seeing pregnant friends or babies in carriers triggered a kind of low ache. I imagined the version of myself who would have made the other choice. I imagined the child who would not be born. That grief was real. I let it be there.

What helped:

• Talking to my therapist openly about the grief, without trying to argue myself out of it
• Talking to other women — both with and without mental illness — who had made the same decision
• Letting myself feel the loss without using it as evidence that the decision was wrong
• Spending time with my friends' children in a way that let me be present for those relationships

What life looks like now

I am the most involved aunt my niece and nephew have. They live three hours from me. I see them regularly. I have a relationship with them that is mine, not a substitute for parenthood. They know me. I know them.

I have invested in friendships in ways that I see other women my age struggling to maintain because of the demands of small children. I am closer to several friends than I have ever been. We have weekly calls. We have weekend trips. We have built a chosen family that is not less than the biological one I might have had — just different.

I have time and energy for work that matters to me. I am part of a peer support group. I write occasionally. I take long walks. I read more than I have since college. None of this is a consolation prize. It is the life that fit my actual capacity.

What I wish people understood

• The decision is rarely simple. People often assume it is either a fear-based decision or a freedom-based decision. For most of us it is both, and several other things, all at once.
• "Have you considered adoption?" is a question that, however well-meant, often misses the point. Adoption involves many of the same demands of full-time parenting that informed the original decision. Some people with schizophrenia do choose adoption, beautifully. Others, like me, are not making a decision against biology — we are making a decision against full-time parenting.
• Genetic risk is one factor and not the deciding one for everyone. Many people with schizophrenia have biological children and parent them well. The decision is personal and there is no universally right answer.
• The grief is allowed. It does not mean the decision was wrong.
• The life on the other side can be meaningful and full.

For others making this decision

If you are working through this question, here is what I would offer:

• Talk to a perinatal psychiatrist if you are seriously considering pregnancy. They can walk you through medication, risk, and planning in a way that general clinicians often cannot.
• Get genetic counselling if the genetic question is weighing heavily.
• Take time. Decisions made under pressure tend to be regretted in either direction.
• Talk to other people with schizophrenia who have made each choice. Both groups exist and both have wisdom.
• Whatever you decide, you are not less of a person for the deciding.

My life is not the life I imagined at 16. It is the life I have, and most days it is enough — not in a settling-for way, but in a real, lived way. I hope yours becomes the same.

This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.