This study aims to examine the polarised discourse surrounding selective serotonin reuptake inhibitor (SSRI) use during pregnancy and to propose a human rights-based and autonomy-focused approach grounded in reproductive justice and shared decision-making.
This viewpoint presents a rights-based ethical reflection informed by a narrative synthesis of current evidence, including the US Food and Drug Administration’s 2025 expert panel on SSRIs during pregnancy, and the literature from perinatal psychiatry, medical ethics, human rights and public health communication. The paper explores how scientific uncertainty, risk communication and social context influence treatment decisions during pregnancy.
The debate surrounding SSRI use during pregnancy is frequently framed as a binary choice between protecting foetal well-being and treating maternal mental health conditions. Such polarised narratives risk oversimplifying a complex evidence base and may undermine informed decision-making. Current evidence suggests that both untreated perinatal mental health conditions and pharmacological treatment involve potential risks and uncertainties. A rights-based approach requires balanced communication, recognition of relational autonomy, attention to structural inequalities and meaningful participation of pregnant women in decisions affecting their health and well-being.
Existing discussions have largely focused on pharmacological safety, maternal mental health outcomes and foetal risks. Comparatively less attention has been paid to how human rights principles, including autonomy, participation, informed consent and reproductive justice, should guide decision-making under conditions of scientific uncertainty. This paper addresses that gap by reframing SSRI decision-making during pregnancy through the lenses of autonomy, participation, informed consent, reproductive justice and rights-based mental healthcare. It advocates a shift from paternalistic and polarised approaches towards more collaborative, person-centred and ethically grounded care.
