| Abstract|| |
Background: Population and its dimensions are considered the focal point of any social system and the present study seeks to determine the factors associated with childbearing intentions in female students. Materials and Methods: This cross-sectional study randomly examined 294 female students of Shahid Beheshti University (SBU) and Shahid Beheshti University of Medical Sciences (SBUMS) in Tehran. Data were collected using a Demographic Questionnaire, the Factors Associated with Childbearing Intentions Questionnaire, and the Multidimensional Scale of Perceived Social Support Questionnaire. The relationship of childbearing intentions was assessed with marital age, duration of marriage, ideal number of children, and ideal birth spacing. Results: Of the factors examined, marriage age had the highest correlation with childbearing intentions (P < 0.001, r = 0.959). After eliminating the statistically insignificant paths, the spouse's role (β =0.325), personal factors (β = −0.100), and family factors (β = −0.072) were found to have a direct effect on childbearing intentions. The variables of age (β = −0.007), educational stage (β = −0.007), family factors (β = −0.013), beliefs (β =0.002), spouse's role (β = −0.033), and financial status (β = 0.015) were found to have indirect effects. Conclusions: Many factors are involved in childbearing intentions, including personal factors, family factors, spouse's role, perceived social support, social support, beliefs, and financial factors. Health teams and policymakers should adopt strategies that can aid the socioeconomic status and family conditions of university students and enable them to have their desired number of children at the most appropriate timing.
Keywords: Childbearing, influencing factor, intentions, University student
|How to cite this article:|
Moradi M, Kariman N, Simbar M, Pourhoseingholi MA, Baki S. The factors associated with childbearing intentions in Iranian female University students. Ann Trop Med Public Health 2017;10:1714-9
|How to cite this URL:|
Moradi M, Kariman N, Simbar M, Pourhoseingholi MA, Baki S. The factors associated with childbearing intentions in Iranian female University students. Ann Trop Med Public Health [serial online] 2017 [cited 2020 May 29];10:1714-9. Available from: http://www.atmph.org/text.asp?2017/10/6/1714/222703
| Introduction|| |
Population issues and the unprecedented decline in fertility rates throughout the world comprise a major global problem in the modern world. In line with these transformations, the Islamic Republic of Iran has also experienced vast changes, and the fertility rate has declined dramatically in Iran over the past three decades. Fertility transition has occurred in Iran along with the changes in the socioeconomic and some traditional dimensions of the family. According to a 2006 census, the total fertility rate in the country was 1.8 children/mother and the national population growth was 1.62%; in a 2011 census, however, the latter fell to 1.29. The population growth rate will drop to 1.23% between 2015 and 2019 and to 1.13% between 2020 and 2024. The general lack of information about health issues related to childbearing, academic aspirations, career targets, and factors such as income, religion, wealth (assets), employment, age, marital age, the developing urbanization, and the desire for social mobility among women have had a significant role in the decline in childbearing.,
The fertility rate has been indirectly affected by women's pursuit of higher education and their extensive university admission by changing their personal beliefs and forming a modern attitude in them and has also been affected directly by increasing their marriage age and causing a delay in childbearing. In addition to this variable, women's social participation is also one of the key variables involved in the decline in childbearing. Research has also shown that, even in the absence of higher education and employment, women are involved in social and cultural societies through the public media and friends and bear fewer children to have the opportunity to carry on with these activities. Financial independence seems to have little effect on women's childbearing intentions since most women are not financially independent due to not being employed and having no income.
Childbearing is an irreversible process that creates a permanent commitment in parents to support their children and take care of them. In the modern world, childbearing and choosing the right time for becoming parents have turned into a mental challenge for couples. Furthermore, the distinction between the issue of sex and having children has led to different choices of lifestyle that is completely unprecedented in human history. Beck and Beck-Gernsheim argued that the time taken for childbearing decision-making is increasing since along with the right to freely choose when and if to have children, children have become a valuable asset, and this transformation highlights the need for prolonged intellectual reflection and debate before childbearing. The results of other studies conducted on fertility suggest that the decision-making process has a small role in childbearing and is not an important topic to bear in mind.,
The present study was conducted in 2016 to determine the factors associated with childbearing intentions in female students of SBU and SBUMS. The researchers seek to offer a perspective on the current status of childbearing and to identify the factors associated with childbearing intentions and to thus facilitate policymakers' decision-making in-line with the current laws of the country and also to help midwives and other health service providers adopt suitable strategies and perform appropriate interventions.
| Materials and Methods|| |
The present cross-sectional study was conducted from September 2016 to February 2017 on 294 single and married female students of SBU and SBUMS in Tehran selected through multistage sampling. In the first stage of sampling, six schools were randomly chosen from SBU and four from SBUMS. In the second stage, the selected schools were visited, and samples were randomly selected from their students in two steps. In the first step (sampling from the schools), the number of classes held on the day of sampling was determined, and some of the classes were randomly selected in proportion to the sample size. In the second step (sampling from the classes), a number of students were selected from the class list in proportion to the number of students present in the class. With a 95% confidence interval and a 5% rate of error, the study sample size was determined as 245. In determining the sample size, P (the affective factors involved in childbearing decision-making; Patterson, 2012) was estimated as 33%. Taking into account, a potential attrition of 20%, the sample size was increased to 294. The study inclusion criteria consisted of Iranian nationality, having studied at either SBU or SBUMS in Tehran for at least 1 year, consenting to participate in the study, being of female gender and a minimum age of 18 and a maximum of 40.
Data were collected using a researcher-made demographic and obstetric questionnaire, the factors associated with Childbearing Intentions Questionnaire (Amerian et al., 2015) and the Multidimensional Scale of Perceived Social Support (MSPSS) (Zimet, 1988).
The researcher-made demographic and obstetric questionnaire assessed variables including age, marital status, marriage age, duration of marriage, ethnicity, place of birth, place of residence, spouse's age, educational stage, occupation, monthly family income, housing status, floor area of the house, household size and issues related to obstetric history, including method of contraception, access to contraception methods, ideal number of children, and ideal birth spacing. The validity of the demographic and obstetric questionnaire was assessed using the content validity method, so that, after confirmation by the supervising and advising professors, the questionnaire was distributed among ten faculty members of the School of Nursing and Midwifery, and the recommendations made by the research committee were reviewed and implemented.
The validity of the Factors associated with Childbearing Intentions Questionnaire developed by Amerian et al. was verified using the quantitative and qualitative content validity methods, and its construct validity was assessed using the path analysis method. The reliability of this questionnaire was confirmed using the internal consistency method (r = 0.89). The present study also confirmed the reliability of this questionnaire with a Cronbach's alpha of 0.85 and reported its test-retest reliability as 0.75.
The validity of the MSPSS was confirmed using principal component analysis. The reliability of this questionnaire has been confirmed in different studies with Cronbach's alpha values ranging from 0.86 to 0.90 for the subscales and 0.86 for the entire scale. The present study assessed the reliability of this questionnaire using the test-retest and the internal consistency methods and reported its Cronbach's alpha as 0.85 and its test-retest reliability as 0.75.
After confirming the validity and reliability of the questionnaire and obtaining a letter of introduction from the School of Nursing and Midwifery of Shahid Beheshti University of Medical Sciences (SBUMS) and a letter of permission from the university's ethics committee (IR. SBMU. PHNM.1395.398), the researcher began sampling by visiting different schools of the universities. The eligible students were then identified and briefed on the study objectives and ensured of the confidentiality of the data, and after submitting their consent, they each completed the questionnaires individually.
Data were analyzed in SPSS-17 and AMOS-20 (IBM Corporation, Armonk, New York, USA). Data were summarized and reported using descriptive indicators such as mean, standard deviation, and frequency percentage. The relationship between the independent variables and childbearing intentions was assessed using Pearson's correlation coefficient and multivariate regression analysis. The direct and indirect effects of the variables on women's childbearing intentions were determined through a path analysis. P < 0.05 was considered as the level of statistical significance.
| Results|| |
The study population consisted of 227 single (77.21%) and 67 married (22.79%) female students. The participants' mean age was 23.64 years with a standard deviation of 3.20. A total of 288 of the participants (97.96%) were born in cities and 292 (99.32%) lived in cities. The majority of the students (60.20%) were at the undergraduate level, and 41.15% of them studied medical sciences, 41.50% studied humanities, and 17.35% studied engineering. A total of 70.11% of the students were unemployed. Most of the students (37.75%) lived with their family or spouses. A majority of them (39.12%) had monthly household incomes in excess of two million Tomans. A total of 65.65% had medical services or social security insurance, and the majority (60.54%) had no complementary insurance coverage. Most of them (65.65%) were not members of any charities or religious associations. Moreover, the majority (57.48%) had a moderate financial status, and 57.48% had moderate social support. Marriage age and duration of marriage were 22.96 ± 3.44 and 2.28 ± 1.74 years, respectively, in the married women. Most of the married students (37.31%) used condoms as their method of contraception. The majority of the spouses of the married students (52.23%) had bachelor's degrees, and 37.31% were corporate employees. Most of the married students (59.7%) had wanted to have two children before their marriage.
[Table 1] presents the mean and standard deviation of the scores obtained in the Factors associated with Childbearing Intentions Questionnaire. Of the variables assessed, educational stage (r = 0.127), beliefs (r = 0.266), spouse's role (r = 0.238), perceived social support (r = −0.322), and social support (r = 0.277) showed significant correlations with childbearing intentions in the female students of SBU and SBUMS. Educational stage (r = 0.183), financial factors (r = −0.215), family factors (r = 0.099), spouse's role (r = 0.099), perceived social support (r = −0.325), and social support (r = 0.334) also showed significant correlations with the age of childbearing in the study population. [Table 2] presents part of these findings.
|Table 1: The distribution of the mean and standard deviation of the scores of the different dimensions of the factors associated with childbearing intentions questionnaire|
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|Table 2: The correlation between the factors associated with childbearing intentions and the age of childbearing|
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The empirical model of path analysis is depicted in [Figure 1]. The path coefficients, standard deviation, and P value of the factors associated with childbearing intentions are presented in [Table 3]. The fit indices of the model are also shown in [Table 4].
|Figure 1: The empirical model of path analysis for the factors associated with childbearing intentions in female students of Shahid Beheshti University and Shahid Beheshti University of Medical Sciences in Tehran in 2016|
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|Table 3: The model coefficients, standard deviation, and P value of the factors associated with childbearing intentions in female students|
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|Table 4: The fit indices of the model of factors associated with childbearing intentions in female students|
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As can be seen in [Table 4], the root mean square error of approximation is <0.1. The comparative fit index, the normed fit index, the goodness of fit index (GFI), and the adjusted GFI are all higher than 0.9. Moreover, the normed (relative) Chi-square is acceptable in the range of 1–5. These results show the model's good fit.
| Discussion|| |
According to the results obtained, the ideal birth spacing was 3 years or more for most of the students (70.75%). In a study conducted in Shahrud, Iran, on the factors associated with men's and women's first childbearing decision-making, most women found a good birth spacing to be 5 years or more., In another study conducted by Hosseini and Abbasi Shavazi entitled “Ideational Changes and its Impact on Fertility Behavior and Attitudes of Kurd and Turk Women,” most women found an ideal birth spacing to be 3.5–6 years.
The ideal number of children was two for most of the participating students, which is in line with the results obtained in a study by Kariman et al. on the socioeconomic factors predicting the timing of childbearing in Iranian women. The present findings also concur with the results obtained by Amerian et al. and with those obtained by Hosseini and Bagi in a study entitled “ Women's autonomy and fertility ideals”., In a study by Schytt et al. on childbearing intentions among Swedish women and men, the ideal number of children was two for most of the participating women.
The students' responses to questions about the timing of childbearing, number of children, birth spacing, and method of contraception showed that in most families, women and men contribute to childbearing decision-making together, which agrees with the results obtained by Amerian et al. Nonetheless, Testa et al. studied couples' fertility behaviors in Italy and found that Italian women have a greater role than their male spouses in childbearing decision-making. The disparity between these findings may be attributed to the differences in the sociocultural settings of the studies, the different data collection tools used and the samples selected from varying age groups.
The mean scores obtained in the dimensions of social support as a factor associated with childbearing intentions, including the family, friends, and influential people dimensions, were 23.02 ± 3.77, 21.04 ± 5.33 and 23.95 ± 2.71, respectively. Similarly, of the dimensions of social support, the group of women obtained the highest mean score in the dimension of influential people and the lowest in the dimension of friends. The categories of social support were adjusted as the factors associated with childbearing intentions, which show that most students received moderate social support. This finding concurs with the results obtained by Amerian et al. and Kariman et al.,
In the present study, a significant and inverse relationship was observed between social support and childbearing intentions. Amerian et al. also found that social support had a significant and inverse effect on age at first childbearing. The increasing number of articles published on social support in various journals and the positive effects of its presence and the negative consequences of its absence show the important role of social factors in childbearing.,
In the population examined in the present study, an inverse relationship was observed between financial status and age of childbearing. A study conducted by Hezarjaribi and Abbaspour entitled “The effect of socioeconomic factors on women's fertility rate” showed that the financial status has a negative correlation with fertility rate; that is, the more well off are families; the lower are their women's fertility rate. Amerian et al. found that age at first childbearing has a direct and significant correlation with financial status. Kariman et al. also found a significant and direct correlation between socioeconomic status and age at first childbearing; that is, age at childbearing increased with household income and the family's level of education and welfare. The disparity of findings between this and the other studies may be due to the differences in the study populations examined since the present study was conducted on 294 female students of SBU and SBUMS, 227 (77.21%) of whom were single and >35% of whom were women younger than 22, whereas Kariman's study was conducted on 32 married primiparous women or those who used contraceptives–>90% of whom were older than 20.
In another study, Kreyenfeld and Anderson found a strong relationship between men's unemployment and couples' childbearing decision-making, whereas women's unemployment had no relationships with their childbearing intentions. The results obtained by Adair showed that aging and income are directly and strongly correlated with the desire and motivation for childbearing. Nilsen et al. showed a negative correlation between childbearing age and socioeconomic status. Benzies et al. showed that women's independence in terms of education, occupation, and family finances are among the factors that significantly affect women's decision about the timing of childbearing.
| Conclusions|| |
The present findings showed that fertility behaviors and ideals in female students are affected by financial status, social support, and personal and family factors. Since the study was cross-sectional, it cannot be considered a reliable study of decision-making processes. Moreover, the findings are limited to the female students of Shahid Beheshti University (SBU) and SBUMS in Tehran, and there is no reason for them to be applicable to the entire nation. Nonetheless, the results can help researchers with the design of interventional studies on childbearing intentions in other universities. Analyzing the findings of these studies can help the authorities and policymakers adopt strategies that can facilitate childbearing in those wishing to continue their study and work.
This article is derived from a Master of Midwifery thesis at SBUMS in Tehran. Hereby, the author would like to express their gratitude to the research committee of the school and all the women who participated in the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Research Center for Midwifery and Reproductive Health, Department of Reproductive Health and Midwifery, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Vali-Asr Avenue, Cross of Vali-Asr and Neiaiesh Highway, Opposite to Rajaee Heart Hospital, P.O. Box: 1996835119, Tehran
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4]