Investigation of women's Reproductive History, attitude toward childbearing and associated factors in Rafsanjan City, Iran, 2021

doi:10.21203/rs.3.rs-4822608/v1

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Investigation of women's Reproductive History, attitude toward childbearing and associated factors in Rafsanjan City, Iran, 2021

https://doi.org/10.21203/rs.3.rs-4822608/v1

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Background:

Addressing recent population growth policies in Iran, this study aimed to determine the attitude toward childbearing, reproductive history, and factors associated with them in women of Rafsanjan City in 2021.

Methods:

This descriptive cross-sectional study was conducted using a census sampling method on 875 married women in 2019–2020 who referred to the premarital counseling center of Rafsanjan. For data gathering, a demographic checklist and childbearing attitude questionnaire were used. Data was analyzed using descriptive statistics and chi-square and t-tests.

Results:

Of the 875 study samples, 27.43% werein engagement period, 27.43% were married and childless, 39.31% were married and had children, and 5.83% were divorced. The outcome of 26.01% of pregnancies resulted in abortion. There was a direct correlation between childbearing attitude scores and the women'sreligiosity (P < 0.001). Women with lower educational levels, no income, unemployed and rural women, had a better attitude towards childbearing (P < 0.01).

Conclusions:

Although people's attitude towards childbearing is positive after three years of marriage, the number of live birth is low. The higher ratio of abortion in the total number of pregnancies compared to the average miscarriage rate, seems to indicate a high prevalence of unsafe and illegal abortion. Considering the potential risks, it is necessary to reconsider the policy of limiting the supply of family planning services, which increases unsafe abortion.

reproductive history

abortion rate

attitude toward childbearing

Iran

The total fertility rate (TFR) indicates the number of live births that a woman would have over her lifetime (1). A TFR of around 2.1 children per woman is the replacement level often cited for broad population stability (2). Between 1990 and 2021, global TFR dropped from 3.31 to 2.32 (3). According to the Statistical Center of Iran in 2016, the TFR was 2/07 child per woman, which decreased to 1/74 child 2021 (4).

Iran has experienced one of the most rapid declines in fertility rates in a short time. This decline in fertility rates is results of a family planning program implementation in 1989 aimed at reducing fertility rates (5). In the next decade, Iran is likely to be classified among countries with very low fertility (6).

Declines in fertility would impact the population pyramid of society (5), and with sustained sub-replacement fertility rate, the incident of population aging is inevitable (7). Iran, like many other countries, is on the path to population aging and the associated political, economic, social, and psychological challenges (8).

In response to the decline in population growth, the Iranian government has modified and changed national population growth policiesdramatically since 2010. The mostrecent and comprehensive national legislation in support of increasing fertility is “the Protection of Family and Youth Population law”, which was established in 2021 (9). According to This law access to family planning services were restricted and a stronger emphasis placed on the illegality of abortion without medical reasons.

According to global statistics, between 2015 and 2019, there were an estimated 121 million unintended pregnancies worldwide, of which 0.6% ended in induced abortion (10). Following an unintended pregnancy, women who face barriers to accessing safe abortion, often resort to unsafe abortions (11). Complications of unsafe abortions may include hemorrhage, infection, and sepsis, which can lead to hysterectomy and, in some cases, death (12).

Childbearing, as a social act, occurs within a social and cultural context (13). Fertility and childbearing are influenced by a multiple of social, demographic, and economic factors (14), including changing attitudes towards abortion and the level of use of new media (15), modern lifestyles (16), and increasing age at marriage and divorce (17).

Attitude, defined as an individual's overall assessment of a concept (18). One of the main determinants of fertility behavior is intention or attitude towards fertility and childbearing (19, 20). Attitude towards fertility recognized as the first element in developing fertility behavior (21). Numerous studies have demonstrated a positive correlation between attitude towards fertility and fertility rates (22–24). Proclivity towards childbearing refers to the desire to have children from both biological and social perspectives (25). Intention and desire are two dimensions of proclivity (14). Regarding the downward trend in population growth in recent years in Iran, the variable of attitude towards childbearing has gained significant importance.

In Iran, the government is actively promoting policies to increase birth rates in recent years. However, there is a lack of comprehensive data regarding women's attitudes towards childbearing in Iran. And, there is a paucity of research on this topic both in Iran and specifically in Rafsanjan. To address this gap, this study conducted in 2021 to determine the reproductive history and attitude towards childbearing and the associated factors among women in Rafsanjan City.

This descriptive cross-sectional study was conducted in 2021 after obtaining ethical approval from ethic committee of Rafsanjan University of medical sciences (IR.RUMS.REC.1401.046). The target population was all women who were officially married in 2019–2020. The participants included 875 and who were selected using a census method based on inclusion and exclusion criteria. The reason for choosing 12 months of the years 2019–2020 (one year in solar Hijri calendar) was the research team's access to women's contact numbers and assumption based on Rafsanjan culture that Three years would be a sufficient time after marriage for being pregnant.

The researcher obtained the names, surnames, and contact numbers from the premarital counseling Center and called participants via her mobile phone. The researcher made two calls at different daytimes (morning and evening). A pre-written message was sent to participants in case: there was no response, the individual was unavailable, the call could not be connected, or the mobile phone was blocked or switched off. Participants were informed about the study's purposes and ensured confidentiality of their information. They participated in the study with verbal consent. Sampling started on June 22nd and finally completed by the end of September.

Inclusion Criteria in this study were: Being alive, willing to participate in the study, having No history of or current illness that contraindicates pregnancy, Iranian nationality, being 45 years old or less, and being Married in Rafsanjan City in 2019–2020,

Exclusion Criteria were: Unwillingness to answer the questions, Infertility of either the woman or her husband, Menopause, and Death of the husband.

Out of 1778 names obtained by the researcher, 875 samples were included in the study. The 903 individuals who leaved out of the study were categorized as follows:

Unwillingness to participate at the beginning of the interview: 32 individuals
Unwillingness to continue answering questions: 32 individuals
Non-response despite calls and message: 394 individuals
Not found in the network, wrong number or no number for the sample, phone line blocked, unavailable, unable to connect, or mobile phone turned off: 244 individuals
Infertility: 41 individuals
Not married (engagement broken): 23 individuals
delayed marriages: 77 individuals
Menopause before 45 years of age: 3 individuals
Afghan nationality: 15 individuals
Death: 2 individuals
Death of spouse: 3 individuals
Age over 45 years: 24 individuals
Duplicate samples: 13 individuals

Data was collected using a researcher-developed checklist consisting of four sections: personal information, information on marriage and fertility, and information on the last miscarriage. The validity of this checklist was confirmed by 5 faculty members of the Rafsanjan School of Nursing and Midwifery. After completing 20 questionnaires, some of the questions were deleted or modified with the help of the supervisor and researcher.

The Attitude toward Fertility and Childbearing (ATFC) questionnaire by Kordzangeneh and colleagues was used to assess childbearing attitude. The original version of the ATFC questionnaire (26) by Söderberg and colleagues is in English and consists of 27 questions and 3 components (importance of children for the future, children as a hindrance in the present, and social identity) based on a 5-point Likert scale with options ranging from strongly agree to strongly disagree. The Persian version of the questionnaire by Kordzangeneh and colleagues (27) consists of 20 questions with the same 5-point Likert scale and has been psychometrically tested in the southern part of the country. The face validity of this questionnaire has been confirmed by 8 individuals. Seven questions with lower overall scale correlation scores and a negative impact on the reliability of the scale were removed from the Persian version, and exploratory factor analysis was performed on the remaining 20 questions. The Cronbach's alpha coefficient of the ATFC questionnaire for the southern regions of the country was 0.88. The inclusion criteria for this questionnaire were: being married, having no children either in this marriage or in previous marriages, not being pregnant, and being between 18 and 40 years old. The exclusion criterion was unwillingness to continue answering the questions.

The Cronbach's alpha coefficient of the questionnaire in this study was calculated as 0.864.

Statistical Analysis

Data analyzed using SPSS software version 24. Results for quantitative data were reported as "mean ± standard deviation" and "range of variation" and for qualitative data as "number (percentage)". To compare the means of quantitative variables between the study groups, one-way ANOVA was used, and if significant, Tukey's multiple comparisons test was used. Additionally, the independent two-sample t-test was used. To compare the frequencies of qualitative variables between the study groups, the Chi-square test was used. The normality of the distribution of the fertility attitude score was assessed by calculating the skewness and kurtosis indices. The significance level for the tests was 0.05.

Frequency of Marital Status after Official Marriage of Women in the Study is presented in Table 1.

Table 1

Frequency of Marital Status after Official Marriage of Married Women in 2019–2020 in Rafsanjan City
Marital Status After Official Marriage	Engagement	Married and Childless	Married with Children	Divorced	Total
Frequency (Percent)	240 (27.43%)	240 (27.43%)	344 (39.31%)	51 (5.83%)	875 (100%)

Out of the 875 participants, 824 (94.2%) were still in a relationship with their husbands, and 51 (5.83%) were divorced. Additionally, 530 (60.6%) were childless, 235 (26.9%) had one child, 85 (9.7%) were in their first pregnancy, 19 (2.2%) had two children, and 6 (0.7%) had one child and were pregnant with their second child.

In Iranian families, it is common for some couples not to start living together after their official marriage until the initial conditions for starting a life together, such as dowry and housing, are met. This period is called the Aghd (Engagement) period. During the Aghd period, the bride and groom live with their parents and according to old tradition, they are supposed to do not have a full sexual relationship, and young woman should not become pregnant.

Out of the 235 women with one child, 87 (37%) gave birth vaginally, and 148 (63%) had a cesarean section. Additionally, out of the 19 women with two children, 2 (10.5%) had vaginal delivery and 17 (89.5%) had a cesarean section in their second pregnancy.

Out of the 875 women, 63 (7.2%) reported one miscarriage, 15 (1.7%) two miscarriages, and 1 (0.1%) three miscarriages.

The mean age of women in engagement group was significantly lower than other groups (p < 0.001).

There was a significant difference in education level between the groups (p < 0.001), with the highest frequency of elementary education among divorced women and high school education among women in engagement.

There was a significant difference in employment between the groups, with the highest frequency of unemployment among divorced women (p < 0.001). More women married with children were without income than compared to other groups, and the difference was significant (p < 0.001). Women with children compared to other women were more likely to live in urban areas (p = 0.001). The mean score of women’s religiosity did not differ significantly between the study groups (p = 0.055).

The descriptive indices of the attitude towards childbearing score for not divorced women who have not any child are presented in Table 2.

Table 2

Descriptive Indices of Attitude towards Childbearing Score for not divorced women without child
Variable	Frequency	Mean	Standard Deviation	Minimum	Maximum	Median (IQR)	Skewness	Kurtosis
Attitude Towards Childbearing Score	469	67.07	10.94	28	100	68	0.362	0.555

As the table shows, the skewness and kurtosis values of the attitude towards childbearing score are within the range of -2 to + 2, indicating that the distribution of the scores is approximately normal.

According to Table 3, there is no statistically significant correlation between the attitude towards childbearing score and the woman's age (p = 0.386). However, there is a statistically significant correlation between the mean of attitude towards childbearing score and the women's educational level and income (p = 0.020 and p < 0.001, respectively).

Table 3

Comparison of Mean and Standard Deviation of Attitude towards Childbearing Score with Demographic Variables in not divorced women without children
Variables	Frequency	Mean ± Standard Deviation	95% Confidence Interval (Lower - Upper Bound)	ANOVA
Variables	Frequency	Mean ± Standard Deviation	95% Confidence Interval (Lower - Upper Bound)	F	Df	P-value
Age (years)				1.04	4 & 464	0.386
13–18	25	66.48 ± 9.27	62.65–70.31
19–25	282	66.78 ± 9.50	65.66–67.89
26–30	96	66.60 ± 14.93	63.58–69.63
31–35	49	68.41 ± 10/98	65.25–71.56
36–40	17	71.65 ± 8.43	67.31–75.98
Educational Level				3.313	3 & 465	0.020
Primary or Less	31	70.58 ± 11.05	67.26–73.90
High School Diploma	203	67.52 ± 10.63	66.19–68.85
Bachelor's Degree or Less	194	66.94 ± 11.84	65.27–68.62
Master's Degree or Higher	41	62.80 ± 12.87	58.74–66.87
Income (Million Tomans)				9.386	3 & 465	< 0.001
No Income	324	68.80 ± 11.52	67.76–69.84
Less than 3 million tomans[1]	77	63.51 ± 12.30	60.72–66.30
3–9 million tomans	33	63.85 ± 12.25	59.50–68.19
10 million tomans ≤	35	61.97 ± 13.62	56.95–66.99
Total	469	67.07 ± 10.94	66.08–68.07

[1] Currency in Iran

According to Table 4, Independent-samples t-tests revealed that the mean of attitude towards childbearing score significantly differed between women based on their residence and occupation (p = 0.023 and p < 0.001, respectively). The mean of attitude towards childbearing score did not significantly differ between engaged and married women without children (p = 0.098).

Table 4

Comparison of Mean and Standard Deviation of Attitude towards Childbearing Score with Demographic Variables in not divorced women without children
Variable/Group	Frequency	Mean ± Standard Deviation	Independent Samples T-Test
			95% Confidence Interval (Lower - Upper Bound)	t	Df	P-value
Residence			-4.59 - -0.34	-2.287	467	0.023
Urban	320	66.29 ± 11.77
Rural	149	68.76 ± 10.69
Marital Status			-3.65–0.31	-1.657	467	0.098
Engaged	234	66.24 ± 9.49
Married Without Children	235	67.91 ± 12.18
Occupation			-7.67 - -3.49	-5.25	467	< 0.001
Employed	145	63.21 ± 12.81
Unemployed	324	68.80 ± 11.52
Total	469	67.07 ± 10.94

A weak but significant positive correlation was found between the attitude towards childbearing score and women’s religiosity (r = 0.337, p < 0.001).

The present study is a descriptive-analytical cross-sectional study conducted with the aim of determining reproductive history, attitude towards childbearing and related factors in women in Rafsanjan City, 2021.

Out of 875 women studied, 530 (60.6%) were childless and not pregnant. If we remove 50 divorced women who also did not have children from it, the number of women who are active for seeking childbearing becomes 480 (engaged or married without children). This finding shows that despite three years of marriage, most of the samples (86.54%) did not have children and the pregnancy rate in this region is low. One of the causes related to this finding could be the numerous economic challenges that childbearing entails (28).

According to the findings of our study, 240 people are still engaged and have not been able to start their independent lives even after about three years of marriage. Living apart and the inability to start a life together can be an important factor in explaining the causes of declining fertility. Another study showed that in Iran, one of the significant causes of inability to start a married life is financial problems for holding wedding celebration, providing dowry and housing. Also, more than 90% of young people aged 15–29 live with at least one of their parents, in this study, Increasing unemployment and housing costs are important economic causes lead to delayed family formation in young people (29).

Most of the 235 women with one child gave birth via cesarean section. Also, of the 19 women who had 2 children, 17 (89.5%) had a cesarean in their second pregnancy. Despite national policies to increase the rate of normal vaginal delivery, most births in primi parous women in this area are cesarean section, which itself can be associated with reduced fertility.

The percentage of abortion among all pregnancies in this study was calculated to be 26.01%. Considering the miscarriage rate, which varies between 11 and 22% in different societies (30), it seems that this percentage cannot be only due to miscarriage and there is a deliberate and illegal abortion involved.

According to an estimate by the World Health Organization, 73 million induced abortions occur worldwide each year, of which nearly 45% are unsafe and 97% of these abortions occur in developing countries (31). Unsafe abortion is more likely than safe abortion to cause endometritis, bleeding, retention of products of conception, uterine perforation, and complications from misoprostol (32, 33), and in Iran, approximately 7.9% of maternal deaths are due to unsafe abortion (34).

Another issue that has been raised in recent years in Iran to increase fertility rate is restricting access to free family planning services. In the past, restriction on access to family planning facilities has led to a temporary increase in fertility rate along with an increase in maternal complications and mortality resulting from the termination of unwanted pregnancies through unsafe abortion (35). While one of the goals of family planning programs is to promote maternal and child health through appropriate spacing between children and plan for becoming pregnant at the right age (36), this goal has been neglected by eliminating these programs. Secondly, this restriction only affects women with a low economic and social level who have a large number of children (35). Another important point is that in 2014 (before the ban on the provision of family planning services in public health centers) only 7% of the decline in fertility was due to the use of governmental contraception services (37).

The findings of this study showed that the mean age of women engaged is significantly lower than other groups. This finding was not unexpected, as usually girls who are engaged are younger than married women. This finding confirms another finding of this study; since among women in engagement, diploma education was more than other groups. Obviously, with marriage at a younger age, the level of education will also be lower.

The mean reported score of religiosity was 7.55 of 10 and did not differ significantly between the study groups. In terms of religiosity and marital commitment, contrary to the results of our study, other studies have shown that adherence to religion is a major factor in marital stability and commitment (38–41). The reason for our finding could be the cultural difference between our samples and the samples of other studies. In addition, in our study, the divorce rate was low, which reduces the generalizability of this finding. In this study, after three years of marriage, out of 875 marriages, 51 people (5.83%) divorced. Official statistics from the Iranian Statistical Center show that in 2015 in Kerman province, 18.38 divorces occurred out of every 100 marriages, while in Iran as a whole, 23.90 divorces occur out of every 100 marriages (42). This finding shows that the divorce rate in our study is lower than the provincial and national rates.

The mean attitude toward childbearing score was 67.07. Only one study in Zanjan city had used this questionnaire, and the average score was 70.46. In this study, a score of 68 or higher was an indicator of a good and high attitude towards childbearing (43). Therefore, the attitude of people towards childbearing in our study is also considered good and high. Despite the high attitude towards childbearing, the number of people who have child in our study (39.31%) is low.

The results of the study showed that there is no statistically significant correlation between the attitude toward childbearing score and the women's age, which is similar to the findings of some previous studies (44, 45). However, the results of a study (2020) showed that women aged 15–19 have a higher desire to have children (46). In the study by Ahmed et al. (2022) and Erfani et al. (2019), age also has an inverse relationship with fertility desire (47, 48). The probable reason for this difference is the selection of a different sample; in the two studies similar to our study, the sample members entered the study around the time of marriage; it is likely that around this time, attitude and desire towards childbearing does not differ between different age groups.

The mean attitude toward childbearing score was lower in women with a master's degree or higher than in other women. Education is often considered one of the most important socioeconomic factors affecting fertility (49). In line with our study, according to Miller, having children has an inverse relationship with educational attainment, as education and the opportunities associated with it promote activities incompatible with childbearing (50). This relationship was significant in several research studies (45, 51–57) (58, 59) However, in contrast to our study, in the study by Ahmed et al. (2022), the positive motivations for fertility in women with high school and university education were higher than illiterate women and those with primary education (47). This result can be explained by the fact that there is a difference between fertility intentions and actual fertility. People with higher education may have a higher desire to have more children, but in reality they have fewer children. This is because they marry at a later age and may not be able to have the number of children they desire (60, 61).

The findings of the study showed that women who have children are more likely to have no income than other groups, and the mean attitude toward childbearing score is higher in women with no income than in other groups. This finding is in contrary to a number of studies. According to these studies, individuals with higher incomes had higher positive motivations for fertility and childbearing (28, 47, 62, 63). The economic challenges of Iranian society today affect people's attitudes towards childbearing, and people would have more proclivities towards childbearing, if they have a higher income, after rationally comparing the costs and benefits of childbearing. The high impact of income and its direct relationship to the desire to have children is a warning sign for fertility in Iran that should be considered by policy makers (28). There are probably intervening factors like culture that cause differences in results.

On the other hand, there are two views in support of our study. One is that parents with higher incomes pay more attention to the quality of life of their children, and as a result, would have less offspring due to economic constraints (64). The second view is that having more children leads to less income, as it is hard to work during childbearing and childrearing periods. Therefore, women with higher incomes are also likely to have fewer children (65). As a result of these two views, the attitude of women with higher incomes towards having children is probably lower. Also, in support of our finding, individuals with a higher socioeconomic status have a more negative attitude towards childbearing than other classes (57). People from the upper socioeconomic classes believe that the fewer children they have, the better they can take care of their own interests and raise their children. They also are more aware of the emotional and psychological costs and opportunities for their children (66).

An independent two-sample t-test showed that the mean attitude toward childbearing score is higher in unemployed women than in employed women. This finding was confirmed in the study by Naderipour et al (45). Employed women are less likely to want more children (46). In addition, educated or employed women have less time to be mothers and prefer to have fewer children for maintaining their social and economic benefits (67). Also employed women face intra- and inter-occupational challenges that reduce their desire to have children (68). A negative relationship between fertility rate and women's employment was reported in the study by Iman et al (2015) (69).

The results of this study showed that the frequency of living in the city was higher in women with children compared to other women. This finding is not unexpected, given the greater and better opportunities in the city for education and living. However, the mean attitude toward childbearing score differs significantly between women's place of residence, and rural women have a better attitude towards childbearing than urban women.

According to the wealth framework theory in contemporary societies, families with a higher social and economic level believe that more children impose an additional burden on the family and take their time. While in societies with a lower social and economic level, more children mean more security in old age and a source of work in traditional agriculture (70, 71). According to the Kaufmann and Skirbekk theory (2012), religion in Islamic societies plays a secondary role, and a set of socioeconomic factors such as illiteracy, rural residence, barriers to access to birth control and the benefits of large children in traditional agriculture play a much more important role in the high fertility rate in religious groups (72).

In this study there is no statistically significant difference between the mean attitude toward childbearing score in engaged women and married women without children. Considering that the most important problem in starting a married life is economic problems and that the attitude towards childbearing in the engaged group is the same as the married group, if economic problems are solved, there is a possibility that the fertility rate will increase.

There is a weak and significant positive correlation between the attitude toward childbearing score and woman's religiosity. In another study, fertility behavior was also weakly and directly correlated with religiosity (73).

In a study (2020), people with an Islamic lifestyle have a positive attitude toward childbearing (74). Religious affiliation affects fertility through socioeconomic and demographic characteristics, for example, by prohibiting or not prohibiting the use of contraceptives (75, 76). While in the study by Kaveh Firouz and colleagues (2021), there was no significant relationship between religiosity and fertility intention, but there was a significant positive relationship between family values and fertility intention, and it seems that religiosity indirectly through family values affects fertility intention (77). Religiosity and familyism, as two important traditional factors in our Iranian culture, can play a role in people's attitudes toward childbearing (78). With increasing loyalty to family and religious values, the tendency to childbearing increases (79). Other studies have also confirmed this finding (57, 80–83).

The results of the present study showed that in Rafsanjan City, most of the samples (54.86%) do not have any children after three years of marriage. Our study also showed that the mean attitude toward childbearing score is not low, and women with lower education, no income, unemployed, and also living in rural areas have a better attitude towards childbearing. Thinking about a solution to these intervening variables that have led to a decrease in fertility can save the country from a population crisis.

Considering the high proportion of abortion to the total number of pregnancies in our study (26.01%), which is higher than the average normal miscarriage rate (11–22%), it seems that some of these cases are related to unsafe abortions. Limiting the family planning services may lead to increased unsafe abortions and compromise women's health. It is necessary to evaluate the policies that limit access to family planning services.

In this study we have limitations. We were not able access to the entire target population and lost information from a significant percentage of the target population. Additionally, our question regarding unsafe abortions remained unanswered as abortion is currently illegal in Iran and carries severe penalties. The strength of our study was access to a cohort of women who all officially registered their marriages during a year in Rafsanjan city in the Persian calendar.

Ethics approval and consent to participate

The code of ethics for this study was obtained from the Ethics Committee of Rafsanjan University of Medical Sciences (IR.RUMS.REC.1401.046). All women participated in the study with verbal consent. We confirm that all methods were carried out in accordance with relevant guidelines and regulations.

Consent for publication

Not applicable

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

This work was supported by the Rafsanjan University of Medical Sciences under Grant 401009.

Authors' contribution

Participation of authors: Zohreh Ghorashi has designed this study according to recent studies. Sania Riahi collected data and managed data sampling. Zohreh Ghorashi and Zohreh Sahebi supervised data sampling. Sania Riahi drafted and Zohreh Ghorashi and Zohreh Sahebi reviewed the manuscript. All authors read and approved the final manuscript.

Acknowledgements

The present article is taken from a master's thesis in midwifery. This project was supported by Rafsanjan University of Medical Sciences with code 401009. The authors further consider it necessary to thank and appreciate the women who participated and the employers of health center, and all those who cooperated in this study.

Hatami H, Razavi SM, Eftekhar Ardabili H, Majlesi F, Sayed Nozadi M, Parizadeh MJ. Textbook Of Public Health: Arjmand publication; 2019.
DESA U. Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat. The 2010 Revision. World Population Prospects; 2011.
The 2022 Revision of World Population Prospects [Internet], Division P, United Nations. 2022. https://population.un.org/wpp/Download/Files/1_Indicators%20(Standard)/EXCEL_FILES/1_General/WPP2022_GEN_F01_DEMOGRAPHIC_INDICATORS_COMPACT_REV1.xlsx
Fertility rate of the whole country by Iran and Iranians: 2017–2021 [Internet]. Statistical Center Of Iran. 2022. http://amar.org.ir/statistical-information/statid/28515
Modiri F, Razeghi-Nasrabad HB. A Study on the Relationship between Religiousity and Fertility Intention in Tehran. J Popul Association Iran. 2015;10(20):128–63.
Razeghi Nasrabad HH-C, Abbasi-Shavazi M. Determinants of First Birth-interval in Tehran Using Event History Models. Popul Stud. 2019;5(2):127–56.
Erfani A, Jahanbakhsh R, Kalantari A. Individualism and Fertility Intentions. J Popul Association Iran. 2020;15(29):239–64.
United Nations DoE. World population ageing. Department of Economic and Social Affairs; 2015.
Ojagh S, Abbasi Shavazi M. Discourse analysis of the mediated policies of population increase: presentation of a Promotional strategy. Letter Iran Demographic Soc. 2018;13(25):133–64.
Bearak J, Popinchalk A, Ganatra B, Moller A-B, Tunçalp Ö, Beavin C, et al. Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990–2019. Lancet Global Health. 2020;8(9):e1152–61.
Ganatra B, Gerdts C, Rossier C, Johnson BR Jr, Tunçalp Ö, Assifi A, et al. Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model. Lancet. 2017;390(10110):2372–81.
Rosenbaum L. Perilous politics—morbidity and mortality in the pre-Roe era. N Engl J Med. 2019;381(10):893–5.
Sadeghi R, Abbassi Shavazi M, Farash N, Ethnicity. Ethnocentrism and Fertility: The Study of the Effects of Ethnocentrism on Fertility Intention and behavior among Kurdish and Turkish Women in Maku City. J Iran Social Stud. 2018;12(3):80–101.
Sadeghi H, Srayi H. Factors affecting the tendency of women to have children in Tehran. Welf Plann social Dev. 2016;7(27):1–32.
Chamani S, Moshfeq M, Shekarbeigi A. The study of challenges pertaining to the child bearing in Tehran City with the emphasis on the mixed method. Gend Family Stud. 2015;3(1):9–38.
Parvinian F, Rostamalizadeh V, Habibi R. The effects of women’s modern lifestyle on their fertility and childbearing–a case study in Qazvin city. Q J Woman Soc. 2019;9(36):39–72.
Jokar M. Modernity, lifestyle changes and population decline in Iran. 2014.
Paul PJ, Olson JC. Consumer behavior and marketing strategy. Homewood, IL, itd: Irwin; 2010.
Williamson LE, Lawson KL. Young women’s intentions to delay childbearing: A test of the theory of planned behaviour. J Reproductive Infant Psychol. 2015;33(2):205–13.
Kearney AL, White KM. Examining the psychosocial determinants of women's decisions to delay childbearing. Hum Reprod. 2016;31(8):1776–87.
Baezzat F, Ahmadi Ghozlojeh A, Marzbani Y, Karimi A, Azarnioshan B. A study of psychometric properties of Persian version of attitudes toward fertility and childbearing scale. Nurs Midwifery J. 2017;15(1):37–47.
Aslangir N, Shaygan F. Study of Relationship between Lifestyle and Attitude to Number of Children.(Case Study, Women Working in the Education Zone 1 of Tehran). Int J Hum Cult Stud. 2016;1(1):834–56.
Khadivzade T, Arghavani E. Religious beliefs and fertility preferences among engaged couples, referring to premarital counseling centers of Mashhad, Iran. J Midwifery Reproductive Health. 2014;2(4):238–45.
Najafizadeh A, Mohagheghzadeh F, Nasiri P, Abachi N, Pour SS. Impact of inflation and unemployment on population growth of iran. J Curr Res Sci. 2014;2(2):257.
Kalantari S, Abbaszadeh M, Aminmozafari F, Rakeibonab N. The sociological study of attitude to child bearing and it’s some related factors (Case study: married youth In Tabriz City). J Appl Sociol. 2010;21(1):83–104.
Söderberg M, Lundgren I, Christensson K, Hildingsson I. Attitudes toward fertility and childbearing scale: an assessment of a new instrument for women who are not yet mothers in Sweden. BMC Pregnancy Childbirth. 2013;13(1):1–8.
Kordzanganeh J, Mohamadian H. Psychometric assessment of the validity of the Iranian version of attitude toward fertility and childbearing inventory in women without a history of pregnancy in the South of Iran. J School Public Health Inst Public Health Res. 2019;17(1).
Abbasi A, Sadeghi R, Maleki A, Balakhani G. A meta-analysis of factors related to fertility attitudes, desires, and childbearing intentions in Iranian studies. Interdisciplinary Stud Humanit. 2022;14(4):63–92.
Abbasi-Shavazi MJ, Bagi M. Household formation and living arrangements of the youth in Iran: Evidence of delay in the transition to independent living. Cult Stud Communication. 2020;16(59):243–74.
Ammon Avalos L, Galindo C, Li DK. A systematic review to calculate background miscarriage rates using life table analysis. Birth Defects Res Part A: Clin Mol Teratology. 2012;94(6):417–23.
Pradhan E, Pearson E, Puri M, Maharjan M, Maharjan DC, Shah I. Determinants of imbalanced sex ratio at birth in Nepal: evidence from secondary analysis of a large hospital-based study and nationally-representative survey data. BMJ open. 2019;9(1):e023021.
Aronoff DM, Marrazzo JM. Infections caused by Clostridium perfringens and Paeniclostridium sordellii after unsafe abortion. The Lancet Infectious Diseases; 2023.
Bridwell RE, Long B, Montrief T, Gottlieb M. Post-abortion Complications: A Narrative Review for Emergency Clinicians. West J Emerg Med. 2022;23(6):919–25.
Harris LH, Grossman D. Complications of unsafe and self-managed abortion. N Engl J Med. 2020;382(11):1029–40.
Erfani A. Curbing publicly-funded family planning services in Iran: who is affected? J Family Plann Reproductive Health Care. 2017;43(1):37–43.
AbbasI Shavazi M, hosseini-Chavoshi M. Recent Changes and Policies of Population in Iran: The Necessity of developing a Comprehensive Population Document. J Popul Association Iran. 2012;7(13):95–117.
Erfani A. Curbing family planning in Iran: an appraisal of Bill 446. J Family Plann Reproductive Health Care. 2015;41(4):317–8.
Golzari Moghadam N, Reza Balaghat S. The investigation of the relationship between religious orientation and moral intelligence and marital commitment of married students in University of Sistan and Baluchestan Province. European Online Journal of Natural and Social Sciences: Proceedings. 2016;4(1 (s)):pp. 1692 – 704.
Sadigi A, Safarbeygi S, Mohebbi S, Shahsiyah M. Investigating the relationship between religious orientation and couples' marital adjustment. J Relig Health. 2014;2(1):49–56.
Khan Mohammadi F, Partovi L. he examination of the comparison of marital satisfaction among couples with traditional and modern styles and social factors related to it in Miandouab. Sociol Stud. 2017;10(34):109–26.
Mousavi SV, Rezaei S, Qorbanpoor Lafmejani A, Ahmadian T. Comparison of Forgiveness and Religious Commitment in Couples on the on the Brink of Divorce and Normal Couples. Posit Psychol Res. 2018;4(2):41–54.
Marriage. and divorce registered in urban and rural areas [Internet]. Statistical Centre of Iran. 2016. https://amar.org.ir/Portals/0/Statistics/2456-5.xlsx
Naderipour F, Abolghasemi J, Dehdari T, Nouri R. Attitude of childless married women towards childbearing in Zanjan. Iran Payesh (Health Monitor). 2023;22(3):335–43.
Farrokh-Eslamlou H, Vahabzadeh Z, Moeini R, Moghaddam Tabrizi F. Pre-marriage couplesfertility attitude following recent childbearing persuasive policies in Iran. Nurs Midwifery J. 2014;11(10):0.
Naderipour F, Abolghasemi J, Dehdari T, Nouri R. Attitude of childless married women towards childbearing in Zanjan, Iran. J Iran Inst Health Sci Res. 2023;22(3).
Ahinkorah BO, Seidu A-A, Armah-Ansah EK, Budu E, Ameyaw EK, Agbaglo E, et al. Drivers of desire for more children among childbearing women in sub-Saharan Africa: implications for fertility control. BMC Pregnancy Childbirth. 2020;20(1):1–11.
Ahmed GS, Saleh L, Alareed HR, El-Shabrawy EM, Elbahrawe RS. Effects of sociodemographic background on fertility motivation patterns in the Beni-Suef governorate, Upper Egypt. J Taibah Univ Med Sci. 2022;17(5):853–60.
Erfani A, Shojaei J. Reasons for intending to have no children in Tehran, Iran. Community Health. 2019;6(2):116–29.
Bongaarts J. Completing the fertility transition in the developing world: The role of educational differences and fertility preferences. Popul Stud. 2003;57(3):321–35.
Miller WB. Childbearing motivation and its measurement. J Biosoc Sci. 1995;27(4):473–87.
Jiang L, Hardee K. Women's education, family planning, or both? Application of multistate demographic projections in India. Int J Popul Res. 2014;2014.
Zare Z, Saffari E, Tabar RK. Fertility motivations and their relation with attitude towards Government incentives for childbearing in women of reproductive age. J Mazandaran Univ Med Sci. 2018;28(162):104–14.
Arjomand E, Boromand N. -A Survey of Social and Cultural Factors Influencing Childbearing in Andimeshk with Emphasis on Lifestyle (Case Study: Married Women less than 35 Years Old). Sociol Stud Youth. 2016;7(21):9–24.
Abbasi Shovazi M, Khaje Salehi Z. Assessing the impact of independence, social participation, and education of women on the tendency to childbearing (case study of Sirjan city). Woman in Development and Politics. (Women's Research). 2013;11(1):45–64.
Abbasi Shavazi M, Khaja Selehi Z. An assessment on the impact of women's autonomy, education and social participation on childbearing intention in Sirjan city. 2013.
Eshaghi M, Mohebi SF, Papynezhad S, Jahandar Z. Childbearing challenges for working women; a qualitative study. Woman Dev Politics. 2014;12(1):111–34.
Abbaszadeh M, Aghayari Hir T, Alizadeh Aghdam MB, Adlipour S. Attitude towards childbearing among married women and men aged 18–49 years: The role of religiosity, family, modern media, and modern rethinking. Payesh (Health Monitor). 2019;18(2):173–82.
Torabi F, Sheidani R. A study of effective factors in tendency to fewer childbearing of 15–49 year old women residents of Tehran. J Woman Family Stud. 2019;7(2):31–67.
Haddad GK, Kabiri-Renani M. Females’ intra-household bargaining power and fertility in Iran. Iran J Economic Res. 2014;18(57):97–124.
Iacovou M, Tavares LP. Yearning, learning, and conceding: Reasons men and women change their childbearing intentions. Popul Dev Rev. 2011;37(1):89–123.
Heiland F, Prskawetz A, Sanderson WC. Eur J Population/Revue européenne de Démographie. 2008;24:129–56. Are Individuals’ Desired Family Sizes Stable? Evidence from West German Panel Data: La taille de famille désirée est-elle stable? Analyse de données de panel en Allemagne de l’Ouest.
Neizi M, Torenjipoor F, Noruzi M, Asgarikaveri A. Social Dev Welf Plann. 2016;8(29):69–119. Meta-Analysis of Social Factors Affecting Fertility in Iran Mohsen Niazi [1], Fatemeh Torenjipoor [2], Mylad Nvrvzy [3] Asma Asghari Kvyry [4] Received: 27/11/2015 Accepted: 12/11/2016.
Nasrabad HBR, Abbasi-Shavazi MJ. Ideal fertility in Iran: a systematic review and meta-analysis. Int J Women’s Health Reprod Sci. 2020;8(1):10–8.
Wei J, Xue J, Wang D. Socioeconomic determinants of rural women's desired fertility: A survey in rural Shaanxi, China. PLoS ONE. 2018;13(9):e0202968.
Van Bavel J. Choice of study discipline and the postponement of motherhood in Europe: The impact of expected earnings, gender composition, and family attitudes. Demography. 2010;47(2):439–58.
Hashemi F, Rajabi M, Ahmadi A. Study of women's attitude toward value of children (case study: women 15–49 years old of Shiraz City). J Appl Sociol. 2017;28(3):61–78.
kaveh Firouz Z, Karami F. Aspects of women’s power structure and its relationship with fertility Case Study: married women in Tehran. J Women Dev Politics. 2015;13(2):291–308.
Eshaghi M, Mohebbi F, Papi Nezhad S, Jahandar Z. Challenges childbearing women in a qualitative study. J Women Dev Politics. 2014;12(1):111–34.
IMAN MT, GOLI A. ZARE A. A study of spatial patterns of marriage prevalence among urban women under 20 years of age and their child-bearing. 2015.
Caldwell JC. Mass education as a determinant of the timing of fertility decline. Population and development review. 1980:225 – 55.
Caldwell JC. On net intergenerational wealth flows: an update. Popul Dev Rev. 2005;31(4):721–40.
Kaufmann E, Skirbekk V. Go Forth and Multiply': the Politics of Religious Demography. Political demography: how population changes are reshaping international security and national politics. New York, US: Oxford University Press (US); 2012. pp. 194–212.
Kazemipour S, Edrisi A, Sadeghvishkayi H. Social factors affecting fertility in the family (among married students of Islamic Azad University, North Tehran branch). Sociol Stud Iran. 2015;5(2):76–57.
Rezvani Divkalayi S, Rezayian Bilandi H, Rahmati A. Attitude towards having children: the role of Islamic lifestyle and demographic characteristics. Psychol Relig. 2020;52(13):107–23.
Nasrabad HBR, Abbasi-Shavazi MJ, Hosseini-Chavoshi M, Karegar-Shoraki MR, editors. Trend and patterns of childlessness in Iran. Proceedings of the XXVII International Population Conference of the IUSSP, Busan, Korea; 2013.
Mahmudian H, Rezaei M. Women and low childbearing action: the case study of kurdish women. Women's strategic Stud. 2012;14(55):173–225. (spring 2012)).
Kaveh Firouz Z, Abbasi-Shavazi MJ, Serajzadeh SH, Ramazi N. The Relationship between Religiosity and Family Values with Fertility Desires and Intention among Married Women in Tehran. Q Social Stud Res Iran. 2021;10(2):587–623.
Rastegarkhaled A. Cultural changes and fertility decline in Iran. J Appl Sociol. 2015.
Rasoulzadeh Aghdam S, Pourjabbar Akhouni F, Adlipour S. The Role of Cultural Changes in the Tendency to Childbearing Among Women. J Res Health. 2020;10(2):103–10.
SAEI GM, Ozgoli G, Hajizadeh F, Sheikhan Z, Nasiri M, Jannesari S. The relationship between religious orientation with intention of desired fertility and actual and desirable number of children in working women of Tehran, Iran. 2017.
Naqibi S, KhazaeiPul M, NajafiTrojany S. The relationship between religious beliefs and the tendency towards childbirth in married women attending to the health and medical centers of Behshahr in 1397. J Halal Res. 2020;2(2):88–101.
Rahnama A, Roozbeh N, Salimi Asl A, Kazemi Gerashi Z, Abbaszadeh M, Dabiri F. Factors Related to Childbearing in Iran: A Systematic Review. J Prev Med. 2022;9(1):6–17.
Rad F, Savabi H. Investigation on tendency to fertility and its related social factors (a case study of married women aged 15 to 50 in Tabriz). J woman family Stud. 2015;3(1):127–55.

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Investigation of women's Reproductive History, attitude toward childbearing and associated factors in Rafsanjan City, Iran, 2021

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