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   Table of Contents      
Year : 2022  |  Volume : 27  |  Issue : 5  |  Page : 413-419

Principal factors affecting couples' childbearing policies: A roadmap for policymaking

1 Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Community Medicine, Tehran University of Medical Sciences, Tehran, Iran
3 Department of Reproductive Health, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran

Date of Submission12-Sep-2020
Date of Decision14-Oct-2020
Date of Acceptance18-Jan-2022
Date of Web Publication14-Sep-2022

Correspondence Address:
Mohammad Shariati
Department of Community Medicine, Tehran University of Medical Sciences, Tehran
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijnmr.IJNMR_225_20

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Background: The concept of negative population growth, population aging, and the need to implement child-encouraging policies is an important concern in many countries. As this issue is completely cultural and country-based, this study is designed to assess and prioritize the perception of newly married couples to the policies that may have a crucial role in the childbearing intention around the world. Materials and Methods: Through a descriptive cross-sectional study, 300 couples were selected by a simple random sampling method. Multilevel binary logistic regression was used for investigating the relationships among dimensions of family policies, socio-demographic variables, and childbearing intention. Results: Childbearing perception positively correlated with education and permanent job in both genders, maternal age range of 25–35, the higher length of marriage, having more children, and living in a government settlement. The most important family policies that couples preferred were contextual requirements (mean rank of 4.50%). Positive childbearing perception negatively correlated with higher age categories in women, the number of children, rental housing status, no insurance access, higher educational attainment, and low employment ranks in both men and women. Conclusions: This study cleared that family policies affect the childbearing intention of young couples. Polices involved contextual requirements, supporting couples to integrate work and home, health promotion plans, child-centered social support, and promoting the level of social and cultural relations.

Keywords: Family planning policy, health policy, Iran, reproductive behavior

How to cite this article:
Hashemzadeh M, Shariati M, Nazari A, Keramat A, Ebrahimi E. Principal factors affecting couples' childbearing policies: A roadmap for policymaking. Iranian J Nursing Midwifery Res 2022;27:413-9

How to cite this URL:
Hashemzadeh M, Shariati M, Nazari A, Keramat A, Ebrahimi E. Principal factors affecting couples' childbearing policies: A roadmap for policymaking. Iranian J Nursing Midwifery Res [serial online] 2022 [cited 2022 Sep 29];27:413-9. Available from: https://www.ijnmrjournal.net/text.asp?2022/27/5/413/356033

  Introduction Top

Today, all the negative rates of population growth, aging, and the need to implement the child-encouraging policies are not devoted to only industrial or developed countries. This tragedy has been experienced by a lot of countries, which makes them find a solution.[1] That is why a good deal of research has been dedicated to childbearing related factors, in recent years.[2],[3],[4] In this way, a growing body of research was focused on childbearing intention. Some studies considered only single policies within one or two special factors (especially employment or financial factors),[5],[6] while the others represented the comprehensive factors as the shape of family policies, which are usually tested by multi-level (qualitative-quantitative) studies.[7],[8]

Family policies might influence fertility intention, not only by affecting the economic determinants but also by affecting institutional settings of social and cultural norms.[7] In this regard, family policies such as parental leave benefits, available and highly subsidized childcare for children, and flexible employment opportunities have been found to dampen the negative effects of childbearing on women's labor force opportunities.[7],[8]

Few studies have been attempted to comprehensively evaluate broader sets of family policies and their interaction on decision-making at the individual-level across a wide range of countries. In this regard, KavehfIrooz et al. evaluated the effect of socio-cultural capitals on attitudes toward childbearing. The most important determinant of attitudes toward childbearing is social participation. They assessed the relation between childbearing attitude and governmental incentives on childbearing intentions.[9] Duvander et al.,[10] Kariman et al.,[11] and Araban et al.[12] studied childbearing intentions among individuals but they did not consider the couples. Therefore, the big shortages of studies were lack of comprehensiveness and considering the nature of decision making that occurs in the context of family life. This study evaluates family policies involved contextual requirements, supporting couples to integrate work and home, health promotion plans, child-centered social support, and promoting the level of social and cultural relations. Which may influence on women's and men's intentions for having a child.

  Materials and Methods Top

The present study was a descriptive cross-sectional study which was a part of a mixed-method study at origin that relates to a Ph.D. thesis conducted between April and December 2019. A comprehensive set of factors were attained that could influence the couple's childbearing decision making in the form of family policy checklists. First of all, we did a qualitative study through unstructured qualitative interviews with young couples and experts as well as a review of childbearing-related family policies worldwide to develop the final policy checklist. Then, a 3-round Delphi study was conducted to identify and prioritize the most important policies.

Following the previous steps, we designed a descriptive-analytical study to determine the effects of each factor in the context of family life on childbearing intention. Young couples must pass the pre-marital training classes before the official registration of marriage in Iran. Thus, we chose our participants from three urban health and marriage consult centers in the south of Tehran. The data related to all couples who referred to these centers were derived from April 2014 to April 2018. The participants were selected by a simple random sampling method (Generated by the Open Epi Random Program- www.openepi.com) among one to five-year married couples, in which the women's age was under 45. The data of 360 out of 1500 young couples were gained. According to study protocol, the eligibility information and also the couple's attitude for participation were checked via phone. After the above consideration, all participants were asked to attend a common session to answer the questions.

The required sample size was calculated as 360 couples using Cochran's formulas with 0.20 error and a 20% dropout rate. Of the 360 questionnaires, 60 incomplete forms were removed and 300 filled questionnaires were considered as the final sample. At the beginning, the researcher had explained the study's aims using a film that showed the social importance of childbearing and also interfered with all aspects of childbearing-related family policies. The questionnaire package with three sections (demographic information, fertility intention questions, and selected family policies checklist involved in financial and welfare incentives, supporting couples to integrate work and home, health promotion plans, child-centered social support, promoting the level of social and cultural relations, and contextual requirements) was distributed among the couples. The components of each group are explained in [Figure 1] and [Figure 2]. Fertility intention questionnaire (developed in Generations and Gender Surveys) with the acceptable psychometric characteristics of criterion and construct validity and 0.86 Cronbach's alpha for reliability helped us to categorize couples according to their positive or negative perception of having a child in the future. According to the study target, we evaluated the effects of both socio-demographic characteristics and family policy dimensions on childbearing intention. We gave young couples a chance to prioritize their opinion about childbearing in the context of family policies. We asked the couples to rate each policy on a scale of one to five. The summary statistics including mean, frequency, and percentage distribution were used to describe study characteristics. Association between childbearing intention and selected socio-demographic variables was assessed by the Chi-square test. The risk factors of positive and negative childbearing intention were determined by multilevel logistic regression.
Figure 1: Components of each policy group

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Figure 2: Mean Rank of family policies

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Ethical considerations

The ethical approval code was (IR.SHMU.REC.1396.119). Participants were informed about the objectives and the methods of the study, and the voluntariness of participation. All participants signed the informed consent form.

  Results Top

The mean age of mean (SD) was 33.28 (5.34) in comparison to women mean age 30.09 (5.78). The mean (SD) duration of marriage among participants was 3.17 (1.52), and 56% of couples had not experienced their first childbearing. According to the result, the majority of participants irrespective of their sex were well educated. Most of the women were housewives, whereas men were most self-employed. Concerning the economic status, which reflects in this study by the variable of the type of housing and housing area, a lot of them were in the middle economic status. The proportions of positive and negative childbearing intention based on selected socioeconomic characteristics are presented in [Table 1]. Based on the result, education, working status, women age, marriage length, child number, and type of housing were significantly associated with positive childbearing intention. There was no association between men's age, housing area, and insurance status. Also, positive childbearing intention negatively correlated with higher age categories in women, the number of children, rental housing status, no insurance access, higher educational attainment, and low employment ranks in both men and women. It had a positive significant correlation with primary and secondary school and permanent job with complete employment in both genders, maternal age range of 25–35, the higher length of marriage, having more children, and living in a government settlement. The negative intention was accompanied by vice versa results. Based on [Table 2], the predictor interactions were not significant in the fitted logistic regression in this study.
Table 1: Percentage distribution of childbearing intention by selected socio-demographic characteristics

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Table 2: Logistic regression models on having a child in couples

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Mean ranks of family policy groups are shown in [Figure 1]. Because this study determined couples' perception toward family policies, mean and standard error of mean of each group of family policies based on the couple's scores are presented in [Table 3]. All the policies got scores higher than 2.50. In financial and welfare incentives, the highest means belong to the delivery of housing units to families with 5 or more members (mean 4.16 in both men and women). In the second group of family policies, supporting couples to integrate work and home, implementation of 2 weeks paternity leave in men, and implementation of 9 months' maternity leave got the highest means.
Table 3: Mean and Standard error mean of main groups scored by couples

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  Discussion Top

In the first part, by analyzing the determinants, we discovered that lower levels of education and job attainment in both genders, lower age of women, marriage length, having more children, and living in government settlements were significantly associated with positive childbearing intention among Iranian young couples.

De Wachter and Neels, 2011,[13] Rosina and Testa, 2009,[14] confirmed the negative effects of higher education in both genders on time of pregnancy or childbearing. The effect of education on childbearing can be justified from two aspects.[3] First, highly-educated women have the benefits of better jobs and higher incomes; therefore, the cost of child care will be higher for these women. Second, women who start childbearing at an early age are likely to continue their education. Based on the longitudinal studies,[4],[10],[15] men enrolled in higher education are more likely to realize their childbearing intention over the subsequent years of marriage. Consistent with our findings, some of the studies declared a strong positive influence of education on the time of the first birth and[12],[13],[14] this may be related to cultural diversity.[16]

The second covariate was the occupation type. In the current research, a lower level of occupation had a positive effect on childbearing intentions. Lotfi et al.[17] reported the same conclusion. One of the probable causes for this effect is the co-linearity between the low level of education and job. Another explanation is that individuals who had a lot of responsibility always try to juggle the demands of work and family life, which prevent them from childbearing.[16],[17],[18] The scrutiny of the precise impact of a job on a child is more complicated than it sounds. It can be due to cultural, familial, or even individual factors. Economic and financial uncertainty and labor market insecurity—whether measured through a rise in unemployment or job precariousness—induce individuals to delay major life commitments such as family formation.[1],[19] Income increases affect fertility behavior, but the impact is ambiguous. Also, an increase in income might ease parts of the budgetary constraint but at the same time families may find it optimal to have fewer children, as to provide each child with a higher level of human capital.[13]

Our study also showed that positive childbearing intention was correlated with lower age in women. In this regard, the other justifications are the lower age of women accompanied by less fear of pregnancy and fetal adverse effects, less marriage age, and less planning for pregnancy and contraceptive methods use. Despite this, some studies did not find any relationships.

In line with the previous studies on different populations,[20],[21] the results of our study indicated that more positive childbearing intention was associated with increased duration of the marriage. This effect may occur due to the accompanying stability of marital life, the desire to complete the size of the family, and the increasing fear of infertility among couples.

Considering family policies as a unique and new part of the current study, our result showed that all the aspects of family policies are important for couples and can affect childbearing intentions in two aspects: Quantum and timing. Also, interpreting our result is limited but the role of couples in directing politicians toward effective decisions are inevitable. We confirmed that financial and welfare incentives and supporting policies to integrate work and home can motivate childbearing decision making in couples. Angela Luci-Greulich and Olivier Vernon (2013)[8] confirmed that each instrument of the family policy package (paid leave, childcare services, and financial transfers) has a positive influence on average, suggesting that the combination of these forms of support for working parents during their children's early years is likely to facilitate parents' choice to have children. Childcare services for children under age three have a larger potential influence on fertility than leaving entitlements and benefits granted around childbirth. The influence of each policy measure varies across different family policy contexts. Kalwij (2010)[22] confirmed that childcare subsidies have no effect on the timing of births, but have a positive effect on second and higher-order births and completed family size. Kim (2017)[23] found a significant effect of childcare enrolment on the total number of children ever born for women aged 18–45 in the early 2000s. There is considerable evidence that family policies can influence the timing of childbearing. A large body of literature confirms the role of policies that provide better opportunities to combine work and family.[11],[12]

Changes in various institutions, including the family, the workplace, and the government, can lift the heavy burdens from the shoulders of women and make childbearing more desirable for them.[24]

Health situation[25] and supporting couples to integrate work and home, both inside and outside the home, have a positive effect on the couples' childbearing decisions.[26]

Our study forges a connection between two increasingly prominent debates on fertility research: The debate surrounding how demographic characteristics such as age and education may relate to fertility intention, and the debate over how family policies affect childbearing intentions. Also, we take on several challenges in the literature by analyzing policy packages and fertility intentions of individuals instead of outcomes, emphasizing the need for multi-dimensional perspectives when evaluating links between policies and fertility intentions of individuals from diverse backgrounds.

It is not possible to separate the influence of one domain from another.[2] To promote childbirth, it is essential to consider a multidimensional program according to the features of each regional and geographic area.

We asked the couples to score the policies, but it is clear that the impact of policies on childbearing intentions can be achieved after the implementation of policies.

The limitation of this study was, conducting the study only on 1 to 5 year-married couples who were living in the south part of Tehran It seems that conducting this study on newlyweds in other cities can provide more comprehensive information.

  Conclusion Top

Family policies might influence fertility intention, not only by affecting the economic determinants but also by affecting institutional settings of social and cultural norms. This study prioritized childbearing related family policies including contextual requirements, supporting couples to integrate work and home, health promotion plans, child-centered social support, and promoting level of social and cultural relations. They had a crucial effect on the childbearing intention of young people.


We hereby acknowledge the research deputy for grant No 9691.

Financial support and sponsorship

Shahroud University of Medical Sciences

Conflicts of interest

Nothing to declare.

  References Top

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Comolli CL. Finnish fertility: Pro-or counter-cyclical. FJSR 2018;11:58-64.  Back to cited text no. 4
Comolli CL. The fertility response to the great recession in Europe and the United States: Structural economic conditions and perceived economic uncertainty. Demogr Res 2017;36:1549-600.  Back to cited text no. 5
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  [Figure 1], [Figure 2]

  [Table 1], [Table 2], [Table 3]


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