Leila Parandeh
1,2 
, Roghayeh Khabiri
3* , Ali Nayerpour
4, Baqer Safa
4, Jila Khalkhali
51 Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
2 Department of Family, Population, and School Health, Shabestar Health Center and Treatment, Tabriz University of Medical Sciences, Tabriz, Iran
3 Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
4 Shabestar Health and Treatment Center, Tabriz University of Medical Sciences, Tabriz, Iran
5 Department of Health and Population, Deputy of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract
Background. Childbearing significantly affects the population's composition and age structure. The decline in fertility rates will disrupt the age balance of the country's population, leading to irreparable economic and social damage. This study investigates the causes of reluctance to engage in childbearing in Shabestar, Iran.
Methods. This cross-sectional, descriptive-analytical study included 346 individuals using a random sampling method. A researcher-made questionnaire containing two parts was used to collect the required data. The first part of the questionnaire included demographic information. The second part was the childbearing desire questionnaire (specially designed for married men and women), each containing 17 items related to independent variables.
Results. The results obtained from the logistic regression test showed that there was a statistically significant relationship between the economic problems of the family (P-value < 0.0001), job (P-value < 0.05), lack of mental and emotional preparation for having children (P-value < 0.0001), worry about preparing a promising future for children (P-value < 0.05), inability to raise children (P-value < 0.05), inappropriate age for pregnancy (P-value < 0.001) and reluctance to have children. Moreover, participants mentioned reasons like lack of psychological readiness to have a child (67.05% of the participants), increasing economic problems with having children (65.90% of the participants), not having enough income to have children (65.32% of the participants), among others, for unwillingness to childbearing.
Conclusion. To promote childbearing, addressing the economic problems of families should be a priority in national policymaking. In addition, various educational and supportive methods can reduce insecurity in young families and bring the fertility rate to the desired level.
Extended Abstract
Background
Fertility is one of the most important demographic components that plays a significant role in the quantitative and qualitative changes of the population in any country. Today, many developed and developing countries have a replacement fertility rate (2.1 children per woman) or less than that, and Iran is no exception to this rule. The fertility rate in Iran has started to decrease since 1985 and has dropped from 6.9 children per woman to 5.5 children in 1988 and 2.8 children in 1996. Then, in 2015, it reached 1.9, below the replacement level. According to the results of the population and housing census of the Iranian Statistics Center (2015), fertility has increased to the replacement level. However, the evidence and statistics suggest that the fertility rate has dropped below the replacement level since 2015.
According to the Iranian Statistics Center report, the fertility rate in East Azerbaijan province in 2021 was 1.62, which is lower than the national average (1.74). Due to the decrease in fertility rate and increase in life expectancy in the country, it is predicted that the elderly population will increase from less than 10% in 2015 to more than 30% in 2050. Based on this, the elderly population of East Azerbaijan province will increase from 12.34% in 2022 to 19.38% in 2036.
A decline in the working-age population, a decrease in economic growth, the collapse of financial markets, the bankruptcy of pension funds, and pressure on health systems are apparent examples of the challenges of population aging.
Considering that childbearing has a significant effect on the composition and age structure of the population, and considering that declines in the fertility rate disrupt the age balance of the country's population, which in turn leads to economic damage and irreparable social problems in the country, this study investigates the causes of reluctance to childbearing in people who refer to urban and rural health centers in Shabestar city.
Methods
The current study is a cross-sectional, descriptive-analytical study with a random sampling method. The total sample was determined by referring to the results of a national survey examining the desire to have children from the perspective of the urban and rural people of Iran, in which 2% of people who participated in East Azerbaijan province had the desire to have children. Therefore, the final sample size was determined to be 346 people. Women and men included in the final cases and willing and capable of sharing their views on the elements and influencing factors of unwillingness to have children/rebirth were interviewed. Informed consent was secured from those women who agreed to participate in the study. Data were analyzed using SPSS 23 software and the logistic regression model with the reference group (Baseline Logistic Regression).
Results
A logistic regression test was used to check any probable relationship between the factors affecting the lack of desire to have children, and the following results emerged:
A statistically significant relationship was observed between the family's economic problems and unwillingness to childbearing (P-value < 0.0001). The reluctance to childbearing in people who "completely agree" was significant and was 2.5 times more than the people who "completely disagree" (0.061) = P-value, OR=2.528).
Similarly, A statistically significant relationship was observed between job and unwillingness to childbearing (P-value = 0.013). That is, the chance of unwillingness to have children in people who declared "completely agree" and "agree" were respectively 3 times higher (completely agree: P-value = 0.02, OR = 3.178, agree: P-value = 0.016, OR = 3.293) than those who declared "completely disagree" in response to the statement that childbearing interferes with job and social responsibilities.
Based on the findings, a significant relationship was observed between a lack of mental and psychological readiness to have children and participants' lack of desire for childbearing (P-value>0.0001). In response to the statement that lack of psychological and mental preparation is a reason for unwillingness to childbearing, the chance of unwillingness in people who selected "completely agree" was about 4.5 times higher than the people who selected "completely disagree" (P-value = 0.003, OR = 4.517).
Concerns about providing a promising future for children have been effective in the unwillingness of the participants to have children (P-value = 0.031). However, no statistically significant difference was observed between the selected options and the unwillingness to childbearing.
Similarly, there was a statistically significant relationship between other people's opposition to having children and the unwillingness of participants to childbearing (P-value = 0.032). However, no statistically significant relationship was observed between options and unwillingness to childbearing.
Finally, the findings revealed that the inappropriate age for pregnancy was effective on the unwillingness to have children (P-value = 0.004). That is, the chance of unwillingness to childbearing in people who selected "completely agree" and "agree" was respectively 4 and 3 times higher than the people who chose "completely disagree" (completely agree: P-value=0.014, OR= 4.24, agree: P-value = 0.034, OR= 2.97).
Conclusion
In the present study, the researchers investigated the causes of reluctance to engage in childbearing by examining participants' viewpoints. Reporting such reasons to the authorities will help take effective measures towards removing the obstacles to childbearing in society. The current research results can be helpful for policymakers and authorities in the population field, so by considering the childbearing concerns of families and removing the barriers, we can witness an increase in the population in the future. In this study and previous studies, the economic problem is the biggest concern of individuals or households wanting to have children or increase the number of their children. There is a need to formulate macro policies, such as social incentives and economic policies, and micro-supportive policies, such as creating welfare facilities, to achieve ideal conditions.
Practical Implications of Research
Investigating the causes of reluctance to have children and the factors affecting management policies in this field at a macro level can accelerate the implementation process of fertility interventions and be considered a successful step towards re-elevating fertility to replacement levels.