Volume 30, Issue 1 (1-2020)                   JHNM 2020, 30(1): 27-34 | Back to browse issues page


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Faghani Aghoozi M, Kariman N, Faiazi S, Joze Mohtashami M, Amerian M. Factors Affecting the First Childbearing Decision in Iranian Males. JHNM 2020; 30 (1) :27-34
URL: http://hnmj.gums.ac.ir/article-1-1015-en.html
1- Instructor, Department of Midwifery, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
2- Associate Professor, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3- Instructor, Department of Midwifery, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran
4- Instructor, Department of Anesthesiology, School of Allied Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
5- Instructor, Department of Midwifery, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran , m.amerian43@yahoo.com
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Introduction
A Significant demographic change in developed countries is delayed childbearing, which is increasing [1]. In line with these developments, the parental age for men aged 30-49 years has steadily increased since 1980; however, parental rates have declined for men aged 25-29 years [2]. According to studies conducted in England and Wales, in 25% of births in 1993, men aged ˃35 years; this rate increased to 40% in 10 years. In the US, the childbearing rate of men ˃35 years has increased by 40% since 1980 [3]. 
In Iran, childbearing process has been commensurate with the changes occurring in various socioeconomic and traditional aspects of the family. Thus, the total rate of childbearing in 24 out of 30 provinces in Iran has decreased below 1.2 the replacement level. In addition, numerous studies in Tehran suggested that childbearing level is <1.5. This is mainly due to applying contraceptive methods in the early years of marriage [4]. Several studies have investigated factors affecting childbearing decision, such as contraception, increased education, women’s employment, gender equality, changing values, poor economic conditions, and the lack of family support policies [5-9]. The effect of aging on women is a well-known risk factor in fertilization and reproduction. Adverse pregnancy complications in women aged ˃35 years include the following: spontaneous abortion, pregnancy complications, congenital malformations, and perinatal complications. Research on infant and childbirth outcomes has mainly focused on maternal age and related complications, and less considered father’s role [10-12]. 
Numerous studies investigating the risks associated with increasing paternal age indicated that it changes the reproductive function at different levels. These levels include reproductive hormones production, sexual function, semen production, fertility, pregnancy outcomes, and some age-related defects and abnormalities [2, 13, 14]. Pregnancy at older ages in men leads to infertility; it also has adverse effects, such as fetal death, preterm delivery, low birth weight, congenital defects (cleft of lip and palate, and cardiac defects), achondroplasia, bone defects, Apert syndrome, schizophrenia, and childhood/adulthood cancers. Possible relevant mechanisms include gene mutations and structural chromosomes abnormalities in sperm, and multiple chromosomal defects. In addition to aging, other factors, like occupation, smoking, and environmental contamination can alter sperm quality. This could result in fetus’s premature death [11, 15]. 
According to Bronfenbrenner’s bioecological model, behavioral interactions occur in the microsystem at the individual level. Moreover, biological factors, intention, preparation, and planning affect childbearing [16]. As countries develop socioeconomically, the effects of individual intention and preference on the fertility behavior of people increases. In any human action whose goal is the same, the person’s intention plays the most important role. Intention creates a favorable content for generating interest in individuals and eventually in their consent to perform an action [17]. One of other necessities of childbearing is to create hope in individuals. This is because if they do not have such feeling, they will abstain from marriage or, if marry, they will refrain from having child or will at most have one child. Miller and Pasta reported a significant relationship between fertility preferences and fertility intentions [18-20]. According to Miller, fertility preferences include three dimensions of childbearing desire, child-number desire, and child-timing desire [21].
Among studies on childbearing decisions in couples, the individual aspects of factors related to men’s decisions for childbearing, such as hope and quality of life, have been overlooked. There is a lack of research that can discriminate between reported voluntary or involuntary (sexual dysfunction) intentions. Additionally, less attention has been paid to men’s roles. Therefore, this study aimed to determine individual and demographic factors affecting first childbearing decision in men. It is hoped that the study results provide an overview of the current situation and a basis for designing appropriate interventions to facilitate decision making in this regard.
Materials and Methods 
This analytical cross-sectional study was conducted in 2014 (March-September). It was approved by the Research Ethics Committee of Shahid Beheshti University of Medical Sciences. The study participants were 360 married Iranian men with no child and history of infertility. They aged 18-45 years and accompanied their wives to receive prenatal care at hospitals (n=4) and private health centers (n=4) of Shahroud County, Iran. We used a multi-stage cluster sampling method. First, Shahroud was divided into two regions of north (2 hospitals) and south (2 hospitals). Then, in each region, hospitals were considered as clusters. Next, some of these hospitals were randomly selected. Furthermore, sample size was determined proportional to the population covered by each hospital (considering 20% dropout rate for 10-15 samples). Eventually, the study samples were recruited from each hospital using convenience sampling technique. In private health centers located in the center of Shahroud, random sampling was conducted. From 360 distributed questionnaires, 60 returned incomplete. Thus, they were excluded from the study analysis and the final sample size was determined as 300.
Data collection tools were as follows:
A demographic data form: It surveyed age, spouse’s age, education, spouse’s education, place of birth, place of residence, age at marriage, marriage duration, desired childbearing time interval and desired child number.
Snyder’s Adult Hope Scale (AHS): It has 12 items rated on a 4-point Likert-type scale (1= definitely false; 4= definitely true) with two subscales of pathway (items 1, 4, 6, and 8) and agency (items 2, 9, 10 and 12). Additionally, 3, 5, 7, and 11 are filler items. The total obtainable score ranges from 8 to 32. Snyder et al. reported its test-retest reliability as α=0.81 [22]. 
World Health Organization Quality of Life (WHOQOL-BREF) questionnaire: It has 26 items rated on a 5-point scale (from 1 to 5). It measures the dimensions of physical health, psychological health, social relationships, and environment. The collected scores are categorized into three levels of poor (0%-33.3%), moderate (33.4%-66.3%), and favorable (66.4% to 100%). It has an acceptable formal and structural validity and its test-retest reliability (using Cronbach’s alpha coefficient) ranges from 0.55 to 0.84 [23-25].
In our study, the test-retest reliability and internal consistency of questionnaires were examined through a pilot study on 20 samples for 14 days. Correlation between questions for WHOQOL-BREF and AHS were obtained as 0.78 and 0.83, respectively. For their internal consistency, Cronbach’s alpha coefficients of 0.86 and 0.75 were reported, respectively. After selecting the study participants, study objectives and methods were explained to them. They were also assured of the confidentiality of their information. After obtaining informed written consent from them, they completed the questionnaires. The collected data were presented using descriptive statistics. Pearson’s correlation coefficient test was used for examining the relationship between study variables and men’s age at the time of deciding to have the first child. This stage was followed by step-by-step multiple regression analysis. Data analysis was conducted in SPSS V. 16 at a significance level of P<0.05.


Results
For 300 participants, the mean±SD scores of age at first childbearing decision, age at marriage, and marriage duration were 28.8±3.74, 25.59±3.68, and 3.17±1.68 years, respectively. The desired number of children was 2, and the desired childbearing time interval was 3 years. More than 40% of men had academic education and were mostly employed (45.3%). Moreover, 92.3% lived in urban areas and 43% in rented houses. The demographic characteristics of samples are presented in Table 1.
The mean scores of men’s quality of life dimensions revealed that their environment-related scores were higher, compared to other dimensions. Moreover, most of them (80.3%) had favorable quality of life. For the AHS, the obtained results indicated that the men’s mean score of hope in the agency subscale was slightly higher than that of the pathway subscale. The mean scores of dimensions of quality of life and hope variables are presented in Table 2.
For analyzing the collected data, first, the correlation of each variable with age at first childbearing decision was examined (Table 3). It was significantly related to age at marriage (r=0.891), and marriage duration (r=0.29), and men’s education (r=0.001); however, it had no significant relationship with hope, the desired number of children, and desired childbearing time interval. Moreover, the quality of life had a significant negative correlation with age at first childbearing decision (r=-0.22, P=0.001). Age at marriage had the highest correlation with age at first childbearing decision (r=0.891, P=0.001).
The stepwise (Backward) linear regression analysis results are presented in Table 4. According to the results, the coefficients of age at marriage and quality of life variables were significant (P=0.001); however, those of hope, marriage duration, desired childbearing time interval, and desired number of children were not significant. Only the variables mentioned in Table 4 remained in the regression model. Among them, age of marriage had more power in predicting factories influencing age at first childbearing decisions. For 1-year increase in marriage age, if other variables remained constant, the age at first childbearing decision of men increased by 0.89. In other words, with the 10-year increase in men’s marriage age, the childbearing age increased by 8.9 years. Moreover, for 1-point increase in the quality of life, if other variables remained constant, age at first childbearing decision reduced by 0.09 years.
Discussion
In this study, marriage age and marriage duration suggested a significant and direct correlation with age at first childbearing decision in men. Furthermore, those who marry at a younger age can have their first child in a shorter time. Numerous studies have also reported that age at first marriage is the main intervening factor and determinant of first childbearing time along with other related factors [26-28]; these findings are consistent with ours. Education also had a significant relationship with age at first childbearing decision in men. Adibi Sade et al. and Sadeghi et al. revealed the negative effect of men’s educational level on fertility [29, 30]. Results of Kreyenfeld and Andersson on socioeconomic panel of German and Denmark indicated that the rate of fertility in highly educated people during unemployment is significantly reduced, compared to those with low education [27].
In our study, hope had no significant effect on age at first childbearing decision in men. Nilsen et al. explored individual and social factors of childbearing decisions in Norwegian older men [15]. As a result, depressive symptoms had a significant correlation with age at first childbearing in men. Results from other empirical studies recognized intention and interest in becoming a father as the strong predictors of outcomes related to childbearing decisions. This discrepancy between studies may be due to differences in the sociocultural conditions of studied societies. International studies have considered childbearing as an impetus for the promotion of the male character. Moreover, they suggested male independence and family motivation as individual factors influencing their childbearing decisions [1, 13, 31].
In the present study, quality of life was another contributing factor. In the study of Thompson and Lee, prerequisites for fathering in young Australian men were readiness and personal maturity before childbirth, financial security, and finding a permanent and flexible job [1]. Physical health/fitness and the lack of chronic diseases as essential causes of decision making for childbearing [1, 15, 16, 31, 32].
The study findings indicated that the age at first childbearing decision had a strong relationship with the age at marriage, compared to other factors. People delay their marriage and then with a short interval, give birth to their first child. Probably because of marrying at lower ages, to achieve high occupational readiness and financial security, they use contraceptive methods and delay the birth of their first child. The achieved results suggest that individual and family changes are accompanied by alternations in the values, motivations, attitudes, and beliefs associated with marriage and childbearing, and ultimately fertility behaviors and ideals. It is basically impossible to implement theories related to fertility increase without providing specific living and psychological conditions among people. Fertility reality is not a mere physical reality, but is rather a phenomenon based on individual intentions and thoughts. Among effective factors in this study, marriage age and life quality were more prominent than other individual factors.
This was a cross-sectional study; thus, it does not allow reliable decision-making processes. Moreover, cultural factors were not studied separately in our study. We suggest studying the role of new government policies in childbearing in the future. The study findings could provide a practical guide in terms of clinical, educational, and research contexts by accurate knowledge of individual factors related to first childbearing decision in men. The study results also present a direct insight into the social beliefs, values, motivations, and norms of the studied community. 
Ethical Considerations
Compliance with ethical guidelines
The study protocols were approved by the Ethics Committee of Shahid Beheshti University of Medical Sciences, Tehran, Iran (No. 1393-1-86-13214). 
Funding
This article was part of the Master’s thesis of the Corresponding author in the School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, and the research project was approved (No. 1393-1-86-13214) in the Committee of Shahid Beheshti University of Medical Sciences, Tehran, Iran. 
Authors contributions
Conceptualization and funding acquisition: Marzieh Faghani Aghoozi, Nourossadat Kariman; Data collection: sanaz faiazi, Maliheh Amerian; Preparing the draft: Mona Joze Mohtashami, Maliheh Amerian; Data analysis: Marzieh Faghani Aghoozi and Maliheh Amerian; Reviewing and editing: All authors.
Conflict of interest
The authors declared no conflicts of interest.
Acknowledgements
The authors would like to thank all the study participants and personnel of study hospitals and clinics in Shahroud contributor for their valuable cooperation.


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Article Type : Research | Subject: Special
Received: 2019/10/20 | Accepted: 2019/11/27 | Published: 2020/01/1

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