Introduction
Fertility is an important factor in population growth, even more important than other population-related factors such as death and migration. Many countries are struggling with problems and issues of overpopulation, while some countries are suffering from the negative impact of population growth reduction [1]. Iran, like these countries, is facing a decrease in the fertility rate, and statistics indicate an alarming reduction in the total fertility rate and population growth [2]. In the last decade, the population under the age of 15 years in Iran has decreased, and it is expected that the ratio of working-age population to the dependent population in Iran will decrease in the future years [3]. The population policies were previously limited to setting regulations to increase or decrease the population, but now attention to the concept of sustainable development has made the policy makers pay special attention to the effects of political, social, cultural, economic and epidemiological factors in the formulation of population policies [4]. Planning and policy-making in the field of fertility and health requires a comprehensive and deep study of fertility behaviors and considering all contributing factors [5].
Various studies have shown that childbearing intention or fertility is related to some factors such as women’s employment, economic and social factors, governments’ deficit in the provision of welfare facilities, negative attitudes, women’s high education and more social participation, women’s age at marriage, number of children, spouse’s age, age at the time of first pregnancy, communication technologies, awareness of pregnancy prevention tools, and individualism [1, 6-12]. It seems necessary to pay special attention to the factors inhibiting the childbearing intention of couples and causing the expansion of only-child families. In Iran, there are few studies that comprehensively examined the effect of different effective factors. This study, in line with the population growth plan of the Iranian Ministry of Health, aims to investigate the childbearing intention and the related psychosocial factors among people in Sirjan City, Kerman Province, south of Iran.

Material and Methods
This is a descriptive and analytical study with a cross-sectional design that was conducted in 2022. The study population consists of married women at reproductive age (15-49 years) and men whose wives were at the reproductive age, referring to healthcare centers in Sirjan City. In other words, one of the couples from each household was selected. The inclusion criteria were Iranian nationality, being married, being at the reproductive age (for women), living in Sirjan for at least six months, having one child or no children, and willingness to participate in the study. Sampling was done using a random cluster sampling method. In this regard, health care centers were considered as clusters. The samples were selected from each cluster proportional to the proportion. The number of investigated households was determined to be 321 by considering an error level (d) of 2, α=0.05, and standard deviation (s)=18.3 according to a similar study [13]. Also, due to the method of cluster sampling, the sample size was multiplied by a factor of 1.2. The final estimated sample size was 386. For data collection, a questionnaire containing sociodemographic information and questions related to psychosocial factors affecting the childbearing intention (attitude, subjective norms (SN), perceived social support, hope, and marital satisfaction) was used.
The attitude was measured using Soderberg’s Attitudes toward Fertility and Childbearing Scale (AFCS)[14], whose Persian version has already been confirmed [15]. This tool has 23 items scored on a five-point Likert scale (from 1=totally disagree to 5=totally agree). The total score ranges from 23 to 115, with higher scores indicating a better attitude towards childbearing. The reliability of the Persian AFCS version in our study was calculated as 0.88. The SN were measured using Billari’s questionnaire [16]. This tool has 6 questions that examine the pressure perceived by people to have children or not, and are scored based on a five-point Likert scale (from completely correct to completely incorrect). The total score ranges from 6 to 30, with higher scores indicating better SN towards childbearing. In Araban’s study, the validity and reliability of the Persian version of this tool were reported [13]. In our study, its reliability was confirmed by a Cronbach’s α value of 0.88.
The perceived social support was measured using Zimet’s Multidimensional Scale of Perceived Social Support (MSPSS) [17], whose Persian version has already been confirmed [18]. This tool has 12 items that measure social support perceived from family, friends, and significant others, rated on a Likert scale from 1 (strongly disagree) to 7 (strongly agree). The total score ranges from 0 to 72, with higher scores indicating higher perceived social support. The reliability of this tool in our study was confirmed (Cronbach’s α=0.94). The hope factor was measured using Snyder’s Adult Hope Scale (AHS) [19], whose Persian version has already been confirmed [20]. It includes 12 items rated on an 8-point scale from definitely false to definitely true. Of the 12 items, four questions are fillers and are not scored. The total score ranges from 8 to 64, with higher scores indicating more hope. The reliability of this tool in our study was confirmed (Cronbach’s α=0.7). 
The marital satisfaction was measured using Fowers’s ENRICH Marital Satisfaction Scale (EMS) [21], whose Persian version has already been confirmed [22]. It includes 35 items that assess nurturing relationship issues, communication, and happiness. The items are rated on a 5-point Likert scale (from strongly disagree to strongly agree). The total score ranges from 35 to 175, with higher scores indicating greater marital satisfaction. The reliability of this tool in our study was confirmed (Cronbach’s α=0.88). Finally, the childbearing intention was assessed using one question with three options: I definitely do it (intended), I might do it (Hesitant), and I definitely don’t do it (not intended). The question scored from 1 to 3, indicating a tendency towards childbearing or having more children.
In order to collect data, after obtaining the necessary permits, the researchers completed the questionnaires on behalf of participants by knocking on the door of 412 houses. Prior to it, researchers explained to them about the study objectives and methods, and assured them of the confidentiality of their information, and obtained their informed consent. The collected data were analyzed in SPSS software, version 26. Descriptive statistics, including frequency, Mean±SD, were used to describe the data. Since the data had a normal distribution, parametric tests, including independent t-test, one-way Analysis of Variance (ANOVA), and multiple linear regression analysis, were used. Additionally, following one-way ANOVA, chi-square test, Tukey’s post hoc test was used for multiple comparisons. 

Results
The mean age of participants was 33.26±6.73 years, ranged 18-62 years. Their mean age of marriage was 23.12±4.59 years, ranged 13-48 years. Other sociodemographic characteristics of the participants are shown in Table 1.


The mean scores of the questionnaires were calculated as follows: AFCS: 71.74±17.41, MSPSS: 43.41±11.78, AHS: 45.55±7.49, EMS: 52.57±11.39, and SN: 21.72±6.64.
Among 358 women who participated in the study, 165(46.1%) had no childbearing intention, 124(34.6%) had childbearing intention, and 69(19.3%) were hesitant. According to the results in Table 2, the mean attitudes toward fertility and childbearing score of participants with childbearing intention was significantly higher than those without intention (P=0.001).


Also, the mean SN score of those with childbearing intention was significantly higher than those without intention (P=0.001). Also, there was a significant difference in childbearing intention based on age (P=0.003), such that the tendency to childbearing decreased with increasing age. 
The results of assessing the difference in other study variables based on the sociodemographic variables are shown in Table 3.


Based on the results of Table 3 the AFC score was significant according to the sample’s education level (P=0.004) and the spouse’s education level (P=0.001). Other results in Table 3 show that the mean score of MSPSS was significant by gender (P=0.006). The data in Table 3 also shows that the mean AHS score was significant by education level (P=0.001), spouse’s educational level (P=0.009) and monthly income (P=0.003). The mean score of SN is significant by monthly income (P=0.003).
Based on the results of Tukey’s post hoc test, the mean AFCS score of people with a high school diploma was significantly higher than that of those with a bachelor’s degree (P=0.012) and master’s degree or higher (P=0.026). Also, the mean AFCS score of people whose spouses had a bachelor’s degree was significantly higher than that of those whose spouses had a bachelor’s degree (P=0.004) and master’s degree or higher (P=0.006). Furthermore, the AFCS of those whose spouses had a high school diploma was significantly higher than that of those whose spouses had a bachelor’s degree (P=0.024) and master’s degree or higher (P=0.043). In addition, the mean AFCS score of people with a monthly income >300 dollars was significantly lower than that of people with an income of 125-200 dollars (P=0.001) or <125 dollars (P=0.009). 
The mean SN score of people with a monthly income >300 dollars was significantly lower than that of people with an income of 125-200 dollars (P=0.004) or <25 dollars (P=0.022). The mean AHS score of people with a master’s degree or higher was significantly higher than that of people with a high school diploma (P=0.001). Also, the mean AHS score of people whose spouse had a master’s degree or higher degree was significantly higher than that of people whose spouse had a bachelor’s degree (P=0.038), high school diploma (P=0.048), and lower than a high school education (P=0.004). Also, the mean AHS score of people with a monthly income >300 dollars was significantly higher than that of people with an income of 125-200 dollars (P=0.017) or <125 dollars (P=0.004).
The study variables that had a significant difference based on at least two components of sociodemographic characteristics in the univariate analysis were further included in the multiple linear regression model. Based on the results in Table 4, only the monthly income level >300 dollars was significantly associated with the AHS score (P=0.022); with every one-unit increase in the monthly income >300 dollars, the hope increases by 4.66 units (B=4.66, 95% CI; 0.67%, 8.65%).



Discussion
According to the findings, most of the participants had no childbearing intention. In another study conducted on 20,935 married people from 32 Provinces of Iran, most participants also did not have a tendency towards childbearing [23]. In Bagi et al. ‘s study in Iran, the results also showed that about 63.6% of the respondents did not have a tendency towards childbearing [5].
Our results showed that the mean attitude score of participants with childbearing intention was significantly higher than that of those with no tendency or those who were hesitant. In Araban et al.'s study, people with a tendency towards childbearing had higher attitude scores compared to the group with no tendency [13], which is consistent with our results. In a study that specifically focused on gender attitudes, the results showed that traditional gender attitudes were associated with a high level of favorable fertility, and women who were exposed to social media were more likely to have fewer children than other women [24]. A study conducted in Iran between 2010 and 2019 found that modern lifestyle had the greatest effect on reducing childbearing, highlighting the significant role of changing beliefs in preventing couples from having children [25]. According to the modernization theory, due to the disruption of traditional values governing people's daily lives, as well as the emergence of new urban and industrial lifestyles, the attitudes towards childbearing change [26]; therefore, the reduction of fertility or childbearing is accompanied by changes in values, norms, and behaviors [27]. 
Based on our findings, the SN score of those with childbearing intention was significantly higher compared to those with no tendency or who were hesitant. In Yan et al.’s study, the SN of having a son or daughter were among the reasons for accepting childbearing [28]. These findings show the important role of SN and pressure perceived on people to engage in childbearing, which is consistent with our findings. Also, the role of social media and the institutionalization of modern life values and beliefs can influence people’s tendency towards childbearing.
The current study showed no significant difference in tendency towards childbearing based on the factors of hope, marital satisfaction, and perceived social support. A study showed that the highest fertility rates occur neither among those with high marital quality nor among those with very low marital quality. Couples with marital high satisfaction may refuse to have children for fear of complications such as reduced marital relationship with each other [29]. In Alipour et al.’s study, among the dimensions of social capital, social support had the greatest effect on the tendency towards childbearing [30]. However, Afarini et al. found no relationship between social support and the tendency towards childbearing [31], which is consistent with the results of our study. The discrepancy in findings between different studies regarding social support can be related to differences in the assessment tools. In most studies, instrumental support was examined, such as child care and financial assistance, while in this study, we focused on social support. Perhaps for this reason, more important factors of social support for having children have been raised. Among the sociodemographic variables, the age factor had a significant effect on childbearing intention, which is consistent with the results of other studies [13, 28, 32-34]. In younger ages, individuals have more opportunities and energy for childbearing, while in older ages, the possibility of having children decreases due to infertility problems and reduced opportunities.
The results showed a significant difference in the attitude score based on educational level, spouse’s educational level, and monthly income. Those with a higher level of education and higher monthly income had lower attitudes towards childbearing. In the SN variable, the results also showed a significant difference based on monthly income; those with higher monthly income had lower SN. In many studies, with the increase of education and income, the childbearing intention has also shown a downward trend [28, 35]. These relationships indicate the influence of individualism and the related thoughts on the childbearing intention.
Our study had two main limitations/disadvantages. The results cannot be generalized to all people in Iran, and it was not possible to examine potential causal relationships, which are among the inherent limitations of cross-sectional studies. The questionnaires were completed by one of the couples from each household; therefore, it was not possible to examine the views of the couples together. It is recommended that in future studies, couples’ views on childbearing be investigated.In conclusion, the childbearing intention of Iranians is affected by their age, attitude, and SN, which shows the impact of the modern lifestyle and the resulting changes on childbearing. Therefore, population policies should take into account the commitments of the modern lifestyle.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Sirjan University of Medical Sciences, Sirjan, Iran (Code: IR.SIRUMS.REC.1401.002). All ethical principles, such as the confidentiality of information, voluntary participation, and informed consent, were considered.

Funding
This article was a part of a research project, funded by Sirjan University of Medical Sciences, Sirjan, Iran (Project No.: 400SIR44).

Authors' contributions
Conceptualization and project management: Omolbanin Atashbahar and Reza Sadeghi; Methodology: Omolbanin Atashbahar, Reza Sadeghi and Mohammad Moqaddasi Amiri; Investigation: Omolbanin Atashbahar and Fatemeh Negahdari; Writing the original draft: Omolbanin Atashbahar; Supervision, review & editing: Reza Sadeghi and Zeinab Naderi; Data analysis: Mohammad Moqaddasi Amiri; Final approval: All authors.

Conflict of interest
The authors declared no conflict of interests.

Acknowledgments
The authors would like to thank the participants for their cooperation.



References

1. Zare Z, Kiaetabar R, Laal Ahangar M. Fertility motivations and its related factors in women of reproductive age attended health centers in Sabzevar, Iran. J Midwifery Reproduct Health. 2019; 7(1):1551-9. [DOI:10.22038/jmrh.2018.28116.1303]
2. Jafari H, Pourreza A, Kabiri N, Khodyari-Zarnaq R. Main actors in the new population policy with a growing trend in Iran: A stakeholder analysis. J Health Popul Nutr. 2022; 41(1):57. [DOI:10.1186/s41043-022-00338-2] [PMID]
3. Zarghami H, Mirzaee M. [Aging of Iran’s population in the preceding four decades (Persian)]. Sci J Iran Islam Dev Model Stud. 2015; 6(3):73-94. [Link]

4. Khadivzadeh T, Hadizadeh Talasaz Z, Shakeri MT. [Predicting factors affecting the delay in first childbearing among young married women using the Bandura’s social learning theory (Persian)]. Hayat. 2017; 23(3):226-42. [Link]
5. Bagi M, Sadeghi R, Hatami A. Fertility intentions in Iran: Determinants and limitations. Strateg Stud Cult. 2022; 1(4):59-79. [DOI:10.22083/scsj.2022.149113]
6. Hosseini B, Esmaiili M, Farahbakhsh K, Salarifar MH. [The pattern of childbearing motivation is based on the lived experiences of families with at least one child (Persian)]. Women Fam Cult Educ. 2023; 18(65):45-68. [Link]
7. Eichenberg C, Huss J, Küsel C, Hertlein K. Desire to have children and the internet: Aspects for psychosomatic practice. J Couple Relat Ther. 2023; 22(2):134-42. [DOI:10.1080/15332691.2022.2136810]
8. Kiesswetter M, Marsoner H, Luehwink A, Fistarol M, Mahlknecht A, Duschek S. Impairments in life satisfaction in infertility: Associations with perceived stress, affectivity, partnership quality, social support and the desire to have a child. Behav Med. 2020; 46(2):130-41. [DOI:10.1080/08964289.2018.1564897] [PMID]
9. Menghan Z, Zhang Y. Parental childcare support, sibship status, and mothers’ second-child plans in urban China. Demogr Res. 2019; 41:1315-46. [DOI:10.4054/DemRes.2019.41.47]
10. Hu LC, Chiang YL. Having children in a time of lowest-low fertility: Value of children, sex preference and fertility desire among Taiwanese young adults. Child Ind Res. 2021; 14(2):537-54. [DOI:10.1007/s12187-020-09753-5]
11. Ayazi R, Amini L, Montazeri A, Haghani S. [Factors related to childbearing willingness in the women attending the health centers in Arak, Iran (Persian)]. Iran J Nurs. 2021; 34(130):15-24. [DOI:10.52547/ijn.34.130.15]
12. Akinyemi JO, Odimegwu CO. Social contexts of fertility desire among non-childbearing young men and women aged 15-24 years in Nigeria. Reproduct Health. 2021; 18(186). [DOI:10.1186/s12978-021-01237-1] [PMID]
13. Araban M, Karimy M, Armoon B, Zamani-Alavijeh F. Factors related to childbearing intentions among women: A cross-sectional study in health centers, Saveh, Iran. J Egypt Public Health Assoc. 2020; 95(1):6. [DOI:10.1186/s42506-020-0035-4] [PMID]
14. 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; 13:197. [DOI:10.1186/1471-2393-13-197] [PMID]
15. Baezzat F, Ahmadi Ghozlojeg A, Marzbani Y, Karimi A, Azarnioshan B. A study of psychometric properties of persian virsion of attitudes toward fertility and childbearing scale. J Urmia Nurs Midwifery Fac. 2017;15(1). [Link]
16. Billari FC, Philipov D, Testa M. Attitudes, subjective norms, and perceived behavioral control as predictors of fertility intentions. Eur J Popul. 2009; 25(4):439-65. [DOI:10.1007/s10680-009-9187-9]
17. Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimension¬al scale of perceived social support. J Pers Assess. 1988; 52(1):30-41. [DOI:10.1207/s15327752jpa5201_2]
18. Bagherian-Sararoudi R, Hajian A, Ehsan HB, Sarafraz MR, Zimet GD. Psychometric properties of the persian version of the multidimensional scale of perceived social support in iran. Int J Prev Med. 2013; 4(11):1277-81. [PMID]
19. Snyder C. Handbook of hope-online version. 1st ed. New York: Elsevier Inc; 2000. [Link]
20. Kermani Z, Khodapanahi MK, Heidari M. Psychometric properties of hope Snyder scale. J Appl Psychol. 2011; 5(3):23-27. [Link]
21. Fowers BJ, Olson DH. ENRICH marital satisfaction scale: A brief research and clinical tool. J Fam Psychol. 1993; 7(2):176-85. [DOI:10.1037/0893-3200.7.2.176]
22. Bahmani B, Askari A, Tamadoni M. [Validation, reliability and standardization of ENRICH marital satisfaction scale for Iranian society (Persian)]. J Natl Congr Fam Pathol Iran. 2006; 2:1. [Link]
23. Tavousi M. Haerimehrizi A, Sadeghi J,Motlagh M, Eslami M,Naghizadeh F, et al. [Fertility desire among Iranians living in IRAN: A nationwide study (Persian)]. Payesh. 2017; 16(4):401-10. [Link]
24. Ambrosetti E, Novelli M, Angeli A. Childbearing intentions among Egyptian men and women: The role of gender-equitable attitudes and women’s empowerment. Demogr Res. 2021; 44:1229-70. [DOI:10.4054/DemRes.2021.44.51]
25. Rafiee Moghadam F, Fathi Ashtiani A. [Discovering the factors that prevent couples from having children in the last decade (structured review) (Persian)]. Cult Educ Women Fam. 2020; 15(53):155-75. [Link]
26. Han SW, Brinton MC. Theories of postindustrial fertility decline: An empirical examination. Popul Dev Rev. 2022; 48(2):303-30. [DOI:10.1111/padr.12490]
27. Parviniyan F, Rostamalizadeh V, Hbibi R. [The effect of modern women’s lifestyle on the fertility rate: A case study of Qazvin city (Persian)]. J Women Soc. 2019; 9(36):39-72. [Link]
28. Yan Z, Hui L, Wenbin J, Liuxue L, Yuemei L, Bohan L, et al. Third birth intention of the childbearing-age population in mainland China and sociodemographic differences: A cross-sectional survey. BMC Public Health. 2021; 21(1):2280. [DOI:10.1186/s12889-021-12338-8] [PMID]
29. Rijken AJ, Thomson E. Partners’ relationship quality and childbearing. Soc Sci Res. 2011; 40(2):485-97. [DOI:10.1016/j.ssresearch.2010.10.001]
30. Alipour R, Foroutan Y, Sharepour M. Social capital and childbearing tendencies with emphasise on generational differences (case study: Babol city). Zesz Pracy Socjalnej. 2021; 26(1): 1-26. [DOI:10.4467/24496138ZPS.21.001.13842]
31. Afarini FS, Akbari N, Montazeri A. [The relationship between social support and the intention of childbearing in women of reproductive age (Persian)]. Payesh. 2018; 17(3):315-28. [Link]
32. Amerian M, Mohammadi S, Fayazi S, Faghani Aghoozi M, Malary M. Related determinants of decision-making in the first childbearing of couples: A narrative review. Prev Care Nurs Midwifery J. 2019; 9(1):49-57. [DOI:10.29252/pcnm.9.1.49]
33. Torabi F, Sheidani R. [A study of effective factors in tendency to fewer childbearing of 15-49 year old women residents of Tehran (Persian)]. J Woman Fam Stud. 2019; 7(2):31-67. [Link]
34. Faghani Aghoozi M, Kariman N, Faiazi S, Joze Mohtashami M, Amerian M. Factors affecting the first childbearing decision in Iranian males. J Holist Nurs Midwifery. 2020; 30(1):27-34. [DOI:10.32598/JHNM.30.1.5]
35. Erfani A, Shojaei J. [Reasons for intending to have no children in Tehran, Iran (Persian)]. Salamat Ijtimai. 2019; 6(2):116-29. [DOI:10.22037/ch.v6i2.22583]