Rashidi Farzaneh, Ghahremani Fereshteh, Mahmoodi Zohreh, Doulabi Mahbobeh Ahmadi
Addiction and Behavioral Sciences Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran.
Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
BMC Public Health. 2025 Mar 19;25(1):1062. doi: 10.1186/s12889-025-22223-3.
Childbearing intention is a complex issue that is influenced by a number of factor. However, childbearing intention does not necessarily lead to actual behavior, and mediating factors are effective in the realization and emergence of reproductive behavior. Since childbearing intention is influenced by several factors, including the social determinants of health, a thorough understanding of the effect of health determinants on this intention will help the reproductive process. Therefore, the present study was conducted using a social support-mediated model to examine the role of social determinants of health in women's intention to pregnant.
This cross-sectional study was conducted on 500 married women of reproductive age (age range 15-49 years old) who were referred to health centers affiliated with Shahid Beheshti University of Medical Sciences during 2022-2023. Sampling was performed in a multi-stage (class-cluster) manner. Data collection tools in this study included the Demographic Information Form, the Childbearing Intention Questionnaire, social determinants of health questionnaires such as the Ghodratnama Socio-Economic Status Questionnaire, the Perceived Social Support Questionnaire, and the Depression Anxiety Stress Scales (DASS-21), and the Dyadic Adjustment Scale (Spinner questionnaire). Data analysis was performed using SPSS21 software with descriptive statistical tests and analytical statistics. Laserl 8.8 software was also used to test the model using the path analysis statistical test.
The mean scores of depression, anxiety and stress were 5.03 ± 4.39, 4.49 ± 3.68 and 7.7 ± 4.67, respectively. The mean score of marital adjustment was 103.26 ± 23.49, indicating that the majority of women (60.4%) had marital adjustment. Based on the results of the path analysis, marital adjustment was the only variable that had a direct positive and significant causal relationship with the childbearing intention from only one path (B = 0.74). Moreover, based on the results of the path analysis, perceived social support had the most direct and indirect positive causal relationship with the childbearing intention to have children (B = 0.74). Among the components of DASS21, depression was the only variable that had both a direct and indirect negative causal relationship with childbearing (B=-0.12). Both stress and anxiety had a direct positive causal relationship with the childbearing intention (B = 0.11 and B = 0.15 respectively).
Factors such as marital adjustment, perceived social support, depression, stress, and anxiety, as structural social determinants of health, are associated with childbearing intention. Accordingly, changes in social structures depend on population planning and policies.
生育意愿是一个受多种因素影响的复杂问题。然而，生育意愿并不一定会导致实际行为，中介因素在生殖行为的实现和出现中起作用。由于生育意愿受到包括健康的社会决定因素在内的多种因素影响，深入了解健康决定因素对这一意愿的影响将有助于生殖过程。因此，本研究采用社会支持介导模型来检验健康的社会决定因素在女性怀孕意愿中的作用。
本横断面研究对2022年至2023年期间转诊至沙希德·贝赫什提医科大学附属健康中心的500名育龄已婚妇女（年龄范围15 - 49岁）进行。抽样采用多阶段（类集群）方式。本研究的数据收集工具包括人口信息表、生育意愿问卷、健康的社会决定因素问卷，如《古德拉特纳马社会经济地位问卷》、《感知社会支持问卷》、《抑郁焦虑压力量表》（DASS - 21）以及《二元调适量表》（斯平纳问卷）。使用SPSS21软件进行数据分析，包括描述性统计检验和分析性统计。还使用Laserl 8.8软件通过路径分析统计检验来检验模型。
抑郁、焦虑和压力的平均得分分别为5.03±4.39、4.49±3.68和7.7±4.67。婚姻调适的平均得分为103.26±23.49，表明大多数女性（60.4%）婚姻调适良好。根据路径分析结果，婚姻调适是唯一从一条路径与生育意愿存在直接正向且显著因果关系的变量（B = 0.74）。此外，根据路径分析结果，感知社会支持与生育意愿之间具有最直接和间接的正向因果关系（B = 0.74）。在DASS21的各成分中，抑郁是唯一与生育存在直接和间接负向因果关系的变量（B = - 0.12）。压力和焦虑与生育意愿均存在直接正向因果关系（分别为B = 0.11和B = 0.15）。
婚姻调适、感知社会支持、抑郁、压力和焦虑等因素作为健康的结构性社会决定因素，与生育意愿相关。因此，社会结构的变化取决于人口规划和政策。
