Factors Associated with Perceived Barriers to Parity Progression Among One-Child Women: A Cross-Sectional Analysis
Sara Khani, Solmaz Mohammadi, Fardin Hashemi, Vahid Rahmanian, Afsaneh Ranjbar, Safieh Jamali, Aryan Khani, Ziba ZiaeifarBackground:
With one-child families becoming more common, Iran is encountering a sudden drop in its fertility rate (total fertility rate is currently around 1.7). Developing evidencebased population strategies requires understanding the barriers these women see regarding having more children.
Objective:
This study aimed to discover how socioeconomic, reproductive, and psychosocial factors impact women’s perceptions of barriers to having a second child in southern Iran.
Methods:
309 women with only one child were selected from healthcare centers in both urban and rural areas of Jahrom County, southern Iran, for a cross-sectional analytical study in 2023-2024. Information gathered using a questionnaire was validated for content (with acceptable CVR and CVI values) and analyzed using descriptive statistics and both univariate and multivariable linear regression with backward elimination in SPSS version 26.
Results:
Participants were predominantly urban residents (68.9%) with tertiary education (55.0%). Economic constraints constituted the most salient barrier, with 70.6% expressing concerns regarding financial incapacity and 64.1% citing insufficient governmental support. Psychosocial challenges, notably emotional unpreparedness (43.0%) and perceived inadequacy in parenting skills (40.5%), were also prominent. The final multivariable linear regression model (Adjusted R² = 0.144) identified urban residence (B = 4.92, P = 0.008), lower desired family size (zero children: B = 17.13, P < 0.001; one child: B = 9.98, P < 0.001, relative to ≥3 children), and a history of infertility (B = –5.14, P = 0.016) as significant predictors of elevated barrier scores. Socioeconomic variables, such as employment and income, lost significance after adjustment. Furthermore, the treebased regression model elucidated critical non-linear interactions, revealing that a prolonged marriage- to-childbirth interval (≥4.5 years) coupled with low fertility preferences and higher education substantially intensified perceived barriers (mean score = 81.67), whereas a history of infertility and miscarriage alongside a preference for ≥2 children corresponded to the lowest barrier perception (mean score = 40.46).
Discussion:
The study suggests that perceived barriers to having a second child among women with only one child are affected by economic instability, past infertility, and adherence to one-child fertility norms. These findings highlight the need for pronatalist policies to go beyond financial incentives to include psychosocial well-being and structural support mechanisms.
Conclusion:
The combined effects of economic insecurity, reproductive trauma, and prevailing fertility norms influence fertility limitation among women with one child. Pronatalist policies should extend beyond mere financial incentives and include structural reforms and psychosocial well-being to be effective.