Introduction

Counseling is one of the most appropriate health interventions to raise the knowledge and attitude of clients (1). As a contributing factor, counseling facilitates the relationship between counselors and clients. This practice leads to better conceptualization of the clients’ characteristics and improvement of the decision-making process in life in a more reasonable and appropriate manner (2). Planning reproductive health programs, especially the ones designed for promoting childbearing, requires the actual participation of people. This participation of the community in such programs is relevant to the level of awareness and knowledge about the need for such program (3).

The Action Plan for the Population and Development Conference in Cairo (1994) stated that all human should achieve the highest level of information (4). The provision of information and education is the main strategy for changing the dominant fertility discourse of society, which has had a clear effect on the fertility behavior of couples in recent years (5). Provision of reproductive health cares, especially family planning services and counseling on healthy fertility, is one of the important skills that midwives ought to acquire for the delivery of pertinent services.

Reproductive health means that people have freedom to choose, reproduce, and decide on the time and frequency of their childbearing (6). There are many individual factors, such as attitude, motivation (7-8), as well as social and environmental factors (e.g., economic status and cultural and population policies) which can influence the fertility preferences and behaviors in the society (9-13).

For many years, healthcare staff has played a significant role in fertility-related programs. They have been mostly providing education and counseling for clients toward the aim of family planning programs (5). In recent years, along with changes in population policies in Iran, many actions have been taken to increase the rate of fertility in the society. Therefore, the role of healthcare providers is to promote attitudes and provide family planning counseling and services in line with the new population policies of the country. The achievement of this goal requires training and changing the attitudes of health providers to enable them to inform
and persuade families about the healthy childbearing (5, 11).

However, there was not enough education for providers with the aim of improving their attitude toward childbearing and promote their skills in this regard. The Office of Population, Families, and School Health planned some Interventional programs in order to increase the overall fertility rate and promote childbearing. In this regard, the emphasis was placed on staff training about reproductive health rights, improving the quality of counseling services, reviewing the fertility health program indicators, and upgrading the present educational contents (14). Improvement of performance, knowledge, and attitude of the women employed at health centers and medical sciences universities will result in the modification of clients’ performance as they act as role models and reliable sources of information for the public (11, 15).

Awareness of reproductive health can be developed using various sources, including newspapers and mass media. However, healthcare workers play a leading role in raising public knowledge in this regard (3,11). In Iran, the midwifery and health staff can make a significant contribution to enhance educational programs. The enhancement of consciousness level and positive attitude towards the program in this group results in a higher impact on the society (16). Accordingly, our previous study showed that the performance of health providers was poor in counseling with the childbearing promotion approach due to their poor knowledge and attitude toward childbearing (17).

With this background in mind, the current study was conducted to determine the knowledge and attitude of midwives and health care providers about childbearing in Mashhad University of Medical Sciences, Mashhad, Iran, in 2015.

Materials and Methods

This cross-sectional study was conducted on 108 multi-profession midwives and family health providers with at least 6 years of work experience in midwifery, maternal, and child health and family planning units in health and treatment centers and community health centers. For this purpose, three out of five districts health centers in Mashhad, including districts No. 2, 3, and 5 were randomly selected. In the next step, 18 health and treatment centers and 23 community health centers covered by these three district centers were randomly chosen as clusters and all their eligible working midwives and health providers were entered the study.

All subjects were able to work with the computer and Internet. They had BSc or MSc degrees of midwifery, family health, or public health. The data collection tools included demographic characteristics form, and two questionnaires for assessing the knowledge and attitude.

The knowledge assessment questionnaire was a researcher-made tool, including eight items. The subjects selected their responses out of two options of ‘Yes’ or ‘No’. The correct answer was given two scores, whereas the wrong ones were assigned a score of one. Based on the obtained scores and a maximum score of 16, the knowledge scores of ≤ 8, 8.1-12, and ≥ 12.1 were regarded as indicating weak, moderate, and good levels, respectively. The validity of this questionnaire was assessed and confirmed by seven teachers of reproductive health, midwifery, and nursing disciplines.

The participants’ attitude was assessed by filling out the Attitude to Childbearing Questionnaire. The items of this questionnaire were generated based on the results of a qualitative study performed by Khadivzadeh et al. (2013) on the process of forming fertility decisions among the Iranian couples (18). This instrument includes 47 items rated on a five-point Likert scale (i.e., strongly agree=1, agree=2, no idea=3, disagree=4, strongly disagree=5). Based on the scores obtained from the questionnaire, attitude scores of <118, 118-178, and >178 were indicative of weak, moderate, and good levels, respectively. The maximum score of this research instrument was 235.

The validity of the questionnaire, was approved by twelve faculty members from the midwifery, reproductive health, nursing, and psychology disciplins. After applying their comments, the content validity ratio and content validity index were calculated, and the tool’s content validity was confirmed (19).

The reliability of the attitude questionnaire was estimated using the Cronbach's alpha coefficient of 0.89. Before filling the questionnaires, the purpose of the research and the confidentiality of the information were explained to the heads of the health centers and health care staff. The subjects were entered the study based on inclusion criteria.

The data was analyzed using SPSS software (version 16) and presented as mean, standard deviation and frequency. The comparison of the quantitative and qualitative data between the two groups was done using the independent t-test and Chi-Square test, respectively. Pearson and Spearman correlation coefficient tests were also applied to show the relationship between quantitative data. p-value less than 0.05 was considered statistically significant.

 Results

The results of the study showed that 52 (48.6%) participants were in the age range of 31-40 years. Furthermore, 69 (64.5%) cases were married, and most of them (43%) had 1-2 children. In terms of employment status,
61 (57%) participants were employed as contractors and 42 (39.3%) cases were working as multi-profession. In addition, 75 (70.1%) subjects stated that they were not familiar with the new policies on fertility control and had not completed a specific course in this regard.

According to the results, 70 (65.4%) health workers had a good level of knowledge (Table 1) and regarding the attitudes toward childbearing, 75 health workers (70.1%) had a moderate attitude (Table 1). The mean scores of health workers' knowledge and attitude about childbearing were obtained as 12.86±1.36  and 166.45±19.99, respectively. The subjects’ knowledge showed a significant correlation with their age, duration of study, duration of marriage, and work experience (Table 2).