Fertility is one of the main determinants of population growth, and women's attitudes to fertility and the number of children are of utmost importance in this growth. Numerous studies have been conducted in different parts of the world, including Iran, on factors affecting fertility. Nonetheless, the impact of each of these factors on fertility has not been fully determined owing to the differences in social, cultural, and economic status in each time perspective (1-6).

    A study carried out in China showed that the preference for a small family was associated with younger age, urban residence, and a higher level of education (3).

    Another study performed in Japan compared the difference between the actual and desired number of children in rural and urban areas. The mentioned study indicated that the mean desired number of children was 2.55 which was significantly more than the mean actual number of children (1.77) in all generations(7). According to the Statistical Center of Iran and the Institute of Statistics, fertility rates declined in all walks of society in our country in the last three decades. However, this rate has been reported to be far below the replacement level in employed people with higher education and people with high economic status(8).

    The Iranian government has recently reversed its population policy since this country is facing a rapidly aging population; therefore, women are encouraged to have more children (9). In our country, several studies have been conducted on factors affecting fertility. For instance, a study carried out in Tabriz assessed the effect of religious orientation, social acceptance, social participation, and children's economic benefits on childbearing. Based on the results of the mentioned study, social participation had a negative effect, while religious orientation exerted an additive effect on the tendency for childbearing (10, 11).

    Given new population policies in the country and specific differences in fertility in the working groups, educated people, and people with high economic status, the current study assessed the childbearing attitudes of employed women in Iran University of Medical Sciences. It strived to answer the following questions: what are concerns or incentives for having children in this group and each one is more important? Is the difference between the real number of children and ideal number of children? What approaches can be used to increase fertility? In this regard, the present study aimed to answer these questions about factors affecting childbearing in employed women.

Materials and Methods

     This cross-sectional study which was conducted in summer 2015 involved a convenience sample of 140 employed women working as administrative assistants in Iran University of Medical Sciences, Tehran, Iran. All employed women who were willing to participate in the study were enrolled. All participants were university administrative staff. The exclusion criteria were as follows: 1) unwillingness to participate in the study 2) being a Faculty member. To increase the response rate, the questionnaires were collected after 20 min. The sample size was calculated based on the formula presented below:

n= (Zα2 *P (1-P))/d²)/1+1/n ((Zα2 *P (1-P))/d²)-1)

    Where P represents the probability of childbearing among working women (considered 50% according to previous studies), and d is 0.05. Out of about 220 eligible study samples, 140 subjects were obtained.

    A self-administered questionnaire was used to gather information. The first group of questions aimed to collect information on the socio-demographic data, including respondent’s age, number of children, the ideal number of children, education level, respondent and her husband's willingness to have a (another) child.

The second set sought information on explanations about personal attitudes toward childbearing. Participants could select as many statements that applied to their situation. The hindrance list included challenges of raising a child, pregnancy/delivery complications, direct costs of pregnancy and delivery, compromise the health of mothers, fear of birth defects, balancing working and parenting, and having the desired family size. On the other hand, the motivation list included the pleasure of having a baby, strengthening family ties, perceiving the “only” child as “lonely”, only children's desire to have siblings, spouse’s willingness to have a (another) child, peer pressure, social norms, and fantasizing a child of the other sex.  Respondents were asked to select their strongest explanation at the end of each list.

    In the third section, respondents were asked the following question: “Thinking of having a/another child, which one would help YOU as a working woman?” Participants could select one or more of the following: Flexible work hours, access to child care facilities at the workplace, availability of nannies or family caregivers, parenting skill development programs, financial and welfare support, as well as job security during and after maternity leave.

For content validity, 10 academic members at the Faculty of Iran University of Medical Sciences (IUMS) reviewed the questionnaire. The final questionnaire was prepared by applying the obtained opinions. Cronbach's alpha was used to determine the reliability of this questionnaire (α=0.7).

    The obtained data were analyzed in the Statistical Package for the Social Sciences (SPSS) for Windows version 16.0 (SPSS Inc, Chicago, IL, USA). Data was summarized through frequencies, means, and standard deviations. Chi-square test was utilized for bivariate comparison of groups according to the willingness to have a (another) child. Moreover, the logistic regression test examined the role of demographic factors, in addition to stated hindrance and motivations, in the prediction of participants’ intention to have a (another) child. A p-value less than 0.05 was considered statistically significant.

Results

     The mean age of participants was reported as 39.48± 6.915. Their current and ideal numbers of children were obtained at 1.32±0.771 and 2.3±1.063, respectively. There was a statistically significant difference between the current and ideal number of children (P-value< 0.001).

     A number of 50 individuals had intentions to have a (another) child, 59.1% of whom had no children, and 31.4% had at least one child at the time of the study (P-value = 0.016).

    Table 1 depicts the demographic characteristics of participants according to their willingness to have a (another) child “The pleasure of having a baby” was perceived as the strongest incentive to childbearing by 71 of all 140 respondents.

    Challenges of raising children” was valued as the strongest obstacle for childbearing by 95 of all 140 respondents, 35 (36.8%) of those who were willing to have a (another) child, and 60 (63.2%) of the other group (P-value=0.710). Table 2 demonstrates the frequency of choosing each explanation as a motivation or hindrance to childbearing. Moreover, out of 50 participants who intended to have a (another) child, 29 cases regarded “flexible work hours” as most helpful to them as working mothers. Table 3 presents the

frequency of choosing each suggested intervention/facility by the participants who were willing to have a (another) child.

    Examining the group of respondents with no children at the time of the study, none of the suggested hindering factors performed any roles in the prediction of their childbearing (UN) willingness. The only significant motivating predictor for these people was “The pleasure of having a baby”. Those who were willing to experience such pleasure were two times more willing to have a child, compared to others (Exp (B)=2.039, P-value=0.048, CI=1.006-4.133)

    Considering childbearing a way for “strengthening family ties” (Exp (B) =2.812, P-value=0.011, CI=1.263-6.262) and fantasizing a child of the other sex (Exp (B) =2.891, P-value=0.035, CI=1.077-7.759) were other independent predictors of childbearing willingness.

Discussion

    The present study was carried out to investigate the determinants of employed women’s attitudes toward childbearing. Based on the results, 35.7% of participants were willing to have a (another) child. Another study conducted across 32 provinces of Iran reported that childbearing intention was 31.8%. The number of participants’ children was significantly lower than what they desired to have. In Japan, the mean desired number of children was 2.55 which was significantly more than the mean actual number of children (1.77) in all generations(7).

    Responses to the questionnaire revealed that “getting a companion for the previous child” was the most prevalent potential incentive for having a baby in the group that already had children. On the other hand, “anxiety about the burdens of childbearing” was reported to be the most predominant potential hindrance to childbearing.  In addition, the most paramount concern among women who had never delivered a baby was childbearing itself, followed by the expenses related to pregnancy and childbearing.

A study conducted among working women in Isfahan, Iran, pointed to the prevalence of the tendency to have a second child among working women. Moreover, the mentioned study indicated that getting a companion for the first child was the most important factor contributing to this tendency. The majority of women delivered their first baby under 30 years old, and the desired number of children for these women was two. The high tendency among working women in the mentioned study does not agree with the fertility intention among women in the present study. Nevertheless, there are similarities between the two studies in getting a companion for the first child and the desired number of children(12) .

    Among the factors inhibiting fertility intention in people with at least one child, the sufficiency of the number of children in women’s view would decrease the probability of fertility intention by 10%. On the contrary, among the factors encouraging fertility intention, social norms, having a companion for the previous child, the insistence on the part of the previous child, the solidarity of the family structure, and having a child of the desired gender boosted the probability of fertility 12, 4, 4, and 3 folds, respectively. In individuals without children, no significant relationship was found among any of the factors inhibiting fertility intention, as well as the factors encouraging fertility intention; nonetheless, the pleasure of having a baby alone would lead a 19-fold increase in childbearing tendency.

    A study conducted in Semnan, Iran, showed that cohorts born in 1961 attached great importance to having children. The reasons for giving such weight among people born in this period include support benefits, emotional factors, as well as the continuity and cohesiveness of the family. The lowest value placed on having children belongs to those born after 1981. Economic costs, costs pertaining to lost opportunities, and the crucial importance of the psychological and emotional benefits of having children are the characteristics of this group of people. The importance of costs and economic problems have been emphasized in this study as the factors differentiating the two generations in their fertility intentions. Nevertheless, in the present study, the sufficiency of the number of children in women’s views has been found as the major contributing determinant discouraging fertility intention (13).

A study in Tabriz, Iran, examined the relationship of fertility intention with religious tendency, social acceptance, social engagement, and economic benefits among young couples in this city. As a result, the variables used in this study revealed a 22% variation in dependent variables.

    In the mentioned study, social engagement and religious tendency were reported to have reducing and increasing effects on fertility intention, respectively (10, 14).  In the current study, social norms performed a prominent role in fertility intention. The individuals with fertility intention in our study regarded “flexible work hours” as the most important solution to help fertility which reflects women’s ability and tendency to play roles both at home as mothers, as well as in society.

     As evidenced by the results of the current study, there was a difference between the actual and desired number of children in the individuals’ views. Considering the obtained results, it seems that the improvement of childbearing conditions and revision of working women’s work hours would contribute significantly to their fertility intention.

Conclusion

    Approximately 36% of the employed women in our study were willing to have a (another) child and there was statistically significant difference between the actual and desired number of children. "The pleasure of having a baby" was the most important incentive for childbearing and "Flexible work hours" Was the most importantly suggested interventions to raise children.

Acknowledgements

     The authors' deepest appreciation goes to all the staff of Iran University of Medical Sciences for their assistance in the implementation of the present study.

Conflicts of interest

Authors declared no conflicts of interest.