Iran Journal of Nursing

Introduction
The population growth in Iran has decreased significantly in recent years, and is expected to continue in the next two decades. Knowing the areas of desire to have children can help increase the population rate. Experts suggest various cultural, social and economic factors to be the cause of decline in childbearing intention. Some of the important reasons for the change in childbearing behavior include high maternal age at first pregnancy, high age of marriage, gender equality, empowerment of women in modern society, and economic and social factors such as women’s participation in workforce, increased educational level, family income, and the couples’ level of responsibility, and their religious tendencies. Religion, as a cultural factor, affects childbearing intention by various norms related to the number of family members, number of children, age of marriage, etc.; Therefore, religious orientation is one of the factors affecting childbearing intention. However, in some cases, despite adherence to religion, people refrain from having more children. Women’s multiple roles and responsibilities in society is another issue related to childbearing intention. Women’s participation in public arenas and the increase in their social roles cause them leave other roles by accepting one role. Therefore, motherhood, which can impose more costs on these women, may lose its priority. Although in some studies, the relationship of the two variables of accountability and religious orientation with childbearing intention has been investigated separately, the relationship of both variables with childbearing has not been investigated so far. Therefore, the present study aims to determine the relationship of accountability and religious orientation with childbearing intention in women referred to comprehensive health centers in Yasuj, Iran.
Material and Method
This is a cross-sectional study that was conducted on 240 eligible married women aged 18-45 years referred to comprehensive health centers in Yasouj city. Sampling was done using a continuous method and based on the inclusion criteria (no infertility, no chronic diseases or mental disorders, or contraception for pregnancy). Informed consent was obtained from all women and completed  the questionnaires. One questionnaire was used for assessing sociodemographic information (surveying age, educational level of husband and wife, employment status of husband and wife, number of female children, number of existing and ideal male children, ideal number of children, and length of marriage) and the information about the intention to have children (Answered by Yes or No). This validity of this questionnaire was approved by three faculty members. The other tools were the Harrison-Goff accountability scale (HGAS) and Golriz and Baraheni’s religious attitude scale (RAS). After entering the data into SPSS software, version 20, they were analyzed using independent t-test, Pearson’s correlation test, and one-way analysis of variance. P<0.05 was statistically significant.
Results
The mean age of the participants was 33.12±6.49 years, and their mean length of marriage was 10.52±6.77 years. Most of the participants considered the ideal number of children to be 1-2(55.4%), and 32.1% had no children. Only 14.1% had no intention to have a girl and 15.4% had no intention to have a boy. For contraception, 45.4% used the withdrawal method, 28.8% used the combined pills, 17.5% used condoms, and the rest used other methods. Only 26.7% of women and 28.8% of their husbands were planning to have children; the rest had no intention to have children. 
The mean score of RAS in total was 46.63±6.81 (ranged 23-63). For its dimension of intrinsic religious orientation, the score was 20.78±4.56 (ranged 9-34), and for the dimension of extrinsic religious orientation, the score was 25.86±4.45 (ranged 14-37). The mean total score of HGAS was 29.63±4.35; most of the participants (96.2%, n=231) had high accountability and 3.8% (n=9) had moderate accountability. None of them had low accountability.
The results of independent t-test showed no significant relationship of religious orientation in total (P=0.508) and in its dimensions (P>0.05) with childbearing intention, but there was a significant relationship between accountability and childbearing intention (P=0.036), where the accountability level of women with no childbearing intention was significantly higher than that of women with childbearing intention. 
The religious orientation had a significant relationship with husband’s educational level (P=0.036) and women’s occupation (P=0.013), where the religious orientation of employed women was significantly higher than that of housewives. The results of pairwise comparison by Tukey’s test showed that the religious orientation in the women whose husbands had university education was significantly lower than in women with illiterate husbands (P=0.042). No statistically significant difference was observed between in terms of other educational levels (P>0.05). Based on the results of one-way ANOVA, accountability had a statistically significant relationship with educational level of women (P=0.006) and educational level of their husbands (P=0.001). Based on Tukey’s test results, the accountability score of illiterate women was significantly lower than women with high school/diploma (P=0.035) and university education (P=0.006). Moreover, the accountability score of women whose husbands had university education was significantly higher than that of women whose husbands had high school/diploma (P=0.039) or were illiterate (P=0.004).
Discussion 
The results of this study showed that only 26.7% of women in Yasouj city and 28.8% of their husbands intended to have children. The most important reason for their low intention to have children may be the increase in economic problems, children’s educational issues, and lack of governmental support in ensuring the welfare of families. Moreover, the time of this study, which was during the COVID-19 pandemic, may affected their childbearing intention and reduced it.
This study showed a significant relationship between accountability and childbearing intention of women; the accountability was higher in women with no current intention to have children. Among the sociodemographic variables, only the educational levels of women and their husbands were significantly correlated to their accountability. It seems that the emergence of the ideas of individual independence and individualism and new demands of women and men in the society, and the inability to coordinate responsibilities inside and outside the home (employment and education) have made women reluctant to have children, although it needs more studies. Low sample size due to the conditions caused by the COVID-19 pandemic can also be effective in achieving these results. Therefore, it is suggested that a similar study be conducted with a larger sample size.
The limitations and challenges of this study, in addition to small sample size, were the effect of the COVID-19 pandemic during the study, as well as the intention of women to have children during the study, since this study assessed the “current” childbearing intention, not their childbearing intention in the future. Moreover, caution should be made in the generalization of the results to all women in Iran. 

Ethical Considerations
Compliance with ethical guidelines
This study has the code of ethics number IR.IUMS.REC.1398.827 from the Ethics Committee of Iran University of Medical Sciences and sampling permission from Iran and Yasouj Universities of Medical Sciences as well as comprehensive health centers of Yasouj city.

Funding
This study is taken from the Master's Thesis of Chemistry, Department of Societal Education in the Health System with the number 98-3-3-16322, which was approved and financially supported by Iran University of Medical Sciences.

Authors' contributions
Executive of planning and preparing the draft and corrections of the article: Leila Amini; Researcher and conducting sampling and drafting the article: Kimia Bakshi; Project consultant: Homa Sadeghi first Shahr; Statistical analysis and table drawing: Shima Haghani.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The support of Iran and Yasouj Universities of Medical Sciences and all the participants in this study is appreciated and thanked.


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