Iran Journal of Nursing

Introduction
Childbearing is affected by the attitude of couples and the perceived norms. In several theories, attitude has been proposed as one of the important and influential factors in childbearing. Several studies have shown the effect of various structural, social, economic, and individual factors on the attitude towards childbearing. Since the decision to have children is based on shared decision-making, the effect of marital quality on the attitude towards childbearing is also important. Good marital quality is needed to have satisfactory and stable marital relationships and family strengths. Regarding the relationship between marital quality and childbearing, there are two opposing hypotheses: the first hypothesis suggests that children increase the costs, and couples take these costs into account in their childbearing decision-making. Accordingly, low marital quality can be associated with reduced childbearing. The second hypothesis states that couples who have marital conflict use childbearing as a strategy to reduce marital conflicts. Considering the importance of marital quality and its potential effects on couples’ childbearing behaviors, and given the contradictory results of the studies in this field, this study aims to determine the relationship between marital quality and the attitude towards fertility and childbearing in married women living in Kashan city, Iran.

Methods 
This cross-sectional study was conducted on 280 married women aged 15-49 referred to selected health centers in Kashan in 2021. In a multi-stage method, the women were selected using a continuous sampling method from 18 comprehensive health centers in four regions. The entry criteria were being Iranian, age 15-49 years, being literate, not having any contraindications for pregnancy, having no children, or having only one child. 
The data collection tools included a sociodemographic questionnaire, the revised dyadic adjustment scale (RDAS) for assessment of marital quality, and the attitudes toward fertility and childbearing scale (AFCS). They were completed through self-reporting in selected comprehensive health service centers after obtaining informed consent and providing explanations about the study objectives. 
The data was analyzed in SPSS software, version 16 using descriptive statistics (frequency, mean, and standard deviation) and inferential statistics (Pearson’s correlation test, t-test, analysis of variance, and Kruskal-Wallis test). P<0.05 was considered statistically significant. 

Results
The mean age of women was 29.97±6.48 years, and most of them were in the age group of 25-29 years; 38.9% had a high school diploma, and 63.6% were housewives. Most of women had a marriage age of 20-25 years and a marriage duration of 5-10 years. Also, 79.3% of women had one child, and the rest had no child. The mean age of husbands was 34±6.80 years, and most of them were in the age group of 30-34 years. Most of the husbands (39.6%) had high school diplomas and were self-employed (41.4%).
The mean score of AFCS was 71.64±15.33, and the mean score of RDAS was 50.52±10.94, both above average. The RDAS score and its domains showed a significant positive correlation with the AFCS score and its domains (P=0.001). There was a significant difference in the AFCS score based on the number of pregnancies (P=0.004), the number of children (P=0.006), and the employment status of women (P=0.025). The AFCS score was higher in women with one child than in those without a child. The AFCS score in women with no previous pregnancy was lower than in women with one pregnancy (P=0.003) and those with two or more pregnancies (P=0.007). Also, housewives had a higher AFCS score than employed women (P=0.022). 

Conclusion
Based on the results of this study, the increase in marital quality can increase the attitude towards childbearing and fertility in couples.  Women with one child have a more positive attitude towards having children and fertility than women without children. Also, women without previous pregnancy have less positive attitudes towards childbearing than women with a history of pregnancy. Housewives have a more positive attitude towards childbearing than employed women. 
The findings highlight the importance of marital adjustment in having a positive attitude towards childbearing. Therefore, policymakers should strengthen the necessary infrastructure to improve the quality of married life by providing support, such as free education and counseling, to families and employed couples and ensuring their financial and economic well-being.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Iran University of Medical Sciences (Code: IR.IUMS.REC.1400.345). All ethical principles were considered in this article. The participants were informed about the study objectives and methods. Before the study, written informed consent was obtained from them, and they were assured about the confidentiality of their information and were free to leave the study at any time.

Funding
This study was extracted from the master’s thesis of Narjes Nejatifar, funded by Iran University of Medical Sciences. 

Authors' contributions
Conceptualization, supervision, funding acquisition, and resources: Homa Sadeghi Avval Shahr; methodology: Homa Sadeghi Avval Shahr and Leila Amini; data collection, investigation, and writing original draft: Narjes Nejatifar and Zohreh Sadat; review & editing: All authors; data analysis: Shima Haghani.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank the Vice-Chancellor for Research and Technology of Iran University of Medical Sciences for the financial support and all the women participated in this study for their cooperation.
 

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