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BACKGROUND: One of the most important population challenges during the last three decades has been the significant decrease in the fertility rate worldwide. Since the validity and reliability of the Male and Female Fertility Knowledge Inventories (MFKI and FFKI) have not been determined in Iran, we conducted this study to assess psychometric characteristics of the MFKI and FFKI in couples in Tabriz and Urmia, Iran. METHODS: This was a cross-sectional study, as the first part (quantitative phase) of a sequential explanatory mixed-method study. The current study was done on 1200 participants (600 women with their husbands) living in the northwestern region of Iran, between January 2023 and September 2023. The psychometric properties of the Persian version of the tool (MFKI and FFKI) were performed in 5 stages, including translation process, content validity, face validity, construct validity and reliability assesment. RESULTS: In this study, the CVI, CVR, and impact scores of the MFKI tool were equal to 0.90, 0.88, 3.26 and CVI, CVR, and Impact scores of the FFKI tool were respectively equal to 0.95, 0.91 and 3.59, that it indicated a satisfactory level of content and face validity. Then, to check the construct validity, the results of the exploratory factor analysis of the MFKI tool on 13 items led to the identification of 3 factors, including Environment and reproductive health (ERH), Lifestyle factors (LSF) and Sperm quality (SQ), which explained 66% of the cumulative variance. The results of the exploratory factor analysis of the FFKI tool on 15 items led to the identification of 4 factors, including Reproductive health (RH), Lifestyle factors (LSF), Chance of conception (CHC) and Ovarian reserve and preservation (ORP), which explained 68% of the cumulative variance. CONCLUSIONS: The findings of this study indicated that the Persian version of MFKI and FFKI has acceptable psychometric properties to measure the awareness of Iranian couples regarding fertility, which can be used as a screening tool for fertility knowledge by health care professionals and also as a reliable tool in research.

The right to sexual and reproductive health (SRH) is considered one of the basic rights of couples all over the world. Increasing childbearing age is a global social issue. In spite of the policies of having children in the previous decade, fertility reduction and involuntary childlessness are still the foremost global health problems. The fertility rate in Iran has reduced significantly in the last thirty years. This reduction can be attributed not only to economic difficulties but also to the postponement of marriage and having children, as well as infertility issues, which, by increasing the awareness of couples about fertility, seems to be able to overcome this problem to some extent. Consequently, we decided to conduct this study with the aim of determining the psychometric properties of the Male and Female Fertility Knowledge Inventories (MFKI and FFKI) in Iranian couples. The results of the current study revealed that this questionnaire, having acceptable psychometric properties to evaluate the state of awareness of Iranian couples regarding fertility, can be used as a valid and reliable tool in Iranian couples. It appears that it is essential for health care providers to play an active role in advising couples about the appropriate age of fertility, the problems of delay in having children, overcoming the value of having few children in society. Accordingly, health policymakers should recommend the use of valid screening tools to identify the knowledge of women and men about fertility in health centers.

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People's fertility preferences are often considered an important determinant of fertility. What is often neglected in studies of preferred fertility, is the uncertainty that people may have about their preferences. In this study, using data on Dutch women through the Longitudinal Internet studies for the Social Sciences (collected early 2018), we examined women's fertility preferences and asked detailed questions about the certainty of these preferences. We also examined whether women agreed with their partner on preferred family size, and to what extent partner (dis)agreement shaped uncertainty. We show that Dutch women expressed much uncertainty about their fertility preferences, with only one-third feeling strongly about their preferences. Uncertainty strongly increased when women preferred higher numbers of children, whereas already having children reduced it. Women who wanted no children were most certain about their preference. Higher preferred family sizes also led to more disagreement with the partner about these preferences, and greater partner disagreement, in turn, led to more uncertainty. These findings imply that people are more likely to downgrade their fertility preferences than to increase them, as women are more certain about their preferences for lower numbers of children and are more open to family sizes below than above their preferred choice. Partner disagreement is often resolved by not having (more) children, lowering realised fertility. Hence, these findings provide another explanation for why many people have fewer children than desired.

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We interrogate the proposition that men's attitudes have constrained the fertility transition in Cameroon, where fertility remains high and contraceptive use low despite much socio-economic progress. We use five Demographic and Health Surveys to compare trends in desired family size among young women and men and analyse matched monogamous couple data from the two most recent surveys to examine wives' and husbands' desires to stop childbearing and their relative influence on current contraceptive use. In 2018, average desired family size was 5.6 and 5.1, for young men and women respectively, and this difference (half a child) has not changed since 1998. Among matched couples, the proportions wanting to stop childbearing were similar in wives and their husbands, but wives perceived husbands to be much more pronatalist than themselves. Surprisingly, men's own reported preferences were more closely associated with contraceptive use than wives' perceptions of husbands' preferences. We discerned little evidence that men's attitudes have impeded reproductive change.

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We study potential non-targeted effects of a large-scale national conditional cash transfer program-Peru's Juntos-on the fertility and reproductive decisions of adult beneficiaries. We use an event study design, exploiting time and geographic variation in the rollout of the program, to identify the causal effects of the program. We find that Juntos decreases the number of children that adult beneficiaries have and that these effects persist over time. We explore various mechanisms and find that Juntos does not affect fertility preferences but rather empowers women to avoid unwanted births. We provide evidence that this decrease is most likely due to better access to and more extensive use of modern birth control methods.

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The DRC has one of the highest fertility rates globally, yet research on fertility preferences in the country remains limited. This study aims to identify the factors contributing to the persistence of high fertility preferences among young and adolescent women (15-24) in the DRC. Using data from the 2013-2014 DHS, the study examines fertility preferences by transition stage. Multinomial logistic regression analysis is used to identify the characteristics associated with mid- (4-5 children) and pre-transitional (6+ children) as opposed to post-transitional (0-3 children) preferences. Results reveal that 43% of the women prefer 6+ children. The relative risk of fertility preference varies significantly based on characteristics such as age, literacy, place and province of residence, religion, employment status, wealth, acceptance of domestic violence, and knowledge of modern family planning methods. The findings provide evidence for both the diffusion and socio-economic theory of fertility decline.

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Intermarriage between immigrants and native individuals highlights the need to study childbearing as a joint decision of couples, because fertility preferences are likely to differ for the two partners involved. This study focuses on Sweden, where the majority population holds a relative preference for daughters but many immigrants come from countries with son preferences. Using longitudinal registers for the period 1990-2009, I analyse third-birth risks according to the sex composition of previous children and type of union. Doing so allows the study of preferences from behavioural data: couples with a daughter preference, for example, are more likely to have another child if their two previous children were boys. Results show that third-birth risks tend to be higher in unions between Swedish women and immigrant men, whereas unions between Swedish men and immigrant women tend to exhibit lower third-birth risks. Son preferences are rarely realized in intermarriages.

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Ideal family sizes remain at or above two in most low-fertility settings, but sub-replacement fertility ideals have been reported for urban China. The presence of restrictive family planning policies has led to a debate as to whether such ideals are genuine. This study exploits the ending of the one-child policy and the beginning of a universal two-child policy in October 2015 to investigate whether relaxing the restrictions led to an increase in ideal family size. We apply difference-in-differences and individual-level fixed-effect models to longitudinal data from a near-nationwide survey. For married individuals aged 20-39, relaxing the restrictions from one to two children increased the mean ideal family size by around 0.2 and the proportion who desired two or more children by around 19 percentage points. Findings suggest that although reported ideal family sizes have been reduced by policy restrictions, sub-replacement ideal family sizes in urban China appear to be genuine.

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Background: Understanding fertility preferences is important for population studies and planning programs. The ideal family size, which is the number of children wanted in one's lifetime, is one of variables used to measure fertility preferences. However, there was limited information on ideal family size decision in Southern Ethiopia. Therefore, this study was designed to assess ideal family size decision and its associated factors among women of reproductive age in Southern Ethiopia. Methods: A community based cross-sectional study was conducted in 2015 in Southern Ethiopia. Multi-stage stratified cluster sampling was used to select 3,205 study subjects. Data on socio-demographic characteristics, reproductive history, deciding ideal number of children, knowledge and utilization of contraceptives were considered. Descriptive statistics and binary logistic regression were done to describe and assess factors associated with deciding ideal family size. The association between variables was presented using odds ratios with 95% confidence intervals. Results: We included 3,205 women of reproductive age from which 37.5% respondents could not read and write and 56.5% were housewives. About half of the respondents, 47.1%, did not decide ideal numeric family size or failed to report numeric preferences while 21.6% desire to have five or more children. The mean ideal number of children preferred was 4.5 ± 1.62. Educational status (P < 0.001), overall knowledge about contraceptives (P < 0.001), current contraceptive use (P < 0.001), place of residence (P < 0.001), age (P < 0.004), marital status (P < 0.003) and number of living children (P < 0.003) were factors associated with deciding ideal family size. Conclusion: Only about half of respondents decided ideal family size from which one fifth prefer high fertility. The mean ideal number of children was comparable with that of Sub-Saharan estimate. Counselling that can empower women to decide family size should be strengthened to empower less empowered women.

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Research guided by demographic transition theory has shown that exposure to mortality influences women's fertility preferences and behaviours. Despite the myriad contexts, methodological approaches, and linkages featured in past studies, they have shared a focus on women, leaving questions on the gendered salience of mortality exposures for adults' fertility-related outcomes unanswered. In this research note, we analyse data from three African countries with distinct fertility profiles (Nigeria, Zambia, and Zimbabwe) to examine associations between sibling mortality exposure and ideal family size among women, men, and couples. We also investigate the stability of these associations over time. The associations between adults' sibling mortality exposure and their own and their spouses' ideal family sizes vary across countries. However, the gendered nature of the results in every country and evidence of cross-spousal effects uniformly demonstrate the need to incorporate sex differences into the study of the mortality-fertility link.

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Background: The COVID-19 pandemic had serious impact on the social, economic, psychological, and physical aspects of a large segment of the society, including women who were married or in stable relationships. Aim: To evaluate changes in the desire to become mothers among married women in Türkiye during the COVID-19 pandemic. Methods: This cross-sectional study used data from a self-administered questionnaire that examined the demographics and fertility preferences of 520 married Turkish women. We used the Fear of COVID-19 Scale (FCV-19S), Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) to measure fear, depression and anxiety related to COVID-19. We evaluated fertility preferences before and during the COVID-19 pandemic. Data analysis was conducted using SPSS version 11.5. Results: Fifty of 112 study participants who planned to get pregnant halted their plans because of the pandemic. In contrast, 21 of 408 study participants who did not plan a pregnancy decided to get pregnant during the pandemic to enhance their positive disposition and overcome loneliness, and because of the increased leisure time and intimacy with their spouses. Mean scores (standard deviation) for all participants for PHQ-9, GAD-7, and FCV-19S were 7.4 (6.02), 4.93 (4.84), and 17.28 (6.16), respectively. Conclusion: This study highlights the negative impact of the COVID-19 pandemic on women's fertility preferences in Türkiye due to uncertainty and anxiety. To confirm the results of this study, more research is needed to examine the longer-term impact and among a larger population.

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Background: Most women with multiple sclerosis (MS) have childbearing potential. Although fertility and pregnancy are not affected by MS, the fertility preferences of women with MS can change due to the risk of complications for the mother and/or adverse pregnancy outcomes resulting from the disease or its treatment. Objectives: To describe fertility preferences (FPs) and their associated factors, to estimate the Unmet Need for Family Planning (UNFP), use of contraceptives, and history of exposure to disease-modifying therapies (DMTs) during pregnancy in women with MS. Methods: In a cross-sectional observational study, a random sample of women with MS were surveyed with the FP subset of the Demographic and Health Survey of Colombia. Factors associated with FP were evaluated through bivariate and logistic regression analysis. The proportion of pregnancies exposed to DMTs, UNFP, and use of contraceptives was estimated. Results: Of the 141 women interviewed, 101 women had childbearing potential, of whom 49 did not want to have children, 38 were sterilized, 33 wanted to have more children, 19 were undecided, and 2 stated they were unable to bear children (menopause or hysterectomy). No MS-related variables were associated with the preference to have more children. Age (OR 0.91; 95% CI 0.84-0.98) and the number of children (OR 0.23; 95% CI 0.09-0.58) decreased the likelihood of desire for children. Of 116 sexually active women, 87.06 % (101) were using contraceptives, and among them, four were using fertility awareness methods and withdrawal. The UNFP was estimated at 6.03% and was not significantly different from the general population. Eighty-two pregnancies were identified, of which 48 occurred after diagnosis, and 25 were exposed to DMTs. Conclusion: Fertility preference in women with MS is not associated with clinical variables. A large proportion of women choose not to have children and prefer to use permanent contraceptive methods. Although the frequency of contraceptive use was high, some women have the UNFP and use low-efficacy contraceptive methods, which may result in unplanned pregnancies.

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BACKGROUND: Starting in October 2019, Lebanon experienced overlapping crises that caused a significant deterioration of the living conditions for Syrian refugees and the host community. Previous studies have shown that difficult living conditions and refugee status alone do not impact the fertility preferences of Syrian refugees. This study seeks to explore the effect of the overlapping crises on the fertility preferences and behaviour of Syrian refugees in Lebanon. METHODS: In this qualitative study, we carried out focus group discussions (FGDs) with married female Syrian refugees recruited purposively from two cities in West Bekaa (Bar Elias and Saad Nayel) and from inside and outside the Informal Tented Settlements (ITS). Transcripts were analysed using thematic analysis. RESULTS: The overlapping crises (political, economic, and Covid-19) in Lebanon influence Syrian refugee women's reported desire for fewer children. Two themes emerged that explained the change in Syrian refugees' fertility preferences towards limiting their number of children or delaying having children, and potentially a change in their fertility practices: the sudden deterioration in their living conditions triggered by the effect of inflation on their daily needs, and decreased support and changes in the job market that led to more women working to support their families. Consequently, refugees expressed a preference towards limiting their number of children due to concern about the consequences of the crisis on their children's physical and mental well-being. This was combined with decreased pressure on women from men and in-laws to have (additional) children and concern over the effect of Covid-19 on pregnant women. CONCLUSIONS: The sudden deterioration in living conditions due to the overlapping crises may have influenced Syrian refugees' preferences towards limiting their number of children or delaying having children until the situation improves. The potential shift in power dynamics in households caused by more women working outside the home also may have increased women's autonomy in making decisions regarding family size and use of modern contraception. These findings have implications for developing programs that focus on female livelihoods and engagement in work outside the home to influence family size and other reproductive health outcomes and gender equity indicators.

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Covert use of contraception is a common but underreported and understudied phenomenon where one partner uses contraception without the other's knowledge. We used Demographic and Health Survey couple data to examine the relationship between wives' perceptions of husbands' fertility preferences and type of contraceptive use (overt vs. covert) in Benin, Ethiopia, Kenya, Mali, Nigeria, Sierra Leone, Uganda, and Zambia using logistic regression. Wives who perceived that their husbands wanted more children than them had increased odds of using covertly, compared to those who perceived that husbands wanted the same number of children in all countries except Benin, and the strength of the relationships ranged from adjusted odds ratio (aOR) 2.89 (95 percent confidence interval (CI) 1.75-4.76) in Zambia to aOR 4.01 (95 percent CI 1.68-9.58) in Mali. Wives who reported not knowing their husbands' fertility preferences had increased odds of using covertly compared to wives who perceived that their husbands wanted the same number of children in all countries except Zambia, ranging from aOR 2.02 (95 percent CI 1.11-3.69) in Ethiopia to aOR 3.82 (95 percent CI 2.29-6.37) in Kenya. Our findings indicate that efforts to increase partner engagement to align couple's fertility preferences may encourage overt use.

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Fertility preferences have long played a key role in models of fertility differentials and change. We examine the stability of preferences over time using rich panel data on Kenyan women's fertility desires, expectations, actual fertility, and recall of desires in three waves over a nine-year period, when respondents were in their 20s. We find that although desired fertility is quite unstable, most women perceive their desires to be stable. Under hypothetical future scenarios, few expect their desired fertility to increase over time but, in fact, such increases in fertility desires are common. Moreover, when asked to recall past desires, most respondents report previously wanting exactly as many children as they desire today. These patterns of bias are consistent with the emerging view that fertility desires are contextual, emotionally laden, and structured by identity.

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The movement of people across international boundaries have been recognized as having serious implication for life-style that migrants experience and manifest after returning from sojourning. This was a qualitative survey of female Nigerian international migrants and their fertility preferences and outcomes. The study explored how the role of length of stay abroad affected their fertility preferences, age at migration and fertility preferences and outcomes and the effect of culture on fertility preferences and outcomes. Results indicated that the length of stay created a change in the migrant's fertility preferences adopting the fertility regime of the country they migrated to. Age at migration was also recognized as playing a significant role in changing the fertility preferences and outcomes of migrants. It is therefore pertinent to note that migration plays a dominant role in changing the fertility preferences of migrants.

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The last four decades have witnessed large declines in fertility globally. This study uses data from 78 low- and middle-income countries to examine concurrent trends in unwanted fertility. Three measures of unwanted fertility are contrasted: the conventional unwanted total fertility rate, a proposed conditional unwanted fertility rate, and the percentage of births unwanted. Incidence of unwanted births and prevalence of exposure to unwanted births are both derived from answers to questions on prospective fertility preference, recognized as the most valid and reliable survey measure of preferences. Country-level trends are modeled both historically and with the decline in total fertility, with a focus on regional differentials. Results show that unwanted fertility rates-especially the conditional unwanted fertility rate-have declined substantially in recent decades. By contrast, the percentage of births unwanted has declined less, remaining stable or even increasing: from a birth cohort perspective, declines in unwanted fertility have been far more modest than the increased parental success in avoiding unwanted births. The regional patterns suggest that sub-Saharan Africa has several similarities with other major regions but also some peculiar features, including a recent stall in the decline of unwanted fertility that persists after controlling for the stage of fertility transition.

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Internal migration's effect on family planning behavior depends upon migration circumstances. While many studies describe instability and displacement's effect on family planning access, fewer studies consider the positive association between internal migration and family planning behavior. Using Performance Monitoring for Action (PMA) survey data, we examine the relationship between internal migration and unmet need for family planning in Ethiopia from 2017-2018. We describe determinants of family planning behavior by migrant status and model migration's effect on unmet need for family planning using multilevel logistic regression. Internal migrants studied tend to be more educated and wealthier and have less unmet need than non-migrants, likely due to different fertility preferences and human capital. This contributes to existing research by illustrating how rural-urban migration in Ethiopia relates to family planning behaviour. Findings will be of interest to social scientists and policymakers evaluating family planning resource allocation to reduce unmet need in African contexts.

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Although many studies have examined the influence of women's fertility preferences on subsequent fertility behavior and the role of contraceptive use intentions on unmet need, very few have explored their concurrent effects on contraceptive use dynamics. This study examines the independent concurrent effects of women's fertility preferences and contraceptive intentions on subsequent adoption and discontinuation, treating pregnancy as a competing risk factor that may alter contraceptive need. The data are derived from a 2018 follow-up survey of a 2014 national sample of 3,800 Ugandan female respondents of childbearing age. The survey included a contraceptive calendar that recorded pregnancy, birth, and contraceptive event episodes, including reasons for discontinuation. We use competing risk regression to estimate the effect of fertility preferences and contraceptive intentions on the cumulative incidence function of contraceptive behaviors, accounting for intervening pregnancy, female background covariates, loss to follow-up, and complex survey design. We find that women's contraceptive intentions significantly increase the rate of contraceptive adoption. After having adopted, women's contraceptive intentions have been realized and do not prolong use. The risk of discontinuation among women who adopted after baseline was significantly higher than for those using at baseline, irrespective of their initial intentions. The effectiveness of the type of contraceptive method chosen significantly lowered discontinuation risk. Fertility preferences were not significantly associated with either time to adoption or discontinuation. The pace of the fertility transition in this sub-Saharan African setting is likely being shaped by reproductive regulation through the intentional use of contraception that enables spacing births.

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OBJECTIVE: We analyze fertility preferences among women at risk of pregnancy with children ages five or younger as a function of two food security metrics: perceptions of household hunger and child stunting (height for age z scores ≤ -2.0) in order to convey a robust picture of food insecurity. METHODS: We use data from the 2016 Tanzania Demographic and Health Surveys to analyze this research question. Multinomial generalized logit models with cluster-adjusted standard errors are used to determine the association between different dimensions of food insecurity and individual-level fertility preferences. RESULTS: On average, women who experience household hunger are 19% less likely to want more children compared to women who do not experience household hunger (AOR: 0.81, p = 0.02) when controlling for education, residence, maternal age, number of living children, and survey month. Adjusting for the same covariates, having at least one child ≤ 5 years old who is stunted is associated with 13% reduced odds of wanting more children compared to having no children stunted (AOR: 0.87, p = 0.06). CONCLUSIONS FOR PRACTICE: In the context of a divided literature base, this research aligns with the previous work identifying a preference among women to delay or avoid pregnancy during times of food insecurity. The similarity in magnitude and direction of the association between food insecurity and fertility preferences across the two measures of food insecurity suggest a potential association between lived or perceived resource insecurity and fertility aspirations. Further research is needed in order to establish a mechanism through which food insecurity affects fertility preferences. SIGNIFICANCE STATEMENT: Individual fertility preferences are sensitive to dynamic multi-level factors in a woman's life. While qualitative research has explored the effect that food insecurity and associated resource constraints have on fertility preferences, results are conflicting. Here, we quantitatively examine how individual woman's fertility preferences associate with two measures of food insecurity and qualitatively compare the associations across food insecurity measures. We establish that two food insecurity measures- household hunger and child stunting- capture similar populations and have similar associations with fertility preferences. This is a critical step forward in understanding the dynamic relationship between resource availability, child well-being, and fertility preferences.

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Despite demographers' long-standing preoccupation with the effects of child mortality on women's fertility desires, scholars continue to know little about the consequences of other pervasive mortality exposures. We use nationally representative data from the high-mortality context of Peru to examine whether the desire to have a(nother) child varies as a function of sibling loss and to assess heterogeneity in this association by women's current number of children and a range of conditions related to siblings' deaths. Women who have experienced sibling bereavement and have two or more children report higher odds of desiring another child. These effects are not contingent on the age or sex of the deceased sibling but are only significant if the sibling died during the respondent's lifetime (not before). These findings highlight the theoretical and empirical import of investigating the relationship between fertility desires and a wider range of familial mortality exposures beyond own child mortality.

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