Determinants of Childbearing: Behavioral Change Models and Theories: A Systematic Review
-
Tayebeh Mokhtari Sorkhani
,
Mahshid Bokaie
,
Farzan Madadizadeh
,
Manoj Sharma
,
Bendaoud Nadif
,
Seyed Saeed Mazloomy Mahmoodabad
Abstract
The decline in total fertility rate (TFR) below replacement levels has significant implications for public health. This comprehensive narrative review aimed to examine behavioral change models and theories pertinent to childbearing decisions. Articles published between 1977 and 2024 were retrieved from from domestic databases (Magiran, SID) and international databases (Web of Science, Scopus, ProQuest, PubMed, MEDLINE), as well as Google Scholar using relevant keywords. Out of 90 articles initially identified, 36 met the inclusion criteria and were selected for analysis. Existing behavioral change models in health education have limitations in motivating couples to increase childbearing. These models do not fully address complex and multifaceted factors such as socio-economic and cultural influences. Furthermore, there is a need for more rigorous and comprehensive evaluations of the effectiveness of interventions based on these models. Evidence-based educational programs, tailored incentive policies, and rigorous model evaluation are essential to promote positive attitudes towards parenthood. Future interventions should assess the applicability of novel theories to optimize fertility program outcomes, with a particular focus on the role of public health. Further research is needed to investigate innovative models for explaining and changing childbearing behaviors.
1. Khani S, Mohammadzade H, Abbasi-Shavazi MJ (2019). The intergenerational comparison of marriage and childbearing ideals with emphasis on background characteristics in Sanandaj district. Social Problems of Iran, 9 (2):49-76.
2. Amar (2024). https://amar.org.ir/
3. Nejati M, Shakibaei A, Gholami M (2023). Investigating the Relationship between Population Structure and Poverty. refahj, 22 (87):35-72.
4. Bagi M, Sadeghi R, Hatami A (2022). Fertility intentions in Iran: Determinants and limitations. Strategic Studies of Culture, 1 (4):59-80.
5. Delavari S ZH, Rezaei S, Moradinazar M, et al (2016). Life expectancy and its socioeconomic determinants in Iran. Electronic Physician, 8 (10):3062-3068.
6. Sørensen NO, Marcussen S, Backhausen MG, et al (2016). Fertility awareness and attitudes towards parenthood among Danish university college students. Reprod Health, 13 (1):146.
7. Schytt E, Nilsen A, Bernhardt E (2014). Still childless at the age of 28 to 40 years: A cross-sectional study of Swedish women’s and men’s reproductive intentions. Sex Reprod Healthc, 5 (1):23-9.
8. Mahmoudzadeh H, Aghayari Hir T, Hatami D (2022). Study and Analysis of the Elderly Population of the Iran. GeoRes, 37 (1):111-125.
9. Alami A, Esmailzade M, Esmaeili R, et al (2020). Effectiveness of an educational intervention based on the theory of planned behavior on fertility intention of single-child women: A field trial study. Internal Medicine Today, 26 (3):212-227.
10. Kashefi F, Bakhtiari A, Pasha H, et al (2021). Student attitudes about reproductive health in public universities: a cross-sectional study. Int Q Community Health Educ, 41 (2):133-142.
11. 11. Ansari Majd M, Khalajabadi Farahani F, et al (2019). Effect of transtheoretical model-based education on women attitudes and stages of change toward childbearing behavior. J Mazandaran Univ Med Sci, 29 (174):134-147.
12. Kavas S, De Jong J (2020). Exploring the mechanisms through which social ties affect fertility decisions in Turkey. J Marriage Fam, 82 (4):1250-1269.
13. Bandura A (1977). Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev, 84 (2):191-215.
14. Chen M-F, Wang R-H, Hung S-L (2015). Predicting health-promoting self-care behaviors in people with pre-diabetes by applying Bandura social learning theory. Appl Nurs Res, 28 (4):299-304.
15. Skakkebæk NE, Lindahl-Jacobsen R, Levine H, et al (2022). Environmental factors in declining human fertility. Nat Rev Endocrinol, 18 (3):139-157.
16. Rahmati R, Khadivzadeh T, Esmaily H, et al (2017). Evaluation of the performance of the health care workers in giving consultation about the fertility promotion. Journal of Midwifery and Reproductive Health, 5 (2):911-918.
17. Ranjbar F, Shirzad M, Kamali K, et al (2015). Fertility behaviour of Iranian women: a community-based, cross-sectional study. Arch Iran Med, 18 (1): 2–5.
18. Bäckström C LT, Thorstensson S (2021). How partners of pregnant women use their social networks when preparing for childbirth and parenthood: a qualitative study. Nord J Nurs Res, 41 (1):25-33.
19. Horwood C, Hinton R, Haskins L, et al (2021). ‘I can no longer do my work like how I used to’: a mixed methods longitudinal cohort study exploring how informal working mothers balance the requirements of livelihood and safe childcare in South Africa. BMC Womens Health, 21(1):288.
20. Gonzalez C, Morawska A, Haslam DM (2021). A model of intention to participate in parenting interventions: The role of parent cognitions and behaviors. Behav Ther, 52 (3):761-773.
21. Abbasi-Shavazi MJ, Dorahaki A (2018). The Effect of Social Networking Mechanisms on Fertility Intention of Women in Urban Areas of Bushehr Province. Population Policy Research, 4 (1):1-39.
22. Becker G (1981). A Treatise on the Family, Cambridge, MA: Harvard University Press.
23. Schwank SE, Gu C, Cao Z, et al (2018). China’s child policy shift and its impact on Shanghai and Hangzhou women’s decision-making. Int J Womens Health,10:639-648.
24. Tavares LP (2016). Who delays childbearing? The associations between time to first birth, personality traits and education. Eur J Popul, 32(4):575-597.
25. Martin LJ (2021). Delaying, debating and declining motherhood. Cult Health Sex, 23 (8):1034-1049.
26. Brauner-Otto SR, Geist C (2018). Uncertainty, doubts, and delays: Economic circumstances and childbearing expectations among emerging adults. J Fam Econ Issues, 39:88-102.
27. De la Croix D, Pommeret A (2021). Childbearing postponement, its option value, and the biological clock. Journal of Economic Theory, 193:105231.
28. Horii M (2019). Historicizing the category of “religion” in sociological theories: Max Weber and Emile Durkheim. Critical Research on Religion, 7 (1):24-37.
29. Mohammadi M, Rastergarkhaled A (2015). Cultural changes, and reduce fertility in Iran (Based on second analyze of data of Iranianâ s survey values and attitudes). Journal of Applied Sociology, 26 (2):159-180.
30. Rindfuss RR, Choe MK, Brauner-Otto SR (2016). The emergence of two distinct fertility regimes in economically advanced countries. Popul Res Policy Rev, 35(3):287-304.
31. Allendorf K (2015). Fertility decline, gender composition of families, and expectations of old age support. Popul Res Policy Rev, 34 (4):511-539.
32. Hammarberg K, Collins V, Holden C, et al (2017). Men's knowledge, attitudes and behaviours relating to fertility. Hum Reprod Update, 23 (4):458-480.
33. Chalabi M (2015). Sociology of order: description and theoretical analysis of social order. ed. Ney Tehran.
34. Bhatta DC (2023). Woman in Beauvoir's Concept: A Feminist Reading. DMC Research Journal, 5(01):1-7.
35. Shabot SC (2021). On motherhood as ambiguity and transcendence: reevaluating motherhood through the Beauvoirian erotic. Comparative and Continental Philosophy, 13(3):207-19.
36. Oliveira SC, de Faria ER, Sarriera JC, et al (2011). Maternidade e trabalho: Uma revisão da literatura. Revista Interamericana de Psicología/Interamerican Journal of Psychology, 45(2):271-280.
37. Thornton A (2001). The developmental paradigm, reading history sideways, and family change. Demography, 38(4):449–65.
38. Abbasi-Shavazi MJ, Askari-Nodoushan A (2012). Family life and developmental idealism in Yazd, Iran. Demogr Res, 26:207-238.
39. Hoseini Soorand A, Miri MR, Sharifzadeh G (2015). Effect of curriculum based on theory of planned behavior, on components of theory in patients with hypertension. J Birjand Univ Med Sci, 22 (3):199-208.
40. Gorman JR, Drizin JH, Mersereau JE, et al (2019). Applying behavioral theory to understand fertility consultation uptake after cancer. Psychooncology, 28 (4):822-829.
41. kgalajabadi farahani F, saraei H (2016). Exploration of underlying factors for single child intention and behavior in Tehran; a Qualitative Study. Women's Strategic Studies, 18 (71):29-58.
42. Zhang C, Yang AZ, won Kim S, et al (2021). How Chinese newlyweds’ experiences as singletons or siblings affect their fertility desires. The China Quarterly, 247:835-854.
43. Ghaffari F, Motaghi Z (2021). Factors affecting childbearing based on women's perspectives: A Qualitative Study. Navid No, 23 (76):33-43.
44. Vahdani FG, Shariat M, Mohammadzadeh Y, et al (2017). Fertility style and its determinants in Iran and Islamic countries: a review study. Medical History, 9 (31):63-74.
45. Bein C, Gauthier AH, Mynarska M (2021). Religiosity and fertility intentions: can the gender regime explain cross-country differences? Eur J Popul, 37 (2):443-472.
46. Ahmadzadeh Tori N, Sharif-Nia H, Ghaffari F, et al (2023). Effective factors on voluntary childlessness and one-child tendency from couples' perspective: Compulsory childlessness or child-avoidance? Caspian J Intern Med, 14 (4):656-667.
47. Aassve A, Mazzuco S, Mencarini L (2005). Childbearing and well-being: a comparative analysis of European welfare regimes. J Eur Soc Policy, 15 (4):283-299.
48. Gietel-Basten SA, Rotkirch A, Sobotka T (2022). Changing the perspective on low birth rates: why simplistic solutions won’t work. BMJ, 379:e072670.
49. Bashirian S, Barati M, Sharma M, et al (2019). Water pipe smoking reduction in the male adolescent students: An educational intervention using multi-theory model. J Res Health Sci, 19 (1):e00438.
50. Mousali A, Moradveisi L, Barati M, et al (2020). Male addicts’ experiences on predictors of relapse to drug use: a directed qualitative content analysis. The Turkish Journal on Addictions, 7 (3):166-173.
51. Bashirian S, Barati M, Sharma M, et al (2019). Predicting to reduce water pipe smoking in male adolescents: using multi theory model (MTM). J Subst Use, 25 (1):50-55.
2. Amar (2024). https://amar.org.ir/
3. Nejati M, Shakibaei A, Gholami M (2023). Investigating the Relationship between Population Structure and Poverty. refahj, 22 (87):35-72.
4. Bagi M, Sadeghi R, Hatami A (2022). Fertility intentions in Iran: Determinants and limitations. Strategic Studies of Culture, 1 (4):59-80.
5. Delavari S ZH, Rezaei S, Moradinazar M, et al (2016). Life expectancy and its socioeconomic determinants in Iran. Electronic Physician, 8 (10):3062-3068.
6. Sørensen NO, Marcussen S, Backhausen MG, et al (2016). Fertility awareness and attitudes towards parenthood among Danish university college students. Reprod Health, 13 (1):146.
7. Schytt E, Nilsen A, Bernhardt E (2014). Still childless at the age of 28 to 40 years: A cross-sectional study of Swedish women’s and men’s reproductive intentions. Sex Reprod Healthc, 5 (1):23-9.
8. Mahmoudzadeh H, Aghayari Hir T, Hatami D (2022). Study and Analysis of the Elderly Population of the Iran. GeoRes, 37 (1):111-125.
9. Alami A, Esmailzade M, Esmaeili R, et al (2020). Effectiveness of an educational intervention based on the theory of planned behavior on fertility intention of single-child women: A field trial study. Internal Medicine Today, 26 (3):212-227.
10. Kashefi F, Bakhtiari A, Pasha H, et al (2021). Student attitudes about reproductive health in public universities: a cross-sectional study. Int Q Community Health Educ, 41 (2):133-142.
11. 11. Ansari Majd M, Khalajabadi Farahani F, et al (2019). Effect of transtheoretical model-based education on women attitudes and stages of change toward childbearing behavior. J Mazandaran Univ Med Sci, 29 (174):134-147.
12. Kavas S, De Jong J (2020). Exploring the mechanisms through which social ties affect fertility decisions in Turkey. J Marriage Fam, 82 (4):1250-1269.
13. Bandura A (1977). Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev, 84 (2):191-215.
14. Chen M-F, Wang R-H, Hung S-L (2015). Predicting health-promoting self-care behaviors in people with pre-diabetes by applying Bandura social learning theory. Appl Nurs Res, 28 (4):299-304.
15. Skakkebæk NE, Lindahl-Jacobsen R, Levine H, et al (2022). Environmental factors in declining human fertility. Nat Rev Endocrinol, 18 (3):139-157.
16. Rahmati R, Khadivzadeh T, Esmaily H, et al (2017). Evaluation of the performance of the health care workers in giving consultation about the fertility promotion. Journal of Midwifery and Reproductive Health, 5 (2):911-918.
17. Ranjbar F, Shirzad M, Kamali K, et al (2015). Fertility behaviour of Iranian women: a community-based, cross-sectional study. Arch Iran Med, 18 (1): 2–5.
18. Bäckström C LT, Thorstensson S (2021). How partners of pregnant women use their social networks when preparing for childbirth and parenthood: a qualitative study. Nord J Nurs Res, 41 (1):25-33.
19. Horwood C, Hinton R, Haskins L, et al (2021). ‘I can no longer do my work like how I used to’: a mixed methods longitudinal cohort study exploring how informal working mothers balance the requirements of livelihood and safe childcare in South Africa. BMC Womens Health, 21(1):288.
20. Gonzalez C, Morawska A, Haslam DM (2021). A model of intention to participate in parenting interventions: The role of parent cognitions and behaviors. Behav Ther, 52 (3):761-773.
21. Abbasi-Shavazi MJ, Dorahaki A (2018). The Effect of Social Networking Mechanisms on Fertility Intention of Women in Urban Areas of Bushehr Province. Population Policy Research, 4 (1):1-39.
22. Becker G (1981). A Treatise on the Family, Cambridge, MA: Harvard University Press.
23. Schwank SE, Gu C, Cao Z, et al (2018). China’s child policy shift and its impact on Shanghai and Hangzhou women’s decision-making. Int J Womens Health,10:639-648.
24. Tavares LP (2016). Who delays childbearing? The associations between time to first birth, personality traits and education. Eur J Popul, 32(4):575-597.
25. Martin LJ (2021). Delaying, debating and declining motherhood. Cult Health Sex, 23 (8):1034-1049.
26. Brauner-Otto SR, Geist C (2018). Uncertainty, doubts, and delays: Economic circumstances and childbearing expectations among emerging adults. J Fam Econ Issues, 39:88-102.
27. De la Croix D, Pommeret A (2021). Childbearing postponement, its option value, and the biological clock. Journal of Economic Theory, 193:105231.
28. Horii M (2019). Historicizing the category of “religion” in sociological theories: Max Weber and Emile Durkheim. Critical Research on Religion, 7 (1):24-37.
29. Mohammadi M, Rastergarkhaled A (2015). Cultural changes, and reduce fertility in Iran (Based on second analyze of data of Iranianâ s survey values and attitudes). Journal of Applied Sociology, 26 (2):159-180.
30. Rindfuss RR, Choe MK, Brauner-Otto SR (2016). The emergence of two distinct fertility regimes in economically advanced countries. Popul Res Policy Rev, 35(3):287-304.
31. Allendorf K (2015). Fertility decline, gender composition of families, and expectations of old age support. Popul Res Policy Rev, 34 (4):511-539.
32. Hammarberg K, Collins V, Holden C, et al (2017). Men's knowledge, attitudes and behaviours relating to fertility. Hum Reprod Update, 23 (4):458-480.
33. Chalabi M (2015). Sociology of order: description and theoretical analysis of social order. ed. Ney Tehran.
34. Bhatta DC (2023). Woman in Beauvoir's Concept: A Feminist Reading. DMC Research Journal, 5(01):1-7.
35. Shabot SC (2021). On motherhood as ambiguity and transcendence: reevaluating motherhood through the Beauvoirian erotic. Comparative and Continental Philosophy, 13(3):207-19.
36. Oliveira SC, de Faria ER, Sarriera JC, et al (2011). Maternidade e trabalho: Uma revisão da literatura. Revista Interamericana de Psicología/Interamerican Journal of Psychology, 45(2):271-280.
37. Thornton A (2001). The developmental paradigm, reading history sideways, and family change. Demography, 38(4):449–65.
38. Abbasi-Shavazi MJ, Askari-Nodoushan A (2012). Family life and developmental idealism in Yazd, Iran. Demogr Res, 26:207-238.
39. Hoseini Soorand A, Miri MR, Sharifzadeh G (2015). Effect of curriculum based on theory of planned behavior, on components of theory in patients with hypertension. J Birjand Univ Med Sci, 22 (3):199-208.
40. Gorman JR, Drizin JH, Mersereau JE, et al (2019). Applying behavioral theory to understand fertility consultation uptake after cancer. Psychooncology, 28 (4):822-829.
41. kgalajabadi farahani F, saraei H (2016). Exploration of underlying factors for single child intention and behavior in Tehran; a Qualitative Study. Women's Strategic Studies, 18 (71):29-58.
42. Zhang C, Yang AZ, won Kim S, et al (2021). How Chinese newlyweds’ experiences as singletons or siblings affect their fertility desires. The China Quarterly, 247:835-854.
43. Ghaffari F, Motaghi Z (2021). Factors affecting childbearing based on women's perspectives: A Qualitative Study. Navid No, 23 (76):33-43.
44. Vahdani FG, Shariat M, Mohammadzadeh Y, et al (2017). Fertility style and its determinants in Iran and Islamic countries: a review study. Medical History, 9 (31):63-74.
45. Bein C, Gauthier AH, Mynarska M (2021). Religiosity and fertility intentions: can the gender regime explain cross-country differences? Eur J Popul, 37 (2):443-472.
46. Ahmadzadeh Tori N, Sharif-Nia H, Ghaffari F, et al (2023). Effective factors on voluntary childlessness and one-child tendency from couples' perspective: Compulsory childlessness or child-avoidance? Caspian J Intern Med, 14 (4):656-667.
47. Aassve A, Mazzuco S, Mencarini L (2005). Childbearing and well-being: a comparative analysis of European welfare regimes. J Eur Soc Policy, 15 (4):283-299.
48. Gietel-Basten SA, Rotkirch A, Sobotka T (2022). Changing the perspective on low birth rates: why simplistic solutions won’t work. BMJ, 379:e072670.
49. Bashirian S, Barati M, Sharma M, et al (2019). Water pipe smoking reduction in the male adolescent students: An educational intervention using multi-theory model. J Res Health Sci, 19 (1):e00438.
50. Mousali A, Moradveisi L, Barati M, et al (2020). Male addicts’ experiences on predictors of relapse to drug use: a directed qualitative content analysis. The Turkish Journal on Addictions, 7 (3):166-173.
51. Bashirian S, Barati M, Sharma M, et al (2019). Predicting to reduce water pipe smoking in male adolescents: using multi theory model (MTM). J Subst Use, 25 (1):50-55.
| Files | ||
| Issue | Vol 54 No 8 (2025) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v54i8.19578 | |
| Keywords | ||
| Behavior change models Behavioral theories Childbearing Health education Health promotion | ||
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How to Cite
1.
Mokhtari Sorkhani T, Bokaie M, Madadizadeh F, Sharma M, Nadif B, Mazloomy Mahmoodabad SS. Determinants of Childbearing: Behavioral Change Models and Theories: A Systematic Review. Iran J Public Health. 2025;54(8):1689-1700.
