Population is one of the complex multidimensional issues of human societies, affected by economic, social, cultural, and political factors (1). Among the various factors, fertility, migration, and mortality as important indicators of population dynamics, exert the greatest impact on the size and structure of the population (2). Iran is one of the countries experiencing a sharp decline in fertility. Censuses and statistics are all indicative of a decline in the total fertility rate from 6.2 children per woman in 1986 to 2.5 in 1996, 1.1 in 2006, and 1.8 in 2011 (3, 4). The current total fertility rate of Iran is 1.9-2.1 births per woman, which is close to the replacement level fertility (i.e., 2.1 births per woman) (5).
A 50% reduction in fertility has not only made Iran unique among the Muslim countries, but also reached a record that cannot be seen anywhere else (6). A falling fertility rate will lead to population aging, followed by reduced workforce and compromised health level (7). Several demographic studies have indicated
the relationship between fertility rate and economic, social, and cultural factors (8). For instance, the results of a study (2010) performed in Nepal introduces age, education, occupation, income, and location as factors affecting the fertility rate (9).
In a cross-sectional study performed by Hezarjarib et al. (2010) in Tabriz, Iran, the fertility rate was reported to show a direct relationship with the infant death experience. This variable was also inversely associated with income, education level, and feeling of having ideal children (10). However, in a study conducted by Abidi et al. (2012) on a Kurdish tribe in Iran, fertility rate demonstrated no significant correlation with family income and employment status (11).
Another variable that could reportedly explain changes in fertility is religiosity (12). Religious beliefs may affect fertility through affecting the marriage age, family size, and number of children (13). The Islamic and Quranic Verses encourage a timely marriage and emphasize the importance of reproduction (14). Heyford (2008) showed that in the US, the women believing that religion is very important in everyday life had a higher actual fertility
rate and tendency to have children than
those considering religion as unimportant or relatively important. They also reported that the women with high religiosity had more traditional attitudes about gender role and family, which result in the enhancement of the fertility rate (15).
Khadivzadeh et al. (2014) also found a significant relationship between religious beliefs and fertility preferences among married couples in Mashhad, Iran (17). On the contrary, the results obtained by Branas-Garza (2007) in Spain and Italy indicated no significant relationship between religiosity and number of children (16).
Limited studies have examined fertility rate and its relationship with socioeconomic factors and level of religious beliefs in Iran. Cultural backgrounds and national and regional policies that may affect fertility differ across societies. With this background in mind, the present study aimed to determine the relationship of fertility rate with demographic, socioeconomic, and religious factors among childbearing women in a city in Eastern Iran.
Materials and Methods
This cross-sectional descriptive study was performed on 254 women of reproductive age (i.e., age range of 15-45 years) referring to the urban health centers of Torbat Heydariyeh, Khorasan Razavi Province, Iran, from February to May 2016. In each of the health care centers, sampling was carried out using convenience sampling method in proportion to the number of the population under coverage. All the women included in the study were Muslims, Iranian, Persian-speaking, and residents of Torbat Heydariyeh and had a minimum of reading and writing literacy. Additionally, they were the biological mother of their children, and all their children were from their present marriage. Pregnant and infertile women
and those with physically- or mentally-handicapped children were excluded from the study.
Data collection tools included a demographic form and the Religiosity Scale developed by Khodayari Fard. Fertility rate (i.e., children ever born alive [CEB] up to the survey date) was considered as the dependent variable. On the other hand, demographic, socioeconomic, and cultural variables that were considered as independent variables included age, education level, occupation status (of both spouses), income level, age at marriage, and child loss experience.
The examination of religiosity was performed using the Religiosity Scale developed by Khodayari Fard. This scale entails 40 items in three subscales, namely religious belief, religious emotions, and religious behavior. These items are rated on a 5-point Likert scale ranging from never (0) to always (5). High scores in each of the subscales signify higher religiosity. The validity of this scale has
been evaluated and confirmed by Khodayari, reporting a Cronbach’s alpha coefficient of 0.89 (18). In the present study, the reliability of
this tool was confirmed using the internal consistency method and Cronbach's alpha coefficient on 20 participants (α=0.8).
The study protocol was approved by the institutional review board of Torbat Heydariyeh University of Medical Sciences (IRB no. IR.THUMS.REC.1394.2). In line with research ethics principles, the participants were informed about the study objectives, and their oral and written informed consent was obtained.
Data analysis was performed in SPSS statistical software (version 16) using descriptive statistics, as well as Kruskal-Wallis, Mann-Whitney U, and Spearman correlation tests. The linear regression was used to determine the role of each variable in predicting the fertility rate.
P-value less than 0.05 was considered statistically significant.
Based on the results of the study, the mean numbers of children ever born per participant was 1.85±0.99 (range: 0-6). Furthermore, the mean number of girls and boys were 1.02±0.77 and 1.10±0.75, respectively. The participants had the mean age of 30.94±6.62 years with the mean marriage duration of 11.55±7.46 years.
In addition, most of the participants were housewives (79.6%), and 40.12% of them had academic education (Table 1).
According to the results of the study, fertility rate showed no significant relationship with employment status, spousal employment status, income level, and child loss experience (P>0.05). However, the relationship between education level and fertility rate was statistically significant (P=0.001) (Table 2). According to the results of the Spearman's correlation test, fertility rate was directly correlated with age (r=0.630, P=0.001), spousal age (r=0.675, P=0.001), and marriage duration (r=0.722, P=0.001). Additionally, this variable had an indirect relationship with age at marriage (r=-0.316, P=0.001).
Based on the descriptive statistics, the mean total score of religiosity was 141.27±20.43 (range: 72-208). Considering the dimensions of religiosity, the mean scores of religious belief, religious emotions, and religious behavior were obtained as 51.29±9.58, 45.78±6.14, and 44.19±7.83, respectively. The results of the Spearman correlation test demonstrated a significant correlation between the mean total score of religiosity and participants’ fertility rate (P=0.009). Additionally, the rate of fertility was significantly correlated with the three religiosity subscales, namely religious emotions (P=0.005), religious behavior (P=0.022), and religious belief (P=0.039) (Table 3).
In order to assess the impact of each independent variable on fertility rate prediction, the linear regression analysis was applied. All variables that were significantly associated with the fertility rate were entered into the regression model. The obtained positive regression coefficient indicated that higher participants’ age and spousal age were associated with higher fertility rate. Furthermore, age at marriage was found to have a significantly negative influence on fertility rate. Furthermore, education level significantly affected this variable. However, the influence of religiosity on the fertility rate was not detected. Generally, these variables could predict 54% of the fertility rate variance (P<0.05) (Table 4).
The aim of this study was to examine the relationship of demographic, socioeconomic, and religious factors with fertility rate among childbearing women in Torbat Heydariyeh, a city in the east of Iran. The results revealed a direct relationship between age and fertility rate. The increased number of children along with aging seems to be reasonable and is in line with the previous studies (19, 20).
Our findings were also indicative of an indirect relationship between age at marriage and fertility rate. Age at marriage and duration of marriage are important factors that can affect fertility rate in two aspects. On the one hand, a higher marriage age is associated with a decline in fertility period, which provides the couple with fewer childbearing opportunities. Furthermore, with the enhancement of age
at marriage, couples would obtain more awareness and experience regarding the contraceptive methods; as a result, they would have more control over their reproductive behavior (21).
These results are consistent with those reported by several national and international studies (11, 19-20, 22). For example, Mobasheri (2013) reported that fertility rate was significantly associated with age, age at marriage, and duration of marriage in women (19). Therefore, rising age at marriage in Iran in recent years could likely justify the reduction of fertility rate.
Similarly, the results of a number of other studies showed an indirect relationship between women's education and their fertility rate (18, 20). Since educated women are usually more aware of family planning methods and advantages and disadvantages of childbearing, they have autonomy and more power in reproduction decision-making; accordingly, they experience a lower fertility rate (23). In addition, most of the educated women work outside, are less present at home, and have concerns about issues related to child care; therefore, they are less probable to give birth to many children (24). These results are consistent with those reported by Hezarjaribi (2010) in Iran, Adhikari (2010) in Nepal, and Al-kandari (2007) in Kuwait (10, 20, 25).
According to our results, fertility rate had
no significant relationship with couple’s employment status and income level. On the one hand, people with a favorable economic situation can have more children and provide their children with all of the required facilities. On the other hand, they may believe that having more children is a sign of social and cultural backwardness (19). This issues can result in finding an insignificant association between fertility and economic factors, such as woman’s career, spousal occupation, and income.
In line with our results, Ider (2012) found no significant relationship between the man’s job and fertility (21). However, in another study an indirect relationship was reported between fertility rate and women's employment status and position, which is inconsistent with the results of the present research (9). The relationship between income and fertility rates was reported to be direct by Al-kandari (2007) and indirect by Hezarjaribi (2010) and Adhikari (2010) (10, 20, 25).
The reason of this inconsistency can be attributed to the fact that the subjects of this study were chosen from the urban areas where even families in the low-income level do not consider children as playing a significant role in the improvement of the family economy. Furthermore, even people with low incomes have access to educational resources, healthcare centers, and mass media that raise awareness. Therefore, people’s income or occupational status could not explain their fertility rate. Nonetheless, in the study carried out by Adhikari, 85.2% of participants were rural people (20).
In our study, no significant relationship was observed between child loss experience and fertility rate. In the past, social and economic conditions were in a way that having a large number of children was ideal for most of the families. In such families, children had a great value and were considered as a capital for the family (26). At that time, the lack of facilities and low levels of health care and hygiene resulted in the loss of a large number of children at different stages of life; therefore, families tended to reproduce rather constantly in order to achieve the appropriate number of children.
However, today, the rate of fetal and neonatal mortality is low; as a result, the number of pregnancies is also decreased (10, 27). This might be the reason explaining the lack of any significant relationship between this factor and fertility rate. Similarly, Rutstein (1974) stated that the couples who have lost their child has a higher ideal number of children (27). Shapiro (2018), Akaberi (2013), and Faryyad (2012) also found a direct relationship between infant mortality and fertility rate (28-30).
In the present study, there was a direct relationship between all aspects of religiosity and fertility rate. In most of the communities, religion is very important from social, economic, and political perspectives and plays an important role in the acceptance or resistance of family planning (31). Islamic teachings, verses, and traditions have directly encouraged the Muslims to childbearing and indicated the benefits of reproduction (14).
In the same vein, in a study performed in Iran, Soroush (2013) observed a significant relationship between religiosity and the actual number of children (12). Likewise, Khadivzade et al. (2017) reported a significant relationship between religious beliefs and fertility tendencies and ideal number of children among marrying couples in Mashhad, Iran (17). Saei (2017) also showed that religious orientation affected the real and ideal number of children among employed women in Tehran, Iran (32). Additionally, Frejka (2008) acknowledged that high fertility rate in he USA, compared to that in Europe, may be due to their stronger religious beliefs (33).
After entering the selected variables in the linear regression analysis, this model was able to predict 54% of the variance in fertility rate for women in Torbat Heydariyeh. Based on the results of the study, couple’s age, age at marriage, and education level had a significant role in the prediction of fertility rate. This reflects the priority of policies, such as early and easy marriage, and the provision of such conditions by politicians to promote fertility rate. In this regard, educated women should be the target group for special interventions to increase fertility rate.
There are a number of limitations in the interpretation of the results of this study. With regard to the cross-sectional design of the present study, insufficient evidence was obtained for the investigation of the relationship between the investigated variables and fertility rate. Moreover, a causal relationship could not be determined easily. In addition, this study included the investigation of only a number of factors affecting fertility.
In the present population, factors having a 46% share in predicting fertility rate still remain unknown. In addition, all the participants in the present study were selected from urban population; however, factors affecting fertility rates may vary based on urban and rural communities. Therefore, it is recommended to perform further studies to investigate the factors influencing fertility rate in other parts of the country and among other groups with different religious backgrounds.
Based on the findings of the present study, fertility rate in the city of Torbat Heydariyeh was found to be as low as that in other parts of the country. This is due to a number of factors, the most important of which include couple’s age, age at marriage, and education level. Comprehensive realization of the population problems and application of appropriate interventions focusing on the most important factors influencing couples’ fertility can provide a bright outlook for the current population problem. This end is likely to be achieved by focusing on the programs, policies, and interventions to lower the marriage age in the population.
This study was extracted from a project approved by the Torbat Heydariyeh University of Medical Sciences. The study was funded and supported by the Research Deputy of Torbat Heydariyeh University of Medical Sciences.
Conflicts of interest
The authors declare no conflicts of interest.