Changes to Fertility Intention- the Effects of Culture and Birth Experience

Background: Women's fertility intentions, i.e., their desired number of children and spacing between births (inter-pregnancy interval; IPI) are related to micro (personal) and macro (socio-cultural) level factors. Little is known on the effect that giving birth has on fertility intentions. In the current study, we investigated background factors related to women's fertility intentions in Israel, a developed country with high birth rates. We focused on a variety of socio-demographic and obstetric history factors as well as the objective and subjective birth experience.

Methods: For this prospective observational study 1163 pregnant women were recruited from prenatal clinics and hospitals in two major metropolitan areas. They completed self-report questionnaires prenatally (≥24 weeks gestation) and postpartum (two months after childbirth). Women reported their socio-demographic background and obstetric history prenatally, their desired number of children and IPI at both time-points, and their objective and subjective birth experiences postpartum. Associations between women's prenatal fertility intentions and their backgrounds were tested using χ², and multivariate analyses of covariance. Postpartum changes in fertility intentions were tested using t test, χ² and logistic regression.

Results: Our findings indicated that socio-demographic (age, income, education) and reproductive factors (parity and fertility treatments) were related to prenatal fertility intentions. The strongest contributor to prenatal fertility intentions was degree of religiosity- the more religious women were, the more children they desired and the shorter their desired IPI. Women's postpartum fertility intentions were mostly consistent with their prenatal reports. Changes in fertility intentions from the prenatal to postpartum periods were related to the birth experiences in univariate analyses: Emergency modes of delivery were associated with a decrease in the desired number of children and women who were less satisfied with their birth were more likely to desire fewer children and increase desired IPI. In multivariate analyses, mode of delivery was no longer significant and only being very-religious, more educated, and previously giving birth decreased the likelihood of desiring fewer children. Greater birth satisfaction and giving birth for the first time were related to a lower chance of decreasing the desired IPI.

Conclusion and implications: In a pronatalist country such as Israel, women's fertility intentions are not easily modified. When social norms, public policy and religious practices and beliefs pressure women to bear children, it is less likely that the birth experiences would affect women's family planning. In other words, women might feel pressure to have another child, even when they are not ready for it. More studies need to examine the role of the subjective birth experience in changes to fertility plans, especially in countries where fertility rates are lower and social pressures on having (additional) children are minor. In such countries, the negative effects the birth experience might have on fertility intentions could go unnoticed and potentially hinder attempts to increase birth rates. This could also help in developing appropriate interventions to ameliorate the deleterious effects of a negatively experienced birth.