Beyond Health: How Do Adverse Childhood Experiences Impact Young Adults' Family Planning Decisions

Background and Purpose: Decisions regarding marriage and parenthood profoundly shape individuals' life trajectories and are influenced by a complex interplay of personal experiences and social contexts. While prior studies have examined various factors affecting these decisions, the role of adverse childhood experiences (ACEs) remains unexamined. This study addresses this gap by investigating whether ACEs are associated with young adults' intentions to marry and have children, and whether mental health and life satisfaction mediate these associations. We hypothesized that ACEs would directly impact young adults' family planning decisions, with depression and life satisfaction serving as potential mediators of these relationships.

Methods: This study utilized data from a longitudinal survey investigating the long-term impacts of ACEs on the health and well-being of educated rural Chinese youth. Data were collected at two time points: first in 2016, when participants were approximately 18 years old; second in 2023, when participants were about 25 years old. A convenience sample of over 300 participants completed surveys at both waves.

ACEs were measured at Time 1 using the Childhood Experiences Survey. At Time 2, depressive symptoms and life satisfaction were assessed using the Patient Health Questionnaire-9 and the Satisfaction with Life Scale, respectively. Intentions to marry and have children were assessed with two binary questions: “Do you want to get married in the future?” and “Do you want to have children in the future?” (1 = Yes). Demographic covariates collected across both waves included gender, parental employment status, family economic status, number of siblings, parental migrant worker status, social support, and participants’ current educational and economic status.

Statistical analyses were conducted using SPSS version 29. Logistic regression was used to examine the associations between ACEs and family planning intentions, controlling for covariates. Mediation analyses using PROCESS explored whether depression and life satisfaction mediated these associations.

Results: Logistic regression analyses showed that ACEs were significantly associated with reduced willingness to marry (OR = 0.76, 95% CI [0.63, 0.92], p < .01) and decreased desire for children (OR = 0.74, 95% CI [0.61, 0.90], p < .01). Mediation analyses revealed that ACEs significantly predicted higher depressive symptoms (B = 0.90, 95% CI [0.49, 1.31], p < .001), which were in turn associated with reduced willingness to marry (OR = 0.91, 95% CI [0.86, 0.96], p < .001) and decreased desire for children (OR = 0.89, 95% CI [0.83, 0.94], p < .001). Although ACEs significantly predicted lower life satisfaction (B = -0.57, 95% CI [-1.05, -0.08], p < .05), life satisfaction was not significantly related to marriage or childbearing intentions.

Conclusions and Implications: The current study is the first study to underscore the significant role of ACEs in shaping young adults’ decisions regarding marriage and parenthood, with depression emerging as a key mediating factor. The findings highlight the importance of incorporating trauma-informed approaches into therapeutic interventions aimed at addressing family planning challenges. By addressing the long-term psychological effects of ACEs, support systems can better empower individuals to make informed and autonomous decisions about intimate relationships and parenthood.