Having a child is one of the important goals of marriage and cohabitation [1] and fertility is one of the important dimensions of a population that can change the age structure of a society [2]. Population issues are multidimensional and complex issues of human societies [3]. In recent years, significant demographic changes have taken place [4]. Fertility can have a significant effect on socioeconomic development, health and well-being of families by influencing population growth [5]. With the improvement of women's education in many countries of the world, the fertility rate has decreased [6].
In public health and demographic studies, the distance between women's marriage and childbearing is very important, given the impact it has on the fertility and mortality of mothers and infants, [13] and the optimal distance between marriage and childbearing determines people's attitudes toward fertility. Fertility in Iran has occurred much faster than in European countries and even faster than in Asian countries [14].
Today, changing attitudes toward fertility and childbearing, such as delayed marriage and many other issues, have overshadowed fertility [25]. The results of studies show that today, fertility developments, changes in fertility attitudes and childbearing are not only due to economic issues and the costs of childbearing, but also cultural-social factors are involved [26, 25]. Counseling on fertility and childbearing by midwives can have a significant impact on increasing couples' awareness of fertility, positive population growth, and ensuring the health of future generations. The aim of this study is to investigate the effect of midwifery counseling on women's attitudes towards children as a pillar of life.

 

The statistical population of this semi-experimental study was two groups of qualified women (test and control) who referred to the comprehensive health service centers selected in Hamadan. The sample size was calculated by considering the 95% confidence level and the probability of sample fall in both test and control groups using the following formula:

 According to this formula, the sample size was 116 people who were randomly selected from women who referred to health centers in 5 areas of Hamadan city, Iran, and 29 people from each center were randomly selected. Inclusion criteria were: Women 18 to 45 years old who have been married for more than a year, have no children, are not infertile, have good physical and mental health, are least literate and are willing to participate in research. The exclusion criteria were the unwillingness to continue working and missing more than one session in counseling classes.
Data collection tools were a demographic profile questionnaire with 10 questions, and a fertility and childbearing attitude questionnaire [13]. The reliability of the subscales was obtained using Cronbach's alpha coefficient between 0.74 and 0.86 and the overall reliability of the scale was 0.79.
After receiving the code of ethics and introducing the research program from Hamadan University of Medical Sciences, qualified people were invited. To this end, the questionnaires were given to the participants after giving sufficient explanations about the objectives of the research and how to complete it, and they were assured that their information would be kept confidential. After 4 sessions of counseling and re-completion of the questionnaire in the test and control group, the data obtained of the questionnaires was analyzed using SPSS 24 (SPSS Inc., Chicago, Ill. USA), descriptive tests (frequency, frequency percentage, mean and standard deviation) and the correlation test. In addition, P-value<0.05 was considered statistically significant.
 

According to the demographic findings, the age of women with average and standard deviation is 25.1±0.4 and 24.29±4.75 years. The age comparison of the two groups showed that statistically the control and intervention groups are not significantly different from each other and the two groups are homogeneous in terms of age (P=0.17). The mean and standard deviation of elapsed time since the marriage of the women were 31.18±12.24 and 41.14±3.02 months, respectively. A comparison of the two-group marriage time showed that statistically the control and intervention groups do not have a significant difference and the two groups are homogeneous (P=0.09). The highest frequency is related to a freelance job with 67.24% in the control group and 48.28% in the intervention group. In total, the freelance job has the highest frequency with 58.75%. The two groups do not differ significantly in terms of the distribution of the spouse’s job status and are homogeneous (P=0.11). The highest frequency of education is at the diploma level with 32.14% in the control group and 36.21% in the intervention group. 30.36% of the participants are in the control group and 24.14% are in the university education of intervention group. The results of Fisher’s exact test showed that the two groups do not have a statistically significant difference in terms of education level and are homogeneous (P=0.81). The highest frequency of household income is in the average situation with 69.64% in the control group and 72.41% in the intervention group. The results of Fisher’s exact test showed that the two groups of control and intervention do not differ significantly in terms of income status and are homogeneous (P=0.11).
 

 Table 1. Comparison of child subscale as the pillar of life of individuals in two groups of control and intervention

Table 1 shows the mean and standard deviation of the child subscale as the pillar of life before the intervention in the control group 24.82±5.10 and in the intervention group 24.66±5.54 and the two groups do not have significant differences and are homogeneous. After the intervention, the mean and standard deviation in the control group reached 24.48±4.69 and in the intervention group it reached 28.76±4.11, which is a significant difference (P<0.01) comparing control and intervention group. It showed that women's attitudes in the intervention group have improved as a subset of life after counseling.

 

The findings of this study showed that women's attitudes towards children as a pillar of life have become positive after counseling. In other words, midwifery counseling has improved women's attitudes toward fertility and childbearing. Research by Söderberg et al. in Sweden shows that urban women with high socioeconomic status have low fertility attitudes and see fertility as an obstacle in their lives, but consider motherhood to be important as a woman's identity [17]. Research by Chan et al. shows that male and female students at Hong Kong University in China have low fertility attitudes, the main causes of which are concerns about economic conditions, future careers, financial problems, lack of preparation and intention to continue their education. Compared to Western students, Chinese students have a higher level of emotional well-being and a lower attitude toward fertility.
This study showed that most women tend to delay fertility (mean and standard deviation of 3.37±3.02 years), which is consistent with previous research. In partial research, about 90 percent of women on the verge of marriage were willing to reduce the waiting time for their first child. In Parnian et al .'s study, the relationship between childbearing and mass media is meaningful and inverse, meaning that communication tools and virtual networks take the individual away from the real world and into the imaginary world. As a result, they cause individualism and reduce fertility [13, 20].

 

The results of this study showed that women's attitudes after midwifery counseling to children have become positive as a pillar of life. Midwifery counseling by educating women on the importance of children in life - given the aging population and the needs of individuals, especially in old age, as well as the need of society for young, productive and efficient to maintain society and increase quality of life and according to Islamic verses, narrations and hadiths - have made their attitude towards fertility and childbearing better and more positive.Given the problems and obstacles in society and the problems of women's fertility, conditions must be created to increase women's motivation and attitude towards fertility and childbearing, as fertility is not just a physical matter, but is based on people's attitudes and thoughts.
 

The author thank all those who helped them writing this paper.
 

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.