Volume 28, Issue 1 (3-2020)                   Avicenna J Nurs Midwifery Care 2020, 28(1): 27-35 | Back to browse issues page

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Khodakarami B, Naseritazehgeshlag M, Parsa P, Mohammadi U. Effect of Group Counseling on Attitude About "Child as a Pillar of Life" in Women Referring to Hamadan City Comprehensive Health Centers. Avicenna J Nurs Midwifery Care 2020; 28 (1) :27-35
URL: http://nmj.umsha.ac.ir/article-1-2036-en.html
1- Department of Midwifery, Faculty of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
2- Department of Midwifery, Faculty of Nursing and Midwifery Hamadan University of Medical Sciences, Hamadan, Iran
3- Department of Mother and Child Health, Faculty of Nursing and Midwifery Hamadan University of Medical Sciences, Hamadan, Iran , P_parsa2003@yahoo.com
4- Depatment of Epidemiology, Public Health Scool, Hamadan University of Medical Sciences, Hamadan, Iran
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 Women's attitudes toward "children as a pillar of life" have become positive after counseling. It is recommended to hold counseling sessions about the position of the child in life in different age groups, educational levels and at all levels of society.
Extended Abstract:   (789 Views)

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.


Materials and Methods

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

Group Before intervention After intervention t df P-value
Control 56 24.82 5.10 56 24.48 4.69 1.07 55 0.29
Intervention 58 24.66 5.54 58 28.76 4.11 6.55- 57 0.01>

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.

Conflicts of Interest

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

Type of Study: Original Research | Subject: Midwifery
Received: 2019/05/12 | Accepted: 2019/08/6 | Published: 2020/01/3

1. Rad F, Savabi H. Investigation on Tendency to Fertility and Its Related Social Factors (a Case Study of Married Women aged 15 to 50 in Tabriz). Journals Managment System. 2015;3(1): 127-55.
2. Hadi SD. Determinants of Demographic, Social, Cultural and Economic Conditions Affecting Fertility: The Case Study of Married Women in Oshnavieh City. Tehran: kharazmi University; 2013.
3. Delavari A, Mahdavihezave A, Nouroozinejad A, Yarahmadi SH. National Diabetes Control and Prevention Program. Tehran: Sound Publishing Center. 2014.
4. Mobasheri M, Alidosti M, Heidari Soureshjani S, Khosravi F, Khalafeyan P, Jalilian M. Determination of the Most Important Factors Influencing the Fertility Patterns of Single Child and Without Child Families in Shahr-e-kord city in 2013. scientific journal of ilam university of medical sciences. 2013;21(6): 63-70.
5. Ramezankhani A, Manouchehri H, Hajizadeh E, Haghi M. The Decision-Making Process of Childbearing: a Qualitative Study. Payesh (Health Monitor). 2013 Oct 15;12(5):505-15.
6. Chan CH, Chan TH, Peterson BD, Lampic C, Tam MY. Intentions and Attitudes Towards Parenthood and Fertility Awareness Among Chinese University Students in Hong Kong: a Comparison with Western Samples. Human Reproduction. 2015 Feb 1;30(2):364-72. [DOI:10.1093/humrep/deu324] [PMID]
7. Jalovaara M, Neyer G, Andersson G, Dahlberg J, Dommermuth L, Fallesen P, Lappegård T. Education, gender, and cohort fertility in the Nordic countries. European Journal of Population. 2019 Jul 15;35(3):563-86. [DOI:10.1007/s10680-018-9492-2] [PMID] [PMCID]
8. Childbearing Among Married Women in Tehran City.2016:2(14): 217-34.
9. Ju K, Kopp M, Wang Y, Yuan G, Zheng W, Ataman LM, Woodruff TK, Chen Q, Xiao S. A Survey Study of Attitude and Knowledge Regarding Female Fertility Preservation Among Reproductive Health Professionals in Fujian, China. Journal of adolescent and young adult oncology. 2019 Feb 1;8(1):67-73. [DOI:10.1089/jayao.2018.0065] [PMID] [PMCID]
10. Saadati M, Bagheri A. Ideal First Birth Interval: A Study of Pre-Marriage Youths. Payesh (Health Monitor). 2017 Apr 15;16(2):239-50.
11. Kavehfirooz Z, Zare B, Jahanbakhsh GS. The Effect of Socio-Cultural Capitals on Attitudes Towards Childbearing (Case Study: Tehranian Couples Going to Marry). 2017
12. Taghizadeh Z, Behmanesh F, Ebadi A. Marriage Patterns and Childbearing: Results from a Quantitative Study in North of Iran. Global journal of health science. 2016 Mar;8(3):1. [DOI:10.5539/gjhs.v8n3p1] [PMID] [PMCID]
13. Colleran H. The Cultural Evolution of Fertility Decline. Philosophical Transactions of the Royal Society B: Biological Sciences. 2016 Apr 19;371(1692):20150152. [DOI:10.1098/rstb.2015.0152] [PMID] [PMCID]
14. Baezzat F, Marzbani Y, Ahmadi Ghozlojeg A, Karimi A, Azarnioshan B. A Study of Psychometric Properties of Persian Version of Attitudes Toward Fertility and Childbearing Scale. The J Urmia Nurs Midwifery Fac. 2017;15(1):37-47.
15. Hosseini G, Hosseini H. Comparing Determinants of Fertility Behaviour Among Kurdish Women Living in Rural Areas of Ravansar and Gilangharb Cities. J Kermanshah Univ Med Sci. 2013;17(5):316-24.
16. Kariman N, Simbar M, Ahmadi F, Vedadhir AA. Socioeconomic and Emotional Predictors of Decision Making for Timing Motherhood Among Iranian Women in 2013. Iranian Red Crescent Medical Journal. 2014 Feb;16(2). [DOI:10.5812/ircmj.13629]
17. Lund EM. Be Ye Fruitful and Multiply: Does Religious Activation Increase Reproductive Desire? 2014.
18. Hosseini H, Bagi B. Socioeconomic, Cultural and Demographic Determinants of Childbearing Desires Among Married Women Attending Health Centers in Hamedan (2012). J Kermanshah Univ Med Sci. 2014;18(1):35-43.
19. Söderberg M, Lundgren I, Christensson K, Hildingsson I. Attitudes Toward Fertility and Childbearing Scale: An Assessment of a New Instrument for Women Who Are Not Yet Mothers in Sweden. BMC pregnancy and childbirth. 2013 Dec;13(1):197. [DOI:10.1186/1471-2393-13-197] [PMID] [PMCID]
20. Seymour JW, Frasso R, Shofer FS, Bennett IM. Cohort Study of Early Literacy and Childbearing Over the Reproductive Lifecourse. BMJ open. 2016 Dec 1;6(12):e013522. [DOI:10.1136/bmjopen-2016-013522] [PMID] [PMCID]
21. 20. Dekker RL, King S, Lester K. Social media and evidence-based maternity care: a cross-sectional survey study. The Journal of perinatal education. 2016 Jan 1;25(2):105-15. [DOI:10.1891/1058-1243.25.2.105] [PMID] [PMCID]
22. Kordzanganeh J, Mohamadian H. Psychometric Assessment of the Validity of the Iranian Version of Attitude Toward Fertility and Childbearing Inventory in Women Without a History of Pregnancy in the South of Iran. sjsph. 2019; 17 (1) :83-94 URL: http://sjsph.tums.ac.ir/article-1-5737-fa.html
23. Saei GM, Ozgoli G, Hajizadeh F, Sheikhan Z, Nasiri M, Jannesari S. The Relationship Between Religious Orientation with Intention of Desired Fertility and Actual and Desirable Number of Children in Working Women of Tehran, Iran. Journal of Research on Religion & Health. 2017;3(1).
24. Keshavarz H, Bahramian M, Mohajerani AA, Hosseinpour K. Factors Effective in Changing of Reproductive Behaviors of Nomadic and Non-Nomadic Tribes in the Semirom Province, Iran 2014.
25. Hosseini. H, Asgare. A, Moradi. N. A Comparative Study of Childbearing Desires of Shia and Sunni Kurdish Women in Rural Areas of Kamyaran. Women and Family Studies. 2016 Mar 20;4(1):63-84.
26. Hosseini H, Asgari-Nadushan A, Moradi N. Comparative study of childbearing desires Shiite and Sunni Kurdish women in rural areas of Kamyaran city. J Woman Fam Stud. 2016;4(1):63-84.
27. Farrokh Eslamlou HR, Mogadam Tabrizi F, Moeini SR, Vahabzadeh Z. Pre-Marriage Couplesfertility Attitude Following Recent Childbearing Persuasive Policies in Iran. The Journal of Urmia Nursing and Midwifery Faculty. 2013;11(10):836-46.
28. Fooladi E, Weller C, Salehi M, Abhari FR, Stern J. Using Reproductive Life Plan-Based Information in a Primary Health Care Center Increased Iranian Women's Knowledge of Fertility, But not Their Future Fertility Plan: A Randomized, Controlled Trial. Midwifery. 2018 Dec 1;67:77-86. [DOI:10.1016/j.midw.2018.09.011] [PMID]
29. Baezzat F, Marzbani Y, Ahmadi Ghozlojeg A, Karimi A, Azarnioshan B. A Study of Psychometric Properties of Persian Version of Attitudes Toward Fertility and Childbearing Scale. The J Urmia Nurs Midwifery Fac. 2017;15(1):37-47.
30. Enayat H, Parnian L. The Study of Cultural Globalization and Tendency to Fertility. 2013.
31. Piltan F, Rahmanian M. Sociological Study of Factors Affecting Willingness to Childbearing Women and Married Men (Case Study: Women and Men 52 to 52 Years Old in Jahrom). Social Development Studies. 2015;7(2):121-34.
32. Adair LE. Fertility Decision Making: to What Extent Do Adaptations, Social Pressures, and Individual Differences Influence Plans to Have a Child? (Doctoral Dissertation, Kansas State University). 2013
33. Mahmoud Tavousi, Aliasghar Haerimehrizi, Jila Sadighi, Mohammad Esmaeil Motlagh, Mohammad Eslami, Fatemeh Naghizadeh, et al . Fertility desire among Iranians: a nationwide study. Payesh. 2017; 16 (4) :401-410 URL: http://payeshjournal.ir/article-1-89-fa.html
34. Tavousi M, Haerimehrizi A, Sadighi J, Motlagh ME, Eslami M, Naghizadeh F, Anbari M, Hasemi A, Montazeri A. Fertility Desire Among Iranians: a Nationwide Study. Health Monitor Journal of the Iranian Institute for Health Sciences Research. 2017;16(4): 401-10.
35. Krisher RL. Maternal age affects oocyte developmental potential at both ends of the age spectrum. Reproduction, Fertility and Development. 2019 Jan 21;31(1):1-9. [DOI:10.1071/RD18340] [PMID]
36. Amerian M, Kariman N, Janati P, Salmani F. The Role of Individual Factors in Decision Making for the First Childbearing. Payesh (Health Monitor). 2016 Apr 15;15(2):143-51.

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