Serbian medical students’ fertility awareness and attitudes towards future parenthood

University students' fertility awareness and its influencing factors: a systematic review

INTRODUCTION

In recent years, a growing number of researchers have begun to study fertility awareness (FA). Evidence suggests that college students in their reproductive years have a common understanding of fertility, risk factors for infertility, and assisted reproductive technologies. Therefore, this systematic review summarizes these studies and explores the factors affecting college students' fertility awareness.

METHODS

A systematic literature search of databases (PUBMED/MEDLINE, Cochrane, Web of Science, Embase, and EBSCO) was conducted from inception to September 2022. Studies that assessed the levels of fertility awareness and factors influencing college students were considered for the review. The qualities of the included studies were evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. This systematic review is reported according to the preferred reporting items for systematic review (PRISMA) guidelines.

RESULTS

Twenty-one articles met the eligibility criteria and were included. The preliminary results showed that participants reported low to moderate FA. Female medical students demonstrated higher levels of fertility awareness. The association between age, years of education, and FA was insufficient.

CONCLUSION

The results of the current study suggest that increased FA interventions are warranted, especially for the male, non-medical student population. Governments and educational institutions should strengthen education programs for young students on reproductive health to help them raise awareness about childbirth, and society should provide family support for young people.

Contraceptive use and reproductive intentions among female students at the University of Novi Sad

Family planning is the ability of individuals and couples to have the desired number of children at a time when they want to. This is achieved using contraceptive methods and the treatment of unintentional infertility. Family planning is crucial for women's empowerment, and gender equality and is an essential factor in reducing world poverty. The research was conducted on an electronic survey questionnaire on the final sample size of 660 female students from the University of Novi Sad (Serbia). Survey results were analyzed using SPSS 23 software for Windows (Statistical Package for Social Sciences). The aim of the study is the analysis of the reproductive intensions regarding the structure of contraceptive use, from which comes the secondary objective, which is identification of the need for the sexual and reproductive education of young people. More than half of female students use modern contraceptives, but a significant proportion of female students rely on traditional methods such as withdrawal (coitus interruptus) (26.0%) and calendar methods (10.7%).

“Psychometric properties and factor structure of the attitudes to fertility and childbearing scale (AFCS) in a sample of polish women”

The study aimed to determine the psychometric properties and factor structure of the Attitudes to Fertility and Childbearing Scale (AFCS) in a Polish context. A cross-sectional self-assessment study was conducted with a total group of 748 Polish women in two studies (n = 187 and n = 561, respectively). Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), using SEM were performed. A three-factor structure was extracted by the EFA; although it differed to that identified in the original studies, the CFA found it to be robust. The final Polish version of the AFCS consists of 26 statements, comprising three factors (Fertility and the child as an important value, Child as a barrier, and Personal awareness and responsibility concerning having a child), which have demonstrated satisfactory internal consistency. Although the original AFCS factor structure was not replicated, our findings demonstrate that the Polish adaptation of the Attitudes to Fertility and Childbearing Scale is a reliable and valid instrument for evaluating attitudes concerning fertility and childbearing in the Polish context.

Translation and psychometric evaluation of the Korean version of the fertility awareness and attitudes towards parenthood questionnaire

PURPOSE

This study presents a translation, cultural adaptation, and psychometric evaluation of two instruments of the Fertility Awareness and Attitudes Towards Parenthood (FAAP) questionnaire (Conditions and Life changes) for use in South Korea.

METHODS

This methodological study included 166 university students for psychometric evaluation in the sixth step. The first five steps included forward translation, backward translation, committee review, assessment of content validity, and a pre-test. In the sixth step, psychometric properties, including internal consistency, construct validity, and criterion validity, were evaluated. Exploratory factor analysis and confirmatory factor analysis were conducted to identify the structure of the tool and to assess its validity.

RESULTS

The Korean version showed acceptable internal consistency. Cronbach's ⍺ was .73 for FAAPC-conditions and .83 for FAAP-Life changes. FAAP-Conditions showed a four-factor structure (social conditions, relationship with partner, external environment, and child-rearing support) and FAAP-Life changes had a two-factor structure (reward and burden). In the confirmatory analysis, CMIN/DF, TLI, IFI, SRMR, CFI, and RMSEA were satisfactory.

CONCLUSION

This study provided preliminary evidence of the acceptability, reliability, and validity of the Korean version of the FAAP questionnaire in university students in South Korea. Nonetheless, further evaluation among Korean young adults is warranted to validate this instrument.

'Doing it in the right order': childless men's intentions regarding family formation

In high-income countries, parental age at first birth has increased and this postponement increases the risk of involuntary childlessness or having fewer children than desired. This interview study was conducted in Denmark and Sweden among childless men (n = 29) in their last year of an education. The aim was to explore the role of individual and societal factors on fertility decision-making and men's reflections on barriers and enablers for earlier family formation. Data were analysed with thematic content analysis. Almost all participants wanted children in the future. Overall, there was a desire to follow the 'right chronology': get educated, having a stable relationship, employment and a good financial status before having children. While most men felt mature enough to have children, they were still not ready. Influences from within the inner social circle, societal expectations, the need for security and stability and being ready to give up freedom and individuality were factors that affected participants' preferred timing of parenthood. Most men did not have suggestions for how earlier family formation could be supported. Results suggest a gap between the ideal biological and ideal social age of family formation that may lead to unfulfilled parenthood aspirations.

Knowledge about the impact of age on fertility: a brief review

Delayed childbearing is currently a major challenge in reproductive medicine as increased age has an important impact on successful conception, both in natural and in assisted reproduction. There is a lack of knowledge about the impact of age on fertility, even in highly educated populations. A number of initiatives have been taken to increase fertility awareness. Health care providers have been encouraged to talk with patients about their reproductive life plan (RLP) for almost a decade based on recommendations from the Centres for Disease Control and Prevention. This concept has been explored successfully in Swedish contraception counselling. A growing number of online interventions aim to raise fertility awareness. These websites or interactive tools provide relevant information for individuals and couples as they consider whether they want children, when they should have them, and how many they may wish to have. These interventions are important, because research depicts that knowledge helps people in their decision-making process. With new fertility preservations such as egg freezing now available, additional education is needed to be sure that women and couples are well informed about the cost and low success rates of this intervention.

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

OBJECTIVES

Reproductive Life Plan (RLP)-based information in counseling has been reported in the USA and Sweden to increase women's knowledge of fertility and informed decision making about future fertility plans. This study examined if utilizing the RLP tool would have the same impact on Iranian women.

DESIGN

A randomized, three-armed, controlled trial. 181 women were randomly allocated to the intervention group (IG, n = 61), control group 1 (CG1, n = 60) or control group 2 (CG2, n = 60).

SETTING

A primary health care center in the Sari city, the Provincial capital of Mazandaran, Iran.

PARTICIPANTS

Women of reproductive age who were able to conceive.

INTERVENTIONS

The intervention group received oral and written information about fertility based on the RLP tool. Participants were contacted 2 months after the intervention. The primary outcome measure was the change in women's knowledge of fertility, particularly folic acid intake prior to pregnancy, over a 2 month period. The change in women's family planning intentions were also assessed. The participants in the IG shared their experiences at follow-up.

FINDINGS

At baseline, there was no difference between the groups regarding the mean knowledge of fertility score. At 2 months, after adjustment for age, history of pregnancy and baseline values, the between group difference in change from baseline was 5.8 (p < 0.001). While there was no significant difference between the IG and CG1 for folic acid intake prior to pregnancy at baseline, the group difference for folic acid intake prior to pregnancy post intervention was statistically significant (85% vs 25%, p < 0.001). At follow-up, women's desire to have more children, preferred age to conceive the last child and the desired age gap between children in the IG and CG1 did not significantly change over time. Women reported the RLP counseling tool used by midwives as useful.

KEY CONCLUSIONS

Provision of RLP-based information for Iranian women with a clear pregnancy intention in the context of a stable relationship, increased knowledge of fertility without changing their future fertility plan. The RPL counseling tool was appreciated by study participants. The lack of improvement in women's fertility intentions over time may reflect the involvement of other factors influencing decision making about childbearing in Iran. Whether the RLP can change women's behavior is yet to be established.

IMPLICATIONS FOR PRACTICE

The RLP can be used by health care professionals, especially midwives, as a tool to increase women's fertility knowledge, which may result in fertility behavior change.