Journal of Preventive Medicine

Extended Abstract
Introduction
Having children is one of the important factors in demography and it is very important in the field of social and cultural issues. Demographic changes, especially the decrease in fertility in Iran, have led to many changes in the age of the population. The decrease in the total fertility rate can be related to the increase in the use of contraceptive methods, the desire of couples to plan a family, the desire for higher education, solving economic problems, religiosity, and family orientation. The decrease in population and the increase in the number of elderly cause a lack of economic and social vitality in the communities and the government faces a decrease in the workforce. There is a significant positive relationship between legal protection and working women’s desire to be fertile. Demographic policies can be much more effective if they can implement programs that make the mother’s role compatible with the continuation of women’s education after marriage. On the other hand, the implementation of educational programs to improve attitudes, promote positive mental norms, and increase women’s empowerment factors can play a major role in increasing fertility intentions. In previous studies, factors, such as an individual role in making the decision to have children and evaluation of suggested methods, such as the effect of support from working women on the desire to have children have been studied. Because comprehensive review studies have not been done in the field of summarizing previous studies and providing appropriate solutions, the present study was conducted with the aim of investigating the factors related to having children in Iran It is hoped that the results of this study will be an important step in identifying and removing obstacles to having children and increasing the population.
Methods 
The present study is a review (Ethical Code: IR.HUMS.REC.1400.362) that examined the barriers to having children in Iran until 2019. Scopus, Google Scholar, PubMed, MEDLINE, Web of Science, and ScienceDirect databases were used to obtain relevant articles. The search in each of the databases was done by searching the titles and using the Persian keywords of “barriers to childbearing”, “desire to bear children”, “driving factors”, “facilitating factors”, “Iran”, “childbearing”, “inhibiting factors” and English keywords of “childbearing barriers”, “inhibitor factors”, “childbearing”, “facilitator factors”, “Iran”, and “childbearing desire”. After reading the summaries of the articles, possible related articles were determined. Based on the inclusion and exclusion criteria, eligible articles were included in the study. 
The inclusion criteria included observational articles related to the investigation of childbearing barriers or factors that drive and facilitate childbearing in Iran. Exclusion criteria included review articles, case reports, brief reports, letters to the editor, and articles in languages other than Persian and English. No restrictions were not taken into account regarding the year, the city of the study, the study community (an urban, rural, ethnic, and religious minority), and the age of the subjects. In order to evaluate the quality of the articles, firstly, the titles and abstracts of the articles were evaluated and their inclusion criteria were checked. The STROBE checklist was used to evaluate the quality of the articles. The STROBE checklist has 22 items and is used for observational studies. Each item is scored 0 and 1. Scoring for checklist items is as follows: the article title and abstract (item 1), introduction (items 2 and 3), methods (items 4 to 12), results (items 13 to 17), discussion (items 18 to 21) and other information (item 22); eighteen items are common and items 6, 12, 14, and 15 may be different depending on the observational study. Three authors independently extracted the data from the full text of the articles. Data extraction was done based on the data collection form. The collected information included the characteristics of the study (first author, year of publication, study design, sample size, study location, results, etc.). After collecting the data, the extracted data were reviewed. Scoring for each study was done by two authors and confirmed after the agreement of the authors.
Results 
As a result of the search, 217 articles were included in the study, and after checking, removing the articles based on the inclusion criteria, the availability of the article file, and also removing duplicate articles, the remaining 38 articles were completely analyzed. The flow chart of studies is shown in Figure 1.



The results showed that factors, such as social status, culture, living in an urban or rural area, level of education, values and religion, and ethnic beliefs of people will play a significant role in the decision-making of couples. In addition, the government’s policy will be effective, including supporting pregnant mothers. The results of the studies showed that factors, such as the education level of the spouse are effective in this regard. On the other hand, the findings showed that the more positive the attitude of the parents towards having children, the greater the desire to have children and the number of children they have. Also, the more negative the attitude of parents towards having children, the lower the desire to have children and the number of children they have. Among the driving factors, we can mention the reduction of the cost of infertility treatment, and the reduction of pain in childbirth, and among inhibitory factors, the concern of providing education and job security for children can be mentioned. A systematic review study showed that unemployment, occupational level, marriage age, religiosity and family orientation, place of residence, socio-economic conditions, and education level are among the most important factors affecting the rate of childbearing in Iran. One of the effective barriers to having children in studies was unemployment. Unemployment in the country creates problems in the field of employment, income and housing, and these problems affect marriage and fertility. Contraceptive devices were reported to be one of the most important obstacles to having children in Iran. 
Discussion 
In the studies conducted, factors, such as socio-economic status, personal decisions, religiosity and family orientation, education level, occupational level, place of residence, ethnic affiliation, age of marriage, unemployment, and government decisions based on population control were important factors affecting the desire or motivation to have children. Contraceptive devices were reported to be one of the most important obstacles to having children in Iran. Traditional values and religious beliefs strengthen fertility and the desire to have children is more in families with low socio-economic status. On the other hand, people with modern values and opinions and high socio-economic status are less inclined to have children. Marrying at a young age is also effective in strengthening fertility. The results of the present study showed that various barriers and facilitators can affect having children. The findings of this study can be a good guide for health policymakers to remove obstacles to having children and increasing the population in Iran.
Ethical Considerations
Compliance with ethical guidelines
The present study is a review study and approved by the (Ethical Code: IR.HUMS.REC.1400.362).
Funding
This article  was  financially supported by the Hormozgan University of Medical Science.
Authors' contributions
Writing the first version: Amina Rahnama; Consultancy, study design and writing of the final version: Nasibah Rouzbeh; Data extraction: Ali Salimi-Assal, Zohra Kazemi, Amina Rahnama and Mahshid Abbaszad; Search: Amina Rahnama and Zohra Kazemi; Referencing: Ali Salimi Asal; Table design: Mahshid Abbaszad; Strobe scoring: Fatemeh Debiri and Nasibah Rouzbeh.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
The authors are grateful to the Mother and Child Welfare Research Center in Hormozgan University of Medical Science.