Journal of Preventive Medicine

Introduction
Iran’s population growth in the last few years has declined, and the birth rate has decreased by about 25% in the last four years. The fertility status of women in Iran is alarmingly low. Many factors influence women's childbearing behavior. It can be due to the change in the attitude of the family, especially women and girls. Many studies have been conducted on the effect of attitude and its changes on fertility in Iran, but there is no in-depth studies for investigating the preferences and the reasons for a change in the attitude towards having children from the perspective of women. Attitude is a multi-dimensional concept; as a result, its influence on people's behavior is complicated. In this study, a qualitative approach was used to survey the perceptions and experiences of women aged 15-49 years in Hormozgan, Iran, regarding childbearing.

 Methods
This is a qualitative study using content analysis method. Participants were 16 married women living in the west of Hormozgan province (7 from Bandar Khamir, 5 from Bandar Lengeh, and 4 from Bastak). Entry criteria were marriage for more than one year and being a resident in the region. The participants were selected voluntarily with snowball method with maximum diversity (i.e., from all different groups in terms of age, number of children, education level, and employment status). Content analysis approach was used to analyze the data. To ensure the acceptability of the data, the opinions of the participants were used. Data validity was determined by the opinions of a panel of experts.

Results
Based on the results of the content analysis, two themes (the concept of childbearing, barriers to childbearing), two sub-themes (internal, external), 7 main categories (positive mentality, negative mentality, identity, adequacy, economic, security/social, support) and 10 sub-categories (emotion-oriented mentality, benefit-oriented mentality, women, family, individual, professional, family-related, policy-making) were extracted.
The theme of the concept of childbearing indicated the understanding of the value of the child, which was grouped into 2 sub-themes (positive mentality, negative mentality) and four sub-categories (emotion-oriented mentality, benefit-oriented mentality). The theme of barriers to childbearing included two sub-themes (internal and external), five categories (identity, adequacy, economic, security/social, support), and six sub-categories (women, family, individual, professional, family-related, policy-making). The internal sub-theme indicated the limiting factors related to the conditions of the women that influence childbearing behavior, which was grouped into two categories (identity, adequacy) and four sub-categories (women, family, individual, professional). The external sub-theme indicated the obstacles and problems that the participants had no any role in them and were caused by macro policies and procedures. It consisted of three categories (economic, social/security, support) and two sub-categories (family-related, policy making).

Discussion
The findings indicated that women in Hormozgan have a positive mentality towards childbearing, but they do not make decisions based on their own mentality; they decide to have children based on the conditions of their own life and environment. Therefore, the environmental conditions in which a woman lives are very influential on her childbearing behavior. Different obstacles and limitations were mentioned by the women. These obstacles may not be effective alone, but the presence of these problems together can lead to a reduction in the tendency towards having more children. The women mentioned four reasons: (a) They do not have any interest in having children at all; (b) they do not have enough motivation to have children, (c) it is difficult for them to have children; and (d) they do not have a pleasant previous experience of having a child. The decline in women's values and beliefs towards childbearing and the inappropriateness of society's conditions in terms of security, well-being, standards of living, and life expectancy were the most important causes of the low number of children in women, which requires careful evaluation and the adoption of facilitating strategies by policymakers to improve women's childbearing behavior. Educational, cultural, social, economic, and health factors are important factors that must be on the agenda to overcome the problems causing low childbearing behaviors. It is also necessary to include family support as a priority in these programs.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the ethics committee of Hormozgan University of Medical Sciences (Code: IR.HUMS.REC.1401.004). 

Funding
This study was funded by the Social Determinants of Health Research Center, Hormozgan University of Medical Sciences.

Authors' contributions
Interview and preparing initial draft: Narjes Akbarian; Writing: Teamur Aghamolae and Abdolhossein Madani; Drawing conclusions: Elham Bushehri.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors would like to thank Hormozgan University of Medical Sciences for the financial support and all officials of health centers in Bandar Khamir, Bandar Lengeh, and Bastak counties and all the women participated in this study for their cooperation.

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