The Relationship Between Social Determinants of Health and Attitudes Towards Childbearing with the Mediation of Social Support Among Women of Reproductive Age: A Path Analysis

Abstract

Background: Attitudes towards childbearing are influenced by various biological, psychological, and social factors. Objectives: This study aims to investigate the impact of social determinants of health on attitudes towards childbearing, mediated by social support among women of reproductive age. Methods: This descriptive-analytical study was conducted on 500 women who were referred to health centers affiliated with Shahid Beheshti University of Medical Sciences in Tehran, using a multistage random sampling method in 2022 - 2023. Data were collected using Soderberg's Attitudes Toward Fertility and Childbearing Scale, the Demographic and Midwifery Questionnaire, Ghodratnama's Socio-economic Status Questionnaire, the Multidimensional Scale of Perceived Social Support, the Depression-Anxiety-Stress Scale (DASS)-21 Scale, Spanier's Marital Compatibility Questionnaire, and the Fear of Childbirth Scale. The data were analyzed using SPSS 26 and LISREL 8.8, applying the statistical method of path analysis. Stepwise regression tests were used to examine the relationship between independent variables (demographic variables) and dependent variables while controlling for contextual and confounding variables. Results: Based on the results of the path analysis, the levels of depression, anxiety, and stress as measured by the DASS-21 had only a direct effect (β = -0.25); fear of childbirth (β = -0.06), socio-economic status (β = 0.057), and social support (β = 0.19) had only an indirect effect; and marital compatibility (β = 0.257), education (β = -0.16), and women's employment (β = -0.13) had both direct and indirect effects on attitudes towards childbearing. Notably, marital compatibility (β = 0.257) had the most substantial positive influence on attitudes towards childbearing. The model proposed in the study showed a good fit (P-value = 0.001; GFI = 0.99; RMSEA = 0.033). Conclusions: Based on the findings, social support plays a significant role as a mediating factor in improving attitudes towards childbearing. Therefore, relevant organizations should recognize their responsibility in implementing laws and policies aimed at enhancing social support, particularly for employed women.