The Impact of Demographic and Health Variables on the Likelihood of Permanent Childlessness among Iranian Women: A Two-Level Analysis

Background & Aims: Considering the changes in fertility in Iran and reaching below the replacement level, the study of infertility is of great importance. intentional childlessness refers to women who are of childbearing age but do not intend to have children. Women who are referred to as "voluntary" or "voluntary childless" women are confronted with women who do not currently have children but will experience childbearing in the future and are called "temporary childless." Those who want to have children but cannot have children due to fertility problems are called involuntary children (1). Childlessness at the end of the reproductive years, or in other words, the same percentage of childless women in the age groups of 40-44 or 49-45, is called permanent or lifelong childlessness (2). Social changes in the educational and occupational status of women are among the most important causes of voluntary and involuntary childlessness (3). In general, on the one hand, relatively few studies have been conducted on childlessness in Iran, and on the other hand, few studies have been conducted on a significant sample of the population. In addition, studies have emphasized individual characteristics while individuals are at higher social levels and are also influenced by macro-social conditions and structures. The present study seeks to use the micro-level data from the 2016 census to examine permanent childlessness among women aged 40 to 49 years and to cover the above study gap to some extent. For this purpose, two categories of variables will be considered in explaining childlessness. Individual characteristics and variables that indicate the health, demographic, and economic status of the provinces of the country. Methods: In the present study, a quantitative approach, a secondary data analysis method, and a multi-level analysis technique have been used. The main difference between this article and other previous articles is the use of two-level analysis method. With this method, the effect of individual and macro variables can be examined simultaneously. The statistical population includes all Iranian women aged 40 to 49 years, and the sample includes 85,799 of the mentioned women, which is available in the raw data of 2% of the 2016 census. To study permanent childlessness, it has been suggested that women aged 45 to 49 years or even 40 to 44 years should be considered. The 49-year-old childless person is considered a permanent childless person. In the present study, the first level units, i.e., the people within the second level units or provinces, are nested. The above model shows how the variables at one level affect other levels. Childlessness (code 0-having a child, code 1-childless) is a dependent variable that is made using the variable of the total number of live children born to women. Women between the ages of 40 and 49 who had no live children were defined as childless, and women with at least one live child were defined as having children. Age, place of residence, educational status, and employment status are the first level independent variables. General marriage rate (per thousand), general divorce rate (per thousand), urbanization as macro-population variables, total economic participation rate of 15 years and older, total unemployment rate of 15 years and above, Gini coefficient in urban areas and total inflation rate as macroeconomic variables and finally the ratio of the number of active hospitals to the population (number to one hundred thousand people), the ratio of the number of beds in hospital wards to the population (number to ten thousand people), the penetration rate of health insurance (percentage) And social insurance penetration rate (percentage) are considered as major health variables. Results: The findings of this study showed that the childlessness rate in the provinces of the country fluctuates between 3 and about 6%. North Khorasan province has the lowest proportion of childless women, while Bushehr province has the highest proportion of childless women. This ratio shows that childlessness in Iran is not yet at a worrying level, but nevertheless, finding a way to reduce these ratios and preventing their increase can prevent a sharp decline in the current level of fertility in the future. Statistical tests show that the probability of childlessness increases with age. The effect of age on childlessness has been confirmed in some previous studies (10). Rural women are less likely to have childlessness than urban women. Unemployed women are also less likely to have permanent childlessness than employed women. Women with a high school diploma and a university degree are less likely to have childlessness than women with a university degree. The effect of residence, employment status, and education on childlessness has also been shown in other studies (3, 5, 6, 7, 8, 9, 10). The research findings also showed that with the increase in the general rate of marriage, the probability of permanent childlessness for women in the provinces decreases. Increasing urbanization significantly reduces the possibility of permanent childlessness for women in the provinces. Increasing the economic participation rate of the population of the province significantly reduces the probability of permanent childlessness, and in contrast to increasing the unemployment rate of the population of the province, significantly increases the probability of permanent childlessness of women in those provinces. Considering the significant relationships that were mentioned in the findings section, it can be concluded that macro-demographic and economic variables are more important in predicting the likelihood of permanent childlessness in women. Health variables had no statistically significant effect on the status of permanent childlessness of women living in those provinces. This does not mean that this group of variables is not important, but it can be due to the fact that the health status of the provinces has a high degree of convergence and relative similarity, and therefore they have not had a significant impact. Conclusion: Improving the economic situation, reducing the unemployment rate, providing a ground for marriage and trying to reduce the divorce rate can reduce permanent childlessness. Reducing the unemployment rate means improving the welfare and economic status of families; providing a ground for marriage means people entering into relationships that could potentially lead to childbearing; and reducing divorce rates means increasing the chances of having children among the population. Therefore, in general and as for policy proposals based on the results of the present study, it can be said that job creation at the macro level, which can reduce both unemployment and relative well-being for families, efforts to provide the basic requirements of marriage and prevent the increase in the age of marriage by providing suitable housing and facilities to solve this problem in society, as well as planning to strengthen family and marital ties and reduce the divorce rate, such as holding counseling classes for couples on the verge of divorce, can prevent an increase in the proportion of permanent childlessness in the future.