Childbirth fear prior to pregnancy and its relationship with attitude toward fertility and childbearing and fertility desire

Fear of childbirth can lead to negative attitudes toward motherhood and avoidance of pregnancy. Considering the declining fertility rate in Iran, this study was designed and conducted to investigate the relationship between childbirth fear prior to pregnancy (CFPP) and attitude toward fertility and childbearing (ATFC)/ fertility desire (FD) among married nulligravid women. This cross-sectional study was conducted in Tabriz, Iran, in 2025 among 200 nulligravid women attending health centers. Stratified multi-stage cluster sampling method was used. Data collection tools included the Socio-demographic Characteristics Form, the Childbirth Fear Prior to Pregnancy Scale (CFPPS), the Attitude Toward Fertility and Childbearing Scale (ATFCS), and the Fertility Desire Scale (FDS). Pearson’s correlation test was applied in bivariate analysis to assess the association between CFPP and ATFC/ FD, and the general linear model was used in multivariate analysis while controlling for potential confounding variables. The mean (SD) scores of CFPP, ATFC, and FD were 39.74 (13.5), 64.03 (18.4), and 54.03 (14.1) respectively. The obtained score ranges were 10–60, 24–100, and 23–89 for the CFPP, ATFC, and FD respectively. There was a significant negative relationship between the total score of CFPP and ATFC (r = −0.310. P < 0.001) and its subscales (P < 0.001). Also, there was a significant relationship between the total score of CFPP and FD (r= −0.244, P < 0.001) and its subscales (P < 0.001). After adjusting for socio-demographic characteristics, the results showed that ATFC score decreased significantly with an increase in CFPP score (B: 0.37, 95% confidence interval (CI) −0.55 to −0.19, P < 0.001) and FD score reduced with an increase in CFPP score (B: −0.28, 95% CI −0.42 to −0.14, P < 0.001). The findings indicate that CFPP has an indirect relationship with both ATFC and FD. Specifically, higher levels of CFPP were associated with more negative ATFC and lower FD. Considering the declining fertility rate in Iran, particularly in recent years, it is recommended that healthcare providers provide preconception counseling to raise awareness, reduce CFPP, and ultimately enhance ATFC and FD.