The impact of psychological factors on fertility intention among women who have given birth in Shanghai: multiple mediating effects analysis based on the theory of planned behavior

The declining fertility rate posed significant risks to social sustainability and development. However, few studies have explored the psychological factors and their potential mediating effects on the fertility intention for another child. Based on the theory of planned behavior (TPB), this study aimed to investigate the relationships among subjective norm (SN), perceived behavioral control (PBC), attitude (AT), and fertility intention (FI) for another child. A multicenter cross-sectional survey was conducted from November to December 2022, using a sample of 455 women who had given birth from 3 districts in Shanghai, China. Structural equation modeling was employed to validate the proposed model. Multi-group analysis was conducted to explore differences across groups with different number of children. PBC (β = 0.212) and AT (β = 0.183) had positive direct effects on FI, while SN had a negative direct effect on FI (β=-0.123). PBC (β=-0.057) and AT (β=-0.035) mediated the impact of SN on FI respectively, functioning as sequential mediators (β=-0.028). The mediating effect of SN on FI accounts for 49.38% of the total effect. Among women with one child group, the path coefficient from PBC to FI was larger than that for women with multiple children (CR = -2.012). SN exerted both direct and indirect negative effects on FI through the multiple mediating effects of PBC and AT, which also acted as sequential mediators. PBC had the strongest direct effect, compared with SN and AT. The effect from PBC to FI for women with one child was stronger than that for women with multiple children. Policy recommendations were provided to increase fertility intentions based on these results. In recent years, the number of births in China has continued to fall, creating challenges for long-term social and economic development. Understanding what influences women’s willingness to have another child is therefore important. This study examined how three psychological factors—subjective norm (SN), perceived behavioral control (PBC), and attitude (AT)—affect women’s fertility intention (FI) for having another child. SN refers to the social pressure women perceived from people around them regarding having another child, PBC reflects how easy or difficult women believe it would be to have another child, and AT represents their overall positive or negative feelings toward having another child. We surveyed 455 mothers in Shanghai between November and December 2022. The results showed that SN, PBC, and AT were associated with women’s fertility intention. PBC and AT also helped explain how SN affected fertility intention. Specifically, women who felt stronger social pressure tended to have less confidence and more negative attitudes toward having another child, which lowered their fertility intention. Among mothers with one child, their sense of control (PBC) played a greater role in shaping fertility intention than among those with multiple children. These findings highlight that reducing social pressure, improving women’s confidence in managing work and family life, and creating a more inclusive environment may encourage more women to consider having another child.