Fertility intentions among medical students in war-torn Ukraine: a cross-sectional survey

BACKGROUND: Ukraine's total fertility rate was 0.9 in 2022, among the lowest in Europe. Amid the ongoing full-scale invasion, understanding reproductive intentions is important for informing future pronatalist policies. This study assessed fertility intentions and attitudes toward parenthood, with a focus on sex differences, and subjective determinants of reproductive decision-making among undergraduate medical students in wartime Ukraine. METHODS: A cross-sectional, confidential, online survey was conducted among students at Odesa National Medical University in May 2024. The Swedish Fertility Awareness Questionnaire was used, supplemented with a question on contraceptive use. Data were analysed using descriptive statistics, univariable, multivariable and stepwise logistic regression. RESULTS: The mean age was 20 years among the participants: 655 women and 191 men. Overall, 75% intended to have children, with a preferred family size of two children. Women preferred to have their first child at a younger age than men (26.1 vs. 28.1 years; p < 0.001). No sex differences were observed in the perceived importance of having children. Oral and long-acting reversible contraceptive use was relatively low. Furthermore 62% of participants indicated that they would support a hypothetical pregnancy to birth, mainly for moral or religious reasons. Among those opting for abortion, the most commonly cited reasons were financial constraints and war-related concerns. In the case of infertility, more women than men were willing to consider IVF or adoption (p < 0.001). Key prerequisites for parenthood included adequate housing (93%) and financial stability (92%). Women were more likely to anticipate emotional benefits of parenthood (OR 1.66), whereas men were more likely to anticipate negative impacts on personal time (OR 1.91) and finances (OR 1.72). Intention to have children was associated with psychological readiness, emotional fulfilment, life priorities, and perceived housing adequacy (aOR 3.02), as a key independent predictor of overall readiness for parenthood. CONCLUSIONS: Despite the ongoing war, fertility intentions among medical students remain relatively optimistic, equally for women and men. As adequate housing was an important prerequisite for parenthood, post-war pronatalist policies may benefit from integrating housing support into broader family well-being strategies, while also addressing sexuality education and cultural influences on family formation and parenthood decisions.