Effect of educational programs based on the theory of planned behavior on childbearing intention in Iran: a systematic review

Abstract Background The implementation of educational interventions in the field of childbearing, as the major concern of health policy makers in Iran, may contribute to addressing population-related challenges. Educational interventions based on the Theory of Planned Behavior (TPB) can promote attitude change and strengthen behavioral intentions. Therefore, this systematic review was conducted to examine the effect of education programs based on the Theory of Planned Behavior on childbearing intention in Iran. Methods A systematic review was conducted by searching the English databases PubMed, Web of Science, Scopus and Cochrane, as well as the Persian databases Magiran and SID, and the Google Scholar search engine. Studies published in Persian or English between 2000 and November 2025 were identified using keywords such as “Theory of Planned Behavior,” “intervention” OR “educational program,” “childbearing,” “intention,” and “Iran,” along with their MeSH equivalents, combined using the Boolean operators “AND” and “OR”. Of the 3,776 records identified, eight studies met the eligibility criteria and were included in the review. The risk of bias of the included studies was assessed using the RoB 2 tool for randomized controlled trials and the ROBINS-I tool for non-randomized studies. The overall certainty of the evidence was evaluated using the GRADE approach. Results All eight included studies were conducted in Iran and involved married women or couples, with sample sizes ranging from 70 to 150 participants. The findings of this review suggest that educational programs based on the Theory of Planned Behavior (TPB) may have a positive effect on childbearing intention. However, given the high risk of bias and the low certainty of the evidence, these findings should be interpreted with caution. The reviewed studies indicate that more favorable outcomes may be achieved when interventions involve not only women or couples but also key influential individuals, such as spouses, mothers, and mothers-in-law, in order to strengthen subjective norms. Furthermore, enhancing governmental support and creating favorable conditions for childbearing may improve perceived behavioral control and thereby contribute to increased childbearing intention among young couples. Conclusions It seems that, by using the Theory of Planned Behavior, which considers behavior as the result of individual intentions and plans, interventions may be designed and implemented to achieve better results in childbearing intention among young couples with or without children.