Iranian single-child couples' perceptions and experiences regarding childbearing incentives.

BACKGROUND: The single-child issue is a significant contributor to population decline, which adversely affects both parents and children. Despite government-approved incentives, the single-child problem remains a major population challenge. This study was conducted to explore the perceptions and experiences of single-child couples regarding childbearing incentives. METHODS: This qualitative study used conventional content analysis and was performed on 21 single-child couples in Mashhad, North East Iran, selected through purposive sampling from urban health centers. Data were collected using semi-structured interviews until saturation was reached. The data were analyzed using the Elo and Kyngas (J Adv Nurs 62(1):107-15, 2008. 10.1111/j.1365-2648.2007.04569.x) method with MaxQDA10 software. RESULTS: Two generic categories emerged from the data analysis including (1) "Advertising and providing information as an influencing factor to encourage childbearing", which included two subcategories of "Attention to the key lever of advertising" and "Necessity of adopting advertising policies and creating a culture of respecting maternal role", and (2) "Focusing on effective incentive policies", which consisted of three subcategories of "Adopting incentive policies to reduce people's financial problems", "Avoiding punitive policies" and "Need to adopt incentive policies for working women and elites". CONCLUSIONS: Incentive policies should focus on the culture building of the general public, implementing effective incentive policies, and addressing economic challenges, particularly for specific groups such as working women and higher education students. In addition, a public mobilization effort is needed to effectively implement population laws.

Single-child issue is a challenge, being a cause of population decline, and poses adverse effects on both parents and children. Various childbearing incentive policies exist, but single-child couples' perceptions regarding these incentives have been less explored. To encourage childbearing, it is crucial to implement effective advertising and information release among the target groups, based on respecting the maternal role and addressing conflicting attitudes towards the influence of employment and education on maternal role. Avoiding punitive policies, using financial incentive policies to reduce people's financial burdens and being ensured of their implementation, and adopting incentives to support working women and elites (female students in higher education), would be among the effective fertility incentives.

Fertility knowledge, childbearing intentions and attitudes towards social egg freezing: A study of female students of a private university in Kumasi, Ghana.

BACKGROUND: As women increasingly delay childbearing for educational and career pursuits, understanding the age-related decline in ovarian reserve becomes crucial to avoid infertility. Egg freezing offers a solution, extending the window for achieving pregnancy with a biological child. However, awareness and acceptance of age-related fertility decline and elective egg freezing vary across countries and social groups. METHODS: This descriptive cross-sectional study investigates fertility awareness, childbearing intentions, and attitudes toward elective egg freezing among 138 undergraduate female students at a private university in Kumasi, Ghana. Data were collected via a Google App-based questionnaire. RESULTS: The majority of respondents were below 28 years old (76.3%), Christians (79.26%), and single (57. 78%). Many respondents overestimated their knowledge of age-related fertility decline, with almost half (48.89%) incorrectly believing it occurs after age 40. Primary sources of fertility education included health professionals, the Internet, and television. While most (62.96%) considered childbearing necessary, they would not have a child without a partner. Acceptance of donor egg in vitro fertilisation (IVF) varied based on circumstances, and a significant portion was open to donating their eggs (41.48%). Awareness of elective egg freezing was low, but nearly half (48.89%) expressed interest in it, primarily to retain the option for a biological child. The cost of elective egg freezing was a significant deterrent. CONCLUSIONS: The study revealed a significant lack of awareness regarding age-related fertility decline and elective egg freezing among female university students in Kumasi. Most prefer having a biological child only with a partner. While few were open to donating their eggs or accepting the same to achieve a pregnancy, interest in elective egg freezing was notable, albeit hindered by cost. The study recommends enhanced education by health professionals using social media and television to address these gaps.

Beyond the First Child: Unveiling the Reasons Behind Stopping Childbearing in Iran.

BACKGROUND: The determinants of the intention to stop childbearing tend to differ over time and contexts. This allows the issue of families' childbearing intentions to continually remain on the research agenda. As societal context and temporal variability will matter for second childbearing intentions, this study aimed at uncovering the reasons behind the intentions to stop childbearing from one-child mothers' perspective. METHOD: A qualitative descriptive study in Isfahan City, Iran, was used to scrutinize reasons behind the unwillingness to have a second pregnancy. A purposeful sampling with maximum variation was used to select one-child mothers. Until reaching saturation, 48 semistructured interviews were conducted. A thematic analysis was used to analyse the qualitative data. RESULTS: Five themes and 19 subthemes emerged from the data analysis as structural attributes (economic, social and political conditions), parental attributes (parental (dis)agreements, childrearing troubles, having impatience and being at the inappropriate age for childbearing), husband attributes (having the intention to stop parenting, financially and emotionally nonsupportive and being busy by working), maternal attributes (health-related problems, adverse experience during former pregnancy, being employed, self-compassion, the fear of parity progression and being pessimistic) and child attributes (having a naughty child and having the physical or mental distress of the first child). CONCLUSION: Overall, findings highlight the multifaceted nature of factors influencing second childbearing intentions. Structural reasons at macro level, intrafamily relationship, mothers' self-related factors and challenges of raising the first child all play distinct roles in discouraging mothers from a second child intention. Understanding these key reasons can help policymakers, researchers and individuals alike to comprehend the complexities involved in family planning and fertility decisions.

Ideal Family Size and Reproductive Orientations: An Exploration of Change Over Time in the United States.

Drawing on more than 30 years of nationally representative microdata from the General Social Survey, this article comprehensively updates recent trends in ideal family size in the United States. It first documents stability in ideal family sizes between the mid-1980s and 2018, even in the face of a recent fertility decline. Next, the study adopts a latent class approach that identifies typologies of "reproductive orientations," defined as multidimensional mental models of reproduction encompassing ideal family size, attitudes toward reproductive labor, and views on reproduction contexts. The findings indicate three distinct classes of reproductive orientations: Progressive Familialists, Conservative Familialists, and Blended Egalitarians. Further analyses suggest that the prevalence of these classes has changed over time and that class membership is associated with distinct patterns of childbearing and marriage. These findings deepen contemporary understandings of ideal family size in the United States and have broader implications for how demographers conceptualize and measure fertility preferences across diverse contexts.

Own depression, partner's depression, and childlessness: A nationwide register-based study.

Depression and other mental health disorders are increasing while childlessness is increasing. However, this relationship has rarely been studied. We examine how depression, as measured by antidepressant use, is related to childlessness. We add to the previous research by examining both the role of current partnership status and having a partner with depression as a mechanism. We use Finnish total population register data for cohorts born in 1977-1980. We estimate discrete time event history models for the likelihood of having a child with average marginal effects separately for men and women. Depression was measured annually with a time-varying indicator of having at least one purchase of antidepressants in the preceding year. We find a positive association between depression and childlessness; the annual probability of having a child was 2.7 percentage points lower for women with depression and 1.6 percentage points for men with depression in age-controlled models. When controlling for all background variables such as education, the likelihood of having a child was 1.9 percentage points lower for women with depression and 0.3 percentage points lower for men with depression. In total, 41% of men and 26% of women who had used antidepressant medication between ages 18-38 remained childless at age 39, compared to 30% of men and 22% of women who had not used antidepressant medication. We also find that a partner's depression increases the probability of being childless, and the likelihood of being childless is even higher if both an individual and their partner had depression.

Causal association between family health, perceived relationship quality components, and attitudes toward childbearing in Iranian women: A WHO model analysis.

BACKGROUND: Given the unprecedented global decline in fertility as a major demographic development in recent years, the present study was conducted to determine Causal association Between Family Health, Perceived Relationship Quality Components, and Attitudes toward Childbearing in Iranian Women: A WHO Model Analysis METHODS: In 2023, this descriptive study recruited 400 married women presenting to selected comprehensive health centers affiliated to Alborz University of Medical Sciences, Karaj, Iran. The data were collected through multistage stratified cluster sampling and using a socioeconomic status questionnaire (Ghodratnama), the Perceived Relationship Quality Components (PRQC) scale, the family-of-origin scale (FOS), the attitudes toward fertility and childbearing scale (AFCS) and a demographic checklist were analyzed in SPSS 25 and LISREL 8.8. RESULTS: According to the path analysis, family health exerted the most significant and positive causal effect on attitudes to childbearing directly through one path (B = 0.334) and relationship quality (B = 0.698) and duration of married life (B = 0.387) both directly and indirectly. The number of children (B = -0.057), however, exerted the most significant and negative causal effect on attitudes to childbearing through both paths. CONCLUSIONS: The present findings suggested the significant effects of family health and relationship quality on attitudes toward childbearing. It is therefore recommended that these variables be screened in comprehensive health centers, the associated limitations and problems be identified and appropriate training and counseling solutions be provided by health specialists.

Factors associated with the health and reproductive autonomy of Quilombola women in Brazil.

Objective: To verify the association between reproductive autonomy and sociodemographic, sexual, and reproductive characteristics in Quilombola women (a term indicating the origin of politically organized concentrations of Afro-descendants who emancipated themselves from slavery). Methods: Cross-sectional and analytical study with 160 women from Quilombola communities in the southwest of Bahia, Brazil. Data were collected using the Reproductive Autonomy Scale and the questionnaire from the National Health Survey (adapted). Results: Out of the 160 participating women, 91.9% declared themselves as black, one out of every three were aged ≤ 23 years, 53.8% were married or had a partner, 38.8% had studied for ≤ 4 years, over half (58.1%) were unemployed, only 32.4% had a monthly income > R$ 430 (80 US dollars), 52.5% had their first menstruation at the age of 12, 70.7% had not accessed family planning services in the last 12 months, and over half used some method to avoid pregnancy (59.0%). The women had a high level of reproductive autonomy, especially in the "Decision-making" and "Freedom from coercion" subscales with a score of 2.53 and 3.40, respectively. A significant association (p<0.05) was found between the "Total reproductive autonomy" score and marital status, indicating that single or unpartnered women had higher autonomy compared to married or partnered women. Conclusion: The association of social determinants of health such as marital status, education, and age impacts women's reproductive choices, implying risks for sexual and reproductive health. The intergenerational reproductive autonomy of Quilombola women is associated with sociodemographic and reproductive factors.

Uncertainty and flexibility of fertility intentions.

Large-scale survey data is widely used to study the intention to have a(nother) child. However, there are further opportunities to understand how these intentions are revised over the life course and the uncertainty surrounding them. We aim to further outline the importance of simultaneously considering change and uncertainty in fertility decision-making. Specifically, we identify uncertainty in the "probably not" and "probably yes" responses to questions on whether an individual intends to have a(nother) child, and compare the differences in individuals' stated intention between survey waves. Using panel data from the Generations and Gender Survey (GGS) for Austria, France, Hungary, Italy, and Poland, we study short-term followed by long-term (overall) fertility intentions. First, descriptive analyses compare and visualise the prevalence of uncertainty intentions at first and second wave using Sankey diagrams. Next, multivariate analyses on transitions in intentions focus on partnership and employment context. The results reveal that for both short-term and overall intentions, four in ten respondents are uncertain about intending a (further) child. Further, one in two report a different intention between waves, with changes mainly occurring from one "probably" response to another (e.g., "probably not" to "probably yes") or through a shift in increasing or lessening certainty (e.g., "probably yes" to "definitely yes"). The childless exhibit by far the greatest uncertainty and revision. Multivariate analyses show that partnership and employment are associated with gradual transitions and larger changes in intentions. Our results also show that fertility intentions form to a large extent along a spectrum of certainty-from "definitely not," to "probably not," to "probably yes," to "definitely yes," and finally to the birth of a child.

Diverse pathways to permanent childlessness in Singapore: A latent class analysis.

The proportions of adults reaching midlife without having children have been rising rapidly across the globe, particularly in Asia. However, little is known about the pathways to permanent childlessness within the region's childless population. This study utilized latent class analysis (LCA) to typologize pathways to childlessness based on dynamic characteristics of multiple life domains (i.e., partnership, education, and occupation) among 489 childless Singaporeans aged 50 and above from a 2022 nationwide survey. Additionally, we utilized multinomial logistic regressions to examine the sociodemographic correlates of pathway profiles and Shannon's entropy index to assess the heterogeneity in pathways to childlessness among successive cohorts. Results revealed five distinct profiles of pathways to childlessness: the Never-Married Semi-Professionals, the Low-Flex Blue-Collars, the Highly Educated Professionals, the Ever-Married Semi-Professionals, and the Flexible Blue-Collars. These pathway profiles were significantly associated with sociodemographic characteristics such as gender and family background. Women's pathways to childlessness were more standardized and heavily influenced by partnership characteristics, compared to those of men. The childless from privileged family background were less likely to follow pathways characterized by disadvantageous education and occupational status. There were also rising trends of voluntary childlessness among married childless individuals and increasing heterogeneity in pathways to childlessness across successive birth cohorts. In sum, our findings are consistent with some of the predictions of the Second Demographic Transition theory, suggesting that Singapore may be experiencing a demographic transition characterized by rising childlessness, decoupling of marriage and childbearing, and de-standardization of the life course.

A crisis in the life course? Pregnancy loss impacts fertility desires and intentions.

BACKGROUND: An unintended spontaneous termination of a pregnancy can be a traumatic experience affecting the subsequent life course, but has received little attention in socio-demographic studies on fertility intentions or behavior. The theoretical background of our study draws on considerations from life course research, the Theory of Planned Behavior and the Traits-Desires-Intentions-Behavior framework. OBJECTIVE: This study investigates whether the experience of pregnancy loss changes the fertility desires and intentions of women in their subsequent life course. METHODS: We use 11 waves of the Panel Analysis of Intimate Relationships and Family Dynamics (pairfam) with 5197 women in total, of which 281 women (5.4%) reported a miscarriage. Data have been collected annually in Germany since 2008. We investigate four dependent variables capturing different indicators of the ideational dimension of fertility: Personal ideal number of children, realistic number of (additional) children, intention to have a(nother) child in the next two years and importance of having a(nother) child. We study the intrapersonal changes in these items among women after a pregnancy loss, applying linear fixed effect regression models. Controls include parity, age, partnership status, pregnancy status and the interaction of pregnancy loss with whether the woman already had children before the pregnancy loss. RESULTS: We found that the importance of having a(nother) child and the intention to have a(nother) child in the next two years increase after a pregnancy loss. These patterns can only partially be explained by control variables. By contrast, an effect on the ideal number of children as well as the realistic number of children could not be found. The patterns varied, however, across age and stage in the life course, most importantly between mothers and childless women. CONCLUSIONS: Our results demonstrate that the effect of pregnancy loss on the subsequent life course varies across the indicators used and by duration after the pregnancy loss. Overall, they suggest that specifically the younger women in our sample might perceive pregnancy loss as a temporary crisis in their transition to motherhood, or to having another child, and as an impetus to reinforce their fertility goals, while for older respondents this might mark the end of their fertility career. Against the backdrop of rising ages at childbirth, future research on fertility and reproductive health care should pay more attention to reproductive complications and how affected women can be supported in coping with them.

Women's involvement in decision-making and association with reproductive health behaviors: findings from a cross-sectional survey in Niger.

BACKGROUND: Though women in Niger are largely responsible for the familial health and caretaking, prior research shows limited female autonomy in healthcare decisions. This study extends current understanding of women's participation in decision-making and its influence on reproductive health behaviors. METHODS: Cross-sectional survey with married women (15-49 years, N = 2,672) in Maradi and Zinder Niger assessed women's participation in household decision-making in health and non-health issues. Analyses examined [1] if participation in household decision-making was associated with modern contraceptive use, antenatal care (ANC) attendance, and skilled birth attendance at last delivery and [2] what individual, interpersonal, and community-level factors were associated with women's participation in decision-making. RESULTS: Only 16% of the respondents were involved-either autonomously or jointly with their spouse-in all three types of household decisions: (1) large purchase, (2) visiting family/parents, and (3) decisions about own healthcare. Involvement in decision making was significantly associated with increased odds of current modern contraceptive use [aOR:1.36 (95% CI: 1.06-1.75)] and four or more ANC visits during their recent pregnancy [aOR:1.34 (95% CI: 1.00-1.79)], when adjusting for socio-demographic characteristics. There was no significant association between involvement in decision-making and skilled birth attendance at recent delivery. Odds of involvement in decision-making was significantly associated with increasing age and household wealth status, listening to radio, and involvement in decision-making about their own marriage. CONCLUSION: Women's engagement in decision-making positively influences their reproductive health. Social and behavior change strategies to shift social norms and increase opportunities for women's involvement in household decision making are needed. For example, radio programs can be used to inform specific target groups on how women's decision-making can positively influence reproductive health while also providing specific actions to achieve change. Opportunities exist to enhance women's voice either before women enter marital partnerships or after (for instance, using health and social programming).

'Do I want children later in life?' Reproductive intentions of 1700 adolescents.

PURPOSE: In the past decades, a positive attitude towards having children has been reported in young people. The current generation of adolescents is increasingly concerned about environmental cataclysm which may have an impact on their desire for children. The purpose of this study is to depict the current attitudes in Flemish adolescents towards having children. MATERIALS AND METHODS: All secondary schools in Flanders (Belgium) were invited to distribute an anonymous online survey among their pupils in the last two years of secondary education. In total, 1700 adolescents participated and provided quantitative and qualitative data on their reproductive intentions. RESULTS: Most pupils expressed a desire for children (60.2%), 24.7% were undecided and 10.8% were not willing to have children. Significantly more boys than girls would like to have children (67.0% versus 61.7%, p < 0.01). Adolescents who were uncertain about having children or not interested, reported financial reasons and loss of freedom as most important reasons. CONCLUSIONS: While most adolescents would like to have children in the future, one in four adolescents is undecided and one in ten indicates a wish to remain childless; reasons for wanting children are rather personal, reasons for not wanting children are rather pragmatic.

A desire for parenthood is no longer the norm: 60% of Flemish adolescents would like to build a family, but many are considering a future without children.

"My Mother Persuaded Me to Have More Children", Understanding the Influence of Social Network on Fertility Behavior in Sub-Saharan Africa.

Introduction: Despite the adoption of an antenatal demographic transition model in sub-Saharan Africa, population growth continues to soar in the region. The reasons for population growth are nebulous and should be approached from different perspectives. Inadequate attention has been paid to how social pressures shape reproductive behavior. Thus, this study examines the association between social networks and fertility behavior in sub-Saharan Africa. Methods: This study used a cross-sectional design that employed a qualitative method to conduct 28 in-depth interviews among married women. Data was collected in 2023. Thematic analyses were utilized to interpret the results. Results: Parental pressure, the desire for more children, the desire for male children, values placed on children, norms, and pronatalist culture were associated with high fertility in sub-Saharan Africa. Conclusions: Thus, there is a need for more awareness of family planning and contraceptive use in order to reduce fertility in sub-Saharan Africa.

What factors influence couples' decisions to have children? Evidence from a systematic scoping review.

BACKGROUND: One of the most significant demographic challenges over the past three decades has been the substantial reduction in fertility rates, worldwidely. As a developing country, Iran has also experienced a rapid decline in fertility over the past decades. Understanding factors influencing fertility is essential for development programs. Moreover, it's crucial to study the parameters that affect the intention for childbearing in any society. Therefore, through a systematic scoping review, the present study investigates the factors influencing couples' decisions toward childbearing. METHODS: This study was a systematic scoping review conducted in 2023. To design and conduct this scoping review, Joanna Briggs Institute's Protocol (Institute TJB, The Joanna Briggs Institute Reviewers ' manual 2015; methodology for JBI scoping reviews, 2015) was used and the framework presented by Levac et al. (2010) was also used as a guide for conducting this review. Studies were searched in three main databases including ISI Web of Sciences, PubMed, and Scopus, using a predefined search strategy. Google Scholar was also used for complementary search. The search period was from 2002 to 2022. RESULTS: A total of 18,454 studies were identified across three primary databases. After evaluating articles in three distinct phases based on title, abstract, and full-text, 46 articles were deemed eligible for inclusion in the scoping review. The qualitative analysis of the collected data from the selected studies through the scoping review led to classifying factors influencing households' desire for childbearing into eight main themes and 101 sub-themes. The main themes associated with factors impacting households' intention for childbearing encompass individual determinants, demographic and familial influencing factors, cultural elements, social factors, health-related aspects, economic considerations, insurance-related variables, and government support/incentive policies. CONCLUSIONS: Comprehensive and holistic attention from governments and officials toward the various factors affecting households' intention and behavior regarding childbearing appears beneficial and effective. Furthermore, given the relative ineffectiveness of some of the current government's supportive/incentive policies to increase couples' desire for childbearing, it seems necessary to review and amend these policies. This review should address the most significant challenges and factors contributing to couples' reluctance to childbearing or strengthen factors that can play a substantial role in fostering fertility and childbearing desires.

Reproductive Decision Making of Spanish Women Living With HIV: A Constructivist Grounded Theory Study.

ABSTRACT: The process of reproductive decision making among women living with HIV is intricate and multifaceted, influenced by health considerations, societal factors, and personal values. In this study, we employed Charmaz's Constructivist Grounded Theory to understand how Spanish women living with HIV make decisions regarding reproduction. We conducted 26 face-to-face interviews until data saturation was achieved. Findings suggested that social constructs such as femininity and motherhood play a significant role in the reproductive decision-making process for women living with HIV. The women's beliefs about HIV, doubts, marginalizing situations, and health barriers create challenges to making reproductive decisions. These findings provide valuable implications for designing care plans that meet the unique sexual and reproductive health needs of women with HIV. An integrated and comprehensive multidisciplinary counseling approach is necessary to improve the quality of care.

Estudiantes universitarias nuligestas en edad fértil y su postura acerca de posibles vías del parto / Nuligest university students of childbearing age and their position about possible ways of delivery

Resumen Introducción: Tanto a nivel sudamericano como mundial, el incremento de la tasa de cesáreas electivas ha sido abrumante. Esto se considera un problema de salud pública, ya que el parto vaginal es la vía más fisiológica para el nacimiento y trae beneficios de salud para la madre y el recién nacido, tanto inmediatos como a futuro. Objetivo: Evaluar la postura de mujeres nuligestas en edad fértil acerca de las vías del parto a través de sus conocimientos, percepciones y preferencias. Método: Estudio de corte transversal. Se aplicó una encuesta a estudiantes universitarias para la recopilación de datos mediante SPSS, y análisis con prueba de diferencias de proporciones y de χ2. Resultados: 210 mujeres encuestadas. Un 80% de ellas desconoce la menor morbilidad infantil asociada a un parto vaginal, más de la mitad estima una ventaja de la cesárea que evite el dolor y un gran porcentaje desconoce los riesgos médicos asociados a la cesárea. Conclusiones: Existe un alto nivel de desconocimiento respecto a beneficios, riesgos y consecuencias de las diferentes vías del parto.

Abstract Introduction: Both in South America and worldwide, the increase in the rate of elective caesarean sections has been overwhelming. This is considered a public health problem, since vaginal delivery is the most physiological route for birth and brings health benefits for the mother and the newborn, immediately and in the future. Objective: To evaluate the position of nulliparous women of childbearing age regarding the delivery pathways through their knowledge, perceptions, and preferences. Method: Cross-sectional study with an analytical component. A survey was applied to university students for data collection through SPSS, and analysis was made with the difference of proportions and χ2 test. Results: 210 women surveyed; 80% of them are unaware of the lower infant morbidity associated with a vaginal delivery, more than a half estimate an advantage of a cesarean section that it avoids pain, and a large percentage are unaware of the medical risks associated with cesarean sections. Conclusions: There is a high level of ignorance regarding the benefits, risks and consequences of the different delivery routes.

The impact of COVID-19 on fertility behaviour and intentions in a middle income country.

The COVID Pandemic may affect fertility behaviour and intentions in many ways. Restrictions on service provision reduce access to family planning services and increase fertility in the short term. By contrast, the economic uncertainty brought about by the pandemic and its impact on mental health and well-being may reduce fertility. These various pathways have been explored in the context of high income countries such as the United States and Western Europe, but little is known about middle income countries. In this paper we asses the impact of the COVID pandemic on fertility intentions and behaviour in the Republic of Moldova, a middle income country in Eastern Europe, using the Generations and Gender Survey. This survey was conducted partially before and partially after the onset of the pandemic in 2020, allowing for detailed comparisons of individual circumstances. The results indicate that the pandemic reduced the used of intrauterine devices, and increased the use of male condoms, but with no overall decrease in contraceptive use. Conversely individuals interviewed after the onset of the pandemic were 34.5% less likely to be trying to conceive, although medium term fertility intentions were unchanged. Indicators therefore suggest that in the medium term fertility intentions may not be affected by the pandemic but restricted access to contraception requiring medical consultation and a decrease in short-term fertility intentions could disrupt short term family planning.

Women's perceptions and experiences of reproductive coercion and abuse: a qualitative evidence synthesis.

BACKGROUND: Reproductive coercion and abuse is a major public health issue, with significant effects on the health and well-being of women. Reproductive coercion and abuse includes any form of behaviour that intentionally controls another person's reproductive choices. The aim of this qualitative evidence synthesis is to explore women's experiences of reproductive coercion and abuse globally, to broaden understanding of the different ways reproductive coercion and abuse is perpetrated, perceived and experienced across settings and socio-cultural contexts. METHOD: We searched Medline, CINAHL and Embase for eligible studies from inception to 25th February 2021. Primary studies with a qualitative study design that focused on the experiences and perceptions of women who have encountered reproductive coercion and abuse were eligible for inclusion. Titles and abstracts, and full texts were screened by independent reviewers. We extracted data from included studies using a form designed for this synthesis and assessed methodological limitations using CASP. We used Thomas and Harden's thematic analysis approach to analyse and synthesise the evidence, and the GRADE-CERQual approach to assess confidence in review findings. RESULTS: We included 33 studies from twelve countries in South Asia, the Asia Pacific, North America, South America, Africa and Europe. Most studies used in-depth interviews and focus group discussions to discuss women's experiences of reproductive coercion and abuse. Reproductive coercion and abuse manifested in a range of behaviours including control of pregnancy outcome, pregnancy pressure or contraceptive sabotage. There were a range of reasons cited for reproductive coercion and abuse, including control of women, rigid gender roles, social inequalities and family pressure. Women's different responses to reproductive coercion and abuse included using covert contraception and feelings of distress, anger and trauma. Across contexts, perpetration and experiences of reproductive coercion and abuse were influenced by different factors including son preferences and social exclusion. CONCLUSIONS: We reflect on the importance of socio-cultural factors in understanding the phenomenon of reproductive coercion and abuse and how it affects women, as well as how the mechanisms of power and control at both individual and societal levels work to perpetuate the incidence of reproductive coercion and abuse against women.