The present descriptive correlational study was conducted on 213 married women aged 15 to 45 years presenting to the family health units of healthcare centers in Tehran during 2015 to 2016. The study population consisted of only women because women are the main caregivers of children and endure a greater parental pressure and stress than men (
30). The study inclusion criteria consisted of 15 to 45 years of age, Iranian nationality, being married, having at least 1 child and at most 3 children, having reading and writing literacy, and having had wanted pregnancies only. The study exclusion criterion was leaving any questions unanswered. Multistage sampling method was used to select the study participants. After obtaining the approval of the authorities at Shahid Beheshti University of Medical Sciences, we divided the municipal areas covered by Shahid Beheshti University of Medical Sciences and Health Services into North, East, and Shemiranat sections. Two healthcare centers were then randomly selected from each area using cluster sampling. A quota was assigned to each healthcare center based on the study sample size of 230 and in proportion to the number of patients admitted to each center. The selected centers were then visited and the admitted women who met the inclusion criteria were selected through convenience sampling and invited to participate in the study. Ethical approval was obtained from the ethics committee of Shahid Beheshti University of Medical Sciences (code SBMU2.REC.1394.152). An informed consent was obtained from all the participants.
Finally, the demographic questionnaire, the ENRICH marital satisfaction scale, and a researcher-made childbearing questionnaire were distributed among the participants. The researcher-made childbearing questionnaire was designed based on different studies and theses (
24,
31-
37) and examined factors affecting women’s childbearing including the age of the woman and her spouse, age at marriage, duration of marriage, the woman and her spouse’s level of education, the woman and her spouse’s birth place, the couple’s ethnicity, the woman’s and her spouse’s occupation, the number of children, children’s gender and age, the age gap between the children, the number of pregnancies and time since marriage, and the birth of the first child.
In the present study, the content validity method was used to evaluate the validity of the demographic and childbearing questionnaires. The childbearing questionnaire was developed based on the set research objectives. After obtaining the approval of the research supervisor and advisor, we distributed the questionnaire to 10 faculty members of the department of reproductive health, school of nursing and midwifery, Shahid Beheshti University of Medical Sciences and to 10 experts of the field (experts in demography, psychology, and health). After making the necessary modifications, the content validity of the questionnaire was qualitatively assessed, and the content validity index (CVI) and content validity reliability (CVR) were measured for its quantitative assessment, Based on Lawshe’s table, items with scores above 0.62 were considered acceptable (
38). To assess the face validity of the questionnaire for item difficulty, relevance, and ambiguity, the questionnaire was distributed to the target group (15 women aged 15 - 45 years) who met the inclusion criteria. The quantitative assessment of the face validity of the items was conducted using the impact score. The reliability of the questionnaire was assessed using the test-retest method. Thus, 20 eligible women completed the questionnaire on 2 occasions with an interval of 14 days, moreover, a correlation coefficient of 0.85 was obtained between the scores, which was acceptable because it was greater than 0.7 (
39). The ENRICH Marital Satisfaction Scale was used to evaluate marital satisfaction. This scale has been used in numerous reliable studies as a valid tool for determining marital satisfaction (
31,
40,
41). The ENRICH marital satisfaction scale was designed by Fowers and Olson in 1989 (
42). The original version is very long and may wear out the respondents. In a study entitled “Factors of Successful Marriage: Accounts from self-described Happy Couples”, Asoodeh (2010) prepared a short 35-item version of this scale and translated it (
43). This scale has 4 subscales including idealistic distortion (Items 4, 8, 12, 16, and 20), marital satisfaction (Items 1, 5, 9, 13, 17, 21, 24, 27, 30, and 35), communication (Items 2, 6, 10, 14, 22, 25, 28, 31, and 34), and conflict resolution (Items 3, 7, 11, 15, 19, 23, 26, 29, 32, and 33). The scale items are designed to be scored based on a 5-point Likert-type scale and their responses include strongly agree, agree, neither agree nor disagree, and disagree and strongly disagree, which are given scores from 1 to 5. Items 3, 5, 6, 7, 10, 13, 14, 18, 19, 21, 22, 23, 26, 27, 28, 29, 32, 33, and 34 are reverse-scored; ie, 1 point is given to a response of ‘strongly agree’ and 5 points to a response of ‘strongly disagree’. Each subscale has a separate total score, which is then converted to percentage. The alpha coefficients obtained were 0.80, 0.86, 0.84, and 0.83 and the test-retest reliability coefficients were 0.86, 0.81, 0.90, and 0.92, respectively, for the marital satisfaction, communication, conflict resolution, and idealistic distortion subscales. In Asoodeh’s study of 365 couples (730 individuals), alpha coefficients were calculated as 0.78, 0.78, 0.62, and 0.77 for the marital satisfaction, communication, conflict resolution, and idealistic distortion subscales (
43).
The data obtained were analyzed in SPSS-17. Descriptive statistics (frequency, percentage, mean, and standard deviation) were used to describe participants’ demographic and childbearing details and their marital satisfaction. ANOVA was used to determine the relationship between the number and gender composition of the children (having only sons, having only daughters, and having children of both genders) and marital satisfaction. The level of statistical significance was set at P < 0.05.