妊娠期女性生育动机与再生育意愿的关系:基于有调节的中介与fsQCA分析

Fertility motivation and reproductive intention among pregnant women: a moderated mediation and fsQCA analysis

摘要

目的 探讨妊娠期女性生育动机与再生育意愿的关系,检验母胎依恋的中介作用以及配偶无效回应的调节作用,并通过模糊集定性比较分析识别再生育意愿的形成路径。 方法 采用便利抽样法,选取2025年4月3日至8月23日在山东省济南市妇幼保健院产检就诊的556例妊娠期女性进行问卷调查。问卷包括一般资料调查表、生育动机量表、配偶无效回应量表及母胎依恋量表。构建有调节的中介模型,结合模糊集定性比较分析,探讨再生育意愿的形成机制。 结果 193例(34.7%)孕期女性报告有再生育意愿。有调节的中介模型分析结果表明,在自主型生育动机模型中,自主型生育动机对再生育意愿的直接效应不明显(P=0.061),母胎依恋的中介效应明显(间接效应=0.002,95%CI:0.001~0.005),配偶无效回应对自主型生育动机与再生育意愿之间的关系具有较大调节作用(P=0.039);在控制型生育动机模型中,控制型生育动机对再生育意愿的直接效应明显(P<0.001),母胎依恋的中介效应同样明显(间接效应=0.001,95%CI:0.001~0.002),配偶无效回应调节母胎依恋与再生育意愿之间的路径(P=0.039)。模糊集定性比较分析(fuzzy-set qualitative comparative analysis, fsQCA)结果识别无再生育意愿多种组态结构:初产妇分为“多维薄弱型”和“压力对抗型”,经产妇则包括“协同决策型”“多维薄弱型”“转化脱节型”。 结论 通过增强生育动机、提高母胎依恋并优化伴侣情感回应,有助于改善妊娠期女性的生育心理环境,为再生育意愿的形成提供支持。

Abstract

Objective To investigate the association between fertility motivation and reproductive intention among pregnant women and to examine the mediating role of maternal-fetal attachment and the moderating role of spousal invalidating responses. Configurational pathways underlying reproductive intention were further identified using fuzzy-set qualitative comparative analysis(fsQCA). Methods Using convenience sampling, a total of 556 pregnant women were recruited from an antenatal clinic of Jinan Maternity and Child Care Hospital in Shandong Province between April 3 and August 23, 2025. Data were collected using a general information questionnaire, the Fertility Motivation Scale, the Maternal-Fetal Attachment Scale, and the Spousal Invalidating Responses Scale. A moderated mediation model, combined with Fuzzy-set qualitative comparative analysis, was used to explore the underlying mechanisms of reproductive intention. Results Among the participants, 193(34.7%)reported an intention to have another child. The moderated mediation analysis showed that, in the autonomous fertility motivation model, the direct effect of autonomous fertility motivation on re-fertility intention was not significant(P=0.061), while maternal-fetal attachment exerted a significant mediating effect(indirect effect=0.002, 95%CI: 0.001-0.005). Spousal invalidating responses significantly moderated the association between autonomous fertility motivation and reproductive intention(P=0.039). In the controlled fertility motivation model, controlled fertility motivation had a significant direct effect on reproductive intention(P<0.001), and maternal-fetal attachment also showed a significant mediating effect(indirect effect=0.001, 95%CI: 0.001-0.002). Spousal invalidating responses significantly moderated the relationship between maternal-fetal attachment and reproductive intention(p=0.039). The fsQCA identified several configurational pathways linked to the absence of reproductive intention. Two patterns were observed among primiparous women(multidimensional weakness and stress confrontation), and three among multiparous women(collaborative decision-making, multidimensional weakness, and transformation-disconnection). Conclusion To enhance fertility motivation, strengthen maternal-fetal attachment, and improve spousal emotional responses may help optimize the psychological context of pregnancy and support the development of reproductive intention.

关键词

再生育意愿 / 生育动机 / 母胎依恋 / 配偶无效回应 / 妊娠期女性

Key words

Reproductive intention / Fertility motivation / Maternal-fetal attachment / Spousal invalidating responses / Pregnant women

参考文献

[1] 国务院. 国务院关于印发中国妇女发展纲要和中国儿童发展纲要的通知[EB/OL].(2021-09-27)[2025-08-25]. http://www.gov.cn/zhengce/content/2021-09/27/content_5639412.htm

[2] Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being[J]. Am Psychol, 2000, 55(1): 68-78.

[3] Miller WB. Childbearing motivations, desires, and intentions: a theoretical framework[J]. Genet Soc Gen Psychol Monogr, 1994, 120(2): 223-258.

[4] 宋健, 胡波. 中国育龄人群的生育动机与生育意愿[J]. 人口与经济, 2022(6): 1-16.

[5] SONG Jian, HU Bo. Fertility motivation and intention of Chinese people of childbearing age[J]. Population & Economics, 2022(6): 1-16.

[6] Bielawska-Batorowicz E, Siddiqui A. A study of prenatal attachment with Swedish and Polish expectant mothers[J]. J Reprod Infant Psychol, 2008, 26(4): 373-384.

[7] 张新涵, 袁苗, 包梦雨, 等. 孕妇生育动机与主观幸福感及母胎依恋的关系研究[J]. 护理学杂志, 2024, 39(1): 26-30.

[8] ZHANG Xinhan, YUAN Miao, BAO Mengyu, et al. Relationships among fertility motivation, subjective well-being and maternal-fetal attachment: a latent class analysis[J]. Journal of Nursing Science, 2024, 39(1): 26-30.

[9] 李海云, 张国春, 褚梁梁, 等. 孕晚期妇女母胎依恋现状及其与分娩恐惧的相关性研究[J]. 军事护理, 2024, 41(3): 1-4.

[10] LI Haiyun, ZHANG Guochun, CHU Liangliang, et al. Status quo of maternal-fetal attachment in late pregnancy and its correlation with fear of childbirth[J]. Military Nursing, 2024, 41(3): 1-4.

[11] 曹丹凤, 李慧. 儿童期不良经历对妊娠期抑郁症状的影响: 母胎依恋的中介作用[J]. 山东大学学报(医学版), 2024, 62(3): 87-91.

[12] CAO Danfeng, LI Hui. Influence of adverse childhood experiences on depression in pregnancy: mediating effect of maternal-fetal attachment[J]. Journal of Shandong University(Health Science), 2024, 62(3): 87-91.

[13] Ko E, Lee Y. Influencing factors and consequences of maternal-fetal attachment among pregnant women in east Asia: a scoping review[J]. J Transcult Nurs, 2026, 37(1): 110-125.

[14] 高珍珍. 整合家庭系统医疗理论下伴侣参与式支持对妊娠期高血压患者负面情绪及自我效能的影响[J]. 中国医药指南, 2025, 23(30):179-181.

[15] GAO Zhenzhen. The impact of partner participatory support on negative emotions and self-efficacy in patients with gestational hypertension under the integrated family systems medical theory[J]. Guide of China Medicine, 2025, 23(30):179-181.

[16] Ghanbari-Homayi S, Mohammad-Alizadeh-Charandabi S, Meedya S, et al. The Impact of first childbirth experience on women’s attitude towards having another child and subsequent vaginal birth[J]. Current Women’s Health Reviews, 2021, 17(3): 244-250.

[17] 卿石松, 温敏. 三孩政策下已婚人群的再生育意愿研究: 基于数量和确定性视角的分析[J]. 中国人口科学, 2024, 38(2): 82-97.

[18] QING Shisong, WEN Min. Analysis on the fertility intention for additional births in the three-child policy era: viewing from quantity and certainty perspectives[J]. Chinese Journal of Population Science, 2024, 38(2): 82-97.

[19] 杨丛品, 罗卓野, 许秀华, 等. 河北省某医院体检3 512例育龄女性生育选择及压力现状[J]. 山东大学学报(医学版), 2022, 60(4): 62-67.

[20] YANG Congpin, LUO Zhuoye, XU Xiuhua, et al. Reproductive choices and pressure in 3, 512 women of childbearing age in a hospital in Hebei Province[J]. Journal of Shandong University(Health Science), 2022, 60(4): 62-67.

[21] 李诗和. 论大生育观及其对理解包容性生育支持政策的启示[J]. 理论月刊, 2025(5): 113-121.

[22] 崔碧颖. 当代女性生育动机及其影响研究[D]. 成都: 四川师范大学, 2018.

[23] Condon JT, Corkindale C. The correlates of antenatal attachment in pregnant women[J]. Br J Med Psychol, 1997, 70(4): 359-372.

[24] 聂戈, 范红霞. 母胎依恋关系量表的修订及信效度检验[J]. 中国临床心理学杂志, 2017, 25(4): 675-677.

[25] NIE Ge, FAN Hongxia. Validity and reliability of the Chinese version maternal antenatal attachment scale[J]. Chinese Journal of Clinical Psychology, 2017, 25(4): 675-677.

[26] 李丹, 王雪琴, 张奔奔, 等. 生育动机与母亲抑郁的关系: 配偶无效回应和情绪调节自我效能感的中介作用[J]. 中国临床心理学杂志, 2024, 32(5): 988-992.

[27] LI Dan, WANG Xueqin, ZHANG Benben, et al. The relationship between fertility motivation and maternal depression: the mediating role of spouses’ invalidating response and self-efficacy of emotional regulation[J]. Chinese Journal of Clinical Psychology, 2024, 32(5): 988-992.

[28] Mountford V, Corstorphine E, Tomlinson S, et al. Development of a measure to assess invalidating childhood environments in the eating disorders[J]. Eat Behav, 2007, 8(1): 48-58.

[29] Morgan SL. Redesigning social inquiry: fuzzy sets and beyond[J]. Social Forces, 2010, 88(4): 1934-1936.

[30] Schneider CQ, Wagemann C. Set-theoretic Methods for the Social Sciences: A Guide to Qualitative Comparative Analysis[M]. Cambridge: Cambridge University Press, 2012: 23-41.

[31] 杜运周, 贾良定. 组态视角与定性比较分析(QCA): 管理学研究的一条新道路[J]. 管理世界, 2017, 33(6): 155-167.

[32] DU Yunzhou, JIA Liangding. Configuration perspective and qualitative comparative analysis(QCA): a new way of management research[J]. Management World, 2017, 33(6): 155-167.

[33] 郑旭君, 徐嘉, 郑慧, 等. 已孕育女性再生育意愿现状及其影响因素[J]. 护理研究, 2025, 39(2): 272-278.

[34] ZHENG Xujun, XU Jia, ZHENG Hui, et al. Status quo and influencing factors of willingness to reproduce among pregnant and postpartum women[J]. Chinese Nursing Research, 2025, 39(2): 272-278.

[35] 杨娟, 尚丽, 陆草, 等. 深圳市育龄女性再生育意愿及生育支持措施需求研究[J]. 卫生软科学, 2025, 39(5): 83-88.

[36] YANG Juan, SHANG Li, LU Cao, et al. Study on the willingness to have children again and the demand for birth support measures of women of reproductive age in Shenzhen[J]. Soft Science of Health, 2025, 39(5): 83-88.

[37] Ayala K, Falcioni L, Eilbott J, et al. Associations between fetal movement and maternal-fetal attachment in late pregnancy[J]. Early Hum Dev, 2025, 210: 106351. doi:10.1016/j.earlhumdev.2025.106351

[38] Canlı A, Demirtaş B. Prenatal attachment and the relationship with body self-perception[J]. J Obstet Gynecol Neonatal Nurs, 2022, 51(1): e1-e12.

[39] Hao MY, Zhang CX, Fu HF, et al. Fertility intentions among Chinese adults: a cross-sectional study using a national survey[J]. BMC Public Health, 2025, 25(1): 2677. doi:10.1186/s12889-025-23725-w

[40] Yu X, Liang JN. Social norms and fertility intentions: evidence from China[J]. Front Psychol, 2022, 13: 947134. doi:10.3389/fpsyg.2022.947134

[41] Purwati Y, Pramono N, Hakimi M, et al. Participant analysis of the need for prenatal attachment education packages[J]. Kontakt, 2024, 26(3): 309-316.

[42] Diezi AS, Vanetti M, Robert M, et al. Informing about childbirth without increasing anxiety: a qualitative study of first-time pregnant women and partners’ perceptions and needs[J]. BMC Pregnancy Childbirth, 2023, 23(1): 797. doi:10.1186/s12884-023-06105-3

[43] Li RH, Wang S, Wu TL. When I receive too much social support: the effect of social support overload on users' life burnout and discontinuance in fitness apps[J]. Healthcare, 2025, 13(2): 191. doi:10.3390/healthcare13020191

[44] Peng YN. Should we have a second child? Reproductive decisions and family negotiation under China’s two-child policy[J]. J Contemp China, 2020, 29(125): 792-807.

[45] Abidin FA, Anindhita V, Sunardy GN, et al. When gratitude and social support make the difference: buffering the impact of parental role restriction on maternal burnout[J]. Acta Psychol, 2025, 260: 105554. doi:10.1016/j.actpsy.2025.105554

[46] Volling BL, Tan L, Rosenberg L, et al. Will I love my second baby as much as my first? Prevalence and psychosocial correlates of maternal-fetal relationship anxiety for second-time mothers[J]. Infant Ment Health J, 2023, 44(4): 541-553.

[47] 杨丛品, 罗卓野, 许秀华, 等. 河北省某医院体检3 512例育龄女性生育选择及压力现状[J]. 山东大学学报(医学版), 2022, 60(4): 62-67.

[48] YANG Congpin, LUO Zhuoye, XU Xiuhua, et al. Reproductive choices and pressure in 3,512 women of childbearing age in a hospital in Hebei Province[J]. Journal of Shandong University(Health Science), 2022, 60(4): 62-67.

[49] Daniele MAS. Male partner participation in maternity care and social support for childbearing women: a discussion paper[J]. Philos Trans R Soc Lond B Biol Sci, 2021, 376( 1827): 20200021. doi:10.1098/rstb.2020.0021

[50] Dehshiri M, Ghorashi Z, Lotfipur SM. Effects of husband involvement in prenatal care on couples’ intimacy and postpartum blues in primiparous women: a quasi-experimental study[J]. Int J Community Based Nurs Midwifery, 2023, 11(3): 179-189.

基金资助

山东省自然基金面上项目(ZR2022MG063)