**What's Known**

Voluntary permanent childlessness among Iranian couples is increasing, but its cause has not yet been determined.Since 1980, several studies have been conducted globally on the issue of permanent voluntary childlessness. However, there have been no studies in Iran on this phenomenon.

**What's New**

The causal conditions of childlessness include high-risk society and adverse experiences. Contextual and intervening conditions include social problems, social support, transitional society, natural resources, social presence of women, and marriage age.Strategies and interactions of childless people include suppression of feelings, conflict, rationality, and malingering. The core phenomenon is individualism.

Introduction {#sec1-1}
============

A decrease in the number of children among Iranian families is a major issue that has attracted the attention of researchers studying childbearing tendency and affecting factors from the viewpoint of the general public.^[@ref1]^ Such a reduction has made Iran unique among the Islamic countries.^[@ref2]^ According to the 2016 National Population Census in Iran, fertility rates have dropped below the replacement level. In the near future, this reduction may cause a decrease in the active and productive population, have higher impact on the aged population, and create social security issues related to the proportion of the aged people.^[@ref3],[@ref4]^ Currently, childlessness based on choice rather than as a result of infertility has increased among married women.^[@ref5]^ There are fertile people who make a conscious and permanent decision not to have children. Many studies have been conducted in Iran on involuntary and temporary childlessness and childbearing intentions.^[@ref4],[@ref6]^ However, studies on the newly emerging phenomenon of voluntary childlessness as a permanent status are scarce.

Childlessness is a predictor of social isolation and loneliness at old age.^[@ref7],[@ref8]^ Voluntarily childless people are perceived as immature, selfish, having sexual problems, and marital issues. These people are generally warned about loneliness at old age.^[@ref9]^ Childlessness, as a social phenomenon and a way of adaptation to social changes,^[@ref10]^ has turned into an important subject in reproductive health studies and has attracted the attention of family health care professionals. The use of contraceptive methods has made parenting an option.^[@ref11]-[@ref13]^ Although the identity of a woman is commonly tied to childbearing, the trend of childlessness is growing among couples.^[@ref14]^ While the physical, mental, social health, and well-being of childless people remain unclear, social scientists and mental health care professionals are attracted to contemplate on and research into the social phenomenon of voluntary childlessness and its negative consequences in terms of health and well-being.^[@ref9],[@ref15]^

Approximately 30% of the Australian and 8% of the American women are still childless at the end of their childbearing age.^[@ref16],[@ref17]^ Unofficial statistics show that 8.5% of the married Iranian women have opted for voluntary childlessness.^[@ref18]^ Additionally, 9% of childless couples in Tehran (Iran) intend to remain childless.^[@ref4]^ In a society where childbearing has a special value and childlessness is seen as generational discontinuity, such statistics is high and require further research. Hence, the present qualitative study aimed to investigate the causes and underlying factors of voluntary childlessness and to provide an explanatory model of this phenomenon among Iranian couples.

Subjects and Methods {#sec1-2}
====================

The present study was carried out to identify and develop the categories and concepts of childlessness from the perspective of Iranian men and women. Childlessness has a complex and multi-factorial nature. It is culturally sensitive, process-based, participatory-oriented, and a context-bound phenomenon. However, despite all these, its dimensions have not yet been thoroughly examined in Iran.

A qualitative study was conducted in Tehran (Iran), during March-December 2016, using the grounded theory approach and purposive sampling followed by theoretical sampling. Fertile couples who made a conscious decision not to have children were recruited for the study. University professors, students, friends, and colleagues were requested to identify and introduce such couples into our research program. Invitation letters were distributed in universities across Tehran and published on social media. The inclusion criteria were being married, living in Tehran, no infertility problems, no children, and having made a conscious permanent decision not to have children. A total of 103 individuals were identified out of which 49 candidates who met the inclusion criteria were selected for an interview. In the process, 9 candidates decided not to participate. After the 33rd interview, no further data that could develop, adjust, or add to the existing categories was extracted. In other words, additional data made no changes to the existing classifications and did not offer any new categories. Hence, theoretical saturation was reached.

*Data Collection and Analysis* {#sec2-1}
------------------------------

Data were collected through semi-structured, open-ended, in-depth individual interviews as well as a focus group (6 participants) interview. Initially, a pilot study was conducted with one man and one woman and the results were used for encoding. Initial questions were: what is motherhood/fatherhood to you? Let's delve into your past, when did you first realize that you really do not want any children? If someone asks you about children, would you tell them that you do not wish to have any children? Additional questions were: tell me why and how you reached such a decision? Under exactly which circumstances and when did you finalize your decision?

The type and the order of the questions were changed considering the progress of the interview and the emerging data. The location for the interview was chosen by the participants, each interview lasted 40-75 minutes, and a tape recorder was used to record the interview. The recorded interviews were transcribed and typed immediately. Nineteen transcripts were returned to the participants for additional comments or corrections.

The data were analyzed with the MAXQDA software 10.0 using the Strauss and Corbin's (1998) method.^[@ref19]^ All interviews were analyzed meticulously, initial codes were extracted during brainstorming sessions and ongoing comparisons, and were then classified according to their similarities and differences to form a sub-theme. Two data coders coded the data. The encoding was carried out on three levels: open coding, axial coding, and selective coding. A description of the coding tree and diagrams were drawn during the analysis after reviewing the field notes, and finally, the resulting 1,178 codes were divided into 44 sub-categories. A central category and 21 themes were derived from the data.

The four criteria (dependability, conformability, credibility, and transferability) provided by Lincoln and Guba^[@ref20]^ were used to ensure the rigor and credibility of the study. Prior to the interviews, a written informed consent was obtained from the participants and they were ensured that their voice and details would not be published without their consent. The present study was approved by the University Research Ethics Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran (IR.USWR.REC.1395.80).

Results {#sec1-3}
=======

The participants consisted of 10 men and 23 women with a mean age of 36 years (21-64) at the time of the interview, and a mean age at marriage of 26 years (17-46). The education level of the participants and their spouses varied from high school diploma to Ph.D. All participants, including their spouses, were employed. Among the options (excellent, good, moderate, and poor), most participants declared their financial status as moderate. The participants had been brought up in households of 3-12 people. Categories extracted from the data are shown in [table 1](#T1){ref-type="table"}.

###### 

Categories extracted from data of permanent voluntary childlessness.

  Theme                               Sub-themes
  ----------------------------------- ---------------------------
  High-risk society                   Vague future
  Fear                                
  Children's expectations             
  Adverse experiences                 Bad childhood experiences
  Negative childbearing experiences   
  Individualism                       Selfishness
  Nonchalance                         
  Indolence                           
  Strategies                          Suppression of feelings
  Conflicts                           
  Malingering                         
  Agreement                           
  Rationalization                     
  Contextual conditions               Social hazards
  Social support                      
  Society in transition               
  Intervening conditions              Lack of natural resources
  Postponed marriage                  
  Social presence of women            
  Consequences                        Freedom
  Abortion                            
  Adopting children                   
  Charitable activities               
  Keeping pets                        
  Loneliness                          

*Causal Conditions* {#sec3-1}
-------------------

-   The high-risk society: Risk is the core phenomenon of progressive modernity. A high-risk society consists of a set of interrelated changes in social life, including the reduced influence of tradition on personal identity and the disintegration of traditional family patterns. Different decisions such as marriage or childbearing involve risks for individuals.

-   Fear of an uncertain future: Hopelessness attitude and financial instability are regarded as the most important obstacles to childbearing. Those who have no hope for the future, try to reduce their problems by controlling reproduction. A 33-year-old man, married for 3 years, stated: "You try so hard to have a child, but then you have no way of predicting the child's future. I will not have a child until I have control over the circumstances."

-   The child's expectations: Life patterns have changed dramatically compared to the past and the demand for amenities has risen. In turn, the resultant expectations have transformed childbearing behaviors and values. A 31-year-old woman, married for 4 years, stated: "You are indebted to one person, all your life, and that person is your child. Children always feel that their parents have not done enough for them."

*Adverse Experiences* {#sec3-2}
---------------------

-   Bad childhood experiences: Adult life is influenced by childhood experiences. Bad childhood experiences and dissatisfaction could be the reason for preventing another child to endure the same experience. A 30-year-old man, married for 4 years, stated: "My adolescence could have been better. Looking back, considering it was the hardest period of my life, I am more determined not to have a child."

-   Negative experiences of others with children: The difficulties of other parents in bringing up a child (defiance, fights, illness, and death) may explain why some people decide not to have any children. A 31-year-old woman, married for a year, stated: "Women my age with children have greatly influenced my decision not to have children. They considered having a child as a mistake."

*Contextual Conditions* {#sec3-3}
-----------------------

-   Social problems: Social problems such as unemployment, addiction, poverty, divorce, etc. are among the contextual conditions for deciding on permanent childlessness. A 35-year-old woman, married for 10 years, commented: "The statistics on runaway girls is high. I know the daughter of a university professor who injects drugs. Why on earth should a baby come to this world?"

-   Social support: Support from other people (family members, friends, and colleagues) makes you feel being cared for, supported, respected, and valued. They offer the required resources if needed. A 33-year-old woman, married for 10 years, argued: "Tehran is an anti-baby city. Only if the community provides support for my child, then I will have a baby. In the old days, families gave support to married couples. I need social and emotional support in order to have a child."

-   The transitional society: Societies in transition toward modernity are imbued with people who attempt to rapidly adapt to the new environment and changes that are taking place. Therefore, they are faced with various social conflicts and abnormalities. Such turbulence affects the balance and stability of families and may manifest itself as childlessness. A 37-year-old woman, married for 14 years, stated: "We married without the usual ceremonies. The traditional structure was unacceptable to us. I saw discrimination between boys and girls and did not wish to conform to these social norms."

*Intervening Conditions* {#sec3-4}
------------------------

In the process of deciding whether to have children, the following conditions intervene as mediators:

-   Natural resources and the environment: Environmental factors are part of the mediating conditions for deciding not to have any children. A 44-year-old man, married for 17 years, stated: "There are not enough resources for the whole population and natural resources are running out. We face unhealthy air, water pollution, and fine dust pollution."

-   Delayed marriage: Marriage at an older age is one of the key factors contributing to reduced fertility and plays a major role in the decision not to have children. A 37-year-old woman, married for 14 years, stated: "Perhaps I would consider having a child if I were younger and had married earlier. But with an age gap of 37years, how am I going to communicate with my child?"

-   Women's social presence: Women's employment and desire to have a role in the society and the tendency toward higher academic degrees had a negative influence on childbearing decisions. A 36-year-old woman, married for 14 years, explained: "Because of my work and education, I decided to postpone pregnancy. We are constantly occupied with study and work."

*Interactions* {#sec3-5}
--------------

Voluntarily childless couples adopt a certain attitude and tactics and take measures that are in sync with their circumstances.

-   Suppression of feelings: The suppression of parenting feelings is one of the strategies adopted by voluntarily childless couples in dealing with childlessness. They regard this as a form of sacrifice. A 31-year-old woman, married for 13 years, explained: "Not having children is a huge sacrifice. My mother accuses me of being selfish. But, I believe they were selfish for bringing me into this world in order to support them when they get old. I made a sacrifice and ignored my instincts."

-   Conflict: The inner conflict of childbearing is often associated with the actual or perceived pressure resulting from the incompatibility between goals and expectations. It introduces doubt about the decision to stay permanently childless. A 33-year-old woman, married for 10 years, described: "I always have doubts about whether I am doing the right thing or not. I always have this internal conflict, but have never been able to convince myself to have a child."

-   Rationalism: As a result of rationalism, supernatural and traditional beliefs lose their cultural importance and are replaced by science-based beliefs. In its social context, childbearing is considered a calculated action. A 33-year-old man, married for 3 years, stated: "I listed the positive and negative points of having a child and found that the negative list was longer. I know I will not regret my rational decision."

-   Agreement: Reaching an agreement with the partner and the family on both sides is a strategy adopted by people who wish to remain permanently childless. This agreement is generally reached with the spouse after extensive and often difficult discussions with the parents and relatives. A 31-year-old woman, married for 4 years, stated: "My husband is a gentle and rational man. From the very beginning, he agreed with not having a child until I am ready for it and to mutually discuss it when the time is right."

-   Malingering: Pretending to be infertile opens a window to avoid pressure from the parents and relatives and to avert repetitive questions. A 34-year-old woman, married for 11 years, commented: "Most of our relatives believe that I am infertile, and I encourage them to think so."

*Core Phenomenon* {#sec3-6}
-----------------

The core or central category extracted from the interviews in the present study demonstrated the main theme of the study that also links to other themes: "Extreme individualism". Individualism is a phenomenon involving the themes selfishness, nonchalance, and indolence. The participants were "perfectionists" who desired personal advancement and were less bothered by the opinion of others. A 35-year-old woman, married for 2 years, stated: "Having a baby requires making a lot of sacrifices and I do not wish to do so. Perhaps one has to be very arrogant to think like that."

*Consequences* {#sec3-7}
--------------

The consequences of permanent childlessness for the study group included freedom, abortion, adoption, charitable activities, keeping pets, and loneliness.

-   Freedom: The term "freedom" means that there is nothing to stop a person from doing something or forcing a person to do what he/she does not wish to do. A 64-year-old man, married for 25 years, stated: "Whenever we have extra money, I ask my wife if we shall plan a holiday abroad. If we had a child, we would never be able to make such a free decision."

-   Abortion: Abortion means the termination of a pregnancy while the fetus is alive at any stage of the pregnancy and by any means. A 32-year-old woman, married for 13 years, stated: "I had an abortion and have no regrets. I will do it again if I have to."

-   Adoption: Adoption means the acceptance of the guardianship of a child supported by the Welfare Organization under the Law of the Protection of Children with no guardians. A 39-year-old man, married for 7 years, argued: "It is questionable to bring a child into this world while there are so many orphans and parentless children. If we ever regret not having a child, we will adopt one."

-   Charitable activities: All but one participant (who wanted to leave his assets to his pet) wished to bequeath their assets to charity organizations. A 26-year-old woman, married for 5 years, explained: "I will leave everything to parentless children in order to give them a better life."

-   Pets: The most popular pets were cats and dogs. A 35-year-old woman, married for 5 years, stated: "A pet is a good companion. I have a little dog which I cuddle and take out for a walk as if he was my baby. He is a small dog and compensates for not having a child."

-   Loneliness: Loneliness is one of the consequences of childlessness. A 29-year-old woman, married for 4 years, stated: "It is quite possible that I will be lonely when I get old. My mother calls us every morning to see how we are. I do not know who to call when I am 60 years old."

*Proposed Theoretical Model* {#sec3-8}
----------------------------

The theoretical model presented in [figure 1](#IJMS-44-449-g001.tif){ref-type="fig"} explains the process of permanent voluntary childlessness. It includes the causal conditions, strategies, contextual conditions, core phenomenon, and consequences of such a decision. These were derived from the themes extracted from in-depth interviews.

![The paradigm model for the process of permanent voluntary childlessness.](IJMS-44-449-g001){#IJMS-44-449-g001.tif}

Discussion {#sec1-4}
==========

The present study investigated the decision-making process of permanent voluntary childlessness and the extreme individualism that emerged as the main theme of childlessness. Individualism is the most important feature of modernity^[@ref21]^ and entails the continuous increase of desires and preferences of an individual.^[@ref22]^ Individualism means that both men and women relieve themselves from gender roles imposed by the society (i.e. their nuclear family roles).^[@ref23]^ Our results suggest that traditional and collectivist models of thinking have no place among the individualists. Merz and Liefbroer referred to the role that individual-oriented views and social status play in childbearing.^[@ref24]^ Enayat and Parnian reported an inverse relationship between individualism and childbearing.^[@ref25]^ Behjati-Ardakani and colleagues stated that individualism had a key role in childlessness in Iran.^[@ref26]^

One of the contextual conditions in which childlessness occurs in the paradigmatic model of our study is the society in transition to modernity. The reduced influence of tradition on identity and the decline in traditional families are among the features of a modern society.^[@ref21]^ Marriage is no longer a lifelong institution and viewed as a high-risk decision.^[@ref27]^ The conventional family model is declining in popularity as the new living arrangements become popular (e.g. the possibility of not living alone and not being married). Such arrangements could take various form of relationships (e.g. cohabitation) and are often associated with childlessness.^[@ref23],[@ref28]^

In the present study, the social presence of women was identified as an intervening condition. These findings were in line with the results of studies by Hamidifar and colleagues,^[@ref28]^ Boddington and Didham,^[@ref29]^ Miranti and colleagues,^[@ref30]^ and Warren and Pals.^[@ref31]^ There were clear conflicts between family roles and academic requirements. Women experienced additional personal fears about employment, childbearing, and marital stability.^[@ref22],[@ref28]^

We found that the fear of an uncertain future in a high-risk society was one of the causal conditions of voluntary childlessness. According to Karimian and colleagues, such fear was the most important concern of Iranian women in deciding whether to have children.^[@ref32]^ These results were in agreement with those reported by Behjati-Ardekani and colleagues^[@ref26]^ and Erfani4 in Iran, and Tanturri and colleagues in Europe.^[@ref33]^

Mutual actions and interactions occur in the process of opting for childlessness, and rationalization is one such action. By evaluating the advantages and disadvantages of childbearing in accordance with an individualistic approach, the choice of childlessness appears to be legitimate and rational. Such rationalization concurs with the theory of utilitarianism in childbearing.^[@ref26],[@ref34]^ Given the shift in the values attributed to children in the family,^[@ref35]^ national and international studies have also emphasized on the importance of rationalization in the process of childlessness.^[@ref33],[@ref36]^

Childlessness entails different consequences such as loneliness. According to Park,^[@ref34]^ people with no children will face a the lack of social support and emotional relationships in the future and might experience an unpleasant social loneliness. Chamani and colleagues believe that although in the past children served as a companion to their aged parents, this role is nowadays expected to be filled by the public social security systems.^[@ref37]^ Studies conducted in Europe on childlessness argue that this phenomenon means a greater use of professional care for elderly^[@ref38]^ and might lead to less contact with the society.^[@ref33]^ Childlessness is significantly associated with loneliness while having children appears as a strong shield against loneliness. Childlessness significantly increases the number of lonely people^[@ref39]^ and childless individuals are concerned about loneliness and care in old age.^[@ref40]^

*Research Limitations* {#sec4-1}
----------------------

In the present study, the selection criteria excluded infertile couples, i.e., childlessness had to be by choice. Proving infertility in those who never actively sought a child was not an easy task. Hence, we had to rely on the statements made by the participants. We were only certain of those participants who stated as having had an abortion. Another limitation of the study was related to the stated intention for a conscious and permanent decision not to have a child. Except for one woman who reached the menopause age, we were not certain of other participants reversing their decision.

Conclusion {#sec1-5}
==========

Various parameters are endangering our society which is in transition toward modernity. Contributing parameters are a wider social presence of women, the older age of marriage, reduced natural resources and social support, bad childhood experiences, and negative childbearing experiences. As a direct result, individualists' resort to permanent childlessness by suppressing parental feelings, overcoming doubts both about childbearing and conflicts with their spouse, and becoming nonchalant by running away from child-rearing responsibilities. These people turn to foster children or keeping pets in order to cope with loneliness. They tend to leave their assets to charities when they die.

**Conflict of Interest:**None declared.
