en Fertility & Infertility Original Article Original Article <div style="text-align: justify;"><span style="font-size:14px;"><span style="font-family:Times New Roman;"><span style="line-height:normal"><span style="unicode-bidi:embed"><b>Background:</b> Global fertility rates have declined in recent decades, with voluntary single-childedness and childlessness (VSCC) emerging as a major social and policy challenge.</span></span><br> <span style="line-height:normal"><span style="unicode-bidi:embed"><b>Objective:</b> This study aimed to identify the personal, social, and economic factors influencing married couples&rsquo; VSCC tendencies in Babol, northern Iran.</span></span><br> <span style="line-height:normal"><span style="unicode-bidi:embed"><b>Materials and Methods:</b> In this cross-sectional study, 452 married individuals (women aged 18-49 yr, men aged 18-55 yr) from Babol, Iran, were recruited using convenience and snowball sampling methods between August and October 2024. Data collection was conducted online, where the participants were asked to complete the validated 22-item questionnaire on the contributing factors of tendency toward VSCC distributed via social media platforms (WhatsApp and Telegram). Statistical analyses were conducted using SPSS version 17, with significance set at p < 0.05.</span></span><br> <span style="line-height:normal"><span style="unicode-bidi:embed"><b>Results:</b> The mean VSCC tendency score was 43.0 &plusmn; 11.8. Among the 5 domains, the highest mean scores were observed for occupational and social insecurity for the child (63.4 &plusmn; 17.6) and inappropriate familial context for childbearing (49.1 &plusmn; 11.9), while the lowest was found for social modeling of childlessness (30.6 &plusmn; 19.4). Women exhibited a significantly greater tendency toward VSCC compared to men (44.0 &plusmn; 12.2 vs. 40.2 &plusmn; 10.2; p < 0.001).</span></span><br> <b><span style="line-height:107%">Conclusion:</span></b><span style="line-height:107%"> VSCC tendencies are shaped by a complex interplay of individual aspirations, relational dynamics, and structural concerns. Among younger couples and women, fears about balancing parenthood with educational and career goals, mistrust in marital relationships, and anxiety about children&#39;s future security are prominent. To support informed reproductive decision-making, policy interventions should prioritize affordable childcare, flexible career and education pathways, gender-equitable parenting support, and couple-based counseling services.</span></span></span></div> Childlessness, Family size, Reproductive behavior, Social determinants of health, Iran. 0 0 http://ijrm.ir/browse.php?a_code=A-10-2959-1&slc_lang=en&sid=1 Zahed Rezaei zahed.rezaei1991@gmail.com 0000-0001-7331-4500 No Social Determinants of Health Research Center, Institute of Health Sciences and Technology, Hamadan University of Medical Sciences, Hamadan, Iran. Hamid Sharif-Nia h.sharifnia@mazums.ac.ir 0000-0002-5570-3710 No Psychosomatic Research Center, Mazandaran University of Medical Sciences, Sari, Iran. Zeinab Gholamnia-Shirvani z.gholamnia@yahoo.com 0000-0002-3372-2451 No Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran. Fereshteh Behmanesh f.behmanesh2015@gmail.com 0000-0001-5837-4265 No Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran. Neda Ahmadzadeh Tori N.ahmadzadeh@mubabol.ac.ir 0000-0001-6538-4146 Yes Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.