Factors affecting women’s decisions on motherhood during the COVID -19 pandemic

Introduction

Over time, the way of perceiving motherhood in Poland has undergone significant transformation. The key moment was the start of political transformation in 1989, as a result of which motherhood was not identified as women’s vocation and duty. Nowadays, it is understood as an individual choice of every woman, who makes decisions related to reproduction, accounting for individually important factors [1, 2]. It is believed that political transformations that took place in the 1990s contributed to the prevalence of late motherhood in Poland. The most frequent reasons for delaying pregnancy in women aged over 35 years include prolonged education process, level of education achieved, access to contraception, significant importance of career in many young people lives, lack of financial stability, infantilization of adulthood, and fear of balancing job and family obligations [3].
Motherhood is a very difficult term to define and currently is a subject of numerous social debates. Over the years, the image of motherhood has evolved due to political, social, and cultural changes. The main direction of the motherhood concept evolution is to stop perceiving maternity as biological and emotional terms, and to draw attention to the context of conscious parenthood planning [4]. The common belief present in many cultures defining motherhood as every woman’s vocation, destination, or duty, is being replaced with perceiving maternity as non-obvious value, subjected to individual choice [1, 2].
The literature presents two opposite discourses of understanding motherhood: conservative and feminist. Maternity can be conceptualized as an institution, where specific caregiving and child-rearing responsibilities are fulfilled. Within the conservative model, women’s primarily assigned roles are centered on domestic work and childcare. In this framework, females are expected to devote themselves to their families, and perform socially prescribed duties for the perceived benefits of a society. Motherhood is constructed as a set of externally imposed norms and obligations, to which women are expected to conform, reflecting a culturally defined model of what it means to be a mother. In Poland, a feminist idea began to gain visibility in the early 1990s, challenging the dominant conservative discourse, and prevailing social expectations surrounding motherhood at that time. A central premise of feminist perspectives on motherhood is the recognition of mothering as a dynamic and evolving process, an ongoing becoming rather than a fixed state of “being a woman” or “being a mother”, defined by pre-determined roles, sacrifices, and socially imposed obligations [2].
Modern women have an increased scope of duties, with constantly growing number of social responsibilities. However, the role of a mother is particularly defined and impacted by social repercussions. Nevertheless, it is not the case to induce every woman to become a mother, but to create appropriate conditions for those who really want that and support balancing their roles. Due to the COVID-19 pandemic, this is even more important, since the outbreak reinforced traditional division of responsibilities and re-traditionalization of gender, which does not facilitate women [5].
The study objective was to analyze factors, which affected postponing women’s decisions on motherhood during the COVID-19 pandemic.

Material and methods

The study was conducted using a diagnostic survey as the research method, and data were obtained by means of research tools in the form of an authorial survey questionnaire and life orientation test.
The survey questionnaire contained 43 single- and multiple-choice questions as well as open-ended questions in the form of a short answer. It provided information primarily on the factors contributing to respondents’ decision-making regarding pregnancy. Life orientation test (LOT-R) by Michael F. Scheier, Charles S. Carver, and Michael W. Bridges (in the adaptation of R. Poprawa and Z. Juczyński) consisted of 10 statements, out of which 6 had a diagnostic value for dispositional optimism. Respondents indicated their answers using a 5-point Likert scale showing to what extent a given statement referred to them. Test results were calculated by adding corresponding values given to particular answers on the scale. The obtained value was then translated into units standardized as STEN (standard ten) scores that enabled the interpretation of results. The LOT-R form provided information whether a given respondent demonstrated a tendency to pessimism (STEN score: 1-4), or had an optimistic attitude (STEN score: 7-10). For statistical analyses, chi-square test of independence and non-parametric Mann-Whitney U test were employed in SPSS Statistics software. Statistical significance was set at a = 0.05.
The study was conducted between February and April 2022 among women admitted to the Delivery Suite of the Obstetrics and Perinatology Ward, the University Hospital in Krakow. Respondents’ participation in the research was voluntary and anonymous. The study included 105 adult women, aged less than or equal to 40 years, who delivered their first child. A planned mode of birth was not considered during selection of the study group. Due to ward characteristics, the inclusion criterion was based on woman’s physical and mental state, allowing conscious participation in the study. Females with a history of obstetric failures, such as past miscarriages or stillbirths, were excluded from the study cohort.

Results

The respondents age was between 19 and 39 years, with the mean age of 28.61 ±3.58 years. The largest group comprised women aged 26-30 years. A total of 26.7% of all the participants declared vocational or secondary education, and the remaining 73.3% of females indicated higher education. The most numerous and equal groups of women (25.7%) included residents of villages and cities over 500,000 inhabitants. At the moment of their participation in the study, 34.3% of the respondents declared marital status as single, while 64.8% were married. One respondent stated her marital status as divorced (Table 1).
Out of the 105 women, 89 planned their pregnancy (84.8%), whereas the other 16 women (15.2%) did not plan to become a mother. Among all women in the study, only two declared they never wanted to have children. The remaining 98.1% admitted they had always seen themselves as mothers, or their attitude towards having children changed with age. The most frequently indicated justification for the desire to have children was the association with a sense of fulfilment (60.0%) and home background (54.3%). In addition, the participants pointed to a change in their attitude when meeting the right partner after reaching mental maturity for motherhood as well as biological need to have children resulting from affiliation to the human species (3.8%). In the study group, there was a statistically significant correlation between women’s age and planning for pregnancy (p = 0.004) (Table 2). The mean age of women planning for pregnancy was 29.07 years, while it was 26.06 years among those who did not plan for the current pregnancy. No association was found between education (higher or secondary/vocational) and planning for the present pregnancy (p = 0.287) (Table 2).
All participants reported being in a steady relationship (41.9%) or married (58.1%) at the time of conceiving. Satisfaction with the relationship with partner/husband was declared by 92.4% of the respondents, while the others declared satisfaction either only in physical sphere (3.8%) or in mental sphere (3.8%).
At the moment of decision-making on having a baby, 90.5% of women declared support and sense of security from their partners, and expressed certainty regarding receiving partner’ s assistance in caring for the child in the future. In total, 9.5% of females showed concern regarding having sufficient support from the child’s father (40.0% of them were in a steady relationship, and 60.0% were married).
A total of 70.5% of the respondents reported to decide on the time of parenthood with their partner, while 5.7% were postponing the plans about pregnancy due to their own or partners beliefs (8.6%). A total of 15.2% of the pregnancies were not planned.
At the moment of pregnancy decision-making, 51.4% of females owned a flat/house, 26.7% lived in a rented place, while the remaining 21.9% permanently resided at their family’s place. In total, 88.6% of the respondents had a permanent job at the moment of becoming pregnant, while 7.7% did not receive employment income. Also, 95.2% of partners/husbands had a permanent job, a contract with an employer, or had a private business. Moreover, 75.2% of the participants declared having a satisfactory salary at the moment of becoming pregnant, and 35.2% were already satisfied with professional standings. The desire to further develop a career contributed to postponing the decision on pregnancy in 21.0% of women, whereas for 24.8% of them having a child was a priority. Altogether, 7.7% of females waited to fulfill their motherhood plans until completing education. More than half of the respondents (52.4%) expressed concerns regarding employment stability and returning to work after maternity leave. The most frequently reported situation was a concern related to balancing professional and family duties (36.2%), meaning development of conflict of social roles.
The most frequently considered factor reported by women planning for pregnancy that contributed to the decision of having a child was satisfaction with relationship they had with their partner/husband (83.3%). Other factors included economic determinants, such as permanent employment (66.7%), owning a flat/house (56.7%), and satisfactory salary (55.6%). Additional common factors indicated by the respondents were their positive childhood memories associated with the sense of security, happy childhood, or having siblings (35.2%). There was no correlation between having siblings and desire of having more than one child (p = 0.213, p > a) (Table 3). The results of the analysis were statistically insignificant, which may stem from the fact that most of the participants (90.5%) had siblings. However, there was a statistically significant correlation between woman’s age and planning for another baby (p = 0.041, p < a) (Table 3). The mean age of women declaring a desire to have more than one child was 28.33 years, while it was 30.06 years among those, who did not plan for another pregnancy.
Additional factors were related to the readiness of implementing parental plans. A total of 78.1% of females declared certainty regarding their readiness to have a child at the moment they became pregnant, which means that the remaining 21.9% did not feel fully ready to become a mother. In this group, about 1/3 of the participants did not plan for the present pregnancy, while the remaining 2/3 (n = 15) decided on the pregnancy despite not being sure about their mental readiness. The lack of readiness could result from concerns related to the overall costs, including restriction of social life or changes in bodies during pregnancy and after delivery. A total of 86.7% of females declared to be aware of the changes related to the body adaptation to pregnancy and delivery, and 56.2% were worried about their figure and physical condition after labor. Within the study group, these concerns affected maternity plans of 7.6% of the participants, resulting in postponing their pregnancies. A total of 16.2% of the respondents were for some time not ready for social life restrictions due to having a baby. The fear of labor and necessity to take care of the newly born child were also significant issues. A total of 33.3% of the respondents were afraid of labor and associated pain, out of whom 9.5% admitted requiring time to grow into the thought about labor. Fear related to taking care of a neonate was experienced by majority of women (44.8%), while in 12.4%, it influenced the selection of time regarding deciding on pregnancy. In addition, before getting pregnant, 37.1% were considering convenience of surrounding infrastructure in the context of caring for a child (pushchair ramps, elevators, public transport facilities, proximity of nursery schools, and kindergartens), and 10.5% took this factor into account in the decision-making process on reproduction.
In total, 90.5% of the respondents declared that when they became pregnant, they felt that their family would accept their decision on motherhood, while worries of non-acceptance affected 60.0% of those whose pregnancies were not planned. A higher percentage of women admitted that they were certain to receive help from their loved ones regarding care for the baby (97.1%), out of whom 1/3 were aware that help would be limited due to certain factors, e.g., distance. However, this aspect was taken into account during the decision-making process on pregnancy only by 6.8% of women. In addition, 31.4% of the respondents described being stressed out due to closest environment (family, friends, peer workers) reactions related to having children, but it did not in any way contribute to the decision on the present pregnancy. Experiencing pressure referred to women aged above 25 years, while 63.3% of the participants were aged 30 years or above.
The declared duration of trying to conceive a baby varied highly in the study group, ranging from 1 month to 6 years. The largest group comprised women who got pregnant during the first menstrual cycle occurring at the time of trying to conceive (25.7%). In general, conceiving a baby occurred within 1 year in 83.1% of the respondents. However, no analysis of activities aiming at conception, such as regularity and frequency of sexual intercourse, was performed. In 11 women, the decision regarding motherhood was postponed due to their state of health, such as post miscarriage, recurrent reproductive tract infections, endometriosis, polycystic ovary syndrome, Hashimoto’s disease, type 1 diabetes, shoulder joint surgery, or antidepressant therapy.
Those who did not plan for the present pregnancy were given an opportunity to answer open-ended questions on the causes of delaying the decision to have a child. For majority of women, the reasons overlapped with factors provided by women who made a conscious decision to become pregnant, including young age, no procreation plans, desire to travel, desire to finish studies, no open-ended employment contract, not owning a flat/house, no formal relationship, short duration of relationship/marriage, partner not ready, and lack of partner’s support.
In addition, the subject of the analysis included factors resulting from the COVID-19 pandemic. A 67.6% of women felt anxiety associated with getting pregnant during this period. Fear of getting infected with COVID-19, concerns related to the access to medical care during pregnancy, restrictions in perinatal care, and fear of losing one’s job and financial stability due to the pandemic, were the reasons to postpone pregnancy decision in 11.4% of women. No correlation was found between age and tendency to resign from motherhood plans due to the COVID-19 pandemic (p = 0.580, p > a) (Table 4). However, a strongly significant correlation was observed between level of dispositional optimism measured with LOT-R and planning for pregnancy during the COVID-19 pandemic. Women having a tendency to pessimism more frequently resigned from getting pregnant during this period compared with women demonstrating an optimistic attitude (p < 0.001, p < a) (Table 4). The most common concerns regarding hospital restrictions included prohibition of visits, no presence of family during delivery, and mandatory mouth-to-nose mask wearing during labor (61%). A total of 29.5% of women admitted that they were worried about the access to medical care due to the ongoing COVID-19 pandemic, while only one respondent actually experienced difficulties in accessing a doctor at the stage of preparing for pregnancy.
In total, 89.9% of the participants planning for pregnancy declared that they had been preparing for it despite the COVID-19 pandemic. In the study group, no correlation was shown between woman’s age and education (higher or secondary/vocational) and deliberate planning for conception (p = 0.144, p > a; p = 0.207, p > a) (Table 5). A total of 49.5% of females received a vaccine against COVID-19 in the period of preparation or during pregnancy. A total of 37% of the respondents who were smokers prior to the decision about motherhood, resigned from the habit in the period of preparation for pregnancy, or at the moment they learned about being pregnant. Two respondents admitted that they did not refrain from smoking cigarettes.

Discussion

Nowadays, motherhood is gradually ceasing to be an obvious value, while more as a result of conscious and deliberate decision. A higher age of women at the moment of first child delivery indicates intentionality of the choice, resulting from the analysis of numerous factors facilitating or postponing pregnancy decision-making. This choice depends on individual priorities and values’ system as well as current potentials [1, 2, 6].
In our study, 84.8% of females declared planning for present pregnancy. An international agency for opinion polls and market research (GIC) reported that in 2009 in Poland, 64% of all pregnancies were planned. Moreover, the reports on health behavior of pregnant women published in 2013 and 2017 showed that the percentages of planned pregnancies were 75.1% and 80.3%, respectively. This tendency might be explained by increased awareness of modern women about health consequences of unplanned motherhood. Furthermore, this results in higher age of women delivering their first baby, which is also confirmed by a correlation demonstrated in the authors’ study between women more advanced age and conscious pregnancy planning [7-9].
The mean age of delivering first baby in women included in our study was 28.6 years, which slightly differs from the value obtained from analysis of population 2021 data conducted by the Central Statistical Office (28.7 years). In a study by Kossakowska, the preferred age to have a first baby was ranging up to 29 years, but only for women who at the time of the survey declared that having children would be an important part of their life. The respondents, who at the time of the study perceived pregnancy as an obstacle and restriction wanted to postpone their childbearing (age between 35 and 39 years). In the light of the above data, it seems necessary to educate women regarding the impact of age on fertility as well as late motherhood consequences both for the mother and child. The acquired knowledge could have a positive effect on taking reproduction decisions at an earlier age [10, 11].
In the present study, more than 98% of women declared a desire to have children in the course of their life, and for majority (60%), this was associated with a sense of fulfilment. In line with a study of Lachowska et al., the results of a previous study show that more than 87% of the respondents wish to fulfil their maternity plans [12].
A highest percentage of women (83.3%) pointed to satisfaction with their relationship with partner or husband as the factor affecting the decision on motherhood being taken or postponed. Considering the fact than more than 41% of the participants were not married at the moment of becoming pregnant, it may be concluded that subjective feeling regarding the relationship with a partner are currently of more value to women than formalization of the relationship. Results of a study conducted by the Regional Centre of Social Policy of the Silesian Voivodship are consistent with the above statement, since a higher percentage of women points to certain desired qualities of the partner who would father their child than a necessity to get married. According to the study, a vast majority of women (90.5%) made decision on motherhood having support and sense of security from their partner as well as certainty of receiving assistance from the partner in the future caring for their child. The respondents in a study by Mynarska presented a slightly more traditional approach, where half of the respondents claimed that marriage should precede a decision to have children. The desire to formalize a relationship is also associated with the degree of religiousness, which was confirmed by a study of Majdzińska et al. reporting that 91% of the participants with moderate or high level of religiousness planned a future marital union and having children (in the current study, only 15.2% of females showed a correlation between religious values and motherhood plans). Being married does not currently seem a necessary condition to implement plans regarding motherhood. A stable relationship is one of the most important factors supporting parenthood. This is confirmed by studies of Söderberg et al. and Mynarska, where the lack of steady partner delays decision related to reproduction, which is the most common cause of female childlessness [13-19].
According to the present research, the second group of factors with the most significant effect on reproduction decisions were determinants associated with the economic situation, out of which, the most important was having permanent employment. More than 88% of women had a permanent job at the moment of becoming pregnant, and for 66.7% of the respondents, this was a necessary condition for deciding to become mother. According to Mynarska, an employment guaranteeing a stable financial situation is a key condition to start considering pregnancy. Furthermore, a study by Gębuś reported that having “a good job” is the most important goal in life for majority of young women (92.5%), and more than 40% of the respondents declared that they could postpone their maternal plans in order to stabilize professional position and develop career. Our study also showed that slightly more than 20% of the participants consider the development of their professional career a priority. According to research conducted by Mynarska, owning a flat is another necessary condition of making a decision to become a mother. The achieved results demonstrated that only half (51.4%) of women planning for pregnancy owned a flat. Respondents of the Regional Centre of Social Policy of the Silesian Voivodship also declared that renting a flat is sufficient, and the most important factor is the possibility of moving away from the family [13, 16, 20].
The current results suggest that concerns related to employment and stability were revealed by more than half of women (52.4%), which was additionally intensified by the COVID-19 pandemic.
Childhood memories turned out to be an important psychological factor. Their positive role in decision-making on having children was indicated by more than 1/3 of the respondents. According to Mynarska, young people who bear in mind the times of their own childhoods, wish to provide the best possible conditions for their own children, despite not having good recalls of early years [16].
The analysis of the results shows that a conscious decision regarding pregnancy was made by 15 women who did not feel ready for the role of mother. This may stem from a different way of defining mental maturity, which could be understood by the respondents as not only changing priorities in life and sense of responsibility, but even as a lack of fears related to motherhood, which could have caused giving a negative answer. However, according to the current study, experiencing concern related to changes in social life, females’ body, labor, and puerperium as well as care of the neonate, are common phenomenon, which is in line with the results of a study conducted by the Regional Centre of Social Policy of the Silesian Voivodship. On the other hand, Lachowska et al. revealed that the weaker the desire to become a mother, the stronger the woman’s belief that bringing up a child is associated with a great sacrifice [12, 13].
Pregnant women experience high level of anxiety and stress. They are worried about the course of labor, potential complications, and health and life of their child. Additionally, if a woman has a history of complications or her pregnancy is threatened, or she faces a difficult time in a relationship/financial problems, her fears significantly increase [21]. Lachowska et al. demonstrated that the strongest concerns experienced by pregnant women are related to the possibility of miscarriage, and worries concerning labor and the child’s condition [22]. Milne et al. in their study investigating the effect of isolation on the mood and relations of pregnant women during the COVID-19 pandemic showed that 44% of the pregnant women experienced a depressed mood resulting from loneliness caused by lack of contact with family and friends. Anxiety resulting from financial pressure caused by inability to work was reported for 14% of the pregnant women. However, more than one third of women (34%) claimed to be happy with the closure and isolation, because this situation ensured relaxation and withdrawal from fast-paced lifestyle [23]. On the other hand, a study conducted by Corbett et al. revealed that before the COVID-19 pandemic, 83% of the study pregnant women were not worried about their health, but due to the pandemic, as many as 50.7% of them were worried all the time, and 35% isolated themselves due to fear of SARS-CoV-2 infection. For the same reason, 32% of the participants worked from home, 46.5% questioned the safety of transportation used so far, and 66.2% started to buy food via the Internet [24]. As a result of the COVID-19 pandemic, attitudes of some women regarding their maternity plans were adjusted to the crisis situation, meaning postponing the decision about motherhood [25]. According to the current study, delaying having a child was primarily declared by women with a tendency to pessimism. This correlation is explained by the theory of dispositional optimism, where subjects with this quality pursuing their goals, they expect positive outcomes from their actions and plans. It is just the opposite in subjects with a tendency to pessimism, who at the occurrence of some difficulties, often resign from further efforts due to their concerns that the effect will not meet their expectations [26]. Therefore, the theory translates into resignation from one’s maternity plans during the pandemic, which could threaten the health of future mother and child as well as the quality of medical care during pregnancy, labor, and puerperium. It may be surprising, however, that according to the present study, the respondents were less worried about the consequences of SARS-CoV-2 infection during pregnancy than about the restrictions in the form of prohibited visits and deliveries in the presence of family, or the order to cover with mask the mouth and nose. In addition, more than half of the respondents did not receive a COVID-19 vaccine, which should increase their sense of security. Therefore, it is probable that women having their own vision about pregnancy and perinatal period decided to postpone its implementation until the time of more favorable circumstances, not necessarily paying attention to the aspect of health. In our study, a delay in the decision on getting pregnant during the pandemic was not related to the woman’s age. On the contrary, Szukalski reported an analysis of demographic data, showing that younger women (mainly aged 20-25 years) were willing more to resign from their maternity plans because of the COVID-19 pandemic. This phenomenon may be related to a less stable career of a younger age group women than those above 30 years old as well as lack of pressure resulting from decreasing fertility with age. Unfortunately, this leads to an accelerated rate of increasing age of women delivering their first child [25]. In our study, a positive aspect is the fact that the state of pandemic did not alter women’s preparation to pregnancy regarding health. Preis et al. conducted a study on stress and anxiety among pregnant women related to the COVID-19 pandemic. In this study group, 21.6% of women showed a moderate and 21.7% a high level of anxiety. However, both a higher age of mother and better health in the prenatal period prevented from anxiety [27]. Kiełbratowska et al. investigated the preparation of pregnant women for labor during the COVID-19 pandemic. In their study, online educational meetings were conducted during the COVID-19 pandemic as a safe and effective form of preparing pregnant women for labor as well as the medical personnel; they were considered good preparation of women for active delivery. Women in labor after prenatal e-education reported a lower level of fear and anxiety, better cooperation with the medical personnel, and their delivery often proceeded spontaneously. The SARS-CoV-2 pandemic created a necessity to develop a new communication strategy in order to facilitate obstetric care and preparation for delivery [28]. Interesting conclusions on motherhood in the time of the COVID-19 pandemic in Poland were drawn by Stępień et al. Based on the respondent answers, it was concluded that the COVID-19 pandemic had a significant effect on mental state of women delivering their babies at that time. The most difficult aspect for the participants was the prohibition of delivery in the presence of family, no mental support, and feeling lonely both during pregnancy and after delivery at the time of quarantine. However, the time of the COVID-19 pandemic did not have a significant effect on the perception of motherhood or women reproduction plans [29].
The main limitation of the study is that it was conducted exclusively among women, who had already decided to become pregnant. However, the findings may be considered preliminary, as the study can serve as a pilot for the development of future research, which can also include women who have chosen not to conceive.

Conclusions

The most important determinant of taking a decision by a woman to have a child was satisfaction with the relationship with her partner/husband and having a permanent job that guaranteed a stable financial situation.
Being in a marital union as well as owning a flat/house gradually ceased to be a necessary condition for women to decision-making on having a child. Pregnancy postponing was primarily caused, aside from unstable economic situation, by factors, such as the desire to pursue a career and concerns related to balancing professional and family duties.
The state of the COVID-19 pandemic contributed to the females’ sense of anxiety associated with getting pregnant in that period, but it was rarely the cause of postponing the decision to have a child. Future mothers were mostly concerned about hospital restrictions, including prohibition of visits and deliveries in the presence of family as well as obligation to cover the mouth and nose with a face mask during labor.
It was shown that the percentage of women planning for pregnancy was increasing with age. However, no significant correlation was demonstrated between education and child conscious planning and preparing for pregnancy.
A significant correlation was found between the level of dispositional optimism and planning for pregnancy during the pandemic. Women having a tendency to pessimism more frequently resigned from having a baby during this period compared with women with an optimistic attitude.

Disclosures

This research received no external funding.
Institutional review board statement: Not applicable.
The authors declare no conflict of interest.

References