Multilevel Analysis of Individual and Community Factors Associated With Childbirth

Purpose: This study aims to identify factors associated with childbirth experiences among women aged 20 to 49 through a multilevel analysis that simultaneously considers individual-level factors (socioeconomic characteristics and health behaviors) and community-level factors.Methods: Data were drawn from the 2021 National Health and Nutrition Examination Survey and the Community Health-Related Factor Database. A sample of 897 women aged 20–49 was analyzed using chi-square tests, t-tests, logistic regression, and multilevel analysis to evaluate the factors associated with childbirth experiences at both individual and community levels.Results: At the individual level, older age, higher income, and occupational status as service and sales workers or being economically inactive, compared to managers and professionals, were associated with a higher likelihood of childbirth experience. Among health behavior factors, non-smokers, those who exercised regularly, had lower levels of depression, and ate out fewer than three times a week were more likely to have experienced childbirth. At the community level, higher unemployment rates were associated with lower likelihoods of childbirth experiences, whereas a higher number of kindergartens was marginally associated with a higher likelihood of childbirth experiences.Conclusion: This study shows that childbirth experiences are strongly associated with individual-level factors, such as age, income, occupation, smoking, physical activity, depression, and dining-out frequency and also with community-level factors including unemployment rates and the number of kindergartens. These findings suggest that low fertility policies should not rely solely on individual incentives but also address structural improvements at the community level. In particular, youth employment stability and expanded childcare services are essential to creating childbirth-friendly environments. Future policy approaches should integrate life-course and behavioral factors with targeted regional investments to reduce fertility-related disparities.