Fertility awareness among Chinese university students: scale development and cross-sectional study

Background Global fertility rates are declining. In China, the total fertility rate dropped sharply from 5.59 in 1971 to 1.15 in 2021. Chinese university students often lack adequate fertility awareness, yet no validated instrument exists to assess this construct in this population, despite its recognized importance for informed reproductive decision-making. Methods The Fertility Awareness Scale for University Students (FASUS) was developed through literature search, semi-structured interviews, and two rounds of Delphi expert consultation. Psychometric properties were tested using exploratory and confirmatory factor analysis, Cronbach's α, split-half reliability, and test-retest reliability. A cross-sectional survey of 750 students examined fertility awareness levels and influencing factors via univariate analysis and multiple linear regression. Results The final FASUS Scale consisted of 22 items across three dimensions: fertility-related knowledge, reproductive health attitudes, and reproductive health skills, with a cumulative variance contribution rate of 67.952%. The scale demonstrated strong reliability (Cronbach's α = 0.97, split-half reliability = 0.885, test-retest reliability = 0.981). A survey of 750 students revealed an average fertility awareness score of 78.01 ± 16.44, indicating a low to moderate level. Key influencing factors included gender, ethnicity, education level, only-child status, and prior fertility knowledge education. Conclusion This study utilized a self-developed scale to assess fertility awareness among Chinese university students. The results showed that the fertility awareness level of Chinese university students was generally low. We suggest that health care institutions implement targeted intervention measures to improve reproductive health outcomes.