Predictors of fertility preservation awareness and willingness among college students and the general population in Henan, China: a cross-sectional study

Background Fertility preservation (FP) enables individuals to maintain future reproductive potential, yet population-level data on FP awareness and willingness remain limited in inland China. Previous studies have been largely descriptive without quantifying the population-level impact of modifiable determinants. This study identified independent predictors of FP awareness and willingness among college students and the general population in Henan Province, central China, and estimated the population attributable fraction (PAF) of key modifiable factors. Methods A cross-sectional survey was conducted (May–October 2022) using stratified sampling among college students ( n = 765) and general population members ( n = 1,008). Two validated knowledge scoring systems (13-point and 11-point scales) were developed. Multivariable logistic regression and PAF analysis were performed. Results Among college students, FP awareness was 21.1% and willingness 65.3%. Knowledge score was the sole independent predictor of FP awareness (aOR = 2.22, 95%CI: 1.92–2.56; PAF = 62.8%). FP willingness was independently associated with medical major (aOR = 1.62, p = 0.003), contraceptive use (aOR = 2.06, PAF = 48.2%), and gender (aOR for female = 0.68, p = 0.024). In the general population, knowledge score (aOR = 1.86, p < 0.001) and medical background (aOR = 1.83, p = 0.003) predicted FP awareness. FP willingness was independently associated with marital status (aOR = 2.10, PAF = 39.7%) and knowledge score (aOR = 1.16, p < 0.001). Educational attainment was not independently associated with FP willingness after adjustment (aOR = 1.09, p = 0.198). Sensitivity analyses using corrected risk ratios confirmed that OR-based PAFs represent upper-bound estimates for common outcomes. Conclusion Knowledge is the primary modifiable predictor of FP awareness and willingness with substantial population-level impact. If confirmed in longitudinal studies, knowledge-centered educational strategies prioritizing non-medical populations, unmarried individuals, and rural residents may substantially reduce current awareness and willingness gaps.