Reproductive concerns and fertility intention among reproductive-age Chinese women with breast cancer: A multiple mediation analysis

Objective This study investigated the relationship between reproductive concerns and fertility intentions among reproductive-age Chinese women with breast cancer, examining the mediating roles of fertility information needs, perceived social support, and marital intimacy. Methods A cross-sectional study was conducted from April 2025 to September 2025 among 463 married reproductive-age women with breast cancer. Participants completed validated questionnaires assessing fertility intentions, reproductive concerns, fertility information needs, perceived social support, and marital intimacy. Structural equation modeling was employed to test a parallel multiple mediation model, with place of residence and number of children included as covariates. Results The mean fertility intention score was 42.77 ± 5.49. Reproductive concerns demonstrated a significant negative direct effect on fertility intentions (β = -0.278, 95% CI [-0.353, -0.179]), accounting for 58.4% of the total effect. All three hypothesized mediators showed significant indirect effects: perceived social support (β = -0.089, 95% CI [-0.133, -0.050], 18.7% of total effect), marital intimacy (β = -0.077, 95% CI [-0.119, -0.042], 16.2% of total effect), and fertility information needs (β = -0.032, 95% CI [-0.060, -0.011], 6.7% of total effect). The total indirect effect through all three mediators was significant (β = -0.198, 95% CI [-0.268, -0.128]), accounting for 41.6% of the total effect. Conclusions Reproductive concerns were negatively associated with fertility intentions both directly and indirectly through lower fertility information needs, reduced perceived social support, and diminished marital intimacy. Healthcare providers should provide proactive, needs-responsive fertility counseling, strengthen social support, and promote couple-centered communication to support informed reproductive decision-making.