The relationship between mental health, marital relationship quality, and attitude toward childbearing among married couples in Khoy, Northwest Iran: a cross-sectional study

Attitude toward childbearing is an important factor influencing reproductive decisions and may be affected by psychological and interpersonal factors. This study aimed to examine the relationship between mental health, marital relationship quality, and attitude toward childbearing among married couples in Khoy, Northwest Iran. This descriptive–analytical cross-sectional study was conducted among 404 married individuals attending Comprehensive Urban Health Service Centers in Khoy, Iran. Participants were selected using a two-stage sampling method combining systematic cluster sampling of health centers and convenience sampling within centers. Participants completed questionnaires including demographic characteristics, the Depression, Anxiety and Stress Scale (DASS-21), the Relationship Quality Questionnaire, and the Childbearing Attitudes Questionnaire. Data were analyzed using independent t-test, analysis of variance (ANOVA), Pearson correlation coefficient, and backward linear regression analysis in SPSS software version 26. The results showed that depression had a significant negative association with attitude toward childbearing (β = −0.55, p < 0.001), whereas marital relationship quality had a significant positive association with attitude toward childbearing (β = 0.52, p < 0.001). Among demographic variables, gender (women compared with men, β = 4.34, p = 0.01), age at marriage (≤ 20 years compared with > 30 years, β = 5.03, p = 0.05), employment status (employed compared with unemployed, β = 14.09, p < 0.001), diploma educational level (β = 14.34, p < 0.001), and good economic status (β = 5.95, p = 0.04) were all associated with an increase in attitude toward childbearing. The findings of this study indicate that mental health, marital relationship quality, and certain demographic characteristics play important roles in shaping attitudes toward childbearing. In particular, lower levels of depression and higher marital relationship quality were associated with more positive attitudes toward childbearing. These findings suggest that improving mental health and strengthening marital relationships may help promote more positive attitudes toward childbearing.