Association between adverse childhood experiences and fertility intention among Japanese youth: a nationwide cross-sectional study

Japan is experiencing a rapidly declining birthrate. Fertility intention predicts fertility behavior, and studies from South Korea and the United States have linked adverse childhood experiences (ACEs) to fertility intention, although findings have been inconsistent. The objective of this study was to examine the associations between ACEs and fertility intention among childless Japanese young adults aged 18–29. Using data from the 2023 Japan COVID-19 and Society Internet Survey (JACSIS 2023), a nationwide, non-probability web panel, we analyzed a final sample of 4,222 childless individuals aged 18–29. Fertility intention was categorized as “wanted”, “unwanted”, or “uncertain”. ACEs were assessed using a Japanese instrument. Sex-stratified Poisson regression with robust variance assessed two contrasts: uncertain vs. definite fertility intentions (combining wanted and unwanted), and unwanted vs. wanted, adjusting for age and parental education. Among 4,222 participants, fertility intention was classified as wanted in 47.8%, unwanted in 23.0%, and uncertain in 29.2%. Compared with no ACEs, individuals with ≥ 3 ACEs were more likely to report an intention not to have children among participants with definite fertility intention (men: PR = 1.52, 95% CI: 1.26–1.84; women: PR = 1.93, 95% CI: 1.64–2.26), with a graded association across ACE-count categories (P for trend < 0.001). Emotional abuse was associated with an intention not to have children in both sexes; in exploratory item-specific analyses, parental overcontrol had the largest point estimate among women. ACEs were not clearly associated with uncertain versus definite fertility intention. ACEs were associated with an intention not to have children among childless Japanese young adults. These findings suggest that ACEs may represent one life-course factor associated with fertility intention and highlight the potential relevance of early-life adversity to reproductive health policy and practice. Not applicable. Many young adults are unsure about having children, and their views may be related to early life experiences. We studied young adults in Japan without children to examine whether difficult experiences in childhood are linked to their plans to become parents. Participants responded to a nationwide, web-based panel survey. We grouped childhood experiences into simple counts and asked whether each person wanted children, did not want children, or felt unsure. In the primary analysis, childhood adversity was not clearly linked to whether participants were unsure or had a definite intention. However, among those who had already made up their mind, people with more adverse experiences were more likely to say they did not want children, with somewhat larger estimates observed among women. Some emotional and over-control-related experiences were linked to not wanting children, although these findings should be interpreted cautiously. These results suggest that childhood adversity may be one factor related to how some young adults think about having children. They also highlight the importance of understanding fertility intentions in the context of young adults’ life experiences and ensuring access, when needed, to supportive counseling, mental health care and youth-friendly reproductive health information that respects young adults’ values and choices. Across different settings, considering the possible long-term relevance of childhood adversity may help inform youth-friendly counseling and reproductive health programs.