Factors associated with fertility intention among adults attending public primary care clinics in Kuala Lumpur: A theory of planned behavior approach
Malaysia’s total fertility rate has declined sharply, falling below replacement level since 2013, with Kuala Lumpur recording one of the country’s lowest rates. Previous Malaysian fertility research has predominantly examined demographic and socioeconomic factors associated with fertility intention, with limited attention to psychological factors based on the theory of planned behavior (TPB). This study aimed to examine sociodemographic and social-psychological factors associated with fertility intention among adults attending public primary care clinics in Kuala Lumpur, using the TPB. This cross-sectional study employed systematic random sampling to recruit 968 adults attending two public primary care clinics, who completed a validated TPB-based questionnaire; multivariable logistic regression identified factors independently associated with fertility intention. Overall, 69.3% of respondents reported that they probably or definitely intended to have children. Attitude (adjusted odds ratio [aOR] = 1.23; 95% CI, 1.17–1.29) and subjective norm (aOR = 1.35; 95% CI, 1.24–1.48) were independently associated with fertility intention, whereas perceived behavioral control was not. Younger age (aOR = 30.25), Islamic religion (aOR = 6.99), and government- (aOR = 2.23) or private-sector (aOR = 3.14) employment were also independently associated with fertility intention. These findings support and refine the TPB’s applicability in a previously untested Southeast Asian, multi-ethnic urban context, indicating that reproductive health policy should incorporate behavioral and social interventions that address personal attitudes and family expectations, alongside attention to employment circumstances, rather than relying solely on economic incentives.
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