Married women’s decision to delay childbearing, and loneliness, severe psychological distress, and suicidal ideation under crisis: online survey data analysis from 2020 to 2021

(2023) 23:1642 Matsushima et al. BMC Public Health https://doi.org/10.1186/s12889-023-16476-z BMC Public Health Open Access RESEARCH Married women’s decision to delay childbearing, and loneliness, severe psychological distress, and suicidal ideation under crisis: online survey data analysis from 2020 to 2021 Midori Matsushima1*, Hiroyuki Yamada2, Naoki Kondo3, Yuki Arakawa4 and Takahiro Tabuchi5 Abstract Background The COVID-19 pandemic has affected every aspect of our lives, including the decision to become pregnant. Existing literature suggests that infertility and the decision to delay childbearing at a younger age are associated with a lower level of well-being and regrets when women start to desire a baby. Thus, the decision to delay childbearing due to the pandemic could negatively affect the well-being of women. This study focuses on how pregnancy decisions affect the well-being of women during the COVID-19 pandemic. Methods From the Japan COVID-19 and Society Internet Survey, a nationally representative web-based survey, 768 observations of married women aged 18 to 50 years who had the intention of getting pregnant during the pre-pandemic period (conducted in 2020 and 2021) were used. Loneliness, severe psychological distress, and suicidal ideation were used as well-being indicators. For pooled data, a generalised estimated equation (GEE) model was used to estimate how pregnancy decision related to well-being indicators. For a sub-analysis, the sample was divided by the survey year and a Poisson regression model was used. Results The GEE analysis showed an association between delaying childbearing and severe psychological distress, with the prevalence ratio (PR) being 2.06 [95% CI (1.40–3.03)]. Furthermore, loneliness and suicidal ideation that occurred after the beginning of the pandemic were significantly related to the decision to delay childbearing—1.55 [95% CI (1.03,2.34)] and 2.55 [95% CI (1.45–4.51)], respectively. Moreover, these PRs were larger for 2021 compared to 2020. Conclusion During the COVID-19 pandemic, approximately one-fifth of married women who had childbearing intentions before the pandemic decided to postpone pregnancy. They exhibited a deteriorated mental health state. Furthermore, the negative associations were larger in 2021 compared to 2020. Loneliness has negative consequences for both mental and physical health, as well as elevated severe psychological distress and suicidal ideation among those who decided to postpone pregnancy. Therefore, the current results should not be overlooked by society. *Correspondence: Midori Matsushima Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Matsushima et al. BMC Public Health (2023) 23:1642 Page 2 of 10 Keywords Loneliness, Severe psychological distress, Suicidal ideation, Pregnancy postponement, COVID-19 pandemic Background Decisions to delay or forgo childbearing during the COVID-19 pandemic have been reported in several countries. Naito and Ogawa [1] revealed that the government’s request to the public stay home decreased the number of pregnancies by 5–8% during the pandemic in Japan. Micro-level evidence was reported in Italy, Germany, France, Spain, and the U.K. in 2021 [2] as 37.9%, 55.1%, 50.7%, 49.6%, and 57.8%, respectively, claimed to have postponed their pregnancy. Evidence was also found in China; 33.8% of couples with pregnancy intentions during the pre-pandemic period decided to cancel their pregnancy plans during the pandemic [3]. Japan is not an exception as Matsushima et al.[4] reported that approximately 20% of the married women who had pregnancy intentions during the pre-pandemic period postponed their pregnancy due to the pandemic-related factors such as a decline in income and anxiety about future household finances. Therefore, these decisions were made as a result of the COVID-19 pandemic. If these decisions have made women’s health deteriorated, this needs to be addressed as a public health concern. Most previous studies on well-being related to pregnancy focused on infertility; there is consensus that infertility lowers the level of well-being, particularly for women [5–8] and successful pregnancy leads to an improvement in well-being [9, 10]. Some studies focused on people with infertility treatment and revealed that women regret their decision to delay childbearing while they were younger and that it leads to a low level of wellbeing [11, 12]. Cooke et al. [11] claim that a complex interplay of factors outside of women’s control and/or conscious choice determines childbearing delay. Furthermore, according to Bunting et al. [13], a lack of fertility knowledge, including age-related infertility and risk factors of infertility, contributes to the childbearing delay decision, leading to regret at an older age, to which Japanese women are not an exception [12]. Given the above previous literature, the potential deterioration of the well-being of women who decided to postpone their pregnancy due to COVID-19 is a concern. Although previous studies explored associations between well-being and infertility and regrets over the decision to delay childbearing of women who desired a child in later life, they were conducted in fertility clinics with a small number of observations. There has been no study investigating how the decision to delay childbearing is associated with the well-being of the general population. Furthermore, the well-being indicators used in previous studies are limited to life satisfaction and regrets. Therefore, this study aims to enhance the understanding of the well-being of women by utilising a large Japanese webbased survey targeting the general population with 768 observations. In addition, examining loneliness, severe psychological distress, and suicidal ideation can provide more insights into how the decision to delay childbearing is associated with well-b (...truncated)