Screens and society: how media narratives influence fertility and reshape childbearing choices; a systematic review

Abstract

Introduction

Declining fertility rates pose a significant challenge to global demographic stability. Factors such as shifting societal norms, economic constraints, and women’s empowerment intersect with media influence to shape reproductive behaviors. This systematic review examines the multifaceted role of media including television, radio, social networks, and online platforms in affecting fertility intentions, contraceptive use, and childbearing decisions.

Methods

Following PRISMA guidelines, a comprehensive search was conducted across PubMed, Scopus, Web of Science, and Google Scholar until 4 May 2025. Keywords related to fertility, media, and reproductive behaviors were used. Eligible studies included quantitative/qualitative designs in English, while reviews, RCT, case studies, and non-population-based research were excluded. Two authors independently screened titles, abstracts, and full texts, with a third resolving discrepancies. The methodological quality of the studies was evaluated using the AXIS and JBI checklists, with 64.3% classified as high quality and 32.2% as moderate.

Results

Out of 1,990 initial records, 27 studies from various countries were analyzed. The results of the study indicated that exposure to mass media was positively associated with the adoption of modern contraceptives. Additionally, media plays a dual role in influencing fertility intentions, family planning use, knowledge and attitude, antenatal care utilization, and childbearing and maternal health decisions, depending on the content, context, and social norms.

Conclusions

Key findings reveal that media consistently promotes contraceptive use. Media’s impact on fertility intentions are context-dependent. Geographical and cultural nuances are critical, as media’s impact on social norms varies. Despite methodological limitations, the evidence underscores media’s potential as a public health tool. Policymakers must leverage media to align with public health goals, mitigate economic anxiety in news coverage, and foster global initiatives for youth education.

Registration

The review study was officially registered on the PROSPERO website (CRD420251045938) and received approval from the jury. Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD420251045938.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-025-03986-8.

Introduction

Declining fertility rates pose a significant challenge to global demographic stability, with profound implications for economic growth, healthcare systems, and social structures [1]. The global total fertility rate (TFR) has fallen from 5.0 births per woman in 1950 to 2.2 in 2024, with projections indicating a continued decline [2].

Low fertility rates can result in a shrinking labor force, slower economic growth, and a rising dependency ratio—particularly in aging societies. According to the United Nations, countries with persistently low birth rates face increasing challenges related to pension sustainability, escalating healthcare costs, and increased pressure on social services [3]. Organization for Economic Cooperation and Development (OECD) also highlights that population aging, if unaddressed, may weaken intergenerational solidarity and put pressure on fiscal systems [4]. Although some studies cite declining fertility as an indicator of progress in human development [5, 6], the broader demographic and socioeconomic consequences of declining fertility require careful attention in global population planning, including understanding the role of influential factors such as media in shaping fertility intentions and behaviors [7].

Fertility behaviour shows the intellectual background, decision-making, and ultimately the performance of people to have children [8] and includes decisions and behaviours that help maintain and increase the probability of fertility in couples [9]. These behaviours include using contraceptive methods, recognizing and treating infertility, maintaining reproductive health, scheduling sex, deciding to have children, choosing pregnancy and intrapartum care [10–12].

Although, women play a central role in reproductive decision-making [13]. In many settings, women still face limitations due to lack of education, social norms, or restrictive healthcare policies [14, 15]. Furthermore, women’s fertility behaviors driven by intersecting factors, including shifting societal norms, economic constraints, and women’s empowerment, all of which are increasingly mediated by the pervasive influence of media narratives [16].

The results of studies indicate that the media as a macro system can influence fertility behaviours [17]. This role can be negative or positive and depends on various factors. Media can convey necessary information and awareness about contraceptive methods and fertility management [18]. TV shows, movies, magazines, and online media can provide women and men with practical information about appropriate fertility and family planning (FP) methods. This information can increase the awareness of women and men about the advantages and disadvantages of each reproductive method and help them make better decisions about fertility [19, 20].

The imperative to undertake this systematic review derives from the pressing need to consolidate fragmented empirical evidence on the media’s multifaceted influence on fertility behaviors—an essential yet insufficiently explored determinant of global demographic trajectories. This review therefore aims to critically appraise the mechanisms by which media narratives shape fertility and childbearing decision-making, synthesize extant evidence regarding the bidirectional impacts of media exposure on fertility outcomes, and characterize regional and sociocultural heterogeneity in media-mediated effects.

Method

This systematic review was carried out by following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines [21].

Search strategy

We conducted an initial, unrestricted search through May 4, 2025, in PubMed, Scopus, Web of Science, and Google Scholar using the following two keyword sets combined with AND: (fertility OR population OR “vital statistics” OR “pregnancy rate” OR “birth rate” OR childbearing OR “reproductive behavior” OR “sexual behavior” OR childlessness OR “contraception behavior” OR reproduction) AND (“communications media” OR “mass media” OR “motion pictures” OR “videodisc recording” OR “videotape recording” OR “folk media” OR “printed media” OR “broadcast media” OR newspapers OR periodicals OR radio OR television OR “social media” OR “social medium” OR “Twitter messaging” OR “mobile social networks” OR “mobile social media” OR Instagram OR “social tagging” OR folksonom* OR “computer communication networks” OR internet)*.

All retrieved results (see Appendix A) were screened, and reference lists and citation trails of pertinent articles were hand-searched to identify additional eligible studies.

Eligibility criteria

In the present study, we included all articles reporting associations between media and fertility or childbearing behaviors that met the following criteria: (i) employed quantitative, qualitative, or mixed-methods designs examining factors linking media to fertility or childbearing behaviors; (ii) were published in English; and (iii) were available as full‐text manuscripts rather than abstracts alone.

Review articles, guidelines, randomized controlled trials, case studies, editorials, expert opinions, and literature reviews were excluded from the analysis. Studies assessed as low quality were also excluded from the final review.

Study selection and data extraction

Two authors (A.H. and F.H.) independently screened the titles and abstracts of all retrieved records, followed by a full-text review. If eligibility was unclear, the third researcher (M.A.) assessed the article, and inclusion decisions were made by consensus. From the studies meeting the inclusion criteria, A.H. and F.H. extracted data on the first author’s name, year of publication, research setting, study design, participant characteristics, media type, measurement tools, and key findings (Table 1).

Table 1.

Summary of the results of articles on media and fertility behaviors

Row	First Author (year)	Location	Study method	Scale	Participant	Media type	Outcomes	Results	Quality assessment
1	Jacobs 2017 (24)	Burkina Faso and Senegal	Descriptive (DHS) b	Survey questionnaire	32,755 women aged 15 to 49	Messaging exposure (via TV, radio, and/or print)	FPh	FP messages were positively associated with the use of modern contraceptives among married teenagers in Senegal, but not in Burkina Faso (AOR a = 0.98; 95% CI: 0.43, 2.26). However, the association in Senegal was not statistically significant (AOR = 2.3; 95% CI: 0.92, 5.73).	17f
2	Sedlander 2019 (25)	Ethiopia and Tanzania	Descriptive (DHS)	Survey questionnaire	11,368 teenagers aged 15 to 24	Mass media	Contraceptive use	Media access affects the link between collective norms and contraceptive use in Ethiopia (β=−0.22, P = < 0.01) but not in Tanzania (β = 0.08, P = 0.10).	17f
3	Goni 2012 (26)	Bangladesh	Descriptive (DHS)	Survey questionnaire	Descriptive married men age 15–54	Mass media	Contraceptive use	Contraceptive use was higher among women who watched TV at least once a week compared to their respective counterparts.	13f
4	Knobloch 2016 (27)	America	Descriptive	Survey questionnaire	166 American, nonstudent, never married, childless women ages 21–35 years old	Media messages	Childbearing,	Exposure to homemakers and beauty portrayals increased the number of desired children (P = 0.047). Women in the professional portrayals group wanted to have their first child significantly later (M = 5.42, SD = 1.93) than those in the beauty portrayals group (M = 4.43, SD = 2.17).	18f
5	Ghosh 2021 (28)	India	Descriptive (NFHS)c	Survey questionnaire	Married women aged 15 to 49	Mass media messages on family planning (FP)	FP	Exposure to television and FP messages through various media had a significant positive effect on the use of reversible modern contraceptive methods (TV/media: AOR = 1.57; FP messages: AOR = 1.22).	17f
6	Retherford 1997 (29)	India	Descriptive (NFHS)c	Survey questionnaire	84,558 Married women aged 13 to 49	Broadcast FP messages on radio and television	FP, and contraceptive behaviors	Media exposure to FP messages has a positive impact on contraceptive behaviors (p < 0.05).	14f
7	Kearney 2015 (30)	-	Descriptive	Google Trends and Twitter data	Adolescents	MTV reality shows 16, Pregnant	Childbearing, and contraceptive use	MTV reality shows led to a 4.3% decrease in adolescent childbearing and an increase in interest in using contraceptives and abortion, as per Google Trends and Twitter data analysis.	13f
8	Sserwanja 2022 (31)	Sierra Leone	Descriptive	Survey questionnaire	6055 young women aged 15 to 24	Mass media and the Internet	Modern contraceptive use	The effectiveness of modern contraceptives was higher among those who used radio (AOR: 1.26, 95% CI 1.06–1.50), mobile phone (AOR: 1.84, 95% CI 1.25–2.69), and internet (AOR: 1.45, 95% CI 1.19–1.78).	20f
9	Cheng 2011 (32)	Taiwan	Descriptive	Survey questionnaire	Married women of reproductive age (18 to 44)	Mass media and social networks	Knowledge on fertility and contraception	Dissemination of knowledge on fertility and contraception through mass media and social networks can lead to a decrease in fertility rates.	16f
10	Do 2020 (33)	Nigeria	Descriptive	Survey questionnaire	777 young people aged 15 to 24 years	Evaluating the impact of a TV drama	Modern contraceptive use	A mediating effect of media exposure with an increased likelihood of using modern contraceptive methods was found (P < 0.05). Over 60% had positive beliefs about contraception, but only 42% supported its norms. Most had positive views on abortion, and while two-thirds found contraception easy, only 45% felt confident using it.	19f
11	Bajoga 2015 (34)	Nigeria	Descriptive	Survey questionnaire	Women aged 15 to 24	Mass media (newspaper, radio, television, and mobile phones)	Sexual experience and the use of modern contraceptive	Exposure to FP messages with media (mobile phones (48%), radio (37%), and television (29%) influence both sexual experience and the use of modern contraceptive methods.	16f
12	Bakht 2013 (35)	Asia (India, Pakistan, Philippines, Thailand)	Descriptive	Survey questionnaire	Married women of reproductive age (18 to 44)	Television	Contraceptive use	Television watching is associated with increased contraceptive use in both males and females in all countries. Watching television is associated with increased condom use: in India, ORs were 1.9 (men) and 1.8 (women); in Pakistan, 1.9 (women); in the Philippines, 2.5 (men) and 1.6 (women); and in Thailand, 19.3 (men) and 1.5 (women).	14f
13	Kabir 2000 (36)	Bangladesh	Descriptive	Survey questionnaire	871 urban married women	Mass media	FP, and contraceptive use	38% of women with radio access heard FP messages, compared to 18.5% and 8.5% for TV and newspapers. Number of living children and contraception use predict exposure to FP messages.	13f
14	Wulandaria 2023 (37)	Indonesia	Descriptive (DHS)	Survey questionnaire	49,627 women aged 15–49	Newspapers, Radio, TV, DHS Internet	Contraceptive use	Watching TV weekly increases contraceptive use among women of childbearing age by 1.737 times (AOR: 1.737; 95% CI 1.549–1.949). Media influences contraceptive use – print media has an effect, radio doesn’t, and the internet has a relative effect.	18f
15	Amoak (2023) (38)	Nigeria	Descriptive (DHS)	Survey questionnaire	13,294 Nigerian men aged 15–59 and women aged 15–49	Mass media (radio, television, newspapers, text messages)	FP	Men who were wealthier, more educated, and employed were significantly more likely to be exposed to FP messages through mass media.	17f
16	Asp (2014) (39)	Southwestern Uganda	Descriptive	Survey questionnaire	765 women	Mass media(Radio, newspapers, and television)	Childbirth	Women who read newspapers were more likely to be prepared for childbirth and motherhood (adjusted OR 2.2), but overall media exposure (radio, television, or newspapers) showed no significant association with childbirth and motherhood preparedness (adjusted OR 1.3).	18f
17	French (2022) (47)	UK	Qualitative study	Interviews	24 cisgender women (24–43 yrs.), 6 male partners (30–39 yrs.)	Digital app (Natural Cycles)	Fertility	Improved understanding of fertility cycles; limited preconception support from health services; uncertainty about when to seek professional help.	6g
18	Ghose (2024) (40)	Mauritania	Descriptive (MDHS) d	Survey questionnaire	7,640 married women	Social media platforms (e.g., Facebook, Twitter, Instagram)	FP	Exposure to FP messages on social media was significantly associated with higher odds of receiving adequate antenatal care (OR = 1.38) and delivering in a health facility (OR = 1.83). Other important predictors of maternal healthcare included age, health insurance, wealth status, and the desired timing of the last child.	18f
19	Gupta, (2003) (41)	Uganda	Descriptive	Survey questionnaire	2,316 women aged 15-49- and 663-men aged 15–54	Mass media (Radio, television, posters, print materials)	FP	Among men, exposure to FP messages increased from 61–79%. Those who heard the messages were more likely to use or intend to use contraceptives. Contraceptive use was 35% among women who heard radio messages and 37% for TV, compared to just 6% among those with no exposure. Use rose from 19–35% among women exposed to radio messages.	16f
20	Islam, (2000) (42)	Bangladesh	Descriptive (DHS)	Survey questionnaire	9640 Married women of reproductive aged 10–49	Mass media (radio, television, newspaper and billboard)	FP	Among them, 8.1% own and watch TV, 9.7% do not own but watch TV elsewhere, and 53.0% of those with TV access listen to FP messages on TV. These findings show a strong link between exposure to mass media FP messages and access to mass media.	17f
21	Khadivzadeh, (2013) (48)	Iran	Qualitative study	Interview	24 participants including married fertile women aged 15–49 years	Social networks	Childbearing	Couples identified various individuals in their social circles, such as family members, friends, and healthcare providers, who influenced their decisions regarding childbearing.	5g
22	Lupton, (2016) (49)	Australia	Qualitative study	Interview	36 women (pregnant or had given birth in the previous three years)	Digital media (websites, blogs, online forums, apps, social media platforms)	Pregnancy and early motherhood.	The study underscores the significant role digital media plays in providing information and support to women during pregnancy and early motherhood.	5g
23	Mutumba (2022) (44)	Sub-Saharan Africa	Descriptive (DHS)	Survey questionnaire	207,782 sexually active men of reproductive age	Traditional mass media (radio, television and print)	FP	Radio had the highest impact on FP knowledge (26.1%), followed by TV (21.4%) and education (20.7%). TV had the greatest influence on method choice (8%). Print media had the least impact: 8% on knowledge, 6.2% on attitudes, and 3.2% on method choice.	18f
24	Guetto, 2023 (45)	Italy	Descriptive	Survey questionnaire	Women aged 15–44	Italian news from the evening program	Fertility	An increase in the number of negative economic news is negatively correlated with fertility and vice versa (p < 0.05)	12f
25	Ning 2022 (18)	China	Descriptive	Survey questionnaire	Women of reproductive age (20–49 years)	Traditional and new media	Fertility intentions	New media negatively influences women’s fertility intentions (p < 0.05), whereas traditional media shows no significant effect. Women with higher levels of social trust exhibit the strongest fertility intentions (M = 1.87 ± 0.72).	19f
26	Merz 2021 (43)	United States	Descriptive	Checking Twitter comments	838,739 women of reproductive age	Social media (Twitter)	Contraception	Increased tweets influenced the use of long-acting contraception (58%) more than short-acting methods (42%).	18f
27	Lee 2021 (46)	South Korea	Qualitative (Ontology)	Interview	Women of reproductive age	183 channels (Social network posts)	Fertility	Social media was one of the fertility determinants.	7g

^aAOR Adjusted Odds Ratio, ^bDHS Demographic and Health Surveys, ^cNFHS National Family Health Survey, ^dMDHS Mauritania Demographic and Health Survey, ^FAXIS Tool Appraisal of Included Descriptive Cross-Sectional Studies, ^gJBI Qualitative Assessment and Review Instrument for Included Qualitative Studies, ^hFP Family Planning

Assessment of methodologic quality

All 28 included articles were critically appraised using appropriate tools based on study design. Descriptive cross-sectional studies were assessed using the AXIS tool, which consists of 20 questions. Each question was scored as “Yes” (1 point), “No” (0 points), or “Unclear” (typically 0.5 points), resulting in a total score ranging from 0 to 20. Based on the total score, studies were categorized as high quality (16–20 points), moderate quality (12–15 points), or low quality (0–11 points) [22]. Qualitative studies were evaluated using the Joanna Briggs Institute (JBI) Qualitative Assessment and Review Instrument, which includes 8 questions. Although JBI does not provide an official scoring system, an informal scoring approach was applied, with each “Yes” response receiving 1 point. Studies were classified as high quality (7–8 points), moderate quality (5–6 points), and low quality (0–4 points). This scoring approach, while not officially endorsed by JBI, is commonly used in systematic reviews and was applied transparently [23].

The quality assessment was independently conducted by two researchers (A.H. and F.H.). In cases of disagreement, a third reviewer (M.A.) was consulted, and consensus was reached through discussion to ensure transparency. The results indicated that 18 studies (64.3%) were rated as high quality [18, 24–40], nine studies (32.2%) as moderate quality [41–49], and one study (3.5%) as low quality. The low-quality study was excluded from our review due to its methodological weaknesses and misalignment with the inclusion criteria (Appendices B & C).

Data synthesis

Due to substantial heterogeneity in study designs—manifested in variations in media type, study design, measurement instruments, statistical analyses, and targeted fertility behaviors (see Table 1)—we were unable to perform a meta-analysis. Consequently, we reported the findings qualitatively, organizing them by thematic content and geographic region. First, we systematically coded each study’s results. Next, employing an inductive approach, we clustered these primary codes into content-based categories. Finally, we synthesized the content-based categories into overarching thematic classes that capture the principal concepts revealed by the data.

It is worth noting, given the substantial variation in social, cultural, and political contexts across study sites—which shape media content, access, consumption, and the childbearing experience—we organized our key findings by region to highlight differences in media’s impact on fertility behaviors. This regional framework allowed us to surface context-specific insights.

Results

In the initial search, 1,990 articles were identified. After screening titles and abstracts and removing duplicates and irrelevant records, 77 potentially relevant articles underwent full-text review. Of these, 49 articles were excluded for the following reasons: conference abstracts (n = 15), non-representative samples (n = 25), inaccessible full texts (n = 5), and ineligible study designs (n = 4). Ultimately, 28 articles were included in the qualitative analysis, and, excluding one study after risk of bias assessment, a total of 27 studies were included in the final analysis (Fig. 1).

Fig. 1.

PRISMA Flow diagram showing the selection process of the qualified articles

Among the 27 articles included in this study, the articles were from a wide range of countries around the world, including the United States, India, Pakistan, the Philippines, Thailand, Bangladesh, Nigeria, China, South Korea, Burkina Faso, Senegal, Ethiopia, Tanzania, Italy, Sierra Leone, Taiwan, and Indonesia. Approximately 85% of the articles were published after 2010, with the majority appearing over the past decade Likewise, about 85% employed survey-based, descriptive-analytical designs [18, 24–45], while four were qualitative studies [46–49]. Most of the study populations comprised women of reproductive age [18, 24, 27–29, 31, 32, 35, 37, 42–46, 48]. The most commonly used tool in the articles was survey questionnaire of descriptive studies [18, 27, 31–36, 39, 41, 45], DHS [24–26, 37, 38, 42, 44], NFHS [28, 29], or MDHS [40].

One study analyzed Google Trends alongside Twitter data [30] while another focused solely on Twitter comments [43]. The qualitative studies employed interviews as their primary data collection method [46–49]. The review examined a range of media types, including television (TV), radio, social media/digital platforms, internet/mobile phones, print media, and mixed mass media campaigns.

Various types of media, including Television (TV), Radio, social media/Digital Platforms, Internet/Mobile Phones, Print Media, and Mass Media Campaigns (Mixed) were examined.

In 19 articles, contraceptive use was examined; in 5 articles, fertility intentions and rates; in 10 articles, FP knowledge and attitudes; in 5 articles, antenatal care and maternal health decision-making; and in 4 articles, childbearing and social norms were investigated. The summary of the results of these articles is given in Table 1. Also, the results of media effects on fertility behaviors are described below (Table 1).

The results are presented in two parts: first, by primary study findings, and second, by the geographical region of each study.

Effects of media on fertility and childbearing behaviors

Contraceptive use

Exposure to mass media (TV, radio, print) is positively associated with modern contraceptive use [24–26, 28, 29, 31, 33–35, 37, 38, 40–42]. Greater television exposure, in particular, corresponds with higher contraceptive uptake among women [37]. Similarly, engagement with social media and digital platforms (e.g., mobile apps, Twitter) is linked to increased contraceptive awareness and use [30, 31, 33, 43]. Overall, media messages shape contraceptive norms and method preferences, with television exerting the strongest influence in low-income settings [26, 27, 35, 44].

Fertility intentions and rates

Media portrayals of gender roles (e.g., homemaker versus professional) may influence desired family size and the timing of first childbirth [27]. Negative economic news in traditional media is associated with reduced fertility intentions [45]. New media platforms (e.g., social networks) exhibit a negative association with fertility intentions in high–trust societies (e.g., China), whereas traditional media show no effect [18]. Additionally, declines in fertility rates have been linked to the increased dissemination of fertility-related knowledge via mass media [32].

Family planning knowledge and attitudes

Exposure to family planning messages via radio, television, and newspapers is associated with enhanced knowledge of, and more positive attitudes toward, family planning [28, 36–38, 40–42]. Wealth and educational attainment amplify the association between media exposure and family planning engagement [38, 41].

Antenatal care and maternal health decision-making

Digital platforms—including apps, online forums, and social media—have been reported to offer pregnancy support and to influence fertility decision-making [43, 47, 49]. Social media exposure correlates with higher antenatal care utilization and facility-based deliveries [40]. Also, media campaigns, such as MTV reality shows, were associated with increased interest in abortion and contraceptive use among adolescents [30].

Childbearing and social norms

Media access may moderates the relationship between collective norms and contraceptive use [25]. The influence of family, friends, and healthcare providers within social networks has been associated with childbearing decisions [46, 48]. Cultural representations of motherhood in the media are associated with childbearing intentions. Exposure to images that emphasize domestic roles and beauty ideals has been linked to a higher desired number of children and earlier pregnancy, whereas portrayals of independent or career-oriented women may be associated with lower fertility intentions [27]. Reading print media, such as newspapers, has been associated with greater childbirth preparedness among pregnant women—such as purchasing childbirth materials, saving money, and identifying the place of delivery and transportation—though not with the intention to become a mother [39].

Geographic differences in media effects on fertility and childbearing behaviors

Sub-Saharan Africa

• Nigeria: Exposure to mobile phone and internet-based media was associated with higher odds of modern contraceptive use (AOR: 1.84 for mobile phones; 1.45 for internet) [31].

• Ethiopia & Tanzania: Media access was linked to variation in collective norms on contraceptive use in Ethiopia (β = −0.22, p < 0.01) but showed no such association in Tanzania, suggesting cultural differences [25].

• Uganda: Newspaper exposure was correlated with greater childbirth preparedness (adjusted OR = 2.2), while broader media access showed no significant association [39].

South/Southeast Asia

• India: Viewing TV and exposure to family planning (FP) messages were associated with increased use of reversible contraceptive (AOR = 1.57 for TV; 1.22 for FP messages) [28].

• Bangladesh: A strong association was observed between exposure to mass media FP messages and access to mass media platforms [42].

• Indonesia: TV exposure was positively associated with contraceptive use (AOR = 1.74; 95% CI 1.55–1.95) [37].

East Asia

• China: Engagement with New media (social networks, apps) was associated with lower fertility intentions (p < 0.05), while traditional media showed no such association [18].

• South Korea: Social media use was linked to fertility-related decision-making, although qualitative studies noted limited support during preconception phases [46].

Europe & North America

• Italy: Exposure to negative economic news coverage correlated with lower fertility rates (p < 0.05), even in the context of pronatalist cultural norms [45].

• USA: Viewing “MTV’s 16 and Pregnant” was associated with a 4.3% reduction in adolescent births and increased interest in contraception [30].

Middle East & North Africa

• Iran: Use of social networks was associated with childbearing decisions through interactions with family and peer, reflecting collectivist social norms [48].

• Mauritania: Social media exposure was associated with higher rates of antenatal care utilization (OR = 1.38) and facility-based deliveries (OR = 1.83) [40].

Discussion

This systematic review comprehensively examines the impact of media on fertility and childbearing behaviors. The quality appraisal tools used included the JBI Critical Appraisal Tool for qualitative studies and the AXIS Tool for descriptive cross-sectional studies. Most studies employed general population-based questionnaires as their main instrument. The results were qualitatively synthesized and reported, which we will discuss in the following.

Media’s role in shaping contraceptive use

This systematic review underscores the pivotal role of media in influencing contraceptive use, a finding supported by robust evidence across diverse global contexts (19 studies). The media can influence the use of contraceptive methods in several ways. The first, information dissemination; exposure to mass media campaigns has been linked to increased contraceptive knowledge and uptake. For instance, in Tanzania, radio and TV campaigns significantly improved awareness of modern contraceptives, correlating with a 15% rise in usage [33]. Similarly, the HealthCOM Initiative in the 1990 s demonstrated that tailored media messages could enhance contraceptive adoption by addressing localized myths and misconceptions [50].

Also, media shapes social norms by framing contraceptive use as a socially endorsed behavior. Entertainment-education strategies, such as radio dramas in Ethiopia, have reduced stigma by depicting characters modeling positive health behaviors, leading to a 10% increase in contraceptive demand [51]. Social media amplifies this effect by enabling peer-to-peer dialogue; influencers and online communities normalize discussions about contraception among youth, particularly in conservative settings [52]. According to the theory of normative social behavior, perceived peer approval mediates media effects on behavior [53]. Yet, the media can also reinforce restrictive norms. Conservative groups have leveraged platforms to oppose contraception, framing it as morally deviant, highlighting the dual-edged nature of media as a norm-setting tool [54].

And finally, digital platforms offer interactive avenues for engagement, such as ChatBots and mobile apps that provide personalized contraceptive advice. Social media campaigns on Facebook and Twitter have increased adolescent intent to use contraceptives by 20% through peer-driven content [55]. Mobile health apps, like those delivering pill reminders, improve adherence by integrating contraception into daily routines [56]. However, the digital divide exacerbates inequalities; marginalized groups with limited internet access are excluded from these interventions [57]. Furthermore, algorithmic biases on platforms may restrict reach to already informed demographics, limiting broader impact.

Media’s influence on fertility intentions and rates

The systematic review reveals that media exerts a profound and multifaceted influence on fertility intentions and rates, mediated through economic narratives, social norm reinforcement, and platform-specific content. These findings highlight media’s dual capacity to either suppress or stimulate childbearing desires, depending on contextual and content-driven factors.

Media amplifies economic narratives that directly influence fertility decisions. During periods of economic instability, such as the 2008 recession, media coverage emphasizing job insecurity and rising living costs correlated with delayed childbearing [30]. Gozgor (2021) found that prolonged exposure to negative economic messaging fosters a perception of financial inadequacy, deterring fertility even among economically stable individuals [58]. Cultivation theory [59] explains this phenomenon: repeated exposure to economic doom scrolling normalizes anxiety about parenthood’s affordability. Conversely, media campaigns promoting family-friendly policies (e.g., subsidized childcare) can mitigate such effects, as seen in Nordic countries [60].

Also, Media perpetuates and challenges social norms around family size and parenting. Social cognitive theory [61] posits that individual’s model behaviors portrayed in media. For instance, TV shows glorifying child-free lifestyles may reduce fertility intentions by framing non-parenthood as empowering [62]. Conversely, pronatalist media in societies like Singapore or Hungary reinforces large families as socially desirable [63]. Media’s dual role hinges on content and context. In South Korea, government-sponsored media campaigns increased fertility intentions by 15% by reframing parenthood as a national priority [64]. Conversely, Italy’s media emphasis on youth unemployment led to lower fertility rates, even amid prevailing cultural expectations [65]. This duality underscores the media’s power as both a mirror of societal trends and an independent actor.

Media’s influence on family planning knowledge and attitudes

The systematic review underscores the media’s pivotal role in shaping family FP knowledge and attitudes. Media platforms—radio, TV, social media, and mobile apps—disseminate FP information at scale, particularly in low-resource settings [65]. Similarly, mobile health (mHealth) initiatives in India delivered voice messages to millions, increasing FP awareness among marginalized women [66]. These examples highlight the media’s capacity to transcend literacy barriers and geographic isolation. A meta-analysis by Rogers et al. (2021) found that while mass media campaigns boosted FP knowledge by 19%, their impact on contraceptive uptake was modest (8–12%), emphasizing the need for complementary interventions [67]. In contrast to our findings, the results of a 2019 meta-analysis indicated that the pooled results of media interventions on contraceptive knowledge remained consistent with potentially null intervention effects. A possible explanation for this outcome lies in the limited scope of the analysis: out of 59 included studies, only 5 were eligible for meta-analysis. The authors themselves noted that while other studies have reported positive effects of media on family planning knowledge, methodological inconsistencies or insufficient data prevented their inclusion in the meta-analysis [68].

Antenatal care and maternal health decision-making

The systematic review highlights the influence of digital media platforms—including social networks, mobile apps, and online forums—on antenatal care utilization and maternal health decision-making. Exposure to FP and reproductive health messages via social media, as demonstrated by Ghose et al. (2024), significantly correlates with higher odds of receiving adequate antenatal care and facility-based deliveries in Mauritania [40].

Digital platforms provide critical support by disseminating timely information, fostering peer networks, and normalizing healthcare-seeking behaviors. For instance, Lupton’s (2016) qualitative study in Australia revealed that pregnant women and new mothers heavily rely on websites, blogs, and social media for advice on pregnancy management, postnatal care, and emotional support [49].

However, the dual role of the media must be acknowledged. While digital platforms enhance antenatal literacy, they also risk perpetuating misinformation. For example, fear-inducing narratives about childbirth complications—often amplified through sensationalized videos or unverified social media posts—can heighten maternal anxiety, potentially influencing decisions such as elective cesarean Sects. [67, 69]. This underscores the pivotal role of national health policies in shaping societal reproductive behavior, as these policies determine whether media emphasize the positive or negative aspects of childbearing.

Media can influence societal perceptions of abortion and acceptance of cesarean sections. By disseminating misinformation (e.g., framing abortion as a simple solution), media can distort public understanding, which may influence abortion rates [70–72]. (Additionally, media coverage highlighting health or economic risks of pregnancy may heighten anxiety, further driving abortion decision. Similarly, sensationalized portrayals of vaginal delivery (e.g., exaggerated risks or traumatic narratives) can amplify fear, increasing social acceptance of cesarean Sect. [69]. However, evidence-based media messaging and sharing positive childbirth experiences can empower informed decision-making, countering misinformation [73, 74].

The role of media in shaping childbearing and social norms

The interplay between media, social norms, and childbearing decisions emerges as a critical pathway through which media narratives influence fertility behaviors. The reviewed studies highlight that media does not operate in isolation but interacts with societal norms to either reinforce or challenge existing attitudes toward childbearing, though its impact varies significantly across cultural contexts [67]. A study found that career-focused media delayed desired childbearing, while homemaker narratives increased the number of desired children [27], aligning with theoretical frameworks suggesting individuals model behaviors seen in media when they resonate with—or disrupt—their lived realities [27, 45].

Key geographic patterns included:In low-income settings (e.g., Bangladesh, Nigeria), traditional media such as TV and radio were more commonly associated with contraceptive adoption, likely reflecting limited digital access and greater reliance on broadcast platforms. In contrast, high-income regions (e.g., Italy, USA) showed stronger associations between digital platforms (apps, social media) and fertility intentions, although these channels also appeared to coincide with heightened economic anxieties related to childbearing decisions. Additionally, media influences appeared to align with prevailing cultural norms: in Iran, pronatalist pressures were reflected in social network discussions that supported large-family ideals, while in China, new media use was associated with lower fertility intentions, possibly mirroring economic concerns despite traditional pronatalist values. These regional differences highlight how socioeconomic contexts and cultural frameworks may interact with media exposure in shaping reproductive behaviors. Based on our knowledge and review, there are currently no systematic reviews synthesizing evidence explicitly on how geographic location (e.g., rural vs. urban, specific regions/countries) relates to the influence of media (traditional or digital) on fertility intentions and behaviors.

Limitations

This systematic review has several limitations that should be acknowledged. The inclusion of only English-language studies may introduce language bias and limit the generalizability of the findings. Heterogeneity in study designs, media types, and outcome measures precluded a meta-analysis, resulting in a qualitative synthesis that constrains quantitative interpretation. The reliance on self-reported survey data in most studies raises the possibility of recall and social desirability biases, which may influence the accuracy of reported outcomes. Additionally, the predominance of cross-sectional study designs limits the ability to draw causal inferences, highlighting the need for longitudinal research to explore temporal relationships between media exposure and fertility-related behaviors. Some media effects were reported in only a single study, warranting cautious interpretation. Moreover, disparities in media access—such as the digital divide in low-resource settings—were not systematically explored, potentially obscuring inequalities in media influence across socioeconomic groups.

Conclusion

This systematic review synthesizes evidence from 27 studies across diverse global settings, demonstrating that media exposure significantly influences fertility intentions, contraceptive behaviors, and maternal health decisions. Key findings reveal that media consistently promotes contraceptive use, with television exerting the strongest influence in low-resource settings, while digital platforms (mobile apps, social media) enhance contraceptive awareness and antenatal care utilization. Effects on fertility intentions are context-dependent; social media reduces fertility intentions in high-trust societies, while negative economic news in traditional media lowers fertility rates. Geographical and cultural nuances are critical, as media’s impact on social norms varies (e.g., moderating collective norms in Ethiopia but not Tanzania).

Despite methodological limitations (predominantly survey-based designs), the evidence underscores media’s potential as a public health tool. Future interventions should leverage context-specific media channels—traditional media for broad outreach in resource-limited regions and digital platforms for targeted engagement—while addressing disparities in media access and content quality. Policymakers must leverage media to align with public health goals, mitigate economic anxiety in news coverage, and foster global initiatives for youth education.

Abbreviations

OECD

Organization for Economic Cooperation and Development

FP

Family Planning

IUDs

Intra Uterine Devices

TV

Intra Uterine Devices

TV

Television

MTV 16

Name of a television program

AOR

Adjusted Odds Ratio

DHS

Demographic and Health Surveys

NFHS

National Family Health Survey

MDHS

Mauritania Demographic and Health Survey

AXIS

Appraisal tool for Cross-Sectional Studies

JBI

Qualitative Assessment and Review Instrument for Included Qualitative Studies

RCT

Randomized Controlled Trial

PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Authors’ contributions

All authors contributed to this study; F.H. and A.H. did the study design. M.A. and N.R. assessed the quality of the article and reviewed the final edition. A.H., T.P. and F.H. Contributed to the literature review. F.H. and A.H. reviewed and extracted the data. A.H., F.H., M.A., T.P. and N.R. took part in writing the manuscript, data analysis, and interpretation. All authors gave their final approval of this version to be published.

Funding

This work was supported by Kermanshah University of Medical Sciences under Grant number 50003436.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

The protocol was approved by the Ethics Commission of the Vice Chancellor for Research and Technology of Kermanshah University of Medical Sciences (Ethical code: IR.KUMS.REC.1402.668).

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.