ABSTRACT
Aim
This paper describes the social support women aged 25–35 years living in Victoria, Australia draw on during the reproductive decision‐making process specific to the type of support they seek and their satisfaction with that support.
Methods
We conducted a cross‐sectional study that collected data through an online questionnaire administered via Qualtrics. This included both closed‐ and open‐ended questions, exploring women's experiences of receiving social support for reproductive decision‐making, the types of support they sought, and their satisfaction with the support received. Using convenience sampling, we recruited 234 women aged 25–35 years.
Results
The women highlighted a myriad of factors that influenced their experiences of seeking and receiving support (or not), both positively and negatively. These included individual or micro‐level factors (e.g., interpersonal relationships); contextual factors (e.g., issue and/or time‐dependent); and macro/societal level factors (e.g., social attitudes and norms). The type of support depends on the reproductive decision, with women employing strategies to enhance their satisfaction with support.
Conclusion
These findings are important to inform and advocate for future public health and social policy to support women's decision‐making and overall health and wellbeing related to their reproductive autonomy.
Keywords: mixed methods research, reproductive decision‐making, social support, women of reproductive age
1. Introduction
The social trend of delayed childbirth, low total fertility rates [1, 2], and growing numbers of Australian women not having children [3] is increasing the focus on what factors influence reproductive decision‐making [4]. The Australian total fertility rate has consistently decreased over time: 1.5 children per woman in 2023, a decrease from 2022 (1.63) and 2013 (1.88) [5]. The current rate is similar to the global average for high‐income countries (1.5 children per woman) and Organization of Economic Cooperation and Development (OECD) countries (1.6 per woman), but lower than the total global average of 2.3 per woman [6, 7]. The average age for first‐time Australian mothers has increased from 28.3 years in 2010 to 29.8 in 2022, on trend with OECD countries, the majority of which now have an average age of 30 years or above [8, 9]. There is also an increasing number of Australian women who will not have children by the end of their reproductive years [10]. Abortion is legal in Australia [11], with research finding that the overall proportion of Australian women reporting an abortion at the average age of 34 was 16% [12]. With the introduction of Assisted Reproductive Technology (ART), data from four states/territories in Australia (Victoria, Queensland, Tasmania and the ACT) indicate that the proportion of women giving birth as the result of ART has continued to increase and was 5.4% in 2021 for these four jurisdictions combined [13]. Adoption rates in Australia are very low (201 adoptions in 2022–2023) and have declined significantly over the past five decades [14].
Reproductive decision‐making encompasses many types of decisions and is a dynamic process whereby multiple decisions are negotiated continuously throughout women's reproductive years. It includes decisions about whether to have children or not, and if so, the number and spacing of children, fertility regulation methods, and access to and use of health care services [15, 16]. Reproductive decision‐making is influenced by intersections of multiple personal and sociocultural factors encompassed by the policy environment [17, 18] and draws on social norms, personal preference, and choice, and moral beliefs [19].
The Australian policy context impacts reproductive decision‐making through the promotion of pronatalist ideologies, access to appropriate services in a timely manner, and financial supports [18, 20, 21]. Our previous research exploring the policy context for reproductive decision‐making identified the regulation of reproduction. While these policies give the appearance of providing women with numerous options, in reality many of these are not feasible, practical, or available to all women, for example the Australian ART policy [20]. Personal and sociocultural factors include individual locus of decision‐making (agency and self‐efficacy), gender, sexual orientation, cultural norms, socioeconomic status, education levels and geographic location [17], temporal factors, experiences of health conditions, health services and professionals, and social support [22]. It is important to understand an individuals' ability to “make decisions concerning reproduction without discrimination, coercion and violence” is a basic human right [23]. Therefore, women's reproductive autonomy should be central to the reproductive decision‐making process, unhindered by the meso and macro contexts.
A key factor influencing women's reproductive decision‐making is social support [24, 25, 26, 27]. Social support forms part of the sociocultural environment that influences women's reproductive decision‐making [24, 25, 26, 27]. It can be categorized into four types: informational, assisting a person to better understand an event, or providing resources and coping strategies; instrumental, providing assistance through services, aid, or goods; emotional, providing reassurance and empathy; and appraisal, which involves validating, accepting, and confirming the feelings, experiences, and behavior of another person [28, 29, 30]. Social support and social networks are important to women's reproductive decision‐making [24, 31], as they enable or hinder access to resources, information, tangible assistance, and autonomy. Social support resources can influence decision‐making; however, so too can perceptions about the availability of and access to social support [28]. We have previously reported that who, and how many people, Australian women seek social support from for reproductive decision‐making varies by the type of reproductive decision [32]. Further, our work has identified that expectations and experiences of social support for reproductive decision‐making among Australian women are constrained by socio‐normative constructions of reproduction as personal and “taboo”; and this reifies those social constructions and women's low expectations and experiences of social support [27].
The influence of social networks on reproductive decision‐making has been highlighted in previous international research [24, 31, 33, 34], with a focus on the role of social networks in constructing and reinforcing gender roles in reproduction and decision‐making [35, 36, 37]. Social networks have been found to construct and perpetuate reproductive matters, including decision‐making, as women's business [25, 26, 27]. Our theory [25, 26] “Optimizing support for the preservation of self” highlights that Australian women's reproductive decision‐making needs are not static and different actions are required to meet women's evolving needs. Through three interdependent phases (expectations, mobilization, and construction of social support) women assess the value of social support for the reproductive decision, seek out the support required, and then construct their support and supportive experiences. The beneficence and impacts of social support provided through social networks are contextual [38, 39]. While social support provided through social networks can have positive impacts on health, unsupportive interactions within social networks, such as the burden of peer expectations, gaps in support, or overly intrusive networks, can have negative health impacts [28, 39].
Research about social support and women's reproductive decision‐making has focused on the influence of individuals and social networks. Further, research has focused on social support once a decision has been made [40]; with little distinction between the types of social support [41]. Given the limited evidence about the types of social support for reproductive decision‐making, the aim of our research was to explore the type of social support women aged 25–35 living in Victoria, Australia seek or receive for reproductive decisions and their satisfaction with that support.
2. Methods
We conducted a cross‐sectional study to describe the social support women draw on during the reproductive decision‐making process. We aimed to address the following questions:
What types of social support do women aged 25–35 years living in Victoria, Australia, draw on during the reproductive decision‐making process?
How satisfied are these women with the social support they receive?
We used an online questionnaire that consisted of closed‐ and open‐ended questions to explore the types of social support women sought, their satisfaction with the support received during the reproductive decision‐making process, and their experiences of receiving social support. The method for this research has been published previously and is summarized below. We obtained ethics approval for this study from Deakin University and La Trobe University Human Research Ethics Committee (2017–104). Our research team brings together expertise in research methods (H.M., G.L.H., and M.G.) and women's reproductive health and social support (C.D., G.L.M., H.M., and M.G.).
2.1. Sample, Sampling, and Recruitment
We included women in the research if they were aged between 25 and 35 years and resided in Victoria, Australia. We selected this age range because it represents peak reproductive age [2] and aligns with the median age of all mothers for births registered in 2016 (31.6 years in Victoria) [42], suggesting that women in this age range are most active in reproductive decisions. We did not restrict eligibility criteria based on relationship or motherhood status, aiming to include women who were partnered or single, and those with and without children.
We used non‐probability sampling methods, specifically purposive and snowball sampling to recruit participants. This enabled us to access and reach the target population to collect exploratory descriptive data, where proportionality of the target sample was not the main concern of the research [43, 44, 45, 46]. We used online and community‐based recruitment methods. This included establishing a dedicated Facebook page which could then be shared. Organizations were contacted (C.D) (n = 18) to promote the study through their channels, such as newsletters and social media. The recruitment materials provided a link to the plain language statement, consent form, and online questionnaire. Participants first provided consent; then were directed to the online questionnaire where they were screened for eligibility before accessing the online questionnaire.
2.2. Instrument Development and Data Collection
We (C.D. and M.G.) developed an anonymous online questionnaire, based on pre‐existing instruments and a review of the literature. The questionnaire included four domains: demographic characteristics, social support, reproductive decision‐making, and the critical incident technique.
We used the Duke Social Support Index (DSSI) to measure participants' satisfaction with social support [47, 48]. The abbreviated 11‐item DSSI measures two dimensions of social support: subjective support (seven items) and social interaction (four items) [48]. The 11‐item DSSI, adapted from the original 35‐item scale, is a valid and widely used measure of social support in the general adult population. We selected this instrument as it has been tested and validated for use on women under the age of 45, was concise enough to include in a broader questionnaire, and focuses on determining an individual's level of functional social support [47, 48].
No existing instrument exists that provides a comprehensive list of the types of reproductive decisions a woman may make. Therefore, we developed an item based on an extensive review of the literature to capture the types of reproductive decisions that women may seek social support for. To assess the type of support drawn on during the reproductive decision‐making process, we asked the women to identify the type of support provided by their social networks. We defined support types using Sherbourne and Stewart's [30] functional support definitions for emotional, instrumental, informational, and appraisal support. We used a Likert scale to assess satisfaction with each type of reproductive decision for which support was received. We constructed an additional item to determine if women acted on the support they were provided.
We used open‐ended questions based on the critical incident technique [49, 50]. Online questionnaires are an emerging yet valuable tool in qualitative research [51]. Braun and colleagues state that “qualitative survey datasets can provide richness and depth, when viewed in their entirety, even if individual responses might themselves be brief” [52, p. 642]. For our research, an online questionnaire enabled recruitment from the entire state of Victoria and for women to share their experiences anonymously. The critical incident technique requires participants to describe specific critical incidents and/or experiences linked to a phenomenon [52] rather than discuss their views of concepts or a phenomenon more generally. We applied the critical incident technique by asking participants three questions related to seeking social support for reproductive decision‐making: (1) Thinking about all the reproductive decisions you have made, tell us about a time you had a good experience; (2) Thinking about all the reproductive decisions you have made, tell us about a time you had a bad experience; and (3) Is there anything else you would like to tell us about your experiences of the social supports you received in regards to reproductive decision making? These questions enabled us to explore women's experiences, including why women sought particular types of social support and an in‐depth understanding of their satisfaction with the support received.
2.3. Data Management and Analysis
We excluded women who did not click submit (n = 102) at the end of the questionnaire, as we assumed informed consent had been withdrawn. We excluded a further 46 women due to not meeting the age criteria and/or residing outside of Victoria.
We (M.G. and C.D.) recoded postcode of residence into major cities, inner regional, outer regional, remote, and very remote based on the Accessibility and Remoteness Index of Australia (ARIA+) [53]. We (M.G. and C.D.) combined the abbreviated DSSI sub‐scales, social interaction and social satisfaction, to produce a total social support score where a higher score indicates a higher level of perceived social support. We reversed scored the social satisfaction items and recoded them so that higher scores indicated better social support [48], prior to producing a summary score. We then categorized the total summary social support score as low to fair (score ≤ 26), high (score 27–29), and very high (score 30–33) as per Strodl [54, 55]. Satisfaction with support was recoded from a seven‐point scale to a three‐point scale (satisfied, neither, dissatisfied).
We (M.G. and C.D.) used descriptive statistics to describe the demographic characteristics of the women, including the Mann–Whitney U test and the Kruskal Wallis H test to describe differences in demographic characteristics and social support. We (M.G. and C.D.) used frequencies and percent to describe the type of support women sought, satisfaction with the support received, and whether they acted on the support received. Likelihood ratios and Fisher's Exact Test were used to examine associations between acting on and satisfaction with support received. We (C.D., G.L.M., H.M., and M.G.) thematically analyzed the data derived from the open‐ended critical incident questions [56]. Our analysis was driven by the research questions and was deductive in nature to explore the types of social support women draw on and how satisfied they were with the support they received. Data were analyzed within each question and then across the questions in an iterative process of coding and theme development. Quotes are included in the results and attributed using pseudonyms, age, and relationship status.
3. Results
A total of 234 women participated in this study. Table 1 describes the demographic characteristics of the women. Most women were heterosexual (91%; n = 212), married (56%; n = 131) or in a de facto relationship (24%; n = 55), had a bachelor's (39%; n = 92) or postgraduate degree (33%; n = 78), and were employed (full time 51%; n = 121; part time 33%; n = 77).
TABLE 1.
Demographic characteristics of the participants (n = 234).
| n | % | |
|---|---|---|
| Age | ||
| 25–29 | 101 | 43.2 |
| 30–35 | 133 | 56.8 |
| Relationship status | ||
| Not in a relationship | 31 | 13.2 |
| In a relationship, not living together | 17 | 7.3 |
| Not legally married but living together | 55 | 23.5 |
| Married and living with spouse | 131 | 56.0 |
| Sexual orientation | ||
| Heterosexual | 212 | 90.6 |
| Lesbian | 2 | 0.9 |
| Bisexual | 17 | 7.3 |
| Other | 3 | 1.3 |
| Highest level of education | ||
| Year 12 or below | 16 | 6.8 |
| Certificate or Diploma | 48 | 20.5 |
| Bachelor degree | 92 | 39.3 |
| Postgraduate degree | 78 | 33.3 |
| Labor force status | ||
| Full‐time | 120 | 51.3 |
| Part‐time | 77 | 32.9 |
| Employed, away from work | 13 | 5.6 |
| Unemployed, looking for work | 4 | 1.7 |
| Unemployed, not looking for work | 20 | 8.5 |
| Total weekly income | ||
| Negative/Nil income | 9 | 3.8 |
| $1–$299 | 14 | 6.0 |
| $300–$399 | 8 | 3.4 |
| $400–$799 | 47 | 20.1 |
| $800–$1249 | 65 | 27.8 |
| $1250–$1999 | 83 | 35.5 |
| $2000 or more | 8 | 3.4 |
| Geographic location of residence | ||
| Major cities | 102 | 43.6 |
| Inner regional | 122 | 52.1 |
| Outer regional | 10 | 4.3 |
| Country of birth | ||
| Australia | 223 | 95.3 |
| Other | 11 | 4.7 |
| Language spoken at home | ||
| English | 228 | 97.4 |
| Other | 6 | 2.6 |
| Aboriginal and Torres Strait Islander | ||
| No | 231 | 98.7 |
| Yes | 3 | 1.3 |
| Religiosity | ||
| No religion | 147 | 62.8 |
| Religious | 87 | 37.2 |
3.1. Social Support
Most women (n = 99; 42%) reported low to fair levels of social support (Table 2). There were no statistically significant differences between social support and demographic characteristics except: highest level of education and social support (Kruskal–Wallis H = 9.8; df = 3; p = 0.02) with those with a certificate or diploma reporting lower levels of social support (mean rank = 94.4) than women who had completed year 12 or below (mean rank = 101.3), a bachelor's degree (mean rank = 121.2) or a postgraduate degree (mean rank = 130.7); country of birth (Mann–Whitney U = 745; p = 0.03) with women born outside of Australia reporting lower levels of social support (mean rank = 73.7) than Australian‐born women (mean rank = 119.7); and language spoken at home (Mann–Whitney U = 262.5; p = 0.01) whereby women who spoke English at home reported higher levels of social support (mean rank = 119.4) than women who spoke another language at home (mean rank = 47.3).
TABLE 2.
Social support scores as measured by the Dukes social support index (n = 234).
| Mean | SD | |
|---|---|---|
| Social interaction score (range 4–12) | 7.8 | 1.6 |
| Subjective support score (range 7–21) | 18.5 | 2.6 |
| Total Dukes Social Support Index score (range 11–33) | 26.3 | 3.6 |
| n | % | |
|---|---|---|
| Total Dukes Social Support Index | ||
| Low to fair | 99 | 42.3 |
| High | 89 | 38.0 |
| Very high | 46 | 19.7 |
3.2. Type of Social Support
Women reported mainly receiving informational support in relation to the oral contraceptive pill (n = 147; 63%), barrier methods (n = 60; 26%) and ceasing contraception to commence a family or spacing of children (n = 49; 21%). Emotional support was mainly reported by the women in relation to ceasing contraception to commence a family or spacing of children (n = 81; 65%), the oral contraceptive pill (n = 99; 42%), and emergency contraception (n = 44; 19%). Instrumental and appraisal support were less frequently reported (Table 3).
TABLE 3.
| Emotional support | Instrumental support | Informational support | Appraisal support | |||||
|---|---|---|---|---|---|---|---|---|
| n | % | n | % | n | % | n | % | |
| Oral contraceptive pills | 99 | 42.3 | 34 | 14.5 | 147 | 62.8 | 55 | 23.5 |
| Implants or injections | 25 | 10.7 | 13 | 5.6 | 43 | 18.4 | 19 | 8.1 |
| Vaginal ring (e.g., Nuvaring) | 3 | 1.3 | 1 | 0.4 | 12 | 5.1 | 4 | 1.7 |
| Intra uterine device (IUD) | 25 | 10.7 | 7 | 3.0 | 25 | 10.7 | 15 | 6.4 |
| Barrier methods | 46 | 19.7 | 41 | 17.5 | 60 | 25.6 | 32 | 13.7 |
| Natural methods | 27 | 11.5 | 3 | 1.3 | 25 | 10.7 | 20 | 8.5 |
| Emergency contraception | 44 | 18.8 | 19 | 8.1 | 39 | 16.7 | 15 | 6.4 |
| Abortion | 25 | 10.7 | 16 | 6.8 | 19 | 8.1 | 12 | 5.1 |
| Ceasing contraception to commence a family or spacing of children | 81 | 65.4 | 18 | 7.7 | 49 | 20.9 | 34 | 14.5 |
| Assisted reproduction | 12 | 5.1 | 2 | 0.9 | 14 | 6.0 | 11 | 4.7 |
| Surrogacy and/or adoption | 8 | 3.4 | 3 | 1.3 | 8 | 3.4 | 7 | 3.0 |
| Not having children | 30 | 12.8 | 4 | 1.7 | 16 | 6.8 | 27 | 11.5 |
| Abstinence | 13 | 5.6 | 1 | 0.4 | 7 | 3.0 | 9 | 3.8 |
| Permanent methods of sterilization | 2 | 0.9 | — | — | 2 | 0.9 | 2 | 0.9 |
Percentages do not add up to 100 as more than one response could be provided.
The data show the women who responded ‘yes’ to each type of support they sought for each reproductive decision as a percentage of all women (n = 234).
3.3. Satisfaction With, and Acting on, the Support Received
Most women reported being satisfied with the support they received; however, the extent of their satisfaction varied by reproductive decision, as shown in Table 4.
TABLE 4.
Participants satisfaction with support sought before making reproductive decisions.
| Satisfied | Neither satisfied or dissatisfied | Dissatisfied | ||||
|---|---|---|---|---|---|---|
| n | % | n | % | n | % | |
| Oral contraceptive pills (n = 204) | 165 | 80.9 | 34 | 16.7 | 5 | 2.5 |
| Implants or injections (n = 80) | 65 | 81.3 | 10 | 12.5 | 5 | 6.3 |
| Vaginal ring (e.g., Nuvaring) (n = 21) | 10 | 47.6 | 10 | 47.6 | 1 | 4.8 |
| Intra uterine device (n = 48) | 37 | 77.1 | 7 | 14.6 | 4 | 8.3 |
| Barrier methods (n = 147) | 110 | 74.8 | 34 | 23.1 | 3 | 2.0 |
| Natural methods (n = 65) | 48 | 73.8 | 15 | 23.1 | 2 | 3.1 |
| Emergency contraception (n = 76) | 56 | 73.7 | 14 | 18.4 | 6 | 7.9 |
| Abortion (n = 32) | 22 | 68.8 | 7 | 21.9 | 3 | 9.4 |
| Ceasing contraception to commence a family or spacing of children (n = 107) | 94 | 87.9 | 13 | 12.1 | — | — |
| Assisted reproduction (n = 21) | 13 | 61.9 | 6 | 28.6 | 2 | 9.5 |
| Surrogacy and/or adoption (n = 15) | 9 | 60.0 | 3 | 20.0 | 3 | 20.0 |
| Not having children (n = 44) | 27 | 61.4 | 8 | 18.2 | 9 | 20.5 |
| Abstinence (n = 25) | 17 | 68.0 | 6 | 24.0 | 2 | 8.0 |
| Permanent methods of sterilization (n = 9) | 4 | 44.4 | 5 | 55.6 | — | — |
Table 5 shows the women who sought support for each reproductive decision, whether they acted on that support, and if support was not received. The percentage of women who acted on the support they received varied by reproductive decision. For example, 88% (n = 192) acted on the support they received regarding the contraceptive pill, while 33% (n = 21) of women acted on the support regarding their decision about not having children. About one‐third (32%; n = 12) did not act on the support they received about assisted reproduction. More than half (56%; n = 18) of the women did not receive the support they sought regarding surrogacy and/or adoption.
TABLE 5.
The percentage of participants that acted on the support received by reproductive decision.
| Yes | No | Did not receive support | ||||
|---|---|---|---|---|---|---|
| n | % | n | % | n | % | |
| Oral contraceptive pills (n = 218) | 192 | 88.1 | 7 | 3.2 | 19 | 8.7 |
| Implants or injections (n = 94) | 54 | 57.4 | 18 | 19.1 | 22 | 23.4 |
| Vaginal ring (e.g., Nuvaring) (n = 38) | 10 | 26.3 | 10 | 26.3 | 18 | 47.4 |
| Intra uterine device (n = 62) | 31 | 50.0 | 13 | 21.0 | 18 | 29.0 |
| Barrier methods (n = 158) | 124 | 78.5 | 7 | 4.4 | 27 | 17.1 |
| Natural methods (n = 84) | 50 | 59.5 | 10 | 11.9 | 24 | 28.6 |
| Emergency contraception (n = 93) | 64 | 68.8 | 7 | 7.5 | 22 | 23.7 |
| Abortion (n = 50) | 24 | 48.0 | 5 | 10.0 | 21 | 42.0 |
| Ceasing contraception to commence a family or spacing of children (n = 122) | 94 | 77.0 | 10 | 8.2 | 18 | 14.8 |
| Assisted reproduction (n = 37) | 9 | 24.3 | 12 | 32.4 | 16 | 43.2 |
| Surrogacy and/or adoption (n = 32) | 2 | 6.3 | 12 | 37.5 | 18 | 56.3 |
| Not having children (n = 64) | 21 | 32.8 | 18 | 28.1 | 25 | 39.1 |
| Abstinence (n = 46) | 16 | 34.8 | 8 | 17.4 | 22 | 47.8 |
| Permanent methods of sterilization (n = 26) | 3 | 11.5 | 5 | 19.2 | 18 | 69.2 |
Table 6 shows the association between acting on support received and satisfaction with support sought. There was a statistically significant association between acting on the support received and satisfaction with the support sought for oral contraceptive pills (LH = 10.6; df = 2; p = 0.005), IUDs (LH = 7.1; df = 2; p = 0.029), barrier methods (LH = 6.7; df = 2; p = 0.034), and assisted reproduction (LH = 7.1; df = 2; p = 0.029).
TABLE 6.
The association between participants acting on support received and satisfaction with support sought before making reproductive decisions a .
| Satisfied | Neither satisfied or dissatisfied | Dissatisfied | LR | df | p | ||||
|---|---|---|---|---|---|---|---|---|---|
| n | % | n | % | n | % | ||||
| Oral contraceptive pills (n = 195) | 10.572 | 2 | 0.005 | ||||||
| Yes | 160 | 84.7 | 25 | 13.2 | 4 | 2.1 | |||
| No | 2 | 28.6 | 4 | 57.1 | 1 | 14.3 | |||
| Implants or injections (n = 69) | 2.409 | 2 | 0.300 | ||||||
| Yes | 48 | 90.6 | 3 | 5.7 | 2 | 3.8 | |||
| No | 12 | 75.0 | 2 | 12.5 | 2 | 12.5 | |||
| Vaginal ring (e.g., Nuvaring) (n = 17) | 3.939 | 2 | 0.139 | ||||||
| Yes | 7 | 70.0 | 3 | 30.0 | — | — | |||
| No | 2 | 28.6 | 4 | 57.1 | 1 | 14.3 | |||
| Intra uterine device (n = 43) | 7.067 | 2 | 0.029 | ||||||
| Yes | 28 | 90.3 | 1 | 3.2 | 2 | 6.5 | |||
| No | 7 | 58.3 | 4 | 33.3 | 1 | 8.3 | |||
| Barrier methods (n = 127) | 6.748 | 2 | 0.034 | ||||||
| Yes | 99 | 80.5 | 22 | 17.9 | 2 | 1.6 | |||
| No | 1 | 25.0 | 2 | 50.0 | 1 | 25.0 | |||
| Natural methods (n = 53) | 4.022 | 2 | 0.134 | ||||||
| Yes | 35 | 84.4 | 5 | 11.4 | 1 | 2.3 | |||
| No | 5 | 55.6 | 3 | 33.3 | 1 | 11.1 | |||
| Emergency contraception (n = 76) | 1.103 | 2 | 0.576 | ||||||
| Yes | 50 | 84.7 | 5 | 8.5 | 4 | ||||
| No | 5 | 83.3 | 1 | 16.7 | — | — | |||
| Abortion (n = 27) | 0.628 | 2 | 0.731 | ||||||
| Yes | 19 | 82.6 | 3 | 13.0 | 1 | 4.3 | |||
| No | 3 | 75.0 | 1 | 25.0 | — | — | |||
| Ceasing contraception to commence a family or spacing of children (n = 99) b | 1 | 0.386 | |||||||
| Yes | 86 | 95.6 | 4 | 4.5 | — | — | |||
| No | 8 | 88.9 | 1 | 11.1 | — | — | |||
| Assisted reproduction (n = 19) | 7.063 | 2 | 0.029 | ||||||
| Yes | 7 | 100 | — | — | — | — | |||
| No | 6 | 50.0 | 4 | 33.3 | 2 | 16.7 | |||
| Surrogacy and/or adoption (n = 11) | 0.896 | 2 | 0.639 | ||||||
| Yes | 2 | 100 | — | — | — | — | |||
| No | 7 | 77.8 | 1 | 11.1 | 1 | 11.1 | |||
| Not having children (n = 37) | 1.838 | 2 | 0.399 | ||||||
| Yes | 17 | 81.0 | 2 | 9.5 | 2 | 9.5 | |||
| No | 10 | 62.5 | 2 | 12.5 | 4 | 25.0 | |||
| Abstinence (n = 21) | 4.920 | 2 | 0.085 | ||||||
| Yes | 12 | 85.7 | 2 | 14.3 | — | — | |||
| No | 4 | 57.1 | 1 | 14.3 | 2 | 28.6 | |||
| Permanent methods of sterilization (n = 6) b | 1 | 0.400 | |||||||
| Yes | 3 | 100.0 | — | — | — | — | |||
| No | 1 | 33.3 | 2 | 66.7 | — | — | |||
Excludes women who did not receive support.
Fisher's Exact test.
3.4. Women's Experiences of Types of Social Support for Reproductive Decision‐Making
Through the critical incident questions, the women highlighted the factors or circumstances that influenced their experiences of seeking and receiving support (or not), both positively and negatively, and what type of support they sought. Some of these factors were individual or micro‐level factors (e.g., interpersonal relationships), some contextual (e.g., issue and/or time‐dependent), while others were macro/societal level factors (e.g., social attitudes and norms) highlighting the complex nature of support networks. Three key themes emerged: (1) type of support depends on the reproductive decision; (2) experiences of seeking and receiving support; and (3) strategies to enhance satisfaction with support.
3.4.1. Type of Support Depends on the Reproductive Decision
Women reported seeking and receiving multiple types of support for reproductive decisions, but predominantly pertaining to starting a family and contraception.
For reproductive decisions regarding starting a family, including ceasing contraception to commence a family, women primarily sought emotional support. Women received and experienced emotional support in a range of ways, including talking, being open and sharing experiences, and were mainly sought and/or received from family and friends.
Coming off oral contraception and becoming pregnant with my first child with the first attempt. Best thing ever. Had an abundance of emotional and informative support from all of our family, friends and colleagues. (Fran, Age 32, Married and living with spouse)
Women also sought informational support for decisions about contraception. Women drew on their support networks as a means of gathering information and personal experiences to inform their own decisions regarding contraceptive use.
The people who were most supportive in my decision‐making were those with the most information or experience themselves. Particularly my mother and some of my older friends who seem more comfortable and open to discussing some of the negative aspects of medical contraception. (Isla, Age 27, In a relationship but not living together)
For reproductive decisions where women felt there might be judgment or wanted privacy, online sources of support were a way of gaining informational support while maintaining privacy and anonymity.
I'm finding a lot of people are going to online groups (forums, Reddit, Facebook groups) for anecdotes about reproductive choices. I think this gives us greater freedom to be able to discuss things that may be “unsavoury” or “taboo” in our real life social circles. (Jessica, Age 26, Married and living with spouse)
The type of support women received in the past influenced future support seeking. As indicated by Hannah below, her reproductive decision to have subsequent children was impacted by her previous positive experience of instrumental support, whereby she would seek out this type of support again.
Having participated in the local midwifery group practice program has positively influenced my decision to have my second and 3rd child. I'm currently pregnant with third child and participating in the program for the third time. Knowing that I could access this program if I had more children was encouraging. (Hannah, Age 33, Married and living with spouse)
Women sought appraisal support for decisions related to starting a family, including if and/or when to have children, spacing of children, adoption, and termination, often by those in their immediate support networks.
My husband is extremely supportive and though he has thoughts on it, he is very much of the opinion that it mostly comes down to me (ie choosing type of contraception, spacing of children). This has given me the freedom to discuss things with him and take his thoughts into consideration. (Nina, Age 27, Married and living with spouse)
3.4.2. Experiences of Seeking and Receiving Support
Women reported on their experiences of seeking and receiving support, influenced by the type of decision, the type of support being sought or received, and the circumstances surrounding their support seeking and needs. While the open‐ended questions did not explicitly ask the women about their satisfaction with their social supports, analysis identified instances where women felt they had the support they sought and wanted, and instances where the support was either not received or not received in the form that they wanted. Women reported mixed experiences with the type of support sought and received, often in reference to specific reproductive decisions including contraception, not having children, and abortion.
Many of the women shared their experiences of seeking support for contraception. For some, the type of support they received was inadequate or negative, particularly informational support:
I have found it hard to obtain adequate information about female contraception options, and overwhelmingly hear negative stories and experiences from friends and family about trying different things. (Paula, Age 33, Married and living with spouse)
One woman highlighted how her unsatisfactory experience with informational support for contraceptive decisions had negatively impacted her, but has subsequently shaped her own behavior to be what she perceived to be as more satisfactory support to others:
Poor parental advice about sexual health and contraception (due to parental moral/religious beliefs) was a contributing factor to pregnancy in my late teens. Despite school based “sex ed”, a lack of open discussion at home contributed to me being unsure about how to access reliable contraception. I am determined to ensure this is not the case with my own daughters and will encourage an open and well informed discussion about how to make appropriate reproductive decisions. (Sarah, Age 31, Married and living with spouse)
Women reported more positive experiences with emotional, appraisal and informational support for decisions about contraception, and highlighted temporal and social factors which impact social support for reproductive decision‐making.
My peers and even colleagues very openly discuss contraceptive options, but it is not a discussion I ever really had with my parents. Our generation is more empowered with information and it is more accepted to discuss experiences and options. (Kate, Age 28, Not in a relationship)
Women's experiences of support seeking were reported for decisions about having or not having children. Women described negative experiences and a lack of support, particularly emotional and appraisal support, for decisions to not have children. Some women perceived this was due to societal norms and family pressure to have children.
My partner and I don't want kids and that is our decision to make, but our wider circle of family and friends keep expecting us to change our minds because it's the social norm. (Anita, Age 26, Not legally married but living together)
One woman indicated that she pre‐empted a lack of support or being dissatisfied with support regarding her decision to not have children, and this made it difficult for her to seek support.
I find it hard to ask for support from friends/family regarding the possibility that I might NOT want to have children. (Laura, Age 30, Married and living with spouse)
Women reported experiencing low levels of satisfaction or dissatisfaction with support received for abortion, whereby a lack of instrumental and emotional support were highlighted:
When I was a teenager and required an abortion in a regional area I had no one to turn to and no resources to use and it was practically the end of the world. (Georgie, Age 28, Not legally married but living together)
For some women, while emotional support was initially forthcoming it was not ongoing. For example, Rebecca described how she was left feeling “isolated and adrift,” highlighting that navigating support needs is an ongoing complex process.
While the decision to have an abortion is not one I regret, I felt that the small number of people I was able to discuss it with were initially emotionally supportive but that there was essentially no “after care”. Once the decision had been made and acted on, there was little follow through in terms of me being able to speak with people about how the decision may have affected me out [sic] what I may be going through. I felt emotionally extremely isolated and adrift. Although I have a supportive family, I have never discussed it with them and they are unaware that I ever did such a thing. (Rebecca, Age 32, Married and living with spouse)
3.4.3. Strategies to Enhance Satisfaction With Support
In response to dissatisfaction with support received (or not received), some women employed strategies to seek and obtain the support which was desired and satisfactory. For example, some women were selective with seeking emotional and appraisal support, indicating this was a deliberate and conscious process as they anticipated that they would not receive the desired support from some in their social networks. This was highlighted specific to the decision to not have children, as evidenced by the quote from Laura in the theme “experiences of seeking and receiving support.” Women actively and selectively choose their social support networks to match their reproductive decision‐making, including seeking support from those in similar circumstances to themselves regarding certain types of reproductive decisions.
I am constantly asked by friends and family when I am having children‐ and they often get upset when I explain why I'm not. My closest friends are my friends who are also childless by choice. (Beth, Age 32, Married and living with spouse)
For these women, this could be seen as their way of seeking appraisal support that aligns with their own views and position.
Past emotional support experiences informed current and future support‐seeking behaviors for some women. For example, a lack of emotional support in the past contributed to women forming new relationships/friendships to ensure they felt better supported.
My experiences of miscarriage were a turning point in my life because they highlighted for me how little social support I had…This prompted me to change my life completely and the people surrounding me now are close, supportive, and I feel I can discuss all aspects of my reproductive health (including emotional aspects) with my current friends and my current partner. (Jane, Age 31, Not legally married but living together)
Some women reported having to tailor what information they disclosed to particular networks in seeking support, influencing their experience of support.
So while with some friends and family I cannot bring up my miscarriage, with others I only talk about how I miscarried not that I chose to terminate the pregnancy, and with friends online I can be more open about why I chose to terminate rather than let nature take its course and what my experience was like so those going through similar things know some of the things they may have to expect. (Jessica, Age 26, Married and living with spouse)
At times women were unable to draw on support (particularly emotional support) from some people, so sought it elsewhere. This was particularly discussed in relation to the issue of abortion.
When considering a surgical abortion in my early 20s, I did not have any emotional support or input from my sexual partner at the time, despite seeking it from him. I also did not feel I would have had any support from my friends. I was incredibly lucky to have the support of my mother who was there for me emotionally, physically and financially. My father was also very supportive. Both encouraged the abortion but would have supported my decision either way, and were aware of how difficult it was to go through with. They never judged me and while I know they would be less inclined to support another one, they were aware of where I was at in my life and supported me to make a decision for my future. (Emma, Age 33, Not in a relationship)
4. Discussion
This research identifies important insights into the types of social support women sought and received, the reproductive decisions for which support was sought satisfaction with support received, strategies used to enhance satisfaction, and acting on the support they received. Figure 1 highlights the bi‐directional cycle of reproductive decision‐making and support experiences of the women. We discuss the collective findings in relation to the figure, with equal weighting of the closed‐and open‐ended responses to provide an account of women's social support‐seeking experiences for reproductive decision‐making.
FIGURE 1.
The cyclic process of social support for reproductive decision making.
A key finding of the research was that the type of social support received varied by the type of reproductive decision. For instance, the women reported support was either not sought and/or received for decisions that were irreversible or had long‐term or permanent implications, such as undergoing permanent sterilization or decisions about adoption or surrogacy, compared with decisions that were more easily modifiable and had shorter‐term implications, for example, decisions about oral contraceptive use. Further, the women predominantly reported emotional, appraisal, and informational support, and less so instrumental support. Women tended to seek support, particularly emotional and appraisal support, for issues they saw as acceptable (such as contraceptive use) and less so for decisions about issues they perceived as controversial, stigmatized, or taboo, such as assisted reproductive technologies and abortion. Socially constructed norms regarding reproduction and the social construction of reproductive decision‐making as private and awkward [27, 35, 57] and gendered [25, 26, 27, 35] may influence the lack of social support sought and received for particular reproductive decisions.
While the most women were satisfied with the support received, the critical‐incident responses highlighted instances of the women being proactive in seeking out desired support based on perceived or actual negative experiences, or where a lack of a particular type of support was received. Past research has shown that peer expectations and overly intrusive support networks can increase stress and have other negative health impacts [28, 39], such as pressure to have children. The women in this research actively constructed their social networks to be amenable to the type of support they perceived they would receive (or avoid) for the type of reproductive decision. Women's active agency was a strategy employed by several women to enhance their satisfaction with their support experience, reinforcing the importance women place on social support for reproductive decisions. This echoes the theory by us [25, 26] whereby women must take different actions to meet their evolving needs, and that social support may only be beneficial if it is responsive to individual needs [39, 58].
Notably, experiences of seeking and receiving social support were dynamic over time and context and influenced by individuals' experiences. While most women acted on the support received, past experiences of support could influence current and/or future support seeking, where, for example, positive experiences lead to future support seeking and lack of support and/or negative experiences lead to support reluctance and specifically selecting what support they sought. This suggests women's experiences of the type of social support sought and received could have a temporal element and are context dependent. These findings reflect our previous research [27] whereby individual experiences and perceptions about usual experiences influence subsequent expectations about social support. This research goes part of the way to address the gaps in existing literature by providing important insight into the specific types of social support during the reproductive decision‐making process for Australian women.
5. Strengths and Limitations
As with all research, this study had strengths and limitations. A strength of the study was the large sample size, which was broadly representative of women aged 25–35 living in Australia. In general, a larger sample is more likely to yield results that represent the wider population; although this is not guaranteed [59]. Previous research exploring reproductive decisions in similar populations suggests a sample of between 200 and 350 is sufficient [60, 61]. The use of social media for recruitment in non‐probability samples has been shown to increase sample representativeness [45]. While non‐probability sampling methods are appropriate [62] such approaches limit the representativeness and generalisability of the study findings; however, the use of social media for recruitment could go some way to account for this. A combination of closed‐ and open‐ended questions in the questionnaire enabled greater insight into the type of social support that women sought and received, the factors impacting this, and the women's satisfaction with the type of support received. The range of types of reproductive decisions included enabled demonstration of how these types of decisions influence the type of support. The online questionnaire enabled anonymity and convenience for respondents, increasing the response rate in a relatively short period of time. However, a limitation of the online questionnaire was that it was only conducted in English, potentially creating selection bias [63], and as such may not reflect the experiences of non‐English speaking women aged 25–35 years living in Victoria. The statistically significant difference between country of birth, language spoken at home, and social support should be interpreted with caution due to the small number of women born outside of Australia or who spoke a language other than English. Further, not all included scales were validated.
6. Conclusion
This research contributes to an emerging body of literature that seeks to better understand the unique and nuanced experiences of women's social support seeking for reproductive decision‐making. Women do not seek or receive social support for reproductive decision‐making passively, or in isolation. Rather, their experiences of the type of support they receive and their satisfaction with the support are shaped by the complex interplay of contextual factors in their social worlds. Although participants predominantly discussed types of support for decisions regarding contraception and whether to have children, this reveals prominent issues of concern/priority for women in seeking support and particular types of support. This may help to inform the design and delivery of future interventions to enhance appropriate support. Further investigation into women's support needs for reproductive decision‐making is needed, including longitudinal research to explore social support needs over time and expanding the sample of women to capture more diverse demographic characteristics. A more culturally and ethnically diverse sample would assist in developing a better understanding of social support seeking among kinship groups and social networks and factors intersecting with and influencing whom women seek support from in culturally contextual situations. While this research highlights Australian women's experiences, the findings may be relevant for consideration in other similar contexts, such as other OECD countries that have similar trends in reproduction as Australia. The findings from this research are important to inform and advocate for future public health and social policy to support women's decision‐making and overall health and wellbeing related to their reproductive autonomy and experiences.
Acknowledgments
Open access publishing facilitated by Deakin University, as part of the Wiley ‐ Deakin University agreement via the Council of Australian University Librarians.
McKenzie H., Haintz G. L., Dennis C., and Graham M., “Reproductive Decision‐Making: What Type of Social Support do Women Living in Victoria, Australia Seek and Are They Satisfied?,” Perspectives on Sexual and Reproductive Health 57, no. 4 (2025): 492–505, 10.1111/psrh.70031.
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