Fertility knowledge as a tool for informed reproductive decision-making

Understanding the intersection of fertility knowledge and reproductive intentions is becoming increasingly important in a context where parenthood is often delayed. While prior research has often examined these two domains separately or within limited age groups, Miserez et al. (2025) offer a timely and valuable contribution by analysing both concepts together in a sample of reproductive-aged individuals without children in Belgium. This study builds on previous work by Delbaere et al. (2021, 2024), who investigated adolescents’ reproductive preferences and found a growing proportion expressing a desire to remain child-free. By extending the analysis to a broader reproductive-aged population, Miserez et al. present the first Belgian study to explore how fertility knowledge relates to reproductive intentions.

The significance of this study lies not only in its inclusive age range, but also in its methodological rigor. The use of two conceptually robust tools, the ABC of Reproductive Intentions Taxonomy (Grace et al., 2022) and the Cardiff Fertility Knowledge Scale (Bunting et al., 2013), lends credibility, strength and comparability to the findings. It is well established that limited fertility knowledge or misconceptions, especially when combined with delayed first births and limited reproductive capacity at older ages, can contribute to involuntary childlessness or unmet reproductive goals. By linking knowledge with intention patterns, this study addresses a critical and underexplored dimension of reproductive decision-making.

The key strength of the paper lies in its effort to map out variation in fertility knowledge across intention groups, going beyond the dichotomous approach (yes/no). By applying the ABC of Reproductive Intentions Taxonomy, the authors distinguish between individuals who intend to have children (‘desirers’), those who do not (‘avoiders’) and those who remain unsure (‘flexers’). This three-fold categorization acknowledges the complexity of fertility intentions, which are often fluid and ambivalent rather than fixed. Moreover, by limiting their sample to childless individuals, the authors focus on a group for whom reproductive decisions are still largely prospective. This approach helps to avoid retrospective rationalizations that may bias interpretations of intentions in studies including parents. Notably, the authors also adopt the term ‘reproductive-aged individuals without children’ rather than ‘childless individuals’, helping to avoid the stigma and negative connotations often attached to the latter label.

The findings reflect earlier studies in revealing the diversity of reproductive preferences: 13% of respondents were identified as ‘avoiders’ who preferred to remain child-free, while 28% were categorized as ‘flexers’, reflecting the widespread reality of uncertainty around childbearing. Such uncertainty often stems not only from limited knowledge but also from deeper social, psychological or structural ambivalence. The study’s inclusion of questions on preferred age for first and last childbirths adds depth, revealing an average desired age of 30 years for the first childbirth and 34 years for the last childbirth. This suggests an interesting tension between the trend of delayed first births and a desire to complete childbearing by the mid-30s, likely reflecting an internalization of social or biological age norms. These findings underscore the complexity of fertility planning, and raise critical questions about how individuals think about parenthood over time, and how biological awareness interacts with personal and societal expectations.

Importantly, the authors examine how fertility knowledge intersects with childbearing preferences. While the study revealed only a modest level of fertility knowledge across intention groups, ‘desirers’ scored significantly higher than ‘avoiders’ and ‘flexers’. However, the less dramatic difference in fertility knowledge scores across groups hints that fertility knowledge may not directly influence whether or not someone wants children, but it appears to help people move out of ambivalence, enabling more informed and confident decisions. In this sense, knowledge functions less as a motivator and more as a clarifier, helping individuals to align their plans with biological and temporal realities. The study’s cross-sectional design precludes any causal claims, but the association between lower fertility knowledge and undecided or negative intentions suggests that better-informed individuals might approach decisions differently. It is an important avenue for both future research and public health messaging.

The study also raises important questions about the interpretation of fertility ‘knowledge’. The findings suggest that knowledge alone does not predict or drive reproductive action. Rather than viewing informational gaps as deficits to be corrected, the paper encourages a more critical reflection on what knowledge means in the context of highly personal and context-dependent decisions. This reframing invites further research into how individuals interpret and emotionally respond to fertility information, particularly when it contradicts their current life situation or available choices.

Another notable contribution is the gendered analysis, which reveals that a higher proportion of women expressed definite negative childbearing intentions, whereas a higher proportion of men were classified as ‘flexers’, indicating uncertainty. These findings suggest that women may be more decisive in articulating their reproductive preferences, whereas men – possibly due to their longer reproductive window – may feel less pressure to decide. Women also scored significantly higher on fertility knowledge than men, echoing patterns observed in other national contexts. Together, these results reinforce the view that gender differences in fertility intentions and knowledge are not merely artefacts of data or design, but reflect persistent social norms, role expectations and awareness of biological capacity among men and women. Future research would benefit from exploring how relationship dynamics, partnership histories, and evolving gender norms contribute to these patterns.

In summary, the study by Miserez et al. is a valuable contribution to fertility research and public health discourse. Its attention to non-normative childbearing desires and recognition that not all childless individuals are in a state of pre-parenthood is particularly important. The study highlights the importance of treating fertility knowledge as more than a clinical concern; it is a social and psychological resource. Improving fertility knowledge does not mean promoting parenthood, but rather supporting individuals in making informed decisions – whether that leads to trying for a child or choosing not to. By focusing on individuals without children across reproductive ages, the authors shift the lens from outcomes to understanding, and from prediction to empowerment. Future studies would do well to build on this integrative approach – one which recognizes that informed intention is at the heart of reproductive autonomy.