Desire vs Intent to Have Children in Women With Reproductive Health Conditions

Women diagnosed with reproductive health conditions were significantly more likely to want a child than their peers who didn’t have a reproductive health condition in a study published in Population Research and Policy Review.¹ However, among those who do want one, they are significantly less likely to actually intend to have one.

The study analyzed data from the 2015 to 2019 National Survey of Family Growth, focusing on women who are not surgically sterile and did not meet the medical criteria for infertility. Data from almost 9000 women showed that more than 1 in 5 women in the sample reported at least 1 diagnosed reproductive health condition.

“What has received virtually no attention, outside of the literature on infertility, is specific attention to the role of reproductive health conditions as a factor linked to the fertility goals of people with the capacity for pregnancy,” the authors explained. “This is true despite the obvious fact that childbearing is situated within a reproductive body and thus, in our view, represents a major oversight in the literature on fertility decision-making.”

After controlling for age, race, education, marital status, and other factors, women with a diagnosed reproductive health condition were 34% more likely to desire a child than women without such diagnoses. But among women who wanted a child, those with a diagnosis were 35% less likely to actually intend to have one. The authors noted that the data showed that “reproductive health conditions did indeed turn out to be linked to both desires and intentions.”

The conditions examined included endometriosis, uterine fibroids, pelvic inflammatory disease, ovulation, and other menstrual problems. These conditions can affect not only a woman's physical ability to become pregnant but also her quality of life more broadly. They are associated with chronic pain, depression, relationship difficulties, reduced work productivity, and extensive engagement with the health care system. Because women who want children may be more motivated to seek medical care in the first place, there are likely higher rates of diagnosis in that group, and this could partly explain the elevated desire scores in this group, the authors explained.

The authors suggest the gap between desire and intention in women with reproductive health conditions may reflect a form of self-protective ambivalence, as women who want children but fear they may be unable to conceive or carry a pregnancy to term may preemptively pull back from making concrete plans, thereby shielding themselves from potential disappointment. This interpretation aligns with prior research finding that women with reproductive health conditions often express deliberate uncertainty about childbearing as a coping mechanism.

The authors also argue that reproductive health conditions have been underresearched in fertility research despite the clear tie-in. While other studies have historically focused on factors such as physical and mental well-being, relationship quality, and economic uncertainty to explain falling birth rates in the US, the total fertility rate hit a record low of 1.62 births per woman in 2023,² and the role of the reproductive body itself has been largely ignored outside the infertility literature.¹

As such, the study was designed to bridge that gap by examining women who fall between the cracks, as they are not infertile by clinical definition but are living with conditions that meaningfully shape how they approach the prospect of having children.

And the findings carry practical and vital implications. The authors suggest that patients with reproductive health conditions may need more proactive counseling from clinicians about how their condition could affect pregnancy and what their options are. They also raise questions about insurance eligibility requirements for infertility treatments, noting that requiring 12 or more months of unprotected sex before covering treatment may create unnecessary barriers for women already known to have conditions that impair conception.

“Reproductive health conditions have largely been overlooked in the literature on fertility decision-making,” the authors concluded. “The results here suggest that, among women who are not surgically sterile and who do not meet the medical criteria for infertility, reproductive health conditions are not uncommon. These conditions are, in turn, linked to women’s fertility goals in ways that merit additional consideration.”

References

1. Guzzo KB, Broussard K. Women’s reproductive health conditions and fertility goals. Popul Res Policy Rev. 2026;45(2). doi:10.1007/s11113-026-09996-0

2. Osterman MJK, Hamilton BE, Martin JA, Driscoll AK, Valenzuela CP. Births: final data for 2023. Natl Vital Stat Rep. 2025;(1):1. doi:10.15620/cdc/175204