Adverse childhood experiences and fertility intention among college students in China: moderated mediation effects of resilience and attachment
Abstract Background The declining fertility rates and aging are becoming major demographic and public health challenges. According to the life course theory, an individual’s current fertility intention is shaped by past experiences, with adverse childhood experiences (ACEs) known to have long-term e...
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| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-06-01
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| Series: | BMC Public Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12889-025-23037-z |
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| Summary: | Abstract Background The declining fertility rates and aging are becoming major demographic and public health challenges. According to the life course theory, an individual’s current fertility intention is shaped by past experiences, with adverse childhood experiences (ACEs) known to have long-term effects on adult physiology, psychology, and society. Existing literature indicates that attachment styles and resilience are important factors in shaping psychological responses to ACEs and may play a role in influencing fertility intentions over time. We aim to investigate how ACEs influences fertility intentions and to identify mechanisms that could inform early intervention strategies. Methods We draw a large-scale design at a comprehensive university in eastern China between September 2022 and October 2023. Validated questionnaires assess ACEs, attachment, resilience, and fertility intentions. Latent class analysis identified three distinct ACEs profiles and logistic regression explored the relationship between ACEs and fertility intention. Mediation and moderation models were then tested using the PROCESS in SPSS, with attachment being a mediator and resilience playing a moderating role in the relationship between ACEs and fertility intention. Results A total of valid 15,969 samples were included, among which 36.5% of adult students intended to have children. Latent class analysis divided ACEs into Severe Adversity (3.53%), Predominant Neglect (3.39%), and Minimal Adversity (93.07%). Logistic analysis indicates that, compared with Minimal Adversity, Severe Adversity(β=-0.45, P<0.01) and Predominant Neglect(β=-0.29, P = 0.02) significantly lower fertility intentions. Mediation analysis found that ACEs influence fertility intentions through attachment anxiety and avoidance, with different mediation effects depending on adversity patterns. “Severe Adversity” showed full mediation, while “Predominant Neglect” exhibited partial mediation. Higher ACE exposure was linked to greater attachment insecurity, which in turn lowered fertility intentions. Additionally, resilience moderated these pathways, buffering the negative impact of ACEs on attachment. Conclusions This study highlights the impact of ACEs on fertility intentions, with attachment and resilience playing key roles. While resilience buffers ACEs’ effects on attachment, it does not directly influence fertility intention, suggesting that strengthening interpersonal relationships is better than resilience alone. Interventions should focus on fostering secure attachment patterns to support positive reproductive decision-making. Clinical trial Not applicable. |
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| ISSN: | 1471-2458 |