Exploring attitudes toward fertility and childbearing among married women in Kabul, Afghanistan: a qualitative study.

Afghanistan faces persistently high maternal mortality, high fertility, and low use of modern contraceptives-trends at risk of worsening under current restrictions on women's mobility, education, and access to health services. Although family planning is a cost-effective strategy in high-fertility, low-resource settings, generating demand has long remained a challenge in Afghanistan. While socio-cultural barriers to family planning are well documented, limited evidence captures how women themselves interpret and negotiate fertility and childbearing within these constraints. This study explored married women's attitudes toward fertility and childbearing in Kabul to inform locally appropriate approaches to strengthening reproductive well-being. Methods In 2024, in-depth semi-structured interviews were conducted with 23 married women aged 20-43 years (mean = 32.1) in Kabul, Afghanistan, purposively selected for demographic diversity. Interviews were audio-recorded when possible or otherwise documented in detailed notes, and analyzed concurrently in MAXQDA 2024, with data collection continued until no new codes or insights emerged across three successive interviews. Results Five major categories were identified: (1) socio-cultural norms and expectations, (2) religious and ethical perspectives, (3) economic and functional dimensions of childbearing, (4) health and well-being considerations, and (5) emotional and psychological motivations. Across interviews, pronatalist norms and expectations for early and repeated childbearing remained dominant and were reinforced by misconceptions about contraception. Nevertheless, some women emphasized maternal health, child well-being, and more balanced decision-making within families-reflecting a diversity of reproductive perspectives within the prevailing social context. Conclusions Women's fertility attitudes reflected the coexistence of enduring pronatalist expectations with value-oriented considerations emphasizing maternal and child well-being. These perspectives illustrate nuanced forms of reproductive reasoning that may inform culturally responsive approaches to reproductive health promotion. Future research should examine how such orientations vary across Afghan settings. Within the current social constraints, discreet and context-appropriate counseling integrated into existing maternal and child health services could help support informed fertility decisions and contribute to safer maternal outcomes.