The Role of Social Vulnerability in Explaining Fertility Patterns: A Case Study of Mashhad The year ۲۰۲۳–۲۰۲۴

Background: Fertility is one of the key demographic indicators influenced by economic, social, and cultural factors. In recent decades, Iran—particularly the city of Mashhad—has experienced significant fertility changes in which spatial and social inequalities play an important role. This study aimed to examine the relationship between social vulnerability indicators and fertility patterns in the urban areas of Mashhad. Methods: This mixed-method (qualitative–quantitative) study employed the Delphi technique with ۲۷ experts to identify and prioritize ۱۳variables across six dimensions of social vulnerability, weighted through the Analytic Hierarchy Process (AHP). Quantitative data were collected from ۲۷۷ service units and the SINA health system, covering a population of over ۳.۵ million people. Data were analyzed using descriptive statistics, Pearson correlation, multiple linear regression, and Z-score normalization in SPSS software. Results: The findings revealed that socio-economic and family dimensions had the greatest influence on fertility. The composite index of social vulnerability explained ۱۶.۴% of the variance in the total fertility rate (F=۲۳.۲۰, df=۶.۲۶۸, P<۰.۰۰۱). Fertility rates were higher in disadvantaged areas than in central districts. Family structure (r=۰.۴۹۷) and socio-economic status (r=۰.۴۶۰) were positively correlated with fertility, while public health infrastructure showed a negative correlation (r=-۰.۳۶۳). Conclusion: Urban fertility patterns in Mashhad are simultaneously influenced by economic, social, familial, and spatial inequalities. Therefore, population policies and urban planning should focus on reducing these inequalities, improving spatial equity, and strengthening social and healthcare infrastructure. This study emphasizes that a comprehensive and multidimensional approach is necessary to accurately understand fertility changes and to design effective policies. Keywords: Fertility, Social vulnerability, Spatial inequality, Human capital, Mashhad Acknowledgments: The authors would like to express their sincere gratitude to Mashhad University of Medical Sciences for providing the research facilities and resources that contributed to the completion of this study. Conflict of Interest: The authors declare that they have no conflicts of interest related to this article. Data and Materials Availability: The data generated and/or analyzed during the current study are available from the corresponding author upon reasonable request. Consent for Publication: Not applicable to this study, as it involved the use of secondary, de-identified data. Ethics Approval and Consent to Participate: This study was conducted in accordance with the principles outlined in the Declaration of Helsinki. The study was carried out after obtaining the necessary research approvals and ethical clearance from the Central Tehran Branch of Islamic Azad University (Ethics Committee approval No. IR.IAU.CTB.REC.۱۴۰۴.۲۳۵). As the study used secondary, de-identified data, individual informed consent to participate was not required. Funding: This article was derived from the doctoral dissertation of Vajieh Shayesteh Shiran in Demography at the Central Tehran Branch of Islamic Azad University. Authors’ Contributions : Vajieh Shayesteh Shiran: Conceptualization and study design, data collection and preparation, data analysis, and manuscript drafting. Ali Pejhan, PhD: Scientific supervision of the research, guidance throughout the study, and final approval of the manuscript as the corresponding author. Ehsan Mousafarokhani, PhD: Contribution to the study methodology, specialized data analysis, interpretation of the findings, and critical revision of the manuscript. Seyed Reza Moeini, PhD: Contribution to the critical revision of the manuscript and final approval of the completed version.  All authors have read and approved the final version of the manuscript and accept responsibility for the accuracy and integrity of its content.

کلیدواژه ها:

Fertility ، Social vulnerability ، Spatial inequality ، Human capital ، Mashhad ، باروری ، آسیب پذیری اجتماعی ، سرمایه انسانی