Determinants of fertility intentions in a low-fertility region of Central Europe: a cross-sectional survey of 1,092 respondents in the Greater Poland Voivodeship.

Persistent below-replacement fertility and accelerated population ageing now drive much of the public health agenda in Europe, with measurable consequences for perinatal services and long-term care demand. Aggregate-level data document these trends well; individual-level determinants of fertility intentions in Central European low-fertility settings remain less well characterised. We carried out a cross-sectional online survey in the Greater Poland Voivodeship of Poland between March 2023 and March 2024, recruiting through mixed online channels. The instrument covered demographic, socioeconomic, residential, normative and behavioural domains, including a 10-item Likert scale on perceived barriers to childbearing. The primary outcome was the desired number of children "regardless of existing barriers." Associations were assessed using Spearman correlation, Kruskal-Wallis and Mann-Whitney tests, and proportional-odds ordinal logistic regression; perceived barriers were summarised by exploratory factor analysis. The sample comprised 1,092 respondents aged 18 to over 40 years, recruited across the rural-urban gradient. The mean desired number of children was 1.84 (SD 1.09); 14.8% wanted no children, while 22.9% wanted three or more. In adjusted ordinal logistic regression, religion influencing family decisions (OR = 2.39; 95% CI 1.75-3.27; p < 0.001), receipt of the 500+ child benefit (OR = 1.58; 95% CI 1.26-1.99; p < 0.001) and age (OR = 1.03 per year; 95% CI 1.02-1.04; p < 0.001) were positively associated with higher reproductive intentions, while urbanisation level was negatively associated (OR = 0.92; 95% CI 0.86-0.99; p = 0.023). Subjective financial situation, educational attainment and perceived influence of the Ukraine war were not significant after adjustment. Factor analysis of the 10 barrier items (KMO = 0.86; Bartlett p < 0.001) identified two dimensions: structural barriers (α = 0.84; 46.4% of variance), encompassing material situation, housing, partner availability and career ambitions; and psychosocial-normative barriers (α = 0.80; 13.1% of variance), encompassing fear of parenthood, perceived lack of support and reluctance to change one's current life. Fertility intentions in this Central European setting are shaped by a heterogeneous mix of structural, normative and life-course factors that cannot be reduced to material conditions alone, supporting a multi-dimensional approach to public health and family policy.