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Background  Japan has consistently shown a low fertility rate, which has been lower than the replacement level since 1974, and represents one of the least fertile countries in the world. This study was designed to determine the family size preference of and its effect on Japanese women.    Methods  We conducted a questionnaire survey among women who visited the obstetrics and gynecology department of 18 hospitals and clinics in the Hyogo Prefecture, Japan, between October 2011 and February 2012. All the women were categorized according to age group and area of residence, and the survey results were statistically analyzed using a  t  test.    Results  A total of 1616 women were included in this study. There was no significant difference between the mean desired and actual marital ages (26.70 and 26.67 years, respectively). The mean desired number of children was 2.55, which was significantly more than the mean actual number of children (1.77) in all generations. The mean desired and actual numbers of children were more in the rural areas (2.73 and 2.09, respectively) than in the urban (2.54 and 1.70, respectively) and semi-urban areas (2.49 and 1.60, respectively). The mean number of family members was significantly greater in the rural areas (3.84) than in the urban (3.25) and semi-urban areas (3.05).  The most important concern among women who had never delivered a baby was childbearing itself, followed by the expenses related to pregnancy and childbearing.    Conclusions  The family size preference of the women in our study was higher than the actual numbers of children. The fertility intentions were low among the younger women but high among those living in rural areas with larger families.

Family size preference and factors affecting the fertility rate in Hyogo, Japan