Background: Iran has experienced a sharp decline in childbearing rates over the past three decades, and the extent to which attitudes toward childbearing are influenced by marital satisfaction, socio-economic status, and spiritual health remains unclear. Additionally, past research has largely focused on women who already have children. This study, however, examines all women who, after five years of marriage, have not yet decided to have children. Objectives: This study aimed to determine the role of spirituality, marital satisfaction, and socio-economic status in shaping attitudes toward childbearing among married women in Semnan City in 2023, specifically those without a history of pregnancy or intention to conceive. Methods: This cross-sectional study included 235 married women who had neither the intention nor history of pregnancy, with a minimum marriage duration of five years. Participants were purposefully selected during visits to the family health center in Semnan City in 2023. Data were collected using the Childbearing Attitudes Questionnaire, the Spiritual Health Questionnaire, the Marital Satisfaction Questionnaire, and the Socio-Economic Status Questionnaire. Statistical analysis was conducted using multiple linear regression tests in SPSS software version 24. Results: The largest proportion of participants belonged to the age group of 26-32 years (31.35%). A majority (137 individuals, 58.3%) had either an associate or bachelor’s degree, and most participants (58.3%) were employed. The results demonstrated that spirituality (41%), socio-economic status (56%), and marital satisfaction (65%) were significant predictors of attitudes toward childbearing (P < 0.01). Conclusions: As marital satisfaction emerged as the strongest predictor of attitudes toward childbearing, it is recommended that health centers offer courses to improve and enhance marital satisfaction among women.