• Topic: Advocacy
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KEY POINTS Contraceptive use is often one of the most cost-effective measures available for improving infant and child health.
1	Family planning can assure at least two years between pregnancies. Spacing pregnancies more than two years apart helps women have healthier children and increases their chances of survival by 50%.
2	When women limit births to their healthiest reproductive years, they have healthier babies. Women under age 20 and over 40 are much more likely than other women to have babies who die in infancy.
3	Spacing births helps assure that babies are adequately breastfed. Breastfeeding saves the lives of about 6 million children each year.

It helps ensure her infant's health when a woman avoids pregnancy for 24 months after a previous birth. A baby born too soon is vulnerable because the mother has not yet recovered from vitamin depletion, blood loss, and reproductive-system damage from the previous birth (273). The fetus may not get the nourishment it needs, and the baby's birth weight may be low, and the immune system, underdeveloped (132, 173).

Studies in Bangladesh, Bolivia, Ethiopia, Malawi, Thailand, and elsewhere consistently have shown a higher risk for short-interval births (7, 64, 86, 136, 137, 141, 174, 175, 185, 203). Analyses of DHS data show that, on average, the risk of death is twice as high for infants conceived less than two years after the mother's previous birth than for those conceived after a larger interval (21, 204) (see Figure, below). The studies suggest that, if women used family planning to space all pregnancies at least two years apart, one of every four infant deaths would be avoided (21, 204).

When births are closely spaced, the next older sibling is endangered as well as the younger child. Even if infants survive the first year of life, they are almost 1.5 times more likely to die before age five than if pregnancies are spaced at least two years apart (204). Siblings spaced too closely are less likely than other children to receive health care (24) and more likely to be malnourished (213). Malnutrition contributes to half of all child deaths in developing countries (235).

The added risk may begin even before the new arrival is born, if the mother thinks, contrary to fact, that she must stop breastfeeding when she becomes pregnant again. The risk persists throughout early childhood. Studies show that, when a sibling is born less than one year after a previous birth, the older child has a 77% higher risk of dying before age five than when the younger sibling is born at least two years after (194).

Children close in age often infect one another with communicable illnesses (98, 194, 226). Treatable illnesses that are rarely fatal in developed countries—including such communicable illnesses as respiratory infections and measles, as well as diarrhea and malaria—cause the majority of child deaths in developing countries (104, 235, 265). Closely spaced children also are more likely than others to suffer accidental injury or death (23), since they often receive less supervision.

Infant and Child deaths by Preceding Birth Interval

Note: Median death rates among infants ages 0–1 year and children ages 0–5 years in 12 sub-Saharan, 5 Asian and North African, and 3 Latin American and Caribbean countries, 1990–1994. Source: Data from Bicego and Ahmad, 1996 (21)

Younger women are less likely to receive prenatal care and more likely to have premature babies and to suffer from obstetric complications (149). Younger women also are less likely to provide adequate care for their infants and young children because they themselves are still maturing and often lack resouces needed for adequate child care (77,81).

Children born to mothers over age 40 and children born to mothers who have had three or more previous births also are more likely to die before age 5 (21, 217). Older women and women with many previous births are more likely to have stillbirths or to have children with congenital abnormalities and who may not survive childhood (43, 72,103).

Pregnancies that occur before age 20 or after age 40 increase the risks of a wide variety of health problems for the child. These problems include low birth weight, birth defects, malnutrition, infectious diseases, and slower physical growth and development. These problems are also more likely among women with more than four children or that follow less than two years after a previous pregnancy (13, 92, 98).

Fill in national data from Table			Spacing births at least two years apart can save the lives of millions of infants and children every year. Population Reference Bureau (204)
Measuring Infant and Child Mortality
	Country Data	Developing Country Average
Infant Mortality Rate*		65
Under-5 Mortality Rate**		96
*Deaths before the first birthday, per 1,000 live births **Deaths before the fifth birthday, per 1,000 live births

Breastfeeding for at least six months helps guard the infant against infection, reducing illnesses and deaths from diarrhea and respiratory infections (255). Breastfeeding provides good nutrition in a readily absorbable form during episodes of diarrhea (181). When the period of breastfeeding is shortened, bottle-feeding and food supplementation may be introduced too early, which increases the risks of illness for the infant. Other food does not contain the same antibodies that breast milk contains, and contaminated water may be used to prepare food supplements (86, 104, 125, 175, 178, 181, 203).

Family planning programs can help ensure better infant and child health by counseling women to breastfeed fully and advising them how to practice the lactational amenorrhea method (LAM) to space births (125). This method protects against pregnancy as long as at least 85% of feedings are breast milk, the woman has not resumed menstruating, and the baby is less than six months old (125).

Programs also can help and encourage women to breastfeed their babies even if they do not choose LAM. Women who have HIV, however, face the risk that breastfeeding will transmit the virus to the baby. Thus they may not find it advisable to breastfeed, if another alternative for safe feeding is available (90).