Child Spacing: A Matter of Choice

For couples, child-spacing decisions can be even more complex than deciding when to start having children and when to end childbearing. Whether explicitly or implicitly, couples weigh the benefits of spacing births longer against their social and economic disadvantages. Although, on a national level, longer birth spacing improves childrens’ and mothers’ survival and health significantly, for many individuals, the disadvantages may outweigh the additional health benefits of another year or two of spacing.

Longer birth intervals are healthier for mothers and their children, enable parents to devote more of their time to each child in the early years, give parents more time for activities other than child-rearing, and often ease pressure on family finances. These are not the only factors that couples consider in making decisions about child spacing, however.

Many couples consider how birth intervals affect the mother’s employment. For example, in Canada, Ethiopia, and Nigeria, research finds that women who work outside the home tend to space their children more closely to complete their families quickly and thus minimize their time out of the workforce, or to compress the economic and physical burdens of child-rearing (71, 126, 143). Other couples space their births based on whether or not childcare is available and affordable. In Taiwan, for instance, couples often space their children close together while they live with the husband’s parents because the parents provide childcare (34).

In some countries, as women tend to marry at older ages, they may want to have children sooner rather than later (8, 197). In Ghana, for example, women who marry later tend to have their children in rapid succession (63, 123). Women may also speed up childbearing as they get older to have as many children as possible before menopause, as in India (132, 200).

Just as some couples space their births based on their own needs or desires, others prefer to leave childbearing unplanned, to fate, or up to God, as some women say in surveys (8).

Since couple’s decisions about birth spacing are influenced by their individual situations and desires, and not just by the health benefits of longer intervals, new messages that inform couples that 3- to 5-year birth intervals are optimal need to be sensitive to their preferences. In particular, couples should not be blamed for choosing shorter intervals or made to feel they are bad parents.

Couples and individuals need to make their own spacing decisions based on accurate information and a range of contraceptive options (188). Health care providers and programs have a responsibility to help them. Regardless of how long couples choose to wait between births, programs and providers need to respect and support their decisions.

Measuring Birth Intervals

Estimating actual and preferred intervals is important because they serve as powerful tools in research, programming, and advocacy (24). The choice of measurement method depends on the intended use of the data. Researchers often compare actual and preferred birth intervals to estimate the potential demand for family planning services. Programs find it useful to measure the percentage of a population with intervals shorter than 3 years. Programs could measure clients’ average actual and preferred birth intervals to assess periodically how well they are helping clients achieve their reproductive intentions. Finally, health advocates can show policy-makers that thousands of children’s lives would be saved if women were able to achieve their preferred birth intervals.

Actual Intervals

Intervals can be measured in three ways, and different programs and researchers use different measurements:

• Birth-to-birth interval (“birth interval”)—the period between two consecutive live births, from birthdate to birthdate.
• Birth-to-conception interval—the period between a live birth or stillbirth and the conception of the next pregnancy.
• Interpregnancy interval—the period from conception of the first child to conception of the next.

The interpregnancy interval is best used to study relationships with maternal health because it includes some pregnancies that end in induced or spontaneous abortion. This is important because fetuses conceived but not born also influence maternal and child health (38).

The birth-to-conception interval excludes any time spent in pregnancy and is often used by researchers because it is not affected if the second baby is born prematurely. A premature birth influences the relationship between intervals and child mortality; excluding prematurity ensures that any mortality found is due to shorter intervals and not to prematurity (109). The conception date, which is needed to calculate the birth-to-conception interval and the interpregnancy interval, is often difficult to estimate, however (111).

Birth-to-birth intervals, used in the DHS, are easy data to collect and calculate, but they miss spontaneous and induced abortions, thus making intervals seem longer on average than they actually are. Most calculations of birth intervals consider only the interval before the most recent birth in the five years before the survey, since women often cannot accurately recall details from longer ago (24).

Preferred Birth Intervals

Preferred birth intervals are more difficult to measure than actual birth intervals. Estimates usually are based on women’s perspectives and do not incorporate their husbands’ preferences, because the DHS do not ask men about preferred birth intervals (14, 155). Researchers can measure women’s preferred birth intervals in three different ways: asking women what they think is the best interval; asking women about their preference for their next birth interval; and asking women their reaction to their most recent birth interval. There is little consensus on which approach is best (155).

Some DHS ask women, “What do you think is the best number of months or years between the birth of one child and the birth of the next child?” (15). This method requires only one survey question and no calculations. Some researchers, however, say that this question is too abstract and may not reflect an individual’s situation or reality (142).

The second approach—asking women who want another child how soon they want to have their next birth—is more practical, and women can relate the question to their personal situations. It is useful for programs assessing their clients’ individual situations and reproductive intentions. It may overestimate preferred birth intervals, however, because some women may have already waited longer than they would have preferred, and surveys do not usually record such responses to this question (15, 141).

The third measurement approach is similar to the one used to derive the estimates of preferred intervals in sub-Saharan Africa (see Comparing actual and perferred intervals in chapter 2_2). The DHS questionnaire asks, “At the time you became pregnant with (name of child), did you want to become pregnant then, did you want to wait until later, or did you want no (more) children at all?” If a woman says she did want the birth then, the interval is considered her preferred length. If she says she wanted the birth later, her preferred birth interval is the actual interval plus the additional time that the woman reports she would have wanted to wait (141). A disadvantage to this method is that some women are unlikely to say that their child was unwanted or came too soon, thus yielding an estimate that is shorter than their actual preferred interval (27). Also, the question does not offer an option for women who wanted the birth sooner. Thus the resulting estimate is longer than these women actually preferred.