• Editors' Summary
• Credits

1. Exploring the New Evidence
2. Actual Versus Preferred Birth Intervals
• Actual birth Intervals
• Preferred Birth Intervals
3. Contraception for Spacing Births
4. Who Has Shorter Intervals?
5. How Programs Can Help Couples Space Births

• Figures
• Tables
• Side-bars
• Bibliography

• Why are longer intervals better?
• Spacing: A matter of choice
• How to measure intervals
• Women want longer intervals
• Demand for spacing is high
• Infant deaths shorten intervals
• Traditional practices can help
• Health programs can spread the message

• POPLINE
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Published by the Population Information Program, Center for Communication Programs, The Johns Hopkins University Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA.

Actual Versus Preferred Birth Intervals

On average, women in developing countries have much shorter birth intervals than they would prefer (15). Many women not only are unable to achieve their own reproductive goals but also are falling far short of the 3- to 5-year intervals that new evidence suggests are healthiest. If more women achieved their preferred birth intervals, fertility rates would fall further, since longer birth intervals typically mean that women have fewer children over the course of their reproductive lives (29).

Birth intervals are growing longer, yet most are still short of the healthiest interval of 3 to 5 years. The median birth interval in developing countries is about 32 months, 4 months short of 3 years, based on Population Reports analysis of 55 countries with DHS data. While this statistic suggests that many women are close to reaching the healthiest birth interval, in fact, 57% of women in the countries included in the analysis space their births shorter than 3 years (see Figure 2).

Current birth intervals. Many more women need to space births longer to realize the health benefits. Even in Indonesia, where median birth intervals are longest at 45 months, 36% of women have birth intervals shorter than 3 years. In Zimbabwe, with the second-longest median birth interval at 40 months, 40% of women have birth intervals shorter than 3 years. (The median is the exact “middle” birth interval of a country, with half of women having longer birth intervals and half having shorter intervals than the median. See side-bar, Measuring Birth Intervals).

In each region, the population-weighted proportions of women with birth intervals shorter than 2 years, 2 to 3 years, 3 to 4 years, and over 4 years are similar. The percentage of women with birth intervals shorter than 3 years ranges from 52% in Latin America to 60% in sub-Saharan Africa. Sub-Saharan Africa has fewer women with birth intervals shorter than 2 years than any other region. Only 22% of women have such short birth intervals, compared with 26% in Asia and the Pacific to 31% in Eastern Europe and Central Asia.

Perhaps surprisingly, of the 55 countries in the analysis, the largest proportions of women with intervals shorter than 3 years tend to be in some higher-income developing countries, such as Jordan, Turkmenistan, and Yemen. In higher-income developing countries, use of long-term contraceptive methods for limiting births is more common than use of short-term methods for spacing. Birth intervals are shorter in such countries because many women prefer to have their births in close succession and then to use contraception for limiting rather than spacing births (15).

Birth interval trends. Birth intervals are growing longer over time in most countries. Of 34 countries with multiple surveys since 1986, the proportion of women waiting at least 3 years between births has risen between the first and last survey in almost all countries. There are several reasons: Women may be more motivated to space their births because their opportunities for education and employment are expanding, and thus more may want to postpone the next pregnancy (17, 106, 147). Also, people have greater means to control their fertility as family planning services have expanded, particularly in urban areas (see Social Status and employment in Chapter 4.2). At the same time, in some countries economic or political instability may have led more couples to postpone having children (5, 199).

Birth intervals are lengthening faster in some countries, such as Indonesia and Zimbabwe, than in others. In Indonesia birth intervals are rising the fastest. Indonesia’s median birth interval has increased from 34 months in 1987 to 45 months in 1997—an average increase of over 1 month every year. The percentage of women with birth intervals shorter than 3 years has dropped from 55% in 1987 to 36% in 1997, a reduction of almost two percentage points per year. Strong government support for family planning, increased access to services, changing reproductive intentions, and high levels of contraceptive use help explain Indonesia’s rapid rise in birth intervals (182, 191). Birth intervals are also rising fast in Zimbabwe. The percentage of women with birth intervals shorter than 3 years has been dropping almost two percentage points per year between 1988 and 1999 (see Table 5). Zimbabwe’s fast reduction in women with short intervals is largely due to increased access to and use of contraception among young and middle-aged women (116, 170).

In a few countries—Haiti, India, and Mali—birth intervals have not lengthened. The main reason appears to be the decline of traditional practices that contribute to longer birth intervals such as postpartum abstinence and prolonged breastfeeding (33, 125, 200) (see Postpartum abstinence and Breastfeeding practices in Chapter 4.3). Contraceptive use for spacing births is rising only minimally in some sub-Saharan African countries (3, 59).