• 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.

In many countries women’s preferred birth intervals also are getting longer. As contraception becomes widely available and social norms change, more people are choosing longer intervals. For example, one analysis found that between the mid-1980s and early 1990s, average preferred birth intervals rose in all 11 countries in four regions—by 9 months or more in 3 countries (15).

In a study of nine sub-Saharan African countries with repeat surveys, women’s preferred birth intervals increased in length in all nine (142). Median preferred birth intervals rose by an average of 5 months between the first surveys, mostly in the 1980s, and the most recent surveys in the 1990s. Countries with the greatest increases in the length of preferred birth intervals were Senegal, at an increase of 9.2 months, and Mali, Uganda, and Zimbabwe, each with a 7.6 month increase.

Pathfinder/JHU/CCP

In rural Egypt a couple and their three children take a walk in the countryside. In Egypt, as in most countries, birth intervals are growing longer over time. The percentage of women with birth intervals shorter than 3 years has dropped from 66% in 1988 to 54% in 2000.

Comparing actual and preferred intervals. In most developing countries women’s actual birth intervals are shorter than the intervals they would prefer (15). In several countries, such as in Egypt and Pakistan, however, women’s actual intervals are close to their preferred intervals (160). Countries with the longest median preferred birth intervals have the largest gaps between their preferred and actual intervals.

Wide gaps between actual and preferred intervals signify that a transition from high to low fertility is underway: that is, reproductive goals are changing, but contraceptive behavior has yet to follow (141). In many sub-Saharan African countries, women are the furthest from achieving their preferred birth intervals—especially in Comoros, Rwanda, Kenya, Zimbabwe, and Ghana (in order of size of gap). In Comoros women need to lengthen their actual birth intervals the most, by just over half (17 months) to achieve their preferred spacing between births of 47 months (142) (see Table 6).

In almost all sub-Saharan African countries, women who prefer longer intervals are more likely to have a surviving previous child, to be older (until age 40, when the relationship plateaus), to have more surviving children, to know and to use contraception, to approve of family planning, and to be married to a man with more education (142).

If women in countries with the widest gaps between actual and preferred birth intervals achieved their spacing goals, child mortality would drop substantially. In Kenya neonatal mortality would decline by 11%; infant mortality would decline by 13%; and under- five mortality would decline by 17% (142).