• Editors' Summary
• Credits

1. Exploring the New Evidence
2. Actual Versus Preferred Birth Intervals
3. Contraception for Spacing Births
• Total Potential Demand for Spacing
• Contraceptive Use for Birth Spacing
• Unmet Need for Spacing
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

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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.

Contraception for Spacing Births

Around the world millions of women use temporary contraceptive methods to achieve their preferred birth intervals. All forms of contraception except for female sterilization and vasectomy are temporary and can be used to space births as well as to limit births—that is, to avoid having any more children.

Many other women, however, are not using contraception even though they would prefer to space their next birth. These women are considered to have an unmet need for family planning. Levels of unmet need for family planning among women who want to space births are even higher than among women who want to limit births, particularly in sub-Saharan Africa.

The number of women currently using contraception to space births plus the number with unmet need equals the total potential demand for contraception for spacing. While many women with an unmet need for spacing do not intend to use contraception, many others probably would use temporary contraceptive methods if various obstacles were overcome (151). Family planning programs can do more to overcome the obstacles.

In developing countries the total potential demand for contraception to space births is large—at about one-third of all women of reproductive age, based on Population Reports analysis of 54 countries with data from the DHS. Married women with few children account for most of the potential demand for birth spacing. Also, some married women with no children want to delay first births (16, 79).

Almost half of total potential demand for contraception worldwide is among people who want to have more children in the future. In other words, the level of potential demand for spacing births is about the same as for limiting births. In 45 of 54 countries, however, less of the potential demand for spacing is being satisfied. One implication is that family planning programs do not meet the contraceptive needs of younger women and others who want to space as effectively as they meet the needs of women who want to limit births. At the same time, however, women who want to space their next birth may be less motivated to use contraception than women who want no more births (195). The consequences of a wanted, but mistimed, pregnancy may be less than the consequences of an unwanted pregnancy, and thus women who wish to delay their next birth may be less likely to use contraception.

In most developing countries aside from sub-Saharan Africa, contraception is used much more for limiting than for spacing. In sub-Saharan Africa, however, a majority of contraceptive use is for spacing, because many people want large families, and birth spacing is common in many African traditions (87). Among the 54 countries surveyed, at one extreme, in Niger 84% of the total contraceptive use rate of 8% is among women who want to delay their next birth rather than limit births. In contrast, in India, at the other extreme, contraceptive use for postponing births is just 7% of the total contraceptive use rate of 48%, largely because the national family planning program has traditionally emphasized limiting family size and not spacing (73, 84, 113) (see Figure 3).

The effect of a country’s contraceptive use level on the median birth interval varies among countries but appears to be less influential where contraceptive use is lower. An analysis of DHS data from 1990 to 1995 in 27 countries, largely outside sub-Saharan Africa, demonstrates a threshold effect in the relation between temporary method use and the length of birth intervals (131). Where fewer than 30% of women use temporary methods, the specific level of contraceptive prevalence for spacing has no major effect on the country’s average birth interval. Once use of temporary methods surpasses 30%, however, average birth intervals are longer.

One explanation is that, since women who want to limit births are more motivated to prevent pregnancy, they are usually the first users of temporary contraception in a country. Eventually, use of contraception becomes more acceptable, and women who want to space their births begin to use it as well. As the percentage using contraceptives for spacing grows, birth intervals begin to grow longer (131). This trend is reversed in sub-Saharan Africa, however, where most contraceptive users have been spacing births (196).

An estimated 17% of married women of reproductive age in developing countries have an unmet need for family planning, a new study has found (156). Among regions, the highest level of unmet need for spacing is found in sub-Saharan Africa, at 16% of married women. The highest proportion of unmet need for spacing births is also in sub-Saharan Africa, at 65% of all unmet need for family planning. Worldwide, more than half of the unmet need is for spacing births (156). Ambivalence, lack of information, and personal and family opposition explain the majority of unmet need among women who want to postpone their next birth. Lack of access to family planning services is also a major factor in many countries (151, 195).

The concept of unmet need for spacing births describes women who are not using family planning and say they want more children, but not for at least two or more years, or who are unsure whether they want to have another child, or who want to have another child but are unsure when. Pregnant women whose pregnancies were mistimed and nonmenstruating women whose last births were mistimed also are included in the definition (79, 198).

Young women and postpartum women have substantial unmet need for spacing. More than 23% of married women ages 15–24 have an unmet need for spacing. Young women account for one-third of all unmet need (156), most of it for spacing (6, 79). In addition, many postpartum women do not use contraception but intend to do so. A study of women within one year after their last birth, among 27 DHS conducted between 1993 and 1996, found that about two-thirds of them had an unmet need for family planning. Almost 40% of the postpartum women intended to use a contraceptive method within the next 12 months (157).