• Editors' Summary
• Credits

1. Exploring the New Evidence
2. Actual Versus Preferred Birth Intervals
3. Contraception for Spacing Births
4. Who Has Shorter Intervals?
• Survival and Health of the Previous Child
• Women's Characteristics
• Cultural Norms
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.

Who Has Shorter Intervals?

Worldwide, women differ widely in their birth spacing practices. A variety of factors influence a woman’s birth spacing, including the health status of her previous child as well as her personal characteristics. Also, traditional practices—particularly breastfeeding and postpartum abstinence, as well as cultural norms—affect birth spacing.

The health of a woman’s previous child often affects the timing of her next birth. If a child dies, particularly within the first year of life, couples tend to have their next child sooner than if the child survives. Similarly, if a newborn is unhealthy in infancy, couples are more likely to have another child without waiting as long as they otherwise would.

Infant survival. Studies around the world, including Bhutan, Egypt, Kenya, Vietnam, and Zimbabwe, show that parents are more likely to have their next child sooner if a newborn dies than if a newborn survives (25, 64, 68, 139, 185, 211, 212). In all 55 countries surveyed by DHS between 1990 and 2001, women are more likely to have their next child within 3 years if the previous child dies (see Table 7).

When a child dies, mothers’ subsequent birth intervals are 60% shorter, on average, than when a child survives, according to data from 46 DHS (62). This study also found that the longer the previous child survives, the less the effect on the subsequent birth interval. After age two a child’s death appears not to influence the mother’s subsequent birth interval at all (62).

Mothers in rural Senegal have their next birth within a median of 15 months if their infant dies in the first month of life. If an infant dies before age one, mothers wait a median of 22 months before their next child. If a child dies between ages one and two, mothers wait a median of 29 months; and when a child survives for two years, mothers wait a median of 33 months to have their next child (153).

Why does a child’s death result in more rapid childbearing? Some couples unintentionally have their next child quickly because a child’s early death ends breastfeeding, and women return to menses and resume ovulation sooner (62). In Ghana the median duration of postpartum amenorrhoea dropped from 12 months to 4 months among women whose child died early (123). Data from the 46 DHS show that, on average, child survival increases the duration of postpartum amenorrhea by 178% (62).

Edson Whitney for JHU/CCP

In Bangladesh a couple takes their newborn to a clinic for a check-up. When an infant survives and is healthy, couples are less likely to have their next child very soon. Programs for child health and for family planning can work together to encourage couples to have longer, healthier birth intervals.

Other couples make a conscious effort to replace the lost child soon. When a child dies, the duration of postpartum sexual abstinence can fall by as much as 47%, according to data from the 46 DHS (62). Some studies have found, however, that resumption of sexual activity is less important than the early cessation of breastfeeding in explaining why the next child is born sooner when a previous child dies (129, 181).

Women whose pregnancies end in miscarriage or abortion are usually more likely to have a next child quickly. Few studies have looked at this relationship, however, because miscarriages, stillbirths, and abortions are rarely recorded. A study by the Latin American Center for Perinatology and Human Development found that half of adolescents age 19 or younger whose pregnancies ended in abortion or miscarriage became pregnant again within 2 years, compared with about one-third of adolescents who had a previous live birth. Among women ages 20 to 24, 28% whose pregnancy ended in abortion or miscarriage became pregnant within 2 years, compared with 21% of those who had a previous live birth (37).

An African study, however, found that women whose pregnancies end in miscarriage or stillbirths are less likely to have a next child quickly. In The Gambia women who had a miscarriage or stillbirth were more likely than other women to postpone childbearing by using contraception. Some 14% of women who miscarried or had stillbirths used contraception subsequently, far more than the percentage who used contraceptives during breastfeeding or after weaning. When asked why they used contraception after a miscarriage or stillbirth, women reported that they wanted to give their bodies time to rest, recover, and have a better chance of conceiving a healthy baby in the future (21).

Infant health. If a newborn survives but is sickly, women tend to have their next child sooner. One explanation is that sick newborns are less likely to breastfeed (112). If infants cannot breastfeed often and intensely, mothers resume ovulation more quickly and, without contraception or sexual abstinence, may soon become pregnant again (115). Also, if a woman is worried that her sick child will die in infancy, she may try to have a healthy child quickly. For this same reason, mothers whose newborns are low in weight at birth may have their next child quickly, too (18, 112).