• 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.

A variety of demographic and socioeconomic characteristics influence women’s spacing practices. These include a woman’s age at the birth of each child, the number of children she already has, and her educational attainment, social status, labor force participation, and place of residence.

Maternal age and number of children. Younger women are more likely than older women to have their next child within 3 years (see Table 7). In all 50 countries with DHS data, 60% or more of women ages 15 to 19 have birth intervals shorter than 3 years. In only 2 of 55 countries do 60% of women ages 40 and older have birth intervals shorter than 3 years. In a few countries, such as Botswana, Brazil, Ethiopia, and Togo, there is little or no difference after age 30.

In most countries women with fewer children have shorter birth intervals than women with more children, but in a few countries the reverse is true. In 21 of 28 countries studied with DHS data, women with one or two children had shorter birth intervals than women with four or five children. In 19 of the 28 countries, their birth intervals were shorter by 2 months or more, and in 4 countries intervals were shorter by 4 months or more. In five countries, however—Brazil, Colombia, Indonesia, Namibia, and Paraguay—women with four or five children had shorter birth intervals (105).

Education. In 38 of 51 countries with DHS data, women with no education were more likely than women with education to space births less than 3 years apart (see Table 7). In seven surveyed countries, however, women with secondary or higher education were more likely to have intervals shorter than 3 years. One explanation is that in these countries women with more education marry at older ages and then have children in quick succession (35, 118, 147). In seven other countries there is little or no difference in birth intervals between women with no education and with secondary or higher education.

Researchers have not explained why women’s education levels affect their birth intervals differently from one place to another. Differences in childbearing preferences may account for some birth spacing differences (see side-bar, Child Spacing: A Matter of Choice). In some countries women with more education are more likely to use contraception to prolong their birth intervals (166, 184). Also, women with more education may work outside the home or live in urban regions, both of which can lead to longer birth spacing.

Social status and employment. Women with lower status, whether within the household or within society, and women who are not employed tend to have shorter birth intervals than women of higher status or who are employed. For example, in Turkey women with less reproductive and economic decision-making power, and who typically do not work outside the home, have birth intervals 5.4 months shorter than women with more decision-making power and who are usually employed (76). In India women of lower social and economic status have median birth intervals of 14 months compared with 21 months among women of higher status (118). In some countries labor force participation has little or no effect on when women have their first child but influences when they have subsequent children (46, 127). Also, women who work outside the home, particularly urban women, may be more educated and more likely to use contraception to space their births (166).

Place of residence. In 51 of 55 countries surveyed by the DHS, women who live in rural areas are more likely than women in urban areas to have birth intervals shorter than 3 years. The greatest differences are in Latin America and the Caribbean, Eastern Europe, and Central Asia. In only three countries—Chad, Mozambique, and Pakistan—are urban women more likely than rural women to have birth intervals shorter than 3 years. In two countries there is little to no difference (see Table 7). These findings are not surprising, as urban women have better access to education and employment opportunities.

Sammy Ndwiga

In this family in Somalia three sisters care for their younger male sibling. Where a cultural preference for sons is strong, many couples have another child soon after the birth of a daughter and continue having children until the birth of a son.

Cultural norms and customs that influence women’s birth spacing practices include social pressure for women to prove their fertility and breastfeeding and postpartum abstinence practices. Preferences for male children can also affect birth intervals.

Pressure to prove fertility. Couples who face pressure for childbearing from their families or society want to have their first child soon after marriage and continue to have children rapidly. In some societies having many children and having them quickly is a sign of male virility and female fertility. In traditional Indian society, for example, childbearing brings prestige to a new wife, and so couples have their first child quickly (118, 148). Social pressure to bear children quickly also is common in sub-Saharan Africa and the Near East and North Africa (49).

Breastfeeding practices. Whether women breastfeed at all, how frequently, and how long influence their birth spacing practices (54, 72, 119, 208, 209). In nearly all developing countries nearly all women breastfeed their newborn children (65, 93). Breastfeeding differs among cultures both in duration and frequency, however (93, 206). Among developing regions the duration of breastfeeding ranges from an average of 14 months in Latin America and the Caribbean to 21 months in sub-Saharan Africa (65).

Breastfeeding practices help determine how long women will remain amenorrheic—without menses and thus less likely to get pregnant—after giving birth (207). Women who fully or nearly fully breastfeed their infants remain amenorrheic longer (92). Among 55 countries with DHS data, women in sub-Saharan Africa have the longest median duration of postpartum amenorrhea, ranging from about 7 months in Comoros to 17 months in Rwanda. Women in the Near East and North Africa have the shortest duration, from 3 months in Turkey to 6 months in Yemen. Having more children and being poorly nourished also lengthen amenorrhea (207).

Postpartum abstinence. Couples who do not practice postpartum sexual abstinence—avoiding sex for several months after a birth—tend to have their next child quickly. Postpartum abstinence is common in many countries, however. When the length of such abstinence exceeds the length of postpartum ammenorhea, this practice can help women delay their next pregnancy.

Traditional beliefs often influence sexual activity after childbirth (149). In Lesotho, for example, mothers are separated from their husbands for as long as the mothers are breastfeeding because they believe that having sex with a lactating woman would spoil her milk (98).

While taboos against postpartum sexual activity are widespread, particularly in Africa, the duration of postpartum abstinence varies greatly both within and among countries (190). Among 55 countries surveyed by the DHS since 1990, the median duration of postpartum abstinence in sub-Saharan Africa ranges from 2 months in Uganda to 22 months in Guinea. Elsewhere, with few exceptions the period ranges from 1 month to 3 months. In countries where the period of postpartum abstinence is nearly the same or shorter than the period of amenorrhea—as in Chad, Guatemala, and Nepal—abstinence alone has little effect on birth intervals (62).

In many countries the effects of postpartum abstinence and amenorrhea combined—postpartum insusceptibility —account for birth spacing for up to 2 years (65, 179). In 26 of the 55 surveyed countries, the median duration of postpartum insusceptibility is 1 year or more, and nearly 2 years in Burkina Faso and Guinea. The median duration is less than 6 months in only nine countries surveyed.

Son preference. Couples who prefer sons tend to have their next child soon after the birth of a daughter. In China, for example, among women who had given birth to a girl most had their next child within 37 months. In contrast, among women who had a boy, most had their next child within 46 months (58). Among 55 countries with data, women are more likely to have a next child within 3 years after the birth of a daughter than after a son’s birth in all regions except Latin America (see Table 7).

The preference for sons is especially strong in South and East Asia, where people often value male children differently from female children. In Korea, for instance, sons continue the family lineage, perform prayers to ancestors, and can help support parents in their old age (96). Similarly, in India sons tend to have higher economic, social, and religious value to their parents (11), while girls may be considered an economic liability (88).