Printable Version

Todd Shapera

Contents

• Editors' Summary
• Credits

1. Exploring the New Evidence
2. Actual Versus 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
• Other Issues
• To order copies
• CCP Home Page

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.

Birth Spacing

Three to Five Saves Lives

Couples who space their births 3 to 5 years apart increase their children’s chances of survival, and mothers are more likely to survive, too, according to new research. Many women want to space births longer than they currently do. Programs can do more to help them achieve the birth intervals they want.

Over the years research has consistently demonstrated that, when mothers space births at least 2 years apart, their children are more likely to survive and to be healthy. Many programs have recommended 2-year intervals, and the message is widely known: In surveys most women say that a birth interval of 2 years is best.

Now new studies show that longer intervals are even better for infant survival and health and for maternal survival and health as well. Children born 3 to 5 years after a previous birth are about 2.5 times more likely to survive than children born before 2 years.

A 2002 study by researchers at the Demographic and Health Surveys (DHS) program finds that children born 3 years or more after a previous birth are healthier at birth and more likely to survive at all stages of infancy and childhood through age five. The study uses DHS data from 18 countries in four regions and assesses outcomes of more than 430,000 pregnancies.

Among the findings: Compared with children born less than 2 years after a previous birth, children born 3 to 4 years after a previous birth are:

• 1.5 times more likely to survive the first week of life;
• 2.2 times more likely to survive the first 28 days of life;
• 2.3 times more likely to survive the first year of life; and
• 2.4 times more likely to survive to age five.

A 2000 study by the Latin American Center for Perinatology and Human Development reinforces the DHS findings about children, using data for over 450,000 women. It also provides some of the best evidence yet that spacing births further apart improves mothers’ health. Among the findings: Compared with women who give birth at 9- to 14-month intervals, women who have their babies at 27- to 32-month birth intervals are:

• 1.3 times more likely to avoid anemia;
• 1.7 times more likely to avoid third-trimester bleeding; and
• 2.5 times more likely to survive childbirth.

While the biological and behavioral mechanisms that make shorter birth intervals riskier for infants and mothers are little understood, researchers suggest such factors as maternal depletion syndrome, premature delivery, milk diminution, and sibling rivalry. For instance, studies suggest that shorter birth intervals may not allow mothers enough time to restore nutritional reserves that provide for adequate fetal nutrition and growth. Fetal growth retardation and premature delivery can result in low birth weight and greater risk of death.

Almost everywhere, women’s birth intervals are shorter than they would prefer. If women could achieve their preferred intervals, child mortality would fall. For example, in Kenya under-five mortality would drop by 17%. In most countries substantial unmet need for spacing births remains. In fact, half of the total potential demand for contraception is for spacing. Addressing the unmet need for spacing would help millions of women to achieve their family planning goals.

Communication campaigns in several countries have already begun using a 3-year spacing message. Messages can emphasize that waiting 3 years between births clearly improves child survival, while waiting even longer is even better. Some have suggested a message that a woman should use contraception until her youngest child is two to four years of age. Emphasizing such social benefits as increased savings and time for the couple may be even more appealing than emphasizing the health benefits. Services can focus more on women who want to postpone their next pregnancy. They can ensure that women who want to space have continuity of care, a full range of methods, and a steady source of supply. Family planning and maternal and child health care providers can work together to help women achieve their preferred birth intervals.