Contents
Chapters
- Exploring the New Evidence
- Actual Versus Preferred Birth Intervals
- Contraception for Spacing Births
- Who Has Shorter Intervals?
- How Programs Can Help Couples Space Births
Highlights
- 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
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.
Volume XXX, Number 3
Summer 2002
Series L, Number 13
Issues in World Health
Exploring the New Evidence
New research shows that waiting 3 years between births is even better for children than 2-year intervals. Children born 3 to 5 years after a previous birth are about 1.5 times more likely to survive to age five than children born at 2- to 3-year intervals and about 2.5 times more likely to survive than children born at intervals shorter than 2 years. Women who space births 3 to 5 years apart not only have healthier babies but also are healthier themselves.
It has long been known that avoiding closely spaced births is advantageous to child health. Two-year spacing was widely identified and promoted as “the healthy interval.” Many studies found that infants spaced at least 2 years apart are more likely to survive than infants spaced less than 2 years (53, 69, 70, 99, 100, 111, 112, 130, 175, 200). In addition, infants spaced at least 2 years apart are less likely to be premature (56, 94, 110, 213), less likely to suffer from low birth weight (61, 97, 109, 110), and less likely to be malnourished (110, 114). The survival chances of the next-to-youngest child improve, too, when births are at least 2 years apart (74, 90, 102, 115, 153).
Findings from the DHS Study
New findings in 2002 from researchers at the Demographic and Health Surveys (DHS) program show that children born 3 to 5 years after a previous birth are healthier at birth and more likely to survive at all stages of infancy and childhood through age five than children born before 3 years (see Figure 1). Analyzing over 430,000 pregnancies in 18 countries, the study compared children born at 3- to 4-year intervals with those born before 2 years, between 2 and 3 years, between 4 and 5 years, and 5 years or later (159, 161).
Many factors besides birth spacing affect infant survival and health, among them the mother’s education and whether and how often she sought prenatal care. In the past, studies of birth intervals have been able to account statistically for some of these confounding factors but not all. The new DHS study statistically controlled—or accounted—for differences in demographic and socioeconomic variables, prenatal care differences, sex and survival of the previous child, and other factors that affect infant survival and health (159, 161).
Separately, the study also examined the confounding effects of breastfeeding on infant mortality and birth spacing. Whether and how long a mother breastfeeds influence her child’s survival chances. Statistically controlling for the effects of breastfeeding allows researchers to be more certain that birth intervals themselves are associated with infant and child survival rather than breastfeeding. The analysis shows that children who stop breastfeeding are at greater risk of dying. Still, when breastfeeding is controlled for statistically, little to no change is observed in the link between birth intervals and child survival. Children born less than 3 years after a previous birth are still at higher risk of dying than children born at 3- to 4-year or 4- to 5-year intervals, after accounting for breastfeeding.
The DHS study found that, when a mother spaces her child’s birth 3 to 5 years after the previous birth, rather than less than 3 years, her infant is more likely to survive in each stage of development—the perinatal period (from 28 weeks gestation through the first week of life), the early neonatal period (the first week of life), the neonatal period (the first 28 days of life), from birth through 12 months, and through age five (159, 161) (see Table 1).
 Liz Gilbert, Courtesy of the David and Lucile Packard Foundation | |||
A mother rests with her newborn infant in a Nigerian clinic. New evidence shows that longer birth intervals are better for health. If all women in Nigeria spaced their births at least 3 years apart, infant mortality could fall from 75 deaths per 1,000 births to 54 deaths per 1,000 births. | |||
Children born 3 to 5 years after a previous birth not only are more likely to survive but also are less likely to be malnourished during infancy and childhood through age five, the study found. Infants born 3 years or more after a previous birth suffer less from stunting (short height for age) and underweight (low weight for age) than infants born after intervals shorter than 3 years (161).
Worldwide, infant and under-five mortality is a serious problem (see Table 2). The DHS study estimates that in every country thousands more children could survive each year if all women spaced their births at least 3 years apart. In Nigeria, for instance, infant mortality could fall from 75 deaths per 1,000 births to 54 deaths—a 28% decline—if all women spaced their births at least 3 years apart. Under-five mortality could fall from 140 deaths per 1,000 births to 108 deaths—a 23% decline (162).
Similarly, in Pakistan infant mortality could fall from 90 deaths per 1,000 births to 55 deaths—a 39% decline—if all women spaced their births at least 3 years apart. The under-five mortality rate could fall from 117 deaths per 1,000 births to 63 deaths—a 46% decline (160).
