JHPIEGO TrainerNews™ |
Birth Spacing: Three to Five Saves Lives
(December 2002)
Reprinted with permission from JHU/CCP
Evidence has consistently shown that waiting two years between births gives infants and children through age five a better chance of survival. Now, new studies find that waiting even longer--three to five years--between births is even better. Mothers as well as children benefit from longer birth intervals, according to the latest issue of "Population Reports," published by the Johns Hopkins Bloomberg School of Public Health's Center for Communication Programs (CCP). Many women want to space births longer than they currently do, and 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.
New Evidence
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.
"In every country thousands more children could survive each year if all women spaced their births at least 3 years apart," according to DHS estimates cited in the report. In Nigeria, for example, if all couples space births between 3 to 5 years, deaths of children under the age of five could fall by 23 percent. Similarly, in Pakistan, death of under-five children could fall by as much as 46 percent, if all women spaced their births 3 to 5 years apart, according to the Hopkins report. Unfortunately, in many countries, spacing births beyond three years is far from the current practice and as a result many lives are still being lost.
The new DHS study statistically accounted for many demographic factors also known to affect infant survival and health. Thus researchers can have greater confidence that the effect of birth spacing is real and not a reflection of some other factor, according to the report.
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.
Mothers Benefit, Too
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.
What Programs Can Do
Worldwide many women have birth intervals shorter than 3 years. In 55 countries studied, some 26 percent of mothers give birth less than two years after a previous birth. About 31 percent of couples wait between 2 and 3 years to have another child. The Hopkins report points out that in many developing countries women would prefer to wait longer between births than they actually do. A 1998 survey in Kenya, for example, found that median intervals were 35 months compared with preferred intervals of 49. If Kenyan women could achieve the 49-month interval, an additional 17 percent of children under five would survive.
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 healthcare providers can work together to help women achieve their preferred birth intervals.
The report was prepared by Vidya Setty-Venugopal, MPH, and Ushma D. Upadhyay, MPH. "Population Reports" is an international review journal of important issues in population, family planning, and related matters. It is published four times a year in four languages by the Population Information Program at the Johns Hopkins Center for Communication Programs for more than 170,000 family planning and other health professionals worldwide, with support from the US Agency for International Development (USAID). USAID administers the US foreign assistance program, providing economic and humanitarian assistance in more than 80 countries worldwide.
JHU/CCP is a pioneer in the field of strategic, research-based communication for behavior change and health promotion that has helped transform the theory and practice of public health communications. With representatives in more than 30 countries, JHU/CCP has been a leader in the development of projects based on systematic needs assessments and clear strategies for positioning and presenting the benefits of health interventions to appropriate audiences.
For the full Birth Spacing issue of "Population Reports" and past issues, visit http://www.jhuccp.org/pr/l13edsum.shtml
For more information contact Stephen M. Goldstein or Kim Martin at press@jhuccp.org.