Patterns and determinants of short and long birth intervals among women in selected sub-Saharan African countries

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Abstract

Optimal birth spacing (defined as a birth spacing of 24–59 months) is incontrovertibly linked to better health outcomes for both mothers and babies. Using the most recent available Demographic and Health Survey data, we examined the patterns and determinants of short and long birth intervals among women in selected sub-Saharan African (SSA) countries.

Reproductive health and sociodemographic data of 98,934 women from 8 SSA countries were analyzed. Unadjusted and adjusted multinomial logistic regression models were used to examine the net relationship between all the independent variables and short and long birth intervals.

Overall, the majority of women in all the countries optimally spaced births. However, a significant proportion of women had short birth intervals in Chad (30.2%) and the Democratic Republic of Congo (Congo DRC) (27.1%). Long birth spacing was more common in Eastern and Southern African countries, with Zimbabwe having the highest rate of long term birth interval (27.0%). Women who were aged 35 years and above in Uganda (RRR = 0.72, CI = 0.60–0.87), Tanzania (RRR = 0.62, CI = 0.49–0.77), Zimbabwe (RRR = 0.52, CI = 0.31–0.85), Nigeria (RRR = 0.82, CI = 0.72–0.94) and Togo (RRR = 0.67, CI = 0.46–0.96) had significantly lower odds of having short birth intervals compared to women aged 15–24 years. Older women (above 34 years) had increased odds for long birth intervals in all countries studied (Chad (RRR = 1.44, CI = 1.18–1.76), Congo DRC (RRR = 1.73, CI = 1.33–2.15), Malawi (RRR = 1.54, CI = 1.23–1.94) Zimbabwe (RRR = 1.95, CI = 1.26–3.02), Nigeria (RRR = 1.85 CI = 1.56–2.20), Togo (RRR = 2.12, CI = 1.46–3.07), Uganda (RRR = 1.48, CI = 1.15–1.91), Tanzania RRR = 2.12, CI = 1.53–2.93).

The analysis suggested that the determinants of long and birth intervals differ and varies from country to country. The pattern of birth spacing found in this study appears to mirror the contraceptive use and fertility rate in the selected SSA countries. Birth intervals intervention addressing short birth intervals should target younger women in SSA, especially in Chad and Congo DRC, while intervention for long birth spacing should prioritize older, educated and wealthy women.

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Breastfeeding and child cognitive development: new evidence from a large randomized trial.

Michael S Kramer (2008)

The evidence that breastfeeding improves cognitive development is based almost entirely on observational studies and is thus prone to confounding by subtle behavioral differences in the breastfeeding mother's behavior or her interaction with the infant. To assess whether prolonged and exclusive breastfeeding improves children's cognitive ability at age 6.5 years. Cluster-randomized trial, with enrollment from June 17, 1996, to December 31, 1997, and follow-up from December 21, 2002, to April 27, 2005. Thirty-one Belarussian maternity hospitals and their affiliated polyclinics. A total of 17,046 healthy breastfeeding infants were enrolled, of whom 13,889 (81.5%) were followed up at age 6.5 years. Breastfeeding promotion intervention modeled on the Baby-Friendly Hospital Initiative by the World Health Organization and UNICEF. Subtest and IQ scores on the Wechsler Abbreviated Scales of Intelligence, and teacher evaluations of academic performance in reading, writing, mathematics, and other subjects. The experimental intervention led to a large increase in exclusive breastfeeding at age 3 months (43.3% for the experimental group vs 6.4% for the control group; P < .001) and a significantly higher prevalence of any breastfeeding at all ages up to and including 12 months. The experimental group had higher means on all of the Wechsler Abbreviated Scales of Intelligence measures, with cluster-adjusted mean differences (95% confidence intervals) of +7.5 (+0.8 to +14.3) for verbal IQ, +2.9 (-3.3 to +9.1) for performance IQ, and +5.9 (-1.0 to +12.8) for full-scale IQ. Teachers' academic ratings were significantly higher in the experimental group for both reading and writing. These results, based on the largest randomized trial ever conducted in the area of human lactation, provide strong evidence that prolonged and exclusive breastfeeding improves children's cognitive development. isrctn.org Identifier: ISRCTN37687716.

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Maternal age and fetal loss: population based register linkage study.

A M Nybo Andersen, J Wohlfahrt, P Christens … (2000)

To estimate the association between maternal age and fetal death (spontaneous abortion, ectopic pregnancy, stillbirth), taking into account a woman's reproductive history. Prospective register linkage study. All women with a reproductive outcome (live birth, stillbirth, spontaneous abortion leading to admission to hospital, induced abortion, ectopic pregnancy, or hydatidiform mole) in Denmark from 1978 to 1992; a total of 634 272 women and 1 221 546 pregnancy outcomes. Age related risk of fetal loss, ectopic pregnancy, and stillbirth, and age related risk of spontaneous abortion stratified according to parity and previous spontaneous abortions. Overall, 13.5% of the pregnancies intended to be carried to term ended with fetal loss. At age 42 years, more than half of such pregnancies resulted in fetal loss. The risk of a spontaneous abortion was 8.9% in women aged 20-24 years and 74.7% in those aged 45 years or more. High maternal age was a significant risk factor for spontaneous abortion irrespective of the number of previous miscarriages, parity, or calendar period. The risk of an ectopic pregnancy and stillbirth also increased with increasing maternal age. Fetal loss is high in women in their late 30s or older, irrespective of reproductive history. This should be taken into consideration in pregnancy planning and counselling.

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Effects of preceding birth intervals on neonatal, infant and under-five years mortality and nutritional status in developing countries: evidence from the demographic and health surveys.

S.O. Rutstein (2005)

This paper examines the association between birth intervals and infant and child mortality and nutritional status. Repeated analysis of retrospective survey data from the Demographic and Health Surveys (DHS) program from 17 developing countries collected between 1990 and 1997 were used to examine these relationships. The key independent variable is the length of the preceding birth interval measured as the number of months between the birth of the child under study (index child) and the immediately preceding birth to the mother, if any. Both bivariate and multivariate designs were employed. Several child and mother-specific variables were used in the multivariate analyses in order to control for potential bias from confounding factors. Adjusted odds ratios were calculated to estimate relative risk. For neonatal mortality and infant mortality, the risk of dying decreases with increasing birth interval lengths up to 36 months, at which point the risk plateaus. For child mortality, the analysis indicates that the longer the birth interval, the lower the risk, even for intervals of 48 months or more. The relationship between chronic malnutrition and birth spacing is statistically significant in 6 of the 14 surveys with anthropometric data and between general malnutrition and birth spacing in 5 surveys. However, there is a clear pattern of increasing chronic and general undernutrition as the birth interval is shorter, as indicated by the averages of the adjusted odds ratios for all 14 countries. Considering both the increased risk of mortality and undernutrition for a birth earlier than 36 months and the great number of births that occur with such short intervals, the author recommends that mothers space births at least 36 months. However, the tendency for increased risk of neonatal mortality for births with intervals of 60 or more months leads the author to conclude that the optimal birth interval is between 36 and 59 months. This information can be used by health care providers to counsel women on the benefits of birth spacing.

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Author and article information

Journal

Journal ID (nlm-ta): Medicine (Baltimore)

Journal ID (iso-abbrev): Medicine (Baltimore)

Journal ID (publisher-id): MEDI

Title: Medicine

Publisher: Wolters Kluwer Health

ISSN (Print): 0025-7974

ISSN (Electronic): 1536-5964

Publication date (Electronic): 08 May 2020

Publication date Collection: May 2020

Volume: 99

Issue: 19

Electronic Location Identifier: e20118

Affiliations

[a ]Sociology Department, University of Fort Hare, East London Campus, 50, Church Street, East London

[b ]Demography and Population Studies (DPS), University of the Witwatersrand, Johannesburg, South Africa.

Author notes

[∗ ]Correspondence: Anthony Idowu Ajayi, Sociology Department, University of Fort Hare, East London Campus, 50, Church Street, 5200, East London, South Africa (e-mail: ajayianthony@ 123456gmail.com , aajayi@ 123456aphrc.org ).

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Oluwaseyi Dolapo Somefun http://orcid.org/0000-0002-3842-2685

Article

Publisher ID: MD-D-19-00154 Accession ID: 20118

DOI: 10.1097/MD.0000000000020118

PMC ID: 7440207

PubMed ID: 32384488

SO-VID: 9e1dc44c-9f28-4fad-bbe7-1e4ec5b9072b

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This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0

History

Date received : 10 January 2019

Date revision received : 4 March 2020

Date accepted : 3 April 2020

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Keywords: long birth interval,short birth interval,sub-saharan africa

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Keywords: long birth interval, short birth interval, sub-saharan africa

Patterns and determinants of short and long birth intervals among women in selected sub-Saharan African countries

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Most cited references 37

Breastfeeding and child cognitive development: new evidence from a large randomized trial.

Maternal age and fetal loss: population based register linkage study.

Effects of preceding birth intervals on neonatal, infant and under-five years mortality and nutritional status in developing countries: evidence from the demographic and health surveys.

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