October 29, 2002 - 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).
Children born 3 to 5 years after the previous child are about 2.5 times more likely to survive to age five than children born less than 2 years after the previous child, according to the report, Birth Spacing: Three to Five Saves Lives. The new findings come from the Demographic and Health Surveys (DHS) program, which analyzed outcomes of more than 430,000 pregnancies in 18 countries.
"In every country thousands more children could survive each year if all women spaced their births at least 3 years apart," according 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%. Similarly in Pakistan, death of under-five children in Pakistan could fall by as much as 46%, 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.
A year 2000 study of 450,000 women and over a million pregnancies in 19 Latin American and Caribbean countries by the Latin American Center for Perinatology and Human Development reinforces the DHS findings. It also provides some of the best evidence yet that spacing births improves mothers' health. Compared with women who give birth at 9- to 14-month intervals, women who wait 27- to 32-months are 2.5 times more likely to survive childbirth, according to the study cited in Population Reports.
Why are short birth intervals riskier for mothers and children? The biological and behavioral mechanisms that make short intervals riskier are little understood, but researchers suspect that mothers who give births frequently may not have time to restore their own nutritional reserves or breast milk. Also, children close in age are more likely to compete for food and other resources.
Worldwide many women have birth intervals shorter than 3 years. In 55 countries studied, some 26% of mothers give birth less than two years after a previous birth. About 31% 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% of children under five would survive.
The report calls on reproductive health programs to help women achieve their preferred birth intervals. "Programs can ensure that women have continuity of care, a full range of contraceptive methods to choose from, and a steady source of supply," according to the authors. Communication campaigns in several countries have already begun promoting 3-year spacing. The Hopkins researchers stress that child spacing is a matter of choice and that couples need to make spacing decisions based on their personal preferences and situations, on accurate information, and with a range of contraceptive options available.
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