Optimal Birth Spacing Interval

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Optimal Birth Spacing Interval
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Keys to Reducing Maternal and Child Mortality

• The Problem
• Births are risky when they are
• Too many
• Too close together
• Or when they occur among women who are
• Too young
• Too old
• One SolutionAvoid Too close together through
  an Optimal Birth Spacing Interval

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Objectives

• Understand the new research findings
• Understand the scope of the problem
• Understand what programs can do

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What Is Optimal Birth Spacing?

• The length of time needed between births to
  minimize the risks for adverse health
  outcomesnew research indicates this is three
  years or longer.
• A fundamental, but often underemphasized, part of
  family planning/reproductive health.
• A way to address family planning that does not
  interfere with many cultural norms.

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Significant Health Benefits

• For Children
• Lower risk for
• Stunted and underweight child
• Small for gestational age
• Low birth weight
• Preterm birth
• Child death
• Infant death
• Neonatal death
• Fetal death

• For Mothers
• Lower risk for
• Malnutrition from overlap of pregnancy and
  breastfeeding
• Puerperal endometritis
• Premature rupture of membranes
• Anemia
• Third trimester bleeding
• Maternal death

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Benefits of Optimal Birth Spacing

• Contributes to preserving the health and
  fertility of women and their overall quality of
  life
• Contributes to improving childrens lives by
  increasing their access to adequate food,
  clothing, housing, and educational opportunities
• Decreases a womans work burden
• Provides a cost-effective means of improving
  health and quality-of-life compared with other
  investments

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New Research

• Child morbidity, mortality, and nutrition
  (developing countries)
• Child morbidity and mortality (developed country
  USA)
• Maternal morbidity and mortality (developing
  countries)

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New Research

• What is new about this research?
• Controls for many important variables
• Allows for comparison between developing and
  developed settings
• Large sample sizes
• Few studies look at impact of birth spacing on
  maternal health

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Intervals Associated with Lowest Mortality Risk
for Children Developing Countries
Source Rutstein, S. 2003.
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Intervals Associated with Lower Mortality Risk
for InfantsAsian Countries
Adjusted Odds Ratio
Source Rutstein, S. 2002.
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Longer Intervals Lead to Improved Child Nutrition
Developing Countries
Source Rutstein, S. 2003.
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Intervals Associated with Lowest Maternal
Morbidity and MortalityLatin America
Source Conde-Agudelo, A. and J. Belizan. 2000.
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Rates of Adverse Perinatal Outcomes According to
Inter-Pregnancy Interval After a Miscarriage
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Birth Spacing Longer than Five Years Is
Associated with Risk for Maternal MorbidityLatin
America
Source Conde-Agudelo, A. 2002.
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Potential Public Health ImpactChildren

• Derivation of deaths averted based on
• Adjusted Odds Ratios derived from the Demographic
  and Health Surveys (DHS) regression equations
• Mortality rates from DHS
• Projected number of births in given year using
  projection of women 15-49 from UN population
• No projections available for maternal healtharea
  for further research.

Source Rutstein, S. 2003.
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Annual Number of Deaths Among Children Under Age
5 with Existing Birth Intervals and Minimum
Intervals of 24 and 36 MonthsDeveloping Countries
1,931,000 deaths averted
Additional 945,000 deaths averted
Source Rutstein, S. 2003.
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Optimal Birth SpacingRelevance for Developed
Countries

• Research from developed country two studies by
  the Centers for Disease Control and Prevention
  (CDC-P) in Michigan and Utah
• Similar methodologies variables between CDC-P and
  CLAP studies
• Offers an opportunity to compare effect of the
  birth interval on children in different settings
• No data comparing effect on maternal healthan
  area for future research

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A Comparison Optimal Birth Spacing in Developed
and Developing Countries
Source Conde-Agudelo, A. 2002. Zhu, B.P. et al.
2001. Zhu, B.P. et al. 1999.
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Scope of the Problem

• Many women, especially young women, in developing
  countries are having births too close together.
  
• Many women want longer birth intervals than they
  are achieving.
• Birth spacing decisions are complex.
• Few tools exist (e.g., job aids, counseling
  manuals) that would help providers educate
  clients on the benefits of optimal birth spacing.

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Issue Many Young Women Have Births That Are Too
Close Together Developing Countries
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49
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Source Venugopal, V. and Setty Upadhyay, V.D.
2002.
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Issue Many Young Women Have Births That Are Too
Close Together Latin American Countries
Source Venugopal, V. and Setty Upadhyay, V.D.
2002.
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Issue Many Young Women Have Births That Are Too
Close Together continued

• Problem
• In Latin America, an average of 90 of women
  ages 15-19 and 68 of women ages 20-29 have birth
  intervals of less than three years.
• Programmatic Strategy
• Focus Optimal Birth Spacing education on young,
  low parity women, newly married and engaged
  couples

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Issue Many Women Want Longer Birth Intervals
Than They Are Achieving
Of postpartum women, only 3 want birth within 2
years, yet only 40, on average, are actually
using a family planning method.
Source Ross, John A. and William Winfrey. 2001.
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Issue Many Women Want Longer Birth Intervals
Than They Are Achieving continued

• Problem
• Only 3 of postpartum women want a new baby
  within two years, yet only 40 on average are
  actually using a family planning method for birth
  spacing.
• Programmatic Strategy
• Integrate Optimal Birth Spacing information and
  services into existing programs and identify
  missed opportunities.

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Issue Birth Spacing Decisions Are Complex

• Focus group discussions from Peru, Bolivia,
  India, Pakistan, and Egypt show
• Beliefs in favor of Optimal Birth Spacing
• Concern for health of mother and baby
• Economic considerations
• Barriers to Optimal Birth Spacing
• Gender inequity
• Cultural expectations and norms as expressed by
  mothers-in-law and community leaders
• Erroneous beliefs about modern contraception

Source CATALYST Consortium. 2003.
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Issue Birth Spacing Decisions Are Complex
continued

• Problem
• There are few programs that emphasize the
  benefits of birth spacing and few communication
  campaigns on birth spacing.
• Programmatic Strategy
• Create culturally appropriate communication
  campaigns on Optimal Birth Spacing.

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Communication Campaigns

• Media Campaigns
• -Radio
• -Television
• -Newspaper
• -Posters

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Issue Great Variation in the Messages Women
Receive from Providers

• Problem
• Many providers did not know about the benefits
  of birth spacing, nor did they communicate this
  to clients.
• Programmatic Strategy
• Create user-friendly and culturally appropriate
  job aids to make the message easy to communicate
  to clients.

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Optimal Birth Spacing Counseling Recommendations

• Women and Couples should be counseled
• About the health and economic benefits of spacing
  their children
• Waiting three years from the birth of the last
  child before getting pregnant

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The Message

• Mothers should wait for their youngest child to
  turn three years old before their next pregnancy.

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Summary

• Women and men have the right to know that Optimal
  Birth Spacing is associated with
• Lower risk for perinatal, neonatal, infant
  mortality
• Lower risk for poor nutritional outcomes
• Lower risk for maternal morbidity and mortality.
• There are simple programmatic strategies that can
  help women achieve the birth intervals that they
  desire and that can contribute to healthy
  outcomes for themselves and their children.

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Resources

• CATALYST Consortium
• OBSI Training Guide for Counselors
• Cue Cards
• Fact Sheet
• Pathfinder
• Family Planning Counseling Manual with OBSI
  content

• JHU Center for Communication Programs
• Population Report
• MACRO
• Recommendations on how NGOs and PVOs can
  integrate OBSI into programs
• USAID
• Guidance document

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For More Information

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