Birth spacing
Birth spacing, pregnancy spacing, inter-birth interval (IBI) or inter-pregnancy interval refers to how soon after a prior pregnancy a woman becomes pregnant or gives birth again. There are health risks associated both with pregnancies placed closely together and those placed far apart, but the majority of health risks are associated with births that occur too close together.
Factors influencing birth spacing
Family planning, such as the use of contraceptives can increase inter-pregnancy interval.[5] Breastfeeding and extended breastfeeding can also increase birth spacing due to lactational amenorrhea.[6][7][8][9]
Cultural and religious attitudes towards both sex and the use of contraceptives,[10] price and availability of health care, and poverty are all factors which can affect inter-pregnancy intervals.[11]
Health risks
Short inter-pregnancy interval
Short inter-pregnancy interval is associated with an increase in maternal mortality,[5][12] stillbirth, and child mortality.[13] Inter-pregnancy interval of lower than 18 months is associated with an increased risk of pre-term birth.[3]
Short inter-pregnancy interval after a prior
Complications of a short inter-pregnancy interval are lower after an abortion or miscarriage compared to a full-term pregnancy.[13]
Long inter-pregnancy interval
An inter-pregnancy interval of greater than five years is associated with an increased risk of pre-eclampsia.[4][12]
Public health
The global public health burden of short inter-pregnancy intervals is substantial.[2] In developing countries, children born two years or earlier after an older sibling were at a 60% increased risk of death in infancy, while those born between two and three years had a 10% increase, compared with those born after intervals of four to five years.[15] Various organisations, including the World Health Organization[2] have identified birth spacing as an important area of public health intervention. Evidence for causality of these associations in high-resource environments is weak.[16]
Epidemiology
In one study, the average birth interval across all countries was 32.1 months (2.7 years). The region with the greatest percentage of short interbirth intervals was central Asia, where a third of children were born less than 24 months apart. The region with lowest burden was Sub-Saharan Africa, with 20% of births having an interval of less than 24 months.[17]
Birth intervals have been found to be higher in traditional hunter-gatherer societies. The median birth interval of the Gainj people of the New Guinea Highlands has been reported as 3.6 years (43 months),[18] and that of the !Kung people of Africa as 3.7 years (44 months).[19]
Other animals
The inter-birth intervals in wild apes are reported to be significantly longer than those in humans, with median birth intervals at 3.8 years for gorillas, 5.6 years for chimpanzees and 7.7 years for orangutans.[18]
See also
References
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- ^ a b c d e Report of a technical consultation on birth spacing (PDF) (Report). WHO. 2005. Archived (PDF) from the original on 2017-02-02. Retrieved 2018-04-03.
- ^ a b "How long should you wait before getting pregnant again?". The March of Dimes. Retrieved 2018-04-03.
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- ^ P, Caldwell; JC, Caldwell (1981). "The function of child-spacing in traditional societies and the direction of change". Archived from the original on 2019-07-04. Retrieved 2018-04-25.
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- ^ Gates B, Gates M. "Warren Buffett's Best Investment". gatesnotes.com. Retrieved 2018-04-22.
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- ^ Rutstein, Shea O. 2011. Trends in Birth Spacing. DHS Comparative Reports No. 28. Calverton, Maryland, USA: ICF Macro.
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