Birth spacing explained

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.[1] The WHO recommends 24 months between pregnancies. A shorter interval may be appropriate if the pregnancy ended in abortion or miscarriage, typically 6 months.[2] If the mother has had a prior C-section, it is advisable to wait before giving birth again due to the risk of uterine rupture in the mother during childbirth, with recommendations of a minimum inter-delivery interval ranging from a year to three years. Pregnancy intervals longer than five years are associated with an increased risk of pre-eclampsia.[3] The global public health burden of short inter-pregnancy intervals is substantial.[4] Family planning can help increase inter-pregnancy interval.[5]

Factors influencing birth spacing

Family planning, such as the use of contraceptives can increase inter-pregnancy interval. 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,[12] stillbirth, and child mortality.[13] Inter-pregnancy interval of lower than 18 months is associated with an increased risk of pre-term birth.

Short inter-pregnancy interval after a prior C-section can be a contraindication for having a vaginal birth after a prior C-section (VBAC). In one study inter-pregnancy intervals shorter than 6 months were associated with 2-3 times increased risk of uterine rupture, major morbidity, and blood transfusion during vaginal delivery in mothers with at least one prior C-section.[14]

Complications of a short inter-pregnancy interval are lower after an abortion or miscarriage compared to a full-term pregnancy.

Long inter-pregnancy interval

An inter-pregnancy interval of greater than five years is associated with an increased risk of pre-eclampsia.

Public health

The global public health burden of short inter-pregnancy intervals is substantial. 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 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.

See also

Notes and References

  1. Interpregnancy interval and obstetrical complications . Bat Zion . Shachar . Deirdre J . Lyell . vanc . Obstetrical & Gynecological Survey . 2012 . 67 . 9 . 584–596 . 10.1097/OGX.0b013e31826b2c3e . 22990461 . 2018-04-22.
  2. News: How long should you wait before getting pregnant again?. The March of Dimes. 2018-04-03. en-US.
  3. Conde-Agudelo A, Rosas-Bermúdez A, Kafury-Goeta AC . Effects of birth spacing on maternal health: a systematic review . en . American Journal of Obstetrics and Gynecology . 196 . 4 . 297–308 . April 2007 . 17403398 . 10.1016/j.ajog.2006.05.055 .
  4. Report of a technical consultation on birth spacing . 2005 . WHO . 2018-04-03 . https://web.archive.org/web/20170202023531/http://apps.who.int/iris/bitstream/10665/69855/1/WHO_RHR_07.1_eng.pdf . 2017-02-02 . live.
  5. Ganatra B, Faundes A . Role of birth spacing, family planning services, safe abortion services and post-abortion care in reducing maternal mortality . Best Practice & Research. Clinical Obstetrics & Gynaecology . 36 . 145–155 . October 2016 . 27640082 . 10.1016/j.bpobgyn.2016.07.008 .
  6. Tommaselli. Giovanni A. Guida. Maurizio. Palomba. Stefano. Barbato. Michele. Nappi. Carmine. April 2000. Using complete breastfeeding and lactational amenorrhoea as birth spacing methods. Contraception. en. 61. 4. 253–257. 10.1016/S0010-7824(00)00101-3. 10899480. 0010-7824.
  7. Kennedy KI, Rivera R, McNeilly AS . Consensus statement on the use of breastfeeding as a family planning method . Contraception . 39 . 5 . 477–96 . May 1989 . 2656086 . 10.1016/0010-7824(89)90103-0 .
  8. P. Caldwell. JC. Caldwell. 1981. The function of child-spacing in traditional societies and the direction of change.. en. 2018-04-25. https://web.archive.org/web/20190704151639/https://www.popline.org/node/384780. 2019-07-04. dead.
  9. Konner. M.. Worthman. C.. 1980-02-15. Nursing frequency, gonadal function, and birth spacing among !Kung hunter-gatherers. Science. en. 207. 4432. 788–791. 10.1126/science.7352291. 0036-8075. 7352291. 1980Sci...207..788K.
  10. Bavel. Jan Van. Kok. Jan. 2004-06-01. Birth Spacing in the Netherlands. The Effects of Family Composition, Occupation and Religion on Birth Intervals, 1820–1885. European Journal of Population / Revue Européenne de Démographie. en. 20. 2. 119–140. 10.1023/B:EUJP.0000033860.39537.e2. 153453194. 0168-6577.
  11. News: Warren Buffett's Best Investment . Bill . Gates . Melinda . Gates . vanc . gatesnotes.com. 2018-04-22 .
  12. Conde-Agudelo. Agustin. Belizán. José M.. 2000-11-18. Maternal morbidity and mortality associated with interpregnancy interval: cross sectional study. BMJ. en. 321. 7271. 1255–1259. 10.1136/bmj.321.7271.1255. 0959-8138. 11082085. 27528.
  13. Fotso JC, Cleland J, Mberu B, Mutua M, Elungata P . Birth spacing and child mortality: an analysis of prospective data from the Nairobi urban health and demographic surveillance system . Journal of Biosocial Science . 45 . 6 . 779–98 . November 2013 . 22958417 . 3785173 . 10.1017/S0021932012000570 .
  14. Stamilio DM, DeFranco E, Paré E, Odibo AO, Peipert JF, Allsworth JE, Stevens E, Macones GA . Short interpregnancy interval: risk of uterine rupture and complications of vaginal birth after cesarean delivery . Obstetrics and Gynecology . 110 . 5 . 1075–82 . November 2007 . 17978122 . 10.1097/01.AOG.0000286759.49895.46 . 71406865 . free .
  15. Rutstein SO . 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 . International Journal of Gynaecology and Obstetrics . 89 Suppl 1 . S7–24 . April 2005 . 15820369 . 10.1016/j.ijgo.2004.11.012 . 37743580 .
  16. Katherine A. Ahrens . Heidi Nelson . Reva L. Stidd . Susan Moskosky . Jennifer A. Hutcheon . Short interpregnancy intervals and adverse perinatal outcomes in high-resource settings: An updated systematic review . Paediatric and Perinatal Epidemiology . 33 . 1 . 10.1111/ppe.12503 . 7379643 . free.
  17. Rutstein, Shea O. 2011. Trends in Birth Spacing. DHS Comparative Reports No. 28. Calverton, Maryland, USA: ICF Macro.
  18. Galdikas. Biruté M. F.. Wood. James W.. 1990. Birth spacing patterns in humans and apes. American Journal of Physical Anthropology. en. 83. 2. 185–191. 10.1002/ajpa.1330830207. 2248378. 1096-8644.
  19. Konner. M.. April 1978. Nursing frequency and birth spacing in Kung hunter-gatherers. IPPF Medical Bulletin. 15. 2. 1–3. 0019-0357. 12278620.

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