Dataset Information

When and Where Birth Spacing Matters for Child Survival: An International Comparison Using the DHS.

ABSTRACT: A large body of research has found an association between short birth intervals and the risk of infant mortality in developing countries, but recent work on other perinatal outcomes from highly developed countries has called these claims into question, arguing that previous studies have failed to adequately control for unobserved heterogeneity. Our study addresses this issue by estimating within-family models on a sample of 4.5 million births from 77 countries at various levels of development. We show that after unobserved maternal heterogeneity is controlled for, intervals shorter than 36 months substantially increase the probability of infant death. However, the importance of birth intervals as a determinant of infant mortality varies inversely with maternal education and the strength of the relationship varies regionally. Finally, we demonstrate that the mortality-reducing effects of longer birth intervals are strong at low levels of development but decline steadily toward zero at higher levels of development. These findings offer a clear way to reconcile previous research showing that birth intervals are important for perinatal outcomes in low-income countries but are much less consequential in high-income settings.

SUBMITTER: Molitoris J

PROVIDER: S-EPMC6667399 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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When and Where Birth Spacing Matters for Child Survival: An International Comparison Using the DHS.

Molitoris Joseph J Barclay Kieron K Kolk Martin M

Demography 20190801 4

A large body of research has found an association between short birth intervals and the risk of infant mortality in developing countries, but recent work on other perinatal outcomes from highly developed countries has called these claims into question, arguing that previous studies have failed to adequately control for unobserved heterogeneity. Our study addresses this issue by estimating within-family models on a sample of 4.5 million births from 77 countries at various levels of development. W ...[more]

PMID: 31270780

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Project description:BackgroundThis study used data from recent Demographic and Health Surveys (DHS) to examine the impact of short or long preceding birth intervals on neonatal and under-five mortality. In order to minimize the effect of selection issues, we examined child mortality outcomes of the same mother, comparing short or long interval births against births with what had previously been considered optimal intervals.MethodsWe analyzed 47 DHS datasets from low- and middle-income countries. For each dataset, we compared neonatal and under-five mortality of short preceding interval births (<18 months, <24 months) to reference interval births (24-<60 months) of a mother, using conditional logistic regression matching on the mother. We also conducted the same matched analysis for long (≥ 60 months, ≥ 72 months) preceding interval births. These associations were then meta-analyzed. We also stratified the analyses by mothers' completed fertility (fertility at end of reproductive period) to assess whether maternal characteristics highly correlated with completed fertility modify the association between birth interval and child mortality.ResultsChildren with shorter preceding intervals had increased odds of both neonatal (<24 months, OR: 1.61, 95% CI: 1.52-1.70) and under-five mortality (<24 months, OR: 1.48, 95% CI: 1.40-1.56). When the associations were stratified by the mothers' completed fertility, the impact of short intervals was greatly reduced or eliminated for low fertility mothers. In contrast, mortality associations became stronger for children of high fertility mothers. However, when the births of high fertility mothers were limited to birth orders 2-4, the associations were comparable to those of low fertility mothers. Longer preceding birth intervals had lower odds of mortality than reference intervals (i.e. under-5 mortality for ≥ 60 months, OR 0.59, 95% CI: 0.52-0.67). This effect was also mediated by mothers' completed fertility; there was a strong protective effect of longer birth intervals for the high fertility mothers but not for low fertility mothers.ConclusionsThese analyses reproduced findings reported in previous literature that shorter birth intervals are associated with higher child mortality. However the negative impact of short birth intervals may only occur in high parity births. Reproductive health interventions that seek to lengthen birth intervals may have larger impact by targeting women with high parity. This finding is consistent with the concept of maternal depletion as the underlying cause of increased adverse child outcomes associated with shorter birth intervals.

Dataset Information

When and Where Birth Spacing Matters for Child Survival: An International Comparison Using the DHS.

Publications

When and Where Birth Spacing Matters for Child Survival: An International Comparison Using the DHS.

Similar Datasets

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