Survey of 345,958 women: 50.4% in sub-Saharan Africa had short birth intervals

A cross-sectional study in Contraception and Reproductive Medicine analyzed recent Demographic and Health Survey (DHS) data from countries of sub-Saharan Africa. The weighted sample included 345,958 women aged 15–49 years. The median birth interval was 32 months, and the prevalence of short birth intervals was 50.4% (95% CI: 50.2–50.6) biomedcentral.comContraception and Reproductive Medicinebiomedcentral.comOpen source ↗.

The authors note that short birth intervals remain a public health concern in the region and adversely affect maternal and child health, while evidence from recent DHS data is limited. To account for clustering, they used multilevel mixed-effects modified Poisson regression and estimated adjusted prevalence ratios (APR). The significance level was set at p < 0.05.

Factors linked to lower prevalence

Older age was associated with a lower prevalence of short intervals: APR = 0.76 (95% CI: 0.74–0.77) for women aged 25–34 years and APR = 0.65 (95% CI: 0.63–0.66) for those aged 35–49 years. A lower prevalence was also found among literate women (APR = 0.93), women with media exposure (APR = 0.97), and those from middle-wealth (APR = 0.97) and rich households (APR = 0.90).

Other associated groups were women with one under-five child (APR = 0.88), with a history of abortion (APR = 0.97), current family planning users (APR = 0.98), currently breastfeeding women (APR = 0.89), and women with health insurance (APR = 0.90) biomedcentral.comContraception and Reproductive Medicinebiomedcentral.comOpen source ↗.

Factors linked to higher prevalence

A higher prevalence was observed among rural residents (APR = 1.06, 95% CI: 1.04–1.09). Women with primary education (APR = 1.03) or secondary and higher education (APR = 1.04) also had higher prevalence, as did women whose husbands had primary (APR = 1.02) or secondary and higher education (APR = 1.04).

The strongest association was with the number of living children: APR = 1.36 (95% CI: 1.34–1.40) for women with five or more. Households with five or more members (APR = 1.09) and women with three or more under-five children (APR = 1.10) also showed higher prevalence.

Family planning decisions made by the husband alone (APR = 1.03) or jointly with the woman (APR = 1.02) were associated with higher prevalence. The same was true for women who reported distance to a health facility as a big problem (APR = 1.03) biomedcentral.comContraception and Reproductive Medicinebiomedcentral.comOpen source ↗.

The authors conclude that socioeconomic status, reproductive history, family planning use, and access to health services significantly influence birth intervals. They name women's empowerment, access to family planning and maternal health services, and rural and household-level disadvantages as areas to address.