Birth Spacing Pearls
I understand adequate birth spacing is important for infant health. But after abortion, is it also advisable to wait for a time before another pregnancy?
Yes at least five months, based on a new large study from Latin America. In that study, post-abortion interpregnancy intervals (PAIIs) of less than six months were associated with sizable increased risks of low birth weight, preterm delivery, maternal anemia and premature rupture of membranes.
Comment: Strengths of the study were - large size, developing world context including 18 countries in Latin America, and careful analysis including control for a large number of potential confounding variables. It had the limitation of not being able to distinguish spontaneous and induced abortion. Also the study was observational and thus subject to potential bias. For example, there could be ways (not addressed in the analysis) that women who get pregnant right away after an abortion are different. Or reporting of previous abortion might be affected in some way. Still the magnitude, pattern of the association and statistical significance of the findings are strong. For example, the risk of preterm birth is over twice as much for a PAII of 0-2 months than for a PAII of 12-17 months.
Significance: Women and their partners should understand that after abortion, it is probably wise to wait at least five months to get pregnant again in order to help prevent adverse perinatal and maternal outcomes. Importantly, it also strengthens the already-compelling need to make accessible, quality family planning services an integral part of post-abortion care (PAC).
I'm familiar with the impact of birth spacing on child survival, but are birth intervals also related to the health of the mother in the developing world?
Yes, although it's only the very short birth intervals that appear to afford higher risk. In a very large study of over 520,000 births in 18 countries in Latin America, after controlling for a number of variables, birth intervals of less than 15 months were associated with maternal mortality levels that were 2 1/2 times as high as longer intervals. These short intervals were also associated with higher rates of third trimester bleeding, premature rupture of membranes, puerperal endometritis and anemia.
Interesting, very long birth intervals (65 months or more) were associated with higher risk of eclampsia and pre-eclampsia.
I know there is good evidence that birth intervals of 3 to 5 years are associated with better child survival. But aren’t women spacing births pretty well already?
No, not really. Actually a surprising number of intervals are short. A recent Population Report looked at DHS data from 55 developing countries and found that on average, 57 percent of births were three years or less and a full 26 percent were two years or less.
I'm familiar with the impact of birth spacing on child survival, but are birth intervals also related to the health of the mother in the developing world?
Yes, although it's only the very short birth intervals that appear to afford higher risk. In a very large study of over 520,000 births in 18 countries in Latin America, after controlling for a number of variables, birth intervals of less than 15 months were associated with maternal mortality levels that were 2 ½ times as high as longer intervals. These short intervals were also associated with higher rates of third trimester bleeding, premature rupture of membranes, puerperal endometritis and anemia.
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