Birth Spacing

	A new pocket guide [PDF, 558KB] from the USAID-funded Extending Service Delivery (ESD) project provides an overview for health practitioners and program managers about healthy timing and spacing of pregnancies (HTSP). It's also available in French [PDF, 178KB], Spanish [PDF, 291KB], and Arabic [PDF, 335KB].

Birth spacing is an important maternal and child health intervention. USAID-sponsored studies have helped establish healthy pregnancy timing and spacing as an important intervention to improve infant, child, and maternal health.

Based on Demographic and Health Surveys (DHS) and other data, these analyses found that:

• Short birth-to-pregnancy intervals are associated with significant increased risk of neonatal, infant, child and under-5 mortality; low birthweight and preterm births; infant/child malnutrition in some populations; and stillbirths, miscarriages, and maternal morbidity (see figure below).
  
  
• From a public health perspective, birth-to-pregnancy intervals of at least two years (or three-year birth-to-birth intervals), but not longer than five years, are associated with the healthiest pregnancy outcomes.
  
  
• Intervals between abortions (spontaneous or induced) and the next pregnancy that are shorter than six months are associated with significant increased risk of adverse maternal and perinatal outcomes in the next pregnancy, such as low birthweight, preterm births, small-for-gestational age, premature rupture of membranes, and anemia.

Under-5 Mortality by Birth Interval

Source: S.O. Rutstein. 2005. 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 Gynecology and Obstetrics, 89: S7-S24.

In addition to these findings, earlier analyses found that pregnancies occurring to women under 20 years of age are associated with significant perinatal risks and that pregnancies in women under 16 are associated with significant maternal as well as perinatal risks.

Additional Resources

• Healthy Timing and Spacing of Pregnancy Trainer's Reference Guide - August 2008 [PDF 3.3MB]
  The Extending Service Delivery Project, which addresses reproductive health and family planning (RH/FP) needs at the community level, has finalized this guide to serve as a resource for trainers in developing in-service training for facility-based healthcare providers and community health workers who already have some basic experience with and an understanding of RH/FP.
  
  
• Engaging the Family in Health Timing, Spacing, and Pregnancy
  This case study examines the rationale, strategy, and impact of World Vision's child survival project, Pragati, which strove to improve health outcomes and change behaviors related to women's and children's health, and to ensure that pregnant women and new mothers in north-central India had ready access to information about and methods of birth spacing and family planning.
  
  
• Promoting Healthy Timing and Spacing of Births in India through a Community-based Approach
  This 2008 report details an operations research study carried out in India to assess the feasibility and effectiveness of using behavior change communication as a strategy for promoting certain birth spacing techniques.
  
  
• Long-Acting and Permanent Methods (LAPMs): Addressing Unmet Need for Family Planning in Africa
  Funded by USAID and produced by Family Health International, a new evidence-based advocacy package is available for program managers and policymakers. The package is a set of eight briefs on the LAPM class of modern contraceptive methods, which is comprised of four highly effective methods for delaying, spacing, or limiting births.
  • Downloaded the package in PDF or order print copies
    (French versions will be released soon)
    
    
• USAID Issue Brief: Healthier Mothers and Children Through Birth Spacing [PDF, 83KB]
  Helping women achieve healthy pregnancies and safe births is one of the highest priorities of USAID’s family planning program. One of the best ways is through birth spacing, which not only results in healthier pregnancy but also reduces under-5 mortality.
  
  
• Couple Years of Protection (CYP)
  An overview of Couple of Years of Protection (CYP), the estimated protection provided by contraceptive methods during a one-year period, based upon the volume of all contraceptives sold or distributed free of charge to clients during that period.
  
  
• Healthy Timing and Spacing of Pregnancies
  The health benefits of a minimum of two years between a mother’s last birth and her next pregnancy are well documented. The USAID-funded Extending Service Delivery (ESD) project has compiled numerous resources and tools to help family planning and reproductive health advocates integrate this message into their current programs.
  • Healthy Timing and Spacing of Pregnancies Pocket Guide [PDF, 558KB]
    Available in French [PDF, 178KB], Spanish [PDF, 291KB] , and Arabic [PDF, 335KB]
  
  
• Birth Spacing and Risk of Adverse Perinatal Outcomes
  This Journal of the American Medical Association (JAMA) study describes the effects of birth spacing exclusively on newborns during the first few days of life (the perinatal period) rather than when they are older.