Determinants of Short Birth Intervals Among Married Women: a Cross-sectional Study in Karachi, Pakistan

Overview

Journal BMJ Open

Specialty General Medicine

Date 2021 Apr 27

PMID 33903142

Citations 13

Authors

Sidrah Nausheen

Maria Bhura

Kristy Hackett

Imtiaz Hussain

Zainab Shaikh

Arjumand Rizvi

Uzair Ansari

David Canning

Iqbal Shah

Sajid Soofi

Affiliations

Soon will be listed here.

Abstract

Introduction: Birth spacing is a critical pathway to improving reproductive health. WHO recommends a minimum of 33-month interval between two consecutive births to reduce maternal, perinatal, infant morbidity and mortality. Our study evaluated factors associated with short birth intervals (SBIs) of less than 33 months between two consecutive births, in Karachi, Pakistan.

Methods: We used data from a cross-sectional study among married women of reproductive age (MWRA) who had at least one live birth in the 6 years preceding the survey (N=2394). Information regarding their sociodemographic characteristics, reproductive history, fertility preferences, family planning history and a 6-year reproductive calendar were collected. To identify factors associated with SBIs, we fitted simple and multiple Cox proportional hazards models and computed HRs with their 95% CIs.

Results: The median birth interval was 25 months (IQR: 14-39 months), with 22.9% (833) of births occurring within 33 months of the index birth. Women's increasing age (25-30 years (aHR 0.63 (0.53 to 0.75), 30+ years (aHR 0.29, 95% CI 0.22 to 0.39) compared with 20-24 years; secondary education (aHR 0.75, 95% CI 0.63 to 0.88), intermediate education (aHR 0.62, 95% CI 0.48 to 0.80), higher education (aHR 0.69, 95% CI 0.51 to 0.92) compared with no education, and a male child of the index birth (aHR 0.81, 95% CI 0.70 to 0.94) reduced the likelihood of SBIs. Women's younger age <20 years (aHR 1.24, 95% CI 1.05 to 1.24) compared with 20-24 years, and those who did not use contraception within 9 months of the index birth had a higher likelihood for SBIs for succeeding birth compared with those who used contraception (aHR 2.23, 95% CI 1.93 to 2.58).

Conclusion: Study shows that birth intervals in the study population are lower than the national average. To optimise birth intervals, programmes should target child spacing strategies and counsel MWRA on the benefits of optimal birth spacing, family planning services and contraceptive utilisation.

Citing Articles

Ensemble learning to predict short birth interval among reproductive-age women in Ethiopia: evidence from EDHS 2016-2019.

Kelkay J, Sendek Anteneh D, Wubneh H, Gessesse A, Gebeyehu G, Aweke K BMC Pregnancy Childbirth. 2025; 25(1):121.

PMID: 39910491 PMC: 11796282. DOI: 10.1186/s12884-025-07248-1.

Inter-pregnancy interval and associated factors among parous women in neighboring low-land ecologies of arsi & east shoa zone, southeast Ethiopia: a community-based cross-sectional study.

Jima G, Biesma R, Sendekie T, Stekelenburg J Contracept Reprod Med. 2025; 10(1):1.

PMID: 39754274 PMC: 11697858. DOI: 10.1186/s40834-024-00333-4.

Prevalence and factors associated with short birth interval in the semi-rural community of Kaya, Burkina Faso: results of a community-based survey.

Coulibaly A, Baguiya A, Meda I, Millogo T, Koumbem A, Garanet F Arch Public Health. 2024; 82(1):171.

PMID: 39354630 PMC: 11446026. DOI: 10.1186/s13690-024-01398-y.

Wealth-based disparities in the prevalence of short birth interval in India: insights from NFHS-5.

Singh A, Singh A, Chakrabarty M, Singh S, Tripathi P Popul Health Metr. 2024; 22(1):14.

PMID: 38992717 PMC: 11238510. DOI: 10.1186/s12963-024-00334-0.

Determinants of chronic energy deficiency (CED) incidence in pregnant women: A cross-sectional study in Banyumas, Indonesia.

Wati E, Murwani R, Kartasurya M, Sulistiyani S Narra J. 2024; 4(1):e742.

PMID: 38798863 PMC: 11125398. DOI: 10.52225/narra.v4i1.742.

References

Hajian-Tilaki K, Asnafi N, Aliakbarnia-Omrani F . The patterns and determinants of birth intervals in multiparous women in Babol, northern Iran. Southeast Asian J Trop Med Public Health. 2009; 40(4):852-60. View

Conde-Agudelo A, Belizan J . Maternal morbidity and mortality associated with interpregnancy interval: cross sectional study. BMJ. 2000; 321(7271):1255-9. PMC: 27528. DOI: 10.1136/bmj.321.7271.1255. View

DaVanzo J, Hale L, Razzaque A, Rahman M . The effects of pregnancy spacing on infant and child mortality in Matlab, Bangladesh: how they vary by the type of pregnancy outcome that began the interval. Popul Stud (Camb). 2008; 62(2):131-54. DOI: 10.1080/00324720802022089. View

Rutstein S . 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. Int J Gynaecol Obstet. 2005; 89 Suppl 1:S7-24. DOI: 10.1016/j.ijgo.2004.11.012. View

Boerma J, Bicego G . Preceding birth intervals and child survival: searching for pathways of influence. Stud Fam Plann. 1992; 23(4):243-56. View

Goncalves S, Moultrie T . Short preceding birth intervals and child mortality in Mozambique. Afr J Reprod Health. 2013; 16(4):29-42. View

Conde-Agudelo A, Rosas-Bermudez A, Castano F, Norton M . Effects of birth spacing on maternal, perinatal, infant, and child health: a systematic review of causal mechanisms. Stud Fam Plann. 2012; 43(2):93-114. DOI: 10.1111/j.1728-4465.2012.00308.x. View

Dewey K, Cohen R . Does birth spacing affect maternal or child nutritional status? A systematic literature review. Matern Child Nutr. 2007; 3(3):151-73. PMC: 6860904. DOI: 10.1111/j.1740-8709.2007.00092.x. View

Kozuki N, Lee A, Silveira M, Victora C, Adair L, Humphrey J . The associations of birth intervals with small-for-gestational-age, preterm, and neonatal and infant mortality: a meta-analysis. BMC Public Health. 2014; 13 Suppl 3:S3. PMC: 3847557. DOI: 10.1186/1471-2458-13-S3-S3. View

10.

Ford K, Huffman S, Chowdhury A, Becker S, Allen H, Menken J . Birth-interval dynamics in rural Bangladesh and maternal weight. Demography. 1989; 26(3):425-37. View

11.

Kassa G, Muche A, Berhe A, Fekadu G . Prevalence and determinants of anemia among pregnant women in Ethiopia; a systematic review and meta-analysis. BMC Hematol. 2017; 17:17. PMC: 5646153. DOI: 10.1186/s12878-017-0090-z. View

12.

Becher H, Muller O, Jahn A, Gbangou A, Kynast-Wolf G, Kouyate B . Risk factors of infant and child mortality in rural Burkina Faso. Bull World Health Organ. 2004; 82(4):265-73. PMC: 2585959. View

13.

Moore Z, Pfitzer A, Gubin R, Charurat E, Elliott L, Croft T . Missed opportunities for family planning: an analysis of pregnancy risk and contraceptive method use among postpartum women in 21 low- and middle-income countries. Contraception. 2015; 92(1):31-9. DOI: 10.1016/j.contraception.2015.03.007. View

14.

Kozuki N, Walker N . Exploring the association between short/long preceding birth intervals and child mortality: using reference birth interval children of the same mother as comparison. BMC Public Health. 2014; 13 Suppl 3:S6. PMC: 3847658. DOI: 10.1186/1471-2458-13-S3-S6. View

15.

Millman S, Cooksey E . Birth weight and the effects of birth spacing and breastfeeding on infant mortality. Stud Fam Plann. 1987; 18(4):202-12. View

16.

Yeakey M, Muntifering C, Ramachandran D, Myint Y, Creanga A, Tsui A . How contraceptive use affects birth intervals: results of a literature review. Stud Fam Plann. 2009; 40(3):205-14. DOI: 10.1111/j.1728-4465.2009.00203.x. View

17.

Appareddy S, Pryor J, Bailey B . Inter-pregnancy interval and adverse outcomes: Evidence for an additional risk in health disparate populations. J Matern Fetal Neonatal Med. 2016; 30(21):2640-2644. DOI: 10.1080/14767058.2016.1260115. View

18.

Klerman L, Cliver S, Goldenberg R . The impact of short interpregnancy intervals on pregnancy outcomes in a low-income population. Am J Public Health. 1998; 88(8):1182-5. PMC: 1508292. DOI: 10.2105/ajph.88.8.1182. View

19.

Yohannes S, Wondafrash M, Abera M, Girma E . Duration and determinants of birth interval among women of child bearing age in Southern Ethiopia. BMC Pregnancy Childbirth. 2011; 11:38. PMC: 3112064. DOI: 10.1186/1471-2393-11-38. View

20.

Tessema G, Zeleke B, Ayele T . Birth interval and its predictors among married women in Dabat District, Northwest Ethiopia: a retrospective follow up study. Afr J Reprod Health. 2013; 17(2):39-45. View