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Introduction: Short inter-birth intervals negatively impact maternal and child health; however, data on their prevalence and associated factors in Tanzania are limited. This study investigates the prevalence of short inter-birth intervals and the associated factors among women of reproductive age in Tanzania. Methods: This was a cross-sectional study utilizing the 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey dataset. The study population included women aged 15–49 years with at least two births within five years preceding the survey. A short inter-birth interval was defined as a birth occurring < 33 months after the preceding birth. A generalized linear model with Poisson as a link and robust standard errors was used to examine factors associated with short inter-birth intervals. A p-value < 0.05 was considered statistically significant. Results: A total of 8,350 births from 6,034 women were included in this analysis. The mean (± SD) age of the women was 31.6 ± 6.8 years. The overall prevalence of short inter-birth intervals was 42.6%. Younger age (aPR 3.12, 95% CI 2.88–3.52 for age 15–24 years, and aPR 1.74, 95% CI 1.62–1.1.86 for age 25–34 years), being married (aPR 1.27, 95% CI 1.03–1.57), late age at first childbirth (aPR 1.24, 95% CI 1.17–1.32) for a 20–24 years and aPR 1.55, 95% CI 1.39–1.73 for ≥ 25 years), and higher birth order (aPR 1.02, 95% CI 1.03–1.19; aPR 1.24, 95% CI 1.14–1.34; aPR 1.72, 95% CI 1.58–1.86 for 3rd, 4th, and 5th or more birth orders, respectively, compared to 2nd birth order) were independently associated with short inter-birth intervals. Additionally, there was significant variation in the prevalence of short inter-birth intervals across different zones and levels of household wealth. Women from richer (aPR 0.87, 95% CI: 0.80–0.95) and richest (aPR 0.84, 95% CI: 0.74–0.94) households exhibited a lower prevalence of short inter-birth intervals. Conclusion: This study highlights the significant prevalence of short inter-birth intervals among women of reproductive age in Tanzania. The associated factors include younger age, marital status, delayed first childbirth, higher birth order, geographical disparities, and lower household wealth. These findings highlight the need for targeted interventions to promote birth spacing and improve maternal and child health outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background Researchers over the years have underscored the role of birth spacing on maternal health, however, inadequate maternal repletion due to shorter birth intervals could also affect the health of the child. Even so, limited studies exist on the linkage between birth spacing and child nutrition. This study examines the association between birth spacing and child stunting and underweight using the 2014 Ghana Demographic and Health Survey. Methods The study sourced data on 1, 904 children less than 59 months from the 2014 Ghana Demographic and Health Survey. The study employed bivariate analysis and logistic regressions to establish the association between birth spacing, and child stunting and underweight. Results The analyses reveal that childbirth spacing between 24 and 35 months (OR = 0.62, 95% CI: 0.38–0.99; p

Abstract Background Unmet need for birth spacing can significantly impact maternal and child health outcomes, leading to unintended or mistimed births, neonatal mortality, pregnancy loss, induced abortions, small-sized births, and malnutrition. Considering the role of women empowerment in women’s sexual and reproductive health, we examined the association between the survey-based women's empowerment index (SWPER) and unmet need for spacing in sub-Saharan Africa (SSA). Methods We used data from the Demographic and Health Surveys of 21 in SSA conducted between 2015 and 2021. In this study, the unit of analysis was women of reproductive age (15 to 49 years) who were married or living together and required family planning during the survey period. Multilevel logistic regression was fitted to examine the association between SWPER and the unmet need for spacing. The results were presented using adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Results The hotspot countries for unmet need for birth spacing were Angola, Benin, Liberia, Mauritania, and Sierra Leone. The findings showed that with the empowerment indicators, women with high attitude to violence (disagreement or rejection of violence) (AOR = 0.95; 95% CI 0.91, 0.99), and women with high decision-making (AOR = 0.90; 95% CI 0.85, 0.95) exhibited lower odds of unmet spacing need relative to women with low attitude to violence and those with low decision making. Women with high autonomy (AOR = 1.32; 95% CI 1.25, 1.39) were more likely to experience unmet need for spacing compared to those with low autonomy. Conclusion Unmet need for spacing has been linked to indices of women's empowerment such as attitudes toward violence, independence, and decision-making. Organizations such as UNICEF, UNFPA, and the Bill & Melinda Gates Foundation should consider incorporating SWPER indicators when planning interventions to address the high unmet need for spacing among women in SSA. Additionally, various governments and aid organizations must give women's empowerment a high priority as a tactical intervention strategy to increase access to contraception in the countries considered in this study. These programmes would contribute to attaining SDGs 3.1 and 3.7.

Background: Researchers over the years have underscored the role of birth spacing on maternal health, however, inadequate maternal repletion due to shorter birth intervals could also affect the health of the child. Even so, limited studies exist on the linkage between birth spacing and child nutrition. This study examines the association between birth spacing and child stunting and underweight using the 2014 Ghana Demographic and Health Survey. Methods: The study sourced data on 1, 904 children less than 59 months from the 2014 Ghana Demographic and Health Survey. The study employed bivariate analysis and logistic regressions to establish the association between birth spacing, and child stunting and underweight. Results: The analyses reveal that childbirth spacing between 24 and 35 months (OR = 0.62, 95% CI: 0.38–0.99; p < 0.05), 36 to 47 months (OR = 0.42, 95% CI: 0.25–0.70; p < 0 0.01), and beyond 47 months (OR = 0.47, 95% CI: 0.28–0.78; p < 0.01) have lower odds of child stunting than children with birth spacing less than 24 months. Children with birth spacing between 24 and 35 months (OR = 0.53, 95% CI: 0.29–0.98; p < 0.05), 36 to 47 months (OR = 0.44, 95% CI: 0.22–0.90; p < 0.01) and beyond 47 months (OR = 0.49, 95% CI: 0.26–0.94; P < 0.05) have lower odds of being underweight than those with birth spacing less than 24 months. Conclusion: The study reveals that mothers with a birth spacing of at least two to three years compared to their counterparts with less than two years of birth spacing have lower odds of having a stunted and underweight child under age five. The study recommends that Ghana Health Service and other healthcare providers should educate mothers on the gains of birth spacing of at least two years on their children. [ABSTRACT FROM AUTHOR]

Abstract Issue Biomedical approaches want to change locals’ behaviors without understanding the sociocultural rationales and contextualizing the cultural and structural backdrop of women’s agency. Objectives This study explored the perceptions and practices of rural mothers about fertility and reproductive health and further examine the lack of preference for contraception and birth spacing in Southern Pakistan. Methodology Using purposive sampling we recruited 15 healthcare providers and 20 mothers from Southern Punjab. Key informants and in-depth interviews were used for data collection. We extracted themes and sub themes to analyse qualitative data. Findings Five major themes identified preventing birth spacing and contraceptive use: (1) cultural barriers (2) economic difficulties and demographic factors; (3) gender-related hurdles; (4) spiritual and religious obstacles, and (5) medico-ethical complications. Nearly, ten sub-themes contributing to these major themes were: custom of girls’ early marriages, in-laws’ permission for contraception, women’s concern for medical complications and preference for safer methods, misuse of contraceptive methods by the medical community, mothers’ perception of contraception as sinful act and controlling birth is against faith, economic and rural-ethnic factors for high fertility, masculine disapproval of condom use, and wishing to give birth to male children. Suggestions We advocate for understanding the sociocultural explanations for low contraceptive use and urge practice of more natural methods of birth spacing over commercial solutions. The study suggests socio-economic development of less developed communities and empowerment of poor, illiterate, and rural women along with behavior change communication strategies.

Abstract Background Sierra Leone is a religiously diverse country, with Christianity and Islam being the dominant faiths. This religious landscape plays a significant role in shaping attitudes towards family planning and contraceptives. We examined religious leaders’ knowledge of family planning and modern contraceptive methods. Methods In September 2021, data was collected from 116 religious leaders in Sierra Leone, including 32 Muslims and 84 Christians from nine different denominations from sixteen districts, through 16 focus group discussions. The data was subjected to a thematic analysis using NVIVO 12 software. Results The study found a spectrum of opinions among religious leaders, both between religions (Christianity vs. Islam) and within denominations of Christianity. There was a general acceptance of natural birth spacing methods, like abstinence during fertile periods, across both Christian and Muslim leaders. Views on modern contraceptives were more divided. Catholics generally opposed them, citing religious doctrines against interfering with procreation. Pentecostals and some Muslims, however, found them permissible under certain circumstances, like promoting family well-being or spacing births for health reasons. Conclusion The study reveals that religious leaders’ views on family planning in Sierra Leone are multifaceted. Understanding these nuances is crucial for designing effective family planning programs. By working with denominations that are more accepting of modern methods and leveraging the support for natural birth spacing methods across religions, there’s potential to improve reproductive health outcomes in Sierra Leone.

The collapse of communism led to highly skewed sex ratios in Albania, which had a long patriarchal tradition before the advent of communism. While the use of sex-selective abortions in the region is well-known, little is known about other forms taken by revealed son preference, such as differential stopping behaviour and birth spacing. Pooling data from the Demographic Health Surveys in 2008–2009 and 2017–2018, we find evidence of a higher proportion of boys being born at the last birth, indicating that parents practice differential stopping behaviour. Using a logit model, we also show that in sonless households parents shorten the birth intervals significantly, endangering mothers' and children's health. We conclude that differential stopping behaviour and short birth spacing are prevalent in all regions and across the socio-economic spectrum. [ABSTRACT FROM AUTHOR]

Background and Aim: Previously observed associations between interpregnancy interval (IPI) and perinatal outcomes using a between‐individual method may be confounded by unmeasured maternal factors. This study aims to examine the association between IPI and adverse perinatal outcomes using within‐individual comparative analyses. Methods: We studied 10,647 individuals from the National Institute of Child Health and Human Development Consecutive Pregnancies Study in Utah with ≥3 liveborn singleton pregnancies. We matched two IPIs per individual and used conditional logistic regression to examine the association between IPI and adverse perinatal outcomes, including preterm birth (PTB, <37 weeks' gestation), small‐for‐gestational‐age (SGA, <10th percentile of sex‐specific birthweight for gestational age), low birthweight (LBW, <2,500 g), and neonatal intensive care unit (NICU) admission. Point and 95% confidence interval (CI) estimates were adjusted for factors that vary across pregnancies within individuals. Results: CIs did not unequivocally support either an increase or a decrease in the odds of PTB (adjusted odds ratio [aOR]: 1.31, 95% CI: 0.87, 1.96), SGA (aOR: 0.81, 95% CI: 0.51, 1.28), LBW (aOR: 1.59, 95% CI: 0.90, 2.80), or NICU admission (aOR: 0.96, 95% CI: 0.66, 1.40) for an IPI <6 months compared to 18–23‐months IPI (reference), and neither did the CIs for the aOR of IPIs of 6–11 and 12–18 months compared to the reference. In contrast, an IPI ≥24 months was associated with increased odds of LBW (aOR: 1.66, 95% CI: 1.03, 2.66 for 24–29 months; aOR: 2.27, 95% CI: 1.21, 4.29 for 30–35 months; and aOR: 2.09, 95% CI: 1.17, 3.72 for ≥36 months). Conclusions: Using a within‐individual comparative method, we did not find evidence that a short IPI compared to the recommended IPI of 18–23 months was associated with increased odds of PTB, SGA, LBW, and NICU admission. IPI ≥ 24 months was associated with increased odds of delivering an LBW infant. Key points: What is already known Short and long interpregnancy intervals (IPIs) were associated with increased odds of adverse perinatal outcomes using a between‐individual method. What this study adds The within‐individual comparative method showed that a short compared to recommended IPI was not associated with increased odds of small‐for‐gestational‐age, preterm birth, low birthweight (LBW), and neonatal intensive care unit admission. IPI ≥ 24 months was associated with increased odds of delivering an LBW newborn. Clinical implications Previously observed associations between IPI and adverse perinatal outcomes using a between‐individual method may be due to unmeasured confounding. Intervening on a short IPI itself may not be beneficial for decreasing the prevalence of adverse perinatal outcomes. [ABSTRACT FROM AUTHOR]

Background: A healthy child can make way for a healthy adult. Some of the factors that can be used to determine the health of a young child are nutritional status of the child, the developmental milestones achieved, and frequency of illness. Objectives: The health status of children and associated factors are determined. Methods: This is a community-based cross-sectional study with 271 participants. The height and weight of the child were measured; questions were asked regarding developmental milestones achieved and frequent illnesses. An interview schedule was used to enquire about the determinants of health status. Descriptive statistics were done; Chi-square test and regression were used to determine association between the health status of children and determinants. Results: A total of 127 (46.86%) were found to have a good health status. Family type (Chi square value 9.568; P value = 0.002), birth spacing (Chi square 20.540; P value < 0.001), term or pre-term birth (Chi square 4.598; P value = 0.032), chronic medical problem in the child (Chi square 11.074; P value = 0.001), and immunization status of the child (Chi square 5.666; P value = 0.017) were found to have significant association with the health status of the child. By logistic regression, pre-term child birth and family type were found to have higher odds. Conclusion: For better health of the child, specific focus on birth spacing, term birth of baby, better care of the ill, and complete immunization play vital roles. [ABSTRACT FROM AUTHOR]

Existing literature documents connections between short birth spacing (birth‐to‐conception interval of under 18 months) and the risk of child maltreatment, but explanations for this relation are understudied. We hypothesise that short birth spacing predicts child maltreatment, and it mediates the association between maternal history of childhood maltreatment and their child's risk of abuse and neglect. We use data for second and higher parity children from the Prospective Study of Infant Development (n = 335) and fit logistic regression models with relevant covariates to examine the association between maternal history of childhood maltreatment, her offspring's short birth spacing and her offspring's child maltreatment (CM) as measured by Child Protective Services (CPS) assessments. Findings demonstrate that children of mothers who reported experiencing any abuse or neglect during childhood have a higher likelihood of being born shortly spaced and a higher likelihood of CM. Additionally, short birth spacing is associated with increased likelihood of CM. No evidence for mediation from maternal history of maltreatment to CM operating through short birth spacing was detected. We conclude that maternal history of childhood maltreatment and short birth spacing are independent, additive factors for CM risk. Key Practitioner Messages: Maternal history of childhood maltreatment is a strong predictor of her children's birth spacing and her children's abuse and neglect risk.Maternal history of childhood maltreatment and birth spacing between her children serve as independent predictors of her children's abuse and neglect risk.Child maltreatment risk assessment models should incorporate historical information about parental childhood trauma, as well as prenatal indicators of wellbeing such as birth spacing.Child maltreatment prevention programmes should address parental childhood trauma as well as family planning to minimise risk. [ABSTRACT FROM AUTHOR]

Mothers with multiple-partner fertility have longer interbirth intervals (IBIs) than mothers with single-partner fertility, suggesting that partner change hinders achieving the preferred IBI. Previous studies have, however, overlooked possible differences in preferred IBI between these two groups. Using data from 724 Finnish mothers, we investigated how partner change between the first and second child moderated the association between actual and preferred IBI. Mothers with multiple-partner fertility had 54 months longer IBIs than mothers with single-partner fertility. The association between actual and preferred IBI was weaker in mothers with multiple-partner fertility. Our results further indicated that this difference could partly be explained by the mothers' deliberate actions, such as contraceptive use and abortions among mothers with multi-partner fertility. Family planning support could gain from mapping out the reasons among women with a partner change for postponing otherwise desired pregnancies and offering increased support in these areas. [ABSTRACT FROM AUTHOR]

Abstract Background and Aim Previously observed associations between interpregnancy interval (IPI) and perinatal outcomes using a between‐individual method may be confounded by unmeasured maternal factors. This study aims to examine the association between IPI and adverse perinatal outcomes using within‐individual comparative analyses. Methods We studied 10,647 individuals from the National Institute of Child Health and Human Development Consecutive Pregnancies Study in Utah with ≥3 liveborn singleton pregnancies. We matched two IPIs per individual and used conditional logistic regression to examine the association between IPI and adverse perinatal outcomes, including preterm birth (PTB,

Research from the medical and social science literature has found that spacing births closely together leads to adverse health and socioeconomic outcomes for the younger child. More recent evidence using inter-family comparisons is challenging the validity of those results. However, while inter-family comparisons allow for time-invariant unobservable heterogeneity across families, they cannot fully control for changes in families that occur over time and may affect both decisions about birth intervals as well as child outcomes. To our knowledge, this paper provides the first examination of the effects of birth spacing on later childhood cognitive outcomes that accounts for both time-invariant and time-varying heterogeneity in the same models. Instrumental variables estimations on data from Indonesia indicate that younger siblings perform significantly better on maths assessment exams when they are spaced farther apart from their immediately older sibling. This effect appears to be concentrated among the poorest and least educated households. The data thus suggest that close spacing may be detrimental to the socioeconomic outcomes of the younger sibling. [ABSTRACT FROM AUTHOR]

Background: Perineal rupture was a quite serious problem. Factors that influence the incidence of perineal rupture were parity, birth spacing, fetal position, birth weight. Birth spacing of less than 2 years was considered high risk because it can cause complications during childbirth Purpose: This research aimed to know the relationship between birth spacing and the incidence of perineal rupture Method: The design of this research was a quantitative analytic retrospective. The population in this study was 268 medical records of mothers giving birth at Private Midwife Practice Place Sudjiati Frans Surabaya and the sample size was 160. The sampling technique used purposive sampling. The instrument used in this research was medical records at Midwife Practice Place Sudjiati Frans Surabaya for the period January – December 2022. Data were analyzed using Pearson correlation test. Results: : Based on the results of pearson correlation with α = 0.05, the value of p = 0.001 (p < α) was obtained, which shows that there was a significant relationship between birth spacing and the incidence of perineal rupture in mothers giving birth. Conclusion: Birth interval had a significant relationship with the incidence of perineal rupture at Private Midwife Practice Place Sudjiati Frans Surabaya. [ABSTRACT FROM AUTHOR]

The coverage of exclusive breastfeeding for infants in Indonesia still needs to be higher compared to the national target (80%). Low coverage of exclusive breastfeeding is a risk factor for various nutritional problems in toddlers. The causes of failure of exclusive breastfeeding are multifactorial, including risky pregnancy. This study aims to determine the association of risky pregnancies with the failure of exclusive breastfeeding using national data from the 2017 Indonesian Health Demographic Survey (IDHS) with a cross-sectional design. The study sample that met the criteria was 6,689 mothers with children aged 6-23 months. The independent variable is risky pregnancy (parity, pregnancy spacing, age during pregnancy), and the dependent variable is the failure of exclusive breastfeeding. Data analysis using multivariate logistic regression. The results found that only 26.2% of exclusive breastfeeding practices. Risky pregnancy is associated with the failure of exclusive breastfeeding. Mothers with too much parity risked 1,195 times, mothers with primiparous parity risked 1,716 times, too close birth spacing risked 1,210 times, and too young mothers were 1,267 times more likely not to exclusively breastfeed than mothers who had normal pregnancies after controlling for the area of residence. It is necessary to improve health promotion programs to the public regarding the importance of offering exclusive breastfeeding to infants and improving fertility characteristics.

Summary: Background: Earlier studies have proposed a link between the Interpregnancy Interval (IPI) and unfavorable birth outcomes. However, it remains unclear if the outcomes of previous births could affect this relationship. We aimed to investigate whether the occurrence of adverse outcomes–small for gestational age (SGA), preterm birth (PTB), and low birth weight (LBW)–at the immediately preceding pregnancy could alter the association between IPI and the same outcomes at the subsequent pregnancy. Methods: We used a population-based linked cohort from Brazil (2001–2015). IPI was measured as the difference, in months, between the preceding birth and subsequent conception. Outcomes included SGA (

Background: Adverse birth outcomes, such as preterm birth and low birth weight (LBW), are leading causes of neonatal morbidity and mortality. In this study, we aimed to estimate the association between inter‐pregnancy interval (IPI) and the risks of adverse birth outcomes in a subsequent pregnancy. Methods: We conducted a retrospective analysis involving 630 mothers who delivered a singleton live infant at a leading tertiary hospital in northern Jordan from March to August 2021. Outcome variables were preterm birth (<37 weeks of gestation) and LBW (<2.5 kg). Using multivariable logistic regression, the association between IPI and these two adverse birth outcomes was investigated. Results: The rates of preterm birth and LBW were 12.4% and 16.8%, respectively. Compared with an optimal IPI (24–36 months), a short IPI (<24 months) was positively associated with preterm birth (aOR: 4.09; 95% CI: 1.48–6.55) and LBW (aOR: 3.58; 95% CI: 1.57–5.15). Infants conceived after a long IPI (≥ 60 months) had increased odds of preterm birth (aOR: 3.78; 95% CI: 1.12–5.78) and LBW (aOR: 2.65; 95% CI: 1.67–4.03). Preterm delivery was also significantly associated with the mother's age (aOR: 1.10; 95% CI: 1.04–1.17), history of multiple cesarean births (aOR: 2.67; 95% CI: 1.14–4.29), prolonged rupture of membranes (aOR: 2.46; 95% CI: 1.10–5.52), and perinatal death (aOR: 3.42; 95% CI: 1.10–5.49). A mother's history of prior LBW (aOR: 4.39; 95% CI: 1.08–6.80), hypertensive disorders (aOR: 1.95; 95% CI: 1.03–3.89), and multiple cesarean births (aOR: 4.35; 95% CI: 2.10–6.99) was associated with LBW. Conclusions: Both short and long IPIs were related to preterm delivery and LBW. Optimal birth spacing is recommended to improve birth outcomes and must be considered when designing effective family planning programs. [ABSTRACT FROM AUTHOR]

Appropriate birth spacing improves the outcomes of children and mothers, but spacing intervals are short in sub-Saharan African countries. This paper investigates one of the behavioural mechanisms behind the short intervals by studying the impact of foetus loss including miscarriage and stillbirth. Since most of these pregnancy losses result from a genetic abnormality in the fertile egg, they can be considered random conditional on factors such as maternal age and fixed effects. We find that a pregnancy loss experience leads to a mechanical increase in the next birth spacing interval that includes the loss and the next conception. More importantly, we also find that a pregnancy loss brings about a decrease in the intervals for all subsequent births and that the shortening effect does not disappear throughout the mother's life. Much of the shortening effect is explained once we introduce an individual-specific indicator for the realised probability of pregnancy loss. These results imply that pregnancy loss affects birth spacing by making mothers overestimate their probability of losing their unborn children. They further suggest a belief updating mechanism where mothers update their subjective probability of losing a pregnancy based on the results of their own pregnancies. [ABSTRACT FROM AUTHOR]

Background: Spacing of birth is an important parameter affecting maternal and foetal health. Optimal birth spacing provides multiple benefits for both mother and her child. Both short and long inter-delivery interval (IDI) is associated with multiple adverse perinatal outcomes. Therefore, inter-delivery interval is viewed as a potential modifiable risk factor for adverse foetal-maternal outcome. The objective of the study was to study the association of inter-delivery interval and pregnancy outcome in a tertiary care hospital, West Bengal, India. Methods: This Prospective hospital based study was done in Dept of Gynae and Obstetrics, Burdwan Medical College and Hospital, West Bengal, India for a period of 18 months from February 2021 to July 2022. All multigravida women with atleast three antenatal check-ups were included in the study. The data were statistically analysed using Microsoft Excel and SPSS software. Results: Most common age group of the mother was found 20-25 years 64 (64%), followed by 26-30 years 24 (24%). Maximum mothers were parity 3 i.e. 48 (48%), followed by parity 2, 40 (40%). Ectopic was present in 12 (12%) of mothers. Preterm <32 weeks was present in 12 (12%), preterm <36 weeks was present in 20 (20%), induction of labour (IOL) was present in 16 (16%) and cesarean delivery (CS) was observed in 24 (24%) of mothers. Normal birth weight babies delivered were 76 (76%%) and low birth babies delivered were 24 (24%). Maximum interval from last miscarriage was 6-12 months i.e. 32 (320%), followed by 19-24months 24 (24%) and 13-18 months 20 (20%). Miscarriage was observed in 20 (20%) mothers and still birth was 4 (4%). Anaemia was present in 34 (34%) mothers. Conclusions: Lack of contraceptive use significantly increases the risk of short IDI which increases the risk of preterm delivery, maternal anaemia PPH and scar rupture in post-CS pregnancy. [ABSTRACT FROM AUTHOR]

IntroductionPostpartum contraception is vital for maternal and child health, and reduces the risk of infant mortality. The Health Belief Model (HBM) is a widely accepted framework for exploring health behaviors, such as contraceptive use. Therefore, this study aimed to investigate the factors influencing postpartum contraceptive use in Nigeria and to contextualize the findings within the framework of the HBM.MethodsThis study was a secondary analysis of cross-sectional data collected from the Demographic Health Survey conducted in Nigeria (NDHS). In total, 28,041 women were included in this study. Self-reported contraceptive use was the outcome, while the explanatory variables included maternal age, place of residence, region of residence, religion, marital status, educational level, household wealth quintiles, knowledge of the ovulatory cycle, decision-maker for health care, and distance to health care facilities. Descriptive statistics and multivariate logistic regression were used to summarize and identify factors influencing postpartum contraceptive use. The HBM was used to discuss the main findings.ResultsThe prevalence of postpartum contraceptive use in Nigeria is 27%. Our findings showed that the odds of using contraceptives during the postpartum period were higher among women who knew their ovulation cycles, lived in urban areas in the southern region, had no distance barriers to health care, and were 25–49 years old. Education, wealth, and marital status also increase the odds of contraceptive use. However, women who lived in the northeast and northwest regions or shared decision-making with their partners had lower odds.ConclusionThis study highlights the need for region-specific and age-focused interventions to increase contraceptive use in Nigeria. Additionally, increasing accessibility and affordability of contraceptives for younger and economically disadvantaged women, along with promoting women's autonomy in decision-making, can further enhance contraceptive use across Nigeria.

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الملخص: أهداف البحث: يمكن أن يكون التقييم الشامل لدوافع الإنجاب في محافظة بني- سويف مفيدا في فهم أفضل لأنماط الخصوبة ووضع سياسات وبرامج عائلية مناسبة لتقليل معدلات الخصوبة ومعالجة مشكلة الزيادة السكانية في صعيد مصر. طرق البحث: أجريت هذه الدراسة المقطعية من مايو ٢٠۱٩ إلى مايو٢٠٢۱ على ۱٠٨٥ سيدة متزوجة حضرت إلى أي من مرافق الرعاية الصحية الأولية في المناطق الريفية والحضرية في محافظة بني-سويف لتقييم دوافعهم المتعلقة بالإنجاب. النتائج: أظهرت هذه الدراسة أن ٤٢٫۱٪ من المشاركات لديهم رغبة إيجابية للإنجاب و٤٥٪ من المشاركات لديهم رغبة سلبية للإنجاب، بينما بقية المشاركات (۱٢٫٩٪) لديهم دوافع مترددة. كان الدافع الأكثر انتشارا بين المشاركات هو حب الأطفال (٤٠٫٨٪). بينما كان الدافع الأكثر سلبية للخصوبة بين العينة المدروسة هو الظروف الاقتصادية (٤٤٫٧٪). كان هناك اختلافا ملحوظا بين السيدات المشاركات لدوافع الخصوبة المختلفة بما يخص العمر، التعليم، تعليم الزوج، سن الزواج، مدة الزواج، عدد أفراد الأسرة، الدخل الشهري، الوظيفة، عدد مرات الحمل، عدد مرات الإنجاب، استخدام موانع الحمل، و مدة استخدامها ووجود الأمراض المزمنة. الاستنتاجات: هناك حاجة شديدة لإشراك الأزواج الشباب الذين لم يبلغوا بعد حجم الأسرة المرغوب والذين لا يستخدمون طرق تنظيم الأسرة في برامج تنظيم الخصوبة. Abstract: Objectives: A comprehensive assessment of childbearing motivations in the governorate of Beni-Suef was conducted to better understand fertility patterns, and to develop appropriate familial policies and programs to reduce fertility rates and address the problem of overpopulation in Upper Egypt. Subjects and methods: A cross-sectional study was conducted from May 2019 to May 2021. A total of 1085 married women who attended any health care service in rural or urban primary health care facilities in the Beni-Suef governorate were included in the study. Results: The results revealed that 42.1% of participants had a positive desire for childbearing, and 45% of participants had a negative desire for childbearing; the rest of the participants (12.9%) had undecided motivations. The most prevalent positive motive for childbearing was a love of children (40.8%), whereas the most prevalent negative motive for childbearing was economic circumstances (44.7%). A statistically significant difference was observed in fertility motivations among the studied women, depending on age, education, husband's education, age at marriage, marriage duration, number of living siblings, monthly income, occupation, gravidity, parity, and chronic diseases (p = 0.001). Conclusion: A great need exists to involve young couples who have not yet attained their desired family size and who do not use family planning methods, in fertility regulation interventions.

Copyright of Diyala Journal of Medicine is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

There is widespread agreement that improved health should be regarded as a means and an end in the context of the development process. The health of the populace and the equitable provision of healthcare are two indicators of a society's level of development. A variety of factors influences child mortality. This study investigated the causes of child death and the interaction effect of birth spacing (B.S.) and maternal health care services (MHCS) on child mortality. Using SPSS version 20, we used the Pakistan Demographic and Health Survey (PDHS) 2017–2018 data set to investigate the associated factors of child mortality and the moderating influence of birth spacing using binary logistic regression. The outcome variable is categorical with two categories. The findings indicated that the risk of infant death decreased with adequate B.S. between two pregnancies and access to maternal health care services. Birth spacing was found to moderate the link between access to maternal health care services (MHCS) and child mortality. Our research leads us to conclude that the amount of time between children's births significantly reduces infant mortality. When the birth spacing is at least 33 months, the relationship between maternal health care services and child mortality becomes more evident and negative. [ABSTRACT FROM AUTHOR]

Abstract Background Though the Rwandan Ministry of Health (MOH) prioritizes the scale-up of postpartum family planning (PPFP) programs, uptake and sustainability of PPFP services in Rwanda are low. Furthermore, highly effective long-acting reversible contraceptive method use (LARC), key in effective PPFP programs, is specifically low in Rwanda. We previously pilot tested a supply-demand intervention which significantly increased the use of postpartum LARC (PPLARC) in Rwandan government clinics. In this protocol, we use an implementation science framework to test whether our intervention is adaptable to large-scale implementation, cost-effective, and sustainable. Methods In a type 2 effectiveness-implementation hybrid study, we will evaluate the impact of our PPFP intervention on postpartum LARC (PPLARC) uptake in a clinic-randomized trial in 12 high-volume health facilities in Kigali, Rwanda. We will evaluate this hybrid study using the RE-AIM framework. The independent effectiveness of each PPFP demand creation strategy on PPLARC uptake among antenatal clinic attendees who later deliver in a study facility will be estimated. To assess sustainability, we will assess the intervention adoption, implementation, and maintenance. Finally, we will evaluate intervention cost-effectiveness and develop a national costed implementation plan. Discussion Adaptability and sustainability within government facilities are critical aspects of our proposal, and the MOH and other local stakeholders will be engaged from the outset. We expect to deliver PPFP counseling to over 21,000 women/couples during the project period. We hypothesize that the intervention will significantly increase the number of stakeholders engaged, PPFP providers and promoters trained, couples/clients receiving information about PPFP, and PPLARC uptake comparing intervention versus standard of care. We expect PPFP client satisfaction will be high. Finally, we also hypothesize that the intervention will be cost-saving relative to the standard of care. This intervention could dramatically reduce unintended pregnancy and abortion, as well as improve maternal and newborn health. Our PPFP implementation model is designed to be replicable and expandable to other countries in the region which similarly have a high unmet need for PPFP. Trial registration ClinicalTrials.gov NCT05056545 . Registered on 31 March 2022.

Background: Short birth spacing linked with adversative health consequences for infant, child and maternal mortality also increases the chances of mother and their children survival. Objective: To assess the determinants and the knowledge of birth space amongst women of reproductive age in Mukalla district, Hadhramout Governorate, Yemen. Patients and Methods: A cross sectional study of 384 women of multiplicative ages (15-49 years) was conducted at primary health care centres in Mukalla district. The study was conducted from November. 2018 to Oct 2019. Results: The median birth spacing was 35 months. (50.8 %) of respondents have been committed undersized birth spacing underneath the indorsed interval of ideal delivery spacing. Multivariate logestic V regression revealed that age of mother between 15-24 years (OR 3.255, 95%CI 1.598-6.629, P=0.001), not enough family income (OR 1.867, 95%CI1.104-3.158, P =0.020 ), number of living children ≤ 3 children (OR 1.225, 95%CI .532–2.520, P=0.027) and breast feeding duration < 6 months (OR7.435 , 95%CI 1.490 – 37.101,P=0.014) or 6-

Introduction: Spacing of birth is an important parameter affecting maternal and foetal health. Optimal birth spacing provides multiple benefits for both mother and her child. Both short and long Inter-Pregnancy Intervals (IPI) is associated with multiple adverse perinatal outcomes. Therefore, IPI is viewed as a potential modifiable risk factor for adverse foetal-maternal outcome. Aim: To study the association of IPIs with adverse maternal and foetal outcomes. Materials and Methods: This prospective observational study was conducted in R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India for a period of 18 months from January 2019 to June 2020. All multigravida women with atleast three antenatal check-ups were included in the study. The subjects were divided in two groups: group A consisted of 86 subjects, who had

Background and Objective: Despite guidelines recommending an interval of at least 18–24 months between a live birth and the conception of the next pregnancy, nearly one-third of pregnancies in the United States are conceived within 18 months of a previous live birth.The purpose of this study was to examine the associations between multiple immigration-related variables and interbirth intervals among reproductive-aged immigrant and refugee women living in the United States. Methods: This was a cross-sectional, quantitative study on the sexual and reproductive health (SRH) of reproductive-aged immigrant and refugee women in the United States. The data were collected via an online survey administered by Lucid LLC. We included data on women who had complete information on nativity and birth history in the descriptive analysis (n = 653). The exposure variables were immigration pathway, length of time since immigration, and country/region of birth. The outcome variable was interbirth interval (≤18, 19–35, or ≥36 months).We used multivariable ordinal logistic regression, adjusted for confounders, to determine the factors associated with having a longer interbirth interval among women with second- or higher-order births (n = 245). Results: Approximately 37.4% of study participants had a short interbirth interval.Women who immigrated to the United States for educational (aOR = 4.57; 95% CI, 1.57–9.58) or employment opportunities (aOR = 2.27; 95% CI, 1.07–5.31) had higher odds of reporting a longer interbirth interval (19–35 or ≥36 months) than women born in the United States. Women born in an African country had 0.79 times the odds (aOR = 0.79; 95% CI, 0.02–0.98) of being in a higher category of interbirth interval. Conclusion and Global Health Implications: Although all birthing women should be counseled on optimal birth spacing through the use of postpartum contraception, immigrant and refugee women would benefit from further research and policy and program interventions to help them in achieving optimal birth spacing. SRH research in African immigrant and refugee communities is especially important for identifying ameliorable factors for improving birth spacing. Copyright © 2023 Olorunsaiye et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Study questionDoes the interval from delivery to initiation of a subsequent ART treatment cycle impact clinical pregnancy or live birth rates?Summary answerAn interval from delivery to treatment start of

Introduction: sub-optimal birth spacing is higher in sub-Saharan countries including Ethiopia. It can affect the economic, political and social aspects of a given country. Therefore, this study aimed to assess magnitude of sub-optimal child spacing practice and associated factors among childbearing women in Southern Ethiopia. Methods: a community based cross-sectional study was conducted from July to September 2020. A random sampling technique applied to select kebeles, and systematic sampling was employed to recruit study participants. Data were collected by pretested and interviewer administered questionnaire through face-to-face interviews. Data cleaned and checked for completeness, and analyzed by SPSS version 23. A p-value of < 0.05 was considered as cutoff point to declare the strength of statistical association with 95% of CI. Results: magnitude of sub-optimal child spacing practice was 61.7% (CI: 57.7: 66.2). Not attending formal education (AOR= 2.1 (95% CI: 1.3, 3.3), family planning utilization for less than 3 years (AOR= 4.0 (95% CI: 2.4,6.5), being poor (AOR= 2.0 (95% CI: 1.1, 4.0), breastfeeding of less than 24 months (AOR= 3.4 (95% CI: 1.6,6.0); having more than 6 children (AOR= 3.1 (95% CI: 1.4,6.7); and waiting time =30 minutes (AOR= 1.8 (95% CI: 1.2,5.9) were predictors of sub-optimal birth spacing practices. Conclusion: sub-optimal child spacing was relatively high among the women of Wolaita Sodo Zuria District. Improving utilization of family planning, expanding all inclusive adult education, delivering community based continuous education on optimum breast-feeding practice, involving women in income generating activities, and facilitated maternal services were recommended to fill the identified gap. [ABSTRACT FROM AUTHOR]

Abstract Background Women with previous cesarean deliveries, have a heightened risk of poor maternal and perinatal outcomes, associated with short interbirth intervals. We determined the prevalence of short interbirth interval, and associated factors, among women with antecedent cesarean deliveries who delivered at Mbarara Regional Referral Hospital (MRRH), in southwestern Uganda. Methods We conducted a cross-sectional study on the postnatal ward of MRRH from November 2020 to February 2021. We enrolled women who had antecedent cesarean deliveries through consecutive sampling. We obtained participants’ socio-demographic and obstetric characteristics through interviewer-administered structured questionnaires. We defined short interbirth interval as an interval between two successive births of

Plain Language summary An inter-delivery interval (IDI) that is too short or too long increases the risk of adverse maternal and neonatal outcomes. However, the optimal IDI for trial of labor after cesarean delivery (TOLAC) remains unclear. We performed a multicenter, electronic medical record-based, retrospective cohort study that included 1080 pregnant women who had one or two cesarean deliveries and underwent TOLAC. Data on maternal and neonatal outcomes were collected from the electronic record system. In multivariable analysis, the incidences of postpartum hemorrhage, preterm birth, and low birth weight were significantly increased in women with an IDI of

Background: Interpregnancy interval (IPI) is spacing between live birth and beginning a new pregnancy. Both long and short IPIs have been associated with adverse maternal outcomes. There is paucity in the Indian literature regarding the impact of IPI on maternal outcomes. Materials and Methodology: The cross-sectional study was conducted in the Department of Obstetrics and Gynecology, King George's Medical University, Lucknow, from July 2019 to June 2020. Women with previous abortions, previous stillbirth, nulliparity, or multiple pregnancies were excluded. A pre-structured pro forma was used for demographic details. IPI was categorized as

Background: The possible impact of interpregnancy interval (IPI) on perinatal outcomes has long been studied, however, a definition of the optimal interval is still not clear. Both short and long IPIs have been associated with obstetrical syndromes and short and long-term complications. In this study, we sought to explore the impact of IPI on the hazard for neoplasm of the offspring, thus contribute to the present literature in determining the preferred birth spacing. Objective: We aim to investigate the association between short and long IPIs and the hazard for childhood neoplasm of the offspring. Methods: A population-based retrospective cohort analysis comparing offspring neoplasm hazard following three different IPIs. Exposure was defined as short (<6 months), or long (>60 months) IPIs, whereas intermediate IPI (6 months − 60 months) served as the comparison group. The study included singleton live births in a tertiary regional hospital between 1991 and 2014. Offspring were followed for 18 years, and all hospitalization records for neoplasm diagnoses were collected. Kaplan–Meier survival curves were used for the cumulative incidence of neoplasm morbidity, and Cox proportional hazards models were used to control for confounders. Results: During the study period, 144,397 deliveries met the inclusion criteria. Of those, 18,947 (13.1%) occurred in women with short IPI, 114,012 (79%) in women with intermediate IPI, and 11,438 (7.9%) in women with long IPI. 61 benign neoplasms and 80 malignant neoplasms were registered in offspring born after long IPI. The total percentage of neoplasm were the highest in the long IPI group versus the intermediate and short IPI groups (malignant − 0.7%, 0.6%, 0.5% respectively, benign − 0.5%, 0.4%, 0.3% respectively). Controlling for maternal age, diabetes mellitus, preterm delivery, birth weight, smoking, cesarean section, and fertility treatments, long IPI was found to be independently associated with high hazard for long-term pediatric neoplasm related hospitalizations (adjusted HR 1.39, 95% CI 1.09, 1.77). Short IPI may be associated to decreased hazard for childhood neoplasms (adjusted HR 0.74, 95% Cl 0.59, 0.92). Conclusions: Long IPI is associated with a high hazard for childhood neoplasms, compared with intermediate and short IPIs. Short IPI may be associated with decreased hazard for childhood neoplasms. [ABSTRACT FROM AUTHOR]

Background: Short birth intervals (SBIs) and long birth intervals (LBIs) have been shown to have serious implications for health of both mothers and their children. This study was aimed to investigate the determinants and reproductive outcome of SBI and LBI in a multiethnic Pakistani population.Methods: In a cross-sectional prospective study design, 2798 women admitted in a tertiary-care hospital in Islamabad for delivery were recruited and data on second or higher birth order deliveries were collected. Birth intervals were defined as short (<24 months) and long (>36 months). The reproductive outcome was defined in terms of perinatal and neonatal mortalities, and neonatal complications. Univariate and multivariate logistic regression analyses were performed.Results: Pregnancies with SBI and LBI were observed in 20% and 24% of 2798 women, respectively. Women with SBI had increased odds of perinatal death [adjusted odd ratio (AOR): 1.50] and neonatal death (AOR: 1.47) as compared to women with optimal birth intervals, while women with LBI had slightly lower odds of perinatal deaths (AOR: 0.96), but increased odds of neonatal deaths (AOR: 1.12). Further, the pregnancies with both SBI and LBI were associated with increased odds of short body length, low birth weight, small head circumference and low APGAR score.Conclusion: Nearly half of all pregnancies do not have optimal birth spacing albeit there is wide heterogeneity in the distribution of BI in various Pakistani ethnicities. Pregnancies with SBI and LBI had high risk of adverse reproductive outcome. Intervention programs for maternal and child health need to emphasize optimal birth spacing. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Obstetrics & Gynecology is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Parents are often not indifferent to the sex of their children. Indeed, while there is an overall preference for having mixed sexes in many Western countries, parents often prefer to have sons in some Asian and Caucasian countries, such as Armenia and Azerbaijan. Although migration may partly change preferences, immigrants are likely to bring with them, to some extent, the fertility preferences from their origin country. Using the confidential major files of the 2001 and the 2006 Canadian censuses, we perform Cox Proportional Hazard Models on samples ranging from a little over 1000 to a little less than 700,000 birth intervals, depending on the ethnic group, for a total of 1.1 million births. We show that some ethnic groups, such as Chinese, Indian and South Korean ethnics are more prone to shorten birth spacing after having two daughters than two sons. For example, the median birth duration between the second and third child of Indian ethnics is 39 and 53 months for two girls and two boys families, respectively. Comparing immigrants who have made their fertility decisions abroad with those having made their fertility decisions in Canada, we show that son preference changes with migration. We also demonstrate that the same ethnic groups implement their son preference in many ways, such as sex-selective abortions, differential stopping behaviours and short-birth spacing, we conclude that among Indian, Chinese and West Central Asian & Middle-Eastern ethnics, extreme short-birth spacing, of less than 6 months between birth and conception, are more common after the birth of a daughter than after the birth of a son. [ABSTRACT FROM AUTHOR]

IntroductionInadequately spaced pregnancies, defined as pregnancies fewer than 18 months apart, are linked to maternal, infant, and child morbidity and mortality, and adverse social, educational and economic outcomes in later life for women and children. Quantifying the relation between intimate partner violence (IPV) and women's ability to space and time their pregnancies is an important part of understanding the burden of disease related to IPV.MethodsWe applied Cox proportional hazards models to monthly data from the Demographic and Health Surveys' Reproductive Health Calendar to compare interpregnancy intervals for women who experienced physical, sexual and/or emotional IPV in 29 countries. We conducted a one-stage meta-analysis to identify the periods when women who experienced IPV were at the highest risk of unintended and incident pregnancy, and a two-stage meta-analysis to explore cross-country variations in the magnitude of the relation between women's experience of IPV and pregnancy spacing.ResultsFor the one-stage analysis, considering 52 959 incident pregnancies from 90 446 women, which represented 232 394 person-years at risk, women's experience of IPV was associated with a 51% increase in the risk of pregnancy (95% CI 1.38 to 1.66), although this association decreased over time. When limiting our inference to unintended pregnancies that resulted in live births, women's experience of IPV was associated with a 30% increase in the risk of unintended pregnancy (95% CI 1.25 to 1.34; n=13 541 pregnancies, 92 848 women, 310 319 person-years at risk). In the two-stage meta-analyses, women's experience of IPV was associated with a 13% increase in the probability of incident pregnancy (95% CI 1.07 to 1.20) and a 28% increase in the likelihood of unintended pregnancy (95% CI 1.19 to 1.38).ConclusionsAcross countries, women's experience of IPV is associated with a reduction in time between pregnancies and an increase in the risk of unintended pregnancy; the magnitude of this effect varied by country and over time.

Non-English language abstract (Spanish) Antecedentes Los intervalos intergenésicos cortos (menores de 33 meses, según la OMS) afectan la salud y el bienestar de la madre, el niño y la familia. Aunque los habitantes del norte de Nigeria reconocen muchos efectos adversos de un intervalo intergenésico corto (kunika en lengua hausa), éstos aún son frecuentes. Nosotros usamos cartografía cognitiva para sintetizar el conocimiento local sobre causas de kunika y guiar el codiseño de estrategias culturalmente seguras que permitan su disminución. Método Grupos de hombres y mujeres en doce comunidades hicieron 48 mapas, mientras funcionarios del Estado de Bauchi y del Área Local de Gobierno (LGA) hicieron otros cuatro. Cada mapa mostraba causas de kunika o de no-kunika con flechas indicando la influencia entre ellas. Los participantes ponderaron la influencia entre 1 (la más débil) y 5 (la más fuerte). Nosotros combinamos los mapas por grupos de mujeres, hombres y funcionarios. Con fuzzy transitive closure calculamos la máxima influencia entre factores cuando todas las relaciones en el mapa son consideraras. Condensamos los mapas agrupando factores individuales en categorías y calculamos la influencia neta acumulativa para cada una. Estos mapas los sintetizamos aún más para revisarlos con sus autores. Resultados Los mapas de los grupos comunitarios identificaron el sexo frecuente y factores relacionados, no usar anticonceptivos modernos o tradicionales y las dinámicas familiares (como el deseo de tener más hijos o la competencia entre esposas) como las causas más importantes de kunika. Los mapas de las mujeres identificaron el sexo forzado como causa importante y los mapas de los hombres destacaron la falta de conocimiento sobre anticoncepción y el temor a los efectos secundarios. La falta de participación masculina apareció en los mapas de las mujeres, del LGA y del Estado. Los mapas de los factores protectores reflejaron en gran medida los de las causas. Los grupos comunitarios aprobaron y apreciaron los mapas que sintetizaban el análisis. Conclusiones Los mapas comunitarios mostraron que kunika es el resultado de una compleja red de factores con dinámicas culturales específicas. Es poco probable que enfocarse solo en promover anticoncepción reduzca kunika. Los resultados del transitive closure pueden comunicarse al público en general para una mayor participación en la interpretación y uso de los resultados.

There is considerable literature on the associations of short birth intervals with adverse perinatal outcomes. However, less is known about the associations with child growth and development. In this study, we investigated the associations between birth intervals and child growth and development and examined child illness, child diet, and maternal stimulation as potential mechanisms. We pooled Demographic and Health Survey data on 8300 children aged 36–59 months from 13 countries (Benin, Burundi, Cambodia, Cameroon, Chad, Congo, Haiti, Honduras, Rwanda, Senegal, Timor-Leste, Togo, and Uganda). Longer birth interval was defined as a preceding birth interval ≥33 months. Child growth was assessed using height-for-age Z-score (HAZ). Child cognitive and socio-emotional development were measured using the Early Childhood Development Index. Child morbidity was defined as any illness in the past two weeks. Child diet was assessed using dietary diversity score and maternal stimulation by the number of stimulation activities. We used generalised linear models to estimate associations between longer birth intervals and child growth and development. Structural equation modelling was used to assess direct and indirect effects. In our sample, 44% of children had a preceding birth interval ≥33 months, 42% were stunted, 25% were cognitively off-track, and 33% socio-emotionally off-track. Longer birth intervals were associated with higher HAZ (mean difference 0.23 (95% CI 0.14, 0.32)) and socio-emotional development (relative risk (RR) 1.04 (95% CI 1.00, 1.09), but not cognitive development (RR 1.02 (95% CI 0.98, 1.06). We observed no significant indirect effects via child illness, child dietary diversity, or maternal stimulation. Although longer birth intervals were beneficial for child growth and socio-emotional development, we found no empirical support for the biological and behavioural mechanisms we explored. Additional research is needed to investigate alternative mechanisms to elucidate underlying processes and inform future interventions.

Objectives Studies showed that short interpregnancy interval - time between birth of the previous (index) child to the conception of the next - is associated with adverse perinatal and maternal outcomes, impacting sibling relations, parenting, and couple relations. This study aims to investigate the demographic and obstetric determinants of short interpregnancy interval in Western Australia. Approach We used a longitudinal study using data linkage obtained from Western Australian Midwives Notification System and Hospital Morbidity Data System for 150,712 women who gave births between 2006 and 2010. We estimated unadjusted and adjusted hazard ratio (aHR) and 95% CI using Gompertz gamma shared frailty model. In the study, event was deemed when women conceived within 18 months after index (previous) births. Otherwise, we considered as censored when women conceived after 18 months of the index births or if they did not conceive until the last date of the follow up period (31st December 2015). Results We found that 20% (n=30,916) of births in WA conceived within 18 months after the index pregnancy. We found that women aged

Abstract Background Strengthened efforts in postpartum family planning (PPFP) is a key priority to accelerate progress in reproductive, maternal, newborn, and child health outcomes. This secondary data analysis explores factors associated with PPFP uptake in Rwanda. The purpose of this study was to explore variables that may influence PPFP use for postpartum women in Rwanda including health facility type, respectful maternity care, locus of control, and mental health status. Methods This secondary analysis of data from a cluster randomized control trial used information abstracted from questionnaires administered to women (≥ 15 years of age) at two time points—one during pregnancy (baseline) and one after delivery of the baby (follow-up). The dependent variable, PPFP uptake, was evaluated against the independent variables: respectful care, locus of control, and mental health status. These data were abstracted from linked questionnaires completed from January 2017 to February 2019. The sample size provided 97% power to detect a change at a 95% significance level with a sample size of 640 at a 15% effect size. Chi-square testing was applied for the bivariate analyses. A logistic regression model using the generalized linear model function was performed; odds ratio and adjusted (by age group and education group) odds ratio with 95% confidence interval were reported. Results Of the 646 respondents, although 92% reported not wanting another pregnancy within the next year, 72% used PPFP. Antenatal care wait time (p =

Background: Interpregnancy interval (IPI) is spacing between live birth and beginning a new pregnancy. Both long and short IPIs have been associated with adverse maternal outcomes. There is paucity in the Indian literature regarding the impact of IPI on maternal outcomes. Materials and Methodology: The cross-sectional study was conducted in the Department of Obstetrics and Gynecology, King George's Medical University, Lucknow, from July 2019 to June 2020. Women with previous abortions, previous stillbirth, nulliparity, or multiple pregnancies were excluded. A pre-structured pro forma was used for demographic details. IPI was categorized as <6 months, 6 to <24 months, 24 to <60 months, and 60 months. Maternal outcomes were studied, and odds ratios were calculated. Results: There were 6984 deliveries in the period. A total of 4812 women were enrolled after following the inclusion and exclusion criteria. Of 4812 women, 142 (2.9%) had IPI <6 months, 3336/4812 women (69.3%) had IPI 6 to <24 months, 1144/4812 women (23.7%) had IPI 24 to <60 months, and 3.9% women (190/4812) had IPI ≥60 months. High risk of fetal malposition (OR 3.84), fetal growth restriction (OR 2.06), and hypertension (OR 1.86) were seen in women with short IPI <6 months. Women with longer IPI (≥ 60 months) had higher chances of preterm labor (OR 3.82), oligoamnios (OR 2.54), gestational diabetes (OR 2.19), and anemia (OR 1.45) Conclusion: Three-fourths of women had IPI less than 24 months recommended as minimum interval by WHO. Efforts are needed to increase awareness and availability of contraceptive choices for postpartum women to ensure adequate spacing. [ABSTRACT FROM AUTHOR]

The relationship between birth interval length and child out comes has received increased attention in recent years, but few studies have examined off-spring out comes across the life course in North America. We use data from the Utah Population Database to examine the relationship between birth intervals and shortand longterm out comes: preterm birth, low birth weight (LBW), infant mortality, college degree attainment, occupational status, and adult mortality. Using linear regression, linear probability models, and survival analysis, we compare results from models with and with out sibling comparisons. Children born after a birth interval of 9-12 months have a higher probability of LBW, pre term birth, and infant mortality both with and with out sibling comparisons; longer intervals are associated with a lower probability of these out comes. Short intervals before the birth of the next youngest sibling are also associated with LBW, pre term birth, and infant mortality both with and with out sibling comparisons. This pattern raises concerns that the sibling comparison models do not fully adjust for within family factors predicting both spacing and perinatal out comes. In sibling comparison analyses considering longterm out comes, not even the very shortest birth intervals are negatively associated with educational or occupational outcomes or with long-term mortality. These findings suggest that extremely short birth intervals may increase the probability of poor perinatal out comes but that any such disadvantages disappear over the extended life course. [ABSTRACT FROM AUTHOR]

Studies have suggested that improving access to family planning (FP) may improve contraceptive use and reduce fertility. However, high-quality evidence, particularly from randomized implementation trials, of the effect of FP programs and interventions on longer-term fertility and birth spacing is lacking. We conduct a nonblinded, randomized, controlled trial to assess the causal impact of improved access to FP on contraceptive use and pregnancy spacing in Lilongwe, Malawi. A total of 2,143 married women aged 18 to 35 who were either pregnant or had recently given birth were recruited through home visits between September 2016 and January 2017 and were randomly assigned to an intervention arm or a control arm. The intervention arm received four services over a 2-y period: 1) up to six FP counseling sessions; 2) free transportation to an FP clinic; 3) free FP services at the clinic or financial reimbursement for FP services obtained elsewhere; and 4) treatment for contraceptive-related side effects. Contraceptive use after 2 y of intervention exposure increased by 5.9 percentage points, mainly through an increased use of contraceptive implants. The intervention group's hazard of pregnancy was 43.5% lower 24 mo after the index birth. Our results highlight the positive impact of increased access to FP on a woman's contraceptive use. In addition, we show that exposure to the FP intervention led to a prolongation of birth intervals among intervention women relative to control women and increased her control over birth spacing and postpartum fertility, which, in turn, may contribute to her longer-term health and well-being. [ABSTRACT FROM AUTHOR]