Background
Methods
Search strategy
Eligibility criteria
Data collection
Methodological quality
Results
First author and year of publication | Country | Sample size | Unit of analysis | Age range/mean (years) | Aim of the study |
---|---|---|---|---|---|
Studies reporting OR/RR | |||||
Abdullah 2018a | Bangladesh | 4504 | Women | 15 to 35+ | “examines the feasibility of integrating a post-partum family planning intervention package within a community-based maternal and newborn health intervention package, and evaluates the impact of integration on reduction of rates of short birth intervals and preterm births.” |
Hailu 2016b | Ethiopia | 636 | Women | Mean 31 (SD ± 5.16) | “assess determinants of interbirth interval among child-bearing age women who have at least two consecutive live births in Arba Minch ZuriaWoreda, SNNP, Ethiopia, 2014.” |
Chirwa 2014c | Democratic Republic of Congo | 7172 | Women | 15 to 49 | “investigate the proportion of short birth intervals at the provincial level among young women in the DRC.” |
de Jonge 2014c | Bangladesh | 5571 | Births | NR | “identify predictors of short birth interval and determine consequences of short intervals on pregnancy outcomes.” |
Begna 2013b | Ethiopia | 636 | Women | 20 to 49 | “assess the determinants of inter birth interval among women’s of childbearing age in Yaballo Woreda, Borena zone, Oromia Regional State, Ethiopia.” |
Dim 2013c | Nigeria | 420 | Women | 20 to 44 | “determined the duration of inter-birth interval and the determinants of short inter-birth interval in Enugu, Nigeria.” |
Muganyizi 2013c | Tanzania | 427 | Women | 15 to 45mean 29.2(SD ± 5.1) | “explored if the use of modern family planning promotes healthy timing and spacing of pregnancy among women seeking antenatal services.” |
Exavery 2012d | Tanzania | 8980 | Women | 16 to 49 | “(1) describe the median level of inter-birth interval (in months), (2) estimate proportions of inter-birth intervals below the recommended minimum inter-birth interval by characteristics of mother and child, and (3) identify factors associated with non-adherence to the recommended minimum inter-birth interval among multiparous women of childbearing age in Rufiji district of Tanzania.” |
Fayehun 2011c | Nigeria | 22,752 | Births | 15 to 49 | “examine the effects of demographic, socioeconomic and socio-cultural factors on birth spacing among Nigerian ethnic groups.” |
Ismail 2008c | Malaysia | 355 | Women | Mean 33.5 (SD ± 5.0) | “determine the prevalence and associated factors for short birth spacing among Malay women who delivered at Hospital Universiti Sains Malaysia, Kota Bharu, Kelantan.” |
Todd 2008c | Afghanistan | 4452 | Women | Mean 25 (SD ± 5.7) | “assess prevalence and correlates of prior contraceptive use among hospitalized obstetric patients in Kabul, Afghanistan.” |
Ngianga-Bakwin 2005c | Nine countries in Africae | 50,596 | Birth intervals | NR | “investigate associations between use of depot-medroxyprogesterone acetate and other reversible contraception and short birth intervals in sub-Saharan Africa.” |
Sirivong 2003c | Laos | 298 | Women | 15 to 49 | “find out whether or not the training of traditional birth attendants had an impact on reproductive health.” |
Atkin 1992d | Mexico | 137 | Women (adolescents) | < 18 | “identifies and explores selected background, pregnancy, and postpartum predictors of short-interval repeat pregnancy among urban Mexican adolescents who were single when they conceived their first pregnancy.” |
Achadi 1991c | Indonesia | 6826 | Birth intervals | NR | “examine the relative impact of breastfeeding and family planning use on birth spacing patterns in two major regions of Indonesia.” |
Franca-Junior 1985c | Brazil | 345 | Children | NR | “investigate the interpregnancy interval and its relationship with breastfeeding”(translated from Portuguese). |
Studies reporting HR | |||||
Blackwell 2015d | Bolivia | 986 | Women | NR | “investigated associations between intestinal helminths and fertility in women.” |
Mattison 2015c | Tanzania | 315 | Children | 2 to 7mean 4.5 (SD ± 1.6) | “ask whether breastfeeding for more than 2 years is associated with discernible health and well-being benefits to children.” |
Erfani 2014c | Iran | 9071 | Women | 15 to 49 | “study the determinants of change in the timing of births.” |
Fallahzadeh 2013c | Iran | 400 | Women | 15 to 49 | “identify the duration and determinants of inter birth intervals among women of reproductive age in the city of Yazd.” |
Singh 2012c | India | 7624 | Women | NR | “see the effect of breastfeeding as a time-varying and time-dependent factor on birth spacing in order to provide input to policy planners.” |
Dommaraju 2008c | India | 64,943 | Women | 15 to 49 | “investigates the complex relationship between marriage age and marital fertility by examining the initiation of childbearing and the transition to higher order births by marriage cohorts in India.” |
Hossain 2007d | Bangladesh | 31,324 | Birth intervals | Mean 21.8 | “examine the relationship between child mortality and subsequent fertility.” |
Ly 2006ba | Senegal | 134 | Children and their moms | 3.5 months old babies | “assess the effects of early, short-term food supplementation of infants (from 4 to 7 months of age) on maternal weight change, duration of breastfeeding and birth interval in a rural West African community.” |
Gyimah 2005c | Ghana | 10,975 | Women | 15 to 49 | “[examines] the relative socio-economic vis-a-vis socio-cultural factors on the timing of births.” |
Upadhyay 2005c | Philippines | 1123 | Women | 26 to 49mean 37 | “look at whether women’s status and autonomy affect birth-to-conception intervals.” |
Youssef 2005c | Jordan | 4349 | Birth intervals | 15–49mean 32.2(SD ± 7.1) | “identify the duration and determinants of interbirth intervals among women of reproductive age in one region of Jordan.” |
van Eijk 2004c | Kenya | 2218 | Women | 14 to 30+ | “studied factors associated with short pregnancy interval (PI) and the effect of PI on birthweight and haemoglobin.” |
Hoa 1996c | Vietnam | 1132 | Women | NR | “explore the reproductive pattern of women in rural Vietnam in relation to the existing family planning policies and laws.” |
Nair 1996c | India | 1829 | Women | < 35 | “examine changes in the timing of birth and the important factors determining birth intervals.” |
Adewuyi 1990c | Nigeria | 8818 | Women | NR | “examine regional variations in birth interval length as reported in the Nigerian Fertility Survey and the pattern in the variation of birth interval length at different parities. [...] examination of the correlates of birth interval length in the country.” |
Lehrer 1984c | Malaysia | 1200 | Women | < 50 | “test the hypothesis that the impact of child mortality on spacing varies across parities.” |
Mixed-methods studies | |||||
Dehne 2003 | Burkina Faso | 350 | Community members | 15–49 | “document current trends in knowledge of, attitudes towards, and relating to traditional and modern child-spacing methods in a remote area in northern Burkina Faso.” |
Qualitative studies | |||||
De Vera 2007 | Philippines | 7 | Couples (husbands and wives) | 20 to 47 | “describe perceptions of birth spacing among rural Filipino husbands and wives.” |
Social & Rural Research Institute 2003 | India | 34 | Focus groups | 17 to 30 | “understand knowledge, attitudes, behaviors and practices with respect to birth spacing; determine the factors that motivate birth spacing among those who practice spacing; identify barriers to adoption of spacing methods; understanding knowledge, attitudes and practices of health personnel and institutional support towards birth-spacing.” |
Dean 1994 | Kenya | 153 participants | Community groups | NR | “examine the beliefs held and concepts behind childbearing practices in the rural communities of West Pokot District in Kenya and the concrete changes in these practices that have occurred.” |
Chad Ministry of Public Health 1992 | Chad | 16 focus groups with 160 men and women | Focus groups | 18 to 40 | “1. Learn how Chadian men and women feel about the concept of family wellbeing; 2. Explore men and women’s understanding of modern family planning methods and family well-being, including rumors and misconceptions; 3. Examine the influence of religion on the use of family planning among Chadian men and women; 4. Examine the image Chadian women and men have of a family planning user.” |
Kiluvia 1991 | Tanzania | 50 | Focus groups | 15 to 35+ | “identify persuasive, educational, and appealing family planning messages for radio and print materials. […] To learn why Tanzanian couples choose to space their births.” |
Van de Walle 1986 | Burkina Faso | 80 | Women | NR | “revisited 80 women, for a longer description of their postpartum experiences.” |
Millard 1984 | Mexico | 285 | Women | > 15 | “shows how cultural systems, in addition to biological constraints, shape lactation patterns and endow breastfeeding with social significance.” |
Lovel 1983 | Zimbawe | 204 | Women | NR | “women with at least one child under five were asked about reasons for birth spacing in their parents’ generation.” |
Adeokun 1982 | Nigeria | NR | Families | NR | “marital sexual relationships (MSR) and the timing of the next child among the Ekiti and Ikale sub-groups of the Yoruba.” |
Adeokun 1981 | Nigeria | 24 | Families | NR | “investigate the patterns of maternal and child care, the parents’ perception of the timing of various milestones in the development of their children, and to seek the links between marital sexuality, child development and the timing of a next child (other than the first).” |
Studies reporting OR/RR
Category / subcategory | Author / year of publication | Factor | Outcome (length of birth interval in months) | Adjusted effect size | Confidence interval 95% |
---|---|---|---|---|---|
Age | |||||
At first pregnancy (years) | de Jonge 2014 | 18.3 vs 18.6 | < 33 | 0.95 | 0.92–0.98 |
At delivery of the last child (years) | Hailu 2016 | 17–24 vs > 34 | < 36 | 0.98 | 0.36–2.66 |
25–29 vs > 34 | 0.9 | 0.40–2.0 | |||
30–34 vs > 34 | 2.58 | 1.08–5.15 | |||
de Jonge 2014 | 22 vs 22.88 | < 33 | 1.11 | 1.08–1.15 | |
Of the mother (years)a | Chirwa 2014 | 15–19 vs 45–49 | < 25 | 2.51 | 1.56–4.04 |
20–24 vs 45–49 | 1.79 | 1.27–2.52 | |||
25–29 vs 45–49 | 1.3 | 0.93–1.84 | |||
30–34 vs 45–49 | 1.25 | 0.89–1.76 | |||
35–39 vs 45–49 | 1.05 | 0.74–1.5 | |||
40–44 vs 45–49 | 0.99 | 0.69–1.44 | |||
Of the mother (years)b | Begna 2013 | 20–24 vs 25–29 | < 36 | 1.36 | 0.53–3.48 |
30–34 vs 25–29 | 0.68 | 0.39–1.17 | |||
35–39 vs 25–29 | 0.31 | 0.17–0.6 | |||
40–44 vs 25–29 | 0.22 | 0.10–0.49 | |||
45–49 vs 25–29 | 0.39 | 0.15–1.01 | |||
Muganyizi 2013 | 30 vs 15–29 | < 24 or > 60 | 1 | 0.5–1.7 | |
Exavery 2012 | 15–19 vs 45–49 | < 33 | 13.65 | 9.63–19.35 | |
20–24 vs 45–49 | 4.3 | 3.16–5.86 | |||
25–29 vs 45–49 | 2.4 | 1.77–3.26 | |||
30–34 vs 45–49 | 2.07 | 1.52–2.8 | |||
35–39 vs 45–49 | 1.64 | 1.21–2.24 | |||
40–44 vs 45–49 | 1.31 | 0.95–1.83 | |||
Ismail 2008 | One-year increase in age | < 24 | 0.86 | 0.8–0.92 | |
Ngianga-Bakwin 2005 | < 21 vs > 21 and < 35 | < 24 | 0.58 | 0.55–0.62 | |
> 35 vs > 21 and < 35 | 0.67 | 0.62–0.72 | |||
Of the woman’s own mother at first pregnancy (years) | Atkin 1992 | 11–17 vs > 17 | < 24 | 5.1 | Not provided |
Breastfeeding | |||||
Duration (months) | Hailu 2016 | 12–23 vs > 23 | < 36 | 60.19 | 31.61–114.59 |
Begna 2013 | < 25 vs > 24 | < 36 | 30.81 | 6.97–136.19 | |
Ismail 2008 | < 12 vs > 11 | < 24 | 6.18 | 3.59–10.62 | |
Type | Chirwa 2014 | Exclusive breastfeeding vs Mixed | < 25 | 1.08 | 1–1.17 |
Never breastfeeding vs Mixed | 1.07 | 0.99–1.15 | |||
Ngianga-Bakwin 2005 | Exclusive breastfeeding vs No breastfeeding | < 24 | 0.67 | 0.58–0.78 | |
Mixed feeding vs No breastfeeding | 0.86 | 0.82–0.90 | |||
Contraception | |||||
Method | Chirwa 2014 | Not using contraception vs Modern method | < 25 | 0.97 | 0.85–1.08 |
Ngianga-Bakwin 2005 | Using injections vs Using other methods | < 24 | 1.23 | 1.1–1.38 | |
Atkin 1992 | Postpartum IUD: No/Yes | < 24 | 26.34 | Not provided | |
Use | Hailu 2016 | No vs Yes | < 36 | 3.01 | 1.68–5.39 |
Muganyizi 2013 | No vs Yes | < 24 or > 60 | 1 | 0.6–1.8 | |
Begna 2013 | No vs Yes | < 36 | 5.91 | 4.02–8.69 | |
Ismail 2008 | No vs Yes | < 24 | 3.95 | 2.21–7.05 | |
Ngianga-Bakwin 2005 | No vs Yes | < 24 | 0.88 | 0.82–0.93 | |
Todd 2008 | Prior contraceptive use: Yes/No | Longer mean birth interval (2.21 ± 0.79 Vs 2.01 ± 0.87 years) | 1.25 | 1.12–1.40 | |
Education of the mother | |||||
Hailu 2016 | No formal education vs Has formal education | < 36 | 3.4 | 1.8–6.43 | |
Chirwa 2014 | No education vs Secondary or higher | < 25 | 1.08 | 0.97–1.19 | |
Primary education vs Secondary and higher | 1.06 | 1–1.16 | |||
de Jonge 2014 | Secondary or above vs None or primary education | < 33 | 1.26 | 1.09–1.45 | |
Begna 2013 | No formal education vs Formal education | < 36 | 1.89 | 1.15–3.37 | |
Muganyizi 2013 | Primary vs No education | < 24 or > 60 | 1 | 0.2–4.6 | |
Secondary or above vs No education | 1.6 | 0.3–7.3 | |||
Exavery 2012 | Never been to school vs Secondary/higher | < 33 | 1.27 | 1.01–1.60 | |
Primary vs Secondary/higher | 1.09 | 0.87–1.37 | |||
Ngianga-Bakwin 2005 | No education vs Secondary education or higher | < 24 | 1.16 | 1.06–1.26 | |
Primary education vs Secondary education or higher | 1.11 | 1.03–1.20 | |||
Sirivong 2003 | Literate vs Illiterate | Birth spacing (length not specified) | 0.27 | 0.08–0.84 | |
Marital status | |||||
Muganyizi 2013 | Not in marriage vs In marriage | < 24 or > 60 | 0.9 | 0.4–2.1 | |
Exavery 2012 | Previously married (widowed or divorced) vs Married | < 33 | 0.56 | 0.48–0.66 | |
Single vs Married | 0.64 | 0.57–0.73 | |||
Atkin 1992 | Women who were in a legal or consensual union at 5 months: Yes / No | < 24 | 6.9 | Not provided | |
Miscellaneous | |||||
Intervention | Abdullah 2018 | Intervention: integrated post-partum family planning and maternal and newborn health. Control: maternal and newborn health only. | < 24 | 0.81 | 0.69–0.95 |
Occupational group | de Jonge 2014 | Tea garden resident: Yes vs No | < 33 | 1.41 | 1.07–1.87 |
Religion | Other vs Muslim | 0.68 | 0.53–0.87 | ||
Time period | Ngianga-Bakwin 2005 | 1998–2001 vs 1991–1993 | < 24 | 0.9 | 0.84–0.95 |
Occupation | |||||
Husband | Begna 2013 | Daily worker vs Animal husbandry | < 36 | 2.19 | 1.01–4.79 |
Farmers vs Animal husbandry | 0.49 | 0.24–1 | |||
Merchant vs Animal husbandry | 0.72 | 0.36–1.43 | |||
Others vs Animal husbandry | 1.17 | 0.47–5.92 | |||
Mother | Hailu 2016 | Farmer vs Others | < 36 | 2.68 | 0.31–23.23 |
Housewife vs Others | 1 | 0.17–5.86 | |||
Merchant vs Others | 1.46 | 0.16–13.24 | |||
Muganyizi 2013 | Employment Business vs Salary employment | < 24 or > 60 | 1.1 | 0.6–2.1 | |
Employment Housewife/others vs Salary employment | 1.6 | 0.7–3.4 | |||
Parity (children) | |||||
de Jonge 2014 | > 3 vs 1 | < 33 | 0.28 | 0.19–0.41 | |
2 vs 1 | 0.53 | 0.44–0.63 | |||
3 vs 1 | 0.38 | 0.29–0.51 | |||
Muganyizi 2013 | > 3 vs 2 | < 24 or > 60 | 1.8 | 0.9–3.7 | |
3 vs 2 | 0.9 | 0.5–1.5 | |||
Begna 2013 | 2 vs > 4 | < 36 | 3.73 | 1.50–9.25 | |
3&4 vs > 4 | 2.69 | 1.23–5.92 | |||
Exavery 2012 | > 3 vs 2 | < 33 | 2.54 | 2.25–2.85 | |
3 vs 2 | 1.29 | 1.19–1.40 | |||
Ismail 2008 | Parity (no further explanation) | < 24 | 1.46 | 1.22–1.76 | |
Previous pregnancy | |||||
Outcome | de Jonge 2014 | Adverse outcome of any previous pregnancy: Yes / No | < 33 | 2.1 | 1.83–2.40 |
Muganyizi 2013 | Immediate past pregnancy loss: Yes / No | < 24 or > 60 | 2.5 | 1.3–4.7 | |
Exavery 2012 | Birth: Multiple vs Singleton | < 33 | 0.74 | 0.57–0.96 | |
Ismail 2008 | History of abortion: Yes vs No | < 24 | 0.09 | 0.02–0.34 | |
Place of delivery | Hailu 2016 | Health institution vs Home | < 36 | 1.53 | 0.61–3.8 |
Exavery 2012 | Elsewhere vs Health facility | < 33 | 1.85 | 1.71–2 | |
Planned | Hailu 2016 | No vs Yes | < 36 | 1.44 | 0.9–2.61 |
Sex of the previous child | |||||
Hailu 2016 | Female vs Male | < 36 | 6.79 | 3.65–12.63 | |
Begna 2013 | Female vs Male | < 36 | 1.72 | 1.17–2.52 | |
Socioeconomic level | |||||
Household assetsc | de Jonge 2014 | 0–3 vs > 3 | < 33 | 1.42 | 1.22–1.65 |
Income | Hailu 2016 | Wealth index: Fourth vs Richest | < 36 | 3.96 | 1.41–11.13 |
Wealth index: Middle vs Richest | 3.98 | 1.39–11.38 | |||
Wealth index: Second vs Richest | 6.46 | 2.26–8.48 | |||
Wealth index: Poorest vs Richest | 14.33 | 4.65–44.15 | |||
Chirwa 2014 | Low vs High | < 25 | 0.98 | 0.8–1.01 | |
Middle vs High | 0.86 | 0.77–0.94 | |||
Ngianga-Bakwin 2005 | Low vs High | < 24 | 1.18 | 1.10–1.26 | |
Middle vs High | 1.25 | 1.17–1.34 | |||
Place of residence | Chirwa 2014 | Rural vs Urban | < 25 | 1.07 | 0.97–1.13 |
Exavery 2012 | Rural vs Urban | < 33 | 1.04 | 0.95–1.13 | |
Ngianga-Bakwin 2005 | Urban vs Rural | < 24 | 0.85 | 0.79–0.9 |
Studies reporting HR
Qualitative and mixed-methods studies
Author and year of publication | Theme | Factor | Quotation | Page |
---|---|---|---|---|
Social & Rural Research Institute 2006 | Autonomy | Lack of decision-making power | “Lack of decision-making powers among the women due to the patriarchal structure of the family that gives the man the reins of power.” | 4 |
Millard 1984 | Breastfeeding | Breastfeeding does not work | “When the issue of lactation contraception is raised with village women, they deny its effectiveness, confidently and laughingly pointing to their own repeated experiences of returning to pregnancy while breastfeeding. They volunteered information no about the return of menses in relation to the probability of conception. Of the women queried about lactation contraception, only one woman in Amanalco stated that she thought breastfeeding probably did reduce the chance of a rapidly ensuing pregnancy.” | 9 |
Adeokun 1982 | Breastfeeding works | “I do not worry my mind about pregnancy, we keep on having sex and as long as she keeps on breast-feeding nothing can happen. Once she has stopped and her period has returned, then we know it is time for her to become pregnant.” | 10 | |
De Vera 2007 | Communication | Couple | “The subcategory, lack of communication, was identified as one of the reasons that couples did not space births.” | 242 |
Adeokun 1982 | Family | “The openness of Yoruba families encourages kin and in-laws to influence a couple’s decisions about child rearing and the timing of the next child.” | 12 | |
De Vera 2007 | “Family and friends influenced couples’ decisions about birth spacing. Some participants received advice on birth spacing from relatives and friends.” | 244 | ||
Social & Rural Research Institute 2004 | “Familial and cultural factors that determine the extent of support lent by the family (or the lack of it) to the woman. Given the nature of the Indian society, the influence of the peers and the community is critical.” | 4 | ||
De Vera 2007 | Media | “The popular media (print and broadcast media) may exert influence on couples’ decisions about spacing births in some communities.” | 244 | |
Observation | “Whereas others observed that their relatives went through hard lives because of too closely spaced pregnancies.” | 244 | ||
Social & Rural Research Institute 2009 | Social | “Fear of social disapproval [is a barrier to adoption of spacing].” | 4 | |
Kiluvia 1991 | Women’s responsibility | “Communication between spouses’ partners on child spacing was not necessary. Reasons varied with age and gender.[...]. Married men also frequently saw no reason to talk to their wives, because they felt the number and timing of births was solely their responsibility.” | 7 | |
Chad Ministry of Public Health 1992 | “While Chadians of both sexes agreed that ideally both husband and wife should decide to use child spacing together, there was consensus that it was ultimately a woman’s responsibility to ensure that children were spaced.” | 8 | ||
Van de Walle 1986 | Health concerns | Child health concerns | “If you have a child in your arms and you become pregnant again, it is not good. The child is tired and you, who are with a belly, are tired also... the child in your womb suffers too. Everyone will suffer, because you must feed the other one in addition to this one. The one in your womb will be tired too. You know that if there is no one to take care of the oldest one you will be obliged to carry it on top of your pregnancy.” | 17 |
Maternal health concerns | “Question. When do you want the next child? Answer: Even if it takes 3 or 4 years, I will be happy. Question: Why do you want to wait? Answer: Because I am old and a lot of blood poured out of my body during my deliveries. Can the same blood flow back into my body so rapidly?” | 16 | ||
Social & Rural Research Institute 2003 | Knowledge and attitudes | Attitudes of the women | “Personal factors driven primarily by the attitude of the woman to self and spacing.” | 4 |
Knowledge | “Ignorance of methods available and negligent attitude towards the concept of spacing per se that is catapulted either by the negative word of mouth or bad personal experiences.” | |||
Dehne 2003 | Local concepts and practices | Abstinence norms | “Women adhering to Gurmance traditional religion reported either 24 or 36 months’ taboos, while Muslims reported much shorter norms. Most Hamallists (and the few Wahabiya) women reported a 40-day norm as prescribed in the Koran, while many ‘moderate’ Muslims reported intermediate norms of 2–5 months.” | 60 |
Van de Walle 1986 | Afraid of being mocked | “As to the women, they crave for a child after 2 years, they are afraid of being mocked because they are finished with childbearing.” | 28 | |
Adeokun 1981 | Agbon (female body odor) | “The condition called agbon or female body odor after parturition. Once the period of agbon is over, sexual activity is commenced. The interbirth interval is thus a function of the length of agbon, the length of postpartum amenorrhoea, and the practice of pregnancy prevention after agbon has ended.” | 14 | |
Dehne 2003 | Amulets, talismans, and cords | “The use of amulets, talismans, and cords […] for instance in cases where women felt unprotected against an early pregnancy or guilty after having resumed sexual relations shortly after a preceding birth.” | 60 | |
Adeokun 1981 | Apa (conflict between children) | “The other Ikale strategy starts from the notion of apa, that is, the principle that if a surviving child is less than 1 year old and another pregnancy occurs, a conflict situation arises between the survival of the nursing child and the survival of the foetus. In order to avoid the conflict, the marital sexual relationship of the parents may be organized in such a way as to prevent the undesirable pregnancy.” | 14 | |
Millard 1984 | Coitus interruptus | “Conjugal disruption is more frequent in Tepetlaoxtoc and may be a contributing factor; possibly conscious efforts are more often made to birth extend intervals through coitus interruptus.” | 7 | |
De Vera 2007 | Hilots (abortion for birth spacing) | “Most participants said that abortion was common and a de facto method for spacing births. Because abortion is illegal in the Philippines, women sought hilots (unlicensed lay abortionists, midwives, and masseuses) to perform an abortion.” | 243 | |
Kiluvia 1991 | Honoured tradition | “We were strongly advised by our parents to take care of the baby for 2 years, then from here you can start thinking about having another baby. We were strictly warned of having too closely spaced children.” | 17 | |
Chad Ministry of Public Health 1992 | “Child spacing was seen as a tradition that protected children’s and women’s health.” | ii | ||
Lovel 1983 | Local knowledge | “These results show that in a traditional society the health benefits of birth spacing to mother and child are clearly well-known.” | 162 | |
Dehne 2003 | Marabu | “When this was becoming difficult, because my husband no longer agreed to abstain, I went to see a Marabu who gave me an amulet.” | 60 | |
Dean 1994 | Polygamy | “The influence of the post-partum abstinence period on birth interval and fertility is important. As outlined, men traditionally visit several wives, living far apart, each for a few months at a time, and this helps to sustain the post-partum abstinence period.” | 1581 | |
Ratat (traditional abstinence) | “Results of this study found that there was a traditional form of contraception throughout the district, called ratat or rotow in most areas.” | |||
Lovel 1983 | Social taboo | “More than a quarter of the families (rural 26%, semiurban 30%) said that in their parents’ generation people were ashamed of having children too close together because it was not accepted in the culture.” | 161 | |
Van de Walle 1986 | “Ah, two years [between children] is good. Certain women don’t reach 2 years. Certain women whose child is not yet walking become pregnant. I cannot understand that... If you have a child in your arms, and become pregnant, don’t you know that you are humiliated [loose face]?” | 16 | ||
Kiluvia 1991 | “Many of the older women felt that engaging in sexual intercourse while the mother is still breastfeeding is taboo.” | 18 | ||
Adeokun 1982 | Traditional medicine | “The other half depends on the use of herbs and traditional devices in the prevention of pregnancy.” | 11 | |
De Vera 2007 | “Five of the seven women admitted using some medicinal herbs and roots to stop pregnancy or stimulate menstruation.” | 243 | ||
Kiluvia 1991 | “Young men also knew few details of how traditional methods work, but they had heard about the traditional use of herbs and abstinence for birth spacing. [...] Among the most frequently mentioned methods were abstinence; “pigi” and “fungo,” in which a traditional healer ties twigs from a special tree or a “medicated” piece of cloth around a woman’s waist; herbal potions; and douching.” | 9 | ||
De Vera 2007 | Modernization | Family planning education | “The health center teaches the use of the modern methods of contraception such as pills and IUD.” | 244 |
Social & Rural Research Institute 2005 | Institutional infrastructure | “Institutional infrastructure provided to the populace has also played a decisive role in adoption of spacing methods.” | 4 | |
Dehne 2003 | Loss of culture | “Many changes have occurred in local customs. Today, the women do not abstain for as long as we used to do.” | 61 | |
Dean 1994 | “Other major factors thought to cause a decrease in child spacing were the loss of tradition generally, the loss of ratat and the loss of the post-partum abstinence period.” | 1581 | ||
Men stay at home more | “With the general degeneration of the traditional society the “men staying at home more” is likely to result in the decrease of the post-partum abstinence period.” | Fig. 8, page 1582 | ||
More food | “When asked specifically what women thought had caused the decrease in birth interval they gave several reasons over and above those relating to traditions, the most important of which was increase in food availability.” | 1578 | ||
More health services | “More health services [cause a decrease in child spacing].” | 1579 | ||
More hygiene | “More hygiene [causes a decrease in child spacing].” | Fig. 4, page 1579 | ||
Dehne 2003 | Religion | “In former times, couples waited for one to two year(s) before resuming sexual contacts. Now the waiting period is 2 months or even 40 days.[...] These changes have all occurred because of the increasing influence of religion. Many people listen to the Marabu now and attend Koranic schools.” | 60 & 61 | |
Dean 1994 | Other | Less drought | “Less drought [causes a decrease in child spacing].” | Fig. 4, page 1579 |
Less war | “Less war [causes a decrease in child spacing].” | |||
De Vera 2007 | Religion | Catholicism | “However, one mother stated that because of the religious saying, “children are gifts from God,” couples end up having many children because they do not have a choice but to accept them.” | 243 |
Adeokun 1982 | God’s will | “Chance or God’s will in the avoidance of an inconvenient pregnancy.” | 10 | |
Social & Rural Research Institute 2008 | Hinduism | “Religious prohibitions dictated by certain scriptures have led to believers not subscribing to spacing.” | 4 | |
Chad Ministry of Public Health 1992 | Religion | “Religion was also used as a reason by some men, in both Sarh and N’Djamena, for not practicing birth spacing because children were a gift from God.” | v |