Interpregnancy Intervals and Birth Spacing
Crystal D. Karakochuk, Kyly C. Whitfield, Tim J. Green, Klaus Kraemer in The Biology of the First 1,000 Days, 2017
Birth spacing is a modifiable risk factor and has the potential to greatly affect maternal and perinatal outcomes at the population level. Due in part to the WHO’s recommended birth-spacing intervals, some countries have integrated birth spacing into their maternal and reproductive health policy. For example, in India, the Ministry of Health and Family Welfare established a campaign called “Ek teen do” (one, three, two), including mass media messaging and health-worker incentives to encourage a spacing of 3 years between the first and second births [57]. In Vietnam, national guidelines dictate only two children, spaced 3 to 5 years apart, although this is not always followed at the population level [58]. However, overall, few countries have implemented birth-spacing programs or successfully addressed the unmet need for family planning services, which would include effective birth-spacing strategies [55]. Birth spacing has been recommended to be included as one of the key evidence-based interventions to address preconception care in order to decrease preventable maternal and infant deaths, and improve maternal and child nutrition [59]. Awareness of the importance of birth spacing by both health providers, women, and their families will be crucial to improving counseling and adoption of optimal birth-spacing practices.
The Cardio-Obstetric Team
Afshan B. Hameed, Diana S. Wolfe in Cardio-Obstetrics, 2020
A triad solution (Figure 2.3) including patient education, cardiovascular screening, and the multidisciplinary team has been proposed to address maternal mortality and morbidity associated with cardiovascular disease of pregnancy [7]. Preconception counseling for all women with known heart disease is recommended. Review of their reproductive goals and an understanding of their disease and potential physiologic cardiac changes in a future pregnancy is recommended [8,9]. A contraceptive plan is essential to optimize pregnancy planning and birth spacing [10]. This counseling can be done in a multidisciplinary setting whereby a cardiologist and MFM subspecialist can assess the patient's options together. The third aspect of the triad is a cardiovascular screening toolkit that has been proposed by the California Maternal Quality Care Collaborative based on a retrospective review of peripartum cardiomyopathy case deaths [11]. This screening tool is used to identify pregnant and postpartum patients at risk for cardiovascular disease who therefore need to be referred to the maternal cardiology team. It is well established that many symptoms of pregnancy overlap common symptoms of heart disease. The challenge of distinguishing between the two has been proposed in Table 6.1 of the Practice Bulletin on Pregnancy and Heart Disease, ACOG [12]; see Chapter 6 of this book.
Management of pregnancy with one or more early neonatal deaths
Minakshi Rohilla in Recurrent Pregnancy Loss and Adverse Natal Outcomes, 2020
Birth spacing should be carefully planned as both too short (less than 18 months) and too long (greater than 60 months) interpregnancy intervals are associated with adverse perinatal outcomes, especially small for gestational age (SGA) babies [27]. A birth interval of less than 18 months has been shown to be associated with increased odds of SGA, preterm, and mortality as compared to that of 36 to less than 60 months. A birth interval at the other end of the spectrum (more than 60 months) has also increased risk for an SGA baby [27, 28].
Community-based postpartum contraceptive counselling in rural Nepal: a mixed-methods evaluation
Published in Sexual and Reproductive Health Matters, 2020
Wan-Ju Wu, Aparna Tiwari, Nandini Choudhury, Indira Basnett, Rita Bhatt, David Citrin, Scott Halliday, Lal Kunwar, Duncan Maru, Isha Nirola, Sachit Pandey, Hari Jung Rayamazi, Sabitri Sapkota, Sita Saud, Aradhana Thapa, Alisa Goldberg, Sheela Maru
The World Health Organization (WHO) recommends 24 months of spacing between births, as shorter pregnancy intervals are associated with adverse maternal and child health outcomes.1–3 Despite the benefits of birth spacing, there continues to be significant unmet need for postpartum contraception worldwide.4 Access to modern contraceptive methods facilitates a woman’s ability to decide freely and for herself whether, when, and how many children she wants to have.5 Universal health coverage for women, girls, and adolescents, a cornerstone of the Sustainable Development Goals, requires the expansion of sexual and reproductive health services.6,7 Expanding access to postpartum contraception, especially in remote areas, will be one critical component towards this end.
Perception and intention to use reproductive life plan among female final year undergraduates of the University of Ibadan, Nigeria
Published in Journal of Obstetrics and Gynaecology, 2022
Mayowa Ayelotan, Ayodeji Matthew Adebayo, Folashade Omokhodion
Table 1 shows the distribution of respondents by perception regarding issues relating to RLP. About two third of the respondents (63.4%) had positive perception of RLP. Regarding planning of reproductive life and its importance, majority agreed that it is important to plan child birth (94.7%), space children (87.6%) and prevent unintended pregnancy (80.3%). However, only 136 (30.2%) agreed that pregnancy should be planned to delay motherhood, 101 (22.4%) agreed that use of RLP is only important to women who are trying to get pregnant and 191 (42.4%) agreed that use of RLP is important in planning to get pregnant. Majority, 432 (93.8%) agreed that regular exercise can lead to weight loss and 194 (43.0%) agreed that domestic chores is equivalent to regular exercise. Most of the respondents’ 440 (97.6%) agreed that eating healthy is important for healthy living, 400 (88.7%) agreed that smoking is bad for healthy living and 385 (85.4%) agreed that smoking can harm the unborn baby. Three hundred and fifteen (69.6%) felt a woman should have her first child between 21 and 25 years of age. Majority, 345 (76.5%) felt a minimum of 2 years should be allowed for birth spacing. Regarding whether respondents would like to become a mother one day, 388 (86.0%) reported they would want to become a mother, 28 (6.2%) were not sure and only 9 (2%) did not want to become a mother.
Rural-Urban Differences in Unintended Pregnancies, Contraceptive Nonuse, and Terminated Pregnancies in Latin America and the Caribbean
Published in Women's Reproductive Health, 2022
Living in rural areas, as compared to urban areas, is associated with 8% greater odds (1–odds ratio) of contraceptive nonuse, after controlling for geographic, socioeconomic, individual, and reproductive factors, but this association is not significant in the model (p > 0.05). Like the results for unintended pregnancies, reporting more wealth and living in a rural area is more protective (more risk reducing) for contraceptive nonuse, as compared to reporting less wealth and living in an urban area, but this association does not provide statistically significant protection against contraceptive nonuse in the model (p > 0.05). In general, younger respondents; those with four or more pregnancies that resulted in a birth; and with lower birth spacing have a higher risk of contraceptive nonuse. Respondents with more wealth; with more education; employed in managerial, clerical, sales, agricultural, domestic and other services, and manual labor; older in age; married/living together; and with living children have a lower risk of contraceptive nonuse.
Related Knowledge Centers
- Birth Control
- Uterine Rupture
- Miscarriage
- Abortion
- Caesarean Section
- Pre-Eclampsia
- Breastfeeding
- Extended Breastfeeding
- Lactational Amenorrhea
- Maternal Death