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  • Title: Preceding birth intervals and child survival: searching for pathways of influence.
    Author: Boerma JT, Bicego GT.
    Journal: Stud Fam Plann; 1992; 23(4):243-56. PubMed ID: 1412597.
    Abstract:
    The importance of the length of preceding birth intervals for the survival chances of young children has been established, but the debate concerning the causal biomedical or behavioral mechanisms continues. This article uses data from 17 Demographic and Health Surveys to investigate the effect of birth intervals on child mortality: Anthropometry of children, recent morbidity of children, and use of health services are examined in addition to child survival data for children born in the five years before the survey. Various methodological approaches are used to investigate the relative importance of the postulated mechanisms linking birth intervals and child survival. Short preceding birth intervals are associated with increased mortality risks in the neonatal period and at 1-6 months of age, and, to a much lesser extent, at 7-23 months of age. The effects of short birth intervals on nutritional status are rather moderate, and there is a weak relationship with lower attendance at prenatal care services. No consistent relationship exists between the length of birth intervals and other health status or health-service utilization variables. The results indicate that prenatal mechanisms are more important than postnatal factors, such as sibling competition, in explaining the causal nature of the birth interval effect. Using data on births occurring 5 years prior to the survey and anthropometry from Demographic and Health Surveys (DHS), 1986-89, this study examined how birth intervals (24 months, 24-35 months, 35 months) may affect early childhood mortality. Discussion is provided on some possible mechanisms prenatally and postnatally to link birth intervals to child survival. A short review of relevant evidence from DHS data is given. Dependent variables include mortality (neonatal, 1-6 months, 7-23 months), anthropometry (stunting), morbidity (diarrhea prevalence), prenatal and delivery care, breast feeding, immunization, and medical treatment. Control variables were socioeconomic status (maternal education, urban/rural residence, household assets, and floor material of the house), biodemographic variables (sex, multiple birth status, maternal age, and duration of breast feeding), survival status of preceding birth, and use of maternity services. Statistical significance was determined by the Wald statistic. Results are reported for the pace of childbearing, the overlap of gestation and lactation, age specific patterns of mortality, previous child survivorship, breast-feeding duration, use of health services, and child health status (anthropometry, health service use, and breast-feeding initiation). It is suggested that postnatal factors are less important than prenatal factors. There is little support for a hypothesis about sibling competition and disease transmission, i.e., short birth intervals had only moderate effects on health status. Mothers with no education placed their infants at twice the risk for stunting and being underweight as mothers with at least a secondary education. Short birth intervals had little or no effect on diarrhea prevalence, child immunization, and medical/service use. The overlap of gestation and lactation in 6% of pregnancies occurred almost 2 times more often in birth intervals 24 months. Short birth intervals are associated with a higher risk of not having prenatal care in contrast to high birth intervals. Preceding child survival does not increase the effect of short intervals on mortality. Short birth intervals have a greater effect at 1-6 months than neonatally, and have the least effect at 7-24 months. In-depth country-specific analysis would contribute to a more complete understanding. Attention should also be paid to short intervals and lactation and sociocultural aspects.
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