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Preceding birth intervals and child survival: searching for pathways of influence
1Institute for Resource Development/Macro International, Columbia, MD 21045.
Insights
Short birth intervals increase young child mortality, particularly in the neonatal period. Prenatal factors, not sibling competition, are the primary drivers of this increased risk.
Area of Science:
- Demography
- Public Health
- Pediatrics
Background:
- The link between preceding birth intervals and child survival is known, but causal mechanisms remain debated.
- Investigating biomedical and behavioral factors is crucial for understanding child mortality risks.
- Previous research highlights the significance of birth spacing for infant and child health outcomes.
Purpose of the Study:
- To investigate the impact of birth intervals on child mortality using diverse data.
- To differentiate between prenatal and postnatal mechanisms influencing child survival.
- To analyze the relationship between birth intervals and child anthropometry, morbidity, and healthcare utilization.
Main Methods:
- Utilized data from 17 Demographic and Health Surveys (DHS).
- Examined child survival, anthropometry, morbidity, and health service use for children under five.
- Employed various methodological approaches to assess causal pathways.
Main Results:
- Short birth intervals significantly increase neonatal and early-infant mortality (1-6 months).
- A lesser, but notable, increase in mortality risk observed up to 23 months.
- Weak associations found with nutritional status and prenatal care attendance; no consistent links with other health variables.
Conclusions:
- Prenatal mechanisms are more influential than postnatal factors like sibling competition.
- Short birth intervals pose a significant risk to neonatal and young child survival.
- Understanding these mechanisms can inform public health interventions for child survival.
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.