Volume 33, Issue 123 (April 2020)                   IJN 2020, 33(123): 35-46 | Back to browse issues page

XML Persian Abstract Print

1- Demography, Department of Sociology and Social Planning, Shiraz University, Shiraz, Iran
2- Social Work, Department of Sociology and Social Planning, Shiraz University, Shiraz, Iran
3- Department of Statistics, Vice Chancellor of Health, Shiraz University of Medical Sciences, Shiraz, Iran (Corresponding author) Tel: 09171209934 Email: afshan.javadi@gmail.com
Abstract:   (2721 Views)
Background & Aims: Proper intervals between births have been emphasized as a factor to guarantee the health of the mother and infant. Therefore, reproductive health programs are essential to achieving this important goal. Birth intervals are an effort to maintain a certain interval between births, which is explicitly defined relative to the newborn. Closely birth intervals are referred to as rapid repeated pregnancy in the public health and medical literature and increase the risk of various disorders in the mother and infant. The current literature in this regard indicates that more than 54 million women suffer from health problems during pregnancy and delivery each year, and approximately 1.5 million die, 99% of which occur in developing countries. Since the time and interval of subsequent births are the main determinants of fertility, fertility researchers have widely investigated these factors. In addition, evidence suggests that short intervals between births cause numerous adverse consequences in childhood and adulthood. The present study aimed to investigate the birth intervals and its determinants in the rural women of Fars province, Iran. In general, we sought to identify the vulnerable groups of women that need special attention in health and reproductive health programs, so that the general health of mothers and infants would be promoted in the community.
Materials & Methods: This cross-sectional, analytical study was conducted using a researcher-made questionnaire on 882 married women aged 15-49 years with two or more children living in the rural areas of Fars province. The survey was performed using cluster sampling in October 2015. The independent variables included age, age of the spouse, year of marriage, ethnicity, religion, education level, and occupation status. In addition, the birth year of each child was recorded by asking the women, and birth interval was the dependent variable. Based on the fertility level of the women, the intervals between the first and second births, as well as the second and third births, were also considered and emphasized. Data analysis was performed in SPSS version 16 using frequency tables and multiple regression analysis at the significance level of 0.05.
Results: The mean age of the participants was 35.29±6.25 years, and the mean age of the spouses was 40.31±6.89 years. The mean age of the women in the first marriage was 19.56±3.95 years. The majority of the respondents were Persians and Shiites, and the majority of the women (53.6%) had two children. Furthermore, 4% of the rural women had academic education or higher educational degrees than diploma, and this rate was estimated at 5.6% for men. The findings also indicated that the largest proportion of the rural women and their spouses had secondary education or lower. In terms of occupation status, 3.3% of the rural women and 94.9% of the spouses were employed. In addition, approximately 83.6% of the rural households earned less than 10 million Rials, and 0.9% earned more than 25,000,000 million Rials per month. According to the results, 31.8% of the women with two children gave birth to their second child less than three years after the birth of the first child. This rate was estimated at 52%, 65.7%, and 80% for the women with three, four, and five children, respectively. The interval between the second and third birth for 25.3%, 50.5%, and 78.8% of the women with three, four, and five children was less than three years, respectively. On the other hand, all the women with four children gave birth to their fourth child less than three years after their last child. The multivariate analysis of the data indicated that ethnicity (P=0.023) and religion (P=0.002) had a significant effect on the birth interval between the first and second births, and the average birth interval in the Persian and Shiite women was higher than the women of other ethnicities and Sunni women. Notably, ethnicity (P=0.001) and religion (P=0.027) were the only significant variables to affect the interval between the birth of the second and third children of the rural women in Fars province.
Conclusion: According to the results, demographic and socioeconomic characteristics had relatively similar effects on the birth interval between the first and third children, while the explanatory power of these factors increased relatively with the interval between the second and third births. In other words, the interval between the first and third childbirths in the rural women was relatively the same, and no significant differences were observed in terms of the socioeconomic characteristics of the women. Ethnicity and religion also had significant effects on the birth interval, which could be associated with the socioeconomic status of the rural women. It seems that the employed women had to increase their birth intervals due to the combination of childbirth and occupation. Nevertheless, no significant correlation was denoted between the occupation status of the women and birth intervals, while our findings indicated that the employed women were more likely to give birth to their second child within an increased interval from the first birth compared to the unemployed women, while it was the opposite in the case of the interval between the second and third births. Previous studies have indicated that the education level of women is a significant influential factor in birth intervals, while no such significant correlation was observed in this study. Furthermore, it could be inferred that the Sunni and non-Persian women needed more attention as a vulnerable population, and they should be properly trained on the importance of adequate birth intervals. These women also need more attention to raise their awareness regarding adequate birth intervals. By adopting and implementing the necessary training courses in vulnerable women, the issues associated with birth intervals could reduce, which in turn promotes the general health of these women and their infants.
Full-Text [PDF 898 kb]   (879 Downloads)    
Type of Study: Research | Subject: nursing
Received: 2020/01/11 | Accepted: 2020/04/13 | Published: 2020/04/13

1. Hayford SR, Agadjanian V. Spacing, stopping, or postponing? Fertility desires in a sub-Saharan setting. Demography. 2019;56(2):573-94. [DOI:10.1007/s13524-018-0754-8] [PMID] [PMCID]
2. Rendall MS, Harrison EY, Caudillo ML. Intentionally or Ambivalently Risking a Short Interpregnancy Interval: Reproductive-Readiness Factors in Women's Postpartum Non-Use of Contraception. Demography. 2020 24:1-21. [DOI:10.1007/s13524-020-00859-7] [PMID]
3. Barclay KJ, Kolk M. The long-term cognitive and socioeconomic consequences of birth intervals: A within-family sibling comparison using Swedish register data. Demography. 2017;54(2):459-84. [DOI:10.1007/s13524-017-0550-x] [PMID] [PMCID]
4. Barclay KJ, Kolk M. Birth intervals and health in adulthood: a comparison of siblings using Swedish register data. Demography. 2018;55(3):929-55. [DOI:10.1007/s13524-018-0673-8] [PMID] [PMCID]
5. Miller R, Karra M. Birth Spacing and Child Health Trajectories. Population and Development Review. 2020;46(2):347-71. [DOI:10.1111/padr.12335]
6. Shakya S, Pokharel PK, Yadav BK. Study on birth spacing and its determinants among women of Kirtipur Municipality of Kathmandu District. Int J Nurs Educ. 2011;3(1):56-60.
7. Timæus IM, Moultrie TA. Pathways to Low Fertility: 50 Years of Limitation, Curtailment, and Postponement of Childbearing. Demography. 2020;57(1):267-96. [DOI:10.1007/s13524-019-00848-5] [PMID] [PMCID]
8. DaVanzo J, Razzaque A, Rahman M, Hale L, Ahmed K, Khan MA, Mustafa G, Gausia K. The effects of birth spacing on infant and child mortality, pregnancy outcomes, and maternal morbidity and mortality in Matlab, Bangladesh. Technical Consultation and Review of the Scientific Evidence for Birth Spacing. 2004. [DOI:10.1016/j.ijgo.2005.01.003]
9. Miller JE, Trussell J, Pebley AR, Vaughan B. Birth spacing and child mortality in Bangladesh and the Philippines. Demography. 1992;29(2):305-18. [DOI:10.2307/2061733] [PMID]
10. Jehanfar M, Jenanfar S. Population and Family planning, fertility health, a step for development. Tehran, Cultural World publication. 2004:94-5.
11. Walsh T, Ronal D, Hopkins J. Population information program, WHO, USAID. The essential of contraceptive technology. A hand book for clinic staff. 2001:1-2.
12. Molitoris J, Barclay K, Kolk M. When and where birth spacing matters for child survival: an international comparison using the DHS. Demography. 2019;56(4):1349-70. [DOI:10.1007/s13524-019-00798-y] [PMID] [PMCID]
13. Omidi A, SalmanI BN, Bagharpush M. A Surveyon Relationship between Birth Spacing in Children Under 5years Their Physical Growth in Reference to Medical and Health Centers in Karaj City. The Journal Of Urmia University Of Medical Scinces. 2002;12(4): 296-305.
14. Forste R. The effects of breastfeeding and birth spacing on infant and child mortality in Bolivia. Population Studies. 1994;48(3):497-511. [DOI:10.1080/0032472031000147996]
15. DaVanzo J, Hale L, Razzaque A, Rahman M. The effects of pregnancy spacing on infant and child mortality in Matlab, Bangladesh: how they vary by the type of pregnancy outcome that began the interval. Popul stud. 2008;62(2):131-54. [DOI:10.1080/00324720802022089] [PMID]
16. Potter JE. Birth spacing and child survival: A cautionary note regarding the evidence from the WFS. Popul Stud. 1988;42(3):443-50. [DOI:10.1080/0032472031000143576]
17. Molitoris J. The Effect of Birth Spacing on Child Mortality in Sweden, 1878-1926. Popul Develop Rev. 2017:61-82. [DOI:10.1111/padr.12050]
18. Rosos BA, Kafury GA. Birth spacing and risk of adverse perinatal outcomes. JAMA. 2006;31(3):245-8.
19. Da Vanzo J, Starbird EH. Correlates of short interbirth intervals in peninsular Malaysia: Their pathways of influence through breastfeeding and contraceptive use. Stud family plan. 1991;22(4):241-54. [DOI:10.2307/1966480]
20. Rutstein SO. Trends in birth spacing. DHS comparative reports no 28. ICF Macro, Calverton, Maryland, USA. 2011.
21. Boerma JT, Bicego GT. Preceding birth intervals and child survival: searching for pathways of influence. Stud Family Plan. 1992;23(4):243-56. [DOI:10.2307/1966886]
22. Zanjani H, Shadpor K. Population, development and fertility heath. 10th ed, Tehran, Boshra publication. 2006;128-32.
23. Baschier A, Hinde A. Determinants of fertility and birth interval in Egypt. Demogr Res. 2000;16(3):54-70.
24. Rasheed P, Al Dabal BK. Birth interval: perceptions and practices among urban-based Saudi Arabian women. EMHJ-Eastern Mediterranean Health Journal. 2007;13(4): 881-92.
25. Hajian K, Asnafi N, Aliakbarnia-Omran F. Birth intervals and associated factors in multi-Para Women. Journal of Mazandaran University of Medical Sciences. 2008;18(66):63-70.
26. Mansoorian MK. Determinants of birth interval dynamics in Kohgylooye and Bovairahmad province, Iran. J Compar Fam Stud. 2008;39(2):165-85. [DOI:10.3138/jcfs.39.2.165]
27. Yohannes S, Wondafrash M, Abera M, Girma E. Duration and determinants of birth interval among women of child bearing age in Southern Ethiopia. BMC pregnancy and childbirth. 2011;11(1):38. [DOI:10.1186/1471-2393-11-38] [PMID] [PMCID]
28. Gough M. Birth spacing, human capital, and the motherhood penalty at midlife in the United States. Demographic Research. 2017;37:363-416. [DOI:10.4054/DemRes.2017.37.13]
29. Tsegaye D, Shuremu M, Bidira K. Practice of child spacing and its associated factors among women of child bearing age (15 to 49 years) in Illubabor zone, South West Ethiopia. Int J Nurs Mid. 2017;9(7):102-8. [DOI:10.5897/IJNM2017.0258]
30. Murphy M, Wang D. Do previous birth interval and mother's education influence infant survival? A Bayesian model averaging analysis of Chinese data. Population studies. 2001;55(1):37-47. [DOI:10.1080/00324720127679]
31. Gribble JN. Birth intervals, gestational age, and low birth weight: are the relationships confounded?. Population Studies. 1993;47(1):133-46. [DOI:10.1080/0032472031000146776]
32. Marini MM, Hodsdon PJ. Effects of the timing of marriage and first birth of the spacing of subsequent births. Demography. 1981;18(4):529-48. [DOI:10.2307/2060946]
33. Rabbi AM, Karmaker SC, Mallick SA, Sharmin S. Determinants of birth spacing and effect of birth spacing on fertility in Bangladesh. Dhaka University Journal of Science. 2013;61(1):105-10. [DOI:10.3329/dujs.v61i1.15105]
34. Karimi Y. Attitudes and Attitude Change. Tehran: Arasbaran Publication. 2000.
35. Ministry of Health and Medical Education. Demographic and health survey in Islamic Republic of Iran. Tehran: Sonaobar Publication; 2000.

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.