Short birth intervals (less than 12 months) between pregnancies increase risks for adverse maternal and child health outcomes like mortality, preterm birth, low birth weight, stunting, and underweight. Waiting at least 24 months between pregnancies could reduce child mortality under age 5 by 13% and waiting 36 months could reduce it by 25%. Breastfeeding is linked to delayed return of fertility through lactational amenorrhea. Early termination of breastfeeding due to a new pregnancy is associated with higher child mortality. Integrating family planning and breastfeeding support could help optimize the benefits of birth spacing on maternal, infant, and young child health and nutrition.

1. Maximizing Opportunities & Strategic
Repositioning PPFP into Maternal, Infant
and Young Child Nutrition Services--- Why
This Makes Sense
H o l ly B l a n c h a r d R H /F P S e n io r Ad v is o r
M C H IP
C O R E M ay 3 , 2 0 1 2

2. Short BTPI intervals increase risk for adverse
maternal, infant/child outcomes
 M o r t a l it y
 P r e t e r m b ir t h
 L o w b ir t h
w e ig h t in f a n t s
 S t u n t in g
 U n d e r w e ig h t
C o n d e Ag u d e l o 2 0 0 2 ; R u t s t e in
2 005 , © 2006 Tom Otieno/Afrishot 21, Courtesy of Photoshare
D e Va n z o 2 0 0 8

3. Rutstein SO. 2008. Further evidence of the effects of preceding birth intervals on
neonatal, infant, and under-five-years mortality and nutritional status in developing
countries: Evidence from the Demographic and Health Surveys. DHS Working Papers,
Demographic and Health Research (41).
 Effects of birth-to-pregnancy interval (BTPI)for
infant/child mortality
 52 DHS surveys from 2000-2005 (1,123,454 births)
 Risk of mortality is highest for very short intervals (<12 months
BTPI) but relatively few children conceived at such intervals
(14 %)
 But more BTPI 12-35 months (42% of total) and @ risk
 If all couples waited 24 months to conceive again, <5
CMR ↓ 13%
 If couples waited 36 months <5 CMR ↓ 25%
3

4. Birth to Pregnancy Intervals & Relative
Risk of Neonatal and Infant Mortality
Mortality Risk
4
3.5
3 Infant
2.5 Neonatal
Early Neonatal
2
1.5
1
0.5
0
<6 6 to 11 12 to 17 18 to 23 24 to 29 30 to 35 36 to 47 48 to 59
Source: Rutstein 2005 & 2008 Pregnancy Interval (months)
4

5. Child Malnutrition by Birth to Conception Interval
1.4 1.30
1.25
1.23
1.3
1.16 265,144 children
1.29
1.2 1.11
1.22 1.07
1.19
1.1 1.13 1.06
1.11
0.98
1
0.98 0.95
0.9
0.89 0.82
0.8
0.82
0.7
0.6 Stunted
Underweight
R
A
0.5
d
k
s
v
a
e
t
i
l
.
j
0.4
<6 6-11 12-17 18-23 24-29 30-35 36-47 48-59 60-95 96+
ref.
Interval in months
5

6. Becker S, Ahmed S, 2001. Dynamics of contraceptive use and breastfeeding
during the postpartum period in Peru and Indonesia. Population Studies (55): 165–
179.
Analysis of DHS data from Peru & Indonesia
 BF women < likely to have resumed sexual
intercourse in the early PP in both countries
than non-BF women
 FP uptake highest after resumption of menses
 10% subsequent pregnancies occurred before
menses
6

7. Jakobsen MS, et al. 2003. Termination of breastfeeding after 12 months of age
due to a new pregnancy and other causes is associated with increased mortality in
Guinea-Bissau. International Journal of Epidemiology; 32:92–96.
Assessment of BF and child health in Guinea-Bissau
 Mother’s reason for weaning & impact on child mortality
(N=1423 children who terminated BF after 12 months)
 62% weaned: ‘healthy’
 all other causes of weaning were associated with a higher
mortality ratio (MR) = 2.97
 237 children weaned due to a new pregnancy (MR = 3.25)
Weaning due to new pregnancy of the mother is
associated with highest mortality
7

8. Unique relationship
 L a c t a t io n a l  E x c l u s iv e
amen o rrh ea b r e a s t f e e d in g
 F e r t il it y r e t u r n  Co m p l e m e n t a r y
f e e d in g
 Ma t e r n a l  In f a n t h e a l t h &
n u t r it io n n u t r it io n
 S p a c in g
 In f a n t s u r v iv a l
 Ma t e r n a l 8
s u r v iv a l