Nausheen Sidrah, Bhura Maria, Hackett Kristy, Hussain Imtiaz, Shaikh Zainab, Rizvi Arjumand, Ansari Uzair, Canning David, Shah Iqbal, Soofi Sajid
Obstetrics & Genecology, Aga Khan University, Karachi, Pakistan.
Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan.
BMJ Open. 2021 Apr 26;11(4):e043786. doi: 10.1136/bmjopen-2020-043786.
Birth spacing is a critical pathway to improving reproductive health. WHO recommends a minimum of 33-month interval between two consecutive births to reduce maternal, perinatal, infant morbidity and mortality. Our study evaluated factors associated with short birth intervals (SBIs) of less than 33 months between two consecutive births, in Karachi, Pakistan.
We used data from a cross-sectional study among married women of reproductive age (MWRA) who had at least one live birth in the 6 years preceding the survey (N=2394). Information regarding their sociodemographic characteristics, reproductive history, fertility preferences, family planning history and a 6-year reproductive calendar were collected. To identify factors associated with SBIs, we fitted simple and multiple Cox proportional hazards models and computed HRs with their 95% CIs.
The median birth interval was 25 months (IQR: 14-39 months), with 22.9% (833) of births occurring within 33 months of the index birth. Women's increasing age (25-30 years (aHR 0.63 (0.53 to 0.75), 30+ years (aHR 0.29, 95% CI 0.22 to 0.39) compared with 20-24 years; secondary education (aHR 0.75, 95% CI 0.63 to 0.88), intermediate education (aHR 0.62, 95% CI 0.48 to 0.80), higher education (aHR 0.69, 95% CI 0.51 to 0.92) compared with no education, and a male child of the index birth (aHR 0.81, 95% CI 0.70 to 0.94) reduced the likelihood of SBIs. Women's younger age <20 years (aHR 1.24, 95% CI 1.05 to 1.24) compared with 20-24 years, and those who did not use contraception within 9 months of the index birth had a higher likelihood for SBIs for succeeding birth compared with those who used contraception (aHR 2.23, 95% CI 1.93 to 2.58).
Study shows that birth intervals in the study population are lower than the national average. To optimise birth intervals, programmes should target child spacing strategies and counsel MWRA on the benefits of optimal birth spacing, family planning services and contraceptive utilisation.
生育间隔是改善生殖健康的关键途径。世界卫生组织建议两次连续分娩之间至少间隔33个月，以降低孕产妇、围产期、婴儿的发病率和死亡率。我们的研究评估了巴基斯坦卡拉奇两次连续分娩间隔小于33个月的短生育间隔（SBI）相关因素。
我们使用了一项横断面研究的数据，该研究对象为在调查前6年至少有一次活产的育龄已婚妇女（MWRA）（N = 2394）。收集了她们的社会人口学特征、生育史、生育偏好、计划生育史以及6年生育日历等信息。为了确定与短生育间隔相关的因素，我们拟合了简单和多元Cox比例风险模型，并计算了风险比（HR）及其95%置信区间（CI）。
中位生育间隔为25个月（四分位间距：14 - 39个月），22.9%（833例）的分娩发生在本次分娩后的33个月内。与20 - 24岁相比，女性年龄增加（25 - 30岁（调整后风险比[aHR]为0.63（0.53至0.75），30岁及以上（aHR为0.29，95%CI为0.22至0.39））、接受中等教育（aHR为0.75，95%CI为0.63至0.88）、接受高中教育（aHR为0.62，95%CI为0.48至0.80）、接受高等教育（aHR为0.69，95%CI为0.51至0.92）以及本次分娩为男孩（aHR为0.81，95%CI为0.70至0.94）会降低短生育间隔的可能性。与20 - 24岁相比，年龄小于20岁的女性（aHR为1.24，95%CI为1.05至1.24）以及在本次分娩后9个月内未使用避孕措施的女性，与使用避孕措施的女性相比，下次分娩出现短生育间隔的可能性更高（aHR为2.23，95%CI为1.93至2.58）。
研究表明，研究人群中的生育间隔低于全国平均水平。为了优化生育间隔，项目应针对生育间隔策略，并向育龄已婚妇女宣传最佳生育间隔、计划生育服务和避孕措施使用的益处。
