Birth Spacing and Child Health Trajectories

Birth spacing, or the length of time women wait after giving birth before becoming pregnant again, has important implications for both maternal and child health. In particular, birth intervals markedly shorter or longer than the recommended minimum of three years are associated with increased risk of maternal and child mortality and morbidity. Most of the literature on the effects of birth spacing has focused on birth and early life outcomes, while there is little evidence of how birth spacing impacts longer-term morbidity and the evolution of child health.

In a journal article published in Population and Development Review, HCI Associate Director Mahesh Karra and Ray Miller document the association between preceding birth interval and child growth trajectories. They draw on longitudinal data collected on a cohort of over 4,000 children and their siblings in Ethiopia, India, Vietnam and Peru between 2002 and 2016, concentrating on height as their primary child health outcome.

Main Findings:

• At age one, short spacing (less than three years) was significantly associated with decreased height, even after controlling for confounding variables. However, there was also evidence of catch-up growth for closely spaced children.
• In contrast to results for short spacing, very widely spaced children (more than seven years) did not significantly differ in height from children spaced three to seven years at age one. However, very widely spaced children outgrew their more closely spaced counterparts over childhood.
• For closely spaced males, the estimated negative effects of short birth spacing are quantitatively and statistically negated by age eight. In contrast, the magnitude and significance of the impact of short birth spacing persists through age 15 for closely spaced females.

The study results suggest interventions aimed at increasing birth intervals and supporting the healthy timing and spacing of pregnancies may be particularly important in promoting early childhood health and development. Karra and Miller encourage further investigations into the mechanisms through which birth spacing contributes to health, noting that more research is essential for the development of effective policies, programs and interventions that seek to promote healthy growth and development in children from conception through adolescence and into adulthood.