Reproductive Health

Birth Spacing

After a live birth, women or their partners use a modern contraceptive method to avoid pregnancy for at least 24 months

Using a modern contraceptive method to space pregnancies at least 24 months apart could reduce maternal mortality by up to 40%1Strategies for reducing maternal mortality: getting on with what works
Lancet. 2006 Oct 7; 368(9543):1284-99
Campbell OM, Graham WJ, Lancet Maternal Survival Series steering group
October 7, 2006
  and child mortality by 26%.2Rutstein and Winter, 2014  This is a preventive behavior that can be successfully carried out using a number of different modern contraceptive methods.

Key Points from Global Research

  • Involving partners, family members, religious and community leaders in the dialogue around birth spacing can ensure understanding and support to contraceptive users.
  • Improving quality, respectful care and provider assistance on birth spacing issues can increase the confidence of users and the likelihood that they will start and continue to use modern contraceptives.
  • Maintaining easy and continual access can encourage women and their partners to start and continue to use modern contraceptives for birth spacing.

Behavior Profile Sample: Birth Spacing

A Behavior Profile is a summary analysis of each behavior. This sample draws from global evidence and illustrates the result of using the Create Behavior Profiles Tool to analyze factors, supporting actors and strategies and to ensure logical pathways exist between strategies proposed and factors related to the practice of the behavior. This sample may be used as a starting point or reference for creating country-specific Behavior Profiles.

CREATE Country-specific Behavior Profiles

Improve maternal and child survival
After a live birth, women or their partners use a modern contraceptive method to avoid pregnancy for at least 24 months
Percentage of currently married or in union women using family planning for spacing

Behavior Analysis

Strategy

STEPS

What steps are needed to practice this behavior?
  1. Obtain family planning counseling from a qualified provider
  2. Select appropriate modern contraceptive method
  3. Obtain chosen method
  4. Use chosen method as instructed

Click on any box
        to see the pathwaysA pathway illustrates how elements in the Behavior Profile are linked. When read from right to left, a pathway highlights how strategies are expected to address the factors to enable adoption of the Accelerator Behavior.  
        of the behavior.

FACTORS

What factors may prevent or support practice of this behavior? These should be analyzed for each country context.
Structural
Accessibility: Commodity supply is irregular or sporadic, especially for certain methods
Service Provider Competencies: Some providers do not emphasize the importance of birth spacing in discussing family planning
Service Provider Competencies: Providers are sometimes rude, judgemental or do not maintain confidentiality
Social
Norms: Large families are often the norm and the risks of children spaced closely together are not well-understood or accepted
Family and Community Support: Community and religious leaders often resist family planning on moral grounds, though less-so the notion of birth spacing
Gender: Men often see large families or a frequently pregnant partner as sign of virility and strength
Internal
Attitudes and Beliefs : Many women and men fear side effects of contraception
Knowledge: Couples do not always understand benefits of birth spacing for their families

SUPPORTING ACTORS AND ACTIONS

Who must support the practice of this behavior?
Institutional
Logistics Personnel: Plan and manage contraceptive supplies to ensure consistent supply of stocked commodities
Providers: Offer respectful care and comprehensive counseling on the benefits of birth spacing and other specific birth spacing messages
Community
Community Leaders: Publicly support birth spacing and seek out spaces to discuss with men and women both on the importance of healthy birth spacing
Household
Male Partners: Actively support wives to select and implement appropriate birth spacing method

POSSIBLE PROGRAM STRATEGIES

How might we focus our efforts based on this analysis?
Enabling Environment
Partnerships and Networks: Extend commodity supply outlets via social franchising or community based distribution networks
Partnerships and Networks: Use community and faith-based organizations, including places of worship, to share and discuss birth spacing
Systems, Products and Services
Supply Chain: Enhance use of Logistics Management Information Systems to better estimate contraceptive needs
Quality Improvement: Expand birth spacing entry points into Integrated Management of Childhood Illness clinics, postnatal care, etc.
Quality Improvement: Integrate specific birth spacing messages and communication skills into pre-service health worker curricula
Demand and Use
Advocacy : Develop birth spacing and Family Planning Advocacy Toolkit to garner support from different levels of leadership
Communication: Use community open forums (with materials produced above) to discuss birth spacing services
Communication: Produce and disseminate birth spacing materials to families that position birth spacing as the healthiest option for a family

Global Status of Accelerator Behavior

Percentage of currently married or in union women using family planning for spacing

The DHS Program Indicator Data API, The Demographic and Health Surveys (DHS) Program

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