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Impacts of Healthy Birth Spacing in Jordan Photo Credit: © Othman Al Othman © Credit: Photo The Impacts of Healthy Birth Spacing in Jordan Photo credit: © Othman Al May 2013 - Issa/Studio Robina Higher Population Council Presentation Outline Birth spacing and the Qur’an WHO recommendations and definition of intervals Benefits of healthy birth spacing Consequences of unhealthy birth spacing Relationship between birth intervals and health outcomes in Jordan Trends in birth spacing in Jordan Impacts of increasing birth intervals in Jordan Interventions to improve birth spacing in Jordan Birth Spacing and the Qur’an WHO Recommendations for Birth Spacing Recommendation for spacing after a live birth After a live birth, the recommended interval before attempting the next pregnancy is at least 24 months in order to reduce the risk of adverse maternal, perinatal, and infant outcomes. In simple terms, couples are encouraged to wait to attempt a new pregnancy until after the 2nd birthday of their last child. Recommendation for spacing after a miscarriage After a miscarriage, the recommended minimum time to wait to attempt another pregnancy is at least six months in order to reduce the risk of adverse maternal and perinatal outcomes. World Health Organization (WHO). 2006. Report of a Technical Consultation on Birth Spacing, Geneva June 13–15, 2005. Geneva: WHO, Department of Making Pregnancy Safer and Department of Reproductive Health and Research. Definitions Recommended Birth-to-Birth and Birth-to-Pregnancy Intervals Birth-to-Birth Interval Period between two live births Birth-to-Pregnancy Interval Period between a live birth and the next pregnancy 24 months 9 months A 24-month birth-to-pregnancy interval is the approximate equivalent of a 33-month birth-to-birth interval. Presentation Outline Birth spacing and the Qur’an WHO recommendations and definition of intervals Benefits of healthy birth spacing Consequences of unhealthy birth spacing Relationship between birth intervals and health outcomes in Jordan Trends in birth spacing in Jordan Impacts of increasing birth intervals in Jordan Interventions to improve birth spacing in Jordan Why is Birth Spacing Important? When pregnancies are too close together Newborns can be born too soon, too small, or with a low birth weight Infants and children may not grow well and are more likely to die before age five years old Mothers may die in childbirth Extending Service Delivery (ESD) Project. 2006. Healthy Timing and Spacing of Pregnancies, A Pocket Guide for Health Practitioners, Program Managers, and Community Leaders. Watertown, MA: Pathfinder International, USAID ESD Project. Who Benefits from Healthy Birth Spacing? Newborns, infants, and children under five years old Mothers Men Photocredit Communities : © Othman Al - Issa/Studio Robina Benefits to Newborns, Infants, and Children Under Age Five Reduces the risk of Pre-term births, low birth weight, small size for gestational age, and, in some populations, stunting or underweight conditions Death for newborns, infants, and children under age five Allows young children to experience the substantial health benefits of breastfeeding for longer periods Jaroudi Lamia 1995 © Extending Service Delivery (ESD) Project. 2006. Healthy Timing and Spacing of Pregnancies, A Pocket Guide for Health Practitioners, Program Managers, and Community Leaders. Watertown, MA: Pathfinder International, USAID ESD Project. Photocredit Benefits to Mothers Gives mothers more time to prepare physically, emotionally, and financially for their next pregnancy, if they choose to have one Helps mothers avoid pregnancy-induced high blood pressure and associated complications like preeclampsia, obstructed and prolonged labor, iron-deficiency anemia, and maternal death Provides mothers with enough time before becoming pregnant again to focus on their newborns, husbands, and other children Extending Service Delivery (ESD) Project. 2006. Healthy Timing and Spacing of Pregnancies, A Pocket Guide for Health Practitioners, Program Managers, and Community Leaders. Watertown, MA: Pathfinder International, USAID ESD Project. Benefits to Fathers Helps fathers safeguard the health and well-being of their wives and children Allows fathers time to plan financially and emotionally for their next child, if the couple chooses to have one Contributes to a father’s sense of satisfaction from supporting his wife in making decisions that are in the family’s best interests Nakkash Haider Extending Service Delivery (ESD) Project. 2006. Healthy Timing and Spacing of Pregnancies, A Pocket Guide for Health Practitioners, Program Managers, and Community Leaders. Watertown, MA: Pathfinder International, USAID ESD Project. Photocredit: Benefits to Communities Benefits communities because it reduces the incidence of death and illness among mothers, newborns, infants, and children In doing so, it can contribute to poverty reduction and improve a community’s quality of life Photo credit: Mohammad - Khawaja Extending Servive Delivery (ESD) Project. 2006. Healthy Timing and Spacing of Pregnancies, A Pocket Guide for Health Practitioners, Program Managers, and Community Leaders. Watertown, MA: Pathfinder International, USAID ESD Project. Presentation Outline Birth spacing and the Qur’an WHO recommendations and definition of intervals Benefits of healthy birth spacing Consequences of unhealthy birth spacing Relationship between birth intervals and health outcomes in Jordan Trends in birth spacing in Jordan Impacts of increasing birth intervals in Jordan Interventions to improve birth spacing in Jordan Impact of Unhealthy Birth Spacing on Children’s Lives Neonatal mortality Postneonatal mortality Under-five mortality Hayes Jennifer Photocredit: Impact on Neonatal Mortality Neonatal Mortality (Weeks 2–4) 3.5 3 2.5 2 1.5 1 0.5 Adjusted Odds Odds Adjusted Ratio 0 <15 15–20 21–26 27–32 33–38 39–44 45–56 57–68 69–104 105+ Interbirth Interval N = 17 p < .01 Rutstein, S. 2005. “Effects of Preceding Birth Intervals on Neonatal, Infant, and Under-five Years Mortality and Nutritional Status in Developing Countries: Evidence from the Demographic Health Surveys.” International Journal of Gynecology and Obstetrics 89: S7–S24. Impact on Postneonatal Mortality Postneonatal Mortality (Weeks 5–52) 3.5 3 2.5 2 1.5 1 0.5 Adjusted Odds Odds Adjusted Ratio 0 <15 15–20 21–26 27–32 33–38 39–44 45–56 57–68 69–104 105+ Interbirth Interval N = 17 p < .01 Rutstein, S. 2005. “Effects of Preceding Birth Intervals on Neonatal, Infant, and Under-five Years Mortality and Nutritional Status in Developing Countries: Evidence from the Demographic Health Surveys.” International Journal of Gynecology and Obstetrics 89: S7–S24. Impact on Mortality among Children Under Five Years Old Mortality among Children Under Five Years Old 3.5 3 2.5 2 1.5 1 0.5 Adjusted Relative Odds Ratio 0 <18 18–23 24–29 30–35 36–41 42–47 48–53 54–59 60+ Duration of Preceding Birth Interval (Months) Rutstein, S. 2005. “Effects of Preceding Birth Intervals on Neonatal, Infant, and Under-five Years Mortality and Nutritional Status in Developing Countries: Evidence from the Demographic Health Surveys.” International Journal of Gynecology and Obstetrics 89: S7–S24. Presentation Outline Birth spacing and the Qur’an WHO recommendations and definition of intervals Benefits of healthy birth spacing Consequences of unhealthy birth spacing Relationship between birth intervals and health outcomes in Jordan Trends in birth spacing in Jordan Impacts of increasing birth intervals in Jordan Interventions to improve birth spacing in Jordan Relationship between Birth Intervals and Health Outcomes in Jordan Neonatal mortality Photo credit: © Karen Kasmauski/Corbis Infant mortality Under-five mortality Relationship between Birth Spacing and Neonatal Mortality Mortality Rate by Length of Birth Interval 30 24 25 22 20 16 15 11 9 10 Deaths Deaths 1,000 per 5 0 <24 months 24–35 months 36–47 months 48–60 months >60 months Birth Interval Department of Statistics (Jordan) and ICF Macro. 2010. Jordan Population and Family Health Survey 2009. Calverton, MD: Department of Statistics and ICF Macro. Additional analysis provided by Dr. Ali Arbaji, USAID/Amman. Relationship between Birth Spacing and Infant Mortality Mortality Rate by Length of Birth Interval 40 35 35 000 , 1 30 28 24 25 19 20 15 11 Deathsper 10 5 0 <24 months 24–35 months 36–47 months 48–60 months >60 months Birth Interval Department of Statistics (Jordan) and ICF Macro. 2010. Jordan Population and Family Health Survey 2009. Calverton, MD: Department of Statistics and ICF Macro. Additional analysis provided by Dr. Ali Arbaji, USAID/Amman. Relationship between Birth Spacing and the Mortality of Children Under Five Years Old Mortality Rate by Length of Birth Interval 45 41 40 35 32 33 30 25 23 20 15 15 Deaths Deaths 1,000 per 10 5 0 <24 months 24–35 months 36–47 months 48–60 months >60 months Birth Interval Department of Statistics (Jordan) and ICF Macro. 2010. Jordan Population and Family Health Survey 2009. Calverton, MD: Department of Statistics and ICF Macro. Additional analysis provided by Dr. Ali Arbaji, USAID/Amman. Presentation Outline Birth spacing and the Qur’an WHO recommendations and definition of intervals Benefits of healthy birth spacing Consequences of unhealthy birth spacing Relationship between birth intervals and health outcomes in Jordan Trends in birth spacing in Jordan Impacts of increasing birth intervals in Jordan Interventions to improve birth spacing in Jordan Trends in Length of Birth Interval 60 49.8 50 44.3 41.1 41.9 40 37.4 33.5 33.2 32.7 31.3 29.3 29.1 30 26.2 24.9 26.3 20 18.8 10 Percentage of Births 0 < 24 mos. 24–35 mos. 36+ mos. Months Since Preceding Birth 1990 1997 2002 2007 2009 Department of Statistics (Jordan) and ICF Macro. 2010. Jordan Population and Family Health Survey 2009. Calverton, MD: Department of Statistics and ICF Macro. Trends in Median Birth Interval 35 31 31 30 30 26 24 irth 25 B 20 15 Months Since 10 Preceding 5 0 1990 1997 2002 2007 2009 Department of Statistics (Jordan) and ICF Macro. 2010. Jordan Population and Family Health Survey 2009.
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