Scaling-up access to family planning may improve linear growth and child development in low and middle income countries.

<h4>Background</h4>A large literature has indicated a robust association between birth spacing and child survival, but evidence on the association of birth timing with physical growth in low and middle income countries (LMICs) remains limited.<h4>Methods and results</h4>Data...

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Main Authors: Günther Fink, Christopher R Sudfeld, Goodarz Danaei, Majid Ezzati, Wafaie W Fawzi
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2014-01-01
Series:PLoS ONE
Online Access:https://doi.org/10.1371/journal.pone.0102391
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Summary:<h4>Background</h4>A large literature has indicated a robust association between birth spacing and child survival, but evidence on the association of birth timing with physical growth in low and middle income countries (LMICs) remains limited.<h4>Methods and results</h4>Data from 153 cross-sectional Demographic and Health Surveys (DHS) across 61 LMICs conducted between 1990 and 2011 were combined to assess the association of birth timing with child stunting (height-for-age z-score <-2). A total of 623,789 children of birth order 1-5 contributed to the maternal age analysis, while the birth spacing dataset consisted of 584,226 children of birth order 2 and higher. Compared to 27-34 year old mothers, maternal age under 18 years was associated with a relative stunting risk of 1.35 (95% CI: 1.29-1.40) for firstborn children, whereas the relative risk was 1.24 (95% CI: 1.19-1.29) for mothers aged 18-19 years. The association of young maternal age with stunting was significantly greater for urban residents and those in the top 50% of household wealth. Birth intervals less than 12 months and 12-23 months had relative risks for stunting of 1.09 (95% CI: 1.06-1.12) and 1.06 (95% CI: 1.05-1.06) as compared to a 24-35 month inter-pregnancy interval, respectively. The strength of both teenage pregnancy and short birth interval associations showed substantial variation across WHO region. We estimate that 8.6% (6.9-10.3%) of stunted cases in the South Asian DHS sample would have been averted by jointly eliminating teen pregnancies and birth intervals less than 24 months, while only 3.6% (1.5-5.7%) of stunting cases would have prevented in the Middle East and North Africa sample.<h4>Conclusions</h4>Postponing the age of first birth and increasing inter-pregnancy intervals has the potential to significantly reduce the prevalence of stunting and improve child development in LMICs.
ISSN:1932-6203