Exploring hot spots of short birth intervals and associated factors using a nationally representative survey in Bangladesh

Abstract

Short Birth Interval (SBI, defined as < 33 months interval between the two most recent births or < 24 months between one live birth to the next pregnancy) is a public health problem in most low- and lower-middle-income countries. Understanding geographic variations in SBI, particularly SBI hot spots and associated factors, may help intervene with tailored programs. This study identified the geographical hot spots of SBI in Bangladesh and the factors associated with them. We analyzed women’s data extracted from the 2017/18 Bangladesh Demographic and Health Survey and the healthcare facility data extracted from the 2017 Service Provision Assessment. SBI was the outcome variable, and it was defined as an interval between consecutive births of 33 months or less, as recommended by the World Health Organization. The characteristics of mothers and their partners were the explanatory variables. Moran’s I was used to examine the spatial variation of SBI in Bangladesh whereas the Getis-Ord $${G}_{i}^{*}$$ G i ∗ (d) was used to determine the hot spots of SBI. The Geographical Weighted Regression (GWR) was used to assess the predictors of SBI at the enumeration areas’ level. The variables included in the GWR were selected using the exploratory regression and ordinary least square regression model. Data of 5941 women were included in the analyses. Around 26% of the total births in Bangladesh had occurred in short intervals. A majority of the SBI hot spots were found in the Sylhet division, and almost all SBI cold spots were in the Rajshahi and Khulna divisions. No engagement with formal income-generating activities, high maternal parity, and history of experiencing the death of a child were significantly associated with SBI in the Sylhet division. Women’s age of 34 years or less at the first birth was a protective factor of SBI in the Rajshahi and Khulna divisions. The prevalence of SBI in Bangladesh is highly clustered in the Sylhet division. We recommend introducing tailored reproductive health care services in the hot spots instead of the existing uniform approach across the country.

Association between maternal high-risk fertility behaviour and perinatal mortality in Bangladesh: evidence from the Demographic and Health Survey

“…Improving the uptake of maternal and postnatal healthcare services are also key to the prevention of neonatal and infant mortality. Access to family planning services and use of contraception, including access to contraception at the post-partum period, should also be ensured, particularly among the disadvantaged and unaware population where occurrence of birth in short interval is very higher 16,42 . Existing health problems, including maternal undernutrition and anaemia, are required to be addressed properly.…”

“…<18 years) or later (>34 years) in the reproductive life course, pregnancies of a shorter interval (<24 months) and higher parity (i.e., more than two children) are common in LMICs 14 . In Bangladesh, the prevalence of early pregnancy (43%), short pregnancy interval (26%), higher parity (24%) are very high in Bangladesh and a significant proportion of pregnancies occur among women with more than one of these specific high risk behaviours [15][16][17] . These independent higher-risk fertility behaviour components have been found to interact with each other and adversely affect several maternal health outcomes, including chronic undernutrition and pregnancy complications, which is a risk factor for increased obstetric and newborn complications 14,[18][19][20][21] .…”

Effects of short birth interval on different forms of child mortality in Bangladesh: Application of propensity score matching technique with inverse probability of treatment weighting

“…This linkage may arise in direct and indirect ways: (i) women having these characteristics, such as early marriage, prefer births in short intervals, and (ii) short interval births increase adverse outcomes, such as pregnancy complications and maternal and under-five nutrition. The associations are mediated by other factors, including the disadvantaged socioeconomic conditions of the mothers, previous child survival status, and the distance from home to nearby clinics [12][13][14]. These linkages indicate a potential association between SBI and under-five mortality.…”

“…Consequently, respondents' options to get healthcare knowledge and contraception accessibility, which is an important determinant of short birth intervals, have been narrowed over the years [9]. This influences the socio-demographic disadvantaged women mostly, among which births in short interval are highly prevalent [14,15,16,68].…”

Suboptimal birth spacing practice and its predictors among reproductive-age women in Sub-Saharan African countries: a multilevel mixed-effects modeling with robust Poisson regression

“…Previous studies in different settings have reported a varying level of suboptimal birth spacing practice among reproductive-age women. Studies based on single-country data revealed that 23%, 26%, 47%, 49%, and 50% of reproductive-age women in Pakistan [ 12 ], Bangladesh [ 13 ], Ethiopia [ 14 ], Ghana [ 15 ], and rural India [ 16 ] respectively had experienced shorter birth interval. Furthermore, a secondary analysis of demographic and health survey (DHS) data showed that the prevalence of suboptimal birth spacing was 59% in ten high-fertility African countries [ 17 ] and 56% in thirteen Sub-Saharan African (SSA) countries [ 18 ].…”