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Abstract
This dissertation investigates the relationships between birth spacing and perinatal health in Hungary, Sweden and the United States using data from the 1973 World Health Organization Study of Perinatal Mortality and the 1980 U.S. National Natality and National Fetal Mortality Surveys. Three hypotheses are proposed to explain the higher than average health risks associated with infants born shortly after the preceding birth--confounding by prematurity, maternal depletion, and selection.
The results obtained here suggest that all three forces contribute to the association between short birth intervals and poor perinatal health. The predominant influence is that of prematurity, which is responsible for roughly three-quarters of the excess perinatal mortality among infants conceived within 3 to 6 months of the preceding birth. This finding underscores the need for accurate measurement and reporting of gestation length and conception interval.
Although there is considerable overlap between the characteristics of women who have short conception intervals and those with high risks of suboptimal perinatal health, selection of high-risk women into patterns of short birth spacing does not account for the excess low birth weight and mortality among fetuses conceived shortly after the preceding birth. Finally, there is indirect evidence of maternal depletion in both Hungary and Sweden, since infants born within 12 to 18 months of the preceding birth have higher mortality and lower birth weight than infants born two to five years of that birth.
These results suggest that elimination of closely spaced conceptions could effect as much as a 5 to 10% reduction in the prevalence of low birth weight and neonatal mortality. In conjunction with the findings of other studies pertaining to the repercussions of short birth spacing on post-neonatal health and the health consequences of other aspects of reproductive patterns, these results suggest that a generalized policy aimed at improving access to family planning is a worthwhile strategy for improving infant health. Particularly if family planning services were coordinated with other health services for women and children, programs directed at affecting the timing and spacing of births could be expected to have significant effects on infant mortality and morbidity.
