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Abstract
Throughout sub-Saharan Africa, traditional birth spacing practices such as breastfeeding and postpartum abstinence are declining, leaving women at risk of very short birth intervals. An increase in contraceptive use may offset the decline in traditional birthspacing practices and maintain long birth intervals. The purpose of this study is to examine the role of contraception for spacing on the length of the birth interval and on women's fertility and reproductive preferences. We use Demographic and Health Survey (DHS) data from 1986 to 1994 in 13 sub-Saharan countries.
Surprisingly, we find that birth intervals to women who have used contraception for spacing are on average only three to four months longer than intervals to women who have never used contraception. This finding is especially worrisome since women who use contraception desire longer intervals than non-users and, therefore, women who use contraception for spacing, especially those who adopt traditional methods such as withdrawal or periodic abstinence, are more (rather than less) likely to have a mistimed birth. Substitution of contraception for breastfeeding and abstinence leads to a smaller difference in birth intervals between contraceptive users and non-users. When women substitute contraception for postpartum behavior, they trade natural protection from pregnancy for imperfect contraceptive protection.
Using the 1994 DHS calendar data for Zimbabwe to examine in more detail the dynamics of contraceptive use, we find that modern contraceptives are effective in months in which they are actually used. If more women were to use contraception beyond the period of postpartum amenorrhea, we would likely observe a substantial decline in mistimed births in Zimbabwe. We examine the broader impacts of contraception on the timing of births within a woman's reproductive lifetime and on her ideal and achieved family size. In most countries women who use contraception for spacing desire fewer births. Lower ideal family size may motivate women to adopt contraception for spacing, but it may also be a result of contraceptive use. Despite their lower ideal family size, women who use contraceptives for spacing do not have fewer children over their lifetimes than non-users.
