Short birth intervals don't kill women: evidence from Matlab, Bangladesh

Abstract

No previously published study has provided evidence to support the frequently made assertion that closely spaced births increase the risk of maternal death. This study reviews the literature for evidence supporting an association between short birth intervals and maternal mortality and presents empirical evidence to address the question of whether short birth-to-conception intervals alter the risk of maternal death. In this nested case-controls study selected from a cohort of women under demographic surveillance in Matlab, Bangladesh, the length of the preceding birth-to-conception interval is found not to affect the risk of maternal mortality. These results do not support the claim that births that are too close increase the risk of maternal death.

PIP: Although it is frequently stated as if fact that short birth intervals increase the risk of maternal mortality, a search of the literature reveals no empirical confirmation of such an association. A nested case-control study conducted in Matlab, Bangladesh, addressed this issue. All maternal deaths occurring in the study area from 1982-93 (n = 390) were included; 3 controls per case (n = 1169) were randomly selected from a list of all pregnancies during the study period. 118 cases (30.3%) and 231 controls (19.8%) were primigravidae. Birth-to-conception intervals of less than 9 months and 9-14 months (corresponding to birth-to-birth intervals of less than 18 months and 18-23 months, respectively--the measures most commonly used in the literature to represent short intervals) were nearly identical between cases and controls and were not associated with an increased maternal mortality risk. Primigravidity and the extreme ends of maternal age (15-19 years and 30 years and older) were the only significant risk factors for maternal death. Although these findings suggest that promotion of a sufficiently long birth interval is unlikely to reduce maternal mortality, this strategy should not be abandoned because of the beneficial impact on infant and child health