Levels and correlates of non-adherence to the WHO’s recommended inter-birth interval lengths among childbearing-aged multiparous women in Rufiji,Tanzania

Amon Exavery, Ifakara Health Institute (IHI)
Sigilbet Mrema, Ifakara Health Institute (IHI)
Amri Shamte, Ifakara Health Institute (IHI)
Kristin Bietsch, Princeton University
Godfrey Mbaruku, Ifakara Health Institute (IHI)
Honorati Masanja, Ifakara Health Research and Development Centre

Poorly spaced pregnancies have been documented worldwide to result into unpleasant maternal and child health outcomes. The WHO recommends an interval length of at least 33 months between two live births in order to reduce the risk of adverse maternal and child health outcomes. Recent statistics shows that Tanzania still experiences higher rates of maternal and neonatal mortality of 454 deaths per 100,000 live births and 26 deaths per 1,000 live births respectively. This substantiates the need to describe levels of inter-birth intervals and assess their correlates in order to unveil possible circumstances leading into inappropriate spacing (if any) which if acted upon may also impact both the mortality and fertility. We analyzed longitudinal data from Rufiji Health and Demographic Surveillance System (HDSS) collected from 1999 to 2010. Median inter-birth intervals were calculated and presented by woman’s background characteristics. Multivariate analysis was conducted using logistic regression with the binary outcome variable having two categories as adherence (inter-birth interval ≥33 months) or non-adherence (inter-birth interval <33 months). A total of 15,373 inter-birth intervals were recorded from 8,979 women aged 15-49 years. Overall median inter-birth interval length was 33.4 months. Of these intervals, 48.4% were below the WHO’s recommended length of ≥33 months between two live births for better maternal and child health outcomes. Non-adherence correlates were parity, multiple births, maternal age, maternal education, marital status and place of delivery. In general, one in every two inter-birth intervals in Rufiji district is poorly spaced. Community and health facility-based optimum birth spacing education is urgently required for better health outcomes of our mothers and children.