Health impacts of family planning

Among the many effects of family planning is the influence it has on mortality and morbidity in women and children through the mechanism of changing the number and spacing of children. There is a complex set of relationships between mother's age, parity, birth spacing and infant and child mortality and morbidity. Much effort has been put into untangling this web in the hope of identifying clear causal connections, but for the most part on the basis of inadequate data. Rather than attempt to establish the relative importance of child spacing as a cause of decreases in mortality, this paper takes as its starting point that there is a connection, and presents some possible causal mechanisms which explain how short birth intervals and child mortality could be related. In addition the most frequently cited hypotheses-maternal depletion and sibling competition-a third is examined-birth crowding which, it is suggested, influences the pattern of the transmission of infectious diseases and, in turn, mortality. In the field of maternal mortality, the data which could be used to quantify the benefits of family planning are in even shorter supply; however, the causal connections are rather more easily identified. The final section combines parity-specific data on maternal mortality with evidence of changes in fertility patterns brought about by family planning to assess how successful we can hope to be in reducing through birth control the number of women who die in childbirth.