Contraception and Birthspacing

In 28 developing countries for which World Fertility Survey data were analyzed an average of 1/3 of birth intervals were found to be under 2 years. Short intervals are more common in Latin America (38%) than in Asia (29%) and are especially widespread in the MIddle East. In general the children at greatest risk of an inadequate interval between them are the 1st and 2nd born. There appears tobe substantial latent demand for the use of contraceptives for birth spacing. Most mothers who desire another child do not want to conceive for at least 18 months postpartum a duration rarely covered by the traditional birth spacing mechanisms of breastfeeding and postpartum abstinence. In 17 Latin American and Caribbean countries there is surprisingly little difference in levels of contraceptive use between those who want no more children (48%) and those who want to postpone the next birth (38%). The disparity is wider in Asia and the MIddle East while few women in African countries are using congtraceptives for either purpose. Survey data suggest that spacing has always been an important motive for fertility control in Latin America while contraceptive demand in Asian countries has been dominated at least initially by the desire to have no more children. Another unexpected survey finding has been that in gneral birth spacers are as likely as limiters to use effective methods of contraception. Despite the negative association between contraceptive use and breastfeeding survey data suggest that postpartum contraceptive practice tends to be a response to the resumption of menstruation rather than a deliberate substitution of contraceptives for traditional methods. Wide variation among countries in the length of postpartum abstinence and anovulation precludes any standardized polciy toward the optimal timing of contraception adoption. (authors modified)