Child survival

Abstract

We commend Gareth Jones and colleagues1Jones G Steketee RW Black RE Bhutta ZA Morris SS the Bellagio Child Survival Study GroupHow many child deaths can we prevent this year?.Lancet. 2003; 362: 65-71Summary Full Text Full Text PDF PubMed Scopus (1674) Google Scholar for advancing our understanding of the causes and magnitude of child deaths in the developing world. They make the important point that their estimates of deaths in children younger than age 5 years are conservative. Data from the US Agency for International Development (USAID) and elsewhere on the association of longer birth intervals with reduced mortality risk strongly support this finding. Jones and colleagues note that further deaths could be prevented “by extension of the interval between births to 24 months.” USAID-sponsored analyses,2Rutstein S Effect of birth intervals on mortality and health: multivariate crosscountry analyses (presentation). USAID, ORC Macro, Washington DCJuly, 2000Google Scholar however, indicate that 24–29 birth-month intervals are still associated with mortality risk (estimated risk 26% for newborns, 43% for infants, and 51% for those younger than age 5 years), and that an interval of 3–5 years is optimum for child survival. The problem is an important one. USAID's Demographic and Health survey data3Setty-Venugopal V Upadhyay UD Birth spacing: three to five saves lives. Population Reports, Series L, No 13. Johns Hopkins Bloomberg School of Public Health, Population Information Program, Summer, Baltimore2002Google Scholar indicate that 35–70% of non-first births in developing countries are spaced less than 3 years from the last.2Rutstein S Effect of birth intervals on mortality and health: multivariate crosscountry analyses (presentation). USAID, ORC Macro, Washington DCJuly, 2000Google Scholar In some countries, such as India, Mali, and Haiti, the average length of the birth interval has not changed in more than 5 years.3Setty-Venugopal V Upadhyay UD Birth spacing: three to five saves lives. Population Reports, Series L, No 13. Johns Hopkins Bloomberg School of Public Health, Population Information Program, Summer, Baltimore2002Google Scholar In many countries, women prefer longer birth intervals, but do not achieve them. Only 2–3% of postpartum women want another birth within 2 years, but post-partum family-planning use averages only 40%.4Ross J Winfrey W Contraceptive use, intention to use, and unmet need in the extended postpartum period.Int Fam Plan Perspec. 2001; 27: 20-27Crossref Scopus (165) Google Scholar Longer birth intervals might also be able to play a part in reducing the synergistic effects on mortality of malnutrition and infectious disease. USAID data2Rutstein S Effect of birth intervals on mortality and health: multivariate crosscountry analyses (presentation). USAID, ORC Macro, Washington DCJuly, 2000Google Scholar show that longer birth intervals are associated with improvements in nutritional status. Compared with longer (36–41 months) birth intervals, 24–29-month intervals are associated with a 28% raised risk of stunting and a 29% increased risk of being underweight. The results of a Latin American study3Setty-Venugopal V Upadhyay UD Birth spacing: three to five saves lives. Population Reports, Series L, No 13. Johns Hopkins Bloomberg School of Public Health, Population Information Program, Summer, Baltimore2002Google Scholar suggests that longer birth intervals might help reduce the 3·9 million newborn deaths that occur annually: compared with 9–20-month birth intervals, infants born at 27–32-month intervals are less likely to be of low birthweight, born preterm, or small for gestational age. The findings of USAID focus groups based in Bolivia, Peru, Egypt, Pakistan, and India indicate that most women, men, and health providers have little understanding of the role of longer birth intervals in infant and maternal survival. Unfortunately, few health programmes educate clients, including young and engaged couples, on this topic. USAID is now developing education and training programmes to address this gap. USAID-sponsored estimates2Rutstein S Effect of birth intervals on mortality and health: multivariate crosscountry analyses (presentation). USAID, ORC Macro, Washington DCJuly, 2000Google Scholar suggest that if no births took place within 36 months of a preceding birth, the under-five mortality rate would drop by 35%, and deaths among those younger than age 5 years would fall by 2 875 000 annually. Longer birth intervals have an important part to play in improving infant, child, and maternal survival. This role is yet to be realised.