Heterogeneous Effects of Birth Spacing on Neonatal Mortality Risks in Bangladesh.

Joseph Molitoris

doi:10.1111/sifp.12048

Abstract

The negative relationship between birth interval length and neonatal mortality risks is well documented, but heterogeneity in this relationship has been largely ignored. Using the Bangladesh Maternal Mortality and Health Care Survey 2010, this study investigates how the effect of birth interval length on neonatal mortality risks varies by maternal age at birth and maternal education. There is significant variation in the effect of interval length on neonatal mortality along these dimensions. Young mothers and those with little education, both of which make up a large share of the Bangladeshi population, can disproportionately benefit from longer intervals. Because these results were obtained from within‐family models, they are not due to unobservable heterogeneity between mothers. Targeting women with these characteristics may lead to significant improvements in neonatal mortality rates, but there are significant challenges in reaching them.

Highlights

Showed that as the overall level of child mortality declined, the negative effect of preceding inter-birth interval length on mortality approached zero (Molitoris 2017)
Do longer birth intervals disproportionately affect the chances of survival for some children over others depending on, for example, their socioeconomic circumstances or mothers’ characteristics? The identification of heterogeneous effects can assist family planning programs to more effectively target subpopulations that can derive the greatest benefit from controlling their tempo of fertility
More precise targeting may be increasingly necessary for realizing improvements in maternal and infant health as international donations to family planning programs have continued to decline in recent decades (Cleland et al 2006), and as major donors have imposed stricter requirements on NGOs relying heavily on their foreign aid (Crane and Dusenberry 2004), exemplified by the United States government’s recent decision to expand the so-called Mexico City policy (Bingenheimer and Skuster 2017; Starrs 2017)

Summary

Introduction

Showed that as the overall level of child mortality declined, the negative effect of preceding inter-birth interval length on mortality approached zero (Molitoris 2017). This article examines heterogeneity in the relationship between birth interval length and neonatal mortality risks in Bangladesh using the Bangladesh Maternal Mortality and Health Care Survey 2010 (BMMS 2010). The present study demonstrates that the strength of the relationship between birth interval length and neonatal mortality risks varies within populations, a fact that has far been largely ignored and can offer valuable insight for family planning programs. I investigate differences in the relationship between birth intervals and maternal education in light of evidence suggesting that lesseducated women are at heightened risk of having shorter birth intervals and tend to have disproportionately high rates of child mortality (De Jonge et al 2014)

Methods

Results

Discussion

Conclusion