Abstract
Longer intervals between consecutive births decrease the number of children a woman can have. This results in beneficial effects on population size and on the health status of mothers and children. The general objective of this study was to model the birth intervals of adult women age 15-49 years old in Ethiopia and to identify the variable that affects the length of birth intervals of women. The study utilizes the data extracted from the 2011 Ethiopian Demographic and Health Survey (EDHS). In this study cox proportional hazards and shared gamma frailty models were adopted for the analysis to identify important demographic and socioeconomic factors that may affect the length of birth intervals and to analyze correlated birth intervals respectively. The result of the two models revealed that mother’s age, place of residence, mother education level, wealth index, mother age at first birth, childbirth order, survival status of the previous child, breast feeding status, and contraceptive use were found to have significant effect on the length of birth interval for Ethiopian women. The analysis with the frailty model shows that child birth order may not be an important covariate for analyzing birth intervals, especially when mother’s age at first birth is already in the model. Moreover, shared gamma frailty model have resulted in a minimum AIC as compared to cox proportional hazard model without frailty term in the model, suggesting that shared gamma frailty model is the most powerful one in predicting the birth intervals of women among regional states of Ethiopia. Hence, the setting of correlated observations, the cox frailty models are recommended for providing statistically valid estimates of the effects of proximate determinants after adjusting for the background variables and unobserved random effects.
Highlights
Birth interval is the length of time between two successive live births
Mother’s education is found to be a very important covariate for birth interval as the analysis shows that highly educated mothers have significantly smaller likelihood of birth compared to illiterate and primary educated mothers, and there is a significant difference in likelihood of birth among women with at least secondary or higher education
In cox proportional hazard with frailty models same to cox proportional hazard without frailty done, first univariable analysis were done for all variables to select variables at 0.02 -0.25 level of significance, variables significant at 25% were considered to fit in multivariable analysis to identify the significant variables associated with the birth interval accounting frailty in the model
Summary
Birth interval is the length of time between two successive live births. Longer time periods between births allow the pregnancy and birth to be at full gestation and growth [1]. The recent evidence showed that births should be spaced at three to five years apart to ensure maximum health benefits for mothers, newborns, and older children [6]. The variations of fertility levels in a country can be attributed to the differences in the length of the reproductive life of women and differences in the length of time between births when women are exposed to the risk of conception Analysis of those factors influencing the span and those affecting the spacing of fertility has proven useful, since in many cases they appear to vary quite substantially across populations [8]. The spacing of births through a deliberately prolonged interval between births and a delay in child bearing following marriage could be logical alternative strategies for fertility control
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