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CSU 76/2009: MORE ON BIRTH SPACING AND THE MILLENNIUM DEVELOPMENT GOALS

Tuesday, 1st of December 2009 Print

  CSU 76/2009:  MORE ON BIRTH SPACING AND THE  MILLENNIUM DEVELOPMENT GOALS
 
 1) READER COMMENT ON CSU 71, BIRTH SPACING AND MDG 4
 
 Writing from Cape Town, Jon Rohde wonders when the US government will wake  up and smell the coffee.
 
 EXCELLENT!!!  Now try to tell this to the US Congress!!
 This needs far more emphasis - even the Child Survival people don't push  it, to say nothing of the maternal health folks who would avoid many  maternal deaths - after all, the best way to reduce maternal mortality is  to avoid pregnancy!!
 

Jon Rohde, MD
 3 Moray Place, Oranjezicht, 8001
 Cape Town, South Africa
 tel: 27 (0) 21-465-0569
 cell: 27 (0) 83-306-7701
 
 
 
  2) ADDITIONAL DOCUMENTS ON BIRTH SPACING
 
 Two Washington readers have kindly supplied several documents from WHO and
 the UN Millennium Project which strengthen the case for birth
 spacing as a priority intervention. Among the documents is the gem
 reproduced below, from 'Sexual and Reproductive Health and the Millennium
 Development Goals.'
 
 Do these documents constitute policy commitments from the UN? I would like
 to think so, but to me they look like evidence reviews from technical
 experts which should form the basis for UN policy commitments. Those
 commitments are, as far as I know, still in posse, rather than in esse. Has
 the UN or any of its interagency committees or international conferences
 said, what is perfectly obvious from the evidence, "Birth spacing is not
 only good, but indispensable to the attainment of MDG 4 and MDG 5"? I pause
 for a reply.
 
 Cheers, BD
 
 
 
 Improving childbirth spacing to reduce child deaths
 
 
 Birth spacing – the practice of delaying the period between births – is an
 important lifesaving measure for both mothers and children. For mothers,
 properly spacing births lowers the risk of maternal mortality, third
 trimester bleeding, anemia, premature rupture of membranes and
 malnutrition. For children, it lowers the risk of fetal death, preterm
 birth, low birth weight and neonatal death, as well as stunting and
 wasting.
 
 
 New evidence indicates that when children are born at least three years
 apart, the health and survival rates of the mother and child significantly
 improve. Previous research had indicated that a two-year birth interval was
 optimal. However, compared to 24–29 month intervals, 36–41 month intervals
 are associated with a 28 percent reduction in stunting and a 29 percent
  reduction in underweight (Catalyst Consortium 2004a). Rutstein (2005)
 assessed the outcomes of pregnancies in 17 countries and found that
 children born three or more years apart are healthier at birth and are more
 likely to survive infancy and childhood (figure 3.3).
 
 
 The Alan Guttmacher Institute (2002) also reports that when births are
 spaced less than two years apart, the infant mortality rate is 117 per
 1,000 live births, compared to 64 per 1,000 when births are spaced two to
 three years apart and 47 per 1,000 when births are four or more years
 apart. This effect was found in every developing region worldwide. In less
 developed countries, if no births occurred within 36 months of a preceding
 birth the infant mortality rate would drop by 24 percent and the under-five
 mortality rate would drop by 35 percent. In total numbers this would
 annually amount to 3 million children under age five, or roughly 30 percent
 of the total child mortality. A minimum of three years birth spacing is
 also important for enhancing the child’s cognitive and social development
 (Catalyst Consortium 2004a).
 
 
 Furthermore, women with pregnancies spaced too closely together do not have
 sufficient time to rebuild their nutritional stores, leading to the
 mother’s poorer nutritional status and worse health outcomes for her child.
 Additionally, maternal depletion syndrome – or the physiological stress
 that occurs in a woman if gestation overlaps with lactation – may further
 worsen the mother’s nutritional status. Such poor nutrition leads to low
 birth weight, preterm birth, stunting and changes in breast milk content.
 
 
 

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