Tuesday, 1st of December 2009 |
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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