The Status and Determinants of Birth Interval in the Rural Women of Fars Province, Iran

Proper intervals between births have been emphasized as a factor to guarantee the health of the mother and infant. Therefore, reproductive health programs are essential to achieving this important goal. Birth intervals are an effort to maintain a certain interval between births, which is explicitly defined relative to the newborn. Closely birth intervals are referred to as rapid repeated pregnancy in the public health and medical literature and increase the risk of various disorders in the mother and infant. The current literature in this regard indicates that more than 54 million women suffer from health problems during pregnancy and delivery each year, and approximately 1.5 million die, 99% of which occur in developing countries. Since the time and interval of subsequent births are the main determinants of fertility, fertility researchers have widely investigated these factors. In addition, evidence suggests that short intervals between births cause numerous adverse consequences in childhood and adulthood. The present study aimed to investigate the birth intervals and its determinants in the rural women of Fars province, Iran. In general, we sought to identify the vulnerable groups of women that need special attention in health and reproductive health programs, so that the general health of mothers and infants would be promoted in the community.

This cross-sectional, analytical study was conducted using a researcher-made questionnaire on 882 married women aged 15-49 years with two or more children living in the rural areas of Fars province. The survey was performed using cluster sampling in October 2015. The independent variables included age, age of the spouse, year of marriage, ethnicity, religion, education level, and occupation status. In addition, the birth year of each child was recorded by asking the women, and birth interval was the dependent variable. Based on the fertility level of the women, the intervals between the first and second births, as well as the second and third births, were also considered and emphasized. Data analysis was performed in SPSS version 16 using frequency tables and multiple regression analysis at the significance level of 0.05.

The mean age of the participants was 35.29±6.25 years, and the mean age of the spouses was 40.31±6.89 years. The mean age of the women in the first marriage was 19.56±3.95 years. The majority of the respondents were Persians and Shiites, and the majority of the women (53.6%) had two children. Furthermore, 4% of the rural women had academic education or higher educational degrees than diploma, and this rate was estimated at 5.6% for men. The findings also indicated that the largest proportion of the rural women and their spouses had secondary education or lower. In terms of occupation status, 3.3% of the rural women and 94.9% of the spouses were employed. In addition, approximately 83.6% of the rural households earned less than 10 million Rials, and 0.9% earned more than 25,000,000 million Rials per month. According to the results, 31.8% of the women with two children gave birth to their second child less than three years after the birth of the first child. This rate was estimated at 52%, 65.7%, and 80% for the women with three, four, and five children, respectively. The interval between the second and third birth for 25.3%, 50.5%, and 78.8% of the women with three, four, and five children was less than three years, respectively. On the other hand, all the women with four children gave birth to their fourth child less than three years after their last child. The multivariate analysis of the data indicated that ethnicity (P=0.023) and religion (P=0.002) had a significant effect on the birth interval between the first and second births, and the average birth interval in the Persian and Shiite women was higher than the women of other ethnicities and Sunni women. Notably, ethnicity (P=0.001) and religion (P=0.027) were the only significant variables to affect the interval between the birth of the second and third children of the rural women in Fars province.

According to the results, demographic and socioeconomic characteristics had relatively similar effects on the birth interval between the first and third children, while the explanatory power of these factors increased relatively with the interval between the second and third births. In other words, the interval between the first and third childbirths in the rural women was relatively the same, and no significant differences were observed in terms of the socioeconomic characteristics of the women. Ethnicity and religion also had significant effects on the birth interval, which could be associated with the socioeconomic status of the rural women. It seems that the employed women had to increase their birth intervals due to the combination of childbirth and occupation. Nevertheless, no significant correlation was denoted between the occupation status of the women and birth intervals, while our findings indicated that the employed women were more likely to give birth to their second child within an increased interval from the first birth compared to the unemployed women, while it was the opposite in the case of the interval between the second and third births. Previous studies have indicated that the education level of women is a significant influential factor in birth intervals, while no such significant correlation was observed in this study. Furthermore, it could be inferred that the Sunni and non-Persian women needed more attention as a vulnerable population, and they should be properly trained on the importance of adequate birth intervals. These women also need more attention to raise their awareness regarding adequate birth intervals. By adopting and implementing the necessary training courses in vulnerable women, the issues associated with birth intervals could reduce, which in turn promotes the general health of these women and their infants.