Determinants of Birth Spacing in Women Attending Antenatal Clinic in University College Hospital, Ibadan

Background: Optimal child spacing promotes child survival by allowing the baby to have more time to be breastfed and cared for, make more resources available for the care of the baby and mother, and also enables the mother to fully recover and prepares for the next pregnancy. The World Health Organization (WHO) recommends a minimum 24-month birth-to pregnancy interval after a live birth or a minimum of 6 months after a miscarriage or induced abortion to reduce the risk of adverse maternal, perinatal and infant health outcomes.

Objective: This study was to access the different factors that contribute to birth spacing among patients attending antenatal clinic in UCH, Ibadan.

Method: A descriptive cross-sectional study involving consenting registered antenatal patients at UCH, Ibadan.

Results: 273 pregnant women attending antenatal clinic at the University College Hospital, Ibadan, participated in the study with majority of the participants (54.2%) having at least 1 previous parous experience. 42.1% of the participants had a birth interval of more than 24 months which follows the recommendation of the WHO. However, only 16.1% of these women uses modern contraceptive for the purpose of birth spacing while 37.5% uses natural/withdrawal method for birth spacing. Husband’s desire was the commonest determinants of birth spacing in this study (29.3%). Others were outcome of previous pregnancy, patient’s age and age of getting married. Religious/cultural belief was the lowest determinant.

Conclusion: This study shows the low level of uptake of modern contraceptives for birth spacing among the participants.

World Health Organization (WHO) defines birth interval as the time period from live birth to a successive pregnancy [1,2]. The number of child births and maternal complications are interrelated, with higher complications associated with more birth frequency, especially in resource-limited settings [3]. The important of birth spacing cannot be over emphasized. It is beneficial to the mother and the baby.  Optimal child spacing promotes child survival by allowing the baby to have more time to be breastfed and cared for, make more resources available for the care of the baby and mother, and also enables the mother to fully recovers and prepares for the next pregnancy [4].

The World Health Organization (WHO) recommends a minimum 24-month birth-to pregnancy interval after a live birth or a minimum of 6 months after a miscarriage or induced abortion to reduce the risk of adverse maternal, perinatal and infant health outcomes [1,5,6]. This recommendation is not widely followed especially in developing countries including Nigeria [7]. Short birth-to-birth intervals, also known as, short birth intervals (SBIs) or simply, short interpregnancy interval are associated with poor neonatal and infant outcomes, including miscarriages, low birth weight, preterm births, small-for-gestational age, neonatal morbidity and mortality and infant mortality and, can also affect the nutrition status of the baby [5,8]. Similarly, SBIs can affect the mother’s nutritional status and result in increased risk of antepartum haemorrhage especially in the third trimester, premature rupture of membrane membranes, postpartum endometriosis and anaemia [5]. Birth interval of more than 60 months is associated with women’s physiological regression, preterm birth, low birth-weight and an increased risk of labour dystocia and preeclampsia [8].

Birth spacing are determined by a range of different factors, some of which are socioeconomic, demographic, cultural and behavioural characteristics [5,9]. This study was to access the different factors that contribute to birth spacing among patients attending antenatal clinic in University College Hospital (UCH), Ibadan.

Study Design: The study was a cross-sectional, descriptive study involving consenting registered antenatal patients seeking care at UCH, Ibadan.

Study Area: This study was carried out at the antenatal clinic at the university College Hospital, Ibadan. At the moment, antenatal clinics are conducted on three days at the University College Hospital.  The number of clients at each clinic session averages 100-150. The routine activities at the sessions include group health education, performance of vital signs by the nurses, and laboratory investigations (urinalysis and packed cell volume). The University College Hospital, Ibadan is a tertiary hospital that serves as a referral centre for private and primary care facilities as well as secondary health care facilities. The hospital was initially commissioned in the year 1957 with a capacity of 500 beds; presently it has 1000 beds and 163 examination coaches. The maternity section has 130 beds.

Study Population: All pregnant women assessing antenatal care at the University College Hospital, Ibadan.

Sampling Technique: Convenience sampling technique.

Sample Size Determination

The sample size was estimated Cochran Formula:

were N = the minimum sample size; Zα = the standard normal deviate corresponding to a side level of significance of 0.05; P = the proportion of respondent who will consider BTL as appropriate from Port-Harcourt study = 0.183 (Enyindal 2018); Q = 1-p D = the desired level of precision = 0.05; N = 1.962 x 0.183 (1 – 0.183) / 0.052 = 230

This gave a minimum sample of size of 230 participants. Assuming a non-response rate of 20%, a sample size of 276 women was gotten.

Ethical Consideration: Ethical approval was obtained from the Institution Review Board (IRB) of the University of Ibadan/University College Hospital, Ibadan with IRB number UI/EC/23/0461.

Data analysis: Self and Interviewer administered questionnaires were used to obtain data from the women. The questionnaires were pretested and validated. The data obtained was imputed on the data page of the statistical package for social sciences version 24, and the data was cleaned as appropriate. Analysis of data was by computer using the Statistical Package for Social Sciences (SPSS; SPSS- 24 for Windows Evaluation Version). Level of statistical significance was set at 95% confidence level.

Out of 276 questionnaires for this study, 273 were properly filled by the respondents which give a response rate of 98.91%. A total number of two hundred and seventy-three respondents with a mean age of 31.41±4.73 years participated in this study. Majority (53.1%) of the respondents were within the age range of 31-40 years. Forty-one percent were within the age range of 21-30 years while only few (3.3%) were from forty-one years and above. 33% of the respondents were professionals; 18% were civil servants while 16.5% were Artisan. Majority (91.4%) of the respondents had tertiary level of education. Almost (97.8%) of the respondents were married. Seventy-five percent of the respondents practice Christianity while (24.4%) practice Islamic religion. Eighty-one percent were from the Yoruba’s ethnicity group. More than half (54.2%) have had 1 or 2 parous experiences.

Table 1: Socio demographic characteristics of the respondents.

Table 2: Birth interval.

As shown in table 2, most of the women (42.1%) had birth interval of more than 24 months, closely followed by those of 18 - 24 months (9.2%), and inter- pregnancy interval of less than 6 months was reported in just 2.6% of the participants.

Table 3: Methods of birth spacing.

Majority of the participants, 102 women constituting 37.5%, used withdrawal method as the method of birth spacing. Surprisingly, only16.1% of the participants uses modern contraceptives for the birth spacing while 6.2% completely avoided pregnancy.

Table 4: Determinant of birth spacing.

The husbands were the main determinants of the duration of inter-pregnancy interval.

273 pregnant women participated in this study to determine the factors contributing to birth spacing among women attending antenatal clinic at University College Hospital, Ibadan. Their mean age was 31.41±4.73 years, 97.8% were married and, 54.2% of them have had at least a previous parous experience. 91.4% had tertiary level of education. Christianity was the commonest religion and Yoruba being the most common tribe.

The study shows that close to half of the participants (42.1%) had a birth interval of more than 24 months which corresponds to the recommendation of WHO [5]. This study agrees with the study by Alex-Ojei et al at Federal University, Oye-Ekiti in which they found that most of the women had birth spacing that agreed with WHO’s minimum standard of 24-36 months [10]. The findings from this study were higher than those in the study by Ahuru RR et al in the Southern part of Nigeria [11]. This finding corresponds to the findings from a study in Yumbe Hospital, Uganda where 47.6% of the participants had birth interval of more than 24 months [1].

Surprisingly, despite the advocacy for the use of modern contraceptive for prevention of short interpregnancy interval, only 16.1% of the women uses modern contraceptives for the purpose of birth spacing while the majority of them (37.5%) prefer the withdrawal method. The findings from this study corresponded to the findings in the study by Dim et al at Enugu where only 18.1% of the participants used modern contraceptives for birth spacing [12]. Also, in the study by Ahuru et al at different communities in Delta State, only 24.3% of the women used modern contraceptive for birth spacing [11]. This shows the need for continuous advocacy and policies to improve the uptake of modern contraceptive methods.

The greatest factor influencing the duration of inter-pregnancy interval in this study was husband/partner’s desire representing 29.3%. Most women depend on their partners/husbands for important decisions including family planning which has negatively affected contraceptive uptake. Fadeyibi et al and Adegbola et al in different studies discovered that counselling of the male partners influenced contraceptive uptake [13,14]. The outcome of the previous pregnancy (whether the baby was alive or dead) was the second determinant of birth spacing. Most women who have still birth or abortion were more likely to get pregnant earlier compared to those who have a live baby. Other factors influencing interpregnancy interval in this study were the age of the woman, age at which the woman got married, and the sex of the baby. Religious and cultural beliefs were the least contributors to child spacing in this study. The findings negated the findings by Wegbom et al in which they discovered that short interpregnancy interval was commoner in the Northern region of Nigeria and more among the Islamic religion [2]. The study contraindicated the findings of Rizvi F And Khan A in which many women in Pakistan, India, Bolivia and Peru expressed concerns that their husbands do not share the responsibility of planning their pregnancies [3]. The findings were different from the finding from the study by Owoyemi et al where maternal age was the greatest determinant of birth spacint [15].

This study shows various determinants of birth spacing among the participants especially the impact of the husbands/partners in determining the next pregnancy. Surprisingly, the level of modern contraceptives uptake was low.