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Table 3 Factors associated with birth spacing from qualitative studies

From: Factors associated with short birth interval in low- and middle-income countries: a systematic review

Author and year of publicationThemeFactorQuotationPage
Social & Rural Research Institute 2006AutonomyLack of decision-making power“Lack of decision-making powers among the women due to the patriarchal structure of the family that gives the man the reins of power.”4
Millard 1984BreastfeedingBreastfeeding does not work“When the issue of lactation contraception is raised with village women, they deny its effectiveness, confidently and laughingly pointing to their own repeated experiences of returning to pregnancy while breastfeeding. They volunteered information no about the return of menses in relation to the probability of conception. Of the women queried about lactation contraception, only one woman in Amanalco stated that she thought breastfeeding probably did reduce the chance of a rapidly ensuing pregnancy.”9
Adeokun 1982Breastfeeding works“I do not worry my mind about pregnancy, we keep on having sex and as long as she keeps on breast-feeding nothing can happen. Once she has stopped and her period has returned, then we know it is time for her to become pregnant.”10
De Vera 2007CommunicationCouple“The subcategory, lack of communication, was identified as one of the reasons that couples did not space births.”242
Adeokun 1982Family“The openness of Yoruba families encourages kin and in-laws to influence a couple’s decisions about child rearing and the timing of the next child.”12
De Vera 2007“Family and friends influenced couples’ decisions about birth spacing. Some participants received advice on birth spacing from relatives and friends.”244
Social & Rural Research Institute 2004“Familial and cultural factors that determine the extent of support lent by the family (or the lack of it) to the woman. Given the nature of the Indian society, the influence of the peers and the community is critical.”4
De Vera 2007Media“The popular media (print and broadcast media) may exert influence on couples’ decisions about spacing births in some communities.”244
Observation“Whereas others observed that their relatives went through hard lives because of too closely spaced pregnancies.”244
Social & Rural Research Institute 2009Social“Fear of social disapproval [is a barrier to adoption of spacing].”4
Kiluvia 1991Women’s responsibility“Communication between spouses’ partners on child spacing was not necessary. Reasons varied with age and gender.[...]. Married men also frequently saw no reason to talk to their wives, because they felt the number and timing of births was solely their responsibility.”7
Chad Ministry of Public Health 1992“While Chadians of both sexes agreed that ideally both husband and wife should decide to use child spacing together, there was consensus that it was ultimately a woman’s responsibility to ensure that children were spaced.”8
Van de Walle 1986Health concernsChild health concerns“If you have a child in your arms and you become pregnant again, it is not good. The child is tired and you, who are with a belly, are tired also... the child in your womb suffers too. Everyone will suffer, because you must feed the other one in addition to this one. The one in your womb will be tired too. You know that if there is no one to take care of the oldest one you will be obliged to carry it on top of your pregnancy.”17
Maternal health concerns“Question. When do you want the next child? Answer: Even if it takes 3 or 4 years, I will be happy. Question: Why do you want to wait? Answer: Because I am old and a lot of blood poured out of my body during my deliveries. Can the same blood flow back into my body so rapidly?”16
Social & Rural Research Institute 2003Knowledge and attitudesAttitudes of the women“Personal factors driven primarily by the attitude of the woman to self and spacing.”4
Knowledge“Ignorance of methods available and negligent attitude towards the concept of spacing per se that is catapulted either by the negative word of mouth or bad personal experiences.”
Dehne 2003Local concepts and practicesAbstinence norms“Women adhering to Gurmance traditional religion reported either 24 or 36 months’ taboos, while Muslims reported much shorter norms. Most Hamallists (and the few Wahabiya) women reported a 40-day norm as prescribed in the Koran, while many ‘moderate’ Muslims reported intermediate norms of 2–5 months.”60
Van de Walle 1986Afraid of being mocked“As to the women, they crave for a child after 2 years, they are afraid of being mocked because they are finished with childbearing.”28
Adeokun 1981Agbon (female body odor)“The condition called agbon or female body odor after parturition. Once the period of agbon is over, sexual activity is commenced. The interbirth interval is thus a function of the length of agbon, the length of postpartum amenorrhoea, and the practice of pregnancy prevention after agbon has ended.”14
Dehne 2003Amulets, talismans, and cords“The use of amulets, talismans, and cords […] for instance in cases where women felt unprotected against an early pregnancy or guilty after having resumed sexual relations shortly after a preceding birth.”60
Adeokun 1981Apa (conflict between children)“The other Ikale strategy starts from the notion of apa, that is, the principle that if a surviving child is less than 1 year old and another pregnancy occurs, a conflict situation arises between the survival of the nursing child and the survival of the foetus. In order to avoid the conflict, the marital sexual relationship of the parents may be organized in such a way as to prevent the undesirable pregnancy.”14
Millard 1984Coitus interruptus“Conjugal disruption is more frequent in Tepetlaoxtoc and may be a contributing factor; possibly conscious efforts are more often made to birth extend intervals through coitus interruptus.”7
De Vera 2007Hilots (abortion for birth spacing)“Most participants said that abortion was common and a de facto method for spacing births. Because abortion is illegal in the Philippines, women sought hilots (unlicensed lay abortionists, midwives, and masseuses) to perform an abortion.”243
Kiluvia 1991Honoured tradition“We were strongly advised by our parents to take care of the baby for 2 years, then from here you can start thinking about having another baby. We were strictly warned of having too closely spaced children.”17
Chad Ministry of Public Health 1992“Child spacing was seen as a tradition that protected children’s and women’s health.”ii
Lovel 1983Local knowledge“These results show that in a traditional society the health benefits of birth spacing to mother and child are clearly well-known.”162
Dehne 2003Marabu“When this was becoming difficult, because my husband no longer agreed to abstain, I went to see a Marabu who gave me an amulet.”60
Dean 1994Polygamy“The influence of the post-partum abstinence period on birth interval and fertility is important. As outlined, men traditionally visit several wives, living far apart, each for a few months at a time, and this helps to sustain the post-partum abstinence period.”1581
Ratat (traditional abstinence)“Results of this study found that there was a traditional form of contraception throughout the district, called ratat or rotow in most areas.”
Lovel 1983Social taboo“More than a quarter of the families (rural 26%, semiurban 30%) said that in their parents’ generation people were ashamed of having children too close together because it was not accepted in the culture.”161
Van de Walle 1986“Ah, two years [between children] is good. Certain women don’t reach 2 years. Certain women whose child is not yet walking become pregnant. I cannot understand that... If you have a child in your arms, and become pregnant, don’t you know that you are humiliated [loose face]?”16
Kiluvia 1991“Many of the older women felt that engaging in sexual intercourse while the mother is still breastfeeding is taboo.”18
Adeokun 1982Traditional medicine“The other half depends on the use of herbs and traditional devices in the prevention of pregnancy.”11
De Vera 2007“Five of the seven women admitted using some medicinal herbs and roots to stop pregnancy or stimulate menstruation.”243
Kiluvia 1991“Young men also knew few details of how traditional methods work, but they had heard about the traditional use of herbs and abstinence for birth spacing. [...] Among the most frequently mentioned methods were abstinence; “pigi” and “fungo,” in which a traditional healer ties twigs from a special tree or a “medicated” piece of cloth around a woman’s waist; herbal potions; and douching.”9
De Vera 2007ModernizationFamily planning education“The health center teaches the use of the modern methods of contraception such as pills and IUD.”244
Social & Rural Research Institute 2005Institutional infrastructure“Institutional infrastructure provided to the populace has also played a decisive role in adoption of spacing methods.”4
Dehne 2003Loss of culture“Many changes have occurred in local customs. Today, the women do not abstain for as long as we used to do.”61
Dean 1994“Other major factors thought to cause a decrease in child spacing were the loss of tradition generally, the loss of ratat and the loss of the post-partum abstinence period.”1581
Men stay at home more“With the general degeneration of the traditional society the “men staying at home more” is likely to result in the decrease of the post-partum abstinence period.”Fig. 8, page 1582
More food“When asked specifically what women thought had caused the decrease in birth interval they gave several reasons over and above those relating to traditions, the most important of which was increase in food availability.”1578
More health services“More health services [cause a decrease in child spacing].”1579
More hygiene“More hygiene [causes a decrease in child spacing].”Fig. 4, page 1579
Dehne 2003Religion“In former times, couples waited for one to two year(s) before resuming sexual contacts. Now the waiting period is 2 months or even 40 days.[...] These changes have all occurred because of the increasing influence of religion. Many people listen to the Marabu now and attend Koranic schools.”60 & 61
Dean 1994OtherLess drought“Less drought [causes a decrease in child spacing].”Fig. 4, page 1579
Less war“Less war [causes a decrease in child spacing].”
De Vera 2007ReligionCatholicism“However, one mother stated that because of the religious saying, “children are gifts from God,” couples end up having many children because they do not have a choice but to accept them.”243
Adeokun 1982God’s will“Chance or God’s will in the avoidance of an inconvenient pregnancy.”10
Social & Rural Research Institute 2008Hinduism“Religious prohibitions dictated by certain scriptures have led to believers not subscribing to spacing.”4
Chad Ministry of Public Health 1992Religion“Religion was also used as a reason by some men, in both Sarh and N’Djamena, for not practicing birth spacing because children were a gift from God.”v