BackgroundPoorly spaced pregnancies have been documented worldwide to result in adverse maternal and child health outcomes. The World Health Organization (WHO) recommends a minimum inter-birth interval of 33 months between two consecutive live births in order to reduce the risk of adverse maternal and child health outcomes. However, birth spacing practices in many developing countries, including Tanzania, remain scantly addressed.MethodsLongitudinal data collected in the Rufiji Health and Demographic Surveillance System (HDSS) from January 1999 to December 2010 were analyzed to investigate birth spacing practices among women of childbearing age. The outcome variable, non-adherence to the minimum inter-birth interval, constituted all inter-birth intervals <33 months long. Inter-birth intervals ≥33 months long were considered to be adherent to the recommendation. Chi-Square was used as a test of association between non-adherence and each of the explanatory variables. Factors affecting non-adherence were identified using a multilevel logistic model. Data analysis was conducted using STATA (11) statistical software.ResultsA total of 15,373 inter-birth intervals were recorded from 8,980 women aged 15–49 years in Rufiji district over the follow-up period of 11 years. The median inter-birth interval was 33.4 months. Of the 15,373 inter-birth intervals, 48.4% were below the WHO recommended minimum length of 33 months between two live births. Non-adherence was associated with younger maternal age, low maternal education, multiple births from the preceding pregnancy, non-health facility delivery of the preceding birth, being an in-migrant resident, multi-parity and being married.ConclusionGenerally, one in every two inter-birth intervals among 15–49 year-old women in Rufiji district is poorly spaced, with significant variations by socio-demographic and behavioral characteristics of mothers and newborns. Maternal, newborn and child health services should be improved with a special emphasis on community- and health facility-based optimum birth spacing education in order to enhance health outcomes of mothers and their babies, especially in rural settings.

The West African Ebola outbreak of 2013–2016 had the potential to devastate family planning programs in affected countries, which had made great progress in years prior. We examine monthly provision of family planning service statistics from government sources for Liberia and Sierra Leone from 6 months before the first Ebola case to 24 months after the last Ebola case to measure the impact during and after the epidemic. By calculating the couple‐years of protection from service statistics, we find that family planning distribution declined by 65 percent in Liberia and 23 percent in Sierra Leone at the peak of the epidemic. Two years after Ebola, Liberia's average monthly contraception distribution is 39 percent above precrisis levels, while distribution in Sierra Leone increased by 27 percent, findings echoed in data from the Demographic and Health Survey and Multiple Indicator Cluster Survey. Increased contraceptive use comes from implants in both countries, and injectables in Liberia. This study indicates that the family planning sector can recover, and continue to improve, following a significant disruption and is a lesson in resilience.

Background Many studies have documented the impacts mothers-in-law have on daughters-in-law living in the same household, but few have quantified the scale of this co-residence.  This study aims to estimate the proportion of married women living with their mothers-in-law across countries and time.  Methods Using household rosters from 250 Demographic and Health Surveys in 75 countries, this paper uses the “relationship to head of household” question to identify households where married women live with their mothers-in-law.  For select countries with large changes, we decompose changes in rates into changes in the age structure of married women and the rate of women living with their mothers-in-law by age. Results This paper finds large variation in family structure around the globe, from 1% of married women in Rwanda to 49% in Tajikistan living with their mother-in-law.  Many countries with high co-residence in the 1990s continue to see high and increasing numbers today, especially in Central and Southern Asia, while some North and sub-Saharan African countries experienced substantial declines.  Decomposing changes by age and rates shows that changes in the age structure of married women is not driving changes in co-residence, but rather the rates are changing across age groups.  Conclusions These findings show the large variation in women living with their mothers-in-law across the globe.  The authors provide publicly available code and future research ideas to encourage others to further our understanding of the impact of living with her mother-in-law on a woman’s life.

Background: The open birth interval -- the time since the woman’s latest birth -- is closely correlated to the usual fertility measures, but it adds important information from the age of the woman’s youngest child, with its implications for her freedom from domestic roles.  Studies of the open interval by age and parity can elucidate the transitions in reproductive behavior that women experience over time. Methods:  249 surveys of married women in 75 countries in the DHS series provide information on the open  interval by age and parity, and by the  fertility measures of the total fertility rate (TFR), the general fertility rate (GFR), and children ever born (CEB), with time trends.  Stata 15 and the “R” software were used, and a two-parameter equation was employed to model the distribution. Results:  The distribution of women by the open interval follows a downward curve from birth to 20 years; it varies across countries and over time only by its starting level and the steepness of the curve. Declines in the shortest intervals soon after birth reflect recent fertility declines. Variations are large by both age and parity, but in quite different patterns. Past modeling analyses demonstrate the effects of female and spouse mortality, declining fecundability, contraceptive use, and reduced sexual exposure. Both period and cohort effects can impact the curve. The open interval distribution is modelled in an equation with two parameters and calculated for the latest surveys in the 75 countries. Conclusions: The time since a woman’s birth is easily captured with a single question in successive surveys. Changes in the open interval distribution serve as sensitive indicators of recent fertility changes, and the dynamics of reproductive behavior across women’s life stages are captured in new ways, as gauged by age and parity trends in the distributions.

The open birth interval is the time since a woman's last birth. It reflects not only desire for contraception and child health services but also freedom for outside activities, employment, and personal autonomy. It merits attention from policy makers, program managers, and service providers.