Breastfeeding as a Time-Varying–Time-Dependent Factor for Birth Spacing: Multivariate Models with Validations and Predictions

Abstract

Data used in the present study are from the National Family Health Survey (NFHS-I) 1992-93 (International Institute for Population Sciences 1995), India. Our study has developed Cox model analyses to see the effect of breastfeeding as a time-varying and time-dependent factor on birth spacing. While it is acknowledged that breastfeeding has a protective effect on birth spacing, such analysis of breastfeeding allows for a more nuanced understanding of that effect. Multivariate analysis revealed that breastfeeding, ever experience of fetal loss, education of women, employment status of women, education of husband, media exposure, survival status of index child and place of residence played an important part in extending birth space in at least one of the birth-spacing intervals (first to fifth). However, the variables varied from the first birth spacing to the fifth birth spacing. Breastfeeding is the only covariate found to be a significant protective factor associated with each birth spacing. Furthermore, this study validates the developed models with their prediction utilities for birth spacing.

Maternal factors contributing to under-five mortality at birth order 1 to 5 in India: a comprehensive multivariate study

“…This is in line with the general perception and is a well- documented fact (Robert et al 2003; WHO 2000; Gareth et al 2003; Singh et al 2012a; Singh et al 2012b). The UNICEF report projects that if all birth to pregnancy intervals were 3 years, approximately 1.6 million under-five deaths could be prevented annually (UNICEF 2012).…”

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“…Women belonging to economically, socially, and educationally weaker sections receive less maternal healthcare services in the southern states [ 26 ]. Education, parity, religion, caste, and place of residence impact breastfeeding activity of women [ 61 ]. Three articles have examined aspects of unmet need, breastfeeding, and C-section [ 14 , 40 , 62 ].…”

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“…Here, malnutrition and infectious diseases remain the main causes of infant mortality and morbidity, not to mention that breastfeeding, particularly in rural areas, also impacts on birth spacing thus mitigating the rates of infant mortality, stunting, and malnutrition. [35][36][37] In view that in previous studies 3,27,28,38 most of the breastfeeding-related transmission occurred in infants who had been breastfed for 6 or more months, an alternative to consider would be a restriction of breastfeeding to 6 months to 1 year in women with HTLV-1. This measure should be actively linked with efforts to improve overall infant nutrition, 35 ensuring access to clean drinking water for these populations, 39 and promoting access to adequate birth control.…”