Critical insights on the demographic concept of “birth spacing”: locating Nef in family well-being, bodies, and relationships in Senegal

Abstract

Birth spacing has emerged since the early 1980s as a key concept to improve maternal and child health, triggering interest in birth spacing practices in low-income countries, and drawing attention to prevailing norms in favour of long birth intervals in West Africa. In Senegal, the Wolof concept of Nef, which means having children too closely spaced in time, is morally condemned and connotes a resulting series of negative implications for family well-being. While Nef and "birth spacing" intersect in key ways, including acknowledging the health benefits of longer birth intervals, they are not translations of each other, for each is embedded in distinct broader cultural and political assumptions about social relations. Most notably, proponents of the demographic concept of birth spacing assume that the practice of using contraception after childbearing to postpone births could contribute to "empowering" women socially. In Senegal, by contrast, preventing Nef (or short birth intervals) is also viewed as strengthening family well-being by allowing women to care more fully for their family. This paper draws on policy documents and interviews to explore women's and men's understanding of Nef, and in turn critically reflect on the demographic concept of birth spacing. Our findings reinforce the relevance of the concept of birth spacing to engage with women and men around family planning services in Senegal. Accounts of the Nef taboo in Senegal also show that social norms stigmatising short birth intervals can legitimise constraints faced by women on control of their body.

Family Planning Beliefs and Their Association with Contraceptive Use Dynamics: Results from a Longitudinal Study in Uganda

“…Agreeing that contraception preserves a woman's beauty was positively related to adoption over the one-year period and, in communities where more women strongly agreed with this statement, women were less likely to discontinue. This supports findings from qualitative  Family Planning Beliefs and Their Association with Contraceptive Use Dynamics research showing that women reported using contraception for birth spacing to avoid distorting their bodies, postpone aging, and maintain strong, feminine bodies (Duclos et al 2019;Withers et al 2015;Kibira et al 2020). Additionally, qualitative studies among men have identified similar shared ideas, specifically that women who space their births by using contraception are healthier, stronger, and, therefore, more beautiful than women who do not use contraception and give birth more frequently (Withers et al 2015;Kibira et al 2020).…”

“…This supports findings from qualitative research showing that women reported using contraception for birth spacing to avoid distorting their bodies, postpone aging, and maintain strong, feminine bodies (Duclos et al. 2019 ; Withers et al. 2015 ; Kibira et al.…”

“…Additionally, qualitative studies among men have identified similar shared ideas, specifically that women who space their births by using contraception are healthier, stronger, and, therefore, more beautiful than women who do not use contraception and give birth more frequently (Withers et al 2015;Kibira et al 2020). Although the majority of positive messaging about the benefits of contraception have emphasized lowering the risk of maternal morbidity or mortality for both mother and child (Farmer et al 2015;Duclos et al 2019;Morse et al 2014), these results highlight another potential positive message: that spacing children can allow women to maintain physical strength, health, and beauty. We found that this belief was influential at both the individual and community levels, indicating that promoting this message through social networks, in addition to individual messages in counseling, may be particularly effective at increasing contraceptive use among women who wish to prevent pregnancy.…”

“…Instead, many studies rely on nonspecific questions (Stephenson et al 2007;Kaggwa, Diop, and Storey 2008;Cleland, Ndugwa, and Zulu 2011;DeRose et al 2004) while most of the evidence exploring specific contraceptive beliefs has utilized qualitative methods and/or studied small samples, thereby limiting the generalizability of results to larger populations. Finally, the majority of research that has assessed specific beliefs has focused on negative beliefs around family planning, with a very limited body of evidence focused on understanding what women see as potential benefits to contraceptive use (Farmer et al 2015;Duclos et al 2019;Morse et al 2014). As behavior is motivated by both positive and negative beliefs (Ajzen 1991), it is critical to understand not only the negative beliefs that may constrain behavior, but also the relevant positive beliefs that may motivate contraceptive use.…”

Community perceptions of the impact of war on unintended pregnancy and induced abortion in Protection of Civilian sites in Juba, South Sudan

“…South Sudan committed in 2017 to increase contraceptive prevalence to 10% by 2020 (Government of South Sudan, 2017), and reducing unmet need for contraception is a specific objective in its 2019-2029 Reproductive Health Policy. One way to frame the discussion, as recommended in a 2011 study in South Sudan (Pillsbury et al, 2011) and by South Sudanese colleagues during the authors' dissemination of these results in Juba, is with the positive effect of birth spacing on women's and children's health and survival, an appropriate strategy in places where contraception may be sensitive (Duclos et al, 2019;Kane et al, 2016;Post, n.d.), or where post-partum sexual abstinence is traditionally practiced (Pillsbury et al, 2011). It is important that a range of short-and long-acting contraceptive methods be made available at no cost and provided by well-trained staff in a private location.…”