Short interpregnancy interval: circumstance or choice?

Abstract

IntroductionDespite the knowledge of pregnancy risks attributable to inadequate birth spacing, over one-third of pregnancies occur within 18 months of a preceding birth. In this qualitative study we sought to interview women with a short interpregnancy interval (sIPI) to explore their knowledge of contraception and birth spacing and their experience of counselling on these themes.MethodsWe conducted in-depth interviews with women with a sIPI (live-birth less than 18 months prior to conception of current pregnancy) at Royal Prince Alfred Hospital and Canterbury Hospital in Sydney, Australia. Women were recruited at the second antenatal visit or day 3 postpartum. Interviews were recorded and transcribed. The six-phase thematic analysis framework described by Braun and Clarke was used to perform qualitative data analysis.ResultsTwenty women were interviewed (IPI range: 3–18 months). The three central themes that arose were that perceptions of IPIs are shaped by individual circumstances, a lack of information from healthcare providers (HCPs) on IPI and contraception limited women’s ability to make informed decisions, and that reproductive life planning is an important element of pregnancy care.ConclusionsIn this study, women with a sIPI did not feel informed about birth spacing, had poor knowledge of reliable contraceptives, and remained at risk of further closely spaced pregnancies. There was a desire among women with a sIPI to receive clear and consistent education on these topics. HCPs need to do more to educate women in the antenatal and postnatal period to help them space their pregnancies appropriately.

Understanding women’s views of and preferences for accessing postpartum contraception: a qualitative evidence synthesis

“…Of the 19 studies included in the QES (table 3), 15 were qualitative and four were mixed methods studies. Most (thirteen) were from the USA,33–45 three from the UK,46–48 two from Australia,49 50 and one from Canada 50. All of the studies included English-speaking participants; six studies34 35 37 38 40 43 also included Spanish-speaking women, and one study included Pashto or Urdu-speaking women 35.…”

“…Table 1 describes the assessment of methodological limitations. No significant concerns were identified, besides a lack of reporting of researcher reflexivity across 17 of the papers 33–37 39–50. There were no concerns regarding coherence of findings.…”

“…One study reported that the majority of women wanted postpartum contraception,50 although some women did not use it due to an ambivalence about future pregnancies 39 50. For other women, misconceptions or low health literacy impeded access to or comfort with contraception,38 39 43 46 49 50 especially in adolescent populations 39 43. Misconceptions included the criteria for using lactational amenorrhoea effectively,34 38 49 50 intrauterine devices (IUDs) contributing to infertility,39 50 and that IUDs could not be inserted in the immediate postpartum period 46.…”

The synergistic effects of short inter-pregnancy interval and micronutrients deficiency on third-trimester depression

“…Nutritional interventions are relatively cheap, easy to manage, and generally accepted by patients. Studies have shown that women with short IPI do not know about birth spacing, know little about reliable contraceptives ( 49 ), and still face the risk of further intensive pregnancy. Therefore, for these women, more guidance is needed to help them properly arrange pregnancy time, promote the use of contraceptives and popularize reproductive health education.…”

Improving Access to and Quality of Postpartum Contraception Provision

“…This short interval places the subsequent pregnancy at higher risk of complications such as preterm birth, low birthweight infants, and neonatal death 5 —a fact that women are often not made aware of by maternity providers. 6 It is for this reason that the World Health Organization recommends an optimal birth spacing of 2 years between pregnancies. 7 Many pregnancies that do occur during this time are unintended.…”