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

  • Pimentel, Juan1, 2, 3
  • Ansari, Umaira4
  • Omer, Khalid4
  • Gidado, Yagana5
  • Baba, Muhd Chadi5
  • Andersson, Neil1, 4
  • Cockcroft, Anne1, 4
  • 1 McGill University, 5858 Chemin de la Côte-des-Neiges 3rd Floor, Suite 300, Montreal, Quebec, H3S 1Z1, Canada , Montreal (Canada)
  • 2 Universidad de La Sabana, Campus Universitario puente del común, Chía, CP, 250001, Colombia , Chía (Colombia)
  • 3 Universidad del Rosario, Carrera 24 # 63 C 69, Bogotá, Colombia , Bogotá (Colombia)
  • 4 Universidad Autónoma de Guerrero, Calle Pino s/n Colonia El Roble, Acapulco, Guerrero, 39640, Mexico , Acapulco (Mexico)
  • 5 Federation of Muslim Women Association of Nigeria (FOMWAN), Bauchi, Nigeria , Bauchi (Nigeria)
Published Article
BMC Pregnancy and Childbirth
Springer (Biomed Central Ltd.)
Publication Date
Mar 12, 2020
DOI: 10.1186/s12884-020-2852-z
Springer Nature


BackgroundThere is ample evidence of associations between short birth interval and adverse maternal and child health outcomes, including infant and maternal mortality. Short birth interval is more common among women in low- and middle-income countries. Identifying actionable aspects of short birth interval is necessary to address the problem. To our knowledge, this is the first systematic review to systematize evidence on risk factors for short birth interval in low- and middle-income countries.MethodsA systematic mixed studies review searched PubMed, Embase, LILACS, and Popline databases for empirical studies on the topic. We included documents in English, Spanish, French, Italian, and Portuguese, without date restriction. Two independent reviewers screened the articles and extracted the data. We used the Mixed Methods Appraisal Tool to conduct a quality appraisal of the included studies. To accommodate variable definition of factors and outcomes, we present only a narrative synthesis of the findings.ResultsForty-three of an initial 2802 documents met inclusion criteria, 30 of them observational studies and 14 published after 2010. Twenty-one studies came from Africa, 18 from Asia, and four from Latin America. Thirty-two reported quantitative studies (16 studies reported odds ratio or relative risk, 16 studies reported hazard ratio), 10 qualitative studies, and one a mixed-methods study. Studies most commonly explored education and age of the mother, previous pregnancy outcome, breastfeeding, contraception, socioeconomic level, parity, and sex of the preceding child. For most factors, studies reported both positive and negative associations with short birth interval. Shorter breastfeeding and female sex of the previous child were the only factors consistently associated with short birth interval. The quantitative and qualitative studies reported largely non-overlapping results.ConclusionsPromotion of breastfeeding could help to reduce short birth interval and has many other benefits. Addressing the preference for a male child is complex and a longer-term challenge. Future quantitative research could examine associations between birth interval and factors reported in qualitative studies, use longitudinal and experimental designs, ensure consistency in outcome and exposure definitions, and include Latin American countries.Trial registrationProspectively registered on PROSPERO (International Prospective Register for Systematic Reviews) under registration number CRD42018117654.

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