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THE EFFECT OF PREGNANCY SPACING ON FETAL SURVIVAL AND NEONATAL MORTALITY IN RWANDA: A HECKMAN SELECTION ANALYSIS

Published online by Cambridge University Press:  13 July 2015

Ignace Habimana-Kabano ,
Annelet Broekhuis  and
Pieter Hooimeijer
Ignace Habimana-Kabano*
Affiliation:
University of Rwanda, Kigali-Rwanda
Annelet Broekhuis
Affiliation:
Utrecht University, Utrecht, The Netherlands
Pieter Hooimeijer
Affiliation:
Urban and Regional Research Centre, Utrecht, The Netherlands
*
1Corresponding author. Email: ignace_kabano@yahoo.fr
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Summary

Most studies on birth intervals and infant mortality ignore pregnancies that do not result in live births. Yet, fetal deaths are important in infant mortality analyses for three reasons: ignoring fetal deaths between two live births lengthens the measured interval between births, implying that short intervals are underestimated; the recommended inter-pregnancy interval (IPI) after a fetal loss is shorter (6 months) than after a live birth (24 months), as the effect of IPI on outcomes might differ according to the previous type of pregnancy outcome; fetal death will selectively reduce the population at risk of neonatal mortality, leading to biased results. This study uses the Heckman selection model to simultaneously estimate the combined effect of IPI duration and the type of pregnancy outcome at the start of the interval on pregnancy survival and neonatal mortality. The analysis is based on retrospective data from the Rwanda Demographic Health Surveys of 2000, 2005 and 2010. The results show a significant selection effect. After controlling for the selection bias, short (<6 months) and long (>60 months) intervals after a fetal death reduce the chances of pregnancy survival, but no longer have an effect on neonatal mortality. For intervals starting with a live birth, the reverse is true. Short intervals (<24 months) do not affect pregnancy survival but increase the odds of neonatal mortality. If the previous child died in infancy, the highest odds are found for neonatal death regardless of the IPI duration.

Type
Research Article
Information
Journal of Biosocial Science , Volume 48 , Issue 3 , May 2016 , pp. 358 - 373
Copyright
Copyright © Cambridge University Press, 2015 

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References

Allen, L. H. (2005) Multiple micronutrients in pregnancy and lactation: an overview. American Journal of Clinical Nutrition 81(5), 12065–12125.CrossRefGoogle ScholarPubMed
Anderson, A-M. N., Wohlfahrt, J., Christens, P. & Melbye, M. (2000) Maternal age and fetal loss: population based register linkage study. British Medical Journal 320, 1708–1712.CrossRefGoogle Scholar
Barbier, J. S., Axinn, W. G. & Thornton, A. (1999) Unwanted childbearing, health, and mother–child relationships. Journal of Health and Social Behavior 40, 231–257.Google Scholar
Basinga, P., Gertler, P. J., Binagwaho, A., Soucat, A. L. B., Sturdy, J. R. & Vermeersch, C. H. J. (2010) Paying primary health care centers for performance: Rwanda, The World Bank Human Development Network. Policy Research Working Papers 5190, Washington.Google Scholar
Basinga, P., Moore, A. M., Singh, S.D., Carlin, E. E., Birungi, F. & Ngabo, F. (2012) Abortion incidence and post-abortion care in Rwanda. Studies in Family Planning 43(1), 11–20.Google Scholar
Basso, O., Olsen, J., Knudsen, L. B. & Christensen, K. (1998) Low birth weight and preterm birth after short inter-pregnancy intervals. American Journal of Obstetrics & Gynecology 178, 259–263.CrossRefGoogle Scholar
Bhalotra, S. & Van Soest, A. (2007) Birth spacing, fertility and neo-natal mortality in India; dynamics, frailty and fecundity. CMPO Working Paper Series No. 07/168, Bristol. URL: http://www.bris.ac.uk/Depts/CMPO/workingpapers/wp168.Pdf CrossRefGoogle Scholar
Binagwaho, A., Hartwig, R., Ingeri, D. & Makaka, A. (2012) Mutual health insurance and its contribution to improving child health in Rwanda. Passauer Diskussionspapiere, Volkswirtschaftliche Reihe, No. V-66-12.Google Scholar
Cleary-Goldman, J., Malone, F. D., Vidaver, J., Ball, R. H., Nyberg, D. A., Comstock, C. H. et al. (2005) Impact of maternal age on obstetric outcome. Obstetrics & Gynecology 105(5), 983–990.Google Scholar
Conde-Agudelo, A., Belizán, J. M., Breman, R., Brockman, S. C. & Rosas-Bermudez, A. (2005) Effect of the interpregnancy interval after an abortion on maternal and perinatal health in Latin America. International Journal of Gynecology and Obstetrics 89, 534–540.Google Scholar
Conde-Agudelo, A., Rosas-Bermodez, A., Castaño, F. & Norton, M. H. (2012) The effect of birth spacing on maternal, perinatal, infant and child health: a systematic review of causal mechanisms. Studies in Family Planning 43(2), 93–114.CrossRefGoogle ScholarPubMed
Conde-Agudelo, A., Rosas-Bermudez, A. & Kafury-Goeta, A. C. (2006) Birth spacing and risk of adverse perinatal outcomes: a meta-analysis. Journal of the American Medical Association 295(15), 1809–1823.Google Scholar
DaVanzo, J., Hale, L., Razzaque, A. & Rahman, M. (2007) Effects of Inter-Pregnancy Interval and Outcome of the Preceding Pregnancy on Pregnancy Outcomes in Matlab, Bangladesh. Labor and Population Program, the RAND Corporation, Santa Monica, CA, USA.Google Scholar
DaVanzo, J., Hale, L., Razzaque, A. & Rahman, M. (2008) The effects of pregnancy spacing on infant and child mortality in Matlab, Bangladesh: how they vary by the type of pregnancy outcome that began the interval. Population Studies 62(2), 131–154.Google Scholar
DaVanzo, J., Hale, L., Razzaque, A. & Rahman, M. (2012) How long after a miscarriage should women wait before becoming pregnant again? Multivariate analysis of cohort data from Matlab, Bangladesh. Biomedical Journal Open doi: 10.1136 /bmjopen-2012-001591.Google ScholarPubMed
Den Draak, M. (2003) Early Life Changes. Transition in Pregnancy and Birth Outcome in South India. Rosenberg Publishers, Amsterdam.Google Scholar
Dewey, K. G. & Cohen, R. J. (2004) Birth Spacing Literature Review: Maternal and Child Nutrition Outcomes. Draft report, CATALYST Consortium.Google Scholar
Heckman, J. (1979) Sample selection bias as a specification error. Econometrica 47, 153–161.Google Scholar
Ibisomi, L. (2008) Pregnancy termination in sub-Saharan Africa: the need for refined data. International Journal of Health Research 1(4), 207–224 (e147p70-88).Google Scholar
Jolie, M., Sebire, N., Harris, J., Robinson, S. & Regan, L. (2000) The risks associated with pregnancy in women aged 35 years or older. Human Reproduction 15(11), 2433–2437.Google Scholar
Khanal, V., Gavida, T., Adhikari, M., Misra, S. R. & Karkee, R. (2014) Poor thermal care practices among home births in Nepal. Further analysis of Nepal Demographic and Health Survey 2011. PLoS One 92, e89950.CrossRefGoogle Scholar
King, J. C. (2003) The risk of maternal nutritional depletion and poor outcomes increases in early or closely spaced pregnancies. Journal of Nutrition 133(5), 17325–17365.Google Scholar
Kozuki, N., Lee, A. C. C., Silveira, M. F., Victora, C. G., Adair, L., Humphrey, J. et al. (2013) The association of birth intervals with small-for-gestational-age, preterm and neonatal and infant mortality: a metastudy. BioMedCentral Public Health 13 (supplement 3), 53. http://www.biomedcentral.com/1471-2458/13/S3/S3 Google Scholar
Lawn, J. E., Wilczynska-Ketende, K. & Cousens, S. N. (2006) Estimating the causes of 4 million neonatal deaths in the year 2000. International Journal of Epidemiology 35, 706–718.Google Scholar
Lindström, D. P. & Kiros, G.-E. (2007) The impact of infant and child death on subsequent fertility in Ethiopia. Population Resources Policy Review 26, 31–49.CrossRefGoogle Scholar
Love, E. R., Bhattacharya, B., Smith, N. C. & Bhattacharya, S. (2010) Effect of interpregnancy interval on outcomes of pregnancy after miscarriage: retrospective analysis of hospital episode statistics in Scotland. Biomedical Journal 341, c3967.Google ScholarPubMed
Lu, C., Chin, B., Lewandowski, J. L., Basinga, P., Hirschhorn, L. R., Hill, K. et al. (2012) Towards universal health coverage: an evaluation of Rwanda Mutuelles in its first eight years. PLoS One 7, 1–16. doi: 10.1371/journal.pone.0039282.Google Scholar
McKinnon, B., Harper, S., Kaufman, J. S. & Bergesin, Y. (2014) Socio-economic inequality in neonatal mortality in countries with low and middle income: a multi country analysis. Lancet Global Health 2(3), e165–e173.CrossRefGoogle Scholar
Makhlouf, M. A., Clifton, R. G., Roberts, J. M. et al. (2013) Adverse pregnancy outcomes among women with prior spontaneous or induced abortions. American Journal of Perinatology 31(9), 765–772.Google Scholar
Miller, J. E. (1991) Birth intervals and perinatal health: an investigation of three hypotheses. Family Planning Perspectives 23, 62–70.Google Scholar
MINECOFIN (2000) Rwanda Vision 2020. Ministry of Finance and Economic Planning, Kigali, Republic of Rwanda.Google Scholar
MINECOFIN(2007) Economic Development and Poverty Reduction Strategy 2008–2012. Ministry of Finance and Economic Planning, Kigali, Republic of Rwanda.Google Scholar
MINECOFIN(2013) Economic Development and Poverty Reduction Strategy 2013–2018: Shaping our Development. Ministry of Finance and Economic Planning, Kigali, Republic of Rwanda.Google Scholar
Mosley, W. H. & Chen, L. C. (1984) An analytical framework for the study of child survival in developing countries. Population and Development Review 10 (supplement), 25–49.Google Scholar
Mutunga, C. J. (2004) Environmental Determinants of Child Mortality in Urban Kenya. University of Nairobi, Kenya.Google Scholar
NISR, MoH & ORC Macro (2012) Rwanda Demographic and Health Survey 2010. National Institute of Statistics of Rwanda, Ministry of Health, Kigali, and ORC Macro International, Calverton, MD, USA.Google Scholar
NISR & ORC Macro (2006) Rwanda Demographic and Health Survey 2005. National Institute of Statistics of Rwanda, Kigali, and ORC Macro, Calverton, MD, USA.Google Scholar
Norton, M. (2005) New evidence on birth spacing: promising findings for improving new born, infant, child and maternal health. International Journal of Gynecology and Obstetrics 89, 51–56.CrossRefGoogle Scholar
Rutstein, S. O. (2008) Further evidence of the effects of preceding birth intervals on neonatal, infant, and under-five-years mortality and nutritional status in developing countries: evidence from the Demographic and Health Surveys. Demographic and Health Research. DHS Working Paper No. 41, Macro International, Calverton, MD.Google Scholar
Santelli, J., Rochat, R., Hatfield, K., Timajchy, B., Colley, G., Curtis, K. et al. (2003) The measurement and meaning of unintended pregnancy. Perspectives on Sexual and Reproductive Health 35(2), 94–101.CrossRefGoogle ScholarPubMed
Sartori, A. E. (2003) An estimator for some binary-outcome selection models without exclusion restrictions. Political Analysis 11, 111–138.CrossRefGoogle Scholar
Smith, G. C., Pell, J. P. & Dobbie, R. (2003) Inter-pregnancy interval and risk of preterm birth and neonatal death: retrospective cohort study. British Medical Journal 327, 313–318.Google Scholar
Smits, L. J. M. & Essed, G. G. M. (2001) Short inter-pregnancy intervals and unfavorable pregnancy outcome: role of folate depletion. The Lancet 358, 2074–2077.CrossRefGoogle Scholar
Spiers, P. S., Onstand, L. & Guntheroth, W. G. (1996) Negative effect of a short interpregnancy interval on birth weight following loss of an infant to sudden infant death syndrome. American Journal of Epidemiology 143, 1137–1141.Google Scholar
Steer, P. (2007) Getting pregnant again too quickly (Editor’s choice). British Journal of Obstetrics and Gynaecology 114, i–ii.Google Scholar
Stephansson, O., Dickman, P. W. & Cnattingius, S. (2003) The influence of interpregnancy interval on the subsequent risk of stillbirth and early neonatal death. Obstetrics & Gynecology 102(1), 101–108.Google Scholar
Van Geertruyden, J. P., Thomas, F., Erhart, A. & D’Alessandro, U. (2004) The contribution of malaria in pregnancy to perinatal mortality. American Journal of Tropical Medicine and Hygiene 71 (supplement 2), 35–40.Google Scholar
WHO (1997) Thermal Protection of the Newborn: A Practical Guide. RHT/MSM/97.2. WHO, Geneva.Google Scholar
WHO(2005) Report of a WHO Technical Consultation on Birth Spacing. WHO, Geneva.Google Scholar
Winkvist, A., Rasmussen, K. M. & Habicht, J-P. (1992) A new definition of maternal depletion syndrome. American Journal of Public Health 82(5), 691–694.Google Scholar
Zhu, Bao-Ping, Grigorescu, V., Thu, Le et al. (2006) Labor dystocia and its association with interpregnancy interval. American Journal of Obstetrics and Gynecology 195(1), 121–128.Google Scholar
Zhu, Bao-Ping, Rolfs, R. T., Nangle, B. E. & Horan, J. M. (1999) Effect of the interval between pregnancies on perinatal outcomes. New England Journal of Medicine 340(8), 589–594.CrossRefGoogle ScholarPubMed