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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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