Optimal Birth Spacing: An In-depth Study of Knowledge, Attitudes and Practices

This 34-page study, published by the Catalyst Consortium, an initiative of the United States Agency for International Development (USAID) from 2000 - 2005, examines attitudes and practices around family planning and birth spacing in Egypt. The study was designed to collect and analyse data in three areas:

• knowledge, attitudes, and practices of married women regarding birth spacing;
• roles of husbands and mothers-in-law in decision making regarding birth spacing; and
• opinions and views of family planning and reproductive health care service providers regarding optimal birth spacing practices.

The study found that general knowledge and awareness of the advantages of birth spacing was relatively high, and noted that this was probably due to counselling and television spots.

The study was conducted via 51 focus group discussions with women, men, and reproductive healthcare providers from two peri-urban areas, two urban areas, and two rural areas. While the research found that awareness was relatively high, they also found that this knowledge did not necessarily affect actual practices. Even though women knew the risks, there were many factors that caused them to have another child without optimal spacing (2-3 years). According to the report, some of the counter-arguments included: families want a boy child; waiting for more than two years is more suitable for a working woman; a healthy woman can afford not to wait; financially secure couples do not need to wait; and pregnancies happen according to God's will. The study also found that beliefs around contraceptive use and post-partum contraception were a barrier to optimal child spacing.

The study gives specific recommendations for the public and for health care providers.

For the public: The report recommends designing birth spacing messages for husbands and mothers-in-law, as they are often the main decision makers when it comes to the timing of pregnancy, especially among young wives. They recommend that messages around the risks associated with frequent pregnancies should be described using scientific documentation, and that messages should be integrated into other non-governmental organisations' and women's programmes. They also encourage religious leaders to disseminate to the public accurate information, as well as Islamic teachings related to breastfeeding.

For health care providers: The study recommends increased emphasis on counselling around post-partum contraception and birth spacing, and that providers should be trained in state-of-the-art counselling methods, especially around contraception and the side-effects of various contraceptives. They recommend that service providers promote optimal birth spacing through posters, brochures, and videotapes made available at health facilities. They also suggest organising scientific workshops for physicians and nurses around birth spacing, as well as incorporating optimal birth spacing concepts into the health service delivery system, including medical and nursing school curricula, postgraduate studies, and reproductive health standards.