Apstrakt
Background: Birth spacing, especially between first and second births, could impact on fertility, and on maternal and child health. While the interval between marriage and first-birth has been widely studied, information on intervals between first and second births (SBI) and its determinants is scarce. We investigated the timing of second childbirth and its determinants among women in Nigeria.
Methods: Using the 2013 Nigeria Demographic and Health Survey, we analysed data on 27451 women of reproductive age who had reported at least one childbirth as of the survey date. We used Kaplan-Meier survival analysis and Cox proportional-hazard regression with 95% confidence interval (CI) computed. Results: The median SBI among women in Nigeria was 34 months (CI: 33.7–34.3). The hazard of second-birth was higher among women from rural (HR=1.161; CI: 1.13-1.19) compared to those from the urban areas. While women living in other regions had tendencies to shorten SBI compared with the North Central, those from South West were 9% (aHR=0.91; CI: 0.86–0.96) less likely to delay it. For every one year age-at-first-birth delayed among women, the hazard of second-birth increased by 1.9%. Wealth status, contraceptive use, being employed, higher education among women and spouses, and first-child survival are protective of SBI.
Conclusions: Contraceptive use, being employed, living in an urban area, belonging to higher wealth quintile and higher educational attainment could lead to longer second birth interval which could lead to a healthier child, safer motherhood, and reduced fertility. Women should be encouraged to delay SBI as a fertility-control-strategy.
Keywords: Hazard ratio, Second birth interval, Kaplan Meier, Cox-regression, Median survival time.
Résumé
Contexte : L’espacement des naissances, en particulier entre la première et la deuxième naissance, pourrait avoir un impact sur la fertilité et sur la santé maternelle et infantile. Bien que l’intervalle entre le mariage et la première naissance ait été largement étudié, les informations sur les intervalles entre la première et la deuxième naissance (DN) et ses déterminants sont rares. Nous avons étudié le moment du deuxième accouchement et ses déterminants chez les femmes au Nigéria.
Méthodes :En utilisant l’Enquête Démographique et de Santé au Nigéria de 2013, nous avons analysé les données sur 27451 femmes en âge de procréer qui avaient déclaré au moins un accouchement à la date de l’enquête.Nous avons utilisé l’analyse de survie de Kaplan-Meier et la régression à risque proportionnel de Cox avec un intervalle de confiance (IC) à 95% calculé.
Résultats : La DN médiane chez les femmes au Nigeria était de 34 mois (IC : 33,7–34,3). Le risque de deuxième naissance était plus élevé chez les femmes des zones rurales (HR = 1,161; IC : 1,13-1,19) par rapport à celles des zones urbaines. Alors que les femmes vivant dans d’autres régions avaient tendance à raccourcir la DN par rapport à celles du centre-nord, celles du sud-ouest étaient 9% fois (aHR = 0,91 ; IC : 0,86-0,96) moins susceptibles de la retarder. Pour chaque âge d’un an à la première naissance retardé chez les femmes, le risque de deuxième naissance a augmenté de 1,9%. Le statut de richesse, l’utilisation de contraceptifs, le fait d’être employé, l’enseignement supérieur chez les femmes et les conjoints et la survie du premier enfant sont protectives à la DN.
Conclusions : L’utilisation de contraceptifs, le fait d’être employé, de vivre dans une zone urbaine, appartenant à un quintile de richesse plus élevé et à un niveau de scolarité plus élevé pourraient conduire à un deuxième intervalle de naissance plus long, ce qui pourrait conduire à un enfant en meilleure santé, à une maternité plus sûre et à une fertilité réduite. Les femmes devraient être encouragées à retarder la DN en tant que stratégie de contrôle de la fertilité.
Mots - clés : Hazard ratio, Second intervalle de naissance, Kaplan Meier, Cox-régression, Durée médiane de survie.
Correspondence: Dr. A.F. Fagbamigbe, Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan,Nigeria. E-mail: fadeniyi@cartafrica.org.
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