Community Factors Influencing Birth Spacing among Married Women in Uganda and Zimbabwe Open Access

Abstract

Sub-optimal birth spacing continues to be a problem in Uganda and Zimbabwe, resulting in negative infant, child, and maternal health outcomes. This study investigates community-level influences on birth spacing outcomes among women aged 15-49 in Uganda and Zimbabwe. The data used in this analysis were from nationally representative Demographic and Health Surveys conducted in 2011 (Uganda) and 2010-2011 (Zimbabwe). The analysis builds upon previous research that moves beyond individual and household variables to examine community-level influences on reproductive health outcomes. Women living in communities with higher maternal age, age at marriage, and parity were significantly more likely to have longer birth spacing. High community levels of contraceptive use and low levels of unmet need were associated with optimal birth spacing. The significance of community-level demographic and fertility norms, gender norms, economic prosperity, and family planning behaviors demonstrate the broad influence of community variables on birth spacing outcomes. This analysis highlights the importance of moving beyond individual and household-level interventions in order to harness the power of contextual influences on birth spacing.

Table of Contents

CHAPTER 1: INTRODUCTION 1

Achieving the Millennium Development Goals 1

Unmet Need and Birth Spacing Issues 3

Ramifications of the Problem 5

Public Health Implications 6

Aims and Objectives: 8

Objective: 8

Aims: 8

CHAPTER 2: MANUSCRIPT 9

Introduction 11

Methods 14

Demographic and Health Surveys, Uganda and Zimbabwe 14

Measures of Community-Level Impact 16

Community Demographics and Fertility Norms 17

Community Economic Prosperity 18

Community Gender Norms 18

Community Family Planning Behavior 19

Individual Measures and Analysis 19

Results 20

Discussion: 24

Conclusion: 26

Tables and Figures: 27

Table 1: Definition and Distribution of Community-Level Variables 27

Table 2: Distribution of Sample Characteristics of Women in Uganda and Zimbabwe 28

Table 3: Results of Linear Regression Regarding Birth Spacing Outcomes, Uganda and Zimbabwe, DHS 30

Table 4: Results of Multilinear Regression Regarding Birth Spacing Outcomes, Uganda DHS (2011) and Zimbabwe DHS (2010-2011) 32

CHAPTER 3: PUBLIC HEALTH IMPLICATIONS 36

CHAPTER 4: REFERENCES 39

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	contextual influences birth spacing maternal health infant health
Committee Chair / Thesis Advisor	Stephenson, Robert, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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