Timing Births

Why it is important?

• Too many births, births too close together and births to adolescent girls under 18 and women over 35 endanger the lives of women and adolescents and their infants.
• Family planning is one of the most effective ways to improve women's and children's health and survival. Family planning services provide women and men with information, education and the means to plan when to begin having children, how many to have, how far apart to have them and when to stop. However, millions of women of childbearing age, including adolescent girls, do not have control over limiting pregnancies or spacing births, nor do they have access to effective family planning methods.
• Both women and men have the right to choose how many children to have and when to have them. With family planning services they are enabled to make informed decisions on pregnancy by taking into account the benefits and risks, including those related to age and level of access to health services.
• Ensuring access to family planning services for women and men, and to education for all children would help prevent many maternal and child deaths and disabilities, particularly in countries where marriage occurs early in life. Together these measures can contribute to women's, adolescent girls' and children's right to survival, health and well-being.

What every family and community has a right to know?

1. Pregnancy before the age of 18 or after the age of 35 increases the health risks for the mother and her baby.
2. For the health of both mothers and children, a woman should wait until her last child is at least 2 years old before becoming pregnant again.
3. The health risks of pregnancy and childbirth increase if a woman has had many pregnancies.
4. Family planning services provide men and women of childbearing age with the knowledge and the means to plan when to begin having children, how many to have, how far apart to have them and when to stop. There are many safe, effective and acceptable methods of planning for and avoiding pregnancy.
5. Both men and women, including adolescents, are responsible for family planning. Both partners need to know about the health benefits of family planning and the available options.

Supporting Information

Key messages - Pregnancy before the age of 18 or after the age of 35 increases the health risks for the mother and her baby.

• Every year over 500,000 women die from pregnancy and childbirth complications. For every woman who dies, approximately 20 more develop infections and severe disabling problems – adding up to more than 10 million women affected each year. Access to and use of family planning services could prevent many of these deaths and disabilities.
• Throughout this publication, references to pregnant women include pregnant adolescents.
• It is important to note that the pregnant adolescent is at increased risk of pregnancy complications such as eclampsia, premature labour, prolonged labour, obstructed labour, fistula, anaemia and death.
• For her baby, there is a greater risk of premature birth, low birthweight, health problems and death.
• For the pregnant adolescent under 15 years of age, these risks increase substantially.
• Delaying a first pregnancy until a girl is at least 18 years of age helps to ensure a safer pregnancy and childbirth. It reduces the risk of her baby being born prematurely and/or underweight. This is especially important where early marriage is the custom and married adolescents face pressure to become pregnant.
• Childbirth is more likely to be difficult and dangerous for an adolescent than for an adult. Babies born to very young mothers are much more likely to die in the first year of life. Young adolescents do not yet have a fully developed pelvis. Pregnancy for them can result in serious consequences, such as eclampsia, premature labour, prolonged labour, obstructed labour, fistula, anaemia (thin blood) or infant and/or maternal death.
• The younger the mother is, the greater the risk to her and her baby. The risk of maternal death related to pregnancy and childbirth for adolescent girls between 15 and 19 years of age accounts for some 70,000 deaths each year. For adolescents under 15 years of age these risks increase substantially. Girls who give birth before age 15 are five times more likely to die in childbirth than women in their twenties.
• Adolescent girls and young women, married or unmarried, need special help to delay pregnancy. All who might be involved with an early pregnancy – adolescent girls and young women and adolescent boys and men as well as their families – should be aware of the risks involved and how to avoid them. This should include information on how to prevent sexually transmitted infections (STIs), including HIV.
• After the age of 35, the health risks associated with pregnancy and childbirth begin to increase again. The risks may include hypertension (high blood pressure), haemorrhage (loss of blood), miscarriage and gestational diabetes (diabetes during pregnancy) for the woman and congenital anomalies (birth defects) for the child.

Key messages - For the health of both mothers and children, a woman should wait until her last child is at least 2 years old before becoming pregnant again

• The risk of death for newborns and infants increases significantly if the births are not spaced. There is a higher chance that the new baby will be born too early and weigh too little. Babies born underweight are less likely to grow well, more likely to become ill and four times more likely to die in the first year of life than babies of normal weight.
• One of the threats to the health and growth of a child under age 2 is the birth of a sibling. For the older child, breastfeeding may stop, and the mother has less time to prepare the foods and provide the care and attention the child needs.
• Whenever a new baby comes into the family, it is important for the father to help the mother with the new baby and the other children. Both mothers and fathers and other caregivers should give equal attention and care to both girls and boys.
• A mother's body needs time to recover fully from pregnancy and childbirth. She needs to regain her health, nutritional status and energy before she becomes pregnant again.
• If a woman has a miscarriage or abortion, she should wait at least six months before becoming pregnant again in order to reduce the risk to herself and her baby.
• To protect the health of their families, men as well as women need to be aware of the importance of (1) a two-year space between the birth of the last child and the beginning of the next pregnancy and (2) the need to limit the number of pregnancies.

Key messages - The health risks of pregnancy and childbirth increase if a woman has had many pregnancies.

• A woman's body can easily become exhausted by repeated pregnancies, childbirth and caring for small children. After many pregnancies, she faces an increased risk of serious health problems such as anaemia and haemorrhage.

Key messages - Family planning services provide men and women of childbearing age with the knowledge and the means to plan when to begin having children, how many to have, how far apart to have them and when to stop. There are many safe, effective and acceptable methods of planning for and avoiding pregnancy.

• Trained health workers and clinics should offer information and advice to empower women to make decisions about family planning and to help women and men choose a family planning method that is acceptable, safe, convenient, effective and affordable.
• Trained health workers and clinics should also provide adolescent girls and boys with reproductive health information and family planning services that are (1) sensitive to adolescents and (2) geared to help them develop their skills to make healthy and responsible life decisions.
• Special channels to reach out to adolescent girls and pregnant adolescents need to be developed to provide them with the support which may include counselling, contraceptives, and prenatal and post-natal services. Pregnant adolescents require special attention and more frequent visits to the health clinic for prenatal and post-natal care.
• Adolescent boys and men can play a key role in preventing unplanned (unintended) pregnancies. It is important that they have access to information and services related to sexual and reproductive health.
• The more formal education an adolescent girl or woman has, the more likely she is to use reliable family planning methods, delay marriage and childbearing, be better off economically and have fewer and healthier babies. Enrolling and keeping girls in school is therefore extremely important for maternal and child health, in addition to all the other benefits of education.
• Of the various contraceptive methods, only condoms protect against both pregnancy and sexually transmitted infections, including HIV.
• It is critical to educate adolescent boys, young men and men on their responsibility regarding condom use. Adolescent girls and boys, married or unmarried, need to know about the dual protection of a condom and another kind of contraception (using two methods of contraception at the same time) to help avoid pregnancy and prevent sexually transmitted infections (STIs), including HIV.
• In some countries, deaths related to abortion are high among adolescent girls. Adolescent girls, young women and their partners should be provided with information on pregnancy prevention and the risks associated with abortion.
• A mother who feeds her baby only with breast milk, on demand day and night during the baby's first six months, can delay the return of menstruation and help prevent pregnancy. There is a small chance that she can become pregnant before her periods return. The risk is less than 2 per cent, which is similar to that of other family planning methods. However, this risk increases after six months.

Key messages - Both men and women, including adolescents, are responsible for family planning. Both partners need to know about the health benefits of family planning and the available options.

• Men and women, including adolescents, must take responsibility for preventing unplanned pregnancies. They should seek advice and have access to information from a trained health worker on the various methods and benefits of family planning.
• Information can be obtained from a doctor, nurse, midwife, maternity centre or family planning clinic. In some places, a teacher, a youth organization or a women's organization may also be able to provide this information.

Source: Unicef