The Association of Contraceptive Use, Non-Use, and Failure with Child Health


  • Jocelyn E Finlay Harvard University



Contraceptive use, birth interval, child health outcomes, Demographic and Health Surveys, infant mortality.


Objective: To examine the association of contraceptive use in the interpregnancy interval with subsequent child health outcomes in low- and middle-income countries.
Design: A cross-sectional analysis of nationally representative household samples was performed. A modified Poisson regression model was used to estimate unadjusted and adjusted relative risk ratios for high prevalence outcomes.
Setting: Low- and middle-income countries.
Population: Births to women aged 12-49 years for which this birth occurred 12-79 months prior to the interview were included. The sample for analysing infant mortality was comprised of 453,795 children from 35 low- and middle-income countries across 67 Demographic and Health Surveys conducted between 1990 and 2011.
Main Outcome Measures: Infant mortality, stunting, underweight, wasting, diarrhoea, and anaemia.
Results: Contraceptive use in the interpregnancy interval, even if contraceptive failure resulted in birth, had a positive effect on all child health outcomes compared to non-use of contraception in the interpregnancy interval. The positive effect of contraceptive use was the lengthening of the interpregnancy interval, but it also had a direct positive effect on child health, independent of birth interval.
Conclusions: Extending the interval between births had a positive effect on child health outcomes, and contraceptive use had a positive effect on child health independent of the birth spacing effect. Additionally, contraceptive failure did not adversely affect child health outcomes.

Author Biography

Jocelyn E Finlay, Harvard University

Harvard Centre for Population and Development Studies


[1] Bongaarts J, Maulden WP, Phillips JF. The demographic impact of family planning programs. Stud Fam Plann 1990; 21(6): 299-10.
[2] Canning D, Finlay JE. The effect of fertility on female labor supply in Africa: Estimating treatment effects with a hazard of treatment. In: Sixth Annual PopPov Conference on Population, Reproductive Health, and Economic Development: Accra, Ghana 2012.
[3] Bloom DE, Canning D, Fink G, Finlay JE. Fertility, female labor force participation, and the demographic divided. J Econ Growth 2009; 14: 79-101.
[4] Cleland J, Bernstein S, Ezeh A, Faundes A, Glasier A, Innis J. Sexual and reproductive health 3 - Family planning: The unfinished agenda. Lancet 2006; 368: 1810-27.
[5] Yeakey MP, Muntifering CJ, Ramachandran DV, Myint Y, Creanga AA, Tsui AO. How contraceptive use affects birth

intervals: Results of a literature review. Stud Fam Plann 2009; 40(3): 205-14.
[6] Joshi S, Schultz P. Family planning as an investment in development: Evaluation of a program’s consequences in Matlab, Bangladesh. Working papers 951. New Haven, CT: Economic Growth Center, Yale University 2007.
[7] Cleland J, Conde-Agudelo A, Peterson H, Ross J, Tsui A. Contraception and health. Lancet 2012; 380: 149-56.
[8] Ahmed S, Li QF, Liu L, Tsui AO. Maternal deaths averted by contraceptive use: An analysis of 172 countries. Lancet 2012; 380: 111-25.
[9] Lancet 2012; 380(9837): Entire issue.
[10] Canning D, Schultz TP. The economic consequences of reproductive health and family planning. Lancet 2012; 380: 165-71.
[11] Carr B, Gates MF, Mitchell A, Shah R. Giving women the power to plan their families. Lancet 2012; 380: 80-2.
[12] Cleland J, Conde-Agudelo A, Peterson H, Ross J, Tsui A. Contraception and health. Lancet 2012; 380: 149-56.
[13] Habumuremyi PD, Zenawi M. Making family planning a national development priority. Lancet 2012; 380: 78-80.
[14] Horton R, Peterson HB. The rebirth of family planning. Lancet 2012; 380: 77.
[15] Shiffman J, Quissell K. Family planning: A political issue. Lancet 2012; 380: 181-5.
[16] Watts G. Amy Tsui: Population expert for whom people count. Lancet 2012; 380: 100.
[17] Ananat EO, Hungerman DM. The power of the pill for the next generation: Oral contraception's effects on fertility, abortion, and maternal and child characteristics. Rev Econ Stat 2012; 94: 37-51.
[18] Bongaarts J, Mauldin WP, Phillips JF. The demographic impact of family planning programs. Stud Fam Plann 1990; 21: 299-10.
[19] Bloom DE, Canning D, Fink G, Finlay JE. Microeconomic foundations of the demographic divided. Mimeo 2011.
[20] Bloom DE, Canning D. Contraception and the Celtic tiger. Econ Soc Rev 2003; 34: 229-47.
[21] Trussell J, Pebley AR. The potential impact of changes in fertility on infant, child, and maternal mortality. Stud Fam Plann 1984; 15: 267-80.
[22] Jain AK. Measuring the effect of fertility decline on the maternal mortality ratio. Stud Fam Plann 2011; 42: 247-60.
[23] Lee R, Mason A. Fertility, human capital, and economic growth over the demographic transition. Mimeo 2008.
[24] Lee R, Mason A, Miller T. Life cycle saving and demographic transition: The case of Taiwan. Popul Dev Rev 2000; 26(Supp.): 194-19.
[25] Mason A. Population growth, aggregate saving and economic development. In: Salvatore D, Ed. World population trends and their impact on economic development. London: Greenwood Press 1988; pp. 45-58.

[26] Bloom DE, Canning D, Fink G, Finlay JE. The effect of fertility on economic growth. Mimeo 2008.
[27] Kalemli-Ozcan S, Ryder HE, Weil DN. Mortality decline, human capital investment, and economic growth. J Dev Econ 2000; 62: 1-23.
[28] Maguire K, Westhoff C. The state of hormonal contraception today: Established and emerging noncontraceptive health benefits. Am J Obstet Gynecol 2011; 205: S4-8.
[29] Jensen JT, Speroff L. Health benefits of oral contraceptives. Obstet Gynecol Clin North Am 2000; 27: 705.
[30] Dayal M, Barnhart KT. Noncontraceptive benefits and therapeutic uses of the oral contraceptive pill. Semin Reprod Med 2001; 19: 295-303.
[31] Ronsmans C, Collin S, Filippi V. Maternal Mortality in Developing Countries 2008.
[32] Ross JA, Blanc AK. Why aren't there more maternal deaths? A decomposition analysis. Matern Child Health J 2012; 16: 456-63.
[33] Lazdane G. Contraception and women's health. J Sex Med 2011; 8: 112-3.
[34] Culwell KR, Vekemans M, de Silva U, Hurwitz M, Crane BB. Critical gaps in universal access to reproductive health: Contraception and prevention of unsafe abortion. Int J Gynaecol Obstet 2010; 110: S13-6.
[35] DaVanzo J, Hale L, Razzaque A, Rahmand M. Effects of interpregnancy interval and outcome of the preceding pregnancy on pregnancy outcomes in Matlab, Bangladesh. Br J Obstet Gynaecol 2007; 114: 1079-87.
[36] DaVanzo J, Hale L, Razzaque A, Rahman M. The effects of pregnancy spacing on infant and child mortality in Matlab, Bangladesh: How they vary by the type of pregnancy outcome that began the interval. Pop Stud-J Demogr 2008; 62: 131-54.
[37] Dewey KG, Cohen RJ. Does birth spacing affect maternal or child nutritional status? A systematic literature review. Matern Child Nutr 2007; 3: 151-73.
[38] Conde-Agudelo A, Rosas-Bermudez A, Kafury-Goeta AC. Effects of birth spacing on maternal health: A systematic review. Am J Obstet Gynecol 2007; 196: 297-308.
[39] Conde-Agudelo A, Rosas-Bermudez A, Kafury-Goeta AC. Birth spacing and risk of adverse perinatal outcomes - A meta-analysis. JAMA 2006; 295: 1809-23.
[40] Conde-Agudelo A, Belizan JM. Maternal morbidity and mortality associated with interpregnancy interval: cross sectional study. Br Med J (Clin Res Ed) 2000; 321: 1255-9.
[41] Adam I, Ismail MH, Nasr AM, Prins MH, Smits LJM. Low birth weight, preterm birth and short interpregnancy interval in Sudan. J Matern Fetal Neonatal Med 2009; 22: 1068-71.
[42] Finlay JE, Ozaltin E, Canning D. Cross sectional analysis of the association of maternal age with infant mortality, child anthropometric failure, diarrhea, and anemia in low and middle income countries. BMJ Open 2011; 2: e000226. doi:10.1136/ bmjopen-2011-000226.
[43] Demographic and Health Surveys. Calverton, MD: MEASURE DHS 2009.
[44] Rutstein SO, Rojas G. Guide to DHS Statistics. Calverton, MD: ORC Macro MEASURE DHS+; 2003.
[45] Wirth ME, Wirth E, Delamonica E, Sacks D, Balk A, Minujin A. Monitoring health equity in the MDGs: A practical guide. New York: CIESIN/UNICEF 2006.
[46] Vaessen M. The potential of the demographic and health surveys (DHS) for the evaluation and monitoring of maternal and child health indicators. In: Khlat M, Ed. Demographic evaluation of health programmes (Proceedings). Paris: CICRED/UNFPA 1996.
[47] Pullum TW. An assessment of the quality of data on health and nutrition in the DHS surveys, 1993-2003. Calverton, MD: Macro International 2008.
[48] ICF Macro. Demographic and health survey interviewer’s manual. In: Macro International, editor. Calverton, MD: ICF Macro 2006.
[49] ICF Macro. DHS final reports. In: Measure DHS, Ed. Calverton, MD: ICF Macro 2011.
[50] ICF Macro. Description of the demographic and health surveys individual recode data file. In: Measure DHS, Ed. Calverton, MD: ICF Macro 2008.
[51] Demographic and Health Survey. Sampling manual. DHS-III. Calverton, MD: Macro International 1996.
[52] ICF Macro. Measure DHS biomarkers inventory. In: Measure DHS, Ed. Calverton, MD: ICF Macro 2011.
[53] Measure DHS. Survey search by characteristics: Reproductive calendar. Measure DHS, Ed. Calverton, MD: ICF Macro; 2012.
[54] Borghi E, de Onis M, Garza C, et al. Construction of the World Health Organization child growth standards: Selection of methods for attained growth curves. Stat Med 2006; 25: 247-65.
[55] Filmer D, Pritchett LH. Estimating wealth effects without expenditure data--or tears: An application to educational enrollments in states of India. Demography 2001; 38: 115-32.
[56] Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol 2004; 159: 702-6.
[57] Deaton A. The analysis of household surveys: A microeconometric approach to development policy. Baltimore: World Bank 1997.






General Articles