Short birth spacing and its association with maternal educational status, contraceptive use, and duration of breastfeeding in Ethiopia. A systematic review and meta-analysis

Abstract

Background: Closely spaced birth increases the risk of adverse maternal and child health outcomes. In Ethiopia, the prevalence of short birth spacing was highly variable across studies. Besides, contraceptive use, educational status, and duration of breastfeeding were frequently mentioned factors affecting short birth spacing. Therefore, this meta-analysis aimed to estimate the pooled prevalence of short birth spacing and its association with contraceptive use, educational status, and duration of breastfeeding among reproductive-age women in Ethiopia.

Methods: International databases: Google Scholar, PubMed, CINAHL, Cochrane library, HINARI, and Global Health were searched systematically to identify articles reporting the prevalence of short birth spacing and its association with contraceptive use, educational status, and duration of breastfeeding among reproductive-age women in Ethiopia. The data were analyzed by STATA/SE version-14 statistical software. The random-effect model was used to estimate the pooled prevalence of short birth spacing and the log odds ratio was used to determine the association. Moreover, egger's test and I-squared statistics were used to assess publication bias and heterogeneity respectively.

Results: After reviewing 511 research articles, a total of nine articles with 5,682 study participants were included in this meta-analysis. The pooled prevalence of short birth spacing in Ethiopia was 46.9% [95% CI: (34.7, 59.1)]. Significant heterogeneity was observed between studies (I2 = 98.4, p <0.001). Not using contraceptives [OR = 3.87, 95% CI: (2.29, 6.53)] and duration of breastfeeding < 24 months [OR = 16.9, 95%CI: (2.69, 106.47)] had a significant association with short birth spacing.

Conclusions: Although a minimum inter-pregnancy interval of two years was recommended by the World Health Organization (WHO), significant numbers of women still practiced short birth spacing in Ethiopia. Duration of breastfeeding and non-use of contraceptives were factors significantly associated with short birth spacing. So, efforts should be made to improve breastfeeding practice and contraceptive utilization among women in Ethiopia.

Fig 1. PRISMA flow diagram describes the selection of studies for a systematic review and meta-analysis of short birth spacing and its association with maternal educational status, contraceptive use, and duration of breastfeeding in Ethiopia, 2020.

Fig 2. Forest plot of the pooled prevalence of short birth spacing among reproductive-age women in Ethiopia, 2020.

Fig 3. Funnel plot with 95% confidence limits of the pooled prevalence of short birth spacing among reproductive-age women in Ethiopia, 2020.

Fig 4. Forest plot of the pooled prevalence of short birth spacing by the area of residence (rural versus both urban and rural) in Ethiopia, 2020.

Fig 5. The pooled odds ratio of the association between contraceptive use and short birth spacing in Ethiopia, 2020.

Fig 6. Funnel plot with 95% confidence limits of the pooled odds ratio of contraceptive use among women in Ethiopia, 2020.

Fig 7. The pooled odds ratio of the association between the duration of breastfeeding and short birth spacing in Ethiopia, 2020.

Fig 8. Funnel plot with 95% confidence limits of the pooled odds ratio of the duration of breastfeeding among women in Ethiopia, 2020.

Fig 9. The pooled odds ratio of the association between maternal educational status and short birth spacing in Ethiopia, 2020.

Fig 10. Funnel plot with 95% confidence limits of the pooled odds ratio of maternal educational status in Ethiopia, 2020.