الفهرس 
Reproductive HealthOnly 14 pages are availabe for public view
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Abstract
Every minute, one woman dies during pregnancy and birth because she did not receive adequate care and prompt treatment. By increasing interventions for safe motherhood, we can save the lives of half a million women and seven million infants, and prevent millions of women from suffering from infections, injury and disability each year.
”Reproductive health (RH) is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this last condition is the right of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of FP (FP) of their choice, as well as other methods of their choice for regulation of fertility which are not against the law, and the right of access to appropriate health-care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant.
Birth spacing (practice of timing the period between births) has been identified as a pertinent lifesaving measure for mothers and children. Even though birth spacing as a concept is the focal point RH/FP methodology, few countries have policies on birth spacing, and in many developing countries there is unmet need for birth spacing services.
Birth interval was defined as the interval between reported dates of birth, rather than the inter-conception intervals. The interval between marriage and the first birth was excluded from the analysis. The period of interest in this study was that between the date of the birth making the start of the interval either the date of the next conception, or the interview date (if no conception had occurred). If the interval is terminated by a conception, it is termed a closed interval otherwise it is termed open interval.
The Optimal Birth Spacing Initiative (OBSI) was created under the auspices of USAID to place optimal birth spacing on the global leadership priority agenda. The goal of OBSI is to institute an optimal birth spacing recommendation of Three to Five Years at the policy, programmatic and behavioral levels.
Birth intervals are growing longer over time in most counties. Of 34 countries with multiple surveys since 1986 conducted by USAID, the proportion of women waiting at least 3 years between births has risen between the first surveys in almost all countries (USAID, 2002).
There are several reasons:
1. Women may be more motivated to space births because their opportunities for education and employment are expanding, and thus more may want to postpone the next pregnancy.
2. People have great means to control their fertility as FP services have expanded, particularly in urban areas.
3. In some countries, economic and political instability may have led more couples to postpone having children.
All the important variation in fertility is captured by variation by the proximate determinants of fertility. Therefore, if we have good enough individual-level data on contraceptive use, breastfeeding and post-partum amenorrhoea and the other proximate determinants, we should be able to capture all variation in individual-level fertility. This means that once we have controlled for the proximate determinants, there should be no residual effect of social, economic and cultural factors.
The proximate determinants can be divided into two groups: those which are measurable with the DHS calendar data and those which are difficult (or impossible) to measure. The first group includes those determinants generally thought to be most influential: those relating to exposure to the risk of sexual intercourse, contraceptive use and the duration of post-partum amenorrhoea. The second group includes such factors as the frequency of sexual intercourse.
A variety of demographic and socio economic characteristics influence women’s spacing practices. These include women’s age at the birth of each child, the number of children she has, and her educational attainment, social status, labor force participation, duration of breast feeding, contraceptive use, place of residence and cultural norms.
The general objective of this Study was to study the determinants of birth interval in Edku district in El Behera Governorate. More over to assess the fertility behavior, to describe the distribution of short and optimal birth intervals in Edku and to identify determinants of birth intervals.
In order to accomplish the aim, a cross-sectional approach was conducted in all urban health centers and health units in Edku district, El Behera governorate. There were three health centers and two health unit.
The study population was selected as follows:
Ever-married women in the reproductive age (15-49 years) attending MCH and IMCI clinics in Edku district who had at least two live births, the participants were selected from all urban health centers and units in Edku district. Each center was visited for one week alternatively with the other centers until the sample summed up to 630 women who was the required sample completed.
The following techniques and tools were used:
Pre-designed Structured interview questionnaire was used to collect the following data
1- Socio-demographic data.
2- Reproductive data.
3- History of spacing between children(birth spacing):
4- History of pervious children.
5- History of the best birth interval.
The study revealed the following results:
• Half of the sampled mothers attained Optimal Birth Interval (OBI) of 3 or more years.
• Using the Logistic Regression analysis, forward stepwise method, 10 variables were introduced into the regression model. Different combinations of variables were used to form a model. The final best model showed that family income (OR=0.38, p <0.01), Crowding Index (OR 1.92, p<0.00) and number of abortions (OR=0.60, p<0.03) were found by the present study to be significantly associated with optimal birth interval.
• Mothers’ age, educational status and mothers’ work status were not found to be associated with optimal birth interval.
• The associations between father’s age, education work status and optimal birth interval were not statistically significant.
• Those women whose index child survives have longer median birth interval length than other women.
• As regard the factors related to short birth intervals, the highest frequency stated that their husbands wanted another child soon, followed by those who stated that they got pregnant despite use of contraceptive method.
• For the sampled women opinion regarding the best birth interval, 53.1% of them mentioned that best birth spacing period in their opinion is 3 years or more.
• Regarding the sampled women attitude, the highest proportion of mothers stated that they did not want another child, thought that four family members are the desired family size, and having two children is the desired number of children.
• Studying women who had optimal birth intervals, among the reasons they have mentioned behind having optimal birth interval, half of them stated that optimal birth interval was good for their health and their children’s health, followed by those who mentioned that having optimal birth interval was God’s will.
• As regards the association between birth intervals and attitude towards children, women with optimal birth intervals were more frequently to mention that; they didn’t want to get another child, they preferred to have 3 children and they stated that their last child was a mistake.
• Concerning the association between birth intervals and some reproductive characteristics, mothers with optimal best birth spacing were more significantly to decide that the best birth interval in their opinion is 3 or more years, more to use contraceptive methods and more frequently to breast feed their children for 18-24 months.
Based on the previous findings the study recommended the followings:
For public:
1. Health education of the women to raise their knowledge and awareness about the importance of family planning, benefits of OBIs, and risks associated with frequent pregnancies for both the mother and the child.
2. Health messages dissemination at should start at the health facilities and mass media. The messages should target the couple, mothers-in-law and the community at large.
3. Involve the NGOs to spread health education messages about best births intervals, contraceptive methods and the benefits of exclusive breast feeding.
4. Encourage religious leaders to disseminate proper messages about birth spacing, and OBI taking into account the cultural and religious barriers.
5. Emphasize on women’s empowerment and total well-being. Empowered women who are aware of their reproductive rights are in a stronger position to decide on their own.
6. Encourage women to make informed choices about the health care they receive.
For health care providers
1. Promote the use of postpartum contraception and emphasize on counseling on OBI, different contraceptive methods, and managing contraceptive side effects.
2. Physicians and nurses should be trained in counseling techniques and management of side effects of all types of contraceptive.
3. Develop written guidelines on OBI that should be evidence-based and be modified to be accepted on a cultural basis.
4. Ensure training of both under-graduated and post-graduated medical students on family planning counseling and on how to deliver culture sensitive messages as it is the case of birth spacing practices.
5. Further research is needed to explore more the issue, highly suggested to conduct qualitative research with in depth interviews with women to disclose their opinion and attitude towards OBI.