Maternal depletion and child survival in Guatemala and Malaysia.

This paper investigates the hypothesis that short interpregnancy intervals affect the health of children by preventing women from recovering adequately from 1 pregnancy before beginning the next using data from 2 very different populations in Malaysia and Guatemala. The Guatemalan data show that the risk of mortality under age 5 is reduced by more than 50% if the previous birth interval was longer than 15 months compared with children whose previous birth intervals were less than 15 months in length. In Malaysia infant mortality was 47% lower for children born after intervals of more than 15 months compared with those born after shorter intervals. The results show some evidence that the length of the recuperative interval may be an important determinant of infant survival once appropriate controls are introduced for confounding variables such as breastfeeding and previous pregnancy outcome. Even when potentially confounding factors are held constant the association between previous pregnancy interval length and the length of the recuperative interval is not accounted for by the length of the recuperative interval. It appears that it is not only the length of recuperation from pregnancy and breastfeeding which accounts for the association between previous pregnancy interval length and infant survival. The investigation of factors related to classical indices of maternal depletion (weight at the time of conception weight gain and birth weight) suggests that only weight gain during pregnancy is affected by the length of the previous pregnancy interval. The results do not provide evidence for an association between short pregnancy outcome-to-next conception intervals and short gestations for the index pregnancy. Evidence from this analysis indicates instead that women with shorter previous intervals have longer lengths of gestation as do women with shorter recuperative intervals. It may be that women who are better off nutritionally or in better health may both become pregnant more quickly and are more able to bring the pregnancy to term than are women in poorer nutritional status or health.