ICMR – STS Project 2024-25

Reference ID (Generated upon registration)

Title (25 words max.):

‘Socio-cultural factors and health implications associated with short inter-pregnancy interval
among Island women – A Mixed Method study’

Introduction (300 words +100 words):

India accounted for 20% of global neonatal and 17% of global infant deaths. Also Indian
infant mortality rate (IMR), at 32 infant deaths per 1,000 live births, is the highest of
neighboring countries such as Nepal, Bangladesh, and Sri Lanka. (1,2) Short birth intervals
varying from less than 18 months–35 months have all been associated with an elevated risk
of early neonatal, neonatal, postneonatal, infant, and under 5 mortality in India in various
studies (3–9). Multiple studies in the Indian context have also reported association between
short birth intervals and higher risk of stunting and underweight among children under age 5.
(6,10–13) In a study done by Kannaujiya et al., 34–38% of the IPIs were shorter than 12
months and an additional 25–27% were 12–17 months.(2)

Short Inter-pregnancy Interval (IPI) is a global public health concern among developing
countries, including India. WHO recommends a birth spacing of 24 months before attempting
the next pregnancy [1]. It poses significant health risks for both mothers and their children.
This phenomenon is deeply intertwined with various sociocultural influences that impact
reproductive behaviors and family planning practices.

Infant mortality, small for gestational age (SGA), Low Birth Weight, preterm birth,
premature rupture of membranes, and birth defects have been associated to short IPI. It is also
associated with a higher risk of maternal morbidities, including preeclampsia, high blood
pressure, and premature rupture of membranes.(14)

Unmet need for family planning (UNF) is a component of the Sustainable Development Goal
(SDG) indicator 3.7.1, which measures the percentage of women of reproductive age who
want to delay or stop childbearing but are not using contraception. According to NFHS – 5,
Short Inter-pregnancy Intervals are more common among women in low and middle-income
countries, where an estimated 4.3% of married women of the reproductive age group in India
have reported having unmet needs for family planning.

Several studies from developed and a few developing countries have examined associations
between IPI and adverse child health outcomes (15–17). However, only three studies from
India examined associations between IPI and low birth weight (18,19) and only one examined
the association between IPI and stillbirth. (16)

There are many studies that have documented the health implications while the other factors
that result in short IPI are not captured. Thus this study is taken up to understand these
factors. Moreover there is no such study done in this area till date.
The knowledge of influence of social and cultural factors on interpregnancy interval will help
us to address this issue in the awareness programs, talk about it one on one basis during home
visits and ‘when people talk they act’.

Objectives (100 words max.):

To study the prevalence of the short inter-pregnancy interval in the rural area.

To find the risk factors of short inter-pregnancy interval and determine the correlation.

To enumerate the health implications in the women with short inter-pregnancy interval.

Methodology (800 words +100 words):

Type of study: Mixed Method study

Study design: A mixed method study.

Study population: All second gravida or multigravida women registered at the centres.

Sample size: According to a study the prevalence of short IPI in India is 69.3% (2). Taking
this as a reference the sample size calculated was 227.

Inclusion criteria:

 Women who are pregnant and registered at the centre.

 Those who are above 18 years.
Exclusion criteria:

 Women with mentally challenged conditions and unable to respond to the questions.
 Those who don’t consent to participate in the study.

Proposed intervention (if applicable), Data collection procedures &instruments used, quality
control, plan of analysis/ statistical tools, ethical considerations: The confidentiality of the
information of the subjects will be maintained. The approval from the institutional ethics
committee will be obtained before the study is commenced.

The teaching college has 4 health centres; one rural and three urban. The population served
by these centres is fixed. The list of pregnant women will be taken from records maintained
at health centers during the study period and total number of eligible participants based on the
inclusion criteria will be short listed. Simple random sampling method will be used to select
the number of participants’ proportion to the population from each area. The random numbers
will be obtained from open-epi application and enrolled in the study. The eligible women will
be approached on the antenatal visit days, purpose of study will be explained and consent will
be taken. Those who are not visiting for 2 consecutive visits will be dropped and next eligible
participant will be included till the desirable sample is reached.. A pre-tested and pre-
validated semi-structured questionnaire will be used for the scheduled interview. The
questionnaire captures the socio-demographic profile, obstetric details of present and
preceding pregnancy, health issues in mother and the last born child, details of child care in
the last born, antenatal care in present pregnancy and social and cultural factors affecting the
present pregnancy. The interview schedule will be taken by the PI or the Co-PI. The
interview schedule will be prepared on Google form application and data collected will be
entered and stored electronically. The participant will be questioned only once.

Implications (100 words + 50 words):

To the best of our knowledge this is first study in the area. It will give the information
regarding the burden and the risk factors of the problem. The identified risk factors and health
implication in the study group will help to introduce specific interventions in already existing
national maternal and child health programs.

References (Vancouver style) (300words max.)

1. Levels and Trends in Child Mortality: 2017 Report - World | ReliefWeb [Internet]. 2017
[cited 2024 Jun 8]. Available from: https://reliefweb.int/report/world/levels-and-trends-
child-mortality-2017-report

2. Kannaujiya AK, Kumar K, McDougal L, Upadhyay AK, Raj A, James KS, et al.
Interpregnancy Interval and Child Health Outcomes in India: Evidence from Three
Recent Rounds of National Family Health Survey. Matern Child Health J. 2023 Jan
1;27(1):126–41.

3. Arulampalam W, Bhalotra S. Sibling Death Clustering in India: State Dependence versus

Unobserved Heterogeneity. J R Stat Soc Ser A Stat Soc. 2006;169(4):829–48.

4. Kumar KJ, Asha N, Murthy DS, Manjunath V. Maternal Anemia in Various Trimesters
and its Effect on Newborn Weight and Maturity: An Observational Study. Int J Prev
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5. Molitoris J, Barclay K, Kolk M. When and Where Birth Spacing Matters for Child
Survival: An International Comparison Using the DHS. Demography. 2019
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6. Rutstein SO. Effects of preceding birth intervals on neonatal, infant and under-five years
mortality and nutritional status in developing countries: evidence from the demographic
and health surveys. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2005
Apr;89 Suppl 1:S7-24.

7. van der Klaauw B, Wang L. Child mortality in rural India. J Popul Econ. 2011 Apr
1;24(2):601–28.

8. Whitworth A, Stephenson R. Birth spacing, sibling rivalry and child mortality in India.
Soc Sci Med. 2002 Dec 1;55(12):2107–19.

9. Williams EK, Hossain MB, Sharma RK, Kumar V, Pandey CM, Baqui AH. Birth Interval
and Risk of Stillbirth or Neonatal Death: Findings from Rural North India. J Trop Pediatr.
2008 Mar 15;54(5):321–7.
10. Chungkham HS, Sahoo H, Marbaniang SP. Birth interval and childhood undernutrition:
Evidence from a large scale survey in India. Clin Epidemiol Glob Health. 2020 Dec
1;8(4):1189–94.

11. Dhingra S, Pingali PL. Effects of short birth spacing on birth-order differences in child
stunting: Evidence from India. Proc Natl Acad Sci. 2021 Feb 23;118(8):e2017834118.

12. Rana MJ, Goli S. Does planning of births affect childhood undernutrition? Evidence from
demographic and health surveys of selected South Asian countries. Nutr Burbank Los
Angel Cty Calif. 2018 Mar;47:90–6.

13. Rana MJ, Gautam A, Goli S, Uttamacharya, Reja T, Nanda P, et al. Planning of births
and maternal, child health, and nutritional outcomes: recent evidence from India. Public
Health. 2019 Apr 1;169:14–25.

14. Wang Y, Zeng C, Chen Y, Yang L, Tian D, Liu X, et al. Short interpregnancy interval
can lead to adverse pregnancy outcomes: A meta-analysis. Front Med. 2022 Nov
30;9:922053.

15. Barclay K, Baranowska-Rataj A, Kolk M, Ivarsson A. Interpregnancy intervals and

perinatal and child health in Sweden: A comparison within families and across social
groups. Popul Stud. 2020 Sep 1;74(3):363–78.

16. Swaminathan A, Fell DB, Regan A, Walker M, Corsi DJ. Association between
interpregnancy interval and subsequent stillbirth in 58 low-income and middle-income
countries: a retrospective analysis using Demographic and Health Surveys. Lancet Glob
Health. 2020 Jan 1;8(1):e113–22.

17. DaVanzo J, Hale L, Razzaque A, Rahman M. Effects of interpregnancy interval and

outcome of the preceding pregnancy on pregnancy outcomes in Matlab, Bangladesh.
Bjog. 2007 Sep 1;114(9):1079–87.

18. Kannaujiya AK, Kumar K, Upadhyay AK, McDougal L, Raj A, Singh A. Short
interpregnancy interval and low birth weight births in India: Evidence from National
Family Health Survey 2015-16. SSM - Popul Health. 2020 Nov 24;12:100700.

19. Kader M, Perera NKPP. Socio-economic and nutritional determinants of low birth weight
in India. North Am J Med Sci. 2014 Jul;6(7):302–8.