Influences on birth spacing intentions and desired interventions among women who have experienced a poor obstetric outcome in Lilongwe Malawi: a qualitative study

Dawn M Kopp, Agatha Bula, Suzanne Maman, Lameck Chinula, Mercy Tsidya, Mwawi Mwale, Jennifer H Tang, Dawn M Kopp, Agatha Bula, Suzanne Maman, Lameck Chinula, Mercy Tsidya, Mwawi Mwale, Jennifer H Tang

Abstract

Background: Stillbirth and neonatal mortality are very high in many low-income countries, including Malawi. Use of family planning to encourage birth spacing may optimize outcomes for subsequent pregnancies. However, reproductive desires and influences on birth spacing preferences of women who have experienced a stillbirth or neonatal death in low-resource settings are not well understood.

Methods: We conducted a qualitative study using 20 in-depth interviews and four focus group discussions with women who had experienced a stillborn baby or early neonatal death to explore attitudes surrounding birth spacing and potential interventions to promote family planning in this population. Qualitative data were analyzed for recurrent patterns and themes and central ideas were extracted to identify their core meanings.

Results: Forty-six women participated in the study. After experiencing a stillbirth or neonatal death, most women wanted to wait to become pregnant again but women with living children wished to wait for longer periods of time than those with no living children. Most women preferred birth spacing interventions led by clinical providers and inclusion of their spouses.

Conclusions: Many influences on family size and birth spacing were noted in this population, with the most significant influencing factor being the spouse. Interventions to promote birth spacing and improve maternal and neonatal health in this population need to involve male partners and knowledgeable health care providers to be effective.

Trial registration: Clinicaltrials.gov NCT02674542 Registered February 1, 2016 (retrospectively registered).

Keywords: Africa; Birth spacing; Malawi; Neonatal death; Stillbirth.

Conflict of interest statement

Ethics approval and consent to participate

Ethical approval was obtained from the National Health Sciences Research Committee of Malawi (Protocol #1354) and the University of North Carolina School of Medicine Institutional Review Board (#14–2677). Women gave written informed consent at the time of enrollment in the language of their choice (Chichewa or English).

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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