MEASURE DHS assists countries worldwide in the collection and use of data to monitor and evaluate 

population, health, and nutrition programs. Additional information about the MEASURE DHS project can 

be obtained by contacting MEASURE DHS, ICF Macro, 11785 Beltsville Drive, Suite 300, Calverton, 

MD 20705 (telephone: 301-572-0200; fax: 301-572-0999; e-mail: reports@measuredhs.com; internet: 

www.measuredhs.com). 

The main objectives of the MEASURE DHS project are: 

• to provide decisionmakers in survey countries with information useful for informed policy 

choices; 

• to expand the international population and health database; 

• to advance survey methodology; and 

• to develop in participating countries the skills and resources necessary to conduct high-quality 

demographic and health surveys. 
DHS Analytical Studies No.21 

Birth Spacing and Limiting Connections 

Charles F. Westoff 

Dawn Koffman 

ICF Macro 

Calverton, Maryland, USA 

September 2010 

Corresponding author: Charles F. Westoff, Office of Population Research, Princeton University, Princeton, NJ 

08544-2901; Phone 609-258-5867; Email: westoff@princeton.edu 
Acknowledgements 

The authors thank Judie Miller for secretarial assistance. 

Editor: Nancy Johnson 

Document Production: Yuan Gu 

This study was carried out with support provided by the United States Agency for International 

Development (USAID) through the MEASURE DHS project (#GPO-C-00-08-00008-00). The views 

expressed are those of the authors and do not necessarily reflect the views of USAID or the United States 

Government. 

Recommended citation: 

Westoff, Charles F. and Dawn Koffman. 2010. Birth Spacing and Limiting Connections. DHS Analytical 

Studies No. 21. Calverton, Maryland, USA: ICF Macro. 
iii 

Contents 

List of Tables ................................................................................................................................. iv

List of Figures ..................................................................................................................................v 

Preface ........................................................................................................................................... vii

Executive Summary ....................................................................................................................... ix

1. Objective ................................................................................................................................... 1

2. Methodology ............................................................................................................................. 1

3. Measurement of the Desired Number of Children .................................................................... 2

4. Number of Children at First Use of Contraception ................................................................... 3

5. Comparisons with Earlier Measurement ................................................................................... 8

6. Estimates of the Spacer-Limiter Transition .............................................................................. 8

7. Trends in the Transition .......................................................................................................... 11

8. Differences between the Two Types of Limiters .................................................................... 16

9. Method Use ............................................................................................................................. 23

10. Multivariate Analyses ............................................................................................................. 25

11. The Effect of Spacing Experience on Desired Family Size .................................................... 26

12. Discussion ............................................................................................................................... 37

Appendix . ..................................................................................................................................... 38
iv 

List of Tables 

Table 1. Percentage of currently married women who are currently using a method for 

spacing or for limiting, and the percentage of Limiters who had formerly been 

Spacers or had only been Limiters. ..............................................................................9

Table 2. Differences in characteristics among Limiters with no former spacing experience 

and those with spacing experience. ............................................................................17

Table 3. Percentage of current Limiters using a modern method and the main method 

used by Limiters only compared with Limiters who had formerly been Spacers. .....23

Table 4. Odds ratios of Limiters having been Spacers, by region. ...........................................26 

Appendix Percent distribution of two measures of number of children desired by married 

women using contraception who want no more children. ..........................................38
v 

List of Figures 

Figure 1. Percentage of ever-married women who first used a contraceptive method before 

the third child. 

Asia and North Africa. .................................................................................................4 

Latin America and the Caribbean .................................................................................5 

Western and Middle Africa ..........................................................................................6 

Eastern and Southern Africa .........................................................................................7 

Figure 2. Percentage of Limiters who previously used contraception for spacing. 

Asia and North Africa. ...............................................................................................12 

Latin America and the Caribbean ...............................................................................13 

Western and Middle Africa ........................................................................................14 

Eastern and Southern Africa .......................................................................................15 

Figure 3. Percentage of last births in the past five years that were unwanted among 

Limiters with (LS) and without (LO) earlier spacing experience. 

Asia and North Africa. ...............................................................................................19 

Latin America and the Caribbean ...............................................................................20 

Western and Middle Africa ........................................................................................21 

Eastern and Southern Africa .......................................................................................22 

Figure 4. Mean number of children desired by married women by current contraceptive 

use and spacing and limiting status. 

Asia and North Africa. ...............................................................................................28 

Latin America and the Caribbean ...............................................................................29 

Western and Middle Africa ........................................................................................30 

Eastern and Southern Africa .......................................................................................31 

Figure 5. Trends in the current use of contraception for spacing and for limiting births, for 

currently married women age 15–49. 

Asia and North Africa. ...............................................................................................32 

Latin America and the Caribbean ...............................................................................33 

Western and Middle Africa ........................................................................................34 

Eastern and Southern Africa .......................................................................................35 

vii 

Preface 

One of the most significant contributions of the MEASURE DHS program is the creation of an 

internationally comparable body of data on the demographic and health characteristics of populations in 

developing countries. 

The DHS Comparative Reports series examines these data across countries in a comparative framework. 

The DHS Analytical Studies series focuses on analysis of specific topics. The principal objectives of both 

series are to provide information for policy formulation at the international level and to examine 

individual country results in an international context. 

While Comparative Reports are primarily descriptive, Analytical Studies comprise in-depth, focused 

studies on a variety of substantive topics. The studies are based on a variable number of data sets, 

depending on the topic being examined. A range of methodologies is used in these studies including 

multivariate statistical techniques. 

The topics covered in Analytical Studies are selected by MEASURE DHS staff in conjunction with the 

U.S. Agency for International Development. 

It is anticipated that the DHS Analytical Studies will enhance the understanding of analysts and 

policymakers regarding significant issues in the fields of international population and health. 

Ann Way

Project Director 

ix 

Executive Summary 

Contraception can be used both for the spacing and for the limiting of births. The main thrust of family 

planning programs in developing countries has been to promote the use of family planning use to enhance 

the health of mothers and of their children. In sub-Saharan Africa, the proportion of women using 

contraception for spacing almost universally exceeds the proportion using for limiting their number of 

births. Because contraceptive use for birth limitation is the driving force to reduce high rates of 

population growth, the question that arises is whether the use for spacing leads to the use for limiting. 

Does spacing behavior eventually result in a desire for fewer births? 

The measurement of this connection between spacing behavior and limiting births is less than 

straightforward with cross-sectional data. Ideally, the analysis would estimate the probability that birth 

spacing lowers the number of children desired which, in turn, increases birth limiting. In the absence of 

longitudinal data, the indicator developed here is confined to estimating the proportion of Limiters who 

had formerly been Spacers. An algorithm was constructed based on the parity at first use of a method in 

combination with the total number of children desired. 

The number of children that people have when they first begin contraceptive use is clearly declining and 

in some countries this trend is striking. 

Estimates of the proportion of Limiters who had been Spacers are presented for 51 developing countries 

in the DHS program. In the DHS countries of Asia, North Africa, Latin America and the Caribbean, an 

average of two-thirds of current Limiters had formerly been Spacers. In Western and Middle Africa, 

about the same proportion of Limiters had been Spacers, though there are only small proportions of 

Limiters to begin with (mostly in single digits). In Southern and Eastern Africa with larger proportions of 

Limiters, the fraction of former Spacers averaged 20 percent. Altogether, 34 of the 51 countries show at 

least half of Limiters with earlier spacing experience. An analysis of trends in the proportion shows a 

pattern of increase in Asia and North Africa but such evidence is weak or non-existent elsewhere. 

Examination of the difference between Limiters with and without prior spacing experience shows a clear 

difference between the two in the proportion of recent unwanted births. In 47 countries there is a 

consistently higher proportion of unwanted last births among Limiters with no previous spacing 

experience. Surprisingly there is no evidence of shifts in method use as Spacers become Limiters. 

Examining the differences between Limiters with and without a spacing background in a multivariate 

context shows that Limiters who had been Spacers, in addition to being less likely to have had unwanted 

births, are less likely to have experienced the death of a child, are more likely to have higher levels of 

education and are more likely to have been exposed to mass media. 

In brief, significant proportions of women who currently limit their fertility were Spacers in the past, 

though there is no direct evidence that spacing experience reduces the number of children desired. There 

is evidence that birth spacing reduces child mortality, a finding that is consistent with other research in 

this area. 

1 

1. Objective 

Contraception is used both to prolong the length of birth intervals and to terminate childbearing. In the 

least developed countries, the use for spacing predominates, motivated in major part by concerns about 

the health of mothers and children. Contraceptive use for limiting is less evident in high fertility 

populations because desired family size is high. These two modes of contraceptive practice have very 

different implications for the fertility rate with the use for limiting showing a much higher correlation 

with the total fertility rate than the use for spacing (accounting for 76 percent and 14 percent of the 

variance of the TFR respectively across 62 developing countries).1

 

The main focus of this research is to examine the extent to which the use of contraception for spacing 

leads to its use for limiting. That transition can occur either with the passage of time and the continuation 

of contraceptive practice or else can occur sooner if the early experience of controlling fertility leads to 

actually wanting fewer children. Note that while we define a Limiter as a woman using contraception 

after she has reached her desired number of children, it is also possible for a woman to want no more 

children, and therefore be a Limiter, even though her ideal number of children has not been attained. An 

example of this might be a woman who is limiting births to protect her own health status. This is a 

particularly important question for countries in sub-Saharan Africa where organized family planning 

programs are largely focused around reproductive and child health rationales with an emphasis on birth 

spacing. Because there is also concern about very high fertility rates and population growth in many of 

these countries, it is important to learn the extent to which use for spacing carries over to use for limiting. 

This relates to the more general question of whether supply generates demand, a topic of recurring 

interest in family planning policy. 

2. Methodology 

The Demographic and Health Surveys project is the source of data in this analysis. Spacers are women 

using a method who want to wait two or more years before having their next child while Limiters are 

women who are using a method to avoid the birth of any more children. Since the DHS questionnaire 

does not include a full contraceptive history or a direct dating of when the woman first wanted no more 

births, the sequence cannot be measured directly but an indirect approach has been developed. The 

algorithm is based on the number of children at first use of contraception which is asked of all women 

who have ever used a method. This information is then combined with the number of children currently 

desired (its measurement is described below) to determine whether or not Limiters had used a method 

before they reached the total number desired. 

To illustrate: a Limiter (a woman currently using a method who wants no more children) who wants a 

total of four children but had first used a method before she had her fourth child is classified as a Limiter 

who earlier had been a Spacer. In contrast, if she had not used a method until she had four or more 

children, she would be classified as a Limiter without prior spacing experience. It is then possible to 

estimate the proportion of Limiters who earlier had been Spacers compared with those who first used 

contraception for limiting. Ideally, it would be preferable to estimate the probability of a Spacer becoming 

a Limiter but data limitations only permit the reverse estimation of the proportion of Limiters who had 

been Spacers. This is a shortcoming that only a longitudinal design can overcome. 

 

1

 These estimates are based on calculations from DHS data for different countries. 
2 

3. Measurement of the Desired Number of Children 

Two different though related measures of the number of children desired have been evaluated. As noted 

above, establishing the number of children desired is necessary to determine whether the first use of 

contraception preceded the total number desired or had occurred later. The objective is to select a measure 

of the desired number of children for married women who are classified as Limiters, i.e. women currently 

using a method to avoid further childbearing. These are the women classified as “Using to Limit” in the 

standard Unmet Need measure. 

The first possibility is the standard number of children desired measure, also known as the “Ideal” 

number of children. The second possibility is the actual number of children minus any recent birth 

reported as unwanted. To reiterate: both of these measures are applied to women currently using a method 

who want no more children (Limiters). One problem with the first measure is that there are some women 

who provide non-numeric responses to the Ideal number question such as “It’s up to God” or “Whatever 

number comes” or “Don’t know.” Although the proportion of women with such responses has declined 

over recent years, there remain countries primarily in sub-Saharan Africa, where the number of such 

answers is not insignificant, for example Mali with 14 percent of Limiters in this category. The average in 

sub-Saharan Africa is five percent and less than three percent in other regions. This shortcoming can be 

adjusted by substituting numerical values to such responses from the second measure, the actual number 

of children minus unwanted births. In practice, the only unwanted birth involved in the second approach 

is the last birth in the preceding five years which implies some overestimate of total wanted fertility in the 

second measure. 

The mean number of children wanted for Limiters in sub-Saharan Africa is 4.6 for both measures. In 

other regions, the mean number for the Ideal measure is 2.9 and for the second measure is 3.2. The 

average correlation between the two measures, 0.44 in sub-Saharan Africa and 0.43 in other regions, 

indicates a moderate positive association. The important question is the extent of the differences between 

the two measures in the estimated proportions of women who began contraceptive practice as Limiters 

and the proportions who had begun as Spacers and subsequently became Limiters. In the aggregate, 

however, the average difference amounts only to about 2 percent. 

Finally, there is another difference between the two measures in the heaping of responses which argues 

for use of the second approach (Appendix A). With the Ideal measure, there is considerable heaping at 

four children in sub-Saharan Africa and at two children in other countries. With the second measure, the 

heaping is significantly lower. The second measure is the one selected for most of the following 

substantive analyses. 
3 

4. Number of Children at First Use of Contraception 

The other main datum needed to estimate the prior spacing record of Limiters is the number of children at 

the time a method was first used. Aside from its use for this purpose, parity at first use is an indicator of 

the general trend of family planning and its demographic importance. To summarize recent trends, the 

cumulative proportion of ever-married women that first used a method before a third birth – an indicator 

that in the less developed countries is largely of spacing behavior – is depicted in Figure 1 for countries 

that have conducted several surveys. The overall pattern of an increasing proportion first using 

contraception before the third birth is very clear and in some countries very strong. In sub-Saharan Africa, 

this trend is clear mainly in Eastern and Southern countries. 

The age of women at the first use of contraception can be derived from the parity at first use. It is 

estimated here for married women who have ever used a method. It shows little international variation 

and an average of 22-23 years of age. Because this will be affected by age at marriage, an estimate of the 

interval between age of first use and first marriage has been calculated which shows a range of 1.2 for 

Colombia to 8.0 for Ethiopia with an average interval of 3-4 years. Ghana and Kenya show an interval 

averaging about 4 years. 
4 

Figure 1. Percentage of ever-married women who first used a contraceptive method before the 

third child: Asia and North Africa. 

70

53

51

47

51

37

38

27

16

77

39

30

57

57

51

33

73

64

57

52

44

38

38

27

21

70

64

51

46

40

34

32

6

63

61

54

46

39

0 20 40 60 80

Vietnam

Philippines

Nepal

Morocco

Jordan

Indonesia

India

Egypt

Cambodia

Bangladesh

2002

1997

2008

2003

1998

1993

2006

2001

1996

2004

1992

1987

2007

2002

1997

1990

2007

2003

1997

1994

1991

1987

2006

1999

1993

2008

2003

2000

1995

1992

1988

2005

2000

2007

2004

2000

1997

1994
5 

Figure 1 (continued). Percentage of ever-married women who first used a contraceptive method 

before the third child: Latin America and the Caribbean. 

79

66

65

60

41

69

56

43

30

24

38

34

27

21

76

69

68

64

56

88

88

79

66

58

59

52

50

46

28

0 20 40 60 80

Peru

Nicaragua

Haiti

Guatemala

Dominican Republic

Colombia

Bolivia

2005

2000

1996

1992

1986

2001

1998

2006

2000

1995

2002

1999

1995

1987

2007

2002

1999

1996

1991

2005

2000

1995

1990

1986

2008

2003

1998

1994

1989
6 

Figure 1 (continued). Percentage of ever-married women who first used a contraceptive method 

before the third child: Western and Middle Africa. 

17

17

10

20

21

19

8

16

13

7

15

16

11

16

41

38

36

33

26

47

36

30

21

19

36

39

35

0 20 40 60 80

Senegal

Nigeria

Niger

Mali

Ghana

Cameroon

Burkina Faso

Benin

2005

1997

1993

2008

2003

1999

1990

2006

1998

1992

2006

2001

1996

1987

2008

2003

1998

1993

1988

2004

1998

1991

2003

1999

2006

2001

1996
7 

Figure 1 (continued). Percentage of ever-married women who first used a contraceptive method 

before the third child: Eastern and Southern Africa. 

79

71

65

63

58

51

42

34

28

28

22

14

35

23

16

18

21

18

65

57

39

48

8

37

30

26

48

27

18

16

51

43

40

31

23

0 20 40 60 80

Zimbabwe

Zambia

Uganda

Tanzania

Rwanda

Namibia

Mozambique

Malawi

Madagascar

Kenya

2006

1999

1994

1988

2007

2002

1996

1992

2006

2001

1995

1988

2004

1996

1992

2005

2000

1992

2007

2000

1992

2003

1997

2004

2000

1992

2009

2004

1997

1992

2009

2003

1998

1993

1989
8 

5. Comparisons with Earlier Measurement 

In Demographic and Health Surveys conducted in the 1990s, some countries included a direct question of 

women who had ever used a contraceptive method to estimate the spacing - limiting distinction that the 

algorithm described above strives to do: “When you first used family planning, did you want another 

child but at a later time, or did you not want to have another child at all?” This question was discontinued 

in later surveys but its earlier inclusion in some surveys permits a comparison of this direct approach with 

the indirect method developed here. The results of this comparison for eight countries show very similar 

distributions with an average difference below 5 percent. 

6. Estimates of the Spacer-Limiter Transition 

The main objective of this study is to estimate the proportion of Limiters that had formerly been Spacers 

(L-S). This proportion is based on the two measures described above: the number of children wanted and 

the parity at first use of a contraceptive method. Estimates of the distribution of this proportion appear in 

columns 3 and 4 of Table 1. There is a considerable amount of international variation in L-S, ranging 

from a low of 24 percent in India to a high of 89 percent in Morocco. The overall average for this region 

is 57 percent. It is important to keep in mind that L-S is a percentage of Limiters which are only a small 

fraction of all married women, especially in Western and Middle Africa where, on average, only 5 percent 

are current Limiters (column 2 in Table 1) with half of these women in the L-S category. In India, 

sterilization is by far the main contraceptive method used by currently married women (38 percent) with 

77 percent of those sterilized not having used any prior method. Nearly all contraceptive prevalence in 

India is for limiting. In Morocco and Jordan, slightly over 60 percent of prevalence is for limiting. In 

general, in regions other than those in sub-Saharan Africa, the overall use for limiting is two to three 

times greater than the use for spacing (columns 1 and 2 of Table 1). Trends in spacing and limiting are 

shown in Figure 5 at the end of this report. 

The Latin American and Caribbean picture is fairly similar to that in Asia and North Africa, with an 

estimated average of 66 percent of Limiters who had been Spacers. Haiti and Bolivia have a lower 

percentage while Colombia shows the highest percentage in the L-S category. 

In sub-Saharan Africa, particularly in the Western and middle region, the use for spacing (columns 1 and 

2 in Table 1) predominates with the use for limiting below 10 percent in every country except Ghana. On 

average, around half of these Limiters began use as Spacers (column 3) but as noted above this means 

only a very small fraction of married women in general. The range of the L-S estimates is from a low of 

about one-third in Liberia, Sierra Leone and Guinea to around two-thirds in Gabon, Benin, Cameroon and 

several other countries. 

In contrast with this region of Africa, the countries in the Southern and Eastern regions show a much 

greater use of contraception for limiting purposes, with an average of 20 percent compared with the 5 

percent average in the Western and middle regions. There is a slightly higher distribution of the L-S 

estimates which reach three-quarters in four of the countries with a high of 86 percent in Zimbabwe. The 

lowest value is in Ethiopia at 32 percent. 

In summary, 34 of the 51 countries listed in Table 1 show at least half of Limiters had prior contraceptive 

spacing experience. The international variations no doubt reflect different family planning program 

histories including different menus of methods available and promoted. One implication is that the 

promotion of family planning for spacing can be viewed as a window onto its use for limiting but this 

generalization needs to be examined further both with time trend data as well as with analyses of 

individual covariates. 
9 

Table 1. Percentage of currently married women who are currently using a method for spacing or for 

limiting, and the percentage of Limiters who had formerly been Spacers or had only been Limiters. 

 

Percentage of married 

women who are: 

Percentage of current 

Limiters who were: 

Country Year Spacers Limiters Past Spacers Only Limiters 

Asia and North Africa 

Armenia 2005 11 42 36 64 

Azerbaijan 2006 8 44 29 71 

Bangladesh 2007 15 41 65 35 

Cambodia 2005 13 27 28 72 

Egypt 2008 13 47 87 13 

India 2005/06 5 51 24 76 

Indonesia 2007 25 36 73 27 

Jordan 2007 23 36 86 14 

Morocco 2004 23 41 89 11 

Nepal 2006 5 43 33 67 

Philippines 2008 15 36 60 40 

Turkey 2003 16 57 78 22 

Ukraine 2007 24 43 62 38 

Vietnam 2002 14 65 58 42 

Mean 15 43 57 43 

Latin America and 

Caribbean 

Bolivia 2008 17 43 55 45 

Colombia 2005 17 63 84 16 

Dominican Republic 2007 16 57 70 30 

Guatemala 1999 8 30 59 41 

Haiti 2006 14 18 43 57 

Honduras 2006 23 42 69 31 

Nicaragua 2001 20 48 73 27 

Peru 2005 23 50 66 34 

Mean 17 44 66 34 

(Continued...)
10 

Table 1 – Continued

 

Percentage of married 

women who are: 

Percentage of current 

Limiters who were: 

Country Year Spacers Limiters Past Spacers Only Limiters 

Western and Middle Africa 

Benin 2006 10 7 66 34 

Burkina Faso 2003 10 4 50 50 

Cameroon 2004 18 8 65 35 

Chad 2004 2 1 49 51 

Congo Brazzaville 2005 35 9 64 36 

Congo, Democratic 

Republic of the 2007 13 7 52 48 

Cote d'Ivoire 1999 10 5 56 44 

Gabon 2000 24 9 70 30 

Ghana 2008 12 11 55 45 

Guinea 2005 6 3 36 64 

Liberia 2007 7 5 28 72 

Mali 2006 5 3 56 44 

Niger 2006 10 2 64 36 

Nigeria 2008 9 6 52 48 

Senegal 2005 7 4 48 52 

Sierra Leone 2008 4 4 32 68 

Mean 11 5 53 47 

Southern and Eastern Africa 

Ethiopia 2005 7 8 32 68 

Kenya 2009 17 28 70 30 

Lesotho 2004 14 24 61 39 

Madagascar 2009 19 21 48 52 

Malawi 2004 16 17 51 49 

Mozambique 2003 16 9 74 26 

Namibia 2006 18 38 62 38 

Rwanda 2005 7 10 46 54 

Swaziland 2006 13 38 74 26 

Tanzania 2004 16 11 65 35 

Uganda 2006 11 13 47 53 

Zambia 2007 25 16 77 23 

Zimbabwe 2006 32 29 86 14 

Mean 16 20 60 40 
11 

7. Trends in the Transition 

We have also examined trends in the proportion of Limiters with prior spacing experience (Figure 2) for 

countries with multiple surveys. An increasing trend is evident in the more developed of these countries, 

especially in the Asia and North Africa region but the pattern is less clear in Latin America and the 

Caribbean. No such pattern is yet apparent in most of the sub-Saharan African countries. The patterns in 

sub-Saharan Africa will likely eventually become more like those in other countries when smaller 

families become more the norm. 
12 

Figure 2. Percentage of Limiters who previously used contraception for spacing: 

Asia and North Africa. 

60

55

65

54

33

29

21

89

68

59

86

87

84

73

73

64

61

57

50

47

24

20

19

87

78

69

68

62

66

28

13

65

63

56

47

44

0 20 40 60 80

Philippines

Nepal

Morocco

Jordan

Indonesia

India

Egypt

Cambodia

Bangladesh

2008

2003

1998

1993

2006

2001

1996

2004

1992

1987

2007

2002

1997

1990

2007

2003

1997

1994

1991

1987

2006

1999

1993

2008

2003

2000

1995

1992

1988

2005

2000

2007

2004

2000

1997

1994
13 

Figure 2 (continued). Percentage of Limiters who previously used contraception for spacing: 

Latin America and the Caribbean. 

6/22/2010

75

62

65

67

58

42

25

37

59

53

52

70

65

70

66

64

54

84

86

81

70

63

55

48

58

60

48

0 20 40 60 80

Peru

Haiti

Guatemala

Dominican Republic

Colombia

Bolivia

2005

2000

1996

1992

1986

2006

2000

1995

1999

1995

1987

2007

2002

1999

1996

1991

1986

2005

2000

1995

1990

1986

2008

2003

1998

1994

1989
14 

Figure 2 (continued). Percentage of Limiters who previously used contraception for spacing: 

Western and Middle Africa. 

48

58

58

52

58

43

65

52

55

56

47

51

54

37

25

55

50

54

59

62

65

59

52

50

64

82

67

61

73

0 20 40 60 80

Senegal

Nigeria

Niger

Mali

Guinea

Ghana

Cameroon

Burkina Faso

Benin

2005

1997

1993

2008

2003

1990

2006

1998

1992

2006

2001

1996

1987

2005

1999

2008

2003

1998

1993

1988

2004

1998

1991

2003

1999

1993

2006

2001

1996
15 

Figure 2 (continued). Percentage of Limiters who previously used contraception for spacing: 

Eastern and Southern Africa. 

86

85

87

87

77

73

73

75

47

47

50

65

53

58

46

66

35

62

65

70

74

45

51

40

44

48

39

46

52

70

65

60

52

54

0 20 40 60 80

Zimbabwe

Zambia

Uganda

Tanzania

Rwanda

Namibia

Mozambique

Malawi

Madagascar

Kenya

2006

1999

1994

1988

2007

2002

1996

1992

2006

2001

1995

2004

1996

1992

2005

2000

1992

2007

2000

1992

2003

1997

2004

2000

1992

2009

2004

1997

1992

2009

2003

1998

1993

1989
16 

8. Differences between the Two Types of Limiters 

Differences between Limiters with and without prior spacing experience are shown in Table 2. They are 

characterized by demographic, socio-economic, and mass media measures grouped by geographic 

regions. In row 2 of Table 2, we see that there is very little difference in their current ages, with an 

average age of 36 years. The characteristic that most sharply differentiates the two is the number of 

children at first use of contraception. In all four regions the mean parity at first use of a method is more 

than twice as high for Limiters with no spacing background than for those with spacing experience (row 

3). This is of course to be expected since former Spacers would have used a method at an earlier stage in 

the reproductive process. Despite the longer experience with contraception that this implies, there is little 

difference either in the total number of children ever born (row 5) or in the number of children desired 

(row 4). On the other hand, Limiters with a spacing background had slightly more births in the five years 

preceding the interview (row 6). Those Limiters with no spacing experience report a higher proportion of 

these births as unwanted (row 7) and also report more deaths of children over the years (row 9). 
Table 2. Differences in characteristics among Limiters with no former spacing experience and those with spacing experience. 

All Regions 

Asia/North 

Africa 

Latin America/ 

Caribbean 

Western/Middle 

Africa 

Eastern/ 

Southern Africa 

Row 

Only 

Limiters

Former 

Spacers 

Only 

Limiters

Former 

Spacers 

Only 

Limiters 

Former 

Spacers 

Only 

Limiters

Former 

Spacers 

Only 

Limiters

Former 

Spacers

1 Number of women 69,927 82,177 50,650 44,035 12,023 27,401 2,712 3,222 4,542 7,510

2 Age 36.2 36.3 36.3 36.4 35.0 35.6 37.6 37.5 34.9 35.6

3 Parity at first use 4.3 1.7 3.1 1.4 4.0 1.4 5.4 1.9 4.4 1.94 Number of children desired 4.0 3.9 2.7 2.9 3.2 3.0 5.4 5.4 4.2 4.05 Children ever born 4.7 4.7 3.3 3.7 4.3 3.9 5.9 5.9 5.0 4.96 Had birth in past 5 years (%) 49 58 30 44 47 48 56 70 62 687 Last child unwanted (%)1 35 22 30 22 52 33 28 16 37 23

8 Using modern method (%) 79 73 71 74 83 83 79 55 87 839 No child deaths (%) 64 74 78 85 69 84 52 59 58 72

10 Age at marriage 18.4 18.8 18.5 19.1 18.6 18.8 17.7 18.1 18.5 19.1

11 Urban residence (%) 45 54 43 53 47 60 53 61 36 4412 Years of schooling 5.2 6.6 6.0 8.0 4.7 6.8 4.0 4.9 5.4 7.013 Wealth quintile (mean) 3.3 3.5 3.0 3.2 2.7 3.0 3.6 3.8 3.5 3.714 Woman working (%) 62 60 51 42 52 54 75 77 64 6515 Husband has final say (%) 1.2 1.1 0.8 0.8 0.7 0.6 1.7 1.7 1.2 1.116 Heard FP on radio (%) 51 50 35 29 51 52 59 56 59 6217 Saw FP on TV (%) 33 39 49 53 31 42 30 35 19 2718 Read FP in papers (%) 15 20 17 20 16 26 12 14 14 2319 Read newspapers (%) 32 43 40 49 44 59 20 25 34 4720 Listens to radio (%) 73 76 53 58 89 91 79 78 80 8321 Watches TV (%) 54 63 83 90 64 76 46 53 30 43

1 Among women with a birth in past five years 

17 
18 

The difference in the percentage of unwanted last births shown in Figure 3 is worth further attention. One 

might plausibly expect that the experience of an unwanted birth might mark the entrance into the category 

of a Limiter. Indeed, there is a higher proportion of women with unwanted births among Limiters with no 

previous spacing record. In all countries except Liberia, the proportion of Limiters with spacing 

experience report a lower proportion of their last birth in the past five years as unwanted (in Niger, there 

is no difference). That adds up to 47 countries with higher unwanted fertility among Limiters with no 

spacing background. 

As Spacers move into the category of Limiters, one might expect that a higher proportion would use 

modern methods. However, this is not clear at all (row 8 in Table 2) and in Western and Middle Africa 

there is a large difference in the opposite direction. A detailed description of method use is presented in 

Table 3 for each individual country. A comparison of the main method used in the last two columns of 

Table 3 suggests that Spacers simply continue to use the same method as they enter the stage of wanting 

no more children. 

Limiters with past spacing experience are more likely to have married at slightly older ages (row 10 in 

Table 2), to live in cities (row 11), to have more education (row 12) and to have slightly greater wealth 

(row 13). Neither the wife’s labor force status nor the index of gender bias in decision making (rows 14 

and 15) shows any association with the Spacing – Limiting dichotomy. The gender role measure here, 

labeled as “Husband Final Say” is a summary index of four questions on who makes the final decisions 

on health care, large household purchases, items purchased for daily needs, and visits to family and 

relatives. The index is constructed so that a positive sign means that the husband alone makes such 

decisions. It is intended as a measure of gender equality and considered relevant to whether birth spacing 

was used before the number of children desired was reached. The Wealth index is coded in quintiles for 

each country. 

Exposure to messages about family planning on the radio shows no association here (row 16) though 

television and print family planning messages suggest greater influence among Limiters with spacing 

experience. Exposure to the media in general shows a fairly consistent higher proportion of Limiters with 

spacing experience. 
19 

Figure 3. Percentage of last births in the past five years that were unwanted 

among Limiters with (LS) and without (LO) earlier spacing experience. 

17

9

0

20

40

60

LO LS

Armenia 2005

Asia and North Africa

23

8

0

20

40

60

LO LS

Azerbaijan 2006

35

25

0

20

40

60

LO LS

Bangladesh 2006

35

18

0

20

40

60

LO LS

Cambodia 2005

37

18

0

20

40

60

LO LS

Egypt 2008

18 13

0

20

40

60

LO LS

India 2005

17 13

0

20

40

60

LO LS

Indonesia 2007

37

29

0

20

40

60

LO LS

Jordan 2007

48

32

0

20

40

60

LO LS

Morocco 2004

36

25

0

20

40

60

LO LS

Nepal 2006

31 29

0

20

40

60

LO LS

Philippines 2008

52

28

0

20

40

60

LO LS

Turkey 2003

22

6

0

20

40

60

LO LS

Ukraine 2007

30

10

0

20

40

60

LO LS

Vietnam 2007

LO Limiters only

LS Limiters, former Spacers
20 

Figure 3 (continued). Percentage of last births in the past five years that were unwanted 

 among Limiters with (LS) and without (LO) earlier spacing experience. 

64

35

0

20

40

60

LO LS

Bolivia 2008

Latin America and the Caribbean

56

37

0

20

40

60

LO LS

Colombia 2005

39

24

0

20

40

60

LO LS

Dominican Republic 

2007

24

16

0

20

40

60

LO LS

Guatemala 1999

55

45

0

20

40

60

LO LS

Haiti 2006

54

31

0

20

40

60

LO LS

Honduras 2005

51

33

0

20

40

60

LO LS

Nicaragua 2001 69

36

0

20

40

60

LO LS

Peru 2005

LO Limiters only

LS Limiters, former Spacers
21 

Figure 3 (continued). Percentage of last births in the past five years that were unwanted 

among Limiters with (LS) and without (LO) earlier spacing experience. 

24

15

0

20

40

60

LO LS

Benin 2006

Western and Middle Africa

25

15

0

20

40

60

LO LS

Burkina Faso 2003

42

26

0

20

40

60

LO LS

Cameroon 2004

38

7

0

20

40

60

LO LS

Chad 2004

18 15

0

20

40

60

LO LS

Congo B 2005

34

23

0

20

40

60

LO LS

Congo DR 2007

36

16

0

20

40

60

LO LS

Ghana 2008

34

7

0

20

40

60

LO LS

Guinea 2005

23

31

0

20

40

60

LO LS

Liberia 2007

31

20

0

20

40

60

LO LS

Mali 2006

10 10

0

20

40

60

LO LS

Niger 2006

34

12

0

20

40

60

LO LS

Nigeria 2008

33 29

0

20

40

60

LO LS

Senegal 2005

31

25

0

20

40

60

LO LS

Serra Leone 2008

LO Limiters only

LS Limiters, former Spacers
22 

Figure 3 (continued). Percentage of last births in the past five years that were unwanted 

among Limiters with (LS) and without (LO) earlier spacing experience. 

42

18

0

20

40

60

LO LS

Ethiopia 2005

Eastern and Southern Africa

36

26

0

20

40

60

LO LS

Kenya 2009

52

33

0

20

40

60

LO LS

Lesotho 2004

14

8

0

20

40

60

LO LS

Madagascar 2009

40

24

0

20

40

60

LO LS

Malawi 2004

26

16

0

20

40

60

LO LS

Mozambique 2003

43

23

0

20

40

60

LO LS

Namibia 2006

30 29

0

20

40

60

LO LS

Rwanda 2005

50

36

0

20

40

60

LO LS

Swaziland 2006

34

11

0

20

40

60

LO LS

Tanzania 2004

46

31

0

20

40

60

LO LS

Uganda 2006

45

30

0

20

40

60

LO LS

Zambia 2007

26

16

0

20

40

60

LO LS

Zimbabwe 2006

LO Limiters only

LS Limiters, former Spacers
23 

9. Method Use 

The prior observation that there is little evidence of method switching associated with the shift from 

spacing to limiting is confirmed in Table 3. This table shows two sections for each country: the 

proportions currently using modern methods for the two types of Limiters in the first two columns (the 

same statistic in row 8 of Table 2 but for countries rather than summarized by regions) and the modal or 

main specific method currently used. As noted above, Limiters with spacing backgrounds are less likely 

to be using a modern method, a difference that is particularly striking in the countries of Western and 

Middle Africa. In the third and fourth columns, for the most part there is little difference in the main 

method used by the two categories of Limiters, those with and without prior spacing experience. This may 

indicate that the same method last used for spacing is continued when the reason for use switches to 

limiting. 

Table 3. Percentage of current Limiters using a modern method and the main method used by 

Limiters only compared with Limiters who had formerly been Spacers. 

 Current Limiters 

Main Method Used* 

by Limiters 

Country Year 

Only 

Limiters 

Former 

Spacers 

Only 

Limiters 

Former 

Spacers 

Asia and North Africa 

Armenia 2005 37 29 W W 

Azerbaijan 2006 29 22 W W 

Bangladesh 2007 85 84 Pill Pill 

Cambodia 2005 74 62 Pill W 

Egypt 2008 97 96 IUD IUD 

India 2005 92 78 Ster Ster 

Indonesia 2007 95 93 Inj Inj 

Jordan 2007 78 76 IUD IUD 

Morocco 2004 87 86 Pill Pill 

Nepal 2006 95 89 Ster Ster 

Philippines 2003 77 65 Ster Ster 

Turkey 2003 57 63 W W 

Ukraine 2007 72 68 Cond IUD 

Vietnam 2002 77 69 IUD IUD 

Latin America and Caribbean 

Bolivia 2008 57 57 PA PA 

Colombia 2005 87 89 Ster Ster 

Dominican Republic 2007 98 97 Ster Ster 

Guatemala 1999 91 81 Ster Ster 

Haiti 2006 82 72 Inj Inj 

Honduras 2006 90 88 Ster Ster 

Nicaragua 2001 97 97 Ster Ster 

Peru 2005 67 67 PA PA 

(Continued...)
24 

Table 3 – Continued

 Current Limiters 

Main Method Used* 

by Limiters 

Country Year 

Only 

Limiters 

Former 

Spacers 

Only 

Limiters 

Former 

Spacers 

Western and Middle Africa 

Benin 2006 67 30 PA PA 

Burkina Faso 2003 86 52 Inj PA 

Cameroon 2004 63 43 Inj PA 

Chad 2004 98 64 PA PA 

Congo, Brazzaville 2005 35 28 PA PA 

Congo, Democratic 

Republic of the 2007 50 28 PA PA 

Cote d'Ivoire 1999 53 47 PA PA 

Gabon 2000 62 55 PA PA 

Ghana 2008 82 68 Inj PA 

Guinea 2005 75 65 Pill LAM 

Liberia 2007 97 94 Inj Pill 

Mali 2006 89 90 Inj Pill 

Niger 2006 93 55 Inj LAM 

Nigeria 2008 77 62 Inj PA 

Senegal 2005 92 83 Inj Pill 

Sierra Leone 2008 72 90 Inj Pill 

Southern and Eastern Africa 

Ethiopia 2005 98 90 Inj Inj 

Kenya 2009 90 86 Inj Inj 

Lesotho 2004 94 94 Inj Inj 

Madagascar 2009 85 63 Inj Inj 

Malawi 2004 92 84 Inj Inj 

Mozambique 2003 86 81 Inj LAM 

Namibia 2006 98 97 Inj Inj 

Rwanda 2005 66 53 Inj PA 

Swaziland 2006 96 93 Inj Inj 

Tanzania 2004 90 74 Inj Inj 

Uganda 2006 81 74 Inj Inj 

Zambia 2007 88 78 Pill Pill 

Zimbabwe 2006 98 97 Pill Pill 

* W = Withdrawal; Ster = Sterilization; Inj = Injectable; IUD = Intrauterine device; Cond = Condom; 

PA = Periodic Abstinence; LAM = Lactational Amenorrhea 
25 

10. Multivariate Analyses 

Thus far we have examined simple differences between the Limiter-Spacer combinations with education, 

residence, wealth and exposure to mass media as well as with age, fertility and methods of contraception. 

The next section examines these and other covariates simultaneously in a set of logistic regressions in 

which the dependent variable is defined as Limiters who had no prior spacing experience compared with 

Limiters who earlier had been Spacers. It is important to remember that these analyses focus exclusively 

on Limiters, a category that varies in size significantly from country to country. On average, the 

percentage of all married women who are current Limiters ranges from a low of 5 percent in western and 

Middle Africa, 20 percent in Southern and Eastern Africa to 43-44 percent in Asia, North Africa, Latin 

America and the Caribbean (Table 1). Countries are weighted equally in these analyses in order to avoid 

giving greater importance to countries with large samples. 

One of the first observations in the multivariate analysis (Table 4) is that the number of births wanted 

increases significantly for Limiters with spacing experience; conversely the number of unwanted births is 

lower. This pattern is present in all regions. This is the complement of the reverse observation that women 

with unwanted fertility had less spacing experience. With greater contraceptive use for spacing, the 

likelihood of later contraceptive failure would diminish. Child mortality is negatively associated across all 

regions – the earlier contraceptive use for spacing is related to reduced child mortality. This association is 

particularly strong and deserves additional attention. 

The use of modern vs. traditional methods shows an interesting pattern. For all countries combined, the 

odds indicate that a traditional method of contraception is used by Limiters with a spacing background but 

in the Asia/North Africa region the odds favor modern method use by this category of Limiters. In the 

other regions, especially in the Western/Middle Africa region, the use of traditional methods dominates. 

Living in rural areas is not associated with having spaced births with contraception except in Asia/North 

Africa and Southern and Eastern Africa. In the Latin America/Caribbean region, residence in cities is also 

associated with having been a Spacer but is not significant in Table 4 because several countries are 

excluded due to missing data on other variables. 

Years of schooling is positively associated with the Limiter – Spacer combination in all regions. Wealth is 

similarly related. 

Exposure to radio messages on family planning is, for unknown reasons, negatively correlated with the 

likelihood of Limiters having been Spacers especially in the Asia/North Africa region. Print messages 

show some positive association. The main finding here is a consistent positive correlation of earlier 

spacing experience with the frequency with which television in general is viewed. 

In summary, the analysis shows that Limiters who had been Spacers: 

• Are less likely to have had unwanted births; 

• Are less likely to have experienced a child death; 

• Are less likely to have adopted a modern method of contraception 

(except in Asia/North Africa); 

• Are more likely to have more years of schooling; 

• Are more likely to have been exposed to mass media generally. 

On the whole, the search for covariates of the Limiter-Spacer combination has not been especially 

fruitful. The most interesting findings are the associations with unwanted births, with child survival, with 

more education and with a greater frequency of watching television. It should be kept in mind that the 

populations examined in this part of the analysis consist only of Limiters who are in the minority 

especially in sub-Saharan Africa. 
26 

Table 4. Odds ratios* of Limiters having been Spacers, by region. 

Covariate 

All 

Countries 

Asia/ 

North 

Africa 

Latin 

America/ 

Caribbean 

Western/ 

Middle 

Africa 

Eastern/ 

Southern 

Africa 

Number of births wanted 1.27 1.47 1.30 1.20 1.26 

Number of births unwanted 0.97 0.90 0.91 0.94 0.96 

Number of child deaths 0.70 0.68 0.58 0.85 0.64 

Age 0.98 0.97 0.98 0.99 

Rural residence 0.90 0.87 

Years of schooling 1.05 1.04 1.08 1.02 1.09 

Wife working 0.92 0.89 

Wealth 1.03 1.03 1.08 0.94 

Using modern method 0.75 1.35 0.78 0.34 0.69 

FP messages on radio 0.84 0.65 0.89 

FP messages on TV 1.14 0.85 

FP messages in print 1.21 1.27 1.44 

Read newspapers frequently 1.06 

Listen to radio frequently 1.05 1.17 

Watch TV frequently 1.11 1.20 1.11 1.15 1.15 

Husband has final say 0.97 

Number of women 115,899 86,626 13,321 5,174 10,778 

Chi squared 1,522 2,973 810 324 670 

R squared 0.04 0.07 0.07 0.06 0.06 

* Only odds ratios significant at least at the 0.05 level are shown 

11. The Effect of Spacing Experience on Desired Family Size 

In this final section, we return to the overall picture for all currently married women and examine the 

association of desired number of children with contraceptive use and spacing and limiting status2

 (Figure 

4). The section concludes with a review of trends in spacing and limiting behavior in countries with 

multiple surveys. 

In Figure 4, we see a general pattern that appears at each age and in each world region. First, the number 

of children desired is, not surprisingly, highest for women who have never used any method of 

contraception. The second category consists of women who have previously used a method but who are 

not currently using contraception which would include those who interrupted use to have a child and other 

reasons. Their desired number of children is essentially the same as the third category of current Spacers 

 

2 The measure of the desired number of children is based on the standard question on ideal number since the sample 

here is not only Limiters but all married women. Women who gave non-numeric responses to the question were 

excluded from the analysis.
27 

which is not surprising considering that many had recently been Spacers. The desired number of children 

for both of these groups is lower than that for those who never used any method except in the Asian and 

North African countries. Of course, the proportion of women that has never used any method is 

considerably lower in the more developed countries. Since the number of children desired by women in 

the second and third categories in other regions is consistently lower, age by age, than for Never Users it 

raises the question of whether Spacers are selected for women who want fewer children to begin with or 

whether the contraceptive experience serves to lower earlier large family-size preferences. 

The remaining two categories in Figure 4 are both Limiters. These women, at all ages, want the fewest 

children. Again the question is whether these women are self-selected for lower reproductive preferences 

or whether their earlier contraceptive experience as Spacers played a role. The fourth and fifth categories 

are distinguished by whether Limiters had previously been Spacers. In the Asian and North African 

countries there is no difference between these two categories. However, in the other regions at older ages 

where Limiters would be concentrated, women who once had been Spacers want slightly fewer children 

than women whose only contraceptive experience had been as Limiters, lending some support to the 

hypothesis that the spacing experience might lower preferences. 

In Figure 5 the trends over time in the proportions of Spacers and Limiters are depicted for 28 countries 

that have conducted three or more surveys. For some of these countries, estimates from surveys before the 

DHS have been included to provide a picture of some 30 years of change. 

In the Asian, North African, Latin American and Caribbean nations included in this review, the 

proportion of Limiters exceeds the proportion of Spacers in every survey (a total of 65 observations in 12 

countries) in these two regions. In contrast, almost all observations in the Middle and Western African 

countries show the reverse pattern: Spacers outnumber Limiters. Countries in Eastern and Southern Africa 

show a much more mixed picture with Limiters more numerous than Spacers in some countries and the 

opposite in other countries. In general, the trend is upward for both spacing and limiting behavior. In 

Bangladesh, for example, the 3 percent spacing in 1980 grew to 15 percent 25 years later while the 

percent limiting increased from 10 to 41 percent. Similar pictures appear in Egypt and in most of the other 

countries in the region as well as in most of Latin American and the Caribbean. There are some variations 

in the magnitudes, e.g., in India the increase is all among Limiters with very little spacing. A similar 

pattern appears in Nepal as well. In contrast, spacing is more prominent in Indonesia although still 

overshadowed by limiting. In the Dominican Republic there is a very pronounced increase in Limiters 

from 23 percent in 1975 to 57 percent by 2007. However, Haiti is a very different story with only 18 

percent being Limiters as of the last survey in 2006. In Peru, after a rapid increase in the proportion of 

Limiters from 1977 to 2000, the upward trend has stalled though a substantial minority uses contraception 

for spacing, a trend that seems to be increasing. 

The situation in Middle and Western Africa is familiar with very low proportions using contraception for 

either purpose, especially for limiting. There are some signs of increases such as in Cameroon and in 

Ghana but little elsewhere. In Nigeria, the most populous country in the region, only 6 percent of women 

were using for limiting by 2008. 

The picture in Eastern and Southern Africa is different. In Kenya, the proportions limiting births grew 

from 4 percent in 1977 to 28 percent in 2009 with an accompanying increase in spacing from 2 to 17 

percent. Similar patterns are evident in Namibia, Zambia and Zimbabwe. On the other hand, there is only 

a slow increase in Tanzania and Uganda. It is going to take a while longer to see a more rapid rate of 

increase but this seems more likely in this region of Africa than in the middle and Western part of the 

continent. 
28 

Figure 4. Mean number of children desired by married women by current contraceptive use and 

spacing and limiting status. 

2.2

2.1

2.5

2.4

2.5

01234567

Limiter, past spacer

Limiter, no spacing

Spacer

Used before

Never used

20 - 24

2.3

2.3

2.8

2.6

2.8

01234567

25 - 29

2.6

2.5

3.1

2.9

3.0

01234567

Limiter, past spacer

Limiter, no spacing

Spacer

Used before

Never used

30 - 34

2.9

2.9

3.3

3.2

3.2

01234567

35 - 39

3.2

2.9

3.6

3.2

3.9

01234567

Limiter, past spacer

Limiter, no spacing

Spacer

Used before

Never used

40 - 44

Asia and North Africa
29 

Figure 4 (continued). Mean number of children desired by married women by current 

contraceptive use and spacing and limiting status. 

2.2

2.1

2.7

2.7

2.9

01234567

Limiter, past spacer

Limiter, no spacing

Spacer

Used before

Never used

20 - 24

2.6

2.6

2.9

2.9

3.4

01234567

25 - 29

2.9

3.0

3.2

3.1

3.9

01234567

Limiter, past spacer

Limiter, no spacing

Spacer

Used before

Never used

30 - 34

3.1

3.4

3.5

3.5

4.3

01234567

35 - 39

3.3

3.6

4.2

3.6

4.5

01234567

Limiter, past spacer

Limiter, no spacing

Spacer

Used before

Never used

40 - 44

Latin America and the Caribbean
30 

Figure 4 (continued). Mean number of children desired by married women by current 

contraceptive use and spacing and limiting status. 

3.4

3.4

4.9

4.7

5.7

01234567

Limiter, past spacer

Limiter, no spacing

Spacer

Used before

Never used

20 - 24

4.1

4.1

5.2

5.1

6.0

01234567

25 - 29

4.7

4.6

5.5

5.4

6.3

01234567

Limiter, past spacer

Limiter, no spacing

Spacer

Used before

Never used

30 - 34

5.0

5.2

6.2

5.8

6.6

01234567

35 - 39

5.6

6.0

6.1

6.9

01234567

Limiter, past spacer

Limiter, no spacing

Spacer

Used before

Never used

40 - 44

Western and Middle Africa

7.1
31 

Figure 4 (continued). Mean number of children desired by married women by current 

contraceptive use and spacing and limiting status. 

2.5

2.5

3.8

3.7

4.6

01234567

Limiter, past spacer

Limiter, no spacing

Spacer

Used before

Never used

20 - 24

3.1

3.0

4.1

4.0

5.1

01234567

25 - 29

3.4

3.6

4.5

4.4

5.5

01234567

Limiter, past spacer

Limiter, no spacing

Spacer

Used before

Never used

30 - 34

3.9

4.3

4.9

4.7

5.8

01234567

35 - 39

4.3

4.8

5.7

5.0

5.9

01234567

Limiter, past spacer

Limiter, no spacing

Spacer

Used before

Never used

40 - 44

Eastern and Southern Africa
32 

Figure 5. Trends in the current use of contraception for spacing and for limiting births, 

for currently married women age 15–49. 

41

39

34

10

15

15

11

3

0 10 20 30 40 50 60

2007

2000

1994

1980

Bangladesh

Asia and North Africa

47

45

39

20

13

11

8

5

0 10 20 30 40 50 60

2008

2000

1992

1980

Egypt

51

45

37

26

5

3

3

6

0 10 20 30 40 50 60

2005

1999

1993

1980

India

36

32

30

15

25

25

18

4

0 10 20 30 40 50 60

2007

1997

1987

1976

Indonesia

35

30

34

17

22

25

18

9

0 10 20 30 40 50 60

2007

2002

1997

1976

Jordan

43

35

26

5

4

3

0 10 20 30 40 50 60

2006

2001

1996

Nepal

36

35

31

25

15

14

9

12

0 10 20 30 40 50 60

2008

2003

1993

1978

Philippines

Spacers

Limiters
33 

Figure 5 (continued). Trends in the current use of contraception for spacing and for limiting 

births, for currently married women age 15–49. 

43

42

35

34

24

17

16

13

11

7

0 10 20 30 40 50 60

2008

2003

1998

1994

1989

Bolivia

Latin America and the Caribbean

53

50

28

17

19

13

17

0 10 20 30 40 50 60

2005

1995

1986

1976

Colombia

57

50

40

23

16

14

10

10

0 10 20 30 40 50 60

2007

1996

1986

1975

Dominican Republic

18

18

12

11

14

10

6

7

0 10 20 30 40 50 60

2006

2000

1995

1977

Haiti

48

48

35

21

24

20

12

12

0 10 20 30 40 50 60

2008

2000

1986

1977

Peru

Spacers

Limiters

 
34 

Figure 5 (continued). Trends in the current use of contraception for spacing and for limiting 

births, for currently married women age 15–49. 

7

7

5

10

12

11

0 10 20 30 40 50 60

2006

2001

1996

Benin

Western and Middle Africa

8

7

5

3

18

12

11

7

0 10 20 30 40 50 60

2004

1998

1991

1978

Cameroon

11

10

5

2

12

12

8

8

0 10 20 30 40 50 60

2008

1998

1988

1979

Ghana

3

3

2

1

5

5

4

4

0 10 20 30 40 50 60

2006

2001

1996

1987

Mali

2

1

1

10

7

4

0 10 20 30 40 50 60

2006

1998

1992

Niger

6

5

3

1

9

8

3

4

0 10 20 30 40 50 60

2008

2003

1990

1981

Nigeria

4

5

3

1

7

8

9

3

0 10 20 30 40 50 60

2005

1997

1986

1978

Senegal

Spacers

Limiters
35 

Figure 5 (continued). Trends in the current use of contraception for spacing and for limiting 

births, for currently married women age 15–49. 

28

25

26

18

4

17

14

13

9

2

0 10 20 30 40 50 60

2009

2003

1998

1989

1977

Kenya

Eastern and Southern Africa

21

15

12

10

19

12

8

6

0 10 20 30 40 50 60

2009

2002

1997

1992

Madagascar

17

18

6

15

13

7

0 10 20 30 40 50 60

2004

2000

1992

Malawi

37

31

18

18

13

11

0 10 20 30 40 50 60

2006

2000

1992

Namibia

10

6

11

2

7

7

10

8

0 10 20 30 40 50 60

2005

2000

1992

1983

Rwanda

Spacers

Limiters
36 

Figure 5 (continued). Trends in the current use of contraception for spacing and for limiting 

births, for currently married women age 15–49. 

11

10

8

4

15

15

10

6

0 10 20 30 40 50 60

2004

1990

1996

1991

Tanzania

13

12

8

3

11

11

7

2

0 10 20 30 40 50 60

2006

2001

1995

1988

Uganda

16

15

10

6

25

19

16

9

0 10 20 30 40 50 60

2007

2002

1996

1992

Zambia

29

24

21

10

31

29

27

30

0 10 20 30 40 50 60

2006

1999

1994

1984

Zimbabwe

Spacers

Limiters
37 

12. Discussion 

This paper began with the observation that the fertility rate is much more responsive to the use of 

contraception for limiting births than to the spacing of births. In the fertility transition historically in the 

now developed countries, the methods of contraception then available plus abortion were typically used to 

terminate childbearing rather than to space earlier births. In more recent times, due in part to the efforts of 

organized family planning programs, the emphasis has focused on health rationales rather than on fertility 

rates, expressed in terms of promoting the health of mothers and children by extending the lengths of birth 

intervals. This is one of the reasons that contraceptive use for spacing dominates in sub-Saharan Africa. 

Another reason is that their desired family size is high. This led to the question of whether use for spacing 

leads to use for limiting, the main focus of this study. 

The short answer to this question is that somewhat more than half of Limiters have been Spacers. The 

remaining Limiters had used no contraception until they had reached the number of children desired, a 

pattern similar to the earlier transition history. The program question of whether introducing 

contraception for spacing purposes is a bridge to later use for limiting certainly seems plausible. What 

remains unanswered is whether earlier experience with spacing generates a reduction in the number of 

children desired. The evidence we have reviewed here does not speak to that question directly but there is 

some indirect evidence that Limiters with prior spacing experience tend to want fewer children than 

Limiters who have not been Spacers. Of course, we have shown many differences between these two 

groups that might explain this. One salutary effect of spacing that we can infer is a significant reduction in 

child mortality. 
38 

Appendix 

Percent distribution of two measures of number of children desired by married women using contraception 

who want no more children. 

0

10

20

30

40

50

Percent

0 1 2 3 4 5 6 7 8 9+

Ideal Actual

Asia and North Africa

0

10

20

30

40

50

Percent

0 1 2 3 4 5 6 7 8 9+

Ideal Actual

Latin America and Caribbean

0

10

20

30

40

50

Percent

0 1 2 3 4 5 6 7 8 9+

Ideal Actual

Western and Middle Africa

0

10

20

30

40

50

Percent

0 1 2 3 4 5 6 7 8 9+

Ideal Actual

Eastern and Southern Africa
DHS Analytical Studies Series 

1. Westoff, Charles F. 2000. The Substitution of Contraception for Abortion in Kazakhstan in the 

1990s.

2. Rafalimanana, Hantamalala, and Charles F. Westoff. 2001. Gap between Preferred and Actual 

Birth Intervals in Sub-Saharan Africa: Implications for Fertility and Child Health.

3. Mahy, Mary, and Neeru Gupta. 2002. Trends and Differentials in Adolescent Reproductive 

Behavior in Sub-Saharan Africa. 

4. Westoff, Charles F., and Akinrinola Bankole. 2001. The Contraception- Fertility Link in SubSaharan Africa and in Other Developing Countries.

5. Yoder, P. Stanley, and Mary Mahy. 2001. Female Genital Cutting in Guinea: Qualitative and 

Quantitative Research Strategies. 

6. Westoff, Charles F., Jeremiah M. Sullivan, Holly A. Newby, and Albert R. Themme. 2002. 

Contraception-Abortion Connections in Armenia.

7. Bell, Jacqueline, Siân L. Curtis, and Silvia Alayón. 2003. Trends in Delivery Care in Six Countries.

8. Westoff, Charles F. 2005. Recent Trends in Abortion and Contraception in 12 Countries.

9. Westoff, Charles F., and Anne R. Cross. 2006. The Stall in the Fertility Transition in Kenya.

10. Gebreselassie, Tesfayi. 2008. Spousal Agreement on Reproductive Preferences in Sub-Saharan 

Africa.

11. Gebreselassie, Tesfayi, and Vinod Mishra. 2007. Spousal Agreement on Family Planning in SubSaharan Africa.

12. Mishra, Vinod, Rathavuth Hong, Shane Khan, Yuan Gu, and Li Liu. 2008. Evaluating HIV 

Estimates from National Population-Based Surveys for Bias Resulting from Non-Response.

13. Westoff, Charles F. A New Approach to Estimating Abortion Rates. 

14. Gebreselassie, Tesfayi, Shea O. Rutstein, and Vinod Mishra. Contraceptive Use, Breastfeeding, 

Amenorrhea and Abstinence during the Postpartum Period: An Analysis of Four Countries. 

15. Mishra, Vinod, and Simona Bignami-Van Assche. Orphans and Vulnerable Children in High HIVPrevalence Countries in Sub-Saharan Africa. 

16. Bradley, Sarah E.K., and Vinod Mishra. 2008. HIV and Nutrition among Women in Sub-Saharan 

Africa. 

17. Johnson, Kiersten, and Amber Peterman. 2008. Incontinence Data from the Demographic and 

Health Surveys: Comparative Analysis of a Proxy Measurement of Vaginal Fistula and 

Recommendations for Future Population-Based Data Collection.

18. Hindin, Michelle J., Sunita Kishor, and Donna L. Ansara. 2008. Intimate Partner Violence among 

Couples in 10 DHS Countries: Predictors and Health Outcomes.

19. Johnson, Kiersten, Monica Grant, Shane Khan, Zhuzhi Moore, Avril Armstrong, and Zhihong Sa. 

2009. Fieldwork-Related Factors and Data Quality in the Demographic and Health Surveys 

Program.

20. Bradley, Sarah E.K., Hilary M. Schwandt, and Shane Khan. 2009. Levels, Trends, and Reasons 

for Contraceptive Discontinuation.

21. Westoff, Charles F. and Dawn Koffman. 2010. Birth Spacing and Limiting Connections.