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 Demographic and Health Research Division, 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 Comparative Reports No. 28 

Trends in Birth Spacing 

Shea O. Rutstein 

ICF Macro 

Calverton, Maryland, USA 

September 2011 

Corresponding author: Shea O. Rutstein, Demographic and Health Research Division, ICF Macro, 11785 

Beltsville Drive, Suite 300, Calverton, MD 20705; Phone: 301-572-0950; Fax: 301-572-0999; Email: 

srutstein@icfi.com 
Editor: Bryant Robey 

Document Production: Yuan Cheng 

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: 

Rutstein, Shea O. 2011. Trends in Birth Spacing. DHS Comparative Reports No. 28. Calverton, 

Maryland, USA: ICF Macro. 
iii 

Contents

Tables............. ..............................................................................................................................v 

Figures......................................................................................................................................... ix 

Preface............... ......................................................................................................................... xi 

Executive Summary ..................................................................................................................... xiii 

1. Introduction ................................................................................................................................1 

1.1 Purpose ..............................................................................................................................1 

1.2 Methodology .....................................................................................................................1 

1.3 Data ...................................................................................................................................2 

2. Actual Birth Intervals .................................................................................................................5 

2.1 Latest DHS Surveys ..........................................................................................................5 

2.2 Trends in Actual Birth Intervals .....................................................................................11 

3. Preferred Birth Intervals ..........................................................................................................17 

3.1 Preferred Intervals and Differences with Actual Intervals .............................................17 

3.2 Trends in Preferred Intervals ..........................................................................................23 

3.3 Differentials ....................................................................................................................27 

4. Contraception for Spacing Births.............................................................................................31 

4.1 Demand for Spacing Births .............................................................................................31 

4.2 Unsatisfied Demand for Contraception for Spacing .......................................................37 

4.3 Differentials ....................................................................................................................38 

5. Discussion ................................................................................................................................43 

6. Conclusion and Policy Implications ........................................................................................45 

References ....................................................................................................................................47 

Appendix (available at www.measuredhs.com/publications/publication-cr28-comparative-reports.cfm) 
 
v 

Tables 

Table 2.1.a. Length of Actual Birth Intervals by Country, for Most Recent Survey ....................6 

Table 2.1.b. Length of Actual Birth Intervals by Region, for Most Recent Survey ......................7 

Table 2.2.a. Trends in Length of Actual Birth Intervals, by Country .........................................11 

Table 2.2.b. Trends in Length of Actual Birth Intervals, by Region ...........................................12 

Table 3.1.a. Length of Preferred Birth Intervals by Country, for Most Recent Survey ..................17 

Table 3.1.b. Length of Preferred Birth Intervals by Region, for Most Recent Survey ....................19 

Table 3.1.c. Differences between Lengths of Preferred and Actual Birth Intervals, by 

Region ............................................................................................................................. 19 

Table 3.2.a. Preferred versus Actual Birth Intervals by Country, for Most Recent Survey ........21 

Table 3.2.b. Preferred versus Actual Birth Intervals by Region, for Most Recent Survey .........23 

Table 3.3.a. Trends in Length of Preferred Birth Intervals, by Country .....................................23 

Table 3.3.b. Trends in Length of Preferred Birth Intervals, by Region ......................................25 

Table 3.4.a. Trends in Length of Preferred versus Actual Birth Intervals, by Country ..............25 

Table 3.4.b. Trends in Length of Preferred versus Actual Birth Intervals, by Region ................27 

Table 4.1. Need for Spacing, by Country .................................................................................32 

Table 4.2. Trends in the Demand to Space Births and Unsatisfied Demand to Space 

Births, by Country ...................................................................................................36

Table 4.3. Levels and Trends in the Demand for Spacing and Percentage Unsatisfied 

of Demand for Spacing, by Region .........................................................................37 

Appendix Tables 

(available at www.measuredhs.com/publications/publication-cr28-comparative-reports.cfm)

Table A.2.1.a. Length of Actual Birth Intervals, by Country 

Table A.2.1.b. Length of Actual Birth Intervals, by Region 

Table A.2.2.a. Length of Actual Birth Intervals by Residence, by Country 

Table A.2.2.b. Length of Actual Birth Intervals by Residence, by Region 

Table A.2.2.c. Changes in Length of Actual Birth Intervals by Residence, by Country 

Table A.2.2.d. Changes in Length of Actual Birth Intervals by Residence, by Region 

Table A.2.3.a. Length of Actual Birth Intervals by Household Wealth Quintile, by Country 

Table A.2.3.b. Length of Actual Birth Intervals by Household Wealth Quintile, by Region 
vi 

Table A.2.3.c. Changes in Length of Actual Birth Intervals by Household Wealth Quintile, by 

Country 

Table A.2.3.d. Changes in Length of Actual Birth Intervals by Household Wealth Quintile, by 

Region 

Table A.2.4.a. Length of Actual Birth Intervals by Maternal Education, by Country 

Table A.2.4.b. Length of Actual Birth Intervals by Maternal Education, by Region 

Table A.2.4.c. Changes in Length of Actual Birth Intervals by Maternal Education, by Country 

Table A.2.4.d. Changes in Length of Actual Birth Intervals by Maternal Education, by Region 

Table A.2.5.a. Length of Actual Birth Intervals by Birth Order, by Country 

Table A.2.5.b. Length of Actual Birth Intervals by Birth Order, by Region 

Table A.2.5.c. Changes in Length of Actual Birth Intervals by Birth Order, by Country 

Table A.2.5.d. Changes in Length of Actual Birth Intervals by Birth Order, by Region 

Table A.3.2.a. Length of Preferred Birth Intervals by Residence, by Country 

Table A.3.2.b. Length of Preferred Birth Intervals by Residence, by Region 

Table A.3.2.c. Changes in Length of Preferred Birth Intervals by Residence, by Country 

Table A.3.2.d. Changes in Length of Preferred Birth Intervals by Residence, by Region 

Table A.3.3.a. Length of Preferred Birth Intervals by Household Wealth Quintile, by Country 

Table A.3.3.b. Length of Preferred Birth Intervals by Household Wealth Quintile, by Region 

Table A.3.3.c. Difffernces in Lengths of Preferred and Actual Birth Intervals by Household 

Wealth Quintile, by Region 

Table A.3.3.d. Changes in Length of Preferred Birth Intervals by Household Wealth Quintile, 

by Country 

Table A.3.3.e. Changes in Length of Preferred Birth Intervals by Household Wealth Quintile, 

by Region 

Table A.3.4. Length of Preferred Birth Intervals by Maternal Education, by Country 

Table A.3.5.a. Length of Preferred Birth Intervals by Maternal Age, by Country 

Table A.3.5.b. Changes in Length of Preferred Birth Intervals by Maternal Age, by Country 

Table A.3.5.c. Changes in Length of Preferred Birth Intervals by Maternal Age, by Region 

Table A.3.6.a. Length of Preferred Birth Intervals by Parity, by Country 

Table A.3.6.b. Changes in Length of Preferred Birth Intervals by Parity, by Country 

Table A.3.6.c. Changes in Length of Preferred Birth Intervals by Parity, by Region 

Table A.3.7.a. Preferred versus Actual Birth Intervals by Residence, by Country 

Table A.3.7.b. Changes in Preferred versus Actual Birth Intervals by Residence, by Country 
vii 

Table A.3.7.c. Changes in Preferred versus Actual Birth Intervals by Residence, by Region 

Table A.3.8.a. Preferred versus Actual Birth Intervals by Household Wealth Quintile, by 

Country 

Table A.3.8.b. Changes in Preferred versus Actual Birth Intervals by Household Wealth 

Quintile, by Country 

Table A.3.8.c. Changes in Preferred versus Actual Birth Intervals by Household Wealth 

Quintile, by Region 

Table A.3.9.a. Preferred versus Actual Birth Intervals by Maternal Education, by Country 

Table A.3.9.b. Changes in Preferred versus Actual Birth Intervals by Maternal Education, by 

Country 

Table A.3.9.c. Changes in Preferred versus Actual Birth Intervals by Maternal Education, by 

Region 

Table A.3.10.a. Preferred versus Actual Birth Intervals by Maternal Age, by Country 

Table A.3.10.b. Changes in Preferred versus Actual Birth Intervals by Maternal Age, by 

Country 

Table A.3.10.c. Changes in Preferred versus Actual Birth Intervals by Maternal Age, by Region 

Table A.3.11.a. Preferred versus Actual Birth Intervals by Birth Order, by Country 

Table A.3.11.b. Changes in Preferred versus Actual Birth Intervals by Birth Order, by Country 

Table A.3.11.c. Changes in Preferred versus Actual Birth Intervals by Birth Order, by Region 

Table A.4.1.a. Need for Family Planning for Spacing Births by Residence, by Country 

Table A.4.1.b. Need for Family Planning for Spacing Births by Residence, by Region 

Table A.4.2.a. Need for Family Planning for Spacing Births by Household Wealth Quintile, by 

Country 

Table A.4.2.b. Need for Family Planning for Spacing Births by Household Wealth Quintile, 

by Region 

Table A.4.2.c. Average Annual Changes in Demand for Contraception for Spacing Births 

and Percentage of Demand to Space that is Unsatisfied by Household Wealth 

Quintile, by Country 

Table A.4.2.d. Average Annual Changes in Demand for Contraception for Spacing Births 

and Percentage of Demand to Space that is Unsatisfied by Household Wealth 

Quintile, by Region 

Table A.4.3.a. Need for Family Planning for Spacing Births by Education, by Country 

Table A.4.3.b. Need for Family Planning for Spacing Births by Education, by Region 

Table A.4.4.a. Need for Family Planning for Spacing Births by Age, by Country 

Table A.4.4.b. Need for Family Planning for Spacing Births by Age, by Region 

ix 

Figures 

Figure 2.1. Median Length of Birth Intervals ........................................................ 5

Figure 2.2. Median Birth-Interval Length by Residence........................................... 9

Figure 2.3. Median Birth-Interval Length by Household Wealth Quintile........................ 9

Figure 2.4. Median Birth-Interval Length by Level of Maternal Education...................... 10

Figure 2.5. Median Birth-Interval Length by Birth Order.......................................... 10

Figure 2.6. Annual Average Change in Median Birth-Interval Length by Region.............. 13

Figure 2.7. Annual Average Change in Median Birth-Interval Length by Residence.......... 15

Figure 2.8. Annual Average Change in Median Birth-Interval Length by Household 

 Wealth Quintile.............................................................................. 15

Figure 2.9. Annual Average Change in Median Birth-Interval Length by Level of 

 Maternal Education......................................................................... 16

Figure 2.10. Annual Average Change in Median Birth-Interval Length by Birth Order.......... 16

Figure 3.1. Preferred and Actual Birth Intervals...................................................... 19

Figure 3.2. Annual Rate of Change in Median Preferred and Actual Length of Birth 

 Intervals......................................................................................

 

 28

Figure 3.3. Average Annual Change in Median Length of Preferred Birth Intervals by 

 Residence....................................................................................

 

 28

Figure 3.4. Average Annual Change in Median Length of Preferred Birth Intervals by 

 Household Wealth Quintile................................................................

 

 29

Figure 3.5. Average Annual Change in Median Length of Preferred Birth Intervals by 

 Education.....................................................................................

 

 29

Figure 3.6. Average Annual Change in Median Length of Preferred Birth Intervals by 

 Parity..........................................................................................

 

 30

Figure 4.1. Average Annual Change in Demand for Contraception for Spacing Births and 

 Percentage of Demand that is Unsatisfied, Total and by Region.....................

 

 31

Figure 4.2. Average Annual Change in Demand for Contraception for Spacing Births and 

 Percentage of Demand that is Unsatisfied by Residence..............................

 

 38

Figure 4.3. Average Annual Change in Demand for Contraception for Spacing Births by 

 Household Wealth Quintile...............................................................

 

 39

Figure 4.4. Average Annual Change in Percentage of Unmet Demand for Contraception 

 for Spacing Births by Household Wealth Quintile......................................

 

 39
x 

Figure 4.5. Percentage of Women with a Demand for Contracepton for Spacing and 

 Percentage of Demand for Spacing that is Unsatisfied by Level of Education...

 

 40

Figure 4.6. Average Annual Change in Percentage of Unmet Demand for Contraception 

 for Spacing Births by Level of Education...............................................

 

 41

Figure 4.7. Average Annual Change in Demand for Contraception for Spacing Births and 

 in Percentage Unsatisfied of Demand for Spacing by Age...........................

 

 41
 xi 

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 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. Whereas Comparative Reports are 

primarily descriptive, Analytical Studies have a more analytical approach. 

The Comparative Reports series covers a variable number of countries, depending on the 

availability of data sets. Where possible, data from previous DHS surveys are used to evaluate trends over 

time. Each report provides detailed tables and graphs organized by region. Survey-related issues such as 

questionnaire comparability, survey procedures, data quality, and methodological approaches are 

addressed as needed. 

The topics covered in Comparative Reports are selected by MEASURE DHS staff in conjunction 

with the U.S. Agency for International Development. Some reports are updates of previously published 

reports. 

It is anticipated that the availability of comparable information for a large number of developing 

countries will enhance the understanding of important issues in the fields of international population and 

health by analysts and policymakers. 

Ann Way 

Project Director
 
xiii 

Executive Summary 

The purpose of this comparative report is to examine the levels and trends of birth intervals as 

documented in the Demographic and Health Surveys (DHS). The interval between births has been shown 

in numerous studies to substantially affect the mortality, birth size and weight, and nutritional status of 

children, and the risk of pregnancy complications for mothers. This report presents information on the 

lengths of actual and preferred birth intervals, trends in actual and preferred birth intervals, the difference 

between actual and preferred birth intervals, and trends in the difference. Additionally, the report gives 

information on the desire for more children and met and unmet need for contraception for spacing births, 

at the time of the survey. 

Using the birth history information from the DHS woman’s questionnaire, the study calculates the 

number of months between births, based on the birth date. This report covers 72 countries with DHS 

surveys representing 371,768 birth intervals. The latest surveys range in date from 1985 to 2008. Overall, 

the median birth interval is 32.1 months. 

Children born after intervals of less than 24 months are considered at a higher risk for child 

mortality and undernutrition, and mothers with those intervals are at a higher risk of birth complications. 

Overall, almost one in four births occurred after an interval of less than 24 months. Children born after 

intervals of less than 36 months are also considered to have an elevated risk of mortality and malnutrition. 

More than half (57 percent) of children are born after such intervals. Long birth intervals also entail 

increased risk for perinatal and neonatal mortality and for pregnancy complications. Overall, 12 percent 

of children were born after an interval of 60 or more months. Birth intervals between 36 and 59 months 

entail lower risk. No country has more than half of births occurring in this lower-risk category. Among 

the most recent DHS surveys in each country, the average percentage of births in the lower-risk interval is 

31 percent. Thus more than two-thirds of non-first births occur in a higher-risk category. 

Forty-six countries have more than one DHS survey, which allows for the examination of trends 

in birth intervals. The trends are based on comparing the first DHS survey for a country with the latest 

survey. For the 46 countries together, the median length of the birth interval increased by 3.1 months 

between the first and last surveys. On a per year basis, this increase was one-quarter of a month. The 

increases in median interval length are accompanied by decreases in the proportions of children born after 

intervals of less than 24 months and less than 36 months, and increases in the proportions born after 

intervals of 60 or more months. For the 46 countries combined, the rate of change in the proportion of 

intervals of less than 24 months is -0.38 percentage points per year, -0.69 percentage points per year for 

intervals shorter than 36 months, and +0.40 percentage points per year for intervals of 60 or more months. 

In the DHS, to ascertain preferred birth intervals, women were asked at the time of the survey 

whether they wanted another birth. Women who did want another birth were asked how long they would 

want to wait until they had the next birth. Women who were pregnant at the time of interview were asked 

how long after the birth of the child of the current pregnancy they would want to wait to have another 

birth. For all the countries together, the most recent surveys indicate that mothers would prefer a median 

birth interval of 41.5 months, over 9 months longer than their actual median interval in the five years 

preceding the surveys. Only 16 percent of mothers prefer an interval shorter than 24 months, but 9 

percentage points more of them have such a short interval. Overall, only 14 percent of mothers had their 

latest birth within 3 months of their preference. More than 6 of 10 mothers preferred a birth interval 

longer by 4 or more months than their actual interval but about one in four women preferred an interval 

shorter than their actual interval. 
xiv 

The length of birth intervals that women prefer has not changed much over time. On average, the 

median preferred interval increased by 0.15 months implying an average increase of 1.5 months per 

decade. 

The demand for contraception for spacing births includes current use of contraception by married 

women who want another birth in two or more years from the date of the survey, plus women with an 

unmet need for spacing. Over all the surveys, about one-quarter (25.5 percent) of currently married 

women have a demand for contraception in order to space the next birth. The demand for contraception 

for spacing has increased at an annual average rate of 0.22 percentage points (+2.2 points per decade). 

While almost half of the demand is unsatisfied (46.3 percent), the percentage unsatisfied has declined at a 

per decade rate of 12.1 percentage points. 

While substantial proportions of births still occur after intervals that are too short for the health of 

infants and their mothers and more than half of births occur less than three years after the mother’s 

previous birth, this proportion has decreased over time, at a rate of about 7 percentage points per decade. 

Preferred birth intervals are still much longer than actual intervals, but the rate of increase in the length of 

actual intervals exceeds the increase in preferred intervals, so the gap between the two is shrinking. 

Family planning and contraceptive use are the principal ways that women can delay the next birth 

until the recommended period of time has passed since the last birth. While postpartum amenorrhea due 

to breastfeeding and postpartum abstinence do delay the next conception, by themselves they are not 

enough to ensure a birth interval of 24 months, let alone 36 months. About one-quarter of women want to 

use contraception to space their next birth. Unfortunately, for almost half of the women who have a need 

for contraception for spacing births, that need is unsatisfied. Over time, the demand for contraception for 

spacing has risen and the percentage of demand that is unsatisfied has fallen. These trends suggest that 

women are receiving the message that short birth intervals should be avoided and that family planning 

programs are increasing the supply of contraception to these women. While there are variations by 

residence, wealth, and education, all groups appear to be participating in these two positive outcomes. 
1 

1 Introduction 

1.1 Purpose 

The purpose of this comparative report is to examine the levels and trends of birth intervals as 

documented in the Demographic and Health Surveys (DHS). The interval between births has been shown 

in numerous studies to substantially affect the mortality, birth size and weight, and nutritional status of 

children, and the risk of pregnancy complications for mothers (Rutstein et al., 2004; Rutstein, 2005). 

Birth intervals shorter than 36 months have been shown to increase the risk of mortality, undernutrition, 

and pregnancy morbidity (Gribble et al., 2008; Rutstein, 2008). Moreover, intervals of more than 60 

months are also related to increased risk of pregnancy complications for mothers and to increased 

neonatal and perinatal mortality (Conde-Agudelo et al., 2006). Changes in birth intervals have been 

studied at least since the 1960s in the United States (Whelpton, 1964), and the gap between preferences 

and actual birth intervals and its implication on level of fertility were investigated for sub-Saharan Africa 

using DHS data from about a decade ago (Rafalimanana and Westoff, 2001). 

This report presents information on the lengths of actual and preferred birth intervals, trends in 

actual and preferred birth intervals, the difference between actual and preferred birth intervals, and trends 

in the difference. The information on birth intervals is tabulated for national totals, urban and rural areas, 

quintiles of the DHS wealth index, maternal education level, maternal age at birth, mother’s birth cohort, 

birth order of the child, the number of living sons and daughters, the number of dead sons and daughters, 

the number of dead children of either sex, the type of contraception known, ever used, and currently used, 

and current pregnancy status. Tables showing these and other differentials are in the Appendix 

(CR28App.pdf) available at www.measuredhs.com/publications/publication-cr28-comparative-reports.cfm). 

Additionally, the report gives information on the desire for more children and met and unmet 

need for contraception for spacing births, at the time of the survey. 

1.2 Methodology 

Actual Birth Intervals 

Using the birth history information from the DHS woman’s questionnaire, the study calculates the 

number of months between births, based on the birth date. Birth dates in the DHS are recorded in centurymonth code, which is the date of birth by month starting in January, 1900, which is recorded with a value 

of 1. Thus a birth that occurred in January, 2000 is recorded as 12*(2000-1900)+1 = 1201. Birth intervals 

are treated as preceding intervals so that the interval between the first and second child of a woman is 

calculated as the century-month code birth date of the first birth subtracted from that of the second birth. 

Thus there is one less birth interval than the number of children ever born, and the first birth has no 

preceding interval. Multiple births from the same pregnancy are treated in this report as being a single 

interval. 

For the tables, four indicators are calculated: the percentage of births with a preceding interval of 

less than 24 months, the percentage with an interval of less than 36 months, the percentage with an 

interval of 60 or more months, and the median length of the preceding birth intervals. First births are not 

considered in the tabulations. 

Preferred Birth Intervals 

Since this report covers birth intervals, only women who have had a birth are included in the 

calculation of preferred intervals. Women were asked at the time of the survey whether they wanted 
2 

another birth. Sterilized women were not asked this question. For pregnant women, the question referred 

to whether they wanted another birth after the current pregnancy. 

Women who responded that they did want another birth were then asked how long they would 

want to wait until they had the next birth. Women who were pregnant at the time of interview were asked 

how long after the birth of the child of the current pregnancy they would want to wait to have another 

birth. The answers to this second question were coded in months and years. The latter codes (years) were 

transformed into months by multiplying by 12. 

To calculate the preferred birth interval, for non-pregnant women, the number of months since the 

last birth was added to the number of months from the date of the survey they would like to wait from 

then until the next birth. Some women responded that they wanted the birth soon or now. For these 

women, a value of 9 (duration of pregnancy) was added to the number of months since the last birth. 

Sterilized women, non-sterilized women who said they were unable to have a child or were unsure 

whether to have another or when to have another child, and women who gave non-numeric answers were 

excluded from the tabulation of the preferred interval. Note that, due to the way the questions were asked, 

the preferred birth interval cannot be shorter than the time since the last birth, for non-pregnant women. 

For the tables, again, four indicators are calculated: the percentage of births with a preferred 

interval of less than 24 months, the percentage with a preferred interval of less than 36 months, the 

percentage with a preferred interval of 60 or more months, and the median length of the preferred birth 

intervals. Women with one birth are considered in the tabulations, but women with no births are not 

considered. 

Met and Unmet Need for Contraception for Spacing 

The need for contraception is measured for currently married women. Women who stated that 

they wanted to delay having another birth and who are exposed to the risk of pregnancy are considered to 

have a need for contraception for spacing. Currently married women who stated that they cannot get 

pregnant, have had a hysterectomy, are menopausic, have not had a birth in the last five years even 

though married and not using contraception, and pregnant women and amenorrheic women whose birth 

occurred less than 6 months prior to the interview are considered as not exposed to the risk of pregnancy1

. 

Women with a need of contraception and using a contraceptive method have a met need. Women with a 

need but not using a contraceptive method have an unmet need. See Rutstein S. and G. Rojas (2006) for 

more information on the construction of met and unmet need for contraception. 

1.3 Data 

The data for this study come from all unrestricted national Demographic and Health Surveys 

(DHS) conducted since the inception of the program, from 1985 through 2008, a total of 179 surveys. A 

few surveys whose data are restricted for public use are not included, nor is the survey of Ondo State, 

Nigeria. Specialized surveys including Malaria Indicator Surveys (MIS), AIDS Indictor Surveys (AIS), 

and other surveys without a full birth history or lacking other essential data also are not included here. 

The DHS includes personal interviews with women age 15-49 who are members of households 

and were in the household the night before the interview, or were overnight visitors to the household. In 

most surveys, women eligible for interview are of any marital status; however, in several surveys where 

non-marital fertility is considered to be non-existent or extremely low, only ever-married women were 

interviewed. Information on actual birth intervals is obtained from a full birth history asked of the 

 

1

 Women who are sterilized are considered to have a met need of contraception for limiting births. 
3 

interviewed women. Intervals that ended with a birth in the five years preceding the interview are 

considered in this study, a weighted total of 951,205 intervals. 

For the last child born in the five years preceding the interview, women were asked whether they 

wanted the child then, would have liked to have had the child later, or did not want any more children. 

Women who said they would have liked to have had the child later were asked how much longer they 

would have wanted to wait. The answer given in months or years is converted to months. The study uses a 

total of 634,882 women who wanted another child and gave a preferred interval. 

Information on the desire for more children is available from 179 surveys including 1,464,635 

currently married women. 

Information on need for contraception is available from 152 surveys including 1,342,699 

currently married women. 

5 

2 Actual Birth Intervals 

2.1 Latest DHS Surveys 

Table 2.1 (a and b) covers the most recent DHS survey in each country. Among the surveys in 

this study, there are 72 countries represented covering 371,768 birth intervals. The surveys range in date 

from 1985 (El Salvador) to 2008. Overall, the median birth interval is 32.1 months. Yemen had the 

shortest intervals, with a median of 25.3 months, and Ukraine had the longest, with a median of 44.1 

months. By region, however, the Central Asian States had the shortest intervals (29.2 months) and South 

and Southeast Asia had the longest (33.6 months) (Figure 2.1). 

Table 2.1 (a and b) also shows the percentages of intervals of less than 24 months, less than 36 

months, and more than 60 months. Children born after intervals of less than 24 months are considered at a 

high risk for child mortality and undernutrition, and mothers with those intervals are at a higher risk of 

birth complications. Overall, almost one in four births occurred after an interval of less than 24 months. 

The region with the highest percentage of births with an interval of less than 24 months is the Central 

Asian States (33 percent), and the region with the lowest percentage is sub-Saharan Africa (20 percent). 

By country, Yemen had the highest percentage of births with an interval of less than 24 months (42 

percent), and Zimbabwe had the lowest (11 percent). 

Children born after intervals of less than 36 months are also considered to have an elevated risk 

of mortality and malnutrition. More than half (57 percent) of children are born after such intervals. There 

is not much variation by region, but there is substantial variation by country, from 40 percent or less of 

births in Indonesia, Ukraine, South Africa, and Lesotho to over 70 percent in Comoros, Guatemala, 

Uganda, Yemen, and Tunisia. 

29.2 29.9

32.6 32.7

33.6

10 

20 

30 

40 

50 

Central Asian States Latin America and 

Caribbean

North Africa, West Asia and 

Europe

Sub-Saharan Africa South and Southeast Asia

Months

Figure 2.1. Median Length of Birth Intervals
6 

Table 2.1.a. Length of Actual Birth Intervals by Country, for Most Recent Survey 

Percentage of birth intervals less than 24 months, less than 36 months, and 60 months or more, and median length 

of birth intervals, for intervals ending in the 5 years prior to the survey, by country 

Survey <24 mos <36 mos 35-59 60+ mos 

Median 

interval 

Number 

of 

intervals1

Central Asian States

Kazakhstan, 1999 36.7 58.5 24.4 17.1 29.1 797 

Kyrgyz Republic, 1997 31.6 62.3 24.8 12.9 29.8 1,287 

Uzbekistan, 1996 30.8 65.6 25.9 8.5 28.7 1,615 

Latin America and Caribbean

Bolivia, 2003 29.8 66.1 24.3 9.6 28.3 7,113 

Brazil, 1996 32.3 55.9 27.6 16.5 31.3 2,783 

Colombia, 2005 24.7 51.4 29.5 19.1 34.3 7,083 

Dominican Republic, 2007 26.2 54.3 30.2 15.5 32.5 6,101 

Ecuador, 1987 36.7 67.6 23.2 9.2 26.8 2,143 

El Salvador, 1985 36.5 68.4 25.0 6.6 27.1 2,469 

Guatemala, 1999 33.1 70.4 22.8 6.8 27.1 3,358 

Haiti, 2005 21.8 58.7 29.9 11.4 31.2 3,863 

Honduras, 2005 21.7 54.0 30.7 15.3 33.1 6,525 

Mexico, 1987 35.6 65.6 24.4 10.0 27.4 4,041 

Nicaragua, 2001 29.0 58.2 28.2 13.6 30.7 4,041 

Paraguay, 1990 39.9 69.7 22.3 8.0 25.8 2,788 

Peru, 2004-2008 16.7 45.5 33.6 20.9 37.4 8,203 

Trinidad and Tobago, 1987 41.5 65.6 23.9 10.5 26.2 1,261 

North Africa, West Asia and Europe

Armenia, 2005 36.9 56.1 29.2 14.7 29.9 672 

Azerbaijan, 2006 39.1 65.6 21.5 12.9 27.1 1,163 

Egypt, 2008 19.6 50.1 35.6 14.3 35.0 6,440 

Jordan, 2007 34.6 62.2 27.6 10.2 28.8 7,157 

Moldova, 2005 21.5 43.2 29.1 27.7 41.3 577 

Morocco, 2003 18.9 44.7 36.8 18.5 37.3 3,831 

Tunisia, 1988 37.4 71.6 23.4 5.0 26.2 3,424 

Turkey, 2003 30.3 57.0 27.5 15.5 31.2 2,389 

Ukraine, 2007 20.3 38.9 28.4 32.7 44.1 319 

Yemen, 1991 42.3 71.4 23.5 5.1 25.3 6,428 

Sub-Saharan Africa

Benin, 2006 14.7 55.4 37.0 7.6 33.5 12,040 

Burkina Faso, 2003 13.6 52.1 41.2 6.7 34.5 8,429 

Burundi, 1987 22.1 67.1 29.2 3.7 29.9 3,183 

Cameroon, 2004 22.9 63.9 29.4 6.7 30.1 5,755 

Central African Republic, 1994 26.4 67.9 26.6 5.5 29.2 3,597 

Chad, 2004 25.9 67.4 27.7 4.9 28.9 4,789 

Comoros, 1996 35.4 70.0 24.2 5.8 27.2 1,546 

Congo Brazzaville, 2005 14.5 45.9 40.2 13.9 36.4 3,273 

Congo, Democratic Republic, 2007 26.6 67.0 28.0 5.0 29.0 6,803 

Cote D'Ivoire, 1998 17.1 54.1 35.9 10.0 33.4 1,584 

Ethiopia, 2005 22.0 57.6 35.7 6.7 32.3 8,914 

Gabon, 2000 22.9 58.9 30.0 11.1 31.7 2,683 

Ghana, 2008 15.2 45.0 41.0 14.0 37.1 1,999 

(Cont’d) 
7 

Table 2.1.a. – cont’d 

Survey <24 mos <36 mos 36-59 60+ mos 

Median 

interval 

Number 

of 

intervals1

Guinea, 2005 11.8 45.6 44.2 10.2 36.0 4,921 

Kenya, 2003 24.3 63.1 27.3 9.6 30.5 4,273 

Lesotho, 2004 11.9 39.6 41.2 19.2 38.7 2,045 

Liberia, 2007 19.1 52.6 34.2 13.2 34.0 3,936 

Madagascar, 2004 25.0 59.6 31.9 8.5 30.8 4,600 

Malawi, 2004 15.5 52.2 38.3 9.5 34.3 7,756 

Mali, 2006 22.3 64.3 29.7 6.0 30.6 11,389 

Mozambique, 2003 17.1 57.6 33.5 8.9 32.8 7,835 

Namibia, 2006-2007 15.4 44.7 36.2 19.1 37.4 2,918 

Niger, 2006 21.2 61.9 31.9 6.2 31.3 8,075 

Nigeria, 2008 24.6 64.2 29.3 6.5 29.8 21,589 

Rwanda, 2005 23.9 65.8 28.0 6.2 29.8 6,801 

Senegal, 2005 20.0 59.8 32.2 8.0 31.9 7,765 

Sierra Leone, 2008 18.8 52.7 33.7 13.6 34.1 4,310 

South Africa, 1998 16.2 39.5 37.1 23.4 40.3 2,741 

Sudan, 1990 29.2 68.2 26.8 5.0 28.0 5,252 

Swaziland, 2006 17.2 50.2 34.2 15.6 34.9 1,739 

Tanzania, 2004 16.7 59.1 31.4 9.5 31.8 6,387 

Togo, 1998 14.9 51.9 40.5 7.6 34.5 5,073 

Uganda, 2006 25.9 70.7 24.6 4.7 28.4 6,678 

Zambia, 2007 15.8 57.2 35.6 7.2 32.8 4,846 

Zimbabwe, 2005 11.2 40.5 42.9 16.6 38.9 3,223 

South and Southeast Asia

Bangladesh, 2007 16.7 40.8 39.6 19.6 39.4 3,579 

Cambodia, 2005 19.7 51.9 34.2 13.9 34.2 5,141 

India, 2006 28.7 63.4 29.1 7.5 29.4 37,648 

Indonesia, 2007 16.3 37.7 32.7 29.6 43.7 8,285 

Nepal, 2006 22.8 57.9 33.1 9.0 31.8 3,686 

Pakistan, 2006 34.5 68.7 24.7 6.6 27.4 6,980 

Philippines, 2008 32.3 60.8 26.7 12.5 29.6 4,054 

Sri Lanka, 1987 30.3 63.2 26.1 10.7 29.4 2,586 

Thailand, 1987 26.4 52.6 31.8 15.6 33.7 2,088 

Vietnam, 2002 18.9 46.2 30.4 23.4 37.6 1,103 

1

 Weighted number of intervals 

Table 2.1.b. Length of Actual Birth Intervals by Region, for Most Recent Survey

Percentage of birth intervals less than 24 months, less than 36 months, and 60 months or more, and median length 

of birth intervals, for intervals ending in the 5 years prior to the survey, by region 

Averages <24 mos <36 mos 36-59 60+ mos 

Median 

interval 

Number 

of 

intervals1

Total 24.6 57.4 30.7 11.8 32.1 371,768 

Central Asian States 33.0 62.1 25.0 12.8 29.2 3,699 

Latin America and Caribbean 30.4 60.8 26.8 12.4 29.9 61,772 

North Africa, West Asia and Europe 30.1 56.1 28.3 15.7 32.6 32,400 

Sub-Saharan Africa 19.9 57.0 33.5 9.6 32.7 198,747 

South and Southeast Asia 24.7 54.3 30.8 14.8 33.6 75,150 1

 Weighted number of intervals 
8 

Long birth intervals also entail increased risk for perinatal and neonatal mortality and for 

pregnancy complications. Overall, 12 percent of children were born after an interval of 60 or more 

months. By region, the percentages born after long intervals vary from 10 percent of births in sub-Saharan 

Africa to 16 percent in North Africa, West Asia and Europe. By individual country, in Burundi, Uganda, 

Chad, Democratic Republic of the Congo, Sudan, Tunisia and Yemen, 5 percent or less of births occur 

after long intervals. In three countries—Moldova, Indonesia, and Ukraine—more than one-quarter of 

births occur after long intervals. 

Birth intervals between 36 and 59 months entail lower risk. No country has more than half of 

births occurring in this lower-risk category. Among the most recent DHS surveys in each country, the 

average percentage of births in the lower-risk interval is 31 percent. Thus more than two-thirds of nonfirst births occur in a higher-risk category. The seven countries with the highest percentages of births in 

the lower-risk interval are all in sub-Saharan Africa—Guinea (44 percent), Zimbabwe (43), Lesotho, 

Burkina Faso, Ghana and Togo (41 percent) and Congo Brazzaville (40 percent). Fourteen of the 72 

countries have less than one in four of their births occurring after a 36-59 month interval. By region, the 

highest percentage with births after an interval of 36-59 months is sub-Saharan Africa (34 percent), and 

the region with the lowest percentage is the Central Asian States. 

Differentials 

The median lengths and the risk category percentages of actual birth intervals have been tabulated 

for urban-rural residence, wealth quintile of the household, level of maternal education, maternal age, and 

birth order or parity. Since this amount of information is too great to discuss and read succinctly, only a 

few of the tabulated differentials are discussed in the text, and the tables are included in the appendices. 

Figure 2.2 shows the median length of preceding birth intervals by urban-rural area, according to 

world region. In all regions, urban areas have longer intervals: the difference in the median length is 

greatest in the Central Asian States (4.4 months) and least in sub-Saharan Africa and South and Southeast 

Asia (both about 1.5 months). The median length of the birth interval increases with wealth, from an 

overall average of 30.5 months for the lowest quintile in each survey to 36.1 months for the highest 

quintile (Figure 2.3). Maternal education shows a large differential in actual birth interval. Women with 

no education and women with primary education have an overall median birth interval of 30.8 months 

and 30.9 months, respectively; women with secondary education have a median interval of 32.2 months 

and women with higher education have a median interval of 35.1 months (Figure 2.4). The length of the 

preceding birth interval also increases with maternal age, from 23.4 months for women age 15-19 to 35.6 

months for women age 40-49. In contrast, there is little difference in median birth-interval length by birth 

order (Figure 2.5).
9 

31.9

30.5

32.9 33.1

34.4

27.5 27.8 

28.8 

31.5 

32.8 

0 

5 

10 

15 

20 

25 

30 

35 

40 

Central Asian States Latin America and 

Caribbean

North Africa and West Asia Sub-Saharan Africa South and Southeast Asia

Months

Figure 2.2. Median Birth-Interval Length by Residence

Urban Rural

30.5

31.3

32.3

33.6

36.1

0 

5 

10 

15 

20 

25 

30 

35 

40 

Poorest Second Middle Fourth Highest

Months

Wealth Quintile

Figure 2.3. Median Birth-Interval Length by Household Wealth Quintile
10 

30.8 30.9

32.2

35.1

0 

5 

10 

15 

20 

25 

30 

35 

40 

No Education Primary Secondary Higher

Months

Maternal Education

Figure 2.4. Median Birth-Interval Length by Level of Maternal Education

31.5 31.1 30.4

0 

5 

10 

15 

20 

25 

30 

35 

40 

2-3 4-5 6+

Months

Birth Order

Figure 2.5. Median Birth-Interval Length by Birth Order
11 

2.2 Trends in Actual Birth Intervals

Forty-six countries have more than one DHS survey, which allows for the examination of trends 

in birth intervals. The trends are based on comparing the first DHS survey for a country with the latest 

survey. Since the number of years between surveys varies by country, two sets of statistics are shown for 

trends in Table 2.2 (a and b). The first set is the difference between the first and the latest surveys, and the 

second is the average change per year, derived by dividing the first set of indicators by the number of 

years between the surveys. The second set is more comparable across countries but assumes a linear 

change over time. The average number of years between the first and latest surveys is a little over 12 

years. 

Table 2.2.a. Trends in Length of Actual Birth Intervals, by Country

Percentage point changes between the earliest and latest surveys and average percentage point change per year in 

the percentage of birth intervals less than 24 months, less than 36 months, and 60 months or more, and in median 

length of birth intervals in months, for intervals ending in the 5 years prior to the survey, by country 

 Total 

Trend (Last-First) Change per year 

Survey 

<24 

mos 

<36 

mos 

36-59 

mos 

60+ 

mos 

Median 

interval 

<24 

mos 

<36 

mos 

36-59 

mos 

60+ 

mos 

Median 

interval 

Central Asian States

Kazakhstan, 1995 to 1999 -1.3 -5.3 0.4 4.9 1.3 -0.32 -1.33 0.10 1.23 0.33 

Latin America and Caribbean

Bolivia, 1989 to 2003 -0.3 0.0 -1.3 1.3 -0.2 -0.02 0.00 -0.09 0.09 -0.01 

Brazil, 1986 to 1996 -9.6 -11.7 3.7 8.0 5.2 -0.96 -1.17 0.37 0.80 0.52 

Colombia, 1986 to 2005 -14.0 -14.8 5.8 9.0 7.4 -0.74 -0.78 0.31 0.47 0.39 

Dominican Republic, 1986 

to 2007 -17.5 -16.9 8.3 8.6 7.4 -0.83 -0.80 0.40 0.41 0.35 

Guatemala, 1987 to 1999 2.0 -0.1 -1.4 1.5 -0.3 0.17 -0.01 -0.12 0.13 -0.02 

Haiti, 1994 to 2005 -4.5 -8.1 3.1 5.0 2.4 -0.41 -0.74 0.28 0.45 0.22 

Nicaragua, 1998 to 2001 -5.3 -6.4 2.8 3.6 2.6 -1.77 -2.13 0.93 1.20 0.87 

Peru, 1986 to 2004 -20.4 -24.6 10.2 14.4 11.1 -1.02 -1.23 0.51 0.72 0.56 

North Africa, West Asia and Europe

Armenia, 2000 to 2005 -1.2 -6.2 2.9 3.3 2.3 -0.24 -1.24 0.58 0.66 0.46 

Egypt, 1988 to 2008 -16.6 -18.8 11.2 7.6 7.7 -0.83 -0.94 0.56 0.38 0.39 

Jordan, 1990 to 2007 -16.1 -19.1 12.4 6.7 6.0 -0.95 -1.12 0.73 0.39 0.35 

Morocco, 1987 to 2003 -11.3 -24.1 11.6 12.5 9.3 -0.71 -1.51 0.73 0.78 0.58 

Turkey, 1993 to 2003 -1.4 -0.8 -1.5 2.3 0.5 -0.14 -0.08 -0.15 0.23 0.05 

Sub-Saharan Africa

Benin, 1996 to 2006 -2.3 -4.7 2.0 2.7 1.2 -0.23 -0.47 0.20 0.27 0.12 

Burkina Faso, 1993 to 2003 -1.5 -4.7 3.0 1.7 1.1 -0.15 -0.47 0.30 0.17 0.11 

Cameroon, 1991 to 2004 -0.4 -3.5 2.5 1.0 1.2 -0.03 -0.27 0.19 0.08 0.09 

Chad, 1997 to 2004 1.8 0.5 -0.8 0.3 -1.0 0.26 0.07 -0.11 0.04 -0.14 

Cote D'Ivoire, 1994 to 1998 -3.9 -6.7 3.4 3.3 1.7 -0.98 -1.68 0.85 0.83 0.43 

Ethiopia, 2000 to 2005 1.9 -1.2 0.6 0.6 0.1 0.38 -0.24 0.12 0.12 0.02 

Ghana, 1988 to 2008 -3.3 -10.7 4.0 6.7 3.8 -0.17 -0.54 0.20 0.34 0.19 

Guinea, 1999 to 2005 -5.5 -8.9 5.7 3.2 2.0 -0.92 -1.48 0.95 0.53 0.33 

Kenya, 1989 to 2003 -4.6 -6.8 2.7 4.1 2.9 -0.33 -0.49 0.19 0.29 0.21 

Liberia, 1986 to 2007 -11.2 -14.0 8.2 5.8 5.6 -0.53 -0.67 0.39 0.28 0.27 

(Cont’d) 
12 

Table 2.2.a. – cont’d 

 Total 

Trend (Last-First) Change per year 

Survey 

<24 

mos 

<36 

mos 

36-59 

mos 

60+ 

mos 

Median 

interval 

<24 

mos 

<36 

mos 

36-59 

mos 

60+ 

mos 

Median 

interval 

Madagascar, 1992 to 2004 -6.1 -11.3 8.4 2.9 3.3 -0.51 -0.94 0.70 0.24 0.28 

Mali, 1987 to 2006 -4.2 0.8 0.3 -1.1 0.3 -0.22 0.04 0.02 -0.06 0.02 

Mozambique, 1997 to 2003 -2.4 1.0 -2.0 1.0 0.2 -0.40 0.17 -0.33 0.17 0.03 

Namibia, 1992 to 2007 -7.8 -14.7 6.3 8.4 5.9 -0.52 -0.98 0.42 0.56 0.39 

Niger, 1992 to 2006 -6.1 -8.5 5.9 2.6 2.5 -0.44 -0.61 0.42 0.19 0.18 

Nigeria, 1990 to 2008 -3.4 -3.3 3.2 0.1 1.1 -0.19 -0.18 0.18 0.01 0.06 

Rwanda, 1992 to 2005 2.8 -0.6 -2.1 2.7 -0.6 0.22 -0.05 -0.16 0.21 -0.05 

Senegal, 1986 to 2005 -0.3 -8.3 4.3 4.0 2.2 -0.02 -0.44 0.23 0.21 0.12 

Tanzania, 1992 to 2004 -1.6 -1.5 -0.8 2.3 0.0 -0.13 -0.13 -0.07 0.19 0.00 

Togo, 1988 to 1998 -1.7 -5.0 4.8 0.2 1.3 -0.17 -0.50 0.48 0.02 0.13 

Uganda, 1988 to 2006 -3.2 -1.5 1.6 -0.1 0.8 -0.18 -0.08 0.09 -0.01 0.04 

Zambia, 1992 to 2007 -3.5 -8.4 7.2 1.2 2.8 -0.23 -0.56 0.48 0.08 0.19 

Zimbabwe, 1988 to 2005 -7.8 -21.9 11.4 10.5 7.9 -0.46 -1.29 0.67 0.62 0.46 

South and Southeast Asia

Bangladesh, 1994 to 2007 -4.3 -14.9 4.6 10.3 6.4 -0.33 -1.15 0.35 0.79 0.49 

Cambodia, 2000 to 2005 -2.4 -4.9 0.8 4.1 1.8 -0.48 -0.98 0.16 0.82 0.36 

India, 1993 to 2006 1.2 1.3 -2.0 0.7 -0.7 0.09 0.10 -0.15 0.05 -0.05 

Indonesia, 1987 to 2007 -9.5 -20.4 1.2 19.2 12.1 -0.48 -1.02 0.06 0.96 0.61 

Nepal, 1996 to 2006 -1.8 -4.1 0.9 3.2 1.2 -0.18 -0.41 0.09 0.32 0.12 

Pakistan, 1991 to 2006 0.4 0.5 0.1 -0.6 -0.3 0.03 0.03 0.01 -0.04 -0.02 

Philippines, 1993 to 2008 -6.1 -9.8 5.0 4.8 3.3 -0.41 -0.65 0.33 0.32 0.22 

Vietnam, 1997 to 2002 -1.9 -9.3 1.5 7.8 5.0 -0.38 -1.86 0.30 1.56 1.00 

Table 2.2.b. Trends in Length of Actual Birth Intervals, by Region

Percentage point changes between the earliest and latest surveys and average percentage point change per year in 

the percentage of birth intervals less than 24 months, less than 36 months, and 60 months or more, and in median 

length of birth intervals in months, for intervals ending in the 5 years prior to the survey, by region 

 Total 

Trend (Last-First) Change per year 

Averages 

<24 

mos 

<36 

mos 

36-59 

mos 

60+ 

mos 

Median 

interval 

<24 

mos 

<36 

mos 

36-59 

mos 

60+ 

mos 

Median 

interval 

Total -4.8 -8.1 3.7 4.4 3.1 -0.38 -0.69 0.29 0.40 0.25 

Central Asian States -1.3 -5.3 0.4 4.9 1.3 -0.32 -1.33 0.10 1.23 0.33 

Latin America and Caribbean -8.7 -10.3 3.9 6.4 4.5 -0.70 -0.86 0.32 0.53 0.36 

North Africa, West Asia and 

Europe -9.3 -13.8 7.3 6.5 5.2 -0.57 -0.98 0.49 0.49 0.37 

Sub-Saharan Africa -3.4 -6.4 3.7 2.8 2.1 -0.27 -0.53 0.30 0.23 0.16 

South and Southeast Asia -3.1 -7.7 1.5 6.2 3.6 -0.27 -0.74 0.14 0.60 0.34 

For the 46 countries together, the median length of the birth interval increased by 3.1 months 

between the first and last surveys. On a per year basis, this increase was one-quarter of a month. Aside 

from sub-Saharan Africa, the annual rate of increase in median interval length was similar by world 
13 

region, from 0.33 months per year in Central Asia to 0.37 months in North Africa, West Asia and Europe 

(Figure 2.6). The average per year change in sub-Saharan Africa was only 0.16 months. Given that the 

latest surveys have similar regional median lengths of birth intervals, other regions appear to be catching 

up to the length of birth intervals that sub-Saharan Africa had some while ago. Only one country, Chad, 

shows a mild rate of decline in median interval length (-0.14 months per year). However, 13 countries 

show very little change in median length (between -0.05 to +0.09 months per year). The largest increases 

in median interval length occurred in Vietnam (+1.00 month per year), Nicaragua (+0.87), and Indonesia 

(+0.61). 

The increases in median interval length are accompanied by decreases in the proportions of 

children born after intervals of less than 24 months and less than 36 months, and increases in the 

proportions born after intervals of 60 or more months. For the 46 countries combined, the rate of change 

in the proportion of intervals of less than 24 months is -0.38 percentage points per year, -0.69 percentage 

points per year for intervals shorter than 36 months, and +0.40 percentage points per year for intervals of 

60 or more months. 

By region, the largest rate of decrease in the percentage of births after a birth interval of less than 

24 months is in Latin America and the Caribbean (-0.70 percentage points per year), and the smallest rate 

is in sub-Saharan Africa and South and Southeast Asia (both -0.27). Considering birth intervals of less 

than 36 months, the greatest rate of decline is in the Central Asian States, -1.33 percentage points per 

year, and the smallest is in sub-Saharan Africa, -0.53 points per year. For the rate of increase in births 

after a 60 month interval, the same two regions have the greatest and least rate of increase, +1.23 and 

+0.23 percentage points, respectively. 

0.33

0.36

0.37

0.16

0.34

0.00

0.05

0.10

0.15

0.20

0.25

0.30

0.35

0.40

Central Asian States Latin America and 

Caribbean

North Africa, West Asia 

and Europe

Sub-Saharan Africa South and Southeast Asia

Months

Figure 2.6. Annual Average Change in Median Birth-Interval Length by Region
14 

Nicaragua and Peru have the greatest rate of decline in the percentage of birth intervals of less 

than 24 months, both exceeding a rate of decline of 1 percentage point or more per year. Five countries 

have more than a negligible rate of increase in the percentage of <24 month intervals: India, Guatemala, 

Rwanda, Chad, and Ethiopia, from +0.09 to +0.38 percentage points per year. A greater number of 

countries, 13, have a rate of decrease of intervals of less than 36 months of 1 percentage point per year or 

more. The highest is again Nicaragua with more than a 2 percentage point decline per year. Chad, India, 

and Mozambique are the only countries with a non-negligible increase in the percentage of intervals of 

less than 36 months; however, five counties show little change per year. 

Ten countries show little change per year in the percentage of long birth intervals, but in three 

countries the percentage increased at a rate of more than 1 percentage point per year (Nicaragua, 

Kazakhstan, and Vietnam). 

Due to decreases in the percentages of births with preceding intervals of less than 36 months and 

increases at 60 months and more, there is little change in the percentage of births in the 36-59 month 

interval category, rising at an annual average rate of about 0.3 percentage points, with the highest increase 

in the North African and West Asian region (+0.5 percentage points per year) and lowest in the Central 

Asian States (+0.1 percentage points per year). The country with the greatest rate of increase of births 

following the 36-59 month interval is Guinea (+0.95 percentage points per year), and the country with 

greatest rate of decrease is Rwanda (-0.16 percentage points per year). 

Differentials 

Figure 2.7 shows that birth intervals have lengthened at much greater annual average rates in 

urban areas than rural areas in all regions except North Africa, West Asia and Europe, where the rate of 

increase was a little higher in rural areas. The rate of change in the length of birth intervals is related to 

relative wealth. Figure 2.8 shows that the annual average change in the median birth interval is over five 

times as high in the wealthiest quintile as in the poorest quintile. This differential is also reflected in 

maternal education (Figure 2.9), in that for women with higher education the median length of birth 

intervals increased by five times the annual change among women with no education. While there has 

been practically no change in the median birth intervals of women age 15-19, women age 30-39 had the 

greatest change per year (0.36 months per year), followed by women age 40-49 (0.29 months per year). 

As noted above, there was little difference in the length of birth intervals by birth order of the child. 

However, the change in interval length is much greater for birth orders below six than for six or higher 

(Figure 2.10). 
15 

1.20

0.59

0.29 0.31

0.70

0.25 0.23

0.38

0.12

0.26

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

Central Asian States Latin America and 

Caribbean

North Africa, West Asia 

and Europe

Sub-Saharan Africa South and Southeast Asia

Months

Figure 2.7. Annual Average Change in Median Birth-Interval Length

by Residence

Urban Rural

0.10

0.25

0.29

0.39

0.53

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

Poorest Second Middle Fourth Highest

Months

Wealth Quintile

Figure 2.8. Annual Average Change in Median Birth-Interval Length

by Household Wealth Quintile
16 

0.12

0.26

0.43

0.60

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

No Education Primary Secondary Higher

Months

Maternal Education

Figure 2.9. Annual Average Change in Median Birth-Interval Length 

by Level of Maternal Education

0.28

0.30

0.12

0.00

0.10

0.20

0.30

0.40

0.50

2-3 4-5 6+

Months

Birth Order

Figure 2.10. Annual Average Change in Median Birth-Interval Length by Birth Order
17 

3 Preferred Birth Intervals 

3.1 Preferred Intervals and Differences with Actual Intervals 

Information on mothers’ preferred birth interval is provided in Table 3.1 (a and b). For all the 

countries together, the most recent surveys indicate that mothers would prefer a median birth interval of 

41.5 months, over 9 months longer than their actual median interval in the five years preceding the 

surveys (Table 3.1.b, Table 3.1.c, and Figure 3.1). The Latin America and Caribbean region and the South 

and Southeast Asia region have the longest preferred birth intervals, at 47.3 and 45.8 months, 

respectively. These two regions also have the greatest differences between actual and preferred birth 

intervals, at 17.4 and 12.2 months, respectively. 

Table 3.1.a. Length of Preferred Birth Intervals by Country, for Most Recent Survey

Percentage of preferred birth intervals less than 24 months, less than 36 months, and 60 months or more, and 

median length of birth intervals, for intervals ending in the 5 years prior to the survey, by country 

Survey <24 mos <36 mos 60+ mos 

Median 

interval 

Number of 

intervals1

Central Asian States

Kazakhstan, 1999 32.3 50.1 26.7 34.5 686 

Kyrgyz Republic, 1997 18.0 37.2 29.6 42.9 656 

Uzbekistan, 1996 20.5 44.7 9.7 37.3 750 

Latin America and Caribbean

Bolivia, 2003 18.9 38.4 38.3 44.1 3,637 

Brazil, 1996 23.0 40.2 30.4 41.6 1,739 

Colombia, 2005 13.5 27.5 46.9 52.8 5,094 

Dominican Republic, 2007 14.6 30.0 43.5 50.3 5,372 

Ecuador, 1987 5.1 20.3 44.3 54.1 508 

El Salvador, 1985 2.7 22.9 33.5 47.9 604 

Guatemala, 1999 26.1 57.9 14.0 31.0 2,470 

Haiti, 2005 15.8 36.4 41.3 41.9 2,869 

Honduras, 2005 10.7 25.2 46.3 54.1 4,898 

Mexico, 1987 6.1 21.7 33.7 48.6 836 

Nicaragua, 2001 17.1 34.0 39.9 48.0 2,859 

Paraguay, 1990 31.2 54.3 17.2 31.5 2,248 

Peru, 2004 8.1 20.3 57.9 60.8 6,159 

Trinidad and Tobago, 1987 3.4 16.0 46.1 56.1 388 

North Africa, West Asia and Europe

Armenia, 2005 24.7 47.2 17.9 36.6 736 

Azerbaijan, 2006 40.4 67.5 8.3 26.4 997 

Egypt, 2008 20.7 54.0 8.4 33.3 5,154 

Jordan, 2007 29.1 53.1 15.9 32.6 5,885 

Moldova, 2005 12.4 26.2 41.0 51.9 707 

Morocco, 2003 13.7 30.8 37.0 47.3 3,126 

Tunisia, 1988 7.6 26.8 35.9 48.4 866 

Turkey, 2003 30.7 54.2 22.5 32.1 1,215 

Ukraine, 2007 15.9 34.2 29.9 45.5 409 

Yemen, 1991 na na na na na 

Sub-Saharan Africa

Benin, 2006 12.5 46.7 10.9 36.0 10,976 

(Cont’d)
18 

Table 3.1.a. – cont’d

Survey <24 mos <36 mos 60+ mos 

Median 

interval 

Number of 

intervals1

Burkina Faso, 2003 8.0 30.6 20.2 41.7 7,854 

Burundi, 1987 2.4 22.7 13.0 42.3 1,330 

Cameroon, 2004 18.5 56.2 12.6 32.3 5,343 

Central African Republic, 1994 20.2 57.1 10.5 31.6 1,601 

Chad, 2004 20.2 58.8 5.4 31.2 4,407 

Comoros, 1996 18.1 39.6 25.3 40.3 656 

Congo Brazzaville, 2005 9.5 30.1 34.8 45.6 3,107 

Congo, Democratic Republic, 2007 21.9 57.2 11.0 31.8 5,955 

Cote D'Ivoire, 1998 14.6 41.4 21.8 38.4 1,546 

Ethiopia, 2005 17.3 40.0 25.1 39.6 6,628 

Gabon, 2000 15.6 34.8 37.4 45.1 2,441 

Ghana, 2008 8.3 27.0 34.5 48.3 1,771 

Guinea, 2005 12.5 46.4 7.6 35.8 4,495 

Kenya, 2003 19.0 44.2 26.8 38.3 3,373 

Lesotho, 2004 10.8 30.3 37.8 44.1 1,416 

Liberia, 2007 15.8 40.0 32.9 40.3 3,421 

Madagascar, 2004 20.8 50.0 16.4 34.9 3,809 

Malawi, 2004 10.9 37.0 21.1 40.0 6,227 

Mali, 2006 22.0 57.4 7.3 32.0 10,063 

Mozambique, 2003 14.9 50.5 10.7 34.7 7,293 

Namibia, 2006-2007 12.8 33.9 35.6 44.5 1,818 

Niger, 2006 16.2 55.8 5.3 32.7 7,849 

Nigeria, 2008 23.8 61.6 6.3 30.3 19,273 

Rwanda, 2005 16.9 44.9 20.0 37.0 5,118 

Senegal, 2005 14.2 46.4 13.2 36.3 7,346 

Sierra Leone, 2008 19.5 49.4 15.9 34.8 3,408 

South Africa, 1998 12.4 29.2 42.2 47.3 1,617 

Sudan, 1990 8.7 39.9 14.5 37.9 1,920 

Swaziland, 2006 13.6 31.9 46.3 49.9 882 

Tanzania, 2004 12.4 44.3 21.0 37.0 6,071 

Togo, 1998 5.8 22.8 32.6 47.2 2,156 

Uganda, 2006 18.1 49.9 17.3 34.9 5,230 

Zambia, 2007 12.3 42.7 21.5 37.4 3,888 

Zimbabwe, 2005 8.6 27.1 39.5 48.9 2,793 

South and Southeast Asia

Bangladesh, 2007 14.4 31.1 42.2 49.6 2,869 

Cambodia, 2005 15.2 37.3 32.5 42.3 3,555 

India, 2006 27.3 58.5 9.7 30.9 27,070 

Indonesia, 2007 10.8 23.2 54.8 61.3 8,000 

Nepal, 2006 21.1 49.7 15.8 35.1 2,435 

Pakistan, 2006 31.9 62.8 8.3 28.6 5,292 

Philippines, 2008 25.3 45.0 30.7 37.8 2,601 

Sri Lanka, 1987 2.8 12.9 46.7 56.4 908 

Thailand, 1987 4.1 16.5 48.2 55.0 878 

Vietnam, 2002 11.7 19.8 56.0 60.8 541 

1

Weighted number of intervals 

na: not ascertained 
19 

Table 3.1.b. Length of Preferred Birth Intervals by Region, for Most Recent Survey 

Percentage of preferred birth intervals less than 24 months, less than 36 months, and 60 months or more, and 

median length of birth intervals, for intervals ending in the 5 years prior to the survey, by region 

Averages <24 mos <36 mos 60+ mos 

Median 

interval 

Number of 

intervals1

Total 16.0 39.5 27.0 41.5 278,098 

Central Asian States 23.6 44.0 22.0 38.2 2,092 

Latin America and Caribbean 14.0 31.8 38.1 47.3 39,681 

North Africa, West Asia and Europe 21.7 43.8 24.1 39.3 19,095 

Sub-Saharan Africa 14.5 42.2 21.6 38.9 163,081 

South and Southeast Asia 16.5 35.7 34.5 45.8 54,149 1

Weighted number of intervals 

Table 3.1.c. Differences between Lengths of Preferred and Actual Birth Intervals, by Region 

Preferred minus actual birth intervals less than 24 months, less than 36 months, and 60 months or more, and 

median length of birth intervals, for intervals ending in the 5 years prior to the survey, by region 

Averages <24 mos <36 mos 60+ mos 

Median 

interval 

Total -8.6 -17.9 (3.8) 9.4 

Central Asian States -9.4 -18.1 (3.0) 9.0 

Latin America and Caribbean -16.4 -29.0 11.3 17.4 

North Africa, West Asia and Europe -8.4 -12.3 (4.2) 6.7 

Sub-Saharan Africa -5.4 -14.7 (11.9) 6.2 

South and Southeast Asia -8.2 -18.6 3.7 12.2 

41.5

38.2

47.3

39.3 38.9

45.8

32.1

29.2

29.9

32.6 32.7

33.6

20

25

30

35

40

45

50

Total Central Asian States Latin America and 

Caribbean

North Africa, West 

Asia and Europe

Sub-Saharan Africa South and Southeast 

Asia

Months

Figure 3.1. Preferred and Actual Birth Intervals

Preferred Actual
20 

Only 16 percent of mothers prefer an interval shorter than 24 months, but 9 percentage points 

more of them have such a short interval. By far, preferences and reality diverge most in Latin America 

and the Caribbean, where 14 percent of mothers prefer an interval less than 24 months but 30 percent of 

birth intervals are less than 24 months. 

For intervals shorter than 36 months, again the Latin America and Caribbean region has the 

greatest divergence between actual and preferred intervals: only 32 percent of mothers wanted an interval 

shorter than 36 months but 61 percent of intervals are shorter than 36 months, a difference of 29 

percentage points. By country, the percentage of mothers wanting an interval shorter than 36 months 

varies from 13 percent in Sri Lanka (in 1987) to 68 percent in Azerbaijan (in 2006). 

For intervals of 60 or more months, the divergence is also greatest for Latin America and the 

Caribbean, with 26 percent of mothers wanting to wait longer between births than they actually waited. 

Table 3.2 (a and b) presents the difference between preferred and actual birth-interval length in 

another way. In this table, mothers are grouped into three categories by comparing the length of the 

intervals: preferred is more than 3 months shorter than actual; preferred is within 3 months of actual; and 

preferred is more than 3 months longer than actual. Overall, only 14 percent of mothers had their latest 

birth within 3 months of their preference. By region, the smallest percentage is in the Central Asian States 

(10 percent) and the greatest in North Africa, West Asia and Europe (16 percent). 

More than 6 of 10 mothers preferred a birth interval longer by 4 or more months than their actual 

interval. In no region is this proportion less than half, and it reaches 7 in 10 mothers in the Central Asian 

States. Again, Sri Lanka has the largest percentage of mothers who wanted an interval of 4 or more 

months longer than they actually had, at 79 percent, and Guinea has the smallest percentage, at 38 

percent. 

Overall, about one in four women preferred an interval shorter than their actual interval. 
21 

Table 3.2.a. Preferred versus Actual Birth Intervals by Country, for Most Recent Survey 

Percentage of preferred birth intervals less than actual intervals1, percentage of preferred intervals within 3 months 

of actual intervals, and percentage of preferred intervals greater than actual intervals2

, for actual intervals ending 

within five years prior to the survey, by country 

Survey 

Preferred 

< Actual 

Preferred within 

3 months of 

Actual 

Preferred 

> Actual 

Number of 

intervals3

Central Asian States

Kazakhstan, 1999 22.3 14.0 63.7 203 

Kyrgyz Republic, 1997 20.1 8.0 71.9 525 

Uzbekistan, 1996 19.6 9.5 70.9 596 

Latin America and Caribbean

Bolivia, 2003 19.6 12.8 67.6 902 

Brazil, 1996 19.1 16.7 64.1 312 

Colombia, 2005 20.0 12.9 67.0 984 

Dominican Republic, 2007 22.5 10.2 67.3 1,537 

Ecuador, 1987 21.7 5.7 72.6 318 

El Salvador, 1985 20.7 8.4 70.9 449 

Guatemala, 1999 22.6 22.9 54.6 731 

Haiti, 2005 14.2 15.9 69.9 845 

Honduras, 2005 19.3 11.1 69.6 1,661 

Mexico, 1987 17.3 6.2 76.5 506 

Nicaragua, 2001 17.0 10.3 72.7 803 

Paraguay, 1990 19.3 20.0 60.7 807 

Peru, 2004 22.4 7.4 70.2 1,586 

Trinidad and Tobago, 1987 17.9 4.1 78.0 218 

North Africa, West Asia and Europe

Armenia, 2005 15.7 8.2 76.1 140 

Azerbaijan, 2006 25.7 20.4 54.0 156 

Egypt, 2008 22.9 20.9 56.2 1,362 

Jordan, 2007 18.1 17.5 64.4 2,622 

Moldova, 2005 33.7 14.0 52.3 101 

Morocco, 2003 16.1 10.4 73.5 1,250 

Tunisia, 1988 14.1 8.9 76.9 693 

Turkey, 2003 20.0 22.3 57.7 213 

Ukraine, 2007 43.5 8.0 48.5 56 

Yemen, 1991 na na na na 

Sub-Saharan Africa

Benin, 2006 29.7 19.4 50.9 5,486 

Burkina Faso, 2003 21.0 16.6 62.4 4,187 

Burundi, 1987 20.1 12.6 67.4 1,298 

Cameroon, 2004 31.8 21.6 46.6 2,482 

Central African Republic, 1994 35.6 14.7 49.7 1,389 

Chad, 2004 35.0 25.0 40.0 2,326 

Comoros, 1996 22.3 11.5 66.2 557 

Congo Brazzaville, 2005 25.4 13.7 60.9 1,562 

Congo, Democratic Republic, 2007 28.6 20.3 51.1 2,719 

Cote D'Ivoire, 1998 28.9 15.2 55.9 792 

Ethiopia, 2005 21.8 15.8 62.4 3,035 

Gabon, 2000 22.1 14.2 63.7 1,005 

(Cont’d)
22 

Table 3.2.a. – cont’d

Survey 

Preferred 

< Actual 

Preferred within 

3 months of 

Actual 

Preferred 

> Actual 

Number of 

intervals3

Ghana, 2008 23.5 10.1 66.4 847 

Guinea, 2005 44.8 16.8 38.3 2,563 

Kenya, 2003 21.3 14.6 64.1 1,292 

Lesotho, 2004 25.9 10.5 63.6 510 

Liberia, 2007 25.5 15.0 59.5 1,656 

Madagascar, 2004 21.5 18.8 59.7 1,529 

Malawi, 2004 19.2 15.3 65.6 2,760 

Mali, 2006 33.2 21.2 45.6 5,228 

Mozambique, 2003 34.9 19.5 45.6 3,567 

Namibia, 2006-2007 35.9 10.9 53.2 611 

Niger, 2006 36.9 20.4 42.8 4,568 

Nigeria, 2008 35.1 21.6 43.3 9,371 

Rwanda, 2005 14.5 15.9 69.5 2,094 

Senegal, 2005 27.6 16.7 55.8 3,715 

Sierra Leone, 2008 42.4 11.8 45.8 1,620 

South Africa, 1998 32.7 8.8 58.6 501 

Sudan, 1990 27.6 12.6 59.8 1,818 

Swaziland, 2006 18.4 9.3 72.3 254 

Tanzania, 2004 22.3 15.9 61.8 2,901 

Togo, 1998 21.7 10.9 67.4 1,975 

Uganda, 2006 18.4 20.7 60.9 2,182 

Zambia, 2007 20.3 17.6 62.0 1,776 

Zimbabwe, 2005 18.7 11.9 69.4 1,126 

South and Southeast Asia

Bangladesh, 2007 21.2 8.5 70.4 699 

Cambodia, 2005 16.0 12.5 71.5 1,237 

India, 2006 28.6 24.6 46.7 6,488 

Indonesia, 2007 23.7 8.7 67.6 2,596 

Nepal, 2006 25.8 22.8 51.4 552 

Pakistan, 2006 26.7 21.5 51.8 1,927 

Philippines, 2008 17.0 16.4 66.6 684 

Sri Lanka, 1987 15.9 5.1 79.0 445 

Thailand, 1987 14.8 7.6 77.6 334 

Vietnam, 2002 22.4 7.9 69.7 255 

1

 Preferred 3 or more months shorter than actual intervals 

2

 Preferred 3 or more months longer than actual intervals 

3

 Weighted number of intervals 

na: not ascertained 
23 

Table 3.2.b. Preferred versus Actual Birth Intervals by Region, for Most Recent Survey 

Percentage of preferred birth intervals less than actual intervals1, percentage of preferred intervals within 3 months 

of actual intervals, and percentage of preferred intervals greater than actual intervals2

, for actual intervals ending 

within five years prior to the survey, by region 

 Preferred < Actual 

Averages 

Preferred 

< Actual 

Preferred within 

3 months of 

Actual 

Preferred 

> Actual 

Total 24.0 14.2 61.8 

Central Asian States 19.8 10.1 70.1 

Latin America and Caribbean 19.3 11.4 69.3 

North Africa, West Asia and Europe 24.9 15.8 59.4 

Sub-Saharan Africa 26.7 15.3 57.9 

South and Southeast Asia 21.2 14.1 64.7 

1

 Preferred 3 or more months shorter than actual intervals 2

 Preferred 3 or more months longer than actual intervals 

3.2 Trends in Preferred Intervals 

The length of birth intervals that women prefer has not changed much over time (Table 3.3 a and 

b). Overall, on average, the median length increased 0.7 months, and the per-year change was +0.15, 

implying that over a decade the average change was +1.5 months. The fastest change was in the Central 

Asian States, where there was a decrease in the median preferred interval of 1.18 months per year. In the 

other regions, the rate of change was positive, and highest in Latin America and the Caribbean, at +0.44 

months per year (+4.4 months per decade). Except for the Central Asian States, the percentage of 

preferred intervals of less than 36 months decreased, but the rates of decrease were very small. In the 

Central Asian States, the percentage increased at a fairly large rate of 17 percentage points per decade. 

Table 3.3.a. Trends in Length of Preferred Birth Intervals, by Country 

Percentage point changes between the earliest and latest surveys and average percentage point change per year in 

the percentage of preferred birth intervals less than 24 months, less than 36 months, and 60 months or more, and in 

median length of preferred birth intervals in months, for intervals ending in the 5 years prior to the survey, by country 

 Total 

Trend (Last-First) Change per year 

Survey 

<24 

mos 

<36 

mos 

60+ 

mos 

Median 

interval 

<24 

mos 

<36 

mos 

60+ 

mos 

Median 

interval 

Central Asian States

Kazakhstan, 1995 to 1999 7.7 6.9 2.5 -4.7 1.93 1.73 0.63 -1.18 

Latin America and Caribbean

Bolivia, 1989 to 2003 12.7 14.3 6.6 -3.3 0.91 1.02 0.47 -0.24 

Brazil, 1986 to 1996 16.3 17.7 -9.8 -10.2 1.63 1.77 -0.98 -1.02 

Colombia, 1986 to 2005 8.9 7.1 8.5 0.4 0.47 0.37 0.45 0.02 

Dominican Republic, 1986 to 2007 4.8 -1.5 12.4 8.4 0.23 -0.07 0.59 0.40 

Guatemala, 1987 to 1999 19.8 24.2 -3.4 -9.6 1.65 2.02 -0.28 -0.80 

Haiti, 1994 to 2005 -3.7 -10.9 13.3 5.7 -0.34 -0.99 1.21 0.52 

Nicaragua, 1998 to 2001 -9.6 -15.1 13.4 13.0 -3.20 -5.03 4.47 4.33 

Peru, 1986 to 2004 2.8 1.2 9.8 5.6 0.14 0.06 0.49 0.28 

(Cont’d) 
24 

Table 3.3.a. – cont’d

 Total 

Trend (Last-First) Change per year 

Survey 

<24 

mos 

<36 

mos 

60+ 

mos 

Median 

interval 

<24 

mos 

<36 

mos 

60+ 

mos 

Median 

interval 

North Africa, West Asia and Europe

Armenia, 2000 to 2005 -10.1 -8.1 3.5 6.0 -2.02 -1.62 0.70 1.20 

Egypt, 1988 to 2008 9.5 14.7 -8.3 -5.1 0.48 0.74 -0.42 -0.26 

Jordan, 1990 to 2007 13.6 9.7 -1.5 -4.1 0.80 0.57 -0.09 -0.24 

Morocco, 1987 to 2003 0.4 -8.3 11.4 7.8 0.02 -0.52 0.71 0.49 

Turkey, 1993 to 2003 3.3 7.1 -3.5 -4.3 0.33 0.71 -0.35 -0.43 

Sub-Saharan Africa

Benin, 1996 to 2006 2.3 6.7 0.5 -1.9 0.23 0.67 0.05 -0.19 

Burkina Faso, 1993 to 2003 -2.6 -9.4 7.9 3.7 -0.26 -0.94 0.79 0.37 

Cameroon, 1991 to 2004 -0.2 -4.2 4.9 1.1 -0.02 -0.32 0.38 0.08 

Chad, 1997 to 2004 -1.3 -1.0 0.6 -0.2 -0.19 -0.14 0.09 -0.03 

Cote D'Ivoire, 1994 to 1998 2.7 -2.4 2.9 0.3 0.68 -0.60 0.73 0.07 

Ethiopia, 2000 to 2005 0.4 -3.6 8.1 2.4 0.08 -0.72 1.62 0.48 

Ghana, 1988 to 2008 6.6 11.6 5.4 -0.6 0.33 0.58 0.27 -0.03 

Guinea, 1999 to 2005 -3.0 -1.7 -1.7 0.4 -0.50 -0.28 -0.28 0.07 

Kenya, 1989 to 2003 14.7 20.9 0.2 -6.6 1.05 1.49 0.01 -0.47 

Liberia, 1986 to 2007 -4.0 -8.3 15.6 4.7 -0.19 -0.40 0.74 0.22 

Madagascar, 1992 to 2004 -5.6 -10.4 7.2 5.2 -0.47 -0.87 0.60 0.43 

Malawi, 1992 to 2004 -4.1 -12.3 10.8 4.8 -0.34 -1.03 0.90 0.40 

Mali, 1987 to 2006 9.4 0.6 0.5 -0.6 0.49 0.03 0.03 -0.03 

Mozambique, 1997 to 2003 -2.8 -2.2 1.6 1.1 -0.47 -0.37 0.27 0.18 

Namibia, 1992 to 2007 -10.1 -24.9 24.8 13.3 -0.67 -1.66 1.65 0.89 

Niger, 1992 to 2006 -4.5 -3.6 0.4 1.1 -0.32 -0.26 0.03 0.08 

Nigeria, 1992 to 2008 5.2 12.5 -2.5 -5.0 0.29 0.69 -0.14 -0.28 

Rwanda, 1992 to 2005 4.4 8.7 -9.1 -5.5 0.34 0.67 -0.70 -0.42 

Senegal, 1986 to 2005 5.9 -3.4 7.4 1.2 0.31 -0.18 0.39 0.06 

Tanzania, 1992 to 2004 -2.0 -6.7 10.3 2.5 -0.17 -0.56 0.86 0.21 

Togo, 1988 to 1998 1.6 0.2 7.6 2.4 0.16 0.02 0.76 0.24 

Uganda, 1988 to 2006 -3.4 -13.4 13.2 4.2 -0.19 -0.74 0.73 0.23 

Zambia, 1992 to 2007 -3.8 -13.4 12.3 4.9 -0.25 -0.89 0.82 0.33 

Zimbabwe, 1988 to 2005 5.4 6.5 4.4 -0.1 0.32 0.38 0.26 -0.01 

South and Southeast Asia

Bangladesh, 1994 to 2007 0.0 2.4 -2.1 -3.1 0.00 0.18 -0.16 -0.24 

Cambodia, 2000 to 2005 -7.3 -12.9 13.2 7.5 -1.46 -2.58 2.64 1.50 

India, 1993 to 2006 6.4 7.4 -0.6 -3.5 0.49 0.57 -0.05 -0.27 

Indonesia, 1987 to 2007 9.8 17.0 -12.1 -4.0 0.49 0.85 -0.61 -0.20 

Nepal, 1996 to 2006 3.6 8.6 -1.4 -4.1 0.36 0.86 -0.14 -0.41 

Pakistan, 1991 to 2006 -1.4 -4.0 2.9 0.7 -0.09 -0.27 0.19 0.05 

Philippines, 1993 to 2008 -1.2 -2.5 7.3 1.5 -0.08 -0.17 0.49 0.10 

Vietnam, 1997 to 2002 -2.0 -6.5 2.8 0.9 -0.40 -1.30 0.56 0.18 
25 

Table 3.3.b. Trends in Length of Preferred Birth Intervals, by Region 

Percentage point changes between the earliest and latest surveys and average percentage point change per year in 

the percentage of preferred birth intervals less than 24 months, less than 36 months, and 60 months or more, and in 

median length of preferred birth intervals in months, for intervals ending in the 5 years prior to the survey, by region 

 Total 

Trend (Last-First) Change per year 

Averages 

<24 

mos 

<36 

mos 

60+ 

mos 

Median 

interval 

<24 

mos 

<36 

mos 

60+ 

mos 

Median 

interval 

Total 2.1 0.3 4.3 0.7 0.06 -0.14 0.46 0.15 

Central Asian States 7.7 6.9 2.5 -4.7 1.93 1.73 0.63 -1.18 

Latin America and Caribbean 6.5 4.6 6.4 1.3 0.19 -0.11 0.80 0.44 

North Africa, West Asia and Europe 3.3 3.0 0.3 0.1 -0.08 -0.02 0.11 0.15 

Sub-Saharan Africa 0.5 -2.2 5.6 1.4 0.01 -0.23 0.45 0.12 

South and Southeast Asia 1.0 1.2 1.3 -0.5 -0.09 -0.23 0.37 0.09 

 

In 19 of the 46 countries with trend data, the median length of preferred intervals shrank, with 

Kazakhstan reporting the greatest rate of shrinkage (-1.18 months per year). In 27 countries, the median 

preferred length increased, with the greatest rate of increase occurring in Nicaragua, at +4.33 months per 

year. 

Another way of looking at trends in preferred birth intervals is to compare them with the actual 

intervals. Table 3.4 (a and b) shows trends in the percentages of preferred intervals 4 or more months less 

than the actual intervals, within 3 months of the actual intervals, and 4 or more months greater than the 

actual intervals. There has been little change overall, with rates of change per year in the respective 

percentages of -0.07, +0.01, and +0.06 points. The greatest rates of change were in the Central Asian 

States, where the percentage with preferred intervals less than 3 months of the actual intervals grew 

(+0.75 points per year), and the percentage with preferred intervals greater than 3 months of the actual 

intervals shrank (-2.05 points per year). 

Table 3.4.a. Trends in Length of Preferred versus Actual Birth Intervals, by Country 

Percentage point changes between the earliest and latest surveys and average percentage point change per year in 

the percentage of preferred birth intervals less than actual intervals, percentage of preferred intervals within 3 

months of actual intervals and percentage of preferred intervals greater than actual intervals, for actual intervals 

ending in the 5 years prior to the survey, by country 

 Total 

Trend (Last-First) Change per year 

Survey 

Preferred 

< Actual 

Preferred 

within 3 

months of 

Actual 

Preferred 

> Actual 

Preferred 

< Actual 

Preferred 

within 3 

months of 

Actual 

Preferred 

> Actual 

Central Asian States 

Kazakhstan, 1995 to 1999 3.0 5.2 -8.2 0.75 1.30 -2.05 

Latin America and Caribbean 

Bolivia, 1989 to 2003 -9.3 4.6 4.7 -0.66 0.33 0.34 

Brazil, 1986 to 1996 0.4 7.9 -8.4 0.04 0.79 -0.84 

Colombia, 1986 to 2005 1.9 7.9 -9.9 0.10 0.42 -0.52 

Dominican Republic, 1986 to 2007 2.2 0.8 -2.9 0.10 0.04 -0.14 

Guatemala, 1987 to 1999 -2.6 12.0 -9.3 -0.22 1.00 -0.78 

(Cont’d)
26 

Table 3.4.a. – cont’d

 Total 

Trend (Last-First) Change per year 

Survey 

Preferred 

< Actual 

Preferred 

within 3 

months of 

Actual 

Preferred 

> Actual 

Preferred 

< Actual 

Preferred 

within 3 

months of 

Actual 

Preferred 

> Actual 

Haiti, 1994 to 2005 -2.7 -7.9 10.6 -0.25 -0.72 0.96 

Nicaragua, 1998 to 2001 2.3 -6.9 4.6 0.77 -2.30 1.53 

Peru, 1986 to 2008 3.5 -0.4 -3.1 0.18 -0.02 -0.16 

North Africa, West Asia and Europe 

Armenia, 2000 to 2005 -6.1 -4.2 10.3 -1.22 -0.84 2.06 

Egypt, 1988 to 2008 3.1 7.6 -10.7 0.16 0.38 -0.54 

Jordan, 1990 to 2007 1.1 8.6 -9.7 0.06 0.51 -0.57 

Morocco, 1987 to 2003 -7.9 -2.1 10.0 -0.49 -0.13 0.63 

Turkey, 1993 to 2003 2.7 1.3 -3.9 0.27 0.13 -0.39 

Sub-Saharan Africa 

Benin, 1996 to 2006 -0.3 2.7 -2.4 -0.03 0.27 -0.24 

Burkina Faso, 1993 to 2003 -3.0 -1.4 4.4 -0.30 -0.14 0.44 

Cameroon, 1991 to 2004 1.8 -0.9 -1.0 0.14 -0.07 -0.08 

Chad, 1997 to 2004 1.0 1.4 -2.4 0.14 0.20 -0.34 

Cote D'Ivoire, 1994 to 1998 -1.6 2.4 -0.8 -0.40 0.60 -0.20 

Ethiopia, 2000 to 2005 -1.6 -2.1 3.8 -0.32 -0.42 0.76 

Ghana, 1988 to 2008 2.6 0.0 -2.6 0.13 0.00 -0.13 

Guinea, 1999 to 2005 7.1 -1.2 -6.1 1.18 -0.20 -1.02 

Kenya, 1989 to 2003 5.4 4.4 -9.8 0.39 0.31 -0.70 

Liberia, 1986 to 2007 -13.0 3.2 9.8 -0.62 0.15 0.47 

Madagascar, 1992 to 2004 0.3 -5.7 5.4 0.03 -0.48 0.45 

Malawi, 1992 to 2004 -9.1 -3.6 12.8 -0.76 -0.30 1.07 

Mali, 1987 to 2006 -9.3 6.2 3.1 -0.49 0.33 0.16 

Mozambique, 1997 to 2003 -8.0 6.2 1.8 -1.33 1.03 0.30 

Namibia, 1992 to 2007 1.2 -9.1 7.9 0.08 -0.61 0.53 

Niger, 1992 to 2006 7.9 -2.2 -5.6 0.56 -0.16 -0.40 

Nigeria, 1990 to 2008 -3.7 7.0 -3.3 -0.21 0.39 -0.18 

Rwanda, 1992 to 2005 4.1 2.9 -7.1 0.32 0.22 -0.55 

Senegal, 1986 to 2005 -5.3 -1.0 6.4 -0.28 -0.05 0.34 

Tanzania, 1992 to 2004 -1.0 -4.9 5.9 -0.08 -0.41 0.49 

Togo, 1988 to 1998 -5.0 -2.0 7.0 -0.50 -0.20 0.70 

Uganda, 1988 to 2006 -18.2 2.7 15.5 -1.01 0.15 0.86 

Zambia, 1992 to 2007 -7.7 -4.3 11.9 -0.51 -0.29 0.79 

Zimbabwe, 1988 to 2005 2.5 2.2 -4.7 0.15 0.13 -0.28 

South and Southeast Asia 

Bangladesh, 1994 to 2007 -1.8 -0.4 2.4 -0.14 -0.03 0.18 

Cambodia, 2000 to 2005 -5.6 -8.3 13.9 -1.12 -1.66 2.78 

India, 1993 to 2006 -0.2 8.0 -7.9 -0.02 0.62 -0.61 

Indonesia, 1987 to 2007 13.5 2.9 -16.4 0.68 0.15 -0.82 

Nepal, 1996 to 2006 1.2 9.5 -10.8 0.12 0.95 -1.08 

Pakistan, 1991 to 2006 -8.4 -4.6 13.0 -0.56 -0.31 0.87 

Philippines, 1993 to 2008 4.6 -4.4 -0.2 0.31 -0.29 -0.01 

Vietnam, 1997 to 2002 7.8 -1.3 -6.5 1.56 -0.26 -1.30 
27 

Table 3.4.b. Trends in Length of Preferred versus Actual Birth Intervals, by Region 

Percentage point changes between the earliest and latest surveys and average percentage point change per year in 

the percentage of preferred birth intervals less than actual intervals, percentage of preferred intervals within 3 

months of actual intervals and percentage of preferred intervals greater than actual intervals, for actual intervals 

ending in the 5 years prior to the survey, by region 

 Total 

Trend (Last-First) Change per year 

Averages 

Preferred 

< Actual 

Preferred 

within 3 

months of 

Actual 

Preferred 

> Actual 

Preferred 

< Actual 

Preferred 

within 3 

months of 

Actual 

Preferred 

> Actual 

Total -1.1 0.8 0.3 -0.07 0.01 0.06 

Central Asian States 3.0 5.2 -8.2 0.75 1.30 -2.05 

Latin America and Caribbean -0.5 2.3 -1.7 0.01 -0.06 0.05 

North Africa, West Asia and Europe -1.4 2.2 -0.8 -0.24 0.01 0.24 

Sub-Saharan Africa -2.2 0.1 2.1 -0.16 0.02 0.14 

South and Southeast Asia 1.4 0.2 -1.6 0.10 -0.11 0.00 

3.3 Differentials 

Except for the Latin America and Caribbean region, the average rate of increase in median actual 

lengths of birth intervals outpaces that of preferred lengths (Figure 3.2). In the Central Asian States, the 

preferred length drops substantially, but this rate is based only on one country’s survey, Kazakhstan. 

In urban areas, the annual average rate of change of median preferred-interval length exceeds that 

of rural areas in all regions except North Africa, West Asia and Europe, where preferred lengths in urban 

areas have decreased (Figure 3.3). The previously noted large decrease for Kazakhstan in preferred length 

occurred only in rural areas. 

By wealth quintile, the increase in preferred length of birth intervals is usually greater as the level 

of wealth is higher. The rate of increase for the wealthiest quintile is more than three times greater than 

for the poorest quintile (Figure 3.4). The time trend of preferences for lengths of birth intervals varies by 

level of maternal education (Figure 3.5). Women with secondary education have the greatest rate of 

increase, while among women with no education the preferred-interval length decreases. Figure 3.6 shows 

changes in preferred length by women’s parity at survey date. Only women who did not have a birth or 

who had only one birth show an increase in their preferred birth-interval lengths. Among women of other 

parities, the rate of decrease is greater the higher the parity. 
28 

0.15

-1.18

0.44

0.15 0.12 0.09

0.25

0.33 0.36 0.37

0.16

0.34

-1.40

-1.20

-1.00

-0.80

-0.60

-0.40

-0.20

0.00

0.20

0.40

0.60

Total Central Asian States Latin America and 

Caribbean

North Africa, West 

Asia and Europe

Sub-Saharan Africa South and Southeast 

Asia

Months

Figure 3.2. Annual Rate of Change in Median Preferred and Actual Length of Birth Intervals

Preferred Actual

0.33

1.48

0.59

-0.20

0.36

0.16

0.06

-2.33

0.19 0.15 0.10 0.06

-3.00

-2.50

-2.00

-1.50

-1.00

-0.50

0.00

0.50

1.00

1.50

2.00

Total Central Asian States Latin America and 

Caribbean

North Africa, West 

Asia and Europe

Sub-Saharan Africa South and Southeast 

Asia

Months

Figure 3.3. Average Annual Change in Median Length of Preferred Birth Intervals 

by Residence

Urban Rural
29 

0.16

0.33

0.29

0.40

0.51

0.00

0.10

0.20

0.30

0.40

0.50

0.60

Poorest Second Middle Fourth Highest

Months

Wealth Quintile

Figure 3.4. Average Annual Change in Median Length of Preferred Birth Intervals 

by Household Wealth Quintile

-0.16

0.12

0.34

0.19

-0.20

-0.10

0.00

0.10

0.20

0.30

0.40

No Education Primary Secondary Higher

Months

Education

Figure 3.5. Average Annual Change in Median Length of Preferred Birth Intervals 

by Education
30 

0.67

-0.09

-0.18

-0.21

-0.30

-0.20

-0.10

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0-1 2-3 4-5 6+

Months

Parity

Figure 3.6. Average Annual Change in Median Length of Preferred Birth Intervals 

by Parity
31 

4 Contraception for Spacing Births 

4.1 Demand for Spacing Births 

The demand for contraception for spacing births includes current use of contraception by married 

women who want another birth in two or more years from the date of the survey, plus women with an 

unmet need for spacing (fecund currently married women not using contraception but wanting to delay 

the next birth by two or more years). Over all the surveys, about one-quarter (25.5 percent) of currently 

married women have a demand for contraception in order to space the next birth (Table 4.1). The 

percentages of demand are somewhat higher in sub-Saharan Africa (28.7 percent) and the Central Asian 

States (27.1 percent) and somewhat lower in the North Africa, West Asia and Europe (20.3 percent) and 

in South and Southeast Asia (20.9 percent) (Table 4.3). 

Overall, the demand for contraception for spacing has increased at an annual average rate of 0.22 

percentage points (+2.2 percentage points per decade). The increase is greatest in the Central Asian States 

(+7.7 percentage points per decade). The South and Southeast Asian region shows a decrease in demand 

for contraception for spacing (-1.4 percentage points per decade), and the other two regions have between 

a 2.8 and 3.4 percentage point increase in demand per decade (Figure 4.1) 

0.22

-1.21

0.77

-0.86

0.28

-1.32

0.04

-0.85

0.34

-1.18

-0.14

-1.46 -1.50

-1.30

-1.10

-0.90

-0.70

-0.50

-0.30

-0.10

0.10

0.30

0.50

0.70

0.90

Demand for Spacing Percent Unsatisfied of Need for Spacing

Percentage point change per year

Figure 4.1. Average Annual Change in Demand for Contraception for Spacing Births and 

Percentage of Demand that is Unsatisfied, Total and by Region

Total

Central Asian States (Kazakstan only)

Latin America & Caribbean

North Africa, West Asia & Europe

Sub-Saharan Africa

South and Southeast Asia
32 

Table 4.1. Need for Spacing, by Country 

Among currently married women, the percentage with an unmet need for family planning to space births, the 

percentage using contraception to space births, the total demand for contraception for spacing births and the 

percentage of demand for spacing births that is unsatisfied, by country

 Need for family planning Percentage 

demand for 

spacing 

 unsatisfied Number 

Unmet 

need for 

spacing 

Using to 

space 

Demand for 

spacing1

Central Asian States 

Kazakhstan, 1995 4.0 19.8 23.8 16.8 2,507 

Kazakhstan, 1999 3.6 23.0 26.9 13.4 3,018 

Kyrgyz Republic, 1997 4.5 26.3 30.7 14.7 2,675 

Turkmenistan 2000 5.2 22.0 27.5 18.9 4,892 

Uzbekistan, 1996 6.6 20.2 26.8 24.6 3,102 

Latin America and Caribbean

Bolivia, 1994 5.5 10.9 19.4 28.4 5,334 

Bolivia, 1998 6.8 13.3 20.1 33.8 6,649 

Bolivia, 2003 6.1 15.8 21.9 27.9 10,569 

Brazil, 1991a 6.7 10.4 18.3 36.6 3,541 

Brazil, 1996 2.6 14.0 17.6 14.8 7,584 

Colombia, 1990 4.1 19.5 24.8 16.5 4,450 

Colombia, 1995 3.2 18.9 24.0 13.3 6,097 

Colombia, 2000 2.6 18.4 22.9 11.4 5,935 

Colombia, 2005 2.6 16.9 20.9 12.4 19,799 

Dominican Republic, 1991 8.5 10.9 20.2 42.1 4,083 

Dominican Republic, 1996 7.1 14.0 22.6 31.4 4,983 

Dominican Republic, 1999 7.4 17.8 26.4 28.0 728 

Dominican Republic, 2002 6.7 14.8 22.5 29.8 13,996 

Dominican Republic, 2007 7.0 16.1 23.1 30.3 15,417 

Guatemala, 1995 12.4 7.6 20.5 60.5 7,984 

Guatemala, 1999 11.8 8.5 21.0 56.2 3,964 

Haiti, 1994 18.4 6.3 24.7 74.5 3,113 

Haiti, 2000 15.8 9.8 25.6 61.7 5,958 

Haiti, 2005 17.0 13.6 30.6 55.6 6,323 

Honduras, 2005 8.4 22.8 31.3 26.8 11,613 

Nicaragua, 1998 6.3 15.9 23.2 27.2 8,045 

Nicaragua, 2001 5.9 20.5 26.4 22.3 7,424 

Paraguay, 1990 8.8 23.6 35.0 25.1 3,574 

Peru, 1992 4.1 13.9 20.8 19.7 8,741 

Peru, 1996 3.5 18.2 24.4 14.3 16,885 

Peru, 2000 3.5 20.3 25.6 13.7 15,628 

Peru, 2004-08 3.1 23.7 28.9 10.7 22,564 

Peru, 2009 2.8 23.9 28.8 9.7 13,828 

North Africa, West Asia and Europe 

Armenia, 2000 2.6 11.8 15.1 17.2 4,125 

Armenia, 2005 3.6 11.4 15.2 23.7 4,044 

Azerbaijan, 2006 3.3 7.6 11.0 30.0 5,269 

Egypt, 1995 5.3 8.6 14.4 36.8 13,710 

 (Cont’d)
33 

Table 4.1. – cont’d 

 Need for family planning Percentage 

demand for 

spacing 

 unsatisfied Number 

Unmet 

need for 

spacing 

Using to 

space 

Demand for 

spacing1

Egypt, 2000 3.1 11.4 14.9 20.8 14,382 

Egypt, 2003 3.5 12.9 17.1 20.5 8,445 

Egypt, 2005 3.6 12.4 16.5 21.8 18,187 

Egypt, 2008 3.4 13.2 17.1 19.9 15,396 

Jordan, 1990 8.6 11.7 22.2 38.7 6,168 

Jordan, 1997 7.4 18.2 28.9 25.6 5,337 

Jordan, 2002 5.6 25.5 33.0 17.0 5,706 

Jordan, 2007 4.9 22.3 28.9 17.0 10,354 

Moldova, 2005 2.5 19.3 22.4 11.2 4,937 

Morocco, 1992 8.5 14.1 24.1 35.3 5,118 

Morocco, 2003 3.5 22.3 27.0 13.0 8,782 

Turkey, 1993 3.6 12.0 16.7 21.6 6,271 

Turkey, 1998 3.8 14.3 19.0 20.0 5,921 

Turkey, 2003 1.2 8.2 9.8 12.2 7,672 

Ukraine, 2007 3.9 23.7 27.7 14.1 4,116 

Yemen, 1997 17.2 7.2 24.4 70.5 9,786 

Sub-Saharan Africa 

Benin, 1996 17.2 11.3 28.5 60.4 4,198 

Benin, 2001 17.5 12.0 29.5 59.3 4,563 

Benin, 2006 17.6 10.2 27.8 63.3 13,403 

Burkina Faso, 1993 18.2 19.0 37.1 49.1 5,326 

Burkina Faso, 1999 19.0 9.0 28.0 67.9 5,181 

Burkina Faso, 2003 21.8 9.9 31.7 68.8 9,655 

Cameroon, 1991 16.8 11.0 27.8 60.4 2,868 

Cameroon, 1998 13.3 12.1 25.4 52.4 3,676 

Cameroon, 2004 14.2 17.7 31.9 44.5 7,166 

Central African Republic, 1994 11.6 11.9 23.5 49.4 4,083 

Chad, 1997 6.6 3.1 9.7 68.0 5,832 

Chad, 2004 16.6 9.9 26.5 62.6 4,663 

Comoros, 1996 21.8 11.8 33.6 64.9 1,634 

Congo Brazzaville, 2005 14.4 35.2 49.6 29.0 3,979 

Congo, Democratic Republic, 2007 19.4 13.4 32.8 59.1 6,622 

Cote D'Ivoire, 1994 20.0 8.0 28.0 71.4 5,271 

Cote D'Ivoire, 1998 20.0 10.0 30.1 66.4 1,863 

Eritrea, 1995 21.4 5.7 27.1 79.0 3,371 

Eritrea, 2002 21.0 5.0 26.1 80.5 5,733 

Ethiopia, 2000 21.3 3.7 25.1 84.9 9,789 

Ethiopia, 2005 20.1 6.7 26.9 74.7 9,066 

Gabon, 2000 19.9 24.0 44.0 45.2 3,348 

Ghana, 1993 24.7 10.5 35.2 70.2 3,204 

Ghana, 1998 21.7 12.3 34.0 63.8 3,131 

Ghana, 2003 21.7 13.7 35.5 61.1 3,549 

Ghana, 2008 22.5 12.3 34.8 64.7 2,876 

Guinea, 1999 16.0 3.6 19.6 81.6 5,561 

Guinea, 2005 13.1 5.9 19.1 68.6 6,292 

(Cont’d)
34 

Table 4.1. – cont’d 

 Need for family planning Percentage 

demand for 

spacing 

 unsatisfied Number 

Unmet 

need for 

spacing 

Using to 

space 

Demand for 

spacing1

Kenya, 1993 21.4 9.9 31.3 68.4 4,629 

Kenya, 1998 14.0 13.4 28.9 48.4 4,834 

Kenya, 2003 14.4 14.3 30.2 47.7 4,919 

Kenya 2008-09 12.9 17.5 30.4 42.4 4,928 

Lesotho, 2004 11.0 13.8 24.8 44.4 3,709 

Liberia, 2007 24.6 6.7 31.3 78.6 4,540 

Madagascar, 1992 16.5 6.4 22.9 72.1 3,736 

Madagascar, 1997 14.1 7.9 22.0 64.1 4,435 

Madagascar, 2004 11.3 12.3 23.6 47.9 5,140 

Madagascar, 2008-09 10.4 19.0 29.3 35.5 12,039 

Malawi, 1992 23.6 7.4 31.0 76.1 3,492 

Malawi, 2000 17.2 12.7 29.9 57.5 9,452 

Malawi, 2004 17.2 15.5 33.8 50.9 8,312 

Mali, 1996 20.1 4.3 24.3 82.7 8,222 

Mali, 2001 20.9 5.1 25.9 80.7 10,723 

Mali 2006 21.4 5.5 26.9 79.6 12,365 

Mauritania 2000 22.9 5.1 28.1 81.5 4,541 

Mozambique, 1997 16.9 2.6 19.5 86.7 6,530 

Mozambique, 2003 10.8 16.0 26.9 40.1 8,736 

Namibia, 1992 14.9 11.2 26.1 57.1 2,259 

Namibia, 2000 9.3 13.1 22.4 41.5 2,610 

Namibia, 2006-2007 9.1 17.6 26.6 34.2 3,451 

Niger, 1992 15.7 3.8 19.5 80.5 5,561 

Niger, 1998 14.0 6.9 20.9 67.0 6,382 

Niger, 2006 13.3 9.7 23.0 57.8 7,941 

Nigeria, 1990 15.5 3.3 18.9 82.0 6,880 

Nigeria, 2003 11.8 7.8 19.6 60.2 5,336 

Nigeria, 2008 15.0 8.8 23.8 63.0 23,578 

Rwanda, 1992 20.8 10.2 31.0 67.1 3,785 

Rwanda, 2000 24.0 7.3 31.3 76.7 5,052 

Rwanda, 2005 24.5 7.4 31.9 76.8 5,510 

Senegal, 1993 22.3 4.4 26.7 83.5 4,450 

Senegal, 1997 25.5 8.0 33.5 76.1 5,851 

Senegal, 2005 24.2 7.3 31.5 76.8 9,866 

Sierra Leone, 2008 16.4 4.3 20.7 79.2 5,525 

South Africa, 1998 4.7 14.4 19.1 24.6 5,077 

Swaziland, 2006 7.3 12.7 20.0 36.5 2,062 

Tanzania, 1996 15.4 10.0 25.4 60.6 5,411 

Tanzania, 1999 13.8 15.1 28.9 47.8 2,653 

Tanzania, 2004 15.1 15.5 31.7 47.6 6,950 

Togo, 1998 21.4 14.6 36.0 59.4 5,819 

Uganda, 1995 18.3 6.9 25.2 72.6 5,136 

Uganda, 2000 20.7 11.2 31.9 64.9 4,881 

Uganda, 2006 24.5 11.0 35.5 69.0 5,337 

Zambia, 1992 21.6 9.0 30.6 70.6 4,457 

Zambia, 1996 18.7 15.8 34.5 54.2 4,902 

Zambia, 2002 16.8 19.2 36.1 46.5 4,694 

(Cont’d)
35 

Table 4.1. – cont’d 

 Need for family planning Percentage 

demand for 

spacing 

 unsatisfied Number 

Unmet 

need for 

spacing 

Using to 

space 

Demand for 

spacing1

Zambia, 2007 17.1 24.8 41.9 40.8 4,402 

Zimbabwe, 1994 9.2 27.0 38.1 24.1 3,788 

Zimbabwe, 1999 7.3 29.4 38.0 19.2 3,609 

Zimbabwe, 2005 7.0 31.2 39.4 17.8 5,143 

South and Southeast Asia 

Bangladesh, 1994 9.2 11.0 21.0 43.8 8,980 

Bangladesh, 1997 7.9 13.0 21.8 36.2 8,450 

Bangladesh, 2000 8.0 15.6 24.7 32.4 9,720 

Bangladesh, 2004 5.1 16.2 22.5 22.7 10,582 

Bangladesh, 2007 6.6 15.0 21.6 30.6 10,192 

Cambodia, 2000 14.4 9.4 23.8 60.5 9,071 

Cambodia, 2005 8.9 12.9 21.8 40.8 10,087 

India, 1993 9.0 3.4 12.4 72.6 84,678 

India, 1999 8.3 3.5 11.8 70.3 84,682 

India, 2006 6.0 4.8 11.2 53.6 93,089 

Indonesia, 1991 7.9 18.7 27.2 29.0 21,109 

Indonesia, 1994 4.8 22.6 28.1 17.1 26,186 

Indonesia, 1997 4.2 25.2 30.0 14.0 26,886 

Indonesia, 2002 4.0 24.2 28.8 13.9 27,857 

Indonesia, 2007 4.3 25.1 29.5 14.6 30,931 

Nepal, 1996 14.3 2.6 16.9 84.6 7,982 

Nepal, 2001 11.4 3.8 15.2 75.0 8,342 

Nepal, 2006 9.4 4.8 14.1 66.7 8,257 

Pakistan, 1991 16.3 2.1 18.4 88.6 6,364 

Pakistan, 2006 10.9 6.5 17.4 62.6 9,556 

Philippines, 1998 8.2 13.1 23.6 34.7 8,336 

Philippines, 2003 7.9 13.7 23.2 34.1 8,671 

Philippines, 2008 9.0 14.7 23.6 38.1 8,418 

Vietnam, 1997 3.5 14.8 18.6 18.8 5,340 

Vietnam, 2002 2.0 13.9 16.4 12.2 5,338 

Average 11.9 13.1 25.5 46.3 1,413,376 1 Includes failure to space in surveys where available 

a Northeast region 
36 

Table 4.2. Trends in the Demand to Space Births and Unsatisfied Demand to Space Births, by 

Country

Among currently married women, percentage point changes between earliest and latest surveys and average 

percentage point changes per year in the percentage of total demand for contraception for spacing births and the 

percentage of demand for spacing births that is unsatisfied, by country. 

 Demand for spacing 

Percentage demand for spacing 

unsatisfied 

 Trend Change per year Trend Change per year 

Central Asian States 

Kazakhstan 1995 to1999 3.1 0.77 -3.4 -0.86 

Latin America and Caribbean

Bolivia, 1994 to 2003 2.5 0.28 -0.5 -0.06 

Brazil, 1991a

 to 1996 -0.7 -0.14 -21.8 -4.37 

Colombia, 1990 to 2005 -3.9 -0.26 -4.1 -0.27 

Dominican Republic, 1991 to 2007 2.9 0.18 -11.8 -0.74 

Guatemala, 1995 to 1999 0.5 0.14 -4.3 -1.23 

Haiti, 1994 to 2005 5.9 0.54 -18.9 -1.72 

Nicaragua, 1998 to 2001 3.2 1.07 -4.8 -1.60 

Peru, 1992 to 2009 8.0 0.46 -10.0 -0.57 

North Africa, West Asia and Europe 

Armenia, 2000 to 2005 0.1 0.02 6.5 1.29 

Egypt, 1995 to 2008 2.7 0.21 -16.9 -1.30 

Jordan, 1990 to 2007 6.7 0.39 -21.8 -1.28 

Morocco, 1992 to 2003 2.9 0.26 -22.3 -2.03 

Turkey, 1993 to 2003 -6.9 -0.69 -9.3 -0.93 

Sub-Saharan Africa 

Benin, 1996 to 2006 -0.7 -0.07 3.0 0.30 

Burkina Faso, 1993 to 2003 -5.4 -0.54 19.7 1.97 

Cameroon, 1991 to 2004 4.1 0.32 -15.9 -1.22 

Chad, 1997 to 2004 16.8 2.24 -5.4 -0.72 

Cote D'Ivoire, 1994 to 1998 2.1 0.47 -5.0 -1.11 

Eritrea, 1995 to 2002 -1.0 -0.14 1.5 0.21 

Ethiopia, 2000 to 2005 1.8 0.36 -10.1 -2.03 

Ghana, 1993 to 2008 -0.4 -0.03 -5.5 -0.37 

Guinea, 1999 to 2005 -0.5 -0.08 -13.0 -2.17 

Kenya, 1993 to 2009 -0.9 -0.06 -25.9 -1.67 

Madagascar, 1992 to 2009 6.4 0.39 -36.6 -2.22 

Malawi, 1992 to 2004 2.8 0.22 -25.2 -2.02 

Mali, 1996 to 2006 2.6 0.26 -3.2 -0.32 

Mozambique, 1997 to 2003 7.4 1.23 -46.5 -7.75 

Namibia, 1992 to 2007 0.5 0.03 -22.9 -1.58 

Niger, 1992 ro 2006 3.5 0.25 -22.7 -1.62 

Nigeria, 1990 to 2008 4.9 0.27 -19.0 -1.05 

Rwanda, 1992 to 2005 0.9 0.07 9.7 0.75 

Senegal, 1993 to 2005 4.8 0.38 -6.7 -0.54 

Tanzania, 1996 to 2004 6.3 0.48 -13.0 -1.00 

Uganda, 1995 to 2006 10.3 0.94 -3.6 -0.33 

Zambia, 1992 to 2007 11.3 0.75 -29.8 -1.99 

Zimbabwe, 1994 to 2005 1.3 0.11 -6.4 -0.55 

(Cont’d) 
37 

Table 4.2. – cont’d

Demand for spacing 

Percentage demand for spacing 

unsatisfied 

 Trend Change per year Trend Change per year 

South and Southeast Asia 

Bangladesh, 1994 to 2007 0.6 0.04 -13.3 -0.98 

Cambodia, 2000 to 2005 -2.0 -0.40 -19.7 -3.94 

India, 1993 to 2006 -1.2 -0.09 -19.0 -1.46 

Indonesia, 1991 to 2007 2.3 0.14 -14.5 -0.90 

Nepal, 1996 to 2006 -2.8 -0.28 -17.9 -1.79 

Pakistan, 1991 to 2006 -1.0 -0.06 -25.9 -1.62 

Philippines, 1998 to 2008 0.0 0.00 3.4 0.34 

Vietnam, 1997 to 2002 -2.2 -0.44 -6.6 -1.32 

Average 2.2 0.22 -12.0 -1.21 a Northeast region 

Table 4.3. Levels and Trends in the Demand for Spacing and Percentage Unsatisfied of Demand 

for Spacing, by Region 

Among currently married women, average percentage with a demand for contraception for spacing births and the 

percentage of the demand for spacing that is unsatisfied and average annual percentage point changes in demand 

and percentage unsatisfied of the demand between the earliest and latest surveys, by region 

 Total Average Annual Change 

Averages 

Demand for 

spacing 

Percentage 

unsatisfied of 

need for 

spacing 

Demand for 

spacing 

Percent 

unsatisfied of 

need for 

spacing 

Total 25.5 46.3 0.22 -1.21 

Central Asian States (Kazakstanonly) 27.1 17.7 0.77 -0.86 

Latin America and Caribbean 24.0 29.8 0.28 -1.32 

North Africa, West Asia and Europe 20.3 24.3 0.04 -0.85 

Sub-Saharan Africa 28.7 60.7 0.34 -1.18 

South and Southeast Asia 20.9 42.7 -0.14 -1.46 

4.2 Unsatisfied Demand for Contraception for Spacing 

The percentage of demand for contraception for spacing births that is unsatisfied is calculated by 

dividing the number of women with an unmet need for contraception for spacing by the total demand for 

contraception for spacing. For all surveys together, almost half of the demand is unsatisfied (46.3 

percent). By region, the percentage unsatisfied has a large variation, from 17.7 percent in the Central 

Asian States to 60.7 percent in sub-Saharan Africa (Table 4.3). The percentage of demand unsatisfied for 

contraception for spacing varies widely, from 89 percent in Pakistan in 1991 to 10 percent in Peru in 

2009. However, in all regions the percentage unsatisfied has declined (Figure 4.1). Per decade, the overall 

decline is 12.1 percentage points, and the greatest per decade decline (14.6 percentage points) has 

occurred in South and Southeast Asia, followed by 13.2 percentage points in Latin America and the 

Caribbean. By country, the largest annual declines in the percentage of demand for spacing that is 
38 

unsatisfied have occurred in Mozambique at 7.8 points and in Brazil and Cambodia with declines of about 

4 percentage points (Table 4.2). Six countries have had increases in unsatisfied demand for spacing, with 

an increase of 2 percentage points per year in Burkina Faso and over 1 in Armenia. 

4.3 Differentials 

The demand for contraception for spacing has risen somewhat more rapidly in rural areas than in 

urban areas, resulting in a greater decrease in unmet need for contraception for spacing in rural areas 

(Figure 4.2). As Figure 4.3 shows, the rate of increase in demand for contraception to space births differs 

substantially by wealth quintile for all countries together and by region. However, the demand for 

contraception for spacing has fallen in South and Southeast Asia among all wealth quintiles, perhaps due 

to increasing demand for limiting rather than spacing births. For all countries as a whole, the change in 

the percentage of unsatisfied demand for contraception for spacing has increased among all wealth 

quintiles except the wealthiest. However, this increase is due entirely to the countries of sub-Saharan 

Africa (Figure 4.4). In this region, because the demand for spacing rose, the increase in unsatisfied 

demand relects a failure of family planning services to keep up with the increasing demand. In the other 

regions the wealth quintiles show a decrease in the unsatisfied percentage, with the exceptions of the 

fourth quintile in the Latin America and Caribbean region and the lowest three quintiles of North Africa, 

West Asia and Europe. 

0.13

-0.91

0.24

-1.32 -1.40

-1.20

-1.00

-0.80

-0.60

-0.40

-0.20

0.00

0.20

0.40

Demand for Spacing Percent Unsatisfied of Need for Spacing

Percentage point change per year

Figure 4.2. Average Annual Change in Demand for Contraception for Spacing Births and 

Percentage of Demand that Is Unsatisfied by Residence

Urban Rural
39 

0.14

-0.35

0.40

-0.44

0.29

-0.18

0.27

1.43

0.39

-0.36

0.46

-0.21

0.26

0.40

0.22

-0.37

0.51

-0.15

0.13

1.55

0.23

0.02

0.12

-0.08

0.27

1.43

0.39

-0.36

0.46

-0.21

-1.00

-0.50

0.00

0.50

1.00

1.50

2.00

Total Central Asian States Latin America and 

Caribbean

North Africa, West 

Asia and Europe

Sub-Saharan Africa South and Southeast 

Asia

Percentage point change per year

Figure 4.3. Average Annual Change in Demand for Contraception for Spacing Births 

by Household Wealth Quintile

Lowest

Second

Middle

Fourth

Highest

0.28

-0.02

-1.14

0.25

1.28

-1.29

0.23

-0.86

-0.45

0.12

1.05

-1.32

0.20

-2.84

-0.69

0.43

0.92

-0.85

0.10

-0.13

0.55

-0.33

0.55

-1.36

-0.04 -0.02 -0.05

-0.45

0.30

-0.78

-3.50

-3.00

-2.50

-2.00

-1.50

-1.00

-0.50

0.00

0.50

1.00

1.50

Total Central Asian States Latin America and 

Caribbean

North Africa, West 

Asia and Europe

Sub-Saharan Africa South and Southeast 

Asia

Percentage point change per year

Figure 4.4. Average Annual Change in Percentage of Unmet Demand for Contraception for 

Spacing Births by Household Wealth Quintile

Lowest

Second

Middle

Fourth

Highest
40 

The demand for contraception for spacing births is greater the higher women’s level of education, 

doubling between women with no education and women with secondary or higher (Figure 4.5). However, 

the percent of women with an unsatisfied demand for spacing is approximately the same across all 

education categories. Over time, in all regions the percentage of demand for contraception for spacing 

that was unsatisfied has declined in almost all education categories, except secondary or higher in Latin 

America and the Caribbean and no education in North Africa, West Asia and Europe (Figure 4.6). 

Women’s age is related to the change in demand for contraception for spacing. The amount of 

yearly increase is highest for younger women and then declines until age 35-39, after which there is little 

change (Figure 4.7). The percentage of contraceptive demand for spacing that is unsatisfied has decreased 

substantially in all age groups. 

17.34

26.29

34.26

11.42

13.85

11.36

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

40.00

No Education Primary Secondary or Higher

Percentage

Maternal Education

Figure 4.5. Percentage of Women with a Demand for Contracepton for Spacing and 

Percentage of Demand for Spacing that is Unsatisfied by Level of Education

Demand for Spacing

Percent Unsatisfied of Need for Spacing
41 

-0.42

-1.89

-1.57

0.16

-0.21

-1.05 -1.06

-0.87

-0.94

-1.38

-0.48

0.22

-0.20

-0.58

-0.90

-2.00

-1.50

-1.00

-0.50

0.00

0.50

Total Central Asian States Latin America & 

Caribbean

North Africa, West 

Asia & Europe

Sub-Saharan Africa South and Southeast 

Asia

Percentage point change per year

Figure 4.6. Average Annual Change in Percentage of Unmet Demand for Contraception for 

Spacing Births by Level of Education

No Education

Primary

Secondary or Higher

Not available

0.46

0.60

0.46

0.27

0.04

-0.09

-0.75

-1.01

-1.15

-1.07

-0.80

-1.09

-1.40

-1.20

-1.00

-0.80

-0.60

-0.40

-0.20

0.00

0.20

0.40

0.60

0.80

15-19 20-24 25-29 30-34 35-39 40-49

Percentage point change per year

Age

Figure 4.7. Average Annual Change in Demand for Contraception for Spacing Births and in 

Percentage Unsatisfied of Demand for Spacing by Age

Demand for Spacing

Percent Unsatisfied of Need for Spacing

43 

5 Discussion 

It has been demonstrated that short birth intervals are detrimental to the health of both the 

succeeding child and to the mother (Setty 2002). The World Health Organization recommends that 

women wait at least 24 months after a birth before becoming pregnant again, resulting in a recommended 

minimum birth interval of 33 months (WHO, 2006). Other research suggests that women would do better 

to wait another three months in order to have a birth interval of at least 36 months. However, waiting too 

long—an interval of 60 months or more—can also be detrimental to health (Conde-Agudelo et al., 2006; 

Rutstein, 2008). 

Substantial proportions of births still occur after intervals that are too short for the health of 

infants and their mothers. More than half of births occur less than three years after the mother’s previous 

birth. The regional variation in this proportion is small. However, this proportion has decreased over time, 

at a rate of about 7 percentage points per decade. Preferred birth intervals are still much longer than actual 

intervals, but the rate of increase in the length of actual intervals exceeds the increase in preferred 

intervals, so the gap between the two is shrinking. There are still important distinctions in both preferred 

and actual birth intervals by area of residence, household wealth, and women’s education. Urban areas, 

richer households, and more educated women both prefer and have longer birth intervals than other 

groups of women, and the more advantaged groups have greater average annual increases in the length of 

birth intervals. 

Family planning and contraceptive use are the principal ways that women can delay the next birth 

until the recommended period of time has passed since the last birth. While postpartum amenorrhea due 

to breastfeeding and postpartum abstinence do delay the next conception, by themselves they are not 

enough to ensure a birth interval of 24 months, let alone 36 months. About one-quarter of women want to 

use contraception to space their next birth. Unfortunately, for almost half of the women who have a need 

for contraception for spacing births, that need is unsatisfied. The percentage of women with an unsatisfied 

need for contraception to space births is highest in sub-Saharan Africa, followed by South and Southeast 

Asia. Unsatisfied need for contraception for spacing is lower in the other two regions but is still higher 

than it should be or needs to be for the health of women and children. 

Over time, the demand for contraception for spacing has risen and the percentage of demand that 

is unsatisfied has fallen. These trends suggest that women are receiving the message that short birth 

intervals should be avoided and that family planning programs are increasing the supply of contraception 

to these women. While there are variations by residence, wealth, and education, all groups appear to be 

participating in these two positive outcomes. 

45 

6 Conclusion and Policy Implications 

Numerous studies have shown that there is an optimal length of time between births for the health 

of both mother and child. Now, health programs, especially maternal and family planning programs, need 

to do more to impart this knowledge and to provide services to assist women in attaining the optimal birth 

interval. While the trend data on actual and preferred birth intervals show that more women want to avoid 

and are avoiding deleterious short intervals than in the past, many women still have shorter intervals than 

they would have liked, and some women increasingly prefer intervals that are even longer than optimal. 

Efforts to inform women about the health consequences of both too short and too long a birth interval 

should be redoubled and family planning efforts should be increased, especially in sub-Saharan Africa, 

where unsatisfied demand for contraception for birth spacing is greatest. 

47 

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