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Community Factors Influencing Birth Spacing among Married Women in Uganda and Zimbabwe

McGuire, Courtney (2014)
Master's Thesis (52 pages)
Committee Chair / Thesis Adviser: Stephenson, Robert
Committee Members:
Research Fields: Health Sciences, Public Health
Partnering Agencies: Does not apply (no collaborating organization)
Keywords: birth spacing; maternal health; infant health; contextual influences
Program: Rollins School of Public Health, Hubert Department of Global Health
Permanent url:


Sub-optimal birth spacing continues to be a problem in Uganda and Zimbabwe, resulting in negative infant, child, and maternal health outcomes. This study investigates community-level influences on birth spacing outcomes among women aged 15-49 in Uganda and Zimbabwe. The data used in this analysis were from nationally representative Demographic and Health Surveys conducted in 2011 (Uganda) and 2010-2011 (Zimbabwe). The analysis builds upon previous research that moves beyond individual and household variables to examine community-level influences on reproductive health outcomes. Women living in communities with higher maternal age, age at marriage, and parity were significantly more likely to have longer birth spacing. High community levels of contraceptive use and low levels of unmet need were associated with optimal birth spacing. The significance of community-level demographic and fertility norms, gender norms, economic prosperity, and family planning behaviors demonstrate the broad influence of community variables on birth spacing outcomes. This analysis highlights the importance of moving beyond individual and household-level interventions in order to harness the power of contextual influences on birth spacing.

Table of Contents

CHAPTER 1: INTRODUCTION 1 -- Achieving the Millennium Development Goals 1 -- Unmet Need and Birth Spacing Issues 3 -- Ramifications of the Problem 5 -- Public Health Implications 6 -- Aims and Objectives: 8 -- Objective: 8 -- Aims: 8 -- CHAPTER 2: MANUSCRIPT 9 -- Introduction 11 -- Methods 14 -- Demographic and Health Surveys, Uganda and Zimbabwe 14 -- Measures of Community-Level Impact 16 -- Community Demographics and Fertility Norms 17 -- Community Economic Prosperity 18 -- Community Gender Norms 18 -- Community Family Planning Behavior 19 -- Individual Measures and Analysis 19 -- Results 20 -- Discussion: 24 -- Conclusion: 26 -- Tables and Figures: 27 -- Table 1: Definition and Distribution of Community-Level Variables 27 -- Table 2: Distribution of Sample Characteristics of Women in Uganda and Zimbabwe 28 -- Table 3: Results of Linear Regression Regarding Birth Spacing Outcomes, Uganda and Zimbabwe, DHS 30 -- Table 4: Results of Multilinear Regression Regarding Birth Spacing Outcomes, Uganda DHS (2011) and Zimbabwe DHS (2010-2011) 32 -- CHAPTER 3: PUBLIC HEALTH IMPLICATIONS 36 -- CHAPTER 4: REFERENCES 39


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