Association Between Daughter-Driven Short Birth Interval and Adverse Maternal and Child Health Outcomes: A Case–Control Study
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Abstract
Background: Short birth interval is associated with adverse maternal and child health outcomes, but limited evidence from Pakistan has examined whether short spacing after daughters and linked with son preference carries additional clinical risk. Objective: To determine the association between daughter-driven short birth interval and adverse maternal and child health outcomes among parous women receiving obstetric care in Karachi, Pakistan. Methods: A hospital-based comparative analytical study was conducted among 364 women, including 182 women with daughter-driven short birth interval and 182 women with optimal birth spacing. Daughter-driven short birth interval was defined as a birth-to-birth interval of less than 24 months after one or more daughters with self-reported desire or family pressure for a son. Maternal and child outcomes were verified through structured interviews and medical records. Crude and odds ratios were calculated using logistic regression, adjusting for age, parity, education, contraception use, and antenatal care utilization. Results: Maternal anemia was more frequent in the daughter-driven short birth interval group than in the optimal-spacing group (64.8% vs. 22.0%; aOR = 4.21, 95% CI 2.38–7.45). Low birth weight (58.2% vs. 14.8%; aOR = 6.12, 95% CI 3.28–11.42) and preterm birth (50.5% vs. 12.1%; aOR = 5.84, 95% CI 2.95–11.55) were also significantly associated with daughter-driven short birth interval. Neonatal death was higher in crude analysis but not significant after adjustment (aOR = 1.92, 95% CI 0.85–4.35). Conclusion: Daughter-driven short birth interval was strongly associated with maternal anemia, low birth weight, and preterm birth, supporting the need for gender-sensitive birth-spacing counseling, contraception access, anemia prevention, and postpartum maternal recovery services.
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References
1. World Health Organization. WHO recommendations on birth spacing. Geneva: World Health Organization; 2020. Available from: https://apps.who.int/iris/handle/10665/332488
2. Murtaza K, Saleem Z, Jabeen S, Alzahrani AK, Kizilbash N, Soofi SB, Shirazi H, Yasin A, Malik S. Impact of interpregnancy intervals on perinatal and neonatal outcomes in a multiethnic Pakistani population. J Trop Pediatr. 2022;68(6):fmac088. doi:10.1093/tropej/fmac088
3. Asif MF, Ishtiaq S, Abbasi NI, Tahir I, Abid G, Lassi ZS. The interaction effect of birth spacing and maternal healthcare services on child mortality in Pakistan. Children (Basel). 2023;10(4):710. doi:10.3390/children10040710
4. Ahrens KA, Nelson H, Stidd RL, Moskosky S, Hutcheon JA. Short interpregnancy intervals and adverse perinatal outcomes in high-resource settings: an updated systematic review. Paediatr Perinat Epidemiol. 2019;33(1):O25–O47. doi:10.1111/ppe.12503
5. Channon MD. Son preference and family limitation in Pakistan: a parity- and contraceptive method-specific analysis. Int Perspect Sex Reprod Health. 2017;43(3):99–110. doi:10.1363/43e4317
6. Hussain R, Fikree FF, Berendes HW. The role of son preference in reproductive behaviour in Pakistan. Bull World Health Organ. 2000;78(3):379–388.
7. Farooqui MN. Son preference, fertility desire and contraceptive use in two largest cities of Pakistan. Pak Popul Rev. 1990;1(1):54–64.
8. Rehman AU, Jehangir S, Rehman F. Common fetal outcome among women with short interpregnancy interval: fetal outcome with short interpregnancy interval. Pak J Health Sci. 2025;6(9):106–110. doi:10.54393/pjhs.v6i9.3351
9. Bhatti TN, Naeem M, Akhtar NU, Hanif A. Impact of short birth spacing on maternal anemia at District Head Quarters Hospital Nankana Sahib. Pak BioMed J. 2023;6(11):8–12. doi:10.54393/pbmj.v6i11.960
10. Parks S, Hoffman MK, Goudar SS, Patel A, Saleem S, Ali SA, et al. Maternal anaemia and maternal, fetal, and neonatal outcomes in a prospective cohort study in India and Pakistan. BJOG. 2019;126(6):737–743.
11. Nausheen S, Bhura M, Hackett K, Hussain I, Shaikh Z, Rizvi A, Ansari U, Canning D, Shah I, Soofi S. Determinants of short birth intervals among married women: a cross-sectional study in Karachi, Pakistan. BMJ Open. 2021;11(4):e043786. doi:10.1136/bmjopen-2020-043786
12. Pakistan Bureau of Statistics, National Institute of Population Studies, ICF. Pakistan Demographic and Health Survey 2017–18. Islamabad: National Institute of Population Studies; 2019.
13. Munir N, Jan F, Hameed H, Inayat A, Baloch B, Hout S. Assessing the prevalence and predictors of short birth spacing and its association with pregnancy outcomes in Pakistani women. Pak J Med Health Sci. 2023;17(7):91. doi:10.53350/pjmhs202317791
14. Ilyas S, Latif F, Yasmeen N. Association of short inter-pregnancy interval with adverse perinatal outcome. Pak Postgrad Med J. 2015;26(1):11–17.
15. Maqbool Ahmad A, Shah IH, Mir AM, Sadiq M, Bosan MA. Demographic, social and health system factors associated with maternal mortality in Pakistan: a nested case-control study. PLoS One. 2025;20(1):e0290492. doi:10.1371/journal.pone.0290492
16. Stakeeva C, Zholdoshbekova G, Topcu EG, Asakeeva R. Interpregnancy intervals and maternal and neonatal outcomes: a retrospective cohort study. Int J Gynaecol Obstet. 2026. doi:10.1002/ijgo.70939
17. Manchanda S, Yadav G, Ahmad A, Gupta U. Study the impact of short interpregnancy interval on pregnancy outcome: a case-control study. Int J Reprod Contracept Obstet Gynecol. 2025;15(1):87–93. doi:10.18203/2320-1770.ijrcog20254264
18. Aziz A, Parveen S, Khan B, Sultana H, Akhtar A, Raza K. Adverse perinatal outcomes: their association with maternal anemia. Pak J Health Sci. 2025:107–111.
19. Boz Izceyhan G, Karakuş R, Erbıyık M. Impact of short and long interpregnancy intervals on neonatal outcomes: a multiclassification cohort analysis. Healthcare (Basel). 2026;14(7):826. doi:10.3390/healthcare14070826
20. Haroon A, Hameed A, Zulfiqar I, Memon FR, Ejaz M, Anwar MI. Impact of maternal anemia on perinatal outcomes: a prospective study. J Neonatal Surg. 2025;14(32S):9646–9650. doi:10.63682/jns.v14i32S.9571
21. Healthy Newborn Network. Pakistan: national clinical standards for care of preterm newborns at the hospital level. Healthy Newborn Network; 2017.
22. Habib MA, Raynes-Greenow C, Soofi SB, Ali N, Nausheen S, Ahmed I, et al. Prevalence and determinants of iron deficiency anemia among non-pregnant women of reproductive age in Pakistan. Asia Pac J Clin Nutr. 2018;27(1):195–203.
23. Rahman A, Lovel H, Bunn J, Iqbal Z, Harrington R. Mothers’ mental health and infant growth: a case-control study from Rawalpindi, Pakistan. Child Care Health Dev. 2004;30(1):21–27. doi:10.1111/j.1365-2214.2004.00382.x
24. Bongaarts J. Fertility and reproductive preferences in post-transitional societies. Popul Dev Rev. 2001;27:260–281.