Susan Muyiyi
22 June 2009
opinion
Kampala — Siblings share a happy moment. Leaving a spacing of at least two years between your children does not drain a woman physically and emotionally
THE idea of women breaking into the work force is not news any more. The tide has changed; the working woman is now having babies in quick succession. Just as you are thinking that she still has a long way to shade off the pregnancy fat, she is taking maternity leave again!
Rhoda Nakimera declares that by the time she clocks 30, she should have closed the chapter on childbirth. She is a mother of two and is expecting her third. She does not care that she is referred to as "the one who is always pregnant." She is 27 and wants to have four children. Her first two children are separated by one year. "This is the time to have babies so that I have ample time to focus on career development," Nakimera says.
Joyce (not real name) was in a fix when her doctor told her that she had developed fibroids. After much thought, she decided to have two children. "He told me to have children immediately because there was no guarantee that I would be able to after the operation to remove the fibroids was done."
Her first-born is older than the second by barely a year. Joyce had her operation and does not worry about never having children.
Rhoda, 29, believes that having her children in quick succession will save her the health complications associated with having children later. "I wasn't about to take chances with delaying childbirth. I embarked on the project the day I got married and since time is not on my side, I want to have them quickly and soon."
For other women, limiting the spacing between their children is justified by the plan for their children to bond well as they grow. There is an assumption that the smaller the age difference, the better relationships they are bound to have.
What is the best recommendation?
Health experts recommend a gap of at least 33 months. The international Journal of Gynaecology and Obstetrics 2005, emphasises the importance of child spacing in limiting maternal mortality rates in developing countries, mainly due to preventable causes.
For infants and children under five years of age, births spaced at least 36 months apart are associated with the lowest mortality risk.
Contraceptive use reduces maternity mortality and improves women's health by preventing unwanted high risk pregnancies and reduces the need for unsafe abortions. With some breathing space between births, you are likely to have more time for personal development. Besides, you would have less strain emotionally and financially.
It is estimated that 100,000 maternal deaths would be avoided each year if all women who said they did not want more children were able to stop child bearing. There would also be a reduction in the number of deaths of children below the age of five.
Repercussions of frequent pregnancies
Dr. Charles Kiggundu of Mulago Hospital says the growing foetus needs several nutrients from the mother. During pregnancy, a woman's body accumulates nutritional resources in order to be able to accommodate the baby for nine months.
The processes of pregnancy, labour and childbirth put a strain on a woman's body. In addition to nutritional drain, there is a lot of blood loss after childbirth. Going through the process very often (a time frame of less than two years) will most likely exhaust your body.
"In most cases, this can lead to maternal depletion syndrome which results into anaemia. In the event of severe bleeding after childbirth, an anaemic woman stands a higher risk of dying during childbirth," Dr. Julius Mugisha explains.
Frequent births also do not allow time for a woman's body to heal. Take the uterus which expands like a balloon to accommodate the baby. "There is a section on the uterus where the placenta attaches itself during pregnancy. When the baby is born, the point of contact between the placenta and uterus becomes a wound which ought to heal before another foetus can grow," Dr. Kiggundu explains. He adds that frequent pregnancies will most likely drain you emotionally and also affect your outward appearance.
An onset of another pregnancy before the memory of the other fades away will most likely create an imbalance in your life. In some cases, the older child who might still need to breastfeed will quickly be weaned. The pressures of the new child on the way leave little time for the older child. The bond between you and the older child will more likely be negatively affected. Frequent pregnancies expose one to the risks childbirth including overbleeding and death.
The flip-side of the coin
While some women plan to have their children in quick succession, others do not. They end up with unplanned pregancies because they do not use contraception.
Fiona Nalwoga's first child is not yet a year old and another is already on the way. She is skeptical about using modern contraceptive methods, yet she does not want any unplanned children.
Primo Madra, a doctor with United Nations Population Fund, notes that the lack of contraception use can be linked to religious sentiments held dear by some women.
Madra notes that there is also a fear that the side-effects of some contraceptive methods might negatively affect their health.
According to the Uganda Health and Demographic survey 2006(UHDS), only 24% of married women use contraceptives. The survey, however, notes that couples can realise their reproductive goals only when they use contraceptive methods continuously. A prominent concern for managers of family planning programmes is the discontinuation of the use of the available methods.
Research by the Alan Guttmacher Institute indicates that although HIV/AIDS is probably Uganda's gravest public health issue, unplanned pregnancy and unsafe abortion also rank high. Unplanned births are common and represent a growing proportion of all births - almost one half in 2000, compared with one third in 1995. With such high levels of unplanned child bearing, it is likely that abortion is becoming increasingly common in Uganda, even though national law permits abortion only to save a woman's life.
Evidence suggests that abortion to end unwanted pregnancies is widespread, that it is usually performed clandestinely in unsafe conditions and unsafe abortion is one of the leading causes of maternal death in Uganda.
While some might argue that deciding on the time frame in which to have children may not be practical for couples, doctors recommend a proactive approach in planning for childbirth with health concerns in mind.
Dangers to the baby
While the baby might not have a say in when they come into the world, if a mother has her babies without adequate spacing, they suffer some consequences. The foetus entirely depends on its mother for nutrients, especially during the first six months.
Dr. Mugisha points out that iron is a very important nutrient which is passed from the mother to the baby through the blood. A mother who does not space her pregnancies as medically required, will be anaemic, thus the baby will not have enough nutrients and will also end up anaemic at nirth. Its body will not develop well. An anaemic new born is a disaster waiting to happen.
Dr. Kiggundu notes that most of the deaths of babies in the acute unit in Mulago are as a result of anaemia. An anemic new born has low immunity, making them prone to malaria attacks, the leading cause of death in babies.
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