Mariamah is 23 years old. She has four children aged 5, 4, 2 and 5 months old.
She is one of the young African women Dr. Fabio Casta-o, the Management Sciences for Health (MSH), Global Technical Lead for Family Planning and Reproductive Health has encountered while trying to find out how to strengthen Family Planning service provision.
Asked if she would have liked to space her children more than two years, Mariamah responded: "Yes, of course" ...but she did not have information on how to do it. Dr Fabiano reported that Mariamah said her mother-in-law told her a woman's duty was to bear all children that life gave. Mariamah is not alone.
Dr. Castano says that in eight of the nine countries they have surveyed, more than 39% of women of reproductive age say they want to space their next birth more than two years.
In Uganda, the unmet need for family planning according to the Demographic Health Survey of 2011 is 34%. Which means that three of every ten women of reproductive age who would like to space their next birth or stop childbirth all together, are not having their family planning needs met.
When this need is not met, women will have unwanted pregnancies or children too close together. This exposes them to fertility-related high risk pregnancies that contribute to maternal deaths.
In Uganda 70% of babies born to women in the lowest income quintile are not adequately spaced. According to research findings shared at the East, Central and South Africa Health Community Best Practices' Forum held in Arusha Tanzania in August, many women in Uganda who are having children too soon and too frequently would like to space them but do not know how.
"In Ethiopia, Malawi, and Rwanda, more than 50 % of women want to space their next birth, in Uganda, it is 41.6%," Dr.Casta-o said.
WHO experts recommend an interval of at least 24 months (two years) before attempting another pregnancy to prevent the risk of maternal and neonatal deaths.
"Ensuring healthy spacing and timing is a challenge for families," said Dr Maureen Norton, of USAID's Global Health Initiative. She said Healthy Timing and Spacing of Pregnancy (HTSP) is an approach to family planning education, counselling, and services which helps women to have wanted pregnancies at the healthiest times of their lives.
By implementing HTSP, families are able to prevent fertility-related, high-risk pregnancies. "Pregnancies too young, too old or too soon after a previous pregnancy are linked to a high maternal mortality and under-five mortality risk," she said.
Experts advise that pregnancies should be delayed until age 18. However, very many women in the region were having their first babies too early, before the age of 18.
"In Madagascar, Malawi, and Zambia, about a third of women aged 15-19 are mothers or are pregnant," Dr. Castano said.
In Uganda, it is about one out of every four nteenage girls is a mother or is pregnant. Apart from early pregnancy, the risk of maternal mortality increases after the age of 34 and after three or four pregnancies.
Dr. Norton said practitioners who were sending out the information on birth timing and spacing to women, their families and
communities highlighting the benefits to both the mother and the baby, were seeing behaviour change happen quickly.
High numbers of maternal and child deaths in Africa are the development indicators with the slowest progress among the eight Millennium Development Goals yet birth spacing and family planning are among the simple interventions that can contribute to this progress.