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Pattern and determinant factors of birth intervals among Iranian women: a semi-parametric multilevel survival model

Published online by Cambridge University Press:  29 October 2019

Maryam Seyedtabib
Department of Biostatistics & Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
Abbas Moghimbeigi
Modeling of Noncommunicable Diseases Research Center, Department of Biostatistics & Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
Mahmood Mahmoudi
Department of Health Services, Science and Research Branch, Islamic Azad University, Tehran, Iran
Reza Majdzadeh
Iranian Institute for Health Sciences Research, Tehran University of Medical Sciences, Tehran, Iran
Hossein Mahjub*
Department of Biostatistics & Epidemiology, School of Public Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
*Corresponding author. Email:


The interval between successive pregnancies (birth interval) is one of the main indexes used to evaluate the health of a mother and her child. This study evaluated birth intervals in Iran using data from the Iranian Multiple Indicators Demographic and Health Survey (IrMIDHS) conducted in 2010–2011. A total of 20,093 married Iranian women aged 15–54 years from the whole country constituted the study sample. Based on the nature of sampling and the unobserved population heterogeneity for birth intervals in each city and province, a multilevel survival frailty model was applied. Data were analysed for women’s first three birth intervals. The median first and second birth intervals were 30.3 and 39.7 months respectively. Higher education, Caesarean delivery, contraceptive use and exposure to public mass media were found to decrease the hazard rate ratio (HRR) of giving birth. Meanwhile, higher monthly income increased the hazard of giving birth. The results suggest that public mass media can play an effective role in encouraging women to have the recommended birth interval. Furthermore, increasing family income could encourage Iranian couples to decrease the time to their next birth.

Research Article
© Cambridge University Press 2019

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