Healthy Timing and Spacing of Pregnancy


Healthy timing and spacing (HTSP) of pregnancy promotes informed decision making about delaying, spacing, or limiting pregnancies to achieve the healthiest outcomes for women, newborns, infants, and children. HTSP centers on free and informed choice with respect to fertility intentions and desired family size. 

Continue reading to learn about healthy timing and spacing of pregnancy:

Health risks of early or closely spaced pregnancies

Research has shown that the length of the interval between one birth and the next pregnancy directly relates to the risk of infant, child, and maternal mortality: the shorter the interval, the higher the risk. Data also highlight the risks of adolescent pregnancy. In fact, pregnancy- and childbirth-related complications are the leading cause of death for girls ages 15 to 19 worldwide. These girls are twice as likely to die in pregnancy and childbirth compared to those ages 20 to 24—and adolescents younger than age 15 who become pregnant are five times more likely to die.

In addition, pregnancies that are too closely spaced or that occur in adolescents younger than 18 also carry higher risk of preterm birth and low birth weight among the babies, and anemia and potentially debilitating childbirth complications, such as obstetric fistula, among the mothers.

Are you a visual learner?

Watch this video to review key HTSP concepts.

Recommendations for HTSP
For the past decade, the World Health Organization (WHO) has upheld three evidence-based recommendations for birth spacing:

  • After a live birth, wait at least 24 months before attempting the next pregnancy to reduce health risks for the mother and the baby.
  • After a miscarriage or induced abortion, wait at least 6 months before attempting the next pregnancy to reduce health risks for the mother and baby.
  • Women should delay their first pregnancy until at least age 18.

Promoting HTSP
HTSP is an effective approach for strengthening family planning in sensitive settings because it focuses on the health of the mother and the baby. In addition to reducing health risks, HTSP can improve quality of life. Children whose births are spaced at healthy intervals are more likely to be well nourished and well educated—and nourished, educated children are more likely to grow into economically successful adults.

Because HTSP can be applied in a variety of settings, programs have many options for promoting this practice, including:
  • Expanding the contraceptive method mix so women and families can choose a family planning option that best meets their needs;
  • Using every window of opportunity to reach women and families by integrating HTSP messaging and family planning services into other health services;
  • Ensuring that postabortion care services include family planning counseling and services;
  • Offering youth-friendly reproductive health and family planning services so that young people can access the information and tools they need to delay pregnancy; and
  • Delivering gender transformative programming to help shift cultural norms about age of marriage and first childbirth.

Click through the menu below to explore messages, research, and educational resources related to this topic.

Healthy timing and spacing of pregnancy helps women and families make informed decisions about delaying, spacing, or limiting their pregnancies to achieve the healthiest outcomes for the whole family. Research shows that HTSP helps save the lives of mothers and babies.

  • For the health of the mother and the baby, couples should consistently use a contraceptive method of their choice in order to:
    • Wait at least 24 months after a live birth to attempt another pregnancy.
    • Wait at least 6 months after a miscarriage or induced abortion to attempt another pregnancy.
    • Delay first pregnancy until at least age 18.
  • Family planning saves lives.
  • Healthy mothers build healthy families.

These terms are commonly used to cover the same or similar topics.

birth intervals | birth spacing | child spacing | optimal birth spacing | pregnancy spacing | family planning

Healthy Timing and Spacing of Pregnancy Global Health eLearning course

This two-hour course from the Global Health eLearning Center will give you the information you need to become an effective champion for healthy timing and spacing of pregnancy (HTSP). 

Increasing awareness of the benefits of HTSP among policy makers, providers, and community members can contribute to efforts to increase the use of modern contraceptive methods.

The Global Health eLearning Center also features several other courses that relate to HTSP.

The Global Health: Science and Practice Journal also contains a wealth of peer-reviewed research relevant to HTSP.

The Journal has also published several papers sharing essential information for integrating family planning into postpartum care to improve birth spacing, including:

The High Impact Practices in Family Planning (HIPs) Technical Advisory Group is comprised of donor agencies, research institutions, and service delivery organizations with expertise in family planning and global public health. The HIP team at USAID has developed briefs that synthesize the evidence and provide recommendations on how to implement selected HIPs.

The eight-page briefs on Postabortion Family Planning (2012; PDF, 766KB) and Family Planning and Immunization Integration (2013; PDF, 1MB) are particularly relevant to HTSP.

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