FACTORS ASSOCIATED WITH SHORT INTERBIRTH INTERVALS AMONG

WOMEN OF REPRODUCTIVE AGE IN TALA WARD, MACHAKOS COUNTY,

KENYA.

BONIFACE KIOKO MUSYOKA

D/CH/23081/097

DEPARTMENT: HEALTH PROMOTION AND COMMUNITY HEALTH

“A research proposal submitted to Kenya Medical Training College in partial fulfilment of

the requirement for award of diploma in community health ’’

MAY, 2025
 DECLARATION

“ This proposal is my original work and has not been presented for a diploma in any other

institution’’

Signature ……………………………… Date …………………

Boniface Kioko Musyoka

D/CH/23081/097

Supervisor

This proposal has been submitted for review our approval as campus supervisor

1. Signature …………………………………………… Date ……………………………

Madam Hellen Mwangi

Department of community health and promotion .

2. Signature ……………………………… Date……………….

Mr. Vincent Omwenga

Department of Health promotion and community

© Copyright, 2025 . Boniface Kioko Musyoka . All rights reserved

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 TABLE OF CONTENT

Contents

DECLARATION ............................................................................................................................ ii
LIST OF FIGURES ....................................................................................................................... vi
LIST ACRONYMS ...................................................................................................................... vii
DEFINITION OF TERMS .......................................................................................................... viii
ABSTRACT .................................................................................................................................. ix
CHAPTER ONE: INTRODUCTION............................................................................................. 1
1.1Background information ........................................................................................................ 1
1.2 Statement of Problem ............................................................................................................ 3
1.3 Justification ............................................................................................................................... 4
1.4 Research questions.................................................................................................................... 4
1.5 Research objectives .................................................................................................................. 5
1.5.1Broad objective ................................................................................................................... 5
1.5.2 Specific objectives ............................................................................................................. 5
1.6 Significance of the study .......................................................................................................... 5
1.7 Conceptual Framework ........................................................... Error! Bookmark not defined.
CHAPTER TWO : LITERATURE REVIEW ................................................................................ 7
2.1 Introduction............................................................................................................................... 7
2.2 Short Birth Intervals ................................................................................................................. 7
2.2.1 Global Perspective to Short Birth Intervals ....................................................................... 7
2.2.2 Short Birth Intervals in Sub-Saharan Africa ...................................................................... 7
2.2.3 Shorth Birth Intervals in Kenya ......................................................................................... 8
2.2.4 Short Birth Intervals in Machakos County ........................................................................ 8
2.4 Socio Cultural Factors .............................................................................................................. 8
2.5 Knowledge Factors ................................................................................................................... 9
2.6 Accessibility Factors ................................................................................................................11
2.7 Reviewed Literature Summary and Gaps ............................................................................... 14
CHARPTER THREE: MATERIALS AND METHODS ............................................................. 15
3.1 Introduction............................................................................................................................. 15
.3.2 Study Design.......................................................................................................................... 15

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3.3 Variables ................................................................................................................................. 15
3.3.1 Independent Variables ...................................................................................................... 15
3.3.2 Dependent Variable .......................................................................................................... 16
3.4 Study Location ........................................................................................................................ 16
3.5 Study Population..................................................................................................................... 16
3.5.1 Inclusion Criteria ............................................................................................................. 16
3.5.2 Exclusion Criteria ............................................................................................................ 17
3.6 Sample Size Determination and Sampling Technique ............................................................ 17
3.6.1 Sample Size Determination Formula ............................................................................... 17
3.6.2 Sampling Techniques ....................................................................................................... 18
3. 7 Research Instruments ............................................................................................................. 18
3.8 Pretesting ................................................................................................................................ 18
3.8.1 Validity ................................................................................................................................. 19
3.8.2 Reliability ......................................................................................................................... 19
3.9 Data Collection Techniques .................................................................................................... 19
3.10 Data Presentation and Analysis ............................................................................................ 19
3.11 Ethical Consideration ............................................................................................................ 20
CHAPTER FOUR: RESULTS ..................................................................................................... 21
4.1 Introduction ......................................................................................................................... 21
4.2 Social-demographic characteristics of the respondents ...................................................... 21
4.2.1 Distribution of social-demographic characteristics ...................................................... 21
4.2.2 Association between social-demographic characteristics and short interbirth
intervals ................................................................................................................................. 23
4.3 Short interbirth intervals ..................................................................................................... 25
4.3.1 Responses on short interbirth intervals assessment tool .............................................. 25
4.4 Socio cultural factors .......................................................................................................... 27
4.4.1 Distribution of socio-cultural factors ........................................................................... 27
4.4.2 Association between socio cultural factors and short interbirth interval...................... 28
4.5 Knowledge factors .............................................................................................................. 29
4.5.1 Distribution of Knowledge factors ............................................................................... 29
4.5.2 Association between knowledge factors and short interbirth interval .......................... 31
4.6 Accessibility factors ............................................................................................................ 32
4.6.1 Distribution of Accessibility factors ............................................................................. 32
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 4.6.2 Association between accessibility factors and short interbirth interval ....................... 34
Table 4.8: Association between accessibility factors and short interbirth interval................ 34
CHAPTER FIVE .......................................................................................................................... 36
5.1 Introduction ......................................................................................................................... 36
5.2 Discussions ......................................................................................................................... 36
5.2.1 Socio-demographics factors ......................................................................................... 36
5.2.2 Socio-cultural factors ................................................................................................... 36
5.2.3 Knowledge factors ........................................................................................................ 37
5.2.4 Accessibility factors ..................................................................................................... 37
5.3 Conclusion .......................................................................................................................... 37
5.4 Recommendations ............................................................................................................... 38
5.4.1 Recommendations from the study ................................................................................ 38
5.4.2 Suggestion for further study ......................................................................................... 39
REFERENCE ............................................................................................................................... 40
Appendix i: Consent Form .................................................................................................... 46
Appendix ii: Research questionnaire ..................................................................................... 49
Appendix iii: Work plan ........................................................................................................ 56
Appendix iv: Budget ............................................................................................................. 57
Appendix v: Map ...................................................................................................................59

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 LIST OF FIGURES

1.7 conceptual framework ……………………………………………………………………… 7

vi
 LIST ACRONYMS

BMC-Biomed central

DHS- Demographic and health surveys

FP- Family planning

IBIs-Interbirth intervals

KDHS - Kenya demographic health

KNBS-Kenya national bureau of statistics

UNICEF-United nations international children’s emergency fund

WHO- World health organization

WRA-Women of reproductive age

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 DEFINITION OF TERMS

Contraceptives – methods or devices used to prevent pregnancy

Family planning – a practice by which individuals or couples control the number and timing of

their children through the use of contraceptives methods , fertility treatment or other health and

reproductive interventions

Interbirth – the period of time between consecutive life birth by the same mother . it refers interval

between two deliveries

Maternal mortality – the death of woman during pregnancy, childbirth , or within 42 days after

the end of pregnancy

Mortality – refers to the incidence or rate of death in a population within a specific time period

Neonatal mortality – the death of a life born baby within the first 28 days of life

Short interbirth – defined as the interpregnancy interval of less than 24 months from the date of

life birth to the conception of the subsequent pregnancy

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 ABSTRACT
Short interbirth intervals (IBIs) defined as time between consecutive life births of less than 24
months. Globally , according to the world health organization (WHO) approximately 25% of births
still occur at intervals less than 24 months .In Sub Saharan Africa the prevalence of short(IBIs) is
reported to be highest in Chad 30.18% and Democratic Republic of Congo 27.12% .In Kenya
approximately 23% of births occur within short intervals of less than 24 months . Short interbirth
intervals are associated with adverse maternal and child health outcomes , including increased
risks of preterm birth , low birth weight , and maternal morbidity . The study therefore, seeks to
establish factors associated with short IBIs among women of reproductive age in Machakos county
Kenya. The study specifically seeks to determine socio demographic factors, knowledge factors ,
attitude associated with short IBIs . The study adopted a descriptive cross sectional study design
.The study will be conducted in Machakos county Kenya. Machakos was selected purposively
because is among the counties with highest number of maternal health issues. The sub county will
be randomly selected for the study. The study will recruit 422 women of reproductive age . one
community health unit will be randomly selected . SPSS version 2026 will be used to analyze data
descriptively and inferentially .Chi square test will be used to analyze data inferentially at a
confidence interval of 95% and error of precision of 0.05 to predict associations .Results will be
presented in terms of tables , graphs and charts. The respondents will be required to consent before
interviews . the data collected will be saved in a safe folder only accessible to the researcher .
Results will be used to improve birth intervals.

KEY WORDS: Short interbirth interval, knowledge, family planning

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 CHAPTER ONE: INTRODUCTION

1.1Background information

Interbirth interval refers to the period between birth to successive pregnancy less than 24 months

(Tesema et. al, 2020). The World Health Organization (WHO) recommends an inter-pregnancy

interval of not less than 24 months or minimum interbirth of 33 months. Short IBIs is an interval

between two successive births of < 33 months . (O Byamukama et .al ,2022) . Birth intervals are

achieved through a combination of biological , behavioral ,and environmental factors that regulate

fertility and pregnancy timing . Lactational amenorrhea , induced by breastfeeding is a key

biological mechanism as it suppresses ovulation and delays the return of fertility . Nutritional status

also plays a crucial role with better maternal health allowing for quicker recovery and shorter

intervals, while malnutrition prolongs them . Cultural practices such as intentional birth spacing

,the use of contraceptives or sexual abstinence ,further influence intervals . Additionally , maternal

age, stress levels and overall health, impact how quickly a woman’s body can conceive again after

childbirth . Together , these factors ensure that birth intervals are adjusted to the needs and

circumstances of the mother and family . Birth spacing intervals are vital for improving maternal

and child health outcomes

Adequate spacing between pregnancies , allows the mother body to recover from previous

pregnancy ,reducing the risks of complications such as preterm births, low birth weight ,and

maternal mortality . Additionally , proper spacing enhances the overall health and development of

children . ( Cleland & Conde-Agudelo [Link] , 2019 ).

Globally ,short IBIs of less than 24 months remains a public health concern , with around 23%of

births occurring withing this time frame (WHO,2020) . In Sub Saharan Africa, the prevalence of

1
short interbirth intervals is higher , with 35-40% of woman experiencing interbirth intervals of less

than 24 months (DHS,2020) program .In Kenya 18% of woman of reproductive age and short

interbirth intervals , (KDHS,2020) . Access to child spacing services has improved globally , but

significant disparities remain .particularly in low and middle -income regions .Worldwide 77% of

women had access to modern contraceptive methods . Sub Saharan Africa was lower with only

56% of women having adequate access to child spacing services (WHO ,2022) .In Kenya 65% of

married woman were using modern contraceptives ,but rural areas such as North Eastern Kenya

continued to face significant challenges with lower access rate due to cultural barriers , healthcare

infrastructure issues and insufficient family planning (FP) education (KNBS,2022). Short IBIs

present several health risks for both mothers and infants .They can lead to maternal health problems

such as anemia ,uterine rupture ,and complications in subsequent pregnancies . For infants the

risks include preterm birth ,low birth weight and increased neonatal mortality.(WHO, 2021). The

insufficient recovery time for the mother’s body and the depletion of essential nutrients are key

factors contributing to adverse outcomes , underscoring the need for adequate spacing between

pregnancies to improve maternal and child health . Efforts to reduce short birth intervals have

focused on improving access to family planning (FP) , increasing public health education , and

promoting maternal healthcare services .Many countries have implemented programs to expand

access to contraceptives , ensuring that woman can plan and space their pregnancies effectively ,

(WHO, 2021) . Additionally , health providers and organizations such as UNICEF have intensified

to raise awareness about the risks associated with short birth intervals through community outreach

and education campaigns . Improved maternal care including regular postpartum checkups , has

also been emphasized to ensure woman receive the necessary guidance and resources to space

pregnancies for optimal health outcomes

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1.2 Statement of Problem

A short interbirth is an interval between two consecutive births of less than 33 months (GN

Mihretie [Link] ,2022) .The (WHO,2022) advises that mothers should wait at least 24 months after

a live birth before attempting the next pregnancy to reduce the risk associated with short interbirth

intervals . Woman of reproductive age(WRA) experiencing short IBIs face complex set of

challenges leading to maternal mortality to mothers and neonatal mortality to infants .Maternal

and neonatal mortality rates in low and middle- income countries remain unacceptably high . In

2020 ,the global maternal mortality ratio was 223 deaths per 100,000 lives birth , far above the

sustainable development goals target of 70/100,000 . Regional disparities persist, with SubSaharan

Africa accounting for 70% of deaths . Similar trends exist in neonatal mortality . In 2019, the global

neonatal mortality rate was 17 deaths per 1000 live births against the sustainable development

goals target of 12/1000 with the highest rate seen in Sub-Saharan Africa in Southern Asia both

accounting for 80% of neonatal deaths (P Izulla [Link] ,2023). In Kenya , infant mortality rate was

32 deaths per 1000 live births and the under-5 mortality rate was 41 deaths 1000 live births

(KDHS,2022 ) .

In Machakos County maternal and neonatal mortality rates have remained a critical public health

concern. Maternal mortality rates stand at around 362 deaths per 100,000 live births. Neonatal

mortality remains at approximately 22 deaths per 1000 live births (KDHS,2022). Short interbirth

interval is also associated with short breastfeeding duration which leads to malnutrition to the child

resulting to health complications . Short interbirth intervals can strain a family’s economic

resources due to increased child-rearing expenses and potential income for parents. Rapidly having

children can limit parental workforce participation , impacting career opportunities and overall

household income .Additionally ,frequent childbirth may lead to higher health cost and reduce time

3
for parents to pursue education or professional development, affecting long-term economic

prospects for the family.

1.3 Justification

This research is crucial because short birth interval is a major health issue affecting the overall

well – being of both the mother and the child . Globally, studies shows that 25% of births still

occur at short birth intervals leading to maternal and neonatal mortality and some poor child health

outcomes such as preterm birth and low birth weight.(Aleni [Link], 2020) The research will be

carried out in Machakos county Kenya since it has been recording high numbers of maternal and

neonatal mortality . Research studies carried out in Machakos county shows that, year 2016,

Machakos county had 50,000women with unplanned pregnancies and maternal mortality .(Owino

et .al, 2022) . Understanding the factors contributing to short birth intervals , such as cultural

practices ,assess to family planning (FP) and education . This research is opt provide insights to

healthcare providers , policymakers and community stakeholders design targeted interventions to

promote healthier birth spacing and improve maternal and child health outcomes, and contribute

to sustainable development in Machakos county .

1.4 Research questions

i. What is the prevalence of short birth intervals among women of reproductive age in

Machakos county, Kenya.?

ii. What are the socio-cultural factors associated with short birth intervals among women of

reproductive age in Machakos county?

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 iii. What are the knowledge factors associated with short birth intervals among women of

reproductive age in Machakos county? iv. What are the accessibility factors associated with

short birth intervals among women of reproductive age in Machakos county?

1.5 Research objectives

1.5.1Broad objective

To assess factors associated with short interbirth intervals among the women of reproductive age

in Machakos county ,Kenya .

1.5.2 Specific objectives

i. To determine the prevalence of short birth intervals among women of reproductive age in

Machakos county, Kenya .

ii. To determine socio-cultural factors associated with short birth intervals among women of

reproductive age in Machakos county. iii. To determine the knowledge factors associated with short birth

intervals among women of reproductive age in Machakos county. iv. To determine the accessibility factors

associated with short birth intervals among women of reproductive age in Machakos county.

1.6 Significance of the study

This study’s outcome finding will help health care providers in the Machakos county to the tailor

Family planning program and the intervention to reduce short interbirth interval leading to

improved maternal and child health outcome it will also inform policy maker in developing

evidence-based policy and strategy to address the effectively.

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1.7 Conceptual Framework

INDEPENDABLE VARIABLE DEPENDENT VARIABLE

Socio-cultural factors

• Family size
• Type of marriage
• Husband educational
level

Short Interbirth
Knowledge factors Intervals.
• Meaning of IBIs
• Benefits of recommended
IBI • Yes
• Recommended IBI • No
• Method of interval

Accessibility factors
• Distance to facility
• Affordability
• Availability
• Attitude of HCPs
• Time spent
• Cost

Figure 1.1 Conceptual framework

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 CHAPTER TWO : LITERATURE REVIEW

2.1 Introduction

In this chapter, information provided on literature review regarding short birth intervals . This

includes, socio demographic factors , cultural factors , knowledge factors and accessibility factors

associated with short birth intervals. The information was obtained review of secondary data

through journals and other relevant publications.

2.2 Short Birth Intervals

2.2.1 Global Perspective to Short Birth Intervals

Globally , research studies revealed that 25% of births still occur at a short birth intervals (Aleni

et al,2023) . A birth of fewer than 18 months is associated with increased for neonatal mortality ,

infant mortality , under five mortality and maternal mortality (Aychiluhm et al,2020). Children

malnutrition remains a significant concern in the Asia -pacific, with short birth intervals recognized

as a potential risk factor (Khan et al,2024).

2.2.2 Short Birth Intervals in Sub-Saharan Africa

The research studies highlighted that the overall prevalence of short birth intervals in high fertile

Sub-Saharan Africa was 58.74 % (Belachew et al, 2023). Infant mortality was lowest in Gambia

3.4% and highest in Sierra Leone 9.3%. Comoros 16.8% accounted for the highest percentage of

low birth weight (Yaya et al,2020) .The prevalence of short birth intervals in East Africa was 44%.

The under-five mortality rate among mothers who had optimal birth intervals was 39.9 per 1000

live births while it was 60.6 per 1000 live births among mothers who had short birth intervals

(Tesema et al, 2023).

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2.2.3 Shorth Birth Intervals in Kenya

The research studies revealed that about 13.6% woman in Kenya are experiencing short birth

intervals (Tesema et al, 2023). In Kenya, neonatal deaths remain unacceptably high, contributing

to 40% of under- five mortality rates (Imbo et al, 2021). Short birth intervals are associated with

risk factors where in Kenya 20.9% of pregnancies had adverse birth outcomes (Mirieri et al, 2024).

2.2.4 Short Birth Intervals in Machakos County

Short birth intervals may result due to unplanned pregnancies .Research studies highlighted that

Machakos county from 2015 to 2016 had 50,000 woman with unplanned pregnancies and maternal

mortality of 100 per 100,000 live births (Owino et al, 2022).

2.4 Socio Cultural Factors

The family size significantly affects short birth intervals study conducted identified that older

woman are likely to have reached their desired family size and are less fertile and therefore prone

to prolong birth intervals (Pimentel et al,2020). Studies from Burkina Faso revealed that woman

with shorter birth interval , particularly those who had never used modern contraceptives tended

to have more children as shorter gaps between birth accelerated family growth (sombie et al

2021).Similarly , a systematic review by BMC ,pregnancy and child birth , identified that countries

with low education level and limited access to health care , short birth intervals contribute

significantly to larger family size especially in rural areas (BMC,2023) .

The type of marriage significantly affects the likelihood of short birth intervals . A study conducted

in Burkina Faso found that women in polygamous marriage were more likely to experience short

birth intervals compared to those in monogamous unions ,as they often faced societal pressures to

have more children quickly to secure their position in the family (Sombie et al,2021) .Study

conducted in East Africa highlighted that short birth intervals are linked to higher
8
There is a significant connection between husband education level and short birth intervals .

Husbands with lower education levels tend to have wives who experience shorter birth intervals ,

which is likely due to limited access to FP information and resources (Dube et al, 2023).

Conversely , higher education among husbands is associated with longer birth intervals is better

educated may encourage the use of contraceptives and health care services , thus supporting child

mortality particularly in contexts of polygamous marriages ,were resources and maternal care

,maybe divided among co-wives and their children (Pimentel et al,2020).

better birth spacing (Ahmed et al, 2023). Study conducted in low- and middle- income countries

revealed that education influences decisions regarding health (Tigabu et al ,2023).

2.5 Knowledge Factors

The knowledge factor plays a significant role in the management of short birth intervals. Women

who are informed about the risks associated with short interbirth intervals (IBIs) are more likely

to engage in family planning practices to prevent closely spaced pregnancies. Studies indicate that

limited awareness about the health risks of short birth intervals, such as preterm birth, low birth

weight, and maternal complications, contributes to the prevalence of closely spaced pregnancies.

For instance, women with limited knowledge about the importance of birth spacing were more

likely to experience short intervals between births, which is linked to adverse maternal and child

health outcomes (Gebreyesus et al, 2021). In contrast, increasing awareness through education can

promote healthier reproductive practices, including the adoption of family planning methods that

help to space pregnancies. Women with a better understanding of reproductive health risks, such

as those associated with short IBIs, tend to use contraception more effectively, reducing the

likelihood of short birth intervals (Mishra et al, 2022).

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An interbirth interval (IBI) refers to the time between the birth of one child and the conception of

the next. Short birth intervals, typically defined as intervals of less than 24 months, have been

associated with various maternal and neonatal health risks. These include a higher likelihood of

preterm birth, low birth weight, maternal anemia, and complications such as uterine rupture or

hemorrhage( McClure et al, 2020). Short interbirth intervals are linked to adverse outcomes,

including maternal exhaustion and poor child health outcomes. The WHO (2021) emphasizes the

importance of longer IBIs to allow mothers time for physical recovery and to meet the nutritional

needs of their children, helping to reduce the risk of complications in subsequent pregnancies. In

regions where short birth intervals are common, understanding the implications of inadequate birth

spacing is essential for improving maternal and infant health.

The recommended interbirth interval (IBI) of at least 24-36 months is associated with significant

health benefits for both mothers and children. Longer birth intervals allow mothers to recover

physically and nutritionally from previous pregnancies, reducing the risk of complications such as

anemia, preeclampsia, and postpartum hemorrhage. For children, a longer IBI is linked to

improved health outcomes, such as better birth weight and reduced risk of preterm birth (

WHO,2019). Research studies highlighted that when women adhered to the recommended

24month interval, there was a marked reduction in neonatal mortality and morbidity. In contrast,

short birth intervals, particularly those under 18 months, are associated with higher rates of adverse

outcomes, as shorter intervals do not provide sufficient time for maternal recovery or adequate

attention to the needs of the previous child. Short birth intervals also increase the risk of maternal

exhaustion, which can further contribute to poor health outcomes( Lassi et al, 2021).

Health organizations such as the World Health Organization (WHO) recommend a minimum

interbirth interval (IBI) of 24 months to reduce the risks associated with short birth intervals.

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Research consistently shows that a short IBI (less than 24 months) is associated with higher

maternal and infant mortality rates ( Askew et al, 2020). Studies highlighted that women with short

birth intervals were more likely to experience adverse health outcomes, such as preterm labor, low

birth weight, and maternal anemia. In comparison, adhering to the recommended 24-36 months

between births improves overall maternal and child health outcomes by providing adequate time

for physical recovery and child development between pregnancies. The (WHO,2021) strongly

advocates for family planning programs that enable women to space their births according to these

recommended intervals to ensure optimal health for both mothers and children.

To manage short birth intervals and achieve recommended IBIs, family planning is a critical

method for spacing pregnancies. Contraceptive use is the most effective strategy for preventing

short birth intervals by allowing women to plan and space their pregnancies according to their

health needs and preferences. Long-acting reversible contraceptives (LARCs), such as intrauterine

devices (IUDs) and contraceptive implants, are highly effective in preventing unintended

pregnancies and promoting longer IBIs (Wang et al, 2020). Research studies highlighted that

LARCs significantly reduce the likelihood of short birth intervals due to their prolonged duration

of action and minimal user intervention. Furthermore, counseling and education on contraceptive

methods, as emphasized increase awareness and improve the uptake of family planning methods.

Through effective contraceptive use and family planning education, women can achieve longer

birth intervals, reducing the risks associated with short interbirth intervals (Mishra et al, 2021)

2.6 Accessibility Factors

The accessibility of healthcare facilities is a key determinant in managing short birth intervals,

particularly in low-resource settings. The distance between a woman’s residence and the nearest

healthcare facility can significantly influence her ability to access maternal and reproductive health

11
services, including family planning. Several studies indicate that long distances discourage regular

visits for antenatal care, postnatal care, and family planning services, leading to higher fertility

rates and shorter birth intervals ( Asante et al, 2021). Studies show that women who live in rural

areas, where healthcare facilities are farther away, are less likely to use family planning services

effectively. Similarly, research shows that women living in remote locations face significant

barriers to accessing birth spacing interventions, which in turn leads to higher risks of short birth

intervals. In such settings, mobile health units or telemedicine may offer solutions to bridge the

gap in healthcare access (Saha et al, 2020).

Affordability of healthcare services is another crucial factor influencing birth spacing decisions,

especially in low-income populations. High out-of-pocket costs for maternal healthcare, including

family planning, prenatal visits, and delivery, often deter women from utilizing services that could

help space pregnancies. Research shows that the high financial burden associated with maternal

health services often leads to unintended pregnancies and short birth intervals (Zhao et al,

2022).Studies highlighted that affordability was a major barrier to accessing family planning

services in South Asia, where many women choose not to use contraceptives due to cost concerns.

The cost burden exacerbates the difficulties of managing short birth intervals, as women with

limited financial resources are less likely to seek adequate care between pregnancies, leading to

increased risks for both maternal and infant health (Hossain et al, 2023)

The availability of health services, including both family planning options and maternal care, is

essential for managing short birth intervals. A lack of accessible services, including insufficient

availability of contraceptives, family planning counseling, and skilled healthcare providers,

directly contributes to high fertility rates and short birth intervals. It was found that women in rural

12
areas of Ghana with limited access to family planning resources tended to have shorter birth

intervals, as they were less likely to use contraceptives due to availability issues (Kpodo &

Mensah,2020). Similarly, a study in Uganda highlighted that the scarcity of reproductive health

services in some regions of sub-Saharan Africa led to unplanned pregnancies and closely spaced

births. Improving the availability of health services, especially family planning, can help manage

birth spacing effectively and reduce associated maternal and neonatal risks (Nansubuga et al,2021).

Healthcare providers’ attitudes toward women with short birth intervals are crucial in shaping how

these women access care. Negative or judgmental attitudes can discourage women from seeking

care, especially for family planning services, which are essential for managing birth spacing.

Research shows that healthcare providers who treat women with short birth intervals with

understanding and empathy are more likely to engage them in discussions about family planning.

This, in turn, helps improve birth spacing practices and reduce health risks. In contrast, providers

with a dismissive attitude may inadvertently push women away from seeking services, resulting in

unintended pregnancies and shorter birth intervals. Ensuring that healthcare providers are trained

to deliver non-judgmental, supportive care is essential for encouraging effective family planning

and optimal maternal health (Kamal et al, 2021)

The time spent managing health complications due to short birth intervals, combined with the

associated financial costs, is a significant burden on women and families. Short intervals between

births are associated with higher risks of maternal and infant morbidity, leading to increased

healthcare utilization. This leads to greater time spent on medical appointments, additional

treatments, and complications that could have been avoided with longer birth intervals

(WHO,2016). Shorter birth intervals contribute to additional financial strain, as women are often

forced to spend more on frequent medical visits for complications such as preterm birth and low

13
birth weight. This financial and time-related burden often impacts women’s ability to work or

contribute economically, further deepening their vulnerability. Reducing the frequency of short

birth intervals through better access to family planning services can significantly alleviate these

time and cost burdens (Lee & Hsu, 2023).

2.7 Reviewed Literature Summary and Gaps

Short birth intervals (IBIs) are linked to various adverse health outcomes, including increased risks

of preterm birth, low birth weight and depletion. This effect is particularly pronounced with

intervals of less than 24 months, as mothers may not have sufficient time to recover physically

and nutritionally before the next pregnancy. While interventions such as family planning programs

have helped in some regions, barriers such as limited healthcare access, cultural norms, and

socioeconomic factors continue to sustain short IBIs, especially in low- and middle- income

countries. Despite existing research gaps remain in understanding the socio-cultural determinants

that influence short IBIs, the long-term health impacts on mothers and children, and effectiveness

of varied intervention types. Additionally, the roles of maternal nutrition, mental health impacts,

and specific health system barriers in influencing IBIs are underexplored. This proposal seeks to

address these gaps to enhance maternal and child health outcomes by informing more effective,

context-specific interventions.

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 CHARPTER THREE: MATERIALS AND METHODS

3.1 Introduction

This chapter explains the study design method, variables , location, study population , sample size

determination and techniques, research instruments, pre-testing and data collection techniques . It

also outlines the data analysis procedures and presentation and the study’s ethical considerations

.3.2 Study Design

The study will employ a descriptive cross-sectional study design . The design is significant because

it will enable the researcher to explain short IBIs at a specific point in time . This will enable the

researcher to describe the socio-demographic factors, socio-cultural factors, knowledge factors,

and accessibility factors associated with short birth intervals. The study will employ a quantitative

approach in data collection in Machakos county, Kenya.

3.3 Variables

3.3.1 Independent Variables

The independent variables will include;

Socio-cultural factors : such as; family size, type of marriage, husband’s education level

Knowledge factors: such as; meaning of IBIs, benefits of recommended IBIs, recommended IBI

and methods of intervals.

Accessibility factors: such as; distance to facilities, affordability, availability, attitude of

healthcare providers, time spent and cost.

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3.3.2 Dependent Variable

The dependent variable is short interbirth intervals. This will be measured by checking the interval

between two immediate pregnancies. If the interval is less than 24 months “Yes’’ and 24 months

and above “No’

3.4 Study Location

Machakos county will be the site of this research .Machakos county is one of the 47 counties of

Kenya , which came into being because of the developed system of governance occasioned by the

2010 constitution of Kenya . The county’s first administrative headquarters are in Machakos Town

, which is the largest town in the county . The county has approximately 264,500 households with

approximate population of 1.42 million as of 2019 census and covers an area of 6,208km2. The

county is bordered by the Nairobi and Kiambu counties to the west, Embu to the north ,Kitui to

the east, Makueni to the south ,Kajiado to the south west , Murang’a and Kirinyaga to the north

west. Machakos county has eight sub counties which include; Machakos Town ,Mavoko ,Masinga

, Kangundo ,Kathiani ,Matungulu and Mwala and divided into 40 wards. The study will

specifically be carried out in Matungulu sub county. And due to time and resources to be used ,

only one ward will be selected randomly from rural to represent all households for this study.

3.5 Study Population

Women of reproductive age will be the study’s target group residing in Machakos county .This will

only focus on those who have resided in the county for a period of at least 9 months .

3.5.1 Inclusion Criteria

Women of reproductive age are the only included in the study . Only those who will consent will

be included . They must have resided in Machakos county for a minimum of 9 months prior to the

16
study . Only those women who will agree to participate will be included and those who can talk

and answer the questions on their own without any assistance.

3.5.2 Exclusion Criteria

Women of reproductive age who are mentally ill , those who are very sick or admitted in hospital,

those who are disabled ,those who are pregnant and those with sickly children will not be included

in this study.

3.6 Sample Size Determination and Sampling Technique

3.6.1 Sample Size Determination Formula

The researcher will use Fishers et al formular (Efron , 1998 ) to calculate study’s sample size . In

Machakos county , the short interbirth interval rate for women of reproductive age the was no data

reported recently citing the rate of short interbirth interval; no = z2(pq)/e2 n =

z2(pq)/e2……..Equation 1

Where;

Z :Statistic for a level of confidence. (for the level of confidence of 95% ;which is conventional ,

Z value is 1.96)

P:Expected prevalence or proportion. ( P is considered 0.5) Q : 1-p e: precision .(e is

considered 0.05 to produce good precision and smaller error of estimate.

no= 1.962(0.05*0.5)/0.052=384 ………..Equation 2

We estimated a sample size of 384 participants using Equation 2. For populations below 10,000

subjects, Cochran’s correction formula will be utilized to adjust sample size. Hence

17
(nf)=(n)÷1±(n/N) =384÷1±(384/600)=[Link] adjust the sample upwards by 10% to account for

non- response and incomplete questionnaires to arrive at final sample size of 272 participants.

3.6.2 Sampling Techniques

Machakos county will be purposively selected for this study because it is among counties with

high number of maternal and child mortality . Maternal mortality was 362 per 100,000 live

births(Owino et al, 2022) . Neonatal mortality was 22 per 1000 live births(Muli, 2020). Machakos

has 8 sub counties which include ; Machakos town, Mavoko, Masinga, Yatta, Kangundo, Kathiani,

Matungulu, and Mwala. Matungulu sub county will be randomly selected . Matungulu sub county

has 4 wards. One ward will be randomly selected . One community health unit will be randomly

selected. Consecutive sampling will be used.

3. 7 Research Instruments

The research will use a semi-structured questionnaires to collect data. The questionnaire will

contain four sections . Section (a) contains socio-demographic factors such; age, education,

religion, and income, section (b) will contain socio-cultural factors such as; family size, type of

marriage, husband’s level of education, section (c) will contain knowledge factors such as;

meaning of IBIs, benefits of recommended IBIs, recommended IBI, method of interval, section (d)

will contain accessibility factors such as; distance to facility, affordability, availability, attitude of

HCPs, time spent and cost.

3.8 Pretesting

The tools will be pretested in one of the other two remaining wards. 10% of the respondents will

be used(38). This will ensure the research instruments are valid and reliable. Necessary corrections

will be made to improve the research instruments for better data collection.

18
3.8.1 Validity

The study will seek expert opinion from research supervisors, by structuring the tools in relation

to the research objectives . Individual question variables will be guided by reviewed literature. The

sampling techniques used will ensure random samples are obtained thus representative to achieve

validity. This will reduce any deviations that will

3.8.2 Reliability

The reliability of the study will be enhanced through proper training and selection of research

assistants. The reliability of the study will be maintained by ensuring that the person collecting

the data from the field is used to the methods and instruments . The respondents will be given

enough time to answer the questions without any disturbances. Sensitive questions will be asked

only when both the interviewer and the respondent at ease.

3.9 Data Collection Techniques

Data will be collected by the researcher and research assistants. The administration of

questionnaires will be done by research assistants trained to aid in answering research questions.

First, look for respondents who fit the inclusion criteria , then ask for consent before giving the

questionnaires. The respondents will be taken to a safe place and interview them. Their views will

be recorded and the research instruments will be kept in safe place to ensure confidentiality.

3.10 Data Presentation and Analysis

Data will be coded and entered to Exell software and exported to SPSS 2022 for analysis.

Descriptive data will be presented as tables, charts, percentages, and graphs. Chi-square tests will

be done to examine inferential statistics at a level of confidence of 95% and error of precision of

0.05 to determine variable association.

19
3.11 Ethical Consideration

The researcher will seek permission from the department then to the county of study to get permit

to do the study. The respondents will consent before participating in the study. Privacy and

confidentiality for data obtained will be observed. The findings will be widely distributed, but all

identifying information will be erased. Only the interviewer will have access to the study

documents which will be kept strictly confidential.

20
 CHAPTER FOUR: RESULTS

4.1 Introduction

In this study concerning factors associated with short inter-birth intervals among women of

reproductive age, 272 questionnaires were administered to women aged between (18-49) who had

lived in Machakos for the last 9 months. After completion of data collection, 272 questionnaires

dully filled were returned for analysis, a response rate of 71%.

4.2 Social-demographic characteristics of the respondents

4.2.1 Distribution of social-demographic characteristics

This table presents the socio-demographic distribution of the 272 respondents. The largest age
group was 25–34 years (43.4%), which aligns with the peak reproductive age, followed by 18–24
(23.5%) and 35–44 (21.7%). Only 11.4% were in the 45–49 age range. Education levels were fairly
high, with 40.4% having secondary and 34.6% tertiary education, suggesting that the majority of
respondents are educated. Only 0.7% reported no education, indicating a literate sample. Most
respondents were married (63.6%), a vital consideration in interbirth interval studies. The
predominant religion was Christianity (92.3%), while Muslim and Hindu respondents made up a
very small proportion (0.7% and a questionable 34.6%, respectively — this likely needs
verification).In terms of income, the majority (38.6%) earned below 10,000, reflecting a
lowincome population, with 12.5% earning 10,000–30,000. The income distribution beyond that
appears skewed, with only 2.9% in the highest categories, which may reflect economic disparity
or potential errors. Most respondents had two (43.4%) or three (33.5%) children, providing a
relevant context for studying short interbirth intervals.

Table 4.1: Distribution of social-demographic characteristics among respondents(n=272)

21
Variable Respondent Frequency (N) Percentage (%)
response

Age of respondents 18-24 64 23.5

25-34 118 43.4

35-44 59 21.7
45-49 31 11.4
Level of education None 2 0.7

Primary 66 24.3
Secondary 110 40.4
Tertiary 94 34.6

Marital status Single 87 32

Married 173 63.6

Divorced/Separated 12 4.4
Religious affiliation Christian 251 92.3

Muslim 2 0.7

Hindu 19 34.6
Income Below 10,000 105 38.6

10,000-30,000 34 12.5
31,000-50,000 8 2.9
Above 50,000 125 2.9

children 2 118 43.4

3 91 33.5

4 43 15.8
5 20 7.4

22
4.2.2 Association between social-demographic characteristics and short interbirth intervals

Age: Significant (p=0.022), showing younger women (25–34) had higher rates of short intervals.

Education: Strongly significant (p=0.001). Lower education levels (none/primary) were associated

with shorter intervals, while higher education correlated with longer intervals. Marital Status:

Significant (p=0.014). Married women had higher proportions of short intervals. Income: Highly

significant (p=0.001). Respondents earning below 10,000 were more likely to report short

interbirth intervals. Number of Children: Also, significant (p=0.001), with those having fewer

children more likely to have shorter intervals. Religion was not significantly associated (p=0.232),

suggesting it might not be a strong determinant in this population.

Table 4.2: Association between social demographic characteristics and short interbirth
intervals

23
Variable Respondent response Short interbirth interval Statistical
significance
Yes No
Age of respondents 18-24 24(19.5%) 40(26.8%) χ2=9.625² df=
25-34 56(45.5%) 62(41.6%) 3
35-44 22(17.9%) 37(24.8%) p= 0.022
45-49 21(17.1%) 10(6.7%)

Level of education None 0% 2(1.3%) χ2=76.929²

Primary 57(46.3%) 9(6.0%) df= 3 p=0.001
Secondary 50(40.7%) 60(40.3%)
Tertiary 16(13%) 78(52.3%)

Marital status Single 29(23.6%) 58(38.0%) χ2=8.599² df=

Married 86(69.9%) 87(58.4%) 2 p=0.014
Divorced/Separated 8(6.5%) 4(2.7%)

Religious affiliation Christian 112(91.1%) 139(93.3%) χ2=2.919² df=

Muslim 11(8.9%) 8(5.4%) 2 p=0.232
Hindu 0% 2(1.3%)
Income Below 10,000 73(59.3%) 52(34.9%) χ2=22.982²
10,000-30,000 42(34.1%) 63(42.3%) df= 3 p=0.001
31,000-50,000 8(6.5%) 26(17.4%)
Above 50,000 0% 8(5.4%)
children 2 26(21.1%) 92(61.7%) χ2=46.463² df=
3 54(43.9%) 37(24.8%) 3
4 29(23.6%) 14(9.4%) p=0.001
5 14(11.4%) 6(4%)

24
4.3 Short interbirth intervals
4.3.1 Responses on short interbirth intervals assessment tool
Among the 272 respondents, 26.8% had a birth interval of less than 24 months, indicating a
substantial portion experiencing short intervals. The most common interval was 24–36 months
(45.2%), while 27.9% had more than 36 months. Only 48.9% were using family planning, and
51.1% were not, reflecting a slight majority without contraceptive use. These statistics are
important for assessing the risk of closely spaced pregnancies.

Table 4.3: Responses on Short interbirth intervals among respondents (n=272)

Variable Respondent Frequency Percentage

response
(N) (%)

What was the time interval between your Less than 24 73 26.8
months
last two pregnancies

24-36 months 123 45.2

More than 36 76 27.9

months

Did you plan for your last pregnancy Yes

No

Are you currently using any form of Yes 133 48.9

family planning

No 139 51.1

Short interbirth interval Yes 73 26.8

No 199 73.1

4.3.2 Proportion of short interbirth interval among respondents(n=272)

25
The proportion of respondents who experienced short interbirth intervals—defined as having less

than 24 months between their last two pregnancies—was 26.8% (n=73 out of 272). This indicates

that more than one in four women had a birth interval shorter than recommended by the World

Health Organization, which advises at least 24 months between births to reduce maternal and child

health risks. Conversely,73.1% (n=272) had birth intervals of 24 months or more, suggesting that

the majority of respondents were adhering to safer reproductive practices in terms of birth spacing.

This relatively high proportion of short interbirth intervals underscores a public health concern,

particularly in light of the fact that over half of the respondents were not currently using any family

planning method (51.1%) and 44.1% were unaware of the recommended interval. These figures

suggest gaps in knowledge, access, or utilization of family planning services, which could be

contributing factors to the observed proportion. The 26.8% figure reflects a substantial public

health issue, warranting targeted interventions in family planning education, service availability,

and cultural attitudes toward birth spacing.

SHORT INTERBIRTH INTERVAL

YES
27%

NO
73%
Figure 2:

Proportion of short inter birth intervals.

26
4.4 Socio cultural factors

4.4.1 Distribution of socio-cultural factors

A majority (77.9%) stated that cultural background influenced family planning decisions, and
75.7% acknowledged that cultural beliefs encouraged short intervals. Most were in monogamous
marriages (64%), while 26.1% were in polygamous ones. On spousal influence, 54% reported no
influence of the spouse’s education on FP decisions, but 33.8% noted a positive influence. Only
19.9% felt pressure from family or society to have more children, indicating limited external
reproductive pressure.

Table 4.4: Distribution of socio-cultural factors among respondents (n=272)

Variable Respondent Frequency Percentage
response (N) (%)
Does your cultural background influence Yes 212 77.9
your family planning decision
No 60 22.1

Are there cultural beliefs that encourage Yes 206 75.7

short birth intervals in your community
No 66 24.3

What type of marriage are you in Monogamous 174 64

Polygamous 71 26.1

None 27 9.9

How does the education level of your Positively 92 33.8

spouse affect your family planning
decision
Negatively 33 12.1

No influence 147 54

Do you feel societal or familial pressure to Yes 54 19.9

have more children
No 218 80.1

27
4.4.2 Association between socio cultural factors and short interbirth interval
Cultural background influence: Significant (p=0.036), indicating cultural beliefs impact birth

spacing. Spouse’s education influence: Strongly significant (p=0.001). Positive influence

correlates with longer intervals. Other factors (marriage type, cultural beliefs encouraging short

spacing, societal pressure) were not statistically significant, suggesting these may not

independently influence interbirth spacing in this group.

Table 4.5 Association between socio cultural factors and short interbirth interval among
respondents (n=272)

28
 Variable Respondent Short interbirth interval Statistical analysis
response

Does your cultural Yes No χ2=4.391²

background influence your df= 1
family planning decision Yes 20(16.3%) 40(26.8%) p=0.036

No 103(83.7%) 109(73.2%)

Are there cultural beliefs that Yes 32(26%) 34(22.8%) χ2=0.375²

encourage short birth df= 1
No 91(74%) 115(77.2%) p=0.540
intervals in your community

What type of marriage are you Monogamous 73(59.3%) 101(67.8%) χ2=4.226²

in df= 2
Polygamous 17(13.8%) 10(6.7%) p=0.121

None 33(26.8%) 38(25.5%)

How does the education level Positively 14(11.4%) 78(52.3%) χ2=51.883²

of your spouse affect your df= 2
family planning decision Negatively 23(18.7%) 10(6.7%) p=0.001

No influence 86(69.9%) 61(40.9%)

Do you feel societal or Yes 24(19.5%) 30(20.1%) χ2=0.016²

familial pressure to have df= 1
more children No 99(80.5%) 119(79.9%) p=0.898

4.5 Knowledge factors

4.5.1 Distribution of Knowledge factors
Knowledge about family planning was moderate to high among respondents: 55.9% knew the

recommended interbirth interval. 67.3% had received FP education from healthcare providers.

57.7% were familiar with modern methods. 69.1% had ever used a family planning method.

Additionally, 80.2% agreed or strongly agreed that short intervals negatively impact child health.

29
Table 4.6 Distribution of Knowledge factors among respondents (n=272)

Variable Respondent Frequency Percentage

response
(%) (%)

Are you aware of the recommended Yes 152 55.9

interbirth interval No 120 44.1

Have you received any education on Yes 183 67.3

family planning from health care
provider No 89 32.7

Do you understand the health risks Yes 152 55.9

associated with short interbirth intervals No 120 44.1

Are you familiar with modern family Yes 157 57.7

planning method
No 115 42.3

Have you ever used any family Yes 188 69.1

planning method No 84 30.9

Do you believe short interbirth interval Strongly agree 62 22.8

can impact child health negatively
Agree 156 57.4

Disagree 54 19.9

30
4.5.2 Association between knowledge factors and short interbirth interval
Knowledge about family planning was moderate to high among respondents: 55.9% knew the

recommended interbirth interval. 67.3% had received FP education from healthcare providers.

57.7% were familiar with modern methods. 69.1% had ever used a family planning method.

Additionally, 80.2% agreed or strongly agreed that short intervals negatively impact child health.

Table 4.7: Association between knowledge factors and short interbirth interval
Variable Respondent Short interbirth interval Statistical analysis
response

Are you aware of the Yes No χ2=81.238²

df= 1 p=0.001
recommended Yes 32(26%) 120(80.5%)
interbirth interval
No 91(74%) 29(19.5%)

Have you received any Yes 54(43.9%) 129(86.6%) χ2=55.739²

education on family df= 1 p=0.001
planning from health No 69(56.1%) 20(13.4%)
care provider

Do you understand the Yes 36(29.3%) 116(77.9%) χ2=64.509²

health risks associated df= 1 p=0.001
with short interbirth No 87(70.7%) 33(22.1%)
intervals

Yes 46(37.4%) 111(74.5%) χ2=37.999²

31
 Are you familiar with No 77(62.6%) 38(25.5%) df= 1
p=0.001
modern family

planning method

Have you ever used any Yes 67(54.5%) 121(81.2%) χ2=22.565²

family planning method df= 1
No 56(45.5%) 28(18.8%) p=0.001

Do you believe short Strongly agree 6(4.9%) 56(37.6%) χ2=44.474²

df= 2
interbirth interval can Agree 81(65.9%) 75(50.3%) p=0.001

impact child health

Disagree 36(29.3%) 18(12.%)
negatively

4.6 Accessibility factors

4.6.1 Distribution of Accessibility factors
All knowledge factors were significantly associated with short interbirth intervals (p=0.001),
including: Awareness of recommended intervals, FP education from providers, understanding
health risks, familiarity and use of FP methods, beliefs about impact on child health. These findings
suggest that knowledge is a critical determinant of birth spacing behavior

Table: 4.7 Distribution of Accessibility factors among respondents (n=272)

32
Variable Respondent Frequency Percentage
response (%) (%)
How far is the nearest health facility Less than 1 km 75 27.6
from your home
1-5 km 123 27.6

More than 5 km 74 27.2

Do you find family planning services Yes 170 62.5

affordable
No 102 37.5

Are family planning methods readily Yes 124 45.6

available at your health care facility
No 148 54.4

How would you rate the attitude of Supportive 100 36.8

health care providers during family
planning visits Neutral 146 53.7

Unsupportive 26 9.6

Do you feel health care services take too Yes 163 59.9
long to access
No 109 40.1

How often do you face stock out of Often 75 27.6

contraceptives at your health care
facility Sometimes 143 52.6

Rarely 54 19.9

Do you experience financial challenges Yes 209 76.8

in accessing health services
No 63 23.2

How much time do you spend accessing Less than 30 min 50 18.4
family planning services
30 -1 hour 110 40.4

33
 More than 1 hour 112 41.2

4.6.2 Association between accessibility factors and short interbirth interval

Accessibility varied across respondents: Distances to health facilities were fairly even across
categories. 62.5% found FP services affordable, and 45.6% said methods were readily available.
Most reported healthcare staff as neutral or supportive (90.5% combined).76.8% experienced
financial barriers. 41.2% spent more than one hour accessing services, showing notable time
investment.

Table 4.8: Association between accessibility factors and short interbirth interval
Variable Respondent Short interbirth interval Percentage (%)
response

How far is the nearest Yes No χ2=15.867²

health facility from your df= 2
home Less than 1 km 29(23.6%) 46(30.9%) p=0.001

1-5 km 46(37.4%) 77(51.7%)

More than 5 km 48(39%) 26(17.4%)

Do you find family planning Yes 52(42.3%) 118(79.2%) χ2=39.183²

df= 1
services No 71(57.7%) 31(20.8%) p=0.001

affordable

Are family planning Yes 24(19.5%) 100(67.1%) χ2=61.550²

df= 1
methods readily available at No 99(80.5%) 49(32.9%) p=0.001
your health care facility

Supportive 20(16.3%) 80(53.7%) χ2=40.641²

df= 2
Neutral 87(70.7%) 59(39.6%) p=0.001

34
How would you rate the Unsupportive 16(13.0%) 10(6.7%)

attitude of health care

providers during family

planning visits
Do you feel health care Yes 80(65.0%) 83(55.7%) χ2=2.445²
services take too long to df= 1
access No 43(35.0%) 66(44.3%) p=0.118

How often do you face Often 49(39.8%) 26(17.4%) χ2=17.213²

df= 2
stock out of contraceptives Sometimes 52(42.3%) 91(61.1%) p=0.001
at your health care facility
Rarely 22(17.9%) 32(21.5%)

Do you experience Yes 104(84.6%) 105(70.5%) χ2=7.509²

df= 1
financial challenges in No 19(15.4%) 44(29.5%) p=0.006
accessing health services

How much time do you Less than 30 min 12(9.8%) 38(25.5%)

spend accessing family

planning services

30 -1 hour 47(38.2%) 63(42.3%) χ2=15.792²

df= 2
More than 1 hour 64(52%) 48(32.2%) p=0.001

35
 CHAPTER FIVE:DISCUSSIONS,CONCLUSION AND RECOMMENDATIONS

5.1 Introduction

The arrangement of this chapter is guided by the objectives of the study. The included objectives

are, socio-demographics, socio-cultural factors, knowledge factors and accessibility factors.

5.2 Discussions

5.2.1 Socio-demographics factors

The study shows that younger women (especially those aged 25–34) were more likely to have short

interbirth intervals (SIBIs) (p=0.022). Women with only primary or secondary education also

reported higher rates of SIBIs (p=0.001). Income level had a significant impact, with those earning

below 10,000 being more prone to SIBIs. These findings align with( Bongaarts & Casterlin, 2018),

who highlighted the link between low socio-economic status and high fertility and short birth

intervals due to limited access to reproductive health services. Similarly, (Rutstein & Winter,2018)

identified education as a protective factor against closely spaced births, emphasizing the role of

female education in enabling informed reproductive decisions.

5.2.2 Socio-cultural factors

Cultural beliefs significantly influenced family planning decisions (p=0.036), with 77.9% of

respondents acknowledging cultural influence and 75.7% reporting beliefs that encourage short

birth intervals. However, variables like type of marriage and societal pressure were not

significantly associated with SIBIs. (Kaggwa e.t.a.l ,2018) found that traditional beliefs and family

expectations often prevent women from using contraceptives, especially in patriarchal societies

where fertility is culturally valued. Cultural norms can override individual preferences, leading to

closely spaced births.

36
5.2.3 Knowledge factors

A significant portion of the population lacked knowledge on recommended birth intervals (44.1%)

and the risks of short spacing (44.1%). All knowledge-related variables, including awareness of

family planning methods and prior use, showed strong associations with SIBIs (p=0.001).(Darroch

et al, 2018) emphasized that awareness and understanding of reproductive health are essential for

informed decision-making. Lack of exposure to family planning education from healthcare

providers contributes to misinformation and lower contraceptive use.

5.2.4 Accessibility factors

Accessibility emerged as a major determinant of SIBIs. Women who lived far from health facilities,

experienced contraceptive stock-outs, or rated provider attitudes as unsupportive were

significantly more likely to report SIBIs (p<0.05). Financial challenges were also a significant

barrier (p=0.006). (Ross &Hardee,2018) emphasized the role of service delivery quality in

contraceptive uptake. Physical proximity, cost, and provider attitudes all influence whether women

seek and continue family planning.

5.3 Conclusion

This study sought to examine the factors associated with short interbirth intervals among women

of reproductive age. The findings revealed that a significant proportion (26.8%) of respondents

experienced short interbirth intervals, which poses potential health risks to both mothers and

children. The study identified several key factors significantly associated with short interbirth

intervals. Socio-demographic variables such as younger age, lower levels of education, low

income, and fewer children were all strongly linked to shorter spacing between births.

Sociocultural influences, including cultural norms and the educational influence of spouses, also

played a notable role in determining family planning decisions. Knowledge-related factors were

37
found to have a profound impact on interbirth intervals. Respondents who were unaware of the

recommended spacing, unfamiliar with modern family planning methods, or had not received

education from health care providers were significantly more likely to have short birth intervals.

Furthermore, accessibility issues—such as distance to health facilities, affordability, availability

of contraceptives, and healthcare provider attitudes—emerged as critical barriers influencing

women’s ability to adequately space births. In conclusion, the study highlights the

multidimensional nature of short interbirth intervals, influenced by a combination of

sociodemographic, cultural, knowledge-based, and accessibility factors. Addressing this issue

requires a holistic approach that strengthens health education, improves access to affordable and

quality family planning services, and engages communities in culturally sensitive interventions to

promote optimal birth spacing.

5.4 Recommendations

5.4.1 Recommendations from the study

1. Implement educational campaigns targeting less-educated and low-income women,

focusing on reproductive health and the benefits of optimal birth spacing.

2. Partner with local leaders and religious institutions to challenge cultural norms that

promote SIBIs through community forums and culturally appropriate education.

3. Strengthen health education through community health workers and integrate family

planning counseling into all maternal health services.

4. Improve family planning infrastructure, ensure consistent contraceptive supplies, and train

providers on respectful and supportive care.

38
5.4.2 Suggestion for further study

A further study should be conducted to explore the relationship between family planning and

short inter-birth intervals among women of reproductive age.

39
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APPENDICES

Appendix i: Consent Form

Introduction

My name is Boniface Kioko Musyoka, a Kenya Medical Training College student undertaking a

Diploma in Health Promotion and Community Health. I will be researching on ‘Factors associated

with short interbirth intervals among women of reproductive age, Machakos county, Kenya.’ The

study aims at assessing factors associated with short birth intervals among women of reproductive

age in Machakos county, Kenya. Obtained information would address effects of short birth

intervals and utilizing services of family planning among women of reproductive age. This would

address unmet need for family planning hence improved maternal health and child outcome. You

are humbly requested to participate in the exercise.

Study procedure

If you agree to participate, you will be asked a series of questions related to your demographic

background, knowledge, cultural and religious factors, toward family planning and interbirth

intervals. You will fill in your response within the blanks in the questionnaire. You may seek

further clarity through asking questions regarding the study.

46
Voluntary Participation

“You can opt out of the study without any consequences. Your participation on this study will not

change how you will be treated in regard of the decision you make whether to participate or not.

You may not answer some questions that are irritating or against your cultural beliefs.”

Discomforts and Risks

This study does not anticipate any significant risks or discomforts to you as a participant. However,

some questions may touch on personal or sensitive topics, such as family planning or reproductive

health. You may skip any question that you are not comfortable answering, or may stop

participation at any time.

Benefits and Rewards

“There is no monetary compensation for participating in this study. However, your responses will

contribute to understanding factors affecting interbirth intervals and may help improve family

planning services and maternal health in the community.”

Confidentiality

“The interview questionnaires will be distributed to women of reproductive age in Machakos

county, Kenya. Information you provide will be privately kept and confidentiality handled. This

won’t be disclosed at any time and the information provided shall be utilized to achieve its aim

only.”

Contact Information

Should you have any queries concerning this work, feel free to contact the undersigned supervisor

47
Hellen Nyambura Mwangi

Email : ………………………………………………………………………………………….

Tel No……………………………………………………………………………………………….

Vincent Omwenga Matoke

Email: …………………………………………………………………………………………...

Tel No: ………………………………………………………………………………………….

Participant’s Statement

“Information concerning my involvement in this study has been clarified. An opportunity has been

accorded to me to seek further clarification and my concerns addressed adequately. Taking part in

this research is optional and voluntary. To my understanding, this information shall be privately

kept and confidentially used. I am at the liberty to pull out of the exercise should need be.”

Sign…………………………………………………………………………………………………

Date…………………………………………………………………………………………………

Principal Investigator’s statement

“I, the undersigned have explained to the participants in the language that they best understand

the procedure to be followed in the research and the risks and benefits to be involved.”

Name: Boniface Kioko Musyoka

48
Email address:kiokoboniface@[Link]

Tel No:0769736806

Signature …………………………………………………………………………….

Date…………………………………………………………………………………..

Appendix ii: Research questionnaire

Section A: Socio-Demographic Factors

1. What is your age?

[ ] 18–24

[ ] 25–34

[ ] 35–44

[ ] 45 -49

2. What is your marital status?

[ ] Single

[ ] Married

[ ] Divorced/Widowed

3. What is your highest level of education?

49
[ ] None

[ ] Primary

[ ] Secondary

[ ] Tertiary

4. What is your religion?

[ ] Christian

[ ] Muslim

[ ] Other (Specify): _______

5. What is your household’s monthly income?

[ ] Below 10,000

[ ] 10,000–30,000

[ ] 31,000–50,000

[ ] Above 50,000

6. How many children do you currently have? ______

7. Where do you live?

[ ] Urban area

[ ] Rural area

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8. What is your employment status?

[ ] Unemployed

[ ] Self-employed

[ ] Salaried employee

Section B: Dependent Variable (Short Interbirth Intervals)

9. What was the time interval between your last two pregnancies?

[ ] Less than 24 months

[ ] 24–36 months

[ ] More than 36 months

10. Did you plan your last pregnancy?

[ ] Yes

[ ] No

11. Are you currently using any form of family planning?

[ ] Yes

[ ] No

Section C: Socio-Cultural Factors

12. Does your cultural background influence your family planning decisions?

51
[ ] Yes [

] No

13. Are there cultural beliefs that encourage short birth intervals in your community?

[ ] Yes

[ ] No

14. What type of marriage are you in?

[ ] Monogamous

[ ] Polygamous

15. How does the education level of your spouse affect your family planning decisions?

[ ] Positively

[ ] Negatively

[ ] No influence

16. Do you feel societal or familial pressure to have more children?

[ ] Yes

[ ] No

Section D: Knowledge Factors

17. Are you aware of the recommended interbirth interval (24–36 months)?

52
[ ] Yes [

] No

18. Have you received any education on family planning from a healthcare provider?

[ ] Yes

[ ] No

19. Do you understand the health risks associated with short interbirth intervals?

[ ] Yes

[ ] No

20. Are you familiar with modern family planning methods?

[ ] Yes

[ ] No

21. Have you ever used any family planning method?

[ ] Yes

[ ] No

22. Do you believe short birth intervals can impact child health negatively?

[ ] Strongly agree

[ ] Agree

[ ] Disagree

53
Section E: Accessibility Factors

23. How far is the nearest healthcare facility from your home?

[ ] Less than 1 km

[ ] 1–5 km

[ ] More than 5 km

24. Do you find family planning services affordable?

[ ] Yes [

] No

25. Are family planning methods readily available at your healthcare facility?

[ ] Yes

[ ] No

26. How would you rate the attitude of healthcare providers during family planning visits

[ ] Supportive

[ ] Neutral

[ ] Unsupportive

27. Do you feel healthcare services take too long to access?

[ ] Yes

[ ] No

54
28. How often do you face stock-outs of contraceptives at your healthcare facility?

[ ] Often

[ ] Sometimes

[ ] Rarely

29. Do you experience financial challenges in accessing healthcare services?

[ ] Yes

[ ] No

30. How much time do you spend accessing family planning services?

[ ] Less than 30 minutes

[ ] 30 minutes–1 hour

[ ] More than 1 hour

55
 Appendix iii: Work plan

Duration in 2024 2025

months/Actvity
Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul
Concept
Paper

Literature
review

Proposal
Writing
Proposal
defense

Proposal
approval

Training research
assistants
Pre-testing

Data
collection

Data cleaning and

entry
Analysis of ▪
Data
Report writing and
presentation
Compilation of
final report

56
Appendix iv: Budget

Activities Item Unit cost No. of units Total cost

(Kshs) (Kshs)

Literature review Internet access/airtime 500 5 months 2,500

Concept paper Concept paper 500 1 500

Proposal Proposal printouts 300 2 copies 600

development

2 Research assistants 150 30 days 12000

Research questionnaires 7 380 copies 4220

Lunch (2 people) 100 30 days 6000

Data collection Transport (2 people) 100 30 days 9,000

Publication 7,000 1 10,000

Results spiral binding 200 2 copies 400

dissemination

Thesis binding 200 1 200

Total budget Kshs 41,200

57
Appendix v: Map of study area

58