Dangers of pregnancy among older women and those with many children rarely discussed

July 4, 2018, Johns Hopkins University Bloomberg School of Public Health

Harmful gender, religious and cultural norms contribute to risky pregnancies in older women and women who already have five or more children, endangering the lives of these women and their babies, suggests new research from the Johns Hopkins Center for Communication Programs. CCP is based at the Johns Hopkins Bloomberg School of Public Health.

In many low- and middle-income African countries – including Niger and Togo, which the CCP team studied – these risky pregnancies are rarely discussed in family planning and reproductive health programs. The findings are published in the June issue of the journal Global Health: Science and Practice.

"In many settings, it is all but impossible to discuss the taboo concept of spacing childbirths or to even bring up the increased risks to mother and child associated with having too many children or having children after the age of 35," says study co-author Erin Portillo, MPH, a program officer for CCP and its Breakthrough ACTION project. "We heard one story about a provider who discussed these risks and then clients no longer wanted to see her because there was a perception that she was wishing ill will on them. Long-held social norms are keeping from understanding the dangers associated with these types of pregnancies."

Niger has the highest fertility rate in the world, with 7.6 children born per woman – a figure that has actually increased in recent years. Women in Niger, in a 2012 survey, on average, said the ideal number of children in a family is more than 9. Men said more than 12. Niger is a conservative Muslim country where discussions of limiting pregnancies are largely forbidden, though the government has committed to increase the rate of contraceptive use to 50 percent by 2020 (from 10.8 percent in 2012).

Togo's fertility rate is 4.8 children, though it has been decreasing, as have perceptions of the ideal family size.

The researchers conducted focus groups and in-depth discussions between January and March 2015 at one urban site and two rural locations each in Niger and Togo to understand how perceptions and attitudes influence choices about reproduction for older women and those who already have many children.

They learned that in Niger participants saw itself as a perilous situation for women but did not think that age or family size compounded the risk. Participants there said that Islam forbids any interference with reproduction and that large families were a benefit, which added to a family's wealth and provided security in old age.

They also found that, in Niger, women in polygamous situations feared less attention from their husbands, fewer resources and eventual losses in social status and inheritance if they had too few children – a fear that some men confirmed.

"Really, it's not good to limit births to three, four or five children," one man in urban Niger told interviewers. "It's not our culture."

After conducting the research, the CCP-led Health Communication Capacity Collaborative (HC3) project created the Healthy Timing and Spacing of Pregnancy Implementation Kit (I-Kit), focused exclusively on addressing pregnancy risks among women 35 and older and those with five or more children. The I-Kit includes context and information on such pregnancy risks, key messages and calls to action for specific audiences, and explains how to integrate such information into existing programs using social and behavior change communication. It also includes a collection of ready-to-use or adaptable health communication tools such as brochures, posters and guides for working with community-based groups and journalists to help them report on the issues and bring them to a wider audience.

Organizations in Niger and Togo adapted and piloted the I-Kit. In Niger, the program reached nearly 13,000 women; in Togo, it reached more than 3,300. The organizations applying the I-Kit have integrated some of the messages into their daily work and found that "discussing the risks led women to share with others their personal experiences with pregnancy or birth complications, realizing for the first time that age or parity [number of children] may have played a role."

While the researchers did not have the opportunity to collect specific data to measure behavior change among these audiences, there were lessons learned and recommendations made about how others could adapt the I-Kit moving forward. Among the lessons was that materials should be adapted to large groups in order to make it easier to convert the counseling guides into a less personal, group discussion format.

They also learned that, particularly in more conservative settings, the emphasis should be on managing and planning to reduce the risks of bearing children once a woman reaches age 35 or when a woman already has five children, rather than on solely avoiding pregnancy among those women. "Participants in Niger especially questioned that five were too many, and participants in both countries had difficulty accepting age 35 as an age to slow or stop childbearing," the researchers report.

The researchers also suggested that tailoring materials to younger women and to men could help them learn to avoid the risks of multiple births for and that the materials could be used on a broader scale in other low- and middle-income countries.

Explore further: 2,500 Niger children die of malnutrition in 2013: UN

More information: Khadidiatou Ndiaye et al. High-Risk Advanced Maternal Age and High Parity Pregnancy: Tackling a Neglected Need Through Formative Research and Action, Global Health: Science and Practice (2018). DOI: 10.9745/GHSP-D-17-00417

Related Stories

2,500 Niger children die of malnutrition in 2013: UN

October 16, 2013
More than 2,500 children under five have died of malnutrition in Niger this year, the UN Children Fund said Wednesday.

University of Michigan professor, graduate work together to empower Sudanese women

May 9, 2018
South Sudanese women have among the highest fertility rates and maternal death rates in the world, yet cultural norms still frown upon contraceptives—even to make pregnancy and birth safer for women.

Plans for children often derailed by chronic illness

March 20, 2018
More than four million Australian women of childbearing age are living with chronic conditions like diabetes, cystic fibrosis and asthma, and many are not aware of the implications their illness has for childbearing, according ...

High-birth Niger strives to lower maternal mortality

June 28, 2014
With the world's highest birth rate in a country where first-time mothers are often barely past puberty, having a baby in impoverished Niger can be tantamount to a death sentence.

Family planning for 'healthier, wealthier' Africa: Melinda Gates

December 14, 2016
Family planning helps people in Africa to be healthier and wealthier, as women without contraceptives become locked in "a cycle of poverty," Melinda Gates told AFP as a conference on the topic was held in Ivory Coast.

Over five million children get polio vaccines in Niger: UN

April 17, 2018
More than five million children were vaccinated against polio in Niger last month, the UN said Tuesday, adding that the number was higher than the target.

Recommended for you

Low-carb diets cause people to burn more calories

November 14, 2018
Most people regain the weight they lose from dieting within one or two years, in part because the body adapts by slowing metabolism and burning fewer calories. A meticulous study led by Boston Children's Hospital, in partnership ...

Survey reveals how we use music as a possible sleep aid

November 14, 2018
Many individuals use music in the hope that it fights sleep difficulties, according to a study published November 14 in the open-access journal PLOS ONE by Tabitha Trahan of the University of Sheffield, UK, and colleagues. ...

Colder, darker climates increase alcohol consumption and liver disease

November 14, 2018
Where you live could influence how much you drink. According to new research from the University of Pittsburgh Division of Gastroenterology, people living in colder regions with less sunlight drink more alcohol than their ...

Want to cut down on your meds? Your pharmacist can help.

November 14, 2018
Pharmacists are pivotal in the process of deprescribing risky medications in seniors, leading many to stop taking unnecessary sleeping pills, anti-inflammatories and other drugs, a new Canadian study has found.

Your heart hates air pollution. Portable filters could help

November 13, 2018
Microscopic particles floating in the air we breathe come from sources such as fossil fuel combustion, fires, cigarettes and vehicles. Known as fine particulate matter, this form of air pollution increases the risk of cardiovascular ...

No accounting for these tastes: Artificial flavors a mystery

November 13, 2018
Six artificial flavors are being ordered out of the food supply in a dispute over their safety, but good luck to anyone who wants to know which cookies, candies or drinks they're in.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.