Birth intervals and the risk of perinatal mortality in Indonesia: Findings from a cross-sectional study

Abstract

Objectives To examine the association between birth intervals and perinatal mortality in Indonesia. Design Cross-sectional study using reproductive calendar data from the 2017 Indonesia Demographic and Health Survey. Setting Nationally representative households in Indonesia. Participants A total of 17 171 women aged 15-49 with pregnancies in the 5 years preceding the survey. Women with missing data or multiple births were excluded. Primary outcome measures Perinatal mortality, defined as stillbirths and early neonatal deaths. Results The perinatal mortality rate was 22 per 1000 births. Short birth intervals (<12 months) were associated with a fourfold increase in perinatal mortality compared with intervals of 24-35 (adjusted OR (AOR=4.07; 95% CI 1.71 to 9.69), while long intervals (≥60 months) showed nearly threefold (AOR=2.94; 95% CI 1.42 to 6.09). First births also had increased odds (AOR=3.55; 95% CI 1.67 to 7.56). Women with no antenatal care visits also had increased odds (AOR=5.93; 95% CI 3.57 to 9.85). Older maternal age was associated with a greater risk (AOR per year 1.03; 95% CI 1.01 to 1.06). Being male was also associated with greater odds of perinatal mortality compared with being female (AOR=1.65; 95% CI 1.20 to 2.26). Conclusions Short and long birth intervals were associated with higher perinatal mortality in Indonesia, with additional associations observed for antenatal care visits, maternal age and newborn sex. These findings underscore the importance of promoting healthy birth spacing within maternal and child health programmes and integrating postpartum family planning into routine care. Further longitudinal research is needed to confirm causal pathways and inform targeted interventions.