title: Local understandings and current barriers to optimal birth intervals among recently delivered women in Sylhet District, Bangladesh.
abstract: BACKGROUND
  Sylhet Division in Bangladesh has the highest proportion of births spaced less than 36 months (46.5%) in Bangladesh.
  
  
  METHODS
  Formative research was conducted on current fertility-related practices in order to explore how to integrate the promotion of healthy fertility practices into a package of maternal and neonatal care interventions. In-depth interviews, focus group discussions and other qualitative methods were utilized with recently delivered women, their families, community health workers and community leaders in Sylhet Division.
  
  
  RESULTS
  Mothers of young children generally understood the benefits of both healthy timing and spacing of pregnancies. However, a variety of factors prevent these desired behaviours from becoming actualized, including the roles of women in the provision of children/grandchildren, local understandings of modern contraceptive methods, perceived side effects, lack of communication regarding healthy fertility practices between partners and extended family members, and limited female autonomy.
  
  
  CONCLUSIONS
  In order to increase families' ability to achieve optimal birth intervals, we propose the promotion and integration of healthy fertility practices into antenatal and newborn care interventions, focusing on providing biomedically correct and culturally appropriate information on modern contraceptive methods to the entire family, while simultaneously encouraging open spousal and family communication patterns regarding timing and spacing of pregnancy.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland USA.
authors.forename: Nicholas B
authors.initials: NB
authors.lastname: Lehnertz
authors.forename: Ashraful
authors.initials: A
authors.lastname: Alam
authors.forename: Nabeel Ashraf
authors.initials: NA
authors.lastname: Ali
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Henry
authors.forename: Emma K
authors.initials: EK
authors.lastname: Williams
authors.forename: Syed Moshfiqur
authors.initials: SM
authors.lastname: Rahman
authors.forename: Salahuddin
authors.initials: S
authors.lastname: Ahmed
authors.forename: Shams
authors.initials: S
authors.lastname: El Arifeen
authors.forename: Abdullah H
authors.initials: AH
authors.lastname: Baqui
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Winch
mesh_terms: D001459:Bangladesh; D001721:Birth Intervals / Q000706:statistics & numerical data*; D003150:Community Health Workers; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003469:Culture; D005190:Family; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D009035:Mothers / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors
keywords: Bangladesh; Birth spacing; Family planning