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Original article
Associations between contraception and stunting in Guatemala: secondary analysis of the 2014–2015 Demographic and Health Survey
  1. David Flood1,2,
  2. Ashley Petersen3,
  3. Boris Martinez1,
  4. Anita Chary1,4,
  5. Kirsten Austad1,5,
  6. Peter Rohloff1,6
  1. 1 Wuqu' Kawoq, Santiago Sacatepéquez, Guatemala
  2. 2 Departments of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, Michigan, United States
  3. 3 Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
  4. 4 Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States
  5. 5 Department of Family Medicine, Boston University School of Medicine, Boston, Massachusetts, United States
  6. 6 Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States
  1. Correspondence to Dr Peter Rohloff; prohloff{at}bwh.harvard.edu

Abstract

Background There has been limited research on the relationship between contraception and child growth in low-income and middle-income countries (LMICs). This study examines the association between contraception and child linear growth in Guatemala, an LMIC with a very high prevalence of child stunting. We hypothesise that contraceptive use is associated with better child linear growth and less stunting in Guatemala.

Methods Using representative national data on 12 440 children 0–59 months of age from the 2014–2015 Demographic and Health Survey in Guatemala, we constructed multivariable linear and Poisson regression models to assess whether child linear growth and stunting were associated with contraception variables. All models were adjusted for a comprehensive set of prespecified confounding variables.

Results Contraceptive use was generally associated with modest, statistically significant greater height-for-age z-score. Current use of a modern method for at least 15 months was associated with a prevalence ratio of stunting of 0.87 (95% CI 0.81 to 0.94; p<0.001), and prior use of a modern method was associated with a prevalence ratio of stunting of 0.93 (95% CI 0.87 to 0.98; p<0.05). The severe stunting models found generally similar associations with modern contraceptive use as the stunting models. There was no significant association between use of a modern method for less than 15 months and the prevalence ratio of stunting or severe stunting.

Conclusions Contraceptive use was associated with better child linear growth and less child stunting in Guatemala. In addition to the human rights imperative to expand contraceptive access and choice, family planning merits further study as a strategy to improve child growth in Guatemala and other countries with high prevalence of stunting.

  • comm child health
  • epidemiology
  • growth
  • health services research

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors DF conceptualised the study, conducted the statistical analysis, wrote the initial manuscript draft and revised the manuscript. AP conducted the statistical analysis and revised the manuscript. BM, AC and KA assisted in the interpretation of the statistical models and revised the manuscript. PR conceptualised the study, assisted in designing and interpreting the statistical models and revised the manuscript. All authors reviewed and approved the final manuscript.

  • Funding This research was supported by the National Institutes of Health’s National Center for Advancing Translational Sciences, grant UL1TR002494.

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health’s National Center for Advancing Translational Sciences.

  • Competing interests PR is an AE for BMJ Open Paeds. No other competing interests.

  • Ethics approval The use of survey data for this study was approved by Demographic and Health Survey.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository.

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