The status of Ohio’s women: Birth spacing

Late last year, The Center for Community Solutions released fact sheets on the Status of Women for each of Ohio’s 88 counties that include a cross section of indicators about women including health, economic, civic and education levels. Modeled after a national report on the Status of Women, by the Institute for Women’s Policy Research, in which Ohio received a C-, our reports provide insight into how Ohio’s women fare at the county level and hopefully will inspire work to improve one or more of the metrics.

Pregnancies timed too close to previous births are linked to premature births

In the fact sheets, we included the following health indicators:

  • Access to a Community Health Center
  • Insurance status and type
  • Disability
  • Age-adjusted chronic disease death rate
  • Preterm births
  • Teen births
  • Late-stage cervical cancer diagnosis

Other health-related indicators we pursued were maternal mortality, behavioral health, family planning access and domestic violence. Since the release, we have received data on family planning access, interpregnancy interval, and maternal mortality by county. This piece will discuss interpregnancy interval more commonly known as birth spacing.

Tied closely to our January piece on family planning services access, birth spacing is an important, and not often discussed, driver of maternal and infant health outcomes.

Pregnancies timed too close to previous births are linked to premature births – the largest independent driver of infant mortality and health issues among infants. Closely spaced pregnancies can also pose a risk for complications that may impact maternal health. Adequate birth spacing is defined as 18 months or more, from a birth to the next pregnancy. The timing ensures maternal recovery to support the next pregnancy.

Birth spacing has become a central feature of maternal and infant health initiatives and social marketing campaigns across the state, to inform women and their caregivers of the importance of ‘safe spacing’ and health care in between pregnancies.

Birth spacing is an important, and not often discussed, driver of maternal and infant health outcomes.

The Ohio Department of Health maintains data on birth spacing, known as interpregnancy interval (IPI), using vital records reports.

Among the 69,872 births in Ohio in 2018 for which IPI can be calculated, 44,263 or 63.3 percent had an IPI of 18 months or more.* Births among Asian American Ohioans were the most likely to have an IPI of 18 months or more (75.6 percent) and births among non-Hispanic White Ohioans were the least likely to have an IPI of 18 months or more (62.4 percent).

Percent of Second or Higher Order Births with an Interpregnancy Interval* (IPI) ≥ 18 Months by Race/Ethnicity, Ohio, 2018   
Race/EthnicityNumber of Births**Number of Births with ≥ 18 months IPIPercent of Births with ≥ 18 months IPI
American Indian846071.4
Asian, Non-Hispanic2102158975.6
Black, Non-Hispanic12658800663.2
White, Non-Hispanic506213158062.4
Other or Unknown24816566.5
Data Source: Ohio Department of Health, Bureau of Vital Statitics
Compiled by Andrea Arendt
* Interpregnancy interval (IPI) is the time between the birth of one infant and conception of the next.
** Number of births refer to the the number of births in which IPI can be calculated. It excludes first order births, multiple gestations, and births where the last pregnancy did not end in a live birth. Additionally, birth records that have missing data for date of last live birth and/or gestational age are excluded.


Mercer, Vinton and Wayne counties had the lowest percentage of eligible births with an IPI of 18 months or greater, only about half. Athens and Lawrence counties had the highest proportion of eligible births with an IPI equal to or greater than 18 months, close to 70 percent.

Cuyahoga County has a rate above the state average, at 66.3 percent and when broken down by race and ethnicity mirrors women across the state. Asian American residents have the highest percentage of births with an IPI of 18 months or more – 74 percent. Non-Hispanic White women have the lowest percentage of birth with adequate birth spacing – 63 percent.

Nationally, approximately 67 percent of pregnancies have an IPI of 18 months or more and the proportion is higher among Hispanic women and non-Hispanic White women compared to non-Hispanic Black women.


This data was provided by the Ohio Department of Health. The Department is not responsibility for any analyses, interpretations or conclusions.

Contact: Andrea Arendt,