Gynaecologists warn against closely spaced pregnancies, cite stillbirth risks

Leading obstetricians and gynaecologists have warned that the growing trend of having children in quick succession, popularly referred to as “two-under-two,” is increasing the risk of maternal death, stillbirth, preterm birth, low birth weight, anaemia, uterine rupture and postpartum depression.

They noted that short birth intervals are a serious but often overlooked public health concern contributing to Nigeria’s high maternal mortality ratio and placing additional strain on the country’s overstretched healthcare system.

The maternal and reproductive health experts stressed that the World Health Organisation recommends at least 24 months between a live birth and the next pregnancy, noting that the interval allows the mother’s body to recover, replenish lost nutrients and heal properly.

The warning comes amid a wave of social media posts where some mothers promote having children in quick succession, often using phrases like “two-under-two” to encourage others.

However, the specialists said while social media has amplified the trend, it predates online platforms and is rooted in cultural expectations, low contraceptive uptake, desire for specific genders, fear of secondary infertility, and poor awareness of the health consequences.

In exclusive interviews with PUNCH Healthwise, the gynaecologists stated that about 51 per cent of pregnancies in Nigeria have short birth intervals, with the highest burden recorded in the North.

They called for routine postpartum contraceptive counselling, integration of birth spacing education into antenatal care, and coordinated efforts by healthcare professionals to counter misleading narratives with evidence-based information.

Without urgent systemic action, they warned, the health system, already strained by brain drain and poor infrastructure, would continue to grapple with preventable complications.

According to the United Nations Children’s Fund, child spacing refers to the interval between births, with optimal spacing recommended at two to three years.

The WHO also advises waiting at least 24 months after a live birth and six months after a miscarriage or abortion before attempting another pregnancy.

Globally, the organisation notes that anaemia affects 37 per cent of pregnant women and contributes to 20 per cent of maternal deaths in Africa.

Providing expert insight, a Professor of Obstetrics and Gynaecology at the University of Uyo, Akwa Ibom State, Aniekan Abasiattai, said the physiological demands of pregnancy make adequate spacing medically essential.

He explained that pregnancy depletes key nutrients such as iron, especially in women with low reserves, and insufficient recovery time increases the risk of complications.

“The body stores nutrients, and during pregnancy, these stores, especially micronutrients like iron, are depleted. The body needs time to replenish them before another pregnancy,” he said.

Abasiattai listed anaemia, premature labour, poor foetal growth, stillbirth, postpartum haemorrhage, gestational diabetes, placental abruption and maternal death among complications linked to short birth intervals.

He added, “Women who are anaemic tend to succumb earlier to postpartum haemorrhage. They also face higher risks of gestational diabetes and placental abruption, which can lead to foetal death. There is also increased risk of uterine rupture, preeclampsia and postpartum depression.”

The don further warned that short intervals could weaken the uterus, particularly in women with previous caesarean sections, raising the risk of rupture in subsequent pregnancies.

“That scar must heal properly to prevent rupture if the woman attempts vaginal delivery later,” he said.

The professor added that beyond medical risks, the trend increases healthcare costs and weakens family stability when mothers fall ill or die.

Abasiattai urged women to prioritise their health, noting that the consequences of neglect often fall disproportionately on them and their children.

“If anything happens to a woman, the husband remarries, sometimes even before she is buried. Women must prioritise their health because survival means being able to care for their children,” he said.

Also speaking, a Professor of Obstetrics and Gynaecology at Usmanu Danfodiyo University, Sokoto, Abubakar Panti, described short birth spacing as a persistent public health issue.

He said clinical data showed that about 51.6 per cent of Nigerian women have short birth intervals, rising to over 60 per cent in the North.

“We see it often. Some women get pregnant again within six or seven months. You may find a 22-year-old already on her fourth or fifth pregnancy,” Panti said.

The professor dismissed claims that the trend is driven mainly by social media, noting that platforms merely amplify existing practices.

“Social media is repackaging what already exists. The problem is low uptake of family planning. Online content highlights success stories but rarely discusses complications,” he said.

Panti explained that short birth intervals pose risks to both mother and child, especially when pregnancy occurs during breastfeeding.

“It places significant stress on the mother and increases the risk of preterm birth, intrauterine growth restriction, low birth weight, stillbirth and neonatal death,” he said.

Panti added that maternal risks include anaemia, nutritional depletion, incomplete uterine healing, pelvic floor damage, fatigue, bleeding disorders and postpartum depression.

The don identified drivers of the trend to include cultural pressure to complete childbearing early, competition in polygamous homes, preference for a particular gender, fear of infertility, and poor access to family planning services.

He warned that the trend is worsening pressure on Nigeria’s fragile health system, leading to more high-risk pregnancies and increased neonatal intensive care admissions.

“Two-under-two is not inherently reckless, but it goes against the body’s natural recovery timeline,” he said.

He advocated routine postpartum contraception counselling and urged healthcare providers to counter misinformation with accurate, balanced information.

Panti also urged women to make informed decisions based on medical advice rather than social media trends, emphasising that proper birth spacing remains critical to improving maternal and child health outcomes.