An Analysis of Birth Intervals and Influencing Factors Among Women of Reproductive Age: Evidence from Ghana

Abstract Birth spacing remains a critical determinant of maternal and child health, yet marked socioeconomic and geographic inequalities persist in many low- and middle-income countries. This study examines the determinants of succeeding birth intervals among Ghanaian women aged 15–49 using nationally representative data from the 2022 Ghana Demographic and Health Survey. A survey-weighted Cox proportional hazards model was employed to account for right-censoring and the complex multistage sampling design. The outcome variable was the duration, in months, between consecutive live births. The findings reveal pronounced structural gradients in birth spacing. Higher household wealth and maternal secondary education were associated with significantly lower hazards of a subsequent birth, indicating longer intervals. Partner’s secondary and higher education demonstrated similar protective effects. Rural residence, certain regional contexts, specific ethnic affiliations, and older partner age were associated with elevated hazards. A strong parity gradient was observed, with higher birth orders associated with substantially reduced hazards of another birth. The survival status of the index child emerged as a key predictor, consistent with replacement dynamics following child mortality. Diagnostic testing confirmed that proportional hazards assumptions were satisfied and multicollinearity was minimal. Generally, birth spacing in Ghana is shaped more strongly by structural and contextual determinants than by individual demographic characteristics such as maternal age or employment. Policies aimed at reducing reproductive health inequalities must therefore prioritize equitable access to family planning, expansion of female education, and regionally tailored reproductive health interventions.