Oklahoma ranks #29 of 51 states (including D.C.) for healthy birth spacing. Idaho ranks first, with 70% percent of women experiencing birth spacing between eighteen months and 5 years. Florida has the most room for improvement, with a little more than half of mothers (56%) experiencing health birth spacing .
Percentage of mothers in 2024 who had a second birth within an interval of less than 18 months.
The data reflected represents the number of births to women who previously had a live birth less than 18 months prior. The data sometimes refers to a lack of healthy birth spacing as rapid repeat births.
There’s rarely a “perfect” time to start a family. However, allowing for time in between giving birth is important to protect the health of mothers and their children, and can improve outcomes later on.
1 in 3 women get pregnant sooner than the ACOG-recommended interpregnancy interval. Pregnancies that start less than 18 months after a previous birth (also called a “rapid repeat pregnancy”) are associated with delayed prenatal care (see Adequate Prenatal Care) and adverse birth outcomes. These unfavorable birth outcomes include preterm birth (see Preterm Birth), neonatal morbidity (see Infant Mortality), and low birthweight (see Low Birthweight). In addition, children born without at least 18 months of birth spacing are at greater risk of developing asthma, vision and hearing loss, and may experience developmental delays.
That said, spacing births too far apart can come with its own set of challenges. Waiting longer than 5 years between pregnancies has been linked to increased risk of preeclampsia, preterm birth, low birth weight, and having a c-section delivery.
Some women are at higher risk of unintentional, unhealthy birth spacing compared to others. Women who are under 20 years old, have less than a high school education, are unmarried, and women of color are all at higher risk for experiencing a rapid repeat pregnancy.
Repeat pregnancies are common among teen mothers – each year, nearly 1 in 5 teen births in the US are repeat births. In Oklahoma, 59% of teen moms report that their repeat pregnancy was unintended, and those with less than a high school education or living in rural areas had higher rates of repeat births compared to other teen moms. Preventing teen pregnancy and repeat teen births can reduce the negative impacts associated with teen childbearing (see Teen Birth Rate). Further, studies have found that children of teen parents are at a greater risk than children of older parents for a host of social, economic, and health-related problems.
The Centers for Disease Control and Prevention WONDER portal was used to find the most recent data on pregnancy intervals to determine state rankings. For each state, the number of births occurring 18 months to 59 months after a previous live birth were totaled and then divided by the state’s total number of births that year. Births in which there wasn’t a previous live birth and cases where the previous birth status/interval was “unknown” were eliminated from calculations to ensure accuracy.
Oklahoma previously ranked #33 (of 50 states) in 2022, with 60.9% of women experiencing healthy birth spacing. This rose to 61.8% in 2024, moving us to #29. Notably, policy changes in 2023 that improved maternal health outcomes likely also contributed to improvements in birth spacing.
In January 2023, the Oklahoma Healthcare Authority increased SoonerCare/SoonerSelect’s income threshold for full-scope pregnancy-related benefits from 138% to 205% of the FPL and extended coverage from 60 days after a pregnancy ends to 12 months postpartum. This significantly increased the availability of care and the number of women able to receive it. In particular, expanding coverage to 12 months postpartum allowed for prolonged access to contraception and family planning services, which is proven to prevent rapid repeat pregnancies (RRP). Continuous coverage also increases patient access to providers, allowing for more opportunities to ensure that women’s postpartum and family planning needs are being addressed. These consultations with healthcare professionals during the prenatal and immediate postpartum period – especially contraceptive counseling – are linked to a lower risk of RRP.
Additionally, in July 2023, Oklahoma became the 11th state to cover doula services under its Medicaid program. Doula care has been proven to improve maternal health outcomes and provide women with invaluable support – even increasing women’s health literacy and confidence in motherhood. We can assume that this includes heightened awareness about healthy birth spacing, but more research is needed. Future studies should explore connections between doula usage and reduced risk of rapid repeat pregnancy.
This issue brief was written by Metriarch staff as part of our Data Lookbook. Contributions and peer review were provided by Alice Blue with Take Control Initiative.
Suggested citation
Metriarch. “Maternal and Child Health,” Data Lookbook (2025). URL: metriarchok.org/healthy-birth-spacing.
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