Background; Population growth is a major challenge in most developing countries, and Uganda is no exception to this. In Uganda, the rate of population growth is 3.2% (UBOS, 2012), which can be attributed partly to an imbalance between infant mortality and fertility. Short birth intervals are associated with an increased risk of adverse health outcomes, including infant, child and maternal mortality. Short birth intervals (< 2 years) can lead to maternal depletion syndrome, milk diminution and competition between siblings close in age for food and other resources. Objective; The objective of this study was to assess the actual and preferred birth intervals of the women in Mbale regional referral hospital Methods; This study adopted a cross-sectional study design. This design was chosen because it could collect data to make inferences about a population of interest (women attending ANC) at one point in time. The study population included women who were attending both antenatal clinics and post natal clinics in outpatient departments who had had at least two children prior to the current pregnancy or had already two children respectively. Data was collected from the women using a variety of methods including interviews and tools. Results; Socio economic factors such as education of the mother/husband, occupation of the mother, transport costs to the hospital, paying some extra fee (bribe) to health workers before getting the service, affordability of services offered by the health centers, whose decision to have the current pregnancy, cultural influence to have shorter or long birth intervals, showed a statistical significance with actual and preferred birth intervals with p values 0.000 (p<0.05). Socio demographic factors like residence, age of mother, and age at first pregnancy were found to be significantly related to the birth spacing where as for community factors, breast feeding of the previous last child, duration of breast feeding, whether they exclusively breastfed their children, community perception on the use of family planning methods and community preferences on the gender of children to birth to showed a statistical significance with actual and preferred birth intervals. Conclusion; Socio economic and demographic factors of the women play a major role in determining birth intervals. Recommendations; Policy makers need to consider the potential for lengthening birth intervals in Uganda where the median birth interval is close to 3 years (2.88 years). Data from other African countries suggests that even in situations when women wish to increase spacing it is by no more than six months (Rafalimanana and Westoff, 2001). It has been found that women who are educated tend to have longer birth intervals, therefore girl child education should be further boosted to increase their literacy rates.

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