Contraception and Breastfeeding at 4 Months Postpartum Among Women Intending to Breastfeed

Prevalence, patterns, and determinants of breastfeeding cessation among mothers of children under 24 months in Uganda

BACKGROUND

Breastfeeding duration is a critical component of infant and child nutrition, providing immediate and long-term benefits to both children and their mothers. This study uses data from the lot quality assurance sampling (LQAS) survey to examine the prevalence, patterns, and determinants of breastfeeding cessation in Uganda.

METHODS

This study was a secondary analysis of data collected by the cross-sectional LQAS surveys in 2021 and 2022 covering 77 districts in Uganda. The LQAS survey methodology employs a systematic sampling approach to assess whether predefined quality standards are met within specific subgroups of a population. The study employed spatial analysis, bivariate analysis and logistic regression, both with and without clustering, to explore associations between independent variables and breastfeeding cessation. Unadjusted and adjusted odds ratios with 95% confidence intervals were calculated. Statistical significance was set at 5%.

RESULTS

Overall, the study analysed 26,377 records of mothers with children under 24 months old. The mothers' mean age was 27.9 years while that of their children was 11.0 months. While the general breastfeeding cessation rate was 17.7%, cessation was highest (49.7%) among mothers of children 18-23 months. Factors associated with increased odds of breastfeeding cessation included older child's age, older mother's age, using modern family planning, being pregnant and having an unknown pregnancy status. Lower odds of breastfeeding cessation were observed among mothers who; were married, lived in larger households, lived in rural residences, whose children received vitamin A supplementation and among all other regions compared to Kampala.

CONCLUSION

One in five mothers cessed breastfeeding before their child reached 2 years, with a significant increase in cessation odds among mothers of older children. These findings underscore the importance of interventions to promote breastfeeding continuation and adequate nutrition for non-breastfed infants, particularly in regions with high cessation rates.

Safety of Progestogen Hormonal Contraceptive Methods during Lactation: An Overview

BACKGROUND

Breastfeeding is a process for not only nourishing infants but also for building a unique emotional bond between mother and child. Therefore, the ideal contraception during lactation should not affect lactation (milk composition, milk volume) and offspring development.

OBJECTIVES

This study aims to analyze the literature on the safety of progestogen hormonal contraceptive methods during lactation.

METHODS

We conducted a thorough search across various databases, including the National Library of Medicine (PubMed), and the Cochrane Database, Drugs and Lactation Database (LactMed). Our search utilized specific phrases such as: "lactation" and "breastfeeding" and "oral contraception" with "drospirenone" or "desogestrel", with "subcutaneous etonogestrel implant" or "etonogestrel implant", with "levonorgestrel-releasing intrauterine system", and "emergency contraception", with "levonorgestrel" or "ulipristal acetate".

CONCLUSIONS

Based on published scientific reports, progestogen hormonal contraceptives can be considered a relatively safe solution for women desiring to continue feeding their infant with their milk while using hormonal contraception. It is important to seek guidance on selecting the best contraception method based on the latest medical knowledge, tailored to the individual needs and clinical circumstances of each woman and place of residence. A woman should always be informed of the potential risks of such a treatment and then allowed to make her own decision based on the knowledge received from a specialist.

Breastfeeding and Hormonal Contraception: A Scoping Review of Clinical Guidelines, Professional Association Recommendations, and the Literature

Background: Postpartum contraceptive use can help prevent short-interval pregnancies, which have been associated with adverse neonatal and maternal health outcomes. Many contraceptive methods are safe for postpartum use, but patients and providers may be confused as to what impact hormonal contraception has on lactation. We performed a scoping review of the most recent U.S.-based guidelines regarding hormonal contraception on lactation to provide synthesis and recommendations to aid providers in counseling their patients. Methods: We conducted a scoping review by identifying the most recent clinical recommendations and guidelines from the Centers for Disease Control and Prevention (CDC) and three maternal and child health professional associations (American College of Obstetricians and Gynecologists [ACOG], Society for Maternal-Fetal Medicine [SMFM], and Academy of Breastfeeding Medicine [ABM]). We also reviewed the citations in these guidelines used in their development. We then conducted an updated literature review to capture studies published since the most recent systematic reviews were conducted. Results: We reviewed 1 clinical guideline from the CDC and 2 systematic reviews cited in its references, 6 professional association recommendations, and 28 publications identified through the updated literature review. Progestin-only contraceptive methods continue to demonstrate safety in breastfeeding patients, while low-quality evidence supports concerns of decreased milk supply with combined hormonal contraception. Discussion: Organizations should consider updating counseling recommendations regarding progestin-only contraceptives and lactation. Further research is needed to examine new contraceptive methods as well as the effect of hormonal contraception on lactation in the setting of preterm birth.

Associations Between Prenatal Intention and Postpartum Choice: Infant Feeding and Contraception Decisions Among Inner-City Women

Purpose: We sought to understand how women's prenatal infant feeding and contraception intentions were related to postpartum choices. Materials and Methods: Expectant women ≥14 years of age receiving care at MacDonald Women's Hospital, Cleveland Ohio were previously surveyed regarding feeding and contraceptive intentions. Here, we asked: (1) What were postpartum feeding choices, and did prenatal intention predict postpartum choice?, (2) What were postpartum contraceptive choices, and did prenatal intention predict postpartum choice?, and (3) What was the relationship of postpartum contraceptive choice to postpartum feeding choice? Results: Of 223 women interviewed prenatally, 214 (96%) were followed to postpartum in-hospital, and 119 out of 214 (56%) were followed to the postpartum visit. The mean age was 25 years, 185 out of 206 (89.8%) were African American, and 149 out of 200 (75.0%) were multiparous. Prenatal feeding and contraceptive intent were significantly associated with postpartum feeding and contraceptive choices, respectively (both p < 0.0001). More women who initiated breastfeeding chose no contraception (54.5% for any breastfeeding versus 32.2% for exclusive formula feeding) versus long-acting reversible contraception (LARC), tubal ligation, or other contraceptive types (χ² = 9.28, p = 0.03). After adjusting for known confounders, only receipt of other contraceptive types (not LARC, not tubal ligation) was significantly associated with decreased odds of any breastfeeding (p = 0.02). Conclusions: Among low-income predominantly African American inner-city women, prenatal intentions were significantly associated with postnatal choices for infant feeding and contraception. After controlling for confounders, women receiving less effective types of contraception (not LARC and not tubal ligation) had reduced odds of any breastfeeding (p = 0.02).