Effectiveness of lactational amenorrhoea in prevention of pregnancy in Manila, the Philippines: non-comparative prospective trail

Challenges and Supports of Breastfeeding at Workplace in Indonesia

Due to increased number of women workers in Indonesia in the last decade, numbers of women living as a worker and a housewife have increased. This also increases the potential risk of breastfeeding discontinuation. Three months of maternal leave policy and inadequate lactation promotion support in workplace have been identified as factors that hinder lactating practices. The World Health Organization recommendation of 6 months of exclusive breastfeeding and joined regulation of three Indonesia ministers (Ministry of Health, Ministry of Labour, and Ministry of Women Empower) have failed to improve the exclusive breastfeeding rate among female workers in Indonesia due to the lack of a standardized guideline on lactation promotion at workplace. In addition, very limited or no studies have been conducted to evaluate the impact of workplace-based lactation intervention programs on exclusive breastfeeding rate among female workers. This is because the relationship of lactation with working performance and productivity could not motivate employer to invest in workplace-based lactation promotion facility or program.

Knowledge and associated factors of lactational amenorrhea as a contraception method among postpartum women in Aksum town, Tigray Region, Ethiopia

Objectives

The objective of the study was to assess the prevalence of knowledge level and predictors of lactational amenorrhea method (LAM) as method of contraception among women who gave birth a year prior to the study period in the Aksum town, Tigray Region. The study was cross sectional in design conducted from March 25 to April 24, 2015. Results of the study could help the design of family planning strategies.

Results

The knowledge status of LAM as a contraceptive method was 8.8% [95% CI 6.4–11%)]. Women who delivered at health institution (AOR = 1.4, 95% CI 1.2–4.3), attended postnatal care (AOR = 1.3, 95% CI 1.2–3.0) and visited home and counseled about family planning by health extension in the last 12 months, (AOR = 1.5, 95% CI 1.3–4.0) were more likely found knowledgeable towards LAM. Secondary and above level of the maternal education was also found a significant predictor variable with LAM as a contraceptive method (AOR = 1.2 95% CI 1.1–4.0). Our findings recommend that to address the knowledge gap of mothers; improving the uptake of maternal health services and strengthening family planning counseling at home are a key area for improving the knowledge level of LAM.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3754-2) contains supplementary material, which is available to authorized users.

Catholic social teaching and America's suboptimal breastfeeding rate: Where faith and policy should meet to combat injustice

Despite the numerous health benefits of breastfeeding, few American women breastfeed for the optimal duration of time. Reasons given for not following national and global institutional breastfeeding recommendations are various and multi-faceted. However, for many American women who would like to breastfeed, unjust historical, social, economic, cultural, and environmental factors negatively impact their ability to breastfeed. Catholic social teaching seeks to protect the poor and the vulnerable by working for social and economic justice, encourages stewardship of the environment, and uplifts the family as the most important unit in society. As such, Catholic social teaching has clear implications for individuals and institutions seeking to make breastfeeding a more widespread, accepted practice. In response to the crisis in American rates of breastfeeding, American Catholic healthcare institutions should work to promote the just economic and social conditions necessary for American women to breastfeed their children, starting by implementing breastfeeding-friendly policies for patients and employees in their own institutions.

SUMMARY

For many American women who would like to breastfeed, unjust historical, social, economic, cultural, and environmental factors negatively impact their ability to breastfeed. Catholic social teaching has clear implications for individuals and institutions seeking to make breastfeeding a more widespread, accepted practice. Therefore, American Catholic healthcare institutions should work particularly hard to promote the just economic and social conditions necessary for American women to breastfeed their children, starting by implementing breastfeeding-friendly policies for patients and employees in their own institutions.

Optimizing maternal and neonatal outcomes with postpartum contraception: impact on breastfeeding and birth spacing

Postpartum contraception is important to prevent unintended pregnancies. Assisting women in achieving recommended inter-pregnancy intervals is a significant maternal-child health concern. Short inter-pregnancy intervals are associated with negative perinatal, neonatal, infant, and maternal health outcomes. More than 30% of women experience inter-pregnancy intervals of less than 18 months in the United States. Provision of any contraceptive method after giving birth is associated with improved inter-pregnancy intervals. However, concerns about the impact of hormonal contraceptives on breastfeeding and infant health have limited recommendations for such methods and have led to discrepant recommendations by organizations such as the World Health Organization and the U.S. Centers for Disease Control and Prevention. In this review, we discuss current recommendations for the use of hormonal contraception in the postpartum period. We also discuss details of the lactational amenorrhea method and effects of hormonal contraception on breastfeeding. Given the paucity of high quality evidence on the impact on hormonal contraception on breastfeeding outcomes, and the strong evidence for improved health outcomes with achievement of recommended birth spacing intervals, the real risk of unintended pregnancy and its consequences must not be neglected for fear of theoretical neonatal risks. Women should establish desired hormonal contraception before the risk of pregnancy resumes. With optimization of postpartum contraception provision, we will step closer toward a healthcare system with fewer unintended pregnancies and improved birth outcomes.

Lactational amenorrhoea method for family planning

BACKGROUND

It is estimated that about 40% of pregnancies in the world are unintended and that the major part of these are unwanted. There are several reasons no or ineffective contraception is used to prevent these pregnancies, including difficulty in obtaining contraceptives. The lactational amenorrhoea method (LAM) is a contraceptive method where the mother is informed and supported in how to use breastfeeding for contraception. LAM is available and accessible to many women.

OBJECTIVES

To assess the effectiveness of LAM, as defined in the 1988 Bellagio Consensus statement, as a contraceptive method in fully breastfeeding women, who remain amenorrheic, using pregnancy and menstruation life tables.

SEARCH METHODS

We searched MEDLINE, EMBASE, POPLINE, and LILACS to 10 October 2014; reference lists of studies; review articles; books related to LAM; published abstracts from breastfeeding, reproductive health conferences; e-mails with study coordinators.

SELECTION CRITERIA

Out of 459 potentially relevant studies, 159 investigated the risk of pregnancy during LAM or lactational amenorrhoea. Our inclusion criteria were as follows: prospective study; cases (intervention group) and, if available, controls, had to be sexually active; pregnancy had to be confirmed by physical examination or a pregnancy test. Our endpoints were life table menstruation rates and life table pregnancy rates. We included 15 studies reporting on 11 intervention groups and three control groups. We identified one additional uncontrolled study in the 2007 update and one additional controlled study in this 2015 update.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data, resolving disagreements through discussion. We analysed the studies using narrative methods because of their heterogeneity.

MAIN RESULTS

For the primary outcome, pregnancy, two controlled studies of LAM users reported life table pregnancy rates at six months of 0.45% and 2.45%, one controlled study reported 5% pregnancies in the absence of life table rates per month, and eight uncontrolled studies of LAM users reported pregnancy rates of 0% to 7.5%. Life table pregnancy rates for fully breastfeeding women who were amenorrheic but not using any contraceptive method were 0.88% in one study and 0.9% to 1.2% (95% confidence interval 0.0 to 2.4) in a second study, depending on the definition of menstruation used. The life table menstruation rate at six months in all studies varied between 11.1% and 39.4%.

AUTHORS' CONCLUSIONS

We found no clear differences in life table pregnancy rates between women using LAM and being supported in doing so, and fully breastfeeding amenorrheic women not using any method. As the length of lactation amenorrhoea in women using LAM differed greatly between the populations studied, and was population specific, it is uncertain whether LAM extends lactational amenorrhoea.

Contraceptive failure in the United States

This review provides an update of previous estimates of first-year probabilities of contraceptive failure for all methods of contraception available in the United States. Estimates are provided of probabilities of failure during typical use (which includes both incorrect and inconsistent use) and during perfect use (correct and consistent use). The difference between these two probabilities reveals the consequences of imperfect use; it depends both on how unforgiving of imperfect use a method is and on how hard it is to use that method perfectly. These revisions reflect new research on contraceptive failure both during perfect use and during typical use.

Why do women experience untimed pregnancies? A review of contraceptive failure rates

Contraceptive failure contributes to a substantial proportion of unintended pregnancy, particularly in the developed world. A number of socio-demographic factors seem to impact on the risk of a woman experiencing contraceptive failure. Many of the issues exist across cultural boundaries and are complex to address. In discussing the failure rates for individual contraceptive methods, this article will highlight the advantage of improving uptake of long-acting reversible methods of contraception which have a high efficacy and are less user-dependent than many of the other available methods.

Acceptance of lactational amenorrhoea for family planning after postpartum counseling

OBJECTIVE

To determine the impact of postpartum counseling on the acceptance of lactational amenorrhoea method (LAM) for family planning.

METHODS

In a prospective cross-sectional study 1490 postpartum women were included. Women who accepted or refused LAM for family planning were identified by means of a written survey. Twelve socio-demographic and clinical variables were included as predictors in a logistic regression analysis, the acceptance or refusal of LAM was the dependent variable; an Alpha level was set at 0.05.

RESULTS

There were 807 (54.2%) women who accepted LAM as a contraceptive method; 683 (45.8%) refused it. Main reasons for accepting LAM were: conviction following counseling (54.4%) and use of LAM initially before switching to another contraceptive modality (18.3%). Main reasons for LAM refusal were: belief that the method was unsafe (62.2%) and fear of some undesirable effect on health (15.8%). In the logistic regression analysis the variables occupation outside the home (P = 0.01) and previous knowledge of LAM (P < 0.001) emerged as predictors of LAM acceptance.

CONCLUSIONS

Postpartum counseling of LAM had a very positive impact on its acceptance. Although it is recommended that information about LAM be given antenatally, in some settings postpartum counseling could improve its acceptance rate.

Understanding contraceptive failure

Contraceptive failure is a major source of unintended pregnancy. This chapter will review sources of data and measurement of contraceptive failure, summarize results from the literature on the risks of contraceptive failure during typical and perfect use for available methods of contraception, provide a tool for communicating risks of contraceptive failure to clients, examine determinants of contraceptive failure, and identify methodological pitfalls in the published literature.

Breast-feeding and lactational amenorrhea in the United Arab Emirates

This study was designed to investigate the relation of breast-feeding and weaning practices with the duration of lactational amenorrhea among breast-feeding mothers in the United Arab Emirates. A total of 593 mothers were interviewed in the Maternal and Child Health Centers in three areas: Abu Dhabi, Dubai, and Al Ain. The total mean duration of lactational amenorrhea in this study was 6.1 months, and there was a direct relation with the length of exclusive breast-feeding. The duration of postpartum amenorrhea was the longest in Al Ain (7.2 months), as compared with Dubai (6.9 months) and Abu Dhabi (4.3 months). The age of the infant when formula milk and solid supplements were introduced was significantly related to the duration of lactational amenorrhea. This study confirms the results of other studies concerning the effectiveness of the lactational amenorrhea method as a natural method of contraception for the first 6 months postpartum, especially for mothers who breast-feed exclusively and more frequently and who delay the introduction of food supplements.

Breast-feeding pattern and onset of menstruation among Yoruba mothers of South-west Nigeria

OBJECTIVE

To determine the breast-feeding practices and duration of lactational amenorrhoea among women within the first year of delivery in a Nigerian population.

METHOD

Cross-sectional study carried out between January 2005 and April 2006, among mothers within one year of delivery, who were attending the Infant Welfare Clinic at Wesley Guild Hospital, Ilesa, Nigeria. Using a semi-structured questionnaire, mothers were interviewed to obtain information regarding their socio-demographic characteristics, parity, breast-feeding habits, use of contraception and onset of menstruation after delivery. Information obtained was analysed using the Statistical Package for Social Sciences (SPSS) software version 11.

RESULTS

All 268 (100%) mothers interviewed breast-fed their babies, 261 (97.4%) of which for at least 6 months. Most (71.6%) suckled exclusively for 6 months and more; only 10 (3.7%) never carried out exclusive breast-feeding. Age, parity and educational level did not affect the duration of exclusive breast-feeding. Lactational amenorrhoea lasted 3 months or more in 229 (85.5%) of the mothers. Of the 174 who exclusively breast-fed for 6 months, 109 (62.6%) remained amenorrhoeic during that time and, hence, met the criteria for use of LAM contraception.

CONCLUSION

Exclusive breast-feeding among nursing mothers is highly prevalent among Yoruba mothers of South-west Nigeria. Since lactational amenorrhoea lasts 6 months in about two-thirds of the women nursing for that period of time, there is a great potential for the application of LAM for contraception.

Actual use of the lactational amenorrhoea method

OBJECTIVE

The lactational amenorrhoea method (LAM) is an effective contraceptive option in developing countries. Post-partum, of the women who accept to apply LAM, many never do. Our aim was to determine the actual use of LAM.

METHODS

A group of 326 post-partum women who accepted LAM use were recruited. After 6 months, they were asked if they actually had applied the method or not. In a logistic regression analysis, nine socio-demographic and clinical variables were studied as predictors of actual LAM use. An alpha level was set at 0.05.

RESULTS

Overall, of the 326 women, only 61 (18.7%) actually applied LAM. The mean duration of LAM use was 4.3 +/- 0.2 months. The main reason for not applying LAM was that women thought the method was ineffective (66.0%). The variable time of menses resumption emerged as a predictor of LAM use (p = 0.001).

CONCLUSIONS

Despite post-partum acceptance, most women did not actually apply LAM. In our setting as well as in other developing countries, regular contacts with a health care provider could improve LAM use.

Lactational Amenorrhoea and Modern Contraceptives Use among Nursing Women in Egypt 2003

OBJECTIVES

To evaluate the potential for Lactational Amenorrhoea Method (LAM) and passive LAM among women with children below 6 months in the 2003 Egypt Demographic Health Survey (2003 EDHS), to assess the determinants of amenorrhea, and to examine the association of exclusive breastfeeding and amenorrhea with using modern contraceptive methods among nursing mothers of children below 2 years, adjusting for other associated variables.

METHODS

Data from the 2003 EDHS was downloaded from the DHS website. A sub-sample of women fulfilling all the four criteria were selected: 1) women with last birth of children less than 2 years; 2) currently married; 3) not being sterilized; and 4) currently breast feeding their children. Accordingly, 1934 women entered into the statistical analysis, of them 629 had children below 6 months.

RESULTS

Nearly 24% of nursing mothers with children below 6 months met LAM criteria, of them passive LAM users constituted 79.1%. For women with children below 24 months, determinants of amenorrhea were exclusive breast feeding, unemployment, number of living children, husband education, number of feeding at night, and having a male sex child. Higher education, urban residence, positive attitude towards contraception increased the likelihood of modern contraceptives use, whereas amenorrhea, exclusive breast feeding, and having a wanted child decreased its likelihood in multivariate analysis.

CONCLUSION

Exclusive breast feeding was associated with amenorrhea and modern contraceptive methods use in a direct and inverse fashion respectively. LAM is a commonly used method but it is liable to discontinuation or violation of its criteria. Hence, it is recommended to educate both the health care providers and users about it.

Contraceptive failure in the United States

This review provides an update of previous estimates of first-year probabilities of contraceptive failure for all methods of contraception available in the United States. Estimates are provided of probabilities of failure during typical use (which includes both incorrect and inconsistent use) and during perfect use (correct and consistent use). The difference between these two probabilities reveals the consequences of imperfect use; it depends both on how unforgiving of imperfect use a method is and on how hard it is to use that method perfectly. These revisions reflect new research on contraceptive failure both during perfect use and during typical use.

Lactational amenorrhea is associated with child age at the time of introduction of complementary food: a prospective cohort study in rural Senegal, West Africa

BACKGROUND

In Africa, lactational amenorrhea is the major reason for birth spacing.

OBJECTIVE

We studied whether the early introduction of complementary food to infants is associated with an increased risk of menstruation resumption in rural African women.

DESIGN

Senegalese women (n = 855) were included at 2-3 mo postpartum and followed up at 4-5 and 6-7 mo in dispensaries. A subsample of 502 women were followed up at 9-10 mo and twice yearly at home thereafter. Risk factors for menstruation resumption were assessed with logistic regression, with control for maternal parity, occupation, education, postpartum body mass index, child sex and weight-for-age, and season.

RESULTS

The risk of menstruation resumption was 4.2% (95% CI: 2.8%, 5.6%) at 6-7 mo and 6.5% (4.0%, 8.9%) at 9-10 mo. Compared with the introduction of complementary food after 6-7 mo, introduction at 2-3, 4-5, or 6-7 mo was associated with a greater odds of menstruation resumption at 6-7 mo [odds ratios (ORs): 5.08 (1.01, 25.5), 6.00 (1.29, 27.4), and 4.45 (0.96, 20.6; NS), respectively]. Introduction of food at 4-5 or 6-7 mo compared with that after 6-7 mo was associated with significantly greater odds of menstruation resumption at 6-7 mo (5.13; 1.16, 22.6) but not at 9-10 mo (3.07; 0.65, 14.4; NS) or year 2.

CONCLUSION

Child age at introduction of complementary food was significantly associated with the odds of menstruation resumption at 6-7 mo postpartum.

Efficacy and effectiveness of LAM

Two major protocols of non-randomized clinical trials of the efficacy of the Lactational Amenorrhea Method of contraception (LAM) were performed in the 1990s that suggested LAM to be a highly effective albeit temporary method of contraception. Data from a longitudinal study of over 4000 breastfeeding women performed by the World Health Organization provide supporting information as to the efficacy of LAM. Effectiveness data are scarce, as is information on the use of LAM in industrialized countries. Issues surrounding LAM efficacy and effectiveness are reviewed, and the existing information from industrialized countries is highlighted.

Lactational amenorrhea for family planning

BACKGROUND

50 % of pregnancies are unwanted. For several reasons including difficulty in obtaining contraceptives, no or ineffective contraception is used to prevent these unwanted pregnancies. The Lactational Amenorrhoea Method(LAM) however is a contraceptive method available and accessible for many women.

OBJECTIVES

To assess in fully breastfeeding women, staying amenorrheic, the efficacy of the Lactational Amenorrhoea Method as a contraceptive method. The efficacy of LAM, as defined in 1988 in Bellagio, was compared with alternative definitions of LAM; the outcomes were measured using pregnancy and menstruation life tables.

DATA SOURCES

MEDLINE searches from 1966 until 2002 and EMBASE from 1988 until 2002; reference lists of studies and review articles; books related to LAM; published abstracts from breastfeeding, reproductive health, contraceptive conferences; and e-mail communication with coordinators of such studies.

SELECTION CRITERIA

From 454 potentially relevant studies 154 investigated the risk of pregnancy during LAM or lactational amenorrhea. Two reviewers applied the following inclusion criteria: prospective study, cases and -if available- controls had to be sexually active, pregnancy had to be confirmed by physical examination or a pregnancy test. Life table menstruation rates and life table pregnancy rates were taken as endpoints. Thirteen publications, reporting on 9 intervention groups and 2 control groups, met the inclusion criteria and were included in this systematic review. Their quality was assessed.

DATA COLLECTION AND ANALYSIS

Two reviewers independently extracted data, disagreements were resolved through discussion. Because of the heterogeneity of the included studies, the studies were analyzed using narrative methods.

MAIN RESULTS

For the outcome two controlled studies of LAM users reported life table pregnancy rates at 6 months of 0.45 and 2.45 percent and 5 uncontrolled studies of LAM users reported 0-7.5 percent. Life table pregnancy rates of women fully breastfeeding and amenorrheic but not using any contraceptive method were 0.88 in one study and 0.9-1.2 percent (95% CI 0. 0-2.4 ) in a second study, depending on the definition of menstruation used. The life table menstruation rate at 6 months in all studies varied between 11.1-39.4 percent.

REVIEWER'S CONCLUSIONS

No clear difference in life table pregnancy rates was found between women using LAM and supported in doing so, and fully breastfeeding, amenorroic women not using any method. Because the length of lactation amenorrhoea of women using LAM is too different between populations studied, and population specific, it is uncertain whether LAM extends lactational amenorrhoea.

Nurse-midwives' knowledge and promotion of lactational amenorrhea and other natural family-planning methods for child spacing

The purpose of this study was to describe and assess certified nurse-midwives' (CNMs) knowledge and promotion of two modalities for child spacing, natural family-planning (NFP) and the lactational amenorrhea method (LAM). One thousand two hundred CNMs were randomly selected from a national membership list and mailed a 24-item questionnaire on NFP and LAM. Of the 514 respondents (42.8% return rate), 450 (87.5%) were currently practicing as CNMs. Respondents had an average age of 46 years, with an average of 10 years of practice. CNMs ranked NFP as the ninth most used and the eighth most effective family-planning method in their practice, with an average perceived method-effectiveness of 88% and use-effectiveness of 70%. Although most respondents felt somewhat prepared during their education program to provide NFP, only 22% would offer NFP as a family-planning option for child spacing.

Effects of breastfeeding on the mother

In the rush to find nutrient alternatives to breastfeeding, a theme that dominated research on infant feeding throughout the twentieth century, only recently have new findings that reconfirm the importance of breastfeeding for maternal and child health begun to influence medical texts and health policy. Approximately 30 years of increasingly rigorous and positive research findings have led to the rediscovery of breastfeeding as a valid and evidence-based health intervention for infants. Unfortunately, because much of the research was designed to assess human milk as a nutrient replacement for infant formula, the literature on the effects of breastfeeding on maternal health remain limited. Nonetheless, a clear pattern of positive physiologic changes that lead to improved short-term and long-term health sequelae are emerging. All patients and their families should be informed fully as to the positive preventive health effects of breastfeeding not only for infants but also for mothers. Women have many difficult choices to make; it behooves physicians to ensure that they receive all of the facts on which to base these decisions.

The World Health Organization multinational study of breast-feeding and lactational amenorrhea. III. Pregnancy during breast-feeding. World Health Organization Task Force on Methods for the Natural Regulation of Fertility

OBJECTIVE

To determine the risk of pregnancy during lactational amenorrhea relative to infant feeding status.

DESIGN

Prospective longitudinal study.

SETTING

Five developing and two developed countries.

PATIENT(S)

Four thousand one hundred eighteen breast-feeding mother-infant pairs.

INTERVENTION(S)

Infant feeding practices, menstrual status, and pregnancy were measured.

MAIN OUTCOME MEASURE(S)

Life-table rates of pregnancy.

RESULT(S)

In the first 6 months after childbirth, cumulative pregnancy rates during amenorrhea, depending on how the end of amenorrhea was defined, ranged from 0.9% (95% confidence interval [CI] = 0%-2%) to 1.2% (95% CI = 0%-2.4%) during full breast-feeding, and from 0.7% (95% CI = 0.1%-1.3%) to 0.8% (95% CI = 0.2%-1.4%) up to the end of partial breast-feeding. At 12 months, the rates ranged from 6.6% (95% CI = 1.9%-11.2%) to 7.4% (95% CI = 2.5%-12.3%) during full breast-feeding, and from 3.7% (95% CI = 1.9%-5.5%) to 5.2% (95% CI = 3.1%-7.4%) up to the end of partial breast-feeding.

CONCLUSION(S)

These results support the Bellagio Consensus on the use of lactational amenorrhea for family planning, and confirm that the lactational amenorrhea method is a viable approach to postpartum contraception.

The World Health Organization multinational study of breast-feeding and lactational amenorrhea. IV. Postpartum bleeding and lochia in breast-feeding women. World Health Organization Task Force on Methods for the Natural Regulation of Fertility

OBJECTIVE

To describe and compare the duration of lochia in seven groups of women; to investigate the occurrence of a possible "end-of-puerperium" bleeding episode; and to determine the frequency of bleeding episodes before postpartum day 56, which applies to the practice of the lactational amenorrhea method of contraception.

DESIGN

Prospective longitudinal study with fortnightly follow-up, beginning within 7 days of delivery.

SETTING

Five developing and two developed countries.

PATIENT(S)

Four thousand one hundred eighteen breast-feeding women.

INTERVENTION(S)

Postpartum lochia and all days of bleeding per vaginam were recorded.

MAIN OUTCOME MEASURE(S)

Duration of lochia, frequency of an end-of-puerperium bleeding episode, and frequency of postlochia bleeding episodes within 56 days of delivery.

RESULT(S)

The median duration of lochia was 27 days; it varied significantly among the centers (range, 22-34 days). In 11% of the women, lochia lasted >40 days. An end-of-puerperium bleeding episode around the 40th day postpartum was reported by 20.3% of the women. Bleeding within 56 days of delivery (separated from lochia by at least 14 days) occurred in 11.3% of the women and usually was followed by a confirmatory bleeding episode 21-70 days later.

CONCLUSION(S)

The duration of lochia varied significantly among the study populations, and long durations were not unusual. The significance of the end-of-puerperium bleeding episode is unknown. Most users of the lactational amenorrhea method will not experience a postlochia bleeding episode before postpartum day 56.

Policy considerations for the introduction and promotion of the lactational amenorrhea method: advantages and disadvantages of LAM

Some attributes of LAM are unquestionably positive, such as the fact that it is effective. Clinical trials of LAM have upheld the Bellagio Consensus that the chance of pregnancy is less than 2% in the first 6 months postpartum in amenorrheic women who are fully or nearly fully breastfeeding. Secondary data analyses in numerous settings have drawn the same conclusion. Whether as a strategy or a method, used correctly or even if used imperfectly, LAM is a reliable way to avoid pregnancy. To the extent that LAM represents an additional contraceptive option, this is also clearly positive since a broad array of contraceptive options maximizes the likelihood of finding a good fit between user and method, and increases contraceptive use. Other characteristics of LAM represent potentially positive impacts. If LAM is shown to be an effective conduit to other modern methods, the implications are profoundly positive. If LAM is cost effective, for households and/or for programs, this will also make the method extraordinarily attractive. Conversely, some aspects of LAM are negative, such as the fact that it affords no protection against STDs, it requires counseling from a well-informed provider, and intensive breastfeeding can make heavy demands on the woman's time. Many of the remaining attributes of LAM may not be important to a policy decision about LAM promotion. For example, whether LAM is actualized as a strategy or a method may not be important to a decision to promote LAM, although it has a huge impact on how services are delivered. Some factors may be profound on a local or individual level. For example, one simple factor, such as the absence of full/nearly full breastfeeding, can rule out the method as an option, while another, such as the fact that it provides the needed waiting period during vasectomy counseling, can make LAM the method of choice. Although LAM seems unlikely to have widespread popularity in societies like the United States, within such settings are breastfeeding women for whom other contraceptive choices are not satisfactory and to whom LAM is attractive. Although clinicians cannot be expected to directly provide LAM education in every setting, women should be informed about LAM as an effective contraceptive choice, and clinicians should be prepared to make referrals to competent sources. The future of LAM, especially in terms of formal, programmatic initiatives, may continue to be focussed in transitional and less developed settings. Comparative cost/benefit analyses for both the family planning program and the household will contribute meaningfully to decisions about whether to use LAM and whether to include LAM in national and local family planning policies and programs. The most important call to action is to implement operations research designed to determine what factors, if any, will maximize the uptake of a second modern contraceptive method after LAM protection expires among never-users of family planning, to compare this with other contraceptive strategies, and to evaluate the cost aspects. If the potential of LAM to be a conduit to other modern contraceptive methods is effectively realized, the method can be profoundly important in the development of communities and in family formation. Because LAM is effective in preventing pregnancies, and because it extends the range of contraceptive choices, considering LAM on the policy level is always appropriate. Despite the array of drawbacks to LAM, as with any other family planning method, the potential assets of LAM, especially the promise to introduce nonusers to contraception, are sufficiently important to warrant the introduction of LAM within an operations research framework to both capitalize on its intrinsic strengths and determine its programmatic robustness. In the 10 years since the concept of LAM was pronounced as the Bellagio Consensus, claims have been made both for and against its use. During this time, program and policy leaders have been giv

Users' understanding of the lactational amenorrhea method and the occurrence of pregnancy

It is unknown whether a user's understanding of the Lactational Amenorrhea Method (LAM) is related to its successful use. A study of 876 LAM users in Pakistan and the Philippines collected information about women's understanding of LAM. The present analysis aims to determine: (1) the proportion of LAM users who understand the method, (2) whether any known factors can distinguish those who understand LAM from those who do not, and (3) whether an understanding of LAM is related to subsequent pregnancy. Over 75% of LAM users could consistently recite the LAM guidelines correctly for a full year postpartum. However, 38% of users failed to display, at least once, an understanding of LAM during the first year postpartum mainly by failing to abstain, to use another method or to explain their nonuse of another method when their LAM protection expired. LAM understanding generally could not be predicted by sociodemographic factors. The occurrence of pregnancy during the first year postpartum was not related to LAM understanding, regardless of how LAM understanding was defined, nor could it be predicted by any other measured characteristic of the users.

The frequency of coitus during breastfeeding

BACKGROUND

New mothers and clinicians would benefit from an understanding of typical sexual behavior during breastfeeding. Unfortunately, little information is available about both the typical length of time to resumption of coitus and the frequency of sexual relations during breastfeeding. This paper describes the commencement and frequency of coitus among breastfeeding women in a variety of settings.

METHODS

The analysis draws on data from two separate research studies. The first was undertaken in three sites (Birmingham, United Kingdom; Montreal, Canada; Sydney, Australia), the purpose of which was to correlate natural observations of fertility with the underlying hormonal profile among breastfeeding women using the symptom-thermal method of natural family planning. The second was a clinical trial of the lactational amenorrhea method of family planning conducted in Manila, the Philippines.

RESULTS

Coital frequency reported by these populations of breastfeeding women appears to be lower than that reported in other studies for married women in general. As other research demonstrated, we found coital frequency and postpartum resumption of coitus to be associated with age, but not with the number of children in the household.

CONCLUSIONS

A better understanding of the level of sexual activity among breastfeeding women could inform and improve programs that offer postpartum support and counseling about family planning.

Multicenter study of the Lactational Amenorrhea Method (LAM): I. Efficacy, duration, and implications for clinical application

A multicenter study of the Lactational Amenorrhea Method (LAM) was carried out to test the acceptability and efficacy of the method. Additionally, the data are used to test new constructs for improvement of method criteria. A protocol was designed at the Institute for Reproductive Health (IRH), Department of Obstetrics and Gynecology, Georgetown University Medical Center, a World Health Organization (WHO) Collaborating Center, and was reviewed and modified in collaboration with the co-sponsors, the World Health Organization and the South to South Cooperation for Reproductive Health, and the principal investigators from each site. Data were gathered prospectively on LAM acceptors at 11 sites. Data were entered and cleaned on-site and further cleaned and analyzed at IRH, using country-level and pooled data to produce descriptive statistics and life tables. The 98+% efficacy of LAM is confirmed in a wide variety of settings. In addition, the results yield insight on the possibility of continued use beyond 6 months. LAM is found to be highly effective as an introductory postpartum method when offered in a variety of cultures, health care settings, socio-economic strata, and industrial and developing country locales. In addition, LAM acceptance complements breastfeeding behaviors without ongoing breastfeeding support services. The parameters studied yield high efficacy and method continuation. Therefore, the basic tenets of the 1995 Bellagio consensus on LAM is reconfirmed and it is recommended that LAM be reconfirmed and it is recommended that LAM be incorporated into hospital, maternity, family planning, maternal and child health, and other primary health care settings.