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Abstract

There is good evidence that lactational amenorrhea (LAM) is an effective method of fertility regulation during the first 6 months postpartum, provided no other food is given to the baby and the mother remains amenorrheic. However, although breast-feeding is strongly promoted in many maternity hospitals that also run postpartum family planning programs, LAM is rarely included among the contraceptive options being offered. This paper presents the results of an operational study which compared the prevalence of contraceptive use and the cumulative pregnancy rate at 12-months postpartum among 350 women observed before and 348 women studied after introducing LAM as an alternative contraceptive option offered to women following delivery at the Instituto Materno Infantil de Pernambuco (IMIP), in Recife, Brazil. The percentage of women not using any contraceptive method was significantly lower (p<0.0001) after the intervention (7.4%) than before (17.7%). This difference remained statistically significant after controlling for age, number of living children, marital status and years of schooling. The proportion pregnant one year postpartum was also significantly lower (p<0.0001) after the introduction of LAM (7.4%) than before (14.3%), but the difference was no longer significant after controlling for the same variables. It is concluded that LAM is a useful addition to family planning postpartum programs.

Outreach and integration programs to promote family planning in the extended postpartum period

“…Educational interventions included 1 or more counseling sessions about contraception and/or breastfeeding during the prepartum period [26–31], on the postpartum ward [32–35], or during the later postpartum period in the clinic [30,32]. The studies varied in the duration of follow-up, which ranged from 6 weeks to 12 months.…”

“…The studies varied in the duration of follow-up, which ranged from 6 weeks to 12 months. Four [30–32,34] of the 5 studies with positive results involved family-planning education during the postpartum hospital stay.…”

“…Of the 10 studies [26–35] evaluating educational interventions, 5 studies [27,30–32,34] of poor to good quality showed an improvement in contraceptive use, and 2 showed a decrease in repeat pregnancy within 12 months [30] or 9 months [27]. In a randomized controlled trial conducted in Pakistan [34], the intervention group received a 20-minute counseling session along with a 1-page leaflet after delivery.…”

“…This trial found improved rates of contraceptive use at 8–12 weeks in the intervention group compared with the control group (56.9% versus 6.31%; P <0.01). In a cohort study [30] that focused on postpartum contraception use and lactational amenorrhea education in Brazil, with participants recruited before and after the intervention, there were significantly fewer pregnancies in the intervention group (7.4% versus 14.3%; P <0.001) at 12 months postpartum. In addition, fewer women in the intervention group were not using any form of contraception at 12 months postpartum compared with the control group (7.4% versus 17.7%; P <0.001).…”

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

“…It increases a subsequent adoption of other modern contraceptive methods. Since counseling on LAM includes information on transition to other modern contraceptive methods once LAM criteria are no longer met, LAM has the potential to increase uptake of contraception after is no longer effective [5, 6, 13, 14]. …”