An Assessment of the Nine-month Lactational Amenorrhea Method (MAMA-9) in Rwanda

Abstract

This report presents a secondary data analysis based on prospectively collected records gathered during a field assessment that was carried out in Rwanda in August 1993. The assessment used service statistics and follow-up interviews to evaluate the efficacy of a modified lactational amenorrhea method (LAM) as a nine-month introductory postpartum natural family planning method. The program, carried out by Action Familiale Rwandaise (AFR), reflects high efficacy of the method in a compliant sample that sought this method followed by another form of family planning. These results are promising and provide guidance for the extended use of LAM past six months. Programmatic findings suggest that studies be conducted of the contribution of extended LAM to improved weaning practices, the high efficacy of continued reliance on substantial lactation and amenorrhea beyond nine months, and male involvement in LAM and breastfeeding.

Postpartum Contraceptive Use in Bangladesh: Understanding Users' Perspectives

“…Although recent studies suggest that the contraceptive potential of lactation may extend beyond six months in intensively breastfeeding populations such as Bangladesh (Kazi et al, 1995;Cooney et al, 1996), the risk of conception does rise as time postpartum increases (Salway and Nurani, 1997). Women who wait until menses resumes before initiating contraception may, therefore, put themselves at risk of unwanted pregnancy.…”

Nurse‐midwives' Knowledge and Promotion of Lactational Amenorrhea and Other Natural Family‐planning Methods for Child Spacing

“…Furthermore, the American Pediatric Association recommended in 1997, that whenever possible, breastfeeding should be encouraged for at least 12 months (34). Although LAM is considered by experts to be 98% effective in avoiding pregnancy for 6 months (6–13), the perceived effectiveness by the CNMs respondents in the current study was only, on average, about 83%, and only 34.5% felt the efficacy extended to 6 months. As with the use of NFP, LAM may not be behaviorally adaptable in the United States because it requires exclusive breastfeeding to ensure efficacy.…”

Lactational amenorrhoea method for family planning

“…As well as the study by Ramos et al, several other reports have been published on the lactational amenorrhoea method,6 12 13 14 15 16 17 18 but experience is still limited. Additional research is needed to determine its effectiveness and acceptability under field conditions, to evaluate the implications of running a programme of the lactational amenorrhoea method for services catering for mothers, and to assess the impact of reliance on lactational amenorrhoea on subsequent use of other family planning methods, especially among women who would not otherwise attempt family planning.…”

“…From the research done to date, the experts participating in the second Bellagio conference (who included two authors of the paper by Ramos et al) also concluded that whereas amenorrhoea is an absolute requirement for ensuring a low risk of pregnancy, it might be possible to relax the requirement of full or nearly full breast feeding 4 10 14 15. It may also be possible to extend the duration of use beyond six months without jeopardising effectiveness 10 14 15.…”

“…It may also be possible to extend the duration of use beyond six months without jeopardising effectiveness 10 14 15. Additional research is needed to establish the conditions under which these modifications to the Bellagio consensus could be made.…”