Lactational amenorrhoea among adolescent girls in low-income and middle-income countries: a systematic scoping review

Abstract

IntroductionFertility levels among adolescents remain high in many settings. The objective of this paper was to review the available literature about postpartum and lactational amenorrhoea among adolescents in low-income and middle-income countries (LMICs).MethodsWe searched Medline, Embase, Global Health and CINAHL Plus databases using terms capturing adolescence and lactational or postpartum amenorrhoea. Inclusion criteria included publication date since 1990, data from LMICs, and topic related to lactational amenorrhoea as a postpartum family planning method or as an effect of (exclusive) breast feeding among adolescents. Thematic analysis and narrative synthesis were applied to summarise and interpret the findings.ResultsWe screened 982 titles and abstracts, reviewed 75 full-text articles and included nine. Eight studies assessed data from a single country (three from India, two from Bangladesh, two from Turkey, one from Nigeria). One study using Demographic and Health Survey data included 37 different LMICs. The five studies measuring duration of postpartum or lactational amenorrhoea reported a wide range of durations across the contexts examined. Four studies (from Bangladesh, Nigeria and Turkey) examined outcomes related to the use of lactational amenorrhoea as a family planning method among adolescents. We did not find any studies assessing adolescents’ knowledge of lactational amenorrhoea as a postpartum family planning method. Likewise, little is known about the effectiveness of lactational amenorrhoea method among adolescents using sufficiently large samples and follow-up time.ConclusionThe available evidence on lactational amenorrhoea among adolescents in LMICs is scarce. Given the potential contribution of lactational amenorrhoea to prevention of short interpregnancy intervals among adolescents and young women, there is a need for a better understanding of the duration of lactational amenorrhoea, and the knowledge and effective use of lactational amenorrhoea method for family planning among adolescents in a wider range of LMIC settings.

Knowledge and use of lactational amenorrhea as a family planning method among adolescent mothers in Uganda: a secondary analysis of Demographic and Health Surveys between 2006 and 2016

“…This may explain the observed high proportion of women that were passively using LAM (meet the LAM criteria but do not report LAM use). The study findings relate to previous studies that also show a low prevalence of LAM use among women of reproductive age in general (Fabic and Choi, 2013) and adolescents in particular (Figaroa et al, 2020). Low correct use of LAM is a result of not fulfilling one or more of the three criteria, which also influence the effectiveness of LAM as a FP method.…”

“…The decreasing duration of PPA points to the need to strengthen postpartum FP among adolescents, as the risk of becoming pregnant may be higher in this sub-population. The review by Figaroa and colleagues noted wide variation in PPA duration among adolescents in LMICs (Figaroa et al, 2020); while a study in India among women with at least one livebirth reported a lower duration of PPA (5.7 months) than what was found in the present study (Singh et al, 2012). Breastfeeding practices have also been linked to a shorter total duration of PPA (Singh et al, 2012).…”

“…In 2019, 43% of adolescents in LMICs were estimated to have an unmet need for FP (Sully et al, 2020). Tackling the unmet need for FP among adolescents is critical especially in LMICs because it has significant implications on their reproductive health and wellbeing (Figaroa et al, 2020). Adolescent childbearing has been associated with multiple adverse health outcomes (Amongin et al, 2020a, Burke et al, 2018, and the literature also shows several challenges of the motherhood transition period for adolescents, which leave them disempowered with feelings of shame and embarrassment (Erfina et al, 2019, Mangeli et al, 2017, Watts et al, 2015.…”

“…Evidence on use of LAM in adolescents in LMICs is still scarce. There is a need to better understand the duration, knowledge, and correct use of LAM as a postpartum FP method among adolescents (Figaroa et al, 2020).…”

Knowledge and use of lactational amenorrhoea as a family planning method among adolescent mothers in Uganda: a secondary analysis of Demographic and Health Surveys between 2006 and 2016

“…There is a need to better understand the duration, knowledge, and correct use of LAM as a postpartum FP method among adolescents. 5 The main objective of this study was to assess the knowledge and use of LAM among adolescents in Uganda between 2006 and 2016 using nationally representative data from Demographic and Health Surveys (DHS).…”