The Lactational Amenorrhea Method (LAM): A postpartum introductory family planning method with policy and program implications

Abstract

It is well accepted that breastfeeding contributes significantly to child survival and child nutrition. Healthful child spacing is associated with improved birth outcomes and maternal recovery. On a population basis, breastfeeding may contribute more to birth spacing than all family planning use combined in many countries. However, while breastfeeding does provide a period of infertility, until recently, there was no reliable way for an individual woman to capitalize on this lactational infertility for her own efficacious child spacing. The Lactational Amenorrhea Method (LAM) is a new introductory family planning method that simultaneously promotes child spacing and breastfeeding, with its optimal nutrition and disease preventive benefits for the infant. LAM, as it is called, is based on the utilization of lactational infertility for protection from pregnancy and indicates the time for the introduction of a complementary family planning method. LAM is recommended for up to six months postpartum for women who are fully or nearly fully breastfeeding and amenorrheic, and relies on the maintenance of appropriate breastfeeding practices to prolong lactational infertility, with the concomitant delay in menses return. A recent clinical trial confirmed the theoretical 98% or higher effectiveness of the method and field trials are demonstrating its acceptability. Nonetheless, some demographers and family planning organizations continue to debate its value. The development, efficacy, and sequelae of the method are presented using data from several studies by the authors.

Use of contraceptives and uptake of long-acting reversible contraception among postpartum women in rural China

“…Moreover, the lactational amenorrhea method (LAM) was not included as a postpartum contraceptive method option. One of the criteria for LAM, exclusive breastfeeding according to the Unicef definition,26 was so rare in rural China that in our study, among 125 mothers delivered within the previous 6 months, no women were exclusively breastfeeding.…”

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.…”

“…It was called the lactational amenorrhoea method, and guidelines for its use were developed 16. These guidelines include the three criteria mentioned above—amenorrhoea, full or nearly full breast feeding, and protection limited to the first six months postpartum—all of which must be met to ensure adequate protection from an unplanned pregnancy.…”

“…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. As indicated earlier, the guidelines for use of lactational amenorrhoea promote the adoption of other methods of family planning as soon as the six month period of protection has ended,16 and it is therefore conceivable that using lactational amenorrhoea may increase subsequent use of contraception 19…”

Translation and Validation of Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) into Indonesian: a Pilot Study

“…The economic advantage and the enhancement of the mother-infant bond have also been discussed as important benefits to breastfeeding. 3,4 Endorsement for breastfeeding has come from the World Health Organization, the International Pediatric Association, the British Department of Health and Social Security, the American Association of Public Health, and the Academy of Pediatrics. The infant feeding decision is complex and involves the influence of psychological, social, and economic factors, and health care system.…”