From efficacy to effectiveness: selecting indicators for a community-based lactational amenorrhoea method promotion programme.

ABSTRACT

PIP: If lactational amenorrhea (LAM) is to reach its full potential as a method of child spacing, additional programmatic interventions must be conducted at the community level--especially in developing countries--to demonstrate its effectiveness. A review of clinical trials and community studies of LAM conducted both before and after the Bellagio Consensus Conference was undertaken in order to develop a set of indicators for the effectiveness of LAM promotion efforts under a range of field conditions. The resultant framework is intended as a tool for health professionals in family planning and maternal-child health service delivery settings who are interested in designing community-based LAM programs. A 5-tiered (individual, interpersonal, community, health system, and macro-policy factors) ecological systems model was used as the framework for indicator development. Laboratory, physiological, and behavioral measures were rated and weighted according to their scientific rigor (quality of data collected, technical feasibility), administrative feasibility (cost to administer, time required and likelihood of compliance), and community appropriateness (cultural sensitivity, contribution to women's knowledge and skills). Included among the suggested indicators are hormonal levels in urine or blood samples, timing of first vaginal bleed, duration of breast feeding, use of pacifiers or nipples, breast feeding knowledge and cultural influences, number of breast feeds per 24 hours, and frequency of intercourse.