Maternal nutritional status is inversely associated with lactational amenorrhea in Sub-Saharan Africa: results from demographic and health surveys II and III.

Breast-feeding is positively associated with the duration of postpartum amenorrhea; thus it is a major determinant of fertility in countries where effective contraceptive methods are not widely available. The objective of these analyses was to examine the association between maternal nutritional status and lactational amenorrhea (LA) among breast-feeding women. Women who were not pregnant, who were breast-feeding, who were not using hormonal contraceptives and who had a child

Multicenter study of the Lactational Amenorrhea Method (LAM): I. Efficacy, duration, and implications for clinical application.

A multicenter study of the Lactational Amenorrhea Method (LAM) was carried out to test the acceptability and efficacy of the method. Additionally, the data are used to test new constructs for improvement of method criteria. A protocol was designed at the Institute for Reproductive Health (IRH), Department of Obstetrics and Gynecology, Georgetown University Medical Center, a World Health Organization (WHO) Collaborating Center, and was reviewed and modified in collaboration with the co-sponsors, the World Health Organization and the South to South Cooperation for Reproductive Health, and the principal investigators from each site. Data were gathered prospectively on LAM acceptors at 11 sites. Data were entered and cleaned on-site and further cleaned and analyzed at IRH, using country-level and pooled data to produce descriptive statistics and life tables. The 98+% efficacy of LAM is confirmed in a wide variety of settings. In addition, the results yield insight on the possibility of continued use beyond 6 months. LAM is found to be highly effective as an introductory postpartum method when offered in a variety of cultures, health care settings, socio-economic strata, and industrial and developing country locales. In addition, LAM acceptance complements breastfeeding behaviors without ongoing breastfeeding support services. The parameters studied yield high efficacy and method continuation. Therefore, the basic tenets of the 1995 Bellagio consensus on LAM is reconfirmed and it is recommended that LAM be reconfirmed and it is recommended that LAM be incorporated into hospital, maternity, family planning, maternal and child health, and other primary health care settings.

Multicenter study of the Lactational Amenorrhea Method (LAM): II. Acceptability, utility, and policy implications.

A multicenter study of the Lactational Amenorrhea Method (LAM) was carried out to determine acceptability, satisfaction, and utilization in 10 different populations, and to confirm the efficacy of the method. Efficacy data are presented in a companion paper. A protocol was designed at the Institute for Reproductive Health (IRH), Department of Obstetrics and Gynecology, Georgetown University Medical Center, and reviewed and modified in collaboration with the co-sponsors, the World Health Organization, the South-to-South Cooperation for Reproductive Health, and the principal investigators from each site. Data were gathered prospectively on LAM users at 11 sites. Data were entered and cleaned on-site, and further cleaned and analyzed at IRH, using country-level and pooled data to produce descriptive statistics. The overall satisfaction with LAM was 83.6%, and continuation with another method of family planning was shown to be 67.6% at 9 months postpartum, in most cases exceeding previous use of contraception prior to use of LAM. Knowledge and understanding of the method at discontinuation were high, ranging from 78.4 to 88.6% for the three criteria. LAM can be used with a high level of satisfaction and success by women in a variety of cultures, health care settings, socio-economic strata, and industrial and developing country settings. The results confirm that LAM is acceptable and ready for widespread use, and should be included in the range of services available in maternal and child health, family planning, and other primary health care settings.

The use of breast milk substitutes in developing countries: the impact of women's employment.

OBJECTIVES: This study quantified the influence of employment, specifically a mother's employment away from her infant, on the use of breast milk substitutes in developing countries. METHODS: Data from the Demographic and Health Surveys were used to calculate the population attributable risk percentage for use of breast milk substitutes among women employed away from their babies in 15 countries for which suitable data were available. RESULTS: The estimated proportion of breast milk substitute use attributable to employment away from the baby ranged from 0.74% to 20.9% in the various countries. CONCLUSIONS: Employment is not the main determinant of breast milk substitute use. Efforts to improve breast-feeding can be safely targeted at the majority of women who are not employed away from their babies while nevertheless giving appropriate attention to the minority of new mothers who are employed away from their babies.

Contraceptive use during lactational amenorrhea.

OBJECTIVE: The study uses data from nationally representative sample surveys in developing countries to estimate the overlap between lactational amenorrhea and contraceptive use during the first 6 months postpartum. METHOD: Secondary analyses of survey data were used to tabulate the proportion of the population in lactational amenorrhea among contraceptive users for all women, for postpartum women and for the country as a whole. RESULTS: Among postpartum women, the proportion in lactational amenorrhea was particularly high in Africa and the Near East and lower in Latin America and the Caribbean where breast-feeding practices have declined. The median duration of use for oral contraceptives is also presented as an aid to interpreting the significance of the findings. CONCLUSIONS: The significance of the findings is considered in the context of planning reproductive health services in the postpartum period. Decisions about timing of contraceptive use for postpartum women, while arrived at on an individual basis, also result from program strategies that focus counseling immediately postpartum or at a later interval, such as when menses resume. On a national level the impact of postpartum contraception policies on use of commodities may be substantial.

Contraceptive use during lactational amenorrhea

OBJECTIVE: The study uses data from nationally representative sample surveys in developing countries to estimate the overlap between lactational amenorrhea and contraceptive use during the first 6 months postpartum. METHOD: Secondary analyses of survey data were used to tabulate the proportion of the population in lactational amenorrhea among contraceptive users of all women, for postpartum women and for the country as a whole. RESULTS: Among postpartum women, the proportion in lactational amenorrhea was particularly high in Africa and the Near East and lower in Latin America and the Caribbean where breast-feeding practices have declined. The median duration of use for oral contraceptives is also presented as an aid to interpreting the significance of the findings. CONCLUSIONS: The significance of the findings is considered in the context of planning reproductive health services in the postpartum period. Decisions about timing of contraceptive use for postpartum women, while arrived at on an individual basis, also result from program strategies that focus counseling immediately postpartum or at a later interval, such as when menses resume. On a national level the impact of postpartum contraception policies on use of commodities may be substantial.(AU)