Premature weaning in east Bhutan: only if mother is pregnant again.

ABSTRACT

The relationship between breast-feeding and subsequent pregnancy in East Bhutan is examined, against the background of local attitudes to family planning. Ninety-eight mothers who had given birth 30-36 months earlier were interviewed. Semisolid supplementary feeding was introduced at a median age of 3 months. Median total duration of breast-feeding was 28 months, and day and night breast-feeding on demand was continued throughout. Median duration of postpartum amenorrhoea was 12 months, and was associated with the timing of the introduction of supplementary foods. There was a significant association between the occurrence of a subsequent pregnancy and early termination of breast-feeding. The relationships between breast-feeding pattern and pregnancy interval are complex, and their relative influence changes with time. During the first year postpartum, infertility during lactational amenorrhoea is important. During the second year there is a strong negative effect on lactation from the next pregnancy. The only important reason for ceasing to breast-feed within 2 years seems to be a new pregnancy.

ABSTRACT

PIP Breast feeding and subsequent pregnancy was investigated against the background of local attitudes to family planning. There were 113 index children born during the period of April-September 1990 in villages in Wamrong subdistrict in East Bhutan. 99 children remained in the sample, including one pair of twins. The 98 women who were their mothers were interviewed during March and April 1993. 7 children died during the study period, leaving 92 children whose average age was 32.7 months. The mean duration of breast feeding was 26.8 months. Breast feeding was halted for 61 children (66%). The median age of the child was 3 months at the time of introduction of semisolid supplementary food in the form of porridge made of rice flour in 61% of cases. 51 (82%) of these 61 children were fed at night; thus breast feeding remained on demand as long as it was practiced. The estimated mean duration of breast feeding for women who became pregnant again was 22.0 +or- 1.7 months and for those who did not it was 32.9 +or- 1.8 months (p 0.001). There was an inverse association between the birth to birth interval and duration of breast feeding in pregnancy. Those with an interval of less than 2 years had a mean duration of breast feeding in pregnancy of 5.2 months, while those with an interval of more than 2 years had a mean duration of 4.3 months. The median duration of postpartum amenorrhea was 12 months. 59 women who had lactational amenorrhea for 12 months or more did not become pregnant during the first year postpartum, while 9 women with amenorrhea for less than 12 months became pregnant (p 0.001). 51 women became pregnant when they were still breast feeding, which they stopped at 4.8 months. The actual birth interval averaged 25 months and the desired average was 40.6 months (p 0.001). A new pregnancy seemed to be the only important reason for stopping breast feeding within 2 years.