Contraceptive use and pregnancy before and after introducing lactational amenorrhea (LAM) in a postpartum program

ArticleinAdvances in Contraception 14(1):59-68 · March 1998with12 Reads
DOI: 10.1023/A:1006527711625 · Source: PubMed
There is good evidence that lactational amenorrhea (LAM) is an effective method of fertility regulation during the first 6 months postpartum, provided no other food is given to the baby and the mother remains amenorrheic. However, although breast-feeding is strongly promoted in many maternity hospitals that also run postpartum family planning programs, LAM is rarely included among the contraceptive options being offered. This paper presents the results of an operational study which compared the prevalence of contraceptive use and the cumulative pregnancy rate at 12-months postpartum among 350 women observed before and 348 women studied after introducing LAM as an alternative contraceptive option offered to women following delivery at the Instituto Materno Infantil de Pernambuco (IMIP), in Recife, Brazil. The percentage of women not using any contraceptive method was significantly lower (p<0.0001) after the intervention (7.4%) than before (17.7%). This difference remained statistically significant after controlling for age, number of living children, marital status and years of schooling. The proportion pregnant one year postpartum was also significantly lower (p<0.0001) after the introduction of LAM (7.4%) than before (14.3%), but the difference was no longer significant after controlling for the same variables. It is concluded that LAM is a useful addition to family planning postpartum programs.
    • "These studies, together with evidence from Peru (Foreit et al. 1993; see Table 2), demonstrate the major impact that counseling combined with postpartum services can make in Latin America. The project in Brazil that promoted LAM is of interest in two regards (Hardy et al. 1998). Adherence to LAM criteria was low, a common finding, but LAM counseling may have encouraged uptake of effective methods. "
    [Show abstract] [Hide abstract] ABSTRACT: This article provides programmatic guidance and identifies future research priorities through a review of interventions to improve postpartum contraception. Thirty-five interventions in low- and middle-income countries were identified and classified according to timing and nature of administration: antenatal, postnatal, both ante- and postnatal, and integration with other services. With the exception of single, short antenatal interventions, the evidence of impact is positive but incomplete. A major gap in knowledge concerns demand for, and means of promoting, immediate postpartum family planning services in Asia and Africa. Counseling before discharge is likely to have an impact on subsequent contraceptive uptake. Integration of family planning into immunization and pediatric services is justified, but policy and program obstacles remain. A case for relaxing the strict conditions of the lactational amenorrhea method (LAM) is strong, but qualitative evidence on the perspectives of women on pregnancy risks is required. Despite the gaps in knowledge, the evidence provides useful guidance for strategies to promote postpartum family planning, in ways that take different contexts into account.
    Full-text · Article · Dec 2015
    • "Their lack of understanding appeared to be unrelated to subsequent pregnancies, however (Kennedy et al. 1998). Similar mixed results have been obtained regarding the role of LAM as a gateway to the use of modern methods; some studies find no greater use of contraceptives at 6 or at 12 months among some previous users of LAM than among those who did not use LAM or those who have used other methods (Hardy et al. 1998; Alvarado et al. 1999; Tazhibayev et al. 2004; Bongiovanni et al. 2005). In summary, although LAM is an effective clinical method, programs must find more efficacious strategies for training providers and counseling clients regarding the three conditions required to use it appropriately and effectively , and how to use LAM as a bridge to the adoption of modern methods. "
    Full-text · Article · Sep 2009
  • Article · Oct 1998
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