No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Multicenter study of the Lactational Amenorrhea Method (LAM): I. Efficacy, duration, and implications for clinical application
Abstract
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, socioeconomic 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 incorporated into hospital, maternity, family planning, maternal and child health, and other primary health care settings.
... 2,3 Several studies on the effectiveness of LAM have been published since this international consensus statement, known as the Bellagio Consensus. 1,2,[4][5][6][7][8][9] Given that LAM is being recommended as one of the modern contraceptives, there is a need to demonstrate its effectiveness as well as women's practice in using LAM as a contraceptive. While multiple research on the efficiency of LAM have been undertaken in various settings, the majority of the known studies are old, and no study has been conducted in Ethiopia. ...
... Depending on whether or not LAM is administered effectively, an efficacy range of 98.3% to 100% has been observed, with decreasing efficacy after 6 months. 6,7,[9][10][11] Though the Bellagio consensus on the effectiveness of the LAM was made only up to 6 months postpartum, there are different studies recommending it beyond the Bellagio consensus up to 12 months after delivery. 6,9,12 As many women are opting to use LAM, 13,14 investigating its effectiveness and women's experiences with LAM utilization is essential for designing tailored intervention and counseling. ...
... 6,7,[9][10][11] Though the Bellagio consensus on the effectiveness of the LAM was made only up to 6 months postpartum, there are different studies recommending it beyond the Bellagio consensus up to 12 months after delivery. 6,9,12 As many women are opting to use LAM, 13,14 investigating its effectiveness and women's experiences with LAM utilization is essential for designing tailored intervention and counseling. 15 In this study, we report the effectiveness and women's experiences of using LAM in a multi-center prospective study in Ethiopia. ...
Background:
Although the lactational amenorrhea method (LAM) is one of the most commonly used contraception methods during the first six months of a woman's postpartum period, there has been little research on its effectiveness in general and particularly in Ethiopia. The purpose of this study was to evaluate the effectiveness of LAM and the experiences of Ethiopian women who used it.
Methods:
This was a multi-center prospective cohort study of postpartum women from five Ethiopian regions and one city administration. All pregnant women who gave birth in these randomly selected hospitals and five health centers directly referring to the hospitals were invited to the study if they selected LAM and were followed monthly at home. Each month, trained researchers visited the woman at her home and collected information about breast feeding, the return of menses, the resumption of sex, the use of another contraceptive, and a pregnancy test using urine human chorionic gonadotropin (hCG). Women who reported starting new contraceptive methods, resumption of menses, starting complementary feeding, neonatal death, getting pregnant, or refusing were excluded from the cohort. The data were collected using ODK Collect and exported to Stata 14 for analysis.
Results:
Among the 2162 women who selected LAM as a contraceptive, 2022 were enrolled in the cohort study, and 901 completed the follow-up. At the end of the sixth month, eight women got pregnant, corresponding to an effectiveness of 99.1%. More than half of the cohort were excluded from the follow-up for reasons of transitioning to other types of contraception, resumption of menses, or refusal to follow-up.
Conclusion:
The effectiveness of LAM is high and should be recommended for postpartum women, with proper counseling provided. A study should be conducted to examine the effectiveness of breast feeding as a contraceptive beyond the Bellagio consensus.
... Furthermore, these obligations are specified in the Act on the profession of doctor and dentist, of December 5, 1996 (Journal of Laws, 1 https://www.gov.pl/zdrowie/npz- -20201997, defining the rules and conditions for exercising the profession. The Act referred to in art. ...
... and covering the first 6 months of life of a child exclusively breastfed (Labbok et al 1990(Labbok et al , 1994(Labbok et al , 1997. ...
... During this period, we can observe the so-called silent ovulation without subsequent bleeding, which is associated with a higher incidence of a so-called LUFT -luteinized unruptered follicule. According to studies, the occurrence of the first bleeding up to 6 months after delivery is not a good marker for ovulation return (Perezi, 1992;Labbok et al., 1997). ...
The sake and care of family procreation health are the main priority of the state especially in the context of demographic winter lasting over 20 years and more in many European countries as well as in Poland. What is anxious and worrisome concern no consequences in between theoretical recommendations and ministerial laws as well as medical standards and its practical application. Doctors, nurses and midwifes are dedicated to promotion of breastfeeding and natural fertility return mechanism. Many research as well as practical experience of authors with mothers and families, clearly point to lack or at least not sufficient time, knowledge and proper procedures apply at lactation problems or lactation amenorrhea method (LAM). Despite many surveys showing evidence of many short and long lasting health benefits coming from exclusive breastfeeding during first 6 months after labor as well as LAM only 40 percent of mothers continue it after release from hospital and only 18% are informed about LAM during puerperal visit. We recommend the standard puerperal visit as well as team work at this special moment of family grow and development. Including non-medical, competent specialist in family care can bring extraordinary benefits to family and state support.
... 10 The results from a large multicentre study on efficacy of LAM conducted in the early 1990s suggest that deviation from specific use of each of the three criteria does not cause a significant upsurge in pregnancy rates. 11 It has been shown that the PVR as a new method of contraception during lactation can provide additional protection to breastfeeding women who want to space their pregnancies for >1 year but may not comply with the strict criteria of LAM. ...
... The investigators calculated the probability of experiencing the first bleeding and the probability of pregnancy in 236 women who were fully breastfeeding, not using contraception, and enrolled during Month 1 postpartum. [4][5][6][7][8][9][10][11] The cumulative probability of bleeding and of pregnancy was 52% and 9.4% at Day 180 postpartum, respectively. The risk of pregnancy was <2% in the subset of amenorrhoeic women. ...
The progesterone vaginal ring (PVR) Progering® has been shown to be effective as a contraceptive in breastfeeding women who need safe and effective methods of spacing pregnancies. Previous clinical trials, of 1-year duration, demonstrated its efficacy to be similar to that of the intra-uterine device (IUD) during lactation. The duration of lactational amenorrhoea is significantly prolonged in PVR users in comparison with IUD users with fewer median numbers of bleeding/spotting episodes and days. This delivery system designed for 3-month use needs to be renewed every 3 months as long as breastfeeding continues, for up to 1 year. The frequency of breastfeeding, breast milk volume, and infant growth were not different in PVR or IUD users, and the safety of this new method has been well documented. This article reviews the literature and describes the mechanism of action of the PVR during lactation to bring additional protection over exclusive breastfeeding only, during the first year postpartum. Further evaluation of the PVR acceptability in different populations where breastfeeding is popular and highly recommended for the infant’s benefit is warranted.
... In controlled settings, two-thirds of women use LAM transition to another method effectively (Peterson et al., 2000). However, studies have suggested that a variable proportion of women between 48% and 86% that use LAM successfully transition to another contraceptive method, indicating some challenges within the transition period (Peterson et al., 2000;Hight-Laukaran et al., 1997;Labbok and Hight-Laukaran, 1997). ...
... In controlled settings, two-thirds of women use LAM transition to another method effectively (Peterson et al., 2000). However, studies have suggested that a variable proportion of women between 48% and 86% that use LAM successfully transition to another contraceptive method, indicating some challenges within the transition period (Peterson et al., 2000;Hight-Laukaran et al., 1997;Labbok and Hight-Laukaran, 1997). ...
... Efforts to improve EBF can dovetail with improving FP use in the postpartum period. The lactational amenorrhea method (LAM) is a natural contraceptive method that is 98.5% efficacious in protecting against pregnancy up to the first 6 months of life (Labbok et al., 1997). Although LAM provides an opportunity for breastfeeding women to use FP, use of LAM remains very low among married women in Tanzania, at 0.5% (Ministry of Health, Community Development, Gender, Elderly and Children, 2016). ...
... Although LAM is a natural contraceptive method that is 98.5% efficacious in protecting against pregnancy when the three conditions for use are met, LAM is often overlooked and not incorporated in country health programmes, including in this region of Tanzania (Labbok et al., 1997). If women are counselled about the three criteria for LAM use, many women do not adequately adhere to them, and/or do not transition from LAM to another modern method before they are at risk of pregnancy (Türk, Terzioğlu, & Eroğlu, 2010;Kouyaté et al., 2015). ...
In Lake Zone, Tanzania, low contraceptive prevalence, closely spaced births, and child stunting are common. Synergies exist between postpartum family planning (PPFP) and maternal, infant, and young child nutrition (MIYCN), yet health services are often provided in silos. This qualitative formative research study aimed to identify barriers and facilitating factors for optimal nutrition and PPFP practices in Mara and Kagera, Tanzania. Results informed the program design of an integrated nutrition and family planning (FP) implementation approach. The study involved in‐depth interviews with mothers of infants under 1 year (n = 24), grandmothers (n = 12), health providers (n = 6), and traditional birth attendants (n = 12), and 14 focus group discussions with community health workers, fathers, and community leaders. Findings reveal that breastfeeding initiation was often delayed, and prelacteal feeding was common. Respondents linked insufficient breast milk to inadequate maternal nutrition—in terms of the quality of the diet and small quantities of food consumed by mothers. Breast milk insufficiency was addressed through early introduction of foods and liquids. Mothers believed that breastfeeding prevents pregnancy, regardless of the frequency or duration of breastfeeding, yet were generally not aware of the lactational amenorrhea method (LAM) of FP. Joint decision‐making on FP was viewed as important, and women often discussed it with their partner. Future programming should address misconceptions about return to fecundity¹ knowledge gaps and concerns about FP methods including LAM; and perceptions regarding insufficient breast milk and early introduction of foods which are impediments to optimal MIYCN and FP practices.
... Breastfeeding -particularly exclusive breastfeeding -has been shown to delay the return of ovulation, a biological necessity for pregnancy (46). While the WHO de nes LAM in strict, time-limited terms, numerous studies indicate that breastfeeding, amenorrheic women are at signi cantly reduced risk of pregnancy at one year postpartum and beyond than their non-breastfeeding, menstruating peers (47)(48)(49)(50). Due to the combined effects of prolonged postpartum abstinence and high rates of breastfeeding, most African countries report long durations of postpartum insusceptibility, the inability to become pregnant due to amenorrhea. ...
Background
Integrating family planning programming into postpartum care is widely established as an effective approach to improve access to family planning. We conducted a pilot in 6 hospitals in northern Ghana to evaluate the effectiveness of two approaches at improving contraceptive uptake. These approaches were: 1) family planning counseling during postnatal care (PNC) appointments and; 2) family planning messaging and referrals during immunization/child welfare clinic (CWC) sessions in the first year postpartum.
Methods
This study used a two-arm non-randomized repeated cross-sectional design. We surveyed 205 women pre-intervention and 226 women post-intervention.
Results
We observed no statistically significant effects on actual or intended contraceptive use in either arm at immediate surveying. Results from two-week phone surveying (n = 202) suggest a 22% increase in contraceptive use (p< .01) and a 25.3% increase in intended use (p <.05) post-intervention in the PNC arm and no statistically significant effects in the CWC arm; however, this data is only suggestive due to its small sample size. High rates of breastfeeding and prolonged postpartum abstinence suggest that the majority surveyed were not at high risk of pregnancy irrespective of modern contraceptive use.
Conclusions
While the relatively small sample size and non-randomized study design limit the generalizability of the findings, the results suggest that contraceptive counseling at CWC may have limited effect on contraceptive uptake, while counseling at PNC is more promising yet still mixed. High rates of breastfeeding and prolonged postpartum abstinence suggest that changes in contraceptive uptake in the first year postpartum in similar contexts may have a reduced effect on unintended pregnancies; this supports similar recent findings in the literature.
Trial registration
Not applicable.
... Кормящие женщины наиболее уязвимы в отношении наступления незапланированной беременности, они часто используют малоэффективный метод лактационной аменореи [7]. В случае грудного вскармливания, начатого сразу после родов, при соблюдении рекомендаций врача эффективность метода достигает 98%. ...
The article presents modern methods of contraception after childbirth, including their impact on the mother and child, the main advantages and disadvantages. Special attention is paid to barrier methods of contraception, spermicides, and their advantages according to the "Acceptance Criteria" of the World Health Organization (2015) and the "National Acceptance Criteria" (2023), their features and prospects for use.
... The Lactational Amenorrhea Method (LAM) is a natural defense mechanism against pregnancy triggered by breastfeeding 1 . It is a natural contraceptive method that is highly safe, effective, inexpensive, available, and accessible to many mothers in the first 6 months postpartum [2][3][4] . The LAM provides 98% protection against pregnancy if the three Bellagio Consensus (LAM) criteria are met: (1) the menses have not returned, (2) the baby is fully or nearly fully breastfed, and (3) the baby is less than 6 months old 3,5,6 . ...
Abstract While the importance of knowledge about contraceptives in improving their utilization and thereby reducing the risk of unintended pregnancies is well documented, there are limited studies documented about the Lactational Amenorrhea Method (LAM). Thus, understanding the knowledge of postpartum mothers about LAM is essential for designing tailored interventions. This study assessed the level of knowledge about LAM and its associated factors among postpartum mothers in Ethiopia. A facility-based cross-sectional study was conducted among 3148 randomly selected postpartum participants. The study utilized multistage sampling approach in hospitals located across five regions and one city administration in Ethiopia. Data were collected using face-to-face interviews at discharge. A participant was categorized as having knowledge of LAM if she correctly answered the three LAM criteria: amenorrhea, the first 6 months, and exclusive breast feeding. A binary logistic regression model was used to identify factors associated with knowledge of LAM. Variables with p
... The lactational amenorrhea method (LAM) is a tool that enables each woman to make use of breastfeeding physiology to assist in spacing out her pregnancies [2] . The LAM has proven to be quite effective for family planning [3][4][5][6][7] . According to a 1988 Bellagio Consensus Meeting, women who fully or nearly breastfeed and are amenorrheic for the first six months after giving birth have a 2% likelihood of becoming pregnant [8] . ...
... 55 More frequent feeding at night may help maintain milk production and is important for lactational amenorrhea. 56 Infants' sleeping through the night is associated with a much lower rate of breastfeeding. 57 Bedsharing affects maternal and infant sleep. ...
A central goal of the Academy of Breastfeeding Medicine (ABM) is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. The ABM empowers health professionals to provide safe, inclusive, patient-centered, and evidence-based care. Pregnant and lactating people identify with a broad spectrum of genders, pronouns, and terms for feeding and parenting. There are two reasons ABM's use of gender-inclusive language may be transitional or inconsistent across protocols. First, gender-inclusive language is nuanced and evolving across languages, cultures, and countries. Second, foundational research has not adequately described the experiences of gender-diverse individuals. Therefore, ABM advocates for, and will strive to use language that is as inclusive and accurate as possible within this framework. For more explanation, please read ABM Position Statements on Infant Feeding and Lactation-Related Language and Gender (https://doi.org/10.1089/bfm.2021.29188.abm) and Breastfeeding As a Basic Human Right (https://doi.org/10.1089/bfm.2022.29216.abm).
... Previous studies of the contraceptive effect of LAM have reported cumulative 6-month life-table perfect-use pregnancy rates of 0.5-1.5% among women who relied only on LAM [12][13][14]. A Cochrane review published in 2015 estimated the typical use failure rate of LAM to be about 0.45-7.5% [15]. ...
... 27 Ethiopian women may also believe that they are not at risk of pregnancy in the first 6 months after giving birth if they are breast feeding their baby, whether or not breast feeding is exclusive. 36 The findings of stronger associations between family planning counselling and postpartum modern contraceptive uptake among women 7-12 months post partum could also be because there might be a greater proportion of women who have re-engaged in sexual activity during this period than in the first 6 months. ...
Objective:
This study examined the association between family planning counselling receipt during the 12 months preceding the survey and postpartum modern contraceptive uptake in Ethiopia. We hypothesised that receiving family planning counselling either within the community setting by a field health worker or at a health facility by a healthcare attendant during the 12 months preceding the survey improves postpartum modern contraceptive uptake.
Design:
We used a cross-sectional study of the Ethiopian Demographic and Health Survey conducted in 2016.
Setting:
Ethiopia.
Participants:
A total of 1650 women who gave birth during the 12 months and had contact with service delivery points during the 12 months preceding the survey.
Primary outcome:
A weighted modified Poisson regression model was used to estimate an adjusted relative risk (RR) of postpartum modern contraceptives.
Results:
Approximately half (48%) of the women have missed the opportunity to receive family planning counselling at the health service contact points during the 12 months preceding the survey. The postpartum modern contraceptive uptake was 27%. Two hundred forty-two (30%) and 204 (24%) of the counselled and not counselled women used postpartum modern contraceptive methods, respectively. Compared with women who did not receive counselling for family planning, women who received counselling had higher contraceptive uptake (RR 1.32, 95% CI 1.04 to 1.67).
Conclusion:
Significant numbers of women have missed the opportunity of receiving family planning counselling during contact with health service delivery points. Modern contraceptive uptake among postpartum women was low in Ethiopia. Despite this, our findings revealed that family planning counselling was associated with improved postpartum modern contraceptive uptake.
... 27 Ethiopian women may also believe that they are not at risk of pregnancy in the first 6 months after giving birth if they are breast feeding their baby, whether or not breast feeding is exclusive. 36 The findings of stronger associations between family planning counselling and postpartum modern contraceptive uptake among women 7-12 months post partum could also be because there might be a greater proportion of women who have re-engaged in sexual activity during this period than in the first 6 months. ...
Objective
This study examined the association between family planning counselling receipt during the 12 months preceding the survey and postpartum modern contraceptive uptake in Ethiopia. We hypothesised that receiving family planning counselling either within the community setting by a field health worker or at a health facility by a healthcare attendant during the 12 months preceding the survey improves postpartum modern contraceptive uptake.
Design
We used a cross-sectional study of the Ethiopian Demographic and Health Survey conducted in 2016.
Setting
Ethiopia
Participants
A total of 1650 women who gave birth during the 12 months and had contact with service delivery points during the 12 months preceding the survey
Primary outcome
A weighted modified Poisson regression model was used to estimate an adjusted relative risk (RR) of postpartum modern contraceptives.
Results
Approximately half (48%) of the women have missed the opportunity to receive family planning
counselling at the health service contact points during the 12 months preceding the survey. The postpartum modern contraceptive uptake was 27%. Two hundred forty-two (30%) and 204 (24%) of the counselled and not counselled women used postpartum modern contraceptive methods, respectively. Compared with women who did not receive counselling for family planning, women who received counselling had higher contraceptive uptake (RR 1.32, 95%CI 1.04 to 1.67).
Conclusion
Significant numbers of women have missed the opportunity of receiving family planning counselling during contact with health service delivery points. Modern contraceptive uptake among postpartum women was low in Ethiopia. Despite this, our findings revealed that family planning counselling was associated with improved postpartum modern contraceptive uptake.
... In controlled settings, two-thirds of women use LAM transition to another method effectively 30 . However, studies have suggested that a variable proportion of women between 48% and 86% that use LAM successfully transition to another contraceptive method, indicating some challenges within the transition period [30][31][32] . ...
In Africa, indigenous methods of contraception continue to play a significant role in preventing unwanted pregnancies despite the introduction and popularity of modern contraceptives. The current review identified the common techniques and practices of
African indigenous contraception, and examined their mechanisms and reasons for use. We searched data bases such as Google Scholar, Scopus, Web of Science, EBSCohost, African Journals, Science Direct, textbooks, thesis and dissertations for research
articles on African indigenous contraception. The six common techniques of African indigenous contraception included periodic abstinence, withdrawal, breastfeeding, use of herbs, postpartum abstinence and waist bands, whilst practices relate to child (birth)
spacing, postponement of first birth (virginity), stopping of reproduction and indigenous emergency contraception. Mother and infant health was stated as one of the reasons for using African indigenous contraception. African indigenous contraception continues to play a critical reproductive role in preventing unwanted pregnancies. However, there is lack of clarity regarding mechanisms, the safety, and efficacy of some techniques.
... Метод эффективен в первые 6 мес. после родов [9]. Если хотя бы одно из этих условий не соблюдается, необходимо использовать другие методы контрацепции [10]. ...
I.V. Bakhareva
Pirogov Russian National Research Medical University, Moscow, Russian Federation
Family planning and contraception after childbirth are important medical and social issues. Reproductive health and full preconception planning (which ensure uncomplicated course of the pregnancy), the birth of healthy children, and prevention of unintended pregnancy will be provided by addressing these issues. The major goals of postpartum family planning are optimal time between the end of the first pregnancy and the conception of the next (at least 2–3 years) as well as the reduction of maternal risks, perinatal and infant morbidity and mortality, and the rate of medical abortions. All these aspects require the choice of optimal postpartum contraception for the couple. This paper discusses current views on the methods of postpartum contraception, both traditional (i.e., lactational amenorrhea, barrier contraceptives, calendar method) and contemporary (hormonal methods). Despite being relatively conservative about postpartum contraception in view of the potential effects of hormonal agents on the child during breastfeeding, modern highly effective methods of long-acting reversible contraception immediately after childbirth (mainly intrauterine devices and implants) are being actively sought worldwide. The choice of optimal method of contraception during breastfeeding, antenatal and postpartum consultation will help decide on the potential risk of unintended pregnancy, contraception method, and the risk of breastfeeding problems.
Keywords: contraception, hormonal contraceptives, postpartum period, breastfeeding.
For citation: Bakhareva I.V. Postpartum contraception: optimal choice. Russian Journal of Woman and Child Health. 2020;3(1):–38. DOI: 10.32364/2618-8430-2020-3-1-31-38.
... Noel-Weiss, Boersma, & Kujawa-Myles (2012) stressed the importance of including feeding modality in defining breastfeeding practices. In addition, Labbok, et al. (1997) published a review of breastfeeding intensity terms used in research, formally documenting divergence and lack of consensus. Despite these efforts, there still lacks consistency in breastfeeding research measurement and a comprehensive and contemporary lexicon. ...
There has, historically, been a lack of consistency in the use and definition of terms and their associated measurement in breastfeeding research. The purpose of this paper is to promote consistency through a taxonomy and lexicon for population-based breastfeeding research with the modern nursing dyad. The taxonomy organizes concepts in categories related to research on feeding human milk to infants, noting the perspective from the provider of human milk (parent or alloparent) and the receiver of human milk (child). The taxonomy includes these categories: psychology, physiology, behavior, and modality. The intensity of behaviors and modalities can be characterized qualitatively or quantitatively. Other terms are introduced or defined for the modern era and measurement standards are posed. These suggestions invite discussion and debate, in an effort to move researchers toward consistent measurement, documentation, and presentation, to build a credible evidence base for breastfeeding and practices related to the provision and consumption of human milk.
... For example, among the physically active Hadza hunter-gatherer population (a non-contracepting population), nursing mothers appear to resume cycling~1-2 yr postpartum, based on observed birth spacing of 2-4 yr (10). By comparison, in relatively sedentary industrialized populations, mothers practicing intensive breastfeeding and relying on lactational amenorrhea for contraception typically resume cycling, and occasionally conceive, within 1 yr postpartum (39). ...
Humans and other species adapt dynamically to changes in daily physical activity, maintaining total energy expenditure within a narrow range. Chronic exercise thus suppresses other physiological activity, including immunity, reproduction, and stress response. This exercise-induced downregulation improves health at moderate levels of physical activity but can be detrimental at extreme workloads.
... below lists specific criteria, which are based on the time during which lactational amenorrhoea provides 98% protection against unwanted pregnancy. 42 (iv) Unmet need for contraception 8 months postpartum We used the revised definition of unmet need provided by the Demographic and Health Survey organization. 43 (v) Good relationship adjustment 8 months postpartum Relationship adjustment was determined from the woman's satisfaction with her relationship with her partner and the degree of communication, shared decision-making and agreement between the couple on key issues related to reproductive health. ...
Objective:
To determine whether an intervention to involve the male partners of pregnant women in maternity care influenced care-seeking, healthy breastfeeding and contraceptive practices after childbirth in urban Burkina Faso.
Methods:
In a non-blinded, multicentre, parallel-group, superiority trial, 1144 women were assigned by simple randomization to two study arms: 583 entered the intervention arm and 561 entered the control arm. All women were cohabiting with a male partner and had a low-risk pregnancy. Recruitment took place at 20 to 36 weeks' gestation at five primary health centres in Bobo-Dioulasso. The intervention comprised three educational sessions: (i) an interactive group session during pregnancy with male partners only, to discuss their role; (ii) a counselling session during pregnancy for individual couples; and (iii) a postnatal couple counselling session. The control group received routine care only. We followed up participants at 3 and 8 months postpartum.
Findings:
The follow-up rate was over 96% at both times. In the intervention arm, 74% (432/583) of couples or men attended at least two study sessions. Attendance at two or more outpatient postnatal care consultations was more frequent in the intervention than the control group (risk difference, RD: 11.7%; 95% confidence interval, CI: 6.0 to 17.5), as was exclusive breastfeeding 3 months postpartum (RD: 11.4%; 95% CI: 5.8 to 17.2) and effective modern contraception use 8 months postpartum (RD: 6.4%; 95% CI: 0.5 to 12.3).
Conclusion:
Involving men as supportive partners in maternity care was associated with better adherence to recommended healthy practices after childbirth.
... For example, among the physically active Hadza hunter-gatherer population (a non-contracepting population), nursing mothers appear to resume cycling~1-2 yr postpartum, based on observed birth spacing of 2-4 yr (10). By comparison, in relatively sedentary industrialized populations, mothers practicing intensive breastfeeding and relying on lactational amenorrhea for contraception typically resume cycling, and occasionally conceive, within 1 yr postpartum (39). ...
... However, exclusive breastfeeding in the first 6 months of life and continuation of breastfeeding as recommended is an effective populationbased method of preventing pregnancy postpartum. It has been demonstrated that breastfeeding is up to 98% effective in suppressing fertility among women who are exclusively breastfeeding an infant of less than 6 months of age and are amenorrheic (Labbok et al. 1997;Van der Wijden and Manion 2015). In the absence of breastfeeding, ovulation can occur within 6 weeks of birth leading to increased risk of pregnancy quickly postpartum. ...
In emergencies, women and children are among the most vulnerable to multiple forms of violence and exploitation as well as illness and death. Displacement during humanitarian crises has a profound impact on maternal and child health, particularly during the perinatal period, with significant consequences for maternal and infant health across the life course. Emergencies disproportionately affect women’s access to medical, social, cultural, and familial support systems; barriers to perinatal and psychosocial care are associated with increased rates of morbidity and mortality among mothers and infants. In this chapter we discuss breastfeeding in the context of the reproductive health continuum and intergenerational health. We use this background to elucidate the critical importance of infant and young child feeding practices in emergencies, an aspect of humanitarian response that is often neglected and poorly executed. Drawing upon a review of the literature as well as presentation of case studies drawn from our own field research, we highlight the importance of prioritizing perinatal maternal and child health in policies, protocols, and humanitarian response.
... Research shows that bedsharing breastfeeding mothers nurse their infants 5.75 times during the night (often without realizing it), compared to 2.5 times a night for moms and babies who do not share a bed (McKenna, Mosko, & Richard, 1997). This increased breastfeeding is especially important for a mother to maintain a robust milk supply (Hartmann, Sherriff, & Mitoulas, 1998) and remain anovulatory so that her children are widely spaced (Labbok et al., 1997). The perception of low milk supply is one of the most important reasons women give for stopping breastfeeding (Ball et al., 2016). ...
... Optimal breastfeeding of infants under age two has the greatest potential impact on child survival of all preventive interventions, with the potential to prevent 13% of all deaths in children under five in the developing world (Jones et al. 2003). LAM is over 98% effective as a contraceptive method when used correctly (Labbok et al. 1997), and programs that have promoted LAM as part of postpartum family planning (PPFP) counseling along with infant and young child feeding messages have demonstrated increases in EBF duration and contraceptive use at 1 year postpartum Bongiovanni et al. 2005). Offering infants foods or liquids other than breastmilk leads to reduced frequency and duration of breastfeeding, which can trigger ovulation, and results in LAM no longer being a viable FP option. ...
Purpose This article shares learning from an innovative demonstration program integrating maternal, infant, and young child nutrition (MIYCN) and family planning (FP) services in western Kenya, providing recommendations for future work to expand MIYCN and FP integration. Description Six health facilities reorganized to integrate MIYCN and FP services and community health volunteers (CHVs) promoted MIYCN and FP in adjacent communities in Bondo Sub-County over a 1-year period. At the facility level, each provider was directed to provide both sets of services in a single room during FP, antenatal care, postnatal care, or child consultation visits (a “one stop shop” approach). At community level, CHVs were to conduct household visits equipped with new integrated materials and incorporate MIYCN and FP within community activities. Assessment Although the “one stop shop” approach, where one provider offers all integrated services in one room, was initially proposed for all facilities, this worked most effectively in the dispensary and health centers. The sub-county hospital adapted the approach such that integrated services were offered by more than one provider during a visit, with clients linked from one provider to another through same-day intra-facility referrals. CHVs were generally able to incorporate MIYCN and FP content within household visits and community activities; however some knowledge gaps were noted after initial training, necessitating additional refresher training. Conclusion This demonstration experience revealed that future replication efforts should enable sub-county team leadership, assess facility readiness, streamline data collection, build local buy-in, and prioritize dispensaries and health centers with high client loads.
... 4 The lactational amenorrhea method of contraception cannot be depended on for longer than 6 months postpartum and even then there is a failure rate of 2% in these 6 months. 5 Thus postpartum IUD is the need of the hour. ...
... Clinical studies of the contraceptive effect of LAM have demonstrated cumulative 6month life-table perfect-use pregnancy rates of 0.5 -1.5% among women who relied solely on LAM. A Cochrane review published in 2015 estimated the typical use failure rate of LAM to be 0.45 -7.5% [12][13][14][15]. ...
Postpartum contraception is important to prevent unintended pregnancies. Assisting women in achieving recommended inter-pregnancy intervals is a significant maternal-child health concern. Short inter-pregnancy intervals are associated with negative perinatal, neonatal, infant, and maternal health outcomes. More than 30% of women experience inter-pregnancy intervals of less than 18 months in the United States. Provision of any contraceptive method after giving birth is associated with improved inter-pregnancy intervals. However, concerns about the impact of hormonal contraceptives on breastfeeding and infant health have limited recommendations for such methods and have led to discrepant recommendations by organizations such as the World Health Organization and the U.S. Centers for Disease Control and Prevention. In this review, we discuss current recommendations for the use of hormonal contraception in the postpartum period. We also discuss details of the lactational amenorrhea method and effects of hormonal contraception on breastfeeding. Given the paucity of high quality evidence on the impact on hormonal contraception on breastfeeding outcomes, and the strong evidence for improved health outcomes with achievement of recommended birth spacing intervals, the real risk of unintended pregnancy and its consequences must not be neglected for fear of theoretical neonatal risks. Women should establish desired hormonal contraception before the risk of pregnancy resumes. With optimization of postpartum contraception provision, we will step closer toward a healthcare system with fewer unintended pregnancies and improved birth outcomes.
... Metode amenore laktasi sangat tergantung pada eksklusivitas pemberian ASI, yang dimulai sejak dini, setiap saat bayi menginginkan, siang dan malam tanpa diselingi susu formula. 10 Prevalensi ibu yang tidak bekerja memiliki peluang lebih besar untuk menerapkan kontrasepsi metode amenore laktasi, dibandingkan dengan ibu yang bekerja. Hal ini sesuai dengan pernyataan Binns et al, 11 bahwa wanita yang bekerja di luar rumah dan menerapkan metode amenore laktasi mempunyai risiko yang lebih besar untuk hamil, sehingga perlu diberikan informasi bahwa ibu dan bayinya akan meningkatkan risiko untuk hamil. ...
Keberhasilan metode amenore laktasi yang merupakan metode kontrasepsi efektif wanita menyusui tergantung pada pemberian air susu ibu (ASI) secara eksklusif. Konseling postpartum diperlukan untuk meningkatkan pengetahuan tentang metode kontrasepsi postpartum. Tujuan penelitian ini untuk menilai hubungan konseling postpartum dan penerapan metode kontrasepsi amenore laktasi setelah mengendalikan pengaruh variabel paritas, status pekerjaan, dukungan petugas kesehatan, dan dukungan keluarga. Penelitian observasional ini menggunakan rancangan cross sectional dengan pendekatan kuantitatif dan kualitatif. Subjek penelitian adalah ibu yang mempunyai bayi usia 7 – 12 bulan dan memberikan ASI eksklusif. Hubungan antara variabel penelitian dianalisis dengan regresi logistik multivariat dengan chi square, kekuatan hubungan dihitung dengan rasio prevalens dan 95% convidence interval odds ratio. Ditemukan hubungan yang bermakna antara konseling postpartum dengan penerapan kontrasepsi metode amenore laktasi setelah mengontrol variabel paritas, status pekerjaan, dukungan petugas kesehatan, dan dukungan keluarga. Konseling tersebut berkontribusi sekitar 24% pada penerapan kontrasepsi metode amenore laktasi. Responden mendapatkan konseling dan dukungan petugas kesehatan tentang ASI eksklusif, tetapi kontrasepsi dengan metode amenore laktasi belum disampaikan.
Kata kunci: ASI eksklusif, kontrasepsi, konseling postpartum, metode amenore laktasi
Abstract
Lactation amenorrheal method (LAM) is an effective contraception method for women that give exclusive breastfeeding. Postpartum counseling is important in order to improve knowledge about LAM as postpartum contraception method. The objective of this research is to measure the relationship between postpartum counseling and lactation amenorrheal method after being controlled parity, work status, health care staff support, and family support. This observational research using cross sectional design with quantitative and qualitative approach. Subject of the study were mother who has 7 – 12 months infant breasfeeded exclusively. Association among variables were analyzed using chi square, strength association was measured using prevalence ratio of 95% convidence interval odds ratio. Multivariate analysis used logistic regression technique. The result of logistic regression analysis showed there was significant association between postpartum counseling and LAM contraception with the control of variables of parity, occupational status, health staff support and the family that contributed 24% in the implementation of LAM contraception. The result of indepth interview showed that postpartum mother got counseling and support from health staff about exsclusive breastfeeding and is not knowledge about LAM as postpartum contraception method.
Keywords: Exclusive breastfeeding, contraception, postpartum counseling, lactation amenorrheal method
... Transition represents a challenging time to practice NFP (Fehring 2010), as a woman may not have resumed menses; or, if she has, she may not have resumed regular cycles. For breast-feeding women, LAM is taught according to evidence-based guidelines (Labbok et al. 1997). These guidelines demonstrate that if a woman meets the three LAM criteria of amenorrhea, fully breast feeding, and baby less than six months of age, then the chance of pregnancy is between 1 and 2 percent. ...
Various fertility indicators are used by natural family planning methods to identify the fertile and infertile phases of a woman's menstrual cycle: mucus observations, cycle-day probabilities, basal body temperature readings, and hormonal measures of LH and estrogen. Simplified NFP methods generally make use of a single fertility indicator such as cycle-day probabilities (Standard Days Method) or mucus observations (Billings Ovulation Method). The Couple Bead Method integrates the two simplest fertility indicators, cycle-day probabilities and mucus observations, expanding its applicability to all women, regardless of cycle regularity and length. In determining cycle-day probabilities, the Couple Bead Method relies on a new data set from ultrasound-derived determinants of gestational age that more directly define the day of conception and the fertile window. By using a visual-based system of inexpensive colored beads, the Couple Bead Method can be used by couples of all educational and income levels.
Lay Summary: Natural family planning methods provide education in regard to the signs of a woman's body which indicate if she is possibly fertile or not. Two important signs are the day of her menstrual cycle and her observations of bleeding and cervical mucus or dryness. The Couple Bead Method teaches a couple how to observe these signs and chart them with a system of colored beads. The Couple Bead Method can be used by women with regular or irregular cycles. The bead sets are inexpensive and consist of a length of plastic cord, colored “pony beads” and safety pins.
The 2024 U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) comprises recommendations for the use of specific contraceptive methods by persons who have certain characteristics or medical conditions. These recommendations for health care providers were updated by CDC after review of the scientific evidence and a meeting with national experts in Atlanta, Georgia, during January 25–27, 2023. The information in this report replaces the 2016 U.S. MEC (CDC. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR 2016:65[No. RR-3]:1–103). Notable updates include 1) the addition of recommendations for persons with chronic kidney disease; 2) revisions to the recommendations for persons with certain characteristics or medical conditions (i.e., breastfeeding, postpartum, postabortion, obesity, surgery, deep venous thrombosis or pulmonary embolism with or without anticoagulant therapy, thrombophilia, superficial venous thrombosis, valvular heart disease, peripartum cardiomyopathy, systemic lupus erythematosus, high risk for HIV infection, cirrhosis, liver tumor, sickle cell disease, solid organ transplantation, and drug interactions with antiretrovirals used for prevention or treatment of HIV infection); and 3) inclusion of new contraceptive methods, including new doses or formulations of combined oral contraceptives, contraceptive patches, vaginal rings, progestin-only pills, levonorgestrel intrauterine devices, and vaginal pH modulator. The recommendations in this report are intended to serve as a source of evidence-based clinical practice guidance for health care providers. The goals of these recommendations are to remove unnecessary medical barriers to accessing and using contraception and to support the provision of person-centered contraceptive counseling and services in a noncoercive manner. Health care providers should always consider the individual clinical circumstances of each person seeking contraceptive services. This report is not intended to be a substitute for professional medical advice for individual patients; when needed, patients should seek advice from their health care providers about contraceptive use.
BACKGROUND
The World Health Organization (WHO) system for the classification of disorders of ovulation was produced 50 years ago and, by international consensus, has been updated by the International Federation of Gynecology and Obstetrics (FIGO).
OBJECTIVE AND RATIONALE
This review outlines in detail each component of the FIGO HyPO-P (hypothalamic, pituitary, ovarian, PCOS) classification with a concise description of each cause, and thereby provides a systematic method for diagnosis and management.
SEARCH METHODS
We searched the published articles in the PubMed database in the English-language literature until October 2022, containing the keywords ovulatory disorders; ovulatory dysfunction; anovulation, and each subheading in the FIGO HyPO-P classification. We did not include abstracts or conference proceedings because the data are usually difficult to assess.
OUTCOMES
We present the most comprehensive review of all disorders of ovulation, published systematically according to the logical FIGO classification.
WIDER IMPLICATIONS
Improving the diagnosis of an individual’s ovulatory dysfunction will significantly impact clinical practice by enabling healthcare practitioners to make a precise diagnosis and plan appropriate management.
Introduction: The lactational amenorrhea method (LAM) of postpartum contraception is more effective than typical use of condoms or birth control pills. However, LAM may be underutilized due to incomplete perinatal counseling. Methods: We compared perceptions of the effectiveness of postpartum contraceptives including LAM among U.S.-born nulliparous pregnant women recruited using social media for a trial (NCT04601987). We used descriptive statistics to summarize data. Results: Of 760 individuals screened, 627 were invited to participate, and 451 (72%) were enrolled. Most (81%) had a college degree; 79% intended to breastfeed for at least 1 month. Only 8% believed exclusive breastfeeding reduces the chance of pregnancy "a lot" within 6 months of delivery and 2% indicated that exclusive breastfeeding is typically more effective than birth control pills or condoms. Compared with those planning to use other postpartum contraceptives, the 17% of respondents who planned to use LAM were more likely to know that breastfeeding delays return of menses (84% versus 44%, p ≤ 0.0001) and provides protection from pregnancy until menses return (54% versus 22%, p ≤ 0.0001). Although 25% of those planning to use LAM believed exclusive breastfeeding reduces pregnancy risk by "a lot," only 5% thought LAM is more effective than birth control pills and only 9% thought that it is more effective than condoms. Conclusions/Implications: First-time U.S. mothers are often unaware of breastfeeding's effects on menses and fertility. Clinicians providing counseling about postpartum contraceptive options should include more information on LAM.
The clinical relevance of amenorrhea associated with contraception and postpartum period is still a matter of debate for researchers in the field of reproductive endocrinology. The contraceptive needs of women in the postpartum period are probably underestimated. It is possible that sexual activity and fertility begin early while, on the other hand, the needs of caring for the newborn may constitute a specific obstacle to access an effective contraceptive method. For this reason, effective contraception should be offered to all women, whether or not they are breastfeeding, as soon as possible and no later than 21 days after delivery. For this purpose, adequate information helps each mother and couple to better plan their fertility. Surgical and intrauterine device, hormonal compounds, barrier methods, and local chemicals could be evaluated in patients during postpartum period.KeywordsAmenorrheaContraceptionPostpartum periodBreastfeedingProgestogens
During the lifespan of women, there are dramatic transitions associated with the beginning and cessation of reproductive function. These transitions, puberty and menopause, result in dramatic changes in the anatomy, physiology, and cognitive function in females and are caused by fluctuating levels of estrogen and progesterone. Regular menstruation is the result of cyclic release of reproductive hormones and is a sign that the reproductive system is functioning optimally. The menstrual cycle has vast implications on the building, maintenance, and break down of skeletal bone in women. Due to the fluctuating level of female hormones, the menstrual cycle plays a distinctive role during various times of the month which in turn affects bone health. Estrogen is a crucial hormone for bone turnover/remodeling which, when released, provides a protective mechanism against the process of natural bone loss due to aging. Acquiring a high amount of peak bone mass during adolescence helps to protect the female against rapid degradation of bone due to the decline of estrogen around menopause. Therefore, taking appropriate steps years before and after menopause is crucial in order to preserve bone mass in females.
It is important for breastfeeding mothers to receive necessary medications whether for chronic therapy or for a newly diagnosed condition. Almost all medications with a molecular weight below 300 Da will appear in human milk. Only a small number of drugs have the potential to harm the nursing infant. Spacing maternal dosing to just after each nursing may decrease the amount of drug appearing in milk. LactMed website contains the known pharmacology information for over 1000 drugs, chemicals, and herbal compounds.
Because breastfeeding provides optimal nutrition and other benefits for infants (e.g., lower risk of infectious disease) and benefits for mothers (e.g., less postpartum bleeding), health organizations recommend that healthy infants be exclusively breastfed for 4 to 6 months in the United States and 6 months internationally. Recommendations related to how long breastfeeding should continue, however, are inconsistent. The objective of this article is to review the literature related to evidence for benefits of breastfeeding beyond 1 year for mothers and infants. In summary, human milk represents a good source of nutrients and immune components beyond 1 year. Some studies point toward lower infant mortality in undernourished children breastfed for >1 year, and prolonged breastfeeding increases interbirth intervals. Data on other outcomes (e.g., growth, diarrhea, obesity, and maternal weight loss) are inconsistent, often lacking sufficient control for confounding variables. There is a substantial need for rigorous, prospective, mixed-methods, cross-cultural research on this topic.
Expected final online publication date for the Annual Review of Nutrition, Volume 41 is September 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
Tanzania has high fertility, low contraceptive prevalence and low exclusive breastfeeding (EBF). The Lake Zone, including Mara and Kagera regions, leads the country in total fertility; use of the lactational amenorrhea method (LAM) is negligible. This pre-/post-study explored the effects of a multi-level facility and community intervention (service delivery support, community engagement, media and LAM tracking) to integrate maternal and infant nutrition and postpartum family planning (FP) within existing health contacts. Mixed methods were used, including service statistics, exit interviews, patient-tracking tools for community health workers, client self-tracking tools, supervision data, focus group discussions and in-depth interviews. Results are presented using the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) implementation science framework. The intervention reached primarily the second and fourth wealth quintiles, increased FP and EBF at six weeks postpartum. LAM was very acceptable, provided an entry point for FP conversations and for addressing misconceptions, and reinforced EBF practices. Partners felt encouraged to support spousal nutrition, breastfeeding and FP. Higher adoption in Kagera may be influenced by performance-based financing. The intervention was implemented with generally high fidelity. Maintenance data reflected stakeholder interest in continuing the intervention. A multi-level facility and community intervention was feasible to implement and likely contributed to improved EBF practices and FP uptake, including LAM use.
Strong evidence supports breastfeeding as the appropriate health choice for both mothers and infants. However, the mechanics of breastfeeding are frequently less well understood. This review of both the research and clinical evidence regarding appropriate breastfeeding management is designed to aid the midwife and other health care professionals in providing care and teaching, which will optimize maternal and infant health.
ทบทวนหลักฐานทางวิชาการที่เกี่ยวข้องกับการคุมกำเนิดในสตรีหลังคลอด และ หลังแท้งบุตร
Die Anwendung von Familienplanungsmethoden hat in den letzten 20 Jahren auch in den Entwicklungsländern deutlich zugenommen. Dennoch ist das Bevölkerungswachstum, insbesondere in den ärmsten Regionen der Welt, bisher nicht aufzuhalten. In den Entwicklungsländern ist der Schwerpunkt für eine erfolgreiche Anwendung einer Familienplanungsmethode von der Sicherheit hin zur Akzeptanz verschoben. Eine Methode, die von den Anwendern akzeptiert und praktiziert wird, wird die Kinderzahl einer Familie signifikant reduzieren, auch wenn sie nur im mittleren Sicherheitsbereich liegt und kann somit als Erfolg gewertet werden. Für die Entwicklungsländer wurden stark vereinfachte Varianten der NFP-Methoden entwickelt: Dabei wird auf Thermometer und eigene Zyklusaufzeichnungen verzichtet. Im Rahmen der Primary Health Care werden einfache Zervixschleimregeln gelehrt oder festgelegte Zyklustage als fruchtbar definiert oder neuerdings mit der Unterstützung von Zyklus-Apps Kalendermethoden verbreitet.
Dieses Kapitel befasst sich mit zwei Sondersituationen für die NFP-Anwendung. Häufig wird NFP unmittelbar nach Absetzen von hormoneller Kontrazeption angewandt. In ca. 50 % der Fälle kommt es zu vorübergehenden Zyklusstörungen und zu einer verzögerten Rückkehr der Fruchtbarkeit. Nach der Geburt ist die Rückkehr des ovulatorischen Zyklus individuell sehr verschieden und hängt vom Stillverhalten ab. Zu beiden Situationen werden die aktuellen Daten und die spezifischen NFP-Regeln dargestellt.
Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding CASRP΄s archiving and manuscript policies encouraged to visit: http://www.casrp.co.uk/journals Abstract The extended postpartum period is the time which is usually given less emphasis regarding family planning by policy makers, service providers and users. However, it is a time with a rising risk of unwanted conception and an often-frustrated desire for contraceptive protection. Understanding the contraceptive behaviors, needs and preferences of women in this period is important the main objective of this study was to assess the contraceptive needs and practices of women during the extended postpartum period. A community based cross sectional study was conducted in Kiramu Woreda. Four kebeles were purposively selected in the Woreda. A total of 120 women 342 who were in the first year after delivery were interviewed by trained data collectors using a structured and pre tested questionnaire. Data were entered, cheeked and analyzed using Microsoft excel. The mean age of the study subjects was 30.25 with minimum age of 23 and a maximum of 37 and median age of 30 years. The prevalence of modern contraceptive Family Planning. Use was found to be 34(28.3%) among women in the extended postpartum period. Two third of women in the extended post partum period were not currently practicing any modern contraceptive method at the time of interview in spite of the doing sex. The reasons for non use were: fear of side effects in 68(56.7 %%) of the study subjects, 14(11.7 %%) due to lack of awareness of contraceptives, 4(3.3%) of them was due to fear of their husbands. In addition to this 77(64.2%) of the Women's started sex early before six weeks. This makes early pregnant before they saw any Menstruation. However, Only 34(28.3%) of women's started to prevent pregnancy during the intended postpartum period in the district. Knowledge and practice of Modern Family planning method in the district was very low. Therefore, continual health education contraceptive method mix during the extended post partum period should be revised by family planning program managers and providers is recommended for the implementation of the program.
Die Anwendung von Familienplanungsmethoden hat in den letzten 20 Jahren auch in den Entwicklungsländern deutlich zugenommen. Dennoch ist das Bevölkerungswachstum, insbesondere in den ärmsten Regionen der Welt, bisher nicht wesentlich aufzuhalten. Aufgrund ihrer Einstellung zu Kind und Großfamilie empfinden viele die Geburtenkontrolle für sich selbst als überflüssig, mehr noch, sie widerspricht ihren Zielen. Schwangerschaft und Kinderreichtum gelten weiterhin als Beweis für Weiblichkeit bzw. männliche Potenz. Nicht selten sind mit diesem Thema ängste und Aberglaube verbunden. Erschwerend kommt bei der NFP hinzu, dass der zeitweilige Verzicht auf Sexualverkehr in manchen Gesellschaften als unakzeptabel gilt.
Rund 60% aller Frauen im Alter zwischen 20 und 40 Jahren, die verhüten wollen, nehmen orale Kontrazeptiva ein. In der ärztlichen Praxis sind Fragen zur Einregulierung des Zyklusgeschehens nach Absetzen der hormonellen Empfängnisverhütung besonders wichtig für Frauen, die eine Schwangerschaft anstreben oder aber zu einer anderen Familienplanungsmethode wechseln.
Reproductive systemLactation
Recognizing the health impact of timing and spacing of pregnancies, the Sustainable Development Goals call for increased access to family planning globally. While faith-based organizations in Africa provide a significant proportion of health services, family planning service delivery has been limited. This evaluation sought to assess the effectiveness of implementing a systems approach in strengthening the capacity of Christian Health Associations to provide family planning and increase uptake in their communities. From January 2014 to September 2015, the capacity of three Christian Health Associations in East Africa—Caritas Rwanda, Uganda Catholic Medical Bureau, and Uganda Protestant Medical Bureau—was strengthened in key components of a systems approach to family planning—training, supervision, commodity availability, family planning promotion, data collection, and creating a supportive environment—with the aim of improving access to women with unmet need and harmonizing faith-based service delivery contributions with the national family planning program. Community-based provision of family planning, including fertility awareness methods, was introduced across intervention sites for the first time. 547 facility- and community-based providers were trained in family planning, and 393,964 people were reached with family planning information. 32,176 clients took up a method, and 43% of clients received this service at the community level. According to a provider competency checklist, facility- and community-based providers were able to adequately counsel clients on new fertility awareness methods. Integration of Christian Health Associations into the national family planning strategy improved through participation in routine technical working group meetings, and the Ministries of Health in Rwanda and Uganda recognized them as credible family planning partners. Findings suggest that by strengthening capacity using a systems approach, Christian Health Associations can meaningfully contribute to national and international family planning goals. Increased attention to mainstreaming family planning service delivery across Christian Health Associations is recommended.
Introduction:
short interval repeat pregnancy increases maternal and neonatal morbidity, and provision of postpartum contraception provides primary protection against these adverse outcomes. Confusion regarding effects on breast feeding and thrombosis risk delaying initiation of contraception in the immediate post-partum interval. Delaying contraception provision until the 6-week postpartum visit misses many women who either do not attend or have resumed ovulation and/or intercourse prior to this visit. Because of this, recent studies have looked into initiation of highly effective contraceptive methods at earlier intervals including immediately postpartum. These data provide strong evidence for immediate post-partum initiation of the most effective long-acting reversible contraception (LARC) methods, intrauterine devices and implants. Areas Covered: We review the data for safety and efficacy, timing of initiation, and continuation rates of various contraceptive methods in the postpartum period. We also evaluate effects on initiation and continuation of breastfeeding for each contraceptive method discussed. Expert Opinion: It is important to counsel patients antenatally regarding the full spectrum of contraceptive options available with a focus on long-acting reversible contraceptive (LARC) methods. When a woman chooses a LARC method, her provider should consider placement in the immediate postpartum period.
The Lactational Amenorrhea Method for family planning, based on the physiology of lactational infertility, has undergone extensive clinical study. Concern remains, among clinicians and demographers alike, that this is a behavior-based method and is therefore unreliable. This study was undertaken to observe method use under conditions that would more approximate use outside of a research setting.
Daten zur natürlichen Familienplanung (NFP) werden normalerweise von gesunden Frauen erhoben. Damit sind sie — im Gegensatz zu pathologischen Kollektiven — prädestiniert, reproduktionsmedizinische Fragen zu untersuchen, die das Normale betreffen. Wir haben vor 20 Jahren begonnen, eine solche prospektive Langzeitdatenbank aufzubauen und haben diese bis heute kontinuierlich fortgeführt [9]. Nach unserem Wissen handelt es sich mittlerweile um die weltweit größte prospektive Langzeitdatenbank dieser Art. Die Teilnehmerinnen haben u. a. die zyklische Zervixschleimsekretion und den Temperaturanstieg aufgezeichnet. Dazu geben sie in jedem Zyklus die Familienplanungsintention für den nächsten Zyklus an. Es kann die klinische Ovulation bestimmt werden. 87% der Teilnehmerinnen geben den Geschlechtsverkehr an. Es gibt einen erheblichen Anteil an Langzeitverläufen, bei denen beispielsweise eine Frau zunächst als Verhüterin erfasst ist, dann der genaue Zeitpunkt ihres Wechsels zu Kinderwunsch, Schwangerschaft, Stillen und wieder folgender Verhütung beobachtet werden kann. Das follow-up findet in regelmäßigen Abständen statt und die lost-to-follow-up-Rate liegt bei dieser prospektiven Studie bei 7%, was für die Datenqualität spricht. Derzeit enthält diese Datenbank 32.461 Zyklen von 1.548 Frauen (s.a. fp@uni-duesseldorf.de). Ähnlich wie diese Datenbank haben wir eine Europäische Datenbank mit 10 Teilnehmerländern aufgebaut [5], und außerdem am Aufbau einer kleineren europäischen Datenerhebung von Colomboetal. [2] teilgenommen. Alle folgenden Aussagen entspringen im wesentlichen diesen aktuellen Datenbanken.
Die Anwendung von Familienplanungsmethoden hat in den letzten 20 Jahren auch in den Entwicklungsländern deutlich zugenommen. Dennoch ist das Bevölkerungswachstum, insbesondere in den ärmsten Regionen der Welt, bisher nicht wesentlich aufzuhalten. Aufgrund ihrer Einstellung zu Kind und Großfamilie empfinden viele die Geburtenkontrolle für sich selbst als überflüssig, mehr noch, sie widerspricht ihren Zielen. Schwangerschaft und Kinderreichtum gelten weiterhin als Beweis für Weiblichkeit bzw. männliche Potenz. Nicht selten sind mit diesem Thema Ängste und Aberglaube verbunden. Erschwerend kommt bei der NFP hinzu, dass der zeitweilige Verzicht auf Sexualverkehr in manchen Gesellschaften als unakzeptabel gilt.
Rund 60 % aller Frauen im Alter zwischen 20 und 40 Jahren, die verhüten wollen, wenden hormonelle Verhütungsmethoden an. Dabei hat sich die Angebotspalette in den letzten 15 Jahren deutlich erweitert. Es bietet sich eine grobe Unterscheidung an zwischen Kontrazeptiva, die eine Kombination aus Östrogen und Gestagen enthalten (klassische Pille, Vaginalring
und Hormonpflaster
) und reinen Gestagenen
(Gestagenpille
, Hormonspirale
, Hormonimplantat
, Dreimonatsspritze
). 90 % der Anwenderinnen hormoneller Kontrazeptiva verwenden derzeit ein Östrogen-Gestagen-Präparat, 10 % ein reines Gestagen [13]. In der ärztlichen Praxis sind Fragen zur Einregulierung des Zyklusgeschehens nach Absetzen der hormonellen Empfängnisverhütung besonders wichtig für Frauen, die eine Schwangerschaft anstreben oder aber zu einer anderen Familienplanungsmethode wechseln.
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.
Graphically presented algorithms are presently used in many settings worldwide for the diagnosis, management, and teaching of curative health services. There is potential as well for using such algorithms for teaching and counseling in the preventive services, especially in family planning services. The employment of paramedical or lesser trained workers in family planning or management requires careful attention to skill development in all phases of training. The use of graphically presented algorithms may simplify this process of skill development. In addition, the algorithms provide guidelines for use in the field by those providing family planning services, and for program management and supervision. Examples of algorithms used in paramedical services are presented. The development of two algorithms are discussed in detail, 1) an algorithm for introduction of contraceptives during lactation, and 2) an algorithm for supervision of data collection.
The effect of breastfeeding on fertility is well known; however, its use as a method of family planning was, until recently, untested. In 1988, the Bellagio Consensus Conference proposed guidelines that became the basis for a method of family planning called the lactational amenorrhoea method (LAM). The principle of LAM is that a woman who continues to fully or nearly fully breastfeed her infant and who remains amenorrhoeic during the first 6 months postpartum is protected from pregnancy during that time. We have assessed this method in the context of a breastfeeding support intervention study of 422 middle-class women in urban Santiago, Chile. The cumulative 6-month life-table pregnancy rate was 0.45% among women who relied on LAM as their only family planning method (1 woman pregnant in month 6). The findings indicate that LAM, with its high acceptance and efficacy, is a viable method of family planning and can safely serve as an introductory method for breastfeeding women.
On 28 April 1988, the Interagency Group for Action on Breastfeeding met to develop and agree upon a set of definitions that could be used as standardized terminology for the collection and description of cross-sectional information on breastfeeding behavior. The schema and potential framework suggested at the meeting were reviewed extensively by breastfeeding researchers and program personnel, revised at subsequent meetings by a variety of organizations, and compared against published research on patterns of breastfeeding and their effects on infant nutrition, health, and fertility. This schema and framework: (1) acknowledge that the term "breastfeeding" alone is insufficient to describe the numerous types of breastfeeding behavior, (2) distinguish full from partial breastfeeding, (3) subdivide full breastfeeding into categories of exclusive and almost exclusive breastfeeding, (4) differentiate among levels of partial breastfeeding, and (5) recognize that there can be token breastfeeding with little to no nutritional impact. The schema and framework should assist researchers and agencies in their efforts to accurately describe and interpret breastfeeding practices.
An interdisciplinary international group of researchers in the area of lactational infertility gathered with the purpose of coming to a consensus about the conditions under which breastfeeding can be used as a safe and effective method of family planning. The consensus of the group was that the maximum birth spacing effect of breastfeeding is achieved when a mother "fully" or nearly fully breastfeeds and remains amenorrheic. When these two conditions are fulfilled, breastfeeding provides more than 98% protection from pregnancy in the first six months. Data are reviewed from thirteen prospective studies in both developed and developing countries supporting the consensus. The rationale for the consensus is given in detail. Recommendations are made based on what is currently known of the antifertility effects of breastfeeding. Research should continue to measure a broad spectrum of variables so that these guidelines can be refined as new information becomes available.
Lactating women are at reduced risk of conception, but the individual woman may not wish to accept even a reduced level of risk. The risk increases when infant feeding supplementation begins and an alternative form of contraception is then required for the lactating mother. The relationship between lactation and fertility, trends in prolonged lactation, factors affecting these trends, and contraceptive use during lactation are reviewed. Suggestions for advising individuals and formulating programme guidelines are discussed.
To determine the efficacy of the lactational amenorrhea method of family planning (amenorrhea during full or nearly full breastfeeding for 6 months postpartum).
Prospective noncomparative study.
Normal breastfeeding women in Karachi and Multan, Pakistan, most delivered at home by a midwife.
Three hundred ninety-nine newly delivered mothers who successfully had breastfed a previous child and chose the lactational amenorrhea method to prevent a subsequent pregnancy, 391 of whom were followed for a full year.
Mothers were taught, before or shortly after delivery, to use the method and were interviewed in their homes each month by a Lady Health Visitor.
Life-table pregnancy rates. Periods of postpartum or lactational abstinence were excluded in the calculation of the pregnancy rates.
During full or nearly full breastfeeding, while the women were amenorrheic and not otherwise contracepting, the rate of pregnancy was 0.6%. The pregnancy rate during lactational amenorrhea alone was 1.1% at 1 year postpartum.
The lactational amenorrhea method was found to be highly effective for 6 months. A high degree of contraceptive protection endures for a full year during lactational amenorrhea, but not after the return of menses during breastfeeding.
The Cebu Longitudinal Health and Nutrition Survey is used to examine the effect of various components of infant-feeding patterns on return of menses postpartum. The results show that factors such as active suckling, the use of two breasts versus one, breast-feeding on demand versus on a fixed schedule, and the feeding of other milks and of nonnutritive or low-caloric other liquids can be important under selected circumstances. Discrete-time logistic hazards modeling is used to estimate the weekly probability of return to menses.
This report presents a secondary data analysis based on prospectively collected records gathered during a field assessment that was carried out in Rwanda in August 1993. The assessment used service statistics and follow-up interviews to evaluate the efficacy of a modified lactational amenorrhea method (LAM) as a nine-month introductory postpartum natural family planning method. The program, carried out by Action Familiale Rwandaise (AFR), reflects high efficacy of the method in a compliant sample that sought this method followed by another form of family planning. These results are promising and provide guidance for the extended use of LAM past six months. Programmatic findings suggest that studies be conducted of the contribution of extended LAM to improved weaning practices, the high efficacy of continued reliance on substantial lactation and amenorrhea beyond nine months, and male involvement in LAM and breastfeeding.
The contraceptive effects of breast-feeding still play an important role in child spacing in developing countries; however, its use as a method of family planning was untested until 1988, when an international group of researchers met in Bellagio and reached a consensus statement that reads "The maximum birth spacing effect of breast-feeding is achieved when mothers fully or nearly fully breast-feed and remain amenorrheic (and no menstrual bleeding has occurred before the 56th postpartum day). When these two conditions are present, breast-feeding provides more than 98% of protection in the first six months. That became the basis for a method of family planning called the lactational amenorrhea method (LAM). Which is a new introductory family planning method that simultaneously promotes child spacing and breast-feeding, with its optimal nutrition and disease preventive benefits for the infant. This method is based on the natural infertility caused by the hormonal suppression of ovulation.
To determine the contraceptive efficacy of the lactational amenorrhoea method.
Non-comparative prospective trial.
Urban Manila, the Philippines.
485 lower income, educated women with extensive experience of breast feeding.
Women were offered all available contraceptives for use after birth. Those who chose the lactational amenorrhoea method were taught the method, screened for the study, and followed for 12 months to determine the risk of pregnancy when the method was used.
Life table pregnancy rates during correct and incorrect use of the method, censored monthly in the event of sexual abstinence or the use of another contraceptive method.
The lactational amenorrhoea method was 99% effective when used correctly (that is, during lactational amenorrhoea and full or nearly full breast feeding for up to six months). At 12 months the effectiveness during amenorrhoea dropped to 97%.
The lactational amenorrhoea method provided as much protection from pregnancy as non-breast feeding women experience with non-medicated intrauterine devices and barrier methods. The contraceptive effect of lactation cannot be attributed to lactational or postpartum abstinence.
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.
Toward consistency in breast-feeding definitions The return of ovarian function during lactation: Results of studies from the United States and the Philippines Biomedical and demographic determinants of reproduction
- M Labbok
- Krasovec
- Campbell Rh 0 Gray
- S Eslami
Labbok M, Krasovec K. Toward consistency in breast-feeding definitions. Stud Fam Plan 1990;21:22630. Gray RH, Campbell 0, Eslami S, et al. The return of ovarian function during lactation: Results of studies from the United States and the Philippines. In: Gray R, Leridon H, Spira A. eds. Biomedical and demographic determinants of reproduction. New York: Oxford Uni-versity Press, 1993:428-45.
Contraceptive technology, 16th rev Macro International. Demographic and Health Surveys: Peru 1991-1992. Columbia, MD: Institute for Resource Development/Macro International An assessment of the nine-month Lactational Amenorrhea Method (MAMA-9) in Rwanda
- S Coly
- Ra Hatcher
- J Trussell
- F Stewart
Coly, S. Values in contraceptive choice: A qualitative study on the Lactational Amenorrhea Method. Master's Thesis, Georgetown University, Department of Liberal Studies, May 1995. Hatcher RA, Trussell J, Stewart F, et al. Contraceptive technology, 16th rev. ed. Manchester, NH: Irvington Publishers, Inc, 1994. Macro International. Demographic and Health Surveys: Peru 1991-1992. Columbia, MD: Institute for Resource Development/Macro International, 1992. Cooney KA, Nyirabukeye T, Labbok MH, Hoser PH, Ballard E. An assessment of the nine-month Lactational Amenorrhea Method (MAMA-9) in Rwanda. Stud Fam Plan 1996;27:163-72.
Guidelines: Breastfeed-ing, Family Planning, and the Lactational Amenorrhea Method
- M Labbok
- K Cooney
- Coly
Labbok M, Cooney K, Coly S. Guidelines: Breastfeed-ing, Family Planning, and the Lactational Amenorrhea Method-LAM.
Institute for Reproductive Health. The Lactational Amen-7 orrhea Method: Are you offering your clients all the options? Washington, DC: Institute for Reproductive Health The Lactational Amenorrhea Method: A postpartum introductory fam-ily planning method with policy and program implica-tions
- Dc Washington
- Institute
- M Labbok
- A Perez
- V Valdes
Washington, DC: Institute for Repro-ductive Health, 1994. Institute for Reproductive Health. The Lactational Amen-7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. Contraception 1997;55:327-336 orrhea Method: Are you offering your clients all the options? Washington, DC: Institute for Reproductive Health, 1996. Labbok M, Perez A, Valdes V, et al. The Lactational Amenorrhea Method: A postpartum introductory fam-ily planning method with policy and program implica-tions. Adv Contracept 1994; 10:93-109.
- V Hight-Laukaran
- M Labbok
- A E Peterson
- V Fletcher
- H Von Hertzen
- Van Look
Hight-Laukaran V, Labbok M, Peterson AE, Fletcher V,
von Hertzen H, Van Look P. Multicenter study of the
Lactational Amenorrhea Method (LAM): II. Acceptability, utility, and policy Implications. Contraception
1997;55:337346.
Institute for Reproductive Health Institute for Reproductive Health. The Lactational Amen- 7
- Dc Washington
Washington, DC: Institute for Reproductive Health, 1994.
Institute for Reproductive Health. The Lactational Amen-
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
Contraception
1997;55:327-336
Are you offering your clients all the options? Washington, DC: Institute for Reproductive Health
- Method
orrhea Method: Are you offering your clients all the
options? Washington, DC: Institute for Reproductive
Health, 1996.
Values in contraceptive choice: A qualitative study on the Lactational Amenorrhea Method
- Coly
Coly, S. Values in contraceptive choice: A qualitative
study on the Lactational Amenorrhea Method. Master's
Thesis, Georgetown University, Department of Liberal
Studies, May 1995.
Are you offering your clients all the options?
- Orrhea Method
orrhea Method: Are you offering your clients all the
options? Washington, DC: Institute for Reproductive
Health, 1996.
Macro International. Demographic and Health Surveys: Peru 1991-1992. Columbia, MD: Institute for Resource Development/Macro International
- R A Hatcher
- J Trussell
- F Stewart
Hatcher RA, Trussell J, Stewart F, et al. Contraceptive
technology, 16th rev. ed. Manchester, NH: Irvington
Publishers, Inc, 1994.
Macro International. Demographic and Health Surveys:
Peru 1991-1992. Columbia, MD: Institute for Resource
Development/Macro International, 1992.