Contraception after LAM -- December 12, 2002

Research Triangle Park, NC -- In an editorial in the December 2002 issue of International Family Planning Perspectives, Dr. John Stanback and Dr. Heidi W. Reynolds of Family Health International urge physicians around the world to help postpartum, breastfeeding clients transition to a new method of contraception after using the lactational amenorrhea method (LAM).

"Lactational amenorrhea is a wonderful contraceptive method," say Drs. Stanback and Reynolds, "but the unacknowledged key to its success in many poor countries is providing women with a seamless transition to subsequent methods."

Research has shown that LAM — using breastfeeding to prevent pregnancy — is at least 98 percent effective if a woman meets the following criteria: She is fully or nearly fully breastfeeding, she has been amenorrheic (without menses) since childbirth, and she is no more than six months postpartum. Advantages of LAM are that it is simple and inexpensive, has no side effects, and has health benefits for both infants and mothers.

When any of the criteria for LAM is no longer met, a woman who wants to delay or prevent another pregnancy should initiate a new contraceptive method because the effectiveness of LAM declines. The catch is that many women who continue to breastfeed past six months also continue to have amenorrhea, but some health care workers are reluctant to provide alternative contraceptives unless the women have menstruated, to rule out pregnancy.

Providers who recommend LAM need to trust that the method is effective and that in the absence of pregnancy tests, the criteria for LAM can be used to effectively rule out pregnancy, argue Drs. Stanback and Reynolds. "If a woman meets all three criteria for lactational amenorrhea, the likelihood of pregnancy is very small," they note. "Thus, she may safely initiate a new contraceptive method without a pregnancy test."

To read this editorial, please see the Web site for International Family Planning Perspectives at http://www.agi-usa.org/journals/toc/ifpp2804toc.html. To read Family Health International's online materials on LAM, see http://www.fhi.org/en/topics/listings/lamlist.html.