Research has shown that breastfeeding suppresses fertility. Yet many women know someone who became pregnant when breastfeeding -- or became pregnant themselves during breastfeeding. Service providers are sometimes reluctant to allow women to rely on breastfeeding for pregnancy protection, and have in certain settings discouraged breastfeeding in favor of initiating a modern method of contraception.
In 1988, a group of scientists met in Bellagio, Italy to define a set of guidelines that a woman could use to predict her return to fertility during breastfeeding. The scientists reviewed data from studies regarding return to fertility and determined that breastfeeding can provide up to 98% effective contraception if three criteria are met:
- The mother has not experienced the return of her menstrual periods (bleeding up to the 56th postpartum day is considered part of the postpartum recovery process and is not counted as menstrual bleeding);
- The mother is fully or nearly fully breastfeeding; and
- The baby is less than six months old.
These guidelines later defined a new method of family planning called the Lactational Amenorrhea Method or LAM. Clinical trials have shown that LAM is at least as effective as the Bellagio scientists predicted it would be. Fewer than 1% of LAM users in three clinical trials became pregnant when all the three LAM criteria were met.
Efficacy of LAM Reported from Several Clinical Trials
| Country |
Number of Women Studied |
Number of Pregnancies |
LAM Failure Rate |
| Chile |
422 |
1 |
0.45% |
| Pakistan |
391 |
1 |
0.58% |
| Philippines |
485 |
2 |
0.96% |
|
Of the three LAM criteria, the return of menses is the most important indicator of fertility. The studies conducted by Family Health International in Pakistan and the Philippines have shown that pregnancy is rare even beyond six months and the end of full breastfeeding among women who do not experience vaginal bleeding. Only 1.1% of the women in Pakistan and 2.6% of the women in the Philippines conceived during 12 months of lactational amenorrhea.
The pattern of breastfeeding exerts a strong effect on the resumption of menstruation and fertility. However, defining what is meant by "full" breastfeeding can be difficult. The following definitions are currently being used by family planning counselors who are teaching LAM:
- Full breastfeeding can be exclusive (no other liquid or solid is given to the infant) or almost exclusive (vitamins, water, juice or ritualistic feeds are given infrequently to the infant).
- Nearly full breastfeeding means that the vast majority of feeds (at least 85%) are breastfeeds. There can be some supplementation with another liquid or food, but supplementation never replaces or delays a breastfeed.
A mother can maximize the contraceptive effect she receives from breastfeeding by following the guidelines for optimal breastfeeding behaviors.
The Lactational Amenorrhea Method is, however, a temporary method of family planning. To continue effective pregnancy protection, a woman who uses LAM must be ready to switch to another family planning method when any one of the LAM criteria changes. She should be made aware that:
- Once her periods return, breastfeeding will no longer protect her from a new pregnancy. She should consider any vaginal bleeding (after the 56th postpartum day) to be a warning that her fertility is returning, even if that bleeding does not resemble her regular menses.
- If she starts to give the infant any food or drink on a regular basis or experiences disruptions in her breastfeeding routine, such as returning to work or ceasing to breastfeed at night, she is no longer protected from pregnancy.
- Once the infant is older than six months, the chance of becoming pregnant, even before her periods return, is increased.
If any of these changes occur, a woman should choose another contraceptive method if she wants to be protected from pregnancy. There is no need to discontinue breastfeeding, however. Family planning methods that are recommended for breastfeeding women include barrier methods, IUDs, male or female sterilization, and hormonal methods that contain only progestin, such as progestin-only pills ("minipills"), injectables and Norplant. Contraceptive pills containing both estrogen and progestin (the most common kind of birth control pill) have been associated with reduced breastmilk production and should be considered a last-choice method.
Optimal Breastfeeding Behaviors for Child Health and Child Spacing
- Begin breastfeeding as soon as possible after the child is born.
- Breastfeed exclusively for the first six months.
- After the first six months, when supplemental foods are introduced, breastfeeding should precede supplemental feedings.
- Breastfeed frequently, whenever the infant is hungry, day and night.
- Continue breastfeeding even if the mother or the baby become ill.
- Avoid using a bottle, pacifiers or other artificial nipples.
- Continue to breastfeed up to two years and beyond.
- Eat and drink sufficient quantities to satisfy the mother's hunger.
Conclusions
Breastfeeding is best for both mothers and babies and should be encouraged. Breastfeeding can also provide natural, safe, effective contraceptive protection, if certain conditions are met, for up to six months postpartum. Women who are interested in using the natural protection of breastfeeding should have access to information about LAM and about other available family planning methods suitable for breastfeeding women.
Source
- Labbok M, Cooney K, Coly S. Guidelines: Breastfeeding, Family Planning and the Lactational Amenorrhea Method-LAM. Washington, DC: Institute for Reproductive Health. 1994.
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