A Comparison of Breastfeeding Exclusivity and Duration Rates Between Immediate Postpartum Levonorgestrel Versus Etonogestrel Implant Users: A Prospective Cohort Study

Abstract

Objective: This study compares breastfeeding outcomes after immediate postpartum initiation of single-rod etonogestrel (ENG) versus two-rod levonorgestrel (LNG) contraceptive implants. Outcomes assessed include the following: (1) breastfeeding continuation through 24 months after delivery and (2) exclusive breastfeeding until 6 months after delivery, at Kasungu District Hospital, Malawi.Methods: We used Kaplan–Meier survival analysis to compare breastfeeding continuation through 24 months and exclusive breastfeeding through 6 months after delivery for ENG versus LNG implant users. We described infant feeding practices up to 6 months after delivery.Results: We analyzed 140 women: 28 (20%) ENG and 112 (80%) LNG impalnt users. Eighty-seven percent (n = 122) of women completed the 24-month study visit. Twenty-four months breastfeeding continuation proportions were 54.2% (95% confidence interval [CI] = 32.7–71.4) and 74.7% (95% CI = 64.9–82.2) for ENG and LNG implant users, respectively (p = 0.10). Breastfeeding continuation was high in both groups at 21 months: 100% and 93.2% (95% CI = 86.2–96.7) for ENG and LNG implant users, respectively (p = 0.18). Seventy-one percent (20/28, 95% CI = 51.0–84.6) of ENG and 72% (78/108, 95% CI = 62.4–79.7) of LNG implant users exclusively breastfed their infants until 6 months postpartum (p = 0.89).Conclusions: Continuation of breastfeeding until 24 months and exclusive breastfeeding until 6 months were high among users of both types of progestin implant initiated immediately postpartum and similar to proportions among the general population of postpartum women in the Central region of Malawi.

Breastfeeding Perceptions and Behavior Among Postpartum Women Initiating Different Hormonally Systemic Contraceptive Methods

“…Healthcare providers must also consider that return to ovulation and sexual activity can occur quickly after delivery; therefore, discussions of what a woman desires for contraception are vital to the medical and social health of the woman, her baby, and her entire family. This prospective, three group comparison study allowed for a direct observation of the influence of all current postpartum contraceptive methods on several breastfeeding metrics with findings similar to results reported by other researchers that show no negative impact (Averbach et al, 2020; Krashin et al, 2019; Turok et al, 2017).…”

“…Researchers have studied this theoretical risk and almost all have found no negative association between immediate versus delayed use of progestin-only contraceptive methods compared to non-hormonal methods on multiple measures of breastfeeding performance (Averbach et al, 2020; Carmo et al, 2017; Krashin et al, 2019; Turok et al, 2017). Studies of high quality methodological rigor evaluating DMPA immediately postpartum are limited and dated, but also have not shown results with a definitive negative effect (Brownell et al, 2013).…”

Safety and Benefits of Contraceptives Implants: A Systematic Review

“…Some studies compared breastfeeding outcomes after immediate postpartum initiation of the ENG subdermal implant with other LARCs; no difference in total duration of breastfeeding and in newborn growth and psychomotor development were detected between breastfeeding implant users and non-medicated IUD users [186]. More recently, Krashin et al [187] compared breastfeeding outcomes after immediate postpartum initiation of ENG (n.28) or LNG (n. 112) contraceptive implants, showing a high 21-month breastfeeding continuation in both groups (100% vs. 93.2% for ENG and LNG implant users, respectively, p = 0.18) [187].…”

Safety of Progestogen Hormonal Contraceptive Methods during Lactation: An Overview

“…Thus, no statistical differences were observed in milk intake or infant development between the methods from day 42 to day 63 of contraceptive use [ 47 ]. Furthermore, when comparing the percentage of breastfeeding women who received either an etonogestrel implant ( n = 28) or a levonorgestrel implant ( n = 112) immediately after delivery, no difference was observed in the rate of exclusive breastfeeding after 6 months between the groups or in the continuation of breastfeeding for up to 2 years [ 48 ]. IUDs that released 10 mcg ( n = 30) or 30 mcg ( n = 40) of levonorgestrel daily were placed at 6 weeks postpartum.…”