Assessing the Quality of Data Regarding Use of the Lactational Amenorrhea Method

Fabic, Madeleine Short; Choi, Yoonjoung

doi:10.1111/j.1728-4465.2013.00353.x

Cited by 40 publications

(36 citation statements)

References 5 publications

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“…Research has shown that postpartum women misunderstand the return to fecundity [18,[26][27][28]. This is true even among self-reported LAM users: a recent analysis of DHS data showed that many did not adhere to all three criteria for LAM effectiveness at the time of the survey [29]. Nevertheless, when postpartum women are exposed to postpartum family planning messages during other visits to health facilities, such as during labor and delivery, they are more likely to adopt a modern method [30,31].…”

Section: Discussionmentioning

confidence: 95%

Missed opportunities for family planning: an analysis of pregnancy risk and contraceptive method use among postpartum women in 21 low- and middle-income countries

et al. 2015

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Objectives: To analyze data from recent Demographic and Health Surveys (DHS) conducted in 21 low-and middle-income countries (LMICs) to examine patterns of interpregnancy intervals, unmet need, pregnancy risk and family planning method use and method mix among women 0-23 months postpartum. Study design: Secondary analysis of postpartum women aged 15-49 years in 22 DHS surveys from 21 LMICs conducted between 2005 and 2012. We applied an adapted unmet need definition for postpartum women to look at prospective fertility preferences. We also constructed a new composite pregnancy risk indicator for postpartum women who have been sexually active since their last birth. Results: In 9 of 22 surveys, 50% or more of nonfirst births occur at interpregnancy intervals that are too short. Overall prospective unmet need for family planning by postpartum women has not changed demonstrably since a 2001 analysis and is universally high: 61% of all postpartum women across the 21 countries have an unmet need for family planning. In 10 of 22 surveys, pregnancy risk rises steadily throughout the 2 years after birth. In the remaining 12 surveys, the risk of pregnancy peaks at 6-11 months after birth. Even when postpartum women are using family planning, they rely overwhelmingly on short-acting methods (51-96% in 21 of 22 surveys). Conclusion: Our approach of estimating pregnancy risk by postpartum timing confirms a high probability for pregnancies to be less than optimally spaced within 2 years of a prior birth and suggests that special consideration is needed to effectively reach this population with the right messages and services. Implications: Using recent, multicountry data for women within 2 years postpartum in LMICs, this paper updates existing estimates of high prospective unmet need for family planning and presents a new composite pregnancy risk analysis based on postpartum women's actual practices to demonstrate the magnitude of missed opportunities for programmatic intervention for the postpartum population.

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Section: Discussionmentioning

confidence: 95%

Missed opportunities for family planning: an analysis of pregnancy risk and contraceptive method use among postpartum women in 21 low- and middle-income countries

et al. 2015

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“…O uso correto da LAM só é possível quando se associa o conhecimento com a confiança no MAC; ambas as orientações são de responsabilidade do profissional de saúde. Uma pesquisa realizada em 45 países entre 1998 e 2011 com o objetivo de analisar o uso correto desse método contraceptivo revelou que somente 26% dos usuários que usam a LAM cumprem os critérios para a prática correta (18).…”

Section: Discussionunclassified

Conhecimento de puérperas acerca do método anticoncepcional da lactação com amenorreia

et al. 2015

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Objetivo: verificar o conhecimento de puérperas acerca do método anticoncepcional da lactação com amenorreia (LAM). Materiais e métodos: pesquisa transversal, realizada com 278 puérperas internadas em alojamento conjunto de maternidade de referência de Fortaleza, Ceará, Nordeste do Brasil, de fevereiro a maio de 2012. Resultados: identificou-se que 131 (47,1 %) haviam ouvido falar sobre a LAM e, destas, 58 (44,3 %) declararam conhecê-la antes da gravidez e 56 (42,7 %) no pré-natal; 94 (71,6 %) puérperas desacreditavam na sua eficácia e 100 (76,3 %) desconheciam os critérios para uso seguro. A fonte de informações sobre o método para 43 (32,8 %) puérperas foi amigos, familiares ou conhecidos, ou seja, de modo informal, e 71 (54,1 %) não foram orientadas por profissionais da saúde. Conclusões: lacunas no conhecimento de puérperas geram baixo uso e uso incorreto da LAM; também se destaca o elevado percentual de puérperas sem orientações por parte de profissionais da saúde.

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“…Since 1989, lactational amenorrhea in the first six months postpartum when accompanied by exclusive and full or nearly full breastfeeding has been considered as a modern method of contraception (i.e., the lactational amenorrhea method, or LAM) (Kennedy, Rivera, and McNeilly 1989). 2 While few postpartum women in low-income countries report using LAM, many in fact meet the three criteria (menses has not returned, infant is less than six months old, and exclusive and full or nearly full breastfeeding) (Fabic and Choi 2013) and thus are de facto LAM users and largely protected from a pregnancy for six months.…”

Section: Reassessing Unmet Need For Family Planning In the Postpartummentioning

confidence: 99%

Reassessing Unmet Need for Family Planning in the Postpartum Period

Rossier

Bradley

Ross

et al. 2015

Studies in Family Planning

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Despite renewed interest in postpartum family planning programs, the question of the time at which women should be expected to start contraception after a birth remains unanswered. Three indicators of postpartum unmet need consider women to be fully exposed to the risk of pregnancy at different times: right after delivery (prospective indicator), after six months of amenorrhea (intermediate indicator), and at the end of amenorrhea (classic indicator). DHS data from 57 countries in 2005-13 indicate that 62 percent (prospective), 43 percent (intermediate), and 32 percent (classic) of women in the first year after a birth have an unmet need for contraception (40 percent when including abstinence). While the protection afforded by postpartum abstinence and lactational amenorrhea lowers unmet need, further analysis shows that women also often rely on these methods without being actually protected. Programs should acknowledge these methods' widespread use and inform women about their limits. Also, the respective advantages of targeting the postnatal period, the end of six months of amenorrhea/exclusive breastfeeding, or the resumption of sexual intercourse to offer contraceptive services should be tested.

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Assessing the Quality of Data Regarding Use of the Lactational Amenorrhea Method

Cited by 40 publications

References 5 publications

Missed opportunities for family planning: an analysis of pregnancy risk and contraceptive method use among postpartum women in 21 low- and middle-income countries

Missed opportunities for family planning: an analysis of pregnancy risk and contraceptive method use among postpartum women in 21 low- and middle-income countries

Conhecimento de puérperas acerca do método anticoncepcional da lactação com amenorreia

Reassessing Unmet Need for Family Planning in the Postpartum Period

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