Prolonged lactation and family spacing in Rwanda

Data were collected from 1044 mothers resident in the rural areas of Zambia during a National Nutrition Status Survey, to determine the effect of lactation on the interval between conceptions. Lactation is very prolonged with a small proportion of mothers continuing up to 33 months. A main reason for cessation of breast-feeding appears to be a new pregnancy, only 1 -5 % of mothers being neither pregnant nor lactating up to 12 months. During lactation, conception is delayed for at least 12 months. The peak in new conceptions occurs between 25 and 27 months. The normal interval between births is 3 years for rural Zambian mothers.

Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Birth spacing and prolonged lactation in rural Zambia

Wenlock¹

1977

“…For instance, studies in which nursing was stopped during amenorrhoea, or in which the use of contraception was suspected. A retrospective study in Rwanda claimed 8 % becoming pregnant in an urban area, and 13% in a rural one (Bonte & van Balen, 1969). Parkes: I am glad to hear emphasis on the possibility of becoming pregnant during lactational amenorrhoea because it is often overlooked, especially by lay people.…”

Section: Discussionmentioning

confidence: 99%

The chance of conception during lactation

Ginneken

1977

Many mothers in low-income countries, particularly in rural areas, nurse their children for 1–2 years on the average. The main purpose of this practice is, of course, to provide the newborn child with the nutrition necessary for its survival. Prolonged breast-feeding, however, also has a birth-spacing effect and postpones the next pregnancy by inhibiting ovulation and by delaying resumption of the menstrual cycle. Suckling of the infant is important for this suppression of the menstrual cycle because it leads to the release of prolactin, which not only plays an important role in milk production but also inhibits the release of gonadotrophins which initiate resumption of the menstrual cycle. For further details about these endocrinological aspects of lactation see, for example, Rolland et al. (1975); Thomson, Hytten & Black (1975) and Buchanan (1975).

“…The incidence of pregnancy during lactational amenorrhoea was extensively studied by a group of workers, (Buchanan, 1975;Bonte & van Balen, 1969;El Minairi & Foda, 1971). Buchanan reported a pregnancy rate of 3-10% in lactating women including those who provided supplementary feeding for their babies during the period of lactational amenorrhoea.…”

Section: Introductionmentioning

confidence: 99%

Postpartum Lactational Amenorrhoea as a Means of Family Planning in the Sudan: A Study of 500 Cases

Adnan

Bakr

1983

SummaryThe lactational histories of 500 Sudanese women were studied retrospectively to examine postpartum lactational amenorrhoea as a method of family planning. Particular attention was given to the factors affecting postpartum lactational amenorrhoea, including supplementary feeding and the use of modern contraceptive methods. Breast-feeding was overwhelmingly practised (90%) among this sample, which was roughly representative of the Sudanese population as a whole. The prevalence of amenorrhoea among this group of lactating women was quite high (73%). Duration of lactational amenorrhoea ranged from 2 to 36 months with a median of 12 months.Introduction of supplementary feeding had little effect on lactational amenorrhoea up to the 9th month of breast-feeding. Beyond the 12th month of breast-feeding, lactational amenorrhoea was significantly prolonged by postponing the introduction of supplementary feeding until the 4th month or later.Ovulation, and hence conception, during lactational amenorrhoea was unpredictable. It occurred as early as the 3rd or as late as the 36th month postpartum. Conceptions interrupting lactational amenorrhoea soon after delivery (3–9 months) were more frequent among primiparous women. The failure rate of lactational amenorrhoea as a contraceptive was 8·4%. Though extremely high compared to that of the pill, lactational amenorrhoea was more useful as a fertility control mechanism because, in this study, a high proportion of women initiated pill use, but soon discontinued it because of side effects. Modern contraceptive practice was not prevalent. Amenorrhoeic mothers accepted the pill after the 6th month postpartum (41%), compared to lactating mothers whose menses had returned who started it much earlier. Forty-nine percent of the women studied relied completely on the protection of lactational amenorrhoea. Fifty-seven percent of all lactating women who used the combined pill reported a reduction in milk production. There are several policy implications of this study.