DOCSLIB.ORG

Based Methods of Family Planning to Breastfeeding Women

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Based Methods of Family Planning to Breastfeeding Women FERTILITY AND STERILITY௡ VOL. 80, NO. 5, NOVEMBER 2003 Copyright ©2003 American Society for Reproductive Medicine Published by Elsevier Inc. Printed on acid-free paper in U.S.A. Application of simple fertility awareness– based methods of family planning to breastfeeding women Marcos Are´ valo, M.D., Victoria Jennings, Ph.D., and Irit Sinai, Ph.D. Institute for Reproductive Health, Georgetown University, Washington, D.C. Objective: To determine the potential efficacy of two simple fertility awareness–based methods of family planning—the Standard Days Method™ and the TwoDay Method™—among breastfeeding women. Design: Analysis of pre-existing data set, collected in 1986–1990. Setting: Pre-existing data from Australia, Britain, and Canada. Patient(s): Seventy-three breastfeeding women in Australia, Britain, and Canada, who were followed starting 42 days postpartum, until they had at least two potentially fertile cycles (defined as cycles with adequate levels of urinary estrogens (E) and pregnanediol glucuronide and a long enough luteal phase to support a pregnancy). Received February 3, 2003; We examine this existing data set. revised and accepted April Intervention(s): None. 14, 2003. Main Outcome Measure(s): Probability of pregnancy from intercourse on different days of the cycle relative Supported by the Institute to ovulation for breastfeeding women following the instructions of the Standard Days Method or the TwoDay for Reproductive Health, Georgetown University, Method. under a cooperative Result(s): These two methods may be appropriate for different groups of breastfeeding women at different agreement HRN-A-00-97- times. The Standard Days Method may be appropriate after cycle regularity is established, whereas the 00011-00 with the United TwoDay Method may be a more effective option earlier in the postpartum period. States Agency for International Development. Conclusion: A need remains for a more appropriate simple fertility awareness–based method during this early ௡ The Family Health period. (Fertil Steril 2003;80:1241–8. ©2003 by American Society for Reproductive Medicine.) International study was Key Words: Standard Days Method, TwoDay Method, contraceptive efficacy, fertility awareness, breast- supported by the Institute feeding for Reproductive Health, Georgetown University, under its cooperative agreement DPE-3040-A- The potential efficacy of two simple fertility breastfeeding (3). Fertility awareness–based 00-5064-00 with the United awareness–based methods of family plan- methods of family planning may be especially States Agency for ning—the Standard Days Method™ and the useful for breastfeeding women, because they International Development. TwoDay Method™—for breastfeeding women do not affect the nutritional quality or quantity The views expressed by the authors do not were examined. Both methods offer simple but of milk, and do not involve transmission of necessarily reflect the effective guidelines to help women identify exogenous hormones to the infant. views or policies of the their “fertile window”—the days each cycle United States Agency for The Standard Days Method, based on a when they should avoid unprotected inter- International Development, fixed formula defining the fertile window as Family Health International, course to prevent pregnancy. or Georgetown University. days 8–19 of the menstrual cycle, was shown Reprint requests: Marcos Worldwide, significant numbers of women in a clinical trial to have a failure rate of Ͻ5% Are´ valo, M.D., Institute for breastfeed their children (1). Many of these when used correctly by women who were Reproductive Health, Georgetown University, women are particularly vulnerable to preg- screened for potential cycle regularity (4). The 4301 Connecticut Ave., nancy because they often believe that breast- TwoDay Method involves noticing the pres- NW, Suite 310, Washington, DC 20008 feeding protects them from pregnancy. For the ence and absence of cervical secretions. Its (FAX: 202-537-7450; health of the mother and the infant, it is impor- theoretical efficacy for non-breastfeeding E-mail: irhinfo@ tant that she not become pregnant again for at women has been established (5, 6), and a clin- georgetown.edu). least 2.5–3 years, and recent research suggests ical efficacy trial is ongoing. The use of these 0015-0282/03/$30.00 that the ideal birth spacing interval is 3–5 years methods among breastfeeding women has not doi:10.1016/S0015-0282(03) 02184-8 (2). This is particularly important if she is yet been tested. Breastfeeding affects factors 1241 that are central to some fertility-awareness–based methods, breastfeeding and fertility awareness–based methods, above including cervical secretions and cycle length and regularity. and beyond the usual requirements of these methods (15, The current study is designed to assess the potential 16). efficacy of the Standard Days Method and the TwoDay Clearly, breastfeeding women could benefit from a simple Method if used by breastfeeding women. The methods are fertility awareness–based method of family planning, pro- described fully in the Appendix. vided that the method is effective in helping them avoid unplanned pregnancies while they continue to breastfeed. Why Focus on Breastfeeding Women? The purpose of this secondary analysis is to assess the Breastfeeding alters the normal pattern of hormonal theoretical effectiveness of such methods for breastfeeding events in the hypothalamus-hypophysis-ovary axis, resulting women, including those who no longer meet the LAM cri- in suppressed ovarian activity and reduced fertility. There is teria. much evidence that the frequency and duration of breast- feeding episodes are important in suppressing ovulation and lowering the probability of conception (7, 8). Even when MATERIALS AND METHODS ovulation returns, hormonal function often remains dis- The original data were collected by Family Health Inter- rupted, resulting in continuing reduced probability of fertil- national (FHI) from 1986–1990 in a study of the Sympto- ization and implantation (9). Yet, fertility eventually returns, thermal Method, and are reanalyzed here. Data are available and the probability that lactating women will become preg- on 73 breastfeeding women in Australia, Britain, and Can- nant if they have unprotected intercourse increases with ada. The mean age of study participants was 29 years, and time. A significant number of women worldwide breastfeed their average number of live births, 2.3. Education levels their children (1), and many become pregnant when their were slightly higher in Canada and more of the Canadian babies are still very young, endangering the health and lives women had professional occupations and worked outside the of themselves and their children. home, but these differences across the centers were not Efforts to determine the timing of the postpartum return to statistically significant (14). fertility and factors influencing it have led to the develop- Study participants contributed daily information starting ment of the Lactational Amenorrhea Method of family plan- 42 days postpartum, and until they had at least two “normal” ning (LAM). LAM is based on three criteria. For a woman to cycles (defined as cycles with adequate urinary levels of be eligible to use LAM, she should be less than 6 months estrogens (E), pregnanediol glucuronide, and a luteal phase postpartum, amenorrheic, and fully or nearly fully breast- long enough to support a pregnancy) (14). Daily information feeding (10). When women are more than 6 months post- is available on breastfeeding patterns, appearance and char- partum, when their menstruation returns, or when they are no acteristics of cervical secretions, and cycle characteristics longer fully breastfeeding, LAM is no longer considered as such as timing of ovulation, bleeding, and cycle length. effective, and they should use another family planning Ovulation was defined as day of maximum urinary E, method if they wish to avoid pregnancy (11). measured by spectrofluorometry. A cycle was said to have A fertility awareness–based method of family planning is adequate luteinization to support a pregnancy if Ͼ9.0 one possible choice for women who continue to breastfeed ␮moles/24 hours of pregnanediol were measured and there and seek an alternative family planning method that does not was a luteal phase, as measured from the E peak to the day affect milk quality or quantity after they no longer meet the before the next menstruation, of at least 10 days. The cycle LAM criteria. Established fertility awareness–based meth- was considered to have an inadequate luteal phase to support ods, such as the Billings Ovulation Method and the Symp- a pregnancy if there were pregnanediol concentrations of tothermal Method, are applicable, with some modifications, between 4.5 and 8.9 ␮moles/24 hours or if the luteal phase to breastfeeding women (12, 13). was fewer than 10 days. Follicular activity with correspond- ␮ Various studies examined their efficacy, concluding that ing pregnanediol concentration of fewer than 4.5 moles/24 these methods can be effective in preventing pregnancy in hours was considered to be anovulatory (14). This definition lactating mothers (14). However, the first cycles postpartum of ovulatory cycles was standard when these data were present additional difficulties for breastfeeding users, be- collected (1986–1990) (17, 18). We recognize that other cause the normal mucus and temperature patterns may not markers of ovulation, such as serum or urinary LH concen- yet be established even after
Load more

Recommended publications
  • Lactational Amenorrhea Method
    Lactational Amenorrhea Method Dr. Raqibat Idris [email protected] From Research to Practice: Training in Sexual and Reproductive Health Research 2017 Objectives of presentation • Define Lactational Amenorrhea Method (LAM) • Understand the mechanism of action of LAM • Know the efficacy of LAM • Know and describe the 3 criteria for LAM • Know the indication and contraindications for LAM • Know the focus and timing of counselling for LAM • List the advantages, disadvantages and health benefits of LAM • Know the elements of programming necessary for the provision of quality LAM services Introduction Breastfeeding delays the return of a woman’s fertility in the first few months following childbirth. Women who breastfeed are less likely to ovulate in this period. When compared with women who breastfeed partially or who do not breastfeed at all, women who breastfeed more intensively are less likely to have a normal ovulation before their first menstrual bleed postpartum (Berens et al., 2015). In a consensus meeting in Bellagio, Italy in 1998, scientists proposed that women who breastfeed fully or nearly fully while they remain amenorrhoeic in the first 6 months postpartum experience up to 98% protection from pregnancy. This formed the basis for the Lactational Amenorrhea Method and has since then been tested and confirmed by other studies (Berens et al., 2015; Van der Wijden et al., 2003; WHO, 1999). Berens P, Labbok M, The Academy of Breastfeeding Medicine. ABM Clinical Protocol #13: Contraception During Breastfeeding, Revised 2015. Breastfeeding Medicine. 2015 Feb;10(1):3-12. The World Health Organization multinational study of breast-feeding and lactational amenorrhea. III.
    [Show full text]
  • A History of Birth Control Methods
    Report Published by the Katharine Dexter McCormick Library and the Education Division of Planned Parenthood Federation of America 434 West 33rd Street, New York, NY 10001 212-261-4716 www.plannedparenthood.org Current as of January 2012 A History of Birth Control Methods Contemporary studies show that, out of a list of eight somewhat effective — though not always safe or reasons for having sex, having a baby is the least practical (Riddle, 1992). frequent motivator for most people (Hill, 1997). This seems to have been true for all people at all times. Planned Parenthood is very proud of the historical Ever since the dawn of history, women and men role it continues to play in making safe and effective have wanted to be able to decide when and whether family planning available to women and men around to have a child. Contraceptives have been used in the world — from 1916, when Margaret Sanger one form or another for thousands of years opened the first birth control clinic in America; to throughout human history and even prehistory. In 1950, when Planned Parenthood underwrote the fact, family planning has always been widely initial search for a superlative oral contraceptive; to practiced, even in societies dominated by social, 1965, when Planned Parenthood of Connecticut won political, or religious codes that require people to “be the U.S. Supreme Court victory, Griswold v. fruitful and multiply” — from the era of Pericles in Connecticut (1965), that finally and completely rolled ancient Athens to that of Pope Benedict XVI, today back state and local laws that had outlawed the use (Blundell, 1995; Himes, 1963; Pomeroy, 1975; Wills, of contraception by married couples; to today, when 2000).
    [Show full text]
  • U.S. Medical Eligibility Criteria for Contraceptive Use, 2010
    Morbidity and Mortality Weekly Report www.cdc.gov/mmwr Early Release May 28, 2010 / Vol. 59 U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 Adapted from the World Health Organization Medical Eligibility Criteria for Contraceptive Use, 4th edition department of health and human services Centers for Disease Control and Prevention Early Release CONTENTS The MMWR series of publications is published by the Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Introduction .............................................................................. 1 Disease Control and Prevention (CDC), U.S. Department of Health Methods ................................................................................... 2 and Human Services, Atlanta, GA 30333. How to Use This Document ......................................................... 3 Suggested Citation: Centers for Disease Control and Prevention. [Title]. MMWR Early Release 2010;59[Date]:[inclusive page numbers]. Using the Categories in Practice ............................................... 3 Recommendations for Use of Contraceptive Methods ................. 4 Centers for Disease Control and Prevention Contraceptive Method Choice .................................................. 4 Thomas R. Frieden, MD, MPH Director Contraceptive Method Effectiveness .......................................... 4 Peter A. Briss, MD, MPH Unintended Pregnancy and Increased Health Risk ..................... 4 Acting Associate Director for Science Keeping Guidance Up to Date ...................................................
    [Show full text]
  • Lactational Amenorrhea Method (LAM)
    Lactational Amenorrhea Method (LAM) What is the lactational amenorrhea method? Lactational Amenorrhea Method (LAM) is a natural and healthy fertility awareness based method (FABM) of family planning. The LAM is a special FABM that can be used by post-partum, breastfeeding mothers. How does LAM Work? Breastfeeding delays the return of a mother’s ovulation (when the woman’s ovary releases an egg) and may make her infertile for six months or more. LAM is an easy tool for post-partum women to use to avoid a pregnancy if they meet the following criteria: 1. Menstrual bleeding has not resumed; AND 2. The infant is exclusively or nearly exclusively breastfed frequently, day and night; AND 3. The infant is under six months of age Women who meet all 3 criteria are not likely to become pregnant and do not need to use another method of birth control. How effective is LAM in helping couples avoid pregnancy? International research among many different populations has shown that the LAM is 99.5% effective with perfect use and 98% effective with typical use. This means that if a woman and her baby meet all three criteria, and she uses every opportunity to breastfeed her baby, the likelihood of an unintended pregnancy is about 2%.1,2 LAM shows that a mother’s body is very good at giving her the time she needs while she cares for and bonds with her new baby! Can LAM help couples achieve pregnancy? No; the LAM is not designed for this goal, but . If a breastfeeding woman notices that one of the three conditions above is missing, then she would know that pregnancy could be more likely since ovulation may return.
    [Show full text]
  • U.S. Medical Eligibility Criteria for Contraceptive Use, 2016
    Morbidity and Mortality Weekly Report Recommendations and Reports / Vol. 65 / No. 3 July 29, 2016 U.S. Medical Eligibility Criteria for Contraceptive Use, 2016 U.S. Department of Health and Human Services Centers for Disease Control and Prevention Recommendations and Reports CONTENTS Introduction ............................................................................................................1 Methods ....................................................................................................................2 How to Use This Document ...............................................................................3 Keeping Guidance Up to Date ..........................................................................5 References ................................................................................................................8 Abbreviations and Acronyms ............................................................................9 Appendix A: Summary of Changes from U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 ...........................................................................10 Appendix B: Classifications for Intrauterine Devices ............................. 18 Appendix C: Classifications for Progestin-Only Contraceptives ........ 35 Appendix D: Classifications for Combined Hormonal Contraceptives .... 55 Appendix E: Classifications for Barrier Methods ..................................... 81 Appendix F: Classifications for Fertility Awareness–Based Methods ..... 88 Appendix G: Lactational
    [Show full text]
  • Recommendations for Contraceptive Use, 2013 Adapted from the World Health Organization Selected Practice Recommendations for Contraceptive Use, 2Nd Edition
    Morbidity and Mortality Weekly Report Early Release / Vol. 62 June 14, 2013 U.S. Selected Practice Recommendations for Contraceptive Use, 2013 Adapted from the World Health Organization Selected Practice Recommendations for Contraceptive Use, 2nd Edition Continuing Education Examination available at http://www.cdc.gov/mmwr/cme/conted.html. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Early Release CONTENTS CONTENTS (Continued) Introduction ............................................................................................................1 Appendix A: Summary Chart of U.S. Medical Eligibility Criteria for Methods ....................................................................................................................2 Contraceptive Use, 2010 .................................................................................. 47 How To Use This Document ...............................................................................3 Appendix B: When To Start Using Specific Contraceptive Summary of Changes from WHO SPR ............................................................4 Methods .............................................................................................................. 55 Contraceptive Method Choice .........................................................................4 Appendix C: Examinations and Tests Needed Before Initiation of Maintaining Updated Guidance ......................................................................4 Contraceptive Methods
    [Show full text]
  • Infertility Services
    LACTATIONAL AMENORRHEA AND OTHER FERTILITY AWARENESS BASED METHODS I. INTRODUCTION Fertility Awareness Based Methods (FAB) or Natural Family Planning (NFP) interprets signs and patterns of fertility to identify days in each menstrual cycle when intercourse is most likely to result in a pregnancy. This information may be used to avoid or achieve pregnancy. Couples who use a barrier method on fertile days or who abstain from intercourse during a woman’s fertile period are using fertility awareness- combined method/natural family planning. Natural family planning methods used to prevent pregnancy are 75-98% effective. Women with conditions that make pregnancy an unacceptable risk should be advised that FAB methods might not be appropriate for them because of the relatively higher typical-use failure rates of these methods. Natural Family Planning may be indicated for purposes of: A. Conception B. Avoiding pregnancy C. Detecting pregnancy (basal body temperature) D. Detecting impaired fertility (charting fertility signs and determining infrequent or absent ovulation with basal body temperature) E. Detecting need for medical attention (change in cervical secretions, abdominal pain, and other signs and symptoms may indicate need for medical attention- reproductive tract infections) II. GENERAL INFORMATION One or more indicators are used to identify the beginning and end of the fertile time in the menstrual cycle. In most cycles, ovulation occurs on or near the middle of the cycle. The fertile period lasts for about 6 days (5 days preceding ovulation and day of ovulation). In cycles that range between 26 and 32 days long (approx 78% of the cycles) the fertile period is highly likely to fall within days 8 to 19.
    [Show full text]
  • Drospirenone and Ethinyl Estradiol
    YASMIN 28 TABLETS (drospirenone and ethinyl estradiol) PHYSICIAN LABELING Rx only PATIENTS SHOULD BE COUNSELED THAT THIS PRODUCT DOES NOT PROTECT AGAINST HIV INFECTION (AIDS) AND OTHER SEXUALLY TRANSMITTED DISEASES. DESCRIPTION YASMIN® provides an oral contraceptive regimen consisting of 21 active film coated tablets each containing 3 mg of drospirenone and 0.03 mg of ethinyl estradiol and 7 inert film coated tablets. The inactive ingredients are lactose monohydrate NF, corn starch NF, modified starch NF, povidone 25000 USP, magnesium stearate NF, hydroxylpropylmethyl cellulose USP, macrogol 6000 NF, talc USP, titanium dioxide USP, ferric oxide pigment, yellow NF. The inert film coated tablets contain lactose monohydrate NF, corn starch NF, povidone 25000 USP, magnesium stearate NF, hydroxylpropylmethyl cellulose USP, talc USP, titanium dioxide USP. Drospirenone (6R,7R,8R,9S,10R,13S,14S,15S,16S,17S)-1,3',4',6,6a,7,8,9,10,11,12,13, 14,15,15a,16-hexadecahydro-10,13-dimethylspiro-[17H-dicyclopropa-6,7:15,16] cyclopenta[ a]phenanthrene-17,2'(5H)-furan]-3,5'(2H)-dione) is a synthetic progestational compound and has a molecular weight of 366.5 and a molecular formula of C24H30O3. Ethinyl estradiol (19-nor­ 17α-pregna 1,3,5(10)-triene-20-yne-3,17-diol) is a synthetic estrogenic compound and has a molecular weight of 296.4 and a molecular formula of C20H24O2. The structural formulas are as follows: CLINICAL PHARMACOLOGY PHARMACODYNAMICS Combination oral contraceptives (COCs) act by suppression of gonadotropins. Although the primary mechanism of this action is inhibition of ovulation, other alterations include changes in the cervical mucus (which increases the difficulty of sperm entry into the uterus) and the endometrium (which reduces the likelihood of implantation).
    [Show full text]
  • Fertility Awareness Methods: Distinctive Modern Contraceptives
    COMMENTARY Fertility Awareness Methods: Distinctive Modern Contraceptives Shawn Malarcher,a Jeff Spieler,b Madeleine Short Fabic,a Sandra Jordan,a Ellen H Starbird,a Clifton Kenona Fertility awareness methods—the Lactational Amenorrhea Method, the Standard Days Method, and the Two Day Method—are safe and effective, and they have important additional benefits that appeal to women and men. Including these modern contraceptives in the method mix expands contraceptive choice and helps women and men meet their reproductive intentions. This peer-reviewed commentary represents the technical position of the Office of Population and Reproductive Health of the United States Agency for International Development. ertility awareness methods (FAMs), comprising the method use as the outcome of interest. In this context, FLactational Amenorrhea Method (LAM), the Stan- common misperceptions that FAMs are traditional dard Days Method (SDM), and the Two Day Method methods mean that countries do not prioritize invest- (TDM), are often left out of the basket of contraceptive ments in their introduction or expanded provision. options for women and couples because governments, These methods may be absent from training curricula, donors, policy makers, and providers perceive them as counseling materials, logistics systems, and procure- inferior contraceptive methods. When FAMs are offered ment processes. FAM users may be left out of key as an option, FAM users may be incorrectly lumped with monitoring and data collection activities. If users of traditional method users in reports and data analyses. FAMs are not counted as modern contraceptive users, Notably, a recent unpublished review of contraceptive we as a community are failing to recognize a valid and method classification commissioned by the World Health important choice to meet client needs—what gets counted Organization (WHO) found that LAM was deemed gets supported.
    [Show full text]
  • Natural Family Planning BRIAN A
    Natural Family Planning BRIAN A. SMOLEY, CDR, MC, USN, Camp Pendleton, California CHRISTA M. ROBINSON, LCDR, MC, USN, Naval Hospital Lemoore, Lemoore Station, California Natural family planning methods provide a unique option for committed couples. Advantages include the lack of medical adverse effects and the opportunity for participants to learn about reproduction. Modern methods of natural family planning involve observation of biologic markers to identify fertile days in a woman’s reproductive cycle. The timing of intercourse can be planned to achieve or avoid pregnancy based on the identified fertile period. The current evidence for effectiveness of natural family planning methods is limited to lower-quality clini- cal trials without control groups. Nevertheless, perfect use of these methods is reported to be at least 95 percent effective in preventing pregnancy. The effectiveness of typical use is 76 percent, which demonstrates that motivation and commitment to the method are essential for success. Depending on the method, couples can learn about natural family planning methods in a sin- gle office visit, through online instruction, or from certified instructors. (Am Fam Physician. 2012;86(10):924-928. Copyright © 2012 American Academy of Family Physicians.) ▲ See related editorials amily planning allows individuals abstinence rather than an artificial contra- at http://www.aafp.org/ and couples to anticipate and attain ceptive method.2-4 afp/2012/1115/od1.html and http://www.aafp. the desired number, spacing, and Although less than 1 percent of respon- 1 org/afp/2012/1115/od2. timing of children. Fertility aware- dents to the 2006-2008 National Survey html. ness methods of family planning use one or of Family Growth reported current use of F ▲ Patient information: more biologic markers to identify fertile days NFP, 19 percent reported prior use of the A handout on natural fam- of a woman’s reproductive cycle.
    [Show full text]
  • Lactational Amenorrhea Method (LAM)
    Lactational Amenorrhea Method A Reference Manual for Service Providers FAprojectM IRH GEORGETOWN UNIVERSITY Lactational Amenorrhea Method A Reference Manual for Service Providers FAMproject IRH GEORGETOWN UNIVERSITY Copyright © 2009 Georgetown University, Institute for Reproductive Health (www.irh.org), and Jhpiego (www.jhpiego.org) Institute for Reproductive Health Jhpiego Georgetown University 1615 Thames St. 4301 Connecticut Ave, NW, Suite 310 Baltimore, MD 21231 Washington, DC 20008 Any part of Lactational Amenorrhea Method (LAM): A Learning Resource Package for Family Planning Service Providers and Trainers (2009) may be reproduced and excerpts may be quoted without permission, provided that the material is distributed free of charge and the Georgetown University, Institute for Reproductive Health, is credited as the source of all copies, reproductions, distributions and adaptations of the materials. Please use the following reference [Adapted (or Reprinted) from]: Georgetown University, Institute for Reproductive Health, and Jhpiego. 2009. Lactational Amenorrhea Method (LAM): A Learning Resource Package for Family Planning Service Providers and Trainers. Georgetown University: Washington, D.C. TRADEMARKS: All brand and product names are trademarks or registered trademarks of their respective companies. June 2009 TABLE OF CONTENTS ACKNOWLEDGMENTS iii ABBREVIATIONS AND ACRONYMS iv INTRODUCTION 1 BASIC INFORMATION ABOUT LAM 2 Mechanism of Action for LAM 2 Effectiveness of LAM 3 The Three LAM Criteria 4 “Transition”: Another Essential
    [Show full text]
  • Promotion of Lactation Amenorrhea Method Intervention Trial, Kazakhstan
    Promotion of Lactation Amenorrhea Method Intervention Trial, Kazakhstan Academy of Preventive Medicine, Republic of Kazakhstan Shamil Tazhibayev, MD, Toregeldy Sharmanov, Ayan Ergalieva, PhD, Oksana Dolmatova, PhD, Orynkul Mukasheva, PhD, Aina Seidakhmetova, and Raikhan Kushenova May 2004 This study was funded by the U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT (USAID) under the terms of Cooperative Agreement Number HRN- A-00-98-00012-00 and Population Council Subcontract Number CI00.100A. The opinions expressed herein are those of the author and do not necessarily reflect the views of USAID. EXECUTIVE SUMMARY Background As a member of the Soviet Union, the Republic of Kazakhstan adopted a national policy encouraging mothers to use artificial foods in lieu of breastfeeding to enable mothers to return to the workforce soon after giving birth. This practice of lactation management, used in Kazakhstan and in other republics of the former USSR, separated newborn infants from their mothers in maternity wards, first placed infants on their mothers’ breasts late after delivery and advocated feeding on a fixed schedule. Additionally, the program promoted supplementary feedings of a boiled water and glucose formula during the first days of infancy and advocated substantial supplementary feeding in the first or second months after delivery. As a result, many women lost the benefits of breastfeeding as a means of natural pregnancy prevention. In 1997, the government reformulated its policy on breastfeeding, reversing the former norms and once again
    [Show full text]